Rational Wellness Podcast 052: Toxins with Dr. Joe Pizzorno

Dr. Joe Pizzorno speaks about how to remove toxins from your body and improve your 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

2:00  Dr. Pizzorno will be giving several talks on how toxins cause infertility and he said he is finishing a textbook with Walter Crinnion for doctors called Clinical Environmental Medicine that will be released in July.  He said that environmental toxins have become the primary drivers of chronic disease.  

3:22  I asked Dr. Pizzorno to explain how toxins damage our bodies?  He explained that we should consider how environmental toxins cause diabetes. Toxins like phtalates that are commonly found in our health and beauty products and Bisphenol A in our soups and plastic containers that we put our foods in attach to insulin receptor sites so the cells stop responding to insulin resulting in the pancreas having to produce more and more insulin. Dr. Pizzorno said that he is shocked how commonly people in the US are being exposed and damaged by arsenic. Arsenic is commonly found in the water, the chicken, and the rice, which is really good at concentrating arsenic if it is grown in water that has arsenic in it.

7:12  Dr. Pizzorno said he is a big believer in eating organically grown food, but then you have to ask what water is being used to grow these organically grown fruits and vegetables and does it have arsenic in it?

7:43  I asked how do we know if we have toxins? What about some of the testing methods?  Dr. Pizzorno explained that to determine current exposure, we can do serum and urine testing. The best test is to do a fat biopsy. What we’re doing is a challenge test with a prescription chelating agent like DMSA or DMPS or EDTA, and then see how much that increases their secretion of metals. That actually is useful, but it’s also flawed.  In general, I prefer more tests like blood tests and tissue biopsies than I do things like urine tests. Because it tells you what’s in the body, not what the body’s getting rid of. I asked what he thinks of antibody testing of chemical and metals, such as developed by Dr. Aristo Vojdani and offered by Cyrex Labs?  He said that he finds these intriguing and he would consider using them but he would like to see more data on them before endorsing them.

15:04  I asked Dr. Pizzorno to talk about how to eliminate toxins from our bodies.  He said that there are a three steps to take: First, decrease exposure. Then number two is support the body’s own natural detox systems, and the third one is, okay, let’s do stuff to directly get things out of the body.  We talked about how to remove toxins from the water by having a whole house carbon filter that removes organic compounds. To support the body’s natural detox system you can increase fiber intake and take N-AcetylCysteine or NAC, which increases the body’s glutathione levels.

20:23  I brought up the thought that those of us like myself who treat a lot of patients with gut problems like IBS and SIBO may put patients on a low fiber diet to avoid feeding the bacteria we are trying to remove and we may actually inadvertently be increasing their toxin load as we try to improve our gut health.  Dr. Pizzorno responded that in his The Toxin Solution book he has patients spend two weeks cleaning up their gut and he likes them to increase their fiber intake. Then, to help patients remove toxins, he recommends that they take oral DMSA 250 milligrams every third night, along with extra fiber and NAC.  He said that it’s a slow process, but it’s extremely unlikely anybody will have a bad reaction. He also likes to use bile sequestrants like cholestyramine that bind to the chemical toxins in the gut. Dr. Pizzzorno said that in his book, The Toxin Solution, he spends two weeks avoiding toxins, two weeks improving gut function, two weeks improving liver function, and finally two weeks strengthening the kidneys. He said we now have an epidemic of kidney failure, which used to be rare.  Now we’ve got dialysis centers all over the place.  People’s kidneys are failing from all the chemicals they’re being exposed to including prescription and non-prescription drugs like nonsteroidal, anti-inflammatory drugs, like acetaminophen. For kidney detox, Dr. Pizzorno recommends an alkalinizing diet that reduces consumption of high sulfur amino acids and decreased salt consumption. 

29:04  Dr. Pizzorno said that after detox, he does nutritional medicine.  When we get people the nutrients they need so the body works properly.

29:47  Dr. Pizzorno explained his gut protocol to get it ready for detox.  He explained his four step program:  1. kill the bad bacteria, 2. absorb the toxins that have been released, 3. re-seed with healthy bacteria, and 4. then stimulate the healing of the gut.  Dr. Pizzorno developed this about 10 years before anybody ever heard about the 4R Program. That’s one of the reasons he’s one of the founders of the Functional Medicine movement. 

31:56  Dr. Pizzorno said that instead of doing stool testing, he does a urine test in his office known as the Obermeyer or Indican test.  It measures levels of indoles and skatoles in the urine, which indicate the breakdown of protein by the wrong bacteria in the gut that produces these chemical toxins.  He has them return once per week to repeat the test.  When their gut cleans up, the test improves.  The formula for making up the indoles to perform the test is in his Textbook of Natural Medicine.  



Dr. Joe Pizzorno is a Naturopathic Doctor who has written or co-authored more than 12 books including, The Encyclopedia of Natural Medicine, which has now sold over two million copies, and The Toxin Solution, his newest book.  Here’s the website to learn more about this book: http://www.thetoxinsolution.com/ Dr. Pizzorno is one of the most important Naturopathic Doctors, educators, researchers, and one of the founding members of the Functional Medicine movement. You can also learn more about Dr. Pizzorno from his website: http://drpizzorno.com/  You can preorder Dr. Pizzorno’s forthcoming textbook on Clinical Environmental Medicine from Barnes and Noble.

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 as well as 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. Sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.

                                          Hey, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy this podcast, please go to iTunes and give us a ratings and review, because that helps more people find out about the Rational Wellness Podcast.

                                          Our topic for today is toxic chemicals that we get exposed to on a daily basis in modern society. We’re going to talk about the role they play in chronic diseases, what we can do to avoid them, and how to detoxify them from our bodies once they become incorporated into us.

                                          Our special guest today is Dr. Joe Pizzorno who’ll be joining us today to talk about toxins. Dr. Pizzorno is one of the most important naturopathic doctors, educators, researchers, and one of the founding members of the Functional Medicine Movement.  Dr. Pizzorno has written or co-authored more than 12 books including, The Encyclopedia of Natural Medicine, which has now sold over two million copies, and The Toxin Solution, his newest book, which was released last year, and which I highly recommend.

                                          Dr. Pizzorno, thank you for joining us today.

Dr. Pizzorno:                     Well, thanks for the invitation. I’m delighted to be talking with you today.

Dr. Weitz:                          I’d like to start the interview by asking you what have you been up to lately? Because I’ve seen some of your recent talks, and I know you’re doing a lot of projects related to toxins.

Dr. Pizzorno:                      Two things have really taken all my attention right now. First off, I’ll be giving a lecture at the end of the month. Actually two lectures, one for consumers, one for doctors, on how environmental toxins cause infertility, because as you know, infertility is becoming a bigger and bigger problem. I’ve been looking at all the research around infertility.

                                           The second major area I’m working on right now is that I’m co-authoring with Dr. Walter Crinnion a new textbook for doctors called, Clinical Environmental Medicine. We’re now just doing the final proofs before it goes to publication. I would say not only is it one of my most important books, but it’s also one of my most depressing books.

                                           Because when we started looking at the data on toxins and disease, it is just stunning. We’re poisoning ourselves. I’m making the case, and I’m literally lecturing all of the world on this, that environmental toxins have become the primary drivers of chronic disease. Not that nutritional deficiencies and excesses have gone away as a cause of disease, we’ve simply added an even worse problem.

Dr. Weitz:                           Yeah, shocking, shocking.

Dr. Pizzorno:                      Very worrisome.

Dr. Weitz:                           Yes. Toxins seem to be involved in almost every chronic disease, and they’re found in our food, our water, in our environment, and the products we put on ourselves.

Dr. Pizzorno:                      Yup, everywhere.

Dr. Weitz:                           Can you talk about how toxins damage our bodies?

Dr. Pizzorno:                      There’s a number of ways in which it happens. Actually, I have three slides, each of which has three reasons. There’s nine key reasons why this happens. I won’t go through all of them.

Dr. Weitz:                           Sure.

Dr. Pizzorno:                      I’ll look at the high points.  The first one that got me most interested in this area probably because the most research is there, is how toxins cause diabetes. It looks like there are two mechanisms by which this happens. The one which appears to be most important is that many chemical toxins like, oh, how about the phthalates that are in our health and beauty products, or how about bisphenol A, that’s in our canned soup, for example, and all those plastic things that we have our food in.

                                           They actually bind to the insulin receptor sites on the cells, so that the cells don’t respond to insulin like they should. Our poor pancreas has to overproduce insulin in order to get sugar into the cells. Well, that’s a good example of how incredibly adaptive our bodies are to the challenges of living. Also, when you’ve overused an organ for 20 or 30 years like that, it burns out and now, you’ve got diabetes. Looking at just one condition like diabetes, which is 20 times more common now than when I was a student in naturopathy medical school half a century ago, this epidemic is primarily due to environmental toxins basically blocking insulin receptor sites.

                                           Not only that, things like bisphenol A and phthalates, but also arsenic. One of my biggest surprises in looking at the research is how commonly people are being damaged by arsenic. Of course, it might, excuse me at the obvious joke that people only think they have arsenic toxicity when their spouse is trying to poison them. While that may be happening, the reality is that 10% of the public water supplies in the U.S. have arsenic levels known to induce disease in humans, and only half the water supplies have even been tested for arsenic.

Dr. Weitz:                            Wow.

Dr. Pizzorno:                      Now, I suspect, I’m being a little pejorative here, sorry, but I suspect some of those public water supplies tested and found the arsenic and didn’t want to report it because of what they found. This air, water, food, health and beauty aids, household cleaning products, everywhere all these chemicals and metals are poisoning or bodies.

Dr. Weitz:                           I heard you talk about how arsenic is often contained in chicken.

Dr. Pizzorno:                      Yes. Up until recently, the USDA allowed farmers to put arsenic compounds into chickenfeed-

Dr. Weitz:                           Wow.

Dr. Pizzorno:                      … for two key reasons. Number one is that it helps address the parasites in chickens that they get when they live in close quarters, and second is it helps to plump them up, makes them fatter so then they can make more money. They finally stopped approving that. Now it doesn’t mean it’s not still happening, but hopefully, we’ll see the arsenic levels in chickens finally start to go down.

Dr. Weitz:                            Yeah, we’ll probably see it get re-approved.

Dr. Pizzorno:                      The problems the chickens have haven’t gone away, so now they’re using different compounds. I’m sure we’ll find them toxic as well.

Dr. Weitz:                            Apparently, there’s a lot of arsenic in rice as well.

Dr. Pizzorno:                      It turns out, and I don’t know why, but rice is very good at absorbing arsenic. If rice has been grown in one of those water supplies that have arsenic in it, and as [inaudible 00:06:33] will absorb it. It turns out rice is a significant source of arsenic for anybody who eats rice.

Dr. Weitz:                            Is there any way to get rice that doesn’t have arsenic?

Dr. Pizzorno:                      Well, of course, if the rice has been grown with water that does not have arsenic in it, it’s not going to have arsenic. I’ve been now asking the organic rice farmers, please tell us how much arsenic is in your rice, and none of them have answered me.

Dr. Weitz:                            Huh.

Dr. Pizzorno:                      Which I find a little worrisome.

Dr. Weitz:                            Yeah, that may be one more of the variables that’s so difficult to control. You go and you get organically grown fruits and vegetables, but what water are they using?

Dr. Pizzorno:                      Yup, yup. I’m a very, very strong believer. Everybody should only be eating organically grown foods, but now having said that, you have to make sure that those organically grown foods are grown properly and are not contaminated.

Dr. Weitz:                           Yeah, I think ultimately we have to accept that we’re all going to get exposed to a certain amount of toxins.

Dr. Pizzorno:                      Yeah, yeah. We can’t get around it, so what we have to do is decrease exposure as much as we can and then support the body’s own ability to get rid of toxins.

Dr. Weitz:                           Right. How do we know if we have toxins? What about some of the testing methods?

Dr. Pizzorno:                      Yeah, great question. I gave a lecture at NIHM last October entitled, How to Practice Environmental Medicine. When you think about toxicity realize that we don’t have, you might say, a monolithic population. I break the population down into three groups when we think about toxins.

                                           The first group is what I would call the yellow canaries. This is from an old practice of coal miners, where they’d bring yellow canary birds down into the coal mines. When they started to faint, they knew they were being exposed to carbon monoxide, and they would then rush out of the mines. The reason they would use the yellow canaries is because they’re much more sensitive to the toxins than are the humans. Yellow canaries are those humans that are most sensitive to toxins. They have their own set of issues.

                                           Then we have people who have an obvious exposure. An obvious exposure will be something like you have a mouth full of silver fillings. Because if you’ve got 10 silver fillings in your mouth, you’re leaking 10 micrograms of mercury into your body every day. And don’t believe the dentist when they say, “Ah, it doesn’t go into your body,” because there’s a direct correlation between the amount of mercury in your mouth and the amount of mercury in your brain, in your kidneys, and your tissues. There’s no question that there’s an exposure problem.

                                           But the third category is probably the biggest, of course, overlaps with the other, but that is anybody with chronic disease must consider the role of toxins in that chronic disease. I’m seeing more and more … I’ve looked at tons of research, and I would assert that at least half of chronic disease is due to environmental toxins. Which means that it’s preventable, and in many cases, even reversible.

Dr. Weitz:                           It’s so interesting. You can put somebody on what seems like an appropriate diet say for a condition like diabetes, but if part of their diabetes is being fueled by toxins, unless you also address the toxin factor, no amount of low carb eating is necessarily going to make those insulin receptor sites work properly.

Dr. Pizzorno:                      Right. That’s absolutely true. Let me go a little further than that, because you brought up a good point. It’s something I’m actually starting to talk more about. That is, how do you measure success in medicine?  Now what conventional medicine says, people have diabetes which means basically high blood sugar, and we are properly treating the diabetes if the drugs we use will decrease the blood sugar levels. Well, of course, that’s reasonable to do, because super-high blood levels of glucose cause all kinds of problems.

                                           But what if you had instead a measure which is, how well is the body itself controlling blood sugar? Because even though things like metformin and insulin will decrease the number of the side effects of high blood sugar, they still will have people progress to the sequelae of diabetes. Which means their arteries and their nerves start to degenerate. They get peripheral neuropathy. They start losing their kidneys, start losing their eyesight, increasing rate of dementia all those kinds of things. Okay.

                                           It’s slowed down by metformin and insulin, but that’s not a substitute for the body itself maintaining proper blood sugar control. Because when the body maintains blood sugar control, you don’t get the sequelae. You don’t get the loss of blood flow and neurological function, and things of this nature.

                                           In many ways, conventional medicine has justified its existence by using these lab tests that seem to show benefit, but in reality, it’s just covering up the fact that the body’s not working properly. If the body’s not working properly, doesn’t matter how much drugs you’re taking, the body’s going to break. You’re going to get disease, and your quality of life and longevity will be lower.

Dr. Weitz:                           Interesting. On the testing, what kind of tests do you recommend that people get that practitioners use? I know there’s serum testing. There’s urine testing. There’s provocative urine testing. But there seems to be a lot of question as to how accurate these tests are.

Dr. Pizzorno:                      Yes, a very good point. When we’re testing, we have to break it down to two categories. One is current exposure, because you want to make sure, is a person currently being exposed? Because if they are, I don’t care how much detox you do. If they’re currently being exposed, they’ll get worse, so acute exposure. What’s generally accepted is blood and urine for that purpose. That’s fine for most acute exposures.

                                           The problem is … What we’re more concerned about is, what’s in the cells? What’s in the brain? Now what are the deep body load of those toxins? That’s more difficult to get.  For example, if you want to know how bad your chemical toxin exposure is probably the best thing to do is to do a fat biopsy to see what’s in there. Okay, well, that’s fine. You can only pick up fat soluble chemical toxins, but the fat soluble chemical toxins tend to be the worst anyway.  In order to determine how much metal is in the body, many of us are using what’s called challenge testing. We give a person a drug, like DMSA or DMPS or EDTA, and then see how much that increases their secretion of metals. That actually is useful, but it’s also flawed. There’s no question that it’s not a perfect test.

                                            Because the only way to determine how much mercury a person has that’s causing trouble, for example, with the brain causing dementia is to do a needle biopsy of the brain. In general, patients don’t want you sticking needles into their brain. The bigger the needle that you need for tissue biopsy, the worse it is. We have to infer what’s going, and those methods aren’t very good. But they’re better than just blood and urine.  And mercury being a great example, because if blood and urine are so great for determining acute exposure, then you’d expect that blood and urine to correlate very well with each other in their levels of mercury. It turns out blood and urine and mercury don’t correlate with each other very well at all.  In general, I prefer more tests like blood tests and tissue biopsies than I do things like urine tests. Because it tells you what’s in the body, not what the body’s getting rid of.

Dr. Weitz:                           What do you think about the chemical antibody testing that’s available now?

Dr. Pizzorno:                      It’s intriguing, and I’m following it. I’m sure you’re aware of the work of another chiropractor, Dr Datis Kharrazian.

Dr. Weitz:                           Yeah, yeah. We just had a Functional Medicine Meeting, and Dr. Vojdani spoke at the meeting.

Dr. Pizzorno:                      Oh great, okay. You know the work of-

Dr. Weitz:                           He developed a lot these tests.

Dr. Pizzorno:                      Aristo and Datis are doing some, I think, really important work. What they’re doing that I find so interesting is they’re pointing out that these chemicals and metals are binding to normal body tissues. Normal body tissue, normal body proteins, which the immune system says are okay. Well, when you change some … adding a chemical or a metal, you’ve now made a new molecule that the body now thinks is an invader, and now you’re setting people up for auto-immune disease.  I think these tests are quite intriguing and may be quite valuable. I think we’re a little early in the process for me to be using them clinically, but they’re at the point now where I would consider using them. I’m not quite ready to say that this is the way to go.

Dr. Weitz:                           Yeah, cool. Can you talk about some of the ways that we can get rid of toxins from our bodies?

Dr. Pizzorno:                      There are three key methods. Number one is stop exposure. I’m going to be really aggressive about this, stop exposure. Because many of these toxins, we’re actually pretty good at getting rid of. Now, I mentioned arsenic for example. Half life of arsenic in the body is only two to four days. That tells me as we evolved as a species, we were exposed to arsenic, we figured out how to get rid of it.

                                           But if your water has arsenic in it, if you’re eating rice and chicken, you’re constantly being exposed to the arsenic which is why it’s the number one toxin right now. It’s a big, big issue. What do we do-

Dr. Weitz:                           What do we do about water? How do we get rid of toxins in our water?

Dr. Pizzorno:                      It depends upon the toxin. If it’s the chemical toxins, a carbon block filter would work just fine. In our house, we have a carbon block filter, a big one, on the water supply coming into the house, so the water in our showers has now been cleaned up. Because it turns out a lot of these organic compounds in the water are more efficiently absorbed by inhaling them than they are by eating them or drinking them.

Dr. Weitz:                           Like chlorine and stuff?

Dr. Pizzorno:                      Chlorine, yes, problematic, but I’m much more concerned about the chlorinated organic compounds. When we chlorinate the water supply to kill bacteria, and it does that by the chlorine binding to the organic molecules in the bacteria and kill them that way. Those chlorinated organic compounds are actually pretty toxic and many of them are carcinogenic.  Now, they’re not a big cause of cancer. I read a study where the public health people said, “Okay, we know that by chlorinating the water supply, we’ve basically dramatically improved human longevity.” If you look at human longevity, three quarters of it was from public health putting … doing things like putting chlorine into the water supply to get rid of invading organisms that are killing babies, so that works really well.  The researchers also know that about three people out of every 10,000 who are consuming this chlorinated water will get cancer from that chlorinated water because of these carcinogens. Now I’m sure these chlorinated compounds cause other trouble as well. It’s a small factor, and if that was the only factor, that’s okay. But the problem is it’s only one of many, many factors.

                                           There are over 100 chemicals and metals in our environment at high enough levels to damage human physiology and cause disease. You might say, “Well, that one only causes like 1% of disease. Why worry about it?” Well, because it’s one of 100. You have to get all hundred of them. You can’t just pretend that they don’t count. They all count. They add up.  It’s worse than that, and that is these things are synergistic. One plus one does not equal two. One plus one equals three. One plus one plus one does not equal three, one plus one plus one equals ten. As our body load of toxins increases, our ability to protect ourselves from the toxins becomes depleted, and you get more and more disease.

Dr. Weitz:                           Interesting. When it comes to doing detox, there are so many different detox programs out there. You see all these programs at the health food store just take this set of pills; just use this detox powder. There are so many different opinions on how to do detox. You get in a special sauna, stick your feet in this ionic bath …

Dr. Pizzorno:                      Let’s finish this question you asked me.

Dr. Weitz:                           Okay.

Dr. Pizzorno:                      First one, decrease exposure. Then number two is support the body’s own natural detox systems, and the third one is, okay, let’s do stuff to directly get things out of the body-

Dr. Weitz:                           Okay.

Dr. Pizzorno:                      … you might say, by chemistry.

                                           Second one is to support the body’s own innate systems. There are a lot of approaches we can take. The two simplest ones which are safe for virtually everybody is number one is increase your fiber. Because our body is constantly dumping garbage through the liver into the gut, and the body’s expecting there to be fiber there to bind to the toxins and get it out of the body. If you have all of those systems, we’re consuming 100 to 150 grams of fiber a day, unfortunately the average person now only consumes 15 to 20 grams of fiber a day. Excuse me. Spring has finally come.

Dr. Weitz:                           Bless you.

Dr. Pizzorno:                      Okay. One thing you can do then is to increase fiber, so that when the liver … Sorry.

Dr. Weitz:                           What type of fiber? You like the modified citrus pectin?

Dr. Pizzorno:                      I like pretty much every fiber except wheat bran fiber. Whether it’s pectin or oat bran or flax seed or whatever it may be, or eating fruits, I like, beans and such, just more fiber will help detoxify.

                                           Then the second one just one simple supplement, and that’s N-Acetyl Cysteine or NAC for short. That increases production of glutathione which plays a huge role in detoxification. There are a lot of other ways we can support detox.  In my new book, The Toxin Solution, … Well, actually, it’s new in terms of the paperback came out, the hardback came out last month, anyway, so I talked in there about ways to support the body’s own detox systems.

Dr. Weitz:                           One interesting point I’d like to make is since I treat a lot of patients with gut problems, one of the trends with patients with IBS and small intestinal bacterial overgrowth is putting the patients on a low-fiber diet, because a lot of times fiber makes your gut worse, because it feeds these bacteria. It’s interesting that we may actually inadvertently be increasing our toxin load as we try to improve our gut health.

Dr. Pizzorno:                      If you look at my book, the first two weeks, I show people how to avoid toxins. The second two weeks, I say, “Now how do we clean up the gut.” Because indeed, the wrong kind of bacteria in the gut will cause all kinds of trouble.  I’m one of these people who … I’m not a great believer in the whole SIBO diet and things like this. Not that they don’t help people in the short term, but in reality what I think they are is they’re just an indication that the gut’s not working properly, fix the gut. Because all those other foods they’re saying you have to avoid, they’re also natural, healthy foods. It’s not the food’s problem, it’s the gut’s at the problem.

                                    Now the third category then is to directly get toxins out. One way to do that, for example, is to be aware of what toxin the person has, and then look at what molecules we can give that person to get the toxin down more efficiently.  I’ve seen a lot of people with high levels of lead and/or mercury. A lot of that is because as people get older when they start losing bone the lead and mercury stored in the bones starts getting released into the system.  For those people, I recommend oral DMSA, and I recommend not very much, 250 milligrams every third night, along with extra fiber and NAC. It’s a slow process, but it’s extremely unlikely anybody will have a bad reaction, and over time-

Dr. Weitz:                           DMSA is by prescription now, right?

Dr. Pizzorno:                      [crosstalk 00:22:10]-

Dr. Weitz:                           Depending on the state, I guess?

Dr. Pizzorno:                      Yes. It used to be available in health food stores, now it’s only by prescription. Actually, when I’ve used it with my patients, I always use it by prescription, because I want to make sure about the quality and dosage and such. Whereas in health food stores, some if you’re with … If you buy from a good manufacturer, everything’s fine. Unfortunately, there are also bad manufacturers, so it’s hard to tell between them.

Dr. Weitz:                          You mentioned NAC. What do you think about taking glutathione orally or IV?

Dr. Pizzorno:                      Oral glutathione is broken down by the bacteria in the gut. While oral glutathione will increase glutathione levels, it does … Basically, it’s expensive cysteine. It’s much cheaper to give people N-Acetyl Cysteine than it is to give them oral glutathione. Now, having said that, you can give them topical glutathione, intranasal glutathione, IV glutathione, there are a lot of other ways to get glutathione into the body. But just oral glutathione doesn’t work real well.

Dr. Weitz:                           Right, they have all these new liposomal forms, and there are claims-

Dr. Pizzorno:                      Those are better.

Dr. Weitz:                           Yeah. M’kay. Go ahead with your detox protocols.

Dr. Pizzorno:                      Okay. Now for a person that has really high levels of chemical toxins, you can speed the process up by giving people, I hate to say it, but sometimes I do recommend drugs. That is, I give them bile sequestering drugs.  Things like costyramine, cholestyramine, things of that nature actually bind to the chemical toxins in the gut much more efficiently than even fiber does. This is a good way of getting toxins out if someone has a really high chemical load.

Dr. Weitz:                          What about using clay or charcoal as binders?

Dr. Pizzorno:                     Right. Clay and charcoal, those all should work. Unfortunately, there’s not much research on them. That’s not surprising, because nobody makes money with those things. I wish there was more research on them. There’s a very small amount of research on rice fiber. There’s a small amount of research on wheat fiber, but not near as much as we would like, but what’s there is very encouraging.

Dr. Weitz:                          Okay.

Dr. Pizzorno:                      Let’s talk about another method, and that is sweating, saunas, okay?

Dr. Weitz:                           Yeah.

Dr. Pizzorno:                      Heavy exercise. It turns out if you … Have you had Stephen Genuis on your show?

Dr. Weitz:                           No.

Dr. Pizzorno:                      If you get a chance, I recommend it. He’s an MD in Edmonton, Alberta.

Dr. Weitz:                           Okay.

Dr. Pizzorno:                      He spends half his time doing research on toxicity and half his time detoxifying patients.

Dr. Weitz:                           Oh, cool.

Dr. Pizzorno:                      Everybody knows, well, saunas are supposed to be detoxifying because of all the sweating. Everybody knows that, but who actually tested it? Stephen went and got a bunch a people, got some volunteers, had them sweat, took the sweat, looked in a laboratory to see what was in it, full of chemicals and metals particularly cadmium. Sweating is a very effective detox system, and I recommend people do a sauna at least once a week and preferably twice a week to get the toxins out.

Dr. Weitz:                           Do you like infrared sauna?

Dr. Pizzorno:                      The nearest we can tell, it doesn’t matter how you’re sweating, just as long as you’re sweating. Whether it’s infrared sauna or regular saunas or running or like me playing basketball, it doesn’t matter, just, you’ve got to sweat.

Dr. Weitz:                           Cool.

Dr. Pizzorno:                      I can keep on going for as long as you want.

Dr. Weitz:                           Let’s keep going on with the detox protocols. You mentioned mercury and lead, and it’s interesting … Myself and I know other Functional Medicine practitioners sometimes get these chronic patients with these elevated levels of mercury and some of these other toxins, and it seems like it’s very, very difficult to get rid of them.  What do you do with some of these patients?

Dr. Pizzorno:                      Yes. I want to state as strongly as I can, that a lot of people say, “Oh, I’m toxic, therefore I should do a detox system protocol.” Well, don’t do a detox protocol until you’re sure that your organs of elimination are working properly. Because if you stir things up and can’t get rid of them, you’ll make yourself worse. A lot of people get discouraged about detoxification because of not appreciating that this is a process that must be done properly.  In my book, The Toxin Solution, I spend two weeks, make people aware of where the toxins are coming from so you stop putting them into your body, two weeks to clean up the gut, two weeks getting the liver to function properly, and two weeks getting the kidneys functioning properly.   We now have an epidemic of kidney failure. This is something that used to be so rare, and now we’ve got dialysis centers all over the place. Because people’s kidneys are failing from all the chemicals they’re being exposed to including prescription and non-prescription drugs. The nonsteroidal, anti-inflammatory drugs, particularly acetaminophen, are very, very damaging to the kidneys.

                                           Okay. Now we have a cleanup, get everything cleaned up, and now we can start going on a detox program. The detox program that I recommend is having people do regular saunas, at least twice a week preferably three times a week. Increase their fiber. Go on a mild caloric restriction, I don’t want to do a lot of caloric restriction. Because for a person saturated with toxins, and they start losing weight, and their fat starts breaking down, it releases the toxins.  Just a little bit to help release, and then I put them on an alkalinizing diet. Reason for that is that many of the toxins in the body are more efficiently released when the body becomes more alkaline. I put them on an alkalinization diet, and what does that mean?  What that means is decreasing consumption of high sulfur containing amino acids, which means basically less meat, and it also means decreasing consumption of salt.    We consume so much salt that we impair the kidneys’ ability to get rid of other toxins such as excess acid but other toxins as well. By making the body more alkaline through decreasing sulfur and sulfur containing amino acids, and decreasing salt, we now have the body more able to get rid of the toxins, and we start detoxifying.

                                           Another point that’s important here is if you’re going to do detoxification not only must you do it properly, but you must also recognize it takes time. We’ve been trained to buy the modern chemistry to expect treatment from doctors to be really fast.

                                           You have pain, you go and take an anti-inflammatory drug, a nonsteroidal anti-inflammatory drug, your pain inflammation well, within a few hours, it’s dramatically better. Well, modern living through chemistry. It sounds good. Well, of course, most of those drugs work so quickly, because they simply poison the body’s enzyme systems that are producing the symptoms not actually dealing with why people are sick but anyway get quick results.

                                           Then we do nutritional medicine. It’s not as fast as drugs, but it is a little quicker than detoxification. When we get people the nutrients they need, it can be weeks, sometimes even months, to get enough nutrients into the body, so the body works properly. That’s fairly good.

How about for detoxification?   First, you have to stop the toxins coming in. Then you’ve got to get the toxins out of the body. Then all those enzyme systems that have been poisoned by those toxins, they’ve got to be replaced, and now your body can start healing. This takes months to even years to get the job done. But if you work at it properly, the health benefits you get are profound and long-lived.

Dr. Weitz:                           Cool. How do you support the gut to get it ready for detox?

Dr. Pizzorno:                      There’s a protocol I’ve been using on patients now for, oh God, 40 years. I developed it myself, and I noticed that other people have now developed derivatives of it, but it’s very straight forward.  First off, kill off the bad bacteria, and I use good old goldenseal to do that. Because goldenseal will kill the bad bacteria but leave the good bacteria alone.

Dr. Weitz:                           Goldenseal is basically a source of berberine?

Dr. Pizzorno:                      Right. The berberine and hydrastine in the goldenseal kill off things like Clostridium and other toxic bacteria.

                                           The second thing I do, and I’ve learned from my poor patients, is that when you kill off all that toxic bacteria, they release a lot of their toxic constituents. Remember there’s 10 times as many bacteria in your gut as there are cells in our body. When they die, they release everything that’s in the cells, bacterial cells, and lots of problems. You have to use a lot of fiber while you’re doing this to make sure you’re absorbing the toxins as they’re being released.

                                            Next thing we want to do, of course, is re-seed the gut with proper bacteria. I prefer broad-spectrum strength bacteria, not just one bacteria, but lots of good ones. Finally, we need to stimulate the healing of the damaged gut.

                                            So four steps: 1. kill the bad bacteria, 2. absorb the toxins that have been released, 3. re-seed with healthy bacteria, and 4. then stimulate the healing of the gut.

Dr. Weitz:                            Essentially, your version of the 4R Program.

Dr. Pizzorno:                      I did this about 10 years before anybody ever heard about the 4R Program. That’s one of the reasons why I’m one of the people who helped found Functional Medicine. Because I’ve been working on this for a long time.

Dr. Weitz:                           Right.

Dr. Pizzorno:                      It’s why I have literally hundreds of patient stories, people with this, that, and the other chronic disease where I did this foundational, age-old naturopathic program which is: clean up the gut. And clean up the gut, a lot of disease goes away.

Dr. Weitz:                           Right.

Dr. Pizzorno:                      Old time age old adage and that is, “Disease begins in the gut.” I was taught that when I was a third-year student almost half a century ago.

Dr. Weitz:                           That’s great, very profound. You ever do stool testing to see what’s in the gut first?

Dr. Pizzorno:                      Yes and no. The method that I use for determining how toxic the gut is, is relatively simple and inexpensive, because that allows me to do it more frequently. There’s something called the Obermeyer test, also known as the Indican test. I don’t know if you’ve run across this.

Dr. Weitz:                           Is it like a urine test?

Dr. Pizzorno:                      A urine test, right.

Dr. Weitz:                           Okay.

Dr. Pizzorno:                      The urine test measures something called indoles and skatoles in the urine. What these are, are the, you might say, the breakdown of protein by the wrong bacteria in the gut that produces these chemical toxins. I say to the patient, “I think you have a toxic gut, and you have a lot of indoles and skatoles,” and, of course, you get a blank face with your patient. Then I say, “Well, they have other names. They’re also called putrescine and cadaverine.” Okay?

Dr. Weitz:                           Right.

Dr. Pizzorno:                      When you say that, all of sudden the patient says, “Oh, that doesn’t sound good.” Anyway, I use this test, and it’s a real simple urine test. Actually, I used to … My undergraduate degree is in chemistry, so I actually-

Dr. Weitz:                           Is this part of an organic acids profile?

Dr. Pizzorno:                      No, it’s unfortunately not.

Dr. Weitz:                           Okay.

Dr. Pizzorno:                      I wish it was available, but it’s a test … There is a website on the internet that does sell it. It’s real inexpensive, and if you have any chemistry capability of your own, you can make up the test yourself.

                                           Well, you take some of the patient’s urine. You shake it up in this little vial, turns bright blue in proportion to the amount of indoles and skatoles or putrescine and cadaverine in the gut. As I put them on the protocol, I have them come back once a week to test the urine. It’s really inexpensive to test.

Dr. Weitz:                           You do the test in your office just like that?

Dr. Pizzorno:                      We do the test in my office, it’s real easy.

Dr. Weitz:                           Wow, very cool.

Dr. Pizzorno:                      Anyway, I just have them come back. I don’t have to see it myself. I have to make sure they’re progressing. We test them every week, and what we find is as we clean up the gut, the indoles and skatoles go away. It goes from blue to light blue to clear, and as their gut cleans up all their health improves as well. It’s a nice objective reinforcement for the patient to show that the subjective feeling their having of feeling better is also objectively demonstrated with the test.

Dr. Weitz:                           Wow, that’s great. That’s a real practical tool that we can use.

Dr. Pizzorno:                      Yes, very practical, very useful.

Dr. Weitz:                           Where do you get the reagent from?

Dr. Pizzorno:                      If you look at my book, the Textbook of Natural Medicine, I have the formula for making up the indoles … The Obermeyer test is in my-

Dr. Weitz:                           Okay, cool. It’s in the appendixes in the back?

Dr. Pizzorno:                      Right.

Dr. Weitz:                           Yeah, yeah. I just finished reading it, highly recommend that book very, very-

Dr. Pizzorno:                      Yeah. Now, that’s in the Textbook of Natural Medicine, not in my consumer book, The Toxin Solution.

Dr. Weitz:                           Oh, okay. Okay. Okay. Cool. Let’s see, so what is your liver detox protocol? How do we support the liver? Now, we’ve been talking about Phase 1 and Phase 2 of liver detox. Now people are talking about Phase 3. Somebody just mentioned Phase 0, so I guess it’s getting more and more complicated.

Dr. Pizzorno:                      You always have to be careful about losing the forest by looking too closely at the trees. I think these are all of interest, and indeed people have problems in every one of them.

                When I go back to the liver, I do really foundational things. That is first off, are the nutrients a person needs available for the liver to function properly? For example, look at those Phase 1, Phase 2, particularly, Phase 1 liver detox systems. They are all based on iron molecules, iron-containing molecules. If a person is low in iron, for example, most menstruating women, if they’re low in iron, they’re going to have trouble with their detox systems. Because they can’t make enough of the enzymes. I want to make sure they have enough iron. Also, those detox systems, enzymes both Phase 1 and Phase 2, are highly dependent upon magnesium and neuro-magnesium as well as the B vitamins. What I do with these people is, I make sure they’ve got the minerals they need like iron and magnesium, make sure the B vitamins are there so the detox functions properly.

                                           In addition, there are some herbal medicines we can use to do things like, I know it’s an age old thought that has been derided by conventional medicine, but liver detox. There are herbs you can use to help the liver get rid of the bile and other things that built up in the liver that are full of toxic material.  Things like artichoke, for example, Cynara, is good at detoxifying the liver. And milk thistle, for example, upregulates liver detox systems. Basically, make sure the nutrients are there, get the herbs in there to help stimulate things, and get the liver working quite well.

Dr. Weitz:                           Phase 2 is really crucial, right? Otherwise, you create too many toxic intermediates?

Dr. Pizzorno:                      Right. The way that many of the most difficult to detoxify chemicals are eliminated by the liver is they’re first activated by Phase 1 detoxification.

                                           Then and the [inaudible 00:36:46] molecules are actually way more toxic, and then they’re then bound to Phase 2 in something called conjugation, where these activated intermediates are more easily conjugated. Phase 2 conjugates them with things like, for example, glutathione.

                                           I mentioned glutathione before. Well, if you have a person who’s been consuming a lot of alcohol, for example, they’re depleting the glutathione stores. If they consume a lot of acetaminophen, they’re depleting their glutathione stores. What happens is that Phase 2 does not work as well, so they actually have more toxic compounds there.

                                           I then looked at Phase 2 and realized some compounds in Phase 2 can be easily depleted. We want to make sure there’s plenty of it there. That’s why N-Acetyl Cysteine is such a good molecule for detoxifications, because it increases glutathione production.

Dr. Weitz:                            Now, NAC, it’s interesting you brought that up. It’s my understanding that in order for Phase 2 of liver detox to work properly, you need sulfur containing amino acids like cysteine. But if you put the patients on a low sulfur diet in order to alkalinize them, you may be depleting Phase 2 liver detoxification.

