Parasites with Dr Jason Hawrelak: Rational Wellness Podcast 169

Dr. Jason Hawrelak speaks about Parasites with Dr. Ben Weitz.

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Podcast Highlights


Dr. Jason Hawrelak is a Naturopathic Doctor, a PhD, and a master herbalist. He has been in practice in Australia for more than 20 years. Dr. Hawrelak is one of the leading experts in the treatment of gastrointestinal conditions with natural medicines and he has written extensively in Australia and International textbooks and journals on digestive topics. He continues to see patients in person and remotely. Dr. Hawrelak has developed an incredible subscription based resource to keep track of all the research on probiotics, called ProbioticAdvisor.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz:                            Hey. This is Doctor Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts, and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness podcasters.

Today, I’m very happy to be speaking with Doctor Jason Hawrelak all the way from Australia about parasites. Parasites is a topic in gut health that seems to have fallen out of favor among functional medicine practitioners who deal with patients with gastrointestinal symptoms in the last five or 10 years. The focus seems to have shifted towards focusing for patients who are negative for having Crohn’s and ulcerative colitis, the focus seems to be towards SIBO and IBS.   Certain parasites are referred to as protozoans. Protozoans are actually single cell microorganisms and they include a large variety including ameba, flagellates, ciliates, parazoans. Protozoans are common in fresh, brackish, or salt water. As well as in other moist environments including in an extreme environments like hot springs, hypersaline lakes. The protozoans can also form cysts to survive in dry environments in a dormant state. Some protozoans live in our guts without causing harm and may even provide some benefits while other protozoans may be a significant cause of disease such as [inaudible 00:01:54], malaria, giardiasis, et cetera. Protozoans are not infrequently found in the stool of patients when undergoing stool testing, especially some of the very sensitive molecular PCR tests. Parasites can take the form of worms or protozoans, of which, Blastocystis Hominis, dientamoeba fragilis, and Giardia are some of the more common parasites. Blastocystis Hominis is often considered by Functional Medicine practitioners to be a particularly difficult microorganism to eradicate and is often associated with a host of gastrointestinal symptoms including diarrhea and it’s also sometimes thought to be associated with Hashimoto’s hypothyroid disease. Some of these protozoans may not always be pathological as many of us think, as Doctor Hawrelak will explain today. One other topic I would like to ask Doctor Hawrelak about is H. Pylori infection, which at one time was considered an obvious problem when discovered on a stool panel, but is now understood to have a much more complex relationship with our gut.

                                                Doctor Jason Hawrelak is a naturopathic doctor. He’s a PhD, he’s a master herbalist, and he’s been in practice for more than 20 years in Australia. He’s one of the leading experts in the treatment of gastrointestinal conditions with natural medicines. He’s written extensively in Australia and international textbooks and journals on digestive topics. He both sees patients in person and remotely, he also teachers other healthcare practitioners. He’s currently coordinates and teaches the evidence based complimentary medicine program in the School of Medicine at the University of Tasmania. He’s the gastrointestinal imbalances lecturer in the master of science and human nutrition, and functional medicine program at the University of Western States in Portland, Oregon. Doctor Hawrelak started and runs an incredible resource to keep track of all the research on the latest probiotic strains called Probiotic Advisor, which I have used and is an extremely valuable resource. Doctor Hawrelak, thank you so much for joining me today.

Dr. Hawrelak:                     You’re very welcome, Ben. Nice to speak to you again. It’s been a while.

Dr. Weitz:                            Absolutely. Before we get started, I don’t know if you saw 60 minutes on Sunday, but I have bad news for you. You’ll have to close down your Probiotic Advisor because 60 minutes reported that there’s absolutely no benefit to any probiotic.

Dr. Hawrelak:                     Great. What can I tell my patients for the last 20 years? I can say it was all placebo perhaps. I haven’t seen that actually. I should put it on my agenda as something to watch to see what the mainstream media is actually reporting there. I think that comes from really misunderstanding some of the nuances around probiotics. Rather than taking them to change the ecosystem or to repopulate, which I think is the more popular idea, with knowing that they actually have specific effects and actions when ingested which creates physiological change, so we can use it for helping to eradicate H. Pylori for example, for decreasing obesity, or for moderating mood. There’s a whole bunch of positive clinical trials that it’s I think pretty mind blowing to come to that viewpoint that probiotics don’t work for anything based on what data has been published for the last 30, 40 years, particularly the last 20 years.

Dr. Weitz:                            Amazing amount of studies. Of course, that was one of their complaints. We’re not going to spend the whole time talking about 60 minutes, but that was one of their complaints that the probiotics that you ingest don’t actually find themselves to populate the gut. We know that.

Dr. Hawrelak:                     That’s not surprising, that’s now why we should be taking them. At least, what the research has shown us is that if that’s why you’re doing it, you’re not really taking it for the right reasons because you’re not really going to achieve that with the current generation that we have. It’s pretty rare to have any sort of longterm colonization, but that’s not to say that won’t be something we generate with future probiotics if we start making probiotics from things like Akkermansia, [inaudible 00:06:24]. Novel species that might actually have that capacity to stick around for longer periods of time or if not permanently. Reality is that they have therapeutic effects when we take them, some of them do anyway if we select them well and make sure they’ve got the right traits and qualities. When we stop taking them, that will stop having that effect just like any pharmacological agent whether that be pharmaceutical or herbal medicine that they’ve got an action while you take it. You cease taking it, it stops having that action.

Dr. Weitz:                            One of the reasons I really have been looking forward to this discussion is that I really wanted to dive into some information about parasites. When I first got into functional medicine 20, 30 years ago, it was a lot of talk about parasites. In the last five or 10 years, we’ve lost that focus, but I think it’s an important topic to talk about. When you’re consulting with a patient, are there any particular symptoms that come up during a consultation that will make you suspect this could be somebody who’s having a problem with parasites?

Dr. Hawrelak:                     I mean, the challenge with most symptoms that we’d associate with gut parasites like Giardia, which is undoubtedly a cause of gut infections, gut damage, Entamoeba Histolytica for example that are in that camp, versus ones that are much more debatable like Blastocystis and Dientomoeba is that the symptoms overlap with irritable bowel syndrome in some degrees with inflammatory bowel disease, functional dyspepsia, post infectious IBS with SIBO. It’s a whole cluster. If someone presents with these symptoms, you really need to do testing to ascertain what’s going on. You might get some clues from history in that they’ve just traveled overseas. They went to developing nations and they got a case of traveler’s diarrhea. That to me is a red flag that there may well be something staying in their gut from that. That time of ingestion and that acute flair. Sometimes, your body will fight that off. Most of the time, it’s a bacterial agent anyway that causes traveler’s diarrhea, but we do get protozoa as part of components of or as contributors to that overall traveler’s diarrhea load.

                                                We might get that flag on the history, but we really need to do testing to ascertain what’s going on. For me, that wouldn’t mean just doing stool testing for parasites because I think we all get the potential of getting quite lost and missing what’s going on if that’s all that we do just because some microbes like Blastocystis and Dientomoeba are so common in healthy everyday people that if they’ve got some runny stool and some abdominal pain, you do one test, you do a stool test. It shows that, I think there’s a decent chance you’re going to miss what’s really causing that person’s issue in that instance. If it happens to be Giardia, fair enough, that’s a different scenario. If it’s Dientomoeba or Blastocystis, we can’t make that assumption that this is the cause of their symptoms because of the prevalence of these microbes in healthy populations. Essentially, to me it means we’ve got to do a suite of tests that if they present with that symptom picture that overlaps with so many other conditions, we actually have to test to rule out those conditions.

                                                That would be things like fecal Calprotectin or Lactoferrin for inflammatory bowel diseases, a fecal occult blood for example also looking for more pathological changes and damage to the small or large bowel. For me, it would mean SIBO breath testing would be a component of that. As well as doing a stool PCR looking for the presence of potential bacterial and protozoal parasites that may have been picked up from overseas.

Dr. Weitz:                            What is your favorite stool test these days?

Dr. Hawrelak:                     I would actually use a number in practice. I’m based in Australia, so we have the conventional pathology labs that do a stool based multiplex PCR that looks for the most common protozoal parasites, the most common bacterial causes of diarrhea. I might run that, but then also do a microbiome assessment as well that tells about the bacterial ecosystem, as well as doing breath testing. Then, the other tests looking for inflammatory markers. In the colon, that might indicate that it’s more likely to be inflammatory bowel disease. Even some of the more rare ones like lymphocytic colitis or [inaudible 00:10:52] colitis for example.

Dr. Weitz:                            Which microbiome tests will you use?

Dr. Hawrelak:                     Good question. These days, I’m using one of mostly between two different labs. One lab here in Australia called [inaudible 00:11:07] that does metagenomic sequencing, which means we get very good detail and data from a species level perspective as well as from genus and higher up the hierarchy up to phylum. It also gives us the markers around levels of LPS production, levels of hydrogen sulfite gas production for example that I find can be clinical useful. Then, I’m also using Thrive as well particularly for my US patients where we get that nice snapshot of the bacterial components of the ecosystem.

Dr. Weitz:                            Yes, you might check out this biome FX test that Microbiome Labs is promoting now that Kiran Krishnan helped fine tune. It looks pretty interesting.

Dr. Hawrelak:                     I haven’t had a chance to look at that yet.

Dr. Weitz:                            Yes, check that out. If you had a patient who came in your office and they’re having some of these symptoms like gas, bloating, maybe diarrhea or constipation, they had a positive SIBO breath test, and you also saw a parasite, which would you treat first?

Dr. Hawrelak:                     For me if it showed up a very clear positive on SIBO breath testing and it had Blastocystis and/or Dientomoeba in the stool, I would treat the SIBO. I do this all the time. The presence of Blastocystis and Dientomoeba is generally completely irrelevant to that person’s symptoms. That’s something I’ve come to from 20 years of practice and reading more the recent literature around the prevalence of these parasites or in parasites. Protozoal and protozoal like organisms in people’s guts is extremely common. What I found is that most patients who present to me with, they go I’ve got a positive stool test for Blasto or Dientomoeba and they haven’t done a breath test yet, we’ll do a breath test for SIBO and it will actually show up positive. We treat the SIBO, their symptoms get better, they still have Blasto in their gut afterwards. That is so common. For me, it really showed clearly … I go back to how I treated patients 15, 20 years ago. If they showed up with a positive Blasto or Dientomoeba, I was like let’s try to kill this. Let’s focus in on that.

                                                Sometimes, you’d get symptomatic improvement for sure, but I think at least temporarily. I still think we were often inadvertently treating the SIBO in these patients, which was the cause of their symptoms because I wasn’t really aware of SIBO 15, 20 years ago. It wasn’t well known as a diagnostic label. Testing wasn’t really promoted, discussed, and talked about very much. I think I’ve seen that major shift in focus. I mean, one patient also illustrated to me very clearly that they came to see me. Classic symptoms of bloating, distention, some runnier stools. Positive stool test for Blastocystis. I just made the assumption that was the cause. I said let’s treat that. Yes, there was symptomatic improvement while they were taking the herbs. Then, I hadn’t seen them for a while. Then, she came back. I think it was probably 12 months later. She said, “I was actually diagnosed with fructose intolerance. I reduced my level fructose and all my symptoms went away.” I just really was like, how could I miss that? I really let this patient down by not doing a proper diagnostic workup.

                                                I got fixated on this thing and that wasn’t the cause of her symptoms, she still has Blastocystis in her gut, but no symptoms if she goes on a low fructose diet. That patient really taught me a major lesson that we can’t … We’re often guilty of this premature diagnostic closure. I try to be less guilty of that now than I was in the past where we wouldn’t do a proper suite of tests to really see what’s going on. We’d get really fixated on that one and actually miss it. I’ve had other patients that I’d subsequently diagnosed with celiac disease that were by other practitioners diagnosed with Blastocystis and not followed up. You think, what’s the consequence of that missed celiac disease because we got so fixated on that Blastocystis on a stool test? Huge.

Dr. Weitz:                            Right. I want to go into some more detail on those two protozoans. I wonder if it’s possible that we have SIBO, which is bacterial overgrowth in the small intestine, I wonder if there’s a SIPO, if there could be a protozoan overgrowth in the small intestine that could be creating some of these problems. I asked Doctor [inaudible 00:15:31] that when he was speaking at our meeting last month. He said, “We’re still going through all the samples. We’re going to look at that as a possibility.”

Dr. Hawrelak:                     Yes, because I think really with the evolution of technology I’ve used in metagenomics, we can actually take samples and see things that exist that we didn’t know existed before. It is interesting. I think because we’ve changed that technology or evolved into using technology that is far more accurate in its capacity to tell us what’s there, we’re seeing now that we all have protozoal organisms in our gut. That’s totally normal for humans. If you go back 20 years ago, people weren’t thinking that. We were thinking if there’s a protozoal there, we must need to kill it because it shouldn’t be there. It’s like, no. We’re supposed to have fungi in our guts, we’re supposed to have bacteria, and we’re supposed to have protozoal. They live in this usually beautiful harmonious ecosystem where they’re all interacting in ways that ensure our state of health until we upset that balance in different ways.

Dr. Weitz:                            Are you proposing that we should really think of protozoans in some cases as commensal?

Dr. Hawrelak:                     Definitely. I think certainly in the camp with microbes like Blastocystis and Dientomoeba, I will generally put them into the commensal camp in vast majority of my patients. Personally, I had a stool test done just because I was testing a bunch of different labs. It turns out I’ve got Blastocystis and Dientomoeba in my gut and I’ve got no gut symptoms. Managed to work 60 plus hours a week for the last 10, 15 years. No fatigue issues like the things that people see as symptomatic with these things, I don’t have. Here’s this one clear example of a case of a healthy person that has these microbes there, no symptoms whatsoever. You look at the literature, we find that’s actually fairly common with Blastocystis and Dientomoeba. They are extremely common in healthy people. The more recent research for the last few years have suggested particularly for microbes like Blastocystis that they actually play a pivotal role in keeping our ecosystem healthier verses the loss of our protozoal species that we’ve evolved with over millions of years some scientists and researchers are suggesting is having negative repercussions on our state of health that we see around us. Just like we’ve had that loss of bacterial diversity and loss of arguable fungal diversity that we are just finding out about now, but the repercussions of which I think we see all around us with the Western disease states that we see in practice all the time.

Dr. Weitz:                            Yes. Maybe we’ll be taking protozoan supplements at some point.

Dr. Hawrelak:                     It’s possible, I reckon. Yes.

Dr. Weitz:                            Maybe, it’s a question of balance. Maybe, it’s a question of you’re supposed to have a certain amount, but maybe if the Blastocystis is too high, it’s not a question of it shouldn’t be there, but it shouldn’t be there at that level.

Dr. Hawrelak:                     Yes. I mean, I do think there might be a part of that. Part of that is around environment. I always go back to that, the train is really immensely important for most organisms whether they can be infectious or not. The train is important and I’d dare say it’s similar with some of these microbes too that if we’re eating the right things and living the right lifestyle, then their presence is probably fairly irrelevant. You throw those things way out of balance and you throw other things in the gut out of balance, then maybe their populations or their behaviors change. I think that’s something we can see with microbes. There is some research around that with Blastocystis for example, research published very recently showing that exposure to Metronidazole, Flagyl, the most common antibiotic used to kill protozoal organisms. Well when it doesn’t kill Blastocystis it seems to actually awaken it’s more pathogenic potential that was lying dormant beforehand, exposed to antibiotics, and it increases capacity to actually cause gut damage to interact negatively with precancerous cells and become much more virulent. I think that there is an argument around how we eat, what our lifestyles are like, and potential functionality and behavior of these organisms within our gut that can be different if we ate a completely different diet, different lifestyles, exposed to low levels of antibiotics in our food chain. Maybe we’re bringing up more of the pathogenic potential.

Dr. Weitz:                            I was listening to an interview that Michael Ruscio did with Ilana Gurevich. She was talking about a study that found that species like Blasto and Dientomoeba fragilis, what they do is they change the microbiome enough to make the bacterial neighborhood more pathogenic and predisposed to negative changes either in the small or large bowels. Therefor, they’re maybe setting up things like SIBO.

Dr. Hawrelak:                     Interesting. I haven’t seen any research around that. I’d be happy to be posted some so I can read it. There is certainly some data. There was one study done in 2019 in vitro data getting a subtype seven from a symptomatic isolate subtype seven Blastocystis and giving it to mice. Finding that in in vitro, that it was able to shift the ecosystem. Maybe that’s what she’s referring to. She might be referring to some other study that I’m unaware of. That was interesting in that it did seem to increase levels of more pro inflammatory bacteria like E coli and [inaudible 00:20:51] for example, and decrease levels of bifidobacteria.

Dr. Weitz:                            We need to discuss the subtype. There’s 17 different subtypes of Blastocystis, right?

Dr. Hawrelak:                     There is and there’s nine that are found in humans. The rest are found in other animals. That said, it’s not like these are only exclusively found in humans. The ones we find in humans, we also find in chickens, primates, pigs, cows, horses, rhinoceroses, zebras, and any animal you can name generally has a Blastocystis that can be in its gut or a number of them. For humans, the most common subtypes are one, two, three, and four. Prominently, types one and three. Extremely common.

Dr. Weitz:                            Is one of those subtypes more pathological potentially than the other?

Dr. Hawrelak:                     Well, there’s been a lot of research trying to tease that out and I would say the research has been generally … has not shown any clarity around that at all. The only small pivot I’d say there is subtype seven is very rare in humans. It’s mostly found in animals, birds. Chickens particularly, they sometimes carry seven. That study that looked at those shifts in bacterial ecosystems was associated with symptomatic type seven isolates. If I had a patient and it did show up a subtype seven Blasto and all the other tests came up negative as in normal, then I might be inclined to go let’s see about eradicating this organism because it could likely be a cause of their symptoms in your case. I certainly don’t think the data is consistent enough because you’ll find one study that goes subtype three is more common with IBS patients. Another study will go subtype three was totally not and it’s subtype one. Another study will show subtype four. There’s no consistency around the findings.

Dr. Weitz:                            Right. I just want to highlight the fact that what you’re discussing is that Blastocystis Hominis, which I still think a lot of functional medicine practitioners if they see that on a stool test are going to say you’ve got this parasite and this parasite is pathological. This is probably the cause of your symptoms. You’re saying that in a majority of cases, it’s probably not the cause of their symptoms and you may be missing another important underlying cause of their symptoms and you may be going up the wrong path focusing on eradicating the Blastocystis Hominis.

Dr. Hawrelak:                     Yes, that is definitely my viewpoint for sure.

Dr. Weitz:                            I just want to make sure that everybody understands that.

Dr. Hawrelak:                     Fair enough, yes. It’s something that for me has evolved over 20 years of practice, of dealing with patients who present with gut symptoms and Blastocystis on stool test from what I used to do, to what the research is saying, and to what I do now and the results you actually see. I generally will see something else. When we do a suite of tests and make sure we don’t stop our diagnostic procedures so early, we’ll find something else that actually explains it. You treat that something else, their symptoms go away, Blastocystis or Dientomoeba are still there. There’s that component of it, but it’s also just the fact it’s so common. I mean, Dientomoeba in Wester Europe where a lot of good studies have been done, it’s found in up to seven out of 10 healthy kids have got Dientomoeba in their guts. What’s normal, what’s not normal? Kids with functional abdominal pain are less likely to have Dientomoeba in their guts than those who are actually healthy.

                                                I still have practitioners here, integrated practitioners who wanted to use antibiotics or a suite of antibiotics to try to kill that Dientamoeba because it shows up on the stool test. Yet, the data tells us that it’s actually immensely common in kids. It’s more common in healthier guts and it’s unlikely to be a common cause of the gut [inaudible 00:24:33] when you look at the research in totality. Yes, if you’re going to be selective and not look at the broader literature, find a study going look we gave them antibiotics and the case study’s showing they improved, will quote that study rather than looking at the totality of data or looking at only one to date, randomized placebo controlled trial that looked at kids with chronic gut symptoms and had Dientamoeba present and that seemed to be the only … everything else had been essentially ruled out. They said they’ve got these kids with chronic gut pain, they’ve got Dientomoeba, let’s give them antibiotics or placebo. Let’s see the response.

                                                Do you know what the response was? Placebo was equally effective as antibiotics for reducing these kids’ symptoms. There was no difference between them. There was no correlation between eradication in Dientomoeba and any change in symptoms. I think the really good quality data is not suggesting that particularly things like Dientomoeba when we’re talking about now is a cause in symptoms in kids and that it is immensely common in health population.

Dr. Weitz:                            In those rare cases when you have a patient with elevated levels of Blastocystis Hominis and you don’t find any other pathology, what natural treatments have you found to be the most effective?

Dr. Hawrelak:                     It’s been years since I’ve found a patient like that, Ben.

Dr. Weitz:                            Really? Okay.

Dr. Hawrelak:                     I can tell you it’s actually really rare that I don’t find something else that’s going on. The biggest challenge can be teasing out the post infectious IBS from a case of Blastocystis induced infection, gut symptoms because you’ll have a similar picture where someone will travel overseas, they’ll get traveler’s diarrhea, their gut’s never well since. You do a stool test, only thing that shows up is Blastocystis. Now, that Blastocystis could have been present in their gut for the last 10 years, 20 years, or 30 years and not be remotely relevant to what’s going on because we know that post infectious IBS happens where two things once post infectious SIBO develops, that’s pretty common. Then, you have more the colonic inflammation that persists after the infection is gone. You might have traveler’s diarrhea caused by E Coli. It’s cause colonic inflammation and visceral hypersensitivity that persists for weeks, to months, to years after that infection.

                                                There’s no more infecting agent present, you just have this residual inflammation that impacts. Causes bloating distension, may alter transit time a wee bit. Certainly, holds a sensation in the gut, so you feel [inaudible 00:26:59] gas being produced. We know that’s common in literature. Yet if you do a stool test and you found Blasto in that case, you might go I want to kill the Blasto. That’s the cause, but it may not be because it may just be post infectious IBS. That’s I think the area that can be the most tricky to navigate because you’ll have normal tests come back. They may not have SIBO, but they can still have post infectious IBS and there’s no test for that. It’s based on history and their symptom pattern.

Dr. Weitz:                            Not to kick a dead horse, but one more attempt. What if this stool test shows a really high level of Blasto? Does that raise any suspicions or not?

Dr. Hawrelak:                     I think …

Dr. Weitz:                            No.

Dr. Hawrelak:                     It would depend on the overall path from the history side. It wouldn’t rely solely on that. Looking at their symptom picture, looking at their history. Let’s assume if there was someone, now it’s been years since I’ve had one of those patients that I think Blastocystis is the cause of their symptoms. Then, there are certainly some herbal preparations, et cetera, that I would use to try to help reduce levels, but you’re also focusing on trying to optimize the microbiome as well, heal up inflammation in the gut, and improve their overall vitality and health anyway. I think for me those are always the core aspects. What can I do to improve this person’s state of health? What can I do to make the ecosystem a more healthy environment that’s less conducive to bringing out the bad behavior in things like Blastocystis?

                                                We know that Blastocystis likes living at a more neutral or alkaline PH. It doesn’t like living in an acidic environment in the colon or levels can be certainly reduced that way. The focus is on having a lot more fiber, using prebiotics, eating predominantly plant based whole food diet as ways of actually shifting the ecosystem in the colon, so it’s actually one more healthy, but two there’s more production of short chain fatty acids like butyrate acetate for example that then will lower the PH. That in itself can be effective in decreasing levels of Blastocystis just by changing the environment. Then, I might compliment that with some herbs. These days because of my concerns of causing collateral damage to the colonic ecosystem, I try to avoid as much as I can when I can. I’ll use agents like pomegranate husks and garlic, which we know that can be effective against Blastocystis. The best data that we really have at this juncture of time is in vitro studies or animal studies for example. Mostly, in vitro. I do use that alongside [inaudible 00:29:33], which we know has got the positive research for eradicating Blastocystis in the human trial alongside the other agents I talked about that they’re focusing on improving the ecosystem balance in the colon. That will generally one sometimes eradicate the Blastocystis, but two certainly improve their symptoms and importantly their overall state of health and wellbeing.

Dr. Weitz:                            Let’s go on to some of the more pathological parasites. Which ones do you see most commonly?

Dr. Hawrelak:                     I would say Giardia would definitely be top of my list. I work in an inner city environment that is a colder climate, so I don’t see Giardia as often as I once did. My first number of years in practice, I was living in the subtropics where people drank creek water and rain water for most of their … it was rural and people were often bush walking, hiking and drinking the water from creeks, et cetera. Giardia was much more common back then, so I had a lot of chance to hone my practice on Giardia treatment over the years. Now, I tend to see it more in the odd returning traveler or I see the odd person who’s got a chronic infection of Giardia that they weren’t able to get rid of with their previous course of antibiotics.

Dr. Weitz:                            What is some of your favorite natural agents for treating Giardia? Also, do you cycle your use of these?

Dr. Hawrelak:                     Generally, there’s no need. My experience with Giardia is it’s immensely responsible to the right treatments and target treatment with natural medicines. I would use raw garlic ideally and if they’re very sensitive, we might use an [inaudible 00:31:17] based product, but most of my patients have tolerated raw garlic. A couple cloves pressed into either little capsules or a little glass of water and swig it down a couple times a day. There’s one study out of Egypt that showed I think a hundred percent eradication rate by day three on having essentially blended raw garlic.

Dr. Weitz:                            Wow, three days.

Dr. Hawrelak:                     That’s impressive. A hundred percent reduction of symptoms or essentially elimination of symptoms by 36 hours into the treatment protocol. That’s very quick. Garlic’s definitely on my list. These days, I would be using pomegranate husk and usually plantain, plantago major [inaudible 00:31:57], which is one of those herbs that grows as a weed almost everywhere in North America and here in Australia. It’s got some lovely potent anti-Giardia activity, but it actually has some healing antiinflammatory effects on the gut as well. It doesn’t taste too bad and it doesn’t have that broad killing effect that I might get with something that was more berberine containing herbs. Years ago when I first started practicing, I used more berberine containing herbs and it’s certainly effective for Giardia, no doubt. I would be using coptis chinensis, which contains more berberine than goldenseal or other berberine containing herbs like [inaudible 00:32:33] a lot more. It’s undoubtedly effective, but I also know from research I did as part of my PhD that it reduces levels of bifidobacteria. It’s not such a big deal for 10 days, which is a usual treatment period for Giardia, but given I can get the same results without having to worry about any collateral damage to my bifidobacteria populations in patients if I use pomegranate husk, [inaudible 00:32:58], and garlic, I’ll choose that.

                                                Then, I would give [inaudible 00:33:02] again as my probiotic of choice because there’s good data on that in Giardia both for helping to eradicate, but I think this is the important aspect too. A number of people have symptoms that persist longterm post Giardia. It’s because Giardia, amazing little protozoal organism that when it exits from it’s little cyst, you often get one or two little guys that come out of that, but they can cover up every single little bit of your proximal small bowel, every little millimeter of space will be covered with Giardia trophozoite. They can actually cause a lot of damage as part of that. They can cause nutritional issues in the short term in that most things you eat are going to be mal absorbed because they’re just covering that entire area, they’re going to eat those foods, you don’t get much if any. They’ll also cause a fair bit of damage to the small bowel. This can sometimes mean that there’s a bunch of symptoms that persist even after eradications.

                                                You might kill off the Giardia with antibiotics or with herbal medicines in my case in probiotics and nutritional supplements, but they might still have some persistent diarrhea, persistent lactose intolerance, persistent fructose intolerance that comes from afterwards because when you flatten those villi and you damage the brush border, you don’t have lactates on those brush enzymes anymore. The fructose transporter is very much impacted by inflammation. If we inflame the small bowel, we really limit the capacity of that fructose transported to pull up the fructose and take it in. We can often get this secondary lactose and fructose intolerance. They’re wonderful for helping to regrow those villi and the brush border. You might do that during, then for at least six to 12 weeks afterwards to speed up healing.

Dr. Weitz:                            Interesting. The villi are damaged by the parasite.

Dr. Hawrelak:                     Yes, by the Giardia because they’ve got this little ventral disc that sucks onto it and actually causes tissue damage, inflammation. It’s a crazy little guy.

Dr. Weitz:                            Do you have to have Giardia for a long time for that to happen?

Dr. Hawrelak:                     One would say the longer you’ve got it, the more severe the level of inflammation would be. There’s a caveat there because we know that most people will throw off Giardia in three weeks with no treatment at all. I think from memory, it’s around 90 percent of people who get Giardia, you do nothing. In three weeks, it’ll be gone in 90 percent of people. It’s going to be an uncomfortable three weeks. There’ll be lots of diarrhea, lots of bloating, lots of nausea. I don’t recommend it, but we know that the immune system can generally deal with it, except for people that have IGA, insufficiencies tend to be the biggest issue where they will have it … it’s impossible for them to throw off Giardia if they don’t produce enough [inaudible 00:35:49] IGA in the gut. There’s some people that it tends to be a chronic infection. Even a week to two weeks is still enough to actually cause a degree of mal absorption. Depending on how severe the infection was and how much of the small bowel was covered will dictate how much of that post infectious symptomatology we have to deal with and post infectious damage we need to heal up to get patients’ function back to a good level and absorbing food again the way that they should be.

Dr. Weitz:                            Interesting. Have you heard this concept that when trying to kill a parasite because parasites are laying eggs, that you want to use the antimicrobials for 10 days, then wait 10 days because supposedly in the presence of the antimicrobials, the eggs won’t germinate, they’ll wait until the antimicrobials are gone, then the eggs will germinate and you’ll have more Giardia or other parasite? Then, you’ll have a reinfection so therefor there’s this thought that you treat for 10 days, you wait 10 days, and then you treat again for 10 days.

Dr. Hawrelak:                     Yes. I mean, I certainly will do that with helminth, actual bigger worms, pinworms, et cetera. I will follow that approach. I don’t with Giardia and I haven’t seen any cases where that particular approach has been problematic in that instance. I think if we’re choosing agents that are not going to cause collateral damage to the ecosystem, then I got no qualms with that approach at all to err on the safety side. I’ve never seen it necessary with Giardia. That’s by far the most common on I would be treating in practice.

Dr. Weitz:                            What’s your protocol for pinworms?

Dr. Hawrelak:                     It’s a tricky one. I’ve tried lots of different things. To be honest these days, I actually recommend the pharmaceutical ones from the pharmacy because they work. Yes, I can give you herbs that taste absolutely ghastly, garlic [inaudible 00:37:55], and essential oil put in a little bit of Vaseline around the anus at night, you can do all that for weeks at a time and will get okay results, or I can give one little dose of that chocolate, 10 days later another dose of that thing, and they’re gone. It’s far less costly. You’re often treating a whole family. I’ve trialed and error-ed lots of different things. Maybe some people have got much better results with herbs than I ever had, but we’re using megadoses of wormwood and pomegranate husks which has got anti worming activity too. Listen, it’s certainly brought worms down. Oiling up a tiny a tiny clove of garlic that’s been peeled and inserting up the anus, that helps break the cycle of bit.

                                                Same way with putting some peppermint essential oil around, a little Vaseline around the anus. The worms come out to lay their eggs and are like I don’t like that oil, so they go back in and it’ll help break the cycle. It’s labor intensive. To do herbs for a family of four for a month, that whole process, is costly. I still don’t find the results as effective as just doing the pharmaceutical twice. In this case, I’m not worried about the collateral damage to the gut ecosystem because the data to date doesn’t suggest this much in the way of collateral damage because worms are actually more related to us than they are to bacteria. The agents that are targeting those worms actually have more capacity to cause us side effects than they do kill bacteria directly. I’m not so concerned and that’s my approach now, which is not so exciting as you got to use this fantastic herb, but I just didn’t find the result with the herbs as what I’ve got with the pharmaceutical. The cost differential didn’t make it worthwhile.

Dr. Weitz:                            Speaking of worms, have you looked into helminth therapy, the therapeutic use of worms? A couple of worms that are used is the pig whipworm or the human hookworm. I’ve read some articles where they’re being used for allergies, autoimmune conditions, inflammatory gut disorders like Crohn’s and ulcerative colitis.

Dr. Hawrelak:                     I’m not super familiar with the literature around that. I’m a little bit around the uses of [inaudible 00:40:05] for celiac disease.

Dr. Weitz:                            Yes, that’s the hookworm.

Dr. Hawrelak:                     That’s right. When I looked at the results, they were very underwhelming in terms of [inaudible 00:40:18]. It was like, okay. They gave them these worms, they had a bought of severe enteritis, and they got a lot of pain from the worms. Then, it slightly diminished the degree of inflammation caused by subsequent gluten exposure. To me, that was underwhelming. Okay. Yes, you made the gluten, you got less gut damage than if you didn’t, but it still didn’t completely stop the gut damage and it didn’t completely stop the pain from ingesting the gluten. Plus, you had the pain and discomfort from ingesting the hookworm in the first place. I thought the worm results were very underwhelming for celiac disease. That doesn’t mean that they might be more useful for inflammatory bowel disease and other conditions. I’m not so familiar with the literature there, not enough to make any judgment calls on their efficacy or not.

Dr. Weitz:                            I like to ask you about one more topic about H. Pylori. H. Pylori is another infection in the gut. Often, occurs in the stomach. There’s a whole story everybody’s probably familiar with that it could be related to ulcers and we have that whole story about Doctor Marshal giving himself H. Pylori. Anyway, H. Pylori is another thing that comes up on stool tests a lot. We’ve learned more and more how H. Pylori’s an important part of the gut. It may not necessarily be pathological. What’s your take on H. Pylori? When is it pathological? How do we know?

Dr. Hawrelak:                     That’s another great thread of questions. I think we’ll answer this question differently in five years’ time than what we can now.

Dr. Weitz:                            I mean, we do have the virulence factors that give us an idea of whether we’re reacting or not.

Dr. Hawrelak:                     That’s right, we’ve got some of them. I think that’s a step in the right direction. For me if I had H. Pylori show up on the stool test for example, I would look at the presence of the virulence factors. That’s the first thing I would do because that’s usually in that same test that might pick up the H. Pylori and tell me those things are present. I would always follow that up with doing a antibody test like a blood test or a breath test because for me I want to see, is the body reacting to that H. Pylori? Is it increasing antibodies to the H. Pylori? Is it high enough of a count that it’s actually showing up on a more conventional test rather than using these genetic markers? Those to me really tell me the data that I’m after as well as, do they have symptoms that coincide with gastritis, gastric ulcer or peptic ulcers? If they do, then I would go H. Pylori’s probably related to what’s going on there.

                                                If I have a patient where they have it negative, no antibodies in the blood, nothing on the breath test, and a small amount in the stool that showed up on a PCR based test that didn’t show any markers of virulence, then I wouldn’t worry about its presence at all because I would be thinking it’s probably benign, it’s probably there in tiny amounts, not enough to cause any issues. Conversely if it actually showed up with antibody levels, they’ve got symptoms that are consistent with peptic ulcers or gastritis, then I would generally treat H. Pylori in that case. For me, it’s always this balance. We know that certain strains of H. Pylori can cause peptic ulcer disease, we know they can cause increased risk of stomach cancer. That is clear. There’s also some concerns about the eradication of that species. One, leaving an ecological vacuum and what will grow in there. What’s next if we take that species out? Some other microbe might start growing in there. That might be more virulent than that. Second point is there are quite benign strains of H. Pylori that might even have some healthful effects for us over time.

                                                It’s just we don’t necessarily have the technology yet and this is where I would say five or 10 years’ time where we know a good chunk of virulence factors now, but we’re still discovering new things. We might discover more, we might be able to get down to strain subtype. [inaudible 00:44:30], look at the genes of this specific strain. Beyond that, and yes. There’s a greater risk of it being a problem, let’s get rid of it. For me if I’m using natural agents that don’t have the capacity to cause widespread damage to the colon ecosystem, I’m not that worried. If I’m going let’s eat some broccoli sprouts for two weeks, have some cranberry concentrate, and take this herb, et cetera, that can be in my experience very effective at getting rid of H. Pylori. I’m not worried about treatment so much. If there’s patients taking triple or quadruple antibiotic cocktail, then we’re talking about big life … essentially, it’s life altering in the respect that colonic ecosystem that will inadvertently be smashed by that antibiotic cocktail will be permanently changed. It will never go back to the way it was before. When we’re talking about those bigger interventions, then I think we need to consider much more about the risk/benefit ratio that are different when we’re looking at using natural medicines to treat the H. Pylori. That the risk is far less, so it’s quite a different way of considering it.

Dr. Weitz:                            The natural agents you would use would be [inaudible 00:45:44] and maybe something else.

Dr. Hawrelak:                     I would usually use a combination of things. You look at the data about natural medicine, there’ll be ones today showing a 16 percent eradication with cranberry juice. 16 percent, not fantastic, but it’s better than none. There’s one study that used the [inaudible 00:46:04] DSM17938 strain. I think it had over 50 percent eradication rate just with that single strain. You combine that and I might combine broccoli sprouts, which I think at a 78 percent eradication rate from memory. You’re going let’s add a few of these things together and [inaudible 00:46:25], so black seed again had over 60 percent eradication rate on its own. You’re doing a few of those things together. Then, I might use some herbs like green tea, rhubarb, pomegranate husks for example, turkey rhubarb, and in my experience we follow a protocol that’s for most of my patients around six weeks. It’s around a 90 percent eradication rate, which is really I would argue better than what we’re getting with antibiotics these days. At the first time they started using antibiotic cocktails like triple therapy, they were looking at 90, 95 percent eradication rate. Now, some of the recent studies are like 50, 60, 40 percent eradication rate because of antibiotic resistance.

                                                I’ve been impressed at how well a combination of herbal agents and natural supplements work versus using them just on their own, much more [inaudible 00:47:14] to get the occasional time just getting one of those things to work for a patient. My experience has been again through a fair bit of trial and error with patients, it actually makes more sense and I get the best results with doing a much more intense protocol for a six week stint. Then, do follow up testing, and go, yes. It’s gone. Generally, that combination of things works well. You get synergy between those agents.

Dr. Weitz:                            You think natural agents like oregano, berberine, and maybe some of these other antimicrobials could potentially have negative effects on the microbiome.

Dr. Hawrelak:                     I would say from both of some of the in vitro research I did as part of my PhD and from clinical work with patients doing pre and post testing, yes. That berberine I think clearly can diminish overall diversity of an ecosystem and reduce levels of bifidobacteria specifically. Some of those species may be fine with it. I’ve even seen one patient who managed to essentially result in the extinction of bifidobacteria population from taking high dose berberine for longer periods of times, so I’ve got some caution around that. Again, some plant essential oils, so oregano essential oil, thyme essential oil, clove essential oil that are potent antibacterial agents. They totally are, anti protozoal, and anti fungal agents. They’ve got a wide set of actions, but I do think they have come collateral damaging effects in the gut too. I think there can be times and places for more potent agents. I try to follow that, the naturopathic therapeutic order where we use the agents that are less likely to cause harm first. Then, we move along that order to those that have greater capacity of causing harm if the other ones don’t do the job. I’ll rarely use berberine when I’m treating Giardia these days, I’ll rarely use berberine or oregano essential oil for treating SIBO these days because I think there are other herbs that are effective that don’t have the collateral damaging effect that those herbs have.

Dr. Weitz:                            That’s interesting because I haven’t seen that sort of negative effect on a microbiome from berberine. I also treat diabetics. We very regularly use a pretty decent dosage of berberine on a regular basis. I have seen no increased gut problems coming from that.

Dr. Hawrelak:                     I wouldn’t say [inaudible 00:49:36]. Obviously, it’s got issues. Although, sometimes longer term I think that can manifest. In terms of populations of bifidobacteria, I would suggest if you haven’t yet, using the test that uses either [inaudible 00:49:48] looking at proportions of bifidobacteria or metagenomic sequencing for bifidobacteria pre and post, you might get a slightly different picture with that rather than some of the previous tests that use two plus four ways of measuring things, which are far less clear what’s going on. You may see that.

Dr. Weitz:                            We’ve been using the GI map with quantitative PCR.

Dr. Hawrelak:                     Okay.

Dr. Weitz:                            Good. Excellent. Thank you for sharing some fascinating information with us.

Dr. Hawrelak:                     You’re very welcome. I’m glad I could come back and chat to you, Ben. It was good.

Dr. Weitz:                            Good. I’m glad we could make this happen across the world even in the midst of the coronavirus pandemic. How can listeners and viewers get ahold of you and find out about some of your … I know you have a number of courses that are available?

Dr. Hawrelak:                     Yes, we’ve got one on Dientomoeba and Blastocystis because I’m trying to get that information out there about that. That change in conception that research has actually made manifest. Also, ones on Giardia too as it turns out. The microbiome, probably more broadly lactose intolerance, fructose intolerance, we’ve got a few different lecture out there on the Probiotic Advisor site. My passion is really around the gut microbiome, probiotics, and prebiotics. I’ve been in this area for 20 years when I first started my honors and my PhD research, so I love this area and I love being a clinician still so you get a chance to actually work with patients and see what works. Sometimes, what works in research doesn’t always manifest in clinical change in any beneficial way or it just doesn’t work in reality. It’s been nice to go, what does? What doesn’t? Over years of working with patients too.

Dr. Weitz:                            What’s the website for the Probiotic Advisor? That’s where they can find new courses, right?

Dr. Hawrelak:                     Yes. Www.ProbioticAdvisor.com. Then, we’ve got a teachable courses page too. I think we’ve got 12 or 13 courses up there now around microbiome and gut health more broadly.

Dr. Weitz:                            Great. Thank you so much.

Dr. Hawrelak:                     You’re welcome, Ben. Nice chatting again.

Dr. Weitz:                            Nice chatting with you too. I’ll talk to you soon.




Preventing Cognitive Decline with Dr. Tom O’Bryan: Rational Wellness Podcast 168

Dr. Tom O’Bryan discusses Preventing Cognitive Decline with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

17:28  When a patient presents with Mild Cognitive Impairment (MCI), such as forgetting where their keys are, where they parked their car, etc.  Dr. O’Bryan explained that his website, TheDr.com is a platform that provides the roadmap that helps to make it easy to take the journey back to health.  Brain deterioration is a condition of inflammation.

22:15   While we can use questionaires to assess the level of cognitive function, the first thing to recognize is that brain deterioration is a state of brain inflammation.  Then we can run some testing to help us identify some of the triggers for this inflammation, including the Neural Zoomer Plus from Vibrant Labs that looks at 48 different antibodies in your brain.  The second test Dr. O’Bryan recommends is the Wheat Zoomer, which is the most sensitive marker for intestinal permeability.  The intestinal microbiome modulates your brain function, so having good balance in the microbiome is important for brain health. 

29:41  Dr. O’Bryan likes using the BiomeFx stool test to assess the microbiome health.  So the basics of reducing mild cognitive impairment is to heal leaky gut, create intestinal microbiome balance, and avoid environmental toxins.




Dr. Tom O’Bryan is a Doctor of Chiropractic, a best-selling author, a professor for the Institute of Functional Medicine and an internationally recognized speaker focusing on gluten and other food sensitivities, environmental toxins, and the development of autoimmune diseases. His 2016 book, The Autoimmune Fix won the National Book Award and the docuseries he released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You  has been seen by over 500,000 people worldwide. He also organized the highly successful The Gluten Summit – A Grain of Truth. His website is www.theDr.com  His second book You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had was released in 2018 and it is another huge hit.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello, Rational Wellness podcasters, thank you so much for joining me again today.

Today, we have a very special discussion with Dr. Tom O’Bryan, and we’re going to be talking about how we can prevent and reverse cognitive decline which as we know is a precursor to some of the degenerative brain diseases like Alzheimer’s.  Alzheimer’s disease is the most common form of dementia and we currently have close to six million Americans age 65 and older living with dementia, and 80% of these patients are age 75 or older. 1 in 10 people over the age of 65 has Alzheimer’s and dementia and almost two-thirds of those with Alzheimer’s are women. We predict by the year 2050, we’ll have 13.8 million with Alzheimer’s.  So, this is now one of the leading causes of death for seniors and a major burden on our healthcare system. And of course, the best time for intervention is prevention and during the beginning stages of when you start to see what we call mild cognitive decline. The current medical model provides very few treatment approaches that can help and not even any of that help with symptoms, never mind preventing the disease progression.

                                                Dr. Tom O’Bryan is going to be discussing with us an approach using a functional medicine model that has been pioneered by Dr. Dale Bredesen that looks at a number of underlying risk factors, triggers, and causes using a network-based approach that looks at functional and lifestyle factors, looks at metabolic parameters, everything from hormones to food sensitivities, to infections, to toxins, to sleep, to insulin sensitivities and a bunch of other factors that we can reasonably intervene on and get some improvement.  Dr. Tom O’Bryan is a doctor of chiropractic, a best-selling author, a professor for the Institute of Functional Medicine. Dr. Tom is an internationally recognized speaker focusing on gluten and other food sensitivities, environmental toxins and its development of autoimmune diseases. His 2016 book, The Autoimmune Fix, won the National Book Award and the docuseries released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You, has been seen by over 500,000 people worldwide.  He’s also organized the highly successful, The Gluten Summit: A Grain of Truth. His website, TheDr.com, is a very popularly visited website and his second book, You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had, was released in 2018 and it’s another huge hit. Thank you so much for joining me, Dr. O’Bryan.

Dr. O’Bryan:                        Thanks, Dr. Weitz. Always a pleasure to be with you.

Dr. Weitz:                            So, before we get into the topic at hand, how are you feeling about life in the midst of the continuing coronavirus pandemic? And you can take that question whatever direction you want.

Dr. O’Bryan:                        Oh, man. It’s really difficult in this world of polar opposites that we’re in now for the last 10 years. Democrats and Republicans don’t agree on anything. They’ll fight to the death on every topic. You’re either red or you’re white. You’re black or you’re white, and not only in that race-wise but in terms of opinions. There’s-

Dr. Weitz:                            And unfortunately all these health factors like wearing a mask or whether or not hydroxychloroquine works is now political and it should just be scientific.

Dr. O’Bryan:                        A paper came out just last week, one of my mentors is Professor Yehuda Shoenfeld from Tel Aviv, Israel. And when I interviewed him for Betrayal, at that time, 28 of the PhD students who received their PhDs in immunology under him, there are many more, but at that time, 28 of them shared Departments of Immunology in med schools and hospitals around the world. This guy is the godfather.   And he just published a paper last week with nine other world famous immunologists. Six of them shared Departments of Immunology somewhere in the world. So, these are the cream of the crop in terms of experts on your immune system, cream of the crop, very best. And in the first paragraph of the paper, they say about this current viral epidemic, pandemic, is that worldwide the death rate is between 0.02% and 2% of the population depending on whether you’re an elder, do you have high blood pressure, do you have diabetes.

                                                But the top end is 2%, and that’s not what we’re hearing in the news, that the numbers are being manipulated. I’m not going to go into why. I don’t know why I have some ideas. But if somebody dies in a motorcycle accident and a family member said, “Well, they had some sniffles.” The death certificate said trauma and SARS-COV2, COVID-19, that they’re manipulating the numbers.   And if somebody gets an antibody test to see if they developed immunity for this thing, they inflate the numbers to say, “Oh, he’s got the virus.” And so, millions of people have, “Well, if you’ve got the antibodies, you’ve got immunity. That’s a good thing,” but they’re representing it as more people are sick with this thing. So, there’s a whole world of things going on and it’s really difficult to understand what to do. It’s really difficult.

                                                And my wife has been so patient with me over the last few years to understand this whole thing about news, and news broadcast because she’s from Poland. And she told me early on in our relationship, US news stations and newspapers don’t say the whole story. And I’m like, “What? You’re challenging The New York Times? Oh, my gosh, I think you’re a pretty cool lady but don’t challenge The Times,” because I read the Sunday times. Every Sunday, I have some coffee, relaxed and just update.   Now, I see because I started … First, I’d read The New York Times, then I’d read the London Telegraph. Then I’d read the French Le Monde in English and I’d see and then I’d read something from Argentina about world events and the whole world is consistent on reporting an event except in the US, that the US story was consistently different. And I was just startled.  I was born and raised in Detroit, raised my family in Chicago, I’m red, white and blue. I just was startled by this. And it was hard to hold. It was hard to accept. I mean, wait a minute … And that’s what’s going on now for people with this whole viral pandemic. It’s when you look, when you really look and say, “Wait a minute. That keeps happening again and again, because it doesn’t make sense.”

Dr. Weitz:                            I think there’s one thing that we should take from this whole pandemic is when they talk about the risk factors, I was talking to somebody and they say, “Well, it’s only people who are high risk are really a problem.” “Oh, really, just a few people?” Well, let’s see. What are the risk factors? One of them is being overweight, 70% of Americans. You got people with hypertension, people with cholesterol. You got people with fatty liver. You got people … You started listing all these chronic conditions and you think, “Wait a minute, maybe in some other country, there’s a small amount in a population.”    But this is like 80% of our population. This should be a wake-up call for us to get more healthy because if we were, we wouldn’t have to worry about having the worst outcome with situations like this.

Dr. O’Bryan:                        Well, you’re exactly right, Dr. Weitz. That’s why it’s important for people to realize that this pandemic is a lifestyle disease, meaning how we’ve lived our lives up to now determines whether or not we get sick, period. No discussion, that every single person that they looked at who has a reaction here, lifestyle, and whether they’ve got deficiencies of vitamin D which over 96% of the people or 5,700 people in New York who died in the hospital from this, 97% of them had low vitamin D levels.

Dr. Weitz:                            Absolutely.

Dr. O’Bryan:                        So in the words of Roseanne Roseannadanna, you think? You just want to check your vitamin D to make sure you’ve got adequate levels. Now, I’m not saying vitamin D cures viral infections, but I’m saying when you have low vitamin D levels, your immune system can’t work the way it’s designed to work.

Dr. Weitz:                            There was another huge study in New York City where they had two groups that both took hydroxychloroquine and azithromycin and one group also took 100 milligrams of zinc. The group that just took the hydroxychloroquine and azithromycin, they got really no benefit. The group that took the zinc in addition had a 49% reduced risk of death.

Dr. O’Bryan:                        Well, I’ll tell you why that is-

Dr. Weitz:                            And so this is the reason why some of the hydroxychloroquine studies have shown a huge benefit is because it’s the zinc transporter.

Dr. O’Bryan:                        That’s exactly right. I’ve done the research on that one. It came from India, the fever tree, the cinchona tree. They take the bark of that tree and they extract quinine from it. And quinine has been an antimalarial drug in India for a couple of hundred years. And what they found was that what the quinine does and that’s where hydroxychloroquine came from was to make a drug that copied what quinine did.  And hydroxychloroquine has been around for over 60 years, really relatively safe as drugs go. Well, what happens is the quinine, it’s called an ionophore and that’s a geek word, but it means as you said, a zinc carrier that if you have enough zinc inside your cells, the only way this virus can grow is it sheds. It’s kind of like dandruff. Viruses have dandruff inside your cells. It’s called shedding. And then that dandruff gets inside some of your DNA and then more virus grows from that.   So, the virus doesn’t reproduce, it sheds. But it only sheds inside your cell. A virus in your lung or in your bloodstream won’t shed. It won’t develop more. It has to get inside your cell to do that. Well, when you enough zinc inside your cell, it can’t shed. That’s why zinc is so important. Zinc of the bloodstream, it doesn’t help very much. It’s necessary to have adequate levels in your bloodstream, but you got to get it inside the cell.   So, to get it inside the cell, you need a carrier, and in the natural world, the most prevalent carrier, number five of all ionophores is called quercetin, which is part of vitamin C.  That’s why quercetin is good to take.  It helps to get zinc inside your cell.  So, when you’re exposed to viruses, the viruses can’t shed. There’s no dandruff.

Dr. Weitz:                            Exactly.

Dr. O’Bryan:                        … the viruses inside your cell. Well, quinine is a zinc ionophore. It carries zinc inside the cell. And in the late 1800s, it was the British who were occupying India and their soldiers were given quinine to prevent malaria but that stuff is really bitter. I mean, it is bad news taste.   And so, they took a little fruit water and added sugar to it with their quinine. That’s where the song came from just a little bit of sugar helps the medicine go down. It came from the Brits from the late 1890s. And the British soldiers and that was the formation of tonic water, which is quinine, a little bit of fruit, a little bit of water, a little bit of sugar.      The British soldiers got permission to put a spoonful of gin with it. Thus was born the gin and tonic. That’s where the gin and tonic came from. It was a medicine.

Dr. Weitz:                            Who knows what you’re going to learn when you talk to Dr. Tom O’Bryan?

Dr. O’Bryan:                        Well, I really like that kind of geek stuff. So, once I learned that, my wife and I started drinking a little bit of tonic water every day. I don’t know that it’s going to help but it sure is not going to hurt. But you just have to make sure of two things if you do this, that there’s commercial tonic waters that are chemical copies and don’t have quinine in them.   So, you have to look on the label and make sure there’s quinine. That’s the first thing. And the second thing is most of the companies add a whole lot of sugar to that bottle of bitter-tasting quinine tonic water. But there’s one–the company’s called Fever Tree, like the tree in India where quinine comes from. And they have five different tonic waters, one of them is India Light.   And so there’s an India tonic water but the India Light has, I think it’s six grams of sugar in the bottle. So, it’s not much at all. So, what we do is we do about a … They’re small bottles so we do like half a bottle and then put sparkling water in there and then a little slice of lime. And it’s a nice pleasant little afternoon drink, but I’m taking a zinc ionophore to help carry the zinc inside the cell.   It may help. It’s not going to hurt. It doesn’t cure viral infections, but it may help a little bit.



Dr. Weitz:                            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 is not just the quality products 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 five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.

                                                Now, back to our discussion.



Dr. Weitz:                            Now, let’s get into our topic. This one got off topic, my fault. So, how would you … Now, your brain book I know was kind of a self-help book but in this discussion, I’d like you to play the role of the clinician and let’s say you have a patient who comes in your office with symptoms of mild cognitive impairment, how would you assess the patient? How would you set up your consultation and then how would you work that patient up and go about making some recommendations?

Dr. O’Bryan:                        Really good, really good question, thank you. And it’s a really tough topic and I’m going to explain why. When someone is suffering from mild cognitive impairment, which means they’re forgetting where their keys are, where did I park the car in the parking lot, things like that. They’re forgetting things that happened yesterday. “What did you have for breakfast yesterday?” “I don’t know.”  When people notice that kind of thing, it scares the hell out of people. And when we get scared, we tend to avoid the topic. That’s human nature especially in the US. We like everything to be convenient and easy. What pill can I take so that this doesn’t happen anymore? So, one of the platforms at TheDr.com, my website, is that our goal is to make it easy to do the right thing. So, what does that mean?   Well, in order to do the right thing, you have to understand what’s going on and what the goal is of every step you take, so the journey to health. When your body is not functioning the way you want it to, it’s a journey to get back to health again. And if you can take a journey to go from New York to Miami, you need a map. And so we have to teach you how to read the map of your journey to health. But people often don’t want to hear that. What they want to hear is what pill do I take that gets rid of this?

                                                So, the first thing is it’s a wake-up call. And the geek term is you have to change your paradigm. You have to be receptive to thinking a different way, obviously, and I don’t mean that in a pun but you have to think differently. So, first, reality check. The Alzheimer’s Association of America which is the number one group. They have hundreds of thousands of people. They get lots of good education programs they have and all of that.  They told us last year, one out of three elders dies with Alzheimer’s or another dementia, one out of three. We’re hearing numbers all the time. You started the show with some numbers about Alzheimer’s. People don’t know how to hold the numbers. So, here’s how you hold that number from the Alzheimer’s Association. Dr. Ben, you’re interviewing me right now, and then there’s that person listening. So, between you Dr. Ben, you the listener and me, one of the three of us will die with dementia and it sure as hell ain’t going to be me.

                                                That’s the goal here. But that’s the reality check. That’s how common this thing is now. And people don’t get it. It’s not going to happen, because everybody knows someone that had a heart attack and survived and changed their diets, started exercising, they looked better than they’ve looked at years. Most of us know someone diagnosed with cancer that went through the protocols, whatever they were, who’s in remission and they feel great.  No one knows anyone diagnosed with a brain deterioration, mild cognitive impairment that’s doing great.  It scares the hell out of us.  So, we avoid the topic. You can’t avoid this topic that you have to learn how to read the map.  And it’s a day by day journey to learn how to read the map. Critically important, or else people are going to feel a little bit better for a while but they continue to go downhill.  And as a doctor, you say, “Well, we told him what to eat and then told him what to take, and they did it most of the time.  But that really didn’t help very much.” So-

Dr. Weitz:                            How do you … Let’s say the patient comes in your office and maybe they recognize their memory is off or maybe their spouse, how do you assess what their level of cognitive impairment is?

Dr. O’Bryan:                        Yeah. Well, so you’re saying let’s get to the meat of the matter?

Dr. Weitz:                            Yeah. Do you use a questionnaire or-

Dr. O’Bryan:                        I understand. Well, the first thing to understand is-

Dr. Weitz:                            I didn’t mean to cut you off.

Dr. O’Bryan:                        It’s all right. I understand. It’s your podcast. The first thing to understand is that your brain deterioration condition is a condition of inflammation. It’s always inflammation without exception and I’ll challenge anyone to show me that it’s not inflammation because there are so many studies that show your brain is on fire. And when your brain is on fire, you’re killing off brain cells.  So, the question is, is it the frontal lobes or the occipital lobes in your brain that’s on fire? Is it gasoline or kerosene? Where is the fire coming from?  But your brain is on fire. And you say, “Well, I feel fine. I don’t have a problem going on.” You don’t feel when you lose a hundred or a thousand brain cells because you got so many.  But every time you pump gas, every time you pump gas, you fill your gas tank, if you can smell the gas, you’re smelling benzene.  And benzene goes right up to your brain, killing brain cells. It causes inflammation killing brain cells every single time you smell gas.   “Well, I have to pump gas.” I understand.  But when you put it on there, if you’re smelling gas, you’re downwind.  Walk around to the other side of the hose, now you’re upwind.  We just have to start thinking differently about this. We need a paradigm shift, and that’s really difficult for people because they want the magic fix right now.  So, what type of test do you do to identify?

Dr. Weitz:                            Do you use a questionnaire to assess cognitive function? I know there are some good online ones.

Dr. O’Bryan:                        There are some really good questionnaires and I don’t, because if someone comes to me and said, “I’ve got mild cognitive … Doc, I’m not remembering the way I used to. There’s something going on.” I don’t need to document it. I get it already. But they’re very valuable to do and you can compare them six months later. We do multiple symptom questionnaires, so we have a number of questionnaires we use specific memory questions.   I think it’s a good idea to use it, and I just don’t in my practice.

Dr. Weitz:                            And then how do you conduct your consultation to get an idea of what some of the underlying triggers might be for this particular person?

Dr. O’Bryan:                        We have to read the map. So, in order to read the map, you have to have a map. So, to have a map, you have to do some testing to identify where is this coming from? What are the triggers setting it off? So, the number one test … There are two tests we do on every single person, two tests that come in with these complaints. The first one is called the Neural Zoomer Plus.  The Neural Zoomer Plus is a blood test that looks at 48 different antibodies in your brain. If you have elevated antibodies, you’re killing off brain cells. And so, it’s the most comprehensive test I’ve ever seen on this. And we use this at the beginning to see how many different tissues are on fire right now, how many are there?

And the second test is the Wheat Zoomer.  And we do the Wheat Zoomer for two reasons. The first is that it’s the most sensitive marker for intestinal permeability or leaky gut. And when you read the science out there, inflammatory diseases whether it’s brain inflammation diseases, kidney inflammation diseases, skin inflammation diseases; inflammatory chronic, inflammatory diseases, there are five factors required or five pillars as Professor Fasano talks about, the five pillars in a development of chronic inflammatory disease.

