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. 

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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.

Rational Wellness Podcast 040: Chronic Fatigue and Fibromyalgia with Dr. Kent Holtorf

Dr. Kent Holtorf speaks with Dr. Ben Weitz about how to help patients with Chronic Fatigue Syndrome and Fibroymalgia.   [If you enjoy this podcast, please give us a positive review on Itunes, so more people will find The Rational Wellness Podcast] 

 

Podcast Highlights

1:49  Dr. Holtorf tells his story of dealing with Chronic Fatigue Syndrome that turned out to be caused by Lyme Disease. He was having thyroid and adrenal problems and needed support for them as well as HGH and testosterone.  He became a new person.

2:47  A few years later he was going through a stressful divorce and he crashed.  He found out he had Lyme Disease and he was being treated with round after round of high dose IV antibiotic therapy. He was even going into heart failure because his blood had become too thick. The antibiotics were not bringing about a long term cure, so he figured out that he had to treat the immune system to create balance.  He used ozone, umbilical cord stem cells, and peptides, all of which helped. The TH1 was suppressed and TH2 was increased and this has to be balanced to overcome these chronic infections.

5:30  We discussed worm therapy for immune system balance

6:07 We talked about a subtle form of hypothyroidism that is not picked up just by looking at TSH that is an important component in patients with Chronic Fatigue Syndrome and Fibromyalgia. Dr. Holtorf said that conventional thyroid testing–looking at TSH misses about 80% of cases of hypothyroidism and he likes to look at the Free T3/Reverse T3 ratio and Sex Hormone Binding Globulin and he is developing a new test, Active TSH. He also explained that the new T3/Reverse T3 assays are not as accurate since they crunch everyone together. He also uses a computer to measure achilles tendon reflex and if it is slow it indicates hypothyroidism.

13:12 We also discussed the role of adrenal dysfunction in chronic fatigue and fibromylagia. Dr. Holtorf will often use low dose timed release cortisol in these patients for three to six months. It’s usually not a primary adrenal problem, it’s a hypothalamic-pituitary-adrenal problem.

17:39 I asked Dr. Holtorf about his articles where he talks about the use of growth hormone for patients with chronic fatigue and fibromylagia. He said he tends to use growth hormone secreting peptides, since growth hormone is so regulated.

20:28 Dr. Holtorf talked about the role of chronic infections in fibromyalgia and chronic fatigue syndrome and he said that he especially sees Lyme Disease. There are often co-infections with Babesia and Bartonella. There may be other chronic infections like Epstein-Barre, HHV6, or CMV. The key to correcting these is to strengthen the immune system along with antibiotics or antimicrobials. He also often uses Low Dose Naltroxene (LDN), which is an opiate blocking drug, but it helps to balance the immune system. It’s also very inexpensive and very safe.

23:43 We discussed the fact that fibromyalgia and chronic fatigue syndrome patients often have coagulation problems. This is because the body responds to infection by increasing coagulation as part of the immune system activation.

 

 


Dr. Kent Holtorf can be contacted at his website https://www.holtorfmed.com/ and he is accepting new patients by calling 877-508-1177.

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 Transcript

Dr. Weitz:                            Dr. Ben Weitz here, and I’m here with a very interesting guest, Dr. Kent Holtorf, and we’re going to talk about fibromyalgia and chronic fatigue problems. Dr. Kent Holtorf is a nationally recognized expert on fibromyalgia, chronic fatigue, and thyroid problems. He’s the medical director of the Holtorf Medical Group, and he has affiliate centers across the country. He’s also founder and director of the nonprofit National Academy of Hypothyroidism, which is dedicated to dissemination of new information to doctors and patients on the diagnosis and treatment of hypothyroidism. We’re going to speak to Dr. Holtorf today about fibromyalgia and chronic fatigue syndrome, two related and very difficult to treat conditions, often affecting women and affecting quite a number of people in the United States. Dr. Holtorf, thank you for joining us today.

Dr. Holtorf:                         Thank you so much. Pleasure. Thanks for having me.

Dr. Weitz:                            How did you get interested in treating chronic fatigue and fibromyalgia?

Dr. Holtorf:                         Well, basically, I was a very standardly-trained physician and going through medical school. I got so fatigued, I was like, “Something’s wrong.” Went to the doctors, who said, “Oh, you’re stressed out like the other students.” I’m like, “That’s not it.” “Oh, you’re depressed. Do they treat you bad?”  “That’s not it,” and just, basically, worried about functioning. Went on to residency and it got very bad. I’m like, “I don’t know if I can see patients.”

                                                Now, you’re kind of trained in medical school about alternative is quackery and all this, and I’m like, “I’m not getting help here. I’m going to some of these so-called alternative conferences,” and I realized, “Oh, my God, they are more evidence-based than what I was learning in residency.”

                                                And basically, I treated myself with … thyroid was the big thing, a little adrenal support, cortisol, growth hormone, testosterone. “Oh, my God, I’m a new person,” and so I was able to function. And then I was doing anesthesia. Got out of that, because I’m like, “Okay, this is so boring.”  But the energy after that.

                                               And then, a number of years later when I was doing fine, I went through a stressful divorce, just crashed. We were treating Lyme disease at the time, and I’m like, “I know it’s Lyme.” This is just too bad, not just chronic fatigue syndrome, but a lot of chronic fatigue is Lyme. And then I went into heart failure, my blood was too thick. You could not pull it out. And what I found … I did four years at the highest dose IV antibiotics that I would never even give a patient. I’d stop for two weeks, it would come back. So, essentially, went all over the world looking at treatments, and I found that really, immune modulation is the cornerstone of successful treatment. Because all these patients just … they get a little better or worse with these antibiotic treatment, but you don’t treat the immune system. That’s the key, that’s what you need to do for long term improvement.

Dr. Weitz:                            So, what kind of treatment did you do to balance the immune system?

Dr. Holtorf:                         I did so many treatments. A lot of things work, but each thing works for different people. Ozone was very helpful, but we really found umbilical cord stem cells, great for immune modulation, lowering inflammation. And peptides, which is a new therapy that’s becoming again, a cornerstone of our therapy.

                                                Really, what you see is what happens with chronic illness, especially chronic fatigue syndrome, chronic Lyme … there’s two sides to the immune system, Th1 and Th2. Th1 gets stuff inside your cells, Th2 gets stuff outside, because normally they’re balanced. With chronic Lyme and when Th1 gets suppressed, then your body increases Th2 and all this inflammation symptoms. But if you don’t increase this, modulate that immune system, then its long term success is very difficult.

Dr. Weitz:                            Yeah, yeah. Isn’t it also important to stimulate T regulatory cells as well?

Dr. Holtorf:                         Yeah, all that goes into it. The immune system is very complex. Th1 and Th2 is a way of looking at it. We’re practitioners, it makes sense, and what you really see … for instance, HIV. You look at who progresses in HIV directly correlates with how low the Th1 and how high the Th2 is.

                                                So, it really shows with these chronic infections, we’re beating on people with these antibiotics, antivirals, and if you don’t address the immune system, you never get there.  Because the immune system is so low, you can get the antibiotics down, but the immune system has to basically, take over, because most people that have chronic Lyme or chronic infections, they basically, are able to suppress the infection, even though they have it. For instance, like getting chicken pox. You say, “Well I’m over the chicken pox, you’re really not. The body just basically, hasn’t suppressed it. It comes back out as shingles when your immune system’s low.

                                                So it’s a good model for, “Hey, keep the immune system high, and you don’t get shingles again.” Same thing with Lyme, chronic fatigue syndrome, fibromyalgia.

Dr. Weitz:                            Yeah, it’s interesting. I interviewed Dr. William Parker last week and he was talking about using worms that you ingest and live in your intestines and the main effect is to help regulate the immune system.

Dr. Holtorf:                          Yeah, and those are great. As you said in your previous podcast, where they’re great with respect to autoimmune diseases of the gut. You find that third-world countries don’t get Crohn’s and Ulcerative Colitis because they have these worms. So, yeah, it modulates the immune system. Same thing, increased Th1 lowers that Th2 and we find … we haven’t used worms, but they seem like they fit right in with the model.

Dr. Weitz:                            Yeah. One of your articles on your webpage, you write that, “Central hypothyroidism and cellular resistance to thyroid hormone exists in the majority of patients with fibromyalgia and chronic fatigue syndrome.” What did you mean by this? How can this be tested for, and then how does it get treated?

Dr. Holtorf:                         When you look at studies that use TRH tests … so, most doctors, they basically look at TSH. The TSH, the basic hormone produced in the hypothalamus, tells the pituitary to excrete thyroid stimulating hormone, which then tells your thyroid to excrete T4, which then needs to go into the cell to convert to T3. So, all these things need to happen. Now, what do most doctors check? The TSH, which tells the level in the pituitary.

                                                So, when the pituitary level goes up, the TSH goes down, or the pituitary level goes down, TSH goes up. Now, what we’ve found with chronic inflammation, chronic infections, diabetes, dieting, obesity, what happens is that the pituitary’s different from every other tissue in the body. You have all this inflammation and this chronic illness going on, the pituitary levels go up, but the rest of the body goes down. So, what happens is, you get low TSH, which doctors will say … they’re taught that thyroid is very easy. If your TSH is high, your thyroid is low, if TSH is low, your thyroid is high. It’s normal, it’s normal.

                                                That is not the case with so many illnesses, especially with chronic fatigue syndrome and fibromyalgia. For instance, they did TRH testing in fibromyalgia patients. All of them were low, even though they had a TSH that was low normal, so it looked like they had a little bit high thyroid. So, it is totally inappropriate to use TSH in chronic fatigue syndrome and fibromyalgia. Also, we’re finding diabetes, and anyone with chronic dieting, any autoimmune disease, inflammation, all these things, the standard blood tests we’re using is missing about 80% of people with chronic illness.