Dr. Pizzorno:                      That’s a very good point. The NAC is a sulfur-containing amino acid and a small percentage of the population, I think maybe around 3%, I’m not sure but just looking at what experience has been treating people, have trouble metabolizing sulfur compounds. They typically are the deficient in molybdenum or the enzymes are genetically made so they don’t work very well, and people need extra molybdenum.

                                           Now when I’m giving people N-Acetyl Cysteine, particularly over a period of time or in particularly higher dosages, I also give them molybdenum to make sure they’re metabolizing it properly. With everything, it’s always a balance. Yes, N-Acetyl Cysteine is more acid-forming, but that’s easily taken care of by eating more fruits and vegetables. Real simple.

Dr. Weitz:                           Right. I think some of these detox powders have those specific amino acids as well. Do you ever utilize those as part of your protocol?

Dr. Pizzorno:                      I have used them, and I think they are useful. I notice that some patients like to be put on a program. They want to get a box with stuff in it that has everything they need. Days one to four, take this formula, then days five to seven, take this formula. Which is fine. There are good ways of doing this, and I support that.

Dr. Weitz:                           Can we order the Pizzorno detox box from you?

Dr. Pizzorno:                      Well, you can actually, if you go to Bioclinic Naturals. They have something called, the 7-Day Detox Kit, and that’s something that I helped design, and-

Dr. Weitz:                           Oh, okay. Cool.

Dr. Pizzorno:                      By the way, fair warning, I’ve had a lot of people tell me it was wonderful. But one out of four people, it detoxifies them too quickly. If you use that formula and aren’t feeling very good, it means your detoxing too quickly. You need to back off. But for everybody else, it works real well.

Dr. Weitz:                           Yeah, yeah. I find a lot of times, a 30-day detox is easier to do than a one week or two week or 10-day detox.

Dr. Pizzorno:                      Right. I want to reinforce what you just said. We have to realize, detox is not a fast process. If you think you’re doing a fast process more likely you’re going to run into trouble. It takes times.

Dr. Weitz:                           Especially if these toxins are stored in your body for long periods of time, in your bones, in your fat.

Dr. Weitz:                           Right. I think some of these detox powders have those specific amino acids as well. Do you ever utilize those as part of your protocol?

Dr. Pizzorno:                      I have used them, and I think they are useful. I notice that some patients like to be put on a program. They want to get a box with stuff in it that has everything they need. Days one to four, take this formula, then days five to seven, take this formula. Which is fine. There are good ways of doing this, and I support that.

Dr. Weitz:                           Can we order the Pizzorno detox box from you?

Dr. Pizzorno:                      Well, you can actually, if you go to Bioclinical Naturals. They have something called, the 7-Day Detox Kit, and that’s something that I helped design, and-

Dr. Weitz:                           Oh, okay. Cool.

Dr. Pizzorno:                      By the way, fair warning, I’ve had a lot of people tell me it was wonderful. But one out of four people, it detoxifies them too quickly. If you use that formula and aren’t feeling very good, it means your detoxing too quickly. You need to back off. But for everybody else, it works real well.

Dr. Weitz:                           Yeah, yeah. I find a lot of times, a 30-day detox is easier to do than a one week or two week or 10-day detox.

Dr. Pizzorno:                      Right. I want to reinforce what you just said. We have to realize, detox is not a fast process. If you think you’re doing a fast process more likely you’re going to run into trouble. It takes times.

Dr. Weitz:                           Especially if these toxins are stored in your body for long periods of time, in your bones, in your fat.

Dr. Pizzorno:                      A good example is people with high levels of mercury. Well, most people will say, “Well, let’s give you an IV,” DNPF, for example. Well, an IV DNPF will get the toxins out really quickly, but you’re much more likely to have adverse drug reactions. I use the oral protocol instead. It takes maybe three times longer, but you don’t get side effects. I’d rather it be a little slower and not cause unexpected damage.


Dr. Weitz:                           That’s great. Well, thank you Dr. Pizzorno. This has been a great interview. You’ve given us a lot of very interesting information about toxins, and how to avoid them, and how to get rid of them.

Dr. Pizzorno:                      Great, happy to help.

Dr. Weitz:                           For those listening to this, how can they get a hold of you?

Dr. Pizzorno:                      Well, you can go to my website drpizzorno.com. D-R-P-I-Z-Z-O-R-N-O dot com. I’m trying to set it up, so that it’ll be easier for people to connect with me. I’m still learning about all this social media stuff.

Dr. Weitz:                           Right.

Dr. Pizzorno:                      Also, I have a Twitter account Dr. Pizzorno D-R-P-I-Z-Z-O-R-N-O.

Dr. Weitz:                           Okay.

Dr. Pizzorno:                      Whenever I say something interesting, I’ll tweet it. Not whenever … When I have some time, and I say something interesting, I’ll tweet it. Because I say interesting things all the time. I don’t always have time to tweet it though.

Dr. Weitz:                           Right. And The Toxin Solution, they get a hold of that wherever bookstores … at all the bookstores, Barnes and Noble, Amazon. And when is your textbook for clinicians on environmental medicine going to be available?

Dr. Pizzorno:                      Clinical and Environmental Medicine  will come out July 7th, and Elsevier will be the medical textbook publisher. I’m really excited about it. Because, while, I have a good body of knowledge in this whole area of environmental medicine, Walter Crinnion my co-author also has a huge body of knowledge. What’s was surprising to us is there wasn’t actually a lot of overlap in our knowledge bases. By putting both of our work together in one textbook and really being rigorous and looking at a lot of science, I think we’ve created something that’s going to be fantastic. I’m so excited that’s going to be coming out.

Dr. Weitz:                           That’s great. I can’t wait. I’m very excited for that book to come out, so put me on the list.

Dr. Pizzorno:                      Okay.

Dr. Weitz:                           Thank you, Dr. Pizzorno. Hope to talk to you soon.

Dr. Pizzorno:                      Great chatting with you.

Rational Wellness Podcast 051: Improving Posture with Dr. Steven Weiniger

Learn how to improve your posture with Dr. Steven Weiniger who speaks 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

1:41  Dr. Weiniger explained that he noticed that his chiropractic patients would often improve but then their symptoms would return. He then studied with Dr. Vladimir Janda in the Czech Republic and also blended yoga and the work of Patanjali, Pilates, Alexander, and Feldenkrais into some systematic clinical protocols.

5:06  Dr. Weiniger said that if you train your body to do stupid things, your body is going to get really good at doing stupid things, meaning that you will become adapted to postures that place structural stress and damage your body. Dr. Weiniger talked about becoming aware of your body and strengthening your posture. 

6:50  Holding your body in an asymmetrical way will lead to abnormal stresses and wear and tear on your muscles and ligaments and calcium deposits building up in your spine and other joints.

9:28  I asked about forwards head posture, one of the most common postural flaws, and what are the health consequences and what to do about it?  Dr. Weiniger explained that you need to look at the whole body from the bottom up and make sure that it is all balanced. He talked about how headaches result from forwards head posture due to the shortening of the suboccipital muscles and the connection between the suboccipital muscles and the dura mater that covers the brain. He also talked about how from sitting with forwards head posture you get a shortening of the suboccipital muscles and a weakening of muscles in the front of the neck. You’ve got tight muscles at the top of the chest and weak muscles in the upper back.  That makes it very difficult to just change your posture since they have trained their body to sit differently.

16:33  Dr. Weiniger highly recommends taking a posture picture so the person can visualize how distorted their posture has become and gain awareness.  Dr. Weiniger talked about the Strong Posture Protocols that he teaches in his book Stand Taller Live Longer.  “So, you want to be addressing the three elements of balanced alignment and motion in a posture strengthening program to connect somebody more accurately with the reality of how are they balancing? How are they aligning, and how are they moving?”

26:53  We discussed lumbo-pelvic alignment and what posture is optimal.  Dr. Weiniger talked about how to create postural balance and how to work toward a pain free range of motion and balanced strength.

38:10  I brought up scoliosis and Dr. Weiniger explained that the focus of his program is not currently on scoliosis and scoliosis is more of a neurological thing to him. But doing a 7 week strong posture program is a good way to start. 

41:09  Dr. Weiniger said that practitioners can go to posturepractice.com . If you are a lay person, please go to Posturezone.com  or to PostureMonth.org  And you can also download the free posture app, PostureZone app onto your iphone or ipad.  


Dr. Steven Weiniger is a Doctor of Chiropractic with a specialty in posture analysis and correction. Dr. Weiniger is an author, speaker, and internationally recognized posture expert  https://www.bodyzone.com/posture-expert/  Dr. Weiniger has written Stand Taller Live Longer: An Anti-Aging Strategy available through Barnes and Noble  https://www.barnesandnoble.com/w/stand-taller-live-longer-steven-weiniger/1009154991?ean=9780979713606  and Posture Principles-–5 Principles of Posture. 

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 as well as chiropractic work by calling his Santa Monica office 310-395-3111.


Podcast Transcripts

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

                                            Hey, Rational Wellness podcasters. Thank you so much for joining me again today. We have a very interesting topic. Normally, we talk a lot about nutrition and functional medicine, and today, we’re going to talk about posture and it’s more of chiropractic oriented discussion but posture is just as important for your overall health and part of your anti-aging strategy as eating right, and exercise, and sleep, and everything else.

                                           Our guest today is Dr. Steven Weiniger. He is an internationally known posture expert. He’s trained thousands and thousands of patients and other doctors on improving their posture. His professional program is known as the Certified Posture Exercise Professional program. He is the creator of PostureZone, a free posture assessment app, and his latest book is Stand Taller Live Longer: An Anti-Aging Strategy. Steve, thank you so much for joining me today.

Dr. Weiniger:                     Ben, thank you for having me.

Dr. Weitz:                            How did you get so interested in posture? How did that become a focal point for you?

Dr. Weiniger:                     Well, I’ll tell you, as you said at the beginning that this is a chiropractic oriented, and you’re right that that’s where we started from but posture is very much health to everybody. The way that I started was as a chiropractor. People came to me with problems: neck pain, back pain, and we got it better but a lot of times their problem came back, and I worked on them again, and I got them better, and their problem came back. This is a common complaint of a lot of chiropractors.

                                           And I started getting into, kind of at the same time, both yoga personally because I had some significant flexibility issues and some issues with my posture and my body, as well as the work of Vladimir Janda, who was the originator of what’s been called the Prague school of rehab. And I spent time in the Czech Republic with Vladimir when he was alive and we observed that there are ways to train bodies to move differently. But if you don’t train the body to move differently, it’s going to start to move the way you’re training it to move, and that was one of the Janda’s big insights and the effect on that are more detailed scientific perspective with things like what’s called Upper-Crossed and Lower-Crossed Syndrome, which are a common posture observation within both the chiropractic and the therapy worlds.

                                          That there wasn’t a systematic way to address a patient and once we started working on melding the work of yoga, and Patanjali, and some other people in the posture world like Pilates, and Alexander, and Feldenkrais into something that was more systematic for a clinical protocol.  And it’s expanded. We started having a practice that we were seeing patients, and then doctors started to come because they were hearing what we’re doing and then we started teaching seminars to other professionals and they wanted the tools. So, we developed other tools and other things to help promote the idea that posture is important and you can do something about your posture, to strengthen your posture. 

Dr. Weitz:                          Yeah, I know, on a daily basis I get patients coming to my office with neck pain or back pain, and they say, “How did it start? I didn’t do anything. I didn’t strain myself. I didn’t lift anything.” And a lot of times, a common factor is they’ve been sitting with lousy posture for hours at a time, slumped, rounded shoulders, forwards head all these different postural flaws. Maybe they’re sitting twisted typing into a keyboard with a monitor off to the side. So, I’ve come to understand the importance of posture and trying to retrain my patients into using better posture and you’ve got a really detailed system for helping to do that.

Dr. Weiniger:                     Well, we do and then part of it is changing the perspective of what posture is because the word that you use kind of says it all. People have lousy posture. It’s putting it into a box where you almost are making pathology of it and it’s not a pathology. If you train your body to do stupid things, your body is going to get really good at doing stupid things. And when you’re focused on your phone or your keyboard, and you’re disconnecting from an awareness of your body, you become disconnected from it. So, changes happen that, “I don’t have to stop. I’m a little bit tight, I can keep on going,” and your body gets better and better at moving in those adaptive ways.

                                           I’m not saying that we should all get rid of our phones and go back to living a simple life because that means we are out in the fields toeing things and running around and chasing bikes in which is not the life that I see myself living but if you’re going to spend a big chunk of your time doing what we do, being more aware of your body so that you’re dealing with a less mechanically stressed posture and doing things to turn your body back the other way. It’s not a matter of just getting rid of the pain, it’s a matter of, “How can I strengthen my posture?” Because it’s not a good or bad.

                                           If I told you your posture was bad, you’d say, “Oh, yeah. I know that. That’s the way that I am,” and a lot of your patients, I’m sure have said that. But if you tell them, “Your posture’s weak, then that opens a little question in your mind of, “In that case, what we need to do? How do I strengthen it?” And that’s what we teach doctors to do with patients.

Dr. Weitz:                          Right. Well, really isn’t it about how efficiently we resist the forces of gravity because gravity, all day long, is pushing down on us and if we’re not properly balanced, then when I can efficiently resist gravity and there’s going to be abnormal stresses on our muscles, our ligaments, our joints.

Dr. Weiniger:                     Almost right. You said abnormal stresses, if you hold your body in an asymmetric position, it’s normal to have those mechanical stresses occurring in that asymmetry that’s going to normally result in asymmetric forces that’s going to make wear and tear. That’s going to make … Calcium deposits, that’s going to make stretching occur. That makes that the easier, mechanically speaking, posture to hold because all other things being equal, symmetry changes when you keep on molding it into an asymmetric position.

                                         So, if it’s somebody that has a marked forward head posture and kyphosis but if they’re laying on their back, their head is extended 30 degrees on a flat surface. You must stand with your head on top of your shoulders for that person’s architecture. That’s not their normal because they’ve worked hard, not intentionally, but they’ve worked hard to change their posture. One of the book that I wrote for the public, and that a lot of professionals use, a lot of CPEPs use to teach their patients and posture programs is based on five principles of posture, five concepts and the second posture principle is balance. Your posture is how you balance your body no matter how … If I’m standing all horribly posture bent forward but I’m standing, the question that we ask people is, “Is my posture balanced if I’m like this? Is it balanced?”

Dr. Weitz:                       No. It looks like you’re going to fall over to your left.

Dr. Weiniger:                  On an overall mechanical basis, is it balanced?

Dr. Weitz:                       Well, I guess you could say because you’re standing, it must be.

Dr. Weiniger:                  It’s not that you could say, but in objective reality, in looking at it from a rational empirical basis, if you are vertical, it is balanced.

Dr. Weitz:                       But you’re not necessarily loading joints on both sides equally.

Dr. Weiniger:                  That’s the point. It’s not symmetric. It’s not efficient. It’s not good long term but on an overruled by a mechanic’s basis, it is balanced. If it weren’t balanced, it would fall down. The principle is your posture is how you balance and that pattern of muscle asymmetry on multiple layers of functional compensation and structural adaptation it’s precisely what you want to be observing, looking at, and working with to address and to strengthen posture.  

Dr. Weitz:                       Why don’t we start by talking about one of the most common postural flaws, certainly, that I see in my practice, which is the forwards head posture and that’s the one where the person’s head is jutting forwards and that’s usually a result of sitting and looking at their laptop, or their iPad, or just using poor posture at their desk writing. What are some of the long-term consequences that can occur from forwards head posture, and then what are some of those strategies that we can utilize to reverse it?

Dr. Weiniger:                  I’ll answer that question but let me change the perspective just a little bit. If your posture is how you balance your whole body, and your head is going forward, even though you’re not thinking about it, something else is suddenly going backwards, or some things are going backwards, or there’s some other zigzag occurring. Your posture is a whole body phenomenon and I agree, the habit pattern of working on a computer, close-quarters texting where you’re looking down instead of up, strategies for addressing texting instead of wrapping your head down to your device, lifting your device up, looking more at it, then that’s part of being conscious of it. The challenge becomes if you only work on the top, then you’re making different compensations occur lower down the chain.

Dr. Weitz:                       Now, that’s while you’re standing, how about when you’re sitting?

Dr. Weiniger:                  When you’re sitting like you’re still balancing and the muscle patterns of asymmetry from standing to sitting, they’re not exactly the same. But if you don’t retrain one, the one that’s been longer standing is going to keep on being a bias towards the one you are trying to retrain. And since humans are made to move from a dynamic point of view, and it’s one of the things that Janda talked about with the Lower-Crossed being the most common postural syndromes, the force propagation is bottom to the top because you’re balancing on your feet.  And just like, if you had a stack of kiddie blocks, I don’t know if you have kids but when my kids were little-

Dr. Weitz:                       Yeah, I have older-

Dr. Weiniger:                  Again, how can you get the stack? And if it was wobbly at the top, you didn’t fix the one on top, you gotta go down to the bottom. Get up a stable base and work your way up. So, in terms of awareness about what a head posture, pulling your head back makes sense, the problem that many people going to have is because they’ve trained that forward head posture. Some muscles have gotten too long and some muscle have gotten too short, and that is symmetry in a front to back direction is what sets up a lot of the health consequences, probably the most. Excuse me.

Dr. Weitz:                       Yeah. You were going to talk about some of the health consequences of having forwards head posture. 

Dr. Weiniger:                  One of the most common everyday health consequences are headaches. And when your head goes forward, it’s going straight forward, your heads going to have to tilt down unless you lift it up again, and when you lift it up again the muscles at the very top of the spine, the suboccipital muscle between the occiput … Exactly, at that last little hinge you just did when your head jerked up the muscles you were using, the back part of your neck, just under the occiput. The occiput to C1 to C2, those muscles are going to have to become shorter and that chronic shortening of that group of muscles called the suboccipital muscles creates muscle tension.

                                        And a lot of people say, “Well, I’m just tense, that’s why I’ve got a headache.” If you’re holding your head in that position, especially if you get more fatigue, those muscles have to work harder. In ’97, they found out that one of those muscles, the rectus capitis posterior minor had fibers that went between the skull and the first part of the spine, and connecting onto the lining around the brain, the dura mater. The theoretic reason for this is, it pulls that lining backwards to allow for more open flow of the fluid around the brain and spinal cord called the cerebral spinal fluid.

                                        In addition, in 2012 at Logan College of Chiropractic in St. Louis University, they found that the other muscles in that area, rectus capitis posterior major, obliquus capitis superior and ligamentum nuchae, which were all part of the deep, deep tissue connecting the skull and upper cervical spine. They also have connections that travel into and between the vertebra, and that directly touch onto the lining of the dura, the meninges that contain the fluid that holds the brain and the spinal cord. So when you have that kind of tension, that can affect that fluid flow.

                                       This is probably the best explanation for why, when somebody has chronic headaches, they go to a chiropractor with a killer headache, they’re dying, and, “Oh, man. Doc, I feel wonderful. Thank you. It’s like you opened a valve,” because you literally took the pressure off the base of the brain, but that’s one of many, many things. Something else that Janda talked about is, it’s very rare to have forward head posture existing by itself–you almost always have an upper torso compensation occurring also where your shoulders are rolling in because the hands are rolling in.

                                          It’s kind of scissoring, it’s called a collapse of the kinetic box where your head should be level, and your torso should be level. When one goes forward and one goes back, you have muscles that are getting tighter and weaker at opposite sides of that box. So, basically, you’ve got tight muscles at the suboccipitals and weak muscles in the front of the neck. You’ve got tight muscles at the top of the chest and weak muscles in the upper back.  And once that kinetic box collapses, that becomes the position of needing less energy to keep it there because of that muscular imbalance.

                                          So at that point, it’s not merely a matter of, “Stand up like this, it takes less energy,” because that person has trained their body to be differently, they can’t do that, and just trying to go in that position, the response is always, “That doesn’t feel comfortable to me,” because in their perception, their body looks like this, but if you took a picture of it, that’s not reality. And this is one reason why we highly recommend posture pictures so that you have a benchmark of, “Hey, how’s my posture doing?” 

In terms of what you can do to begin awareness, take a picture, see what you look like and try to text somebody take a picture, if a selfie of yourself doesn’t work. Having someone do it, you can do it with the phone that you have. The free postures on app will let you do it but you need someone else to help you. And when they take the picture, try to stand tall with what you feel like is, “Yes, I’m standing tall,” which is probably better than your habit is and that’s fine because people will must always find when there’s a problem they’re blown away by when they thought they were standing tall, what the picture really says.

Dr. Weitz:                          So, after you take a picture, then what are some of the strategies that you do to try to help a client like that?

Dr. Weiniger:                     The protocols that we teach professionals and that we talked about in Stand Taller Live Longer, are called the strong posture protocols.  And the strong constant protocols work with the three elements of posture. We’ve talked about sitting posture versus standing posture. Posture is not just when you’re static, not moving. If you’re running, you’re going to have a running posture. Your running posture will have the patterns of your standing posture, your sitting posture, because your posture is not just when you’re standing statically, it’s when you’re moving dynamically as well. And the three elements of posture begin with, what I spoke about a moment ago, balance.  Your posture is how you balance your body.  It’s also how you’re aligning your body, and you align and you move your body in patterns of motion.

                                        So, you want to be addressing the three elements of balanced alignment and motion in a posture strengthening program to connect somebody more accurately with the reality of how are they balancing? How are they aligning, and how are they moving? So, in terms of posture picture, that’s a benchmark of how you’re aligning and beginning retraining your benchmark of your perception of, “Yes, I feel like I’m standing tall and straight, the camera says otherwise,” me just telling you to move differently, you’re going to keep on coming back, “Well, that doesn’t feel right to me,” because your body has what’s called a proprioceptive system.

                                       I know you know what I’m talking about with that and it’s not something that’s an intellectual and you can just change it because you want to decide to, it’s something that you need to have a program or some way to retrain it bit by bit, pushing it in a direction that is more accurate to reality. We use a very, very expensive high-tech tool to help connect somebody to reality, it’s called a wall, you may have one. Seriously, using the wall to focus your attention on one thing at a time, and because you can’t focus on more than one thing at a time because that’s what focus is, one thing at a time. You can’t focus on your head, your shoulders, and if you ever think of a golf lesson and had somebody try to-

Dr. Weitz:                         I golf every week. 

Dr. Weiniger:                    If you’re changing a sway, if somebody tells you three things to change, what happens?

Dr. Weitz:                         It’s really hard.

Dr. Weiniger:                    Okay, the best coaches pick the most effective thing to change. Focus on one thing and work on that. And we do the same thing with retraining posture. And this is what CPEPs do to retrain people’s posture, to help them find their weakest link in their chain.

Dr. Weitz:                         What part can chiropractic adjustments or other parts of a chiropractic treatment play in making sure you improve posture?

Dr. Weiniger:                    Huge, because when you have a collapse of the kinetic box, if there is a segment or the spine or a shoulder, and hip, especially lower extremity, a knee or an ankle that is not moving with symmetry, you’re going to have that adaptive motion pattern keep on recurring so the best results with retraining and strengthening posture include restoring motion to links in the kinetic chain that aren’t moving and parts we haven’t moved for a long time. So, you can then direct the exercise to that previously neglected, unused link and use strong posture exercises to strengthen it to move towards symmetry, beginning with the alignment of using the wall and focusing on one, what’s called the posture zone at a time. The first torso pelvis linkage, then head torso linkage, then lower extremity integration, and then upper extremity integration.

Dr. Weitz:                         What do you think about some of the chiropractic strategies that various chiropractic gurus have come up with to passively stretch the ligamentous structure back into a more efficient shape? Things like traction devices with a roll here, and a weight, and different types of things like that where you stay for a period of time, maybe with some weight or something like that to try to re-stretch the passive structures?

Dr. Weiniger:                    Not necessarily evil but if you’re only working on the passive structures and you’re not working to strengthen it, the moment you load it, if you’re adding more stretch, why is something that’s overly stretched already going to change? Your body is not just things that are as tight, it’s things that are tight paired with things that are lengthened. And if you’re not teaching it to actively move towards symmetry, you’re not going to be fixing it, moreover, in a kinetic chain because your body is a kinetic of chain.

                                       It’s not just your neck. I know a lot of chiros dial into forward head posture and that’s an important thing but if you’re not done with the whole body, you’re missing a big chunk of what should be addressed effectively strengthening in a kinetic chain. If there is a tight link and a loose link and you scratch the whole chain, which link moves first? Think about it for a second.

Dr. Weitz:                         Yeah, you’ve got to repeat that question for me. 

Dr. Weiniger:                    Okay. Before we talked about, in the spine, if a spinal joint isn’t moving, that means it’s tight, agreed?

Dr. Weitz:                         Yap, yap.

Dr. Weiniger:                    And so, within the entire chain, if one link is tight and one link is loose, and you stretch the entire chain, what does it stretch? Where it’s loose or tight?

Dr. Weitz:                         Yeah. I guess the problem is it’s liable to stretch the loose part because that’s already moving. So, that’s one of the reasons why chiropractic adjustments say, “Get in there and mobilize the-

Dr. Weiniger:                    Tangling.

Dr. Weitz:                         … junction,” it’s important.

Dr. Weiniger:                    And the thing about chiropractic, as we learned in school back in the day, is you need to find the restricted link of motion and then you need to take out the tissue slack. If you try to adjust somebody without taking it at the tissue slack, what happens is nothing because most is going to go up and down the chain and part of what in effect chiropractic adjustment is identifying a site and identifying the direction that it should be moving and tractioning it in that direction to take out the type of the slack in motion.

                                       If you teach someone how to move differently, you also need to be incorporating their personal awareness of how they’ve trained their muscular system to move, which means how they’ve trained then neurological system to move and to stabilize that muscular system to make the force move in a different pattern. The problem is, if the pattern that you’ve been moving in that feels normal to you and that’s what your posture truly is when you look at it from a global biomechanic perspective.

Dr. Weitz:                         And of course, the person who has forward head posture, they also usually have certain other postural issues, such as a collapsed thoracic spine, internally rotated shoulders, and you’ve got to address those concerns as well, right?

Dr. Weiniger:                    Right. In terms of looking at internally rotated shoulders is it because someone’s got a tight pec, or a weak serratus, or is the problem the rhomboid stabilizing that? But then how does that tie into the psoas, but in that case, we also have a problem with its glutes and piriformis is neglected and you can’t get what’s going on back on top with the upper extremity with coracobrachialis. And this is why, from our point of view, the approach of work on one muscle at a time becomes this, like, you’re keeping that very long chain.

                                       Whereas, working with global body awareness and motion to address how the global body is balancing, how it’s aligning, and how it’s moving and looking and focusing on one possible zone linkage at a time has incredible leverage from what patients and doctors, of course, do all the things to help them make a dramatic difference and how they feel how they move. Very often the sports performance as well if they’re athletes because we want to move the accurate to reality. And if you know you’re standing tall on screen, that’s the beginning point of all your motions. All motion begins with posture, all emotion ends with posture. So, that resting position is not just an arbitrary position, it’s your perception of where your body is in space and what you’re doing to keep it there.

Dr. Weitz:                       So, when you look down at the lumbar-pelvic region, what are some of the most common postural flaws? There’s a lot of discussion about the fact that you’re supposed to keep the proper amount of backwards lumbar curve. Some people train flattening neck curve. Other people work on making sure you have enough curve day. We have a Pilates program in our office and there’s always a big discussion of neutral, and what is neutral, and everybody defines neutral differently. Do you try to flatten the lumbar spine or recruit the deep abdominal muscles? Do you keep it slightly arched? How much arched? So, what do you see as some of the most important postural issues related to the lumbar-pelvic region?

Dr. Weiniger:                  You’re encapsulating the problem that we work to solve because one of the challenges is that different people playing these games, doing these things … Not playing games but doing work and therapeutic modalities like this have different personal histories and experiences, and when you step two steps back, it’s not about what the perfect lumbar curve is nor is it, to me, about the perfect cervical curve, it’s about strengthening the body that you have because … and you would despite the fact that your body might not be perfect. Moreover, if you’re like the rest of humanity, it probably never will be.

                                       We need to take care of back and treat you, or that we need to work out how to functionally strengthen the body that you have been given genetically and in the way that you’ve treated it and take those consequences of those actions and actions are consequences into effect, including things like injuries that have created patterns and strengthening how that unique system can function in daily life. So, to answer your question about lumbar curve, because the big question is that is, if it should be more, if it should be less, if it should be stabilized in this way, if it should be stabilized in that way.

                                       I said that the second principle of posture was balance. Your posture is how you balance your body. The first principle of posture, your body is designed to move. If you recall muscle anatomy, a muscle contracts, the quick motion. Muscles only contract. Muscles don’t push. Muscles are never ropes. So, if I’m pushing, it’s not my muscle pushing, it’s a combination of leverage of muscles being combined to create that but the muscle itself is only shorting. Within a muscle, the shorting happens because of shortening of a muscle fiber.

                                       A muscle fiber is an individual cell. A cell will shorten because a nerve impulse hits it and there is depolarization of the membrane, calcium ions rush in. You have two different fibers actin and myosin, and there’s a little head on one of the other. When the calcium rushes in it goes like this and it shortens. Anatomy 101, remember that from school? When an individual muscle fiber contracts, it contracts fully or it doesn’t contract. An individual muscle fiber cannot contract halfway.  Is that truth to you? Is that truth to everybody that knows anything about biomechanics?

Dr. Weitz:                       Yeah. I completely agree. However, there is certainly a lot of discussion about things that don’t quite fit into that paradigm, like somebody has a lot of tone in their muscles. They’re not necessarily … Their muscles are not stronger. They’re just more toned, or they’re harder, or they’re-

Dr. Weiniger:                  And that’s totally agreed. The resting muscle tonus will affect appearance, but in terms of gross anatomic function from Guyton’s Physiology on down, there’s no one that I’ve ever met that will say that the muscle fibers can contract fractionally, that a fiber can contract halfway. It’s fully contracted or not at all. 

Dr. Weitz:                       But when it comes to the lumbar spine, isn’t it the case that having the curve there, some amount of curve, gives the spine more resilience to be able to handle load? So, if you look at somebody-

Dr. Weiniger:                  The question about curve though I think is misplaced because the point that you’re making … The question is which is more stable? The argument is, this amount curve or that amount of curve, which opens the question of, “Which direction do you stabilize in towards neutral, which is where a lot of your Pilates that came from?” And if you have Pilates in the office, you might feel … and that’s where your orientation comes from and that’s why I went through that because we’ve had people from every different niche that look at posture-

Dr. Weitz:                       No. Actually, my orientation comes from weight training. I did the whole bodybuilder, power lifting, weight training thing and studied that for years and years and years, and even wrote a book called The Back Relief Book. So, I’ve really studied it from that. So, I kind of clash with the Pilates instructors a little bit.

Dr. Weiniger:                 And when you talk to them, one way despite the model that I’m still at right now, which is like hardcore science biology 101, maybe 102.  Data that you can’t possibly argue it. And my point is from in terms of principles of posture that pretty lights are also immutable, your body is designed to move. So, the best strategy is not to get really good at stabilizing in this angle, or this angle, or this angle, but teaching people how to move with fluid accurate control all the way through a functional range with that load and with stabilization in different directions. That’s why we use balls and a lot of tools to strengthen people. The whole motion track of these wrong posture exercises use balls but that’s only after we’ve started working with before that alignment and before that balance.  Because the way that you move is dependent upon how you align in order to balance-

Dr. Weitz:                      Let me ask you the same question.

Dr. Weiniger:                 I’ll come back to it. Working with full range comes first and then yes, a little bit of curve makes sense. How much curve? Depends what your body genetics are and that’s why feeling your body and working with that makes more sense than an arbitrary, “This is perfect and you should be like this.”

Dr. Weitz:                      Okay, let me add another layer or a different way of looking at the same sort of situation. When you’re working with a client with a specific type of injury or low back condition. So, let’s say in one case you have somebody who has a confirmed herniated disc in their lumbar spine versus somebody who say has bony stenosis, where the bones actually are narrowing the space where the nerves and the spinal cord comes out of and is leading to pain. Do you treat those two types of conditions in terms of the posture of the lumbar spine differently …? For example, if I have a patient with a herniated disc, we’re going to tend to use more of an extension strategy.

                                      Usually, I’ll test a person and you know if they feel more pain or they feel radiating pain when they lean forwards and leaning backwards doesn’t make them worse, I’ll tend to focus on having more of a curve in their lumbar spine or working on having them do more exercises that involve putting a curb there as opposed to the stenotic person where we’ll work on trying to flatten a lumbar spine. 

Dr. Weiniger:                 That’s not a bad direction. If you’re curious, sometime I might challenge you to try to work on that person a little bit differently and then observe if there’s any difference in your outcome. My anticipation is you’ll find that what you’re doing passively when you work with somebody, and passively is both chiropractic, traction, muscle therapy to unlock and to facilitate the possibility of motion in an arc is something that you do want to work with and with a plan and a direction. But once you unlock something, any additional exercise for a couple of times doing extension is going to be a good stretch to them and you want them to be able to have that kind of practice.

Dr. Weitz:                       Oh, sure. Yeah, we definitely do that.

Dr. Weiniger:                 But having them go in stretching directions that’s going towards their pain free range is the big idea, and using that pain as a diagnostic makes sense. But using the direction of that motion being with stronger posture to take out other compensations up and down the kinetic chain is one of the things that really makes a huge difference.  Because otherwise, if it’s a low back problem that was someone’s got a stenotic canal, the stenosis is likely not in just the lumbar spine.  Moreover, the symptoms did not just start with the onset of the problem.  The body has been compensating into that for a long time.

                                      So, there’s things don’t wind up and down the chain. So, when you look at the person that you’ve taken care of that’s got, for example, marked forward body lean as you were describing with stenosis and you look at their head, they’ve got that same kind of head forward posture with extension, and if you start to teach them how to incorporate that strong head torso position as well as doing the extension you’re doing, my anticipation is you’ll find the results are better.  Because you look at people doing it right now, most of them, if not all of them, are using some compensation in the top of their kinetic chain and below the kinetic chain.

                                         They do more knee bend and you’re saying something, “Well, you want to keep the knees more straight,” and one of the things that we do with the strong posture protocols is by tiering where you want to be focusing the effort, using what we call mass versus dry cueing, to focus some of the tension on this is the important thing right now to gain that control to the maximum of their biomechanic potential.  And then sequencing it in a direction, you can get a more profound change more systematically, because you’re making them focus on the things that they reflexively don’t want to move that are weak, because that’s where their reflexes are.

Dr. Weitz:                         Interesting. So, what about scoliosis or this curvature that some people have? Is that beneath the posture thing? Is that something you address as well?

Dr. Weiniger:                    I have addressed it. I’ve seen some cool things with it. Even though some CPEPs … CPEPs are Certified Posture Exercise Professionals the people that use the tools that we talked about and that teach … And they are chiropractors, largely, they’re also trainers and physical therapists, and Pilates teachers, and Feldenkrais teachers. And one of our CPEPs is Feldenkrais instructor of other Feldenkrais teachers, and yoga people, and anyone that looks at biomechanics like trainers. A lot of people, in their own practices, incorporate strong posture. I lost my train of thought, what were we talking about?

Dr. Weitz:                         Oh, scoliosis.

Dr. Weiniger:                    Oh, scoliosis. Scoliosis to me is more of a neurologic problem than a muscular problem and I know that there’s people that we trained in that direction using different kinds of braces that are potentially interesting, I know a lot of this stuff that’s been done historically is with surgeries and what not, and braces, and Harrington rods is … I’m less focused on that, some of the muscular as things going for scoliosis like Scott, and others in those directions, have reported decent results and we’ve looked at it but I’m not focused on scoliosis. I’m focused on overall body posture, because, if and when we come with a scoliosis program, there’s other things that I see that are not being effectively incorporated into it that should be and could be, and I think chiropractic should be a good part of it. 

I personally have had some wild, wild cool scoliosis cases but candidly, I’ve had some that haven’t responded as well. Incorporating things like kinesiotape, instrumented soft tissue mobilization are as some of the things that can be incorporated that makes sense. We have a lot of people that work in those realms and that’s good. I would say if someone haven’t grown scoliosis, beginning a seven-week strong posture program is an easy down and dirty way to begin and see what happens. Take a picture and see what happens, and that’s why taking the picture here is such a valuable way to benchmark rather than getting into how you feel and not what do you think, and it’s a lot easier than taking x-rays.

Dr. Weitz:                         Right, cool. Well, I think you’ve provided us with quite a bit of interesting information Dr. Weiniger. For patients, people who are viewing this or listening to this as well as practitioners, what’s the best way for them to get a hold of you?

Dr. Weiniger:                    Two different questions: if you’re a doctor or practitioner, go to posturepractice.com, that is information on CPEP, certified posture exercise Professionals program. It’s got the CPEP logo on it. If you are a member of the general public, I would suggest going to posturezone for overall information, and for both, I wouldn’t suggest going to posturemonth.org. May is posture month and we are the instigators, and they call me the chief posture evangelist of posturemonth.org. Posture is important and having a good awareness of posture begins with being aware, taking a picture.

                                          In fact, the campaign for 2018, for this month’s posturemonth.org a program is ACE your posture. A, stands for awareness, C for control and E for environment. Be posture aware, take a picture. As I said I like the PostureZone app and the app is … It’s not ready, it’s my camera. Basically, use the app to take a picture of somebody, not my office, but to take a picture of somebody and to measure where the body is in space, to measure … Can I share it with you? It’ll be good if I share.

Dr. Weitz:                          Yeah, sure, yep.

Dr. Weiniger:                     So, this allows somebody to assess somebody else’s posture, and can you draw lines on it as well? Okay, so let’s go back. I’m uploading up a picture-

Dr. Weitz:                          And this is a free app that we can download and put on our phone or our iPad.

Dr. Weiniger:                     It’s a free app. PostureZone is a free app for iPad, iPhone, and Android.

Dr. Weitz:                          Okay.

Dr. Weiniger:                     I don’t know if it’s going to work. If you can see this from there.

Dr. Weitz:                          Okay, yap.