                                                The first one is you’ve got the gene that says you’re vulnerable to that. It doesn’t mean you’re going to get it. It just means you’ve got the vulnerability. The second one is an environmental trigger that sets it off. And that can be benzene you’re breathing when you pump gas, or wheat if you have a sensitivity to wheat. The third one is the environmental trigger alters your microbiome, the intestinal microbiome which the geek word is modulates your brain function.   Now, what does that mean? It means it had its hands on the steering wheel, that the bacteria in your gut have their hands on the steering wheel of how your brain functions. For every one message from the brain going down telling the gut what to do, there are nine messages in the gut going up telling the brain what to do. So, when your gut is out of balance, the term is dysbiosis. But when your gut is out of balance, you’re sending the wrong messages to your brain.   So, just imagine you’re driving down the road, if the bacteria has got its hands on the steering wheel of your brain function and you just turn the steering wheel 10 degrees to the right, a hundred yards down the road, you’re off the road. And in your brain that means the hormones that your brain makes called neurotransmitters that they’re way out of balance when your gut is out of balance. And that sets up brain dysfunction. So, that’s the third one, is the microbiome in the gut.   The fourth pillar is intestinal permeability or leaky gut. And when you come back positive for leaky gut, you’ve got leaky brain and we’ll talk about that in a minute. And the fifth one is chronic inflammatory immune response. Whether it’s going into your brain or into your kidneys or your joints or your skin or your heart, but this chronic inflammation is determined by your genes where it’s going to manifest.

                                                So, there are five different parts to this, but the ones that we got complete control over without exception, we’ve got our hands on the steering wheel ourselves is the environment that you expose yourself to, what’s on the end of your fork is the most common environmental trigger, changing the microbiome to a healthier more balanced microbiome, and focusing on healing intestinal permeability. And those three, you’ve got complete control over.  So the baseline, the very baseline of dealing with mild cognitive decline is those three, what’s on the end of your fork, what foods are you sensitive to, what’s your microbiome like, let’s rebuild the healthier microbiome which helps to heal the inflamed gut causing the leaky gut or intestinal permeability. That’s the key, those three.

Dr. Weitz:                            So, how are you going to assess the microbiome?

Dr. O’Bryan:                        There’s a number of gut tests, stool tests that you can do that look at the microbiome. Currently, we’re working with one called BiomeFX that I’m seeing as the most sophisticated one out there right now. But there’s a number of good ones that different doctors will use. And some focus on one piece of information, some focus on others.

Dr. Weitz:                            The BiomeFX is the one that Microbiome Labs is involved with, right?

Dr. O’Bryan:                        That’s correct.

Dr. Weitz:                            Yeah. We just had Kiran Krishnan on our monthly meeting, talking through Zoom. And he was talking about the microbiome and gave us some information about that full molecular analysis stool test.

Dr. O’Bryan:                        Right. It’s a great test. I’m really impressed by it. But that’s the three. That’s the three things that everybody has control over. Now, you don’t fix them in a day. You have to first be able to read the map and then start heading in the direction from New York to Miami. You have to be on the right road to eventually get to health, to better health.

Dr. Weitz:                            What are some of the things that you might see on that Neural Zoomer panel?

Dr. O’Bryan:                        Oh, man, we’ve never had one come back negative yet. Of all the ones we do, every … And I tell people. I tell them this when they first come. And I say, “Mrs. Patient, my favorite patients are the ones that have been to Mayo Clinic and they’re told that they don’t know what’s wrong.” I said, “That’s great. That’s really great.” And they looked at me like I’m a little weird which I am.  But I say, “That means that you don’t have a disease because if you had a disease, Mayo Clinic would find it. You’ve got dysfunction. Something is not functioning right, so the tests we’re going to do are going to look at functional problems, not disease markers.” And they’d say, “Oh, okay. That kind of made sense.”    Then they come back in the next visit, everybody is nervous with test results. They always are. And I look at the test results and I say, “Well, this is really good news. You’re a mess. Look at all these problems on here. These are great because this one will take two months to fix. This one might be six months. This one, somewhere of six months to a year. But every single one of these markers can be turned around and we’ll show you how to turn them around. But this is what we have to focus on, is get the inflammation down in your brain.” So, what’s it going to take? Whatever it takes to get the inflammation down.

                                                I’ll give you an example. The number one type of Alzheimer’s, you mentioned Dr. Bredesen, the real pioneer here. And Dale says that of the five types of Alzheimer’s, the number one most common type is inhalation Alzheimer’s. It’s what you’re breathing that goes right up to your brain. That’s the gasoline on the fire causing the inflammation, killing off brain cells.   And you learn that indoor air pollution is much worse than outdoor air pollution. Molds are huge problem in our country today, huge. “Well, there’s just a little bit of mold on the shower curtain. It’s not too bad.” Yes, it is. If you see it, it’s way too much. It’s way too much, right?   And NASA came out with a study and they showed these common houseplants. You put two six-inch houseplants in every room and you suck up formaldehyde, trichloroethylenes, molds, spores by depending on the chemical for anywhere from 42% to 76% of what’s in the air. The plants suck it in, take it down into the roots of the plant. The microbiome in the dirt converts that stuff, breaks it down and then the plant produces more oxygen in the air.   So, it’s really simple things. You get houseplants in every room. “Well, I don’t have a green thumb.” So if they die, you buy more. You don’t have to have a green thumb, and you’ll learn how often to water them and when not to water them. But the idea is-

Dr. Weitz:                            What about air purifier or plants that are-

Dr. O’Bryan:                        Exactly, much better if you can’t afford an air purifier or in addition to an air purifier, houseplants in every room. And people don’t know that your air … If you can see the sunshine coming through the window, sometimes the rays of the sun and you see kind of the dust in the air, you’re sucking all that stuff in all day every day. And what’s in that dust? Formaldehydes from pressboard, cabinets like your kitchen cabinets or your bathroom cabinets. They outgas formaldehyde into the air. You just can’t smell it.

                                                Scotchgard on your sofas outgases into you and this stuff causes cancer. These chemicals cause cancer. Now, there is no evidence that the amount of Scotchgard that reaches out into the air is toxic to humans. And that’s true, there is no evidence because it’s a minor amount. But this stuff accumulates in the body over years and years and years. Now, you got a problem. And that’s how the chemical industry got away with this crap, excuse me, but they had the legislation passed that you have to prove the amount of toxic stuff in the air is dangerous to humans. It’s not.

Dr. Weitz:                            Yeah, it turns out they actually stopped regulating PFOS and PFO recently. They said, “No, we’re not going to regulate it.”

Dr. O’Bryan:                        Yeah. And when Trump came to the office, I’m not getting political here, but in his first month in office, he removed the regulations for filters on coal burning power plants to filter the mercury, so that mercury doesn’t spew into the air. For the last seven years, there’s been a whole lot more mercury spewing into the air because of our government regulations or lack of regulations.

Dr. Weitz:                            Actually when they remove the controls on the PFOS, it was right after two scientists from his own organization published some studies showing that these chemicals and these are like the chemicals that are found in Scotchgard and Teflon pans and stuff that they’re actually way more toxic at much lower levels. And we’ve already got reports that they’re in the drinking water throughout most of the country including in California.

Dr. O’Bryan:                        Right. See, that’s why all these stuff is overwhelming.

Dr. Weitz:                            And all these chemicals build up in the body like you’re saying.

Dr. O’Bryan:                        Exactly. That’s the danger, is the accumulative aspect. That’s why part of the roadmap to better brain health is teaching people how important it is to detox and that we have to be thinking a little bit every day about helping our detoxification pathways, break down these chemicals we’re exposed to.

Dr. Weitz:                            How do we detox? That word is thrown around a lot.

Dr. O’Bryan:                        Yeah. The first and most important thing is the highway of detox needs to be open and clear. If you’ve got a four-lane highway that’s narrowed down to one lane, everything backs up. You back your car into a snow bank, the exhaust pipe is full of snow, the exhaust comes back into the engine. What does all that mean? You have to drink a half ounce of water per pound body weight.  A half ounce per pound body weight. You just have to have the highway available to flush this stuff out.  “Oh, my god. Well, let’s see, I weigh 140 pounds, that’s 70 ounces. So that’s a half a gallon of water. Oh, my god. I’ll be peeing all day.” That’s the idea. You got to get this stuff out of you. I mean if your brain is on fire, where are the triggers coming from? And there are many, many triggers. And once again, it’s an overwhelming thing to deal with. That’s why you have to understand the paradigm, I’m learning how to read the map to get to Miami.

Dr. Weitz:                            What else can we do to promote detox of chemicals?

Dr. O’Bryan:                        Number one most important is be well-hydrated with the purest water that you can get your hands on.

Dr. Weitz:                            Is there a particular type of water you like?

Dr. O’Bryan:                        Yeah, tap water through a really good filtration system.

Dr. Weitz:                            Okay.

Dr. O’Bryan:                        Yeah. That’s the only time you’re safe. If you can afford it, to spend 400 to a thousand dollars and get a really good water filter … The best one would be a couple of thousand dollars for the water coming into the house [crosstalk 00:38:36] to the kitchen sink because you brush your teeth in the bathroom. You take a shower and you get water in your mouth in the shower. So, having a whole house water filtration system is the best.  But if you can’t afford that, whatever you can afford is better than nothing. Even if it’s just a little countertop Brita that you put the tap water into and it goes through a little filter in the top and it drips down into the container. That’s better than nothing.

Dr. Weitz:                            You can get one of those systems that goes onto the sink that does reverse osmosis and a bunch of filters. And there’s a number of companies that will actually do it for a monthly rental fee. You pay 30, 40 bucks a month or something like that.

Dr. O’Bryan:                        So, that’s the important component on the map of getting to Miami, of getting to better brain function. You have to understand you’ve got lots of cities to drive through, lots of states to drive through to get from New York to Miami.   So, with detox, what else is critically important after water, the next in my opinion most important thing is what’s on the end of your fork. That is the most common trigger, fueling inflammation in the body. And so, the first concept is always get organic whenever you can. And when you go shopping at your local supermarket and they don’t have organic potatoes or sweet potatoes, you ask for the produce manager. There’s always some guy putting out more fruit or something. And say, “Hi, is the produce manager in?” “Yeah.” “Could you get him please?”

                                                And the guy comes out and he’s really happy, he’s the produce manager. Say, “Hi. I’m wondering how come you guys don’t have organic sweet potatoes?” “Oh, well, there’s really not … We just … There’s not that much to manage.” “Oh, my friends and I, we know how important organic is and if you carry organic, we’ll buy it. I promise.”   And then he walks away, “Oh, okay.” he walks away and he might blow you off. But what if 20 people a week do that? It won’t take long before he goes to the store manager and says, “I’m having people every day asking for more organic produce.” That’s the only way you’re going to get a change in the supermarket, is that everybody takes five minutes and ask for the produce manager and does your own due diligence to tell them you want organic carrots. You want organic apples.

                                                And you tell him and a hundred people a month do that, you think they’re not going to get organic? Of course, they’ll get it. They’ll start with a little bit and you say, “Oh, it’s there.” And you ask for the produce manager again six months later and say, “Hey, I see you got some organic rhubarb here. That’s really great. Thanks so much. Now, what about avocados?” And then they’ll have regular avocados and the organic ones that are a little bit more usually. And you just start building it up.

                                                But anyway, when you go shopping, always think of the rainbow diet. Most important concept in your food selection is the rainbow diet. The deeper the colors of the rainbow, the more polyphenols and antioxidants in the fruits and vegetables – blueberries, purple cabbage, red tomatoes, green broccoli, chard. The list goes on and on.   But you think of the colors of the rainbow, critically important. Because the more of the polyphenols you get in your diet every day, every meal, even breakfast, every meal … The more polyphenols you get, the more you support your detoxification pathways so that your liver is better at breaking down the chemicals you’re exposed to. Your lungs are better at breaking down the chemicals you’re exposed to. Your microbiome is better at breaking down the chemicals you’re exposed to.

                                                So, of course you want to reduce exposures of the bad stuff but you can’t in our world today. So you want to enhance your detoxification pathways. One is water, two is food. It’s critically important. And then your doctors can check you for compromised detox pathways and there are some geek terms like methylation, others that you may need more extra support and certain vitamins to help. But your doctor can find that out for you.

                                                But the simple things, you can do it every day and it should be just your new paradigm, is always a rainbow diet and always hydrating really well. You want to be at the point just from those two things, just from that where you wake up in the morning and your spouse wakes up. And you say, “Honey, I just had the best bowel movement I’ve had in three weeks. Holy cow, I feel great.” We think that intimacy and sex is great, but I’ll tell you what man, good bowel movements, you’re a happy man.  And we don’t talk about that stuff, but those functional abilities are critically important to get your brain working better because the ratio is nine to one. The message is coming from your gut nine times more of them going up to your brain. You want a gut that’s working really well.

Dr. Weitz:                            And most of the toxins are being put into the stool and pooped out. So, that’s a major route for detoxification.

Dr. O’Bryan:                        Right. And I could talk about vitamins and take this one or take that one. And those are valuable. Those are really valuable. But if you don’t do the basics, if you don’t learn how to read the math, you can temporarily feel a little better because you’re taking vitamin and caffeine. You’re taking things that jack up your brain to work better, so it’s going to work better for a little while but you keep throwing gasoline on the fire, what do you think is going to happen?

Dr. Weitz:                            So, you’re saying even if you use a specialized detox program, take a detox powder, certain capsules, glutathione, binders, things like that, all those things need to be added on top of having a healthy diet, drinking a lot of water, getting sleep. You’ve got to have those fundamentals first before those specialized detox protocols are going to be beneficial.

Dr. O’Bryan:                        That’s exactly right. When you get out of New York, you need to get … You have to go through the city of New York to get on the highway to get down to Florida. And now, it’s a straight shot on the highway once you’re there. But you’ve got to do all those maneuvering to get on the highway. And the maneuvering … What people have to understand, and people don’t like to hear this. But what they need to understand is that if you have cognitive decline, if you’re forgetting things, if your memory is not working very well, what you’re doing, the way you’re living your life ain’t working. If you’re lucky, you’re going to be one out of the three, you’re at risk of that. So, what you’re doing ain’t working, period.  And you have to understand first because if you keep doing those same lifestyle, you got mold in your house but now you’re going to take some smoothie combination and put this brain powder in there and with 18 different ingredients for your brain and you take the smoothie and your brain is working really good and you’re fired up for a while but you’re still sucking the mold air into your brain, killing off your brain cells, what do you think is going to happen?

                                                It’s like we have to change our paradigm first. I never talk to people about a bunch of supplements to start with ever because you have to change the way … You have to realize the way you’ve been living your life has created the problems you got right now.   So, the definition of crazy is doing the same thing and expecting different results. “So, I’m going to do the same thing but now I’m going to take some brain powder with my smoothie. Oh, I feel better. My brain is working better,” for a short period of time but your lifestyle is the same. You’re breathing the same air. You’re eating the same foods that you’re sensitive to. “Well, I don’t get gut pain when I eat wheat. I don’t have a problem with wheat.” Really? Just do the Wheat Zoomer test and find out.

Dr. Weitz:                            Should everybody stop eating wheat?

Dr. O’Bryan:                        Say it again.

Dr. Weitz:                            Should everybody stop eating wheat?

Dr. O’Bryan:                        I never say that, ever. I’ve never ever said that. But I’m misinterpreted that way because what I do say is that if your immune system is fighting wheat, you can’t eat wheat, period. So, you just have to have an accurate test to see, is my body fighting wheat right now? Because the ratio is eight to one, for every one person that get gut complaints from eating wheat, eight people don’t have gut complaints. They’ve got brain complaints or joint complaints or skin complaints. They don’t have gut complaints.

                                                So, you think I eat wheat, I feel fine, it doesn’t matter how you feel if your brain is fried because it may be your genetics the wheat is causing gasoline on the fire in your brain. So, what I always say, if you’re not happy with your current health and how your body is functioning, do the test to see, does my immune system say I have a problem with wheat? If it says yes, you do, you don’t eat wheat anymore, period. So that’s what I always say.

Dr. Weitz:                            Right. What about just doing an elimination diet and taking wheat out and see if you feel better?

Dr. O’Bryan:                        The concept of … I have to plug my power in here on my phone, there we go … The concept of an elimination diet, the danger of that, it’s a good concept but the danger of that is that you’re looking for how you feel to determine whether or not wheat is a problem. And quite honestly, most people that eliminate wheat, they feel better pretty quickly. But some don’t or they feel better, and if they have a little wheat once in a while, they’d still feel fine. They can’t tell.

                                                So, by the time you’ve got symptoms, it’s the end stage of that organ or that tissue and its ability to function normally. You can’t function normally anymore? You got symptoms. So, there’s a long degenerative process that goes on before you ever have a symptom. That’s the whole world of predictive autoimmunity. That’s what my book The Autoimmune Fix is about.

                                                So, it’s a good idea to do an elimination diet but it’s not comprehensive. Let me see if I can come up with the analogy for that. It’s kind of like saying if you’re driving on the highway through the city and everything is fine, you’re just driving along, everything is fine. You may not know there’s a riot going on four blocks over and there’s lots of chaos and lots of police and maybe the National Guard has been called out. But you’re on the highway and everything is fine.   So, you eat a little wheat once in a while and you can’t tell your brain is on fire. You can’t tell. Sometimes you can, but most of the time you can’t.

Dr. Weitz:                            Your immune system could be reacting to wheat. You could be having some clinical inflammatory reaction that hasn’t created symptoms yet and it could be a period of time before symptoms occur and by then you may be risking organ damage, so better to know early.

Dr. O’Bryan:                        That’s exactly right. You say it much clearer. And there’s only one test, though there are two tests that are really good tests now compared to the ones that almost every doctor does. The ones that most doctors do, the tests have been around for 25, 30 years and they’re good tests but they’re not comprehensive. Then in 2010, a laboratory opened up called Cyrex Labs and they looked at 10 different components of wheat instead of just one. So that’s better. But then a lab opened in 2015 called Vibrant Wellness that looks at 26 different components of wheat, and not just one. Most doctors look at one or maybe two components.

                                                So, if you test for that one component, gluten, and it comes back negative, your doctor says, “Oh, wheat is fine for you. See, the test is negative.” But you may not be reacting to gluten, you may be reacting to what’s called the wheat amylase trypsin inhibitors, that’s in wheat, and that’s causing your brain inflammation or that’s causing the thrombosis, the clots that you’re forming in your blood stream. And wheat does that a lot and you don’t feel any of that. So, you have to test comprehensively. So, those two labs are the only labs that are in the ballpark of being comprehensive.

Dr. Weitz:                            Great. So, I think we have to wrap because I have a patient coming up. As usual, it’s always fun to talk to you.

Dr. O’Bryan:                        I’d like to say one more thing if I may.

Dr. Weitz:                            Oh, yeah, absolutely. I was going to give you an opportunity to give some final thoughts.

Dr. O’Bryan:                        The subtitle of this book, You Can Fix Your Brain, the subtitle is Just 1 Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had. And it’s not a cutesy subtitle. It’s the only way to be successful with mild cognitive impairment, is that you don’t think you’re going to do it all immediately today. You just allocate a little bit of time if you have impairment every day one hour a day or one hour every two days, every Tuesday night after dinner or every Tuesday and Thursday or every night after dinner, I’m going to spend one hour. And I’m just going to review a little bit more.

                                                So, what’s the name of those plants that I need to buy? You go back to the book and you write down the name of the plants or you write down the URLs to look for glass storage containers to get rid of the Tupperware. The only thing Tupperware should be used for is out in the garage for your husband to store nails or for your kids to store crayons, but not around food. But you have to order glass storage containers, that’s going to take an hour, you’re done for the day. But you do this regularly, consistently.  And that’s how you start to change your lifestyle, is a little bit every day, a little bit every week, depending on how severe your symptoms are. In the book, I said one hour a week. But if you’ve got mild cognitive impairments, one hour a day.

Dr. Weitz:                            Yeah, absolutely. We all need to take steps to get as healthy as possible and mild cognitive impairment is one of the more important conditions that we want to do all these things, optimize our lifestyle and once again using a functional medicine approach. This is something that could be prevented and reversed. And just relying on the blockbuster drug that’s going to fix that is not the way to go. And that drug doesn’t exist with this condition anyway.

Dr. O’Bryan:                        Well, you know I know of two, there may be more, pharmaceutical companies that closed down their Alzheimer’s research departments. They closed them down and laid off the scientist after spending literally billions of dollars over the years trying to find the drug because they now know there is no drug and Dr. Bredesen taught us there’s 36 different things that have to be looked at and fixed. It’s a step by step progression. You have to fix this, fix this, fix this, and fix this.   That means there’s a map. To get from here to there, there’s a map and you have to learn how to read the map, which is every step along the way. That’s where the one hour a day or one hour a week comes into play. Be patient, be consistent and you will make it to Miami.

Dr. Weitz:                            Excellent. On that thought, we’ll bid adieu and listeners can find out more about you through TheDr.com website, correct?

Dr. O’Bryan:                        Yes. That’s TheDr.com. Don’t spell the word “doctor” out, TheDr.com.

Dr. Weitz:                            Okay, excellent. Thank you Dr. O’Bryan.

Dr. O’Bryan:                        Thank you, Dr. Weitz.



Lyme Disease with Dr. Darin Ingels: Rational Wellness Podcast 167

Dr. Darin Ingels discusses Lyme Disease with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

6:35  Dr. Darin Ingels contracted Lyme Disease, so he learned first hand about the condition and it took him three years to get his life back.  Lyme is a bacterial infection caused by the Borrelia species with Borrelia burgdorferi being one of the more dominant species and it’s transmitted primarily through the bite of a deer tick.

8:20  In the early 70s there was a mysterious group of cases of Rheumatoid Arthritis in children in Lyme, Connecticut. They thought that it was a Rickettsial infection, which is a different type of infection, so they started sending samples to a doctor named Wille Burgdorfer, who was a Rickettsia expert who worked for the government in Colorado. It took him about 6 or 7 years to isolate that this was not Rickettsia, but an infection caused by a spirochete, which was named Borrelia Burgdorferi, after Willie Burgdorfer.  There are at least five different subspecies of Borrelia burgdorferi and at least 100 different strains of Borrelia in the U.S. alone, and more than 300 strains worldwide.  However if we run a Lyme test through a conventional lab like LabCorp or Quest, they are only looking for one species, one strain, Borrelia burgdorferi, so if your patient happened to be exposed to a different strain, there is a high probability it will miss it on that test.

9:47  Some doctors mistakenly think that Lyme Disease only exists in New England, buy Lyme does exist in Southern California as well as in Northern California and California is the 5th fast growing state for the number of Lyme cases in the US. In Southern California we do have hills, mountains, trees, and we have areas where ticks live. In fact, Lyme disease has been reported in all 50 states, including Alaska and Hawaii and there’s more than 300,000 new cases of Lyme disease each year in the U.S. And Lyme is the number one spreading vector-borne epidemic worldwide. Here is a picture of the Ioxodes tick that causes Lyme disease:


13:00  Lyme is a spirochete, which has a corkscrew shape, so it can penetrate other tissues and cells a bit different than other bacteria, and this results in many different kinds of symptoms.  In fact, there are over 100 different symptoms, so Lyme is known as the great imitator, since it resembles so many other diseases.  Borrelia is a shape shifter, since it can ball itself up like a slinky called a cyst form and there is a cell wall deficient form which looks like a long, straight line. Borrelia’s ability to shape shift allows it to evade the immune system.

14:12  Another interesting thing about Borrelia is that it has a very slow replication cycle. Most bacteria replicate every 10-20 minutes and Borrelia replicates every one to 16 days, which is one reason why Lyme often requires many months of treatment.

15:40  Most of us are unlikely to see patients with acute Lyme disease since this is when the patient is first bitten with the tick and 20-40% end up with a bulls eye rash and Dr. Ingels noted that in California he hardly ever sees a bulls eye rash.  Symptoms can occur anywhere within 3 to 30 days following the tick bite, though many patients have no recollection of being bit by a tick.  Symptoms of acute Lyme include headaches, neck pain, fever, swollen joints or spine pain, fatigue, heart palpitations, and others.

19:37  Chronic or persistent Lyme disease occurs after the acute infection, though the CDC refuses to acknowledge that chronic Lyme exists, even though there’s multiple studies out of Johns Hopkins University showing otherwise, and millions of patients living with chronic Lyme.  Symptoms of chronic Lyme include fatigue, GO symptoms, memory loss, cognitive impairment, neuropathy tends to get worse and spread, burning sensations, feeling of creepy crawlies under the skin, wandering joint pain, light and sound sensitivity, dizziness, vertigo, sleep problems, Lyme carditis, (which can cause mitral-valve prolapse, heart block, heart palpitations, chest pain), balance, coordination problems, newly acquired dyslexia due to a type of brain inflammation, and endocrine disruptions (including hypothyroid, adrenal issues, and menstrual problems).

22:02  Lyme is the great imitator, so it may resemble autism, multiple sclerosis, ALS, chronic fatigue, fibromyalgia, mono, herpes 6, parvovirus, RA, lupus, and pretty much any autoimmune disease.  So if you have been diagnosed with any of the above, you should consider if Lyme could be an underlying root cause.  An autoimmune disease that is triggered by Lyme often looks different and CRP, rheumatoid factor, and ANA may all be normal, whereas we would expect them to be elevated. Some of these patients when they get tested, they will show evidence of Lyme and then you treat them and they get better.

24:07  While we are focusing on Lyme, there are a quite a number of other tick borne infections, including Babesia, which is a blood parasite and a cousin of malaria, Bartonella (aka cat scratch fever), Anaplasma, Ehrlichia, Mycoplasma, Rickettsia, Rocky Mountain spotted fever, Powassan virus, Colorado tick fever, Heartland virus, Tularemia, and Brucella.

25:16  The reason there is a rise in Lyme is because of climate change, which is also leading to an increase in other insect-borne illnesses, including Dengue virus, Zika virus, and Chikungunya virus.  The World Health Organization published a paper and here is a similar paper with the same conclusion: “Ticking Bomb”: The Impact of Climate Change on the Incidence of Lyme Disease.

26:37  The diagnosis of Lyme disease is complicated. The CDC criteria is that you run an elisa antibody test for IgG and IgM antibodies and if it’s positive, then you should run a western blot, also looking at IgG and IgM antibodies. For a test to be positive, you have to have 5 out of 10 IgG bands or 2 out of 3 IgM bands. But sometimes Lyme patients don’t produce antibodies or don’t make an adequate response and for those that do, over time, immunity tends to wane, so it depends upon then their exposure was.  There is no test that measures Borrelia directly in the body. Dr. Ingels prefers to use Medical Diagnostic Labs, because they do very comprehensive tick-borne testing and they bill insurance. IGeneX up in Palo Alto, California is also a great lab, its very expensive and outside of Medicare they don’t bill insurance. Dr. Richard Horowitz has developed a questionaire for Lyme called the MSIDS, Multiple Systemic Infectious Disease Syndrome questionaire: MSIDS.

32:42  Treatment for Lyme should start with diet and Dr. Ingels prefers to have patients follow a nutrient dense, alkaline diet.  Darin points out that with the exception of the skin, the stomach, the bladder, and for women, the vaginal area, which are very acidic, to protect against outside invaders, by and large, the rest of your body is mostly alkaline.  The enzyme systems work best and cell repair work best in an alkaline state. It’s not about the pH of the food, but how the food breaks down in your body. This has nothing to do with blood pH.  Urine pH should be above 7.2  Dr. Ingels breaks down his dietary recommendations into three categories:

1. Foods that can be consumed as often as possible, including vegetables, avocados, citrus fruits, sweet potatoes, some nuts and seeds (almonds, brazil nuts, coconut, flax seeds, pumpkin seeds, sesame, chia, sunflower seeds), some grains, legumes, some oils (avocado, olive, coconut, flax, safflower), and some beverages. 

2. Foods that should be restricted to 20-25% of the dietary intake, including some fruits, some nuts (pecans, hazelnuts) some grains (rice, oats, organic soy, rye, hemp), animal proteins like meat, eggs, fish, and some oils (sunflower, grapeseed). 

3. Foods that you should avoid, like dairy, dried fruits, certain nuts (macadamia, peanuts, pistachios), junk food, artificial foods, processed foods, sugar, condiments (honey, jelly, mustard, soy sauce, vinegar), oils (corn, cottonseed, soybean, vegetable, hydrogenated fats), and beverages like coffee, which is very acidic, alcohol, black tea, and fruit juice.  Then you need to get your gut healthy, which can be adversely affected by the long term used of antibiotics. 

39:14  After getting the diet and the gut in order, the next step is targeting the Lyme and the coinfections.  Antibiotics can be very effective following an acute infection, but the longer you are away from the initial exposure, the odds of antibiotics being effective go down. Antibiotics can disrupt your microbiome and can damage your mitochondria and Dr. Ingels has seen patients that come to see him who have been on antibiotics for many years. Dr. Ingels prefers using herbal protocols, which tend to be more effective than antibiotics, can kill Lyme in multiple forms, and they don’t damage your microbiome, are anti-inflammatory, and can also boost your immune system.  The first botanical protocol that Darin likes is the Cowden Protocol, developed by Dr. Lee Cowden, a cardiologist.  Here are some of the botanicals that may be included in the 5 to 9 month protocol that involves changing the herbs each month, that are designed to kill the microbes, support detoxification, and clear heavy metals:

  • Amantilla
  • Banderol-microbial defense
  • Burbur-detox
  • Cumanda
  • Enula
  • Magnesium Malate
  • Mora
  • Parsley-detox
  • Pinella-brain/nerve cleanse
  • Samento-microbial defense
  • Sealantro-metal detox
  • Serrapeptase
  • Sparga-sulphur detox

These herbs are liquid extracts and can be used easily in kids and you can easily titrate the dosages.  The herbs that Dr. Ingels uses most often are Samento, Banderol, and Cumanda and he will recommend 15-30 drops in 1 oz of water twice per day for at least 6 weeks. If the patient has a herxheimer reaction, he may add Burbur.  He may have patients start with 2-4 drops in 1 oz of water twice per day and slowly increase dosage by 1 drop every 3-4 days till they get up to 30 drops per day.  If a patient has a herx reaction, then leave the dosage the same. For severe herxheimer reactions you can give 10 drops of Burbur every 10 minutes. 

45:51  Zhang herbal protocol.  The clinical protocol that Dr. Ingels took to help himself when he was suffering with Lyme disease after being on antibiotics for 9 months that were not helping and he has found to be the most effective for his patients with Lyme is the herbal protocol that was developed by Dr. Qincao Zhang, LAc and it includes the following herbs:

1. Artemisiae
2. Houttuynia (HH Caps)
3. Circulation P
4. Coptis
5. Cordyceps
6. Pueraria
7. R-5081
8. AI-M
9. Allicin

The downside to this protocol is that it is fairly expensive, since some patients are on at 5-6 products and this involves taking 15-20 capsules.  The patient cost is at least $500 per month with Dr. Zhang’s herbs.  Dr. Zhang’s protocol helps eradicate the infections, improves circulation, reduces inflammation and improves detoxification. It is one of the most comprehensive herbal protocols to address each aspect of Lyme Disease.  Dr. Ingels pointed out that he tends to use Coptis for acute Lyme but not as much for chronic Lyme because it contains berberine, which might potentially disrupt the microbiome during long term usage.

49:56  There are other herbal protocols, like Byron White’s. His formulas are based on what you know your patient has. If your patient has Lyme, you use AL-Complex.  If your patient has babesia they get A-Bab and if they have Bartonella they get A-Bart, etc..  These herbs are extremely strong and herxing reactions are very common.  These are tinctures, so you should start with a low dosage, say 1 drop and slowly increase. Stephen Buhner is a well known herbalist who has a very good protocol for Lyme that includes Japanese knotwood, Cat’s Claw, Andrographis, Wireweed, and Yellow Dye Root.

53:30  Breaking down biofilms is another important aspect of treating Lyme.  There are specific enzymes that can help to break down biofilms, including serrapeptase, nattokinase, and lumbrokinase.   Interface Plus is a product from Klaire Labs that has EDTA and serrapeptase in it that works pretty well. Coconut oil contains monolaurin, which can break up biofilms. N-Acetyl Cysteine is an amino acid that breaks up mucus and has been shown to break up biofilms. Long term use of NAC can deplete zinc and copper, so you should also supplement with these.

56:12  Low Dose Immunotherapy can also be helpful for patients with chronic Lyme disease. It was developed by Dr. Ty Vincent and it helps to down-regulate the TH2 dominant immune response.  It’s based on the concept of molecular mimicry. The goal is to promote tolerance to the offending antigen, using homeopathic doses of nosodes.   The antigen we select is really depending on what we think is triggering the symptoms. If we think Lyme is the trigger, that’s what we use. If you’ve got someone, based on stool testing or organic acid testing, if it’s an overgrowth of candida or yeast, maybe you want to do the candida antigen. Maybe you want to do the strep antigen. We probably have about 40 different antigens we use right now, and I know Dr. Vincent keeps expanding that in experiments with different things, and every year it grows a little bit, based on what he and other doctors around the world have been finding.  This is given as a sublingual administration every seven to eight weeks, depending on patient response.




Dr. Darin Ingels is a Naturopathic Doctor licensed in both the state of California and the state of Connecticut. His practice in Irvine, California, focuses on environmental medicine with an emphasis on Lyme disease, Pediatric Acute-onset Neuropsychiatric Syndrome (PANDAS) and chronic immune dysfunction.  Dr. Ingels has published three books, including his most recent book, The Lyme Solution: A 5-Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease, and his websites are Wellness Integrative and DarinIngelsND.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz:            Thank you for joining us this evening for our Functional Medicine group meeting on Lyme disease with Dr. Darin Ingels. I’m Dr. Ben Weitz, and I’m so happy that you’ve taken the time out from your busy schedule to join us, and hopefully to participate in our discussion tonight. If you’d like to ask a question, please type it into the chat bar, and we’ll get to it once Darin has finished his presentation. He’s going to speak for about 45 to 60 minutes, and after that, we’ve allotted approximately 30 minutes to Q and A.  Please consider attending some of our future Functional Medicine discussion group meetings, which are going to continue to be virtual through Zoom at least through the end of this year, and probably the beginning of next year. Dr. August 27th, Dr. Chris Shade of Quicksilver Scientific will be speaking about heavy metal detoxification, and he’s an awesome speaker, so that should really be good.  September 24th, please mark your calendar, another incredible speaker, Dr. Isaac Elias, on the survival paradox. October 22nd, we will do a deep dive into how to understand a GI map stool test, with Tom Fabian of Diagnostic Solutions. And November 19th, Dr. Steven Stanford Lewis will be speaking to us about some GI-related topic, yet to be decided. December we’ll be off, and then we’ll start up again in January of 2021.

                                Please join our closed Facebook page, Functional Medicine Discussion Group of Santa Monica, so we can continue the discussion beyond this meeting. Please check out my rational wellness podcast, which is dedicated to all things functional medicine. You can listen to it on your phone through Apple Podcast or Spotify, or you could watch it on YouTube and video recordings of most of our Functional Medicine meetings for the last three years can also be found on my Weitz Chiro YouTube page.  I’ve now posted over 166 episodes on my podcast, and there’s some amazing information contained in these interviews with many of the top names in functional medicine, including this week’s interview with Dr. Joel Khan on Lipoprotein (a). So, please subscribe and give me a positive review on Apple podcasts. Metagenics is our sponsor this evening, so Kailey Oogaard, my Metagenics rep, is going to tell us about a few Metagenics products, after which I will introduce our speaker, Darin Ingels, and we’ll get started. So, Kailey, let’s see.

Kailey:                 Can you hear me?

Dr. Weitz:            Yep.

Kailey:                 Hi everyone. Thanks Dr. Weitz. As Dr. Weitz said, I’m one of the local Metagenics reps in Southern California. There are about seven of us down here, from LA to San Diego, and I’m happy to put you in touch with your local rep if you would like to learn more about Metagenics, but I’d like to take this time to discuss one of our newer products, which is Hemp Advantage Plus. Hemp Advantage Plus features organic, broad-spectrum hemp extract, and a natural occurring bio-lipid, called palmitoylethanolamide, also know as PEA. PEA is an endocannabinoid-like molecule that interacts with the endocannabinoid systems, and PEA has been the subject of numerous clinical trials and studies, with results that support its clinical potential for safety and for patients with chronic pain and inflammation.

                                Studies have been conducted on chronic sciatic pain, fibromyalgia, osteoarthritis, and many other inflammatory conditions. If you’d like additional research about PEA, you can log on to the Metagenics Institute website, at www.metagenicsinstitute.com. There are lots of podcasts, research articles, and just hot topics out in the functional medicine world there. You can also contact your local rep to learn more, and if you don’t know your local rep, you can go ahead and shoot me a text. And my number is 310-321-8785. I hope that you all are doing well and I hope I get to see you all in person soon. Thanks Dr. Weitz.

Dr. Weitz:            Absolutely. Thank you Kailey. So, our special guest for this evening is Dr. Darin Ingels, and he will be joining us for a discussion on Lyme disease. He’s got a presentation for us. Dr. Ingels is a licensed naturopathic doctor in both the State of California and the State of Connecticut. His practice focuses on environmental medicine, with an emphasis on Lyme disease, pediatric acute onset neuropsychiatric syndrome and chronic immune disfunction. Dr. Ingels has published three books, including his most recent, A Lyme Solution: A five-part plan to fight the inflammatory auto-immune response and beat Lyme disease. So, without further ado, Dr. Darin Ingels.

Dr. Ingels:            Thanks Ben. All right, I’m excited to join you guys tonight. I wish we were all doing this in person, but this is the way life goes, so if you guys have questions, I think it would be best, if you go ahead and just go into the chat box and put your questions. When I get to the end of the presentation, we’ll just answer them all then. It will be easier than trying to disrupt the presentation. So, let me share my screen. Ben, you need to enable me to share my screen.

Dr. Weitz:            Let’s see. What do I do?

Dr. Ingels:           Go into the Zoom preferences.

Dr. Weitz:            Multiple participants can share simultaneously, is that right?

Dr. Ingels:           That should work.

Dr. Weitz:            Okay. Did that work?

Dr. Ingels:           There we go.

Dr. Weitz:            Okay. Couple people reminded me to record.

Dr. Ingels:            Okay, here we go. Hopefully you guys can see my screen. If there’s a problem, I can’t see the chat box, so just post it and Ben will let me know. Today, we’re going to talk about Lyme disease and co-infections, diagnosis and treatment options. I’ve got about 45 minutes plus of material, and then we’ll do some Q and A afterwards.   Lyme disease is near and dear to my heart. I’m a Lyme patient. I contracted Lyme disease in 2002 and spent three years trying to get my life back, so I know what it’s like for so many of these patients to really have to struggle with what can be sometimes a very debilitating illness. So, to start off, just a little background on what is Lyme disease? Many of you already know this, but it’s a bacterial infection, primarily caused by Borrelia species, Borrelia burgdorferi being really one of the more dominant species, and it’s transmitted primarily through the bite of a tick, specifically the Ixodes ticks, which are the deer ticks.    There are a lot of different ticks out in the world, deer ticks, dog ticks, wood ticks. The overwhelming majority of these cases are transmitted by deer ticks. Dog ticks, wood ticks and other ticks have really not been shown to be major carriers of Lyme disease. They carry a lot of other disease that can infect people and cause problems, but Lyme disease specifically is really more around the deer ticks. There is some evidence that perhaps other insects, such as mosquitoes and fleas, may transmit Lyme as well. To be honest, it’s really speculative. There’s literally just a few studies done in Europe on it. So, again the consensus is that the overwhelming majority of these cases are coming from tick bites.

Dr. Weitz:            Isn’t there a study about a mouse being involved in this too? That the tick bites a mouse, a certain type of mouse?

Dr. Ingels:            Well, ticks can bite any number of animal vectors. Mice are probably the primary carriers, more than the deer itself. We call it the deer tick, but mouse, rabbits, raccoons, any of these furry little creatures can potentially carry these ticks and potentially be reservoirs for Lyme.  So, in the early seventies, there was a mysterious group of cases of RA in children in Lyme, Connecticut. So, if you didn’t know, Lyme disease is named after Lyme, Connecticut. And juvenile rheumatoid arthritis is a pretty unusual condition. There were also several adults in Lyme, Connecticut that were also having this arthritic flare-up. So, it took actually several years. They originally thought it was a Rickettsial infection, which is a different kind of bacteria. And then they started sending samples to a guy named Dr. Willie Burgdorfer, who was a Rickettsia expert. He worked for the government in Colorado, and it took him about six or seven years to isolate that it was a spirochete, and the rule is, when you discover the organism you get to name it after yourself. So, that’s why it’s Borrelia burgdorferi, named after Willie Burgdorfer.

                                We know there’s at least five different subspecies of Borrelia burgdorferi and at least 100 different strains of Borrelia in the U.S. alone, and really more than 300 strains worldwide. This becomes relevant, because when we talk about testing, we are generally testing for one species, one strain, Borrelia burgdorferi, that’s pretty much it. So, if you’ve ever run a test through LabCorps or Quest or your conventional reference lab, they are only looking at that one specific strain. So, if your patient happened to be exposed elsewhere and they have a different strain, there is a high probability it will miss it on that test and you’ll get a negative test. Which doesn’t exclude the possibility of Lyme disease, and I’ll talk a little bit more about that when we get to the testing section.

                                And for those of us in California, which is all of us, when I first moved here, I grew up in Southern California and moved away and lived in Connecticut for almost 20 years, and moved back about two years ago full-time, I’ve been shocked at the number of healthcare practitioners, doctors that tell patients, “Oh no, we don’t have Lyme disease in California.” That is the most ignorant statement, uninformed, and if you look at, even according to the CDC, they’ve identified California for the fifth fastest growing state for the number of Lyme cases in the country.  The northern area, the Bay Area, is more endemic than Southern California, but again, we have hills, we have mountains, we have trees, we have areas where ticks do live, and we do see cases here. So, if your patient gets dismissed by another doctor, please be the one to do the diligent work and help identify it. Most of the cases, more than 95 percent, still come from New England and the central part of the U.S. However, Lyme disease has been reported in all 50 states, including Alaska and Hawaii. People travel, so even if you’re in a state like Arizona, that we don’t think about having really a lot of deer ticks, people in Arizona like to leave the heat, they travel, and they may have acquired it elsewhere, outside of the state they reside.

                                We know according to the statistics, that there’s more than 300,000 new cases of Lyme disease each year in the U.S. Remember that’s new cases. That’s not existing. That’s new, every year, so we are literally talking about millions and millions of people in the United States living with Lyme disease, many of which who don’t realize it. And in Europe, it’s about 65,000 cases a year. As you move to different parts around the world, some governments are very cognizant and recognize it. We find most governments are really blind to it and it’s overlooked. But we’ve got cases in Asia, Africa, and other continents outside of Europe and North America.

                                This is just a picture of the Ixodes tick. Out on the East Coast, Ixodes scapularis. Out here on the West Coast, it’s mostly Ixodes pacificus. Honestly, I’ve looked at pictures of both. I can’t tell the difference. They look kind of the same to me. They very much have this tear drop shape to them, with the sort of black back and sort of reddish orange lining. They look significantly different than dog ticks and wood ticks, which have a much rounder body and kind of a hard shell. If you push on a deer tick, their outside is as little softer.  Part of the reason that Lyme disease is so difficult to pick up is these ticks are teeny, weeny tiny, about the size of a poppy seed. Maybe when it’s fully engorged, it’s as little bit bigger. I can remember seeing a tick on my arm, actually when I actually had Lyme disease, I thought it was just a fleck of dirt, and I went to flick it off and it started walking, so small I couldn’t see the little legs. So, it’s a good idea to keep a magnifying glass in your office. It’s rare that you’re actually going to be able to find a tick on someone, but if you do, having something to magnify to really help identify if that’s a deer tick can be really helpful.

                                It is the number one spreading vector-borne epidemic worldwide. So, we see this all over the world. We see more cases in terms of rate than … I mean there’s still more cases of malaria and things like that, but in terms of the rate of infection, Lyme disease is still the fastest growing. And because Lyme is a spirochete, the nature of these corkscrew shaped organisms is that they can penetrate other tissues and cells a little bit different than other regular rods or other types of bacteria. And as a result of that, it can cause many different kinds of symptoms. In fact, there’s over 100 different symptoms that are associated with Lyme disease.  So, we call Lyme the great imitator, the great mimic, because it looks like so many other things. And I think that’s why it gets overlooked so often, because people think it’s an autoimmune disease. They think you have mono. They think you have a bad flu. It’s very easy to overlook it, but when you start to see these symptoms go on and on and on for a much larger period of time than what you would expect for some of these other infections, that’s where the red flag goes up that maybe it’s Lyme or some other tick-borne illness.  So, Lyme itself, Borrelia, is a shape shifter. If you see these pictures, it’s always that long corkscrew shape form. It can literally ball itself up like a slinky, and that’s called a cyst form or round body form. There’s also the cell wall deficient form and what they call an uncoiled filaments form, which just looks like kind of a long straight line. And it’s ability to shape shift allows it to evade the immune system, it allows it to penetrate other cells and tissues, and again, that’s what makes it a little bit more unique than other types of bacteria out there.

                                And the other thing about Borrelia that’s really interesting is that it has a very slow replication cycle. Most bacteria replicate about every 10 to 20 minutes, and to put it in perspective, if you get tuberculosis, microbacteria tuberculosis replicates every 15 to 20 hours, so that is much slower than every 10 to 20 minutes. And if you get TB, you go on a triple antibiotic cocktail for nine to 12 months. Well, if you look at the research on Borrelia, it replicates every one to 16 days. So, for the life of me, I can’t figure out why the recommendation has always been two to three weeks of antibiotics for an organism that may replicate once during that life cycle.  And considering the standard treatment is doxycycline, which actually is bacteria static, it’s not bactericidal, all it’s doing is stopping the organism from replicating, which means it needs to be in a replication phase to work. So, there’s a little bit of madness here that I can’t really get my head around. I don’t understand it, but this is sort of the politics of medicine and the politics of Lyme disease. But just understand that you’ve got an extremely slow-growing organism. So, as we start talking about treatment, that becomes relevant, because these courses of treatment do tend to go long term, often for many months, where it’s not like a sinus infection that you treat for seven to 10 days. Most Lyme patients are looking at many months of treatment.

                                So, I kind of break Lyme down into what I’ll call acute Lyme disease and chronic Lyme disease. This is just for simplification. In reality, there’s a lot of overlap. But your acute Lyme people, you’re probably not going to see very often unless you do primary care medicine, because these people are generally acutely ill. They’re sick. They’ve got headaches, stiff neck, fever, arthritis, neuropathy, muscle pain, fatigue, chills, lymphadenopathy, heart palpitations, shortness of breath, sometimes Bell’s palsy. The hallmark of Lyme disease is that classic erythema migrans or bullseye rash.  The CDC says up to 70 to 80 percent of people who get Lyme disease get that rash. If you look at the literature, the literature suggests it’s probably closer to 40 percent, and those of us in clinical practice, who work with a lot of Lyme patients, it’s probably less than 20 percent. So, if you have a patient who has a bullseye rash, do not pass go, do not collect $200. It’s absolutely Lyme. There’s nothing else in the world that causes that classic rash.  The absence of a rash, though, doesn’t exclude the possibility of Lyme disease. Whatever you learned in medical school, don’t let that be your guide about if someone does or does not have Lyme. The rash itself is not a reliable marker, and at this point, since I’ve been in California, I pretty much hardly ever see a bullseye rash. Now there are other rashes associated with Lyme that are not the bullseye rash.   So, when you see a flat rash that’s red and spreading, that would still make me nervous, even if you don’t see the central clearing. I get a lot of messages from people, especially on social media. They take pictures of, is this a bullseye rash? They freak out. Remember when you get bit by a mosquito, you will get a histamine reaction, and histamine reactions do not always cause a uniform redness spreading away from the puncta, so people will often mistake it, because they see a little bit of clearing, thinking it’s a bullseye rash.   Your biggest thing is when you get a typical insect bite, it usually goes away with 24 to 48 hours. At least the redness goes down, the swelling goes down. Mosquito bites, specifically, get raised. Tick bites are generally flat. They don’t get raised. You can usually feel another insect bite, if you get stung by a bee, you get bit by a mosquito, usually you will feel it. Ticks have a little bit of anesthetic in their saliva, so when they bite you, you don’t feel it.

                                So, that’s just a couple of quick, little ticks to differentiate, is it just another insect bite, like a spider bite or a mosquito bite, versus a tick bite? Most erythema migrans rashes are flat, they will spread. When I got bit, my rash spread for almost eight weeks before it started to dissipate. So, that is pretty common.  So, here’s a picture of the classic bullseye rash, red in the middle, central clearing, another red ring. And again, if you were to see it early, it might be small, but it will continue to spread. And again, mine got to be almost 18 inches by the time it was done spreading.

                                Symptoms can occur anywhere within three to 30 days following a tick bite. CDC, again, says up to 70 percent of people get the EM rash; as I just mentioned, that’s not always the case. Most people have no recollection of being bit by a tick. These ticks actually like the dark, warm, moist areas of the body. So, behind the knees, under the armpit, the belt line, under the butt cheeks, hairline behind the ears. So, often they go to places that people don’t necessarily see. So, if you’re out hiking in the woods, you like camping, you like outdoor activities, make sure that you do thorough tick checks, particularly if you’ve got kids. It’s very easy to overlook, and remember they’re small, so just make sure you’ve got a place that has good light and you can really do a thorough inspection.  So, I tell parents, if they go camping, strip your kids naked, go through every crack and crevice. They don’t like it, but it’s the safest way to ensure that they don’t get exposed. As I mentioned again, the symptoms are vague, look like a lot of other things, and misdiagnosis is very, very common.

                                So, if people miss that window of getting diagnosed to acute Lyme, it can progress more into what I’ll call chronic or persistent Lyme. As a political note, the government refuses to acknowledge that chronic Lyme exists, even though there’s multiple studies out of Johns Hopkins University showing otherwise, and millions of patients living with chronic Lyme. But their feeling is, three weeks of antibiotics and regardless of how you feel, you’re done. Whatever you’re dealing with, they now call it post-Lyme syndrome, but they don’t think it’s Lyme disease. They think it’s just something else, so kind of odd.

                                So, again, you can get the fatigue, but then you’re going to start getting more gastrointestinal problems, more neurological problems, memory loss, cognitive impairment, neuropathy tends to get worse and spread, sensory distortions, which is really a type of neuropathy, but burning sensations is a very common complaint, or this feeling of creepy crawlies under the skin, and wandering joint pain. Wandering joint pain is another hallmark of Lyme disease specifically. There’s nothing else we know in recorded literature that causes wandering joint pain.  What that means is, one day it’s my left shoulder, then it’s my right knee, then it’s my right shoulder, then it’s my left ankle, and it just seems to keep moving. If you’ve got rheumatoid arthritis or other types of autoimmune arthritis, they tend to be the same joints. Now they can come and go in terms of their intensity, but they tend to be pretty consistent. But with Lyme, it can be completely different joints altogether.  Light and sound sensitivity, dizziness, vertigo, sleep problems, general rheumatism. There is a thing called Lyme carditis, which can cause mitral-valve prolapse, heart block, heart palpitations, chest pain. So, I always send someone I’m suspicious has Lyme or if I know they have Lyme, we’ve already diagnosed it, if they’re complaining of chest problems, I always send them to the cardiologist, get a cardiac workup and make sure they don’t have Lyme carditis, because that can become very serious.  Balance, coordination problems, people say, all of a sudden, I’m clumsy, I trip a lot, I drop things. What I call newly acquired dyslexia, where all of a sudden people start transposing their numbers, their letters, whether they’re writing or typing. The brain has an element of inflammation. I think it is a type of encephalitis that ensues, and that’s what triggers a lot of these neurological problems.  And finally, we’ll see a lot of endocrine disruption, particularly underactive thyroid, hypothyroidism following Lyme is a pretty common occurrence, well documented in the literature. And sometimes we’ll see women having menstrual problems, adrenal issues and so forth.

                                So, as I mentioned, it’s the great imitator, looks like a lot of these things; autism, multiple sclerosis, ALS, chronic fatigue, fibromyalgia, mono, herpes 6, parvovirus, RA, lupus, name any autoimmune disease pretty much, and there is some association with Lyme. And if you look at this list, a lot of these things are descriptions. They don’t really tell you why. Rheumatologists, to their credit or to their fault, can help identify that there’s an inflammatory process going on in the body, but I don’t think they’re terribly good at telling you the why. And these people who get these labels, and say, “Well, I’ve got a diagnosis of MS.” You say to the neurologist, “Well why?” “Well, I don’t know. That’s just the way it is.”

                                Well, it makes a lot of sense, and again, we’ve got as lot of ample literature showing that microbes are major triggers for autoimmune disease, not just MS in particular, but Klebsiella’s a major autoimmune trigger, strep is a major autoimmune trigger, so we have a lot of microbes that can do that, and Lyme just happens to be really effective at triggering autoimmune problems.  And a lot of these autoimmune issues don’t fit the bill of what you typically think of with lupus and rheumatoid arthritis.  Often, the CRP is normal, rheumatoid factor is normal, ANA is normal.  I often do see the ANA will come in and out of being positive with people if you measure it over time. That’s pretty common with Lyme, but it’s always very low titer, and you do all the follow-up tests and everything comes back negative. So, it doesn’t really point to any one autoimmune problem, but again you will see that with Lyme.    So, again when you see these patients that have these chronic labels without an understanding of really why, it should be probably at least part of your differential diagnosis to test appropriately and just make sure that tick-borne illness is at least part of the underlying cause.  We all practice root medicine, we want to get to the cause of these things, and I’ve been shocked at the number of people I’ve seen who have been to 50 doctors, and nobody ever bothered to test them for tick-borne illness, and then we test and it lights up like a Christmas tree and you treat them and they feel tremendously better.

                                We’re focusing really on Lyme on this talk, but I at least want to mention that a lot of these ticks that carry Lyme do carry other infections. So, here’s just a short list of things that are pretty common. Babesia, which is a blood parasite, it’s a cousin of malaria. Bartonella, which we typically think of cat scratch fever, but it can be transmitted through a tick bite. Anaplasma, Ehrlichia, Mycoplasma, Rickettsia, Rocky Mountain spotted fever. Powassan virus, which has shown up in the last handful of years as a very deadly virus, unfortunately. We’ve seen most of those cases out in New England. Colorado tick fever, Heartland virus, Tularemia, Brucella. Every time I go to a Lyme conference, I swear this list of things that ticks transmit gets longer and longer, and it’s exhausting when you’re trying to do as workup with patients.  So, just keep in the back of your mind that if you’re suspicious of a tick-borne illness, you probably want to test for the gamut. I will tell you I test for the things I see most commonly first. We see what happens, and then I do a second-tier testing. Instead of doing 50 tests at once, let’s take the top 10, the top 12, because those are the most likely ones anyway, and then if we run into a wall, then we can go back and look at all the other ones.

                                So, why is there a rise in Lyme disease? Well again, worldwide, we’re seeing an increase, not just in Lyme, but other insect-borne illnesses. We’ve had more Dengue virus. Remember Zika virus? That freaked everybody out for a long time, and it kind of just magically disappeared. Chikungunya virus in Central South America. Of course now, SARS-COV2. So, we’ve got these different infectious agents, particularly viruses that have been emerging for a number of different reasons, and really the World Health Organization attributes it to climate change.  I didn’t put the list, or the reference here, and I apologize, but if you want to message me and I’ll send it to you. But the World Health Organization published a paper. It was actually pretty good, and basically because we’ve got a warmer climate, that allows, ticks in particular need the cold to get killed off, and New England, the central part of the U.S. has been warmer overall. They’re not getting those cold, cold winters to really kill off the ticks, and therefore the tick population continues to explode. Birds are migrating further away than they used to before, so they can carry these ticks to other places.  [Here is a paper with this conclusion: “Ticking Bomb”: The Impact of Climate Change on the Incidence of Lyme Disease]

                                There was one study, it was done in Canada, where they found that birds in the U.S. can get as high as the Yukon, and so they can go pretty faraway, and therefore, these birds have the ticks on them, they go somewhere else, carry the tick. Now the tick is implanted somewhere else and it just starts a new tick population. So really, climate change is to partially blame for all of this.

                                So, the diagnosis of Lyme, I will tell you this is extremely controversial. The CDC has a very hard line on it, and understand that, when we talk about testing, the testing that is available out there through commercial labs was never designed to be diagnostic, ever. It was designed to monitor people that had known Lyme disease. So, once we discovered Lyme back in the early eighties, they developed a test not long after, and again, they wanted to monitor people who had the bullseye rash, the high fever, all the classic symptoms, and they wanted away to kind of monitor and see how their progress was going.  So, if you go to the CDC’s website, they will tell you today that Lyme is a clinical diagnosis. It’s based on signs and symptoms and particularly people that live in endemic areas, and you kind of have to rule out everything else. You’ve got to rule out autoimmune disease. You’ve got to rule out other neurological issues, if they’ve got neuro symptoms. So, there’s a whole process of trying to pinpoint, is it Lyme? And as best, what these tests tell you is, has your patient been exposed. It does not tell you if they have Lyme disease.

                                I can promise you if we tested everybody in this country, we would find a huge number of people show evidence of exposure who have never had a single symptom. So, it’s kind of like SARS-COV2 right? We’re testing all these people that have no symptoms. I think there’s an analogy between Lyme disease that’s kind of scary, but very, very close, and it’s true for the Lyme testing.  So, as I go through this, I will explain a little bit why that’s so. The typical CDC criteria is you run a screening test, which is an elisa test. It’s just an antibody test, IGG and IGM antibodies. If that test is positive it flexes over to a western blot, also looking at IGG and IGM antibodies. So, to call a test positive, you’ve got to have five out of 10 IGG bands or two out of three IGM bands. And that’s what they call a positive test.

                                And in 40 years of research and understanding more about these antibodies, some being very specific to Lyme, some of them being non-specific, I don’t know why we’ve never changed that criteria, and really just focused on the Lyme-specific antibodies. And the way I think of it, if you’ve got a Lyme-specific antibody, and it’s there and it’s strong, it’s kind of like being a little pregnant. I mean you are or you aren’t. What difference does it make if it’s one or two or three or four? Having evidence you’ve had exposure when you’ve got clinical symptoms is hugely important and relevant. So again, keep that in mind.

                                Some of the pitfalls of this test is a lot of Lyme patients are [inaudible 00:29:06] negative, which means they just don’t produce antibodies. Now, is it because they have an immune deficiency? Is it because they’re so far away from their initial exposure that their immunity has naturally waned with time? There’s any number of reasons that people don’t make antibodies or don’t make an adequate response, and as a result of that, this test might look negative.  We don’t have good technology to date that measures Borrelia directly in the body. There was a lab in Pennsylvania that was doing a Lyme culture for a while. They got shut down by the FDA, so we don’t really have any direct Borrelia testing in the body. And for an antibody to be considered positive, it has to be at least 60 percent of the control. And I was a former microbiologist, medical technologist before I was a doctor. I used to do these western blots for a living, and then one thing that is very odd is that when you run pretty much any lab test out there, if you’re running a CBC or a chem panel, there’s always a low, a medium and high control to represent that there’s a gradation of what represents normal.

                                And with a western blot, there’s not. It’s black-white, yes-no. So, they set this threshold at 60 percent. What that means is that, the CDC’s perspective is that if you’ve got Lyme, you make a ton of antibody. You make a lot of it, and if you were to do this test within maybe a few weeks to maybe a month and a half or so of someone being exposed, you might expect that there would be a decent antibody response. But if you learn in immunology, over time, it’s that immunity wanes. If your exposure was a year ago, three years ago, 10 years ago, I wouldn’t expect to have the same level.   So, it doesn’t reflect the nature of how antibody levels can change, and that’s why I said earlier, if you’ve got Lyme-specific antibodies, I think that’s relevant, in conjunction with a patient in front of you that actually has the clinical symptoms.  So, most conventional labs don’t test for the breadth of antibodies associated with Lyme, so you can also miss people. There was a Lyme vaccine that was available, back in, I think, the nineties. It went off the market. It was out for maybe three years. Anybody who would have gotten that vaccine would test positive for the 31 antibody. So reference labs intentionally leave it off, because anyone who might have had the vaccine, they don’t want to call the false positive. But we now know that A) there’s not that many people who got the vaccine, particularly now, and that 31 antibody can be very specific to Lyme.