Dr. Weitz:                            That’s kind of a controversial viewpoint, though, isn’t it?

Dr. Holtorf:                         Well, it is, because we’re just taught over and over that the TSH is what you look at, but I’ve published numerous reviews on this with hundreds of references from standard medical journals. It’s clear, it shows it, and when you show this data to people … “How come I don’t … why haven’t I heard this before?” I’m like, “It’s very complex. Doctors learn what they learn.”

                                                Basically, you look at the studies, most doctors are practicing twenty years behind what’s available in the medical literature. And they did a study and they found that it takes an average 17 years for a proven, new concept to be accepted into mainstream medicine.  And why is that? One, doctors don’t read medical journals. They don’t. They don’t have time, and if they do, they read the abstracts of the whole thing. Also, drug reps, basically, drive doctors prescribing, but the biggest reason was they found that if you give a doctor … Here’s a study, here’s five studies, ten studies, a hundred studies showing what you’re doing is wrong, they don’t want to read it. They say, “No, what I’m doing is fine.” They don’t have time. When you look at all these tests we’re doing for thyroid, you can’t just do the blood test. Doctors are like, I don’t have 15-20 minutes to spend with the patients and ask them all their symptoms. They have nine minutes, now.

                                                So, what do you get? You get an antidepressant. If your TSH is high, you get Synthroid, which doesn’t work very well, or if it’s normal, again, you’re just depressed or stressed. Go away, you’re done. So, that’s the really driving force. No one wants to take the time that it does to basically, treat thyroid appropriately.

Dr. Weitz:                            So what are the best tests to get an accurate measure of thyroid?

Dr. Holtorf:                         Now, we’re developing a new test called the Bioactive TSH. You find with, again, that pituitary dysfunction, your body secretes less active TSH, but that’s not available right now. That’s up and coming, hopefully.

Dr. Weitz:                            Active versus inactive TSH?

Dr. Holtorf:                         Yeah. And the standard test just picks up the amount of TSH, not the activity. So, you can see that if you have chronic illness, the TSH may be the same, but it’s less active. We’re working on that for 10 years, but we’re making some progress. You need to look at the Free T3, Free T4 levels. But one key is the Free T3/Reverse T3 ratio.  So, the body will take T4, which is inactive, secreted by the thyroid. It can either convert to T3, which is active, or Reverse T3.

                                                So Reverse T3 is the same thing, but backward. So it goes to the cell receptor, sticks there, but doesn’t do anything, so they say it’s inactive. But actually it’s blocking the active thyroid, so it’s a brake pedal for the thyroid. With stress or chronic illness, inflammation, chronic infection, you’ll make high Reverse T3. If you look at the Free T3/Reverse T3 ratio, it’s a very good marker. Now, with the little caveat, the new assays out are not that good. They kind of crunch everyone together. Before, five years ago, they were very telling. Now they’re a little … they’re telling, but not everyone’s exact cutoff. We need to look at that.

                                                Another marker is sex hormone binding globulin. People think of that in terms of testosterone, because it binds up testosterone, so people will say, “Well, we want to see what’s the free testosterone.” So, hormones can be bound up or free. The only ones that are active are the free. But sexual binding globulin goes up in the liver in response to two things. One is estrogen, one is thyroid. So, a woman comes in. Let’s say she’s menstruating normally, probably normal estrogen. If her sexual binding globulin is below 80, you know they’re low thyroid. And also, if you give thyroid and SHBG does not go up, you know they have thyroid resistance. So that’s a key test that so many doctors don’t know about, and they just don’t think about it.

Dr. Weitz:                            Interesting.

Dr. Holtorf:                         Symptoms are key, also. I mentioned body temperature, low body temperature, symptom assessments correlate very well. We have a computer that measures the relaxation phase of the muscle reflex. So, normal thyroid, the reflex will go “chu-chu”, but the lower the thyroid it goes “duhn-nyah.” The computer measures that.

                                                British Medical Journal, obviously, a major medical journal, showed that that test was better than blood tests for thyroid, correlated with symptoms better. Then we’ll also check everyone’s basal metabolic rate. And we’ll find that most people come in that have…

Dr. Weitz:                            How do you measure their BMR?

Dr. Holtorf:                         Basically, with a device that measures the oxygen output over 10 minutes. And it extrapolates for the whole day, so it tells you how many calories you burn. How much oxygen utilized equals how many calories you burn. Let’s say my metabolism is low, everyone’s like, “Yeah, right.” They’re metabolism is 25% lower. That correlates to about 500 calories a day, so they either have to eat 500 calories or less just to stay even, or exercise for about two hours. Or fix your metabolism. So we find that is a gold standard for basic metabolism, which equals the thyroid. The thyroid is the gas pedal for the metabolism.

Dr. Weitz:                            Right. So you’ve also written that most patients with fibromyalgia and chronic fatigue syndrome suffer from clinically significant andrenocortico dysfunction due to hypothalamic and pituitary dysfunction. And I see from some of your articles that you often treat both of these conditions with low-dose cortisol. How does this help, and maybe you could explain the mechanism.

Dr. Holtorf:                         The adrenals, as you know, basically, and a lot of people know, it’s a stress response. It helps your body to deal with stress. So many people say adrenal fatigue, I think that’s overused, you know that …

Dr. Weitz:                            Right. That seems to have been critiqued, right?

Dr. Holtorf:                         Yeah, and everyone’s like, “Okay, adrenal fatigue [inaudible 00:13:58].” But when-

Dr. Weitz:                            Do you like the four part adrenal-cortisol testing with the saliva?

Dr. Holtorf:                         I do. That way … because a lot of times you’ll see it. They’re not, in fact, when are they low or high? But it should be high in the morning and then come down and low at night. But, you’ll see people completely opposite. They don’t sleep, then they’re tired during the day. So, I think it is a good test.

                                               We’ll do a lot of blood tests, because we’ve been doing them a long time. We don’t need to do those things, but they’re certainly useful, because you get multiple times during the day. What happens with chronic infection, we talked about.  Pituitary dysfunction with the thyroid, same thing happens with the adrenals. The pituitary secretes ACTH, which tells the adrenals to go up.

                                               Now, what we find, it’s usually not a primary adrenal problem, it’s a hypothalamic-pituitary-adrenal problem. Normally, what they did, was do ACTH stimulation tests, which was considered the gold standard for adrenal dysfunction, and they found no difference in chronic fatigue syndrome or fibromyalgia. But the problem is, that only tests for primary. But when they did central testing they found that there’s again, hypothalamic-pituitary-adrenal dysfunction, which these tests showed up 90+ percent actually had HPA axis, hypothalamic-pituitary-adrenal dysfunction and responded very well to treatment. And they found that the ACTH stimulation test was no better than flipping a coin. So, again, that gold standard testing missed 80% of them, was no better than flipping a coin.

                                                And it’s very hard to do the central stimulation test. But if you look at the studies, for instance, the Journal of Infectious Disease in Brazil looked at chronic infections and how the adrenal levels correlated to serum levels. They found if they were lower than 12.6, they had about an 85% chance of being low adrenal, because when you’re sick, you should be higher, right?

                                                Let’s say, “What is normal adrenal function?” It depends on the person, it depends on the stress. If you’re in the ICU and have a normal adrenal level, you’re probably going to die. You need much more during times of stress, so with chronic infection you need more. So that’s just a quick and easy test to do for adrenal function, and say, “Hey, is this person low?” Look at all the symptoms. Giving low-dose cortisol, everyone’s like, “Oh, my gosh.” You know, especially if you’re an endocrinologist. It’s safer than actually doing the testing, the basic stimulation test. Much safer, does not suppress the adrenals, actually at low dose, it will improve adrenal function. And then, as you treat everything else, that will get better. Usually, we’ll treat for three to six months, or depends on the case. They’re often not on it longterm, and a lot adrenal support as well, and that often comes back.

Dr. Weitz:                             Yeah, I guess a lot of us have seen patients who are on prednisone for a long period of time for asthma, or some other condition, and they have all these side effects, and loss of bone, and all kinds of other things. That, I think- [crosstalk 00:17:01] worry comes from.

Dr. Holtorf:                          I also have written on this, about the low-dose, completely different. And I can’t remember the last time I gave prednisone, or any high-dose, because, yeah, you’re basically doing a disservice to the patients. Suppressing their adrenals, they’ve got to be on it, all the side effects, but again, optimal is optimal. Prednisolone is mega-doses, which, it’s going to have issues.

Dr. Weitz:                            Does it matter if you use cortisol or cortisone? Those are different, right?

Dr. Holtorf:                         Yeah, cortisol or hydrocortisone are the same thing. Those are interchangeable. We used to give time-released, compounded.

Dr. Weitz:                            You’ve also written about lower levels of growth hormone being correlated and being a contributing factor in fibromyalgia and chronic fatigue syndrome.

Dr. Holtorf:                         Again, the same thing. Growth hormone produces pituitary, usually at night, and it goes through your liver, increases IGF-1, things like growth factor, which has a lot of effects on healthy immune system, weight, all those things. Just like everything else, again, when you look at these chronic illnesses, everything that the pituitary controls, which is a lot of things, are dysfunctional.

                                              Studies by Bennett from the University of Oregon found that giving growth hormone, dramatic improvement in symptoms. And growth hormone is very controversial and very regulated because of athletes using for performance, which shows that it does work. We stopped over the years using straight growth hormone and more using secretagogues that stimulate your body’s own production, including peptides, we’re finding our key for that.