Dr. Weiniger:                     Okay. I took this picture before … When you take the picture, there’s a line on the top on the bottom that you want to rotate it to make it level and that’s aside view, so it’s taking a side view. And I don’t even see the bracket, you can move around to bracket, the head, the torso, the pelvis over the feet, and you can double tap to make it a bit more precise in the pro version. To get a picture of where someone … Basically, your posture is how you balance your body. So, benchmarking when you’re trying to stand tall. It’s like as where’s your head or your torso, it’s where’s your head torso and pelvis over your feet because it’s about the whole body and then assessing the picture to benchmark the degrees of deviation of the head over the feet, the torso over, the feet and the pelvis over the feet when you believe you’re standing straight.

                                         And then you can save that in a folder and this is my messing around folder and compare today’s picture to prior pictures and see what kind of changes occur. If you’re a professional, the free version … If you’re a professional. It’s a one-time purchase, there’s no monthly things. I think it’s 29 bucks, and you can chuck the rate reports on and PDFs, and email amount and communicate to patients and people what their posture looks like and that’s what we do. If you’re a member of the public and you’ve got a question about your posture, if you look in the PostureZone app when you get it, there’s a button that says, “Find a posture professional.”

                                         And all hands on, there’s a CPEP near you that does strong posture work and that may be even be doing free posture pictures for the month of May, and if you would like to have a free posture picture, go to your CPEP and let him or her take your posture picture so you know what you will look like when you’re trying to stand tall.

Dr. Weitz:                        Cool. That app looks like something that would be really useful. I’m going to go download it as soon as I get off this call.

Dr. Weiniger:                   Fantastic. If I can give you a hand with it, let me know, doc.

Dr. Weitz:                        Thanks, doc. I really appreciate your time and we’ll talk to you soon. I’ll put your information in the show notes on my website.

Dr. Weiniger:                   And I forgot, buy Stand Taller Live Longer, its a prejudice but it’s a great beginning to understand more about posture.

Dr. Weitz:                        That’s great. Buy Dr. Weiniger’s book, Stand Taller Live Longer, and until then, we’ll see you next time.

Rational Wellness Podcast 050: Lyme Disease with Dr. Darin Ingels

Dr. Darin Ingels talks about how to manage patients with Lyme Disease with Dr. Ben Weitz. 

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


Podcast Highlights

3:15 Dr. Ingels explains that he got interested in Lyme Disease because he suffered with it and found that antibiotics were not the long term solution. He realized that taking herbs and changing his lifestyle were better long term strategies for treating Lyme Disease. 

5:25  We discussed the symptoms that might alert you to the fact that a patient has chronic Lyme Disease. Dr. Ingels pointed out that it can be confusing to diagnose Lyme, which is why it’s known as the great imitator. Patients may complain of brain fog, memory problems, dizziness, and balance problems.  There can be migrating joint point, numbness and tingling, and a sensation that there are ants crawling under their skin, or a burning sensation in the skin.  There can also be chronic swollen glands, fevers, and chills.

7:30  Dr. Ingels points out that Lyme is often associated with chronic rheumatological conditions like rheumatoid arthritis and lupus. Lyme can also be a trigger or catalyst for things like Multiple Sclerosis, Parkinson’s, and Alzheimers. Dr. Ingels explained that if you treat the Lyme their MS may get better or go away. He explained how when the immune system attacks an infection like Lyme Disease, through molecular mimicry it may then attack our own tissues and this can result in triggering an autoimmune diseases like MS.

10:40  I asked what is the best way to test for Lyme Disease?  Dr. Ingels said that the conventional testing is not very sensitive–say 40%–and the diagnosis a lot of times is based on clinical symptoms.  The testing is less accurate the further away you are from the initial infection.  He said that the testing offered by Quest and Lab Corp is not very accurate but testing offered by specialty labs like IGenx are somewhat better. 

15:32  Dr. Ingels recommended also testing for common Lyme Coinfections, like Bartonella, Babesia, Anaplasma, Ehrlichia, Tularemia, and a new virus called the Powassan virus, which has been responsible for a few recent deaths.  These are infections that are also spread by ticks.

18:03  Dr. Ingels described his 5 step plan for treating Lyme Disease: 1. Treat the gut, 2. Alkaline diet, 3. Herbal protocols, including the Zhang protocol and the Cowden protocol,  4. Clean up the toxins from your environment, like mold, 5. Lifestyle factors like sleep and exercise. 

28:34  I asked Dr. Ingels about using Ozone therapy, a commonly used modality among Lyme practitioners I know, and he said that the benefits of oxidative therapies like ozone and hyperbaric oxygen are short term and they are also expensive, esp. since you have to do quite a bit of it.  Dr. Ingels likes to use Low Dose Immunotherapy (LDI), which he finds very effective.

34:05  Dr. Ingels explains how you repeat his 5 step protocol again for patients who are still symptomatic.



Dr. Darin Ingels is a Doctor of Naturopathic Medicine practicing in both Southern California and also in Connecticut, who has a specialty in treating patients with chronic Lyme Disease and he has recently written The Lyme Solution: A 5-part Plan to Fight the Inflammatory Auto-immune Response and Beat Lyme Disease, which can be found on Barnes and Noble, https://www.barnesandnoble.com/w/the-lyme-solution-darin-ingels/1126791520   Dr. Ingels can be reached at https://dariningelsnd.com/ or you can call his office in Irvine at 203-254-9957.

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 as well as 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. Hey, Rational Wellness podcasters thank you so much for joining me again today. For those of you who enjoy this podcast, please give us a review on iTunes, it helps more people find out about the Rational Wellness podcast.

                           Our topic for today is Lyme disease, and we’re here with Dr. Darin Ingels. Let me tell you a little bit about Lyme disease first. So, Lyme disease is actually a very complicated and confusing disease that starts originally with an acute infection that can become chronic, and that goes on for years. Unfortunately a lot of people are not even aware that they have the initial acute infection, and this Lyme disease actually starts with a tic bite. Of course the tics can be so tiny that they’re very hard to see. And this results in an infection, with a corkscrew like bacteria, known as Borrelia Burgdorferi, although now we know that there are a number of different strains, including Borrelia, Miyamotoi, which is found more commonly on the West Coast, and a bunch of other strains found in other parts of the country and in other parts of the world.

                         After the initial infection, Lyme may create a chronic condition that’s very difficult to detect and treat. Such patients may not have any knowledge about having been bitten by a deer tic, and exposure could’ve been years ago. The Centers for Disease Control estimates that there are approximately 300,000 new cases of Lyme disease per year in the US, and this number seems to be increasing.

                         I’m happy that we have Dr. Darin Ingels joining us today to explain how to deal with Lyme disease. Dr Ingels is a licensed naturopathic doctor in both the states of California and Connecticut. His practice focuses on environmental medicine, with an emphasis on Lyme disease, pediatric acute onset neuropsychiatric syndrome, known as PANDA’s, and chronic immune disfunction, including allergies and chronic infections. Dr Ingels has published a number of books, including the Natural Pharmacist, Lowering Cholesterol, Natural Treatments for High Cholesterol, and his book, The Lyme Solution, a five part plan to fight the inflammatory auto-immune response, and beat Lyme disease, which will have been just released by the time this podcast airs. 

                           Thank you Dr. Ingels for joining us today.

Dr. Ingels:            Good morning Ben, thank you for having me.

Dr. Weitz:            So, Darin, can you tell us how you became so interested in Lyme disease?

Dr. Ingels:            Sure, I became interested in it because I got it. There’s nothing like some personal experience to give you a very quick education on how to deal with it. So I actually contracted Lyme disease about 15 years ago, 3 weeks before I was set to open my own practice. I had classic Lyme disease with headache, joint pain, 105 fever, and a big bullseye rash on the back of my leg.  And I underwent conventional treatment with doxycycline, and after four days of treatment I actually felt quite well. But in retrospect, when I opened my practice, as you know I was the doctor, the receptionist, the bookkeeper, and I was doing everything. So it was 10, 12 hours days, and after about eight months of keeping up that schedule, I started to relapse and get symptoms again.  So I went back on treatment, and it wasn’t working, it changed treatments, it didn’t work.

Dr. Weitz:            So your initial treatments were antibiotics, right?

Dr. Ingels:            Yeah, my initial treatments were doxycycline, which is the recommended treatment for acute Lyme disease. And I did take it for 21 days, even though I felt better after about four. But after eight or nine months of keeping up with that schedule, and I started getting symptoms again, when I went back on the doxycycline or the antibiotics, it really didn’t do anything.

Dr. Ingels:            So I changed antibiotics and it still didn’t do anything, and over the course of really eight or nine months I kept changing antibiotic protocols, but it wasn’t helping, in fact I was getting a lot worse. So I had actually had a couple of patients that had seen a doctor in New York City, a Dr. Zhang, who’s a Chinese medical doctor, and licensed acupuncturist, and he had been treating people with Chinese herbs.

Dr. Ingels:            So I saw him, he treated me, and it really got me 85% better in the course of about three to four weeks after starting his therapy. So I realized that I had kind of set the stage with my own lifestyle, that by not really taking care of my self it had allowed this organism to persist and eventually start to creep up and cause problems again.

Dr. Weitz:            Interesting. So what are the symptoms that would make you first suspect that a patient may have chronic Lyme disease? Because, you know, the acute disease with the bullseye rash, that’s relatively easy to know what’s going on, but the chronic patients, which is really the bulk of the patients that we might see for Lyme disease, and which is really the biggest problem, how do you identify that?

Dr. Ingels:            You know it can be challenging. We call Lyme the great imitator or the great mimic. It looks like a lot of different things, in fact there are upwards of 100 different symptoms that are associated with Lyme disease. So my feeling is when you have a chronic illness, if you’ve ruled out everything else and you can’t figure it out, that might be worth investigating.  But one of the things that we typically see in the chronic Lyme is this sort of myriad of different neurological symptoms, and people will complain of brain fog, short term memory problems, dizziness, balance problems. We can still see a lot of the symptoms you might see in acute Lyme disease, so people will complain of migrating joint point where it kind of wanders from joint to joint. One day it’s your left knee, one day it’s your right elbow, next day it’s your right ankle. You can see what’s called neuropathy, numbness and tingling, typically in your hands and feet, but really can occur anywhere on your skin.

                           People also describe what we call a sensory distortion where they’ll feel like there’s ants crawling under their skin, or a burning sensation in the skin. And you look at the skin and it looks completely normal, that tends to be associated with Lyme. You can also get chronic swollen glands, some people will still get fevers, chills.  So when you feel sick, and if it hasn’t been explained, and it’s been going on for not just a handful of days or even weeks, but when it starts to go on for months, that’s usually evidence that there’s some sort of persistent infection. And there really aren’t too many bugs that do that. So Lyme and some of these other co-infections that you can get through a tic bite tend to be associated with these long term effects.

                           So those chronic rheumatological symptoms, even things rheumatoid arthritis, lupus. A lot of autoimmune diseases have been associated with Lyme disease. And so it’s possible that Lyme really is the trigger or the catalyst for things like Multiple Sclerosis, Parkinsons, and Alzheimers.  If you go to your doctor and you ask him “Well, gosh, I’ve been diagnosed with MS. Okay, well why?” They’re not going to have a clue, and I think there’s some pretty good evidence in the literature that Lyme at least can be one of these organisms that triggers that kind of problem.

Dr. Weitz:            So, if Lyme is a trigger for some of those problems, if you go back and address the Lyme, will that help that condition, like MS or some of the other conditions you mentioned?

Dr. Ingels:            Absolutely, and I’ve treated several patients who were diagnosed with multiple sclerosis, that we also found out they had Lyme disease, and in treating their Lyme, their MS improves and sometimes even goes away. All the symptoms, and I’ve even had a couple of patients where they’ve had a repeat MRI, that’s part of how you diagnose MS, and there’s typically specific lesions you see on the brain, and we’ll see those lesions go away.  So was it MS?  Was it Lyme disease?  It gets to be a bit complicated, and I think the neurologists out there might have a different opinion on this, but a lot of these conditions are really descriptions, and they don’t specifically tell you why you have that condition. But again, I think there’s been some pretty compelling evidence that Lyme disease can become a trigger for autoimmunity. And whether it’s affecting your joints, or affecting your brain, that seems to vary from person to person who gets Lyme, but again, a lot of the issues that come up with chronic Lyme disease, there’s really this capacity for it to trigger autoimmune problems.

Dr. Weitz:            Is that because essentially when we’re dealing with Lyme disease, your chronic Lyme disease, we’re really not so much dealing with an infection, but with a condition of immune dysregulation?

Dr. Ingels:            Yeah, you know I think the infection is the initial problem, that’s why people feel acutely ill when they get affected. But the longer it stays in your body, there’s a concept in immunology called molecular mimicry, and what that means is that there’s a molecule on the organism that’s similar to a molecule that’s in your own body. So the immune system tries to fight the infection, it accidentally starts fighting your own tissue.  And so whether it’s in your joints, your intestinal tract, your skin, it really can affect any tissue. But again, there’s been some good evidence and studies that Lyme has this capacity to trigger that autoimmune event. And I think in most cases the brain and the neurological tissue just happens to be more affected perhaps than others.  So any of these autoimmune conditions, whether it’s Lyme, and there’ve been a lot of other organisms that have been identified as trigger autoimmunity, I think it’s important that people start investigating that microbe trigger. And fortunately we have a lot of different ways we can evaluate them.

Dr. Weitz:            Well when you suspect Lyme disease, what’s the best way to confirm that, or test for it?

Dr. Ingels:            The testing is a bit controversial, the CDC recommends what’s called a two tiered testing, where the first test is a Lyme screen, it’s a blood test, it’s an antibody test. And if that test is positive, it then flexes over to a more detailed test called a western blot.  The general rule is if your Lyme screen is negative, they don’t even do the second test. I was a microbiologist before I was a doctor, I used to work in a lab and do these tests, and in the laboratory world, a test to be a good test has to be both what we call sensitive and specific. So what are the likelihood it’ll pick up the disease if you have the disease? And if the test is positive, what is the likelihood that that’s an accurate result and not a false positive?

Dr. Ingels:            And a good test should be at least 95% sensitive and specific. Well, what we find with the Lyme testing is that it’s about 40% sensitive, which means it doesn’t even pick up half the people that have Lyme disease. In our world that’s a terrible test, so I find it ironic that in 40 years of doing Lyme testing, we’ve really never changed that criteria. And we’ve learnt so much about Lyme disease that it just seems odd that nothing has really changed in how we’re looking at Lyme.  So if you go to the CDC’s website and read, Lyme disease is really what we call a clinical diagnosis. It’s based on your symptoms, particularly if you live in an area that’s endemic for Lyme. Plus you have to rule out all these other things like autoimmune disease. And when you’ve done that, that sort of starts narrowing it down. If your Lyme test comes back positive, false positives with Lyme tests are actually quite rare, but false negatives are extremely common.

                           So the bottom line is that a negative test through the conventional testing methods doesn’t necessarily exclude the possibility of Lyme. Now, the good news is we do have other labs out there that do more sensitive testing, they use different test kits. They also report it in a slightly different way, that increases your likelihood of picking up Lyme.

                            So, if someone’s really interested in getting tested, I recommend going to one of these labs that does better Lyme testing, and probably forgoing the standard Quest, Lab Corp test, just because of the small likelihood of picking it up, particularly the further you get away from being infected. Because we’re measuring antibody levels, your antibody levels should be highest closest to the time you get infected. The further you get away from that, immunity naturally wanes. So the likelihood of picking it up two years, four years, ten years after you’ve had exposure goes way down.  So, I think if you use some of the other labs out there, you increase your likelihood of picking it up.

Dr. Weitz:            Have you used Dr. Vojdani’s Immunoscience lab?

Dr. Ingels:            I have used his occasionally. There’s a lot of good labs out there, Immuno science I think does a good test. IGeneX, are probably the one that most people in the Lyme community use. They’ve been around a long time and they do very good testing. I also use a lab called Medical Diagnostics Laboratory in New Jersey. I like them, I think their testing is equivalent to IGeneX, plus they bill insurance. So for a lot of our patients who’ve already paid so much out of pocket, it’s nice that you can actually bill something to your insurance plan.

                           And then there’s a new lab that just came out, in fact I’m actually on their scientific advisory board, called Global Lyme Diagnostic. And the doctor that developed their test is actually a vaccinologist, and he was tasked to find a vaccine for dogs, for Lyme disease. But to create a vaccine you have to find something that’s very common to all these different strains of Borrelia. We know that in the United States there’s about 100 different strains of Borrelia, and there’s about 300 strains worldwide. We don’t even know how many of them are clinically relevant, our guess is it’s probably somewhere from 10 to 12.  So he had to find a sequence of part of the organism that’s common to all Borrelia, and so instead of making a vaccine, he actually turned it into a laboratory test. And because Borrelia Burgdorferi is the dominant strain, there are these other strains like Borrelia Miyamotoi, and many others. So this test actually looks at all the different strains of Borrelia.

Dr. Ingels:            The testing, I did mention it earlier, but the testing that’s available through what the CDC recommends, only really looks at Borrelia Burgdorferi. So if you happen to have another strain of Borrelia, either your test might be negative, or it might look kind of gray where maybe you get one or two antibodies, but not the full complement that you might expect.      So this is where we come back that a negative test doesn’t necessarily exclude the possibility of Lyme, because maybe you have a different strain of Lyme that’s not Borrelia Burgdorferi.  So the good news is we’re getting better in our testing, we have a lot more available to us, but again, at the end of the day, that piece of paper is really only confirming what we really already suspect, and you really have to go based on patients symptoms.

Dr. Weitz:            And is it valuable as well to test for some of the common Lyme co-infections like Bartonella, Babesia, et cetera?

Dr. Ingels:            Absolutely. So whenever we’re working anybody up for Lyme disease, you want to test for all these other co-infections. We know that in New England, where I spent part of my time, about a third of the tics that have Lyme disease also carry some other infection. I go to these Lyme conferences every year, and it seems like that list of things that tics spread gets more and more every year.  I don’t even know how practical it is to test for everything, now that we know that there’s a lot of bacteria, other viruses that can be transmitted through these tics. So we tend to go for at least the big ones, and then depending on what we find sometimes we have to start looking at the more obscure things that you can get through tic bites.

           But things like Bartonella, which is a bacteria that we typically associate with cat scratch fever. So even if you never have a cat, you can get this bug through a tic bite. Babesia, which is a cousin of malaria, it’s a blood parasite so it causes a lot of malaria like symptoms where you can get cyclical fevers. And there’s a thing called air hunger where you just feel like you can’t get a deep breath. Anaplasma is actually quite common in the North East, which is another bacteria. There’s Ehrlichia, there’s Tularemia, there’s a lot of other things.

           And I think the one that’s come out in the last year, especially in New England, is there’s a virus called Powassan virus. And viruses, because they behave differently than bacteria and they’re able to penetrate your cells a little more easily, can potentially cause a lot more problems. So Powassan was scary this year because there were actually several deaths associated with Powassan.

Dr. Weitz:            How do you spell that?

Dr. Ingels:            It’s P-O-W-A-S-S-A-N.  So for someone that’s got a really high fever, very acutely ill, particularly if you know that there’s a tic bite, there are a couple of labs now that are testing for Powassan virus.  But antibiotics don’t do anything for viruses, so I think what happened in those few cases is that they were probably treated with antibiotics, but it’s not the appropriate treatment, and unfortunately it was lethal in those cases.  Again, it’s an emerging virus, we haven’t had a lot of cases, but the few cases we had have been very severe.  So, it’s just one of those things that depending on how people are presenting, you have to rule out the possibility of having more than just Lyme, and look at the breadth of all these different infections you can get through a tic bite.

Dr. Weitz:            Can you talk about your five step plan for overcoming Lyme disease?

Dr. Ingels:            Sure. So, you know, I laugh when I say it out loud, a five step plan, it makes it sound so easy. Lyme disease is actually very complicated, but I was trying to condense it into a way that could really help people focus on some of these things that I see as really being obstacles for people getting better when they have Lyme disease. So, I don’t mean to simplify Lyme in any way, but this an easy way for people to think of it.

                             So the first step is really about treating the gut. And the reason is that your gut accounts for about 80% of your immune function. So if your gut’s not functioning well, your immune system’s not going to function well. And so many people I see with Lyme have chronic constipation, chronic diarrhea, poor digestion, gas, bloating, the whole gamut of things.  So, it tells me a little bit that your body’s ability to digest your food, absorb your food, might be compromised. And since you need all that nutrition to drive the rest of your engine, we want to make sure that all that’s working properly. So it’s important that people take stock of how their elimination is, their digestion, and you should be having at least one to two bowel movements a day.    I’ve had doctors tell patients that they poop once a week “Oh no, that’s fine. That’s normal.” That’s really horribly constipated, that is not normal. So it’s a good idea to take stock of how you’re eliminating, and then again I talk about in the book, there’s a lot of things we can do nutritionally to help support better bowel habits.  So things like glutamine can be very nutritive to the gut, to help heal the large intestine. Of course probiotics can be beneficial to help repopulate the gut, particularly if you’ve already been on antibiotics for Lyme disease. Antibiotics of course do set the stage for having an imbalance in your gut floor, or creating an overgrowth of yeast. So I use a lot of probiotics. And then we can use things like fish oil, and curcumin as natural anti inflammatories to help quell any kind of inflammation of the gut.

            So the first step is really let’s get the gut in good working order. The second step is really about diet, and I’ve tried a lot of different diets with people. There’s the paleo diet, the anti candida diet, of course the keto diet is very popular now. And having tried a lot of different things, the diet I’ve found for myself and for my patients that seems to work best is what we call an alkaline diet.

Dr. Ingels:            And what that means is that you’re eating foods that help promote better alkaline PH in your body. So for people who don’t know, PH tells us about how acidic or how basic your body is. It talks about your body chemistry. And virtually all your cells, with exception of your stomach, your bladder, and for women the vaginal area which is very acidic to help protect against outside invaders, the rest of your body is actually very alkaline.  So, by eating certain foods we can help keep that PH more balanced. And we get exposed to so many things in our world that make our body very acidic, whether it’s chemicals, medication, acid rain of course affects the PH of the foods that we eat. So that tends to make us acidic. And it’s a lot of details to simplify it for our purposes here, it’s basically eating a mostly vegetarian plant based diet.  We try to limit animal intake, so that’s meat, fish, shell fish, eggs, we try to keep that down to about 20% of your total dietary intake for the week. And then we eliminate all junk foods, all dairy, coffee, I know, I love coffee, but I found for myself even a few sips of coffee would trigger inflammation in my body. So if you’re a coffee drinker, it’s a good idea to start working on weaning that off.

                          And it’s not really about the PH of the food, it’s about what the food does in your body. So for example lemons and limes are very acidic, if you squeeze them on a PH strip they’ll turn very acid. But in your body they break down in a way that actually makes your body very alkaline. So starting your morning with a glass of lemon water or lime water is actually a great well to help start moving your body in a more alkaline state.  And this is one of these things where people can buy PH strips and they can do urine testing before they eat in the morning and later in the day. And they can monitor their progress, and kind of show how their body’s moving, whether it’s more acidic or more alkaline.  And it takes a little time and a little practice, but once people start to shift their diet we’ll see that they’re able to maintain that body PH a little bit better.

                         So that’s the second step. The third step is really about going after the active infection. So I talk about a lot of herbal protocols that I’ve used on myself, and I’ve used on my patients, to help treat the infection. I think when a lot of people get Lyme they feel like antibiotics are the only option, and in acute Lyme I’m a big proponent of antibiotics. I think for a lot of people it helps get rid of the infection before it ever gets to be a problem. But once you’ve gotten into the chronic stage there’s actually not very good evidence that antibiotics are terribly effective.       And I’ve heard people, and I’ve seen people who have gone on antibiotics and did okay, but I’ve seen a lot more people that went on antibiotics and got worse, or it did nothing at all. Or they had a temporary benefit, and as soon as they came off the antibiotics they started to relapse again.

                       So I talk about some of the herbal protocols I’ve used, if you go online and read about herbs there’s probably eight or nine different protocols out there. The top two that I tend to use, again, Dr. Zhang has a Chinese herbal protocol, that’s what I used to pull myself out of the weeds. And in Chinese medicine they always use formulas, they never really use single herbs.  So I like his protocol because it really addresses the gamut of everything Lyme does to your body. So not only does it go after eradicating the organism, it helps improve circulation, it helps boost your immune system, it’s anti inflammatory, it’s analgesic. So it does all these over things that Lyme can do to the body. So I think it’s really one of the more comprehensive herbal protocols out there.

                       And I’ve also used a variation of Dr. Cowden’s protocol. So Lee Cowden was a cardiologist in Dallas, I think he’s retired now, but he created a series of tinctures that come from the Amazon. And I like them because they’re liquid, so they’re great for kids who have Lyme disease that can’t swallow capsules. And his protocol’s actually been studied by a research at the University of New haven, here names Dr. Eva Sapi. And she’s actually found that those herbs worked better than antibiotics. So if people are concerned “Oh Gosh, herbs aren’t very effective,” well she’s actually proven that’s not the case.

                      So, going after the active infection is important. People ask all the time “Well, do you ever really get rid of Lyme?” My personal opinion is I don’t think so. I think it’s kind of like when you get chicken pox when you’re five years old and then get shingles when you’re 55, it’s the same virus that’s stayed in your body for 50 years. Oh, and the immune systems become compromised, it can start to become problematic.  So I think dealing with Lyme is really about controlling the organism, keeping it at bay, keeping it from getting to the point where it tips the scales that you become symptomatic. But because we can’t measure the organism directly in your body, at least not easily, we don’t really know if you completely eradicate it 100%. But my feeling is if we can get you to a point where you’re symptom free, then we’ve done a positive thing.

                   The fourth step is really look at things around your environment that undermine your immune system. So this is looking at things you put on your body, and in your hair, personal hair products that might contain potential toxins. Cleaning chemicals around the house, things you spray on your lawn. All these different chemicals can have a negative impact on your immune system, and we want to give your immune system every fighting chance it can.

                    And the one thing I probably talk the most about in that part is mold. Pretty much no matter where you live in the country, mold can be a bit of an issue. And symptoms of mold exposure or microcytotoxicity look almost identical to Lyme disease. When I have patient where we know they have Lyme disease, we’ve been doing Lyme treatment and we’re really not seeing a lot of progress, the next step is to look and see if mold might be part of the problem, because the treatment of course is going to be very, very different.  So evaluating your home, making sure your home is safe and free of mold. It’s always a good idea, particularly if you live in areas where there’s a lot of moisture or humidity, they tend to be at higher risk of having mold. And you could have a pinpoint hole in your roof and never see it through your walls, but there’s enough water that’s collecting there that creates a mold issue. So always a good idea to check that out.

Dr. Ingels:            And then the last part of it is really looking at lifestyle factors. Looking at things like how well are you sleeping. We know that your brains and your neurons repair themselves when you’re in that deeper start of sleep, and a lot of people I see with Lyme disease will tell me that after they got Lyme they started sleeping very poorly.  So whether they’re not getting enough sleep, or not getting a deep sleep, we have to find ways to encourage better sleep habits, to get you to that deeper start of sleep, because that’s when your brain and your body’s really going to start repairing itself.  And then looking at things like exercise, moving your body. I’m sure you know in your practice too when you get people who are chronically ill, the last thing on earth they want to do is move their body. But trying to find ways to get your blood moving is part of the way that we can help bring oxygen, nutrients to the tissue.

                           So, even for people who are in wheelchairs and are very limited in their abilities, if find that you can do stretching, you can do very mild forms of exercise like Tai Chi or Chi Kung, that are very low impact, but they still have a positive benefit on both your physical body and your mind.  And with regards to the mind, I think teaching people how to deal with the stress of having a chronic illness is really important. We tend to focus so much on the physical aspect of Lyme disease, we kind of ignore that psycho-emotional aspect of Lyme, and what it’s like to be chronically ill. And the impact it has on you, your spouse, your loved ones, your family, your friends. It’s very stressful, and at some point your friends and family get tired of hearing about it.

                           So I think it’s really important that people have a good support network, have a system in place, whether it’s a therapist or a support group they’re involved with. But have some outlet that you can share your experience openly and without judgment. And just finding different ways to help manage stress.  So, that kind of rounds out the five parts to the plan, and then in the book I have one chapter that talks about various therapies you can do in conjunction with your healthcare provider. But those are therapies that really need to be medically supervised, so it’s something you’ll want your practitioner on board with. 

Dr. Weitz:            Yeah, I read through that section and there was quite a number of interesting therapies. One that I didn’t see there that a lot of Lyme practitioners talk about is Ozone. What do you think about the use of intravenous Ozone?

Dr. Ingels:            My experience with oxidative therapy is both Ozone and hyperbaric oxygen, is it tends to be I think more of a short term benefit. I went through Ozone myself, I would feel better for a day or two and then I was right back to square one. And I’ve had several patients that have had similar experiences.  I think Ozone probably has a lot of benefit, particularly for people with acute Lyme disease, because it does have a nice anti microbial affect. But if you’ve gotten to the point where it’s not just the infection anymore, it’s really more of an auto immune issue, I don’t know how well the oxidative therapies are going to help with flipping the switch on the autoimmune process.  So again, my experience with oxidative therapies has been perhaps a little bit disappointing, and I know a lot of my colleagues who do Ozone therapy that tell me how wonderful it works. Unfortunately it hasn’t been my personal experience or my experience with my patients.  So, the other thing we get into is most oxidative therapies tend to be pretty expensive for people, and it requires if you’re going to it you kind of have to do quite a bit of it to get the potential benefit anyway. So again, I find in my population that the cost and the time of doing it for most people is somewhat prohibitive.

Dr. Weitz:            So of all those specialized therapies that you have in that section, which is the one that you would think would be most useful adjunct for most people?

Dr. Ingels:            The one I think I get the most bang for the buck is what we call Low Dose Immunotherapy. Low dose immunotherapy, or what we call LDI for short, was developed by Dr. Ty Vincent. He’s a medical doctor in Hawaii, and it’s basically build on the concept of using a microbe to help turn off the reaction to what that microbe’s triggered.   So in my ways it’s a bit of like homeopathy, of what we call isopathy. We basically take a dead bug, we dilute it out, and we mix it with an enzyme called Beta-glucuronidase. And we’ve found in the allergy world is that this enzyme has the capacity to alter the way your immune system reacts, to whatever it’s mixed with.   So if we mix it with dead Lyme, dead Bartonella, dead [inaudible 00:30:59] virus. If that organism has triggered any kind of auto immune issue, we think it’s working at the level of the immune system that switches that, or flips that switch, to try and help turn off auto immunity.  So I’ve had a lot of patients who’ve undergone a lot of different therapies for Lyme. Didn’t have a lot of success, and this is one therapy that really helped turn the tide for them. So there about 100 or so practitioners I think around the country that are doing this therapy now. So if people get stuck in their Lyme treatment, I think this is a great therapy.

Dr. Weitz:            And for people wanting to learn more about Low Dose Immunotherapy, a few episodes ago I interviewed Dr. Karima Hirana, specifically we talked about Low Dose Immunotherapy.  

Dr. Ingels:            Yeah, that’s wonderful. I know she does a lot of it in her practice, but, again, it’s one of these things that depending on the organism, so whether it’s Lyme or Bartonella Babesia, we can really use it for any of these microbes that might become immune triggers. In some cases it might be more than one, so if you’ve got Lyme and Bartonella, or Lyme and Babesia, we can use these different dilutions to help figure out what’s causing the problem.

Dr. Weitz:            So, of your patients in your clinic, I’d like you to give me just an estimate of the number of patients with Lyme who go through your five step protocol, how many of them are cured permanently would you say?

Dr. Ingels:            Oh gosh, the C word! Cure is a tough word. I mean I’d say probably 80% plus of my patients improve. In terms of what percentage get to the point where they’re 100% symptom free, that’s hard to measure because it happens over the course of such a long time. I’d probably say we can get 50% plus to the point where they’re symptom free. I have a lot of other people that get a lot better and sometimes they still have a nagging symptom.  It’s so hard because … It’s a little bit like filling up a bathtub and draining it at the same time, there’s so many other things going on in people’s lives and world that undermine their immune system that we’re constantly trying to battle all of those different aspects of what they’re eating, what their lifestyle’s like, what their job’s like.

                            My office is in Connecticut, I’m in suburban New York City, so everyone I work with there is pretty much a Wall Street person. You know these Wall Street people work ridiculous hours, and they’re up early for the stock market. So how easy is it for your body to heal when you work 14 hour days, and you’re commuting four hours a day? It’s tough.  So I think that often becomes a limitation on people’s ability to really get well, and sometimes it’s just a practical matter that it’s a little bit challenging to overcome.   But I want people to understand that there is hope, there is a way to get there, and again, I feel like I’ve had as good success, or more, than most other practitioners, because, again, we’re not just focusing on killing the bug, we’re really trying to expand and deal with all these other issues that Lyme creates in the body.

Dr. Weitz:            I know it’s in your book after you go through these five steps and talk about a few other things, you go back and explain how a patient would go back through those five steps again, and elaborate on some of the details that you didn’t elaborate on the first time.

Dr. Ingels:            Yeah, you know when people go through that five step process, if you get to a point where you find that you’re not really getting the improvements you expect, I think it’s important that first and foremost is it really Lyme or is there something else going on? My experience has been when we go through this process, and particularly for people who get no improvement at all, my thought is that there’s probably something else going on beyond Lyme.  And again in some cases it may be that they’ve had some other exposure that we didn’t identify, there was some other chronic stressor that I didn’t know about, that we weren’t really dealing with. So the first step is really look at other aspects of your life that might be contributing to the way that you feel.

                           And then beyond that, I always ask people to be really honest, I mean have you really done everything that we asked you to do? And in some cases people are like “Well, kind of. I kind of followed the diet, but not really, because it’s really hard.” So if you only do it 50% you might only get 50% improvement. So it’s important to take stock and be honest with yourself, are you really following the steps?  But for people who legitimately follow those steps, do everything we ask, get stuck, again, first and foremost I think it’s just a function of looking at other things that might be contributing to their health. And again, sometimes we’ll do other blood tests, other imaging studies, and we’ll find there actually is something else going on that we didn’t identify initially, and that might explain.   So work with your healthcare provider in trying to dig a little bit deeper and find those causes.

Dr. Weitz:            I noticed when you were talking about the gut, I wonder if you don’t find sometimes that patient with gastrointestinal symptoms like gas, or bloating, or discomfort, et cetera? Maybe they have some form dysbiosis, or small intestinal bacterial overgrowth. Do you ever have to go back and treat that, and clear that out in order to get a complete recovery?

Dr. Ingels:            Yeah, and the one you just mentioned there, SIBO, small intestinal bacterial overgrowth, is a very common one. In fact, I had one patient who she went through her Lyme treatment, she did well, and she got maybe 70% better, but she was still having neuropathy, numbness and tingling in her feet. And then we did a SIBO test and she was positive, and when we treated her SIBO her neuropathy went completely away.

                            So, yeah, we talk about gastrointestinal health, I mean part of my standard workup is we typically do stool testing on pretty much everybody with Lyme, just to make sure. And particularly if you’ve been on antibiotics, but if there’s a lot of gas, bloating, reflux, symptoms that might suggest SIBO, we might also do a SIBO test at the same time just to try and rule that out, because if you’ve got SIBO and you keep doing all the other Lyme treatment, yeah, you’re going to hit a wall at some point because you haven’t really addressed that issue.

                            So when I talk about gastrointestinal health we’re really talking about from top to bottom, from your mouth all the way down. So what’s going on in the stomach, looking at H Pylori, looking at SIBO, looking at any kind of parasite infection, overgrowth of yeast, all of that becomes very important in how well your gut’s functioning.

Dr. Weitz:            Awesome, Darin, I think we’ve got a lot of very useful, interesting information from you today. Thank you for sharing that. For listeners, viewers, practitioners, who’d like to get hold of you, what’s the best way for them to find out more information and contact you?

Dr. Ingels:            The best way is just to go to my website, it’s dariningelsnd.com, D-A-R-I-N-I-N-G-E-L-S, N as in Nancy, D, .com. And we’ve got a lot of great information, we’d love people to sign up for our newsletter. And I’ve also got a free chapter of my new book that you can download, or we also have a free e-book of my top 10 immune boosting recipes, that we’d love people to have.  So please sign up, follow us, and we’d love to help share some more information about Lyme disease and other things that we deal with.

Dr. Weitz:            And where can they get The Lyme Solution

Dr. Ingels:            The Lyme Solution, well as of now, I’m one week away from when it actually comes out, so it’s available through all your major book retailers like Amazon or Barnes & Noble for pre-order. But the book itself drops on March 27th.

Dr. Weitz:            That’s great, we’ll be looking for that Darin. Thank you for joining me today, and I’ll see you in a few months at our functional medicine meeting.

Dr. Ingels:            All right, thanks Ben.

Dr. Weitz:            Thanks.

Rational Wellness Podcast 049: Small Intestinal Bacterial Overgrowth

Dr. Kenneth Brown describes strategies for treating Small Intestinal Bacterial Overgrowth with Dr. Ben Weitz. 

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


Podcast Highlights

1:46 Small Intestinal Bacterial Overgrowth SIBO is caused by an overgrowth of bacteria that normally live in your colon that have gotten translocated and are growing where they shouldn’t be–in the small intestine, esp. in the duodenum. This can be caused by stress, an infection, taking antibiotics, or poor diet. Then when you eat, the bacteria will break down the food, creating gas, bloating, discomfort and change in bowel habits. And this is the main cause of Irritable Bowel Syndrome. This was first demonstrated by Dr. Mark Pimentel. If you have bacteria that produce methane gas, it will cause constipation and if they produce hydrogen sulfide, it will cause diarrhea.  Dr. Brown said that it always bothered him that you had patients with opposite symptoms–diarrhea and constipation–and they were both diagnosed with Irritable Bowel Syndrome and the SIBO diagnosis explains and unifies this.

4:56  We discuss briefly the gut brain connection.

