Epigenetics and Skin with Dr. Anne Marie Fine: Rational Wellness Podcast 089

Dr. Anne Marie Fine discusses Epigenetics and Skin with Dr. Ben Weitz.

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Podcast Highlights

7:09  Some of the most important factors that lead to aging of the skin include sun exposure, air pollution, inflammatory skin care products, our diet, our stress levels, toxins, and sleep. Personal care products that are inflammatory will ironically plump up your skin and make your wrinkles look better but on a long term basis they will prematurely age your skin.

10:25  Genetics probably dictates no more than 25% of your aging, which means that epigenetics and environment are much more important, which should be hopeful for people. You can take the HomeDNA test to look at some of the gene SNPs that relate specifically to our skin.




Dr. Anne Marie Fine is a Naturopathic Doctor who focuses on Enivornmental and Functional Medicine. She is the Founder and CEO of IAmFine, a line of safe, non-toxic, vegan, and sustainable anti-aging skin care products. She wrote the bestselling book, Cracking the Beauty Code: How to Program your DHA for Health, Vitality, and Younger-looking Skin. You can find more information about Dr. Fine through her website Dr.AnneMarieFine.com  and she is available for consultations by calling 480-510-3448.

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 Transcripts

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

Most of the time when the average person thinks about the health of our skin, we think about the exposure of our skin to sun and other environmental factors, and about various products that we apply to our skin. But our skin is clearly also a reflection of our overall health, including health of our digestive tract and our other organs, our metabolism. Our skin health is a reflection of everything we put in our bodies, how we treat our bodies, how we lead our lives. Our skin health is also a reflection of our epigenetics.

For those of you who are not familiar with that term, what that means is genetics, I think most of us understand, is the set of genes that we are born with. These definitely have some influence over what happens with us during our life. But what’s even more important are a set of switches that determines which of our genes get turned on or turned off, or another way to put it, which of our genes get expressed or which of our genes get suppressed, which we’ve referred to as the epigenome. Dr. Fine, who will be our guest today, describes this as the control panel to our genes. We are going to focus on how we can flip these switches to the correct position to have healthy, glowing skin well into our later years in this discussion.

Dr. Anne Marie Fine is a practicing naturopathic doctor. She focuses on environmental and functional medicine. She’s also an award-winning researcher, internationally recognized speaker, and a Founder and CEO of IAMFINE, a line of safe, non-toxic, vegan, and sustainable anti-aging skin care products. Dr. Fine also wrote the bestselling book Cracking the Beauty Code: How to Program Your DNA for Health, Vitality, and Younger-Looking Skin. Dr. Fine, thank you so much for joining me today.

Dr. Fine:    Well, thank you, Dr. Weitz, for the introduction. I’m really excited to be here on your podcast because I want to talk about epigenetics and beauty. You’ve already said it so beautifully. Your skin is basically just a reflection of your health on the inside. Even though the title of my book is epigenetics and beauty and really speaking more conceptually about epigenetics and our health, our aging process, our disease processes, which all show up on our skin.

I’m also going to talk about today some of the toxins found in personal care products and the latest advancements of how to address them in ourselves and our patient population, because I feel this is a missing link in how we evaluate and treat patients today. I’m also going to take the opportunity to talk about where I’m taking my practice in 2019, where, to my knowledge, very few practitioners have done yet. I’ve already started taking this to the next level in a personalized way to help patients get better faster. This is my main focus for 2019, engaging my patients in a whole new way, in an ongoing platform that’s palatable and cutting-edge.

Why am I doing this? How did I even get started? More than likely, many of you, and I can put myself in this category, too, is we really overlooked personal care products as a source of toxicants in our patient population. This is a mistake. There’s so much emphasis on the heavy metals and some of the more egregious of the toxins that are in our environment, but the whole topic of personal care products has not received the attention that it really deserves.  We have to think about the fact that ourselves and our patients, we basically are just slathering on these products, our shampoos, our conditioners, our body wash, and our face wash and our makeup and perfume and everything. I mean it’s ongoing. Washing our hands. What are we washing our hands with and brushing our teeth? There’s just so many opportunities for exposure during the day that I really wanted to bring more focus to this. Then I also wanted to talk about the epigenetic environment and how it impacts the skin.

At the end of the call, I want to offer a surprise for Dr. Weitz’s listeners. Then with all of that being said, I just want to start with a question. Are you sick of all the toxins out there? Have you had trouble breathing from the wildfires? Have you or your patients been impacted by autoimmune disease or other chronic diseases of aging? That’s where we’re going to go today. We’re going to talk about understanding the relationship between those questions and our health and our patients.

Dr. Weitz:  Yeah, absolutely. Lots of patients have been complaining for several months now about the aftermath of the fires and breathing all that crap in. Unfortunately, I guess that’s becoming a regular thing every year in California, with the wildfires.

Dr. Fine:    Do you know that in many parts of the global world, that wildfire emissions, PM 2.5 in wildfire emissions, now exceeds anthropomorphic emissions from car exhaust and coal-powered fire plants, coal-fired plants?

Dr. Weitz:  Is that right? Wow!

Dr. Fine:    Yeah.

Dr. Weitz:  Well, it’s equally probably related to what we’re doing, but a little more long term. But we certainly need to do something about it. Dr. Fine, what are some of the main factors that lead to the aging of our skin?

Dr. Fine:    Everyone always wants to talk about the sun, sun damage, as being the primary skin ager. It does have a pretty good effect on the skin, but it doesn’t end there. Sun exposure is considered an extrinsic cause of aging, but you know what else?  Studies are now showing that the particulate matter in air pollution is now being found to prematurely age the skin in terms of loss of elasticity and also in terms of age spots and wrinkling.  That’s what I just mentioned before. It’s like air pollution. Who would have thought?  But now studies are actually backing this up. They started the studies in places like China, which everyone’s like, “Well, they’re so polluted. Of course.”  But they’re now finding it in other places that are not so polluted.  We have the air pollution.

We also have, well, the personal care products that you use on your face. Some of them are … They’re inflammatory. They are so cheaply made that these products are inflammatory, which ironically will plump up your skin a little and make you look like your wrinkles maybe look better, but on a long-term basis, if you look in my book, I’ve got a chart on the molecular basis of skin aging, and inflammation is right at the top.  We have skincare products, we have the foods that we eat, what we drink. Our stress levels are very impactful on an epigenetic level. We see that in twin studies where the twins don’t age the same. You can look that up on the internet. There are some pictures that are really quite striking at the difference in these twins.  One twin had a lot more stress than the other, or smoked.  Of course, smoking is bad for your skin, too.  Stress levels, food, how you sleep.  Basically, it’s stress, toxins, and food are the three main epigenetic modifiers in your body.  It’s going to be the same for the skin.

Dr. Weitz:  What about smoking marijuana? That’s becoming a new health food. I just came back from the American Academy of Anti-Aging Medicine, and they were talking about CBD and marijuana. Isn’t marijuana smoke probably fairly bad for your skin, too?

Dr. Fine:    I actually don’t know, but that’s a good question, isn’t it?

Dr. Weitz:  Yeah.

Dr. Fine:    I really don’t know. Didn’t they talk about that at all?

Dr. Weitz:  No.

Dr. Fine:    No, they didn’t.

Dr. Weitz:  Everybody’s talking about all the benefits of it right now its enjoying it’s heyday.

Dr. Fine:    Right. Well, I’m sure part of it has to do with the fact that cigarette smoke has so many toxins in it that you’re creating a lot of oxidative stress and damage, and that’s creating DNA adducts and inflammation. I really can’t answer that question, but that’s-

Dr. Weitz:  What part does genetics play in as far as your skin health?  Maybe you can talk about genetics and epigenetics a little bit.

Dr. Fine:    Yeah. It’s so interesting that when I was doing the research for this book, I wanted to see globally how much of your skin aging is genetics and how much of it is something else, because I noticed that years ago, when I started speaking on aging, healthy aging, and people would say, “Well, the reason why you look so young is because of your genetics,” and I’m like, “Seriously? Do you know how well I take care of myself?” I started looking into it, and really it’s only about 25% of your aging can be dictated by your genes, which means the bulk of it is epigenetic, it’s your environment, which I think can be very hopeful for people.  The other thing I want to say is I have tested my skin genes because I wanted to see on me, am I a really good ager or am I really a bad ager? But I do so many other things. I’m really helping my-

Dr. Weitz:  So how do you test your skin genes?

Dr. Fine:    You know what? It was a special gene test just for skin. It’s called HomeDNA. They have one for skin. I tested it, and you know what I discovered?

Dr. Weitz:  What?

Dr. Fine:    They don’t do that many … Okay, they don’t. I’m sure there’s more skin genes, but what they did, like half of mine were pretty good, like green light, yes. Then half of it were pretty bad, red light. That’s all the Irish skin. It’s like I burn easily and the sun damaging aspect of my genes are very bad because I’m so light and Irish. I feel like, maybe in totality, I’m average in terms of skin aging on the genes. But I thought that was interesting to just see what came up for that.

Dr. Weitz:  They picked out particular genes that seemed to relate to skin, or SNPs?

Dr. Fine:    Yeah. I don’t have that report in front of me, but it’s HomeDNA. They have different panels. You can do it yourself. It’s very easily available over the internet. You can see what your skin looks like.

Dr. Weitz:  Cool, yeah. I mentioned a little bit about epigenetics, but maybe you can talk a little bit more about exactly what epigenetics is and maybe give some examples of some epigenetic effect.

Dr. Fine:    Yeah, I’ll do that. Epigenetics means above your genes. It’s like the genes are the hardware and your environment is the software telling the hardware what to do. Your hardware doesn’t really do anything by itself. You’ve got to have software to tell it what to do. Your environment in which you are bathed 24/7 basically is providing information continuously to your hardwired DNA on what to express and what not to express. We are very much in tune with our environment and we can change it moment-to-moment, day-to-day, hour-to-hour based on what we’re doing.

It’s so different than last century’s dogma of your genes are your destiny. This gives us power to change our genetic destiny and to be healthier, but you have to know what to do. You have to know which foods turn on your healthy genes and which foods are turning on inflammation, which foods turn them off. You do have to know how it all works. Epigenetics is very, very exciting. I think this is where the future of medicine is going to be, in epigenetics.

Dr. Weitz:  You mentioned in your book a little bit about methylation. Can you explain that and how that can relate to this topic?

Dr. Fine:    Well, so methylation is one of the main roots of epigenetic marks. Histone modification is another one and the microRNA would be another one. Methylation is just putting a methyl group on the DNA. Methylation, it’s tricky because if you have too much methylation on a particular gene area, you may turn that particular gene expression off. Overmethylation can produce cancer by turning off tumor suppressor genes. Too much methylation is not good, but too little methylation is not good as well.  You can see that in my book. I talk about the rats, with the fat rats with the yellow coats, and their brothers had the same DNA but they were sleek and lean and they had brown coats. It was the same strain and the same genetic makeup. In the lean brown rats, the mothers, while they were pregnant, were fed methyl donors. They came out healthy-

Dr. Weitz:  Randy Girdle and the agouti mouse model.

Dr. Fine:    Yes, the agouti genes and then the other ones turned out to be overweight and prone to chronic diseases. That chat, in a nutshell, gives you an idea of how important the maternal-fetal environment is for the fetus.

Dr. Weitz:  In order to stimulate methylation, we have to take, say, B vitamins in a methyl form, like 5-hydrotetramethylfolate and methylcobalamin for B12, et cetera, right?

Dr. Fine:    Right, exactly. That brings up the whole concept of prenatal vitamins and do they have the right forms, the active forms, of the B vitamins that can methylate properly. But MTHFR gene defect, you may not be able to utilize the B vitamins as well, so that’s a consideration, too.

Dr. Weitz:  Right. Let’s talk about toxins. What kind of toxins are in the environment and what we can do about some of these toxins?

Dr. Fine:    Okay. We’re not going to talk about heavy metals. We’re going to talk more about the ones I talked about, which a lot of them are endocrine disruptors. The endocrine disruptors are something that are going to disrupt the hormone system. They may do so in many different ways. One of the ways that … This is fascinating to me because type 2 diabetes is like the Black Plague of the 21st Century. Yet when we ask our patients are they eating Snickers bars for breakfast with Krispy Kreme donuts, they’re not. They’re not dumping sugar in their system.  Typically their diets could use improvement, but what’s not known is there are environmental chemicals that are pushing the diabetes pathway. That would be fantastic for us to know and to recognize and to test for in our patients, because I don’t know about you, but have you noticed your patients’ blood sugars are rising over the years?

Dr. Weitz:  [crosstalk 00:18:57].

Dr. Fine:    I’ve noticed it.

Dr. Weitz:  Blood sugar levels are rising, hormones are getting lower, and cortisol-

Dr. Fine:    Testosterone is in the toilet.

Dr. Weitz:  Yeah.

Dr. Fine:    I just wrote an article for Thrive Global on The Handmaid’s Tale Becomes A Reality. Are you familiar with that show, that TV show?

Dr. Weitz:  Wasn’t that one of the Chaucer’s tales? Handmaid’s-

Dr. Fine:    No.

Dr. Weitz:  No.

Dr. Fine:    It was a Margaret Atwood book that came out in the ’80s.

Dr. Weitz:  No, I’m not familiar with it. [crosstalk 00:19:26].

Dr. Fine:    The premise is that the environment, the world got so polluted that the men became infertile. Then they took a special group of young, fertile women to be the breeders for this whole new society. Then they made a TV show out of it, which is very interesting. Decades later, they made a TV show out of it. It’s kind of scary. I think it’s an Emmy Award-winning show.

Dr. Weitz:  Oh, really?

Dr. Fine:    But people are acting like it’s entertainment. The reason I wrote my article is that it’s true. It’s already starting to happen. I wrote this article called The Handmaid’s Tale Becomes A Reality. It was published on Thrive Global, which is Arianna Huffington’s new platform. It talks about the toxins in the environment contributing to infertility and really tanking testosterone, sperm counts, sperm motility. I mean the sperm, they swim like crazy, drunken sailors. I mean they can’t really even deliver the goods anymore. I talk about this, and one of the main instigators of the effect on male hormones is this class called pthalates. You’ve heard of pthalates?

Dr. Weitz:  Oh, absolutely. Yeah. They’re used as fragrances in personal care products as well as in plastics. They’re really common.

Dr. Fine:    The pthalates-

Dr. Weitz:  [crosstalk 00:21:16] ingredients, of course.

Dr. Fine:    It’s like they’re in everybody and they’re really hard to get away from, but what they’re finding in the male babies is that they’re being born … They can correlate this to the higher [inaudible 00:21:35] of pthalates in the moms, correlate to smaller penises and testicular dysfunction and a shorter anogenital distance, which that distance, that is your marker for virility. As that becomes smaller, that is these babies are being born more feminized.  That’s a big one. They’re finding that in adult males that the pthalates are being linked to lower testosterone and all the sperm things I talked about before. The average man today has about half the testosterone that his father had.  You can basically look at any adult man today and say, “Yeah, you’re like half the man your dad was.” Right?

Dr. Weitz:  Yeah, I know. There’ve been documentaries. I think one of them was called The Shrinking Male. There’s no doubt. We measure hormones on a lot of the men, and especially free testosterone, almost every man is low.

Dr. Fine:    Yeah. It’s true.

Dr. Weitz:  [inaudible 00:22:46] these endocrine substances are estrogenic, so they’re really inhibitory for testosterone.

Dr. Fine:    Yeah. Pthalates are a big one. Then you’ve got … This is crazy, but these products being marketed to these teenage boys by Axe … You know that company?

Dr. Weitz:  Oh, yeah. Yeah, it’s horrible. All those products.

Dr. Fine:    They have extra fragrance in them. Their whole marketing platform is you’re going to be so sexy that you’re going to get not just one girl, you’re going to get two girls. [inaudible 00:23:18] taking their testosterone. They may get a girl, but they’re not going to know what to do with them, right?

Dr. Weitz:  Yeah, I know. I’ve seen the commercials with the guy and all the women on the beach, and they’re all chasing them.

Dr. Fine:    Yeah. That’s crazy. It’s interesting, I was in Europe over 10 years ago attending a show, a business platform for personal care product development. This is kind of like my entree into this becoming an expert in this area. I started with my global travels to get the information.  Anyway, it was a market research talk and it was my first market research talk on personal care ingredients. I was skeptical that anybody could have advanced information on how this was really going to go and I really wasn’t sure I wanted to spend my time in this lecture, but I was totally closed off, “Oh, what are you going to tell me here?”

The first thing they’ve said was … And they were really excited, “We’ve got some good information.” They were like, “In the United States, the young male grooming category is going to explode with these Axe products.” I was like, “Oh, should I leave now? Because no self-respecting mother is going to let her teenage boy talk her into buying these terrible fragrance products.” I’m just thinking to myself, “That can’t be right. This is a stupid lecture.”  At the time, I had a teenage boy. I went home and two weeks later, he walks in with this bag from the grocery store and I’m like, “What did you get?” Axe products. I’m like, “I buy your stuff for your shower. What are you doing?” I do not approve of those products. I’m like, in two weeks, their marketing research was spot on. Oh, yeah. It’s like you can smell those boys … They’re 10 rooms away and you can smell them.

Dr. Weitz:  Now one of the things I’ve noticed, because I only use natural products for myself and my wife, and I recommend for my kids as well, but my kids are kind of on their own now, but I do think they tend to use what I recommend. But you use these natural products and they don’t have, say, sodium lauryl sulfate, but they have some other ingredient that sounds sort of like it, like calcium laureth something else. You wonder is this just another version of this toxic product that’s not on the list yet, but probably will be in a few years? Like we’ll take the BPA out and we’re going to put BPS in, which is probably just as bad, it’s not just not on the list yet. Right?

Dr. Fine:    Yeah, worse. Yeah, this is called greenwashing. Well, actually, this is called the case of regrettable substitutions, where they say, “Oh, my gosh. This thing, BPS is bad and worse. The consumers know it’s bad. We can’t sell this anymore.” Then they put in BPS and then BPF and then BPAO. It’s like it’s all from the bisphenol family. I mean you would think that chemists that are involved in this would say, “Well, maybe it’s the chemical family that … ”  What they’re finding is that those new BPA substitutes are as bad, just as bad, or even worse in terms of effects than just the BPA, but the consumer hasn’t made that leap, and now they’re like, “Oh, BPA’s back.” Then they see a product, BPA-free, and they’re like, “That’s it. That’s the product I’m going to get,” and you don’t want it. You really don’t want it.

That’s why I’m changing the way I practice is because people think they get it. They get it a little bit, they’re starting to get concerned, but they still don’t have the right idea on what actually is good. The greenwashing, your question about the ingredients sounding the same but being a little bit different, is that I … And I also consult with companies who manufacture personal care products and I also lecture to companies in the personal care industry, like CEOs of these companies, and they don’t even know a lot of times what’s truly non-toxic.

There’s a lot of education that has to happen in this arena. They’re slipping in other things that maybe it’s not really any better, and sometimes it’s better. Or this drives me crazy, too. They’re like, “Oh, here’s our blockbuster product for 80 years,” like Johnson & Johnson’s baby shampoo. They finally took out the formaldehyde-releasing preservative system, which nobody even knows that it had it in there, but I know.  It’s interesting. When I had babies, I put it on them, and they screamed and shrieked. There were lots of tears. I’m just like, “This is not truth in advertising. My babies are crying.” I went to the health food store and I got something else. But recently, like two or three years ago, they reformulated it. Wasn’t that nice? They took out the preservative-releasing system that dumped formaldehyde into your product.

Of course, they knew at the time they did it that you can’t just put formaldehyde in a product. Everybody knows formaldehyde is a good preservative, because we had to work on cadavers, and they were all preserved with horrible [inaudible 00:29:07], which is formaldehyde. We know it worked. But they were savvy enough to know you couldn’t put formaldehyde on the label, so they put in formaldehyde-releasing preservative systems that had different names altogether.  But if you knew … Like this is what I teach people to recognize. These chemical systems, they get into the product and then the product sits in the warehouse for who knows how long. Then it’s on the truck and it’s on a boat and then it’s at another warehouse. Then it’s on the shelf. Then you buy it two for one. Then you bring it home. I mean years later, the whole time it’s releasing formaldehyde slowly because that product is old. You took it out of the Johnson and Johnson’s baby shampoo, but it’s like it’s still not a great-

Dr. Weitz:  So how do we know how to get healthy products? Is the Environmental Working Group a good resource to look up products?

Dr. Fine:    Yeah, they have a really big database on ingredients, so that’s a good resource. There’s also madesafe.org is another certifying organization that will actually certify something made safe. I’m actually on the scientific advisory board for them, so I know what their criteria are. It’s very solid. There’s an app called Think Dirty. It’s a provocative name, but it’s free. Do you know about this one? You put it on your phone-

Dr. Weitz:  No, no.

Dr. Fine:    Okay, I’ll tell you. It’s going to [crosstalk 00:30:48]. It’s a free app on your phone.

Dr. Weitz:  What’s it called again?

Dr. Fine:    Think Dirty.

Dr. Weitz:  Okay.

Dr. Fine:    Then I hope that’s right. But, anyway, you put it on your phone, it’s free. When I first got it on my phone, I went into the department store-

Dr. Weitz:  You go to download it, you find out it’s some porn site or something.

Dr. Fine:    I know. I hope it’s not. [inaudible 00:31:12]. I know. But, anyway, you put it on. I went into a department store and I went to the cosmetic counters, which are all toxic, and I started … You scan the UPC codes with this cool thing. It does its thing and then it comes up with a score. It explains which ingredients are causing the bad score. It’s pretty easy.  The problem is it’s fairly new, and so it doesn’t have every single product in there. It has some of the more obvious ones in there, but you take it into a health food store or something and with smaller companies, smaller brands, and it’s like, “We don’t have this product.” But if you take it into a grocery store or you take it into Nordstrom’s and you’re at the counter, yeah, you get really terrible scores on all that stuff, including the ones that claim that they’re not allergenic or clean. That one’s fun. Then I have some resources on my website. I have a class. I have a digital class, online class, that I teach-

Dr. Weitz:  Hang on. Hang on just one second. I’m sorry. We’ll clip and paste this. One of the other doctors was having a loud conversation in the room right next door.

Dr. Fine:    Oh, wow! Are they even good?

Dr. Weitz:  Okay. I’m sorry. We have all these toxins. How do we get rid of these toxins from our body? How can we detox them?

Dr. Fine:    Yeah. Well, that’s part of what I work with on my patients. But I will say the first rule of environmental medicine is avoidance. The first thing is recognizing that you have a bad product if you need to get rid of it. Then you just have to know what are the ingredients in there. Is it a persistent toxin? Usually not.  Usually things like phthalates, they’ve done studies and they’ve taken away the bad products in, say, teenage girls. Within three to five days, their levels start to drop pretty dramatically. Same thing with parabens. But it’s interesting how they never go to zero because they’re not getting them all. That’s the thing that I take away from that. I would say you just have to do a beauty detox. Read my book, look on my website for the resources I have on these bad products. But it does take some-

Dr. Weitz:  Let’s say we eliminate these products. How do we get the toxins out of our body? Do you recommend some sort of liver detoxification program?

Dr. Fine:    Well, because my focus is on environmental medicine, what I do is I really evaluate patients in the office with a very detailed environmental health history. Then I look at their symptoms and then I test them for certain toxins, so I’ve really got a good picture.

Dr. Weitz:  Cool.

Dr. Fine:    Because, for example, I worked with a patient who was a natural aesthetician. She told me she didn’t use phthalates or parabens anymore, and I could have said, “Okay, cool. That’s not your problem,” but instead I tested her for phthalates and parabens. What did I find? Phthalates and parabens, because it’s not as easy as you think to get them all out of your life. I do tests, I’m a big believer in testing, and then I design for-

Dr. Weitz:  What kind of testing do you do? The urinary testing?

Dr. Fine:    I like that. There’s also the Toxic CORE test from Genova, which is very comprehensive. There’s other ones that are not quite as comprehensive.

Dr. Weitz:  Okay, cool.

Dr. Fine:    That’s an addition, too. Everybody tests for heavy metals. Heavy metals are important still, but I like to know some of these other things because the effects are so insidious. I mean look at testosterone. I mean you’ve got to have your testosterone, right?

Dr. Weitz:  Absolutely.

Dr. Fine:    Especially if you’re a man.

Dr. Weitz:  Let’s talk about what’s the best diet for healthy skin.

Dr. Fine:    Oh, the best diet. This is my book. In terms of diet, you want to make sure that you’re having an anti-inflammatory diet, because if you look at my flow chart on how your skin ages, it’s like inflammation is pretty much at the top. You’re basically going to go through and you’re going to increase matrix metalloproteinases, which are enzymes that cut up your collagen. As you get older, you don’t make as much new collagen to make up for the collagen you’re losing. That’s a problem. You increase your NF-kappaB.  Anyway, you’re going down the wrinkle pathway starting with inflammation. We want to have … Basically a Mediterranean diet has been the best diet for skin. It’s not vegan, it’s not keto, it’s not Paleo, it’s not vegetarian, but it’s got olive oil, it’s got some red wine, it’s got vegetables, it’s got legumes. It does have some meat, but you want to push the anti-inflammatory foods.

Then the other thing you want to do is you want to consume things that turn on your own endogenous antioxidant system, as oxidative stress is also at the top of that wrinkle pathway. These are foods that push Nrf2, for example, which turns on your own antioxidants and also your detoxifying enzymes in your body.  Even though the fruits and the vegetables do have antioxidants in them, the antioxidants, the half-life of those, not very long at all. You probably can’t even eat enough of them all day long. But by consuming foods that push your Nrf2 pathway, you’re telling, you’re turning on your own genes to make your own darn antioxidants and detoxifying enzymes, which are so important. Those are things like olive oil and green tea. Green tea is the number one beverage for good skin and shown to help with inflammation, elasticity, microcirculation.  I mean the skin on your face, the stuff right on the top is old, dead skin. Old, dead skin. It’s hard to get blood flow into those levels, and so microcirculation for skin is very, very important to keep it oxygenated and nourished. Green tea has been shown to do that. Fish oil is another one that’s been shown to help with elasticity of the skin. The amount they used in the study that I referenced in my book was only one gram per day. I don’t remember the length of the study, but one gram, as you know, is not [crosstalk 00:39:18].

Dr. Weitz:  Not very much, no.

Dr. Fine:    It’s not very much. I mean we typically do more, don’t we?

Dr. Weitz:  Oh, absolutely.

Dr. Fine:    Yeah, and so things like that. Blueberries are very anti-inflammatory. Your berries are very important. Pomegranate is very important, the pomegranate juice, the sulforaphane, the detoxifying enzymes that [crosstalk 00:39:43].

Dr. Weitz:  Which is from broccoli and cruciferous vegetables, right?

Dr. Fine:    Yeah. You’re pushing the Nrf2. You want your anti-inflammatory foods to knock down NF-kappaB. Then you want to push up your Nrf2 systems. This is how you’re manipulating, I guess, your genes to support good health and good skin.

Dr. Weitz:  What are your favorite nutritional supplements for skin health?

Dr. Fine:    The supplements that I like for skin health are … I do like vitamin C for the skin because it helps make collagen. Then I have the collagen and-

Dr. Weitz:  Do you like collagen supplements?

Dr. Fine:    Collagen supplements, I think, are … I’m a little mixed on that because you’re just digesting them in the gut. It’s protein. You’re just digesting it. But it is collagen and it is protein, and protein is good for the skin. I like it from that standpoint, too. I think there’s some newer products that are coming out that have different digestibility and different qualities that can make it better. I do like proline. I do like astaxanthin for the skin. It’s got some really good research behind it and-

Dr. Weitz:  It’s an important carotenoid, right? For [crosstalk 00:41:12].

Dr. Fine:    The carotenoids are really crazy good for your skin.

Dr. Weitz:  Yeah.

Dr. Fine:    Lycopene is very good for your skin. I’ve seen that available as supplements as well. But, gosh, there’s so many that I could say. The other thing that I didn’t mention in diet, but I’ve been mentioned in my book, which is very important, is you’d want to watch your glycation and your food. You don’t want the browning on your chicken breast. You don’t want the grilled meats. You don’t want the glycation because glycation is an irreversible process. That is also aging your skin, and I talk about that at length. I have a great chart-

Dr. Weitz:  You want to be careful about barbecuing or avoid barbecuing, right?

Dr. Fine:    Yeah, barbecuing is not so great.  In my chart, it talks about a fried egg, how many glycating units it has, versus a poached egg.  If you poach things, proteins in water, you can see on my chart how much less glycating it is for your skin.  Very interesting research.

Dr. Weitz:  Interesting.

Dr. Fine:    Yeah.

Dr. Weitz:  Maybe let’s do one more topic. H ow about sleep for your skin?  How important is sleep?

Dr. Fine:    Yeah. One night of sleep interruption has been shown to epigenetically alter your skin health genes. One night of interrupted sleep. I could do several of those in a week.

Dr. Weitz:  Yeah, of course.

Dr. Fine:    Yeah. I was shocked. I was like, “Wow!” because I was really hoping to find research that said if you have to miss an entire night of sleep, you knock off a little bit. No, it’s just like one interrupted night, that’s it. That was very discouraging, I thought.  Sleep is very important. I mean it’s true, there is no beauty without beauty sleep. Your body rests and repairs the brain. Now we know the brain has a glymphatic system and it’s detoxing overnight. Your skin is also … Everything is just regenerating and healing overnight. You do have to sleep.

I want to talk about tai chi for a minute. Tai chi [inaudible 00:43:36]. Actually, I do tai chi. I have a story about it. I have a friend and she said … I was talking to her about my book, tai chi, “Oh,” she said, “I had a client come in once. This woman looked like she was in her 60s, but I asked her she was. She was like 93. I asked her, ‘What do you do?’ She said, ‘In my 60s, I took up a new job of teaching,'” I don’t know, “‘women.'” I don’t know if they were pregnant women or … She was teaching some group of women tai chi. She started doing that in her 60s, and she just looked so youthful. She lived into her 100s.  I looked into tai chi and it’s like tai chi, in the study that … There’s more than one study, but in a particular study, they looked at six different gene regions that affected aging. Six. That’s what I looked at, six. Tai chi positively affected all six. Not one of six, not two of six, not three. All six. Six out of six, which makes you think, “I wish [inaudible 00:44:45] more”, right? Well, it affected all six. What’s interesting is that those particular gene regions were mostly involved with DNA repair. That’s something that’s really important. Our DNA, as we get older, it’s crumbling.

Dr. Weitz:  Absolutely. Physical activity is so important.

Dr. Fine:    That’s a medical term, crumbling.

Dr. Weitz:  There you go. Okay. Why don’t you tell us how listeners can find out about your programs and get a hold of you? I know you said you have a special offer.

Dr. Fine:    Yeah, I do. I do have a website. It’s drannemariefine.com. My online programs are on there. I’ve got a newsletter and different things like that. Anyway, if you would like to book a complimentary 30-minute consultation with me, we can explore how we might work together outside of the podcast to implement some of these things into your life or in the lives of your patients for all the doctors out there. You can contact me at my email, which is info@drannemariefine.com, or you can give me a ring on my phone. Do you want to just put that in your show notes or should I say it to you?

Dr. Weitz:  It’s up to you.

Dr. Fine:    Okay. You can call me at 480-510-3448.

Dr. Weitz:  Great. Your office is located where?

Dr. Fine:    It’s in Corona del Mar, California.

Dr. Weitz:  Okay. Your book is available on Amazon and Barnes & Noble, right?

Dr. Fine:    Yes. Well, not Barnes & Noble. It’s available at Amazon.

Dr. Weitz:  On Amazon, great. Cool. The name of the book again is?

Dr. Fine:    It’s Cracking the Beauty Code: How to Program Your DNA for Health, Vitality, and Younger-Looking Skin.

Dr. Weitz:  Great. Thank you so much, Dr. Fine.

Dr. Fine:    Thank you, Dr. Weitz. Thanks for having me on your podcast.

Dr. Weitz:  Yes. I very much enjoyed it. We’ll talk to you soon.



Anxiety with Dr. Kendra Becker: Rational Wellness Podcast 88

Dr. Kendra Becker discusses Anxiety in Children with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights

4:02  There has been a large increase in the percentage of children and teens suffering with anxiety in the United States in the last 20 years and Dr. Becker feels that part of this is due to the implementation of the Common Core curriculum in public schools in 2007, which promotes teaching that doesn’t match where children are neuro-developmentally. In other words, they start teaching children to learn things before their brains are ready for it and they also placed too much focus on testing, including even testing kindergartners.

9:30  Social media and screen time have a role to play in increasing anxiety in children.  Screen time turns off the creative center in the brain, which is especially problematic in a brain that’s underdeveloped due to being very young.  Humans really don’t fully develop their brains until about age 25, so parents should limit the time kids spend in front of a screen.

13:38  Dr. Becker likes to do comprehensive lab work on her patients that includes vitamin and mineral testing, including vitamin D, vitamin A, mineral levels in red blood cells, cortisol testing, hormone testing. She will often start with serum levels of nutrients that are covered by health insurance.  Dr. Becker said that she does use Great Plains lab for toxins.  She also likes to test for toxins.  She tries to be mindful of her patients finances and tries to use conventional labs that are covered by insurance, but she will use the Spectracell Micronutrient test or the Genova NutraEval test for some patients that require it. Dr. Becker also tests for genetics.

16:47  Toxic chemicals like heavy metals, BPA, and glyphosate can also be factors in causing anxiety in children.  Anxiety results from a state of inflammation, which can result from toxins or even heavy metals like lead that competitively inhibit the body’s ability to use beneficial minerals and vitamins and this is even more problematic if the patient has certain genetic defects, like MTHFR, which can jam up your methylation pathway and result inflammation without the right nutrients.

19:17  Certain nutritional deficiencies, like vitamin B12 can cause anxiety or if there is too much B12 for that person, this can also cause anxiety.  She will look at serum B12, folate, methylmalonic acid, homocysteine, ceruloplasmin, C-reactive protein and the whole methylation pathway.  You also have to look for MTHFR or COMT, etc.  Sometimes Dr. Becker will recommend B12 and folate, sometimes B1, and sometimes molybdenum, which helps B12 to get through the receptor more efficiently. Also molybdenum breaks down the Epstein-Barr virus.

22:35  Diet, esp. fluctuations in blood sugar levels, can affect anxiety levels in children.  Dr. Becker recommends feeding your kids protein in the morning.  Throw out the cereal and feed them eggs. If you front load kids with carbohydrates and sugar in the morning, they’ll peak and then they’ll tank.  Her kids have eggs and vegetables like onions, peppers, spinach, etc. and also bacon.  She said that her son had sausage and kale soup for breakfast this morning. Right after an athletic event, her son will often have low blood sugar, so she will give him something that has both some quick carbohydrates and a little bit of long-acting carbohydrates and a ton of protein.

26:37  Dr. Becker said that she’ll speak to the parents about gluten and dairy. Gluten is a sticky protein found in wheat and it causes leaky gut for up to three hours after consumption.  And if you have leaky gut, you probably have leaky brain, since these proteins like gluten go straight to the brain and can affect the anxiety center or cause aggression in children.  She highly recommends avoiding gluten, diary, corn, and soy. She generally does not order a food sensitivity panel from Cyrex or one of the other companies offering such panels due to the cost. She will sometimes order standard IgG testing for gluten, dairy, corn, and soy from standard labs, which is usually covered by insurance.

31:46  To assess gut health in children, Dr. Becker will often order the GI Effects stool test from Genova Labs and she includes the zonulin marker for leaky gut.  She will then use nutritional products like antimicrobials, probiotics, gut healing combination products, chlorophyl, molybdenum which helps with acetylaldehyde, or colostrum.   

34:27  Dr. Becker explained that the following nutritional supplements can help children with anxiety, depending upon the child: 1. Glycine, which binds to the same receptors that benzodiazopenes do, 2. vitamin D, which is a precursor to dopamine, 3. fish oil, 4. a probiotic.

35:27  There are some genetic factors that affect anxiety like MTHFR and COMT. COMT is like the garbage man that gets rid of the old, used up neurotransmitters. Some have a variant that makes them COMT up-regulators and they can be very sensitive to B vitamins. Everybody needs methyl B12, but if they are COMT up-regulators you need to be careful not to give them too much. Sometimes it is better not to give them B12 at all and hope that they can get their B vitamins from green vegetables. Sometimes it is better to give them B1 or B2 and avoid B6, 9, and 12. Sometimes you want to give adenosyl or hydroxy B12. If a patient has a down-regulated CIMT, you may need to support the adrenals and exercise can be very helpful for these patients.

40:09  Dr. Becker does not believe that kids should be doing any homework since it does not enhance learning.  She often gives them a doctor’s note so that they do not have to do homework.

46:01  Dr. Becker finds that chiropractic is helpful for children with anxiety.  When you get a chiropractic adjustment, not only are you removing interference from a spiritual level, but you’re also increasing endorphins, oxygen, and healing components of your immune system into your brain and into your nervous system.  For some patients, chiropractic can be a real game-changer.


Dr. Kendra Becker is a Naturopathic Doctor who has a specialty in treating children with asthma, autism, allergies, eczema, and anxiety disorder, among other conditions. Dr. Becker teaches and lectures on various topics, including concussion, autism, MTHFR, and genetic mutations. She is also the author of two books, A Delicious Way to Heal the Gut, and All You Can EatDr. Becker can be contacted at the Family Wellness Centre Of Connecticut.

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 Transcripts

Dr. Weitz:     This is Dr. Ben Weitz with the Rational Wellness podcast bringing you the cutting edge information on health and nutrition from the latest scientific research by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcasts, please go to iTunes and give us a ratings and reviews so more people will find out about our Rational Wellness podcast. Today our topic is anxiety in children with Dr. Kendra Becker. In the pediatric population, anxiety is a common phenomenon and it is growing fairly rapidly.

According to the National Institutes of Health website, 31.9 percent of adults in 2018 suffered with an anxiety disorder. Between 2007 and 2012 there was a 20 percent increase in diagnoses of anxiety among children ages six to seventeen. A survey of incoming freshman at UCLA found that when asked if they felt overwhelm with all they had to do in 1995, 18 percent answered yes. By 2000, that number had climbed to 28 percent.  By 2016, the percentage that said yes was 41 percent. According to anxietycenter.com, anxiety is defined as a state of apprehension, uncertainty and fear resulting from anticipation of an event or situation which is perceived as being threatening, often impairing physical and psychological functioning. In other words, anxiety occurs when we behave in an apprehensive manner, such as when worrying about a non-threatening event or situation.