Dr. Weitz:                            Which peptides?

Dr. Holtorf:                         Ipamorelin, CJC. I’ve done a lot of lecturing on growth hormone secreting peptides, growth hormone secreting hormone. Now, you’ll get Sermorelin, or Semorelin, however people pronounce it, but either way. That is a growth hormone secreting hormone, and it does work, but it stops working in a couple months, so if you had a growth hormone secreting peptide to that, it works much better and longer. And it’s really, you can’t overdose, because your body will actually regulate it.

                                                It’s a nice way, very safe, much more cost-effective than growth hormone and you get the effects. It’s not great for bodybuilders, which we don’t see, but for the sick patient. Usually, the sicker the patient, the better the response to growth hormone, and healthy people, they might see some performance, endurance, but usually they don’t see dramatic effects. But, the sicker the patient, the more they respond, and very well-tolerated. I can’t remember the last I’ve had a side effect from growth hormone, or especially the secretagogues.

Dr. Weitz:                            What about some of the natural methods of elevating growth hormone levels, including certain amino acid supplements, and even heavy weight training has been shown to elevate growth hormone levels.

Dr. Holtorf:                         I think especially those you’ll see with healthy patients, the people that need it the most, those don’t work too well. Usually, they can’t do that stuff, especially heavy  weight training. They’re so fatigued. But healthy people can see benefit in those things, although, oftentimes, it’s highly variable and depends on the person. Those things can work, but usually with someone who’s very motivated to do those things.

Dr. Weitz:                            Okay. I see that you often see chronic infections as a factor in fibromyalgia and chronic fatigue syndrome. Which infections do you see most prevalently?

Dr. Holtorf:                         The big thing we’re seeing is Lyme, but there are so many other infections that go along with it. When someone has Lyme, they usually have multiple other infections, including co-infections. Babesia is a huge problem. It makes Lyme symptoms much worse and the treatment much harder. Bartonella, we’ll see much worsening symptoms, a lot of neurologic. People get diagnosed with schizophrenia and bipolar and they actually have Bartonella. But also when you see with Lyme, it suppresses the immune system, so you get all these … they’re not new infections but they’re reactivating infections. Such as Epstein-Barre, HHV6, CMV.

                                                The problem is when you test them. Normally, when you get an infection, we’re taught in medical school, your IgM antibody goes up first, and then after a while, IgG.  If it’s a new active infection, you should up IgG positive, whether HHV6, Epstein-Barre, but these are not new infections, they’re reactivating. So the body secretes  IgG.  The higher the IgG, the more like you have this active, chronic active infection. But a lot of people are told they don’t have these viruses. Not uncommonly, you need to treat the virus along with the Lyme or the other bacterial infection, because that’s suppressing the immune system. Antibiotics don’t touch it. But immune modulation, again, is key for all those, because they’re all coming out, because the immune system’s too low.  Whatever antibiotic or antiviral you need to get down the immune system. But if you get the immune system up, those start working. They work much better together.  We rarely give antibiotics or antivirals without the immune modulator.

Dr. Weitz:                             Do you use Immunoglobulin?

Dr. Holtorf:                          I love Gly BIG. And it, again, is another immune modulator.  It does the same thing; it increases Th1 and lowers Th2. It can also kill passively with the infections. But, the problem is, it’s expensive. So we’ll do, typically, the lower doses so people can afford it. It’s a great treatment. I wish it wasn’t so costly.

Dr. Weitz:                            What about LDN? Have you used that?

Dr. Holtorf:                         Yeah. LDN, I’m …

Dr. Weitz:                            Which is Low Dose Naltrexone.

Dr. Holtorf:                         Yeah, Low Dose Naltrexone, I’m on the advisory board for them, spoke at their conferences many times, and written a couple of chapters on LDN in chronic fatigue syndrome and fibromyalgia. Your listeners have probably heard of it before. It’s an opiate blocker, and they found that it’s usually used for people who go to the emergency room. They overdosed on opiates, pain pills, they give them that, it reverses it. But, what they found at a very low dose, it modulates the immune system. It kind of does that same Th1/Th2, so it’s a first-line treatment. Very safe, very little side effects. Some people get a little insomnia with it, but like anything, it doesn’t work for everyone, but it’s something to try because it’s very inexpensive, very cheap, very safe.

Dr. Weitz:                            I notice in your writings, you also talked about coagulation problems, fibrinogen, that kind of stuff, as being related to fibromyalgia and chronic fatigue.

Dr. Holtorf:                         And that’s another big issue that if you miss this, you may not get better. And what we found is, you get immune activation coagulation. A number of studies by Berg,  and others. The infection sets off the coagulation system, the body tries to wall off the infection by laying down fibrin and the blood gets very thick. I’ve mentioned that you could not draw my blood when I was very sick. You couldn’t take it out with a giant needle. And my D-dimer, which is a marker for this immune activation, was so high it was at about 50-fold increased risk for cardiovascular event in the next year. I said, “Oh, gee, I’ve got to get that down.”

                                               So the body lays down this fibrin, covers up the infection, which is good in the short-term, but now the body can’t get at it. And oxygen that normally takes two seconds to get in the cells, now takes up to two minutes. The cells are starved for oxygen, hormones can’t get through, waste products can’t get out, so until you clean up that fibrin, which may be a little bit of blood thinner, like Heparin. Coumadin and those other new ones don’t work. Or some fibrolytic enzymes can also help. And once you clean that up, it’s interesting. You’ll have people doing, let’s say, [inaudible 00:25:06] that it didn’t work. You give them a little, clean that up, do the same treatment again, and they’re like, “Oh, my gosh, it works.”

                                                That’s one of the keys that I think are missed frequently in providers that are treating Lyme, and it can make all the difference in treatment.

Dr. Weitz:                            Yeah, I found a combination of those enzymes along with high-dose fish oil also very helpful.

Dr. Holtorf:                         I agree. Again, multifactorial treatments usually are the key.

Dr. Weitz:                            Good, good, good. I think that’s all the questions I had for you. Anything else that you want to say about fib … By the way, fibromyalgia and chronic fatigue, for the most part, they can be treated as one condition?

Dr. Holtorf:                         Yeah, they’re essentially the same. You look at the … also the diagnoses are crazy, like, fibromyalgia, 11-18 tender points. There’s nothing special about those tender points. Look, you ask the patient if they’re significantly fatigued, if they have brain fog, sleep disorders, may or may not have muscle pain. They have it. You look at the blood test. People will say, the standard is, “Oh, there’s no blood test to detect it.”

                                                We can pick out chronic fatigue syndrome, fibromyalgia, on a blood test, on a panel, and how severe it is, about 80% of the time. So when people say, “Oh, there’s no  blood test that’s …”, we can pick how this person’s going to be essentially, probably bedbound, this person’s probably not too bad. And the blood test tells you. So it’s  not … everyone’s “Oh, it’s mental, it’s made up.”

Dr. Weitz:                            Right.

Dr. Holtorf:                         Well.

Dr. Weitz:                            And so the blood panel basically includes thyroid and cortisol and all these other factors we’ve been talking about?

Dr. Holtorf:                         Right. It’s usually a large blood panel because we like to get all the information, because they’re so many symptoms that are dysfunctional. We talked about a couple of  them. You got the pituitary-hypothalamic pituitary, all the hormones, mitochondrial dysfunctions, so the cells can’t make energy. You have the coagulation defects, you have the gastrointestinal system, what else? So many things you got, you got toxins, that are wrong with this condition, so when you look at studies, people say, “Oh, it’s because of sleep” or “it’s because of mitochondrial dysfunction or hormones or thyroid.” Who’s right? Well, they’re all right and it depends. You’ve got to find in the patient which things are affecting them the most.

Dr. Weitz:                            Great, great. You’ve provided us some really useful information, Dr. Holtorf. Thank you.

Dr. Holtorf:                         Great.

Dr. Weitz:                            For listeners and viewers who would like to get ahold of you, what’s the best way for them to get in contact with you?

Dr. Holtorf:                         Have them call the office, so we are in El Segundo by Los Angeles. We have centers also in Foster City, by San Francisco, Philadelphia and Atlanta. But you can call our 800 number, which, I’m not sure what it is. Our L.A. number is (310) 375-2705, or go to our website, holtorfmed.com or our nonprofit National Academy of Hypothyroidism, where all these studies that say, “Oh, they say my thyroid’s normal” and you’ll see hundreds of references showing that’s not true. And that’s N-A, like national academy, nahypothyroidism.org.

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

 

Rational Wellness Podcast 039: Brain Health with Dr. Steven Masley

Dr. Steven Masley explains how to improve your brain health with Dr. Ben Weitz. Dr. Masley just published The Better Brain Solutionhttps://www.barnesandnoble.com/w/the-better-brain-solution-steven-masley-md/1126646685#/    [If you enjoy this podcast, please give us a positive review on Itunes, so more people will find The Rational Wellness Podcast]

 

Podcast Details

1:30 I asked Dr. Masley how he came to write a book about the brain?  Dr. Masley explained that in his clinic he looks at 100 markers of aging. He looks at arterial plaque growth, cholesterol, lipids, sugar, etc. He also looks at brain function, brain processing speed, memory, attention span, reactivity, and executive brain function. He also looks at food intake, nutrient intake, fitness, stress management, and toxic exposure. He has an easy to follow five step plan that improves brain processing speed by 25-30%.