6:02  Dr. Brown talks about Dr. Pimentel’s post food poisoning, post-infectious explanation for the cause of SIBO in some patients. Your body can produce antibodies to some common bacteria, like salmonella, that end up damaging the neurological control of the intestines, the Migrating Motor Complex. This decrease in the motility, esp. the cleansing waves of the intestines, facilitates the buildup of bacteria in the small intestine and makes it more likely to recur even after treatment. Dr. Brown also also explains that some of the damage to the microbiota that can result from taking antibiotics and how this can cause bacteria to overgrow into the small intestine. The same goes for ingesting pesticides like glyphosate in our food. Dr. Brown also explains how stress can play a role as well. Post-infectious, antibiotic use, stress and diet can all play a role in SIBO developing.

10:51 We discuss whether ileocecal valve dysfunction is a reasonable explanation for the cause of SIBO. Dr. Brown said he has seen a lot of patients with Crohn’s Disease who had their ileocecal valve removed as part of a surgical resection of part of their bowel and he does not see SIBO in the majority of these patients.

13:00  Dr. Brown said that he feels that patients who get a recurrence of their symptoms are looking for an explanation of why.  He said that he spoke with Chris Kresser who told him that he thinks that toxins like mercury might be playing a role in these difficult patients who keep recurring.

14:20  I asked what happens when a patient has had their colon completely removed? Are they then supposed to have a microbiome? Do they not have a microbiome? I mean does your small intestine become the place with your microbiome? Can you live without a microbiome? 

16:45  We discussed SIBO breath testing. 

22:14  I asked Dr. Brown when he treats SIBO with Atrantil, is that the only product he’ll use and does he also place the patient on a special diet? Dr. Brown explained the composition of Atrantil and how it works.  He said that he may add Rifaximin or another herbal antimicrobial and Saccharomyces boulardii. He may recommend a gluten free diet. He also feels that using a motility agent is very important, such as Erythromycin.   

30:22  We discussed the concept that the patient may have several layers of dysfunction or gut dysbiosis, such as SIBO plus a fungal overgrowth, and how candida and SIBO can feed off each other.  Dr. Brown also talked about the significance of leaky gut for patients with SIBO.



Dr. Kenneth Brown is a conventionally trained Gastroenterologist and researcher who now takes a Functional Medicine approach and has developed an herbal product for treating SIBO, called Atrantil. He can be reached through KBMDhealth.com or KennethBrownMDHealth.com or just KennethBrownMD.com. You can also go to Lovemytummy.com or go to Atrantil.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure as well as chiropractic work by calling the 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 Doctorweitz.com. Let’s get started, on your road to better health.

Dr. Weitz:            Hey you Rational Wellness podcasters, thank you so much for joining me again today for another episode of the Rational Wellness podcast. If you enjoy this episode, please give us a review on iTunes, that helps more people find out about it. And today, we’re going to interview Dr. Kenneth Brown, a functional gastroenterologist and the developer of Atrantil, a herbal product used to treat methane producing Small Intestinal Bacterial Overgrowth. And this is a very interesting product, we’re using it in our office very successfully. Dr. Brown has done several studies showing it to be 80% effective in relieving SIBO symptoms such as bloating, constipation and abdominal discomfort. And he’s also in the process of completing a multicenter trial and we love that kind of scientific approach. So Dr. Brown thank you so much for joining me today.

Dr. Brown:          No, thank you so much Dr. Weitz. I appreciate you having me on. It’s an honor to be on the Rational Wellness podcast.

Dr. Weitz:            So since we’re going to be talking about SIBO. What do you think are some of the most common causes of SIBO?

Dr. Brown:          So when we talk about SIBO, I’m sure most of your listeners-

Dr. Weitz:            I guess we should probably define what it is to begin with, yeah.

Dr. Brown:          Yeah. So when you say SIBO, it’s Small Intestinal Bacterial Overgrowth. And what that means is whenever … What people don’t quite realize is that your microbiome, we’re always talking about the microbiome or the bacteria that live within us, they really should exist primarily in your colon and that’s where you have 100 trillion bacteria, a thousand different species and they coexist with us. I mean it’s an argument, do we exist for them or do they exist for us? But when we treat them right, they can be very beneficial for us. Now, so it isn’t so much that bacteria are good or bad, it’s just that bacteria can start to grow where they shouldn’t be.

Dr. Brown:          So in the upper intestine, specifically the duodenum, what can happen is that bacteria can start to grow there, that can be due to severe stress and infection, taking antibiotics or very poor diet will allow the bacteria to start to grow. And when that happens, you have bacteria growing where it shouldn’t be, so when you eat, the bacteria will break down the food before you can, creating bloating, discomfort, change in bowel habits and all these other symptoms like that. That’s really what bacterial overgrowth is, bacteria growing where it shouldn’t be.

Dr. Weitz:            And basically this is believed to be the main cause of Irritable Bowel Syndrome.

Dr. Brown:          Exactly. So I was doing research … So my background as a gastroenterologist, I have been doing clinical research, pharmaceutical research specifically, for the last 15 years. And when I was working with one of your prior guests, Dr. Pimentel, he came up with this whole model. He had a mouse model that demonstrated that you can actually have bacteria growing where it shouldn’t be and then you can develop these symptoms. So he was the first guy to really demonstrate that, “Hey, this is very similar to that paradigm shift that took place over 35 years ago, when we used to think that ulcers were actually caused by stress and anxiety.” And then an Australia gastroenterologist figured out that it was caused by Helicobacter pylori or H. pylori. So a similar paradigm shift.

Dr. Brown:          So all these people that we’ve been patting on the head saying, “Oh, you have IBS, take this anti-depressant. Oh, you’re just stressed, don’t worry about it.” And these people would come back and go, “Well, if it’s just IBS, why am I so miserable?” All these people we now realize probably have a bacterial component to it. And if you have a bacteria that produce a certain type of gas like methane, it will cause constipation. If you have bacteria that produce hydrogen sulfide, it’ll cause diarrhea. One of the problems I’ve always had as a gastroenterologist is the fact that you have this unifying diagnosis called IBS, but you’ve got opposing symptoms. That’s always bothered me. Either you have back pain, or you don’t, so when you have somebody that has diarrhea and then the opposing symptom, constipation, and we call it the same thing? That’s not right. And now we have a unifying diagnosis, and SIBO kind of explains all of it.

Dr. Weitz:            And it’s kind of interesting that the anti-depressants may have actually had some benefit, but not because it improved their depression or their psychological outlook but because there are serotonin receptors in the small intestine and decreased motility may be a factor in the cause of small intestinal overgrowth, and it may be that the anti-depressant stimulated the serotonin receptors in the small intestine, so some of those patients may have actually got benefit for their small bacterial overgrowth that they didn’t know they had. 

Dr. Brown:          Exactly. What people don’t realize is, you have more serotonin receptors in your gut than you do in your brain.

Dr. Weitz:            Yeah.

Dr. Brown:          This is why as a gastroenterologist dealing with these functional medicine problems, I call it the gut-brain connection. That’s what’s going on. I treat the brain as much as I treat the gut and vice-versa, because the two interact with each other. And you know as functional doctor that you don’t just treat the end organ, you have to treat the whole body. And definitely the brain is almost always involved in everything.

Dr. Weitz:            Right. So what do you think … What are some of the causes of this Small Intestinal Bacterial Overgrowth? I know Dr. Pimentel feels that a percentage of these result from a case of food poisoning that leads to damage to the migrating motor complex due to toxins released by the bacteria that causes food poisoning that damages the nerves that control the motility of the small intestine.

Dr. Brown:          Exactly. So he was smart enough to actually realize that we were calling people post-infectious IBS. Where actually some people would develop inflammatory bowel disease, Crohn’s or ulcerative colitis, and they’re called post-infectious. What he realized is, is that when you get exposed to a certain bacteria, salmonella, shigella or these very common ones, then your body can overreact, produce antibodies to get rid of it, which is important, but then these antibodies hang around, and they misinterpret these cells of Cajal, which are these electrical pulse, think of it that way. So you’ve got a current that goes through, and in your intestines there’s a migrating motor complex, meaning an electrical impulse starts and makes sure intestines move from the stomach all the way to the cecum, which is how we move our food through. Well, antibodies can be produced called vinculin antibodies, and they can actually bind to those things and actually shut them off.

Dr. Brown:          So think of them like cell towers being turned off. And that happens in about 20% of the people that actually have an infection like that. So 20% of our SIBO patients, we look for that, and you can actually get … He actually developed a very eloquent test called the IBS check test, where you can see if somebody has these antibodies. What that tells us is, you’re going to be at risk for having recurrent issues and that’s something that I discuss with my patients. When they say, “Look why every few months I’ll get treated, I’ll feel better, five months later I have this?” I’m like, “Okay, it looks like you have essentially developed an autoimmune disease, to the motility of your intestines.” So that’s one cause, that’s how the infections cause it.

                           The infections also cause it by having your body overreact to it and have it … You don’t have to form the antibodies, but it changes the whole bacterial motility for a little bit, and what you would normally have as a free-flowing stream crystal clear, it shocks it and then bacteria start to grow, and the bacteria themselves can produce gases to slow it down. So now we end up going from a small little stream to a bigger sewer and then the bacteria start growing. And then the other couple reasons that actually can happen, taking antibiotics would do it. We don’t realize the destructive nature of these antibiotics. I try to only use them when it’s completely necessary. And there’s a lot of researchers out there showing that we really disrupt a lot of things by giving so much antibiotics.  And then ultimately …

Dr. Weitz:            And by the way with antibiotics, so anything that would kill the bacteria, so that also includes pesticides that are found in our food and insecticides used around the house et cetera, et cetera.

Dr. Brown:          I love that you brought that up, because that was the other thing. People don’t realize that when they’re eating a lot of refined foods it has all that Glyphosate in it. Glyphosate is Roundup, which is an antibiotic, and it can do the exact same thing. If we eat a lot of meats that are with that. I think you probably saw that recent study where if you work with household cleaners it’s just as dangerous as smoking for 20 years.

Dr. Weitz:            Yeah.

Dr. Brown:          So unfortunately, our people in the industrial cleaning industry are exposing themselves to a lot of toxins and it does very, very similar things. So the bottom-line is where I tell people … And the final thing that gets missed a whole lot is, any time you go through a very stressful situation, you can actually go through this fight or flight process and ten that … And you go through a sympathetic response of fight or flight, it actually slows down your intestines. I like to tell my patients … I get so many people that are like … It’s like having insult to injury.

                       Somebody will go through the death of a family, or they’ll go through a bad divorce, and then they’ll show up at my office, and I have to explain to them that, “Look that was very traumatically stressful for you. Your body was in a constant state of fight or flight, it’s going to reserve its energy so that you can get out of the situation. You know if you’re being …” From paleo times when you’re being chased by a saber tooth tiger, you don’t want to get hungry or stop and have to use the restroom, you want to just get out of the situation. In our society today that stress just stays so high that, that can affect the intestines. So those major things, antibiotics, post-infection, diet and stress can all do it.

Dr. Weitz:            What you think about … A lot of people talk about that the ileocecal valve problem is playing a role. How often do you think that really happens?

Dr. Brown:          That’s fascinating to me because that’s one of those deals where I think more clinically, as opposed to what’s actually being said. So for instance, I was listening to a podcast by J.J. Virgin, she had a functional medicine doctor on and he was citing that as one of the causes of bacterial overgrowth. Very clearly the ileocecal valve is built to be there. For those that don’t know, that’s the valve from the end of the small intestine going into the cecum or the first part of the colon. What it does is, we have these valves, it’s job is to let things into the cecum and prevent the cecum from coming back in. We call that backwash ileitis, when you can actually have some inflammation in the ileum. So it makes sense. Oh, if a lot of your stool is going back into the small value, you can colonize it.

Dr. Brown:          Here’s the problem I have with it. I deal with a lot of inflammatory bowel disease, which includes a disease called Crohn’s. So one of the things in one of the treatments of Crohn’s, since 70% will show up in the ileum, is the surgical resection. This takes out the ileocecal valve in the right colon and my surgeons will hook up the last part of the intestine, a portion of the ileum, directly to the colon, so there is no more valve. And I don’t see SIBO in most of these people. And I’ve got, I don’t know, a couple of hundred people who have had this done.  So yes, I guess it’s plausible but I think we’re giving too much credence to it and I think people want to give a reason as to why they’re developing it.  I was talking to … I don’t remember. It was another doctor and we were actually discussing this, about the exact same concept.

                          And he said, “I think people are trying to wrap their hands around why and patients want to know why.” They want to say, “Oh, I’m having this because my ileocecal valve is this. I’m having this because …” And then what we realized is that maybe there’s other things going on, and it probably comes down to pure motility issues. And I was speaking with … I think you know him, Chris Kresser out there in California.

Dr. Weitz:            Oh yeah.

Dr. Brown:          So we were conversing about this, because he has a lot of patients that are extremely difficult to deal with as far as recurring issues. And he’s realizing that, when you take even a more Functional Medicine approach and look at some people and realize that possibly they’ve got mercury toxicity or different things, and he’s got me thinking that, “Oh, some of these things we need to treat.” I can fix the symptoms, it’s the person that keeps coming back to me they’re like, “I was better and now I’m back to where I was again.”

                         And we keep treating and I guess that’s good for business if I’ve got this company where I’m selling a product, but as a physician I want them to get better. And he brought to my attention that maybe we’re missing a certain amount of environmental toxins, which are actually affecting the motility, which is causing the bacterial overgrowth. If we look at the big picture, I think that the ileocecal valve thing is plausible, but I have so many patients that have had that completely cut out and they don’t show up two months later with bacterial overgrowth.

Dr. Weitz:            I’d like to go off topic for just a second because you brought up this surgical situation. I’ve had a number of patients who had their colon removed completely, how are we supposed to think about that? Are they then supposed to have a microbiome? Do they not have a microbiome? I mean does your small intestine become the place with your microbiome? Can you live without a microbiome? What does that mean?

Dr. Brown:          That’s called a total colectomy. So, when have a total colectomy, it’s usually due to a disease called ulcerative colitis. Maybe due to other things, but the majority of people that are going to continue to live without a colon is because of ulcerative colitis. What the surgeons will do, is they will take the last part of the small bowel, so they cut out your colon put it in a bucket and it goes away. Now, something to keep in mind is that that microbiome is so sick due to inflammation, that they’ve been living without a proper functioning microbiome for a long time. So keep that in mind with these people. So the body is already starting to adapt.

                         Then they will take the last few loops of the small intestine and they cut the middle of it and they essentially build what’s called an ileal-anal pouch or they build a kind of a fake rectum, and then they attach it to the anus. That mucosa starts to become like colonic mucosa. And so it actually develops its own microbiome and people can end up with situations like proctitis … I’m sorry, we call it … Basically it’s the ileum that gets there, it gets essentially inflamed. And so that inflamed area there we can treat. And we have to treat it with typical ways that we treat, probiotics will actually help those people. That’s one of the few places where the literature has really shown that it’s been very, very effective is in people like this … Oh, pouchitis.

                        I’m sorry I had a little brain slip there. It’s called pouchitis. So, which might actually help with pouchitis and we sometimes use antibiotics for those people, which means that the microbiome is certainly playing a role in that. So yes, you can certainly live without a colon, people do and they live very fruitful lives, the body adapts, the body is very resilient through it. I think that we’re just scratching the surface about what the microbiome can actually do but maybe we don’t need the whole colon, because I have all kinds of patients that have sections of it taken out. The whole colon taken out and they’re perfectly healthy for years and years and years, decades perfectly healthy.

Dr. Weitz:            Interesting. Do you use breath testing for diagnosing Small Intestinal Bacterial Overgrowth? And if so, do you use lactulose or glucose or fructose or all of them?

Dr. Brown:          So this comes down to the, what is the best test to diagnose bacterial overgrowth, SIBO?  So when we started looking at these different tests, the one that keeps being referenced in the literature is the very old way of doing it, which is a jejunal aspirate. And the original studies with that … We call that the gold standard. But then we’ve learned in more recent literature that the jejunal aspirate is actually not nearly as sensitive nor specific as we thought. The thing about that is, the old way of doing it was dropping a tube down and then aspirating. And we know that there’s lots of contamination. There’s only a few gastroenterologists in the country, one of them is named Satish Rao, he’s out of Augusta, Georgia and he will do it with a very dedicated sterile endoscopy. And they don’t go to the jejunum. The jejunum bowel. Most bacterial overgrowth takes place in the duodenum.

                          So when people are referencing jejunal aspirate studies, that is an archaic method of doing it. So now if you talk to a guy like Dr. Rao, he’ll explain that he goes into the duodenum and aspirates, and then tries to selectively keep it totally sterile. And it’s a very laborious and hard process. So that being said, that’s what we thought was the gold standard and as time has gone on, we realized it’s probably not. So we’re left with the next best thing, which is a breath test. And this is where you will have somebody take some sort of, we call it a substrate or some sugar, and you measure baseline hydrogen and methane. Then you take this in and if bacteria are growing, high up into the small bowel, the thought process is, they will break it down and then the gas gets absorbed and then you will breathe it out. So by definition that seems like a cool thing, but it’s flawed from the beginning, because there’s so many ways it can be messed with, both the type of test that’s done. So there’s many companies out there.

                            The one that I’m using right now, because I can hand my patient a kit and he’s actually in LA, is the gastroenterologist that started this company, it’s Pivotal Diagnostics. Yeah, this is where I can hand them a kit, so I know my patients are leaving with a kit and I say, “I expect you to do this.” Aero diagnostics is a pretty good one but they have to mail them the kit and they have to do it and I can’t expect that to happen. So there is a rule for breath test, I don’t start with that. And what I do is, if you show up to me and you eat a substrate, in other words, starches and you bloat. And you develop these symptoms, especially when people come to me and they go, “Man I was totally fine, five years ago and then X, Y, Z happened. I went to India and I got really bad food poisoning and I’ve never been right since.”

                         You’re screaming to me those causes that can bring on SIBO, so I’m going to treat you like SIBO, if you don’t get better or if there’re other reasons then I consider doing the breath test. And that’s just because the breath test … There was a recent review in 2017 with Dr. Pimentel, Satish S. Rao, Brooks Cash, sort of the guys in my neck of the woods in the non-functional area, the research area and their conclusion was really funny, after all of this it was, “There is distinct heterogeneity amongst the data, so we can’t make a conclusion.” Basically, it is probably the best thing that we have and really use it judiciously, but don’t hang your head on it.  It will not pick up hydrogen sulfide. If it is methane, some of the experts like Dr. Pimentel will say, “If you are methane positive, it’s probably positive.”

                        So you can trust that as long as you have a rise in methane. Some people start high in methane and that’s a different situation, but if you get a rise then maybe that’s going on. I use it when people don’t get better, if they have recurrent situations, if they’ve got atypical symptoms. And I’ll tell you where I like to use it. I can look at this and I say, “I’m 100% sure you have SIBO.” They’ve got classic symptoms. “Why are you not getting better?” So many times, since I get people that have already seen a lot of other doctors, they’ll come in with a baseline and they’ll say, “This is my test, they treated me for this and I didn’t get better.” I will repeat the test. And for me if somebody is methane positive, if they are normal and then all of sudden like 20 minutes it spikes, and possibly goes down then possibly what’s missing is that the bacteria is living very high up, like the duodenal bulb, and the duodenal sweep.

                        And maybe the medications we’re giving including natural products like Atrantil, herbal antibiotics, Xifaxan and all these other things, it’s not even dissolved yet. So it’s dissolving further now. And then vice-versa can happen, I’ll see these people with peaks later and go, “Oh, we’re not getting enough concentration to where we need to.” So I use breath test to fine tune what I’m already doing. That’s how I use it.

Dr. Weitz:            By the way, Genova Labs will mail you the kits that you can hand to your patients now and they also have a three hour kit.

Dr. Brown:          I forgot you also know the hazard also, yeah.

Dr. Weitz:            Yeah, so when you treat with Atrantil, is that the only thing you’ll use or do you use other herbal products at the same time? Do you also use an agent for motility? Do you also put the patient on a special diet as well?

Dr. Brown:          All fantastic questions so Atrantil is basically a combination of three polyphenols that work together. And the way it works is we use a little bit of the peppermint leaf, not the oil, but the polyphenol component of it and that calms the area down. Then the second ingredient, which is the one that I get a lot of questions on, is called Quebracho. It’s Quebracho colorado. It’s a beautiful polyphenol known as a proanthocyanidin and it’s a tenant. It doesn’t get absorbed. So we put that one in there because it is a very old ancient tree that has specific defense against archaebacter. An archaebacter is the type of organism that produces the methane. So in the intro you mention methane producing, that’s a route that we initially started because that was the tough group to treat.

                           So we know that the Quebracho can get rid of the methane and then the Conker tree works … It’s a saponin and basically works by getting rid of the bacteria and that shuts the enzyme off in the archaea species. So in our clinical trials with two published studies, one randomized, one where we treated people with the worst of the worst. We were able to show that really four out of five people definitely get better. So, that being said, because of the type of practice I have, I get the people, I get that fifth person. Almost always I get the fifth person that has tried different things. So what I do for my … I listen to what they say, first thing is history says so much. When you eat and 20 minutes later, an hour later, you’re bloated like that, the timing of when you get bloated tells me what’s going on. If you’re bloated all the time, I’m really worried that something else is going on.

                         So I get a bunch of people that come in and they said, “I saw Dr. So and so, they put me on Xifaxan and I’ve done some natural antibiotics, I went to a Naturopath. Eventually, I tried your stuff, I’m still bloated.” And I’ll talk to them. Are bloated when you wake up? “Yes.” Are you bloated this? And then you really start looking so I realize that … Well, I’ve been able to find a lot of very interesting things.  Occult celiac disease. I have found Crohn’s. I found five or six carcinoid tumors. We’ve found … Things that I normally when you walk through … I mean the old adage in medicine training is if you hear hooves steps you don’t think zebras, you think horses. Well in this case I’m getting zebras walking through at this point.

                        Then that leaves the people that we’ve ruled everything else out, I’ve done a full work up, what else do I do? I believe that since the starches are a significant problem we’re feeding the bacteria, I like to put people on, at a minimum, a gluten free diet. Now, you’ll hear a lot of people throw around the FODMAP diet, that’s the sort of de jure knee-jerk in my field at least. And there’s elemental diets, SCD diet, GAPs diet, there’s all these other diets out there. The one thing that they all have in common is you really take away a lot of the starches, and you certainly take away the gluten.

Dr. Weitz:          Especially fermentable fibers. Right?

Dr. Brown:         Exactly, yeah. So that comes down to the … Fermentable fibers are essenially prebiotics and bacteria love them, and they’re very good for us when you’re in a normal state. So when you’re in a healthy state, taking those prebiotics or fibers are very good, the polyphenols are prebiotic, your bacteria will break them down and generate energy for you. So coming back to an evolutionary type thing when we couldn’t really have access to all the food we needed, you could actually eat a plant based diet and your bacteria will produce short chain fatty acids that will help feed the tissue around your colonic mucosa and give you energy. So I like to do at least a gluten free diet, I’m not a big fan of gluten in general, I myself I’m gluten free, so I try to only recommend things that I’m willing to do myself.

                        I have a lot of people that have tried these extreme diets and it’s just temporary. When you look at the data, the most recent data looking at this is that, FODMAP map diet is about 28% effective in relieving IBS symptoms, gluten free diet is 28% effective in relieving IBS symptoms. And these are the IBS population–not necessarily the SIBO population. There’s lots of overlap and we can talk about the problems with some of the literature with. So going gluten free. Then I have Atrantil. I look at this and if they’ve got more diarrhea predominant, I do have some success by adding something else. I do have some success by possibly using Xifaxan. I have used other herbal antibiotics to augment this. 

Dr. Brown:          I think that … I met a Naturopath out of Australia. Her research was in Saccharomyces boulardii, which was one of the original probiotics. What’s really cool about this, it’s not a commensal organism, meaning we don’t really have a whole lot of Saccharomyces in us but what it does is it boosts your new secretory IGA, so I’m having good success adding Atrantil plus Saccharomyces, we’re going to stay all natural. There are other herbal antibiotics, which I’m having some fun with also. I mean the typical ones, Berberine, Allicin. I’ve got a lot of people that are really struggling if I can throw anything at them. But the most important thing is the motility agent.

                          I think the thing I can help the most and get a sustained response is the motility agent, because, if you think of it this way, if you’ve got those antibodies that we were talking about, the vinculin antibodies, and they do not allow the small intestine to move, you can treat it with whatever you want, and then when they go to sleep at night, then the bacteria will just start growing again. So I like to use a motility agent when they go to bed. And we used to have some other pharmaceutical agents, which are used for constipation, which were serotonin agonists, but they got pulled off the market, that was Zelnorm.  And Zelnorm was fantastic for that, really low dose. We’ll use Erythromycin when they go to bed to help create that motility.  If they want to stay all natural, then we’ll go with the other motility the agents like Iberogast and things like that. I’ve had less success with that, but if we’re to stay all natural then I’ll do that.

Dr. Weitz:            By the way, that seems to be off the market right now for some reason.

Dr. Brown:          Oh, I don’t know that really. Wow.

Dr. Weitz:            Yeah. Some pharmaceutical company bought the company and nobody knows what’s going on, but it’s not really available. So I’ve been using MotilPro, which has 5-HTP, which simulates serotonin and ginger.

Dr. Brown:          Yeah cool.

Dr. Weitz:            We do get some results.

Dr. Brown:          Make sure that … You only really want that to kick in at night, that’s the most important thing.

Dr. Weitz:            Absolutely, yeah. It’s the migrating motor complex that only comes in when you haven’t eaten for like more than three or four hours.

Dr. Brown:          Exactly, yeah. That’s known as the housekeeper phenomenon and when you go to sleep, you get into a deep sleep, which is a whole separate discussion, but sleep is super important to treatment. You probably use … Probably talk sleep all the time for any other process, but I talk sleep a lot. We need to make sure that all these people get a good night sleep because if you don’t get into certain depths of sleep, you will not activate that migrating motor complex. So make sure you have a good sleep hygiene, take it at night and that housekeeper phenomenon does this very large contractions, which move everything from the small intestine into the colon.  And that’s a physiological process, but for whatever reason, people with SIBO can lose that. And when that happens, it’s just a recurring hamster wheel. You can treat it during the day, and it grows at night.

Dr. Weitz:           I’ve seen a lot of cases where the patient who recur, have several layers of dysfunction. So we’ll do a stool test or find out that in addition to SIBO, they have some potentially pathogenic bacteria, or they’ll have a parasite, or they’ll have fungal overgrowth, and so I usually sequence it into several layers of treatment, maybe one period of time where we’re trying to work on their fungal overgrowth and one period of time where we are focusing on the SIBO. And I wonder, how often do you think that’s the case? Where you have layers of dysfunction?

Dr. Brown:          Well, I think that it probably happens all the time because … I inadvertently mentioned earlier the microbiome, which is the bacteria. But honestly Ben we should be talking about the multi-biome. It’s not just bacteria, we’ve got an interaction with the bacteria and fungus and even viruses and even some parasitic organisms. We don’t think about that a whole lot when disruption happens. So one of the things that gets talked about a whole lot is the fungal overgrowth or the candida phenomenon that was the … Before SIBO came on, I think everybody was using candida as the term. What’s fascinating to that is … I’ve been doing a lot of thinking about this and I’m going to publish something you can download from my website because there’s some misinterpretation of it. And when I really started looking at them at the multi-biome, one of the problems I always had was that people … Patients were coming in and they’re like, “I believe that I have candida overgrowth.”

                          And they would come in and I would explain to them, “Well, tell me what happens.” They would eat and they would bloat. Okay, so it is possible but it really sounds like more of a bacterial issue, bacterial overgrowth, and that’s when the pendulum starts moving over here. So I started to really think about that more, instead of just discounting it, I started looking into it more. And then I realized that when we have Candida albicans, which is the genus and species of the organism, when we had rampant AIDS before we had treatment and when we had chemotherapy, I would do endoscopy on people, And I would see their whole esophagus, stomach, and small bowel, essentially coated with white, white plaques everywhere.

                       Such an overgrowth that it was becoming to the point where it could … Once it crosses in the blood then it’s a systematic disease that will kill you very quickly. They never complained of these symptoms, they never had bloating, they never had this, they never had that. And so this wasn’t a GI situation. But really got me thinking, I’m like, “Well, what is the role of this multi-biome?”  Then I found some incredible literature where it shows that the fungus when it breaks down starches, it is a fermentation organism. It’ll produce the CO2. So carbon dioxide is what we use when I do colonoscopies and endoscopies, we use CO2 because it doesn’t stay in your intestines, it freely goes through the intestinal wall and you just breathe it out. So it can’t create the bloating.

                      And I’m like, “Man, this is crazy.” But then I realized oh, part of the multi-biome, the CO2 is the carbon backbone that the bacteria use to form the methane. So if an archaea actor and a Candida species are side by side, the Candida will produce the carbon backbone and the archaea will produce the methane and allow both organisms to grow more. So that’s where it was kind of the aha moment, I’m like, “Oh, we don’t have to separate it, we have to treat the multi-biome.” So you’ve already figured out that there are layers to this. And yes, if you treat the bacteria and you still have this abundance of Candida maybe they’re not creating symptoms but they’re creating the backbone for the bacteria to have a party and vice-versa. They have shown that when you treat people with antibiotics, obviously you will have this rise in fungus.

                     Just ask any woman that’s ever had the whole yeast infection after they get antibiotics, it’s exactly what’s going on, we disrupt the checks and balances. Same thing can happen, we have shown that if you treat just the fungus then you have a disruption and sometimes you’ll have a rise in the type of bacteria that you don’t want, they keep each other in check. So that whole thing that you’re talking about is brilliant and I think that we’re going to develop some protocols to treat these layers.

Dr. Weitz:            Interesting, we had a functional medicine meeting recently and we had Dr. Rahber who runs the Integrative Gastroenterology Center in Los Angeles, and he feels that a lot of cases of methane producing bacterial overgrowth is actually related to Lyme disease that leads to immune dysfunction.

Dr. Brown:          Oh, wow. Interesting.

Dr. Weitz:            And so as a part of his protocol before he’ll use Rifaximin or herbal anti-microbials, he’ll use a few nutritional agents to try to strengthen your immune system first.

Dr. Brown:          So I think that, that is another great take. So admittedly I am not a Lyme specialist and I always have this in the back of my mind because when I talk to infectious disease guys in Dallas, Texas where Lyme isn’t supposed to exist. Lyme is the candida, the fibromyalgia, the whatever, they …

Dr. Weitz:            The chronic disease de jure.

Dr. Brown:          The chronic disease de jure. And so when I started asking about Lyme … The reason why I started working up with it is because I’ve had several patients that have traveled to the Northeast, they’ll find somebody who’s a true Lyme expert, and they’ll find a different way to diagnosis this. So I always leave Lyme as a possibility, I just haven’t figured out quite, there’s only so many hours in the day, I’ll let those experts figure that out and then treat it. But think about this, so my research is headed this way. We now know that there is this overlap between IBS, food, and leaky gut, so when I talk leaky gut to my partners, and if a patient goes in and says that, they get laughed at. And the doctors stick their head in the sand.

                          So when I bring up leaky gut to my patients they’re always like … Because they’ve already found it on the internet. I mean everybody has information, they can listen to your podcast, they can hear your guests. They can do all that. What I like to address is the fact that leaky gut is intestinal permeablity, a more scientific way to say leaky gut. We know that bacterial overgrowth, infections, a protein called Zonulin and diet, and this gets back to the GMO, glyphosates things like that, they can actually affect the intestinal membrane. So normally you should have this very tight junction, and one of those things happens and it opens it up and allows some movement of energy of antigens, and so the way this works on the immune level.

                        And the reason I’m referring to this is because I think this is exactly what that the doctor you’re referencing was talking about the immune system. When you have a situation that is bothering the body, the dendrite, which is like a security guard, will reach a sample, hand it to a B-cell and go, “What do I do with this?” And the B-cell will look at it and be like, “Oh, that’s a normal bacteria, just ignore it.” Or the B-cell will go, “Whoa, this is Shigella.” And mobilize, sound the alarms, hands it to a T-cell. T-cell turns around, builds up all these antibodies, the antibodies drop and they get rid of the infection, which is what keeps us alive. The problem is that sometimes those antibodies will misinterpret our own body or something and then that’s the autoimmune process.

                       Well, what can happen with bacterial overgrowth, is that the dendrite keeps handing it to the B-cell and the B-cell is like, “I told you it’s normal, ignore it.” And the B-cell is like, “Maybe it’s not normal because it’s been around here so long, now I’m getting really angry.” Then it starts mobilizing the same process to fight infection, and that creates more intestinal permeability. And then all of a sudden you start having the patient show up with the extra intestinal issues, “I’ve got brain fog, I’ve got fibromylagia, I’ve got fatigue. I don’t feel right, something is wrong.” And if you let that process continue, then that becomes an autoimmune situation. All these people with autoimmune disease: thyroid, autoimmune liver, Crohn’s, ulcerative colitis and they’ll say, “yeah, it all started about seven years ago, I got sick and the belly started acting up and then these other things can of started showing up.”

                       That’s the explanation for celiac disease also and so on. So when it comes down to the immune system, anything that’s revving it up, which is what I think your doctor was referring to, if you’ve got Lyme disease, which is an intracellular organism that does a great job of avoiding the immune system but periodically could turn it on, then you have these little hypersensitive immune situations, and that’s my theory as to probably what he’s getting at with the Lyme disease. I’m going to eventually learn a lot more about that, but I think it’s all interplay. I think it’s part of that multi-biome.

Dr. Weitz:            Well, this may also be why there’s a connection between SIBO and ulcerative colitis and Crohn’s, which are the autoimmune intestinal issues, the inflammatory bowel disease. And why patients who have SIBO have an increased risk of getting one of those. And I’ve seen patients with say, ulcerative colitis or Crohn’s and then we treat them for SIBO, and their Crohn’s will get better and I think it’s because it’s probably decreasing that leaky gut and decreasing the additional stress on that autoimmune component.

Dr. Brown:          100%. And almost all my patients with inflammatory bowel disease are on this. I just got contacted last week, there’s a conference in Austin if any of your listeners are on there called Paleo f(x), and they’re going to ask me to give a lecture on this exact topic, with this interaction between all these things, trying to make sense it.

Dr. Weitz:            When is that going to be?

Dr. Brown:          April … It’s late April. Late April this year. April 25th, 30th. Somewhere around there.

Dr. Weitz:            Okay, cool.

Dr. Brown:          Yeah, Paleo f(x) 2018. There’s some … I’m on a little side stage. There’s some really cool speakers this year, J.J. Virgin is speaking, Joseph Mercola is speaking, Ben Greenfield, Rob Wolf, so I’m just honored that they kind of threw me in there also. I don’t think I’m on the main stage but … But I would love to have people learning about this, because I’m passionate about it and it’s an opportunity to sort integrate all that.

Dr. Weitz:            Yeah, that’s great. So it’s been a great podcast Dr. Brown. I don’t have any further questions. Any other pressing thoughts that you had that you want to get out there?

Dr. Brown:          I mean my deal is just keep an open mind, we’re still learning. I think that … My new research right now is getting into this whole aspect of leaky gut and brain inflammation. We do have a Facebook group where I would love to hear people’s opinions on this, it’s a closed group, really want very serious people the Gut Brain connection. And I believe and it’s not just me-

Dr. Weitz:            Is that what it’s called Gut-Brain Connection in Facebook?

Dr. Brown:          Yeah. Gut-Brain Connection Community. Yeah.

Dr. Weitz:            Okay.

Dr. Brown:          I love it because I did … I’m having some other functional medicine guys come on that can offer things. You should join also to go ahead and give your insight. And we’re going to go ahead and eventually we’ll get our podcast up and running and do a few things like that. We’ll have you on. I learned so much doing this, like now I’m going to go back, the layers you’re talking about is fantastic. I love the good that you’re doing for your community, and I think that we just make each other better, kind of iron sharpens iron.

Dr. Weitz:            Cool. And we also have a closed Facebook page, it’s called The Functional Medicine Discussion Group of Santa Monica, if you’d like to-

Dr. Brown:          Oh, really?

Dr. Weitz:            … Add your input. Yeah, yeah. We have a monthly discussion group, we have Dr. Vojdani speaking in a few weeks. So I’m really looking forward to that on autoimmune.

Dr. Brown:          Oh. That’s awesome.

Dr. Weitz:            So for practitioners and listeners who want to get a hold of you, what’s the best way for them to contact you?

Dr. Brown:          Easiest way is to KBMDhealth.com, just KB, KennethBrownMDHealth.com or just KennethBrownMD.com we’ve got both and we’ll be able to connect and do the usual stuff. I learned so much by having questions from people, because it makes me go look it up.

Dr. Weitz:            And where can they go to get hold of Atrantil? Where can that be purchased?

Dr. Brown:          Yeah just go to Lovemytummy.com

Dr. Weitz:            Okay.

Dr. Brown:          Lovemytummy.com or go to Atrantil.com. It’s A.T.R.A.N.T.I.L.com-

Dr. Weitz:            Where did you come up with that name? It sounds like some French cosmetic or something.

Dr. Brown:          We’re here in the studio that’s what it looks like right there. So we developed … I mean we basically developed this, it’s a first thing and so when you go to trademark a name, you will find that pharmaceutical companies have whole divisions where they will trademark thousands of names, and if you are phonetically or visually even close to them, then they will become trademark bullies and sue you. So you have to just do this word lab. So I was at my endoscopy center, we got about 30 employees. And I just put blank piece of paper up and I was like, “Come up with the name of my product.” And nurses would walk by and just write stuff. And eventually it came down to Trantil, just T.R.A.N.T.I.L..

                          I was like, “That makes me think that, that’s tranquil. I like that.” And we went to file that, our attorney said, “Listen, it’s too close to something. If you throw an A in front.” We’re like, “All right, we’re this far into it, let’s do it.” So now the A became our symbol here. It’s kind of a funny deal. It’s life lessons. I’ve never done a startup before, so we’re two years into it, it’s growing rapidly. I’m having fun but it’s just jumping one hurdle after another, that’s why when you say Iberogast, there’s probably … The CEO of that company is probably wrestling with the idea that a pharmaceutical company is hiding his product, they’re going to trying to stuff. They’re probably behind closed doors and he’s probably thinking, it was a whole lot more fun when he was just producing it helping people but-

Dr. Weitz:            I’m sure.

