Migraine Headaches with Erin Knight: Rational Wellness Podcast 061

Erin Knight speaks about how to cure migraine headaches with Dr. Ben Weitz.

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Podcast Highlights

3:50  I asked Erin what are some of the more common triggers for migraine headaches?  Her answer is that some of the more common triggers are weather changes, hormones, and food triggers, but she feels that the key to treating migraines is not to focus so much on the triggers, which can change, but to look at the body’s capacity to manage stress, which includes biomechanical stress, mental/emotional stress, and chemical and biological stress.  Figure out how you can reduce your body’s stress load and heal, so you become less sensitive to triggers. We used the barrel or bathtub analogy that the immune is filled to the top and tends to react to lots of things, but if you can pour out some of the barrel, then it won’t be spilling over the top so often and causing symptoms.

6:40  Erin discussed how gut problems can be a factor leading to migraines. They can help to fill up the barrel. Leaky gut can lead to more toxins. Gut problems can lead to nutrient deficiencies. She likes to use the GI Map stool test.

9:41  Erin explained that the most common finding she sees on the GI Map test is elevated H pylori infections, which she addresses with mastic gum supplements and saccromyces boulardi probiotics.   

13:32  Food sensitivities can be an underlying cause of migraines and she likes to do the ALCAT food sensitivity panel.  Almost all of her patients do better when they eliminate gluten for at least three months.

19:01  Hormonal migraines are very common and she does the DUTCH (Dried Urine) test to analyse hormonal status. 

23:58  Chiropractic can address some of the structural issues. Erin explained that there are three prongs to her approach to migraines: 1. mental/emotional stress, 2. biomechanical stress, which can be addressed with chiropractic, and 3. chemical/biochemical stress. Chiropractic can also help if they are under chronic emotional stress by relieving the tension in the muscles. Erin found that chiropractic worked, but she kept having to go back for adjustments weekly till she looked deeper and addressed problems with her gut, with heavy metals, and with liver detoxification and then she was able to hold her adjustments much longer and was able to just go in monthly or unless she fell off her bike.

25:40  What is the ideal diet for migraines? Erin said that she likes her clients to eat whole, organic foods with a lot of vegetables but not to get too stressed out over an overly complicated diet. 

27:33  Should we skip breakfast, which is how many people are now practicing intermittent fasting?  Erin explained that if you are having problems with blood sugar fluctuations, then skipping meals may not be such a good thing. She sees clients who are too busy at work to each lunch and they end up getting a headache from the roller coaster of their blood sugar crashing.

30:20  Magnesium is a very important supplement for migraine patients, since it can help with muscle spasm, sleep and constipation.  Erin prefers to do Micronutrient testing to see what people really need the most.  Test, don’t guess. 

34:23  For those who are looking for the quick fixes for migraines, Erin offers her Quick Fix Checklist for Migraines  Erin can be reached through her website, Engineering Radiance.com


Erin Knight is the founder of Engineering Radiance, believes that no one should miss out on life because of migraine headaches. Erin has her Masters in Pharmaceutical Engineering from the University of Michigan and advanced training in functional nutrition and nutrigenomics. Her website is https://www.engineeringradiance.com/  You can get her free Migraine Relief Checklist to help you with migraines https://www.engineeringradiance.com/migraine-relief-checklist/

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


Podcast Transcripts

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

Hey, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, so more people can find out about the Rational Wellness Podcast. Our topic for today is migraine headaches. This is the first time we’ve talked about headaches in a very common ailment among Americans. Migraines are occurring at the rate of more than three million cases per year in the United States, perhaps more that are undiagnosed. Migraines are typically severe, recurring headaches, usually felt on one side of the head. They’re frequently accompanied by nausea, vomiting, dizziness, sensitivity to light, sensitivity to sounds, and/or sensitivities to smell. A lot of times, there will also be a lack of appetite, and there may be a change of bowel function.

Up to 30% of migraine sufferers experience an aura ahead of time, letting them know that a migraine is coming. An aura is typically a visible, or a sensory, disturbance, such as blurred vision, seeing flickers, or flashes of light, or lights that distort your vision, or wavy or a zigzag vision. There could be pins and needles feeling on one side of the face or one side of the body. You may feel like things are spinning. It’s generally not understood what causes migraines, or how to prevent them. And for traditional medical practitioners, they’re generally treated with pain medication once they start.

However, from a Functional Medicine perspective, we always want to try to find the root causes of problems, and migraines are no different. Which means that we want to find the triggers that will increase the likelihood of a migraine occurring, which usually means that we look for food sensitivities, nutritional deficiencies, heavy metals and other toxins, hormonal imbalances, blood sugar imbalances, et cetera. And these are similar to a set of things that we look at for many different conditions, trying to find those underlying root causes and triggers.

I’m happy that we have Erin Knight here with us today to help sort some of these issues out with migraines. She’s the founder of Engineering Radiance. She believes that no one should miss out on life because of migraine headaches. She has a master’s in pharmaceutical engineering from the University of Michigan, and advanced training in functional nutrition and nutrigenomics.    Erin suffered from debilitating migraines for over a decade before uncovering the underlying biochemical causes. And she went on to reverse engineer what worked for her. This led to the development of her four-step migraine freedom process that’s now a blueprint for thousands of people looking for root cause solutions to their migraine pain. Erin, thank you so much for joining me today.

Erin Knight:       Thank you. It’s an honor.

Dr. Weitz:          Okay. So, Erin, let’s get right to the issue. What do you think are some of the more common triggers for migraine headaches?

Erin Knight:       The things that people are most aware of tend to be things like weather changes, or hormonal migraines, and even food triggers. But, from a more holistic, functional perspective, the way I see it is that your body’s … has a certain capacity for managing stress. The stress can come from … biomechanical stress, mental/emotional stress, and then of course, chemical and biological stress. And if that starts to pile on, then it’s set off by one little thing that just is … the straw that broke the camel’s back, as they say.

Triggers can seem kind of random and frustrating to even track. So, one day somebody might be … just cannot do chocolate. Chocolate puts them over the edge and puts them to bed for a few days. And then, other times, maybe at a different time of the month or a different time in the year, they’re totally fine, and that just tends to make you feel a little crazy if you’re trying to really figure out what your triggers are and just avoid them all of the time.  And if you look at it, instead of the sense of, okay, your body’s under a certain stress load, let’s lower that stress load and then build more resilience to those kinds of things, like weather change or jet lag, that we don’t have as much control over. Then, you can go around life being less sensitive to all those kind of common triggers and the things that people tend to be sensitive to. So, that’s how I work, and what I try to educate people on is really shifting their perspective instead of … chasing triggers or running away from triggers, just help your body heal and be stronger in general, and then you’ll be less sensitive to migraines.

Dr. Weitz:          Sure. I’m sure you’ve probably heard of the barrel metaphor, which is that your immune system is this barrel, and when it’s filled up to the top, any little thing will cause it to spill over, so you empty out part of the bucket by removing different things that stimulate the immune system, and then your body has enough room if there is a trigger or something that stimulates it, so it doesn’t necessarily enter into the point where you have symptoms.

Erin Knight:       Yeah. That’s exactly it. And you mentioned … on the intro that the things that we help people with with migraines are really similar to the same things people would do if they had eczema, or autoimmune issues, or aches and pains and things like that, because really, it’s the same concept. The migraines are just the way that somebody who’s prone to migraines, our body expresses the fact that it’s overburdened and at its limit by having the migraine. Other people’s bodies are just genetically set up to express that through a different route.

Dr. Weitz:          Right. In some of your writings, you mention that digestive issues can be one of the root causes of migraines. Not a surprise from the Functional Medicine perspective. How do you assess and test the digestive system?

Erin Knight:       Any digestive issues will make migraines worse, because they’re filling up that barrel … I call it a bathtub full of stress, in a big way they can impede digestion and absorption, so you end up with nutrient deficiencies. They can be adding to the toxic burden that your liver has to process. If you have a parasite, and its metabolism is producing extra toxins that your body just has to process. And then, on top of that, the different digestive issues can just increase overall gut inflammation, systemic inflammation. So, any … lot of different ways that can go wrong and be a contributor, and we look at that … My favorite test at the moment is called the GI Map. It’s very comprehensive, and we can get markers on people’s enzyme status, how well they’re breaking down their food, gut inflammation, as well as looking for different bacterial balance, or infections, like H pylori, or parasites and things like that.  So, it’s a lot of information and a lot of starting points. I haven’t found anyone yet that didn’t have something to work on. If somebody’s not feeling well, then they probably can trace it back to the gut, and that’s a good place to start for any investigation. We really recommend that. Everybody does that.

Dr. Weitz:          We’ve been using that test a lot lately, also. And I interviewed Dr. David Brady [who helped create the GI Map test] about a month ago, and we discussed some of the parameters involved in designing that test, so I find that very helpful. What about SIBO? Do you find SIBO as an underlying factor in some migraines?

Erin Knight:       Some, yes. Not as much. Just more like, if we’re not getting anywhere, or if somebody has obvious bloating issues or obvious symptoms, then we would talk about that. But, not necessarily the first thing to look at. But, gut health is a interestingly … it’s kind of a vicious cycle with migraines, because it may or may not have been the initial trigger, but if somebody’s had migraines for years or even decades, they might have been put on birth control to manage hormonal migraines, or they’re taking lots of lots Ibuprofen, like I did, and both of those are really destructive to our gut integrity and gut health, and it sets us up for more gut problems because we don’t have the same strong mucosal barrier, and healthy gut balance and things like that, that somebody should have, so then we’re more prone to getting infections, too.

I don’t think in conventional medicine, gut health is addressed very much for migraines. It may not be acknowledged, but it’s definitely our starting point. And what helps people realize that there’s more to the story, and that they have some room to heal.

Dr. Weitz:          So, why don’t you give me a few examples of a few recent patients that you’ve worked with with migraine headaches, and you did the GI map, and what did you find and how did you address it?

Erin Knight:       H pylori is pretty common. Like, maybe 50% of people will have that, and that impedes your digestion of your food, so it can lead to nutrient deficiencies and things like that. So, sometimes people with migraines are aware that they might be deficient in B vitamins, or magnesium, or this and that. But to backtrack, where do those deficiencies come from? If you have an overgrowth … So, H pylori is pretty common, and people argue whether it’s normal or not, but if it’s an active overgrowth, then it’s going to be eating … feeding on your stomach acid, if you will, and reducing that stomach acid’s availability to then digest your food, so that’s how it can impact that. And people always have the choice to take that information and go to their GI doctor, primary doctor, or we can talk with them about an herbal protocol to address that.

Dr. Weitz:          What kind of herbal protocol? Would you mind telling us?

Erin Knight:       So, kind of a first line of defense is I like to use mastic gum, and try to heal up the gut. Or sorry, the stomach mucosal barrier and things like that, and then also use probiotics like Saccharomyces boulardii, and things like that, at the same time. And then, if somebody’s not getting better, which happens occasionally, then sometimes the H pylori could be linked to heavy metals. So, we have to look a little bit deeper. If somebody’s had some dental work, or some kind of known exposure, or genetic impairment to their detox pathways and things like that, and that … if somebody’s fighting this H pylori, and it’s not getting better, not getting better, then we look … layer two. Or three or four, would be a detoxification and see what’s going on there.

Dr. Weitz:          How will you assess for heavy metals if you suspect them?

Erin Knight:       So, it’s not the first thing that I would do with somebody, but sometimes you do see … there are kind of obvious things, where somebody had got dramatically worse. Or even, their migraines just started a few months after having dental work. Or sometimes having their amalgam fillings removed, and then you’re like, hmm, we should talk about this.  But, before even testing, ’cause there’s so many different ways to test, and none of them are really considered perfect, and then when you find that information, what are you gonna do about it? So, my first line of defense with really anybody is just work on gentle detoxification, and opening up the natural pathways, and supporting the body. That could be … There’s a whole lot of things. This is a core part of our program that we work on with people, but things like moving their limbs, making sure their bowel movements are regular, sweating, dry skin brushing, so you have to pay attention to our largest organ, which is the skin. Taking binders, correcting mineral deficiencies. So, there are a lot of things you can do to just help the body work better, basically, and do its own job better. I would rather do that than do some harsh, actively detoxification protocol.  If somebody’s not responding, we have to look at that, then we can do … provoked urine test, or a hair test, and find something out. If somebody does have a really major issue, then I would connect them with a heavy metal specialist, because it can get pretty tricky to do that safely.

Dr. Weitz:          Okay, cool. You say that food sensitivities can be triggers for migraines, and we’ve heard that certainly before. What types of food sensitivities do you find most commonly, and how do you test or screen for these?

Erin Knight:       So, somebody’s listening right now and they have migraines, are probably more than aware of the migraine trigger food list. Like, processed meats, chocolate, red wine and those kind of things, and that’s not really what I’m talking about. They might actually find that they feel better if they avoid some of those foods, and some of them are just downright unhealthy, like MSG and things like that. They should probably all avoid MSG, but when I’m talking about food sensitivities, I’m talking about undigested proteins that are entering your bloodstream through your gut when they really should not, and then they create an immune response, ’cause your body’s like, “You don’t belong here. We’re gonna react to you.”

So, this wouldn’t normally happen because the gut is designed to really just absorb the smallest molecules and keep out larger ones, but if it’s been damaged by pesticides, by stress, or medications over years and years, then somebody’s gonna be more prone to this type of food sensitivity issue, and they could be getting chronic inflammation from reactions to even healthy foods, like chicken or broccoli, and things that aren’t on the typical migraine trigger list.  And this is especially helpful, I think, if somebody has several migraines a week, or even daily headaches. Because that just means your body’s super inflamed, and we want to do anything that we can to lower it. Wouldn’t do it with everybody, but if somebody’s really chronic like that, then we could discuss and see if they think it would be something that they could integrate and actually make use of. It’s a blood test, so it’s quick and easy to find out what’s going on, and all it requires is somebody change up their diet for a few months. So, sometimes people have some hesitation around testing ’cause they think that they’re gonna get this life sentence where they can’t eat their favorite foods and things like that, which it’s not what it is. It’s just trying to lower the inflammation and let your body heal.

Dr. Weitz:          So, which food sensitivity panel do you like to use?

Erin Knight:       I like the ALCAT test. Sometimes a LEAP MRT, depending on what people have access to.

Dr. Weitz:          Okay. I was just reading about two classifications of diabetes drugs, and they actually work by blocking certain enzymes to keep your body from absorbing carbohydrates. And one of those enzymes is the enzyme that allows you to digest gluten. So, we actually have patients who are gonna have an increased risk of gluten sensitivity as a result of taking one of the new classifications of diabetes medications. So, we talked about medications that can mess things up, but that’s just another example.

Erin Knight:       Yeah. Since you mentioned gluten, a lot of people do feel better if they avoid gluten and dairy. You can do some testing for that, if you need to see it on paper, or you can just try it for a few months and see if you feel better. I know sometimes people don’t want to hear that, ’cause it’s a major lifestyle factor. But, I don’t think anyone died from not eating pasta for three months, so it’s worth a shot and see if it helps calm that inflammation and you feel better.

Dr. Weitz:         What percentage of patients… what just happened?  Little bit of a technical glitch. There we go. Okay. Okay.

                          Okay, good. You can hear me now?

Erin Knight:       I can hear you now.

Dr. Weitz:          What percentage of your patients do you think do better when they avoid gluten?

Erin Knight:       Almost everyone. We do get a small indicator of that on the GI map, which can be motivating for people that have some hesitation to try it. But then, once they do, if they stick to it, they … that’ll be one of the top things that really helps them, and then that they end up sticking with because they found that it was a game changer.  So, one thing that can go wrong there though is, some people think that, “Oh, I’m just gonna reduce gluten.” So, they’ll just have less. Or maybe just have it once a week or something like that. That is pretty much pointless, because the gluten is so irritating for people that are sensitive to it that it takes weeks if not months to recover from one tiny exposure. So, if you’re gonna do it, give it a real shot. Give it a real shot at working to know if it’s gonna work for you or not. And then, you can always try later, if you don’t believe me. You can try it in three months and see how you’re doing. But, if you have never given it a 100% effort and 100% elimination, then you don’t know if it’s gonna help or not.

Dr. Weitz:          You wrote that hormones can be out of balance, and that this can be a factor in migraines. What types of hormones do you typically see as being a factor of migraines, and how do you assess and treat these?

Erin Knight:       Right. So, hormonal migraines are very common, and this is one of the things that people tend to be really aware of. They’ll know, for example, that their migraines are correlating with their cycle, or that their migraines either got better or worse during pregnancy. But then, I’ll hear some crazy things like, “Well, they’ll get better eventually, when I get menopause.” Or, people go then to try to suppress all their hormones with birth control and things like that as a solution. But, I really hope to convey and let people know that there’s more that you can actually do.

What a common imbalance would be, and probably the most common, is estrogen dominance, which can either be too much estrogen or just relatively more estrogen than progesterone. So, low progesterone, which can be low from chronic stress and things like that.  So, we can look at that really easily with at-home urine test called the DUTCH test. It’s a dried urine test that lets us look at, in a lot of detail, how your estrogens and other hormones are metabolized and processed through the body. So, we can see if it’s phase one liver detoxification that’s going wrong, or phase two. The methylation problems, and all this kind of things, can help us figure out, then, how to support the body’s natural hormone balance. Like supporting the liver, or looking more heavy metals and things like that, instead of just trying to tune, and play around, or fix your hormones with hormone replacement or birth control and things like that. We can actually figure out why they were off in the first place. And this can be something have been dealing with their entire lives, and they didn’t even know it was an option. So, I really … I’m excited to talk about the DUTCH test and all the information you can get.  Is that something that you guys use also?

Dr. Weitz:         You know, I haven’t. I’ve been mostly testing hormones either with blood, or 24-hour urine, and done a little bit of saliva. I haven’t done the DUTCH test. But you’re really happy with the results you’re getting?

Erin Knight:      Yeah. You can really … you can really get in there. I’ll show you sometime, if you want to look at an example, and it’s fascinating also, the things that I would have missed on a saliva test that I find out on the dried urine test. It’s really been around for a few years, I think. As things evolve, we’re able to help people be even more specific with their protocols, and more holistic with this testing.

Dr. Weitz:         Right. I know other urine testing, you can get the metabolites, you can tell about the estrogen metabolism, which is really important. And then, because you can easily get different measurements at different times of the day, maybe it tells you about some of the fluctuations that occur?

Erin Knight:      Yeah. The measurements throughout the day are especially helpful for the stress hormones, like cortisol and cortisone. Which, in functional training, that’s one of the core topics, ’cause we say, everybody has this stress hormone issue. But, not as much for migraine people. That’s not the most common thing that I see people dealing with. Occasionally, some adrenal issues or what have you, but mostly it’s more in the sex hormones.

Dr. Weitz:         And what is the issue that you see most commonly with migraines and sex hormones?

Erin Knight:      There’ll be clues that … For example, if the estrogens aren’t clearing well, then we have to question why. And, if the liver’s busy detoxifying other things in our environmental pollution.   Or toxins and toxic products in the household, or beauty products, or whatever else. Or, from parasites. Then, it’s not as capable of processing the estrogens correctly. Or even alcohol can slow down that process, ’cause you’re body’s like, oh, I’m always gonna prioritize the alcohol, and it puts estrogen on the back burner. So, it can help bring to the forefront the importance of cleaning up some of those common-sense things. But, once you see it in front of you, how it’s affecting you, how this plays a role even in cell health. Long-term avoiding cancer and things like this. So, I test myself regularly, even though I’m not getting migraines anymore, just because I want to have that all working and balanced, just give myself the best chance for healthy aging. Avoiding problems and having a smooth transition as my hormones change over the years and things like that. So, I think being proactive, it’s a good thing to take a look at.

