Immune Strengthening Kimchi & Coronavirus with Dr. Susanne Bennett: Rational Wellness Podcast 149

Dr. Susanne Bennett discusses the benefits of eating Kimchi including strengthening the immune system and we also discuss the coronavirus pandemic with Dr. Ben Weitz.

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Podcast Highlights

6:05  Kimchi is a traditional food that everyone eats in South Korea.  Kimchi consists of fermented vegetables, such as greens, cucumbers, radishes, and cabbage and it is a way that vegetables were preserved long before refrigeration.  Vegetables are brined with salt, which increases the lactic acid bacteria content, and it is the live bacterial cultures that make Kimchi so healthy.  In Korea there are over 250 different varieties of kimchi.  Prior to refrigeration, the Koreans would place large earthenware pots with Kimchi under the ground, which freezes over in the winter and then they would be able to have vegetables all year round.

8:12  Dr. Bennett went back to Korea for the first time since her childhood when she was age 50 and she discovered that Koreans were eating tons of unhealthy noodles, white rice, and sugar.  But the obesity rate in Korea is only 5.8% compared to 35% in the US!  And rates of other chronic diseases like diabetes and heart disease are equally low despite such a poor diet.  It is because Koreans eat kimchi with virtually every meal that they maintain their health.  Kimchi with burgers. Kimchi with tacos. Kimchi with pizza.

11:17  The intro to Dr. Bennett’s Kimchi Diet book, which was published a year ago, talks about the SARS epidemic in Asia, which was also caused by a slightly different coronavirus than our current pandemic.  The South Koreans did so well with that pandemic because of the benefits of kimchi for their immune system that it almost appeared that SARS bypassed Korea. Eating Kimchi contains lactic acid bacteria cause the body to produce immunoglobulins in the gut, which turns into IgG, which helps fight viral infections. Here is a video from Arirang News on how Kimchi Combats MERS. 

17:07  Lactic acid bacteria contained in Kimchi, including Lactobacillus acidophilus, Leuconostoc, and Weissella, are the main bacteria responsible for its health promoting properties. These probiotic strains have a number of powerful health promoting properties, including improving cardiometabolic health. They help to manage cholesterol and triglyceride levels and improve insulin sensitivity. And you get approximately 300 billions CFUs in a daily serving, which is a lot more than you can get in a probiotic supplement.  And you get a larger diversity of bacteria than you get in a supplement. Dr. Bennett recommends that if you are just starting to eat fermented foods like Kimchi that you start with cucumber Kimchi, since cucumber is not a FODMAP food. Cucumber does not contain fermentable carbohydrates. If you start with cabbage Kimchi you might end up getting a lot of gas and bloating and some additional bowel movements.  So you want slowly innoculate your gut. Then after doing the cucumber kimchi daily, you switch to bok choi or mustard greens kimchi, and then you go to radish kimchi, and finally after about 6 weeks you go to Napa cabbage kimchi. Kimchi simulates your gut to produce short chain fatty acids like buyrate and propionic acid.  Propionic acid has been studied a lot in Korea and it has anti-inflammatory, antioxidant, and lipid lowering properties. It also raises nitric acid levels.  It has even been shown to reduce fatty streaks in the aorta.  And kimchi also have anti-bacterial and anti-viral properties. You should start with one tablespoon twice per day and ramp it up till you get to 1/2 cup of kimchi per day.

23:48  You can make kimchi at home and this way you can make sure that you use all organic ingredients and you don’t use any chemicals or MSG.  You take your vegetables and you add sea salt, as explained in Dr. Bennett’s Kimchi Diet book. Himalayan pink salt does not work as well. The salt brines the vegetables, which kills off the bad bacteria, like staph, shigella, klebsiella, and E. Coli.  This results in the proliferation of the good bacteria. Kimchi can be eaten after 2 days but Dr. Bennett feels the sweet spot is in the 14-21 day period, which is when it will be a bit salty, a bit sweet, and there’s also a tang to it.  If you ferment kimchi too long it gets more sour and acidic. 

31:40  Kimchi helps to increase bacterial diversity in our microbiota, which many of us lack.  Many of us are low in Akkermansia muciniphila, which is the good bacteria that’s known to produce mucin, which helps to produce the mucus barrier in our intestines.  And without the mucus barrier, that’s where the toxins that we eat, the junk food, the GMO, the glyphosate, the pesticides, the alcohol, the sugars, the viruses, the bacterias, even parasites can all be penetrating through and creating leaky gut.  Increased intestinal permeability can lead to increased chronic illnesses like inflammatory, cardiovascular, and neurodegenerative diseases.  Kimchi can help to heal leaky gut and reduce LPS penetration into our system and this can help reduce inflammatory reactions in the brain.

36:25  Kimchi is high in a bacteria called Lactobacillus Sakei and studies show that you can take kimchi juice from white kimchi with no red pepper and put it up the nose.


Dr. Susanne Bennett is a holistic chiropractic physician with over 30 years clinical experience and advanced study, specializing in allergies, gut and skin disorders, environmental and anti-aging medicine. She’s the #1 international best-selling author of The Kimchi Diet: Revive Your Gut, Get Lean and Live Longer: Mighty Mito: Power Up Your Mitochondria for Boundless Energy, Laser Sharp Mental Focus and a Powerful Vibrant Body;  and The 7-Day Allergy Makeover: A Simple Program to Eliminate Allergies and Restore Vibrant Health from the Inside Out. She also has a very successful talk show, Wellness for Life on RadioMD and iHeartRadio.  Her website is DrSusanne.com 

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


Podcast Transcript

Dr. Weitz:                            Today, I’ll be speaking with Dr. Susanne Bennett, who’s an expert on Functional Medicine and she published a book last year called The Kimchi Diet. So we will be speaking about the benefits of eating kimchi and this has particular importance for many parts of your health as well as the immune system. And because we’re recording this in the midst of the COVID-19 Coronavirus pandemic, we ended up shifting the focus a little bit more towards things that you can do to strengthen your immune system to possibly help you if you get infected with the Coronavirus, this new novel Coronavirus that is spreading around the world right now.

I would like to make clear that neither myself nor Dr. Bennett is saying that any of the recommendations that we make in terms of diet or nutritional supplementation will prevent you from getting the Coronavirus or should be suitable cures for the Coronavirus. We are not making any of those types of claims. On the other hand, Dr. Bennett and myself, and I hope I can speak for her, as Functional Medicine practitioners, we’re both big believers in strengthening your body’s own immune defenses and let’s make no bones about it, the reason why the overwhelming majority 80%, maybe 99% of people who get infected with the Coronavirus recover without any additional sequelae is the fact that their immune system is able to fight this off. That is how our body fights bacteria, viruses, fungi, et cetera, that we normally come into contact with every day in our environment.  Now our body has antibodies to certain viruses because we’ve been exposed to them in the past. And this novel Coronavirus, we don’t have any antibodies to, and that’s one of the reasons why it’s more dangerous. But it’s very clear that the people who recover well and that’s up to 99% of us and that’s because we have a healthy, robust immune system and people who have a compromised immune system tend not to do as well. So the recommendations that Dr. Bennett is making in this video that involved diet and some rational nutritional supplementation are simply ways to strengthen your immune system. So I hope you’ll enjoy this discussion.

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. Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy the podcast, please go to Apple Podcast and give us a ratings and review. And if you’d like to see a video version of this podcast, go to my Weitz Chiro YouTube page.  And if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today we are going to speak to one of my close friends, Dr. Susanne Bennett, about her latest book, The Kimchi Diet. Dr. Susanne Bennett is a holistic chiropractic physician with over 30 years of clinical experience and advanced studies. She specializes in allergies, gut disorders, skin problems, environmental and antiaging medicine. She’s the number one international bestselling author of her new book, The Kimchi Diet: Revive your Gut, Get Lean, and Live Longer. And her book before that was Mighty Mito: Power Up Your Mitochondria for Boundless Energy, Laser Sharp Mental Focus and a Powerful Vibrant Body. And her first book, The Seven Day Allergy Makeover. She has a very successful talk show, Wellness for Life, on Radio MD and iHeartRadio. Dr. Bennett, thank you so much for joining me today.

Dr. Bennett:                       Thank you Ben. So good to hear your voice and see you. And you know what? Because of this time right now this is fantastic. Modern life allows us to be able to communicate and see each other.

Dr. Weitz:                            Exactly.  Yeah, absolutely. For those of you who maybe might not be aware, I don’t know who couldn’t be aware, but we’re right in the middle of the COVID-19 Coronavirus pandemic and those of us in California have been given a stay at home order. So we’re supposed to stay away from other human beings, but through the digital media we can still interact with each other. I think it’s really important that we have these forms of communication right now because we still need those social connections, even though we’re supposed to stay six feet away from each other.

Dr. Bennett:                       That’s right. That’s right. And it’s also super important because this is our way of being able to distribute information, information that’s a clear, sound, scientific oriented so that everyone can make their own decisions, what they want to do and how they live their lives right now in these trying times.

Dr. Weitz:                            Absolutely. So Dr. Bennett, you’re originally from South Korea and the traditional food everyone eats in Korea is kimchi. So maybe you could explain to us what is kimchi?

Dr. Bennett:                       All right. So kimchi has been around for thousands of years. It is a fermented food that Koreans have made for like … I mean, I think the numbers that go back at least two to 5,000 years. And what they’ve done was that … during the wintertime, way back when, there was no such thing as having fresh vegetables in the winter, so what they would do is they figure out a way to preserve vegetables, keeping it raw with all the nutrients and the value and by fermenting it, utilizing the brining method with salt and increase the lactic acid bacteria. And that was the magic of kimchi.

Although back then they didn’t know that’s the reason why it was so healthy for you. But the whole idea was for five, six months at a time, you can have fresh vegetables without really having a refrigerator. The Koreans would put big earthenware and that’s like ceramic ware pots into the ground when it was ice cold obviously, doing it before the snow came and then all the vegetables they would harvest and it would be, ah, all kinds of radish and a lot of greens and of course everyone knows about, well not everyone, but the Napa cabbage types. We have over 250 different kimchis in Korea. So all sorts of different forms of vegetation, vegetables. And the whole idea is to get vegetables fermented properly and have it for months at a time without it literally going bad.

That’s what’s great about kimchi is that you got live food, live food because it’s raw, but it also has live cultures. And that’s what I want to talk about and how important it is for your immune system. So yes, can I go on and tell you what happened though and how I really discovered this?  Because I will tell you, when I went to Korea when I was 50 years old … and I’m from Korea originally, I didn’t go back until I was about 50 and with a big family trip.  My son really wanted to go to where his mom was from.  So I go there and I was really blown away by what people ate.  Ben, I’m telling you, people eat tons of sugar, noodles, rice, white rice. There’s everything that we have here. They’ve got, in fact, a ton of those restaurants, there’s coffee shops.

Dr. Weitz:                          Thank you America for spreading American culture around the world.

Dr. Bennett:                       That’s right. The Western culture, I mean, that’s what it is. When I was there in the early … I was born in ’62 and into the 70s, I left in 1975, we barely had anything. That was when the military was there, but we didn’t have any forms of American food except on military base, which I had the luxury to be able to go to school there and all.

Dr. Weitz:                           And I bet the rates of chronic diseases like diabetes were minuscule compared to what they are now that the American diet has made its way there.

Dr. Bennett:                       That’s true. But I’ve got to tell you something, and that’s what was blowing me away with all the crap that everyone was eating there. And they eat enormous amounts of food, bowls and bowls of this white rice. They don’t have any brown rice. I asked for brown rice, there’s nothing there that’s brown rice, quinoa, forget it. So then I started doing some digging because I couldn’t believe how people were lean, and beautiful skin, and a lot of muscles, very active, and even the older folks were very, very energized there. And I really wanted to know their secrets. So when I started digging online, I couldn’t believe that South Korea has obesity rate of 5.8.  Now 5.8 is really low because we know in America it’s pretty much close to 35%.  5.8%, so I’m thinking, “Okay, that doesn’t make sense. They’re eating all this crap. We’re westernizing Korea, but why is it that they’re not at all affected?”  And so I started digging deeper and I started looking at everyone and everyone was eating kimchi, kimchi with their burgers, kimchi with their tacos, kimchi with their pizzas. So I realized the magic was really the kimchi that was affecting and mitigating any of the diseases. So when I got back home, I became a Kimchiologist and all I started doing was looking at kimchi. That was seven years ago. I’ve been implementing kimchi into my patients’ lives. And I started seeing the results that truly backs up the science that I wrote in the kimchi book here, The Kimchi Diet. All the science and majority of the science is in here. And I wanted to share that with everyone, including what it does to immunity.

Dr. Weitz:                           Yeah. I thought it was amazing that in the intro of that book, which was written, what? A year ago?

Dr. Bennett:                       That’s right. Last year.

Dr. Weitz:                           Okay. Last year that you start off by talking about how they had the SARS epidemic in Asia, which was another coronavirus. And this was in 2003. And how the South Koreans did so well, and one of the reasons why was because of the benefits of kimchi for the immune system and even having antiviral properties. So it was just so timely that your whole intro was about the SARS epidemic.  And here we are in another coronavirus epidemic.

Dr. Bennett:                       That’s right. And that’s what was … what I started digging up was that, boy, if we can definitely use kimchi as a way to build our immunity. And what the scientists found was that it actually, kimchi, produces immunoglobulins, immunoglobulin IgA, in the gut, which turns into IgG and which really helps with viral infections. And what they’ve also found was that it pretty much the SARS kind of bypassed Korea. If you looked at a map of the SARS, and I’m talking about the original SARS, the SARS 1, it bypassed Korea because a lot of the doctors really believed, number one, yes, they really cracked down. The Koreans’ ability to crack down and really move fast is incredible.  I mean, when we think about the SARS 2 that’s happening right now, what I understand is they were testing … like they had drive through testing sites.  We have nothing here.  It’s really ridiculous when you compare the level.  And I really hope that Koreans will come out here and start teaching us what to do because that’s what we need state to state because it’s not being done here..

Dr. Weitz:                           But you know what? If I can’t see anything, I don’t think you can teach me. I don’t think it’s a problem here.

Dr. Bennett:                       There you go.

Dr. Weitz:                           It’s going to be gone by next week.

Dr. Bennett:                       Honestly, I think there’s a lot of denial here. People really, they don’t know enough about it. They just don’t know enough of what it is. I’ve already started supporting my two patients who’ve got Corona now, the SARS, Coronavirus two. And one is a 10-year-old child, another one’s in their ’60s. But in California, we’ve got a complete lockdown, as you said earlier, and it’s going to make the biggest difference. But at the same time, I really think we’ve got to use other, food is our medicine and kimchi can do it. Evidence is the loudest voice and the evidence shows that kimchi can definitely help.  I want to ask you something, if I can play something, a little video, if you don’t mind. It’s only a minute and 30 seconds video, but it’s about kimchi. And I found this video … I subscribe to Arirang. It’s a Korean news, Arirang News. And this is a video that I just got yesterday morning…timely. And this was made when the MERS was out. Remember the Middle Eastern Respiratory … that one.

Dr. Weitz:                           Syndrome.

Dr. Bennett:                       Exactly. And this is specifically about how Kimchi with a scientist found out at that time. So it was published in 2015, but it’s specifically about the Coronavirus. So I’m going to show it to everyone here so that you can see … you can get this online. If you go to Arirang, and is A-R-A-I-A-N-G, Arirang News. I think that’s how it is. But you know what? If you can put it in your notes that would be great. So people can watch it directly. But I’m going to go ahead and tell me-

Dr. Weitz:                            [crosstalk 00:15:18] this way, yeah. It’s too bad because through Zoom you can actually share-

Dr. Bennett:                       Oh, you can?

Dr. Weitz:                            Yeah.

Dr. Bennett:                       Shocks. I don’t know if you can see. But let’s see-

Dr. Weitz:                            Well, it looks kind of dark, but let’s see.

Dr. Bennett:                       It does? Maybe you can hear.


Kimchi Combats MERS video from Arirang News

Speaker 3:                           The MERS outbreak appears to be winding down here in Korea as we just mentioned. But research is always a mode of health for new ways to treat viruses like MERS and based on results gleaned from animal testing, a team of researchers here in Korea has found that lactic acid bacteria in kimchi is effective rather in preventing and treating similar viruses. Park Se-young has this report.

Speaker 4:                           Lactic acid bacteria found in kimchi are known to have numerous health benefits. In the past year, Korean scientists discovered its effectiveness in preventing and treating viral diseases like Middle East Respiratory Syndrome. All 2000 pigs infected with Coronaviruses recovered completely a week after they were injected with the healthy bacteria.

Speaker 5:                           Lactic acid bacteria from kimchi protects us from viruses by increasing immune globulin A in the intestine. The body then produces more immune globulin G or interferon gamma to prevent viral infection.

Speaker 4:                           The study conducted by university professors from Korea and Malaysia found that using probiotics as an alternative to antibiotics also produce healthier chickens. The researchers also believe kimchi probiotics can prevent influenza and immune system disorders in humans. At a hospital in Gyeonggi province some patients with respiratory problems are already being administered the healthy bacteria. Once proven effective, the researchers plan to initiate full-scale clinical trials. Park Se-young, Arirang News.


Dr. Weitz:                           By the way, for those of us who are not aware, lactic acid bacteria essentially is referring to lactobacillus acidophilus and similar probiotics that you often see in probiotic supplements.

Dr. Bennett:                       Right. But just to let you know, probiotic supplements compared to fermented foods is like a drop in the ocean. We get probiotics six, maybe you get 12 strains of lactobacillus or in bifidus. But when it comes to kimchi and its number of lactic acid bacteria, you can have anywhere from 900 to over 2000 strains of lactic acid bacteria. There’s so many different kinds that are in kimchi and other forms of fermented foods. Now, there are a lot of different ferments out there. We know that there’s pickles and sauerkrauts, cavas, even chocolate is considered a fermented food. Many, many different countries have fermented food for the same reason that Korea developed and created it, and it was because of preservation of food for long periods of time during wintertime.

But the interesting thing about the kimchi is that there’s three main bacteria. One is Leuconostoc strain. There is another is Lactobacillus. And then the other one is Weissella. And what I found is that, doing the research, that these three main strains are the ones that are very, very powerful in mitigating health issues. I’d love to chat about each one in a … for instance, starting with cardiovascular, it really helps with reducing cholesterol. Amazing for metabolic syndrome, triglycerides, if you have high triglycerides, diabetes, insulin, and sensitivity. I can go on and on and maybe what we can do is just go through each one, so people could understand how important it is to have high levels of the lactic acid bacteria that you get daily, daily.  I get about 300 CFUs per day, 300 billion CFUs, whereas a supplement would be maybe, if you’re lucky, five, 25, and some are a hundred which are super expensive. You know which ones I’m talking about, right?

Dr. Weitz:                           Sure.

Dr. Bennett:                       Right Ben?

Dr. Weitz:                           Yeah.

Dr. Bennett:                       But if you just ate regularly two servings a day, that’s where you’re going to get a great deal of lactic acid bacteria.

Dr. Weitz:                           A serving is like a tablespoon or two tablespoons?

Dr. Bennett:                       I would start … because I put in the book on how important it is to start to seed you little by little because you will start to feel, how do I say, a little war going on in the gut. Because if you’re not used to eating fermented foods, especially Napa cabbage, then you’re going to have a lot of gas and sometimes it creates extra bowel movements. And for some cases who have … constipation’s a great thing. But remember that in my book I give you four phases because the phase is important to slowly inoculate.

Phase one, I tell people to make cucumber kimchi because cucumber kimchi is not a FODMAP food. And if you know what FODMAPs are, those are vegetables that have fermentable carbohydrates. And if you make kimchi with a FODMAP food such as cabbage and I’d say that you could even make it with Brussels sprouts. There’s many, many vegetables you can make kimchi with. But if you make it with those FODMAP veggies, then you’re going to have a lot more irritation. And I just say a window of a lot of gas and bloating. But if you start with a phase one, the cucumber kimchi, then you go to bok choi or mustard greens, then you go to the radish, and then you finally, after six weeks or so, you go into the Napa, you’re going to gently inoculate and then you’re going to start getting some major power in your gut to build your immune system.  And of course help you with all of the different, different conditions that it can with your skin, with your weight for obesity, like I said earlier, it really helps with obesity. It helps reduce cholesterol, LDL cholesterol. There’s a science, everything that I’m talking about, you can find if you go in and look up in the PubMed and look up kimchi and basically all the health benefits. And interestingly, majority of the studies are coming out of Korea because kimchi is Korean food. They also found that kimchi also produces what’s called short chain fatty acids, short chain fatty acid butyrate and propionic acid. Propionic acid is very highly studied in the kimchi and that has really helped as an anti-inflammatory, antioxidant, and a lipid lowering propionic acid. So these are amazing studies.  Now, some of them are animal studies as well, where streaks of cholesterol, and streaks and fatty streaks, I should say fatty streaks out of the Aorta has been literally reduced in animal studies. They found nitric oxide increases, amazing. People with hyperlipidemia, again it lowers that. And biocidin. Let’s go into the biocidin or the bacteriacidin and the viralcidin and effects as well. So if you were going to eat kimchi and use that, I would definitely start slowly, but ramp it up within the next week or so. So you started about two tablespoons, so one tablespoon for lunch and let’s say one tablespoon for dinner. And then you start to ramp it up and I would get to about a half of a cup if your body can handle it.

Right now I have about three different types of kimchis that are just made. I’ve got cucumber kimchi that I’m making and radish kimchi I’m making today because I want high levels. I just dropped some off in my mom’s a doorstep so that she can have it because it’s really difficult. My mom’s 88 year young and she’s doing great, but I want her to continue by improving.  And kimchi, everyone, you can make it at home.  I really highly recommend you making it at home because if you make it at home, then you know you can get organic ingredients and you don’t use any forms of chemicals, or MSG and there are a lot that’s out there that could be MSG added. And then you can make it all vegan if you don’t want. If you don’t want the fish sauce, if you don’t want the shrimp sauce, you make it all vegan by using Kombu, which is seaweed. And I teach you exactly every little detail on how to make it, all the details. There’s amazing pictures all here on what it is and what you look out for.

Dr. Weitz:                           Everybody has a lot of time now. You’re staying at home so you have no excuse why you can’t make your own kimchi.

Dr. Bennett:                       That’s exactly right. I have a kimchi … it’s called The Kimchi Diet Facebook Group and everyone comes on. They show how to make … of course I teach about how to make it, but everyone makes it after reading my book and they show their photos. And there are people that have farms and loads of vegetables. Share your vegetables so that everyone has the ability to make it. I tell this to everyone, it’s in my book, if you can just have solar sea salt. Solar sea salt basically means salt that you have that’s been dried from the sunlight at sea, sea salt.

Dr. Weitz:                           Can you use any kind of salt?

Dr. Bennett:                       No. You cannot.

Dr. Weitz:                           Can you use Redmond sea salt? Can you use Himalayan pink salt?

Dr. Bennett:                       I would not use Himalayan pink salt. And I’ll tell you why. Himalayan is a beautiful color and it has a bit of iron in it, but also that’s the reason why there’s pink color in the mineral content. But the reason why I don’t use that, it’s all sodium based. 95% of pink salt is sodium based. If it’s solar sea salt, sea salt has the most benefit of all of the other minerals. And what am I talking about? The magnesium, the chloride, the potassium, calcium, those are in it. And the sodium content in sea salt is about 65 to 75%, and the rest are healthy minerals. So you want a balance, you want an optimal balance. And if you don’t get the Korean solar sea salt, then you can use Celtic sea salt or Celtic sea salt if you want to use that. You can also use kosher sea salt. So sea salt to me is the number one choice.

Dr. Weitz:                           Can we use the Redmond sea salt now?

Dr. Bennett:                       No. Redmond sea salt, is that the one from Utah? I’m asking you this because-

Dr. Weitz:                           It’s from an old, ancient seabed, supposedly.

Dr. Bennett:                       If this an ancient sea, but I would ask them to give you the actual analysis because most of them have it. If it is lower like 75%, I would use that for sure. I’m not familiar with Redmond. I know about it. I’ve read about it in some book. But anyway, I don’t know because I don’t know the details of it. I’ve only done the details on the sea salts I’m talking about.

Dr. Weitz:                           Okay. Okay, sounds good.

Dr. Bennett:                       But anyway what the whole idea of kimchi is, well, if you’ve got salt, and garlic, and ginger, and then basically have a vegetable, you can do this anywhere in the world without any forms of gas, any forms of lighting, nothing. You can do this outdoors. I can teach you how to do it in the deserts of the Serengeti and in the jungles of the Amazon. It doesn’t matter where you’re at, you don’t have to have anything but that. And of course a jar to ferment it. And the salt is the most important. The brining process, I talk about it in detail. The brining is most important because Ben, if you don’t brine to kill off the bad bacterias and bugs that naturally grow on every vegetable, so there’s Staph and Shigella, Klebsiella, all the bad ones, and E. Coli, then you’re not going to have optimal kimchi.

Dr. Weitz:                           In a sense foods like kimchi is a way to get back to our roots before refrigeration and modern methods of storing food.  We used to use things like salt, brining, and fermentation, and that was the only way to preserve our food.  And there were lots of benefits to these, but we’ve gotten to these modern refrigeration and easy methods of storage, so we’re losing out on a lot of that.  So this is a way to get back to our roots.

Dr. Bennett:                       That’s absolutely true. I mean, our ancestors have been doing this in thousands of years and it works. And now because of modern medicine understands why it’s so good for you because they have the ability to analyze all the bacterias and what the capabilities are, that’s the reason why we want to go back and do it. And like I said, regarding the salt and the brining, if we can get rid of the bad ones, and the salt is a medium that lactic acid bacteria loves lactis acid bacteria or LABs love salt. And that’s the reason why it increases as the time goes on. The sweet spot for me where you have the highest level of bacterias and it really starts at about 21 days, 14 days I start to really … the one thing about kimchi is you can make it and in two days start eating it. You can make it, in two days start eating it, whereas saurkraut, it takes three to four weeks minimum, pickles as well.  So remember kimchi, you can start eating it and get the benefits right away and it keeps on growing.  And those three bacterias I talked about keeps on growing. It kind of changes it’s levels one by one, but it keeps on growing. 14 to 21 days is the way I like the taste because there’s a tang to it, there’s a salt to it, there’s a sweetness to it-

Dr. Weitz:                          If you ferment it too long it gets more sour, right?

Dr. Bennett:                       Sure it does. The pH drops very considerably. The pH can go down to five, six, and even down to three, four the higher you let it go, but that’s okay, Ben, because you can leave it in the refrigerator for six months. I have right now old kimchi and I don’t like the taste of it as much, but I use it for cooking like kimchi … it’s called kimchi stew, kimchi jjigae. When you do cook it, all the benefits are gone. So just know that.

Dr. Weitz:                          I want to make two anecdotal comments. I don’t want to throw you off track, but they’re just things that came to mind. One is the acid thing, is among the nutrition world we’re kind of overboard on alkalinizing, alkalinizing as the answer for everything. And I just want to point out that a lot of the bacteria in our gut need a slightly acidic environment. And so let’s not think that acid is always bad. That’s first comment. Second comment is, we talked about cucumbers and there’s some nutritionists out there saying, “Don’t eat cucumbers because they have lectins.” But it turns out that there is actually some reports showing that lectins actually help to kill viruses. They actually have some antimicrobial activity. So just to throw that in there.

Dr. Bennett:                       Hey, that’s great. Absolutely. These are things that we realize and we want to work around. The reason why I like cucumbers so much is because of the taste. Keeping kimchi is by far what everyone … the Western people love the taste of cucumber kimchi. My recipes are all handed down from generations through my mother’s lineage, my grandmother’s, my great grandma, all of them use these recipes. So these are not my recipes per se. I’ve only changed it so that I don’t use a lot of sugar. I don’t use sugar in fact at all. I use the fruit, apples or pears, so that you have natural sugars. I do want to comment something on why kimchi is also important. The thing about what we have in the Western culture, in America, and pretty much everywhere else who do not eat a lot of fermented foods, is that we’ve got a huge problem of diversity issues in our gut microbiome, very low diversity. We don’t have enough.  And not just that, we have very low Akkermansia muciniphila, which is the good bacteria that’s known to produce mucin, produce a mucus barrier. And without the mucus barrier, that’s where the toxins that we eat, the junk food, the GMO, the glyphosate, the pesticides, the alcohol, the sugars, the viruses, the bacterias, even parasites can all be penetrating through and creating leaky gut. All right? Leaky gut. And that is definitely one of the factors that we all … everyone’s talking about it now of course, that when there is permeability is when we start to have more chronic illnesses and diseases, inflammatory diseases, heart disease, brain issues because we get the lipid polysaccharides going in, the inflammation. And by the way, kimchi is known to reduce the LPS penetration and reduces inflammatory reactions in the brain. That is a study done with people that are suffering from brain issues and Alzheimer’s.

Dr. Weitz:                           You just touched your face now. You have to go wash your hand. It’s one of the hardest things not to touch your face. Right?

Dr. Bennett:                       Honestly, it’s ridiculous. I mean, this is … I’ve had for a long time. This mask, I use it for other forms of toxicity like formaldehyde and stuff.

Dr. Weitz:                           Do you want to play ant woman in a new science fiction film?

Dr. Bennett:                       For the life of me, I can’t find anymore masks.

Dr. Weitz:                           No, you can’t get them right now.

Dr. Bennett:                       There’s nothing, there’s absolutely nothing.

Dr. Weitz:                           They’re telling healthcare workers to put a scarf around their face.

Dr. Bennett:                       Oh God, this is awful.

Dr. Weitz:                           That’s America in 2020.

Dr. Bennett:                       Right now I’ve contacted already Korea to see if we can get some. I’m serious. I’m literally serious because one of my best friends called me and asked me for a mask and I don’t have them.

Dr. Weitz:                           You know what’s happening right now in LA?  The TV hospital shows like ER are actually taking the masks that they have on the set and bringing them to the hospitals because the hospitals are in such short supply.

Dr. Bennett:                       This is terrible.

Dr. Weitz:                           That is what a bad state we are in right now in America.

Dr. Bennett:                       That’s terrible. I’m just hoping that-

Dr. Weitz:                           Totally unprepared.

Dr. Bennett:                       Exactly. If you look at pictures and videos of Korea, everyone wears a mask. Everyone. It’s just the nature of … they understand it. Nobody. I went out and I went out with a white mask and I had these goggles on. These are my fashion, Beverly Hills goggles. And I had gloves on at the Farmer’s Market on Wednesday this week. And I’m going to tell you, I think myself and one of the person out of the people at the Farmer’s Market had the mask. Nobody has it. And it’s a serious thing because 50% of us can actually be carriers. And the reason why I’m wearing it, because last week I saw patients. This week I closed it up and I’m not seeing anyone, but who knows? It could have been two weeks ago that I might’ve been exposed and I’m someone that doesn’t get sick in the 30 years I’ve been in practice. I don’t know about you, Ben, but I haven’t at all missed a day of work in the 30 years plus I’ve been in practice and maybe it’s because I’ve been eating kimchi. Right?

Dr. Weitz:                            Absolutely.

Dr. Bennett:                       That’s it. There’s so many benefits. I mean, I will tell you what? There’s a bacteria because it enters through the nose. Lactobacillus Sakei, it’s called. It’s one of the bacteria that are very high in kimchi. And there are studies where they show where you can actually … I tell my patients to do this. If you make white kimchi, I teach you how to do that in the book. White kimchi, which means no red pepper, no red pepper. Let me tell you something, you know Ari Whitten, right? I love that man.

Dr. Weitz:                           Yeah.

Dr. Bennett:                       I did an interview for his podcast last year.

Dr. Weitz:                           The Energy Blueprint, yeah.

Dr. Bennett:                       Exactly. And Ari I am talking to because I recommend you to put basically the juice of the non spicy kimchi. You don’t have to put red pepper in it, non spicy. You can do all non spicy.

Dr. Weitz:                           So he used the spicy one.

Dr. Bennett:                       Yes. Oh, he said that it hurt like a mother, you know what, hen. But can I tell you it totally got rid of his sinusitis. That and he did get off a dairy. And I’m going to tell you why it’s so important not to eat dairy. Dairy has bacterias that causes acne and phlegm. There is a bacteria that’s in dairy. It can be a natural ferment, like let’s say cheese, right? Cheese. I’m talking more about cheese. Cheese’s a natural ferment of milk, cow’s milk and sheep’s milk, et cetera. But there’s a bacteria called Propionibacterium acnes bacteria. Are you familiar with that bacteria?

Dr. Weitz:                           I’m not.

Dr. Bennett:                       Yup. That bacteria is very high in cheese, dairy products. I treat a lot of skin disorders including acne, eczema, psoriasis, neurodermatitis. I treat a lot of that because my son used to have it when he was young, and so I became pretty much an expert on skin diseases. But anyway, and there’s the bacteria Propionibacterium acnes and that’s super, super … The bacteria that also is on the skin and that causes acne. So if you cut the cheese out, all dairy out, the acne will go down at least 50% of the time. This includes foods that have dairy in it, and I’m talking about sour cream-

Dr. Weitz:                           That’s a Greek critical pearl.

Dr. Bennett:                       Oh, it’s amazing the difference, how your skin will heal. Sugar too.

Dr. Weitz:                           Now what about yogurt? Does that have that same bacteria?

Dr. Bennett:                       Yogurt is different. No. yogurt is more lactobacillus because of the way they use a starter. There’s a difference between yogurt as well as kimchi. Kimchi is a wild ferment. And what I mean by wild ferment, there is nothing you need to put in to start the process. Every vegetable you have in kimchi to make kimchi has its own microbiome. Did you know that ginger has its own microbiome and its own quality of bacterias compared to garlic, compared to the cucumber? On the outside it has its own microbiome. And that’s the beauty of kimchi and all natural wild ferments. Yogurts, the reason why it only has a certain number of bacteria and it’s because of the starter it uses. The starter develops the different kinds of lactobacillus, right? So lactobacillus and streptococcal [thermia 00:39:57], thermophilus, lactobacillus acidophilus, bifidus. So that’s the reason why you want to have wild ferments, not just yogurt.

Yogurt to me, again, is a minimal amount and the amount you get is nothing. Nothing like kimchi, sauerkraut, fermented pickles, the cultured pickles. And to me, vegetable ones are better because you’ve got a whole variety and you’ve got the antioxidant properties. Kimchi is known to be an anticarcinogenic. It has properties like mannitol. Mannitol is anti-carcinogenic. If I remember correctly, they found that kimchi helps with pancreatic cell lines and it reduces that more so than liver apparently between the two. There’s many different studies out there. So many, I must have, I don’t know, went over 200, 300 studies for my book. There’s also very, very good high, high levels of GABA. So if you have anyone who has anxiety, sleeping issues, I tell my patients who have that, you take kimchi or kimchi juice and I teach people how to make kimchi juice.

I have a detox program. It’s called Kimchi Detox program and you can be a student of mine and learn how to make kimchi juice. And is basically I use radish and then a big jar of liquid and it creates just juice and you just drink that every day. If you don’t want to eat the veggies, then drink the juice. If you’ve got FODMAP problems, just drink the juice. It’s like the kimchi cure. I’m telling you, it’s the best gut sealant around. And I was talking about GABA. High levels of GABA. It has a lactobacillus [inaudible 00:42:00], I believe it’s called. So if you take it at nighttime or when you’re under a lot of stress, which is right now everyone’s stressed out, you take a little bit of that and drink it or eat it and that will help with GABA levels. GABA is high in kimchi.

Dr. Weitz:                           GABA is a calming neurotransmitter for those of us who are not aware.

Dr. Bennett:                       Yes, thank you. GABA, gamma-Aminobutyric acid. Now you can buy GABA online and also use it. But they say that the GABA doesn’t cross the blood brain barrier. But I’ll tell you why it works for anxiety is because it calms your gut down, and the connection of the gut brain, and then of course the psychobiotics, which is the good bacterias that make GABA. It’s just promoting that and the connection of the vagal nerve to the brain, parasympathetic nervous system and the gut, that’s where you’re going to have it work. And it works. I’m telling you GABA works. And if you combine it with L-theanine, you even have a much better reduction of anxiety. I also, for anxiety, use other nutrients like low levels of lithium, micro dosing lithium as well as some zinc and B6. And that combination is just powerful in addressing anxiety. So I can go on and on about the health benefits.

Dr. Weitz:                           So let’s see. I think we’ve got about 10 more minutes left. I know you wanted to maybe talk about some nutritional recommendations to strengthen our immune system since we’re in this Coronavirus pandemic.

Dr. Bennett:                       Oh, absolutely. I’m a big believer in supplements and the reason is because our food that we have and most of us eat out, we bring food in, take out. We don’t have the opportunity because people to work. We all work across America and everywhere around the world, our mother and father.

Dr. Weitz:                            [crosstalk 00:44:03] that is, we did before yesterday.

Dr. Bennett:                       This is going to pass. This is going to pass.

Dr. Weitz:                           I know. I know.

Dr. Bennett:                       I know there’s a lot of hysteria about millions of people, but if everyone, everyone globally, everyone in America will stay home for the next two to four weeks, then we’re going to contain this virus. There’s no other way and we’re going to contain it for sure. We really need to buckle down and don’t go out. I’m telling all my patients to only go shopping once a week and having everyone wear their garb. There is what’s a seriousness about fomites. Do you know what fomites are.

Dr. Weitz:                           It is part of how the virus spreads, right?

Dr. Bennett:                       Well, you’re absolutely right. It does spread that way. But fomites are anything inanimate, inanimate objects, not a human person, but objects that can actually keep the virus alive or any infectious agent. It can help spread it, a purse, a phone, your sunglasses, clothes, things like that. Those are called fomites and fomites, depending on what it is, it can keep the virus alive a specific amount of time. And like cardboard is a certain amount of hours, stainless steel clothes. So I recommend person who goes out once a week for the food, you get your mask as much as you can or whatever to … you can use a Gator. Let’s say a Gator is like when you go skiing, you put it on your face. Get goggles because you don’t want any type of virus going in. Remember, in your eyes there’s a tube that that goes in the tunnel that goes in from your eye, the duct that goes into your nose. So it’s all connected, all connected.

So goggles, mouth, and wear your gloves, and clothes. And I would say that I would layer it and I’m going to tell you why. Because when you walk back in, before you do that, you take off all your top layer, take it all off. All right? Because those are fomites. Fomites again, carry the infectious agent, anything that’s inanimate. So it’s important that you do that. And if you do that, then the likelihood of you contaminating indoors will be much, much less. So social distancing is important and the recommendation that I make for all my patients to what kind of supplements to take to keep their immunity strong so that they start to create T-cells and immunoglobulins to be able to fight off this virus. And of course, this is a new virus and a lot of people have not been exposed yet, but some of them actually have and they don’t even know it.

Some of them have been exposed and, like I said, 50%. We just don’t even know it. And if you take the following supplements, it’ll make a huge difference. For instance, vitamin D. We don’t get enough vitamin D and I like high levels. Right now you can do about 10,000 IUs a day. That you could take daily so that you can build your immune system. A vitamin A, I love vitamin A. And vitamin A, you could go up to 5,000, even 10,000 per day. Not longterm, because it can be toxic. Both vitamin D and A can be toxic, but at 5,000, 10,000, that’s not going to happen. And then I love zinc. I like zinc lozenges. Vitamin C, of course. Vitamin C IV drips are great, but you can use vitamin C liposomal which delivers much easier.

But I love Ultra Potent-C from Metagenics. That’s my number one go-to because it’s been tested by Dr. [Bhojani 00:47:58] many, many years ago. This must have been 20 years, 25 years ago, Bhojani did with immuno science a test on the natural killer cells, increasing natural killer cells, increasing by taking Ultra Potent-C. Yeah, he and I talked about this I don’t know, three, four years ago we were chatting about it, how long I’ve been taking it. And I knew about it because I read a very old study that he did. Anyway, let’s go into selenium. Many years ago I’ve been using selenium because it works like a … how do I say? It’s like a viral control, birth control for viruses. Yeah, that’s what I called it for a long time, birth control for viruses. But apparently it also reduces the spread of the virus, mitigates the spread.

So anyway, I think selenium is a really great product, maybe a hundred micrograms twice a day, which is what I tell my patients. And then I’m a big believer in immuno acid therapy, mine is called Super 8 Aminos. And amino acids, why is it important? Because all of your immune factors are built through protein synthesis, every one of them. And if you don’t have amino acids, then your ability to build your immunity is altered. So I highly recommend that. I love Isotonic by Kington and that really helps with your gut, microbiome, and the flora, the terrain, and support of micro nutrients, minerals. I’m also a big fan of the ion, which the old name is RESTORE liquid. This is Zach Bush’s work. And I love that because it does help again with the leaky gut and the tight junctions as kimchi does as well.

Kimchi’s known to tighten up those junctions. So use that because remember the mucosal, the gut, you can eat it and it can still get into your body. All right? Because the ACE receptors are also in the gut. It’s in our respiratory mainly. It’s also even in the kidneys, small intestine in our gut. So it’s important that you’ve got to protect your gut. And then let’s dig into … I like herbal remedies for boosting your immunity. Of course, Elderberry, Echinacea, things like that. But antivirals, I love olive leaf. If you don’t have the virus, if you don’t think you have it, and you don’t have any symptoms, you can do a very mild maintenance dose of olive leaf and Andrographis. Andrographis is also really good for viral infections. I love Viragraphis by Xymogen, but I’m all out. I’m getting some more, which is great.

But what’s great about of Viragraphis is it has licorice root in it. And I’m going to tell you why licorice root is so important. One of the problems about this SARS-CoV-2 is that it accelerates very quickly in an autoimmune type of condition where your own immunity fights for the virus and it tags it, but it also attacks your own tissues. And that’s the reason why all the lungs end up being loaded with your own dead tissue. And that’s how white people need to be on ventilators and possibly die. You literally die in your own juices. So the thing that mitigates that is anti-inflammatory agents, but not NSAIDs. And Ben, you know this too, you told me a part of this as well, not NSAIDs. NSAIDs are ibuprofen, Motrin, Aleve, things like that, that reduce inflammation because apparently that actually effects and could spread the virus more.

But I’m talking more about corticosteroids. Natural cortisone is what you need and we all have it, and it’s called cortisol in our own body. And what licorice root does is that it stops the breakdown of cortisol and it keeps the cortisol around longer. And Viragraphis has both the Andrographis and the licorice root. Now, I never give this to anyone who’s got high blood pressure. If you have high blood pressure, licorice root is contra-indicated. So please do not take it if you’ve got high blood pressure. But you can get Andrographis.  It’s a natural herbal formula. You can get Andrographis.

And before I finish, black currant, black currant seed oil and black currant seed extract. I use GMO base stem cells. I like plants’ stem cells because it’s super powerful. You got the stem cells of the bud of the plant and that’s like major power. We all know what now stem cells are. And so I use plant stems a lot. And black currant will do the exact same thing similarly to the licorice root. But before I’m done, we have got to talk about antioxidants such as glutathione and a precursor NAC. I highly, highly recommend glutathione. I like the watermelon flavor because it tastes the best. And that’s my research nutritionals. It comes in a yellow tube and I use a teaspoon twice a day right now. That’s the dose I use and that’s about 450 milligrams twice a day. And so it’s a high dose. But if you’ve got genetic issues where you can’t make glutathione, for instance, as of myself, then you are going to have more viral infections, so I use that powerfully.

Dr. Weitz:                            And by the way if you’re taking Tylenol because you have a fever or you’re using it for pain because maybe you’re avoiding your ibuprofen because ibuprofen makes it easier for the Coronavirus to attach and you may get a worse response. So you avoid your ibuprofen, you take your Tylenol, Tylenol actually lowers your body’s production of glutathione. So beefing up your glutathione production through glycosomal glutathione or you’re just about to talk about NAC is even more important for that reason.

Dr. Bennett:                       Oh, absolutely, because NAC is the precursor, right? It makes glutathione, so you want optimal levels of N-Acetyl Cysteine. There’s so much more I can go over, but these are the basics that I tell people to get. And then you just got to avoid it, and wear your protection, and eat real food. Make your own kimchi. Kimchi makes glutathione. The studies show that the glutathione levels just spike up when you eat kimchi and they’re finding that in Korea. They’re using it for Alzheimer’s cases because glutathione levels are super low in people who’ve got dementia and Alzheimer’s. But you know what? We need glutathione altogether all around, all around.

Dr. Weitz:                           Absolutely. One more hand for everybody out there. As much as we need to be informed, don’t watch the news all day and especially don’t watch it at night because you’re going to have trouble sleeping.

Dr. Bennett:                       That’s correct. There’s one other thing that I don’t like using hand sanitizers, Ben, because of the chemicals and toxicity in the hand sanitizers, Triclosan is one of them. But anyway, what I use is I use a gel. I like the Silver Silent Gel or Silver Sol Gel. It’s called Silver Sol Technology. There’s a lot of different types of labels that use this. The gel works just as good. It’s more of an expensive product than regular hand sanitizers. But Silver Sol Technology, it kills off all the bad bugs, including viruses within 60 seconds, but it doesn’t get rid of the lactobacillus bacteria. And Dr. [Pedersen 00:55:50] mentioned that in one of his old videos and that was brilliant because we all have lactobacillus bacterias and good probiotic lactic acid bacterias on our skin. So we want to protect that. And Silver Sol Technology products will prevent that from … you won’t kill it as the hand sanitizers do.

Dr. Weitz:                           Awesome. Awesome. Great information. Rapid Fire, great clinical pearls. Thank you so much Dr. Bennett.

Dr. Bennett:                       You bet. You bet Dr. Weitz. I love you guys. i love everyone. You take care.

Dr. Weitz:                           Tell us about your contacts real quick.

Dr. Bennett:                       Everyone can go on my website, drsusanne.com, is at D-R-S-U S-A-N-N-E.com. And I think right now you can get information about the kimchi. There’s a pop up. Please sign up because I’ll send you more information about what to do and how you can get into The Kimchi Diet Program, et cetera. But also my recommendation is get the book, everyone make your own kimchi. You will be able to find my email and my phone number to the office. I take care of people. I take care of people. I have consultation all around the world. I’ve been doing that for the last two years, three years now. So most of my patients, in fact, I don’t go to the office much, majority of the time it’s on the phone. So I consult with everything on the phone and I’ll be able to help you boost your immunity, get your energy back, get rid of all of your problems that we’re all suffering from throughout the world. But most importantly right now, let’s get you and your family safe and healthy. Okay?

Dr. Weitz:                           That’s great. Thank you so much, Susanne.

Dr. Bennett:                       Thank you, Ben.

Dr. Weitz:                           Be safe. Talk to you soon.



COVID-19 with Dr. James Lyons-Weiler: Rational Wellness Podcast 148

Dr. James Lyons-Weiler discusses the COVID-19 global pandemic and what to do about it 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  This new Coronavirus is different than other coronaviruses, such as the ones that previously caused the SARS (Severe acute respiratory syndrome) epidemic in 2003 and the MERS (Middle East Respiratory Syndrome) outbreak that started in 2012, in various ways, including the distinct spike protein that the virus uses to enter its host cell. These spike proteins bind to the ACE 2 receptors on the cell membrane and this allows the envelope to open and allow the virus to enter the cell and then make more viruses that spread from cell to cell.  This virus has a 4-5 day incubation asymptomatic period and about 80% of people have mild symptoms. But about 14% require hospitalization and a lot of these need intensive care and help with breathing, including a ventilator.  We have instituted social distancing, but we are at least 3 weeks behind the curve due to the fact that the number of positive cases are increasing dramatically, exponentially.

8:00  During the incubation period, you have the virus in your system and if tested, you should test positive. However, the test that the CDC came out with is only about 60% sensitive, which means that a lot of people are getting false negatives.  The US appears to have made a mistake by not using the German test that the WHO offered the CDC and instead the CDC developed their own test that took several weeks of lost time and this may be because the CDC is more like a business corporation than a regulatory regulation.

9:39  The value of coronavirus testing at this point is not to shut the virus down.  We have made our testing available too late to utilize the South Korean model where they were able to identify and isolate each case and all their contacts. But in the US at this point, it has spread too far to really contain it. Testing can help us to allocate resources and to let us know how much time we have to be able to get the supplies and resources that hospitals will need, like intensive care beds, protective equipment like masks, and ventilators. The point of social isolation like we are doing is to slow it down till we can increase our hospital capacity.

14:00  Even if we are asked to quarantine, like California’s Stay At Home rule, you can still go to the grocery store and the pharmacy and there is no reason why you need to horde 3 months of food. And the roof of your house is not going to blow off and the water supply will still work, so there is no need to stock up on water bottles.  On the other hand, stocking up on food does drive the economy a bit.

14:55  In China they were able to flatten the curve through a combination of social distancing and therapeutics. And there is no vaccine in China and they have essentially stopped the spread of this virus.  Forget about waiting for a vaccine and the first trial for a vaccine that is being tested in Seattle is using the spike protein, which is why it may have a high mortality rate, since some of the proteins are very similar to immune system proteins, so it might trigger autoimmune conditions.  When this type of vaccine for SARS was tested on animals, there was a much higher mortality rate due to the autoimmune reaction.

19:40  In Italy we are seeing very high morbidity and mortality right now.  One reason is that Italy has an older population and a lot of people smoke there. If you have a cardiovascular issue, which is more common in older folks, you have a 10% chance of mortality. If you have diabetes, also more common in older folks, you have 6% mortality rate.

22:30  Dr. Lyons-Weiler emphasized that we should contact our US Senators and Congresspeople to push for using convalescent plasma therapy as one of the strategies to help us get out of this COVID-19 crisis. You take blood out of a patient who has been sick and recovered and isolate the antibodies he has built up and these antibodies become a biological product and they can be given to front liners, the military, and the medical staff and they are given a dose of these antibodies, which gives passive immunity. Johns Hopkins University is currently conducting a clinical trial on this therapy with coronovirus patients. If all we do is social distancing for too long, it will completely destroy our US economy. And waiting for a vaccine will take too long, even if it works.  We need to look at other therapeutics, like remdesivir, made by Gilead, which has some value against Ebola, chloroquine phosphate, and other antivirals.  Also, the Chinese have been using high dose IV vitamin C, which appears to have a protective effect by reducing viremia, the number of viruses in your body, so you can’t transmit it.

26:30  There is a huge variance in mortality rates from one country to another. In Italy the mortality rate is 7.7%, whereas the fatality rate in Germany is 0.23%.  Italians tend to be older and smoke more.  Also the soil in Italy has less selenium since Germany was glaciated and deglaciated 16 to 18 times during the Pleistocene period, whereas Italy was not.  Selenium supplementation might really benefit the Italians.  Also, there are a slow and a fast version of the coronavirus with the fast version coming out of Hubei province in China, which is what might have ended up in Italy, and a slower version that resulted from mutations that came from the rest of China.  There are also genetic factors.  Smoking definitely increases your susceptibility by increasing the production of ACE 2 proteins.  Also, if you are on ACE 2 inhibitors or ARBs for blood pressure (like Losartan, eprosartan, and irbesartan), these also make it easier for the coronavirus to enter your cells and increase your risk of a more severe response.  Also, taking non-steroidal anti-inflammatories, like ibuprofen, also worsen your response.  On the other hand, taking corticosteroids actually seem to help, which indicates the significant autoimmune component. 

30:33  Unfortunately taking Tylenol (aceteminophen) might not be a good alternative to NSAIDs, as the health minister of France has recommended, since when you get an infection, your body produces cellular toxins and glutathione is crucial for your detoxification system to get rid of the toxins.  Aceteminophen suppresses the production of glutathione. This is a good reason for taking either supplements of liposomal glutathione or N-acetyl cysteine, which is a precursor for glutathione. It also might make sense to take selenium, zinc, and glycyrrhizin (from licorice extract).


Dr. James Lyons-Weiler is a PhD researcher and the founder and CEO of the Institute for Pure and Applied Knowledge, a not-for-profit research institute, also known as IPAK. He is the author of three books, one on Ebola, Cures vs. Profits, The Environmental and Genetic Causes of Autism, which was based on over 2,000 peer-reviewed studies on autism. His website is IPAKnowledge.org.

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


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. 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 Podcasts and give us a ratings and review. If you’d like to see a video version of this podcast, please go to my YouTube page, weitzchiro, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today, we will be discussing the coronavirus pandemic with Dr. James Lyons-Weiler. COVID-19 is the disease caused by the infection with the coronavirus that has made its way from a bat to humans in China and now has spread around the globe creating a global pandemic.  Dr. James Lyons, is it Weiler or Weiler?

Dr. Lyons-Weiler:           Weiler.

Dr. Weitz:                       Weiler, thank you. Sorry about that. Is the founding CEO of the Institute for Pure and Applied Knowledge, a not-for-profit research institute, also known as IPAK. He’s the author of three books, one on Ebola, another on Cures Vs. Profits, and a third on The Environmental and Genetic Causes of Autism which is based on over 2,000 peer-reviewed studies on autism.   Thank you, Dr. Lyons-Weiler, for joining us today.

Dr. Lyons-Weiler:           Thank you, Ben. It’s a pleasure to be part of your experience here on this planet.

Dr. Weitz:                       Thank you, and that’s definitely a good way to phrase it on a day like this when living in Los Angeles and trying to run a chiropractic practice, and people are afraid to come out of their house, and the level of fear, panic and anxiety seems to be rising by the minute. So, let…

Dr. Lyons-Weiler:           You mean, you guys haven’t figured out all you have to do is put a shower curtain between you and your patient and you’re fine like in the movies?

Dr. Weitz:                       So, I thought we’d start with the most important question and that is what part does drinking Corona beers play in this coronavirus pandemic?

Dr. Lyons-Weiler:           I think it’s an essential part. You get the most clear-headed, rational thoughts that come to you. It doesn’t necessarily have to be Corona either.

Dr. Weitz:                       Oh, okay. So, can you explain how this coronavirus… Because we’ve had other coronaviruses before. We had SARS and we had MERS. Can you explain how this coronavirus is different than the other coronaviruses?

Dr. Lyons-Weiler:           Absolutely. On that topic, I’ll be talking about published research and not yet published research. So, in a published research, we know that there are genomic differences that’s at the genome level. And in important parts of important proteins, there are large differences. The spike protein seems to be quite distinct. The spike protein on the coronavirus is the protein that sits on the surface of the virus that allows entry. The virus uses it to enter into the host cell and this partic-

Dr. Weitz:                       Is that when we see those diagrams and those things sticking up?

Dr. Lyons-Weiler:           Yup, exactly. Exactly, so those actually bind to a protein on the surface. It’s called an ACE2 molecule in this virus, and it then fuses to the cellular membrane, and then the envelope opens up and becomes part of the cellular membrane, and then the contents of the virus which is RNA is spilled into the cell. The RNA is seen by the cell as any other RNA and then it starts creating viral proteins. So, then you get a new virion or population of viruses in the cell, and then the cell bursts, and then the virus is spread from cell to cell.  This particular virus has a spike protein that has a number of unique characteristics. There’s a new nature study that I just finished looking over this morning that shows that the spike protein has distinct… Well, it’s citing some previous literature. It has a virion cleavage site which we’ve known about for about two, three weeks but it has a number of distinct elements including one that appears to potentially help the virus target immune cells.

My own research, and this is the unpublished part of it because it’s still under peer review, my own research shows that there is a protein motif signature that is characteristic of this particular spike protein. There are four elements that we’re paying attention to, and it seems to have… And I want scientists to understand this. It has a truncated N-terminal domain in the spike protein, in the first part of the protein that’s unusual compared to other SARS and other related betacoronaviruses. And then it’s missing two other domains that appear to be present in all other coronaviruses that are related to this. And then it appears to have a gp40-like domain. I will say gp40-like domain because it is not a gp40 domain.

So, there are very specific molecular differences in the spike protein. It’s going to have a different molecular function, therefore, because the sequence determines the structure, which determines the function. With that, clinically then, this is a different virus because this virus has a four to five-day asymptomatic period. So, you can get infected and then four or five days later before you have your first symptoms. About 80% of people could be expected to have mild symptoms, but the people that do have serious symptoms, 14% need hospitalization and 66% need an ICU.  So, we’re at the onset of the outbreak here. We are at least three weeks behind where we could have been with accurate testing, initially. We really, really missed the ball in accurate testing, but nevertheless, we’re in the exponential part of the curve. And during that exponential part of the curve, it’s a race between the ability to produce enough tests and the virus to spread. And so, now, we’ve enacted some pretty serious social distancing, if you’ve noticed. It’s impacting everyone’s lives now.

Dr. Weitz:                       Yes.

Dr. Lyons-Weiler:           And two months ago, I was saying that we should stop shaking hands. We should start using the Ebola fist bump and so on. We need to sanitize public places. We need to tell people that are not essential to work from home if they can. And had those policies been implemented then in a gentle way, we would have bought more time.  But now, we’ve already reached the exponential curve. And in the exponential curve then, even 60% on complete quarantine with this virus will not lead to a shutdown. You can force quarantine 60% of the American population, it’ll spread.

Dr. Weitz:                       So, I’ve got a bunch of questions, but one question I wanted to ask to follow-up on the fact that you said there’s this incubation period. During that incubation period, if you get tested, would you potentially test positive or not until you become symptomatic?

Dr. Lyons-Weiler:           Those high levels of viruses in the presymptomatic period or the asymptomatic period, unfortunately, the test that the CDC put out is maybe 60% sensitive, which means that there’s a lot of people that are going to be getting false negatives.

Dr. Weitz:                       Wow.

Dr. Lyons-Weiler:           Yeah, a lot of people are going to be given false confidence that they don’t have the virus and that’s why we’re where we are. I analyzed the CDC’s primer/probe sets and I found that a quarter of them actually amplified human proteins or likely to amplify human proteins as well as a viral protein which could… Unfortunately, the way they set up the test, it was best three out of fours amplification reactions as a diagnostic. So, if a person didn’t have… They basically needed three out of three, because one the primer/probe sets, that reaction was probably not going to lead to a true positive effort. And so, they said that there’s some contamination or something like that, but I sent this information to CDC, and then I sent it to the FDA and they showed great interest. The FDA showed great interest in what potentially could be wrong with this kit.  Now, because we’re already in the exponential part of the curve, places like the University of Pittsburgh Medical Center have announced that they’re making their own test. People are not waiting. We cannot wait for the CDC to distribute accurate testing. That’s what people have decided. I think it’s a clinically ethical thing to do, to want to know…  The value of testing at this point is not to shut it down.  Make no uncertain terms… Don’t be confused by this.  If we have 100 or 200 cases or 1,000 cases, for every one case, there might be 80 to 100 more cases that are out there that we don’t know about.  And so, there’s no way that the medical community is going to find all those people at this point.  We’ve lost contact tracing. The asymptomatic period, contact tracing is not going to be useful.  The only utility of testing at this point forward that I see would be expeditious use of resources, like ICUs.  So, we need really accurate testing. We need ventilators. There are projections….

Dr. Weitz:                       How can we know where the curve is to decide upon strategies?  Like how long are we going to do social distancing and quarantining or whatever you want to call it unless we really know what the numbers are, and do we even know to what extent the numbers are going up?  Or just the fact that we’re testing all these people who maybe were already positive and …

Dr. Lyons-Weiler:           I’ll take that question as a serious one. There are two countries that we could have followed the model of. One is South Korea. We cannot follow the South Korea model. It’s too late. We already reached the exponential point. They did expert contact tracing with online information systems that were really exquisite. They did testing, testing, testing. They had it in place in time.  It’s too late for us to have a serious impact in terms of slowing down the spread of this because we have… For every case that you see right now, that person was also… Four to five people five days ago were also infected along with that one person. So, we’re looking at, of the number of cases that we have, we maybe may know 20% of what we have.

