SIBO with Dr. Allison Siebecker: Rational Wellness Podcast 110

Dr. Allison Siebecker discusses Small Intestinal Bacterial Overgrowth with Dr. Ben Weitz.

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Podcast Highlights

2:20  Dr. Siebecker got interested in digestive disorders and SIBO in particular because she had IBS since she was five years old.  She started getting constipated and bloated and it got her interested in researching about health and medicine.  This also led to her starting her website 14 years ago, SIBOinfo.com to provide a comprehensive source for information on SIBO. 

4:45  If SIBO is the cause of IBS in 70% of cases, what about the other 30% of patients with IBS?  IBS has a set of non-specific symptoms that include bloating, constipation or diarrhea, or a mixture of the two, and abdominal discomfort or pain, at the minimum.  Figuring out the causes of IBS besides SIBO is where the differential diagnosis comes in and the causes include about 40 different conditions, including yeast overgrowth, parasitic infection, large intestine overgrowth or infection, H. pylori infection, celiac disease, non-celiac gluten intolerance, inflammatory bowel disease, IBD, carbohydrate malabsorption, like lactose or fructose, food intolerances, histamine intolerance, salicylate intolerance, hypchlorhydria (too little stomach acid), cancer of the adbomen, pancreatic enzyme insufficiency, diabetes, hypo or hyperthyroid, insufficient chewing, gastroparesis or stomach emptying, bile acid malabsorption, VIPomas, or Zollinger-Ellison Syndrome, any kind of obstruction in the small intestine, Parkinson’s, scleroderma, systemic sclerosis, Ehlers-Danlos Syndrome, mast cell activation, MCAS, mast cell activation syndrome, POTS, Lyme and co-infections, various immune deficiency diseases, and endometriosis.

8:35  And some of these can be co-existent with SIBO, which is why it may be a good idea to have patients with gut problems to do both SIBO breath and stool testing. And for many patients who have several different conditions co-existing, like SIBO and candida, it is part of the art and science of medicine to figure out if you treat one first and then the other or try to treat both at the same time.

11:11  It is often thought that in SIBO you have an overgrowth of bacteria from the large intestine into the small intestine, made possible by decreased motility.  Dr. Siebecker thinks that while this is possible, she’s not convinced that this is what happens most of the time. She said that it is possible that the bacteria come down from above, up from the bottom, or that the bacteria that are already growing in the small intestine overgrow.  We have to keep in mind that we have bacteria entering into us constantly every day at all times, swallowing, eating, etc.  Dr. Siebecker mentioned that she spoke to Dr. Pimentel about this and he did say that the bacteria that are down in the large intestine do also exist there in the small intestine in very small amounts, and they could just be overgrowing right there. Dr. Siebecker wonders if they are normal to the small intestinal microbiome, then we should stop thinking about them as large intestinal bacteria.




Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist and she is very passionate about education.  She specializes in the treatment of Small Intestinal Bacterial Overgrowth and she teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO on her website, siboinfo.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:                   This Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to Rational Wellness Podcast on iTunes and YouTube, and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. Thank you so much for joining me again today for another episode of the Rational Wellness Podcast. For those of you who enjoy listening to this podcast, please go to iTunes and give us a ratings and review. That way more people can find the Rational Wellness Podcast. Also, there’s a video version on YouTube and if you want the show notes, and a complete transcript just go to my website drweitz.com.

Our topic for today is small intestinal bacterial overgrowth, which is the main cause of irritable bowel syndrome in approximately 70% of the cases. Today we plan to focus on how best to understand some of the mechanisms, the latest diagnostic methods, and to hopefully gain some new insights on which integrative treatments strategies work and don’t work. And to help us to take a deep dive into SIBO then with our special guest, Dr. Allison Siebecker, the Queen of SIBO. I feel so fortunate that I recently had the opportunity to speak to Dr. Pimentel, the King of SIBO, and now I get a chance to speak you.

Dr. Allison Siebecker is a Naturopathic Doctor and acupuncturist, and she’s very passionate about education. She specializes in the treatment of small intestinal bacterial overgrowth, and she teaches advanced gastroenterology at the National University of Natural Medicine. She also lectures all around the world at conferences, and she is the most incredible resource of research articles and information about SIBO on her website siboinfo.com. Allison, thank you so much for joining me today.

Dr. Siebecker:          Thanks, Ben, so happy to be here.

Dr. Weitz:                 How did you get interested in digestive disorders and SIBO in particular?

Dr. Siebecker:          Like so many people, it’s because I have the problem. I think, as far as I’ve known, I could recall I had what I now know to be IBS, since I was about five. It was interesting because I wasn’t born with it. My parents and family tell me I had normal function, like normal bowel movements and things like that. But after, somewhere around five or six, I became constipated and also had bloating. I never knew what it was. No one in my family knew what it was and I spent this whole time trying to figure it out. It’s not really why I went to medical school, but it certainly is what steered me in this direction.  I read various things and then I came upon the term, SIBO, and it just all clicked. But there was barely any information out there at the time. This was like 14 years ago or something like that. I can’t remember exactly how long ago. Then I just started researching and researching. Then that’s when I made my website, because when you would Google, or search, nothing would come up. There’s one Medscape article and there was … where you could get the test came up on page four. Then I made my website. Now, of course, my website is like, “Is it even needed?” Because everyone and their brother and their cousin has a site on SIBO. But it’s done its job. It helped people during the pinch when there was no info.

Dr. Weitz:                  No, it’s still a great resource, especially when you update all the most recent studies.

Dr. Siebecker:           Yeah, I’m so glad that you use that, because I work really hard on that. It’s very interesting to me. Every quarter I go through and anything new that’s been published on SIBO I put on my site. Especially, my favorite part of the associated diseases page.

Dr. Weitz:                  Right.

Dr. Siebecker:            God, you just wouldn’t believe the studies. Things you’d never even think of, like acromegaly being associated with SIBO and a study on it. It’s like, “Wow, okay.”

Dr. Weitz:                   Yes. Skin disorders, epilepsy, I had a woman who had seizures, she lost her driver’s license, and you fix the SIBO, and she’s better.

Dr. Siebecker:            Wow.

Dr. Weitz:                   I mean, it’s great. To start off with, I want to take a little bit of a side turn for a second. In 70% of the patients who have IBS, which is caused by SIBO, I wonder what about the rest of the other 30% or so. What do you think is probably the cause of their IBS?  Or is it SIBO that we haven’t been able to diagnose because we don’t have the new breath test, the hydrogen sulfide. Do you speculate about the other 30%?

Dr. Siebecker:            That’s such a good point that you bring up. The other 30% is the differential diagnosis, which just for any lay person listening, that just means what else could it be. This is what we have to go through in our heads. The differential diagnosis for IBS, irritable bowel syndrome, is huge. That’s because the symptoms are what is called, non-specific. The symptoms are bloating, constipation or diarrhea, or a mixture of the two, and abdominal discomfort or pain, at the minimum. At the minimum, right?

Dr. Weitz:                   Right.

Dr. Siebecker:            What causes that? Like so many things, right?

Dr. Weitz:                   Right.

Dr. Siebecker:             Right now, I just brought up in front of me, on my screen, just to remind myself the list that I compiled of the differential, and it’s got 40 conditions on it. I’ll just read a few of them.

Dr. Weitz:                  Sure.

Dr. Siebecker:           And some of them could be causes of SIBO, but some of them they might not be causing SIBO. They just have similar symptoms. We’ve got things like yeast overgrowth, parasitic infection, large intestine overgrowth or infection, H. pylori infection, celiac disease, non-celiac gluten intolerance, inflammatory bowel disease, IBD, carbohydrate malabsorption, like lactose or fructose. I mean people can have that and not have SIBO, and causes the exact same symptoms. Food intolerance, which most people typically think of as a protein type allergy, but there’s also histamine intolerance, salicylate, on and on. General hypochlorhydria, too little stomach acid that can be caused by 15 to 20 things just regardless of SIBO. Pancreatic enzyme insufficiency, diabetes, hypo or hyperthyroid, these have the same symptoms. Something as innocuous as … This does need to go on the differential for IBS, insufficient chewing.  I have all these dietician friends that tell me that’s the first thing they do when someone has IBS symptoms. They coach them on how to chew their food well, and be able to do that. Because, instead you just have the impulse to swallow real quick. And that a large proportion of their patients to IBS, so to speak, is solved by proper chewing. Then all the way on the other side of this differential diagnosis, we have got cancer, any kind of cancer of the abdomen, could create the same symptoms. And we’ve got, from the innocuous, to the very serious. There’s things like gastroparesis or stomach emptying, bile acid malabsorption, VIPomas, or Zollinger-Ellison Syndrome, any kind of obstruction in the small intestine, Parkinson’s, scleroderma, systemic sclerosis, Ehlers-Danlos Syndrome, mast cell activation, MCAS, mast cell activation syndrome, POTS, these are the New Kids on the Block. Everyone’s like, “Whoa, complicated patients might have these.”

These have the same symptoms. Lyme and co-infections, various immune deficiency diseases actually have the same symptoms, and endometriosis that’s a really common one. Lot of patients with SIBO will have that as their cause, the endometriosis, but even if you don’t get SIBO from endometriosis, it has extremely similar symptoms: swelling, bloating, pain, diarrhea, you can vomit from the pain. There you go. That’s not the complete list, but it’s just a massive differential.

Dr. Weitz:                  Right. And, of course, these can be coexistent with SIBO at the same time. You can have several layers of problem dysfunction.

Dr. Siebecker:            Most patients, that I see, have more than one thing wrong.

Dr. Weitz:                   Right.

Dr. Siebecker:            Same with you? Have you ever seen anyone with just one thing wrong?

Dr. Weitz:                  Sometimes, yeah.

Dr. Siebecker:           We have to keep that in mind.

Dr. Weitz:                  Right.

Dr. Siebecker:           The patients, a lot of times, are like, “What’s the one thing?” And it’s often more than one.

Dr. Weitz:                  Right. Yeah, I try to get all the patients with gut disorders, at the very least, to get a stool test and a breath test.

Dr. Siebecker:           Excellent.

Dr. Weitz:                   So we can start to put a couple of layers together.

Dr. Siebecker:            Excellent. The thing about this is that what I think happens to a lot of people with IBS, unfortunately, is it’s not investigated at all. Like this differential I was just reading, which SIBO would be on with the 60 to 70% prevalence. Than all these would have 30 to 40% prevalence. No one looks at any of them or, maybe, they look at one thing. Maybe the doc is advanced enough to check for SIBO, but if that was negative, then they don’t look at all these other things. So it’s, “Oh, you just have IBS.”  I guess the thing is, what really is IBS? I my mind, the way I think about it is, that it’s what would be left if absolutely every single one of these 40 plus things was ruled out. Which, of course, then that’s a burden on everyone, the system, and tests. It might not be practical to rule out all these things, but I’m just saying philosophically what is it? It’s still just a name for when you looked at everything and you don’t know what is causing these symptoms.

Dr. Weitz:                   Right. Then, of course, if you do find several different things, it’s a question of what do you prioritize? If there’s SIBO and there’s blastocystis hominis, or there’s candida, or there’s dysbiotic bacteria, or there’s worms. What do you treat first?  Do you treat both things simultaneously?

Dr. Siebecker:             Questions, just big old questions there.

Dr. Weitz:                   But that’s something that would be interesting to have some guidelines as a continuum, as to, “Okay. If it’s a parasite, treat that first. Then SIBO. If it’s you know.”

Dr. Siebecker:            Yes.

Dr. Weitz:                   But that’s part of the art and science of practice.

Dr. Siebecker:             Yes.

Dr. Weitz:                   When I was speaking to you at the Integrative SIBO Conference in Seattle, you said that you thought that we generally think that the bacteria in the small intestine have overgrown from the large intestine. That’s especially the story that Dr. Pimentel tells, because of a decrease motility and then you get this backwash. You said to me that you think that’s not what happens in a lot of cases. That the bacteria come down from above, is that right?

Dr. Siebecker:             Yeah. I don’t know, it’s just that I’ve read so many articles on SIBO, obviously. I’ve got two file cabinets full. I’ve read them all multiple times. It’s just that there’s this … Something hasn’t made sense to me, and I get a picture in my head. What seems likely to me is that all three things are possible in terms of top-down, bottom-up, or just from the small intestine itself. I do think it’s possible we can have a back migration, but I think it’s just as likely, if not even more likely, that the normal bacteria that are in the small intestine are simply not moved down and are overgrowing. And, also, we have bacteria entering into us constantly every day at all times, swallowing, eating, everything. They’re in the atmosphere. They’re everywhere.

Basically, think about it. How did our large intestines get colonized with these bacteria? Some say from vaginal birth. What if you weren’t vaginally born? They’re going to come from, somehow, the top-down and they’re going to be passing through us. What if then those bacteria just didn’t get the chance to move all the way down? What most experts say is that the way you say it’s SIBO is that the types of bacteria that are in the large intestine are now in the small intestine. That is a very strongly held opinion, but it is debated. It is debated. There are articles currently, in fact, just our symposium, our integrative conference in New Orleans, which was a year ago, we had two researchers discussing that. Discussing the oral upper respiratory bacteria. That being a form of SIBO as well.

Even though it’s what is generally held, I just want people to know that there are other people thinking other thoughts and publishing on that as well. I did talk to Dr. Pimentel about this, and ran some of my suspicions or thoughts by him, and he did say that the bacteria that are down in the large intestine do also exist there in the small intestine in very small amounts, and they could just be overgrowing right there. That’s an odd thing, because they’re really large intestine bacteria but then if they’re always there in the small intestine in small amounts, are they just large intestine bacteria?

Now, he’s just come out … Digestive Disease Week is occurring right now, a big gastrointestinal conference. He’s just come out with a full sequencing of the small intestine microbiota. He’s been working on new technology, and I quickly looked at those articles, but they were abstracts, so I don’t have the full information. Maybe this will become a little bit more clear now.

Dr. Weitz:                  Yes, yes. I had the opportunity to interview him, and he was telling me about that. That he’s mapping the small intestine microbiome.


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Dr. Weitz:                   There’s a number of factors that have been discussed in the literature that help to keep the small intestine relatively free of bacteria. As most of our listeners probably know, your colon is backed with tons and tons of bacteria, and there’s bacteria throughout our digestive tract, and in most of the mucosal surfaces of our body. But the small intestine is supposed to be relatively free of bacteria, because that’s where most of the absorption of nutrients occurs. So getting too many bacteria becomes problematic. There’s a number of mechanisms by which the body typically keeps the small intestine from having too much bacteria, and those include hydrochloric acid secretion, digestive enzymes, bile, motility, the migrating motor complex, the ileocecal valve. Which, if it maintains its integrity, prevents the bacteria from the large intestine from growing in. And then 80% of our immune system is focused around the gut. That’s referred to as the GALT, and that also helps to keep the small intestine clear of bacteria.  I asked Dr. Pimentel about this and he’s a big believer motility is pretty much the main factor. He doesn’t think that the others are really important factors. I also spoke to Dr. Rahbar recently and he thinks that a lot, especially the problematic cases of SIBO, were really dealing with this function of the immune system, and that’s one of the underlying problems. What do you think? Do you think these factors can all play roles and which do you think are the most important?

Dr. Siebecker:                      Yeah. I think certainly what everyone else thinks, and what the literature supports, is motility and the anatomy or the structure of the body. The migrating motor complex probably being number one, and number two being the anatomy of the intestines allowing for the passage of bacteria down. The number one problem that would happen there would be obstruction, some kind of partial obstruction. If those things fail, we know it’s really high likelihood someone will get SIBO. That’s very well accepted.  But then when we look at all these other factors, there’s not a lot of studies to support, or there’s a lot of contradicting evidence. I also agree with Dr. Rahbar that, I think, the immune system would be number three, coming after structural and motility, as a very important factor. How important, I’m not sure. I actually brought up a chart. I want to give you the rates I have in one of my slides. The rates of SIBO immunodeficiency that have been published. We don’t have a ton of articles on this.

Dr. Weitz:                   Right.

Dr. Siebecker:                     We’ve got anywhere from about 18%, that’s for common variable immunodeficiency disease, up to 88% for HIV. That’s pretty extraordinary. If a person was to go and look at this article that was written on SIBO and HIV, one thing you would need to keep in mind is that the positive value for … They used culture. They used culture test for the diagnosis. The positive value for that has changed. This article says that it’s not very associated, because it was using the old standard, which was 10 to the fifth, or 10 to the sixth. Now, it’s been lowered to 10 to the three. So taken into account the 10 to the three is 88%.

 Then we’ve got chronic lymphocytic leukemia 50%, actually, high. And various immunodeficiency diseases in children 41%. The thing about this is that these are all frank immunodeficiency diseases. I think what a lot of people wonder about is, what about when you see, like on a test, you see low IGA on a saliva test or stool test? What about that? And we just don’t know. I think what we can say is, “Yeah, I think it would be a risk.” I think it would. How much? We don’t know. At least, when we have these frank immunodeficiency diseases in our mind, these percents, we can maybe put it into perspective. But, for instance, with Lyme. We know that Lyme is an underlying cause for SIBO and there’s various theories as to why. One of them is the nerve damage that occurs, probably, from one of the co-infections. But the other is the immune system deficiency that occurs. And I think it’s an important factor.

I would put that as number three, after first motility, and then structural and, particularly, partial obstruction. Now, bile enzymes, hydrochloric acid, these are … Not much is known about the bile and the enzymes. Hydrochloric acid, that one’s hotly debated. Really where it’s debated is with proton pump inhibitors. Deficiency of hydrochloric acid is actually well documented in studies. That it leads to an overgrowth of bacteria in the stomach, itself. That’s where the acid is missing. For me, the concept with how it would then lead to SIBO is then that overgrowth would just move on over, spill over, into the small intestine. If the migrating motor complex would be working, it could clear it out. We actually have studies that simulate this, where tubes have been put right into the upper small intestine with fetal bacteria, like an FMT type of situation, but those people have been shown to have a functioning migrating motor complex, and all the bacteria was cleared out and they didn’t get SIBO.

That’s the concept, I think, we’re working with here. Therefore, how much would hypochlorhydria effect? I think it would be a significant risk factor, if someone also had deficient motility. I could imagine a scenario like this. You have some deficiency of motility, maybe, not enough to give you SIBO, but you’re heading in the direction. You’re like, “You’re at risk.” Then you have the low hydrochloric acid. Together, it gives you SIBO. See, that’s what I would imagine.

Now, with the proton pump inhibiting drugs being such a highly popular prescribed drug, they, on purpose, create hydrochloric acid deficiency, and that is hotly debated back and forth, back and forth. For every article that comes out saying that they’re a risk factor for SIBO, another one comes out saying that it’s not. Just now, Dr. Pimentel’s team came out at DDW with one saying it’s not. I feel like this is going to go on forever. To me, if you’ve got half the articles saying it’s a risk factor, and half saying it’s not, I don’t know, to me, I feel there’s a risk factor there. I believe it’s a risk factor.

Dr. Weitz:                   Right.

Dr. Siebecker:             It puts at greater chance that’s all.

Dr. Weitz:                   Right.

Dr. Siebecker:             I don’t think it’s a major underlying cause.

Dr. Weitz:                    I spoke to Dr. Rezaie, who’s one of Dr. Pimentel’s associates, who spoke at one of our functional medicine meetings, and he discounted it as a possible factor, because he said that once the hydrochloric acid gets into the proximal part of the small intestine, it gets flooded with bicarbonate, so it would have no effect in the small intestine anyway. In other words, it gets neutralized.

Dr. Siebecker:              I remember you told me that and I thought that was so interesting, because I think he was thinking of a different mechanism here for how it would cause a problem. For me, I’m thinking of actual spillover.

Dr. Weitz:                    I was thinking it had an antibacterial effect.

Dr. Siebecker:              Yeah, right. I wasn’t thinking of it in that way. I had a different concept. But let me just think if there’s anything else. The ileocecal valve, now, that one’s also very controversial, because … You brought that up, right?

Dr. Weitz:                    I did, yes.

Dr. Siebecker:              Okay. Because I actually have … It might be interesting, if I bring this up. Let me just see here. There have been a lot of studies. Well, not a lot, but some that maybe show it’s not so obvious that it is, for sure, a problem. Again, I think what we’re looking at here is the migrating motor complex having the ability to compensate. We actually have some studies like that, where people have their ileocecal valve removed. But they have intact migrating motor complex, and they don’t get SIBO.

Dr. Weitz:                    These are people who had part of their intestine removed due to cancer, or IBD, right?

Dr. Siebecker:                      Exactly, exactly. Let me see if I can bring up the one. There was one that they had controls. Let me just see here. I want to see if I can find it. I’ll just read you what I have, because it’s kind of interesting. In a study of 17 children with bowel surgery, they found that the loss of the ileocecal valve was not associated with an increase risk of bacterial overgrowth. And another study looked at 40 patients with SIBO and concluded there was no significant difference between patients with, and without, SIBO and the presence of the ileocecal valve. Then there was this one that was … Let me find it. Eight resection patients … The ileocecal valve was removed because of cancer. This was the one, they had eight controls. They found then the distal small intestine, ileocecal valve, and proximal large intestine were removed, but the transit was normal. The small intestine transit was normal. The same as the healthy controls. There was no reflux from the large intestine into the small intestine, the remaining aspects.

Now, they didn’t look at SIBO, they looked at reflux, but they did not see it back migrating, and the motility was normal, and there’s more. There’s studies on children and everything. This is not to say it isn’t a risk factor. I believe it’s a risk factor, but I guess the concept to get across here is that risk isn’t a guarantee. It’s that it increases chances somewhat. Here are people that have their whole ileocecal valve removed and they didn’t get SIBO, but then other people do. I have patients who they have an absent ileocecal valve and they have continuous chronic SIBO.

It’s interesting, what they did find, actually, in the study with one of the children’s studies, was it had to do with the length of the small intestine that was removed. The more small intestine that was left in the body the lower the chance of SIBO. And, again, they didn’t say it, but my thought here is because then it could perform the migrating motor complex. It has the chance to do a clearing downward sweeping action. I would say for anyone who’s needing to have their ileocecal valve removed, there’s a couple things to ask for, and that’s to leave as much a small intestine as possible. And, also, there’s studies done where they reconstruct and create a fake valve. That actually also helps. Then there’s studies on which fake valve works better than the others.  If somebody is listening, and heading towards that in surgery, they can look into this.

Dr. Weitz:                    Interesting. Which are the most effective antimicrobial herbs for SIBO, hydrogen methane, hydrogen sulfide, et cetera?

Dr. Siebecker:                     Well, there’s a whole bunch that we use that seem to have equal effectiveness. We use berberine containing herbs. You can buy products that just say berberine or berberine complex, things like that. But the herbs that have it are goldenseal, Oregon grape, things like that. That’s an excellent one.

Dr. Weitz:                   Does it matter if the product is from all those variety of different berberine containing herbs, or has the complete herb, or just a berberine extract? Do you think those are equally effective?

Dr. Siebecker:                      I do. I’ve tried single herbs and I find them to be just as effective as a combination. The only difference, for me, with a combination is some people are quite sensitive. A lot of people with SIBO are very sensitive to really anything that comes in. So sometimes it’s nice to use just one item and not multiple herbs, because then if they become reactive you just have one thing to remove and figure it out. So that’s excellent. One thing I want to mention about that is that the dose for berberine, I have found, at least in my patient population, which is a bit more of a challenging, we need a pretty high amount. I use, and my colleagues use, five grams a day.

Dr. Weitz:                    Five grams, okay.

Dr. Siebecker:                     In split dose, yeah.

Dr. Weitz:                  I was in milligrams.

Dr. Siebecker:                      That’s it. It winds up being anywhere from nine to 11 pills. Now, a lot of my colleagues say three grams, 3,000 milligrams is plenty. But, I guess, the key thing I want to get across is, two pills a day, three pills a day, isn’t going to do it.

Dr. Weitz:                   Is that the same if you’re using it with one or two other herbs?

Dr. Siebecker:                     It is.

Dr. Weitz:                  Okay.

Dr. Siebecker:                     It is. Then the next one would be neem, N-E-M. The one we tend to use a lot is called, New Plus, I guess it has Atripla in it, which is really a mild prokinetic. Again, we’re adding extra things here, but people tolerate it very well. We use about six pills of that one a day. Then oregano. I tend to use one that’s not an oil in a capsule, because I find the oil in the capsule is a bit more caustic. Sometimes oregano is hard on people’s mucus membranes and it can hurt. Other people do fabulous with it, no problem. But the one that’s in a dry tablet seems to be tolerated by more people. Of that one, I use it in my-

Dr. Weitz:                  Which product is that?

Dr. Siebecker:            I use Biotics A.D.P. for oregano.

Dr. Weitz:                  Okay.

Dr. Siebecker:            We use six a day, again, of that. Then there’s allicin, the antibacterial aspect of garlic. The product we use is called, Allimed. It’s also sold as Allimax Pro. But that allicin company, they have three levels. They have Allimax, which is the lowest, Alliultra is middle, and Allimed is the highest. So we use the highest one, and that we use six a day of that. Now, that one is the one, the allicin, is specific for methane. The other three work beautifully on hydrogen. And, actually, the Allimed works well on hydrogen, but we don’t typically start with that because it’s more so for methane.

For myself, I will use two herbs at once. I would do berberine neem, or berberine oregano, or oregano neem for hydrogen. And then, when someone has methane, I will choose one of those three, and I will add Allimed. Another one we can use for methane is Atrantil. I can use that one alone sometimes, or I’ll just use it like the Allimed. Those are our main workhorses, and I find them all to have equal effectiveness. But I do just want to say, another point here is, a lot of docs, particularly those who are more primary care physicians, they’ll use combination formulas that also have herbs that work on yeast, and parasites, and viruses, big antimicrobial formulas. I talk to them, and they report good effectiveness with that. I just don’t go that way, because I’m not seeing that population. I’m seeing people that have already failed and I’m getting a bit more specific. But either method works well.

Dr. Weitz:                   What about the elemental diet? Have you found that to be effective either, by itself or in combination?

Dr. Siebecker:             Well, we don’t use it in combination. I mean, I guess there are some people that do, but that’s against Dr. Pimentel’s recommendation. He’s the doc who came up with this as a treatment for SIBO. It’s highly effective, highly, highly effective. I feel, in terms of killing, I guess it has equal effectiveness to herbals or pharmaceutical antibiotics. But it has that one advantage, which is that it can kill more in the same time period. So we’ll typically see somewhere around 70 to 100 parts per million of gas be lowered in one two-week course, a huge amount. It’s a special treatment, because it can safe time. Because a key thing to know, like the little gold piece, I figured out very soon into my SIBO specialty practices that both, herbs and pharmaceutical antibiotics, seem to lower gas, on average, around 30-ish parts per million per treatment course.

 A treatment course for a pharmaceutical antibiotics is two weeks. A treatment course for herbal antibiotics is four weeks. It takes longer with herbs to get the same effect. Within those time periods, we tend to get around a 30 part per million decrease. It’s all they can seem to do. I mean, occasionally, of course you get something fabulous and through it. But elemental diet, on average, lowers about 70 in two weeks. It’s not a very pleasant treatment. A lot of people don’t want to do it, but you really have to think about this because if you’ve got high gas, that could be what could convince you. Then you just do that elemental diet.

Dr. Weitz:                  Do you prefer the dextrose or the dextrose free version?

Dr. Siebecker:           I like to use dextrose. Now, this is not for a patient that has yeast, obviously, or a strong history of yeast. This could be problematic. But the only reason why is because I have a lot of sensitive patients, and I’ve had a lot of patients who reacted poorly to the maltodextrin. Most formulas either have maltodextrin or maltodextrin with dextrose, which is glucose. I think those are all wonderful, but if you’re just truly asking … If I was going to pick on out of everything, I would probably pick a dextrose simply because I’ve had a lot of patients react.

Dr. Weitz:                   Right. Do you find some patients are developing antimicrobial resistance the way patients can develop bacterial resistance?

Dr. Siebecker:            You sent me this question ahead. This is to herbs, right?

Dr. Weitz:                  Yeah, to herbs, yes. They can’t tolerate oregano anymore, or they don’t react to it the way they used to.

Dr. Siebecker:            I find this in just about every patient I see. It is absolute norm. Now, this could be, of course, because I’m seeing people farther down their journey and they’re harder cases. So everyone I see is going to have this kind of thing. It is expected and the norm. I see it all the time. I constantly have to rotate my herbs, and this is another reason why I don’t like to use these huge formulas. Because then I’m exposing them to everything. I want to pick and choose, and I want to reserve herbs aside for future use, because most people need multiple rounds because of this high gas.

Dr. Weitz:                   And is the rate around four weeks, six weeks, eight weeks?

Dr. Siebecker:            Yeah, as I mentioned, for pharmaceuticals it’s two weeks, elemental diet it’s two weeks, herbal antibiotics it’s four weeks. Of course, we can stretch that out a bit, so we can go to three weeks for elemental diet, which isn’t the most pleasant, and pharmaceutical antibiotics, and six weeks for herbals. The question here is, well, why not just keep going and get the thing done? It’s because I find that it peters out. I’ve seen this over, and over, and over, and particularly for herbal antibiotics. I will see patients actually start to relapse while they’re taking the herbal antibiotics usually in around six to eight weeks. So I don’t usually go past about six weeks.  I know a lot of docs, standardly, will just give an eight week. In my patient population I can’t do that, because they actually begin relapsing. I certainly have seen some cases where people have been on three months of pharmaceutical antibiotics and it was still working and lowering, but that is not the norm. That is a rare circumstance. You just seem to not get anymore effect. You have point of diminishing returns after about three weeks for pharmaceuticals and six-ish to eight on herbals.

Dr. Weitz:                  What are the most effective natural pro-motility agents?

Dr. Siebecker:                    Well, for the natural prokinetics … By the way, a funny thing here is a lot of the SIBO patients have diarrhea, so I specifically don’t say, “Promotility agent,” because they’re going to go, “I can’t take it.”

Dr. Weitz:                   Of course, exactly.

Dr. Siebecker:                     Prokinetic, I like to use that term instead, and always try to tell the patients that have had diarrhea, or still do, that they can take it, because it’s not a laxative. It’s possible that it might give them a worsening of diarrhea, because pretty much anything you give could and certainly, as you’re stimulating the upper small intestine motility, it might. But, in general, we don’t see that it does that. For the natural ones, I don’t really see one of our options being more effective than another. I see it’s … We have ginger, which if you just use that alone, ginger root, it would be 1,000 milligrams at night before bed. Then we’ve got all these ginger containing prokinetic formulas. There’s MotilPro. There’s Prokine. There’s SIBO MMC. There’s Motility Activator. And from the UK there’s Bio.Me.Kinetic. Am I forgetting any? Did I get them all? I hope I did.

Dr. Siebecker:                     Well, anyway. We’ve got all of those. Then we usually have things like fine HGT and a few other things that can help potentially stimulate migrating motor complex. Then we’ve got Iberogast. I would say they’re pretty equal. Mostly, we just really have the Iberogast, and then ginger or ginger containing formulas. For the pharmaceuticals we have … The main ones we use are low dose-

Dr. Weitz:                 Let me just ask you another question.

Dr. Siebecker:                    Yeah, sorry.

Dr. Weitz:                  How easy … It seems to me that with the natural prokinetics, it’s hard to gage your effectiveness, and a lot of patients don’t necessarily feel anything. I often wonder, “Should I be going up on the dosage?” Especially, maybe you have a 240 pound patient. What do you really think are … Take some of the popular ones, like Motility Activator, or MotilPro, what do you think is the most effective dosage?

Dr. Siebecker:                     Well, it’s the same issue with the pharmaceutical prokinetics. No matter what, whether it’s natural or pharmaceutical, how do we know it’s working? This is so frustrating.

Dr. Weitz:                  We need a way to test motility.

Dr. Siebecker:                      Yes. Very unfortunately there was this … Fortunately and unfortunately, there was this machine that was being developed. Right when I first talked to Dr. Pimentel, he was helping them run some tests on it. It wasn’t his development, but he was helping and it was acoustic. It was meant to be able to tell us about the migrating motor complex. I spoke to them, and they just decided not to use it for this purpose, at all. Apparently, it’s not even available. Honestly, I haven’t checked back and I should. We were all waiting for this. It was like, “This will be the way. We’ll be able to take a baseline, then give someone a product and check them again.”

Right now, the only way we would be able to know is two ways. One, you would send them for the costly, invasive, have to travel to it, antroduodenal manometry test, which is the way you test for the migrating motor complex. Then that’s performed as a functional test, at least the way Dr. Pimentel does it. You would test the baseline, then you would give them the product. Then you would test again. Can it make the migrating motor complex? Well, obviously this is not very realistic, right? Then what’s the other way we would know? We would know from watching how they relapse. How frustrating, right? When do they relapse? I mean, the best thing I can say about this is I would say for patients that are not doing badly, they probably-

Dr. Weitz:                  What about having them eat some charcoal and see how long it takes to come out in the stool?

Dr. Siebecker:            That’s transit. That doesn’t really have anything to do with migrating motor complex.

Dr. Weitz:                   Okay.

Dr. Siebecker:             Yeah. You’ve got several regions, very different motilities. Anyway, I would say that your relapse rates … If a person’s doing pretty good, they’re probably in the four, to six, to eight month range of relapse, even after a year. When a person is a chronic patient, they often will relapse at about a month or two months. You have to judge like that. If your patient is relapsing, they get better, and then they relapse at two months, that’s pretty average. Now you know, I got to try, and do something to make this better. Then you might increase your dose. You might add a second prokinetic. All the prokinetics, and I didn’t mention the pharmaceuticals, so just quickly, low-dose erythromycin, procalopride, and LDN, low-dose naltrexone. These are the main ones we use.

All of these, that I’ve mentioned, have different mechanisms of action and, therefore, can be used together. One thing, you just want to be very careful erythromycin, because it can prolong QT. But with these particular prokinetics, they can go together. But just anything you’re going to add with erythromycin, check it. Then I will do that. Then I might combine two. To your question, what about if somebody’s heavier weight, should you go up? You can go up. I wouldn’t go higher than 2,000 milligrams in a day of ginger. That’s just from reading studies. And for the low-dose that we use for pharmaceuticals, I wouldn’t go above the standard dose. But for erythromycin, the thing is, with that one, it’s the low-dose that really has the prokinetic effect. When you start going higher it actually doesn’t work as well as a prokinetic. I wouldn’t go above, probably, 100 milligrams two to three times a day on erythromycin.  For the ginger-

Dr. Weitz:                    Has anybody experiment with red yeast rice? Because I know Dr. Pimentel was talking about using low-dose statins, at one time.

Dr. Siebecker:                      Yes. That’s different. What that’s about is not as a prokinetic. That’s about inhibiting methane gas formation. Then the idea would be your motility … Because methane gas causes constipation. It slows motility. This is a different mechanism, but people have and when I first did it, it was a little like I had some positive I thought. Then I had some negatives. Then when I really followed it out, I really didn’t have those positives. You know how when you do something, and you’re like, “Oh my God, it’s working.” Then there’s confounding factors. Then as you trace it through you’re like, “Wait, that wasn’t it.”

Dr. Weitz:                  Right.

Dr. Siebecker:                     I actually feel better about the Atrantil for this purpose than the red yeast rice. Back to the question of, should you increase your motility activator? You can, just check that dose of ginger, and don’t go above 2,000. Yes, you absolutely can do that. One problem with those is that the ginger often burns people’s throats, so that can be a limited factor or causes reflux. In many patients I’ve had, they just want to drink water, because they like the effect of it. One last thing on this. There are patients that are sensitive enough that they can actually sense and feel a prokinetic working. And it’s an odd thing to describe, but, I wonder, you might have had some patients give you this feedback. It’s different from when somebody has a really excellent bowel movement, and they feel all cleared out, and they’re like, “Wow.”

But, yet, patients will say, “I feel cleared out,” but it’s not like a bowel movement. It’s like an upper clear out. And they’ll say, “Things feel different. Things feel like they’re working better.” It’s like the upper abdomen region and they get a good feeling, some patients. The vast majority, they can’t tell a thing. And one last thing, patients will often confuse this with bowel movement, and they’ll say, “Well, I’m not having a bowel movement anymore than I was before, so my prokinetic isn’t working.” It’s not supposed to give you a bowel movement.

Dr. Weitz:                   Right. Have you experimented with any of the manual or other techniques for stimulating the vagal nerve?

Dr. Siebecker:                    I haven’t. Well, actually, I did experiment with gargling and gagging, like the classic from Dr. Crossey. And I found no benefit, at all, which has been confounding to me, because Dr. Crossey reports these amazing case successes, and I was dejected. It was like, “Why aren’t I seeing this?” Now, I did hear a lecture recently by Neil Nathan. He just came out with the book, Toxic. He was talking about polyvagal syndrome and various vagal issues. He did make this one comment that depending upon the reason of what’s wrong with the nervous system, and the vagus, and everything possibly those exercises just might not be targeted enough. There might be some more targeted treatments that would help. That’s about the extent of my experimentation.  Do you want to make a comment on this?

Dr. Weitz:                  We’ve experimented a little bit with using infrared laser, and chiropractic treatment, sometime to the thoracic spine or the cervical spine. I’m not really sure if it helps or not.

Dr. Allison S.:                      Well, if we’re on the subject of what could help nerve repair. I think there’s a few things that I would be aware of, and you might have others to offer. One is prucalopride, it is a neuro regenerative. That’s the prokinetic. That’s probably my favorite prokinetic that we have to offer, because of this. It actually protects nerves from damage and regenerates them. Then it also stimulates the migrating motor complex. I like that one. I think doing things that help protect from autoimmune damage, because a lot of people are having SIBO from autoimmune damage to nerves, like in the case of food poisoning, the most common cause of SIBO. That’s the mechanism there. Anything we can do to calm down autoimmunity, LDN, that’s another one of our prokinetics could help that. But then my colleague, Dr. Mona Morstein, she uses aceytl L-carnitine. She specializes in SIBO, but also diabetes and that’s been proven to help regenerate nerves in diabetic neuropathy, so that would be another option.  Then myself, and Mona, also have both spoken about Lion’s mane mushrooms has been shown to help do some nerve regeneration.

Dr. Weitz:                  Interesting.

Dr. Siebecker:                     Yeah. Then, lastly, frequency specific micro current is something I’ve just recently been learning about. They have an enteric nervous system healing protocol and also a vagal healing protocol. They can heal a lot of tissues with frequency specific micro current. That’s one I’m getting very excited about.

Dr. Weitz:                  I’m loving this conversation, but I think only have time for one more question.

Dr. Siebecker:                     Really, only one more? Come on.

Dr. Weitz:                    Unfortunately, the last question is going to be a big question. Probiotics, do you ever use probiotics, part of your treatment protocol, or after the treatment protocol?

Dr. Siebecker:                     Yeah.

Dr. Weitz:                  I know it’s controversial. There’s a thought that any kind of probiotics is adding bacteria, and we’re trying to get rid of bacterial overgrowth. It’s a bad idea. There’s some prominent functional medicine doctors who feel like probiotics should be a frontline treatment because of the antimicrobial effects. Some functional medicine doctors say, “Well, I use probiotics, but I don’t use those. I just use soil-based, or I just use saccharomyces.” What are your thoughts about that?

Dr. Siebecker:                     Exactly. Dr. Hawrelak, he’s wonderful on showing what strains have been studied, and he’s got some strains that … Or he’s educated an awful lot. Some bring down methane. There are other studies that show probiotics help motility and, maybe, even the migrated motor complex. It is really confusing. I am absolutely not opposed to probiotics. Most of the studies on SIBO and probiotics are positive. They show, actually, probiotics decontaminating, like decreasing the rate of SIBO due to antimicrobial aspects. I can’t say I’ve seen that in my patients. This is a case where, for me, the studies don’t match clinical. Although, I haven’t exactly tried the same strains, because a lot of them in the studies aren’t available, at least in the US.

That’s one of Dr. Hawrelak’s arguments. He’s always arguing for strain specificity and that you can’t just generalize, and say, “Well, I tried probiotics.” You have to try the exact thing that was in the study. I guess what I can say is this, I am not of the belief of one way or the other. There’s some docs who say, “No one with SIBO should have … There should be no probiotics used with SIBO.” And others say, “Everyone should use them.” I’m in the middle, because I just like to go by the case of the person in front of me and ask, because so many patients are very aggregated by probiotics. And my explanation for this with SIBO, would be cross-feeding, because when you give a probiotic it makes acids. Then other bacteria can then take those acids and turn them into gas.

I think that it’s possible for probiotics, through cross-feeding, to increase gas. And it’s the gas that hydrogen, methane, or hydrogen sulfide that causes the symptoms, primarily. You have other pathophysiology stuff, the number one. Sometimes it’s just going to be too aggravating. What I do is, I just ask, “How have you done with them.” I take a look at the brands they’ve had. I always want to see if they had one with a lot of prebiotics in it. Prebiotics can very much aggravate symptoms, especially if there’s a large amount. I think, also, we can, on a side note here, we can use prebiotics. Certainly some are better handled than others and, especially, if you start very slow and go lowly high … bringing it high up slowly.

But, I guess what I would want to say about this is, my preference is to try probiotics while a person still has SIBO, while you’re giving antimicrobials. Because, if there is a real problem, you can be simply correcting with the antimicrobials. The other reason is because, in the past, I followed the classic thing that everybody does where you-

Dr. Weitz:                    The four hour …

Dr. Siebecker:                    Yeah, right. You mentioned this to me, where you give the probiotics when you’re done. I have a lot of problems with that. I seem to relapse a lot of my patients. I didn’t forget it. I felt so horrible and it isn’t my preference to wait and try probiotics after everything’s perfect. I do not like to rock the boat, because these people are sensitive. It took us a long hard time to get their tests cleared and get them feeling … I’ve challenged my … We work like [inaudible 00:51:31] to get them. Now, you’re at 80%. Now, you’re at 90. We got you to take all this time. I don’t want to rock that boat.  I would rather rock the boat when we’re in the middle of treating. That would be my personal recommendations. Try probiotics when you’re still treating. Of course, you can try them at anytime, but I’m just sharing what happens with me.

Dr. Weitz:                    So, basically, you’re saying the four hour approach, which is almost like a Biblical verse in the functional medicine world. Probably first taught to us by Dr. Jeffrey Bland, maybe, the father of functional medicine. That, basically, we want to remove, replace, reinoculate, and repair. That protocol probably isn’t great for SIBO.

Dr. Siebecker:                     I don’t think it exactly fits, but it’s not awful. Obviously, we’re doing the remove or the reduce.

Dr. Weitz:                  Right, with that microbials or antibiotics.

Dr. Siebecker:                    The replace, I feel, a lot of people can start with the replacement right up front, because it helps the symptoms anyway. You don’t have to wait. I mean, but it’s still good. Then does everybody need that? Also, no, not everybody needs HVL, or the bile, or the enzymes. Again, you can just try, and see. Then the reinoculate and repair. Reinoculate, again, I might like to give that a test a little earlier. Then repair is nice too. The interesting thing is that there was these two studies done on SIBO and leaky gut. What they both showed … They both actually showed about a 50% rate of leaky gut and SIBO, which is surprising. I think most people would think it would be like 100%. I tested a bunch of my patients, and I also found a 50% rate. If we believe our tests.

Dr. Weitz:                  What test do you do for leaky gut?

Dr. Siebecker:                    I was doing the Cyrex test, Array2.

Dr. Weitz:                   Okay.

Dr. Siebecker:                     Because there’s issues if you use lactulose. That’s funny, because it’s the same test used for SIBO.

Dr. Weitz:                    Right.

Dr. Siebecker:                      So you could get a false negative. But, anyway … All right. Anyway, then what these two studies showed is that they did nothing other than clear the bacteria. Then they retested one month after the bacteria was gone, the SIBO was negative. And close to 100%, in one study it was 100%, another it was like 80%, of the patients had their leaky gut … They were now healed. What this really shows us, if you remove the cause, if you really did identify and then remove the cause, the body heals, unless you some wound healing issues it should be able to handle it. Do we have to go in there and throw in all these repair elements?  On the other hand, if we get a cut and we put aloe on it, it heals faster. So, okay, I guess it’s just for discussion, right?

Dr. Weitz:                   Right.

Dr. Siebecker:                      But I do think some repair things are nice. And I just want to share one of the ones that I’ve been liking the most recently, because I’ve tried so many things with my patients is actually the serum bovine immunoglobulin.

Dr. Weitz:                  Okay.

Dr. Siebecker:                    I used to use colostrum all the time, and I’m finding that the IGG, that a purified IGG, is more effective. One thing colostrum has that purified IGG doesn’t is it has epithelial growth factors. And, honestly, that’s what I was really after with the colostrum. But I’m more excited right now about IGG than the whole product of colostrum. Just thought I’d share that.

Dr. Weitz:                 Okay, awesome. Unfortunately, I have a patient coming up here.

Dr. Siebecker:           Well, fortunate for them.

Dr. Weitz:                 How can our listeners and viewers get a hold of you, or find out about your programs?

Dr. Siebecker:           Yeah, so just my website is siboinfo.com. I would highly encourage signing up for the newsletter, because that’s where I put all the … It comes up quarterly, and then with event updates. Whenever there’s classes, or conferences, or something. That’s where the newest news comes.

Dr. Weitz:                  Awesome, awesome. Thank you so much, Dr. Siebecker.

Dr. Siebecker:            Thank you, Ben.

Dr. Weitz:                   Okay, talk to you soon.



The Skin Gut Connection with Jennifer Fugo: Rational Wellness Podcast 109

Jennifer Fugo discusses The Skin Gut Connection with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

1:48  Jennifer got interested in the nutrition field when she got sick. She had gut issues for many years and then she developed rashes, brain fog, and fatigue in her early 20s. She was told by doctors that nothing was wrong, so she went to see a nutritionist, who determined that she had food sensitivities to gluten, dairy, eggs, cruciferous vegetables, and cashews. She had come to accept that having chronic diarrhea and horrific smelling gas was normal.  She decided to go into nutrition and when she went for a Masters in Clinical Nutrition at the University of Bridgeport, she developed dyshidrotic eczema on her hands and the skin on her hands was so flared up that her hands would burn even running them through water.  She had to wear disposable gloves on her hands and the dermatologist told her to use steroid cream and vaseline and that she would just have to live with it.  The toolbox for conventional dermatologists is incredible limited.  She had already been gluten-free, dairy-free, and egg-free, so she decided to figure out how to rebalance her skin and cure herself, which she did and then she started the Skinterrupt website and The Healthy Skin Show podcast to spread the information she learned.  Part of it was that she was incredibly stressed at the time.

4:58  Some of the underlying, root causes of skin conditions start in the gut.  Jennifer explained that you have to not only make sure that you have good digestion and absorption of nutrients from food but you also have to balance the microbiome and makes sure that the gut is not inflamed or that you are not absorbing fats, since vitamin A is so important for the skin. You want to remove infections and correct gut dysbiosis.  It is also important to make sure that the hormones, like thyroid, are balanced.  Environmental allergens, food allergies, and food sensitivities are also important triggers, as are drug triggers.  There are increasing number of drugs, like Atenolol, that can trigger skin rashes like psoriasis.  There are even psoriasis drugs that can trigger psoriasis flares. Here’s an article that Jennifer wrote about Medications That Worsen Psoriasis. Other triggers for skin problems can be heavy metal toxicity, liver detoxification challenges, and trauma.  There are also genetic factors that can predispose you to certain skin conditions, esp. those with more of an autoimmune like psoriasis, vitiligo, and scleroderma.  Jennifer says that there are 16 different possible root causes.

9:31  Jennifer does not consider food sensitivities other than gluten to be a root cause. They are more of a symptom of an underlying gut problem such as leaky gut or poor digestion or dysbiosis of the microbiome.  She cautions patient against thinking the only reason they are sick is because of food and to go from one restricted diet to another. Patients can spend years with an increasingly shrinking diet that causes them to become malnourished and feel worse and worse.  Jennifer cautions against using an elimination diet as the number one cause of Functional Medicine. 

12:44  Jennifer explained that she has a number of patients who have skin rashes but no gut symptoms and you do a stool panel and they have infections and dysbiosis. She said that Kiran Krishnan told her about the connections between short chain fatty acids produced in the gut by bacteria, like buyrate, and skin conditions, and sometimes supplemental buyrate can be helpful.  But Jennifer cautions patients against doing this on their own. They should really be working with a Functional Medicine practitioner. 

18:55  Even though Jennifer has written a blog post about how some patients react to nickel in foods, she does not recommend following a nickel-free diet. She did mention that some patients are having histamine type reactions, such as developing hives or having itchiness or waking up at night, they may have trouble breaking down histamine in their gut and they may benefit from taking supplemental Diamine Oxidase, which is the enzyme that helps break down histamine, in addition to the digestive enzyme they are already taking.  Histamine intolerance can also be related to gut infections or it can be due to cortisol elevations.  They may also benefit from a low histamine diet by limiting fermented and pickled food, including vinegar, ketchup, and mustard.  Other patients may benefit from a low salicylate diet, since their diet may have difficulty processing salicylates.  Nutrients like glycine, magnesium, and vitamin B6 can all be very helpful in supporting the liver, as well as glutathione, and these can help the liver to process salicylates.

24:42  Even though coconut oil is very popular today, Jennifer does not recommend using coconut oil on the skin, and she notes that it can even cause skin rashes.  The main reasons for not using coconut oil on your skin are 1. coconut oil is too anti-microbial and it wipes out the good bacteria on the skin and some with skin conditions already are having problems with skin microbiome. 2. coconut oil is too saturated and such long chain fats are difficult to be absorbed, so it just sits on the skin like Saran wrap. 3. It’s too alkaline and your skin’s pH needs to be acidic with a level of 4.5 to 5.5, while coconut oil has a pH of around 8.  Jennifer says that jojoba and olive and avocado and sunflower oil are much healthier for your skin than coconut oil.