Dr. Weitz:         Interesting. As a chiropractor, we’ve treated plenty of patients with migraines. Some with great success, and others not quite as much. And we’re using a structural approach. We’re particularly focusing on the joints in the upper part of the neck, and those suboccipital muscles that connect directly to the dura mater, and have you found structural issues to be a factor in migraine patients?

Erin Knight:      Of course. That’s one of the three prongs, if you will. There’s mental/emotional stress, biomechanical stress, and then this chemical/biochemical stress. So, by the time somebody comes and talks to me, they’ve probably already seen a chiropractor, but if they haven’t, then I highly encourage that they go see one. And it can be a great tool to either fix them completely, if it was maybe some kind of a structural issue to begin with, or car accident, or whatever else. Or, a relief, too. If somebody’s under this kind of chronic stress, then you can be out of alignment more often, which is my experience. I found that chiropractic helped a lot. But, I have to go regularly. I would go every month for probably close to 10 years. And my chiropractors would get frustrated with me, and then the insurance just stopped paying, and they’re like, “Why don’t you get any better?”  And it wasn’t until that I really looked deeper in the gut health, and supporting my liver, and getting rid of heavy metals and things like that, that I was able to hold alignment for months, or just go in occasionally for maintenance or if I fell off my bike or something like that. Which I think is how it’s intended to work. I mean, you tell me, is that … That’s kind of the goal of chiropractic, right? Is to get somebody where they can hold an alignment for a few months.

Dr. Weitz:         For sure. What do you consider the best, most healthy diet? I don’t know if there’s an ideal anti-migraine diet. But, what do you consider in the range of all these healthy diets out there, or is it depend on each person? I’m sure it’s gonna be some variance, but … among the healthy diets, do you tend to promote a vegetarian diet, or a Paleo, or a ketogenic, or what?

Erin Knight:      Well, I’m glad you asked that. ‘Cause there’s a lot of arguing back and forth about different diet philosophies, but it really doesn’t need to be that complicated, in my opinion. I think the best thing is just to go really simple. Eat whole foods, eat organic with lots of veggies. Like, veggies in the forefront and then whatever else you add. And sometimes people, especially it seems like people with chronic problems like migraines are desperate, so they go reading on the internet, and go finding healthiest complicated detailed diets, and that causes them more stress than I think it even helps. Like sure, some of them can be really healing in some sense, but if it’s causing you so much stress on a daily basis, you’re gonna have to weigh that.

And it doesn’t have to be that complicated, because a really healthy diet can be simple and delicious. So, that’s my philosophy, as some people need more fat, some people need more protein and all that kind of thing, is a little bit individual in what we work with people on, is to really tune in to how they’re feeling with different ratios. Even different timing of meals and things like that, and starting to listen to clues like your energy level. Not just headaches, but your energy level, your sleep, your focus at work, how your stomach feels, and once you start to really listen to that, I think it … will give you the motivation and the feedback to find what works for you.

Dr. Weitz:         What about the timing of meals?

Erin Knight:      Yeah. What about it?

Dr. Weitz:         I don’t know. We’re hearing so much these days about the timing of meals. You know, we went from you should eat every three hours, you have to eat as soon as you get up. The most important thing, you have to eat breakfast. Everybody skips breakfast. And now, we’re back to skipping breakfast is the best thing you can do. So, what about the timing of meals?

Erin Knight:      I do find that kind of entertaining, because … I wonder if … I’ve done that a little bit more recently, and I’m like, why?

Dr. Weitz:         30 years ago.

Erin Knight:      I save so much time.

Dr. Weitz:         When I first got into this, you have to eat breakfast. That’s why you’re fat, you’re skipping breakfast. Now, the key to anti-aging is skipping breakfast.

Erin Knight:      I know, and it saves you hours a day, and increases your productivity ’cause you don’t waste time making breakfast. But, in seriousness, I talk to people first and see … ‘Cause there’s a big portion of people who find that blood sugar crashing will cause their migraines. And if they’re in that cycle of unstable blood sugar, and we’re trying to heal some of the reasons for that, which again, go back to your liver, and hormones, and stress and all that stuff. So, if they’re still in that healing phase where all that’s unsteady, then I wouldn’t really push to skip meals, because I would rather just get it under control.

What I do see as an even more common a problem is people are so busy with work, they forget to each lunch. I used to do that. You’re so busy, you forget to eat lunch. You’re working at your desk, or in the lab, and then it’s like three o’clock, and all of a sudden it’s … that just brings on the headache freight train. So, kind of being conscious of taking care of yourself is layer one. And if you’ve got everything under control, you want to go to phase two and look into intermittent fasting or all these more advanced things, then go for it. We can talk about that. But I think layer one is just making sure somebody’s getting the nutrients that they need out of whole, healthy foods, and avoiding that roller coaster of … blood sugar crashing, which it sounds so simple to people, probably, that are living in this health bubble, but I still talk to people too that think having a granola bar or a banana as a snack is a good idea, but the fact is, something like that could really spike your sugar for a little bit, and then it will crash again. So, we spend more time talking to people about having well-balanced snacks with fat and protein, or even a mini meal instead of worrying about whether or not they should try intermittent fasting. That’s later. Let’s worry about the basics first, in almost every case.

Dr. Weitz:         So, what are your three or five favorite supplements for migraine headaches?

Erin Knight:      Magnesium is a big one. Sometimes, I have people write me. They write about magnesium, or heard me talk about that, and they’re fine now. So, they just wrote in for my newsletter, and they’re like, “Well, I followed your advice, and now I don’t have migraines anymore.” I’m like, that is so fantastic that it was so simple.

Dr. Weitz:         That’s great.

Erin Knight:      It’s really bad for business, but it’s really good for you. So, that’s probably number one.

Dr. Weitz:         I can say, not too many of my functional medicine patients come in, I give them magnesium, they say, “I’m all better,” and that’s it. I wish it was that easy.

Erin Knight:      But, yeah. Yeah, definitely not always, but sometimes it is. And the thing is, we’re just chronically deficient, and it solves a lot of issues with muscle tension, sleep, and helps people sometimes if they’re constipated, which leads to this toxic stuff circulating in your body. So, it helps with a lot of different things, and a lot of the different root causes.  After that, I would just tell somebody to … Sorry to do more testing, but I would tell somebody to test, don’t guess. Because otherwise, you can waste a lot of money on different supplements and trial and error to find something that’s working for you, and the stuff that works for quote-unquote “all migraine people,” like B vitamins and things like that … When I look at people’s SpectraCell Micronutrient reports, they will have … everybody has a different pattern. And I don’t think it’s … I think it’s kind of a waste of time to try to throw supplements at the problem, instead of figuring out what they are.

Dr. Weitz:         So, you prefer SpectraCell Micronutrient versus Genova NutrEval?

Erin Knight:      That’s good, too. It depends where somebody lives. ‘Cause the SpectraCell’s only in the US, as far as I know.

Dr. Weitz:         Oh.

Erin Knight:      In Australia and stuff like that, then the NutrEval. But, I think that one is a little pricier.

Dr. Weitz:         It depends.

Erin Knight:      Yeah.

Dr. Weitz:         If they have insurance that qualifies, it’s about 200 bucks.

Erin Knight:      Okay. Yeah. But, anyway, the point is just to look at your nutrient status, and then you can fill that gaps, ’cause … CoQ 10 is another example that’s recommended a lot of times, and can be very effective for people. But, the amount I test and find that you’re not deficient in that at all, then you can save your money that you were gonna spend on that and work on something else instead.

Dr. Weitz:         There you go. Okay. I think those are the questions that I had prepared. Do you have any other pearls of wisdom for migraine headache sufferers? Or for practitioners dealing with patients with migraines?

Erin Knight:      I’m curious to hear from your end too, because we were starting to talk about chiropractic a little bit, but … Since you’re doing both the functional approach and the chiropractic approach, do you find that there are all those people that don’t really get better until they address the underlying issues with their gut health, and hormones, and things like that?

Dr. Weitz:         Oh, sure.

Erin Knight:      Then it’s the magic switch, or?

Dr. Weitz:         I would say, of the patients that I see chiropractically for migraines, probably half of them get significant relief, but then of those, maybe half of them, just the chiropractic alone is enough. The other half are gonna need some sort of nutritional intervention, and then the other half of the patients who don’t respond to chiropractic, most of those will respond to some sort of nutritional intervention if they’re willing to hang in there and go through some experimentation. A lot of them want the quick fix, which when you deal with Functional Medicine, takes a little bit of time to sort things out.

Erin Knight:      It does. It does. We get that all the time. ‘Cause we’re so used to getting medications for migraines, and if somebody really wants to look at the root causes, it takes several months if not longer. But, if somebody is looking for the quick fixes, I have a gift I could share with them. Is that okay?

Dr. Weitz:         Yeah, of course.

Erin Knight:      It’s called the Migraine Relief Checklist. And maybe you can put that in the notes, or if you just click on my website you can find it. https://www.engineeringradiance.com/migraine-relief-checklist/  Erin’s website is https://www.engineeringradiance.com/

Dr. Weitz:         Yeah. Sure, I will. Sure.

Erin Knight:      It’s called the [inaudible 00:34:38] the fastest, most natural things that somebody can do. And it works best if you layer it. So, we have a whole principle thing that walks you through. So, if somebody having a migraine, or doesn’t feel very well … I don’t know about you, but when I don’t feel well, I just kind of lay there on the couch. And I don’t even want to think about what I should be doing. I don’t even drink water, unless I have it written out for me. So basically, it’s like, when you don’t feel good, you grab this, and then you don’t have to think so hard about what to do. You just follow the instructions. So, that’s the idea behind it.

But, we have essential oils, meditation tracks, and different things that work if you’re layering them. And, it’s very interesting. Usually, people need to get four or five working for them. Pick four or five, and trial and error them. But, that combination is what will be able to shut off a migraine, believe it or not. Just from natural things like that. So, it’s really … I love hearing the stories of what works for people, and what their combination is. But that’s the quick fix. I still want people to find the root causes, and heal their bodies so that they can live a long, healthy, happy life. But, in the meantime, there’s plenty of natural alternatives to support their nervous system and calm that down, and really stop a migraine before it gets out of hand. So, that’s my gift if somebody listening has migraines.

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

Erin Knight:       Okay.

Dr. Weitz:          For joining me today. And, I’ll talk to you soon.

Erin Knight:       Thank you.

Inflammatory Bowel Disease with Dr. Sam Rahbar: Rational Wellness Podcast 60

Dr. Sam Rahbar talks about treating Inflammatory Bowel Disease patients with Dr. Ben Weitz.

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


Podcast Highlights

0:50  I introduced the topic–Inflammatory Bowel Disease–and reviewed some of the basics of Crohn’s and Ulcerative colitis, the two most common conditions in this category.

4:12  I asked Dr. Rahbar what would make him suspect Inflammatory Bowel Disease (IBD) in a patient?  Answer: 1. GI symptoms for more than 2 wks,   2. abdominal pain,  3. diarrhea,  4. bloody stools,  5. secondary symptoms could include uveitis, skin problems, joint pain, back pain,  6. elevated inflammatory markers on lab tests, including an elevated HsCRP, SED rate, or an elevated white count. 

5:34   Examination should include colonoscopy plus endoscopy and/or imaging or a combination of the above.  Dr. Rahbar explained that a colonoscopy should include the physician entering the terminal ileum to look for evidence of inflammation. Some cases of Crohn;s may be limited to the small intestine, requiring capture endscopy or additional imaging studies, such as MRI enterography or a CT scan.

6:33  While symptoms of IBD are similar to IBS, IBD patients have physical damage to the lining of their intestines, whereas with IBS there is no physical damage.

11:28  I asked Dr. Rahbar what type of diet is best for patients with Inflammatory Bowel Disease? He said that he likes the Specific Carbohydrate Diet, though he will individualize the diet for each person. He has used SCD, Low FODMAP, and gluten free. The Specific Carbohydrate Diet, which can be helpful since there are a variety of carbohydrates that tend to promote inflammation in the gut, but it also tends to deplete the patient of vitamins and probiotics, which can negatively impact the microbiome, so they should be augmented with additional supplements to maintain balance in the body. Some of his patients have done well with a ketogenic diet, though he doesn’t like them to eat a lot of meat, which can also be inflammatory. Dr. Rahbar likes to do food sensitivity testing to see which foods to avoid for each to individualize the diet. He also looks for infections and fungal overgrowth and may treat them at the same time. But if you limit carbs too much, the patient may become depressed. 

16:50  The Elemental Diet can be helpful for a few weeks, sometimes for patients who haven’t responded to other approaches.

18:08  Check for infections such as SIBO or yeast overgrowth and clearing these out with with antimicrobials or antifungal herbs can help. 

18:40  I asked Dr/ Rahbar if he finds any nutritional supplements to be of benefit?  He said that if he feels the patients are not breaking down their proteins, he may add amino acids. He often uses oral immunoglobulins, which can help with surface healing. He has used a peptide PBC 157, which is very helpful, and is administered orally. He frequently uses zinc carnosine, omega three fatty acids, vitamin A, vitamin D, multivitamins, and anything that will improve surface healing of the gut lining.  He may use micronutrient testing to see which nutrients are most needed.  Curcumin, esp. liposomal form, at 3-5 gm per day can be helpful in reducing the inflammation. 

26:23  I asked Dr. Rahbar if he has ever tried helminth therapy–the use of parasitic worms therapeutically?  He is not yet comfortable with this therapy and would like to see more research on it. He is worried that in some of these immuno-compromised patients that the worms may take off and overgrow. 

27:43  I also asked him about Fecal Microbial Transplant (FMT) and he said that the research data is there and strong, but that with patients with Crohn’s, in order to get them into the terminal ileum, they will need to be ingested orally and not just implanted rectally. While one FMT may be helpful for C-diffocele infection, for Crohn’s it will probably have to be an ongoing set of FMTs to be effective. 

32:01  Stress is a modifier of the inflammatory response and weakens the immune system, resulting in both the immune system attacking the body’s own tissues but being less able to fight off infections.  The immune system ends up being dysregulated. Dr. Rahbar cited an article from the CDC that noted that IBD patients tend not to get enough exercise or enough sleep. Here is a reference on IBD and sleep: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995194/  Dr. Rahbar mentioned that exposure to mold, heavy metals, and tick borne illness can all play a role in inflammation and immune dysregulation.  Dr. Rahbar explained that some patients are harboring low grade, stealth infections. This is different than our classic understanding of infections and violates Koch’s postulate that one bug causes one illness. What we see in such cases are a variety of low level infections that could be bacterial, viral, or fungal and they work together in the background to keep the host busy and causes the immune system to be dysregulated and may result in various mild symptoms like allergies, skin problem, rashes, hives, itching, irritation, problems with sleep, joint problems, and energy issues. Essentially, such stealth infections can be triggers for autoimmune diseases.



Dr. Sam Rahbar is an Integrative Gastroenterologist in Century City combining conventional gastroenterology, performing colonoscopies, endoscopies, and Heidelberg pH testing, but incorporating anti-aging and Functional Medicine into his unique treatment approach. He can be contacted thru his website http://www.laintegrativegi.com/ or by calling his office 310.289.8000.  

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


Podcast Transcripts

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

Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy the Rational Wellness podcast, please give us a ratings or review on iTunes so more people can find Rational Wellness podcast.

Our topic for today is Inflammatory Bowel Disorders. This is a very important topic. This is a very serious set of gastrointestinal conditions and if it’s not treated properly, this is a set of conditions that can sometimes require extreme surgery. People can even die from this set of conditions. So this is a very important topic to cover, and we’re going to be focused on trying to understand it from a Functional Medicine perspective, as we usually do.

So within the inflammatory bowel disorder topic, we have Crohn’s and Ulcerative colitis, which are the two most common conditions in that category. There’s a few less common inflammatory bowel conditions, including microscopic colitis. Inflammatory bowel disease or disorder is characterized by chronic inflammation of the gastrointestinal tract that means the lining from the esophagus all the way down to the colon and it leads to damage to the mucosal lining of this digestive tract.

Crohn’s disease can effect any part of the GI tract including the mouth, the esophagus, the stomach, and the anus. But most often if that’s the portion of the small intestine closest to the large intestine and there tend to be patchy areas of damage and this damage may reach through multiple layers of the intestinal wall.

Ulcerative colitis, in contrast, occurs only in the large intestine, the colon, and the rectum. Damaged areas typically are continuous and this usually starts at the rectum and spreads into the colon. It’s usually present in only the inner most lining of the colon.

Symptoms of inflammatory bowel disorders include persistent diarrhea, abdominal pain and cramping, bloody stools, weight loss, fatigue, among others. Anemia and other nutritional deficiencies are common with this disorder. The main stays of conventional medical treatment for inflammatory bowel disorders include immunosuppressant drugs including the newer biological drugs like Humira and Remicade, and surgical resection in severe cases. That’s where they’re actually removing part of the intestines or the colon. Some experimental treatments include fecal microbiol transplant, helminth or worm therapy, and cannabis.

I’m so happy to have an interview today with Dr. Farshid Sam Rahbar, integrative gastroenterologist in Century City. Dr. Rahbar is one of the smartest guys around and he performs endoscopy and colonoscopy like traditional gastrointestinal doctors, but he also incorporates anti aging and functional medicine for a integrative, holistic approach to digestive care.

Dr. Weitz:            Dr. Rahbar, thank you so much for joining me today.

Dr. Rahbar:         Thank you. Thank you for this invitation and greetings to your audience.

Dr. Weitz:            Great. So when you get a patient, what would make you suspect that they might have an inflammatory bowel disorder?

Dr. Rahbar:         First of all, if the duration of symptoms have gone for more than two weeks, one has to be suspicious. The main symptoms are abdominal pain, diarrhea and blood in the stool. Obviously there could be other symptoms, but then there could be a second category of symptoms called non-digestive symptoms. Sometimes an eye related issue such as uveitis or a skin problem or joints or low back pain. Something else may be the primary manifestation, depending upon the genetic disposition of the individual. Occasionally we’re just dealing with some abnormal labs or something that suggests there are markers are inflammation or immune dysregulation and we would like to look and see if the patient’s suffering from an inflammatory bowel disease.

Dr. Weitz:            What would be some of those markers on labs that you might see?

Dr. Rahbar:         The common one is usually a C-reactive protein or a highly C-reactive protein. It may be an elevated white cell count or a SED rate. I mean, it could be common ones that we use to look for evidence of inflammation internally.

Dr. Weitz:            Okay. Great. So then how would you work that patient up if you suspect them of having potentially an inflammatory bowel disorder?

Dr. Rahbar:         Obviously at one point the patient would require anatomical assessment either in the form of an endoscopy and colonoscopy or imaging or a combination of these. If one does a colonoscopy, particularly in corelation to Crohn’s disease, then the physician tries to intubate or enter the very end of the small bowel called term terminal ileum to see if there’s any evidence of inflammation there. However, with Crohn’s in some rare cases the scenario of inflammation may be limited to the small bowel. In those cases, additional imaging and studies, such as a capture endoscopy or MRI enterography, or a CT scan with an imaging emphasis on the small bowel maybe necessary.