Dr. Weitz:                       Wow.

Dr. Lyons-Weiler:           So, because we don’t have the contact tracing combined in parity with the clinical testing and the test that people are being shipped is not accurate, that is …

Dr. Weitz:                       How did that happen? Why is there such a massive screw-up on the testing? Why were we so late with the testing? Why didn’t we take the World Health Organization test, and what’s the screw-up at the CDC?

Dr. Lyons-Weiler:           Unfortunately, CDC is more like a business corporation than it is a regulatory agency. They have a not for profit that pharmaceutical companies donate over $27 million to every year in the name of doing good for humanity. However, the World Health Organization offered the CDC the German’s test, the test from Germany, and they declined and that cost us a valuable, incredibly valuable, two weeks. And I was hammering on, “No, we need to get the testing now. We need to get the testing now.”  The other country whose model that we… Where do we know where we are in the curve?  Well, we know we’re exponential. We know we’re only seeing maybe 20% of the cases that are actually residents in the country. We don’t know where they are. We don’t know who they are. They include medical staff right now. They include nurses. They include the doctors and so on. They include taxi cab drivers. They could be anyone.  And the point is, not to scare people, but China did not wait for a vaccine. China used social distancing. They put the people at home and if you broke quarantine, you were arrested. That’s why you saw people arrested. People say, “Oh, my God. That can’t ever happen here.” Believe me, every governor in every state will prosecute you if you’re under mandatory quarantine and you’re found to violate the quarantine. You will be arrested. You will be tried. You could be fined and put in prison, absolutely. Okay? So-

Dr. Weitz:                       But to this point, we’ve never had mandatory quarantine, right?

Dr. Lyons-Weiler:           I think San Francisco is now pretty close to that. Pretty close to where everybody is supposed to stay at home, right?

Dr. Weitz:                       Well, my son’s in San Francisco right now going to college. So, they’re basically told they’re supposed to stay at home except for important things like going to the grocery store.

Dr. Lyons-Weiler:           Okay, right. So, we’ll get to that. Right. So, a quarantine does mean that you have to have three months of food in your house, right?  It means it’s a good idea to have a week or two, but here’s the deal. China shut this down.

Dr. Weitz:                       And we’re not going to… The water supply is not going to be jeopardized.

Dr. Lyons-Weiler:           The roof of your house is not going to blow off. It’s not a hurricane. You’re going to have electricity.  Okay?  The wastewater treatments are still going to work. Okay? So, the utilities will all be there but in China, they shut this…

Dr. Weitz:                       So, stop stocking up on water bottles.

Dr. Lyons-Weiler:           If it makes you feel better, there’s that aspect of it. If you like to see 20 cans of sardines in your pantry, go for it if it makes you feel better. You’re not hurting anybody by doing that. So, you’re actually driving the economy a little bit. That’s an actually very serious point. There’s kind of a silver lining here.

Dr. Weitz:                       No, I know. The supermarkets are booming right now.

Dr. Lyons-Weiler:           So, in China, they shut this down through a combination of therapeutics and social distancing. They didn’t just use social distancing, and there’s no vaccine in China. They shut it down. And let me show you a curve. Okay?  China was doing this. And we’re now talking about extending the curve out, flattening the curve out so that the medical community has time to be able to prepare to handle it. China’s curve went just like this. They ended it.

Dr. Weitz:                       I know. I just looked at it on the map. Can we trust those statistics?

Dr. Lyons-Weiler:           Yes. Yes, we can. The doctors were taking their… Yes, we can. The doctors were taking, the nurses were taking their masks off. People are showing up in the streets. You’re going to see a video over the next few days or next week of Wuhan itself returning to normalcy. And that’s what we want because we cannot afford an extended social distancing. It will destroy our economy to maintain social distancing.  And there’s no promise that the vaccine that’s being tried right now in Seattle is going to show the safety profile that it needs to. I’m very, very skeptical that the animal studies… They skipped the animal studies and they went right to human trials.  The problem with that is that the animal studies in every other SARS-like, MERS-like vaccine that used the spike protein, the animals getting the vaccine when they were challenged with the virus after the vaccine had worst clinical outcomes, higher morbidity, higher mortality. They had immunopathology in their lungs. They had hepatitis. They had serious issues and I think it’s an autoimmune reaction, that you get sensitized to it by the vaccine, and then you get challenged by the virus.

So, I did a deep dive into the epitopes that are in the virus in SARS-COV2. And the deep dive that I did showed that out of the 37 proteins that I studied, all of them except for six had immunogenic peptides. So, there’s six of them that won’t be useful in a vaccine. Out of all of those that had immunogenic peptides, all of them except for one had a match to a human protein, and a third of those matches were two immune system proteins.  So, that’s probably why these animals had a worse outcome because their own immune system was being attacked by their own immune system after they were challenged by the second virus. It’s a two-hit hypothesis. People are calling it immune enhancement, which it’s a misnomer. It’s a gross misnomer. We’re changing the terminology to pathologic priming where the first exposure to the virus sets you up for worse outcomes whether it’s through clinical exposure. You get a double infection and you get the SARS virus this year. You get another SARS coronavirus next year, whatever the second exposure is.  And I think that probably explains why the mortality was so, so, so high initially in the Hubei Province and in Wuhan because the people there had been exposed to coronaviruses for years. And yet, the national vaccine program that was mandatory, a widespread vaccine program, only got started on December 1st.  So, you’ve got people that are exposed to this virus while their bodies still has adjuvants from the vaccines in them. In many cases, multiple adjuvants and so…

Dr. Weitz:                       Wait a minute. So, starting in December, they were vaccinated with which vaccine?

Dr. Lyons-Weiler:           They just started a national mandatory vaccine program. It was to do…

Dr. Weitz:                       For this novel coronavirus?

Dr. Lyons-Weiler:           No, no, no, no, no. No, just for vaccination programs for the pathogens.

Dr. Weitz:                       So, did they get immunized against SARS?

Dr. Lyons-Weiler:           No, they don’t have the SARS. Not to my knowledge. That was my initial concern. So China, a company called Sinovac, actually in the 2000s did a vaccine safety phase one trial on humans. They did a vaccine trial on humans. I think they had 45 participants. I’ve never seen a phase two or a phase three, but my initial suspicion, because the mortality was so high, I couldn’t believe that a super coronavirus could possibly lead to such high mortality and morbidity.  And people are saying we can’t trust from China what’s going on. No, it’s real and if it’s that high, what possibly could have caused it. And I suspect that perhaps the Chinese had on December 1st started a secret phase two or three clinical trial in Hubei Province with a SARS coronavirus, setting people up unbeknownst to them, for this pathogenic priming a.k.a. immune enhancement.

Dr. Weitz:                       Wow.

Dr. Lyons-Weiler:           I’m not sure if that’s real or not, but I know they didn’t do that in Italy. So, Italy has high morbidity. If you want to talk about the risk factors, about who’s most likely to get truly sick and die here, there’s a linear relationship between your age and your risk of serious illness, critical illness, and death. If you’re above the age…

Dr. Weitz:                       Is that mainly because older people a) are more likely to have cardiovascular or respiratory problems, and because they’re more likely to have immune issues?

Dr. Lyons-Weiler:           I think that’s probably a big part of it because if you have a cardiovascular issue, you have like a 10% chance of mortality.  If you have diabetes, you have a 6% chance of mortality. What are we doing here in the United States with such a high rate of what we call metabolic syndrome?  We’re sitting ducks for this virus.  So, we absolutely have to shut it down or we’re going to see mass mortality… Like 6% of people, people who even have…

Dr. Weitz:                       Well, if you don’t believe in exercise and you’re just going to sit around and eat Big Macs and tweet all day, then there you are.

Dr. Lyons-Weiler:           Absolutely. Think of all the people that you know with diabetes and imagine 6% of them getting this virus and dying. That’s a serious amount of morbidity and mortality. There are other underlying conditions. People that get the virus one time can get infected again, and it appears that they can suffer from myocarditis and die, some of them.  And we don’t know if that’s due to direct effect…

Dr. Weitz:                       So, you’re saying you can get it again the second time?

Dr. Lyons-Weiler:           Unfortunately, some people appear to. Yeah, there’s multiple reports from multiple countries….

Dr. Weitz:                       Because, theoretically, once you get a virus, then your body builds antibodies to it, right?

Dr. Lyons-Weiler:           Correct. And remember, I just talked about how there’s this pathogenic priming.

Dr. Weitz:                       Cross-reactivity to your own immune cells.

Dr. Lyons-Weiler:           Right, so the patients in the ward next to you actually… If you had checked me with the SARS-coronavirus-2 and then I’m sick for a live one, and then I’m sick for a week or so, and then you isolate the virus after I’ve been sick for a week or so, you’re going to see a different virus. There’s huge amount of selection to adapt to my immune system.  Plus, this corona virus is always recombined. If there’s more than two types of coronavirus in the same animal or the same body of a human, the very nature of their transcriptional process means if you had one cell infected with two types, they recombine. You get a new virus.  So, we don’t really know what’s going on, but we know that there’s probably a huge autoimmune component. So, if you have cellular myocarditis because you’ve got cellular infiltrates like eosinophils in other aspects of the immune system, you could end up with a very serious death rate of people who get a secondary infection.  And that’s why I am proposing very, very strongly, and we’re about to go huge with this, that everyone should contact their congressional representatives. I’m talking federal, not state, and everyone should contact their senators and say that we need the CDC, the NIH and the FDA to get behind convalescent plasma therapy now. There’s going to be so many people that survive from this. They’re walking around with antibodies …

Dr. Weitz:                       Okay. Can you explain what convalescent plasma therapy is?

Dr. Lyons-Weiler:           Absolutely. So, let’s say that I had the sickness and I get well again. I have the antibodies. So, I donate a liter of my blood and then you isolate the antibodies, and then those antibodies become a biological product. That biological product is screened for other viruses to make sure that I’m not carrying HIV or something.  And then if you’re a front liner, or if you’re in the military, or if you’re an EMT or a medical staff, you’re given a dose of those antibodies.  It gives you a form a passive resistance and it works.  There’s great… Ten out of 10 patients in a recent study on this came out great.  Ian Lipkin, who’s a world renowned virologist, has announced that John Hopkins University is entering into a clinical trial.  I think we need everybody to ask for 50 clinical trials now in all 50 states.  Most of the money that’s afforded to the CDC, the $8 billion is allegedly, I guess, going towards distribution of tests and vaccines.  And the problem is, if we wait for two months, people are losing their houses.  People are losing their jobs.  People… We’ve only been under partial… kind of like a hint of social distancing for two days and the world’s falling apart.  How are we supposed to do this for two months or let alone 18 months?  We cannot.  It will destroy our economy to wait for a vaccine. Absolutely.

Dr. Weitz:                       And by the way, I believe that that phase one trial that’s going on is going to continue for like a year or something, right?

Dr. Lyons-Weiler:           Yeah, it’s absolutely ludicrous and it’s unbelievable. I’m not going to be too critical, but it’s unbelievable that knowing the plasma convalescent therapy is an option, that the bulk of the money is going towards things like testing when we need to shut down…  Let me make the following prediction. The way that this epidemic, this outbreak in the United States, this pandemic will end, it will not involve a vaccine. It will end through a combination of social distancing and therapeutics. There are antivirals that pharma will be asked to start mass-producing, like remdesivir and chloroquine phosphate which is an anti-malaria drug, and others. There are supplements that are very important that people have, like selenium. If you’re selenium-deficient, the virus can enter your cells more easily.

High-dose vitamin C, the Chinese used that as well. They used vitamin C and it appears to have a protective effect by reducing viremia, the number of viruses in your body, so you can’t transmit it. It’s very, very important that we understand that this epidemic, this outbreak, will end through a combination of social distancing and therapeutics.  Social distancing alone will just destroy our economy, and we’re not going to let 20% of our elderly people die. We’re not going to let 6% to 45% of Americans with diabetes die. And we’re not going to let 10% of people on ACE2 inhibitors with cardiovascular disease die.  So, the way that this is going to end, I’m predicting right here and now, is that people are going to say, “No, I can’t do this anymore. I’m going to lose everything that I’ve built. I’m going to lose everything I’ve saved up 20 years of my effort for. Please give us therapeutics, and we don’t have time for a vaccine. We don’t have time to wait for it.”

Dr. Weitz:                       Right. It’s interesting the big variance in fatality rates. I looked at the Worldometer.info website and the fatality rate in Italy is 7.7%, whereas the fatality rate in Germany is 0.23%. That’s a freaking amazing contrast.

Dr. Lyons-Weiler:           It is. So, look at factors like smoking in Germany compared to smoking in Italy. Look at the age distributions. There’s a lot of older Italians because of their Mediterranean lifestyle, the diet. That mysterious thing that keeps Italians alive older, right? There’s these factors that play into it.

Also, look at the nutrients in the soil. So, how much selenium is in Italian soil and how much selenium is in the vegetables that they eat compared to that in Germany? I don’t know. I know Germany was glaciated and then deglaciated during the last… 16 or 18 times through the Pleistocene. I don’t think they made it past the Alps. I think Italy was always… What you have in Italy was there throughout. They’ve probably been flooded and reflooded. So, they might have a very different soil in Italy. They might benefit from selenium. There might be a genetic component too.

So, there’s a genetic component in the virus. We think that there’s two types of the virus. There’s the slow and the fast. There’s S and the L. The one that’s more deadly apparently is the one that was clustered in Hubei, the ones in Hubei Province in China. The story goes from the Chinese that once it got out into the rest of China, there was another virus that came about with a mutation and that it’s less lethal. That’s exactly what we expect to happen. Okay?  So, they should type the virus in Italy and see if it’s the more dangerous type. If that’s true, then we know, “Okay, we’re dealing with a more dangerous type.” So, you need to type the virus. And then there’s also genetics in people. So, the human genetics plays a role here too in terms of susceptibility to these factors.

Smoking, I mentioned smoking.  Right now, all Americans everywhere, quit smoking everything.  Don’t let your smoking habits or your pleasure that you get from smoking outweigh the fact that this virus is more likely to enter your cells if you smoke because smoking causes increased production of availability of ACE2.  If you’re on ACE2 inhibitors, ACE receptors I should say.  So, there’s receptors on the cell and if you’re on an ACE inhibitor for blood pressure, then you’re inhibiting the ACE2 molecules that usually go into the receptor and by doing that then, you’re freeing up all the receptors to be available for the virus to enter cells.  So, you’re going to get more rapid viral growth and more viremia, more…

Dr. Weitz:                       So, ACE inhibitors increase your risk. I also just read that one of the officials in France today came out and said that taking nonsteroidal anti-inflammatories also increases the ACE receptors.

Dr. Lyons-Weiler:           Right, and the fact that steroidal treatments seem to help really points to an autoimmune component to the base, the root cause, of this disease.  We see a cytokine storm.  That, to me, is an outcome of an autoimmune. It’s in a vicious cycle, cytokine storm.  But to me, if you start to see cytokines released, that’s a signal that you have an autoimmune attack going on for the most part.  Or a really extensive, rapid viral attack.  But the autoimmune component, because if you use steroids, that tends to actually modulate the immune system, so you might be seeing the fact that the steroidal anti-inflammatories were safer, but the other thing… Unfortunately, the French also recommended paracetamol. They recommended what we call “Tylenol.” And I think that’s a big problem, because you need your glutathione to be able to fight off infections, you need your glutathione to…  Because when you get an infection, your body starts producing cellular toxins. The cellular toxins are strange-formed, misformed, misfolded proteins that your body doesn’t… They see it as foreign and so, your body doesn’t know to attack with the immune system or what.  So, if you have glutathione, it gets tagged. It goes to the liver and it gets removed. That’s a much better route and if you have…  Of course, if you have a very serious fever of 104.5 or so, you’ve got to get that fever under control because the fever itself can start denaturing critical proteins.  But the medical community in France did a service by saying, “Watch out for ibuprofen. Go for steroidal if you can.” I think they don’t what they’re looking at is autoimmune.

Dr. Weitz:                       Right, yeah. Well, it’s one of the reasons why we’ve been recommending a nutrient known as N-acetyl cysteine because it’s a precursor of glutathione and it’s been shown to have some activity against viruses.

Dr. Lyons-Weiler:           Yeah, absolutely. So, I’m taking NAC. I’ll tell people what I’m taking. I’m taking N-acetyl cysteine. I’m taking selenium.

Dr. Weitz:                       How much NAC are you taking?

Dr. Lyons-Weiler:           I don’t talk doses because I’m not a medical doctor. Right? Then it becomes like, “Okay, wait a minute.” But people can look at the package and they could figure out for themselves.

Dr. Weitz:                       Well, you don’t have to recommend it. You can just tell us what you’re taking. I can tell you that I take 900 milligrams of NAC twice a day.

Dr. Lyons-Weiler:           That’s fantastic. Yeah, so how’s your selenium?

Dr. Weitz:                       I also take 200 to 300 micrograms of selenium and I take 45 to 60 milligrams of zinc partially because I have a…

Dr. Lyons-Weiler:           Zinc is important.

Dr. Weitz:                       gene that makes it more difficult to absorb zinc and…

Dr. Lyons-Weiler:           Yeah, so I also take glycyrrhizin which is a licorice extract.

Dr. Weitz:                       Licorice. Correct, yup.

Dr. Lyons-Weiler:           Right? And these are supposed to be helpful in some way although I’m pretty…

Dr. Weitz:                       Licorice is also really good for adrenal support and any signs of stress and anxiety. That’s not a bad idea either.

Dr. Lyons-Weiler:           Absolutely. So, what we’re talking about is licorice root extract. Don’t go out and buy Twizzlers and think you’re going to save the world. It’s not going to do it for you.

Dr. Weitz:                       And also don’t DGL, which is deglycyrrhizinated licorice. The one thing you have to look out for with glycyrrhizinic acid is it can raise your blood pressure. So, monitor your blood pressure.

Dr. Lyons-Weiler:           There you go. Yeah, so when we’re looking at the clinical, the epidemiology of this thing, this is a fascinating moment in the history of epidemiology in the United States as well, because I’m seeing kind of an inversion. I’m seeing the people who are skeptical of allopathy looking at it more like, “Okay, this is a pattern at the population level.” And I’m seeing now epidemiologists really super focused on the molecular level.  It’s a really strange kind of inversion; whereas in other aspects of medicine, I see the people that are concerned about toxins in vaccines or that kind of thing really more focused on the molecular end and doctors are saying, “No, the epidemiology shows there’s nothing there at the population level.” What about the individual, right?  So, we don’t have to rehash that whole thing, but it’s really interesting because I think there’s a teachable moment here, a really big learning opportunity here where we argue a lot about causality when it comes to like vaccine adverse events. We argue about, “Well, it’s just a correlation.”  Here, we really don’t have the luxury of a randomized prospective clinical trial with infecting people with the virus and then saying, “Okay, so therefore, we know because it was a saline controlled, placebo-controlled, double-blinded randomized placebo clinical trial of virus infection.” And yet, we know so much about how this virus is affecting people by observational data.  So, it’s kind of a fascinating moment in time where we can see people struggling to understand mechanisms of disease, the mechanisms of pathophysiology from a virus using the tools that we’re restricted to use in terms of a vaccine injury. Yet, they’re somehow able to sort it out and come out with pretty strong statements like you probably shouldn’t use ibuprofen, this kind of thing. Right?

Dr. Weitz:                       Right. Are any of the antiviral medications like the one from Gilead liable to play a role in this?

Dr. Lyons-Weiler:           Absolutely. So, in addition to the plasma therapy, we absolutely have to… You said earlier if you were this omniscient or powerful, mighty person. If I was president of the United States right now, I would do a press conference, sit in the Oval Office, and I would ask on television for pharmaceutical companies to ramp productions of antivirals for the US Military, for front line defenders, the first responders, and for families and coworkers that have it.  So, we’re talking about remdesivir.  We’re talking about chloroquine phosphate. There’s actually an expert opinion piece, a consensus panel out of China that said, “These are the treatments that we use that worked.” So, we know what works. If we don’t do antivirals and if we don’t do the plasma therapy, we’re going to see the curve extend out for months and months and months, and it’ll destroy our economy.

Dr. Weitz:                       Yeah, there’s no way we can survive months and months and months.  So, what’s your prediction?  How long are we going to be involved in the social isolation thing we’re doing?

Dr. Lyons-Weiler:           Great question. If after you watch this podcast, you find your senator’s email and you find your congressional representative’s email, and you find their phone number, both the Washington office and the local office, and you email both of them, both types of people. You’ve got two senators and a certain number of congressional reps. Email all of them, I should say, and call both offices and say that you want therapeutics added to the agenda. Tell them you want plasma convalescent therapy and antivirals added to the agenda as the first step of defense to shutting down social distancing.  That’s what we need. We need to promote that this is a… It’s readily available. We can do this now and like I said, China took their curve which was going up like this, they did social distancing, added antivirals and had convalescent, and it dropped to zero. The number of new cases remarkably went from like thousands to 46. Right? Because they…

Dr. Weitz:                       It sounds like probably adding some IV vitamin C and maybe some IV glutathione wouldn’t be a bad idea as part of the mix as well.

Dr. Lyons-Weiler:           So, for treatment, IV therapy would be great. If you have access to an IV system, you could do IV vitamin C. That probably would have the same kind of antiviral effect, right? The glutathione, absolutely. Look up on the internet how to enhance your glutathione.  In America, we are so proud of our independent. We don’t want to turn to the government to do the right thing, but take care of yourself. Increase your glutathione intake, take everything out of your lifestyle that’s depleting your glutathione, and be as healthy as you can. Get sunshine when you can. Get out in the sunshine every day if you can. Get the exercise you’re talking about.  But we’re not turning to the government for support. We’re turning to the government to tell them, “Don’t make a mistake. Don’t do the wrong thing.” And this is why I think we need to bring civics back into the classroom, because one thing that I hope that my sons learn from me other than the science that they know and the love… They fell in love with science. They’re both on route to be scientists.  The one thing that I hope that they got from me, and I know that they did because I can see what they’re doing, is that you don’t just have the right to participate in your own government in the United States. You have a moral obligation and responsibility to be part of your own governments. You can’t just sit back on your couch and wait for somebody else to make the decisions. Right?  So, even if you know nothing about coronavirus, the more you learn… This week, read everything that you can. Read all my blog articles at jameslyonsweiler.com and watch all of the videos at WWDNYK Studios on YouTube about coronavirus.

There’s another guy I would say… You guys need to watch this John Campbell out of the UK. This man is doing a saint’s job since the beginning. He’s been tracking the numbers, and he’s calm and he’s not excitable like me. I’m excitable and agitate-able, but he’s calm, grandfatherly. He will make you feel like the world is not ending, but he also from time to time gets…  When he gets emotional, he’s such a gentleman. He turns the camera off. That’s how he does. When he starts getting upset and angry at the World Health Organization for not declaring a pandemic, he stops talking and turns off the camera. And I have no idea what he does once the camera is off. But John Campbell, this guy is great.  And I believe he should be nominated for some serious Nobel Peace Prize or something like that, because he’s a PhD nurse that’s been teaching the public what coronavirus is as well as he can. There’s sometimes when he speaks that I’m like, “That’s not exactly right,” but he’s excellent. John Campbell, he’s a hero of mine, for sure.

Dr. Weitz:                       So, we’re going to have to continue with the social isolation until we see that curve start to go down? Or are we just going to say, “We’re getting tired of this and…”

Dr. Lyons-Weiler:           There’s no way that they’re going to let, like I said, 20% of everybody over the age of 60 get this virus. So, it’s not going to happen, and they’re not going to let 6% of diabetics die. They’re not going to let 10% of people with cardiovascular disease die.

So, the only option that we have one way or the other, whether it’s because I say it, or you say it, or because the rest of society wakes up that we need therapies. We need therapeutics, and until we clamor and really… If you want to go back to work, you want to go make some money, call your congressman and your senator. And tell them that you think therapeutics are 100% necessary to shutting this down now.

Dr. Weitz:                       I, personally, think that there’s huge numbers of small businesses, there’s no way they can hold out more than four weeks.

Dr. Lyons-Weiler:           Yeah. Well, some are folding right now.

Dr. Weitz:                       No, I know that.

Dr. Lyons-Weiler:           So, be a decent citizen. People that are stockpiling food, that’s fine. But I hope that you bought non-perishables because if you’ve got three months’ worth of food and they are successful in shutting this down next month, you’re good for the rest of the year, but be a good citizen. The restaurants that you used to frequent, they still will deliver. They still allow carryout. So, use the restaurants and keep the money flowing.

And by the way, if you’re in quarantine, there’s some psychological advice too. Do things that… Look at it as a staycation. Don’t look at it as the end of the world. We’re such type A Americans. We don’t know how to relax, “Oh, my God, I’ve got to be home with my wife and kids for so long.” Or if you’re a wife, “I’ve got to be home with my husband and kids for so long.” Or if you’re a kid, “Oh, my God, I’ve got to be with my parents for so long.”  Take a moment and reconnect as a family. Get out the board games that you always wish that you taught your kids how to play. Monopoly, it’s fun. The Game of Life, it’s fun. Okay, have fun. If you’re kind of isolated and alone, take that moment, take the next eight weeks or whatever it’s going to be to learn a new language.  I use Duolingo and I’ve learned German using Duolingo. I have no financial relationships or financials to disclose, but you can learn a new language, learn a new musical instrument, learn some new life skill. If you always wanted to master that one recipe that your grandmother used, it doesn’t matter. Take up gardening. Do something that’s healthy and productive. How about those projects around the house that you’ve been delaying and you don’t want to get to?  So, there’s a lot that you can do and take advantage of this time and still feel like, “Okay, I…”

Dr. Weitz:                       Read a book. Read one of Dr. Lyons-Weiler’s books.

Dr. Lyons-Weiler:           Oh, thanks for bringing that up, Ben. I appreciate that.

Dr. Weitz:                       You can always gang watch the Rational Wellness Podcast.

Dr. Lyons-Weiler:           That’s right. Here’s The Environmental and Genetic Causes of Autism, which I hear is a sleeper. There’s 1,000 studies on autism. Cures vs. Profits for you, you want to learn some things about. Yeah, there’s 16 or 18 different topics, I think, in here on biomedical research and what makes legitimate biomedical objective research and what makes it not legitimate.  It’s got things like why do we know that the hormone receptors on breast cancers will help us determine which chemotherapy is likely to be effective? How did that come about? It tells the history of the things that we take for granted, but it goes also into some controversial areas, which I’m proud to say I didn’t shy away from.

ADHD, for instance. While the pharmaceutical companies were saying, “It’s genetic, there’s nothing you can do,” I was writing a chapter, It’s Their Brain, Not Yours. And I go right deep into science about what’s right and wrong with the studies, about the things that we think that we know from biomedical research.  And yeah, the podcasts, what we do not yet know. Studios, it’s called Unbreaking Science, and we get into a lot topics that I think people find really interesting. And also, if you’ve always wanted to create your own outlet… People need outlets. They want to be heard. Do what Ben here is doing. Dr. Weitz is doing this. Get out there and do your own podcast if you always wanted to do it. We need to hear from people that have creative and good ideas.

Dr. Weitz:                       Awesome. I think that’s a good way to wrap this podcast interview.

Dr. Lyons-Weiler:           Right on, thank you.

Dr. Weitz:                       Okay. Thank you, Dr. Lyons-Weiler. I think this is super timely. I’m going to definitely get this up tonight.

Dr. Lyons-Weiler:           All right, thank you. Also, please stop by ipaknowledge.org if you could and check out what IPAK is doing. That’s the Institute for Pure and Applied Knowledge. We’ve been up and running since 2015, doing research in the public interest without profit motive. No connection to the government except for regulatory, and no connection to any corporate finances. So, take it easy, you guys.

Dr. Weitz:                       Are you guys looking for donations?

Dr. Lyons-Weiler:           Oh, absolutely. We’re 100% funded by the public and we’re almost done with our 501(c)(3) application. So, we’re not yet a charity, but we’re not for profit in Pennsylvania.

Dr. Weitz:                       Cool and your books are available through?

Dr. Lyons-Weiler:           I would recommend people go to independent booksellers near you and if they don’t have it on the shelf, ask for it because they look my name, James Lyons-Weiler. Because when they order one, then they tend to order multiple ones. But also, we want to keep local businesses in business. Amazon’s got enough money.

Dr. Weitz:                       I’m with you on that.

Dr. Lyons-Weiler:           Right on. All right. Well, thanks. Thanks for having me.

Dr. Weitz:                       Okay. Thank you, James.




Integrative Approach to Heart Disease with Dr. Howard Elkin: Rational Wellness Podcast 147

Dr. Howard Elkin discusses an Integrative Approach to Heart Disease 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

3:42   What is coronary artery disease and why are so many patients dying of heart attacks?  There are close to a million heart attacks per year in the US and heart disease is still the number one killer of both men and women.  Heart disease is a disease of excess–excess blood pressure, excess cholesterol, excess sugar, excess stress, excess smoking, however there is a lack of one thing and that’s exercise.

4:35  Why does cholesterol build up in the walls of the arteries, given that our bodies are designed to protect us and promote our survival?  It is because of inflammation in the endothelium, which is in the lining of the artery walls.  We now know that the simple theory that heart disease was caused by eating cholesterol and saturated fats is not correct.  Cholesterol is actually very important for many functions in the body, including the absorption of fat, vitamin D, sex hormones, acids, myelin sheath in the brain also with new nerve cell formation, it’s essential. We cannot live without it.  When it comes to cholesterol, it’s not as simple as just thinking of LDL as bad and HDL as good.  Particle size matters and larger particles of both LDL and HDL are better, while small dense LDL is more likely to cause arterial plaque.

7:05  Cholesterol in our diet does not equate with cholesterol in our blood.  Saturated fat can be an important factor and there were several often cited studies published in the 60s and 70s that appeared to show that saturated fat was associated with an increase in cholesterol. Since then, these studies have not quite stood the test of time and saturated fat is not as bad as we thought it was.  But then we learned that we need to look not just at cholesterol as a risk factor, but we broke it down into (bad) LDL and (good) HDL.  In recent years we have learned that the size of the cholesterol particles is potentially even more important and generally speaking bigger is better.  Oxidation leads to inflammation and because of inflammation, the LDL particles can burrow into the wall of the artery, which is coronary artery disease.  Eating fruits and vegetables can supply antioxidants that can reduce the oxidation.

8:35  There are a number of factors that can result in inflammation, including toxins, stress, food sensitivities, and inflammatory foods like sugar and refined carbohydrate foodsChronic infections can play a role in inflammation, including periodontal disease caused by P. gingivalis infection in the gums. Inflammation can be monitored with HsCRP serum levels. Additionally, gut health and uncorrected sleep apnea are also both causes of inflammation. 

10:40  The Functional Medicine approach gives you such a different perspective on heart disease. The average person finds out they have high cholesterol and they see a cardiologist and they get put on medications like statins, end of the story. But this doesn’t consider what are the root causes of the inflammation that results in the cholesterol building up in the arteries.  Functional Medicine model helps us to look for the periodontal disease, the gut dysbiosis,food sensitivities, toxins and heavy metals that may be some of the underlying reasons for the inflammation that results in heart disease.  If you see a traditional cardiologist, you will get a prescription for a statin and probably an aspirin or blood pressure medication, if the problem is blood pressure.  Dr. Elkin’s approach if a patient has high blood pressure, he prefers not to place them on medication and instead would rather give them a few supplements and talk to them about lifestyle. 

12:56  The recommendations for aspirin have been updated recently.  Doctors have been recommending that patients take aspirin to prevent heart disease to prevent heart attacks and strokes, since aspirin thins the blood out a bit.  It turns out that there is more risk of a major bleeding event from taking aspirin, like an intracranial hemorrhage.  This was shown in the ARRIVE trial (Aspirin to Reduce Risk of Initial Vascular Events) published in Lancet in September 2018: The use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomized, double-blind, placebo-controlled trial  and the ASCEND trial (A Study of Cardiovascular Events in Diabetes) published in NEJM in October 2018:  Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus.   

14:36  A plaque in a coronary artery can be stable or unstable and that plays a big role in whether or not it leads to a heart attack or a stroke.  If plaque has a larger lipid pool and thinner margins, it is more likely to rupture and form a blood clot and this can lead to a heart attack or a stroke. Dr. Elkin recommends that a lot of his patients get a coronary calcium scan, which tells you the degree of calcium in the three major arteries to the heart. It helps to stratify your risk, but it only shows calcified plaque and it doesn’t tell you if you have soft plaque and it also doesn’t tell you if the plaque you have is stable or unstable.  A calcified plaque, because it tends to be more stable, is less risky than an unstable plaque that is more likely to rupture.

19:07  There is a new lab test called a PULS (PULStest.com) that Dr. Elkin is running that utilizes biomarkers to determine the likelihood that a plaque is stable or unstable.  Once you identify a patient with an unstable plaque, you need to be very aggressive with treatment and this is where the full Functional Medicine workup can be very beneficial.

20:57  The standard lab panel that your primary doctor orders is usually governed by what the insurance company will pay for, so it is usually very limited and usually only involves total cholesterol, estimated LDL, HDL, and triglycerides.  It is much more accurate to run an advanced lipid profile looks at LDL particle number (instead of estimating it), LDL and HDL particle size, Lp(a), oxidized LDL, homocysteine, HsCRP, and other tests. But this does not fit into the standard cardiology or primary care practice model and it takes more time and insurance companies do not reimburse doctors for time spent with patients. So doctors are forced into a short (5-10 min) office visit and they need a quick, cookie cutter approach, such as your LDL is above 100, so take this statin.  End of story.


Dr. Howard Elkin is an Integrative Cardiologist and he is the director of HeartWise Fitness and Longevity Center with offices in both Whittier and Santa Monica, California. He has been in practice since 1986. While Dr. Elkin does utilize medications and he performs angioplasty and stent placement and other surgical procedures, his focus in his practice is employing natural strategies for helping patients, including recommendations for exercise, diet, and lifestyle changes to improve their condition. He also utilizes non-invasive procedures like External Enhanced Counter Pulsation (EECP) as an alternative to angioplasty and by-pass surgery for the treatment of heart disease.  Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient, that will soon be published. He can be contacted at 562-945-3753 or through his website, HeartWise.com.

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


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.  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 Podcasts and give us a ratings and review, or wherever you listen to your podcasts. Also, if you would like to see a video version, please go to my YouTube page, Weitzchiro. If you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Our topic for today is Natural Approaches to Preventing and Managing Cardiovascular Disease with integrative cardiologist, Dr. Howard Elkin. Heart disease continues to be the number one cause of death in the US and around the world. This is an incredibly important topic. However, despite many improved treatments, especially heroic lifesaving procedures, we often fail to identify ahead of time who is going to have a heart attack. More than 50% of heart attack patients have normal cholesterol based on a standard lipid profile, but deaths from heart attacks are potentially preventable.

For this discussion, we are going to try to split our time between coronary artery disease and arrhythmia, and I know it’s going to be difficult because coronary artery disease could probably take up three hours, but we’re going to see what we can do. Coronary artery disease is all about cholesterol and lipids, and the prevention of heart attacks and strokes.  For the rest of the discussion, we are going to talk about arrhythmia which is a condition not often discussed, especially in functional medicine quarters. An arrhythmia refers to problems with the rhythm of your heart that occurs when the electrical impulses that coordinate your heartbeats don’t work properly.  This results in the heart beating too fast, too slow, or irregularly. There are a number of forms of arrhythmia. As with arterial disease, we will focus on a functional medicine natural approach to arhythmia.

Dr. Howard Elkin is an integrative cardiologist with offices in Whittier and Santa Monica, California, and he’s been in practice since 1986.  While Dr. Elkin does utilize medications, and he performs angioplasty and stent placement, and other surgical procedures, his focus in his practice is employing natural strategies for helping patients, including recommendations for exercise, diet, and lifestyle changes to improve their condition. He also utilizes noninvasive procedures like external enhanced counterpulsation as a noninvasive alternative to angioplasty and bypass surgery for the treatment of heart disease. Dr Elkin has written a book from both sides of the table, When Doctor Becomes Patient, that will soon be published. Dr Elkin, thank you so much for joining me today.

Dr. Elkin:              Thanks. I’m delighted to be here, Dr. Weitz.

Dr. Weitz:            Excellent. Let’s start by having you explain, what do we mean by coronary artery disease and why are so many patients still ending up with heart attacks?

Dr. Elkin:              Well, here’s the thing, coronary artery disease, there’s close to a million heart attacks in this country every year, and I believe every 39 seconds, there’s a person that dies of heart disease. So it’s really prevalent, it’s your number-one killer of both men and women, so it’s very common. It’s a disease of excess. We’re talking about excess blood pressure, excess cholesterol, excess sugar, excess stress, excess smoking, it’s really a disease of excess, however there is a lack of one thing and that’s exercise.

Dr. Weitz:            Can you explain why would cholesterol, which is a fat in the body, why does it start to build up in the walls of the arteries?

Dr. Elkin:              It’s really funny, this whole cholesterol hypothesis started way back, it’s been for several years now, in the ’50s. The ’60s and ’70s, there were studies that were going on saying that, “Okay, well cholesterol and saturated fat are really the culprit when it comes to causing heart disease.” And it’s not that simple. We’ve learned other things in the last few years. So-

Dr. Weitz:            Well, I just wanted to also add in here, when I ask why would cholesterol build up? I just want to make sure everybody has in their minds the fact that our body is basically designed for us to work properly, to protect us. It’s a normal part of the life cycle for us to eat, for us eat animals. We’ve been doing it for thousands of years, and animals are going to contain fat, there’s going to be cholesterol, saturated fat. So what’s going wrong that there’s cholesterol starting to build up in the arteries?

Dr. Elkin:              It’s just one term called inflammation, and when I was a fellow studying cardiology several years back, we didn’t know anything about inflammation, we didn’t know anything about endothelial injury.  We just thought that there was a blockage in the artery that got worse and worse, it was probably related to cholesterol. Around that time when I was finishing my fellowship, the first statin came out, so that was what we thought, but we really-

Dr. Weitz:            By the way, for those who don’t know, you mentioned endothelial and that’s related to the arteries, the inside of the arteries is the endothelium, and a statin is a medication used to lower cholesterol.

Dr. Elkin:              Correct. Thank you. So let’s face it, cholesterol is essential for life, we wouldn’t be here if it wasn’t. It does everything from help with the adsorption of fat, vitamins, vitamin D, sex hormones, bile acids, the myelin sheath in the brain, also with new nerve cell formation, it’s essential. We cannot live without it. But it got a bad rap because of this whole thing, this assumption that it really caused coronary disease.  Now a couple of things you need to know, as far our audiences are concerned, we now know that cholesterol in our diet does not equate to cholesterol in the blood. So if anyone is still eating egg white omelettes, is just like totally out now. We know that doesn’t exist. Now the whole thing about saturated fat, that’s an important thing. That came out in the ’60s and ’70s and these were like small, short studies based on… They were short term studies first of all and they showed that saturated fat was associated with an increase in cholesterol.  As we learned to classify cholesterol, most specifically LDL. Just think of LDL is lousy and HDL as healthy, it’s not quite that simple.  So what we’ve learned in recent years is that it’s about the size of the particle and all your audience really needs to know, is that bigger is better. Whether it’s HDL healthy or LDL lousy, the bigger the particle size, the less likely it is to get oxidized. Oxidation is what leads to inflammation, which is really a long answer to your question. Because once we have inflammation, okay, that LDL particle can burrow into the wall of the artery and that’s where we really develop coronary artery disease and also progressive coronary artery disease.

Dr. Weitz:            So obviously oxidation if we’re consuming lots of fruits and vegetables, those are going to contain antioxidants. But other than consuming fruits and vegetables, what other factors result in inflammation in the walls of the arteries?

Dr. Elkin:              Lot of things. First of all, the environment, air pollution, we know that’s effective. Toxins in the environment.  Stress is a big one. Stress affects everything. Also eating foods.

Dr. Weitz:            Food sensitivities.

Dr. Elkin:              Inflammatory foods that add inflammation, I tell people all the time. Sugar is our biggest villian, it’s not cholesterol, it’s sugar. Eating sugar and carbohydrates and grains that break down to sugar, it’s like pouring gasoline over fire. These are major culprits that lead to inflammation in our arteries and source coronary artery disease and heart attacks.

Dr. Weitz:            Also chronic infections, and I know you like to look at the gums.

Dr. Elkin:             Right.

Dr. Weitz:            as one of the sources of that.

Dr. Elkin:              I think I mentioned when we talked earlier is that when I have a person, a patient that’s persistently demonstrating inflammation, just a systemic  inflammation, which is a simple lab test, I have to ask why.

Dr. Weitz:            Which is high sensitivity CRP.

Dr. Elkin:              Right. Let’s say it’s three or four, it remains that way for like several months. Then I say, can we have to look further? What’s happening? One of the major causes of inflammation is the oral cavity or Periodontal disease. A lot of people say, oh, well my dentist says that everything’s fine. But not every dentist really knows how to evaluate periodontal disease. You often have to go, I send people to periodontists all the time because a pocket of 4 is not o.k., it’s like not good. It’s not okay. That’s a nidus of infection and inflammation based on that infection. The other one is the gut.  That’s probably the second most common cause that’s very important.  Also uncorrected sleep apnea. These are all things that lead to systemic inflammation and whether it’s heart disease, cancer, autoimmune disorders or Alzheimer’s. All four of those big causes, the pillars of aging, have to do with inflammation. It’s like the common denominator.

Dr. Weitz:            Yes. I think the average person out there when they’re worried about heart disease, they’re thinking, okay, I just need to go to cardiologist and I need to get put on some medications. But if you really utilize the full functional medicine model, that’s really the only way you can start to consider some of these underlying causes rather than, okay, you have high cholesterol, you have high blood pressure, you take this medication, end of story.  You’re talking about looking at the underlying factors that create the inflammation and it is possible, but you need to cast a wider net. You need to consider P. gingivalis infection in the mouth, gut dysbiosis, food sensitivities, toxins, heavy metals.  All these things are possibilities when you clear some of those underlying causes of inflammation that can cause the underlying reason why you have cholesterol buildup in the first place and that’s truly getting to the root cause. It’s one of the reasons why I think the Functional Medicine model can be so effective for heart disease prevention.

Dr. Elkin:              You’re absolutely right. The model that we use in Functional Medicine, it’s really the only way because if you go to traditional medicine, and in my case traditional cardiology, if you have high cholesterol they’re probably going to give you a statin.  They’re going to probably tell you to maybe take an aspirin or there maybe… Or if you have high blood pressure, they’re not going to wait and see whether you can get it down on your own.  They’re going to put you on a blood pressure medication. We’re masking things by giving people medications.  Not that there’s not a role for medications, there is.  But it’s like we jumped to medications.  I have a patient yesterday came to me, she was a registered nurse and she’s telling me she’s struggling with her blood pressure’s bad.  I said, it looks like you will probably need medication, but let’s not jump to that right now.  It’s not so high that I need to worry about it.  So let’s track it, let’s go on a couple of supplements, let’s talk about lifestyle and where we evaluate. The average doctor or cardiologist would not do that.

Dr. Weitz:            Right. Absolutely. By the way, you mentioned aspirin, I guess the recommendations for aspirin have been taken back a bit, huh?

Dr. Elkin:              Yes, thank goodness. I really never believed that everybody over 50 for prevention should be on aspirin. But for years it was given as primary prevention. So let me just segue away for a minute. So primary prevention is to prevent a heart attack or a stroke and someone who has no known coronary disease whatsoever. But now secondary prevention is someone that’s had a heart attack or a stroke, they’ve had a stent, they’ve had bypass.  This is a higher risk population and we still think that these patients should be on aspirin for the duration of their life.  But at the study that came out whose name I can’t remember right now, came about actually about a year or so ago,  that it’s overkill and actually there’s more bleeding from aspirin, then saving heart attacks and strokes. So that was changed.

Dr. Weitz:            So essentially the reason why aspirin was being given was because aspirin and all nonsteroidal anti-inflammatories tend to thin the blood out a little bit. So if the blood is a little thinner, it’s likely to clot and form strokes. Form clots, lead to strokes and heart attacks. What they found was that while it thins the blood out, the risk of having a bleed somewhere’s counteracts the potential risk of a clot, unless you really know the person’s at higher risk of a clot, it’s not worth it.

Dr. Elkin:              That’s right. I should mention, just to understand this thing about blood clot. So you have a plaque in the coronary artery and it could be there for years and it often is there for years. We still don’t know in 2020 what makes a stable plaque become an unstable plaque. We don’t know that.

Dr. Weitz:            Okay. Can you explain what a stable plaque is.

Dr. Elkin:              A stable plaque is just, mostly, it’s going to be more… It’s a cholesterol smooth muscle plaque. But the composition, it actually, it has more fibrous tissue in it, more scar tissue in it. So the lipid pool, the fat pool is actually less and these can stay. There’s certain way to look at an artery, tell that from a scan, but we know by looking at them at autopsy and so forth if this is a stable plaque.  I think with plaque has a larger lipid or fat pool and thinner margins, the thinners fibrous tissue, and those can rupture at any time without warning. Once that plaque ruptures, and it can be a 40% blockage, once that plaque ruptures, then a blood clot forms and that’s where aspirin can help.  So it’s a plaque rupture that leads to a blood clot or thrombosis and then you have a heart attack or a stroke depending on the location.

Dr. Weitz:            So you have this plaque that’s blocking, say 20, 30% of the artery and it becomes, it can lead to a heart attack if either A, it blocks the entire artery, continues to grow and grow, or a piece of it breaks off, and that’s what we mean by this unstable plaque. Then you get this inflammatory reaction and you get this clot formation, and that then blocks the artery, right?

Dr. Elkin:              Right. You remember there’s still almost a million heart attacks a year in this country. That’s a lot and probably 50% of these people have normal cholesterol levels.

Dr. Weitz:            So a lot of doctors that have been having patients get a test called a Coronary Artery Scan and that’s to look for these plaques. But what does that really show?

Dr. Elkin:              It’s a good test, I use it a lot. It helps me to prepare my patients for their treatment protocol.  I’ll tell you how.  So you get this test done and it tells you the degree of calcium in their three major arteries. It tells you the degree of calcium…

Dr. Weitz:            The three major arteries that go to the heart.

Dr. Elkin:              Yes. So you get what’s called a coronary artery calcium score. A perfect score is zero. You don’t have any calcium in your arteries but it’s unlikely as you get older. But then what happens… I happen to like Harbor-UCLA because they have a very large database and they have a wonderful doctor who’s been researching this scan for over 25 years. Anyway so they have a database of 30,000 patients who I say, okay, this is how you compare to other 60-year-old males. You’re in the 30th percentile. Not too bad. You’re in the 40th, 50th. Well, that’s a little worrisome. You’re in the 80th, 90th, that’s high risk. So it does help stratify your risk, but it doesn’t tell you who has a stable plaque or an unstable plaque.

Dr. Weitz:            It also doesn’t tell you… It only shows calcified plaque, not soft plaque.

Dr. Elkin:             Really if you look at a plaque, if you could microscopically, about a third is calcium and the two thirds is like soft tissue that you do not detect with that scan.

Dr. Weitz:            So you get a coronary calcium scan. It can be helpful if you have a calcified plaque.  But even if you have a score of zero, it does not mean you don’t have any plaque.

Dr. Elkin:             I was one of those people.

Dr. Weitz:            Exactly. It just means you don’t have any calcified plaque. Noncalcified plaque tends to be less stable, right?

Dr. Elkin:             Right. 

Dr. Weitz:            Less stable means that it might break off, in which case it could form a blockage.

Dr. Elkin:             Right. The end result is always going to be a thrombosis or a blood clot and that’s where the aspirin does come in. But yeah, so that’s what it’s really based on knowing different calcified plaque actually could be considered protective. It’s less likely to rupture.

Dr. Weitz:            Is there a way to test if you have a calcified plaque or not?

Dr. Elkin:             Well, calcified plaque is very well done with the coronary artery scan, it’s how can we detect…

Dr. Weitz:            Unstable plaque?

Dr. Elkin:              So as we were starting, I told you there’s a new laboratory test. It’s relatively new, it’s not been used much in this country. It’s called a P-U-L-S, PULS. It started off, it actually, I forgot what it stands for, but it was started off in Canada and now it’s being adopted in the United States. What they’ve done, they’ve set a number, like over 100 biomarkers to detect an unstable plaque and they tested three different centers and they all came down with nine biomarkers, I’ll explain that in a minute, and then taking those biomarkers into consideration, if you take someone’s blood sample, it can give you a score.  So the higher the score, the worse off you are. So you wouldn’t have a score less than 10. Although it’s new thinking and it’s a new test, what a great novel idea because it can take someone who’s got risk factors, who’s totally asymptomatic, but who has a high score. That means there’s endothelial damage in that vessel and there’s ongoing inflammation that we cannot see and that can presage a heart attack. So it’s very exciting to be able to do this and I think we’ll be getting more of this the next couple of years. It’s a simple blood test.

Dr. Weitz:            So therefore, once you find a patient who has an unstable plaque, this is a person you need to really focus on and be very aggressive with treatment.

Dr. Elkin:              Right. This is when what we do in functional medicine really makes a difference. It’s more than a statin, it’s more than a beta blocker or an aspirin, it’s involves lifestyle and that’s what we do.

Dr. Weitz:            Now, when you go to your standard, get your standard physical exam from your primary care doctor, they do what’s called the lipid profile as part of the blood screen if you’re lucky. Because insurance companies are so strict these days, they hardly want to cover any lab testing and it’s only gotten worse and worse over time. So if they do this standard lipid profile, it looks at total cholesterol, it looks at estimated LDL, it looks at HDL and triglycerides. But that’s not really an adequate way to screen for heart disease, is it Dr. Elkin?

Dr. Elkin:              Not at all. But I will tell you that most cardiologists do that simple lipid profile that you can get from a family practice or general interest. It just tells you what’s normal and what’s abnormal. But it doesn’t tell you anything else because once I get a LDL, let’s say it’s 110, which is barely above normal. As soon as it tells what’s going on, and so I want to know more so we can order what you and I know about is called advanced cardiac testing or advanced lipid testing. That tells us about the particle number and even more helpful, the particles’ size. Remember like I said, bigger is better. You won’t know that unless you do a more advanced test. 

Dr. Weitz:            Why is it that the average cardiologist is not taking advantage of this available testing?

Dr. Elkin:              I think to be perfectly frank with you, I think there’s a lack of time and effort because the way medicine is practiced today, it’s so robotic. It’s like, “Oh, do you have this? You want a statin and you have this, you got it…” That’s why I practice on my own so I can do the type of medicine that appeals to me and I think really helps people and saves lives.  I think it’s, the doctors are burnt out as standard medical doctors and I think they said that they still have all the surveys I’ve read the major one complaint that patients have about their doctors, they do not feel heard. They say, oh, he got one foot on the door, one foot out the door. Or they’re sitting there typing while the patients… I don’t bring my laptop in the room with me, I can’t do that. I can’t focus on the patient. So it’s time-intensive. I have to do a lot of education and I have a nutritionist that’s in my office two days a week that does a lot of… As far as chips a lot. But when it comes to limits, I’m the guy and lifestyle because I have to walk my talk.

Dr. Weitz:            Yeah. [inaudible 00:23:39] is unfortunately and I’m not sure if all the patients are aware of this, but the healthcare system today is essentially controlled by the insurance companies and doctors unfortunately do not get reimbursed by insurance companies for the amount of time they spent. So therefore based on the way the insurance controls stands and the reimbursement, medical doctors, primary care doctors and cardiologists are basically limited to a five or 10-minute office visit. Unfortunately, you can’t go into having time to explain this kind of detailed testing and lifestyle recommendations and diet in a five or 10-minute office visit.

Dr. Elkin:              You really can’t. Let’s just take whether it’s Cleveland HeartLab or Boston HeartLab, and they’re both very good [inaudible 00:24:33].

Dr. Weitz:            Those are examples of advanced lipid profiles.

Dr. Elkin:              But when I get the test packet, after much over the liquid virus and I’m just saying, “Okay, this is your inflammatory profile. You have inflammation, this is your metabolic profile. You’ve got diabetes or prediabetes or you’re at risk of diabetes.” There’s so much to explain. You cannot do it in five or 10 minutes.

Dr. Weitz:            Right. So these advanced lipid profiles, they vary. But typically besides the things you mentioned, like LDL particle number and particle size, and also look at the size of the HCL. They also look at a particle known as LP(a). They look at homocysteine, they look at so many inflammatory factors like, high sensitivity CRP. They look at whether the LDL is oxidized.

Dr. Elkin:              Yes. Really useful information.



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                                                Now, back to our discussion.




Dr. Weitz:             So let’s go over some of the particular things that are found on advanced lipid profile and some of the recommendations we can make from a natural approach for helping these patients. So let’s say we have a patient with an elevated LDL particle number and/or an increase in small dense LDL.

Dr. Elkin:              Okay. Remember, bigger is better. So if you have a small dense particle size versus a large buoyant, it’s not in your favor because it’s about 30% more likely to get oxidized, which we know leads to inflammation and clot. So what can we do? First of all-

Dr. Weitz:            What type of diet to start with is beneficial for these patients?

Dr. Elkin:              Absolutely a lower carbohydrate diet. That definitely does better when it comes to, if you want to decrease the size…, if you want to increase the size of the LDL particle.

Dr. Weitz:            Why are you mentioning carbohydrates?  Most cardiologists would say, hey, you got to lower the fat.

Dr. Elkin:              Right. I know it goes against what everybody’s been taught. If you look in the ’90s, everything was low fat and high carbs and what happened? The country got fatter and we have more diabetes than ever before. But definitely I put them on a low carb diet and you have to explain to them, because a lot of their standard cardiologists are still telling me to go low fat. Why? I don’t know.  When we have signs that tell us otherwise. Then I use niacin, which is actually a vitamin, vitamin B3. I’m using it in a larger dose and I would if I was giving it as a vitamin, but niacin can do what statins can’t. Statins are very good at one thing, lowering your LDL but it will not lower… It will not make a small particle into a large. It won’t effect [inaudible 00:28:53], it won’t effect HDL, it won’t affect Lp(a), whereas niacin has the potential to do all those things. It’s pretty well tolerated and guess what? It’s been around a lot longer than statins have and it’s a supplement. So I do use that quite a lot of my [crosstalk 00:29:10].

Dr. Weitz:            I will say that if you ask the average standard primary care doctor, they will tell you that niacin, that the study show that niacin doesn’t work.

Dr. Elkin:              It’s based on one crummy study that really wasn’t well… It was a flawed study about just a few years ago. It really…

Dr. Weitz:            Yeah. There were a couple of studies and they were both terrible. One of them actually didn’t use niacin. It used niacin in combination with a drug that prevented the flushing. There’s all sorts of side effects that come with that drug and they reported the study as being a study on niacin.

Dr. Elkin:              Here’s another problem that a little off the record here is that, see when you’re in medical school, you go through your training, you are taught how to evaluate studies. We learn about statistics, we learn about meta-analysis, Beysian analysis, all that stuff. But when you’re in practice, you forget all that stuff. There’s no time to think. Oh, so this drug rep comes and tells you what this is and you just buy it. That’s another thing about the current medicals and that really gets to me. But niacin can be very useful. I’m using it for years and again, it does things that statins don’t.

Dr. Weitz:            What about using Red yeast rice?

Dr. Elkin:              Red yeast rice is also, so actually if you look at the original statin that came out, when I was a fellow in the early mid ’80s, it was red yeast rice, which actually is a supplement that came from a plant in China.  There’s certain patients that refuse to take a statin, just refuse and I don’t try to fight it even if they have coronary artery disease. I always believe in patient’s match and what they feel comfortable doing. But I’ve had some success with red yeast rice supplement and I believe Dr. Mark Houston uses a much larger dose, but he’s got success. But I have found to be useful. What else?

Dr. Weitz:            Adding tocotrienols.

Dr. Elkin:              Yeah. So tocotrienols it’s like a form of vitamin E, it’s got tocopherols and tocotrienols and there’s various subclasses with each. But the tocotrienols are an interesting class, which actually lower cholesterol and do it quite nicely. So that’s another thing. Another thing that can be helpful is bergamot. Bergamot is a supplement that you can get and it actually works two ways. It works by decreasing cholesterol production by the liver and also by decreasing cholesterol absorption in the gut, which is kind of unusual.  But I’ve had some success with that. Is it as good as a statin? No, probably not. But it depends on what I’m after and I also get, I listen to what a patient’s preferences are.

Dr. Weitz:            So besides statins, what other medications are there for lowering LDL levels?

Dr. Elkin:              One say we talked about Red yeast rice, we talked about niacin, we talked about bergamot, there’s also berberine. Berberine is another herb that we use a lot. We use it, well, we use it in for functional gut disease, also we use it in diabetes and prediabetes. But it also has an interesting effect, and I didn’t want to go into all this detail, but there’s a new class of drugs that are very expensive that you take twice a month subcutaneously called a PCSK9 inhibitor and I don’t mean to bore the audience here.  If there are receptors, PCSK9’s receptor is in the liver. We know that that’s where cholesterol is produced. But basically berberine is a natural PCSK9 inhibitor. So the supplements can be very additive. I don’t necessarily think that one would do the entire trick, but it depends on what you’re after and how low do you have to lower cholesterol anyway, unless you are at high risk.

Dr. Weitz:            Right. By the way, one of the reasons why sugar and carbohydrates are such a problem is when you look at the mechanism by which these drugs work, like statins and PCSK9 inhibitors, they’re not binding with cholesterol and taking it out of the system. They’re reducing the body’s production of cholesterol. That’s right. Most of the cholesterol that’s in the bloodstream is being produced by the liver, and the liver makes cholesterol from glucose. So that’s how the statins and these other drugs work. Now there’s a new cholesterol lowering medication that works by a different mechanism.

Dr. Elkin:              Yeah, I forgot the name of it. It was just a…

Dr. Weitz:            Bempedoic acid.

Dr. Elkin:              It just was approved by the FDA I think it was a couple of weeks ago. It’s not a statin, I think it does work in the liver. It’s a different, I don’t know where in the chain of events, but it will have a modest effect on decreasing out our costs. So I think if you look at Statins can decrease at 30% or more and then [inaudible 00:34:14] which works on decreasing cholesterol [inaudible 00:34:17] and got maybe 10%.  This is like in between my 20, 25%. So it’s another tool to use are certain people that are statin intolerant or who won’t take statins. But again, I would probably want to use this more in my higher risk patients versus just anyone with an elevated cholesterol level, but I’m sure it will be misused. [inaudible 00:34:39]

Dr. Weitz:            So now let’s say we have a patient who’s has low HDL. Now HDL is the potentially protective lipid that HDL if it’s effective, if it’s functional will produce reverse cholesterol transport meaning it takes the bad cholesterol, the LDL out of the system. So ideally you want to have a higher HDL level.