There are literally hundreds of symptoms that have been associated with anxiety disorder, though some of them more common include rapid heart rate, shortness of breath, excess sweating, twitching, insomnia, frequent urination or diarrhea. However in children, anxiety can be difficult to diagnose and it’s easy to mistake anxiety for a learning disorder or Attention Deficit Disorder.  Anxiety in children can manifest as agitation, restlessness, inattention, poor focus, refusing to go to school, meltdowns, crying, et cetera. In reality, some children may have anxiety and ADD at the same time. Children may also experience somatic manifestations of anxiety that can include stomach pain, muscle pain, or headaches.

Our special guest today is Dr. Kendra Becker, who’s an integrated naturopathic physician with a specialty in treating children with asthma, autism, allergies, eczema, and anxiety disorder, among other conditions. Dr. Becker teaches and lectures on various topics, including concussion, autism, MTHFR, and other genetic mutations. She’s the author of two books: A Delicious Way to Heal the Gut, and All You Can Eat, which was just released in May.  Dr. Becker, thank you so much for joining me.

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

Dr. Weitz:     Can you talk about some of the reasons why we have this big increase in anxiety among children?

Dr. Becker:   I think it’s really like everything else with the human body; it’s multifaceted. I think, especially with the statistics that you just read, around 2007 is when they introduced Common Core, which is a different learning form in the public schools. One of the biggest shortcomings with Common Core is that the way that the curriculum was set up, it wasn’t set up to really match where children were neurodevelopmentally.  They were teaching children younger than their brains were developed to be able to learn the skills that were on the roster. The other thing that they added was they started testing kindergartners. The testing wasn’t this global comprehension. It was a very concrete paper, write the answer, it’s either correct or wrong testing. They were doing things like putting up cardboard petitions between children sitting at their desks.

They were really putting a real hyper-focus on this testing. I think that in and of itself is a huge thing that really contributed to what we were seeing as far as anxiety and the epidemic numbers. In my practice it was exactly the same. I had seen maybe prior to 2007 a handful of kids with anxiety that had manifested, as you spoke about, in ADD or ADHD. But after 2007 I would say probably is about 20 percent of my practice.

It was just really interesting how it was literally like a light switch. The other thing, which is where my area of expertise is, is just to focus on the genetic predisposition. Our genetics don’t define us. I always use my 96-year-old grandmother as an example. She lived to be 96. She died with all of her teeth in her mouth. She was the same weight the day she died as she was the day she graduated from high school.  She was an Italian immigrant that walked everyday and ate a bunch of green vegetables morning, noon, and night. Her genetics were terrible. They were absolutely terrible. She had all the genetic predispositions for tons and tons of inflammation: cancer, thyroid disease. None of which ever manifested in her body because of the way she took care of herself.  I think that having a genetic predisposition doesn’t mean you have to own a diagnosis but in this case, certainly with the exogenous stress from our environment: schooling, stressful home life, whatever it is that predisposes that child, can certainly play a huge role in what we’re seeing as far as anxiety in little kids.

Dr. Weitz:     Yeah. I could understand that test score thing. I live on the west side of L.A. and we’re talking about a big focus on kids being super successful and being able to go to really good colleges. There’s so much emphasis on test scores. Everybody’s got tutors and sending their kids to special programs for learning outside of school, on top of paying for expensive private schools. It’s amazing the amount of pressure on these kids.

Dr. Becker:   I know. It’s really interesting yet the Bill Gates’ of the world don’t allow their children to have any electronic devices and send their kids to Waldorf. That always is so fascinating to me because if you know anything about Waldorf, they don’t really give children a pen and a paper to physically write until their about nine years old because that’s when the brain catches up with the fine motor.  It’s just a really different learning structure. I think there’s something to be said about that. You’ve seen the schools across the country that doubled up recess or doubled up the amount of time kids have at lunchtime, and all of their test scores went up. I definitely think all of those things are a great shakeout for kids that have anxiety.

Dr. Weitz:     Yeah. You wonder if all this emphasis on test scores is not the best way to be rating our schools or our teachers. Are we trying to force kids into some narrow model that’s maybe … They have this objective performance but maybe you’re creating psychological problems and maybe we’re de-emphasizing creativity, which I think is super important.

Dr. Becker:   I totally agree. I think that’s a lot of what you’re seeing in children is they don’t fit into this little square box. That’s where some of the anxiety comes in. Even with the kids in my practice what I hear all the time … Here’s a really great story about a little girl with anxiety. At home, she’s a beast. The parents schedule their parent-teacher conference.  They’re going in with the tissues and their going in with a rescue remedy because they’re sure that it’s going to be a horrible, horrible conference. Well what they heard from the teacher was is that kid is an angel all day long. She’s a helper, her grades are fine. Everything that she’s supposed to be doing, she’s doing. But what was happening to her is she was so stressed out for keeping it together for the six hours that she was in school that when she would come home she would literally fall apart.  Her symptom picture manifested in just very, very aggressive belligerent behavior.  I think she was 12 at the time, which is uncomfortable for parents that see that in their child.

Dr. Weitz:     Interesting. What role do you think social media plays in this anxiety?

Dr. Becker:   I don’t know. Social media I’m sure plays a huge role in it. I think screen time starts far earlier than social media. We know, just like you said, screen time turns off the creative center in the brain. When you’re turning off the creative center in a brain that’s undeveloped, and humans really don’t fully develop their brains until about 25, then you’re really only allowing for one trajectory to really develop.  I think that’s definitely part of it, and then certainly social media in general. There’s a lot of pressure for us, for adults that are emotionally well-developed, on social media. Who’s putting out a course this week and who had their 20 pound weight loss transformation? And everything else. I think these are the conversations that you have to have with your kids.  My kids are young. My kids are nine and 12. They get about 30 minutes a day. My son who’s nine gets about 30 minutes a day of screen time. My daughter gets a little bit more based on her behavior. For them, I think that’s enough. In fact for me, if it were up to me, I would say absolutely none whatsoever but we make our accommodations.

Dr. Weitz:     Yeah. No, I can see from the parents who come in with their kids to see me for chiropractic, for years there would be books and there would be various toys.  Even if they were doing something electronically a lot times it would be some educational game.  Now the parents just hand the kid a phone or an iPad.  They’re just …

Dr. Becker:   Yeah. We do the same thing. It astounds me every time that I see a baby under two years old with a phone that knows how to use it, that can scroll through. It just is astounding to me. Astounding.


Dr. Weitz:     I’m proud that this episode of the Rational Wellness podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional nutritional products that I carry 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.

Integrative Therapeutics is also the founding sponsor of TAP Integrative, which is a dynamic resource for practitioners to learn with and from leading experts and fellow clinicians. I’m a subscriber and this resource includes a service that will provide you with full copies of journal articles. This alone is worth the yearly price of subscription. If you use a discount code WEITZ, my last name, you’ll be able to subscribe for only $99 for the year.


Dr. Weitz:     What are the most common symptoms you see with kids with anxiety?

Dr. Becker:   Actually it manifests a lot in aggression. That’s what the patients come in the office for. You know what I mean? The other thing I see a lot is the ADHD, ADD inattentive-type behavior at school. Those are the two things that I actively treat for. I would say 90 percent of ADD or ADHD that I see in my office is generally anxiety in kids.

Dr. Weitz:     Well how do you know that belligerent behavior isn’t bipolar disorder or some other psychological condition, rather than anxiety?

Dr. Becker:   Because you got to tease it out, right?

Dr. Weitz:     Okay.

Dr. Becker:   For me, I do comprehensive lab work. I look a lot at genetics. Family history is huge with things like bipolar and schizophrenia, things like that. The other thing, years ago we would say “Oh bipolar really doesn’t take hold in a body. It’s hard to diagnose before the age of 20.” That was the standard rule that I left medical school with. These days, that is certainly not the case. You can diagnose bipolar way, way younger than the second decade, third decade of life.

Dr. Weitz:     When you talk about comprehensive lab work, is there a standard panel that you’ll use for all patients or do you tailor it after doing the history?

Dr. Becker:   Generally in my practice one thing, as you know in naturopathic medicine, is that it’s a very unique individual trajectory with each patient. As a rule, I do pretty comprehensive vitamin level testing and mineral level testing.

Dr. Weitz:     How do you do that?

Dr. Becker:   Usually through blood work. Some of the standard labs around-

Dr. Weitz:     Do you use SpectraCell’s Micronutrient or-

Dr. Becker:   Sometimes I use SpectraCell. I generally try to meet the patient where they’re at. I try to use conventional lab work on the outset. In most cases the labs are covered by the patient’s commercial insurance and it’s an easy place to start with people. I’ll do just-

Dr. Weitz:     Including the nutrient analysis?

Dr. Becker:   Absolutely. I’ll just look at Vitamin D levels, Vitamin A levels. I’ll look at mineral levels inside the red blood cells. I look at a lot of cortisol testing, hormone testing, things like that. I do use Great Plains lab and I test for glyphosate in a fair amount of my patients. Certainly my waiting list is a bit long. What happens with a lot of my patients is my staff is really excellent at saying, “Why don’t you get a hold of Dr. Kendra’s book which has a lot of healing diets in it, which reduces inflammation, and in the meantime do one of the genetic testing company tests that are out there.”  By the time they come in my office they’ve already been on a healing diet for three or four months and they already have their genetic testing, so it’s a very easy way to get a jump-start with my patients.

Dr. Weitz:     For genetic testing, are you talking about 23andMe, Ancestry, or-

Dr. Becker:   Uh-huh. Yep.

Dr. Weitz:     … specialty labs? Okay.

Dr. Becker:   I’m also currently in negotiations with a company from the Northwest. We’re looking to put together my own personalized panel because as you know there’s like four billion genes in the genome and about 4,000 of them separate us from apes. About 400 of those have implications on our health, and about half of that is stuff that we can actually modulate as physicians with diet, supplements, and lifestyle suggestions.  I’m looking at putting together my own personal panel. They’re in the final stages in opening up their company. I’m really hoping to move forward with them because they’re not a standard 23andMe or a Ancestry company which sells your DNA for data mining. It’s deidentified so they shouldn’t be able to identify who you are personally but you don’t know that. You really don’t.

Dr. Weitz:     Unfortunately in the age that we’re in with social media and everything else, privacy’s pretty much out the window.

Dr. Becker:   It’s funny because I have patients who are very concerned about sending out information, blood or saliva or whatever, for DNA analysis.  I’m like, “Oh please, they already got it and if they wanted to find you they would. Trust me.”

Dr. Weitz:     In the post-9/11 world, forget about privacy.  As much as I would like to have privacy, I don’t think it exists.

Dr. Becker:   I totally agree with you.  Totally agree.

Dr. Weitz:     Can you talk about exposure to toxic chemicals like heavy metals, Bisphenol A, and you mentioned glyphosate and how this might be related to anxiety in children.

Dr. Becker:   Sure. Again, it comes down to whatever your genetic predisposition is. If you have a gene for example, MTHFR which is methylenetetrahydrofolate reductase, that helps convert folic acid which is synthetic into the usable form of folate. However in order to do that you need to recruit all the other B vitamins from your food and a bunch of minerals.  If this enzyme is not working properly and they pathway is jammed up in some way, what ends up happening is you end up using up your B12, using up your magnesium, and some of these other co-factors in a little bit of an inefficient way. When that happens you’re robbing your body of the co-factors for any of these other nutrient pathways that would utilize those minerals.

Because this happens, it creates inflammation in the body. When we create inflammation in the body, we end up eliciting an immune response. When we have an immune response, that immune response could be misdirected if the body is out of balance. Recent research has shown us that conditions like depression and anxiety come from an inflammation state.  By looking at those things, the Bisphenol A, the glyphosate, even heavy metals like lead, those things competitively inhibit the body’s ability to use the beneficial minerals and vitamins and can certainly throw a wrench in your cogwheel of the MTHFR, for example.

Dr. Weitz:     How do you test for heavy metals and how do you test for some of the other toxins?

Dr. Becker:   For heavy metals, it varies. Sometimes I’ll do blood. I’ll look at an RBC lead level. I’ll do a standard lead level, things like that. With glyphosate I’ll use the Great Plains lab. You asked me one other thing but I forgot what that was.

Dr. Weitz:     I don’t remember either.

Dr. Becker:   Oh okay, fine. Anyway but that’s how I test for those things. As far as Bisphenol A it’s just really for me, I look at genetics. I try to be really mindful about people’s pocketbooks. If we can’t make progress then I will go into the NutrEval testing and the micronutrient testing. But for the most part a comprehensive analysis and a look at some just standard conventional blood work can really, I would say 80 to 90 percent, lead you down the path to help your patient heal.

Dr. Weitz:     You mentioned nutritional deficiencies. Can you explain what are some common nutritional deficiencies that may have a role in anxiety disorders?

Dr. Becker:   Sure, low B12. We know with B12 it’s a little bit of a slippery slope. You can have a normal serum B12 level but still not have the B12 where you need it inside the cell. Conversely you can have B12 that looks normal and it be too elevated for that patient, which can also give that patient anxiety symptoms.

Dr. Weitz:     Are you looking at homocysteine levels or methylmalonic acid? What marker for functional B12 status are you looking at?

Dr. Becker:   I do the whole pathway. I do the B12, folate. I do the MMA (methylmalonic acid). I look at ceruloplasmin. I look at homocysteine and I look at C-reactive protein. That’s generally how I do it. Depending on-

Dr. Weitz:     For those who aren’t aware, can you explain what you mean by the B12 pathway and how those factors fit into it?

Dr. Becker:   Sure. B12 comes into our bodies via food for the most part. Then the food is broken down and the nutrients are disseminated through the circulatory system. When it’s disseminated through the circulatory system and we draw blood, that’s called the serum B12 level. That’s a level of how much B12 is in your blood.  However if you have impaired pathways for whatever reason, MTHFR, COMT, any of the other to MTHFR or whatever, you certainly could have B12 that looks adequate or even elevated in the blood and then not have any of the B12 inside the cell. Then you can look at a level like methylmalonic acid which actually looks at the transmission across the cell membrane for the B12 to make sure that there’s adequate B12 inside the cell.  As you know it’s a lab test that isn’t a hundred percent accurate but it gives us a best indicator because the methylmalonic acid is a byproduct of how the cell uses B12. It’s good enough. A lot of times what happens with those patients is you can’t give them B12 because it does make them anxious, impairs their sleep, or it makes their behavior worse.

You have to do something else to help the pathway, support that pathway. In some cases you use B1. In some cases I use the element molybdenum, which I’ve had very, very good success with. Sometimes you don’t do any of that and you just tell your patients to go home and eat a whole bunch of cooked green vegetables. Each patient’s really, really individual and you have to meet them where they’re at.

Dr. Weitz:     What does molybdenum do?

Dr. Becker:   Molybdenum, the way I describe it to my patients is it works like lubricant. It lubes up the B12 to get it through the receptor a little bit faster and more efficiently. The other thing with molybdenum is it’s a great byproduct of methylation. It tends to be very, very delicious “food” or energy for the Epstein–Barr virus, and molybdenum tends to be really, really effective in breaking down the Epstein-Barr virus also. It’s a twofold.

Dr. Weitz:     Interesting. It also binds with copper. You can change your zinc-copper ratio that way as well.

Dr. Becker:   Absolutely.

Dr. Weitz:     Let’s talk about diet and food, and how it impacts anxiety and blood sugar.

Dr. Becker:   Oh yeah, let’s do that. The first thing is I’ll practice-

Dr. Weitz:     None of our kids have any blood sugar problems, right? Because they’re-

Dr. Becker:   No.

Dr. Weitz:     … just eating green vegetables.

Dr. Becker:   Exactly. My son, my nine-year-old, plays hockey. This is a constant conversation with him about being hangry, because if he was hangry it would be so much easier to figure out what’s wrong with him. But with him, he gets in the car after hockey and he’s silent. I was like, “Your blood sugar low?” Nothing. I’m like, “Eat something. Eat something right now.” All kids are really, really different.  But when kids have labile blood sugar, they certainly can get anxious. That’s always my first advice to patients and to teachers is before you’re worried about any diagnosis, feed the kid and give them something that has a little bit of quick carbohydrates and a little bit of long-acting carbohydrates, and a ton of protein. That tends to be really, really effective as far as digestion for those kids and staying power. But-

Dr. Weitz:     I know my kids, right after they … When my son was done with a soccer event there was never any problem in the car because right after, the parents would always bring snacks so they’d carb it up right away.

Dr. Becker:   Yeah. Yeah, we don’t have that luxury. With hockey, it’s a little different. You’re so beholden to the ice time gods. These kids get dressed and they get right in the car. Then you’re off to the next thing. You’re off to the next game, the meet, or whatever activity you have. They get right in the car. There’s not a lot of social stuff unless it’s the end of the season unfortunately.

Dr. Weitz:     Oh, okay. How do you manage the blood sugar levels besides just getting some carbs in after an athletic event?

Dr. Becker:   My advice in general across the board is protein in the morning.  Throw out your boxes of cereal and your real milk, fake milk or whatever. When you front load kids in the morning with carbohydrates and sugar like that, they’re going to peak and then they’re going to absolutely tank. Because of that, a lot of times you can see that hangry behavior, that anxiety behavior, or however kids manifest their low blood sugar. I always say protein in the morning.  For me, I’ve never been a breakfast person. I’m hypoglycemic myself so I’m really mindful of where I’m at with my blood sugar. I always say to parents, protein in the morning. I love eggs, but for me it’s very cyclical. I’ll eat eggs everyday for three weeks and then be over it and eat something else. I always recommend some really high-quality protein shake, or a piece of chicken from last night’s dinner, which is a far better source of protein or nutrients to start your day than a bowl of cereal.

Dr. Weitz:     For breakfast for kids, you give them some eggs? Is that it?

Dr. Becker:   Everybody is different. My kids, no. My kids get eggs, bacon a lot of times and then we mix usually onions and peppers. In the summer we do a lot of spinach and basil or garlic scapes, depending on where we are seasonally. Then for me, I would give my kids in particular they’ll have a snack two hours later. That’s generally nuts. Right now we’re on a macadamia-

Dr. Weitz:     No toast or oatmeal with the breakfast? Just eggs.

Dr. Becker:   Just eggs.

Dr. Weitz:     Okay.

Dr. Becker:   No, my kids don’t have toast. Sometimes, this time of year they’ll ask for hash browns so I’ll make either a white potato or sweet potato or a yucca hash brown but who’s got time for that in the morning? Not me.

Dr. Weitz:    Okay.

Dr. Becker:   But this morning my son had sausage and kale soup for breakfast. You know what I mean?

Dr. Weitz:     Wow.

Dr. Becker:   My daughter made herself a smoothie.

Dr. Weitz:     That’s pretty impressive.

Dr. Becker:   Absolutely. Then the other thing is-

Dr. Weitz:     Kale soup for breakfast. Wow.

Dr. Becker:   Yeah. You don’t mess around.

Dr. Weitz:     You’ve got some strange kids.

Dr. Becker:   I know, right? I know. Then the other thing is too is I have a big conversation with my parents about gluten and dairy. Gluten, which is the protein that’s found in wheat and wheat products is called gluten because it’s like glue. That’s why they call it gluten. If you think about that and these processed grains, you have this overexposed surface area that allows that stick gluten glue protein to stick anywhere it wants.  Now, we know by research that if you have the most perfect, beautiful balanced gut and you consume gluten, you’re going to have leaky gut for up to three hours after that consumption. If you have a leaky gut it can be inferred that you have a leaky brain. In many cases those proteins go straight to the brain.

The problem with that is, is that glue sticks in those areas of the brain that very would could be the anxiety center, the aggression center or whatever in those children. Almost across the board a hundred percent, I highly recommend getting rid of gluten in the diet. That can make a huge difference with anxiety because as you know, with food allergy and food sensitivity you don’t have an immediate reaction.

You don’t consume gluten and then your throat closes, or you don’t consume gluten and then get immediately anxious although some patients do but a lot of times we have what’s called the delayed hypersensitivity reaction. The reaction comes 30 minutes up to 72 hours after the consumption of the food. You eat a turkey sandwich on white bread on Monday and now Tuesday night you’re trying to go to sleep and you have heart palpitations that could very well still be associated with the gluten that you consumed.

Dr. Weitz:     Do the kids need a gluten sensitivity panel from Cyrex or one of these companies, or are you just automatically “no gluten?”

Dr. Becker:   I don’t generally use Cyrex’s panel. I used to almost exclusively order the celiac panel, which had the tissue transglutaminase, the IgG, and the IgA. Then the insurance started kicking it back to me. I’ve actually stopped doing that over the last five years or so. What I do instead is I just order standard IgG testing for gluten, dairy, corn, and soy. That seems to be pretty well supported by the insurance companies that are around here in this area.

But a lot of times it’s a diagnosis of exclusion. I never tested for gluten sensitivity until about seven years ago when I had a patient that walked in the office whose kid was absolutely positively from the second she walked in the door diagnosed with a gluten sensitivity. The family just wasn’t going to get on board until I drew the labs. The labs that we use is anything greater than two is considered a gluten sensitivity. Well this kid was over 300.  It wasn’t until that point, until they saw it on black and white on paper that they realized that their kid had an issue. Remove the gluten from the diet, symptoms went away. Sometimes, like I said, you got to meet your patients where they’re at. Those people needed it. They needed to see it on paper.

Dr. Weitz:     Right. But if you’re just doing an IgG for gluten it might not be as accurate as some of these more elaborate panels.

Dr. Becker:   Sure.

Dr. Weitz:     For example, I know the Cyrex panel for wheat measures 15 different proteins in wheat that can all create sensitivity reactions.

Dr. Becker:   Oh, absolutely but like I said, I tend to be a real practical naturopath. I use my diagnosis skills and my comprehensive assessment first, generally because I’m in an area that my patients are not wealthy. They pay out of pocket to come to see me to begin with. To be able to drop $300, $400, or $500 on one isolated test can be very, very financially stressful for them.  I don’t do that kind of testing unless the patient comes back in the office and they’re not better. Then I’ll tend to look a little bit further. But like I said, I think it’s about 80 to 85 percent of my patients are better just with that. I tend to be really lucky.

Dr. Weitz:     You tend to just exclude gluten or do you do an elimination diet?

Dr. Becker:   Depends on the patient. Generally the things that I would go to initially are generally gluten, corn, dairy, and soy. Those are the four things that are usually the absolute must to remove. Again, every patient is different. I’ve had patients who have just exclusively removed gluten and their symptoms have resolved. Sometimes you need to go a little bit further and add additional things into the removal list, but I try to really be very practical and pragmatic with families because even just …

I had a woman who came in with raging anxiety. She had two young kids who she was caring for. She was like, “I’m super, super anxious.” I said, “You got to get rid of gluten.” She’s like, “I’m not ready to get rid of gluten.” I was like, “All right. Call me when you are.” I would get emails from her three or four weeks later, “I’m so anxious. I feel I need to go on a pharmaceutical. What else can I do other than removing gluten?”  I’m like, “Nothing. You have to start there.” Finally she did it and she lost 60 pounds. But again, you just got to meet patients where they’re at. Sometimes they’re not ready in spite of the fact that they’re paying for your advice to walk through your door.

Dr. Weitz:     Dr. Becker, the “Gluten Nazi.”

Dr. Becker:   Indeed. That’s exactly what my kids call me. Indeed.

Dr. Weitz:     How do you assess gut health and how do you treat problems with gut health?

Dr. Becker:   Again, it all depends on what’s in there. Who do I use? I use Genova’s test which I really, really like. I always add the zonulin on there.

Dr. Weitz:     You’re talking about the GI Effects stool test from Genova labs?

Dr. Becker:   Correct. I use that because it’s easy to rule out whether there’s a parasite or some pathogenic bacteria. It’s a relatively easy collection test. Genova’s really great when working with parents with their insurance and really helpful with billing and things like that. That test tends to be really effective. As far as treatment, it all depends on what you’re seeing. If there’s a parasite or a bad bacteria in there, you got to get rid of that first.

If it’s just a matter of commensal bacteria being out of balance, then you got to support that. But that test is really great at giving you a nice smattering of what is wrong and what is right. I use a lot of probiotics. I use a lot of gut healing combination products.

Dr. Weitz:     How would you support commensal bacteria out of balance? Let’s say you have potentially pathogenic bacteria are elevated and maybe slightly lower levels of commensal bacteria. How would you address that and then put to your patient?

Dr. Becker:   Well it depends on the patient. It depends on what bacteria is high and what bacteria is low.

Dr. Weitz:     Okay.

Dr. Becker:   Sometimes you can use things like chlorophyll. You can use molybdenum, which helps with acetaldehyde. You can use immunoglobulins or colostrum. It all depends on what you’re seeing. Sometimes you give specific strains of probiotics based on what the patient needs. You can use specifics, just lactobacillus gasseri or lactobacillus acidophilus, depending on what you’re trying to really support in that patient. It’s difficult to say what I do because I am not an always or a never kind of girl. You know-

Dr. Weitz:     If your lactobacillus is low, you might particularly try to support that particular type of bacteria?

Dr. Becker:   Yeah, absolutely.

Dr. Weitz:     Okay. Then what if there are pathogenic bacteria and/or parasites? What type of treatment will you do then?

Dr. Becker:   Well it’s different for every patient. I have prescribed antibiotics. I’ve used herbal combinations. I have used liquids, tinctures, all stuff like that. I’ve used mastic gum. I’ve use glutamine. It all depends on what the bacterias and what the symptom picture is for that child.

Dr. Weitz:     Mastic gum is something you use for H. pylori?

Dr. Becker:   Mm-hmm (affirmative). Absolutely.

Dr. Weitz:     Okay. What about nutritional supplements for children with anxiety?

Dr. Becker:   Again, it depends on the kid. You have to figure out where the anxiety is coming from. Is it a food allergy problem, is it a cortisol issue, is it a lack of sleep or a home stress? Things like that. You certainly could use amino acids like glycine which are really, really effective. Sometimes you just give Vitamin D.

Dr. Weitz:     What does glycine do?

Dr. Becker:   Glycine binds to the same receptors that benzodiazepines do. It works like a benzodiazepines without the addiction. Give Vitamin D. Vitamin D is a precursor to dopamine, which is a happy hormone. Those things can be really effective in kids. Fish oils. It all depends. Sometimes they just need a probiotic.

Dr. Weitz:     What levels of Vitamin D do you supplement with children?

Dr. Becker:   All levels. Generally I try to keep my patients between 55 and 80 or 85.

Dr. Weitz:     That’s pretty aggressive.

Dr. Becker:   Yep. I do what I can.

Dr. Weitz:     Good, good. I know you’ve touched upon genetics a little bit. Can you talk a little more details about a few genetic factors? I know you mentioned MTHFR. What are some of the other genetic factors that can play a role in anxiety in children?

Dr. Becker:   Sure. There’s another genetic mutation or marker called COMT (catechol-O-methyltransferase). That basically works like the garbage man up your neurotransmitter system. It picks up all the old, used up neurotransmitters. If that system is not working properly you basically have all these random neurotransmitters that have never been recycled that potentially could refire at any time.  Then when you have the refiring you again create inflammation. People that are what’s called COMT upregulators … I always compare the COMT upregulators and the COMT downregulators to the Eeyore versus the Tigger, which we all love Eeyore but we all know he’s chronically depressed. We all love Tigger but we all know he’s got ADHD. That’s how we look at it.

The truth of the matter is that there are definitely personality types that go along with individuals that have COMT. They are what we call the 0 to 60 types. They can be provoked very easily and then get very angry very quickly. That’s a classic sign of a COMT upregulator. The problem with that is when you get angry you raise your cortisol. When you raise your cortisol, you raise your blood sugar.  When you raise your blood sugar you increase the leakiness of the blood-brain barrier. It’s a big trickle-down effect. Based on that, what we also know about people that are expressing their COMT mutation is that they can be estrogen-dominant. We know that estrogen in general, whether it’s real or fake, can cause leaky gut. Leaky gut … Because 90 percent of our neurotransmitters are manufactured in the gut, really needs to be intact for proper neurologic functioning.

Dr. Weitz:     Let’s say you do have a patient with or two copies of the COMT single-nucleotide polymorphism variant. How do you treat that?

Dr. Becker:   Again, it’s very different because sometimes you have patients that are COMT upregulators that are very, very sensitive to B vitamins. Everybody needs Methyl B12. Period, end of story. It’s gasoline for our cells. However, if you give a lot of Methyl B12 to somebody who is a COMT upregulator, you can make them super anxious, really mean or hate you. It doesn’t-

Dr. Weitz:     What do you do then?

Dr. Becker:   Depends on the patient. Sometimes you have to use a different form of B12. Sometimes you don’t use any B12 at all and hope that they can tolerate green vegetables. Sometimes you give them B1 or B2, or sometimes you give them a B-complex that avoids B6, 9, and 12. It all depends. Sometimes you just start with minerals. Every-

Dr. Weitz:     What other form of B12 will you use besides Methyl B12?

Dr. Becker:   Depends on the patient. It could be adenosyl or hydroxy.

Dr. Weitz:     Okay. What about patients who have down-regulated COMT?

Dr. Becker:   If they are not methyl-sensitive, sometimes those are patients that require higher doses of B12. It all depends. Sometimes you’d have to support the adrenals. Sometimes they have Epstein-Barr. You get a whole wide variety of patients across the board and unfortunately there’s no one-size-fits-all.

Dr. Weitz:     Okay. What role can exercise play in reducing anxiety in kids?

Dr. Becker:   Well we all know that exercise is the number one misused drug in this country. It is completely underutilized. By exercising we know that we first of all burn off a lot of simple carbohydrates. Number two, it increases all the happy hormones and the endorphins in the brain. It improves sleep, can actually balance brain waves, and certainly help a physical body release any tension or stress that it’s holding. I think it’s grossly underused in this country for sure.

Dr. Weitz:     Also increases brain BDNF levels that promotes learning.

Dr. Becker:   For sure. Absolutely. It also helps with the translation of short-term into long term memory I believe. But I think BDNF does that, too, really.

Dr. Weitz:     Yeah. It’s interesting how many schools now because of budget problems and stuff have cut down on exercise programs and phys ed.

Dr. Becker:   Mm-hmm (affirmative). Recess even.

Dr. Weitz:     Yeah. What other lifestyle factors can be helpful for helping kids to manage anxiety disorder?

Dr. Becker:   As a rule I say no screens whatsoever two hours prior to bedtime. Come up with a pretty, I hate using the word “regimen,” but regular bedtime routine.

Dr. Weitz:     Well what if all their homework is online and they have to submit it online.

Dr. Becker:   Well in my practice I have kids on IEPs and 504s and I regularly write letters to not do any homework. It’s just part of my treatment plan. I don’t believe in it.

Dr. Weitz:     What age is that?

Dr. Becker:   I use it for all ages because I don’t … I-

Dr. Weitz:     No homework?

Dr. Becker:   … don’t believe in homework. Nope. Absolutely not. Your brain’s a muscle. It needs a rest. You’re going to go to the gym and work out for six hours, and then go home and work out for another four hours?

Dr. Weitz:     What school is going to allow your kids not do homework?

Dr. Becker:   If they have a doctor’s note, they get it done in school.

Dr. Weitz:     Really?

Dr. Becker:   Oh yeah. Yep. For the patients that don’t require a doctor’s note, that have 504s and IEPs and all that, it’s the first thing I tell them to say: “You go in their with your advocate if you have an advocate and tell them no homework.”

Dr. Weitz:     Wow.

Dr. Becker:   There’s no evidence that shows that homework that kids are doing at home is actually … Number one we know the test scores have gone down in the last nine years since Common Core, number one. Number two, that homework actually increases or enhances learning in any way.

Dr. Weitz:     Wow. You should just put that on your website: “The kids that I treat don’t do homework.”

Dr. Becker:   Oh my gosh.

Dr. Weitz:     Your waiting list is going to grow. You’ll have a three-year waiting list.

Dr. Becker:   Well, there’s lots of schooling programs that don’t require homework. Montessori doesn’t give homework. Grant it, the Montessori schooling program is generally over by 8th grade. Waldorf generally doesn’t start homework until around 5th or 6th grade. That homework is very constructive. It’s all project-based. You’re not sitting there writing answers on a sheet that somebody thinks is the right answer. It’s a creative project. It’s really only the public school that’s challenged. Countries all over the world don’t do homework. It’s only here.

Dr. Weitz:     Wow. Yeah, my kids are both in college now but they’ve had hours of homework everyday for years, years and years. It’s surprising to hear that. What about strategies for managing anxiety, like meditation, yoga, breathing?

Dr. Becker:   Yeah. All the things. I teach the kids in my practice the “I love you. Goodnight.” It’s what I call the “I love you. Goodnight.” What I teach them is that when they get in bed, they start with the top of their head and they say, “I love you. Goodnight.” to every single one of their body parts. “I love you. Goodnight, forehead. I love you. Goodnight eyes. I love you. Goodnight nose.” They do this throughout their whole body. I’ve never had a kid that’s gotten past their knees.

Dr. Weitz:     Wow. It’s a variation of the progressive relaxation strategy, right?

Dr. Becker:   Absolutely but you can’t teach a six-year-old how to do progressive relaxation. It’s really a take on counting sheep. It’s just a repetitive, calming exercise.

Dr. Weitz:     Right.

Dr. Becker:   But we all know yoga, any of these relaxation exercises, prayer, devotions, whatever it is, is very, very beneficial for sleep. Sometimes what you have do is, it’s not even about what the activity is … Here’s a funny thing. Before I became a doctor I was a nurse. I went to nursing school. I went to nursing school long before nursing was what it is today. We held our patients’ hands, we talked to them. We sat on the edge of their beds and asked them how they were feeling.

It’s a different experience that nurses have now. I’ll never forget, you wait all this time to get into these nursing classes. I get into my first nursing class and the teacher said to the class, “You have to remember that when patients are anxious about sleep, you can tell them that it’s okay to not sleep and to just lie there and take a rest.” For me, still after all these years that absolutely resonated. I tell that to my patients all the time because there is nothing worse than having anxiety about not being able to sleep when you’re trying to sleep, and then you can’t sleep. It’s just awful.

Dr. Weitz:     Right.

Dr. Becker:   Sometimes it’s just a matter of making a space for those people, those patients. Even kids, because kids have that level of anxiety at this point, too. You just tell them that it’s okay and just don’t do it. Just lie there and take a rest.

Dr. Weitz:     How about talk therapy for anxiety?

Dr. Becker:   I think it depends on the talk therapist. I think that’s really a decision that has to be made by the sufferer and the family because I think in some cases, talk therapy can be really, really effective. The problem here in Connecticut is that there’s been a lot of legislative action around what can actually be discussed in talk therapy.  I think that when you’re going to a licensed provider, you’re regulated by the state. I worry about that. I almost think that talk therapy could be much better in the confidence of somebody who’s qualified but isn’t a licensed therapist, if that makes any sense. Maybe a Reiki practitioner, a local pastor, or somebody like that.

Dr. Weitz:     Interesting. What about cognitive behavioral therapy?

Dr. Becker:   Again, I think it’s a personal choice.

Dr. Weitz:     Okay.

Dr. Becker:   I think there has been some success with it. It’s generally not my first line of recommendation unless a patient actively seeks it out themselves. But I think you have to remember with any therapy it’s a little bit like dating. You have to remind patients that you’re not going to schedule an appointment with a therapist that your friend liked and loved, and go in there and have a magical relationship. You may have to see two or three different therapists before you find the one that’s really effective for you.

Dr. Weitz:     Last question. I read in your blog post that you find chiropractic helpful for children with anxiety.

Dr. Becker:   Absolutely. My husband is a chiropractor so I’ll preface my statement by saying that, but we know that chiropractic removes interference. We know that things that cause interference in our body makes us sick. When you get a chiropractic adjustment, not only are you removing interference from a spiritual level, but you’re also increasing endorphins, oxygen, and healing components of your immune system into your brain and into your nervous system. Of course it is beneficial.

I’ve had lots of patients too over the years that have come into my office that I’ve said to them, “I’ll be happy to sell you a room full of supplements and do a ton of lab testing but I think a lot of what you’re experiencing is coming from your spine. Perhaps you want to try chiropractic.” Sometimes it’s all they need. Sometimes they will require a combination. But chiropractic can really be a game-changer for people.  I think the biggest challenge is people don’t normally think of treating something like anxiety, ADHD, or even autism with chiropractic as a primary form of treatment.

Dr. Weitz:     Interesting. Music to my ears as a chiropractor.

Dr. Becker:   I know, right?

Dr. Weitz:     Thank you for the interview. For those listening, how can they get a hold of you and find out about your programs?

Dr. Becker:   Sure. My website is drkendrabecker.com. That’s where my blog is, all of my speaking engagements and things like that. My office website is FamilyWellnessCenterofConnecticut, or fwcct.com. There you can schedule appointments, purchase supplements, see what classes we’re offering at the office and things like that.

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

Dr. Becker:   Oh, my pleasure. Thanks so much for having me.



Toxic Mold with Dr. Jill Carnahan: Rational Wellness Podcast 87

Dr. Jill Carnahan discusses Toxic Mold with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights

2:52  Dr. Carnahan explained that she suffered with mold toxicity in 2013 after there was a big flood in Boulder, Colorado and they found Stachybotrys mold in the basement of the building where her office was. Dr. Carnahan started to have symptoms, including shortness of breath and exercise intolerance.  She would get brain fog and was having trouble finding words and it would take her twice as long to write an article. She had skin rashes and burning eyes and eczema on her scalp.  Dr. Carnahan tested her urine and found Trichothecenes, which are mycotoxins that are very toxic. She left her office with her patient charts and never set foot in that office again. Even the paper patient charts were bothering her, so she needed to scan them in and throw them out as well. 

6:54  When Dr. Carnahan is taking a patient’s history, her intuition can help her connect various bits of data and give her a sense of what’s going on with the patient. She will ask when the patient first got sick. Was it after a move to a new home? She asks about allergies, asthma, respiratory immune issues. Did multiple family members all get ill with some unexplained illness?  Was there water damage in their home? If you just ask people if there is mold in their home, most people will say no because they don’t know that it’s there.  Did they feel better when they went on vacation and got out of their home?  Dr. Carnahan asks about washers, dryers, dishwashers, flat roofs, leaks in the basement, the sump pump, the crawl spaces, window condensation, etc. The mold can be behind the walls or under the floors.  It can be in the schools.  Musty smells are often VOCs from mold. And there can also be other toxins in their environment for chronic illness besides mold, like radon and heavy metals.