Dr. Weitz:            Some of the symptoms of inflammatory bowel disorders are similar to some functional bowel conditions like IBS. But the big difference is there’s actually physical damage to the intestinal tract in inflammatory bowel disorder and not in irritable bowel syndrome.

Dr. Rahbar:         Exactly. I mean, generally there’s anatomical changes and pathology and that suggests that there is an inflammatory bowel disease going on as opposed to irritable bowel syndrome.

Dr. Weitz:            So how do you apply a functional medicine approach to such patients?

Dr. Rahbar:         Right. There are few things to review here. First of all, when we talk about a functional medicine approach, it really refers to the mindset of the physician who’s handling the clinical picture. We like to believe that a functional medicine model will entail a scenario that the mindset of the physician involves the whole body approach. One may want to look at evidence of a nutritional status, micronutrient deficiencies, ability of the individual to detoxify, the relationship with the environment. Do they live close to a farm? Do they live in a mobile area where they might have been exposed to mycotoxins, or perhaps some suboptimal eating habits, fast eating too much, too late, high carbohydrates or eating barbecue and charred type of foods, which all increase the oxidative stress burden to the body. There’s also mind and body connection that effects the stress, which is tremendously important. At last, but not least, the integrity of the intestine itself, particularly small bowel, which had this in our practice and it’s an area of emphasis because we look for and we try to treat for a condition called increased intestinal permeability or what they call the so called leaky gut type problem. The idea would be if one can work on that model, can you reduce the overall inflammatory process in the person and help reduce their symptoms.

Now, having said that, I want to emphasize one thing that in our practice we still are integrative and we look at the spectrum of the illness. I have patients who have mild disease or moderate disease or more severe. I had one patient one day come in with abdominal pain and fever, had significant tenderness in the abdomen and he said, “Can you do a holistic approach for me?” The answer is, “No, you’re going to go to the hospital. They have to do antibiotics and steroids to calm down the severity of the problem.” When we’re running into the zone of the mild to moderate activity, we can rely on those alternative and integrative approaches to control the problem as opposed to relying, for example, on biological drugs and so forth.

Dr. Weitz:            Right. I think the important point for everybody to consider is that when we talk about the advantages of Functional Medicine in treating certain conditions, we’re not promoting Functional Medicine as an alternative to traditional medicine. Traditional medicine has great benefits, especially when somebody has an acute condition. You talk about the patient who’s having an acute attack of an inflammatory bowel disorder with fever, that’s when Western traditional medicine is really at it’s best. The problem is is that when you try to apply that acute care using these steroids and these other medications that can be very helpful in these acute situations and have patients continue taking them for months and years on end, when you have all these horrible side effects.

So I think it’s great that there’s somebody like you out there who can integrate both the acute model of traditional care and then maybe that patient who’s suffering from an acute aspect level of inflammatory bowel but maybe after he gets calmed down, then you can start looking at a Functional Medicine approach, try to find some of the triggers for the inflammation, and give him an alternative to simply being on these very harsh drugs the rest of their lives.

Dr. Rahbar:         Exactly.

Dr. Weitz:            So what type of dietary approaches do you find can be helpful in inflammatory bowel disorders?

Dr. Rahbar:         Obviously one model of diet would not fit all. Like anything else, the dietary changes may have their own benefits or drawbacks and one has to be careful with that. I do believe in similar traditional experience of a lot of our patients using a Specific Carbohydrate Diet without to this … At some point and time bring down the inflammatory process. It appears that the inflammation tends to get aggravated by a variety of carbohydrates. If you use carbs that are extremely simple for digestive process it’ll have less impact on the inflammatory process. However, if one, for example, stays on a specific carbohydrate diet which was defined some years ago. One on the other hand may get depleted of vitamins and prebiotics and other things that maybe necessary to keep the microbiome in good shape. So we may have to either augment with additional supplements or foods to be able to keep the balance going, if you will.

Dr. Weitz:            There seems to be a wide range of different dietary approaches. There’s one hospital that recommends a low fiber diet and they have the patient eating white bread and white rice. The Specific Carbohydrate Diet that absolutely recommends avoiding all grains. So how do we figure out what type of dietary approach makes the most sense and for any individual patient?

Dr. Rahbar:         There may not be an exact formula to follow, and I think each patient might have to individualize that. Sometimes go through a little bit of a trial and see what happens. I also have patients who have used a ketogenic diet. Again, the component of that would involve significant limitation of carbohydrates. On the other hand, I don’t like the idea of eating a lot of meat, particularly highly cooked or barbecued or processed foods, such as bacon and so forth and diary products because on the other hand, these by themselves may be inflammatory.

We also look at a variety of food sensitivity models using different labs. I know some of these may be considered experimental my insurance companies, but that’s different than our experience. I think a lot of patients have benefited from following some of the guidelines. So I would say you will have to customize it.  I mean, I would probably do a food sensitivity test and also a food allergy test to see if anything shows up. Maybe I should avoid or limit some of those. Then overall give a pattern of carbohydrate reduction without maybe going to the extremes, if you will. It doesn’t have to have a name. It’s more so the principle that needs to be followed.

We’re also search for infections. For example, if yeast is a problem, then again the sugary stuff coming into the picture and some of the newer research suggests that fungal elements may actually have a growth in the exacerbation of these inflammatory problems. With some of patients we have used anti-fungal herbs or medications to control that. So I wish I could give you a quicker answer with different names, but all of these Low FODMAP, SCD, there is gluten free. All of these we have at one point or another used for our patients.

Dr. Weitz:            What would you say are the most common carbohydrates you’re typically recommending that people avoid?

Dr. Rahbar:         I mean, if you look at the grains and the wheat, particularly in U.S., they may have high lectin levels. A lot of people show reactivity to those. Many of our patients have already tried those things with some benefit. I have to say by time they get to me, people are already sugar free, soda free, gluten free. It’s not like I have to walk them many times through it. But I think if the grains would be a target for me, then perhaps some refined sugars and also … I mean, most of us don’t eat bad food, but if somebody drinks a lot of carbonated beverages, that may add to the inflammatory process, particularly because of the high fructose corn syrup and so forth. So I mean, it goes back again to limiting some of the carbs. I may even limit fruits. Although some carbohydrates are needed to maintain physiology and maintain serotonin levels and the patient may otherwise become depressed. 

Dr. Weitz:            Have you used the Elemental diet in cases where patients are really inflamed?

Dr. Rahbar:         Yes. Absolutely. We have used the Elemental diet, which I think is a great …

Dr. Weitz:            Can you explain what the Elemental diet is?

Dr. Rahbar:         Elemental diet is basically the type of diet that all the nutrients that the body needs, the have been turned down to the basic molecules. The body basically has to do nothing. They’re ready for absorption. As long as you expose them to the lining, it can get absorbed. The oil part is usually MCT oils, which these are smaller molecules than the big oil that we eat in the food. The sugar is dextrose, which is a single molecule like glucose, and the protein is basically amino acids, which basically does not have to be broken down. There are scenarios that this could be really helpful. For example, when we had a patient who did not respond to the treatment and we found out the patient had SIBO. I put the patient for two to three weeks on the elemental diet, without any medication. The SIBO was resolved, and the inflammation went into remission. Basically it worked.

Dr. Weitz:            Yeah. I personally have found the inflammatory bowel disorder patients that I’d seen, a lot of them do seem to have some overlying infection with either SIBO or yeast or something else. A lot of times I have found using herbal antimicrobials when we cleared that out, a lot of times that will help the inflammation to go down.

Dr. Rahbar:         Yes. That has been my experience with that as well.

Dr. Weitz:            Do you find any particular nutritional supplements to be of benefit with patients with inflammatory bowel disorders?

Dr. Rahbar:         Right. I mean, I think to answer that question I would say first one needs to change the mindset as what are we trying to target.

Dr. Weitz:            Right.

Dr. Rahbar:         Traditionally, the models of care fall into blocking inflammatory pathways or inflammatory compounds. We need that to keep it under control. But you still have to go back and see how do I get here. What went wrong? From my experience, we know a lot of patients have ability issues in their small bowel level. So some of the concepts that they deal with  leaky duct and the intestinal permeability issues that would help to repair the small bowel may give a fresh benefit to reduce the inflammation elsewhere. Be it the inflammatory bowel disease or some other inflammatory component in the body.

So the things we do in elimination of some of the foods that may not be desirable. The second thing is that if I feel the patient is malnourished or if they’re not able to break down protein, I may use pure amino acids as a supplement. We frequently use oral immunoglobulin because the data suggests that it does help with surface healing. We have used a peptide called BPC157, which is a 15 amino acid peptide, is made in the stomach juice. The research and this goes back to the 1990s by a professor from Europe. It seems that to be very helpful for our patients and it’s very safe to try it out.

Dr. Weitz:            How is that administered?

Dr. Rahbar:         In our practice, we use it orally as opposed to injection. I know there are some orthopedic indications for that and they use it by injection. But it’s cumbersome. I think for peptide that is made in the stomach considerably, I can just swallow it and be fine. It’s very stable in the stomach acid so why not do it that way?

Dr. Weitz:            That’s by prescription?

Dr. Rahbar:         It is not pharmaceutical, but it’s not quite nutraceutical. So it is some research and monitoring and education. So it still requires prescription for that.

Dr. Weitz:            Interesting. Yeah. Peptides seems like a new interesting part of the Functional Medicine playbook.

Dr. Rahbar:         Exactly. So other things we use, we use frequently zinc in the form of zinc carnosine. We use omega three fatty acids. I use vitamin A, because I think it may help with the infections and also surface healing. Vitamin D for keeping the immune system in balance. Some general multivitamins including the Bs, anything that will actually help to improve surface healing. Because when you look at the blood surface, you’re looking at a huge area of one layer of cells, and if there’s infection or malnutrition associated with it, you have some holes in there. The stem cells are not able to rapidly replace those cells that are lost. Practically every five to seven days, the surface area of the gut tends to get self-replaced. So we need to have a lot of nutrients to the other to accomplish that.

Dr. Weitz:            Do you run any of the nutrition panels to see what their status is of vitamins or amino acids or things like that?

Dr. Rahbar:         Yes. We do. Because it’s not always easy to predict what micronutrients we would be missing. A variety of these tests tend to be not available by blood but by urine test, for example, in children and it’s easy to do. They’re not that expensive. Use some guidance as how to deal with it. Of course we use clinical judgment, but I find those to be valuable as well.

Dr. Weitz:            Great. So what you’re saying is, I’ve looked at some of the papers about using nutritional supplements for inflammatory bowel disorder, and I think some of the authors still have this medical model. We’re just going to use this basically a supplement as a drug. But if you’re really applying a Functional Medicine model, you’re trying to analyze what are some of the underlying root causes and triggers and imbalances in the body. Then using nutritional supplements specifically to try to sure up some of those deficiencies and imbalances and things like that rather than just saying, “Instead of using this drug, we’re just going to use (name whatever the nutritional supplement is).”

Dr. Rahbar:         Right. I wish I could tell you you could call it one for everybody. But the purpose of nutrient replacement, especially at the micronutrient level, will be mostly for three areas. One is for providing the basic elements that several replenishment would require as you create cells again, you’re going to need yours. The second thing is to support the liver and other types of detoxification. Otherwise when you go to the area of detoxification, many things can add to this and we are constantly exposed to compounds in our bodies to clear that. Another one is basically what I call mitochondrial support. Energy speaks to that. If somebody is starting to feel fatigued, there is a problem with mitochondrial dysfunction, and obviously everyone knows that we don’t want to challenge our mitochondria. So the energy would actually be one of the greatest indicators of how we’re doing this to help it.

Dr. Weitz:            So what kind of supplements or foods would you use to help support the mitochondria?

Dr. Rahbar:         The basic nutrients would be important. Amino acids. We use a variety of antioxidants, in addition to some herbal products. There are really great combinations out there to do that.  Depending upon the number the patients are taking, what combinations, I don’t want to stick to one specific item. But anything that will improve the rate of antioxidant effect or indirectly by stimulating the NRF2s levels in the liver I think will give you benefits in the recovery.

Dr. Weitz:            Yeah. I personally found curcumin to be a really beneficial supplement in some of these patients.

Dr. Rahbar:         Exactly. Again, it has anti-inflammatory effect. You can use it with boswellia as well. If you use curcumin, the amount of the product is to increase about three to five grams a day. If it’s liposomal, it probably would be better. That could be piggybacked with everything else that we’re dealing with.

Dr. Weitz:            Yeah. I would caution practitioners out there if you decide to use curcumin, I personally have found that if you use the form that’s combined with black pepper at high dosages, that tends to be very irritating for the gut. So I would not use that form for these types of patients.

Dr. Rahbar:         Thank you, Dr. Ben. Great feedback.

Dr. Weitz:            Have you ever tried a worm or helminth therapy for these conditions? I interviewed a doctor from Duke University–Dr. William Parker–talking about some of the new worm therapies that are being used. I guess there’s some anecdotal evidence and some limited studies showing that some patients get great benefit from actually ingesting worms.

Dr. Rahbar:         Right. I’m personally not ready for that yet. Maybe just because I’m very conservative. But I’m not quite comfortable with that approach. I think we need to know more. The research is not entirely clear. Sometimes these bugs can take over if somebody’s highly immune suppressed. So I’d be very careful with that, if you will. At least for now.

Dr. Weitz:           I think there are several helminths that are being used now that tend to be self limiting, meaning that they’ll live a certain period of time in the human gut. Then unless you keep ingesting more, they’ll die off. So I guess there’s a certain amount of safety there. But I don’t blame you for being a little bit cautious until there’s some more research on helminth therapy.

What about fecal microbiol transplant? I’ve heard some other doctors talk about this, especially for Crohn’s disease. Several doctors I know feel that this is probably going to be approved at some point in the near future by the FDA for Crohn’s disease.

Dr. Rahbar:         The research is there and it’s very strong. The three countries that I’ve seen are doing a lot of research on this are Netherlands and Australia and Canada. When you look at the research, they’re not exactly similar to each other. They’re all doing something a little bit different. I can tell you that from what I learned C-Diffocele, for example, if you do one fecal transplant, it may knock off the infection. For inflammatory bowel disease, this probably has to be FMT transplantation, and it’s not entirely clear. Does it need to be done daily or is it weekly? Do you use one donor or multiple donors? The universities are into discussion on this subject.

I just reviewed a nice article on this, and I can make it available as a question and answer group. One of the professors from Canada. The bottom line was that we’re not ready for prime time. A lot of unanswered questions. With Crohn’s, particularly, it may have to be swallowed to populate the terminal ileum. If you have overgrowth or bacteria in the small bowel, that may be an issue. A lot of unanswered questions and I wouldn’t rush into this at this time.

Dr. Weitz:            I think some patients are going to be a little apprehensive about swallowing capsule filled with poo.

Dr. Rahbar:         Yes. Well, it’s out there for a purpose, but we’re not quite there yet.

Dr. Weitz:            By the way, for those listening who don’t know what fecal microbiol transplant is, can you explain what that is?

Dr. Rahbar:         It’s basically a purified form of the bacteria that have been obtained from fecal material from volunteers that have been screened to be healthy. They’re available in frozen format through the rectum. Some people do it by colonoscopy installation, if you will. But to do it for IBD, most likely has to be done through the rectum like an enema without doing a colonoscopy. They also have them in capsule that open up in further down small bowel. Again, I think these probably have a role. We just don’t have enough information to make it publicly available.

Dr. Weitz:            Yeah. Great. So this was some really good information. I think for those who are dealing with patients or patients who are listening to this who have inflammatory bowel disorders like Crohn’s and ulcerative colitis, who may not be aware, there are alternative functional medicine approaches like the one that you use, Dr. Rahbar, to help besides simply having to take some of these drugs that sometimes have a lot of side effects for years on end. I personally have seen patients even taking some of these drugs still really bad symptoms and just got used to having six to eight loose bowel movements a day, constantly running to the toilet, having to plan their day around it. After applying a Functional Medicine approach, looking for triggers and food intolerances and nutritional imbalances and things like that, found that they could live a much healthier, happier life, and were either able to reduce or eliminate some of their medications. So I think that’s a great thing for patients out there.

Dr. Rahbar:         Absolutely. I mean, lifestyle is very important. For example, stress is usually a huge modifier of an inflammatory response by weakening the immune system, making more susceptible to infections. At the same time, turning up the heat in the way that is used in fighting back against the body itself. Sleep is a great issue, and also doing some regular exercise. I want to show you this article. This is in the Traditional Journal. Can you read that? Here is a reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995194/ 

Dr. Weitz:            Yeah. IBD patients are falling short on exercise and sleep.

Dr. Rahbar:         But look at the reference is Center for Disease Control.

Dr. Weitz:            Right.

Dr. Rahbar:         This is more traditional model. I think if the emphasis is coming out, that these other ancestrally lifestyle modifications will be very, very important. We generally tell our patients to eat slowly and chew well and not eat before they go to bed. Obviously limit carbohydrates. The issue of fish and tuna and sushi, these are important. I’m not in favor of having these sorts of proteins frequently taken without knowing what the exact source is. We frequently find heavily metals in our patients, and that will definitely change the intestinal microbiome. It’s probably going to increase the risk of yeast problems. It’s going to confound this in you.

Dr. Weitz:            So do you test your patients for heavy metals?

Dr. Rahbar:         Yes. We routinely do. I don’t do necessarily chelation to see what’s in the tissue. At least I do not want to see it in the blood floating around.

Dr. Weitz:            Right.

Dr. Rahbar:         Because once you eat let’s say tuna, it may take three to four weeks for a normal person to eliminate that from the blood circulation. Once a week may still be too much.

Dr. Weitz:            Yeah. According to Dr. Chris Shade, a patient who’s sick, who’s system is not working well at detoxifying, once you ingest mercury from fish, it can be in your system for over 200 days.

Dr. Rahbar:         That makes perfect sense. Yeah.

Dr. Weitz:            Yeah. So then you also mentioned mold is a factor. Do you often find that with inflammatory bowel disorders or sometimes you find it?

Dr. Rahbar:         Yeah. We look for anything that potentially can turn up the inflammatory process and produce immune dysregulation. The issue of environmental toxicity is extremely interesting and important because for a variety of susceptible patients who have the proper genetic profile, exposure to the mold and the process of mold may be a huge additional burden, if you will, and can be another dis regulator. Now, you add that to stress, add that to alcohol, to sugar, to bad lifestyle, add that to mercury and lead and we have a whole soup of events going on here. We also have several patients where they had some manifestation that suggested neuropathy. When we checked, we found there was evidence of tick borne illness or vector borne illness as another component of immune dysregulation. 

Dr. Weitz:            So you’re talking about something like Lyme disease.

Dr. Rahbar:         Yes. I’ll give you an example of scenarios. For example, the patient who comes with constipation, but when you do colonoscopy, you see colitis. The patient is taking laxatives and a part of the colon looks black because of the laxative use. But in another part of the colon is read and inflamed. So that suggests to me you have two problems. One is the nerve component of the colon is not working. So that’s neuropathy. The other part is immune dysregulation and colitis. What would cause this type of combination? Usually it would be vector born illnesses like bartonella, borrelia and babesia are very, very powerful to create this type of combination, if you will.

Dr. Weitz:            You mentioned immune dysregulation and that’s something that’s hard to wrap your head around. When you think of an inflammatory, an autoimmune disease, an inflammatory bowel disorder, you’re thinking you have a situation where the inflammation is revved up. But now you have these patients where the immune system is revved up and attacking but actually a lot of times the immune systems not working probably. So can you explain that? How do you end up having an immune system that’s in attack mode, but it’s actually not working that well?