Dr. Brown:          … It’s life.

Dr. Weitz:            Okay. This is great Ken. Talk to you soon.

Dr. Brown:          All right buddy. Thanks.

Dr. Weitz:            Okay.


Rational Wellness Podcast 048: Erectile Dysfunction with Dr. Geo Espinosa

Dr. Geo Espinosa speaks about Erectile Dysfunction with Dr. Ben Weitz.

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


Podcast Highlights

1:05  Erectile Dysfunction is defined by the Mayo Clinic as the inability to get and keep an erection firm enough for sex.

3:10  Dr. Geo started the discussion by telling us that the penis is a barometer to a man’s health.

4:00  Dr. Espinosa said that the main causes of Erectile Dysfunction are anything that interfere with nerve flow to the penis, blood flow to the penis, or hormonal.

5:39  Dr. Geo shattered a myth when he explained that there is actually no decreased risk of erectile dysfunction or of incontinence for men who undergo robotic prostatectomy versus open surgery, despite all the outstanding marketing from DaVinci, the company that sells the robotic devices.

7:19  Radiation can also damage the nerves, Dr. Espinosa explained, depending upon what type of radiation you get.

8:50  Dr. Geo explained that even after surgery and radiation there is still a 50% chance of recurrence of prostate cancer and you can get secondary cancers, such as bladder cancer, from the radiation.

11:12  Dr. Espinosa said that there are no objective tests for decreased blood flow to the penis but he gets 80% of the information he needs from a good exam and asking key questions. He said there is the Sexual Health Inventory for Men (SHIM) http://www.urologysa.com.au/pdf/sexual-health-inventory-for-men-shim.pdf so you can place the patient on a protocol and then repeat the SHIM.

15:10 I mentioned that when it comes to neurological causes of Erectile Dysfunction, besides prostate surgery, you have to consider lumbar spine problems that can result in nerve injury. Dr. Geo said that he finds that chiropractic adjustments help to open things up and he recommends his patients get adjusted.

16:46  Next we reviewed the hormonal factors that influence Erectile Dysfunction. Dr. Geo explained that testosterone is a major factor both in sexual interest and in sexual function. He said that he does not like to put his patients on testosterone because their body stops making it and they become dependent upon it. He tries to get their own body to produce testosterone naturally by using nutritional supplements, like his Mr. Happy product/aka, XYVigor (the practitioner version).  He’s o.k. with them using a small amount of a PDE5 inhibitor like 5 mg of Cialis or 25 mg of Viagra. Actually his Mr. Happy product contains 5 products, one of which is Horny Goat Weed which contains Icariin, which is actually a natural PDE5 inhibitor. It also contains L-Citruline, which leads to the production of arginine in the body, which stimulates nitric oxide inside the arteries, which increases blood flow. It also contains Rhodiola, an adaptogen.

23:30  If the total testosterone is normal but the free testosterone is low, you need to make sure you have enough protein in your diet and you need 500 mg BID of Nettle Root–not Nettle Leaf–to inhibit overproduction of Sex Hormone Binding Gobulin.

25:45  If men have too much estrogen, that can be a problem also. Dr. Geo likes to see estradial levels between 10 and 20 ng/mL which has been shown to be associated with lower heart disease, despite the fact that most labs say normal is below 40. If estrogen is too high, he will put patients on a liver detox using products like DIM and milk thistle and broccoli extract. You also need to reduce soy and other estrogenic foods.

28:45  I asked about low testosterone resulting from medication side effects? Many blood pressure medications like beta blockers are a problem. H2 blockers like Tagamet. Statins can reduce cholesterol too low, which reduces the production of sex hormones like testosterone.

30:16  Dr. Geo talked about a patient who was on a vegan diet with lots of soy products who had low testosterone and he got him to start eating grass fed beef and reduce all that soy. He also got him to weight train in a fasted state using heavy weights with lower reps, which stimulates testosterone production. He has him add a protein drink with creatine after the workout. He also uses Fenugreek, Maca 3 gms per day, and Ashwaganda. Tribulus is not that effective. He also works on improving their sleep if that is a problem since you make most of your testosterone during your sleep.

36:08  I broached the marijuana question and how it might affect testosterone? Dr. Espinosa said that marijuana lowers testosterone levels. Excess alcohol can also be an erection killers, though a small amount may be helpful.

39:00  Dr. Geo talked about Peyronie’s disease, which results from scar tissue and their penis becomes curved, which can result in erectile dysfunction.

43:09  Dr. Geo mentioned that low protein diets can play a role in ED by resulting in an arginine/amino acid deficiency. Zinc is a major male mineral and he likes to recommend between 30 and 60 mg but not higher, since too much zinc can create a copper deficiency. Also magnesium is perhaps the most important mineral. Also antioxidants like vitamin C, Alpha-lipoic acid, a mixed tocopherol vitamin E, and plant-based phytochemical antioxidants.

45:20  Next we talked about pyschological factors influencing Erectile Dysfunction and Dr. Geo explained that stress causes your body to release adrenaline, and adrenaline is the biggest erection killer. Sometimes your relationship is a big factor and the problem can just be that you no longer find your partner to be attractive. The other factor is porn. This is a huge factor in men under 40 and particularly millenials, who have incredibly easy access to porn on the internet.



Dr. Geo Espinosa  is a Naturopathic doctor and men’s health expert and can be reached at http://drgeo.com/ His book on prostate cancer Thrive Don’t Survive: Dr. Geo’s Guide to Living Your Best Life Before & After Prostate Cancer is available on Barnes and Noble https://www.barnesandnoble.com/w/thrive-dont-only-survive-dr-geo-espinosa/1123391807 and Amazon. Dr. Geo’s new book, Integrative Sexual Health is now available on Barnes and Noble https://www.barnesandnoble.com/w/integrative-sexual-health-barbara-bartlik/1127405046?ean=9780190225889&st=PLA&sid=BNB_DRS_New+Core+Shopping+Books_00000000&2sid=Google_&sourceId=PLGoP164972&gclid=Cj0KCQjwy9LVBRDOARIsAGqoVns8kBd4mo4HQ09QF8oIP6DxDzQUE-6R-6o22z4erYsRl7yi3LVhLr4aApX5EALw_wcB

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 as well as chiropractic work by calling the 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.

                                                Hey, Rational Wellness podcasters, thank you for joining me today and we’ve got a very interesting topic. We’re going to talk about men’s health, and in particular, we’re going to talk about erectile dysfunction, which is a very important topic. By the way, everybody who enjoys this podcast, please go to iTunes and give us a rating and review. That helps more people find out about our Rational Wellness Podcast.

                                                So, Erectile Dysfunction is defined by the Mayo Clinic as the inability to get and keep an erection firm enough for sex. Erectile dysfunction affects quite a large number of men in the United States. The long-term results from the Massachusetts Male Aging Study reported in 2000, an overall incidence of erectile dysfunction of 26% among men in the United States, with the rate of erectile dysfunction increasing with increasing age. There’s approximately a 12-1/2% prevalence at age 40, a 29.8% at age 50, and 46.4% at age 60. Besides age, the prevalence rate will also increase due to lower education and increased rates of diabetes, heart disease, and hypertension. Psychological factors can also play a role. Erectile dysfunction is a side effect of many medications. Poor diet and lifestyle, fatigue, excess alcohol are some of the other factors that can play a role.

                                                To help sort this out, we have Dr. Geo Espinosa who is the go-to guy in the Functional and Integrative Medicine world on men’s health. He’s the Director of the Integrative Urology Center at New York University Langone Medical Center. He’s a licensed naturopathic doctor. He’s a licensed acupuncturist, a certified nutrition specialist, and a registered herbalist. He’s the author of Thrive Don’t Survive: Dr. Geo’s Guide to Living Your Best Life Before & After Prostate Cancer, which is an excellent informative guide to dealing with prostate cancer. He’s one of the editors of a new book on integrative sexual health. Geo, thank you for joining me today.

Dr. Espinosa:                      Hey, thanks so much, Ben. It’s a pleasure.

Dr. Weitz:                            Okay, so how should we get started on this topic?

Dr. Espinosa:                      There’s many places to go. There’s many places to go, but it’s very important to understand first and foremost that the penis is a barometer to a man’s health. Every time I talk about this topic, I say the same thing because it’s really important for everyone to understand. A man who does not get an erection for three months, whether it’s because they don’t have a partner, or because they don’t have a morning erection, that’s a health problem. Other factors might be that need to be investigated. So, it’s not only for pleasure, which is a very important organ for pleasure, but it’s very important for just overall health.

Dr. Weitz:                            Right. What are some of the causes of erectile dysfunction? What are some of the most important ones?

Dr. Espinosa:                      The main causes are that it could be neurological. So, anything that interferes with three things: the nervous system, a problem with the nervous system, a problem with blood flow, or hormonal. Any of these three problems can interfere with either the nervous system transmitting signals to the penis or blood flow that can cause an erection. So of course, there’s things like multiple sclerosis, and sometimes surgery from prostate cancer can cause it, particularly if they sever the pudendal nerve that goes into the penis that can cause erectile dysfunction.

Dr. Weitz:                            What’s the actual numbers on that? I’ve heard like 50%.

Dr. Espinosa:                      Minimum. After a prostate cancer surgery, minimum 50%. It’s more toward 60% of men that actually get erectile dysfunction from these treatments.

Dr. Weitz:                            Okay. How much does getting the robotic surgery decrease that percentage?

Dr. Espinosa:                      How much is getting what? I’m sorry?

Dr. Weitz:                            Robotic surgery versus the open surgery? How much does the robotic surgery decrease the likelihood for there to be erectile dysfunction, because that’s one of the big selling points of it, right?

Dr. Espinosa:                      Well, it depends if you ask the robotic surgeon, because many of them would probably want you to think that it’s a very low rate. Actually, there’s very little change in both urinary incontinence and erectile dysfunction with men who undergo robotic surgery versus open surgery. So, there’s very little difference. There’s almost no difference.

Dr. Weitz:                            Wow.

Dr. Espinosa:                      You never want to make a decision of whether or not you will undergo robotic surgery versus open based on whether or not you can function afterwards.  It doesn’t make much of a difference in that regard.

Dr. Weitz:                            Wow, so you’ve really popped a myth because I think there’s a very common perception that the robotic surgery is much safer.

Dr. Espinosa:                      Yeah. The company that creates the robotic machines and all the gadgets for the machine is called the Da Vinci Company, like Leonardo da Vinci. Their marketing has been outstanding. Their direct to consumer marketing has been outstanding, to the point that everyone asks for a robotic surgery these days, and they think they’ll get a better result, but that’s not necessarily true.

Dr. Weitz:                            Interesting. What kind of alternative is doing radiation, or radiation seed in terms of sparing the nerves?

Dr. Espinosa:                      So radiation also, that can damage the nerves of the penis. It depends upon what kind of radiation. There’s different kinds. There’s external beam radiation that radiates the whole pelvic area. There’s more focal radiation, something called CyberKnife now that’s proton beam radiation. That’s more focal. That can save the nerves a whole lot more than external beam radiation. Sometimes men need both. Sometimes, they get a radical prostatectomy. Let’s say the physician saves the nerves of the penis–that can happen, but sometimes they need radiation afterwards and it makes it almost 100% impossible to get an erection after that.

Dr. Weitz:                            Yeah. One of my patients had … He was told originally that it was confined to the prostate, to the gland, and when they went in, they found out that it broken through the capsule. Then, they subjected him to 60 sessions of radiation. Unfortunately, there wasn’t any sign of the cancer, so I questioned what they were radiating–just the area around it.

Dr. Espinosa:                      They’re radiating blindly sometimes thinking that there is or will be cancer cell somewhere around the pelvic area, but they won’t know exactly where. So, they radiate blindly throughout the whole pelvic bed.

Dr. Weitz:                            How effective do you think that is for decreasing recurrence?

Dr. Espinosa:                      Well, the reality is that the recurrence of prostate cancer after all that can occur up to 50% of the times. So, you go through all that and up to 50% of the times, you can have a recurrence of your prostate cancer, not to mention that after radiation, you can have secondary cancers like bladder cancer, and that’s in the data. So, it’s a fine line between what you think will keep you living longer, and the quality of life that you can live while you stay living longer.

Dr. Weitz:                            Right. Okay. In terms of the vascular supply, the blood flow to the penis. Really in this case, we’re talking about this is another barometer of your overall cardiometabolic health. So if you’re going to have blockages to the arteries, to your heart, and your coronary arteries, you’re talking about the same type of situation that’s going to decrease blood flow to the penis, right?

Dr. Espinosa:                      Absolutely, absolutely. You want to make sure that the vessels are not atherosclerotic. So, the penile vessels are very small. They’re much smaller than other vessels particularly to the heart. So, things that can happen to the penile vessels can certainly work its way up and eventually happen to the heart vessels. So, you want to make sure that the vessels are nice and supple, like all your vessels, not just the vessels from your penis, so that they expand, and dilate, and constrict. Dilation of the vessels of your penis is what gives a man an erection. Then, the venous level closes in so that the blood stays in there and so a man gets an orgasm, then blood flows back into the system. That having clean blood vessels is the name of the game, along with a clean nervous system as well.

Dr. Weitz:                            So what are some of the tests that you would do with a man who had erectile dysfunction and you wanted to see if vascular issues were a problem?

Dr. Espinosa:                      You know Ben, there are no objective tests for that really.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      One of the better … As a practitioner, I think you’ll appreciate this. I still get 80% of what I need from a good physical exam and asking key questions. That cannot be overlooked to try to find a fancy test. So then, we have all these tests on purpose. So along those lines, there’s the sex inventory questionnaire called the SHIM, S-H-I-M, which you can download. Anyone can download, and that still one of the best questionnaires is sexual history inventory questionnaire that it could quantify the issue, and you can put them on a protocol and then give them another SHIM score questionnaire three months after or six months after, and you can see the difference if they’re improving or not.

                                                There’s no objective test at this point where we can measure nerves are going … There’s actually an old test that you may not be aware of or you may, where if you insert the … You can do it yourself or do it to a patient. Insert the tip of your finger in the tip of the anus of the patient or yourself, and then if you squeeze the tip of your penis, you can feel the tip of the anus tighten at the tip of your finger as you press on the tip of your penis. That’s an indicator of… if that makes any sense.

Dr. Weitz:                            I couldn’t hear the last part. It’s an indicator of what, of neurological?

Dr. Espinosa:                      Yeah, neurological health of the pelvic area of the penis.

Dr. Weitz:                            Okay. I just got to turn the music off. Somehow, it popped on in my office. Okay, good.

Dr. Espinosa:                      Okay.

Dr. Weitz:                            Yeah. I never heard of that one, but that’s kind of interesting. Yeah, I like to run those advanced lipid profiles and take a look at all those factors, and then try to change their nutrition to balance those things out.

Dr. Espinosa:                      Yeah. You want to rule out metabolic syndrome.

Dr. Weitz:                           Right. So, diabetes obviously, blood sugar problems, hemoglobin A1c, inflammation, which is going to increase the likelihood, right?

Dr. Espinosa:                      Yes. Absolutely, absolutely.

Dr. Weitz:                           What’s your favorite way to measure inflammation? Do you use hsCRP to measure inflammation?

Dr. Espinosa:                      I do.

Dr. Weitz:                           Yeah. Okay.

Dr. Espinosa:                      I do hsCRP. That’s my main form of measuring inflammation. I use hemoglobin A1c, fasting glucose, and I use the NMR LipoProfile as well that has an insulin resistance marker there that I find valuable.

Dr. Weitz:                           Right. I like to look at also the omega-6 to omega-3 ratio as inflammation marker and then try to modulate that.

Dr. Espinosa:                      Excellent. What labs do you use for that? 

Dr. Weitz:                           We’ve been using the CardioMetabolic test through SpectraCell. It’s a really nice test and they’re offering it at a really reasonable price. For a patient with insurance, it’s 50 bucks. It includes all the particle size, homocysteine, CRP, omega-3. It’s a neat test. I’d look into that. So, when it comes to neurological problems, besides prostate surgery, I know, as a chiropractor, that problems with lumbar disk or nerve injury that can affect the nerves from the lumbar spine can affect the ability for erection. Isn’t that correct?

Dr. Espinosa:                      It is correct. Absolutely, it is correct. Certainly as a non-chiropractor, I do find value in those lumbar adjustments that you guys do, just kind of opening things up for my male patients. So, I get them to get adjusted as well.

Dr. Weitz:                           Yeah. We get patients who find that when they’re having an issue with their lower lumbar region, sometimes they’ll get pain into the testicles or pain into the groin. We know that it can have an effect, and diabetic neuropathy, that can be a factor as well, right?

Dr. Espinosa:                      Absolutely, absolutely. Anything that contribute to any type of the metabolic type of syndrome presentation, high lipids, high blood glucose, big waist size, all those things are contributing factors and you have that hormonal aspect that’s very important as well.

Dr. Weitz:                           Right.

Dr. Espinosa:                      We can segue into that if you want or we can pause if you want.

Dr. Weitz:                           Yeah, sure. Let’s do that. So what are the hormonal factors that you like to look at the most?

Dr. Espinosa:                      So, we looked at how well … Testosterone is a major, major hormone not only for sexual interest, but sexual function. Interestingly and infrequently, I find men that say that they can function with lower testosterone levels in the three and 400s, that’s not too common. Oftentimes, these guys say that they don’t wake up with an erection. So, waking up with an erection or at least you recognizing that you have one is actually a very important thing. It doesn’t have to happen every day, but every now and then, you should be able to say, “Hey, I woke up with an erection.” The morning woody is a healthy thing.

Dr. Weitz:                           How much does free testosterone versus total testosterone matter? How much importance are given to each of those measures?

Dr. Espinosa:                      That’s a great point. I had a patient today with a total testosterone of 486 and a free testosterone of 7.2, which was very low free testosterone and total is actually low, but within normal. Normal range is a wide range, but it’s very low free. It was very important, and if you don’t have free testosterone, it won’t work. When it’s bound to sex hormone-binding globulin, that testosterone is not free to do what it’s supposed to do. So, it’s very important.

Dr. Weitz:                           So, how would you treat a patient like that?

Dr. Espinosa:                      I tell you what I don’t do and it’s not that I’m against it. It’s that, I try to have the patient make the amount of free testosterone that they need as naturally as possible. So, I don’t do exogenous testosterone. Again, it’s not that I’m against it necessarily. I think for some patients it’s the right thing, but they become so dependent on it that their body just shuts down from making it, and it’s very difficult to get them off it once they’re on it.

                                            So, what I do is … There’s two things that I do. Number one is if they have erectile dysfunction, and it’s associated with poor hormone or low free testosterone, they want to function as soon as possible sexually. So, that functioning sexually is more important than health to them. It’s just the way it is. So, I don’t mind that they use a low amount of PDE5 inhibitor, whether it’s Cialis five mg, very low dose, or 25 mg of Viagra. Again, very low, that’s the lowest dose that they have.

                                                I get them some extra nutrients that I use. I use a supplement called … Well, actually it’s my formula, so I don’t want to sell on your podcast, but it does have L-citrulline…

Dr. Weitz:                            No, feel free to mention it. It’s your Mr. Happy formula?

Dr. Espinosa:                      It’s Mr. Happy and there’s XYVGGR is very good. So, I get them to do two of those with those formulas, these Mr. Happy formula. They have to take two twice a day on an empty stomach and that’s a very important factor. Then, they may not need a PDE5 inhibitor.

Dr. Weitz:                            What does that product have in it?

Dr. Espinosa:                      Yeah. So it’s five ingredients at a very high dosage. It has L-citrulline, which L-citrulline makes more arginine in the body than just taking arginine by itself.

Dr. Weitz:                           Right.

Dr. Espinosa:                      It has epimedium. Epimedium has a chemical in it called Icariin I-C-A-R-R-I-N. Icariin is actually a PDE5 inhibitor just like Viagra, Cialis, and Levitra. So there’s these chemicals-

Dr. Weitz:                            Arginine helps with-

Dr. Espinosa:                      … in epimedium.

Dr. Weitz:                            Arginine helps with nitric oxide production, right?

Dr. Espinosa:                      Correct. So, eventually what you want is your blood vessels to open up. Arginine helps with that. So, your arginine helps stimulate the inside of the arteries to produce nitric oxide, and then your vessels open up. How you get more arginine in your body? You could eat arginine or drink supplements but you have a lot of arginase in your system that breaks it down very quickly. So, you have to take … I mean, studies have shown that arginine works at about five grams a day, but you have to break that up to [inaudible 00:21:42] as shown to actually make more arginine in the body than just taking arginine. So, it was always my preference when I’m trying to raise arginine levels. There was one randomized trial that showed that it helped with sexual erections specifically with the citrulline.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      Epimedium or horny goat weed, is the other herb. It’s a layman’s term. It’s called horny goat weed. It actually has icariin, which is like a PDE5 inhibitor, very good. The other is you want adaptogens in the system. Adaptogenic herbs, this is a group of category of herbs that kind of like the name implies, it helps your body adapt. So, adaptogenic herbs are very important. The one in Mr. Happy is rhodiola and it’s one of my favorites, but then you have ashwagandha and you have Siberian Ginseng. Those are good too.

                                                I have to say those are not in the formula and the reason why they are not is because I like the studies in rhodiola, not so much in relation to sexual health, but in relation to extra energy that you would get after a long day’s work, per se. So, that one of the problems that men have is that they work all day, and then they’re pooped out at the end of the night. We try to avoid that. Rhodiola is the best type of herb adaptogen for that.

Dr. Weitz:                            If you have a man who has total testosterone levels but the free testosterone is low, that means too much is being bound up by like sex hormone-binding globulin. Are there specific nutrients that can help with that issue?

Dr. Espinosa:                      Yeah. There are two things. A low protein diet, it’s a contributing factor to high SHBG. So, a low protein diet. So, vegans sometimes have high sex-binding globulin hormones, and I use nettle root. I don’t use it in a formula because I use high dosage of nettle root up to 500 mg twice a day of nettle root, not a leaf.

Dr. Weitz:                           Nettle root?

Dr. Espinosa:                      These things are all very … yeah.

Dr. Weitz:                           Is that the same thing as stinging nettles?

Dr. Espinosa:                      It’s the same thing as nettles but sometimes you see nettles, and it’s nettle leaf.

Dr. Weitz:                           Okay.

Dr. Espinosa:                      We don’t want nettle leaf for this particular purpose. We need the root.

Dr. Weitz:                           Okay.

Dr. Espinosa:                      Nettle root, it’s what’s important to inhibit over production of sex hormone-binding globulins.

Dr. Weitz:                            So, do you use capsules or tincture?

Dr. Espinosa:                      I use capsules for the most part and I use about 500 mg. It’s high dosages and only nettle root, not in a mixed formula. I kept emphasizing that because then, if you use a formula, and I’m okay with formulas but not for this particular purpose, then the dosage will be too low, and the dosage needs to be high for this particular purpose.

Dr. Weitz:                            You have a favorite manufacturer for that product?

Dr. Espinosa:                      Yeah, I like MediHerb. First of all, for herbal products, I like MediHerb.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      I’m a big fan of MediHerb. So that’s the main one and I like … I also use Gaia sometimes.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      G-A-I-A.

Dr. Weitz:                            Yes.

Dr. Espinosa:                      Yeah.

Dr. Weitz:                            Okay cool. What if they have excess estrogen?

Dr. Espinosa:                      Great question, yeah. There’s not such a thing as bad chemicals or bad hormones in men. I think we get very caught up with bad this, the problem with cholesterol.

Dr. Weitz:                            Sure.

Dr. Espinosa:                      Let me say this before I answer your question because my mind is going somewhere else briefly as I mentioned cholesterol. I saw a patient, I posted on Facebook with a 101 total cholesterol level and very low testosterone, 101 without being on a statin. I’ve never seen that before.

Dr. Weitz:                            Wow.

Dr. Espinosa:                      I’ve never seen 101 cholesterol in a man that’s not on a statin.

Dr. Weitz:                            Right, very unusual.

Dr. Espinosa:                      It is unusual, and so this guy’s not making any of his hormones. His hormones are low. So, as a result, that’s throwing things off. My point with that is that there is … We used to think and of course forever cholesterol is bad, cholesterol is bad, cortisol is bad, estrogen is bad in men. We don’t want any estrogen in men, that’s not true. Estrogen is a very important hormone in men and studies have shown that men that have levels of estrogen, estradiol between 10 and 20 nanograms per milliliter actually have lower heart disease. So, I like men to have between 10 and 20, not higher than 20.

Dr. Weitz:                            Right.

Dr. Espinosa:                      Or certainly not lower.

Dr. Weitz:                            I know a lot in the lab say it’s normal until 40, but I agree with you. I think 20 is probably a better cutoff.

Dr. Espinosa:                      Yeah. You know what we do? We optimize our ranges, is what we do as functional medicine doctors, and that’s the number … and this is based on research. This is not my opinion.

Dr. Weitz:                            No, I know you’re always based on research.

Dr. Espinosa:                      Yeah. So, that’s what I like my men to be. So, yeah. We look at estrogen levels, and so if it’s over, sometimes it’s over a 20, or 30, or 40.

Dr. Weitz:                            Right, what do you do in those case?

Dr. Espinosa:                      What we do is liver detox. Liver detox, get them away from … My vegans are sometimes very high in estrogen because they start … They’re probably eating too much soy products. So, I get them to lower down their soya intake, and I do liver type of detoxification. I use a lot of DIM and broccoli type of extracts, milk thistle, get him on a good detox and just get their bodies normalized typically if you reduce estrogenic foods and just clean your liver.

Dr. Weitz:                            Yeah, good. Cool. So, we know that low testosterone or erectile dysfunction is actually a side effect of a lot of medications. What medications do you find are the most common culprits in this regard?

Dr. Espinosa:                      So many of blood pressure medications are a problem like beta blockers. So, beta blockers contribute to erectile dysfunction. Some H2 blockers for acid reflux like Tagamet interferes with the production of testosterone.

Dr. Weitz:                            Those are among the most commonly prescribed medications?

Dr. Espinosa:                      You better believe it, yeah. You better believe it. Statins, sometimes they lower cholesterol way too low, and so the patient is not making enough cholesterol to make their steroid hormones, their reproductive hormones. So, statins can be an issue.

Dr. Weitz:                            By the way, you mentioned the patient with low cholesterol. What do you do with a patient with low cholesterol? Do you actually have them … What do you do to try to increase their cholesterol? I heard of a product from sheep’s skin or something, some cholesterol product that one doctor said she used.

Dr. Espinosa:                      Yeah. I’m not familiar with that. I’m familiar with … So, I’ll tell you what I do in general, and then I’ll tell you what I’ll do with this patient because there are two different things.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      This patient is 51 and he has concerns about prostate cancer, so he’s doing a lot of things from an anti-prostate cancer perspective. A lot of that is being vegan and eating soy products.

Dr. Weitz:                            Oh, I see.

Dr. Espinosa:                      Which I never put him on that diet for prostate cancer prevention. So he loves meat, and so one of the things we’re going to do is … He’s a blood type O, and I think O’s can handle, they do better with eating a grass-fed beef and animal products. So, I’m going to get him to eat animal products again. I’m going to get him off all that soy. I’m going to get him to focus on big muscles and train big muscles, less repetitions not high reps, more weight, and that’s another way of increasing testosterone. I’m going to get him to do weight resistant exercise on a fasting state. So, that’s interesting because that also helps increase testosterone. So, no pre-workout anything to drink.

Dr. Weitz:                            Oh, really? Ha, that’s interesting.

Dr. Espinosa:                      Yeah. Then a protein drink with creatine because I think that’s what he wants after his workout.

Dr. Weitz:                            Really? Don’t you want to take creatine before because-

Dr. Espinosa:                      Yeah. So, for the purpose of testosterone, I’m a big fan of lifting, weight resistant on a fasting state only water, only water. Creatine can give you that extra push and that extra … Drink creatine to help you get that extra lift.

Dr. Weitz:                            Yeah, right.

Dr. Espinosa:                      It has a pretty decent lifetime, and I’ll get him to take it hours before or the night before. I know creatine can help for certain people. For example, if you have normal testosterone, creatine as a pre-workout is fine, but for guys that I’m trying to raise their T levels and their free T, I get them to just do on an empty stomach with no macronutrients in their system at all.

Dr. Weitz:                            Interesting.

Dr. Espinosa:                      Yeah. So, with regards to supplementation, I use herbs. I use fenugreek. That’s been studied quite extensively. Testofen is what’s used. I use maca, and again when it comes to maca, I use only maca three grams a day, so I don’t mix it with anything else. I use XYVGGR or something like Mr. Happy. So, what I’ve noticed in my patients that use … XYVGGR is the practitioner line for Mr. Happy by the way.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      So, the formula is the same thing, so I may use the names interchangeably as we talk.

Dr. Weitz:                            I see, I see. Why do you take the maca by itself? Is it different if you mix it with other products or foods?

Dr. Espinosa:                      I take it by itself because you need three grams for it to have any efficacy. You can only fit so much into a capsule.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      That’s the only reason.

Dr. Weitz:                            Right.

Dr. Espinosa:                      Yeah. The other adaptogen that has actually been shown in studies to help increase testosterone is ashwagandha. So between ashwagandha, fenugreek, and maca, that’s my main three herbal combination. It’s not tribulus.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      It’s not tribulus because I know a lot of people are taking tribulus, and I just don’t know the evidence for it. I don’t see it, and I don’t see it clinically.

Dr. Weitz:                            Okay. Interesting.

Dr. Espinosa:                      Then I get them to … I figure out their sleep patterns and then if that’s a problem, we work on that.

Dr. Weitz:                            Okay, what if-

Dr. Espinosa:                      As you know, you may … Sorry to interrupt Ben. As you know, we make most of our testosterone during our sleep cycle, anywhere between 4:00 to 5:00 in the morning.

Dr. Weitz:                            So, is it crucial when we test testosterone that we test it pretty early in the morning?

Dr. Espinosa:                      It is. Particularly on younger men, younger than 50. Older men, older than 50, studies actually show that it doesn’t matter because their testosterone is pretty leveled off throughout the day. So, I don’t know.

Dr. Weitz:                            I thought that older men category started at 70.

Dr. Espinosa:                      Well, I want to think that too by the way. As you see, my face is graying by the day. When they talk about older men and younger men, I take that a little bit with a grain of salt because a 60-year-old man is not a 60-year-old man. You could be a 60-year-old man who’s like 70 biologically, or who’s 40 biologically. So, I’m very careful with that. I’m just a messenger here.

Dr. Weitz:                            What do you think about marijuana and testosterone levels? Especially since marijuana is-

Dr. Espinosa:                       I’m sorry, marijuana.

Dr. Weitz:                            Yeah. It’s getting more popular, and even CBD oil, and it seems to be a very hot topic right now.

Dr. Espinosa:                      Right. So, marijuana lowers testosterone levels, and so man, want to be careful. Is there a toxicity to the dose? I don’t know. I don’t know if you smoke two joints versus one if there’s a difference. Same with alcohol. Alcohol in excess, it can be an erection killer. A little bit of alcohol can take the edge off and can help you get into the mood. So, there’s a fine line. I don’t know if there’s a fine line with marijuana. I think men, I want to be very careful, but I do know that it lowers testosterone level. So, men want to be very careful with the usage of marijuana.

                                                I know it’s now the in thing and there’s a big industry now. I think Snoop Dogg is a partner in one of these marijuana companies and everything is big business, but I think men want to be careful if they want to keep their testosterone levels high.

Dr. Weitz:                            What about adrenal fatigue? I know DHEA, which is produced by the adrenals is a precursor to testosterone.

Dr. Espinosa:                      Yeah. So, that’s very good. So, DHEA has shown to help with erections as well in men who are deficient in DHEA, and men who have no deficiencies in DHEA, I would not give DHEA for that particular purpose anyway. If there is a deficiency in DHEAS, then you would want to give DHEA and that may help as well with erections.

Dr. Weitz:                            You know just-

Dr. Espinosa:                      Yeah?

Dr. Weitz:                            I was having some discussion about sexual issues with women, and women are using a bunch of topicals including topical DHEA cream now. Are there topical creams like that? Does that have any effect for men? I’m just curious.

Dr. Espinosa:                      Not that I know of and not from an erection perspective.

Dr. Weitz:                            Right.

Dr. Espinosa:                      That I know of anyway.

Dr. Weitz:                            Okay. So, I’ve heard of a few patients who had scar tissue in their penis from riding a bike or other trauma. Can you talk about that as having an effect on erectile problems?

Dr. Espinosa:                      Well, I don’t know if these particular patients you’re referring to if they’ve had Peyronie’s disease. So, that with scar tissue, their penis bends a little bit and becomes like a curve, it curves. If there is Peyronie’s, there can be erectile dysfunction. There’s like three levels of Peyronie’s. If they have like level one, they may just see a slight curvature upward or sideways, and that’s not … If you have a level one, it doesn’t interfere with intercourse at all.

                                                If they have a level two or three, they may have erectile dysfunction from that. A little bit harder to treat, the natural approach is very, very extensive. It’s very difficult. I have not been that successful, I have to say with Peyronie’s disease just with natural methods alone anyway. So, that’s very difficult to treat. So, any other type of trauma not so much from bike riding. I mean, it depends. If they have prostatitis and maybe prostatitis or an inflammation of the prostate, and that can contribute to erectile dysfunction because now, the nerves that are going to the penis are irritated and inflamed as well.

Dr. Weitz:                            Well, I’ve also had some of those bike riders tell me about just numbness in that whole area too. I suspect that, that could potentially be a-

Dr. Espinosa:                      Yeah. That’s neurological for sure, yeah.

Dr. Weitz:                            Yeah. There are some physical treatments for erectile dysfunction. I was listening to one of Mike Mutzel’s podcast and he had this Dr. Kathryn Retzler on, who’s a naturopathic doctor. She mentioned, number one, giving PRP injections into the penis, and she also talked about-

Dr. Espinosa:                      Yeah.

Dr. Weitz:                            … a GAINSWave sound therapy. What have you … Do you know anything about those?

Dr. Espinosa:                      Yes. I don’t do them, and not because I’m not interested is because I can only do so much. I know that PRP is used for Peyronie’s disease.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      On that curvature of the penis-

Dr. Weitz:                            Yeah.

Dr. Espinosa:                      … with some level of success. So, that with sound wave therapy, I’ve heard anecdotally good things. Ben Greenfield, who actually we met at Mindshare-

Dr. Weitz:                            That’s right.

Dr. Espinosa:                      Actually was that Mindshare?

Dr. Weitz:                            Yeah, I met him as well.

Dr. Espinosa:                      He is like a guinea pig with all kinds of things, and he’s reported to do that with his penis without having to. He didn’t have a problem. He just wanted to do it, and he’s openly talked about it. He talks positively about it that his organ is bigger at least to him.

Dr. Weitz:                            Right.

Dr. Espinosa:                      That it works. There’s a stronger orgasm when he has intercourse, and then indeed it helps with longer erections. So, there’s a lot of anecdotal information. There’s a big to do, to do the PRP and the sound wave. Quite frankly, I think it’s a little bit … I like to see some objective evidence before I send a patient to do that. I would send a patient to do PRP for Peyronie’s just because there’s not much out there to begin with. So, for that purpose, I would … but yeah. I’m still waiting for a little bit more data or something for me to hang onto, so I can say with low level of concern for patient to move forward with that.

Dr. Weitz:                            Are there any nutritional deficiencies that you think can cause erectile dysfunction or play a role in that issue?

Dr. Espinosa:                      Yes. So, guys that are with low protein diets because they probably not … They don’t have enough arginine in their system. That’s a concern. So, it’s some sort of amino acid deficiency like arginine, and once again zinc. Zinc, it’s a major male mineral, other than magnesium, which magnesium obviously it’s involved in many biological pathways and is probably the number one mineral. Other than that for a man, zinc is a man’s best friend.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      Anti-oxidants because there’s a lot of … much of erectile dysfunction and male infertility can be due to oxidative stress. So, you need to find combination of antioxidants and you know the deal. Alpha-lipoic acid, vitamin C, mixed tocopherols, vitamin E, all those are all very good and plants. A plant-based phytochemical antioxidants as well.

Dr. Weitz:                            Is there an upper limit to zinc supplementation that you don’t like to not go above?

Dr. Espinosa:                      Great question, I hang around 30 to 60.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      Which is fine anywhere once. I try not to go at … I’d never go above 60 or anywhere near a 100 with any mineral. Too much of a good thing may not be such a good thing. Zinc is one of them, and of course zinc and copper they work together. So, once you start giving more than 30 to 60 milligrams of zinc, you may want to give one or two milligrams of copper so that you don’t have a copper deficiency. So I don’t go higher than 60 milligrams.

Dr. Weitz:                            Okay. And one last issue I’d like to touch on because I don’t think it would be complete to talk about this topic without mentioning some of the psychological issues like depression, stress, relationship problems, and even watching porn, which seems to be a problem.

Dr. Espinosa:                      Yeah. So, adrenaline is the biggest erection killer in the world.

Dr. Weitz:                            Stress.

Dr. Espinosa:                      So, there is no strong chemical, any type of stress, or anxiety, or guilt, or anything like that can … It will cause the production of adrenaline, norepinephrine, epinephrine, and there’s no chemical that I can inject in your body that’s stronger as an erection killer than these adrenaline chemicals. Okay, so that’s one big takeaway.

Dr. Weitz:                            Cool.

Dr. Espinosa:                      Now, with that comes the relationship, the importance of how you get along. There are times when people are saying … Guys come into my office and say, “Well, I have erectile dysfunction.” I was like, “Oh, how do you know? What if I, I don’t know, what if I bring JLo into the office, will you have that …”. “Well, I don’t think so.” So, sometimes you can see there’s problems in their relationship. Do you still think that your woman, if it’s a woman, do you still think she’s hot and all these factors?

                                                Now, these things are overlooked all the times but if we’re trying to address the underlying cause, then that needs to be addressed. So, how often do you wake up with an erection? Then, I do give them like some Cialis even if they’re not functioning to see if they get more spontaneous erections. If they do, that means it’s psychological. If they get an erection from anything, from a drug, or a supplement, that means that it’s psychological. So, I cannot overestimate the importance of just a good relationship, and we can have another podcast on what that would look like.