                                So, that’s where if you’re using labs that specialize in Lyme testing. I use specifically a lab out of New Jersey called Medical Diagnostic Labs. I like them because they do very comprehensive tick-borne testing, and the best thing is they bill insurance. IGeneX up in Palo Alto, California is also a great lab. They do fantastic testing. The only down side is outside of Medicare they don’t bill insurance, so it just gets to be another out-of-pocket expense for your patients.   It can also take up to six weeks for people to produce antibodies, so depending on when you do the testing, if someone truly, you thought, had acute Lyme, if you test too early, it may just be that you missed that window yet. They haven’t made enough antibodies to show up as positive. So, I generally, if someone has a suspicious tick bite, I will wait at least three or four weeks before I do a blood test, just to make sure we hit the right window of actually picking up a positive.

                                ILADS has a different criteria. I don’t know if you guys know, the International Lyme and Associated Disease Society, they have their own criteria, where again, it’s more of kind of I explained, looking at these Lyme-specific antibodies and not really following the hard line five our of 10 IGG or two out of three IGM antibodies that the CDC sets. And again, really based more on clinical symptoms, but again, you do have to rule out other inflammatory, other autoimmune conditions as part of your process.

                                So, let’s jump in a little bit to talk about treatment. You’ve gone through this whole process. You’ve got this patient who’s got clinical symptoms. And I didn’t put a slide, but I should mention it, Dr. Horowitz, Richard Horowitz is kind of a Lyme guru in the U.S. He has a questionnaire called the MSIDS questionnaire. He has actually validated this questionnaire in clinical studies and found it is a reliable marker on the probability your patient has Lyme.  So, if you have a patient that just can’t afford the testing, or for any reason, maybe that’s not available to them, you can always have them, it’s a free download online, they can take the questionnaire, and if they score high on it and they have the clinical symptoms, you can probably feel pretty good and I think you’ve got some teeth in justifying your treatment, because again, this questionnaire actually has been validated in clinical studies. So, there is evidence that this is a reliable way of identifying those people that have been exposed to a tick-borne illness.  [Here is the Multiple Systemic Infectious Disease Syndrome questionaire: MSIDS.]

Dr. Weitz:            One more time, the name of that questionnaire.

Dr. Ingels:            It’s the MSIDS.

Dr. Weitz:            Okay, thanks.

Dr. Ingels:            So, first and foremost, I think diet plays a huge role. I know we’re hearing this again with SARS-COV2, that people who are overweight, obese, diabetic, they are some of the highest risk people of getting SARS-COV2. I think these are also the highest risk people of getting Lyme disease. So, getting people to start eating healthy, nutritious, nutrient-dense foods is important. However, we know from the research that eating what I call an alkaline diet, I mean I didn’t start that. There’s plenty of books written about an alkaline diet, but it’s not really a diet, in terms it’s not calorie-restricted. It’s not a diet to lose weight. This is a way of people learning how to eat.  And what I like about it is that it doesn’t restrict calories. It’s not really that restrictive. So, people can actually follow this. Some of the diets out there, like Keto for a lot of people, is really challenging. They can’t stick with it. This is a diet I find people will actually stick with, and the alkaline diet is based on the premise that as you eat certain foods and they break down in your body, they become alkaline-forming. So it’s really about shifting your tissues, your cells to be more alkaline.

                                I mean, with the exception of the skin, the stomach, the bladder, and for women, the vaginal area, which are very acidic, to protect against outside invaders, by and large, the rest of your body is mostly alkaline. So, we know that the enzymes systems work best, cell repair works best in really an alkaline state. So, it’s not about the pH of the food. It’s how the food breaks down in your body.  So, for example, lemons, if you squeeze lemon juice on pH paper, it’s very acidic. However, when you drink lemon juice, it actually breaks down and makes your body very alkaline. We’re not taking about blood pH by the way. I get this from time to time, “Well blood pH is very tight.” That’s stupid. We’re not talking about blood pH. Yes, you’re right, blood pH is 7.2 to 7.4, up or down you’re dead. So, this has nothing to do with changing blood pH at all. This is really about changing cellular pH, and again there’s a lot of studies out there that validate this.

                                So, what I recommend for people when they’re transitioning their diet, just go ahead and buy that pH paper at the pharmacy. It’s really cheap, and 30 minutes after they eat, you have them go pee on the strip, and we really want to see their urine pH above 7.2. Some people like doing saliva pH. I find salivary pH is a bit more variable, because of all the other microbes in the mouth, but if that’s easier for people, that’s another way. But I do like the idea of doing urine pH better.

                                Just talking about some of the diets, I’ve really broken this down to three categories for people. The first category are foods that can be consumed as often as people like. I won’t go through all of these. I’ll let you read through it, but basically it’s mostly vegetables. Most vegetables, thank goodness, and seaweeds, are very alkaline forming. Avocados, the citrus fruits, by and large, sweet potatoes and so forth.

                                Some nuts and seeds, there are some grains, legumes, some oils, some beverages. I deviate a little bit away from the Gundry work about lectins. My personal opinion, I don’t think lectins are as pro-inflammatory as suggested, considering most of the world they’re staple food are high-lectin foods, and yet autoimmune disease allergies are extremely low in these countries. My clinical experience with Lyme patients is that they eat legumes, and outside of the normal farting, they actually do pretty well. So, I think that’s okay.

                                Category two are foods that I like to restrict to about 20, 25 percent of their dietary intake for the week, and you’ll see this is a lot of fruits, some grains, like rice and so forth. It’s all the animal proteins, meat, eggs, fish, some of the oils. And the reason is, when these foods break down is they’re either neutral to even slightly acidic. So, that’s why it’s not that they can’t have it. We just don’t want it to be the bulk of their diet. So, I think if you kind of go back to our true paleo forefathers, we didn’t kill every day. We killed when we could, so we still foraged off the land, ate mostly plant-based foods, and then had some mixed in animal protein, and I think this kind of reflects that a little bit better.

                                And people might say, “Well do I have to do 20 percent? What if I do 30 or 40?” And look, check your urine pH, and if you can maintain your pH in an alkaline state, then it’s fine. This gives you the opportunity for each of your patients to play around with what works best for them. There is no hard and fast rules here. Again, this is just my experience in working with Lyme patients that this works very well. It’s sustainable. It’s nutrient-dense, and it gives them all the things they need to heal.

                                And the last part here is really just foods to avoid. So, these are dairy products. There’s probably a million reasons we could talk about why to avoid dairy products, dried fruits, some of the nuts listed there, any junk food, artificial foods, processed foods, condiments, oils and beverages. The next one that gets a lot of my Lyme patients it coffee. Coffee is very acid-forming. Again, the pH of coffee itself is like two or three right? It’s very acidic.

                                So, I do have some people that will drink a little bit of coffee every now and then. And again, if they’re eating so well with the rest of their diet to balance it, then it’s fine. So, for your heavy coffee drinkers, maybe have them scale back. Someone told me that there is a low pH coffee. I have yet to find it yet. If it exists, great. Again, the easy way is just check urine pH and make sure everything is okay.

                                Beyond getting the diet, get the gut in good working order, the next step is really start targeting the Lyme itself, or some of these co-infections. So, I want to just talk through some of the herbal protocols that I use. I didn’t really talk about it, but I’ll just give you a quick synopsis. Antibiotics early on in Lyme disease can be very effective, and I’m certainly not opposed to it. However, when you get further and further away from your exposure, the odds of antibiotics being effective go down.

                                And I’ve seen patients literally have been on antibiotics for six years, eight years, 10 years, 12 years continuously to treat Lyme disease, and they have not improved. And you have to draw a line in the sand of when do you get to that point when the treatment is worse than the condition? And when you’re on long-term antibiotics, I guess depending on which ones you’re on, obviously you’re disrupting your normal gut microbiome, which you need to have a healthy immune system, and there’s also a greater potential to damage your mitochondria. And we know that Lyme itself can damage mitochondria.

                                So, for your Lyme patients that are tired, have problems with wound repair or tissue repair, if the mitochondria don’t work well, it’s going to be really, really hard to get over that hump, if they’re on hardcore antibiotics. With antibiotics, you’re really just targeting killing the bug or at least stopping the bug from replicating.

                                With herbs, herbs have so many other components in it, that they’re anti-inflammatory, they help promote better circulation, they help boost your immune system. So, we get multiple functions out of herbs that we just don’t get with antibiotics. So, a lot of potential upside, and there’s this myth out there. Let me dispel it very quickly. “Well, they’re not as strong as antibiotics,” and that’s not true at all. There is actually a handful of studies out there looking at herbs compared to antibiotics, albeit in vitro, and across the board, the herbs tend to be more effective than the antibiotics, and can kill Lyme in multiple forms, where antibiotics typically only address Lyme when it’s its uncoiled normal spirochete form.

                                So, the first protocol I want to talk about was developed by a Dr. Lee Cowden. Dr. Cowden here is a cardiologist out of Dallas, and he started working with a company called NutriMedics. They’re based out of Jupiter, Florida, and these herbs are all wild crafted out of Peru, down in South America and the Amazon jungle. So, I like these herbs for a lot of reasons. Again, clinically, they can be very effective. If you guys want to do a little bit more research. There’s a doctor named Eva Sapi. It’s S-A-P-I. She’s at the University of New Haven and she’s published a handful of studies looking at these herbs, specifically in vitro with Lyme against different antibiotics, doxycycline, rifampin, a couple of others, and again, she found that the herbs were actually more effective.

                                So, there’s some evidence that these are effective. Clinically, I’ve been using these for almost 20 years. I find they work really well for patients. These are liquid tinctures, so the other nice thing for your really sensitive people is you can do drop doses, and titrate up to a point where you start to see clinical benefit, without getting any kind of die-off reaction, Herxheimer reaction, or other side effect.

                                Dr. Cowden’s protocol himself, the way that he has it structured is that every month he kind of changes the protocol, the concept being, if we keep confusing the bug, maybe it won’t adapt. We don’t actually have any evidence that this organism can become resistant to herbs. It’s a little bit different than antibiotics, because herbs aren’t used nearly with the frequency of antibiotics. So, that has not been my clinical experience, and when I looked at Dr. Sapi’s work, there was really just a few of these herbs that were doing the heavy lifting in the whole protocol.  So, what I have listed here are all the herbs that he includes in his protocol, and then the ones in bold are really the ones that I use most often.  The combination is designed to, again, kill the microbes, support detox pathways, clear metals, basically make the terrain a more hospitable environment to do what you want to do. It’s a five to nine-month protocol, again of constantly changing herbs and again, they’re liquid extracts, so drop doses are possible. I use this with a lot of my kids, just because they don’t taste horrible, they’re drop doses, you can mix in water or a little bit of dilute juice, and again, it gives us a lot of flexibility to adapt it.

                                This is just my protocol on treating acute Lyme disease. I’ll let you read through the slide, but there is a difference between, if you’ve got someone who’s been exposed fairly recently, versus someone you think has more persistent Lyme. With acute Lyme disease, we basically go in at a fairly high dose to try and hit it hard right off the bat, and we’ll typically do a treatment for at least six weeks. Six weeks is the minimum. Because it’s a slow-growing organism, we don’t want to short ourselves. So, at least six weeks, and at six weeks we re-evaluate, how are you feeling. Sometimes we’re on longer, but really no less than six weeks.

                                For persistent Lyme disease, I just start at smaller doses and titrate up slowly. When people have had it longer, they’re disposition to Herxing or getting that die-off reaction goes up. So, if you just start slow and work your way up, drop by drop, again, it just minimizes that impact. Herxing with this particular protocol is not that common. Maybe 10 to 15 percent of people, where with antibiotics it’s much, much higher. Again, it’s a much more tolerable treatment.   And again, I just have them titrate up one drop twice a day every three or four days. If there’s really no improvement in the way they feel, up to really 30 drops twice a day. They do have one formula here called Burbur or Burbur pinella. This is to help mitigate the detox reaction. If people start to Herx, this particular formula, they can take 10 drops every 10 minutes every hour, as frequently as they need to. There’s nothing toxic about it. It really is to help open up those detox pathways, and sometimes it really helps curtail that die-off reaction.

                                So, the advantages of this protocol, it’s really easy to administer, clinically it works and it’s pretty cost-effective. Those four tinctures I mentioned, for most people, at max dose, 30 drops twice a day will last them about a month. It will cost about $135 for their cost on all that, so it’s not terrible.

                                The disadvantages, again, you can get Herx reactions. As I said, they’re not really that common, but they’re more common than with some of the other protocols. It is a long, potentially long-term treatment. It does require multiple bottles and dosing schedules, so it’s a bit more labor-intensive, especially when people get to the higher doses. They pour their glass of water, and then they grab the one bottle and they count out 30 drops, grab the next bottle, count out 30 drops, and so forth. So, for people who hate counting drops, they don’t like it. But aside from that, it’s actually pretty simple.

                                The other protocol I want to talk about is developed by Dr. Zhang. He is a Chinese medical doctor and licensed acupuncturist in New York. When I had Lyme disease myself, after having been on antibiotics for nine months, I went and saw him, and after being on his herbs for three to four weeks, I was 80, 85 percent improved. So, the proof was definitely in the pudding with me, and I’ve since used his protocol. In fact, it is my primary protocol for Lyme patients, and I’ll talk about, again, the advantages and disadvantages. There is one major disadvantage to this protocol, and that’s cost, but it is the most clinically effective protocol that I use with my Lyme patients.

                                In Chinese medicine, they don’t use herbs singly. These are all formulas, so each one I’ve listed here, even though I’ve listed an herb, like artemisia, it’s actually a formula with artemisia, a formula with houttuynia and so forth. Artemisia is a well-established antimicrobial, as is houttuynia. Circulation P, as the name suggests, helps promote better circulation, breaks up immune complexes. Coptis is an herb they’ve used in Chinese medicine for years, as an antimicrobial. Cordyceps is a medicinal mushroom to help boost the immune system and adrenals. Pueraria is an herb they use a lot, actually, for a lot of sinus infections, but it also helps open up the blood vessels. It’s great for brain fog.  R5081 is to help boost the immune system. BAIM is an anti-inflammatory formula, so that’s for inflammation. And allicin, which is a garlic extract, is also a very potent antimicrobial. I don’t really use the allicin much anymore, only because of the social issue that it makes people reek and smell like garlic all day, and they hate it. So, I used to take allicin and my patient would just look at me like, “Dude, did you just have a pizza in here?” So, there is this social issue around it. If people don’t mind it, it’s very effective, but I don’t use it as much, because most people are still functioning in the world and they don’t like smelling like pizza.

                                The goal of the protocol, again, treat the infection, improve circulation, reduce inflammation, improve detoxification, boost the immune system. I will use actually all of these protocols. All my protocols, I actually give a minimum of two months, especially if it’s chronic. Six weeks if it’s acute, two months if it’s chronic. At two months, if we haven’t seen the needle move at all, then it’s time to move on and try something else. But I tell all my Lyme patients that have had it for a long time, anywhere from three months to a year is normal treatment. Sometimes it’s longer, so just kind of prepare them mentally that they’re in for the long game in most cases.

                                Here’s my protocol for acute, for Dr. Zhang. Again, I’ll let you read through that. And by the way, if you guys want copies of these slides, just message me and I’m happy to send you a .pdf of all these slides.  And then for persistent Lyme disease, with the Zhang protocol, there’s not as drastic of a difference. There’s just a little bit of a difference in the the types of herbs I use. I use coptis initially for acute Lyme disease. I don’t use coptis as much for chronic Lyme disease, because if they’re on it longer, it has a greater disposition to disrupt the gut microbe biome, so that’s really the big difference between the two.

                                Advantages, again, clinically beneficial, Herx reactions are actually not that common. I think those combination of herbs actually work well to offset any potential side effects. The disadvantage is it’s kind of of difficult to administer, because you’ve got to take a lot of capsules. Each formula is one capsule three times a day. Some people are taking five or six of his formula, so 15 to 20 capsules a day. And when they’re already taking a lot of other supplements, it just starts to add up.  So, a lot of people like the Cowden stuff, because at least it’s not capsules, they can drink it. In this case, these are capsules and some people prefer it. So, you can just talk about your patients, and gain, as I mentioned earlier, the biggest downside is just cost.  Patient cost on these herbs run about $500 or more a month. So, for people who might be on a budget, this may not be the best option, but if money is not the limiting factor and they don’t mind swallowing capsules, this is really my go-to protocol.

                                There are other herbal companies out there. Byron White is an herbalist. He’s developed different formulas. The biggest difference is that his formulas are really based on what you know your patient has. So, if they have Lyme disease they get AL Complex. If they’ve got Babesia, they get A-BAB. If they have Bartonella, they get A-BART. So, each one of his formulas are really targeted towards the bug. He also does have formulas for detox and so forth, so that one is not so much a protocol as you the practitioner picking and choosing what you think is appropriate for that patient. These herbs are very strong. Herxing is extremely common with these herbs, so we use teeny, tiny doses of these herbs. They are liquids; they’re tinctures.  So, again, if you’re going to use these, have them start really small, one drop a day, one drop twice a day. Go up very slowly. Most patients don’t tolerate more than six to eight drops twice a day. So again, it’s very concentrated herbs and they pack in quite a punch. Again, these therapies are really targeted towards the organism and just a little bit different than the Cowden stuff.  Advantages again, clinically it works for some people, very easy to administer, because usually there’s less product, less drops. Disadvantages is Herxing is pretty common. Again, it’s still long-term treatment. And each bottle is pretty expensive. Each bottle to the patient is around $100, so if they are getting multiple bottles, that can add up pretty quickly.

                                Other herbs that I at least want to mention. Steven Buhner has written two excellent books on treating Lyme with herbs. He’s an herbalist. I highly recommend picking up his books if you’re interested in using herbal medicine in your practice and you already don’t. He uses Japanese knotweed, Cat’s claw, andrographis, wireweed, yellow dye root. Hopkins actually published a study earlier this year looking at, I think, it was 17 or 19 different herbal extracts, and just looked to see which ones were most effective in treating Lyme. And Japanese knotweed and cryptolepis were actually at the top of that list. So, good evidence that these herbs work well as well.  The problem with the Buhner protocol I had at least early on is that he never had one company that made all the different herbs, so you, as the doctor and the patient, had to go find different companies that made each individual one and put it all together. So, it was just kind of labor-intensive to get it put together, but now I think there’s a couple companies that make everything. I think Research Nutritionals makes a lot of these herbs and so forth.

                                Beyond Balance is another great company. I use a lot of their herbs. It’s a little bit more akin to some of the Byron White stuff, that there are herbs that are developed by Susan McCamish, who is an herbalist, and there’s one for Bartonella. Actually, there’s I think three for Bartonella, two for Borrelia, three for Babesia. So, there’s a couple of different formulas. A lot of herbs for detox and those kind of things, so I like them a lot. The other big thing with their herbs, to be aware of, is that all of their extracts are in glycerine. Most other companies when they make tinctures, they put them in alcohol. If any of your patients are using disulfiram to treat Lyme, they have to stay away from alcohol. They get really sick, so you don’t want to use any of these tinctures that contain alcohol, if your patients are on disulfiram, but you can use Beyond Balance, because they’re in glycerine and it’s perfectly safe.

                                And there’s a lot of other herbs out there, again, to help support the immune system, have antimicrobial effects. They’re anti-inflammatory, help improve circulation, reduce pain. So again, if you look at the fundamental aspect of what these herbs are doing, there’s a lot of overlap between these different protocols.

                                Breaking down biofilms, another important aspect of treating Lyme, a lot of bacteria in your body make biofilm. That, by itself, is not abnormal. In fact, it’s essential for these bacteria to survive. It so happens that Lyme is exceptional, or Borrelia is exceptional at making biofilm. So by breaking down that biofilm, it’s easier for us to, whatever we’re using as our therapy, plus your own immune system, to actually get to the microbe. And if you look at some of the studies on biofilm, you have to use up to 250 percent the amount of drug to get the same effect when biofilm is in place versus when it’s not in place.   So again, biofilm itself is not abnormal, but we do want to help break it down to make our treatment more effective. There’s a lot of enzymes on the market that break down biofilm. I use a lot of serrapeptase. I use nattokinase. I use lumbrokinase. I know they have different price points. I think if you look at the research on cardiovascular disease and the fibrinolytic effect of enzymes, lumbrokinase is the most effective by about tenfold over nattokinase. Serrapeptase is probably somewhere in between. But lumbrokinase is an excellent biofilm disruptor, and when we think about biofilm, it’s not like popping a balloon. It’s really dissolving, so it’s a different process. When they say biofilm busters, again, we’re not just popping it. It’s just really breaking it down.  I kind of have a discussion with patients about what they feel comfortable with, a bottle of nattokinase is probably $20 and change. Serrapeptase is probably around $40. Lumbrokinase is about $100. So again, if it’s a cost factor, lumbrokinase may not be the best option, but it does work quite well. Interface Plus is a product from Klaire Labs that has EDTA and serrapeptase in it. I’ve used that quite a bit and it works pretty well for people too.  The trick to [inaudible 00:55:24] all these biofilm disruptors is you do want to get these enzymes between meals, so we don’t want them to become digestive enzymes for their food. We do want them to break down their … to get absorbed into the bloodstream without food.

                                Coconut oil itself is actually a natural biofilm disruptor. I don’t ever really give it as a supplement. I just tell them, just use coconut oil in your cooking and use it on your food, and most people can get a decent amount of coconut oil in that case.

                                N-acetyl cysteine, NAC, this is an amino acid that we use a lot to break up mucus in the body. It does help break up biofilm. 200 to 600 milligrams TID. Just be aware if you’re going to use NAC long term, it can deplete zinc and copper, so make sure they’re supplementing with those. And also make sure you don’t ever give NAC to anyone who’s got a stomach ulcer. It will make them significantly worse.

                                Low-dose immunotherapy, this was developed by Dr. Ty Vincent. If you guys haven’t been exposed to LDI, I know there’s a handful of us here in Southern California, I know Dr. [inaudible 00:56:23] has been using LDI. We use LDI, and the concept behind this is that, if your immune system starts treating the organism as an antigen, sorry as an allergen instead of a pathogen, that changes the part of the immune system that gets engaged. And that’s what really triggers these autoimmune reactions, so we want to alter the way the immune system is reacting to these bug. We want to down-regulate, really that TH2 dominant response that drives allergy and autoimmunity. So, we don’t wasn’t to interfere with TH1 that’s going to go right after the organism and eradicate it. And we find that that’s exactly what this does, is it seems to modulate that reactivity.

                                It’s based on the concept of molecular mimicry. There’s something in the molecule that’s similar to our own tissue, so in the immune systems effort to get rid of, in this case Lyme disease, it actually starts cross-reacting with your joints, your brain, your nerves. When I was writing my book, I came across all these references showing how Borrelia targets these different human cell tissues, and it just makes a lot of sense of why we get this broad scope of different systems, because again, it does target those different tissues.

                                So, again, this is a way to try and help modulate that immune response. The goal really is to promote tolerance to the offending antigen, using homeopathic doses of nosodes. So, if you guys aren’t familiar with homeopathy, a nosode is basically a homeopathic microbe. They take strep, they stake staph, they take whatever it is, it’s been irradiated, it’s killed, it can’t reproduce, it can’t cause disease, and then you just dilute it out in homeopathic dilutions. And then we mix it with an enzyme called Beta-glucuronidase, and this enzyme was found actually kind of by mistake, that whatever you mix it with would actually help build immune tolerance to it.

                                LDI stems out of another therapy called LDA or low-dose allergy therapy. It used to be called before that enzyme potentiated desensitization, and it was a way of treating allergies, like food allergies, mold allergy, pollen allergy, dust, dog and so forth. And so, Dr. Vincent had been doing LDA, kind of said, well it makes sense that what’s happening with microbes is very similar to what’s happening with these other allergens. So, he just started experimenting with different nosodes, and found clinically it was working really well, and we’ve now been doing it for six or seven years, and there’s maybe a couple hundred doctors around the country that have trained with him on doing it.

                                Clinically, I have found for a lot of my patients it has been a game changer in their Lyme treatment. If you’re ever interested in learning this, I can get you the information to contact Dr. Vincent. He’s got some online YouTube videos you can watch for free. He does have a training course coming up in September that’s going to be virtual. It was supposed to be in Hawaii, but travel right now is almost impossible, so it’s going to be virtual, and you can go through and get all the details on how to do this in your practice. It’s a fairly easy thing to utilize. There is an art to it, where you’ve got to learn how to figure out where to start people with their doses. Generally, kind of like, if you’ve got a sensitive person, you’re starting them on a drug, you start them on a low dose and then incrementally go up in small amounts until you hit that target dose.

                                The antigen we select is really depending on what we think is triggering the symptoms. If we think Lyme is the trigger, that’s what we use. If you’ve got someone, based on stool testing or organic acid testing, if it’s an overgrowth of candida or yeast, maybe you want to do the candida antigen. Maybe you want to do the strep antigen. We probably have about 40 different antigens we use right now, and I know Dr. Vincent keeps expanding that in experiments with different things, and every year it grows a little bit, based on what he and other doctors around the world have been finding.

                                This is given as a sublingual administration every seven to eight weeks, depending on patient response. So, the nice thing about this too is, they’re doing all these things every day, this is something they don’t have to do every day. It’s really about every two months. And when you hit the nail on the head, often we’ll see changes within 24 to 48 hours. Although it may take longer, in some cases, to see the full benefit, it doesn’t usually take that long to see if we’ve really hit the right dose.

                                Pulse electromagnetic frequencies, I just want to mention. PEMF, we actually utilize this in the office. This is basically a device that helps put a resonant energy that matches your normal human cell vibration, and if you think about pushing a child on a swing, every time you keep pushing the same direction, it moves them further and further. It’s kind of the same thing. So, our bodies get exposed to so many frequencies that are against us, WiFi and cell phones and things of that nature that probably inhibit our own natural frequency. This is a way of kind of restoring that.

                                We’ve got over one million receptors on any given cell, and applying the right EMF can really help stimulate these receptors to alter cell function. The goal is really to find the right frequency that stimulates the body towards better health. We always talk about the chemistry of the body, and we pretty much ignore the physics of the body. I think getting down at that level of intervention, it’s nice, because it’s safe, it’s easy. You don’t have to worry about side effects. It’s a very gentle way to try and help facilitate tissue repair in a very easy way. There are professional devices. There are devices they make for people’s homes that they can do at home.

                                The professional devices obviously give you more options and different ways to treat people, but again, for people who like the therapy, there are plenty of companies out there that make devices you can use at home. The benefits is improved circulation, decrease pain, reduce inflammation, faster recovery after injury, faster healing of skin wounds, and acceleration of nerve regeneration. So much of this is important for our Lyme patients, that again, I’ve found some people do remarkably well with this therapy.

                                Like physical therapy, they do need to do it somewhats frequently. We recommend doing two sessions a week when they come to our office. If they’ve got a machine at home, they can probably do it every other day, but you don’t necessarily need to do it every single day to get the benefits.

                                Germans have published a ton of research on this. There’s literally over 1,600 studies on the use of PMF. These devices are FDA approved in the U.S. So, again, this is something that can be very beneficial for people who have access to it. And in your own practice, may be something worth adding in too, as another tool to put in your tool chest for your patients.

                                Low-dose naltrexone, I like. I’ve been using it for a long time. I’m actually a part of the LDN Trust, which publishes a book and several research studies on their website. And the naltrexone is an opioid antagonist, but at low doses it actually enhances and dodges opioid production. So, basically gets your brain to make its own natural opioids. The short-term block in these receptors for four to six hours leads to an increased level of endogenous opioids for up to 20 hours.

                                So, we typically give this at bedtime for that very reason, so by the time daytime rolls around, those endogenous opioids are already circulating. This is all off-label use. There’s actually over 40 studies using it off-label for cancer, MS, fibromyalgia, autism. Unfortunately, there’s no studies on Lyme disease specifically, but a lot of us in the Lyme world do use this for our patients, particularly those who have pain issues, sleep issues, muscle issues. Here’s just a list of some of the studies that have been published. Again, you can read through that.

                                But again, what I like about it is that the side effect profile is excellent. The biggest side effects you typically see, tend to circle around sleep. Some people will talk about getting wild, vivid dreams, but outside of that, it’s very well tolerated. I’m a naturopathic doctor. I’m supposed to tell you drugs are bad, and I’m telling you, I use a lot of this medication. I think it’s great.

                                The other thing is it’s very cost-effective. We have a compounding pharmacy here in [inaudible 01:04:25] that makes a three-month supply for about $45. So, even for people that are on a tight budget, this is doable. It takes about three months to get the full benefits once you start people on it. So, just tell them, if you’re going to use it, to give it a little bit of time, and we’ll typically start with one milligram at bedtime, and every two weeks go up by one milligram. You can go as high as six milligrams. I find most people, somewhere between three and four and a half milligrams where they hit their sweet spot.

                                If you start to get up to five or six milligrams and they don’t feel any different after two weeks, you’re barking up the wrong tree, and at that point I would ditch it.

                                Just to summarize, our treatment approach, obviously we want to treat the organism if it’s acute. We want to treat these other immune distractors, if they’ve got food allergies, environmental allergies, because it drives that TH2 pathway. We want to promote better detoxification, fix these endocrine problems that get disrupted, make sure they’re sleeping well, get their inflammation under control, get their diet and nutrition under control, help their mitochondrial function if you think it’s been disrupted, get their circulation moving, boost their immune system. These are the fundamental things I think about when I’m dealing with Lyme patients.

                                It’s sort of naturopathic medicine 101, functional medicine 101. A lot of these things you’re already doing in your practice are very easy to apply. But hopefully the things we’ve talked about tonight will give you just a few more tools to add to the tricks. This is the book I wrote called The Lyme Solution. If you guys are interested, please feel free to pick up a copy. The information in it, I think, as a … it was written for patients, but I think as a practitioner, there’s a lot of great information. It goes into a lot more detail about the things we talked tonight, especially the herbs, what they do, why we use them, their chemical action.

                                All the references are in there. It’s a very well-referenced book. I have almost 300 references in there, so it’s not just my professional experience. It’s backed up by research as well. And just conclusion, here’s my information if you need to … if you want to follow me, in my information I talk a lot about Lyme and tick-borne illness. If you’ve got follow-up questions, there’s my e-mail address and phone number. And I think that concludes the talk tonight, so I’m open to any questions.

Dr. Weitz:            That was a lot of information Darin.

Dr. Ingels:            Let me stop sharing my screen here and we’ll turn it back over to the video.

Dr. Weitz:            So, let’s see. Some of the questions that have come in about sharing the slides with me, and I can send it out in an e-mail. Something about weaponized ticks released by the Department of Defense.

Dr. Ingels:            Well, you know, that’s been hearsay. The thing with that is that there’s a little place called Plum Island off the coast of Connecticut, which is a government research facility, so the theory has always been, is that, something got off the island, got to Connecticut, because Lyme, Connecticut is sort of across the pond, the Lond Island Sound from Plum Island. It’s all hearsay, and then Kris Newby came out with a book, last year maybe or the year before, where she interviewed Willie Burgdorfer, seems to suggest that ticks were being weaponized.

                                It’s hearsay. Maybe it was, maybe it wasn’t. At the end of the day, at this point it doesn’t matter. For people who have been infected, that’s what we have to deal with, so we don’t really know. There’s no concrete evidence that that’s a fact at all. She took some of Willie Burdorfer’s words and I think twisted it a little bit to make it sound like it was fact. Look, we know our government does things to weaponize viruses and bacteria. I’m not sure the benefit of weaponizing a tick. Again, that’s not my area of expertise, but to date, we have yet to really see any hard evidence that that’s true, unfortunately.

Dr. Weitz:            Which PEMF device do you use?

Dr. Ingels:            We have one from a company called Lenyosys. They’re based out of Ford Lauderdale, Florida. There’s a lot of good companies. There is another company based out here in Southern California. If you guys are interested, off the top of my head I forget the name of the company, but if you message me I’ll send you their information, a contact with their rep.

Dr. Weitz:            So, is the type of PEMF device you have the one where you lay on a mat, or is it the coils that you put on-

Dr. Ingels:            Yeah, so the one that we have, there is a big mat that you put behind your back. We do it in a recliner chair, and then depending on the protocol we’re using, there’s different leads that’s you connect to their wrists, their chest, their ankles, and so each protocol tells us where you need to connect each lead. What that one is doing is it’s basically getting the feedback through the skin during the protocol, so that one is a little bit different. Some of the coils, you put around your body or on your body. Yeah, so there’s a lot of different variations of PMF devices. Talk with different reps and again, the price ranges are enormous. I had been talking with Lenyosys for years before we actually bought our machine.

                                We bought their professional machine. It’s called the Cellcom. It’s $18,000. A lot of these good ones are about that price range, and then we charge, I think, $75 a session when people come in. Because it’s a set it and forget it. Once you get them set up, you set it and then you walk out of the room. You don’t have to stay in there with them, so our tech, our MA sets them up and then leaves.

Dr. Weitz:            And what’s the main benefit that patients notice?

Dr. Ingels:            With the PMF? Well, it depends what their primary symptoms are. Sometimes it’s improved energy, better mental clarity, better sleep, less anxiety, they feel less stressed. We put an adrenal protocol in all of our Lyme patients, because they’re all stressed. They’re sick, they don’t feel well, and yeah, sometimes circulation. I had a woman who came in, she was a new patients, she came in in a wheelchair. She could walk, but it was very hard for her. She did one session of PMF for about an hour and a half, and she stood from the table, she pushed her wheelchair out. She didn’t get in it. She’s like no, I’m fine, and then she walked out. I’m like, oh, well that was amazing for one session.  So, that’s my N of one, and the asterisk, the result is not typical, but again, for people who are sensitive, that may be enough.

Dr. Weitz:            So, you use your Lyme protocol to try to treat the Lyme. When do you start looking at things like heavy metals and mold and some of these other things? Is that something you tend to look at once the original protocol is not getting the results you want, or is it based on history, or …?

Dr. Ingels:            Well, in reality, we’re talking about Lyme disease. In clinical practice, we’re always looking at everything. If I have someone who, based on their history, has occupational exposure, I may test for heavy metals at the same time. If I know that they’ve been in a mold-damaged building or I’m suspicious, I’ll test them for mycotoxins. We’ll do mold allergy testing. It’s not like we’re only looking at Lyme. We’re looking at the whole person, so I’m doing all this simultaneously.

Dr. Weitz:            But let’s say you find mold and mycotoxins or Lyme and heavy metals, do you treat one and then the other? Is there a certain order? Do you treat them all at the same time?

Dr. Ingels:            I treat simultaneously. If they’re both problems for patients, I have heard other practitioners say, well you have to treat the mold before you treat the Lyme. That makes no biological sense. It’s never the way that I practice. I treat them simultaneously and I find that works perfectly fine. If we’re giving people glutathione to mobilize, which his good for their nervous system and Lyme anyway, and then we’re still using a binder to help pull out mycotoxins, it’s perfectly fine to do in conjunction with a Lyme treatment.  It gets to be kind of a pain, because sometimes people are taking more stuff than I would prefer, but I don’t think it’s fair to patients to make them wait if they’ve got a problem that you’re not specifically addressing. My approach is really just to try and cover as many bases without overwhelming them.

Dr. Weitz:            And how often do you have to work on gut health?

Dr. Ingels:            Always. Yeah, I mean, gut health is an ongoing thing. My feeling is, depending on the nature of what their gut was prior to us working together, I want them to have one to two healthy bowel movements a day, no indigestive food, blood, mucus, easy to pass, they’re not straining. So, if we can get to that point, then I kind of feel like our work with the gut is good. And at that point, they’re maintaining it through their diet and lifestyle. They’re eating good nutrient-dense foods. They’re getting good sleep to promote better peristalsis. They move their body. So, as long as they can maintain it with their lifestyle, then I don’t think we have to keep giving them tons of stuff to keep healing the gut.

Dr. Weitz:            And since Lyme is a chronic disease, do you find that after six months or a year, patients need refreshers or is there sometimes maintenance dose of herbs that people take long-term?

Dr. Ingels:            Well, not unless they’re having symptoms again. Now, I’ve had plenty of patients that get to a point where they’re pretty much symptom-free, they’re doing great, and then some big stressor hits their life, whether it’s a death of a family member, a divorce, whatever it is, and then we’ll see relapse of symptoms. So, I think stress is that one trigger for a lot of Lyme patients that can make them slide back very quickly, even if they’ve been doing well for a very long time.    The patients I’ve seen who really take to task their ability to maintain their diet and lifestyle, even when those stressful events happen, they are less prone to the effects of it. The people who let themselves go a little bit and get kind of lacks on that stuff, are more prone to it. So, yeah, my goal is to get people to the point where they’re functioning at a high level and hopefully symptom-free. It’s challenging, but it does happen. I also tell my Lyme patients, “Don’t ever go on social media.” It’s the worst place for a Lyme patient. Especially these Facebook groups that are Lyme groups. They’re allowed to come to mine, because I monitor it, and if there’s stuff that’s really negative or really misinformed, I either comment on it or I just flat out delete it. So, I think people need to be very wary, because they’re getting so much information off the internet and Facebook, and in the Lyme world, there’s a lot of misleading information.

Dr. Weitz:            Now, it looks like you find a protocol of herbs and then keep the patients on that for quite a period of time, but it’s kind of a naturopathic principle that I hear a lot of practitioners talk about, and I’ve gone back and forth on this myself, but is that, you need to constantly rotate the herbs, because otherwise you stop getting response if you continue to use the same herb?

Dr. Ingels:            Yeah, and as I mentioned, that I’ve never really seen. The reason for me to change a protocol is it’s just not working, or if someone’s having a side effect. They’re just not tolerating it well. But as I said, I give it that two month mark. Again, we’re trying to find what works best for each patient, and that’s a function of what they tolerate, and that’s, of course, factors of their genetics, how well their liver detoxifies, all these other external factors.

                                So, it’s a constant fine-tuning of whatever. We need a place to start, and once we start on that path, as I said, with herbs, we give it two months to give it its full time to really see how it works. Because sometimes, as I said, people will start the first month, there’s not a lot of progress, and people get very discouraged, and then they get to week five, week six and then they turn a corner. I don’t want to keep switching so quick that we can’t say that it really didn’t work. We may not have given enough time, but I kind of feel like I have a good sense of how long each thing should take to get the kind of results we want to see, and if we’re not seeing that, we need to change.

                                What makes me crazy is when I see practitioners that start people on a protocol, they’re not six months into it, there’s no improvement at all, and they want to keep waiting for the corner to turn. At that point, it ain’t going to happen. Give yourself a reasonable timeframe. Make sure you’re clear with your patients that this is what I expect, and if we don’t see the kind of improvement we’d like to see, then we’ll switch gears.

Dr. Weitz:            Is there part of your protocol that’s particularly designed to strengthen immune function or specific supplements that are out there that are specifically to strengthen parts of the immune system?

Dr. Ingels:            Yeah, and some of that is accomplished through the herbs, but I still, it’s really patient-specific. Most of our Lyme patients are Vitamin D deficient, so most of my patients are getting Vitamin D as supplements, and of course, encouraged to be out in the sun. There’s a lot of them taking Vitamin C, some of them take Vitamin A. A lot of them take zinc, so yeah, we’re still doing a lot of things nutritionally to help support their immune system. So, yeah.

Dr. Weitz:            Do you use things like colostrum or bovine serum?

Dr. Ingels:            Yeah, I don’t really use a lot of colostrum, for no really particular reason. It’s just something I’ve never really used in my practice. I tend to use more of the nutrients for those things. Alan Gaby was my nutrition teacher when I was a med student, and he literally wrote the textbook on nutritional medicine, so mine tends to be probably more nutrition-oriented.

Dr. Weitz:            Right. Somebody asked, do we need to retest to know that we successfully are-[crosstalk 01:17:52]

Dr. Ingels:            That is a great question. I don’t know who asked it, but thank you for asking that. No, don’t ever retest them again. Honestly, and this is why, I’m not being facetious. The problem is, we know from the research that Lyme antibodies can stay elevated for 20 years after you’ve treated someone, and it will not change your treatment. And what it’s going to do is it’s going to make you and your patient crazy.   I used to test every couple of months, and we’d see antibody levels go up and down, even if the patient was improving or not improving. So, you always feel like you’re chasing these antibodies. The likelihood of getting someone completely antibody free, it’s not zero, but it’s pretty close to it. They will probably have IGG antibodies their whole life and they will come, potentially, in and out of being IGM positive.    I was exposed 18 years ago. I actually did my Lyme test, just for fun, about a month ago, and it looks like I have acute Lyme disease.

Dr. Weitz:            Wow.

Dr. Ingels:            So, don’t use it as a marker. Unfortunately, there’s not a single, reliable blood marker that we can use to tell whether somebody is better or not. Now, if you do your standard chemistries, someone did have a high CRP, maybe we will see it come down. But outside of that, CD57, a lot of doctors like to tout it as being a reliable marker for Lyme. It’s not. And I have yet to see a single person that ever had their CD57 checked before they had Lyme. So, they come in and say, [inaudible 01:19:12], you’ve got chronic Lyme because you have a low CD57. So, yeah, I mean I have not found a single marker that we can reliably use to monitor people’s progress.  This is the slippery part of managing Lyme patients, is that you’ve just got to go with their symptoms. I think having them take that questionnaire periodically is a good way to see how they’re progressing. In my book, I have an abbreviated version of the MSIDS questionnaire. If people want, you can photocopy it if you like and hand it out to your patients, but that’s a really easy way to monitor in between, without doing more complicated testing. Just where are you at?

                                And it’s good for patients too, because they live with themselves. It’s like watching grass grow sometimes. Day to day, they don’t necessarily see the progress, but over the course of weeks and months, you start asking about, well what about your neuropathy? “Oh yeah, I forgot I had that. Oh yeah, I guess that’s gone, because I still have joint pain.”   So, it’s a good way to keep tabs, and it’s also for documentation standpoint. It’s good to have them fill out that questionnaire periodically and just put in your chart as a way of monitoring their progress.

Dr. Weitz:            Is that questionnaire in place of an MSQ or you use an MSQ as well?

Dr. Ingels:            No, it’s different than the MSQ.

Dr. Weitz:            Okay. Couple people asked about Rife, and somebody asked about Magnawave.

Dr. Ingels:            I don’t know what Magnawave is. I think the Magnawave, correct me , I think it’s a thing you put on your wrist. I think that’s what it is. You can chime in if that’s what it is.  

                                Rife, I’ve had patients who have used Rife, who have actually reported they feel a lot better. I had one patient I worked with for a long time in New York, and she got marginally better, but not 100 percent. And then she kind of disappeared from my practice, and she popped up in California five years later. And when I first saw her, she was very feeble, she walked with a cane, very disabled. And she walks in next time, no cane, strong, I didn’t even recognize her. And I said, “Well what did you do?” And she said, “Well I stopped doing everything and I did Rife every day for two years.”

Dr. Weitz:            Wow.

Dr. Ingels:            So, again, N of one. Take it for what it’s worth. I have several other patients around here in Southern California who have Rife machines. Again, I think it’s a tool. I don’t think I would rely completely on Rife, but it’s another tool. I think the concept behind it makes sense. The whole thing is you’re putting a frequency in the body to disrupt the organism, much like an opera singer breaking a glass with their voice. It’s the same kind of concept. There’s a practitioner here in Orange County who has been doing Rife for 40 years very successfully.  So, again, it’s not the first thing I go for, but if you’ve got patients asking about it, if they’re interested, I don’t see really a lot of harm to it, and you can buy some of these Rife machines for under $1,000. They’re not super expensive. They’ve just got to learn how to dial in the right frequency.  The FDA doesn’t like it at all. They think it’s nonsense, but I never argue when people tell me they do something and they get better. And I’ve had enough people over a 21-year career telling me that they did it and they felt better, and I’ve rarely ever had someone tell me that they tried it and it made them worse.

Dr. Weitz:            Somebody asked about CellCore, it’s another line-

Dr. Ingels:            Yeah, it’s another company. I’ve not used their products, in particular, but if you look at the ingredients, again, there’s a lot of similar concepts behind the products in there. Again, I don’t have any experience using their particular products. I’ve got about eight other companies I work with and they all work well, so I’ve never had to deviate to try something new. But yeah, if you’ve used it and it works, then I think they’re fine.

Dr. Weitz:            Okay. So, I think that’s a wrap.

Dr. Ingels:            That’s a wrap. Well, thank you guys very much for joining us tonight, and as I said, if you guys are interested in getting a copy of the slides, just e-mail me and I’ll be happy to send those to you. Absolutely.

Dr. Weitz:            And if we want to contact you, what’s your website?

Dr. Ingels:            All that is on the last slide. Well, my website is just DarinIngelsnd.com. And all of my information is there if you’re interested.

Dr. Weitz:            Okay. And your book is available through Barnes and Noble and Amazon.

Dr. Ingels:            The book, Amazon, Barnes and Noble, not that you can go anywhere to buy a book anymore.

Dr. Weitz:            Thank you Darin.

Dr. Ingels:            All right. Great. Thanks Ben.




Lipoprotein (a) with Dr. Joel Kahn: Rational Wellness Podcast 166

Dr. Joel Kahn speaks about Lipoprotein (a) with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

4:18  Lipoprotein (a) is a particular type of cholesterol particle that can be measured on a blood test.  We know that only 50% of those people who have a heart attack have elevated conventional cholesterol levels, so there must be some other risk factors and elevated levels of Lipoprotein (a) is one reason in some of those cases.  Lipoprotein (a) has at least three dangerous properties: 1. It is called the sticky cholesterol because it promotes blood clotting. 2. Lipoprotein (a) causes atherosclerosis and it may be found in the plaque that closes your carotid artery, your heart arteries, your sexual organs or your kidney arteries. 3. Lipoprotein (a) causes inflammation. All three of these properties promote heart disease and Lipoprotein (a) is found in one out of every four Americans.  A celebrity case is Bob Harper, the trainer from The Biggest Loser television show, who was in tremendous shape and yet suffered a major heart attack. It turns out that Lipoprotein (a) was his main risk factor.  In fact, elevated levels of lipoprotein (a) increases the risk for coronary artery disease, heart attack, stroke, thickening of the aortic valve, and even heart failure.  If you have elevated lipoprotein (a), you are 2 to 4 times more likely to have a stroke, heart attack, or scarring of the aortic valve. It causes inflammation and foam cells and plaque.

12:04  Since we are in the midst of the COVID-19 pandemic, having elevated levels of Lipoprotein (a) is liable to increase the likelihood of a more severe case if you get infected.  It would be interesting to know if actor Nick Cordero, who had severe blood clotting and who died from COVID-19, had elevated Lipoprotein (a).

13:31  The clotting associated with Lipoprotein (a) seems to be an evolutionary disadvantage, so why would it be there?  There must be some evolutionary advantage for it to be present in so many people, which was hypothesized by the late, great Dr. Linus Pauling.  It turns out that 40 million years ago we developed the ability to produce Lipoprotein (a) at about the same time we lost the ability to make vitamin C.  Most animals can make vitamin C, except humans. Perhaps we were eating so many leafy greens and fruits that we just didn’t need that enzyme to make vitamin C. If you are deficient of vitamin C, you can develop scurvy.  And you’re going to bleed in your skin and your gums because your collagen and your tissues are super weak, including your arteries. Well, it turns out that lipoprotein (a) tries to prevent breaking down clots. So if you had weak arteries 40 million years ago from scurvy or something close to scurvy, it might be an advantage to have lipoprotein (a) when you have a baby or when you got cut chasing a saber tooth tiger because this would keep you from bleeding to death.  Lipoprotein (a) is considered elevated when it is over 30 mg/dL, though some labs measure it in nm/L where the normal range is less than 75.

18:57  If a patient has elevated Lipoprotein (a), you should listen to their heart with a stethoscope to hear if there is a murmur from the aortic valve.  You might want to get a heart calcium CT scan (Coronary Calcium Scan) to see if there is any calcified plaque in their cardiac arteries.

22:55  What can you do if you have an elevated Lp(a)?  For one thing, statin medications do not lower Lp(a) and they may even raise it.  CoQ10 and ground flaxseed can both help to lower Lp(a) 5-10%.  L-carnitine might drop Lipoprotein (a) 20-25%. (Impact of L-carnitine on plasma lipoprotein (a): A systemic review and meta-analysis of randomized controlled trials.)  If a woman goes on hormone replacement therapy after menopause, that can lower Lipoprotein (a). The most significant supplement is Niacin, vitamin B3, which can lower Lipoprotein (a)  by 20-80%.  Niacin will lower overall LDL cholesterol, raise HDL, and also lower triglycerides.  The downsides are the patient may get flushing. It could elevate blood sugar.  It could raise liver enzymes. It could increase risk of gout. The recommended dosage is to start with 500 mg twice per day and you can slowly up the levels if needed, up to 3,000 mg per day.  But these patients should be monitored carefully.  If you take the niacin with applesauce, it will lower the flushing due to the quercetin in the apples.

26:27  The average Primary Care Physician or Cardiologist is often skeptical of using niacin because of two questionable studies that showed no benefit with niacin. The AIM-HIGH Study tried to raise HDL in patients with almost normal lipids and another study that used an odd combination of niacin and a drug that blocked the flushing, so it did not test niacin alone.  Unfortunately, since niacin is an over the counter, inexpensive vitamin, nobody is going to come up with $80 million to do a three year study looking at its effect on the carotid arteries.  So the large, long term studies with it have not been done.

29:17  There’s a study that showed that a whole food, plant based diet can modestly lower Lipoprotein (a)  (Consumption of a defined, plant‐based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeksDrinking coffee can also slightly lower Lipoprotein (a) levels.  A small company called Akcea Therapeutics has developed something called antisense oligonucleotide, which can drop Lipoprotein (a) by about 80% with a once per week injection. One study in patients with existing heart disease was published in the beginning of 2020 and a five year study will be started soon. (Lipoprotein (a) reduction in persons with cardiovascular disease.)  The injectible cholesterol drug Rapatha does help to lower Lipoprotein (a) but at a cost of $6000 per year. There is also a treatment called lipopheresis, where your blood is removed and filtered and then placed back after about 3 hours and this must be repeated every few weeks.  It definitely removes Lipoprotein (a) and it decreases your risk of heart attack, stroke, and all the important measures.

33:27  Dr. Linus Pauling hypothesized that since Lipoprotein (a) helps your body when your collagen is deficient, then by supplementing with vitamin C and Lysine, the two essential components to make strong collagen, then Lipoprotein (a) would be neutralized. This was shown in a mouse study conducted by his protege, Dr. Matthias Rath published in the American Journal of Cardiovascular Disease in 2015:  Hypoascorbemia induces atherosclerosis and vascular deposition of lipoprotein(a) in transgenic miceSupplementing with 2-5000 mg of vitamin C per day along with 1500 mg per day of lysine will keep the Lipoprotein (a) from causing harm to your arteries, though the level of Lipoprotein (a) will not go down and there is really no way presently to know if this strategy is working.

35:07  Low dose aspirin or natural anti-clotting agents like Nattokinase or Lumbrokinase might be beneficial due to the clotting factor of Lipoprotein (a).



Dr. Joel Kahn is an Integrative Cardiologist, internationally known speaker, and best selling author.  He has a weekly podcast, Heart Doc VIP and he’s written 7 books, including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No BS Diet, The Plant Based Solution, and Lipoprotein (a): The Heart’s Quiet Killer. Dr. Kahn’s goal is to prevent heart disease by promoting a plant based diet, exercise, and a healthy lifestyle. His website is  DrJoelKahn.com   

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz:            Hey, This is Dr. Ben Weitz host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me. And let’s jump into the podcast. Hello Rational Wellness Podcasters, Dr. Ben Weitz here. Thank you so much for joining me again today. For those of you who enjoy listening to the podcast, please go to Apple Podcasts, give us the ratings and review. If you’d like to see a video version, go to my YouTube page. And if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript. So today our topic is lipoprotein(a) with Dr. Joel Kahn. So we are going to talk with integrative cardiologist Dr. Joel Khan, about a very specialized factor that increases your risk of heart disease. This is a specialized lipid particle that is not often measured but, can be seen on a specific blood test.

                                We’ve all heard about cholesterol as a major risk factor for heart disease. Most of us have also heard about LDL, the so called bad cholesterol, and HDL the so called good cholesterol. And you may have even heard about triglycerides, but you likely have not heard about this specific particle. And it’s unlikely that your primary medical doctor or cardiologist has even measured it. The conventional medical way to think about lipoprotein (a) is that it’s determined by genetics and there’s no prescription drug that can lower it.  So what’s the point of measuring it.  At least that’s what I’ve been told by some primary care doctors and conventional cardiologists but, from a functional medicine perspective, from an integrative perspective, there are some natural strategies that can lower lipoprotein(a). And it’s very important to know if you have this respect, we’ve known for years that a sizable percentage of patients who have heart attacks actually have normal cholesterol.  So there must be some other factors that account for why they have this heart attack. And lipoprotein (a) is one such factor.  There’s a famous example that’s been in the news a few years ago.  One of the trainers from The Biggest Loser, Bob Harper, who was in incredible shape, and yet he had a massive heart attack and almost died.  And he had essentially normal risk factors, normal cholesterol but, he had very high LP little a lipoprotein levels.  And so elevated levels of lipoprotein (a) increases the risk for coronary artery disease, heart attack, stroke, thickening of the aortic valve and even heart failure.

                                Dr. Joel Kahn is an integrative holistic cardiologist, internationally known speaker and best selling author. He has a very popular weekly podcast Heart Doc VIP, that I listen to regularly. And he’s written six books. At least six including; Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No B.S, The Plant-Based Solution, Young at Heart by Design. And his newest book, an Amazon best seller, Lipoprotein(a) The Heart’s Quiet Killer. Dr. Kahn, thank you so much for joining me today.

Dr. Kahn:             You need an ice cold water for all that incredible, kind both very appropriate introduction. And then the kind words. I was at a podcast recently as a guest and I did write a book called Dead Execs Don’t Get Bonuses, how to survive your career without the arc. I was introduced as the author of Dead Exes Don’t Get Bonuses which, if I write a divorce book would also be a… So, you nailed it buddy. 

Dr. Weitz:            I remember the golfer, John Daley wrote a song called All My Exes Have Rolexes.

Dr. Kahn:             That’s very funny, a little play on Willie Nelson there.

Dr. Weitz:            So what is lipoprotein (a)?

Dr. Kahn:             And this is authentically. I’m so happy to share this with your audience. Nothing about me, it’s about their health, your health, our ability to make a dent in the number one killer of men and women in the United States. That rolls off your tongue; number one killer of men and women. That means 39 year olds die of heart attacks. And 44 year olds have bypassed and 51 year olds have stroke. And we’re also going to talk about a valve in the heart called the aortic valve, which doesn’t get as much press but, creates a couple 100,000 procedures that some people make it through ad some people have complications. So it’s just what you said. We learned way back in the 1960s. Why would I go there? If you smoke, do you have diabetes? Do you have high blood pressure? Do you have a high cholesterol?  Do you have a mother, father, sister, brother with an early heart attack, early death from heart disease? These so-called Framingham risk factors. Your doctor sits down with you and might pull out a little app on the phone, on their laptop. “Hey, you’re in really good shape. Your numbers, your history, you’re at low risk.” That does help us define a one-to-one patient. Are you a really high risk patient or low risk patient?  Do you need medications?  Do you need lifestyle?  If you do your best job at that, it’s still missing about 40% of the people that go on to have heart attack, strokes, drop dead or in this case also aortic valve surgery. That is called residual risk. Just as you said, we should care about identifying 50% to 60% of the explanation. You’re a root cause guy, I’m a root cause guy.

                                Your cholesterol, your blood pressure, your blood sugars up. It’s not just a prescription.  It’s diet, fitness, stress environment, chronic infection, toxicity and all the rest. We should be searching why don’t we reach more than 50%, 60% of explaining heart disease.  Lo and behold, 57 years ago, 1963, a Scandinavian researcher found a new cholesterol particle in the blood. And now there’s several thousand research papers. And we know which gene and we know what RNA. We’ve characterized it completely. It got the name, It’s not a good name. That’s the biggest problem. It’s like the Pinto. If you go back long enough for a Ford car, it never was a good name; name a car after a bean. This was named Lipoprotein-little-a. Some people call it the sticky cholesterol. Can you imagine if all the research called it the sticky cholesterol? That has Madison Avenue attraction, because we just got to get it unstuck.  But, what we’ve learned, I’ll be brief, is you go to your doctor, you have your annual physical. You go to a wellness fair. You go to a corporate wellness fair at your business. You get your finger poked or a full blood draw. And your doctor says cholesterol, HDL, LDL, triglycerides, blood sugar, blood pressure, all those things. They’re great to know but, they did not measure this cholesterol particle that was found 57 years ago. Although it is simply a blood test, you can’t do it as far as I know from a finger prick.  Any lab; Quest lab, LabCorp, any hospital in LA, anywhere for about $30. So what have we learned? We have learned that this cholesterol particle does three things that are just awful.  It causes atherosclerosis. It actually may be found in the plaque that closes your carotid artery, your heart artery, your sexual organs, your kidney arteries, leg arteries. It may be found in the plaque more than the one we talked about a lot, LDL cholesterol. There’s a reason, I’ll tell you in a minute. So it causes plaque. That’s bad. Plaque causes people to lose quality of life and quantity. Number two, it causes inflammation. It has some really unusual attachments called oxidized phospholipids. You teach your patients about inflammation as a root cause of many chronic diseases. This particle is pro-inflammatory. And the third thing so unique is it actually promotes clotting of the blood, is prothrombotic.  Even LDL cholesterol doesn’t do all that. Some people have said, imagine LDL cholesterol, has cholesterol in the middle, has some things called phospholipids on the outside.  And then it has, it’s called apolipoprotein B.  It’s something you can measure in the blood. I don’t want to get too technical. People say LDL is like a baseball and apolipoprotein B as the stitching holding it all together. So it can float through the blood either back to the liver on its way to tissues on its way to your arteries. Lipoprotein(a) has the LDL, then it has a little, it’s called two sulfurs, a little bridge. And then it’s got this unique tail and people say, imagine a baseball, the pitcher is throwing at you with huge spikes all over the place. God forbid you get hit by that sucker. You’re going to have a lot of damage. That’s just an analogy. But, that’s the difference between LDL, which is already a problem if you have it in excess.  Potentially, getting under your arteries, responding, it’s called the retention of the cholesterol in your arteries to drive the plaque.  And now we’ve got these spikes all over the place. So lipoprotein (a) is a nasty little beast. And this is the magic. You said the word genetic. Okay. I learned when I was a cardiology fellow in Dallas where a Nobel prize in medicine was awarded to two of my professors. When I was there about LDL cholesterol in the pathways, one in 500 people, maybe one in 250 from their parents inherit a high LDL cholesterol purely on genetic. Eat sprouts, go to the gym. Be thin, still got a cholesterol of 400 that’s genetic. It turns out this lipoprotein (a) is the new kid on the block in terms of what most people know about it. One out of every four people, not one out of every 250, or one out of every 500. That means right now how many people are listening to this very valuable podcast?