30:27 There currently is no accurate way to analyse the microbiome of the skin, the way we can analyse the microbiome of the colon with a stool test, though companies are working on it.  One company has a sensor you wear on your arm. There are a lot of skin care products with probiotics in them. like Mother Dirt. One complicating factor is that the microbiome on your skin varies by location, so the microbiome of the front of your thighs is different than what’s in your armpit.  Jennifer has had good luck with applying some olive oil on her skin where there is a rash and then sprinkling some MegaSpore probiotic and let it sit for a few hours.  She has also had luck with clients who have had good luck with taking a swab from their cheek and dabbing it into the areas where there is an issue and then applying some oil over that.  For Jennifer, when she had her severe skin issue, it took 6 months of this type of protocol just to stop the flares and another six months to get the rashes to stop.  The rashes were gone but she till had dry skin that cracked and messed up nails and it took another 3-6 months for the skin to even out and the nails to come back to close to normal.  So patients need to know that it will take a lot of time to heal difficult skin issues.

34:50  The bacteria on the skin are lipid-loving, which means they consume fat, so they are different from the bacteria in the colon. The microbiome of the skin has been called a lipidome, except for the skin around the mouth, where oil is not a good thing to apply to rashes there.

35:50  Small Intestinal Bacterial Overgrowth is the underlying cause of Irritable Bowel Syndrome in the majority of cases and it is sometimes associated with rosacea and other skin conditions. Dr. Leonard Weinstock wrote a paper describing this SIBO and Rosacea connection:  Rosacea and small intestinal bacterial overgrowth: prevalance and response to rifaximin. While there are more and more topical rosacea products on the market, few dermatologists consider the SIBO connection or attempt to address it. 

42:24  Jennifer explained that producing enough hydrochloric acid is very important for proper digestion and a lot of people who have been chronically ill don’t have enough stomach acid.  Many patients are taking drugs to reduce stomach acid (Proton Pump Inhibitors like Prilosec) to help with their stomach and digestive problems, but they may actually have low stomach acid, not high.  Jennifer she has a simple test for assessing stomach acid levels. You simply mix baking soda and water and drink it and wait to burp in about 10-15 minutes.  If you have sufficient acid you will want to make a big belch, a burp.  If you don’t have enough stomach acid, you won’t belch or you will only have very tiny little burps.  Jennifer Fugo’s Low Stomach Acid Test. Here is the link to the eguide to the low stomach acid test.  If you don’t have sufficient stomach acid, you won’t be able to break down your proteins and you’ll lack vitamin B12.  Jennifer will recommend her clients take a digestive enzyme that also contains some betaine HCL and some ox bile prior to meals.

45:55  Thyroid function is also connected to skin and patients with hypothyoid, will tend to have chronically dry skin.  When there is not enough thyroid hormone, your cells don’t turnover as quickly and there tends to be poor circulation to the skin cells.  You want to measure not just TSH, but also Free T3, Free T4, Reverse T3, and the thyroid antibodies.  If the patient has Hashimoto’s, you want to make sure over time that you see an improvement in antibody load. Jennifer also finds that many of her clients have low vitamin A, which is important for thyroid function.



Jennifer Fugo is a clinical nutritionist with a focus on skin and gut problems. She has a masters in Human Nutrition and is an Amazon best-selling author of The Savvy Gluten-Free Shopper: How to Eat Healthy without Breaking the Bank, and the host of a popular podcast, the Healthy Skin Show.  Her website is Skinterrupt

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Ben Weitz:                   This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please, subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign-up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, that way more people can find out about the Rational Wellness Podcast. For those of you who are only listening on your phone with the audio version, I just want to let you know that there is a video version if you go to the YouTube page, the WeitzChiro YouTube page, there are additional videos that are not on the audio version. You might want to check that out and subscribe.

Today we’re going to talk about how to improve your skin with Jennifer Fugo, and what to do with … about all these skin conditions that so many of us are dealing with. Jennifer Fugo is a clinical nutritionist with a focus on skin and gut problems. She has a Masters in Human Nutrition, and she’s an Amazon best-selling author of The Savvy Gluten-Free Shopper, How to Eat Healthy Without Breaking the Bank. (Don’t go to Whole Foods.) I was just kidding, and the host of The Healthy Skin Show. Jennifer, thank you so much for joining me today.

Jennifer Fugo:                   Well, thank you so much for having me. I really appreciate it.

Dr. Ben Weitz:                   Good. How did you get interested in the nutrition field?  Tell us a little bit about your personal journey.

Jennifer Fugo:                   Well, I got sick. I think that’s one of the commonalities for most people, is you get sick and you end up thinking, “There’s got to be something else out there.” I had gut issues for probably over 15 years since I was a kid, and rashes, brain fog, and really bad fatigue in my early 20’s, and it got to the point where I was told by doctors that nothing was wrong. I found a nutritionist and she’s like, “Hey, I think you have some issues here.” We determined that I had food sensitivities to things like gluten, dairy, eggs, the cruciferous family, the cashew family, and I had no idea what a food sensitivity was, what that meant. I had no clue, I just thought that having chronic diarrhea, and horrific smelling gas was normal.  I got into nutrition that way because I came to realize that there was this whole other side of nutrition, and helping people improve the quality of their daily life by changing food and whatnot, but eventually I came to realize that there’s only so much you could do with food. There are some things that go above and beyond what we can oftentimes do in the kitchen.  It’s not to put that down, food is certainly medicine, but there’s a lot of other things that I found to be helpful because of clients that I was dealing with who were chronically ill, and had autoimmune disease and whatnot.

I went back for a Masters in Clinical Nutrition at the University of Bridgeport, I finished that up a couple of years ago, and actually this sort of leads into my story of how I ended up interested in skin issues. My final year in my Masters Program I developed dyshidrotic eczema on my hands, and it got to the point where it was so flared that I was wearing blue gloves that I would buy–these disposable gloves that I could get at Home Depot–just to protect my hands because I couldn’t even run them under water. It burned so badly. I tried topical steroids. I went to the dermatologist, and they’re just like, “I don’t know, just use a steroid cream and put some Vaseline on top to keep the moisture in, and you just have to learn to live with it.”

Dr. Ben Weitz:                   I remember Woody Allen’s sketch where he said dermatologists are dealing with 5,000 different skin conditions, and they only have four creams.

Jennifer Fugo:                   That’s a good way to put it, and that’s kind of what it feels like. Their toolbox is incredibly limited. I said, “Look, I’m gluten-free, dairy-free, egg-free,” like I had been that for years, eating a more, not restrictive, I didn’t consider it restrictive, but I had had these restrictions in my diet. It wasn’t like I had to then take them out, I was already like that and I developed this condition, and a lot of it had to do with the amount, the sheer amount of stress that I was under at the time.  Anyway, the point where I hit rock bottom, my husband had said to me, “Well, what would you do if somebody came to you and said, could you help me with this?” I was like, “I don’t know. I never thought of it.” I started doing research and came to discover that there really weren’t good resources out there. A lot of the information was super generalized or it didn’t really work after I tried it.  I just started playing around, I thought, “Well, I’m my own best experiment, if I screw up I only have myself to blame.” Eventually I did actually figure out how to correct and rebalance my skin issues so that I no longer have eczema at all. I haven’t had it in probably well over a year and a half. I started the website Skinterrupt, and The Healthy Skin Show Podcast in order to share the information that I just … people aren’t telling the patients who are stuck in these chronic skin rash conditions, and all the other options out there aside from those four creams, and maybe some biologics, and immunosuppressants and such.

Dr. Ben Weitz:                   What do you think are some of the underlying root causes of skin rashes? What are some of the most common triggers?

Jennifer Fugo:                   Well, the first thing I will tell you is absolutely gut issues. I’m sure for anybody listening to this who is a practitioner is like, in the functional, integrative realm you’re like, “Duh, sure. Yeah, of course, Jen, you’re not sharing anything that isn’t obvious.” But here is the thing, what a lot of people discount is that you have to balance your digestion and absorption with what’s going on with the microbiome, both are equally important, and you can’t just do digestive enzymes and be like, “Oh, that will take care of the problem.” You have to look and make sure that the person has enough stomach acid, that they have a gall bladder.  Is there too much inflammation for example, where the … there is such a thing where we see that when somebody’s gut is very inflamed their body has a hard time absorbing fats.  We know that the cellular membrane is made up of lipids, and if you’re not able to absorb lipids, especially Vitamin A is vital for the skin, the thyroid, your eyes, your eyesight, you have a real problem.  Again, you got to balance that with what’s going on with the microbiome. We can certainly talk about that in a little while, because dysbiosis and infections are both two problems, as well as the amount of acidity in the colon, which I’m sure we can talk about too.

I’d also say hormones, thyroid is really important. You can have genetic factors that can predispose you to having certain skin conditions, specifically those with more of an autoimmune like psoriasis, vitiligo, scleroderma, however with eczema it’s a little trickier, there’s a lot more factors involved in it unfortunately than some of the other conditions. Because sometimes we can have things where you’ve got more histamine-dominant, you’re looking at environmental allergens, environmental triggers, food allergies, food sensitivities, but I consider those a symptom. Your thyroid has to be balanced, I will say that.  The other piece to this is drug triggers. You have to also do a really good … You have to actually ask people what drugs they’ve taken in the past, because believe it or not the research that I’ve done shows that there are increasingly number or increasing number of drugs that are prescribed by doctors, like Atenolol for example, that can trigger skin rashes. Atenolol for example can actually trigger psoriasis. There’s also-

Dr. Ben Weitz:                   Interesting.

Jennifer Fugo:                   Psoriasis drugs that can trigger psoriasis flares, which doesn’t make any sense whatsoever. Those are some of the key pieces that you could be looking at heavy metal toxicity, liver detoxification challenges, trauma, and trauma as in maybe you experience something like your father passed suddenly when you were a child or you’re in a horrific car accident or like I lived in New York City when 9/11 happened, that was a terrible thing, or it could be small traumas, like you go to work everyday and your boss is incredibly abusive. There’s a whole litany, I consider it to be about 16 different root causes, but those are probably the most common that I see.

Dr. Ben Weitz:                   Which psoriasis drugs trigger psoriasis flares?

Jennifer Fugo:                   I have to look that up for you. I got an article for you on that.

Dr. Ben Weitz:                   I am sorry, I didn’t mean to put you on the spot.

Jennifer Fugo:                   No, that’s okay. It’s a good question. I don’t know offhand, I just don’t remember offhand, but I’m-

Dr. Ben Weitz:                   That’s okay.

Jennifer Fugo:                   We can certainly share that if you want to share that in your Shownotes. I could send you that link.

Dr. Ben Weitz:                   Yes, sounds good. You can e-mail me that.

Jennifer Fugo:                   Absolutely.

Dr. Ben Weitz:                   What’s your take on food sensitivities triggering skin rashes?

Jennifer Fugo:                   Food sensitivity, I don’t consider to be a root cause as I was saying, I consider them to be a symptom, and this is an important distinction that I think has gotten very muddied in functional medicine. We fixate so much on taking foods out, and the first … You should remember, when people have chronic skin problems they come out of the dermatologist, the first thing they do is go, “The dermatologist hasn’t told me everything, maybe it’s something in my diet.” They start reading online, and they see all these information, there is something called the eczema diet, there is also something called the psoriasis diet. They will begin seeing as they join Facebook Groups the people who’ve taken out increasing number of foods, and what happens is they end up on a smaller and smaller diet. They oftentimes don’t feel better, and a lot of times people who do things like the eggs in the diet or the psoriasis diet sometimes will get better, but then cannot add those foods back in without triggering flares, and it becomes an incredibly frustrating state.

My thing is like, “Hey, you know, food doesn’t cause leakiness throughout the gut.” It really doesn’t. Gluten is the only protein that has been clinically proven through studies to have that capacity, so we can’t blame all foods. You can’t blame eggs. You can’t blame dairy. You can’t blame all these other food groups that we keep telling people, “Oh, you should avoid them because they’re bad for you.” I’m not saying that everyone should eat all of these things or that they’re going to work for everybody, but the thing is they’re not the reason that the gut ultimately became leaky to the point where it can no longer find it’s sense of tolerance again. It’s lost that tolerance for those gut junctions to be closely sealed.

The thing from having done so many interviews and talked to so many microbiome experts, it’s really a state of, A. Are we digesting our food? Are we absorbing it? Because that impacts the microbiome. What then is the state of the microbiome? Do we have infections present? Do we have, say too much e-coli? Even though it’s an opportunistic bacteria and should be there or candida, which it’s an opportunistic yeast, and it should be there to some degree in the gut, but is it in too much of a quantity? That’s where usually, I mean stress certainly plays a role, NSAIDs can play a role, but we’re so fixated on food we don’t realize that as practitioners what we do is we make people afraid of food. They get to a point where they are thinking that the entire reason they’re sick is just because of food, and they spend years with increasingly shrinking diet that causes them to become malnourished and feel worse, and worse, and worse.  That’s why I think food sensitivities are important to identify, but we can’t rely on an elimination diet to be the number one tool of Functional Medicine. That really confuses me because all the clients that I see who have chronic skin conditions have done all of these like sugar-free, dairy-free, egg-free, salicylate-free, nightshade-free, and they’re not any better.

Dr. Ben Weitz:                   Well, I think where it comes from is so many … like yourself, who is maybe seeing the really advanced cases, once the patients go down this chronic gut road, and they’ve layered one diet on top of the next, the FODMAP diet, and the no-histamine diet, and the no-this diet, and there’s nothing left to eat, and then they’re afraid to eat anything. For those patients it’s definitely not a good idea to start talking about eliminating any foods. Then you do have some of these patients who don’t really have any gut problems, and they’re coming to you for something else, and then they get a skin rash and you take out one or two common foods. You take out gluten and it’s gone, and they eat it again, and it comes back. We know there’s some relationship, but-

Jennifer Fugo:                   Absolutely. I’m not saying there is none, and actually the one thing that I do ask people regardless of what their gut circumstance is, I do ask them to take gluten out because of that increased leakiness. However, I will share this, and I don’t know how many people listening to your podcast are practitioners, but pretty much every single chronic skin client, they’ve got eczema, psoriasis, whatever, those who have no gut symptoms, like literally I’m asking and I’m digging, no gut symptoms. Completely fine, they poop like a champ, one to three times a day, no straining, no diarrhea, no gas, no bloating, whatever. When we do a stool panel they either have dysbiosis or they have infections.  You can’t say that just because they don’t have any gut symptoms that there’s no problem with the microbiome. One of the reasons why that a lot of people don’t know about, this blew my mind, I learned about this last summer from Kiran Krishnan, was that butyrate.

Dr. Ben Weitz:                   I’ve had him on the podcast before, he’s really good.

Jennifer Fugo:                   He’s a genius. Man, I love talking to Kiran. I always learn like 20 million things every single time. The one thing that he had shared with me was about a bunch of studies that had been done looking at the different … the importance of short-chain fatty acids in the gut, and how that communicates with the skin. I was like, “What? What are we talking about here?” I go and look it up, and lo and behold there were some really incredible research of linking the acidity essentially of the colon to establishing this healthy microbiome balance, because dysbiosis of the skin is one significant problem or challenge that a lot of people with skin rashes have, and butyrate specifically … for those of you who are like, “Butyrate?” Well, it’s a small, short-chain fatty acid that these bacteria, the healthy gut bugs produce when they munch up your fiber basically.  Butyrate is really important to help maintain that healthy microbiome balance on the skin. If you do, say like a GI effects, and you discover that they have low butyrate, that’s a problem if that person we already know has dysbiosis of the skin because they’re missing this important link between the two.

Dr. Ben Weitz:                   Right. It brings up the issue of fiber, which is such an important issue, and we have patients with chronic gut problems who get flared with fiber, but yet fiber is a prebiotic, and can help the growth of those bacteria in their colon. It can be beneficial and not beneficial, and sometimes it depends on the type of fiber.

Jennifer Fugo:                   There’s also too, now there are butyrate supplements that you can try.  I’m actually testing them out in some clients, and I can’t speak about it extensively and say, “This works,” but in the clients that I’ve tested this out with, who have issues with dysbiosis of the skin, using supplemental butyrate has actually really helped them.  I would just say if you’re not working with a practitioner I wouldn’t recommend you doing this by yourself, but if you’re working with a practitioner or you are a practitioner it might be something to look into.

Dr. Ben Weitz:                   In some conversations with some other practitioners a lot of people seem to like this one product that has a combination of butyrate, acetate, and propionate, which are three of the short-chain fatty acids.





I’ve really been enjoying this discussion, but now I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic, research-based dietary supplements. Pure products are meticulously formulated using pure, scientifically-tested, and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners, and preservatives.

Among other things, one of the great things about Pure Encapsulations, it’s not just a quality product, but the fact that they often provide a range of different dosages and sizes which makes it easy to find the right product for the right patient, especially since we do a lot of testing, and we figure out exactly what the patients need. For example with DHEA they offer 5mg, 10mg, and 25mg dosages in both 60 and 180 capsules per bottle size, which is extremely convenient. Now back to our discussion.




Dr. Ben Weitz:                  In one of your blog articles I noticed you mentioned foods that are high in nickel, which I have never heard before. I find that kind of interesting. I’ve had several patients where we ran like the NutraEval, and they’re high in nickel, and it’s like, “Where did I get nickel? I don’t know.”

Fugo:                                 Yeah, there’s foods, and actually a lot of them unfortunately are gluten-free foods.

Dr. Ben Weitz:                   Which foods are high in nickel?

Jennifer Fugo:                   Well, I’m going to tell you this much, I actually don’t recommend the nickel-free diet. One of the reasons why is in having done my research, and actually talked with a bunch of dermatologists, Dr. Peter Leo for example, he’s been on my podcast, he …

Dr. Ben Weitz:                   Wait a minute, would eating nickel foods help to prevent breaking the bank?

Jennifer Fugo:                   Basically the problem is that there’s such little nickel in food that for those who actually have a sensitivity to it sometimes this becomes too much of a challenge, and not actually worth it. While it may be something where people say, “Hey, if you have a really extreme nickel allergy,” I mean you’ve got to get tested by somebody. I think it’s more than just like, “Oh, I wear a piece of cheap jewelry, and my skin reacts to it,” but in his clinical experience, because I was one … I was kind of on the fence about whether it was even worthy to suggest it, because that’s a problem I recommend people go gluten-free, but a lot of the gluten-free grains, a lot of gluten-free foods have some level of nickel in them. He just said that in his clinical practice, and he is up at Northwestern University I believe, that they found it to be of almost no benefit to have people fixate on removing nickel foods, that they found other things to be more important in helping them.  There is a lot of other diets that can be, I think helpful to some degree, but I think one thing that people oftentimes confuse is if you have an issue with histamine for example, like you’ve got a lot of itchiness, and you’re waking up at night or you become incredibly itchy at night or you’re developing hives, that can be caused sometimes by infections, gut infections. It can also be issues due to cortisol elevations. We also see sometimes that people have difficulty breaking histamine down in the gut, and they may require a DAO supplement in addition to any digestive aid that they’re taking, that can sometimes help.

Dr. Ben Weitz:                   That’s diamine oxidate.

Jennifer Fugo:                   Correct. Also, too, limiting their diet in fermented foods and cured foods, and pickled foods as well, and all types of like … and that includes vinegar. A lot of people don’t realize that, they go, “Oh, well, I don’t really eat a lot of fermented foods.” I’m like, “Do you eat ketchup? Do you eat mustard?” They’re like, “Oh.” That can be something that can sometimes be helpful. Some people will also focus on low salicylate foods, but here is the thing with that, you don’t have a sensitivity to salicylate foods, your liver has difficulty processing salicylates, which is basically a chemical, a naturally-occurring chemical that exists in certain foods to help preserve them. It’s Mother Nature’s brilliance at work, but it’s just your body for whatever reason has difficulty, and using something else-

Dr. Ben Weitz:                   By the way it’s the active ingredient in aspirin.

Jennifer Fugo:                   Yes, exactly. Well, that’s what got me thinking, I’m like, “Why does everybody think they’re sensitive?” Because it doesn’t make any sense, salicylates are processed in the liver, it’s not a gut problem but we position them as if it is a food problem in it of itself, and it’s not. Things like glycine, B6, magnesium can all be very helpful in supporting your liver, as well as glutathione in making sure that your liver has enough of it’s, I like to call them ingredients that they requite in order to do their jobs. But specifically glycine and B6 are necessary because that’s the pathway, the glycine pathway is where salicylates are processed.

Dr. Ben Weitz:                   Great, interesting. In one of your articles you talked about the difference between food allergies, food sensitivities, and food intolerances, and I think there’s a lot of confusion about that. Can you help clarify that?

Jennifer Fugo:                   Food allergies are typically described as an IGE response, you could think of the E as emergency, like throat swelling closed, eyes are closing, if it’s really bad you could die, whereas a food sensitivity is an IGG reaction, it’s a different type of immune cascade that’s happening, typically not life-threatening, and it could be delayed as well, you might not experience something for a number of days. Another reason why I’m not the biggest fan of relying on extensive food sensitivity testing is sometimes they’re kind of transient, and they can change with time depending on what you’re eating and exposed to, whereas food intolerances are an entirely different piece, it just means that you don’t have an enzyme in your system that’s capable of breaking down that particular thing like histamines. Histamine-intolerance is a thing, where’s you’re not … there’s no histamine sensitivity, you’re missing that DAO enzyme in the gut that’s necessary to break histamines down, and so it’s an intolerance, like lactose-intolerance you’re missing lactase, the enzyme.  They’re very different, and people like to interchange those terms and it’s very incorrect, and it’s also confusing to me as a practitioner. I have to question when people say, “Oh, I have this allergy to this,” I’m like, “Okay, could you describe that? Did you go to an allergist? Do you have an allergy panel?” “Oh, no, no, I had a food sensitivity test.” I’m like, “Okay, that’s not an allergy, it’s a different response.” I think we have to, as practitioners have to get a little clearer with people. I know that it’s easy because that’s what they’ve read about, but it also is our job to make sure that they understand what’s actually happening to them, not just making it super easy so we can breeze through the appointment.

Dr. Ben Weitz:                   In one of your articles you talked about the fact that a lot of people see coconut oil as a super healthy oil, really good for us, and people use it in cooking, and people put it on their skin, but that’s probably not the best idea, right?

Jennifer Fugo:                   No, as far as skin rash conditions are concerned. Initially when I wrote the article I was very much just focused on people with skin rashes, but I’ve noticed recently that we’ve had more and more people who were using it, and then developed skin rashes as a result of using coconut oil. This may be a heads up to those of you who don’t have issues, and are using coconut oil as your lotion, but there’s three reasons why, well four, but the fourth reason is basically there are way better options out there than coconut oil to be using as part of your moisturizing regimen, but basically coconut oil is way too anti-microbial. For those who have skin rashes, you’re basically wiping out everything that’s on the skin, and if you’re already struggling, and you’ve got this tug of war going on, on the skin and say you don’t have enough butyrate in your gut to help establish that, you’ve got gut infections, you’re wiping out everything, and then the bad guys rush back faster. It’s not a good situation in that front.

Number two, it’s also too saturated. I’m not going to get into the debate about how coconut oil is really good for us, we need these medium chain triglycerides, blah-blah-blah, our digestive system is much different than our skin, they’re not the same thing. I know it’s a part of the body, but for your skin to properly absorb those lipids they have to be smaller. A lot of times people will notice that coconut oil feels like it’s just laying on your skin, it’s not being absorbed, and that’s the reason why, it is not being absorbed, the molecules are too large. For some people that it feels almost like the skin is being covered in Saran wrap, and at times almost feels like the heat from the body is being trapped as a result of that. That’s not good.

Last but not least, it’s too alkaline. Your skin environment actually needs to be on the more acidic side. I know everybody loves alkalizing everything, that’s like a big thing in nutrition, but the problem is that your skin’s ph to be healthy needs to be around 4.5 to like 5.5 on the ph scale, that’s acidic. Unfortunately coconut oil is around 8, it’s much more alkaline than your skin is, and as you apply that to what should be a more acidic environment you’re causing the ph to go up, and what happens is the ph is really important. You might think like, “What does it matter?” But the ph helps, it’s basically one of the chemical waste that your body prevents microbes that shouldn’t be there or shouldn’t be there in the quantity that they end up being there. It’s a control mechanism, and when you start manipulating the ph from what it should be you’re inviting in problems.

Those are three reasons why, the fourth is just basically like if you want something that’s closest to your natural sebum it would be jojoba, but olive oil is a great choice, even sunflower oil. Believe it or not there’s some great research for eczema that sunflower oil … not the cooking stuff, the stuff that’s meant for your body. Avocado, I’ve heard great things about, and especially testimonials from people who have given that a shot. Olive oil, avocado, jojoba, even sesame oil can be a good option, it just has a pretty strong odor that some people find a bit of a turnoff.

Dr. Ben Weitz:                   Right, interesting. This alkaline thing, it’s very common in the Functional Medicine world to eat a alkaline diet, there’s alkaline water, and people say a high alkaline diet as being better for hormonal balance, for cancer prevention, for all these different things.  But I think number one, people forget about the fact that our body needs, it prefers an acidic environment, especially in the stomach, especially in the large intestine colon, where I think everybody assumes that your intestinal tract is supposed to be more alkaline, but don’t forget about those acid-loving acidophilus, acid-loving bacteria that need a somewhat acidic environment in the colon.  I think there’s a lot of hype associated with these alkaline diets. I’m not so sure that they’re beneficial for the reasons people think they are, number one. It’s my take that probably the fact that they’re eating more green vegetables, and maybe cutting back on their grains, they’re getting some benefit from it, but probably not because of the alkalinity.

Jennifer Fugo:                   I totally agree with you, and plus, you don’t want an alkalized stomach, you can’t digest anything, your stomach has to be very, very acidic in order to appropriately break proteins down for example. It’s complete, I mean it flies in the face of human physiology that every part of your body needs to be alkalized, that’s ridiculous and that’s not based on science.

Dr. Ben Weitz:                   By the way I think you’re pissing in the wind if you think that drinking some alkaline water is going to suddenly turn the environment in your stomach into this alkaline state anyway.

Jennifer Fugo:                   No.

Dr. Ben Weitz:                   You were talking about the microbiome of the skin, it’s interesting, is there any way that you assess the microbiome of the skin?

Jennifer Fugo:                   I wish. I really wish there was one test.

Dr. Ben Weitz:                   Right, that you could just take a skin.

Jennifer Fugo:                   I know.

Dr. Ben Weitz:                   Test, and send it in like you get a stool sample, that would be cool.

Jennifer Fugo:                   There’s this one test that I found that they did that, but I don’t think it’s actually being utilized anymore. I know that a lot of companies, big companies, pharmaceutical and skin care companies are really driving in full steam ahead into the more probiotic microbiome realms. We are going to see more and more products coming out that actually have … that have the microbiome in mind. There is actually a sensor I believe, that I can’t remember whether it’s L’oreal or who is making the sensor that you would wear on your arm, I think it’s a patch, and it will tell you what the ph of your skin is. There’s a lot of creams now that have probiotics infused into them, how well they work is questionable.  A lot of people also want to believe, and this is the other piece, I mean I love products like Mother Dirt. It’s nice because it’s helping to replace some of the microbiome, the good bugs that help establish that healthy balance, but the thing is if you’ve got really bad rashes it’s probably not just one thing, like one cream. You’re not one cream away from being fixed. I think unfortunately that’s the mentality, and it’s not, and here is the other piece, the microbiome on your skin actually varies upon location. What’s going on the front of your thighs is very different from what’s going on in the armpit.  There’s different regions, and it varies, but some things that are interesting is that you can apply probiotics topically. I’ve had really good luck with MegaSpore for example, and you apply your olive oil, not coconut oil, to that area, and then sprinkle lightly some MegaSpore on and let it sit for a couple of hours. I wouldn’t do this during the day when you’re at work, probably wait until you get home, and that can help rebalance the skin microbiome. I’ve also had some great luck with people just saying that they’ve taken like a swab from say their cheek or some place that has no rash whatsoever, and then dabbing it into the areas where there is an issue, and again applying the oil and whatnot, and they’ve had some luck with that.  Those are two things that can be helpful, but again if you’ve got a lot of stuff internally that’s out of balance that might help some, but again you’re not one step away from getting your skin rashes figured out if you’ve had them for a long time unfortunately. I wish it was simple, and this is the thing with the gut world, and the chronic health world we’re like, “Oh, if you just take this one supplement, if you just do this protein powder, if you just do this you’re going to be better. You’re going to have all these energy.” Like we’re super hype-y about it, but with skin it’s so complicated because the skin is the lowest on the totem pole, and nobody tells you that.

For me, the thing I didn’t actually tell you in the beginning, it took six months of consistently taking action on the protocol that I built for myself in order to stop just the flares. I still had rashes. I still had cracked, dry skin. My nails were all messed up, and it took another six months to finally get the rashes to stop. I still had dry skin that cracked. I still had messed up nails, it took another almost three to six months to finally see then that the skin evened out, and the nails were pretty close to being back to normal. It takes time because the rest of the body needs attention before the skin unfortunately. I think when we don’t appropriately provide people that expectation of what’s ahead it is a long journey, especially if you decide to go the natural route it’s a scenic route. Think of it as taking a scenic route, it’s going to take a while and you have to be mentally prepared for that journey. You’re not going to get better in a month, if you do I’m happy for you, but that’s not most people’s experience.

Dr. Ben Weitz:                   Do we know about which organisms are present on the skin compared … are they similar to the bacteria that are present in the colon?

Jennifer Fugo:                   There is a little bit of a similarity, but the bacteria on the skin are actually lipid-loving, which is different from what goes on in the colon. They call the microbiome on the skin a lipidome, and they actually consume fat. For most skin conditions they do … You’re okay, you’re good with using oils, the only one that I know of, and I mean I’m not necessarily an expert in every single chronic skin condition, but if you do have peri-oral dermatitis where it affects right around the mouth, oil is usually not a good thing to apply to your rashes. I don’t know why, it’s one of the most frustrating, difficult conditions to work with unfortunately.

Dr. Ben Weitz:                   Good. I just came back from this Integrative SIBO Conference in Seattle this past weekend, and a condition I often see in my practice is small intestinal bacterial overgrowth, which is the underlying cause of irritable bowel syndrome in quite a number of cases. Can you talk about how this can be related to skin conditions?

Jennifer Fugo:                   Absolutely. One of the really interesting things that I’ve been reading up on, I mean, A. It’s gut, right there you know that if we’ve got SIBO for example that’s a problem. However, there’s a really interesting connection to rosacea that a lot of people don’t realize. What’s fascinating to me is it was an incredible study done back in 2013 by Dr. Weinstock, who discussed and looked into this because he is a GI doctor. He started to notice this interesting correlation between both ocular and skin rosacea, and what was going on with the use of Rifaximin in treating the SIBO, and that once they did that treatment a lot of times rosacea would clear up.  It’s staggering to me to think after all this time they’re coming out with more and more rosacea products, more and more, and yet why is this research that’s been out there for a while, I mean it’s six years, why isn’t that something that’s used in clinical practice. I can’t even tell you how many times I’ve said, “Go back to your dermatologist. Talk to your dermatologist about doing these tests.” The dermatologist don’t want to do any tests. They say that’s not their responsibility, that you have to go see a primary care doctor, and I’m like, “You know you’re a doctor too, you’re allowed to run labs.” I’m confused. They don’t see any-

Dr. Ben Weitz:                   I can tell you it doesn’t fit into the model.

Jennifer Fugo:                   No.

Dr. Ben Weitz:                   It’s basically since everything’s dictated by the insurance companies the conventional docs are limited to short office visits, if they’re going to go out and start testing your gut, and these tests are really complicated to understand and to interpret. Then you have to put people on complicated protocols, and then it takes a period of time, and they have to watch your diet, and it just does not fit into the model.

Jennifer Fugo:                   No, not at all. It’s really sad. Even my father who is an ophthalmologist, he’s in his 70’s, he was just like … I was like, “Dad, did you see this? Have you heard of this, like ocular rosacea SIBO?” He’s like, “What’s SIBO?” I explained it to him and he was like, “Can you send me that? That sounds fascinating.” Because apparently ocular rosacea tends, if you do have rosacea, and you end up with ocular rosacea usually the ocular form will show up first before it results in the skin, at least that’s my understanding.  I just think it’s a shame that we’re not … We talk about all the research being done, but I think people, they are only looking at certain areas, and we don’t realize that medicine is evolving, but the way that it’s being handled and done is really only evolving at the pace of drug companies. Because now on the TV you see all these ads for Dupixent biologic drug for eczema, and that’s considered, I read an article, it’s considered to be one of their next blockbuster drugs because of how much money it’s going to make them, and all it does is suppress the inflammatory, one of the inflammatory pathways, and that’s it.

Dr. Ben Weitz:                   This unfortunately is the story of why so many of the drugs that have come out for a lot of chronic conditions, just look at the Alzheimer’s Research, they’re trying to find the one pathway, and the drug that blocks that one pathway, and that’s the end of the story. Unfortunately there’s many pathways, you have to look at a number of things and address a number of days if you’re really going to get success, but that’s just not part of the model.

Jennifer Fugo:                   No.

Dr. Ben Weitz:                   That’s what’s going on with the skin too, they want to find this one inflammatory pathway, how do we block that one pathway with this one particular product that blocks it, and that’s what fits into their model.

Jennifer Fugo:                   Well, and I’ll say this much to anybody who is listening who’s like, “Wait, I’m on one of those drugs or I’m considering one of those,” I’m non-dogmatic. Listen, you have to make the decision within your values, and what’s going on in your life, and where you are with things about what your choices are, because it’s your choice in the end, but I personally think that you as a patient, you as a steward and caretaker of the one body that you have in this life, you should do your research. You should decide if that 2% or 1% risk is worth it for you, because there are risks of cancer. There are very serious complications that can occur, and you can have bad reactions to those drugs. I had worked with people who have had bad reactions to them, and so you shouldn’t assume it will never be you, but at the end of the day I don’t think you should throw the baby out with the bathwater and say that all pharmaceutical drugs are necessarily bad.

There’s a time and a place for everything, but I think you as the patient, again that steward type position, you have to do your research and be comfortable with the decision that you’re making. Go in with your eyes wide open, and know what the potential issues and hiccups could be, and especially too the thing that’s nice is if you combine complimentary and the conventional together … I still used steroids when I was going through my journey. I had to use topical steroids.  I had to keep the … I couldn’t even touch a stinking knob on the door.  I couldn’t open a door.  I had to do what I had to do to get through daily life, but in the meantime I was working on all the other stuff under the surface.  You can find a way forward that meets your needs and values, and I just want to encourage people to know that it’s okay, and you should never feel bad or ashamed for whatever your decision, but just own it, and make it with eyes wide open.

Dr. Ben Weitz:                   I want to clarify, I’m not trying to bash pharmaceutical companies for trying to help people with medications, and I don’t want to tell people to stop taking their medications, especially if they’ve been helping them.  But they need to understand that there’s underlying reasons for this conditions, and simply blocking the immune response long-term is not going to be the best answer.

Jennifer Fugo:                   Absolutely. I mean that’s what I said, go to the simple things, look at … The first thing to do no matter where you are in your journey, I would say the first thing I ask people to do honestly is to check their stomach acid level. Because if you’re not able to properly digest your proteins, number one, for example B12, which is a really important nutrient is actually connected in foods to proteins.  If you don’t have enough stomach acid you’re never going to break that apart, number one.  Number two, if the proteins aren’t broken down into their smallest little building blocks, I like to think of it as like Legos, they’re not going to be able to be absorbed.  As they head further down stream they feed the gut bugs, which is not necessarily a good thing, and then you’ve got some very expensive poop on your hands, which nobody wants because you want to absorb that expensive food, you don’t want to be pooping that out. You don’t want to be feeding bad gut bugs either.  I typically recommended people check the level of stomach acid that they have because we want an acidic stomach acid environment, we want to make sure we’re producing enough stomach acid. It’s a really simple and easy test, to be able to do that you’re basically just combining some water and baking soda. I don’t know if you are open to sharing the resource that I have, it’s just a really simple direction of how to actually do that test at home. It doesn’t cost anything, and it will get you-

Dr. Ben Weitz:                   Is this the test where you start taking hydrochloric acid tablets?

Jennifer Fugo:                   No, no, you actually just mix baking soda and water.

Dr. Ben Weitz:                   Then what?

Jennifer Fugo:                   You wait to burp, about 10 or 15 minutes, it’s really simple. The thing that’s nice is that the hydrochloric acid, that test makes me uncomfortable because-

Dr. Ben Weitz:                   The hydrochloric acid challenge test…

Jennifer Fugo:                   Yeah, it just makes me uncomfortable. I’ve had really good luck correlating this with actually doing like a GI effects, and also taking a look at the products of protein breakdown and whatnot. You can really see that there is some great correlation even if you don’t have GERD or any heartburn issues. A lot of times people who have been chronically ill don’t have enough stomach acid, and just that alone can really start to alleviate some of the issues immediately, because you’re feeding the gut bugs that you don’t want to be feeding. That’s not a good situation right there. We start to right the shift, and obviously if you don’t … if you discover, basically you want to burp. You want like a big, big belch, like when you’re a kid and you drink a lot of soda, and if you’re not belching or you have the little tiny, little burps, that basically means that you don’t have enough stomach acid present.  Then the next thing to consider is do you have a gall bladder? If you don’t, you really need to supplement ox bile for the rest of your life, and that’s before every single meal. Then consider, I like to do usually a full spectrum digestive aid, it will typically be between HDL, ox bile, and digestive enzymes. That way we’re making sure that all pieces are supported, because if you’re really not well it’s just, “Let’s try and do our best to help your body, let’s make it easy,” but again it’s just a really simple, easy, free thing to do, and get some answers quickly.

Dr. Ben Weitz:                   That’s great. What’s your resource for patients to go to your website and find out about the acid, stomach acid test?

Jennifer Fugo:                   I will be honest with you the link is a little tricky. I can certainly give it to you, and make sure that you have it, if you will put it-

Dr. Ben Weitz:                   Well, you know what, we’ll just put it in the Shownotes.

Jennifer Fugo:                   That will make it super easy for people because the link is … I don’t think anyone would get it from me. They’d be like, “What?”

Dr. Ben Weitz:                   There’s so many things we can talk about, I like to hit on one more thing.

Jennifer Fugo:                   Sure.

Dr. Ben Weitz:                   I know you’ve talked about thyroid and the connection with skin, can we talk about that for a few minutes?

Jennifer Fugo:                   Absolutely.

Dr. Ben Weitz:                   Give me everything you know in the next three minutes.

Jennifer Fugo:                   I would say this, you should make sure that your thyroid is optimized, the function is optimized, because we know for sure that in people who have hypothyroidism and Hashimoto’s, a lot of times some people don’t realize that they’re … Hashimoto is a low thyroid state, and that chronic dry skin is one of the symptoms, and one of the reasons why is that thyroid hormone helps tell your cells what to do, how fast to go. It’s part of your whole system of homeostasis, and so when you don’t have enough appropriate thyroid hormone the cells don’t turnover as quickly. It also, from what I understand in talking to a lot of thyroid experts it causes there to be a poor circulation out to the cells of the skin, and we’re seeing less removal of waste as a result, and as an end you’re seeing less nutrients getting out to those cells.  Optimizing your thyroid and making sure that you’re seeing optimal levels of T3, T4, TSH, that the reverse T3 level is in balance with T3, and I’ll just say this too, always make sure that your T3, T4 are that you’re looking at the free values. That is important, and that you’re also making sure that there are no antibodies or that you’re slowly with time, seeing an improvement in antibody load if you do have Hashimoto’s for example, but that’s a really important part to the piece. Again, Vitamin A, I can tell that pretty much everybody that I talk to and I work with has low Vitamin A, and low Vitamin A is really important to improve because your thyroid needs it, your skin needs it, your eyes need it. I think there’s just some very basic things that we should look at, that way we can just make sure to support the body as a whole.

Dr. Ben Weitz:                   That’s great. Thank you so much for providing us with a lot of interesting information about the skin, and what we could do to improve our skin. How can listeners find out about you, and the things that you have to offer?

Jennifer Fugo:                   You can visit me over at skinterrupt.com. This is basically the words skin and interrupt slammed together, and then basically also if you love-

Dr. Ben Weitz:                   Can you spell that? Can you spell that out?

Jennifer Fugo:                   Yes. S-K-I-N-T-E-R-R-P … U-P-T, there we go. I know it’s a little tricky, that’s what I say, it’s skin and interrupt slammed together. If you certainly search my name it will come up with very easily. You can also check out the healthy … just healthyskinshow.com, and that will bring you to my podcast, which we’re on most of the podcasting platforms. It’s a twice a week podcast where we’re delving into all the different areas of chronic skin conditions. I also have inspirational stories, looking at research, we even answer listener questions. It’s a great resource for people. Those are really the two spots you can find me, and I’m on Instagram, I do a lot of stuff on Instagram too.

Dr. Ben Weitz:                   Wow, twice a week podcast.

Jennifer Fugo:                   Yes.

Dr. Ben Weitz:                   I know how hard a once a week podcast is, that’s great to be able to do that. Okay, thank you, Jennifer.

Jennifer Fugo:                   Thank you for having me, I really appreciate it.



Fertility and Sexual Intimacy with Denise Wiesner, LAc: Rational Wellness Podcast 108

Denise Wiesner, LAc discusses Fertility and Sexual Intimacy with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

2:14  Denise Wiesner’s practice has a focus on women’s health and fertility.  She found that a lot of couples that are having trouble conceiving having problems with their sexuality and intimacy and their doctors were not offering any help with those problems.  In fact, their doctors do not get a lot of training in sexuality and did not really feel comfortable even talking about such issues.  This is why Denise felt the need to write this book.

5:43  Denise discusses some Chinese medicine and Taoist concepts (Taoist tradition is the precursor to Chinese medicine) in her book and she pointed out that the Taoists had this really equal relationship between yin and yang, male and female, and they would actually prescribe certain sexual positions to help patients cure certain problems.  Denise also has chapters in her book on orgasm and foreplay and stress in her book.

7:37  Denise includes a discussion of the Chinese five elements of wood, water, earth, metal, and fire.  In Taoist tradition, the earth is the center and this is about digestion and if you don’t feel good, it gets in the way of intimacy for men and women. This also includes the microbiome in your gut, your mouth, your skin, on the penis, and in the vagina. If a woman is trying to get pregnant, its not good if she has yeast and other infections in her vagina, so we want to have that balanced.

9:21  The vaginal microbiome is really important and we’re just starting to understand it. The vaginal pH is supposed to be acidic and it starts becoming a little more alkaline around the time of ovulation, so the sperm can live in the cervical fluid and they can swim up to meet the egg.  If the vagina becomes too alkaline, a woman will get more yeast overgrowth.  The vaginal mucous membranes are very permeable, so you want to make sure that if you use a lubricant that it does not contain preservatives, like parabens.  Only a few lubricants have been approved for fertility by the FDA.  A lot of lubes have a high osmolality, which means that they have the ability to pull water from the tissues and this makes their vagina very wet, but it is not so healthy for the tissues. It is better for the woman to produce more cervical mucous, which can be facilitated with acupuncture and herbs and even something like N. Acetylcysteine can thin out the cervical mucus and this can be helpful. Denise mentioned that a lot of people like to use coconut oil. But ideally it is best if a woman produces her own cervical fluid and this can be facilitated with proper diet and more time spent on foreplay. She said that it often takes women 20-45 minutes to become aroused, so you have to give them more time.

14:00  Functional Medicine can help with fertility by looking at the hormones, like the thyroid to make sure that it’s working properly. Traditional MDs usually only look at the TSH, so we should also look at T3 and T4 and the thyroid antibodies. If they have very high levels of antibodies, this means that they have a lot of inflammation and we need to help them to bring this down with diet and look at a stool test and see if there is dysbiosis, which is part of the Functional Medicine approach. 

15:32  Electronics, laptop computers, and cell phones can decrease fertility. If you keep your phone in your pocket next to your scrotum or your laptop on your lap, it can decrease sperm counts and electronics in the bedroom can interfere with intimacy.  So we should keep electronics out of the bedroom.  And with 5G coming, we will have even higher levels of magnetic radiation entering our homes.  Also, pesticides, pthalates, fire retardants, Teflon pans, all are estrogenic and can interfere with testosterone levels in men.  So some detoxification can be helpful for fertility. When women are going through an IVF they will be taking high levels of synthetic hormones, so afterwards, some detoxification can help to make sure they get rid of these hormones.

18:14  Being on birth control for women can be very effective in preventing unwanted pregnancies, but after being on them for years and decades, some women have a tough time getting their periods back.  It can be a struggle to reestablish their normal hypothalamus/pituitary/ovarian axis.  Birth control is chemical castration and their bodies stop producing hormones naturally.  It can take some work to get their natural hormone production restored. 

19:52  Men and women often have sexual problems that a play a role in their difficulty in getting pregnant. There are a number of men who have been avoiding ejaculating in a woman for years to prevent a pregnancy or they may have ejaculatory problems due to masturbation to porn or due to the side effects of SSRIs. Antidepressants known as SSRIs (like Prozac, Zoloft, and Lexapro) make it difficult for men to ejaculate and make it difficult for women to reach orgasm.  It’s hard to make a baby if no one’s orgasming or ejaculating.  Another issue is women wanting to have sex while they are ovulating and men having trouble performing on demand. Denise suggested that men may not need to know when their wives are ovulating and they can just focus on having intercourse more often. There are some women who have pain with sex who may need a pelvic floor physical therapist.

23:38  The benefits of orgasm is that your brain stops thinking and you reach an enlightened or spiritual state.  Sex actually strengthens our immune system.  People today are so busy due to the modern work schedule and culture that there are couples that don’t even have time to see each other very much, except on weekends. 

26:58 When men have issues with low sperm count or sperm that don’t swim as well, Denise will use a Functional Medicine approach and prescribe a fertility formula that contains CoQ10, vitamin E, selenium, zinc, L-arginine and L-carnitine.  Herbs like ashwaganda, rhodiola, Siberian ginseng, cordyceps, and horny goat weed can also be helpful. 

31:33   Denise mentioned that sexuality after menopause can also be a significant problem for some couples and women.  Some women in their 50s continue to have a very active and happy sex life. One of the problems is that women may be in the same relationship for so long that everything has become so predictable and boring.  Men and women need to spice things up and men need to make sure that they take plenty of time with foreplay.



Denise Wiesner is a licensed acupuncturist, herbalist, and certified sex coach. She is the founder of Natural Healing and Acupuncture in West Los Angeles, where she sees patients 310-473-7474, and her website is DeniseWiesner.com and her clinic website is  NaturalHealingAcupuncture.com.  She has recently published a book on Fertility and Intimacy, Conceiving With Love: A whole body approach to creating intimacy, re-igniting passion, and increasing fertility.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe the the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website to going to DrWeitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you enjoy listening to the Rational Wellness Podcast, please go to iTunes and I’ve us a ratings and review. That way more people can find out about the Rational Wellness Podcast. For those of you who’d like a video version, go to the YouTube page, WeitzChiro, search for Rational Wellness Podcast and please subscribe there. And also I provide a full transcript of every podcast, and it should be connected with the iTunes link, or you can go to my website at DrWeitz.com.  Great, so we’re going to get started.

So our topic for today is how to increase fertility by addressing issues about intimacy, as well as overall health and wellness, with Denise Wiesner.  Denise is a licensed acupuncturist and an herbalist, and the founder of Natural Healing and Acupuncture in West LA. She’s certified by the American Board of Oriental Reproductive Medicine, she’s a certified sex coach, and she’s also a faculty lecturer for the Doctorate Fertility Program at Yo San University. And we’ll be talking about her new book, great new book, which will available very shortly, right? And you can pre-order right now on Amazon and Barnes & Noble. Conceiving With Love: A whole body approach to creating intimacy, re-igniting passion, and increasing fertility.  Denise, thank you so much for joining me.

Denise:                Thank you so much, Ben. Looking forward to it.

Dr. Weitz:            So how did you become so interested in fertility, and the second part is why did you decide to write this book?

Denise:                I got interested in fertility when I was having sort of my own fertility challenges, trying to have my second child. And what happened was I noticed that it was just becoming a chore and I wasn’t having, being able to conceive, and I was pulling my hair out, and very upset, and I was going to all sorts of different kinds of healers.  And one of the acupuncturists I went to actually kept wanting to treat my breathing, and she didn’t want to treat my fertility, and I was like, “I don’t care about my breathing, just put a baby in me.”  So I kind of really understand the struggles that my patients go through in trying to conceive.

Dr. Weitz:            Which is why a lot of patients literally go and have an embryo stuck in them, you know?

Denise:                Right. Yes. Absolutely. So I appreciate it, and so my practice became primarily women’s health and also fertility.  So I treat both men and women going through, trying to get pregnant naturally, and also using Western reproductive medicine. So that’s part one.  And part two is that, you know, as I’m treating all these fertility patients, I’m noticing that people are starting to talk to me about, that conceiving is a chore. And they’re starting to tell me all these kinds of issues, like men who aren’t able to ejaculate in their wives, so they’re now turning to reproductive medicine like an IVF in order to make a baby. And when I ask them if they spoke with their doctors about it, they told me they said something, but nobody gave them any kind of help.  And that made me really want to look at, you know, is there help out there? Are there people talking about sexuality and intimacy and conception? And I found that there wasn’t. So I decided to write a book.

Dr. Weitz:            No, it’s great. I think there’s a number of issues like that, you know? Doctors just not comfortable talking to their patients about sex, and their sex life, other than in a very cursory way, or just handing them a drug or something.