Dr. Elkin:              So where did we see low… I’m talking levels like 20, 30, really low level. First of all, it tends to be genetic. I’ve got enough families that it’s in my career to see that. It tends to be low with obese individuals. So weight loss can be important and actually improving the HDL. Omothyroid is one other condition. I want to check the thyroid status. Smoking. Smoking is known to be a factor in decreasing HDL.  But again, there’s also a genetic component. Also, there’s a metabolic situation. If you look at your diabetics, your prediabetics or your metabolic syndromes, they tend to have kind of like low HDL, high triglycerides and moderate LDL. So there’s a pattern we look for. They tend to have a very low HDL as well. Now, so what did we do about it?

Dr. Weitz:            Then we have bodybuilders on steroids who are on very low HDL.

Dr. Elkin:              I have seen in my practice, women, who seek competitors that take both of those, they still called safe steroids. I don’t know what safe means anymore and I’ve seen single digit HDLs, really scary, like levels of eight, nine. Very scary. So yes, certain drugs can certainly cause that.

Dr. Weitz:            So how do we elevate HDL?

Dr. Elkin:              Weight loss, smoking cessation, you have to just quit. Note, it’s not an exercise. Probably more cardio [inaudible 00:36:42] activity. So that’s going to be important. So a lot of lifestyle can improve HDL and I haven’t seen gone like 10, 15 points. Would that really employ those methods. I will tell you that in the last 25 years it’s been at least three different trials based on different medications that we thought would improve HDL or augmented.  What happened, all these trials they were halted midway because they actually found more depths from those taking this medication. That was before we knew about particle size and functionality. Like we’ve learned that some HDL was functional and some isn’t and it’s more than about what’s the number is.

Dr. Weitz:            [crosstalk 00:37:21] there are patients who have very high HDL that tends to be nonfunctional, right?

Dr. Elkin:              Right, exactly.

Dr. Weitz:            They have HDL of 90 or 100 or…

Dr. Elkin:              It’s got great, but it’s not necessarily good at all. So drugs have not been helpful in that regard. Now diet is very interesting. So although saturated fat has been maligned or vilified, like beyond, yeah, I believe saturated fat has a few advantages. It can actually increase your HDL level. It can actually decrease LP little a which we haven’t really talked about and can also increase the size of the LDL particle, which is really interesting. So even though it’s been maligned, it does have some potential benefits when it comes to this cholesterol thing.

Dr. Weitz:            Yeah, I’ve used coconut oil with some patients and seen a rise in the HDL. What about fish oil for improving HDL?

Dr. Elkin:              I haven’t seen it do… But basically anybody with age of 40 it’s going to benefit. I use it as my right hand supplement.

Dr. Weitz:            Very cardioprotective, reduces inflammation…

Dr. Elkin:              It can also help with blood thinning and in a protective way as opposed to causing bleeding that you would get from aspirin. It also can help prevent, but we’ve talked about [inaudible 00:38:48] prevent sudden death. It’s been shown to be useful there. So as far as HDL, it may have an additive effect.

Dr. Weitz:            I think it can help somewhat with HDL, right?

Dr. Elkin:              Definitely. I’ve had niacin and I’ve had people increase like 15 points with taking [inaudible 00:39:07] to be dose dependent when they can tolerate and I usually go up to like max two gram today. I don’t feel comfortable going beyond that.

Dr. Weitz:            Yeah. I think there’s some other nutraceuticals like Copine some other…

Dr. Elkin:              I’m kind of basic. I stick to the ones that I know work that I’ve had good experience with. But I’m always open to new ideas and suggestions.

Dr. Weitz:            Right. Another factor on advanced lipid tests is homocysteine, which is another protein found in the blood that increase the risk of heart disease.

Dr. Elkin:              Right. So homocysteine is really a big thing now. It’s really an amino acid and your body normally wants to break it down to something called [inaudible 00:39:48] but some of us aren’t able to do that and so the homocysteine is built up in the arteries and they could also cause plaque of the arteries especially in the heart and in the brain, so it’s not a good thing.

Now that we’ve done a lot of genetic testing, which [inaudible 00:40:02] there to talk about now, there tends to be a propensity of people that have this thing called MTHFR. They have a variant, it’s that which is basically a typo in your genetic makeup. But these people, and I’m one of them, but I’ve [inaudible 00:40:20] my genes not being expressed.

But 60% of us have this and that can lead to high homocysteine levels. So it’s easy to decrease homocysteine levels and I have my own kind of product that put together and it’s B vitamins. But it’s higher dose B vitamins [inaudible 00:40:35]. So it’s always worth to try that because again, if you’re high risk, you want to be able to decrease that risk easily and you don’t need a medication. It’s simply a combination of B vitamins.

Dr. Weitz:            Yeah. One other nutrient is trimethylglycine and also can be very effective for homocysteine.

Dr. Elkin:              Naturally I include that in my supplement. So [inaudible 00:40:56].

Dr. Weitz:            What about LP little a? Now LP little a is the particle that the trainer Bob Harper from The Biggest Loser who had a massive heart attack, he had an otherwise great clusteral profile except he had elevated LP little a.

Dr. Elkin:              Lp(a) is the biggest bugaboo I know and it’s part of the advance of the profile. So you’re going to get the value. In my younger patients that have heart attacks and I have quite a few, invariably you’re going to see oftentimes I should say, at least elevated LP little a. It’s a fragment of LDL, it’s very sticky, very inflammatory, and it’s like not a good thing to have. Unfortunately diet and exercise won’t touch it.   So it doesn’t have much role there other than perhaps saturated fat might help. There’s no medication that has been really useful. Again, I’ve had some good success with niacin. It doesn’t always work, but I have had someone drop their [inaudible 00:42:07] as much as 100 points with high dose niacin. So I have had success. There is something in the pipeline I [crosstalk 00:42:15].

Dr. Weitz:            I think there’s a drug that is in the final stages of testing and we’re close to getting improved…

Dr. Elkin:              [inaudible 00:42:23] and we’re talking about a 70% reduction in like less than six weeks, which is amazing. However, it’s a drug. It’s going to be a biologic, which means it’s going to be, have to be injected probably a couple of times a month.

Dr. Weitz:            It’s probably thousands of dollars per month.

Dr. Elkin:              But in those that are really high risk, it could be a life saving [inaudible 00:42:47]. So it’s a beautiful thing.

Dr. Weitz:            Right. Let’s bring up one more particle and then we’ll move on. Arrhythmia is T-M-A-O, which is very controversial and I know that you’ve been starting to test it as part of the Boston HeartLab. TMAO is another protein in the blind that was developed by Stanley Hazen from Cleveland HeartLab that’s been shown to correlate with higher rates of heart disease.  But it’s very controversial and I’m skeptical of this concept because when you consume fruits like fish or eggs that have choline or L-carnitine or fuss with title choline that increases the levels of TMAO and we know that those foods are hard healthy and yet we’re being told that these nutrients like choline and L carnitine, which we know are super helpful for patients with cardiovascular problems are, we’re being told that they’re harmful.

Dr. Elkin:              Also brain-healthy for that matter.

Dr. Weitz:            Choline, crucial for brain health.

Dr. Elkin:              I look at it because I do a lot of [inaudible 00:44:06] HeartLab testing and it’s kind of standard. I will tell you, most of the patients that I test don’t have a, I wonder whether it’s over emphasized because I see a lot more abnormalities when I study, when I look at profile. But with some are elevated. But I would say the majority of those that I’ve tested really aren’t. So what do I do? Right now I’m just observing because it’s like, okay, what do I know that can help a patient [inaudible 00:44:33]? Particle size, LP little a, homocysteine, working on their diet.

I totally agree with you, choline is lacking in so many people and their diets as it is and it’s so useful and as far as [inaudible 00:44:48] but it’s like very important in cardiovascular health. Because it helps you bring nutrients to the mitochondria if it reduce. So I just don’t see at this point, I’m not changing people’s diet because of it. Also, is it really the food or it’s because the gut isn’t healthy? Is there a microbiome problem?

Dr. Weitz:            Right. Yeah, absolutely. So that’s something to continue to discuss over time. So let’s move on to Arrhythmia. This is a topic not often discussed but is increasingly common, especially among us aging baby boomers. Perhaps you can tell us what is Arrhythmia.

Dr. Elkin:              Okay. Arrhythmia is really a rhythm disturbance. So you have this thing called normal sinus rhythm or sinus rhythm which is your standard rhythm that most of us have. Even if you have a disruption in that, it’s an Arrhythmia. So it’s kind of a wastebasket term for a lot of different things. Let me break it down to what type of Arrhythmia is it, are they isolated atrial beat or premature beat, or it’s something that’s sustained. [crosstalk 00:46:00]

Dr. Weitz:            Or somebody who just can’t dance.

Dr. Elkin:              It’s interesting. So a very common complaint in the cardiologist office is palpitations. Now I for one, have never had a palpitation [inaudible 00:46:23]. So I have to really delve into, I have to really ask people, what does it mean? Is it skipping, is it fast, is it slow because I can’t relate. But fortunately there are two ways we can monitor patients.

Now, mostly with me is [inaudible 00:46:37]. So what I’m treating are symptoms and [inaudible 00:46:42] out. But some are malignant like ventricular tachycardia, atrial fibrillation that leads to sudden death. So part of my job is to figure out what’s really important and what’s not and if it’s not important, what can I do to assuage the patients feel, they’re uncomfortable with feelings because it can really run you.

Some patients are very debilitated by the presence of palpitations and arrhythmias. What I’ll talk about briefly is that what I’m seeing more and more of is atrial fibrillation, which used to be the most common Arrhythmia that we saw in people over the age of 70. But I will tell you, I’m seeing the younger, younger people with it now. Two of my closest friends had to have ablations in their early 50s because if such refractory [crosstalk 00:47:30].

Dr. Weitz:            What’s an ablation? Can you explain what that is?

Dr. Elkin:              So ablation is done by a cardiologist like me but they specialize in electrophysiology. So they specialize really in Arrhythmias and trying to study with me as, and if they find something that… Because Medicaid patients are really suboptimal. Tons of side effects that can actually make arrhythmias worse. So with ablation, it’s a procedure in which you go through the heart, into map out where the Arrhythmia emanates from and then you can sap it with either radio frequency waves or cryotherapy, which is cold. You can potentially cure an arrhythmia problem with ablation. So it’s evasion…

Dr. Weitz:            So basically damaging, either burning or freezing a part of the nerve that is leading to that contraction of the heart.

Dr. Elkin:              Sometimes part of the heart muscle but we don’t want to do that. But it’s pretty actually in the proper hands, the side effects are pretty low. So [inaudible 00:48:38] I’m a solo practitioner. I probably get three or four new cases of atrial fibrillation every month in my office. It’s so common. That’s probably the most significant thing because we used to think that, okay, well it’s important to treat because the kinds of hearts beating irregularly, irregular is [inaudible 00:49:05] for blood clots to form in the heart and to break off and cause a stroke which is devastating or could be potentially devastating. But also what we’ve learned in recent years, it can be a cause of heart failure, progressive heart failure. But here’s the new one that we have found is that it also can lead to early dementia. Maybe there could be a little microemboli go into the brain that we don’t really recognize as strokes. So it’s not a good thing.

Dr. Weitz:            So which dietary factors are important for helping to manage a patient with Arrhythmia?

Dr. Elkin:              It’s a good point. Well, first of all, magnesium is always important. Actually if you look at the sodium, potassium, magnesium, they all or your basic minerals and they deal with… They’re essential for proper nerve and muscle and nerve function. Well, sodium regulates body fluids. So you want to…

Dr. Weitz:            Do you want to add salt or you want to remove salt?

Dr. Elkin:              I don’t usually deal with removing salt unless I’m dealing with a patient with heart failure, liver failure or kidney failure. I think this whole thing about salt, we pretty much have discounted the importance of it. I know that the heart association is still saying low salt diet or less than 2.5 grams a day. I don’t. If you’re active person, that’s nothing. It’s nothing. So I don’t think salt affects your heart rhythm at all. So what affects it? Stress is a big one. I think fatigue, another big thing is sleep apnea, uncorrected sleep apnea. So there are things that we have to look…

Dr. Weitz:            Caffeine, energy drinks.

Dr. Elkin:              Yeah. Energy drinks are the worst because they not only can be [inaudible 00:50:59], they can also is an EKG abnormality called a long QT interval, which doesn’t mean much, but it’s an EKG diagnosis and that itself can lead to life threatening with news as in sudden death. It’s been reported in the young people like not good things to have.

Dr. Weitz:            One of your articles I read said that celery, garlic and onions can play a role. Have you heard that?

Dr. Elkin:              I haven’t heard that. I’m a big user of magnesium and hydration in general. I also use an amino acid called taurine, useful. Magnesium tends to quiet the heart and it can be very important, especially people that have bothersome palpitations. Another thing in women that are going through menopause is hormone replacement therapy. It’s not the only reason they need to go it, but low progesterone is a very important factor and causing irregular heart rhythms which I didn’t learn, I didn’t know that until I did my anti-aging medical township. I didn’t learn it at all in cardiology.

Dr. Weitz:            Now what about hawthorn extract?

Dr. Elkin:              Hawthorn berry is good for the heart. It’s not my go-to, but it’s something that it’s additive and a lot of patients take it and they’ve heard about it. They see it on the Internet and they’ve heard the utility of it. So it can be useful for heart rhythm. Yes.

Dr. Weitz:            What about CoQ10?

Dr. Elkin:              Definitely CoQ10. Yeah, that’s…

Dr. Weitz:            I’ve also seen some articles mentioning vitamin C and of course vitamin C there’s actually a protocol for using vitamin C for LP little a, right?

Dr. Elkin:              Yes. So definitely, so vitamin C, magnesium for sure. Taurine it’s for sure and also looking at the lifestyle. Smoking is bad, fatigue or poor sleep habits are not good. Lifestyle today, we’re living very stressful times along with political scene, but we all know what’s happening. People are stressed. I think when they come into my office but I can’t say it over the air. But they say, you know why my blood pressure is high? [inaudible 00:53:12].

Dr. Weitz:            I hear you Howard. Well, we’re going to try to stay away from politics. Can maneuvers that stimulate the vagus nerve be helpful?

Dr. Elkin:              Okay. That’s interesting. I do this diagnostically. If someone has an arrhythmia in my office and I’m trying to… Yeah, you can actually do vagus maneuvers like it’s called a carotid massage. A carotid massage will activate the Vegas nerve cause you’ve got a sinus in there. I’ve had it actually break Arrhythmia, it can be very useful. So I use that. I don’t use drugs per se for that because they can have some nasty side effects. But I do use it. I tell my patients if they’re having what’s called SVT or supraventricular tachycardia, which is very common. I say, okay bear down, cough a lot.

Dr. Weitz:            Coughing [inaudible 00:54:09] flax.

Dr. Elkin:              I put your head in a bowl of ice water. If you have a partner or someone, it’s hard to do your own carotid massage because people are turning to the extreme. You have to get on top of the carotid artery and go up and down kind of firmly and it’s not real comfortable so every person want to do it on their own. But if they have a partner or a friend or bystander, they can do that.

Dr. Weitz:            Then what about natural procedures that reduce stress like yoga, meditation, and I know you were involved in a study on grounding as well.

Dr. Elkin:              Yes. So grounding, I did a study with Dr. Sinatra. We did it mostly looking to see the effects of blood pressure and it can really reduce blood pressure. It’s really cool. But it’s also anti-inflammatory and it’s also an actual blood thinner. It also helps us sleep. I love it because it’s free. You’re just using the electrons or surface but…

Dr. Weitz:            I should consider seeing if it has a positive effect on Arrhythmia, I would think it probably would.

Dr. Elkin:              Yes. We didn’t study that per se because we were looking at one component and blood pressure is such a big target. But these are all additive things. I think a lot is on lifestyle and hormonal and environmental and we live in a very toxic world. Pesticides, there’s formaldehyde in everything. I didn’t even know that until recently. I got scared when I started seeing all the things in our household that could potentially contain formaldehyde. Do you believe that? Like our carpets. That’s why I got rid of all the carpets.

Dr. Weitz:            Yeah. They have those flame retardant chemicals and yeah, a lot of furniture. You got to really try to go nontoxic as much as you can. Well, this has been a great discussion, Dr. Elkin. Any final thoughts for our viewers and listeners?

Dr. Elkin:              Well, here’s my final thought is that I believe in patient smart and I tell patients you need to become your own medical advocate. Yes, you want excellence in doctors and nurses and health care. You don’t depend on your doctor, the hospital, your insurance plan or the federal government to take care of you. So do your research, try to find functional medicine people.  If you have a doctor that’s traditional, you can develop your own dream team because you need to look at those lifestyle factors, nutrition on stuff that we talked about. That’s really what I like to leave people with is that stay in the driver’s seat when it comes to your health. That’s a very important message that I always try to get across. I’m your second and you’re your first.

Dr. Weitz:            Exactly. I think that’s also very important. A lot of times people will see different doctors as, is this doctor, is it better to go to a conventional doctor or should you go to an alternative doctor? Really they both have their place and you’re suggesting for ideal health, for optimal health it’s best to have a team and there’s some great benefits to having a conventional primary care doctor and there’s all kinds of routine testing and it’s great to see them for infections and things like that.  But on the other hand, it’s also good to have a functional medicine doctor as part of the team to look at some of those underlying causes of some of these chronic diseases so you can look at things from different approaches and really get to the root causes.

Dr. Elkin:              [inaudible 00:58:02]

Dr. Weitz:            So how can listeners and viewers get hold of you, Dr. Elkin?

Dr. Elkin:              Okay. Well, if you go to my website, it’s www.heartwise.com, you learn about me and I try to put things there on a regular basis. On Facebook is HeartWise Fitness and Longevity Center and on Instagram, it’s Doc HElkin and I always try to post some things couple times a week. So I try to keep current and I try to inform people what’s happening. So it’s kind of a, I like to be contribute in that matter.

Dr. Weitz:            Thank you, Howard.

Dr. Elkin:              Alright, great. Thanks, Ben. I loved it. Very good. Thanks.

Dr. Weitz:            Me too.



Natural Solutions for Anxiety and Depression with Dr. Peter Bongiorno: Rational Wellness Podcast 146

Dr. Peter Bongiorno discusses Natural Solutions for Mood Disorders like Anxiety and Depression 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

4:45  Rate of anxiety and depression are rising today, esp. among teens.  When depression becomes severe, you wonder about suicide, but suicide rates that been soared, despite the use of all of these antidepressant drugs being prescribed.  In fact, some of the SSRI (serotonin reuptake inhibitor) drugs are known to increase suicide rates.  These drugs do have benefit, esp. in urgent care situations, where they can be life saving.  SSRIs are commonly used for depression and anxiety, but for mild to moderate depression, they work about 30-35% of the time, which is a hair more than placebo.  Usually after 2-5 years these drugs tend not to work as well. And these drugs are not getting to the underlying problem, even if that is a serotonin imbalance. You still want to ask, why did your serotonin get out of balance?  If we can treat the underlying causes, then that is a better solution, which is why the Functional Medicine approach can be so helpful.

7:52  The neurotransmitter imbalance theory of depression is questionable, since brain chemistry appears to be much more complicated than some think, since we have drugs that increase serotonin levels, drugs that increase norepinephrine, dopamine, GABA, and reduce glutamate levels that all seem to have some efficacy. In fact, there is even an anti-depressant that decreases serotonin levels that seems to have equal efficacy to drugs that decrease serotonin levels. Dr. Bongiorno points out that the older tricyclic antidepressants are actually more effective for depression. For anxiety, while anti-depressants are not very effective, the benzodiazepines, like Xanax and Ativan, are fairly effective. But the problem with these drugs is that you can’t take these drugs long term because they have a lot of side effects, they are very addictive, and they stop working after a while. If the Ativan stops working, they may get put on Xanax and eventually other, stronger drugs.

10:25  Natural Treatments for Anxiety and Depression. Diet, sleeping, and exercise are all important factors that affect the risk of depression and anxiety.  The digestive tract is super important, since most of the neurotransmitters are produced in the digestive tract, and diet directly affects digestive health.  While dietary recommendations are best individualized, in general, the Mediterranean style diet is probably best and it has been shown to raise GABA levels, which is the calming neurotransmitter.

12:32  Balancing blood sugar is very important for patients with mood disorders.  If blood sugar is not balanced, insulin will be elevated and this can drive inflammation.  While it is popular in the Functional Medicine world to do intermittent fasting and skip breakfast, Dr. Bongiorno finds that “for mood, it’s really helpful to have a good breakfast, to have a good lunch and have a smaller dinner.”  It is best to have meals based on healthy proteins with healthy fats, in addition to some healthy carbs, like whole grains and beans.  Dr. Bongiorno pointed out that if you look at the diets where people live the longest in the Blue Zones, they include some healthy carbs like whole grains, beans, and legumes.  For patients with mood disorders, getting some of those carbs are really helpful to keep the serotonin levels up.

18:12  Lab testing can help us to sort out some of the underlying imbalances that might lead to anxiety and depression.  A full lipid/cholesterol panel is important since if cholesterol is too low, this can lead to hormone deficiencies.  If the HDL goes below 35, LDL goes much below 90 or total cholesterol goes below 190, that can be negative for the brain. In our drive to lower our cholesterol levels to lower heart disease, we are pushing cholesterol levels too low for optimal brain function and cognitive function and this can be playing a role in mood disorders. Labs should also include a good iron panel, vitamin D, RBC magnesium, Carnitine, B12, salivary cortisol test, and sex hormones like estrogen, progesterone, and testosterone. Melatonin levels are helpful when there are sleep problems. 

24:29  Sleep.  Dr. Bongiorno mentioned that he emphasizes the importance of sleep in all of his books and makes it the first chapter. If people aren’t sleeping, it’s very hard to make them feel better. The first thing that needs to happen is that your patients need to be sleeping and pooping every day before you can fix any other problems. It is important to go to bed no later than 10 or 11, since most of our melatonin gets released somewhere between 8:30 and 10:30, which is needed to get into a deep sleep state.  If you stay up late playing video games that cause the elevation of our dopamine and our norepinephrine, which are neuroexcitatory, you will much more likely have mood disorders. We need to respect our normal circadian rhythm if we want to have a good sleep pattern. wearing blue light blocking glasses at night can be helpful, esp. if they are looking at their phones, computers or TV.

29:00  There is a therapeutic benefit to spending time in nature, which the Japanese call shinrin yoku.  Molecules known as phytoncides are emitted in a forest and we breath them in and they get into our bloodstream and they help our immune system to work better and balance our neurotransmitters. Just standing on the earth, grounding, changes our electromagnetic field and has therapeutic benefit.

30:25  Exercise has been shown to be as effective as the leading antidepressant medications.


Dr. Peter Bongiorno is a Naturopathic Doctor and Acupuncturist and he is the co-director of InnerSource Natural Health and Acupuncture, with offices in New York City and on Long Island. He also works with clients via phone and Skype. He’s written a number of books, including Healing Depression in 2010 and Holistic Solutions for Anxiety and Depression in Therapy in 2015, targeted for physicians, and How Come They’re Happy and I’m Not, and Put Anxiety Behind You: The Complete Drug Free Program, both for patients. His website is DrPeterBongiorno.com.

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


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.  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 podcasts and give us a ratings and review. That way more people will be able to discover the Rational Wellness podcast. If you’d like to see a video version, please go to my YouTube page. If you go to my website drweitz.com, You can find a complete transcript and detailed show notes.

Today our topic is in integrative approach to mood disorders like depression and anxiety with Dr. Peter Bongiorno. Depression is a mood disorder characterized by a persistent feeling of sadness and loss of interest. According to the journal, the American Medical Association, in 2013 16.7% of adults filled one or more prescriptions for psychiatric drugs with most being anti depressants. This prevalence is higher among women than men.  An estimated 3.2 million adolescents aged 12 to 17 in the US had at least one major depressive episode representing 13.3% of adolescents. Anxiety is characterized by feelings of worry, nervousness or fear that are strong enough to interfere with one’s daily activities. Anxiety is even more common than depression with 19.1% of US adults having experienced an anxiety disorder in the last year and 31.1%, having experienced an anxiety disorder sometime in their lives.

These numbers for rates of anxiety have been rising in the US. Depression and anxiety are typically treated within conventional medicine with medications like antidepressants such as Prozac, Zoloft, and Lexapro. These are among the most commonly prescribed medications in the US. The number of people taking these medications has been rising rapidly. Recent statistics show 64% increase in the number of people taking antidepressants in the last 15 years. 12.7% of the US population took antidepressants in the last month and older adults took them in even higher numbers.  Most of these antidepressants were originally approved by the FDA for short term usage, and there are only a few studies that lasted longer than a few years. But yet many patients are being placed on these drugs indefinitely. It’s very difficult to get off these drugs. A large percentage of patients who take them report severe withdrawal symptoms when trying to wean themselves off or are unable to wean themselves off.  One of the focuses of our conversation today will be whether these drugs are actually effectively treating the causes of depression and anxiety and what alternative treatments might be available, taking a holistic or functional medicine approach. Either as alternatives for patients who do not want to take these medications, or perhaps to make these medications more effective.

Dr. Peter Bongiorno is a Naturopathic Doctor and acupuncturist and he’s the co founder, co director of Inner Source Natural Health and Acupuncture with offices in New York City and on Long Island. He was a researcher at the National Institutes of Health in the department of Neuroimmunology. Then he went to Bastyr University to study naturopathic medicine and acupuncture. He’s written a number of books, including Healing Depression, in 2010, and Holistic Solutions for Anxiety Depression, as well as How Come They’re Happy, and I’m Not and Put Anxiety Behind You The Complete Drug Free Program.  Dr. Peter is a sought after speaker and he spoke at the A4M conference in Las Vegas in 2018 where I saw him speak. Dr. Bongiorno, thank you so much for joining me today.

Dr. Bongiorno:                   Oh, gosh, it’s my pleasure.

Dr. Weitz:                          Why do you think rates of depression and anxiety are so prevalent today and especially anxiety seems to be rising among teenagers?

Dr. Bongiorno:                   I mean, there’s no question that anxiety and depression rates are just soaring. It’s really interesting because as you alluded to at the statistics, we’re using more and more of these drugs for depression and anxiety every year. Yet, more and more people are getting anxiety and depression every year. If you look at, for example, depression, one of the things you worry about the most, of course, is suicide.  Suicide rates have soared. There’s a few studies that look at rates from between 2007 and now. We’re seeing these incredible jumps and even in just the past few years. Despite the fact that all of these drugs are being used and more and more are coming out on the market, the endpoint, which we’re most concerned about is only becoming more and more of a problem.

Dr. Weitz:                          In fact, the side effect of some of these drugs is that they actually increase suicide rates, right?

Dr. Bongiorno:                   Yes. So now they’re putting black box warnings on things like SSRIs which are serotonin reuptake inhibitors, which are commonly used for depression and anxiety. But now they’re showing that in younger people, they may actually increase suicide rates. In fact, it started out with very young people like teens and adolescents, and now they’re bringing it up to young adults that they’re seeing this concern with.  It’s not to say that medications don’t have their place. Sometimes when someone is in a real urgent care situation, and there’s really no other choice, then sometimes a drug can be life saving. It’s not that they’re completely not useful and always a bad idea, but they’re certainly being far overused. They’re not getting to the underlying problem. For many people, they might numb the symptoms when they do work.  For example, depression, in mild to moderate depression, which is when SSRIs are used the most, they work about 30 to 35% of the time, which is maybe a hair more than a placebo would work. Even in those cases, at some point, it’s usually within two to five years, those medications tend to not work as well anymore anyway. At some point, you still have to say, okay, we have to figure out what’s going on. Even for people when they work in the case of depression, you still want to sit down with these person and say, well, what’s the reason things went awry.  If an SSRI fixes serotonin, and that helps, you still want to ask, but why did the serotonin get out of balance to begin with? These are the questions that aren’t being asked. Instead, people are just being put on medication and sent on their way. Then once it stops working, it becomes a crisis.

Dr. Weitz:                            You wonder if this whole concept of these mood disorders actually being caused by neurotransmitter imbalance is really valid. If you think about the fact that we have drugs that increase serotonin, you talking about SSRIs. Then we have drugs that increase Norepinephrine. Now we have drugs that increase dopamine. We have drugs that affect GABA, glutamate. We even have drugs that decrease serotonin and seem to be equally effective. You just have to wonder what do we really know about the complexity of brain chemistry? It certainly doesn’t seem to be as easy as just increasing serotonin production.

Dr. Bongiorno:                   No, absolutely right. It’s interesting because the drugs that seem to work the best, not great, but certainly the best of what are called tricyclic antidepressants, which are the old ones. They just seem to basically raise everything. So it’s just pull everything up and hopefully it will help somebody feel better. The problem with those drugs is that they do have a lot of side effects, which is why they are considered first generation not really used so much anymore.  Like I said, in mild to moderate depression, which is the vast majority of use of these prescription drugs, it only works maybe 30, 35% of the time tops. Anxiety, on the other hand, benzodiazepines, drugs like Xanax and Ativan, they do work. If somebody takes one of those, they get calmer. But the problem with those drugs are, is you can’t keep taking them. You get addicted to them, they stop working and need more and more, and I can’t tell you all the patients I see on the same path trajectory.  They’re young, they get anxious, they get put on an Ativan. The Ativan doesn’t work, they get put on Xanax. Now they get withdrawal at night, they have trouble sleeping, so they get put on Klonopin, and then the Klonopin stops working so they get put on Tramadol or something even stronger. Trazodone and just… We keep upping the ante and these gets stronger and stronger to the point where people, they can’t get off them but they’re not working anymore either.  I can’t say how many patients I’ve seen in that situation as well. It’s just a testament to the fact that the body is not being treated to heal. It’s just being treated for symptoms. That doesn’t work.

Dr. Weitz:                            Right. Let’s get into some of the natural approaches. What role does diet play in depression and anxiety? What’s best type of diet to control it?

Dr. Bongiorno:                   The first thing I want to say is that there’s a lot of factors that play a role. You just touched on a major one. Diet, if people are sleeping, whether they’re exercising or not. Certainly what’s going on with their thoughts, play a role, environmental toxicities, inflammation in the body, digestion, hormonal balance, nutrient deficiency. When I look at a patient, I try to assess all of these different things at the same time and figure out for them, what are the factors that are contributing to what we’re calling anxiety or what we’re calling depression.

Diet is clearly one of them. Our digestive tract is such an important place in terms of making the neurotransmitters. If neurotransmitters are off, we really want to start thinking about the digestive tract. What we eat and what we put in our mouth, of course, is going to play a huge role and how well that digestive tract functions. To answer your question, if I don’t know a patient and someone asked me well, what is the best diet? I would start with something probably like a Mediterranean style diet.  Mediterranean style diets are shown to be very beneficial to help raise GABA which is the calming neurotransmitter. It helps lower inflammation. We know that inflammation that goes to the brain can play a really strong role in all kinds of mood disorders. The Mediterranean diet really provides a lot of nutrients, a lot of good fiber for the microbiota in our body, which is clearly an important part of how we can balance neurotransmitters in our brain. Without knowing a person, if I had to pick a diet and didn’t understand their sensitivities, I’d probably start with some version of the Mediterranean style diet.

Dr. Weitz:                            Good. What are some of the dietary factors that play a role here? I know in your book you talked about the importance of balancing blood sugar.

Dr. Bongiorno:                   Yes, blood sugar is very vital because what I find is a lot of people who have both anxiety and depression, their blood sugar tends to bounce around a lot or sometimes their insulin, which is the hormone that takes the sugar out of the blood and puts it into the cells, can get very high for some people and that can also drive a lot of inflammation. Eating in a balanced way can be very useful.  Now everybody’s different, of course one size doesn’t fit all. But usually I find if patients are very susceptible to mood changes when they don’t eat, then the first step is really to make sure you’re eating throughout the day at least three good meals and definitely a good breakfast. I tell a lot of patients: eat like a king for breakfast, a queen for lunch, and a pauper for dinner. It does work because I find when people eat a good breakfast… I know right now, with intermittent fasting, sometimes it’s become desirable to not eat and have a breakfast later so that you lessen your hours.

Dr. Weitz:                            Yes, very popular, especially in the holistic Functional Medicine circles. We skip breakfast so we have a longer period of time between dinner the night before and lunch without eating.

Dr. Bongiorno:                   That could be fine for some people therapeutically if they want to lose weight. But I always like to check in because if they have mood issues, and especially if they have mood issues associated with not eating, then we might want to modify that for them. Again, everybody is different and there’s no one size fits all and that might be great for some people, and not so good for other people. But I find for mood, it’s really helpful to have a good breakfast, to have a good lunch and have a smaller dinner.  Make those meals very healthy protein based, whole foods, good healthy fats, and also some healthy carbs. If you look at the diets really where people live the longest in the Blue Zones, they don’t really get rid of all the carbs. They tend to eat good whole grains, beans, legumes and things like that. I find for my patients with mood, getting some of those carbs are really helpful to even keep the serotonin levels up. Everybody’s different, but I think for mood that’s a good general rule.

Dr. Weitz:                            I think it’s important that you’re emphasizing the benefits of carbohydrates because especially in the last five 10 years, carbs have been demonized as some of these low carb diets have become more and more popular like the paleo diet and the ketogenic diet. People are really seeing carbs as just completely evil. I think we need to rethink that and realize that carbohydrates can play an important role, especially healthy carbs or low glycemic ones that have a lot of nutrients and fiber and can be part of a healthy diet.

Dr. Bongiorno:                   Yes, absolutely. When I was a student over 20 years ago, I had the opportunity to spend time with Dr. Atkins in his center in New York.

Dr. Weitz:                          Okay, Mr. Low Carb himself.

Dr. Bongiorno:                   Yes, the guy who really figured out that not eating fat and eating all of these bagels was a bad idea. Nobody was talking about it. He was a very nice man. The thing that I learned in his clinic is that therapeutically, using very low carb can be really helpful and get people out of crises when there’s a lot of inflammation, when there’s heart disease, things like that, but for the long term, it’s not always a good idea. I think even Dr. Atkins himself started people on a pretty strict diet and then eventually put them on a more modified diet.

Dr. Weitz:                          That’s not information that you hear a lot.

Dr. Bongiorno:                   Yes. Now you hear about eating a lot of bacon and stuff but I don’t think that’s what it was really about there.

Dr. Weitz:                          Right.

Dr. Bongiorno:                   I think that’s interesting. All of these tools can be used therapeutically for the right person, but we really have to say, as a practitioner, do I want everyone not eating breakfast? Maybe some people that works, some people that’s a disaster. We really have to tailor.

Dr. Weitz:                          I’ve been in the healthcare field for 30 years. When I first got into it, the big thing was, everybody said because they skip breakfast, they don’t have time, they rush off to work. One of the big keys was you have to eat within that first hour of eating, you have to have small meals or snacks and now skipping breakfast, which was a bad thing is now supposedly the good thing. It’s funny how these things go in cycles.

Dr. Bongiorno:                   Yes, as info comes out, the pendulum keeps swinging. The truth is, it’s all can be useful and it’s all could be not appropriate. It all depends on the patient. Everyone is different. That’s really what’s in a sense, I think what’s fun about our job. We get to sit with the person. It’s really an honor to spend a lot of time with this patient, learn about their life and their history. Then, based on our knowledge, help them figure out what really works for them.

Dr. Weitz:                          Exactly.

Dr. Bongiorno:                   That’s what’s exciting to me about the job.

Dr. Weitz:                          That’s great. We have all these different complicated factors, and you just touched on a bunch of them. One of the ways to sort this out, besides taking a detailed history is to do some lab testing. What do you think are some of the most beneficial lab tests that help sort out patients with anxiety and mood disorders?

Dr. Bongiorno:                   Well with blood work I definitely like to do a good cholesterol panel. Believe it or not just to find out to make sure it’s not too low. Because cholesterol is the major molecule your body uses to make your other steroid hormones. Sometimes I worry it’s too low. I know regular doc’s worry about it’s too high. In fact, HDL levels, when they’re low, that’s actually considered a marker of depression. You want to have good lipid levels.



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Dr. Weitz:                          What level of HDL is considered a marker for depression?

Dr. Bongiorno:                 Under 35.

Dr. Weitz:                         Okay.

Dr. Bongiorno:                  It depends on the lab tests but around there, around under 35.

Dr. Weitz:                         Interesting. It’s interesting because today you hear the latest drug, the PCSK9 inhibitors, which when combined with the statin we get your LDL below 40.

Dr. Bongiorno:                  Low low low.

Dr. Weitz:                         Exactly and there’s problems with getting your LDL level too low.

Dr. Bongiorno:                  What are we doing to the brain, right?

Dr. Weitz:                          Right.

Dr. Bongiorno:                   It’s just not a great scenario for the brain.

Dr. Weitz:                          Is there a level of LDL or total cholesterol that you like to keep the body from getting too low on? Is there a cut off?

Dr. Bongiorno:                   I like to see the total cholesterol at least around 180. I think is a good place to be in and maybe LDLs around 90.

Dr. Weitz:                          Oh, wow. Okay.

Dr. Bongiorno:                   Maybe 100. It just really depends. Because we’ve been lowering them and lowering them and lowering them. I’m not sure we’re seeing the benefit of that. But we are seeing the detriment to the brain and cognition and cognitive function. It’s… I mean, I think there’s still a lot to be learned there so I’m still open but-

Dr. Weitz:                            Probably plays a role in the rise in neurodegenerative diseases like Alzheimer’s and Parkinson’s.

Dr. Bongiorno:                   That’s what it seems to be. It’s-

Dr. Weitz:                            Okay. So besides lipids, what other…

Dr. Bongiorno:                   Good iron panel and iron storage. Of course, vitamin D. Then I like to look at thyroid, a full thyroid profile, not that thyroid is perfect in terms of lab testing, but I think it’s good to see where it is in terms of labs and then correlated with how people are feeling clinically.  Certainly look at things like red blood cell magnesium.  Carnitine is another amino acid that I like to look at. B12 certainly. Then I like to do a full hormonal panel. I like to look at the four or five point cortisol test, see how people’s stress hormones are doing throughout the day and see what their circadian rhythm looks like. Especially for women looking at the estrogen levels. But even in men seeing what the estrogen level is is important too, because that’s important for serotonin and serotonin receptors.

Progesterone in women as well is really important for the calming GABA neurotransmitter, testosterone for both men and women can be very important for the brain. Melatonin levels are useful especially when there’s sleep issues to see what’s going on there. Pretty full profile and then depending on the patient, there could be other things they might want to look at like histamine levels, mitochondrial function, mold toxicity.  Everyone’s history is a little different. Then that might give me clues. Unfortunately, there’s so many tests you can do. You can’t run them all on everybody. You need to listen to the history and then start looking down those roads first.

Dr. Weitz:                          How do you assess mitochondrial function?

Dr. Bongiorno:                   I mean, you could start with things like lactic acid, which is an easy test. Pyruvic acid, which you can do with blood work. Certainly looking at CoQ10 levels. CoQ10 levels, believe it or not, if they’re low, that can suggest mitochondrial issues or if they’re too high. Because if a patient starts taking CoQ10 but their levels are high, that usually means the mitochondria is in some sort of distress.

Dr. Weitz:                          Interesting.

Dr. Bongiorno:                  Things like that. Then now there’s more specific mitochondrial profiles and genetic profiles that look at mitochondria as well. I’m starting to learn more about those two. It’s pretty exciting stuff.

Dr. Weitz:                          Right, there’s that Mitoswab test that’s available now.

Dr. Bongiorno:                   Have you used that test?

Dr. Weitz:                          I haven’t yet but I interviewed the doctor who came up with it, Doctor Ganeshan.

Dr. Bongiorno:                   Oh it’s terrific. Things like that I think are really fascinating. For a lot of patients too, I see especially when they have a lot of sensitivity to noise and light, as well as being very fatigued, looking at mitochondrial function, I think is a really great idea.

Dr. Weitz:                          Yes good. You mentioned sleep, how important is getting good quality sleep for us?

Dr. Bongiorno:                   If anyone’s ever looked at any of my books, sleep is the first chapter. That tells you how important it is. Sleep is… If people aren’t sleeping, it’s very hard to get them to feel better.  Sleep is absolutely imperative. The two things that I look at for patients is if they’re not sleeping, and if they’re not pooping every day, that has to be worked on first.  No matter what they’re coming in for, because I find is really hard to fix anything.  If those things aren’t happening.  Sleep is really… It’s where our brain detoxes and where it de-inflames and fixes things.  That’s where our mitochondria fix themselves and rebuild. It’s critical.

Dr. Weitz:                          Do you use devices to help assess sleep?

Dr. Bongiorno:                   You mean like wrist devices..

Dr. Weitz:                          Yes.

Dr. Bongiorno:                   There are a few different ones. I haven’t found anything that has been especially useful yet. I don’t think they’re quite there yet. I mean, it’s interesting. But to tell you the truth. Usually just by getting a good story from the patient, you’d like to figure out what’s happening with the sleep.

Dr. Weitz:                          Check out the Oura Ring.

Dr. Bongiorno:                   Oura Ring?

Dr. Weitz:                          Yes.

Dr. Bongiorno:                   Okay. I’ll give that a try.

Dr. Weitz:                          Does it matter what time we go to sleep?

Dr. Bongiorno:                   I think it does. I mean, in Chinese medicine, they’ll say an hour before midnight is worth two after midnight. Our melatonin gets released somewhere between probably 8:30 and 10:30. If we go to bed too far after that, we start to lose the beneficial effects of melatonin to get into a deep sleep earlier. We end up staying in more surface sleep that lasts the whole night. Even if we’re sleeping, the sleep isn’t going to be deep. Getting to bed earlier is definitely advantageous because we’ll get into a deeper sleep.

Dr. Weitz:                           This refers to our natural circadian rhythm, right?

Dr. Bongiorno:                   Mm-hmm (affirmative).

Dr. Weitz:                           That’s why the body secretes the melatonin when light comes down.

Dr. Bongiorno:                   Yes, but our eyes recognize when it’s evening and when it’s nighttime, and that starts that whole process of melatonin. Melatonin really is a master hormone that tells our body it’s time to go to sleep. Then Once it does that, then it starts all those processes I mentioned before about detoxing, getting rid of inflammation and fixing the brain and all that.  It’s one of the reasons why these computers that we’re on and all this blue light, and TV watching and games. I had a patient I was working with yesterday, who had pretty… He was in his early 20s, had pretty significant depression the first time I’d seen him. For the last couple of years, he’s up every night just playing games till late. Of course, his sleep is completely disrupted. That seems to predate a lot of this mood.  I know it sounds simple, but that routine has got to get changed, and it’s hard because those games they raise our dopamine. They raise their norepinephrine and we get addicted to them. Between the addiction of those neuro chemicals and the excitement of the game and then that changes of our circadian rhythm, then we get into these patterns then we wonder why we don’t feel good. Very disruptive.

Dr. Weitz:                           Do you recommend blue light blocking glasses or using red light bulbs or things like that?

Dr. Bongiorno:                   Yes, absolutely. In fact, with the patient I spoke about yesterday, that’s one of the things we talked about is looking into blue light glasses. Because when people are in a certain pattern, it’s usually hard just to ask them to completely stop something. They’re not ready and frankly, they’re addicted to it. We do it in steps, right?  Something like lessening the amount of time, using blue light glasses is a good place to start.  If possible, I’d like to get people to shut all the screens and blue lights an hour before bed, and if they want to read they could read by an orange light or an orange red light. Just enough light so that they could see but not a color in the spectrum that’ll suppress our natural melatonin. Right.

Dr. Weitz:                           Let’s see, in your book you talk about therapeutic benefit of being in nature like taking a hike.

Dr. Bongiorno:                   Yes, the Japanese have a term for it, it’s called shinrin yoku. What they recognize through studies in Japan and elsewhere is that the forest and nature emits these molecules they called phytoncides. We actually breath them in, they get into our bloodstream, and they interact with our immune system and help our immune system work better and interact with our nervous system and balance our neurotransmitters.  There’s clear benefits from a research and scientific standpoint of getting into nature. We all know that it just makes us feel good. There’s no question about it, but there’s real reason for it. I know. Dr. Sinatra, I don’t know if you’ve talked to him at all. He’s a big proponent now of grounding. Taking your shoes, your socks off, going to the sea putting you’re feet in the sand.

Dr. Weitz:                           Yes, one of the doctors in my office, Dr. Howard Elkin, he worked with him on that grounding study.

Dr. Bongiorno:                   I love it. It’s great stuff. That’s getting into nature and just changing your whole electromagnetic field and getting together with the earth. Our bodies respond very positive with it.

Dr. Weitz:                           What about the role of exercise for depression and anxiety?

Dr. Bongiorno:                   Exercise alone has been proven to be as effective as any of the medications by itself. We know the medications for depression don’t work so great and for anxiety, they do work well and so does exercise. Exercise is just… It’s an interesting thing. As I’m learning more about depression, I’m learning how there’s something… You know that mTOR, mammalian target of rapamycin?

Dr. Weitz:                           Yes.

Dr. Bongiorno:                   There’s a molecule in our body that’s mTOR that shuffles between building us up and breaking us down. We need this balance of both. Exercise has really been shown to create that balance for that. It helps us clean out when we need to clean out, and then build back up when we need to build up. That has very beneficial effects on the nervous system. For anxiety and depression, exercise is just such a key, especially in the way that it burns our stress hormones.  Let’s say you’re anxious, in the wild, if we’re anxious, I feel my heart beating and I get very stressed and upset and I see a bear behind me. That would be the reason why I’d feel that way and I’d run. I burn off those stress hormones, burn off that norepinephrine. Get away from it, and then feel calm.

Well, in today’s society, we have those feelings, and we get very stressed and anxious, but we’re not burning it off. We’re not doing anything to release it. So It does build up in our body, and then it comes out as panic attacks, and anxiety attacks. In most cases, in my opinion, depression is really just anxiety and overwhelm that gets to the point where a body can’t take it anymore.  We start to almost decompensate for all that overwhelm and then we get depressed. Anxiety and depression are almost two sides of the same coin in most cases. Exercise is just a brilliant way to help remedy that.

Dr. Weitz:                            I think exercise is overlooked as a solution for so many problems. Everybody’s into fasting these days. One of the benefits is something called autophagy, which is where you break down yourselves to rebuild yourself. Exercise is the original stimulator of autophagy. You don’t necessarily have to starve yourself.

Dr. Bongiorno:                   The only thing I would say for my patients is if you’re not getting enough sleep, don’t trade sleep or exercise. Make sure you’re sleeping first, and then get up and go exercise.

Dr. Weitz:                            Right, what type of exercise? Do you think it matters?

Dr. Bongiorno:                   From the studies I read, all exercise is good. Certainly up to what a person can do. I generally recommend doing something you enjoy, because if you do something you enjoy, you’ll continue to do it. What seems to be the most beneficial is actually having a mix where people are doing strength training, and are doing cardiovascular. In the mitochondrial studies I’ve seen, to build optimal mitochondrial function doing both seems to be optimal.  We were talking about testing. I wanted to ask you, what do you think about the urinary neurotransmitter test to get a sense of what’s happening with neurotransmitters?

Dr. Weitz:                            Yes absolutely. I think tests all have their value and have their limits, but I do think looking at neurotransmitter testing through urine can be very helpful.

Dr. Bongiorno:                   Okay. Then what about the role of the gut and the microbiome in mood disorders? What we’re learning now and every day I see new papers on the microbiome and the microbiota. There’s little bacteria in our digestive tract we’re finding, plays such an important role in keeping the environment of our digestion proper. That environment is really key to how sending signals to our brain that helps our brain create the right neurotransmitter balance. Also that environment in our gut also plays a really strong role in how inflammation happens in our body or doesn’t happen.

As we were saying before, the foods we eat are certainly the first key towards that. But then, there’s other things that we can do as well. There’s specific foods that help raise the microbiome in different ways. Then there’s certain fibers specifically that can help that process. I think there’s so much that we still have to learn about it. But the way I think about it is the microbiota in there, is like this garden.  When you have a garden that has certain plants that are too many and other plants that aren’t enough then it creates a lot of imbalance and it’s not a very productive garden. But when you have a very balanced garden, with all different plants and species, that’s usually when you get the most productive use out of it.

Dr. Weitz:                            There are supplements on the market like probiotics that claim to specifically improve mood. What do you think? You think it’s early for those?

Dr. Bongiorno:                   I think a lot more studies have to be done. I think the most compelling studies… There’s some small clinical studies that are showing things like lactobacillus and bifidus can increase GABA levels in the brain. Even though those studies aren’t large, there’s a number of them now that are pointing in the same direction. I think using basic keystones like that seem to make sense.  Now there’s some other studies coming out with a few other strains, which I think still need to be replicated I’m very interested in. It certainly does make sense. One thing we do know though is that the strains… A lot of the streams of interest, we’re not actually capable making into a supplement, at least at this point. My general idea, my general tact is to give patients the probiotics that we know can be helpful, that are basic Keystone strings, and then make sure we’re filling in with all the proper fibers and vegetable matter and fermented foods that can help add all those other and help our body make all those other strains that we probably can’t supplement on our own.

Dr. Weitz:                            Outside of probiotics, let’s go over some of the most beneficial nutritional supplements for mood disorders.

Dr. Bongiorno:                   Okay, well, I mean certainly the basics, having a patient take a multiple vitamin, a good B complex with a [inaudible 00:37:26] is a great idea. Then certainly a fish oil as well as the probiotic. Those to me are the basics probably for most patients to at least get started.

Dr. Weitz:                            Fish oil has quite a bit of studies showing benefits for brain health as well as for mood disorders.

Dr. Bongiorno:                   Yes, in fact, the newest studies right now coming out of the psychiatric journals are showing that in patients who are treatment resistant, meaning that they’re on a drug, but the drug isn’t working, when you give them fish oil, then the drug seems to start working. Which makes me think, well, maybe if you just gave them the fish oil and without the drug, you probably get them feeling better too.

Dr. Weitz:                            Right.

Dr. Bongiorno:                   So I’m not sure… Anyway.

Dr. Weitz:                          What about the best… What’s the most effective dosage for fish oil and also, do you think it matters? As far as, I keep seeing studies showing well, EPA is really better. No, DHA is better.

Dr. Bongiorno:                   No.

Dr. Weitz:                          Do you think we know if it’s better to have just a balanced EPA, DHA or if it’s better to have more of a concentrated EPA or DHA?

Dr. Bongiorno:                   It’s a good question. I think the studies are fairly clear that EPA levels of around 1000 to 2000 milligrams are a good idea with the associated DHA that would normally come with that in a regular fish oil. Maybe like a 1000 milligrams of EPA, around 300 milligrams a DHA. I usually shoot for that ratio, and then depending on the patient, starting with either 1000 milligrams or 2000 milligrams of the EPA.  It seems pretty clear to me that for anxiety and depression, looking at those levels of EPA seem to be the best. I know in children, sometimes giving higher levels of DHA can be useful for certain cognitive reasons and attention deficit. For those specific sometimes I think, a higher DHA might have some benefit. But I think in general for anxiety and depression looking for those higher EPA levels, which frankly, are what comes naturally in fish oil seems to be the way to go.

Dr. Weitz:                          Can you get those levels of EPA DHA from vegetarian sources?

Dr. Bongiorno:                   I find it pretty difficult to do so. It’s not that easy. My strong preference when possible is to use fish oil. If I have a patient for ethical reasons or other religious reasons, or for allergies, they can’t take fish oil, then we’ll use other vegan oils and try to make up the difference. I’ll give patients things like ahi oil which has a reasonable amount of EPA for a vegetarian source.

Dr. Weitz:                          What’s it called?

Dr. Bongiorno:                   Ahi flower.

Dr. Weitz:                          Never heard of that one.

Dr. Bongiorno:                   A-H-I flower oil.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   There are few vegan vegetarian version that are out there that are a little higher. A lot of people are cognizant that they need to get those essential fats. Unfortunately, and I discussed this in my books, a lot of patients who have mood disorder, they’re not very good at converting the vegan oils into the EPA. So because they have the delta desaturate enzyme, genetically maybe isn’t working as well.  For those patients, unfortunately, it’s really important to try to get the EPA indirectly as possible.

Dr. Weitz:                            You mentioned B vitamins, you monitor some of those genes like the MTHFR and the COMT, and so many others?

Dr. Bongiorno:                   I do. For a lot of patients, I do run the genetic snips to take a look at that. Again, I think a lot of that is in its infancy, I think to look at one gene snip and say, okay, you need this vitamin [inaudible 00:41:36] another, I think it’s very premature because there’s so many gene interactions that we don’t understand. But I think it’s helpful. In other words, if you see a patient who has a snip of the COMT, and a snip of the DRD and a snip of the Chip the fan hydroxylase enzyme. You see they’re testing… all their neurotransmitter there low. They’re depressed. It starts to add up. [inaudible 00:42:04] the gene cell that they’re probably not keeping them up and certainly their testing shows it’s low and clinically they’re low. Then we know we have to work on that. I like using it to just basically inform.

Dr. Weitz:                            Quite a clinical picture, but don’t place too much importance on just any one particular gene.

Dr. Bongiorno:                   Yes, absolutely. I mean, what I’ve learned in this job is not to be religious about anything I’ve learned. Because as soon as I get a little religious and they go, this is what people need. Then it turns out not to be correct. I find you have to always be flexible and look at the patient first and then look at all this testing as part of information to help make the best choices.

Dr. Weitz:                            What about-

Dr. Bongiorno:                   Another thing about genetics, I think in the future, it’s going to be more and more useful.

Dr. Weitz:                            Yes, I totally agree. What about other fatty acids like GLA?

Dr. Bongiorno:                   GLA actually has been shown to be very useful in alcoholism, to help patients… A lot of people who are alcoholics, one of the reasons why they drink alcohol is because it artificially raises prostaglandins, these feel good molecules as well in our body and in our brain. What’s been shown is that when we take things like GLA and certain oils in that realm, that we can actually help ourselves make those natural prostaglandins. I’ve seen patients with alcoholic tendencies and things like that do really well with those oils.  They’re also very good for hormonal balancing like a primrose oil. When you see women who have mood issues, and they also have menstrual cycle disorders and things like that, I like using those. So yes, they’re definitely helpful.

Dr. Weitz:                            What about vitamin D?

Dr. Bongiorno:                   Vitamin D, it’s the sunshine vitamin. It’s the sunshine… I remember Alan Gabby. You know, Alan Gabby?

Dr. Weitz:                            Yes.

Dr. Bongiorno:                   He used to give us… He used to tell us that John Denver said sunshine on my shoulder made him happy. That was the best study on vitamin D there was. I mean, vitamin D it’s a neuro steroids. It’s important for so many factors in our brain, and in our body. I think, by itself, it doesn’t cure depression if it’s low, and you bring it up or anxiety, but I think it is a major factor that needs to be looked at. I remember when I was in school, 23 years ago, naturopathic school, they talked a lot about vitamin D. When I got out to New York, nobody was running vitamin D 16, 17 years ago. Then I was just so amazed after all the things I’d learned about how wonderful it is. Now it’s nice to see that people are running it. That it’s a common thing to look at now even in conventional medicine.

Dr. Weitz:                            Right, absolutely. What about some of the most important minerals like zinc and magnesium?

Dr. Bongiorno:                   Magnesium is I think a must for most people with anxiety. It plays a role in helping relax the muscles, and it plays a role in helping the brain form GABA. There’s just so many effects all over the body with magnesium. I typically use magnesium glycinate which is very calming form. Sometimes I’ll use magnesium threonate which does seem to have an even more calming effect. I know when I take it’s very relaxing, the magnesium threonate. I’ll use that with some patients, especially if they’re really anxious.

Dr. Weitz:                            What dosage of magnesium do you like?

Dr. Bongiorno:                   Depending on the patient, I’ll usually start with 250 milligrams maybe in the evening before bed. Especially if there’s sleeping issues. I am careful though sometimes magnesium can cause loose stools. Different forms of magnesium might be better for that than others. But other than that, magnesium is usually a really nice choice for patients for both anxiety and depression. It’s good for blood sugar balance. Lot of benefits.

Dr. Weitz:                            Yes, I think the glycinate has less bowel issues.

Dr. Bongiorno:                   Yes, absolutely. What was the other [inaudible 00:46:24]?

Dr. Weitz:                            What about so many other minerals?

Dr. Bongiorno:                   Zinc is such an important co-factor in so many places. Zinc is really important to the digestive system as well. I do like to look at that zinc to copper ratio. I do find with most patients with mood issues, you’ll see a very low zinc to copper. Sometimes you’ll even see patients with high copper and high copper can be a problem in terms of estrogen balance and that can throw off serotonin as well.  Zinc itself is a co-factor for making the neurotransmitters too. For all those reasons I like To check Zinc when it’s low or low normal, I typically will supplement with Zinc. I don’t supplement too high. Usually just 15 to 30 milligrams [crosstalk 00:47:10].

Dr. Weitz:                            What is the zinc to copper ratio you like to see?

Dr. Bongiorno:                   At least one to one and preferably I think a little bit higher.

Dr. Weitz:                            What if the copper is too high? Do you ever use things like molybdenum or other things to lower the copper?

Dr. Bongiorno:                   Usually I’ll start with zinc. Then if that doesn’t work, then bring in things like molybdenum or just a good minerals formula, obviously, copper.

Dr. Weitz:                            What about lithium orotate?

Dr. Bongiorno:                   Lithium is one of my favorites for anxiety. It seems to be quite safe and it’s not… Just for everyone listening, when we talk about lithium, we’re talking about lithium orotate which is a mineral, which is used in very low doses. Maybe 15… I’m sorry. Five to 20 milligrams in adults.

Dr. Weitz:                            And you’re saying which is different than the prescription lithium?

Dr. Bongiorno:                   Right. Prescription lithium is lithium carbonate, which is a much higher dose of lithium, maybe 900,000 milligrams plus carbonate which is a separate drug on town. Lithium orotate it’s been used for a long time. It’s quite safe, it’s even safe in children. What they saw many years ago in the early part of the 19th century is that places that had high levels of lithium in the water-

Dr. Weitz:                            There’s a crackling coming from your microphone somehow.

Dr. Bongiorno:                   Oh really? Okay. Is that any better now?

Dr. Weitz:                            I think it’s better if you hold it.

Dr. Bongiorno:                   I might have been moving it around there. Thank you. What they noticed is that areas in the United States and even around the world that had higher levels of lithium typically had… Still doing it?

Dr. Weitz:                            Yes.

Dr. Bongiorno:                   Let me see if I can adjust it. I don’t hear it from here.

Dr. Weitz:                            Okay. We’ll keep going.

Dr. Bongiorno:                   Any better?

Dr. Weitz:                            Yes right now I don’t hear it.

Dr. Bongiorno:                   Okay. I’ll stay still. Lithium was… In places where lithium levels-

Dr. Weitz:                            Need some lithium pill.

Dr. Bongiorno:                   Yes, I do. That’s why I play the drums. It helps me get some of that.

Dr. Weitz:                            Okay.

Dr. Bongiorno:                   So yes, lithium is just one of those things that in higher levels seem to lower… There’s less rates of suicide. People are generally happier, less anxiety, less depression, in fact, Seven Up the beverage was originally lithiated water.

Dr. Weitz:                            Really?

Dr. Bongiorno:                   Yes. Then when I think they decided to take the cocaine out of Coca Cola, lithium they said, okay, we’re not putting anything in these beverages anymore. We don’t know what this stuff is. They took it out but actually lithiated water was around for a long time as something to just help people generally feel happier.

Dr. Weitz:                            Wow. Interesting.