                                One out of every four, you got it. You got it. You got it. You got it. It’s a lot of people. That’s 90 million Americans and those 90 million Americans from the time they’re one years old have this triple threat particle in the blood and slowly, slowly, they might, It’s not inevitable. Like these risk factors, you can have a high cholesterol and not end up with a heart attack but, you’re at risk. You end up about two to four times more likely stroke, heart attack, valve scarring; the aortic valve gets scarred. And need heart valve procedure.  And Doctors scratch their head and say, “Bob, Sue, why did you have a heart attack? You’re numbers look so good; your lifestyle, your diet.” You know, “Mr. Jones, you just said your heart valve up. We have no idea why you developed this problem but, we’ve taken care of it.”  Well, it turns out very frequently. It’s lipoprotein-little-a that drives all this. That’s the broad picture. Would you want to know that you inherited one out of every four people? It could be one pair. You could get the double jeopardy of both parents on chromosome 6, there is a gene in one out of every four people. And there’s a whole lot of discussion, why do we have it? When did we get it? What can we do about it? But, it will become in the next five years routine. You’re hearing it now early, five years. So now there’ll be an expensive drug that the pharmaceutical industry will be sure every healthcare provider in America knows to check lipoprotein (a). They do it in Europe but, God bless America, great country, or sometimes a little slow to adapt new science, like 57 years a little slow.

Dr. Weitz:            How about adding this to the risk factors.  Here we are in the midst of the coronavirus pandemic, which causes clotting.  What’s the likelihood that somebody with elevated lipoprotein (a) if they get coronavirus is liable to have a worse prognosis?

Dr. Kahn:             You are like a visionary.  That is a theory.  There’s very few people in the country that are studying lipoprotein-little-a.  There’s not a lot.  And some of them have brought up this question.  Could it be if you’re at UCLA or you’re at USC, and you’re sick in the ICU. Like Broadway actor Nick Codero has been in the news in Los Angeles. So 39 years old, and he’s still 90 days later, clotting has taken one of his legs. And I hope that God doesn’t take his life.  Could it be since it’s one out of every four, that ICU bed, that one, that one, no clotting, clotting here. It’s been hypothesized that it could be somebody needs to draw the blood and run the numbers and see if it correlates. And tries to explain this monster problem in COVID-19 of apparently blood vessel damage and clotting which is a real deal. It’s become even more in the focus of the media to some degree, the science community to some degree. We got to get the word out and then we can play with it. Let me talk to you about the clotting for a minute, because it’s a question. Why do we have things in the blood that seem to be all a disadvantage? What is the reason?

Dr. Weitz:            Right. It’s got to be an evolutionary advantage if it’s there.

Dr. Kahn:             And so it turns out the only species on the planet that have the ability to make lipoprotein (a) in the liver. It’s not made like LDL. That is made in the liver. This is a whole different factory. Now, GM and Ford, totally different. About 40 million years ago, we may have developed the ability, one out of every four people to produce lipoprotein (a). Well, why would we do that? This is a little complex but, it’s really interesting. And it’s going to fit with your emphasis on nutrition for sure. That, also about 40 million years ago, humans lost the ability to make vitamin C and very few people know that your dog and your cat make vitamin C whatever amount they need from glucose. Actually glucose can be converted to vitamin C. Humans lost the enzyme. It’s believed maybe we were in the jungle and eating so many leafy greens and fruits and such that we just didn’t need an enzyme pathway anymore. And maybe there was an advantage that whoever lost that gene had some super power that evolutionary, favored their survival.

                                Dr. Linus Pauling, who wanted to know about prizes into some people, they immediately would say the vitamin C guy, yes, he’s passed away. But he was the vitamin C guy.  He hypothesized when we lost the ability to make vitamin C, if you have the gene for lipoprotein (a), you had an advantage.  Let me just run you through this.  If you are deficient of vitamin C, you can develop scurvy.  And you’re going to bleed in your skin and your gums because your collagen and your tissues are super weak, including your arteries. Well, it turns out lipoprotein (a) tries to prevent breaking down clots. So if you have weak arteries 40 million years ago from scurvy or something close to scurvy, might be an advantage to have lipoprotein (a) when you have a baby. When you got cut, chasing a saber tooth tiger, if that’s the right term. I haven’t said that word in a while.  It might’ve been an advantage in terms of excess bleeding by favoring clotting. It is similar to something in our body called plasminogen.  Plasminogen breaks down clots.  Here’s a competitor that interrupts that process.  Very complex idea to think about it but, it’s interesting and when you talk COVID-19 all of a sudden, it might just be the factor that’s a disadvantage by promoting clotting and not allowing breakdown of clots. Interesting theory, more traditionally it’s an issue with just clogging your arteries. And if you have carotid surgery and you take the plaque and look at it under a microscope, you can find a ton of lipoprotein-little-a structures in the plaque.  Same with if you have bypass surgery and they take out some of the tissue of the heart arteries and look at a very dense concentration. So it’s in the plaque. It’s not some window dressing. It gets under the endothelium. It gets retained. It causes inflammation and foam cells and plaque. And it does it on the heart valve too, which is really unusual. One out of every seven aortic valve surgeries in the United Sates are believed to be due to the constant from the time your one year old irritation, inflammation and a thickening of the valve from lipoprotein-little-a. So it’s just a monster to deal with clinically that we haven’t even addressed really.

Dr. Weitz:            So when you see it on a lab, what level do you consider significant? A couple of the labs that we typically use, usually say anything over 30 milligrams per deciliter. Some people say 50, I’ve heard other people say, “Well, it should be as low as possible.”

Dr. Kahn:             So it turns out, and I want to stress as again, this is just a lab test. This is $30. We’re not talking about needing to have a bone marrow biopsy to determine this. Tomorrow at your doctor you can have your blood drawn for this or at any lab. There’s two ways unfortunately like pounds and kilograms. They both describe your weight. There is a unit milligrams per deciliter, less than 30 is normal. And over 50, just an arbitrary cutoff is felt to be the higher risk group. But, that can go 50 milligrams, a hundred milligrams per deciliter, 200, 300, 400, 500. I’ve got patients who I practice that are 400, 500 plus.  Not much more than that. You’re not going to see a thousand. And again, one out of four is over 30 but, a substantial number is over 50, 60, 70, 80, I think. But, two or 3% of people are over 100. There is another unit called nanomoles per liter. Quest Lab now reports in nanomoles per liter. Other labs report… It doesn’t really matter. They’re the normal range there is less than 75 is normal. Over 125 is considered high risk. They’re pretty similar. I think pretty soon we’ll stop doing the milligrams per deciliter. But again, there’s no real issue about one more accurate than the other, or ignore one. Pay attention either way it’s measured. Simple, simple lab tests.

Dr. Weitz:            So, if a patient has an elevated LP little a, how do you work them up to see if they’re having any negative effects from it?

Dr. Kahn:             So for the past 10 years, if you do find lipoprotein-little-a mentioned in the guideline, the American Heart Association might come out with somebody about prevention, the National Lipid Association. A group that really deals with complex pharmacology and pathophysiology. They might tell you if your family history is strong for early heart attack, early stroke, early valve problems, calcified aortic valve, ask your doctor if it’s reasonable to measure the lipoprotein-little-a. Again, blood tests has been available for over a couple of decades but, not a routine test has been recommended. That’s starting to change in November 2019 pretty recently. In Europe, it’s called the European Society of Cardiology. They’re equivalent. They came out with a new guideline that said, “We not believe it’s prime time.” Everybody once, should have the level measure. If you’re normal, you don’t need it again. You don’t have the genes that are actively reducing lipoprotein-little-a. And if you’re elevated, well, it fits in the risk factor profile.

                                It may explain some of the risks that your standard approach hasn’t identified. So the workup is take out a stethoscope if you have one as a healthcare provider, make sure there’s no murmur from the aortic valve. Make sure there’s no noise. And then that [inaudible 00:20:27]. And make sure they’re not describing anything that suggests blockage like shortness of breath or chest tightness or chest pressure. Look at the other numbers; blood pressure, blood sugar, weight, waist circumference, inflammation, maybe homocysteine and the other cholesterol panel. My approach, I think it’s consistent with the general approaches. If you’re 40, 45 and you’re really a health seeking individual, and now you’ve checked your lipoprotein-little-a and it’s abnormal, you might want to get a heart calcium CT scan. You have no symptoms.

                                That’s a quick five seconds CT scan. It costs about a hundred dollars at UCLA, at Cedar Sinai, at Good Sam. Some of the best places in America where they’re done. No injection, no IV. And it takes a quick look at your heart arteries. And if it comes back really good and your blood pressure’s good and your other numbers are good, okay, you’ve got no risk factor. Eat a little better exercise a little more and do the whole program of heart disease prevention with maybe a little more incentive to really do it well because you identified it. If you knew you were prone to kidney cancer, if you knew you’re prone to breast cancer. There’s some measures, you might not be going to Arby’s and McDonald’s every day.

                                So lipoprotein (a) to me is a good platform just to get people on a good place. But, if there is known disease, “Doc, I had a stent last year and nobody checked my lipoprotein-little-a. And now you’re telling me it’s 300 milligrams per deciliter.” Or if they’re silent but, by calcium scoring or a murmur, you identify there’s a disease process that isn’t yet overt. There’s room to consider what do you do about it? And before we dive into that, you always treat all the other stuff.  You want your blood pressure to be at its best, use all the approaches, standard and natural from yoga to acupuncture, to breathing, to sleep. And the whole thing that your audience knows so well from your good work. Now you want your cholesterol to be in range and do it with diet, you watch your blood sugar. But, do you specifically address the lipoprotein (a)? And in 2020, there’s a divergence of opinion. And to tell you the standard opinion is, use it as a risk factor but, there’s no way to deal with it just as you said at the beginning of the podcast, I disagree with that but, that’s the standard approach.

Dr. Weitz:            So, why don’t we start with the nutritional supplement approach?

Dr. Kahn:             Sure. And thank you. Let me just say what doesn’t work right off the table; Lipitor Zocor, Crestor, the statins. What’s your doctor’s going to ask you to consider taking if your cholesterol is very high and certainly if you’ve had an event like a stent, they do not lower… Again, the production of lipoprotein (a) in the liver is totally different than LDL cholesterol. Your LDL cholesterol will fall with a statin almost always. But, it actually doesn’t address lipoprotein (a) and it’s sometimes raises it. That’s the disconcerting part. “Doc, my lipoprotein (a) was 180 milligrams per deciliter. We went on Crestor and you just told me it’s up to 207.” I’ve seen that dozens of times. Now, some would say don’t reject it. The reason you started Crestor was to lower the LDL, lower the C-reactive protein, be consistent with a lot of studies in somebody with known heart disease. But, don’t expect your lipoprotein (a) to go down.  That’s the main prescription drug. Back to natural. There’s been an adequate number of studies to look at some issues, Coenzyme Q10, a great heart supplement, it goes down a little; ground flaxseed, might go down a little [inaudible 00:24:17], 5%, 10%, nothing substantial and nothing in the range that’s really felt to really move the needle a lot in terms of better outcome. There are no large long term studies. There is the supplement your well aware of, L-Carnitine. That isn’t a lot of energy drinks. Even it’s in Red Bull or Monster but, that’s not where I’d prefer a patient to be getting their L-Carnitine. It’s obviously comes from red meat. So the carni of carnitine but, you can take a capsule or a powder with L-Carnitine. You might drop your lipoprotein(a) 20, 25%. A little more substantial. If a woman’s perimenopausal and chooses to go on hormone replacement therapy, lipoprotein(a) tends to go up a little at menopause and it’ll come back down maybe substantially with hormone replacement therapy if they find a practitioner that does that.

                                The big one though is niacin. Niacin, plain old $10 a month. Get a big red hot flush face from taking vitamin B3 will lower LDL cholesterol. Nice. We’ll raise HDL cholesterol often. We think that’s good. We don’t know. Will lower triglycerides. Nice. Will lower overall cholesterol but, it actually can lower lipoprotein (a) pretty predictably and variably 20% to 80%. So you can sometimes, if you choose to use niacin, you got to tell a patient about the flushing, about rash, about watching your blood sugar, your blood enzymes, gout. But, it’s been around for 50, 60 years. You can buy a big bottle of good natural niacin for $30 to last three, four, five months.  So it’s not been studied though. I mean the big drawback from the academics, like if you go 90 miles south where you live, and UCSD has the leading academic physician. And he won’t publicly blast out use niacin, because where’s the thousand patient 10 year study that identifies you just drop that person’s risk of heart attack or stroke. Privately, and in certain publications he uses niacin too, because we know it’s on a limited range of therapeutics. It works. And now there’s new stuff. We’ll talk about that, one second.

Dr. Weitz:            Yeah. The average primary care doctor who doesn’t really study this stuff a lot, who’s not really up on supplements. The few things they’ve seen about niacin is, “Oh, niacin doesn’t work. It might even be harmful, forget it.” They basically have a negative view of niacin but, that’s because of a couple of studies that weren’t really valid, right?

Dr. Kahn:             Yeah. The idea of people that had an almost normal lipids trying to raise the HDL, called the AIM-HIGH Study and another study with a very odd form of niacin that had a combination drug. So, for many years we used just plain old niacin or prescription niacin and saw good results in the blood work and had reason to believe we saw some benefits in the arteries but, never has there been a substantial study; a hundred people, 500 people. So it’s untested. Problem is that  niacin’s cheap and niacin’s generic. Who’s going to come up with $80 million to do a three years study looking at carotid arteries. It’s a hot potato. The exciting news but, it’s not…

Dr. Weitz:            By the way, what dosage do you find you need with niacin? Do you get results with 500, how much do you have to take?

Dr. Kahn:             I will start a person and I’ll say the name of a brand. It’s not my company. I use a over the gutter brand called Endur-Acin, E-N-D-U-R-A-C-I-N. It’s been used for decades. It’s inexpensive and I will start 500 twice a day, warning the patient about flushes, rash, take niacin with applesauce so you don’t get as much rash, or with a nonfat yogurt. Typically, they don’t complain that much but, I will try and work them up based on labs to 1500, maybe 500 or more than a thousand a night, off into a thousand out of a thousand. You can go higher: 3000, 4,000 but, you really got to watch that patient. The flush isn’t bad. I take niacin a lot just for the fun of it.

Dr. Weitz:            Yeah the apple contains quercetin and that’s what we need to help counter the flush. So you might be taking quercetin now as part of your immunity programs, So you can probably…

Dr. Kahn:             Exactly. That’s a study Merck should have done. They did niacin with a noble prostaglandin inhibitor. And the study gave niacin a bad name. You should have done the niacin with applesauce study. And we could have probably been much more optimistic. Now, just recently, I don’t know, five years, there’s been a growing emphasis. We need a pharmacologic approach. I will say exercise, please. If your lipoprotein (a) is found to be high, exercise. It’ll improve all your other risk factors. It doesn’t do much to move lipoprotein (a) though. You can drop your cholesterol substantially with exercise and weight loss. There’s one distressing study, if you lose weight, your lipoprotein (a)  goes up. Oh my God but, exercise anyways. There’s a 2018 study that a whole food plant diet healthy, bright colored may lower lipoprotein (a) but, it was a modest amount. It’s not the kind we expect with…

Dr. Weitz:            In your book you mentioned coffee.

Dr. Kahn:             Yeah, coffee a little bit. It could lower it. So there’s a lot of reasons to drink coffee rather than Coca Cola or Mountain Dew.

Dr. Weitz:            That can be the new marketing campaign for Starbucks.

Dr. Kahn:             That’s right. Coffee for your lipoprotein(a). We may even put niacin in coffee beans and we could corner the market. But, a little company called Akcea came up with something called antisense oligonucleotide, ASO. This is not a word we say too often but, as the gene for lipoprotein(a) produces RNA, this thing binds and mimics what should happen normally to stop. So you don’t make lipoprotein (a) it’s an antisense oligonucleotide. It’s actually an injectable once a week product.  And about 280 people with high lipoprotein (a) and some sort of vascular disease, completed a study published late 2019, very little side effect injecting this once a week.  And about an 80% drop in lipoprotein (a). The company, I’m not sure if it was bought or merged with Novartis. One of the giant pharmaceutical houses. And so this spring there was supposed to be a 7,600 patient study moving forward now; placebo, the same drug, high lipoprotein(a), vascular disease. Because you can’t get FDA approval nowadays.  Dropping lipoprotein(a) doesn’t get you FDA approval. You got to show heart attack, stroke, safety measures and all the rest. With COVID-19, I’m sure recruitment and follow up has been very, very difficult. So we can only hope they can get that study really quickly going and enrolled. So by 2024, that was the original estimate, we’ll get some data. I’ll say two others actually to be thorough because your audience is sophisticated. There is a very bizarre therapy. You inherited the other kind of genetic cholesterol. Your cholesterol was 700 and at 32 years old, you had a stent.  There are people out there, one in 250, one in 500.  And it may be very difficult to get your cholesterol down with lipitor and other drugs in the market.  There’s a procedure that’s like dialysis. It’s called lipopheresis.  They stick a needle in your vein.  They take blood out for two, three hours.  It filters but, the filter doesn’t get rid of kidney products. The filter gets rid of cholesterol. Your plasma goes back in your body. Three hours later, you got a bandaid, you can go home and two weeks later you come back and do it again. So your LDL cholesterol, if you have that problem can fall 95% in three hours and it’ll slowly go back up and do it again.  That has been shown in the United States, in Europe and it’s insurance covered for the right person to decrease your risk of heart attack, stroke, and all the important measures.   It’s also approved for lipoprotein(a), very few places doing, Germany’s a hot hotbed. They got thousands of people with cholesterol disorders that use that approach. And you might find that Cleveland Clinic and perhaps UCLA or Cedar Sinai, you’ll find one or two programs in the state if they’re a densely populated state. Lastly, there’s an injectable cholesterol drug that is FDA approved called Repatha. And probably it turns out they’re very powerful lowering LDL cholesterol but, they modestly lower lipoprotein-little-a. They’re just not approved for that. So if I submit to insurance, my patient Charlie needs to get his Lp(a) down and I want to use… That’s the other name for lipoprotein(a), Lp(a). I want to use Repatha at $6,000 a year. They’ll tell me that’s not appropriate. We can only use it to treat LDL cholesterol. So, you work around that and help to get a patient on that if they meet the criteria.

Dr. Weitz:            And then there’s the Linus Pauling thing with vitamin C.

Dr. Kahn:             Oh, so good you mentioned that, which goes back to what we said 40 million years ago. We’re dependent on vitamin C exogenously. That’s called food usually because our collagen production is dependent on intake of vitamin C. So he hypothesized, he wrote an article in 1990 and then he died in 1994. He was like 95 years old. So he’s 91 years old writing original research. I think there’s lipoprotein(a), vitamin C thing is real. And if people would just take in more vitamin C and lysine. The two essential components to make strong collagen, and then this lipoprotein(a) thing would be neutralized. It would circulate in the blood but, it wouldn’t be able to actually harm arteries. That was a theory till 2015, when his protege a guy named Matthias Rath, did a mouse study. And the mouse study confirmed the theory. There’s still no human data.  What’s the bottom line. I have a lot of patients with high lipoprotein(a). What’s the harm to take in two, three, four or five grams of vitamin C powder or capsules. Certainly to eat the foods rich in vitamin C.  And what’s the harm to add 1500 milligrams a day of lysine as a powder or capsule.  But, you won’t see the blood level necessarily go down.  There really isn’t a way of objectively to monitor it. So I have to tell my patients it’s faith based therapy until the definitive study is done that shows we blocked lipoprotein(a) from being the sticky cholesterol. That’s the idea and makes it not so sticky to your arteries. Cool stuff.

Dr. Weitz:            Yeah. I think you mentioned a low dose aspirin as well.

Dr. Kahn:             Well, because of the vascular risk you might argue. You could talk about Nattokinase, Lambrokinase.

Dr. Weitz:            I was just going to ask about that.

Dr. Kahn:             There has been a study suggesting in a high lipoprotein(a) patient. And certainly if you have abnormal calcium score, or if you find a center that does carotid ultrasound medial thickness. If you have plaque, you’re probably going to want to be on a 81 milligram aspirin anyways.

Dr. Weitz:            I saw an article that showed EPA from fish oil had some benefit as well.

Dr. Kahn:             These are all… That’s the problem. Other than niacin, carnitine, modest, HRT, hormone replacement, modest. CoQ10, flaxseed and Omega 3, really modest. There’s been an estimate that you really need to drop lipoprotein(a) something like 50 to 60%. It was a modeling thing to expect that you’re going to see a significant drop in event. So it’s important to get to that point. The future is some sort of gene editing and I’m not a world expert on gene editing. There’s a new company I would call Verve Therapeutics, bright people and a lot of money right now. And they just announced in an animal model that they were able to cut out and turn off an LDL cholesterol gene and a triglyceride gene and successfully dropped blood levels of those markers, provocateurs of vascular disease significantly.  Nobody’s yet got to that point to do it for the lipoprotein(a) but, with 90 million people in this country alone, somebody is going to get hot on the trail of finding out how to do that. That may be the next five to 10 years. It’s very hopeful. It raises all out of other questions. You’re a 54 year old man or woman at your doctor, and they tell you your a lipoprotein(a) is high. What do you say to your 25 year old kids? Because there’s a chance your spouse may or may not have lipoprotein(a) as a genetic inheritance. But, your kids may or may not. Should they know at age 20,25 that their smoking habit is double jeopardy and their cheeseburger habit is double jeopardy. I would argue why wouldn’t you want to be fair with the data and not scare but, educate. American Heart has something called the simple seven on, or it should be the simple eight. Do a little bit more if you’ve inherited Lipoprotein(a). It doesn’t have to be the scariest conversation in the world.

Dr. Weitz:            Yeah. Everybody thinks about heart disease for people in their fifties and sixties. But, they’ve done autopsies on 17 and 18 year olds like I think in Vietnam. And a lot of them had atherosclerosis that had already started then. So this is long term process…

Dr. Kahn:             Very slow progressive deterioration on blood vessels, that is detectable in your teens, twenties and thirties but, we just don’t have a system that encourages that. So, yeah. I would want my kids to know. I happened to have had… You really only need the blood test once and if you’re normal, you’re done. And I’m normal and my wife’s normal, so our kids not going to have a high level, assuming they’re my kids. You never can really be sure. But, if it was a different situation I would want them to know.  Just the BRCA gene, a lot of conversation about that.  And we’re getting a little better at measuring pancreatic cancer genes and other disease states.  You can tailor your life a little bit in favor of avoiding the disease.

Dr. Weitz:            Right. Great. So I think that pretty much wraps it.

Dr. Kahn:             Yeah. I’m trying to think of there’s any wow factor.

Dr. Weitz:            We talked about diet a little bit. Anything else about diet?

Dr. Kahn:             Now, there was originally a paper 20 years ago that a high… I don’t want to get into diet wars. There’s a bunch of ways to eat poorly. And there’s a bunch of ways to eat in a healthier pattern. There was a study some 20 years ago that a higher saturated fat diet may lower lipoprotein(a). It was also modest. Subsequent studies haven’t confirmed it. In fact, there’s an acute feeding study, take humans, measure their lipoprotein(a) for six hours. When you feed them a diet high specifically it’s called palmitic acid and stearic acid, the long chain saturated fatty acids find the meat in animal products. You really get a spike in lipoprotein(a). It actually has a little bit of cool studies have been done that… And this gets into why we have in our blood, if I take you to the cath lab and do an angioplasty and stenting, which is part of my history and training.   And you measure lipoprotein(a) for a few hours, it spikes up for a while and then it falls back to baseline. It has called an acute phase reactor. And the idea there is perhaps we don’t want plaque to form. That it’s fighting with plasminogen, it’s kind of reacting to this activated balance of clotting and unclotting. There are some little neat factors in some of the studies that have come up. But, I just want to emphasize again, the biggest challenge will be your listener has a annual physical scheduled next week after July 4th or after [inaudible 00:40:40] whatever it is, goes to the doctor and says, “I heard this really interesting podcast, and I want you to check my blood.” And the doctor’s going to say, “I don’t think our lab does it. I’ve never really heard about it.” Because doctors who’ve been in practice for a while are smart and wonderful and good meaning people by in large for sure.

                                But, no pharmaceutical reps coming by right now. No grand rounds lectures coming by right now. It’s in the medical literature. Anybody can just go look it up. There is a nice site, lipoproteinafoundation.org. A woman who had a heart event in her thirties. I love people that take their personal problems and turn them into a passion to help others. And the woman that’s behind Lipoprotein(a) Foundation is one of those women. It could be a man but, everyone I know who’s done it is a woman. And it’s a very informative website. It’s a little conservative. They don’t encourage niacin. They’re waiting for definitive trials. Their board of academic advisors are good academic doctors that like to see big outcomes studies. I honor that but, real people right now are challenged by their levels. And so one-on-one, you can be a little bit creative with people.

Dr. Weitz:            Right? And then we talked about exercise, right? Exercise obviously is beneficial for anything related to lipids.

Dr. Kahn:             You better believe it. And changed particle size and particle number and insulin resistance goes away. And you can’t depend on some pharmacology that might come down the road in four to five years. So you’ve got to do the hard work but, consistently we see over and over the lifestyle, the avoidance of smoking, the regular fitness, the real food diet, the emphasis on sleep, stress management, optimal weight is the pathway that has been shown recently to help prevent Alzheimer’s disease type 2 diabetes, inflammatory diseases. And it’s the heart program. I mean, body reacts, you know it; oxidative stress and inflammation. I know it can damage all the organs or if you play your cards right and do the hard work, it can avoid damaging all our organs.

Dr. Weitz:            Excellent. So how can our listeners get a hold you, find out about your book?

Dr. Kahn:             Yeah. I mean the books and all the online sellers of course it did spend March as the number one heart book on Amazon, which is always a treat because I didn’t have a whole big press team behind me. I tried to blab about it. Some, because I really want people to know about it. I’m at drjoelkahn.com, D-R-J-O-E-L-K-A-H-N.com. And I see patients and I do a lot of interviews and I have a podcast. And like you said, it was very kind of give me a shout out. I just like to educate and like you, if I’m going to educate, you got to read, you got to study, you got to learn. So it’s the best of medical practice when you’re fired up about bringing people new stuff. So you do a great job of that. And I appreciate you letting me share this time with you.

Dr. Weitz:            Absolutely. And I thank you for joining me today.

Dr. Kahn:             So what’s the other thing we learned today? Don’t wear a denim checked shirt on a [crosstalk 00:43:58]. I started with that before we went live and it looked like some kind of electric Kool-Aid, 1960s experimentation. So I feel down to a simple green shirt.

Dr. Weitz:            I was listening to one of your recent podcasts and you were talking about fish oil and some people have kind of been maligning fish oil because there was a couple of studies that maybe fish oil might lead to prostate cancer risk.

Dr. Kahn:             Right. But, nutrition science is tough. [crosstalk 00:44:36].

Dr. Weitz:            It turns out that both of those studies that were authored by [Borowski 00:44:40], both of them were based on levels of DHA and EPA in the blood. Neither study were patients given fish oil.

Dr. Kahn:             Right. That is an issue you can see on meta analysis that included people that got a hundred milligrams of EPA DHA in the same database that got 2000 milligrams, which is probably a much far reasonable and therapeutic level but, you lump them all together and you dilute out the good studies with studies that may have been dramatically under-dosed. And who’s the group you’re studying, it goes on and on. That’s the challenge. That’s why once in a while the Cochrane database will come out with a statement that most people feel is of higher quality on a nutrition topic. And no one study changes everything forever with very rare exception. You just got to put it all together and say where does this fit in the big picture?

Dr. Weitz:            Exactly. Awesome, Joel.

Dr. Kahn:             Thank you.

Dr. Weitz:            Thank you. Talk to you soon.

Dr. Kahn:             I hope you have a wonderful summer.



Endometriosis with Dr. Lara Briden: Rational Wellness Podcast 165

Dr. Lara Briden speaks about Endometriosis with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

2:50   It has been thought that endometriosis occurs because of retrograde menstruation, which is when the menstrual fluid flows backwards out the fallopian tubes, thus letting the endometrial cells to get into the peritoneal cavity, where they can sometimes grow. A lot of experts in endometriosis now do not endorse this theory about why endometriosis occurs.  There’s some evidence that some of this endometrial tissue was laid down from birth and some evidence for this is that endometrial lesions have been observed in fetuses and also occasionally in men.  So there is a paradigm shift that is occurring in thinking about endometriosis.  This disease can cause debilitating, life-destroying pain for some women that prevents them from working or having a normal life.

5:40  Endometrial lesions are hormone sensitive tissues, but Dr. Briden does not feel that these lesions are caused by hormones and common treatments that involve suppressing estrogen like Lupron and other hormone suppressing drugs or birth control pills are not a great solution.  The common conventional medical approach is to give birth control pills, which shuts down your natural hormones, which is potentially harmful, since women need their hormones. Shutting down estrogen has a cost.  Dr. Briden’s approach is to dial down the inflammation and the immune dysfunction that’s driving the disease.

7:45  Estrogen metabolism and the ability to excrete estrogen plays a role, but this should not be seen as the main focus of treatment.  It is also interesting that endometrial lesions have progesterone resistance.  Normally, progesterone has a downregulating effect on endometrial tissue, prescribing progesterone can play a role in treatment for endometriosis.

9:18  Endocrine disrupting substances like BPA, pesticides, teflon cookware, fire retardant chemicals, and dioxins can play a role in the cause of endometriosis.  These estrogenic substances are epigenetic triggers and switches that determine whether your genes get turned on and expressed or turned off and not expressed. And even these epigenetic switches can get passed on for up to four generations.  They can change the genetic expression of progesterone receptors and of immune system function. 

12:43  There has recently been a paradigm shift in our thinking about endometriosis from focusing on the lesions, why they got there, and removing them or to suppress the estrogen that causes the lesions to grow.  Even the diagnosis in the traditional paradigm is via surgery, since a typical ultrasound exam cannot rule out endometriosis, since these endometrial lesions are difficult to detect.  The new thinking, the new paradigm is to focus on the immune dysregulation that has led to the inflammation that is facilitating the growth of these lesions.  If you have the celiac genotype, the HLA-DQ2 genotype, that puts you at risk of celiac, but it also puts you at risk for endometriosis.  The Functional Medicine approach is well suited to helping to find the root causes to modulate the immune dysregulation that underlies endometriosis. 

19:12  Because of the new paradigm, there has been effort into finding a biomarker for endometriosis so that young women do not have to go on the operating table to diagnose their condition.  To recap, first there is the genotype, such as the celiac genotype that puts you at risk, then compound that with epigenetic changes that creates an immune environment that is primed for this to happen. Then you have the lesions, whether laid down before birth or retrograde menstruation, and there has to be estrogen present, which is why children don’t typically have endometriosis.  The presence of gram negative bacteria in the pelvic microbiome is also a factor, including that women with endometriosis have six times the level of LPS in the pelvic cavity and in the menstrual fluid. This is referred to as the Bacterial Contamination Theory.  One study showed that antibiotics could reduce endometrial lesions, though this was an animal study.

23:12  Given the factors we just mentioned that promote the growth of endometrial lesions, the first tow steps of the treatment should include: 1. Strictly eliminate gluten, 2. Dial down those gram negative bacteria with anti-bacterial herbs, and repair gut integrity.

24:37  Nutritional deficiencies can trigger inflammation, including zinc and vitamin A, both of which are often low in vegans.  Dr. Briden mentioned that vegans can lack the following nutrients: 1. zinc, 2. preformed vitamin A, 3. Omega-3s, 4. B12, 5. Iron, 6. Iodine, 7. choline, 8. selenium, 9. activated B6, 10. B2, and 11. taurine. 

27:17  Food sensitivities can be triggers for the immune system for endometriosis. Besides gluten, cow’s dairy, particularly A1 casein is similar to gluten in that both create an opioid type molecule that upsets the immune system.  Eggs can sometimes be an immune disruptor.  Soy is another common sensitivity. And then there is the issue of histamine and mast cell activation.

30:02  While you can’t eliminate histamine containing foods, a low histamine diet might be beneficial if there are signs of excess mast cell activation, such as hives, urticaria, headaches, congestion, nasal congestion, swelling, and especially if they’re a cyclic pattern to that, because histamine will usually check up with estrogen.  Improving the gut will improve histamine levels over time.  You may not need to avoid avocado and high amine foods.  You can take DAO enzyme and vitamin B6 to help clear histamine. And progesterone has an anti-histamine effect.

31:42  Dr. Briden may recommend oral natural bioidentical progesterone for women with endometriosis, though she does not like the synthetic progestins. Progesterone can help to down-regulate the endometrial lesions and reduce the pain, as well as help with mood, sleep, and hair.

34:02  Nickel sensitivity can make endometrial lesions worse. Nickel is present in the soil and can get into certain foods, like wheat, high coco chocolate, and foods that come in cans, like tomatoes.  There is also nickel in some jewlery.  Mercury is another heavy metal that can also be very damaging to the immune system.  Zinc, N-Acetyl Cysteine, curcumin, and selenium are nutrients that can help with detoxification of heavy metals like nickel and supporting immune function. NAC has also been shown to help patients with endometrial lesions actually shrink. Dr. Briden recommends taking 1000 mg twice per day of NAC.



Dr. Lara Briden is a Naturopathic Doctor with more than 20 years experience and her practice is in Christchurch, New Zealand.  She is a period revolutionary–leading the change to better periods.  Dr. Briden is the author of a best selling book, Period Repair Manual, which is a manifesto of natural treatment for better hormones and better periods and provides practical solutions using nutrition, supplements, and natural hormones. Her website is Larabriden.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz:            Hey, this is Doctor Ben Weitz, host of The Rational Wellness Podcast. I talk to the leading health, and nutrition experts, and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to The Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com.  Thanks for joining me, and let’s jump into the podcast.  Hello, Rational Wellness podcasters. Thank you so much for joining me again. For those of you who would like to see a video version to this podcast, please go to my YouTube page. If you go to my website, drweitz.com, you can see detailed show notes and a complete transcript. For those of you who enjoy listening to The Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast and give us a ratings and review.

                                Today our topic is, endometriosis, and this is when endometrial tissue, the tissue that lines the uterus, grows outside of the uterus. Most commonly on the ovaries, the fallopian tubes, or the intestines, though it could occur anywhere in the body. It affects one in 10 women in the United States. The most common symptom is pain, especially in the pelvis or the lower back region. Endometriosis can also be associated with bladder problems, gut problems like diarrhea or constipation, and bloating, sounds very much like IBS or SIBO, headaches, menstrual irregularities, and infertility. There can also be pain during sex, or during urination. The conventional medical treatment typically consists of contraceptive pills, surgery to remove the endometrial tissue, and pain medications.

                                Doctor Lara Briden is a Naturopathic Doctor with more than 20 years of experience. She’s a period revolutionary, leading the change to better periods, in fact, the best periods ever. In fact, Lara will be having a huge rally in Oklahoma just so she can make women great again. Just kidding.  Lara is a passionate communicator about women’s health, and alternatives to hormonal birth control. In her book, Period Repair Manual, is really a manifesto of natural treatments for improving hormones, and periods, and providing many natural solutions, including the use of diet supplements and natural hormones. Thank you so much for joining me today, Doctor Briden.

Dr. Briden:          Hi, Ben. Thanks for having me.

Dr. Weitz:            Absolutely. So when we think about endometriosis it’s hard to understand how endometrial tissue ends up in another part of the body other than the uterus, until I read that retrograde menstruation occurs in up to 90% of women. Perhaps you can explain how that occurs.

Dr. Briden:          Well, the menstrual fluid flows backwards out the fallopian tubes, into the pelvic cavity, and as you said, that’s a pretty standard, common thing to happen.

Dr. Weitz:            If that’s really the case, how come a lot more women don’t have endometriosis?

Dr. Briden:          Well, that’s probably the fatal flow of the retrograde menstruation theory of endometriosis, which a lot of experts now do not endorse, so that was the theory that … it’s almost 100 years old now. The surgeons who first described endometriosis decided that’s how the disease came about, that it just happen to flow back out into the pelvis, and that was the origin of the disease, of course as we’ll talk about today there’s a lot more to the story. In terms of how the lesions actually get there with endometriosis sufferers, the consensus seems to be it’s probably a combination of reasons. Some think maybe it was from retrograde menstruation, and there’s some evidence that it can be laid down before birth, that tissue, that type of tissue is laid down as a fetus, but that doesn’t mean it’s necessarily going to turn into endometriosis. One of the bits of evidence of that, endometriosis lesions have been observed in fetuses, and actually men can have endometriosis as well. It’s very rare, but you can get, there’s been a few cases in the literature of men having active endometriosis lesions, but they have-

Dr. Weitz:            Oh, interesting.

Dr. Briden:          They have no retrograde menstruation.

Dr. Weitz:            Fallopian tubes.

Dr. Briden:          No. So there’s a lot more to the disease than the standard model. I think it’s fair to say that this disease is undergoing … well, not a bit, but a paradigm shift. You can’t have a bit of a paradigm shift, can you? It’s an all or nothing thing. A paradigm shift is coming for this disease. I think we’re just on the tipping point of that actually, and that will be looking beyond just the presence of the lesions, and really thinking more broadly about what’s going on that could allow such a terrible disease process to take … to begin. It can be terrible, I mean, terrible is not a hyperbole for this disease, it can be mild for some women, but for some women it can be life-destroying, as in just pain, debilitating pain that prevents them from working or having a normal life. It’s very sad when that’s the case.

Dr. Weitz:            So what role do hormones, particularly estrogen and progesterone play in endometriosis?

Dr. Briden:          Well, this is probably the paradigm shift. The lesions are definitely sensitive to hormones because they’re hormone-sensitive tissues, so by definition they’re affected by hormones of course. But the the position I take, my reading of the literature is that the disease, and the lesions are not caused by hormone imbalance. So they’re affected by hormones … once the lesions are there, and it’s active disease it’s affected by hormones, particularly by estrogen, which is kind of like petrol or gasoline on the fire. Once there’s a fire you put estrogen on that situation, and that can make it a lot worse. So that’s why the conventional treatment, in addition to surgeries, the conventional treatment of the lesions, the conventional treatment has been, and still is to suppress estrogen. The problem with that approach, as you can imagine, is that women actually need their estrogen, so estrogen … It’s not great for anyone to just shut that all down, whether that’s with Lupron, like the MediTropin suppressing drugs or even just hormonal contraception. Shutting down estrogen has cost, and I would argue it’s actually not really the right tool for the job for this disease anyway.

                                My approach is to, as we’ll get to, to try to dial down the inflammation and the immune dysfunction that’s driving the disease, and so therefore a woman can have … can enjoy the benefits of her own cycling hormones. I think one thing it’s fair to say is, it’s in the literature, and what I’ve seen with my patients, most women with endometriosis do not … their hormones are okay, as in their hormone balance can be pretty normal, they could be having pretty regular cycles, going through the normal estrogen and then progesterone, it’s just that they’re being affected by those hormones.

Dr. Weitz:            What about the estrogen metabolism, their ability to excrete estrogen, and what pathway, does that play a role?

Dr. Briden:          I think it could play a small role, yes. I think definitely with an estrogen-sensitive disease you want to optimize how well your body clears estrogen, and don’t have any inflammatory … as few as possible inflammatory estrogen metabolites around. I think that can be part of the treatment strategy, but it’s not the only one, and it’s really not even the most targeted part of treatment, but it’s … Yes, I think there’s a role, certainly a place for trying to promote healthy estrogen metabolism.   The other thing just to say on hormone balance, is there’s pretty strong evidence now that endometrial lesions, endometriosis has something called progesterone resistance.  Normally, hormone progesterone should have a down regulating effect on endometrial tissue, that’s the normal response, but endometriosis lesions don’t experience that as well as they should. The situation could be a woman is who’s making progesterone, the beneficial hormone progesterone, but the progesterone is not managing to suppress the lesions. Then, of course there’s a whole strategy of coming in onboard with treatment with either a progestin drug, which is actually quite different than progesterone, or even using real progesterone as part of a whole treatment strategy to try to suppress the lesions, and there’s a place for that as well. I’m sure you get the feeling, people say it’s a complex disease and it is.

Dr. Weitz:            What about the role of so-called environmental estrogen or endocrine-disrupting substances like BPA and pesticides, and non-stick cookware chemicals, and fire retardants, and all those lovely chemicals?

Dr. Briden:          Well, there’s definitely a role. You know what, Ben? I think some of the role of those environmental toxins, particularly dioxins, that’s where a lot of the research has been around endometriosis, are epigenetic. What that means … There’s some research, I call it kind of troubling research, I mean, troubling in the sense that it just is sad to think it’s happened a couple of generations ago, but there’s some evidence that dioxin exposure creates epigenetic change. Do your listeners knows what epigenetic, what I mean by epigenetic?

Dr. Weitz:            Yeah, yeah, it’s the sets of triggers and switches that determines whether your genes get expressed or not.

Dr. Briden:          Right.

Dr. Weitz:            Whether they get turned on or turned off.

Dr. Briden:          Yeah, turning on and off genes that is inheritable. Right, inheritable, so you can-

Dr. Weitz:            Right, the genes are inheritable, yeah.

Dr. Briden:          Well, and the epigenetic changes-

Dr. Weitz:            I guess-

Dr. Briden:          The epigenetic changes as well.

Dr. Weitz:            Right.

Dr. Briden:          This is the radical thing about epigenetics. We used to think with every new generation, every baby they’re just kind of a clean slate, these genes are just waiting to be turned on or off, but now we know from studies of epigenetics, which is really less than 20 years old, that expo … not just exposure to environmental toxins, but any kind of environmental influence to one generation can switch on and off genes, alter gene expression that they can then pass on to subsequent generations, for generations. Potentially what some of the research … these are animal studies, but what some of the research are showing for some models of endometriosis is for example dioxin exposure to a woman, especially maybe with a daughter in utero alter some epigenetic expression of genes both in the immune system, and probably in hormonal receptors as well, particularly progesterone receptor. That is then passed on to the next generation, and then passed on to the next generation.

                                So potentially you have a situation of where one of the reasons that we’re seeing … starting to see quite a sharp uptick in cases of endometriosis, in severity of endometriosis, it wouldn’t surprise me at all through my lens, or I’m just looking at the literature that some of these is a lifetime delayed effect from, say toxin exposure two generations ago, in the 1950s or something. What this means for women who suffer the disease is … I think it’s important to say it also means it’s not something, it’s not a lifestyle disease. It’s not something they brought on themselves by eating wrongly, or having … or necessarily even poor estrogen clearance, or anything like that. There was something in the blueprint both genetically, potentially epigenetically that set them up for this disease. I think that’s important that you feel like it’s not your fault, it’s definitely not your fault.

Dr. Weitz:            But even though some of these epigenetic changes are passed on, still there is an opportunity for us to modify our epigenetics by our diet and lifestyle.

Dr. Briden:          But there’s still the opportunity to modify genetic expression through diet and lifestyle, and some other strategies as well, so yes. On the one hand, you can say that this is something that happened maybe out of your control, two generations ago, plus, but at the same time it doesn’t mean there’s nothing you can do about it. You can still, especially because we’re mainly going to be talking about the immune system, and immune dysfunction with endometriosis, then there are ways we can access that. In fact, in many ways natural medicine is better set up to … were better positioned to influence or modulate immune function arguably that some parts of medicine right now, because they don’t … we just have some tools in our tool box that are quite useful particularly for this disease.

Dr. Weitz:            Right. Certainly we have the capability of being able to modulate immune dysfunction as opposed to just turning it off or turning it on the way some of the heavy-hitting pharmaceuticals do.

Dr. Briden:          Yeah. I might just describe, because I’ve used the word paradigm shift, so I might just describe for your listeners what I mean by that in a nutshell. The old paradigm is that the problem is all about the lesions themselves, probably presumably from retrograde menstruation. You get these bits of endometrial tissue that lands in the pelvis, and then there’s kind of a to be expected sort of inflammatory response. Everyone knows it’s an inflammatory disease, but in the old paradigm the problem is these lesions shouldn’t be there, therefore this inflammation ramps up. Therefore, the treatment is to remove the lesion, or to suppress the estrogen that causes the lesion to grow, so that’s the old paradigm.

                                I think obviously the new paradigm is best described as the problem is the immune environment, that would permit these lesions, and not even permit, but promote the growth of these lesions, that probably got there by a variety of mechanisms, maybe by retrograde menstruation. But the interesting thing about endometriosis lesions compared to normal endometrial utero lining tissue is they’re not the same, they’re similar but they’re not the same. For example, endometriosis lesions have a nerve supply, which the endometrial tissue does not, so there’s some things going on, and there’s an active … with endometriosis lesions there’s an active, what’s called angiogenesis, its invasive characteristics to them, which is actually quite similar to a lot of autoimmune diseases, which is why there’s been a controversial part of this conversation is to discuss endometriosis as an autoimmune disease.  Eight years ago I had gotten into a lot of trouble for saying that, quoting the literature that was saying that, at that time it was a lot more controversial. A few years on, I think it’s still controversial to say it’s autoimmune, at the end of the day I don’t think … We don’t necessarily need to designate it as autoimmune to state quite clearly that it has many aspects of immuno dysfunction, and it looks very similar to other autoimmune diseases, particularly inflammatory bowel disease, and celiac, and rheumatoid arthritis. In fact, the celiac genotype, or as you know the HLA-Q genotype, immune system genotype, basically if you have the genes that encode for that kind of immune system that puts you at risk of celiac disease, but also at risk of endometriosis.  There’s a lot of overlap, in fact, there was a reproductive immunologist, Jeffrey Braverman, who did … he never published his research, which is a real shame, he only published it casually, but he tested the haplotype, HLA haplotype of all his endometriosis and subclinical endometriosis patients, and found that something like 95% of them had the celiac genotypes. So it’s hard to get a picture emerging of what kind of immune system you need to develop this disease.

Dr. Weitz:            It’s interesting. I mean, it’s kind of been a big trend in, especially in medicine in the last 20 years, is so many diseases now have an autoimmune origin. We just had a discussion with Dr. Mark Pimentel, and there are just autoimmune story about the origin of IBS, which is the most common GI condition. We always distinguish between the autoimmune conditions like IBD and IBS, which wasn’t, now that has an autoimmune origin, and a lot of heart disease now seems to have autoimmune origin, so that seems to be an increasing story about health and disease.

Dr. Briden:          Yeah.

Dr. Weitz:            So if endometriosis is related to immune dysfunction, how do we analyze this? What kinds of things are affecting the immune system?

Dr. Briden:          In terms of treatments or in terms … Yeah.

Dr. Weitz:            Yeah, in terms of diagnosis, and essentially we want to look for the underlying triggers and causes. We have, for example, food sensitivities, right?

Dr. Briden:          Sure. Let’s talk it through. So in terms of diagnosis, I’ll just touch on that first because this is … we’re 2020, but the diagnosis of endometriosis is trapped back in the Middle Ages somewhere, and the diagnosis is by surgery currently, which is …

Dr. Weitz:            Right.

Dr. Briden:          Bizarre, like kind of-

Dr. Weitz:            You have these lesions, so let’s cut them out. They shouldn’t be there.

Dr. Briden:          Well, and also the only way to definitively diagnose a lot of the time is with surgery, which is really … anyway, that is changing a little bit. There’s a new research about using a really specific type of ultrasound, or the old technicians have to be very trained to look, to try to see, and even then you can’t see all endometriosis, but to be able to try to see something on ultrasound. Just for your listeners, having had a normal ultrasound finding, like your run-of-the-mill ultrasound, pelvic ultrasound cannot rule out endometriosis. You could still totally have the disease, and [crosstalk 00:19:04].

Dr. Weitz:            Is there any other imaging technique that can look at it? MRI?

Dr. Briden:          No. Well, laparoscopy. So surgery, but the other … Because of the nature of the disease, that it is arguably a disease immune dysfunction, there should be a biomarker. There’s been a lot of, well, not a lot, but there’s been some research the last few years trying to find other blood tests, or a test of menstrual fluid or something, a marker that you could start to measure the presence of this disease. It would be really helpful for young women who don’t want to have to go on the operating table just to try to … so there is that in terms of diagnosis. Now, in terms of treatment, I guess, and what sets up for the difference, I want to talk about the cascade of things that need to happen.

Dr. Weitz:            Sure, let’s do that.

Dr. Briden:          To develop the disease. Because back to … We had read the role of estrogen, tons of women have high estrogen, and poor estrogen clearance who never get endometriosis, like you could have extremely high estrogen and endometriosis is just never going to happen for you because you don’t have that immune system. We’ve got top of the cascade, if you will, is having the genotype, probably the celiac genotype that puts you at risk, compound that with probably some epigenetic changes that happened either to your ancestors, recent ancestors, or to yourself, that creates an immune environment that is already kind of primed for this to happen, but still may not happen. Then you have the presence of the lesions, you had to get those somehow, whether laid down before birth or retrograde menstruation, somehow the lesions get there, but then that’s not even enough.

                                Then there has to be some estrogen present, which is why children don’t typically have endometriosis, but it can kick in as soon as puberty hits, so then estrogen has to come on the scene to start, not just in creating the lesions, but altering immune functions into … pushing immune functions to more of a potentially autoimmune state. But that’s the final, fifth ingredient, that I think is pretty important, and is something we can access and treat, which is the presence of gram-negative bacteria in the pelvic microbiome. As you know, E. coli, gram-negative bacteria are present in the gut, and they produce something called LPS, micro polysaccharide toxin, which is highly … it’s a part of their cell wall, it’s a bacterial … bit of a bacteria, which the immune system can go a bit crazy when it sees that. It really doesn’t like to see bits of gram-negative bacteria floating in the body, somewhere in the bloodstream or in this case in the pelvic area.  There’s pretty fascinating research called the Bacterial Contamination Theory, where they’ve … a few things they’ve done, they’ve measured that women with endometriosis have … it’s not small, it’s six times higher level of LPS in the pelvic cavity, and in the menstrual fluid, compared to women who don’t have endometriosis. Then there’s evidence that certain types of antibiotics can reduce the size of endometriosis lesions, although that was an animal study. The mechanism is proposed to be translocation from the gut to the pelvis. In other words, intestinal permeability but not to the bloodstream, and not just to the bloodstream, but actually into the pelvis, and then you get this combination of … There was an animal study that I’ve quoted a few times, where they had animals with epigenetic changes progesterone resistance, and with dioxin, combined with estrogen, combined with LPS toxin, and the lesion just went crazy basically. That is the perfect storm for how to create an active inflammatory disease in the pelvis. If you understand that, and think about it through that lens then, well, the first step would be … Well, the first two steps I’ll just say off the top are strictly-

Dr. Weitz:            Fix the gut.

Dr. Briden:          Strictly eliminate gluten, particularly if you have that gluten genotype, and dial down those gram-negative bacteria. Either do kill them off, I use anti-microbial herbs, not permanently, but knock them back, and yes, work on repairing gut integrity. This link with gut is why we see so much extreme overlap between irritable bowel, and inflammatory bowel disease, and endometriosis. It’s like 95% overlap or something like that, and in terms of endometriosis sufferers, 90% to 95% of them have pretty serious hardcore gut issues going on. It used to be thought, “Well, the endometriosis affects the gut,” which is true, but I think a lot of it is the gut is affecting, driving endo.

Dr. Weitz:            From a functional medicine perspective, how many conditions are not related to the gut? It’s amazing.

Dr. Briden:          True. It’s true. It should be no surprise, and ultimately it’s all right there in the same area. I mean, I think there’s something to be said for anatomical proximity, the gut is right there, and it can become quite an inflammatory environment.

Dr. Weitz:            Right. So what are some of the other things that trigger that inflammation?

Dr. Briden:          Well, nutrient deficiency, because the immune system is very nutrient hungry, like it has some requirements for, particularly I would argue zinc, and Vitamin A, these are simple nutrients, but are pretty darn important, and I mentioned them … I mentioned zinc, and preformed Vitamin A for any of your vegan listeners. I don’t know how many you have, but I would say pretty please, if you’re exclusively plant-based you need to think about some zinc, and Vitamin A because you can’t get it from plant-based diet. Your immune system requires that. Your gut integrity requires that. Yeah, gut integrity.

Dr. Weitz:            People don’t often mention that for vegetarians. They usually talk about the need for Omega-3s, and B12, and iron, but they usually not talk about-

Dr. Briden:          I would say iodine and … iodine and choline, and selenium, I mean, on one of my blogs I have a list of about 20 nutrients that I think-

Dr. Weitz:            Right.

Dr. Briden:          Anyway, but staying on the topic of … staying on the topic of-

Dr. Weitz:            No, no, that’s good. Why don’t you mention those real quick? So besides B12, and iron, and Omega-3s, you just mentioned zinc-

Dr. Briden:          Zinc.

Dr. Weitz:            And then preformed Vitamin A, which is only found in animal foods, right?

Dr. Briden:          Correct.

Dr. Weitz:            Can they get a vegetarian form of Vitamin A?

Dr. Briden:          That’s a really good question. I believe so. I mean, most Vitamin A supplements are derived from fish oil, so you would have to … a fish liver, so you’d have to kind of source that. I’m not a 100% sure.

Dr. Weitz:            Right.

Dr. Briden:          Then the other nutrients that would be missing on a vegan diet arguably, hopefully we’re not making too many people angry right now, but choline, iodine, activated B6, Vitamin B2 to some extent, taurine, which is a … this is a little bit off topic of endometriosis, but taurine is actually considered a non-essential amino acid, but it’s actually really essential for women’s health. Estrogen increases a requirement for taurine, it’s a neurotransmitter. It’s a common neurotransmitter for the brain. Again, I would argue if you don’t eat meat or don’t eat animal products you just take taurine, although I’m personally telling I think it’s often derived from animal products, so you kind of get into confusing territory around that, but yeah.

Dr. Weitz:            Okay. So we got these nutrient deficiencies.

Dr. Briden:          Yeah, and also, I guess carrying on with in terms of endometriosis and other things, yes, you mentioned food sensitivities in general, so there’s going to be some individual … I think gluten is across the board almost, and it has to be strictly. There’s no such thing as being partially gluten-free for an autoimmune disease, right?

Dr. Weitz:            Right.

Dr. Briden:          Unfortunately, you can’t just mostly do it, because unfortunately my experience is you might not get any benefit at all, which is really frustrating. In terms of other food sensitivities the big ones I see for endo would be cow’s dairy, particularly A1-casein normal cow’s dairy. It’s pretty similar to gluten, as you probably know they both create this opioid type molecule that could be very upsetting the immune system. Sometimes eggs, not always but eggs can be an immune disruptor in some people, and sometimes soy, and then of course there’s going to be sometimes, there’s going to be people who have another food sensitivity, but again, if you have a really long list of food sensitivities then you can’t just kind of accept that that’s going to be your life forever. I think a lot of that then goes back to fixing the gut, repairing gut integrity, so that you can then tolerate some of the other foods, some of the other offending foods. I mean, I guess the other thing to mention is the role of histamine, and mast cell activation in a lot of conditions, in a lot of women’s health conditions that definitely-

Dr. Weitz:            Maybe you could briefly explain mast cell activation.

Dr. Briden:          Yeah. So mast cells are part of our immune system, they’re the primitive part of our immune system, their strategy … They’re not making antibodies and targeting things, although that probably happens with endometriosis as well, but the mast cells are … if they get upset about something, and they just blow, they just send inflammatory cytokines everywhere, including histamine, and heparin. That kind of histamine response is quite inflammatory, and there are ways to try to stabilize that, including … I would argue avoiding casein, back to dairy, casein, A1-casein can be quite a strong mast cell activator in some people, not everyone. Also, for some women with endometriosis, avoiding foods that are really high in amines and histamine can help to reduce the pain. Foods like that would be fermented foods, smoked fish … Your listeners might be familiar with histamine intolerance or high histamine foods.

Dr. Weitz:            Right.

Dr. Briden:          But you don’t have to eliminate those completely, because you can’t for one thing, and they’re not like … they’re different category than gluten.

Dr. Weitz:            Do you recommend a low histamine diet?

Dr. Briden:          It depends. That would depend on the patient. So I would look for signs of histamine intolerance or mast cell activation, particularly hives, urticaria or hives, headaches, congestion, nasal congestion, swelling, and especially if they’re a cyclic pattern to that, because histamine will usually check up with estrogen. So if you get those kind of allergic symptoms during your high estrogen phases of your menstrual cycle, then that can be a clue, for example. Then I think that can be part of the strategy. Even then with improving the gut, even the histamine mast cells side of things should improve over time, so you won’t necessarily always need to avoid avocado and high amine foods.

Dr. Weitz:            Are there certain natural substances you can take to manage or down-regulate histamine and mast cells?

Dr. Briden:          Yeah. Well, yes, and I’m sure you had mast cells experts on your podcast before, I mean, I’m not fully situated as an expert in that whole field, but I’m happy to answer a little bit, but I can say for example the enzyme, DAO enzyme, it helps to clear histamine, that is dependent on B6. So B6 can be quite helpful for that. Having a healthy gut in general can be quite helpful for clearing histamine, reducing mast cells activation. Progesterone itself, the hormone progesterone generally has an anti-histamine effect. It’s another argument potentially for bringing some progesterone on board.

Dr. Weitz:            So will you, maybe use progesterone even if women say, seems to have somewhat normal progesterone levels?

Dr. Briden:          Yes. So in chapter nine of my book, Period Repair Manual, I would refer to this. There’s a patient, so there’s stories throughout my book, so chapter nine the patient story is Hannah, and she ended up with pretty severe endometriosis. She’d get gluten-free, and some of the things we’ve already spoken about. She also … she’s been on a progestin called, brand name called [inaudible 00:32:11], which have sort of down-regulating effect on the lesions. She switched to oral micronized progesterone on natural progesterone capsules, as that component of her treatment, and did quite well. The advantage of progesterone, real progesterone over, versus a progestin drug is usually progesterone is a lot more friendly to the mood, sleep, and hair, and also it’s a nicer thing to take than a progestin.

Dr. Weitz:            Do you prefer oral progesterone over topical?

Dr. Briden:          Yeah, generally yes. Mainly for a few reasons, but mainly because it actually … The first [inaudible 00:32:50] can be good because it generates a lot of, something called allopregnanolone, which can be quite good for mood. But just staying on the topic of histamine activation, mast cell activation, progesterone for many women, not all women should have a stabilizing effect on mast cell and histamine, so that can sometimes relieve those migraines, hives, kind of premenstrual histamine symptoms, and at the same time, help to manage or control endometriosis.  The goal for endometriosis is not cure, because we all … most people agree that there is no cure for the disease, but the term I use is remission. I think a lot of patients can reach a point of if not no pain, no pain would be great, but if not no pain, then close to no pain, at least very much reduced pain, and that would be arguably a state of remission where the disease is not active. The disease is not invading, it’s not progressing, it’s not causing pain.

Dr. Weitz:            I saw you write about certain heavy metals like nickel in particular. I saw that article where you wrote about nickel. That’s kind of interesting.

Dr. Briden:          It is fascinating. The nickel-

Dr. Weitz:            Now, is this somebody who is high nickel, like you’re on heavy metal panel, and they’re high in nickel?

Dr. Briden:          No.

Dr. Weitz:            No.

Dr. Briden:          No.

Dr. Weitz:            Okay.

Dr. Briden:          It’s not heavy metal toxicity. It’s not heavy metal toxicity, it could be another … sure, I mean, that can affect the immune system, so that’s probably, that’s a separate issue, but this is … Now, this didn’t make it into my book because I only learned about it … there was a study that came out last, maybe six months ago. What they found is pretty mind-blowing. Some people have nickel sensitivity, immune system that reacts badly to nickel, and you know that, the test for that is jewelry allergy. If you try to wear earrings that aren’t pure gold, if there’s any nickel basically in your jewelry, and you get a rash from that, you have nickel allergy.  The problem is that a lot of foods have nickel. So some foods contain it naturally, particularly high coco chocolate, some of the ones that make me … I don’t have a nickel allergy, but still I was feeling for my patients, it’s like, “Oh, that’s sad.” But also any canned foods are going to be high, particularly canned tomatoes because they pick up a lot of the nickel from the can.

Dr. Weitz:            Is there a way to test for this? I’ve never seen nickel on a food sensitivity test?