2:45 I answered that that is great because cognitive problems, neurodegenerative conditions like Alzheimer’s Disease, are really on the rise and are now the leading cause of death in women, exceeding even cardiac and breast cancer. Dr. Masley said that he agreed and the number one most expensive disease is memory loss at $215 million per year and that is supposed to double in the next 12-15 years. It’s because the number one cause of memory loss is elevated blood sugar. I mentioned that some practitioners are now calling Alzheimer’s Disease Type III Diabetes due to this relationship between blood sugar and insulin resistance.

3:58 I asked Dr. Masley to explain what does blood sugar have to do with the brain? Dr. Masley said that it has to do with insulin resistance. Insulin is the hormone that helps us to store energy. When we eat carbs, whether it’s a healthy carb like broccoli or blueberries or whether it’s a refined carb, which causes a much bigger blood sugar surge like sugar or flour, the insulin rises in order to push the sugar into the cell. That’s a normal function, just like muscle cells. We push glucose in, and we build glycogen. When we go for our next workout, that glycogen in that muscle cell is ready to burn as energy. The challenge is if we don’t have a healthy lifestyle …if we don’t work out enough; if we eat too many refined carbs … our cells become full. They no longer respond to insulin. In fact, they become insulin-resistant. Once they’re full of energy, they say, “No, we’re not listening any more. We can’t store any more energy.”

Dr. Masley continued to explain that when brain cells become full of glucose, they shut down and stop working. Insulin resistance makes brain cells unable to process and use energy, so if we do a PET scan on the brain of someone who’s super fit and healthy, it would likely light up like a Christmas tree. When we do a PET scan and we look at energy burn on brain cells in patients with insulin resistance, it’s pretty quiet.  The brain is unable to process glucose’s energy. It’s dysfunctional. They have brain fog. They’re forgetful. They walk into a room; they don’t know why they’re there. They read a passage in a book, and they have to keep rereading paragraphs and they can’t remember people’s names.  Their brain’s not functioning, and if that’s not just a day or so, but it’s ongoing, that insulin resistance state, the brain cells being unable to use energy, they become dysfunctional. Then they die, and if they die, then every time a brain cell dies, the brain shrinks a little bit. If you have millions of brain cells dying, your brain is shrinking a lot, so insulin resistance, this abnormal blood sugar regulation, literally makes us unable to use our brain, shuts our brain down, kills off our brain cells, and it’s shrinking our brain. Nobody should want a shrunken brain. That’s what’s happening with this whole process, and it’s just … Who would’ve thought, at a time when blood sugar levels are high, that our brain cells would be starving? That’s normal physiology. That’s how our body works.

6:41  I interjected that an easy answer is to just have 10 Diet Cokes a day. We see what that does to brain shrinkage. Dr. Masley answered, Yeah, just shrink your brain like a grape to a raisin as quickly as humanly possible. That would be an effective way to finish yourself off.

7:03 I asked what is the best way to test for cognitive decline in your office? Dr. Masley answered that while there are many labs we could look at, like thyroid and blood sugar and sodium and mercury and B12, but he does cognitive testing on the computer.  These tests measure how your brain functions, looking at memory, both word memory and visual memory, as well as at brain processing speed and the ability to focus.  By doing such computer cognitive testing on a computer he can detect that someone’s having gradual cognitive decline 20 years before they have real memory loss, which gives you plenty of time to try to prevent it.

8:04 I asked which test he likes the best? Dr. Masley said that he uses CNS Vital Signs, Central Nervous System Vital Signs.

8:19 I said that in your book, The Better Brain Solution, you mention you write about 12 foods that will promote brain health. Which are these brain-healthy foods?

Dr. Masley said that he organizes these foods into groups. One group would be those with plant pigments, things like green, leafy vegetables; blueberries and cherries, those anthocyanins; dark chocolate. Those pigments literally protect our brain from oxidation and inflammation. They block it. One cup of green leafies a day, and your brain is literally 11 years younger than someone who doesn’t eat green, leafy vegetables. These plant foods are really pretty powerful, and we need more of them. Even coffee is beneficial, whether it’s decaf or not. It’s the pigment in coffe that protects our brain, rather than the caffeine.  Now with coffee, one or two cups of coffee has a benefit, maybe three. Four or more is actually harmful.  We call that a J-shaped curve. A little bit is good; excess is not better. That also applies to alcohol. Red wine in moderation also improves brain function and decreases cognitive decline, one or two servings with dinner.  Hard liquor and beer had no benefit, and if you drink more than two, three servings a day, no! It’s not good. All these are plant pigments, so those are all plant pigments that are good.

Another category is smart fats.  Our brain is mostly fat by weight. It’s 40 percent fish oil by weight, and 60 percent fat. We need healthy fats in our diet, and the idea of a low-fat diet to me is crazy. It’s now a closed case. They did the largest study probably ever with the low-fat diet versus a Mediterranean diet where they added more extra virgin olive oil or they add extra nuts, and by adding nuts or olive oil, brain function improved and cognitive decline slowed down. Those on the low-fat diet, their brains just kept shrinking, and they had increased dementia. Yes, we need healthy fats, like cooking with avocado oil and eating avocados and wild salmon and all the seafood that’s so good for us. Extra-virgin olive oil, nuts, dark chocolate, those are all great fats for our brain that we want more of.

Dr. Masley continued, that we need spices and herbs, because they’re anti-inflammatory. His favorite spices are Italian herbs, especially rosemary, and curry spices like tumeric. Those are very anti-inflammatory and they block oxidation,  He would also include a probiotic in the foods that have been shown to protect their brain.

11:29 I said that in your book, when you were talking about the healthy fats, I noticed that there was one healthy fat that’s really embraced by the functional medicine community today, and that’s coconut oil. It’s frequently mentioned as a fat that you should purposely take to promote brain health, but I get the impression that you’re not entirely convinced that coconut oil is a healthy fat.  Dr. Masley explained that he thinks of MCT oil (medium-chain triglycerides) from coconut oil as more of a supplement, which has been used in clinical studies and shown for people with mild cognitive impairment to improve their brain function.  But coconut oil only has 20 percent medium-chain triglycerides and it’s mostly other forms of fat.  Dr. Masley said that he uses coconut milk in his recipes in his Better Brain Solution book. But he doesn’t feel that we have the data for coconut that we do for MCT oil.

Also, there is one cardiac concern about coconut oil in people who have known cardiovascular disease, when we give them coconut oil versus olive oil, they showed endothelial dysfunction. Their arteries literally constricted, and they showed increased oxidation. Dr. Masley doesn’t recommend people with known heart disease or people who are being treated with cholesterol meds add coconut oil, because it can increase cholesterol 50 to 70 points.  For athletes, coconut oil is a great fuel source. If I’m on a two-, three-hour bike ride, I’m probably going to use coconut milk in my shake before I go to get those MCTs. I think of it as a healthy food source. I think it’s probably good for the brain but not proven. It’s great for athletes, but I’m still waiting to see. We don’t have the proof like for olive oil or for nuts or for seafood, which clearly have been shown to have brain help. We don’t have that yet for coconut oil, so I’m glad you asked.

14:01 I asked Dr. Masley if the worry is because of the saturated fat content, and what he thinks about the role of saturated fat in heart disease? Dr. Masley explained that he doesn’t think know that saturated fat is harmful and the bigger question: Is it clean? Does it have pesticides? If you’re eating meat and butter, is it organic? Is it from from a feed lot where they used Round-Up and all these chemicals? He’s much more concerned about, “Is it a clean fat?” than, “Is it saturated fat?”

There’s a caveat to that, which is that the 20% of people who have the APOE-4 genotype.  They tend to have more oxidation, more inflammation, have a higher risk for heart disease, for memory loss, and Alzheimer’s disease.  They tend to have very high cholesterol, so for them, saturated fat tends to increase their cholesterol even more, and there’s actually studies that show in the APOE-4 folks, that more saturated fat increases beta amyloid production.  Those with APOE-4 genotpye should keep saturated fat intake moderate, like no more than one or two servings per day.

16:12  I asked what is the best oil to use for cooking?  Depending upon which chart you look at, there’s a lot of controversy which temperature different oils burn at and which is the best oil to use depending upon what temperature you are cooking at.   Is it okay to use coconut oil at high heats? Dr. Masley said that if you use extra virgin olive oil, the smoke point’s 400, so he never goes above 375.  Coconut oil has an even lower smoke point–350, so it’s not a good oil for high heat cooking, but most people think that it is.  If the smoke point’s 350, he will only use low or medium-low heat. Rather than coconut oil, Dr. Masley prefers to use avocado oil, because it tolerates up to 520 degrees. If you use use coconut oil or coconut milk in a curry or a recipe like that, you should wait til you drop the heat to add it.  For high heat, the best oils are pecan or avocado.

18:07 I asked what constitutes high heat?  Dr. Masley answered that high heat is more than 475 degrees. Medium-high, like when we saute vegetables and protein is about 450-475, so you could use almond or macadamia nut oil. Or you could use pecan or avocado oil. Another alternative would be ghee, clarified butter, which tolerates up to 475 degrees. Regular butter only has a smoke point of 350 degrees and it starts to be damaged and turns brown as with medium to medium-high heat. When you purify it and you cook it at low heat and the foam comes up and you scoop off all those bubbles and you’re just getting it down to an oil that is very stable. Ghee is basically clarified butter and can be heated up to about 475. Also most people who are dairy intolerant can tolerate ghee because almost all of the proteins are gone. 

19:48 I then asked what are the most important supplements for brain health? Dr. Masley talked about the benefits of vitamin D, mixed folates, extra B12 in the methylcobalamin form rather than cyanacobalamin, chromium, and magnesium, which you could get in a two pill multivitamin/mineral. Dr. Masley also recommends fish oil, a probiotic, and curcumin, which comes from the spice turmeric. Rather than test patients for MTHFR, Dr. Masley prefers to just give all of his patients the active form of B vitamins, since it is so safe. 