Dr. Bongiorno:                   Sometimes for the young children, I’ll have parents soak thyme, the herb thyme which has high level of lithium in it. You can soak it in olive oil for a month or so and then you could spoon out, maybe a teaspoon and put it on food once a day and you’ll get a couple of micrograms of lithium out of it.

Dr. Weitz:                            Really? Interesting.

Dr. Bongiorno:                   Is there any downside to using lithium orotate? I mean, in those levels, it doesn’t seem to be. I know early on I always was interested in checking kidney function and thyroid because we know the drug can cause problems with those but lithium orotate those levels. I haven’t seen anything. The literature that suggests a problem and I certainly haven’t seen it in patients.

Dr. Weitz:                            Cool. What about use of amino acids as precursors for neurotransmitters.

Dr. Bongiorno:                   Amino acids, to me thinking about using amino acids is similar to thinking about using drugs, right? Because we use drugs to stop the breakdown of a lot of those neurotransmitters. We want to use amino acids to more naturally bring up the levels of the neurotransmitters which makes sense if you give the body the precursor, it will help to make its own.  I think that makes sense to me. I think it’s safer and more gentle on the body than drugs. Certainly not as strong as drugs are but I think if you’re using it in combination with all the therapies we just talked about, it can be very supportive. I find tryptophan is… I have a patient who did well on an SSTRI, but for some reasons, they don’t want to stay on it or they’re having side effects. Transitioning to tryptophan can be really helpful.  Instead of just taking everything away from them and removing the drug, you can bring in the tryptophan and slowly lower the drug and raise the tryptophan. If we get all the basics right, the sleep, the diet, the exercise, it’ll work.

Dr. Weitz:                            And use tryptophan or 5-HTP.

Dr. Bongiorno:                   It depends. Theoretically 5-HTP should be better because it’s closer already and the pathway to serotonin. But I do find a lot of patients seem for whatever reason to do well with tryptophan. I tend to use maybe equal amounts. At night if people have sleeping issues, I tend towards more of the tryptophan. I can’t explain why that’s better.  I know, there’s some studies that suggest that there’s a lot of inflammation in the body, you might be better off using 5-HTP. Because the certain pathways, one pathway that’s called the [inaudible 00:52:45] pathway suggests that if you use tryptophan it could actually create more inflammation. But I have to say clinically, I find tryptophan generally seems to work better. I’m open to either.

Dr. Weitz:                            Interesting. What about some of the other neuro transmitters. Any of them you find particularly helpful? Any other amino acids?

Dr. Bongiorno:                   Yes, I like using tyrosine sometimes. I created a formula that uses tyrosine in combination with mucuna. I find that can be really useful… Let’s say you have a patient who did really well in wellbutrin, then dopamine’s low. Their genetic show they’re probably low. The neurotransmitter test show they are low, using things like tyrosine and mucuna can be very helpful for that purpose.

Dr. Weitz:                            What about GABA?

Dr. Bongiorno:                   GABA, I find for some people it works well, for other people it doesn’t. Theoretically, I’ve read if you have a leaky gut, then GABA can work well because it gets to the brain. You need both the leaky gut and a leaky brain barrier. Both of those it works.

Dr. Weitz:                            That’s what Dr. Kharrazian says. Right?

Dr. Bongiorno:                   Yes, but GABA I think can be very helpful. A lot of times they’ll use GABA and lithium orotate together, or sometimes I’ll even use GABA with [inaudible 00:54:04] seem to work really well together.

Dr. Weitz:                            What about some of the herbs like St. John’s-wort?

Dr. Bongiorno:                   St. John’s wort is the most studied herb of all time, and it’s very solid evident. It’s interesting. I just read an article in the Washington post which I wrote a letter to the editor about. Basically it was this woman who’s a nutritionist who is basically saying how supplements don’t work. One of the experts that she quoted was saying how St. John’s-wort really has no studies suggesting it works.

I read that and I was just amazed. I’m like well, apparently that person isn’t looking at PubMed at all. There are scores of analysis and scores of meta analysis. Then there’s a bunch of a meta analysis of the meta analysis all Showing that St. John’s-wort head to head to the SSRI’s most commonly used antidepressants work just as well in mild to moderate depression with much less side effects.

It’s amazing to me that a major paper like that could have this kind of information, it just shows you the bias that these people have going in. Again, if you want to challenge me on that, you could say, well, you just told me the drugs themselves don’t work much better than placebo. That’s true. What I’m saying is, St. John’s-wort, I think, has an effective rate at least as well as the drugs, but it doesn’t mean it’s the whole story.

That’s why I don’t want people to get the idea of oh, I don’t feel I have anxiety, I have depression. I’m just going to take St. John’s-wort and go along my way. No, we still need to work on sleep and exercise and our thoughts and going to therapy and the right foods. Then with St. John’s-wort, I think it’s a slam dunk. It works great.

Dr. Weitz:                            Right, and you’re really bringing up the importance of employing the entire functional medicine model and not thinking you can reduce it to just simply taking a particular supplement. If all you do is take a particular supplement like St. John’s-wort instead of taking an antidepressant, you just practicing an inaugural form of the same type of limited medicine.

Dr. Bongiorno:                   Right, exactly. That’s exactly right. It might work and that’s great, but I still encourage everyone listening to still dive into all of those basics and make sure those are right because that’s why things probably got out to begin with.

Dr. Weitz:                            Right, great. I think we’re done here. Any final thoughts-

Dr. Bongiorno:                   No, I mean-

Dr. Weitz:                            … listeners and then how can those listening contact you, find out about your books, your programs and how to consult with you?

Dr. Bongiorno:                   Okay. Well, first of all, I want to thank you for doing the work that you’re doing and getting out all this great information to people. For anyone listening, anxiety and depression, it’s not easy. I think these are the toughest conditions because when you’ve had it, and you’ve gone through it, it feels very insurmountable sometimes. For those people, I want to say a couple things. One is, if you’re taking drugs, don’t just stop taking them. Because that’s never a good idea. That can be dangerous.  You always want to continue, but I want to let you know that there are practitioners, there’s naturopathic doctors, functional medicine doctors, and they have answers that I think are more holistic and can really help. So that it is really worth pursuing this thinking. I do see daily how it can help people. Don’t give up and please do keep working on this because it’s absolutely worth it and you’re absolutely worth it. As far as contact information. My clinic website is www.innersourcehealth.com. That’s I-N-N-E-R S-O-U-R-C-E health.com. Our phone number is 631-421-1848. It’s really been such a pleasure to be here. Thank you so much.

Dr. Weitz:                          You’re welcome. Thank you, Dr. Bongiorno.

Dr. Bongiorno:                   Okay. Have a great day.





Organic Acid Testing with Dr. Jeff Moss: Rational Wellness Podcast 145

Dr. Jeff Moss discusses Organic Acid Testing 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

1:01  Organic acids are chemical compounds excreted in the urine that are products of metabolism. Organic Acid Testing has been validated by the medical community for many years to measure genetic inborn errors of metabolism, such as phenylketonuria, methylmalonic acidemia, and pyruvate dehydrogenase deficiency, among others. But today we are discussing the use of Organic Acid Testing by the Functional Medicine community to look for possible mold exposure, fungal or bacterial overgrowth, detoxification, oxalates, mitochondrial function, neurotransmitters, nutritional deficiencies, et cetera.

3:25  Organic Acid testing involves measuring acids that are metabolic intermediates.  In order to speed up these metabolic processes in the body, the body uses enzymes and most of these enzymes have vitamin or mineral co-factors. If the conversion of substance A to substance B is happening well, then you will have a normal amount of substance B. If you have a buildup of substance A, then that indicates the metabolic process is not working properly and it could indicate that there is a deficiency of a vitamin or mineral co-factor.  Or it could be that the enzyme is not working as well as it could because of chronic inflammation caused by a gut disorder or a chemical or metal toxin.  So organic acid testing is a way to test chronically ill patients to discover why they are feeling poorly and what we can do about it.

7:50  While organic acids is a nice test to run as a basic screen on chronically ill patients to help discover the cause of metabolic issues and chronic inflammation, it is fairly expensive and not covered by insurance, so it may be better used as a second line diagnostic after the usual diagnostic workup and treatment plan did not work.

9:58  Organic acids testing is a way to identify tissue levels rather than serum levels of nutrients, which is more relevant for assessing patients with chronic diseases, since these patients do not have gross malnutrition. Organic acids is a functional test, since it tells us how well the nutrient is helping the body to function.  Serum levels of many nutrients often do not indicate functional or tissue levels.

14:38   One of the organic acid markers is Formiminoglutamic acid, also known as FIGLU, which is a marker for intracellular folate.  You might have good levels of serum folic acid, but this doesn’t mean that your body can utilize it.  If FIGLU is elevated, it tells us that we need more folate, even if serum levels are normal.  We could be taking in folic acid from fortified foods, but this is not being absorbed and utilized.

17:39  Methylmalonic acid is a well validated functional marker for B12 status.  Serum B12 can be elevated if there’s chronic inflammation. And patients with SNPs like the C677T and A1298C mutations of MTHFR will have trouble absorbing forms of B12 like cyanocobalamin rather than methylcobalamin.

23:28  Organic acid testing for gut health.  While we do now have very accurate DNA stool tests now, like GI Map from Diagnostic Solutions, but the organic acids testing can be a screening tool, for example, that there might be a fungal overgrowth and this points out the need for such a stool test to target if there is fungal overgrowth and what type.  We have markers for fatty acid metabolism like adipate and suberate, which indicate impaired fat metabolism, and markers for impaired carbohydrate metabolism like lactate and beta hydroxybutyrate. The mitochondrial markers like citrate, succinate, fumarate, and malate are metabolites of amino acids. They are significant for mitochondrial dysfunction is they are elevated, but if they are too low they indicate that you are taking in too few amino acids or malabsorbing them.  You may need more protein in your diet or may not be properly absorbing protein, or a combination of the two.

30:24  Intermittent fasting and Beta Hydroxybutyrate.  Intermittent fasting may have some health benefits and too many folks are grazing or continually eating all day now. This results in insulin being secreted all day long, which is not that healthy and inhibits fat burning.  Chronic insulinemia is a factor in many chronic illnesses.  Beta hydroxybutyrate is a ketone body and if it is trending high, it indicates that you are getting good fat burning in a fasted state, which is a good thing. Also consider that this organic acid test is done in the morning after an overnight fast. 

35:06  HMG, Hydroxymethylglutarate, which is a precursor to cholesterol synthesis, can be very high for a patient on statins, which inhibit cholesterol synthesis.  or it could indicate inflammation.  If the HMG is low, it may indicate malabsorption or malnutrition, such as in the anorexic or the bulimic and the tendency for some older folks not to eat much or to skip meals, for a number of reasons. Dr. Moss finds that when possible he will ask the children of an older person if their mother or father is really eating well, since such patients may not be accurate at reporting their eating habits. If their HMG is low, they will also likely be low in CoQ10, since this is the same pathway that produces cholesterol. 

40:03  Neurotransmitters.  Organic acid testing includes markers for neurotransmitter status, such as homovanillic and Kynurenic acid.  These can indicate if patients are overly in sympathetic, stress mode, instead of in parasympathetic rest and relax state.  Neurotransmitters are derived from amino acids and organic acids are metabolites of amino acids like tryptophan such as Kynurenic Acid, Quinolinic Acid, Picolinic Acid, and 5-HIAA and the end points of some of these organic acids are the production of B vitamins. The 5-HIAA tells us how well are we converting tryptophan to serotonin.  But if people are chornically stressed, the tryptophan will be redirected to the kynurenine pathway.  If these organic acids are high, it is an indication of chronic inflammation and is also correlated with behavioral and neurodegneerative  disorders, like depression, bipolar disorder, anxiety, Parkinson’s disease, but most notably elevated kynurenine and the quinolinic acid have been highly correlated with Alzheimer’s and senile dementia profiles.  Another test that can be run to screen for the possibility of developing Alzheimer’s Disease the Alzheimer’s Linx Test from Cyrex Labs that looks for antibodies to see whether your immune system is starting to attack any of the tissues related to your brain function.

46:53  Toxins.  Organic acid testing can tell us about the pathways involved in toxin metabolism, though they are not a direct measure of any toxins. History can tell you a lot about exposure and then you can do direct testing for toxins. The hippurate pathway and the glycinate pathway are indicators of glutathione status and tell us how well we are metabolizing toxins.  If we are having problems making gutathione, this is usually related to not having enough sulfur, which is an underappreciated mineral. Sulfur is found in red meat eggs and if you follow a plant based diet, you may be deficient in sulfur. N-Acetylcysteine, Alpha Lipoic acid, and MSM can all be helpful for adding sulfur.



Dr. Jeff Moss is a former Dentist who became a certified nutrition expert and started and operates a professional line of nutritional supplements, Moss Nutrition Products. Dr. Moss speaks regularly around the world about various topics in Functional Medicine and clinical nutrition, including organic acids. He established the popular online course “Expanded Organic Acids & Amino Acids Testing”.

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


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 Podcast listeners, 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 podcasts and give us ratings and review. If you’d like to see a video version of this podcast, 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 we have an interview with Dr. Jeff Moss on Organic Acid Testing. Organic acids are chemical compounds excreted in the urine that are products of metabolism. Organic Acid Testing has been medically validated for many years to measure specific genetic inborn errors of metabolism such as phenylketonuria, methylmalonic acidemia, and pyruvate dehydrogenase deficiency, among others.

But many in the Functional Medicine community have been using Organic Acid Testing to provide information for patients about possible mold exposure, fungal or bacterial overgrowth, detoxification, oxalates, mitochondrial function, neurotransmitters, nutritional deficiencies, et cetera.  Some use organic acids profiles on all new patients as an initial screening tool, so for example, I like to run on some of the patients Genova’s NutrEval as an initial screening tool to look for nutritional deficiencies and for metal toxicities, but this also includes organic acids as part of the profile.

There’s quite a bit of controversy about the validity of Organic Acid Testing for such uses, since at least some of these markers ranges as to what constitutes normal have not necessarily been sufficiently validated by scientific studies as some routine lab tests have been. To sort out the validity and benefits of Organic Acid Testing as well us to provide us with some interesting pearls about what some of these metabolites mean, and how they can help us manage patients, I’ve asked Dr. Jeff Moss to join us today.

Dr. Jeffrey Moss is a former Dentist who became a certified nutrition expert and started and operates a professional line of nutritional supplements, Moss Nutrition Products. Dr. Moss speaks regularly around the world about various topics in Functional Medicine, clinical nutrition, and including about organic acids.  Dr. Moss, thank you so much for joining me today.

Dr. Moss:             Thank you so much for having me.

Dr. Weitz:            Good. What are organic acids and how are these best measured?

Dr. Moss:             What are organic acids? Number one, they’re exactly what the word says, they’re acids. Many of the people you work with, we work with are familiar with the idea of… and measured in urine, the idea that you check the pH of the urine and for the most part, we’re trying to see if their urine is too acid.  Measuring urine acidity is a quantitative measurement, if you will. What organic acids tell us is, it’s qualitative. In other words, if your urine is too acid, what is it in the urine that made it acid? So you’re basically measuring the acids in the urine that made the acid urine acid. So that’s basically what it is, what an organic acid is.

As you mentioned beyond that, they are metabolic intermediates, if you will. Basically, what the body does in the course of everything it does, millions, maybe billions of times of the day, is convert substances, metabolism. You have substance A and it’s got to be converted to substance B, that’s basically it.  And if you just put substance A in the test tube and let it sit at room temperature, it happens real slow. And so the body to speed it up uses two things. Number one, with an enzyme, and most of these enzymes require a nutrient co-factor, a vitamin or mineral co-factor to speed it up.  So if the enzyme isn’t working properly or you’re lacking the co-factor, the nutrient co-factor or both, you won’t get enough for the A going to B, and so you get a buildup of A. That’s what you’re measuring, is there’s too much of A and not enough B. That’s basically what you’re doing with it.

Also with this ID, if you have too much of A for example, the assumption has been made by the designers of the Organic Acids Test and the profile that I use, is the one from Genova where actually came from Metametrix originally. This is back in the ’90s in the work of Richard Lord and Alexander Bralley, Andy Bralley. They came up with the initial profile, and as you said they basically extrapolated existing literature.  Now, traditional thinking was that you couldn’t convert A to B, it was due to a hardwired genetic defect of the enzyme called inborn errors of metabolism. And when you see this hardwired defect in the enzyme, a SNP, if you will, usually people get very sick at a very young age and sometimes die.

Is it a black and white issue? Can you have varying shades of gray? In other words, yes, the enzyme is working perfectly or no, it’s not working at all, like an inborn error of metabolism, you can have a situation where the enzyme may be working less perfectly, it working at 50, 60, 70% and that you may be lacking in the nutrient cofactor.  And so when they noticed that and the research on that, they said, “Well, there’s a lot of sick people, the enzyme is working, but it’s not working as well as it should–usually due to lifestyle issues and it may be lack of the nutrient cofactor.” But they also know that maybe it’s not working as well as it can because of maybe chronic inflammation caused by some type of a gut disorder, or maybe it’s a toxin, a chemical or metal toxin.  Maybe they’re not eating enough protein, or maybe it’s psychological stress. All of them can affect this enzyme activity.  And so what they devised is a test where we can measure these different acids, the As, if you will, and the Bs, and from that we can get some idea of really why people… mainly chronically old people, why they’re feeling poorly and what we can do about it.

Dr. Weitz:            Okay. Do you like the idea of using organic acids as a first-line test? Or do you think it’s better used as a test later on? Or can it be used as either depending upon what you’re looking for?

Dr. Moss:             From a strictly clinical academic point of view, you can use it for either, but there is a practical aspect to it, and that is that the test is fairly expensive and rarely if ever covered by insurance. So there are the practicalities, but dismissing the monetary issues, would it be ideal to run it on every single patient, particularly those who are suffering from chronic illness, they’ve gone from sometimes pharmaceutical type therapies and not getting results, basic nutritional therapies and not getting results.  Certainly, it would be great to do what on every patient to detect as you suggested, are there some nutrient deficiencies that were missed with your usual basic clinical workup that you may have instituted therapies, they didn’t work. So what did you miss from a nutritional standpoint. The NutrEval organic acid is excellent first-line test basically fine tune the nutritional program.

But beyond that it’s also very good for finding these other metabolic issues, chronic inflammation. But from practical standpoint, most of the clinicians that I work with do not do this as a routine test strictly because of the practical aspects. They’ll do their usual diagnostic workup and treatment plan, and then what doesn’t work, they’ll tend to use it as a second-line diagnostic to basically answer the question or the patient didn’t respond, what did we miss?  Was it a nutrient deficiency? Was there some toxin?  Was there a gut problem?  Maybe underappreciated psychological stress?  All that can be found out with the organic acids and used as a second-line test.  You can be use it either way.

Dr. Weitz:            So with respect to looking at nutritional deficiencies, what are some of the advantages of using an Organic Acids Test versus using serum test for vitamins and minerals?

Dr. Moss:             Basically we have to understand the people that we are dealing with is that they don’t have acute illness for the most part, they’re chronically ill and they’re not in a gross malnutrition type situation. We’re not dealing for the most part, although some practices maybe dealing with-

Dr. Weitz:            They don’t have scurvy or beri beri…

Dr. Moss:             Exactly right. And that’s the main value of serum testing is to tell you about gross deficiency. Most of the nutrients do not stay in the serum very long, and so even if they are nutrient replete, it’s very time sensitive in terms when you measure it. And to see gross deficiency, they’d have to be significantly undernourished, which we tend not to see.

Dr. Weitz:            I think the point you’re making right there is that there are a few nutrients like Vitamin D that you can measure serum levels and you get a pretty good idea of what the tissue levels are, but for a lot of other nutrients, serum levels really are not a good gauge of the amount of nutrients that are in your tissues and your real need for those nutrients. For example-

Dr. Moss:             Yeah.

Dr. Weitz:            … blood calcium levels are always going to stay in a very narrow range, even if the person-

Dr. Moss:             Exactly.

Dr. Weitz:            … is osteoporotic and definitely can use a lot more calcium. Ditto for serum of B Vitamins, a lot of times the serum levels are not really accurate of what the tissue levels are and what the real needs of the person are.

Dr. Moss:             But there’s another big X factor that is really underappreciated, and that is, as you know that most chronically ill people, what do they share in common? Chronic inflammation.

Dr. Weitz:            Right.

Dr. Moss:             And what we know, the literature is very clear that chronic inflammation will alter a serum levels of virtually every macro and macro nutrient. And so if you’re inflamed, the blood will never be a true indicator of dietary intake, either too much the right amount or too little. And that’s the beauty of organic acids, it’s what we call a functional test.  What we really want to know is… We basically can assume they’re not grossly deficient. What we want to know is are they taking any enough for the particular problem we’re trying to address, and maybe they are taking enough, but the question is, all right, they’ve eaten enough, we know it was absorbed, the question is, did it go where we want it to go?  And healthy people, that’s not really an important question, but in sick people it is an important question, did it go where we want it to go? So we want to know how was it metabolized? And that’s the beauty of organic acids. We call a functional test, it tells us how well the body is functioning to utilize the nutrient. Is it really going where we want it to go to solve the problem and organic acids superior over our blood?

Dr. Weitz:            And also for patients who are coming to us for anti-aging programs, we want to know, not just have they resolved a frank deficiency, but do they have optimal levels to function at their highest level? And this is one way to look at metabolic pathways to see if they’re functioning at that optimal level. Right?

Dr. Moss:             Precisely. Aging itself is going to make people more prone, for example, to inflammation. There’s going to be aging impact on renal function, all of which can have an impact. So just by the fact of aging, you’re going to utilize it, I won’t say not as well, but differently. Are you utilizing it well enough to accomplish what you want to accomplish?  Again, maybe it’s a chronic illness, maybe it is anti-aging, optimizing wellness, we still want to know how well is the body using anti-age organic acids is a superior tool for that.

Dr. Weitz:            When it comes to nutritional deficiencies, one of the markers that I see when we run the NutrEval is formimidoyl-glutamic acid, also known as FIGLU, right?

Dr. Moss:             It’s called FIGLU because nobody-

Dr. Weitz:            FIGLU.

Dr. Moss:             … can pronounce that. Just say FIGLU. We all say FIGLU.

Dr. Weitz:            So this is a marker for intracellular folate.

Dr. Moss:             Yes.

Dr. Weitz:            So how does this correlate with serum folate levels and what is this telling us?

Dr. Moss:             Serum folate is very good for gross deficiency or excess because folate is actually interesting because of food fortification, many people are getting excess intake of folic acid in their diet and there’s a whole body of literature on that excess intake of folic acid.

Dr. Weitz:            Which is different than folate.

Dr. Moss:             Exactly right. And that’s another common misconception, misunderstanding that food folate is what we find in our green leafy vegetables. What we find in processed food is a synthetic compounds called folic acid that happens to act very similar to food folate in small amounts. In large amounts, over 400 micrograms a day, the body can’t metabolize it. You get unmetabolized folic acid, which is considered to be, I guess for lack of better word, a toxin.

Dr. Weitz:            Yes.

Dr. Moss:             It is an enzyme inhibitor. And so a blood can fool us because of that, but what we want to know again, with the organic acids with FIGLU, it can tell us how well the body is utilizing what it’s taking in. And so if we see FIGLU elevated, it tells us, “Oh, it’s not metabolizing folate correctly.” Is it an issue of just the need to eat more?  Maybe there was a malabsorption issue, maybe they’re taking in the wrong kind. They’re taking in too much processed food and not enough whole foods and getting the whole folate. Organic acids can help us make these subtle distinctions on how to proceed.

Dr. Weitz:            And this can also help us with piece into may have problems with methylation issues since-

Dr. Moss:             Exactly.

Dr. Weitz:            … some of us are doing genetic testing and looking for MTHF SNPs, and COMT SNPs, and these can affect methylation and.

Dr. Moss:             Yeah, you bring up another good point. We’re bringing a whole issue of very common SNPs with methylation pathways. In these circumstances, the individual may need more than the usual RDA or whatever it is. And so if this is a functional measurement if we see this SNP, we may have to give larger doses.  Maybe the individual, the patient didn’t respond because we didn’t give enough because we didn’t understand their polymorphism and the SNPs, and organic acids can help us understand those subtleties.

Dr. Weitz:            Right. Another marker which I think has been pretty well validated even from medical perspectives is methylmalonic acid, which is a marker for B12 status.

Dr. Moss:             Yeah. When that’s elevated there is an enzyme that converts B12 to what is known as succinic acid and the enzyme is absolutely vitamin B12 dependent. And so if there’s not enough B12, and again, I emphasize enough, either because you didn’t take in enough, it wasn’t absorbed well enough or wasn’t metabolized correctly, the methylmalonic acid will tend to go up. That’s correct. So it’s a good functional indicator for B12 metabolism need issues,

Dr. Weitz:            And really a better marker than serum B12, which is often-

Dr. Moss:             Yes.

Dr. Weitz:            … run.

Dr. Moss:             There’s a lot of interesting research on serum B12 and that one of the risks is not when it’s too low, although that can be an issue, but there’s a lot of information. The serum can go too high mainly due to inflammation. High serum B12, which you see fairly often is a good indicator that there was a chronic inflammation that wasn’t fully appreciated.

Dr. Weitz:            It’s funny, one of the panels we’ll do sometimes include some serum markers and we often see B12 high-

Dr. Moss:             Yes.

Dr. Weitz:            … but even patients who have high homocysteine, meaning that they really need more B12.

Dr. Moss:             Yeah. In this case, they need B12, but there’s also an issue of metabolism of B12. Some of these people already taken large amounts of B12 and not getting results because there was some type of metabolic issue. It may be a SNP, as you mentioned.  There may be inflammatory issues that are going on.  It could be a toxin that can act as a major enzyme inhibitor.  So yeah, you can see even the elevations and stare at B12, even though they’re taking in a fair amount because there’s these metabolic issues.

Dr. Weitz:            Or they could be taking the wrong type of B12-

Dr. Moss:             Correct. Yes, absolutely.

Dr. Weitz:            They might be taking cyanocobalamin which is actually… includes a small amount of cyanide with their B12 in instead of a methylated form of B12, which is easier for people with certain SNPs to be able to absorb.

Dr. Moss:             Yeah, your point is a well made in that we now understand that the old thinking was the synthetic forms of many of these vitamins. They’re good enough, they’re cheap, readily available, and so folic acid, cyanocobalamin, it’s good enough. And maybe it is in healthy populations, but we get into chronically ill populations, aging populations, they really need a supplement that is more, if you will, bioidentical to what’s in the food.  And as you mentioned, a methylcobalamin is a bioidentical to B12.

Dr. Weitz:            Or people who have any of these SNPs that make it more difficult for them to absorb standard B12, and now we’re learning that a huge percentage of people have at least some of these genetic variations that make it difficult to absorb some of these B vitamins.

Dr. Moss:             Yeah, extremely common now. The MTHFR SNP is considered to be about 25% of the general population. In certain populations, there are some very interesting and controversial, research suggested may even higher. The autism spectrum community suggested that it’s even more prevalent, although that’s very controversial, but the research is certainly compelling, if you will.  So yes, very common and really needs to be taken into account for more and more people.

Dr. Weitz:            Yeah. I think it’s more common than 25% for them to have at least one of them.  And especially if you run a number of these MTHFR SNPs because there’s one or two that are typically offered, but there’s actually about 15 of them.

Dr. Moss:             Yeah, exactly right.  MTHFR is getting the most publicity, but certainly there can be a lot of different SNPs in these nutrient metabolism pathways. Absolutely, you’re right.  And so these profiles are really giving us a much better idea of what’s going on.



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:            So let’s go to organic testing for gut health.

Dr. Moss:             Okay.

Dr. Weitz:            What do you think is some of the most significant things we can learn about gut health from organic acids?

Dr. Moss:             Organic acids right now with… we have to look at it in terms of the newest generation of DNA-based stool tests. The old type of stool testing, which was called culture testing-

Dr. Weitz:            Yes.

Dr. Moss:             … you basically take a stool sample and try to culture out the organisms was okay at best. On those days, what we saw on organic acids was probably the best out there. It was not good enough to help us determine specific organisms that may be overgrowing or in the wrong place, like ESBL, small intestinal bacterial overgrowth situation, but it could give us a good general idea that there may be dysfunction in the gut.  With a new generation of DNA tests, stool tests now, that is the preferred way to really determine the nature of a chronic GI dysfunction. The Organic Acids Test is good for gut, but would I recommend running organic acids for gut?  No, I just say, spend the money on the stool, the newer generation of DNA-based stools test.

Dr. Weitz:            Now on the other hand, if you do an Organic Acid Test as part of your screen and it indicates there might be some fungal overgrowth, for example, then you could do a stool test to really narrow that down.

Dr. Moss:             Precisely, yes. Your point is well made, it’s a good gross screening tool. Is it accurate enough and definitive enough to tell us specifically what needs to be done in terms of lifestyle or recommendations for specific supplementation? Really, no. Yeah. You’d run the stool analysis and that’ll give you a definitive idea of what you’re dealing with so you can be much more targeted on your therapies.

Dr. Weitz:            Right. Now, I know there’s certain markers for malabsorption. What do you think about the validity of that? Because that’s not something that you necessarily get from other testing.

Dr. Moss:             Yeah. Many of the markers are good indicators of malabsorption. Certainly, the gut section specifically is suggestive for malabsorption. But I think the sections that are underappreciated are the the mitochondrial sections, the sections that relate to mitochondrial function-

Dr. Weitz:            And so cellular

Dr. Moss:             … which would be the fatty acid sections, adipate suberate, the carbohydrate metabolism sections, pyruvate lactate, beta hydroxybutyrate, and particularly the mitochondrial section. One thing we often underappreciate that was brought up to me about 10 years ago was that all of these mitochondria metabolites are metabolites of amino acids.  And therefore, generally speaking, the thinking has been they are only significant if they’re too high. But if you’re taking in too little amino acids or you’re malabsorbing amino acids, there’ll be too low. And this is an area that I’ve really emphasized in my courses, in my teaching that traditional thinking with a Genova profile was that the low values tended to be insignificant, the first quintile.  The literature suggests just the opposite. When you seek kind of everything trending low, one of the things you have to find out, number one, are they getting enough protein in their diet, and many people are not getting optimal amounts or is there a protein malabsorption issue, which is also very common or a combination of the two?

Dr. Weitz:            Yeah, there seems to be a lot of controversy in the nutrition world right now about protein as the plant-based documentaries are proliferating especially all over Netflix and you’re hearing from advocates of a plant-based program that you get plenty of protein in spinach and just eating vegetables, and there’s really no need for concentrated sources of amino acids like from animal products.

Dr. Moss:             My position on that is I understand the need to have generalizations for population recommendations, but I’m a clinician, I deal with one person at a time. And so my mind defaults to what is right for this particular person, and I find I can judge best by checking all my agendas at the door, plant versus animal.  I find some people do better on an animal-based, the right amount. Too much of anything is bad, but optimal amounts, some people do better on animal, some people do better on plant, some people do better on more of a Mediterranean blend of plant and animal. I tend to think of what is right for the individual, and so I find in terms of treating individuals, generalizations I find hurt more than help.

Dr. Weitz:            To be honest, I totally agree. In fact, I think the time for these broad-based generalizations for recommended diets for the entire population, I think we should be past that. The time for biochemical individuality is here and I think we shouldn’t be recommending the one best diet for the whole culture or society.

Dr. Moss:             Yeah. We are on the same page on that, biochemical individuality, everybody is a different, and yes, I think trying to convince one size fits all is really a big disservice to the population.

Dr. Weitz:            Yeah. I remember going to Jeffrey Bland seminars 25 years ago, talking about biochemical individuality, but I think the time is really here now, instead of trying to find the best recommended diet for everybody, let’s find what program’s going to be best for each individual.

Dr. Moss:             Exactly right. I was at those seminars and profoundly influenced me, and I’ve really been on that page ever since Bland talked about it, that we have to look at everybody as an individual, not as someone who has to fit into our agenda.

Dr. Weitz:            Give us some pearls about energy metabolism and mitochondrial status from organic acids.  What are a couple of tests that and what steps can we take to optimize a person’s health on the basis of that?

Dr. Moss:             Sure. I think right now where I have been most influenced, like many of us, I’m sure you’re familiar with what is known as intermittent fasting.

Dr. Weitz:            Sure.

Dr. Moss:             The idea not so much of what you eat, but when you eat it.  And the idea is that to maintain optimal health, we have to have two basic energy periods.  We have what is known as the postprandial right after the meal, which is what we call insulin mediated. In other words, we eat something, maybe a carbohydrate, but any food and we have a shot of insulin, which is designed to stimulate conversion to various factors such as pyruvate…

Dr. Weitz:            By the way, when you say a shot of insulin, this is not something you’re drinking.

Dr. Moss:             No, no, no. You’re right. The body makes that-

Dr. Weitz:            This is something being secreted by your pancreas.

Dr. Moss:             Right. No, no, exactly. This is already… I don’t want to give the wrong info… Basically, you get a little squirt of insulin from your pancreas literally. And the food is metabolized, and this is what is known as postprandial metabolism. But then we are supposed to have a period, what they call fasting metabolism, where fat is broken down, protein is broken down, including muscle, and those are converted to energy also.  Now, if that goes on too long, we’re going to lose too much fat or lose too much protein, but then we have the next meal. So it’s supposed to be this continual ebb and flow, but what we see in many people of course, is they’re grazing, they’re continually eating, constantly secreting insulin.

The one indicator that we look at in terms of is that eating too much, if you will., there’s an indicator called beta hydroxybutyrate, it’s a ketone body. Now, this is a fasting test. It’s a fasted test.  In other words, you stop eating and then you take the urine sample, the first thing the next morning.  In a healthy situation, we want good fasting, fat burning metabolism, and so we want to see that beta hydroxybutyrate trending high, trending high, so we know that we’re getting good fat burning because that’s the… 

Dr. Weitz:            By the way, this is the same thing that people are measuring when they’re doing a ketogenic diet and they want to see that they’re actually burning ketones.

Dr. Moss:             Yes, exactly right. And so the beta hydroxybutyrate is a ketone. It’s an excellent measurement if you’re burning fat well. So right now in terms of two things, number one, are you burning fat well, but also, if your beta hydroxybutyrate is high, that means the insulin is not high. If you get excess insulin production, you’re going to get production of energy and other pathways, the lactate will tend to be high. The pyruvate will tend to be high, the beta hydroxybutyrate will tend to be a little bit lower.  And now this chronic elevation in insulin called hyperinsulinemia is now considered to be a primary factor in all kinds of chronic illness, a tremendous amount of research is going on now looking at what happens when we’re eating all day, constantly stimulating insulin production.  So right now I’d say in terms of a general health, dietary recommendations, I’m looking at that beta hydroxybutyrate and if I see it not a little bit high, I’m wondering if you’re eating too much, not having a long enough fasting period.

Dr. Weitz:            Okay. And what about any of the other markers for energy metabolism? What can you tell us about… And by the way, do any of these markers for mitochondrial function, has there been research to correlate these with like muscle biopsies to assess mitochondrial function? What kind of validation has there been for some of these markers?

Dr. Moss:             Good point. These specific mitochondrial markers on the profile, citrate there are several of them. Lord and Bralley in their book looked at several different scenarios. And from a practical clinical standpoint, the scenarios can be they’re so numerous and so confusing that it’s really hard to apply them clinically in my experience.

Dr. Weitz:            Okay.

Dr. Moss:             So I’m looking for trends. I’ve looked at the literature and when you tend to see all these mitochondrial markers trending high, you’re thinking about chronic inflammation, not making conversions properly. They’re being inhibited usually by inflammation. Trending low, I’m thinking about deficiency or a malabsorption issue of amino acids.  Now, there are some specific markers that can be looked at for other scenarios. The HMG, which is a precursor to cholesterol synthesis, that can be very high on a person on statins because it inhibits cholesterol synthesis.

Dr. Weitz:            Oh, interesting.

Dr. Moss:             So that can be a useful. Citrate, we need a certain amount of citrate in our urine to-

Dr. Weitz:            One more time on the HMG because that’s one I’ve never really paid any attention to it-

Dr. Moss:             Okay.

Dr. Weitz:            … if I happened to be looking at NutrEVal here. So say it again. HMG is a precursor for cholesterol synthesis …. and what’s being blocked by statin drugs. Right?

Dr. Moss:             That’s exactly right. And so if you’re taking a statin drug, they can’t make the conversion, the HMG will tend to go up. So if you see high HMG, you want to rule out statins, that’d be one clinical pearl certainly.

Dr. Weitz:            Or red yeast rice.

Dr. Moss:             Yes, correct. Typically, red yeast rice, when taken the in the correct dosages is more metabolically kind, if you will. It doesn’t have that gross effect that a statin drug would. But yes, if they’re not using it correctly, you could see it with red yeast rice.

Dr. Weitz:            Okay. And then if it’s low.

Dr. Moss:             If it’s low, again, you’re thinking about this issue of deficiency of precursors, malabsorption, malnutrition. Very often the people I encounter, either my patients in my small practice or people who are referred to me from my customers are older patients where malnutrition… Shouldn’t say mal, sub optimal nutrient intake or malabsorption is incredibly common.  Older people for many reasons are not eating well, they skip meals for a variety of factors.  One of the things I find that’s often missed when they analyze diets, they’ll take a look at the nutrient content and very often the nutrient content will be excellent. What they forget to do is ask how much did you actually eat? And sometimes you have to ask the kids. “Yeah, I know what you put on the plate, how much on the plate did mom actually eat? Add it up.”  And so this is where we get fooled very often older populations, the quality is good and we know there was enough but on the plate, but they aren’t finishing their food and they get into a malnutrition issue, which can be exacerbated by malabsorption, very common in older populations.  And so if we see mitochondrial indicators trending low and I asked the question, “Oh, tell me about your diet.” And, “I’ve already done that,” and I hear about the high quality, the broccoli and the fish, I hear about all that. But then my next question is, “How much did you eat?” And the patient, “Oh, I eat fine.” And then if available, I ask the kids, “How well does your mother eat?” “Oh, she doesn’t eat at all.” She’s always skipping meals.

Dr. Weitz:            And of course that HMG, and so now we’re talking about the anorexic, the bulimic, the undernourished… 

Dr. Moss:             That’s what I find the mitochondria indicators most valuable for is these general trends.

Dr. Weitz:            And so that HMG pathway, which produces cholesterol is also the pathway that produces coenzyme Q10-

Dr. Moss:             Yes, 

Dr. Weitz:            … so if they don’t have enough HMG, they’re not going to produce CoQ10, and that’s a super important mitochondrial nutrient.

Dr. Moss:             Yeah, very good point. Very misunderstood, underappreciated is the need for coenzyme Q10 and the body makes it. And yeah, we need these nutrient precursors, and again, it’s underappreciated that certain populations, suboptimal intake is extremely common.

Dr. Weitz:            So if that HMG is high though and they’re not taking a statin, and they also have high cholesterol, then that would be a clear correlation of something going on, right?

Dr. Moss:             Sure. Something is going on. Again, the most common thing in the ailing population is going to be looking for a chronic inflammation. They can’t make the conversions, the inflammation is a major enzyme inhibitor. It’s a common thing, and the next thing would be a chemical or metal toxins acts as enzyme inhibitors.

Dr. Weitz:            Right. Now organic can also be markers for neurotransmitter status.

Dr. Moss:             Yeah.

Dr. Weitz:            What can we learn about this?

Dr. Moss:             Oh, this is a really one of the most important sections for me mainly because when I were trying to help people who are not responding, one of the things we tend to under-appreciate or sometimes the patient can hide it is the impact of psychological stress, worry. Well, just thinking about stuff all day and this kind of PTSD type scenario where just everything reminds them of something bad. And so-

Dr. Weitz:            Being in sympathetic mode the whole day.

Dr. Moss:             Exactly right. And so-

Dr. Weitz:            Not spending enough time in parasympathetic rest and relax state.

Dr. Moss:             Right.  You’re right.  And so the indicators the homovanillic, there’s a couple of other indicators out there.

Dr. Weitz:            Kynurenic acid.

Dr. Moss:             Yes. They first two indicators in that profile are indicators of catecholamine metabolism, and in many people they tend to be on the high side and that would indicate, oh, we were dealing with a stress situation, the sympathetic nervous system is just being turned on too often, most often due to chronic worry, and thoughts, and negative thinking.  The other section, the other indicators and there relate to the serotonin mediated pathways or more precisely the tryptophan meted pathways. Almost all the neurotransmitters are derived from amino acids. The catecholamines are from the essential amino acid, phenylalanine, and we’ll see how well they’re converted, but the others the kynurenine, quinolinic acid, picolinic acid, 5-HIAA, these are all tryptophan metabolites.  Now the 5-HIAA tells us about how well are we converting tryptophan to serotonin. Now, tryptophan actually can go in two major directions and it has to do both for good health. We all know about the serotonin direction. We want some tryptophan to go to serotonin. Serotonin is like the life is good neurotransmitter. Everything’s fine, no problems.

The problem is people chronically stressed, they’re inflamed, they’re worried or they have other stressors such as poor diet, or toxins, or whatever, the body is in a stress response scenario, and so the body says, “Well, life is not good.” So the body says, “Well, we’re not going to take tryptophan over to serotonin and melatonin because it’s not time to sleep. We’re worried, we’re stressed. We have to get into the reaction phase, the worry phase.” And the tryptophan is redirected to what is known as the kynurenine pathway.  And there’s several indicators on organic acids that can tell us about this is how much the tryptophan is going down this other pathway. Now, it’s not a bad pathway, it’s supposed to be there. The end point of the kynurenine pathway is the production of niacin, B3. So it’s supposed to be there.

But with chronic stress, toxins, et cetera, we can get too much going down this pathway, and the big one we’re looking at is the quinolinic acid because this is not only an indication of inflammation, it’s an also a good indicator of neuro-degeneration. It’s a neuroexcitatory metabolite and that has been highly linked with virtually every behavioral and neurodegenerative disorder you can think of from depression, bipolar disorder, anxiety, Parkinson’s disease, but most notably elevated kynurenine and the quinolinic acid have been highly correlated with Alzheimer’s, senile dementia profiles.

Dr. Weitz:            Wow. Interesting.

Dr. Moss:             Somebody says, “My father got Alzheimer’s disease at 60 and I’m 40. Is there any way that you can tell me that I’m more prone to heading in that direction?” This is a good early screen. Now it’s not 100%, but it can basically say, “All right, you’re heading down this pathway and…” but most people think, oh my God, just write your will, it’s all over.  No, this pathway tends to be elevated because of lifestyle issues. And so this is one of the things that is misunderstood. Alzheimer’s disease is not a hardwired genetic disease. Maybe 5% of the population is hardwired genetic. The research is clear, this is mainly a lifestyle disorder.  So we see the elevated kynurenine and the elevated quinolinic acid, all right, you’ve got a tendency, but if we can change your lifestyle, good self meditation, exercise, stress management, we can easily change this to a more health producing pathway, most health promoting scenario.

Dr. Weitz:            So what particular factors are these quinolinic acid and kynurenic directly related to in terms of lifestyle diet?

Dr. Moss:             They go up because of inflammation.

Dr. Weitz:            Right.

Dr. Moss:             So anything that’s causing inflammation and everybody’s different. Somebody, it may be due to a poor diet, somebody it’s due to a toxin. Infection is a big factor. What are the things that we often miss is we understand the infections like Lyme disease and viruses we’re all hearing about now, but some of the infections that are most underappreciated are the infections that we get in our gut.

Dr. Weitz:            Right.

Dr. Moss:             Chronic low grade dysbiosis, chronic pathogens are often due to over use of antibiotics, and this can be immensely pro-inflammatory. And so we see this elevation, one of the things you may want to check out, did we miss something in the gut?

Dr. Weitz:            Right? And this is where a good stool test like the GI Map from Diagnostic Solutions can be helpful.

Dr. Moss:             A big fan of that test.

Dr. Weitz:            You were talking about what can we do to screen for the possibility of Alzheimer’s and I wanted to mention that Cyrex Labs has an awesome test called the Alzheimer’s Linx Test that looks for antibodies to see whether your immune system is starting to attack any of the tissues related to your brain function.

Dr. Moss:             Oh yeah. Cyrex is great, these antibodies are really wonderful. And certainly if we see these trends on a basic organic acids screen, yes, we’d want to go ahead and do additional testing to gain more information, and we’d do that with Cyrex. Absolutely.

Dr. Weitz:            Right. Now the last area I’d like to touch on, you mentioned toxins and organic acids can give us some information about toxins as well. So can you talk a little bit about what we can learn about exposure to toxins from an organic acids test?

Dr. Moss:             Sure. What we measure in the organic acids is not the toxins per se, but the enzymes and, I should say, the pathways involved in toxin metabolism. And for many people, this is really more important than knowing the toxins. For most people, what do we know about toxic exposure? That for most people it’s the same as everybody else, we live in a toxic world.

Dr. Weitz:            Right. We’re all getting exposed.

Dr. Moss:             We’re all getting basically the same amount, but this particular person for whatever reasons seems to be less able to handle the load that everybody else can handle, and what do we-

Dr. Weitz:            This person gets sick where somebody else is exposed to the same thing as him.

Dr. Moss:             The soap everybody else uses with no problem, this person reacts to the soap, they get headaches from the perfume. Why are they reacting to something that most people don’t react to?

Dr. Weitz:            Right.

Dr. Moss:             And what we’re learning-

Dr. Weitz:            You have mold in a household and one family member gets really sick and so many other family members don’t.

Dr. Moss:             Right. So why are they reacting is the key question. Obviously, practicalities aside, it would be great if we can just eliminate all the toxins, but from a practical standpoint, it’s just not going to happen. The world’s not going to get any cleaner anytime soon. And to tell people, “You’ve got to completely rip out all your dry wall, repaint, new carpeting, $10,000 filtration system,” not really practical for most people.  So we want to focus on how can we better and help them improve their ability to metabolize of the toxins. And so the indicators, these glutathione indicators, we can look at these… this one is a hippurate pathway, glycinate pathway, all help us, tell how well are they metabolizing these toxins.  Now, history is very important. Very often if we’re dealing with an occupational situation, occupational exposure, that’s entirely different, they work with it. A dentist working with mercury, people who work in beauty parlors, nail salons, these are occupational exposures where history is going to be an important indicator.

But for the person we can’t find any obvious source of excess exposure, organic acids will tell us, “All right, you’re having a problem with metabolizing.” Is there a nutrient problem? Are you getting enough sulfur in your diet, which mainly comes from protein. Maybe they need some supplementation for that.  There is the other amino acid pathways that are underappreciated involved in detoxification, known as the glycine pathway. Very important in this pathway particularly-

Dr. Weitz:            What role does the glycine pathway play in detoxification?

Dr. Moss:             That is involved in detoxification of key solvents such as taurine in particular that taurine type compounds are very common solvents in cosmetics for example. Now, this is one of the things that I know very often female patients don’t want to hear about, but sometimes we have to talk about this is that I’m sick, we’ve ruled out the usual things, so I like to ask about the unusual, and I ask the question.

I know they don’t want to hear, “Tell me about your hair dyes and your cosmetics,” which commonly have these solvents in there. So if I see elevations of the hippurate pathway, the glycine pathway, I’m thinking about, are we getting excess exposure from solvents that can be found in things like hair dyes and cosmetics.

Now obviously to tell a woman, “You can never do that again.” That’s impractical and on harsh. We don’t want to be cruel. So what can we do to maybe create more reasonable utilization, but along with improving lifestyle supplementation to improve these detoxification pathways so that to a certain extent they can use the things, these cosmetics they’re used to, but at the same time get better health. That’s how [crosstalk 00:51:18]-

Dr. Weitz:            How can you promote the glycine pathway? Is that through taking glycine or?

Dr. Moss:             It’s interesting, the body makes glycine. It’s a non essential amino acid and so it’s been virtually ignored because the body makes it, but the literature is now is showing in certain selected individuals, particularly those who are having a toxic challenge, they’re not making enough. And so yes, using a glycine supplementation has been very impressive in the literature for these detoxification pathways. Sure.

Dr. Weitz:            What other supplements can be beneficial if we see problems with detoxification pathways?

Dr. Moss:             The big one that we see, the alpha hydroxybutyrate and the pyroglutamate, these are indicators for glutathione. And the big thing with glutathione is that we’re not getting enough sulfur. Sulfur is really an underappreciated mineral. Traditionally, according to the literature I saw was basically ignored by the research community for the simple fact sulfur is very common in red meat.

And in the early days when they were doing the research, nobody ever thought you could ever be too low in sulfur because everyone’s seeing too plenty of red meat. But now we’ve gotten people to stop eating red meat and we’re seeing more and more sulfur deficiencies because there’s not a lot of sulfur in a plant-based diet. And what is in there is very hard to digest and absorb.  So sulfur deficiency is becoming much more common, so we’re looking at the supplements in this case like N-Acetyl Cysteine, alpha-lipoic acid, methylsulfonylmethane (MSM) can be very helpful in this situation.

Dr. Weitz:            Interesting. So I normally think of NAC as a precursor for glutathione, but you’re saying it also supplies sulfur, which helps with that whole detox pathway as well.

Dr. Moss:             Absolutely. Yeah, it certainly is great for building glutathione. And many of these people have two… There’s two indicators there; one, the alpha hydroxybutyrate tells us how well they’re making it, and the pirate glutamate… Glutathione basically you use it, what known always reduced unused glutathione, the GSH and the body converts that to oxidized or used glutathione.  And what the body is supposed to do, it wants to conserve it. It’ll take that used glutathione and convert it back to unused, the GSH converted, and there is an indicator called pyroglutamate. If that’s too high it tells you’re not recycling glutathione very well, so you’re not using your sulfur well.  And the other extremely important indicator is the urinary sulfate, which is often too high in the chronically ill people, and what that tells you basically is you’re peeing out all your sulfur. Certainly you want to do things to help improve metabolism, with these indicators, it tells us we’re probably going to need more sulfur supplementation and a diet that is a more replete in healthy sulfur resources.

Dr. Weitz:            And what would be the healthy sulfur sources?

Dr. Moss:             Number one, I know I sound [crosstalk 00:54:36] politically correct, but a meat-based or an animal-based diet. Too much of anything is bad, but good quality variety of protein sources. When I say red meat may be good, I’m not saying every day, and not saying go to your fast food restaurant. What I’m saying is if you can-

Dr. Weitz:            Live a carnivore diet.

Dr. Moss:             Yeah, a good quality source. If you go to the farmer’s market and they have these grass-fed cuts of meat, the local and eat that maybe once or twice a week, and maybe a couple of meals a week or a couple times a week, you’re going to have a plant-based diet, and then a fish-based, and then eggs, so variety.  Eggs are a very good source of sulfur. That’s a really good way to get good sulfur in your diet without getting into any overload situations. And then of course the supplementation is very helpful.

Dr. Weitz:            Why wouldn’t somebody recycle their glutathione?

Dr. Moss:             The big X factor, I keep on coming back to it is because it’s underappreciated, inflammation.

Dr. Weitz:            Inflammation.

Dr. Moss:             Inflammation is such a massive enzyme inhibitor, virtually every enzyme you can think of so why… And again we know they’re inflamed, our job is to do is that why, why are they inflamed? What did we miss? Was it a toxin? Were they worrying too much? Are they getting enough sleep? Are they spending up to 2:00 AM on the computer? All pro-inflammatory, we just have to weed that out and make proper recommendations.

Dr. Weitz:            That’s interesting. So maybe we’ve done a CRP and that’s normal, but this is still telling us that there’s inflammation that’s not being picked up by the CRP.

Dr. Moss:             Yeah. It’s been thought that C-reactive protein is kind of like a universal indicator and very sensitive. And the high sensitivity hsCRP is more sensitive, but yes, you will see many people who have excess inflammation due to other pathways, and that’s where the Cyrex testing for example, could come into play.  Very often we know they’re inflamed, but the C-reactive protein is negative, what are the other sources or indicators of inflammation? Cyrex testing can be very helpful in that regard.

Dr. Weitz:            Okay, good. I think those are the questions that I had prepared. Are there any other things you’d like to talk about?

Dr. Moss:             I guess I would finish up by saying that the test is… there’s so many people who are just, they’re discouraged, and they’re confused, and they’re depressed because they’ve been suffering, and everybody is trying to throw supplements at them, “Take this, take this, take this, take this.” Most of these people are searching its cart before the horse. The issue right now at this point is not which supplements to take, it’s not a treatment challenge, it’s an assessment, it’s a diagnostic challenge, what’s wrong with them?  We’ve done the usual, we’ve done the usual blood tests, where can we turn to on cost-effective basis to answer that question to this patient. What’s wrong with me? Organic acids is a great gross screen to answer that question, what’s wrong with me?

Dr. Weitz:            Right. Great. Can you tell us about your organic acids course and about your Moss Nutrition supplements?

Dr. Moss:             Yeah. The organic acids course basically came from a need I felt to really look at organic acids as more than just a simple test to determine micro nutrient deficiency. I started reading the literature and I noticed, boy, there’s just so much information here related to inflammation, all the things that I’ve talked about and I really wasn’t seeing any good information geared towards the practitioner where they could basically get this in one place.

So I decided, well, might as well do it myself. And so I created a very in depth, a series. It’s 15 parts where I go into each section for basic an hour, hour and a half, using this idea of what did you miss? And look at each section in terms of what information can you gain to answer that question, what did I miss?  It’s a 15 session course and to learn about it, you can go to our website or give our office to call. In terms of our Moss Nutrition line, it is a practitioner [crosstalk 00:59:09]-

Dr. Weitz:            Hang on one second. I just wanted to give a plug for your course.

Dr. Moss:             Thank you.

Dr. Weitz:            It’s very well organized, very well in depth and Jeff keeps using this sort of format that sort of reminds me of the IFM course is to organize information in terms of the different types of problems like toxins, and et cetera, and keeping us focused on the patient and how we can use the information to help the patient rather than getting too focused on the course, which I think is very, very helpful. So-

Dr. Moss:             Yes, it’s very patient-

Dr. Weitz:            … I do recommend his organic acids-.

Dr. Moss:             Thank you.

Dr. Weitz:            … course.

Dr. Moss:             It’s meant to be very practical and very patient centered.

Dr. Weitz:            Okay. And what’s the cost of that right now?

Dr. Moss:             Right now, what are we offering it? I think it is… my goodness. I don’t even know off the top of my… It’s right around in the $200, $250 range.

Dr. Weitz:            Okay.

Dr. Moss:             My wife keeps track of all of that. I can’t even tell you what we’re charging for it now-

Dr. Weitz:            Okay.

Dr. Moss:             … but it’s in the $200 to $300 range.

Dr. Weitz:            Okay. And then about your Moss Nutrition line.

Dr. Moss:             Our Moss Nutrition line, it’s a practitioner baseline. It’s geared towards practitioners and I emphasize that. You will not find our product line on amazon.com or any major retail sites. We do allow practitioners to sell our supplements on their own websites to their patients, but the idea is, is we want to have a product line that is geared specifically towards the needs of chronically ill individuals answering this question of what’s wrong and what tools can we use specifically to help them metabolically to get to better health?

We’ve designed products specifically for that and in particular addressing some of the very underappreciated metabolic imbalances. Certainly, we have a lot of good products for example, for gut health, but one of the areas that’s grossly underappreciated is loss of muscle mass, very common in older populations.  One of the things that’s underappreciated is that most glucose receptors sites are on muscle so that type 2 diabetes is not a disease of the pancreas. That’s end-stage diabetes. Early onset is a muscle disease. And so building muscle is incredibly important in maintaining muscle, so we have products like SarcoSelect that are specifically designed, particularly older patients to help them build and maintain muscle.

Acid alkaline imbalance, grossly underappreciated. And of course this is an issue of electrolytes. When we think electrolytes, we all know about sodium, and chloride, and magnesium, but what’s the big one that it’s under appreciated that you never hear about in the seminars? Potassium.  So we talk a lot about potassium, we have a very bio available form potassium, Potassium Bicarbonate. We have the pH strips to look at first morning urine pH. We talk about how to assess serum potassium, and it’s one of our foundational products. And we’ve heard so many good reports how people don’t believe, how could this complicated problem nobody could solve got resolved by electrolytes, potassium?

Well, we hear about it all the time, so we’re back to basics. That’s the other aspect of Moss Nutrition. We’ll address complexity, but we like to bring things back down to simplicity and basics, and very often for many of these people, everybody assumed it was complicated and so they never looked at the simple stuff. We look at the simple stuff at Moss Nutrition. That’s the heart of our product line. Simple answers for complicated problems.

Dr. Weitz:            Excellent. Thank you, Jeff.

Dr. Moss:             Thanks Ben.



Plant Based Diet for Diabetes with Dr. Cyrus Khambatta: Rational Wellness Podcast 144

Dr. Cyrus Khambatta discusses how A Plant Based Diet Benefits Patients with Diabetes 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

3:12:  Dr. Khambatta was diagnosed with Type I Diabetes when he was 22 years old and he developed 3 separate autoimmune conditions within a 6 month period of time.  Dr. Khambatta developed Hashimoto’s hypthyroidism, Type I Diabetes, and Alopecia universalis, which is why he has no hair.  He followed his doctors’ recommendations to follow a lower carbohydrate diet with 100-125 grams of carbs per day.  He started eating more peanut butter, eggs, chicken, fish, olive oil, and reduced his intake of carbohydrates, including fruits, starchy vegetables, and whole grains.  Not only was he having trouble controlling his blood glucose, but his insulin use was gradually going up as well, from the mid 20s, to the mid 30s, to 40-45 units per day.  He decided to try a plant based, high carb, whole food, low fat diet, with the help of Dr. Douglas Graham.  He started eating 5 to 6 times the number of grams of carbohydrates per day and his blood glucose fell within the first 24 hours and he cut his insulin use by 40%!  This led Dr. Khambatta to get a PhD in Nutritional biochemistry from UC Berkley in order to understand what was going on in his own body.  He claims to have dug up over 100 years of information from scientific researchers that document how a low fat, plant based, whole food diet can help maximize insulin sensitivity and enable people with both Type I and Type II diabetes and prediabetes to get the same results. This led him and Robby Barbaro to see up the Mastering Diabetes coaching program to educate people about the benefits of the plant based diet for diabetes.

11:55  The recommended diet for those with both Type I and Type II diabetes can be quite similar, according to Dr. Khambatta. There are three components to a plant-based diet that are beneficial for those living with diabetes: 1. Low fat, 2. Plant based, and 3. Whole food.  Dr. Khambatta recommends that no more than 10-15% of calories should be consumed as fat because low fat will improve insulin sensitivity.  You should eat as much plant material as you can, but you should avoid processed and packaged food products, even if they are plant based. You should stick with whole fruits, vegetables, whole grains and legumes and avoid plant based burgers and soy ice cream and crackers and chips, etc.

14:26  Insulin. If you consume too many calories, insulin will signal your liver and muscle to store the excess energy as glycogen and then as bodyfat.  Insulin is a very powerful anabolic hormone that has many other effects, including to signal amino acid uptake from protein and fatty acid uptake from fatty acids. Insulin can signal cholesterol uptake.  Insulin can also promote DNA synthesis, DNA repair, RNA synthesis, and glycogen synthesis. 