10:37  When it comes to testing, Dr. Carnahan will start with a questionnaire, the cluster symptom analysis for CIRS. If 8 out of 13 symptom clusters are present, it is considered positive.


Dr. Carnahan will also do a visual contrast study in her office that tests retinal acuity between darkened and light lines.  If this is impaired, there is likely a biotoxin exposure.  If either the questionnaire or the visual contrast study are positive, then she will do further testing.  She will do chronic inflammatory response labs, which you can do through any major lab, like LabCorp or Quest, which will include TGF Beta, MSH, melanocyte stimulating hormone, and VEGF.  She may also look at genetics, though she has been finding genetics testing less reliable for predicting outcomes. Dr. Carnahan will also do urinary mycotoxin testing, which measures mycotoxins being excreted from the body in the urine. The controversy here is could they be from food, but usually we can see a pattern if there’s a lot of different micro toxins in a person that has mold related illness, it’s more likely the environment than foods.  Dr. Carnahan started out using Real Time Labs, which does Elisa testing, but she has been using Great Plains Labs, since it uses mass spectroscopy, which is more sensitive. She will usually have her patients take glutathione or use an infrared sauna or both to help mobilize the mold prior to the urine test.  She will recommend that her patient take 500 mg liposomal glutathione twice per day for five days prior to the urine test.

15:33  For Functional Medicine practitioners who would like to get more training about treating patients with toxic mold, Dr. Carnahan explained that Dr. Richie Shoemaker has been at the forefront in this training for years, but he was reprimanded from the Maryland State Board of Physicians in 2013 and he closed his practice then, and there has been a lot of controversy over his methods. From my perspective, Dr. Shoemaker is clearly an innovator and has pushed the limits with his testing and protocols, including the use of various prescription drugs off label.  But Dr. Shoemaker has set up protocols and some basic treatment protocols that are very helpful today. Dr. Carnahan is now on the board of a new group, known as International Society for Environmentally Acquired IllnessISEAI.org. This is a non-profit group that is devoted to bringing science to the field of mold and toxic exposure and they will be having their first conference May 3-5, 2019 in Phoenix, Arizona entitled Healing Complex Patients in a Toxic World.

16:57  Treatment for patients with mold toxicity must involve first removing yourself from further exposure to mold, whether that be proper removal or remediation of the mold or moving out of the home or office that is contaminated with mold.  Second, treatment should involve either taking liposomal or IV glutathione or the glutathione precursors, vitamin C, glycine, and NAC. Third, treatment should include binders, including bile acid binders, like cholestyramine.  We can also use clay, charcoal, zeolite and other binders, depending upon which mycotoxin you are trying to bind. For example, okra toxin is probably best bound by cholestyramine, whereas aphlatoxin is better bound by clay and charcoal.  Binders need to be taken away from food or supplements, either an hour before a meal or two hours after. They can be taken all at once or twice a day is usually sufficient.  Supporting the gut, treating dysbiosis, and making sure their GI tract is moving is also very important.  Due to weakened immune systems, many of these patients will also have viral and fungal infections. You also have to check the sinuses for colonization by antibiotic resistant strep infection known as MARCONS (Multiple Antibiotic Resistant Coagulase Negative Staphylococci).  She also recommends vitamin D, a probiotic, fish oil, Alpha Lipoic acid, NAC, milk thistle, green veggies to alkalinize the body, infrared sauna, and epsom salt baths.  Dr. Carnahan recommends going slow with binders since as these toxins are leaving the body, the patient is getting re-exposed to the toxins and can get very sick.

24:45  Dr. Carnahan recommends her patients who have been exposed to mold to follow a low mold diet and it should also be low in carbs and sugar, since they feed fungus. This diet should avoid grains, legumes, and dried fruits. Coffee and chocolate tend to have a higher mold content. You should also avoid fermented foods and mushrooms.



Dr. Jill Carnahan is a Medical Doctor who runs the Flatiron Functional Medicine clinic in Louisville, Colorado and has a specialty in treating patients with chronic diseases, including with mold related toxicity. Dr. Carnahan can be reached at JillCarnahan.com.  Here is a link to a free guide to mold toxicity from Dr. Carnahan: https://www.jillcarnahan.com/exposed-to-mold-now-what/

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 Transcripts

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

Our topic for today is toxic mold, it’s effect on our bodies and how to get rid of it with Dr. Jill Carnahan. Exposure to mold and micro toxins affects many people and often is an undiagnosed underlying trigger for many other symptoms and conditions. Many people are unwittingly living or working in water damaged buildings.  This exposure may be causing many negative effects on their health. Not only can mold and micro toxin exposure cause a host of symptoms that we will go into, but it can also be an underlying trigger or root cause for many other serious health problems, including affecting our sex hormones, thyroid, adrenals, fibromyalgia, hypertension, heart disease, autoimmune diseases, Alzheimer’s, and even cancer. When looking at a patient from a Functional Medicine perspective, we usually focus on underlying triggers and root causes of their health condition. Mold may be one that is frequently overlooked. Research indicates that mycotoxins can bind to DNA and RNA and cause damage, alter protein synthesis, increase oxidative stress, deplete antioxidants, alter cell memory, function, act as potent mitochondrial toxins, and alter apoptosis, which is important for killing off cancer and other cells that we don’t want in the body.

Dr. Jill Carnahan is an MD who runs the Flat Iron Functional Medicine clinic in Louisville, Colorado. Dr. Carnahan is one of the first hundred doctors certified by the Institute of Functional Medicine. She’s a survivor of breast cancer and Crohn’s Disease and she’s a sought after speaker and she loves teaching other healthcare practitioners the Functional Medicine approach, which is to look for the root case and underlying triggers for chronic illness. Thank you Dr. Carnahan for joining us today.

Dr. Carnahan:                    Thanks. Excited to be here.

Dr. Weitz:                          Thank you. So how did you become interested in studying mold and patients suffering with mold toxicity?

Dr. Carnahan:                    Well like things in my life, there’s a happenstance. In fact, in 2013 was the big flood in Boulder. There’s been a lot of this lately with climate change. We had a massive epidemic –

Dr. Weitz:                          Fake news. Fake news.

Dr. Carnahan:                    Yeah. We had a massive epidemic flood in Boulder in 2013 and ever since as a physician who knows mold, I’ve been picking up the pieces. But it hit me very personally because my office basement was flooded. I think the office itself maybe had some minor issues even before the flood and the flood just took it over the edge. I was two stories up above the basement where there was water damage and Stachybotrys mold which is a really nasty, toxic black mold in the outside of a crawl space right under my office that in hindsight was probably really toxic, as well. There was probably water sitting in there.

So bottom line is I started to have symptoms. Shortness of breath, exercise intolerance. I used to be able to run a 5k no trouble and then I was having trouble running and breathing. So my respiratory system was affected. I would have brain fog in the sense of I could still do my work, but I would have difficulty finding words. I would misplace words and say the wrong words when I meant something else and it was kind of strange. Focus concentration was affected, so instead of being able to write an article in an hour, it would maybe take me twice that time. My skin was affected, so I had rashes. Red, itchy, burning eyes, eczema on my scalp. Just all kinds of things as far as on the body and skin.

Mold, one of the things it does is create a lot of histamine response.  So a lot of the symptoms we see with mold exposure are histamine, or mass cell related.  All this to say I kind of knew there was something going on.  And I have such compassion for my patients who go through this because I myself ignored it for about six months.  I thought no, this can’t be mold. If it were mold, it would affect my office or workplace or home and I didn’t want to deal with it.  I kind of put my head in the sand.  But finally, it got bad enough that I knew I had to check it out.  I actually was diagnosed with an immune deficiency, so it was significantly impairing my health.

So I did my own testing of my urine and found Trichothecenes, which is some of the mycotoxins you talked about. Trichothecenes are used, they’re actually being studied as chemical warfare agents. They’re so toxic. They are neurologically toxic, immune toxic brain toxic, so very, very toxic to the body. I had this actually in my body from the exposure. Then we found the Stachybotrys in the basement and I literally, this was at the very end of 2014, the day after Christmas. And I never set foot again in that office. I left everything. I ended up getting my paper charts because obviously for patient care I needed those, but every single book, desk, everything else I left and walked out and started over.

It was one of the hardest and best things I’ve ever done because now I’m completely well, but it took really getting rid of all those things and getting out of that office in that time. Even my paper charts ended up bothering me quite a bit until I scanned them in a few months later. So even that paper. Now we know that those mycotoxins and VOCs can actually attach to course materials. If someone’s exposed, they don’t always have to leave everything. It’s not all catastrophic. But in my case, it just made sense. I wanted to get well and I didn’t want to be exposed at all. But it was quite an experience. And then over the following year or two, I really dove in because I wanted to heal from this exposure and I learned how it all connected.  I just, understanding it from that level as an experience gives me a whole different level of understanding. Now when I hear patient’s histories in front of me, there’s so often clues in their history that remind me of a likely mold exposure. Then I ask more questions and do more testing.  But because I’ve lived it and overcome it, I really have a greater understanding of what it looks like and I can see it.  And once you know this, a lot of practitioners don’t know mold illness, it’s very, very prevalent.  It’s very prevalent.  Surprisingly so.  So that’s my story.

Dr. Weitz:                          What are some of those things that make you suspect mold?

Dr. Carnahan:                    Yeah, so history is huge. Before you spend a penny on testing, I would say 99% of the time, I have a really good idea just from the questions I ask, the patient may have a mold exposure and I’ll tell you some of those things.  But you don’t always, if you’re a good clinician and a good detective, history can tell you so much.  I know you understand this well.  My staff actually jokes because literally when I go to test for mold or some of these other infections really, some of the diagnoses that I think might be there to prove it, I’m pretty much batting 100%.  If I think it’s there, it’s almost always confirmed.  That’s just because of the history and really knowing what to ask.

So what questions-

Dr. Weitz:                          Yeah. I think a good clinician really does testing to confirm what they already suspect.

Dr. Carnahan:                    Yes. And you know, I just have to stop here because, at least in my training, there was so much emphasis on objective science which I love. I’m all about science. But I kind of lost my intuition for several years.  I put it aside and felt like it wasn’t valid. I feel like now, I’m really, really embracing that intuitive sense that tapes together millions of pieces of data much more quickly than my brain could do.  Then I confirm it with the science, but my intuition is right on.  And most of the time and most of us in this field, we have a very strong intuitive sense.  And we actually rely on that and then prove it out.  It’s probably the best tool that we have.  Yeah, you’re nodding. I know you understand this. Back to the question. I’ll ask for the history.  When did you get sick?  What happened?  Was it after a move?  So a couple of things that would be … a new move to a new home and then the next year or so, lots of different autoimmunity, allergies, asthma, respiratory immune issues, all kinds of things crashing.  If there’s a family and multiple family members are all ill with unexplained illness, that’s guaranteed there’s some environmental trigger, especially if they’re all pretty healthy, they all move into a new home and within a year they all have issues.  That’s classic for an environmental trigger.

I ask about water damage because if you ask point blank have you had mold in your home, most people would say no. They don’t know it, they don’t see it. Musty smells, because people don’t understand that those are VOCs from mold, so if there is a musty, kind of bad smell, that probably means there’s mold growing somewhere.  Again, just them moving to a new environment. If they have maybe gone on vacation for 10 or 14 days and started to feel better out of that environment, that could be a trigger. And mold is one thing. There’s other things in the environment that could be issues. Like radon, heavy metals, chemicals. But typically mold is a real clear thing as far as a new home or water damage.  I’ll ask about washers, dryers, dishwashers, flat roofs, leaks in the basement, the sump pump, the crawl spaces, window condensation, all of these.  I’m kind of becoming a building expert too even though that’s not my expertise because you really have to understand how the envelope of the building and intrusion of water can create a mold illness.  And most of the people, I’d say 90%, you don’t see this.  You don’t really see it.  You don’t know it’s there.  It’s behind the walls, it’s under the floors.  I just found out this last month that in many of the schools that uses vinyl tile, there’s actually a huge problem, there’s this variegated system that goes under to hold the tile in place and it actually has these ridges where when they flood the tile with water, it’s porous. It goes into these ridges and just sits there in this dark, warm, damp space.  And it’s going to be an epidemic like the asbestos stuff for school systems because it’s a really big deal and no one knows about it.  So things like that where you can’t see it, you can’t smell it, but it is causing illness. And I see school systems as probably being the number one areas, kids and teachers that are affected by mold, it’s epidemic.

Dr. Weitz:                          Wow. You mentioned testing. What kinds of testing do you find are helpful once you suspect that a patient has mold?

Dr. Carnahan:                    Yeah. I just want to emphasize history because I get a ton with history, asking the right questions.

Dr. Weitz:                          Right.

Dr. Carnahan:                    There’s a symptom cluster analysis that I do that’s been validated. So I’ll give them that questionnaire.

Dr. Weitz:                          Oh yeah, good. What is the name of that questionnaire?

Dr. Carnahan:                    It’s just called cluster symptom analysis for CERES and I’m happy to share that with you or your listeners.

Dr. Weitz:                          That would be great. We’ll put it on there.

Dr. Carnahan:                    You got it. Basically, there’s 13 different categories and if you have any one symptom in each category, eight or more out of those 13 are positive. It includes things from brain fog, focus concentration, memory issues to trouble breathing, cough, shortness of breath, sinus pressure, congestion, numbness, tingling, something called “ice pick pain” where you have these sharp, stabbing pains, digestive issues like diarrhea, constipation, heartburn are really common. The skin, the rashes. The brain fog. Fatigue is incredibly common. Weight gain or weight loss. Just all systems are affected. So symptom analysis is free. I do that to every patient that I suspect. Then I also do a visual contrast study in office. This test, retinal acuity between darkened and light lines and if this is impaired, there is likely a biotoxin exposure. They used this in the 1940’s, years ago in the armed services for their armed service people exposure to chemicals.  So it’s not just mold, but it tells you if you have kind of a toxic exposure that affects the retinal blood vessels that are so small that it’s one way you can actually test for that capillary cytokine damage in an easy way in the office. So those two things are free and I always start there. Then of course if they’re positive, I go further. Testing wise, doctors, people I work with, always want to know what’s the one test. Unfortunately, this is a very complex field and there is no one test. You really cannot rely on one thing. History is huge. I just cannot emphasize that enough. But testing wise, there’s about three different things that you can do. One is chronic inflammatory response labs, which you can do through any major lab, like Lab Corps, Quest, or your hospital lab. The most common ones to check are TGF Beta, MSH, melanocyte stimulating hormone, VEGF, and then you can check genetics.  Genetics we’re finding are less and less reliable for really predicting outcomes.  So while there is a stratified risk, it’s not that … they used to call the set of genes a dreaded gene and that really is not valid.

So people who thought they were dreaded and they never get well, it just doesn’t prove out in science. So while I do look at the genetics to follow that, I don’t rely nearly so much on the genetics as I used to. That’s kind of new in this field to not rely on those. Often, we’ll do urinary mycotoxin testing, so testing for the mycotoxins coming out of the body in the urine. The controversy here is could they be from food, especially okra toxin and that answer is yes. So while we don’t always know, usually we can see a pattern if there’s a lot of different micro toxins in a person that has mold related illness, it’s more likely the environment than foods.

Dr. Weitz:                          By the way, do you use a glutathione ahead of time to increase the likelihood that they’ll be excreting mycotoxins?

Dr. Carnahan:                    Yes, great point. So four or five days prior, I like to instruct them to use either infrared sauna or glutathione or both because what you want to have … years ago, I did a couple of these mycotoxin tests in the early days and I had patients that I was sure there was mold issues and they came back completely negative. Really sick people, mold issues and I was so puzzled. I thought how in the world are these people negative? But what I realized is our very sickest people are so toxic, they’re not excreting anything. So you just hit the nail on the head in the sense that some of those really sick people, you will get false negatives if you don’t pre-treat them with something to push those toxins a little bit. Now you still, even if someone is very toxic, you still might get a false negative, so you just have to know that is a possibility, but you’re going to be less likely if you pre-treat with glutathione or infrared sauna.

Dr. Weitz:                          How much glutathione?

Dr. Carnahan:                    Yeah, I do 500 BID for five days.

Dr. Weitz:                          Great. Do you find the Real Time labs, or Great Plains, one more reliable than the other?

Dr. Carnahan:                    Yes. The first one that came out was Real Time Labs and they do Elisa testing and they’re fantastic. They have a really large panel. That was who I, when I first got sick, used. Then Great Plains came along and their technology is a little bit more sensitive with mass spectroscopy.  So we pick up more detail.  It’s more sensitive.  The downside is you may pick up foods more quickly than you would environmental.  So there’s pros and cons of both.  I probably use Great Plains more now because of the sensitivity.  But every once in a while I’ll go back to the Real Time just because they really both are valid.  They’re both great tests.

Dr. Weitz:                          Related question for those Functional Medicine practitioners who might be listening to this conversation, what’s the best training or learning program for them to become more knowledgeable about treating patients with mold?

Dr. Carnahan:                    Yeah. Dr. Shoemaker’s been at the forefront in this training. He really set a lot of the foundation in place. The newest group that I would highly recommend is ISEAI, it’s International Society for Environmentally Acquired Illness, so ISEAI.org.  It’s non-profit.  I’m on the board, so I’ll disclose that, but other than that it’s completely non-profit. The real push there is literally I don’t get paid by them at all. I just want to bring the science to this field and so does everybody else who’s there. So a lot of the docs who have been doing this the longest and really understand all the nuances have created this organization.  They’re bringing, in fact in May there’s going to be the first conference so stay tuned for that. But I really think the best and most scientific data will come from that organization. So most of my colleagues and friends who ask how can I learn more? I would say join the ISEAI group because you’re going to stay in touch with the latest scientific. There was a lot of politics historically in this field, and I won’t go into that, but I feel this is really free from those biases and really the people who are in charge are trying to bring great science to a very difficult and changing field.

Dr. Weitz:                          Great. Let’s get right into treatment.  How do we treat patients who are sick from mold or mycotoxin exposure?

Dr. Carnahan:                    Yeah. This is … if you’ve ever heard me lecture on toxic exposure and environmental toxicity, it’s all about toxic load.  So I always talk about the bucket capacity. We are born, some of us genetically have a very small bucket, but that’s our capacity to hold onto toxins and to actually get rid of them and deal with life.  What we should have is a nice little margin at the top and that allows us to take in and get out every day.  Most people should actually do a daily detox, whether it’s making sure they’re eating clean, incorporating infrared sauna or Epsom salt baths.  There’s all kinds of ways, but just a 21 day detox once a year is probably not going to cut it in our toxic environment.

Most people, including myself that I see at least, have a smaller bucket and they’ve completely reached capacity. They’re spilling over the top. That’s when they present with us with illness. Commonly with environmental toxicity, it’s neurological illness, it’s autoimmunity and it’s cancers. So these things we see are all epidemics. But back to treatment. Thinking about the toxic load, the first thing you want to do is start to decrease that load. So you cannot really … you can give them glutathione or binders which I’ll talk about specifically. But if you don’t get them out of that exposure, you’re not going to get very far and you may not make any progress at all. So the hardest thing is to find where this exposure is coming from and get out, because it could involve selling, losing a house, losing your job. There’s some really big ramifications of this illness. It’s like a tornado or fire sometimes when people lose a lot of stuff. But, the bottom line is your health is the most valuable asset you have. For me, I was worth walking away from probably hundreds of thousands of dollars of things that it didn’t matter because my health really did matter.

All of that is replaceable. So when patients finally get that, they get it and they’ll do anything. And I don’t mean to be fatalistic, because not everybody has to give up everything. You can move and keep your stuff, no problem. But it is a big deal to make sure that you’re in a pretty clean environment because you will not be able to get well without that piece. I always just have to emphasize because people think they can take a bunch of stuff and stay in their home and that will not work. So once you find the culprit, get it out. And again, it could take a few months or a few weeks. You do what you can in the meantime. But, when you get out, or even while you’re getting out, glutathione is really powerful because when you have a mold exposure, you tank.

You basically use up your glutathione, especially if you have any SNPs for glutathione synthase, or any of those which a lot of our patients have. They will be impaired. Now, I will say not everyone tolerates glutathione for reasons that they can cause oxidation. So there are people who need precursors like glycine, vitamin C and maybe NAC and they do better with those than glutathione.  I’m one of those. I’ve never done well with glutathione, but I can take all the Vitamin C and glycine in the world and I do fine as long as I take the precursors.  So everybody is different, but you need to be producing glutathione and you need to give your body all the raw materials or the liposomal or IV forms.

Second would be binders. The way these mycotoxins and molds are detoxed from our body, one of the main pathways is the liver-gallbladder transformation there. What happens is phase one, makes an intermediate that’s very toxic. Then phase two takes it into a more water soluble form. It’s excreted into the bile and stored in the gallbladder.  So our bile excretion is actually one method of elimination of these toxins.  What you’ll find is bile acid binders, or sequestrins, are very powerful ways to pull those toxins through the bile out of the body. If we do not do that, about 95% of the bile is intrahepatically recirculated.  It just is like a merry go round and those toxins go right with it and they never really get out of the body.  So we can use clay, charcoal, zeolite, a cholestyramine, Welchol, these are all substances that have affinities for toxins. I like to combine binders because each of them have a different affinity to different mycotoxins and even endotoxins from the gut. So we’re getting a much bigger, broader spectrum when we combine. I will say that for example, okra toxin is probably best bound by cholestyramine, whereas aphlatoxin is better bound by clay and charcoal.

So there is differences to the types of mycotoxins and based on the results, I can pick and choose the binders to use. But, it’s probably best to use a multiple. People can take them all at once and usually twice a day is sufficient. They need to be taken an hour away from food or supplements, either an hour before a meal or two hours after.  So it’s a little tricky.  In the old days, we used four times a day, but I find that just to be incredibly difficult and people can get well at a little bit lower dosing.

Dr. Weitz:                          That’s great. Let’s see. Do you also support liver detoxification as part of the program?

Dr. Carnahan:                    Yeah. That’s just scratching the surface because surely as you do, I do a complete Functional Medicine approach.

Dr. Weitz:                          Yeah.

Dr. Carnahan:                    You have to get the bowels moving. You have to treat dysbiosis, which is really common. A lot of these patients because of weakened immune system will have viral or fungal burdens, very commonly fungal burdens and also viral. So you have to treat those in the gut or in the body. You have to check sinuses for colonization of MARCONs, which is a methicillin resistant bacteria or also fungal and treat that as well. So you’re really treating the whole body for infections and toxic load. There’s a lot more things I put people on. The very basics would be a Vitamin D, a probiotic, fish oil. Fish oil actually helps with the detox and the reactions people have. 

Then, making sure they have all the Alpha Lipoic acid and the N-Acetyl cysteine; milk thistle, glutathione, all the good liver support. And you sometimes have to go very slowly because as you bind, I think of it as if you have a magnet and metal filings on your desk and you pull that magnet and most of the metal filings stick, but there’s a little trailing along. It’s very similar when you’re binding mycotoxins out of the body with these binders. They don’t have an iron grip. They’re pulling gently with a small affinity, but you’re actually often in the beginning getting re exposed on the way out. So when you start binders, if you start too heavy, often people will feel more sick, they’ll have more symptoms because they’re actually kind of getting re-exposed to this toxin on the way out. That’s super common.  My best tips for that would be mineral water or alkalinization of the body with greens and things. Infrared sauna is super powerful. Epsom salt baths are amazing. And go slow. So all those things can be helpful in the process.

Dr. Weitz:                          What’s the typical length of treatment?

Dr. Carnahan:                    Yeah, I would say six to 18 months is pretty typical. Sick people are pretty resilient and sometimes longer. Again, in that period, they become hyper sensitive. There’s an unmasking. So when they’re in the moldy house or the moldy office, they don’t feel well.  But they don’t even notice the mold as far as smell or how they feel.  As they start to detox, what’ll happen is they’ll become super sensitive and they’ll notice if they walk into a building or somewhere with mold.  So they think they’re getting worse.  It’s actually a really good sign because all of a sudden, the water… sensitive. Some develop multiple chemical sensitivities.

Dr. Weitz:                          Okay, great. I don’t know if you’ve noticed, but consumer products with charcoal are really hitting the market big time these days.

Dr. Carnahan:                    Yeah, you find it … in the airport the other day, I saw lemonade charcoal for post hangover.  I’m like gosh, they’re really getting into this. Just a travel tip; I always, always travel with charcoal and I pretty much take it every day when I’m on the road because it’s a great binder for bad food.  I don’t drink, but too much alcohol if someone were a drinker.  It’s also a binder for just environmental toxins.  I find I feel much better when I travel to take that charcoal.

Dr. Weitz:                          Maybe in the last few minutes we have, we could talk a little bit about a low mold diet, which I know you recommend.

Dr. Carnahan:                    Yeah. When patients are in the midst of this detox, often getting mold out of the diet can be a really helpful thing. Also, like I said, some of them are colonized with fungal species like candida or even they could have aspergillus in their sinuses or lungs as well. All of these things feed on refined carbs and sugars. So at the very core, it’s eliminating … like a paleo-style diet tends to be fairly close, because it’s grain free and legume free, especially the flours and the sugars. Those just have to be out. Dried fruits are notorious for not only mold, but high sugar, so dried fruits should be out.  Coffee and chocolate tend to have a higher mold content unless you’re really sure about the clean.  So those are better to avoid or be cautious. Then anything that’s … your blue cheese, fermented foods, things that are either fermented or moldy by nature are a problem.  Mushrooms are usually a problem. So temporarily, patients can get all of these things out of their diet and then start to add them back in as they get better. It’s just most patients who have mold related illness are incredibly sensitive to both alcohol and sugar. Those are probably the two biggest things to avoid.

Dr. Weitz:                          That’s great. So for listeners who’d like to get a hold of you, what’s the best way for them to contact you and find out about your programs?

Dr. Carnahan:                    Thank you. Yeah, my website is just a plethora of information, all free. So I hope you visit. It’s just my name, JillCarnahan.com. I do have a free mold guide. I’ve updated it just this last year. A lot of patients, I get all the time emails from patients how have just read the guide and started to get well. I can’t sere them, but it’s free. And it is out there for your listeners. I’ll be sure and send you the link, but if you have trouble, if you just Google Dr. Jill mold guide, you will get it right there up on Google and it’s free. I hope you’ll download that. [Here is the link to the mold guide: https://www.jillcarnahan.com/exposed-to-mold-now-what/ ]

Dr. Weitz:                          Excellent. Thank you so much Dr. Carnahan for joining us today.

Dr. Carnahan:                    You’re welcome. Thank you for the interview.



Histamine Intolerance in Patients with SIBO with Dr. Nirala Jacobi: Rational Wellness Podcast 86

Dr. Nirala Jacobi talks about Histamine Intolerance in Patients with SIBO with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights

0:53  Histamine intolerance sometimes occurs in patients who are also suffering with Small intestinal bacterial overgrowth. Histamine is a neurotransmitter that signals your immune system to launch an inflammatory response in your gut, your lungs, your skin, your brain, or your cardiovascular system. When dust makes you sneeze or you get a skin rash from eating gluten, this is a histamine-mediated response.  Most of the histamine is generated in mast cells, but it is also produced in the enterochromaffin-like cells in the stomach that are involved in the production of hydrochloric acid for digesting your food.  Histamine is produced from the amino acid histidine, with the help of the histidine decarboxylase enzyme. Histamine is usually broken down by the enzyme histamine N-methyltransferase or the enzyme diamine oxidase, with diamine oxidase being the most important one.  If you’re deficient in diamine oxidase, you’ll likely have histamine intolerance, since the histamine does not get broken down and it builds up. There are various causes of low diamine oxidase, including gluten intolerance, leaky gut, small intestinal bacterial overgrowth. There are certain foods that tend to block diamine oxidase like alcohol and energy drinks. Inflammation blocks diamine oxidase. And a number of medications also reduce diamine oxidase. 

4:30  Histamine is involved in a lot of functions in the body and it can present with classic allergy symptoms, but it can also present with digestive symptoms like bloating or cramping, and more systemic symptoms like fatigue and headaches. Dr. Jacobi explained that when she is treating a patient with digestive conditions like SIBO and she doesn’t get the expected response, then she will see if their symptoms might indicate histamine intolerance.  Sometimes she can pick out histamine intolerance patients early on.  Extreme histamine intolerance can be mast cell activation syndrome.  Histamine can stimulate hydrochloric acid production, so reflux can be caused by histamine intolerance. 

6:39  Dr. Jacobi explains that you have to break down histamine problems into exogenous histamine production found in foods we are eating, like spinach, canned fish, and cured meats and then you have endogenous histamine production where histamine is either over produced by the body or not being cleared. Histamine intolerance can result from a lack of diamine oxidase because of microvilli destruction due to SIBO or Celiac Disease. 

8:32  If Dr. Jacobi suspects a patient may have histamine intolerance she might test serum histamine, chromogranin A and a host of other urine measures that are more specific for mast cell activation syndrome. Lately, she has been running the Dunwoody Intestinal Barrier Function test, which measures histamine and diamine oxidase levels, though measuring serum histamine levels is not that reliable since it has a very short half life.  If diamine oxidase levels are low, she will prescribe a product containing pure diamine oxidase called Umbrellux. 

12:28  Dr. Jacobi has developed a SIBO histamine biphasic diet for SIBO patients in collaboration with dietician Heidi Turner. It’s a variation on her biphasic diet for SIBO patients and for the first two weeks you avoid histamine liberating foods, like lime and citrus, and histamine containing foods. If you’re improved after two weeks, then you can start adding back in the histamine liberators. You remain on the histamine avoidance foods and then you phase into the biphasic diet for SIBO (her version of a low FODMAP diet) starting with phase two.

14:51  Sometimes it is easy to suspect that histamine is a problem for SIBO patients, such as when they tell you that they eat tuna every day for lunch and get bloating. You can just have them remove canned fish and the other high histamine foods right off the bat.  Fresh fish does not have a lot of histamine until it is allowed to age in the can or in the refrigerator. In fact, any protein food that is allowed to age will develop histamine, such as leftovers.  Now there is another reason not to eat tuna besides histamine, which is because it is so high in mercury.  The exception is the baby tuna in a can sold by Vital Choice, which is much lower in mercury.

19:28  There is probably not much need for supplements to promote diamine oxidase production, even though it is supported by B6 and copper.  It is more beneficial to heal the gut and the microvilli.  So gut healing formulas can be helpful and folate and methylation factors can also be beneficial.  Using a supplement of diamine oxidase for a month or two and treating the SIBO or the other underlying cause is the most beneficial treatment for histamine intolerance.  If they have mast cell activation, which means they have a large pool of endogenous histamine, they will need mast cell stabilization, such as by taking quercetin or other mast cell stabilizers. Here is a paper on the effectiveness of quercetin: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033805

22:49  Some probiotics have been shown to be beneficial for patients with histamine intolerance, including Lactobacillus plantarum strain 299V, lactobacillus ramnosus, bifido infantis, and bifido longum have all been shown to help degrade histamine.  But Dr. Jacobi said that she has not seen much benefit just using probiotics in these patients, though she often does include them in her protocol.  And histamine is a bioactive amine can actually be produced in the microbiota in the large intestine.  Here is a paper on lactobacillus plantarum degrading biogenic amines like histamine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316997/  Here is a paper that discusses how bifidobacterium infantis and longum suppress histamine signalling: https://www.jstage.jst.go.jp/article/jphs/107/2/107_08028FP/_article/-char/ja



Dr. Nirala Jacobi is a Naturopathic Doctor who specializes in treating patients with functional gastrointestinal disorders like SIBO and she directs the Biome Clinic in Australia.  Dr. Jacobi runs the SIBO test online breath-testing and educational service. She is also the host of the popular SIBO Doctor podcast on Itunes

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 Transcripts

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

Today we are going to talk about histamine intolerance, especially in patients who are also suffering with small intestinal bacterial overgrowth. SIBO is the underlying cause of IBS in the majority of cases.  First of all, what is histamine? And what is histamine intolerance? Histamine is a neurotransmitter that signals your immune system to launch an inflammatory response in your gut, your lungs, your skin, your brain, or your cardiovascular system. When dust makes you sneeze or you get a skin rash from eating gluten, this is a histamine-mediated response. Most of the histamine is generated in mast cells, but it is also produced in the enterochromaffin-like cells in the stomach that are involved in the production of hydrochloric acid for digesting your food.

Histamine is the chemical involved in common allergies, which is why drugs that block histamines are often prescribed for patients with allergies. We have H1 receptor blocking agents, like Benadryl, Zyrtec, Claritin, and Allegra. We also have H2 receptor blocking agents, like Tagamet, PEPCID, and Zantac. And as you can tell those are drugs that help in the GI tract. There are also quite a number of foods and nutritional supplements that can modulate histamine levels, which we’ll probably get a chance to talk about today.

Histamine is produced from the amino acid histidine, with the help of the histidine decarboxylase enzyme. Histamine is usually broken down by the enzyme histamine N-methyltransferase or the enzyme diamine oxidase, with diamine oxidase being the most important one.  If you’re deficient in diamine oxidase, you’ll likely have histamine intolerance. There are various causes of low diamine oxidase, including gluten intolerance, leaky gut, small intestinal bacterial overgrowth. There are certain foods that tend to block diamine oxidase like alcohol and energy drinks. Inflammation blocks diamine oxidase. And a number of medications also reduce diamine oxidase.

I’m so happy that Nirala Jacobi will be joining us today to help give us some clarity on what do to about histamine intolerance, especially in patients suffering from small intestinal bacterial overgrowth. Dr. Jacobi is a naturopathic doctor who graduated from Bastyr University in 1998. She’s now the director of the Biome clinic in Australia, where she takes care of patients with functional gastrointestinal disorders.  Dr. Jacobi is the host of The SIBO Doctor Podcast. She runs the SIBO test online breath-testing and educational service. And she develops courses for training functional medicine practitioners. Dr. Jacobi has developed her version of the low FODMAP diet, the biphasic diet for patients with SIBO, and recently she developed the SIBO histamine biphasic diet.  Dr. Jacobi, thank you so much for joining me today.

Dr. Jacobi:  My pleasure. Thanks for inviting me.

Dr. Weitz:  So when you’re working with a patient with small intestinal bacterial overgrowth, what we call SIBO, when do you suspect that histamine intolerance may also be a problem?

Dr. Jacobi:  Well, as you so aptly pointed out, histamine is involved in a lot of different functions in the body. And it’s a really important molecule, a biogenic amine. And it can sort of present with pretty classic symptoms. As you mentioned, allergies, but also what we see are a lot of digestive disorders like bloating, cramping, more systemic symptoms like fatigue and headaches and so forth. And what happens is … I usually start my treatment out and if I don’t get the expected response, or if people have sort of dysautonomia symptoms that are more classic along the spectrum of histamine intolerance all the way to mast cell activation syndrome … That’s a real spectrum. So you could have simple histamine intolerance all the way to mast cell activation syndrome. So wherever they are on the spectrum, and I sometimes suspect it fairly early on. But mainly-

Dr. Weitz:  What are some of the symptoms of histamine intolerance?

Dr. Jacobi: Well, some of the symptoms of just plain histamine intolerance is bloating after meals. It can even be reflux because of this histamine actually stimulating hydrochloric acid production. Cramping is pretty common, abdominal cramping or hypersensitivity. Those are pretty classic. Diarrhea or constipation, but more predominantly diarrhea, which of course all those are SIBO symptoms as well.  So after treatment and if the patient tests clear after treatment and they still continue to have symptoms, I start to suspect this.

Dr. Weitz:  Okay. What about if you get a patient and you work them up for SIBO and they have some of the histamine symptoms outside the gut? Do you change your-

Dr. Jacobi: Do you mean like rashes … I mean, the thing is-

Dr. Weitz:  Yeah, skin rashes or other allergy symptoms, respiratory, et cetera?

Dr. Jacobi:  So the way I think about histamine, because I really did a pretty deep dive into histamine intolerance, and the way to understand it is that you have exogenous histamine production, which is found in food that we’re eating. Histamine can be found in things like spinach or canned fish, all canned products, cured meats, that type of thing. And then you have also conditions where histamine is endogenously over-produced or not cleared. So those two are very separate conditions that I wouldn’t class them necessarily all in one ball of histamine intolerance.  I usually think of histamine intolerance as a lack of diamine oxidase, which could be because of microvilli destruction due to SIBO or, as you mentioned, celiacs, those types of conditions, where really the main enzyme that breaks down food-based histamine is destroyed.

Dr. Weitz:  Okay. If you suspect a patient of having histamine intolerance, do you do any specific testing? Do you do serum testing? Or how do you try to work them up?

Dr. Jacobi: It’s a good question, because it is woefully inadequate is what I would say in terms of how to really get a good grasp of what’s going on with histamine. Because it has a very, very short half-life, so typically serum testing of histamine is not all that reliable. But there are a battery of tests that … I usually do that if I suspect mast cell activation syndrome, which include things like serum histamine but also chromogranin A and a host of other urine measure or markers that are more specific for mast cell activation syndrome.  But for simple histamine intolerance, there are some tests like I’ve been using the Dunwoody Intestinal Barrier Function test. That’s what it is. And it does measure histamine and diamine oxidase levels just on a … it’s a blood test. Like I said, the histamine I’m always a little bit iffy with, but with diamine oxidase that can be helpful. And then I prescribe a product called Umbrellux, which is a diamine oxidase, which is difficult to find pure diamine oxidase, but that’s one of the ones I use.

Dr. Weitz:  Oh, okay. Have you read about the connection between H. pylori and histamine intolerance?

Dr. Jacobi: So, H. pylori has so may different triggers in the upper gut, in terms of hydrogen sulfide production and so forth. But, yeah, there are some connections. When you have H. pylori, it’s sort of like it’s one of those ancient species that have been with us for so long, that it doesn’t always cause a problem and it only is a problem when you’re actually symptomatic for those things.  But I haven’t particularly noticed that my H. pylori patients are particularly histamine intolerant. I can’t say that clinically, no.