Denise:                Yeah. No, it’s happening a lot in my practice, where nobody’s really talking. When I look at like, MD’s, and how many hours they get learning about human sexuality, I think it’s like 20 hours or so.  And therapists get about 10 hours talking about, learning about sexuality, unless they go on to become specialized in sexuality.

Dr. Weitz:            Yeah, no, I think many of the most important human concerns are sort of treated summarily like that.  Depression, here’s a pill. You know, what about the end of life? You know, doctors don’t even talk about a patient’s undergoing cancer treatments, they’re just taking these treatments a lot of times, which really aren’t even designed to save them, because doctors don’t want to talk about that, have those difficult conversations. And so this is great that you’re breaking this ground, this is very important that health practitioners either learn and become comfortable talking to their patients about this, or be able to refer to somebody like you, who is comfortable about it.

Denise:                Yeah. I think it, was it death, sex, and taxes are really hard to talk about?  Something like that? Yeah, so and it’s funny because …

Dr. Weitz:            You know, I’ll never show my tax forms…

Denise:                Yeah. That’s a whole other conversation. Whole other podcast.

Dr. Weitz:            So, in your book, you bring in a lot of Chinese medicine, and I was reading about some of these concepts of the wood, and the air, and the water, the energy, things like that.  Maybe you can explain, you know, how Chinese medicine can help us understand some of these issues.

Denise:                Yeah, okay. So in my book I have a lot of chapters. I mean, there’s chapters on fine tuning the engine, there’s chapters on orgasm and foreplay, and stress, and all sorts of things. But in this fine tuning the engine part, I really talk about the Chinese five elements. There’s wood, water, earth, metal, and fire.  So in Taoist tradition, earth is the center. And it’s really about kind of your digestion, really.

Dr. Weitz:            By the way, what’s Taoist tradition mean?

Denise:                Oh, Taoist tradition is really where I base a lot of my stuff. Because way back before … Taoist tradition was the precursor to Chinese medicine.

Dr. Weitz:            Oh, okay.

Denise:                Really what’s incredible about the Taoists is that they have this really equal relationship between yin and yang, male and female. So actually sexuality, and sexual positions were given to patients if they had issues. Like, “Oh, go do this position and that’ll cure this problem,” right? So the Taoists had a really great relationship to sexuality, which has since changed in our modern society, right? We have a lot of shame around it. So there’s a lot of Taoist breathing exercises that I brought into my book. But anyway.

Dr. Weitz:            But is there a double blind placebo controlled randomized clinical trial that shows that position is of clinical benefit?

Denise:                I think Masters and Johnson started doing that research, right? They had all that research on sexuality that came. I don’t know if it was … they were the ones who really founded a lot. Kinsey. They did research.

Dr. Weitz:            Right.

Denise:                But lab research is a little different than actually what happens in person, right?

Dr. Weitz:            Right.

Denise:                 So the earth element is kind of like the center, and digestion, and it’s important because right if you’re felling funky in your body, if you don’t feel good, you’re not gonna wanna make, you don’t want anyone to touch you, right?  That really gets in the way of intimacy for both men and women.  If they’re not healthy, if they’re not feeling good, right?  So earth element, we deal a lot with the center.  And that also includes the digestion, and your microbiome, right?  How that’s a big buzzword, right?  You talk a lot about microbiome.

Dr. Weitz:            Yes.

Denise:                 Yeah. So making sure … because there’s not only a microbiome in your gut, right? There’s one in your mouth, and on your skin, and there’s actually on on the penis and there’s one in the vagina. And we want that to be healthy. We don’t want a woman to have yeast infections and all sorts of infections, which women do get. And we want to have that balanced. So that’s kind of part of the earth element, is learning about the center.  And Chinese medicine is funny, because it just doesn’t look at digestion only, it kind of looks at emotions. So there’s this saying that overthinking and over worrying damage spleen and stomach, which is digestion. Right? And we know that doesn’t happen for anybody in this society anymore, right?

Dr. Weitz:            Yeah.

Denise:                 Yeah. So.

Dr. Weitz:            Everybody’s so highly stressed and overworked and trying to fit everything in, and yeah. Absolutely.

Denise:                Right, like eating in your car? I’m trying not to do. But like, shoving in the food as fast as you can, right? There’s no digestion happening, no enzymes.

Dr. Weitz:            Absolutely. And it facilitates eating of fast food because so many fast food items come in wrappers that you can hold in one hand, and shovel in.

Denise:                While you’re driving and talking on the phone.

Dr. Weitz:            Exactly. So you mentioned the vaginal microbiome, and that’s a really interesting topic. We’ve have some women use probiotics vaginally to help with yeast infections, and that’s something we’re just starting to understand.

Denise:                Yeah. No, it’s really important because what happens with a woman during her cycle is her pH for her vagina, which is supposed to be acidic, starts changing around the time of ovulation because the cervical fluid that she produces becomes a little more alkaline, so the sperm can live in the cervical fluid, right?  So they can swim up to meet the egg.  If a woman is not acidic, she’s more alkaline during the month, she’s going to produce more yeast, right?  Because you really want an acidic vagina. So there’s all sorts of lubrications that people use out there, and I had spoken to lots of lube companies and got a great education on lubrication, and really more than I wanted to, but I learned a lot.  Because you know, unlike our mouth, when we digest something, we have a lot of acid in our stomach which breaks things down and gets rid of bacteria, right?  But we put something in our vagina, the mucus membranes, it absorbs. It’s much like our rectum, as well.

So when you go to use a lubrication, you want to make sure that it doesn’t have preservatives in it, like parabens.  Which the FDA has said is fine, but I don’t think is fine. So no parabens. And then there’s also this thing called osmolality of lubricants, which means the ability of it to pull out water from the tissues.  So a lot of lubes, the reason why women get very wet is because it pulls out the water from the tissue and that helps, it really dehydrates the tissues.  It’s not good for the tissues, and there’s a lot of lubes that have this high osmolality.  So with lubes like, there’s lubes that are good for fertility around that ovulation window because they’re a little more alkaline, they say they don’t kill sperm. There’s only a few that have been FDA approved, the FDA now approves them for fertility, believe it or not.

Dr. Weitz:            Huh.

Denise:                Yeah. So there’s a few of them have …

Dr. Weitz:            Is there a natural type of oil or other fat that makes a good lubricant?

Denise:                Yeah. I mean, I think like, I personally think coconut oil is great. I mean obviously if you’re trying to protect, using a condom it’s not good because it’ll just eat up the latex. But in terms of, you know, hopefully women, truthfully if women are healthy, and their cycles are really good, and they haven’t had surgeries on their cervix, they should be producing a lot of cervical mucus.  And that’s kind of what my job is as an acupuncturist and herbalist is to kind of help women to produce more cervical mucus.  And even something like N Acetylcysteine, right? It thins out mucus, right? It’s an antioxidant. But I give it sometimes for women because it actually thins the cervical mucus as well. Right?

Dr. Weitz:            Interesting. Now coconut oil’s a little alkaline, right?

Denise:                 You know, I don’t know the pH of the oils. Do you know the pH of them?

Dr. Weitz:            You know, I just recently interviewed Jennifer Fugo and we’re talking about the gut skin connection and she was very outspoken about the fact that, I haven’t posted the interview yet, so it’ll still be several weeks away, but she felt that coconut oil was too alkaline and the skin needs to be more acidic. So she didn’t think coconut oil should be used on the skin.

Denise:                 That’s really very interesting since everybody uses coconut oil everywhere these days. But the thing about it is is really, truthfully, women who are trying to conceive, really should produce their own cervical fluid.  If you’re not producing, you’re dry, then there are things that we can do the help make that by giving women herbs, and nutrition, and looking at everything.  Looking at their whole body.  And that’s really the truth, unless a woman has had like, surgery.  So I sort of steer away from the lubricants, because, “OK, here’s another thing.” This is in my book, and a lot of times women will become, because we have all these glands that secrete lubrication, right? If a woman’s not sometimes making her own lubrication, not only can it be from just maybe her diet’s not good, but it can also be from not enough foreplay. Which, you know, people don’t know, but it takes women like 20 to 45 minutes to really become aroused. And if you give a woman enough time, she will be.  And when you’re doing baby making, a lot of that time map goes out the window, so a woman’s uncomfortable and it’s painful. So that’s just one thing.

Dr. Weitz:            Interesting. What role can Functional Medicine play in understanding fertility, and in helping a couple improve their ability to conceive, and have a healthy baby?

Denise:                I mean, Functional Medicine is much like Chinese medicine, right? It’s looking more in depth at like, what’s out of balance in a patient’s body, right? So Functional Medicine is great because it’s really looking at the systems, like doing blood. You know, making sure, obviously the thyroid’s working efficiently. Thyroid has to function for fertility, and there’s actually lower ranges for fertility. Doctors want your TSH 2.5 or less. But what happens with doctors is they just do a TSH, and they don’t look at like, antibodies, TPO antibodies, TGB antibodies, and some women have very, very high levels. That’s where the functional medicine do look at those things, and therefore are interested in why someone would have high inflammatory markers, and try to get the inflammation down.  So you know, if I have women that has high TPO antibodies, we’ll be doing some type of antioxidants to help bring down this high level of inflammation. And also looking at their diet, like functional medicine does, right? Are they eating an inflammatory diet? Are they eating a lot of grains? Are they eating dairy?  And so Chinese medicine has similar kind of ways that we look at things, but functional medicine brings in the actual lab values, the actual stool test, the actual hormone test, and we can look at those in a much more in-depth level than just … or sperm, for that matter. You know? Yeah.

Dr. Weitz:            Good. Can electronics like laptop computers and cell phones affect fertility?

Denise:                 Yeah. You know, I treat a lot of men, and I’m pretty lucky that way. And it’s amazing how many men carry their cell phone right next to their scrotum. And it’s, you know, electronics are heating, and there’s research about even just talking on the phone can increase your chance of having lowered sperm counts. So I really do try to discourage use of electronics.  And electronics in the bedroom get in the way of making babies. ‘Cause when everyone’s like, on their, checking their email and doing all this, right? There’s no intimacy. So one of my big things is trying to get electronics out of the bedroom, I’m probably guilty of that too. But yeah. So …

Dr. Weitz:            And you know, with 5G coming, we’re going to have even more higher levels of magnetic radiation entering our homes through our electronic devices, etc.

Denise:                 Yeah. You know, it’s very scary. My son’s a computer science major, and he’s always like, “That doesn’t matter,” whatever, he’s like, “Show me the research.” But I think it does interfere. I mean, what’s going on with our society that men’s sperm counts are so much lower than they’ve ever been? What’s going on when I see these men who have unexplained low sperm counts? Like, the doctor can’t find anything wrong genetically, and they don’t know why. That’s very interesting to me.

Dr. Weitz:            Yeah. Literally from the small sample we’ve had of the men we tested for hormones, 80% or more have low free testosterone, so it is truly getting to be really common. And part of the problem has to be some of these estrogenic substances that you mentioned. Pthalates, and there’s a whole series of this in a way, pesticides, fire retardants, Teflon, etc., etc.

Denise:                 Right. That’s sort of that idea, you know, about detoxification, right? And we have that, that’s functional medicine, it’s also Chinese medicine. It’s the liver, and we have to be able to detoxify. So oftentimes I’m testing and also putting people on detoxification. Especially if they’re going through an IVF and they’re taking a ton of hormones. I mean, these women have estrogen levels really, really high. And I will afterwards just tell them to do a little bit of a liver detox.  Because I know that, you know, we’re not supposed to have those superhuman levels of estrogen in our bodies, right? And then they pee that out, and you wonder where does that estrogen go? Right?

Dr. Weitz:            Yeah, I mean, speaking of hormones, what does being on birth control for years and even decades do to a woman’s ability to become pregnant?

Denise:                 Some women who are on birth control pills, some women don’t get their periods back. It’s very interesting, I have to work very hard to reestablish the HPOA access. You know, the hypothalamus pituitary ovarian access. Some women do get their periods with a little coaxing. I think, you know, they give birth control pills oftentimes without really checking women. I mean, they don’t check to see if women clot. Have any kind of clotting disorder. It’s interesting, and then they find out like, “Oh, I had a clot on the airplane,” and it’s like, “I’m on birth control pills. Whoops, I shouldn’t be on them.”  But they don’t do a lot of testing, they hand them out like you said. They just sort of hand them out to everyone.

Dr. Weitz:            And essentially it’s a chemical castration. These women are artificially having their menstrual cycles stop with chemicals for years and years, and so their body’s not naturally producing these hormones.

Denise:                 Right. And there’s a difference between the synthetic hormones that you get, and the ratios of them, and how they’re pulsed, right? We take, hormones all pulse in a certain way, and you take a pill it’s not quite the same. So I think it must have some impact, and I don’t know there’s a lot of research on that, I’d have to really look stuff up, it’s a very interesting thing. I’m not a big fan, but for those who have unwanted pregnancies I do see that birth control pills are the best form of birth control at this point in time.   So it’s a hard call for women. It’s a hard thing, what to do. You know?

Dr. Weitz:            Yeah. No, I understand. Can you talk about some of the sexual problems that men and women have that they often don’t want to talk about and why don’t they talk about these?

Denise:                 Yeah. This is my favorite thing to talk about, actually. Really because it just let’s people know they’re not alone. So I have men who have difficulty perhaps ejaculating in their wife, and I have a lot of men that are really shamed around that, because they’ve not ejaculated in a woman for years because they were trying to prevent pregnancy, so they didn’t learn how. And maybe they’re masturbatory style is very different than when they make love to their wife, and so it’s just a different sensation.  And so it’s learning how to re-do that style so that they can ejaculate. And there’s many reasons for why men can’t ejaculate in their wives, right? Fear of making a baby, or sometimes … you know, what’s really interesting is there’s a lot of SSRI’s, and one of the side effects of SSRI’s is they have like, it’s hard for men to ejaculate, and it’s hard for women to reach orgasm. And I actually interviewed somebody that was a psychiatrist in functional medicine, Hyla, Dr. Katz.

Dr. Weitz:            Oh, yeah.

Denise:                 Yeah, I interviewed her because we were talking about what can these people do? Because they’re given SSRI’s and maybe that’s not the best thing in order to make a baby because no one’s orgasming and no one’s ejaculating.  So that’s a problem, so that’s one of the things. And then I also have, men can’t get an erection when there’s pressure. Like, when they know their woman’s ovulating, and they all of a sudden have to perform, you know, that moment, and the woman’s like, “Okay, now honey.” Men sometimes just can’t really perform on demand, right? And so my book is really this idea of maybe men don’t need to know when their wives are ovulating. Some men like to know, but maybe it’s this idea of having intercourse more often, having connection more often so it’s like your having it and you’re also having it during baby making time. It’s not just, “Okay, this window we have to do it now.” And then men are like, “Ah!”

So I see those things in men, and I see some sexual pain in women. That they don’t tell anybody. That like, it actually hurts, and they don’t know why. And you know, oftentimes my job as a a Chinese medicine practitioner and sex coach is to like, “You know, you need to go to a pelvic floor physical therapist. Your pelvic floor is like, ripping.” God, I had a woman who couldn’t have intercourse because every time she had intercourse with her husband she’d get a UTI, urinary tract infection. And so it started becoming, she had vaginismus, her muscles started closing down, and they couldn’t have intercourse for a long time, ’cause of the trauma of thinking like, “Every time we have intercourse I’m in pain.”  So unraveling that takes a few people, right? Takes like the physical therapist, and some emotional support, and I can help, and so it’s really pointing people in the right direction.

Dr. Weitz:            Yeah. Probably could use some cranberry D mannose to coat the urinary tract to make bacterial less likely to adhere.

Denise:                 Right. So it’s really addressing, exactly. It’s addressing it in many different avenues, not just the pelvic floor physical therapist, but it’s also looking at how to relax the woman, and how to prevent UTI’s. Like, what’s going on that she keeps getting UTI’s? And you know, help the gut function, and exactly what you’re saying. Perfect.

Dr. Weitz:            Yeah, and those antidepressants are handed out like candy. And then there’s a series of other drugs. So for example, some of the drugs that men take to try to increase hair growth, like Propecia also affect erectile dysfunction.

Denise:                Oh my god, and toxic to fertility. So not good for, yeah. All those things, right?

Dr. Weitz:            Right.

Denise:                Yeah.

Dr. Weitz:            So when you, in your book you talk about the benefits of orgasm in sex besides, you know, being able to conceive.

Denise:                Oh yeah. It’s orgasm, but you know what? It could be like a deep hug, it’s oxytocin. It’s the hugging drug, right? And it’s like 30 seconds, 20 to 30 seconds of like that deep embrace, and you produce these chemicals, and orgasm is the best. Because orgasm, there’s something that happens where your brain, it just stops and you don’t think about anything, it’s this moment that’s really beautiful for men and for women, and it’s sort of an enlightened state. I mean, it’s a state where you can really ascend, it can be a very highly spiritual state. It’s not just about like, gotta have an orgasm, but it’s this connected, beautiful moment in time where all these feel good hormones are in your body and we want more of that.  Because those help our immune system, actually. Like, sexuality is good for our, it helps our immune system. And that’s a very important fact that people forget because they’re so busy.  People are so busy at work, and so stressed out, that they like, they can’t, you know, the idea of taking an hour to like, have lovely, slow connection with a partner doesn’t happen.  I mean, I have people that don’t even have date nights.  They see each other very little, maybe on the weekends only.

Dr. Weitz:            Right. It’s interesting that this problem of, you know, if you call it a problem, right? I think it is, of people having less sex and having less babies is actually something that we see throughout the western world, and you see it in a lot of these countries in Europe, etc., where the native population is becoming a minority partially because they’re not having a lot of kids.  And in some of the Scandinavian kids, they actually have commercials on TV encouraging people to have sex.

Denise:                Yeah, you know …

Dr. Weitz:            Government incentives and stuff for them to conceive.

Denise:                Yeah. It was kind of scary because I attended a reproductive endocrinology lecture and the doctor, a reproductive endocrinologist, was talking about he thinks that one day it’s just going to be like you go to get an IVF to conceive your baby, and sex is only for fun, and it’s not used for fertility anymore, for making a baby, you just sort of do it in the lab. And I thought, “Oh no. That’s such a scary … is that what’s going to happen? We’re going to all have these like, designer babies?” To me, that’s a scary thought, you know?

Dr. Weitz:            Yeah. We should be way more connected to the earth than we are, and that’s like the most extreme example, you know? Yeah.

Denise:                Yeah. I mean, when healthcare dictates that.  You know, right now IVF is, some insurances cover it, but you have to have money.  And it’s really unfortunate, because there’s some people that really need IVF.  I have men who sometimes have, have had … I have testicular cancer guys, like quite a few in my practice.  And their sperm counts sometimes aren’t as good to make a baby naturally, so they need the help of IVF.  And that’s what IVF is for.  I’m not anti-western medicine, it’s just that some people rush to it when they don’t really need to. ‘Cause of the fear, and the anxiety we have in our society, and maybe they’re having relationship issues as well.

Dr. Weitz:            Right. When men have issues with sperm count, or swimming ability, etc., what are some of the things that can be done to help?

Denise:                So glad you asked that. You know, in Chinese medicine … okay, first of all. Western medicine. There’s a lot of, or I should say Functional Medicine, there’s a lot of nutritional substances that we give men. We give men fertility formulas that contain CoQ10 and Vitamin E, and selenium, and zinc. Zinc is very important. L-Arginine is good, L-carnitine, those are sort of standard in men’s fertility formulas. But then there’s actually specific herbs that men can take to help their libido and help sperm, but it really depends on what’s going on.  So a man who maybe has a low sperm count due to maybe a varicocele, so it’s like a varicose vein in his scrotum, he in Chinese medicine would need more cooling of his testicles and more blood flow and cooling herbs. We might have him just put an ice pack actually, to cool them down and take herbs for blood flow, which would be different for a man who has a low sperm count due to, we call like, low kidney energy in Chinese medicine. Or maybe he’s over stressed, or he’s over exercising or something of that nature.

So herbs like, I was just pulling them up actually, looking at my book. One of my patients who had testicular cancer, a doctor told him he should take ashwagandha, and he called me. “Doctor says I should take ashwagandha. What do you think?” And I thought, “Yeah. Ashwagandha.” Ashwagandha is a great adaptogenic herb, it’s shown to like, improve sperm, interesting enough. And it’s calming, so it would be a great herb for him because he was sort of anxious.  And I also give cordyceps, it’s a fungus, it lives on caterpillars, but they make it.  Cordyceps also helps sperm, and it also helps egg quality. And it also helps, good for stress, good for your adrenal glands to be good for them.  So that modulates. And then there’s things like, we call yin yang huo. Horny goat weed. Horny goat weed is an herb that helps libido, there’s a bunch of them.

Dr. Weitz:            Yes.

Denise:                And what I want to say is like, ashwagandha. Okay, you can take ashwagandha singly, but there’s these amazing formulas that have all the adaptogens. Like, rhodiola, and ashwagandha. You know, and Siberian ginseng. And I kind of like to take herbs in formulas as opposed to just single herbs. It’s how the Chinese do it, and I find it’s much more effective to give a formula for a man than just a single herb.

Dr. Weitz:            As a provider, how do you bring up questions about sexuality with the men and women you’re seeing?

Denise:                That’s a great question. I have a form that they fill out, and one of the questions is about libido. Because it’s part of who we are as humans, right? It can tell us a lot of about what’s going on, if there’s deeper issues.  I mean, I had a man who couldn’t get an erection, and really, he ended up having a heart attack because it was blood flow issues. So I think it’s a really important question that we need to ask for providers, our patients, yeah? We shouldn’t eliminate that question. So basically they put a check on my form, and a lot of women, really I would say 98% of my patients that are women check the low libido box.

So I basically ask them, “Hey, you checked the low libido box, and I want to know what’s going on.” And really just try to find out, libido is really complicated. It’s complicated for women, maybe less so for men, but it’s complicated for women. Like, is it stress, is it past trauma, what’s going on? So we go a little in there, and then men oftentimes, on their checkbox, if they have erectile dysfunction, they check it. Believe it or not. So I just say, “Hey, you checked the box with low libido, erectile dysfunction, what’s going on?” And believe it or not, people really wanna talk about it.  Because nobody asks them. And they don’t know what to do about it, and they don’t know who to go see, and it’s just this sort of shame that they live with, and I’m really encouraging more providers to talk about this area. You know, and also refer out, let them know that there’s therapists that actually specialize in sexuality. That you can talk about these things to, if there’s trauma, or past issues with this, right? And I just feel like it’s important for people to be empowered around this topic.

Dr. Weitz:            Yeah, no, I think this very important book, and by the way I think your next book should be about sexuality after menopause, ’cause that’s another whole set of issues.

Denise:                Oh, yeah. I also treat that. That’s a whole, or sex after kids. Right? Where everybody’s like, scrambling around, you remember that. You know, everyone’s like, “Oh my gosh, I need to sleep, don’t touch me.” So yeah, sex after you have the baby, or in menopause. But you know, there’s an interesting …

Dr. Weitz:            Sex after your hormones fall off a cliff.

Denise:                Tank, yeah. I think that you know, and just to mention that, that’s not in my book, but just to say that because you know, yes. Menopause. I know that intimately. It’s not, I think it doesn’t have to be a tank. And if you ask some women in their 50’s, they’d say they have the best sex that they’ve ever had in their entire life. So this idea that everything has to tank, sometimes it’s just that women have been in the same relationship for a really long time, and everything’s very predictable and everything’s kind of boring. And remember I mentioned that like, 30-45 minutes of foreplay? That’s not usually happening.  And so maybe if there’s a way to spice things up or recreate things, or … women, surprisingly enough, maybe can change. So women think, “Oh, no, it’s very common that a woman in menopause, her husband will be like, ‘Hey, let’s have sex,’ and the woman’s like, ‘Ugh, god, I don’t want to.'” But if a man were to really arouse, and I don’t mean like just touching, maybe a woman would be in the mood. So I just got a rose today from one of my colleagues, and these rose petals are super amazing. You could just take a rose petals, lie them on the bed, and just do a touching exercise with rose petals. I mean, when do we do that? Who has time for that anyway?  But it’s just to remember these kind of small things can really wake people up and that even though a woman’s in menopause, maybe she hasn’t been touched by rose petals in a very long time in her life. And maybe that would be the thing that would kind of light her up to really back into her moment. So I’m not sure, I’m not wedded to like, it’s only because women’s hormones drop. You know? I see plenty of women who don’t have hormones, who have a fine sex drive. So that’s a whole other topic.

Dr. Weitz:            That’s great. So one more question since we seem to be in a marijuana revolution in this country, and we live in California where marijuana is now legal and it seems like everybody’s starting to experiment with CBD oil in healthcare practices for every possible condition. How do these affect fertility?

Denise:                 We see CBD everywhere. First of all, marijuana is not good for sperm. Sperm slow down, and it’s not good. So if your man is smoking marijuana, or ingesting with edibles, or whatever, I would say give him 70 days of no edibles. Because it’s not good for sperm counts. That’s just …

Dr. Weitz:            Sperm slow down, they just want to sit on the sofa and not go to work.

Denise:                 Yeah. Not so good. Yeah, sperm, it’s just not good for sperm. And that’s, I’ve interviewed enough urologists, reproductive urologists, and they’ve told me firsthand, “Please don’t, no marijuana for sperm counts.” We don’t know, I don’t know there’s any research on egg quality, but I imagine if it’s not good for sperm, it’s probably not good for eggs. We just don’t know enough about that. That’s just THC, right?  But then there’s CBD. The problem with CBD is that we don’t know enough about CBD. So there’s CBD from hemp, and there’s CBD from, with THC in it, and we don’t even know. There’s no quality control with CBD at all. So you take CBD you don’t even know what you’re getting. Every vendor wants to sell me CBD, and I don’t know really how much is in it. Do you find the same thing?

Dr. Weitz:            Yes. I think there’s a lot of confusion about it. I think there are some specific rules as far as, if you want to sell CBD it has to have less, a certain amount of THC, and if it has more then it has to be … it’s all legal, but …

Denise:                 You know what? No, but there’s CBD from hemp, and there’s CBD from cannabis. Right? The CBD that’s made from hemp has no THC in it. And the CBD from cannabis I think maybe does or doesn’t or I’m not really sure. And there’s so much debate about that. I’m not anti-CBD, I see it do some good things, I don’t think it’s the do-all end-all, I think it’s just the rage right …

Dr. Weitz:            People use it for sleep and relaxation.

Denise:               Yeah, yeah. And I’m not anti-CBD at all, I actually have used it myself and think it’s really good and I love the CBD ointment for pain, I think that’s great, and inflammation. But I think if you’re trying to have a baby, until we know more, it’s just hard to say because I don’t know that there’s any research. I do have a colleague that did a lot of CBD oil in her 40’s and did get pregnant. So that’s just kind of a funny aside, but I don’t know and I don’t recommend it because I don’t know enough research about it.

Dr. Weitz:            Right. Great. So any final thoughts for our listeners? And maybe you can tell us how viewers and listeners can get a hold of you and where they can pre-order your book?

Denise:               Okay. The final thing I wanna say, and we’re so focused sometimes on you know, on money-making, and busy, and lab tests, and health, that we forget to kind of drop into the place in our hearts where the love lives, and it’s always a good reminder to really live in that place of love. You know? We can live in fear, and there’s enough of it in our society right now, but just be in gratitude and love is the best place we can arrive to. So that’s really my, that’s why I think conceiving with love, it’s all about the love.  All about the love. That’s my final thought. And then if you want to get a hold of me, I have a website that’s my name, DeniseWiesner.com, and there’s a lot of information about me and what I do, and it also links to my clinic, and my book is available through Amazon. It’ll be available pre-order and out May 28th. And it’s also I think in Barnes & Noble, and it’s also, it’s published by Shambala so you can also get it on their website as well.

Dr. Weitz:            Awesome. Thank you Denise.

Denise:               Thank you, Dr. Ben Weitz. You’re the best.



Ketogenic Diet with Dr. Josh Axe: Rational Wellness Podcast 107

Dr. Josh Axe discusses The Ketogenic Diet with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

5:05  One of the biggest benefits of a ketogenic diet is balancing insulin levels. And insulin imbalance causes inflammation, PCOS, Alzheimer’s disease, negatively affect brain health, and cause hormonal imbalances.  It also is very effective in helping clients/patients to lose weight. 

7:25  The main components of a ketogenic diet involve a macronutrient breakdown of about 70% fat, 20-25% protein, and about 5% fat. When your body starts burning fat instead of carbohydrates, you are said to be in ketosis.  This diet was created by Johns Hopkins researchers to fight epilepsy and to mimic fasting. Dr. Axe does not believe that the keto diet should be done for too long a period of time. It should be done for 30-90 days, like a long term fast or cleanse. And it can take 4-6 days of being on the ketogenic diet till your body truly gets into ketosis. Drinking matcha green tea, using adaptogenic herbs, keeping stress levels low, taking exogenous ketone supplements and taking other herbs that support thermogenesis like ginger and cayenne can help getting into ketosis.

9:33  If you are highly stressed, your cortisol levels will cause your body to produce more sugar from protein.  If the person has thyroid or adrenal fatigue and they are highly stressed and go on a ketogenic diet, they likely won’t do well on it.

10:18  Dr. Axe usually has his clients on keto consume 30 grams of carbs per day or less.  He does not like counting calories, so he will tell them that they can only have one serving per day of carbs and it’s either blueberries, beets, or carrots and that’s it for carbohydrate rich foods per day.  The carbohydrate rich foods are grains, legumes, fruits, and the starchier vegetables, like beets, carrots, potatoes, yams, butternut squash, etc.

13:15  Dr. Axe said that exercise is not required to follow a ketogenic diet and you can lose weight following a keto diet without exercising.  But exercise will help to lower stress, increase your metabolism, burn up carbs, and help you get into ketosis more easily.

14:23  Dr. Axe explained that it is o.k. to have small amounts of alcohol while following a keto diet, such as a 3 1/2 oz glass of dry farmed red wine once or twice a week.

14:58  Dr. Axe pointed out that there is a right way and a wrong way to follow a keto diet. He said that he saw the ultimate keto recipe posted on Pinterist and it involved taking conventional shredded cheese, fried in butter, with bacon in the middle, and then you more cheese fried on top, and you have a keto quesadilla. But that is not healthy on any diet. Dr. Axe recommended eating real, healthier fats like avocados, coconut, tahini, almond butter, grass fed butter. ghee, olives, etc.  Dr. Axe goes through a 30 day keto meal plan and has lots of recipes in his Keto Diet book that make it easier to follow a keto diet. 

16:51  A ketogenic diet will not be detrimental to your microbiome if you do it the right way with lots of fermentable fiber and fermented foods. If you do keto with loads of vegetables and you include some nuts and chia, flax, and pumpkin seeds, and berries, you will be getting plenty of fiber. You want to include some fermented foods like sauerkraut. You also want to include plenty of spices and it can be helpful to include matcha green tea, turmeric, ginger, and the supplement, triphala.  Dr. Axe pointed out that some ancient civilizations, like Eskimos and the Hadza lived on a keto diet and they had very diverse microbiomes.

19:00  The most beneficial nutritional supplements to take while following a keto diet are: 1. Probiotics, esp. Soil-based Probiotics, 2. Collagen protein or bone broth protein for tissue regeneration, 3. An organic green powder, 4. Adaptogenic herbs like ashwaganda, 5. Exogenous ketones, and 6. A multivitamin/mineral or drink celery juice or some other green vegetable juice.

22:18  The ketogenic diet is difficult to stay on long term, so Dr. Axe recommends doing it for 30-90 days and then adding back in some healthy carbs, say 30-40%.  That’s about 100 gms of carbs per day, which would be a serving of blueberries, a half a sweet potato, and one serving of rice.  Some people also do well cycling keto, such as doing keto and then adding some additional carbs every third day.


Dr. Josh Axe is a Doctor of Chiropractic, a certified doctor of natural medicine, and a clinical nutritionist. He has the No. 1 natural health website, Dr. Axe.com, with over 17 million monthly visitors, and he created a supplement company, Ancient Nutrition. He has written several best-selling books, including his new book, Keto Diet, and Eat Dirt.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with The Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to The Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hey. Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to The Rational Wellness Podcast, please give us a ratings and review. That way, more people can find out about The Rational Wellness Podcast. Also, check out the YouTube page where we have videos that are not included in the podcast.

Our topic for today is ketogenic diet with Dr. Josh Axe. The ketogenic diet is a high-fat, medium protein and very low-carb diet. By severely restricting carbs, your body gets used to burning fat for energy instead of carbs. And this can facilitate the loss of body fat. When your body is burning fat, it produces ketone bodies in the process. This means that your body is in ketosis. Dr. Josh Axe is a doctor of chiropractic, certified doctor of natural medicine, and clinical nutritionist. He has the number one natural health website, draxe.com, with over 17 million monthly visitors. He’s written several bestselling books including his new book, Keto Diet, Your 300-Day Plan to Lose Weight, Balance Hormones and Reverse Disease, which is what we’ll be speaking today.  Dr. Axe, thank you so much for joining me today.

Dr. Axe:               Awesome. Hey, thanks for having me Dr. Ben.

Dr. Weitz:            Excellent. So, Dr. Axe, can you tell us how you became interested in a Functional Medicine approach to health?

Dr. Axe:                Yeah. So for me, I got into the natural medicine space through a health crisis in my family. My mom growing up was always into fitness, but we were never into nutrition or natural health. And so she was surprisingly diagnosed with cancer at 40.  We lived in that medical model.  We were always getting put on medications, and my mom decided to go through all the conventional medical treatments.  So she had a mastectomy.  She went through rounds and rounds and rounds of chemotherapy. And I remember her losing all of her hair. Just being so sick.  And she went through all those treatments, and then she was diagnosed as being cancer-free and healthy but really, after that, she seemed sicker than ever.  She got diagnosed with chronic fatigue syndrome, depression, anxiety, got put on multiple medications.  And she was just sick and tired all the time.

And that’s really, essentially, what inspired me to become a Functional Medicine doctor and a chiropractor, and nutritionist, and want to learn natural medicine. And so, I went to school, started studying to become a doctor. And about a year before graduation, get a call from my mom, and she says, “I’ve got bad news. I’ve just been diagnosed with cancer again. What do I do?” And I said, “I’ll be home.” I flew back from Florida back to Ohio where I grew up. We sat down and prayed together. And we felt led to take care of her all naturally. And so, she started juicing vegetables every single day. We started doing natural remedies like reishi mushrooms, and turmeric, and vitamin D. She started getting chiropractic adjustments every week. And using essential oils like frankincense.  And also doing positive affirmation.  We worked on her spiritual and emotional health.  We followed this plan for about four months.  We went back to Columbus, Ohio and redid a CT scan with her oncologist.  And they called us the next day and they said, here’s what their exact words were, “This is highly unusual.  We don’t typically see this, but your tumors have shrunk by more than half.  We want to see you again in nine months for another scan.”  She went back nine months later, complete remission.  And now, my mom’s in the best shape of her life.  She just turned 67, and she’s running 5Ks, and she water skis, and feels better now in her 60s than she did in her 30s.  And so for us, that’s a big part of what inspired me to start practicing natural medicine.

Dr. Weitz:            Just out of curiosity, did the oncologist ever call you and say, “Hey, Dr. Axe, what did you do?”

Dr. Axe:                No, no. Of course not. Well actually, on that call, they kind of said, “What have you been doing?” And their long-winded response was, “Hmm.” Was what it was. And at the time-

Dr. Weitz:            They really thought about it deeply.

Dr. Axe:                Exactly. Now another thing what my mom was doing as the time though diet-wise, all the vegetables she did were green vegetable juices, she was sort of doing a form of the keto diet. We removed all sugar, all grains from her diet. Her only source of carbohydrates was, she was doing about a half a cup to a cup of blueberries a day, some beets and carrots, and that was really it in terms of carbohydrates. And so, that was another thing that we felt like was pretty important as part of her treatment plan.

Dr. Weitz:            Great. So what is some of the primary benefits to following a ketogenic diet?

Dr. Axe:               So, the keto diet, big benefit there is balancing insulin. And most people, of all the macronutrients we eat, we overconsume sugar and carbohydrates are the most. We know different organ systems have to deal with different macronutrients, and so your kidney and your stomach, and to a degree, your liver, have to do with protein digestion. We know that fat digestion’s primarily your liver gallbladder, but your pancreas, in a big way, is responsible for carbohydrate digestion. And so for that, most of our pancreases are just worn out. So, when you can balance insulin… When people think of insulin, they tend to just jump to diabetes and think that’s what it does, or if it’s imbalanced that’s the disease it causes.

The truth is, research today is showing insulin imbalance causes severe inflammation. It causes PCOS, that’s polycystic ovary syndrome. In fact, Alzheimer’s disease is called type three diabetes because of insulin issues. And so, and then most hormonal issues, whether it be cortisol or progesterone or estrogen or testosterone, those hormones, a lot of times are at certain levels because of where insulin is at. And so, again, I think it’s really critical that we keep insulin balanced. But again, the benefits can be especially neurological in brain health. It can be big for that. Digestive health. Certain types of hormonal health, especially PCOS and fertility. And weight loss, of course. Probably of all the things, probably it’s most well-known for its ability to help people lose weight and fight diabetes.

Dr. Weitz:            I just did an interview with Dr. Bob Rountree, and he was talking about fatty liver disease, which is also related to insulin sensitivity. And that’s a tsunami of problems that’s coming down the pipe that is going to be the leading cause of liver transplant.

Dr. Axe:                Absolutely. So again, as you can… insulin resistance is a huge… And most people don’t think, unless they have diabetes, they think, “Oh, I don’t have insulin resistance.” Most people are sitting in that sort of syndrome X, that level of not full-blown diabetes, but most people, if they’re carrying an extra 20 pounds of body fat especially, there’s a great chance that they’ve got insulin issues.

Dr. Weitz:            Absolutely. So what are the main components of the ketogenic diet?

Dr. Axe:                So, a keto… Now, here’s the other thing too. There’s a right way and wrong way to do keto. So, keto tends to be about 70% fat, 20-25% protein, and about 5% carbohydrates. That gets your body in state of ketosis, where your body starts burning fat for energy because it doesn’t have carbs to burn for energy. And the other thing important to note about keto is, is that it was created by John Hopkins Medical researchers to fight epilepsy. And to mimic fasting. So think about it like that. The keto diet, for me… By the way, the keto diet is not a lifetime diet.  The keto diet is a long-term fast or cleanse. That’s why most of the time it can be done for 30 days or up to 90 days. Most people, unless somebody has maybe MS or Alzheimer’s or certain forms of cancer, those people may do it for longer periods. Or severe obesity. But for most people, if somebody’s looking to lose 20 pounds, or somebody’s looking to get rid of diabetes, for most of those people, the keto diet should be done 30 to 90 days. And then transitioning into just generally adding some good healthy carbohydrates back in. But it’s really meant to be like a long-term fast or cleanse. But the key is, your body’s getting into ketosis where your body breaks down body fat. That body fat is turned into ketones, which then your brain and other parts of your body can use as fuel.

Dr. Weitz:            From what I’ve seen, it’s not easy to get into ketosis.

Dr. Axe:                No. It does take typically four to six days for a lot of people to get in. There are secrets and ways I cover in my book, Keto Diet. Some ways to get into ketosis faster, such as using certain types of healthy caffeine like matcha green tea, using adaptogenic herbs, keeping stress levels low, keeping those cortisol levels low, taking exogenous ketone supplements, taking other herbs that support thermogenesis like ginger and cayenne. So there are ways to get into ketosis faster, but it does take at least four days for most people, if not six days, to get into that state.

Dr. Weitz:            I think if your cortisol levels go up because you’re stressed, that’ll cause your body to produce more sugar from protein.

Dr. Axe:                Absolutely. And that’s a huge deal. The people that I see that don’t do well on the keto diet, are the people that have… At the same time they’re keeping their stress hormones are very, very high. And, because I had somebody ask, “Is the keto diet good for people with thyroid disease like hypothyroidism?” The answer is, it depends. For the people that are to, with the diet, keep the stress hormones low, yes. Those people will do well on keto if they have thyroid disease. But if somebody has thyroid or adrenal fatigue, and they’re doing keto and they keep stressing out that entire time, they’re just going to create more problems for themselves.

Dr. Weitz:            So, do you have people actually count a specific number of grams of carbs? I saw in your book you said 5%, but that’s kind of hard to figure. How did they determine how many carbs they should be on?

Dr. Axe:                I have most people do 30 grams or less a day. Some people, if they’re athletes, can do 50 grams or less a day. But I… it tends to be… I’ve never been one into counting the calories. It’s more eat these foods. And eat some of them liberally. Eat your avocados liberally. Eat your coconut liberally. So, that tends to be how more I have had patients do it in the past. I found that hey, you add an extra stress on weighing everything, measuring everything, journaling everything. Some people want that. 20% of people may like to do it that way. But 80% of people, they just want to know what foods can I eat and not eat. Or I tell people, “Don’t eat carbs. You can have one serving of carbs a day, less than 30 grams and it’s either blueberries, beets or carrots. Outside of that, just don’t eat any carbohydrate-rich foods.”

Dr. Weitz:            And basically, carbohydrates are grains, legumes, most fruits and the starchier vegetables, right?

Dr. Axe:                You got it. And some squashes I think are fine. I think if somebody’s doing some spaghetti squash like a serving of a cup, that’s going to be fine for most people on the diet, versus if somebody’s doing butternut squash or sweet potatoes, of course. That’s going to get them out of ketosis for sure. Just too carbohydrate rich.



Dr. Weitz:                          I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness Podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top-tier manufacturer of clinician-designed, cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally. Integrative Therapeutics is also the founding sponsor of Tap Integrative. This is a great resource for education for practitioners. I’m a subscriber to Tap Integrative. There’s videos. There’s lots of great information constantly being updated and improved upon by Doctor Lise Alschuler who runs it. One of the things I really enjoy about Tap Integrative is that it includes a service that provides you with full copies of journal articles and it’s included in the yearly annual fee. And if you use a discount code, Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. And now, back to our discussion. Here is the link to TAP Integrative.



Dr. Weitz:             How important is it to exercise while you’re following a ketogenic diet?

Dr. Axe:                It’s not. It’s really not important. I mean, people may expect me to say it’s very important. Listen, I believe everybody should be moving. Everybody’s healthier doing some form of exercise, whether it be intensity, high-intensity interval training, or yoga or Pilates or barre or weight lifting or cardio, whatever it is. But what I encourage people to do is just move 20 minutes a day. If it’s that’s walking, that’s fine. But what I tell my keto… people I care for, is “Hey, just move 20 minutes a day.” But I don’t… I think people could lose lots of weight if that’s their goal, or balance their blood glucose levels and insulin levels very easily, even if they aren’t exercising if they’re doing keto the right way.

Dr. Weitz:            But doesn’t exercise make it easier to get into ketosis?

Dr. Axe:                It does. Yeah, absolutely. So again, I think movement is going to support your body in doing that. In fact, movement helps all kinds of things from lowering stress hormones to elevating your metabolism, to start to burn up any of those carbohydrates that might be in your diet. So, yes, it definitely can.

Dr. Weitz:            Good. So, can you drink alcohol while you’re following a keto diet?

Dr. Axe:                You know what, you can in small amounts. And it depends on the type of alcohol. Beer, absolutely not. Maybe some dry farmed red wine. Probably one glass or less a few times a week.

Dr. Weitz:            Now what if the glass is about this big, and you fill it to the top?

Dr. Axe:                Right. So we can stay, I think the-

Dr. Weitz:            Have you seen some of the sizes of some wine glasses?

Dr. Axe:                I have. So we’ll say three and a half ounces or less.

Dr. Weitz:            There you go. So what are some of the biggest problems people have trying to follow a keto diet?

Dr. Axe:                Well one, knowing what… Let me say this. I think one of the things people have to know too, and I alluded this earlier, there’s a right and wrong way to do keto. I was on Instagram and I saw somebody post the… Or maybe it was Pinterest. They posted the ultimate keto recipe. And they said you take conventional shredded cheese, you fry it in butter, put bacon in the middle, and then you fry another shell on top, and you have a keto quesadilla. That’s not healthy on any diet.

Dr. Weitz:            Right.

Dr. Axe:                It’s pure conventional beef and butter. That’s… No, that’s not good. Versus eat real, healthy fats. Eat avocados. Eat coconut. Eat tahini. Eat almond butter. Eat grass-fed butter. Do ghee. Eat olives.

Dr. Weitz:            Can you fit some hummus in there?

Dr. Axe:                Yeah. I think a little bit of the hummus is fine. People do fine if they’re just eating that with their vegetables. But I think that’s a big thing to know is that you got to get a lot of these sources of healthy fat in your diet. And that’s what’s important. So knowing, and in my book Keto Diet, I go through a 30 day meal plan of what a keto breakfast looks like, keto lunch, keto dinner, keto desserts, keto snacks. And so we have all those recipes in the book as well. But I think if you have the recipes in the 30-day meal plan like I have in my book, it’s actually… I don’t think it’s that difficult to follow then.

Dr. Weitz:            No, I appreciate the fact that you emphasize the importance of doing it a healthy way with avocados and vegetables, because that’s one of the things that really turned me off to the whole idea of the Atkins diet which was kind of the progenitor of the keto diet, which people are eating bacon and cheese and all this unhealthy food. And I just, it was like, I get it. I understand how fat could be healthy, but there’s just no way that eating pork bacon can be good for you.

Dr. Axe:                Totally agree. And it’s not. In any setting.

Dr. Weitz:            So, will a keto diet be detrimental to your microbiota?

Dr. Axe:                So the answer is, not if you’re doing it the right way. It’s important to remember, certain civilizations lived on keto. Eskimos lived on a keto diet. Sometimes the Hadza possibly did. We know sometimes people lived on keto diet. But the thing is, you got to be getting the right fermentable fiber in your diet. That’s key in probiotic rich foods. So when you do keto, you got to get fiber. So again, one serving of berries a day, and then loads of vegetables and some nuts and seeds like chia and flax, pumpkin seeds, almond. But getting the fiber in your diet, and then getting some of those fermented foods like sauerkraut in there, and all the vegetables. If you’re doing loads and loads of vegetables, and then herbs or spices. Doing matcha green tea. Doing tumeric. Doing ginger. Doing supplements like triphala which is an ancient Ayurvedic yoga gut digestive support.  But doing those types of things, your microbiome will be healthier than ever. In fact, there’s an animal model study for people with ASD, autistic spectrum disorders. And they found that actually, their gut microbiota dropped especially the bad bacteria which improved behavioral outcomes, their overall digestion, their memory, their focus. So, if anything, it’s actually going to have a great benefit on the gut microbiota if people are doing loads of vegetables, herbs and spices and fermented foods.

Dr. Weitz:            Cool. Do you have people measure to see if they’re in ketosis? Use those urine dipsticks?

Dr. Axe:                Most of the time I don’t have people do it. Now if somebody’s having some issues, absolutely. And if somebody loves to measure things, that’s great. What I’m looking for is how you’re feeling. And are your symptoms changing? How do you look? And so people noticing, oh, I can tell my face is leaning in. I can tell I’m leaning out here. I can tell my energy now is better. I can tell my hormones are… I have people more so listen to their body than I do using the strips. But I think using ketone strips can be great.

Dr. Weitz:            What are some of the most beneficial supplements to take when following a ketogenic diet?

Dr. Axe:                I think number one would be making sure that we’re getting plenty of probiotics. So getting quality probiotics, especially the soil-based organisms, those SBOs. So I would look for a good quality soil-base probiotic supplement that also contains herbs and spices like triphala and ginger that support digestive health. But a probiotic supplement would be number one. Number two, collagen. I think collagen is critical for tissue regeneration. When people go keto, I not only want them to balance insulin and to lose the extra body fat, I want them to regenerate and heal. And so in that case, I’d say number two would be a collagen protein or a bone broth protein. Bone broth protein’s probably even the best, because that also has hyaluronic acid and glucosun and a chondroitin. So a scoop of that a day in a smoothie.

Dr. Axe:                The third supplement I would say would be… I think you want to stay alkaline. I think doing lots of greens. So something like chlorella or spirulina or organic super greens powder of some sort could be great for people. Just a couple more. I think taking adaptogenic herbs can be good. I think ashwagandha is one of those that can be very good to help keep those cortisol levels lower. And for some people, exogenous ketones, if somebody really wants to amp up the weight loss and get into ketosis faster. For a period of time, I think that’s another good one that people can consume.

Dr. Weitz:            Probably minerals too, right? Because there’s a lot of electrolyte imbalances that result from a keto diet.

Dr. Axe:                That’s the other thing I was going to say. In fact, one of the things I have a lot of people do when they’re on the keto diet is drink loads of celery juice. But celery juice to get the minerals. Lots of steamed spinach.

Dr. Weitz:            The cure for everything. Celery juice.

Dr. Axe:                Listen. I do want to say this. I’m not… And by the way, I’ve never met the guy, Medical Medium. He seems like… Obviously a lot of his stuff has a very, just polarizing effect in terms of the way he markets.

Dr. Weitz:            My wife read it. Had her first dose of celery juice, got sick as a dog, concluded this must be good for me. So now every time I go to the market, I have to call ahead and have them stock up on celery.

Dr. Axe:                I was actually recommending celery juice before that guy ever came out with the celery juice book or whatever he came out with. Which at least it’s better than the book before, not by him. Two years ago, it’s the grapefruit juice diet. At least this time it’s celery. So, but I do think some vegetable juice that’s mineral rich, especially celery, cucumber, spinach, ginger, lemon, that sort of… I think can help. But, you’re right, a multi-vitamin mineral can also be great for people that are looking to… That they’re on keto.

Dr. Weitz:            Now, you talk about using the keto salts. But isn’t the whole idea to get your body to produce those ketones?