24:55 I asked Dr. Masley to explain how exercise is important for brain health. Dr. Masley explained that his clinic data demonstrates that the number one factor that improves brain processing speed … literally to make your brain quicker, sharper, more productive … is fitness. It’s not about how many minutes spent per week.  All the relationship is with how aerobically fit you are and your muscle mass and strength. Independently, aerobic fitness clearly helps brain processing speed and even increases the size of your brain and helps improve insulin resistance, which is the number one cause for memory loss. Strength training does, too. Independent to aerobic activity, adding more strength training, adding more strength, muscle mass, improves insulin resistance. It helps enlarge the brain. You get brain derived neurotropic factor BDNF that goes up.  80-year olds have been shown to increase the size of their brain when they add strength training, so we really want both aerobic work and we want strength training on a regular basis. 

26:44 I asked about the dosage–How long do people need to exercise for? How much should be strength versus cardiovascular training, and how many times a week should they exercise?  Dr. Masley answered that he does  fitness testing in his office, so all his patients are required to come in and do push-ups and sit-ups and sit and reach and VO2 Max Stress testing. They show up in gym attire, and that’s what my patients expect. Other doctors’ offices, they get a blood pressure. With Dr. Masley, they’re doing push-ups and running up a hill. He goes through their nutrient intake and harasses them over their food.  Dr. Masley explained that when he measures fitness, he compares his patients to their age group and he’d like them to be in the top third for someone 10 years younger than their age. Dr. Masley feels that 20 minutes of intense interval training three days per week can give you the same benefit 30 minutes of moderate activity five days per week.  An ideal routine would be do intervals three times a week, strength training twice a week and then add yoga once a week and then do a moderate, long thing on the weekend, like a 23-mile bike ride or like a two-hour bike.

28:57 I asked Dr. Masley about the software program Heart Math, which he talks about in his book?  Dr. Masley explained that with Heart Math the patient is hooked up to a monitor to measure their heart rate variability and they are asked to do a meditation exercise and see how calm and relaxed they can get in two minutes. Most patients are so stressed out that they are not very good at relaxing. Heart Math tells patients whether they are calm, semi-calm, or agitated. Dr. Masley works with them with different verbal cues to get them to practice relaxing, such as “Think of going to the beach.” It’s a really fabulous feedback tool to help people get calm.

32:17 I asked Dr. Masley about the role of toxins such as tobacco, mercury, pesticides, etc. in affecting brain health.  Dr. Masley answered that the brain’s the most sensitive part of your whole body to toxins. If you have elevated pesticide levels, you’re 350 percent more likely to get Alzheimer’s, so we really do need to worry about pesticides. Tobacco drops brain processing speed and overall cognitive function. Alcohol at more than one or two glasses of wine is also a toxin. BPA lined cans are also a problem and two cans per week increases your risk of diabetes and insulin resistance by 20%. Dr. Masley also said that people should stop cooking with plastic and putting plastic containers in the microwave. He also talked about the danger of eating deli meats, hot dogs, and bacon with nitrosamines, which have been shown to be neurotoxic and to kill brain cells. We can actually kill off and make rodents have Alzheimer’s just from eating the amount of bacon people would get from going to the restaurant every day. 

 

Dr. Steven Masley can be contacted through his web site https://drmasley.com/ where you can get a free Better Brain Shopping Guide or by calling his office 844-300-2973.  I highly recommend his book, The Better Brain Solution, which is available from Amazon and Barnes and Noble, https://www.barnesandnoble.com/w/the-better-brain-solution-steven-masley-md/1126646685#/

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

 

Rational Wellness Podcast 038: Worm Therapy with Dr. William Parker

Dr. William Parker talks about Helminth Therapy, the therapeutic use of worms that are eaten and grow in your intestines to promote your health, with Dr. Ben Weitz. This may sound crazy, but recall when we found out that bacteria were the cause of disease in the 1800s and we figured out that we could kill bacteria with antibiotics and antibacterial soap and using modern sanitation methods like toilets, refrigerators, and water treatment centers. It wasn’t until the 1990s when we realized that there were beneficial bacteria growing within us in our intestines, our skin, our mouths, our mucous membranes, etc..  We learned that consuming live bacteria in the form of probiotics and fermented foods could improve our health.  And consider that for thousands of years, humans developed with bacteria, fungi, worms, and protozoa growing within us.  Today we know that we have a loss of diversity of our microbiome. We don’t have as many species of bacteria in our colons and this is partially because we live in such a clean, sterile environment compared to our ancestors.  This lack of exposure to pathogens has led our immune system to become dysregulated and this has increased autoimmune disease risk. This leaves our immune system with nothing to do and at times to attack our own tissue. This may occur through the mechanism of molecular mimicry whereby our immune system attacks protein found in our tissues that resemble proteins found in pathogens. Dr. Parker uses the analogy of leaving your teenager home alone with nothing to do–he or she is likely to do something stupid. Without bacteria, viruses, fungi, or worms to attack, our immune system attacks our self. 

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Podcast Details

3:47 I introduced Dr. William Parker as a Duke University professor who is one of the world’s leading experts on Helminth therapy.  I asked how he got interested in Helminth Therapy?  Dr. Parker said that he was working on studying microbes and microbiotia before it was called the microbiotia. They were studying the gut bacteria and they figured out that the immune system was supporting the gut flora and they figured out that the purpose of the human appendix is a safe house for beneficial bacteria, which is what his lab is best known for. But they were also interested in figuring out about diseases, like inflammatory bowel disease, and one of the things that he thought about is that in rats, the appendix is normal, but in modern humans something has gone wrong since the appendix gets inflamed for no reason and a large percentage of people have to have it taken out. So the situation with the appendix is kind of like a form of mini inflammatory bowel disease.  Appendicitis was virtually unknown during early history since there would have been some discussion of it, since without having it removed there is a 50% rate of death with appendicitis. You can read about how in the late 1800s surgeons were very interested in why they were suddenly starting to have so much appendicitis. We have a good cure for appendicitis, which is just to remove it, but we have much less of a cure for inflammatory bowel disease.  And inflammatory bowel disease also appears to be a modern disease. Dr. Parker said that he was trying to figure out why this was happening and the hygiene hypothesis was evolving at this time. They thought about their rat models and noted that their laboratory animals have this disease but what about wild rats?  They should be more like our hunter gatherer ancestors and they went back and studied these wild rats and found out that nearly everything about the immune system was different, including how antibodies are made, to compliment, to all the different cells in the immune system. Then they took lab rats and put them out in the wild and the big difference was not so much in their microbiome, which is largely related to diet, but what has been completely washed out are the complex eukariotic symbionts like protozoans and intestinal worms.

9:16  Inflammatory bowel disorders, like Ulcerative colitis and Crohn’s disease, are very difficult conditions to treat and these patients often have inflamed and ulcerated intestinal mucosa and it looks like from some of the studies I’ve seen are conditions that worm therapy may benefit. Dr. Parker answered that he thinks so, but it’s not proven yet.  Joel Weinstock in 1999 was looking at the effects of helminths on inflammatory bowel diseases and he found that the patients who were not responding to pharmaceuticals were responding extremely well to the porcine whipworm (TSO). He published papers in 2005  https://www.ncbi.nlm.nih.gov/pubmed/15825065 and in 2007  https://www.ncbi.nlm.nih.gov/pubmed/17313951  looking at both Crohn’s and Ulcerative Colitis and found that this TSO worm to be effective and you can still buy that worm today–it is produced in Thailand. What happened next is that they spent tens of millions developing this and they did a phase 2 trial and it did not work very well. What went wrong is that they changed the formula of the worm. You can think of worms as exercise for the immune system. Secondly, since they are not a chemical, if you change the pH, the acidity, they don’t work as well.  They changed the formula for some complex reasons, which is why it didn’t work.

13:32 I pointed out that this Helminth therapy fits very well with the Functional Medicine model. The traditional medical model involves using immune suppressing drugs like Humira, which don’t do anything to affect the cause of the condition. In Functional Medicine we try to balance and regulate the immune system and these worms seem to have a similar effect and seem to affect T-regulatory cells. Dr. Parker said that there are a couple of things that are very interesting. Let’s talk about Vitamin D insufficiency, for example. When he goes to conferences he often hears that they’ll talk abut how patients who are low vitamin D and vitamin D supplementation helps those patients in so many ways–neuropsychiatric function, immune function, etc. Based on our studies, patients are getting the same benefits from getting their Helminths back. He refers to getting Helminths back because it’s something that we lost between 1850 and 1950 and there are epigenetic effects which builds generation after generation. But he feels you get a bigger bang for your buck with Helminths than with vitamin D.  Dr. Parker also explained that in his wild rat studies they did not see any effect on T regulatory cells, but they saw effects on macrophages, T cells, B cells, etc. Modern immunology has recently been focused on T reg cells but that is the flavor of the month. It might be T reg cells or toll like receptors or the fast ligand.  Despite learning more and more about the immune system, immune disease keeps getting worse and worse. Dr. Parker said that Helminth therapy fits well with Functional Medicine but you can’t prescribe or give worms to your patients, since it is not approved by the FDA. Getting these helminths can be a tricky thing.

16:47  I said that I guess it’s not illegal to order them online? The United States is the only country where you cannot legally ship a helminth for therapeutic purposes, so the companies that are shipping them to people in the US are violating some regulation, though it is not a federal crime. 