Dr. Briden:          Well, the test is the jewelry sensitivity. I think there’s some other skin tests they can do, where they actually just rub some nickel, and see if you get a rash, but I think the jewelry sensitivity is a pretty … When I posted that on my Instagram … So I’ll finish explaining what the situation is. So they’ve known for a while that nickel can play a role in IBS. So nickel foods can contribute to the inflammation, the dysfunction of the gut for some women, and that by removing nickel, you can’t remove them entirely, but dialing them down, reducing nickel intake can relieve IBS symptoms. Then there was a research paper about six months ago that found that endometriosis is the same, that women … I forget the details of the study, but basically it was that four people who have a nickel allergy, that allergy itself in the presence of nickel can worsen endometriosis, not cause it. Because as we said the cause is multifactorial, but can aggravate it.   So when I shared that on my Instagram I got maybe a couple hundred women with endometriosis saying, “I have a nickel allergy. Oh, that makes sense. I have a nickel allergy.” I’m sure probably there are some endometriosis sufferers who don’t have a nickel allergy, but I haven’t encountered them yet, so it does seem to be … I think the underlying thing is the immune dysfunction. It’s not normal for the immune system to get upset about nickel.

Dr. Weitz:            So is nickel … it’s in the soil, and it gets … is that how it gets to some of the food?

Dr. Briden:          Yes. So it’s in the food, within cans. So it’s in the soil, so it’s just present in some foods that [crosstalk 00:37:07].

Dr. Weitz:            Right. Okay. So foods that you buy in cans.

Dr. Briden:          Yeah, so canned food is a big part of it, and the confusing thing about it is there’s actually been an overlap with other things, like FODMAPs and gluten. There’s quite high nickel in wheat. So then the question is … Okay, using wheat as the example, so wheat seems to be quite a problem for endometriosis for a lot of people, is it the nickel? Is it FODMAPs, because it’s aggravating SIBO or IBS? Is it gluten? I suppose it can be all three sometimes. I would argue probably it’s gluten, and truly gluten a lot of the times, but as you know not everyone who reacts badly to wheat has a gluten sensitivity. It can be those other things, it could be FODMAPs.

Dr. Weitz:            Right. I think Alessio Fasano has taught us that virtually everybody is going to get some gut irritation or tendency towards loosening of the mucosal membranes, leaky gut from eating gluten, so we’re probably best avoiding it.

Dr. Briden:          Yeah, all that he said that my two cents would be, I mean, yes, I’m very familiar with his observation that gluten does create some level of intestinal permeability for everyone, but I think for the majority, because for example I’m not gluten-free, so I don’t think every single person needs to be gluten-free. I think … I think it’s important to demarcate those people who do, and particularly if you have an active inflammatory disease, and then particularly if you have that haplotype HLA, celiac haplotype, then I think even if you’re not a confirmed celiac I think the writing’s on the wall that gluten is highly problematic.

Dr. Weitz:            Right. What about other metals?  Is nickel the only one?

Dr. Briden:          Well, in terms of allergy type reaction, I believe so, but in terms of other metals that’s going to be more insidious. As you know mercury is an immune toxin, it’s nerve toxin as well, but I’d say immune toxin is one of its more stronger aspects.  So we don’t want a lot of mercury as to how big a player that is for someone. I don’t know. That remains to be elucidated, discovered.

Dr. Weitz:            Do you find any … Have you found use of detox protocols have some benefit for patients with endometriosis with active symptoms?

Dr. Briden:          I don’t call it detox. I still don’t use that word. I don’t know why. I just … I start with the gut, and like I said I usually start with an anti-microbial, which is often kind of part one, phase one of detox things. I address SIBO if it’s there. Give the nutrients that are required for repairing intestinal permeability. A lot of it has a natural detox effect. For example, zinc helps with it, just getting your zinc back online helps promote … protect your body from heavy metals, and promote the active excretion of heavy metal. So anything you do to help the immune system also helps the detoxification system, and you know this, but they’re quite closely related actually, the detox and immune function. There’s some upstream signaling molecules like NR2, if your listeners are familiar with that, but it switches on and off genes, both involved with both immune function, and detox.  As soon as you start supporting that system you’re going to be getting detox. You’re going to be getting … because we’re supposed to be detoxing everyday, like eliminating pesticides and heavy metals, and at the same time, yes, it always, in any scenario makes sense to try to minimize your exposure to any of those things.

Dr. Weitz:            Yeah, I guess when I think of detox I’m thinking about particular the nutrients that support the liver, pathways that facilitate detoxification.

Dr. Briden:          For example, one of the best studied nutrients, a couple of the phytonutrients that are … well, one is a phytonutrient, one is just an accessory nutrient that are studied for endometriosis. One is n-acetyl cysteine, which has a reputation as being a detox nutrient, it’s also an immune modulator.

Dr. Weitz:            That’s an all-star nutrient [inaudible 00:41:28], and so many purposes.

Dr. Briden:          Yeah, so it … there had been a … Well, there was one pretty famous clinical trial using NAC or n-acetyl cysteine for endometriosis. It was years ago now. It was in 2014 or something, and I was so … and of course they were recommending that this be followed up, there’d be more trials, I’m not aware if there  have been many more trials, which is kind of sad, probably it’s because NAC is … Who cares? No one’s going to make money on NAC, but in that trial, it was an Italian study, and it was about a 100 women or something like that, and their results were astounding. Not to hyperbole, not to overstate it, but there were women who had surgery, women who became pregnant, women who had surgeries plan to remove endometriomas, which is quite a large mass of endometriosis, whose endometriomas shrunk to some degree, who canceled their surgeries just from that one intervention.

Dr. Weitz:            What was the dosage of NAC?

Dr. Briden:          It’s a really good question. I tend to give 1000 milligrams twice a day. In the study, off at the top of my head I don’t know what they use. It’s in that range?  So that’s one.  Another one that is, probably borderline superstar for endometriosis is curcumin or turmeric, which you can imagine that works by modifying, modulating so many aspects of the immune function.

Dr. Weitz:            You have your favorite form of curcumin?

Dr. Briden:          I don’t. I’m always asking my supplement reps, “What’s the … I know there’s all different forms. It is true that some are better than others, the question is, how much-

Dr. Weitz:            The supplement companies are always coming up with a new, greatest form of curcumin.

Dr. Briden:          The interesting thing about it … Some of the questions they will have you need to be able to absorb it, which is probably true, but also we know now that curcumin exerts a lot of its actions in the gut itself, healing probably, probably having an effect in the microbiome, healing the intestinal permeability. So even if you’re not absorbing, and I think it’s exerting benefits.

Dr. Weitz:            Right.

Dr. Briden:          Curcumin is also a natural aromatase inhibitor, so it can help to dial down estrogen a bit more. So those are a couple of the big ones. Arguably, lots of different modalities or nutrients could be brought on board to try to heal endometriosis. The other one I’ll just mention is selenium just because it’s such an important immune-modulator. For people who live in a selenium-deficient region, and this is interesting because … I don’t know. I think it depends where you are on the state, it depends where your food supply is coming from, but down under, down here Australia, New Zealand, the food supply is very low in selenium, so I feel very confident that everyone needs it, eating food grown down here. But I think it’s going to vary a little bit [crosstalk 00:44:09].

Dr. Weitz:            Our commercial farming techniques in the United States, and the overuse of commercial nitrogen-based fertilizers, and the overuse of pesticides, and glyphosate, and the way our food is so processed, our foods here are pretty much deficient in many things.

Dr. Briden:          Arguably, yes.

Dr. Weitz:            Yeah, yeah, yeah. So it’s interesting, some of the same nutrients that could be potentially beneficial in this arena can also be part of your anti-COVID program to support immune function. You mentioned NAC, that’s all-star for COVID, and zinc, and Vitamin D, Vitamin A, selenium, curcumin, those would all be great in that arena too.

Dr. Briden:          Probably true. I won’t weigh into that conversation, but yes, yes, probably.

Dr. Weitz:            Well, not a problem for you.

Dr. Briden:          No, New Zealand, we always-

Dr. Weitz:            New Zealanders.

Dr. Briden:          Yeah.

Dr. Weitz:            Great. So thank you for this discussion.

Dr. Briden:          Yeah.

Dr. Weitz:            Any final thoughts you have for our listeners, viewers? Tell us about how they can get a hold of you, and get your book.

Dr. Briden:          Sure. Well, I guess my final thought in endometriosis is just to take heart, there is a lot more … there are more options than you might realize. There’s stuff out there you can do, and I’ve seen in patients, and colleagues, lives, just be transformed. You can … even if you think all hope is lost, and you’re different, and your situation is way worse, you can always be better than you are. So I would look at it … like I said, I have a couple blog posts about endometriosis, one is called Treat The Immune System, something like that, Immune Treatment for Endometriosis. I have chapter nine in my book, Period Repair Manual, it’s about that. So my blog is larabriden.com, all my social media is at Lara Briden, I’m the easiest person in the world to find, and my book is Period Repair Manual. I have a second book coming out next year about menopause.

Dr. Weitz:            Oh, wow.

Dr. Briden:          Pausing menopause, so it’s a slightly different topic that we could-

Dr. Weitz:            Oh, that’s great. Okay, and then it will be out when?

Dr. Briden:          Not ’til early next year.

Dr. Weitz:            Right.

Dr. Briden:          It’s just being edited right now, fact-checked and all that.

Dr. Weitz:            There you go. Awesome. So you’re keeping yourself busy. Thank you, Lara.

Dr. Briden:          Yes, thanks for having me.



Bone Health with Dr. Lani Simpson: Rational Wellness Podcast 164

Dr. Lani Simpson speaks about Bone Health with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

3:30   The standard American diet and our sedentary lifestyle significantly contribute to risk of osteoporosis. Dr. Simpson explained that she has osteoporosis and was diagnosed in her mid 40s, while she is now age 71.  We build up 80% of our lifetime bone bass by the time we’re 18 and Dr. Simpson was not leading a healthy lifestyle at that time.  She started smoking at age 12 and she was drinking and doing drugs but at least by age 21 she stopped doing those things and started living a clean life and eating well, which is probably why she has never sustained a fracture.  Not only are these early years very important for building up bone, but women can also lose 20% of their bone during the first 5-7 years after menopause, so it is crucial for these women to have good levels of vitamin D and not have a lot of digestive issues as well.

6:53  The bone density test (DEXA scan) is a type of x-ray that measures the density of the bone, specifically in the hip and the spine and possibly also the forearm.  Dr. Simpson pointed out that she often includes the forearm in the bone density tests that she usually orders for her patients.  During a bone density test, the patient lies on a table and should be properly positioned with their hips internally rotated 15 degrees. If the hips are not properly positioned there can be a 7% difference in bone density and this can makes the difference in the recommendation for taking a medication or not.  If the person has a lot of arthritis in the spine, it might appear to be more bone density due to the calcium in the bone spurs.

13:49  A patient with osteoporosis is defined as having a T-score of -2.5 or less, which means that they have 30% less bone than the average 30 year old.  When you get your bone density measured it is important to go to the same lab and make sure the lab uses the same machine, since the results can vary.  It’s also best to place the hips in a 90 degree angle when measuring the spine, since this will flatten the lumbar spine and prevent viewing L4 overlapping L5. 

20:02  When analyzing a DEXA scan report, the T-score is comparing that person to a 30 year old bone density, whereas the Z-score compares their bone density to an age matched group. In general, a T-score of negative 1 to negative 2.4 is considered to have osteopenia or low bone density, while a T-score of negative 2.5 or less indicates osteoporosis. For women post menopause it is recommended to focus on the T-score, while for women prior to menopause, you should focus on the Z-score. For men after age 50, focus on the T-score, whereas prior to age 50, focus on the Z-score. To measure bone quality, when they get their DEXA scan we can also order a Trabecular Bone Score that measures bone quality, typically for an additional $150 or so.

26:04  If you see a loss of bone on a conventional x-ray, that’s osteoporosis, not osteopenia.  It must be a significant loss of bone to be seen on x-ray.

27:05  Lab testing for bone health should include a metabolic panel, CBC, urinalysis, Vitamin D, 25 hydroxyvitamin D, and 1,25 hydroxyvitamin D.  Full thyroid panel including TSH, Total T4, Free T4, Total T3, Free T3, Reverse T3 and the thyroid antibodies.  Bone markers, including C-telopeptide (CTX) is the best one to look at osteoclastic activity, while P1Np and Osteoclacin both give you a sense of bone buildup, of osteoblastic activity. Urinary NTX is the least valuable bone marker to measure. 

34:17  If you have a patient with severe osteoporosis, say a negative 3, 3.5, or 4 or they have cascading fractures in the spine one after another, they may need medication and Dr. Simpson prefers the use of Forteo. Forteo upregulates both osteoblasts and osteoclasts, so you are going to lose and gain bone, but you will definitely end up with more bone. And Forteo has a very short half life, either seconds, minutes or a few hours at most. 

36:43  Bone is like muscle in that we are constantly in a process of losing and gaining bone. Osteoclasts break down old, broken down bone, osteoblasts build new bone and the key that the proper balance be maintained. Bone gets broken down from the course of normal life, strain, etc., and the osteoclasts clear this out, so we can build new, stronger bone. That’s how our bone quality stays good.  The most popular drugs for osteoporosis are the bisphosphonates like Fosamax and Actonel, which act by inhibiting osteoclasts.  You get more density and for some patients in the right dosage and for the right period of time, these drugs can be helpful, but they tend to get a buildup of junky bone, so the bone quality tends to go down and that’s why some patients suffer unusual fractures, such as of having your femur snap in half.  Dr. Simpson prefers drugs like Forteo or Tymlos, but some patients can’t take them, such as if they have had breast cancer,  So if patients do take Fosamax or one of the bisphosphonates, they should be followed with the bone turnover markers and they should only take them for as long as they are effective and no longer, preferably for as short a period of time as possible.  The common recommendation is just to take these bisphosphonates for 5 years and bone turnover markers are usually not followed.



Dr. Lani Simpson is a Doctor of Chiropractic and a Certified Clinical Densitometrist and Bone Health Expert. She is the author of Dr. Lani’s No Nonsense Bone Health Guide: The Truth About Density Testing, Osteoporosis Drugs, and Building Bone Quality at Any Age and of Dr. Lani’s No Nonsense SUN Health Guide: The Truth about Vitamin D, Sunscreen, Sensible Sun Exposure and Skin Cancer. Most importantly for us, Dr. Simpson is the most knowledgeable doctor I know about bone health and osteoporosis and her website is LaniSimpson.com.  The following is a special discount code to get Dr. Simpson’s book for only $15:   15 book   A discount code will get you a discounted fee on Dr. Simpson’s masterclasses for only $25:   25 special

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz host of the Rational Wellness Podcast. I talked to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website drweitz.com. Thanks for joining me and let’s jump into the podcast.  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 Apple Podcast and give us a ratings and review. If you’d like to see detailed show notes and a complete transcript, please go to my website, drweitz.com and if you’d like to see a video version of this podcast, go to my YouTube page Weitz Chiro.

                                                Our topic for today is osteoporosis and bone health. Our special guest is Dr. Lani Simpson. Osteoporosis according to the International Osteoporosis Foundation literally means porous bone. It’s a disease in which the density and quality of bone are reduced. As bones become more porous and fragile the risk of fracture greatly increases. The loss of bone occurs silently and progressively and often there are no symptoms until the first fracture occurs. Worldwide, 1 in 3 women over the age of 50 and 1 in 5 men will experience osteoporotic fracture sometime in their life.   Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million US women and men age 50 and older. Overall, 80%, 75%, 70% and 58% of forearm, humerus, hip and spine fractures occur in women, especially women over the age of 65. A 10% loss of bone mass in the spine could double the risk of spinal fractures and a 10% loss of bone mass in the hip can result in 2-1/2 times the risk of hip fractures. Breaking a hip can be particularly disastrous as 24% of those who break a hip will die within the next 12 months.

                                                Dr. Lani Simpson is a doctor of chiropractic and a certified clinical densitometrist. She’s the author of Dr. Lani’s No-Nonsense Bone Health Guide, The Truth About Density Testing, Osteoporosis Drugs and Building Bone Quality at Any Age, which is going to be the focus of most of our talk today. If Dr. Lani’s No-Nonsense SUN Health Guide, The Truth About Vitamin D, Sunscreen, Sensible Sun Exposure and Skin Cancer. By the way, after this podcast gets posted, any of the listeners if you go to the show notes there’ll be a discount to purchase both of these books.  Dr. Lani is also the co-founder of the East Bay Menopause and PMS Center and of the East Bay Osteoporosis Diagnostic Center. Most importantly, for us, Dr. Simpson is the most knowledgeable doctor I know about bone health and osteoporosis. Thank you for joining us today.

Dr. Simpson:                    It’s great to be here. It’s great to see you too.

Dr. Weitz:                         Good. Good. Good. How much does the standard American diet and our sedentary lifestyle contribute to our risk of osteoporosis?

Dr. Simpson:                    A lot. Just to give you a little brief in terms of my own situation and why I ended up with a diagnosis of osteoporosis. I was diagnosed in my mid-40s. I’m 71 now. I’ve never taken a bone drug. Why is that? We have to look at a lot of things. But one of the reasons I ended up with osteoporosis was not what I was doing in my 40s but what I did and didn’t do in my teens. Because we build up 80% of our lifetime bone mass by the time we’re 18 and there’s still some building that goes on until we’re around 30 years old.   I didn’t do that time well. I started smoking at the age of 12. I was drinking, doing drugs. I mean I did a lot of things. In fact, it’s amazing my bones are as good as they are. But I stopped all that nasty stuff by the time I was about 21 and I got a clue. Now, I’ve never sustained a fracture. Why is that?   I have osteoporosis. I’ve had it for years, still do. The reason I haven’t fractured, some of its genetics, some of it is just the fact that I’ve also been eating really well since the age of 21. My bone health I think has been pretty darn good because I eat well. I have nuts. Don’t eat inflammatory foods. Don’t drink alcohol. I mean I live a really clean life now. That helps boost bone quality.  There’s two things in terms of this… Well, there’s a lot of stuff is involved with the strength of bone. Again, genetics plays a role. Having good density and also bone quality. So, quality means there’s still some flexibility. I’m very athletic at my age. I took a very bad fall a couple of years ago where I wrenched my ankle worse than I ever have. I thought for sure I’d fractured it. It didn’t fracture.   It just says that there’s a lot to this bone stuff. I work with people every week. By the way, I have a group over on Facebook that’s a free group. It’s called Dr. Lani’s Osteoporosis Myths and Facts. I have about 1000 people over there. But I deal with fractures every day. It’s so preventable. If I may just say one more thing. One of the things I’m trying to really educate people about is the loss of bone. That women are going to incur at menopause.  Their doctors don’t tell them, and then I end up, they end up coming to me in their late 50s and all of a sudden they’ve lost an additional, sometimes 20%. Women can lose 20% of their bone density in that 5-year, 5 to 7 years post menopause. Then, let’s say you add to this Dr. Weitz a vitamin D deficiency and going through menopause or digestive issues and going through menopause. Those are going to be the high losers. Diagnosis of osteoporosis doesn’t mean you’re losing. We can talk about that in a minute actively. But I can tell you during that time, for women, they are actively losing bone.

Dr. Weitz:                        Now, one of the things you mentioned which is that bone density which is one of the main tests to assess bone health is a measure of the amount of bone. But it doesn’t actually tell us that much about the bone flexibility or the bone quality.  It’s too bad that I don’t believe there’s really a good test for that… 

Dr. Simpson:                    No. There is. Let me tell you about that.

Dr. Weitz:                         Okay.

Dr. Simpson:                    Okay. There’s bone density and if we’re talking T-scores here because that’s how it’s measured. If you got a T-score negative 1, negative 2-

Dr. Weitz:                         So, maybe you can explain what a bone density test is.

Dr. Simpson:                    Yeah. Okay. Go ahead.

Dr. Weitz:                         Okay. No. A bone density test is you go in and they take some… Well, why don’t you explain exactly what a bone density test is?

Dr. Simpson:                    Okay. It’s very simple as you’re about to point out. You go in, there’s no… Because a lot of times people think it’s something invasive, it’s not. They’re on a table and it takes about 20 minutes to do a bone density. Typically, doctors order the spine, and when they do order the spine they only are getting L1 to L4. The reason for that is is because the lower spine doesn’t have ribs over it and the pelvis over it so you can get a clear shot. That’s why we do L1 to L4.    Then, they do the femur or what’s known as the hip and in two areas. They’ll look at the neck of the femur and what we call the total hip area which is more of an area. Any one of those areas, you’re diagnosed with osteoporosis. You have osteoporosis. Okay. It’s not like you have osteoporosis in one area and not another typically. Sometimes you can have it in say an arm from a disused thing or something like that. But typically, it’s systemic.  You can also do the forearm. I always order the forearm, by the way, doc, in addition to the hip and the spine. Now, the other test for the bone quality-

Dr. Weitz:                         What’s the advantage of ordering the forearm?

Dr. Simpson:                     Well, there’s a lot of information I can get. When I’m looking at bone densities, I’m looking at nuances. I’m looking at the images. It’s kind of like a small x-ray and all that. What the forearm gives me is the wrist measurement and the diagnosis though for osteoporosis in the, or bone density in the forearms and mid-forearm. That’s compact bone.    Now, compact bone up until you’re 65 should be good. Everyone uses their arms, right? I had a case this week she had a negative 3.5 which is, if we’re just looking at numbers… I’ll talk percentages. About 45% less bone density didn’t have as 30-year-old. She shouldn’t have that. This woman is athletic. Why did she have it? Because she has a condition called primary hyperparathyroidism.   What does that do? It goes after compact bone. But also this is another area for me to look at a combination bone.  Mostly cancellous bone. Let’s say, for instance, you’ve got arthritis in the spine. You’re going to have a false negative reading.  Meaning, it’s going to look like you have more bone density in the spine because you have osteoarthritis. 

Dr. Weitz:                         Because you have the bone spurs and-

Dr. Simpson:                     Yeah. That’s right. For me, when I’m analyzing a case, when I’m looking at bone, I’m looking at very carefully at bone density. I can tell you that frankly they’re wrong most of the time. There’s errors I find almost on every case. It’s stunning but people do not have to be trained and be in these facilities, even the doctors. It’s just-

Dr. Weitz:                         So, you say in their report that comes with the bone density test is not giving you the most accurate information all the time?

Dr. Simpson:                    Well, in fact there’s two videos that are on YouTube about this. I’m saying to you and especially the hip. The hip measurement is commonly incorrect. Here’s where we get into troubles when you do comparisons because just the rotation of the hip can cause a 7% difference. Then, the doctor says, “Oh my god. You’ve lost 7% in the last year. You need to do a bone drug when they haven’t actually lost.  There’s a lot about this bone business, but I want to go back from them just to tell you about the bone quality test. It’s called trabecular bone score. Now, that means cancellous bone. What they’re going to be doing is looking… They can do this, it’s done on a bone density machine. But not very many places have it. Kaiser doesn’t have it. We’re in California and they don’t have it. The reason they don’t is because it costs $10,000 to buy the software to give them this information.   There’s also a video on YouTube that I did where I interviewed the Swedish doctor who developed the software. What I can tell you, Dr. Weitz, is that when I look at bone density, I take history. I question thoroughly about fractures if they’ve had them. I look at that bone quality. Then, I feel prepared to make decisions.   You got a lot of people in the gray area. Does someone need a medication or not? The answer to that is medications are needed by some people for sure, and then which ones? I mean, again, there’s a lot to think about and a full lab workup is very extensive.



Dr. Weitz:                            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.

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                                                Now, back to our discussion.



Dr. Weitz:                        You want to talk about what a full lab workup is for a patient [crosstalk 00:13:54]

Dr. Simpson:                    Okay. Well, of course if somebody comes in… Well, everyone pretty much who finds me has osteoporosis. They’ve had a bone density they come to me, right? Beyond bone-

Dr. Weitz:                         On a bone densitometry test that’s a T-score of minus 2.5 or greater?

Dr. Simpson:                    Yeah or lower you would say, actually.

Dr. Weitz:                         Or lower. Okay.

Dr. Simpson:                    Negative 2.5 that each standard deviation is about 12%. You’re looking at about 30% less bone density than an average 30-year-old. Somebody could live their entire life with that. It depends on bone quality. It depends on a lot of things. But now let’s say you have a negative 4. That is a whole different story. You are not going to reverse that despite what you see on the internet about OsteoStrong or a lot of these companies that are putting out false information. You are not going to be able to reverse that.   You’ve got a 60-year-old person. You don’t have the advantage of bone building hormones that are happening all the time. You got a 60-year-old person, you’re not going to reverse osteoporosis at that level. You can maybe halt it. Here’s who I can halt it in. People who are having what we call normal age-related loss, which I don’t really like that term but that’s 0.5 to 1% a year. But you think about this. Dr. Weitz, just add that up over 10 years. So, this somebody is not exercising because they just don’t or they can only do some what because they’ve got a foot problem or a knee problem. I mean you get my point here.

Dr. Weitz:                         Oh, I’ve heard that plenty of times. Yeah. Yeah. Yeah.

Dr. Simpson:                    Yeah.

Dr. Weitz:                         Just talking to patients everyday.

Dr. Simpson:                    They will lose and especially the small women. They are going to lose.

Dr. Weitz:                         By the way, I think maybe before we get to the lab testing, since we’ve been talking about bone density test, why don’t we go over some of the issues with bone density test first?

Dr. Simpson:                    Sure you want to go there?

Dr. Weitz:                        Well, because you were mentioning like the positioning area. What are some of the important things about the way the person gets positioned about the bone density test?

Dr. Simpson:                    I advise people get my book and in the book it tells you what to say when you go in to try to get the best bone density. I mean one of the things I tell people to say is my doctor suggests that you really make sure you’ve got that hip rotation right. You put them on and then, “Oh, somebody’s paying attention.”

Dr. Weitz:                         They’re positioned on a table and their legs are supposed to be against something, and then their feet are supposed to be rotated a certain degree, right?

Dr. Simpson:                    If you can. Sometimes you can’t rotate people. But, yeah. Again, this all pictured in my book and I’ll highly recommend it. You’re not going to get that whole picture from this discussion but that’s it. Yes.

Dr. Weitz:                         Do all the labs have that positioning?

Dr. Simpson:                    They have it. Do they use it?

Dr. Weitz:                         Oh. Okay.

Dr. Simpson:                    If you’re doing things quickly, a lot of times they don’t use it. Here’s the thing, again, to really get the technicians must often have not been trained. It’s not required. The doctors are not required to be trained and even the radiologists who do this lack training. They don’t even know how to interpret.

Dr. Weitz:                         I believe you said that the hips are supposed to be like internally rotated 15 degrees. Yeah.

Dr. Simpson:                    15 degrees. They have a little thing that you put your feet in. When you’re on your back, although a lot of places don’t do this. I prefer it this way. But depends on the type of machine. There’s GE Lunar, there’s Hologic, there’s Norland. Most common is Hologic and GE Lunar but I like it best and Hologic typically does this when they put your knees, your lower leg up so that your legs are like that.

Dr. Weitz:                         Right. 90 degree angle with the hips-

Dr. Simpson:                    That’s what flattens the spine to the table. That’s going to get a more… Because a lot of times when they don’t do that, what you see is the lumbar vertebrae.

Dr. Weitz:                         [crosstalk 00:18:13]

Dr. Simpson:                    The lumbar vertebra half the size because it’s overlapping L5.

Dr. Weitz:                         Right.

Dr. Simpson:                    Then, let’s say the next time they have a bone density test the person didn’t do that. The density is going to, the comparison’s wrong. See my point? Yeah.

Dr. Weitz:                         There’s a lot of very subtle positioning differences that can change the results. The results will change if you’re in a different machine. Therefore, going to the same lab but even if you go to the same lab they might put you in a different machine.

Dr. Simpson:                    Well, you want to ask, good question. Yes. Kaiser does this a lot. When you go in say, “I’d like to be put on the same machine.” They may have it right in the room and still not put you on the same machine. Because when you are not on the same machine, you can have 2% to 3% to 5% difference just based on the machine itself. How often it was-

Dr. Weitz:                        Calibrated?

Dr. Simpson:                    Calibrated. Yes. Finish my sentences at any time.

Dr. Weitz:                        Thank you.

Dr. Simpson:                    I do actually… I used to hate people like that. Now, they’re my best friends. Yeah. You’ve just got to kind of do the best you can with getting through this. Again, our bones, we all have to get through this lifetime with pretty good bones. I mean that’s the name of the game. I mean you want physical independence that’s what we want.  As you point out, those hip fractures change a person’s life. It might not kill them but you know that a lot of times the hip, the leg lengths may be different, a lot of different things can happen.

Dr. Weitz:                        When you’re looking at the report, the analysis of the dexa bone scan, the T-score is comparing them to a 30-year-old, correct?

Dr. Simpson:                    Yes. That’s correct.

Dr. Weitz:                         Then, what is the Z-score and how important is a T-score versus the Z-score? I’ve kind of been trained to just look at the T-score but-

Dr. Simpson:                    No. That’s correct. Except, okay, so women post-menopause regardless of age, you look at T-score. Women prior to menopause, Z-score. Men after the age of 50, T-score. Before that, Z-score. I don’t always pay attention to those hard lines because I know how to look at all this stuff. But the reason they have it like that is because that’s what’s been studied.

Dr. Weitz:                         We just described what the T-score is, what’s the Z-score?

Dr. Simpson:                    It’s age matched. It’s still the same difference, but you’re now looking at age matched. Then, a lot of people say, “Oh, well, it makes much more sense to do an age matched. I’m 60 years old. I’m not 30.” Well, I don’t want to be measured up against a average 60-year-old. I want to see how far I’ve come from an average 30-year-old.   Now, let me give you another interesting tidbit. I’m 5’6 but my wrist size is 5 inches. I have tiny bones. My wrist size is not an average 30-year-old. That’s about six inches, okay? Some of my bone density as what we call false positive. I didn’t lose it. This is why I’m saying earlier, having a diagnosis of osteoporosis does not mean you’re actively losing. But anyway, I didn’t gain this because my bones are smaller. That’s about maybe 8% to 10% of my case.   That said, smaller bones are at higher risk for fracture because there’s just smaller. I can jump just for a moment to the lab tests if you want me to do now because we’re talking about active bone loss.

Dr. Weitz:                         Yeah.

Dr. Simpson:                    You want to finish up or you have any other questions there?

Dr. Weitz:                         On the bone densitometry. Well, let’s see. What else do we want to talk about? What does the Z-score, and so Z-score, you’re comparing someone of the same age.

Dr. Simpson:                    Correct.

Dr. Weitz:                         What if there’s a discrepancy between the T-score and the Z-score?

Dr. Simpson:                    It depends on the age but you’re not going to see much. A lot of times like say if the woman is 30. You look at the teen and see it’s going to be pretty similar. But, again, as we get older that shift is going to happen between that T-score is going to be lower than the Z-score. If you have a 60-year-old woman, the Z-score could look normal. But if you look at that T-score, it’s going to show her well into osteoporosis.

Dr. Weitz:                         So, anything greater than minus or less than minus 1.5, we consider low bone density or osteopenia and then-

Dr. Simpson:                    Osteopenia is a misnomer. It’s kind of. It was never meant to be a diagnosis. So, negative 1 to negative 2.4 is osteopenia. If you want to use that term.

Dr. Weitz:                         Okay.

Dr. Simpson:                    Yeah. Or low bone density. Now, I did a whole webinar just on this topic of gray area. Because I also have a lot of patients, Dr. Weitz that have normal bone density and fracture and what does that say? That says several things that it could just be their bone quality is that poor. Some people can have good density but the quality of it, it’s like a piece of chalk. It can break. It’s dense. But it can break.  But that said, the most typical thing I see when people start breaking and is low bone density and low, and often they’re going to have poor bone quality in the TBS score if I can get it. Because look, in California, we can typically find a place. But it can be hard to find.

Dr. Weitz:                         So, essentially, when we send them for the bone density scan, we ask for… What do we ask for to get a quality test?

Dr. Simpson:                    Well, first of all, the doctor has to be on board and a lot of them aren’t. A lot of them do not value the TBS score. I can tell you that tide is beginning to shift. I’m in a group of a hundred, probably more than that, top bone doctors in the country, and boy, did they use it as they have it. Because it just adds to the picture.

Dr. Weitz:                        If the patients have to pay extra for it, how much would… Is it an expensive addition?

Dr. Simpson:                    Well, you’re still going to have to order it. It’s not covered by insurance. It’s up to maybe $150.

Dr. Weitz:                        Okay. Yeah. I ordered a bone density test over here.

Dr. Simpson:                    Now, here’s another thing for people to know. If you don’t have insurance, don’t get a bone density test at a hospital. They can cost you as much as 1200 bucks. In other places it’s 300.

Dr. Weitz:                         Oh, so go to an outside lab rather than the hospital.

Dr. Simpson:                    An outside imaging facility. You might want to ask, “Are you ISCD certified?” Probably not but that’s my governing body, the International Society of Clinical Densitometry and if they’ve been trained that way, you’re likely to get a better technique. It doesn’t mean you’re not going to get someone that’s pretty good because if they’re really good they’ve actually studied what they’re doing and read the book. You can see it. It’s right there in the books, but training helps as you know. I mean it’s sort of like learning chiropractic from books. It’s different.

Dr. Weitz:                        Now, if you get a patient who has a conventional x-ray that shows a loss of bone, what does that mean?

Dr. Simpson:                    Oh, that’s osteoporosis. It’s not osteopenia. For you to see that on x-ray and that’s a very good point. Anytime on x-ray the word osteopenia is on the diagnosis. That is not osteopenia. It’s osteoporosis. Because you can’t see… In order to see anything in terms of bone on an x-ray you have to have about 40% if not more, less bone density, notice I’m not saying loss, but less bone density to be able to see it on x-ray.  It’s missed on x-ray a lot. But that term is as you know has been used since we were in school but it doesn’t reflect really what the truth is.

Dr. Weitz:                        So bottom line if you see an x-ray of the spine or whatever it is and you see a loss of bone. That’s really significant. There’s no way it’s just a small minor-

Dr. Simpson:                    Oh no. It’s a big deal.

Dr. Weitz:                         Okay. Let’s go into the lab testing for a full workup for somebody with osteoporosis or bone loss.

Dr. Simpson:                    Okay. Well, we could be here for a long time.

Dr. Weitz:                         okay. So maybe some of the highlights.

Dr. Simpson:                    Okay. Again, there’s a whole chapter about this in my book but basic would be I’m going to get a comprehensive metabolic panel. CBC, the basics. Now, let’s say I’ve got somebody who has… It really depends on how severe the case is and what’s going on. Let’s say the person has digestive problems. I’m really concerned that this probably potential loss and also they’re just not absorbing right.   But if I’ve got a case, I’ve got one bone density, it’s negative 2.5, I don’t know when that happened. Maybe it happened like me in my teens. I didn’t gain. Therefore, I’ve got to order more lab tests to determine whether or not active loss is occurring.   A lot of people think, and I remember when I was diagnosed. I thought I was peeing out my bone every day. I just freaked out. I wasn’t actually losing at that time. I do the comprehensive metabolic panel 14. That’s the one I ordered. CBC, I do basic urinalysis, and then everyone’s going to get this, a vitamin D test, the 25 hydroxy vitamin D. Typically, by the way, I also… Because my new book is a lot about vitamin D. But I also order the 125 vitamin D and you have to know how to look at that. But the point is, I do order that on my osteoporosis patients.  I’m going to order parathyroid test with calcium. It’s called intact parathyroid intact with calcium.

Dr. Weitz:                        So, analyzing calcium levels that’s something at [crosstalk 00:29:09]-

Dr. Simpson:                    I’m going to get back to that in a moment. Let me [crosstalk 00:29:10]

Dr. Weitz:                         … different point. Okay.

Dr. Simpson:                    Then, depending on what they say to me in terms… Because I take like a seven-page history along, have them write down everything they eat for a week and all that depth and forms. What I may do next? I might be thinking that person has thyroid disease. Because what people have to understand is that everything affects the bone. I’ve got to do a comprehensive evaluation. You’re smiling because you know what I’m talking about.

Dr. Weitz:                         Yeah. It’s what we call functional medicine.

Dr. Simpson:                    There you go. Okay. I have to look at all systems. As you know, in thyroid testing, they’re only going to do the TSH and the total of T4. I’m going to do free T3, free T4, TSH, total T4, total T3, and then I’m going to do reverse T3. Although I rarely find that by the way. I’m going to test the-

Dr. Weitz:                         Antibodies.

Dr. Simpson:                    … the thyroid antibody test. Because it’s that important. The third time in a woman’s life where she’s most likely to present with thyroid because puberty, pregnancy, perimenopause, menopause that’s when women express and so much more common in women. But I catch it with men too because I look for it, right? Because it’s not often looked for men anyway. Thyroid is one, parathyroid, I’m going to look at the kidneys. I’m going to do a 24-hour urine. That’s a basic test.

                                                Then, I’m going to do bone markers. There could be a whole bunch of other tests. These are the basics I’m giving you. But bone markers are critical. You’re going to read or hear some doctors say, “Oh, I don’t order those. They don’t mean anything.” BS. I am so tired of hearing that. I can tell you that no top doctor who’s really evaluating bone doesn’t use them that I’m aware of, okay?  That would be the C-telopeptide or CTX is the best one to look at osteo classic activity in terms of bone breakdown. But we’re really looking at bone turnover. The P1NP, so those two are always going to, and osteocalcin, I’m always going to order those. Osteocalcin is also, gives us a sense of buildup, P1NP does also. But you know what? If Osteocalcin is high… Well, let me just go to, I have to explain too much.   The P1NP if that’s elevated or high end of normal, a lot of docs just used that. I don’t agree with that. But that typically is used to also follow anabolic medication such as Forteo and Tymlos because it’s showing osteoblastic activity. What I want to look at is bone turnover. The minimum I would order with bone markers would be the CTX, P1NP, and the only reason I might not order osteocalcin on the other ones because they can’t afford it. But osteocalcin would be in there and also an NTX, which is the least valuable but that’s what everybody orders. Often, they’re the one.

Dr. Weitz:                         The NTX is usually by urine, is that the one?

Dr. Simpson:                    There’s three. There’s a 24-hour NTX, don’t do that one. There’s a blood NTX, don’t do that one. The one to do is the random second catch. Now, a lot of doctors think it’s the better one but they say, “Well, some…” A lot of women this is true, you have to think about your patient may have trouble actually getting the second catch.  If you’ve got somebody who has Parkinson’s, you’ve got somebody who has problems with, they might not be able to get the second catch, then do one of the other ones. But what I like to do is look at all of those together. That gives me an inside look that day of the workings of the bone. They’re not 100% accurate. But let’s say that CTX comes in at 700D and the NTX comes in on that high end also. Then, I know, I’m looking at active loss.

Dr. Weitz:                         Basically these markers of bone turnover are telling you, first you found out that you have some bone loss and now they’re telling you, right now are you in the process of losing, gaining or staying the same as far-

Dr. Simpson:                    Well, they don’t typically look at that. If you go to Kaiser, what you’re going to get is a diagnosis of osteoporosis, none of this kind of testing other than maybe the metabolic panel. You’re going to be put on Fosamax for five years and told to come back for a bone density test in five years. That’s absurd because in three months if somebody does require medication or let’s say they’re borderline. You say to yourself, “Well, this person’s borderline. They’ve never had a fracture. Their bone markers are a little high. I think I can handle this with this patient because they’re willing to work on nutrition and supplements and exercise. Let’s see if we can bring it down.” I do it all the time with people.

Dr. Weitz:                         Of course.

Dr. Simpson:                    Yeah. But let’s say we have somebody who’s a negative 3, negative 3.5, negative 4 becomes different. But there’s never a time where the foundation of what I do with patients is always nutrition, gastrointestinal health, exercise, and anything else that’s going on. Then, when medications are needed, the right medication and they’re … I can just tell you and I used to be anti-medication but medications when… I’ve seen people who are in what we call cascading fractures in the spine one after the other. It’s a scary situation and Forteo will stop it.  You have pregnancy osteoporosis or women are fracturing giving birth. I get these patients. I see them.

Dr. Weitz:                         Forteo, you just mentioned is a medication that increases osteoblastic activity?

Dr. Simpson:                    It’s an amazing medication. But, again, and I want to say this. This is after a full evaluation has been done with somebody because if secondary causes are not fixed, those are the people who say, “Oh, I took Forteo. It didn’t do anything for me.” Well, they didn’t maybe fix the thyroid problem you have anyway. But, yeah. Dr. Claude Arnaud, who wrote the foreword to my book was my mentor for 20 years. He developed Forteo. Principal developer of Forteo.   So, I was back there actually in the ’90s when this was being tested. Everyone was just blown away by what it was doing because it has short half-life. Fosamax has a half-life of 12 years. Forteo, we used to think had a half-life of seconds. But it can be minutes or hours. But the point is it has a relatively short half-life. It goes through the body and up regulates osteoclasts and osteoblasts, both of them.  You’re going to lose bone and gain bone. But the osteoblasts are going to win out. But what the end result is going to be is that it’s gone after the old bone, got more, with more damaged bone and laid down new bones. It does a remarkable job with that. Yes. You’ve got to follow up with other things. I mean, again, all these areas are huge conversations.

Dr. Weitz:                         For patients who might be listening or practitioners who are not aware of these as we go through our life, it’s not just a question of you gaining bone up to a certain age, and then after that you just lose bone. Bone is like your muscles, we’re constantly in a process of losing and gaining bone. It’s more of a question of the balance. At any one point in time, we have osteoclasts breaking down bone that’s been damaged from the course of life and strain and et cetera.  Then, we have osteoblasts that are building new bone. It’s really a question of that.

Dr. Simpson:                    Wait. That’s how our bone quality stays good.

Dr. Weitz:                         Right.

Dr. Simpson:                    By getting rid of old bone laying down new bone. That was a mistake when they were giving the bisphosphonates like Fosamax and the other drugs that we [crosstalk 00:37:39]-

Dr. Weitz:                         Yes. So, bisphosphonates is the most common category of prescription pharmaceutical drugs for improving bone density. As you mentioned, Fosamax and Actonel and there’s a whole series of these drugs and maybe you can explain what they do and what the problem is with these drugs.

Dr. Simpson:                    What we discovered was back in the ’90s, they were giving it out like candy. They were giving it as a prevention. I have a really good video with Dr. Jennifer Schneider who’s an internist and here’s her story. She was on a subway in New York, she’d been taking Fosamax for a long time. She’s having some thigh pain. She was on it for maybe five years and how when you stop on either a BART train or like in a subway, you kind of [inaudible 00:38:39] but her femur snapped in half.

Dr. Weitz:                            Wow.

Dr. Simpson:                    Now, after many of those started showing up they started getting a clue. But I’ll tell you something, doc. I predicted this back in the ’90s and I don’t think it’s because I’m that smart. It’s because I know that what they do is go after the osteoclasts and the osteoclasts are there for a purpose, to get rid of old bone. So, if you are too successful at suppressing those, you do it for too long and you’re not following bone markers… I’m going back to bone markers again. You overly suppress that bone. You’re not following bone markers because you don’t know what the hell you’re doing and what’s going to happen for a small percentage of people, but it still happens, they’re going to have more fragile bones.       Why is it though and I’ll say this too, I’ve seen people who’ve been on it for 15 years, never had a fracture who come to me and I might freaked out. I’ll get them off. Help them get off of it. But-

Dr. Weitz:                            Because the current protocol is you should only be on a bisphosphonate for five years, is that correct?

Dr. Simpson:                    No. Well, that’s not my protocol. The current protocol should be with any medication what the bone markers tell you. You follow people with bone markers. The same thing even when you’re doing Forteo or Prolia, which I’m not a fan of. I’m just saying. Prolia injections, it does the same in a different way. But it goes after osteoclasts primarily.  The recommendation by the companies do it every six months. Well, that’s lazy. No. Do the bone markers. Give the injection when the bone markers and maybe it’s nine months it starts, the turnover starts. But I’m not a huge fan of that. But also I might say too that and bisphosphonates and even Prolia. The first year, you’re going to have a kick in osteoblasts, and then you’re not going to have that. But there is a kick that does happen kind of through the backdoor in a way.  I did want to mention that because a lot of people are unaware of that. Fosamax, I’ve learned that there are appropriate times for it. If you’re watching bone markers and you’re careful if that patient, it just depends. Maybe they can’t take Forteo or Tymlos because they’ve had breast cancer. Again, you’ve got a lot of things to think about.

Dr. Weitz:                        Your favorite drugs for patients with osteoporosis after you’ve done your nutritional protocol is Forteo and-

Dr. Simpson:                    Well, if it’s clinically appropriate. That my favorite drug is the one that is needed for that patient. It could be a bisphosphonate, even Reclast which is the yearly infusion. But there’s a way to get to that point. I would never like to see anyone just start on Reclast. I just had a patient the other day, negative 2.5. They’ve recommended the heavy-hitter without doing any bone markers or anything. I’m like, “This is ridiculous.”   There’s a place for it. Again, it’s a longer conversation. But there’s a whole chapter of that in my book too, about medications that you can get a pretty good, a few of.

Dr. Weitz:                        But, in general, it sounds like you would prefer not to use a bisphosphonate unless that was absolutely necessary.

Dr. Simpson:                    In my perfect world if somebody, it’s not contraindicated to do an anabolic. I would prefer doing anabolic first because, let’s say you do it the other way around. Someone’s on Fosamax. Then, they got put on Forteo, it’s not going to have as big of an effect. Yeah. In my perfect world I’d want to build up the bone, help that bone stay there. You’re going to have to give them Fosamax or something or even hormones, by the way, bioidentical hormones for about a year.

                                                Watch the bone markers. Make sure they stay stable. Then, you have to just watch bone markers over time. You may have somebody because you have these patients where you can’t correct a digestive problem. They have malabsorption really or they have horrible anxiety that just that you do your best, right? We have those patients.

Dr. Weitz:                        Right.

Dr. Simpson:                    Those folks may need more medication because they’re just unable whatever reason, physically or otherwise to handle what’s causing the bone loss. The stress and anxiety is a huge, huge impact on bone.

Dr. Weitz:                            We’re on lab testing and one of the things a lot of people would like to know is do I have enough calcium? Then, sometimes the patients will say, “Well, I had my serum calcium done and it says that’s normal. So, I don’t need calcium.”

Dr. Simpson:                    Oh, boy. Can we do another hour on this? No. Okay. In my new book I tackled this a lot more because I don’t think anyone should be taking vitamin D over 2000 and they even would question that honestly without taking the calcium level too. That’s because primary hyperparathyroidism, maybe I could argue well before early and 30 is fine. Because it comes on more as people are aging, parathyroid issue. But some people are, and the other big reason and I can tell you, I’ve had a lot of these people.  When they take vitamin D and they’re over 50 ng/ml. Okay. The blood measurement nanograms per milliliter or in animals, it’s too tight. I’m not going to give the how to do the equation.

Dr. Weitz:                        Yeah. We’ll stick with the nanograms per milliliter.

Dr. Simpson:                    Nanograms per milliliter. Their blood calcium level will go up. You don’t want that blood calcium to be on the high end of normal. I don’t like high circulating calcium. I like to see it around 9.5 or 9.3, 9.5 is my sweet spot. I don’t want to see these people running around with 10. I interviewed one of the top bone, excuse me, repair thyroid surgeons in the country. We compared notes. If you’ve got someone let’s say a high end to normal calcium. That is never good. Never good.   You cannot give people more vitamin D if they have that. You have to see, is it vitamin D causing it or is it primary hyperparathyroidism? Because she says anyone over 60 with high-end and normal calcium 10 is highly suspect of having an adenoma. They’re not cancerous but they are small tumors or enlargements of this very tiny parathyroid gland, which there’s four of them in the neck. So can be either that or can be high serum calcium in addition to that.  By the way, I also order ionized calcium. That’s a basic order for me. So, ionized calcium because it’s that free and available calcium. It’s just a little different.

Dr. Weitz:                         Yeah. I’m familiar with that ionized calcium. But I noted in your book, you also talked about possibly a 24-hour calcium-

Dr. Simpson:                    Yeah. The 24-hour urine.

Dr. Weitz:                         24-hour urine calcium.

Dr. Simpson:                    Yeah. That’s an interesting one too. Sometimes I will order three of them. I also interviewed one of the top nephrologists in the country about this and sometimes I have to order three of those to get what’s really going on. I might order the first 24-hour urine not change anything. Don’t tell them to go off calcium supplement is nothing. See what it is. Comes back 500 or 600. Whoa. Yeah. There’s a problem or they’re taking way too much calcium.   Then, you want to do the next one where you have them not calcium for, calcium supplements or high calcium foods to make sure it’s not a kidney problem.

Dr. Weitz:                         Now, what you were just saying about vitamin D I didn’t quite get. You’re saying you think it’s dangerous to take too high a level of vitamin D for what reason?

Dr. Simpson:                    I’ve completely changed my viewpoint about vitamin D and how to correct a deficiency, number one. But it’s a hormone as you know. It’s in the androgen family. It’s a [inaudible 00:47:24] hormone. It’s a powerful hormone. Let’s say somebody’s been deficient for 30 years, which is likely in North America.   Now, all of a sudden you’re giving him 10,000 a day. A lot of alternative doctors do. What’s the freaking hurry? What’s going to happen when that six week hits to two months and it becomes active? Oh my goodness. It’s just like, “Let’s have that flood of calcium come in.” Well, if you haven’t corrected the inflammatory issues in the diet and everything else that patient can end up in trouble as far as I’m concerned.  I go more slowly with people. If they’re deficient I give him 2000. So 1000 should increase the blood level 10 nanograms per milliliter. Again, this is just me and a lot of people still feel very differently about it.

Dr. Weitz:                            I have to say I get a lot of patients and they’ve gone to their MD and had their vitamin D levels measured and they were 20 or 25 and they took 1000 and they went up to 26, really did nothing, maybe they took 2000. I find until we get them up to 5000 or 10,000, we don’t really see those vitamin D levels go up to the [crosstalk 00:48:42]-

Dr. Simpson:                    No. That’s not true.

Dr. Weitz:                            … range.

Dr. Simpson:                    That’s not true. Here’s the problem. They have to take it with fat.

Dr. Weitz:                            Right. I understand.

Dr. Simpson:                    Then, they have to have no problems with digestion. I’ve done this for so long that I’m utterly convinced that either they’re not getting a fat meal with it or the vitamin itself is incorrect. By the way, this vitamin D, the measurement in that, what’s in the bottle is commonly incorrect.

Dr. Weitz:                        Really?

Dr. Simpson:                    Yeah. I can’t remember the doctor’s name right now. I’ll remember it after we get done. But one of the most notable cases, you’d know him if I could remember his name. Instead of 2000 I used, there was 2 million.

Dr. Weitz:                        Right.

Dr. Simpson:                    You know I’m talking about?

Dr. Weitz:                         Yeah.

Dr. Simpson:                    But-

Dr. Weitz:                         Gary-

Dr. Simpson:                    N. Starts with an N.

Dr. Weitz:                         Yeah.

Dr. Simpson:                    Okay. You know what? But the point is that’s how it can be wrong. So, there are many things I think about with vitamin D. But if you give somebody 5000, that would get them to 50 because if they’re 20, it should get them to 70. So, unless there’s something wrong with the supplement or their digestion or fat, it should raise it.

Dr. Weitz:                         Okay. 2000 vitamin D, what about taking calcium? Does calcium cause cardiovascular disease? How much calcium do they need?

Dr. Simpson:                    Okay. I wrote an article on that. It’s in Huffington Post and that came out years ago when my position’s still the same. Here’s what the doctors are saying to patients [inaudible 00:50:17]. “Get all your calcium from your food. Get all your calcium from your food.” “Well, I don’t eat dairy. Am I getting all my calcium from my food? Do I really want to drink green smoothies that are full of oxalates?” We can go way into a lot of different content here. But I take calcium citrate. I do it in powder form and when I do, when you do take calcium, you only do it in small amounts.  When they look back at those meta-analysis, Dr. Weitz, they’re looking at high dosing of calcium carbonate, which is the wrong one, we both know it.

Dr. Weitz:                         Yeah.

Dr. Simpson:                    They were giving it to them all at once. They never tell… So, could that be the reason that it showed that some people and they didn’t remove inflammatory diets. It’s not a functional medicine approach shall we say to be nice about it.

Dr. Weitz:                         Right. What’s a moderate dosage of calcium? 200, 500-

Dr. Simpson:                    No. It’s individual. In my case, I do… Because I do non-dairy. I eat a small amount of food. I don’t really don’t take in a lot. I’m a small person. A lot of the people come to me that way so it depends on the person. But what you want to think of and how I get my patients to think because I teach them is that you want to get about 12,000 a day of calcium.   Now, if they have Crohn’s disease, if they’ve got something else, we might have to up it. Again, you got to look at all the different factors for each person. But around 1200 from all sources is good. If you are taking it, I try to keep it at around 200.

Dr. Weitz:                            [crosstalk 00:51:57]

Dr. Simpson:                    At a time. I take 600 so I’m taking it… I get a calcium citrate, put it in water and I drink it.

Dr. Weitz:                         Do you add magnesium at the same time?

Dr. Simpson:                    Well, that [inaudible 00:52:08].

Dr. Weitz:                         Two to one or what?

Dr. Simpson:                    I’m going to turn the tables on you. I’m going to turn the tables on you. Okay. There’s always that question, should you take… Do the two cancel each other out if you take it together? In other words, calcium and magnesium or do you take it separately?

Dr. Weitz:                        They help each other, don’t they?

Dr. Simpson:                    Well, depending on who you’re talking to and I’m in kind of in agreement with you. But I see it written a lot both ways and I’ve talked to a lot of chemists about this. They said, “No. Really. I mean to some extent it does.” But if you also look in nature other than dairy, you look at nettles, you look at oat straw, you look at a lot of different herbs that have a lot of calcium. They always have magnesium also.  One of the biggest problems and I know you know this because we become gods to some patients. Patients who have suffered so much constipation because they have no magnesium and they are just blown away than in a week, we can cure that, and more water. I mean a lot of people it’s that simple, right?

Dr. Weitz:                            Yeah. Vitamin K.

Dr. Simpson:                    Okay. So, and K2.

Dr. Weitz:                            Can we measure vitamin K? By the way, should that be part of your lab panel?

Dr. Simpson:                    That test doesn’t really work. I interviewed also the woman who wrote the book. I know Kate something. I can’t remember. The vitamin K book she wrote that. Yeah. So that test doesn’t turn out to be that great. But osteocalcin is a bit of a marker because vitamin K increases osteocalcin activity. Honestly, I don’t worry about any of that. I just want people to take it.  Why do I want them to take it? Because vitamin K has been shown in multiple studies at this point, not enormous studies but there’s enough I’m convinced that, and vitamin K2, MK7, MK4, I’ll talk about the two. Basically, and this is just people in the audience but basically helps bone take up calcium. This could be the missing link when you’re talking about people gobbling, taking high doses of vitamin D, they’re increasing calcium absorption by 50%, and on top of it they’re taking calcium. But they’re also not taking vitamin K.

Dr. Weitz:                         Right.

Dr. Simpson:                    Eating, again, inflammatory foods. Is that a set up for heart and artery problems?

Dr. Weitz:                         Right. Because one of the things that vitamin K does is reduces the potential for arterial calcification.

Dr. Simpson:                    Right. By the method I just said-

Dr. Weitz:                         Right. About regulating osteocalcin. Yes.

Dr. Simpson:                    The interesting thing about osteocalcin is the discovery that osteocalcin, that that was occurring in bone makes bone actually part of the endocrine system. It’s a gland. It’s a rigid gland. When you think of it that way, I mean I have such a respect for bone. It does so much and most people just think it’s just kind of sitting there. But it’s so active. I mean it’s really amazing. But then we have MK7 and MK4.

Dr. Weitz:                         Most of the supplements have MK7, but apparently most of the studies were done with MK4, right?

Dr. Simpson:                    That’s right. MK4, you’d be doing, by the study, about 670 milligrams of MK4 three times a day because it doesn’t stay in the system long enough. So, MK7 came about and got promoted a lot through the Canadian writer. She wrote the book, I just wish I could remember her name because I want to promote her book. Vitamin K, MK7 came along, it has a longer tail on it and it lasts longer in the system.  Now, that’s in micrograms. So, when you ever see MK4 in micrograms, it’s not doing much. I mean it’s like not much. But MK7, minimum 100 milligrams a day or up to 180 for some people. But here’s the interesting thing. For some people it can cause insomnia. I have heard it enough and I just had a case last week where the patient was like, “I just can’t sleep. My skin is crawling. I cannot sleep at night.”  We went back and forth with the MK7. It was definitely MK7. I’ve heard it enough. I’ve not seen studies show this and Kate said this too. The woman who wrote the book. She says, “I’ve seen it enough too that I think in some people that’s happening. So, if you’re taking MK7, do it early in the morning.” I’ll tell you something, in the near future I’m doing a whole webinar on the MK case myself. I’m leaning more towards MK4, again, as a treatment.

Dr. Weitz:                        On the other hand, MK7 has a lot of cardiovascular benefits.

Dr. Simpson:                    Well, they both do.

Dr. Weitz:                         But I think MK7 has more data on the cardiovascular.

Dr. Simpson:                    Well, MK4… No. They’re doing the same thing by the osteocalcin.

Dr. Weitz:                         Okay.

Dr. Simpson:                    It’s the same route. But MK4, and MK4 by the way, we actually produce it and interestingly enough in our large intestine too.

Dr. Weitz:                         Right. Gut bacteria.

Dr. Simpson:                    Yeah. It’s kind of interesting. Not much. I mean it doesn’t do that much but MK4 as you point out has been the most studied and my view might change on it in the near future. I have to kind of go back every now and then, as you know new stuff comes out. I got to go back and look at everything. Yeah.

Dr. Weitz:                         So, let’s say you have somebody and you have them on a nutritional protocol and just to finish up the supplement and I know once, again, everyone these topics we could talk another hour-

Dr. Simpson:                    Yeah, and I got to stop in about five minutes so…

Dr. Weitz:                         Oh, okay.

Dr. Simpson:                    Yeah.

Dr. Weitz:                         If there were one or two other supplements besides taking vitamin D, vitamin K2, calcium and magnesium, what would those be?

Dr. Simpson:                    Sometimes a protein supplement depending on the person. I’ll tell you something. I see quite commonly in my demographic of small women. Now, I get those are the prime. The osteoporotic patients I get are typically not diabetic. I get the small women who read, who are really in… Not that the diabetic people don’t read. I’m just saying I get a certain demographic.   Small people don’t eat as much. They just don’t. So, sometimes they need a protein something. Okay? Boron, 3 to 6 milligrams a day. I want to have a full range of the B vitamins. I mean I think you should do. You and I are both going to go over diet, try to get as much as we can, people to look at diet and to get as much as they can from diet, and then we supplement from there.   I mean there’s so many things you have to discover about bone. But, for instance, B12 is another one. B12 is important for them. B12, we now also know that if it’s too high is not good for bone. I keep learning that one too. So, I’d like I like to see B12 kind of in the upper three-fourths of the range, not high anymore.

Dr. Weitz:                         I have to say when we do serum B12 and B6, I’m seeing a lot of people high.

Dr. Simpson:                    Me too. B6, by the way, I’m glad you mention that. Because we now know that B6, you’ve got to go off of all B6 for about three or four days before you get tested for thyroid as well as that CTX.

Dr. Weitz:                         Got to go off of B6 before you take thyroid testing?

Dr. Simpson:                    Yeah, and also CTX. Now, the thyroid we thought about, that was true for a long time but Quest just came out with this in terms of the CTX test it’s influencing that. I tend to take people off of supplements unless it’s really important for them to be off of it for a couple days at least anyway because I just don’t want anything to influence the test if possible.

Dr. Weitz:                         Oh interesting. Before lab testing.

Dr. Simpson:                    Make sure that they drink water the day of the test because people think fasting, they’re not drinking. You have to drink water or the tests can be off.