Dr. Weitz:  Right. Okay. I guess I saw a paper where H. pylori can increase histidine carboxylase, which is the enzyme that helps promote formation of it.

Dr. Jacobi: Yeah, which is interesting and I would kind of want more research on that. Because as we know, H. pylori lives in the stomach and it sort of survives these extreme conditions by creating an alkaline cloud around it. So by increasing histamine, it effectively would increase stomach acid, which would be a real surprise to me actually. Because it is a bug that lives there but it doesn’t thrive in stomach acid.

Dr. Weitz:  Yeah. Interesting. Maybe it just happens as a result of having H. pylori and maybe they just saw an association.

Dr. Jacobi: Yeah. Perhaps.

Dr. Weitz:  I just interviewed Jill Carnahan this morning and she was mentioning how mold toxins can result in histamine intolerance. Have you seen this…

Dr. Jacobi: Yeah, mold toxicity is not my specialty. I know that mold toxicity, obviously, because of its connection to a rampant, innate immune system, can have a lot of different causes of lots of different systemic issues. I haven’t seen the connection specifically to histamine. I know that there is a very specific connection to SIBO, simply because of the vasoactive intestinal peptide that’s often an issue with mold toxicity. And so if you have SIBO as a result of mold toxicity, that could be a very easy explanation as to why your patient is histamine intolerant.

Dr. Weitz:  Interesting. So can you tell us about your SIBO histamine biphasic diet for SIBO patients?

Dr. Jacobi: It’s a mouthful, I know. It’s a real mouthful, the name of it. So because I’m a SIBO specialist and I came across actually quite a few papers that mentioned the prevalence of histamine intolerance in a number of digestive disorders which are fairly benign. But the authors of these studies suggested that histamine is actually very often the culprit in terms of digestive symptoms.  So I looked into this a lot deeper and collaborated with Heidi Turner, who’s a fantastic dietician in Seattle. She gave a very riveting presentation at one of the SIBO symposiums about rheumatoid arthritis and SIBO, but also mentioned histamine in that whole process. And she was on my podcast talking about mast cell activation syndrome.

So we collaborated and came up with a fairly straightforward but quite restrictive approach. And anyone who’s listening who’s heard of a biphasic diet, it’s really a staged approach to SIBO treatment. And so we wanted to take that same blueprint and have a staged approach to histamine intolerance. And the way we did that is, rather than just remove pretty much all foods, which would be the case if you’re treating SIBO and histamine intolerance at the same time, we’ve sort of used the histamine intolerance diet as a starting point before you go into the straight biphasic diet.

So what we did is we staged the histamine liberators and histamine foods. So histamine liberators are foods that actually, just as the name implies, liberate histamine from foods. Such as lime and citrus, et cetera. So the first part is where you’re avoiding all histamine liberators and histamine foods, which is about two weeks. And if you’re improved then you can start adding in the histamine liberators. Then you remain on the histamine avoidant foods and then you sort of phase into the biphasic diet stage two, or phase two.

So it’s a great way to manage symptoms really quickly for people where you really suspect they have histamine intolerance. And sometimes people will be really obvious. They say, for example, they eat a can of tuna every day for lunch. You and I know that’s not a good practice, besides histamine. But it is something that people do a lot and they have a lot of bloating, they have a lot of issues. And so you just can start with saying, look, just remove that food and remove all the main heavy hitters and see if there’s any improvement.  And I often do that with my SIBO patients, sort of like a histamine intolerance 101, kind of a light version of the histamine biphasic diet.

Dr. Weitz:  Yeah, so you brought up tuna fish. So from what I understand, fish, if it’s really fresh, is going to be very low in histamines. But as it sets, whether it’s sitting in your fridge or whether it’s in a can, right, that’s when it starts developing higher histamine levels?

Dr. Jacobi: Yeah. Yeah, fish tends to be very high. There’s actually a condition called … I think it’s scombroid poisoning. Some kind of crazy name.

Dr. Weitz:  Yeah…

Dr. Jacobi: I actually have a patient where I very much suspected that it was a triggering event for him, of subsequent histamine intolerance. And he had a lot of systemic symptoms. But anyways, yes, tuna fish or any tinned or canned fish, any protein, really, that’s allowed to age. And so sometimes people are so sensitive that they can’t even do leftovers. They have to eat their meals very fresh, freeze them fresh. Those would be suspect. Also, in terms of … if people come in and they just have a ton of sensitivities, you have to suspect histamine as your first priority.

Dr. Weitz:  So what about fish that’s frozen? Is that going to prevent the histamine formation?

Dr. Jacobi: Yeah, you’d want to really check the label that it says flash frozen on the ship or on the boat. That’s a good practice. The reason I mentioned why it’s not such a good practice to eat tuna, really, anymore is because of mercury levels, right?

Dr. Weitz:  Right. Yes.

Dr. Jacobi: Which is a whole nother kettle of fish in another way. But yeah-

Dr. Weitz:  Except that one company that makes the baby tuna. You know about that one?

Dr. Jacobi: That they … isn’t that horrible? That they’re using that, it’s now a thing? Yeah. Where are we going to stop destroying the planet?

Dr. Weitz:  It’s not going to stop, unfortunately. There’s not going to be any wild fish soon, so …

Dr. Jacobi: That’s right. So I usually promote companies like Vital Choice, which is an Alaskan fishermen cooperative-

Dr. Weitz:  I think that’s the one that has the baby tuna.

Dr. Jacobi: Oh, really? That would surprise me. I mean, I’ve talked to the main guy. But look, I don’t know this. I haven’t actually come across this-

Dr. Weitz:  So I think what they said is the baby tuna accidentally get caught up in the nets with the bigger tuna, and the fishermen used to throw them away. And then they realized that the baby tuna actually have very low levels of mercury, so…

Dr. Jacobi: Yeah, they do. They do.

Dr. Weitz:  … they buy them up from the other fishermen … that’s what-

Dr. Jacobi: Oh, I see what you’re saying, right. Well, that’s a whole new thing. I thought that they’re specifically targeting tuna day care centers.

Dr. Weitz:  Yeah. We separate the baby tuna from their mothers when they cross the border.

Dr. Jacobi: Oh, God. We shouldn’t laugh about that but it’s pretty funny.  Well, Vital Choice, the reason I like them is because they do, according to my own research, they do very sustainable practices. And so that’s really the way forward with all this. It’s like, we can’t possibly expect things to be sustainable the way we’re doing it now. And so I like to promote or support companies that have much better sustainable practices.

Dr. Weitz:  Right. Yeah, absolutely. I think it’s important where you get your fish oil from too, because some of them-

Dr. Jacobi: Exactly, yeah.

Dr. Weitz:  … you get them from the small fish that the whales eat, the krill, that’s going to be a problem because that’s going to deplete the whales, right?

Dr. Jacobi:  Well, actually Antarctic levels of … I mean, this is way off the topic, Ben, but … krill levels. I’m quite close to Antarctica, you know close, how close I don’t know.

Dr. Weitz:  That’s true, that’s true, yeah.

Dr. Jacobi: But we do have plenty of krill down there. We have great thriving humpback migration routes here.

Dr. Weitz:  Okay, so anyway, so, getting back to the topic of histamine… So what about foods and nutritional supplements that can promote diamine oxidase production?

Dr. Jacobi: So it’s supported by B-6 and copper. So that’s one thing. But it’s a rare patient that’s really depleted in copper in my experience. So I don’t usually use precursors or supplements to promote the replenishment. It’s really about healing the gut. Because as soon as the microvilli return, you should have ample amounts of diamine oxidase. And it’s a protective mechanism for all of us to have this in our microvilli, because all of us have a certain tolerance to histamine after which it gets really overloaded.

So if you’re somebody who’s listening and reacts a lot to green smoothies, thing like that where you eat a lot of spinach, and you have reactions, I would suspect histamine intolerance. But really it’s about healing the microvilli, and that is take your gut-healing formula of choice to really regrow that. Which requires a lot of folic acid. Actually if we think about that we have this gut lining that’s one-layer thick from mouth to anus, more or less. Well, it’s actually in the small intestine where it’s one-layer thick. And all the way through the large intestine.  And that cellular turnover to renew itself occurs every 48 to 72 hours. And so for that DNA replication you require a lot of folate and methylation cofactors, which is … I go easy on them. I always start very easy on them. Because a lot of people react to B-vitamins, especially if they still have SIBO, because it’s like a food for the bacteria. So you gotta be easy on that. But I just wanted to make that point that folic acid is really important in cellular replication.

Dr. Weitz:  Right. You ever use natural agents that are … like natural histamine blockers like quercetin in the short term to help modulate symptoms?

Dr. Jacobi: Yeah, so it’s not really a histamine blocker, quercetin. It’s more of a mast cell stabilizer. And it does a really good job. Really, really good job in doing that. You gotta go up high. And it does do that. But remember that if we’re talking about histamine intolerance, where it’s not a mast cell problem. It’s actually more of an issue of where you’ve destroyed the very enzyme that breaks down histamine at the very get-go.  So I usually find that using Umbrellux or something like that for about a month or two is really helpful. And then treating SIBO if that’s the underlying cause, or treating whatever other underlying cause.  Crohn’s disease, celiacs, that type of thing.  And really healing the gut lining is my primary objective then. But if they’re moving on this spectrum where in other words, it’s not just exogenous or outside histamine that’s the problem that’s coming in from food, but they have an aberrant mast cell response where that was triggered by stealth infection, by mold, by a number of insults, then they actually have an endogenous pool of histamine that’s very high. And for that they’re going to need a lot of mast cell stabilization.

Dr. Weitz:  Right. Yeah. There’s also some genes that could predispose them. What about probiotics?

Dr. Jacobi: So I often get asked about probiotics, and I’m a single-strain kind of person.  Or no more than a few strains.  Sometimes I go above that and I use research strains. We don’t really know enough yet about which strains … there are conditions in which your microbiome actually produces histamine. That does occur. And it is a biogenic amine. So that often happens in the large intestine where we see further degradation of histidine into histamine.  So that does happen. And so I sometimes recommend probiotics like lactobacillus plantarum and lactobacillus rhamnosus gg, specifically. But to be honest, I haven’t seen a great deal of relief with just probiotics.  And I do a lot with probiotics.  So I’m a little underwhelmed as it is right now with just using probiotics.  And there’s very little research.  I’m hoping it’s coming very soon, but there’s very little research on even the strains that I’ve mentioned.  But there is some.  So I do use it for those instances.

Dr. Weitz:  I did see a few papers that show that certain strains of probiotics, bifido infantis, longum, and bifido plantarum helped to degrade histamine.

Dr. Jacobi: You mean lactobacillus plantarum?

Dr. Weitz:  Yeah, lactobacillus plantarum.

Dr. Jacobi: Yeah. That’s the one I mentioned that’s a really well researched strain, it’s usually 299v. And it’s the one in sauerkraut, which is kind of mean because sauerkraut’s full of histamine. But it is in the fermented vegetables. And so, yeah, that’s a very well researched strain for a lot of different things. Also for hydrogen sulfide. So I use it for a lot of purposes.

Dr. Weitz:  Okay. Let’s see. So your biphasic diet involves testing back in some histamine-liberating foods.

Dr. Jacobi: Yeah, so, the SIBO histamine bisphasic is … like I said, it’s sort of like the entry point into the biphasic SIBO diet.  Which is really about minimizing die-off symptoms and having a very streamlined approach to SIBO treatment.  But the histamine was a very specific part of this process for those that are very, very sensitive.  I don’t know about you, Ben, but I’m seeing increasingly people that are eating only five different foods or so.  Extremely sensitive.  Very reactive patients.  And I mean, I specialize in digestive disorders, so that’s not a surprise.  But still it seems to be getting quite, quite intense for people out there.

So really this diet was necessary for me as a starting point for many of my patients that are super sensitive. So yes, once again the first part is histamine liberators and histamine foods are to be avoided. And the second part is where you can introduce the histamine liberators again and then still remain off of the histamine foods. And then the third part is you transition into the phase two of the biphasic diet, of the SIBO diet.  So it took us a long time to produce this diet, because we had to juggle these two conditions, SIBO and histamine intolerance.  And if you combine them … you’re left with hardly any food.  And so we had to have this staged approach to treatment.

Dr. Weitz:  And that happens a lot, especially in patients that are treating themselves and they go on the internet and they find another list and another restrictive list. And you start layering these lists, there’s no foods to eat anymore.  I’ve been amazed with patients with gut problems that I’ve treated. And when they start to feel better I would have thought that they would be very anxious to have a much broader diet and they would be bored with eating those foods.  But I’m shocked a lot of times when they say, no, I’m okay.  I’ll just keep eating this way the rest of my life. I finally feel okay.  And as you mentioned, it’s not that healthy to have a very limited diet, so …

Dr. Jacobi: It’s not healthy at all, and there is a lot of food fear out there. And to some extent … I mean, people feeling sick, of course, they have to find a way to feel better. But that often creates a situation where they are very fearful to reintroduce foods. And so we have to really counsel them around that. And what I usually say is, look, you’ve basically selectively fed a very small number of bacteria. Whatever food you’re going to start eating after your two-year stint of just chicken breasts, Brussels sprouts, and maybe white rice … whatever you’re going to start putting back in will cause you some reaction. I fully expect that.

So if you actually preface that by saying that, I think that makes a big difference for people. Like, oh, okay. I’m not going to relapse all the way; I’m just going to have a few reactions, maybe, but I’ll be okay. So that’s important for practitioners to really understand, is like if they’ve painted themselves in a corner, they will have some reactions. And you just mitigate that by reducing doses and very small amounts.  I’m a big fan of collaboration as a practitioner, so I have a team of people around me that I can delegate stuff to. So I have a nutritionist that I work with that does a great job with food reintroduction, again. So I highly recommend that to anyone that has any food issues, is go to a really qualified nutritionist or dietician like Heidi Turner, for example. She’s fantastic with things like that.

Dr. Weitz:  That’s great. I think that’s pretty much all the questions I had about histamine intolerance in SIBO patients.

Dr. Jacobi:  It’s a big deal.  Do you see a lot of them?  Do you have a lot of people with histamine intolerance?

Dr. Weitz:  I have some. I have a lot of patients with SIBO and I’m not always sure if they have histamine intolerance.  It’s always tricky to figure out, so …

Dr. Jacobi:  Well, one of the things that was interesting … I belong to quite a few professional forums and one of my colleagues … Because I kept saying, look, I sound like a broken record. But if somebody was posting, I’m treating them for SIBO, they’re not improving, I said, try removing histamine food.  And I was sounding like a broken record and a colleague was saying, I finally did it and these patients that were not improving had a miraculous turnaround.  So really don’t underestimate the power of histamine intolerance in patients that have very tough-to-treat SIBO or not so much frequent relapses … it’s not really a cause of a relapse.  But people that are just borderline on a test, not really terrible fermentation but still have really pretty tremendous symptoms, I would put that at the top of my list.

Dr. Weitz:  Does anything show up on stool tests with histamine intolerance? No …

Dr. Jacobi:  No. No. Not at all. Stool testing really is … I think in the future maybe … only this Dunwoody lab that I … it’s a new one, I can’t really fully endorse it yet. I’ve had it maybe with 20 people. But so far, it’s holding its weight. So it’s looking promising.

Dr. Weitz:  That’s the one where you’re measuring the diamine oxidase levels?

Dr. Jacobi: Yeah. Yeah. And they also have histamine levels. They actually also do LPS antibodies. So that’s interesting, and zonulin, of course, and things like that.

Dr. Weitz:  Yeah, yeah, yeah. Okay. Great. So how can listeners and viewers get a hold of you and find out about your programs?

Dr. Jacobi: So I’ve created thesibodoctor.com, which is an educational portal for practitioners and also soon to be patients. I have a clinic in northern New South Wales in Australia called The Biome Clinic, and you can just find that at thebiomeclinic.com. And I have a breath-testing company, but if you’re listening to this podcast in America I say, look, just go with a local breath-testing company to reduce the carbon footprint of sending test kits.  I take that stuff very seriously. We’re soon to be 100 percent solar-powered company, so that makes us all very happy and doing our part.

But yeah, you can find us on Facebook. The SIBO Doctor is our main page, where we talk pretty much everything related to SIBO. I’m just about to launch a gut-healing program for patients that will be also great for practitioners to recommend to their patients. And I intend to cover topics like histamine intolerance and how people can really help themselves. And I teach people how to do enemas, how to do hydrotherapeutic treatments at home, how to do a carminative tea, how to really help themselves and empower themselves again with healing their digestive tract. So it kind of is a good adjunct to the practitioner treatment plan. So that’s kind of what I’m working on right now.

Dr. Weitz:  Great. And your podcast?

Dr. Jacobi: The podcast is called The SIBO Doctor Podcast. It’s on iTunes as well. We just finished our second year. So it’s a really popular podcast for practitioners. It’s not just about SIBO. It’s really about the entire universe that is the digestive tract. And it’s fantastic. As you know, it’s just so wonderful to be talking to experts and have very lively, stimulating conversations with other practitioners and experts and researchers.  Just did one on lactic acidosis that just was very interesting, with Dr. Satish Rao. So, yeah. You can find us on iTunes. It is definitely more geared towards practitioners, but as you know, patients are becoming a lot more educated and want to learn more about their own health, which is great.

Dr. Weitz:  Yeah. It’s definitely on my list of favorite podcasts. So thank you.

Dr. Jacobi: Well, thanks, Ben. Appreciate it.

Dr. Weitz:  Okay. I’ll talk to you soon, Nirala.

Dr. Jacobi: All right. Take care.


Histamine Intolerance in Patients with SIBO with Dr. Nirala Jacobi: Rational Wellness Podcast 86

Dr. Nirala Jacobi talks about Histamine Intolerance in Patients with SIBO with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights


24-Hour Urine Testing for Hormones: Rational Wellness Podcast 85

Dr. Frank Nordt discusses 24 Hour Urine Testing for Hormones with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights

1:07   My goal for this podcast is to gain some insights in what we can learn from 24 hour urine hormone testing that can help guide patients to feel better and be healthier.  Hormones can be testing using serum, urine, saliva, blood spot, or dried urine. Serum testing is the most common method since it’s easy and is usually covered by insurance. But urine testing also allows you to be able to test not only hormones but their metabolites, which can be helpful, esp. with estrogen metabolism. Dr. David Zava from ZRT Labs has argued that the best way to monitor hormones administered topically is to use saliva testing. And the dried urine testing from DUTCH has recently become one of the more popular methods with the Functional Medicine community. 

6:00  Dr. Frank Nordt, the CEO and director of Rhein Labs explained that there are various methods of hormone testing today, including blood, blood spot, 24 hour urine, and dried urine testing. With regard to dried urine testing, while it is convenient to do, since all you have to do is urinate on a piece of filter paper and send it in the envelope, but there is not one published study that supports the validity of dried urine spots.  Therefore, according to Dr. Nordt, it is junk science. 

7:28  Let’s start by talking about 24 hour urine testing for hormones. It provides insight into the metabolism and turnover of hormones in the body. Dr. Nordt believes it provides the best measure of hormone levels in the tissues.  You cannot directly assess hormones in the tissues without taking a biopsy, but that can’t be done on an outpatient basis. So while urine is measuring the levels of hormones that have been excreted versus serum which is measuring hormones in the blood, the key is to find out what levels are in the target tissues of the body.

9:12  Dr. Nordt divides the Rhein Labs 24 hour urine hormone report into estrogens, androgens, and corticosteroids. Estrone (E1) is the storage form of estradiol (E2) and the Estrone:Estradiol ratio should be 2:1, though in the case of estrogen dominance, this can be 4:1. The reference ranges that are reported are divided by decade and include plus or minus one standard deviation from the mean. Some doctors like to look at an ideal reference range, though they may have different ideas what this is. Some feel ideal is what a woman’s levels are in their 20s and other feel it is what hormone levels a woman in her 30s would have. 

15:10  When we look at the estrogen metabolites, it appeared a number of years ago from the literature that an increased amount of the 16 hyroxyestrone and looking at the 2:16 ratio would indicate a higher risk of breast cancer. But the more recent research has not really panned out.  With respect to oncogenesis, the 4-hydroxyestrone appears to be the better indicator of higher risk than the 16. If the 2 hyroxyestrone is especially high and the 2 methoxyestrone is unusually low, then the person is not methylating properly.

24:02  When we look at testosterone and the other androgens, we can see what is up and down regulated. For example, in men, 5-alpha-reductase upregulation leads to an increase in DHT levels. Or 5-alpha-reductase can be downregulated by drugs like Finasteride, which completely knocks out the 5-alpha-reductase and this can lead to impaired sexual function.  If a patient is taking DHEA we can see if it is converted into androstendione and it can then be converted into testosterone or into estrone.  For men, DHEA typically does not raise testosterone levels to any substantial level, though it can do this in women.

39:21  Progesterone cannot be measured directly in urine, but we measure the metabolite, pregnanediol, which is a very sensitive indicator for progesterone. 

40:14   Dr. Nordt explained that when you measure hormones with either saliva or blood spots, you are only measuring hormones at one spot in time, when hormones are produced in a pulsatile fashion. What if you measure testosterone in the morning and it is normal in the morning but it is low later in the day?  You will miss that. One of the problems with saliva testing is that many people have buccal microbleeds, or bleeding from the gums, which will contaminate the samples. Another problem is that saliva testing uses immunologically based assays and these antibodies can have cross-reactivity, which can alter the results.  Also, as we age, we have less saliva, so salivary testing gets more difficult to do.  If you have difficulty generating enough saliva, then this can create stress and raise cortisol levels.

46:12  Dr. Nordt talked about some of the issues with blood spot testing for hormones, where you prick your finger and drip some blood onto a piece of cardboard. In such a situation, blood often gets contaminated with interstitial fluid and therefore the results are not as reproducible. With respect to the dried urine testing, the results collected at different times during the day are normalized by using an algorithm an algorithm should have no place in a clinical lab.  All the results are normalized to creatinine, but to accurately measure creatinine, you need a 24 hour collection. Dr. Nordt’s 24 hour urine collection testing is not available for direct testing to patients but must be ordered by a clinician. Rhein Labs can be contacted through their web site, RheinLabs.com  or by calling 503-292-1988.



Dr. Frank Nordt has a PhD chemistry and is the CEO and the Laboratory Director of Rhein Consulting Labs, which offers quality 24 hour urine testing for hormones for both men and women and you can call 503-292-1988

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 Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting-edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and give us a ratings and reviews so more people can find out about the Rational Wellness podcast. Today, our topic is to look into 24-hour urine testing for hormones and what we can learn from looking, not only at hormone level but at the hormone metabolites that are also excreted in the urine. My goal for this podcast is to gain some insights in what we can learn from this type of hormone testing that can help guide patients to feel better and be healthier.

To analyze our hormones like estrogen, progesterone, and testosterone, there are various testing methods available today, serum, urine, saliva, blood spot, and dried urine. Serum hormone testing is the most commonly employed method by doctors in the US, especially conventional MDs. It’s certainly the easiest testing requiring only a blood draw on the part of the patients and it’s often the cheapest since it is more likely to be covered by insurance.  Many Functional Medicine doctors like urine testing since it allows the measurement of the metabolites of estrogen, which are important for assessing the risks for breast and other estrogen-related cancers. On the other hand, urine testing is not directly measuring hormone levels in the bloodstream or in the tissues, but instead, is measuring hormones and metabolites that have been excreted.

Besides serum and 24-hour urine collection for hormones, there is also saliva, blood spot, and dried urine testing. David Zava from ZRT Labs has published a number of widely read articles that have been published in the Townsend Letter.  And he argues that serum, urine, and saliva can all reliably measure our natural hormones, though there is a difference when measuring hormones that patients are taking. He argues that saliva is the best way to monitor hormones that have been administered topically. I’ve read articles by and spoken to other prominent functional medicine doctors who’ve told me that saliva is very unreliable. I also know there are very successful clinicians who use serum, urine, and saliva. They all use different methods, and they all claim to get good results.

The newest method is to use dried urine testing, which is quite popular now with the Functional Medicine community.  And it was the most popular form of hormone testing in an informal poll that I gave to 1,300 Functional Medicine practitioners on our closed Facebook page.

So what is the most effective method for testing hormones, both for looking at natural hormones, and to monitor hormones that patients are taking?  To sort out this controversy, I’ve asked Dr. Frank Nordt, the president and lab director of Rhein Consulting Laboratories in Portland, Oregon to join us. Dr. Nordt has a PhD in biochemistry and he’s published extensively on hormone testing methodologies. Rhein Labs is a small boutique lab that was the first to develop a reproducible, accurate, and clinically relevant hormone profile for both men and women in 24-hour urine, long before the entry of Genova and others into this arena. Dr. Nordt, thank you for joining us today. And can you tell us about your background and how you came to start Rhein Consulting Labs?

Dr. Nordt:            Yes.  First of all, I appreciate the opportunity to speak with you and your audience today and I hope to clear up a few or throw some fire on, some controversies that have arisen over the years.  My background, as you said, I received a PhD in biochemistry and biophysics at the Oregon Health Sciences University, after which I did a postdoc at the Max Planck Institute in Munich. I went on into industry and worked in pre-clinical research. I was primarily interested in blood flow properties and I worked in the area of stroke. I came back to academia at the medical school and worked in neurology.  And to be quite frank, no pun intended, I got sick and tired of academic politics and decided that my skills and interests were in the private sector.  And I like to innovate.  I continue to collaborate with academia and continue to publish.  I’ve been doing this since 1991, and I’ve been doing hormone testing since then using various modalities, primarily serum and then the 24-hour urines.

You’re right, there are various matrices, blood, venous blood, blood spots, 24-hour urine, and as you said, the dried urine testing, which has gained popularity in the last five years or so. I will be quite direct with regard to the dried urine testing. It is convenient, certainly. All one has to do is urinate on a piece of filter paper, basically, and send it in in an envelope and hopefully, get results that are meaningful. I can tell you that there is not one published study that supports the validity of dried urine spots. I have been asked by people to collaborate in regard to this, but I won’t because, quite frankly, it is junk science and I will stand by that. And I will elaborate on that a little bit later.

So why don’t we, first of all, talk a little bit about the 24-hour urines and then I will go into what I think of the other modalities, including blood. As you say, it’s convenient. It’s the most widely used. But let’s go and first look at what I think a profile should look like. And a profile is not just a “panel”, but it’s a well thought out, I think, profile, which, again, provides insight into the metabolism and turnover of the hormones in the body. You mentioned that it’s what is excreted, you’re absolutely right. It is excreted, but I think it provides the best measure of hormones and hormone levels in the tissues. You can’t directly assess hormones in the tissues without taking a biopsy. There have been studies that have actually done that, looked at, for example, breast biopsies, looked at local concentrations of estrogens, androgens, et cetera. But, obviously, that’s not an approach that can be used on an outpatient basis.

Let me throw up a … Can you see that?

Dr. Weitz:            Yeah, we can see that.

Dr. Nordt:            Okay. First of all, I divide the report into estrogens, androgens, and corticosteroids. On the following page, this is an example of a graphic format. Some people like it, some people don’t. Patients tend to like it because it’s colorful. Frankly, for me, it’s attractive, but not that easy to look at. So mostly what we do is we stick to our old format. This is kind of difficult because I can’t see the sharing. Oh, here it is. I’m sorry. I found it. I’m working with more than one monitor here. So anyway, here we go.  So what I want to do is go through what I call the tabular format. These are the same results and as I said, we have estrogens, androgens, and corticosteroids.  Starting with the estrogens, we look at estrone. This is an example of a premenopausal patient that is menstruating regularly, and it’s an example of a typical, let’s say 30 to 40 year old. We have all of our reference ranges divided into age by decade. So from 30 to 39, 40, to 49, et cetera. So this is a typical reference range for a 38-year-old in this case, and we see her estrone at 9, estradiol is about half of that.

The importance of looking at ratios, the estrone is the storage form for estradiol and there is an equilibrium between estrone and estradiol. And in aberrant cases, the estrone, for example, in estrogen dominant women, the ratio of estrone to estradiol will be much higher. And we look at that, for example, down here, what I call the potent estrogen ratio, which varies between approximately one and four. Ideally, that ratio is around two. In the graphic format, we have what I call ideal reference ranges. I’m not exactly sure what ideal means, but a lot of the functional medicine people would like to see something idea, an ideal reference range where, for example, a 20 to 30 would be … Some people think we should adjust hormones in postmenopausal women to what they were for a woman in their 20s, some people feel it in their 30s.

As I say, I’m not exactly sure what people mean by an ideal reference range. What we’ve done is taken it from, basically, plus or minus two standard deviations of the mean. We’ve taken it down to plus or minus one standard deviation approximately. What ideal is, is oftentimes in the eyes of the beholder.

Dr. Weitz:            I think it’s common in the Functional Medicine world for there to be labs to have normal ranges. And we often consider normal meaning like for example, you measure vitamin D and if it’s above 30, that’s considered normal. But most people in the Functional Medicine community feel that, based on the research, you have the least risk of chronic diseases if you get that level up between 50 and 70. So that’s what we consider an ideal range versus a normal range from a lab.

Dr. Nordt:            Right. Now, the problem with hormones is that the research in terms of what is ideal is lacking. And I think there is also a lot of misinformation out there regarding how one should, for example, adjust the postmenopausal woman. As I say, some people think it should be where hormones were in their 20s to 30, others 30s to 40s. Other people feel that, and this is quite controversial and I don’t agree with it. There are what I call high estrogen protocols where women who are postmenopausal actually start menstruating again.

Dr. Weitz:            Yeah, that’s because they cycle the progesterone for two week periods to sort of duplicate.

Dr. Nordt:            Correct.

Dr. Weitz:            Basically, the idea is, or the theory is, that you’re duplicating the hormone levels and the sequence of a woman in her 20s.

Dr. Nordt:            Exactly. Again, it’s in the eyes of the physician what they feel is ideal for their patients. As a laboratory, quite frankly, I don’t think it’s my place to prescribe what various practitioners should do.

Dr. Weitz:            So let’s go into some of these estrogen metabolites like the 2-hyroxyestrone, the 16-hydroxyestrone, and the 4-hydroxyestrone.

Dr. Nordt:            Right. Now, let’s, first of all, talk about the two. Normal metabolism of, for example, estrone, and we use the metabolites of estrone because it is the most abundant if you will estrogen that is active. In other words, the two active ones are estrone and estradiol. There’s more estrone, so we use the metabolites of estrone because the fidelity of the measurement is better than it would be with estradiol. The estradiol actually mimics the estrone, so I’ve never found much point, and we’ve done some work in this regard, I’ve never put a lot of emphasis on measuring the metabolites of estradiol because they, basically, mimic those of estrone. Having said that, there has been controversy about the two to sixteen ratio. Some people continue to feel that it’s a valid marker for-

Dr. Weitz:            Breast cancer.

Dr. Nordt:            And frankly, a review of the literature would indicate that it isn’t what it was cracked up to be. We continue providing those levels for those people who continue to feel that it is important. And there are people and there is literature that would indicate that it is, so what we do is we provide the information and let the practitioner deem and interpret it how they wish to.  I think in terms of oncogenesis, a more current hypothesis revolves around the metabolite that are what we call depurinating adducts leading to apurinic sites leading to errors in DNA repair and mutations and then leading to breast, and in males prostate cancer.  Also, the role of catechol estrogens, the estrogen quinones, specifically the oxidation, unfortunately. And catechol estrogen quinones, the oxidation of 4-hydroxyestrone, they act as carcinogens that damage DNA leading to again, cancers of the breast and prostate.

Dr. Weitz:            So what you’re saying is that the 4-hydroxyestrone may be a better measure of potential breast cancer risk than the 2:16 ratio.

Dr. Nordt:            Correct. And then, following from there is the final metabolism, the hydroxyestrones, it leads to the methoxyestrones, namely 2-methoxy and 4-methoxyestrone. We can get an idea of the efficacy of methylation by looking at those levels. Now, the 4-catechol estrogens in animal models are carcinogenic. The two 2-catechol estrogens are not. There haven’t really been any studies that I’m aware of in humans, but again, like I say, the hypothesis is that it’s the 4-hydroxy and 4-methoxy, if the individual is methylating that those are the “carcinogenic” if you will, estrogens.

Dr. Weitz:            Yeah, I interviewed Dr. Lindsey Berkson, and she actually takes the 2-methoxyestrone and she had a whole series of cancers prior to doing this. And she feels that is really significant in helping reduce cancer in her body and I know she was working on possibly trying to get that approved for use.

Dr. Nordt:            Yeah. Again I think the evidence is sketchy. I think that we have hints as to what is going on. And to be at the forefront, I think it’s important to measure these and if they are way out of range, if the person is not methylating by, for example, looking at the relationship between the estrone and the 2-hydroxy and 2-methoxyestrones, if the 2-hydroxyestrones are inordinately high and the 2-methoxyestrone is inordinately low, that is an indication that the person is not methylating. I will tell you that the 4-2-methoxy and the 4-hydroxyestrones are relatively low in most individuals. And in most cases, you cannot detect with any degree of certainty that the levels of 4-methoxyestrone in urine. They will be, quite frankly, mostly on the low side and we take the 2-hydroxyestrone and the 2-methoxyestrone to be the indicator of methylation.

Dr. Weitz:            By the way, I wanted to mention to the listeners that if you’re listening to this on your phone or in your car, if you want to see the slides that Dr. Nordt is putting up, go to the YouTube page, the Weitz Chiro YouTube page and the video version of the podcast will be there.

Dr. Nordt:            Good.

Dr. Weitz:            I noticed that you have a separate reference range for women who are taking hormone replacement.

Dr. Nordt:            Correct. Because we divide the reference ranges for the estrogens by decade, women who are on hormone replacement are going to have somewhat different levels of estrogens. And most practitioners feel that they do not have to replace the estrogens to the levels of premenopausal women, but should replace them to the point where the patient has no symptoms. And those reference ranges tend to be lower. And again, we provide those reference ranges and they’re taken, basically, from a cohort of patients who are on hormone replacement.

Dr. Weitz:            Would it matter what for of estrogen that they’re taking though?

Dr. Nordt:            Most people these days are on topical estrogens. If they are on oral estrogens, which I think most people have gotten away from because of the significant first pass effect which occurs. These estrogen levels are primarily from topicals whether they be topical creams or, for example, the patch. I will tell you that with the patch, you can get away with lower doses of estrogen using the patch because it tends to be more efficacious in getting through the skin and into the circulation. And we find that with these lower levels, patients will be without climacteric symptoms. We look at the androgens also and the androgen metabolites of testosterone. There are many women who are on testosterone replacement. The does there generally vary between one and four milligrams per day. Generally, you can get away with one to two milligrams and get adequate levels.  The metabolites become important, and I should point this out, metabolites become important in looking at the … Let me bring up another slide here.

Dr. Weitz:            Well, right now you’re talking about the metabolites of testosterone, which, if we’re not doing 24-hour urine or dried urine, we are not testing. So what are some of the benefits of looking at these? What can these tell us?

Dr. Nordt:            These tell us, I think, if you can see, this is a flow chart. What we can look at and infer are the enzymatic activities which lead to these metabolites, and what is up and downregulated. As an example, 5-alpha-reductase metabolism in women is less important than in men. In men, 5-alpha-reductase upregulation leads to increase in DHT. And the downregulation of 5-alpha-reductase, for example, by drugs such as Finasteride, which completely knocks out the 5-alpha-reductase. And in some men, it cannot recover, which is referred to as the Finasteride syndrome. Oftentimes, these people will probably never have prostate cancer, but sexual function is impaired.  Finasteride, the commercial name, if it’s for BPH is Proscar. If it’s for hair growth for the follicularly impaired, it’s known as-

Dr. Weitz:            I see that you’re scratching your bald head there Dr. Nordt, for those who are listening and not watching.

Dr. Nordt:            Yeah. I’m a little follicularly impaired, yes. In any case, even at low doses of Finasteride, which is, as I said, known as Propecia commercially, it does lead to knocking out, basically, the 5-alpha-reductase. We can look at other enzyme systems. I’ll go back to the profile and-

Dr. Weitz:            Yeah, so what do we learn out of looking at these metabolites? So we’ve got the DHT and so the benefit there is we can look at that for prostate health and hair loss. Right?

Dr. Nordt:            Correct.

Dr. Weitz:            What do we get out of these other metabolites? What can they tell us?

Dr. Nordt:            Well, we’ve gone a little bit through the estrogens as far as looking at the various estrogen metabolites and the risk in breast cancer, et cetera. With the androgens, primarily, for example, taking DHEA, DHEA is preferentially metabolized to the other 5-beta-reductase to etiocholanolone down here. Again, the relationship between androsterone and etiocholanolone is 5-alpha and 5-beta-reductase. When we go to the corticosteroids, these metabolites … The corticosteroids starting here with cortisone, again we have the THF and 5-allo-THF, 5-alpha and 5-beta-reductase. But then there’s also an equilibrium between cortisol and cortisone, which is a 17-beta-hydroxysteroid dehydrogenase. And there are two forms of this enzyme.

Dr. Weitz:            Hang on one second, Doc. Let’s just finish with the testosterone stuff. So you mentioned DHEA, which converts into androstenedione into testosterone and then into etiocholanolone.

Dr. Nordt:            Etiocholanolone and-

Dr. Weitz:            What’s the benefit of looking at that? What does that tell us?

Dr. Nordt:            Okay. Androsterone, for example, has androgenic activity, whereas the etiocholanolone does not.

Dr. Weitz:            Okay.

Dr. Nordt:            Eating a lot of DHEA, for example, you can see, by looking at a profile, you can see if there is significant conversion of DHEA into estrogen. These are things that you’re not going to gather from any kind of blood test. You’re not going to be able to see that in any kind of saliva testing because they do not measure the metabolites.

Dr. Weitz:            I got it. So you have a patient, they’re low in testosterone and they’re low in DHEA, and you give them supplements of DHEA hoping that’ll boost their testosterone levels, but it may get pushed over into forming more estrogen.

Dr. Nordt:            Correct. And that’s especially true in men who oftentimes eat DHEA like candy and end up with mild forms of gynecomastia.

Dr. Weitz:            What does eating DHEA like candy mean?

Dr. Nordt:            What I mean by that is higher than 50 milligrams.

Dr. Weitz:            Okay.

Dr. Nordt:            We see people taking 25, 50, 100 milligrams of DHEA. In men, you can never eat enough DHEA to raise testosterone levels in a clinically significant way.