Dr. Axe:                Yeah again, I’m not… Anytime I’ve done keto in the past, I’ve never used the salts or the exogenous ketones. Again, it’s just a supplement there for people if they want to see, get into ketosis faster, or they’re going to do it for 30 days and want to sort of reap the ultimate benefits. I think it’s fine thing to take. But do I think it’s number one on the list? No, by any means, in terms of supplements. But again, a lot of people I have do it without it.

Dr. Weitz:            Now since the ketogenic diet is hard to stay on long-term, once your recommendation for them to do it for 30 or 60, 90 days is over, what should they do then long-term?

Dr. Axe:                So, I recommend eating a healthy amount of carbohydrates. And so I think, realistically, now what we think of as normal is not normal. I think what the normal amount of carbohydrate consumption is probably close to, let’s say, 30% maybe. Maybe 40. But it’s not 50, 60 or 70.

Dr. Weitz:            You mean Big Mac, fries and Coke is not a reasonable way to eat?

Dr. Axe:               That’s not it. That’s definitely not it. So, I do think that keeping that protein around 25%, keeping the fat around something like 40%. What does that leave? 35% probably for carbohydrates. So, I do think about a third of your diet at carbohydrates is fine. It’s probably 100 grams or less is probably going to be about 100 grams a day for most people is great, and that’s three. It’s a serving of berries. It’s a half a sweet potato. It’s one serving of rice. It’s the right amount.

Dr. Weitz:            And I saw in your book you also talk about keto cycling as a way to sort of integrate some keto diet into your-

Dr. Axe:               I think for some people if they sort of liked being on keto but they wanted sort of a break, to be able to go out with friends and be able to do something long-term, keto cycling can be great. It’s sort of carb cycling meets keto diet. My wife actually did this. I hadn’t thought of it necessarily until my wife said, “Hey, I’m going to try this.” She did keto 30 days and then she started doing sort of these just a carb day every third day. And she said she actually felt better doing that than actually full-on keto, and she actually, the result she saw were just as good and long-term, better. She noticed, and my wife is a chiropractor. She’s a fitness instructor, yoga instructor. She’s super healthy. But she ended up losing just a few… Just leaning out a little bit more and getting her body to kind of ideally where she wanted it to be doing that. So I think the keto cycling as we cover in my book, is a great thing for a lot of people to do.

Dr. Weitz:            Cool. Well, thanks for the interview, Josh. How can our listeners get a hold of you and find out about your books and your supplements?

Dr. Axe:                Sure. Well, you can follow me on Instagram, Facebook and draxe.com. Here’s the new book that just recently came out, Keto Diet. You can see it here. You can buy it on amazon.com. In fact, it’s been ranking as one of the top-selling health books the past three months. International best seller. But in this book, we have 80-plus recipes, 30-day meal plan, and also a keto cancer plan and others. So people can check out this book here, and check it out on Amazon, read some of the reviews there we have. And then-

Dr. Weitz:            No, I read it.

Dr. Axe:                Awesome.

Dr. Weitz:            It’s an easy read. It’s great.

Dr. Axe:                Awesome. And then draxe.com. It’s D-R-A-X-E dot com, my website. But I want to say, Dr. Ben, thanks so much for having me on your show.

Dr. Weitz:            Thank you so much, Josh, Doctor Axe.

Dr. Axe:                All right, God bless.



Cancer Related Fatigue with Dr. Lise Alschuler: Rational Wellness Podcast 106

Dr. Lise Alschuler discusses Fatigue in Cancer Patients with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

1:45   Fatigue in cancer is under reported, underdiagnosed, and undertreated.  That’s because cancer doctors tend to focus on patients pain and tend not to pay attention to fatigue even though many patients report that the fatigue is their most distressing symptom. 

3:33  Cancer related fatigue is a very severe fatigue and not the kind of fatigue that you can sleep off or easily recover from. 80% or more of cancer patients suffer with this type of fatigue. Dr. Alschuler explained that “from a functional perspective, we would think of this kind of fatigue as the fatigue that is happening on a cellular or even mitochondrial level and, has really gotten to a point where it’s influenced our endocrine system. So, it’s obviously going to take quite some effort to get people out of this type of fatigue.” And for up to 50% of these patients will have this fatigue for years after the cancer is gone, and this where a Functional Medicine approach can be helpful.

5:22  Dr. Alschuler feels that most of the fatigue is related to the cancer more so than the cancer treatment, though the treatment adds to it. The mechanism is the release of inflammatory cytokines by the cancer cells or the stromal response around those cancer cells, like Tumor Necrosis Factor alpha (TNFalpha) and Interkeukin 6.  This is the initial cause of the fatigue and one of the next phases of cancer related fatigue is the circadian rhythm disruption and the hypothalamic/pituitary/adrenal access dysfunction that occurs.

7:06  Sleep is very important in being able to recover from cancer and many patient have their circadian rhythm and their normal sleep cycle disrupted, so you want to help the patient to reinstate their circadian rhythm and their normal sleep pattern.  We’ve discovered clock genes, which occur in every cell in our body and they are tied to our circadian rhythm.  These clock genes are also involved in really important things like cellular repair, cell cleanup, autophagy, so we want to have our circadian rhythm in tact. Dr. Alschuler will often measure the adrenal stress profile with the cortisol awakening response.  She will also measure cytokines, including C Reactive Protein and Interkeukin-6, which are acute phase reactants, 11-Dehydrothromboxane B2, which is a measurable metabolite of the arachidonic acid LOX and COX pathways, and 8-hydroxy-2-deoxyguanosine, which is a good indicator of oxidative stress.

12:46  Cancer and chemo both result in a lot of oxidative stress on the body, so everybody who goes through cancer and cancer treatment will be depleted of antioxidants. They need some antioxidant repletion either from antioxidant supplements or from a good plant based vegetable and fruit diet. The oxidative stress contributes to the HPA hypothalamic/pituitary/adrenal/circadian rhythm dysfunction, as well as a contributing factor to mitochondrial dysfunction, both of which are related to fatigue.

13:45 It is understood that chemotherapy and radiation use oxidative stress (free radicals) to kill cancer cells and we need to be careful about recommending antioxidant supplements while treatment is occurring.  We now have a lot of data to be able to determine which particular nutritional supplements might help or interfere with specific chemo drugs.  But it is a different story with the newer targeted drug therapies of cancer, like the molecular based, antibody based, or immuno therapies and new drugs are being released quite often. And we are still learning whether there might be interactions with natural therapies. We need to understand how each of these drugs work and how they are metabolized and then try to figure out if there is a likelihood that there might be an interaction between a given supplement and a targeted treatment. 

21:44  The best type of diet for patients with cancer is the one that is going to lower inflammatory cytokines. Intermittent fasting for 13 hours helps to lower inflammation. Fasting for a day or two before, on the day, and the day after chemo infusions helps to minimize toxicities, esp. to the digestive tract, and may improve their energy a bit.  While cancer patients should avoid a high carb diet, they shouldn’t necessarily follow a ketogenic diet.  But should make sure that they get plenty of healthy fats like omega 3 fats, though one recent study found that soy oil was better than fish oil in reducing cancer related fatigue:  Multicenter randomized controlled trial of omega-3 fatty acids versus omega-6 fatty acids for the control of cancer-related fatigue among breast cancer survivors.  Coconut oil and MCT oil also reduce cancer-related fatigue. The effects of virgin coconut oil (VCO) as supplementation on quality of life (QOL) among breast cancer patients. Dr. Alschuler also recommends that cancer patients consume high quality proteins like legumes, tofu, seeds, nuts, eggs, grass fed or wild meats, fish, and organic poultry.  When it comes to consuming legumes and seeds, one prominent Functional Medicine doctor–Dr. Steven Gundry–has been claiming that the fact that these foods contain lectins is a problem for our health.  In advocating consuming legumes and seeds I asked Dr. Alschuler if she worries about lectins and her response is “You know, there’s many thing’s we can worry about but, no, lectins hasn’t made my list recently.”  Dr. Alschuler also recommends branched chain amino acids, which have been used in several studies that show benefit for cancer-related fatigue. 

27:18  Recommended nutritional supplements for cancer-related fatigue include:  1. Panax quinquefolius (American Ginseng) when taken at a dosage of 2 gms per day during cancer treatment and continued for 8 weeks after reduces cancer-related fatigue.  2. Rhodiola rosea is an adaptogenic herb that makes cancer patients more energetic. 3. Ashwaganda is also an adaptogenic herb that may be helpful. 4. CoQ10, esp. the ubiquinol form helps with mitochondrial support, 5. Reduced Glutathione can help support the mitochondria, 6. L-carnitine helps with fatigue at a dosage of 4 gms per day, though if the patient is on ataxane chemotherapy it can make peripheral neuropathy worse and 7. Acetyl L-Glutathione may be better for both fatigue and also cardiovascular support. 

32:14  Exercise is important in rebuilding the mitochondria and their functionality.  Exercise also helps to increase hypothalamic/pituitary/adrenal resilience and reinstate the normal circadian rhythm.  It is beneficial to do a combination of aerobic and resistance exercise for at least 45 minutes per day at a level that is moderately strenuous.

34:02  Some organic coffee with caffeine or green tea can stimulate sympathetic nervous system responsiveness and help reinstate normal circadian rhythm and enhance cognition.  And both coffee and tea are inversely associated with cancer risk.


Dr. Lise Alschuler is a Naturopathic Doctor with board certification in Naturopathic Oncology and she was past president of the Oncology Association of Naturopathic Physicians. She is the executive director of TAP Integrative, a nonprofit educational resource for integrative physicians. If you use the discount code WEITZ you can subscribe for only $99 for the year.  Dr. Alschuler wrote The Definitive Guide to Cancer and The Definitive Guide to Thriving After Cancer. She sees cancer patients in Scottsdale, Arizona and is a sought after speaker at conferences around the world and she co-hosts a ratio show, Five To Thrive Live! on the Cancer Support Network. Her website is DrLise.net.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition from the latest scientific research and, by interviewing the top experts in the field.  Please subscribe to the Rational Wellness Podcast on iTunes and YouTube. And, sign up for my free ebook on my website by going to doctorweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way more people can find out about the Rational Wellness Podcast.

Our topic for today is fatigue and cancer with Dr. Lisa Alschuler. The National Comprehensive Cancer Network says that, “Cancer related fatigue is a distressing, persistent, subjective sense of physical, emotional and, or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.”  Pain is very common in cancer and, up to 80% of patients receiving chemotherapy or radiation and, cancer survivors report that fatigue is a disruptive symptom months and even years after treatment ends. I meant to say, fatigue is a common symptom in cancer. Fatigue in cancer is under reported, underdiagnosed, and undertreated.  That’s because cancer doctors tend to focus on patients pain and tend not to pay attention to fatigue even though many patients report that the fatigue is their most distressing symptom.

Dr. Lise Alschuler is a naturopathic doctor with board certification in naturopathic oncology, she was past president of the oncology association of naturopathic physicians, she’s executive director of TAP Integrative, a non-profit educational resource for integrative physicians, which I use regularly and very, very helpful.  They have tons of great educational videos and other information, and the service also includes free retrieval of full journal articles all for the price of the annual membership, which I take full advantage of.  Dr. Alschuler wrote, The Definitive Guide To Cancer and, The Definitive Guide To Thriving After Cancer, and The Definitive Guide To Cancer is just an amazing resource and, anybody who sees cancer patients, you have to have that book as a resource.  Dr. Alschuler sees cancer patients in Scottsdale, Arizona, she’s a sought after speaker at conferences around the world, she co-hosts a radio show, Five To Thrive Live on the cancer support network and, she’s also a cancer survivor herself.  Dr. Alschuler, thank you so much for joining me today.

Dr. Alschuler:                     My pleasure, Dr Weitz. It’s nice to talk to you again, its been a while so, looking forward to it.

Dr. Weitz:                          Absolutely.  So, what are some of the reasons that cancer patients get fatigue?

Dr. Alschuler:                     You know it’s a really, first of all, I want to just emphasize the introduction that this kind of fatigue is not the kind of fatigue that maybe we all think of. Like, the fatigue that we get when we’re working too hard and, we just need to sleep in on the weekends and then, we kind of wake up rejuvenated. This is not a fatigue that people can sleep off, it’s not something they can recover from, it’s a very debilitating fatigue and, it’s associated, actually, with anxiety, with depression, with cognitive dysfunction. It’s a very, so, it’s a very deep seated fatigue.  I think, from a functional perspective, we would think of this kind of fatigue as the fatigue that is happening on a cellular or even mitochondrial level and, has really gotten to a point where it’s influenced our endocrine system. So, it’s obviously going to take quite some effort to get people out of this type of fatigue.  But, so I just wanted to really emphasize this type of fatigue is quite different and, as you said, the majority of people going through cancer and treatment, upwards of 80% have this kind of fatigue. It may not be severe, it may be sort of mild but, even mild cancer related fatigue is pretty significant and, some people fortunately probably over half do kind of spontaneously, as we would say, their innate healing process takes over and they can overcome the fatigue, maybe six months out from their diagnosis but, the rest can have it for years and, years and, years.  So, this is something, I think, our prime opportunity for integrative practitioners to really jump in on. And now that I’ve taken us on this tangent, I don’t even remember your question.

Dr. Weitz:                          That’s great.  How much of fatigue do you think is related to the cancer versus the cancer treatment?

Dr. Alschuler:                     Yeah, I think that the majority of fatigue is related to the cancer and, I think that the treatment is basically jumps onto that.  The reason I say that is, because there seem to be some emerging underlying mechanisms that are becoming commonly accepted. So, one is, that there’s clearly a cytokine aberration in cancer related fatigue. We think that it probably is, that sort of the main culprit is high levels of Tumor Necrosis Factor Alpha and, then along with that, of course, that Interleukin six, those two, when they’re in high levels, the classic symptom is fatigue.  So, there’s definitely something to do with cytokines and cancer when you have the malignancy, there is cytokine aberrations as a result of the malignancy, either the malignant cells are secreting these cytokine’s in high levels because of up-regulated NF Kappa B in those cells or, and, or the stromal response in and around those cancer cells, there’s a high level of inflammation.  So, I think it’s mostly the cancer but, you take that kind of inflammatory, simmering mix and, you throw some chemo in there and, you’re just going to aggravate those inflammatory cytokines.  One of the next phases of cancer related fatigue then is, the circadian rhythm disruption and the hypothalamic/pituitary/adrenal access dysfunction and, that system, as we know, is also very sensitive to cytokine induced oxidative stress. So, I think that that’s kind of a secondary event in the continuum of cancer related fatigue. 

Dr. Weitz:                           So, you mentioned the circadian rhythm and, cancer patients often have trouble sleeping, either as a side effect of treatment or, due to stress or, due to other factors. What role does sleep play in this?

Dr. Alschuler:                    Yeah, it’s a really important point.  So, as I mentioned earlier, if somebody has cancer related fatigue and, they just say, “Okay, I’m just going to sleep for eight hours a night,” they still may have cancer related fatigue if the mitochondrial dysfunction is not addressed, if the inflammation isn’t mitigated and, if the circadian rhythm isn’t reinstated.  That being said, all those three things won’t do anything for somebody if they’re not sleeping so, sleep is essential, it’s an essential component to recovery and, as you mentioned, a lot of people go through this disease and treatments because their circadian rhythm is so disrupted and, so shifted their sleep cycle gets very disrupted as well.  So, one of the key cornerstones, if you will, of addressing recovery and survivorship is to reinstate circadian rhythm and, as a component of that, sleep.

Dr. Weitz:                            So, let’s say the person normally wakes up every day at 6:00 or 7:00 or, 8:00 in the morning, goes to work, goes through their day, et cetera, et cetera. Now they get cancer and, maybe they’re off work and, their schedule changes so, it kind of throws their circadian rhythm off. Is it better for them to just go back to waking up every day at 7:00 and, having their regular schedule? Is that something that’s beneficial?

Dr. Alschuler:                     Yeah, I think it is. There’s, you know, now that we’re learning more about the circadian rhythm, I think that we understand how sensitive it is to what I call, ritual and rhythm and, the more ritual and rhythm we have in our day-to-day lives, the easier it is for us to have a healthy circadian rhythm.  And, remember, that even within the last 10 years, we’ve just now discovered clock genes, which occur in every cell throughout our body, are directly tied to the circadian rhythm. They only function or turn on in accordance with the circadian rhythm and, most of the genes controlled by clock genes are involved in really important things like cellular repair, cell cleanup, autophagy, so we want to have our circadian rhythm in tact for lots of reasons, that being the primary one.  So, yes, to go back to your question, if somebody had kind of a rhythm, ideally a rhythm that were used to, now they’re off work, their rhythms kind of all crazy, it would really be helpful to try to go back as closely as possible to what they had before, assuming that that rhythm was optimal for them.

Dr. Weitz:                            When you’re treating a patient who has cancer related fatigue, do you, when you work them up, do you try to sort through which, you know, what are some of the causes of the fatigue?  Like, for example, do you measure cytokine’s, are there certain questionnaires you use?  Do you try to figure out how much is hormonal, how much is related to different factors in coming up with a treatment plan?

Dr. Alschuler:                     Yeah, I often do.  You know, not 100% of the time if I have a good kind of, I don’t know if it’s intuitive hit or, just having done this for a while hit but, if I’m really wanting to be very precise then, yes.  So I’ll do an adrenal stress index test and measure cortisol at four points over the 24 hour period. Get a really good sense of their cortisol awakening response, as well as their full circadian rhythm and then, I do often …

Dr. Weitz:                            That’s just, that’s the new part of the adrenal stress test, is the cortisol wakening response where you are measuring how their cortisol changes in the first 30 minutes after awakening.

Dr. Alschuler:                     Yeah, haven’t seen a normal one yet but, I’m still holding out for it.  But, I think it is important, this is really actually a pretty substantial body of literature just on cortisol awakening response in relationship to depression and, anxiety and, all sorts of things.  So, yeah, adrenal function, for sure. I do measure cytokine’s for this purpose and also, just as a way to assess, to some extent, what’s the milieu of this person like so that I have a, kind of I can determine whether or not they are more or less at risk for occurrence.  So, for cytokine’s, I will most commonly measure include C reactive protein as an acute phase reactant, Interleukin 6, I definitely look at and, those two alone are usually enough to do it. There’s another inflammatory test that I have started to use quite a bit, it’s a urine test and, it measures 11-Dehydrothromboxane B2, which is a measurable metabolite of the arachidonic acid LOX and COX pathways.  So, it’s a very important way to assess the eicosanoid side of inflammation, and then the CRF and the IL-6, sort of measure the genetic side of the inflammation, the NF Kappa B, up regulation side so, all that together can give me a pretty good sense of what’s going on.  And then sometimes I might also look at, see if there’s any evidence of oxidative stress, which would be another indication of the fact that there’s up-regulated inflammation so, looking at 8-hydroxy-2-deoxyguanosine would be kind of my go to.

Dr. Weitz:                            Okay so, oxidative stress means that there’s not enough antioxidants to block some of the excessive oxidative stress.  And, of course, oxidative stress is often part of the chemotherapy if they’re getting chemo.

Dr. Alschuler:                     Yeah, most everybody who goes through cancer and its treatments will be depleted from an antioxidant perspective at the conclusion of that treatment.  So, typically, some degree of repletion is necessary.  It doesn’t necessarily have to be supplementation, a good plant based vegetable and fruit rich diet can restore people’s antioxidant capacities but, yeah, it’s very common and, that oxidative stress is a contributor to the HPA hypothalamic/pituitary/adrenal/circadian rhythm dysfunction, as well as, a contributing factor to mitochondrial dysfunction, both of which, as we talked earlier, are related to fatigue.

Dr. Weitz:                            I know we’ve discussed this in the past but, where are we in terms of the use of antioxidants during cancer treatment?

Dr. Alschuler:                     You know, again, I think that the controversy, I will say is a little bit muted right now and, maybe because we’re starting to get a little bit more savvy and realize that when you say, antioxidants, we’re talking about such a large and diverse group of compounds, some of which are problematic with certain chemotherapy agents or, certain radiation treatments, some of which are actually very helpful.  So I think we have to sort of say, the question shouldn’t be, are antioxidants safe or not? The question should be, can I use X, Y or, Z?

Dr. Weitz:                            Right.

Dr. Alschuler:                     Then we have data now to answer that very specific to the actual treatment that somebody’s getting, the cancer type even and, figure out, yeah, you were a prime candidate for using this antioxidant or, nope, this is not good for you.

Dr. Weitz:                            Okay, good, good, good.  And, does that apply to the newer drugs, the targeted drugs?

Dr. Alschuler:                     So, you know, as you mentioned, cancer treatment is changing and, hopefully, some day, chemotherapy will be a thing of the past but, we’re not quite there yet.  But, more and more we’re moving towards molecular based therapies or, antibody based therapies or, immuno therapies so, these all target tumors in one way or another by either, capitalizing on a genetic aberration in the cancer and targeting that very precisely or, by stimulating our own innate healing mechanisms, like the immuno-therapies are essentially un-breaking the immune system to attack.  And, we’re getting a lot more sophisticated with all this now. Because this is all new and, it’s happening so fast and, there’s new drugs in trial all the time, we, in the integrative space, are playing catch up, for sure and, we just are really in a place of trying to understand what we have that’s helpful, not contraindicated.  Generally speaking, this is an area where it would really be important to be under the care of an integrative practitioner with an expertise in integrative oncology because, like even me, when I had a patient that, and that’s all I do is, integrative oncology and, when I have patient, I get patients every week with new drugs I haven’t heard of so, I have to go, I have to research the drug and, really understand its mechanism, it’s metabolism and then, I have to apply that with a knowledge of it’s side effect profile, figure out what I have to use, see if there’s any potential for a reaction and, be very cautious around that whole thing. So, it takes a lot of time and effort so it’s not, you know, we’re still learning, that was a long-winded answer.

Dr. Weitz:                            You know, I was looking at some studies on some of this stuff and, a couple of the papers were mentioning the part of the cytochrome P450 pathway that this nutrient affects and that could interfere with this drug. And you start going, oh my God, you can’t take this, you can’t take that and then you start looking at the drugs and you realize that this cocktail of cancer drugs are actually interfering with each other.  And, you know, nine other things that they’re taking to control their blood pressure and, everything’s interacting on these cytochrome P450 pathways and so, it occurs to me that, if you use that as the basis for not eating something, it’s way to complicated to use that as a rule out, don’t you think?

Dr. Alschuler:                     Well, I think, so eating for sure but, I think that with supplements the challenge is that, so, yeah so, first of all, a good practitioner, conventional practitioner will do a drug/drug interaction check when they’ve introduced chemo to make sure, because, and sometimes I’ve seen patients get pulled off of pre-existing antihypertensive drugs, or whatever, because of potential interaction.  That being said, there are some that are left but, the degree of the interaction can really vary so, it may have a little reaction but, it’s not clinically significant. So a lot of the nutrients in herbs, the data we have is pre-clinical and, that has almost no relevance to what happens in the human.  So, really, I look for human pharmacokinetics studies so that I can see, is there really a potential for interaction here?  And, that being said, if somebody’s on a small targeted molecule type of therapy, which has a very small dose and, a very narrow, kind of a very, the blood dose, the concentration that is targeted is very narrow, I don’t want to mess with that because, if I mess with that, I could run the risk of increasing side effects and, you know, who knows what.  So, you know, in general it’s best to be cautious with drugs that have a high percentage of toxicity.

Dr. Weitz:                          Right, okay.  So, back to the fatigue. What role does anemia play, which is a common side effect of a lot of chemo?

Dr. Alschuler:                     Yeah so, it’s a really good point.  So, generally speaking, when we’re talking about care to related fatigue, that’s, in medical kind of perspective, that has the assumption that we’ve ruled out known causes of fatigue.  So, if somebody comes to treatment, I’m tired, you need to check, are they anemic, do they have thyroid dysfunction or, are there any other obvious causes of fatigue and, obvious nutrient deficiency, for example? Address all that and, if that takes care of the fatigue, we’re good, if they’re still tired, then they have this cancer related fatigue.

Dr. Weitz:                            Do you have a certain panel you like for assessing nutrients because, there’s a lot of controversy as to the best way to assess nutrients because, a lot of times just serum levels are not indicative of tissue levels, et cetera.

Dr. Alschuler:                     Yeah so, I don’t run serum vitamin levels except for vitamin D and, vitamin D deficiency is associated with fatigue so, that’s one that we want to check.

Dr. Weitz:                          Right.

Dr. Alschuler:                     I do look at red blood cells zinc, red blood cell magnesium, I think those are very accurate and nice reflections.  To get at B vitamins in general, I typically run a urinary organic acids test.

Dr. Weitz:                          Okay.

Dr. Alschuler:                     Yeah, which kind of looks at the metabolites from the TCA or the Krebs cycle where, we use the vitamins to make energy so we can tell by the ratio of metabolites whether we’re lacking certain B vitamins or, we have kind of a blockage in that pathway.

Dr. Weitz:                          Yeah.  Have you used the NutrEval? Do you like that test?

Dr. Alschuler:                     I have ordered that on occasion and I think that it is, it provides a really broad view of nutrients, nutrients status so, I think it can be helpful.  I’m not 100% sure and, this could just be my ignorance, the data but, I’m not 100% sure that that snapshot in time is truly representative of an ongoing functional deficiency that’s related to symptoms or, pathology.  So, I’m not sure how actionable some of that information is. And there’s always a range so like, what’s really the cut off? You start to, what indicates, yes, we need to give this person this supplement.  So, I still have some questions around that but, I think it could be a guide.

Dr. Weitz:                          Yeah, because it includes an organic acids and then, there’s also some red blood cell minerals and so, throw in some other stuff.  So, what type of diet?  So diet is very controversial when it comes to cancer and, when we have patients with cancer with fatigue, you want to make sure they’re getting the right nutrients to give energy. We often think of carbohydrates for energy but, these days, one of the more popular strategies for dieting cancer is to use a lower carb approach, a ketogenic approach, maybe intermittent fasting.  What’s your take on that?  How does that interact with fatigue?

Dr. Alschuler:                     Yeah, excellent question.  So, with cancer related fatigue, again, because it’s primarily a cytokine disorder, the diet interventions that are going to lower inflammatory cytokine’s are going to be the ones that would be most effective.  So, for example, intermittent fasting, we know lowers CRF, sorry, high sensitivity to reactive protein. So, we know that when we intermittent fast, we lower inflammation in the body so, that’s a perfect dietary strategy for somebody with cancer related fatigue. My goal is 13 hours as an overnight fast, anything above that, bonus but, 13 hours is kind of the magic number from a research perspective. And then, beyond that …

Dr. Weitz:                          What about fasting, some clinics are recommending fasting the day of chemo, maybe the day before, the day after or, some level of complete fasting all centered around when they get their chemo.

Dr. Alschuler:                     Yeah, so that’s kind of a separate strategy in terms of minimizing some of the toxicities from the chemo, particularly to the digestive tract.  It does appear, maybe, in some people to also improve people’s energy a little bit within the time of getting chemo, whether that has any impact on post treatment, cancer related fatigue is, to my knowledge, not known. I haven’t personally observed a strong correlation there. But, it may, I don’t know.

Dr. Weitz:                          Okay. I’ve thrown you off track.

Dr. Alschuler:                     Yeah, no, that’s fine.  But, yeah, post treatment, I think, intermittent, overnight fasting, definitely. I would not go for a high carb diet unless you’re talking about complex carbs from vegetables through whole grains but, simple carbs, although they give us immediate energy, are very oxidative over time.  So, that’s going to worsen the cancer related fatigue. So, really what’s more important is, two things. Number one, fats and, it doesn’t have to be necessarily a ketogenic diet but, we know that omega three fatty acids and, actually there was a very recent study that somewhat surprisingly found that soy oil was more effective than fish oil in reducing cancer related fatigue.

Dr. Weitz:                          Really?

Dr. Alschuler:                     Yeah, which is kind of crazy that they attributed that to the soy oils content of omega six and omega nine.

Dr. Weitz:                          What?

Dr. Alschuler:                    And that that had a decreasing effect on tumor necrosis factor alpha.  Kind of interesting, I don’t know, its just sort of an outlier for me but, I think really what it speaks to is, we need good fatty acids, that our body needs.

Dr. Weitz:                          Was that study funded by the American Heart Institute?

Dr. Alschuler:                     No, I don’t think so.

Dr. Weitz:                          Okay.

Dr. Alschuler:                     And, the other things so, fatty acids so, fish derived fatty acids for sure.

Dr. Weitz:                          Coconut oil, MCT oil.

Dr. Alschuler:                     Coconut oil, yes.  I think that, actually, has been studied and seems to improve cancer related fatigue.  And then, protein, you know, people really need a lot of protein. The range, generally is, just for an average person is like point 0.6 to 1.2 kilogram or, grams of protein per kilogram of body weight so, after treatment, I go to the high side of that. 1.2 grams of protein per every kilogram of body weight and, try to get people eating really high quality protein.  And so, high quality protein, high quality fats, overnight fast, from a dietary perspective, are kind of the keys and then …

Dr. Weitz:                          When you say, high quality protein, you’re advocating animal products, right?

Dr. Alschuler:                     I’m fine with animal products, you know, I think that if so, high quality proteins for me, for my vegetarian perspective include, legumes, tofu, seeds, nuts, eggs. And then, from my non-vegetarian perspective, grass fed or wild meats, fish, organic poultry.

Dr. Weitz:                          Okay.  You worry about lectins?

Dr. Alschuler:                     You know, there’s many thing’s we can worry about but, no, lectins hasn’t made my list recently.

Dr. Weitz:                          You mentioned protein, I saw one of the studies used branched chain amino acids as part of the protocol.

Dr. Alschuler:                     Yes. I think branched amino acids are really helpful for cancer related fatigue and, I think that that’s probably where supplementation is the easiest way to get that in.  So, getting a protein powder with a good whey or, amount of branching amino acids, people can really subjectively feel the difference pretty quickly with that.

Dr. Weitz:                          So, which nutritional supplements can be beneficial for patients with fatigue, cancer related fatigue?

Dr. Alschuler:                    So, from a, there are many, first of all and, the first thing that comes to mind, of course, when we’re thinking about circadian disruption are, adaptogenic herbs. And there was actually a really nice study that was done using Panax quinquefolius so, American Ginseng, specifically on cancer related fatigue and, they started the Panax quinquefolius, it was, I think two grams a day during the treatment, and then they continued it beyond treatment for eight weeks and, there was a substantial reduction in the degree and, the severity of the fatigue and people taking the Panax quinquefolius and so, that really just speaks to the role of preserving the circadian rhythm, which is one of the things that these adaptogenic plants do.  So, I use Panax quinquefolius, American ginseng, often. I also use an adaptogen called, Rhodiola rosea, which is, although adaptogens aren’t sort of like energy pills, there are some adaptogens, which are a little more energetic than others and, so Rhodiola is one.  It just really increases people’s physical stamina, their mental clarity so, I find that very helpful.

And, there’s also adaptogenic blends, which work beautifully for people. If people are really depleted, really depleted coming out of therapy, I’ll probably start a little more gently, something like, ashwagandha and, you often dose that at night because, it has a little bit of a sedative effect to it.  So I definitely use that. Then I think about mitochondrial support and, you know, mitochondrial support can get very complicated but, I think, fundamentally, CoQ10 is critical and, I happen to favor, ubiquinol as the form of CoQ10 and, I dose it pretty aggressively so, I’m giving people 100 milligrams, two or three times a day to really try to get their CoQ10 levels up and, to try to improve their mitochondrial health. Because, the mitochondria themselves become oxidized and, they need to get that redox balance back.  Along those same lines, I’m also a fan of glutathione and I will use glutathione, reduced glutathione post treatment.  That’s not something I use concurrent with treatment but post treatment, to help replete people’s redox potential or, antioxidant levels. Typically dose that in the morning and, that can be quite helpful for people too. And, that supports, of course, mitochondrial function.

Dr. Weitz:                          You like a liposomal form?

Dr. Alschuler:                     You know, I don’t need a liposomal form, actually, there’s some good data by a researcher, by the last name of Ritchie, at Pennsylvania, Hershey State, the University of Pennsylvania, I can’t quite get his university quite right but, he really eloquently demonstrated that glutathione is very well absorbed orally and, it increases glutathione levels in various bodily compartments in accordance with the dose. Doesn’t need to be liposomal.  Liposomal, I think, probably does enhance the glutathione absorption even more so, especially if there’s compromised intestinal integrity, which often is another sequelae of chemo, for example or, radiation, then liposomal might be even better.  But, you know, it’s a cost issue, whatever, I think just straight up, reduced glutathione works well.

Dr. Weitz:                           L-Carnitine?

Dr. Alschuler:                     Yeah so, L-Carnitine’s a good one, you know it’s been studied and it for sure reduces fatigue, particularly kind of muscle fatigue.  And it’s particularly good for people who have had radiation and, L-Carnitine is effective but, it needs to be dosed the four grams a day. Anything less than that just doesn’t work.  The challenge with L-Carnitine is that, if somebody’s had ataxane chemotherapy, it can make peripheral neuropathy worse. So it’s contraindicated in people who have had ataxane chemotherapy.  Other people seem to do fine with it.

Dr. Weitz:                          Is that just Acetyl L-carnitine or, does it not matter?

Dr. Alschuler:                     No, it’s all of it, all carnitine and acetlyl L-carnitine.

acetlyl L-carnitine is the one that I use when I want to address the fatigue and I’m also concerned about heart function, which I didn’t really speak about, it can be another contributor to fatigue. There are some cardio-toxic both chemo’s, some radiation and, even in these targeted therapies or, hormonal therapies that can make it a little harder for the hear to function optimally.  So, supporting heart with CoQ10, acetlyl L-carnitine can be very effective.

Dr. Weitz:                            Good, interesting.  What about exercise recommendations?

Dr. Alschuler:                     Oh, I’m so glad you asked.

Dr. Weitz:                            I remember going, I met you at that 2010 Institute of Functional Medicine conference about cancer and, I think Keith Block showed a video of patients rollerskating attached to their getting their chemo infusion at the same time and, he had a treadmill in his office and the patients were on the treadmill getting their infusions.

Dr. Alschuler:                     Yeah so, exercise is absolutely critical.  So we know that exercise rebuilds mitochondria and rebuilds their functionality. We also know that exercise helps to increase hypothalamic/pituitary/adrenal resilience or, reinstate circadian rhythm. So, I’m very specific about my exercise recommendations for cancer related fatigue.  So, most people are very tired and it’s hard to exercise so, I talk to them about figuring out where their fitness level is, being right on the edge of their fitness, exercising at that edge and then, continuing to move that edge out so that they’re getting more and more fit.  But they have to be reasonable, start where they are and then just keep pushing.  So, that exercise, as I say, should always be fun and never really easy.  And, what we know from a data perspective is that, people who exercise aerobically and, actually a combination of aerobic and resistance exercise, it seems to be for at least 45 minutes a day, at a level that’s moderately strenuous or, strenuous to them, at least five days a week, have a much lower duration and severity of cancer related fatigue.  So, exercise is absolutely an evidence based, very effective recommendation.

Dr. Weitz:                          Great.  What about a little bit of caffeine from organic coffee or, green tea?

Dr. Alschuler:                     Yeah, I’m all about it.  Not only because caffeine in, as you said, a little bit so, you know, in the morning, not kind of getting too much stimulation to the nervous system towards the end of the day but, in the morning, caffeine not only helps to in some ways actually reinstate circadian rhythm by creating that sympathetic nervous system responsiveness but, caffeine and coffee, both and, tea, are inversely associated with cancer risk for almost every cancer that we study.  So, coffee drinkers have a lower risk of occurrences, therefore and, plus, from a botanical perspective, coffee has been used to address people with mental fuzziness so, it’s a cognitive enhancer and, that’s one of the symptoms of cancer related fatigue.  So, coffee’s also going to help stimulate cognition.  So, yes, I think it’s actually very medicinal suggestion.

Dr. Weitz:                          Great so, thank you so much for spending some time with us, Dr. Alschuler. How can listeners get a hold of you to find out about your programs?

Dr. Alschuler:                     Yeah.  Well thank you for having me, first of all and, I’ll give a couple of things for listeners.  For practitioners, you mentioned TAP Integrative, I really encourage you to check it out. TAPintegrative.org. And, if you use the code, WEITZ, then you get your membership for only $99.00 which is an awesome deal.  Clinical protocols and all that stuff and, Dr. Weitz doesn’t make any commission on that, just so you know, it’s just, it’s because we love him.  So, yeah, TAPintegrative.org, you can send, find me on that site as well. There’s place to shoot an email there.

And then, for patients, I think you mentioned our radio show, which is, Five to Thrive Live and, that’s now streamed on iHeart and, Spotify and, so that’s easy to find.  And then we have a personalized online cancer survivor program, which I really encourage people to check out. It’s actually available now through AICR, which is really cool and, you can also find it directly on, ithriveplan.com.

Dr. Weitz:                          That’s great.  Thank you, Doc.

Dr. Alschuler:                     Thank you.



The Mitochondria in Complex Illness with Dr. Eric Gordon: Rational Wellness Podcast 105

Dr. Eric Gordon discusses The Role of the Mitochondria in Complex, Chronic Illness with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

2:07  According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it and then the body heals and we’re back to health. Chronic illness is not often an isolated response to a toxic exposure or an infection. Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event and the complexity that’s you. Dr. Gordon explained that complex chronic disease is indeed complex it is difficult to understand for doctors who are trained to find the simplest explanation for a given problem. In philosophy, this is known as Occam’s Razor. Interestingly, Dr. Lawrence Afrin, a former oncologist who’s practice is now focused on patients with Mast Cell Activation, wrote a book on Mast Cell disorders called Never Bet Against Occam.  But when you deal with patients with complex chronic illnesses, there often is not a simple cause. In fact, there may be 10, 20 or even 50 causes.  

8:08  Dr. Gordon explained that the way he got involved with treating patients with complex chronic illnesses is that he tends to believe his patients. Dr. Gordon often sees patients with chronic fatigue (myalgic encephalitis is a preferred term) and with chronic inflammatory response syndrome, which was termed by Dr. Shoemaker, or chronic Lyme Disease. The body ends up in a state of chronic inflammation.

11:58  A number of years ago patients with chronic disease were being diagnosed with hypoglycemia and then it was hypothyroid and then it was adrenal fatigue and then it was candida and then it was Lyme Disease, etc.  Dr. Gordon explains that in these complex, chronic diseases the body is stuck in a pattern of response. This same kind of stuckness also exists at the mitochondria level.

16:37  We’ve always been taught that the mitochondria are the energy producers, but they are also the main modulators of the immune response, which Dr. Robert Naviaux has been writing about.  Dr. Naviaux has written several landmark papers on the cell danger response, which is that cells will turn down the energy production for survival purposes when they sense danger.  If the cells sense that there is a virus in the cell and the virus is starting to reproduce, the cell will turn down energy production and  they will use less oxygen, which means that there will be more oxygen in the cytoplasm, which helps kill the virus. Dr. Gordon pointed out that many of the herbs that we consider antioxidants, like resveratrol and curcumin, are actually pro-oxidants which cause stress to the body and make it stronger. This is in a similar way to how exercise tears down your tissues and then your body rebuilds them to be stronger.  There is a cycle of stress and response.

20:14  I pointed out with all this talk about how fasting creates autophagy, we have forgotten that one of the best ways to create autophagy is with exercise.  Dr. Gordon pointed out that “when the body is in a fed state, it wants to build tissue and when its in a less fed state, like at night when you are sleeping with the fast, your body works at breaking down old tissue and using those parts to rebuild with. But as we get older, if all we keep getting is the signal of fedness and is that we keep old half dead cells alive and we wind up with a whole body burden of half, like people are talking about zombie cells.  Basically, they are cells that are growing and living but they really are not communicating well with each other and they’re not doing the cellular function. Like the liver, they’re in your liver and they’re alive but they are not processing chemicals like they should be. They’re just busy trying to stay alive and so when you exercise, you stress them but if you want to stress your liver cell, you’re better off doing it by not feeding it for awhile.” 

22:22  If you have a patient with adrenal fatigue or hypothyroidism and you support them with dietary changes like getting off gluten and nutrients and possibly hormones, they can get better. If their mitochondria are just not working well, then you can give them mitochondrial nutrients like CoQ10 and carnitine and they will get better. But in these cases of complex, chronic illness, like chronic fatigue, the mitochondria have turned themselves down and changed function and giving them more raw materials to make energy doesn’t work.  The mitochondria have reprogrammed themselves to modulate your immune response.  To stimulate change we can look at it from different perspectives, such as the structural component with chiropractic and bodywork, and the cranial mechanism and the vagus nerve.  In the Functional Medicine world we are trained to figure out what some of the triggers are, like Lyme or HH6 [aka, Human Herpes virus 6, aka HHV-6] or EBV [Epstein Barr Virus] or other viral infections or heavy metals or toxic load, etc. and treat them, and this may help to some extent, but many of these chronic complex patients don’t respond as well as most other patients would.  80% of patients will respond to this type of care, but the chronic, complex cases will not as well, since in some of them the trigger is either gone or not as important anymore.  We have to look at how to treat these patients from different perspectives. Because these chronically unwell patients don’t respond like other patients do to the same treatments, they are often labelled as having psychological disorders, as being depressed. 

32:47  We do not understand these chronic patients and we need to focus on why particular individuals get such severe and long term reactions to some of these diseases like Lyme, which Dr. Gordon feels is ubiquitous, or herpes, which nearly everybody has.  But most of us with exposure to Lyme or herpes don’t get sick.  Everybody gets exposed to mold and heavy metals at some point, but depending upon your biochemical individuality, some people detoxify them, while others get sick.  The challenge is how to analyse each person to see how their genes are being expressed.  We are getting closer to being able to measure a person’s expression of their genes (transcriptomics) and which proteins they are making (metabolomics), so we can see which pathways are most stressed and need supporting.  There is hope for many of these patients but there is no on easy answer.




Dr. Eric Gordon is a the Medical Director of Gordon Medical Associates, a medical practice focused on serving patients with complex chronic illness in Santa Rosa and San Rafael, California.  According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it, and then the body heals and we are back to health.  Chronic illness is not often an isolated response to a toxic exposure or an infection.  Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event(s) and the complexity that is you. His website is GordonMedical.com and he has started to see new patients again.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition. From the latest scientific research and by interviewing the top experts in the field. Please subscribe to Rational Wellness podcast on iTunes and YouTube and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters! Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and gives us a ratings and review, that way more people can find out about the Rational Wellness podcast.

Our topic for today is a complicated one. We’re going to talk about the role of the mitochondria in complex chronic illness. The mitochondria is the organelle that’s most responsible for cellular energy and it plays a crucial role in chronic diseases. Every cell in our body contains several thousand mitochondria and mitochondria produce 90% of the energy our body needs to function. Mitochondrial dysfunction is understood as a decline in the ability of the electron transport train to generate high energy molecules like ATP and this is often seen with aging and virtually all chronic diseases. Including neurodegenerative diseases, heart disease, diabetes, autoimmune diseases, autism, bipolar disorder, cancer, chronic infections, chronic fatigue, and fibromyalgia.

Dr. Eric Gordon is the founder and medical director of Gordon Medical Associates. A medical practice focused on serving patients with complex chronic illness in Santa Rosa and San Rafael, California. According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it and then the body heals and we’re back to health. Chronic illness is not often an isolated response to a toxic exposure or an infection. Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event and the complexity that’s you. Dr. Gordon thank you so much for joining me today.

Dr. Gordon:        A pleasure. A pleasure Ben. Yeah. It’s good to be here.

Dr. Weitz:          So how did you get interested in treating-

Dr. Gordon:       A stuck note sounds easier to me.

Dr. Weitz:          You seem to have a musical orientation towards health.

Dr. Gordon:        Well, it’s funny. I’m actually tone deaf but I love the complexity of the orchestra and the possibilities. And it’s always been clear to me once I started treating people that it is an orchestration because it’s not … in health and in disease, you rarely have one player that stands out. It really is an interactive whole, and that’s what makes … it makes medicine hard to understand and is why I think doctors fall back on the single cause for the illness routine because that’s how our minds tend to work. We tend to have engineering minds. That’s just the nature of people. The animal. We see a problem, we want to figure out what caused it and the idea that you can have 10, 20, 50 causes for an outcome is difficult for us to get our heads around.

Dr. Weitz:          Absolutely. I was trained in philosophy and in philosophy there’s something called Occam’s Razor and you always prefer the simplest explanation for any problem that you are trying to solve.

Dr. Gordon:        Absolutely. It’s funny because that’s the title of Dr. Afrin’s book on mast cell disorders.

Dr. Weitz:           Oh really?

Dr. Gordon:        Yes. Never Bet Against Occam. And I’ve had this discussion with him, Dr. Afrin, the whole thing … he’s one of the proponents … proponents? Yeah. He’s one of the people who helped introduced us to the concept of mast cell activation syndrome and he got there, just a little quick aside, by looking at being … he’s a very bright man who is an oncologist but he actually would listen to his patients.  So when other doctors, other oncologists had patients that didn’t fit what they thought they should have, they knew that Dr. Afrin would actually listen and try to keep figuring it out rather than just go, “This isn’t in my box. Go somewhere else.” They did send them somewhere else, but they sent them to Larry to think about. And so he started to see these people who had multiple symptoms. They had irritable bowel syndrome. They had asthma. They had migraines. And they had rashes. And maybe they had interstitial cystitis. And he goes, “Why should somebody have five different diseases?”  And being an oncologist, and being familiar with something called mastocytosis, which is a disease, a cancer of mast cells when you make too many of them. Mast cells make histamine and they cause allergy responses, but they also when they make … Histamine is a big part of each one of those things. Irritable bowel, migraines, asthma, interstitial cystitis, inflammation. He thought, “Huh. These people look like the mast cell people.” And he started treating them with anti-histamine medicines and many of them significantly improved. So his point is Occam’s Razor, look for the single … let’s make it simpler. So that being said, I thought that was a brilliant piece of medical detective work. But, that’s really not how the body works though. The body is a symphony where there are … very simple with genetic diseases. One of the reasons genetics has been kind of a lot of noise but not a lot of … hasn’t been as helpful in chronic diseases is because there are only a few hundred genetic diseases and they are very rare that involve one to five genes. Okay?

Most chronic illnesses, heart disease, Parkinson’s, we don’t even know about Parkinson’s but esp. heart disease, we know. There’s hundreds of genes interacting that you wind up there. So, Occam’s Razor doesn’t work so well there. Looking for the simple answer. It does in the things that kill us quickly. An infection that’s overwhelming. But if your body can deal with the infection and it just hangs around, then you’re no longer dealing with the bug, you’re dealing with your biochemical individuality’s response to the bug. And that’s what chronic illness is, is it’s about the individual. Rather than about the population. And that’s why it’s been so difficult to work with. My favorite subject.

Dr. Weitz:          Yeah. You know what? I would like to-

Dr. Gordon:        Let’s go back to mitochondria a little bit.

Dr. Weitz:          Sure. Yeah. Sure. How did you become interested in treating patients with chronic diseases?

Dr. Gordon:        Well, I had that bad habit of, I believe people. Okay? And when you are a doctor, especially when you are in the hospital, you’re used to people who come in and they have a big … like a pneumonia. A gallbladder attack. A heart attack. But lots of them, even when you take care of that, they still feel terribly, and they felt terribly in ways that didn’t make sense to me. Because they didn’t make sense to medicine. They’re again, they’re the people kind of like Dr. Afrin was seeing. They had so many complaints and they had complaints that moved around. One day they had really bad shoulders. The next day they had bad knees. That doesn’t make sense.

Dr. Weitz:            Right.

Dr. Gordon:        We don’t have a … But I believe them. These were people who I didn’t think we’re coming to lie to me.

Dr. Weitz:            Right. I’d like to clarify for those of us out there listening when they hear the term chronic disease, yes, it’s true that chronic disease is like heart disease and diabetes or the predominant diseases of today. But, what we’re talking about is these complex chronic diseases. What you might call the chronic-chronic diseases. There’s acute diseases, like you get an acute infection and you take an antibiotic, it’s over. And then there’s these chronic diseases like diabetes and you have these blood sugar problems and there are strategies that can fix some of these people by following diet, lifestyle, et cetera. And sometimes these strategies work and they’re totally under control. In other cases, maybe they have to be managed. But we’re talking about a third category of chronic patient who have these unexplained diseases.