Dr. Weitz:                         Right.

Dr. Simpson:                    Yeah.

Dr. Weitz:                         I don’t know what to touch on next because I know we got a minute or two. Strontium, fluoride, those are two substances that-

Dr. Simpson:                    I’m not a fan of strontium.

Dr. Weitz:                         Not a fan of strontium. Okay.

Dr. Simpson:                    I’m not and for a couple… Well, for a lot of reasons. But one is this that it gives false readings with bone density, much higher false readings than we thought. You can’t really trust bone densities once somebody starting strontium. The question is how good is the fracture reduction? Because that’s really what you were always looking at.   There’s other issues in terms of heart potential and some other things with strontium. I just don’t see the need when I feel I’ve got much more data on the other medications when needed. I mean somebody’s borderline, I don’t see the need for anything. I see the need for nutrition and a lot of other things. Yeah. I just wouldn’t use it.

Dr. Weitz:                            [crosstalk 01:01:56]

Dr. Simpson:                    [inaudible 01:01:56] that’s what’s typically-

Dr. Weitz:                         Okay. What do you think about fluoride?

Dr. Simpson:                    Yeah. Don’t take fluoride.

Dr. Weitz:                         Okay. I’m not a great fan either.

Dr. Simpson:                    Well, fluoride, natural-occurring fluoride. Fluoride helps bone. I mean to some extent, a tiny amount would get in foods and all of that helps bone.

Dr. Weitz:                         It just replaces the calcium, right?

Dr. Simpson:                    Well, so does strontium by the way. That’s what it does.

Dr. Weitz:                         Right.

Dr. Simpson:                    Replaces calcium. So, you better think that’s a good idea and that’s how what I always say. You better think that fluoride or strontium is better than calcium in the bone. I just can’t go there with it.

Dr. Weitz:                         Right.

Dr. Simpson:                    No. I’m not a fan.

Dr. Weitz:                         Okay. I guess that’ll be a wrap. Any final words and best where get in contact with you to [crosstalk 01:02:49] about you and your programs?

Dr. Simpson:                    I do have a master class. People can join that. I do webinars that are strong teaching thing. I have slides and the whole thing. I’ll be doing a mentoring program in the fall. I hope that people go. They’re going to get a discount because you’re going to send them that in terms of my books. I also have videos over there like on fractures, individual things that are I think very high quality teaching tools.

Dr. Weitz:                        What’s the website?

Dr. Simpson:                    Lani, L-A-N-I, Simpson, S-I-M-P-S-O-N.com.

Dr. Weitz:                        There you go. Thank you, Lani.



Microbiome with Kiran Krishnan: Rational Wellness Podcast 163

Kiran Kirshnan discusses The Microbiome with Dr. Ben Weitz and the Functional Medicine Discussion Group.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

6:55  Among its other roles, the microbiome is responsible for the maturation and proliferation of immune cells like T cells, B cells, and macrophages, etc... Our bone marrow produces B cells and our thymus produces T cells, which is like producing 15 year olds to defend our country, but in order for them to succeed they must first go through basic training and learn how to fight and get their equipment, which is what the microbiome does. This has been studied in mice without a microbiota and you see very poor and complete attenuation of the development of their immune system. The microbiome also supplies the energetics, like butyrate, and the equipment for the natural killer cells, the macrophages, and the dendritic cells of the immune system that are continuously circulating around looking for pathogenic viruses and bacteria to attack or to use the compliment system to neutralize it. Everything inside our bodies is covered by a mucosa. This mucosal surface of the inside of our bodies are approximately 4,000 square feet, which would be a really large house to live in. It is in this mucosa where the viruses and bacteria interact with our microbiome and this is where all the sampling and action takes place. 70-80% of our immune system is centered around our gut and in such eubiotic mice, this never develops.

12:58  There is a Prevotella-to-Bacterides ratio that is reported on the Biome Fx stool test that Microbiome Labs is working with. When people consume a lot of meat and protein, you tend to start to lose prevotella and then you start to increase bacteroidetes. This imbalance tends to be associated with insulin resistance and the inability to be able to build glycogen storage, both part of prediabetes and metabolic syndrome. Such patients also tend to get lethargic and tired at some point during the day because they are struggling to produce energy.  Some of these people with lower levels of prevotella and higher levels of bacteroides will have blood sugar drops in the middle of the night and they may get awakened by this. Kiran mentioned a study that will be published soon that showed that by adminstering a prebiotic that raised levels of Akkermansia and bifidobacteria along with the spore probiotics, these obese patients exhibited 38% reduction in visceral fat mass along with improvements in blood sugar regulation.

18:47  Kiran is involved in a prediabetes study with UCLA using the prebiotics, the probiotic, and also berberine, which is a type of herbal bitters and could be looked at as a natural metformin.  Bitters like berberine can trigger peptides like YY and GLP-1, which are transducers that improve leptin response and increase fat burn by increasing something called cyclic AMP.  It stimulates all of the cells in your body to start burning fat for fuel, it improves gastric emptying and motility in the gut, and then it dramatically improves the insulin sensitivity as well. And prediabetes often results in diabetes in the next number of years and diabetes dramatically increases the risk of almost all chronic conditions.

23:42  In order to help with weight loss, the best thing to do is to do intermittent fasting.  You can start with 12 hours and build up to 14-15 hours. Intermittent fasting will cause Akkermansia and bifidobacteria levels to increase and the microbiome diversity will increase.  It’s complicated to explain, but this type of intermittent fasting can actually improve the microbiome and stimulate certain types of bacteria to grow and certain other species to become reduced. Also taking the right prebiotic or resistant starches will promote the formation of butyrate, which is important for metabolic health and which turns on the cyclic AMP process that causes all of your cells to burn fat. But taking oral supplements of butyrate does not work because it will get absorbed in the stomach or small intestine before it makes it to the colon. Butyrate enemas can work, because you are putting it into the large bowel, but even better when it is produced endogenously by having the right bacteria and feeding them the right prebiotics.


Kiran Krishnan is a Research Microbiologist and has been involved in the dietary supplement and nutrition market for the past 20 years, including hands on involvement in university research.  Kiran is a Co-Founder and the Chief Scientific Officer at Microbiome Labs, a leader in microbiome and probiotic research. He is a frequent lecturer on the Human Microbiome at Medical and Nutrition Conferences.  He is currently involved in over 18 novel human clinical trials on probiotics and the human microbiome. Kiran is also on the Scientific Advisory Board for 7 other companies in the industry. Kiran has published clinical trials in peer-reviewed, scientific journals and several global patents in his name.  The new stool test he has helped developed is the Biome FX

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talked to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.

                                Hi there, this podcast is a recording of our monthly Functional Medicine discussion group meeting, and it’s similar to the normal podcasts, and that it’s basically an interview style, in this case it’s with Kiran Krishnan of Microbiome Labs who sponsored this podcast. And the topic was the microbiome, and we were having an amazing discussion and it went on for about 90 minutes.  Unfortunately, I didn’t hit the record until about 30 minutes in, so I’m going to try to set this up for you so that it’ll make some sense. So I’m going to give some a little introductory remarks to set up the topic, and then just keep in mind that it’ll start with the speaker speaking and I’ll try to help with what he was talking about. So let me set this up. So as I just mentioned, the topic for today is the microbiome, which as many of us know is of crucial importance for our overall health and it’s no accident that many of us in the Functional Medicine world tend to start by looking at the gut as the most important underlying factor or one of the most important underlying factors in many aspects of our health.  Just to be clear, the more than one trillion bacteria, fungi, protozoa, and viruses that live largely along our digestive track, especially in our colon, but also in our small intestines as Dr. Pimentel explained to us last month, but also on our skin, in the vagina, in our nearly every mucous membrane that the body is referred to as our microbiotaThe microbiome is the genetic material of all these microbes. Now, the bacteria and the microbiome are incredibly important for our health as all of us know and we’re starting to learn about some of the importance of the fungi, and there’s even been some interesting data looking at the benefits of parasites. But we’re going to focus on the bacteria today and these bacteria help us to digest our food, regulate our immune system, protect against other bacteria that cause disease, and produce various vitamins, amino acids, short chain fatty acids like propionate and butyrate, and neuro-transmitters among other important substances.

                                The father of Functional Medicine, Dr. Jeffrey Bland once said, “The relationship between our diet and the trillions of bacteria in our intestinal tract is one of the most important features that regulates the way our genes are expressed.”  We now know that the concept of trying to map out the microbiome so that we can determine which ideal set of specific microbes determines a healthy microbiome is no longer a practical definition.  What I mean by that is we thought at one point that if we simply figured out exactly which set of specific bacteria map out a healthy microbiome, then we could just try to duplicate that, and now we know that it’s way more complex than that. There’s a huge amount of diversity in what constitutes a healthy microbiome and that’s between people living in different countries over the course of their life, and many different factors.  So unfortunately that simple definition is not going to work for us. So given that what are some of the factors that can help us determine if a given patient has a healthy microbiome? Or if their microbiome may be contributing to their disease or symptoms or imbalances?  For example, there’s growing body of evidence showing that having a more diverse microbiome is associated with improved health, and then the lack of diversity is associated with obesity, inflammatory bowel disease, obesity, diabetes, and many other conditions.

So Kiran Krishnan is here to enlighten us on some of these topics. And he’s a research microbiologist who’s been involved in a dietary supplement and nutrition market for the past 20 years, including hands on involvement in university research.  Kiran is a co-founder and the chief scientific officer at Microbiome Labs, a leader in microbiome and probiotic research. He’s a frequent lecturer on the human microbiome at Medical and Nutrition Conferences. He’s currently involved in over 18 novel human clinical trials on probiotics in the human microbiome. And he’s on the scientific advisory board for seven other companies and he’s published clinical trials in peer reviewed scientific journals.  So Kiran, we started off the discussion by me asking Kiran about what are some of the most important components to a healthy microbiome. And he talked about one thing that’s important is that there are certain key stone, super important species. He talked about akkermansia muciniphila, he talked about faecalibacterium prausnitzii, and he also talked about some of the ratios like the Firmicutes to Bacteroidetes and the Prevotella-to-Bacteroides ratio.  And now as the discussion starts, he’s talking about how the microbiome positively affects the immune system and how these microorganisms actually help with the maturity of our immune cells?  So with no further ado, we’re going to go right into discussion with Kiran Krishnan speaking. And I hope you really enjoy this, even though we missed the beginning, there’s some amazing, interesting information that he’s sharing with us.

Kiran:                    Maturation and proliferation come from the microbiome predominantly, right? So we have certain amount of machinery to make immune cells but we’re making baby naive immune cells. And it’s the role of the microbiome to train and mature, and then proliferate those immune cells in order for them to actually do their job. The analogy I give is like, we can make children that are immature and small and tiny, and we can’t send our, 15-year-old without any equipment to war, right?  If we want them to go out and defend the country they have to go through basic training and all the training, get the equipment and all that to actually be able to go and fight. So what our bone marrow and what our thymus is doing is actually producing children essentially, which are ineffective at fighting for us. And then our microbiome trains those soldiers. So without the function of the microbiome, you would not get maturation of those T cells, B cells and macrophages and so on.  And this has been studied extensively in no biotic mice, for example, the germ free mice, right? When you rear a mouse germ-free meaning it has no microbiome, you see very poor and complete attenuation of the development of their immune system. In fact, the amount of immune tissue in the gut, which is where about 70, 80% of your immune tissue exists, that becomes attenuated dramatically. So you don’t even develop all of that immune tissue in the gut.

                                A second part to that first claim is a lot of the energetics that the roving immune system requires in order to continuously circulate through. And then when they find something, attack it, eat it up, use the compliment system to neutralize it or the natural killer cells and their ability to use nitric oxide and all the super oxides, all of that equipment and energetics come from the microbiome.  So the microbiome produces the equipment for our defense cells to kill off viruses, bacteria infected cells and they produce the energy, like butyrate is a really important energy source, macrophages and dendritic cells who are circulating around trying to protect us. So again, that relationship is so intimate and the immune system would cease to exist and function if it wasn’t for the microbiome. Then the claim about the neighborhood watch, I’ve been trying to eliminate the importance of the microbiome for people using what I think are sensible analogy.

                                So think about inside the body, everything is covered by a mucosa. So we used to say that the skin, the outer skin was the largest organ in the body, it’s a huge barrier, it’s protecting us, but the skin is only about two square meters in surface area. The mucosa on the inside is about 400 square meters. So it is way larger in terms of area than the skin. And most people here are from the US, so translation of 400 square meters is it’s close to 4,000 square feet.   So imagine an apartment or a house that’s 4,000 square feet, we’d be pretty happy in that space. All of that is packed in as our mucosa. So a virus or bacteria basically enters through a mucosal layer, whether they’re going into the eyes, nose, mouth, they’re going in through your genital tract or even through the skin, they’re going to enter the mucosa.  So that’s where all the sampling and action takes place. Now, in this mucosa, you’ve got about 40 trillion microbes that already lived there, right? So imagine you’ve got 40 trillion microbes covering the space where new pathogenic microbes enter and it’s a job of the immune system to somehow sift through all of the 40 trillion to find the one or two that might be causing you a problem.  And in fact, to survey those 40 trillion or so microbes that already live in your system, you’ve got about 200 million immune cells that do that job, right? So it’s a 200,000 to one ratio.

Dr. Weitz:            Wow.

Kiran:                    It’s an absolute mind-boggling feat when you think about it. The analogy I give is imagine you’re at a music festival and it’s good to imagine it because it’s never going to happen again, or at least not for another year or more. But imagine where like a really fun music festival and it’s in a pretty big field and there’s 200,000 attendees there. So that’s a lot of people, it’s a big event.  Among that 200,000 attendees, you get word that there may be five that are potentially egregious, that could be toxic and somehow hurt some of the other attendees could bring all kinds of paraphernalia and drugs and really kind of cause issues. And you are the lone security guard in that sea of 200,000 people and it’s your job to find those four or five potentially harmful attendees, it would be an impossible task.  The only way you could do it is if the other 199,995 attendees are also keeping eye for you being a neighborhood watch and can radio you, should they see anything suspicious? That’s the only way you can serve it, that’s what occurs in your body. The sea of microbes that predominate cells, all of the cells in your body, they are the neighborhood watch for their immune system when they sense a new pathogen entering a system, whether it’s in the lung with the along microbiome or your sinus cavities in your gut, anywhere else in the body, the microbiota, the resident microbiota in that space signals to the immune system that something is going on, here you got to come pay attention, right?  That’s the only way the immune system can survey this amazing surface area that is already covered with potentially harmful microbes.

Dr. Weitz:            Somebody asked the question, I guess you had mentioned a Prevotella-to-Bacteroides ratio, and maybe you could explain what that is and its importance.

Kiran:                    Sure. Yeah. And what’s interesting, another interesting thing we’re seeing prevotella and bacteroides are also two file up. And this is not bacteroidetes which is the one we were talking about with firmicutes, this is bacteroides, so it’s very close in name but slightly different. What we’re seeing is that when people consume lots of meat and protein, you tend to start to lose prevotella and then you start to increase bacteroidetes. And again, not to confuse me, but this is not the bacteroidetes we were talking about earlier, this is bacteroides.  And what we start to see in this pattern is the formation of insulin resistance. There’s two things that occur, one is the inability to balance blood sugar levels, and then the second thing is the inability to build glycogen storage. So people that tend to have really low prevotella and much higher bacteroidetes tend to have blood sugar dysfunction, and then also tend to have, like get really lethargic and tired at some points of the day they can’t produce the energy.  This is really profound because they’re seeing this more and more in the Western world. And when we do the biome effects test, this is another one of those functionalities that we measure. What’s interesting about when I’ve done a consult, so one of the things that we offer for all of you guys that you should know when you start getting the test done for either yourself or your patients, we offer consults with either our biome effects clinical director, Dr. Sam Molt or we’ve got groups within our learning and development team that will go over the test with you so you get familiar with it, right?   But for some practitioners who are friends of mine, I’ve done it myself and they’ll send me their patients test beforehand and I’ll tell them, “Don’t tell me anything about the patient,” in the first few minutes I’m talking to you, I want to guess what they’re coming in to see you about, just from looking at their tests. And so far, I think it’s been five out of five that I’ve been able to guess.  And the last three have been this same issue like, are they having glucose metabolism issues? Which they may not know because they’re not necessarily pricking their finger and testing the glucose levels because they’re not diabetic. But the way it cycles is it causes massive drops in blood sugar levels in the middle of the night. Some of these people awakened because of that, they get a panic response, during the day, they have real big swings in energy levels.  And then when you encourage them to do a 24-hour glucose and insulin cycle, you see these massive swings up and down throughout the day, and they’re not diabetic, their A1C is may be a little bit of elevated but they’re not completely diabetic. And all of them have this diminished prevotella and really high bacteroides.

                                So that’s another function that dictates like, and it doesn’t have to be obese, like the last two people I talked to about this one was 110 pounds, so she’s not in any way shape or form obese and never has been. But because of multiple rounds of antibiotics and because she has SIBO like condition, she’s basically completely eliminated plant-based foods and she’s very high on the protein and that starts to cause that dysfunction.  So that’s another one that we tend to look at what people in metabolic dysfunction is, how do we bring back that ratio, get that akkermansia up. Between those two things, you’ll start to see a big change, we have a study publishing just on that recently, I’m sorry to keep running on about this, but we have a study publishing recently where we took obese individuals, so these are people, the BMI of 30, 30 to 31 somewhere around there.  So they’re not morbidly obese but they’re overweight. And we did full DEXA scans, we were looking at visceral fat, subcutaneous fat, we were looking at a whole bunch of metabolic parameters. There was a 90-day study, right? And what we did is all we added into their system, and this was a placebo controlled study was a little bit of a prebiotic that we know increases Akkermansia and bifidobacteria as well and then the spores, the spores that stopped the LPS, the leaky gut.  It was a 90-day study, we told them not to change anything about their diet, don’t add any exercise in that they weren’t normally doing. So they’re continuing all of the behaviors they normally continued that kept them overweight and kept them gaining weight.  And what we saw in that 90-day period with no changes in diet, exercise or anything was in the group that was getting that probiotic, prebiotic combination. We saw a 38% reduction in visceral fat mass, and that’s a really dangerous fat around the organs. We saw some weight reduction as well but weight is just not a great measure of metabolic activity, but doing the DEXA scan we saw real fat being lost quite dramatically. And we also saw an inching up of their lean mass, so they were putting on some lean body mass, and then we saw all of these beneficial metabolic changes as well.  So that just goes to show without even diet and exercise and those other aspects of it, just shifting the microbiome we can start shifting their metabolic profile. And then if you add diet exercise and all that to it, the results can be quite profound.

Dr. Weitz:            That’s amazing. Can this be used as an adjunct to working with a patient with diabetes or prediabetes?

Kiran:                  Absolutely, yeah. In fact, we’re starting a diabetes, a prediabetes study with UCLA right now on the same principles but in this case, we’re going to have the probiotic, we’re going to have components of the prebiotic but we’re also adding in bitters, in fact berberine. And one of the important…

Dr. Weitz:            Natural Metformin.

Kiran:                  Exactly, completely natural Metformin. And one of the things that’s really interesting about it and the professors that we’re working with already have published on some of the mechanism of action of bitters, we have bitter receptors right in the upper part of our GI, right where the stomach dumps out, and then in the lower part of our intestines as well, those bitters trigger things called peptide YY GLP-1, these are transducers or transmitters that actually improve leptin response, increase fat burn by increasing something called cyclic AMP.  So it stimulates all of the cells in your body to start burning fat for fuel, it improves gastric emptying and motility in the gut, and then it dramatically improves the insulin sensitivity as well. So simple thing like that and we know that, you guys all know that prediabetes is going to be one of the biggest health pandemics in the next couple of decades because not only do we have so many diabetics right now in the world, we have four times as many prediabetics as we do diabetics and almost 80% of them are going to become diabetics over the next 10 years.   And when they all become diabetics, morbidity and mortality for all of the chronic conditions increased dramatically with diabetes, including COVID right? The mortality rate for diabetes with COVID is seven-fold, seven times higher than a non-diabetic. And that’s scary because in the US we have lots of adults and even some children who are diabetic.

Dr. Weitz:            Absolutely, get into discussion with somebody about COVID, they go, “Well, it’s only people who have these high risk factors.” And when you look at the American population you’re talking about obesity, we’ve got 70% of people are overweight read in the number of people with diabetes and heart disease and autoimmune or immunological compromise. And then you add some cardiovascular conditions, you’re talking about a huge percentage of our unhealthy population.

Kiran:                  Per CDC data, 60% of US adults have at least one of those chronic illnesses falls under the high risk category, right? Hypertension, diabetes, cardiovascular disease, obesity, 60% or more. So yeah, we have a tremendously high risk population in general which goes beyond just the age factor.

Dr. Weitz:            Right. This should be one of the messages we get out of this pandemic crisis we’re in is we have a really unhealthy society and we’ve got to get do something about improving our overall health.

Kiran:                    Yeah, absolutely. That to me was, I’ve done lots of interviews so far on COVID and the pathology and so on. One of the first interview I ever did, I said, my point was that there is a silver lining here because when you look at this virus it’s developed the capability of taking advantage of our vulnerabilities. And that vulnerabilities, the ACE2 receptor, the ACE2 receptors is expressed in cases of chronic low-grade inflammation, which is a epidemic in our society.  And this pathogen has figured out a way to take advantage of that vulnerability. What it tells us is that we should have resilience against these kind of things, and many people do but it’s really painting a picture of how vulnerable we are as a population. Because the thing is, we’ll get through this one and it’s not as bad as it could be as other viruses could be. It doesn’t have the mortality rate as MERS did or the first SARS did, or Ebola does, it doesn’t have 15, 16% mortality rate.  But somewhere around the corner, that’s another one of these coming around and it could be as infectious but 10 times the mortality rate. Again, taking advantage of our vulnerabilities, so to me that is really the silver lining in all of this is like, we should realize that as a population, we are ill equipped to handle something like this only because our systems are vulnerable. Our immune system can take care of this kind of virus very easily if we are allowing it to function in the right way.

Dr. Weitz:            So, bottom line for patients who are overweight, a couple of people asked questions about this, what can we do now to help in terms of the microbiome to make it easier to lose weight?

Kiran:                    Yeah, so really important practical things and this is exactly what I do too and I’ll go through swings with my own weight, and I actually just saw my sister the other day and she’s like, “How did you lose?” I leaned down over the last two and a half weeks because I was like, “Yeah, I’m getting a little too pandemic chubby. So I got to lean down.” So what do I focus on when I do that? And what I think will be really effective to start stoking people’s metabolism. Number one is the fasting, right? If you can add in some intermittent fasting and yes, it will be hard for certain people to go 14, 15, 16 hours right off the bat, but you could totally taper them up.  If they can go 12 hours without eating 8:00 PM to 8:00 AM for the first week, have them do that next week, go 8:00 PM to 9:00 AM, start pushing them, right? If they can get to that 14, 15 hour range metabolic changes already start to happen. Akkermansia levels will increase, the microbiome diversity will increase, bifidobacteria levels will start to increase. Those will be profound changes for their microbiome.

Dr. Weitz:            So why will our microbiome flourish when we don’t eat anything?

Kiran:                    Yeah, so that’s a really important question. So part of it is about food utilization. So if you think about it, every meal that you eat takes about depending on your system but it will take eight to 12 hours before you deprecate that part of the meal, right? It takes that long to go through your system. Now, the way the microbiome is organized is there are many community structures that feed off of one another, there are primary digesters of the macronutrients that you take in, and then they produce secondary metabolites.  And then those secondary metabolites metabolized by another group of bacteria that then produce tertiary metabolites. And then another group of bacteria can eat those and produce another set of metabolites. So that’s part of the reason it takes so long, especially when the food gets to the colon for it to start passing through and all of the digestion that occurs in the colon to happen, or at least a fermentation to happen.  And the thing is when you have primary digesters, let’s say bacteria A is a primary digester of the carbohydrates that enter in as food products, right? Bacteria A seize the carbohydrates, it becomes really active and it starts digesting those carbohydrates.  When it is active it suppresses the growth and the functionality of vector B, C, and D, right? So it starts metabolizing and then it produces all of these secondary metabolites, its primary food is gone so it becomes, it starts lowering its activity. Then bacteria B jumps on these metabolites and starts producing bacteria B gets to flourish to a certain degree. When its primary food source has gone it pushes goes down the row, bacteria C starts to flourish.

                                So when you give your body time to digest the food and ferment the food completely, you actually get to flourish lots of groups of bacteria. What tends to happen is that bacteria A is digesting its primary food, and then that food is gone then it kind of takes a metabolic risk, bacteria B starts to digest the metabolites. All of a sudden the primary food comes back in, then bacteria A start getting active again, which suppresses this next group of bacteria.   So it’s this staircase type of metabolic process, hopefully that’s… I know it’s a little abstract to think about but hopefully that is understandable. So when you give your gut time to actually process all of the food, you get complete fermentation and digestion, and that completeness in fermentation and digestion allows more and more microbes to flourish that utilize different parts of the meal and diet. So that’s a really important thing to understand.  So if we just continuously keep feeding, we’re really only supporting certain categories of bacteria, others get suppressed, they don’t ever have a chance to flourish.

Dr. Weitz:            Would it be even better to fast for three or five days?

Kiran:                  So there can be some diminishing returns if you go too far, and we need more studies on that. There’s a lot of great studies on intermittent fasting, there’s some pretty good studies on 24, 48 hour fastings, but there’s very few studies so far in longer fast, like six, seven, eight days.  I would think that there’s a point in most people’s microbiome where you start losing the benefit and start gaining some dysfunction from that longer fast. It’s probably less typical for us as a species to go that long without eating than it is to go 14, 15, 16 hours. Our ancestors routinely went that long without eating because they didn’t always have food at the ready, they would wait for the hunger pangs to kick in, to motivate them to go out and start looking for food.  So I would say you push that, the longest I’ve ever done is about 30 hours. And I could tell for me, and I intermittent fast every day, pretty much and have been for the last three, four years. That 30-hour period was kind of, I could feel was not really producing much more benefit for me. So then I had small food, small meals, I started feeling great.

                                So that intermittent fasting becomes really important, that’s one of the easiest things to implement. If you could start getting some prebiotics into them, the illegal saccharides particular, the ones that we use is in that Mega Pre, the fructooligosaccharides that come from Kiwi especially are really important for increasing akkermansia and increasing bifidobacteria. Bifidobacteria is another group of bacteria that are inversely correlated with metabolic dysfunction.   Now, the question is, if I take high doses of bifidobacteria, will I achieve the same thing? In fact, you don’t, you don’t see studies that show high dose of bifidobacteria having metabolic impact. There is one bifidobacteria strain called Blp1 I think that when it’s dead will actually help induce some metabolic improvements. That’s again, one of those special cases where there’s something within that bacteria strain that when it’s killed and it opens up will actually provide a metabolic benefit.  So the prebiotic will do a lot more to increasing your endogenous bifidobacteria, giving that metabolic support. Using the spores can be very powerful to megaspores because it stops that leaky gut. So you want to stop the leaky gut, you want to use a prebiotic to increase akkermansia and bifidobacteria, you want to add in a degree of fasting, and then if you can get them to take additional things like resistant starches, that’ll help because one of the really important metabolites in the microbiome that controls body weight controls metabolism are short chain fatty acids.  Like butyrate is so important for metabolic health, butyrate is one of the main signals that turns on the cyclic AMP process that causes all of your cells in your body to burn fat. Butyrate also helps with the leptin response and the satiety signaling, so they’re really, really important. If you can just increase short chain fatty acids, you’ll start to see changes in weight.

Dr. Weitz:            Is it beneficial to take supplements in butyrate and short chain fatty acids?

Kiran:                   Yeah, that’s an interesting component of butyrate therapy because what they found is that butyrate is really useful in things like colorectal cancer or really severe colitis when you have inflammation in the large bowel, but when you take it orally, it doesn’t seem to help. So what they’ve started doing in hospitals is they all still do butyrate enemas instead to get it into the large bowel, so it actually has that function. So there’s a big question of whether or not orally supplemented butyrate actually will get to the large bowel where it needs to be, or does it get dissipated and absorbed in the small intestine, or maybe even the stomach.  So that’s the part that’s unsure, increasing your endogenous butyrate is not hard at all. Our study that we published last year showed that when we added the prebiotic and the probiotic in, we increase butyrate production by 150%.

Dr. Weitz:            One of the tricky things about using prebiotics since a lot of us have patients with SIBO and they’re very sensitive to prebiotics and fiber, and it tends to flare them up.

Kiran:                    Yeah. That is problematic. So we say with the prebiotic that we use, which are highly specialized oligosaccharides designed to make it to the large bowel so they should not have a lot of bacteria in the small bowel that can ferment it to create the gas and distension, but we tell them to test it. They can go as little as like an eighth of a scoop, mix it into a jug of water, shake it up and kind of sip it throughout the day.  We’ve even had some people that go as far as not being able to take it in orally, so then they do prebiotic enema to get some oligosaccharides into the large intestine, which is where the bifidobacteria acclimates are all there, so you can do a retention enema with the prebiotic mix. So that’s one way to start getting it in there. If you can, because if we can’t do it this way, you might try the other way.

Dr. Weitz:            So it’s interesting as some of these probiotics that are dead are actually more beneficial, myself and I’m sure a lot of the practitioners who are listening probably have probiotics in our refrigerators at our office, which we’ve made a big deal out of making sure that they will refrigerated the whole time thinking that we’re providing an extra benefit, because if the temperature gets too high the bacteria will die and these are more potent. Are we really helping our patients?

Kiran:                    Yeah. No, all of that work to try to keep it alive in the room is really all for nothing because the moment they hit 98.6 degrees in the body and pH a one and a half or something going through the stomach, they just obliterated. And we’ve tested that, we’ve tested 40 or so of the top retail probiotics and even the probiotics in the health space and all of them die going through the gastric system.  So the key is then finding ones that have shown studies that the dead versions are actually beneficial. And that’s specialized. Like for example, with rhamnosus GG, when you kill it and you administer it, it has all of these benefits but regular rhamnosus, the generic version of rhamnosus wouldn’t have that same effect.  You kill it, it’s just dead and it’s not really doing anything, you’re going to poop it out 12 hours later. So the metabolic response modifiers, the types of strains that when dead can have specific metabolic effect are very specialized to those subspecies of the strain, it doesn’t translate to the wild type version of this strain.

Dr. Weitz:            With respect to intermittent fasting, somebody asked the question, do you think it’s more beneficial to skip breakfast or to skip dinner?

Kiran:                  Ah, great question.

Dr. Weitz:            What do you think it matters?

Kiran:                  So yes, there are at least two studies that came out that showed that if your fasting window is basically from the afternoon till the morning that, that actually has a bigger impact on weight loss than the overnight to the afternoon fast. So if you’re fast with somewhere around like 12:00 or 1:00 PM all the way until like 8:00 or 9:00 AM, that seems to have a more profound effect on weight loss and fat loss than the overnight to noon fast.  Now that being said, the overnight to noon fast also has benefit, right? The problem I have, and I can’t do the other way around just because dinner becomes such a big important social thing. Whether it’s business related, it’s family, it’s friends, so it becomes really hard to skip dinner, just from the social side of it.  And so that’s why for me, I’ve not been able to do that kind of routine, I can do the skip the breakfast very easily. Now, the other advantage for me in skipping breakfast is that I can do my workouts in the morning and doing your workout in a fasted state really amplifies your growth hormone levels, and that has a huge metabolic impact as well. If you can fast through the late afternoon and evening and then throw in a workout sometimes somewhere in that evening period, that’s fantastic but a lot of people find it very hard to skip dinner. There are too many social things surrounding dinner.

Dr. Weitz:            Yeah, actually for me it’s easier because a lot of times I’m busy with patients and I don’t really have time. And a lot of patients want to come in after work, and so rather than eat late, a lot of times I’ll just skip dinner just because it’s easier.

Kiran:                    Yeah, that actually has a bigger impact metabolically than skipping breakfast. But if you can’t skip dinner, then skipping breakfast will help as well.

Dr. Weitz:            Is there ever going to be a probiotic, protozoa or fungus?

Kiran:                    Oh, fungus yes, so we already have saccharomyces.

Dr. Weitz:            Yeah. That’s true. That’s true.

Kiran:                    Well established. We will have, yeah, I believe we will, we’ll have potentially things like amoebas, we’ll potentially have protozoas, we may have organisms that we don’t even know exist yet. When prions became a thing with mad cow disease 20 years ago I was actually still in university and it was so interesting to see my immunology, microbiology professors like losing their minds as to what the hell is this weird alien thing.  Because imagine viruses are really fascinating all themselves, because they’re not even living creatures, viruses are technically not alive because they cannot create any sort of metabolic effect on their own, they can’t reproduce on their own, they’re just like a fatty envelope with RNA or DNA sitting in it or protein envelope with RNA and DNA sitting in it and just floating around.  And it just has this mechanism that allows it to bind to certain things, inject its RNA or DNA and hijack the cell. So that in itself is fascinating, then you think about a prion which doesn’t even have that sophistication, it’s just a strand of protein. And this strand of protein, it just so happens the prions that we know of right now are really devastating that’s what created the mad cow disease. So it creates the encephalitis, so basically bus holes in your brain, but it’s this tiny little thing of protein and there’s like no functional way of killing it, that anyone knows it can withstand all kinds of heat, it can withstand all kinds of acid, it’s really mind boggling.

                                So we may find organisms that we don’t even know exists right now that are really important therapeutics within our system. I think the next one’s beyond bacteria and fungus are likely going to be in the parasite family, the parasitic family, just because there’s so much work being done with that already in a fringe world, the helmet therapy and all is considered by many to be like really weird. But the data’s good and they’re showing real progress in certain parts of the world in treating allergies.  And when something like allergies becomes more and more of an epidemic in our country, we’ll start having to go towards those types of therapies.

Dr. Weitz:            Don’t we know that societies where worms are endemic have much lower rates of allergies and asthma and autoimmune diseases?

Kiran:                    Yep, absolutely. And there’s a double edged sword that there are certainly some worms that will then create all kinds of other problems down the road, but absolutely. And I think in part, what that speaks to, to me is it speaks to our disconnect from the natural world. So we’ve evolved to have a pretty intimate relationship with all of these organisms in the natural world.  And the more we disconnect from them, then the more susceptible we become because we’re missing key links to our function and our phylogenetic tree. And so understanding what those things that we’re missing are, and putting it back into our system, I think will be a really big part of microbiome therapeutics moving forward. We are engaged with lots of very big companies in the world and massive companies. What’s exciting about it and then many people are turned off by massive companies. I totally understand that, but massive companies like Nestle, for example, who’ve spent their whole lives feeding sugar to people and sugar to kids.  When you look at their new focus, they’re saying we’re going to de-invest from all of our candy sugar stuff and focus on health wellness and microbiome science. There are companies like Chris Hanson and ADM, Archer Daniels Midland, these are massive billion dollar companies and they’re all seeing the writing on the wall.  I get calls from these kinds of companies and I talk to the leadership within those companies, they’re all trying to figure out how do we focus and hone in on the microbiome. They all see the microbiome as like the big thing over the next several decades to really improve health and humanity. So it’s really exciting. I think we’ll see lots and lots of innovations.  One of the areas that we’ll start to see more and I’m always advising companies to disrespect is the microbiome modulation. We’re getting to understand more that A, if you have high risk for certain types of cancers, you have certain type of microbiome, there are certain features within your microbiome that are characteristic of that condition.  So as we can better monitor and understand and test for those features, we can hopefully modulate features as we go along to fix people’s ecosystems in a very precise way to improve their overall outcomes.

Dr. Weitz:            How does the microbiome change with diet? You mentioned that if we eat heavy meat diet, that that’ll influence the diet one way. And right now in the diet world, we have these really extremes, we have people eating meat only the carnivore diet, we have people only eating vegetables and everything in between.

Kiran:                    Yeah, absolutely, and that to me is one of the scary things in the whole world of wellness and functional medicine is the adaptation of real extreme and exclusive diets. We’re just not designed to function that way. I think one of the things that makes the human species really unique in the animal kingdom is our incorporation of a really large diversity of microbes into our system, which really gives us strong omnivore qualities.  And that omnivore quality actually is a big part of our evolutionary ascent up the ladder, because if you think about other species that we essentially we would be competing with that are obligate carnivores or obligate herbivores, they are very susceptible to environmental and other changes. If you think of a lion is as powerful and ferocious as a lion is, if there’s a drought and the wildebeest levels are low, or its main prey, the lion’s going to starve to death.  If a human is in that same drought, we can go and dig for roots and tubers, we can eat insects, we can eat plants, we can eat rodents, we can eat a whole bunch of different things and survive through that. The same with on the opposite end with the lions prey, the wildebeest was an obligate herbivore can only eat plants. And so if those plants are dead and the Savannah is dry, they’re going to die, they can’t just go and eat insects and they can’t just go and catch a muskrat and eat it.  So we’ve got this really unique capability of producing tools using these hands, we’re upright, we’re [bi-pi-to 00:44:50], we can move long distances and we can eat lots of different things. Our microbiomes are really designed to do that. So the moment we go to a very exclusive diet especially if we do it for long period of time, it’s going to have a long-term negative consequences. I think short-term, like if you’re really trying to change your metabolism and you’re going to go keto for a short period of time, that could be totally fine.

                                Because one of the big benefits of keto is you’re actually eliminating sugar, and that to me is where you get a lot of the benefits of keto. So you can go keto for a short period of time, but then get those vegetables and the plant-based foods back into your diet. You also shouldn’t be going vegan forever and not getting any complexity in your amino acid profile and so on.  So to me, it’s really about much more of a balanced diet and I think that’s how we’re evolved to exist.

Dr. Weitz:            It’s a really big current trend in the Functional Medicine world as you mentioned to talk about the dangers of eating lectins, the dangers of eating meat, because everybody’s going to get heart diseases. And it seems like everybody’s looking to the specialized diet that subtract certain types of foods as the answer to fixing people with certain types of problems.

Kiran:                    Totally, yeah, and that’s a problem because we’re not talking about enough is how do you build a resilient microbiome that handles all of these things? I mean, you talk about lectins, one of the types of diets have tend to a lot of lectins is the Mediterranean diet, they eat lots tomatoes and all that. It’s one of the healthiest diets ever, there’s more studies on the Mediterranean diet than any other kind of diet and we’re talking huge studies and we’re talking 50,000 patients longevity studies on it.  So clearly it has benefit and there’s a way of eating it and there’s a way of preparing it, and the people’s microbiomes are resilient to handle it. We have amazing capability of neutralizing things that are not actually good for us, the anti-nutrients people talk about. If we have a resilient diverse microbiome, we can absolutely neutralize those, we can neutralize glyphosate in our gut, not to say that we should have glyphosate in our food, but just to show the ability the resilience of our microbiome to protect us.  So to me and people always ask me, like what is your focus and goal with your microbiome? What do you try to do? And to me, my goal for health is about being resilient, because I don’t want to have to live a really structured control life in order to feel good. Like you talked a lot of people and you go, “How you feeling? How’s your gut doing?” “Oh, I feel great as long as I don’t eat this, this, this,” and they’d rattle off 17 things. “And I feel great as long as I don’t do this.”

Dr. Weitz:            That’s one of the biggest issues of a lot of us in the functional medicine world, we have these patients that come to see us for these severe gut problems. And gluten was a problem, they cut out gluten, they cut out dairy, they cut out this vegetable, we cut out that vegetable, we cut out, they went on a low FODMAP diet, so they cut out all the cruciferous vegetables and then they found out about the next category of foods to cut out and they come in and they’re eating two or three fruits and [crosstalk 00:48:19] anything.

Kiran:                    Yeah, absolutely.

Dr. Weitz:            And your gut has no tolerance to be able to eat these different types of fruits.

Kiran:                    And the thing is the elimination doesn’t do the healing, and that’s the important part that people need to understand. And in fact, speaking of gluten, there’s a really good study on this, and I think it’s fine for people to avoid gluten if they want to reduce the risk for that permeability. But you cannot avoid carbohydrates, you cannot avoid fiber because one of the big studies on gluten they showed that in the first year of gluten intolerant people going on a gluten free diet, their mortality rate almost doubles.

                                And you would think like, wait a minute, that makes no sense. So these are gluten intolerant people, meaning when they eat gluten, they get all this inflammation, they get all this intestinal permeability. Why is it when they go on a gluten free diet, does their mortality rate increase in that first year? And then it tapers off a little bit in second year, but in that first 24 months, their mortality rate almost doubles.

                                So the reason for that is in Western society and in our culture and our society, more than 85% of our fiber intake comes from wheat. So you’re getting all of this fiber, despite getting the gluten that’s also harming you, but you are getting the fiber component. So then also then you eliminate gluten and most people who eliminate gluten we’ll replace it with proteins and fats.

                                So you’re taking out fiber completely out of your diet and then you’re replacing it with fats and proteins. So now the expectation is what I removed the offending thing my gut should be healing. As it turns out, when they look at these individuals, the gut doesn’t heal at all, it stays susceptible and because you increase the intake of other things like fats that can increase endotoxemia, you are actually increasing your risk for other conditions.

                                So what you should do in that case is eliminate the gluten, that’s fine, but you have to replace it with other non-gluten sources of fiber and so on, because that is what drives the repair. Just eliminate, eliminate, eliminate is not going to cause a repair. We need to maybe temporarily eliminate foods that are clearly offending your system, but then make sure we’re getting things in there to provide some diversity, provide some resistant starches, some fiber, all of those things are really important.

Dr. Weitz:            Is there any way that people following a carnivore diet by eating the entire animal, every part of it. Is there any way they can have a healthy microbiome?

Kiran:                    So if they’re eating the entire animal then potentially, and that would include intestinal content. And we see that in hunter-gatherer tribes, right? So in the hands of tribe in Tanzania and the tribes in Papua New Guinea, when the hunters go out and they catch their prey like in, I think it’s in the one in Tanzania, the porcupine is like a delicacy for them.  And they’re not doing this often, even though they’re called hunter-gatherers, they hunt way less than they gather, they gather a lot more. But they do go out as hunting parties. One of the first things they do when they capture the animal, is they cut open the intestines and then they eat the intestinal content. Most of these animals that they eat are ruminant to certain degree, they’re picking up seeds and nuts and all that from all over the place.  They’re fermenting it in their guts and if you eat that intestinal content, you’re getting all kinds of amazing carbohydrates and resistant starches and so on. So you likely can, if you’re eating connective tissue and you’re getting different forms of collagen, you’re getting some of the glycoproteins from connective tissue, if you’re eating organ meat, if you’re eating brain, if you’re eating liver, you can get diverse enough macronutrient to maintain diversity within the diet.

                                But the unfortunate thing is in the US, when you’re saying, when someone’s saying the carnival diet, they’re just eating a steak and that’s about it. And I’ve met a lot of people like that. I mean, I get to speak at places like the paleo effects like I spoke last year. I met so many people at that show they go, “Yeah, I’ve gone full carnivore.” I’m like, “Okay, what do you eat?” “I eat two steaks a day. That’s it. And sometimes I’ll have a dollop of butter on the steak.”   And I’m like, “Okay, well, that’s not a good thing necessarily.” And also it depends on your microbiome in large part, because if you look at it, one of the ill effects of meat metabolism is the formation of TMAO. And there are certain types of bacteria that produce high levels of TMAO.  If you happen to be one of those people that have high TMAO producing bacteria, and you eat lots and lots of meat, it’s going to cause heart disease. There’s no if, and’s or but’s about it, the studies on TMAO are pretty clear. But if you happen to have very low levels of those bacteria, you can sustain this for a period of time until those bacteria grow because you’re giving it so much meat. So that’s another kind of catch that whole thing is what happens to the food when it enters your system.

Dr. Weitz:            I know this is kind of going off our topic, but I love to get your take on this TMAO thing, because those of us who are working with patients with cardiovascular risk factors we have found that certain supplements, like L-carnitine, incredibly helpful for mitochondria, for the strengthening the heart, and all need super important nutrients for liver health, for brain health.

                                And it’s really hard to, it doesn’t really seem to make sense, it doesn’t fit with our experience that patients who are eating foods or taking supplements with choline or L-carnitine are really putting themselves at increased risk of heart disease.

Kiran:                    Yeah, because of the potential of TMAO.

Dr. Weitz:            TMAO.

Kiran:                    [crosstalk 00:54:28] of TMAO.

Dr. Weitz:            Yeah. So I think the answer to the TMAO question is more about making sure we have a healthy microbiome than about not consuming L-carnitine or choline.

Kiran:                    Exactly. Yeah, because again, it comes back to that balance issue. So one of the things that we test in the biome effects tests is TMAO producing bacteria.

Dr. Weitz:            By the way, if everybody’s not familiar with this, why don’t you explain that Microbiome Labs is offering a stool test. And how can practitioners find out about this?

Kiran:                    Yeah, absolutely. So  the test is called biome FX, like the letter F and the letter X. It’s a whole genome sequencing test, just to give you a little bit about the difference between what we’re doing and what you have already experienced in the market. We started seeing a lot of issues with accuracy in stool testing. One of the big problems is most of the stool tests, in fact, all of the ones you’ve used use something called 16S sequencing, 16S sequencing if you’re not familiar with sequencing information, 16S is like taking random Polaroids of a single of parts of someone’s body, and then trying to piece it together and identify who that person is.   So it’s a really low resolution inaccurate way of identifying species level for the bacteria in your system. So it tends to have a very high error rate. And what the companies aren’t telling you when you look at your test results, and they’re showing certain bacteria that they’ve picked up, they’re not telling you that they have an algorithm in their bioinformatics pipeline that makes a prediction that this is likely the bacteria we found, it’s not absolute at all.

                                In fact, all of the big microbiome research organizations, the American Gut Project, the Human Microbiome Project have come out and said, you cannot use 16S to identify bacteria to the species level. So we saw that as a big problem, and so we wanted to make that in itself a change. So we started working with the top lab in this space called CosmosID on developing a whole genome sequencing test, which means that we actually have to sequence in bacteria’s entire genome from end to end in order to identify, we’re not looking at just little snippets of the bacteria.  So it’s a far more accurate, it’s 99% or more accurate. So you’re getting the most accurate species level information. Now, why is species level information so important? Well, because like we’ve been talking about with the microbiome, it’s really about what does that total ecosystem look like. Outside of the keystone strains you can’t necessarily just pinpoint singular bacteria and their levels as being problematic because everybody at the species level has most of those bacteria different frequencies.

                                And so what we look for is we look for really important trends, well-established trends because in the microbiome, one of the things I say is, it’s not who’s there, it’s who else is there, right? The function of certain bacteria are dictated by what other bacteria are in that environment and what are all of their relative abundances? That’s where the mapping becomes really important. So we can map out functionalities within your microbiome by understanding the species level, relative abundance data, and the best researchers who have done this is led by Rita Colwell.  Rita Colwell is the most decorated scientists in this whole world of microbiome mapping, she’s got 60 honorary degrees including a couple PhDs that she first earned and then 60 other degrees, she’s published 800 papers in this space in peer reviewed journals, which is a mind-boggling amount for any researcher doing work.

Dr. Weitz:            Isn’t it the case that the PCR, quantitative PCR testing is actually more sensitive and specific for picking out organisms? And if you go into a hospital and they suspect CDF, they’re not doing a whole genome sequencing stool tests, they’re doing a PCR test, right?

Kiran:                    They’re doing a PCR test and that’s important because the relative abundance of that pathogen compared to all of the other DNA may be really low. So for them, in order to find that bacterial DNA or viral DNA in the case of COVID or any other virus, they need to amplify that bacteria viruses DNA. And that’s what PCR does, the polymerase chain reaction amplifies the DNA. The problem with doing that in a stool test to try to understand your microbiome is it artificially amplifies the volume of that particular species DNA.  So it gives you erroneous relative abundance numbers, so we need to be able to get really accurate relative abundance numbers. And the thing is that the sequencing work takes longer, that’s another reason why, if you’re ill with something, they’re trying to figure out what is making you ill, they use PCR because it can be done pretty quickly. You can get PCR done in an hour or 35, 40 minutes.

                                The genome mapping using full metagenomics takes much longer than that. However, CosmosID, the lab that we’re working with are the only lab that are FDA approved to do whole genome sequencing for pathogen identification, because now we’re starting to see some issues with PCR, even in pathogen identification because you might go to a doc, or you might have diarrhea and your doctor, your infectious disease doctor gastroenterologists might say, “You might have C diff, this looks like C diff. So let’s take a stool sample and then we’ll look for C diff.” But they were using the PCR, they will amplify the C diff DNA and they’ll pick it up.  Now, C diff may not even be causing you the problem, because C diff may be there but its levels may be low enough that it’s not the one causing you the problem. And the PCR is absolutely focused on that one organism, it’s not like it’s amplifying everything to pick up whatever it can find, it’s going in, honing in on that one organism saying, “Hey, we found some C diff, that must be your problem so we’re going to give you vancomycin all day long.”  Well, that might not be the solution, right? So now the FDA and the infectious disease specialists starting to see that PCR may be problematic even in trying to identify an infectious agent, what may be better is sequencing everything that’s there and seeing what is just popped up at the highest that could cause those symptoms. So CosmosID is the only FDA approved lab in the country that can do that kind of work.  So we partnered with them to get the best sequencing data. And then our other thing that we focus on the stool test is we want to give you functionality, we want you to be able to tell what your patients microbiome tends to do and tends not to do. It’s not absolutes, there’s no absolutes within the microbiome, but you will have a guide for you to understand where the real issues may be within that patient’s microbiome that you can start honing in on to help.

                                And everything we test actually gives you actionable steps that have references. On lifestyle changes, diet changes, and even supplement changes that can help that particular area. Coming back to TMAO, that’s one of the things we test. So you could eat meat and choline there and L-carnitine all the time and be absolutely fine and it’d be very healthy for you as long as you don’t have really overgrown levels of bacteria that create TMAO.  And you may have that because of previous dietary choices, when you bring back balance of the microbiome, then you don’t have that issue. And so one of the things you can do is you could test your patient’s microbiome and say, “Hey, your TMAO levels are really producing bacteria really high, so let’s reduce these kinds of things for a period of time until that comes down, then we can bring them back into the system.”  Just another example of that sulfate reducing bacteria. Nobody would have really thought about it or heard of these things within functional medicine, but they’re so important because one of the things that they do is they take sulfate from sulfate rich foods, and they convert it to hydrogen sulfide in the body which then becomes really inflammatory to the bowels. And so many healthy foods are high in sulfates, seafood is high in sulfates, and the leeks and garlic and artichokes, all of these things, high in sulfate.  So you might have a patient that’s going, “Doc, I’m eating pretty clean. I’m eating healthy fish in a line caught fish, I’m eating these vegetables. I still have really bad diarrhea…”

Dr. Weitz:            I just had a patient today and she had a flatline SIBO breath test which is usually indicative of hydrogen sulfide.

Kiran:                    Yup, exactly. So, yeah, and then you will know from the bio effects test like, “Oh, okay. It’s because your sulfate reducing bacteria are really high, these categories of foods really are actually counterproductive in your gut. So let’s bring those down over time and you could see all of the recommendations that allow to bring that down, bring that down over time and then rebalance microbiome, then you can reintroduce foods like normal.”

Dr. Weitz:            So how do we order this stool tests and how much does it cost?

Kiran:                    Yeah. So the practitioners you can order, I think we sell them in bundles kits of four, there’s no cost to order them of course because you can order the kits and have it within your practice until you have the right patient to use it on. The price that we charge is 299, we leave it up to you if you want to mark it up above that, but that’s a price that we only talk to practitioners about.  So the patients don’t know what the cost of this is. We have a mix of practitioners, some that don’t mark up tests at all but then charge a consultation fee to go through it or some that double the price depending on how they’re set up. So we allow you to decide how to do that. So then the functionality of it is if you have patients coming into your clinic, you can hand them a test, you can either have you or your staff registered the kit for them.   It’s a very quick process maybe it takes two minutes and you can either put in the payment and then charge them back, or you can have them take the kit home and have them register it using your code in there and then they will pay for it directly too. So you can manage it however you want, they do this test at home, we’ve got a very painless sampling procedure. That was another thing that we really wanted to improve, we didn’t want people like scooping poop and doing all kinds of stuff.   So we have this piece of paper that actually sticks to the toilet seat that has a bowl in it and then you take care of your first void and then we give you a brush, a coring brush, and you kind of core through a few spots in the stool, stick the coring brush in the test tube, close it off, then that’s what you mail back the paper, you can actually just unstick it and flush it. So you’re not dealing with actually managing anything.

Dr. Weitz:            That’s cool. It’s always tricky trying to hold that with [crosstalk 01:06:13] basket.

Kiran:                    Exactly, yeah. And the brush, what’s cool about the brush is we even thought about this like, we don’t want you to get too close to the stool. So the brush actually has a long handle when you first get it and you can actually core through the poop sample. I think we recommend somewhere around like five or six times you core through it.

                                And we use a brush because one of the things we found was you’re not getting adequate sampling of the DNA from the stool when you swab the surface or when you scoop a tiny bit of it. The DNA and the bacteria in the stool is not homogenous, so the bacteria on one side is going to look different than the bacteria and the other side and their relative abundances can change. So we wanted you to be able to go through the whole core of the stool and use a brush with lots of bristles to pick up as much as we can.

                                The more you pick up the more accurate the data it would be. So the brush has a long handle, you core through it a few times, you put it into the test tube, and I think you just off the top of the handle and then screw the cap on it, then you’re just mailing it back in a prepaid envelope.

                                And here’s the exciting part about it is we now have an FDA approved COVID diagnostic in the stool tests, and it’s an actual diagnostic meaning you can diagnose COVID in the stool. And that’s really important because studies have shown that you can actually pick up COVID in the stool for up to two to three weeks longer than you can pick it up in the upper respiratory tract. So you might have a patient that was feeling pretty crummy.

                                And in fact, we just had this with one of our employees, she was feeling pretty crummy and she went and got the nasal pharyngeal test and it was negative. But there’s studies that show, you can get up to 50% false negatives with that test. And so she’s like sitting at home having lots of similar COVID like symptoms and doesn’t know if it’s COVID or not.

                            So we’re having to do the stool test instead and the stool test will come back in about four days for the COVID part. The sequencing takes a little bit longer, but the COVID part comes back faster. And if you had somebody that had COVID maybe a couple of weeks ago, I suspect they did, you could still pick it up in the stool test up to two, three weeks after symptoms go away.  So it’s a great way to do that diagnostic, and you can do it at home. You don’t have to go to a testing facility where you’re around a bunch of other people that also think that have COVID and you could kind of keep yourself just safe distance from all of that.

Dr. Weitz:            This has been an awesome discussion Kiran, and I could talk to you for hours.

Kiran:                  Thank you.

Dr. Weitz:            Thank you for being so generous with your time. And so I think we got to most of people’s questions.

Kiran:                  Awesome.

Dr. Weitz:            And I really appreciate it.

Kiran:                  Well, yeah. Thank you so much for the opportunity, I always treasure any opportunity to talk about this with people, because clearly everybody here are the people on the front lines, you guys are the ones making the difference out there. And nothing I do is meaningful until it translates to the work that you do, so I’m always grateful for these opportunities. So thank you, Tanya, so great to see you and thank you for getting this set up for us as well and really enjoyed it, really enjoyed it myself.

Dr. Weitz:            Excellent. And thanks to everybody.

Kiran:                  Yeah. Take care.




Emotional Eating with Melainie Rogers: Rational Wellness Podcast 162

Melainie Rogers speaks about Emotional Eating with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

5:22  Losing weight is difficult, which is why 70% of the population is overweight.  One of the problems is that many people overeat or binge eat for emotional reasons. When our clients are feeling anxiety, they tend to eat carbohydrate foods, which tend to increase the amount of serotonin in the brain.  And while we are in this global COVID-19 pandemic, we are seeing a lot of anxiety and lot of this type of overeating.

7:34  When working with a weight loss client, we have to try to help our clients to understand their eating behavior and then work backwards to try to understand what feelings are triggering their behavior.

9:12  Not everybody who’s eating for emotional reasons have an eating disorder, but many do.  A good acronym is HALT, which refers to eating for the following reasons: 1. feeling hungry, 2. feeling angry, 3. feeling lonely, or 4. feeling tired.  If you do this occasionally, this could be normal, but if you’re doing this two or three times per week and feeling out of control, this is an eating disorder.

10:18  The difference between overeating and binge eating is that if you ate a whole pizza and then felt really full, that would be overeating. But if you did it and felt out of control and great distress by doing it, that would be binge eating.

11:00  One of the best strategies is to sort out what is biological or physiological from what is emotional. If someone skips breakfast and eats very little for lunch, then it is biological to be extremely hungry and to overeat because of that.  If they binge at this time it would be considered a physiological binge. For patients with emotional eating problems it is important to eat consistently throughout the day.

12:20  Eating consistently is important for emotional eaters to break their cycle, but in the Functional Medicine world now the hottest trend is to skip either breakfast or dinner so that you 12-14 hours without eating, which is referred to as intermittent fasting, which is considered to have anti-aging properties. Melainie said that if intermittent fasting works for you and you don’t binge at the end of the day, then continue doing it.  But if you find yourself overeating during that 8 hour window, then that may not be the right program for you. During Ramadan where you fast from sunrise to sunset, they often gain weight, since they tend to overeat or gorge at night. 

15:22  The difference between physiological and emotional binging is that if the client is eating food consistently throughout the day and meeting their nutritional needs and they are still overeating or binging, this is emotional because they are hungry or angry or lonely or tired.  It is important to make clients aware of this.

16:26  Mindfullness is being aware of what you are eating. Paying attention to whether or not you are really hungry.  You should not eat when you are distracted, such as by watching t.v..  It can be helpful to jot down on a notepad how hungry you are on a 1 to 5 pt scale before the meal and how you feel after.  It can also be helpful to write down what you are eating throughout the day, so you are aware of how much you ate.

20:15  The app Recovery Record can be helpful for clients with eating disorders.

20:50  Negative body image can be the motivation for eating disorders, so it is important to work towards having a positive body image or at least get to body neutrality, which means I just appreciate what my body can do for me. I may not love my body, but I’m not beating myself up all the time. It can be very difficult in our society where we are bombarded with imagery around the thin ideal.

23:25  If we eat unhealthy foods, we deplete our bodies of necessary vitamins, minerals, and other nutrients such as protein, which may make us crave more food.  For example, craving sweets could be an indication that we are dehydrated or lacking vitamin C, while a craving for salty foods might mean that we’re deficient in sodium or calcium or magnesium or zinc.  Eating a lot of low nutrition junk food can lead to someone being overfueled calorically, but underfueled nutritionally.

25:40  Eating foods like breakfast cereals that are fortified with vitamins and minerals is not as nutritious as eating real, natural foods like fruits and vegetables that are naturally high in vitamin and minerals and many other phytonutrients that are important and others that have yet to be discovered and appreciated.  We are programmed to seek out variety in food so that we are more likely to eat all of these important nutrients and this can’t be replaced by a poor diet and a multivitamin.  Supplements can be most beneficial when they top off a healthy diet. 

27:21  A lot of people are feeling extra amounts of stress due to the current coronavirus pandemic and are more liable to eat unhealthy, processed foods that require minimal preparation. And such processed foods are actually less expensive per calorie than natural, healthy foods and many people are out of work or making less.  And such processed foods tend to have a longer shelf life if you are stocking up to avoid frequent trips to the grocery store.

29:56  A lot of people are confused about what to eat, since the science seems to be changing and there is so much misinformation on social media around food and wellness.  There are many wellness coaches and diet gurus with very minimal training in the science giving advise about the best way to eat.  We have completely opposite diets–the meat only carnivore diet and the vegetable only vegan diet both being promoted and discussed as the best way to eat, so it is not surprising that so many people are confused about what the best way to eat is.  The diet debate is as polarized as the political debate in the US right now.