Dr. Weitz:                            Right.

Dr. Espinosa:                      The other aspect is porn. You mentioned some statistics initially that about 30% in men under 40 roughly have ED. I would argue that. What I see is a whole lot more than that in men under 40.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      The reason for that is because the men under 40 particularly millennials have been … have had free access or paid access, easy access to porn since they were probably born. Well, that’s if they had access to it because they’ve been around iPads and so forth looking at porn, and they have this perception of what sexual intimacy is like. Then, once they start having intercourse and they start mating, then they think that, that’s what it looks like and they are having a lot of erectile dysfunction issues. When you and I, Ben, you look like a millennial but I know you’re not.

Dr. Weitz:                            No, I’ll be 60 this year.

Dr. Espinosa:                      Wow, you’re a milestone. Ben, that’s amazing actually. I think I’ll have to interview you sometimes to figure out what you’re doing.

Dr. Weitz:                            Sounds great.

Dr. Espinosa:                      Geez, that’s …

Dr. Weitz:                            Thank you.

Dr. Espinosa:                      If you or I, when we were growing up.

Dr. Weitz:                            When I finished my anti-aging book, you can interview me.

Dr. Espinosa:                      Absolutely, absolutely, would gladly do so.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      When you or I wanted to get a porn flick, we had a VCR. We had to go to the store, go to the corner store, which was in this isolated section, nice and big, you see triple X. It’s a little bit embarrassing to go in there. So, we didn’t watch much porn relative to what’s available now growing up. So these young guys are more screwed up in bed than ever before.

Dr. Weitz:                            Right.

Dr. Espinosa:                      A lot of it has to do with excessive porn watching. It’s not my opinion. It is an absolute fact, and it’s been proven and confirmed in scientific studies. It’s bad. It’s a problem. Briefly, I’ll say this. Why is it a problem? Many reasons. They are watching positions and things that once they start mating with females, or whatever, or whoever, they may not do all those positions that are so wild and so forth. The other thing is that they all think they have a small penis, part of the reason why they think they have a small penis is because watching porn.

Dr. Weitz:                            Right.

Dr. Espinosa:                      Which is magnifying the size of the penis, and sometimes they’re holding it and inserting it at the same time, and they’re thinking that they could do that. Well, I can’t do that if I hold it. I can’t insert it. There’s not that much left. So, all these issue … I’m serious. I speak to these guys all the time, so they’re thinking that they could do all these things and they can’t. Almost at least five times a week, a guy comes into my office and say, “Oh, I think I have prostatitis. I think I have prostate. I’m urinating a lot, and I think I have a small penis. I think I have microphallus.”

                Now, microphallus is a real diagnosis. That’s a real diagnosis. I’ve met one guy in my lifetime that has microphallus. In my lifetime, I’ve been practicing now for 13 

years mostly men, once have I seen them. Microphallus is just the glans, only the head of the penis and that’s all they have.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      So, most guys are not. They don’t have a small penis. Yes, some guys are bigger than others, but most guys don’t have microphallus. In any event, watching porn I think is one of the biggest no pun intended, contributing factors to erectile dysfunction amongst young men.

Dr. Weitz:                            Great, Dr. Geo Espinosa. This was a lot of great information. For those listening or watching this podcast how can they get hold of you?

Dr. Espinosa:                      Thank you so much. So, my website is drgeo.com, D-R-G-E-O.com, E for erections, not I. The book that just came out Integrative Sexual Health that I’m one of three editors.

Dr. Weitz:                            Okay.

Dr. Espinosa:                      We were talking about it before Ben. You almost don’t feel when you’re done with it that you have a good book out. I’ve written several books and at the end, I’m like, “God, I could have done more.” Then you read it, and then just like, “Oh, wow. Oh, wow, yeah.” It’s almost like you’re reading somebody else’s book. This particular book Integrative Sexual Health along with my coeditors Barbara Bartlik and Janet Mindes. It’s probably, not probably because I love to have many books behind me on sexuality.

                                                It is the most comprehensive book on integrative and functional medicine for sexual health both for male and female. I actually learned tons from a female perspective because we got all kinds of expert authors to contribute, and quite frankly I know very little about female sexuality, which I think it’s important for men to know actually in order to … If you’re going to have intimacy with females. In any event, Integrative Sexual Health, it’s out now as part of the Weil Integrative Medicine Library of books.

Dr. Weitz:                            Good.

Dr. Espinosa:                      It’s a great, great, great resource. So, thank you for allowing me to mention it to your audience.

Dr. Weitz:                            Absolutely, and I’ll put a link to it on my web page, and add it to the YouTube page as well.

Dr. Espinosa:                      Thank you.

Dr. Weitz:                            Okay, talk to you soon.

Dr. Espinosa:                      Thank you very much.

Dr. Weitz:                            Thank you, thank you.


Rational Wellness Podcast 047: Busting Fitness Myths with Dr. Philip Goglia (Part 1)

Dr. Philip Goglia busts some fitness and nutrition myths while speaking with Dr. Ben Weitz.

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


Podcast Highlights

1:55  The first concept we reviewed was whether it matters how many of your calories comes from fats, carbohydrates, or proteins, as long as you eat fewer calories? The myth is that it doesn’t matter where your calories from. Philip emphasized that if you reduce your calories too much, you will not burn any fat. According to him, fat will only convert to energy in a calorically hot environment.   

5:40  Dr. Goglia talked about how a lipid profile and a HgA1c measurement from blood are clues to how a person metabolizes fats, proteins, and carbohydrates.  For example, if your triglycerides are elevated, that indicates that your body is unable to burn all of your carbohydrates for energy and instead you are storing it in your liver as triglycerides, which is referred to as fatty liver. Philip said that when he talks to some of his patients with high triglycerides about eating too much sugar, they often say that they don’t eat any sugar. He explains that if what they are eating is not meat with eyes and it’s not nuts and seeds, then it’s sugar. If it doesn’t have a heart beat, if it can’t run after you in the woods or take a dump in the woods or swim or bite you, then it’s sugar. 


Dr. Philip Goglia is available to see clients by contacting his office at 310.392.4080 or through his website http://www.pfcnutrition.com/

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


Rational Wellness Podcast 046: Eye Health with Dr. Travis Zigler

Dr. Travis Zigler speaks about Eye Health with Dr. Ben Weitz. 

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


Podcast Highlights

1:42  Dr. Zigler mentions some of the conditions of the eye that we can improve with diet and lifestyle changes, including dry eye, macular degeneration, gluacoma, and cataracts.

3:01  Dr. Zigler explains how to prevent and treat dry eye, including an anti-inflammatory plant based diet with lots of leafy green vegetables. He also recommends drinking a lot of water to hydrate the body and the eyes. Warm compresses and massage to the eyelids can help to soften and facilitate the flow of oil from the Meibomian glands that help to keep the eyes moist. Dr. Zigler also recommends using a spray cleanser on the eyes using hypocholous acid to kill bacteria that often develop on the eyelids and cause blepharitis.

6:52  We discussed the benefits of taking omega 3 fish oils and eating fish as well as whether it is a good idea or not to rub coconut oil into the eyes for lubrication.

9:22  There are a number of medications that can result in dry eyes, including antihistamines, decongestants, antidepressants, birth control medications, and blood pressure medications. Thyroid disease (both hyper and hypo), high blood pressure, and diabetes also tend to lead to dry eyes. Also post-menopausal hormone imbalances can result in dry eyes.

11:42  We talked about how blue light from computers, TVs, and phones results in dry eyes and macular degeneration.

13:50  Dr. Zigler explained dietary approaches that can help to prevent or reverse macular degeneration, including supplements like lutein, zeaxanthin, astaxanthin, zinc, and omega-3s, and eating kale and spinach. 

18:00  We discussed whether exercises for the eye, such as the Bates method, can help to improve eyesight. There is also something called vision therapy that helps the eyes to work together better and helps with conversion insufficiency, conversion excess, and a few other problems.

21:45  Dr. Zigler explained what causes floaters in the eye.

23:30  We discussed glaucoma and what can be done about it. 

28:20  Dr. Zigler discussed cataracts, what causes them, such as vitamin C deficiency, and what to do about cataracts.


Dr. Travis Zigler is an Opthamologist who provides information and natural products for eye health at his website, eyelovethesun.com, where you can also check out his blog.  He also encourages listeners to check out dryeyecommunity.com

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure as well as chiropractic work by calling the 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 top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.

                                Hey, Rational Wellness podcasters. Thank you so much for joining me again today. I’m really excited that we are going to be talking about eye health, which is so important and we’d never had a conversation about eye health. I just wanted to mention if you appreciate this podcast and you enjoy it, please subscribe on either iTunes or YouTube and please go to iTunes and give me a positive review that will help more people find out about it.

                                So our interview today is with Dr. Travis Zigler. He is an ophthalmologist and he is the CEO of Eye Health. So we want to talk about what things we can do to improve the health of your eyes. We constantly talk about the health of the gut and the thyroid and all the other systems in the body, but we’d never talked about improving eye health and how important is that. If you don’t have the health of your eyes boy, that’s real bomber so.

                                Travis, thank you so much for joining us today.

Dr. Zigler:             Hey, thanks Dr. Weitz for having me on. I’m excited to be here.

Dr. Weitz:            Good, good, good. So what are some of the conditions of the eye that we can improve with a healthier diet and lifestyle?

Dr. Zigler:             So conditions that, I mean, any condition of the eye is pretty much improved through a healthy diet and lifestyle, because most of the eye problems that are occurring are due to inflammation, so just reducing that inflammation. Examples would be the one that we specialized in is dry eye. We have a whole line of dry eye products that we use to help with that called Heyedrate. Then dry eyes are big one because dry eye is inflammation and then macular degeneration is another inflammatory disease in the back of the eye. Macular degeneration is where the macula of your eye where light is focused starts to degenerate. It doesn’t go through its metabolic process as well and therefore accumulates waste product, which then causes it to degenerate. Glaucoma is another condition. We don’t really know what causes glaucoma, but I never see glaucoma in healthy individual. It’s always in somebody that has a lot of inflammation with diabetes and high blood pressure. Then cataracts are another one. Everybody gets cataracts eventually, but there are some things that help speed those up.

                                So those are the kind of four main diseases that we focus on with eye care and then just keeping your eye healthy in general is, I mean, following the path that you can lead your patients and your listeners down to.

Dr. Weitz:            Great. So let’s start with dry eye. I understand that dry eyes is real risk factor for damage to the cornea.

Dr. Zigler:             Yes.

Dr. Weitz:            What are some of the therapies and techniques we can use to prevent or cure dry eyes?

Dr. Zigler:             So dry eye is this kind of multifactorial disease, meaning there’s a lot of things that go into it all the way from your eyelids to the surface of your eye where like you stated the cornea is. So I always like to start out my therapy for dry eye with diet, because all this inflammation is occurring and inflammation begets inflammation so it creates this kind of cascading pattern of just more and more dryness, the more inflammation that you have. So if we start out with a diet and start shifting patients into an anti-inflammatory diet with leafy green vegetables and probably some things that you talk about too. Leafy green vegetables I talk about hydration, switching to more of a plant-based diet. You’re going back to hydration, 80% of people are dehydrated in this world and simply getting in a floater can eliminate a lot of disease. Then I usually start them on a simple exercise regimen of just walking to your mailbox and back a day. Some people just need that simple starter-

Dr. Weitz:            Very ambitious…just walking to your mailbox.

Dr. Zigler:             It is, but some people that is a lot of walking in a day. So it’s getting them started in that kind of loop to get them exercising and then add five minutes a week to get them going. Then what I usually do is focus on eyelid health first. So a lot of people don’t realize that the eyelids play a crucial role in dryness because they have oil glands called Meibomium glands. These oil glands every time you blink, they secrete or put out oil onto your eye. This oil is responsible for keeping your eye lubricated and comfortable. So these oil glands if they’re not producing oil well enough, if the oil is getting hardened or if your glands are clogged, that’s going to cause that oil not to get out. Therefore that oil layer responsible for keeping your eye lubricated, keeping the tears on the surface, is not there.  Therefore your tears are going to evaporate and your eyes are actually going to start watering more because that oil layer of tears isn’t there.

                                So we talk about warm compresses. Warm compresses heat up that oil, turn it into more of a liquid. We then massage the eyelids, so just closing your eye and gently massaging it. That’s going to help break up those oils get them flowing again. Eating healthier oils like omega-6s and omega-3s. The key thing is there’s healthy omega-6s and healthy omega-3s. Americans get a lot of omega-6s in their diet. Unfortunately, it’s from bad oils, but you want to get good oils like avocados and chia seeds and ground flaxseed, things like that. That’s a good balance of getting those omega-6s and omega-3s in your diet. Then nuts, of course, that’s always a good thing as well.

                Combining good oils coming in with those warm compresses with a good hypochlorous acid eyelid cleanser sounds crazy because I said acid and it’s going near your eye. This is actually a natural mechanism that your body uses to battle bacteria. If bacteria overgrows on your eyelid, it creates a condition called blepharitis. So again, we’re getting that eyelid under control so battling the bacteria that can become overgrown. The bacteria like I said is normal, but it can become overgrown. So using a hypochlorous acid solution helps your body’s natural ability to fight the bacteria that’s there and then getting the oil glands in place. So just cleaning up the eyelid helps tremendously with dry eye.

                                That’s kind of the first steps of therapy as diet, exercise, hydration, warm compresses, lid massage and then using a hypochlorous acid cleanser. That’s going to get people going in the right direction and then that is usually where I start them and then we can go further in the therapy if you want. Did you have any questions over anything that I just went over?

Dr. Weitz:            Sure. What about eating fish and fish oil to increase your omega-3s? That’s one question. The second question is, I saw people advocating rubbing coconut oil directly into the eye.  What do you think about that?

Dr. Zigler:             Yes, so I’ll talk about both of those. So fish oil is very controversial. I’ll put that-

Dr. Weitz:            Not in my world.

Dr. Zigler:             Not in your world, okay good. I believe in omega-3s. Omega-3s are great. With fish, unfortunately our oceans are becoming so contaminated that it’s hard to find pure fish oil and fish oil capsule. So if you do take an omega-3, make sure it comes from a good manufacturing practice lab or supplement company and then-

Dr. Weitz:            Yes, yes, we only use professional brands and they’re molecularly distilled, so they are free of mercury or PCBs or anything else in them.

Dr. Zigler:             Yes, so we developed an omega-3 fish oil that’s specifically formulated for dry eye. We searched long and hard for our manufacturer and we get it out of the seas over by Iceland and it’s very sustainable source of fish. So that’s what you want to look for when you’re doing this and look for a less polluted area because the oceans unfortunately are getting polluted. Yes, they do play a big role and then eating fish, try to stay away from farm raised all the way. Always eat wild caught and that’s pretty much for everything, organic food instead of traditionally grown even though I think it’s reversed, because traditionally grown was organic and then it became pesticides.  Yes, anyway, and that’s it. What was the second question? I’m sorry.

Dr. Weitz:            What about rubbing coconut oil directly into the eyes?

Dr. Zigler:             So as an eye doctor, I can’t really recommend that just because there’s no studies that support it. Again, it’s coconut oil so it is a very good oil. Just make sure it’s organic, unrefined and if it causes any reaction, stop using it. I never recommend directly to my customers or my patients to do that and a lot of my customers online have seen success with it. So I’m not against it, but I can’t say I’m for it just because there’s no studies that support it. Because there’s no money in it from a pharmaceutical standpoint, so pharmaceutical companies aren’t going to study it.

Dr. Weitz:            Correct. So do you recommend … Well, if I was going to choose a coconut oil to rub in my eyes, would it be extra virgin?

Dr. Zigler:             Yes, so go with the highest quality you can, organic, extra virgin, just as pure as you can go.

Dr. Weitz:            I also saw there’s a whole series of medications like antihistamine, decongestant, even antidepressant, birth control medications, blood pressure medications that could all increase the risk of dry eyes as well as a whole bunch of common disorders like thyroid disease and diabetes.

Dr. Zigler:             Well, you covered the medications. I don’t have to say anything, you covered them all. Yes, so medications definitely. The problem with Western medicine and we follow more of an Eastern medicine approach, which I’m sure you do, is if you try to find the root cause of the problem of it and look at dry eye as a symptom instead of actual disease, you’re then going to solve the issue that’s causing the dry eye in the first place. Whereas in Western medicine, what we’re doing and what I was trained; I don’t think you are trained this way but I was, is there’s a disease here treated with this medication. Now the unfortunate thing is this medication then causes three more diseases or three more side effects. So the problem with decongestants and Lasix for high blood pressure and antidepressant is they’re treating a condition but causing other diseases. So that’s why I recommend going for the root cause first versus going after a disease with the medication and then battling these other diseases because of it.

                                Now as far as other diseases that cause dry eye, thyroid is a big one. So hyper and hypo both cause it because hyper can cause your eyes kind of be opened more. So if your eyes are opened more, that’s going to cause more dryness because of exposure. Then hypothyroidism just because your hormones are out of balance. Postmenopausal females are the most common customer online because of hormonal imbalance, so that hormonal imbalance causes just a dryness in general. Then there’s lots of other diseases that can cause this. Diabetes is a big one just because their whole body is inflamed. High blood pressure is a big one because, again, their whole body is inflamed. So we always see this kind of low-grade inflammation taking place in our patients and then around the ages of 40, 50 and 60s, when all these diseases hit including diabetes, high blood pressure and dry eye. It only just takes kind of a shift in your awareness and belief of how you treat these things to solve these problems.

Dr. Weitz:            Interesting. So is spending a lot of time on computers and looking at our phones is that bad for our eyes?

Dr. Zigler:             Yes, so definitely. So phones, computers, TVs, they all emit blue light. What blue light is, it’s normal. So blue light ray comes out when the sun raises or sun rises. When the sun rises, blue light tells your body to wake up. So that’s why the sky is blue because you see blue light. As the sun sets, blue light goes away and body starts producing melatonin and that tells our body to go to sleep. Now the unfortunate thing is that we get all this blue light from our screens, from our TVs, from our smartphones and we’re doing this right up until bedtime. As we’re doing that, it’s not letting us get into our deep REM sleep and therefore we’re not getting as much rest. Not getting as much rest or getting kind of tossing and turning rest leads to more dry eye because you’re not sleeping and recovering.

                                Then also blue light can cause macular degeneration. These are studies that came out in the ’80s for blue light causing macular degeneration. That was before smartphones and before computers remained stay and before flat panel TVs were emitting tons of blue light. So it’s scary for me to think about people my age, millennials and younger that have grown up with this technology, how their eyes are going to be in 40 to 50 years, hopefully in that time we’ll have a cure for macular degeneration, which I think we will. It’s scary to think about the disease that could happen if we don’t have a cure for it. So I always recommend blue blockers, which I have on right now. These are about 30% blue light blocking and these are great during the day. So when I’m on my computer, it still allows blue light to come through because you need blue light. It is healthy during the day. Then I put my 100% on blue blockers around 7:00 PM at night and then those helped me get that melatonin production up before I go to sleep.  Then I also always recommend getting off your computer for about two hours, computers, smartphones, TVs for about two hours before you go to bed too.

Dr. Weitz:            Great. So what about macular degeneration? I hear about that a lot. It seems to be really common especially people in their 50s and 60s.

Dr. Zigler:             Yes.

Dr. Weitz:            I’ve heard about there are specific supplements, formulas for macular degeneration. They typically have ingredients like carotenoids, like lutein and zeaxanthin, zinc, omega-3s. How much of a role can diet and supplements play in preventing or reversing macular degeneration?

Dr. Zigler:             It is huge. I think it’s bigger than what we actually know, because it’s not studied as much. Just like I said before, pharmaceutical companies aren’t going to sponsor studies on diet because there’s no money in it for them. So it’s very hard to find the diet that’s or study that’s related diet to macular degeneration. I’ve seen patients that have completely reversed and macular degeneration is an irreversible condition according to most textbooks. I’ve seen patients reversed macular degeneration just by changing to an anti-inflammatory lifestyle, getting rid of their mineral deficiency, getting rid of their vitamin deficiency. When you’re looking at vitamins, make sure it does follow the AREDS2 formulation. AREDS2 stands for age-related eye disease study. Two means it was their second go-around for their study. They’re probably doing a third study right now. Just like you just talked about, the vitamins A, C and E were studied pretty intensively, lutein, zeaxanthin, all those phytochemicals.  I always recommend getting it through your diet first and the easiest way to do that is kale and spinach. Adding those to your diet on a daily basis makes a huge difference in lutein and zeaxanthin. Then take the supplement as it’s intended to be taken as a supplement too in already healthy diet. So we have in our ocular health formula that’s based around the AREDS2 formula. We went beyond AREDS2 because we added some other minerals in there that help out with preventing macular degeneration from getting worst. These were kind of more independent studies that were done. They haven’t studied it in the AREDS study yet so that’s why they haven’t released it yet as a fish oil. The diet is huge.

Dr. Weitz:            So just to get into the weeds a little bit is for those geeks like me, as far as the particular carotenoids, lutein and zeaxanthin seemed to be mentioned all the time and I’ve seen those in some of the studies. I’ve also heard some people mentioned astaxanthin, but that doesn’t seem to be part of that AREDS formula. In cryptoxanthin, which I guess comes from corn, is another one that I’ve heard mentioned. Does it matter or did you want to just get all those carotenoids? Which one is really the most important?

Dr. Zigler:             So I think the best one is like you said the one that’s talked about the least is astaxanthin. Astaxanthin is kind of just a power pack haunch towards inflammation. It’s kind of one of the best phytochemicals that’s out there. Getting them all is great, so. As far as a corn product, I tried to steer away from corn products just because there are so much GMO corn that’s filled with pesticides out there and mold and everything that I try to stay away from anything that’s corn-related unless it’s non-GMO and it can be proven.

Dr. Weitz:            Yes, and I do as well.

Dr. Zigler:             Yes good. Then astaxanthin is probably the best one, but lutein and zeaxanthin have their place as well. Like I said, if you eat kale and spinach, you’re going to be fine.

Dr. Weitz:            I looked at that AREDS formula and the amount of zinc was very high. It was like 80 mg.

Dr. Zigler:             I think they’ve since cut that to 40 mg and studies now show it doesn’t need to be that high. They can bring it down and I think they’re starting to bring that down now. I should know this off the top of my head, but I think ours is 40.

Dr. Weitz:            Are exercises for the eye, are they beneficial? You see a lot of people claiming that you can reduce nearsightedness or farsightedness or astigmatism?

Dr. Zigler:             That’s a great question and that’s called the Bates method. I’ve been reading more into it so I was very against it because I was Western medicine trained in school. It was always just give them glasses, give them contacts to correct their vision and hopefully we can prevent it from getting worst by using XYZ, but there’s no studies proving that we could lessen any of that. So the Bates method is just this kind of process of relaxing your eyes throughout the day in order to prevent your nearsightedness from getting worst. He did it and it worked for some of his patients. Can I say that it’s effective? I don’t know enough to really say yes or no. It is something that I am looking into because as we’ve shifted from Western medicine to Eastern medicine, it is something that has picked my interest because a lot of people ask about it.  So we have been looking into it more and more, but I can’t say yes it works or no. If you’re like a minus 10, it’s not going to work for you. If you’re like a minus one or minus two, it may and so you can try it. So it doesn’t work for those severe cases.

Dr. Weitz:            If you would compare it to say chiropractic or treating people with musculoskeletal conditions, the analogy is instead of giving somebody say a back brace to support their back, you give him exercises to strengthen their muscles to support their back, their core muscles, their back muscles or abdominal muscles. So it makes sense the eye is focused by muscles that potentially could be affected by the right exercises.

Dr. Zigler:             Kind of digging into that a little bit more. There is something called vision therapy and that kind of relates to what you just talked about with chiropractic as well in vision therapies where we trained the muscles that are around the eye to help the eyes work together better and so that’s not going to help with nearsightedness or farsightedness. A lot of people don’t realize if there’s more division than seeing 20/20, the vision is how your eyes work together, how your eyes can follow an object, how your eyes can read and sometimes people have problems with that. Actually, about 30 to 40% of people have problems with that and they don’t even know it. They just get diagnosed with like a learning disability or having ADHD-

Dr. Weitz:            Interesting.

Dr. Zigler:             … but really it’s just their eyes aren’t working together that well. You put them through vision therapy, teach them these eye exercises and they usually come out the other side after about three or to four months doing pretty well, and that’s very similar to what you’re just talking about with chiropractic.

Dr. Weitz:            Wow, very interesting. I never heard of that.

Dr. Zigler:             It’s called vision therapy.

Dr. Weitz:            Where would people find out about that?

Dr. Zigler:             You could really just type in vision therapy in the Google and learn more some of the diseases that are not diseases but conditions that we treat vision therapy with or once called convergence insufficiency. Converging is bringing your eyes together, which we’re doing when we read. Insufficiency, meaning you just have trouble doing it. Then there’s things like convergence excess where they don’t come in or they come in too much and so you have kind of battle to bring them back to focus. We can kind of play with our eyes to balance them. These are my two eyeballs by the way my hands-

Dr. Weitz:            I got it.

Dr. Zigler:             … and so in tracking. So when you’re tracking an object, you can have problems with that too, so that’s called saccadic deficiency. So saccadic deficiency, convergence insufficiency, convergence excess, those are all problems that we see very commonly. Simply vision therapy it’s very simple. It’s just a 20-minute exercise a night for your eyes and it can make a big difference.

Dr. Weitz:            What do you know about floaters in the eye?

Dr. Zigler:             I know a lot about floaters in the eye.

Dr. Weitz:            I had one. It just sort of came on. I tried to ignore it. After about six months, it just went away.

Dr. Zigler:             You described a perfect kind of prognosis I guess or phase of a floater. So a floater is simply just … In the back of our eye, we have a jelly that filling the eye called vitreous. Inside that vitreous jelly, we can get clumps of collagen and clumps of protein that formed. Since it’s a jelly, these clumps just kind of hang out in that jelly. As the light comes into your eye, it hits those little clumps and then casts a shadow on your retina. Your retina is what captures light. So essentially you’re just seeing shadows of things floating around in your eye. What we hope happens is gravity takes it over, moves it down out of your vision, and then you no longer see it anymore. Now what you were probably seeing is occasionally what happens is as that jelly starts to condense on itself just over the years and it has a really strong attachment to the back of our eye.  On the back of the eye when it pulls off that part it creates a very, very big floater. That’s probably what you noticed.

                                Then we hope gravity takes it over and just sinks it to the bottom or what can also happen is your brain gets used to it. Your brain is amazing. You actually have a blind spot in your vision and your brain completely ignores it. Otherwise it will drive you crazy all day. The fun part about doing that is just close your eye, take your kind of thumb out here and just move it 15 degrees off to the center and your thumb will disappear. That’s your blind spot of your eye that your brain just kind of ignores. No party trick.

Dr. Weitz:            So what about glaucoma? What can we do about that? Because that’s a pretty dangerous condition and you can lose your eyesight.

Dr. Zigler:             Yes. We don’t know much about glaucoma. We just know that we lower the pressure to treat it. Really we think it has very little-

Dr. Weitz:            That’s how it is measured, right? Is it measured?

Dr. Zigler:             Exactly, yes. So pressure is one thing that we look at. We then look at your peripheral vision because what glaucoma does is it takes away your peripheral vision, which is all your vision out here. It slowly comes in over your central vision. The most important part that we look at is the optic nerve of your eye. The optic nerve connects your eye to your brain. That’s how you see. That’s how you interpret what you’re seeing. So the eye is the camera film and then the cord attaches it to the computer. The optic nerve attach the eye to the brain. So when damage is occurring to the optic nerve, that is what glaucoma is. What we know is that usually it occurs in patients that have higher pressures. By bringing those pressures down, it helps prevent it from getting worst. The problem is I have patients that have pressures of 40. Normal is 22 and under. Those patients with 40 pressures never develop glaucoma, but then on the other side I have patients that have pressures of 10 who have glaucoma.

                                So just we don’t know much about it. What we’re starting to see, what studies are going into is that they think it’s a gradient of your pressure in your brain versus your pressure in your eye. If the pressure in your eye is higher than the pressure in your brain, it’s pushing therefore it’s causing glaucoma. If the pressure in your brain is higher, it’s pushing back this way and that will cause other problems like optic neuritis and papilledema, which is just a swelling of the nerve that can cause a whole slew of problems anyway. If those are in perfect balance, you’re not going to have any of those problems.

                                So the second one I talked about is papilledema, a swelling of that nerve, usually occurs in overweight women. We don’t know why their brain pressure tends to increase a little more. You can also get pressure increases in the brain from like a tumor or something like that too, so we always have to rule that about first. We think glaucoma is this gradient difference between the two. Like we said before, we treat it by lowering the pressure but we know there’s more to it than that and so there’s a lot of studies going into glaucoma. Again, going back to what we talked about with every disease, I don’t see glaucoma in my healthy patients. It’s always in my unhealthy patients that have diabetes, that smoke, that have high blood pressure. They just have the slew of inflammation in glaucoma just comes kind of naturally and that progression with them.

Dr. Weitz:            So let’s say I get a patient who comes in with glaucoma. He wants to do whatever it is natural besides, let’s say he is already on a healthy diet. He was on one before, I put him on one. Are there any specialty, are there any particular foods or supplements or strategies that can help naturally to reverse glaucoma?

Dr. Zigler:             Yes, there’s always a lot of studies that go into. Unfortunately, all the studies haven’t been great. The best thing is anti-inflammation. So going back to the lutein and zeaxanthin and kale and spinach and just basing your diet around plant-based organic vegetables is key. Especially leafy greens, it’s going to help just reduce that inflammation, scrub out that eye. That’s what lutein and zeaxanthin do. They just scrub out all the free radicals that cause damage in the eye. Then some studies have shown that sleep apnea plays a big role in it and that’s because most sleep apnea patients, lack of oxygen and so they feel like if they’re having those periods of two to five minutes where they’re not breathing, that’s starving the eye of oxygen too, causing glaucoma to get worst. I’ve read that study or that when you sleep, sleeping on an incline will actually help with the pressure inside your eye because our pressure tends to fluctuate throughout the day.

                The main glaucoma drop that we use we actually take at night to decrease the pressure in the morning because your pressure is usually highest in the morning, avoiding inversion. So if you have a patient that’s a glaucoma patient, they do a lot of yoga, you have to kind of tell them to avoid that kind of inverted position because that is yoga. I mean, you’re inverted a lot so avoiding being upside down is big. Yes, just healthy diet in general is one of the best things. There are optic nerve support formulas. I can’t think off the top of my head… I think it’s called pycnogenol is the herb. Don’t quote me on that one, but I’m pretty sure it’s pycnogenol. That’s been shown to help a little bit, but again no conclusive studies. There is optic nerve support formulas out there.

Dr. Weitz:            What about the natural anti-inflammatory formulas or products like curcumin, et cetera?

Dr. Zigler:             I will always recommend those because, I mean, again all these are inflammation so just getting that diet right and then any anti-inflammatory products will help with that.

Dr. Weitz:            So what about cataracts?

Dr. Zigler:             Cataracts, yes, great question. Not a great question just statement but great statement. It does tend to be an age-related condition. So we-

Dr. Weitz:            A lot of these tend to be age-related conditions.

Dr. Zigler:             That’s true. That’s true. Cataracts to protect against it, we see higher cataract rates with lower vitamin C and so a vitamin C deficiency can cause cataracts; high UV exposure. When I lived in Columbus, Ohio practicing, I didn’t see cataracts until usually around the age of 60 to 70 because there’s not as much sun up there, not as much blue collar work. Then when I moved to South Carolina, it’s sunny every day here and it’s a lot of blue collar welding work. Welding causes a lot of UV light. The sun is out every day. A lot of people are out to their jobs. So I started seeing cataracts down here around 40 to 50. I send a lot more people out for cataract surgery down here than I ever did in Ohio and that’s just because of the UV exposure that they get.

                                Now when I go on my mission works down to Jamaica and Ecuador, there’s a ton more down there. Ecuador is right on the equator so you could imagine the amount of cataracts we see at a younger age there and some other problems too. Then Jamaica is the same thing. It’s a tropical island. People don’t wear their sunglasses, lots of UV exposure. UV light is just like blue light. UV light is healthy. It’s just not in high amounts and so you have to take it in moderation. Ten to 20 minutes a day is usually all you need. You can stay out longer, of course, but just don’t overdo it and you can avoid cataracts.

Dr. Weitz:            What about the importance of getting an eye exam every year?

Dr. Zigler:             I love that question. I love that question. So a lot of people think-

Dr. Weitz:            What should eye exam include? Because some are really quick. They just tell you to look at a chart.

Dr. Zigler:             Which are my at least favorite eye exam. So a lot of people think an eye exam is just a vision test. So a lot of people will tell me they got their eye test at the DMV or they got their eye exam at school. Those are vision screening so all they’re doing is checking your vision. There’s more to vision than 20/20 vision and that is just a very insignificant part of the exam. Yes, it’s great because it gets people to see. The reason we have you in every year and once you in every year is because we dilate your pupil. The pupil is black because it is a hole. It’s an opening to your eye. So when we make that hole bigger, we can see in the back of your eye and that’s where problems can occur that you won’t notice until they’re too late.

                                So high blood pressure, diabetes can both cause blindness. If you get to the point where they have caused blindness in you, it is too late for you. If we catch it before it gets to that point because we can through a dilated eye exam, then we can fix the problem before it gets any worst. Same thing with glaucoma. Glaucoma is that peripheral vision. It takes it from out here and closes in. By the time you notice it, it’s already too late. Glaucoma is irreversible. Glaucoma is actually irreversible. There hasn’t been any proven studies that have shown vision coming back. Then same thing with macular degeneration. We can catch that before vision gets worst before it’s too late. We have seen reversible macular degeneration but it’s a lot harder than catching it early and fixing it. It’s very similar to think of a stage one cancer versus a stage four cancer. It’s a lot easier to treat a stage one than a stage four. So if we catch that at stage one point, we’re going to be able to do things to fix it.  That’s the importance of a dilated eye exam is because we can check everything in the back of your eye and to make sure your eyes are healthy.

Dr. Weitz:            I know your company makes specific products to help with various eye disorders. What are some of the products that we could consider using and what conditions with the health?

Dr. Zigler:             I love that question too. So thanks for letting me say that too. So if your listeners go to dryeyecommunity.com, that’s where we kind of start. We give them a free e-book there. They get on our email sequence of teaching you how to deal with inflammation and dryness naturally. It does talk about our products in there. We have a product called Heyedrate Lid and Lash Cleanser. That’s the hypochlorous acid solution that you actually spray on your eyelids it cleans up those eyelids naturally by helping your normal immune response to the bacteria in your eyelids. We very had an enormous amount of success with that product. We released that last June and it’s been a game changer for us and our patients. We are beyond excited to get that to more and more people. We then have an omega-3 for dry eyes specifically formulated for that like we talked about molecularly. It’s very purified and it comes from a sustainable source and good manufacturing practice facility. Then we have a warm compress specifically made for warm compresses of the eye.

                                Then we have a soap bar that actually has Tea Tree Oil in it. We didn’t go into this, but you can actually have eyelash mites that live in your eyelashes. It’s very prevalent. They usually don’t cause problems but they can. So Tea Tree Oil actually kills-

Dr. Weitz:            These are separate from dust mites that people have in their mattress?

Dr. Zigler:             Yes, totally separate, but Tea Tree Oil can help treat both of them. They kill all these mites and this washing with the Tea Tree Oil soap will help with that. So we developed one and it’s five ingredients, very organic. Then we also have an ocular health formula that follows the AREDS2 formulation.

Dr. Weitz:            How could you clean your eyelids without getting it in your eyes? 

Dr. Zigler:             It is 100% safe for your eyes. We have had approved for that so that’s why we say spray it on your eyelids. We have had it proven for safety. So it’s safe to ingest, inhale, on your skin and on your eye. We had it safety tested it for all that.

Dr. Weitz:            We’re talking about the spray or are you talking about the Tea Tree Oil soap?

Dr. Zigler:             The spray, yes, the spray. I wouldn’t recommend getting the soap in your eye.

Dr. Weitz:            Yes I know. Does it sound like much fun. Okay great. Is there any other things that you wanted to cover? I think we did a pretty good job.

Dr. Zigler:             No, that was great. I think just having your listeners check out dryeyecommunity.com. Our website is eyelovethesun.com and they can view all our products there too and follow our blog and everything.

Dr. Weitz:            That’s great. Thank you so much Travis. You brought us some great information about improving your eye health.

Dr. Zigler:             All right, thanks for having me on.

Dr. Weitz:            Okay, thank you. Talk to you soon.


Rational Wellness Podcast 045: Low Dose Immunotherapy with Dr. Karima Hirani

Dr. Karima Hirani speaks with Dr. Ben Weitz about Low Dose Immunotherapy and Low Dose Allergy therapy.

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


Podcast Highlights

3:33 We discussed Low Dose Allergy therapy (LDA), Low Dose Immunotherapy (LDI) and the differences between them. Low Dose Allergy therapy has been around for 50 years, having been called Enzyme Potentiated Desensitization in England. This was eventually brought to the US by Dr. William Shrader, who is one of the head people at the American Academy of Environmental Medicine. LDA is a form of Low Dose Immunotherapy using a proprietary formula of a broad-based mixtures of allergens (antigens) made immunologically active by the enzyme glucuronidase. It is used for allergies, but allergies can present as autism and using LDA you can see improvements in speech and language.

6:00  Besides LDA, her other top LDIs are yeast, Lyme, and strep for PANDAs.  Rather than the traditional method of subcutaneous injections of the FDA, they are using it as sublingual drops, thanks to Dr. Ty Vincent.  And they are using further serial dilutions of the FDA tincture that comes from the compounding pharmacy that makes it, since it is too potent. It ends up being diluted a quadrillion times, so it is really a homeopathic formula.  The same T regulatory cells that are found under the skin are also present under the tongue.  This is a way to train the immune system to build tolerance.

10:08  Dr. Hirani often finds Lyme Disease in her patients with autism and Lyme Disease is really a condition of immune dysfunction. The Lyme LDI seems to turn off the autoimmune component of the chronic Lyme disease.