16:39  It is important to avoid consuming too many calories if you have diabetes, since excess calories will tend to be stored as fat.  But if you avoid refined carbohydrates and you eat a whole food plant based diet, it is very rich in fiber and water and this creates bulk, which fills you up and makes it hard to eat excess calories. Fiber is very important for slowing the breakdown of the food into sugar, for creating bulk in our stool, and helps feed our microbiome and promotes the production of butyrate by our microbiota.

18:21  People who are overweight usually tend to overeat carbohydrates, but these are usually refined carbohydrate foods, like chips and cookies and crackers and pastas and cereals. Such foods are made hyperpalatable that tend to encourage overeating, whereas whole food plant-based carbohydrate foods, like potatoes are filled with fiber and water and tend to fill you up.

20:58  Eating carbohydrates with proteins or fats does slow the absorption of the carbohydrate into sugar in the bloodstream.  But if you eat in a way that promotes insulin sensitivity with a high carb, low fat, whole foods, plant-based diet, then the glucose molecules from the potato you eat will get inside of your muscles, which will keep your blood glucose from going high.

25:10  If you eat too many carbohydrate calories, more than your caloric needs, then you can have your blood glucose spike and start storing some of those carbohydrate calories as fat in the liver and in adipose stores. But if you eat a low fat, whole food, plant-based diet without refined carbohydrates, then you are less likely to eat excess calories and you are likely to be sensitive to insulin, so the glucose will continue to be shuttled into the muscles and liver and your blood glucose will not be high.

30:37  The Glycemic Index, which rates carbohydrate foods based on the rate that they are turned into sugar, matters, but not so much if you are insulin sensitive due to eating a low fat, whole food, plant-based diet.

36:04  Insulin resistance is a complex topic, but Dr. Khambatta feels that the research shows that eating both fat, esp. saturated fat, and/or protein increase insulin resistance, as compared to eating carbohydrates. Saturated fat appears to be the most significant contributor to insulin resistance, according to Dr. Khambatta.

39:57  Dr. Khambatta recommends eating a fruit-centric meal in the morning and if you exercise in the morning, which he recommends, this can give you a lot of energy fro your exercise. Such a meal could consist of a bowl with two bananas and a mango with a tablespoon of flax seed oil dripped on it or you can have oatmeal with fruit. If you are a Type I diabetic, it is best to eat and then exercise and under-dose your insulin a little bit so you don’t get hypoglycemic with exercise.  If you have Type II diabetes, then it’s fine to exercise first in a fasted state and eat your fruit after you exercise.  Lunch could include some starchy carbohydrates like potatoes, squash, corn, or some whole grains.  In the evening would be a good time to have some green leafy and non-starchy vegetables with some legumes.

44:50  Nutritional Supplements.  Dr. Khambatta recommends a supplement containing Indian gooseberries, Amla Green, which contains Amla berries with green tea.  He also noted that there are some effective anti-diabetic medicinal herbs, including cinnamon, berberine, fenugreek, gymnema sylvestre, and bitter melon, but he does not see them as a core component of the natural managing diabetes approach.

46:08  Exercise.  It is recommended to do at least 30 minutes of exercise six days per week with 50% being cardiovascular exercise and 50% resistance training.  Exercise should be intense enough that you cannot talk or answer a phone call or sing your favorite song while exercising.  Exercise is a powerful insulin sensitizer and has many benefits for your glucose management, your brain, your bones, your muscles, your thyroid, and your mental health.


Dr. Cyrus Khambatta has a PhD in Nutritional Biochemistry and he has coauthored a number of peer-reviewed scientific papers and he is the co-host of the annual Mastering Diabetes online summit.  He is also the co-author of a new book along with Robby Barbaro, Mastering Diabetes, which was just released on 2/18/2020.

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


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. For those of you who enjoy listening to our Rational Wellness Podcast, please go to Apple Podcasts or wherever you get your podcasts and give us a ratings and review. Also, if you’d like to see a video version, go to my YouTube page, and if you go to my website, you can find detailed show notes and a complete transcript.

Today our topic is, The Prevention And Treatment Of Diabetes With A Diet And Lifestyle Approach.  Type 1 diabetes is an autoimmune condition that usually starts in childhood or in the teenage years and is marked by damage to the ability to produce insulin, and requires taking insulin injections for the rest of their lives.  But 90 to 95% of those with diabetes have Type 2, and this is a condition that results from diet and lifestyle and is entirely preventable. One of the biggest questions is, which diet and lifestyle factors are the most effective for this task? For example, is it more effective to follow a lower carb diet, which as Dr. Brian Mowll recommends, who we spoke to in episode 139?  Or is it more effective to follow a higher carb, lower fat program such as Dr. Cyrus Khambatta, our guest today advocates? This is a very important topic because diabetes and prediabetes are epidemic and the prevalence continues to increase in the United States and around the world.  9.4% of adults in the US are diabetic and at least 87 million people in the US have prediabetes and rates are climbing, especially among children and teens. Dr. Cyrus Khambatta has a bachelor of science in mechanical engineering from Stanford university in 2003 and a PhD in nutritional biochemistry from UC Berkeley in 2012. He’s coauthored a number of peer-reviewed scientific papers. He appeared on the Forks Over Knives’ documentary and he’s the co-host of the Annual Mastering Diabetes Online Summit, and he’s coauthored the soon to be released book, Mastering Diabetes With Robby Barbara. There you go. Is it available right now?

Dr. Khambatta:                 It’s available for pre-sale right now and it’ll be available on February 18th for everyone.

Dr. Weitz:                         Okay. And he’s also a nutrition and fitness coach and he’s been living with Type 1 diabetes since 2002. Dr. Khambatta, thank you for joining me today.

Dr. Khambatta:                 Thank you so much Dr. Weitz. I really appreciate the opportunity to be here today.

Dr. Weitz:                          Excellent. So maybe you can start by telling us about your personal experiences living with Type 1 diabetes and eating a plant-based diet.

Dr. Khambatta:                 For sure. I was diagnosed with Type 1 diabetes when I was 22 years old, I was a senior at Stanford university at the time and I was just trying to graduate and move on with my life, and I started to feel really thirsty, like incredibly thirsty where I was drinking about one to two gallons of water per day, and my energy levels were just terrible, very little energy. So I picked up the phone and I called my sister and she’s a doctor of osteopathy and I said, “Hey Shanaz, here are my symptoms, what am I experiencing?” And she said, “Cyrus, you are explaining Type 1 diabetes to the T, go to the health center right away.”  And I was like, “Shanaz, I don’t have Type 1 diabetes. What are you talking about?” And she said, “I don’t have time to explain, just go.” So I didn’t know anything about biology, I didn’t know anything about medicine at that point. I just thought that diabetes literally had something to do with old people and cake. That was it. So here I am, I’m like 22 year old guy, I’m athletic and I’m like, “I’m not overweight. I don’t understand what’s happening.” So I checked myself into the health center and while I’m there, they checked my blood glucose and it’s over 600. My brother goes, “Anybody’s blood glucose is supposed to be between 80 and 130 on a given day.” And mine was basically six times higher than it needed to be. And I didn’t know what that meant, but they basically looked at me and they said, “We’re taking you to the ER right now.”

So we go to the ER together. When I checked myself in there, they basically put me into a room. They gave me an IV of saline in one arm to hydrate me, and then they also gave me an IV of insulin into the other arm and they started to control my blood glucose and bring it down using insulin. While I was in the hospital for 24 hours, they pieced together my health history, and they helped me understand that I now had developed, not one, not two, but three autoimmune conditions within a six month period. So the first autoimmune condition was Hashimoto’s hypothyroidism. So I developed Hashimoto’s about six months prior and I was taking a synthetic thyroid supplements, was taking Synthroid and that was supposed to solve that problem.  Then a couple of months later, I developed alopecia universalis, which is why I have no hair, I have no eyebrows, I had no eyelashes, I had no ear hair, no hair, nothing, I’m gone. And then in addition to that, I developed Type 1 diabetes. So all of those setting within a six month period and all three of them were autoimmune. So the doctors looked at me and they were like, “We’ve never ever seen somebody that has these three conditions before.”

Dr. Weitz:                          But actually autoimmune conditions do tend to group together. Having one autoimmune condition increases your risk of another.

Dr. Khambatta:                 No questions asked, you’re absolutely correct. And I’ve gone on to learn over the course of time that there’s actually different types of autoimmune conditions that cluster together. So Hashimoto’s, hypothyroidism, Type 1 diabetes, celiac disease, they all cluster, but I didn’t know that at the time, all I knew was that I’d felt thirsty and I needed some help. And the doctors were basically telling me, they were like, “Well we kind of know what to do and we kind of don’t know what to do.” So I got discharged from the hospital 24 hours later with a blood glucose meter, test strips, two different types of insulin, syringes, carbohydrate counting guide and a life alert bracelet that basically said, “If something happens to me and you find me passed out on a field, call 991.” So I got really nervous really quickly because-

Dr. Weitz:                          Yeah, that’s pretty scary.

Dr. Khambatta:                 Yeah, exactly. So I followed the advice of my doctors at the time and they basically said, “Listen, we know how to treat Type 1 diabetes because it’s pretty classic and there’s a safe way to treat it and that is, to eat a low carbohydrate diet.” So I said, “Great. Let’s do this.” So I started eating more peanut butter, more eggs, more chicken, more fish, more olive oil, and I was trying to reduce my intake of carbohydrate rich, anything, whether that was fruits or starchy vegetables or whole grains. And by doing so it was supposed to make my blood glucose more controllable and it didn’t. It definitely did not.

So maybe I did a low carbohydrate diet terribly incorrectly, but I was trying to control my carbohydrate intake to be about 100 to 125 grams per day, which falls within the low carbohydrate classification. And not only was my blood glucose hard to control, my insulin use was going up over time, started out in the mid-20s, and then it creeped up to the mid-30s, and before I knew it, it was 40 to 45 units per day. And then in addition to that, I also just started to feel very tired and my joints and my muscles were starting to hurt and I couldn’t be as athletic as I wanted to be. And having grown up as an athlete, a soccer player, weightlifter, and just like generally, very active, as soon as my mobility got compromised, I got really frustrated.

So I started looking for more information, I got introduced to this idea of eating a plant-based diet and I said, “Heck, I’ll try it out. Let me do it.” So under the guidance of a nutrition professional named, Dr. Douglas Graham, he helped me transition to a plant-based diet, literally overnight, cold turkey. Now, I don’t really recommend transitioning cold turkey overnight, but I happened to do it just because that’s the situation I was presented with. So I switched over to a plant-based diet and Dr. Weitz, I can’t even tell you how incredible it felt for the first week. Within 24 hours, my blood glucose went from being relatively high and difficult to control, I hit six hypoglycemias within 24 hours. So my blood glucose began to fall and it began to fall rapidly.  And as a result of that, I had to back off on the amount of insulin I was giving myself so that I wouldn’t drive myself more hypoglycemia. Over the course of one week, I’d cut my insulin use by 40%, which is mind boggling, but the beauty was that I was doing it by eating five to six times the number of grams of carbohydrate per day. So that was really where this light bulb went off in my head when I was like, “Wait a minute, I had been told up to this point that carbohydrates equals more insulin, but now I’m eating way more carbohydrate energy and my insulin use is going down, so there’s like they’re moving in opposite directions. How is that possible?” So that’s when I got really interested in studying it at the PhD level, so I went to UC Berkeley. I enrolled in a PhD program there and I got to try and understand what was happening inside of my own body because it was a fascinating experiment.

Dr. Weitz:                          Well, it certainly is counter intuitive.

Dr. Khambatta:                 Oh, it’s fascinating. Yes, absolutely perfect..

Dr. Weitz:                          We basically, carbohydrates, pick a carbohydrate, rice is essentially a long chain of glucose molecules together. And when you eat a carbohydrate like rice, it gets broken down over a period of time, faster or slower depending upon the carbohydrate, into glucose, and if the issue is glucose, it certainly makes sense that eating more carbohydrates is going to raise your blood glucose.

Dr. Khambatta:                 That’s exactly So the overall philosophy of eating more carbohydrates equaling more glucose, equaling more insulin, it makes perfect sense. From like if you step backwards and draw it out on a piece of paper, it makes perfect sense, but my personal experience went exactly opposite to that. And so that’s where I either thought to myself, I was like, “Either I’m a fascinating “N” of one experiment, and what’s happening inside of my body is I’m a genetic anomaly or what’s happening inside of my body is actually applicable to other people living with Type 1 or maybe even other people living with any other form of diabetes.”

So that’s why I went to school and that’s why I tried to educate myself about it so that I could answer that question. Then while I was there, I was able to dig up almost 100 years’ worth of information, from the 1920s and beyond of experiments that scientific researchers have run that mimic exactly what I had gone through myself. And there’s a whole collection of information that really highlights the power of a plant-based diet, especially a low fat, plant-based whole food diet in helping to maximize insulin sensitivity and really enable people living with Type 1 and Type 2 diabetes and prediabetes to see the exact same results, which is higher carbohydrate and take less insulin demands, less insulin biological requirements.  And that’s when I started to say, “Oh, wait a minute, I’m not special. I’m really not special. I just happened to be one person that experienced something that has already been documented for over 100 years.” And so we set up the Mastering Diabetes coaching program to teach people living with all forms of diabetes, how they can also transition to a plant-based diet so that they can achieve incredible similar results.

Dr. Weitz:                          So how should a diet for somebody with Type 1 be different than somebody with Type 2 diabetes?

Dr. Khambatta:                 It doesn’t necessarily have to be that different. At the basis of what we teach, and the basis of all of the scientific investigations that I’ve been involved in in the past 15 years, is that there’s three components to a plant-based diet that are really going to be beneficial for people living with diabetes. Number one, low fat. And when I say low fat, I basically mean approximately 15% of total calories as fat or maybe even a little bit less, somewhere between 10 to 15%. Number two, plant-based, meaning eat as much plant material as you possibly can. You don’t have to go 100%, but it does the further you can increase your plant intake, the better.  And then number three, whole food. And I want to put a focus on whole food too, is very important because as you know yourself, there’s a lot of plant-based packaged products that are now available on the market. There’s plant-based burgers, there’s soy ice cream, there’s crackers, there’s chips, there’s cookies, there’s enchiladas, there’s burritos, you name it.  And we don’t actually recommend eating more of those products even though they’re technically plant-based.  We’re talking about literally eating more fruits, more vegetables, more whole grains and more legumes.  So when you eat a low fat plant-based whole food diet, what ends up happening is that in a low fat environment, when the total quantity of that is quite low in your diet, that enables glucose metabolism to function very efficiently and then enables insulin to become very effective at signaling glucose to enter tissues.

And so to answer your question, you say, “Well, how would a diet for somebody with Type 1 be different than a diet for somebody with Type 2?” The answer is, it doesn’t necessarily have to be. As long as you’re eating a low fat, 10 to 15% of your total intake as fat, plant-based, whole food diet, then what we find is that people with Type 1 diabetes, Type 2 diabetes, people with prediabetes, we’re all doing the same thing under the surface.  And that same thing is we are maximizing insulin sensitivity.  And when you maximize insulin sensitivity, then effectively you allow insulin to do its job very effectively.  So small amounts of insulin can then usher or signal large amounts of glucose to get inside of tissues and that helps keep your blood glucose controlled very well.

Dr. Weitz:                         Isn’t the amount of calories really significant? Isn’t insulin essentially the hormone that allows us to store extra energy?

Dr. Khambatta:                 Yes.

Dr. Weitz:                         In other words, if we consume more calories, calories being a measure of energy, than we need, then we can store some of that energy as glycogen or as fat, and that insulin helps to stimulate that, right?

Dr. Khambatta:                 Yes. So insulin is actually a pretty misunderstood molecule, and what you’re saying is actually very true. So think of insulin as being basically the single most powerful anabolic hormone in your body. And when I say anabolic hormone, I mean, anabolic is a term given to like growth. It stimulates synthetic processes. So insulin is more powerful at stimulating synthetic processes than is testosterone, than is estrogen, than is growth hormone, than is IGF-1, you name it. So insulin’s role in your body, its primary function in your body, is to signal to tissues that glucose is available in your blood.

So when insulin is present, it’s a high energy signal that basically says, “Hey, liver, Hey muscle, would you like to take this glucose up? There’s glucose in the blood, go get it.” And then glucose, if the tissue say, “Yes, okay, no problem,” then glucose can get inside of those tissues. But insulin also has a number of other effects. Insulin can signal amino acid uptake from protein and insulin can signal fatty acid uptake from fatty acids. Insulin can signal cholesterol uptake.  Insulin can also promote DNA synthesis, RNA synthesis, glycogen synthesis. It can stimulate DNA repair. I mean, it’s literally endless what insulin is capable of doing.

But everything that insulin does is synthetic by nature or building by nature. And it also shuts down catabolic processes, meaning it shuts down the oxidation of fatty acids, it shuts down the oxidation of glucose. So it’s basically simultaneously turning up synthetic processes and minimizing or impairing catabolic processes, etc. So to answer your question, if you eat excess calories, does that stimulate an excess insulin production and then increased fatty acid synthesis or increased glycogen synthesis? The answer is absolutely, no questions asked.  So it’s very important for somebody living with any form of diabetes to be very cognizant of the amount of calories they’re consuming and to not over-consume calories.

And one of the things that’s actually very beneficial about a plant-based diet in particular that I’ve learned over the course of many years is that, when you eat a plant-based diet, it’s actually relatively challenging to overeat on calories, just naturally. And the reason for that is because when you’re eating a whole food plant-based diet, the whole food plant-based diet is incredibly fiber rich and is incredibly water rich. And if you add fiber and water together, you end up creating this thing called bulk, this substance called bulk. And there have been many experiments that have been performed over the course of time. And there’s a woman named, Barbara Rolls, who’s the pioneer of this branch of biology.  And what she has shown is that the single most satiating aspect of food, of all food is bulk. So when you consume foods that are fiber rich, that also are pre-packaged with a ton of water, then it’s actually, it fills you up quickly, and as a result of that, you don’t take very many bites before your digestive system signals up a neurological signal to your brain that says, “Hey, I’m getting full, slow down.” And as a result of doing that, you end up not actually taking on too many calories, it’s a natural break to prevent you from taking on excess calories.

Dr. Weitz:                         It doesn’t seem to match with my experience.  From what I’ve seen, people who tend to be overweight, tend to overeat carbohydrate foods. Rarely do people gorge on chicken or eggs–they’re eating bowls of pasta and chips and bagels and those are the typically the foods that lead people to be overweight.

Dr. Khambatta:                 The types of carbohydrate that you’re talking about are actually refined carbohydrate foods. You’re talking about chips and cookies and crackers and pastas and cereals and carbohydrates, sorry, carbohydrate-rich food that has gone through a manufacturing process in order to become a thing that you buy at the grocery store. And you are absolutely correct.  Refined carbohydrate foods can be very addictive because food manufacturers play games with those foods and when they put them into a package, they add natural flavorings to them such that they make them hyper palatable and it makes it much more likely that as soon as it hits your tongue, it sends a dopamine signal into your brain, sorry, your brain generates dopamine, which then gives you a happiness signal, which then makes you want to eat more.  So the nice thing about eating a whole food plant-based diet is that when you’re eating potatoes, potatoes don’t have that same hyper palatability, they’re tasty, and they’re filling and they’re filled with fiber and water. And as a result of that, they fill you up without making you feel like you’re addicted to wanting to eat more and more and more.



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:                          Now, don’t carbohydrates break down into sugar more quickly if they’re consumed alone versus if they’re consumed with protein and/or fats because the proteins and fats take longer to digest, you’ll get less of a blood sugar response from eating that meal, isn’t that the case?

Dr. Khambatta:                 I’m very glad you asked me this question because this is a highly misunderstood topic and the answer is true but also true but. If you eat a carbohydrate-rich food, like let’s take for example, sweet potatoes. You eat sweet potatoes and you also eat the sweet potatoes with a protein-rich food. Give me an example of a protein or fat-rich food.

Dr. Weitz:                          Salmon.

Dr. Khambatta:                 Perfect. You eat it with salmon. So you eat the two of those foods together, they basically go in your mouth, they travel down your esophagus, they get into your stomach and then they get into your small intestine. Now, once they get into your small intestine, the lipid soluble components are actually absorbed into your lymph system quickly. So effectively, what that means is through the walls of your small intestine, the lipid soluble components being fatty acids plus cholesterol, they get absorbed through the walls of your small intestines, they get put into your lymph and then they get put into your blood and they circulate as chylomicrons.  These chylomicrons basically are just delivering fatty acids, “Here, you want this fatty acid, go for it. Take it, take it, take it.” Once that lipid absorption starts, that lipid absorption process has a whole bunch of complex signaling mechanisms back up to your brain that then signal back down to your digestive system. So there’s a two way neurological pathway that happens as soon as lipid-rich food gets into your mouth.  So one of the things that happens is that your brain gets a signal from your digestive system that there’s lipid present in the food, and your brain then sends the same signal back to your stomach and it slows your gastric emptying rate.  So it actually slows down the rate at which your stomach passes food into your small intestine. So there’s a pyloric sphincter at the base of your stomach and that pyloric sphincter basically just like closes and its harder to open.  So as a result of that, you actually have like a small, a minor traffic jam of chyme or undigested food material inside of your stomach.  And that’s actually a good thing because what it does is like you said, it slows down the absorption.  So carbohydrates is slowed down as a result of that, and it basically evens down blood glucose response. That is a true statement.

Well, let’s do the opposite now, suppose you just ate the sweet potato by itself and there wasn’t any salmon to come along with it. Does that mean that the glucose from the sweet potato would be present in your blood and it would cause a blood glucose spike?  And the answer is, yes and no, depending on the situation.  So I’ll give you two different scenarios.  If you were to eat a sweet potato and you ate that sweet potato and it went into your small intestine and it got absorbed through the walls of your small intestine and the glucose is put into your blood.  If the glucose cannot get outside of your blood and into tissues, then it’s going to get trapped inside of your blood and you’re going to see a high blood glucose value and you’re going to see that quickly.   The reason that that would happen is if you already are living with insulin resistance, if you’ve eaten the diet that has made you insulin resistant such that your liver and muscles are not accepting of glucose. So if you’re already insulin resistant to begin with, you eat that sweet potato, if you check your blood glucose and it’s going to be high.  If you had eaten yourself into insulin sensitivity and you’ve reversed insulin resistance using your diet, then as soon as the glucose molecules from that sweet potato get inside of your blood, they have an exit route and they can get inside of your liver and they can get inside of your muscle, and that’s going to prevent your blood glucose from going high. The glucose will get inside of your blood and it’ll get out of your blood very quickly and that will keep your blood glucose from going too high.

Dr. Weitz:                          But let’s say I don’t have insulin resistance, but because I’ve been eating a lot of carbohydrates, I have plenty of carbohydrates, my muscle glycogen, my liver glycogen is filled with as much glucose stored as glycogen as it can handle, so I have plenty of glucose and now this is an excess glucose that can’t go anywhere.

Dr. Khambatta:                 There’s a couple of things to think about.

Dr. Weitz:                          In other words, can’t it be the case that it’s not just that we’re not sensitive enough to insulin to utilize it, but that there’s just an excess of glucose.

Dr. Khambatta:                 I mean, sure. You can always eat a diet that has an excess amount of carbohydrate and/or glucose energy, that is absolutely possible. And that is most likely going to happen when you’re overeating calories, period, end of story.  But if you’re not overeating calories and you just happen to be, let’s just say your calorie requirement for a daily basis is 2,500 calories, just for the sake of argument.  Let’s say you’re eating a diet that contains 2,500 calories, so you’re not overeating.  If the majority of your energy was coming from carbohydrate. And when I say the majority, I mean, like 70% or sometimes even more, does that mean that you run the risk of glucose overload, of carbohydrate overload and that’s going to cause your blood glucose to go up?  And the answer is, it depends.  If you are insulin sensitive, if you truly are insulin sensitive, then you can eat a dramatically high carbohydrate intake, 70 to 80% or even higher, and you will not get glucose overload.  Glucose will not get trapped inside of your blood, it’ll easily get imported into glucose, sorry, into your liver and muscle, and that will prevent against high blood glucose values.

Dr. Weitz:                          But can’t my liver and muscles have all the glucose they can use? Can’t they be filled up?

Dr. Khambatta:                 The answer is yes. Yes and no. Glucose is present in your blood at all times, and glucose gets inside of your liver and gets inside of your muscle.

Dr. Weitz:                          But there’s a limit to how much glucose you can store, right?

Dr. Khambatta:                 There’s a limit to how much glucose you can store, absolutely. There’s no question about that.

Dr. Weitz:                          And after that, it turns into fat, right?

Dr. Khambatta:                 Well, let’s think about it this way. Glucose can get inside of your liver and it gets inside of your muscle and it can get stored as glycogen. And on average, you have approximately about 1800 to 2000 calories of glycogen at any given time. So let’s say for now, you ate a dinner that was carbohydrate rich and you topped off your glycogen stores inside of your liver and muscle, and you’re full of glycogen and that’s it. Then you go to sleep, you wake up in the morning, your glycogen stores are now less than they were when you went to sleep. So you’re actually burning glycogen in the middle of the night while you’re sleeping.

Dr. Weitz:                          Okay. But let’s say I wake up and my glycogen stores are still full.

Dr. Khambatta:                 Okay. My point is that that doesn’t happen.

Dr. Weitz:                          It doesn’t happen?

Dr. Khambatta:                 No. So glycogen is a temporary storage tank that you can always fill. You can put more glucose into the glycogen repository, but it’s not like glycogen is a stagnant structure and that as soon as you put stuff in, it’s full and then it stays full for 24 hours. Glycogen is constantly being depleted at all times, 24 hours a day. Right now, you are going through your glycogen stores and so am I. We’re sitting in a chair, we’re not doing anything because glycogen is a fuel tank. It’s just that like if you were to go exercise, you would burn through your glycogen stores much quicker.  Right now your glycogen stores are decreasing, so that means the next time you go eat a glucose-rich meal or a carbohydrate-rich meal, you now have some space to put more glucose back into that glycogen storage tank. So I think what you’re trying to get at is-

Dr. Weitz:                          Let’s say I have this much space but I take this much glucose.

Dr. Khambatta:                 For sure. So you can have a small amount of space and you can take on an extra amount of glucose and yes, that can be a problem. But the question really becomes, is that clinically relevant? And the answer is, if you’re eating a refined carbohydrate diet, you will find two things that are happening. Number one, glucose gets into your blood much quicker than it would if you’re eating whole foods, no question. Number two, it can actually create insulin resistance inside of your liver in particular. So you’ve got hepatic insulin resistance, and as a result of developing hepatic insulin resistance, now you have a traffic jam of glucose that’s present in your blood so your glucose can go higher.  And then like you said, also some of those glucose when it gets inside of your liver, if it’s insulin resistant, boom, now, all of a sudden your liver says, “You know what, let me convert this into fatty acids.” And then it does this conversion of glucose into fatty acids, DNL. However, DNL is actually, it’s a last resort mechanism and it doesn’t really happen as efficiently as most people believe. So we can go into that in detail in a little bit.

Dr. Weitz:                          This is also why you often see people who overeat refined carbohydrates have fatty liver.

Dr. Khambatta:                 No questions asked. Absolutely, 100%. So you’re on the ball about the fact that refined carbohydrates are not healthful foods by any stretch of imagination. So you don’t recommend eating them, I don’t recommend eating them, nobody from the functional world, the plant-based world, we all agree, everyone’s like, “You know what, refined carbohydrates is not an ideal option.”

Dr. Weitz:                         How much does glycemic index matter?

Dr. Khambatta:                Ooh, good question. The glycemic index is important-

Dr. Weitz:                         By the way, for the listeners who are not aware, the glycemic index is a measure of the rate at which a carbohydrate food gets converted into sugar in your system.

Dr. Khambatta:                Exactly right. It’s the speed at which a carbohydrate-rich food gets converted into glucose.

Dr. Weitz:                         You get a big spike or is it a slow gradual release.

Dr. Khambatta:                So the glycemic index is important for people, let’s say you’re eating a plant-based diet and you tend to be eating high, you’re on the glycemic index.  Does that mean that that’s bad for you?  Does that mean that it’s going to-

Dr. Weitz:                         You’re having a lot of white potatoes?

Dr. Khambatta:                 The answer is if you are living with insulin resistance to begin with, if your liver has accumulated a sufficient amount of insulin resistance over the course of time, if your muscles have accumulated a significant amount of insulin resistance over time, then when you eat high glycemic index foods, those high glycemic index foods will get absorbed into your blood, the glucose is going to get into your blood quickly. And it’ll get trapped inside of your blood and it will absolutely cause the glucose spike. If, again, the name of the game is reversing insulin resistance. If you have or have become insulin sensitive through many lifestyle factors, including a low fat plant-based food diet, including frequent movement, including maybe some intermittent fasting.

If you do all those and you do those on a daily basis and you have become tremendously insulin sensitive, then when you eat a high glycemic index food, your blood glucose does not spike, absolutely does not spike. One other thing that I also want to say about the glycemic index and I think is slightly deceiving is that, the glycemic index is basically a measurement of how quickly an individual food metabolizes to glucose inside of your blood. So white potatoes as an example have a higher glycemic index and then does beet-

Dr. Weitz:                          Sweet potato.

Dr. Khambatta:                 Or a sweet potato. Now, when you put a meal together, generally speaking, you’re probably not eating just one food in isolation. Some people might do that, but if you’re putting together a meal, you might have a little bit of salmon, you might have some white potatoes, you might have some broccoli, you might have some wild rice in there. So the glycemic index of each one of these foods matters.  And then when you actually eat the meal together, you’re getting a combination of glycemic indexes, which is going to slow down the rate of absorption of all material that comes from that food.  So the glycemic index is important in isolated situations when you’re living with insulin resistance or when you’re only eating one food at a time.  And the glycemic index is also something that you can change literally, by changing the way you cook a food or by changing the temperature at which it’s served.  So it’s a helpful indicator, but it’s also slightly not that helpful.

Dr. Weitz:                          Right. For example, if you were to cook those white potatoes and then you were to eat them cold, you get an increase in the resistant starch.

Dr. Khambatta:                 That’s exactly right. So the glycemic index then gets lowered as a result of that, even though it’s still the same white potato.

Dr. Weitz:                          Is that something that you employ in some of your strategies?

Dr. Khambatta:                 What? To lower the glycemic index in particular of a certain foods?

Dr. Weitz:                          Yeah. Using say, resistant starches or, you know.

Dr. Khambatta:                 We don’t directly employ that because we don’t necessarily find that it’s necessary. So we are a huge fan of resistant starch because resistant starches, very helpful at blunting of glycemic response, no questions asked. But people can get resistant starch also from eating slightly unripe bananas, they can get it from. Tell me, what other foods are high in resistant starch that you know of?

Dr. Weitz:                          Jerusalem artichoke.

Dr. Khambatta:                 Yup. I think certain types of beans are also high in resistant starch if I’m not mistaken.

Dr. Weitz:                          I think so.

Dr. Khambatta:                 Yeah. So they’re helpful for sure.

Dr. Weitz:                          And then we got the fiber. That’s another big factor in this whole release of carbohydrates, right?

Dr. Khambatta:                 Exactly right.

Dr. Weitz:                          If you talk about whole food, whole grains, you’re talking about foods that are higher in fiber.

Dr. Khambatta:                 Absolutely. Fiber is such an important molecule for a bazillion reasons, but at the upper end of your digestive system, the presence of fiber slows down the rate at which glucose enters your blood. So it blunts your glycemic curve after you eat a meal. By the time fiber gets into your large intestine and then becomes a food for your microbiome, your microbiome can secrete cellulase, break it down into cellulose, and as a result of that… Sorry, break down the cellulose into glucose, and as a result of that, they can metabolize those glucose units and use them to create short chain fatty acids like butyrate, which is going to help not only your small intestine, but other tissues as well.  And then also fiber tends to block your stool, which is a good thing. So yes, fiber is a magical molecule in 1,000 different ways. And again, when you’re eating a plant-based diet, especially if it’s coming from whole foods, then you can dramatically increase your fiber intake without even trying.

Dr. Weitz:                            So insulin resistance seems to be a very complicated and confusing concept when you really get into it. I read several recent papers and it seems like even the top researchers are a little confused about exactly what results or how it results in changes in insulin resistance.

Dr. Khambatta:                 Yes. So over the course of time, insulin resistance has become a more complex topic than I think, even researchers had once believed it to be. And so as a collection of medical professionals, I think the answer is, we don’t know everything that contributes to insulin resistance, but we absolutely do know certain components of food and certain nutrients that are more influential in creating insulin resistance. And we know certain types of nutrients can also reverse insulin resistance at the same time. So if you really look at the types of… What we’re trying to understand here is very simple. Are there specific components of your food that block the action of insulin? That’s what it boils down to.

So are there certain nutrients that you can find in either animal-based foods or plant-based foods or both that when you eat them, the action of insulin is decreased? And if the answer is yes, then those foods are going to contribute to the development of insulin resistance because insulin resistance is at its core, a reduction in insulin signaling and an inability or reduced ability of insulin to do its job. So the question really becomes, well, what nutrients in food are impairing the insulin signaling pathway inside of your muscle and out of your liver. Now, there’s been investigations as far back as 1920s to try and answer this question, and they’re still ongoing today.

And what many of these investigations have found is that, lipids as a general class of molecules are definitely, they can impair insulin signal. So lipids refer to like fat rich molecules, but not necessarily all fat rich molecules are going to impair insulin signal. The most problematic are saturated fatty acids. Now, what ends up happening is that when you eat a food that’s rich in saturated fatty acids, the saturated fatty acids, they can get inside of your liver and they can get inside of your muscle and they can directly slow down the action of insulin inside of those exact cells. So there’s a whole collection of intracellular mechanisms that are initiated when cells uptake saturated fatty acids, and that leads to insulin receptors that are less functional than they were before the saturated fatty acids came in.

So if you have a meal, there’s just some, actually some phenomenal research here that’s been done in Type 1 diabetes in the last couple of years, that takes individuals and they feed them either a meal that’s high in saturated fatty acids or a meal that’s high in protein or a meal that’s high both. And what they find is that over the course of the next three to five hours, insulin signaling is impaired dramatically. And as a result of that, people with Type 1 diabetes who eat either a fat-rich meal or a protein-rich meal or both end up with an increasing need for insulin as much as 65% increased need for insulin over the course of the next five hours.  And that is an indicator again, that saturated fat as one type of molecule can impair the insulin signaling pathway and can alter the biology of your liver and muscle to make it such that those tissues have a difficult time responding to insulin.

Dr. Weitz:                            Do you recommend eating the same types of foods throughout the day or do you recommend for example, eating say, less starchy carbohydrates at night, or maybe more fats, having nuts or things like that?

Dr. Khambatta:                 We have found that over the course of time, that eating certain types of foods at certain times of the day can be very helpful at controlling your blood glucose. So I’ll start out with the morning. In the morning hours, we recommend eating a fruit-centric meal, for a number of reasons. Number one, fruit-centric meals at the beginning of the day, can actually… It’s easy to prepare for breakfast, they don’t require much preparation from like a logistical stand-

Dr. Weitz:                         What would a fruit-centric meal look like?

Dr. Khambatta:                 Suppose I were to put together a fruit bowl that contains two bananas and one mango. That’s it. Two bananas and one mango, or it could be two bananas, one mango with a tablespoon of flax seed drip on top of it. Very simple. If you were to eat that in the morning hours, what we find is that number one, it keeps your blood glucose nice and controlled. Again, assuming that your overall diet has made you insulin sensitive to begin with, and if you are insulin sensitive, then metabolizing that fruit rich meal is very simple. Number two, it keeps you full for two to three hour period until lunch rolls around.

And number three, we also recommend people to exercise in the morning hours, if they can make that happen because it’s a simple way to get your day started and it makes sure that you do it. And so having fruit bracketed with your exercise either before, during or after, is something that’s very helpful at giving you a ton of energy so that you can actually go perform exercise.

Dr. Weitz:                          Do you recommend eating the fruit and then exercise or vice versa?

Dr. Khambatta:                 It’s a personal choice at that point. It depends on the type of diabetes you’re living with, to be quite honest. For people living with Type 1 diabetes, we absolutely recommend eating something before you exercise, and then giving yourself like under-dosing on insulin just a little bit, to have a little-

Dr. Weitz:                          Yeah. You don’t want to take a chance of hypoglycemia.

Dr. Khambatta:                 Exactly, right. For people living with Type 2 diabetes, they have a choice. If they want to eat breakfast before they exercise, go for it, if they don’t want to eat before exercise, they can exercise in the fastest state, it’s no problem. Now, some people choose not to have a fruit-centric breakfast and they instead want to eat something that’s a little more savory. So in that situation we recommend having something that’s containing either beans or quinoa or some rice and some vegetables. So if they want to go for a more savory dish, totally fine as well, both of them are going to give you a good glycemic response.  Then when it comes to lunchtime, lunchtime is our favorite meal for increasing the intake of starchy carbohydrates.

Dr. Weitz:                          It’s interesting. I would say, the most calming carbohydrate-centric meal, you hear people eat is oatmeal with fruit.

Dr. Khambatta:                 Yeah. Oatmeal with fruit, that’s a great example. You can absolutely eat oatmeal with fruit. We’ve got no problems with that.

Dr. Weitz:                          Okay.

Dr. Khambatta:                 How was that? So when lunch rolls around, that’s your opportunity to eat slightly more starchy carbohydrates. So we recommend eating, you can either eat potatoes or squash, you can have some corn at that meal, you can have some more fruits at that meal if you want. You can even eat some whole grains at that meal as well. And we find that people who do that in the middle of the afternoon or for lunchtime are able to keep themselves full for a three to four to five hour period until dinner rolls around, which prevents them from overeating and trying to eat more refined carbohydrates. And their blood glucose response is actually because starchy carbohydrates slow down the glucose response and not necessarily get you a high blood glucose size, it takes time for that to unfold.

So if you put the starchy meal in the middle of the day, then over the course of three to four or five hours or so, you get a nice distribution of glucose coming into your blood, feeding your brain properly and keeping you energized. Then by the time dinner rolls around, we actually recommend eating things that are more what I would consider to be fluffy. When I say fluffy, I mean, more green leafy vegetables, more mushrooms, more non-starchy vegetables. And then having some legumes as well. At that time of the day, we don’t necessarily recommend starchy vegetables, because we find the people who’d start your vegetables in the evening hours sometimes can find their blood glucose to go high and/or stay high in the middle of the night, and then that can be problematic and it can drive your A1c value higher.  So it’s like fruit and/or whole grains in the morning, starch and whole grains in the middle of the day, and then more vegetables and fluffy material towards the end of the day. It’s a simple way to think about it.

Dr. Weitz:                          Are there nutritional supplements that can help patients with diabetes?

Dr. Khambatta:                 Nutritional supplements that can help patients with diabetes?

Dr. Weitz:                          Are you not a supplement guy?

Dr. Khambatta:                 No, not a huge supplement guy. Truth be told, we sell a tea, it’s considered a supplement, I guess you’d call it, and it’s made of this stuff called amla, which is Indian gooseberries, and Indian gooseberries have tremendous anti-diabetic properties. And so that’s something that we encourage people to incorporate into their diet as well. So ours is called Amla Green because it’s basically amla berries mixed with green tea. But it’s not required by any stretch of imagination, so something that’s very helpful.

Dr. Weitz:                          What about herbs like cinnamon or berberine?

Dr. Khambatta:                 Yeah, for sure. There’s plenty of anti-diabetic medicinal herbs. So there’s cinnamon, which is like controversial as to whether it actually helps blood glucose management, then there’s berberine, then there’s fenugreek, then there’s gymnema sylvestre, then there’s bitter melon. And we love all of these things. Sometimes they can be hard to find. And so again, if people want to incorporate them into their diet, green light, absolutely love them, but they’re not necessarily required, it’s not necessarily a core component of the natural managing diabetes approach.

Dr. Weitz:                          What is the best type, amount and frequency of exercise for patients with diabetes?

Dr. Khambatta:                 Okay. 30 minutes per day, six days a week. And when I, when I want you to exercise, I’m asking you to do a couple of things. Number one, I want you to get a good distribution of cardiovascular movement versus resistance movement. So when I say that, it’s hard to put specific numbers on it, but if I were to tell you to distribute your activity between approximately 50% cardiovascular movements and 50% resistance movements, that makes sure that your cardiovascular system is in check and that makes sure that you’re also putting a significant stress on your muscles to keep your bones strong over the course of time.

Dr. Weitz:                          Is it okay to do an hour of exercise a day?

Dr. Khambatta:                 For sure. 30 minutes minimum. Absolutely. Sorry, didn’t mean to confuse. 30 minutes minimum, no question. And then I also want to make sure when you’re exercising, that you’re exercising significantly hard enough and fast enough that you cannot talk to someone else, that you cannot answer a phone call and that you cannot sing your favorite song.

Dr. Weitz:                            Some level of intensity.

Dr. Khambatta:                 Exactly right. What types of recommendations do you have in general for exercise?

Dr. Weitz:                            I like to seem amount and frequency. I think it’s best for diabetics to exercise every day as you just mentioned. I think seven days a week if possible to help regulate your sugar and your insulin in accordance with your exercise. I think resistance training and cardiovascular exercise are equally important as well as incorporating some stretching and balance training even though those are not necessarily for blood sugar control, they’re still beneficial for health.

Dr. Khambatta:                 No doubt. 100%. And exercises is… I think in this world of nutrition, we’d like to talk about food a lot of the time. And I’m actually glad you brought up the exercise topic because exercises is something that is, it’s such a powerful insulin sensitizer. It’s hard to put into words, exercise has so many tremendous benefits, not only for your glucose metabolism but also for your brain, for your bones, for your connective tissue, for your muscles. It can improve the health of your thyroid gland, it can improve your mental health. It’s endless what exercise can do. And teaching people how to move their body on a daily basis is something that I think can become very addicting and something that we are huge proponents of.

Dr. Weitz:                         What about the effects of stress on blood glucose?

Dr. Khambatta:                 Yeah. Stress can be a doozy on your blood glucose. When you get stressed either like in a traumatic situation or whether there’s some baseline chronic stress, that can increase your cortisol levels as one type of hormone. And that cortisol can go signal to your liver and it can basically, it can significantly impaired glucose metabolism. And as a result of that, if you’re living in a high stress environment and that’s chronic, blood glucose can absolutely go up and it can make it such that your medication requirements can increase. And simply by, just like you’re saying, literally stretching your body, taking a mindful practice, relaxing, going outside and going for a walk, these are all simple things you can do that have a physiological effect on your blood glucose level.

Dr. Weitz:                         Yeah. If you’re having trouble with that morning fasting glucose number and it’s higher than it seems like it should be based on their diet and everything else, definitely look at stress

Dr. Khambatta:                 For sure. No questions asked.

Dr. Weitz:                          Do you ever address adrenal function or measure adrenal function as a way to look at salivary cortisol levels?

Dr. Khambatta:                 No, actually we don’t. Feel free to educate me on that. I’d love to learn a little bit more.

Dr. Weitz:                          You can measure your cortisol levels through the saliva and you can just spit into little tubes and you can measure them multiple times a day. What’s common is a four-part cortisol test. And now we have the cortisol awakening response where you’re actually measuring your cortisol as soon as you wake up and then 30 minutes later after you get out of bed, and then three other times during the day. And then you plot it out, you get a plot as to what happens with your cortisol curve.

Dr. Khambatta:                 That’s phenomenal. And where can you get these cortisol kits from?

Dr. Weitz:                          Oh, there’s a number of companies. Genova is a common popular company that people use. Great Plain labs, Dutch Lab testing, but-

Dr. Khambatta:                 Very cool. Yeah, I think that’s actually a very important component of monitoring your diabetes health because, even if you don’t have diabetes we live in the modern environment, which we live in, it’s stressful.

Dr. Weitz:                          Yeah, absolutely.

Dr. Khambatta:                 Whether you’re sitting in traffic, whether your internet connection went down, whether your phone is working, whether your boss is breathing down your neck, these are all mildly stressful enough. And when they count down one on top of the other, before you know it, you now are living in a state where you’re like, “I’m exercising, but how come my chronic disease went up? How come my hypertension is gone high? How come my cholesterol’s gone high?” And sometimes the answer is stress.

Dr. Weitz:                          Chronically high cortisol levels, or you can reach a point of burnout and then you have chronically low cortisol levels. A cortisol flat line is correlated with the worst prognosis for cancer and other chronic diseases. So, those are important. Yeah. And then of course we have sleep.

Dr. Khambatta:                 Sleep, sleep, sleep, sleep, sleep, sleep. Yes. There’s this interesting statistic that losing one night of sleep… I’m sure you’ve heard this. It says something like losing one night of sleep puts you at the functional equivalence of somebody who’s had, I think it’s like four beers. So if you don’t get sleep one day and then you go try to drive a car in the next morning to go to work, you’re effectively driving with the same level of mental capacity as if you had four beers. As far as diabetes is concerned, losing even one night of sleep, it has a dramatic effect on insulin resistance in the next morning. You can measure it.

You can actually see how your blood glucose levels are rising and how insulin has become less effective. So imagine if you’re in a position where you’ve become an insomniac or maybe you’re not sleeping enough or maybe the quality of your sleep has gone down. You’re doing everything else, you’re getting a plant-based diet, you’re exercising frequently, you’re doing a mindful practice, but yet you’re not sleeping properly. That unto itself can cause blood glucose to go up and it can frustrate you.

So addressing sleep is something that’s absolutely important and there’s many specific techniques that you can utilize to try and get yourself to go to sleep and stay asleep. And that’s something that’s there’s this research actually that’s actually linking sleep deprivation over the course of many years to cognitive decline, so increased risk for Alzheimer’s and dementia.

Dr. Weitz:                          Absolutely.

Dr. Khambatta:                 Right. And so sleep has profound effects not only for diabetes but also just for your brain health, for your heart health, for kidney health, you name it. All of these tissues require sleep in order to fully function at their optimal.

Dr. Weitz:                          Absolutely. Just as important as unregulated blood sugar is for brain health and Alzheimer’s risk.

Dr. Khambatta:                 Absolutely. And type three diabetes, no question.

Dr. Weitz:                          Right. Good. Okay. Any final thoughts for our viewers, listeners?

Dr. Khambatta:                 Yeah, I would say in this world of nutrition, it’s easy to get caught in between different ideologies. One nutrition expert can say go eat a ketogenic diet, the other nutrition, “Oh, I listened to that guy, he told me a plant-based diet. Oh, I listened to that guy who told me to eat a paleo diet.”

Dr. Weitz:                          No, I mean, we are so polarized in the nutrition world, it’s kind of like our politics. You’ve got carnivore diet and then you’ve got the complete opposite.

Dr. Khambatta:                 Exactly right.

Dr. Weitz:                          Yes. More information and people are more confused than ever.

Dr. Khambatta:                 Than ever before. Exactly right. So the thing that I like to focus on is, rather than like spending your time getting frustrated by the differences, try and find the commonalities because there are some serious commonalities that I think unite every single health professional or most health professionals, and those are the commonalities that are really important. So just like you said, number one, sleep. Please go to sleep, stay asleep and improve the quality of your sleep. Number two, move your body. Please move your body on a daily basis.  Number three, do whatever you can to minimize your stress levels because chronic stress is a real doozy and it can increase your level of chronic disease. Everybody’s going to agree on this. Number four, vegetables are good for you. Everybody would agree that eating vegetables is good for you. Eating vegetables isn’t sexy. People aren’t like, “Oh, I can’t wait to go home and eat lettuce and broccoli.” Right?

Dr. Weitz:                          Yeah. Not everybody’s going to agree quite as much on unlimited fruit, but definitely vegetables.

Dr. Khambatta:                 That’s exactly right. People will not agree on unlimited fruit, that’s what we have seen and the research that we’re privy to. And our results show that it’s not about unlimited fruit, but about fruit is not your enemy. Right? And so increasing the quantity of fruit in your diet is something that can be tremendously beneficial for many tissues in your body, and it can help you control and reverse insulin resistance. And then another thing that we would all agree upon-

Dr. Weitz:                          And you also don’t think it matters if you… because you mentioned having bananas, it doesn’t matter if you have berries versus bananas versus grapefruit.

Dr. Khambatta:                 Yeah, it does not matter what type of fruit you eat. And there’s this common misconception that like bananas as an example are a high-glycemic fruit. Bananas are actually not a high-glycemic fruit. Just as one example, bananas are actually medium glycemic. There’s only really one fruit that’s high glycemic, and that’s a watermelon. All the other fruits, pawpaw, mangoes, strawberries, peaches, pears, plums, nectarines, you name it, those are all medium to low-glycemic even though-

Dr. Weitz:                          Part of it depends on how ripe they are.

Dr. Khambatta:                 Even in the ripest state, a banana as an example, a ripe banana is not technically considered a high-glycemic food, which is crazy because if you look at its placement on the glycemic index, you’ll actually find that it’s in the medium category. But point being is that no, we don’t differentiate between the types of fruits because again, your ability to eat fruit is dependent on if you are eating an insulin sensitive diet, an insulin sensitizing diet. But to get back to what I was saying, one thing that we all agree upon as well is that packaged and processed refined foods, there’s not a single health professional that I know that’s saying go eat more refined foods.  You would agree, I would agree, every single health professional says, “Okay, fine, let’s eat more natural foods because that’s actually going to improve your overall health.” And then another thing that we would agree upon, this could be the final one is that there are many ways to eat to reduce your dependence on pharmaceutical medications. And the goal is not to eat a diet that enables you to take a pill to live, instead, we as a community of healthcare professionals, regardless of our ideology, are trying to help you use food as a substitute for pharmaceutical medication.

And if you approach food from that perspective, then I think you’re going to be pleasantly surprised by what you find and that whether you’re going high fat, low fat, high carb, low carb, high fiber, low fiber, like you can experiment around to find something that feels good for you and it gets you good results. But the goal is to try and minimize your dependence on pharmaceutical medications and live as free of pharmaceutical medications as possible, and do it in a way where you’re eating real food as much as possible, and that’s going to have lasting, lasting benefits for every single tissue in your body.

Dr. Weitz:                          Awesome. How can our viewers find out about you and your programs and your book?

Dr. Khambatta:                 Cool. Thank you for asking that question. We wrote this book, Mastering Diabetes, hopefully you can see it on the screen here. And so this book basically is 400 pages long with 800 scientific references inside of it. And we’ve scoured the literature to really understand what is insulin resistance, and how can you wrap your head around it. And it also has a go-to manual for exactly what you can do today to start improving your health and become the most insulin sensitive that you’ve ever been.  You can get it on Amazon, you can get it on Barnes and Noble, you can preorder it right now. It’s going to go live on February 18th.

Dr. Weitz:                          I’ll make sure to put a link in the show notes.

Dr. Khambatta:                 Thank you. Thank you for doing that. And then if you’re also looking for more information, we have a coaching program for people with all forms of diabetes, go to masteringdiabetes.org. You can learn about it there and you can see if this approach is something that resonates with you. And we have tremendous success with our clients and we’d love to be able to help you out if diabetes is something that you’re dealing with.

Dr. Weitz:                          Awesome. Thank you.

Dr. Khambatta:                 Thank you.



How to Heal From a Traumatic Brain Injury with Dr. Kabran Chapek: Rational Wellness Podcast 143

Dr. Kabran Chapek discusses How to Heal from a Traumatic Brain Injury 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

2:17  Dr. Chapek just published a book, Concussion Rescue: A Comprehensive Program to Heal Traumatic Brain Injury, which he wrote partially while riding public transportation to and from work each day, so he dedicates this book to bus route 532.

3:07  Traumatic Brain Injury involves a blow or jolt to the head and minor traumatic brain injury is actually major cause of mental health issues that is often overlooked as a cause. A concussion is a form of mild traumatic brain injury where there is a loss of consciousness.  The standard protocols for treating such injuries have not improved at all in 20 years.  There are many others who have a brain issue, such as dementia, memory problems, depression, anxiety, etc. and this can be due to a past brain injury.  Mild traumatic brain injury is one of the silent causes of mental health issues and nobody knows about it.

4:40  Even the NFL, which is supposedly focused on reducing head injuries with their current concussion protocol, but they are not doing anything about the many minor slaps and blows to the head that do not involve a concussion but that are cumulative and can result in Chronic Traumatic Encepalopathy (CTE).  CTE is the condition highlighted in the movie Concussion and it cannot be diagnosed with a CT scan. This has even led some football players to retire early to avoid permanent brain injury.

8:37  A whiplash car accident can result in a brain injury without ever hitting your head.  This is because the skull has many sharp, bony ridges and the brain is soft as butter.  During a whiplash accident, you can have a shearing of the neurons between the cerebrum and the brain stem as the heavier cerebrum slushes forwards and then backwards in relation to the brain stem. and you also get a secondary injury from the cascade of inflammatory mediators and oxidative damage that results from this. A chronic inflammatory state can result, leading to damage to the brain over months and even years.  Dr. Chapek sees patients coming to see him at Amen Clinic with complaints of depression or ADD and a SPECT Scan finds that they have structural damage to their brain and sometimes it takes repeated asking (up to 10 times) during the history taking till the patient recalls hitting his head or some other trauma to his head.  Once this is determined, the patient is placed on a program involving diet, lifestyle and nutritional supplements to heal the brain and the depression and other symptoms often resolve.  Even though it may be years later, you can still heal your brain.

15:38  Dr. Chapek, as part of his evaluation of patients, besides taking a careful history, will use an online cognitive tool, WebNeuroIt measures attention processing speed, memory, and then emotional states of depression, anxiety, emotion identification, and it’s simple and somewhat objective. It is validated and correlated with MRI.  At Amen Clinic they also do SPECT imaging, which is like 3D imaging of the brain. 

20:27  If a patient has had an acute head trauma, then they should go to the hospital and get a CT scan to rule out a brain bleed or major damage.  Most of the time this will be negative. MRI is best for looking at the brain vasculature and for looking for amyloid plaque in dementia.   After a head injury or concussion, it is good to do a CT or MRI first to rule out severe injury and then if it is negative, do a SPECT scan to pick up mild traumatic injury.  Here is a good paper explaining the utility of doing both types of scans: Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review.

22:00  Dr. Chapek also likes to do some lab testing including looking at nutrient status. He likes to assess serum zinc, RBC zinc, copper, vitamin D, B12, homocysteine, inflammatory markers, hs-CRP, and lipids (cholesterol).  If any of these nutrients are low, it is harder to heal from a brain injury.  He does not like total cholesterol levels to go below 150, since a healthy brain needs plenty of fat and cholesterol.  The medical profession is a bit overzealous now trying to drive LDL levels down as low as possible using statins and the new PCSK9 inhibitor drugs and this may be sacrificing the brain for the heart.  Having a good vitamin D level is important for healing from a brain injury.  Vitamin K is also important.  Dr. Chapek also measures the Omega 3 index and the Omega 3:6 ratio.  Hi likes his patients have at least 3 gms per day of EPA and DHA.  Dr. Amen completed a study demonstrating the benefits of omega 3s and other nutrients for NFL players after head injuries and had them take 3 gms of Omega 3 fatty acids (fish oil), Gingko, Vinpocetine, Acetyl-L-Carnitine. NAC, alpha-lipoic acid, Huperzine A, and phosphatidylserine in a formula and also a multiple vitaminReversing brain damage in former NFL players: implications for traumatic brain injury and substance abuse rehabilitation. They experienced a 70-80% improvement in cognitive symptoms. 

31:41  25 to 50% of people with brain injury have damage to the pituitary gland, your master hormone gland.  Thus various hormone levels can be affected in head trauma, such as thyroid, adrenals, growth hormone and testosterone in men, and estrogen and progesterone in women.  Dr. Chapek said that we can measure IGF-1 and IGFBP3 levels first thing in the morning in order to monitor growth hormone levels and he said that a good target level for IGF1 is over 200.  This is very controversial now in the anti-aging community where lower levels of IGF-1 are considered better for anti-aging purposes, by Dr. Valter Longo and others.  But Dr. Chapek feels that there should be a balance between lowering IGF-1 levels with fasting and raising IGF-1 levels for growth and regeneration purposes for the neurons in the brain.

36:59  In Dr. Chapek’s book, Concussion Rescue, he talks about a first aid kit for the brain.  There’s a study of active service members in the battlefield who were getting exposed to IEDs. Those who were immediately given N-acetylcysteine (NAC) 86% recovered within a week, whereas only 42% of those who did not get NAS (received a placebo) recovered within a week.  Amelioration of Acute Sequelae of Blast Induced Mild Traumatic Brain Injury by N-Acetyl Cysteine: A Double-Blind, Placebo Controlled Study  NAC is a precursor to glutathione.  In this study, the soldiers were given 4 gms immediately and then 2 gms twice per day for 4 days. Then 1.5 gms twice per day.  This is why NAC is one of the ingredients in Dr. Chapek’s Concussion Rescue first aid kit.  Vitamin D (5000 mg) and vitamin C (1000 mg)  are also part of the program.  We can also use liposomal glutathione under the tongue and even topical gluatione is worth a try, such as to the back of the neck. Curcumin (500 mg) from turmeric is also part of the first aid program.  Omega 3 fats. MCT oil powder or capsules to enhance the brain’s utilization of ketones for fuel.  Branch chain amino acid powder.  Infrared light to the back of the neck can also be helpful.  Exogenous ketones can also be helpful.

43:01  They used to use IV corticosteroids for spinal cord injuries until the CRASH trial published in 2005 study showed it increased mortality, so they stopped doing this.  Inflammation is part of the way the body heals and it is best to dampen but not shut down the inflammatory process.  It is not clear if icing the brain is helpful or not.

45:48  The ketogenic diet appears to be the best diet for healing the brain after trauma. It has been shown to help with other neurological conditions and Dr. Chapek’s clinical experience is that the keto diet helps the brain to heal.  He recommends no more than 30 gms of carbs per day, which requires eating a lot of fat with each meal by adding mayonnaise, avocados, and coconut oil, and by eating those fat bombs.   It can be difficult to digest this much fat, so taking some ox bile can help with digesting them. 

48:50  Sleep is also very important for brain healing, but patients after head trauma often have trouble sleeping and getting into deep sleep.  You don’t necessarily need to do eight hours of sleep straight. But you need at least a four hour chunk to get several cycles of REM sleep to get that restorative sleep. Growth hormone is released during deep sleep.

50:53  Dr. Chapek pointed out that high intensity interval training is another way to increase growth hormone production. 

52:14  Brain training can also be very helpful, including meditation, which strengthens the frontal and temporal lobes of the brain.  Neurofeedback can also be helpful. And there are online brain training games like BrainFitLife that was developed at Amen Clinics, where Dr. Capek works.  There is also Brain HQ, Cogmed, and there are many other brain training programs available. But it is important to train different areas of the brain, so if you’ve been doing cross word puzzles for 30 years and you are really good at them but you are not so good at math, then do some Sodoku.

54:50  The structural alignment of the cranial bones and the spine is also very important to insure the cerebro-spinal fluid flow through the spinal cord and brain, as well as insure blood flow and neurological flow to the brain and spinal cord.  This is where Chiropractic and Osteopathic medicine can play a role in brain healing.

56:00  Hyperbaric oxygen can also be very helpful to push oxygen in for healing of the brain and for the brain to be more metabolically active.



Dr. Kabran Chapek is a Naturopathic Doctor and a staff physician at Amen Clinics and the author of a new book, CONCUSSION RESCUE: A Comprehensive Program to Heal Traumatic Brain Injury. Dr. Chapek is available to see patients at Amen Clinics Northwest in Bellevue, Washington and the phone is 425-250-9564. Amen Clinics has a website where their custom nutritional supplements are sold, BrainMD.com.  Dr. Amen offers a number of online courses for both patients and practitioners at Amen University.