Dr. Weitz:            Okay, so you’re putting an end to the thought that some clinicians have and patients who are trying to boost their testosterone levels, you’re saying that taking DHEA in no way is going to meaningfully boost testosterone levels.

Dr. Nordt:            That’s correct. In women, in some cases, you can because the testosterone levels in women are much lower than in men. You can raise, in some cases, the testosterone levels in women in a clinically significant way.

Dr. Weitz:            On the other hand, I have male patients who when we’ve given them a modest dosage DHEA, like 25 or 50 milligrams, notice significant difference in the way they feel in terms of energy levels and things like that.

Dr. Nordt:            Correct. But again, if you look at the testosterone levels per se, and I think in some cases when you look at DHEA, DHEA, as you say, there are some physical effects that people tend to feel better. This is true in women also. But you have to watch it in terms of the aromatase activity, which is oftentimes upregulated.

Dr. Weitz:            Which would convert it into estrogen instead of testosterone.

Dr. Nordt:            Correct. So they may feel a little bit better, but again, looking at their testosterone levels, per se, you’re not going to see an increase as a result of the DHEA. Some people use 7-Keto-DHEA because they feel that it is not converted to estrone and so we measured-

Dr. Weitz:            Is that true?

Dr. Nordt:            First of all, if you take 7-Keto-DHEA, it is always going to be outside of the “references range”. The supplementation will lead to higher levels than for example what we call here, the 45 micrograms per day. I’ve seen indications that this is probably a misnomer that 7-Keto does not lead to. Although, chemically, it should not revert to DHEA, so I don’t quite see how it ends up as estrone because once the ketone group has been added at the 7 position, it is then oxidized to the hydroxy and I just don’t see a way of it getting back to estrone. I don’t know what your experience is. I just talked to someone who felt that giving 7-Keto has no advantage in terms of they see that estrone levels are increased by giving 7-Keto. I don’t have enough data.

Dr. Weitz:            Okay. So let’s move onto the cortisone and cortisol, and maybe you could start by explaining what’s the difference between cortisol and cortisone.

Dr. Nordt:            Okay. Just like estrone is the storage form for estradiol, cortisone, in essence, is the storage form for cortisol. There is an equilibrium between cortisol and cortisone. And in cases where cortisol is needed, there is the reverse direction going from cortisone to cortisol. And there are, basically, three metabolites that I look at in terms of corticosteroid metabolism. That’s the THE, which is tetrahydrocortisone, the THF, tetrahydrocortisols.

Dr. Weitz:            So what can that tell us, looking at THE?

Dr. Nordt:            Okay. There are two things to look at. One is, if the enzyme is upregulated to metabolize cortisol leading to a depletion of cortisol to cortisone, then that cortisone, in order to get rid of it, it is metabolized at the THE.

Dr. Weitz:            Okay.

Dr. Nordt:            If you look at the sum of the three metabolites, and I think that’s probably the most important thing that we can say, the THE plus THF plus 5-allo-THF, if that is elevated in men greater than about 6,000 to 7,000 micrograms per day, you can almost bet that individual is insulin resistant, has metabolic syndrome, is pre-diabetic, or frankly, diabetic. We have found, I’d say, over a dozen cases where these enzymes with the THE, THF, and 5-allo-THF rise to levels greater than about 15,000, you can almost bet that individual has most likely an adrenal adenoma. And the cortisol levels continued to be normal. What happens is the body compensates for the increases in cortisol by upregulating the enzymes, metabolizing cortisone and cortisol, and until, basically, there is no more headroom and you end up with very high levels of these metabolites.

At which point, when you do run out of headroom, it’s at that point that the cortisol levels actually elevate. And we’ve had, like I say, around a dozen, a little bit more, about fifteen of these kinds of cases where the surgeon then remarked, when imaging these individuals, “How did you ever find this?” These people end up in the physician’s office. They measure 24-hour urinary cortisols and they are perfectly normal. They’re sent home but they know that something is wrong.

 So there are two advantages to measuring these metabolites. One is an early warning indicator for insulin resistance. And the second one, like I say, which is relatively rare, but nevertheless, you can catch these adenomas at a very early stage, and at least watch them until they become clinically significant and need to be surgically removed.  There are a couple of other metabolites, the 11-beta-OHAN, which is the androsterone.  Again, the relationship there is 5-alpha and 5-beta-reductase metabolism. The same kind of thing the corticosterones, THA, THB, and 5-allo-THB. Some people ascribe significance to those in terms of their metabolism toward aldosterone.  We have clients that want those. I don’t personally ascribe that much significance to these other than, again, an indicator of 5-alpha and 5-beta-reductase metabolism.  But again, like I say, we try to cover the bases if you will.

Dr. Weitz:            Okay.  That’s good.  I don’t want to get too much into the weeds on some of this stuff.  We may lose some of the viewers and listeners.

Dr. Nordt:            Right. This is the problem and some of this stuff, certainly for lay individuals, gets to be pretty technical. And as you say, especially for lay people, I tend to stay out of the …let me put it this way, over interpretation.  I do want to say something about progesterone. Progesterone cannot be measured directly in urine. We use the metabolite, which is pregnanediol. It is a very sensitive indicator for progesterone and there is a lot of fidelity to the measurement. If you’ve ever looked at progesterone in serum, in premenopausal as well as postmenopausal women who are on replacement, serum levels are oftentimes quite low. The reason for that is the progesterone is rapidly compartmentalized taken out of the serum. But if you look at the target tissue and you look at the urine where you actually are looking at turnover, you can get very nice measurements of progesterone.

I do want to say something about both the saliva testing and blood spots, as well as urine spots. The major drawback of any kind of spot testing, in other words, it’s a single point in time. Hormones are produced in a pulsatile fashion. And in serum, for example, testosterone is a good example, testosterone measurements in serum should be taken in the morning. That’s convention. What happens after the morning is oftentimes not looked at at all. And we have lots of indications that testosterone levels may be perfectly normal in the morning, but decrease over the day and become quite low in the afternoon and evening.

The issue there is that if you look at a spot test, whether a blood spot of a saliva test, and I should say that saliva tests for the sex hormones are controversial because of the relatively low levels, and all of the saliva measurements and this is where I think some people find them to be useful. Some people say well, I get different levels all the time testing the same patient. All of the saliva testing is done using immunologically based assays. In other words, they involve using an antibody to the hormone which is being measured. The steroids and again, this gets technical, but the steroids to an antibody tend to look the same. And there is a considerable cross-reactivity. In the case of testosterone in women, for example, using an immunologically based assay, and there’s a serious paper out there, you can guess better than you can measure because the measurements tend to be all over the place.

The other problem with saliva testing, there are two issues. One is buccal microbleeds. The hormone levels in serum or in blood are approximately 1,000 times higher than they are in the saliva. Depending on the oral health of that individual and all of us have buccal microbleeds to one extent or another.

Dr. Weitz:            You’re talking about tiny bits of blood in your mouth.

Dr. Nordt:            Correct.

Dr. Weitz:            From your nose or something like that.

Dr. Nordt:            Yeah. From the gums. Some people who have oral health that is somewhat compromised, you crush your teeth and all of a sudden you have some blood on the toothbrush. If you contaminate the saliva, even to a level where you cannot see the blood, that measurement in the saliva will be compromised. The other issue with saliva is the lack thereof. People, as they grow older, the amount of saliva that is secreted decreases significantly depending on stress levels. We’ve all experienced this. So you get a dry mouth syndrome. Dry mouth syndrome is also an issue in people who are on certain medications. Saliva testing becomes really problematic and unless done under very rigorously controlled circumstances, these measurements on an outpatient basis are oftentimes not particularly efficacious.

So to summarize there, a contaminated saliva sample is a compromised sample. If you stimulate saliva flow using chewing on cotton. Some labs have you try to stimulate saliva flow. That also becomes a compromised sample. I work with the primate center here, the Regional Primate Center here in Oregon where cortisol measurements are taken from monkeys in order to evaluate stress levels. They are very, very careful not to stress these monkeys before taking the saliva sample because even the act of collection, and this is true in human also, the act of collection can change the cortisol levels.

Dr. Weitz:            But, Doc, living in the modern world, I feel like we’re all a bunch of stressed-out monkeys.

Dr. Nordt:            You have a point. Right now, to be honest with you, I’m a little stressed talking about all of this and I have a dry mouth. People who will sit for 30, 45 minutes trying to collect an adequate specimen. It’s problematic.

Dr. Weitz:            Hey, let’s go back to full screen view for the last few minutes here.

Dr. Nordt:            Are we back?

Dr. Weitz:            Yeah, that’s good.

Dr. Nordt:            Let me then talk a little bit about blood spots.

Dr. Weitz:            Okay.

Dr. Nordt:            And I’ve asked this question and I’ve never gotten an adequate answer.

Dr. Weitz:            This is where you prick your finger like you would do to check your blood glucose.

Dr. Nordt:            Correct.

Dr. Weitz:            Some practitioners like this form of testing as do patients because you don’t have to go into a lab to have it done and you can just put the blood on a little piece of cardboard and mail it in.

Dr. Nordt:            Correct. I hope and I don’t know how many people in your audience are aware of the Theranos Labs.

Dr. Weitz:            Yeah, but I think that’s not really comparable to-

Dr. Nordt:            Well, no it’s not.

Dr. Weitz:            I mean that was a big scam. They were claiming that they had this machine that you could just put the blood in. Meanwhile, somebody took the blood, brought it in the back, had a bunch of lab technicians using the normal testing everybody else is using and it was just a big show for the investors.

Dr. Nordt:            Correct. It goes beyond that. I asked the question what is the difference between a blood spot taken from a finger prick on a piece of filter paper and a blood spot in a nanotainer. The issue here is every time you take a finger prick, that blood is contaminated with interstitial fluid. This goes back to my days in graduate school. Much of my work was done on the red blood cell membrane. If you did a finger prick and you looked at, for example, the surface properties of red cells from a finger prick, they will be different every time, and it’s because of the absorption of proteins from the interstitial fluid. One of the hypotheses of why the nanotainer didn’t work is because of the contamination. And there were some really good editorials in the Wall Street Journal from experts in this field that feel that finger pricks, and I certainly share that, that finger pricks lead to blood samples which cannot be tested adequately and reproducibly. Having said that, blood spots the same problem, you have a point in time. Getting to-

Dr. Weitz:            Of course, there could be benefits to having a point in time too. Like, for example, when we do the salivary cortisol testing, we don’t just learn what the total cortisol level is, but we learn is it low or high in the morning as opposed to the evening, if it’s supposed to be higher in the morning and then it’s supposed to drop in the evening. If it’s lower in the morning and then it’s higher in the evening, that interferes with sleep. So there could be benefits to knowing where hormones are at a certain point in time during the day.

Dr. Nordt:            Yeah, the issue again gets back to adequate collection of the samples. And we actually did a study in conjunction with the University of Washington, the Fred Hutchinson Cancer Research Institute, on cortisol levels in shift workers. And quite frankly, there are very few people who work a normal shift, in other words, a day shift, who have abnormal cortisol rhythms. They may have low cortisol. You will discover low cortisol and at the 24-hour urinary cortisol is still the gold standard in that regard. If you have low cortisol overall, you will see that in the 24-hour urine. If you have high cortisol levels in the morning, for example, you will see that in the 24-hour urine.

Dr. Weitz:            Right.

Dr. Nordt:            The rhythm is very rarely an issue per se.

Dr. Weitz:            I would say just to give you a little argument, pushback on that. Would say that most of us in the Functional Medicine community, myself included, feel that the majority of our patients are stressed out and we do see that the cortisol tends to be lower in the morning and it’s not unusual to get a spike in the evening when they’re not supposed to.

Dr. Nordt:            Yeah. The evening spike, oftentimes, and this I st problem, you don’t really know how to interpret it because you don’t know under what circumstances that sample was collected. Let’s say that individual is, in the evening, they normally don’t collect their saliva in the evening, they sit there, they have a little bit of trouble producing enough saliva. And then, all of a sudden, that cortisol level is artificially increased in the evening. It’s true in some people, not true in others. How do you know when?

Dr. Weitz:            You mean they’re so stressed out from having to spit into the tube that their cortisol level goes up?

Dr. Nordt:            Absolutely, absolutely.  This is exactly what I’m getting at.  Not in all cases, but if you don’t know and you see the spike in the evening, is it due to stress.

Dr. Weitz:            Well, you know, I would say that I’ve seen enough patients with that sort of effect who report having trouble with sleep.  And then we use adaptogenic herbs that help to calm out the adrenal levels and sometimes glandulars.  And we often find that those patients feel better.  I think that there’s some truth in that.

Dr. Nordt:            I think this is really important because, as you mentioned, the urine spots have become very popular.

Dr. Weitz:            Yeah.

Dr. Nordt:            As I indicated, there is not one publication out there that supports the validity of this type of testing.

Dr. Weitz:            Okay.

Dr. Nordt:            Number one. Number two, there are different modalities that are being promulgated, but a urine sample collected at 8:00 in the morning is, if you’ve gone to the bathroom at 5:00 in the morning, that 8:00 sample is going to be different if you didn’t urinate at 5:00 in the morning. The attempt is made to normalize these results by using “over several samples throughout the day”, the attempt is made to normalize these results and approximate the total production using an algorithm. An algorithm infers information that isn’t there. And I think an algorithm has no place in a clinical laboratory. If we can measure it, measure it.

And a third issue is that all of the results are normalized to creatinine. The creatinine levels that are reported as being the normal range are in these urine spots differ by a factor of ten. In other words, from low to high is a tenfold difference. In urine, in the 24-hour urine, that factor is roughly four, so it’s twice as much. Why do they have such a broad range for creatinine is to try to get relatively “normal” results. Creatinine varies with age, it varies with diet, it varies on the basis of genetics. Why do we take a 24-hour urinary creatinine level to measure kidney function? We don’t use a spot creatinine.  We don’t use a serum creatinine.  No, we use a 24-hour urinary creatinine.

Dr. Weitz:            Okay.  I got it, Doc.  Yeah.  You made some good points there.  So we need to wrap.

Dr. Nordt:            Okay.

Dr. Weitz:            So why don’t you tell us how we get a hold of your lab testing and how do we sign up as providers? Is it available just through providers? Can patients-

Dr. Nordt:            There is a law in the state of Oregon and I agree with it, that it can only be ordered on the basis of a provider.

Dr. Weitz:            How do providers sign up?

Dr. Nordt:            They give us a call at 503-292-1988. As you mentioned at the beginning, we are a small lab. We specialize in this. We do bill insurance. 24-hour urinary profiles are reimbursable by most insurance companies. We are preferred providers for a number of insurance companies. Even if we are not preferred providers, we oftentimes are successful at getting full, or at least partial reimbursement, usually somewhere around 80%. Our pricing is such that it is the same for all practitioners and patients. We bill insurance companies the same amount that we bill a patient without insurance. In that sense, and we pride ourselves in this, we do have transparent pricing. We don’t, like I say, charge an insurance company a different price than we charge a patient. The pricing is presently $280 for the full profile. I think that’s quite reasonable.  I am available to help with interpretation. If you do one, two, or three of these and give me a call, you will become an expert in interpretation. The profile, like I say, is a profile you oftentimes have to take a little bit of a step back and not just look at each individual value, you look at it sort of like an impressionist painting. If you get too close all you see are dots. Step back and you get the complete picture.

Dr. Weitz:            Sounds good, Doc. And what’s the website for your company?

Dr. Nordt:            Www.rhein labs, that’s spelled R-H-E-I-N, as in November, R-H-E-I-N L-A-B-S.com.

Dr. Weitz:            Excellent.

Dr. Nordt:            We’re available and if you have more questions, if you want to talk about some of these things a little bit more in terms of the matrices, saliva, blood, whatever, give us a call, I’m available.  We do answer our phones and you do get to talk to me also.

Dr. Weitz:            Excellent. Thank you so much, Doc.

Dr. Nordt:            You’re welcome.



Homeopathy with Ananda More: Rational Wellness Podcast 84

Ananda More discusses Homeopathy with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights

7:58  The majority of the scientific studies about homeopathy are either positive or inconclusive.  Only 5% are negative. There are over 1000 published studies and close to 200 randomized clinical trials.  On the other hand, quite a number of studies on drugs that were negative were never published and, in fact, the pharmaceutical industry had a history of doing a study over and over many times till they got three that were positive, that they would then pass on to the FDA for approval.  Ananda said that she has “heard many stories throughout my life with my friends and family who are doctors in research where they’ve been asked to change their results for specific studies, because the results didn’t quite line up with the expectations of the funders. I had a friend who was told that if she published her results, she wouldn’t be allowed to get her PhD, for example.” We also have to consider that these medical journals are being funded by advertising from big pharma.

12:47  Mainstream medical journals like the New England Journal of Medicine, rarely ever publish papers on homeopathy.  Ananda said that when the word homeopathy is in the abstract and the result is positive, the study isn’t even sent out for review. Also, there is very little funding for research on homeopathy.  Homeopathic medicines can’t be patented and they are easy to replicate.  So you don’t have the same possibility of profits that you do with other forms of medicine.

14:19  In the Magic Pills documentary there’s a section where there was an outbreak of leptospirosis in Cuba due to some severe hurricanes in 2007. They only had enough leptospirosis vaccine for 1% of the population and besides the vaccine requires two separate dosages to incur immunity. So they decided to do a homeopathic intervention, which they distributed to 2 and a half million people.  It completely stopped the epidemic and the levels of this disease dropped far below the historical averages for years afterward. But when these scientists (immunologists and epidemiologists) tried to publish their results, they were turned down by all the medical journals. They did eventually publish their results, but only in a homeopathic journal, Homeopathy. The paper is:  Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. The lead author, Dr. Bracho, started receiving death threats after publishing this paper. 

18:05  How can Homeopathy be effective when the active ingredient is is so diluted?  Homeopathy is an energy medicine and not only do you need to dilute the active ingredient, but there is this process of producing the formula that includes hitting the glass vials that the formula is in very hard against a surface, known as succussion. This creates high temperatures in the bottles and it creates nano particles of the active ingredient within the vial. It also sloughs off nano particles from the glass and silica is a conductor. 

22:38  Ananda was at a conference and Dr. Bracho from Cuba came and told this story about the homeopathic intervention that was so effective and long lasting and she wanted to get this story out there to help change people’s attitude about homeopathy, which is why she decided to make Magic Pills.

24:04  The Australian National Health and Medical Research Council released a report in 2015 that has been very influential and has led to a shift in public policy and opinion against homeopathy in a number of countries around the world, including in Australia. In both Australia and the United Kingdom homeopathy was covered by the national health system and now it is not due to the influence of this report.  This report was supposed to be a review of the research on homeopathy, but in the end they cherry picked the data and only included five studies, four of which were negative and one of which was positive, and they concluded that there is no evidence that homeopathy is effective for any condition. But this review had serious methodology problems, including using an arbitrary criteria that excluded any study with less than 150 subjects. NHMRC’s own guidelines are that a good study is over 20 subjects. Their methodology was so poor that they were refused for peer review publication. When the Australian Homeopathic Association did a freedom of information request they found out that there had been a previous study done by a well respected scientist, but they refused to release that first report. The speculation is that first report concluded that homeopathy was effective for certain conditions, so there is a global movement to release the first report, where you can sign a petition. 

28:28  Homeopathy has a long history in the United States and in fact, the senator who brought the bill that created the FDA, Royal S. Copeland, was an MD who practiced homeopathy.  There are homeopathic hospitals, which still exist today, including Hahnemann Hospital in Philadelphia, and there is a statue of Samuel Hahnemann and a memorial to homeopathy in Washington, DC, that was endorsed by President McKinley. But now the FDA has decided that they wanted to change the oversight on homeopathy and they have created a draft document that is creating some oversight over homeopathy but might be setting themselves up to make homeopathy illegal, since in order to go through a new drug application process, it requires a minimum of $300 million and homeopathy has thousands of medicines and which medicine is used is individualized for each person. The homeopathic industry isn’t big enough to be able to afford this process, so this could be setting the stage for removing homeopathy in the US.  And we know that in the US, the ability to lobby congress is what allows you to get favorable legislation, and homeopathy is a threat to the pharmaceutical industry, which spent $240 million to lobby congress in 2015 alone. 

35:16  The other problem with this draft document is that it is removing the FDA guidelines for manufacturing a homeopathic product, the CPG Sec. 400.400, which outlines proper manufacturing guidelines. By getting rid of these guidelines, it will be more difficult to assess if a homeopathic product is being properly manufactured.  Based on what has happened in other countries, this has created a worry that this document is part of a process that will limit or make homeopathy illegal in the US. 

36:24  There’s a group of mothers that depend upon homeopathy that have created this organization, Americans for Homeopathy Choice, to lobby for homeopathy and they have already delayed the passing of this draft document. You can go to Homeopathychoice.org and learn more, sign up, and write letters.  According to Ananda, “Even if you don’t believe in homeopathy, I think this is about protecting our rights to freedom of choice. It’s a basic human right to decide how you want to treat your body and how you want to medicate yourself. If you want to try other options first in a safe manner, I think that’s absolutely a human right.” 

39:48  Ananda has made this documentary about homeopathy, Magic Pills, which she if inviting people to screen with groups of people in their homes, coffee shops, churches, theaters, etc. which you can learn about by going to the website, magicpillsmovie.com or by going to the Magic Pills Movie Facebook page.


Ananda More is a Homeopath in Toronto, Canada at Riverdale Homeopathy, where she sees patients and teaches educational programs for homeopathy and she made an incredible documentary on homeopathy called Magic Pills that has not been released in the US yet but you can screen with groups of people in your home or in other public places.  She is dedicated to spreading the word about homeopathy. 

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 Transcripts

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

For those of you who are not familiar, what exactly is homeopathy? Well, according to Wikipedia, the source of all knowledge, skepticism, sarcasm there, homeopathy is a system of alternative medicine created in 1796 by Samuel Hahnemann based on his doctrine of like cures like, a claim that a substance that causes the symptoms of a disease in a healthy person would cure similar symptoms in a sick person.  

There are quite a number of studies that show the effectiveness of homeopathy, while quite a number of other studies show no benefit. Scientists and mainstream doctors tend to be skeptical, because some of the theories behind homeopathy don’t line up with the general accepted principals of chemistry and physics. For example, the concept that by diluting a homeopathic formulation more, it gets stronger. Goes against the principle that you need a minimum of the active ingredient to create an effect in the body, and having less than this amount will tend to be less effective or have no therapeutic effect.  This skepticism, combined with a report produced in 2015 in Australia by the National Health and Medical Research Council that declared that there are no health conditions for which there is reliable evidence that homeopathy is effective. Homeopathy, in other words, according to them, is no better than placebo. They stated that homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.

Yet over 5 million adults and over a million children in the US and many more million around the world use homeopathy on a yearly basis. Many get positive results with very few side effects. We have asked Ananda More, a homeopathic practitioner from Toronto, Canada, and a filmmaker to help sort out the truth about homeopathy. Ananda wrote, directed, and produced an incredible documentary on homeopathy called Magic Pills that includes some amazing footage on how homeopathy is saving lives in Africa, India, South America, and Cuba, among other countries. Homeopathy can be delivered at a fraction of the cost of traditional medicine and medical care, which some of these people don’t have access to in these developing countries because of their poverty levels.  Ananda, thank you so much for joining us today.

Ananda More:                   Hi, Ben. Thanks so much for inviting me on.

Dr. Weitz:                         That’s great.

Ananda More:                   Wow, you started with a challenge there.

Dr. Weitz:                         Ananda, can you tell us how you came to become a homeopath?

Ananda More:                   Sure. So I was very, very skeptical of homeopathy. I did this course in university on witchcraft and the occult.  One of the things we studied under witchcraft and the occult was homeopathy. Were were taught that the idea is that they’re giving you highly diluted substances-

Dr. Weitz:                         Is that a broom in the back? Oh no, I’m kidding.

Ananda More:                   Probably.  So we were taught that it’s a medicine that believes that there’s these highly diluted substances, and they dilute them and dilute them and dilute them until there’s nothing there. Then we’d give this to people to treat whatever is ailing them. We’ve decided that this is medicine. To me, it just sounded preposterous. The way it was taught as well with that perspective also made it sound preposterous. I was very skeptical.  I was willing to open my mind up to traditional Chinese medicine, herbology, even Reiki, like the idea of energy medicine appealed to me, but this, I just couldn’t wrap my head around.

Then I found myself in India very sick. I was in this place called Pune, and I was traveling with a friend of mine, who’s German, which is where homeopathy originates. Her mom was a homeopath, and she had her nice little first aid homeopathic kit with her. I was, to be graphic, throwing up and everything going out both ends. It was really bad.  She comes along and goes, “Hey, want to try one of my little sugar pills?” I was delirious. I was like, “Whatever. I’ll make you happy. I’ll take your little placebo pill.”  When 15 minutes I felt absolutely fine, I was kind of floored.  In a way, there was a control, because other people in the place where we were staying had the same illness and were sick for days.  Not very scientific, but I had a nice way to compare what had happened.  I was kind of surprised.

At that point, I decided to go see a homeopath in India. That homeopath gave me some remedies. I’d been dealing with and struggling with depression most of my life. I think it’s genetic. It runs in my family. The depression that I had been dealing with, but that’s how I knew the world, that’s how my filters worked, that’s how I perceived everything around me, suddenly changed and my perception of life changed. It wasn’t sudden. It was gradual over a couple of months, but it really changed my life. At this point, I was heading to law school. I was all gung ho about doing human rights work. I realized that I thought I could help a lot of people with homeopathy, if it really did work for others the way it worked for me.  That’s when I decided to go study homeopathy, and my aspirations of being a lawyer went down the drain. Sometimes when I see what I pay my lawyers, I’m a little disappointed in my choices, but not really. It’s been an incredible journey really.

Dr. Weitz:                         That’s great. Let’s talk about homeopathy. Is there a science that proves that homeopathy is effective?

Ananda More:                   The majority of the science either shows that it’s effective or the study couldn’t tell. In a very equivalent manner to what you see in conventional medicine, you get about 40, 45% of studies have positive results for homeopathy. You get around 40% that are inconclusive, and around 5% that are negative. If you really look at the scientific literature, you’re getting more of a positive overview rather than a negative one.  We have over 1,000 clinical trials. We have almost 200 randomized controlled clinical trials that have been published. In terms of basic science, there’s thousands of studies that have been done as well. By basic, I mean working in vitro with cell lines, with plants, sometimes with animals. Many of those studies have been replicated. Again, they often more often than not show a positive result for homeopathy.  There’s something there definitely. This idea that homeopathy is unscientific I don’t think is true. Science is a way of studying things. We can set up appropriate ways of studying the effects of homeopathic medicine. Now as more and more science, particularly in physics, and our technology improves and we have more ways of looking at water molecules, at what’s going on in these solutions, we have a better understanding that what may be the basis for how homeopathy works.

Dr. Weitz:                         I’d like to point out a lot of people don’t realize this, but quite a number of studies on drugs that end up with negative results end up never getting published, whereas they tend to only cherry pick the studies that are positive and publish those.

Ananda More:                   Right. So there was this history in the pharmaceutical industry of doing a study over and over again until they were able to get enough positive studies to pass onto the FDA. I think they need three studies for the FDA. So they could do 900 studies and only three of them are positive, cherry pick those three studies and use those to defend their case. There’s more controls put in place against that now, but I know it’s still happening. But technically what’s supposed to happen is the study is supposed to register before it’s done in a way to kind of control that aspect of things.

Dr. Weitz:                         Do you think that’s actually being done?

Ananda More:                   I think it’s improving. Is it being done 100% of the time? I doubt it. I’m not one of the keepers of that process, so I can’t speak to that, quite honestly, in a good way. But the honesty is too that a lot of studies, they’re manipulating the data set. They’re finding ways to get the results they want. We see a lot of research is being funded by the pharmaceutical industry, and they have ulterior motives. I’ve heard many stories throughout my life with my friends and family who are doctors in research where they’ve been asked to change their results for specific studies, because the results didn’t quite line up with the expectations of the funders. I had a friend who was told that if she published her results, she wouldn’t be allowed to get her PhD, for example.

Dr. Weitz:                         Wow.

Ananda More:                   There’s a lot of research going on where people have created false studies and delivered them, submitted them to journals, only to have them accepted and published. This has been a matter of exposing the weaknesses of the peer review system. There’s also a lot of publishing bias, because who is it that’s actually funding these medical journals? It’s advertising dollars from the pharmaceutical industry. That really affects what we see as our evidence base. We’re talking so much about evidence based medicine, and yet how do we know we can trust that evidence base? We don’t. That’s very problematic.

Dr. Weitz:                         Yeah, that’s really important to point out. Have you found that mainstream medical journals, like the New England Journal of Medicine, you don’t see many papers on homeopathy in those journals.

Ananda More:                   I think there’s two issues going on there. One is that publishing bias that we discussed. A lot of the people I interviewed for my film, top scientists in their fields, said that as soon as the word homeopathy is in the abstract and the result is positive, the study isn’t even sent out for peer review. It’s rejected at the editorial stage. Another issue is that we don’t really have a ton of funding for homeopathic research, because there isn’t a lot of money in homeopathy. You can’t patent our medicines. They’re very easy to replicate. They’re very cheap to make. So you don’t have the same possibility of profits that you do with other forms of medicine.  Who funds most of the medical research? It’s the pharmaceutical and the medical industry. They’re not going to be funding homeopathic research. We depend on very few grants. A friend of mine, Dr. Alex Tournier, who’s a physicist in Heidelberg, he’s been struggling to raise enough money to maintain his lab, which is dedicated to homeopathic research. You’ve got both of those things, a profound publishing bias, along with a lack of funding for research.

Dr. Weitz:                         In your Magic Pills documentary, there’s a section where some doctors submitted a paper about their experience in Cuba after the hurricanes where they didn’t have enough money for medication or vaccines for leptospirosis, which commonly occurs after flooding and other types of water damage. Homeopathy was incredibly effective at reducing the rates of leptospirosis, but they were turned down for publication.

Ananda More:                   Yeah. So I just want to, just to get a few listeners up to date, what they did was there’s this disease, leptospirosis, which in North America is relatively unknown, but in tropical countries, it’s a pretty significant problem. It’s hard to diagnose, because it looks a lot like dengue and has some very generalized symptoms that are hard to specifically assign to a disease. It’s fatal up to 10% of the time, and it’s spread through water.  In Cuba in 2007, they had severe hurricanes that left the eastern coast of Cuba quite decimated. Homes were destroyed. There was no clean water, and flooding was everywhere. The Finlay Institute, which is a pharmaceutical company in Cuba that actually makes vaccines and is the only company on the planet that makes vaccines for leptospirosis, the issue wasn’t that they didn’t have the money. The issue was that they didn’t have enough vaccine on hand to take to those areas. They only had enough vaccine for 1% of the population.

The other issue is that that vaccine takes two doses and months to incur immunity. It’s not an instant fix. It takes a long time. In order to get it out there, it’s an injection. You’re dealing with cold chain, you need to be able to get to that area and maintain the vaccines cold. There’s a lot of issues with trying to get something like that to people in a fast manner.

They decided to attempt a homeopathic intervention instead, which they got out to 2 and a half million people. In the course of two weeks, they completely stopped the epidemic. Not only that, but the levels of the disease were far below their historical averages for years afterwards. Yeah, when these guys, who are immunologists, epidemiologists, they were scientists, they were not homeopaths, they have never had issues getting their work published, they got their work published all the time, and they even have their own vaccine journal that they’re the editors of. Suddenly they send it out for publication, and they were shocked, because in Cuba, they’re more isolated, they didn’t realize that there was this bias against homeopathy, and everyone refused to publish these results. They would get excuses like, “Well, we need a signature from all two and a half million people involved.” That sort of thing they’d never been asked for before. It was ridiculous.  So it was quite evident to them the level of bias that existed. They did eventually publish their results in a homeopathic journal called Homeopathy. When they did, Dr. Bracho told me he stopped reading his email because of the death threats that he was receiving.

Dr. Weitz:                         Wow.

Ananda More:                   He didn’t leave the country for over two years of fear of being attacked.

Dr. Weitz:                         Wow. Can you explain to the skeptics out there how can it be that by diluting the active ingredient that … Well, to begin with, everything we’ve learned about other forms of medicine is you need to find the right amount of the active ingredient and give that in an effective dosage. In some cases, if it’s not effective, then you give it more frequently or you give an additional dosage. That’s how we use herbs. That’s how medications are typically used. How can it be in homeopathy that by first of all diluting it so much that you’re going to have any effect at all, and then how can it be that by diluting it more, it makes it stronger?

Ananda More:                   Well, so I don’t want to say that diluting it more actually makes it stronger. We think homeopathy is an energy medicine. By diluting it more, you’re changing its signal. For one person, a higher dilution may be more effective. For another person, a lower dilution may be more effective. But in terms of this idea of dilution, what’s important isn’t just the dilution, but rather this process that we call succussion, which is we have machines or we do it by hand, and we hit these glass vials very hard against a surface. This actually causes very high temperatures to happen in those bottles for microscopic moments in time.  We believe what’s happening is it creates nano particles as it breaks down the material within the vial. It also sloughs off nano particles from the glass as well, and silica is a conductor. There’s a lot of things that are happening that isn’t just diluting a substance until it disappears.

We don’t have exact clear answers at this point, but we have several theories. We have discovered that there are nano particles of source material and very highly diluted remedies. This has been seen over and over. They’ve done this with metals like gold. They’ve done this with organic substances now too. What they do is they put the remedy under an electron microscope and look for the nano particles and see if there’s any trace. Then they have special ways using spectrography to understand what that source material is that they’re looking at.  This has been replicated dozens of times. We know for a fact now that there are nano particles in these solutions of the source material. How that relates to the mechanism, we’re not sure. How are those nano particles maintained in that solution? We don’t know, but they are there. They’re observable.

There’s ideas around now nano clusters, so actual formation of the water molecules and various … I have a cat that’s trying to get on my keyboard. He likes the keyboard. We can see these nano structures of the actual water molecules where they take on specific structures. Those have been observed. We can measure a difference in electromagnetic resonances or fields from remedies that have been actual just water to homeopathically prepared water. We have, what was it? Polar dyes. Studies have been done using polar dyes where they bring the remedies to very low temperatures. As they rise, these dyes change color and respond to usually material in the water. But what they’re doing is they’re actually responding as they should in the homeopathic remedies, if that substance was in the water, where they don’t with the plain water.  We can actually measure and see differences within those preparations. There’s still a lot to understand where it’s just at the infancy of the science, but it’s not because it’s unscientific. It’s because the technology’s just catching up that’s allowing us to look at these models. The funding is lacking.

Dr. Weitz:                            How did you come to make this documentary, Magic Pills?

Ananda More:                   So the story about Cuba that I just told, I was sitting at a conference, and Dr. Bracho from Cuba came and presented their results. I thought to myself, “Everybody needs to know about this. If this was a vaccine that had no adverse reactions, that could be prepared within minutes, or not minutes, but could be prepared within a manner of days, enough doses to reach two and a half million people, you don’t need cold chain, and it’s that effective and long lasting? Wouldn’t everybody know about it? Wouldn’t this be headline news?” But nobody heard about it.  I was racking my brain as to what do we, as a homeopathic community or scientific community need to do to get that data out there to let people know what’s going on, because in my view, this was all being suppressed. That’s where the idea of a film was born. I’d seen movies have incredible results in terms of changing how we respond to things like black fish and our responses to Sea World and how we raise animals, or rather marine mammals and how we keep them. Things like that. I was hoping that we could have a larger influence through a film and reach more people.

Dr. Weitz:                            Cool. Can you talk about the Australian National Health and Medical Research Council report that found that their conclusion was that there’s no good scientific evidence that homeopathy is effective?

Ananda More:                   Yeah. So this has been a very, very influential study. They’ve really shifted policy in Australia, according to what the study has said. They’ve done the same in the United Kingdom where homeopathy has been part of the culture there for a long time. The royal family, themselves mostly use only homeopathy, and they have these incredible homeopathic hospitals across the country. Homeopathy was covered by the national health system there and it was part of your public healthcare plan. Suddenly with the use of the study and some other commissioned reports, they decided that, “Oh, there’s no evidence that homeopathy works, so therefore we shouldn’t fund it anymore.” But the study is very problematic. From the point in time where they reached out to other scientists to say, “Can you look at our methodology and give us some feedback?” They got a lot of feedback, because their methodology was very poor, but they didn’t respond to those criticisms, and they didn’t change how they were doing the study.

When the report came out, it’s supposed to be a review of all of the literature out there, but their final data is based on five and only five studies, because they created a, in a way, very arbitrary data set that they decided was what qualified a good study versus a bad study. Part of that data set was a study that was over 150 people. That may sound reasonable, but if you look at the NHMRC’s guidelines, what they think is a good study is over 20 people. When they really cherry pick the data down to five studies, four of which were negative, one of which is one of our best studies showing that homeopathy works, which is a study on diarrhea in children, and they, based on these five studies, they didn’t even address the one study that was positive and didn’t look at it. They just said there is no evidence for any disease to say that homeopathy works. Also, yeah, just the rabbit hole just keeps going and going and going around why didn’t they look at these studies? Why didn’t they look at those studies?

When the Australian Homeopathic Association reached out and tried to get … Well, they did a freedom of information request to learn more about the study, they learned that there had been a previous study that had been done. That previous study had been done by a very well respected scientist. They’d seen the feedback on that study, which said that the methodology was of very high quality, and yet that study was buried. The lead scientist on that study was fired, and they decided to make a whole new study. They’re refusing to release that first report.

Dr. Weitz:                         Wow.

Ananda More:                   On top of that, this current report was rejected for peer review because its methodology was so poor.

Dr. Weitz:                         Wow.

Ananda More:                   So now we’re using this to uphold that homeopathy doesn’t work, and yet it couldn’t even get published, an anti-homeopathy study that couldn’t get published. I think that’s very meaningful. Now there’s a campaign, and it’s a global campaign, so I invite everyone who’s listening to this to go and sign this petition to release that first report. That could be a game-changer. People can go to releasethefirstreport.com. There’s tons of information, a real in-depth analysis of what is wrong with this study. Other people won’t say it, but I’m willing to say that I think the study is quite fraudulent and had something to prove that they couldn’t prove the first time. Yeah, I invite everyone to go there, learn more, sign, share. I think it’s really important.