12:15  Dr. Hirani explains that PANDAS found in kids is the pediatric autoimmune neuropsychiatric diseases after strep infection.  She gets amazing results with LDI to create immune tolerance and this alleviates many of the symptoms. This also turns off such infections that create chronic illness. She will also often give such patients high dose vitamin D to help the immune system. 

15:25  Dr. Hirani noted that if she gives a dose that is too strong and it can trigger a herx reaction. If she has an autistic kid and she gives too strong a dosage of strep LDI, it can trigger a strep infection and these kids will have strong reactions, so she may prescribe an antibiotic and she will use a rescue formula of supplements.

20:04  Dr. Hirani explains that in the last few years many more patients are testing positive for Lyme infections with the Western Blot and they will also often have a low CD 57, which is a marker of immune dysfunction.  She will also often test her patients for Lyme, Epstein-Barr, cytomegalovirus, Human Herpes virus 6, herpes 1 and 2, mycoplasma, measles, mumps, strep, and varicella IgM titers. The measles, mumps, and varicella titers can result from the vaccines and these things can trigger an autoimmune disease in these kids, as these infections turn off and on.  


Dr. Karima Hirani is available to see new patients by calling her office in Culver City at (310) 559-6634. You can get additional information about Dr. Hirani by going to her website http://www.drhirani.com/

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure as well as chiropractic work by calling the 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 Bible interviewing top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.

                                Hey, Rational Wellness podcasters. Thank you for joining me again today. We have a very exciting show. We’re going to be interviewing one of my friends for a long time Dr. Karima Hirani. She has a thriving practice in Culver City. She is a medical doctor who specializes in functional and integrative care. Doctor, let me give you a little bit of introduction into her background and then we’re going to highlight a couple of therapies that she’s using in her practice, which are low dose allergy and low dose immunotherapy. We’ll also going to try to cover neurotherapy if we have enough time.

                                So Dr. Karima Hirani is board certified in family medicine, as well as in integrative and holistic medicine, as well as in clinical homeopathy. She holds a Master’s Degree in Nutrition from UCLA.  She specializes in autism, ADD, and PANDAS in children. She also treat adults with chronic illness.  She is an expert in specific types of treatment that she uses for her chronic patients, including low dose allergy therapy, low dose immunotherapy, and neurotherapy.

                                Low dose allergy therapy and low dose immunotherapy are essentially ways to help individuals overcome allergies and food sensitivities to foods, chemicals, molds, toxins. This therapy can be used for whole range of chronic illnesses, including autoimmune diseases and chronic fatigue and Lyme disease, et cetera. So this is a type of therapy that helps to balance the immune system when the body is not able to tolerate certain bacteria, fungi, viruses that live within us that others can tolerate or maybe that your own body could have tolerated at a different point in time. This is certainly the case with Lyme disease and many other chronic diseases that many of us in the functional medicine world find coming into our offices very frequently.

                                Dr. Hirani, thank you for joining me today.

Dr. Hirani:           Thank you for having me. It’s a pleasure.

Dr. Weitz:           Boy, we’ve known each other for a long time. How many years have we known each other?

Dr. Hirani:           A long time, maybe 15, 20 years.

Dr. Weitz:           Yes, yes. I remember going to all those Dr. Bland seminars and I would always get to talk to Dr. Hirani.

Dr. Hirani:           Yes.

Dr. Weitz:           So can you explain a little bit about the differences–What is low dose allergy therapy? What is low dose immunotherapy? What are the differences between those?

Dr. Hirani:           So low dose allergy therapy has been around essentially for about 50 years now. It was first discovered in England. It was called Enzyme Potentiated Desensitization. It was brought to United States several decades ago by Dr. William Shrader. He is one of the head people at the American Academy of Environmental Medicine. He and many other doctors have been using low dose allergy therapy for several decades. What they’re using it for is to treat allergies. As you know as a functional medicine doctor, one of the most important things that we look at is allergies in our patients. Sometimes allergies don’t present as the classical symptoms, where you have the runny nose, itchy eyes, teary eyes, et cetera, sneezing.  Allergies can present as chronic fatigue.  Allergies can present as autism. When we treat with LDA, we see amazing things happen, anything from improvement in speech and language.  To my adults patients, they are not tired as much anymore.  Their brain fog is better.  They lose weight, because when you have allergies or you have a chronic infection, it can cause inflammation and then it can lead to weight gain.

                                So we see a whole spectrum of improvement by just giving the patient the LDA.  Again, I have to really stress the fact that it’s not the typical allergy symptoms that you should be looking at. You should really be thinking of everyone as having potentially allergies and then to just give them a trial dose of the LDA. That’s usually one of the first treatments that I offer without even doing any functional medicine testing on my patient. I just give them the LDA dose and then we see what happens.

Dr. Weitz:           What percentage of patients do you see some sort of positive response?

Dr. Hirani:           I haven’t really like scientifically quantified it, but if I could just generalize, my top three most beneficial LDA-LDIs is LDA is one of them and then I have my other LDIs, which are really effective in my patients are yeast and Lyme and then Strep for PANDAS. These four seemed to be my most effective treatments.

Dr. Weitz:           Interesting. So my understanding of LDA is that this could best be described as a form of low dose immunotherapy and is a proprietary mixture of foods and other things that could create allergic reaction.  Is that sort of the way to understand it?

Dr. Hirani:           Absolutely, absolutely. Ty Vincent, thanks to Ty Vincent.  We’ve taken it one step further and that traditionally, most doctors were just injecting in the skin. They were just using the original dose that you get from the compounding pharmacy because this proprietary mixture comes from one compounding pharmacy in the United States. What Ty Vincent has been doing and he’s taught doctors like myself to do is to make further serial dilutions of the actual LDA because many, many patients are extremely sensitive. The original tincture that comes from the compounding pharmacy is too potent.  So that’s something that we’ve done.  We’ve been able to help even more patients than we could by LDA by making the serial dilutions.

Dr. Weitz:           Now it’s interesting because this is something that’s alluded billions even trillions of times, right?

Dr. Hirani:           Correct, yes, like quadrillion, quadrillion times.

Dr. Weitz:           Essentially, we’re talking about a homeopathic formulation. There’s really no real amount of the original compound sort of just the energy of it essentially, right?

Dr. Hirani:           It’s the energetic imprint that’s been left in the mixture and that’s what we’re giving the patients, and I do it and I think Ty Vincent does it also. We do it sublingually. We’ve moved away from the subcutaneous injection because it’s very painful.  It leaves behind big red bump and itchiness and swelling.  Patients don’t care for that.  So when we do it sublingually, we have the same T regulator cells that are subcutaneous that are under the skin.  There are also under the tongue.  So we’re basically training the immune system to build tolerance.  That’s what we’re doing.

Dr. Weitz:           In contrast with homeopathic medications, if a homeopath wants to give you a more potent formulation, he makes it more dilute. But with the low dose immunotherapy when you make it more dilute, it’s less potent, right?

Dr. Hirani:           Correct, yes.

Dr. Weitz:           I mean that makes rational sense to me. One of the problems I always had with homeopathy is to tell me you’re going to dilute it, another hundred thousand, million times and it gets more potent. It just totally is very difficult for my rational, scientific mind to wrap around.

Dr. Hirani:           The way that traditional homeopaths look at it is when you further dilute it, it’s working at a deeper level. To me it makes sense because when we have to further dilute these potions and we give them to patients who can tolerate them, these are patients that are probably really affected at a deeper level than somebody who can just handle the original mother tincture.  So to me, I see a correlation.

Dr. Weitz:           So when you’re treating a chronic condition like … I read some of your blog posts and watched your video that you did at the Autism conference. So you often find Lyme disease as an infection that affects patients with autism, right?

Dr. Hirani:           Yes, and my adult patients as well with chronic illness.

Dr. Weitz:           So essentially, when you look at Lyme disease, you’re not really looking at it as a disease that is like a typical acute infection. This is something that’s really creating a problem because it’s created, the body is reacting, the immune system is overreacting to it. It’s not that the bacteria is actually eating away your tissues or things like that, right?

Dr. Hirani:           Exactly. I think that there’s two processes going on. One is there is this infection that seems to turn on and off. When it’s off, the immune system thinks the infection is still there, so it’s mounting an attack against the patient. It’s this autoimmune phenomenon that is really making the patient really ill, so that the LDI, the line of the I that we give to the patient seems to turn off the autoimmune aspect of the illness.  Does it ever get rid of the illness?  We’re not quite certain, but we certainly seem to have amazing results just in curing all of these symptoms and getting rid of all of these symptoms from the fatigue to the joint pains to the brain fog.  I mean, you name it, we’ve seen 

improvements.  So the autoimmune concept, the reason why it makes a lot of sense to me and it may not make a lot of sense to a lot of doctors if they’re not treating PANDAS. Are you familiar with PANDAS?

Dr. Weitz:           Somewhat.

Dr. Hirani:           So if you understand PANDAS, for your audience, PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep.  So this is an autoimmune phenomenon that has occurred after a Strep infection.  These kids can have OCD. They can have ticks.  They can have aggression, ADHD, anxiety, bedwetting, whole host of symptoms that they can have.  So this is an autoimmune response to this infection.  When I first heard Dr. Ty Vincent speak and he was talking about the autoimmune concept of infection of these infections like Lyme and yeast and Epstein-Barr, it just like it rang bells in my head and it just made sense.  I just dived into it and I’ve had amazing results in my chronically ill patients.

Dr. Weitz:           Now this is a different way of thinking about infections and say the average person who thinks about a flesh-eating Staph bacteria, you have this bacteria, it’s eating away at you. Unless you get rid of it, you’re going to end up suffering dire consequences. In this sense, you’re thinking of an infection as the problem is not really the bacteria per se that’s damaging your tissues. It’s that your immune system is not tolerating it, right?

Dr. Hirani:           Exactly. It’s the autoimmune aspect of it. For example, I’ve had patients who come in with oral herpes or with genital herpes. We’ll give them their herpes LDI and we will turn off the infection. So we can literally turn off active infections by giving the LDI to them. So what does that tell you? It tells me that there’s a huge autoimmune component to these infections and that a lot of these infections are probably they’ve been living with us for eons.  Probably not causing us a lot of harm but for some reason in the last several decades, these infections are being threatened and so they’re coming alive. They’re creating all of this autoimmune havoc in the body and then creating all this chronic illness.

Dr. Weitz:           So do you ever use killing strategies at the same time? Do you ever prescribe antimicrobial herbs, so that you can knock down the bacteria at the same time that you’re getting your body to be more tolerant of it?

Dr. Hirani:           No, I don’t need to.

Dr. Weitz:           You don’t need to.

Dr. Hirani:           I don’t need to. It’s wonderful.  Patients come to me from other doctors with this laundry list of supplements and herbs that they’ve been on.  I don’t need to give them anything other than just high dose vitamin D, because the vitamin D seems to just really help the immune system and help the LDIs and the LDA work better. That’s really all I need. Now if I give a dose that’s too strong, say let me use PANDAS again, so I gave a Strep dose to a child and it was too strong for the child, it can trigger a Strep infection. In autistic kids, they can go bonkers. So in that case, I do sometimes need to prescribe the antibiotics and some rescue treatments to turn off the, we call it the herx reaction. So sometimes I do need to prescribe antibiotics, but it’s very rare or we have the parasite LDI. The parasite LDI is just a boon for my children, because they have classical symptoms of parasites from teeth grinding to foul-smelling gas to hair pulling, licking, chewing, mouthing.

                                So when I give them the parasite LDI, if it works, it’s miraculous. It turns all of the symptoms off and the parents are thrilled. When it’s too strong, it can actually worsen all of those behaviors, so in which case sometimes I have to prescribe a parasite medication for them and a bunch of oral supplemental rescue treatments for them.

Dr. Weitz:           So it’s interesting you bring up parasites. We know that there are some parasites where protozoans or even some worms that coexist in humans and actually maybe beneficial for us and there are others that can kill us. So how do you resolve knowing when you want to be tolerant, the difference between I want to be tolerant of something my wife does that’s really annoying to me as opposed to I don’t really want to just be tolerant of Charles Manson living in my house because it’s probably not going to be good to just be tolerant of it?

Dr. Hirani:           Well, basically if you’re walking into my office and you have symptoms, you’re not tolerant of these organisms that are living in you. Then if you got classical symptoms, in adults it tends to be just a foul-smelling gas.  I had one young woman.  She is still a patient of mine. She had this habit of picking at her skin.  She was picking away at her skin and she had all of this scarring and acne.  I treated her with the parasite LDI and all of that picking went away.  So if the patient presents to me with classical symptoms of parasites, you have to know what those symptoms are.  If you give them the LDI, you’re going to turn it off and you’re going to be so grateful.  The foul-smelling gas, I mean, how many patients have you seen that have problems with flatulence and foul-smelling?  You give them the right dose of the LDI and you just turn it off, I mean it’s miraculous, so.

Dr. Weitz:           I just read about some airplane. that had to have an emergency landing because some guy wouldn’t stop passing gas.

Dr. Hirani:           He needs the parasite LDI.

Dr. Weitz:           Once again, I just want to come back to the same thing. How do you know that it’s not a parasite that’s going to eat its way through your intestine and eat away at your liver and your brain? There are some parasites that are deadly and you don’t just want to be tolerant of them.

Dr. Hirani:           I get what you’re saying. What you need to understand is that LDI isn’t going to kill these infections. LDI is just helping your body become tolerant to them. If you already have a tolerance, then that LDI is not going to do anything. It’s not going to make it worst. For example, like Ty Vincent says, he doesn’t really have any symptoms of Lyme but he tried one of the Lyme LDIs and he noticed that his plantar fasciitis went away. So he obviously had a symptom that he didn’t associate with Lyme. Again, if you don’t have any 

symptoms and I give you the LDI and you don’t have a problem, it’s not going to make anything worst. It’s not going to turn off the parasites. Does that make sense to you?

Dr. Weitz:           Yes, it definitely makes sense. Treating somebody’s chronic conditions are so difficult.  So when you get a patient with autism, how do you know where to start? I know that you said you find Lyme. Do you test for Lyme? Do you just try a Lyme protocol or?

Dr. Hirani:           I’ve been doing this for a long time now so I can have it down to science. So I do do a whole battery of testing on these patients. Before I even get the results back, they all go home with the LDA, because like I said the LDA is one of my most effective treatments. When they come back for follow-up to do lab work review, I am now testing for Lyme through Medical Diagnostics Laboratories. A ton of these kids are coming up positive with the Western Blot whereas way back like maybe 10 years ago, nobody was turning up positive. All of a sudden, so many patients are turning up positive with Lyme. So this is very helpful to convince my parents. Before I was even doing the western blot or the MBL labs, I would just use the CD57 as a biomarker and everybody has a low CD57.

Dr. Weitz:           What is the CD57?

Dr. Hirani:           The CD57 is a white blood cell that gets rid of infection and also cancer cells. So in everyone that walks in my door, adult or child, the majority of the time I would say about 90% of the time, this biomarker is abnormal. It’s low and that’s a marker of immune dysfunction. Lyme disease, Epstein-Barr, CMV, even heavy metals have been shown to lower the CD57. So when I do this lab test and I show it to the parents or my adult patient, I tell them that, “Look, this could be a marker for Lyme and let me treat you with the Lyme LDI.” I do so and then lo and behold they’re better.   

Dr. Weitz:           So what percentage of the improvement do you see in kids with autism using your protocol with the Lyme LDI? Do you do other things or is that a protocol in of itself?

Dr. Hirani:           So almost every kid gets the Lyme LDI.  It may not be the second or the third, because sometimes they have active measles or mumps in their blood.  So I check for IgM titers in kids that have been vaccinated. So if they come and they have anything that’s IgM positive, like either the measles or the mumps, now nobody is testing for this. I’m probably one of few physicians that’s doing this testing.  I’m encouraging other doctors to measure this but if they’re not, shame on them.

Dr. Weitz:           Well, so is that a test offered by conventional labs? Where do you got to tested it?

Dr. Hirani:           Quest, LabCorp, they all do that. The LA County Department of Health doesn’t like that I’m measuring the IgM, because IgM means active infection. So they have to go through the process of calling me and finding out if this patient has active mumps or active measles. Usually, the child does not have any evidence of an active infection, but I know that it’s affecting their brain because these infections can cause an encephalitis. So when I see these IgM positive infections, sometimes even the varicella because these two vaccines, the MMR and the varicella were live viral vaccines. So sometimes these vaccines can trigger an autoimmune response and then the infection is turning on and off. So if I see these active infections and the titers are really high in the blood, I might first want to treat these infections. Or if the Strep titers are really high indicating PANDAS, I might want to treat with that first. So it really depends on what lab results show and then I go by all of that. So I usually go after, of course, the active infections first.

Dr. Weitz:           So what’s your complete panel? Which different things are you testing for when you get a typical kid with autism say?

Dr. Hirani:           So I test for Lyme. I test for Epstein-Barr. I test for cytomegalovirus. I test for Human Herpes virus 6. I test for herpes one and two. I test for mycoplasma and then I test for varicella. I think that’s about it and I check the IgG and the IgM titers, so.

Dr. Weitz:           IgG and IgM titers for which particular vaccines or organisms?

Dr. Hirani:           All of those that I just mentioned.

Dr. Weitz:           Oh okay.

Dr. Hirani:           IgG and IgM for all of those that I mentioned.

Dr. Weitz:           I mean, you also do the measles-mumps-rubella.

Dr. Hirani:           Exactly. The MMR, IgG, IgM exactly yes.

Dr. Weitz:           Okay, and the varicella, right?

Dr. Hirani:           The varicella, correct.

Dr. Weitz:           What about other vaccines like influenza?

Dr. Hirani:           So I don’t necessarily test titers for those if the parents tell me that my kid got the DTaP and then we lost him. We have the DTaP LDI. We have the hepatitis B LDI. I don’t use those quite as often as I use the MMR and the varicella. Now I do need to tell you that I don’t just treat the IgM. If the IgG, which indicates past infection and these IgG antibodies are super high in the blood, I will also treat those with LDI. I mean, we’ve seen just amazing things happen like I had two-year-old kid with active Epstein-Barr virus. We gave him the EBV LDI. Luckily, it was the right dose and he is talking now. So, I mean, when you treat these infections especially these active infections, it’s a big deal. Of course, infection is not the only thing we treat. We treat heavy metals, because these kids are loaded with heavy metals. So aluminum is huge in these kids.

                As being a proud … I don’t now if you came across a recent study that was published just at the end of last year. It came out of England where they autopsied the brains of I think 10 autistic kids who had died for unfortunate reasons. They found shockingly high amount of aluminum in their brain. So we know that these heavy metals are also playing a role in these kids.

Dr. Weitz:           Where are they getting these levels of aluminum?

Dr. Hirani:           That’s the big controversy. You may have heard of the chemtrails. Have you heard about the chemtrails?

Dr. Weitz:           No.

Dr. Hirani:           So I think that’s something you need to really look into, because you see those planes flying above when it’s a clear sky? You see those planes?

Dr. Weitz:           Okay, yes.

Dr. Hirani:           They’re spraying aluminum on us.

Dr. Weitz:           Really?

Dr. Hirani:           It’s been purported that it’s for climate control. However, a lot of people question the truth to that because-

Dr. Weitz:           How does it affect climate control?

Dr. Hirani:           Yes, exactly, I don’t know. Why are we trying to control the climate, I don’t know. Basically, every single country in the world has chemtrails. These are chemtrails you can see in every country in the world yet nobody seems to question it. Nobody seems to care about it. Nobody is talking about it. [inaudible 00:28:01] from Malibu collect her rainwater two days in a row. She sent it to a lab that tests for heavy metals. The rainwater had 50 times the acceptable amount of aluminum in-

Dr. Weitz:           Wow.

Dr. Hirani:           So, yes, it’s coming down on us. The aluminum is coming down. Obvious sources of aluminum are also aluminum foil, non-stick cookware. All of these things are sources of aluminum.

Dr. Weitz:           What about the aluminum that’s often found in vaccines?

Dr. Hirani:           They’re definitely an issue as well, absolutely yes. We have to consider that as a concern for these kids.

Dr. Weitz:           In fact, my understanding is the aluminum is often added to the vaccines as an adjuvant, meaning it’s something to actually create immune system reaction, because-

Dr. Hirani:           You know what? The aluminum hasn’t been found to be a great adjuvant. It’s not a great adjuvant-

Dr. Weitz:           Oh, really.

Dr. Hirani:           … but yet they use it. There’s a really great book that you might want to read. It’s by Mayer Eisenstein. He’s an MD, PhD. He’s a pediatrician, sorry, he’s an MD, JD; I apologize. He’s an attorney. He had to go back to law school to protect himself because he’s not anti-vaccine, but he’s very pro educating his parents about what’s in the vaccines. He’s published a book showing you the effectiveness of these adjuvants and aluminum is really not a very effective adjuvant.

Dr. Weitz:           Interesting. So then you will administer a low dose immunotherapy of aluminum to help these kids?

Dr. Hirani:           Yes. Again, we see amazing results. Even my Alzheimer’s patients, their cognition gets better, their thought processes in another language. The autistic kids their speech becomes amazing what we see with the aluminum.

Dr. Weitz:           Once again, one thing I’m having trouble wrap my head around is you’re now creating a tolerance to the aluminum. Don’t you want to remove the aluminum?

Dr. Hirani:           That’s something we don’t know for sure because we haven’t studied it. I personally think that by giving the aluminum LDI to the patient we’re actually helping the immune system remove these metals from the body, because these metals–it’s very hard to eliminate them especially if you have poor detoxification. I think that these LDIs are helping the body excrete them. I haven’t really done like a comparison study, some case studies on my patients to show like a before and after urinary porphyrins perhaps because that’s a lab test that we can use to determine if they have heavy metals. That’s something I definitely need to do and then I can really definitively say we did this LDIs and now the porphyrin levels have lowered so obviously it’s helping excrete these metals. So I personally think it’s doing that.

Dr. Weitz:           Do you ever combine it with a heavy metal detox protocol of some kind whether that be glutathione or NAC or chelators or something along those lines?

Dr. Hirani:           I combine it a lot. So I’m actually known as the chelating doctor. So I have a lot of experience chelating these kids from doing the transdermal, so topical to suppository to IV chelation, so I combine those a lot. Then I also have patients who don’t want to, parents who don’t want to do any kind of traditional chelation then we will just do the LDIs, and I have them on detox supplements as well, like glutathione, etc.

Dr. Weitz:           Interesting. Of those various forms of chelation, which one do you find to be the most effective?

Dr. Hirani:           As far as the traditional?

Dr. Weitz:           Yes, yes, but just stepping away from the LDI just for a second, even though I know that’s our main topic. We were talking about chelation. You mentioned suppositories and oral chelation, etc. Which do you find to be the most effective?

Dr. Hirani:           So the IV chelation is the most effective. The number two most effective is the suppositories. The number three most effective is the transdermal. I like to start with the transdermal actually on the younger kids because it’s so non-invasive. It’s just a cream that parents can apply at home. I send them home with the mineral supplement. I tell them that it’s going to pull out the good stuff as well, so you need to replenish with the mineral supplement. Then you need to look at for yeasty and parasite behaviors, because remember that parasites and yeasts, they actually hold on to your metals for you. So when you’re chelating, you’re also removing the metals from the yeast and you’re removing the metals from the parasites. So these bugs are going to get activated and these kids will present with symptoms of yeast and parasites, so we have to treat with either LDI and/or prescription medications like for yeast or for parasites.

Dr. Weitz:           Interesting. So one of the real benefits of using this low dose immunotherapy is not only is it especially effective, especially in the case of a skilled practitioner like yourself, but it has very low side effects. Isn’t that right?

Dr. Hirani:           Exactly, exactly. So with the LDI, parents are usually very eager to jump on it and I’m happy to prescribe it because it’s very safe. There’s always the risk of having a dose that’s too strong and I warn the parents about that. I tell them that “Look, if that happens, you just have to email me and I will send a protocol to do that’s a rescue treatment protocol with high-dose glutathione, high-dose CoQ10, high-dose vitamin D. If those three supplements are not working, then I’ll bring them into my office and we do rectal ozone and we do an auto-urine injection and we do a foot bath. I find that the ionic foot bath is very, very complimentary to detox and to treating especially herx reactions in patients. So I have a whole host of rescue treatments that I offer in the office for patients to do at home should the dose be too strong. I haven’t had too many problems with children herxing from the heavy metal LDIs, as I have with, I’ve had more herx reactions from the infection LDIs than I’ve had from the heavy metal LDIs.

Dr. Weitz:           For people watching this podcast who aren’t familiar with the herx reaction, can you explain what that is?

Dr. Hirani:           A herx reaction is a reaction that you get after you’ve taken a particular treatment. So for example, even Lyme patients who were doing antibiotics can have a herx reaction. So when we give an LDI dose that was too strong, the patient can have a herx reaction. The herx reaction is basically a worsening of your current symptoms or an emergence of new symptoms that you never had before, or a re-emergence of symptoms that you had before but they’ve come back again and now you’re really ill from these reactions, the symptoms that you had in the past but now they’ve come back again, or you never had them and now you have them. Or you have symptoms already and now the herx reaction is making your symptoms just worse than what they were before you took the LDI. So that is the risk that we are taking. We’ve tried to come up with methods to lower the risk especially with the muscle testing.

                I’ve identified 18 red flag symptoms that if the patients have any one of these 18 red flags, we automatically go 10C weaker on the dose that we find through the autonomic response testing to further minimize the risk of having a negative reaction. So it’s very important to have that discussion with parents because it is going to happen at some point with some particular LDI. We just have to reassure them that majority of the time, probably about 95 to 98% of the time, we’re able to reverse it.

Dr. Weitz:           When the patient does have adverse reaction to this low dose immunotherapy, you have to wait a certain period of time and then give them a lower dosage or less concentrated dosage.

Dr. Hirani:           Exactly. We tell the parents or we tell the patient that we need to wait now two months before we can retry this same LDI again, but we’re going to go 10C weaker or 20C weaker in terms of the dosing to really, because what I explain to them is if you herx from this reaction, that means you have a serious major issue with this particular bug or with this particular heavy metal and that we need to treat that again.

Dr. Weitz:           With respect to kids with autism, I’m sure it’s best if you can get to these kids early. What about the parent who has a kid who’s seven years old, 10 years old, 16 years old and none of the treatments have really been effective. Is this something that at that point can still be beneficial?

Dr. Hirani:           Oh, yes. Older kids, I have a 20-year-old kid and a 22-year-old kid that are just doing amazing. In fact, their dad is supposed to send me a video testimonial so I can post it on my YouTube channel, https://www.youtube.com/user/HiraniWellness. This kid, for example, his dad has left no stone unturned. His dad has tried everything out there for his kid. He has done chelation. He has done everything. He will tell you that nothing has helped his kid as much as the LDIs have helped his son. They can have a normal life now.

Dr. Weitz:           He just started this recently, right?

Dr. Hirani:           Two years ago, because I’ve been doing it. I just started it in 2015, so it will be three years now.

Dr. Weitz:           Wow, that’s great. That’s awesome, Dr. Hirani. What is your YouTube channel?

Dr. Hirani:           It’s just Dr. Hirani.

Dr. Weitz:           Okay good.

Dr. Hirani:           Dr. Karima Hirani.

Dr. Weitz:           Okay great. So I think that was a great amount information for our listeners to absorb and very, very helpful. Is there any final thoughts you would like to provide us?

Dr. Hirani:           Well, if your patients are out there struggling especially the adult patients with any kind of chronic illness, whether it’s IBS or chronic pain or brain fog, do give LDI and LDA a chance because it could be really life changing.

Dr. Weitz:           For practitioners who are listening to this who’d like to investigate LDA and LDI, where should they go to learn more information or attain some of these products?

Dr. Hirani:           They should contact the American Academy of Environmental Medicine. They should buy the LDA manual and they should attend one of the LDA courses at AAEM. Then they should also contact Ty Vincent and then buy his manual for LDI. When you buy his manual, he will also send you all of the LDIs and then in his annual he tells you how to make the further dilutions and how to use LDI. Nobody talks about the muscle testing. So if you’re new to muscle testing, I recommend you maybe check out Dr. Dietrich Klinghardt and take one of his courses on autonomic response testing. I’ve only taken level one. I don’t need to do all of the other levels because I don’t need to. The level one was good enough. So do think about using some sort of muscle testing to find the right dose. If you don’t and you’re just guessing like Ty Vincent and other doctors are, then you’re going to herx more patients than you want. So that’s my advice.

Dr. Weitz:           It’s my understanding that these are over the counteri and can be recommended by chiropractors and non-MDs as well. Isn’t that correct?

Dr. Hirani:           I’m really not sure about that because you have to check with Ty Vincent about that. With the LDA, I know you have to be an MD because you have to-

Dr. Weitz:           The LDA.

Dr. Hirani:           … order that from a compounding pharmacy. With the LDIs, it’s possible that you can get it from Ty Vincent. I don’t know if he is requiring you to be an MD. I don’t know because he never asked me for my medical license, so it’s possible.

Dr. Weitz:           Okay, excellent. So for viewers, listeners, and practitioners who would like to get ahold of you, what’s the best way for them to contact you?

Dr. Hirani:           Drhirani.com is my website. There’s a Ask Dr. Hirani a Question, so they can contact me there. So it’s D-R, Hirani, H-I-R-A-N-I dot com.

Dr. Weitz:           Great. Thank you so much, Dr. Hirani. I’d love to have you back at some point and talk about neurotherapy.

Dr. Hirani:           I would love to, I can’t wait, because these are two of my most amazing treatments on mother practice.

Dr. Weitz:           Awesome. Thank you and so nice to touch base with you again.

Dr. Hirani:           So much, Ben. It was a pleasure. Bye.

Dr. Weitz:           Bye.

Rational Wellness Podcast 042: Weight Loss with Dr. Philip Goglia

Dr. Philip Goglia speaks with Dr. Ben Weitz about how to help his clients lose weight. 

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


Podcast Highlights

1:48  Dr. Goglia explains how he increases compliance among his clients by asking clients who don’t follow their food program to “walk the pig.” He actually has a large plastic pig with wheels and a leash around it that he asks clients to bring home if they have not been following their meal plan. This increases his clients’ compliance with their weight loss program. 

3:56  Philip briefly explained his metabolic typing concept that allows him to determine the best nutrition program for each person.  Philip explained that this program is both proven by science and tested in practice by him and others since the 1980s. He says that when he was studying nutrition at Duke University they discovered three metabolic structures: clients who are efficient at digesting fats and proteins, clients who are efficient at eating carbohydrates, and duel metabolizers. This will also be indicated by their lipid profile that he tests in office. Once you are eating an appropriate macronutrient pattern for how your body works, you’ll find that you have more energy, you’ll lose weight, and you’ll be healthier.  And this food program will be sustainable over time. If not, you’re on the grapefruit and milk diet and you might lose 10 lbs but you’ll just gain it back later. Also, don’t be fooled by weight loss. If you start almost any new food program, because your calories were mismatched and all over the place and because your caloric heat patterns are stabilized, you’ll lose 10 lbs.  But does this program suit your chemical structure–that is the big question?  According to Dr. Goglia, if you are on the wrong food program for your metabolic type, your weight loss will stop. At this point, clients are inclined to think that they need to exercise more and eat less. But calories are a measure of heat energy and your metabolism is a measure of that heat. If you don’t create enough heat, you can’t burn fat. If you exercise more, you break down muscle tissue. If you exercise more, you need to eat more to support new muscular density. The more you eat, the more heat you generate and more bodyfat you lose. Think about taking up less space in the room. Weigh as much as you can, taking up less room in the room. Muscle is heavy and dense.

11:20  Dr. Goglia explained that you need to keep in mind that working out, going to the gym is not building you up. It breaks you down. It is when you rest and sleep and when you eat protein that you use to build muscle.

12:44  Philip discusses the proper diet and explains that 70% of the population is fat and protein efficient and have insulin resistance and will do better on a high protein, high fat, managed carbohydrate program. We have all these low carb programs today like Paleo, South Beach, Bullet Proof, and Ketogenic, but Dr. Atkins was very successful years ago with a low carb program and his program is really being rebranded without giving him credit. Dr. Atkins was the one who said you are not going to run a marathon at night and you don’t need a bunch of carbs with dinner. These carbs will just prevent your body from going into deep REM sleep, so you’ll wake up tired and craving carbs again. Your dinner should be your biggest protein meal to rebuild the muscle you have broken down.

15:16 I asked Dr. Goglia what his recommendations are for types of exercise for weight loss?  Philip explained that he will often recommend that they start by focusing on changing their diet and just continue with their current exercise regimen. Once they are eating properly, then we can strategically modify their exercise to help them accomplish their goals. 


Dr. Philip Goglia is available to see clients by contacting his office at 310.392.4080 or through his website http://www.pfcnutrition.com/

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

Rational Wellness Podcast 041: The Microbiota, Autoimmune Disease, and Stool Analysis with Dr. David Brady

Dr. David Brady discusses the microbiota, autoimmune diseases, and stool analysis with Dr. Ben Weitz.

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


Podcast Highlights

4:53  I mentioned that I had just reread Dr. Brady’s 2013 excellent and important paper clearly laying out some of the connections between the microbiota and autoimmune diseases, Molecular Mimicry, the Hygiene Hypothesis, Stealth Infections and Other Examples of Disconnect between Medical Research and the Practice of Clinical Medicine in Autoimmune Diseasehttps://scirp.org/journal/PaperInformation.aspx?PaperID=27948  I consider this mandatory reading for anyone in Functional Medicine. 

7:10 Functional Medicine doctors might look to the gut and order stool testing for patients with autoimmune disease but this makes no sense to conventional medicine. But Dr. Brady pointed out that medical research is in line with the Functional Medicine approach, as there are many studies linking gut dysbiosis and specific gut pathogens with specific autoimmune diseases. Here is a slide that Dr. Brady provided me on this: 

10:10  The Importance of the Microbiota and the Microbiome.  Dr. Brady discusses the need to look at ourselves and our state of health in what is called the super organismal context, meaning it’s not just us and our cells, and our biochemistry, and our physiology. It’s also all of those other organisms that share our experience. The organisms that live on us, in us, through the gastrointestinal track. Research is really supporting the importance of the microbiota and the links with chronic diseases, like autoimmune conditions.

13:02  Discussion of Dysbiosis.  Dr. Brady explained that dysbiosis is a term that came from EE Metchnikoff and it refers to an imbalance of the bacteria in the gut. You don’t necessarily have a parasite or pathogen. You get an overgrowth of opportunistic organisms, which when overgrown become problematic, referred to as potentially pathogens. It’s aligned more with a state of illness or lack of optimal wellness of the host.

15:58 I asked why we might have a pathogenic bacteria that comes in through our gut and it becomes a permanent resident that we have trouble erradicating, but when we consume healthy probiotics they are only temporary residents?  Dr. Brady explained that this is not necessarily the case. Most pathogens fortunately pass through and don’t actually take up residence in our gut. And when you look at beneficial probiotics, like lactobacillus, bifidobacteria, they make up a small minority of the GI microbiota in its totality, which is mainly made up of anaerobic bacteria, not aerobic or facultative organisms. These beneficial organisms have an incredibly beneficial effect even though you are not really reseeding the gut, which a lot of practitioners make the mistake of thinking that they can if they just take enough billions of probiotics. They are more like pixie dust. They change cytokine expression. They are more like messengers than foot soldiers.

20:27 We discussed the link between digestive health and autoimmune diseases, including the hygiene hypothesis.  Dr. Brady pointed out that he laid out some of these arguments in his paper in the Open Journal of Rheumatology and Autoimmune Disorders noted above and also in a similar paper that he wrote in the Townsend Letter   http://www.townsendletter.com/June2012/autoimmune0612.html   Our modern methods of sanitation and hygiene have reduced our exposure to infectious diseases in order to reduce cholera, typhoid, dysentery and and similar serious infections that result from drinking contaminated water. But we have taken it too far by the overuse of antibiotic soaps and wipes and the frequent use of antibiotics and not letting your infants play in the dirt and put things in their mouths. This reduces our exposure to microbes in our environment and prevents us from developing the tolerance that we should have and our immune system may overreact to organisms that are not much of a threat. We’re left instead with an immune system that’s stuck in an overaggressive stance, and more likely to crossover with subtle differences between what it’s trying to actually attack, which would be a microbe, and a host tissue, like a joint, or like a thyroid gland.

23:30 Dr. Brady discussed how helminths therapy (worms) can help with immune system regulation. 

28:29  We discussed the best way to test the microbiota with proper stool testing, including using the GI Map test through Diagnostic Solutions that Dr. Brady is has helped to develop. Dr. Brady explained that GI Map uses a more sophisticated quantitative PCR, polymerase chain reaction, method of detecting both pathogenic and also opportunistic microbes that may have overgrown. Dr. Brady explained that this is a clinical test that can enable you to determine if a microbe that is found is clinically relevant and needs to be treated, including if it may result in autoimmune diseases. This should be distinguished from testing that uses next-gen sequencing like a uBiome test, which was not meant for making clinical decisions on patients at the point of clinical care.  


Dr. David Brady can be contacted at his website https://drdavidbrady.com/  You can check out the site for The Fibrofix book at https://www.fibrofix.com/  You can get information on his GI Map stool test from Diagnostic Solutions at https://www.diagnosticsolutionslab.com/

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure as well as chiropractic work by calling the 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 at iTunes and YouTube and sign up for my free ebook on my website, by going to drweitz.com. Let’s get started on your road to better health.

                                Hey, Rational Wellness podcasters, thank you so much for joining me again today, and we’ve got a very interesting topic. We are going to talk about the microbiota, autoimmune diseases and stool testing, with a very special guest, Dr. David Brady. The microbiota is a community of commensal or good bacteria, symbiotic, neutral and pathogenic bad bacteria. This microbiome has been found in every multi-cellular organism from plants to animals that has ever been studied. The microbiota includes, bacteria, archaea, protozoans, fungi and viruses. The microbiota is crucial for the health of the host, esp. for the immune system, hormone production, metabolism and a host of other important health processes.