Dr. Rahbar:         Well, simply what it means is in attack mode against our own tissue, but since it’s too busy doing that, it won’t be able to fight infections properly. So if you end up picking up a bug here, you’ll end up with scenarios where this low grade infection may stay in the body and they produce what we call the stealth infection. This term unfortunately is not in the classic books. We think about chronic infections with antibiotic. But what stealth infection is is a little bit different. You have to do your own reading on this, because you won’t be able to see it in classical descriptions. What it simply means that the Koch postulate that one bug causes one illness is probably not true at least nowadays. What we see is a variety of infections, it could be bacterial, viral, fungal. They work in harmony with each other. They keep the host busy, and they just kind of mess up the system a little bit. Just a little bit, won’t kill. But it’s uncomfortable. You can see evidence of allergies, skin problem, rashes, hives, itching, irritation, problems with sleep, joint problems, energy issues. When you go deeper, you see a variety of these infections may be sitting in the background. It’s hard to know which one is the creator. Sometimes you have to use kind of a try different things and see how you can hit the target.

Dr. Weitz:            So basically it’s not that the immune system is so much just up or down. It’s that it’s dysregulated, right?

Dr. Rahbar:         Exactly. Yeah. More change of autoimmunity and at the same time more chance of having difficult dealing with infection.

Dr. Weitz:            Right. Okay. Great. Lots of interesting topics. I’m sure we can talk about this for a long time. But I think you provided our listeners some great information. For those watching or listening to this podcast, how can they get a hold of you and get more information about you?

Dr. Rahbar:         The best way to approach us is to check out our website. We have tried to put as much information there. The telephone is always available. But telephone, once they ring more than two or three lines, there’s only one nurse.

Dr. Weitz:            What’s your website? Can you give that to us? Of course, I’ll put it in the show notes.

Dr. Rahbar:         Yeah that would be LA then the word integrativegi.com.

Dr. Weitz:            Great. What’s the phone number to your office?

Dr. Rahbar:         310-289-8000.

Dr. Weitz:            Great. You’re available for consultations both in person and remotely?

Dr. Rahbar:         Yes. Still in practice.

Dr. Weitz:            That’s great.

Dr. Rahbar:         Thank you.

Dr. Weitz:            Thank you, Dr. Rahbar. Look forward to speaking to you soon.

Dr. Rahbar:         I hope so. Thank you for this invitation.


Natural Solutions for Depression and Anxiety with David Foreman: Rational Wellness Podcast 59

David Foreman, the Natural Pharmacist, speaks about natural solutions for depression and anxiety with Dr. Ben Weitz.

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


Podcast Highlights

0:52  My intro on depression and anxiety and how such patients are treated with drugs that modulate neurotransmitters like serotonin, despite the fact that there’s never been a successful human study linking low serotonin levels with depression. I also talked about how difficult it is to get off these drugs once you have been taking them. 

8:50  I asked David what should patients do who are suffering some mild depression?  David responded that they should use his four pillars of health program encompassing diet, exercise, spirituality and supplements that you can find in his Pillars of Health Heart Disease book.   

10:54  David recommended that someone with mild depression should contact a Functional Medicine practitioner like one of us to help explore some of the underlying causes of depression by looking at diet and lifestyle. Alcohol is a depressant for the nervous system and should be avoided. You need to feed your brain by avoiding refined, sugary, starchy foods and eating more fruits, veggies, nuts, seeds, legumes, lean cuts of meat, and wild salmon for the omega threes for your nervous system. 

13:51  From a Functional Medicine perspective, rather than treating depression, depression is just a symptom and we need to find out what the underlying cause including nutritional deficiencies, lack of exercise, if you have a lot of inflammation, then your brain will be inflammed. You need to look at hormone imbalances and the gut, considering the gut/brain connection. 

21:16  David mentioned three herbs that can help with depression and anxiety: 1. Zembrin from South Africa, which comes from a cactus, helps you relax and calm down and also help your concentration and focus, 2. Rhodiola, which is an adaptogenic herb that helps to balance your system, 3. Passion flower, that helps with sleep.



David Foreman, the Herbal Pharmacist, is available for speaking engagements and can be contacted through his website,   http://herbalpharmacist.com/  and you can email him directly and he will respond.

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


Podcast Transcripts

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


Dr. Weitz:                            Good morning Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy this podcast, please go to iTunes and leave us your ratings and review so more people can find out about the Rational Wellness Podcast. Our topic for today is depression and anxiety, what to do about it. For depression in the United States it’s very common if you go to see your doctor that he’s going to prescribe a medication like a selective serotonin reuptake inhibitor, or SSRI, like Prozac, Zoloft, Lexapro, and these are among the most commonly prescribed medications in the United States.  They’re prescribed not just for depression and anxiety but for a whole host of other disorders, obsessive compulsive disorder, eating disorders, arthritis, chronic pain, neuropathic pain, IBS, migraines, ADHD, addiction, sleep disorders, and now mind wandering. The problem is that these medications–it’s not clear that we have any idea how they work or even if they do work. In fact, it’s only a conjecture that depression is actually caused by a deficiency in serotonin or norepinephrine. In fact, there’s never been a successful human study linking low serotonin levels with depression.

According to a recent article in the New York Times, the long-term use of depressants is surging in the US. According to federal data, some fifteen and a half million Americans have been taking these types of medications for at least five years, and the rate has almost doubled since 2010. Unfortunately most of these antidepressants were originally only approved for short-term usage by the FDA, and there’s only a few studies that have actually looked at the safety of taking these for longer than a few years, yet many patients are put on these indefinitely. Then when they try to get off them, it becomes very, very hard to get off them. A large percentage of patients, a significant percentage of patients have a very difficult time getting off these antidepressants, and a lot of them just stay on them because they can’t get off.

To talk about this and some other related topics, I’m very pleased that my friend David Foreman, the Herbal Pharmacist is here, and we’re going to talk about some alternatives of other things you can do for depression and anxiety. Hi, David. Thank you for joining me today.

David Foreman:                Thank you. For the people that listen to your podcast that heard that background on antidepressants, if they have depression already now they’re even more depressed. I don’t want to make light of their situation. You and I have a cool rapport. I think we have very similar beliefs. One of the things I like to do is just I like to be real about things, so hopefully I don’t offend anybody by my commentary. Depression is definitely a very serious thing. As a guy that owned a pharmacy, I still owned my pharmacy when the introduction of those SSRI drugs you were just talking about came out, and at one point one of them, and I’m not going to mention brands, but was actually the number one most prescribed drug in the world.  It’s a big deal, and it’s a big topic. I feel like a lot of times people don’t talk about it. Who likes to talk about their mental health? Unless you have really good mental health, most of the time if you’re bringing it up it’s basically a chink in your armor, and especially for guys, man, we’re like bullet proof. We’re like superheroes. It doesn’t get talked about, so I’m glad we’re covering this topic today.

Dr. Weitz:                            I second your thoughts. I certainly sympathize with people who have been dealing with depression. I know it can be a very difficult situation to deal with. If you’ve been taking these medications and they’re working for you, all power to you. I just wanted to point out some of the issues with these drugs. I know quite a number of people who didn’t really get much benefit from them, and then they have trouble getting off them. We’re just trying to get to the science behind these things. Certainly if you’re listening to this podcast and you’re taking antidepressants or any other kind of medication that’s been prescribed by your doctor, certainly don’t stop it without talking to your doctor. That’s the most important thing.

David Foreman:                Definitely. I can’t stress that enough. I got to drive that one point home that you just said about the people that actually have more severe cases of depression, a lot of times I run into. Those are the people who really want to get off of their meds. I recently did a couple of TV engagements on this topic in Phoenix, and I had people emailing me: “My wife has bipolar disorder. Which is a more severe version, and she doesn’t …” They always don’t want to take their meds. My thing is like if you’re that severe and you’re doing well, why would you want to rock your boat? That’s one.

Two is if you haven’t taken the medications for a long time and maybe you do just have mild depression or mild anxiety, the side effects that people go through when they come off of those meds, like if you went cold turkey within a couple of days you’re going to feel horrible, like flu-like, achey. You’ll have focusing issues, sleep problems, more anxiety. We’re now finding out, and I don’t think they’ve been … They haven’t been classified as addictive yet, but I feel like with all of the things that people have going on, I mean the anti-anxiety one for sure are addictive, but antidepressants usually are not.  These are things that people need to be weaned off of, and the cool thing is a lot of the things I’ll talk about today, some of them can be integrated into your current regimen. Again, like you said, and I like to drive those points home, just because people sometimes, I feel like, are thick-headed, because they just want to stop having all the side effects from their meds, and they’re anxious to change, but you got to consult with your health care provider. It’s got to be a team effort. It can be done, unless you really do have something more severe going on.

Dr. Weitz:                         In fact, I think an excellent point to make here is I’m a big believer that everybody needs a team of people to help them. If you’re dealing with psychological issues, you should have a psychological counselor, but I think most people would be best-suited to not only have a traditional MD that they work with, but also a Functional Medicine practitioner like myself or yourself who knows the nutritional end of things. We should all be working together for the betterment of the patient, and not one being better than the other.

David Foreman:                I’ll tell you what, if we were in the same room right now I’d be high-fiving you on that one. I’m a high-fiver. We can do a fist bump, so we can do a virtual fist bump. How about that?

Dr. Weitz:                         I think everybody does the fist bump because they’re paranoid about getting germs. I’m a big believer in germs. I like germs.

David Foreman:                I know they exist. I feel like if I believe-

Dr. Weitz:                            … for our immune system.

David Foreman:                I know. I feel like if I believe in them too much, then I will get sick, and I pretty much just don’t care. It’s those moments where I have that mental … Perfect. It’s those moments where I have that mental weakness that “are they actually going to bother me,” that they do, and I’m like, “I had a weak moment.”

Dr. Weitz:                         There you go, the power of the mind.

David Foreman:                Right on.

Dr. Weitz:                         How do you want to start this conversation? What should patients do when they’re just feeling a little depression? What’s the first thing they should do, do you think?

David Foreman:                This is where I love the fact that I came from traditional medicine, and now I’m this natural medicine expert, because I feel like as opposed to people that are all on, all-in on just natural medicine, they hate when I say what I’m about to say. If you’re having-

Dr. Weitz:                         By the way, I’m not talking about somebody who’s about ready to hang themselves.

David Foreman:                That’s not even funny. I’m sorry I laughed, but I was just-

Dr. Weitz:                         I know exactly what you’re talking about. You’re feeling a little blue. You can’t quite get motivated. Not somebody with a long-term history of depression.

David Foreman:                If it’s something that’s just new and coming on, for one thing, for years I’ve been preaching something called four pillars of health which are diet, and I know these things all resonate with you as well: diet, exercise, spirituality and supplements. I feel like in order to really be that truly healthy individual you need to have a balance of all four of those components. You can’t just eat right, or you can’t just take supplements, or you can’t just be a work-out warrior. You just can’t pray the paint off the walls. You’ve got to have a balance of those things.  Usually when someone, and I’ll throw myself into this equation, because I’ve walked that world before. First thing is to really do some introspective thinking about, which is more probably on the spiritual side of it is like try to figure out what might be triggering you to feel that way. Are you having financial problems, or is one of your kids getting into trouble? Are your parents aging and you’re worried about taking care of them? Dig inside yourself and try to figure out what the root of that concern is, and perhaps even contact someone such as yourself and say …

I always feel like that’s a good start. Start with someone that’s open to the natural modalities that is a qualified health care provider as well, which both of us are. Let us get a better spin on it. Again, this conversation is really more for the people that … You’re not a chronic depression person. If you are, that’s a whole other discussion which we can have if we have time. Then look into through guidance through this health care provider. There’s definitely some things that we can do diet-wise, like so, again, my four pillars.  For me getting out and getting some exercise is critical, because it helps take care of stress. Your body releases hormones it normally wouldn’t, called endorphins, which would give you that high, uplifted feeling, not high like you’re stoned, but high like you’re just feeling better about yourself. Diet plays a huge role-

Dr. Weitz:                         By the way, exercise also increases brain derived neurotropic factor (BDNF), so it makes it easy to read and learn things, so there’s a lot of huge benefits to the brain from exercise.

David Foreman:                Exactly. Then you get into the diet part. What are you eating, drinking? Alcohol is a depressant. A lot of times people that are feeling down or blue may have a cocktail or two or three to take the edge off. I was just traveling in Europe with one of my really good friends, and he kind of had a come-to-Jesus moment with me, and not about myself but about himself. We kind of rolled the bus over and he’s like, “Man, I’m dealing with so much stuff right now with my dad, and my family, and my work. I’m just drinking way too much right now, because it helps numb that feeling.” Alcohol is actually more of a depressant. It’ll actually make the cycle go more and more.

People do a lot of caffeine or if … You got to feed your body. You got to feed your brain, and so you want to make sure you’re eating a cleaner diet, and cleaner meaning avoiding all those processed, refined, sugary, starchy foods, and eating more fruits, veggies, nuts, seeds, legumes, lean cuts of meat. Man, nothing better than a salmon or whatever for the omega threes for your nervous system. Diet plays a role in there. Spirituality. I’m not going to get into the religious side of things, because everybody has a different way of doing it. For me, I’m a Christian, so I’ll go back to my Bible or I’ll look up passages or I’ll pray. I’m not saying that’s what you have to do, but I feel like you should pick something and practice it, whatever it may be.

Then there are supplements that you can take to help your body either re-nourish it or take the edge off. I’m going to cover some of those later in this podcast, but that’s the kind of approach I would take, and I know it’s probably a long-winded answer for you there, but I felt like it all needed to be said.

Dr. Weitz:                         Good. From my perspective, trying to employ a functional medicine perspective on it, which is the way I tend to look at things, depression is really just a symptom. It doesn’t tell you what the cause is. We need to find out what the root cause of depression is, and there’s a whole series of things that can cause it. You mentioned nutritional deficiencies, lack of exercise. If you have a lot of inflammation in your body, you’re going to end up with inflammation in your brain, that’s going to cause depression. If there’s an imbalance in your hormones, in your body, that can lead to depression.  There’s a whole series of things. If your gut, you know the connection between the gut and the brain?

David Foreman:                Yeah.

Dr. Weitz:                         Huge. 80% of the neurotransmitters are produced in the intestinal tract. If you’ve got a messed up gut and you’ve got gas and bloating and constipation, you got to clean that up if you want to really address what’s going on in your brain.

David Foreman:                That’s why you do go to somebody who practices a Functional Medicine approach. I used to get really frustrated when I actually did consultations with people, because I’d spend an hour and a half or two or three hours trying to dig to the root, get down in there and figure out why. You got to figure out why you have what you have before you can actually do anything to fix it. For me, it’s either how do you fix it or how do you prevent it. If you don’t want to have these issues, what do I do? It’s a blend of all those things that you just mentioned and I mentioned previously.

Dr. Weitz:                         Absolutely. Let’s see. Do you want to talk a little more about nutrition and what kind of nutritional factors you think are really important? I know blood sugar imbalances are really crucial. In this society with the overuse of high-glycemic carbohydrates and sugar foods, that’s a really big issue.

David Foreman:                I feel like we could spend a day in hours discussing the nutritional link to this. One of the things, I think, that I’ve gotten good at is instead of telling people what not to do, I tell people what to do. Then when they say, “Well, what about this?” I’m like, “Well, was it in the what I said to do part?” Sorry, I’m a super-science, like I’m super-smart on science, but I’m also super-awesome at, and no offense to people, but kind of like … Well, I won’t say dumb it down. I was going to, but I like doing things foundationally and fundamentally. It doesn’t have to be hard. I’m going to go back to-

Dr. Weitz:                         No. That’s great. That’s one of the hardest things to do is to make the science easy to understand for people who don’t have hours reading journal articles like you and I do.

David Foreman:                Yeah. Again, I’d rather not get into what … You just talked about the sugars and all that stuff and the negative effect they have. I’d rather just tell people this, like, hey, if it’s not a whole food, meaning it’s not in its original form, like apple sauce isn’t necessarily an apple, because usually the skin’s not there, and they add stuff to it. If it’s not a whole food, so going back to instead of listing off all the possible things, it’s a lot easier for me just to go, “Hey, fruits, veggies, nuts, seeds, legumes, meat, pork, chicken, fish. Those are all …” Everybody’s like, “Pork, really? Meat, really?” I’m like, yeah, leaner cuts, and that’s what you eat.  Then I get these people that say, “Well, what about my Chex cereal?” I really do want to go, “You’re smarter than that.” Then I think there really are people that don’t have that cognitive sense. Again, it’s-

Dr. Weitz:                         Have you taken a look at the supermarket, David? We got row after row of foods like boxes and cans and packages.

David Foreman:                I’m not trying to dodge your question either. At the end of the day the reality is if it’s not on that list, and you definitely have a problem … One of my favorite things is if you’re diabetic and you’re listed critically diabetic, you’ve got those blood sugar swings that are just like you’ve ended up in the hospital. I associate that with this: you are covered in gasoline and you’re playing with matches. Would you do that?

Dr. Weitz:                         I hate to tell you, I treated a number of patients with diabetes and there’s a lot of people that just don’t want a test, they hate the test. They’re all over the place. 

David Foreman:                I know, but that’s where it is. It’s like how much do you appreciate your life? That’s when I go if it’s not on my list, how else could I say it? That’s my answer to the diet part. Seriously, if you’re dealing with a health challenge and you really are sick of it, and maybe you are on … I run into this a lot where people are like, “Well, I’m really tired of taking my XYZ for whatever the challenge is.” I had a radio show, and this guy called into my radio show one time, and he was like, “Well, I’ve got type II diabetes, and my doctor’s talking about putting me on insulin. Blah blah blah.”

I’m like, “Well, you got to, like I just told you, like you got to avoid all those processed foods, sugar, focus on those foods.” He was like, “Yeah. I don’t know if I want to do that.” I’m like, “Wait, you got to decide which do you want to do. Do you want to take your meds that cause other side effects?” I ran into a medical doctor the other day that was totally dialed in on it. She was like, “Hey, I am finally …” You never know what causes that epiphany, but she was like, “I finally realized that when I prescribe this medication for blood pressure that the blood pressure comes down but I just gave them 10 other problems.”

I’ve been doing this long enough, and I’m sure you have as well, that I’ve seen enough with those people that really are committed to the program of getting their exercise, eating the right foods, and then getting well. It’s when you get well that then you can play with it a little bit. You can go out with your friends and not worry about, or a holiday or a birthday or whatever, and you can go ahead and have whatever you want, and you can skip a day of working out. Until you get there, and you really want to get off your meds, like I can’t tell you how many times people were like, “Man, I lasted like four weeks, and then I just said to heck with them, and just take my blood sugar pill.” Well, then stop complaining about taking it. Sorry, Ben. I got kind of crazy there.

Dr. Weitz:                         I totally agree with you. I’ve heard the same kind of stories. What kind of alternatives are there for people who want to find another approach for depression and anxiety?

David Foreman:                I’m going to start with depression, and I’m going to cover it really quick. I’m going to just focus on the supplemental side of things. I trademarked years ago Herbal Pharmacist, because when I got started on all of this I really only understood the herbal part of it. Now, I’m like a natural, healthy lifestyle guy, but I’m going to cover a few herbs. On depression, in Germany or in Europe they’ve been prescribing for years a standardized extract of Saint John’s-wort, but/and/or, however you want to pick it, that was used for mild to moderate depression. Keyword is mild to moderate.