17:20 There are other autoimmune conditions that helminths are beneficial for, such as MS.  You wrote that autoimmune conditions that are relapsing and remitting tend to respond better to helminths, like MS. Dr. Parker explained that Dr. Joel Weinstein looked at inflammatory bowel disease and another group looked at asthma. Some folks have looked at autoimmune diseases such as multiple sclerosis, including a group in Argentina that published a landmark study on this showing that patients with MS who were accidentally infected with helminths had complete resolution of their condition. https://www.ncbi.nlm.nih.gov/pubmed/17230481  Here is a review paper discussing this and other studies on this:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666823/  If they lose their helminths, their MS will come back. Helminths help with the relapsing and remitting form of multiple sclerosis but don’t help as much with the progressive form of MS.  Similar effects are being seen with allergies. Someone who is allergic to mold in their house where they are just not getting a break, helminths don’t help as much as they do with seasonal allergies. The first report of humans having having a therapeutic effect was by a British parasitologist named John Turton, who treated himself with a bunch of hook worms and his seasonal allergies went away.  So helminths look like a cure for seasonal allergies.  Dr. Parker said that he views it as a cure rather than as a treatment for allergies, because he views it as exercise for the immune system. If your patient has cardiovascular disease and starts exercising, we don’t view that as a treatment even though their disease may have gone away. Helminths have been with vertebrates for approximately 300 million years ago, so they have always been with us and they are something our immune system needs to function normally. 

21:00 I said that I imagine that just like there are good and bad bacteria, that there are good and bad helminths.  I recall Parasitology class and learning about parasitic worms that travel through your body and eat at your liver and your brain and kill you. So when we are talking about using worms, we are talking about certain worms that have a therapeutic value but are benign. Dr. Parker explained that during the agricultural revolution and people started living in crowded conditions and the number of worms per person went way up. If we talk about the porcine tape worm, you have a worm that is bad and it can form a cyst in the brain that would have to be surgically removed. Whereas the rat tape worm is one of the best hopes for getting helminths approved by the FDA.

23:35  I asked is that the TSO worm you are talking about? Dr. Parker answered that the TSO is the porcine whipworm not to be confused with porcine tapeworm.  And then Dr. Parker is working on the rat tapeworm. I then asked about the HDC worm. Dr. Parker explained that the HDC is the therapeutic stage of the rat tapeworm. I then interjected that it is my understanding that these TSO and HDC worms will grow temporarily inside us but then they’ll die. There are are cases with someone who is immuno-compromised that they’ll reproduce in humans, but for most people, you have to keep re-exposing yourself to these worms to maintain a certain level of exercise for the immune system.

26:01 I commented that this is kind of like the next level of probiotic.  Dr. Parker answered that there is one physician who refers to them as premobiotics. He said he’d like to get them approved as a dietary supplement. Unfortunately, it is going to require legislation for that. But he believes that humans in general need worms.  First we will have to treat the desperately ill and prove efficacy and safety. Then we’ll move on to less debilitating patients, such as allergies.

27:57 I asked if IBS is a condition that can respond to worm therapy? Dr. Parker responded that there are some studies using worms successfully with IBS patients. Dr. Parker is concerned that patients will think of helminths as a drug, but helminths should be thought of as part of a healthy diet. Dr. Parker said that there are five deadly factors in our society that are killing us early, which include, 1. bioalteration–the loss of our helminths and protozoans, 2. diet, 3. sedentary lifestyle, 4. chronic stress, including sleep alterations, and 5. vitamin D deficiency. 

29:08 I said that it sounds like worms would be most effective for prevention. With IBS, I believe that most cases are not really stress related but caused by dysbiosis, specifically small intestinal bacterial overgrowth and perhaps the helminths are balancing our microbiota. Dr. Parker said that studies they have done show profound changes to the microbiota when we put in a helminth. There is a change of up to 20% of the microbes, including ones that are associated with less inflammation. When the immune system gets inflamed, that affects the microbiota. I suggested that perhaps these helminths have a similar effect to phages, which are viruses that crowd out certain non-beneficial bacteria. Dr. Parker said that we don’t really know if our bacterial phages have changed since hunter-gatherer times. We don’t view the microbiota as a primary causative agent in disease and we see it more like a victim of what is going on in the body. This has to do with our thinking back in the 80s that the immune system is supporting the microbiota, which was originally ridiculed but is now widely accepted. This is what led us to figure out what the appendix does.

34:01 I said that the next topic I would like to touch on is autism and you (Dr. Parker) have written and talked about how worms can potentially be beneficial for autism and you have also written a paper on how acetaminophen use is associated with increased risk of autism. http://journals.sagepub.com/doi/abs/10.1177/0300060517693423   Dr. Parker answered that the idea of looking at autism was something that came up because many patients with autism are trying helminths, since there are not a lot of effective treatments for it.  When you look at the epidemiology of autism what you see is that it doesn’t match other inflammatory conditions like allergies or appendicitis or MS but yet autism is associated with inflammation and there is some sort of trigger that accelerated the incidence of autism and it corresponds to the increased use of acetaminophen from birth till age 5 or 6 due to stopping the usage of aspirin due to Reye’s Syndrome. We switched over to a drug that had not been tested and shown safe for neural development.

36:32 I interjected that I recently did a podcast with Del Bigtree and he believes that childhood vaccines are a major factor in the rate of autism and he talked about the fact that in 1986 the Vaccine Safety Act was passed that shielded manufacturers of vaccines from all liability.  There is less of a concern from the company side in terms of proving that the vaccines are absolutely as safe as they can, because there are no market forces to hold these companies accountable. There have not been a lot of studies on whether vaccines are associated with an increase in autism, despite what the industry says,    Recently, there was a paper published in April and they looked at kids who were vaccinated versus kids who are unvaccinated. And the kids who were vaccinated had six times the rate of autism and seven times the rate of asthma and allergies. http://www.oatext.com/Pilot-comparative-study-on-the-health-of-vaccinated-and-unvaccinated-6-to-12-year-old-U-S-children.php  It looks like there is some sort of an overlap here between what’s happening with these kids and and some of the stuff that you’re talking about. And when I watched your YouTube video where you were talking about autism being possibly related to Tylenol you were talking about the fact that you have to have an oxidative stress on the body which then when you consume acetaminophen at the same time that is sort of a toxic brew that can lead to damage to the brain.  And one of the things that happens with vaccines is that they add these adjuvents, like aluminum, to get the body to react to the vaccine and I wonder if the combination of these kids being exposed to substances like aluminum, which create oxidative stress, in combination with Tylenol can be one of the underlying factors in this increase in autism.  Dr. Parker pointed out that that study was only done with home schooled kids and parents with kids with autism tend to home school their kids. He explained that any form of oxidative stress and inflammation can be a factor in autism, including obesity. Obesity is a highly inflammatory state and results in a 70% increased risk of autism.  I pointed out that since you can’t go to public school in the US , the only population of unvaccinated kids are in the home schooled population, which is why that study used home schooled kids. Dr. Parker pointed out that when older kids with autism use helminths, it can’t fix their social skills but it may help their digestive problems. Helminths may be helpful as preventative agents prior to the onset of autism to regulate their inflammation by providing exercise for their immune system.  Here is Dr. Parker’s YouTube video on acetominophen as a causative factor in autism:  https://youtu.be/oD_opnk4nxU 

48:30  I asked when he speculates that we’ll have the studies to prove efficacy and helminths will be approved so that they can be used in the US for therapy?  Dr. Parker explained that he believes that the market would be huge and nearly every person could benefit from them, but the financial incentives make it difficult. Studies cost tens of millions of dollars and since helminths are biological agents that cannot be patented so it would be difficult to make your money back. And there was already a porcine study that bombed out that we mentioned earlier. Dr. Parker compared it to the fecal transplant which has yet to be approved except recently only for C-Diff infections and yet it was nailed down in 1958 by a group in Denver. 

 

Dr. William Parker can be reached through the Duke University website, https://medschool.duke.edu/about-us/our-faculty/william-parker

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

 

Rational Wellness Podcast 037: Leaky Gut with Dr. Cheryl Burdette

Dr. Cheryl Burdette speaks to Dr. Ben Weitz about how to understand and test for leaky gut, histamine intolerance, and food sensitivities.

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Podcast Details

1:45 I asked Dr. Burdette to explain what leaky gut is and why we should care about it?  Dr. Burdette answered that leaky gut is a key to treating chronic diseases. Inflammation is a key factor in chronic diseases and much inflammation starts in the gut. Dr. Burdette explained that if we stretch out our gut it would cover a tennis court, but it is shoved inside us and has good bacteria and bad bacteria and is our interface with food and the outside environment. When the gut is not interfacing correctly, it can create inflammation, and gut based inflammation creates systemic inflammation and be responsible for fatigue, weight gain, osteoarthritis. By understanding leaky gut, we can better understand how to control inflammation, which will enable us to decrease chronic diseases.

3:48 I pointed out that this gut lining is only one cell thick. Dr. Burdette explains that your gut is trying to do this enormous job and it is one cell thick and it turns over every three days. Your body has to reproduce those cells and if the nutrition is not right and if there is too much of an assault because of bad bacteria it is easy to get behind in your gut health and then you are on your way to inflammation and that inflammation can drive many conditions. We can have inflammation that starts in the gut that we can measure in the blood stream as CRP that tell us about inflammation in the rest of the body and this is a risk factor for heart disease, stroke, etc. You often will not feel this inflammation, so just because you don’t feel gut pain, doesn’t mean that you don’t have gut based inflammation. Gut based inflammation can even contribute to depression, insomnia, as well as gas and bloating.