                                The term, the microbiome is often used interchangeably with microbiota, even though technically microbiome refers to the genetic makeup of these microorganisms. The main place that the microbiota exists in humans is along the digestive tract. But these microorganisms also live in the vagina, along the urinary tract, the lungs, the mouth, the eye, on the skin, lining virtually every mucous membrane in the body. In fact, almost everywhere. Some would also argue that worms that have lived in the bodies of humans for thousands of years, are also important organisms that contribute to this community of microorganisms, and are important for the health of the host. Listen to episode 38 of this Rational Wellness Podcast where I interviewed Dr. William Parker about worm therapy.

                                Now, when it comes to autoimmune disease we’ve been seeing a huge increase in the rate of autoimmune diseases, especially in the US and other developed countries in the last 10 to 20 years. Now, autoimmune diseases are diseases in which our immune system, which is designed to kill outside pathogens starts focusing its attention inwards, and starts attacking our own tissues. This is believed to be partially related to the decline of bacterial diversity in the microbiota in the gut, and the breakdown of the gut lining, often referred to as leaky gut. There are now over 80 recognized autoimmune diseases including Hashimoto’s hypothyroidism, celiac disease, type I diabetes, inflammatory bowel disease, MS, psoriasis, lupus, rheumatoid arthritis. Properly analyzing our microbiota with accurate stool testing can potentially enable us to determine whether we have a healthy microbiota. It may enable us to intervene and potentially prevent or reverse autoimmune diseases through changes in diet, lifestyle and nutritional supplementation.

                                In order to help sort this out, I’m thrilled that we’re being joined today by Dr. David Brady, an internationally known speaker, Doctor of Chiropractic, Naturopathic physician. He’s also a Professor at the University of Bridgeport. He’s the Chief Medical Officer for both Designs for Health, and Diagnostic Solution Labs. Dr. Brady is a prolific writer, having published a number of scientific papers, contributed chapters to various text books, and he’s also written several books, including his latest, The Fibro Fix, published in 2016. Dr. Brady, thank you for joining me today.

Dr. Brady:            Hey, thank you for having me. It’s a pleasure to be on your podcast.

Dr. Weitz:            Excellent. So, before we get started with the questions, I just wanted to say, this morning while I was eating breakfast, I just reread your 2013 article from the Open Journal of Rheumatology and Autoimmune Diseases on “Molecular Mimicry, the Hygiene Hypothesis, Stealth Infections and Other Examples of Disconnect between Medical Research and the Practice of Clinical Medicine in Autoimmune Disease”. I feel like this is such an important paper. It so clearly lays out the link between the microbiota and autoimmune diseases. For me, this is one of those seminal papers in Functional Medicine, along with Dr. Fasano’s Scientific American paper on leaky gut, and some of Dr. Vojdani’s papers, that I strongly encourage every Functional Medicine practitioner and even laypersons interested in a functional approach to autoimmune diseases, to read this paper. And so, on behalf of the functional medicine community, Dr. Brady, I thank you for your contributions to our profession.

Dr. Brady:            Well, thanks for those nice comments. I’m sorry to ruin your breakfast, but I’m very happy to be included in that prestigious list of colleagues that you threw me into. I’m not sure I deserve that, but thank you anyway. It was just me trying to get some of these concepts out there into the conventional medical literature, which we’ve always held true for my whole career in Functional Medicine, which is over 25 years. These concepts are nothing new to us in Functional Medicine, that the ecology of the gut is of prime importance to the over health of the organism. That it’s really the place where the meter, the setpoint, the balance of the immune system in general starts, is with mucosal immunity in that really quite complex and potentially full of toxins and antigenic material in the GI lumen. It was really getting some of those overarching concepts out to colleagues that may not be familiar with the way we deal with autoimmunity and we deal with chronic disease even.

Dr. Weitz:            Yeah. I imagine that a lot of the conventional medical doctors, if somebody went to a Functional Medical practitioner and was concerned about autoimmune disease and ordered a stool test, they’d say, what are you doing? Are you out of your mind? What does that have to do with anything.

Dr. Brady:            Yeah. It’s amazing. Medical research is right in line with Functional Medicine. What they’re looking at right now in the fields of immunology, in the fields of autoimmune disease and rheumatology, and gastroenterology, and right on down the line is really in harmony with what we’ve understood in Functional Medicine for a longtime. They’re pushing the boundaries of the granularity at which we understand it and how all the dominoes fall and how all the underlining mechanisms, and making new associations between aberrant patterns, let’s say, in the GI health area or the microbiota, and specific chronic disease including autoimmune diseases, but really we’re kind of talking the same … We’re singing the same tune, but that’s not the case when you cross over into clinical medicine.

                As you said, if someone with an autoimmune disease goes to a rheumatologist, let’s say a classic rheumatology managed disorder like rheumatoid arthritis, they’re highly unlikely to have any attention paid to their GI microbiota, or their gastrointestinal environment, or the health of their GI mucosa. Getting a stool analysis, they don’t do that. That’s what the gastroenterologist does. The problem is, the gastroenterologist doesn’t do a stool analysis for those things. They don’t do any work-up in autoimmune disease. When they do, do a stool analysis, it’s a very limited stool analysis that’s really meant to look for pathogenic disorders that cause diarrhea or maybe fueling an inflammatory bowel disease in some cases. Even that is generally not done.

                                There’s really a disconnect right now between conventional medical research in the conventional Western paradigm, and the practice of medicine. They really don’t connect very well. I really do think that the current research and the threads of it and where it’s going really harmonizes more with the Functional Medicine approach than it does with the conventional medical approach.

Dr. Weitz:            Can you explain the important of the microbiota and why it plays an important role in our overall health, as well as with the link with autoimmune diseases?

Dr. Brady:            Yeah. From a 30,000 foot sort of overarching kind of concept, I will try to do that. For most of Western Medicine’s history, we’ve looked at the human condition from the standpoint of our own physiology, our own biochemistry, our own metabolites, and things like that. But, we really have just now begun to break out of that very reductionist, myopic way of looking at ourselves. We need to look at ourselves and our state of health in what is called the super organismal context, meaning it’s not just us and our cells, and our biochemistry, and our physiology. It’s also all of those other organisms that share our experience. The organisms that live on us, in us, through the gastrointestinal track. We know that they are roughly equivalent to us as far as number of organisms to number of cells in our body. We know that they house many more genes than we do, probably 100 times or more, more genetic material than we do. They genes talk to our genes. We have to deal with and process and react to their metabolites, the things that they express on their surface. It’s really a community. We think that we carry around these bugs, and maybe they’re carrying around us when you look at the numbers. When we look at our overall state of health or dis health, or illness we have to factor in all of those components, not just ourselves.

                                Finally, that’s beginning to happen. It’s with the microbiome project and the study of the microbiota in general. As you correctly pointed out and most practitioners don’t understand the nuance there. The microbiota are the actual organisms, their phylum, their genus, their species, that are on us, in us, around us. Where the microbiome is all of the genetic material of those organisms plus all of the metabolites that they’re producing. It’s really more, when we look at the microbiome, we’re looking at not what bugs are present, but what is their overall impact on our condition. They are slightly different, but usually they’re used interchangeably. It is true that we have a tremendous amount of organisms living on our skin, living in our lungs, any mucous membrane, but the most complex environment is the microbiota, the portion of the microbiota that has been most firmly linked to not only the association, but now the genesis of specific chronic diseases, and nothing more closely connected or the dots most conveniently connected than in autoimmune disease than the GI microbiota.

                All those bugs that live in the gut are of prime importance and it’s probably along with specific immune modulating antibody drugs if you will, in onco therapy, that and the microbiota and the microbiome are the hottest areas of research in the Western Medical paradigm, by far.

Dr. Weitz:            You use the term dysbiosis is some of your writings. Can you explain what that means and what it’s importance is?

Dr. Brady:            Yeah. It’s actually quite an old term that has had a reemergence with this sort of burgeoning microbiota research and understanding of why these bugs are so important in the gut. But, it was originally termed I believe, by E. E. Metchnikoff, who is a Russian zoologist and physiologist who is known to have coined the term, orthobiosis and dysbiosis. Orthobiosis, ortho meaning normal, biosis the microbes that live in the gut. So, orthobiosis is a healthy beneficial balance of microbes in the gut, that would be aligned with a healthy state of the organism. Where dysbiosis is where there is some sort of aberrant pattern. Things are not quite in the right balance. It’s not necessarily a state where there’s pathogenic infection that would cause acute fulminating diarrhea or some specific acute disease state, but dysbiosis is when things are just not right. There’s overgrowth of opportunistic organisms of various classes. It’s aligned more with a state of illness or lack of optimal wellness of the host.

                                Of course Metchnikoff is the father of probiotic therapy in the modern western paradigm, after he observed mainly populations, which we would now call a blue zone, in Bulgaria who were living high up in the mountains. They were living to very advanced ages for the time, and they were living very healthfully into those advanced ages. He wanted to know what was different about them. They lived in a very nice environment up in the mountains. They never retired. They kept working. They were very active. They had a good social network. All the things that we understand now about the blue zones. But what he really found striking is that they tended to use the milk, or the dairy from cows that were free-range feeding on the local vegetation in the mountains. They were culturing it and making what we would now call like a yogurt or a cultured dairy product from it, a kiefer, a yogurt, cheeses, things like that. They were getting a high intake of these organisms that were used to ferment the dairy. Now we know that strain is lactobacillus bulgaricus. Right? Because of Bulgaria, from that community. So he was really the father of probiotic therapy and obviously a real hero of Functional Medicine.

Dr. Weitz:            Isn’t it interesting how when we consume bacteria from yogurt, or if we get some pathogenic bacteria that enters our GI tract, it ends up populating our microbiome, or microbiotic? But, when we take probiotic supplements, apparently they’re only temporary residents there. Do we know why that is? Why is it that if a bacteria, especially a pathogenic bacteria comes into our system through our gut, all of a sudden becomes a permanent resident, whereas we take these healthy probiotics and they only become temporary visitors.

Dr. Brady:            Well, I’m not sure that’s always accurate.

Dr. Weitz:            Oh, okay.

Dr. Brady:            I think it depends on the state of the GI environment in that host. Certainly we’re exposed to pathogens transiting our GI tract all the time in food mass and things like that. They probably don’t setup more than they do. It depends on the virulence of the specific pathogen. Some of the are really nasty critters and if we get almost any exposure to them, even a robust host would be very likely to fall ill. But, we’re getting exposure to lots of organisms that we would not want to set up and colonize our GI environment all the time, and they don’t.

                                Conversely, the beneficial organisms, some of them colonize, some of them don’t. They can colonize from a good quality probiotics, or cultured or fermentable foods, or not. I think in both cases, I think it’s really host-dependent than it even is what the actual source of the environmental seeding of the gut is. But, you mentioned the pathogens might be more likely to take hold than a beneficial organism. Why might that be the case? Well, pathogens are pathogens for a reason. They’re very virulent. They’re aggressive. They’re very robust, so they can cause significant disease, where things that we would consider commensal or beneficial organisms don’t have that dramatic effect on us. Quite frankly, they’re extremely outnumbered.

                                When you look at things like beneficial probiotics, like lactobacillus, bifidobacteria, they make up a small minority of the GI microbiota in its totality, which is mainly made up of anaerobic bacteria, not aerobic or facultative organisms. But, it’s interesting, those beneficial or commensal organisms, they are very powerful. They have tremendous clinical effects as we know from the research studies, and as we know from clinically utilizing them even though they don’t represent much of the population in the gut. They have effects that are far more powerful and reaching than their numbers suggest. That is sort of a pet peeve of mine. I think even in functional medicine, in nutritional medicine, and integrative medicine, I think practitioners still make the mistake of thinking of probiotics and probiotic therapy as a numbers game. That you’re going to fundamentally reseed the gut and change the numerical arrangement of the person’s gut, and we know that that doesn’t occur, from serial assessments with molecular stool analysis.

                                You can change it temporarily but you don’t change it long term, numerically. But that doesn’t mean that you don’t have profound clinical effects, because Stig Bengmark, one of the world’s experts in probiotics for instance, talks about probiotics as pixie dust. Right? It’s not a matter of how much. It’s a matter that you actually introduced the organism and the peptides associated with it, and the metabolites associated with it. It’s actually talking to the GI or what we would call the enteric nervous system, but also the enteric immune system. That it’s actually changing cytokine expression. It’s changing mucosal immunology by virtue as being a messenger more than a foot soldier, if that makes sense.

Dr. Weitz:            Sure. It’s about communication.

Dr. Brady:            Yeah, exactly.

Dr. Weitz:            You often speak about the links between digestive, or gastrointestinal health and autoimmune diseases, including what is known as the hygiene hypothesis. Dr. Parker, who I interviewed a few weeks ago, he uses an analogy of leaving your teenager home alone with nothing to do. He or she will often get into trouble. Can you explain what the hygiene hypothesis is and how this contributes to autoimmune diseases?

Dr. Brady:            Yeah. There’s a couple of major thematic things that you need to understand in the modern autoimmune epidemic. I do try to go through them one at a time in that paper that you mentioned in the open, Journal of Rheumatology and Autoimmune Disorders, and also in a similar paper that I had in the Townsend Letter. The hygiene hypothesis is pretty simple. It just basically says that, in the western industrialized countries, we’ve cleaned our environment up so much, and some would argue with that because they think, what about all the toxins. We’re talking more from an exposure to microbe standpoint. The way we’ve cleaned it up is basically with modern hygienic water treatment, water supplies to large populations. We’re no longer in a village taking water out of a stream, that another village a couple miles up was going to the bathroom in.

                                It’s not that kind of environment anymore. We don’t live in caves. We don’t live on dirt floors. We live in houses. We use antibiotics. These days, a lot of mothers unfortunately are scrubbing their young children with antibiotic triclosan laden soap every ten minutes because they’re germaphobic. They won’t let them crawl on the ground. They won’t let them put something in their mouth that was on the ground. Really that’s part of … Infants have that oral phase where they’re putting things in their mouth all the time, purposely to get exposure to their environment, to learn to have some level of tolerance to the microbes we share our planet with and learn how to react appropriately. To have the right setpoint of surveillance, where if we’re exposed to something that could really do us harm, like a pathogen that we would mount a robust reaction, appropriately. But that if it is other organisms that really aren’t that much of a threat, that we don’t freakout and overreact to them.

                                Part of that learning process, when the immune system is young and learning to size up their environment, is to have exposure to a larger diversity of different types of organisms. We’ve taken away that exposure to a large degree, and we’re left instead with an immune system that’s stuck in an overaggressive stance, and more likely to crossover with subtle differences between what it’s trying to actually attack, which would be a microbe, and a host tissue, like a joint, or like a thyroid gland.

                                It’s interesting you brought up helminth through worm therapy. One of the things we’ve eliminated most dramatically compared to our ancestors even 100 years or more ago, is helminths, or worms. Worms have been in our intestines for the whole time we’ve been on the planet essentially. We’ve radically changed the landscape when it comes to helminths in the last 100 years, certainly in the last 50 years, in particular in the western industrialized countries, where we really don’t have nearly as many worms or helminths in, let’s say, young childrens’ intestinal tracks. Those helminths, it’s very interesting. In order to survive and be symbiotic with us, they put out different chemical messengers that actually down-regulate our immune response. The body’s response to that is to up-regulate. It’s reaction to try to kind of find this homeostatic balance. We kind of meet in the middle, if you will.

                                But if you very suddenly in an evolutionary context take away the helminths that are suppressing the immune system, the body’s set point then is left to hobbit in too aggressive of a stance. With that theory there were certain researchers that talked about using maybe helminths as therapy. Of course, they observed populations in what we would consider underdeveloped countries where these helminth infections, round worms and things like that, are extremely common. It was probably most observed in Laos, in Vietnam, and stuff like that, and westerners were in there in different interventions as we know. They did observe that the children there had no allergies, no atopy, they didn’t have hay fever. They didn’t have dermatitis. They had none of that kind of stuff until they started treating them for the worms. When they started giving them anti-helminthic, antiparasitic medication, all of sudden those pediatric populations started developing those disorders like we see in western children. That provided further connect the dots kind of information.

                                Joel Weinstock, who is a famous medical physician and researcher, did most of this work seminally at the University of Iowa, but now I believe he’s at Tuft’s in Massachusetts for quite a longtime. He did work with trichuris, or pig whipworm, in treating inflammatory bowel disease, like ulcerative colitis and Crohn’s disease, to significant success in that there’s actually helminth-based drug therapy for inflammatory bowel disease in Europe. The drug is call OvaMed, there. It’s in, I think, phase three trials here in the US, but not approved to date.

Dr. Weitz:            Interesting. So, they’re actually using helminths? Is that what it is?

Dr. Brady:            Yes. A lot of integrative or functional medicine practitioners use helminth therapy sort of in an off label way. They’re not a drug, per se, but it’s called h.diminuta, which some people call it, rat tapeworm. It’s not a tapeworm. It’s a helminth, or roundworm, actually. It’s really a beetle derived, or an insect derived helminth that is then consumed by rodents when they eat the insects, and then it can inhabit their GI microbiota. But, it’s a benign helminth that if you give it to the human host, it will setup there. It will exert the beneficial immune modulatory effects of a helminth, but that if you stop giving it over a time, it goes away. It will not sustain over long periods of time in the human host unless you keep reseeding it.

                                That’s one of the reasons why Weinstock used trichomatous, because for the same reason that roundworm can affect positive changes associated with helminths, but you have to give it continuously. So, if you do give it as therapy, you don’t then have to go eradicate it with another therapeutic agent should you want to get rid of it in that subject.

Dr. Weitz:            Now, it’s my understanding that at the present time, helminths are not approved by the FDA, so how would one of your patients get a helminth?

Dr. Brady:            Well, there are some practitioners who use them.

Dr. Weitz:            Can they be legally administered?

Dr. Brady:            I don’t know, technically. It’s not approved as a drug. They’re not being used as a drug, per se, for specific disease process, but they can be accessed, I believe online. I have patients coming in that are using them, and they are getting them, but they’re not technically approved in the US, no.

Dr. Weitz:            Right. Okay. Interesting. I think the human hookworm is another one that’s being used for certain therapies. So, let’s see. What are some of the best ways to analyze the gastrointestinal system? I understand you’re involved with Diagnostics Solutions, GI-Maps is your stool test. So, a lot of us Functional Medicine practitioners have been using stool testing to try and analyze microbiota. My limited understanding of stool testing is, a number of years ago we started using the GI Effects stool test, which was a genetic based test. Genova bought it, and then at some point, I remember going to a seminar that was put on by Doctors Data, and some paper came out criticizing genetic-based stool testing, and saying that there were problems with it. As I understood it, one of the issues with it is if you’re detecting the genetic basis, of let’s say, a parasite, it could be a parasite that’s not really there. So, they were touting their culture-based stool testing.

                                Genova then seemed to have modified the GI Effects and started using culture again, for parasites instead of pcr genetic testing. A number of the practitioners that I know in the Functional Medicine community were not happy with that test anymore. They felt like it wasn’t picking up things that like, parasites and other pathogens that they had seen on the GI Effects and they were able to eradicate and help their patients. Now they felt like this test wasn’t finding some of those. It’s my impression that your GI-Maps test is stepping in to help out using a more sophisticated type of genetic testing to help us find what’s going on in the gut. Is that right?

Dr. Brady:            Yeah. Well, that’s a long story and I’m going to probably differ from getting involved in the internal squabbles and politics between the various commercial interests in companies, but I can say that I’ve been doing stool analysis in my clinical management of patients and research for 25 years plus. Once upon a time, the only thing we had was culture-based old school microbiology-based testing, because that’s all we had. It was really before PCR was readily accessible, certainly by clinicians.

Dr. Weitz:            And by the way, PCR is what?

Dr. Brady:           Polymerase chain reaction. It’s what’s used to amplify DNA to be able to do a lot of the molecular or DNA-based technologies that we see today that have transitioned from research to actually clinical tests. But basically, here’s the reality. Molecular is where it’s at. A lab that does a microbial or culture-based technology claiming that molecular is not the way to go and we should do culture-based methodology, is like someone driving by on Main Street in a modern US city, in a horse and buggy, yelling that we should not use cars. This is a better mode of transportation. That’s how absurd it is.

                                This is based on one study, with about 30 samples, funded by that lab and it was directly comparing to another lab who is a competitor of theirs who was using a test that was developed in-house with a quasi-molecular methodology, which was not a developed methodology by a major bioscience company, and had a valid third party validated. In many cases these platforms are FDA cleared for various uses. That’s not what this was. This was the first attempt in the Functional Medicine space, many years ago at a molecular stool technology, and the first attempt was at Metametrix Clinical Laboratories. They did it for all the right reasons. I applaud them for the first attempt. For whatever reasons they decided not to use one of the already developed and vetted out by very large bio companies technology, they decided to develop their own methodology, in-house. I don’t know what their exact reasons for that was. Sometimes that’s done for reasons of developing protected intellectual property rights and things like that.

                                We know when that test first came out, it was a big step forward. But it did suffer from some problems. One there were  longer than expected turnaround times, because the methodology was a little bit long and unwieldy. It wasn’t fully molecular either. Elements of it were molecular. Elements were not. And, it actually did not suffer from not finding things. It suffered if anything from oversensitivity. And what practitioners may remember is getting a lot of what’s called, basically that the organism type was detected, but taxonomy unavailable. A lot of that was theorized to be what we call, scattered DNA. A little bit of DNA of different kind of organisms that can be located in the food mass.

       That doesn’t implicate all molecular technologies as suffering from those same problems. If you go to any major hospital pathology lab, at an academic medical center in the western world right now, they are running their samples using DNA molecular technology. When someone has a systemic infection, if they nick a bowel, and they have sepsis or something, and they’re coming in with some really weird infection, and they’re going into organ failure, and they need to know what it is, they need to know now and they need to know what’s going to kill it, what antibiotics will be effective, which antibiotics will it be resistant to, they do not do culture technology. They do molecular technology. That’s just how it works. You just need to apply it to stool testing in the proper way.

                                That’s what we set about doing with GI-Map. We developed this in the incubator at the molecular biology center at Georgia Tech University, which is the number one molecular biology center in the world.  Along with one other center in Massachusets who were the first to map the human genome.  Very advanced technology and talents. Basically, when we developed the GI-Map, we took a very different route. Many of us were actually involved in that first generation testing. We were sort of the ones who didn’t win out in the argument of look, we need to use a bulletproof technology that’s already been totally vetted, tested out, and in many cases cleared by FDA for certain applications. That’s what we did, but we applied it across a wide spectrum of clinically relevant organisms in a manner that a Functional Medical doctor would want to see.

                                In conventional Gastroenterology, when they do stool testing, even if they’re using molecular, they’re generally looking for a very short list of pathogens that may be causing diarrhea in a patient. The Functional Medicine doctor needs a much wider lens. We want to look not only across pathogens, and not only five or six pathogens, but a long list of pathogens in classes including bacterial, fungal, protozoal, helminth, viral. Right? The viral realm, but then we want to look at commensals. We want to look at beneficial organisms, and a whole range of those. We also want to look at opportunistic organisms. That’s really where the gold is, the opportunistic organisms that have the potential to overgrow if the environment is right, if the host is susceptible to it.

                                A lot of these opportunistic organisms when they overgrow to a certain level, can then create problems, and they are associated with the genesis … First of all they were just associated with different disorders, like various autoimmune diseases, but now we actually have the emergence of causal data and mechanisms by which we know how the higher presence of a certain bacterium, let’s say, in the gut, can actually ultimately translate to an immune attack against your joints, or against your thyroid, or against your nervous system. In the GI-Map, we’re using what’s call quantitative PCR. PCR, polymerase chain reaction, right? It’s a molecular technology. We’re hunting the DNA of these bugs, but we’re doing it with a quantitative platform. What that means is we get the actual numbers of the organisms, versus other molecular technologies, which are also good, but they’re not meant for the same application, which is caused next-gen sequencing, which many people may know of.

                                Examples of the two. Next-gen sequencing is a test like a uBiome test, where a lot of people get that done. It’s not a test that was ever meant for, nor was it developed for making clinical decisions on patients at the point of clinical care. It’s a research test meant for metadata collection and analysis to quantify signatures, not qualify, I should say, signatures of the microbiota. Meaning, what is a normal GI microbiota looks like on the West coast of the United States, or in Eastern Europe, or in Asia? Because it’s not going to be the same. It won’t be the same in people following different types of diet schemes. What those kind of tests do with next-gen sequencing is they look at a long, long list of organisms in the gut, many of which have no clinical significance that we’re aware of. They’re reporting them as a percentage of the total organisms. They’re never saying how many are there. They’re just saying what percentage of the total organisms does this genus of organism makeup, or they can look at it from the phylum level. They’re only looking at one little portion of the DNA.

It restricts them from getting down to the species level, and they certainly cannot get to the level of looking at the characteristics of the organism, like virulence factors for instance, which answers the question, is this form of lets say, H-pylori a problematic form, or a benign form? Because it was never meant to do that. They don’t look at pathogens. They don’t quantify anything. It’s a very valuable test for research. The reason uBiome, and companies like that are doing that test is to try to answer these questions, and find these major associations between overgrowth in one way, and a certain autoimmune disease, and what they were really doing is collecting massive amounts of data to then monetize it by selling it to pharma as a metadata set to develop drugs and things like that. That’s why you can do the test at such a small amount and actually you’re paying less than it probably costs them to run the test. Same with 23andMe. They made all their money by selling all their metadata to pharma. So, if you’re okay giving your data over, and your genetic information for that purpose, that’s fine.

                                The GI-Map though, uses quantitative PCR, because it’s a clinical test. We’re looking at a range of organisms in the classes of pathogens, commensals and opportunists that we know have clinical significance. If they overgrow they’re going to cause diarrhea, or they’re going to cause gastric upset, or they’re going cause disease, or they’re associated with autoimmunity. We carve out different sections for autoimmune triggers that we know have this organism has a certain expressed, let’s say peptide on its surface, which looks a lot like a host protein. Organisms like klebsiella, citrobacter, or proteus, prevotella, overgrowing in the gut beyond a certain point, puts the person at risk if they’re genetically susceptible to things like rheumatoid arthritis ankylosis spondylitis, or Yersinia overgrowth and Hashimoto’s or Grave’s disease. I can go on down the line with a whole bunch of other ones, but the test is quantifying using molecular technology across that broad range of organisms that have clinical significance so you can decide for instance, if a pathogen is coming back elevated, it’s beyond a certain cut point, which we know is clinically significant, it means you need to treat that.

                                You’re not going to get that from a uBiome.  It’s just not intended to do that.  And then parallel to that, we’re running all of the modern stool chemistry.  We’re calculating for inflammation, and even bowel cancer risk.  Zonulin for intestinal permeability or leaky gut. Things like elastase-1 for pancreatic excretin output. Steatitic for amount of fat in the stool. Beta glucuronidase for risk for estrogen dominance in females based on the function of their microbiota.  Things like total secretory IgA and antigliadin secretory IgA, are you reacting to gluten and gliadin containing grains at the level of the gut lining, that’s mucosal immunology. It’s not a test for Celiac disease per se, but it let’s someone know, hey, maybe my immune response is not super compatible with these field grass greens.

Dr. Weitz:            Let’s say you find a pathogen like Yersinia, which you’ve written about how that’s connected with autoimmune thyroid disease. Can you explain how the appearance of a pathogen in your gut can lead to an autoimmune disease that affects your thyroid?

Dr. Brady:            Yeah. There’s a couple of possible mechanisms, but probably the most direct line or understood one is a process called molecular mimicry. Let’s take Yersinia as an example since you brought it up. Yersinia on its surface has some proteins or peptides that … All microbes have surface characteristics, structurally. These help communicate with other like organisms. It helps them form a locus of infection, or a colony, and provides communication and other types of things. That is where the immune system learns that organism. So, a naive T-cell let’s say, will be educated to react to that peptide on the Yersinia because other parts of the immune system have looked at it and said, this isn’t me. I don’t know this structure, therefore it must be something foreign. It’s a potential threat. It’s an antigen. Let’s develop antibodies to bind to that antigen to cover all those surface peptides so it can’t communicate and bind and form a locus of infection. But, it’s also being tagged for other cellar elements of your immune response, to take it out basically, whether its phagocytosis of other types of processes. Basically it’s using the structure of that protein or peptide on that surface of that organism.

   Now, the reason why we can have an association between not just one microbe, but a long list of microbes and a certain autoimmune disease is because many of these surface proteins or peptides are conserved across various families of organisms. In rheumatoid arthritis, we have klebsiella, citrobacter, prevotella, we have proteus, we have a lot of different organisms, which we have a similar response to. It’s not a one organism, one disease type of scenario. That’s what freaks conventional medicine out, because it rocks the one cause, one disease paradigm. You have to think a little bit more complicated. But, those surface proteins on Yersinia, coming back to the question, have a structural similarity to TSH receptors on the thyroid. They’re not exactly the same, but they’re enough the same that if you also harbor a genetic propensity or an HLA pattern to overreact to that environmental antigen, that you will kind of freakout when you see that reaction. You’re going to then be susceptible to reacting to something else that looks a lot like it.

                                It’s a mistake in identity. It’s like the TSH receptor is a doppelganger to the protein on the Yersinia, and when you develop these antibodies to bind to that antigen to get to the gut to fight the infection, they see the TSH receptor on the thyroid and they go, close enough, and they lock into your thyroid and they tag your thyroid for destruction by the rest of your immune system and you get an erosive inflammatory response against the gland, which in the early stages creates an over secretion of the gland. So, inflamed glands generally over secrete their hormone. So with Hashimoto’s you get a hyperthyroid state, but when enough of the thyroid is destroyed and you don’t make enough thyroid hormone, you end up in the hypothyroid sort of bimodal presentation of Hashimoto’s. Most people don’t even get diagnosed until it’s in the hypo stage, where they have high antibodies, low hormones.

                                So, that’s an example of molecular mimicry, but there are other examples that we know, such as if you have bad oral hygiene and you have overgrowth of P. gingivalis, which is the most common organism that causes gum disease or periodontal disease. We know that that organism produces an enzyme, which actually will citrullinate host peptides, so it modifies arginine on host proteins and citrullinates them and makes them a hapten. They’re no longer your own structure. They look foreign to the immune system. The proteins that they citrullinate are things like collagen, vimentin, fibrinogen, all of the things that make up the schematics structures of joints and things like that. You’re really susceptible to develop autoimmune arthritides, basically like rheumatoid arthritis. That’s why in diagnostics when we do a rheumatoid panel, yeah, they do rheumatoid factor, but what’s the other test they do? Anti-cyclic citrullinated peptide.

                                What’s creating the citrullination of those peptides that has been understood for a while, we’re not finding out is the organism overgrowing in the mouth creating the enzyme, which is facilitating that protein modification. We’re going to learn a lot more about these type of phenomenon in the next 10 or 20 years, I’m sure. We’re probably just scratching the surface.

Dr. Weitz:            I just want to point out that one of the really exciting things is, you can have a patient who doesn’t have hypothyroidism, doesn’t yet have an autoimmune disease, and you can find some of these pathogens like Yersinia and some of these other pathogens in the gut, and or you could do auto antibody testing.

Dr. Brady:            Usually you do them in combination if you have a strong family history, you’re suspicious for some reason. If you come back with thyroid predictive auto antibodies in a serological test, then we look into the GI microbiota for sure, to find out if there is Yersinia, or is there other changes in the ecology that we need to address by either eradicating the bug that we know is associated and trying to change the landscape to the level of our ability to do so. But, also addressing things like hyperpermeability or leaky gut. We’ll have our eye on the zonulin and the calprotectin marker. We’ll look at anti-gliadin secretory IgA in the case of autoimmune thyroiditis, because we know agglutinate and antibody complexes have an affinity for the thyroid. That’s why people with let’s say, frank’s Celiac disease, where they have significant reaction to gluten and gliadin, they have about 20 times the rate of autoimmune thyroid conditions as non-Celiac’s.

Dr. Weitz:            Through this analysis and through a Functional Medicine approach you can truly prevent some of these autoimmune diseases before they’ve even developed. I just think that, that’s so amazing.

Dr. Brady:            Hypothetically, we don’t have the long term, longitudinal studies to prove that, but certainly there’s no harm in doing so, and there’s potential big upside. I can tell you that clinically we have seen patients who we did all of these things, taking what we call the straws off the camel’s back. We can’t change their genetic propensity for a certain autoimmune disease. We can’t change our HLA patterns and things like that. Right? At least now. At least yet, but what we can do is change their exposures within our ability to do so, within the ones that we understand. Right? Which is if I have someone that’s coming back with HLA B27, and they’ve got a family history of rheumatic arthritides and things like that, well, I’m for sure going to be doing a stool analysis on them looking for klebsiella, citrobacter, patellare, all of those.

                                If I find those things, I’m using things to eradicate that to the best of my ability and I’m usually using standardized botanicals, volatile oils, things that have a little bit more of a functional nudging affect and are going to take down those opportunists without bombing everything out. Without getting rid of all the normal organisms, I’m going to backfill with probiotics and the right pre-biotics. I’m going to use the right kind of blocking agents to block antigen antibody interaction and immune proliferation. Things like N-acetylglucosamine. Things like mycologist botanicals. We use these in gut therapy all the time, whether its okra, cat’s claw, aloe, there’s slippery elm.  There’s all these kind of botanicals that have historical use in gut function that we used to think just coated the gut and allowed it to heal. Actually they work in a much more complex fashion with glycobiology on blocking immune proliferation and docking of the antigen or the antigen with the antigen presenting cell to the T-cell. And we’re going to be doing things like glutamine, and other things to help the gut lining. Making sure the vitamin D levels are good, because that affects junction expression proteins that can treat leaky gut. We’re going to get them on a good whole fresh food diet. We’re going to get them off of dietary antigens.

                                Sometimes we’ll run a cellular response test looking for up regulation of innate immunity or inflammation due to certain foods, like an ALCAT test or something like that which is not a food allergy test. It’s innate immune response to food test. We’ll utilize those types of strategies and basically bring everything we can to the fort to change their lifestyle, change the landscape to where … Fasano talks about the triative autoimmune disease. Genetic susceptibility, an environmental antigen and leaky gut. We can’t change the genetic susceptibility, but we can change the exposure in many cases. We can certainly change the leaky gut. That’s where we go after, on those two legs of the stool, if you will.

Dr. Weitz:            So, leaky gut or hyperpermeability, you’ve mentioned that several times. That is where the mucosal membrane of the gut breaks down, creating spaces where toxins say, given off by bacteria like endotoxins and other toxins can enter our system and create problems.

Dr. Brady:            Right. Correct. Not only LPS, and things from the microbiota, but actual toxins themselves in the food mass, and toxins that are metabolites of the microbiota, but also foods themselves. If we’re allowing translation of complex peptides that are not broken down enough in the digestive process, of food that maybe perfectly benign if you had an intact gastrointestinal lining and adequate stomach acid and digestive enzymes, becomes antigenic and fuels the fire of the immune system if you’re not producing enough hydrochloric acid, or you’re taking a PPI, or histamine receptor, antacid type of medication, and or you’re not putting out enough digestive enzymes, and you have leaky gut. Sometimes it takes a bunch of things to gang up on you, but these things are not all that uncommon.

                                What the GI-Map tries to help the clinician do is answer a lot of those questions. Are there pathogens there? Are there overgrowth of opportunistic organisms? Are there not enough commensal organisms? But also, is the pancreas putting out enough enzymes? Do you have enough secretory IgA to have proper immune surveillance along the GI mucosa? Are you reacting to gliadin in a way that would be more excessive than what would be considered normal? Is there signs of inflammation, which causes damage to the GI mucosa like calprotectin being elevated? And, are you producing the glycoprotein that can actually directly cause leaky gut, which is zonulin? Trying to put all of those things together, all the clinically relevant markers that make sense for the clinician to need to know.

Dr. Weitz:            Do we know how accurate the zonulin measured in the stool is compared to serum zonulin versus zonulin antibodies?

Dr. Brady:            I don’t have a nearly as much familiarity with serum zonulin and zonulin antibodies. I know some laboratories do that. I know that there’s been some controversy over serum zonulin as a valid marker of intestinal permeability. But the best data and information out there is on fecal zonulin because that is where the rubber meets the road. It’s the enterocytes producing the zonulin, which is creating the hyperpermeability. I don’t think serum is the logical place to look for zonulin. I think the stool is the logical place to look for it.

Dr. Weitz:            Great. This has been an amazing podcast, Dr. Brady. Thank you so much for bringing our listeners some really interesting and clinically useful information.

Dr. Brady:            Sure.

Dr. Weitz:            Where can listers learn more about you, and your GI-Map testing?

Dr. Brady:            Sure. Well, if they just want to access some information about me and a lot of my articles, including the autoimmune articles we talked about and so forth, they can just hit my website at, drdavidbrady.com. Just D-R davidbrady.com. There’s a media tab with articles and things like that. A lot of full text stuff you can pull down. There’s a lot of interviews on different topics, in the media tab as well.

                                If they want more information on global pain and fatigue syndromes like fibromyalgia in my new book, The Fibro Fix, they can just go to fibrofix.com. F-I-B-R-O-F-I-X.com. And then finally, if they want information on the GI-Map test, from Diagnostic Solutions Labs, just go to diagnosticsolutionslab, so diagnosticsolutionslab.com. There’s a whole whitepaper, all supportive literature, lots of webinars, tutorials on interpreting the test, and there’s full clinical support when you order your first couple of tests and you need some assistance with that, as well. There’s instructions there on how to get test kits and so forth.

Dr. Weitz:            That’s basically for practitioners. For laypersons who’d like to get your stool tested see a functional medicine practitioner, like yourself Dr. Brady, like myself, Dr Weitz. If you want a listing for a functional medicine practitioners, you can go to the Institute of Functional Medicine website, and they have a listing of functional medicine practitioners. I think a good idea to see somebody like that who can really go through and interpret the data and help you to set up a program to improve your overall health.

Dr. Brady:            If there are practitioners out there who are not ordering clinicians with diagnostic ordering privileges, the GI-Map is also available for those practitioners through Evexia Diagnostics. So, E-V-E-X-I-A Diagnostics.com, formerly known as Doctor’s Choice. They have you work with physicians to get the test ordered.

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

Dr. Brady:            You’re welcome. Thank you.