Again, if people are already being treated then you can’t just throw this in and mix it what you’re already taking, because depending on the type of medication you’re taking it could cause even more side effects for people. That’s really my go-to. Again, it’s mild to moderate. It’s good for people if you have that thought in the back of your head of like, “Well, maybe it’s more than just that.” Well, then you need to seek help. You need to find out what’s really going on. Then, of course, throwing in those other components that I mentioned. I know that’s probably oversimplifying it.  I have this elaborate approach for people to help balance neurotransmitters when it came to that kind of stuff. It was high in certain B vitamins and magnesium, and adding serine and choline and all those types of things. We don’t really have time for that on this. I didn’t necessarily want this show to necessarily go down that path anyway. I think what is better to get into is when we use the word anxiety, I think it gets used loosely. In all honesty, I feel like, Ben, that what we’re talking about is we’re just stressed out. We have a high-stress lifestyle, and for that I’ve got a lot of really cool things.

I’m always learning. I’ve got three herbs that I can talk about real quick that help with that stress component to help take the edge off in different ways, or help the body adapt. Again, these are not a replacement necessarily for diet, exercise, or spirituality as well. I can tell you though that they help. They help quick, until you can learn. It’s hard to change everything at one time.  The cool thing is, I talked to you about this right before, and I got a little globe here. The reason I have the globe is the three herbs I’m going to talk about come from three different completely unique regions of the world. They have been used by indigenous tribes in those areas for hundreds of years, and now in the last couple of decades or so we in the natural medicine and modern medicine field have actually identified why. They’ve done clinical trials. Everything I’m going to talk about actually has clinical research behind it to prove how much, and that kind of stuff. I’ve actually got some things I can show on the screen if that’s okay with you, too.

Dr. Weitz:                            Sure. That’d be great.

David Foreman:                Cool. I’m going to start in South Africa, way down at the bottom. I’m sure they don’t like me calling it the bottom of the globe. Southern hemisphere, there was a tribe there that’s been using an herb that comes from a succulent, like a type of cactus. The tribesmen were using it on hunting missions. It helped keep them calm and relaxed and focused. Even actually helped curb their hunger, because that part of South Africa, I think it’s actually the oldest known still living, existent civilization on the planet. Other civilizations have died off, and this is like the oldest tribe we know of. If people want to learn about them, it’s the San tribe, or S-A-N. Really cool stories on the internet on that.

The herb that we get and that we have available to us now that came from that is called Zembrin. I don’t know if I can get a close up of the spelling, but it’s on the bottle. It’s Z-E-M-B-R-I-N. This is just one of the many brands. The ingredient’s called Zembrin, again Z-E-M-B-R-I-N. The clinical research on Zembrin in humans showed that a small dose of 25 milligrams worked really fast. Literally within two hours it affected the stress center of the brain in a positive way. The research showed that it helped relax you, calm you down, but not cause drowsiness. A lot of things that de-stress us or help us unwind, we’ll say, will cause drowsiness.

Those things will normally make you lose focus and concentration, whereas the research on Zembrin says small dose, once a day in the morning helped you relax and calm down really quick. I actually started using it about eight weeks ago, and, man, it works. It’s cool. It also helped improve the people that took it, it helped improve their ability to concentrate and focus. Then one of the things that goes hand-in-hand with the stress module, and I actually attended a seminar in Geneva, where I was just yesterday or two days ago, on the whole thing with stress. One of the things with stress is that it affects your sleep.  What they found in their studies was that it helped relax you, and we’ll say chillax; we’re mellow. Improve your concentration and focus, and actually helped a lot of people improve their quality of sleep at night. It’s not a sleep aid per say, you don’t take it at bedtime. It really needed to be taken in the morning to have that sleep component added to it. That’s Zembrin. I don’t know if you have any comments or you want me to keep on going.

Dr. Weitz:                         No. That sounds kind of interesting. It’s not something I’ve heard of. Would that be considered an adaptogenic herb?

David Foreman:                No. Actually my next one is more adaptogenic. To me that’s more experiential. The fact that you can truly feel it work and literally within a couple of hours. My publicist even told me she started taking it. She was like, “Oh my God. Within a couple of days I noticed a huge difference.” Like I said, a lot of things that relax you, they actually will affect your ability to concentrate and focus. They will make you drowsy, maybe a little too much, and so it works differently.  My next herb though, we’re going to go to Siberia. We’re going all the way up, and think of the environment in Siberia. Never been there. Personally not necessarily sure I really want to go there. It’s a very harsh environment. The people there have been using an adaptogen-

Dr. Weitz:                         Just say something bad about Putin, you’ll end up there.

David Foreman:                I’m going to try to stay away from politics. Because, Ben, half the people are going to love me and half of them are going to hate me, and I’m not going-

Dr. Weitz:                         We got to make sure we appeal to the Putin lovers.

David Foreman:                Believe whatever you want to. In my head I could think you’re an idiot, but right now believe whatever you want. I’m cool. You said adaptogens, so the people that listen to and watch your podcast they’re probably familiar with adaptogens. You cover them a lot.

Dr. Weitz:                         Yeah.

David Foreman:                Cool. The adaptogen I’m going to talk about today is Rhodiola. R-H-O-D-I-O-L-A. I brought an example. I’ve got a couple of examples of Rhodiola that you can find pretty easy at health food stores. You might even sell products like this, Ben. I don’t know.

Dr. Weitz:                         We do.

David Foreman:                Well, then I’ll put them down. Rhodiola is an adaptogen, and just real quick, my spin on adaptogens is that whenever you’re stressed, you’re out of balance.

Dr. Weitz:                         I thought you were going to go with Siberian ginseng.

David Foreman:                Well, we could go there. We could go with ashwagandha. There’s a lot of them out. That’s a good one though.

Dr. Weitz:                         I didn’t know that Rhodiola came from Siberia.

David Foreman:                It comes from other areas, but the good stuff, man, comes from Siberia. That stuff is really bad.

Dr. Weitz:                         Herbal stuff, man.

David Foreman:                Yeah, it brings a whole new definition to the Herbal Pharmacist if we go down that route. I don’t want to go there. Rhodiola, so when you’re under stress, especially prolonged period of stress, it affects your endocrine system, the hormones, and you’re out of balance like this. What Rhodiola and other adaptogenic herbs do is it helps slowly bring the body back into balance, so that when you do have … We have stress, I think, all day long, for whatever it is. I wouldn’t say I’m feeling stressed out, but right now when I do these interviews I’m stressed out.  My body takes a beating. My endocrine system is going, “What’s going on here?!” That affects so many aspects of my health. It brings you back into balance so that when I have this moment that’s a little more stressful than others, I’m not going to go, “Shooo!” Like that. I’m going to be like, oh, it’s just going to hopefully help my body adapt to that change. Rhodiola, it works not only just on that psychological, mental health part of it, but it also works on the physical side of stress. Actually, Zembrin does as well. The difference here is that Rhodiola doesn’t work quick. It might take a week or two to work.

It’s helping your body just be more balanced, I guess you could say. Actually, I have been taking Rhodiola. I only learned about Zembrin a year ago. Like I said, I started taking it about eight weeks ago. I’ve been taking Rhodiola, God man, eight years, maybe longer. I take Rhodiola because I do work out. I do have a super-freak active lifestyle, and I travel a lot. For me, it also helps my immune system so that I’m not necessarily going to get as worn down, because stress wears you out. My last herb-

Dr. Weitz:                         Hey, man, on that Zembrin stuff, can you take it more than one time a day?

David Foreman:                Pardon me?

Dr. Weitz:                         The Zembrin, the first herb you talked about, can people take that more than once a day?

David Foreman:                No. Actually the clinical trials say literally one 25 milligram capsule a day is really, and you need to take it in the morning at some point. I’m in California right now, and I’m getting to the point where if I don’t take it soon … I could probably take it as late as 1:00 or 2:00 in the afternoon, but I find that if I take it when I get up when I take my other supplements. Like I said, it works quick, and it’ll last me all day, but I feel like to get my day going, keep me calm and focused all day long I need to take it just once a day in the morning. You may actually see Zembrin combined with Rhodiola out in the marketplace.

David Foreman:                You’ll see Zembrin sometimes in sports supplements, because there is a positive effect there, kind of like I mentioned with Rhodiola as well. The last spot, we’re going to go nearer … Where’d my pin go? There it is. Well, this is in the southern part of Mexico, but the herb that we’re going to talk about, passion flower, was used by the Aztecs. It was used in Polynesia. Passion flower is so different than the other two in that … Actually, the Aztecs used it for insomnia. This is where you normally will recommend passion flower for people that, you know, you’re just so wound up and you are that person that’s like, “Oh, yeah. Man, I come home from work. I’m all wound up, and I pour myself a …” Fill in your favorite adult beverage.

This will cause drowsiness. It’s more for me for people that have trouble sleeping because of the stress, than anything. As I said earlier with the Zembrin, I don’t really have trouble sleeping. You can ask my wife. I don’t have trouble sleeping. I noticed I slept better which is really a cool thing. I slept deeper. Zembrin does work, but it’s not going to kick my butt. If I take passion flower, it’s going to kick my butt. It’s going to make me drowsy. Some people may even have trouble operating a car, so it’s not something I’m going to take it in the morning before I work, because I feel like I’m going to lose my concentration and focus taking passion flower. It’s been one of my go-tos for taking the edge off years ago. It does work pretty quick, probably 45 minutes, however long it takes to digest it, I guess, you could say.

Sometimes I’ll even recommend it in … I do have an example of it in capsule form here, but I tend to like it in the liquid form if you really want it to work quick. A lot of times in natural products for sleep, it’ll be combined with things like lemon balm and valerian root. Those are the three main herbs. Again, I feel like the Zembrin and Rhodiola you can use together, and that’s something I am now doing, because they work differently, and I feel like I want the benefits of what both offer me as opposed to just the benefit of one. You can get by with one. I’m just saying.  If I was going to pick one out of three, I’d start with Zembrin because I feel like it crosses more pathways. I also feel like taking something like Rhodiola, man, there’s a lot of other cool stuff that goes on there too.

Dr. Weitz:                         Would you say that somebody dealing with mild depression or anxiety who’s never taken anything would do well to try one or all three of these herbal formulas?

David Foreman:                I would not recommend passion flower for someone that has those down feelings.

Dr. Weitz:                         That’s more for sleep.

David Foreman:                Yeah, because I feel like anytime we add something that brings you down, slows the mind down a little bit like I feel passion flower does, I feel like, like I mentioned earlier in the beginning about alcohol and how it could keep the wheel going in the wrong direction. Actually, alcohol causes nutrient depletions that your body actually needs those nutrients to make and balance your neurotransmitters. You’re digging yourself a deeper hole by doing that. No, I wouldn’t say that. If you are stressed out, the three things that I talked about, yeah, they all work really well. Again, it all boils down to what level are you at.

 If you’re feeling, I mean I think you said hanging yourself earlier. If you’re feeling that down and out, then you need to seek professional help. About six or seven years ago I was going through a really just horrific part of my life, and actually at one point was being treated by a counselor for PTSD, that’s how crazy it was. For me, it was changing my diet and making sure I got my exercise. For me, making sure I was really grounded in my spiritual walk, and taking supplements. As an adjunct to all that, sometimes you got to talk it out with people.

David Foreman:                Sometimes it’s hard to figure out what the root of your wires touching in the wrong way, and so I feel like it’s always a good idea. Maybe you call your doctor, or somebody that you trust in the medical profession and say, “It’d be really cool to find …” I used to think counseling was for idiots. I hate to say it that way, but man, I’ll tell you what, my counselor really helped me dig the root of some other things that really helped me. Not just the traumatic life stuff I was dealing with, but also helped dig to the root of why maybe I wasn’t handling those situations as well. I’m sorry, Ben, I’m giving you a really long-winded answer on that, but I-

Dr. Weitz:                         No. That’s great.

David Foreman:                I feel like people need to know it’s more than just one thing. Yeah, these supplements rock. None of the three would I be … Was something for depression at all, at all. Again, that’s a disease state anyway, so I can’t really use those words. For stress, I feel really comfortable these work, but if you’re way out there, you’re feeling like ramming your car into somebody. I hate to say it, but road rage is a big deal, and that’s like you’re not handling your stress well. You know?

Dr. Weitz:                         Yeah. Okay, David. I think that’s pretty good. Any final thoughts you want to tell our listeners?

David Foreman:                No. I feel honestly like I got real long-winded in a few spots, and I feel like if people have questions they can either go back and listen to this again, or I welcome people to email me directly on my website: herbalpharmacist.com. No, I don’t really have a lot to add, Ben.

Dr. Weitz:                         Great. That’s the best way for people to get a hold of you is to go to the herbalpharmacist.com.

David Foreman:                Yeah. Herbalpharmacist.com. I have social media links there as well. Then, of course, when you put this available I’ll make sure that I reciprocate sending the links out on all my social media as well: Twitter, Facebook, LinkedIn. I feel like it was a great topic today. Thank you for having me on. I really appreciate it.

Dr. Weitz:                         Absolutely. I enjoyed talking to you again, and I’ll talk to you some time in the future. Thank you, David.

David Foreman:                Thank you. Take care.


Resolving Chronic Pain with Dr. Joe Tatta: Rational Wellness Podcast 058

Dr. Joe Tatta explains how to Resolve Chronic Pain by using his Functional Medicine approach when interviewed by Dr. Ben Weitz.

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


Podcast Highlights

2:03  Dr. Tatta explains his journey from being a traditional physical therapist who sees pain as a mechanical phenomenon, to seeing the role of diet and the brain in understanding what causes pain. About 15 years ago he realized that 75% of his patients were obese and he had to address their nutrition to help them reduce their chronic inflammation and exercise alone could not do that.  He studied Functional Nutrition and incorporated it into his practice. He also became aware of the neuroscience of pain and the role of the brain and of stress in chronic pain.

6:08  We discussed the role of excess bodyfat on back and joint pain, esp. chronic pain, both from a mechanical stand point and from the role it plays in inflammation.

8:45  I suggested that we approach this interview a little differently–that we go through first how Dr. Tatta’s approach to pain works for a patient with chronic back pain and then how it works from a practitioner standpoint. Dr Tatta said that he thinks of three questions. One is, what’s happening to your biology? Two is, what’s happening to your psychology? And three, what’s going on in your environment? With respect to biology, Dr. Tatta asks if they are someone who could benefit from nutrition?  One, are you overweight or obese? If you are, you can benefit from a nutritional intervention. Two, do you have some kind of metabolic factor, or some kind of metabolic test that we can look at? Things like high cholesterol, high LDL, high C-reactive protein. If there are inflammatory markers on your blood work, then nutrition’s a key.  Third, when it comes to your biochemistry, if you are diagnosed with an autoimmune disease, or one of your parents have an autoimmune disease that has caused them to have some kind of joint pain, or some type of chronic pain syndrome, you want to be really aware that that tends to run in families. And you may be predisposed to developing an autoimmune disease. Or, if you actually have one, that nutrition is definitely one of the first steps in helping heal and/or possibly reverse that autoimmune disease. 

13:42  Two is looking at our psychology, which means looking at if you are someone with high levels of stress or anxiety, then you likely have high cortisol levels and poor digestion and you likely will develop leaky gut and poor motility and constipation and this can lead to more toxicity. Anxiety can also lead to more muscle tension and sleep disturbances, all of which can over-sensitize your nervous system and can increase the likelihood of chronic pain.  Chronic pain can then lead to depression. You also have to consider their history and if they come from a family with divorce or trauma or a history of abuse or addiction.

16:28  Dr. Tatta then explained that there is the environmental or social part, which involves having nurturing relationships, stress reduction strategies, and having an outlet for joy and doing things that make you happy and give you a purpose or passion in your life. And once you find those things, pain starts to quiet down and relax.

17:28  I then asked if I am a patient who is seeing a traditional physical therapist or chiropractor who has given them a musculoskeletal diagnosis and is performing manual therapy and is giving them exercises, etc. What do I do about the nutrition part? Dr. Tatta explained that movement and manual therapy are helpful and they make you stronger and more flexible and able to function.  Movement also helps to promote relaxation, enhances your mood, and decreases your fear about moving, so movement also has some of the psychological parts in there, so continue with the movement. but then ask if there is a “Is there a place for nutrition in my rehabilitation?” And, if the answer is yes, ask them, “Hey, what’s maybe one or two strategies I can implement into my life this week that will help my nutrition?” If that practitioner does not know, then you might ask for a referral to someone to help them with the nutrition part of things.

20:00  Dr. Tatta addresses the psychoneurological aspects by looking at sleep hygiene and developing a mindfulness-based stress reduction routine. He also recommends mindful based meditation and also acceptance and commitment training.

23:50  We changed course and I asked Dr. Tatta to take things from the practitioner side and explain how the busy Physical Therapist or Chiropractor can incorporate nutrition and the psychoneurological aspects of pain into a busy musculoskeletal practice.  Dr. Tatta recommended adding a question to your intake form like, “Are you interested in learning about how nutrition can improve your health?” Or, “are you interested in learning how nutrition can improve your pain?” That way you can see if this is something that your patient is open to learning more about and is ready to change their nutrition. If they are interested, you can start by asking them about added sugar in their diet. Then you can ask them if they know where the omega 3 fats are in their diet?  Dr. Tatta mentioned the Paleo diet and that ancient man had lots of omega 3 fats in their diet and they are anti-inflammatory. Dr. Tatta mentioned that he has a Functional Nutrition course coming out in a few months to train practitioners. He mentioned that when he sees a new patient, he may spend most or all of his first visit explaining to his patient about nutrition.

32:04  Dr. Tatta explained that when addressing the psychological aspects of pain into your practice, you need to assess and test the patient using a questionaire, like the Pain Catastrophizing Scale or the Tampa Kinesiophobia Scale.



Dr. Joe Tatta is a doctor of physical therapy, board certified nutrition specialist and functional medicine practitioner.  You can get additional information at his website, http://www.drjoetatta.com/   Dr. Tatta has a great podcast, The Healing Pain Podcast, which provides lots of information about healing pain naturally. And if you’re a practitioner, or you’re interested in getting certified, and ways to heal people naturally, from a mindfulness, cognitive-based aspect, you can go to theintegrativepainscienceinstitute.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 sports chiropractic work by calling his Santa Monica office 310-395-3111.


Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. This is Dr. Ben Weitz again, and for those of you who enjoy the Rational Wellness Podcast, please go to iTunes and give us a ratings and review so more people can find out about our podcast. Or, if you’d like to watch the video version, go to YouTube and become a YouTube subscriber to my Weitz Chiro, or you can look me up through Rational Wellness or Doctor Ben Weitz.

Anyway, today we are going to talk about pain. It’s the first time we’ve talked about this very, very important topic. And, we have Dr. Joe Tatta with us. And he’s a doctor of Physical Therapy, he’s also a board certified nutrition specialist and a functional medicine practitioner, like myself. And he specializes in treating persistent pain and lifestyle related musculoskeletal, metabolic, and autoimmune health issues.  He’s the host of the very successful The Healing Pain Podcast, and he has a number one best-selling book, Heal your Pain Now: A Revolutionary Program to Reset your Brain and Body for a Pain Free Life. He’s currently in private practice in New York, where I grew up, and also provides online health consulting to help people achieve a pain-free life, free from chronic disease. Joe, thank you so much for joining me today.

Dr. Tatta:             Hey Ben. It’s great to be here, thanks for having me on.

Dr. Weitz:            Great. So can you tell us about your journey from being a traditional physical therapist who typically see pain as a purely mechanical phenomenon, to seeing the role of diet and the brain in understanding what causes pain.