Dr. Weitz:                         So how about in the United States? I understand the FDA has taken note of this report and issued some sort of a warning or something.

Ananda More:                   So homeopathy has been, in a sense, accepted by the FDA since its inception. Homeopathy was grandfathered in. The senator who brought in the bill to create the FDA was actually a homeopath himself.

Dr. Weitz:                         Really?

Ananda More:                   Yeah. So there’s a long-

Dr. Weitz:                         What was his name?

Ananda More:                   Pardon?

Dr. Weitz:                         What was the name of the senator?

Ananda More:                   I can’t remember his name. I’ll have to look it up.

Dr. Weitz:                         Wow. Interesting.

Ananda More:                   Quick Google search. But homeopathy has a long history in the US. We’ve had homeopathic hospitals, which still exist today. They’re just not homeopathic anymore, like the Hahnemann Hospital in Philadelphia. There is a memorial to homeopathy that was built by a president in Washington, DC.

Dr. Weitz:                         Really?

Ananda More:                   Yeah.

Dr. Weitz:                         Which president built it?

Ananda More:                   Again, I can’t remember his name. I’m not very helpful there, am I?

Dr. Weitz:                         You Canadians, you don’t know anything about American history.

Ananda More:                   It wasn’t a major president whose name was burning in my ears.

Dr. Weitz:                         That’s okay.

Ananda More:                   Resonate. But now the FDA has decided out of nowhere that they wanted to change how homeopathy is the oversight, how it’s overseen. They created this draft document which basically in a sense states that homeopathy is legal. It stated that we brought homeopathy in, but these remedies haven’t gone through the new drug application process. Therefore, we’re going to pursue this on a risk basis, on a high risk basis.  To the industry, they were saying, “Don’t worry. We’re only going to address remedies that are going to people that are immunocompromised and babies and things like this where there may be a risk to them using these remedies.” But in all honesty, what’s the risk if there’s no active ingredient in it? It’s not going to hurt anyone. It’s non-toxic, and in many situations, it’s the only medicines available to pregnant women and compromised individuals, people like that.

The other issue is that they’re basically setting themselves up to make homeopathy illegal with this document. In order to go through a new drug application process, it’s at minimum around $300 million. We have thousands of medicines. There’s a level of individualization to homeopathy, so you could have one remedy that could be good for 50 different ailments in 50 different individuals in different ways, and the kind of research that the FDA requires is very pathologically centered and per drug rather than homeopathy as a whole, which does not allow for individualization and using homeopathy as it’s actually used in practice.  Being able to pass those requirements are very doubtful, and our industry isn’t big enough to be able to afford that kind of money to pass every medicine for every possible indication. It really complicates things, and it’s basically setting the stage for the removal of homeopathy in the United States.

Dr. Weitz:                            Yeah. No, I can totally understand that. On the one hand, I saw a recent report where the FDA stopped the use of a particular brand of homeopathy, because they found bacteria or something in some of their products, and that sounded totally reasonable and sounded like what they were talking about. On the other hand, we have to understand in the United States especially, and I don’t know how many other countries follow this, but our government is increasingly controlled by big corporations and even the heads of the FDA and these other agencies are often lobbyists or people who work for these big corporations because of the way that the government is set up with the lobbying and everything.  For example in California, where I practice as a chiropractor, all the individual healthcare plans include no chiropractic coverage. How can that be in a liberal state like California where people use chiropractic and other alternative medicine quite readily?  It came down to lobbying, and the chiropractic profession didn’t do a good job of lobbying to make sure that chiropractic, which is relatively inexpensive, was going to be included in the new healthcare plans.  They wanted to cut something, and that was a low-hanging fruit they could cut.  It was based on lobbying. That’s I think one of the risks for homeopathy in the future is that everything seems to be based on influences based on the amount of funding.

Ananda More:                   Mm-hmm (affirmative). Yeah, and like what you’re talking about, there’s been a few situations recently where they have found bacteria in remedies. There is a story of Highland’s Teething Tablets, which garnered a lot of news because of their belladonna content, or deadly nightshade. Again, there was a freedom of information request done on that data, and it was so arbitrary. These supposed cases of death attributed to this remedy had nothing that was very hard to attribute the death to the remedy. You’d see cases like a child born without kidneys or who then had a dose of this remedy and died three months later. They were just completely … It just looked like falsified data. A lot of the data had been doubled as well. So they had to do a lot of filtering, and they claimed it was hundreds of thousands of complaints when you really looked at it, half of them you didn’t know what the complaint was about. Half of them were replicated from other things. Half of them had nothing to do … I keep saying half, but it dwindled down to almost nothing, in terms of complaints.  If you really took those teething tablets, in order to intake enough to have the minimum level for toxicity, you’re looking at taking hundreds of boxes or consuming hundreds of boxes of this medication. It really feels like there’s a witch hunt out there.

The other problem around that with this document is that if it passes, they’re actually removing the manufacturing guidelines for these remedies. There’s a document called the CPG 400.400. Within that document, it outlines proper manufacturing practices. The FDA has every right to go after these manufacturers who aren’t maintaining the purity of their remedies. What they’re doing is they’re getting rid of that. Suddenly you can’t even go after them with proper manufacturing, and we can’t even assess whether they’re selling a product that they say is what it is, because there’s no manufacturing guidelines.

Dr. Weitz:                         Wow, so you can’t go after the big pharma companies are having this stuff made in China that has all kinds of proven toxins.

Ananda More:                   But that’s very specific to homeopathy. That’s what they’re removing, the guidelines for manufacturing a homeopathy, which makes no sense.

Dr. Weitz:                         Right.

Ananda More:                   There is this fantastic group of mothers that formed in the United States headed by this very vibrant woman named Paula Brown. These were all moms who depend on homeopathy on a daily basis. It really amazed me, because we have public healthcare here. I can go to the hospital, and it doesn’t cost me anything out of pocket. But a lot of these-

Dr. Weitz:                         What a concept? You socialists.

Ananda More:                   Yeah, I highly recommend it. But these women were either didn’t have access to healthcare, couldn’t afford these hospital visits.

Dr. Weitz:                         We’ve got the greatest system in the world where a simple emergency room visit for a flu can cost you $3,000.

Ananda More:                   Yeah. I can’t wrap my head around that in any way, shape, or form, because I’ve never experienced that. But you see these women who were dependent on drugs and suddenly lost their plans and couldn’t get their thousands of dollars worth of medications anymore. They couldn’t afford to take their kid to the hospital. They saw miracles happen with homeopathy, so they really stand behind it. You hear these stories. They’re just astounding. They were so terrified of losing access to homeopathy that they formed this organization called Americans for Homeopathy Choice.  These women have been a powerhouse in the US, in terms of lobbying for homeopathy. This document that the FDA, this draft would have passed already if it wasn’t for them. They’ve put in place a petition and were asking for people to write letters to the FDA to support this petition. It’s not the kind of petition that everyone signs. It’s a petition specifically for them that’s clogged up the passing of this document. People can go to homeopathychoice.org and learn more, sign up, and write their letters. There’s all the instructions there as to what needs to be done.

Even if you don’t believe in homeopathy, I think this is about protecting our rights to freedom of choice. It’s a basic human right to decide how you want to treat your body and how you want to medicate yourself. If you want to try other options first in a safe manner, I think that’s absolutely a human right.

Dr. Weitz:                            I totally agree with you on that. There’s many cases now in the United States where those options are being taken away, where vaccines are being made mandatory to send your kids to school, and there’s a lot more things, a lot more cases where those individual choices for choosing your own healthcare, making your own healthcare decisions are being taken away.

Ananda More:                   Mm-hmm (affirmative).

Dr. Weitz:                            Well, this has been a very interesting interview, Ananda. Thank you so much for joining us.

Ananda More:                   Thanks so much for letting me talk and spread the word. I appreciate it.

Dr. Weitz:                            So how can listeners get a hold of you, if they want to talk with you or if they want to get more information about homeopathy? I’ll put links in the show notes, of course?

Ananda More:                   Brilliant. Well, we have made this … I think it’s a fantastic documentary called Magic Pills. We’re inviting people to screen it all over the US. We have a goal of 1,000 screenings. It’s actually been screening all over the world. It’s been in a bunch of film festivals. But what we want to do is bring it into people’s homes. There’s this model of you can screen the film in your own living room, invite your friends and family to come watch it. Or you can screen it in the church, a theater, all kinds of different places are being used. Coffee shops, museums. But we want to make it really accessible, and we want people to come together so there could be a really great discussion afterwards and a building of community around the issues presented.  We invite you to go to the website, magicpillsmovie.com. There’s lots of information there on how to make that happen. Through the contact us link there page, you’ll definitely reach out and you’ll hit me. Could also check us out on Facebook, which is Magic Pills Movie. We’re pretty active there as well. Those are the two excellent ways to reach us.



Men’s Health with Dr. Myles Spar: Rational Wellness Podcast 83

Dr. Myles Spar discusses Men’s Health with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights

1:22  Some of the ways in which men’s health is different than women’s, is that men die younger. They have higher rates of heart disease. They may have issues with erectile dysfunction, prostate problems, and low testosterone especially as they age. Men, on average, die five years younger than women.  According to the Harvard Health Blog, the reasons why men die younger are that: 1. men tend to take bigger risks, 2. have more dangerous jobs, 3. die of heart disease more often, 4. are larger than women, 5. commit suicide more often than women, 6. are less socially connected, and 7. tend to avoid doctors.

3:45  Dr. Spar said it appears to be masculinity that results in men dying younger than women. In countries where the masculine machismo is more prevalent and they engage even less in the behaviors we know contribute to longer life and healthier living, are countries where men’s health is actually worse.  Dr. Spar said that we need to figure out how to message wellness to men so that they respond, which is what his professional mission has been about.

4:31  Dr. Spar said that the five factors that most contribute to premature death in men are 1. lack of exercise, 2. drinking too much, 3. engaging in risky behaviors, 4. smoking, and 5. being overweight.

5:29  We need to message in a way that men will tend to respond. Talking about a prevention and wellness approach means a lot to us as practitioners, but it only resonates to someone who is fairly abstract thinking, while guys tend to be more specific results oriented. Dr. Spar explained that we need to message to what matters to that person, such as performance at work, losing weight, getting cholesterol down, sexual function, etc. Men tend to respond to a more performance oriented message. but there are also lots of women who also think in this goal oriented way of thinking. 

7:11  When working with men to lose weight it is important to measure not just weight but bodyfat percentage and setting goals and holding men accountable.  Dr. Spar finds that apps like Strava are helpful in using technology that helps with accountability and tracking improvement or not. 

9:25  Dr. Spar prefers to look at genetics to see if his patients have trouble with detoxification. He uses either Pathway Genomics or PureGenomics from Pure Encapsulations that allows you to put your 23and me raw data through. But he is concerned about a report that such programs that analyse genetic data tend to have up to 20% errors when reporting on the SNPs of these genes.

12:17  To help men reduce their risk of heart disease, men need to have an advanced lipid profile, since the tests that are run with the annual physical exam are inadeguate in assessing the risk for heart disease. Dr. Spar likes to use the Cardiometabolic Profile from Spectracell, which looks at LDL particle size and number and also at inflammatory markers like CRP. We also need to look at Lp(a), which is a huge risk factor for heart disease.  Take the case of Bob Harper, the trainer from Biggest Loser who appears to be in great shape, and had no risk factors except that he had a high Lp(a) and had a near fatal heart attack.  It will also look at homocysteine, which is a risk factor for heart disease and is easy to lower with the right supplements. And homocysteine is also an indication that you don’t methylate well, if you haven’t had genetic testing. Your primary MD will usually not order such an advanced lipid profile because it’s usually not covered by insurance and they usually avoid such conversations.  Dr. Spar also likes some of his patients to get a coronary calcium score to see directly if there is any plaque in their arteries, which is another useful test that is not covered by insurance. But despite some patients’ concerns, there is very little radiation associated with such a limited scan and there is no radioactive dye.  If he has a patient who has cholesterol problems and he has them on fish oil and plant sterols and he is deciding whether to place them on a statin, the coronary calcium scan can help him and his patient make that decision. 

17:08  Men tend to have lower testosterone levels today because of 1. stress and anxiety, since our bodies shut down reproductive drive if we are under stress, 2. environmental toxicity, which especially seems to affect free testosterone, and even lowers sperm count, and 3. opioids, which have been correlated with lower testosterone levels.  Testosterone should ideally be in an optimal range betweeen 350 and 900. Too much and too low can both be risks for heart health. Men should also have an optimal range of estrogen with an ideal estradial range of 15-30. Men who are taking a lot of estrogen blockers can be causing themselves harm with respect heart and bone health if they drive their estrogen down too low.

23:50  Natural ways to raise testosterone levels include: 1. zinc and chrysin are both natural aromatase inhibitors and will block the conversion of testosterone to estrogen. When you take zinc you should also take 1/10 as much copper. 2. Chinese panax ginseng, 3. Tribulus, 4. Maca root, 5. stress management techniques, including meditation, yoga, Tai chi, journaling, prayer, some breath work, 6. 7-9 hours of sleep per night is very important 

26:45  Free testosterone levels seem to be often very low, even more so than the total testosterone.  Some of this can be due to thyroid and liver problems, but most of this is probably related to increases in SHBG (sex hormone binding globulin), which may be related to environmental toxins.  Dr. Spar noted that when tracking men whom he has placed on topical estrogen supplements, he will track them with saliva free testosterone levels, which is more sensitive for this than serum. This is part of his tack180.com program.

31:57  Dr. Spar does measure PSA levels in men, especially if he has placed them on testosterone.  We do know from the work of Dr. Abraham Morgentaler that testosterone does not cause prostate cancer, though if someone has prostate cancer, we don’t want to give them testosterone.  Dr. Spar will do a digital exam and if the prostate is enlarged he will also check a free PSA. If the PSA is elevated, will have the patient get a prostate MRI. If that is positive, only then he will recommend a biopsy.  This reduces unnecessary biopsies.



Dr. Myles Spar is a Medical Doctor who practices in Hollywood, California and he is a leading authority on men’s health. He is a co-author and editor of a comprehensive book on men’s health, Integrative Men’s Health. Dr. Spar provides a lot of useful information on his website, MDSpar.com where he offers his Tack180 program of comprehensive men’s care.

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 Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with The Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition, from the latest scientific research and by interviewing the top experts in the field. Please subscribe to The Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and leave us a ratings and review. That way more people will find out about the Rational Wellness Podcast. Today we are going to focus our discussion on men’s health, with our special guest, Dr. Miles Spar. We’ve talked in prior episodes about prostate health, and libido, with Dr. Geo Espinoza in episodes eight and number 48. These are important issues for men. But today, we’re going to talk about these and other factors in an overall approach to improving men’s health.

Some of the ways in which men’s health is different than women’s, is that men die younger. They have higher rates of heart disease. They may have issues with erectile dysfunction, prostate problems, and low testosterone especially as they age. Men, on average, die five years younger than women. What are some of the reasons for this? According to the Harvard Health Blog, men tend to take bigger risks, have more dangerous jobs, die of heart disease more often, are larger than women, commit suicide more often than women, are less socially connected, and tend to avoid doctors. As a chiropractor, I can definitely endorse this, because my practice, like most chiropractors, is 60% women, and a lot of the men who come in are only there because their wives or girlfriends pushed them to come in.

I’m happy that Dr. Miles Spar will be joining us today. He’s a medical doctor in Hollywood, California. He practices Functional Medicine, and he also directs the integrated medicine program at the Venice Family Clinics, Simms/Mann Health and Wellness Center. Dr. Spar is a leading authority on men’s health. His comprehensive book on integrated men’s health was published in 2014. When Dr. Spar sees patients, his consultations usually include an analysis of genetics, nutrient levels, hormones, and advanced cardiovascular testing. Dr. Spar is also an iron man athlete, and he works both with Hollywood celebrities, and professional athletes, including being a medical advisor for the NBA. I’m honored that you’ll be joining our podcast Miles, to speak about men’s health.

Dr. Spar:              Thank you. Thanks Ben. It’s great to be here.

Dr. Weitz:            Absolutely. So, do you agree with those reasons the author of the Harvard Health Blog wrote about why men tend to die younger?

Dr. Spar:              Yeah I do. I think it’s definitely proven at this point, that it’s not genetic, it’s not biologic. There’s differences in life expectancy between men and women, but those differences change over time, and across cultures. If there’s really biology, it would be a fixed difference or more close to a fixed difference. It really just seems to be, it’s more like masculinity is killing us, as opposed to being male. There’s a really interesting report, just a couple of weeks ago, the World Health Organization put out on the status of men’s health in Europe saying very similar things to what you quoted from that Harvard blog, that the countries where the masculine machismo is more prevalent, are countries where men’s health is actually worse. There are countries where they are engaging even less in behaviors we know contribute to longer life and healthier living.  Absolutely, I think it’s coming upon us to really try and figure out what are we doing wrong, and messaging wellness towards men. Why aren’t they responding? What can we do differently. That’s really what my professional mission has been all about.

Dr. Weitz:            Of those factors we mentioned, which ones do you think are the most important?

Dr. Spar:              Basically I think there are five that are most important. There are five that are most likely to contribute to the decrease in mortality, the decrease in life expectancy, because they contribute most to the preventive causes of premature mortality. That’s basically lack of exercise. It’s a lot of what you mentioned, but I think … I can’t narrow it down to one. I think it’s lack of exercise. It’s drinking too much or not moderating alcohol. It’s taking risky behaviors. It’s smoking. I have a little thing here. It’s also maintaining a healthy weight. Men are more likely to be obese than women, and I think that may be the most important cause of it right there.

Dr. Weitz:            Yeah great. How do you address some of these issues in your practice?

Dr. Spar:              I think, first of all, like I kind of refer to we don’t message what we’re trying to do to men very well. We’ve been using this prevention and wellness approach, which is great, and it means a lot to us as practitioners, but it only resonates to someone who is fairly abstract thinking, able to put off things now for future benefit. By and large, guys are a little more result oriented. “What do I need to do now, and how is it going to impact me now?” It’s more about results, outcomes, specific goals, as opposed to broad ideas of wellness or prevention. I think part of what we need to is really think about messaging that’s directed at what matters to the person that you’re in front of. Is it about performance at work? Is it about losing weight? Is it about being more on mentally? Is it about getting cholesterol down? Is it about sexual function? Then making very specific recommendations that will impact that particular goal that’s of concern to that person. I call it a men’s approach, that it’s really about performance oriented, but it’s really not just for men.

I think that would help us in general, because there are a lot of people who think in this more stereotypical masculine way that’s result oriented, goal oriented that is more abstract and wellness orientated. By and large, that’s more men than women, but this is a caveat to our whole conversation today. When we talk about men, I really mean anyone who thinks in a stereotypical male way. It doesn’t have to be a person who’s a male in gender. That’s the first step, is really more goal results oriented way of talking about why it’s important to make behavior change.

Dr. Weitz:            You mentioned weight gain and obesity. How do you specifically deal with that with men, and how do you come up with more … How do you approach it in a way that’s more impactful than just making general recommendations, “You should lose some weight”?

Dr. Spar:               Yeah. Good question. I think it’s about measuring and holding patients accountable and having real milestones. As opposed to a general grid. “I have this great anti-inflammatory diet. Here’s what you eat. Here’s what you shouldn’t eat.” That doesn’t work as well as, “Okay, let’s look at specifically what you’re eating, meet with a nutritionist, and then let’s measure not just weight because with guys oftentimes they’re working out and then they don’t lose weight because they’re building muscle mass, so let’s look at waist circumference or let’s put you in a DEXA scan, which you can do now pretty inexpensively and check your body fat percentages. Whatever single measure can really be important to that guy, find that, and then check it periodically because guys like to compete even if it’s against themselves or against other people.  That’s the other part of that. I think physical activity is as important as diet. With guys especially trying to get them to engage. I love Strava, which is an app that’s like a social media/competition app or Weight Watchers even now has a great app. They’re using some kind of technology that helps have accountable measures. It’s all about having a measurement that you track and being able to show improvement or lack thereof and then figuring out where do we need to change our tactics.

Dr. Weitz:            Yeah, we use bioimpedance in our office, and that’s helpful.

Dr. Spar:              That’s great. Something that you use the same one each time, then it really is good. It’s showing changes, and then you know if you’re going the right direction or not. I think guys especially, everybody, especially guys like to feel like you’re holding yourself accountable. As a practitioner you’re going to say, “Look, I know this is going to work, and we’re going to show it’s working. If it isn’t, we’re going to change things. Then they like to see that they’re making improvements in black and white.

Dr. Weitz:            Do you ever look at toxins as a factor in having trouble losing weight or so many other health issues?

Dr. Spar:              Yeah. I like to do both looking at toxins and looking at genetics because sometimes people have genetics where they’re not detoxifying as well, so I like to do genetic testing to see if they need issues with detoxifying because it may be that they’re being exposed to the same amount as everybody else, but their hormones are getting messed up because they’re not clearing them out. Even if you do measure their testosterone, TSH and all that, it’s kind of okay, but their hormones aren’t operating as maximally because there’s so many toxins. Some of that is determined I think by how good their liver is at clearing things out. We can measure that through some of the genetic tests. They can tell us, “Oh, okay. This person really does have a propensity to not clearing stuff out, so let’s give him supplements that help boost whatever phase of detoxification they might need help with.”

Dr. Weitz:            What’s your favorite genetic panel?

Dr. Spar:              That’s a really good question. I play with all of them. Right now I’m using Pathway Genomics. It’s not really my favorite, but I like it for right now in terms of price and availability. I also like Pure Encapsulations products. It has this free if you’re one of their clients. It has this thing called PureGenomics, which is great. You can run 23andMe data for free through there. You get a great report.

Now the caveat is I’m concerned because I’m hearing that there is concern with some of these secondary data analyses from 23andMe data, that there have been found to be quite a bit of misinterpretation. I take it all as one piece of evidence. None of them is going to be a sole decision maker for me. It’s just if someone comes in with symptoms that could be relating to, let’s say, detoxification, then I look to see how are they detoxifying. How is their SOD? How is there MTHFR or some of these other genes? To see, okay, that could explain it or, “You know what? This doesn’t even make sense. I don’t really think this is significant.”  I mean I think hopefully whole genome sequencing will become more affordable, and that’s going to be a lot more reliable than any of these tests that look at individual SNPs.

Dr. Weitz:            What was that concern about the 23andMe?

Dr. Spar:              There are some just some studies that are showing that these Promethease and PureGenomics and some of these other programs that basically do secondary data analysis, they basically take the raw data from 23andMe and run it through their systems, that there’s a lot of error.  I forget the numbers now. I wish I could tell you. It was 20% or more were recording genes that were just inaccurate, that patients didn’t have those genes as it said they had.

Dr. Weitz:            Oh, wow.

Dr. Spar:              Yeah. It was really high rate of error. It definitely gave me some pause.

Dr. Weitz:            Interesting. Yeah, we’ve been utilizing that service as well. How do you deal with the heart disease risk that men have?

Dr. Spar:              Well, I think it’s important number one to look beyond just the general annual physical lipid panel. That’s a big thing. I think that just plain old cholesterol and LDL cholesterol is one part of the picture. You need to really look at these advanced VAP panels like Berkeley Heart Lab or I use SpectraCell, one of these advanced panels that looks, A, at things that go beyond the plain lipid panel. So they look at lipid particle number and particle size. Do they have a bad pattern of LDL or bad kind of cholesterol. You can have the worst pattern or the not as bad pattern.  Then especially looking at other markers because we know that heart disease number one is plaque and inflammation. Those are the two essential parts, right? We know that cholesterol can increase risk for plaque, but if their inflammation markers like CRP are really low, I’m less concerned. It’s really important to measure that. Then we know things like Lp(a), separate from cholesterol, a huge risk factor for heart disease. Bob Harper made that famous. He’s the guy that is a trainer on Biggest Loser, really in shape guy, had a heart attack or at least needed a stent placed emergently, and I think it was a heart attack.  Then there was a big article in the New York Times about the fact that his only risk was his high Lp(a) back in January or February of this year, your listeners can look that up, by this really good science writer for the New York Times. It really brought to light how important that marker is, which unfortunately isn’t always covered by insurance, but it’s a really important mostly genetically based risk.

Dr. Weitz:            I think that’s one of the big factors why when someone goes for their typical annual physical and they get this very limited number of blood tests, especially today, which when it comes to lipids is maybe going to be like LDL and HDL, total cholesterol, and triglycerides and sometimes even less because that’s what the insurance is going to pay. Unfortunately, most primary MDs are trying to stick with the insurance guidelines, and so unfortunately I think short changing the patients.

Dr. Spar:              Yeah. I mean there have been studies showing the annual physical as it’s currently done literally is a waste of time. It doesn’t provide any change in mortality or morbidity. There have been articles in the New England Journal of Medicine and JAMA and in very prestigious, very conservative journals about that. It’s because it’s all based on what insurance says as opposed to what is really optimal in terms of preventative medicine and evaluating risk, which is unfortunate because then it puts us in this position of saying, “You know, you really do need this test and this is how much it’s going to cost, and I’m not making money off of it, but you really need this.”  Patients who are low income, it’s not fair.

Dr. Weitz:            MDs rarely even offer patients that choice, though.

Dr. Spar:              Right because it’s a whole discussion that they don’t feel like to have. Either they don’t know about it because they don’t learn about it.  It kind of goes down they only learn about what’s in the annual physical or they’re like, “Okay, I know he needs this, but I got three patients waiting. Do I really want to go into ‘Well, you need this. This is why. Is it covered or not covered.'” They’re just like, “No, I’m just going to check off the lipid panel.”  It’s really unfortunate.

Dr. Weitz:            Yeah.

Dr. Spar:              Then the other marker I would say in there that I didn’t mention is homocysteine. That’s if someone can’t afford genetic testing that’s kind of a hint that they might have like an MTHFR, a gene where they don’t methylate their B vitamins well and don’t clear homocysteine.  Homocysteine is easy to lower, and it’s a very known risk factor for heart disease.  That’s part of it. And then imaging, I really think again is not covered by insurance but is not that expensive.  It’s like $200 for a coronary calcium score.

Dr. Weitz:            Right.

Dr. Spar:              To me, I love those because if somebody does have high cholesterol, but they don’t really want to go on a statin and I don’t really want to put them on a statin, we’re trying fish oil, we’re trying plant sterols. They’re watching their diet. The thing that will help me decide, “Okay, do we really need a statin or not?” is something like a phenotypic test. Is that risk translating into real disease? The way to look at that is something like a coronary calcium CT scan, which is only a few cuts, a couple inner bugs, and we can see do they have plaque or not, and if they don’t, then I know, “You know what? Don’t worry about it. You have some cholesterol, but it’s not really manifesting as plaque,” versus, “Ooo, you have a high calcium score of 100, we’re putting you on a statin.”

Dr. Weitz:            I think the reason why you mentioned that it’s just a few cuts is to point out that it’s not a lot of radiation.

Dr. Spar:              Right. Exactly. Some people get scared of having too much CAT scanning. This one, there’s no contrast dye that they’re injecting in you. It’s really limited to just looking at the arteries around your heart.

Dr. Weitz:            Right. Good. Yeah. Let’s bring up the testosterone topic.

Dr. Spar:              Yes.

Dr. Weitz:            First of all, we’re seeing lower levels of testosterone in men over the last several decades. Why is that?

Dr. Spar:              Good question. I don’t know that we know. I mean, I think the hypotheses that seem most likely are number one, anxiety and stress. There’s just more stress. There’s less time to do what we need to do. There’s less people unplugging and relaxing. We know that reproductive drive is completely directly correlated with or inversely related with stress. Women stop menstruating when they’re really stressed. Men stop making testosterone. It’s literally evolution protecting our progeny because if our bodies sense stress or crisis, and that can be emotional stress from work or from relationships just as much as being under attack from a saber tooth tiger, it’s going to say, “Whoa, we need to protect the home front. We can’t make progeny that we may not be able to protect. Let’s shut down reproductive drive and just focus on survival.”  It’s kind of hard where it ends. Stress lowers testosterone. I think that’s a lot of it.

I think some of it is environmental toxicity. We see that in to some degree this difference between total testosterone and free testosterone, which I know you were going to ask about anyway. Basically, some guys like their total testosterone is okay, but they have so much of this binding up protein called sex hormone binding globulin that their amount of testosterone available to really work is low. Some of that, I think, is due to environmental toxins that affect the liver and then the liver makes more of that protein.  I think between the stress and the toxins, those are probably the most likely. We see fertility going down. We see sperm counts going down. There’s something really affecting reproduction in general in men and women, but you can see a direct correlation in men.

Then opioids as well I guess would be the third one. We hear a lot of this opioid epidemic. Opioids are very directly correlated with lower testosterone, completely, even if you’re just appropriately taking them for a couple of weeks after having surgery or something. Your testosterone is going to go down while you’re on them.

Dr. Weitz:            Yeah. Opioids have all sorts of negative effects on the gut, every system of the body really. When it comes to testosterone levels, it’s interesting that really high levels of testosterone like professional body builders have will increase their risk of heart disease, while really low levels also increase their risk of heart disease. Then, yes, testosterone levels lower. A lot of times there’s higher estrogen levels, and it’s interesting that that’s a negative for men.  For women, higher estrogen levels are very protective for heart disease, which is one of the reasons why women have lower risk of heart disease.

Dr. Spar:              Yeah. I mean, I think there’s this whole controversy about testosterone, but it shouldn’t be a surprise that it’s not good if it’s too high or too low. I mean, we know with thyroid for example if it’s too high you can have problems. You can have palpitations and a risk of heart attack. If it’s too low, you get a wheeze and constipated, and you can even have all sorts of skin and other immune system conditions. All hormones are very finely tuned. They affect each other. It’s the same with testosterone. There’s definitely evidence too low testosterone affects increased risk for heart disease, increased risk for obviously osteoporosis and bone problems, and too high of testosterone increases it as well.  Really, it does need to be in the optimal range. I think that’s part of the issue with guys like bodybuilders that are taking too much of it. It’s not like … I don’t know if there’s any good example, but it’s not like more is better. You know? I mean, more is better if they’re low and they’re just getting it to the upper 25% of the normal range.  If they’re taking it over the normal range, it’s not good.

Dr. Weitz:            Yeah, what bodybuilders are taking though is nowhere close to the normal range, you know?

Dr. Spar:              No, no.

Dr. Weitz:            They’re taking thousands of times above what the normal range is.

Dr. Spar:              Exactly. They get results in terms of muscle mass, but they also get dangerous side effects, liver, heart disease, all sorts of issues. I think the estrogen is the same thing. You want it in that what’s normal for men. That’s the other thing bodybuilders and some guys do. They’ll read it in Men’s Health magazine or these magazines to take all these estrogen blockers, and then they take too much, and their estrogen is unmeasurable. They think that’s great, but that actually puts them at risk for osteoporosis because you want between 15 and 30, if you’re measuring your estradiol level. If it’s much higher than that, no it’s not good. You can get breast tenderness and issues if you do maybe take a blocker a couple of days a week.  These guys who are taking blockers like every day, and they feel great that their estrogen is unmeasurable, are really in trouble.

Dr. Weitz:            You think 15 to 30 is the sweet spot for estrogen for men?

Dr. Spar:              Yeah, for estradiol specifically. Yes.

Dr. Weitz:            Estradiol. Yes. What about for testosterone? When you look at these testosterone tests, let’s start with the total testosterone. The range on some of these labs is 150 to 900, which is a big range.

Dr. Spar:              Yeah. I know. I think for a total really if it’s under 350, they’re likely to have symptoms.  First of all, with testosterone I rarely just treat the number. If it’s in the 100s, I will treat the number.  Even if they don’t have symptoms, that’s dangerous for bone and heart health and even diabetes risk. If it’s in the 300s, likely they’re going to have symptoms if it’s under 350. So the symptoms that a guy can have, they may not report sexual function issues, but they could have depression. They could even be put on antidepressants because nobody checked testosterone, but really they’re depressed because their testosterone is low.  They can have low energy.  They can just have lack of muscle mass or losing muscle mass or losing weight. Sometimes guys won’t talk about having issues with sexual function, but they’ll talk about these other things.  Those all can be improved if you get the testosterone normal.  I would say probably 350 is the lower limits of normal, optimal, and up to maybe 900, probably much above that you risk the blood count getting too high. You risk acne. You risk getting that kind of road rage kind of feeling.  There’s probably no extra benefit of getting it to 1,100 versus 900.

Dr. Weitz:            What are some of the strategies for helping to normalize or elevate testosterone levels besides taking testosterone?

Dr. Spar:              A couple of things. Number one, you can take some things that naturally do block some of that conversion of testosterone to estrogen, like zinc for example or there’s a natural herb called chrysin which you can even put into a topical thing. Those help a lot.  The conversion, you know we all convert testosterone to estrogen via this enzyme aromatase.  Those are natural aromatase inhibitors, so they will naturally boost testosterone a little bit.

Whenever you take zinc, you want to take a little bit of cooper with it in a ratio of about ten to one zinc to copper because they go together, so they are supplements that will have those combined. Those are kind of natural ways.  Other than that, there are other things that help boost libido and male energy, but they don’t boost testosterone per se.  Still, I think they’re worth using if testosterone is mildly low and somebody has symptoms.  For example, in Chinese medicine the ginsengs, we all know about, right? Especially Panax ginseng. In Indian medicine there’s Tribulus, which is kind of like the Ayurvedic form of ginseng. In South America, there’s Maca root, which is what they call Peruvian ginseng. Every culture kind of has their own male energy formula.  I really like Tribulus.  Maca has been really well shown to help with mood changes. There is a good study showing men on I forget if it was Celexa, Prozac, one of those SSRIs, which are known to cause sexual side effects taking Maca I think it was about two grams a day.  This was like a very well peer reviewed study.  They had a decrease in those side effects after they started the Maca, those sexual side effects.  I think that’s a great thing to try.  Those don’t raise T per se, but they do help some of the symptoms of low T.

Dr. Weitz:            Right. Tongkat Ali, have you tried that herb?

Dr. Spar:              No, I haven’t.

Dr. Weitz:            Yeah, check that one out. Look into the research on it.

Dr. Spar:              Okay. Great. Yeah, I definitely will. Obviously the other things we talked about that are real important. We talked about how stress lowers testosterone, so one of the most important interventions to increase testosterone is to find some stress management approach, whether it’s meditation, yoga, Tai chi, journaling, prayer, some breath work. I counseled a guy to do every day to really help decrease the impact stress has on the body. That’s probably the most powerful thing.

Dr. Weitz:            I found sleep to be really impactful as well. So many of us are sleeping four, five, or six hours a day.

Dr. Spar:              Yeah. That’s true. Most people do need seven to nine on average. You can get away with one or two less than that, but over time that absolutely decreases your ability to deal with the stress of life and then that’s going to cause a cascade of events. Yeah, that’s a really good point.

Dr. Weitz:            To bring up the free testosterone thing, I’ve noticed a huge percentage of men with low free testosterone levels. Even if their total testosterone level has sort of been normal or mid-range.

Dr. Spar:              Yes. Yeah, I don’t know that we know exactly why. Like I said some of that is from this increase in this binding protein, HDGN. We don’t know why that’s raised. We know thyroid disease and liver disease affects it, but it seems like more and more guys are getting a lot of testosterone gunked up with this SHBG, and I suspect myself, and I don’t have a lot of scientific basis for it, that it is part of this environmental toxicity affecting the liver and liver manufacturing more of this.

Dr. Weitz:            A lot of these environmental toxins are estrogenic substances.

Dr. Spar:              Exactly. The program I do called Tack 180, and in the show notes I’m sure you’ll have a link to that, it’s tack180.com that does a lot of this testing like we’ve talked about. I do saliva testing in addition to the blood. The blood is good for checking total, and you can check free as well, but the saliva is really good because it only checks the free really available testosterone and especially if I’m using topical testosterone replacement for a guy. Sometimes that salivary will really help me hone it in better because you can kind of overdose pretty easily a patient on topical testosterone just checking serum levels. The saliva will help you catch if you’re using too much or not.

Dr. Weitz:            Just in conversations with some patients who have used topical, they often feel like it doesn’t do much especially that AndroGel stuff.

Dr. Spar:              Yeah, it’s funny. You know, I think it’s like 50/50. I don’t know the percentage, but some guys it absolutely works, and it’s great. Some guys it does nothing. A, they don’t feel anything, and, B, it doesn’t even raise the level much. It must have something to do with the carrier and whether it gets absorbed or not. Just so your listeners know, bioidentical testosterone, it’s all the same. It’s much less complicated than with women, right? With women you can have all these nonbioidentical estrogens and progesterones, but, man, it’s all the same testosterone compound. It’s all pretty much bioidentical.

Dr. Weitz:            Yeah, there’s no testosterone coming from horses.

Dr. Spar:              Right. That would be right. I guess if they would take like stallions maybe they could get some or something.

Dr. Weitz:            Actually, that could be a big seller.

Dr. Spar:              As opposed to the mares, yeah. Okay. Let’s delete that. It’s going to be my patented thing. I don’t know how we’re going to collect it, but we’ll figure it out. Yeah, it is all the same. That’s why sometimes I like to go with compounded because you can put it in a carrier that might work better than whatever AndroGel uses. You can put it in a cream instead of a gel so it’s a little less sticky. You can use less volume and make it more concentrated so it’s less done. I’m using more and more of clomiphene, which is a pill so it’s easier, but it is off label. It’s not FDA approved for men. It’s approved for women. It’s safe. Urologists started using it a lot a few years ago, and so those of us doing men’s health started looking at that. It’s been out for a long time, so it’s available generically. It’s not that expensive.  It especially is good because it helps get the testosterone to be made by the patient themselves, so it stimulates their own testicle production so you’re not taking over completely the testosterone by putting it in either injecting it or topically. You’re just kind of fooling the pituitary gland into telling the testicles to make more testosterone.

Dr. Weitz:            Yeah. Dr. Elkin who’s in my office on Tuesdays, he’s an integrative cardiologist, he likes to use that in combination with HCG.

Dr. Spar:              Yeah. They work in a similar way, so it’s working on the level of the pituitary and hypothalamus. The other thing people don’t talk about when you use testosterone testicles shrink because you’re really taking over production. I don’t care with doctors say. You are taking over production unless you’re adding in HCG or clomiphene. As soon as the body senses you’re taking much higher doses of testosterone than you would make on your own, they’re like, all right we’re good. You’re just going to handle it through the shot or the topical. And the testicles stop producing and do shrink. That’s a concern for a lot of guys.