Dr. Gordon:        Chronic fatigue. I mean people don’t like … people prefer the term myalgic encephalitis or chronic … And I agree because chronic fatigue is insulting to many people because it sounds, “Oh, you’re just tired.” Which is far from it. It’s much … yeah. Much more life defeating than that and intrusive. But yeah, it’s when people are left with inability to function and we don’t know why. Often it’s precipitated by an infection but it doesn’t have to be. It can be a minor trauma, car accidents. I mean just things happen and the body winds up in a state of chronic inflammation and it doesn’t always have to have pain. Sometimes the inflammation is mostly in the brain and in that case, it just might be difficulty thinking and being able to organize your day. I mean, it’s amazing how debilitating these illnesses are.  Now they are often lumped under this chronic fatigue, immune deficiency syndrome or chronic Lyme disease, or post-Lyme. I mean these are all names depends on which doctor you go to. Or, some people they are called CIRS, chronic inflammatory response syndrome. Dr. Shoemaker has put forward. But basically, these are illnesses that we do not understand. We have lots of theories about and thankfully in the last few years, we’re actually beginning to get research which has been quite amazing. So anyway, so those are the people that I work with-

Dr. Weitz:            Isn’t it interesting how there’s almost this chronic disease de jour diagnosis? So, you get a lot of these patients at one time were all being diagnosed as having hypothyroid. And then they’re all being diagnosed as having adrenal fatigue. And then everybody’s being diagnosed as having Lyme disease. And then everybody’s being-

Dr. Gordon:        Absolutely. When I started, everybody had this in these … like I said, in the 80s, it was everybody had candida. Actually, hypoglycemia was the first thing. But what it is is that this is the blind men and the elephant okay? Each thing, number one, there are some patients who that is their problem but this is what they look like. And otherwise, as doctors learn things, the problem with being a doctor is that it’s a, as you know, it’s a very difficult business because you get good at pieces of it. It gets too broad for most people to be good at everything. I mean nobody’s good at everything in this business. So, the tendency is to get better and better at one aspect of it. I happen to have a little ADD so I kind of go all over the place, but that’s why I have people who work with me who really go deep in certain aspects, because there’s just too much to know.  So the problem is that many people who have “adrenal fatigue”, quote on quote, now some of them do. Some of them really are people who are fairly healthy who just overdid it. Okay?  And those folks do great with rest. Graded exercise, proper nutrition. Fix their guts and kind of maybe address their hormone and support them with herbs or some hormones and they do phenomenally.  But, they’re the kind of like the outskirts or the suburbs if you will of the people that I see.  The people that … I used to see those folks.  But the people that I see have failed that, okay?  They kept staying sicker because their system is more stuck, okay?  When you have adrenal fatigue, usually, if you remove the stressor, the body kind of comes back online. Generally.  And with a little bit of support. Okay?  But with these chronic … what I’m calling the chronic complex illnesses, you are now in a system that’s not allowing you to get better. And this goes back. We’re stuck. I hate to use psychological … actually I love to use psychological terms but I always wary of them because these are not psychological illnesses, you know?

Dr. Weitz:          Right.

Dr. Gordon:        I just find that the story that psychology weaves, it’s a little bit like Chinese medicine in the sense that it’s much more fluid and able to explain things that aren’t linear. I mean, because it’s the idea that the body is stuck in a pattern of response and so a great example of that is like behavior. I mean some people have trouble with time. No matter how often, they are always late. They are not doing it on purpose. It’s just how they’re wired. They don’t quite believe … they really think that they can get something done in a minute or five minutes, that’s going to take half an hour, and they just can’t get through their heads that every day they do the same thing. I’m going to be on time and they forget that they got five things to do. They’re not going to do them in five minutes.  So that’s the kind of same stuckness that we have at the mitochondria level.  At the biochemical level in the body, in these chronic complex illnesses. The body is stuck in a behavior, and even when we remove the inciting event, like the infection or the stressor, the body doesn’t turn back on and go back to the health.  And go back to health. It is stuck in a lower level of functioning. But it’s doing that as a survival mechanism. It’s not doing that … it’s just that it’s a survival mechanism that is no longer probably useful as far as we can tell.

Dr. Weitz:          Right.

Dr. Gordon:        So, and that’s where the mitochondria come in because we’ve always been taught that the mitochondria were the energy producers and they are. But also serve as one of the … well, you never know but we believe main modulators of the immune response which is something people haven’t thought about or hadn’t quite put into the words. Dr. Naviaux, Robert Naviaux from the University of San Diego has been writing about this a lot and he’s well … well, well known or should be better known for … He developed a treatment that may work for autism that involves trying to restore how you say … mitochondrial communication with the rest of the cell, or cell to cell communication. But I don’t want to go too far afield. It’s like the mitochondria, when they sense danger, they are … I mean in single cell organisms, and in your body, as soon as they can tell like a virus is in the cell and the virus is starting to use your raw materials to make more virus, the mitochondria sense that and they begin to turn down energy production, okay?  And when they turn down energy production, they use less oxygen and suddenly there’s more oxygen in the cytoplasm, in the material that’s in the rest of the cell, and that creates an oxidative stress that helps kill the virus. And it also gets the nucleus to make proteins that will help kill the virus and at the same time increase oxidative stress and then after a short period of time, begin to make more things like glutathione, and NfKB, which will begin to reduce the oxidative stress. You see, this cycle, there’s a cycle in health. It’s not linear. It’s a circle. Okay? You get … your body gets stressed and then you respond. Like a lot of the herbs that we use. That most of the herbs that we consider antioxidants are actually pro-oxidants, okay?

Dr. Weitz:          We’re talking about things like vitamin C and vitamin E and folic acid and …

Dr. Gordon:        I’m thinking more like some of the herbal things like-

Dr. Weitz:          Resveratrol or carotenoids.

Dr. Gordon:       Especially resveratrol is a good example and-

Dr. Weitz:          Curcumin.

Dr. Gordon:        Curcumin. These things actually cause stress but the body’s response to the stress is stronger, okay? And you make more of the antioxidants, but you need that little stress. I mean just like exercise. I mean, when you exercise, you actually are tearing down, you are disrupting tissues.

Dr. Weitz:          Absolutely.

Dr. Gordon:        And it’s the healing that makes you stronger. And that’s happening … that’s orchestrated by, or conducted by the mitochondria. And it’s a separate function but it’s a dance. The mitochondria are constantly moving between this stance of producing, of using oxygen up or sometimes just not increasing the oxygen content in the cytoplasm to kind of stress the system.

Dr. Weitz:          Right. By the way, I just wanted to go astray a little bit. I wanted to point out that there’s all this talk these days about fasting creating autophagy. Well, guess what? Exercise creates autophagy. That’s how it works. We’ve known about this for a long time. This idea of that you have to do this special kind of fast to get rid of old, damaged cells to create autophagy, exercise.

Dr. Gordon:        Yeah, no, exercise does it. But the problem we have, if it’s just exercise is that if you, for instance, if you take a lot of antioxidants before you exercise, you don’t get the training effect because you got to stress the system. It’s just nice because when the body is in a fed state, it wants to build tissue, and when it’s in a less fed state like at night, when you are sleeping and with the fast, your body works at breaking down old tissue and using those parts to rebuild things with. Because the problem we have is when you are young, and you’re healthy and you’re rebuilding tissue, it’s really great. Those signals for growth are perfect. But as we get older, if all we keep getting is the signal of fedness and is that we keep old half dead cells alive and we wind up with a whole body burden of half, like people are talking about zombie cells.  Basically, they are cells that are growing and living but they really are not communicating well with each other and they’re not doing the cellular function. Like the liver, they’re in your liver and they’re alive but they are not processing chemicals like they should be. They’re just busy trying to stay alive and so when you exercise, you stress them but if you want to stress your liver cell, you’re better off doing it by not feeding it for awhile.

Dr. Weitz:            Right. Okay. Well let’s get back to mitochondria. So how is mitochondrial issues related to this chronic disease cycle?

Dr. Gordon:        Okay. Well I think the big thing is it was kind of like I was saying in the beginning, if you have somebody with quote on quote, “adrenal fatigue” or hypothyroidism or things of that nature, usually if you support them either with the hormones or even better, with lifestyle changes that will allow these things to happen, maybe getting rid of the gluten so you stop causing the inflammatory response in the thyroid, that’s great. But, if … one second. I’ve lost my train of thought there for a second. But when you are in complex disease, what I call the chronic complex diseases, it doesn’t work anymore because the problem isn’t that the mitochondria are low in let’s say CoQ10. I mean CoQ10 is very important in the electron transport train and if you give lots of people like with sometimes with adrenal fatigue, as they’re getting better, CoQ10, carnitine, which helps get the fatty acids into the mitochondria. Those things really help.  But, that’s because their mitochondria are functioning normally and they just needed a little help. But in things like chronic fatigue, you are actually … your mitochondria have turned themselves down for a reason. So it doesn’t matter. It’s like they have locked the door. So it doesn’t matter how much you are giving them, okay? They’re not going to use it and they’ve turned themselves down because they’re trying to … instead of just working right now as a energy production machine, because when they are working as the energy production machine, you give them more CoQ10. They’re able to move more electrons along that chain more efficiently, okay?  But when they are now working as to modulate your immune defense system, they’re not producing energy. They’ve changed what they’re doing.  So, I guess it’s like if you have a factory that’s making cars and you’re delivering carburetors, that’s great.  But if suddenly the factory decides now to start making artillery, the carburetor isn’t used anymore.

Dr. Weitz:          Right.

Dr. Gordon:        And that’s basically it. So the mitochondria have changed function, partially. Obviously it’s not 100%, but it’s a significant change.  So giving them more raw materials to make energy doesn’t work because they’ve reprogrammed themselves to actually modulate your immune response.

Dr. Weitz:          So how do we fix these people? How do we change their mitochondria? How do we-

Dr. Gordon:        Well, that’s the million dollar question. That is what everybody is working on from different perspectives. Remember, this is one way of looking at the problem. I don’t want to tell you that this is the issue. This is one way of looking at it. But because the body is a system, we keep trying to get at it from a multitude of ways because ultimately, if you are stuck in one way, we start looking at others. So structure is one of the ways that I often begin to work with people who have been chronically ill because the vagus nerve has two components and one of the most basic component, the older component, is about self-defense. The newer component of the vagus nerve is about love and relaxing and feeling good. But the primitive part of the vagus nerve is there for self-defense and it also has a lot to do with controlling the gut.  And if we can begin to get the cranial mechanism and the thoracic spine and all that working better, we take some of the stress off the vagus nerve and we change the information because remember, this is an information system. What we’re talking about, I think, in chronic complex illness, is often the trigger is either gone or not as important anymore. The thing that caused it. And I have spent my life trying to get rid of the triggers. Treating Lyme disease. Treating all the HH6 and the EBV and all the viral infections. The heavy metals and the toxic load. So, these are all triggers and perpetuating factors that we have to address but in many people, that doesn’t work so well because when you try to treat the infection, you make them sicker because they can’t detox. They can’t detox because their whole body is stuck in this self-defense mode and it’s like frozen.

Because it’s very simple. Like when you get scared normally you can jump and then you can run. But when you get really scared, you freeze. You don’t even move. That’s the ultimate defensive mode. Like ontologically, how organisms are wired. It’s not about personality. It’s just about, you scare anybody, anybody deep enough, they will just freeze. And that’s what your cells do. That’s what your whole system does. When it’s significantly stressed, it stops moving. So any way we can return movement to the system might signal the body that it’s safe and the mitochondria are sensing danger signals. And this is what gets confusing. People always, once we start talking about safety and danger, people think we’re talking, oh this is a psychological problem. But safety and danger signals also operate, yes in a psychological space but on the chemical space.  Smells can trigger danger.  Viruses trigger danger signals.  There is no psychological body separation.  Every immune cell has receptors for the neurotransmitters that deal with mood.  Serotonin and dopamine.  There’s no psychological, physical separation. I get so frustrated when people try to make things, oh this is a psychological illness.  One of the things that I’ve been interested in is something called metabolomics, which is looking at a few hundred chemicals in the blood and we can see depressed people by the biochemical signature.  This is a strict … so it doesn’t mean that … so yes, you can be depressed because you’ve been divorced. Your mother died. But ultimately, it’s a biochemical state. And that biochemical state is what controls the organism and because the mitochondria are just sensing those small chemicals that affect mood, that’s the same chemicals that your mitochondria are sensing. So when you get infected by a virus, you get sickness behavior. What happens? You get tired. And you don’t want to be around people.  I mean not many people when they get sick want to go to a party. They want to go quiet … in a quiet room, by themselves. That’s a strictly physiologic response, but it’s driven by the same chemicals. This is driven … this is what we call a sickness behavior and it’s biochemical. It has psychological outcomes. And so I just … I might be killing this but I just always worry that people are going to hear me saying that these are psychological illnesses, when they’re the farthest thing from it. Most of my patients were successful, highly motivated, and not depressed human beings. The problem is is that when they go to the doctor, and the doctor, their blood tests are normal. Their regular blood test, like their blood count, and their kidneys and liver functions look good. And their EKGs normal, and their chest x-ray is normal and whatever else they test-

Dr. Weitz:            But patients think those are very sensitive tests to how their body’s functioning but those are very insensitive tests and your liver enzymes are only going to be positive if there’s significant destruction of liver cells.  It doesn’t tell you whether your liver is really functioning very well.

Dr. Gordon:        At all. Absolutely. So the bottom line is, is that these people who I see are almost always labeled for the first five or 10 doctors that they see as being depressed, and that’s why I am so sensitive to the idea that I’m talking that this is a psychological illness. But it is not. But that is what medicine has always done. And multiple sclerosis. 40 years ago, half the time that people were diagnosed as depressed. Okay? And before we had … well, we had an MRI 50 years, but still, before the diagnosis was made conclusively by physical, by evidence, people were told that they were depressed.

Dr. Weitz:            Right.

Dr. Gordon:        And that’s what we do. So we do not understand these illnesses well. We’re developing more and more treatments, and they work. The problem is, we’re now dealing, like I said in the beginning, the disease of the individual. Because I think Lyme disease is ubiquitous. I think it’s all over. I think millions of people have Lyme disease. But they don’t have any symptoms. Just like how many people have the herpes infection? Everybody’s got herpes.

Dr. Weitz:            Or get exposed to some mold or get exposed to some heavy metals. You start measuring trace amounts of mercury.

Dr. Gordon:        Everybody. It’s just that … but some people because of their biochemical individuality, and the number of environmental stresses they’ve had, they wind up with illness, and that illness is just a reflection of their body and their life exposures. And that is why we don’t do well with them in a medicine that is looking for treatments that are going to work for 80% of the people. So it gets difficult and we start having to look much more at the individuality and we’re getting there, because finally in the last five years and maybe hopefully in the next two or three, we’re going to get enough ability to look at what’s called transcriptomics, what RNA … not just your genes, but what genes are you actually expressing, okay? So what proteins you’re actually making, plus what I call the metabolomics, what small molecules you’re making and maybe when we put these together, we’ll actually be able to see which pathways in you are most stressed and need supporting or addressing.

Because right now, the more information we get, we’re actually getting almost more … I think I’m getting more confused, anyway. I don’t know about the other people out there. It’s because individual chemicals … I mean, you can be very high in succinate, but succinate can be used all over the body for different processes. So we only think of it in terms of the Krebs cycle. But, it’s a building block. You used to make porphyrins, and just make hemoglobin and all these parts of your body. So when it’s high or low, assuming it has something to do with the Krebs cycle, is a huge assumption. And that’s the problem.  We have to look at the body from multiple viewpoints. And we’re almost there. I think we’re almost there but-

Dr. Weitz:            And by the way, for those listening who are not familiar, succinate is something that might show up in an organic acids profile, right?

Dr. Gordon:        Yeah. Exactly. Exactly. Yeah. Because it’s like … and these tests are … I mean, I don’t mean that we shouldn’t be doing them because occasionally, they do give us insight but lots of times, the insight isn’t really useful for that person because it’s not like when we measure your blood count, and you’re anemic, we know that for most … I mean, that’s not always true, but for most people if they are anemic, their blood count is low. We measure their iron is low. We go, oh, give them iron and their blood count goes up and they feel better. That’s wonderful. Right. But if you have chronic disease, many times your iron can look low but giving you iron might even make you worse because your body has turned down production of the red blood cells for a reason and when you give more iron, you’re just increasing oxidative stress because iron really … excess iron might be one of the more toxic things we have.

There are some people in the longevity world that are actually busy donating blood a few times a year because they want to keep their iron stores low. It’s … that’s what I meant about the symphony. All these things play a role but if they don’t play a role at the right time, if they’re making discordant notes, then we get disease. And it’s just a … I guess my plea to patients, I should say actually the point of all this. I don’t want to sound overwhelming. Like oh my god, we know nothing. The beauty of all this mess is that we still know a lot of what to do for the individual but what happens is that people get very frustrated because as you said in the beginning is that when you start off with this complex disease, and if you go to one doctor, you’re going to be told you have hypothyroidism. You try that, it didn’t work. Then adrenal fatigue. And then you’ve got mold illness and then maybe you go to somebody else and you got Lyme.  And it’s frustrating. The point is, there’s a lot of doctors out there right now who are getting the experience and beginning to be able to tell when you just have a positive test, or whether that test is being expressed. Whether the symptoms you have really fit the Lyme or the mold or more importantly, it’s often … many people … what really makes this tough is that in my experience, most people don’t develop significant mold illnesses. Mycotoxin sensitivity … Now I’m talking about allergy, but sensitivity to the toxins that molds can make. Most of us can be exposed to that and we can detox them and deal with them fine. Okay? It’s the people who’ve often had Lyme disease, and Lyme changes how your immune system responds and then they have difficulty with being able to metabolize the mold toxins. So it’s a house, not of cards, but it’s a house being built in your body of reactions to things because it’s a interactive dance between your immune system and these bugs.  Because these are the bugs that want to live with us. They’re not trying to kill us. They want to be part of our community.

Dr. Weitz:            And should we think of it in terms of cumulative overload? Some people refer to the, you have this giant bucket and when it’s close to the top and you get exposed to something that stresses your system, it overflows and you get all these symptoms and if you could empty out several pails of water from the bucket, now you’ve got a reserve so you can deal with things.  

Dr. Gordon:          Well, yes. I think that always has been a good analogy.  

Dr. Weitz:            Right. That’s kind of the model that we look at.  So okay, we take the mold factor out. Maybe we get rid of the heavy metals, and now we’ve removed some of the triggers, so now you … yeah, rebuild some of your cellular reserves. So now if you do get exposed to something, it maybe is not problematic for you. Whereas if you are always close to the top, you’re going to react to everything.

Dr. Gordon:        Well, yeah. I mean, and another lens on that is that when you remove, let’s say the heavy metals, then suddenly your immune system is now working better and then it can keep Lyme or the viruses in check.

Dr. Weitz:          Exactly.

Dr. Gordon:        And so if you remove them slowly, they’re not making you ill. Because you see, or more importantly, sometimes I think you actually can control your own immune response because many times, there are people who’s significant symptoms in Lyme and the tick borne illnesses are not the bugs, but their body’s response to the bugs are overwhelming. They create this … The cellular defense response is so heightened that it makes you sick because remember, most symptoms of inflammation, the swelling, the redness, that’s your own cellular response. That’s not the bug. Your body does that while it’s fighting. And like I said, the sickness behavior. Wanting to go lie down. Fatigued. Not losing your appetite. That’s not the bug. That’s the body’s own self-defense response that’s now stuck on. So when we remove some of the toxic exposure, your immune system can often come back and stop overreacting and stop acting like a three year old. I mean, that’s the problem. The immune system goes into a primitive place where everything is danger. Everything is no, or screaming at …

Dr. Weitz:          And then the immune system starts tweeting in the middle of the night and declaring national disasters and where there aren’t any.

Dr. Gordon:        Exactly. That’s it.  But it goes back to a primitive pattern. Right, a fear. Very similar to yes, our midnight tweets. Yes. Fear. Instead of reacting like an adult which can grade and realize that life … You see, that’s it. It’s very interesting is that life, in the complexity of life in the organism only happens when there can be learned of cooperation and balanced responses because that’s how your body works. In fact, that’s how we interact well with viruses. Viruses will succeed if they learn how to have a balanced response, if they kill us, which is the … like not the win-win, but I win, you lose situation, they don’t do well in the long-run.

Dr. Weitz:          Right. No, they want a host that they can reproduce and go into another host. Right.

Dr. Gordon:        Exactly. That requires cooperation which is another … but that’s really what happens. So getting back to the idea is the toxicity of our world. One of the points that I’d like to make that I think is so important is I been doing this now since 19 … so close to 40 years. And I can tell you that … autoimmune diseases, like Hashimoto’s for instance, thyroiditis, I mean when I started in medicine, we could test for it. It was not that common. Now it’s a dime a dozen. I mean, all the autoimmune … it’s called autoimmune diseases, the kind of Lyme symptoms we see. When I … Joe Verscano, like my partner, like Wayne Anderson, he started treating Lyme in like 1990, ’91. It was still often relatively easy. The people have gotten sicker, and sicker and sicker and sicker. I don’t think the bugs have gotten … maybe the bugs have changed. But I think it’s us. I mean, the toxic load in our environment has gone like not linearly but logarithmically up over the last 40 years.  And I think that is why we’re seeing these illnesses and we’re seeing so much dysfunction at the mitochondrial level because when the mitochondria sense toxins, part of their job … They are smart but they are not that smart. If the toxin ties up the biochemical reaction that is going to produce the raw materials that the mitochondria need, the mitochondria can’t tell the difference between that and a virus using those same raw materials. All I knows is that it’s not getting the raw materials that it should get. The NADH and NADPH. It’s not coming in, into the mitochondria from the cell. And that triggers the, what we call the cell danger response. Where the mitochondria stop producing as much energy. They start using ATP, the energy molecule, as a messenger, okay? The ATP, they start sending ATP outside the cell.  So normally, there’s a very tiny amount of ATP around the cell because actually, it’s a neurotransmitter in a way. There’s actually 17 receptors on the cell membrane and different cell membranes for what they call purinergic ATP, and AMP and all these energy molecules. They actually work to communicate. They’re part of the cell’s cell signaling function and when the mitochondria sense danger, they start sending more ATP outside the cell and this gives the signal that the cell’s in danger and they’re also making less energy so toxic load acts the same as a virus on your body.

Dr. Weitz:          Cool. So I’m going to have to bring this discussion to a close in the next few minutes.

Dr. Gordon:        We were definitely not linear.

Dr. Weitz:          Definitely not. So how do we want to end it?

Dr. Gordon:        Oh.

Dr. Weitz:          What kind of final thoughts you want to have?

Dr. Gordon:        Final thoughts. Is I think the most important thing is to if you’ve been ill for a long time, is to not give up hope. Okay? Is that it’s … the unfortunate part of this illness I think is many more people actually run out of money than of hope. Because, honestly, because we don’t have perfect treatment regiments. We don’t even have … I don’t even think we have decent treatment regiments. So much of the time, I said what that doctor knows how to do, that you wind up spending a lot of money and not getting very far. But the reason I say don’t give up hope is I’ve seen people who have been sick for 20, 30 years, get better. But, to be fair, I’m not going to tell you. I don’t get everybody better. Far from it. I mean, I wish I did. These are difficult illnesses. But so many people do get better because there are so many different reasons that you can wind up with chronic fatigue. And I think that’s the thing. Don’t give up because somebody you know didn’t get better. You are different, and it might turn out that with you, the pick-up sticks model that’s need is maybe just getting out of the moldy environment for you.

Maybe that’s going to be the big deal. Maybe getting the toxins out of your system. Maybe just getting the right structural work done. I mean, there’s so many pieces that can then allow the body to enter the healing cycle and really go back to normal. I mean, that is my message of hope. The frustration is picking the first step, is not always clear. But don’t give up because there is a step that will help you. We just have to find it for you.

Dr. Weitz:          Great. So how can listeners get a hold of you or find out more information about you? Are you accepting new patients?

Dr. Gordon:        Yeah. I started to again. For awhile I wasn’t and it was getting … but now I started seeing new patients because I like to send people on quicker. I find that what I’m really good at is evaluation and giving people pretty good idea of where they need to go. But I like to send people because I do so many things, I prefer to send people on to other doctors who kind of specialize in the area that they need the most support in. And then they can come back to me and we can go to the next level. So with that being said, I am concentrating my practice, as of May, in San Rafael. Our website, or what is it … I think it’s gordonmedical.com, I believe. I don’t know these things. Okay. Yeah, is the website and they can find the information there. But I just … what I’m hoping to do is more research. I’m trying to get, I said some of the right called leaders together because the more brilliant doctors are, often the harder it is to get them to work together.

Dr. Weitz:           Yes. Absolutely.

Dr. Gordon:        And that is my dream, because I don’t know everything. I need a lot of help.

Dr. Weitz:          You sure know a lot and thanks for sharing with us today, Dr. Gordon.

Dr. Gordon:        My pleasure. Really. It was fun, Ben, and next time we get to chat, we’ll talk more about … I would love to talk to you about the body.

Dr. Weitz:          Absolutely. Yeah.

Dr. Gordon:        That to me is what’s missed by so many physicians. The structural…

Dr. Weitz:          The structural component. Yeah.

Dr. Gordon:        How important structural component is.

Dr. Weitz:          Yeah. Great. Excellent. Thank you, Eric.

Dr. Gordon:        Be well.




Gut Bacteria and Detoxification with Dr. Grace Liu: Rational Wellness Podcast 104

Dr. Grace Liu, the Gut Goddess, discusses Gut Bacteria and Detoxification with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

1:20  Gut bacteria play a role in detoxification, esp. since our air, water, and food is so contaminated.

2:03  Gut bacteria also produce toxins. They transform arsenic into a more dangerous form. Gut bacteria can also produce TMAO from food or supplements containing carnitine or choline, which Dr. Stanley Hazen from the Cleveland Clinic has argued is a marker for heart disease. Dr. Liu points out that vegans don’t eat foods that have a lot of carnitine (like red meat) or choline (like egg yolks) or contain TMAO (like fish), but yet still get heart attacks, strokes, and embolic events. Our gut bacteria protect us and create this non-leaky permeability of the gut lining.

6:04  We have evolved being close to the earth and eating food off the earth, covered with soil, which contains soil-based bacteria.  We used to ferment foods to preserve them, since we had no refrigeration, which contain lactobacilli and other acid-producing bacteria.  But now we refrigerate our food and don’t eat as much fermented food and due to c-sections we no longer get our flora from our Mom during delivery. This has created a generation without a firewall of protection. Also, during childbirth, many mothers are given an IV with pitocin and antibiotics to prevent the risk of sepsis or infection and this has a negative effect on our microbiota.  We also get exposed to antibiotics fed to the cattle and sprayed on the grains and other crops. We also get exposed to glyphosate, which is an herbicide and pesticide and it has been shown to cause a kind of soil dysbiosis. Our guts are reflecting our earth right now.

9:53  People who have a healthy gut flora, like hunter gatherers and people living in very rural communities and in Europe, have very few of the unhealthy, putrefying bacteria, like Klebsiella, Citrobacter, and E. Coli.  These unhealthy bacteria produce TMAO and other toxins that can damage our heart or cause cancer.

12:07  Dr. Liu talked about a genetic obesity study where they used a diet very high in prebiotics and they found that this would grow good flora and lowered their BMI. 

13:29  Dr. Liu likes to look at various markers to assess gut health, including urinary organic acids, like Cresol, which comes from Claustrium Diffocele. She likes to look at other fungal markers, including Furans and tartaric acid.  There are 9 markers on a standardurinary organic acids profile, such as the one from Great Plains.  She will also look at the Oxalates that tells a lot about fungal overgrowth. When looking at the microbiome, Dr. Liu focuses on what she calls the A,B,C s, which stands for Akkermansia, Bifido (like Bifido longum, lactis, and infantim), and Clostridiales (butyrate producers like F prausnitzi, Roseburia inulinovorans, Eubacteria etc) and Christiansenella.  Healthy people like hunter gatherers, people without disease, and centenarians have lots of these bacteria in their guts. 

On the other hand, Akkermansia eats mucous and if there are high amounts of it, this indicates that the there is too much mucous in the gut and this is not healthy.  There are also good and bad forms of Bifido bacteria. The bad Bifido tend to eat a lot of sugar and carbs and they are not foundational bifido. The good bifido include strains like bifido longum, bifido infantis, and bifido lactis.

16:50  I commented that when we consume probiotics by mouth, they are only temporary visitors, so I questioned how we can change our gut bacteria to have more Akkermansia or whichever other strains you’re trying to promote by consuming probiotics?  But Dr. Liu disagreed and stated that our good gut flora follow us everywhere and some come in a pill and some come in food and they are not just transient visitors. The species that are core to our guts are our Mucosa-Associated Microbiota (MAM) and they eat the mucous and they do become permanent visitors and its called anchoring and engrafting.

21:35  I asked if it is more effective to consume the bacteria as probiotics or to consume perbiotic fuel to cause those bacteria to grow that we’re trying to promote? Dr. Liu pointed out that some bacteria eat fiber like inulin or oligosaccharides, but when she starts working with a patient who is suffering with a gut disorder like IBS or inflammatory bowel disease, she won’t use fiber at the beginning because it might aggravate their symptoms. But she will use polyphenols, since only the good gut bacteria can eat these and the pathogenic flora have not adapted to eat polyphenols.

23:31 The strains of gut bacteria that help us to detoxify heavy metals and arsenic and xenoestrogens, etc., are the ABCs, such as the Bifido longum and L. Rhamnosus, that are in high amounts in the Bifido Maximus probiotic formula that Dr. Liu has formulated. There is a study from Dr. Gregor Reid where they found that probiotic yogurt containing L. Rhamnosus GR1 reduced mercury by 36% and arsenic by 78% in pregnant women in Tanzania.  Here is a Townsend Letter article discussing this issue and this study: Probiotics vs. Heavy Metals: A Win for the Good GuysDr Liu’s protocol for removing toxins is glutathione, binders like Quicksilver Ultra Binder, which has a bunch of different resins like charcoal, clay, sulfur-based resins, and a biological one called chitin, along with probiotics and polyphenols.  Dr. Liu mentioned that if estradiol is higher, it’s a marker for stress, esp. for gut stress, due to aromatase. To correct it, Dr. Liu will use DIM and botanicals like olive leaf and bitter melon.

34:14   High blood sugar is just leaky gut, according to Dr. Liu.  She cited the work of Dr. Patrice Cani, such as this paper: Gut microbes and health: A focus on the mechanisms linking microbes, obesity, and related disorders.

37:19  Some probiotics can help us to detoxify mycotoxins from mold. esp. soil-based probiotics, but also B. Longum and L. Ramnosus. Dr. Liu says that she likes the Shoemaker and some of the other Functional Medicine protocols for eliminating mycotoxins, but she stressed the importance of having a good microbiome, which help us to lower mycotoxin concentrations. Certain botanicals can shut off the genetic expression translation for mycotoxins.  B. longum and L. Ramnosus also degrade glyphosate and help with heavy metal remediation. 

40:42 Dr. Liu would ideally like her patients to have both a DNA based stool test like GI Map from Diagnostic Solutions or Thryve and also a culture based stool test, since they both provide different information that can be helpful.  Dr. Liu explained that she works with clients with four phases and she goes big to small. She starts by focusing on parasites, helminths, and eukaryotes, then she goes fungal, then she focuses on bacterial, SIBO, and finally she looks at viral, spirochetes, and phages. E. Coli is a major problem these days, but there are also good forms of E. Coli and one form of E. Coli probiotics can be used to treat SIBO.  Dr. Liu pointed out that many commercial forms of probiotics contain the wrong form of step (Streptococcus Thermophilus) and many people have antibodies against strep. Dr. Liu also does not believe in using Saccharomyces probiotics since many patients will also have an immune reaction against this as well.



Dr. Grace Liu, the Gut Goddess, is a Doctor of Pharmacy and a Functional Medicine practitioner. She consults with patients, offers courses, teaches practitioners through her Microbiome Summit, and develops and sells probiotics and other nutritional products, all available through her website, The Gut Institute.   Dr. Liu offers an incredible masterclass to learn how to manage gut health: Master Your Microbiome.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or by going to www.drweitz.com.


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to DrWeitz.com. Let’s get started on your road to better health.  Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way, more people can find out about the Rational Wellness Podcast.

Our topic for today is the role that our gut bacteria play in helping us to detoxify toxins. Dr. Grace Liu is a doctor of pharmacy and a Functional Medicine practitioner, and she’s known as the Gut Goddess. Grace, thank you so much for joining me today.

Dr. Liu:                Dr. Weitz, thank you so much for having me here. I’m so grateful and glad for this opportunity to talk about all our good friendlies in the gut.

Dr. Weitz:            So, what the hell do gut bacteria have to do with toxins?

Dr. Liu:                Well, it’s a very, very minor role that they may play, but because our world is like a big toxic soup that we live in currently, our air, water, food is all very much contaminated, it may be playing more of a major role. Even in Functional Medicine, their role is not fully known. I actually wasn’t even fully aware of all their roles for our detoxification pathways until more just recently in the last few years, because the studies now are available, which are just amazing. We don’t have a lot, but just like a lot of Functional Medicine studies, there’s not a lot out there unless you have a big, deep pocket pharma behind you.

Dr. Weitz:            Right. It’s interesting. It seems like it goes both ways. There are a number of ways in which the gut bacteria actually create more toxins. I had a discussion a couple of podcasts ago about TMAO, which is this marker for heart disease, and TMAO actually is produced by the gut bacteria in the presence of carnitine and choline, either from food or supplements. So, there is several ways in which gut bacteria actually create toxins for us. I also saw a study where arsenic, gut bacteria change arsenic and make it from inorganic to a more dangerous form of arsenic.

Dr. Liu:                I know. Yeah. Those are fascinating, controversial points, which we often talk about as practitioners on your amazing forum in the closed group. I love that.

Dr. Weitz:            Yeah. The TMAO thing I think is really interesting, because the Cleveland Clinic is really touting that as a major factor in heart disease.

Dr. Liu:                Yeah. And as we know, vegetarians and vegans who don’t eat those high carnitine sources, they still get heart attacks, strokes, and embolic events.

Dr. Weitz:            Absolutely, yeah. I don’t buy this TMAO thing because carnitine and choline are so important for our health.

Dr. Liu:                And detox.

Dr. Weitz:            And for detox and even the health of the heart, so I just can’t believe that those are bad things to consume, especially when one of the foods that most causes TMAO is fish. Anyway, so, how can gut bacteria help us get rid of toxins?

Dr. Liu:                So, what I do at the Gut Institute, I’m founder of the Gut Institute, and we are an educational platform. We love to share about how our amazing gut flora, the probiotics primarily, are really what we need to safeguard our health. They protect us. They keep our health tight, as well as our butts, and create this non-leaky permeability of the gut lining.  All our guts are leaky. Babies are born leaky so they can take in immunoglobulins from breast milk and mom. They have no immune system when they’re born, so it’s mainly what mom shares with them, right? And actually, their probiotics. They get baby probiotics through Mom through the breast milk. It’s not sterile. It starts there.

Dr. Weitz:            Do you test for that or do you just sort of assume we all have it?

Dr. Liu:                Yeah, there’s no point in testing. Our modern testing methods are just so lame and primitive, actually. We can presume if someone has a chronic condition and the degree of it, there’s quite a lot of permeability. So depending on the test you decide to choose on, you may find it or you may not. It may be just selective permeability. It actually has to do with-

Dr. Weitz:            Do you find zonulin of any benefit?

Dr. Liu:                No. A lot of times, I suspect it, but 90% of the time it won’t be all abated on the testing that you pull. Actually, now, it’s good these test companies are reconciling what we see because they’ll have a disclaimer, “Oh, just ’cause it’s negative, it doesn’t mean anything.” Well, yeah, hello. Just like we do stool testing, we don’t find fungal overgrowths, just ’cause it’s negative doesn’t mean it exists there. You just pulled the wrong test. You pulled a lousy test. You’ve got to pull your organic acid out.  So how we look at the environment is very important for what we do. We do terrain medicine now in functional medicine, and this is how conventional may be moving eventually if there’s not a lot of barriers, because sometimes there’s not a lot of money for the things that recover our terrain. Yeah. So it doesn’t behoove FDA, who are not always for the health of the populous.

Dr. Weitz:            Yeah. It’s hard for me to see conventional medicine moving towards terrain medicine because it’s complex medicine and it’s not part of the model.

Dr. Liu:                 Maybe, yeah. So when we lose this legacy from Mom, then we don’t have our protection and our firewalls, just like our computers have firewalls, right? Do you have a cleanup system, a malware protection on your computers, Dr. Weitz?

Dr. Weitz:            Sure. Yep.

Dr. Liu:                Yeah. So our bodies have that, as well. We’ve co-evolved with it for the last one million, two million years, soon as our kind emerged, if you believe in evolution, and moved toward that. We have always been near the earth, eaten off the earth. Things were covered with soil. There’s soil bacteria, as well as vegetation has different kind of bacteria.  A lot of above ground have lactobacilli, so when we ferment foods like kimchi, sauerkraut, kombucha, we’re getting a lot of those lacto strains and other acid-producing strains. And then when they go anaerobic a bit without oxygen, without air, when we seal a system, those flourish, right, and they prevent mold from growing. So we didn’t have refrigeration up until 1500 years ago chilling our food, so we always relied on preserving our food via actually our bacteria. So we had many ways of replenishing.  But now, we refrigerate now and we don’t eat these foods, Mom’s legacy may be disrupted and broken. The flora that Mom used to have is no longer conferred to the baby, and this new generation is moving without a whole firewall, even our generation a bit.

Dr. Weitz:            When you’re talking about the Mom, you’re talking about the fact that we have so many C-sections and-

Dr. Liu:                Formula.

Dr. Weitz:            Formula, right.

Dr. Liu:                If you get pitocin as a mom, a pregnant mom, if they need to induce the baby, they give something called pitocin. If you’re in the hospital, a hospital gets many fines or negative points if there’s complications that arise, so to prevent a complication like sepsis, which is a bacterial infection in the blood, or abdominal skin infection as a result of hospital procedures, they give everyone IV antibiotics with pitocin.

Dr. Weitz:            Right.

Dr. Liu:                Does that make sense? Yeah. So now you have high dose IV antibiotic in the system that literally wipes everything clean. Can you imagine, you’ve wiped clear your hard drive every time you go into a hospital?  No more memories, no more pictures. Your documents are gone, right?  You’re kind of screwed, right?  So this is what’s happening. It’s not just C-sections. It’s also any surgery. Some of my worst cases are where they’ve had … I mean, something happened, an accident happens, a knee breaks, right, you need to have surgery, so guess what? Sometimes IV antibiotics or many oral antibiotics, by mouth antibiotics are given.   And it’s also permeating our food now, right? The last 20, 50 years, domestic farmers found that if they gave antibiotics to their herds, they’d instantly gain weight, so it meant more money for them, but they were really causing diabetes and morbid obesity, but animals don’t live that long. They just got many fat, right? They got fat, so it meant more profits for them, but we’re eating fat animals that are also ill and sick and they’re just fat. Not more muscle, necessarily. They’re just weighing more. It helped the farmer, but it doesn’t help our kind.

Dr. Weitz:            Right.

Dr. Liu:                Yeah. So grains are laced with pesticides. Pesticides are actually antifungal, or the good ones, and they’re antimicrobial in a bad way. Glyphosate has shown over and over that it causes a kind of soil dysbiosis. So really, our guts are probably reflecting our earth right now. It’s horrible to imagine how it’s going to go forward the next 20, 50 years. It’s not really sustainable to have soil with such a low diversity and having plants that are just full of yucky flora.  So it’s really great. I think you brought up the TMAO.  If we dig longer and further, deeper, the signature of people who have heart disease is one of really severe, deep dysbiosis. They’re lacking all the good flora.  So I’m going to delineate what the good flora are. In healthy control guts, whether they’re in rural communities, hunter gatherer societies, European tend to have better, healthy controls. I wouldn’t look at any of the last 20 years of US studies, their ideas of healthy controls. If you look at their BMIs, they’re not healthy. They’re very obese. They have yet to manifest something. But if you look at the BMIs, they’re not actually healthy, or if you look at a liver test, they all have non-alcoholic fatty liver. They’re not healthy. Yeah. They have early dysbiosis or really severe dysbiosis.

But if you look at European studies, all their functional markers rack up to a really healthy person. All their conventional labs as well as functional labs tend to fall in place.  So if you look at them, they have a really healthy signature.  I kind of look at things like a financial portfolio.  So you can have assets, right, and you can have liabilities, debt, right?  The worst debt might be multiple credit card debt, right?  I mean, assets are like a diverse portfolio.  It’s got bonds as well as S&P 100 stock and real estate maybe, good real estate, right?  We know this for many things, for financial things.  Now we have to think about that, apply those analogies to the gut. When we look through the signature of people who are healthy, they have very few of the TMA-producing, putrefying bacteria actually, which are known as Klebsiella, Citrobacter, E. Coli. We all know these to be very, very, not very good. There’s many reasons. They are producing toxins that may kill our heart or cause cancer.  It’s not that we want to eradicate these. This whole idea like, “Oh, let’s eliminate, eradicate,” it’s actually not good because along there, we’re going to also be messing up the terrain further. Yeah. So we have to think about how to rejuvenate maybe.

Dr. Weitz:            So maybe TMAO is a marker for dysbiotic gut.

Dr. Liu:                Yeah, exactly. Yeah, exactly. There’s an amazing study by someone I really follow ’cause he has a lot of great protocols and studies. So we have adapted things in Functional medicine, but one is Dr. Jolly Pink. He had a genetic obesity study. He had just conventional obesity, as well as genetic. There’s a condition called Prader-Willi, Willis, I think, and it’s genetic.

Dr. Weitz:            What is it called?

Dr. Liu:                Prader-Willi.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. There’s various genetic mutations that allows these people to get overweight really quickly. It’s genetic. He applied a diet very high in prebiotics and found that he could grow all the good flora. So the good flora eat fiber. They don’t eat garbage. And he was able to shift it. They lowered their BMI, very slowly. I would’ve done things a lot differently for faster results. We tend to get really good results with reduced brain fog, body fat and fatigue in usually six months or less. So his is a very long story, over six months long.  But they did see results with that. What they did was they focused on how to regrow the good flora, and then naturally, the good flora, they’re going to help change the terrain, eliminate, eradicate for us the bad flora, the TMAO-producing flora. So what they found in the study was that TMAO levels went down in the treatment group, not compared to the control group, who were eating a standard diet.   Yeah, so we have many markers.

So I look at the urine organic acid. We look at Cresol, which comes from clostridium. We look at various fungal markers, Furans, as well as tartaric acid, many others. There’s nine markers on a standard urine organic acid testing from Great Plains, and then three other markers known as Oxalates that tells a lot about the fungal overgrowths.  This is easily overlooked by a lot of functional medicine practitioners. They don’t know how to look for this, and so they’re missing a whole side of the terrain. In fact, I would say for disease, maybe 90% of the terrain.  All our protocols, yeah, we combine anti-fungal botanicals, and even prescription sometimes if needed to the protocols to see what we’re trying to help to change in the terrain in terms of negatives.  In the portfolio, what I look for is to see the good stuff growing back up, lactobacilli, bifido. Our ABCs start with the As. You don’t have to remember all these technical names, but Akkermansia is one of our big ones, A for Akkermansia.  Yeah. It’s actually like a U-shaped curve. Too low is not great, and we may over-focus on that. Actually, excess levels aren’t great, either. Akkermansia love to eat mucin as their prebiotic. Their fiber is more gooey things, like our mucous, as well as RO mucous, so they’re mucous-eaters.  So Akkermansia muciniphila, that’s the name of the A, the species that stands for A, that all the healthy people have. Centenarians have high amounts of it. Healthy people in the ruralest areas, hunter gatherers, people without disease, people without cancer.  Now, going, swinging on the other side, ’cause it eats mucous, if someone’s sick, it’s kind of like having a runny nose, like if you have allergies or hay fever, right, or ill, you have a cold. Same like the gut. The gut can get runny. If there’s a lot of stress and inflammation in the gut, it may get runny, so there’s excess mucous.  And then if we see high, high levels of Akkermansia, it’s not a good sign. So it’s always the context of what’s going on. Sometimes people are a little over-focused on high or low and you totally ignore the context of the host, right, the whole ecosystem, the whole terrain.

So part of ABCs, the B is called the bifido. We think of these as our standard probiotics, but there’s actually good bifido and bad bifido in our little financial portfolio. The bad bifido tend to eat a lot of sugars and carbs, and they’re not the foundational bifido that we need. We need some but we don’t need a ton. For a lot of people, they’re overgrowing and they don’t have the other Bs.  The other good bifido, like bifido longum, bifido infantis, bifido lactis … Just by the way, too, these probiotics, they cost an arm and a leg. They cost more than coke per kilo. So I’m a probiotic formula maker.

Dr. Weitz:            Can we make money selling our gut bacteria short?

Dr. Liu:                Yeah. One of my friends, I told them, their kids have great flora. When I looked at their portfolio, I’m like, “You should start saving for their college,” and they have. They submit the stools to the FMT banks.

Dr. Weitz:            Oh, really?

Dr. Liu:                Yeah, yeah. My kids ignore me when I talk about this. They don’t want to get involved at all.

Dr. Weitz:            They don’t want to eat capsules filled with poop, huh?

Dr. Liu:                Yeah, yeah. They’re contributing to society. It’s awesome.

Dr. Weitz:            There you go.

Dr. Liu:                People can make a grand or two a month.

Dr. Weitz:            Yeah.

Dr. Liu:                Yeah. Income, off of poop.

Dr. Weitz:            One of the interesting things when we talk about trying to improve your gut bacteria and your microbiota is that we know that when you take probiotics, they’re only temporary visitors. They don’t continue to live there. So, how is it that you can actually change your gut bacteria to have more Akkermansia or whatever strains you’re trying to promote if the probiotics we consume are only there for a short period of time and then gone?

Dr. Liu:                So first of all, there are various studies that show actually that’s not true, Dr. Weitz. Yeah. So I don’t know if it’s a fallacy, yeah, promoted by people who don’t read super deep in the literature, but our good gut flora, they follow us everywhere. Some come in a pill, in a capsule. Some come in food. But they aren’t just transient visitors. The ones that are core to our … They’re called the MAM, mucosia-associated microbiota. Let’s say this is our GI tract, right?

Dr. Weitz:            Okay.

Dr. Liu:                Here’s the muscle, right, smooth muscle.

Dr. Weitz:            Right.

Dr. Liu:                You have several layers. There’s two layers of mucous. The inner layer is full of some flora, good flora, but they don’t trespass beyond, and there’s an inner layer of mucous, which is pretty much almost sterile. Our flora, when they’re present, the ABCs are present and they actually make all these chemicals that keep the boundary tight and target certain pathogenic flora that really like to invade. So that inner mucous, the deep, deep mucous actually is very sterile.  And then we have some flora that live there, and they’re very few. It’s called the MAM, mucosis-associated microbiota. These actually include the good bifido lacto, and also good Roseburia that eats inulin, Roseburia inulinivorans. There’s other Roseburia that actually aren’t so good for us.  So we can actually drill down a lot of the strain, just like you know there’s good strep, right? There’s even good strep that help our gums and combat cavities. There’s good strep, but there’s also bad strep. In fact, almost all the other strep are kind of bad. Strep sanguinis, strep mutans, those cause cavities…

Dr. Weitz:            Are you saying that some of the bacteria contained in probiotics, whether it be lactobacillus or bifido, et cetera, et cetera, that those have become permanent residents in our gut?

Dr. Liu:                Especially yes, if they eat the mucous, yeah. It’s called anchoring and engrafting. It’s really awesome. In my last year in pharmacy school, I spent a year at Stanford as part of my rotation. I was so lucky. I did one rotation actually in the transplant unit. It was so cool seeing different protocols that would inhibit something called graft-versus-host disease. It was a rejection syndrome, graft-versus-host disease.

Dr. Weitz:            Okay.

Dr. Liu:                What studies show now for transplant, and actually, even same with implantation after IVF, in-vitro fertilization methods, transplantation and then the implant of a human cell requires actually good flora in the terrain.

Dr. Weitz:            Okay.

Dr. Liu:                Now, a lot of these floras are our ABCs, it turns out. They need to be present to help facilitate the organ to stay there without rejection. Basically, this is going to save the person’s life, or for a woman who’s infertile or barren, trying to have kids, that means success for her, for her body to actually take what is evolutionary, our full right to bear children. Yeah, but it requires flora, the right flora, the good flora, not the bad versions of the flora.

Dr. Weitz:            Right.

Dr. Liu:                Yeah. So it has to do with their DNA, too. They all share DNA. One minute, they may be resistant to high dose antibiotic, and another minute they’re not. They’re always sharing their DNA. It’s called conjugation. They’re an amazing organ for us. They’re a silent organ.  So when we think about them, we don’t think about them as … They weigh as much as our brain, actually, two or three pounds or more. The light is starting to be seen by what they do for us and what they don’t do. They can prematurely end our life easily. It’s usually when the ABCs aren’t there.  It’s not hard to get them back in, too. It takes some protocols actually, a little bit, to help open up ecological niches for them so they actually have a chair to sit in. It’s like magical chairs in a way. My goal is to open some of these niches so we can get the high dose probiotics in.

Dr. Weitz:            So is it more effective to consume the bacteria as probiotics or to give them the proper prebiotic fuel to cause those bacteria that we’re trying to promote?

Dr. Liu:                Oh, that’s a great question. It depends on the stage of healing. So early on, I don’t use actually a lot of fiber. For instance, some of the really nifty, swifty kind of bacteria, like for instance, strains that secrete TMAO, they also have adapted. They can eat some of our fiber that we tend to think about as really great, awesome prebiotics. Some eat inulins. Some eat oligosaccharides.  For instance, some people with dysbiosis, they don’t tolerate FODMAPs.  Not everybody, but a lot of people, when they find that they eliminate the FODMAPs, they find out, “Oh my gosh, my bloating and brain fog actually go away.”  Well, they have actually flora, it could be good or bad even, but they’re in the wrong place.

Dr. Weitz:            So you’re saying when we’re working with a patient who’s suffering from a GI disorder like IBS or inflammatory bowel disease or something like that, you won’t use fiber at the beginning.

Dr. Liu:                No, but I use a different kind of prebiotic. They’re called polyphenols, antioxidants. So we utilize a lot of these in Functional Medicine. Little did we know that actually, we’re super-feeding our good gut flora, the ABCs primarily. It’s really interesting. The bad flora, the pathogenic flora, they have not adapted yet to eat polyphenols. Polyphenols are usually low quantity. They’re very bitter. They’re medicinal. Usually besides feeding good gut flora, they actually antimicrobial benefits.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. They actually will kill them. So, they have not adapted to learn how to eat them, fortunately. So we can really create this selective ecosystem and terrain by using the right ones. A lot of them are found in ancient Russian medicine, German medicine, Chinese, Korean medicine, TCM, traditional Chinese medicine, Japanese medicine.

Dr. Weitz:            Okay. So let’s get to the gut bacteria. Which gut bacteria help with detoxifying heavy metals and arsenic and xenoestrogens and things like that?