Dr. Tatta:             Yeah, it’s a great question to start with. And you know as a physical therapist, similar to chiropractors and other types of professionals out there, when you go to school, you get mostly a biomechanical framework of the human body as it relates to pain. So, things like range of motion strength, how joints move and glide and slide, all those types of things. And when it comes to treating pain we look at things like joint manipulation, joint mobilization, therapeutic exercise, and all those are extremely important when it comes to pain.  Somewhere within the evolution of my, I don’t know, 25 years in practice, I had kind of two epiphanies. One was, I don’t know how long ago, it may be fifteen years ago, and I looked around my clinic, and everyone was pretty obese. And, I did a little survey, sent to all the therapists. I think I had about … There were about five therapists working with me at the time. And I said, “Hey, let’s just do a quick little clinical study in our practice. Let’s see how many patients are overweight, that wind up in the overweight category, and let’s see how many patients are obese.” And it turned out something like 75 percent of our entire clinic caseload, the patients were obese.

And, that’s in line with the clinical data that we have. You start to look at people with osteoarthritis, rheumatoid arthritis, all the autoimmune diseases that, as you start to get inflamed, and you put extra weight on your body, you start to develop more types of pain syndromes. So that’s what kind of delved me … Or that’s what kind of took me to a deep dive into functional nutrition. Because exercise is only … It’s super important, don’t get me wrong. I’m a physical therapist, so of course I love exercise, but it’s only going to get you so far.  If you have someone who’s overweight, if you have someone who is obese, as a patient. If you have someone who has chronic inflammation, you’re starting to see there are certain things in their lab values that are pointing toward inflammation or inflammatory markers that, yes, exercise is going to help turn that around, but we have to look at nutrition as really one of the first steps in helping those patients.  So that’s kind of what made me get into functional nutrition, and start to study functional nutrition. Which is not common for a physical therapist.

Dr. Weitz:            Yeah.

Dr. Tatta:             Just about a year ago, I worked with the American Physical Therapy Association, actually changing our scope of practice. In saying, “Hey, as physical therapists, we should be screening and evaluating patients for challenges or problems with their nutrition. And, if it’s something that we feel like we can’t handle, then we can refer them on to the appropriate practitioner, but at least screen them and provide them with some basics.” I mean, every licensed healthcare practitioner, as well as health coaches, can do things like that.

So that was the nutrition. The other part, when we talk about the neuroscience behind pain, it is one … Again, when I went to school, I studied neuroanatomy. I studied neurophysiology. But, the field of pain science has exploded in probably the past about ten years. And, it has really started to inform all of our practice, as it relates to helping people with pain. And a lot of that relates to two things. One, it relates to an education piece, that we have a big role, as practitioners, to educate patients about what pain is, and what they can do to empower themselves. Nutrition is part of that, but the other part of it is about the brain and about stress. And how pain and stress are uniquely related, and you really can’t have one without the other, and what patients can do, and what practitioners can do to help educate their patients and to help their patients with regard to helping them cope with the chronic pain that they’re having.

Dr. Weitz:            Yeah, it’s interesting you mentioned the weight. I know that … I remember looking at the literature five, ten years after I got out of school, and it didn’t seem like there was a lot of correlation between gaining weight, unless you really gained a lot of weight, and back pain. And then I was at the gym, and I grabbed a thirty pound dumbbell, and I was using it for something, and I thought, “Oh my god, can you imagine dragging this thing around all day long? Every time I do everything?” And, it made it obvious. This has got to put a stress and an extra load on the musculoskeletal system, on your spine, on … Just doing this all day long. I don’t care what the studies show. This has got to be a big negative for back pain.

Dr. Tatta:             Yeah, we did have, I think when … I graduated in 1996. So I’ve been practicing now for a number of years, and-

Dr. Weitz:            Yeah, I’ve been practicing thirty years as well. I started in ’88.

Dr. Tatta:             Yeah, and we didn’t have the research then, we really didn’t. Like back when I went to school, there was a lot of talk about, “We need more research, we need more research.” Now, pretty much, if you go into Google, you go into PubMed, and you put things in, something’s going to come up that’s going to start to inform some of the theories that you may have. There’s a great study, I can’t remember which journal it’s in, but they actually did a phone survey of a million people. And if you know anything about clinical studies, a million people is a huge study.

Dr. Weitz:            Yeah.

Dr. Tatta:             And they asked them really two key questions. One is, what’s your BMI? So what’s your Body Mass Index? Have you had pain within the past thirty days? And have you had pain within the past year? And those two questions, pain within the past thirty days, and pain within the past year, start to point to the fact that someone has chronic pain. The definition of chronic pain is pain that persists more than three months. And as the BMI goes up, the likelihood of someone having pain, or chronic pain syndrome, goes up well.

Now, weight on your joints is a big part of that. No one wants to carry around this spare tire. But, we also look at that body fat, or that fat around the midsection, the visceral fat, is inflammatory. When you look at CRP, C-reactive protein, or high sensitivity C-reactive protein in patients with back pain, have been noted to have higher levels of CRP that have back pain. So we have to look at the mechanical, so we have to look at things like movement, exercise, what type of postures are you sustaining for longs periods of time. But also looking at, how much weight are you carrying? Where is that weight distributed around your body? And, what does your diet look like?

Dr. Weitz:            Good, interesting. So, we could do the conventional approach that I usually use, which is, we go step-by-step through some of your system, and the strategies you lay out in your book. But I was thinking it might be more interesting to approach this interview this way. Since my goal of my podcast is to help educate both the layperson and the practitioner, I thought it would be an interesting exercise to go through, first as a layperson who ends up with pain of some kind. Let’s say I’ve had back pain off and on for a number of years. How would I approach it using your concepts and strategy in terms of looking at not only the mechanical causes, but the nutritional and mind-based strategy.

So, if I’m a patient with low back pain, and just had another episode, and I come in, and I go, “You know, Dr. Tatta, I’m sure you can fix me. But, I’m sick of this back pain. It just keeps coming back. And I was hardly doing anything, I was just tying my shoes, and now I’ve got to go through this whole thing again. I’ve got to wait weeks before I can get back to my activities.” So, what else should I be looking at? And when do I want to look at nutrition as playing a role in back pain?

Dr. Tatta:             Yeah, so, this will be good for first, anyone who suffers with pain. But, practitioners will also like this kind of quick framework also.

Dr. Weitz:            Great.

Dr. Tatta:             So, I think of three critical pieces. One is, what’s happening to your biology? Two is, what’s happening to your psychology? And three, what’s going on in your environment? So, one, what’s happening to your biology? Two, what’s happening to your psychology. And three, what’s happening in your environment.

Dr. Weitz:            Okay.

Dr. Tatta:             Now, the biology is, are you someone who could benefit from nutrition? Because nutrition affects the chemistry, the biology of your body. How do you know? One, are you overweight or obese? If you are, you can benefit from a nutritional intervention. Two, do you have some kind of metabolic factor, or some kind of metabolic test that we can look at? Things like high cholesterol, high LDL, high C-reactive protein. If there are inflammatory markers on your blood work, then nutrition’s a key.

Dr. Weitz:            Elevated blood sugar, yeah.

Dr. Tatta:             Yeah, HBA1C, the things like that. Third, when it comes to your biochemistry, is if you are diagnosed with an autoimmune disease, or one of your parents have an autoimmune disease that has caused them to have some kind of joint pain, or some type of chronic pain syndrome, you want to be really aware that that tends to run in families. And you may be predisposed to developing an autoimmune disease. Or, if you actually have one, that nutrition is definitely one of the first steps in helping heal and/or possibly reverse that autoimmune disease.

Dr. Weitz:            And, by the way, a lot of people are not even aware that they have an autoimmune disease. They just know that they have, for example, hypothyroidism, which is the most common autoimmune disease. And, the fact is is, in the United States, over ninety percent of patients with hypothyroidism is actually autoimmune in nature, known as Hashimoto’s. And so, not only patients who are aware of having an autoimmune disease, but autoimmune diseases, they may not be aware of. They may just think they have some flakiness on your skin. Or they just have psoriasis on your skin. That’s an autoimmune condition. So there’s a whole range of autoimmune conditions that people don’t realize. And when you factor those in, there’s a huge percentage of the population with autoimmune disease.  Go ahead, sorry-

Dr. Tatta:             No, that’s … They’re great points.

Dr. Weitz:            Yeah.

Dr. Tatta:             I’ll give one more caveat to that biology section, that bio part. And, it’s a diagnosis that doesn’t really fit clearly into any one category. And that would be fibromyalgia. So, we can look at fibromyalgia from the lens of a central nervous system disorder. Where the brain and central nervous system have a difficult time processing pain in the normal way. We can look at fibromyalgia from more of an endocrine perspective. We can look at fibromyalgia from more of a gut nutritional perspective. And, the real part about fibromyalgia is that it will traverse all of those things.  So, fibromyalgia is going to be in every category. But, nutrition can be a wonderful place for those with fibromyalgia to begin as well. It may not cure some with fibromyalgia, but it’s definitely going to be the first stepping stone.

Dr. Weitz:            And by the way, fibromyalgia’s often … The person comes in who says, “You know, I just hurt everywheres. I’m sore up and down my back, my arms, my legs,” right?

Dr. Tatta:             Yeah, that’s right. That’s right.

Dr. Weitz:            Yeah.

Dr. Tatta:             So that’s the bio. Two, looking at our psychology. So, if you are someone who has, or had, anxiety, those with high levels or anxiety are predisposed to developing chronic pain type syndromes. And it makes sense. If you think about general anxiety, those with anxiety get tense. Their HPA access, or the hypothalamic pituitary adrenal access, is often in overdrive. And they have very high cortisol levels. When you have high cortisol levels, a number of things happen in the body. It affects your digestion. You develop leaky gut. The motility of your digestion tends to slow, so people tend to become constipated. They don’t have a bowel movement as frequently, which leads to things like toxicity.  Having anxiety leads to muscle tension and tightness throughout the body, especially the muscles around the spine. Having anxiety often leads to sleep disturbances. So, looking at psychology, looking at things like anxiety. After that, looking at things like depression. So those with chronic pain often … Upwards of fifty percent, if you look at studies, struggle with depression. And it’s difficult to figure out whether that’s chicken or the egg. Did depression start first and then the chronic pain? Or did the chronic pain start first and then the depression?  I like to think, and this is not true for everyone, but for a lot of patients, the depression started second. Because oftentimes people have dealt with chronic pain for so long and have struggled to find an answer. Struggled to find a clinician who will work with them one-on-one, listen to them, treat them as an individual. And when you’ve been in that kind of tug-of-war with pain for a long time, it gets exhausting. And that’s why you see people with not only chronic pain, but chronic fatigue.

So, anxiety, depression. The third one I put under the psychological realm. Or anyone that has kind of an early life trauma. So, if you come from a family where there was divorce and trauma. If there was a parent who was abusive, if there was addiction, if you struggled with things like bullying, problems in childhood. Any type of adverse childhood experience can predispose you to having chronic pain.  And what happens with that, is it wires your nervous system. The nervous system becomes very sensitized. It becomes very sensitive to any kind of input. So, normal movement, or one night of poor sleep, can cause the nervous system to become very excited, and the nervous system creates pain as a warning sign. It’s this warning sign that there’s something wrong in your life, in your environment, and pain is ultimately something needs to be taken care of.

So that’s the bio. We did the psycho, or the psychological. And then the environmental, or what technically is called the social part, is what’s happening in your environment. Do you have nurturing relationships? Do you have a stress reduction routine that you implement? For those with chronic pain it may be daily, but most of us should be doing something at least twice a week that lowers our stress level. Do you have an outlet for joy and things that make you happy and give you purpose in life?  When you’re just going … And, we’ve all been there, Ben. Right? We’ve all been there … Times in our life where we had to work hard, we had to work extra, we had to be in school and have a job, we had to have a job and raise the kids, and put extra hours in at the office. But, there’s times where we have to sit back and say, “Hey, I’m only human. And I need to figure out how can I alleviate my stress, how can I find an outlet for purpose and passion in my life?” And once you find those things, pain starts to quiet down and relax.

Dr. Weitz:            So as a patient, what should I do? Let’s say I go to traditional physical therapists who’s says, “You strained your back,” or, “You have X diagnosis, you have,” whatever, “A bulging disk.” And, “Here, you need to do these exercises. You need to take ice.” Or you go to chiropractor and he says you need to come in twice a week for adjustments, and manipulative care, and other therapies. And then you need to do these exercises, et cetera. What do I do about the nutrition part?

Dr. Tatta:             Yeah, so, movement and manual therapy is wonderful. And it’s often a first step in the care of pain. And, movement of course, makes you stronger, it makes you more flexible, it helps you function. But, movement also helps to promote relaxation. Movement also helps enhance your mood. Movement also helps decrease your fear about moving again. So movement has the biomechanical parts, but it also has some of the psychological parts in there. So if you’re seeing a physical therapist or a chiropractor, and movement is part of your routine, awesome. Keep it in there and keep up the good work.

If you’re seeing a professional that is not up-to-date on some of the latest pain science techniques, then there’s a couple of key questions you may want to ask them. You may want to ask them, “Is there a place for nutrition in my rehabilitation?” And, if the answer is yes, ask them, “Hey, what’s maybe one or two strategies I can implement into my life this week that will help my nutrition?”  Oftentimes, like if you’re online and you’re watching a podcast, or watching a summit, there’s all sorts of biochemistry information, all sorts of supplements, all sorts of different diets. Oftentimes it could just be one or two simple things that you start to do on a weekly basis that can help you reverse your pain. So, ask your practitioner, “Does nutrition play a role in pain? Does it play a role in my type of pain? Can you help me? And if you can’t help me, can you refer me to someone who might be able to help me with nutrition?”  So that would be my recommendation to a patient if they’re talking to any kind of practitioner about their pain and what their course of treatment would include.

Dr. Weitz:            Okay. Well what about some of the mental aspects of pain? Should I be concerned about that? Does that really matter?

Dr. Tatta:             You should. Because pain, the definition-

Dr. Weitz:            What do I do about it?

Dr. Tatta:             Yeah, you definitely should. The definition of pain is that it’s both that physical experience, as well as that emotional experience. So, the first thing is to look at sleep. You don’t necessarily need to go to a practitioner if you have challenges with sleep. But if you’re not sleeping at least seven hours a night, then you’re going to be more predisposed to having things like anxiety, depression, problems with stress reduction. So, go to bed and wake up at the same time every day. So, let’s say you’re in bed by 10:30, and you’re up by, let’s say, 6:30. Make sure you have that set routine every day of the week, even on the weekends.  Big thing with all my patients, and I even notice it with my friends and family, is that phone, that television, the computer, the laptop, the iPad. We can go down the list of all these things, they really need to start to be powered down around 9:30 because that blue light keeps you wired. All of us are on computers all day long, and we don’t realize how stimulating it really can be. So, shut those down. I love to tell patients like start a nice little gentle stretch routine at night, some mindfulness meditations, five or ten minutes before you go to bed, is a wonderful thing to help you relax your nervous system. And then, start to get in bed … And, really bed is meant for two things. Sleep and sex. So that’s what the bedroom is meant for. Set it up for that. So, make time for sleep, make time for sex as well, and enjoy your bedtime.

The other thing I did mention along with that is, when we talk about the brain and pain, or the emotional or the cognitive psychological aspects of pain, it doesn’t necessarily mean that you have to run out and see a psychologist. It doesn’t mean that you’re crazy. It doesn’t mean there’s anything wrong with you. And in fact, developing a mindfulness-based stress reduction routine, whether it’s ten minutes in the morning, or ten minutes in the evening, has been shown to decrease pain, and the pain actually stays away almost indefinitely in a lot of the studies. So, that’s easy. You can find things online. I have downloads on my website, I talk about it in my book. They’re really easy, simple things that people can do for themselves.

Dr. Weitz:            Yeah, I noticed you talked about graded motor imagery, overcoming negative thoughts, embracing forgiveness and acceptance, acceptance and commitment therapy, which is a form of cognitive behavioral therapy, and then you also mention the mindful meditation techniques.

Dr. Tatta:             Yeah, mindful meditation is my first go-to.

Dr. Weitz:            Okay.

Dr. Tatta:             So again, you can find the downloads on that. I have some free things on my website. If that doesn’t do it, so if you develop a mindfulness-based routine, let’s say for ten to twenty minutes a day, and you don’t feel like your pain’s going to get any better. You find that you’re still kind of really attached to thoughts of like, “I feel like I’m disabled, I feel like I’m never going to get better, this pain is never going to go away.” Then, I love what’s called acceptance and commitment therapy, or acceptance and commitment training. Which I’m actually going to have a course available for practitioners in a couple months on that. so, it’s not like traditional cognitive behavioral therapy. It takes mindfulness-based principles, but it takes them kind of to a different level that lays them over your specific problems with pain.

So it takes mindfulness, but puts it over a kind of psychological framework that really helps people look at pain in a different way. Where they say, “Okay. I have pain, everyone has pain, how can I learn to approach this pain in a way that doesn’t scare me? How can I learn to approach this pain in a way where I can be willing to maybe start to move a little bit, even though I have a little bit of soreness, where I can accept the fact that I have to make some changes to my diet. I can start to work on my thought patterns and my emotions that are related to pain.” Acceptance commitment therapy is a really wonderful way for people to kind of go one step deeper into mindfulness.

Dr. Weitz:            Cool. So now, let’s reverse course here. And let’s talk to the practitioner out there. Let’s say the conventional physical therapist who’s treating patients for neck pain, and knee problems, and rehabbing them after shoulder surgery, etcetera. Or the chiropractor who’s treating patients for various musculoskeletal pain. How do they go about incorporating nutrition into their practice? Even if they believe in it, considering all the parameters related to trying to run a practice and cover your rent. How do you incorporate nutrition into a musculoskeletal practice?

Dr. Tatta:             Yeah, it’s a great question. And, I want to preface to practitioners that, nutrition is a huge field. But, the principles to help patients can be quite easy. And you can really work them into your practice with a couple of simple steps. The first one, and you can just put this on your intake form, is just a simple question that you pose to your patient. Are you interested in learning about how nutrition can improve your health? Or, are you interested in learning how nutrition can improve your pain?  That question alone can be really powerful. Because, even if you love nutrition, and you’ve tried it on yourself, and you’ve studied it for months and years and read all the books out there and followed all our great podcasts and information, if your patient’s not ready, that readiness for change, if they’re not ready, then there’s no point in really going there. So one is, see where the patient’s readiness is. If they say, “Yes, I’m interested,” then you say, “Okay, I have a couple of questions for you.”  One is, “Do you add sugar to any of your food?” That can be your coffee in the morning, that can be your sugar in the morning, that can be your cakes and desserts that maybe you’re making, things like that. Or you can ask people, “Do you know where the added sugar is in your diet?” Because sugar probably is the biggest pro-inflammatory food that we have. And obviously it leads to things like pre-diabetes, diabetes, and all the other metabolic and autoimmune diseases that we spoke about. So, just turning people on to sugar is a great way to help them with their weight reduction, and weight maintenance. It’s also a great way to help decrease the inflammation in their body.