32:52  We know that exercise has incredible benefits for mental health, physical health benefits, motility, flexibility, joint stability, bone density, etc.   But high intensity exercise or overexercising can be another form of obsession like an eating disorder.  This can be just as harmful as undereating.   Overexercising can be very harmful and is done for an underlying body image issue, so we need to find out what is underlying the motivation for their behavior. 

36:11  It is not unusual that clients who come to us for weight loss will tend to underreport what they are eating by about 50% because they feel shame and guilt that they have over not being able to do what we have asked them to do. Our job is not to shame them further, but to figure out how we can set them up to be more successful.



Melainie Rogers, RDN is a Certified Eating Disorder Registered Dietician and accredited supervisor in the treatment of eating disorders. She is the Founder and Executive Director of BALANCE eating disorder treatment center™ and Melainie Rogers Nutrition, LLC in New York City. Among her many affiliations Melainie is the founder and recent past president of the New York City Chapter of the International Association of Eating Disorder Professionals (IAEDP), an Advisory Board Member at the Center for the Study of Anorexia and Bulimia (CSAB) and a former Board Member of the Binge Eating Disorder Association (BEDA). She is also an adjunct professor in the Department of Nutrition and Food Studies at New York University. She recently published Redefining Wellness: The Ultimate Diet Free Guide, a free e-book that contains contributions from 150 experts, which can be found on her redefiningwellness.co website.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. To learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello Rational Wellness podcasters, Dr. Ben Weitz here. Thank you so much for joining me again today. For those of you who enjoy listening to this podcast, please give us ratings and review on Apple podcasts. If you’d like to see a video version, go to my YouTube page. And if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                            Today our topic is emotional leading with Melainie Rogers. I think I butchered your name, but there are many-

Melainie:              Oh, that’s perfect.

Dr. Weitz:            There are many reasons why approximately 70% of Americans are overweight or obese. There are genetic factors that make it difficult to get and keep your weight into a healthy range. We may be taking certain medications such as antidepressants that tend to make us overeat. There are various hormonal factors, many of which can be treated. Insulin is secreted when we consume foods with a lot of sugar, and a large insulin surge in response to eating a bowl of breakfast cereal or a doughnut will tend to drop your blood sugar making you crave more sugar.    By the way, I saw an executive from one of the companies that make cereal on CNBC, and he was bragging about the fact that, “Isn’t it so great that Americans now are eating cereal for dinner as well as breakfast?”

Melainie:              No. Wow.

Dr. Weitz:            Anyway, back to sugar and insulin. Every time we develop insulin resistance, so our pancreas needs to pump out ever greater amounts of insulin, which makes us crave more and more sugar, and more carbohydrates, and we end up in this vicious cycle that is hormonally related. In our society, inexpensive, highly processed, and addictive junk food is readily available. Such unhealthy food products have been specifically designed to be hyper palatable and addictive. And there’s aggressive marketing to convince us that eating such foods are good for us. And if we eat such high sugar, high fat, high salt foods regularly, we end up being depleted of necessary vitamins, minerals, phytonutrients. And so this may encourage our bodies to eat more to get those nutrients we need. Of course, being cooped up inside due to the COVID-19 crisis, which we’re currently undergoing with the stress and worries about getting infected and dying, as well as our loss of income, provide additional reasons for unhealthy eating.

                                Melainie Rogers is here to join us today. And she’s a registered dietitian and a certified dietitian and a certified eating disorder registered dietitian. She’s the accredited supervisor in the treatment of eating disorders. She’s the founder and director of BALANCE Eating Disorder Treatment Center in New York City. She’s the founder and past president of the New York Chapter of the International Association of Eating Disorders Professionals. And she is definitely one of the top experts in binge eating and anorexia, et cetera. She recently published Redefining Wellness: The Ultimate Diet Free Guide, which is a free ebook that contains contributions from 150 experts, which can be found on her redefiningwellness.co website. Melainie, thank you for joining us today.

Melainie:              It’s a pleasure, Ben. Thank you for having me.

Dr. Weitz:            Before we start the conversation, I’d like to start with a request or a comment. I know that, looking at some of your work and your blog posts, that you’re used to often speaking to a lot of women who may be more right brain in their thinking about emotional eating. I assume that they are probably a big part of your target audience. But I think most of my audience and myself are very left brain analytical focused. We talk about health and functional medicine. I think it’s important to deal with the emotional stuff, but if there’s a way that we can do it so that limited left brain people like me can understand it, that would be helpful.

Melainie:              Sure. As a left brain person myself, I’m trained in research. So we will definitely talk about the research, and then of course behaviors.

Dr. Weitz:            Very good. Losing weight is very difficult for most people, which is one of the reasons so many people are overweight. I think the latest statistics show in the United States, something like 70% of the population is overweight. I work with a lot of clients who are trying to lose weight and many of them have emotional reasons for why they eat. Can you explain some of the emotional reasons people have for overeating or binge eating?

Melainie:              Absolutely. Not most people, but many people, guys and gals, I know you mentioned women earlier, but for overeating and emotional eating, it’s about a 50/50 split between guys and gals. The reason for that is because we all, male and female, experience emotions, and a driving force behind the key emotion, which is anxiety, is actually our amygdala. Amygdala is a part of the brain that is responsible for that flight freeze response. And that’s the part of the brain that’s responsible for pumping out this feeling of uncertainty and anxiety, generalized anxiety.  What we know from emotional eating, Ben, is that most of our clients or general population, when they’re feeling anxious, they seek out carbohydrates, usually. They don’t usually seek out a chicken breast, right? The reason to that, my clients say to me, “My God, I don’t know what it is. Why am I addicted to carbs or sugars?” It’s not that you’re addicted to carbs or sugars. It’s that carbohydrates, specifically, when you ingest them increase the amount of serotonin in the brain.  Now, many of your viewers may know that serotonin is the chemical that reduces anxiety. So we’re talking about a neurobiological process here, that we call emotional eating, because we think it’s all about emotions, but it’s actually a whole chemical response and a domino effect that leads to overeating. And right now with COVID-19, we’re seeing so much more of this type of eating.

Dr. Weitz:            When we come in contact with someone who’s trying to change their weight, how do you determine what the underlying reasons are? Not everybody is willing or able to actually articulate why they’re overeating.

Melainie:              Absolutely. And a big part of that, too, is that, as a society, we’re not actually encouraged to check in with our emotions, and certainly there’s a gender bias there. Where guys are definitely not at all encouraged to connect with their emotions, they’re encouraged to be stoic and to pull yourself up by your bootstraps and just get on with it. Which that kind of a suppressed emotion just leads to a lot of things going sideways, hence we’ve got guys and gals, but more predominantly guys, who drink excessively, who have sex addictions, who gamble excessively. Those are behaviors that are working sideways; too many underlying emotions, which they really have lack of awareness around.  For us, what we try to do is help our clients understand, or at least start with the behavior because that’s very concrete, and then work backwards to, what’s the trigger around why you would do that? Often, for many people, that’s pulling back the layers to figure out what are those underlying feelings, which make people really scared. People get really scared to think about feelings. It’s amazing, actually, but yes, that’s the process.

Dr. Weitz:            So is everybody who’s eating for emotional reasons, do they all have an eating disorder?

Melainie:              No, not at all. But they probably have disordered eating. So it’s on a spectrum. For many of us at some time, we’re all going to eat out of emotion. A really good acronym that’s often used in the substance abuse world that we’ve adopted in the eating disorder world is HALT, hungry, angry, lonely, tired. The whole quintessential, I roll into bed or I crawl into bed with my pint of ice cream and binge, watch TV, Netflix, or whatever. So that’s emotional eating for comfort. Maybe there’s been a break up, or your boss yelled at, you or COVID-19. So it’s on a spectrum. And doing that occasionally just means you’re normal. But if you’re doing that two or three times a week and feel very out of control and can’t stop it, then by default of the frequency and the severity of it, then it may fall into the criteria of what is an eating disorder.

Dr. Weitz:            And then, what’s the distinction between emotional eating or overeating and binge eating?

Melainie:              Binge eating is when you eat a larger amount of food than other people would normally have. Let’s say you have two entrees for dinner. You eat very quickly, and you feel great distress doing it. It’s one thing to sit down and eat a whole pie of pizza, pizza pie, and be like, “Oh gosh, I’m really overfull. Wow, I ate all that.” But there’s not a distress attached to it. That wouldn’t be considered a binge. A binge is when people feel out of control and feel great distress by what they’re doing.

Dr. Weitz:            Okay. What are some of the best strategies and tips to help patients, clients avoid overeating or binge eating?

Melainie:              Number one thing we find is biological. My job as a registered dietitian is to separate out biological or physiological binges from emotional binges. How I would differentiate the two then is that, a physiological binge is when our clients get up in the morning, maybe they’ve binged the night before and they decide, “Oh, I’m going to skip breakfast this morning.” Or, “I’m not hungry for breakfast.” They get to lunch, and they decide that they’re going to have a tomato and a piece of lettuce, because they’ve got to make up for calories that they consumed the night before. And you guess it, by the time they get to the end of the day for dinner, they’re absolutely ravenous. That’s a physiological hunger.  Then when they sit down to dinner, they don’t just have their steamed chicken breast and a little portion of broccoli that they intended to have, they in fact, go on an outright binge and usually have fried this and fried that and fried this and feel out of control. So that’s a physiological binge. How we try to reduce that is by having people eat consistently throughout the day. That means you have to have a breakfast, you have to have a lunch, you have to have snack, you have to have dinner. Go ahead.

Dr. Weitz:            Yeah, I have to jump in here because this is a constant discussion we have in the functional medicine world. I’ve been working with clients with nutrition for over 30 years now. The big thing we started with was, people skip breakfast, they’re rushing around, they have a snack for lunch and then they overeat for dinner, and that’s why they’re all overweight. And the mantra was, “You have to eat breakfast, you have to eat within so much a period of time of waking up. You have to have small meals throughout the day.” For years we were preaching, “That’s the way to be healthy. That’s the way to balance your blood sugar.” And now the big thing in Functional Medicine is, the way to be healthy is to do intermittent fasting by skipping breakfast.

Melainie:              I know. I know, right. I know. Because it’s the goal of getting a 12-hour break on your body, right? 

Dr. Weitz:            Yeah, or 14 hours or 16 hours, and pressing your eating window into a narrow range It’s funny how it comes full circle, but anyway go ahead…

Melainie:              It’s so funny because… No, you’re absolutely right, because it used to be low fat and then it was no carbs, and now it’s, sorry, intermittent fasting. I don’t really advocate any one diet. What I do for my clients is try and figure out what works for them. But we do know conclusively that if you skip breakfast… Or let’s say you don’t do breakfast, I’m cool with that too. I’ll work with whatever the client wants to do in the sense of guiding them. But if you’re just eating lunch and then you’re eating dinner and you’re binging, I would suggest that you’re just not taking in enough calories for the day, and that’s a physiological binge. Yeah, those intermittent fasters out there, whatever works for you. But if you are binging towards the end of the day, then you may want to have a look at that.  What’s interesting about that, Ben, is that it used to be, “Don’t eat after 7:00 PM.” But I think that went out the window because with our current lifestyle, people don’t usually get to dinner until 8:00 or 9:00. So I think this is the new modification on that, which is just trying to create some kind of gap. But also it makes me wonder that, are people just there for binge eating or grazing through those eight hours that they can eat? During Ramadan, for example, when the Muslims fast for a month, people gain weight.

Dr. Weitz:            Is that right?

Melainie:              Because they starve and then they binge. I’m laughing. I’m sorry. It’s not a laughing matter. But we know that the-

Dr. Weitz:            No, no. I know that you’re laughing out of irony. Yeah.

Melainie:              Yes, out of irony. I mean, we know from the research that the number one way for people to gain weight is by restricting so excessively that they end up being out of control around food. That’s just a physiological fact.

Dr. Weitz:            If that’s the physiological or part physiological-

Melainie:              Yes, binge.

Dr. Weitz:            Then what’s the difference between the physiological and the emotional?

Melainie:              If a client is then eating consistent food intake throughout the day and meeting their nutritional needs, their fuel needs for the day, and they’re still finding that they’re getting out of control with eating and it’s not hunger-driven, we know it’s emotionally-driven. So then that becomes the big question of, what are those underlying emotions? So for people who are overeating it can be, the acronym I used earlier.  Well, hungry, we just eliminate it, because we’re having consistent eating. But now we’ve got angry, now we’ve got lonely, now we’ve got tired. And so it’s important for clients to then have a look at, “Why am I eating right now? I know I’m not hungry.” That brings into play mindfulness, which is just observing your behaviors and not judging, Ben, but just being curious. Like, “Why am I doing this? I don’t want to eat this. I’m not even tasting it.” So helping clients increase that awareness around their behavior.

Dr. Weitz:            What is mindfulness? Everybody throws it around. And when I talk to people, a lot of people are not really sure what it is.

Melainie:              Sure. Mindfulness from the definition or how we operate with our clients is really awareness. Just being aware that, “Hey, I’m reaching for the third or fourth, or fifth slice of pizza, and I haven’t checked in if I’m even hungry because I’m usually disconnected.” If we think most of us are disconnected like this from what our body is needing from a hunger and fullness perspective, that’s our internal regulatory system. Leptin, ghrelin, PYY, all those great feedback hormones are dictating that. What we really want to practice or get back into doing is checking in with our body and saying, “Gosh, I think I’m full. I don’t actually need that extra slice.”

Dr. Weitz:            What’s a practical tip for somebody who’s sitting down and they’re eating. Is there a little tool that they can use to be mindful while they eat?

Melainie:              Absolutely. There’s a lot of different ones. Some of them come back to the oldies but the goodies which is, “Don’t eat when you’re distracted.” And for many of us it’s for dinner anyway, sitting down in front of the TV or the computer and eating, and we look at our plate, “My gosh, gee, did I eat all that? I didn’t even realize it. The plate’s empty, I must have eaten it.” That’s distracted eating. First and foremost, try to reduce the distracted eating. Which means, turn off the TV, shut down the computer, sit there and be thoughtful and notice yourself eating your meal and check in with your body.  For some people, it can be helpful if they have a little notepad and just think, “Oh, how hungry am I?” And use a one to five point scale? “How hungry am I when I go in? How full am I at the end of the meal? So that they have a little bit more data collection that can feel more concrete for them around this process, so it doesn’t feel new and ethereal and not scientific. Those are just a couple of real simple things.  The other thing is when you plate a meal, if you go back for more check in, ask yourself, “Am I still hungry?” “Yeah, I’m still hungry. Maybe I’ve got some mouthfeel going on, so maybe I want some dessert to wrap up,” or something like that. It’s really checking in with yourself.

Dr. Weitz:            Okay. What are some of the other techniques we can use?

Melainie:              Some other techniques to use would be having a look at… Checking in, “Did I eat throughout the day today?” For some people, writing it down can be really helpful as a scientific experiment on themselves. So that-

Dr. Weitz:            You mean write down what they’re eating?

Melainie:              Yeah. Or even if you don’t want to write down what you’re eating, just write down the time that you ate throughout the day. So for some of us, we’re so crazy busy, Ben, and honestly, you can forget to eat. Your introduction earlier was about people who are just on the go, and you can really get delayed in eating consistently throughout the day. So if you even just decide that you’re going to write down what time of the day you eat throughout the day. It doesn’t matter what the food is for now for this example. Then you can just check, “Did I eat lunch?” “Yes, I did.” “Did I have a snack?” “Yes, I did.” “Did I have dinner?”   If on one particular day, you’re overeating at the end of the day and you go back to your notepad and say, “Why am I crazy hungry? Or why am I wanting to overeat right now? Did I eat today?” And you check back and go, “Oh, I forgot to have lunch.” It can happen. It could happen. Or, “I grabbed a snack for lunch instead of a real meal. And that’s why I’m starving right now.” That kind of data collection is important.

Dr. Weitz:            Do you have any apps for doing that?

Melainie:              Yeah, I do, actually. We don’t tend to use apps that have calories, because I find that that keeps everything external. I want clients to get back to their internal regulatory system with those hormones we talked about earlier. There’s a wonderful app we use called Recovery Record. And it’s really about logging what time, what you ate, but also hunger and fullness. Then of course, if we think about hungry, angry, lonely, tired, it can also tap into if there’s any kind of emotional eating going on as well.

Dr. Weitz:            What role does negative body image or body dissatisfaction play in? How can this be overcome?

Melainie:              It plays a huge role. Because usually what happens is that there is a dissatisfaction with your body and a desire to change it, which usually in our society now, which idolizes the thin ideal, that usually means weight loss, or for a lot of us it means beefing up. And so therefore there is usually an attempt to, in the weight loss case, there’s an attempt to lose weight and reduce calories. What we know is that when you reduce calories below a certain amount for an extended period of time, that physiological response we spoke about kicks in and then people end up overeating, they’re fallen off the wagon, they feel despair, they regain the weight plus some. So body image in our current society can be a huge trigger for dieting, weight loss, and weight regain.

Dr. Weitz:            How does somebody get a positive body image?

Melainie:              It doesn’t happen overnight. I would say it’s pretty tough to do in the current society where, Ben, we’re just bombarded with imagery around the thin ideal. What we work with with our clients on is, “Okay, let’s not go from negative body image and hating your body to, ‘I love my body overnight.'” I think that’s almost impossible. What if we just get to body neutrality, which means I just appreciate what my body can do for me? I may not love it. I may still think this about my stomach and my thighs, but I’m not beating myself up all the time. So we work on our clients trying to reduce behaviors that might add to the negative body image, which means unfollow on Instagram and social media accounts that have you comparing yourself to others.  In some cases, we even have our clients take up their full length mirrors and just have the mirror above your head, for example. Because if you can’t view your body without picking it apart, then maybe it’s time to just take a short break from doing that. And then there’s a lot of cognitive challenging of a lot of the thoughts that we all have, some challenging on those thoughts and some reframing of those thoughts to get to at least an appreciation of what your body can do for you.

Dr. Weitz:            Can you talk about how, if we eat unhealthy foods we tend to deplete our bodies of necessary vitamins, minerals, and other needed nutrients, such as, say, protein that may make us crave more food? In one of your blogs, you wrote that craving sweets could be an indication that we are dehydrated or lacking vitamin C, while a craving for salty foods might mean that we’re deficient in sodium or calcium or magnesium or zinc.

Melainie:              Yeah, absolutely. Well, we know that, and you alluded to this earlier, that if you’re eating a lot of what we call low nutritious food, which still has a role in an overall eating plan, but not if it makes up all of the eating plan. So foods that don’t have a lot of vitamins and minerals in them can ultimately lead to someone being overfueled calorically, but underfueled nutritionally, which means they’re deplete in vitamins and minerals. Then I think that blog really just speaks to cravings and how cravings can direct us. If you listen to your cravings, they can direct you in a way of what you might need a little bit more of.

Dr. Weitz:            But it says on that box of breakfast cereal that it’s fortified with vitamins and minerals.

Melainie:              I know. I know. Which is why maybe it could be a good dinner choice. Yeah, I know. Isn’t that crazy? Absolutely. We’re finding that out that the portion of the population that might be nutritionally depleted, even though we do have a lot of fortification, vitamins don’t necessarily, because we’re still doing the research on this, right? They don’t necessarily check all the boxes just as a sole entity. It’s a lot more complicated when vitamin C is detracted from a food source because of all the other elements that play along with the vitamin C, versus a synthesized vitamin C supplement, as we well know. Yeah.

Dr. Weitz:            When vitamin C is found in foods like oranges, there’s all sorts of bioflavonoids and other phytonutrients, many of which we’ve not even figured out what their role is. I’m a big believer in supplements, but supplements are topping off a natural diet. So you’re getting at least a good background of all those phytonutrients that are contained.  Just recently, one of the studies on COVID-19, we’ve seen some positive data on vitamin C, but the bioflavonoids have been shown to be super helpful. I mean, some of the ones particularly that are found in foods that have vitamin C, like hesperidin and rutin. And so I think it’s important that you have a phytonutrient rich, healthy diet with lots of different colors of fruits and vegetables. And then take your vitamin C on top of that, you’re going to get a different response than eating Cheerios that are fortified with vitamins.

Melainie:              Exactly. It’s amazing, Ben, because we’re actually designed to seek out variety in food. And this is the very reason for it. Because prior to us being able to actually identify that there are such things as vitamins and minerals, no one’s got a gauge built into their arm that says, “You’ve met your zinc intake and your magnesium intake for the day, et cetera.” Right? The way that our brains are structured is, we seek out variety of food to make sure that we’re actually getting in adequate vitamins and minerals throughout the day. Which is pretty genius when you think about it. And it can’t be replaced by just a simple supplement, as you rightly said.

Dr. Weitz:            Unfortunately, a lot of people now are stressed, so they’re eating some of these unhealthy foods because they don’t require a lot of preparation. But the reality is, is we really have more time now because people are at home to fix yourself a really good healthy meal with lots of fruits and vegetables and actually being involved in preparing it, and prepping it, and cooking it. It’s actually an important part of getting the benefits and enjoyment out of a meal. I encourage everybody to do that.  Now, on the other hand, I also understand that unfortunately, healthy foods are more expensive. You see at these food banks, you don’t see a lot of fresh produce being put into those boxes. You see boxes of cereal, and packaged foods and things like that. And because those are relatively inexpensive and ditto for junk foods, our fast food industry, which is probably still doing as much business as they were before because you can’t dine in but a lot of people do takeout anyway and it’s fast and inexpensive.

Melainie:              Right. That’s so true. Also there’s a shelf life on those items that you mentioned at the food bank. Those things can be put on a shelf or put in a box, easily and stored, whereas fresh fruit and veggies don’t and they spoil. It’s just logistically a lot tougher. And also what we find with food scarcity is that some of the more socioeconomically challenged areas, particularly I can speak for New York City, anyway, there’s not a lot of grocery stores in certain areas, but there’s hell of a lot of fast food chains in those areas. It’s also access to food. So there’s a lot of factors that play into it.  One other thing, Ben, is, yeah, some people are looking for what’s readily available. And this would be a good time to take the time to prepare some of these more nutritious meals and such. But I think honestly, it also comes down to motivation. I think so many people are feeling so flat right now with so much uncertainty that it’s just stressful. And when stress is high, your motivation tends to go low, which is counterintuitive to what would make you probably feel better. But we know about that, right? Motivation and behavior change is really tough as well.

Dr. Weitz:            It’s interesting that there seems to be more information and ever on food, and healthy eating, and nutrition, and yet, a lot of people are still confused. Can you comment about that?

Melainie:              Absolutely. I think it’s because there’s information overwhelm. They’re confused because, for example, we used to say that butter was bad, and then we went to margarine, and now maybe margarine is bad. So the science keeps changing and therefore consumers can’t keep up, is one thing. And now with social media, there’s such a plethora of information out there, it’s hard to even follow. And there’s so much contradiction out there as well. What my pet peeve is, is all the pseudoscience that is out there on social media.  There was one stat I saw recently, which suggested that between eight to nine out of every 10 comments and information out there on social media around food and wellness is actually bad science or even no science. I mean, I’m a registered dietician. I was medically trained. And so everything that we do is based upon what is the research. So it’s frightening to see a lot of wellness coaches out there who have no training and no understanding of the research spreading incorrect and inaccurate information.  I feel sorry for the consumer, because how can you possibly try to sort through what’s rubbish to fact? Then the facts actually do change as more and more research comes in as well. So it’s tough. I’m glad that I have the training that I have, but it’s still a lot of information to filter through.

Dr. Weitz:            Yeah. If you’re on social media, it seems to me that the biggest trend right now is the carnivore diet, which is meat only. All you eat is meat.

Melainie:              Right. Yeah. So a bit of caveman coming in there, but even caveman used to run around and get their root vegetables and fruits and berries from the trees and such like that. Yeah, it’s just another form of like the Atkins that was around a couple of decades ago, and it’s just the same thing-

Dr. Weitz:            Even more extreme, you know?

Melainie:              Yes, it is very extreme. It’s very extreme. The difficulty with that, and I know there are people who are pro; the difficulty with that, as we’ve seen with any of these eating plans, is that for a while it works for people until it doesn’t because taste fatigue, physiological needs are not met, et cetera. And then-

Dr. Weitz:            Starving the microbiome…

Melainie:              Exactly microbiome, and then people fall off the wagon. Then what’s so beautiful and brilliant about these diets is that when the consumer falls off the wagon, they blame themselves. They don’t look at the diet and say, “This diet was setting people up to fail.” Hence, it just perpetuates itself.

Dr. Weitz:            What do you think about high intensity exercise for emotional leaders? You see people who are obsessed with exercise, especially the gyms are closed, but I’m a gym person and used to seeing certain people at the gym for hours at a time. And that’s another form of eating disorder is over exercising. So how should people who have a tendency towards emotional eating approach exercise?

Melainie:              Exercise in moderation is really great for so many reasons. And you as a chiropractor and sports chiropractic person know this. I have a sports nutrition background as well, Ben. So you know that the mental health benefits, the physical health benefits, motility, flexibility, all of these things, we know exercise is really helpful up to a point. But what you’re speaking to is a behavior of obsessiveness and going above and beyond what actually technically is healthy. In fact, obsessive exercising is very unhealthy.  What we look at with what we do is not just people’s obsession around food, whether it be undereating or overeating, but that obsessive tendency carries forth in other areas. And one of them, as you said, is over-exercising, which can be really harmful. But what’s really interesting about that is that some people overeat, or express their emotions through other ways; over-exercising is a way that people are trying to manage anxiety. It certainly has health benefits and therefore, unfortunately, it’s pretty normalized in our society because it’s like, “Oh, I envy that guy. Look, they’re three hours at the gym.” And it’s like, “Uh-uh (negative), that is so unhealthy.” I wonder about the work ethic, and also wonder about their relationships, because if you’re three hours in the gym, you’re not going to have some pretty happy people at home.

                                What we try to do there is we treat the whole person. So it’s not just about the food. It’s about what is your relationship with exercise? And also what’s driving that, and often it’s a body image underlying piece is driving that. For the guys it might be the bulking up, because there’s an underlying body image issue, which is an underlying anxiety issue. I mean, I’m simplifying these concepts, but for the point of the illustration. So we try to get at the underlying reason that one might be over-exercising and try to pull that back.  Usually what happens is when you reduce, someone who’s an over-exerciser, when you reduce their activity, their anxiety goes right through the roof. Which is exactly what we want to see because then we’re like, “Okay, you’re self-medicating with exercise. So let’s get it, what’s the underlying anxiety about?” In the same way that someone might be drinking excessively, you take the alcohol out of the picture and you’ll see their anxiety going up. So we need to get at the underlying anxiety.

Dr. Weitz:            How about a few tips for those of us who’re working with clients with weight problems? How about the client who’s not being honest with you? You make recommendations for changing their diet and exercise and they come back and four weeks later, no change, haven’t lost a pound, maybe gained a pound and they claim that they’ve eaten nothing all day except a salad and some tuna fish and an apple and they’re doing excessive amounts of exercising. You just know it’s not the case. How do you approach them?

Melainie:              Well, there’s a couple of different things there. First and foremost, we know that for a lot of our clients, because of shame, and they want to be seen as doing the right thing, and they want to not do the right thing. They want to follow your recommendations. They want to please you, Ben, they want to please me. They’re coming in, they’re paying us money. And then they find they can’t. Then they feel great shame about their behaviors. And they also feel shame about the fact that they can’t do what you asked them to do. So they’re not always forthcoming with the reality.  We know with our clients that 50% of what they tell us is either true or not true in the sense of, for our under-eaters, they’ll report that they’re eating a lot more than they are by about 50%. And for our over-eaters, they’ll under-report how much they’re eating by about 50%. So we know that from the get go, that that is part of the shame. Our job is not to shame them further, but to figure out how we can set them up to be more successful. So maybe those goals were too ambitious. Or maybe, actually, this is not just occasional over-eating, but there’s a serious problem going on here that they’re not able to rein in on their own, and they actually need more help and more support around that. And maybe they need more therapeutic support to handle the emotional stuff that’s causing them to overeat and then lie about it.  Then of course, there’s the other piece… Sorry, Ben. The other comment there is, the lessons learned from the greatest loser is that people massively restrict and they’ve lost a lot of weight, even though they still may be in a higher body weight, their metabolic rate shuts down and all sorts of biochemical processes change. And that endures for up to six or seven years; we’ve seen from the research thus far. So-

Dr. Weitz:            What have we seen from the biggest loser? Can you go over there?

Melainie:              Yeah. From the biggest loser where they’re able to do research on people who’ve lost a hundred plus pounds and are able to follow up with them six and seven years later, all of them regain plus some. And what they actually found is that the weights they return to, their metabolic rates never recovered fully to what we would expect a person of their body weight to be. If you-

Dr. Weitz:            Wow. This is almost all of them, you’re saying?

Melainie:              Yes. If you look at the Biggest Loser, which I hate that show but for research I have to watch it. And I was horrified by the shaming and it’s just disgraceful. But if you remember, those contestants were exercising six and seven hours a day plus. So it wasn’t that a lack of exercise was affecting their metabolic rate, which is a common thought in the sports nutrition world, that’s for sure, that exercise will protect your metabolic rate. It’s not true.  Again, I guess what I want to say for our higher weight clients, it’s complicated. There’s so much that we still don’t know because of weight bias actually, Ben. There hasn’t been good research done because assumptions were calories in calories out. We now know that that’s not the case. That it’s much more complicated and nuanced and sophisticated than that. And so our higher weight individual, our clients, we don’t have good research to be able to advise them accordingly. So compassion is really important. And then making those recommendations more baby steps so that they can feel good, and they can feel that they’re succeeding.

Dr. Weitz:            What could you do? Let’s say you’re in with a client and this is somebody who’s trying to lose weight, and you know they’re not being honest about the food they’re eating, how do you coax it out of them? What kind of a conversation or what can you do? So, for example, you’re recommending that they need psychological counseling besides the nutrition coaching that somebody like myself can provide. But how do you even bring that up if they’re not even admitting?

Melainie:          Well, if they’re not admitting that means their shame is too great. Even if you were able to… So here’s the thing, previously, what I guess might’ve    been encouraged is to just say to them blatantly, “I don’t believe a thing you’re telling me and you’re lying because the scale tells me the truth.” So my question to anyone who would approach them in that manner is, A, “Will the client come back?” B, “Did you help that client in the future to seek out help?” What we find is that when clients drop out of treatment, it may take them two years to come back, if at all. And we know that higher weight clients disproportionately don’t seek out help because they’re ashamed about their body and their weights. So shaming is not a way to go.

                                We know that our clients are going to under-report how much they’re eating because they’re ashamed of it. I’m just going to keep that in my mind, but I’m going to work with what they’re willing to talk about. That might be, I’m not going to comment on how much they had for dinner or not. I’m going to say, “Okay, well, did we have that breakfast?” How did you go with trying to get that breakfast in?” Or, “How did you go trying to get that lunch in?” “You know how we talked about having to make sure we get some protein in there? How did you go with that?”  We talk about those one or two, or even three simpler ideas. Because the idea is if we can get food in and by food, I mean, you make sure you get your protein there, make sure you get your fat for satiety, make sure you get the carbs in there. I don’t want low carbs because you’re going to binge on those later. It’s a physiological response. If we can work on what we can add in at the times where there are gaps, then that can also help with overeating later on, even if they’re not reporting that.

                                I had one client that I worked with, Ben, for two years before she admitted that she was binging. I knew she was, but that’s part of her process. It’s like if someone’s drinking alcohol, and you know they’re drinking, but they won’t admit to it because that’s their process; denial. If you think of stages of change; denial, and then there’s pre-contemplation and contemplation. Motivational interviewing and thinking of stages of change with behavior can be really helpful as well.  Also managing our expectations as the clinicians, because we know that if you just follow what I tell you, you’re going to really just see some great results and you’re going to be healthy and you’re going to recover. Then when they don’t do it, it’s really takes away from our sense of accomplishment. And so we have to check our egos as well and pull back and meet the client where they’re at with their process.

Dr. Weitz:            How about when they come in for their first consultation and you’re somebody like me who just is super disciplined, and it’s like, “If this is healthy, then I’m going to do it. I can’t imagine why anybody wouldn’t do that.” You’re meeting a client and you know that they’ve had problems with weight for a long time. They may be told you that. How do you set them up for success? Because I know I’ve had the occasion more than once, unfortunately, of setting them up on a program and asking them to write everything down, and this is going to be so great. We’re all excited, and that’s it. Never saw them again.

Melainie:              That’s right. That’s absolutely right. Because you set them up, you’re like, “We’re going to do this.” Yeah, because it’s overwhelming. It’s overwhelming for them. I think what’s really, really hard is, and I encounter this too, because I’m a registered dietician, so therefore, I know what to eat and what not to eat and all that stuff. I studied it for seven years, and other things. We have to be a little bit careful, Ben, because we bring our enthusiasm for what we do but if our clients were wired in the same way that we’re wired with our interests and our level of passion for this, they wouldn’t need our help. We have to bring it down a notch or two or three.

                                I like to share with my clients occasionally whatever, that I love my Doritos and my glass of wine. And I have to make sure I have my Kit-Kat or my chocolate every day; to normalize it and come down to their level, and to be able to say, “Gosh, I know this is really hard.” And maybe even reflect what other clients struggled with and how they were able to overcome it. Because I think using us as a benchmark… We’re the supposedly expert and we’ve done, hopefully, all this study and clinical practice to get where we are, but we still have to moderate that to help the clients. And maybe their baseline is this. Maybe that’s as good as it’s going to be for them, and they’re thrilled with that because it was better than where they were.   But I hear you and I’ve been in the situation too. Beautiful plan and the client doesn’t come back, or they come in and they’ve done none of it. And that’s when you’re like, “Okay, those goals were way too big and overwhelming. Let’s just start with the basics.”

Dr. Weitz:            Good. Okay. That was great. Any final thoughts you have for our viewers or listeners?

Melainie:              I hope people have gotten out of this today just that, most people are doing the best that they can, and we can definitely help them to take that next step and take it in baby steps. Those extreme diets are usually not exactly what they’re cut out to be.

Dr. Weitz:            How can people find out about your programs and getting in touch with you and your clinic and-

Melainie:              Absolutely. Check us out on our website, which is balancedtx.com. And also we have a free 20-minute complimentary discovery call, Ben, for any callers who want to call in or sign in via our website. If you feel as though maybe you’re struggling or someone you love is struggling and you want to just get a better sense, “Is this disordered eating? Is this emotional eating? Is this an eating disorder?” We can help you sort through that.

Dr. Weitz:            How about practitioners? Let’s say somebody like myself who’s not typically focused on the emotional stuff, is there a way, if I’m working with a client and I’m working with the dietary stuff, can we interface with you and your office on emotional part?

Melainie:              Absolutely. I have a team of therapists and I have a team of nutritionists, so we have the medical piece and we have the psychological piece. Our whole philosophy is, gold standard of practices working collaboratively. So we would love to do that, Ben.

Dr. Weitz:            So as a practitioner, how would I approach that with sending one of my clients too, but making sure that I can continue to work with them on the nutrition part?

Melainie:              Oh, absolutely, that’s essential. Is if our clients come in with any kind of team member that they’ve been working with, our goal is to absolutely insist that they continue to see you because you know them the best. We want to hear from you what you’ve seen and observed so we can then set up the best care package for them with your collaboration and theirs. And then-

Dr. Weitz:            So as a practitioner, would I call or-

Melainie:              Absolutely. Just give us a call.

Dr. Weitz:            Okay. Awesome. Thank you, Melanie.

Melainie:              Thank you so much, Ben.

Dr. Weitz:            Melianie

Melainie:              That’s okay. It’s all good. Thanks, Ben. What a pleasure.

Dr. Weitz:            It was a pleasure for me as well. Thank you.




Fasting with Dr. Daniel Pompa: Rational Wellness Podcast 161

Dr. Daniel Pompa discusses fasting with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

2:37  Some of the smartest doctors in the Functional Medicine field just happen to be chiropractors.  The reason is because we share a major premise that the body has innate intelligence that heals itself if we just remove the interference for this. 

3:13  Dr. Pompa became interested in fasting in the 90s from his involvement with a vegetarian group that was inspired by some books by Herbert Shelton on fasting and he went to some of the seminars. At that time, fasting was not very popular.

4:15  Intermittent daily fasting is where you don’t eat for a period of time that could be 12 or 15 hours or even 24 hours.  Extended fasts are where you go without food for between 2 and 5 days. And there are certain conditions that will benefit from an even longer fast.  Dr. Alan Goldhamer, who I interviewed on episode 116, has patients do a 30 day medically supervised fast.  30 Day Fasting with Dr. Alan Goldhamer: Rational Wellness Podcast 116   

5:36  Dr. Pompa discussed a patient that he fasted years ago for a grapefruit sized tumor for about 26 days. It took that long to reduce the tumor to the size of a golf ball. She was detoxing and her tongue went from coated white to green to black and fuzzy her family had to cross ventilate their house since she smelled so bad.  When you do a 5 day fast, the magic happens after 3 days when you have lost your hunger and you get your energy back. Day four we hit max autophagy, which is when your body eats broken down and damaged cells, organelles, and even DNA and recycles these proteins and nucleic acids. So then you continue the fast one more day for 5 days to really take advantage of this autophagy and then you see a massive rise in stem cells to rebuild and massive rise in growth hormone as well. The benefits of a fast tend to decrease after 5 days, so multiple 5 day fasts is the way to go in order to maximize autophagy and allow the body to heal itself.

9:22  Dr. Pompa prefers to do water only fasts, but he often starts clients with a partial fast, such as using the five day partial fast developed by Dr. Valter Longo, which makes it easy. You just eat what’s in this box, nothing else, for 5 days. You can design such a program yourself and Dr. Pompa in his Beyond Fasting book explains how you can design a partial fast around the foods that you like.

11:12  With a partial fast you get a lot of the benefits of a full fast. You still get autophagy and stem cell production.  It is helpful to work up to a complete water fast by starting with a partial fast that contains between 500 and 1,000 calories, depending upon the person.  But such a fast does need to get the protein levels down to below 15-20 grams per day, depending upon the size of the person.  Many of the studies that look water only fasts do not see as many results as Dr. Pompa’s patients get because they prepare and train for the fast so that their body is fat adapted and ready for the fast, much as you would train to be able to run a marathon. He lays out a seven week program in his book, Beyond Fasting, for how to prepare to do a 5 day water only fast. With a water only fast you get energy divergent where your body uses it’s energy that does not need to help digesting food and this energy can be used to help the body to heal, whether it’s a knee or the kidneys.

14:18   Fasting can actually stimulate the immune system and that could be very helpful during this coronavirus pandemic. Back in the 90s fasting was considered to be harmful to immunity because during a fast you might see a drop in white blood cells, but this is actually part of autophagy and it is getting rid of old white blood cells which we call senescent cells that drive inflammation. Then, a month or so after the fast you will see an increase in the immune system to preventative levels.  With fasting we also see an improvement with patients with autoimmunity.

16:48  To prepare for a 5 day water fast, it is advantageous do a ketogenic diet to get your body to become fat adapted. If your body is fat adapted, you may start having autophagy on day one of your water fast instead of on day three.

18:12  The key to weight loss is to eat less often rather than eating less, according to Dr. Pompa.  If you eat too few calories for too long, your metabolism will slow down and your body thinks it is starving and it will hold onto fat but break down your muscle and turn it into sugar for fuel. Dr. Pompa noted that he eats only two meals per day in a 4-5 hour window and one of these meals he eats until he is a bit beyond full, which signals the body that you are not starving and you can burn fat for fuel.

22:32  For many years it was believed that the key to losing weight and being healthy was to eat breakfast and to have small, frequent meals throughout the day to keep an even blood sugar, so that you didn’t eat too large a dinner.  But by doing this, you never give your body a chance to burn its own fat because you are always feeding it.  And it’s a bit ironic that now one of the keys to losing weight and being healthy is to skip breakfast so that you are doing an intermittent fast. Dr. Pompa pointed out that because of the Dawn Effect, where you get a rise in blood sugar from the morning rise in cortisol, it is easy to have energy in the morning without eating anything. Hunter-gatherers in Africa usually just eat one meal per day. The men are up early and spend all day tracking down and hunting prey and they don’t eat until evening when they come back to the tribe in the evening and they would eat together.  And these hunter-gatherers were lean, ripped, and healthy.

25:48  On the other hand, Dr. Pompa said that if it works better for your schedule to skip dinner rather than breakfast, then that works as well. The key is giving your body time to go through autophagy by not eating for a period of time and it doesn’t really matter what meal you skip. 

26:33  When people follow a ketogenic diet for too long, the body will think it’s starving and will hold onto fat. We have to have periods of feasting as well as periods of fasting. And we should change our diet based on the seasons and environmental changes.

27:43  To measure cellular aging vs biological aging we can use telomere testing.  Telomere testing measures the length of our chromosomes and we now have DNA methylation testing. Looking at your telomere length is like looking at the tread you have left on your tires. To promote better cellular aging it is best not to do low carb or keto for too long.  It’s best not to do too much fasting since stimulating autophagy long term is not good. It’s also not best to do vegetarian all the time or to eat a bodybuilding high protein diet. For short periods, a high protein diet can be healing, but for long term, high protein will age you by stimulating the mTOR pathway. It’s best to alternate periods of fasting with feasting, moving in out of low carbs and higher carbs. The magic is in the change.

30:12  While a ketogenic diet has less fiber and stresses the microbiome, this will actually help to increase bacterial diversity once you come off the ketogenic diet.  By stressing your microbiome, you stimulate change and improvement, much like exercise stresses your system to make you stronger.

34:46  When you follow a ketogenic diet initially you start to burn fat for energy, so you produce ketones and during the first week or so you spill a lot of ketones into the urine and these can be measured with ketostix. But once your body gets used to using ketones for energy, when you become fat adapted, you will no longer spill a lot of ketones into the urine, so you need to measure ketones in blood instead of in urine.


Dr. Daniel Pompa is a global health leader and innovator on a mission to educate practitioners and the public on the origins of inflammation-driven diseases, cellular detoxification, fasting strategies, and diet variation principles.  Dr. Pompa is the host of Cellular Healing TV, and the author of the books Beyond Fasting and The Cellular Healing Diet. His website is DrPompa.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz host of The Rational Wellness Podcast, I talk to the leading health and nutrition experts and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to The Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello, Rational Wellness Podcasters. For those of you who enjoy listening to The Rational Wellness Podcast, please give us a ratings and a review on Apple podcasts. If you’d like to see a video version, please go to my YouTube page. And if you go to my website drweitz.com, you can find detailed show notes and a complete transcript.

                                Today our topic is fasting with Dr. Daniel Pompa. Fasting is one of the oldest healing strategies in natural medicine. And it’s been advocated for thousands of years by alternative health care practitioners and utilized by almost every religion today that’s around. For years the medical community has essentially dismissed fasting as having no randomized double blind clinical trials, proving that fasting has significant benefits for reducing or curing diseases. But the studies have been accumulating especially on intermittent fasting. And Dr. Valter Longo of USC has been publishing a number of scientific articles and a book that have really been placing the spotlight onto fasting, highlighting some of the anti-aging benefits with his fasting mimicking diet program that involves eating a low calorie diet while eating only food products contained in his ProLon kit. That includes a low protein vegetarian nutrition plan.  Dr. Daniel Pompa is a global leader, and an innovator on a mission to educate practitioners in the public on the origins of inflammation driven diseases, cellular detoxification, fasting strategies, and diet variation principles. Dr. Pompa is the host of Cellular Healing TV, and the author of the books Beyond Fasting, which is going to be the focus of our talk today, and The Cellular Healing Diet. Dr. Pompa, thank you so much for joining me today.

Dr. Pompa:         Yeah, thank you for having me. I love these topics.

Dr. Weitz:            I just think it’s so interesting that I’m a chiropractor. You’re originally a chiropractor So many of the smartest people in the functional medicine world are chiropractors for whatever reason.

Dr. Pompa:         There’s a reason it’s because we share a major premise of the fact that the body has innate intelligence that heals itself and all we can do is remove interference and it does, right? And so fasting is one of those things that harnesses that innate intelligence and allows the body to heal itself, and that’s the magic. That’s why we all unite around that philosophy, honestly.

Dr. Weitz:            How did you get so interested in fasting?

Dr. Pompa:         It was back in the ’90s. I joke because I say it was just me and some natural hygiene society guys that were into fasting. That was a vegan vegetarian group, but they were all really big into fasting and there’s a guy named Herbert Shelton that read a lot of books on fasting and so I would go to the seminars. I was intrigued by fasting because again, it’s the philosophy of the innate intelligence, right? It’s like the body heals itself.   Yeah, I got very sick, so it was something I had to apply to myself but fasting does, it harnesses that innate intelligence and my fascination with it came out of that.  Back then it was very few people are into it.  And now it’s popular, I just had to stick around for 20 more years.

Dr. Weitz:            These trends in natural health world. So what is the definition of fasting? And then what is intermittent fasting? Because those are two terms you hear a lot, and I think there’s some confusion over exactly what fasting includes.

Dr. Pompa:         Yeah. So intermittent fasting daily is where you just don’t eat for a period of time, maybe it’s 12 hours, 15 hours, 24 hours, right? That’s an intermittent fast and you can do it daily. Now, extended fasts are when you take and you go without food beyond that, maybe it’s two days, maybe it’s three. I prefer and always have five-day fasts. And I believe there’s a magic number in that five days. But with that said, there are certain conditions that you will benefit fasting longer.  But there’s also a time to stop fasting and we talk about all those things but extended fasts has different benefits. Some of the same benefits is intermittent fasting daily, where you just do that 15 hours, 18 hours, whatever it is. So some of the same benefits you pick up even at a short fast like that, but certain conditions, certain health aspects, extending it longer is critical.

Dr. Weitz:            Yeah. I interviewed about a year ago Dr. Alan Goldhamer and he-

Dr. Pompa:         Yeah.

Dr. Weitz:            … puts people in 30 days medically supervised fasts.

Dr. Pompa:         Yeah, and there’s a time for that. Back in the day, I took some people through some really long fasts and they definitely have to have more body stores just to put it nicely. Certain tumors, a bit longer fasts. I fasted a woman, it was probably about 26 days, she had a grapefruit sized tumor and man it took that many days to bring it down to it was about a golf ball. And then she fasted like another week after three months and then she got rid of it completely.  But in that time, her first week was horrible. She was detoxing, her tongue went from coated white to coated green to black and fuzzy and her family literally had to cross ventilate the house. They had a fan on one side and they would open the windows and blow it through because she stunk up the whole house, right?

Dr. Weitz:            Wow!

Dr. Pompa:         In the first week, she came in complaining to the clinic everyday. Oh, my gosh. Right? And then after that she came bounding in every day with her reports of healing. So I’ve watched fasting really deep, deal with some incredible things and I’ve watched incredible things happen with the fast. But I learned through that process is shorter, five-day fast. You can achieve the same thing with a lot less pain, multiple five-day fasts. And why five days? Because look, it takes about three days for people to go, “Okay, I can do this. I actually lost my hunger. I actually have energy back.” So I would always carry them at least one more day, right? But again, three days is suffering. So day four was like, “Okay, it’s a good day.” So why not carry an extra day, day five, when they finally feel good to get that healing. Look, I didn’t know a lot of the science back then because there wasn’t any frankly on some of this.

                                Now, we know that some magic happens day four, we hit max autophagy. What autophagy is, is this happens during fast, the body to get energy eats. It’s so intelligent. Here’s that inborn intelligence thing right, that heals the body. It’s so smart, it wants to survive. It will eat only the bad cells of the body. It’s that smart to even know, here’s bad DNA, here’s a bad cell. It’ll take those out and not harm the good cells. So autophagy is the body getting rid of these bad cells and other debris and rubbish that it needs to get rid of. It’ll eat that first. That’s autophagy. So when I use that word autophagy, so think of auto automatic. Phagy as eating, so automatically eating the bad.  So what happens is, is during that this fast, day four we have max autophagy, meaning that all of a sudden the body’s just crushing bad cells, why would you cut it off then? And then day five, we see what we call max stem cell production. Because every time the body gets rid of a bad cell, it doesn’t just go, “Oh, you’re going to have to live without that white blood cell.” No, it stimulates and produces a new white blood cell via of the stem cell production. So about day five, we see this massive rise in stem cells.  And then after that, there’s a plateau effect. So if we do multiple five-day fasts, we maximize the autophagy, we maximize the stem cell production and we also maximize the hormones. We have this massive growth hormone rise that takes place day five. So multiple five-day fasts is how you can shut off autoimmune-

Dr. Weitz:           And a fast for you is water only right?

Dr. Pompa:         Yeah. I do prefer water only.  So you mentioned Valter Longo, right?  I love Valter and his group.  Pleasure to work with them.  I thank God for some of his studies because he really brought what we learned clinically years ago five-day fast is he’s the one that really spearheaded that max autophagy, max stem cell and some others have done that work too.  But so he’s brought a lot to this.  One of his studies was taking five months and this was an animal study, a rat study. Type 1 diabetic rats and fasting them. And really watching the beta cells regenerate because of the stem cell rise that takes place and after month four and five, we would see this the beta cells coming back and they were able to reverse the condition. So more and more studies, very exciting have been done, so I thank Valter for that.  But Valter and I definitely disagree in that I think that again, I train doctors on these topics. And clinically, I can tell you the most powerful still is a water fast.  Now, I still utilize partial fasting and I have for years.  So Valter’s fast where he boxed the foods for five days.  I’m a big fan.  I think it’s easy.  I think it’s a great partial fast, and I’ll explain what that really is because there’s a definition of partial fast.  I’ve used it for many, many years.  And oftentimes the first fast I’ll do with someone is in fact, a partial fast, and then move them to water fasting, which is a little more aggressive in getting rid of bad cells.  So I’m a fan of pure water fast.  But yet, I’m still a fan of partial fasting. Okay, so…

Dr. Weitz:            So partial fast, you’re not getting the same benefits as a full fast.

Dr. Pompa:         Yeah. You’re still getting a lot of benefits, you still get autophagy, you still get stem cell production. We have a way of measuring autophagy, and I talk about that in my book that doing your fast you can measure this in a very simple way. But we don’t see as much autophagy in a partial fast as a water fast.  And Valter really loves the partial fast. I have a lot of respect for him. But again, clinically, I just see, in a lot of the studies, they just put the average person into a water fast. It’s a mistake, you’re going to not see these major benefits. In my book. I have a seven week program. This is what you do five weeks up to the fast. Week six is the fast, week seven is breaking the fast. So it takes you through that whole process.  You don’t just run a marathon, you train for a marathon. So number one, you can finish it. And number two, you get the best result, right? So you don’t just do a fast. My book takes you through how to train for it. So a lot of the studies that just do look at water fasting or taking someone who’s not fat adapted, they’re not able to fast very well. So they’re not getting these benefits that I’m talking about right out of the gate.  So anyways, the bottom line is Valter has made the partial fast very popular, and he even boxed the foods that follow the rules of a partial fast. So what is a partial fast? If you have to get your calories, depending on body size down somewhere between 500 calories a day to 1000. Figure people can do a little more calories. Protein is important. You have to get your protein at least under 20 grams a day. The reason is, is if you have too much protein, it will knock you out of that autophagy. You won’t get any autophagy, so you have to get the protein down.

                                So a smaller person, you might need less protein, even under 15 grams of protein a day. So Valter put those in five boxes. So you have what it is you’re eating. In my book I give a partial fast, you can design it yourself around the foods you like, right? So I talk about that. But yeah, so partial fasting you still get the benefits, you still autophagy, you still get stem cell production. Water fasting, you get something a mass of what I call energy divergent, where your body has so much energy not eating any food, it has so much extra energy that it takes that extra energy and it just doesn’t sit on it and have a vacation. It takes it and all of a sudden the stuff that it wanted to heal, but it couldn’t because you never gave it a break. It takes energy and it starts healing it.  So maybe it was a knee problem from 20 years ago. All of a sudden, you get this knee pain, that’s the body healing it. It will divert these extra stem cells to the knee and start healing it. Maybe it’s kidney pain. Maybe it’s this pain, whatever it is, the body will take that extra energy, utilize its stem cells, and magic happens.

Dr. Weitz:            And of course, right now we’re going and at the time of this recording, we’re going through the corona virus pandemic. And fasting is actually something that can stimulate immunity.

Dr. Pompa:         Yeah, very much because, one of the things that back in the 90s was a criticism of fasting was it lowers your immune system. Because we would do blood tests, right? And you’d see this massive drop in white blood cells. Well, that can’t be good. But clinically, we’d say, “Wow! But we see the opposite.” We see autoimmune which is mean hyper immunity, which is really bad immunity, right? Where your body’s hyper responding, creating inflammation, sick people, people don’t feel well will have autoimmune even if you don’t diagnose, your body’s attacking itself, not good.  We see a lowering of the autoimmunity. And then we see this rise, especially a month or so after a fast of the good immune system would go up. Well, now, one of the Valter studies showed this drop in white blood cells is the autophagy, meaning the body gets rid of these old white blood cells, immune cells that are living too long. We call them senescence cells. They live too long, they cause mishit, they drive inflammation. They don’t work. They’re like union workers. I just insulted somebody out there. I didn’t mean to do that. I met like the bad union workers, the guys that sit around. The PennDOT guys or what are those? Government workers. There’s the word I was looking for, not union. Sorry, union people. My father was a union guy, didn’t mean that. The government workers they get paid anyway, so they don’t want to do anything.  So anyways, there’s probably better analogies out there but insult nobody. I don’t mean that. The point is, is these white blood cells that live too long, they just hanging around causing bad stuff to happen not doing their job. So what we learned is that drop in white blood cells, the body eats those guys out. And when we get rid of those, it stimulates a stem cell and it  creates a brand new white cell that is working and doing its job. So it’s like hiring the good employee again, right? It’s like, bam, doing everything correct. And so that’s how you end up with better immunity.  So right now, with this virus, I’ve recommended people to fast. My kids, they all fasted together, they did a five day water fast, and upregulated their immune system to preventative levels.

Dr. Weitz:            Cool. So, in order to do to get ready for the fast, in your new book you talk about putting people on a ketogenic diet. So what exactly does that consist of?

Dr. Pompa:         Yeah, so chapter one is fat adaptation, becoming fat adapted will get you into this autophagy instead of taking four days to get there, you can get there day one. And in the book I talked about, again how to measure that. We look at ketone levels, glucose levels, but there’s a ratio, but we can get there day one.  So chapter one is how to get your cells using fat for energy, because that will create more autophagy faster, and ketosis is that way of doing it. And then we take each chapter takes you through another step, then we start eating less often and we start doing some of that intermittent fasting. I call it mitochondrial fitness. We stress the mitochondria without eating in periods of time. Again, we’re training it for the fast that’s going to happen. And then I take you through some of my diet variation strategies, which is a whole nother subject, chapters four and five, really, how these various strategies take you to another hormonal level to become this efficient fat burning machine. So when you go without food, your body’s just crushing bad cells. So there’s a process there.

Dr. Weitz:            So in terms of weight loss, I know in your book, you say that the key to weight loss is to eat less often rather than eating less.

Dr. Pompa:         Yeah. Look, when we look at, especially in this country. We look at weight loss, you can’t flip a television on without a morning show anyway, talking about a calorie restricted meal, right? There’s a menu of low fat low calories, right? That is the cornerstone of weight loss still in this country, even though scientifically we know it doesn’t work. Now, when we say that though, people listening will say, “Yeah, okay. I want to believe you, but I restrict my calories, I lose 10 pounds.” And I would say, “You’re right, you do. And if you’re a bigger person, you may even lose 20. Gosh darn it, it works.”  Well, long-term it doesn’t because the weight loss ends up to be more muscle. Even if it’s fat, what happens is it’ll stop at a certain point because the metabolism gets lower and lower. As you restrict calories, the body eventually says, “I’m starving.” And when it says I’m starving, now it will start to use its muscle, break it down into sugar, it’s called gluconeogenesis. And then it will hold on to fat, which is not what you want. So therefore, now you can be down to 500 calories a day that used to work for you. Now you’re at 500 calories a day. And again, remember I said that a partial fast short-term, that’s great. But long-term, it’s very destructive to your metabolism and your health in general. So long-term caloric restriction does not work.   So how when we look at … we talked a little bit about anti-aging, right? You mentioned that I should say. When we look at that, there’s only one thing that really works for anti-aging, and that’s eat less. So you just said caloric restriction doesn’t work. So when we look at countries cultures that live long, healthy, we know they eat less, but they don’t do it the American way of pushing food away eating half your meal, caloric restriction. No, they don’t do that. They eat less by eating less often. And there’s our conversation of intermittent fasting daily.

                                So I typically eat two meals in a day in a very short window four to five hours. So I’m eating less often. At the end of the day, I eat less calories than the average American my age no doubt about it. But if I did the exact same amount of calories, but pushed my meals away, I still ate four meals a day or five meals or even three and I ate half of my meal my body would go, “You’re starving,” because you’re not eating too full. Something magic happens when you eat one meal to full a day.  So I always make sure I eat at least one meal to where I’m literally, even a little bit beyond full. The body likes that because it goes, “I’m not starving and I’ll keep using your fat.” If you start stopping meals and eating partial meals, the body will go, “I’m starving, and then it will start holding on to your fat.” So eat less often and eat too full would be the rest of that conversation.



Dr. Weitz:                            We’ve been having a great discussion, but I’d like to take a minute to tell you about the sponsor for this episode. I’m thrilled that we are being sponsored for this episode of the Rational Wellness Podcast 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 patients prevent chronic diseases and feel better naturally.

                                                Integrative Therapeutics is also the founding sponsor of Tap Integrated, a dynamic resource of practitioners to learn with and from leading experts and fellow clinicians. I am a subscriber and if you include the discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99, instead of $149 for the year. And now, back to our discussion.



Dr. Weitz:              I think it’s so ironic that I’ve been doing this for over 30 years. And when we started, the big key to helping people lose weight was the fact that people rushed out of the house with eating breakfast, and then they would eat too much for dinner. And so for years, the mantra was, you have to eat breakfast. You have to eat within an hour of waking up. You got to have small frequent meals throughout the day.  And it’s just so ironic that now … so before then the key to being healthy was having breakfast, having small meals spaced throughout the day so you can keep an even blood sugar. And now the key is skipping breakfast.

Dr. Pompa:            You know it’s funny as I some years ago, I think it was 2005 was the first time I had the opportunity to go visit this hunting gathering tribe in Africa. And I was still a four or five meal a day person, like you’re saying, right? That philosophy, and I saw something completely different. I saw a tribe, I said, “Where are the men?” They were up and gone at like 4:30 in the morning when it was still cool off in their hunts, tracking down pray, and they’d be gone all day to three or four in the afternoon. “So how do they eat? What do they do?” “They don’t eat at all.” They’re out all day tracking down pray. So oftentimes jogging, running, right? It’s like, “And they do without food?” “Yeah.” And then I noticed the women never eat, even the ones that were gathering. They weren’t eating because they would wait and eat one meal together as a tribe. Now that meal may have lasted three hours, right? They’d start eating and start preparing but, a very European way of eating.  And I was fascinated by it because these people were lean, ripped. Amazing, right? Without disease, it was a pretty amazing experience. It made me question that, like, what are we doing? It’s like, because every time you’re eating, you’re basically not allowing your body to burn its own fat. But like caloric restriction, it works in the beginning. Because if you’re eating five meals a day, your body’s not eating its muscle, it will prevent that. So it maintains the metabolism that way, and people feel that but the problem is, we never give it a chance to burn it’s stored fat, that’s what our bodies are designed to do.