Dr. Liu:                It turns out our ABCs are the ones that do that for us.

Dr. Weitz:            Okay.

Dr. Liu:                Not the bad signatures that show up, the bad signatures which are contributing to disease, the ones that putrefy TMAO, the ones that cause a lot of cancer chemicals or are associated with cancers, not those, but our ABCs, the good ones.

Dr. Weitz:            Okay.

Dr. Liu:                They all do that. Yeah. So let me tell you about Bifido longum and L. Rhamnosus. These are high amounts in our Bifido Maximus probiotic, actually the highest strength in the market right now.

Dr. Weitz:            That’s a probiotic that you sell.

Dr. Liu:                Yes, Bifido Maximus is only sold by us here at the Gut Institute.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah, and the way I formulate it is that it’s based on all the studies where healthy controls have the good gut flora, they don’t have celiac, they don’t have gluten intolerance, and they also don’t have heavy metal problems. They don’t have other health issues.  So for instance, one study by Gregor Reid, he’s a big, big probiotic formulator. They were able to get funding to do studies in Africa, Tanzania in particular. There’s a lot of silver mines and metal kind of mining there. In the process of silver mining, they leech out a bunch of heavy metals that are toxins for humans and other animals and fish. They go into the water. So, even their small fish. Usually we say, “Oh, the big predator fish have a lot of concentration of heavy metals.” Well, it turns out in Africa, in Tanzania, even the small fish that the villagers were eating ended up being very high and toxic in heavy metals.  So what he designed was a yogurt, a 200 gram yogurt with 10 billion L. Rhamnosus GR1, strain GR1, and they made it into a yogurt and they gave it to pregnant women and children. This would not pass IRB in the US.  Maybe it would. Who knows, right?  ‘Cause there’s no other solutions, really.  In that village, people were able to also create little economies, too, to make the yogurt.  So it actually could increase economic advantages for the impoverished here.  So what they showed was in pregnant women, the women who took the yogurt, they found that they had 36% less arsenic in the body compared to the controls who did not have the yogurt and had the placebo, 36% less mercury, and 78% less arsenic, which is so substantial for this population that they actually have really high heavy metal toxicity. All it was was just a daily yogurt.

Dr. Weitz:            Which particular strain was in that yogurt?

Dr. Liu:                 It’s called L. Rhamnosus GR1, but it turns out, many of the L. Rhamnosus strains also have this benefit to detox. In an in-vitro plate, they can lower the concentrations of all kinds of heavy metals. Yeah. And it would go out in the system.

Dr. Weitz:            So these are particular strains of bifido longus, right?

Dr. Liu:                Lactobacillus rhamnosus is a lactobacilli.

Dr. Weitz:            Oh, lactobacillus rhamnosus.

Dr. Liu:                Yeah. They also did the same study with bifido longum, and many strains of bifido longum also contributed to this benefit. So it’s believed actually it’s a class effect.

Dr. Weitz:            Okay.

Dr. Liu:                All of them have this ability, unless they’re a weird mutation or something. Yeah. I would say for our probiotic, invariably, when people go through our program, they’re always using high doses of Bifido Maximus.  We don’t always do testing in the beginning, but we test later. No one has glyphosate after provocation with glutathione for a month. That’s the typical way to do it. You provocate with glutathione.  We check using a glyphosate study from Great Plains.  People had not really any detectable levels at all.  Then people start with those, we do really gentle chelation. We don’t really do a ton, ton, ton. It’s not so healthy when you don’t have a good gut anyway to do that. But we will see people also, their numbers go down. I didn’t know where to attribute it, but I think actually the probiotics make a big difference. We do so many different things. I can’t say that’s the factor that accomplished that result.

Dr. Weitz:            So how do you discover that a patient has heavy metals? Does it come from history? Does it just come up on one of your routine testing? And then when you do suspect somebody has heavy metals, how do you like to test for it?

Dr. Liu:                 I look at sometimes their genetic SNPs. If they have mutations on glutathione, several, several of the MTRR, MTHFR mutations, and then APO E4, any of those will contribute to more heavy metals. I don’t always test, ’cause I know our protocols end up lowering it, but some of my clients, they’re great bio hackers. They come to me and they already have a lot of this testing from prior practitioners.  Yeah. Sometimes we will test. So we’ll do different kinds of testing, either hair provocation. You could do urine. Again, it depends on the variants they have, the genetic variants. Some don’t release. You have to provocate for not just on month, but even two months to actually see something, ’cause they hold onto it.  Also, they all have poor guts in the beginning, too. They may not release. Even though they look like a picture of heavy metal toxicity, they don’t always release. A lot of our protocols help to move those pathways. We try to look what the genetic SNPs are so we can start to bypass them. It’s not necessary to bypass all of them in the beginning. It’s also going to be like 20 million supplements. So what we do is just try to get the gut back online. We try to get the ABCs back online because they do it all.  So for instance, bifido and lacto, what’s so awesome about these strains is that as you know for detox, we can use different resins, right? Questran, Welchol, these are all resins, pharmaceutical resins, so they pull mycotoxins. They also pull xenoestrogens and they pull glyphosate pesticides. They pull heavy metals often, right? We use also Quicksilver Ultra Binder. It’s got different resins in there.

Dr. Weitz:            Right.

Dr. Liu:                  Yeah, right. Charcoal, clay, as well as sulfur-based resins, and a biological one called chitin, chitosan or chitin. So these bind. Well, it turns out, the cell wall, certain strains of the good bifido and the lacto, again, they’re in the Bifido Maximus, their cell wall acts as an ionic resin.  So whether it’s a highly, highly charged positive heavy metal or highly, highly negatively charged heavy metal, from mercury, arsenic, cadmium, all of them have different charges, they still get bound up. We don’t use too much of them. Sometimes we pulse these, ’cause they also can, I think theoretically, also bind our good stuff, our good zinc, good mag, good iodine. So we don’t want to pull too much of the good stuff, especially if people are already depleted. We want to make sure they get repleted as safely as we can.  But as they bind them, especially at a high dose, they anchor and then some are going to leave and die, and then they’re defecated out. They take with them all these yucky things. Yeah.

Dr. Weitz:            So your protocol for heavy metals is glutathione binders and then specific probiotics? Is that it?

Dr. Liu:                 Exactly, yeah, and opening up biofilms is really important. A lot of people don’t realize, the higher dose of antibiotic they had–Rifaximin–it selects for toxic strains that are super weedy. They’re like weeds. They’re also super nasty. So once the drug leaves the system, they’re only left with these nasties. If you don’t have the good ABCs in there, they’re just going to proliferate.  Only the ABCs keep them in check. You can meditate, do prayer, yoga, all the F you want. They are not going to keep out the bad guys as soon as stress happens. Everyone’s got stress now. We have real life stress, right? All kinds of stress we’re not even aware of, EMFs, smart meters. I don’t need to really go in depth on all that, but go take a class, right? But all these bombard us all day, like you mentioning assaults to our gut. We have multiple assaults on the gut that did not even exist like two years ago.

Dr. Weitz:            Okay. Now, you mentioned biofilms. Do you try to address biofilms in some way?

Dr. Liu:                 We must, yeah, especially when people have more of those genetic mutations that I mentioned to you. FU22 is a big one, as well. All our clients, 99% all have mutations on FU22. The healthier ones, like I also work with MMA fighters and endurance athletes, Spartan racers, champions, iron men, iron women. Actually, the better genes someone has to withstand environmental assaults, they’re usually going to excel in life through athletics, or I work with executives, too, multi-tasking ones. They tend to all excel in life, but they also have a few of these relevant kind of genetic markers and variants. But they also have-

Dr. Weitz:            MMA fighters probably have plenty of bacteria. They get their faced rubbed in those mats and-

Dr. Liu:                 I know, and they withstand all of them. They withstand all of them because they’re usually not FU22 and they’re not APO E4 ever. When you look at their MTHFR reports, I use MTHFR Support, the Sterling’s app. They’re like seas of green, just all green, green, green, green, green. Yeah, especially next to mine, I’m like, “Wow, what a difference.” They’re genetically like another species, and their hormones kind of show it, as well, too. They have all the healthy longevity hormone patterns.  We do something called fertility physics. No matter how old someone is, there’s certain ratios where higher anabolic is going to be higher than the estradiol. Estradiol is just a marker. It’s usually a stress marker, so we pair it up against there and look at it.

Dr. Weitz:            What is that now? Estradiol is a stress marker?

Dr. Liu:                Yeah. So it’s released when aromatase goes high, especially with gut inflammation.

Dr. Weitz:            Estradiol goes higher with gut inflammation. You mean because estrogen’s being recirculated instead of excreted out?

Dr. Liu:                There’s a hormone called aromatase. It gets lit up when there’s central stress going on, central inflammation going on. Gut stress is literally 90% of the stress I see people in. When we eliminate that using four phases, we target different things, and always at every phase, we’re trying to bring back the ABCs, the polyphenols and our protocols and really high, high dose. We even use a trillion a day probiotics every day of the Bifido Maximus. You’re able to massage all that. Yeah. We see aromatase go down.  Also, I use specific botanicals to lower the aromatase activity, so it’s not so turned on for people, and they feel better…. Oh, way more than that. Way more than that.

Dr. Weitz:            What do you use?

Dr. Liu:                Olive leaf. Bitter melon’s amazing, which is like an ancient Chinese-

Dr. Weitz:            Bitter melon? I always think of blood sugar, but that helps with estrogen detoxification?

Dr. Liu:                High blood sugar is just leaky gut. All these people on the keto diets, awesome. What they’re trying to do is just repair their gut, but they don’t realize without polyphenols and certain prebiotics, they’re going to keep losing their ABCs. That’s what studies show. They particularly lose the Cs, the butyrate producing Clostridiales.

Dr. Weitz:            Wait a minute. High blood sugar isn’t just leaky gut, right? I mean, it’s also-

Dr. Liu:                You should read the work from Patrice Cani. [Here is one paper from Dr. Cani on this topic: Gut microbes and health: A focus on the mechanisms linking microbes, obesity, and related disorders. ]

Dr. Weitz:            Okay.

Dr. Liu:                He’s from Belgium. Yeah. He did all the seminal landmark work.

Dr. Weitz:            But I mean, it’s also eating the junk that people eat, the sugars and the breakfast cereals and the Hostess Twinkies and on and on and on.

Dr. Liu:                It’s so fascinating. There’s a group called Ilan Ilanoff. They’re from Israel. They have a certain stool kit that’s pretty interesting. What they found is that they checked people’s blood sugars eating the same food. Let’s say rye bread, for instance, okay? Some people, based on just blood sugars alone and their microbiome data, some people had, let’s say, high blood sugars with eating rye bread, right? We see this often. They have gluten allergies. They have the whole bad signature of bad gut flora, right?  He was looking at all kinds of people, and other people had low blood sugars, better blood sugars, better insulin sensitivity eating rye bread. Rye bread also is full of really good prebiotics. Grains actually can have really great oligosaccharides from the bran part, rye bran and whole grain, and there’s a lot of fiber, both soluble and insoluble fiber, right?

Dr. Weitz:            Okay.

Dr. Liu:                Legumes, too. They have a lot of these good fibers. And they would see low blood sugar. It was all dependent on a microbiome signature.

Dr. Weitz:            But you’re being sacrilegious right now. In the religion of Functional Medicine, though shall not say anything positive about grains.

Dr. Liu:                All the longevity societies eat grains and beans all day long. I can’t think we could dismiss their data. Did you ever watch the Longevity film with Jason Prall and Michael Wesley?

Dr. Weitz:            I never saw it. Is it worth watching? Yeah.

Dr. Liu:                Yeah, I think so. If you’ve never interviewed Jason Prall, you should interview him, too.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. The diet of our ancestors is very important. I’m also … At one point … Well, I kind of gave it up now, but I was chapter leader for our area for Weston A. Price. Are you a fan of Weston A. Price?

Dr. Weitz:            Not necessarily, but I know everybody else is.

Dr. Liu:                I’m Chinese. When I took rice out of my life, my health went down.

Dr. Weitz:            Okay.

Dr. Liu:                Yeah. I can’t tell you how. I’m also APOE2. We’re agrarian adjusted.

Dr. Weitz:            Oh, okay.

Dr. Liu:                Yeah. Even when I was sick and I had Hashimoto’s and I was eating 400 grams of carbs a day and a lot of sugar, my triglycerides didn’t go over 100.

Dr. Weitz:            Wow.

Dr. Liu:                Yeah.

Dr. Weitz:            Okay. So, which goes to show, there’s no one diet that’s right for everybody. So, as far as gut bacteria-

Dr. Liu:                That’s Functional Medicine for you, right, Dr. Weitz?

Dr. Weitz:            Exactly.

Dr. Liu:                Customized. Yeah.

Dr. Weitz:            So as far as helping us detoxify mold, mycotoxins, how do we accomplish that with probiotics?

Dr. Liu:                So I love the Shoemaker Protocol and all these other mold ideas and stuff, but I go back to the microbiome, right? If we don’t have a good microbiome, we also aren’t going to survive mold.  We have mold everywhere. Our ancestors grew up with mold all over with them.  So, it turns out, a lot of the soil probiotics, many strands like L. Rhamnosus in our probiotic and B. Longum, they have the ability to actually, in in-vitro, lower mycotoxin concentrations. It’s pretty amazing, amazing.  We also have different protocols using certain botanicals. They shut the genetic expression translation off for mycotoxins. So mold may be present in the ecosystem. Doesn’t mean it has to be super bad all the time every day.  It turns our food, if we eat an ancestral diet, which is high in polyphenols, antioxidants, and prebiotics, even grains, okay, we feed these bacteria. Guess what B. Longum and L. Rhamnosus eat, right? They eat a lot of FODMAPs. They eat our mucous. Also, studies show, I don’t know if they eat polyphenols, but polyphenols increase their growth and proliferation.

Dr. Weitz:            Can we really eat an ancestral diet?

Dr. Liu:                I have a hard time. I don’t eat as much fermented foods as my ancestors did, for sure. I don’t eat as much plants, either.

Dr. Weitz:            I mean, none of our fruits and vegetables at all resemble the fruits and vegetables and tubers that ancient humans ate.

Dr. Liu:                No. A lot of GMO now, too.

Dr. Weitz:            Yeah.

Dr. Liu:                Exactly.

Dr. Weitz:            And the hybridized farming for hundreds of years.

Dr. Liu:                A lot of the fruit aren’t as high in antioxidants, either. They’re all farmed. Our fish is farmed. It is difficult.

Dr. Weitz:            Yeah.

Dr. Liu:                I would say it’s not impossible, but it would be a part-time job, right? If I did eat all the vegetables and fruit, I’d be gnawing like a horse and cow all day, right? I don’t have time for that, either. I do like something called bionic fiber to make up for it. It makes my stools like Bristol 4 twice a day. [Dr. Liu is saying that her stool corresponds to the Bristol Stool Chart, which is a diagnostic medical tool designed to classify the form of human feces into 7 categories and it describes the ideal stool as either type 3 or 4]  I don’t even worry about it. 

Dr. Weitz:            Oh, okay.

Dr. Liu:                Yeah. That’s the only thing I bring on travel sometimes. I get bummed when I lose that.

Dr. Weitz:            I was looking at some studies on a mycotoxin thing, and I saw that the soil-based probiotics have been shown to have some benefit, as well.

Dr. Liu:                Yeah. The bacilli all do. Just like bifido and longum, the strains that I mentioned, they also degrade glyphosate and have helped with heavy metal remediation. Yeah. But bifido and lacto might be our mainstay. They are in much higher concentration than the bacilli. With the bacilli, you just need a little. A little bit goes a long way.  With bifido and lacto, literally, they can be, healthy controls can be .5 to 1% out of the whole gut consortium. With bacilli, you’ll see the strains, but they’re much lower, much, much lower, like .1% or way lower, like when you’re looking at a 16S analysis like from uBiome or Thrive Kit.  Yeah. The Vibrant kit they don’t give percentages right now, or they’re going to give number quantities.  On the GI Map from Diagnostic Solutions Lab, you can also see quantity. I kind of look at that as we look at our clients, but it’s also great to get a culture.  So, we have media when we culture using CDSA, a comprehensive diagnostic stool analysis-

Dr. Weitz:            So it might be beneficial to get a culture stool sample, as well as a DNA based stool test?

Dr. Liu:                I’ll take any data. All data is limited to information, but yeah, I like seeing it all, but then it ends up costing thousands of dollars.

Dr. Weitz:            Right, right, but if you had a patient who’s willing to do whatever and cost wasn’t a factor, you would get a genetic stool test and a culture-based stool test?

Dr. Liu:                Absolutely, yeah, yeah. Absolutely, yeah. You see just a different picture. The media is still old school, but it still shows us our most vile kind of bacteria that grow out.  With the DSL, Diagnostic Solutions Lab, GM map, it’s awesome. They probably over-visualize right now. I’m sure some of it’s kind of noise. You can’t see to that degree, but what we see is with each of the phases we work on, we always go big to small. We work with people for four phases. We go big parasites, helminths, eukaryotes, then we go fungal, then we go SIBO, bacterial, and then lastly, we do viral. Viral, spirochetes, phages, small things. We go in that order. We always are looking at other eukaryotes through the whole thing. Fungal is really big, so we look at fungal throughout the whole thing.

But with the GM map, it’s really cool. Because the flora live in layers, the first layer is kind of the most needy kind, more toxic, severely toxic, like the C. Difficiles, right, and campylobacter, the enterohemorrhagic E. Coli. They can’t really drill down E. Coli well. You have to do genetic tests, so that’s why the culture’s not going to work so well. You have to use genetic testing to look at the different toxic species in there.  E. Coli is such a menace right now, but what studies show is L. Rhamnosus, B. Longum, all are ABCs. They have all natural anti E. Coli abilities. Not all E. Coli is bad, either. There’s a Canadian and other European strains of good E. Coli. These are our first bacteria that were used to treat SIBO, actually. We gave 50% success rates, but we couldn’t use that in the USA.

Dr. Weitz:            Killing SIBO with probiotic bacteria. Yeah.

Dr. Liu:                Yeah. Depending on the study you look at, it could be 60, 80%, or even a higher percent, 97% improvement in SIBO. I see 100%.

Dr. Weitz:            A lot of practitioners are still dead set on not using probiotics when treating SIBO.

Dr. Liu:                That’s probably ’cause they’re using strep ones, right, and they have a form of PANDAS. They have antibodies against strep. You can’t use step probiotics. Many of the probiotics in the functional medicine field have very high amounts of strep. Strep thermophilus is not a natural native of the human gut. If people are reacting to it, it’s like a food allergy. Would you give gluten to someone who’s reacting with a high IGG, IGE with gluten? No, right? You take it out temporarily.

Dr. Weitz:            Would you say the probiotics on the market have the wrong form of strep?  That’s-

Dr. Liu:                Yeah, and they may also have Saccharomyces. Our Saccharomyces is our-

Dr. Weitz:            You don’t use Saccharomyces?

Dr. Liu:                No, I don’t use any Saccharomyces.

Dr. Weitz:            How come?

Dr. Liu:                We look at the IGG panel from either Cyrex or Great Plains. When there’s a reaction, you definitely don’t want to use it. But some of the IGG panels, they’re not graded or calibrated to a person’s immunoglobulins. Some are under-producing a lot of immunoglobulins ’cause they’re immunocompromised.  80% of our immunity’s in our small intestine, so if they’re not lacking our ancestral core, like the ABCs, you can’t trust the immunoglobulins. They’re immuno suppressed, so their SigA isn’t going to light up. It’ll be even zero. You can look at total immunoglobulins. Let’s grade them against everything. Vibrant now has a free add-on you can just-

Dr. Weitz:           Cyrex does the same thing. If the IGG is low, they’ll recalibrate the numbers.

Dr. Liu:                Yeah, so you actually will see if it’s lit up. Yeah. So a lot of our clients, they light up for Saccharomyces. You definitely don’t want to be giving Saccharomyces, but we take it away from everybody ’cause again, we don’t always trust the testing.

Dr. Weitz:            But what about for C. Diff? We find it really helpful for C. Diff, and also for fungal infections.

Dr. Liu:                B. Longum’s even better. Yeah. They did a study in babies, ’cause all babies now are born in hospitals, right? The higher in the gut B. Longum was present, the lower the C. Difficile colonization. All babies get C. Diff. They’re colonized. It doesn’t mean anything. But the second they get stress or antibiotics or formula, this increases their risk to express it, right?  C. Diff, literally spores are all over hospital workers, nurses, doctors, everybody. It’s on all the surfaces, doorknobs, everything. The more bleach they use, the more antiseptic they use, the more it becomes heartier. Spores last forever. Studies have found spores that are millions of years old embedded in the amber of different insect guts. Yeah. So C. Diff is one that is virtually indestructible.

Dr. Weitz:            So, one more time, why don’t we want to take Saccharomyces boulardii as a supplement?

Dr. Liu:                Saccharomyces, as you know, is a wild yeast. It’s actually one of our number one healthy, good flora in the gut, good fungi in the gut. But when someone’s permeable or they have toxic flora, they have the signature of toxic flora … They could be selectively permeable. Wherever these bad flora are, they’re causing little ulcers, so then they can enter the bloodstream, right?  When Saccharomyces enter the bloodstream, what happens? The body launches an attack against it, right, just like it would for gluten or dairy or, yeah, who knows what. We see a lot of joint problems, fibromyalgia. A lot of times, it’s Klebsiella Citrobacter, right? It’s growing in the gut. It’s entering the bloodstream. The body’s launching an attack.

Unfortunately, a lot of our tissues look like the cell walls of Klebsiella or Citrobacter, and then it can be muscles or mitochondria even, and then they get attacked, so people feel achy. They don’t feel well.  As soon as people go on a certain diet and they also fix their gut, all these aches go away. Even if they’re 60, 70, 80 years old, their aches go away. Aching is not really the best sign. It’s not normal. It’s not part of our aging process. It’s a sign of decrepitness, right? Sarcopenia. Muscles go down, as well, typically as well, too. So there’s a lot of different ways to assess leakiness or what’s going on in the gut.

Dr. Weitz:            As a chiropractor, we get a lot of decrepit patients.

Dr. Liu:                I know, I know. So looking at the fungal markers on the Great Plains lab is really the best ’cause you’ll see the fungal there. The thing is, it’s not direct, so we don’t know if it’s Saccharomyces. I look at the IGG to Saccharomyces. If it’s even in the upper green or yellow zone on the IGG Great Plains panel, that means they’re going to potentially be having IGG against Saccharomyces. It’s not safe to give it if that’s the case, nor is it safe to eat any of the foods that are slightly yellow, until one or two months later, then they heal the gut and immune system calms down. They’re kind of having this hyperimmune thing, right? They’re attacking everything that falls into the bloodstream.  But we can assuage the immune system. There’s so many ways to calm the immune system down. Treating the adrenals. We use something called NanoMojo. Mojo is amazing. Using certain botanicals that balance TH1 and 2. We use mistletoe now. We use actually cancer treatments for educating our clients to help them normalize their immune system.

Everyone’s at risk for cancer now. Even some of our best Functional Medicine leaders, they’re drug-addicted. There are mental issues, depression, cancer. Why is that? They’re missing something. They’re missing the probiotics, I have to say. They don’t have actually a great financial portfolio. I’d say it pretty much sucks, actually. If they’ve never evaluated, they don’t know, right? Better be ignorant I guess.  But it’s good to know there’s steps that can be done. Not to go overboard crazy, but not to ignore ancestral past. We’ve always co-evolved with this legacy of our flora. The first time in the human history now, kids are dying before their parents, or even before healthy grandparents. It’s insane. We must change this tide. It’s not good for us to ignore it and ignore the earth terrain, too, yeah, ’cause we’re just reflections of the earth terrain and how we treat the animals and the plants and the way we do farming.

Dr. Weitz:            Yeah. We’re not doing a good job of that. Well, I think we have to bring this to a close. So, any final thoughts you want to give our listeners and tell us how we can get in touch with you and find out about your programs, et cetera, et cetera?

Dr. Liu:                Absolutely. I’m at TheGutInstitute.com. We also do Facebook Live every Tuesday at 2:00 Pacific Time at our Facebook, The Gut Institute page. You can contact us through our website, TheGutInstitute.com.  I also teach practitioners. We have a 50 hour gut certification immune certification program and love sharing our protocols for what works and the cases. I have a very concierge practice, so yeah, usually we don’t have a lot of openings, so we don’t have a lot of openings. I have a class, like a Master Gut class if people are interested, as well, just to learn. We have a lot of practitioners and coaches that go through it, as well. They learn all the basics and get their gut a lot better.  But thanks so much for having me on. I think everyone should be happy and have a look at their gut flora. Test it, don’t guess it.

Dr. Weitz:            Great. Excellent. Thank you, Grace.

Dr. Liu:                Thank you, Dr. Weitz.



Medicinal Mushrooms with Jeff Chilton: Rational Wellness Podcast 103

Jeff Chilton discusses Medicinal Mushrooms with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

3:32  The health benefits of mushrooms include the immune strengthening properties. This is due to the beta glucan compounds found in the cell walls of mushrooms. Each mushroom has a different architecture of that beta glucan and that determines how immunologically active it is.  There are specific receptor sites in our intestines for beta glucans.

5:27  To get the immunomodulatory effects of mushrooms, to get a therapeutic benefit, you need to eat about 100 gms, which is about 4 ounces. And it is better to cook them to get the full therapeutic benefit or to consume them in powder form, such as in capsules. It’s not harmful to eat raw mushrooms, but they have chitin, which tends to bind up some of the compounds in mushrooms and cooking helps to break that down. or if you take them as supplements

11:20  The mushrooms that tend to have the strongest immune strengthening properties, such as part of an integrative cancer protocol, are Maitake, Reishi, Shitake, and Turkey Tail. In Japan they have developed drugs from mushrooms, including PSK from Turkey Tail and Lentinan from Shitake.

17:20  Mushrooms have both antibacterial and antifungal properties, which means that if you have mycotoxins (mold toxins) you probably don’t want to restrict consuming them. Some practitioners when treating patients for mold toxins tend to place them on a diet that restricts eating mushrooms to avoid getting exposed to more fungal/mold compounds is the wrong thing to do.

21:32  Mushrooms can have beneficial effects on cholesterol and red yeast rice is where statins (HMG-CoA-reductase inhibitors) come from. Oyster mushrooms have a good amount of a natural HMG-CoA-reductase inhibitor in them.

22:42  Reishi mushrooms in particular and mushrooms in general seem to be beneficial for blood sugar regulation and diabetes because they contain a lot of fiber, are 20-30% protein, and the primary carbohydrate is mannitol, which does not raise the blood sugar. and because of the fiber content, mushrooms are good to feed your microbiome.

24:14  Lions mane mushrooms help with brain function by stimulating BDNF production.  The therapeutic dosage would be 3 gms, which is 1-2 teaspoons. Jeff said that often too small a dosage of herbs is recommended than is optimal and that’s often because they often put 30 or 60 capsules in a bottle and then want to make sure that a bottle is a month’s supply. Typically the same dosage is recommended for all patients regardless of how big or small they are.

30:07  Mushrooms can be helpful for sleep, esp. Reishi mushrooms. Reishi helps with stress and insomnia at a dosage of 2-5 gms per day and they should take it for 2-4 weeks before expecting results.  Jeff explained that you need to make sure that the product that you are taking a quality product that actually contains the mushroom and not just the mycellium. The mycellium is the vegetative body of the mushroom–sort of like the roots–and it is often grown on grains and it does not contain the active ingredients, which are only found in the actual fruiting body of the mushroom.  There are no good mushroom products made in the United States, according to Jeff.

39:02  Jeff explained that mushrooms are one of the most overlooked foods and we should start eating mushrooms, because they are so rich in nutrients like B vitamins and other nutrients. Just make sure that you cook the mushrooms properly to unlock the value. Mushrooms are also high in potassium and phosphorus.  Jeff’s company that sells wholesale is Nammex and he also has a retail outlet called Realmushrooms.com that sells mushroom extracts.



Jeff Chilton studied Ethno-mycology at the University of Washington in the late 1960s. He has worked in mushroom production at a mushroom farm, organized educational conferences on mushrooms, wrote a highly acclaimed book, The Mushroom Cultivator, and started Nammex, a medicinal mushroom company that sells wholesale organic mushroom extracts.  He also has a retail outlet called Realmushrooms.com that sells mushroom extracts.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or by going to www.drweitz.com.


Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz, with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition, from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and signup for my free eBook on my website, by going to doctorweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who are enjoying listening to the rational wellness podcast, please, please go to iTunes and give us a ratings and review. That way more people can find out about the Rational Wellness Podcast.

Our topic for today is the health benefits of medicinal mushrooms, with Jeff Chilton. Jeff studied Ethnomycology at the University of Washington in the late 1960s. He’s worked in the mushroom business since then. He worked in mushroom production at a mushroom farm. He’s organized educational conferences on mushrooms. He wrote a highly acclaimed book, The Mushroom Cultivator, and he started Nammex, a Medicinal Mushroom Company that sells mushrooms, wholesale and also retail. Jeff, thank you so much for joining me today.

Jeff:                     Otherwise, thank you so much for having me. It’s great to be here.

Dr. Weitz:            So why don’t you tell us how you got interested in mushrooms and in their benefits?

Jeff:                     Well, you know what, I grew up in the Pacific Northwest, Seattle area, and it’s an area that is wet. We get a lot of rain up here. We’ve got beautiful forests and because of our climate, which is a mild maritime climate, that’s especially wet in the fall, we get an abundance of wild mushrooms coming up. And that was fascinating to me. I got out when I was younger and did some wild mushroom hunting and later at the university, my major actually was anthropology, but I studied some mycology, and really what I did was, I kind of blended the two together, and I did a lot of work on the use of mushrooms worldwide in cultures, whether it would be for food, for medicine, or also the use of mushrooms in shamanism. And as you know, in the 60s, we practiced a lot of shamanism.

Dr. Weitz:            I assume by shamanism you mean, the psychedelic properties?

Jeff:                     Yeah, that’s right. We didn’t have a set of rules to go by unfortunately. So we were flying a little bit blind. But you know what, we were discovering a lot of things and we were sort of in a sense, creating a new culture and, Dr. Weitz, a part of that culture too, was looking at the food we were eating and deciding, hey, there’s something wrong about the diet that we’re being fed. So there were a lot of things going on back then that we were essentially rejecting and trying to find out more information about.

Dr. Weitz:            Great. So let’s talk about some of the health benefits of mushrooms. I know one of the first things that comes to mind, from what I know is the immune strengthening properties. Maybe you can talk about that.

Jeff:                     Oh, yeah, absolutely. The interesting thing about mushrooms is that, in the cell wall of a mushroom, they have compounds called beta glucans. And, that makes up almost 50% of the cell wall of all mushrooms and what’s interesting is that, these beta glucans have… the… each mushroom has a little bit different architecture of that beta glucan. And the structure or the architecture of that beta glucan determines how immunologically active it is. So just eating mushrooms, no matter which mushroom we eat, we’re going to get those beta glucans. But certain mushrooms have medicinal properties where the beta glucan has a structure that will actually activate immune cells.  And what’s really interesting is that we have receptor sites in our small intestine that are very specific to these beta glucans, these fungal beta glucans. So when those beta glucans go down there, they hit those receptor sites and then that will activate different, the production of different immune cells. What I would say is, that is the really, the key underlying benefit to almost all of what we would call a medicinal mushroom. And you can get those benefits either through eating mushrooms or supplementing mushrooms. Of course when you supplement with mushrooms you’re not going to have to take quite as much because it might be a little more concentrated form. But still…

Dr. Weitz:            If we’re going to eat mushrooms, how much mushrooms do we have to eat to get, say a therapeutic benefit? Let’s say somebody is taking mushrooms to help with some health condition or, some people use it as part of their cancer protocol. How large you are serving a mushrooms and how many times a day would you have to eat them to get a therapeutic amount?

Jeff:                       Well, in terms of eating mushrooms, what I would say is probably to get a therapeutic amount you’d want to eat about a hundred grams. And, a hundred grams, I think that would be about a four ounces. And look, you think, oh, four ounces or a hundred grams, that seems like a lot. Not a lot. The other day I weighed up a common button mushroom that you see in all the supermarkets, and I weighed up a medium sized button mushroom and it weighed 40 grams! Well that basically is an ounce and half or something.  So really in terms of fresh mushrooms, you don’t have to eat that much. But what I would say is, what’s important is cooking them properly for one. You know what happens is that, and I’ve heard it for 40 years, ever since I was the guy in the mushroom business was, oh yeah, mushrooms, man, they are slimy. They are … One thing I got, people just have this conception of mushrooms. No, you have to cook them in a hot pan. You have to cook them where … I like to slice them about a quarter inch thick, throw them into your favorite oil, whatever you want to cook them in, a hot pan.  Brown both sides of them. Cook them a little bit longer than shorter. So that when they come out of that pan, they’re not wet and soggy. Actually they’re dry. Because … Or if anything, they’ve maybe got a little bit of oil, but if you brown them up and then, to me, if I’m just going to eat the mushrooms alone or even like I did a couple of nights ago with a steak, and I’m a meat eater, I just put a little bit of salt, a little bit of pepper. Oh man, they were delicious.  And, the thing about it is they go with about anything. So you can put them into stir fries, you can put them into your eggs, but again, cook them properly. Otherwise you’re going to go out and man, the texture’s not so good. These were dry and almost a little bit crunchy. They’re really tasty.

Dr. Weitz:            Can you get the medicinal value? Eating them raw?

Jeff:                     You know what, I would not recommend eating mushrooms raw. I think, generally speaking-

Dr. Weitz:            You see them at salad bars sometimes.

Jeff:                     You know what, it’s not like it’s going to harm you in any way. It won’t harm you in any way. And if you like to eat them raw, go right ahead.

Dr. Weitz:            But you might not get the full therapeutic benefit.

Jeff:                     True. Because, the other thing about mushrooms is that, in that so all, they also have a compound called Chitin. And for those people who are unfamiliar with Chitin, normally we think about Chitin, it’s what makes up the shell of a crab or other crustacean. But, that particular Chitin actually, they use calcium carbonate to build up their shell. Mushrooms don’t. But there is some Chitin in there. It does bind up some of the compounds in mushrooms. So cooking helps to break that down a little bit. The other issue really is that, one of the things about when you go to supplementation for example is that, you have a dry, it’s a dry product. It’s been ground to a fine powder. So you have a tremendous amount of surface area.  And when you’re consuming anything, I mean, let’s face it, just like if you make a soup. Well, you’ve got those compounds in whatever you got in your soup. Now they’re in a form where they’re readily available, you can take them in and they will go right to work almost immediately.

Dr. Weitz:            When you speak about beta glucans, I’ve always heard of the mucopolysaccharides as a component of the mushrooms that have the immune strengthening properties. Is that the same thing?

Jeff:                       You know what, I’m not really that familiar with a mucopolysaccharide, because that’s not really very, what they talk about very often.  But what I would say is that, beta glucans are polysaccharides. They are a … let’s just say they’re a subset in the sense that polysaccharides can be a lot of things.  Like for example, starches are polysaccharides.  And that’s a huge issue because, one of the great things about mushrooms is that, mushrooms have storage carbohydrates, much the same as we do. They have glycogen, plants produce starches that are storage carbohydrate.  So two very different types of carbohydrates there.  In fact, the other thing about mushrooms and eating mushrooms is that, one of the major components of the carbohydrate in mushrooms is mannitol.  Now mannitol is a low glycemic index carbohydrate that will slowly work in your system.  They’ve actually shown that mushrooms can be very good for people who are diabetics. They have a lot of fiber. They will fill you up, but they have a low glycemic index carbohydrate in there in this mannitol.  So even people who are in fact, diabetic or prediabetic or something like that, mushrooms are a good food for you.

Dr. Weitz:            So since we’re on the immune strengthening properties, I know several practitioners who use mushrooms as part of a integrative cancer protocol. Which particular strains of mushrooms do you think are most effective as having some sort of an anti cancer effect?

Jeff:                     Well, you know what? I would say the species that you should look for in that sense would be Maitake, Reishi, Turkey Tail. Those three are, would probably be my top three. They’re not now, Shiitake is also been shown to have those properties. And the wonderful thing about Shiitake or Maitake, is both of them, especially where you are in Southern California. I mean you could probably go into any market in Southern California and find fresh Shiitake and fresh Maitake, I mean Reishi is not really something you’re going to eat because it is hard and woody. So traditionally it’s made into a tea. But Shiitake and Maitake.  So those four I would say really would be the top ones that I would recommend for people in that sense. And, that is really the interesting part about these medicinal mushrooms, is that in Asia, they’ve actually produced some drugs based on these specific mushrooms. Like for example, Turkey Tail, there’s a drug in Japan called PSK, that’s been developed from Turkey Tail and a drug in Japan called Lentinan, which has been developed from Shiitake mushroom. So these mushrooms, there are that beta glucan as that’s part of what they have produced from these mushrooms.  That is really the key here. And what they do is they use it as what we could call an adjuvant to a cancer therapy, which is, you take it along with your therapy to help keep your immune system operating in a little bit higher level. Because it’s being torn down by those, whether it be the chemotherapy or the radiation.

Dr. Weitz:            Are you familiar with AHCC?

Jeff:                     I am, yes. And, to tell you the truth, I don’t know too much about that, other than it is a proprietary type of product that is … they use different mushrooms to break down certain organic products into this final AHCC. Again, my company doesn’t deal pretty much with those kind of products. I call that product and others like it, a process driven product, where rather than being what we considered a natural or herbal type of supplement, it goes through multiple steps to reach its final state. And so it’s quite different than most standard of your mushroom products, mushroom extracts.

Dr. Weitz:            I see. I did a little reading, prior to this podcast and I read that a couple of popular chemo drugs, paclitaxel and vinblastine are actually synthesized from mushrooms.

Jeff:                     Well, you know what, and here’s … This is interesting because. And what I want to tell your listeners right now is, what you have to remember is the mushroom is what we would call one plant part of an organism that has a couple of different plant parts. Mushrooms don’t have seeds, they have spores. And those spores will be out in nature, whether in the soil or in wood. They will germinate into fine filaments. And when multiple filaments come together into … they will form a fuse, they’ll form a network. And that network is called mycelium. That’s the actual what we would term a vegetative body of this organism. And that’s what’s out there. That’s one of the primary decomposers we have in nature. It’s breaking down organic matter out there and turning it into humus.  Without it, we’d be buried in all sorts of woody tissue and leaves and all sorts of organic matter. So we’ve got a spore. We’ve got this mycelium, which is the vegetative body when conditions are right, like I was talking about earlier, here in the Pacific Northwest, where it’s fall, the temperature goes down a little bit, it rains, humidity goes up, up pops a mushroom. So when you were talking about those particular drugs coming from a mushroom, actually, there are two divisions in this fungal kingdom and one is what we would call perfect fungi. And those are the mushrooms, the other called imperfect fungi, which are what you might consider a mold.  And the differences is that, mold does not produce a mushroom. And that, mold is where penicillin came from. So fungi have produced all sorts of really interesting compounds and a lot of them come from these compounds or these types called imperfect fungi or what we would just call molds. And normally when we see a mold, it’s like on our bread or it’s on like a piece of fruit. And we go, “oh my God! It’s a mold! Throw that out.” Right? Well, that again, that funguses, has attacked that piece of fruit or that bread because it’s getting older. The spores are there. They germinate. It’s just doing its thing of, okay, I’m going to decompose this. Right.

Dr. Weitz:            Right. So, I was reading about how mushrooms can have antibacterial and antifungal effects. Which is kind of interesting because sometimes I deal with patients that have mycotoxins, mold toxicity. And, I usually tell them not to eat mushrooms because they’re already having a problem with mold. But it looks like from some of the reading I did, that mushrooms actually can help you to fight off toxic mold.

Jeff:                     Yeah, that’s absolutely right. They can. And remember, you know that a mycotoxin, that’s actually from a, again, an imperfect fungus. And what happens is it’s an aflatoxin, it comes from a specific mold. And it will invade moist grain. And so a lot of the aflatoxins that people get are from eating grain products. Because of this mold, I mean. So people growing all those grains, they’re constantly checking their grains for these aflatoxins and the toxins. Once this mold gets into the grain, it can produce these toxins, and aflatoxins are very toxic.  I mean, you definitely, it’s very important that you never end up consuming them. You can get very sick from them. But, I don’t know whether you’d heard too? There used to be a meme going around and it was there for a long time, especially back in the ’90s where it was like, if you’ve got candida, don’t eat mushrooms. And it’s like, I know herbalists that treat candida with mushrooms, you know what I’m saying? There’s this whole idea of somehow, like produces like. And, it’s an ancient idea that’s more mythological than it is real. It’s like, okay, I’ve got a fungal infection, but that means I shouldn’t eat mushrooms.

Dr. Weitz:            Well, I think it comes from the concept that, the first step to clearing out some toxin, is stop getting exposed to it. So if you’re in a moldy house, leave the house or, remedy it. And, so avoiding foods that might have mold or mushrooms seems like that would be part of the same concept.

Jeff:                       Yeah. And here’s the thing too, because, when people are susceptible to molds, what we’re talking about here is we’re talking about molds growing in their house, on the walls or somewhere. And what they are allergic to, are the mold spores. Because those molds, when you see, like for example, a black mold, well normally most molds start out and they’re kind of whitish, but when they reach a certain point, they will mature. They will produce spores. And it’s those spores which people are breathing in. They’re not eating those spores, they’re breathing them in. And that’s causing this allergic reaction. And that’s when people have this mold issue. And it’s due to environmental factors. It is because they’re actually breathing in the mold spores and, there’s actually a thing called mushroom worker’s lung. And what it is, is that, some mushrooms, because a lot of mushrooms are grown indoors, in large houses or warehouses.  And if that cap of the mushroom is allowed to mature, the spores will come out and be in that environment. And if you’re in there, harvesting, you’re in there for hours. And you’re breathing in all of these spores. It is a very bad environment to be in. And that’s where, really, people that are harvesting mushrooms should always wear a respirator. And one of the reasons why, the button mushroom that you see in the market, it is harvested before, it actually matures and produces spores.

Dr. Weitz:            Interesting. I know mushrooms can have beneficial effects on cholesterol. And I know red yeast rice is where statins come from, right?

Jeff:                     That’s right. Yeah. That’s really, really interesting because the oyster mushroom, pretty, it was a lot of these statins. And what also is interesting is how, the company that produced the drug had the FDA keep these red yeast rice products out of the markets, and were suing people that were putting them out there. Because they said, no, you can’t do that because, we sell statins and we’ve got patents and all of this. And, isn’t that crazy? Here it is. It’s a natural product that has the statins in it and yet they’re going, you can’t sell those.  What! Oh God, are you kidding me? No. Oyster mushrooms. Oyster mushrooms have the … and they’ve got a good amount of them. I mean, people who have those issues could be putting oyster mushrooms into their diet and getting those benefits.

Dr. Weitz:            Cool. What about mushrooms that are beneficial for blood sugar regulation and diabetes?

Jeff:                     Well, that’s again, Maitake is the primary one for that. Although I think that’s something, again, that gets back to the fact of, mushrooms having this mannitol as one of their primary carbohydrates. Because mushrooms are mostly carbohydrates. They’ve got a 20 to 30% protein. So it, and it’s good quality protein, but that’s not really why you’re eating mushrooms. But they have this carbohydrate. And again, it gets back to the fact of the mushrooms being very, very high in fiber. So if you want something to feed your microbiome, man, mushrooms are perfect for that and they’re very good for your microbiome.

Dr. Weitz:            Really. What form of mushrooms would you want to eat to promote your microbiome?

Jeff:                     Well, any of them. Because they’re all very high in fiber. And that’s one of the reasons too. Foods that are high in fiber, they’re basically not super digestible. So what’s happening is a lot of that food is just going right through and right down in the colon, and that would be your nondigestible fiber that goes to your microbiome. And if it’s a good food, it will be essentially worked on there and a lot of the benefits will come right out of the food at that point.

Dr. Weitz:            So I understand lion’s mane has been touted as helping brain function. And, I did some reading apparently, it stimulates nerve growth factor.

Jeff:                     Lion’s mane. I tell you, we can’t keep lion’s mane in stock right now. I think in the US right now, everybody must be losing their memory.

Dr. Weitz:            We are seeing a rapid increase in neurodegenerative diseases like Alzheimer’s and Parkinson’s.

Jeff:                     I know, I know, I know. And, that reminds me, I better start taking more of it every day because I’m at that age. No, it’s really interesting because, it’s what, I don’t know. You’ve probably heard of this whole category now called nootropics.

Dr. Weitz:            Yes.

Jeff:                     And that’s becoming a huge category. Anything that helps us to function at a higher level. Now the nootropic that I love the most is called coffee. And that’s what I use in the morning to get me going. And it has a real effect on me. But right now lots of people want the lion’s mane because of the whole memory benefits. And I think we all could use that. We’re all, I mean, it doesn’t matter what age you are. We all think we don’t, our memory’s not quite sharp enough. Right? And so lion’s mane stimulates nerve growth factor.  Nerve growth factor is something that we produce that then will actually stimulate the growth of neurites and neurons, which are nerve cells. And those nerve cells are constantly being destroyed and regenerated all the time. And unfortunately as we get older, the destruction increases while the construction of new cells doesn’t keep up. And that’s where all of a sudden … “What did you say your name was again? I forget.” It’s like those types of issues come up and it’s not really comfortable when you start to lose your memory and it becomes a little more difficult. And so right now, certainly, lion’s mane, it’s our top selling mushroom right now.

Dr. Weitz:            Is there only one type of lion’s mane? That’s number one. And then number two is, what is the best form in dosage? Is capsules better than T versus powdered form versus … What is the best form?

Jeff:                     Well, you know what, I personally think that when something is in a powder form, you just have that much more surface area. The thing with eating mushrooms, like eating any food, how long are you prepared to chew it? Now if we all chewed our food up as much as we should, we would be probably getting a lot more nutrients out of that food. So having that food in a powder form I think in supplement, in that sense is probably very good. So that’s what I would say about the form.

The other thing too is, there are clinical trials out there with lion’s mane, which was really interesting because we don’t get many clinical trials when it comes to actually any kind of herbal products. Right? In Japan, they gave a group of people, elderly people in their seventies, three grams of lion’s mane. They had a control group. They all took a test, a bunch of battery of tests. They continued to take the lion’s mane, powder, three grams, just three grams, that’s not a lot for 90 days. At the end of the 90 days, they tested them again. The people taking the lion’s mane scored higher than the control group. And then as they did in the beginning.  What was interesting about that was that the, after they stopped taking lion’s mane, they tested everybody 30 days later. People who had taken the lion’s mane dropped back down to where they were previously.

Dr. Weitz:            I guess you’re relying on natural light; you’re starting to get washed out…

Jeff:                     Yeah. It’s interesting. That will probably in all of this, turn this over here because I’m facing south. So I’ve got the sun in my eyes right now, but I’ll get back over here a little bit.

Dr. Weitz:            There you go. So how much is, would you say three grams, how much is three grams? How much is that in terms of say tablespoons?

Jeff:                     Three grams would probably be two or maybe a one heaping tablespoon of Lion’s mane powder.

Dr. Weitz:            That’ll be the appropriate dosage to take one or more times a day.

Jeff:                     Yes. Absolutely. If you took that once a … And, look-

Dr. Weitz:            What if you are using it therapeutically for patients in early stage dementia?

Jeff:                     Well, you know what, I personally think that all of the herbal products and supplements out there, including mushrooms, that nobody ever takes enough. I mean, in traditional Chinese medicine, they would give people pretty significant doses of herbs because they wanted to see some activity. They wanted to see something happen. And you know what, the way all of the supplements are, it’s like, okay, here’s your 60 capsules, take two a day and you end up like, “okay, one gram a day of this product.” And that’s just because they want you to have a month’s supply. And also they say, “okay, take two capsules.” Well, what have you weigh 120 pounds or 200 pounds? Doesn’t make sense. Right. So I mean, if you’re a large man, you’re definitely going to take a lot more than a normal size woman.

Dr. Weitz:            Yeah, so what about mushrooms for sleep?

Jeff:                     Reishi, absolutely Reishi. Reishi’s been a mushroom that’s been used for a long time for insomnia, stress, to relax some. And, one of the things that I think everybody has to remember is that, don’t expect mushrooms to work immediately. That’s not how they work. You have to be taking them for a while.

Dr. Weitz:            So let’s say you have somebody who’s dealing with insomnia and they’d been trying some other things and now they’re going to start using Reishi mushrooms. How much should they take and how long trial do you think they should give it before they expect to see some results?

Jeff:                     I’d say probably two to four weeks before you see any results. I’d say take two to five grams. And, two to five grams. That would be … Two grams would be, in a lot of cases twice what they might tell you to take, because maybe they say two, 500 milligram capsules. Well, that’s only one gram.  So, don’t under dose so to speak, be sure you’re taking enough of this so that you know that in fact, you’re going to get sufficient to have some kind of activities.

Dr. Weitz:            It might be saying anywhere from maybe four to 12 capsules at night before bed.

Jeff:                     Well I would take it in the early evening. And also, this gets back into, what you’re actually taking and making sure that you’re taking the real thing and not some something else because there’s so many products out there that are not the real deal and would end up being nothing more than a placebo.

Dr. Weitz:            Right. How do we know if we’re getting the real deal?

Jeff:                     Yeah, that’s a really good question. I mean, my God, you go into one of the stores out there and you wanted to shop. Have you done that in a whole foods or something? How does anybody ever know what to buy? It’s like how many choices do you need of everything? What I would say with mushroom products, and this is something that I address a lot, because there’s a lot of mushroom products that are not actual mushrooms. And that’s so important because, we talked a little bit before about mycelium and mushroom to very different things. There are companies in the United States that grow that mycelium on grains, sterile grain in elaborate.