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


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 Podcast listeners. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please give us a ratings and review on Apple podcasts or wherever you get your podcasts. Also, 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.

Our topic for today is Healing From Concussions and Other traumatic Brain Injuries with Dr. Kabran Chapek. Our focus will be on using a functional medicine approach to help patients heal from either resent or a past traumatic brain injuries.  A traumatic brain injury, which may or may not include a concussion is caused by sudden damage to the brain, caused by a blow or jolt to the head. Common causes include car or motorcycle accidents, falls, sports injuries, and assaults among many other types of trauma. According to the CDC, there are over two million new head injuries in the US per year. Dr. Kabran Chapek is a naturopathic doctor and a staff physician at Amen Clinics and the author of a new book, Concussion Rescue-

Dr. Chapek:        Hey, there it is.

Dr. Weitz:            … A Comprehensive Program to Heal Traumatic Brain Injury. Dr. Chapek uses a functional and integrative approach to the treatment of patients with traumatic brain injuries, Alzheimer’s and dementia, PTSD and anxiety disorders.

Dr. Weitz:           Dr. Chapek, thank you so much for joining me today.

Dr. Chapek:        Oh, it’s my pleasure and an honor to be here.

Dr. Weitz:           Excellent. So I’d like to start the interview by asking, how did taking a bus to work help you write this book?

Dr. Chapek:        No one’s asked me that. That’s awesome. I’m a busy guy. And also, it’s there’s always something you can do. So riding bus route 532, from Edmonds to Bellevue just is like, I had the time and it’s focused time. It’s like I get the most done. And so I devote this book to bus route 532.

Dr. Weitz:           Soon, we’ll be able to do that when the driverless cars come in. We’ll get to sit back and read and work on our-

Dr. Chapek:        Can’t wait.

Dr. Weitz:           Good. Okay, how many more books will get published?

Dr. Chapek:        Right.

Dr. Weitz:           We’re just going to get people reading them.

Dr. Chapek:        Yeah.

Dr. Weitz:           So can you explain what traumatic brain injuries are? What’s the difference between a traumatic brain injury and a concussion? You refer to traumatic brain injuries as a silent epidemic in your book.

Dr. Chapek:        Yeah, so concussion is just a form of mild traumatic brain injury. So when we talk, we’re talking TBI, traumatic brain injury. A concussion is all the treatments are going to be pretty much the same, as far as this is concerned. Of course, severe brain injuries like life fighting to the hospital. That’s a severe brain injury and needs a different approach than what’s in this book. Really, the book is targeted for those who have had a concussion and haven’t gotten better. And those people who have some other brain issue whether it’s dementia, memory problems, depression, anxiety, and it may be due to a past brain injury, you just didn’t know about it. So those are the two.

And then, in my past 12 years working in mental health, one of the major causes of mental health issues is mild traumatic brain injury, and nobody knows about it. And that’s why I call it the silent epidemic because like you said, there’s millions of Americans going to the ER every single year, the number has actually gone up, even though death rates have gone down. The number of people suffer, and part of it, there’s more people, but the solutions haven’t gotten better. The standard protocols haven’t changed a bit in past 20 years. Well, not much.

Dr. Weitz:            Right. And we can look at the NFL as an example of this because everybody knows about concussions but really, the movie Concussion came out, it talked about a condition called traumatic … Was it chronic?

Dr. Chapek:        Chronic Traumatic Encephalopathy, CTE.

Dr. Weitz:            Encephalopathy, exactly. And so this is a condition that doesn’t require a concussion. It can occur from a series of lower level blows that lead to damage to the brain that actually was only discoverable after slicing the brain up and looking at it with a microscope and conventional CT scans didn’t show anything. And so therefore, even current NFL protocols, which are all focused on when the patient has a concussion are still not really addressing some of these milder forms of brain injury that become chronic and overtime get worse and worse.

Dr. Chapek:        Mm-hmm (affirmative). Yeah, absolutely. I think that’s the key that we had. Brain injuries are cumulative, whether it’s from a concussion or subconcussive hits to the head. There’s a study done on football or high school football players, these kids and just playing high school football showed cognitive changes and brain injury on fMRI, functional MRI. It’s like, oh my God.  So these bright, young future leaders and contributors to society are damaging their brains by playing high school football, most of them are not going to become professionals and even if they do, some are actually starting to not say, you know what, I can’t remember who it was but there’s a really talented I think he’s a 49er. He decided not to go on because he didn’t want to suffer brain injury.

Dr. Weitz:           Yeah, I remembered he like retired at age 25 or something like that.

Dr. Chapek:        Yeah. And so this is starting to happen. Pop Warner, parents are pulling their kids out. And I think it’s really smart because they’re recognizing damages cumulative these … we’re seeing these retired athletes, these heroes who are now some of them, like Dave Pear, publicly said, “I regret ever playing football,” even though he missed his career and because he had dementia at age 50.

Dr. Weitz:           Wow.

Dr. Chapek:        The rest of his life totally changed. He has anger problems, memory problems, depression. And that’s like a delayed reaction. So some people think that’s one of the common myths of brain injury that I had this car accident. I was fine and then a month later, why is did this person change?  Why are they angry now?  Couldn’t have been the car accident because it was so far away. But actually, it was a delayed like, swelling slowly increases. There’s chronic inflammation that is under the hood, like you can’t see it.  Inflammation under the skull. That’s part of why it’s the silent epidemic because, just President Trump not to take politically into this, politics into this, but then.

Dr. Weitz:           Talk about a brain injured person.

Dr. Chapek:        Oh, my God. Don’t get me started there, but that’s not what I meant. I meant like he made comments about minimizing. Did you hear about that? Minimizing the veterans who had–had there was a missile strike?

Dr. Weitz:           Yeah. He said they just had a headache or something.

Dr. Chapek:        Yeah, he said, “Just a headache.” These are valuable. These are service men that are putting their lives on the line. So what if it might have been, might not have been? Let’s at least take it seriously and assess them. And let’s not take a chance with their precious people, our brains like that’s who we are, God.

Dr. Weitz:           Absolutely.

Dr. Chapek:        So it’s frustrating.

Dr. Weitz:           We mentioned car accidents. Isn’t it the case that you can have a whiplash injury, never hit your head on a window and still have a brain injury?

Dr. Chapek:        Yes, exact great point. You can have injury from it’s just it’s acceleration deceleration. And it’s horrible, think Shaken Baby Syndrome. Severe brain injury lifetime of disability potentially or death from just shaking a baby. Their brain is so soft. This is why, it’s as soft as butter. The skull has many sharp bony ridges and it’s really hard. So there’s nowhere for the swelling to go.  And it’s like, you can look, you can Google this. But brains if you take a brain out fresh brain, put it on the table. It’s a pile of goo in a few hours.

Dr. Weitz:            Right.

Dr. Chapek:        So the brain is very vulnerable. We’re not designed to hit our heads, in the movie Concussion, rams, they have some spongy bone, woodpeckers, there’s some shock absorber. But humans, no. We’re like the last people to-

Dr. Weitz:            And part of what happens in a car accident is the car is moving at a certain rate of speed and then suddenly stops. And so what happens with the neck is that the body moves forwards the head stays back because it doesn’t weigh as much. Then the body stops and the head moves forward. So you get this deceleration acceleration, injury that occurs at the shearing of the muscles and deaths etc in the cervical spine. But within the skull, you also have this differential between the weight of the skull and the weight of the brain. And you can also get this shearing between the … with the cerebellum and the cerebrum and the brain stem, which is fixed. And so you can get this diffuse brain injury that can occur from a whiplash without any damage that had.

Dr. Chapek:        Great description. Yeah, perfect. Exactly. And so that’s the primary injury, damage to the neurons, breaking of the tissue, stretching of the axons. And then there are secondary injury, and that’s like the cascade of inflammatory mediators, the oxidative damage. It’s like rusting from the inside out, free radicals are produced, Calcium is released, exciting mitochondria, they burn out is what happens and become very … There’s like this glucose spike and then drop and so there’s this metabolic deficit. This hungry organ, this brain that uses 20 to 30% of calories in our diet all of a sudden has less glucose and it’s damaged. So that’s secondary injury, that chronic inflammatory state. It’s like a fire that hasn’t been put out. It continues to smolder for months and sometimes years is where we want to intervene.

Dr. Weitz:            Right. And sometimes patients come into your office, and they don’t even realize it. They’ve had a brain injury.

Dr. Chapek:        Right. That’s key to assess them thoroughly. Now, four out of 10 patients who come to Amen Clinics, because we do brain imaging, we can see that they’ve had an injury, but they’re coming for some other reason. They’re coming for ADD, depression.

I had a patient, we’ll call him Jeremy. And he was 21 when he came in, he’s this jazz drummer, this really bright kid. But on the inside, he was suicidally depressed every single day of his life from age 14 to 21. He’d seen some great therapists, tried every class and medication and was still suffering. He was referred by one of really good therapists in Portland. And he’s been smoking pot every day just to feel better, bad relationship. He was dating a girl who was borderline and a lot of difficulty. And so when we came in, came in from depression, treatment resistant depression. We scanned his brain and he had clear evidence of brain injury. Damage to his left temporal lobe, left frontal lobe.

And it was asymmetrical the type of imagery we do is called SPECT, S-P-E-C-T. It’s functional, looking at blood flow versus MRI, which is structural. We showed him the scan and nowhere on his history had he listed a brain injury. So I said, “Jeremy, have you ever …” This is what you have to do is think back so we minimize it. “Have you ever fallen out of a tree? Have you ever dove into a shallow pool? They were falling off a log? Fallen off your bike? Ever been in a fight?” “No, no, no.” “Have you ever played contact sports?’ And his mom was there said, “Oh, remember you started playing football and you’re about 13 years old. And you’re matched up against the coach’s son who was already six feet tall and you were the scrawny little kid whose got pounded every day and would have headaches.” At that time he was diagnosed with ADD, started having trouble in school and started having depression, which started the next year.  And so by putting him on a program to help him heal his brain, he started to feel better within the next several months, the depression lifted and he’s about to graduate from the Berklee School of Music in the next, this is two years later and broke up with the girl, not smoking pot, doing good.

Dr. Weitz:            That’s great. I saw where in your book you described asking patients sometimes up to 10 times during their initial consultation if they’ve had some sort of brain injury because patients so often don’t remember or don’t connect the dots.

Dr. Chapek:        Right? We think if I didn’t go to the ER, if I didn’t lose consciousness, it must not have been that bad.  It couldn’t be contributing, so that’s one why people don’t and also there’s amnesia.  And we just forget and so it’s like the same with when you’re looking for mold in a home while doing functional medicine you have to ask specifically, or if you are looking for toxicity, because we tend to not think about it. This is the same for brain injury, it’s really helpful to ask your patients or to think back in your life. Okay.  Have I actually and as I started working at Amen Clinics, when I first scan my brain didn’t look so good.  I was like oh crap. Don’t show Dr. Amen my scans.  I need to get this, I need to heal this.  And what must have happened oh, I did fall.  I never lost consciousness.  But I did fall off my skateboard a few times. I fell out of trees, the real active kid. And I can tell you my story about how hoping to heal and improve my brain and re-scanning later, but it is possible to actually improve even if it was many years later, you can actually heal from that fact.

Dr. Weitz:            Right. So we were talking about history, which is first part of a workup for somebody with a traumatic brain injury, or one of these other conditions like ADD.  Does your initial paperwork include some assessment of cognitive function?

Dr. Chapek:        Yeah. Great. In addition to the history, yes we do. We use WebNeuro. This is a cognitive tool. It’s web based and can be repeated. We like that so-

Dr. Weitz:           You logon to the internet and a patient goes out the questionnaire online?

Dr. Chapek:        Yeah, measures attention processing speed, memory, and then emotional states of depression, anxiety, emotion identification, and it’s simple and somewhat objective so that can be repeated three months later how are we doing?  Six months later, how are we doing? And it’s less invasive.

Dr. Weitz:           Why do you like that questionnaire better than so many others?

Dr. Chapek:        It’s validated. It’s also correlates with MRI.

Dr. Weitz:           Okay. 

Dr. Chapek:        They have it correlate to a database. There’s other good ones out there. But the other reason I like it, it’s not just cognitive function, it also does affect or take into account emotional states.

Dr. Weitz:           Okay.

Dr. Chapek:        Because sometimes it’s hard to tell if the memory problems or attention problems are actually due to depression or anxiety or how much is playing in there and that can get missed.

Dr. Weitz:           Right? Good. If you can send me a link to that, I’ll put it in the show notes.

Dr. Chapek:        Happy to.

Dr. Weitz:           And then so we have history, we have some this form of cognitive testing, and then do you typically do an MRI or a CT scan?

Dr. Chapek:        Sometimes. We like SPECT imaging for picking up more subtle changes. We actually have the SPECT scanners in all of our clinics.

Dr. Weitz:           Now what exactly is a SPECT scanner? Do you use an MRI or it’s a completely different machine?

Dr. Chapek:        It’s more like a CT scanner.

Dr. Weitz:           Okay.

Dr. Chapek:        How it works is a patient is injected with a little bit of radioactive isotope.  We use technetium.  It’s about equivalent radiation to a head CT scan. So think about the difference, and then so they’re injected, then you lie on the table and it’s not really a die but the technetium goes to the brain to the most active parts and gets fixed there and then emits a signal which is picked up by the camera as it spins around their head. So a CT camera radiation in taking a picture. This is like the brain emitting a signal and picked up by a camera that spins around the head. So there’s no tube that you go in like an MRI, it’s more just goes around the head and it’s … Most hospitals have some form of SPECT imaging for heart studies and for brain studies. It’s similar to PET differences being PET is much more radiation and is mostly looking for amyloid and different glucose metabolism in the brain.

Dr. Weitz:           Amyloid would be more beneficial for a patient with Alzheimer’s?

Dr. Chapek:        Right. And we say yes or no for Alzheimer’s, Parkinson’s, but the thing is with PET, it’s none. It’s less specific. It tells us less about what else is going on. Yes, it answers a question beta amyloid. So if it’s negative, that’s very reassuring and helpful.  But if it’s positive, that could be amyloid due to past brain injury, could be due to Alzheimer’s dementia. It’s based on history, where a SPECT imaging, you can see it’s like a 3D image of the brain. And you can tell, “Okay, the temporal lobes damaged or the frontal lobes damaged?  Is it the cerebellum? Is it the limbic system? Is there a lot of depression associated with limbic activity?” And in that way, for example-

Dr. Weitz:           Can you do it without the contrast material?

Dr. Chapek:        No, not the SPECT.

Dr. Weitz:           Okay.

Dr. Chapek:        So that’s that. If people can’t do radiation or get a needle, an injection, then it’s very small needle but still, some people have needle phobia.

Dr. Weitz:           I just worry about that stuff. I know there was a report that the MRI contrast with gadolinium that the gadolinium tends to build up in the brain.

Dr. Chapek:        Yes. So this is radiation. So in 150,000 scans, no reactions.

Dr. Weitz:           Oh, okay.

Dr. Chapek:        Because it’s just radiation and sailing. There’s no actual die, although it feels like that. So that’s hopefully helpful.

Dr. Weitz:           That’s good. Okay. So typically at a hospital, they’ll do a CT scan, what are they looking for there?

Dr. Chapek:        So if you’ve had a concussion, you do want to go to the hospital, go to the ER, make sure there’s no brain bleed, especially after concussion. If you have slurred speech, can’t stay awake, you keep passing out. There’s many warning signs, but and you’re looking for brain bleed. So Liam Neeson, his wife, Natasha Richardson. She was skiing on the bunny Hill at Mount Blanc, a couple of years ago and fell, hit her head waved off the emergency personnel said, “I’m fine, I’m fine.” But then the next day she had a massive brain bleed. So I think it was a subdural hematoma and died, so sad.  We need to we need to rule out the worst. CT scan is still important for that. But basically it’s just looking for a brain bleed or major damage. It’s mostly negative and it’s not sensitive at all picking up mild traumatic brain injury.  In fact, there’s a study done in the journal PLOS One in 2013, I believe that looked at 2400 patients who compared SPECT to MRI and CT and found that SPECT imaging picked up mild traumatic brain injury and 94% of the cases that was missed in MRI so it’s more sensitive, but MRI is useful and looking at vasculature and dementia. And the two together is actually a helpful combination.  Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review.

Dr. Weitz:           Cool. So what type of lab testing can be beneficial and working up patients with traumatic brain injury?

Dr. Chapek:        Love doing labs, love doing labs looking for nutrient deficiencies because oftentimes there are like zinc deficiency, vitamin D. And if you’re low, it’s been shown in many studies it’s harder to heal.

Dr. Weitz:           How do you test zinc deficiencies? Do you do one of these nutrient panels like the NutrEval or the micronutrient test, are you doing serum or red blood cell?

Dr. Chapek:        We just do serum because there’s more research on serum. But I like if I’m really concerned, I’ll do serum and RBC zinc, red blood cells zinc too, because serums outside the cell, RBC is inside the cells. It’s nice to know both. And if someone’s low in serum zinc, they’re low, for sure. But I do like the other panels as well. It’s just for screening, we’ll do serum zinc and we want the levels to be closer to 100 or above. And that copper ratio we want copper to be around 100 or below high copper associated with inflammation although you do need some copper as well. And we do, so we look at nutrient deficiencies.

Dr. Weitz:            You look at the zinc copper ratio?

Dr. Chapek:        Mm-hmm (affirmative). Yeah, zinc copper ratio.

Dr. Weitz:            And you want that to be what?

Dr. Chapek:        I think greater than 1.3. But I don’t calculate it. I want serum to zinc to be around 100 or above and copper around 100 or below, essentially.

Dr. Weitz:            Okay.

Dr. Chapek:        So I keep it simple. And then I look at vitamin D, zinc, copper, B12, homocysteine, inflammatory markers, hs-CRP, look at the cholesterol. Actually want cholesterol to not be too low. High cholesterol is associated with heart disease, low cholesterol associated with brain disease.

Dr. Weitz:            Right, so what level cholesterol is associated with brain disease?

Dr. Chapek:        Below 150.

Dr. Weitz:            This is for total?

Dr. Chapek:        Total. Thank you. Total cholesterol below 150 is associated with suicide and homicide.

Dr. Weitz:            And what about LDL? Is there a cut off for that as well?

Dr. Chapek:        I don’t know the answer for that one. I just don’t total. It’s a good question.

Dr. Weitz:            Okay.

Dr. Chapek:        But usually the LDL is what makes it go a little higher or too low.

Dr. Weitz:            What I’ve seen LDL below 60 I think is problematic with lowered brain function.

Dr. Chapek:        Perfect. Now, thank you for telling me that. It’s good to know. And it’s like their brains are 70% fat by dry weight.

Dr. Weitz:            Yes.

Dr. Chapek:        And we need that fat the brain loves it, it loves cholesterol. So it does well with cholesterol so a higher fat, lower carbohydrate diet.

Dr. Weitz:            And I do think in cardiovascular medicine today there’s, we’re a little bit too overzealous in trying to drive that LDL as low as possible. And now that we have some of these new PCSK inhibitors that can be added to statins, people are celebrating getting the LDL down to 40. And I think we’re overzealous on that not looking at some of the negative effects of that.

Dr. Chapek:        Yes, sacrificing the brain for the heart.

Dr. Weitz:            Exactly.

Dr. Chapek:        That’s so sad. Well, sometimes I can get cardiologists and primary care Doc’s to lower the stat and if we talk about the brain and the heart, and it’s like, tell them hey, we need I understand risk factors. And there’s more benefits beyond just cholesterol lowering effects of statins that are preventing heart attacks. But come on, do we really need it to be 100 total cholesterol, can we just go up to 150, 160 and see if memory improves at that point because a lot of people are having memory problems from too low cholesterol.

Dr. Weitz:           Yeah. And vitamin D is very important, right?

Dr. Chapek:        Oh my gosh, it’s a real key, like it’s going to be hard to recover from brain injury. If vitamin D is deficient. There’s certainly studies to show this. If your vitamin D levels are low prior to injury, then you’re going to have more post concussive symptoms. These are animal studies, but I think they do apply to humans because there’s a number of human studies. Giving vitamin D after injury helps in the recovery process, especially progesterone and vitamin D or other things with vitamin D, because it’s neuro anti-inflammatory.

Dr. Weitz:           Right, and essentially, vitamin D is a hormone, even though it’s not often referred to as that and the interesting thing is, a common recommendation is just go out in the sun and it makes a lot of sense that our body make vitamin D from the sun, but my clinical experience is even practicing in Southern California where we have plenty of sun and even patients who are going out in the sun, often present with very low vitamin D levels.

Dr. Chapek:        Fascinating. So even I was hoping maybe at least you’d have good vitamin D patients but not the case.

Dr. Weitz:           It’s amazing. You would think nobody would be deficient in vitamin D in Southern California and they are. And by the way, for most patients, it’s not easy to bring their levels up to what I consider most functional medicine doctors consider a therapeutic level which is say 50 to 70 or 60 to 80 nanograms per milliliter and we often find we have to go to five or 10,000 units per day to that level.

Dr. Chapek:        You have to work hard at it. I agree with you. Vitamin D is key. Vitamin D is key. Yeah, absolutely.

Dr. Weitz:           We’re big on vitamin K too.

Dr. Chapek:        Vitamin K is important. Yeah, absolutely.

Dr. Weitz:           That works synergistically with vitamin D, uses arterial calcification, important for bone and …

Dr. Chapek:        Are you checking Omega-3 index?

Dr. Weitz:           Absolutely. Yeah.

Dr. Chapek:        I think that’s a great one. And we’ve been doing that I think it’s also helpful because, you can actually measure your Omega-3 to 6 ratio course. And Omega-3 is important anti-inflammatory but also helping heal the the cell membrane and the neurons. So that’s another key aspect.

Dr. Weitz:           Yeah, they’ve been some really good studies on the higher dose Omega-3s for brain injuries right?

Dr. Chapek:        Absolutely, yeah.

Dr. Weitz:           What dosage level do you like for Omega-3s?

Dr. Chapek:        Minimum of three grams, EPA DHA calculated not just total Omega-3, but EPA DHA three grams a day. That’s what we used in the NFL study. So we had 30 NFL retired players, we had them take three grams of Omega-3, they took Ginkgo fossa title searing Acetyl-L-Carnitine. NAC alpha-lipoic acid, Huperzine A, and anthocyanins in a formula with a multiple vitamin. That’s it for supplements and three grams of Omega-3.

We had them exercise, lose weight if they needed to. They ate a … they were treated for sleep apnea, many of them had sleep apnea. And some were given hyperbaric oxygen. And then after six months, believe it was 70 to 80% improvement in cognitive symptoms. So again, that testing before and after attention, memory, processing speed, less anger, less depression, and their brains look better. We could prove this, we could actually document on their scans terrible, and then better.

Dr. Weitz:           Wow! Awesome. When was this study published?

Dr. Chapek:        This was in I believe, 2013, 2014.  I’ll find it and you can put a link if you want to on that.

Dr. Weitz:           Yeah, that would be great.  I’d love to do that.  So I know we’re going to get into supplements in a few minutes a little more, but since we’re on the Omega-3 thing, some practitioners recommend focusing on DHA when it comes to the brain.  And there’s a number of supplements on the market now, including a prescription one that’s mainly DHA. What about using more DHA than EPA or you find the balance better?

Dr. Chapek:        I find the balance better because and I think a little bit of it depends on where you’re at in the process. If it’s acute brain injury, a higher EPA, chronic brain injury you’re trying to rebuild, probably more DHA. My rule of thumb is at least three grams total EPA/DHA, higher EPA to DHA, but at least 1,000 of DHA because that’s what’s been shown in many of the studies for memory and dementia.

Dr. Weitz:           And is there a target you like to hit on either the Omega-3 index or the Omega-6 to 3 ratio?

Dr. Chapek:        We try to shoot for eight to 10. In the studies in around the world, there’s less schizophrenia, less depression if the Omega-3 index is higher like in Japan, so that’s where we’ve shoot. What do you shoot for?

Dr. Weitz:           I like eight to 10 as well. I like to try to get the six to three ratio below four ideally below two. Two is really difficult.

Dr. Chapek:        Yeah, I haven’t seen that very often.

Dr. Weitz:           Yeah, I keep mine below two but I have to take six to eight grams of EPA/DHA.

Dr. Chapek:        Wow, that’s awesome.

Dr. Weitz:           So hormones are often affected by brain injuries. Why is that?

Dr. Chapek:        25 to 50% of people with brain injury have damage to the pituitary gland, your master hormone gland, and it’s because it’s like an upside down ice cream cone. It’s very boldness at the bottom and is surrounded by the sella turcica this very bony ridge, so same idea with this-

Dr. Weitz:           This is inside the skull?

Dr. Chapek:        Deep inside the skull. And so with that acceleration deceleration injury, or a hit to the head and especially a concussive blast injury which many veterans come back with, it can penetrate and damage and hit that pituitary gland. So especially it happens in concussive blast injuries, but also in our football players.  They damage the pituitary fully or partially and if that pituitary is damaged, we will have deficiencies in thyroid hormone, there’s less TSH produced, growth hormone, testosterone, estrogen, progesterone in women, low adrenal function. The top two being growth hormone and testosterone in men, estrogen, progesterone in women. And these hulking guys, these football players 20 to 30% of them have deficiencies in testosterone and growth hormone.

Dr. Weitz:           Yeah.

Dr. Chapek:        I was trained by Dr. Mark Gordon endocrinologist out in your neck of the woods, who’s really done a lot of good work with the veterans and military folks on how to assess and treat for hormonal deficiencies and that really enhanced healing for people. It’s like we need the nutrients for decreasing inflammation. We need the hormones for growth and healing and really accelerating that. Putting the brain into a healing environment where it can heal.

Dr. Weitz:           How do you assess growth hormone levels?

Dr. Chapek:        IGF-1 and IGFBP3.

Dr. Weitz:           Okay.

Dr. Chapek:        First thing in the morning. That’s really the best and if there is a-

Dr. Weitz:           What the target for IGF-1.

Dr. Chapek:        Over 200.

Dr. Weitz:           Over 200?

Dr. Chapek:        Mm-hmm (affirmative).

Dr. Weitz:            Interesting.

Dr. Chapek:        Yeah. According to quoting, Dr. Gordon and there’s this debate between IGF one right.

Dr. Weitz:            I was going to bring that up right now for people don’t know. Actually in a functional medicine in anti-aging world, we have Dr. Valter Longo from USC. And he’s been finding that lower IGF-1 levels are associated with greater longevity.

Dr. Chapek:        Mm-hmm (affirmative). It’s like a tug of war. Of which it’s low. Oh, no, it’s high. So that growth hormone folks, anti-aging folks, high levels, and then it’s the low calorie diet folks, low levels. And I think it’s like there’s this in between, that’s-

Dr. Weitz:            Absolutely.

Dr. Chapek:        It’s like the same in the bones osteoblasts and osteoclast. You don’t want too much. And then the brain there’s APP gene. So this is the Dr. Dale Bredesen’s work and this is his whole theory cannot condensed into the APP gene.

Dr. Weitz:            Right, exactly. We have this just like in the bone where you have this balance of osteoblasts cells that are producing new bone and osteoclast cells which are clearing away, broken down junkie volume and you need this balance. Same thing in the brain, we used to think you had all the neurons you were ever going to have for the rest of her life. And it was just a question of holding on to as many as you can. But now we’ve learned that there’s a turnover of neurons throughout our life, and that we have this neuro, we have production of more neurons and a breakdown of neurons and we need that balance as well.

Dr. Chapek:        And what it’s not one thing that causes that to shift. It’s putting all of them together. It’s the diet, the supplements, the hormones, no toxins, healthy thinking, and that’s what will create that healthy balance between the two verses tons of growth hormone or really low calorie diet. We need to put them together to actually … It is not one thing that heals the brain, it’s a multitude.

Dr. Weitz:            Absolutely. And just to add something to this discussion, because right now you go to an anti-aging conference and it’s pretty much all you want to lower growth factors, you want to lower IGF-1.  The first study that actually showed a reversal of the aging time clock….  That’s one of the new things in anti-aging medicine, it’s they have these biological methylation time clocks.  So Dr. Horvath from UCLA and some other doctors have come up with these ways to measure longevity.  And the first study that was actually shown to show a reversal of one of these aging clocks was utilizing growth hormone and DHEA.

Dr. Chapek:        No kidding. There you go. You get on these tracks and-

Dr. Weitz:           There’s got to be a balance and I totally agree with you on that. In your book, Concussion Rescue, you talk about a first aid kit for the brain. When someone sustains a head injury. Can you talk about what that is?

Dr. Chapek:        Yeah. So I got to tell you about a little bit of science to help it make even more sense.

Dr. Weitz:           Lot’s of science, we love the science.

Dr. Chapek:        Theodore Roth is this undergraduate student at Stanford, and he got to implant an intracranial microscope into the mouse skull. And watch what happened when he hit these poor little mice and cause a concussion and never been seen footage. This is in the journal Nature 2013 where you actually saw oxidative damage, saw the microglia the resident macrophages are immune cells in the brain swell and try and eat up the the damaged tissue, fill in spaces and gaps, saw the tearing and ripping of the vessels and permeation of fluid where it shouldn’t be.  And he didn’t stop there, though. He then applied glutaraldehyde to the mouse skull, which is thinner than the human skull, and saw if applied immediately, there are 67% less cell death. If applied, within three hours, there was 50% less cell death. So there’s this window of time in which to act. And so why are we just standing on the sidelines watching and hoping players get better and in your car, you have a car accident? I hope I get better. Why aren’t we doing something immediately?

In the journal PLOS One 2013, there’s a double blind placebo controlled trial with 81 active service members, they were in the battlefield and an IED would go off, they’d run to the medic or be carried to the medic and then immediately give them either NAC or placebo and the group that got NAC, 86% of them recovered from concussive syndrome after a week, whereas 42% recovered after a week.  Amelioration of Acute Sequelae of Blast Induced Mild Traumatic Brain Injury by N-Acetyl Cysteine: A Double-Blind, Placebo Controlled Study

Dr. Weitz:           That’s amazing.

Dr. Chapek:        Yeah, just NAC. N-acetylcysteine precursor to glutathione.

Dr. Weitz:           That’s one of the most amazing traditional compounds.

Dr. Chapek:        Isn’t it? There’s so many studies on it and we need to be using it. So I can tell you the dose that they used in this study. Four grams immediately they met it gave them four grams, and then days one through four, they were given two grams twice a day. Days five through seven they were given 1.5 grams twice a day. Pretty pretty high doses, and then they stop.

Now, if it was my patient, or my family member or myself, I would take it ongoingly 1.5 twice daily after that, it wouldn’t hurt and I would take vitamin D, I would take vitamin C. This first aid kit outlines all of those and the specific doses.

Dr. Weitz:           Changing glutathione being being used topically on the back of the neck?

Dr. Chapek:        That would be cool. If it penetrates and gets in, the back the neck makes sense when carried in.

Dr. Weitz:           That’s what you put in your book, right?

Dr. Chapek:        Yes.

Dr. Weitz:           Yeah.

Dr. Chapek:        Uh-huh (affirmative). And also light therapy to the back of the neck.

Dr. Weitz:           Okay.

Dr. Chapek:        Possibly, too.

Dr. Weitz:           So is that you are talking about like infrared or what type of light?

Dr. Chapek:        Red light, infrared light. I think that’s helpful.

Dr. Weitz:           Though, is that helpful by itself or it works synergistically to help get the into the glutathione into the tissues?

Dr. Chapek:        It’s just by itself, it would work. So both glutathione and red light. Topical glutathione is worth a try. I would always do topical plus oral NAC because we still don’t know. There’s various companies out there. Is it good what you’re taking or not and it’s not widely available. But if you can get some good quality glutathione topically or IV even better, or nebulized, I would do it.

Dr. Weitz:           And of course now we have Liposomal glutathione and it’s available for oral usage.

Dr. Chapek:        My kids hit their head, Liposomal glutathione under the tongue immediately. I give them NAC, vitamin D. I just carry this around with me.

Dr. Weitz:           So go through your whole first aid kit. So it’s NAC, glutathione, go ahead. What are the rest of them?

Dr. Chapek:        Curcumin because turmeric from turmeric it’s from the spice and it’s not only anti-inflammatory, it does something special, it opens up the aquaporins so when there’s swelling, there’s nowhere for the brain to go against inside of the skull so that can cause damage and sometimes it delayed damage. So that is an important one. Vitamin C doesn’t get enough respect, antioxidant vitamin C.  Vitamin D of course. Omega-3 fatty acids. MCT oil, because like I said there’s a spike and then drop in glucose metabolism. And so MCT oil will help feed into the ketone production and then provide an alternative fuel source. There’s a study where they had a patient in a coma, either gave them IV glucose to just try and overcome that low glucose metabolism, or not.  And if they gave them IV glucose, their utilization of ketones for fuel from their brain was 16%.  And it went to zero.  So they were actually their brain was trying to use those ketone bodies.  So we want to enhance utilization of ketones for fuel into the brain by MCT oil and branched chain amino acids useful for recovery after I go for a run, but also for healing the brain from brain injury.

Dr. Weitz:           Cool. Awesome. I know for spinal cord injuries, they’re still protocol where they use IV prednisone.

Dr. Chapek:        Yes. Great point.

Dr. Weitz:           Haven’t they also experimented with like, ice water in the veins or something like that.

Dr. Chapek:        Yes. Right. Now this is a great, great point. And as I’ve been thinking about this, and trying to understand how best to approach healing the brain from brain injury, I looked at the literature, and there were many failures. There’s been over 35 large scale trials that have all failed to find the one thing that cures a brain from brain injury. They used to give corticosteroids which makes sense, lower inflammation throughout the body. This was done for 30 years, up until 2005 when they did the CRASH trial, and they said, “Okay, what is this actually helping?”  More people died who were given corticosteroids.  So they stopped. It was a standard of care until 2005.  We don’t want to just totally slam down inflammation.

Dr. Weitz:           Right.

Dr. Chapek:        The brain is more complicated and has many other mechanisms that are trying to heal.

Dr. Weitz:           The inflammatory process is part of the way the body heals. It’s sending those those immune cells to the area, and we want to dampen it down, but we don’t want to stomp it out.

Dr. Chapek:        Exactly. Well said. The ice water thing, I just was talking to someone the other day about this certainly saves lives. In surgery, they cool the brain in the body so that they can decrease the swelling and edema and that now there’s those caps like the ice caps, possibly to help with healing. And I don’t know.

Dr. Weitz:           Those for chemo to reduce hair loss.

Dr. Chapek:        Yeah, and when I was writing the book, I’m open to looking at new literature. But when I was looking into this, all of the studies showed it didn’t help.  It didn’t help.  And I don’t know if it’s maybe too powerful like the corticosteroids it actually decreases inflammation too fast and too much or maybe they’ve done more research and figured out maybe it is helpful.  Maybe I need to relook it.  I’m open to that.  But at least when I looked at it before, wasn’t helpful.

Dr. Weitz:           You mentioned MCT oil. What do you think about the exogenous ketones?

Dr. Chapek:        I think they can enhance the ketogenic diet really well, and I think they should be used. I mean, they should be part of the first aid kit. All right, put those in mind KETO//OS, and I have those little packets, and that’s what I’m going to do if I ever hit my head or my family members, because at least the brain will be getting some ketones.

Dr. Weitz:           Right.

Dr. Chapek:        Your listeners probably know.

Dr. Weitz:           Which brings up what’s the best diet for healing from a brain injury?

Dr. Chapek:        The ketogenic diet’s really popular right now.  It’s a fad, but it has been around a long time since the ’20s for seizure disorder. And it’s essentially restricting carbohydrates to less than 30 grams a day net carbs, which isn’t much.  A couple of apples.  And so if you restrict that the body will be forced to burn fats for fuel, which can get into the brain much easier. There’s fewer steps to use for fuel ketones, and that’s why it’s called a ketogenic diet. And so it’s been studied for various neurological problems, brain injury, there’s a few studies they’re working actually right now, on a study in humans with the ketogenic diet, which is going to be done this year. It’s certainly safe.  And it’s been studied for other neurological conditions.  And I think it really helps.

I had a patient who was an airline pilot, who had been knocked out in a bar in Australia and couldn’t fly back, cognitively impaired and he wasn’t able to work for two years. So I was working with him ongoingly.  He’s now able to go back to work just this year recently, which is awesome.  But for a while there, he just was overwhelmed and many people with brain injury can’t take something well, many of our patients, they get overwhelmed by the protocols. He’s like, okay, what’s the one thing I can take? I can’t do all this.  And I said, Let’s forget the supplements let’s do the ketogenic diet.  And so he got into that.  His energy improved, his sleep improved, he started feeling better and then he could add in the supplements again, and now like I said, he’s going back to work now.

Dr. Weitz:           That’s awesome.

Dr. Chapek:        I was a key for him.

Dr. Weitz:           Yeah, so your keto, your recommendations for the ketogenic diet is 30 grams of carbs?

Dr. Chapek:        Mm-hmm (affirmative). Yeah, 30 grams of carbs a day. I recommend doing it for three months and reassess. Is it working or not, give it a good try. It’s hard.  I did it myself after recommending it for people. It took me three weeks to figure out what the heck to eat and to get it figured out.

Dr. Weitz:            It’s actually hard to get the level of fats up.

Dr. Chapek:        Mm-hmm (affirmative). It really is, and a couple tricks that I tell people, you do have to push the fats, you have to add fat to each meal. It’s not just like eating a fatty steak or eating eggs that have fat you have to add fat to each meal, mayonnaise, avocados, coconut oil, eat those make those fat bombs. And I had a hard time digesting all that fat.  Honestly, I got a little nauseous.  So I took Ox Bile, bile salts, and that helped me be able to digest all that fat and then I did much better.

Dr. Weitz:            Right. Yeah, it’s true. Our bodies enzyme systems are adapted to the types of foods we need. If we change that diet and suddenly add a bunch of fat. It’s not ready for that.

Dr. Chapek:        Mm-hmm (affirmative). Exactly. That makes sense.

Dr. Weitz:            So you mentioned sleep, what part does sleep play and healing from brain injuries?

Dr. Chapek:        It’s hard to heal without good sleep. I would say it’s nearly impossible to fully recover without good sleep. Sleep is needed for the brain to restore and heal is when you’re in deep sleep, there’s like lip channels that open and help the brain detoxifying.  In deeper stages of sleep, you produce those hormones that you don’t otherwise like growth hormone, testosterone. And also the brain just needs to get into those deeper stages to really heal and restore. And it’s one of the curses of brain injury that nearly 30 to 70% of them, people with brain injury have sleep problems, and that’s what they need to heal, but they can’t sleep and they’re tired. Oh, it’s like the lights are flickering, and they’re like the neurons are on but not all the way on. They’re firing and not firing. So during the day, they’re tired at night, they can’t sleep. And a lot of people can relate. A lot of people have sleep problems.

One of the recommendations in the book and that we talked about will help anyone to see problems whether it’s turning off the screen an hour before bed. That’s a big one. Not having light in your room, turning the clock around, making sure it’s dark and quiet and cold just for sleep and sex, only the bedroom is just for sleep and sex only.  And that’s not that you have to sleep eight hours solid or doesn’t count. You can do chunks at time. But ideally like a four hour chunk, at least once a night is what I recommend, because you need a couple of REM cycles to really get that restorative sleep. And then you can go pee or wake up, whatever, but go back to sleep. So take away some of that stress and pressure and perfectionism around perfect sleep, doesn’t have to be that but just getting good rest waking up feeling somewhat rested.

Dr. Weitz:            Yeah, and one of the things you point out is growth hormone is often released during deep sleep. And that’s one of the reasons why sleep is so helpful.

Dr. Chapek:        Right? Absolutely. It’s very hard to produce growth hormone without deep sleep. And interval training is another way if people are trying to increase their growth hormone, you can increase it almost 500% if you do really intense interval training, and that will last for a couple of hours.

Dr. Weitz:            For people aren’t familiar, what it what exactly is interval training?

Dr. Chapek:        Oh yes. So interval training is in a nutshell going fast then going slow, sprinting and then moderate pace, sprinting and moderate pace. One easy protocol actually learned from Dr. Mercola was you do a 90 second warm up 30 second sprint 90 second moderate, 30 seconds and you repeat that eight times 20 minutes and you’re good and so a sprint can be doesn’t have to be running. It can be I often do the recumbent exercise bike on the gym or you can run you can go run a block, jog a couple blocks, run a block, jog just fast even walking fast walking slow walking.

Dr. Weitz:           I heard Peter Attia on his podcast and he was saying he likes to use 10 seconds blasts. He says you can really only go run all out for 10 seconds.

Dr. Chapek:        Yeah, that makes sense. It makes sense.

Dr. Weitz:           Anyway, I think as long as you get that intensity up, and-

Dr. Chapek:        Yeah, that’s the key.

Dr. Weitz:           … your weekly routine, you’re good.

Dr. Chapek:        Intensity is key.

Dr. Weitz:           So what about brain training as part of the recovery process?

Dr. Chapek:        Brain training is a real key and I like to think about it in stages. So first we reconnect the wire, so to speak. So we’ve got the chemistry right with the nutrients, the diet, the sleep, structural integrity, and then retraining the brain, so we can do meditation. There’s a pilot study showing that an eight week meditation training course improved fatigue quality of life in patients with brain injuries, which is huge because it’s so hard for anyone to meditate, myself included is the most hardest thing I’ve ever done, but it really strengthens the frontal lobe and the temporal lobes, which is focus and memory. And also-

Dr. Weitz:            It really should be the simplest thing. It’s really just calming your brain.

Dr. Chapek:        I know, but it’s frustrating. It’s so simple, but so hard and it’s so good for the brain. And then there’s more advanced brain training, like neurofeedback, where you have wires connected to your brain to understand the electrical activity, you work with a coach who can coach you on areas that specifically for you that are weak that need to be strengthened and doing a series of this. So you can do brain games on like an app. So we have BrainFitLife at Amen Clinics, which has brain training games, there’s brain HQ, there’s cogmed, which you work with a psychologist on, there’s many programs improve working memory. There’s lots of different brain training programs out there. Any of them are good, some are better than others. And part of it’s cross training, training areas that you’re weak in. So talk with dementia patients about this a lot like, you’ve been doing crossword puzzles for 30 years, you’re really good at them. But you’re not so good at math. So let’s do some Sudoku.

Dr. Weitz:            No, I find the same thing with patients coming in with musculoskeletal complaints. And the ones who are like super flexible, love to do yoga all day long. And they hate doing strength training, which is what they need.

Dr. Chapek:        That’s exactly what they need.

Dr. Weitz:            Usually you’ll find what you’re really good at is what you’re not going to get much benefit from. And you’re not as good at. If you’re super flexible, you’re probably going to do better at focusing on more strength training. And if you’re super tight and have very low flexibility, you’re probably going to get a lot more benefit out of yoga, which you probably don’t like to do because you’re not good at, but that’s an indication that that’s what you need.

Dr. Chapek:        I’d love to talk with you about the structural piece, because that’s an area that you’re more of an expert in than I am, but I recognize the importance of early on because, a in Naturopathic Medicine. Philosophy is looking at the whole person treating the cause and making sure that structural alignment is there.

Dr. Weitz:            Right.

Dr. Chapek:        I did miss this for a while. It’s like we have to have structural alignment so the cerebral spinal fluid and blood flow can be going to the brain and so in the book I talked about NUCCA or Upper Cervical Chiropractic, Atlas Orthogonal and Dr. Scott Rosa’s work, functional neurology, neuro cranial restructuring. It’s like little balloons up the nose. So just making sure that craniosacral, making sure that the that the bones are in alignment, the tissues in alignment, so that everything works properly because you can’t supplement that away, right.

Dr. Weitz:           Absolutely, yeah. No, it’s probably an under discussed part of the Functional Medicine approach.

Dr. Chapek:        Cool.

Dr. Weitz:           So let’s see. One more thing you also mentioned the benefits of hyperbaric oxygen.

Dr. Chapek:        So that’s something that I recommend people do either early or late. And I like to layer it in because of the cost and the time involved. But hyperbaric oxygen is essentially a chamber, like you’ve seen divers go into after they go deep and then they have the bends to push oxygen in and push nitrogen out. The same idea can be used for stroke and brain injury and other conditions, but essentially, you’re under pressure, oxygen is pushed to the deeper structures and it can help the brain to become more metabolically active and to heal.  And so you need to do a series of treatments 40 at least to start all in a row if possible. And 1.3 to 1.4 atmospheres, so that’s the pressure in the chamber, it doesn’t have to be a ton. That lower pressure over time that seems to really help heal. And if I had one magic bullet, the one thing that I could do to help people heal from brain injury, it would be hyperbaric oxygen.

Dr. Weitz:            A lot of the athletes are using it. I know LeBron James has one that he uses regularly.

Dr. Chapek:        Oh, he does.

Dr. Weitz:            Yeah. What do you think about ozone, which is another way to add deliver oxygen to tissues?

Dr. Chapek:        I’m not as familiar with ozone. I guess I’ve thought of it mostly for treating Lyme, infections and things like that. It’d be interesting to look at though, interesting.

Dr. Weitz:            I mean, if hyperbaric oxygen works, and essentially it’s adding the oxygen into the brain, I would think that ozone would be beneficial as well.

Dr. Chapek:        Yeah, There’s NAD, IV NAD would be-

Dr. Weitz:            Yes.

Dr. Chapek:        So a lot out there.

Dr. Weitz:            Nicotinamide riboside.

Dr. Chapek:        Right. Energize into the … especially if there’s almost all patients with brain injury have fatigue, some element of fatigue.

Dr. Weitz:            Mitochondrial support, yeah.

Dr. Chapek:        Exactly. Their mighty mitochondria, those energy producing cells, and they need some help. So there’s ketogenic diet, antioxidants, NAD, hyperbaric oxygen. The key really is not just one thing, but putting the pieces together.

Dr. Weitz:            Absolutely. And from a functional medicine approach, one more thing I would suggest is gut health because of the gut brain connection, which is crucial.

Dr. Chapek:        Absolutely agree with that. And a lot of people actually will start having food allergies after brain injury. And it’s like, why is that? The brain is injured the Vegas nerve can be … there’s less peristalsis, there can be constipation and leaky gut. And so it makes sense what you’re saying that we need to have healthy gut so that there’s less inflammation in the gut, there’s less inflammation in the brain. So …

Dr. Weitz:            Great.

Dr. Chapek:        Love it.

Dr. Weitz:            Thank you Dr, Chapek. It’s been a great discussion, any final thoughts you have for our listeners? And then if you could tell us how patients can get ahold of you and find out about seeing you or finding out about your programs and as well as your book.

Dr. Chapek:        Great. No, it’s been an honor to talk with you. Really, it’s been great. And the one thing I’ll leave you with is that it’s never too late to heal the brain from injury to at least try. Even if it’s been many years. It’s never too late. And three, go back to the drawing board. Your brain is your most precious asset. Let’s really optimize it. So whether it’s think back, have you had any head injuries? Have you had any concussions? Could that be contributing to your issues today, or your patient’s issues? Or have you not recovered from an injury? Those are the two things to think about, and that it’s not too late for you. Even if you’re in your ’60s, ’70s, ’80s we can always improve our brain. And that’s so important because that’s who we are. Our brains are who we are and that’s so precious.

So that’s why I wrote this book and you can find it on Amazon. Wherever books are sold. There’s an Audible version and we’re coming out with the program next week. We filmed me doing a set of the video series on the book Concussion Rescue, which people can watch.

Dr. Weitz:            Cool.

Dr. Chapek:        And that’s it. BrainMD, which is where we sell supplements and stuff and also Dr. Amen’s books. And there’s Amen University is what it’s called.

Dr. Weitz:            Okay.

Dr. Chapek:        Where I’m at Amen Clinics Northwest. So you can just Google that. Amen Clinics, Northwest, we’re in Seattle. And we see patients from all over the country. People come in from Idaho, Alaska, California, wherever, and I do collaborate with other Amen Clinic doctors. So someone does an evaluation in New York with Dr. Sood or Dr. Grin, I will sometimes do a consult with their patients if they need me to, so happy to help.

Dr. Weitz:            Awesome. Thank you Dr. Chapek.

Dr. Chapek:        My pleasure. Great to meet with you.



Challenging the Low FODMAP Diet with Angela Pifer: Rational Wellness Podcast 142

Angela Pifer Challenges the Efficacy and the Research Behind the Low FODMAP Diet with Dr. Ben Weitz.

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Podcast Highlights

This discussion with Angela Pifer is based on the following two articles that she wrote and which were published in September and October 2019 in Today’s Practitioner that critically assess the benefits and the research that supports the low FODMAP diet for patients with SIBO: 

Part 1: The Pervasive Misunderstanding of What The FODMAP Diet Does And Does Not Do

PART 2: The Pervasive Misuderstanding of What the FODMAP Diet Does and Doesn’t Do


4:00  Today Angela Pifer is going to set the SIBO community straight about the low FODMAP diet and what the studies actually show about it.  There are a number of problems with this diet, including that patients get stuck on it for too long a period of time. 

IBS is a chronic gastrointestinal condition that is marked by abdominal pain or discomfort, diarrhea (IBS-D), constipation (IBS-C), or alternating of the two (Mixed IBS). 

SIBO refers to an overgrowth of the bacteria in the small intestine and it is usually secondary to another condition, such as hypothyroidism reducing motility leading to bacterial overgrowth.

The low FODMAP diet is a diet low in fructo-oligosaccharides, disaccharides, monosaccharides, and polyols.  It reduces the fiber and starches in food that tend to cause an increase of water into the small intestine and bloating and distension. The low FODMAP diet was created for people with IBS and the SIBO world adopted it and it does tend to calm symptoms in patients with SIBO.  But it’s supposed to be an elimination diet and not a long term diet.  It’s best to start challenging the patient with the different FODMAP groups after the first month or so to see which foods they can tolerate and which foods they react to.   

10:26  The low FODMAP diet is supposed to help starve out the bacteria from the small intestine by not providing the food that these bacteria need to eat.  But the studies don’t actually show this and when you look at before and after lactulose breath tests with these patients, the test results do not change.  We do not see patients with SIBO have their SIBO go away after being on a low FODMAP diet for months.  We have to learn from that.  Studies that look at patients who are positive for methane SIBO based on a lactulose breath test and symptoms and we put them on a high FODMAP diet, say 50 gm of FODMAP, and the methane does not go up and when we place patients on a low FODMAP diet, say 7-9 gm of FODMAP per day, and methane levels conversely do not go down.   In fact, Angela asserts that if a patient has methane and constipation, then such a low fiber diet, like the low FODMAP diet, should be contraindicated because it will make them more constipated.  She pointed out that it is a bad idea to just put everyone with SIBO or IBS on a low FODMAP diet.  It is more restrictive than many patients need.  While it is likely that all patients with IBS or SIBO will need to modify their diet in some way, this low FODMAP diet is too extreme for what most patients need.  But if you have a patient who has severe symptoms and can’t tell what they are reacting to, it can be a good idea to put the patient on low FODMAP for 3-4 weeks to settle things down and then challenge each of those food groups separately and see what you can add back.

18:00  There are three studies that showed a reduction in breath hydrogen with a low FODMAP diet, but these studies were poorly done. They didn’t perform the lactulose breath test the proper way.  There is supposed to be a proper low fiber diet the day before followed by a 12 hour/overnight fast.  Then you are supposed to drink the lactulose solution with the SIBO breath test and then breath into tubes every 15-30 minutes for 3 hours, during which time you are required to be fasting. Any increase in hydrogen or methane gas after 100-120 minutes is considered to have occurred in the colon, where you are supposed to have fermentation of fiber leading to gas production and this is not considered indicative of SIBO, which is a condition that occurs in the small intestine. These studies did not have the subjects do the proper test prep and in some cases the subjects involved performed the lactulose breath test all day long and they were eating while they were doing the test, which makes the results completely invalid.

20:18  There are three studies that showed a change in hydrogen gas on the breath test, but there were a lot of problems with these studies.  When you really look at these studies, you see that they didn’t use the lactulose breath test in the way that it was validated for. The first study is called, “A low FODMAP diet is associated with changes in the microbiota and reduction in breath hydrogen but not colonic volume in healthy subjects.” The group that were described as eating the high FODMAP diet were not really eating high FODMAPs, but were on a low FODMAP diet with the addition of taking an oligofructose supplement. The low FODMAP group were supplemented with maltodextrin, which is a starch made from corn, rice, potatoes, or wheat, and which should not be included in a low FODMAP diet. Essentially, rather than testing low FODMAP vs high FODMAP, this study compared low FODMAP plus maltodextrin vs low FODMAP plus fructans in healthy subjects.  The participants in the study were normal and were not suffering with SIBO or IBS, which are the group of patients we are interested in. The subjects did not fast for 12 hours or follow the proper food prep the day prior to the breath test that are needed for the SIBO breath test to be considered valid. 

23:05  A second study that found a change in breath hydrogen is Randomised Clinical Trial: Gut microbiome biomarkers are associated with clinical response to a low-FODMAP diet in children with the irritable bowel syndrome. This study only had the children follow the low FODMAP or the high FODMAP for 2 days. And the breath test was conducted over 8 hours rather than the 3 hours that is the standard way to conduct the test.  To insure that the hydrogen gas is being produced in the small intestine, there must be a positive result in an increase in breath hydrogen or methane gas within the first 100-120 minutes.  And they were eating while conducting the breath test, which also violates the recommended test procedure.  The results from this study cannot be considered valid.

24:39  The third study that found an increase in breath hydrogen gas with the low FODMAP diet is Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome.  In this study, the subjects only followed the low or high FODMAP diet for two days, which is too short a period of time to really determine if there could be a change in the level of bacteria in the small intestine.  But the food they fed them was incredibly unhealthy. The low FODMAP group were fed rice flakes, lactose free milk, tea, rice, bread, margarine, orange juice, an orange, rice, pasta and lemonade with sugar. They were also given snacks of hot chocolate with lactose free milk, and chocolate muffins.  This is not representative of a healthy version of the low FODMAP diet.  But they didn’t do the proper food prep required for the breath test to be considered valid and they collected data for the lactulose breath test over 14 hours while they ate instead of over 3 hours while fasting. The results cannot be considered valid. The high FODMAP group was also given high fructose corn syrup soda and gum with sorbitol, a sugar alcohol.  And there is a study that shows that if you combine sorbitol gum and high fructose corn syrup, it exacerbates symptoms by swiftly delivering malabsorbed carbohydrates to the colon.

28:36  There is one other study that is often quoted that saw a change in breath hydrogen, which was by Mcintosh et al. called FODMAPs alter symptoms and the metabolome of patients with IBS: A randomised controlled trial, published in Gut in 2017.  They claimed to have seen a change in breath hydrogen levels when comparing baseline data to post intervention data, but while there was a very small difference but it did not reach statistical significance.  So at this point we do not have a single valid study that demonstrates that a low FODMAP diet lowers hydrogen or methane levels in patients with SIBO using a lactulose breath test.

30:31  If you have been on a low FODMAP diet for a long time and it has helped to manage your symptoms, that’s great. But even if you still have SIBO, then it doesn’t make sense to continue to have such a restrictive diet that negatively affects your microbiome and provides a lack of nutrients.  You have to understand that if you eat something and you have a symptom flare, it doesn’t mean that your SIBO is growing or that it is getting worse.  You should pick your five favorite foods, other than garlic and onions, and see if you can try a tablespoon of something and slowly build up your ability to tolerate these foods again. Your enzymes that enable you to digest these foods have become down-regulated because you haven’t eaten them in while.  This is where adding some digestive enzymes, like Intolerase by Vita Aid, can help to break down those starches and indigestible fibers.  You should go slow and trickle the foods back in.  You have to get past the mindset that because you have SIBO you have to be on such a restrictive diet, with all the anxiety and food disorder type of behavior that accompanies it.

37:07  If the low FODMAP diet has not been shown to be effective for curing SIBO, are there any other diets that have been proven to be effective for SIBO, such as the Specific Carbohydrate Diet (SCD) or the GAPS diet?  Angela said that GAPS has a lot of fermented foods, so it is not good for SIBO and while SCD has some research behind it’s efficacy, it is more for Ulcerative Colitis that it is for SIBO.  Angela prefers to find the food groups that the patient is reacting to, like fructans (onions, garlic, leeks), or fuctose, or lactose, or sucrose, and see which is the most problematic and pull these out for 3-4 weeks and then test them back in. Restricting our diet down to 7 to 9 grams of FODMAPs per day is not going to starve our SIBO out.

41:25   Angela suggests that doing a more conventional elimination style for 3-4 weeks for SIBO patients rather using a highly restrictive low FODMAP diet and then testing back those foods will likely to be more effective.




Angela Pifer is one of nation’s foremost Functional Medicine nutritionists in Seattle, Washington with a focus on Gastrointestinal Disorders like SIBO and IBS. Angela is known as the SIBO Guru. Her website is SIBOGuru.com and she has launched a gut prescription recipe site, Simply SIBO and a FODMAP-free line of bone broths, Gut Rx Gurus Bone Broth.

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


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. Thank you so much for joining me again today. For those of you enjoying listening to our Rational Wellness podcast, please give us a ratings and review on Apple Podcasts or wherever you listen to the podcast. Also, if you’d like to watch 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 the low-FODMAP diet with SIBO Guru, Angela Pifer. The low-FODMAP diet is often touted as a beneficial diet for patients with small intestinal bacterial overgrowth, commonly found in 60% to 80% of patients suffering with irritable bowel syndrome, one of the most common gastrointestinal conditions. Irritable Bowel Syndrome, or IBS, is marked by stomach pain, gas and bloating, constipation, diarrhea, alternating of the two, as well as a host of other symptoms. Small intestinal bacterial overgrowth is a condition marked by having higher concentrations of bacteria in the small intestine than normal, and treatments often include a low-FODMAP diet or a similar diet such as a specific carbohydrate diet, a GAPs diet, or Nirala Jacobi’s SIBO biphasic diet, in order to starve the bacteria. Since these bacteria eat fiber as their food. Some studies, Angela is shaking her head now, some studies, and some practitioners are claiming at a low-FODMAP diet, may be all the treatment that’s needed for six patients. Of course, Angela is going to set them right today. Or they may combine the low-FODMAP diet with antimicrobials, motility agents, probiotics, and other treatment protocols.

Angela:                 Yes. Which I wholeheartedly agree with. Yes. And not to starve them out with a FODMAP diet. 

Dr. Weitz:            Our guest today, Angela Pifer has recently published two articles warning that we may be mistaken about what the research shows about the low-FODMAP diet, but the benefits of the low-FODMAP diet are, and what are the dangers of the low-FODMAP diet, especially followed for a long period of time. Angela Pifer is one of the nation’s foremost functional medicine nutritionist with a practice in the state of Washington and her practice is focused on functional gastrointestinal disorders, especially SIBO and IBS. She is known as the SIBO guru and she’s launched a gut prescription recipe site, GutRX Guru and a FODMAP free line of Bone Broths, GutRX Gurus Bone Broths, of course, if we don’t need the low-FODMAP diet, I guess we don’t need-

Angela:                I know. We’ll talk about that in a second.