Dr. Weitz:            Over a period of time if men stay on that they may lose the ability to product their own testosterone, right?

Dr. Spar:              I don’t know if that’s true. I don’t think we know that.

Dr. Weitz:            I know it’s the case with former body builders because I used to treat a lot of these guys, and that was pretty common. They would take them in crazy excessive amounts.

Dr. Spar:              Right. Yeah, definitely if you’re using high doses like that. If you’re using just kind of therapeutic doses, I don’t know because the reality is guys are guys, right? No offense. They don’t use it all the time. Even guys on it for years are missing a lot of doses that are going on. They run out. They forgot how they felt off of it, so then they stop. It really ends up not being an issue. Most guys are not on it day in and day out for years unless they’re like you said body builders or something.

Dr. Weitz:            Do you use PSA to screen for prostate problems? I just recently had a physical with my primary care doctor, and he said, “I don’t believe in PSA anymore.”

Dr. Spar:              Yeah. No, I definitely do if they’re on testosterone. You have to. I do believe in annual exams.

Dr. Weitz:            But even if they’re not?

Dr. Spar:              Yeah. I mean, it’s really important. I mean, we know testosterone treatment does not increase risk for prostate cancer. That’s been proven. Abraham Morgantelar from NYU or Columbia proved that. If somebody gets prostate cancer, you don’t want to keep giving them testosterone. Yeah, I do screen for it with PSA. You know, in the other patients it’s tough. I will have the discussion. Basically I always do a digital exam and feel the prostate. If it’s enlarged, I will check it. I usually try and also check a free PSA. I think on one hand, yes, it’s like what do you do if the PSA is elevated. Half the time it’s just causing stress and worry, and it’s nothing, but the good thing is nowadays most men have access to a prostate MRI. That can really make the need to jump from a high PSA to biopsy much less likely.  They can instead have an MRI if the PSA is a little high, and if the MRI is fine, they don’t need to have the biopsy. If the MRI is not fine, they know exactly where to go for the biopsy so they’re not just doing a ton of random punches. The MRI helps me feel better about ordering a PSA.

Dr. Weitz:            Unfortunately, once again, we have another situation where you’ve got a procedure that’s not always covered by insurance.

Dr. Spar:              Right, right. Usually if the PSA is over 4, at least in my patients who are mostly PPO kind of insured, they’ve had it covered. Sometimes you have to go through the urologists, but usually they can get it covered.

Dr. Weitz:            Right. I think the big issue with the PSA test is that men who have positive PSA who show elevated PSA levels sometimes jump to biopsy and then just jump to surgery and then have a lot of side effects when maybe it was a slow growing prostate cancer that they could’ve monitored for years without any problems.

Dr. Spar:              Exactly. It’s heartbreaking. It really is. We’re trying to figure out. We need better tests to know which ones are just there and will never cause problems and which ones are scary.

Dr. Weitz:            Yeah. I think we’re doing a disservice though to not do the PSA. We just need to make sure that when they get it that they don’t panic and rush out and get a procedure that can cause incontinence and impotency when they might not need it.

Dr. Spar:              Right. Exactly. Yep. The free PSA even if there’s not access to the MRI it’s a little bit helpful. It kind of breaks out if someone has an elevated PSA into the percentage that is what’s called free, and that correlates with the likelihood that that elevated PSA is just enlarged prostate versus cancer.

Dr. Weitz:            Right. I think those are most of the questions that I had. Is there any other issue you’d like to raise?

Dr. Spar:              No, not really. I think it’s just important for listeners to know that, number one, there are ways to help men make behavior change, and I think it’s really, really important whether you’re a practitioner or patient to do that. It’s Movember right now. I’m not sure when this is going to air, but this is men’s health month. It’s literally life and death. I mean, it sounds like a hyperbole, but men are dying because they’re not resonating with the message you are giving. I just encourage listeners to really think about one step at a time. Don’t talk about big global prevention messages. Talk about one thing you or your patient can do to decrease the risk of getting some kind of problem. Make sure they understand how it affects something they’re concerned about. Make it goal oriented.

My whole tag line is when you’re healthy you can win. When you’re not healthy, there’s that saying, I forgot who said it. Somebody who is healthy has a thousand dreams. Somebody who’s unhealthy has one. That’s really something to think about.

Dr. Weitz:            That’s great. That’s a great note to end on. How can listeners get a hold of you and find out about what you offer?

Dr. Spar:               Sure. My website and blog and everything is at drspar.com. D-R-S-P-A-R dot com, and then the program I have for optimal men’s health is called Tack180, T-A-C-K 1-8-0, so Tack180.com. Really, I encourage you to sign up for my newsletter. It’s very brief. It’s once a week, just three nuggets of information that are germane to men’s health, and you can sign onto that right on the website.

Dr. Weitz:            That’s great. I’ll put links to that in the show notes. Thank you, Miles.

Dr. Spar:               Thank you. Appreciate it. It was a pleasure.

Dr. Weitz:            Yeah, excellent.



Breathing with Emma Ferris: Rational Wellness Podcast 82

Emma Ferris discusses proper breathing with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast]


Podcast Highlights

5:20  Most of us come out as belly breathing babies, but then either trauma or infections or stress lead to bad breathing habits that we get stuck with.  So then we need to retrain these people to use proper breathing techniques. 

6:17  Emma explains that when you feel stress, your sympathetic nervous system takes over and results in faster, shallower breathing through our mouth, rather than slower, deeper, belly breathing.  This shallow, fast breathing tends to recruit our neck muscles, like our scalenes, SCMs, and our upper trapezius muscles and can contribute to neck pain.  We should be using our diaphragm as our primary breathing muscle.  Activating our diaphragm helps to support our back. Taking a longer exhale will tend to activate the parasympathetic system, that teaches the body that it can go into the rest, digest, and recovery mode.

10:11 When you’re breathing too fast, you breath out too much carbon dioxide and your blood chemistry shifts, making your body more alkaline.  When your body becomes more alkaline, you get more anxious and you may have trouble sleeping.  This reduces blood flow to the brain and also to the fingers and toes. 

13:45  The importance of deep, belly breathing is that you use your diaphragm to breath. If you breath fast and shallow through your chest, you’ll end with tightness and trigger points in your scalene, SCM, upper trapezius and your other neck muscles. Your diaphragm on the other hand has several roles, including respiration, speech, and stability. Using your diaphragm helps to stabilize your lower back by building up the intra-abdominal pressure. Manual therapy and chiropractic manipulation can be helpful for reducing trigger points in these neck muscles, the ribcage, and the diaphragm. 

18:40  When you are in sympathetic, stress mode it tends to shut down three systems in the body: 1. Hormones, which results in more infertility, 2. Immune system, so you tend to get more colds and flus, etc., 3. Digestion, so IBS is more common. If you are running away from a lion, it is no time for digestion.  This is a result of our inability to handle stress. Breathing is a strategy that can help.

29:30  When Emma works with athletes she will often have them use a device called a PowerBreathe, which is an inspiratory muscle training device. It is like dumbbells for your diaphragm and it makes it harder to take a breath in.



Emma Ferris is a physical therapist and acupuncturist from New Zealand who created an online breathing hub called The Butterfly Effect and The Big Exhale breathing course to help patients recover from dysfunctional breathing patterns.

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 Transcripts

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

Our topic for today is breathing. How important is breathing, what proper breathing is, why breathing properly is important for our health, and how improper breathing can lead to the following health consequences: neck and back pain, the inability to recover from injuries, fatigue, depression and anxiety, stress, concentration and memory problems, reduced performance for athletes and the inability to work through emotional trauma or grief.  While there are a large number of different breathing techniques out there, especially when you start looking at all the different forms of breathing coming out of the yoga tradition, but when it comes to the more therapeutic forms of breathing, breathing through your nose and deep, slow belly breathing, rapid and shallow rapid mouth breathing seemed to be two of the more important concepts I’ve come across.

Today, our special guest is Emma Ferris. She’s an acupuncturist, a Pilates instructor, a registered physio therapist, and a public speaker, and she’s joining us all the way from New Zealand. Emma created an online breathing hub called the Butterfly Effect, and she offers the Big Exhale Breathing Course to help patients recover from dysfunctional breathing patterns. Emma, thanks so much for joining us today.

Emma Ferris:                      Thank you Ben for having me.

Dr. Weitz:                            Good. So, can you explain how you became so interested in breathing as a form of therapy?

Emma Ferris:                      Well, breathing kept coming up in my life with my experiences, both with my patients as a physical therapist, but my first exposure to learning about breathing was when I was around 12 years old. I struggled with a speech impediment and a stutter. And so for me, I started at a very early age getting some speech and drama and therapy for that. And, one of the most important things for that was learning to breathe. I particularly learned to breathe into my belly. So I learned that, but I never connected the dots as I went through my physical therapy training; we often put things in silos, which they often do in medicine and healthcare. Cardio, respiratory was over here, and neuro or the brain work was over here, and then muscular, which I was really fascinated with by fixing necks, back pain, all that sort of stuff; that was what I loved.

But, what really changed for me was the patients that I couldn’t fix, and it frustrated with me. You know, the neck pain and back pain that kept coming back. People that struggled with the multiple symptoms that when with it, the fatigue, anxiety, the poor sleep, and I guess in my training and in my life experiences, it wasn’t really explained how key that was until I began to dig a bit deeper and look at what the underlying causes and what the wires, and that’s obviously what you’re all about here too, Ben, is finding out what the why behind people getting to that place of dysfunction.

So, definitely in my patients, it began to show up for me. Then, I had my own life crisis when I was around 28 when I got pregnant with a condition called hyperthermesthesia. So, it’s extreme morning sickness. I realized that all the things I’d done before that point with my life; I had a busy physio practice, I was teaching, I was running workshops, and my body was running on empty before I even started to carry this little baby, little human being. I ate okay. I did a bit of exercise, but the reality was that’s not good enough, and my nervous system was just shot.  So, I learned then that what I’d been doing beforehand wasn’t good enough, and so I went into this process of researching and trying to formulate my own thesis, and I became a bit of a mongrel with breathing. So, I got all these different ideas from yoga and Pilates and Butyeko and Greycliff breathing, all these different versions. And, what really stuck with me for learning about breathing was it’s actually the story about why we connect with every person, why that’s important and why breathing as it makes a difference, but the reason they got here in the first place. You know, what was the stress and trauma, what was the environment that got them to learn to need to change?

And, I think that’s so important because most of us come out breathing like babies that are beautiful belly glorious breathing. So, we don’t come out sometimes when people don’t come out screaming and yelling and appraising very well, but most of the time we’re naturally belly breathers. So, things happened along that process, whether it’s trauma, illness, infections, stress, and then the habit gets stuck, and so I’m all about looking at the why, but retaining the habit and looking at the science behind it and the muscles because it, as a physical therapist, that’s what I treat a lot of, you know, motor patterns, dysfunction, and that actually has a huge trouble with breathing retraining. Yeah.

Dr. Weitz:                           So, that’s interesting. So, we start out as mouth breathers. Is that what you said?

Emma Ferris:                      No, we start as nose breathers.

Dr. Weitz:                           Oh, okay.

Emma Ferris:                      But, belly breathing. Sorry, so we start out as beautiful, slow belly breathing. Watch a baby sleep. It’s just glorious. And, they do it so naturally.

Dr. Weitz:                           Right. So, can you go into some of the details about what’s proper breathing is and, and why is it so important to breathe through your nose rather than your mouth?

Emma Ferris:                      Yep. Well, I’ll go into the nose and the mouth breathing constantly mistaken, but a lot of it’s all about the reaction to stress and how our body’s nervous system gets overridden with breathing. So, breathing is both under conscious and unconscious control. And, that’s a really powerful point because we have the power to actually override our autonomic nervous system, which more often than not gets pushed with our busy modern day lives or the stresses we have in it, and that changes us to push into what we call your sympathetic nervous system, much of which I know you’ve talked about before on the podcast, and the reaction to stress, whatever it is, whether it’s past, present or future, drives us to change our breathing. So, if you imagine that lions are chasing us, we take a big breath in, we inhale, and we use our neck and shoulder muscles.  We prepare our hip flexor muscles that like to get us out of danger, and we use those muscles to mobilize and get more air in. Now, that’s really important for that stress with danger that’s coming after us, but if that danger is a relationship issue or a problem with somebody at work or you’ve had back and neck pain for a long time, and even the thought process behind that keeps you stuck in that space of going, oh, this is dangerous. I’m sore. I’m going to get sore if I do this. In a response to a dangerous activates that fierce into our brain to trigger that reaction, and so the problem is we get stuck in that cycle, and one of the main things that changed is our breathing. So, we become faster or begin to breathe through our mouth because that’s a fast way of getting air in and getting more oxygen. which again is important for exercise, in and times of stress, to get us out of danger, but not all the time. So, as learning why we use it, people say to me, “Should we be using our nose all the time?” And, it’s like, well no, that’s not practical because when you walk up a hill, your body’s going to need to get more oxygen in, so you need to be able to go to mouth, but it’s as soon as possible going back to that nose breathing and reconnecting with it.

So, the reason why the nose is important is because it’s got two holes versus one for the mouth, and so it slows the air down. Like, it’s simple concepts, but if you can use that, it slows the air down, which is really important for your diaphragm, and the diaphragm is your main breathing muscle, and that sits between your rib cage and your stomach, so to say, and your lungs, and learning to use your diaphragm in the right way is really what for me, changes people’s perception and understanding of breathing, so it’s not about taking big breaths, and that’s the content I want people to be aware of as well.  When you say take a big breath, it’ll calm you, that doesn’t actually work always. That can actually stimulate you more. So, for me, it’s about low, slow belly breathing and long exhale, which is why my program is called the big exhale, so then you need to get out of that fight or flight inhale mode and learning to drop the chest down, and that’s really important for neck and back pain, which we can talk about it a bit more later on.

Dr. Weitz:                           Why is it more important to have a longer exhale?

Emma Ferris:                      Well, that’s one of the easiest ways to activate that parasympathetic nervous system, so activating that teaches the body that it can go into that rest, digest, and recovery mode. And, that’s why in Yoga and pranayama and all the techniques like Tai Chi work on lengthening the exhale, free diving, Pilates, meditation; naturally they’re getting your comps of your breathing, which is activating that parasympathetic nervous system.  That’s why people feel good doing those activities that you don’t always know why. So, and the other reason is that we’re not meant to be driven into that fight or flight response. And, we do, when our blood chemistry changes over time, when we’re breathing too fast. And, I know you’ve talked about this before with Rosalba Courtney, who I’m a really big fan of; she’s a wonderful breathing teacher around the world, an osteopath from Australia. Now, the blood chemistry shifts when you’re breathing too fast. What it does is your, by breathing out too much carbon dioxide, which is way more important than oxygen, you end up increasing your pH and making it more alkaline. So, over time that if your body stays in that state, it thinks that that’s normal, that new level of CO2 balance is what you’re supposed to go to and keeps you driven physiologically to breathe in that vast state.

So learning to lengthen your exhale also overrides that new level of normal or what you think is normal, and that’s really important for anxiety, patients who struggle with anxiety, with a shortness of breath and a suffocation response. And, so a lot of the techniques that are out there are great, like Butyeko, which gets you to lengthen your exhale to increase that CO2 liberal response, so that your brain goes, okay, I can now hold for longer. I don’t feel that fear and danger response of suffocation, which means I need to take a big breath in and gets you stuck on the inhale mode.

Dr. Weitz:                            Most of us think that the whole purpose of breathing is just to get oxygen. So, can you talk about why getting enough carbon dioxide is important?

Emma Ferris:                      Well, CO2 has a really big impact onto both the pH, like I say, because it actually shifts the … By breathing out too much CO2, you shift the pH, and then your body’s going to try and replace that acidic component, and it’s going to start leaking bicarbonate into the blood. So it has a bit of a knock-on effect and disseminates systems. One of the other impacts is the brain, so when you change that pH and the CO2 depletes, you actually reduce the blood flow to the brain, which is why there’s a connection with memory and concentration, brain fog, or whatever you want to call it, processing and cognition, and for learning, that’s a really important part for children and for adults. And, one of the things that I find really powerful was when people get stuck in that fastest stressed breathing and our habits contribute to that, like caffeine or alcohol that can shift our breathing. But, stimulants we don’t realize then that our body will be shifting its blood chemistry, and it takes a while to recover. And, even those habits and stimulants can actually then create a shift in the blood chemistry, which then creates more anxiety and other components of poor sleep that gets you stuck in that cycle.

So, the pH is pretty powerful. One of the other things is it actually causes, with that shift in pH, your blood is going to go from our limbs and our extremities because we don’t, we’re not worrying about feeding the blood into the limbs and the hands when you are in that stressed state, and this is important for athletes as well, so it’s going to divert blood flow to areas that need it, like our organs. And, so we can get cold fingers and toes. This is one of the signs of breathing dysfunction. I get tingling in fingers and as well. And, so there’s a change even in blood flow and our brain and our organs. We just divert things around because of that physiological push.

Dr. Weitz:                            What’s the importance of deep belly breathing as opposed to, I guess more shallow chest breathing?

Emma Ferris:                      Yeah, one thing is that as changing the right breathing muscles to work, so most of the breathing, like 70 to 80 percent of our breathing should come from our diaphragm, our big belly breathing muscle. So, what happens when you’re stressed and you start to use the inhale?  You’ll get stuck with what we call breath stacking, where you breathe in and you hold, and then you might do that a little bit, but then your brain goes, oh, I feel like I’m suffocating. I’ll take another breath in. Then, you get stuck in that mode and using our backup breathing muscles and what I call your parachute reserve.  And these are your neck muscles, your scalenes on the side of your neck, your sternocleidomastoid from the front of your neck all back up into your head and your skull down into your sternum and your upper traps, those muscles that get really sore and tight on the back of your shoulder.

Now, we’ve seen them all the time. Clinically, I know you do too, Ben, with our patients. I gave you a cue there, and this is a really important point because we’re using those muscles between, depending on your breathing, that breathing frequency between 17,000 and 210,00 times a day, the amount of breaths we take. So, if you’re using the wrong muscles in the first place, you’re going to cause more trigger points, those achy, knotty spots that can become active and referred to be trigger point index or trigger front for zero down the arms. So, that’s one of the main ones is that you’re actually using the wrong muscle all the time, and it’s like a reverse drug when you start using the top part and not the bottom part. So, teaching them how to use the diaphragm is really important, but also what I talk about is 360 degree breathing.  So that diaphragm has attachments right from the front of your stomach all the way around the ribs down the sides because it’s like a dome and all the way into your lower back into by your L1, L2, your lower vertebrate, and your hip flexor, your fight or flight stress muscle, and it has that neural connection through the ear, which is pretty powerful. So, learning to activate the diaphragm is really important for both intraabdominal pressure, and there’s a lot of research now looking at diaphragm function and dysfunction with back pain, and when someone has an episode of back pain, one of the first things we’re going to do is inhale and protect, and they actually lose that activation of the diaphragm, which actually is needed to actually stabilize. So, you get in this vicious cycle because of not breathing right, and they create more trigger points because the physiologic physiology changes, and then they also feel more stressed and anxious about being in pain. And, so when I go to bend or twist, they go, “This is how I injured my back last time; I’d better protect.”

So, from the point of view of the diaphragm, it has several roles: respiration’s king, speech is queen. And, I guess the next one is stability. So, if you’re walking up a hill, first thing that’s going to go is stability. You start to not stabilize very well. And, then you speak each, and then respiration. So, that’s always going to be the key thing. So, you start to recruit from other muscles. So, it’s really important to look at that role of diaphragm, but to understand that it actually, it’s a one way muscle, and that only works on the inhale, and then if you learn to lengthen your exhale and relax as a diaphragm recoils back up, then you can activate that parasympathetic nervous system.  But, a lot of time, when I’m looking at people that have been training yoga or training other techniques, they’re actually forcing the air out and causing that CO2 balance to actually be shifted just by the way they’re breathing, so a lot of it’s just conscious retraining and moments.  You know, I had to lie down for 20 minutes. It can be I’m going to stop right now on my drive around LA or New Zealand and just cause an exhale. You know, simple things add up.

Dr. Weitz:                            You’ve refined restrictions in the diaphragm and have to use manual techniques to free those up. Yeah.

Emma Ferris:                      Absolutely, and, all of those breathing, so scalenes, verse ribs, upper traps, and I use a lot of dry needling or I think … What do you guys call it over there? Trigger point needling, and that’s really effective for releasing the result of the poor breathing pattern, but unless you change the breathing pattern, the driver on the why it comes back. So I love the manual therapy for that.

Dr. Weitz:                            Yeah. We find chiropractic manipulation also beneficial in those cases as well.

Emma Ferris:                      And, particularly for thoracic because if you’re not getting thoracic mobility and ribcage, you’re not going to get that lower stability. So, I 100 percent agree because that also goes into that parasympathetic loop, automatic nervous system.

Dr. Weitz:                            Yeah.

Emma Ferris:                      So I love manual therapy. There’s so many ways of getting somebody into a calm state. That’s why I love acupuncture as well to go look, what is the right formula for a person in front of you?

Dr. Weitz:                            Yeah. One of the things, one of the conditions we didn’t talk about or I didn’t mention, which comes to mind when you talk about rest and digest, is IBS or CBO, and I could see how breathing be really super important for those patients because if they’re always in this sympathetic mode, they’re never going to properly digest their food, and it’s going to increase all their digestive symptoms.

Emma Ferris:                      Absolutely, and the same stress mode … If you’re stacking stress on that sympathetic thing, they usually change the bacteria in your stomach in the first place. So, one of the great things with learning to use a diaphragm and is that you’re actually going to pop through, you get the empty stomachs to actually work in the right way, get the blood flow, and when you are in a stressed state, blood flow is diverted from your bowel and your stomach because when you’re running away from that lion, you’re not worried about processing food. There are three areas that get shut down hormones, so particularly females, and we’re seeing that a lot with infertility problems these days, but that cycle and upset from that by being stuck into the sympathetic drive and immunity, so we get colds and flues, we’re rundown, or we’re stressed and particularly the digestive system.

So, there’s so many more problems these days all because of our inability to manage stress, and that comes in so many forms, and there’s a lot of pressures and by society that drives us, and I just think as the more that we can get this understanding out because people are hungry. There’s a groundswell of looking at techniques that are focused on holistic treatments like the manual therapy, like acupuncture, like yoga, because it makes you feel good in a way that is not a pill in a bottle. It’s very hard to override that nervous system.

Dr. Weitz:                            Yeah. When it comes to nose breathing, when I talked to clients there’re so many people that have problems with allergies and with you know, issues not being able to breathe properly. How do you deal with some of those issues if you’re trying to get them to breathe through their nose, and their sinus passages are partially clogged, or they have deviated septum, or they have allergies, or they have, you know, some of these chronic respiratory problems?

Emma Ferris:                      They’re huge problems, and that can be the driver in the first place for getting stuck in the habits, but then also that habit of mouth breathing gets them stuck with the sinus problems as well because they’re not actually using that nose as a filter and keeping the blood flow through there. So, it’s really problem solving for the individual. And, so one of my first steps for someone struggling, getting them back to the doctor and check for any polyps and any problems in teeth. And, then there’s simple things that you can do, like sinus rinses for instance. Have you done them, Ben, a sinus rinse?

Dr. Weitz:                            Yeah.

Emma Ferris:                      People don’t always like them, but they’re so satisfied, and that’s a really good way of cleaning out the nose and allowing it to get that filter through. And, one of them is learning to breathe through both nostrils because you actually switch nostrils through the day that you break through. Do you know that?

Dr. Weitz:                            No.

Emma Ferris:                      So, every one to four hours, you’re switching nostrils, so one side becomes the one you’re breathing through. And, the other side is the cleaning system. So, if you have one side that is actually blocked, you have a deviated septum, then even in your sleep, you’ll be switching through the mouth breathing because you’re short of air. So, getting that correct is very important, and during those steps, before you try anything like mouth taping, because that’s not for everybody. You’ve got to check people’s saturation and stuff as well, but you know, I use it myself. I use it on different patients, and it’s very successful. So again, it’s not a one size fits all model for nose breathing but learning to-

Dr. Weitz:                            How do you decide when somebody, when it’s appropriate for somebody to do mouth taping, and can you explain what mouth taping is? This is where you use special tape to shut your mouth while you’re sleeping, right? To keep it closed.

Emma Ferris:                      Yeah, absolutely, and you don’t need to have much on it because a lot of people can even open your mouth. People go, “Oh, that feels really scary. I don’t like the idea of that.” And, it’s always a bit of a jug of patients, you know, they keep them quiet, and I said, look, you can say goodnight to your partner and husband then rollover and then take your mouth up. I have to see it, but it’s actually really effective in getting that diaphragm to actually activate when you’re sleeping in the first place instead of going to that mouth breathing, but really what people got to think about is … I’ll come back to nose taping in a second, but you’re breathing at night is a consequence of what you’ve been doing with your habits in the day. So, if you have been caffeinated, if you have, which is very strong culture we have, and you’ve been pushing your body hard and driving it hard, and you’re basically running a marathon through the day with your breathing, then when you go to sleep, your body’s not going to go, oh, I’m going to go calm and relax. It’s going to go really fast, be fast, be fast. And, so you’re not going to sleep well; you’re not gonna get into that nice delta wave when you’re sleeping. You’re gonna keep that mouth breathing.

So, taping is again as dependent on to make sure that people can breathe through here. So, I do a test to check that they can put like a knife or a spatula under there, and we can say if they’re breathing through both nostrils. I can check the nozzle sides. I usually get an EMT to check or a Dr. to check to make sure there’s no polyps or anything else, and we checked saturation as well, so make sure when you do practice, that’s a practice that before you go to sleep, have a lie down and see how that feels and that I get too anxious or short of breath with that and that saturation levels don’t drop down.  So, it’s kind of a looking at the why behind that person. It’s used really commonly, but again, don’t use it for just everybody. I have a lot of athletes because they have already been breathing too much mouth breathing too much in the daytime, and what they try, and they don’t realize that that’s still contributing to the recovery at night. And, so when they start doing that, they sleep in the muscles, at least teens. They don’t need as much magnesium, which is to relax muscles and help with recovery.

Dr. Weitz:                            Interesting. Can everybody change their breathing? Or, are some people just stuck with mouth breathing?

Emma Ferris:                      Well, there’s some physiological reasons which will be driving you to breath faster. And, so there could be. It’s really important to get checked out by your doctor. What we find is that breathing dysfunction is often the last thing that gets diagnosed, and for reasons like diabetes, that can be a real reason why you’re driving faster. I have a lot of patients. I work with a lot of people with Parkinson’s as well, and the anxiety behind that also drives you to breathe faster within the breathing faster drives you to have more anxiety. And, so that has low dopamine as a big part of it. So, there are some people that need even medical support to help shift and get them into a good space. Like, I don’t say that this is going to cure everybody, like there’s not a one size fits all model, but learning to use breathing as an adjunct like with asthma, it’s a really important part. It’s like 40 percent of people that are asthmatic also breathing dysfunction in them, so you can use breathing alongside your other tools into that you can wean off or get the support and work with the respiratory physio to help get that under control.

So, there’s lots of conditions that also benefit highly from training your breathing, become a conscious of it, but anybody can do it, and in regards to how long it takes, it depends how long you’ve been stuck in that fight or flight mode. And, I have a patient that I worked with recently or the last last year really, and he’s a good example of someone that he came into his doctor with several factors, not sleeping well. He’s 40. He was going through a cardiac experience. So, he went to the emergency room thinking he was having an anxiety … Sorry, having a cardiac, a heart attack, and he was getting tingling in fingers and arms, and so many symptoms, the body, stomach problems, erection dysfunction, which is also a sexual dysfunction can be also linked to breathing function because you’ve got to be able to get arousal both sympathetic and parasympathetic with your breathing. So that’s an important area to look at all aspects.

So this guy, because Dr Stefanie was very switched on and went, “I think your breathing’s part of it,” and sent them him to see me, and over three or four sessions, that stress dropped down dramatically, and it was a huge shift for him. And, so he’d basically been, the why behind it though was he was going through a huge a court case trying to get custody of his children through a big divorce, and that had been driven him, and he was really PTSD; he was posttraumatic stress given his marriage, struggling with balancing business and life, and it wasn’t until he got those tolls he can recover, but there was a lot more behind the scenes for that too with family experiences, and so you’ve got to dig deeper and not go there’s not just a habit. There was the driver and the why behind it.

And, when he started to see that his breathing pattern was actually linked to emotions, so when he came in, I’ll be like I, “Okay, so what’s the fear today, mate?” Because, he’d be out here and holding that upper chest, breathing in, and beholding and be like, “Okay, no, this is what’s happening in my life.” And, when we actually talked about and expressed it, it dropped away and belly breathing, they need to do actually to activate the diaphragm is also linked in with your emotions with happiness and joy. So, that’s one of the powerful things I find too is that it’s not just about breathe through your nose and breathe through your belly and actually has an impact on our emotions. And, the research for me that has changed it was a few years ago now, in 2011. It was a guy called Pierre Philpot, and he did this research study. And, I love it because for me, emotions is important in life; we connect; we interact with people. Relationships are huge. So, what it showed was he had this group A, and it looked at four emotions: sadness, joy, fear, and anger. And, he asked that first group to think of those emotions and then look at their breathing patterns.  And, each emotion had a separate breathing pattern. So, I look at it clinically; we see that fear and anger is upper chest breathing. We see. Sorry, fear is upper chest breathing, anger as bracing and holding through our stomachs and obliques, which has a big impact onto a stomach and digestive system. Sadness is often that depressive, a posture that slumped down teenagers, posture that impacts, again, the way we breathe. And so, and the joy breathing is that belly breathing opening up into their stomach. So, what he found in the other group, group b, who knew nothing about group a, once he said, “Breathe in these four patterns, and then what emotion do you feel? The top summary of it.” And it was either the joy, sadness, fear, or anger. So, we have the power to change our emotions by the way we breathe, and we have the power to change our breathing by the way, our emotions, which is why coming back to the simple practices like gratitude, which, you know, hard to put the science behind that, but it’s getting there, you know, and mindset and our shifts behind that has a huge physiological impact onto our body and the way that we breathe in and breathing has a huge impact onto the way we sleep, the way we play, they way we love. That’s huge.

Dr. Weitz:                            Cool. So, you work with people in a one on one basis as well as offering group classes, right?

Emma Ferris:                      Yes, absolutely.

Dr. Weitz:                            So, when you’re working with a professional athlete, how is that different and do have them try to breathe through their nose while they’re running or doing their athletic performance?

Emma Ferris:                      Yeah, so it depends on the athlete and what their sport is. Many athletes need to train specifically for what they’re doing, like swimmers and rowers and cyclists all have different aspects, and many of the sports that actually impact diaphragm position like rowing and cycling ’cause they’re bent forward have more breathing dysfunction in the first place, so they’ve got to work harder to control that, and that one is a high link with back pain and neck pain because of that, because they’re having to switch between. So, the reality is when I look at training somebody, it goes back to breathing pattern first. So, how are they breathing? Have they got the right control? Can I activate the diaphragm? And, you might have to train them for a while to get that right in the first place. Once you’ve got pattern right, then you go to strengthening, and I use a great device called a power breathe. Have you heard of that before?

Dr. Weitz:                            No.

Emma Ferris:                      So power breathe is a … So, I’ve talked about exhaling being really important in that first phase, it really is getting that long exhale and activating because if you can’t exhale, you can’t inhale. It sounds really silly again, but if you don’t get that diaphragm to lift up and exhale, you can actually get the power into it to actually get the right inhale into the base. So, for that second stage, particularly for athletes, though I do use this to people that got anxiety, neck pain, back pain, COPD problems as well. We use a device called power breathe and that is inspiratory muscle training. So, it’s training your diaphragm to actually be strong for the activity. And, it’s pretty powerful. It’s only the science behind it, the research shows 30 breaths twice a day using this inspiration master trainer is enough to get the same results as a … So, there was one research study that showed over six weeks, I think it was, four to six weeks later the research.  And, one group was using the inspiratory trainer, and the other group was using, was running 45 minutes five times a week, and they had the same changes in the respiratory function from doing the diaphragm strengthening. So, it’s, you know, it’s a lot, a lovely adjuncts to training for people because they can actually get really good changes in physiology because the diaphragm is getting thicker, and it also shows after six weeks of using that, that your diaphragm thickens up to around 13 percent, which is quite a lot for work-

Dr. Weitz:                            Well, how does this device work? Does it wrap around you or something like that?

Emma Ferris:                      I actually brought one from the clinic I was going to show, you know, it’s in your mouth, so you put in your mouth, and you’re going a quick breath into using a diaphragm and to get in there. So, it’s a quick, breath in, fast and hard. You’ve got to work at least 50 percent resistance to get the diaphragm. So, they learned from the research as well that you can’t go at like resistance training for like 30 percent on your one rep maximum isn’t actually enough to get the changes in your diaphragm strength. I think it needs to be that 50 percent to 60 percent mark, and so I teach people in the clinic that you can work at it to sort of feel what that energy is or that level is for you when you train it. There’s a company out of UK that’s created them, and there’s a wonderful respiratory physiologists, and she is Allison Connell I want to her say name is that’s loved a lot of this research, and there’s great research now even in New Zealand, physio, and Aukland is looking has led to the break of breathing at the diaphragm, changing the strengthening and the dysfunction that occurs, people with anxiety, with back pain, and looking at that under ultrasounds, which is pretty cool seeing those changes.

Dr. Weitz:                            I’ve seen people in the gym with these things, so it’s some sort of a mouthpiece. And what does it do exactly, makes it harder to get a breath in?

Emma Ferris:                      Absolutely. I mean it’s like breathing through lots of straws. So it kind of risk for respiratory through there, so it’s like dumbbells for your diaphragm. And, so if that’s targeting that breathing muscle, you still want the pattern to be right though. Some of the research I went and saw a respiratory researcher in Canada about two years ago who was researching the respiratory training with athletes. And, what they noticed was the pattern store. If you don’t breathe in the right pattern, all your training is the upper chest breathing muscles, and what he wants to do is that diaphragm, so it might mean you turn the resistance down, and you work on the pattern, but then that diaphragm strengthens to actually help pay for working in a high level when you go and run or when you go and lift something, it’s going to naturally activate and do its job, so it doesn’t fatigue faster. And, what I loved about the research there as well, another, I think it was in the UK, they looked at the blood flow and the limbs.  So, they’re looking at when you were doing your exercise and training. So, I think this is cycling athletes; they looked at the blood flow in your veins and the legs, and what they found is after six weeks of doing the the inspiratory master training with the power breath thing, it was a device they used, they reduced the … The blood flow stayed in the limbs for longer. So, what it showed was the body’s stress response was better. So, the body didn’t go all right, I can train harder, and then when I get fatigued I had to pull the blood in, and it could actually keep the blood and the limbs for longer, which is really important for athletes, for endurance and for training. So, lots of consequences with using something like that. 

Dr. Weitz:                            How do you tell if they’re using their diaphragm? Do you put your hand on their diaphragm?

Emma Ferris:                      Yeah, I’m very manual with that. So, very much feeling that, you can see it. You can get them to put hands on their chest while I’ve got one hand here, and they don’t all use a mirror, biofeedback in any way that you’ve got. Posture’s a huge part of that, so if you slumped down and then you’d try and breathe, your diaphragm is going to start recruiting somewhere else. If you lift up too much, you’re gonna use your upper chest. So, even teaching people when your choose is like good simple habits add up, and that’s like a modeler for me is small changes make a big impact with what we’re doing.

Dr. Weitz:                           We work a lot with posture, and that’s super important, and it goes hand in hand with the breathing.

Emma Ferris:                      Yeah, absolutely. So using that posturing, raising that with your breathing is a very powerful tool, and then add some credit to it that you’re doing really well.

Dr. Weitz:                           Great. So, any other final thoughts you want to have for our audience? I think we got some good information to help folks with their breathing.

Emma Ferris:                      I think my take-home and something that I really like people just to be aware of is just take a moment and enter the day as many times you can is just to exhale, and the one thing I can say is you can do it out the mouth just once. Do it for me now, Ben. Breathe out the mouth, go uh, noticing your chest drops down, so that’s like a little valve release, then go back to nose breathing, but that little we exhale just drops you bit more into that calm part of that nervous system that needs a bit of love and attention. So, do it when you had the kids, when something’s winding you up, when you’ve got a traffic, wherever you are. I don’t have much traffic in my small town in New Zealand where I live, but you never know in LA and around the world.

Dr. Weitz:                           Oh yeah, LA traffic is brutal all the time. Yep.

Emma Ferris:                      Take moments. Take moments and use it to change that breathing. And, when you think about that, a lot of conscious drop, see what emotion you can bring up. Can you create joy? Can you shift your mindset, which will then impact your nervous system? Okay, take power back.

Dr. Weitz:                           I’ll be using it on the drive home because I’ll be hitting the 4:00 traffic. And then I’m going to go vote after that. So, I’ll need some stress reduction there too.

Emma Ferris:                      And, the next few days, good luck in New York is all I can say.

Dr. Weitz:                           God help the world.

Emma Ferris:                      And, please help us out over here.

Dr. Weitz:                           So how can listeners get a hold of you and find out about your programs?

Emma Ferris:                      Well, there’s a few ways. I have my online breathing hub called thebutterflyeffect.online. So, if you go through or search the “big exhale” or my name “Emma Ferris.” I’m not related to Tim Ferriss. I’ve got only one s at the end of my name. You can find me there, and there’s lots of ways. I have a free online Pilates video, 15 minutes that you can do, which helps work through some of the stretches that I do because what I find is if you can’t get the neck muscles and chest muscles and the hip flexor to release in the breath flow dropdown. So, that’s the place to sign up and join in and watch that. I also have my online breathing course called the big exhale, and that’s a 30 day program, but you can do it over a whole year. And, the first five days of it are free, so if you want to sign up for the big exhale, you can do that. Or join me on a workshop, come to New Zealand’s, come on my retreats, or meet me around the world in Malaysia or wherever the next one’s gonna be I have tour retreats in the states, so I can fly over and change the way that we breathe in the states post election.