5:17 I said that our gut barrier is our protection from toxins that are present in our environment, such as heavy metals like mercury, pesticides, and BPA from plastics, etc. So if there is some damage or decreased efficiency of this gut barrier, then that can be a factor in chronic diseases. Dr. Burdette explained that our gut lining is our first interface with the outside world and it is where we absorb nutrients and have the right immune conversation with the outside world or where it becomes disrupted and we get inflammation. It is where we decide we are either tolerant or inflamed. Many people don’t realize that 85% of our immune system lines our gut and the immune system in our gut has to deal with more outside invasion in one day than the systemic immune system sees in our lifetime.

7:00 I mentioned that for years we used to measure gut permeability with the lactulose-mannitol test and after a while I think a lot of Functional Medicine practitioners like myself just came to assume that most patients in modern society seem to have some level of leaky gut. I see that your Dunwoody Labs offers a Intestinal Barrier Function Test that measures zonulin, which is a protein that is a marker for leaky gut, and it also measures histamine and diamine oxidase (DAO) and a couple of other markers. Can you tell us about that test? Dr. Burdette   

 

Dr. Cheryl Burdette can be reached at her clinic, Progressive Medical Center in Atlanta, Georgia   https://www.progressivemedicalcenter.com/staff/burdette/ and you can access her lab testing at Dunwoody Labs   http://www.dunwoodylabs.com/ 

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

Rational Wellness Podcast 036: The Spanish Flu Pandemic with Ken Rosen

Ken Rosen, author of 1919 The Search For Mankind’s Greatest Killer, speaks to Dr. Ben Weitz about the Spanish Influenza pandemic, why it was so deadly, and what we can do to prevent it.  We discussed the Spanish Flu of 1918 and 1919 which affected approximately 500 million people worldwide and killed between 50 and 100 million people, the greatest pandemic in mankind’s history.

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Podcast Details

1:45 I asked Ken what made him decide to write a book about the Spanish Influenza. He explained that he was working as an executive producer for the National Hockey League and wondered why the Stanley Cup trophy was not given out in 1919 and started to research it.

3:42 I asked why this flu affected so many young, healthy folks, as opposed to most flus that mostly affect the old and the young, who have the weakest immune systems? And why was this flu so severe and why did it kill so many people? Ken explained that they did not even know what was wrong with most of these people and they did not have the medical techniques that we have today. Now, looking back, we understand that it was an avian flu and if you look back at history every 100 years or so, this avian flu mutates and creates some kid of epidemic or pandemic. We think that medical science has now reached a level where we think we could control or stop it, but we don’t really know, and we are due for such an epidemic. 

5:20 I asked why bird flu is so unusual and I pointed out that birds are an incredible vector for spreading the flu across the globe. Ken explained how in his book, which is based on real characters and based on history, that Dr. Taubenberger worked with a Russian doctor and they figured out that this flu started in Siberia, which is one of the places that most of the major bird routes originate because of the food and the space. A bird flu is the perfect bioweapon because of how the birds can spread it across the globe by passing it to local birds wherever they migrate through.  The only spot where this flu never reached was New Zealand, because none of the major bird routes pass over or stop at that island. Initially experts thought it was a swine flu but after studying the remains frozen in permafrost 100 years later, Dr. Taubenberger figured out it was a bird flu rather than a swine flu.

9:40 I commented that it is interesting that you have such a devastating flu and then it just ends. Ken explained that it just burned itself out. He pointed out that once it became so destructive that people became sick so fast, that the virus was not really passed from person to person very effectively. People just got very sick and died fairly quickly. Also governments figured out that this virus was airborne so all social life was shut down. Churches, schools, ballgames, etc. were all closed, which stopped the spread. This flu helped to stop World War I since so many troops on both sides were being carted away due to being sick, which led to the discussions over the proposed Versailles treaty where they were trying to end the war. The Versailles treaty was the worst treaty ever put together, according to Ken, since it led to World War II since Germany couldn’t handle all the war reparations. So this virus that only really lasted a few short bursts in 1918 and 1919 had an impact on the world for the next century.

12:00 I asked again why this flu killed so many young healthy, since it is usually infants, the old, and those who are immuno-compromised who are tend to die from the flu?  Ken said that they didn’t really know why. 


 

You can get Ken Rosen’s book through his website, http://www.1919mankind.com/ or through Amazon, https://www.amazon.com/1919-Search-Mankind%C2%92s-Greatest-Killer/dp/1543449794  

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

Rational Wellness Podcast 035: Sleep Hacks with Dr. Ken Redcross

Dr. Ken Redcross talks with Dr. Ben Weitz about sleep hacks and the importance of getting the right type of sleep on a regular basis.

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

 

Podcast Details

1:41 I asked Dr. Redcross how much sleep should everyone get? Dr. Redcross answered that the CDC says that we should be getting 7 hours of sleep per day, but you know how elusive that can be. 

 

Dr. Ken Redcross has a few openings for new patients and he can be reached through his website  http://drredcross.com/ 

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

 

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Rational Wellness Podcast 034: Maximizing Fitness with Nutrition with James LaValle

Pharmacist James LaValle discusses how to maximize your fitness levels by following the optimal nutrition program with Dr. Ben Weitz.

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I started the discussion by asking James LaValle to comment about high intensity forms of exercise, such as Tabatas, which might involve doing high intensity exercise, such as sprinting for 30 seconds to one minute, followed by a 1 minute or longer rest, and the whole workout may take 5 or 10 minutes.  I asked Jim if this is enough exercise to get someone into shape?  James said that while he likes high intensity exercise like Tabatas, it is not enough, esp. not for a type II diabetic or someone who is really overweight. They have to burn it off over a period of time to affect their blood sugar and their cortisol levels. One of the problems is that we need to be careful not to say that everyone should train one way. For people’s different metabolic demands, they will need different programs. James explained that the football player’s nutrition program should be different than the hockey player’s and may have different metabolic demands than the baseball player or the gymnast. But for the average person, you just have to get them moving. They are too sedentary.

3:59 I asked isn’t it the case that just getting them to get up and move around at work and not just sit all day is beneficial. James answered that it’s not ok to just go the gym for 30 minutes per day and be sedentary the other 23 1/2 hours.  We need to be active and move and keep our bodies in the shape that we need to be able to exercise and train.

4:40 I asked if he likes any of these wearable devices that help you track your steps? James said that anything that brings awareness is great, but people tend to burn out using them after a while. He said that the device he likes the most for sleep is the Oura Ring, but some of the other devices are less accurate for tracking sleep. Tracking can be helpful when you are trying to create a new habit.

5:35 I asked what he thinks about monitoring heart rate variability, such as for measuring overtraining in athletes? James explained that heart rate variability is incredibly important because when you lose heart rate variability, you lose vagal tone, which is the balance between your sympathetic and parasympathetic nervous systems. When you lose that balance, your blood vessels stay stiff and you don’t get compensatory relaxation when you need it and you get dizzy upon standing and in the worst case you get POTTS, Postural Orthostatic Tachycardia. For monitoring heart rate variability, he recommends an app called Inner Balance for his patients. Also, if you are sympathetic dominance, then you are catabolic, and muscle is the currency for aging.

7:05 I pointed out that with respect to heart rate variability, you want more heart rate variability, which signals health. James explained that there is a rhythm between the brain and the heart and there is a built in variability in it. When the variability shrinks, that means that the nervous system is miscommunicating with the heart and the neurovascular network. There are strong correlations between performance and also with what you eat and your heart rate variability. 

8:21 I asked if any of the wearables are accurate for heart rate variability?  James explained that if you are going industrial, a lot of the sports teams are using the omega wave. If not, then Interbalance from HeartWave has a real simple device using an ear clip on that’s a medical device and can be helpful.

9:20 I said that I read that James was not a fan of sports drinks. Don’t they help with replenishing electrolytes? James responded that the typical sports drink has a lot of sugar with very little electrolytes. And 

 

James LaValle can be contacted through his website, http://jimlavalle.com/ where you can order his latest book, Cracking the Metabolic Code.       

Dr. Ben Weitz is available for nutrition consultations. Dr. Weitz specializes in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and he also specializes in helping you to reduce 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 033: Nutrition to Improve Athletic Performance with Dr. Tommy Wood

Dr. Tommy Wood discusses with Dr. Ben Weitz how to improve athletic performance through the proper use of nutrition. I asked when you see a professional cyclist or runner, what is the first thing that you will do. Tommy explained that the first thing they will do is have the patient take their subjective questionaire and this can get an idea if the athlete has any particular issues with their health, such as with their gut.  Then they will do a thorough consultation with the client and then they will have the client get some blood, urine, and stool testing, since many of the clients that come to see them have digestive issues. This may be because high intensity and endurance exercise may be very taxing on the gut. Or you may have been overtraining, under sleeping, under eating, etc. and may have made yourself susceptible to whatever came along to populate your gut. Then he and the other coaches at Nourish, Balance, Thrive will intervene with dietary recommendations, supplements, and other lifestyle recommendations.

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4:54 I then asked if he typically sees mostly endurance athletes?  Dr. Wood explained that that’s where the company started, since it was started by Chris Kelly and another doctor who are both pro mountain bike racers. But they have expanded out to all sorts of people after that.