Dr. Weitz:            But that’s great.

Angela:                The take home message is I know FODMAP, I think I’m going to switch with that.

Dr. Weitz:            Angela’s recently published two articles, part one and part two. The pervasive misunderstanding of what the FODMAP diet does and does not do. And these are the basis for the discussion we will have today.

Angela:                Yes, please.

Dr. Weitz:            Angela thank you so much for joining me.

Angela:                Of course. Of course. Thank you for having me. I appreciate it.

Dr. Weitz:            So today we’re going to set the SIBO community straight.

Angela:                We’re going to set anybody that thinks about the FODMAP diet straight, and the use of FODMAP and what the studies actually show because, oh my gosh, the amount of conjecture. And I think wishful thinking that is happening online and even how some people are implementing this in their clinic leaves a bit to be desired. I think people are getting stuck on this long term. It’s causing a lot of anxiety. Just taking a group of people who already have IBS or SIBO that are dealing with chronic presentation symptoms feeling socially isolated already because they can’t just go eat whatever they want and they have to deal with that.

Now they’re on an even more restrictive plan, which causes more anxiety and stress. And we’ve got to figure out as clinicians why we’re so quick to jump to this study, when, excuse me, sorry. Why we’re so close to quick to jump to this diet, when we start to really dissect the studies. I think it’ll make a little bit more sense. But we’ve got to be mindful that we’re not just putting people on this as we’re thinking clinically, Oh, I’m going to starve out the organisms or I’m going to drop histamines or I’m going to favorably alter the microbiome, because none of those have been proven. In fact, they’ve all been disproven, as we start to look at the studies. So-

Dr. Weitz:            So, just to make sure everybody’s on the same page, including people listening who are not that familiar with IBS or SIBO. How about if we define some terms, can you basically define what is IBS? What is SIBO? And what is the low-FODMAP diet?

Angela:                Yeah, absolutely. So IBS, there’s multiple presentations within IBS, but it, depending on, there’s ROME criteria for actually diagnosing it, but it’s a chronic nature of symptoms in irritableness, diarrhea or constipation or a mixed presentation. And there’s very specific criteria that somebody would look at for diagnosing that. Oftentimes it’s a diagnosis of exclusion. Everything else has been cleared off. It’s not that, here’s what you have. Sometimes it’s been perhaps used as a catchall. You’ve got chronic symptoms, but we haven’t figured out what it is, you have IBS.

SIBO is a small intestinal, I like to say, bowel overgrowth because it’s not all bacteria that can be overgrown, but basically SIBO is an overgrowth of a microbiota within the small intestine.  And for people moving through life and trying to consume a normal diet, some of what they are eating might ramp symptoms up and cause bloating and gas. And sometimes it can be debilitating if it is ramping up another condition that they have, somebody has a hyperthyroid condition, which might slow motility, which might affect the microbiota and build up in the small intestine. All of that is kind of making things worse than that feedback. So it’s a very complex condition, it’s secondary, it’s never a primary, so it’s always there because of something else that’s happening.

And when we look at something like the FODMAP diet, which the FODMAP diet is fructo-oligosaccharides, disaccharides, monosaccharides, and polyols, they are the fibers and starches within the foods that we eat that are known to cause an osmotic shift if eaten in larger amounts within the small intestine so they can cause water movement and fluid moving into the intestine, rapidly moving things causes some bloating and distension and not feeling so great.  And then with SIBO, as it moves through, not only can you get the osmotic shift.  But if you have an overgrowth of organisms in the small intestine, you can have those organisms be able to break down some of those indigestible fibers and consume them.  And they basically off gas and that fermentation produces gases. And now we’ve got a bloat going on as well.

So when we look at the FODMAP diet, the FODMAP diet was really created to help people with IBS.  And the SIBO world, shall we say, readily adopted it because pretty much everybody with, most people with SIBO, also have IBS symptom presentation. And so it can very quickly for, I’d say the majority of people with SIBO, calm symptoms down. The problem is, is that as we look at the FODMAP diet, the way that it is supposed to be used is as an elimination diet.  It’s not meant as a, oh, you have IBS or SIBO, here’s your diet, thank you for coming. They should not be stuck on this long term. There should be a three or four week elimination diet where you ramp down the loads of all those FODMAPs and then on the end of that you’re going to start challenging the different FODMAP groups to see which ones you react to. That’s how it’s supposed to be used. It’s not being used that way. So I’ve been in practice about 16 years now. Long time… I can say, maybe seven, eight years focusing on SIBO. I am as guilty as all the other clinicians. As all of this kind of came into being, we use the FODMAP diet. When I first started, everybody who went on that had SIBO, and that’s just what we did.  As a matter of fact, when somebody walks through the door, we can calm your symptoms down. People feel better at least from getting that calmed down. But the longer and longer you’re in practice treating SIBO, the more and more people you see that have been on the FODMAP diet for two months, six months, two years. I had somebody a month ago come to me, that came to me that had been on it for seven years. And more often than not, when you run a SIBO test and you have a test back when to compare it to, their numbers are similar. So if you’re on a diet that’s supposedly starving out anything like the FODMAP diet is supposed to, a lot of people think that it’s going to starve out the organisms because you’re not sending those fibers that they can break down and consume and produce that gas with…

Dr. Weitz:            Logically it makes sense, you have this bacteria, the bacteria eat fermentable fiber, if we eat foods that are high in fermentable fiber, it’s going to feed the bacteria, the bacteria will grow and we’re trying to get rid of the bacteria, so.

Angela:                 It makes sense. But unfortunately, or fortunately, as you look at it, when you actually look at the studies, it’s not what the studies are showing. And clinically, as we step back. If we ignore the studies. As clinicians, again, we’ve all seen the person that had been on this for two months, six months, two years, seven years, and they still have SIBO. So if the diet treated, if the diet starved anything out, wouldn’t that be all they needed? Wouldn’t that be the fix? It might take them longer to start things out, but that’s not what we see clinically. In fact, I would love any practitioner to talk with me about, oh I just put somebody on a low-FODMAP diet for six months and their SIBO test is negative, here we are. We just don’t see it. So we have to learn from that and we have to look at the studies as well.  So when we actually look at the studies around the lactulose breath test and using a FODMAP diet. So the lactulose breath test, would you like me to explain that one for just a second?

Dr. Weitz:            Sure.

Angela:                 Just to make sense for people. So basically what we’re trying to figure out is, do you have too much gas production in the small intestine? Thereby we can identify SIBO. That overgrowth in the small intestine. What we have is, studies where they put people on a high FODMAP diet, and they put people on a low-FODMAP diet and then they tested their breath test prior to putting them on it and after they put them on it. And we’re starting to, are there any changes? So when we look at methane production. It’s really interesting because as we start to think about, this makes sense, if we put somebody in a low-FODMAP diet, it’s going to start things out.

We should see after someone’s on a FODMAP diet, we should see methane go down. We should see hydrogen go down. So when someone has SIBO and they have an overgrowth of organisms in their small intestine, the gas production is hydrogen, methane or hydrogen sulfide. Right now we have the ability to test for methane and hydrogen. The hydrogen sulfide test is in the works. Hopefully it will be here soon. When we look at the test, when somebody with SIBO is put on a high FODMAP diet and that’s going to be 50 grams of FODMAP a day, to understand where the average person, is basically going to consume around 20 to 24 grams of FODMAP a day. So at least twice what the average person is consuming. You take somebody with SIBO, you give them 50 grams of FODMAP a day in a diet for three weeks or six weeks, depending on the study.

Methane does not go up. So what we know of methane is that when methane is present, transit time slows down. So if we’re feeding more and more FODMAP, that should be feeding more and more methanogens or the archaea that actually produce methane, which means we should see more and more slow down. We should see a bigger niche created for those organisms to grow up to larger numbers producing more methane. We just see that go up and we don’t. So three weeks on a high FODMAP diet or six weeks on a high FODMAP diet and methane doesn’t go up. Conversely, on a low-FODMAP diet on seven to nine grams of FODMAP a day, which is extremely low, methane doesn’t go down at all. It’s not statistically significant.

Dr. Weitz:            Now could this be?

Angela:                What?

Dr. Weitz:            Could this be because what happens with methane is you have these methanogens and the methanogens eat the hydrogen. So it’s a secondary factor. So if the low-FODMAP diet reduced the food for the hydrogen eating organisms, couldn’t it just take a longer period of time before the methanogens were secondarily affected by starving out the hydrogen organisms? In other words, could it be that you just need a longer period of time and could that correlate with why practitioners sometimes see that treating methane SIBO is more difficult and often takes a longer period of time?

Angela:                 I don’t see that for methane taking a longer period of time. I think you just have to be really specific about how you’re treating it and from the start support motility. I don’t wait until after treatment to add in motility support. And there’s other things to do with that I think to make that a little bit more effective. What I would say is that we need longer studies. We need standardized-

Dr. Weitz:            And we need better studies.

Angela:                 … longer studies. But feeding studies are incredibly difficult because how do you control for population, feeding them all the same thing. It’s incredibly expensive. What would be the benefit? Some of the studies looked at a FODMAP diet for two days. What are we supposed to do with this?  So, we definitely need longer studies. I would say clinically when we see patients come in that have been on a low-FODMAP diet for, again two months, six months, two years, they still have SIBO.  Methane does not go down.  In fact, I find, and many practitioners find it’s, and it just is, the FODMAP diet is actually contraindicated. If somebody has methane because you’re basically likely going to make them more constipated by pulling the fiber that’s keeping them regular. So, putting somebody on a low-FODMAP diet is probably not a good idea when somebody has methane production. And I’ll, if we could back up for a second, because I have a bone broth company that has, it’s low-FODMAP ingredients. People who have SIBO and people who have IBS, will likely need to adapt their diet in some way.

What I’m cautioning people about and downright saying don’t do it, is that everybody with IBS and everybody with SIBO does not need to go on this diet full force, even as an elimination diet. Where this diet shines a bit more is when somebody has symptoms that are so deep irritating all over the place, they don’t know what they’re reacting to. And then, great, let’s do the elimination diet three to four weeks, settle things down, challenge each of those groups separately and see what you can add back in. That’s a really good use of that diet, but blanketly going out and saying everybody has to be on this and then insinuating, perhaps with all the info that’s online that we just can’t get away from at this point, or even clinicians still doing it, saying, well, we need to starve things out with this.  And it makes people really worried. Really freaked out about anytime they eat and they get a symptom, SIBO’s getting worse. But when we look at methane, if you produce, or if you, pardon me, feed them, 50 grams of FODMAP a day for three weeks or six weeks, nothing doesn’t go up.  SIBO’s not getting worse. So we need to look at these studies to gather that info. There’s actually three studies that showed a change in hydrogen, but when you really look at those studies, they didn’t use the lactulose breath test in a way that it was validated for. So, well actually-

Dr. Weitz:            I was amazed to read your article where you broke this down. Anybody who’s treated patients with SIBO, anybody who’s had SIBO who’s seen a reasonable practitioner, especially somebody in the functional medicine world, knows that there’s a specific protocol you have to follow before you take the lactulose breath test, you do it for two or three hours. It’s very specific in it. The timing is very important because you want to make sure that if there is gas that it’s being produced in the small intestine. And these studies, it’s amazing how poorly they were done.  They were doing, having them do the breath tests like all day long. They were eating at the same time. It’s unbelievable.

Angela:                 It really is. So they’ll actualize the breath test. I mean, basically you can see lactulose, as the substrate, this fermentable sugar that we don’t really absorb and you breathe out a tube at 15 or 20 minute intervals over a three hour period. And as that moves through the small intestine, if there’s an overgrowth, you’re just going to have a little bit of production because your small intestine is not sterile.

But as that moves past the overgrowth, you’re going to get a larger fermentation reaction, more gas production, and that’s going to cross your intestinal track into the bloodstream. Exchanges in your lungs and comes out your breath. It’s fascinating. But the crux of it is, it was only validated when you do a 12 hour food prep, basically eating chicken and rice, reducing the fermentation that is always going on in the large intestine so you can get a clear read in the small intestine and then you follow that 12 hour food prep with a 12 hour fast basically, again, to decrease the colonic fermentation. When we’re looking at the test time range, to diagnose you. But we’re looking at the 100 to 120 minute mark with the task, not three hours in, because it’s in the colon at that point.

So the three studies that looked at this, I mean one was so interesting, it’s called “A low FODMAP diet is associated with changes in the microbiota and reduction in breath hydrogen but not colonic volume in healthy subjects.”  So first of all, healthy subjects, they ate their habitual diet, their regular diet for seven days. They were provided 24 hours worth of food, which is a standard package.  So at least they’re all doing the same thing.  Right?  It wasn’t low-FODMAP. They did the lactulose breath test the next day and then they took the group as a whole, divided it in two.  The low-FODMAP group, they were given maltodextrin, which we see repeated in other studies where maltodextrin is basically a starch made from corn, rice, potatoes, or wheat.

Dr. Weitz:            Why do they add that?

Angela:                They’re just calling it a control, I guess they feel like, basically it’s a polysaccharide if we’re worried about the FODMAP diet that would be in there. But basically they’re considering that as a control. Nobody really knows why. We’ve seen it in other studies. It doesn’t make any sense issues.  So I don’t even know that it’s a comparison. And then the high FODMAP diet group was on a low-FODMAP diet, but then supplemented with oligofructose, which is basically a fiber supplement. So they weren’t even put on a high FODMAP diet. And then they follow that. And then the whole group was given 24 hours worth of food, which was low-FODMAP, and then they did a lactulose breath test. Just at that point, I don’t even know what we’re testing. Like none of this makes sense. But what the problem is, is that when you read the study title and even if you probably look at the summary on PubMed, it all looks like a low-FODMAP diet is responsible for reducing breath hydrogen.

But when you actually look at the study, you can’t even compare the baseline because it wasn’t low-FODMAP. They didn’t do or implement the instructions for the test that made it a validated test. So to speak to that, when we start to look at actual studies on FODMAP diet, some of them actually offer a high FODMAP diet versus low-FODMAP diet just 50 grams in and around for a high FODMAP and seven to nine grams in and around for the small, excuse me, for the low-FODMAP. And then they compare them over a period of time. That’s really the right way to do it. Others, they basically put everyone on a low-FODMAP and put them on starch or FLS or GOS, which is fiber. Or they basically do a low-FODMAP and a high FODMAP, but then add more fiber, there’s nothing standardized within it, it just doesn’t make a lot of sense.  The other study that saw a change in hydrogen was called Randomized clinical trial: Gut microbiome biomarker, excuse me.  My goodness. Gut microbiome biomarkers are associated with clinical response to a low-FODMAP diet in children with the irritable bowel syndrome.  So they looked at 33 kids, and they basically had them follow the diet for two days. Then they did a wash out period for five days and then they cross them over and it was typical kid diet or a low-FODMAP diet just two days.  But when they did the lactulose breath test, they actually sampled for over eight hours. And then some of the kids up to 15 hours while they ate.  So again, we can’t really draw a lot of conclusions from these tests. We have a third study that kind of hits something very similar.

Dr. Weitz:            Completely invalid.

Angela:                Yeah.

Dr. Weitz:            And this comes to scientific studies and people can cite scientific studies and a lot of times people are trying to make a point, maybe they’re just repeating a citation that somebody else cited and they never went and read the actual paper. And at most they looked at the summary and this goes to show you how just looking at the abstract or the summary of the study is often not accurate. So if you really want to be scientifically accurate, you’ve got to read the whole study and look at how it was done to see if it’s really valid.

Angela:                 And I think this next study that I’d like to talk about really speaks to that because you have to dig a little bit deeper to figure out a couple of items here, which I, once I found the study, another study on this, I thought it was just fascinating. So the third study that showed a change in hydrogen is Gut microbiome biomarkers are associated with clinical response to a low-FODMAP diet in children with the irritable bowel syndromeThis is one of the studies by Shepherd, the two Shepherds out of Australia. She’s basically the creator of the FODMAP diet. And then Monash University, she had an association with them and they’ve got a great app for FODMAP.  So to give them a bit of a shout out there. This study is cited so often. I see this all the time. So basically they had 15 healthy subjects, 15 people with IBS, and they either ate a low-FODMAP diet, nine grams a day, or a high FODMAP diet, 50 grams a day for two days only. This is why it’s like, who looks at anything for two days?

Dr. Weitz:            Yeah, two days, so short. Two days.

Angela:                 So they followed a seven day washout period where they ate their normal diet, and then they cross them over and did the two day diet intervention, which is, you want to have a crossover, make sure there’s no differences between the groups. Food was provided, which is fantastic because then you really get the standard effect. Everyone has fed the same thing. What do we see? So for the low-FODMAP diet, they fed them rice flakes, lactose free milk, tea, rice, bread, margarine, orange juice, an orange, rice, pasta and lemonade with sugar. So really not healthy. Who’s going to stay on that long term? Incredibly whites, nothing, where’s the fiber? Where’s the vital nutrients? Where’s, nobody got an orange in there.

Dr. Weitz:            By the way, I read your article and then I read this study, it’s even worse than that. On top of all that, they gave them snacks containing hot chocolate with lactose free milk, and chocolate wheat muffins.

Angela:                 Yes.

Dr. Weitz:            To both groups.

Angela:                 Yes. Yeah. Really not healthy. Really not healthy, right? So what they found was that there was a change in hydrogen. So what’s interesting, so both groups have higher hydrogen levels and response to the high FODMAP diet. So this is healthy in IBS groups, but the IBS group had higher levels than the controls. So as you did deeper into this, they didn’t do a proper food prep and they didn’t fast for the lactulose breath test. They collected data for the lactulose breath test over 14 hours while they ate. And then they also didn’t control for timing of the meal, so they didn’t feed everybody the same thing at the same time. So I thought that might’ve just been a little bit of an outlier. But what’s so interesting about this that the high FODMAP group was given high fructose corn syrup soda.  And they were also given sorbitol gum with sugar alcohols. And there’s a study that actually shows if you combine sorbitol gum and high fructose corn syrup, it exacerbates symptoms by swiftly delivering malabsorbed carbohydrates to the colon. There’s a study on this.

Dr. Weitz:            Wow.

Angela:                 I know, so you can’t, so for the group and the high, people with IBS are already going to be sensitive to that osmotic shift, probably more so than the healthy individuals. And now you give them high fructose corn syrup and sorbitol gum in there, quicker to malabsorb, quicker to have bloating and excess gas and shift things and kick things up. So again, it’s not just the study, but you have to really get in, look at the point by point. Well, what did you feed? What’s different here? What do we have to question?

Because we can’t just take this at face value at all. There’s one other study that saw a change in hydrogen and that was, which we’ll probably talk about a few times here because the study again is one of those that cited everywhere. It’s FODMAPs alter symptoms and the metabolome of patients with IBS, a randomized controlled trial. And that was by Macintosh et al. They claim to have found a difference with hydrogen levels. But when you actually look at the study, there’s no statistical significance when comparing baseline data to post side intervention. There’s none. So we’re done. They went on to have a big discussion about it, but there’s no statistical significance. So I don’t know why they kept talking about it.

Tell you how I really feel. I know. So at this point right here, we have no study that backs up a low-FODMAP diet, lowering hydrogen levels or methane levels and people with IBS or people with SIBO. None. It’s not even controversial, there’s just none there. If you actually look at those, they didn’t do the lactose breath test right. There’s no data to confirm. That’s all we have.

Dr. Weitz:            It may or may not work. We just don’t have proof that it does.

Angela:                Yeah, and so far it’s pointing towards no, clinically we don’t see it. And when we actually look at the studies where they implemented it properly at three weeks and six weeks, there’s no change to hydrogen and there’s no change to methane.

Dr. Weitz:            And because this diet removes lots of healthy foods like broccoli, avocado, we could go on and on about all these healthy foods that are being removed from your diet.  And because we know that there’s a negative effect on the microbiome, then what you’re saying is we should all stop using the low-FODMAP diet in patients with SIBO.  What about the ones who say they’ve gotten results with it?

Angela:                I’d say this, if you have been on a low-FODMAP diet for a long time and your symptoms are managed with it, I get it. I really get it. What I want to connect with that person with, because I have so much empathy for people not feeling well.  On one hand, obviously there’s some things to figure out because they still have SIBO with SIBO, otherwise they wouldn’t be reacting that way or there might be some other things that we can add to support them that isn’t just restrictive diet.  Additionally, for that connection piece, if we know from the data and again, seeing people on this forever not getting better, in terms of lowering the hydrogen and methane loads on a breath test.

When you eat and have a symptom flare, I know it’s not fun, but it’s not SIBO growing in a Petri dish.  SIBO’s not getting worse.  So what we want to do is basically, pick your five favorite foods that aren’t garlic and onion because those ones are hard to include back in, and see if you can try a tablespoon of something. Really the unfortunate part of expanding off of a really restrictive diet is that you have to do it really slow, and methodically and it takes time. Rebecca Coombs, love her, she shared a story one time where, it took her, I think about four months to introduce pumpkin again, where she would try a tablespoon of pumpkin, did not go well. Waited a month, tried it again, did not go well and it took her until the third month or fourth month for finally for her system to say, all right, it’s not so bad.  So, I think that’s kind of the unfortunate part. This isn’t somebody on, reacting a little bit to dairy and gluten and they eat it on occasion and they don’t quite get a flare up. These are people that if they have, and for a lot of them, if they have a cup of potatoes are going to be down for three days with their symptoms flaring up.  So for some people just depending on where they’re at, they’re going to have to go very slow with the reintroduction.

Dr. Weitz:            What’s happening? Why can’t they tolerate these foods anymore?

Angela:                So, what I consider is that when we were back as hunters and gatherers and running around and looking at things seasonally, we’re going to upregulate or downregulate digestive enzymes based on what we’re consuming on a regular basis. So seasonally, because it doesn’t make sense to me to make a bunch of digestive enzymes to consume certain plant foods that aren’t going to be, if they’re not around all the time.  So, when we’re really pairing somebody down, and having them consume little variety and a lot less food, it takes a little bit to start to reintroduce foods to get their body to start to acclimate to that a little bit. I think there’s some support out there that we had that can really help them introduce things a little bit more easily. There’s some really great, Intolerase by Vita Aid is a really great digestive supplement that was made for SIBO that can help with all those different starches and indigestible fibers to help break those down a bit more. So, I think too, maybe to explain it too, if you haven’t had, let’s say non-SIBO people, just healthy individuals running around.

If you haven’t eaten beans in a year and a half and you go have a cup of beans, you’re going to have probably some gastric distress from the gas production. But if you eat beans on a regular basis, your body will get used to it and acclimate.  So I see that with FODMAP, like the more and more we restrict, the first couple of forays into expanding foods.  If they do it too fast, they react.  So we just go really slow as we trickle that food in, as we start the expansion.  But it’s also getting past the mindset because the mindset has been, I have SIBO, I have to starve this out.  Every time I have a reaction, it’s SIBO growing in a Petri dish and I’m making this worse. I’m never going to get better. I need to restrict.  And that whole mindset, I mean that’s why I basically, there was a whole, at the SIBO symposium last year, there is a full tract on anxiety and food related disorders based in and around SIBO.  Because everybody’s restricting a lot. And I think unnecessarily for a big degree.

Dr. Weitz:            I wonder if we could make use of low dose immunotherapy in such a situation to start getting your body be able to tolerate some of these foods.

Angela:                Possibly. Possibly. I think. 

Dr. Weitz:            It’s interesting how these enzymes are really specific to the exact types of foods that we consume.

Angela:                And that’s where I think something, honestly, like Intolerase comes in. It’s a really broad spectrum, covers a lot of bases in terms of some of these ingestible fibers and stuff. We can do that. If we can go, tablespoon worth the food. Give it a couple of days, double it, give it a couple of days, double it. If all that’s going well, then we can start to increase some of those loads for people and just start to get their body used to it a bit more.  And breed some confidence for the person too, which I think is really important. Cooking grains longer, adding more water, cooking them longer, understanding that if you cook something like rice.

Dr. Weitz:            Using a pressure cooker.

Angela:                I love it.

Dr. Weitz:            Soaking grains, overnight-

Angela:                All of that can help.

Dr. Weitz:            The lectins.

Angela:                Yes, yeah, I think that can help. I’d say also-

Dr. Weitz:            The deadly lectins.

Angela:                Mm-hmm, I’d say that also if you’re, so some people know too, if you cook rice as normal in water on the stove when you boil that and then cool it, you create resistant starch. And so you might do fine as you eat that cooked initially, but if you keep it in the fridge day after day, the more you heat and cool that the more resistant starch is created and that might be a little bit of a key that person reacting more and more as they introduce that.  There’s different types of white rice too. If you don’t do well with Jasmine rice, it doesn’t mean rice is out. There’s different rices and you might do well with another type.

Dr. Weitz:            Depending upon whether they’re higher in amylopectin or-

Angela:                Yep, exactly, exactly.

Dr. Weitz:            If the low-FODMAP diet hasn’t been proven to be effective, are there any other diets that have been proven to be effective for SIBO?

Angela:                No, not to date.  So, basically we’ve got the low-FODMAP diet, we’ve got the SIBO specific food guide, which basically combines the FODMAP and SCD, and then the Bi Phasic is implementation of the SIBO specific food guide, where the groups of foods are phased in at different times. So we don’t have any studies. 

Dr. Weitz:            So really no research to back up the Specific Carbohydrate diet or the GAPS diet, either one of those.

Angela:                Gaps isn’t often used because gaps has a lot of fermented foods in it. And so I think people shy away from that a little bit with SIBO, a lot with SIBO. Who am I kidding there? They really shy away from it.

Dr. Weitz:            But Specific Carbohydrate?

Angela:                SCD actually has some fairly good studies behind it, but not for this.  It’s more related in and around to ulcerative colitis and some other things, but not specifically for SIBO. So and I’ll say there’s, different practitioners have a different way of getting a patient from A to B.  I’m not trying to get in the way of that. I’m trying to have a discussion on what we’re trying to do with the low-FODMAP diet.  And I see so many patients come to me having been on this for so long and it’s almost like you see their shoulders go, huh, when you say, I give you permission to eat, please go eat.  Because I’ve even had people come to me and they said, “Oh, you’re probably going to, I’ve been cheating, you’ll probably going to tighten up my diet.”  And I’m like, “Go eat whatever you want.”  Of course it’s going to be healthy and we’re going to work on it, but I give you permission to eat.  What are the next five foods you want to try?  Let’s do it methodically with purpose. Let’s start to expand.  Give them something to look forward to. So many people expanded with their diet and they’re better for it. They’re not worse.  SIBOs not getting worse. They’re better for it because they have better endurance, they get better emotionally. They’ve got more nutrition coming in.  It’s all positive.  It’s not ever going to be a negative with that.  So we just have to look at this from that perspective.  I’d say again, if you’re working with a practitioner and you’re listening and they really love the SCD, or they really love a FODMAP or the SIBO specific or Biphasic, and they have an in and out plan, that’s fine.  But the in and out plan is three to four weeks. It’s not, you’re going to be on this for four months or five months or this is just the diet you do because you have X, Y, and Z.

So I would challenge the practitioner you’re working with and ask them why they’re choosing this diet, how long you’re going to be on it, what is the plan and when are you going to start expanding your diet? If you can get all of that in writing, the three to four weeks of a regroup could be fine based on what they see. I think it’s, again, the elimination diet as a whole for a FODMAP diet to me is really reserved for people that just cannot figure out what they’re reacting to and through conversation with your clinician, we’re not able to pick it out off the top of their head because it sounds like you’re reacting to everything. Great case for an elimination diet, but for the rest of the groups, then we look at fructose and lactose and it’s just the sucrose, even for some, we reverse engineer it. You don’t have to pull everything.  Fructans are probably the one, like garlic and onion and leeks. Those are the ones that usually are suspect. And the problem is of course, is they’re looking, onion is in everything. If they’re trying to eat out and that would be the first thing that we look at and have suspect about for people reacting and then fructose and lactose.  So it’s not that you have to just pull everything.  We might learn a little bit from the FODMAP diet and what people are less likely to react to, and what we can gravitate towards.  That’s great.  But the whole idea that we have to restrict down to seven to nine grams of FODMAP a day and stay on that to starve something out is ridiculous.

Dr. Weitz:            Essentially, you’re suggesting that we do something like a conventional elimination diet. We just pick two, four, six, eight foods, something like that, eliminate it for a specific period of time, and then try to test them back in and bring those foods back.

Angela:                 I am suggesting that, but that’s also what the studies are suggesting.  Time and time again, the studies are suggesting this is a three to four week diet plan. This is not a long term diet. We need longer studies on this. This should never just be put, have somebody put on long term. So this is the study, is in their commentary and summarizing their investigation study after study after study, says this is a three to four week plan.  So I am suggesting that for people that have more deep irritating symptoms, that from this three to four weeks as an elimination diet pull everything, and then there’s really good, Kate Scarlata has info on what to challenge.  There’s people online that have found what to challenge. You can get that info for free. I really recommend that you do this with a practitioner.  However, not only that, all the effort you put into doing this over a month, if you’re not realizing, oh, X, Y and Z are actually high in FODMAP, they’re just not on any list. You want to make all your efforts count. So work with somebody as you do this because it’s fairly restrictive.

Dr. Weitz:            It’s pretty much what I do. But I typically do it for four to eight weeks rather than two to three weeks, but.

Angela:                Three to four weeks is usually the timeline that is recommended within the studies, and enough time to let symptoms settle down because again, this isn’t food sensitivity. We all learned the elimination diet way back when as pulling gluten, corn, soy and wheat, eggs, all of that. And then some, but that was more sometimes a month, sometimes two months. It was more like a month, month and a half.  But we’re calming down the immune response as well as we challenge that.  We’re getting kind of a reset button on that.  So for this, this is really more what’s ramping up symptoms, osmotic shift and maybe the bloat response from that fermentation piece. 

Dr. Weitz:            And isn’t it interesting that gluten and dairy and soy are some of the same foods in the low-FODMAP diet too that you take out.

Angela:                Yeah. Yup. It definitely is. Definitely is. The other thing I would say I think is really interesting and maybe to make the point here. I’m in the clinician group on Facebook for SIBO and we’re often discussing cases and points and it comes up time and time again that if there’s a pediatric case of SIBO, you completely throw the SIBO test out, ignore it, and you basically fix the foundational parts, clean up the diet, probably dairy and gluten free.  Support the child nutritionally and see and try to figure out really what’s stirring up the emotional piece, what’s adding, where’s the stress coming from.  We ignore it because we don’t want to over-treat and that’s that. I mean that’s said by everyone, Mona, Lisa, Shiva, everyone. So as we start to look at all this, which I will heartedly, I don’t work with a ton of pediatric cases, but I wholeheartedly agree with that. But I feel like we should have also be doing that in adults. So if somebody comes to me with five SIBO tests in a row, I still set them aside.  We look at everything else.  What else could it be?  Let’s start with the basics.  Let’s clean things up.  Let’s settle things down.  Let’s work on motility.  So many people aren’t doing that and then wrap back to that and see if we even need to treat.  So, I think we just don’t want to jump the gun.  I think we get again this, when you have a way of testing for SIBO, that’s fairly easy, fairly affordable for some or most, and you get these test results back and you’re like, aha, that’s it.  Well, it’s secondary. You still haven’t figured out the root cause of it and you can very quickly throw an antibiotic at it or herbals at it and put them on a low-FODMAP diet, which might make them feel better, but now they’re stuck on the low-FODMAP diet and SIBO’s maybe not fixed. So, we still want to look at what set this up and treat from that perspective. The other thing that I think is very interesting to me about the FODMAP diet and how quickly people are quick to jump on it and talk about it online and use it, is that we’ve got this idea that if you put people on this low-FODMAP diet, it’s going to cherry pick and reduce the specific species that are causing IBS or SIBO.  And again, in the studies that’s just completely unfounded.

There was one great study that found that a low-FODMAP diet made the microbiota more dysbiotic and I loved what they said in their work because the way that they said it is it, it made the microbiota more dysbiotic in a group that already has been shown to have a dysbiotic microbiota. So it’s another study, dysbiosis is causal and IBS, although there’s no direct evidence to support this, being kicked around so much in the studies, then the effect of a strict low-FODMAP diet might be counterproductive. So what are we doing? It’s just really interesting. The one study I mentioned earlier about the hydrogen, altering hydrogen where they didn’t see any statistical significance in pre and post data, FODMAPs alter symptoms and the metabolism of patients with IBS, a randomized control trial.

That study again is one of those foundational studies within the SIBO rule that’s been cited so much. And they found no statistical significance when comparing their baseline data and their posts, diet intervention data with the microbiome.  But again, they had a page and a half of summary because then they went on to actually just compare their post intervention data.  So we can’t, we’ve got to look at these studies and this is the one study that actually kicked my whole, wait a second, what the hell is happening?  You got to be kidding me, moments because this one study again that everybody talks about, it’s always cited wherever on everybody’s stuff is they found no statistical significance with hydrogen. They found no statistical significance with the microbiota. They actually said alpha and beta diversity were the same when you compare the pre and post test.  They also, and this is the study that kicked off the whole conversation around histamines because what they claimed in their study was that there was an 8 fold decrease in histamines when people follow the low-FODMAP diet versus the high FODMAP diet. And I was looking at that to write an article off of it and there’s an asterisk on the data for the histamine piece.  And I was like, wait, what?  You can do that?  You can put an asterisk on stats.  So if you read it, what they had to do to get a correct… the statistical significance was that basically I think they started out with like 37 people. They went down to 34 people when they were looking at histamines. That didn’t tell us why a few people were discarded.  And then there was no difference between pre and post data for histamines.  So they only looked at the post data for low-FODMAP and high FODMAP and they had to adjust that subject group down four more times for age and gender, and IBS subtype to actually see a difference between a couple of people. And so-

Dr. Weitz:            Wow.

Angela:                I know, and then you back up and you kind of, you look at what they actually did to test histamines and they did a single point. You’re in test first thing in the morning, which for histamines, for urine histamines we look at a 24 hour collection because histamine is up and down all day long. So they didn’t test it correctly.  There was no difference in pre and post data. That citation is in 50 other studies that the low-FODMAP diet alters histamines.  And then whenever you look at those other studies, they make that citation and go into everything that’s happening with the immune system because we know that it lowers histamine.  It’s all complete conjecture because that study didn’t show it. So it’s really, it was absolutely interesting. I sent it to all my colleagues. I sent it to a friend who’s a colleague who’s a gastrointestinal doctor. Like am I seeing what I think I’m seeing? And he’s just like, “Oh my God, this makes no sense.” So it’s just interesting. It’s interesting, it’s really sad, I mean if you go online and search for FODMAP and histamine, you get a hundred thousand plus results. It’s just everywhere. And it’s, I don’t know what to say.  And when we actually look at the study, it doesn’t show it.

Dr. Weitz:            And its being recently embraced by conventional gastroenterologists now too?

Angela:                 Yes.

Dr. Weitz:            The ones who are involved with diagnosing and treating SIBO.

Angela:                 Yes, and that’s where, I think it’s really, it’s like it’s fortunate unfortunate. I saw the about shift with the GI docs. It was like at the front of, maybe it was like two years ago at the start of the year.  They all thought SIBO was crazy, at the end of the year. I don’t know what conference it was presented all of a sudden SIBO exist, and the FODMAP diet is great.  And that’s not for all of them.  I’m sure there’s lot of them that still think it’s crazy.  But enough of them are treating that, it’s just here’s the test, here’s the antibiotics, here’s the FODMAP diet.  Thank you for coming.  And your GI doc is not who you see on a regular basis. I hope it’s not.  That means you got a lot of gut stuff going on.  Ulcerative colitis patient, you’re going to see your GI doc a lot.  It’s just is what it is.  But for the most part, that’s not where you go for primary care.  And so, are you going to even see them again in six months?  Now you’re stuck on that diet because you’re supposed to follow this.  There’s not a lot of follow through or follow up with that.

Dr. Weitz:            I think Dr Pimentel’s research has been very influential and we know that IBS is the most common gastrointestinal condition. And though, I’m sure a lot of GI docs feel like, wow, we’ve got all these patients with IBS and we don’t really have a lot of tools right now. And so, maybe now we have a strategy that makes sense.  We have a diagnosis, we have a drug that goes with it, and we can throw in a diet too.

Angela:                 Yeah, yeah. It’s true. It’s true. It’s true. And then they again, in the IB, and the study is looking at FODMAP and IBS, they’re showing that about 40-45% of people will improve on a FODMAP diet, again, as an elimination diet.  So it’s not everybody, but that’s a pretty big chunk that somebody can make a difference with a handout.  But then, how long are they following it, and what issues come from that?

Dr. Weitz:            Okay, awesome. Thank you, Angela.

Angela:                Yeah, of course.

Dr. Weitz:            We’re going to shake up the SIBO world a little bit.

Angela:                I hope so. I hope so. Thank you for having me. It was a great conversation, and I hope to continue it.

Dr. Weitz:            Good, good, good. And so how can listeners get a hold of you and find out about your programs and your products?

Angela:                Best site to reach me through is my website, siboguru.com. And then my bone broth is definitely out there, a gutrxbonebroth.com and everything’s linked for my website, so you can just come through me and find info there.

Dr. Weitz:            Awesome. Thank you.

Angela:                Thanks Ben.




Epigenetics and Cellular Detoxification with Dr. Ashley Beckman: Rational Wellness Podcast 141

Dr. Ashley Beckman discusses Epigenetics and Cellular Detoxification 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

4:42  Epigenetics is the study of how certain mechanisms like diet, lifestyle, and behavioral choices can switch our genes on or off.  We have a lot more control over our future and our genes are not our destiny.  In fact, according to Dr. Beckman, they are our greatest opportunity.

5:50  Cellular detoxification is a detox program specific and targeted to our genetic predispositions and our constitution our detox needs.

7:15  To determine our genetics and our epigenetics, Dr. Beckman prefers to determine our genes with a testing company like Apeiron Genomics rather than using 23andMe or Ancestry, since these companies are generally selling your data and now offer a limited number of genes.  Apeiron Genomics uses a large number of genes and provides actionable reports with recommendations for diet, exercise, supplement, and lifestyle tendencies and it does not sell your data.

12:22  Dr. Beckman explained that her patient who gets tested through Apeiron Genomics receives various categories of their tendencies.  For example, they get an insulin resistance score based upon about approximately 20 genes, which gives them a score of the likelihood of developing type II diabetes.  This can provide motivation for people to be mindful and makes changes in their diet and lifestyle, esp. if they have a high propensity for developing insulin resistance and diabetes.

23:22  Looking at your genetic tendencies can help you tailor your detox program to be more effective. Dr. Beckman said that she had been doing Dr. Schultz’s detox programs since she was a kid and did them seasonally. She eats very clean and uses clean products and doesn’t use plastic and doesn’t buy plastic bottled water, etc., but when she did the Great Plains toxin test, she was one of the most toxic folks they had ever tested. She was in the top 75-95% of the highest levels for 15 different toxins, like BPA, MTBE, and perchlorate.  She also learned from her genetic testing that she does not make or process glutathione much at all. So now her detox program involves precursors for glutathione and also binders to soak up the toxins to get rid of them, like fulvic and humic acids and modified citrus pectin, which are more effective than charcoal. For testing for toxins, she likes to run the organic acids, the mycotoxin, and the environmental toxin tests. She also likes the Quicksilver Mercury Tri-test, which is a combination of serum, urine and hair mercury testing.  She may also run a fuller heavy metals screen.  She may also run a GI Map stool test or a Gut Zoomer test.

34:25  Dr. Beckman combines the genetic testing and what shows up in the labs to tailor the detox program for each patient.  She will do a preparatory phase prior to starting the detox and if the person cannot tolerate toxins well based on the genetics, then this phase will be longer.  She will start patients with certain foundations, like optimizing nutrient levels and making sure their bowel is functioning properly and that they are not constipated and ideally pooping twice per day.  If they are constipated, the toxins will recirculate instead of being eliminated.  Dr. Beckman will also give them some nutritional formulas to support the lymph, the kidneys, and the liver.  She likes CellCore Bioscience products, including their HM-ET Binder product, which contains extracts of humic and fulvic acid, and their Biotoxin Binder, which contains humic and fulvic acid and also molybdenum, broccoli sprouts, and yucca root, as well as some products from Designs for Health and also from Quicksilver.  She likes to get her patients off eating gluten, dairy, and refined sugar.  She also works with her clients on breathing and also with dealing with stored grief and sadness and other emotions, including with acupuncture, meditation, and visualization.  Dr. Beckman works out of offices in both Beverly Hills and Malibu and she can work with clients through the phone and her website is DrAshley.com.


Dr. Ashley Beckman is a Doctor of Chinese Medicine and a licensed Acupuncturist and herbalist. She received her doctorate in Healthy Aging and Longevity and wrote her thesis on Epigenetics, the study of how our genes are affected by our diet and lifestyle.  She specializes in healthy aging, epigenetics, pain management, fertility, detoxification, headaches, stress reduction and facial rejuvenation.  She also co-founded Golden Path Alchemy, an organic skincare company based on the principles of Traditional Chinese Medicine.  She can be reached through her website, DrAshley.com.

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


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. Thank you so much for joining me again today for another discussion on important functional medicine topic. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple podcast and give us a ratings and review that will help move us up the rankings and help more people find the Rational Wellness Podcast. If you’d like to see a video version of our podcast, 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.

Our topic for today is Epigenetics, and Cellular Detox with licensed acupuncturist, Dr. Ashley Beckman.  Our genetics are the DNA code that we inherit from our parents and these direct the activities of our cells and our DNA code does not change over time. Our DNA code is a sequence of nucleotide basis known as adenine, cytosine, guanine, and thymine. I know that it’s kind of scientific jargon, but it’s the specific sequence of these A, C, G and T bases. This is the code that provides the instructions for our cells to make specific proteins that trigger various biological functions in our body, including the production of insulin, for example.  The definition of epigenetics, epigenetics is a set of triggers and switches that turn our genes off or on, and so epigenetics doesn’t modify the genetic code, but it modifies the expression of our genes. And our genes, our epigenetics is based on a whole series of factors including environmental factors, diet, lifestyle, and our exposure to toxins. Such toxins that have been shown to be drivers of epigenetic processes include heavy metals, pesticides, diesel exhaust, tobacco smoke, bis phenolate, mycotoxins, radioactivity, as well as hormones, bacteria, and basic nutrients. Some of our genes get switched on and get expressed and other of our genes get turned off and do not get expressed.

The other part of our discussion is about detoxification and detoxification is how we get rid of toxins that we’ve been exposed to over our lives and then may be stored in our cells, our organs, and even our bones. This occurs naturally on a daily basis, but we can also stimulate the detoxification process by doing a detoxification program, which often involves some form of fasting combined with taking specific nutrients to support delivery detoxification pathways to support cellular detoxification, and to support the various forms of elimination, including the digestive track and it facilitate sweating another form of elimination such as by using infrared sauna.

Dr. Ashley Beckman is a licensed acupuncturist and herbalist and a doctor of Chinese medicine practicing in Los Angeles. She received her doctorate in healthy aging and longevity and wrote her thesis on epigenetics. The study of how our genes are affected by our diet and lifestyle as I just mentioned. She specializes in healthy aging, epigenetics, detoxification, pain management, fertility, treatment of headaches, stress reduction, and facial rejuvenation. She also co-founded Golden Path Alchemy, an organic skincare company based on the principles of Traditional Chinese Medicine. Dr. Beckman, thank you so much for joining me today.

Dr. Beckman:                     It’s a pleasure to see you and be here today.

Dr. Weitz:                           Good. Let’s start by giving some definitions. I know I’ve gone into it some, but why don’t you explain what epigenetics is?

Dr. Beckman:                     Sure. Epigenetics is the study of certain mechanisms such as diet, lifestyle, behavioral choices that we have like exercise and these different factors we have in our different … in the way we live. And basically these can switch our genes on or off. One thing that I really like about this is that we have a lot more control over our health destiny than what we have been known to believe in the past. So many people just believe if something has been passed down to you by your parents, that you’re destined to get this and more likely doomed to get it.  And so people just really focus and are scared for their future. And I love this theory of epigenetics because we really have a lot more control than people had thought before.

Dr. Weitz:                           Right. Our genes are not our destiny.

Dr. Beckman:                     No. And I say they’re our greatest opportunity.

Dr. Weitz:                           Great. The other part of our discussion is going to be about cellular detox. Maybe you could explain what is cellular detox?

Dr. Beckman:                     Sure. The word detox gets thrown around all the time and people equate this with a three day juice cleanse that they picked up at a juice bar. And especially as someone coming from Chinese medicine, you really need to tailor things towards someone’s constitution. Even on the detox level, we have to know how the body is and even some genetic predispositions and how we detox, like how our phase one and phase two pathways are wired, so that we can actually tailor a detox specific to that person. Some detox that you pick up, like I said, like at a juice bar or even off the shelf at Whole Foods, it’s not going to be exactly what you specifically need.  And so a cellular detox really we want to get in, make sure that you’re targeting all the areas that really need to be addressed and taking the right supplements. And then kind of what you were speaking about, all the other lifestyle factors that accommodate what is needed in a detox with, from mindset to some fasting, the right foods and the right supplements. Something that’s very targeted and actually effective.

Dr. Weitz:                           Okay. With respect to epigenetics, how do we find out what our epigenetics are?

Dr. Beckman:                     Well, so the main way is you basically … what I do with patients is you take someone’s raw genetic data, so you get a test. There are various ones out there. I have utilized raw genetic data that people have already received from somewhere else, like 23andMe or … there’s a various amount of companies now.

Dr. Weitz:                           Ancestry.com, so why don’t we talk a bit for a minute about which is the best one to use?

Dr. Beckman:                     Sure.

Dr. Weitz:                           Because for a while I heard that 23andMe was providing the most amount of genes and then they change the way they do their testing, so they actually provide fewer genes. What do you think is the best company to use if we have a choice?

Dr. Beckman:                     Sure. I use a company called APEIRON and that’s the company that I’ve actually trained with and studied with. They do not store your data and it’s actually extremely private. Your name is not associated with the bar code on your test. That is something because they will never sell your data. And I think that that is actually one of the most important pieces right now.

Dr. Weitz:                           And you’re referring to the fact that 23andMe and Ancestry, the way they make a lot of their money is by selling your data to be used for research by Big Pharma and others?

Dr. Beckman:                     Yes, I believe that that’s accurate. I think a lot of the companies out there are data mining companies and where you get in exchange your raw genetic data. But at the same time I caution anyone who has not done that already to pick another company that does not work in the same manner.

Dr. Weitz:                           Do you mean for privacy concerns?

Dr. Beckman:                     For privacy, and the thing, this whole area is very new and nobody really knows what they’re going to be doing with gathering all this genetic data. I think privacy is of utmost concern. And sometimes I tell people, “If you want a little bit more privacy you could also maybe use a different name when you send it in,” things like that. But at the same time, my number one choice is to tell people to use another company that doesn’t do that and the one that I’m secure with is APEIRON.

Dr. Weitz:                           Okay. How do you use this APEIRON to find out about your genetic code and your epigenome?

Dr. Beckman:                     Sure. It’s the same as the little swab that you do, and the cheek swab, you send it in and then about six weeks later you’re given your raw text file. And then, so what I do is I take that information and put it through a program and then also go through it with this long Excel sheet that I have that has a lot of different of the expressions and what they can mean and what they’re significant for, for different health reasons. Then I compile this report and I go over that with my clients. And it looks at different factors, so it looks at the foods that you eat, supplements, athleticism, hormones, the way you detox and sleep patterns. Those are main areas of epigenetics.

Dr. Weitz:                           When you take the results from that test, what exactly are you getting? Are you getting a genetic code? Are you getting the epigenome? Can you explain?

Dr. Beckman:                     I’m sure. It’s the genetic data, so it’s your genetic blueprint and it is grouped in certain … it’s put in certain groups to test a variety of the SNPs together. When you’re looking at something-

Dr. Weitz:                           Can you explain what a SNP is?

Dr. Beckman:                     That’s basically just like the single nucleotide morphism. It’s the little genetic codes for each area, but what we do is we look at the ones, so you … Sorry, you need to look in a grouping of things. It’s not that great to single out one genetic code and say, now you have this. You know what I mean? We look at a group together usually-

Dr. Weitz:                           What software do you prefer to use?

Dr. Beckman:                     I use the software from APEIRON. And then I pair that with, like I said, this kind of like long Excel sheet that then I dive deeper into which one is the norm and which one is the exception. And so then it gives you some more probabilities of how this might express in your system. This is all just the genes and then

Dr. Weitz:                           How many genes are you analyzing with this software?

Dr. Beckman:                     Oh, shoot! I would have to look it up. I don’t remember.

Dr. Weitz:                           Okay.

Dr. Beckman:                     I’ll look it up so you can put it in the notes though. But it’s very comprehensive.

Dr. Weitz:                           Okay. And then how does this help us?

Dr. Beckman:                     For example, one of my favorite areas is it gives an insulin resistance score. This is a probability that you might have, based on your genes, of your probability of having an issue or developing type 2 diabetes. It basically, for me, and especially because I’m very passionate about getting people to reduce their sugar consumption and because I think that it has such long lasting effects, but a lot of these clients have a high insulin resistance score, so … And they might not even know that. They could be someone, though that tends to be eating a lot of starchy carbs and things like that and is not really that cognizant of how much sugar they’re eating.  And so when I see this in someone’s report, to me it’s a really big push for them to start being mindful of that and to change that. Because that’s, as you probably see with your clients as well, prediabetes is so rampant and most people in their 50s and 60s and unfortunately now children are getting prediabetes at much younger ages. And so it’s something we can completely prevent.

Dr. Weitz:                          Which gene or genes are the ones that most commonly code for insulin resistance? Do you know those offhand?

Dr. Beckman:                     I don’t know them offhand, but I have-

Dr. Weitz:                          Okay.

Dr. Beckman:                     Do you want me to give? I have them right here. Okay, so the thing about the genes that’s kind of … so okay, this grouping is actually about 20 genes that we use to look to-

Dr. Weitz:                           20 genes for insulin resistance, okay.

Dr. Beckman:                     Yeah. This is one thing that I think is very important and I touched on a bit, it’s these grouping of genes. Often we hear about one specific gene all the time, but it really is how they work together. That’s one thing I really like about this company too, like is that it’s never just one gene and then you create this whole idea around it.  We hear about these famous genes, sort of from certain people and I think a lot is built on that-

Dr. Weitz:                           Some of these genes are now being referred to as diseases. “I have MTHFR”

Dr. Beckman:                     Right, exactly. And there’s actually a kind of a little joke that a friend of mine who’s another Functional Medicine doctor said. He just, it’s kind of like, no one would know that unless you recently went to a Functional Medicine doctor and you were told you now have this terrible disease that you need to change all these things.

Dr. Weitz:                           Or they could have gone to Dr. Google or Dr. YouTube.

Dr. Beckman:                     Yes, I know the amount of people actually that talk to me and ask about it, again, I just say actually we look at a bit of a grouping of a lot of genes to see how big of an impact that might be for you.  But that’s just one of them. You know what I mean? There’s a whole lot that are, like I said, they are getting well known.

Dr. Weitz:                           When a patient has … How do you determine how significant these genes are? Let’s say you have one copy, which means you’re … or heterozygous or two copies, which means you’re homozygous or you could have multiple copies of one, multiple versions of one copy of these different genes. How do you know when it really matters? And then do you need to wait until they have positive testing in terms of a fasting glucose and Hemoglobin A1C, et cetera?

Dr. Beckman:                     No. One thing that I like about this is that they give us clues. They give us areas to focus on. There are certain genes that have more weight than others. That’s why these ones, it is true, the ones that are more well known have more weight. But again, it’s still the grouping. Let’s say you have one that is more weighted and more significant, but then you have three that are totally normal. Then that average is your risk down a little bit less than if you were just looking at that one gene, because you do need to look at them together. I mean, the genetic code doesn’t work independently and genes don’t work independently unless it’s something very specific that has a genetic, very specific genetic disease where there’s one …  When you have that switch on one specific thing that it actually creates a very specific pattern or disease in somebody. But those aren’t as common as these groupings creating a probability, if that make sense.

Dr. Weitz:                           Let’s say they have an increased risk for insulin resistance, but they actually have a fasting glucose of 80 and a fasting insulin of three and their Hemoglobin A1C is 5.0. What do you do with that?

Dr. Beckman:                     This is one other thing I love. I love having this and then backing it up with data. I love using even regular lab tests and then Functional labs to basically get a better idea of what’s actually happening right now. Because the genes give you your blueprint and some of your probabilities; your lifestyle, your emotions, your exercise habits. Those are what really can turn things on and off and make significant change. When you have some of these probabilities and then you look and see what their Hemoglobin A1c it’s, it’s steadily creeping up and creeping up, then this person needs to make significant changes so that they can revert back to somebody who doesn’t have those extra probabilities or increased probability of getting the type two diabetes.

Dr. Weitz:                           Does everybody who has some of those genes that code for increased insulin resistance, do they all need to follow a low carb diet?

Dr. Beckman:                     Well, so again, I would say I like to look at them individually. Certain people constitutionally, according to Chinese medicine do better with some starches and grains. A lot of people don’t, especially if there’s some sort of autoimmune issues happening, things like that. I personally don’t think anybody does well with refined sugar. I mean, that’s not any type of news, but my main thing is really getting people just cognizant of how much sugar they’re getting, that they’re not even realizing. Most people never flip something over and read the label.  I tell everybody if there’s double digits, 10 grams of sugar in something, you should not be eating it. And then I give them an amount per day, so a max of 25 grams a day. My goal, like I said, is I don’t want people really having much sugar at all. There’s no benefit of having refined sugar. It actually is just more detrimental. And people, once they get it out, they start to feel better and it has a long reach, I believe in their health span in multiple ways.

Dr. Weitz:                           Right, okay. Give us some other examples of what you get from doing the genetics. And then explain how epigenetics factors in here.

Dr. Beckman:                     Sure. The epigenetics part really is … that is not tested in kind of what you’re getting with the raw genetic data. The raw genetic data shows you what areas you could focus on, so like, which foods would be helpful to silence some genes that might create a problem or the same. It talks about supplements, so sometimes certain supplements would be toxic to somebody if they take too much. But for example, a lot of people were taking a lot of vitamin E for a long time as an antioxidant. It’s one that can be toxic for a lot of people if they take too much of it. It actually shows that-

Dr. Weitz:                          Vitamin E?

Dr. Beckman:                     Yes. But it shows that in the raw genetic data. Some of those are pretty interesting. And then also checking the types of the B vitamins to take, for vitamin D. It shows, which is pretty interesting if people can get the benefit from the sunlight and absorbing it or if they’re not someone that actually can absorb much of the D from sunlight. Because I’m sure as you’ve seen with some of your patients, some people can absorb it really well and some people don’t. Even though they’re in the sun all the time, they’re still deficient.

Dr. Weitz:                           I’m amazed in Southern California how many people get exposed to sun all the time and their vitamin D levels are low.

Dr. Beckman:                     Right. Yes.

Dr. Weitz:                           I think it’s more common than not.

Dr. Beckman:                     Yeah. And a lot of people think … they just think that, and actually I was one prior to testing it is I just thought there’s no way I’m in the sun constantly. And you know, the first time I checked, I think I was at 19 and I literally-

Dr. Weitz:                           Very low

Dr. Beckman:                     … always in the sun because I love sun. I’m just not someone that actually absorbs it from the sun, so I need the supplementation. That’s one thing that I really love again is I’m sure you go by this too, is test, don’t guess.

Dr. Weitz:                           Absolutely.

Dr. Beckman:                     We assume all the time these things that we hear and have known for a while, but they’re not always accurate.

Dr. Weitz:                           Yeah. We occasionally get people with modest amounts of supplementation that their levels shoot up, but more common, it’s really hard to get the levels up. And sometimes doing modest supplementation, like 1000 or 2000 milligrams of vitamin D doesn’t do anything. And it’s not unusual that we have to go to like 10,000 a day to get up to those target ranges that we’re trying to hit, like 50 to 70 or 60 to 80 or something like that, nanograms per milliliter.

Dr. Beckman:                     Right, yeah. And that’s not something from, sort of, in the natural medicine world, we have not heard that. We just thought, if you’re out in the sun and the right hours of day without sunscreen, you’re fine. And as you know, vitamin D is one of those precursors that it’s implicated in over 200 genetic processes. It’s crucial on so many levels that it’s actually in an optimal range.

Dr. Weitz:                           Yeah. And of course we can measure vitamin D receptors and whether people are going to respond and produce vitamin E or absorb the vitamin D that they take in.

Dr. Beckman:                     Yep.

Dr. Weitz:                           How does genetics, how does that change a detox program?

Dr. Beckman:                     Sure. I can give an example of myself for one. I’m someone who, since high school had been doing detoxes. I studied Dr. Schultz’s products, got into that. And since you’re from LA, right, or you’re in LA. I’ve been doing Dr. Schultz’s products since I was a kid. I’ve been obsessed with detoxes since I was little and I did them seasonally. All of that.

Dr. Weitz:                           And what did most of these detoxes consist of?

Dr. Beckman:                     Sorry. Okay, so it’s like a bowel, kidney, liver detox with herbs and just raw foods. It was five days, but I would say–

Dr. Weitz:                           For five days you eat raw foods and you take a series of supplements in pill or tincture form?

Dr. Beckman:                     Yeah, tinctures, pills and tea. And I did this for years. Well, I wouldn’t say I loved it, but I love detoxing. And so I really thought that I was just cleaning everything out. It was great. And then I even did these things for preconception planning. I’m a huge fan of preconception planning, checking for heavy metals, things like that. And I had my daughter almost eight years ago now, but I thought I did all this to clean myself out. I recently did some testing with Great Plains Lab. I love their organic acid tests, their environmental toxin tests. And it turns out on my environmental toxin test, it was one of the most toxic they’d ever seen. No, it was terrible.  And, and I mean, granted, I live in LA, so there’s that factor, which is very big. But I literally have … I don’t use plastic ever. I don’t use any … ever buy bottled water, only grass fed meat. I’m one of the cleanest people that you would come across. Like I said, I even created my own skincare company because I was concerned that a lot of the things were stored in plastic when they had essential oils and-

Dr. Weitz:                           What kind of toxin showed up and where do you think you got these from?

Dr. Beckman:                     Well, basically almost, I think it was 15 out of the ones that they tested were all 75 to 95%. That means that I was in the highest group possible.

Dr. Weitz:                           Right, what kinds of toxins were these?

Dr. Beckman:                     They were still the ones from the plastics, so the Bisphenol A, the ones that have … they are all with the gasoline, very high. And that makes sense because I live in LA.

Dr. Weitz:                           Okay. Like MTBE and-

Dr. Beckman:                     Yeah. The MTBE was very high, the perclorates, high. That again is from the air generally and the rocket fuel, believe.

Dr. Weitz:                           Which was dumped into the water and-

Dr. Beckman:                     Yeah. And that’s the thing, but I-

Dr. Weitz:                           Still found in Colorado River where we get some of our water in Southern California.

Dr. Beckman:                     Yeah. And again, those things aren’t filtered out with filtered water. I mean, not everything can be. I mean, again, it depends on your system that you have, but a lot of the organophosphates from pesticides, things like that. And that’s the thing that was shocking to me-

Dr. Weitz:                            That might be a good marketing strategy. Get your rocket fuel water.