                                So long-term, you want to live long, healthy, eat less, but eat less by eating less often, and that’s what we see very healthy in the Hadza people did this. So were basically short cutting something that works short-term, not long-term. And that was the five meal a day thing. And by the way, eating breakfast in the morning, that’s the most natural meal to skip. And the reason why is because you get something called the dawn effect. In the morning, oftentimes you’re not hungry because your body releases glucose. If you test your glucose, the highest glucose you have all day long in the morning, because your cortisol rises to get you up. That’s what gets you up in the morning. Glucose falls cortisol. So that just means your glucose goes up. And that gives you your energy for several hours after you get up, right? So that’s why you’re not hungry because your glucose is high because of your cortisol level. So that dawn effect of glucose we’re meant to run on, and then again, you can run on that for pretty long time.

Dr. Weitz:            Yeah. I know for me, for some reason, I do better if I have a good breakfast. And if I’m going to skip a meal, I’ll skip dinner.

Dr. Pompa:         I was going to say this. So people always asked me, “Well, which meal should I skip if I’m going to eat two meals?” I said, “Whichever one works best for you and your schedule.” In other words, if eating dinner is important to your family you can’t skip, then eat dinner. Skip breakfast. If for you it’s the other way around, right? And some people for diabetics, I’ll have them skip dinner and eat the breakfast and skip dinner. So it’s whatever works. The key is, is just opening up that time giving your body time to go through autophagy, and giving it time to fast. It doesn’t matter what meal you skip, really.

Dr. Weitz:            When people follow a ketogenic diet or try to follow a ketogenic diet, what are some of the biggest mistakes they make? Why are they not successful? Can’t produce enough ketones? What are some of the mistakes that people make?

Dr. Pompa:         One big mistake is, first of all, I’m not a believer that there’s one diet, you should stay on your whole life, right? That tribe that I spent time with, they were constantly changing their diet based on what foods they have, environmental changes. So in my book, I talk about seasonal variation, how important that is, and weekly and monthly variation. And if you’re low carb too long, the body will think it’s starving, and we need times of feast and we need time to famine. And that balance is emulating these really healthy cultures. So it’s really key for hormone optimization. And that’s really how we age slowly, right? So, I’ve been able to measure my cellular age every way possible. And I spent some time sick some years ago, and my cellular age was much older than my actual age. Now-

Dr. Weitz:            What method for measuring cellular aging have you found to be the most effective or accurate?

Dr. Pompa:         Well, telomere testing has gotten better.

Dr. Weitz:            Right.

Dr. Pompa:         That measures … It’s the biological clock that, protects our DNA and the shorter they get the closer you are to death, simply put. It’s gotten better and better and more accurate, but now that we have DNA methylation testing.

Dr. Weitz:            Right.

Dr. Pompa:         If the given analogy, looking at your telomere length is looking at the tread you have left on your tires. DNA methylation is looking at the parts of the engine, how well are your organs aging, compared to your … Look, I’m a mid 50s, I’ll be 55 this year. I’m getting younger every year at the cellular level compared to my actual age. And I was the opposite. And again, everything I’m saying right now is what I do and how I’ve done it, amongst other things. But you will age according to your cellular health. Honestly, on the outside is what I’m saying.  Right anyways, so diet variation strategies is a anti-aging strategy as well. Shifting your diet is critical. So the answer to your question is one of the biggest mistakes for people is they try to stay in ketosis all the time or low carb, big mistake. And again I’ll throw criticism both ways. Staying vegetarian all the time big mistake. Staying keto, paleo all the time, big mistake. If you want to die sooner, eat a bodybuilding diet high protein diet will age you sooner, right? But eating high protein for short periods is very healing, right? So it stimulates a pathway called mTOR, mTOR long-term is bad for you. Low mTOR stimulation short-term very good for you, that means high protein or high calories that stimulates mTOR.

                                So too much fasting is not good that stimulates the autophagy pathway long-term is not good. So variation, you need autophagy to get rid of bad cells, you need mTOR to stimulate production of new cells. So feast famine, I talked about in my book and how to do feast famine. So when people do ketosis, the big mistake is just staying in ketosis. Big mistake, you need feast, you need famine, you need moving in and out of high healthy carbs, low carbs. The magic is in the change.

Dr. Weitz:            Cool. You also talk about how ketones when you’re following a ketogenic diet helps to heal the gut and helps to diversify the microbiome. But one of the traditional criticisms of the ketogenic diet is that there’s not enough fiber which typically comes from starchy vegetables, beans, grains, seeds, and so that a ketogenic diet tends to starve the microbiome.

Dr. Pompa:         Great question. Let’s make it even more extreme. First of all, with the improved testing on being able to measure the microbiome or like the types of bacteria, the amount of bacteria in our gut, right, we call that the microbiome. That’s not just bacteria, but viruses, funguses, right? It’s all of these pathogens and everything that’s included in our gut.

Dr. Weitz:            Right.

Dr. Pompa:         Okay, so we have better testing to measure. The one thing that we can take away from all of this testing really isn’t what we thought in the beginning we would get, we thought, we’re going to be able to be able to, “Oh, there’s these bad guys, you have this too many bad guys, you have too many this.” It really didn’t turn out like that, it turned out to be diversity. If we look at very healthy people, their microbiome on a test versus unhealthy people, the one thing that stands out is not what type of bacteria, it’s the diversity of the bacteria. The more diversity, the healthier the person.  So the question should be then how do we increase the diversity? Stress the microbiome, honestly, just like how do I get more fit and healthy? Exercise, what’s good exercise? You have to stress your body, right. If you stress it too much, you won’t recover. Not good, right?  And the more the better shape you are, the more you can stress.  So fasting is a stress. When you change your diet, it’s a stress to your microbiome.  So my point is going to be this.  Take a carnivore diet, that’s an extreme diet of eating only meat and fats. Zero fat, okay. It’s caught on out there, right? People are showing their pre blood and post blood tests, you would think eating only meat and fat? Oh, my gosh, their cholesterol must go up. Obviously, it’s the opposite. Their blood test transforms.

                                Now, the challenge that I propose is stay on that diet.  Maybe genetics carry you a year, maybe two. But now all of a sudden, you’re going to see massive changes the other way.  Now, let’s pick on the other side, you have the vegans, right?  So I got on the diet.  I felt great.  Stay on that diet, we’re going to start to develop certain deficiencies. The point is, I love being vegan or vegetarian for a period of time, I love being on a carnivore diet for a period of time. So to answer the question how you increase the diversity of your gut, do those extremes.  So going without fiber for a month on a carnivore diet, it stresses those bacteria, oh, they don’t die, they back up, they get stronger, they get resistant, and then you start eating again. And they’re just they take off and they get four. So we know that the change of diet, the more you change your diet, like the Hadza people, the more diversity you have in your microbiome.  So it’s magic.  It really is.

Dr. Weitz:            Now it’s tricky to change your diet. I know over the years, when if I change from eating more animal protein to suddenly eating more fiber, initially, you start getting GI upset and your enzyme system isn’t ready for that change. So …

Dr. Pompa:         Yeah. To your point, and you know what’s happening because here’s what, your body has to change its microbiome to make the enzymes that it needs to start breaking down. Eventually, it adapts. So the advice is just take it slow. Take it slow. If you just drastically change, your body will catch up, but you’re going to have to deal with symptoms. All right, so if you just go slower, then maybe when you first start eating more meat, you’d have to take some HCL, digestive enzymes, HCl or bile, the body will change its microbial and start producing more bile, it will start producing more HCl. It’s that smart.  It is, but it takes some time.  So your question or your comment really gives an explanation for why the diversity increases because it has to survive.

Dr. Weitz:            Right. So when patients try to follow a ketogenic diet, a lot of people will recommend that they use these urine Ketostix. And that’s a way to measure if you’re excreting ketones in the urine, but some people use those through their whole ketogenic program and that’s not really appropriate, right?  Why is that?

Dr. Pompa:         Yeah. Ben, you’re well read. Yeah, you’re right. And I’ve had good doctors say, “Well, my diet gets you in ketosis in two days.” I’m like, “Really? How are you measuring that?” “Urine.” Okay. You eat more fat in the diet, you’ll start producing more ketones. You’ll see them in the urine. So what happens is ketones, let’s back up. What are ketones? I don’t know how educated you’re listening audience is. But ketosis means that where your cells can use two things for energy, sugar or fat. So when we become fat adapted or going into a ketosis diet, we’re shifting the cells energy to where 95, 98% of the energy is from fat, not sugar, right? So we reduced our carbs down to so low that it has to eventually to survive use fat. When it burns fat, it makes something called ketones because your brain can’t use fat as energy. It can only use sugar or ketones. So when we drop sugar down, it burns the fat. The body uses the fat as energy, and then it makes ketones and your brain uses the ketones.  Okay, so just a little bit of chemistry there. So ketones have a major healing effect on the body for your brain. We know that keto diets would take people out of seizures, neurodegenerative conditions, alters people’s brains wake up. Hugely healing for the brain and the gut. That was one of your questions earlier.   We also know studies the ketones help heal the gut. Again, staying on the diet can create problems, down the road, but by shifting people over into this fat about the diet and making ketones, it’s magic. So the first week or so we see this urine rise up if ketones, and then we see it go away. Well, where did they go? Because now the body’s actually using the ketones and you don’t see them in the urine anymore. So it takes about two weeks for someone to fat adapt to become keto adapted. And one of the telltale signs is you don’t have ketones in your urine as much anymore. So means your body’s finally using. So we can’t use urine as a good measurement. You have to use a little blood.

Dr. Weitz:            Right. So let’s see. How long do you recommend people follow this ketogenic diet?

Dr. Pompa:         Again, it’s different for everybody, and it’s interesting, because one of the things that some of your viewers may be saying is, “I tried it, didn’t work for me.” And, well, that’s just that it works for everybody because the body is meant to go in these ketosis states. But when you’re really stuck in is a sugar burner, you meaning your cells can only use sugar, it’s oftentimes hard to break out of that. It’s very dangerous just to be in that zone, it can lead to cancer and other problems. But what we’ll do clinically, is we’ll take somebody and put them in a keto diet for like, two, three months. They’re hardly getting in whether you’re measuring your blood ketones, and you have to be above 0.5 to say, “I’m in ketosis, right?” And their 0.5, 0.6, 0.3, 0.2, they’re in they’re out, they’re barely in. What’s going on?  We’ll pull them out of a ketone diet after two months, put them on a healthy higher carb diet. Two months later, we put them back into a keto diet. And by the way, when they’re on keto, they’re not feeling good yet, right? They’re just not using the ketones, their brain’s not using them, they don’t feel good. We move them back to a higher healthy carb diet. Now they feel good because they’re using more sugar again. So then, two months later, now we put them back into ketosis. Now their ketone numbers go higher 0.8, 1.2, 0.3. I still feel great, but better, and then we’ll move them out again.  So we’ll do that a few times. And then each time they get more fat adapted, each time they get more grit. So we actually use that variation strategy to help people break through into this phase that everybody should be able to get into. So answer your question, sometimes two months, sometimes three months, sometimes six months, and but I always move them in and out of the state.

Dr. Weitz:            Are there some people based on their genetics and their lab values that maybe shouldn’t do a ketogenic diet? For example, maybe patients who have APOE-e4 variation?

Dr. Pompa:         Yeah. Look at our bodies, everybody can benefit from it. Why? Because it’s survival mechanism. It’s a survival mode. And during survival modes, the body turns off bad genes that have been turned on. it’s called epigenetics. It resets the microbiome, right? You get rid of bad cells, because bad cells don’t adapt to the stress of ketosis. So I believe that it’s a stressor that everybody can benefit. Fasting is the same way, meaning we’re genetically programmed to fast. The problem is today is we’re always in a feast mode, whatever diet you’re on. We always have access to food, it’s not healthy. We’re meant to go through these resets and fasting gives us that reset. Ketosis gives us a reset.

Dr. Weitz:            Right? But what about, let’s say somebody goes on a ketogenic diet, and then you say, do lab testing and you find out that there’s small, dense LDL is shooting up?

Dr. Pompa:         Interesting. So when I am in a state of ketosis, my particle numbers of cholesterol rise up, which I always educate people that total cholesterol doesn’t matter.

Dr. Weitz:            Right.

Dr. Pompa:         Typically, with total cholesterol, you’ll see that drop and triglycerides will drop typically in ketosis, right? But total cholesterol doesn’t matter but the particle numbers and the size do in fact, matter. It sounds like you know that. When I’m in ketosis, I’m in about a 20% group that actually sees a rise in my particles. And yet, all of my inflammation numbers drop dramatically. So I struggled with that for a while, what’s going on? And I found out that there’s 20% of people that that happens. And there’s theories around why that happens. But one of the things is they learned that it’s not a dangerous state, the body’s raising up the particles to carry more cholesterol, and it’s doing … it’s an adaptation mechanism. But the fact is, as my CRP drops, all of my inflammation numbers that we possibly measure drop down, showing that it’s really not an inflamed state, and I’ve done that with some others like myself, who get that phenomena opposite.   So the point is, is when most people go into ketosis, we see a drop in particles. That’s most people, 80% of the people.

Dr. Weitz:            Right.

Dr. Pompa:         But again, I would argue if you stay in that state too long, you could see a shift again, right? So we’re all genetically different. I think that’s the point you’re making. But one thing is, is that we all need variation. I don’t care what diet is best for you. All we need is variation. Now, how long you can stay vegetarian successful without creating certain deficiencies, genetics will determine that. How long you can stay in a carnivore or keto diet without creating problems, genetics will determine that, but we all need change.

Dr. Weitz:            Can you do ketogenic diet and be vegetarian?

Dr. Pompa:         Yeah. No, you can because the key to it is low carb. So and when we look at ketosis, the average with the way to get into ketosis is get your carbohydrates down below 50 grams a day. Now that’s net carbs. What that means is you minus the fiber, so think of it this way, and a cup of blueberries. Let’s say it has 15 grams of carbs and seven of them are from fiber, you minus the seven and you’re left with eight net carbs. So vegetables typically, some of them can have high carbs, but when you minus the fiber, you’re at a much lower net. So it’s very easy to lower your carbs below 50 on even a vegetarian keto. I put people in a vegetarian keto for different reasons. And sometimes I put people on high fat, with a higher meat, so there’s a lot of different ways to do ketosis. You can do ketosis on any diet really, except high carbohydrates.

Dr. Weitz:            Do you lose muscle when you fast?

Dr. Pompa:         No, here’s the funny thing, right? So I told the story in my book. My son, Isaac was like, “I want to put on muscle. Why would I fast?” I said, because you need to get rid of the bad muscle that’s not adapting anymore. That’s why you’re not getting gains in the gym anymore.” And so I gave him a challenge. So he fasted and he lost about eight pounds. Very typical, I would say, I told him you’d probably lose 10. Anyways, and, “Oh my gosh, I’m losing.” I said, you only lost bad muscle, the body’s too smart for that. Now watch what happens the next month. So the bet was that he would put on not only that weight, but he would for the next few months, he would actually gain weight and he did. Because the body, it really gets rid of the muscle cells that aren’t adapting causing problems, inflammation.  You remember, you don’t make gains in the gym. You make gains when you’re recovering. So by getting rid of bad cells via autophagy, the body will recover faster. Arguably his microbiome got better, his assimilation got better. But we even use fasting for people who can’t gain weight and they end up putting on muscle after a fast so typically a month after you’ve gained your your weight back and then some muscle.

Dr. Weitz:            So it’s really about stimulating the body, stressing it and then having the body adapt in a positive way, which is as you mentioned, what happens with exercise.

Dr. Pompa:         That’s right. Yeah, exactly right. Everything is about adaptation. So the key to the stress of fasting is creating a hormone optimization. Because of forcing the adaptation, how does the body adapt? It does it via hormone optimization. So when we look at that day five of a fast, I said, we see this maximum growth hormone rise. Even after one day of fasting, the body raises up the growth hormone and you know why? It’s holding on to its muscle. It knows I need it to fight or flight. It knows it needs the muscle, so it raises a growth hormone, and it stops the loss of muscle, and it only allows the loss of bad tissue.

                                And even your cells become more sensitive to hormones, which carries on after the fast. So I talk about in the book, how to hormone optimize using these strategies, even when you change your diet. Let me give me a great example with exercise because I think all of your listeners can understand this. If you start exercising, you always get a benefit. I don’t care what type of exercise you feel better, whatever benefit is, you feel better, you get a benefit when you start exercising. However, if you still do the same thing over and over again in the gym, it plateaus. Oh, and then now there’s a plateau, you actually start losing things and you’re like, “What’s going on?” Hire a good trainer and he goes, “Oh, you just have to change your workout,” and you start getting benefits again. Why? And then a good trainer changes your even every routine, he changes things, right?

                                So because the moment you change, the body has to readapt and then it does it by hormone optimization. So every time you force your body to adapt that it does you get stronger, you get better. Same with diet. So you start the new diet, whether it’s vegan vegetarian, carnivore, whatever it is, I feel so much better. And then not maybe like this first few days, you know how it is your body shifts around but eventually you feel better. So you become a firm card carrying paleo diet person, right? That says me because it helped me I’m a vegan, and I always will be because it helped me.

                                Now here we are a year later. “Yeah, I’m fatigued.” It’s not the diet because this diet helped me, right. But then someone comes along, convinces you to change your diet. It’s like, “Oh, my gosh, I feel so much better.” Don’t be a card carrier, the magic is the change like exercise, just keep changing the diet, keep changing exercise force the body to adapt, and your microbiome will change. You’ll turn off bad genes. I hormone optimize. All of that happens when you change your diet, just like exercise.

Dr. Weitz:            That’s great. Dr. Pompa, any final words for our audience?

Dr. Pompa:         Well look, at this time, as we said, I would argue all of it starts with mindset, right? It’s like, during this time of this Coronavirus, I’ve told my family, the doctors that I train, this is an opportunity to change our lives for the better. Or you could focus on the fear and your life will get worse. It will, you’ll get more sick, you’ll gain weight, you’ll feel worse, you’ll make less money, all these bad things.  My heart breaks for people who aren’t able to work, but out of these times is a soil ripe for change. You will come out of this stress just like fasting, making less money, being trapped at home, you will come out better, but you have to choose it. You have to think about it now, set the intention that this is an amazing time. Thank God for this time, out of it will come creativity, a job change you needed. You’ll look back if you create these intentions and say, “That was one of the greatest times in my life.”    So even though the adversity is hard now for us, and I believe that they are not minimizing your stress, but you have to change the intention to opportunity in what you can change. And believe me, fasting is another way of changing those intentions and creating new ones, because it just adds that stress. So I challenge you to fast and I challenge you to change your mindset.

Dr. Weitz:            That’s great. And how can our listeners and viewers get ahold of you and find out about your books and programs?

Dr. Pompa:         Yeah. The link is … if you go to it right now, that’s a first book. We really haven’t even have the hardcopy yet. So there’s still one more editing that goes back so you all are getting a special prelaunch right there. So if you go to beyondfastingbook.com you can get that prelaunch, beyondfastingbook.com and you can check it out. And then you can go just to my website drpompa.com. So Dr like doctor. D-R and then P-O-M-P-A.com. So there you go.

Dr. Weitz:            Awesome. Thank you Dr. Pompa.

Dr. Pompa:         Yeah, you’re welcome. Thank you for having me.




Cancer, Incorporated with Dr. Ralph Moss: Rational Wellness Podcast 160

Dr. Ralph Moss talks about Cancer, Incorporated, his latest book, with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

3:45  Dr. Moss shares some thoughts about the current coronavirus pandemic, including that if every particle of coronavirus were visible with a light, we’d be amazed how widespread it is. He likes the medicinal mushrooms, including shitake, maitake, and reishi, for immune system support.  Dr. Moss is intrigued by the concept of Superinfection Therapy, which has been used in the treatment of hepatitis B and C and for the seasonal flu and the concept is that one infection stimulates the immune system that knocks out another infection, such as with a poultry virus that does not cause any disease in humans.

12:29  Dr. Moss discussed the use of the BCG vaccine, which is used for TB, and this shows some effectiveness both as a treatment and for prevention for the SARS-COV-2 virus.

13:56  The areas where there are the highest amounts of fatalities from COVID-19 are occurring in areas with high rates of air pollution.

17:07  Dr. Moss’s latest book is Cancer, Incorporated, which talks about the war on cancer and the drugs and the financial ties between the researchers and the drug companies and the regulators.  One shocking fact is that when we look at some of the new targeted drugs, like the immune therapy ones like Yervoy, which are used for solid tumor cancers during stage four, on average these drugs only extend survival by 3 to 6 months.  On the other hand, some people are completely cured by targeted drugs, such as former President Jimmy Carter, who had melanoma that had spread to his brain.

21:59  These newer, targeted cancer medications tend to have much fewer side effects than traditional chemotherapeutic drugs. But there are a number of questionable ways that they were able to get some of these drugs approved, such as that some of them are approved not because of curing any cancer patients but because they improve some surrogate marker, such as a score on a test. For a drug to get approved for cancer it should either cure you or extend life in a meaningful way or improve the quality of your life.  For example, some drugs are approved because they extend disease-free survival or progression-free survival, which may mean that there is actually no increase in the rate of survival from the cancer.  And these drugs can have a number of uncomfortable side effects.

29:40  Immunotherapy for cancer includes drugs like Yervoy, Opdivo, Keytruda, and Tecentriq, which are heavily advertised to the public.  Cancer tends to confuse and turn down the immune system, so these drugs activate the immune system and they can be very effective in certain cancers like melanoma.  They are also often referred to as immune checkpoint inhibitors. But these drugs are very expensive, costing approximately $150,000 and it may be most effective to take two of these drugs at a time. There’s new drug, Kymriah, a CAR T therapy drug, also an immunotherapy, that costs $475,000 per injection, while the actual cost of production is $20,000.  One of the justifications from the pharmaceutical companies is that they spend lots of money doing research and development for these drugs. But Dr. Moss points out that most of the basic research is actually done by the National Institutes of Health, by the government, paid for by taxpayers. After the taxpayers pay for much of this research, it is then handed over to big pharma, who reap most of the rewards.

35:15  These pharmaceutical companies can no longer be taken to court for price gouging since congress passed the Medicare Modernization Act of 2003. It included in the law that the government, which means Medicare, Medicaid, and the VA could not contest the prices, could not negotiate over the price of the drug.  The sole reason why the same drugs are cheaper in Canada than the United States is simply because they have a universal healthcare system that goes through the government, and the government negotiates those prices down.  This same provision that we not negotiate to lower the price of the drugs was also written into the Obamacare legislation in order to keep the big pharma lobbyists from opposing the legislation and keeping it from passing. When they were passing Obamacare, there were three times as many lobbyists from big pharma and the insurance companies for every member of congress.

40:25  Dr. Moss’s book Cancer, Incorporated highlights how money flows from big pharma to the oncology profession.  A lot of money especially flows to the key opinion leaders, the most influential doctors, the ones whose names show up on the key clinical trial papers. In fact, if you go to a website called Open Payment Data, you can track all the money paid to doctors by drug companies. This database was part of the Obamacare bill and it requires that drug companies have to reveal all the money they give to doctors, universities, and hospitals.


Dr. Ralph Moss is the former science writer and assistant director of public affairs at Memorial Sloan-Kettering Cancer Center. He is known for his Moss Reports which are detailed reports on the most common cancer diagnoses for lay persons and he also provides informational and personalized consultations for cancer patients. Dr. Moss was a founding member of the National Institutes of Health’s Alternative Medicine Program Advisory Council, and of the Complementary and Alternative Medicine panel. Dr. Moss has written a number of books, including his latest Cancer, Incorporated.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.


Podcast Transcript

Dr. Weitz:            Hey. This is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello, Rational Wellness Podcasters. For those of you who enjoy listening to the podcast, please give us a ratings and review on Apple podcast. If you’d like to see a video version, please go to my YouTube page, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                Today, I will be talking to the medical writer, Ralph Moss, PhD, who has written or edited 14 books and collaborated on four film documentaries related to cancer research and treatment. We will be talking about modern cancer treatment, especially chemotherapy and some of the newer targeted medications. Dr. Moss is a former science writer and assistant director of public affairs at Memorial Sloan Kettering Cancer Center in New York back in the ’70s.  Since leaving Sloan Kettering, Dr. Moss has independently evaluated the claims of conventional and nonconventional cancer treatments all over the world, and he currently writes the Moss Reports, which are very detailed reports on the most common cancer diagnoses for laypersons, and he also provides informational and personalized consultations for cancer patients and their families. Dr. Moss was also a founding member of the National Institutes of Health’s Alternative Medicine Program Advisory Council, and he has served as a peer juror for a dozen medical journals.  Dr. Moss, thank you so much for joining me today.

Dr. Moss:             My pleasure.

Dr. Weitz:            So, I definitely want to focus our talk on your latest book, The Cancer Industry, but before we do-

Dr. Moss:             Cancer Incorporated.

Dr. Weitz:            Cancer Incorporated, okay. Sorry about that. Cancer Incorporated. Before we do, I wanted to ask you a few questions about the current coronavirus pandemic situation that we’re in. At the time of this filming, that’s what’s going on right now in the country, and you can tell from this mark on my nose from wearing a face mask almost the entire day, which is not something I’m used to since I don’t work in an emergency room. I’m in private practice.   So, I know that you’re an expert at cancer, but you’re also an expert at integrative approaches to cancer, and as I think about this pandemic, I think that the way I like to look at a viral epidemic like this is the key, I think, from my integrative functional medicine perspective is that we want to make the host, which is us, very inhospitable to the virus stinking root and growing. I think of integrative cancer care the same way. We want to make the terrain of our body hostile for cancer to be able to take root and grow.   So, from your perspective, what are some of the most important things that we can do to protect our bodies against this coronavirus that’s spreading around the world right now?

Dr. Moss:             Well, as you say, I’m not an expert on this topic with the other 320 million Americans trying to figure out how to survive in all of this, and given my age, and some of other health conditions, I feel personally that my wife and I are at increased risk. So, we’re very vigorously following the standard recommendation, and treating like it is already in our area, although I live in Maine, and we have not been hard hit in the rural parts of Maine, but, of course, if every particle of coronavirus were visible with a little light on it, we’d probably be amazed at how widespread this thing is.  Actually, that’s how we conceptualize it. So, we do take very seriously the need to wear a mask and gloves and all the rest of it. In our community, which is a very small community, the neighbors have gotten together and made a group plan where we’re all in touch via instant messaging, which initially was for helping each other do shopping, and we’ve utilized that, but it also is a way to keep in touch and know if anybody’s gotten sick and where are things then. The first notice we got of the lockdown of the state was through that little informal messaging system. I think this is going on all over the country. It’s very, very good. Oddly, the social distancing has led to greater closeness among neighbors in some parts, at least, and this has been very good.

Dr. Weitz:            That would be a great positive that could come out of this situation is it actually brings the country together to fight this common condition.

Dr. Moss:             No doubt. No doubt. I think history will be rewritten to be pre-COVID-19 and post-COVID-19. I see it as that. Let me just get rid of this call. So, as far as what one could do about it, I think of this in two different ways. One is what can you do personally and then the other one is what can you do society-wise. Personally, I’ve written a blog about mushrooms, medicinal mushrooms.  Why? Because the strengthening of the immune system and the healing healthfulness of the immune system I think is very important. So, the things you would normally do to keep your immune system healthy and keep the numbers in a high normal range would be beneficial, and the most neglected supplement in that regard, I think, are the medicinal mushrooms, which have a tremendous amount of research behind them in Asia, not so much in the US.   People go to my website, which is mossreports.com, they’ll find my blog about this and how you could prepare a soup out of medicinal mushrooms, especially shiitake, maitake, and reishi or oyster mushrooms. Amazingly, almost all of the exotic Asian mushrooms also double as immune modulators. So, I think that’s important.

                                A woman that I knew when I worked as a consultant to the National Institute of Health, Jennifer Jacobs, MD, has put out a blog about homeopathy and COVID-19, which I thought was very interesting. She’s a medical doctor. She’s had 40 years experience with homeopathy. So, I think her word should be taken seriously.

                                Then I think also from a societal point of view, the ideas that have intrigued me the most about potential treatments have been the ones that work on the immune system, and two in particular. I’ve written a blog about one of them. The other one is very much in the news, if people search for it.   The first one is called Superinfection Therapy. It seems like a contradiction of terms to give an infection on top of an already existing infection. This has been used in the treatment of hepatitis B, hepatitis C, and seasonal influenza, flu in Russia from the ’60s to the ’80s. Hundreds of thousands of people who got basically non-disease-causing superinfections were deliberately given this. Some of them were given, for instance, the Sabin oral polio vaccine.   So, what would that do? Well, there’s a funny thing called superinfection where if you have an infection, you give another infection on top of it, sometimes that second infection knocks out the first infection. It’s like they’re competing for the same ground. You could think of it that way.  The other idea is that the superinfection, the second infection stimulates the immune system in a nonspecific way that then enhances your ability to deal with the first one. Whatever the reason is, there’s a lot of potential to this, and it’s been shown in other situations. This may be applicable to SARS type of infections, coronaviruses, and so forth. There’s a petition at the White House. The White House has the petition process and we have started the petition basically to bring this to the attention of Anthony Fauci, who is a big top scientist on the president’s COVID-19 taskforce. So, we’re hoping.   It’s a long shot, but if you get 100,000 signatures on a petition to the White House, somebody in the White House has to respond to it. So, we’re trying. What else can we do, right? There isn’t much more. We’re trying to-

Dr. Weitz:            Just let President Trump know how he could personally make an investment in a company that provides this therapy and you’ll be golden. It will be on every press conference.

Dr. Moss:             My problem in life is I’m always trying to find the least expensive, least profitable treatments. To me, the most effective treatment would be water or something, something that was free.

Dr. Weitz:            Sleep, exercise, right, meditation.

Dr. Moss:             Walk in the pine forest in Maine might be the best treatment. You know what I’m saying is that … So, that’s a treatment that would be incredibly inexpensive because the one that they use in Europe experimentally is a poultry virus. These poultry viruses are very good because they are highly contagious and active, but they don’t cause any human diseases. There’s a couple of them.  So, one of them is currently being proposed as a treatment. We’re not asking for anymore than a fair test initially, like a pilot study, and maybe 10 patients to start, and then, of course, we’ll work through clinical trials, although the clinical trial system seems to be tremendously under stress now for the obvious reasons.

Dr. Weitz:            Oh, sure, but there are actually a huge number of clinical trials that the FDA is allowing without the normal controls because of the situation we’re in. So, actually, the scientific community is very excited about the ability to launch somebody’s treatments.

Dr. Moss:             The other treatment that interests me very much is BCG, bacille Calmette-Guerin, which is the standard TB vaccine.

Dr. Weitz:            They use that for bladder cancer sometimes, right?

Dr. Moss:             Correct. Correct. That was your first use medical, well, repurposed use in cancer, and it’s used at very high level, instilled into the bladder mainly to prevent recurrences of bladder cancer, which are relatively easy to treat, but very difficult to keep from coming back.   So, they use the BCG, instill it, but BCG has many uses. It’s been in literally over a billion people. It’s given to babies. It’s considered, of course, a very safe thing, and it seems to correlate with lower rates of viral infections, but more importantly, BCG is being tried in Europe as a way of actually treating people.  Again, I think the philosophy is almost identical to superinfection theory, therapy in that it makes a nonspecific stimulation of the immune system. That can be enough to help the person in the initial stages to keep that virus from taking over the lungs. So, I think that this is very important.

                                Another one more thing I’ll mention, which is, and it came out, I mean, there was an article about it today in the New York Times, but there have been hints of this all along, which is that the greatest number of fatalities from COVID-19 are occurring in areas with high rates of air pollution.   I thought about this because I, luckily enough, and not by accident, I live in an area with very little air pollution. I mean, we get what blows up the coast from Boston, and maybe Portland, but that’s about it. I mean, so if you-

Dr. Weitz:            So, it’s probably a great idea that the president right now is trying to reduce the fuel emission standards on cars.

Dr. Moss:             Well, nature is carrying out an experiment, which is to reduce air pollution. So, we got the green new deal, but we got in a way we never expected. All the industries shut down. Car manufacturing is all shut down and so forth. So, in a way, I mean, it’s ironic that it took that in order to get us to reduce our pollution of the planet, but I’m not saying … This is more like a longterm thing, but it also points to the fact that the health of the lungs proves critical in a surprise, surprise, in a respiratory disease.   So, whatever you can do to improve the health of your lungs, whether it’s through exercise or through supplements, through walking in the woods, whatever you need to do, that would be a beneficial thing.



Dr. Weitz:                            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.

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                                                Now, back to our discussion.



Dr. Weitz:             Let’s talk about your book, Cancer Incorporated, which talks about the laws and the war on cancer and the drugs that ties between the researchers and the drug companies and the regulators.

Dr. Moss:             Yes. So, I wrote the book. It took me about a year to do this, and it just came out in January. Of course, then overwhelmed by our more oppressing problems, but the cancer problem is not going away, and it will-

Dr. Weitz:            In fact, patients who are currently undergoing some of these treatments for cancer actually at increased risk of COVID-19 infection and having a worse response as well.

Dr. Moss:             Absolutely. Absolutely. It’s a disaster especially for cancer patients, especially people with lung cancer. It’s a terrible situation. What I focused on in Cancer Incorporated, though, is the manner in which these drugs, these new drugs in particular have been presented to the public, and what I see as the corruption of the oncology profession, the leading cancer researchers in terms of approving drugs and getting the FDA to approve drugs that are not really effective.   I was led to this by the speech that James P. Allison of the MD Anderson Cancer Center gave upon accepting the Nobel Prize in December of 2018. He was contrasting a treatment that he invented called Yervoy, which is a immune therapy with all previous drugs I targeted, so-called targeted drugs, and he made a comment that I can’t quote exactly, but, basically, on average that these drugs extend survival by a few months. You push the envelop by a few months.    When I looked into this, I was startled. I hadn’t realized, as critical as I’ve been of the cancer industry, I hadn’t realized that it was that limited. When I looked into this, I found that it was in fact the actual increase in overall survival from these new drugs in stage four cancers. We have to specify. We’re not talking about pediatric cancers or relatively rare kinds of cancer, but on average, for the solid tumors of adults in the final stage, in the stage four, metastatic disease, is I think-

Dr. Weitz:            For those who are not aware, stage four means that the cancer has now spread from the initial organ where it was throughout the other parts of the body.

Dr. Moss:             Correct. So, it’s about 3.8 months. That’s what this clinical trial show. These are the actual benefit on average of all of these targeted drugs that are now the bulk of the drugs that are being approved or what we would call targeted drugs. Even with the immunotherapy, which I do believe in in general terms, it’s really only about five or six months on average.   Now, you hear about people being cured by immunotherapy. This is true. This is-

Dr. Weitz:            For example, former Vice President Jimmy Carter who was diagnosed-

Dr. Moss:             President, yeah.

Dr. Weitz:            Yeah, former President Jimmy Carter who was diagnosed with, I think it was metastatic. What was it?

Dr. Moss:             Melanomas spread to the brain.

Dr. Weitz:            Spread to the brain, and it’s been years now, and he seems to be doing phenomenal.

Dr. Moss:             Phenomenally well. He did have a pinpoint radiation to the brain, but especially in an older person like himself, and he’s I think in his 90s, you wouldn’t expect that to result in a-

Dr. Weitz:            He takes one of these targeted meds or took one of these targeted meds, right?

Dr. Moss:             He took one of the very first immunotherapy drugs. So, the targeted drugs could be divided into precision medicine, let’s say, and then a subset of that would be immunotherapy.

Dr. Weitz:            By the way, these are somewhat of an improvement over the traditional chemotherapy, which were basically drugs that just kill everything and are designed to kill the cancer cells and hopefully they don’t kill you. Whereas these targeted drugs don’t have as many of the side effects.

Dr. Moss:             No. That was the main selling point of that, but I go in great detail in Cancer Incorporated into what these drugs actually do, and the manner in which they’ve been approved. I was shocked by what I found because there’s couple of things.   One is that, now, we’re not talking about fraud here, which sometimes occurs, but I’m no saying that there’s actual making up of data. It isn’t that, okay? So, people can disabuse themselves of that notion. It does happen, but that’s not what I’m talking about. That’s not the general course of thing. What I’m talking about is that most of the time, the drugs are approved by FDA based upon a surrogate marker.  A surrogate marker means I can’t prove to you that the drug actually conveys true patient benefit, but I’ll choose something else like a score on a test or another. I’ll redefine what I mean by benefit, so that I can then get approval. The main scam going on here, and it is a scam, is a drug to be effective, for a cancer drug to be effective in stage four cancer, it basically has to do one of three things.  First of all, it could cure you. That would be great. You take the drug, you have a complete response to the drug, meaning that the cancer disappears, and you live out your normal lifespan. That would be a cure.  Second thing, it could extend your survival in a meaningful way. So, what would that be? Meaning that in the group as a whole, we’re not going to just consider anecdotes, individual cases, we’re going to consider the entire group being tested. They live months or years longer than they would have if they took a different treatment or if they took no treatment or they just have best supportive care. That would be increased overall survival, okay? That’s another palpable benefit of treatment.  The third one would be increased quality of life, but the vast majority of drugs do not cure. They almost never tested for quality of life, very rare or they don’t really extend the overall survival. So, how could it be then? How could the FDA, the Food and Drug Administration or the equivalent agencies abroad, how could they approve a drug without it showing any benefit?

                                The answer is that there are a dozen definitions of survival at the National Cancer Institute dictionary, cancer terms, and they usually substitute something like disease-free survival or progression-free survival. What does that mean? So, it means that between the time that they administer the treatment and the time that they first noticed that the cancer is in fact getting bigger, progressing, spreading to other organs, whatever, that period of time, the progression-free time is longer in the patients who get the treatment than in those who don’t.  So, now, when you read a headline that says, “Such and such drug increases survival in cancer patients,” most often, if you drill down and you’ll read, bother to read the article not just the headline, much less read the actual study that it’s based upon, not just the abstract but the actual study, you find that what they’ve done is they changed the shape of the curve. They moved it over so that some more time elapse between the time the person was first treated and the time that they first noticed the disease is progressing, but they didn’t increase the actual time the patient live.

                                So, I give an illustration on how that could be you. You have two people, patient A and patient B. So, patient A and B, they have the same disease, same stage, same type of cancer. They’re both treated on, let’s say, January 1st. One of them gets the experimental drug, and one of them gets no further treatment, okay?  So, at three months, there’s no sign of further progression in patient A, but patient B is going downhill. The cancer is still growing, it’s still causing a problem. At the six-month point, patient B, of course, is still going downhill. Patient A may detect that patient A actually now has an increase in progression of the cancer, and they both continued downhill from there, and they both died exactly one year after starting the treatment.  So, from a common sense or a patient or a laypersons’ point of view, what exactly was the difference between those cases? They both lived exactly to the day, one year from the time that they started the treatment. It didn’t make any difference. If you take the word survival, I mean, increased lifespan, which I think 99% of people would, it didn’t make any difference.    Did patient A have a better quality of life? That’s debatable? Patient A had a period of false hope, let’s say, a period of six months where she thought that she was maybe going to be cured, but during that time, she was getting this toxic drug. So, she may have spent that time in very, very difficult, uncomfortable or dangerous circumstances.  So, which is better? I don’t know. No one has ever figured that out because I think it depends on the person. Do you want that period of that false hope of six months and you can enjoy that and have a normal … or do you want to just accept your fate, not do anything, and slowly go down? I don’t know.

Dr. Weitz:            You know who benefits from that.

Dr. Moss:             Right.

Dr. Weitz:            The executives and the shareholders of the big pharma company that are making more profits supplying this drug that costs hundreds of thousands of dollars when you’re treating that.

Dr. Moss:             Right, and can have a horrendous side effect. Yes, it’s true that with chemotherapy, one of the most brutal treatments ever invented, chemotherapy, or probably the most poisonous that’s deliberately given to human beings since the bloodletting era or the mercury era, whatever you want to call it.  Yes, you don’t get that kind of … but you get other toxicities, some weird things. Even with the immunotherapy, which as I say, for the highly mutated cancers like melanomas and lung cancers, can be very effective, but the guidebook on the side effects of those new immunotherapy runs to, I think it’s 65 pages of fine print for what can occur following this kind of immunotherapy.

Dr. Weitz:            By the way, which are some of the examples of some of the immunotherapies and how do those drugs work?

Dr. Moss:             Right. So, it’s Yervoy, and Opdivo, and Keytruda, which are heavily advertised to the public, by the way, only two countries in the world.

Dr. Weitz:            Is it Yervoy, the drug that Carter was given?

Dr. Moss:             I believe it was.

Dr. Weitz:            Yeah.

Dr. Moss:             It was either that or, yeah, I think it was or it was Opdivo, but, yes, I think it was Yervoy because that was the first one to be developed, and then there’s Tecentriq, and there’s a few others, okay? The idea is a very good one. It’s based on a very, very important fact that Dr. Jim Allison and others discovered, which is that cancers have the ability to confuse and turn down the immune system.  So, the immune response can be inhibited by the cancer itself. So, it’s like a fifth column within the body that’s preventing your armed forces from being able to act, okay? So, the brilliance of what Jim Allison did, who discovered Yervoy, was to figure out a way chemically to block the interaction of the cancer cell with the immune cell, the crosstalk that goes on between the cancer and the immune system, and to block that, and then the immune system is able to be activated.  This can be very, very effective in melanoma. It’s something like 50% or 60% of the patients, melanoma stage four patients are now having these major responses and durable remissions from this drug. So, I understand the excitement and enthusiasm for it, but through not any fault of Jim Allison, the company, Bristol-Myers Squibb, which owns both Yervoy and Opdivo, set the price of the drug at around $150,000, and if they’re given in combination, which is the most effective way, the price can go up to a million dollars per person.

                                Some oncologists in Latin America analyzed the situation and they said … They were in Chile, country of Chile, and they said only 10% of the population would even be covered through insurance for this type of treatment. Forget about the people who don’t have insurance, but just of the insured population. In Peru, a less affluent country, only 5% of the population would be covered for that treatment.  So, you could be sure that 95% of humanity will be left out of that kind of treatment, that kind of pricing. It’s just out of this world. The height of absurdity came with a different type of immunotherapy called Kymriah. It’s what’s also called the CAR T cell therapy. That drug sells for $475,000 per injection, per injection.  We know from the inventor of that treatment who let the cat out of the bag because he said that the actual cost of production, it’s a living drug, it’s a very interesting drug, but it’s a living drug, he says that the actual cost of production is $20,000. So, 455,000 or about whatever that is 96% is profit.

Dr. Weitz:            Now, is there any justification for that based on the fact that I’m assuming to take a devil’s advocate position a drug company would say, “Look, we had to spend years researching this, and we spent years researching other drugs that didn’t work that we never got paid for.” The cost of running these trials is very expensive, right?

Dr. Moss:             Right. Right, but what most people don’t realize, if we want to talk about fairness, is that the vast majority, I think some people have said 100% of all new cancer drugs are basically researched by the federal government at taxpayer expense.

Dr. Weitz:            You mean, initially, the NIH is doing the basic research.

Dr. Moss:             Exactly. All the basic research of almost all the drugs, the taxpayer pays for to an amazing degree, sometimes up to actually the finished product, which is then handed over to a drug company on the very disadvantageous terms to the government. The taxol famous case of the derivative, the only herbal treatment, well, one of the few herbal, the derived treatments for cancer, Bristol Meyers was given a monopoly on the sale and distribution of that drug for an incredibly small amount of money compared to the billions that they made on it. It was a scandal that actually wound them up in court, eventually, in the old days when drug companies could be taken to court, but the basic-

Dr. Weitz:            Can they not be taken to court anymore?

Dr. Moss:             Not for what we’re talking about because they pay … I mean, for price gouging, and monopoly practices, no, it doesn’t happen, but basically, the drug companies through the corruption of the congress and the FDA, they’d pass the law in 2003 that we live with the consequences are called the Medicare Modernization Act of 2003.   One of the things that this did where they slipped in was that the government, meaning Medicare, Medicaid, and VA could not contest the prices, could not negotiate over the price of the drug. So, it’s like if you go to a plumber and you say, “You can charge me anything you want. Go ahead. Just whatever it is, I’m going to pay it and I have no recourse,” and the public is demanding that you give them that drug because of good public relations and complicity of the media.   So, they got that law passed. They got it passed at 3:00 in the morning by one vote in the senate, and emergency, they called a surprise vote, the proponents of the bill, 3:00 in the morning. A lot of the opponents were not there, and they pushed it through. We’ve lived with the consequences of this-

Dr. Weitz:            By the way, the sole reason why the same drugs are cheaper in Canada than the United States is simply because they have a universal healthcare system that goes through the government, and the government negotiates those prices down. That’s the main reason why-

Dr. Moss:             That’s right. I mean, I’m in favor of a Medicare for all system, but we wouldn’t have even needed a Medicare for all system. All we needed was for Medicare to have the right and the requirement to economize on behalf of the American public by negotiating over the price. It wouldn’t have been perfect, but we wouldn’t see 150, 175,000, much less $475,000 drugs. It would be impossible.  You know why? Because if you look at Great Britain, which has a special committee, they have national health service, so they have a special committee that judges the value of the drug. They have formulas that they work out and everything, but the basic bottom line is that set they will say, “No. We don’t want it.”  It’s not enough of an innovation over the previous drug, and it’s not cost-effective. Invariably, what happens is that the company then comes back and says, “All right. Well, how about half? Would you do half?”  Then they’ll look at it again, they run their numbers and they say, “No. Still no good.”    The company will come back, “All right. We’ll take a quarter,” because 95% of the price is markup. That’s business.

Dr. Weitz:            By the way, these companies just by partially by talking about how much they spend on research and development, and the fact is is these companies spend more money on marketing than they do on research and development.

Dr. Moss:             Overwhelmingly so. Overwhelmingly so.

Dr. Weitz:            That same provision was written into the Obama Care, Affordable Care Act that was written into the Medicare bill.

Dr. Moss:             Yeah, because if you look at opensecrets.org and you can see to the penny how much the drug companies are giving to the different campaigns, so-called of the congress people.

Dr. Weitz:            There are three times as many lobbyists for the pharmaceutical industry and the insurance industry than there are for every member of congress.

Dr. Moss:             Correct. There’s between … because this came out at the time of that bill, the Medicare Modernization Act, but also more recently, the precision medicine initiative, which was Obama’s pride and joy, 1,350 drug company lobbyists were creeping and crawling all over the congress, which is exactly what you said, three times, three lobbyists for each and every member of congress. The money just flows like water, and-

Dr. Weitz:            In defense of the congress people, that’s the system we have. They can’t get reelected unless they can raise millions of dollars.

Dr. Moss:             Well, Bernie Sanders did it. I mean, he didn’t win, but it wasn’t for lack of money. That’s a different issue.

Dr. Weitz:            Right, but that’s an exception. That’s not that easy to do what he did.

Dr. Moss:             There are other countries that have public funding of election that don’t allow that.

Dr. Weitz:            Absolutely. Absolutely.

Dr. Moss:             So, it’s a solveable problem, but the fact is that corruption is always good with people who are going to find an excuse for corruption, but the corruption is there. A big part of my book, of Cancer Incorporated, is concerned with how this money flows to the oncology profession, and I don’t just mean the profession individually, but individual payment to leading what I call key opinion leaders, KOLs, the key opinion leaders within oncology, the most influential doctors, the ones who show up first author, second author, and final author on the key clinical trial papers.   Most of those people are in the pay personally of the drug companies. This is public knowledge. There’s a website called Open Payment Data. It’s run by the Medicare facility. This is one good thing that came out of the Obama era, Obama Care era, and it basically stipulates that the drug companies have to reveal to the penny how much they’re giving to individual doctors, which is amazing because it isn’t just like, “Oh, we gave 10 billion to the oncologist.” No.  You can enter in the name of the doctor, the medical doctor, American medical doctor and see who they took how much from. It’s very interesting because most of the situations that I looked at and I looked at a lot of different clinical trials as you can imagine, it’s a pattern that the key researchers, the key opinion leaders, and many of the other people included in that paper as well, the top people, the top academics, a person taking personal payments.   I want to emphasize they were personal, they call these general payments. What that means is I think that’s euphemism, but what it means when not talking about the money they take for their lab or their clinic to do the research on these drugs, which is questionable in and of itself and undoubtedly you bring $12 million into your institution. You’re going to rise, you’re going to climb up that totem pole. I’m not talking about that.  I’m talking about how much money you took to put your kid through a fancy school or a fancy college or you took for the yacht or you took for the second or third-

Dr. Weitz:            Now, to play devil’s advocate again, I thought it was illegal for doctors to get direct payments from pharmaceutical companies.

Dr. Moss:             No. It’s not illegal, and it never was illegal in oncology. Oncology wrote its own rules, which is called the chemotherapy concession by which they could buy drugs wholesale and sell them to the patients and get reimbursed at retail rates. At one time, that constituted, according to one source, that constituted two-thirds of the income of oncologists in private practice.   The oncologist in private practice makes about, I think the average figure is $367,000, but that means that these people, these individuals were making the equivalent of a million dollars, two-third of which came from the sales of chemotherapy, the chemotherapy concession.   Now, that all changed also with changes to the Medicare reimbursement rules, and so I’m not saying that that’s going on to the same degree as it was because oncology changed from a private practice-centered profession to a group, I mean, to it working for hospitals, basically.

                                This is something else. What I’m talking about is something else. This is, I don’t even know how to describe it. It’s payments for what they describe as honoraria or speakers bureau fees or consulting, different names are given, but it’s money that flows for vaguely defined services right into the pocket or to the account of the doctor who’s involved oftentimes in evaluating the product of that company.   I don’t know how much more clear cut it could be, how much more grazen it could be. You’re evaluating a drug that people are going to make life and death decisions based upon your statements and your evaluations. You’re going to take up to $3 million from the company who produces that drug and then you’re going to make, you’re telling me that you’re going to make an objective evaluation of the efficacy of that drug.

                                I’m saying, again, they stay on the very side of the law by not lying about the results. I’m not accusing them of lying. It’s the interpretation of the results. In other words, it increased survival. Well, it did if you look up survival in the NCI, National Cancer Institute dictionary, and you want to define progression-free survival or disease-free survival as survival, they’re not lying, but the way you spin the results, the way you write it up for New England Journal of Medicine of JAMA Oncology or any of the other big journals, that’s critical because the average person is only going to read the headline of the story.    Some will read down into the story itself. Some may go look at the title or the abstract of the paper. Believe me, very few people actually read the entire paper through with a critical eye, but when you do that, you see there’s no, “There, there.” There’s nothing there. It doesn’t do anything. If they’re going to charge you $150,000, we have nothing. What are they sowing? Oh, the greatest commodity in the history of the world.

Dr. Weitz:            So, Dr. Moss, what are some of the solutions to the situation that we’re in?

Dr. Moss:             How about reforming the congress so that they don’t take any more money for coverage?

Dr. Weitz:            Well, I think there’s a lot of people who’d like to do that. The problem is is since the Supreme Court ruled on Citizens United, there’s no way that we could pass a law, even if we wanted to, because it would be overruled by the Supreme Court. So, the only two choices we have are A, to have a significant change in the Supreme Court, which is very difficult, and seems to be going the wrong direction right now or B, we would have to have a constitutional amendment that would go over the Supreme Court, and we never even passed the women’s rights amendment.

Dr. Moss:             I’m totally aware of that. So, I mean, I can only put forward Utopian solutions.

Dr. Weitz:            No, absolutely.

Dr. Moss:             At this moment, we’re just spinning our wheels. I understand that. I’m not saying that I have a solution that’s a practical thing that could be implemented right now because the problem is so pervasive. It’s so systemic.

Dr. Weitz:            No. I think it’s totally corrupted, all are on politics, and having public financing of campaigns and getting rid of lobbyists, absolutely has to be a goal how do we end up eventually accomplishing it.

Dr. Moss:             Yeah. A couple of chapters were written in conjunction with other individuals who I think I was very lucky to get their input. One of them was the final conclusions of the book, of Cancer Incorporated. I co-wrote or bounced back and forth with Wayne Jonas, who was my colleague at the Office of Alternative Medicine back in the ’90s, and was the director of the OAM office, now National Center for Complementary and Integrative Health. I was an adviser to that committee.

                                So, Wayne and I have kept in touch for decades now. He’s a brilliant thinker and has thought of many of these. Lives in Washington area, has participated in endless discussions at the governmental level. He and I came to the conclusion quite through our own surprise that we felt that the main recommendation we could make would be to nationalize the cancer drug industry.

                                We don’t go as far as to say nationalize the whole drug industry. That wasn’t our focus, and I don’t really know enough about other areas where drug industry maybe is better than it is on oncology, but we feel that it’s actually an impediment to the overall drug development in the United States that the NIH and the NCI already does the heavy lifting in terms of drug development and could do a better job, and by better job, what I mean is that they wouldn’t have the same pressures that the drug industry has to show increased profits every quarter because that’s the imperative of Wall Street, of capitalism.

                                So, we felt that scientists would still do their work. You don’t even need the patent system. You could reward people. You could give them amazing rewards for discovering new drugs and new treatments based upon actual benefit to people. I’m talking about large rewards. You could give 50 million or $100 million to people who discover and effective new treatment. Why? Because you’re ready. Every year, the world is spending about $120 billion on cancer drugs, most of which as we see probably 90%-95% of which is pure profit to the industry, and they’re spinning their wheels.

Dr. Weitz:            So, essentially, what you’re saying, doc, is right now, for those people who don’t realize it, National Institutes of Health does a lot of the basic research, they’re finding out maybe some of the mechanisms, some molecular processes, et cetera, and then that’s all done paid for by the taxpayers done by the National Institutes of Health, and then pharmaceutical companies cherry pick what they see as the more promising research and then do the last steps, and get all the money for the drugs. You’re saying just have the National Institutes of Health just finish the process and take those promising processes and develop the drug and market it, and not have those huge profits to the benefit of the taxpayers.

Dr. Moss:             Correct. I fully and freely admit, I didn’t come up with this idea. What happened was is that in the course of writing the book last summer, an article appeared in JAMA Oncology. JAMA is, for those who don’t know, is Journal of the American Medical Association, advocating exactly this for cancer drugs. I mean, it blew my mind, and Wayne Jonas’ as well because he’s the one who actually brought it to my attention. He said, “Look at this.” We haven’t even gone that far in our thinking.

Dr. Weitz:            Now, one of the immediate objections is going to be, “Well, we know that government can’t do anything well. They’re totally inefficient. The private sector always does things better.”

Dr. Moss:             So, we talk about immune checkpoint inhibitors, okay? Immune checkpoint are the most important advance in cancer treatment in at least 25 years came about by, entirely, by government funding, NIH, National Institutes of Health and National Cancer Institute grant to a salary employee of a public institution. James Allison was a professor of virology and immunology at University of California Berkeley, a public institution, which used to be free, by the way.

                                So, the entire development of the immune checkpoint drugs up until the point where he had to find a private firm to take it over, which eventually wound up to be Bristol Meyers Squibb. So, government-funded, government-run, government laboratory, government-paid, and the drugs were all invented there. I could tell you many other drugs. Adriamycin got developed by the government, had to be handed over to a private company that invent the private company because none of the drug companies wanted to touch it. It wasn’t profitable enough.

                                Taxol, entirely developed within NIH and then NIH funded lab in New York at a public hospital in New York City, which isn’t the case. The government functions very well in the realm of biomedicine, but nothing’s ever going to be public. I’m no saying that some Utopian era is going to dawn if the government … Of course, you always, in life, it’s you go from one set of problems to another one at a “higher level” but there’s still problems. You solve one problem and then you get another problem. I mean, that’s just the nature of reality.

                                So, yes, we will have issues if the government takes over the drug, but you know what? I felt this way when I was consulting for almost nine years for the government. As bad as it was, you still could drag somebody up before a committee and drill them and find out and investigate, and find out where the … There’s that potential for public exposure and disclosure, right?

                                I said about the government runs the website that lets us see the degree of corruption of the oncology profession. It doesn’t happen automatically, but I saw it happen with my own eyes. It can happen.

                                So, it’s always going to be a problem to administer a country of 320 million is never going to be easy, and much less a world with whatever, seven or eight billion people, but at least there’s some disclosure. What goes on inside the boardroom at Bristol Meyers Squibb? We don’t know. I don’t know, and we’ll never know or the boardroom at Memorial Sloan Kettering private institution. You’ll never know.

                                This is kept close to the vest, but one thing you can be sure of with the imperatives of a private corporation, especially a corporation that’s traded on the stock exchange and is competitive with other companies and so forth that their imperatives are profit and growth, and it usually is on the quarterly basis. They’re all racing to show how well they did because Wall Street will react even to one quarter downturn.

                                So, they’re kind of a cancer because they have to keep on growing and spreading and metastasizing, and that’s their imperative. You don’t have the same imperative-

Dr. Weitz:            It’s really the system, not the companies because as public corporations, they’re required to maximize profits, to maximize shareholder value.

Dr. Moss:             Right. Even if they weren’t, they’d still have to do it because who would invest in the company that was lagging? Sometimes you get the best results at privately owned companies, and I own a company, so I’m not saying that companies are necessarily bad, but my son and I, we’re in business together, we could decide, “Oh, well, this quarter, we’re going to focus on doing something that’s not immediately profitable, that maybe it’s an investment in the future or something.”  Nobody, except for our wives, nobody is going to criticize or have any word to say about this, but when you’re a publicly owned corporation, you’ve got the lash of profitability at your back and nothing can stop that. The really interesting thing was they held a meeting that this immune checkpoint inhibitor thing is just phenomenally big. I mean, it’s billions and billions. One drug alone makes, that’s Keytruda, makes over eight or nine billion dollars a year.

                                Everybody wants in on this, and the FDA last year held a meeting, and they brought together whoever wanted to come to discuss the development of new cancer drugs, and it was new immune therapy drugs. This was chaired by Richard Pastor, who’s considered the cancer Tsar in the United States. He’s the most powerful person probably at the FDA.  In the course of the meeting, he listened to the presentations from this company, that company, this company. At the end of the presentation, he said, “So, now, what you’re telling me is …” I’m paraphrasing, “You’re all basically creating the same drug.” They all were creating Keytruda, and Keytruda is another version of Opdivo. What does that mean?  It means that everybody wants in on the $8.8 billion Keytruda market. So, if I could splinter one little thing, I’ll take a cancer, a very, very small portion of that, maybe I’ll just take an angiosarcoma and I’ll run my drug against that drug, and I find that there’s some positive thing. Now, that’s not covered by your patent. I just cut away a little sliver. What can I do with that? The drug could be then extended into other kinds of cancer, become competitive with your big drug or I could sell it out to the highest bidder because even a sliver of the cancer market is worth billions of dollars. It’s so big. Huge market.   So, the head, basically, I call him the head of the FDA, I mean, the top most influential person in cancer in the FDA basically said, “It’s all the same, isn’t it? It’s all the same drug.” So, you got hundreds of companies competing to create a drug that already exists. In fact, it already exists in two forms. There’s no innovation going on there. They don’t want it. Innovation is too risky. It’s much safer to create a me-too drug and then cash in your chips three, five years down the road. That’s what’s going on.

Dr. Weitz:            Thank you, Dr. Moss. I’m going to have to bring the discussion to a close because I am still seeing patients at this time, and I do have a patient coming up. So, maybe you can tell everybody how they can get a hold of your reports, and find out more information about you.

Dr. Moss:             Right. So, our website is mossreports.com, and I’ll hold up a copy of my book, Cancer Incorporated. This book just 250 pages in length, including all the references is available for free as an ebook at our website. So, you just go to mossreports.com/cancerinc or Cancer Incorporated, and you download a copy of the book. We wanted to get this out to as many people as possible or you can get a paperback of it if you choose. That’s not free, but not expensive either.     In our Moss Reports, we have 38 diagnoses of disease, specific reports on different forms of cancer, and we have phone consultations as well. So, we’re busy. We’re active. I’ve been doing this for 45 years. Hopefully, we’ll do it another 45 years.

Dr. Weitz:            Thank you so much, Dr. Moss. Fascinating discussion and a great contribution.

Dr. Moss:             Thank you.

Dr. Weitz:            Thank you.