Dr. Weitz:            What is the Mycelium?

Jeff:                     The mycelium is this vegetative body and, one way to really picture this is, are you familiar with the food called Tempeh?

Dr. Weitz:            Yeah, but I’m not sure what it looks like.

Jeff:                     Well Tempeh, if you’ve never eaten it before, tempeh is cooked soy beans with like a paste. Well, it’s kind of black, but it’s a cooked soy beans and they grow a fungus on it. And, if you open it up, it’s white. And that white part of the tempeh, which is growing all around the soybeans is actually mycelium. Tempeh is actually a mycelium product. So people will grow a, let’s just say a Reishi tempeh, but instead of giving it to you as food, they will actually then dry it, grind it to a powder, grain and all. And then when you go to test it, it turns out that that product is mostly starch. But what they say on the label and what these companies claim, is, they’ll sell it as mushroom.  And it’s not mushroom. It’s mostly starch from all the grain in there. And so if that mushroom product says, “made in the USA,” it is going to be that grain based. Myciliated product.

Dr. Weitz:            So there is no good mushroom products made in the USA?

Jeff:                     If it’s made in the USA. No, there’s not.

Dr. Weitz:            Because we’re trained. We’re trained to want to avoid China because you hear about all the-

Jeff:                     Absolutely, I know,

Dr. Weitz:           …poor manufacturing in but China and all the toxins found in products.

Jeff:                     Dr. Weitz. Look, do you want to go out to Long Beach and deep into the water out there and the port and have a nice swim? Do you want to go out in front of the river down there, the Tijuana river down in San Diego and have a nice swim in the water down there?

Dr. Weitz:            No.

Jeff:                     It doesn’t matter where you are. What really matters is whether the products that you’re getting have been tested sufficiently. We grow and process all our products in China back far away from the large cities, from the industry and all of that, and then we have to test them and we test them before it leaves China. We test them again once it arrives over here. In 1997 I went to China with OCIA, the largest organic certifier in the United States, and we did the first organic certification for mushrooms in China, 1997!  I totally believe in organic products. When I buy my fruits and vegetables, I’m going to a store that has organic fruits and vegetables. Where the most people buy. What do they sell in most supermarkets? Well, most people buy the products that have been grown with pesticides and chemicals and so on and so forth.

Dr. Weitz:            Medically modified and sprayed with RoundUp.

Jeff:                     Yeah exactly, and where are they produced? Well, a lot of them are producing the United States and mean. So for me it’s, yeah, I’ve heard that a lot from people. And look, don’t get me wrong. I mean there are products and things from China and then no, you don’t want to consume them. Absolutely. But I’m just saying, there’s a lot of products in the US that you don’t want to be consuming either, because they’re just as contaminated.

Dr. Weitz:            So what do we look for on the label? Is there some sort of certification, certified by something?  How do we know if a mushroom product is good.

Jeff:                     You know what? That’s what’s so crazy about it. Because you can buy this myciliated grain product and it’ll say Vegan, kosher, organic, everything. It’ll have all the merit badges

Dr. Weitz:            organic. Really?

Jeff:                     Yes. Because they’re using an organic grain to grow it, but they’re growing in a lab with, and it’s just mycelium and they don’t take the grain out. So it’s mostly starch. What you need to look for is this, a product that you won’t see. All of these products will say the same on the front panel. They’ll say mushroom. And some of them will even say made with 100% organic mushrooms, even though they’re not. If you turn around the supplements facts panel and if it says mycelium, stay away. If it says mycelium in the other, you know the fine print, down at the bottom. If it says myceliated rice, myceliated oats, that’s what you are getting. You’re getting myceliated rice, you’re getting this tempeh product.  What you really want to look for in the product it says no mycelium, no grain, no starch. And a lot of products are starting to say that now because it’s like, yeah, they know and they know that people want the real thing.  So that’s really the issue. It’s not … these myceliated grain products. That’s not what they’ve used in China for thousands of years. They’ve used actual real mushrooms, and that’s where all these compounds are really made.

Dr. Weitz:            The mushroom products should come from the fruiting body of the mushroom, not my mycelium, which is like the sort of root structure.

Jeff:                     That’s exactly right. And, you put it right in the mycelium for a lot of people, if you were ever to see it, it would look like a root structure. And it’s functions like a root structure, because it’s … they’re supplying nutrients up to this mushroom. When you harvest the mushrooms, the mycelium stays in the ground. Now, it’s like, okay, I’m going to just harvest this plant that I’ve been growing, and not only am I going to harvest the plant, I’m going to harvest the roots and all the dirt around it.  It’s like, no, that’s not what you want. Right? You want the actual plant itself without what was in the ground.

Dr. Weitz:            Cool. So I think those are the questions I have. Any other things that you’d like to talk about today?

Jeff:                     Well, you know what, what I’d like to do is just to, mushrooms are kind of like one of those overlooked foods. It’s something that we’re just catching up to right now in the United States and North America. In Asia, they’ve eaten dozens of mushrooms for thousands of years. When I go in the marketplace in China, there are at least 12 different mushroom species there that you can buy. And so that’s something I think that we’re missing in our diet in a sense, I consider that the dietary missing link. So what I tell people is look, before you supplement and look, maybe you want, you’re having insomnia issues and you want Reishi, fine.  That’s different. Get your Reishi product. But before you supplement, buy mushrooms and start putting them into your diet. Cook them properly. But eat mushrooms. Mushrooms are a great food. They’re high in B vitamins. The mushrooms are for a hundred grams or four ounces of mushrooms, you’re going to get 25% of your RDA of a riboflavin and Niacin. Out of a hundred grams of fresh mushrooms.

Dr. Weitz:            What other nutrients do you get-

Jeff:                     They are also very high in potassium and phosphorous. Those are the two major minerals in mushrooms in. You know what’s really cool about mushrooms is that, they actually have a compound in there called gastrol which of you take a mushroom and slice it up and put it into the sun. The UV from the Sun will turn a gastrol into vitamin D too. It’s like. So if you want to like a slice up your mushrooms, stick them out there for 15 minutes, you’re going to get probably a hundred IUs of vitamin D2 from that. They’re just a great food. And that’s what I really like to tell people is, put them into your diet.

If you want to go a little deeper, you have some issues, especially immunological issues, try to supplement with them, and be very careful when you buy that mushroom product out there. Make sure it has no mycelium and it doesn’t say on the other, is kind of … a lot of people don’t eat grains anymore. They buy these products, they tell me about how much they love mushrooms, and then I asked them the brand and I say, you know what, you’re getting mostly grains. They’re shocked. Absolutely shocked. So, definitely, think about that. And maybe even in a year I … because I know you’re really a nutritional expert, and I’ll send you some papers on mushrooms and nutritional values and stuff like that, that you can access, but maybe that’s something you’d look at for some of your nutritional counseling.

Dr. Weitz:            That sounds good. So, do you want to give any links to contacts for you or your companies?

Jeff:                     Sure. Yeah. You know what? My company’s Nammex N-A-M-M-E-X, go to Nammex.com, we have a lot of information there about mushrooms. The benefits of medicinal mushrooms. Come to nammex. I’ve got slide shows on how our mushrooms are grown, and then, we have a retail outlet called Realmushrooms.com. You can go there and you can access our mushroom products right there at realmushrooms.com. You’ll actually get real mushrooms.

Dr. Weitz:            Awesome. Thank you, Jeff.

Jeff:                     Thank you very much. I really appreciate it.



SIBO and IBS with Dr. Mark Pimentel: Rational Wellness Podcast 102

Dr. Mark Pimentel discusses SIBO and IBS with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

4:29  Dr. Pimentel stated we now know that 60-70% of patients with IBS have SIBO, based on culture of the juices from the small intestine, not based on breath testing. There has been some controversy with breath testing, primarily because it had not yet been validated against a gold standard because we did not have good techniques for culture. He said that he’ll be presenting some data at DDW (Digestive Disease Week) with respect to better validating breath testing.

6:17  Re-Imagine Study.  Dr. Pimentel talked about the Re-imagine study who’s goal is to attain juice from the small intestine from 10,000 human samples in order to map out the small bowel microbiome. Some of the results will be presented at the DDW conference in San Diego in May. 

7:47  Autoimmune SIBO.  Dr. Pimentel explained his concept of the autoimmune origin of SIBO.  It starts with a bout of good poisoning from bacteria like Campylobacter, which release an endotoxin called Cytolethal Distending Toxin B (CTDB). The immune system reacts to this CDTB and then cross-reacts and creates antibodies against a structural protein in the intestinal wall called vinculin, which damages the nerves that control the motility of the small intestines. And there is a new blood test that measures these anti-CTDB and anti-vinculin antibodies–IBS-Smart that can help to identify this autoimmune type of IBS.  Dr. Pimentel explained that this blood test is not a substitute for the breath test, which identifies more patients with IBS and also tells the clinician which variant of SIBO is present–hydrogen or methane and these each require a different treatment protocol.  Dr. Pimentel also mentioned that while it hasn’t been published yet, the higher the level of antibodies, the more difficult the condition is to treat. 

13:19  Motility. Of the factors that have been described to potentially play a role in keeping the small intestine clear from bacterial overgrowth: 1. Hydrochloric acid, 2. Digestive enzymes, 3. Bile, 4. Motility, 5. The Ileocecal valve, 6. The GALT, the immune system surrounding the gut, Dr. Pimentel said the motility is the most important factor. Dr. Pimentel said that low acid from taking a proton pump inhibitor doesn’t give all these people IBS, so he doesn’t think low HCL is a big factor.  He also said that having low pancreatic enzymes or low bile are quite rare.  He said he’s seen a weak immune system in patients with HIV, but we don’t see it that often now, given how effective the HIV drugs are now.  As far as ileocecal valve function, Dr. Pimentel mentioned that we see a lot of patients with ileocecal resections in patients with Inflammatory Bowel Disease and they don’t all get overgrowth.  But if you have someone with an ileocecal resection and you have a little motility issue, then you can get overgrowth.

20:20  While it is easy to understand how there is a motility problem when the patient has constipation, but it is difficult to understand how there can be a motility problem when the patient has diarrhea. Dr. Pimentel explained that motility is not a passive process and motility involves the holding and moving backwards and moving forwards.  If you get amyloidosis, which is a type of scarring of the lining of the intestine, you actually get diarrhea because the tube is like a drainpipe, and water just blows right through it. So it’s motility that prevents it from being just a drainpipe.  Methane gas doesn’t paralyze the gut.  It actually causes the gut to tighten, which resists the flow of material, leading to constipation.

25:04  METHANE SIBO. Methane SIBO is particularly difficult to treat. Dr. Pimentel typically uses Rifaximin plus Neomycin. Neomycin is an aminoglycoside. There is another aminoglycoside, a Neomycin derivative drug, Genamycin that is given intravenously that can cause ringing in your ears and some patients are concerned that Neomycin can cause ringing in the ears, even though Dr. Pimentel has not seen it in clinical practice, so he will use Flagyl aka, metronidazole, which is equally effective as Neomycin, though he hasn’t published that yet.  Methane SIBO is caused by archaea, which are primitive organisms but are not, properly speaking, bacteria.  The archaea also tend to live very close to the mucosal surface and antibiotics may not penetrate the mucus layer, so Dr. Pimentel is looking at new drug proposals.  I mentioned to Dr. Pimentel that Dr. Rahbar has spoken about finding patients with methane SIBO often also having co-infections including with Lyme Disease, which could help explain why they are so difficult to treat. Dr. Pimentel said that he hasn’t seen that but he also hasn’t studied that association very much.  Here is a link to a presentation that Dr. Rahbar gave on IBS last year at our Functional Medicine meeting https://youtu.be/fd3fR97ilUA.

29:44  Methane SIBO contributes to weight gain through two mechanisms: 1. Hydrogen producers eat the fiber that we can’t digest and when they derive calories from fiber, we get the calories. If they produce too much hydrogen, they start to pickle themselves and inhibit themselves from continuing. But if there are also methane producers, they eat the hydrogen and allow the hydrogen producers to keep working. 2. Methane slows gastric transit and the more time the food comes into contact with your intestines, the more calories are absorbed from the food.

31:32  Hydrogen Sulfide.  The new SIBO breath test that measures hydrogen sulfide gas, as well as hydrogen and methane will be out soon.  The more hydrogen sulfide the more diarrhea, while the more methane the more constipation.  The hydrogen is the fuel for the methane or the hydrogen sulfide.

33:47  SIBO Recurrence.  In order to reduce recurrence of SIBO, Dr. Pimentel emphasized the importance of using a prokinetic such as low dose erythromycin or prucalopride and Zelnorm (tegaserod) which were both recently approved. In the Functional Medicine world we have a number of nutritional prokinetics, including Motility Activator, MotilPro, and others.  Dr. Pimentel referred to the Reimagine study where they are looking at aspirates from the small intestines and mentioned that they are looking at histamine in the juice. Some of the bugs produce histamine, which can explain some of the food intolerances we see.

37:09  Small Intestinal Fungal Overgrowth. We don’t know how often fungal overgrowth is playing a role in SIBO. Dr. Pimentel did say that there are cases where nothing seems to work and antifungals do work.  We don’t have a validated process for identifying fungal overgrowth of the small intestine, but he hopes that this may come out of the Reimagine study.  Dr. Pimentel said that this study will help to validate the proper way to collect juice sample from the small intestine and the right way to look for bacteria and fungus in this juice using proper extraction techniques.

42:12  Probiotics.  I brought up the topic of probiotics with Dr. Pimentel and I said that I had heard him say previously that he does not believe in probiotics.  I also mentioned that many Functional Medicine doctors use probiotics when treating SIBO, including some who will use Saccharomyces boulardii, which is not known to grow in the small intestine, or they’ll use a spore-based probiotic, which is believed to get all the way into the colon before it opens up.  Dr. Pimentel made it clear that he’s not anti-probiotic, but he does not feel that the data is strong enough to support their use at this time.  Most of the studies on probiotics are not that strong and they all use many different strains, so it is hard to even compare them in a meta-analysis. He said that once they can map out the organisms in the small intestine, which he will do in the ReImagine study, he does believe that there will be a probiotic way of manipulating the flora for the better, such as by putting some organisms that can crowd out the hydrogen producers. He just wants to make sure that we use the right probiotic, or probiotics, for the right thing.

46:06  Diet for IBS and SIBO.  Dr. Pimentel said that a low FODMAP diet has a lot of good data that it will reduce gas and bloating in patients with SIBO.  But long term it will lead to measurable nutritional deficiences and it will reduce microbial diversity in the microbiome. Thus, it is important to broaden out the diet for patients after 2-3 months.  Dr. Pimentel recommends a low fermentation diet that he developed at Cedars Sinai in 2001 that’s a little more lenient than the low FODMAP diet.  Here is the paper that Dr. Pimentel published in The American Journal of Gastroenterology in 2019 on Influence of Dietary Restriction on Irritable Bowel Syndrome.



Dr. Mark Pimentel is a Gastroenterologist who is head of the Pimentel Laboratory and Executive Director of the Medically Associated Science and Technology (MAST) program at Cedars-Sinai, which is focused on the development of drugs, diagnostic tests, and devices related to condition of the microbiome, with a focus on IBS. Dr. Pimentel has published over 100 scientific papers and speaks around the world at conferences, esp. about SIBO and IBS. Here is a list of some of Dr. Pimentel’s key publications: https://www.cedars-sinai.edu/Research/Research-Labs/Pimentel-Lab/Publications.aspx

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or by going to www.drweitz.com.


Podcast Transcripts

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Resubscribe to Rational Wellness Podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us ratings and review. That way more people can find out about the Rational Wellness Podcast.

Our topic for today is Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome and our special guest is Dr. Mark Pimentel. Irritable Bowel Syndrome is the most common gastrointestinal condition with an estimated prevalence of between 10 and 15% in the United States. IBS is a condition marked by abdominal pain, gas, bloating, diarrhea or constipation or both, sometimes urgency, sometimes nausea, et cetera. When patients with IBS undergo a colonoscopy, there’s no visual pathology, unlike patients with inflammatory valve disease, like Crohn’s. For many years, IBS was seen as a condition arising primarily from psychological stress until Dr. Pimentel discovered that an overgrowth of bacteria from the colon into the small intestine was the causative agent in a majority of cases of IBS.  However, this has not been easily accepted by the medical profession and, from my perspective, for the most part it still looks like it’s not fully accepted. For example, the website for the American Society for Colon and Rectal Surgeons states, “No clear answer exists as to what causes IBS. It’s believed that the symptoms occur due to abnormal functioning or communication between the nervous system and bowel muscles.” Even Cedars-Sinai’s website, where Dr. Pimentel works, states that “Health experts have not been able to find an exact physical cause for IBS. It’s often thought that stress is one cause.” Quote, unquote. Most gastroenterologists continue to treat IBS with an array of drugs that control the symptoms that the diarrhea or constipation pain or one way or another modulate the symptoms without even trying to address what the underlying causes might be.

Dr. Pimentel is the head of the Pimentel Lab and executive director of the Medically Associated Science and Technology Program at Cedars-Sinai, which is focused on the development of drugs, diagnostic testing, and devices related to conditions of the microbiome with focus on IBS. Dr. Pimentel has published over 100 scientific papers and among his many accomplishments are the following. He’s pioneered the use of the Lactose Breath Tests for SIBO and has published studies correlating with IBS and he’s been development a new version of the breath test that will include a third gas besides hydrogen and methane, which is hydrogen sulfite. He’s discovered the use of rifaximin as a treatment for IBS. He’s developed an autoimmune model of IBS. He’s developed a blood test looking at antibodies to be able to diagnosis this autoimmune cause of IBS. He’s discovered that the methane-producing organism, methanobrevibacter smithii causes the constipation. And Dr. Pimentel has really spurred the development of a SIBO community, complete with SIBO testing, SIBO drugs, SIBO supplements, the SIBO doctor podcast, SIBO conferences like the one in Seattle that I’ll be attending later this week. But most importantly, he’s given hope to millions of patients with IBS that they might be able to feel better and stay better. Dr. Pimentel, thank you so much for joining me today.

Dr. Pimentel:                     Thanks Ben. That’s quite an introduction. I appreciate it.

Dr. Weitz:                          So what is your best estimate of the percentage of patients with IBS that’s caused by SIBO?

Dr. Pimentel:                     So the data are quite clear on this. It’s about 60 to 70% of IBS is SIBO and this is not based, not just on breath testing, but actually on culture.

Dr. Weitz:                          Okay. Because there still seems to be some controversy. People continue from time to time to cite different studies that show these big ranges for what’s positive and question whether breath testing is really effective or not.

Dr. Pimentel:                     Yeah, I think the problem we had was with breath testing. So breath testing is a really good technology. However, it had never been validated against a gold standard because culture, at the time that breath testing emerged in the 19 late ’70s, early ’80s, we didn’t have good techniques for culture, so it really wasn’t ever properly assembled in the way that would make people confident. And yet, despite all of that, all these doctors across the US were using breath testing. So they didn’t like it, but they still used it and they were able to diagnose SIBO and make that affirmative. It’s only when we said that IBS could be SIBO that people started to sort of say, “Well, breath testing isn’t accurate” and all of this. But all that’s sort of disappearing because we’re now showing with culture, and there’ll be some data at DDW [Digestive Disease Week] that I can’t talk about yet. I think we’ll be able to say that breath testing is accurate to a certain level and that what we were saying all along just with breath testing alone was relevant. And we can talk more about that, during your Q and A.

Dr. Weitz:                          Right. Well, what do you think about when we start using PCR testing instead of culture? We’ll probably have even more accurate results.

Dr. Pimentel:                     Yeah, that’s what we’re doing here. We have a study, which, I’m sort of jumping the gun, but is called the Reimagine study. And we’re … Our goal is to attain 10,000 human samples, juice from the small bowel to try and figure out who’s who, what’s what, and what bacteria belong there, what don’t, and what is SIBO. And the first slice of the pie of that data is going to be at the D.E.W. meeting in about six weeks. And the one on … One particular is getting a plenary session and I think your viewers may be very interested in the results from that because it’s very compelling.

Dr. Weitz:                          Right. And yet, we’re still only able to get the juice from the proximal part of the small intestine, right?

Dr. Pimentel:                     Right, but what we’re doing with this study is that anybody who gets what’s called a double balloon enteroscopy, meaning they’re going the full length of the small bowel.

Dr. Weitz:                          Oh, okay.

Dr. Pimentel:                     Also getting juice. So we have 20 or 30 patients already in the trial who’ve gone all through the bowel. So for the first time, some … Another way of saying what the Reimagine study is, it’s really the first study in the world looking and mapping the small bowel microbiome. Because everybody’s focused on stool and we’re really redirecting to the small intestine.

Dr. Weitz:                          Cool. Can you explain your concept of the autoimmune origin of SIBO?

Dr. Pimentel:                     To me, this is probably the most exciting thing because it’s one thing to say you have SIBO. It’s another thing to treat it with antibiotics or even natural products. The problem is it just keeps coming back, so we’ve really been determined to find out why the heck is this happening? And can we get in there and stop it before it starts? Or intervene once it’s there to really … maybe we don’t need antibodies, but that’s a long way away. The point is, we started to show … And this predates us, that food poisoning could be a trigger for IBS. We then took it to the next level and said, “Well, we need to develop an animal model where a food poisoning we know causes IBS in humans,” and the biggest culprit is campylobacter. Could we create a model in rats where we infect them with campylobacter and they develop IBS? And we did. And it’s that model that we’ve been able to dissect every step of the process of how this happens. And so we now know most of the steps.

So there’s a particular toxin of food poisoning called CDTB, Cytolethal Distending Toxin B. And most of the bugs that cause IBS have that toxin. So we actually proved that if you just inject that toxin in the skin of a rat like a vaccine, they get IBS. But that toxin is a marker for the food poisoning, so that’s important, but it triggers an auto antibody call to a protein that’s you called vinculin. And then you get these anti-vinculin antibodies, which are really important for the nerves of the gut. And so we think it’s the anti-vinculin that damages and keeps the nerves damaged because the nerves that are damaged recover very quickly if the antibody’s gone, but it’s there and it’s keeping the situation tenuous. So the nerves are effected. The flow of the gut is effected and then the bacteria are allowed to accumulate. And so that’s the new philosophy and there’s a new blood test that sort of measures those antibodies and we can actually diagnose IBS. But people think, “Oh, you’re diagnosing IBS.” We’re not. We’re work … Yes, we’re identifying you as IBS, but we’re also identifying you as IBS having come from food poisoning. So the test is actually much more specific than it even suggests.

Dr. Weitz:                          So it can’t be a substitute for a breath test.

Dr. Pimentel:                     No, in fact, it works synergistically. So think of it like you have a heart problem and you go to the doctor and the doctor does an EKG and they do an echocardiogram to see the function of the heart. It’s the same sort of thing. If you do the blood test, which I think for my patients now is really important because I can tell them how it all started, number one. Number two, I can tell them “This is a real disease. Not in your head. You don’t have antibodies like this because it’s in your head or it’s psychological. This is an organic disease.” So that, I can tell you a lot of stories from patients who are in tears. They say that finally somebody found something in my blood that tells me I have something because all the doctors have been saying I’m crazy and everything is normal.  So that’s important because it’s not just about the doctor. It’s about the patient. The patient wants some comfort and knowing that they have something real, but the second part of that is, if you have a positive antibodies, then you know you need to be careful with food poisoning. You can’t just be eating off food trucks or being a little more risky with your eating behavior because if you get another food poisoning, those antibodies go higher. And I know from clinical experience, this hasn’t been published yet, higher the antibodies, the tougher you are to treat with antibiotics or any other remedy for this SIBO that develop.

Dr. Weitz:                          Interesting.

Dr. Pimentel:                     The SIBO tells you what type of treatment to use, what antibiotic and so methane versus non-methane and so forth.



Dr. Weitz:                          I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness Podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top-tier manufacturer of clinician-designed, cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally. Integrative Therapeutics is also the founding sponsor of Tap Integrative. This is a great resource for education for practitioners. I’m a subscriber to Tap Integrative. There’s videos. There’s lots of great information constantly being updated and improved upon by Doctor Lise Alschuler who runs it. One of the things I really enjoy about Tap Integrative is that it includes a service that provides you with full copies of journal articles and it’s included in the yearly annual fee. And if you use a discount code, Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. And now, back to our discussion. Here is the link to TAP Integrative.



Dr. Weitz:                          So of the factors that result in increased risk of bacterial overgrowth, we have hydrochloric acid production that helps to keep the small bowel clear, digestive enzymes, bile has been shown to do that. We have the motility, the migrating motor complex. We have the integrity of the ileocecal valve. We have the GALT, the immune system around the intestines. What do you think is the most important factor that help to keep the small bowel from being overgrown with bacteria?

Dr. Pimentel:                     So if I were to rank it based on my experience, 50,000 patients in the last 10 years running through our clinic doing breath tests and so forth, hands down motility is the highest rank. So I’m ranking them based on the likelihood they’re causing overgrowth and the commonness combined because the most common cause, I think, is motility and the most provocative cause is a poor motility. Of course if you have an adhesion of the small bowel, like scar tissue from surgery, almost universally you have overgrowth. Fortunately, that’s not as common. But again, the functional part, low acid … We make people low acid all the time and they don’t suddenly develop IBS. So the link between having low acid, using a proton pump inhibitor, something like Nexium or … it’s not so well defined. Yes, you do get some bacterial buildup, but I think the other mechanisms can compensate to some degree. That’s why not everybody who goes on a PPI suddenly blows up and gets distended and then gets diarrhea. Some do, but it’s not so clear cut. Pancreatic enzymes, fortunately most people produce pancreatic enzymes and the juices that digest bile and so forth, so yes, if those are deficient, you can get overgrowth, but that’s quite uncommon to have pancreatic atrophy or something to that nature.

And then the GALT, the immune system of the gut, we do see … We used to see people more commonly with HIV who progressed in their illness would get some form of overgrowth, but fortunately, we don’t see that these days. The therapies are quite good.

Dr. Weitz:                          And what do you think about the ileocecal valve? Do you think that plays a role?

Dr. Pimentel:                     So we see a lot of people with ileocecal resections here at Cedars because it’s a large IBD program as well.

Dr. Weitz:                          So these are patients with Crohn’s who have part of their colon removed, right?

Dr. Pimentel:                     Yeah, exactly. And so they don’t have a valve anymore, and yet they don’t all get overgrowth either. I guess if they motility is really, really good, you’re able to clear it out. Nobody’s really studied the ilium motility very well because it’s really hard to access that area for motility studies, but I think about it like the esophagus. So when you have reflux or food or liquid from the stomach going into the esophagus, the esophagus immediately starts contracting. It doesn’t like the acid. It detects the acid and squeezes it back up out into the stomach. That’s normal and that’s why most people don’t get heartburn because they just … A little bit of acid comes in every day and we know how to squeeze it out automatically. I think the ilium probably has some similar things that go on. Yes, the ileocecal valve, if it’s not there, you’re at risk, but as long as the motility is good.

So and there are … I know this gets complicated, but there are people, for example, that have overgrowth and you treat them once. Then you don’t see them for two years. So they probably don’t have that bad a motility. The motility’s just a little off, but not deeply damaged. Maybe the antibodies aren’t high enough. So I think if you combine an ileocecal resection, you’ve lost the ileocecal valve, and you have a little motility issue, it doesn’t have to be strong, then you can suddenly have overgrowth and it becomes an issue. So it may be a combination of factors. 

Dr. Weitz:                          What about people who don’t have a colon at all? Do you want there to be overgrowth then in the small intestine?

Dr. Pimentel:                     Yeah, I know-

Dr. Weitz:                          I know that’s a little bit off the topic, but …

Dr. Pimentel:                     So people live forever … Not forever, but they live a pretty similar length of life without a colon. So your lifespan is not reduced simply you have part or all of your colon removed because the small bowel’s where all the action is, in terms of absorption. I sort of make a joke with the … It’s not really a joke, but I joke with the fellows and the residents. When I train them, I said, “The greatest gift for us is a colon and an anus” and it’s really the anus, but we can get into that because birds don’t have that. They can let go of their excrement all day because they’re flying and nobody’s going to trace them back to their nest. If you’re dragging this stuff along all the way to your cave, the lions, they’re going to find you and they’re going to eat you. So our survival depended on creating packages and delivering the packages at a time that is most safe or convenient, when the lions aren’t around or whatever, so that you’re not tracked back. And so another way of looking at the colon is really your trash bin and you’re basically preparing the trash for pickup. And it doesn’t have as much of a role in your health as we used to think.

Dr. Weitz:                          On the serum test for antibodies, one quick question is, isn’t it the case that the primary immune factor in the gut is IgA versus IgG? And why not test for IgA reactions?

Dr. Pimentel:                     Yeah, so we tested it early on and the problem with IgA is that it’s mainly in the gut. So how do we get our IGA? We could test it in the blood, but maybe it’s not there. Maybe it’s just in the gut. You’d have to get the right kind of sample. There’s that problem first of all. But second of all, for autoimmune disease, we don’t know a lot about IgA-driven autoimmune disease. I don’t even know of an example of one. Since IgA is mostly secretory, it goes into the gut, I don’t know how that would get to the nerves of the gut. So we followed the breadcrumbs and found that the breadcrumbs led to more of a really systemic autoimmune response and then kept going in that direction. Haven’t gone back to the IgA, but it’s a good question. 

Dr. Weitz:                          When it comes to motility, and I know addressing motility is a factor I’m sure we’ll get into in a few. When trying to keep SIBO from recurring, one of the questions a lot of people have is, when they have constipation, it makes sense that they have a motility problem. But when they have diarrhea, they don’t understand how they could have a motility problem.

Dr. Pimentel:                     Yeah. So for the viewers, this is sort of a thing even a lot of doctors don’t quite get and I try to explain it to them. So motility is not a passive process. So if you paralyze the small bowel, completely paralyze it, like it’s rigid. Let’s say it’s thickened with tumor or amyloidosis, which is a type of scarring in the lining of the intestine, you actually get diarrhea because the tube is like a drainpipe, and if water just blows right through it. So it’s motility that prevents it from being just a drainpipe. So your gut is not moving things through in one direction. It’s actually holding and moving backwards and moving forwards. There’s a complicated process that goes so that you aren’t just a drainpipe. Otherwise, you’d put food in and about 10 minutes later food would come out if it was just a drainpipe. So that’s what confuses people. For example, when you talk about methane and constipation, methane isn’t paralyzing the colon or the gut. It’s actually causing the gut to tighten, and by tightening, it resists the movement or flow of the material and so then you get constipated because it isn’t allowing things. Things can’t go because it’s holding it up. And so it’s a little difficult sometimes to explain to patients how that all works, but that’s some of the nuts and bolts.

Dr. Weitz:                          Yeah, the whole constipation thing is way more complicated than we realize. A lot of times I’ll be a conversation with a patient about constipation and there’s a bunch of things that are all called constipation. There are patients who don’t go to the bathroom for days on end. There are patients who go to the bathroom multiple times a day, but nothing comes out. There are patients who can go to the bathroom, but they have to strain like crazy and it’s hard. So there seems to be multiple variations of what’s called constipation.

Dr. Pimentel:                     Yeah, you should be teaching my residents and fellows because you almost said it exactly the same as I do. So constipation is what the patient feels, not the textbook. The old textbook definition of constipation is less than three bowel movements a week is constipation, but as you very accurately point out, I have patients coming to my office say, “I’m constipated,” and then I say, “Do you go every day?” “I do, but it’s like two hours on the toilet every day before I can get anything out.” So of course they’re constipated. It’s obvious, but they don’t meet the definition that 30 years ago, doctors set in textbooks as the definition. So constipation’s complicated and you need to take a proper history, as you described.

Dr. Weitz:                          And is one of those forms of constipation more related to methane?

Dr. Pimentel:                     Yeah, so what we’ve seen … So there’s … I sort of bucket in three ways. There are the patients where it’s more of an anal-rectal problem. They feel the stool there and they just can’t get it out or they have trouble getting it out. And those patients, we need to do some physiological testing. Sometimes, more commonly in women, because they don’t have a prostate gland, the anterior front of the rectum can bulge and the stool gets trapped there and that’s called a rectal seal. And there are other little structural things that can happen that can make that particular type of constipation. That history’s pretty clear. I usually can pin it down with history and then do a couple of tests and we’re on our way to figure it out.  The middle group are the patients where they’re constipated. Every week’s a little different, but they have some bloating with it. And those tend to be more the methane patients, where they’re probably going two or three times a week completely, and then they have a smattering of other things.  And then there’s the third group where they’re not going for two or three weeks at a time. Like literally not a drop. And those are called colonic inertia and that’s a different animal all together. That is not methane, at least we haven’t seen it that way.

Dr. Weitz:                          Okay. So why is methane SIBO so difficult to treat?  Not that either form is easy to treat, but the methane seems to be particularly problematic.

Dr. Pimentel:                     Yes, this is why we’re working on this Centene project because we know even from our double-blind study using rifaximin and neomycin versus neomycin, yes, rifaximin and neomycin was superior, but a month later, things start coming back. So we know on the diarrhea side, people can go a month, six months, two years and not have recurrence. On the methane side, that’s not the case. They’re more troublesome. So-

Dr. Weitz:                          By the way, just to stop you for a second. I read something online, it was an interview with you or somebody talking about the fact that you prefer now flagyl, rather than neomycin. Have you changed your protocol on methane SIBO?

Dr. Pimentel:                     Happy to talk about the neomycin versus flagyl topic. So neomycin is a drug that’s been around for a long time. It’s a categorical drug called aminoglycoside. Now, back in the ’70s and ’80s and even further back, aminoglycosides were used intravenously because, in general, they’re not absorbed. They don’t get into your body. When you use gentamycin, which is a neomycin derivative intravenously, if you use it for an infection of a heart valve you got to be on it for three months back then. And so you’re on it for three months and then you started to get ringing in your ears and so they realized that that category, when it gets in your blood, can eventually cause ringing in the ears and those kinds of neurological changes.  So the FDA basically brush stroked neomycin with the same potential side effects, but neomycin’s taken by mouth, not absorbed. 95% stays in the gut, so it’s not like gentamycin where you would give it intravenously. And so people have said, “Well, what about this ringing in the ear business?” And I have never seen ringing in the ears after neomycin and we’ve treated thousands of people. Not even one case. There was one case in a trial. The neomycin and rifaximin trial. The first patient in the trial complained of ringing in the ears and they were getting the neomycin. And we had done, because of the FDA, ear testing before and then we did ear testing after. Turns out the day after he described the ringing in the ears, he developed a sinus infection and cold and all this stuff. So it as an impending flu that he was developing that was causing. And then we did ear testing two weeks later and his testing after neomycin was better than before neomycin. So I’m not saying neomycin makes your hearing better, but there was no damage even in that one instance that I’m describing to you. So for people who are uncomfortable about neomycin because of what I just described, we have used metronidazole in the clinic and it seems to have the same sort of efficacy as neomycin with rifaximin and so we’ve suggested that as an alternative, but haven’t published it.

Dr. Weitz:                          Okay, so let’s get back to just in general, why methane is so hard to treat.

Dr. Pimentel:                     Yep. Again, we don’t know. I’ve spoken to a lot of archaea experts and methanogens or methane-producing organisms are in the category archaea. And they seem to think, in the veterinary world, because they study methane production more, that these organisms are very close to the mucosal surface and maybe the antibiotics penetrating the mucus layer, maybe that’s a challenge. We don’t know the answer to that, but we’re working towards trying to find better and better treatments. And that leads us to the Centene proposed drug because we’re using a different mechanism.

Dr. Weitz:                          I spoke to Dr. Rhabar, an integrative gastroenterologist in LA, and he said that often when he has patients with methane, he often finds other infections, like Lyme, et cetera. And then so you have a complicated factor and that’s what he deals is one of the reasons why it’s so difficult to treat methane.

Dr. Pimentel:                     There can be complicating factors with methane. We haven’t seen that association with Lyme so much, but I should admit that I haven’t studied it as much as he has, perhaps, and so I’m not … I don’t know. I don’t know.

Dr. Weitz:                          How is methane SIBO related to increased risk of obesity?

Dr. Pimentel:                     Yeah, that’s a very interesting story. There’s sort of two perspectives on that and probably two mechanisms. The first mechanism is, you need hydrogen to make methane. So you need hydrogen bugs sitting beside methane bugs to give the fuel. Hydrogen is the fuel for methane production. So it’s like you have a car, but you have no gasoline. Nothing happens. So, but the fumes from the gasoline, all that hydrogen intoxicates the hydrogen producers. Now, the hydrogen producers, let’s talk about them for a second. They’re eating all the junk that you can’t eat, the lettuce, the fiber. They’re chewing on everything to get calories. And when they do that, they give the calories to you, but if they produce too much hydrogen, they start to pickle themselves and inhibit themselves from continuing. So they can’t fire through as much material when their hydrogen is intoxicating them, but when there’s methane bugs around, the methane’s sinking the hydrogen away and allowing the hydrogen producer to keep firing through and they get actually creating more calories for you by burning through all that lettuce and material that humans generally can’t digest. So that’s one mechanism.

The second mechanism is methane slows your transit. Slower transit, more time to absorb food. So I tell patients this if they’re methane. If you look at the calories on the back of a box that you’re buying at the grocery story, that’s not the calories that you’re going to get from this material. It’s going to be something different, something higher, because of the mechanisms I just described.

Dr. Weitz:                          Can you talk about the new breath test? And when is that going to be available?

Dr. Pimentel:                     Yeah, so it’s coming out shortly. It’s weeks or months. It should be weeks, but it’s basically measuring three gases, hydrogen, methane, and hydrogen sulfite. And just to explain, methane is causing constipation. We know the higher the methane, the more constipated. We put methane into animals, they get constipated or slowed transit. So we know methane’s the culprit and hydrogen is the fuel for methane. The higher the methane, the more constipated you are. We were never able to correlate hydrogen with diarrhea. So you could have a hydrogen of 200 or a hydrogen of 50. Your diarrhea could be the same, the bloating could be the same. It was not statistically different, even thousands of breath tests analyzed, we couldn’t see that signal.  So we knew there was another gas. We knew hydrogen sulfide was there because that’s been known for decades, but nobody’s measured it on the breath. So we did and we presented that last year and the more hydrogen sulfide you produce, the more diarrhea you have. So basically what we now understand is hydrogen is a marker for SIBO, but it’s a fuel marker. So it’s providing the fuel for either methane or for hydrogen sulfide and depending on who’s winning the battle for hydrogen in that game of thrones, so to speak, you either have diarrhea or constipation.

Dr. Weitz:                            Interesting. So would that mean in the future you’re going to focus on just treating the methane or the hydrogen sulfite and not treat the hydrogen?

Dr. Pimentel:                     Well, the funny thing is, it just goes back to what I said earlier. If you get rid of the methane, the hydrogen goes up and pickles the hydrogen bucks. So you could, in fact, by getting rid of methane, impact the amount of hydrogen produced by hydrogen organisms. So as in medicine, the story is always more complicated than when you first start and we’re getting more complicated, which is why we’re doing podcasts so people can be educated and as up to date as possible.

Dr. Weitz:                            So what do we do about SIBO recurrences? In the functional medicine world where we usually don’t use antibiotics, we’ll use antimicrobial herbal combinations. And when we treat once and then it recurs, we of course think about using motility agents. And a lot of times we’ll use a motility agent like things … 5HTP and ginger and things like that. And there’s a number of products on the market. And then if they don’t resolve in two or three months or they recur, then we think about changing the antimicrobials. We sometimes think about getting a biofilm busing agent or we wonder, could this be a case of fungal overgrowth or could there be another infection? Could it be histamine intolerance? That’s another common concept now in the functional medicine world that some of these patients with these functional gut disorders who have SIBO but they don’t get better, one of the reasons could be histamine intolerance.

Dr. Pimentel:                     Yeah. Well, so you asked a very compound question with a lot of facets.

Dr. Weitz:                          I threw a bunch of stuff out there.

Dr. Pimentel:                     Yeah, you did, but it’s all important and so one of the mainstays of preventing SIBO is we use a prokinetic of some kind. You mentioned some of the natural prokinetics, so we use a low dose of erythromycin, which is a prokinetic and not an antibiotic at that dose. Prucalopride just got FDA approved and so that’s available now. Zelnorm (tegaserod), which is another product which hadn’t initially got approved in December now got approved. So we’ve got, at least on the allopathic side, we’ve got a plethora of prescribable preventative or maintenance therapies that we think are very effective. We’ve been using resolor or prucalopride, it’s called motegrity here in the US, extremely successfully with some patients lasting a year or two years with no recurrence. But the histamine story is very interesting and again, I go back to what we first said at the beginning of this interview is the Reimagine study that we’re doing. We’re not just taking aspirates and looking at bugs. We’re looking at the juice, what the bugs produce. We’re looking at histamine in the juice, histamine in the blood, serotonin in the juice, in the blood, genetics. We’re looking at immune markers in the blood, in the biopsies.  The collection of data that we’re getting around … because bugs produce histamine. There are many organisms in the gastrointestinal tract that are histamine-producing and can explain maybe some of these food allergies or food intolerances, especially if you’re feeding that one organism that happens to be producing histamine, that’s not a good thing. And so there’s … We don’t have all the data yet, but I am greater than 90% certain we’re going to see some really interesting signals because bacterial can also produce serotonin, as you probably know. And if we happen to be feeding the wrong types of bacteria in there, we’re going to overproduce those chemicals that can make people unwell.

Dr. Weitz:                          And when is fungal overgrowth or what we could call SIFO, how often is that seen?

Dr. Pimentel:                     So we’ve treated a lot of people with antibiotics and we would imagine that they would get worse if it was fungal, or at least that’s the old teaching, but we do see some patients where nothing works and antifungals do work. We don’t … Dr. Cynthia [Shroun 00:37:33] in Georgia has a process by which she identifies SIFO. We haven’t validated a process like that here at Cedars, so I think we should. I think as we’re doing this Reimagine study we’re actually looking for fungus as well, and as we identify who would be the target, I think we’ll have some better … So again, not continuously going back to this Reimagine study, but part of the Reimagine study was people were doing cultures from the small bowel wrong. People were getting juice from the small bowel wrong. People were handling the juice wrong.  We’ve been validating every step of what … because at the end of this next year, we’re going to educate on how to get those samples, how to process those samples in papers that we’re publishing. How to look for fungus the right way. How to look for bacteria the right way, because we get 10 times more bacteria after we pretreat our samples. And so if we’re getting 10 times more bacteria, we’re getting a better perspective on what all is there because some bacteria are locked in certain compartments of the juice and if you don’t unlock them, you don’t even know they exist. Same with fungus. So the problem with just taking the juice and looking for fungus is none of this has been bedded through proper validation and extraction techniques. So we’re going to educate around all of this over the coming years. Maybe we’ll do more podcasts.

Dr. Weitz:                          Have you considered urinary organic acids as a way to screen for fungal?

Dr. Pimentel:                     Absolutely, I think there’s something to be said about that. So we are not collecting urine as part of this. We’re looking at blood as a hopeful area. So let me paint a picture for you so that you can see where we’re going. So let’s say we find a bug. Maybe it’s candida, maybe it’s klebsiella or something in the gut that’s the culprit for that patient. Is there are a marker in the blood that tells us it’s there? Because we’re collecting blood and so we’re able to find some chemical that that organism produces that happens to be spilling over into the blood. We can measure it and then a doctor can diagnose that patient with that bug in their gut as a cause of that disease and then be able to get it. We haven’t turned towards urine, only because urine is important right now, but urine tends to be a filtrate of blood. So it only detects some of the things in blood. Blood has everything in it, so we think we’re going to have a better capture rate by doing blood rather than urine as we refine our searching. But you’re right, maybe we have to do some urine in this as well eventually.

Dr. Weitz:                          Now, when it comes to treatment, we have all these complicated protocols, but can we just drink celery juice? I read on the internet that it cures SIBO. I’m kidding.

Dr. Pimentel:                     There’s a lot of things on the internet report to cure many things. I never bash anything because the way I look at … There are doctors who will say, “Oh, that’s just rubbish.” And this. We don’t know what we don’t know and until we study it, we don’t know. There were many people in the 1980s and ’90s who said that H pylori is a joke. It doesn’t cause ulcers. There are people who said that the herbs are not antidepressants and then we learned about studies from St. John’s Wort and other products and they are antidepressants. So I don’t say no til I see a study that says no, a good study. And so I’m sort of giving you a vague answer. I’m sorry.

Dr. Weitz:                          That’s okay. So-It wasn’t a serious question anyway.

Dr. Pimentel:                     I know, but I really don’t … I don’t really like criticizing until I know that … What I don’t … Here’s what I don’t like. I don’t like when there are companies making a lot of money on the backs of patients suffering and not putting the money where their mouth is and do a couple of trials and give us some good information about it. That’s what I like. And I’m happy to talk all day, all night about good trials and good products.  Whatever it is, I don’t care.  If there’s good trials and good information around it, let’s help some patients.  Let’s get them the black, white, or gray answers, but let’s get the answers.

Dr. Weitz:                          I’d like to talk about probiotics. I know I’ve heard you say in the past that you didn’t think there was any benefit, but in the Functional Medicine world, we tend to use probiotics for patients with SIBO. And I did see a meta analysis in 2017 from Zhong, and others in the Journal of Clinical Gastroenterology, who did find that even though probiotics didn’t prevent SIBO, they were effective at decontaminating SIBO and reducing hydrogen gas levels. And I know one prominent Functional Medicine doctor is very big on using probiotics and I know other Functional Medicine who want to use a probiotic to see. They want to make sure we maintain the integrity or improve the microbiota and so they’ll use Saccharomyces boulardii, which is not known to grow in the small intestine or they’ll use a spore-based probiotic, which is believed to get all the way into the colon before it opens up. What’s your thought about probiotics and SIBO?

Dr. Pimentel:                     So I’m not, again, anti probiotic. I think people get that perception that I’m anti probiotic. I’m not. Again, I’m pro data. And so yes, this meta analysis came out and kind of affects us in a way because you’ve got a whole bunch of tiny trials that … and mostly small trials that if you pool them all together, you get some power. So I’ve heard the probiotic companies say, I’ll quote a trial that says, “Look, this probiotic didn’t work.” And they say, “Yeah, but that’s not our strain. Our strain is different,” right? And I said, “Okay, so we need a study with your strain.” But then the probiotics will come and they’ll quote this meta analysis, which is 10 different probiotics that are totally unrelated and say, “Look, probiotics work for SIBO.” So that seems dichotomous to me. On the one hand, when a study’s negative you’re quoting that’s not our strain. On the other hand, when there’s a meta analysis of 10 different strains, you’re saying, “Look, probiotics work.”

It’s a little mysterious to answer in that way. My answer is, once we understand the organisms better, I do believe there’s a probiotic way of manipulating the flora. I do believe if you put more of one organism in, you’ll overcrowd some of the hydrogen producers and maybe that will reduce hydrogen and so forth, but I also know that no matter what bug you put in there, it’s producing gas because that’s what they do. So the question is, are you just shifting it from one phenotype of overgrowth to another type, because the motility’s still bad. So you’re shifting it to another type of overgrowth that may have a different phenotype, so maybe you’ll say, “Oh yeah, my bloating’s better, but now my diarrhea’s worse” or my … What are we really, really doing? And again, this speaks to the Reimagine trial because the Reimagine trial is going to say, “Okay, this is what the normal small bowel bacteria look like.” Never had that answer. So until we have that answer, we don’t know how to make it look normal because we don’t know what bugs to put in there.  So we’re going to educate around probiotics eventually, but I know it’s a long answer to a tough question. I’m not against probiotics. I just want to make sure that what we end up doing in the end is the right probiotic for the right thing. And it may be five different probiotics with five different scenarios, or maybe even more. It may be much more complicated.

Dr. Weitz:                          On diet, I read your paper on diet and IBS and you talked about the low FODMAP diet. Which type of diet do you use with your patients?

Dr. Pimentel:                     So everybody is pretty convinced with the research that’s been published on the low FODMAP diet. So it’s sort of like I put the things on a spectrum.

Dr. Weitz:                          It certainly is the most common diet used in the Functional Medicine world for SIBO.

Dr. Pimentel:                     Well, absolutely. And for good reason. There’s good data. But I look at diet on a spectrum. If you don’t eat anything, you won’t be bloated. So that’s the ultimate extreme. If you go on a low FODMAP diet, which is fairly extreme, you will reduce gas and bloating. I’m convinced of that, because you’re not eating anything that produces much gas. We tend to lean more towards the low fermentation diet because it’s more tolerable. The problems we’ve encountered and seen in the science on low FODMAP is, after three months, there are measurable nutritional deficiencies on the low FODMAP diet.

Secondly, and functional medicine people know this almost better than anybody else. Low diversity of bacteria is a bad thing. That’s why you’re administering probiotics and other things, trying to expand the diversity. Low FODMAP equals low diversity over time, so it’s … You could say in the 2019 way of thinking of the microbiome, it’s damaging the microbiome and we don’t know … And a lot of times when we damage the microbiome, it doesn’t bounce back after stopping. We see that sometimes with antibiotics as well. So in essence, it’s acting like an antibiotic because it’s destroying a part of the microbiome in some way. So we try to be a little more liberal with the diet and that’s why we favor the low fermentation diet, something that we started in 2001. Never really published a lot about it because we’ve been focused on the other stuff that you and I’ve been discussing today, but we like it because it’s more lenient and a little bit more tolerable for patients.

Dr. Weitz:                          Yeah, we usually just use the low FODMAP diet for no more than two to three months and then we try to expand the diet as much as possible.

Dr. Pimentel:                     And that’s the right way to use it. So it is effective, but you have to start reintroducing for the sake of the things we talked about.