After that, I would really turn toward a brief intervention on omega-3 fatty acids. And asking people if they know where the healthy fats are in their diet. When you look at the Paleolithic Diet, the Paleo Diet, which people have heard about, and patients even read books on it, ancient man or Paleo man, probably had about ten thousand milligrams of omega-3 fatty acids in their diet, that came from a combination of plant food, and obviously, fish.  Now, so many Americans don’t eat plant foods. And, a lot of Americans don’t eat fish. When you look at the benefits of the Mediterranean diet, it’s that … One of the key benefits of the Mediterranean diet is that they consume fish two to three times a week. Steadily, every day, and they’re rich in omega-3 fatty acids. Those omega-3 fatty acids are inflammatory. They work on the same pathway in your body as Advil does. Or the non-steroid anti-inflammatories do. Except, they have no side effects. You can’t hurt someone with salmon, scallops, and some shrimp. Or, an omega-3 fatty acid.

Dr. Weitz:            And, by the way, grass fed beef would also contain omega-3s because there are omega-3s in the grass, whereas conventionally raised cattles, which are being fed cornmeal, which is high in omega-6, grass fed cows are eating a lot of grass, and that incorporates more omega-3s into their meat.

Dr. Tatta:             That’s right. And, a lot of patients … They don’t realize that they’re not consuming fish, or they’re not consuming grass fed raised beef. And, just opening them up to those things. And they’re simple because they can go to the store, they can purchase that, they can look at packages and read labels. And they feel like they’re empowering themselves with a way to help themselves.  Once you start taking out the sugar, once you start taking out the processed food, you start putting in a little bit more vegetables, some fruit, fish three times a week, people’s weight starts to drop. They start to feel better, sometimes within three to seven days, which is really a fast turnaround for a lot of patients who have had pain. And the only thing about patients who have pain is they realize it fast. They’re very in tune with their bodies. They know what they feel like on a daily basis, and once they start to get relief, they realize it, and they’re like, “Wow, I had no idea that salmon a couple times a week, as well as some scallops, really could make a difference in my life.”  As a practitioner, after that, then kind of separate. You can start to venture into some of the supplements. That takes a little bit more education. Because you need to educated about what supplements are important, what supplements to use first, what supplements are a bunch of hoo-hah. Because there’s a lot of things out there that have some claims on them that probably aren’t really substantiated. But, after that, you get into supplements, and supplements have a definite place in your practice as a practitioner.

Dr. Weitz:            What about doing a full blown, functional medicine, treatment plan for them? Having them come in on a separate day, or at a different time, or bringing in a nutritionist?

Dr. Tatta:             You can do that, of course. If you want to build an integrated practice, you can bring in a nutritionist, or a dietician, or a health coach. Or you can train yourself in functional nutrition. I have a functional nutrition course coming out in a couple months for practitioners where I train them on that. And I think for a lot of practitioners that it fits so beautifully into a musculoskeletal practice. Because you can do the manual therapy, the exercise, and work in functional nutrition, the functional medicine aspect of it as well.

Dr. Weitz:            After all, it’s a little difficult, when you’re on the floor trying to show the patient some exercise, explaining the intricacies of the Paleo Diet.

Dr. Tatta:             That’s right. I mean, what I tell … A lot of PTs ask me now, like how much nutrition do you do? And I say, “Well, show me the patient you’re talking about first. Who’s in front of me?” And a lot of times now, if I ask someone … If someone comes to me and they’re overweight, plus they have rheumatoid arthritis, and I ask them, “Are you interested in nutrition?” They say, “Yes.” Then, the first one or two visits, I may just spend on nutrition. I may not do any joint mobilization, I may not do any exercise. It may just be nutrition, and lay that groundwork first. Because the patient’s going to go home everyday and they’re going to work on their nutrition. So-

Dr. Weitz:            If we talking to practitioners right now, how does that fit into the model?  So, how do you make that work [financially]?

Dr. Tatta:             Yeah, it depends. I mean, I have a cash-based practice.

Dr. Weitz:            Oh, okay.

Dr. Tatta:             Patients come to me, they know that I’m out of the network. They know they’re going to pay cash for it. There are certain insurance companies that will reimburse for one or two … It usually falls under education. Or nutrition consultation. But, you’re right. Nutrition is not really something that gets reimbursed by a lot of insurance companies or Medicare.

Sometimes the most important thing we can do for people is education. And there’s a lot of education that goes into a nutritional consultation. And, that first visit, if you can get a lot of education in around food, diet, what they should be eating, what their plate should look like, what they should be putting in their shopping cart, what they should be feeding their kids, how to look at a menu when they go out to eat. And say, “Okay, this is not good for me. These are better options for me.” At that first visit, may be well spent by just using that first visit and billing it as patient education, or billing as nutritional consultation. Before you get into, let’s say the lumbar stabilization exercises, or the manipulation or the manual therapy, whatever it is that’s part of your practice, it really does have its place. I also think that, let’s also be ahead of the curve. So as practitioners, let’s also say that within a couple years, insurance companies are going to have to wake up to the fact that we have a hundred million Americans with chronic pain. Probably two thirds of every American is overweight or obese. These two types of conditions or diagnoses are intimately related. And nutrition probably should be the first place we go for a lot of patients. So, we need to start to practice what we preach.

Dr. Weitz:            Certainly what you’re saying made sense, but whether insurance companies are going to start reimbursing doctors for time spent for preventing some of these issues, I’ll believe it when I see it. So, how can a practitioner work in some of these mind-reprogramming techniques? Is it enough to just say to the patient, “I want you to visualize your pain going away,” or, “I want you to have a positive mindset,” Or, do you need to sit down and go through some of these exercises with them and really explain and do you need to do psychological session with them? Or sessions?

Dr. Tatta:             Yes, you don’t need to be a psychologist, or a mental health practitioner, but you do need to assess, and you do need to test. There are two really simple things you can use to do that. One is called the Pain Catastrophizing Scale. It’s a really simple test you can give the patient. I think it’s about ten or fifteen questions. That ask them information about what their thoughts are related to their pain. And it looks at things like how they ruminate about pain how many negative thoughts they have about pain. And if they have a score that’s significant, usually above a thirty, then it tells you that they oftentimes think about their pain. They ruminate about their pain. And when they become kind of attached, or kind of stuck to those negative thoughts, it makes pain worse.  So, the pain catastrophizing scale is first.

Dr. Weitz:            Okay, would you mind emailing that to me so I can include it in the show notes?

Dr. Tatta:             I sure will, yeah.

Dr. Weitz:            Thanks.

Dr. Tatta:             The second one is what’s called the Tampa Kinesiophobia Scale. And I can email you that as well.

Dr. Weitz:            Great.

Dr. Tatta:             And what that does, that looks at someone’s fear of movement. And, when you think about patients who are not compliant, or they’re scared to begin to exercise, because they have pain, usually it’s because they fear that exercise is going to make them worse. So we know that exercise can be really powerful, but at times it can be really difficult to have the patient buy into that, so to speak. So this scale, the Tampa Kinesiophobia Scale, will tell you if that’s part of the patient’s problem. If fear is their overriding emotion that’s preventing them from moving at home, from doing their daily activities, from being compliant with the home exercise program.

So those are the two most important. A lot of it is just bringing awareness to the patient. So you can actually go through those tests with your patient and explain to them, and say, “Hey, it’s totally normal that you have some fear around pain. Just realize that, when you have that fear, it prevents you from exercise. What we’re going to do together is I’m going to start you on a nice, gentle exercise program. That’s going to build day by day, or week by week. And, it should make you feel better. You may have a little bit of soreness after doing some more exercises, but you shouldn’t have intense pain for days. If you do, just let me know. But realize that, exercise has effects on your body, it also has effects on your mood, and your psychology. It makes you feel better as you start to move. So give me a couple weeks, let’s develop the exercise program together. Find a type of exercise that works for you. And over time, the fear and the anxiety that you have will decrease.”  So those are the two things that you can … Again, you can put that into your paperwork, into your initial intake paperwork to see how someone’s doing.

Dr. Weitz:            That’s great. So I think that’s pretty good. A valuable amount of information about pain, and how we should think about it. How both patients should think about overcoming pain, and how a practitioner can think about how we can incorporate nutrition and some of these mindful-based strategies into their practice as well. So, I thank you for that. How can patients and/or practitioners get a hold of you to get more information about your programs that are available, or you’re developing, as well as about your practice?

Dr. Tatta:             Yeah, everyone can find me on my website, doctorjoetatta.com. I have a great podcast, as you mentioned before, called The Healing Pain podcast. Which has tons of free information about healing pain naturally. And if you’re a practitioner, or you’re interested in getting certified, and ways to heal people naturally, from a kind of mindfulness, cognitive-based … The biopsychosocial aspect, you can go to theintegrativepainscienceinstitute.com.

Dr. Weitz:            Cool. Great. Thank you, Joe.

Dr. Tatta:             Thanks Ben, great being here with you.

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

Natural Childbirth with Midwife Anne Margolis: Rational Wellness Podcast Episode 57

Anne Margolis, midwife, talks about how to have natural childbirth with Dr. Ben Weitz.

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


Podcast Highlights

2:14  Anne Margolis explained that she started out as an Obstetric nurse and she developed “fear of birth”.  She saw that many of the routine interventions that occur in a hospital to healthy women resulted in more interventions and surgeries and turned what should be a natural process into a crisis situation. She got pregnant and was going to have her first baby at the hospital where she worked. First she was told to take her clothes off and put a hospital gown on, which seems innocuous, but it disempowers the patient. Then she was told not to eat or drink, and no one running a marathon would go without fuel or hydration and having a baby is like running a marathon. Then she was attached to an IV and told she had to lie flat on her back and be attached to continuous fetal monitoring, which actually results in a lot of false positive fetal distress and this leads to more c-sections. The evidence shows that continuous monitoring has not improved outcomes or reduced oxygen deprivation or cerebral palsy.  Naturally, women need to labor in a more upright position with gravity helping the birth process. And they kept monitoring her and if she wasn’t dilating a centimeter per hour, they wanted to give her pitocin, which makes the labor harder, which she refused. But eventually she gave in and then they gave her an epidural and her baby’s heart rate bottomed out, so they ordered an emergency C-section. But it took an hour and the assistant surgeon hadn’t arrived yet and she thought her baby was brain dead from oxygen deprivation. She was traumatized and then she started pushing and gave birth waiting for the C-section. She suffered a PTSD birth trauma.

10:30  A friend suggested that she become a midwife and she had no idea what a midwife was and she looked into it and realized that this was for her.  Midwifery “restored the normalcy, it restored power back to the woman and her family. It restored the celebration, it restored the beauty.  We are experts in normal. Like our philosophy is birth is normal until proven otherwise, but we can certainly screen for problems and handle them. Simply we try to keep it simple, but what a difference. It was like night and day and the crisis and the emergencies became way more the exception and I was seeing that birth works. Like women can birth like they breathe.”

11:50  Anne spoke about going to a midwifery conference, where a French obstetrician asked “what is the best intervention that an obstetrician or a midwife can do during birth?” He said, “To knit.” During a normal birth, the best intervention is no intervention.

15:15  Anne explained that the US has the highest rates of maternal mortality, infant morbidity, and infant mortality of all the developed countries, as I pointed out in my intro. It’s not the case that people are significantly healthier in countries like Norway, but they have much fewer C-sections than we do. The average rate in the US in hospitals is over 30% and it is 50% in some hospitals. Women should be with midwifes rather than with obstetricians. 

18:44  I pointed out that this is kind of the problem with our whole healthcare system in general, is we’ve taken this acute care model of care and trying to extend it to everybody to well-patient care, to chronic conditions, and it doesn’t really work and your concept of midwifery is very much in tune with both a chiropractic concept and the functional medicine concept, which is to respect the wisdom of the body, intervene just enough to help the body to heal itself, rather than taking over and intervening when it’s not necessary. 

19:22  Anne said that the longer she is in practice, the more she has come to understand that “when she helps a woman to prepare in advance for her pregnancy and help her with her fear and boost her confidence and billions of women have birthed for thousands of years and while she’s birthing 300,000 are birthing and I really help her to tune into her intuitive, primal, sensual, instinctual, self, I am amazed. I just catch.” 

21:09  I asked if the fact that in the US we seem to have more older women trying to have babies using IVF and other medical interventions is responsible for the higher maternal mortality rates and Anne did not feel that this was a significant factor. 

22:04  Anne said that in our culture we always feel a need to numb any discomfort and we give too many epidurals, which increases the c-section rate. 

27:43  Anne explained how giving birth is like surfing. 

30:07  Anne talked about how some of the after birth procedures at the hospital are not ideal for the baby. As the baby is coming down the birth canal up to a third of its blood volume backs up into the placenta and at the hospital they immediately clamp and cut the umbilical cord, thus depriving the baby of its blood and the stem cells, the immune complexes, the iron, etc. You can wait till the cord stops pulsing or you can wait till the placenta comes out and then cut it.  In the hospital they take the baby away from Mom and put it under bright lights and do all these procedures like suctioning the lungs, etc. and the baby should just be left with Mom.

34:22  They give the Hepatitis B vaccine, which makes no sense unless Mom is positive, since a newborn infant has no chance of getting hepatitis. 

36:03  I asked Anne what she thought about circumcision and she said that it is genital mutilation and not evidence based care.


Midwife Anne Margolis  is a holistic, certified nurse midwife and Certified Clarity Breathwork Practitioner. She is dedicated to improving maternity and newborn care and experiences, preventing and healing birth trauma, and empowering women to give birth naturally and LOVE their experience. Her website is homesweethomebirth.com. She has written two #1 international best selling books, “Natural Birth Secrets.” (Here is a link to it https://www.amazon.com/dp/B0786WNWMJ)  and “Trauma Release Formula” (https://www.amazon.com/gp/product/B0786V4VXD/ref=as_li_qf_sp_asin_il_tl?ie=UTF8&tag=homesweehom0e-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B0786V4VXD&linkId=a2c7fdec4c3a635b3abc206976607cb6 ).  She also offers a comprehensive online course to help you ROCK your pregnancy to birth and new mama-hood in ALL settings,  leading you through the journey as she does with the families in her thriving local practice: http://homesweethomebirth.com/loveyourbirth/ . 

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


Podcast Transcripts

Dr. Weitz:            This is Dr. Dan Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to Rational Wellness podcast on iTunes and YouTube and sign up for my free 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 us again today and we have a very interesting topic. We’re gonna talk about birthing and all the issues related to that in the United States. I want to give you a little intro about this, but first I want to ask you, for those of you who enjoy the Rational Wellness podcast, please go iTunes and give us a rating review so more people can find out about it.

Okay, so, despite spending more than twice as much for healthcare as other developed countries, maternal mortality rates in the US are rising, they’re much higher than all these other countries and whereas maternal mortality rates are declining in other developed countries. So, for example, the maternal mortality rate in the US is 26.4 deaths for every 100,000 live births, whereas it is 3.8 in Finland and below 10 in every other advanced country except ours.  Infant mortality rates in the US are also significantly higher than in 20 other developed countries. To help give us some information about this topic as well as other information about how to have a healthy, happy birth, Anne Margolis is an international speaker, birth educator, certified nurse midwife, licensed OBGYN nurse practitioner for over 20 years. Hi Anne, welcome.

Anne Margolis:    Hi.

Dr. Weitz:            Can you tell us a little bit about yourself and how you decided to become a midwife?

Anne Margolis:    I started out as an OB nurse. Actually, my grandfather was an obstetrician, but I never thought I’d be in that world, you know I didn’t know. I ended up in nursing school and when I did my obstetric rotation in college I knew this is what I wanted to do. My first job, now this was back in the ’80s, my first job as an obstetric nurse I worked there about four years, and that was a regular, typical, standard hospital and that’s where I developed fear of birth.  I was having to rescue a lot of the problems caused by just routine interventions that are done to all healthy women walking in to have a baby, let alone people that have complications, but most women are healthy and having healthy pregnancies and they were just the routine care, which often led to a cascade of interventions that caused problems, that caused more intervention, and as the nurse I was having to rescue that and do that and I was having to be in more operating rooms than I ever imagined.  I never really saw natural birth like I was taught about in nursing school, so I had fear of birth. Birth was a crisis, it was an emergency waiting to happen, a disaster waiting to happen, it was a potential lawsuit. That was the experience on the unit where I worked.

Dr. Weitz:            How sad.

Anne Margolis:    That’s all I knew, right? There was no internet then. That’s all I knew and I was pregnant with my first baby on this unit, so I was given the royal treatment, “Oh, one of nurses is gonna have a baby,” but I was given the standard treatment. What I want to share with you is my experience because it’s still going on today despite all the evidence that the harm of this kind of care and this is what gave me the passion to do what I’m doing.  So I had fear but I went in and the first intervention that seems innocuous is I was told to take off my clothes in labor and put on a hospital gown, which is what we all do. It seems harmless, right? But that begins the dis-empowerment and I feel like sick when I’m a healthy woman having a baby. I didn’t really know this then. I’m now in a hospital gown, I’m dependent, disempowered, kinda of like an assembly line patient and now you guys know everything, I know nothing. That’s what happens when you put … so I tell all these people when they go into a hospital, keep your clothes on, retain your power, your individuality.

Anyway, so then I was told you can’t eat or drink and any athlete knows when you’re doing any sort of major event, it’s not wise, it’s actually totally not advised to go without oral fuel and hydration. I was attached to an IV and labor is a major physical event for the body. It’s like running the 26 mile marathon or climbing a big mountain. It’s very arduous so you need to be hydrated and nourished.  I was told I had to lie down flat and be attached to continuous electronic fetal monitoring, that now the electronic fetal monitoring that monitors every contraction and every fetal heart rate, they’re doing this routinely despite all the evidence that that has not done a thing to improve outcomes of baby, reduce cerebral palsy or oxygen deprivation, and issues with baby. It has only increased cesarean rates by three to five times that of having just the intermittent monitoring, which is equivalent but you’re not attached to anything.  Being told to lie flat on their back. No animal could labor that way. Naturally, women when they’re left to their own devices need gravity. We need to be upward, we need to be moving and it’s helping the baby navigate its way down the pelvis. You know the pelvis, as a chiropractor, is three bones connected by ligaments, so on the back it’s smaller capacity and in asymmetrical positions and lunges and rocking and all sorts of upward positions, the pelvic diameter can stretch and is the largest capacity.  So all these things, I was setting myself up. Already I did not labor well. I was put on a clock, so I had to dilate a centimeter an hour and every hour the doctor kept coming in sticking his hands up me and going outside and telling the nurse outside the door, “She’s still four, she’s till four and give her PIT,” at one point I heard. Now as a nurse I knew what that was. So when she comes in and puts that in my IV, like if I hadn’t been a nurse, they just do these things, but I’m like, “I don’t want pitocin. That’s gonna make everything harder, stronger.”

Dr. Weitz:            By the way, pitocin is a hormone that increases the strength of the contractions, right?

Anne Margolis:    It’s a synthetic version of the natural hormone in my body that would have done just fine if they would have left me alone. Yeah, it’s a synthetic hormone of what’s natural in the body, but yeah, it makes it stronger, harder and more intense, the contractions, to speed up the labor.  I told my colleague, the nurse that I work with, “I don’t want pitocin. I know what that’s gonna do,” and she says, “Oh, but honey,” and her response was well meaning, “You don’t want a cesarean do you?” and I’m like, “No …” you know I was an athlete myself and I’m a dance, I have yoga. I was scared of cesarean. I do not always see good outcomes during cesarean birth.  So I was kind of feared into it. I’m in a vulnerable situation now and then my coping went out the window. I heard them say, “Give her an epidural,” and once I had that epidural my daughter’s heart rate bottomed out so dangerously low that I see panic in everyone’s eyes. They call a stat emergency cesarean. As a nurse I know they have minutes to get my baby out.