Dr. Beckman:                     I know. And it seeped into the groundwater. I mean, it’s terrible. And you know, you do everything you can, right? I mean, I buy organic products, but then I still eat out at restaurants. And I tell this to patients too. I mean, the meat is not grass fed out. And generally the fruits and vegetables aren’t organic, unless you’re really going for that. That’s the thing is that I know a lot of it is because I live in Los Angeles, but the main factor which came back to my genetics is that I don’t process or make glutathione like much at all.  I had never taken any precursors for glutathione. I’d never taken glutathione. I was doing these traditional detoxes that were still very strong, but they didn’t actually work for my system. I had also gone to the process where I was doing IV glutathione and it made me so sick within about five seconds. I realized that something was … that pushed toxins into my system and they were recirculating and then I felt sick instantly.

Dr. Weitz:                            That’s one of the things that can happen when you do a detox is a lot of these toxins may be stored somewhere in your body. And if you use a strategy that helps remove some of these toxins, they may not get all the way removed. They may come out of storage into circulation and then that can create a lot of detox reactions like you’re describing.

Dr. Beckman:                     Right. And so now the products I use are very different and they go into soak those up so that you basically … my whole goal is to really minimize any detox reactions that people have. And I think a lot of the things that we used before, if your body and detox pathways weren’t prime to deal with that, that’s where everyone’s getting really sick and nauseous and headaches and those are just minimal side effects. It’s really important to do a detox properly and prime the pathways, and have the binders in there that will soak it up properly.

Dr. Weitz:                           Okay. So you’re saying your detox now that you’re doing involves binders and what are some of the substances involved in binders?

Dr. Beckman:                     I use some products that have fulvic and humic acids. I like them a lot. The way that they have been described to me is that they are much more effective and powerful at soaking up things beyond an activated charcoal because the activated charcoal does not have enough energy left in it to actually go in and soak a lot of that.

Dr. Weitz:                           Activated charcoal is one of the most common substances being sold as part of a binding product or separately. And in fact charcoal is right now being used in many consumer products. You can find-

Dr. Beckman:                     It is. Charcoal lemonade.

Dr. Weitz:                           Exactly.

Dr. Beckman:                     And charcoal toothpaste is everywhere.

Dr. Weitz:                           Yeah.

Dr. Beckman:                     I have changed what I’ve done-

Dr. Weitz:                           Those two, what other substances do you find effective for as binding agents? What about modified citrus pectin?

Dr. Beckman:                     Yeah, I like that. And it’s-

Dr. Weitz:                           Cilantro.

Dr. Beckman:                     Yes. And it just depends the … everyone is a little bit different, so some people can handle one type and other people can’t. Some people are so sensitive and so bound up that they basically really need something super gentle. And sometimes I start people off with the homeopathic detox so I can go drop by drop because there are patients that are that sensitive. There’s a wide spectrum, but I think that it’s really important to prep the body before dumping it, like getting all these toxins just dumping into your system without anywhere to go.

Dr. Weitz:                           How long should a detox program take?

Dr. Beckman:                     I would say always customize the patient kind of, so that’s why I like the testing because we want to see if there’s mold exposure, what the viral load is, possibly what the bacteria situation is, what’s going on with the gut, fungal issues, metals, parasites. So it all depends.

Dr. Weitz:                           How do you determine what testing to do and what testing is … Do you have a standard screen or does it depend on history?

Dr. Beckman:                     Yeah, it depends on history. I pretty much always run the organic acids test with Great Plains. I love the mycotoxin test if they have anything positive on the oat. I love the environmental toxin test to see what’s happening there. Some sort of heavy metal testing, I use the Mercury Tri-Test a lot from Quicksilver.

Dr. Weitz:                           Okay, so that utilizes a combination of serum, urine and hair mercury testing?

Dr. Beckman:                     Yes. And then still if they need to check for other metals, can do a metals test. Let’s see what else I love. I mean, I add in the genetics so that we can put that piece in there. And then sometimes like a GI-MAP for stool or to see what’s going on in the gut or as a Zoomer test, Gut Zoomer test.

Dr. Weitz:                            Okay. Just out of curiosity, what’s the approximate cost of that genetic test you’re talking about?

Dr. Beckman:                     The genetic test varies based on kind of how many areas you want to look at. People can get, let’s see like-

Dr. Weitz:                           Just ballpark.

Dr. Beckman:                     All right. Like $1,000.

Dr. Weitz:                           Okay. Now they can get a 23andMe or Ancestry for $100.

Dr. Beckman:                     Yes.

Dr. Weitz:                           Is it that much better?

Dr. Beckman:                     Well, I just think that 23andMe is sort of fluff. It’s not actual information that you can utilize much for your health. That’s what I’m thinking, but it has … it’s like, do you turn red when you’re drinking? Do you have-

Dr. Weitz:                           No, but even if you get the raw data, there’s not enough genes there?

Dr. Beckman:                     No. They’ve changed it a bit and there are less, but there … I mean, yes, the raw data on itself is good, but you are giving up your privacy, which I 100% think is not a good idea.

Dr. Weitz:                           I agree. But I doubt there’s any privacy in our society since they’re monitoring every phone call, every email.

Dr. Beckman:                     I know. If someone really needed to, they could link up everything that you … if they were really trying to find that out for you.

Dr. Weitz:                           Your phone is monitoring every place you’re going. Your phone right now knows that you’re talking to me, where you are. I mean, yeah.

Dr. Beckman:                     I know. It’s so scary. You could talk about something your phone’s off and then that’s all your Instagram feed, Facebook feed, you know everything. It’s true there really is no privacy.

Dr. Weitz:                           Absolutely. I got in my car this morning and my phone says it’s 13 minutes to Gold’s gym. How do you know I’m going to Gold’s gym, right?

Dr. Beckman:                     I know. It’s pretty scary.

Dr. Weitz:                          How does the detox program … you were talking about epigenetics changing your detox, so give me a little more meat on the bones there about how you change the detox according to epigenetics.

Dr. Beckman:                     Basically what I do is, I mean I have a program that I use with a lot of people, but what gets tailored is what we focus on first based on what shows up in their labs and then with their genes. If there’s somebody that can process toxins better, then they might not need as much time in the prep phase. Or if there’s somebody who tends to be more sensitive to metals, then we might need to work on that a lot longer.

Dr. Weitz:                           What’s the prep phase?

Dr. Beckman:                     Sorry, so that’s where we … Certain people need certain foundations, so that would be where I would put in certain vitamin deficiencies that they might have or just optimizing some of their nutrient levels so that they’re prepared to start a detox. And then again, and this part is a bit traditional. We still want to make sure that the bowel is functioning really well. If someone’s constipated, you have to get that under control before you start anything.

Dr. Weitz:                           Number one, you want to make sure somebody is not deficient in nutrients. How do you determine that? You do some sort of nutrient panel?

Dr. Beckman:                     Yes, I can do a nutrient panel. The organic acid test does have part of that in there utilized as well. There are special tests you can do in addition to just see. The SpectraCell has a micronutrient deficiency panel, which can be good if people like that. I use the organic acid one quite a bit.

Dr. Weitz:                           Okay, so you’ll beef them up with some nutrients first to get them ready for the detox?

Dr. Beckman:                     Yes. Then we look at their bowel and make sure that, like I said, they’re not constipated. Make sure they’re going to the bathroom twice a day as ideal.

Dr. Weitz:                           Because if they’re constipated, they’re going to be recirculating the toxins, correct?

Dr. Beckman:                     Yeah. And that happens a lot with estrogens and different toxins and things like that. And then we make sure we look at the lymph, the kidneys, and the liver. I have special supplements for that as well.

Dr. Weitz:                           How do you look at those?

Dr. Beckman:                     Sorry, not look. I just mean address-

Dr. Weitz:                           Okay, so you give them supplements to make sure those are working properly?

Dr. Beckman:                     Yes. Yeah. And then we figure out what-

Dr. Weitz:                           What do you give him to make sure the kidneys are functioning properly?

Dr. Beckman:                     Let’s see. There’s some different herbs that, sorry … There are some herbs that I use. I like some homeopathic tinctures too. You mean which specific herbs?

Dr. Weitz:                           I was just curious. You have some kidney formula you like to use in some-

Dr. Beckman:                     I use CellCore products a lot. I really like them. They have a great kidney-liver formula. And then, I mean, I’ve used other ones in the past too. I also use some products from Designs for Health. They have some great detox packets that are super simple and altogether. And then they have some that are spread out, individual products.

Dr. Weitz:                            Okay. Yeah, go ahead. So you support lymphatic’s, the kidneys, the liver?

Dr. Beckman:                     Yep. Then we need to make sure too what’s going on with the gut. We need to see if there’s any intestinal permeability to make sure that we’re working on the lining. I check, if there’s someone who has a lot of autoimmune or food sensitivities, we need to make sure that’s a big factor. See if they need to eliminate some foods just temporarily, if it’s making things worse. Often I see a lot of issues with gluten, dairy and sugar. Nobody really likes to hear that, but initially I just ask if they can try to go off things for maybe 30 days minimum to just see if we can get some information down as well from what they’re putting in their body.

Dr. Weitz:                            What’s a specific food regimen you put them on? You eliminate gluten, dairy, and what else did you say?

Dr. Beckman:                     Refined sugar. And then-

Dr. Weitz:                            And refined sugar. Are there other things or just those three?

Dr. Beckman:                     It all depends on the person. If there’s somebody who already has a lot of issues, we need to see what would be specific for them. Some people think they’re totally healthy and they don’t feel anything from food, so they … it’s a big deal for them to just get off of sugar. I work with the client to see where they are too. But if someone who-

Dr. Weitz:                           Get them off of caffeine and alcohol as well while they’re doing the detox?

Dr. Beckman:                     Yes. The caffeine is less of an issue for me. If someone can get off all those other things and they still want one cup of coffee a day, usually I say that’s okay. But-

Dr. Weitz:                           Especially if it’s organic.

Dr. Beckman:                     Yeah. And I then love Purity and Bulletproof Coffee. I at least send them to ones that are mycotoxin free and tested. And just, yeah, it’s all about, to me, making healthier choices and swaps too. If I can get people to just make some better choices in their life, get off the granola and yogurt, they start their day with that has 25 grams of sugar, get them onto something that’s healthier. I think those are all big wins and can take them a long distance.

Dr. Weitz:                           Yeah. Or their Count Chocula cereal.

Dr. Beckman:                     Oh yeah. Or even cheerios. There’s better things to do. There’s all these … We have to pick our battles, right? And food is a really one that people like grip on and hold tight to or they have, again their favorite cup of coffee with sugar and cream. And so if I can get them to switch to a healthier version of that, then I feel like I’ve had a good win. And that they will benefit greatly. Because again, I say to people, we often have to look at our daily habits cause it’s in our daily habits where we see some of these really big things that make a big difference, so we can change those. It’s very important.  And even hydration. Many people still just don’t drink enough water. And these are core foundations that if you don’t have sleep, hydration, good food and exercise and some form of meditation, it’s hard to build a base from that.

Dr. Weitz:                           How do you know if somebody is drinking enough water and how much water is enough?

Dr. Beckman:                     I look at their caffeine intake for sure. A lot of people are drinking way more caffeine than water, so that’s my first area to start with. I still do go by the half your weight and ounces. I know some people say that works, some people say it doesn’t. I think it’s a good barometer just to start with. Most people though are drinking so little water that I tell them to just double what they’re doing. And honestly for a lot of people they’re drinking two glasses of water a day. Then I say, drink four and that seems like a stretch for them, but it’s not a huge stretch. If I tell someone that’s drinking two glasses to then go to half a gallon, that doesn’t make any sense to me, and they don’t do it. Sometimes it’s baby steps and-

Dr. Weitz:                           Try to meet them where they are and get them to make changes that are reasonable.

Dr. Beckman:                     Exactly. Again, those are some of those things that are in the beginning part of a detox and the prep phase, is really just getting their foundation solid and then getting them prep so that we can then start addressing the things that are more pertinent and causing more damage, I guess I would say. Like the gut bacteria, the fungus, any sort of mycotoxins, viruses, bacteria … sorry, parasites and then metals we do last usually.

Dr. Weitz:                           Okay, so then-

Dr. Beckman:                     It can be awhile.

Dr. Weitz:                           Right, so multi-phases of this program?

Dr. Beckman:                     Yeah. And it’s based on the lab testing to see what’s there. We want to a lot … for people in general, we have things where basically a big host for a lot of different organisms. And so to think that they’re not all living in us I think is sort of inaccurate. It’s basically something’s high. You know, we have viruses that just lie dormant and then they get activated. Basically if we can create our system to be a good environment, then it’s kind of the best shot we have. And then [crosstalk 00:43:16] up things that are creating damage.

Dr. Weitz:                           Let’s do a couple of sample detox programs. Let’s say the person tests high in mercury. What’s your preferred protocol for that?

Dr. Beckman:                     I do use a lot of Quicksilver products and CellCore products. They have really great binders for pulling out heavy metals. CellCore has something called HM-ET, which I really love. But again, this is the thing. This is all done after months of preparation. You don’t just go in and start trying to pull out heavy metals, which is what everyone wants to do. And that’s where people feel really sick. And another thing is heavy metals can reside inside parasites. If you don’t kill the parasites first, then you could be pulling out all these heavy metals and then you haven’t even addressed the parasites and then you could be releasing more metals that you thought you’d cleaned up.

Dr. Weitz:                            Get rid of parasites and clean up the gut, get rid of nutritional deficiencies, show the body up that way, support the basic organs and then go for the metals and the other toxins?

Dr. Beckman:                     Yes. Yeah.

Dr. Weitz:                            Do you incorporate glutathione in that detox protocol for mercury?

Dr. Beckman:                     I do. I do use glutathione even earlier in the phase to just start helping support the liver, helping it support what already is there before we’ve really started to detox. Sometimes using a precursor like NAC, just it depends on how the person is and what they can handle. A lot of clients have had so many bad issues with taking really strong chlorella, things like that. I just have to be careful with … I tend to get a lot of patients who are really sick and really toxic, so it’s just seeing what works for them and creating something that has the minimal side effects.

Dr. Weitz:                            How long does it typically take to get rid of mercury?

Dr. Beckman:                     Kind of depends on the levels and it can take a year, but that’s the whole thing. You know what I mean? That’s at the end. I wouldn’t just target mercury and it would be so rare that nothing would come up before then. I mean, that actually wouldn’t happen. Like, you know what I mean? No one would just have a mercury issue. I’ll just say.

Dr. Weitz:                            Okay, so what’s your protocol for mycotoxins, which is for mold?

Dr. Beckman:                     Right. Again, I do use CellCore products for that. And so I love the mycotoxin test, because then you can see exactly which ones are the strongest. And again, you still have to really prep the body first, of course, which we talked about. And then in Chinese medicine too, like we want to see what’s happening with the lungs. We want to support. Sometimes I use some other herbs that are kind of like a lung support. Yeah, I know the mold … that’s the thing about mold is it can go everywhere and anywhere, so that’s why it’s extra detrimental. But a lot of people, a big part is from inhalation. I work on a bit with stored grief and sadness with the lungs and we want to make sure just to always addressed the emotional issue of things.  And detox is stir up a lot, because they deal with lungs, they deal with liver, which is related to anger and resentment and depression. A lot of people have some issues with that. We just want to make sure that we’re addressing the emotional side of things as well as the physical.

Dr. Weitz:                            Okay. How do you address the emotional side of things?

Dr. Beckman:                     Well, I love acupuncture and if someone’s not local or not getting acupuncture on the side, there’s visualizations with color that support each organ. And as with Chinese medicine and this people know, the emotional side and the physical side, they’re intertwined. When we’re treating a physical condition, we want to also address the emotional aspect of that. One of my favorite things again is acupuncture, meditation, and then some visualization.

Dr. Weitz:                            Okay. I think that’s pretty good. Everything is-

Dr. Beckman:                     Yeah, we covered a lot.

Dr. Weitz:                            Yeah. I think we covered a lot. Any other specific things you’d like to make the listeners aware of or talk about?

Dr. Beckman:                     No. My main thing is that, and this is what I talk about with my clients every day, is you have a choice every day. You choose what food you put in your body, you’re choosing what products you put on your body, you’re choosing some of the thoughts you have, the way you live or lifestyle. And it’s so crucial for us to be mindful of what we’re doing that everything that we’re doing is either feeding our body or doing something that’s going to make it harder and possibly leading to disease down the future.

We have so much control and I think we forget that. And I see our body as a machine and what we’re doing and putting into it as fuel, and we want to be putting the best quality fuel in it. And you know, we have these beautiful bodies and so we just need to take care of them and you get to do that.

Dr. Weitz:                           All right. How can listeners and viewers get a hold of you and find out … how can they contact you?

Dr. Beckman:                     Sure, my website’s, drashley.com, and that’s D-R-A-S-H-L-E-Y.com. And I always offer a complimentary call if someone wants to just see if we’re a good fit to work together.

Dr. Weitz:                           And so you can work with them by phone?

Dr. Beckman:                     Yes.

Dr. Weitz:                           And if they’re in the Los Angeles area, where’s your practice?

Dr. Beckman:                     I’m in Beverly Hills and in Malibu.

Dr. Weitz:                           Okay, great. Thank you Dr. Beckman.

Dr. Beckman:                     Sure. It’s always fun.

Dr. Weitz:                           Thank you.




Integrative Pediatrics with Dr. Joel Warsh: Rational Wellness Podcast 140

Dr. Joel Warsh discusses Integrative Pediatrics 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

2:26  Dr. Warsh sees Integrative Pediatrics as blending the best of Western medicine with holistic and Functional Medicine.  Dr. Warsh got frustrated with the regular system and was frustrated that the only treatment in most conditions is pharmaceutical medications.  He has found that there are many situations where you don’t need a medication and some dietary changes or a nutritional supplement might be better. If the child is sick with a virus, then an antibiotic isn’t going to help and might make them worse, and this is a great time to use a natural approach. On the other hand, if there is something serious going on, your child may need an x-ray or an antibiotic or may need to go to the hospital.

6:07  A cough is a common symptom of a cold or a flu.  The best way to prevent colds and flus is to focus on what Dr. Warsh calls the SEEDS of health: Sleep, Exercise, Environment, Diet, and Stress.  These are the foundations of health.  When your child first gets a tickle in their throat or a low grade fever before they get really sick, that’s a good time to use vitamin D, vitamin C, elderberry, or some essential oils or colloidal silver to help their body fight it off.   

10:27  Dr. Warsh generally finds most herbs to be safe for children and certainly much safer than many pharmaceutical medications.

12:51  Homeopathy is extremely safe for children, as it is for adults, and can be very effective at times.

17:15  Fever has benefits and helps the body to fight off illness and there is not much risk of harming the child until it gets to 104-105 degrees.  Taking Tylenol or ibuprofen should only be done if the child is extremely uncomfortable or has severe ear pain, but not to lower the fever unless it is 104 or higher. Taking these medications will actually increase the length of your infection. It’s also a good idea to double check the temperature by getting a second thermometer, since some of these thermometers can be inaccurate.  If the fever continues for a month or longer, then you should go the hospital for a full workup.

21:23  Diet is important and Dr. Warsh is a moderate on diet and tends to avoid extremes. He feels the focus should be on eating healthy, whether that includes meat or not. You should eat the rainbow of different colored vegetables and remove the sugar, preservatives, food coloring, and crap out of your diet. If you eat meat, it should be grass fed and sustainably produced.  Fish should be wild and not farmed. You should eat as clean as possible.

23:45  Toxins can play a significant role in the health of our children. We live in Los Angeles and we are surrounded by toxins in the air, food, and water.  Toxins lead to inflammation and it’s one of the reasons children are getting more and more sick.  It is playing a role in the rate of chronic diseases, such as asthma, ADHD, autism, rheumatoid diseases, lupus, and eczema, which are epidemic now. According the CDC, 10% of kids have mental health problems, 7% have anxiety, and 3% have depression and toxins are playing a role in these conditions.  You should have an air filtration system in your house. You should get a reverse osmosis filtration system for your water and you should avoid tap water. Avoid using chemicals to clean your homes and use baking soda, vinegar, and essential oils.  It’s good for kids to get exposed to germs and to play in the dirt, since it stimulates our immune system and our microbiome. Kids that play in the mud and live on farms and in rural areas have lower rates of allergies than kids that live in the city.

29:40  We used to have kids avoid peanuts and common allergens when they were young, but the rates of allergies skyrocketed and now it is recommended that we purposely expose kids to peanuts and other common allergens at six months, since this leads to a lower rate of allergies. The thought process has completely changed. On the other hand, with a little older child who has a lot of allergies or asthma or eczema, the first thing to do is to have them clean up their diet and remove gluten and dairy.

32:17  While serum food sensitivity testing can be helpful, it can be difficult to get kids to have blood drawn and it can be a big expense, so tries to work with the diet first and see if using an elimination diet can resolve symptoms.  But in some cases, food sensitivity testing is warranted and can be helpful.

33:51 Dr. Warsh finds that for eczema, calendula, coconut oil, shea butter, and castor oil are all good to use on the skin, and fish oil can be helpful. Vitamin D and E are beneficial and eating some turmeric, such as in a smoothie, and quercetin and bromelain can also helpful. 



Dr. Joel “Gator” Warsh is the Medical Director of Integrative Pediatrics and Medicine Center in Studio City in Los Angeles, California. Dr. Warsh is certified by the American Academy of Integrative Medicine. He has published research in peer-reviewed journals on topics including childhood injuries, obesity, and physical activity. He has been featured in documentaries, podcasts, and articles, including Broken Brain 2, Dr. Nandi Show, CBS News, LA Parent, Dr. Taz Show, and many others. You can learn more information about Dr. Warsh by going to IntegrativePediatricsandMedicine.com.

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


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. 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 podcasts or whatever podcast app you use and please give us a ratings and review. Also, if you’d like to see a video version, go to my YouTube page. If you go to my website, drweitz.com you can find detailed show notes and a complete transcript.

Today our topic is integrative pediatrics, which means incorporating holistic and functional medicine along with conventional medical care when providing health care for children. This means using nutrition, nutritional supplements, and various natural healing methods and avoiding prescription meds except when absolutely necessary. There is also a focus on promoting health and preventing illness rather than just treating sickness.

Our special guest is Dr. Joel Warsh. He’s an integrative medical practitioner who’s certified by the American Academy of integrative medicine. Dr. Warsh started the Integrative Pediatrics and Medicine Center in 2018 in Studio City in LA County of California. Dr. Warsh has published research and numerous peer review journals on topics including childhood injuries, obesity and physical activity. He’s been featured in various documentaries, podcasts, and articles including Broken Brain 2, Dr. Nandy show, CBS news, LA parent, Dr. Taz show and many others. He has an upcoming pediatric summit and also a online course, so watch out for those. Dr Warsh, thank you so much for joining me today.

Dr. Warsh:           Thanks so much for having me. I’m looking forward to it.

Dr. Weitz:            Great. What is integrative pediatrics and is it commonly accepted by mainstream medicine?

Dr. Warsh:           It’s a great place to start. The first thing is I don’t think there is a specific definition of integrative pediatrics. I think everybody defines it a little bit differently. But to me it’s blending the best of Western medicine with holistic or alternative medicine. It’s not that you’re picking one or the other, it’s doing whatever you think is best on that day.  What got me into integrative medicine in the first place was just being a bit frustrated with the regular system and really only having pharmaceutical medications to treat everything. My wife is very holistic minded and I had seen some of her friends go to natural paths after being adopters for many years and they would get better. I was like, “There’s got to be something else. What else is there to learn?” That’s what really spurred me to start learning about functional medicine and homeopathy and supplements and then blending those two together.

Because what I found is that a lot of times you don’t need a medication. Parents definitely want to do something when their kid is sick. But a lot of times if it’s a virus then really an antibiotic or another medication isn’t the answer and isn’t going to do anything, it might even make them worse. It’s a really good time to see if there’s something natural that you could do.  But also you want to have that Western side as well because maybe something natural isn’t the right thing to do in a situation where there’s something serious going on, you need to go to the hospital, you need an x-ray, you need an antibiotic. That’s where blending those two together are important.

Then for your second question, it’s not very accepted in regular Western medicine yet. I think it’s moving in that direction. There’s definitely more focus and discussion around prevention and some of the natural modalities are starting to be accepted. Acupuncture is probably the best example of that where it used to be woowoo and crazy and now you see it everywhere with the opioid epidemic and you see it in hospitals. Slowly some things are moving into Western medicine, but it’s not fully accepted by a lot of practitioners yet.

Dr. Weitz:            I think one of the issues is that if you’re going to use preventative, nutritional, integrative medical approaches, it takes more time. The current medical model based on insurance companies controlling things makes it very difficult.

Dr. Warsh:           That’s correct. Number one, with the system as it is today, it’s really hard to spend 45 minutes or half an hour or an hour with a patient, which sometimes is really what you need to go through and get an extensive history. It’s oftentimes a lot easier with a cough or a cold to say, well, just take this antibiotic and then you cover yourself and get them out the door. That certainly is a part of it.

But the other part is there’s a lot of training involved and even learning about natural medicine. You really need to have a lot of communication with your patients when you’re using something natural because things can progress pretty quickly. If you have, let’s say a cough for example it’s a really good example. You have a cough, patient comes in and they’re totally fine, then that might be a great time to do something natural, but you have to be in really good communication because that could change really quickly. They could get pretty sick and then the natural remedy isn’t the right tool that time. Might need an antibiotic.  That Western model where you might have four or five, 10,000 patients in your practice or however many you have, it doesn’t necessarily work as well for natural medicine because you really need to have that good communication to know when you have to step up the treatment to something that’s more Western.

Dr. Weitz:            You brought up a cough and that’s a common symptom of flu. Right now we’re in the midst of cold and flu season. What can be done from your perspective in preventing and treating children with colds and flus, besides giving antibiotics, which probably shouldn’t be indicated at all, since these are caused by viruses?

Dr. Warsh:           That’s correct. For me, what I always focus on with patients is the prevention. We always talk about the foundations of health. A term that I coined was the seeds of health. Sleep, exercise, environment, diet and stress. These are the big factors that we really need to think about because nowadays we have almost forgotten about these basics. Whether you look at Functional Medicine or Ayrevedic or all of the other modalities, this is the foundation of all of those but in Western medicine we’ve forgotten a lot about it.  Certainly if you go to the doctor, they might talk to you for 30 seconds about physical activity or making sure you can exercise. But that’s not really what we mean when we talk about the foundations. It’s really setting up a good lifestyle. You might need a 30 minute or hour discussion with a nutritionist or a health coach just about a child’s diet really making those major changes overall.

That’s really where to me it starts and it starts with those checkups or the well visits where you discuss a little bit more about these foundations. Because if you have a good foundation then you’re not as likely to get sick. We know this, this is not woo woo, this is not alternative medicine. This is Western medicine. There’s plenty of studies where they took viruses and they put them into nodes of patients. Some that were stressed, some of them were not stressed, some that were sleep deprived, some of them were not sleep deprived.  Anytime these foundations are not there, you’re much more likely to get sick. That comes into play with something like the flu. We know this because what happens when you have a test and you’re studying? You’re going through, you’re really stressed. Five minutes after you’re done studying and your body calms down after the stress, you get sick. It’s common knowledge.  We just need to remember this common knowledge is things that we used to talk about and get back to the foundations just like diet. Because we’re literally built of what we eat. If we don’t eat healthy and we don’t have the nutrition then our body doesn’t have those building blocks for our immune system to fight off the infection. That to me is the key overall, is really thinking about the seeds of health and the foundations and setting yourself up for success.

Then when you first get sick, before you really know what’s going on, you start feeling that little bit of tickle in your throat or a little bit of a low grade fever, that’s a great time to try to really do some great view and support. It depends what the situation is, but things like vitamin D, vitamin C, elderberry, essential oils, all sorts of things can be helpful that first three, four hours. If you get some of that stuff in your system, then hopefully your body’s able to fight it off a little bit better before you get really sick.

Dr. Weitz:            Do you have a favorite formula? Should we just hit the vitamin C? Should we hit the vitamin C, vitamin D and the elderberry?

Dr. Warsh:           It’s hard because with kids especially, it’s always been… Anybody it’s going to be different and unique to each patient. With kids, every age group is very different. It really would depend on how old the patient is because obviously a newborn or a two month old would be very different than a 15 year old. You’re very limited with the babies and that’s why I think this advice is very cautionary in terms of you really need to speak to your practitioner before doing any of this stuff, especially with a baby. Because it’s a completely different scenario with one month old who is sick than a 15 year old who says, yes I have a little tickle in my throat.  But in general for the older kids, I think a good multivitamin is going to be helpful. Vitamin D will be helpful. Vitamin C, elderberry. Some people like colloidal silver. It depends on what the scenario… But we’re talking about flu and those are some things you can think about.

Dr. Weitz:            Okay. Do you recommend a high dose vitamin C for that type of situation?

Dr. Warsh:           Usually. I mean it depends and there’s so many different formulations out there, but I’ve used Metagenics before with patients that I have in my office. It will depend on the age, but I don’t usually… Each patient is different so it’s hard to say what the dose would be. But yes, a good dose of vitamin C at least once or twice is going to be helpful.

Dr. Weitz:            Are herbs safe and effective for children?

Dr. Warsh:           I think so. I think to me this is one of the biggest misnomers out there. I think it’s a little bit funny when having discussions with my Western practitioners about this, because these are things that have been used for thousands of years and we call it alternative, but really Western medicine is what’s alternative. That’s the thing that’s been around only 50 years or a hundred years or however long you want to go back.  Sometimes you hear things like, “Oh, you’re going to get… You’re going to try peppermint oil with a child. That’s so dangerous. How could you do that?” That makes me laugh because comparing it to the Western treatment which… Look, everything has risks, right?

Everything has risks, everything has side effects. Everything could possibly have an allergic reaction. When you have a 10 year old who has a little bit of sniffles and you’re trying a little peppermint essential oil, that versus using over the counter cough syrup, the medication has a list of known side effects this long. We don’t even look at it and it’s like, it could cause death, could cause allergic reaction, all these hundred things.  These are known risks versus maybe one child at some point somewhere had a reaction to some not so good herb that was made improperly or had some contaminant. Which one is at more risk? To me it’s crazy and again there’s certain situations where certain herbs and natural things are not safe for sure. Of course that’s true. That’s where we need good science and we need good research and we need good practitioners to know what are the right things to use when.

But in general, for a child who’s not severely ill, a natural item, a natural herb, a natural supplement is almost always going to be way safer than the medication. There’s so many risks to every medication. For whatever reason we’ve forgotten that because you see on the news that anything bad happens with the essential oil or homeopathic, but realistically, if we use our brains for one second, we know that that’s not true. But that’s why the practitioner’s important. You can’t just use the herb because it might be serious. You have to go see a Western doctor, make sure there’s no pneumonia going on, then that’s a good time to try the natural thing.

Dr. Weitz:            What about homeopathics? Do you like those for children?

Dr. Warsh:           That’s a… It’s an interesting topic and I think homeopathy of all the modalities is probably the most controversial, I would say. Just because it’s not used that commonly in Western society. It’s very commonly used in Europe and in other countries. But it’s not that commonly used here. Philosophy is a little bit counterintuitive to anyone who has a scientific mind.  For those that don’t really know, basically using very small diluted doses, using like to cure like or to work with like and so, if you have something that causes… You have a cough, you give something that might cause a cough or stimulate a cough to try to help the body balance. Some people are extremely into this and think it works amazingly, I don’t think it’s all hooey. I think there’s very minimal risk and if you work with a trained homeopath that knows what they’re doing and it seems to work for you, then there’s no reason not to try it.

It’s far and above the safest modality out there. I think really the big question for most people is, does it really do anything or are you just wasting your money? That’s a question that each person has to decide on their own. But you talk to people who take homeopathics and work with homeopathics and most of them love it. Say it works amazingly, say it works better than most medications.  I think if it’s done correctly with somebody who’s trained in it, then it’s reasonable. Just going to the store and picking up a random homeopathic, is that going to work? Maybe, maybe not. But again, it’s safer and if it helps even a little bit, avoid using a medication, then that’s a good thing.

Dr. Weitz:            I agree that homeopathics are super safe. They’re typically using a product that’s so dilute. All there is is the original energy of the original substance in there. On the other hand, looks like our government is said to be banning homeopathy pretty soon here.

Dr. Warsh:           I mean, there’s always discussion about that. I don’t know… Who knows whether it’s actually going to happen or not.

Dr. Weitz:            Well no. Apparently the FDA now has made a ruling that homeopathics are going to have to be approved as drugs. No homeopathy companies have the money to do that type of study to prove this. Homeopathy has been banned in England. This started in Australia, there’s actually a movement to try to ban homeopathy around the world.

Dr. Warsh:           I mean it’s a tough fight because it’s not the same as Western science and so anything that’s different and that can be proven that way has its issues with-

Dr. Weitz:            No, I think what you’re referring to especially is the fact that when you take a homeopathic formulation and you dilute it another hundred times, it’s considered to be more stronger, more powerful. The more you dilute it, the more powerful it gets supposedly. That’s one of the parts of homeopathy that seems very counter to Western scientific thought.

Dr. Warsh:           It is, it’s very different. But then again, the interesting part to me is things like allergy shots and stuff like that where it’s a fairly similar concept where you’re giving very dilute minute doses of something to help the body and immune system create a tolerance to it. It’s so hard because energy is such a foreign concept and it’s like, oh, this is all crazy we’re talking about energy.  But then again, you talk about the moon and how the moon affects the tides. We’re obviously all made of energy and particles and so there is some definite science there. I just don’t think we’re smart enough to understand everything yet. I think it’s frustrating that we’re not open to these discussions, especially when things are safe. I think we need to spend more time studying these as opposed to just thinking they’re crazy because they’ve been used successfully for so many generations in so many places. Just to ban to me is not the answer, is to study it more thoroughly.

Dr. Weitz:            The reason why it would be getting banned is most likely because it’s competition with medications. Since we’ve been talking about colds and flus, I’d like to bring up the concept of fever. What do you think about the whole concept of fever? Typically parents have a kid with a fever and right away they’re rushing for Acetaminofene or other medications to bring the fever down.

Dr. Warsh:           Sure.

Dr. Weitz:            But fever actually has a lot of benefit. It’s part of the way the body fights off an illness.

Dr. Warsh:           For me, that’s a big part of discussion in my office all the time. It’s probably one of the top three most common messages and texts that I get from parents all the time about fever in their kids. A little bit of is education about it. I think it’s a great topic to bring up because it’s so important to recognize that fever is beneficial. Fever is not the thing that we should be worried about. Fever gives us an indication that our kids are sick or that we’re sick.  A fever in and of itself, unless it’s super high, is not really dangerous. It’s pretty hard to get a fever high enough that it’s dangerous to your brain. Once you’re getting over 105 that’s pretty high. But in general, unless you’re talking about a newborn baby in the first few months, when a child first gets a fever, you don’t necessarily need to do anything about that.

It’s not the fever that the doctor is worried about. It’s the fever and the symptoms. I am much more concerned about a child with a 101 fever who’s lethargic, having trouble breathing than a kid with a 104 that’s running around and playing. If the reason to use Tylenol, Motrin, Acetaminophen and ibuprofen would be because your child is extremely uncomfortable.  If your child has a 102 fever, a little bit of congestion, then the reason your body is raising your temperature is to fight off the infection to make an inhospitable environment for the infection that way it kills it faster. There are plenty of studies out there now that those who take Motrin, Tylenol, it does increase the length of your infection by a little bit as well. Is it really damaging to children? It’s probably not super damaging, but any medication can have side effects.  Certainly over a million kids, one kid takes Tylenol, it’s going to affect that kid pretty severely. But here and there using medication, it’s not going to be a huge issue, but use it when you need it. Just because your kid has a little sniffles in a 101, to me that’s not a good time to use Tylenol. It’s if they’re miserable 104, if severe ear pain, something like that, it’s a good time.

Dr. Weitz:            You’re saying 104 would that be the cutoff for when you think fever might be high enough where it could cause brain damage?

Dr. Warsh:           Based on the research that I have seen and what we learn in residency, it’s above 105 where you start to worry. I mean when you’re getting into 106, 107 that’s when it’s pretty high. But the reality is most of the time when you have a temperature that high, it’s the thermometer that’s off. It’s not actually the temperature that’s that high. If you’re getting a really high temperature, my first advice always parents, get a second thermometer and make sure that that’s correct.  If it is correct and the child is very miserable, lethargic, other symptoms, you get seen right away. There’s no question. If you have above a 103 that getting to a higher fever. You don’t necessarily have to rush to the emergency department unless there’s other symptoms, but if it’s staying above 103, it’s been 103 for a day or two, 103 with symptoms, that’s more indicative of a bacterial infection. Something to get seen for. 100, 101 fever, kids okay. Little cough, a little cold. Usually a virus is going to last three to five days. You can watch that.

If you’re ever worried, always safest to go to see your doctor, go to urgent care. No doctor is going to be upset if you give us a call and say, “Hey, my kid’s got a fever of 101. I’m pretty sure they’re fine, but I just want to get their ear check.” Absolutely reasonable. The only caveat to this whole thing that I’m saying is for a baby. In the first couple of months, two, three months, any baby with a fever, that’s a much bigger deal. That’s something they get seen right away. Especially in the first month to month and a half, you want to be going to the hospital for that because babies get sick much more quickly and they can’t tell you how sick they are.  A little bit of a fever can turn into something very serious very quickly. That’s why standard of care in America is first month, month and a half a fever. You’re going in the hospital getting a full workup.

Dr. Weitz:            You mentioned diet. Right now there seems to be more information about diet than we’ve ever had and yet there seems to be more and more confusion. It seems like the diet debate is as polarized as a political debate. We have the carnivore diet on one side, we have the plant-based folks on the other side and everything in between. So where do you stand on diet?

Dr. Warsh:           For me, I’m in between. I, for the most part when I talk to diet about families is eat whole foods, eat real foods, try to eat as healthy as you can and have a variety. We’re in LA, so there’s lots of people that are vegans and vegetarians and I’m totally fine with that. You can be very healthy and never eat any meat and that’s fine for most people. There are some people that they get fairly sick if they don’t have any meat, they need some other nutrients. That I’ve seen it before.  But in general, for almost every kid, if they want to be vegan or vegetarian, that’s fine as long as they’re making sure to get a very diet for that. But I think the more important thing is not to worry about dieting, it’s to think about eating healthy. Eat your fruits, eat your vegetables, eat the rainbow, all sorts of different colors. Get out the crap out of your diet. Get out the sugar, get out the preservatives, get out the packaged foods, the things with fancy coloring and big logos.

Any of that stuff in the middle of the supermarket is generally not going to be good for you. I’m big on telling my patients to read labels. I think it’s super important for them to learn and for the parents to really turn the box over, look at the back and see what’s in there. If there are words on it that you don’t know, it’s not going to be good for you. Don’t buy that. If it says almonds, peanuts, cashews, coconut oil, it’s generally going to be a lot better for you.  I’m more of a peaceful in between thing where I think a little bit of everything is fine. When you’re going for the meats and fish, if you’re going to go for that, then you just want to think about sustainably produce, grass fed meats, not having farm raised fish, Just as good a quality as you can that you can afford. I don’t know if we’re going to go into talking about toxins next, but I think toxins is a big issue that we’re dealing with. I think trying to eat as clean as you can afford is very useful.

Dr. Weitz:            Sure. Let’s hit the toxin issue. We live in a big city, Los Angeles, and like most big cities, there seems to be tons of toxins in the food, water, air, et cetera.

Dr. Warsh:           Yes. It’s one of the big issues. That to me, the environment piece is where I think about toxins for families. That’s absolutely a core foundation that everybody needs to start thinking about because we are surrounded by toxins and toxins are in everything. Unless you’re planning to move to the mountains or go somewhere way out in the country, this is going to be something that you’re going to have to deal with. The good news is human bodies are amazing and we have great filtration systems. Our liver and our kidneys do a great job for the most part. We can handle a fair amount of toxins, but at some point it overflows.

At some point there’s too much inflammation. That to me is one of the big reasons why we’re seeing children getting more and more sick. There have been statistics that I’ve read up, almost 50%, adults certainly around 50% chronic disease and kids somewhere between 25 and 50%. That number has skyrocketed in the last 50 to a hundred years. Used to be three to 5%. The only thing that’s changed is our environment. Genetics can’t change that fast. I mean maybe they’re small little things, but in general it’s our environment. What has changed? It’s the chemicals that we’re surrounded by all day and all the things that you mentioned.

Dr. Weitz:            When you say chronic diseases, what diseases are you referring to?

Dr. Warsh:           Everything. Asthma, ADHD, autism, rheumatoid diseases, lupus and eczema, everything. We’re seeing more and more kids with something. I mean every other kid seems to have an allergy. Every other kid seems to have asthma. Every other kids seems to have something. I mean there’s also all the mental health diseases as well go into that category as well. I think the CDC statistics are 10% of kids have mental health disease, 3% have depression, 7% have anxiety. It’s staggering numbers of children have something, that has to have some part to do with toxins.

Let’s go through a couple of big ones and talk about some tips and solutions because I think this is a big one. To me, environment with diet are the two big pieces that we have a big ability… We have a huge ability to change those things around us. Not everything, but there are certainly small changes that you can make at home for free today that can make a big difference in your kids’ lives.

Number one, the air that we breathe. Our air. We’re certainly surrounded by in LA, lots of chemicals and toxins. You have some control over your house so you can get an air filtration system. You can put a bunch of air cleaning plants in there, aloe plants, snake plants, things like that. It does make a big difference overall. We’re breathing all day, lots of breaths every day. If you are decreasing the toxins even a little bit, that’s going to make a big difference.

 Second, you have the water in your house. You can get a filtration, reverse osmosis or some sort of filtration system. The water that we get in LA is not the best. If you’re going to drink any tap water, which probably isn’t super recommended, but if you’re going to then filtration system is going to help at least to some degree, in filtering out some of those chemicals and toxins around your home.

Go through your closets and think about all the things that you use as cleaners. Look at the labels. We’ve been so trained to think about we need to kill 99.9% of bacteria. We need to kill everything and we’re surrounded and we’re made of germs. You probably don’t want to stick your hand in the mud and eat it, but we don’t need to use all these harsh cleaners all the time. You know how grandma’s always used to use baking soda, vinegar, essential oils. That does a great job for the most part, maybe not for some crazy stain, but for your daily cleaners get rid of all that expensive stuff and just go back to the basics.

You don’t have to kill every single thing. There’s a lot of research now in the allergy world where kids that live Brooklyn farms that live in the mud have much lower rates of allergies than kids in the city. The theory is that we’re too sterile, we’re not being exposed to the germs and then that leads us to having more and more allergies. It’s just an interesting theory to think about because we think about sterilization as being best, but it’s not necessarily.

Dr. Weitz:            Absolutely, hand sanitizer. What you’re saying is it’s really beneficial for us to get exposed to germs and microbes. It helps prime our immune system and it stimulates our microbiome, which is so important for overall health.

Dr. Warsh:           Think about babies. What do they do in the first couple of months? They put everything in their mouth. That has to be biologically relevant. Otherwise, if we were dying and babies are all dying from touching all these bacteria, then we wouldn’t have this reflex to take every single thing and put in our mouth and put our hands in her mouth. It’s very logical that that’s one of those things that’s been selected for, but you’re touching your environment around you. You’re getting exposed to some of those bacteria, then your body’s getting used to it.  Again, you don’t want to go beside someone with the flu and wipe your hands all over their cough and then put that in your mouth. That’s not very smart, but in general, we’re talking about just your general daily life. We don’t have to be sterile everywhere. This isn’t… We’re not living in a hospital.

Dr. Weitz:            In fact, just the opposite. We’re now seeing this huge increase in autoimmune diseases and a hygiene hypothesis seems to be one major reason why, which is the fact that we’re not playing in dirt and getting exposed to germs and bacteria as much as we used to.

Dr. Warsh:           Right. For just general allergies, when we were growing up, it was don’t eat the allergenic foods. Wait until you’re older. Don’t give them peanuts until they’re one or two. And then allergies skyrocketed. All the new research came out that said, expose your kids to it early. Give them peanuts at six months. Try this because the earlier you do it, the lower your allergies are. Even in the regular Western science, the thought process has been completely changed to exposing things earlier. I think to me there hasn’t been as much research on the other topics. I think you can infer that would apply to everything else as well.

Dr. Weitz:            What is some of your favorite natural treatments for kids with allergies and asthma and eczema?

Dr. Warsh:           For allergies, eczema, anything really with autoimmune disease, I think number one, again, so going back to the foundations, absolutely important. Number two is talking about diet. Thinking about the allergenic foods. We know that the number one and two things always are gluten and dairy. If you’re going to pick one thing to think about, if your kids eat a lot of wheat or dairies, try to pull those out of their diet for a month and see what happens. It’s not the easiest thing to do, but you’re going to get the most bang for your buck. You can always just start there. You can see if you can take that out and see if the symptoms improve. It’s crazy how often they do improve.

Dr. Weitz:            Now do you get skeptical parents saying, “Isn’t this just a scam now I’m supposed to avoid gluten?”

Dr. Warsh:           Sometimes. But honestly I think the information’s been out there enough and there have been enough people who have seen significant benefits that people don’t necessarily think it’s a scam. I think the bigger issue is usually with the toddlers. They only eat this. They only eat bread. They only pasta.

Dr. Weitz:            Right.

Dr. Warsh:           Taking that out of their diet means they’re going to eat nothing. That can be hard but if you really have difficulty, sometimes working with a nutritionist can be helpful to see if you can think about things. But most kids don’t starve themselves. If you don’t have it around or you provide other things, they might not eat for a couple meals, but they’ll usually eat eventually if they get hungry enough.  Sometimes it just takes them some tough parenting to hang in there. You’re doing this for your kid and it’s not easy, but it can be helpful. Sometimes it’s just, okay, well we eat pasta every day, so let’s move it to once a week. You have to meet people where they are. It’s very different working with kids than adults because sometimes you just have to do whatever works. When we’re talking about supplements or anything like that, not every kid is going to take it. You have to be careful about what you use and work with the family to use something that they’re actually going to take.

Dr. Weitz:            Do you ever do food sensitivity testing to have it on black and white paper that they have issues with certain foods?

Dr. Warsh:           Definitely. I think a big thing again is different for kids and adults is you really have to be sensitive to blood work with kids. Because it’s a big deal for some kids to take them, give them a poke and get a whole bunch of tubes of blood and send off testing. You have to really think about what is the utility of this test and is it going to be very helpful or helpful enough to warrant the cost and the poke and everything like that.  In some cases it definitely is warranted. I’m big on trying to do whatever we can do first without doing any blood testing. If it’s not improving, you’re not getting better or something is serious, then that’s a good time to do it. Sometimes patients come to me after they’ve been through the whole medical system and they really want to do it and then that’s fine, then we’ll do it then.

It really just involves a lot of discussion and going through the pros and the cons of doing food sensitivity testing because there’s lots of great testing and information you can get out there, but it’s certainly not perfect. You would just, I think want to make sure that patients understand the utility of it and the benefit of it, but sometimes it can be super helpful.  You might come back and have things you would never think of that you’re sensitive to. Sometimes pulling those things out makes a big difference. Sometimes pulling them out makes no difference. Other times you’d send sensitivity testing and everything comes back normal. It just depends. You have to take it with a grain of salt, but when you’ve tried everything else and nothing’s working, then sometimes getting more lab information can be very helpful to push you in a direction to try something else.

Dr. Weitz:            What are some of your favorite nutritional supplements for allergies, asthma, Eczema?

Dr. Warsh:           That’s a good question. Each of those are a little bit different, but for general inflammation, let’s say which-

Dr. Weitz:            Okay, pick any one of those that you want to address.

Dr. Warsh:           Well for eczema, I would say the rashes, lots of creams and lotions that are natural are great. Calendula cream is really good. Coconut oil, Shea butter, Castor oil, fish oil tends to help with the skin rebuilding. Almost everybody is deficient in vitamin D these days. So you can probably just take some vitamin D and E that’d be safe. Turmeric is really wonderful too. That’s something to consider. I always try to get people to eat it as opposed to just taking a supplement if they can.  If you can get some smoothies in with your kids and maybe throw some turmeric. When you’re talking about allergies, things like quercetin and bromelain can be helpful to that kind of stuff.

Dr. Weitz:            Okay, good. You mentioned autism. Do you treat kids with autism?

Dr. Warsh:           Definitely. That’s a statistic that we’re seeing in skyrocketing numbers. Used to be 100 kids with autism, then it was 150, then 140. I’ve seen numbers now as low as 130 to somewhere within 140. It’s becoming very prevalent. Certainly have a fair amount of kids in my practice with autism.

Dr. Weitz:            Why is it becoming so prevalent?

Dr. Warsh:           I don’t think we know. We have no idea why it’s becoming so prevalent. Logically it’s the chemicals, toxins, things we’re exposed to, but they’re… I don’t think there is one thing that is the reason, because I don’t think autism is one thing. It’s a term for a group of diagnoses or a group of symptoms that we give a diagnoses to. I think there are multiple different causes.  My guess and assumption is, because this is becoming so prevalent, we’re going to have a lot more research on this and autism is going to turn into five or six or 10 different things. Because sometimes you’ll see it be a chemical ingestion. Some led toxicity, some sort of toxicity, and you take that toxicity out, the kid gets back to 100%. Other times it’s maybe the environment that they’re in. Most of the time we have no idea.

Dr. Weitz:            Have you used low dose immunotherapy for autism or other conditions?

Dr. Warsh:           Every once in a while I have used it, but in general I send off to other practitioners that specialize in that. We have a pediatric naturopathic doctor in our office and he takes care of a lot of the children that have any developmental disorders. He has a very interesting background history. He’s a toxicologist, he had children that had developmental issues and so he went back to naturopathic school and this is his passion. A lot of the patients will see him for more of their natural medicine and then see me just for their regular medical treatment.

Dr. Weitz:            You mentioned that certain psychological conditions like depression and anxiety are on the rise and really common. What’s your approach for seeing kids like that?

Dr. Warsh:           First thing really is to get a really good history, go back and really see where this stems from, how long has it been going on for, and then to really see how serious it is. For me, anything with mental health, it’s really important to have a good team. I think of myself as the captain of the team and make sure from a medical standpoint we’re not missing anything.  Once you go through the history then thinking about doing the blood work just to make sure that we’re not missing sleep or not missing a vitamin issue. Make sure that their sleep is okay, make sure they’re connected with the right team. If they need a psychiatrist, a psychologist, a nutritionist, whatever it is, having them connect with that team. Then for me, I’m thinking about the medical standpoint and because I’m an integrative doctor sometimes thinking about the integrative health and what we can do from a foundational perspective, and what we can potentially do from a supplement perspective to try to boost that.

It depends because if somebody is severely depressed, that’s not going to be necessarily the right time to do a supplement. They got to go, they got to get their psychology or psychiatry evaluation and then we can work on natural methods to try to help or work in conjunction with the practitioner. To me that’s really important. I think that’s where a lot of people in the natural world don’t do a great job. Is you have to know your limits and stay within your lane and it’s not a good time to start something natural. If something is severe, like someone’s suicidal, that’s not a good time to say, “Okay, well let’s think about some [inaudible 00:38:21].” Or, “Let’s think about some magnesium.” Those are great things to do but maybe not right now.

Dr. Weitz:            Well, how do you work up a kid with say anxiety?

Dr. Warsh:           Usually it will start with… Depends again, because each kid is different so it’s going to be very much dependent on their history and what they’re telling me because some of the tests that we might do would be diet testing, like you said. So sensitivity testing. Sometimes it’s going to be nutrient testing. Sometimes it’s going to be stool testing. Sometimes it’s going to be metal testing. It just depends on when you go through their story, you hear what other symptoms they’re having along with it. Then you think about where do I think is going to be the best bang for my buck.  A lot of times it’s going to be nutrient testing in that case because you’re thinking, maybe there’s a B vitamin deficiency, maybe there’s a D deficiency. Those kinds of things are what goes through my mind with someone with [inaudible 00:39:14].

Dr. Weitz:            Do you have a favorite nutrient panel you like to use?

Dr. Warsh:           I use Genova usually, but they’re-

Dr. Weitz:            [inaudible 00:39:18] NutrEval.

Dr. Warsh:           NutrEval, yes. I like that one. It gives you a lot of information. You get some toxins with it as well. It’s pretty extensive and in general it does a pretty good job of matching up what I’ve seen with other just basic quest or lab quest or lab core workup. It’s not super expensive and generally a lot of insurances will cover at least a portion of it. To me that’s the one I like. They’re easy to use, but there’s a lot of good ones out there.

I think that the bigger key is to think about something that’s going to give you a more broad panel than what you’re going to be able to get from your regular Western lab. I think it’s important to get that a lot of this testing is validated and it’s really good testing, but it’s not something you can necessarily do even from the Western perspective just because… With insurance it’s not medically necessary stuff. They’re not going to cover it. It becomes really risky when you’re trying to run a lot of these tests through your insurance because they usually don’t cover it or they might say they’re going to cover it and then not cover it.

For a lot of my patients, I feel it’s a little safer to say, just go do this test. You know exactly what the cost is going to be and you’re going to get this huge panel. That’s what we do, but not everybody can afford that. Sometimes you just do whatever you can do with [inaudible 00:40:32]. You can do a lot of great stuff through the regular testing too, but you just not going to do nearly as extensive of a workup.

Dr. Weitz:            Right. I think one thing you’re pointing to is this issue with insurance and testing is if you have a patient, you send them to your standard quest or lab core and you do say… You put together say 20 different markers for vitamins and nutrients and they get covered by insurance, fine. If they don’t get covered, the patient could end up having a huge bill. Whereas Genova puts this panel together and say the most it’s going to cost him is 400 bucks and that way you know you’re going to get a lot of info and they’re prepared okay. It’s going to cost me at most 400 bucks. I can handle that or I can’t.

Dr. Warsh:           It’s really important if you’re going to go to your regular pediatrician or regular doctor that you have a discussion about the lab work because it happens all the time where we’ll send… Even just the regular stuff, you send them vitamin D and they won’t cover it. There is… I think people don’t get this. We don’t know. As a doctor, we have no idea what they’re going to cover. You can call them, you can talk to your insurance person. “Oh yes, we’re going to cover it.” Then five months later they send you a bill and say, “Oh, actually by the way, we’re not going to cover it. It’s going to be $1,000 for this one test.” Then the fighting starts.

Usually they can work with the patient and send in a letter or do something with the insurance to fight it and change up the codes or whatever it is. But there is no way, absolutely no way to know. Every insurance is different, every plan is different. Every time it’s different. Basic testing, which should obviously be covered sometimes isn’t covered. It’s just how it is and there’s no way to know that. That’s why when you’re doing these extensive things, as you say, sometimes it’s better just to, if you can afford it just to send the panel because you know exactly what the cost is going to be.

Dr. Weitz:            Right. Great. I think this has been a really good discussion. Any additional thoughts or issues? Is there anything you’re really excited about right now in your field of integrated pediatrics?

Dr. Warsh:           I’m really excited that I think people are starting to become savvy to this and are very interested in learning more about holistic and alternative modalities. Kids are getting sicker and sicker and so people are starting to seek this out on their own. Parents are starting to take health into their own hands and to seek out additional information. I’ve seen this when my practice exploded so quickly. We just opened a new practice where I am, I used to be in Beverly Hills and now I’m over here. People are flocking to this because-

Dr. Weitz:            You’re in Studio City as I mentioned.

Dr. Warsh:           Yes. They’re so excited to be able to discuss alternative modalities. They don’t want just that. Most people don’t want just natural, they want both, but they want someone who’s open to that. The more patients that want it, the more practitioners are going to learn it. To me, I just had a baby and I want him to be healthy and grow up healthy. This is one of the reasons why I’m working on so many other projects on the outside. We’re working on a summit, which is going to be hosted… Well, you can find on integratedpediatrics.com.

We’re working on a wellness care which is basically a course that’s going to go through many different modalities like [inaudible 00:43:56], homeopathy and how those work in with Western medicine and also going through the major conditions, things that we talked about. Like asthma, inflammation and talking about both sides and here’s the Western treatments and here’s some of the alternative treatments and here’s some things you can think about.

Because a lot of parents don’t even know, I could go to a acupuncturist or Chinese medicine doctor for this condition. So just making people think a little bit more about it because if that’s the thought process, I think more Western doctors are going to start to learn this because we need to work as a team. We’re all on the same team, us, chiropractors, acupuncturists. We’re all on the same trying to get kids healthy and adults healthy and hopefully practitioners are going to know where their acupuncture and the yoga studio is as opposed to where their cardiologist is. Right now that’s not the case. We know where our GI referrals are. We know where our allergy referrals are, but you don’t know where your health coach is, where your chiropractor is. If we work together, we’re going to have much healthier patients.

Dr. Weitz:            Just for practitioners out there say who are caught up in our current healthcare system. They’re a pediatrician, they’re taking insurance, racing from room to room, they’d love to talk to their patients about some of this natural stuff. How do you make it work? If you don’t mind talking a little bit about how do you make it work financially? You’re in Los Angeles, there’s a lot of rant, you’re taking insurance. We know insurance is not paying very much. You’re under pressure to see a lot of patients. How do you make it work?

Dr. Warsh:           I think it’s a matter of building up the office in a certain way and using technology to its fullest so that you can cut some of the costs that you have. For me, number one-

Dr. Weitz:            You are a provider for most insurance companies?

Dr. Warsh:           We take the major PPOs. I think the one thing that’s been really helpful is being involved in the American Academy of pediatrics in the background of the business side and seeing what a lot of practitioners do. Just having systems in place. It’s a big conversation so it’s going to be hard to [inaudible 00:46:03].

Dr. Weitz:            I understand.

Dr. Warsh:           But just having systems in place that cut out a lot of the redundancy and having a lot of staff so that way it can keep the costs down to a place where you can do things. I do a lot of other projects on the outside too, so it’s a mix of the two together. Just having other practitioners in here as well. So keeping my costs of rent and things like that down because one of the things that I wanted to do was have a integrative practice actually. So we have a naturopathic doctor in here, a nutritionist in here. A lot of them are renting space from here so it keeps my rent really low.

Dr. Weitz:            Do you charge a concierge fee on top of the insurance?

Dr. Warsh:           We have a small one. A lot of the… Whether it’s an integrative or not, most of the many practices now that are private practice are having some small administrative fee. It’s not a huge thing but these are things that are being charged anyways throughout the year. You’re charging for forms, you’re charging for access after hours, you’re charging for things that insurance doesn’t cover.  Whether integrative or not, most private practices at this point are moving to the hybrid model where they have some small fee that covers the little things. 100 bucks, 300 bucks, whatever it is for the year for the family. It just covers those little things so that families don’t have to come in, 20 bucks for this form and 20 bucks for the vaccine form and 20 bucks for this. They just pay it at the beginning. That gives you a big chunk of… a little chunk of change that can sustain you to buy your supplies and then you don’t have to worry as much. Then the insurance covers the rest.

Dr. Weitz:            Okay, great. How can patients get ahold of you and find out… be able to see you and find out about your programs?

Dr. Warsh:           Sure. You can either go to integrativepediatrics.com. That’s going to be the website we’re working on that right now to get all of these summit and course together, but my website for the office, integrative pediatrics and medicine.

Dr. Weitz:            Okay, great. Thank you, Dr. Warsh.

Dr. Warsh:           Thank you so much for having me. It was a fun time.