Dr. Weitz:                           Sounds good.

Emma Ferris:                      Yeah.

Dr. Weitz:                           Emma, I really enjoyed this.

Emma Ferris:                      Thank you. I appreciate you having me on.

Dr. Weitz:                           Okay. I’ll talk to you soon.



Hypochlorhydria as a cause of SIBO with Angela Pifer: Rational Wellness Podcast 81

 Angela Pifer discusses how Hypochlorhydria can lead to SIBO and IBS with Dr. Ben Weitz.

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Podcast Highlights

6:26  Low stomach acid or hypochlorhydria can result in Small Intestinal Bacterial Overgrowth (SIBO), which is the cause of IBS in the majority of cases.  Low stomach acid can be caused by chronic stress or hypothyroidism. There are pathogens that come into the digestive tract through your food and we need hydrochloric acid and a pH of 3 to kill such pathogens. Such acidity also signals gastric emptying, a release of digestive enzymes, and a release of bile, all of which help to reduce bacteria in the small intestine. And when it comes to treating SIBO, it is easy to just think that we have to kill the bacteria. However, to really fix the gut, we need to help reset and rebalance and reseed to cure SIBO and get someone to a negative breath test. 

12:17  There are certain symptoms that might make you suspect that your SIBO patient has low stomach acid, such as when they feel that food is just sitting there and does not move through their stomach normally of if they say that they’re not breaking down their food. You might also suspect low stomach acid if there are intact pieces of food in their stool or if they have peanut butter stool that is very sticky and requires multiple wipes. We can also look at a Spectracell Micronutrient test and look at nutritional deficiencies like iron or B12, which might be trending lower if they have low stomach acid.

13:38  Once you suspect a patient may have low stomach acid, Angela will rule out H. pylori as a cause and she recommends looking at the urea breath test for H. Pylori and she also likes to order a GI Effects stool test and include a stool H. pylori antigen test.  She finds that more sensitive than the blood antigen test for H. pylori.  Interestingly, if H. pylori grows in the antrum or lower portion of the stomach, H. pylori can cause increased hydrochoric acid production and ulcers.  But if the H. pylori grows in the fundus or upper portion of the stomach or in the body, or corpus, the areas where the parietal cells are that make the hydrochloric acid, it can lead to decreased acid production.  If there is chronic burping or you have any kind of burning or warmth in the stomach or a sense of fullness, we need to rule out H. Pylori.  If you suspect it is a chronic case of hypochlorhydria, then Angela will look at advanced markers, like anti-parietal cell or anti-intrinsic factor antibodies to see if it is a case of atrophic autoimmune gastritis. If there is no H. pylori, then we should see what can be done with diet, lifestyle, and supplements. If they are stressed and in sympathetic mode, then we need to work on stress reduction and this could include the Wim Hof breathing technique. 

18:55  When Gastroenterologists do an endoscopy and biopsy for H. Pylori they usually biopsy the antrum and the duodenum to look for celiac.  They will miss H. pylori in the fundus or the body of the stomach.

20:33  When it comes to Atrophic Gastritis, one cause is H. Pylori and the other cause is autoimmmune gastritis, in which you get antibody production against the parietal cells. We routinely check of celiac, despite the fact there is only a prevalence in the US of .5 to 1%, whereas autoimmune atrophic gastritis has a prevalence of 2 to 8% and we hardly ever screen for this and the rate is going up.  These parietal cells that produce stomach acid also produce intrinsic factor, which is required to absorb B12.  And if they are not making stomach acid, then they will not be breaking down their proteins to be able to absorb B12.  If you suspect a patient of having low stomach acid you can send them for a Heidelberg test.

27:26  When you are treating a patient who has low stomach acid because they have been on PPIs, Angela will work with their MD to slowly wean them off the PPIs.  Angela likes to add in bitters, like Bitters 9 or Bitters X from Quicksilver Scientific, to stimulate their own production of digestive enzymes and hydrochloric acid production. She has them use the Bitters X and do one or two pumps and hold it in their mouth for 90 seconds, swishing it around, before swallowing it.  She will also have them cook all their vegetables and eat smaller, more frequent meals, and chew their food three times more than they think they need to. She will also sometimes add digestive enzymes. She will have them use a little baking soda in water if they need to to take the edge off.

31:10  Angela treats autoimmune atrophic gastritis by treating both the gastritis and also by treating the underlying autoimmune condition.  We have to look for the triggers for the autoimmune condition, whether they are stress, environmental toxins, food sensitivities, etc. We need to treat the nutritional deficiencies that result, including vitamin B12 and iron.  They may initially need iron and B12 injections.  Such patients may need hydrochloric acid supplementation for life.



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 SIBO Gurushe has launched a gut prescription recipe site, Gut Rx Gurus 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 Transcripts

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

So on this episode of the Rational Wellness Podcast, we are going to focus on low stomach acid as a cause of SIBO. Small Intestinal Bacterial Overgrowth, abbreviated as SIBO, is the cause of irritable bowel syndrome in the majority of cases. While the large intestine or colon is lined with trillions and trillions of bacteria, the small intestine is relatively free of bacteria. This is because this is where most of the absorption of nutrients from our food occurs, and if there were a lot of bacteria lining the small intestine, it would interfere with that important function.

There are a number of mechanisms that prevent more than a small amount of bacteria from growing in the small intestine. These include the migrating motor complex, which are the peristaltic waves that occur when you haven’t eaten for more than three or four hours, when you hear your stomach gurgling. These help to sweep out any bacteria out of the small intestine. There’s also the GALT, or GI-Associated Lymphoid Tissue, which is the immune system that surrounds the digestive tract. This tends to remove pathogens that enter our body with the food. Then there is the hydrochloric acid secretion from the stomach, and this also serves to kill unnecessary bacteria as well as help us digest our protein. Bile, which is secreted by the liver and stored in the gall bladder, which not only helps us digest fat, but has an antiseptic function, and stands to scrub away bacteria from the small intestine. You also have digestive enzymes, which besides helping us digest our food, have an antimicrobial function. And then we also have the ileocecal valve, which is a protective barrier to stop bacteria from migrating from the colon back up into the small intestine.  When any of these processes and structures fail, it can facilitate the growth of SIBO. Today, we’re going to focus on what happens when you have inadequate amounts of hydrochloric acid produced by the stomach.

Our special guest is one of the nation’s foremost functional medicine nutritionists, Angela Pifer, who practices in Seattle, Washington. Angela specializes in treating patients with functional gastrointestinal disorders like SIBO and IBS, and she’s known as the SIBO guru. She lectures around the world on such topics, and has launched a gut prescription recipe site, Gut RX Gurus, and a FODMAP free line of bone broths, Gut RX Guru Bone Broth. Angela, thank you so much for taking time out of your busy schedule to speak to me and our listeners.

Angela Pifer:                      Thank you, Ben. Thanks for having me.

Dr. Weitz:                          Great. So how did you get interested in treating patients with gastrointestinal disorders?

Angela Pifer:                      Gosh, you know, I’ve been in practice about 13 years, and it was just out of the gate, the gut has always fascinated me. There was never anything else. It wasn’t even a thought, and I loved it. To me, there’s some other things going on with the body. We can look at the brain and everything, but we start with the gut in so many cases, don’t we? Like you know, how we’re digesting, how are bowel movements moving along, is digestion working from top down? Like we have to look at all of that to see how we can then support the body and the system with almost everything else. So it’s really kind of this hub, and working with people with functional or chronic gut presentations has always just fascinated me.  And honestly, I think that population as a whole, my lovely patients and anyone out there who’s listening who has a functional gut disorder being in that chronic state, they need help. They need support. They need hand-holding, and they really need someone to sometimes step in and be that hub between all their other specialists, because everyone seems to be going off in a different direction sometimes when they’re seeing different specialists, and to have somebody pull everything together is really really helpful.

Dr. Weitz:                          Yeah, absolutely. You know, if you deal with Functional Medicine, the gut has got to be one of the starting places for almost everything. I just saw a patient this week, and her big complaint is that she’s having unexplained seizures, one after the other, and she’d been to the neurologist and nobody could figure anything out. So we did some stool tests, and she’s got all kinds of things going on in her gut. You can’t even believe the things happening there. Layers and layers. And it turns out, she’s had all these gut symptoms which she was really sort of used to and not even complaining about, and now she’s doing so much better just by fixing her gut.

Angela Pifer:                      Yeah. And I say the word complacency with so much love and respect and empathy for a person, but I think they have this known sense of norm. “This is what I deal with day in and day out, this is just how it is,” and over time, they adapt to it.  Never liking it, but adapt to it, and it isn’t until you show them what it really feels like to not have to sit with that, it’s mind-blowing sometimes what they’ve had to deal with, right?

Dr. Weitz:                          Yeah, no, absolutely.

Angela Pifer:                      Yeah.

Dr. Weitz:                          Yeah, they don’t know what it’s like not to be constipated or not to have gas.

Angela Pifer:                      Yep. Yeah yeah.

Dr. Weitz:                          So can you explain how low stomach acid can be a cause of SIBO, which is the cause of IBS in a majority of cases?

Angela Pifer:                      Yeah, absolutely. So when we look at SIBO, we really have to always consider that SIBO is a secondary condition. It’s never a primary condition. It was set up because something else has happened, some other thing or things have happened. And so we have to try to get at the root of what is setting this up for the person. You know, SIBO needs to be addressed, but we have to look at everything else as well to fix that root cause. So SIBO doesn’t continue or come right back or be reoccurring because you’re not fixing the real correct thing here.  So one of the very big contributors can be low stomach acid.  Low stomach acid can be caused by a few different things.  Low stomach acid could be caused by really really really chronic stress, it could be caused by hypothyroidism as well.  So it’s this spiderweb of connections that we have to get in and try to figure out this root cause for people.  And we’re starting to look at low stomach acid, I mean this is, you know, it’s like not chewing your food. This is like a major component and stuck within the digestive tract, and if you can’t use low stomach acid to actually break your food down properly … And really the main thing is we’re talking about SIBO is to clear up pathogens that are coming in.  You know, we need that proper really acidic pH that’s under three pH to actually clear everything off, otherwise we’re just gonna get bombarded with things that we’re taking in by mouth multiple times a day.  We want that first step, it’s a really big line of protection there.

We also have to look at, we’ve got a pH at that acidity for a reason, and it signals gastric emptying properly, it signals the proper release bile, it signals the proper release of digestive enzymes. So as you were talking about in your intro, bile being needed as well to clear out the intestinal tract. We have a lot of conjugated bile with our intestinal tract. It actually acts as a detergent. And every time we eat some fat, your gall bladder goes squish squish. It’s like a stress ball, squish squish. And it’s gonna release some bile, and with that, that will help your emulsify your fats. Then it’s also coming through as a detergent and clearing out that small intestine. And it also happens in between meals, so it doesn’t just happen that you get a bile release with your meals, you also get it in between meals, and that’s gonna piggyback the migrating motor complex and those cleansing waves that come down.

So in your intro, I’m going to disagree just a little bit here because I think it plays into the conversation we have about what the heck to do with SIBO. I think if we start to compare the trillions of organisms that are in the large intestine, there’s so many massive amounts of organisms in the large intestine that when you look at the small intestine, it seems quite minuscule. And yet if we look at the small intestine just by itself, we’re looking at millions and upwards of billions of microorganisms per milliliter, per teaspoon of fluid. So it’s not sterile by any means, there’s lots of organisms there. But we also have forward-moving matter. Everything’s moving forward, it’s not hanging out like it does in the large intestine where everything hangs out there and ferments and we get all this beautiful relationship with our microbiota in that area. Things are moving through a lot faster, so we don’t get this big buildup of organisms in the small intestine. And we’ve got bile moving through, like there’s lots of mechanisms to help keep the organism load at a specific load.

When one of those mechanisms, or multiple mechanisms, goes wrong, of course, then we get a buildup. And then we get fermentation happening in the small intestine and lots of other things that could come with SIBO that’s quite debilitating, because that small intestine is not meant to stretch, and that causes a lot of pain. And we don’t get as much gas movement of course, out or just spilling across the intestinal lining.  So why I say that is so many people think SIBO, “I gotta kill it.” And we can’t Drano that small intestine, we want to look at this as a re-balancing. Really fixing the underlying issue, getting on the mechanisms and what’s going on there, but then re-balancing and just taking the person to that level. Not “kill kill kill,” and then stepping back, because that’s not gonna work either. We’ve got to help reset and re-balance and reseed, affect change with the immune system, and there’s so much that goes into play with this even once you get somebody to a negative breath test. There’s so much healing on the other side to make all this beautiful work that you’ve just done stick.

Dr. Weitz:                          Do you sort of use the four R or five R program as kind of a backbone of your approach?

Angela Pifer:                      Yeah, you know, I don’t. Not with SIBO specifically. There’s so many other things I do. I mean as we start to look at autoimmune and others, I know we’re gonna talk about an autoimmune condition as we talk here. But in terms of SIBO, I don’t … There’s so many beautiful things that that four R program does, and there’s bits and pieces filled in along the work that is done, that really it’s more, you know, stabilize the patient and whatever that means. We’ve gotta evoke change with the diet, oftentimes. We don’t always have to go drastically low, but we wanna adjust the diet to make sure they’re nourished, adjust it to how they’re digesting and absorbing, adjust it to make sure their symptoms are somewhat calmed down so they can hang out in this period of time as we treat properly, you know. So there’s a lot of change that happens with the diet.  And in terms of kind of that whole repletion, we’ve got to get on the other side of actually treating SIBO to get to that point where we can start to work on more of that reseeding of the gut, a lot of immunoregulatory support at that point. And it’s bits and pieces, but not the perfect four R.

Dr. Weitz:                          Okay. Sounds good. So when would you suspect low stomach acid as a cause for a patient with SIBO?

Angela Pifer:                      You know, I would say that I actually assess that with every patient. It kind of comes out of the gate when you’re doing the intake with the patient, and they start to talk about different symptoms that they have, 

Dr. Weitz:                          What symptoms would make you think about low stomach acid?

Angela Pifer:                      Yeah, absolutely. Food just feels like it’s just sitting there and not moving through their stomach.  A little bit bit of food makes them feel full fast.  It could be that we start to look at, you know, they’re not breaking down their food, they see a lot of intact pieces of food in the stool, or even peanut butter stool, I call it.  So it’s really sticky stool, it takes a lot of wipes.  They’re probably not breaking their proteins down, so then we would look back upstream and figure out what’s going on there, which low stomach acid is oftentimes a culprit at that point.  I would say what I see with a lot of patients is a lot of burping.  Food just feels like it’s a heavy weight in their stomach.  They need to space their food out because they don’t feel like they’re digesting at a quick enough clip that they can eat a little bit more consistently than that. And then as we step back and look at labs, you know, Spectracell and nutritional markers, we can look at different things to see if their iron is trending lower or B12 is trending lower, and we would see that if they have low stomach acid.

Dr. Weitz:                          Okay. Once you suspect that a patient has low stomach acid, how would you figure out what is causing the low stomach acid, whether it be a H. pylori infection or autoimmune-related or something else?

Angela Pifer:                      Yeah. I think we always are gonna start with the basics, I mean unless somebody presents with a really chronic case where they’ve had just chronic low B12 over time, I’m gonna start to step into some of those advance markers, looking for anti-parietal cell or anti-intrinsic factor antibodies to see if there’s actually something going on more as an autoimmune front.  But once we start to look at this, you know, how are they digesting their food, what is their diet presenting like, can we correct this with supplements, and then what is also going on in terms of their lifestyle?  If they’re, you know, really in a sympathetic state, we work a lot on stress reduction because a sympathetic state, being more stressed chronically over time, is really gonna drive digestive chemicals away from the digestion, from top-down. So there’s a lot of lifestyle effect that we can have as we start to see people move away from that. But really, and again, I say this with great love for the patient that is sitting there feeling like this is just … ‘Cause chronic presentation, and they deal with this all the time. Most people with functional gut disorders like this feed forward cycle, stress is always gonna contribute to that, but then once it’s present, they’re having to deal with these symptoms all the time. And so stress is almost always some sort of factor that’s adding to that, and so I think there’s a lot of … You know, I introduce people to the Wim Hof breathing method, I have them make sure they’re walking an hour a day …

Dr. Weitz:                          Wim Hof is when you take a cold shower?

Angela Pifer:                      No, Wim Hof is actually … So that’s more contrast hydrotherapy. Wim Hof is actually a breathing technique. You should look him up on YouTube, he’d be interesting to have on your podcast. I don’t even know if I’ll explain it correctly. It’s this beautiful way of actually really taking in almost this hyper amount of oxygen into your blood, and huge diaphragmatic breathing technique, and then you actually ride that out a little bit. But in terms of oxygenation and capacity, people aren’t using the full lung that they have, or lungs, and moving it up. And so it’s a really interesting breathing technique to get them to use that entire space and diaphragm. Yeah, it’s very very cool.  So yeah. So I think there’s a lot that we can do in terms of just the stress piece, you know, to really help people out. So as we’re starting to look at the low stomach acid piece, you know, we’ve gotta really listen to the patient, and SIBO is going to contribute. Once SIBO is set up in terms of … And where SIBO is at the small intestine. So the further SIBO is up, and the worse SIBO is with all those contributing factors, it can start to break down digestive enzymes in that brush border, uncoupled bile. It can really interfere with a lot of nutritional absorption that we’re doing in that area. So it just depends on the patient as we’re working on, to what degree we need to come in and do any kind of intervention at that point.

Dr. Weitz:                          So how would you rule out H. pylori?  What tests do you like to use for H. pylori?

Angela Pifer:                      Yeah. I actually prefer the breath test for H. Pylori.  I really do.  The urea breath test.

Dr. Weitz:                          Okay. Why is that?

Angela Pifer:                      That’s my favorite one. Oftentimes I want to see a GI Effects so I’ll add that on, as we look at a stool antigen for that.

Dr. Weitz:                          Yeah.

Angela Pifer:                      You know, if they’ve never been diagnosed with H. Pylori, then we’ll do a blood antigen, but I really like the breath test. I know there’s a like controversy on SIBO’s presence, sometimes you’ll get a false positive. I’ve not seen that line up.  And of course we have endoscopy, right, is where rather referring over to the GI doctor. But I think the urea breath test is really pretty straightforward to me. I think the antigen test with the stool antigen actually misses it a lot more than when we see that breath test.

Dr. Weitz:                          So the notes you sent me over before we did this podcast, it was really interesting that you talked about how if H. Pylori grows in one part of the stomach, it’s associated with increased hydrochloric acid. For those of you who aren’t aware, H. Pylori is often an undiagnosed cause of ulcers because you get this bacteria that burrows into the wall of the stomach, and then the stomach produces more and more acid to try and get rid of it, and so it can often be the true cause of ulcers. On the other hand, if that H. Pylori grows in another part of the stomach where the cells that make the hydrochloric acid are, it actually destroys those parietal cells, and you end up with less hydrochloric acid from H. Pylori.

Angela Pifer:                      Yeah. So you really can’t go off of … There’s some symptoms that are present that we need to investigate if H. Pylori is present. I mean to me, if any kind of burping, if they’re chronic burping, I think H. Pylori should be ruled out. But any kind of burning, any kind of warmth in the stomach, a really early sense of fullness, we really should be ruling out H. Pylori and stepping through the sequence from there.

Dr. Weitz:                          And you also mentioned in your notes that GI docs, when they do an endoscope, they’re often looking in at that part of the GI tract where H. Pylori leads to ulcers, but not the … What’s the other part of the stomach where …?

Angela Pifer:                      Yeah, so if you think about the stomach like a kidney bean, like up on it’s end, you’ve got the fundus is up top, the body is kind of in the middle, and then the antrum is on the bottom. When we start to look at parietal cells, which produce stomach acid, they’re in the fundus and the body, so in this upper two thirds part. And then in the bottom part is the antrum, and if you look on almost every single endoscopy, they’re doing biopsies on the antrum. They’re looking for H. Pylori, and they’re gonna miss if there’s an autoimmune issue with parietal cells. And they’re also doing biopsies in the duodenum to see if there’s celiac.  So I feel like, especially as we’re gonna get into it here, we really should be assessing the whole stomach and looking a little bit beyond this. But it’s interesting that even when recommended that, it doesn’t come back as the biopsy in that area. I think they’re just on … And I say it with great respect, they do things none of us can, but that’s just where they’re looking, and they’re not looking in the fundus or the body.

Dr. Weitz:                          Yeah, interesting. Yeah, you have to try to develop a relationship. There’s not many integrative GI docs around.

Angela Pifer:                      Yeah.

Dr. Weitz:                          Fortunately we have Dr. Rhabar in LA, so …

Angela Pifer:                      Yeah. Yeah, and Dr. Mullen. Yep.

Dr. Weitz:                          Yeah. Is he in LA?

Angela Pifer:                      No, Dr. Mullen, Jerry Mullen up in …

Dr. Weitz:                          Yeah yeah yeah yeah.

Angela Pifer:                      Yeah.

Dr. Weitz:                          Yeah. So let’s talk about autoimmune atrophic gastritis. What are some of the symptoms associated with that in particular, and how do we assess for that?

Angela Pifer:                      Yeah, absolutely. Well I think when we start to look at autoimmune, there’s a lot of conversation around the CDTB toxin and autoimmunity coming from that, and that being a cause of this IBS-C or SIBO.  What we have to look at is that’s definitely a percent, that can set SIBO up, but when we’re starting to look at the population that has low stomach acid and trying to get to the root of what’s going on with SIBO, there’s going to be a small percentage there that we really do have to have, you know, a keen eye on to see if any of those people have autoimmune atrophic gastritis.  And basically what that is is you’ve got some atrophy of the stomach, and you have gastritis, which is inflammation.  So we’ve got atrophy and inflammation, and then you’ve got this autoimmune involvement.  So atrophic gastritis, there’s two types.  One is caused by H. Pylori, and the other is autoimmune atrophic gastritis.  And so basically you’ve got the autoimmune involvement and you’ve got antibody production against the parietal cells.  And so as we start to tuck deeper into low stomach acid and its implications, when we start to look at autoimmune atrophic gastritis, this is everything that we’ve just talked about tenfold because this isn’t simply more stress induced or a bit of hyperthyroid pushed in in terms of setting that metabolic rate and how much stomach acid you’re producing, or you’ve got a zinc deficiency.  All of those can be recovered fairly easily, depending on the case.  But what we’re really talking about is an autoimmune connection here with low stomach acid.

I think to discuss this, we kind of have to talk first about prevalence, because I think it seems like kind of a foreign term, and yet when we start to look at prevalence, everyone’s pretty much heard about celiac.  Almost everything is screened for celiac, especially if there’s digestive stuff going on. So even as practitioners, we’re so quick to jump on that. But when we look at celiac disease, it’s .5 to 1% prevalence in the U.S.  Very, very small percent of people, and if you have it, it’s a very big deal.  But it’s a small percent of people, and yet, as practitioners, we’re fairly quick to rule that out.  When we look at autoimmune atrophic gastritis, we’re actually looking at a 2 to 8% prevalence.  So even if we just take the 2%, it’s 2 to 4 times more likely present than celiac.  And so we really have to kind of stand up and pay attention to this.

When we look at atrophic gastritis caused by H. Pylori, that’s actually going down in America because it’s being screened for.  But when we look at autoimmune atrophic gastritis, it’s going up. It’s starting to increase as are a lot of the autoimmune conditions, right?  People are becoming more susceptible, and we can have a whole ten shows over why we think that is, right?  But when we’re starting to look at the autoimmune atrophic gastritis, basically what we’re looking at is, we’ve got inflammation of the stomach, atrophy of the stomach, we see a breakdown of the parietal cells because you’re making antibodies against those.  And when we look at the parietal cells, those make stomach acid, and they also make intrinsic factor.  And intrinsic factor is what binds to your vitamin B12, and that coupling, as it moves through the intestines, is absorbed together.  If you’re not making intrinsic factor, you’re not gonna absorb your B12, and if you’re not making stomach acid, you’re not gonna break down your proteins to get to your B12 in the first place.

So as we start to look at this patient population … This isn’t everyone that needs to be screened for this, but we have to start to look at if there’s a chronic digestive presentation here. And we really want to start to key into this is if somebody’s taking massive handfuls of HCl Betaine and they’ve been doing that for a really long time or they don’t digest their food, this is something that we should be screening them for.  When we start to look at this, you know, we kind of have this …

Dr. Weitz:                          By the way, do you ever use that HCl challenge test as a way to screen for this?

Angela Pifer:                      You know, I don’t as a way to screen for this. I refer people over for the Heidelberg test if we’re suspecting low stomach acid, especially if I see them on this level of HCl Betaine.

Dr. Weitz:                          Okay.

Angela Pifer:                      I feel for a time, that was really working for me. So setting aside autoimmune atrophic gastritis, it was working for me in terms of getting people on a certain load, and it was making a difference, and then I feel like it just didn’t work as well anymore.

Dr. Weitz:                          Right. By the way, for people that aren’t aware of what we’re talking about, this is where you give a patient one HCl tablet taken before a meal, and then you give them two or take it after a meal, and then three, and you keep increasing it until they get a burning sensation, and then you back off.

Angela Pifer:                      Yeah. Or a warming sensation, but yes.

Dr. Weitz:                          Warming, yeah.

Angela Pifer:                      Yeah. So I’ve seen that work for some people. I’ve seen other people … A lot of times when people come to me, they’ve been to quite a few practitioners, and they’ve already done that test in the past, so you know, we just kind of learn from what they’ve already been working through.

Dr. Weitz:                          Yeah.

Angela Pifer:                      Yeah. So it’s pretty interesting. So I would just go off more symptoms of what we would expect. Again, you know, total protein’s low in a lab. You’ve got B12 that’s chronically low.  Iron is low with no really good cause for it, and when you’re recovering.  You know, they’re kind of the slight, not life-long, but say for the last few years at least this has kicked in at some point, they’ve been trending more towards meat, yeah, they’re not quite getting it recovered.

Dr. Weitz:                          What tests do you like for B12 and for iron?

Angela Pifer:                      I do serum B12. And then when we’re looking at iron, it’s just the full panel.  Serum, TIBC, saturation, ferritin.  And then of course looking at all the rest of the CBC, looking up, you know… 

Dr. Weitz:                          You don’t find the need to do like methylmalonic acid or homocysteine for B12 status?

Angela Pifer:                      I actually like both of those when looking at folate and B12.

Dr. Weitz:                          Okay.

Angela Pifer:                      Yes yes. I look a little bit more at that, and of course it depends on what I see in terms of supplementation that they’ve been on, you know, for a really long time. I’m also looking at that more for folate and B12 status, and methylating. Yeah.

Dr. Weitz:                          Okay, cool. So let’s talk about treating a patient with low stomach acid.  How do you approach that?

Angela Pifer:                      Yeah, absolutely.  Well I think low stomach acid and autoimmune atrophic gastritis are gonna be really two different things in terms of approaching that.

Dr. Weitz:                          Okay, so let’s start with a few different cases.  With somebody who’s got low stomach acid because they’ve been taking proton pump inhibitors for years, how do you handle that?

Angela Pifer:                      Yes, absolutely. So with their doctors approval for coming off of medication, of course, I actually will start to add in bitters. I’ll have them cook all their vegetables.  I’ll have them eat more frequent meals just to start, and then we’re really gonna work on stress management, setting the tone for the meal, and chewing their food three times more than they think they need to.  We might need to address fat load a bit, just depending on how well their gastric emptying is going.  We might need to adjust things that way.  I work a lot with that.  I love bitters, I love them.

Dr. Weitz:                          And bitters are designed to stimulate your own digestive enzymes and acid secretion, right?

Angela Pifer:                      Yeah, absolutely. Our food, I mean it’s kind of crazy to think about, even our broccoli and brussel sprouts are bred for sweetness.  All of like the bitterness, the different species within those, they’re all bred more sweet. We’re like setting aside anything that has more bitter because the masses don’t trend towards that, right, in terms of what we’re choosing at the supermarket.  So when we give somebody bitters, it literally is bitter.  Your mouth has these beautiful taste receptors back here that just light up when you give somebody bitters, and if you even think about it if you’ve done it, it makes your mouth water. Like it’s really stimulating digestion from the top down. So I have people … I like Quicksilver Scientific, their Bitters 9.

Dr. Weitz:                          Oh, okay.

Angela Pifer:                      And their Bitters X is fantastic, and I just have them do one or two pumps 15 minutes before a meal. They hold it in their mouth for 90 seconds, swishing it around, trying to get it to the back, and then they swallow. We’ve got bitter receptors in our stomach as well, so it’s wonderful. It’s a great way to kind of help stimulate digestion there.  In terms of digestive enzymes, one of my favorites is Panplex 2-Phase by Integrative Therapeutics.  It has a low-level digestive enzyme, low-level bio-support, and just a little bit of HCl Betaine.  So I think less is more.  I wanna kind of just start with these lower levels and work up from there.  So that’s my way to approach it.  I would try to set the tone for the meal, really look at your food, smell your food, think about where it came from, what it’s gonna taste like, put that first bite in your mouth and really set your fork down and taste it.  And to me, that sets the tone for the meal and really slows people down.

Dr. Weitz:                          When you’re weaning patients off of PPIs, you have to be careful about sort of a rebound, right?

Angela Pifer:                      Yeah, you do. You know, I’ve had really great luck again with, you know, Dr’s approval on this, and really great luck in weaning people off of proton pump inhibitors. There hasn’t really been a case that I haven’t been able to do because we set everything else up first, and then depending on the medication, we might be able to halve that medication, or we just start to slowly take that every other day. And I’ll always aim that around a weekend, because if you’ve ever really watched people’s food journals over the course of a week, like year after year like I have, you realize that hunger is much more increased during the week. Like there’s just more stress going on. So I start to wean them over a weekend, and you know, have just a little bit of baking soda on hand if they need to do like a half teaspoon of baking soda and water just to take the edge off. And then they have the medication. If something comes up, nobody is asking them to sit in misery with heartburn.  It’s usually pretty good. I think most people just try to stop cold turkey, and then they realize that didn’t go well, so they feel like they’re really chained to it. So you just have to work with them to get them set up.

Dr. Weitz:                          Okay. And then how do you treat patients with atrophic gastritis, and is it the same treatment if it’s autoimmune origin or H. Pylori?

Angela Pifer:                      Yeah, so atrophic gastritis is caused by H. Pylori, and so there’s some great treatments out there for H. Pylori. What we’re talking about is the autoimmune atrophic gastritis, and that’s gonna be more from an autoimmune perspective. So you know, just as if there’s autoimmune thyroid, you’re going to treat the thyroid, but you’re also going to treat the autoimmune condition. So with autoimmune atrophic gastritis, you’re going to treat the autoimmune condition in that you’ve got to work on the whole stress cycle with everybody, getting them sleeping well, calming down the body’s reason for ramping everything up and attacking.  You want to calm down and figure out triggers, you know, where triggers are coming from, whether it’s stress, environmental, internal in terms of food and all.

And then we really want to look at treating nutritional deficiencies, making sure that they’re recovering their B12, recovering their iron. So when we look at autoimmune atrophic gastritis, the vast majority of cases aren’t even diagnosed until they’re completely at this end stage of pernicious anemia, and that pernicious anemia is basically you’ve got anemia because you can’t absorb your vitamin B12, and you need B12 along the iron pathway.  And then you’ve got this autoimmune component causing this.  So pernicious anemia is also an autoimmune condition, but it’s this end stage of autoimmune atrophic gastritis.  So most people aren’t diagnosed ’til that point, so we want to catch them before that. We want to catch them when they consistently have B12 levels of under 500, that we see indications of pancreatic insufficiency.  So they’ve got this low stomach acid and signaling of the pancreas, you know, we don’t see that and that connection. We wanna look for vitamin B12 deficiency symptoms like peripheral neuropathy.  We want to look for even restless leg syndrome, which is strongly connected to this.  That you know, again, at that beginning they’re going to have poor gastric emptying, they’re gonna feel full, they’ve got this excessive burping, sometimes they feel a little nauseous ’cause food is sitting there, and all of this has been kind of chronically presenting.  We’ve got a store of iron in our system, you know, in our body. It isn’t until we really start to see this very big shift, and same thing with B12, this really big shift with this autoimmune attack. We don’t usually start to see this rear up for a good year and a half, two years, so we wanna catch this earlier on, and it might be that chronic presentation that we get to see that with.

So again, first rule out H. Pylori. Absolutely let’s rule that out, but then let’s start to look at, you know, do we start to see B12 levels dipping down? Which is kind of hard sometimes because everyone’s taking B12. And serum B12 is a really great indication that you’re taking good supplements sometimes, so maybe we need to take people off of things for a couple of weeks to get a better read on that serum level. But we wanna look at that, we want to investigate gastroparesis if that’s there, or again, if gastritis is present, we’re going to look for H. Pylori and then start to look at iron and B12 and start to recover those.

If somebody’s gotten to the point of pernicious anemia, they might need iron shots, they might need intramuscular B12 shots, you know, the supplementation may not do it. And this population of course is interesting because they’ve got lower stomach acid and poor signaling, and oftentimes they’re gonna have slower motility. So if you’re trying to recover iron on a consistent basis, you know, you can really slow things down more because iron can be quite constipating. And iron isn’t necessarily … It can be toxic to the colonocytes as well, so you know, sometimes iron shots are gonna be a better choice depending on that patient and what’s going on there.

Dr. Weitz:                          Interesting. And of course, trying to heal the gut as well, right?

Angela Pifer:                      Mm-hmm (affirmative). Absolutely, absolutely. I think that’s going to come with it, and I think that comes with a lot of conditions after as well.

Dr. Weitz:                          And those patients are going to need HCl supplementation probably for the rest of their lives, right?

Angela Pifer:                      They probably will, and you know, I think it’s again, if somebody has an autoimmune condition, we need to be able to tell them that they have an autoimmune condition, because autoimmune comes in pairs. And also, I would say that autoimmune, you know, as we start to look at this, we need to be able to say like there is a reason that you might need ongoing supplementation, in terms of HCl Betaine, in terms of B12 support, in terms of iron support. There’s a connection to be made there with the patient, because sometimes I think, you know, patients might go from practitioner to practitioner and they’ve got these long laundry lists of supplements, and we don’t know which are necessary and which aren’t. But if we’ve got an autoimmune condition set up for this, they’re going to need to really support their system long-term because of the autoimmune condition that’s present.  And the more stressed out they get from wherever this is coming at, the worse the autoimmune cycle can get. And then you get more degradation and targeting of those parietal cells which makes everything downstream worse. So the stress management piece can’t be talked about enough with this population, but then we also have to start to look at how else are we gonna support them, and they’re gonna need supplementation lifelong. They’re going to need it, like absolutely. So they need to know that and be able to connect with that because I think people can fall in and out of favor with supplements, or you know, “I don’t know if these are even doing anything for me” kind of thing. In this case, this is really something that needs to be looked at.

Dr. Weitz:                          So can you monitor those anti-parietal cell antibodies the way you monitor like TPO antibodies with patients with Hashimoto’s to see to what extent their autoimmune component is active, or?

Angela Pifer:                      Yeah. You really can, but I think we have to be careful to say, you know, parietal cell antibodies are at 82 and they go to 72, it doesn’t mean that they’re necessarily getting better. You know, antibodies are volatile. They don’t just go up a ladder and down a ladder depending on two things. If we are in a very stressful situation, we can see a shift there. If we are fighting off a cold, we can see a shift. If we …

Dr. Weitz:                          Right, but maybe are there bigger shifts? Like with TPO, you know, antibodies for thyroid, if they have 500 and it goes up to a thousand, that’s significant, or it’s 1,200 and it goes down to 150, you still have elevated antibodies, but that’s a significant shift, whereas if it goes from 100 to 400, maybe it’s insignificant.

Angela Pifer:                      I agree. I completely agree, yeah. When there’s 

Dr. Weitz:                          Is there a similar sort of range with the anti-parietal cells?

Angela Pifer:                      You know, I think it’s going to be based on the person and what we’re looking at with both of those and where they kind of fall into. I think as we start to look at the progression and how long this has been there for people and how advanced they are, they might not be able to get those fully recovered like we’d like.  But for the anti-parietal cells, the anti-intrinsic factor antibodies, you know, we’d look at both of those, and of course if there’s a positive test, we’re gonna refer over to a GI doc to get a biopsy. But in the right place, they’ve got to biopsy the fundus or the body of the stomach to be able to actually confirm that.

Dr. Weitz:                          Cool.  Okay, that’s good.  Very interesting information.  Thank you for informing us about a condition I think most patients and even a lot of practitioners are not aware of, which is autoimmune atrophic gastritis as a cause of low stomach acid leading to SIBO.

Angela Pifer:                      Yep.

Dr. Weitz:                          So how can listeners and practitioners get a hold of you if they want to contact you, sign up for your courses, get your bone broth?

Angela Pifer:                      Yeah, absolutely. So my practice site is siboguru.com, and I’d love to have everybody visit me there.  And then GutRxGurus.com is a beautiful collection of practitioners and chefs that are in the low-FODMAP realm. And there’s a SIBO-specific category in there, and everything is low-FODMAP.  And I’ll say it really quick, I don’t as a whole put every single person that’s ever even, you know, SIBO glaring, on a low-FODMAP diet, but there’s going to have to be some adjustments, and so to be able to have a recipe set that you can go to to really fill in the gaps and give people ideas … Because we’re so used to eating what we eat, and then when we can’t eat that anymore, it’s like chicken on a plate. Like what do you do? So it’s nice to be able to have all these beautiful recipes for sauces and sweets if you need them, and the foods just really tasty. So that’s a subscription site for recipes, gutrxgurus.com.

And then GutRxBoneBroth, the first low FODMAP bone broth to hit the market, and people can order that online. It just ships directly to their door, and we actually ship beautiful high-protein, high-gelling bone broth that tastes absolutely amazing. We’ve got a big plant here in Seattle, and we sell beef and we sell chicken, and it is just absolutely delicious, so it’s just nice to have that to kind of fill in the gaps and have that as a base of a soup, because you can’t just go to a store and get a garlic-free, onion-free anything, right? Everything has it in it. So it’s nice to have a broth that people can really connect to there.

Dr. Weitz:                          Cool, great. Thank you so much for spending time with us.

Angela Pifer:                      Of course, thank you!

Dr. Weitz:                          Okay, I’ll talk to you soon, Angela.