Dr. Weitz:                          In that review article, you mentioned Curcumin, which I thought was really interesting because it’s one of my favorite herbs and I use it regularly with patients with inflammatory bowel disorder. And you mentioned that it reverses gut hypersensitivity, which can be beneficial for IBS. So I thought that was really interesting.

Dr. Pimentel:                     Yeah, Curcumin is a fascinating chemical. You think about all the stuff that has been done over the millennia, pickling, anything to preserve food. You didn’t have a refrigerator back then. You couldn’t even get ice. So how do you keep food from spoiling? So herbs were one of the mechanisms and my wife said, so it’s an interesting story. We were watching a movie and there’s a scene that … There was a battle and the new person in charge said, “We’re going to move the capital of India to Delhi.” And they said, “No, you can’t do that because the river is contaminated.” And the king says, “We’ll figure it out.” And the way they figured it out, and actually, I think it’s a docuseries to be honest. The way they figured it out was they added spices, which were able to ward off some of the poisonings and things and kill the bacteria that was in there, and tumeric was one of the roots. Think about it, roots growing in a dirt of bacteria and it manages to survive. So roots are interesting and so I guess they figured out that tumeric doesn’t have a lot of flavor, just preserves. So it’s an interesting compound and interesting root.

Dr. Weitz:                          Yeah, I followed up with your references, the paper from Dilbecco, and he was particularly talking about the Curcumin phytosome form, which seemed to be particularly beneficial. So I think that might be something for us to consider in the functional medicine world for adding to our SIBO protocol.

Dr. Pimentel:                     Yeah.

Dr. Weitz:                          So your clinic at Cedars, are you guys still looking to see more patients or are you not accepting new patients there?

Dr. Pimentel:                     So I’m, as you can imagine, full to the gills.

Dr. Weitz:                          With research, yeah.

Dr. Pimentel:                     Not just research. I’m trying to do the research. So there’s two problems for me. If I don’t have time to do the research, we don’t get the new things that are really good for patients because I’m too busy with clinic. But I still see patients in clinic. It’s just … The number of calls we get a week to see me is more than my capacity, so I’ve sort of shut things down because what happens, and I’ll be very transparent here, is that they wait six months to see me and then when I see them, I find something catastrophic that should have been diagnosed six months ago. It’s not fair for people to wait six months. Better not to accept a patient than to have them linger on the hope of finding something for six months with an illness that’s more tragic than they expected. So there’s a lot of things that I’ve encountered over the years that have made me stop seeing news until I have room again and then I open up and then I close down again. But we have other motility doctors who work with me who have the same sort of skill and experience I do and they’re still accepting patients and we’ve just hired a new doctor who’s starting in September and I trained her way back and she’s coming back and she’s incredible. So we’re trying to find the space for all the patients.

Dr. Weitz:                          Great. Do you want to leave a way for patients who are listening to this to contact your clinic?

Dr. Pimentel:                     Our clinic … No. If you look on the website at Cedars-Sinai, you can definitely find the telephone number, but I don’t want to have a … Our call center is already overwhelmed. And if I leave that …

Dr. Weitz:                          Right.

Dr. Pimentel:                     But I do want to say one last thing if I can. I think the biggest thing I experience with some of our discoveries, like the blood test for example, is that patients are frustrated. It’s, “Well, my doctor doesn’t know about it and I really want it and I can’t get it and my doctor is … ” We had the same problem with rifaximin back in the day. The doctors weren’t believing. Now everybody believes. Everybody’s onboard with the SIBO IBS concept. It’s not a mystery anymore and so that’s really good, but all this stuff takes time and I … If your viewers are patients, I’m sorry for the frustration that your doctor doesn’t know about this stuff yet. This stuff takes months or years to filter to them. And we’re doing our best, like this, to try and get as far out there as possible and educate. And I appreciate you taking the time to do this podcast with me now.

Dr. Weitz:                            Excellent. Thank you so much, Dr. Pimentel.



Non-Alcoholic Fatty Liver Disease with Dr. Bob Rountree: Rational Wellness Podcast 101

Dr. Bob Rountree discusses Non-Alcoholic Fatty Liver Disease (NAFLD) with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

0:53  Non-alcoholic Fatty Liver Disease is the leading cause of liver disease in the US, even though many people have not heard of this condition.  75% of patients who are overweight have this condition, which consists of an accumulation of fat in the liver. Nonalcoholic fatty liver disease, NAFLD, is an asymptomatic condition, but it can progress to non-alcoholic steatohepatitis which can lead to fibrosis, cirrhosis, liver cancer and liver transplantation. Dr. Rountree described it as a tsunami that no one’s paying attention to.  Technically, the definition is when 5% of your liver tissue is replaced with fat.  What is usually seen first is that one of the liver enzymes (AST, ALT, or GGT) is mildly elevated on a blood test.

8:25  It’s not just that the liver stores fat, but it produces new fat.  We know how to create fatty liver, which is when we produce fois gras.  We do this by force feeding the goose or duck grains, which is turned into fat by the liver. It’s eating sugar and carbs and esp. high fructose corn syrup, that turn on genes in the liver that cause fatty liver and not eating fat that causes this. Big Pharma is investing billions of dollars trying to develop drugs to reverse the progressive form of fatty liver, known as Non-Alcoholic Steatic Hepatitis (NASH). Technically speaking, fatty liver doesn’t hurt you, but a percentage of people with fatty liver will develop fibrosis because the inflammatory pathways have been turned on–an auto-inflammatory process. If you lay down enough scar tissue, eventually you end up with cirrhosis or possibly liver cancer.  It is expected that within the next 5-10 years, NASH will be the number one cause for liver transplants.

13:20  Studies show that when you track patients with fatty liver, they have much a higher incidence of mortality from other diseases. [Here is a good review paper on this topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397356/?fbclid=IwAR19ujpU2qfD7mFaV-bAM96oN_SNZRoHiXb1BU3AbRM7xE4BLUmPUl-RW0g] The number one marker for this is C-reactive protein (HsCRP) and you start to worry especially when it is above 3. We also know that gum disease, like the existence of a bacteria known as Porphyromonas gingivalis in the gums, increases this risk.  Also dysbiosis of the gut increases inflammation and leads to fatty liver. 

15:56  We diagnose fatty liver first by measuring liver enzymes on a blood test, esp. ALT, AST, and GGT.  ALT and AST are called transaminases because they move amino acids around–they’re part of the digestion process.  Dr. Rountree feels that GGT, (Gamma-glutamyl transpeptidase), is a more sensitive test, though it is often not tested. GGT is an enzyme involved with glutathione metabolism.  But when you discover that these enzymes are elevated, you must first make sure that they don’t have a virus, that they haven’t taken too much Tylenol, or have some other toxic exposure.  After ruling these out, if you are suspecting Fatty Liver, then you should order an ultrasound.  A biopsy would be more definitive, but nobody wants to have this procedure done.

19:37  Elevated triglycerides indicate a condition we call Metabolic Syndrome, which Dr. Rountree believes is an intersection between several different biochemical pathways that have gone awry, and at the core is a person who’s over-producing triglycerides. This means that you have insulin resistance, that your body is not responding well to insulin, which is why high triglycerides can be a tip-off that the person has fatty liver. High triglycerides and low HDL is a really big deal.

22:57  To reverse Fatty Liver the conventional medical approach is to put you on a statin or Metformin, which is a drug for diabetes. From a Functional Medicine perspective, the first thing to do is to get them to change their diet and stop drinking sweetened beverages and get rid of processed food and high fructose corn syrup and start eating fresh foods. Eliminate refined carbohydrates and sugar and go on a Mediterranean diet. You don’t need to go on a Ketogenic diet. And you have to get active and do some exercise every day and lose some weight.  Exercise improves your sensitivity to insulin. High intensity interval training is the most effective form of exercise.

29:03  Dr. Rountree recommends the following nutritional supplements for reversing fatty liver: 

1. Curcumin phytosome–500 mg twice per day. This is a form of curcumin that’s better absorbed because its blended with lecithin.  There are at least three published studies showing that this resulted in dramatic improvements in fatty liver. Here is one study that I found using Curcumin phytosome for NAFLD:  Efficacy and Safety of Phytosomal Curcumin in Non-Alcoholic Fatty Liver Disease: A Randomized Controlled Trial

2.  800 IU of vitamin E in the mixed tocopherol form

3.  Fish oil is sold as a drug that lowers triglycerides, so it shouldn’t be a surprise that it improves fatty liver. Dr. Rountree recommends 2-3,000 mg of EPA and DHA per day. 

4.  Milk Thistle phytosome

5.  Berberine at a dosage of 1500 mg/day helps to reverse fatty liver. Berberine can also help with blood sugar and compares with Metformin, so it can also be thought of as a anti-aging compound. Dr. Roundtree notes that berberine can cause upset stomach, so if that happens you can start with just 500 mg and take it with food and work your way up to 1500. If you take berberine long term, you should take it with probiotics so that you don’t have an adverse effect on the microbiota.

41:02  One of the reasons that Dr. Rountree likes the curcumin and milk thistle phytosome/phosphatidylcholine supplements is because they are also good sources of choline. Many people don’t get enough choline, which can result in fatty liver.  I asked Dr. Rountree about Dr. Stanley Hazen from Cleveland Clinic who has developed a test for measuring TMAO levels and he has found that elevated TMAO levels contribute to heart disease.  Dr. Hazen tells patients that they shouldn’t consume choline or L carnitine because it’s going to increase their TMAO.  But Dr. Rountree thinks that TMAO is actually a marker for choline deficiency. When TMAO is up that means that bacteria in the colon are consuming dietary choline and turning it into TMAO. The problem is not the TMAO but the reduction in choline. Therefore you need to take more choline, not less.  Choline is a great source of methyl groups and undermethylation is a major cause of fatty liver.


Dr. Bob Rountree is an MD with certifications in Family Medicine, Nutrition, Herbology, and Mind-Body Medicine and he is in private practice in Boulder, Colorado and he is the Chief Medical Officer of Thorne Research, a nutritional supplement company. He has written three books on Integrative Medicine, Immunotics: A Revolutionary Way to Fight Infection, Beat Chronic Illness, and Stay Well (Putnam, 2000); Smart Medicine for a Healthier Child (Avery Publishing, 1994); and A Parent’s Guide to Medical Emergencies (Avery, 1997). He also teaches regularly for the Institute of Functional Medicine.   

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or by going to www.drweitz.com.


Podcast Transcripts

Dr. Weitz:                     This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to the Rational Wellness podcast at iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com.  Let’s get started on your road to better health.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please give us a ratings and review on iTunes. That way more people can find out about the Rational Wellness podcast.

Our topic for today is Nonalcoholic Fatty Liver Disease with Dr. Bob Rountree. While many people have never heard of it, nonalcoholic fatty liver disease is actually the leading cause of liver disease in the United States, and as obesity rates continue to rise, so does this condition. It’s estimated that 75% of patients who are overweight and 90% of patients who are morbidly obese are afflicted with nonalcoholic fatty liver disease.  Nonalcoholic fatty liver disease, NAFLD, is an asymptomatic condition meaning, you have no idea that you have it and it’s marked by an accumulation of fat in the liver. And while it’s traditionally been considered a benign condition, it can progress to nonalcoholic steatohepatitis which can lead to fibrosis, cirrhosis, liver cancer and liver transplantation.

 Dr. Bob Rountree is an MD who’s one of the founding members of Functional Medicine along with Dr. Jeffrey Bland and Sidney Baker, et cetera. In today’s parlance, he would be referred to as an OG. Dr. Rountree has certifications in family medicine, nutrition, herbology and mind-body therapy. He’s written three books in integrative medicine, Immunotics, Smart Medicine for a Healthier Child, and A Parent’s Guide to Medical Emergencies. He also teaches regularly for the Institute of Functional Medicine.  Dr. Rountree, thank you so much for joining me today. I’m very excited to get an opportunity to speak to you.

Dr. Rountree:                    You bet. It’s a real thrill to be on.

Dr. Weitz:                          Good. So, maybe you can tell us how you first got involved with Functional Medicine.

Dr. Rountree:                    Oh, my God, that’s a long story. When I was in training in my residency, one of my fellow residents went to a conference put on on Integrative Medicine, and Dr. Jeffrey Bland was one of the speakers, and this resident came back and said, “You will not believe this guy. He talks about nutrition from a highly educated standpoint where he cites all of the research and connects the dots in a way that no one has ever done.” So I got intrigued and I ended up tracking Jeffrey down and went to hear him lecture, and then when I finished residency I spent a week at a place called the Omega Institute in upstate New York, and I studied with Jeffrey Bland and Leo Galland, Sid Baker, and a guy named Neil Ornstein, who are the founding fathers of Functional Medicine. That was about 38, 39 years ago.

Dr. Weitz:                          Cool.

Dr. Rountree:                    So there was no Functional Medicine at the time, but this is this group of forward thinking people, were putting these ideas together and eventually I continued to follow their work and go to Jeffrey’s seminar year after year after year, and eventually it became what we call Functional Medicine.  I actually taught in the very first Functional Medicine training, which was out at the Orchid Hotel in the Big Island in Hawaii. It was a lovely experience.

Dr. Weitz:                          Cool. Yeah. I used to listen to Dr. Bland’s audio tapes every month. I think it was originally called preventative medicine update, and …

Dr. Rountree:                    Yeah. PMU.

Dr. Weitz:                          Used to get those little cassette tapes, pop them in the car …

Dr. Rountree:                    Yeah. Yeah. I still got a stack of them in my closet. Yeah. Yeah. Well, Jeffrey still had it. I just heard him on a conference last weekend, and he’s still cranking away and he’s in his mid-70s now, and quite robust and healthy and alert and his brain is just going 100 miles an hour as always.

Dr. Weitz:                           That’s great. Yeah, I know, he’s got his preventative, PLMI Institute. Right?

Dr. Rountree:                      Preventative Lifestyle Medicine Institute.

Dr. Weitz:                           Right. Cool.

Dr. Rountree:                     Yeah.

Dr. Weitz:                           So tell us about nonalcoholic fatty liver disease and what causes it.

Dr. Rountree:                     Oh, my God. This is one of these huge problems that nobody’s ever heard of. Right? They call it the tsunami because this is such a huge problem that doctors aren’t paying attention to. In the past, if you read a typical mainstream medical article on metabolic syndrome or prediabetes, they would always say, “Oh, and you can have this complication of fatty liver.” And they just described it as, “Oh, it’s not that big a deal. You’ve a little bit of fat in your liver and it could cause some problems,” and now we’re realizing that fatty liver may be the problem.  It may be one of the main causes of diabetes, not the other way around.  So, what is it exactly? It’s an accumulation of fat in the liver, just like the name says.  It’s not caused by drinking alcohol or a toxin.  I mean we know there’s toxins out there like acetaminophen or Tylenol.

Dr. Weitz:                           Yeah. The number one cause of acute liver failure, right?

Dr. Rountree:                     Absolutely. I just saw a patient a couple of weeks ago that had a routine blood test and her liver enzymes were both elevated and I said, “Well, this is either fatty liver,” she was a bit overweight, so I said, “This is either fatty liver or it’s Tylenol.” It turned out she was taking 1,500 milligrams of Tylenol every day. She stopped and her liver enzymes came back to normal, so she got off the hook for the fatty liver. But that raises the point of the fatty liver, is when you got something going on with the liver, it’s not because of another proveable condition like a toxin or alcohol, which is a toxin.  So they call it nonalcoholic fatty liver. Technically, the definition is that when 5% of your liver tissue is replaced with fat, you have fatty liver. 5%. So, in order to get that you’ve got to have some kind of scan of the liver. You can’t tell that based on blood tests alone. Typically what would happen is a person’s getting a routine screen, like the patient I mentioned, and she’ll get told, “Okay, your hepatic transaminases, the ALT and the AST, one or both of these are increased.” And again, the first thing you think is, “Well, is there a toxin, or is there … does she have a virus or something like that?”  But when you’ve ruled those things out, you go, “Why will the liver show an increase in these enzymes?” It’s because there’s a very mild level of inflammation that’s going on there. In the past, they would have said that fatty liver doesn’t really cause a problem. It’s a consequence of other problems, and as I said, the newer thinking is, no, this may actually be at the core of the problem.

Dr. Weitz:                          Why does the body store fat in the liver?

Dr. Rountree:                    Well, everything’s being processed through the liver, if you think about it. When you’re ingesting foods, right, the extract of the food goes into the lymphatic system and that drains into the liver. The liver is like a big sponge.

Dr. Weitz:                          Right.

Dr. Rountree:                    But it’s not just that the liver is storing fat, it’s actually making new fat.

Dr. Weitz:                          Okay.

Dr. Rountree:                    This is a really important point. So, how do you create fatty liver? Well, we’ve been doing it for centuries. It’s called fois gras. Right? That’s fatty liver. And how do you produce fatty liver in a goose or in a duck? You force feed them grains. Right? It’s not fat. So the logical thing would be to think, “Okay, you eat too much fat and so the liver just stores it.”  Instead, what happens is, you eat too much sugar and the sugar actually turns on genes in the liver that tell the liver to convert that sugar into fat, into what’s called triglyceride, the triglyceride form of fat. So it’s a partially genetic thing. So, yeah, if you eat, you know, gobs and gobs of fat in your diet, some of that will end up in your liver and get stored there, but a big proportion of the fat in the fatty liver scenario is from high fructose corn syrup. That’s a big wow, right?

Dr. Weitz:                          Yeah. Yeah.

Dr. Rountree:                    Wait, wait a minute. I get fat from eating sugar. Yes.

Dr. Weitz:                          Right. Sure. We know that most of the cholesterol in the body is produced by the liver. That and drugs don’t work by blocking the cholesterol that we eat. It stops the liver, reduces the liver from producing cholesterol.

Dr. Rountree:                    Well, there’s this old notion. Somebody’s got high cholesterol, so maybe it’s just ending up in the blood stream. They’re eating too much high cholesterol food therefore they have high blood cholesterol. Well, now we know that even going on a low cholesterol diet doesn’t change blood cholesterol levels that much.

Dr. Weitz:                          Right.

Dr. Rountree:                    Even restricting cholesterol and fat from the diet doesn’t change blood cholesterol.

Dr. Weitz:                          Right.

Dr. Rountree:                    Right? It’s because the liver’s making that cholesterol and the odd thing is that even, as the same scenario with fatty liver, eating too much sugar can actually stimulate the liver to make more blood fats.

Dr. Weitz:                          Yeah. It’s interesting when you talk about fois gras. I guess the aliens are fattening us up for a big meal.

Dr. Rountree:                    They’re getting ready for a big meal. Yeah. They’re preparing us for the yummy feast. Yeah. Either that or if it’s not the aliens, it’s the big agricultural companies. They’re really … they’re having a field day with us.

Dr. Weitz:                          Oh, yeah, absolutely. And Big Pharma, right?

Dr. Rountree:                    Big Pharma. You know, so Big Pharma knows that this fatty liver problem is an epidemic, right. They’re not denying it at all. And they are investing billions of dollars in drugs, because they figure, if we find the drug that will reverse … It’s not so much reversing fatty liver, but reversing, as you mentioned, the progressed form of it, which is called NASH. Now NASH is the concern here.  So, technically speaking, fatty liver doesn’t hurt you, but it does increase your risk of other diseases. But the problem is a certain percentage of people with fatty liver will develop fibrosis, and you get the fibrosis because you turn on inflammatory pathways. The immune system gets involved. You don’t want that. Once the immune system is involved, you’re in trouble. When the immune system gets involved, you start laying down scar tissue, and if you lay down enough scar tissue, then eventually you end up with cirrhosis or possibly liver cancer.  So, for that reason, they’re expecting that within probably the next five to ten years that fatty liver NASH, the progressed form of it, is going to be the number one cause for liver transplants in this country.

Dr. Weitz:                          Wow.

Dr. Rountree:                    And that’s what they mean by the tsunami. We don’t have enough livers for all these people.

Dr. Weitz:                          Right. Wow. So, essentially when you say the immune system gets involved, we’re creating autoimmune liver disease.

Dr. Rountree:                    I guess you could call it an autoimmune thing because the body is attacking itself.

Dr. Weitz:                          Exactly.

Dr. Rountree:                    Technically, we call it autoinflammatory. So it’s not quite … autoimmune be like very specific attack on the joints. Right? Autoinflammation is like autoimmunity but it’s more like there’s inflammation in a certain area, like hardening of the arteries, arthrosclerosis, that’s autoimmunity.

Dr. Weitz:                          Right.

Dr. Rountree:                    That’s autoinflammation.

Dr. Weitz:                          Okay.

Dr. Rountree:                    So, autoinflammation. They overlap. They’re very similar. So, this is an autoinflammatory disease, it’s inflammation that’s somewhat confined to the liver. Now here’s a little interesting tidbit about it. Well, I don’t know if you’d call it interesting if you have the problem, but, people with fatty liver, again, were not thought to have any consequences of it, but what they’ve done is they’ve tracked people with fatty liver, know their diagnoses for years, and they found their incidence of mortality from other diseases goes way up. And probably the number one marker for that is something called the C-reactive protein which I’m sure you’re aware of.

Dr. Weitz:                          Sure. Absolutely.

Dr. Rountree:                    Yeah. If your CRP, if you’ve got fatty liver and your C-reactive protein is up, which is a marker for inflammation, then that’s a very bad sign, right? That tells us that your risk of dying or getting ill from a number of different diseases goes way up.

Dr. Weitz:                          And when you say the CRP is up, do you mean anything over 1, or anything over 3, or …

Dr. Rountree:                    Oh, over 3 is when you start to get worried. When you get up to 4 or 5, then it’s a real concern.

Dr. Weitz:                          Okay.

Dr. Rountree:                    But hopefully not over 1 or a lot of us would be in trouble.

Dr. Weitz:                          But I guess a lot of us Functional Medicine practitioners now are using 1 as the optimal range.

Dr. Rountree:                    Right. So we’re talking about optimal, but when you get into the danger ranges, more like your 3, 4, 5 et cetera. I find a lot of people, if they got a C-reactive protein of say 2, they can get it down just by flossing their teeth. Because bad gums can definitely cause inflammation in the body.

Dr. Weitz:                          Yeah, it’s amazing what bad gums can be involved in. They can increase your risk of heart disease, as we know, that’s why a lot of people get dental work and they get prescribed antibiotics to decrease the possibility of a heart infection, and recently we’ve seen research correlating it with Alzheimer’s disease.

Dr. Rountree:                    Yup. Yeah. Absolutely. There’s actually a bacteria that gets under the gums called Porphyromonas gingivalis. You probably heard of it.

Dr. Weitz:                          Yes.

Dr. Rountree:                    That’s one of the bad guys, and I bring this up in the context of the discussion on fatty liver, because now there’s a lot of research coming out showing that dysbiosis, which is unhealthy bacteria in the intestines, can actually lead to fatty liver.

Dr. Weitz:                          Right. Which-

Dr. Rountree:                    You know, powerful.

Dr. Weitz:                          From a Functional Medicine perspective, not surprising at all, because essentially dysbiosis seems to be a factor in everything.

Dr. Rountree:                    Every chronic disease.

Dr. Weitz:                          Yes. So, how do we diagnose fatty liver?

Dr. Rountree:                    Well, it’s mostly diagnosed in people as part of a routine screening. What’s called a chemistry profile or a liver function test. I would say a large percentage of patients in my practice came to see me because they’d been to a health fair and had a routine screen, and said, “Gee, I thought I was healthy. I’m just a little overweight. I got a little paunch going on, but otherwise I thought I was pretty healthy, then I went to a health fair, and lo and behold, my liver enzymes were elevated and they told me, go see a doctor.”  Those liver enzymes, as I mentioned earlier, can be a tip-off that something’s wrong but you’ve got to first make sure it’s not a virus, make sure they’re not overdosing them on Tylenol which isn’t hard to do, make sure they don’t have any toxic exposures, and when all that’s left, you get, “Okay, let’s get an ultrasound.” The ultrasound is really the best test, I think, to determine it, because it will tell you whether there’s a lot of fat in the liver.  Unfortunately, ultrasound doesn’t specifically say, you have 8% fat or 10% fat or 15. It just says, you’ve got enough fat that you qualify for having at least 5% of your tissue replaced with fat. So, again, starts with abnormal liver enzymes and then it’s confirmed with an ultrasound.  Now, if you want to be technical about it, you probably should get a biopsy, but nobody wants to do that. Right? If you don’t have any symptoms and your doctor says, “I think you’ve got this bad condition that could lead to something even worse,” and then you say, “And I want to stick this huge needle into your liver and get a piece of your liver and see what it looks like there,” that’s not going to go over very well. So, no one gets a biopsy for fatty liver.

Dr. Weitz:                          So, which of the liver enzymes are most important?  And how much do they need to be elevated to indicate this?

Dr. Rountree:                    They don’t need to be very elevated. So the two that we look at, there’s three actually, ALT, AST and GGT. Those ALT and AST are called transaminases and they’re called that because they move amino acids around. They’re part of the digestion process. And when the liver has this fat built up and for some reason it will leak these enzymes into the blood stream. But an even more sensitive test that a lot of doctors don’t do is called the GGT, Gamma-glutamyl transpeptidase, that’s involved in our old friend, glutathione.  And you know that if an enzyme that’s involved in glutathione metabolism is elevated, that’s not good news.

Dr. Weitz:                          Right.

Dr. Rountree:                    Because you’re only increasing your glutathione processing enzymes if you’ve got some kind of toxin to be processing. Right?

Dr. Weitz:                          Right.

Dr. Rountree:                   The liver’s saying, “I’m under stress and I need more glutathione.” That’s actually … It’s a better enzyme but for some reason doctors don’t do it that much, so I always add it on. If I get a chemistry profile, I always add on the GGT.

Dr. Weitz:                          What about alkaline phosphatase and, or elevated triglycerides?  Are those potential indicators as well?

Dr. Rountree:                    Though alkaline phosphatase can be, it’s generally not the first one that goes up.  It’s a little bit later in the process, but, yeah, alkaline phosphatase can definitely be increased.  I just saw it in a patient the other day.

Dr. Weitz:                          Okay.

Dr. Rountree:                    And your other question was about triglycerides, and there, again, there’s this condition that we call metabolic syndrome, right?  And metabolic syndrome is either its own deal or it’s prediabetes depending on whether you’re a diabetologist or not. Diabetologists say you either have diabetes or prediabetes.

Dr. Weitz:                          Right.

Dr. Rountree:                    The endocrinologists, who are not diabetologists, and the cardiologists, they say there’s a whole other syndrome called metabolic syndrome that it’s own deal that can lead to diabetes. And the reason that’s important is because I’m in that camp. I think metabolic syndrome is a phenomenon, it’s an intersection between several different biochemical pathways that have gone awry, but at the core of it is the person who’s over-producing triglycerides.

Dr. Weitz:                          Okay.

Dr. Rountree:                    Why is this a big deal? Because, in the old days when we did a cholesterol panel, we looked at their LDL cholesterol and HDL cholesterol, and that’s all that mattered. Well, occasionally, you’d see a person whose high triglycerides were part of the deal, and we would tell them, “Oh, that’s no big deal.” No big deal. Now we know … I mean, high triglycerides and low HDL is a really big deal. What it means is that the body is not responding well to insulin. It means you have insulin resistance. And insulin resistance, it’s not the only cause of fatty liver, but it’s clearly one of the major causes, so the same thing that causes metabolic syndrome causes fatty liver.  And so, that’s why, high triglycerides could be a tip-off that the person has fatty liver. We generally think, if a person is a Type 2 diabetic, if they’re at the point where they have to take drugs to keep their hemoglobin A1C down, chances are 70% that they’ve got some degree of fatty liver. If they’ve got metabolic syndrome, it’s not quite as high but it’s definitely moving in that direction.

Dr. Weitz:                          Right. And when the ALT is elevated, it could be like, say, 45 instead of below 40, right? It doesn’t have-

Dr. Rountree:                    It doesn’t … it’s only a slight increase.  In fact, when you have these super high increases, you actually don’t think of fatty liver, you think of virus or a toxin.

Dr. Weitz:                          Right.

Dr. Rountree:                    Right?  You think there’s been some kind of damage and there’s certainly viruses like Epstein-Barr virus that people can get.  Even a younger person who gets Kissing disease, mono, you know, their liver enzymes can go through the roof.

Dr. Weitz:                          In the thousands, even.

Dr. Rountree:                    Yeah, in the thousands. So when I see that, I don’t think fatty liver. I only think fatty liver when, if the normal range is up to 40 and they’re 45 or 50. So, it can stay that way for months or years, and that’s your tip-off as you go … You know, the first thing is if you see these enzymes and they’re 3 points up, the first thing I think is, “Okay, I’m going to repeat this in a month and see if it’s real.”

Dr. Weitz:                          Right. So, when we have patients with this condition, how do we reverse it?

Dr. Rountree:                    Well, that’s the million dollar question.  As I said, you know, the drug companies-

Dr. Weitz:                          Is that going to be revealed in the next Dr. Rountree book on fatty liver?

Dr. Rountree:                    Well you know, my wife was saying, “Why don’t you write a book about it?”  I’m like, “Who’s going to buy a book called Your Liver May Have Fat In It.”  It’s not exactly what you’d call a sexy topic for the public in general, but I tell you, so many people have it and the doctors are not recognizing it, and then they go on from fatty liver to NASH and they go, “Why didn’t anyone tell me? Why hasn’t anyone said anything about it?”  Well, so that gets us back to, how do we treat it? You know, the drug companies are saying, “Let’s run-

Dr. Weitz:                          You don’t call the book that. You call the book This Is Going to Rejuvenate Your Sexuality, Make You-

Dr. Rountree:                    Yeah, you’re right.  Right.  Win Free Something. Win and free has got to be in the title if you want it to sell.

Dr. Weitz:                          Sex is somewhere in there too.

Dr. Rountree:                    You know what the drug companies think? They’re expecting that there’s about a 35 billion dollar market in drugs for NASH.

Dr. Weitz:                          Wow.

Dr. Rountree:                    35 billion dollar market. But the first drug they came up with was a total failure.

Dr. Weitz:                          Not surprising. Right?

Dr. Rountree:                    And I think it’s because they’re going at the wrong thing. I mean the first thing you do, really, is look at it from a Functional Medicine perspective. I think Functional Medicine has got the solution.

Dr. Weitz:                          They never do that.

Dr. Rountree:                    They never did that 

Dr. Weitz:                          They went on one pathway, the one drug that blocks out one pathway …

Dr. Rountree:                    Yup. And so, let me put you on statin.

Dr. Weitz:                          Yeah.

Dr. Rountree:                    Or let me put you on Metformin, which is a drug for diabetes. Well, those drugs, they’re somewhat helpful, but they don’t make that big a difference. Now if you look at it from the Functional Medicine perspective, the first thing you ask is, “What are your lifestyle factors that are … What’s contributing to this condition?” Right?  And a lot of times it’s got to be the person drinking a lot of pop or eating a lot of foods that are processed and have the high fructose corn syrup. Now people say, “Wait, it’s corn syrup. How could it be a problem?” Well, it is a problem. There’s no question. There’s many published papers on it, so the first thing is to get rid of the sweetened beverages, and to get rid of processed food. Almost all processed food has got high fructose corn syrup in it.  So, look for that on the label, or better yet, just stop eating things with packages. You know, go to fresh, all the time.  It doesn’t even have to be organic. Just fresh.

Dr. Weitz:                          Right.

Dr. Rountree:                    That’s going to make a huge difference. So, that’s the first step. The second thing is to cut back on any kind of refined carbohydrate, any kind of sugar or sweets, candy, things like that. Do you have to go to a ketogenic diet, extreme low carb? It doesn’t have to be. It’s just carbohydrate restricted. In fact, studies have shown that the single best diet for people with fatty liver is the Mediterranean diet. That’s not a super carb restricted diet, but it’s minimal carb, there’s minimal sweets, there’s a nice mix of fruits and vegetables, there’s a lot of olive oil, not a ton of meat but some meat, a fair amount of fish. So, that doesn’t even have to be a really kind of crazy, elaborate diet, just a basic Mediterranean diet.  But then you got to have people working out. That’s a stumbling block for a lot of people. If they’re not working out, if they’re not exercising, you’re never going to burn that fat.

Dr. Weitz:                          Right.

Dr. Rountree:                    And I’ve certainly, I’ve seen it in patients where their liver enzymes will go up and down depending on how much they’re exercising. And the standard complaint I hear is, “I don’t have to time to exercise. I can’t fit it in. I got too many things going on.” It’s like, you know, “Would you rather …” So, the whole joke is, “Would you rather exercise for 30 minutes a day or be dead 24 hours a day?”

Dr. Weitz:                          Exactly. Yeah, that’s no excuse. I just tell patients, “What time do you wake up? Whatever time it is, wake up an hour earlier, and that’s when you get your exercise in.”

Dr. Rountree:                    You’ve got to do it, and studies have shown that exercise lowers fat in the liver regardless of weight loss. So, it’s not that you’re exercising to lose weight. Probably what’s happening when you exercise is you get more sensitivity to insulin. So, again, at the core of this problem is resistance to insulin.

Dr. Weitz:                          Right.

Dr. Rountree:                    When you have resistance to insulin, then for the same level of blood sugar your body makes more insulin because it’s harder to get that blood sugar down, but when you make more insulin, insulin turns on the genes that generate fat in the liver. So, you exercise, you decrease the insulin resistance, you increase the sensitivity to insulin. And how much do you need? Probably about 150 minutes a week. That’s 30 minutes, five days of the week. Not a huge amount, and it doesn’t have to be super-duper intense, although it’s better if it is. So high intensity interval training works better than anything.

Dr. Weitz:                          Cool.

Dr. Rountree:                    And you know what that’s about. That’s telling the person to get on the treadmill, go all out for 20 to 30 seconds. Just as hard as they can until they can’t stand it anymore, doesn’t have to be a long time, then you rest, then a few minutes later you do it again. If you do that, you can get as much benefit from 15 minutes of exercise as you do from two hours of slow walking.

Dr. Weitz:                          Right. And weight training is high intensity exercise also.

Dr. Rountree:                    Absolutely. Yeah. When you’re doing these really intense reps, you know, that’s definitely working your muscles.

Dr. Weitz:                          I was at the gym this morning.

Dr. Rountree:                    At the gym doing that, getting your insulin sensitivity up.

Dr. Weitz:                          Absolutely. So besides losing weight, what else can we do about this condition? What nutritional supplements can be of benefit?

Dr. Rountree:                    Oh, I’m glad you asked that question. As it turns out, there’s a lot-

Dr. Weitz:                          I never ask that question.

Dr. Rountree:                    Okay. Well, you know, what would surprise you is that if you look at the mainstream text books where articles that have been written on fatty liver, they say there’s no proof drawn, and you go, “Wait a minute. So that means there’s nothing you can do but lose weight and exercise?”  No, actually, if you do what I did, which is you start talking to my friend Mr. Google, or I should say, Dr. Google. And just started messing around looking at articles that people have written, what do you find? You actually find that there’s a huge number of dietary supplements that have been studied, and really good studies, for fatty liver, and you think, “Why doesn’t the mainstream doctor know about this?” It’s because there’s no financial incentive, there’s no drug rep that’s going to come in and say, “Hey, you should take curcumin, which is an extract of turmeric. You should take milk thistle, you should take berberine.” So I’ve already listed a couple of my favorites-

Dr. Weitz:                          Right.

Dr. Rountree:                    Probably the top of the list is curcumin phytosome. Curcumin is the active ingredient in the herb turmeric, curcuma longa. Turmeric is fine for general health purposes, but it’s not well absorbed, so there’s a version of it called curcumin phytosome where it is mixed with lecithin, which is a substance that you find in soy and sunflower, you can find lecithin in eggs, and when you combine the curcumin with the phytosome, it dramatically enhances absorption.  Well, I mention that form of it because there’s at least three, and maybe four published studies where they took people that had significant fatty liver based on ultrasound and they gave them curcumin phytosome, 500 milligrams twice a day. That’s the dietary supplement that you can get, it’s pretty widely available if you ask for that specific form. They found dramatic improvements with the dropping of liver fat, people lost weight, their liver enzymes came down on every single study they’ve done on.  So here’s something that is inexpensive, it’s easy to take, it’s non-toxic, and it’s been proven in three to four studies, that are all published in medical journals. So that’s my first choice. I put everybody on that.

The second one would be vitamin E. Now vitamin E is actually something that the mainstream liver specialists agree on. The American Association for the study of liver diseases, you know that’s kind of the mainstream organization that is an advocate for doing something about fatty liver, they actually say, “Everybody with fatty liver should get vitamin E.”

Dr. Weitz:                          And you prefer the high Gamma-tocopherols?

Dr. Rountree:                    Yeah. Well, it’s mixed tocopherols that are high in the Gamma-tocopherol. So, that’s the way … I don’t … So a lot of Vitamin Es that you buy or d-alpha-tocopherol 

Dr. Weitz:                          Yeah, the synthetic form. Yeah.

Dr. Rountree:                    I’m not a big fan of straight d-alpha-tocopherol because the active form of vitamin E is actually Gamma-tocopherol.

Dr. Weitz:                          Correct.

Dr. Rountree:                    But I don’t think you have to isolate the Gamma-tocopherol, I think you just get the mixed tocopherols. And a typical dose of that is 800 international units, or IUs a day. So, everybody with fatty liver should be on that.  The third thing would be fish oil, right? The Omega-3 fatty acids. There are very good studies showing that fish oil can improve fatty liver. Well, that shouldn’t be a surprise because fish oil is actually approved by the FDA as a drug. Fish oil is a drug to lower triglycerides. Well, it’s going after the same thing.  Again, if a person didn’t understand this, they might say, “Wait a minute, you’re recommending a fat, which is fish oil, to treat fatty liver. That doesn’t make any sense.”

Dr. Weitz:                          Right.

Dr. Rountree:                    Except that what the fish oil does is it decreases inflammation and it actually improves the genetic activity in the liver so it stops making all that fat. How much do you need? About 2 to 3,000 milligrams of the active ingredient, which is EPA plus DHA. And that ends up being somewhere between 2 to 4 caps a day, or about a tablespoon of cod liver oil. So everybody can do that.

Dr. Weitz:                          Yeah.

Dr. Rountree:                    The next supplement that I recommend a lot that’s actually got good research on it, is milk thistle. We know that milk thistle has been around for a long time, for a wide range of liver conditions. Now, similar to the curcumin, the milk thistle extract called silymarin is not well absorbed, and there are a number of studies using the phytosome which complex with lecithin showing that the phytosome is much better absorbed and actually works really well in the liver.  I believe that that’s actually a trademark name and I would say this, I’m not plugging a specific company’s product, but this is what’s in the medical research, it’s called Siliphos. That’s made by a company in Italy. A lot of companies will sell the Siliphos, so it’s sold under different brand names, but that’s the one you want to look for and there’s two or three published studies showing that that improves fatty liver.

Dr. Weitz:                          Cool.

Dr. Rountree:                    So that’s a good one. Another one I love is called berberine. I’m sure you’re familiar with berberine.

Dr. Weitz:                          Use it all the time. Yup.

Dr. Rountree:                    Berberine, you know, why mainstream doctors don’t know about it just completely beats me.

Dr. Weitz:                          There’s been studies where it’s gone head-to-head with metformin and this is useful.

Dr. Rountree:                    It works just as well as metformin for diabetes. Sometimes I actually combine the two for a person that’s got bad diabetes, and when I do that it keeps me from having to go to insulin or more powerful drugs. So, berberine is a yellowish chemical that’s found in a lot of medicinal plants. Plants are found basically all over the world. In China, it’s in a plant called coptis chinensis. A European plant that’s used a lot is Berberis vulgaris. Here in the United States we have a plant called Oregon-grape root, and all of them have berberine.

Dr. Weitz:                          Do you think it matters where it comes from, because some of the products on the market have it from four different sources, some don’t.

Dr. Rountree:                    Berberine is berberine.

Dr. Weitz:                          Okay.

Dr. Rountree:                    In my opinion, and there are studies using different sources of it, but berberine is the active ingredient. Now, berberine for years is mostly used to treat infections in the gut.

Dr. Weitz:                          Absolutely. SIBO, dysbiosis.

Dr. Rountree:                    Yeah. Dysbiosis. Candida. We used it for years for that. And the way I understand it is that some astute doctor in China said, “Wait a minute, my patients are taking berberine to treat dysbiosis or treat infectious diarrhea, that kind of thing, but gee, their blood sugar is getting better.”

Dr. Weitz:                          Right.

Dr. Rountree:                    So it was some chance discovery. The berberine had been around for a long time, but nobody thought of using it for diabetes, but the Chinese jumped on that, started doing some studies and found out that it lowers blood sugar. And it’s fabulous for that.

Dr. Weitz:                          What dosage do you like for the berberine?

Dr. Rountree:                    If a person’s got full-on fatty liver, they need about 1,500 milligrams a day.

Dr. Weitz:                          Okay.

Dr. Rountree:                    And that’s of berberine, that’s not of Oregon-grape root, or Berberis vulgaris, right? So you’ve got to say, how much of the active ingredient, 500 milligrams up to three times a day. Now there’s some caveats with that. Berberine is a very powerful substance. It can’t interact with certain prescription drugs. For example, it can interact with statins and when you take the two together, it can make the blood level of the statins go higher, so if somebody is on a statin and they take berberine, then they may need to reduce the dose of the statin. So not a problem if they’re not on prescription drugs, but if they’re on prescription drugs and they want to do berberine, they should probably either talk to a pharmacist or a doctor about it.

Okay? So that’s number one thing that they should be concerned about, but the other thing to be aware of with berberine is that it can cause upset stomach, and the way you get around that is you start with one a day. 500 milligrams, take it with food, and generally take it for one to two weeks, make sure the stomach is settled down, and then you bump it up to two a day, and then eventually three a day.  Is it worth it? I mean, what? Why, that sounds like a hassle. It could upset your stomach, could interact with drugs. Well, I mean, the amazing thing about berberine is that, again, it works as well as metformin for lowering blood sugar. That’s a powerful effect.

Dr. Weitz:                          Anti-aging.

Dr. Rountree:                    It has the anti … Well, I just gave a lecture on longevity pathways at a conference and I was looking at some of the drugs that are being touted. There’s a drug called rapamycin-

Dr. Weitz:                          Yes.

Dr. Rountree:                    … being touted as an antiaging product.

Dr. Weitz:                          mTOR, yeah.

Dr. Rountree:                    It’s an mTOR inhibitor. I was looking at metformin. There’s actually a study that the FDA approved looking at metformin as an antiaging drug. But then I started diving through my friend Dr. Google’s research, and I found a paper saying, “Could berberine be acting as an antiaging drug the same way that metformin is.”

Dr. Weitz:                          Absolutely.

Dr. Rountree:                    And the doctors were saying, “Yeah, actually it’s doing the same thing as metformin, but it’s cheaper and easier. It’s not prescription. It’s safer.” So, yeah, berberine may be something you would take, maybe a lower dose. I wouldn’t take the 1,500 just for anti-aging, but 500 to 1,000 a day, seems plenty safe. People can use it for a long period of time, but they should take probiotics with it, regularly.

Dr. Weitz:                          Right. To make sure. You don’t want to kill off too much of your microbiota.

Dr. Rountree:                    Yeah. You don’t want to mess with your microbiota. Now, I haven’t actually seen it be a problem with the microbiota, but it’s so this is a theoretical concern.

Dr. Weitz:                          Right.

Dr. Rountree:                    But it’s the real deal. Now, what about fatty liver? There’s several published studies showing that berberine can decrease fatty liver. There are animal studies showing it and human studies showing it. So it’s not hypothetical, it’s not theoretical, it really does work, so it’s well worth it.  But berberine, I don’t put it in my first level, right, because it’s stronger, it’s more potent, and some people do get the upset stomach. So, again, I start with the curcumin phytosome, the vitamin E, the fish oil, the milk thistle phytosome, the Siliphos. I try those things first and if I need something stronger, I go to berberine.

Dr. Weitz:                          And one of the reasons why you like the phosphatidylcholine supplements it’s because of their benefits of choline, right?

Dr. Rountree:                    Well, okay. I’m glad you asked that question. Again, for a long time, we thought that fatty liver was only a result of being overweight, having insulin resistance and eating too much sugar or high fructose corn syrup. But now we know that there are people that can have a genetic abnormality in the ability to process folic acid. It’s called the MTHFR. I’m sure you know all about it and probably talk to your listeners. Right?

Dr. Weitz:                          Yes.

Dr. Rountree:                    Well, the fact that methyl compounds can help fatty liver has kind of opened up this whole new realm of research, right? A lot of people aren’t aware that choline in the diet, which you can find in eggs and meat and dairy products, that choline is actually a great source of methyl groups, and it turns out that undermethylation is a major cause of fatty liver. Why is this a big deal? Because we think fatty liver affects somewhere around 20 to 25% of the population.  Nutritional surveys that have looked at choline intake and what percentage of the population you think gets enough choline?

Dr. Weitz:                          Probably most don’t.

Dr. Rountree:                    Yeah. Most don’t, and up to 20, 25% are actually deficient in choline. So that is totally parallel to the people that get fatty liver.

Dr. Weitz:                          And yet you have a doctor from Cleveland Clinic measuring TMAO levels and telling patients that they shouldn’t consume choline or L carnitine because it’s going to increase their TMAO.

Dr. Rountree:                    Yeah, that’s doctor Stanley Hazen’s hypothesis. I think TMAO is a marker for choline deficiency.

Dr. Weitz:                          Interesting.

Dr. Rountree:                    It’s the other way round. So I think when TMAO is up, that means bacteria in the gut are consuming dietary choline and turning it into this toxic compound. Well, I think, the problems you see associated with the TMAO are a result of the choline deficiency.

Dr. Weitz:                          Ah. I see.

Dr. Rountree:                    Now, what’s the evidence for this? If you take people that are, for some reason they can’t eat and they get all their feeding intravenously, called total parenteral nutrition. So, you put it in an IV and you give them all their food intravenously. If you leave choline out of that formula so that they have a totally controlled formula, you know everything that’s going into their body. If you don’t put choline in there, 100% of those people will get fatty liver, 100%. And if you add the choline back in, then the fatty liver goes away within a couple of weeks.

Dr. Weitz:                          Wow.

Dr. Rountree:                    Very clear, very elegant. So, again, these phytosomes are a source of phosphatidylcholine and I think they’re quite beneficial. So not only am I not concerned that they’re contributing to the TMAO, I think the high TMAO is an indicator that they need more choline.

Dr. Weitz:                          Wow, we should take two groups of patients that have elevated TMAO levels and give one group choline and then measure their liver and their …

Dr. Rountree:                    Do their ultrasound. Look at their ultrasound and see … Yeah, they’ve done similar kind of tests, again with these people getting total parenteral nutrition, with the ultrasounds before and after where they add the choline. That’s a similar kind of experiment to what you’re talking about. They just need to add in the TMAO and see which direction that’s going.

Dr. Weitz:                          Interesting.

Dr. Rountree:                    Yeah. So, choline is a good thing. You know, you can actually take choline as a separate supplement and a typical dose is about 500 milligrams twice a day. Who needs choline the most is pregnant women.

Dr. Weitz:                          Oh, yeah?

Dr. Rountree:                    Yeah, for the baby’s brain.

Dr. Weitz:                          Absolutely. And it’s added to some of the newer supplements in the Functional Medicine world. [crosstalk 00:45:08] back in the day taking choline and inositol to help clean out your liver.

Dr. Rountree:                    It’s an all kind of naturopathic formula which they called lipotropics.

Dr. Weitz:                          Yup.

Dr. Rountree:                    I thought it was interesting because I, for years, I kind of used them but didn’t know why.

Dr. Weitz:                          Right.

Dr. Rountree:                    My naturopathic friend said, “This is good for your liver.” “Well, why?” “Well, because they’re lipotropics.” “Well, why are they lipotropics?” “Because they’re good for your liver.” Right? They’re just kind of a natural observation. And one of the things that in this lipotropics is called trimethylglycine, TMG. TMG is great for the liver, so that’s another source of methyl groups.  Well, where does TMG come from? It’s made from choline.

Dr. Weitz:                          Ah, interesting. What about inositol? That probably would be beneficial too.

Dr. Rountree:                    I’m not … Maybe. I’ve not seen any research on inositol for fatty liver.

Dr. Weitz:                          Yeah, we use it for PCOS right now.

Dr. Rountree:                    I use it for mood disorders.

Dr. Weitz:                          Oh, okay. Yeah.

Dr. Rountree:                    You know, in high doses, like 10 to 20 grams a day.

Dr. Weitz:                          Right.

Dr. Rountree:                    Really good for mood. For panic, anxiety, things like that.

Dr. Weitz:                          Yeah. Cool.  So, this has been a great discussion, Dr. Rountree.

Dr. Rountree:                    Cool.

Dr. Weitz:                          How can our listeners get hold of you and find out more about your programs and your books, et cetera, or be able to contact … Are you available for consultations? You do-

Dr. Rountree:                    Well, my practice is pretty full right now because I’m mostly on the road traveling, but I do have a LinkedIn website so that’s probably the best place to find out more about my practice, is just go to LinkedIn.

Dr. Weitz:                          Okay.

Dr. Rountree:                    Type in my name and Boulder Wellcare, or I highly recommend that people go to the Institute for Functional Medicine website. So they don’t … I do have people occasionally fly in to see me, but if there is Functional Medicine doc near you, like, what about you?

Dr. Weitz:                          All right. Absolutely. What about me?

Dr. Rountree:                    Yeah. What about you?  So that, Institute for Functional Medicine has got a great referral network.

Dr. Weitz:                          Yes. Absolutely. Awesome. Thank you so much for spending some time with us, Dr. Rountree. This was a great podcast!

Dr. Rountree:                    You bet. It’s been a pleasure.