5:55 I asked if he has an athlete who has gut issues, and he is complaining of symptoms of gas or bloating or abdominal discomfort or diarrhea or constipation, what are some of the things that you are looking for and how do you approach it?  Tommy explained that the testing is important. How do you know what’s in there unless you look?  He does a combination of urinary organic acid testing (through Great Plains) and he does both culture (through Doctor’s Data) and pcr stool testing (GI Map through Diagnostic Solutions).  I also asked what are some of the most common gut problems and how does he approach the treatment and does he handle the gut problems first and then go to the athletic performance program or incorporate it into it? Tommy explained that he likes to address the whole person and he will look at sleep, stress, diet quality, the person’s purpose in life, etc. Their performance may be the hook why they came to get help, such as “I want to qualify for the Boston Marathon” or they may be an Olympic athlete who wants to perform as well as they can at the next Olympics. Dr. Moore explained the types of gut problems they tend to see: H. pylori, yeast overgrowth, Claustridium difficile, parasites. They tend to treat using herbal protocols.

10:44 I mentioned that C diff is often a very difficult condition to treat and asked how he treats it? Dr. Wood answered that C diff can be very dangerous and cause toxic megacolon and sometimes you need to go straight to antibiotics. Other times he will use a ketogenic diet, black cumin seed oil, lauricidin, and saccharomyces boulardii.

12:25  I asked about how he manages the  carbohydrate intake in athletes and does he take care to restore depleted glycogen, does he use glycogen loading, the window for replenishing glycogen immediately after exercise? Tommy said that he often tells his clients that they should eat more carbs because his clients tend to be on a low carb/paleo approach already and carbohydrates have become something that we are not supposed to eat any more. And now we are even told that we are not supposed to eat protein because it will activate mTor and IgF1. Some of his clients are not eating enough of anything because they are intermittent fasting, they don’t want to eat too much fat, they are low protein, they don’t want to eat carbs and they are training 20 hours per week. They may be doing low FODMAP, low histamine foods, with autoimmune paleo and intermittent fasting and this just doesn’t work if you are trying to fuel for training. Then their thyroid function goes through the floor and sex hormones go down and they can’t sleep and are anxious all the time.  On the other hand, Dr. Wood does not believe in eating the type and volume of carbohydrate intake that has traditionally been recommended for endurance athletes, such as 2-4 grams of carbohydrates per pound of bodyweight or more of highly refined flours and sugars. He does believe in the targeted application of carbohydrates, such as after an intense training session. He likes to use carbohydrate cycling–something called “sleep low”. You do a high intensity workout in the evening and then you have a low carb/high protein/high fat dinner and the next morning you do a fasted workout of 1-2 hours of lower intensity and then after that you eat a high carbohydrate meal. You have depleted glycogen, you do an aerobic exercise session that activates those pathways like AMPk, mitochondrial genesis, etc. and then you load back up with carbohydrates and you get some of those anabolic pathways and glycogen restoration. This allows you to get those benefits without just overloading on carbs or completely restricting carbs.

16:33 I asked how much carbohydrates he is recommending for say a 170 lbs athlete and what form does he like?  Dr. Wood said he likes to start with a gram per pound of bodyweight or carbohydrates and it can go up 2,3,4 times that if you are doing high volumes of high intensity exercise. He focuses on real foods like sweet potatoes, bananas, rice, other potatoes. I then asked if uses high or low glycemic carbs? Tommy said that it depends. In some clients he will recommend a protein shake with maltodextrins, a high glycemic carb.

18:35 I asked what about using the ketogenic diet with athletes who are essentially fueling with fat. What are some of the advantages and disadvantages of that? Tommy talked about Stephen Phinney and Jeff Volek who wrote The Art and Science of Low Carbohydrate Performance http://www.artandscienceoflowcarb.com/the-art-and-science-of-low-carbohydrate-performance/  and they have done research on this topic. They did a study that looked at how keto adapted athletes use fuel compared to high carb athletesknown as the FASTER study (Fat Adapted Substrate use in Trained Elite Runners). http://www.sciencedirect.com/science/article/pii/S0026049515003340   We know that fuel selection and usage changes on a ketogenic diet but we are not at a point where we can say that that improves performance.  Professor Louise Burke in Australia is running very short term and poorly controlled studies of a ketogenic diet and she shows that it makes the athletes worse. But this is just muddying the waters because such short term studies do not give the athletes time to adapt.  The most recent study that came out of New Zealand that was conducted for ten weeks by Caryn Zinn found that some athletes did well and some did not with a ketogenic diet. Overall performance was neither increased or decreased.   https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0180-0   If you look at some of the famous keto athletes, like Zach Bitter and Sammy Inkinen, when they are doing a long, hard exercise session, they will eat some carbs.  Sammy Inkinen published on his blog that he was doing a very tough mountain bike stage race and when he had a long, hard day on the bike he ate 200-400 grams of carbs afterwards.  The next morning he was still in ketosis, so a ketogenic athletes can still eat some carbs. There are certain things that go on in the gut where a keto diet seems to be beneficial, but other things, such as proteobacteria that secretes endotoxins and the fat seems to increase the translocation of the endotoxin across the gut wall into the circulation. If they have a Bulletproof coffee they will feel really foggy after.  But there are some potential benefits.  When you exercise, you divert blood away from the gut and it is not a great time to ask your gut to digest or absorb some food.  If you are doing very long exercise sessions, someone who is fat adapted, will better utilize stored fat for energy and will not need to fuel as often during exercise. This is easier on the gut. Right after the ride, the blood comes rushing back to the gut and this is also not a great time to shove some food into your system, as some riders will do who may grab some tacos and a beer.

24:33 I said that I spoke to one nutritionist who said that he likes to use a lipid profile to determine how well their body processes different types of fats to see if this is something is working for them.  Dr. Wood said that it depends upon what type of lipid profile you look at.  If you look at an advanced lipid profile, like the True Health Diagnostic lipid profile, and you look at cholesterol absorption and particle size, this might tell you that saturated fats are not good for you because you have an increase in LDL particle number that occurred when you went on a ketogenic diet. On the other hand, some individuals might find that when they go on a ketogenic diet, their LDL goes up, but they tend to get a shift in energy distribution and then the more fat they eat, their LDL goes down because you are transporting fat in chylomicrons rather than in LDL.  If we look at a standard lipid profile, your LDL can go up because you have a chronic infection or because you are hypothyroid.

26:53 I asked what he thinks about supporting the mitochondria for sports performance? I explained that I heard a discussion that Lebron James in the off-season two years ago went paleo/low carb and was training very hard and he got extremely lean and it was thought that this would create increased mitochondrial density. Then when he kicked carbs back in before the start of the season, he could benefit from both increased mitochondrial density and from carb loading. Tommy said he thought this made sense and that you do stimulate your body to produce more mitochondria with ketogenic diet or training fasted and you might reduce inflammation and set yourself up to use carbs better at a later date.  He said that there are some potential discussion points and some people would say that there are certain enzymes that are down-regulated when you are on a low carbohydrate diet which then may prevent your from being able to use carbohydrates later on, such as pyruvate dehydrogenase, which can be measured. Pyruvate dehydrogenase turns pyruvate from glycolysis into acetyl CoA to be used in the Kreb’s cycle in the mitochondria. Some of the discussion of whether ketogenic diets are good or bad for performance is centered on that enzyme. If you spend a long time doing low carbs and not doing any high intensity exercise, you may reduce pyruvate dehydrogenase and then if you eat some carbs, you won’t be able to process them. But if he did some high intensity exercise during that time period [which I’m sure Lebron did], then you may maintain your levels of this enzyme. Tommy said that he recalled seeing Lebron James doing this several years ago and by going low carb and losing excess bodyfat and gaining metabolic adaptations and then going back to eating and training in a more traditional way for basketball, that could be beneficial.

31:20 I asked if there is good data showing that training on low carbs will result in increased mitochondrial density? Tommy said that that had not been established in humans. I next asked if Dr. Wood uses nutritional supplements to support mitochondrial function? He answered that if someone is on a ketogenic diet, they will usually benefit from carnitine, CoQ10, D-ribose, riboflavin (to make FAD) and you can get them as a combined mitochondrial health supplement.

33:22 I asked Tommy about a blog post he wrote where he talked about how people with more muscle live longer and you quoted Mark Rippetoe, who said that more muscular people are harder to kill and more useful in general. I asked Dr. Wood to explain the importance of lifting weights for longevity. Tommy responded that there is a load of data looking at strength such as grip strength, and longevity and those with more strength live longer. And muscle mass also has some benefits as does strength. If you have a large set of quads from doing squats, that is a way to absorb glucose from your blood stream.  If you are stronger it means that you can walk up and down stairs, you can get up and down from the toilet, you can do everything you want to do in life much longer. Art Devaney and Doug McGuff  talk about physiological headroom, which means that there is a difference between what you are capable of doing and what you do every day in your normal life.  Tommy explained that walking up and down stairs and getting up and down from bed, etc. is a very small percentage of what he can do when he goes to the gym and lifts some weights. There is a big difference between what he is capable of doing and what he does in everyday life. So when he is asked to do something, such as stop himself from falling and prevent breaking a hip, he is able to do it.  This is very important for longevity because if someone in their 70s or 80s breaks a hip, there is a 50% risk of death within a year.

36:48 I commented on an article that Dr. Wood wrote entitled Practical Alternatives to Processed Protein Bars, which is a critique of relying on processed foods, but while I thought I would find all these great, healthy snack ideas, Tommy recommended eating a tin of mackerel in tomato sauce, which does not sound very appetizing.  Dr. Moore explained that so many people are taking and advocating taking fish oil, but eating a can of sardines or mackerel is a great alternative to get your omega 3s, along with some calcium and other nutrients. Tommy said, “You just don’t need to be buying Quest bars. You can eat real food.”

 

Dr. Tommy Wood is the Chief Medical Director at Nourish, Balance, Thrive and can be reached through their website for consultations: http://www.nourishbalancethrive.com/   Dr. Tommy also offers an email newsletter.

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