I was now, my biggest fear happening, whisked off to the OR and waiting for the assistant surgeon. I was on the operating table all scrubbed and ready waiting for the assistant surgeon who never came. So I’m looking at the clock, I was alone, 10 minutes, 20 minutes, a half-an-hour, and 45 minutes, an hour. I had moved from utter fear to thinking that my baby is now oxygen damaged, gonna be a vegetable, to now dead. In that hour, that’s what I was convinced.

Dr. Weitz:            Wow.

Anne Margolis:    Yeah. I didn’t rationally know that in that time that the reason that continuous electronic fetal monitoring, one of things, why it’s not improving outcome and it just increases c-section is, is a lot of false diagnosis of fetal distress when there is one, but I didn’t … so I started pushing when I was an hour into that from the medication and I called for help. The doctor comes running and he’s in a frenzy, “Get me a vacuum,” he’s calling to the staff and he cut a big episiotomy and vacuumed, he suctioned her head out.  I couldn’t look at her. I was afraid of what I was gonna see and she’s pink and breathing and like not phased by this apparently. She was fine. I was not fine. Now I know I had all the symptoms of what they call PTSD birth trauma, when you undergo such a horrific situation. The nightmares, I couldn’t talk or think about it, any kind of trigger would trigger this whole sympathetic nervous system torture in my body and I was scared to back and see.

That happened, the same kind of birth I had a second time, just like that. So it was between that and experience and my working there and I was talking to a friend about my frustrations about this and she says, “Why don’t you be a midwife?” and I literally said, “What’s a midwife?” and she started telling me and I went to the library and it was like, I came home.  I came home and I applied and I went to midwifery school and it was like the whole experience … as midwives, the training is expensive training. In New York you have to have a masters degree, it’s postgraduate training and you have to be nurse, you know, bachelors of nursing and then a masters degree. It restored the normalcy, it restored power back to the woman and her family. It restored the celebration, it restored the beauty.  We are experts in normal. Like our philosophy is birth is normal until proven otherwise, but we can certainly screen for problems and handle them. Simply we try to keep it simple, but what a difference. It was like night and day and the crisis and the emergencies became way more the exception and I was seeing that birth works. Like women can birth like they breathe.

I remember going to a midwifery conference, a big packed midwifery conference and there was an obstetrician speaking, beloved obstetrician, he’s a French obstetrician, he works in England now and he said, “What is the best intervention that a midwife can do at a birth … or an obstetrician?” He was speaking to midwives but “an attendant obstetrician or midwife can do at a birth?”  His answer is brilliant. He said, and it’s kinda funny but it’s brilliant. He said, “To knit, K-N-I-T.” That is because, first of all evidence-based care is that when a healthy woman goes into labor, first do no harm. Medical intervention is not warranted. The best intervention is no intervention. Women birth like we breathe, like our heart beats, like we go to the bathroom. If nothing is wrong, don’t fix it. The Hippocrates Oath when doctors take their … in training doctors take their graduation oath. Part of that is first do no harm. So when all is going well, no intervention.  But to knit is brilliant because it’s this calm, seasoned midwife whose seen thousands of births and knows that everything is fine and she’s with the woman and she’s so calm that she can knit and that laboring woman is so receptive to the calm. If she sees that calm that’s exuding, she’ll feel calm and she’ll labor well because a fearful animal or a fearful woman or a tense woman, if there’s tension in the room, she won’t labor well. The knitting keeps an attendant’s hands occupied ’cause nurses and midwives and doctors, sometimes they need to like fix something when they’re in labor, you know, do something with their hands and nothing is broken so you don’t need to … so it just kinda keeps the hands occupied with the eyes open, heart is open, ears are open and mouth is open.  Of course, encouraging words when she doubts her strength, but she can put the knitting down if necessary, but that’s the best intervention at a birth. I thought it was brilliant coming from an obstetrician and I believed in all this.

So when I had my second two babies the midwifery way I was still scared because I believed in it but because of what happened to me, the trauma that I had gone through and what I had seen I had to feel it within me, experience it myself, for me to authentically promote this for other women. Oh my gosh, I remember my midwife saying, “Oh, you’ll be fine,” and it was beautiful. It was a beautiful experience and it was very healing. I felt very well supported. My body just worked and she was there as a lifeguard but she just allowed and supported my body to do what it knew how to do.  So now I can authentically and I became very … I opened up my own practice. I worked in a hospital practice for a while and then I opened up my own practice. The hospital practice where I worked, which is the kind of practice model that gets the best outcomes, so I wanted to address your opening about how our country is ranking. We have hard statistics in our country. We rank among the highest compared to developed nations in maternal mortality, newborn mortality and morbidity, despite being most technically advanced, having very high cesarean section rates, twice that of Europe, spending more money.

So what’s the common denominator in these countries like Finland and Sweden and Holland, Japan? Why are these countries with very similar demographics, it’s not like they’re healthier over there, right?  Why are they doing so much better? So Dr. Marzden Wagner, he’s a perinatologist, high-risk obstetrician, a former Director of the Maternal Fetal Health Department of the World health Organization, written many peer reviewed articles, very scholarly books and articles and he’s a big proponent of midwifery because he says, “The common denominator in these other countries, when a healthy woman is having a pregnancy, she never sees an obstetrician because healthy women need experts in normal and that’s what the midwife is.”  The obstetrician we need thankfully, and they work together in a team, but they are needed for the high-risk situations, like if the woman has heart disease and she’s pregnant, if a woman has insulin dependent diabetes and she’s pregnant, if there’s triplets. That’s their expertise, they go to medical school, they’re surgeons, they learn how to deal with complications and disease and treat them medically and surgically. Part of holistic care is sometimes we need that. My cesarean section rate is 5%. There is a time and a place for cesarean birth. It should not be 30% and higher, which is the national average. Some hospitals around here could be 40%, 50%, around the country too.  So what he said is the common denominator is that both are using their expertise, serving the entire childbearing population, but when you have in the United States this high-risk kind of care, high use of surgery and medical and surgical interventions and technology applied to just the healthy women and babies, then you get the risk and the poor outcome that you’re seeing. That’s the practice where I worked. It was this team obstetricians and they just, “Just call us when there’s a problem.”  They even wanted, somebody, let’s say, who high blood pressure, insulin dependent diabetes, they even wanted them to get midwifery care and they would just deal with the medical issue or, “Just call us when surgery is needed.” It was that teamwork, not that one is bad, one is good. It depends on the mom, what that mom needs, but the vast majority of women having babies are healthy and they benefit most from no intervention.

Dr. Weitz:            Yeah, and I think this is kind of the problem with our whole healthcare system in general, is we’ve taken this acute care model of care and trying to extend it to everybody to well-patient care, to chronic conditions, and it doesn’t really work and your concept of midwifery is very much in tune with both a chiropractic concept and the functional medicine concept, which is to respect the wisdom of the body, intervene just enough to help the body to heal itself, rather than taking over and intervening when it’s not necessary.

Anne Margolis:    Right. I’ve been a midwife 22 years. The more I practice the more I’m in awe of how little I have to do. I mean I have a lot to do in terms of there’s a lot of fear now, women have a lot of fear, they lack confidence, there’s a lot of myths, and misunderstanding, but when I help a woman to prepare in advance for her pregnancy and help her with her fear and boost her confidence and billions of women have birthed for thousands of years and while she’s birthing 300,000 are birthing and I really help her to tune into her intuitive, primal, sensual, instinctual, self, I am amazed. I just catch.

Dr. Weitz:            Great.

Anne Margolis:    My presence is there. I’m a lifeguard. Sometimes I do have to intervene, but it could be simple like, “Let’s get up and dance. Let’s go for a walk, go in the shower, make sure you’re eating and drinking.” It could be very simple stuff like that that just … that’s all you need.

Dr. Weitz:            That’s great. How much do you think the higher maternal mortality rate has to do with the rising rates of c-sections, essentially turning a natural process into a surgical procedure.

Anne Margolis:    Huge correlation. That’s major abdominal surgery. Most other surgeries they’re trying to make more laparoscopic, they’re trying to make the incision less, but this is like a total, major abdominal surgery and it has huge risk. Unfortunately that’s hugely responsible for the high mortality rate in this country.

Dr. Weitz:            To play devil’s advocate a little bit and I don’t really know what the difference is between the US and these other developed countries, but is some of this potentially related to the fact that we use … and I don’t know that this is the case, I’m just speculating, we use more in vitro procedures, maybe in higher risk populations, using hormones and medical intervention in the first place.

Anne Margolis:    It is related to-

Dr. Weitz:            In other words do we have more risky complicated pregnancies to begin with?

Anne Margolis:    I don’t think IVF in a healthy woman, once a woman is pregnant it doesn’t increase her risk if she’s healthy.

Dr. Weitz:            Okay.

Anne Margolis:    No, no.

Dr. Weitz:            Okay.

Anne Margolis:    But what does increase the risk is like all the interventions, high rates of inductions, high rates of epidurals. There’s hospitals … we live in a culture that likes to numb. We’re not comfortable with discomfort.

Dr. Weitz:            Right.

Anne Margolis:    But I help women in my practice, whether through my practice or through my course or online consulting, I help them so that they can transcend the sensations, embrace the sensations. Just like if someone is running the 26 mile marathon, it’s not easy. I’m sure mile 10 or 5 or 12 or whatever it is something is hurting. They’re thinking, “I can’t do this.”

Dr. Weitz:            Right.

Anne Margolis:    A lot of athletes … I’m a dance, so I like to talk about professional dancing, things are hurting but their eye is on, “I’m gonna rock this,” or “I’m gonna win this for my team,” or “I can do this.” The beta endorphins and the hormonal recipe that’s going on when an athlete is running or when a woman is giving birth helps numb the sensations and a woman can tap into her strength and she can do it.  I have a 93% … like women in my practice, and they come from all walks of life, engineers, physicians, nurses, chiropractors, acupuncturists, corporate people, and they’re doing it naturally, 93%. That means that the majority of women are doing it naturally. Only 7% need to have medical or surgical intervention. My c-section rate is 5%, but I have not once had to transfer a woman to have an epidural because she could not cope with the pain of normal labor.

Dr. Weitz:            Now I’m sure a lot of women when they consider natural childbirth are gonna say, “Well, if I’m not gonna get an epidural, what am I gonna do?”

Anne Margolis:    The problem is the epidural is contributing to high c-sections rates and all of the other and the hard statistics that we’re seeing.  Look, I’ve had epidurals my first two babies, but I so preferred having my third and fourth naturally. What a different experience. I’m working hard-

Dr. Weitz:            So the pain is not overwhelming?

Anne Margolis:    No. No, because I’m up, I’m moving, I’m in the shower and I’m also embracing it and it’s also I see labor for what it is and I help women to see labor for what it is. It’s the uterus, it’s coming and going in waves and it’s a healthy pain, it’s a pain of hard work. It’s not a pain of suffering. It’s not a pain of illness.

Dr. Weitz:            And when you have natural childbirth you’re an active participant as opposed to a passive-

Anne Margolis:    Yeah, we need to woman to be an active and she moves in positions to help the baby… and her body is giving her messages to move in a different position, not just to help her cope, but help the baby physically navigate its way down.  Not even one person in my 20 plus years of my own practice have I had to have transferred because she needed an epidural for normal labor. You need to be well prepared, but just even seeing labor for what it is. Like here’s an example. Do you have kids?

Dr. Weitz:            Yes, I have two older kids.

Anne Margolis:    Okay, so you’ve seen labor unless she-

Dr. Weitz:            No, I have, yeah.

Anne Margolis:    Right. So in the beginning the wave comes and it’s like … I like to call it wave because contraction implies tension and it’s not completely accurate ’cause the top of the uterus contracts so the bottom can open, so it would be just the same to call it expansions, but hypno-birthing, they call it surges and waves. You can call it waves. I’ve had women make up names like hugs to the baby. You can play around with it. Why not have fun? Why not make it like an adventure of a lifetime, you know”

Dr. Weitz:            Right.

Anne Margolis:    I’ve had women be in ecstasy with their pain, I’ve been people have explained their … I’m in the documentary “Orgasmic Birth” not that women are having orgasms in birth, but they’re tapping into their sensual and their experience is orgasmic because they’re doing it on their own and they’re so darn proud of themselves and they’re being honored and treated like a goddess in a warrior-like. The power is restored to them, you know? Yes, they need support.  Anyway it’s seeing labor for what it is. So yeah, the contraction, the wave builds in the beginning and it reaches a peak and then it comes down again and in the beginning that might be 15 seconds and then there’s not another one for 10, 20 minutes and they’re mild, you can talk through them, and it gradually builds. So at the max peak intensity the wave is 60-90 seconds and coming every two, three minutes, but the peak is really where it’s the most intense and I’m like you can do anything for like 45 seconds, right?

Dr. Weitz:            Right.

Anne Margolis:    So get a now clock instead of saying one, two, three, four five, just say now, now, now and you just stay in that one. I teach women and women can learn coping, relaxation, grounding, visualization or just sort of surrendering to it, like, wow. Any surfer knows, when you fight the wave it will knock you down, but if you just ride the wave it will just take you.

Dr. Weitz:            That’s great. Childbirth like surfing.

Anne Margolis:    It’s so similar.

Dr. Weitz:            Yeah.

Anne Margolis:    And there comes a point and it’s part of like this psychological different stages of early labor versus when labor gets more intense right before the baby is born, women will say to me, and these are women, hardcore … I’ve had women chiropractors, husbands that … a homeopath and natural, natural, natural and she’s in transition, she’s in the last part of labor and she’s like, “I want a cesarean. I can’t,” and I’m like, “That’s great. Baby is coming soon.” I’ve prepared them that they’re gonna think they can’t at the end.

Dr. Weitz:            Right.

Anne Margolis:    That’s just a normal part of the emotional symptoms of having such intense sensations and it’s when I encourage them to just, “You know what? I got you. Just go into it. Dive right into it.” Mindfulness practices, meditative, just dive right into it, or women will sing their baby out or dance their baby out, like sort of pleasure overrides the intensity of it. Just give into it and then they find the actual fear of feeling was actually worse than the actual sensation and then they birth and then it’s gone, it’s done. Then the real work begins, creating healthy, normal children in this world.

Dr. Weitz:            So why don’t they let women eat or drink?

Anne Margolis:    That’s not evidence-based care. Add it to the list because of the rare need for general anesthesia in an emergency that if she were to have food in her upper GI tract.

Dr. Weitz:            Esophagus, yeah.

Anne Margolis:    Yeah, she would aspirate, but actually the food would make it … it wouldn’t affect, meaning the evidence according to all the scientific evidence, it is beneficial for women to eat and drink in labor and it’s harmful to deprive them of food and drink.

Dr. Weitz:            And even if they were to end up with a cesarean section, most of the time they use an epidural, right?

Anne Margolis:    Yeah.

Dr. Weitz:            Okay. So can you talk about some of the processes that occur after the kid is born and how the hospital handles it compared to how it should ideally naturally be handled?

Anne Margolis:    Yeah, one of my pet peeves is the cord clamping. We’re the one species on the planet that cut cords. Animals don’t cut cords. Animals give birth, it’s just not complicated and it’s cool because like dolphins, they have female dolphins that surround them, like dueling them or midwifing them. Lamas, the pack surrounds them.

Dr. Weitz:            But we got to schedule, the insurance, and we got to get to the bottom line.

Anne Margolis:    Yeah bottom line but unfortunately it’s not serving the mom and her family and the baby. Yeah, one of my big pet peeve I have is that … so a third of the blood volume of the baby, that’s a lot of baby blood volume-

Dr. Weitz:            Wow.

Anne Margolis:    Backs up into the placenta as the mom is pushing, as the baby is coming through the pelvis and when the baby is born, the baby needs that blood back. I don’t know when this, why this started happening … in the early 1900s when birth was moved to the hospital that the cord was just clamped so the baby was deprived of a third of its blood volume, which is equivalent to a hemorrhage that no one sees.

Dr. Weitz:            Wow.

Anne Margolis:    So those babies were lacking the stem cells and oxygen to transition, the blood volume to transition, all the immune components, iron.

Dr. Weitz:            Colostrum, yeah.

Anne Margolis:    Well the colostrum is in the breast milk.

Dr. Weitz:            Okay.

Anne Margolis:    This is their blood. So that’s a big thing. If you’re gonna have a hospital birth make sure that’s evidence-based care. The process has worked for thousands of years, don’t cut the cord. Allow the cord to just give the baby back its blood volume. You can cut it when the cord stops pulsing or just want till the placenta’s birth, then cut it. That’s a big thing. 

They’re sticking, suctioning tubes down babies that are vigorous just to clear lung fluid. Babies in the womb, their lungs are collapsed and filled with fluid. They don’t need to breathe because the cord is giving the moms … mom breathes, it goes to her blood, and then the oxygen goes from her blood through the placenta to the baby through the cord. So the baby doesn’t need to use the lungs, but after the baby’s born and takes that first breath, the baby needs the blood volume and the oxygen from the cord to help as its transitioning, and the baby with that big squeeze through the vagina clears a lot of the long fluid, at least two-thirds of it and then the other third gets absorbed. Babies don’t need to be suctioned. We’re sticking tubes down their trachea to … suctioning vigorous babies.

Then they take the baby away from the mother and put it on a warmer, bright lights, and they’re doing all these procedures. That baby needs to be with mom. Just think, the baby had 24 hour room service for nine, for 10 months and warm and quiet and close to mom and then suddenly born. Modern medicine does not … the majority, I mean there are some wonderful practitioners that are into this cutting edge research that actually babies are born fully conscious and there’s a huge profound psychological impact of birth on both mother and baby. Babies are very receptive and sensitive to rough handling and all these procedure and things that are just done to them routinely when all they need is to be … when a healthy baby is breathing and vigorous, they just need to be with mom, never separate.  Any procedure or exam can be done with mom holding baby or baby next to mom or dad/partner next to mom. So these are some things. They’re also giving in the hospital hepatitis B vaccine to all babies.

Dr. Weitz:            Yeah. What’s the point of that? That’s crazy, right?

Anne Margolis:    Come on. if they’re in the hospital, that’s why. Get them now.

Dr. Weitz:            There’s zero risk of hepatitis B in infant.

Anne Margolis:    And a newborn, especially if mom is negative. If mom negative … ’cause hepatitis B is spread, it’s like HIV in the way it’s spread, blood and body fluids. So if the baby is gonna do IV drug use or promiscuous sex or be a doctor or an obstetrician and have blood exposure risk or something like that. There’s no need for the baby to have hepatitis vaccine, but that’s just become routine.  So there’s a lot of things that are done. In my course or in my practice or with women I work with online, there’s a list of like, now it’s 50 things that you have to be aware of, what could be done to you if you’re pregnant, birthing, or for the baby. So let’s discuss the pros and cons. Let’s research this now in the pregnancy so that when you’re in the heat of it, you already know. You make a list of what you want, what you don’t want and communicate that with your provider in your setting so that your wishes can be honored as long as there’s no crisis emergency and make that known ’cause if your baby is taken to the nursery, things are gonna be done to your baby you might not even know anything about it.

Dr. Weitz:            What about circumcision? I know that’s a controversial one.

Anne Margolis:    It’s harmful, it’s genital mutilation. The thing is I don’t really think it’s controversial.

Dr. Weitz:            Okay.

Anne Margolis:    Meaning-

Dr. Weitz:            There are a few studies that show there’s a decreased risk of genital infections or something like that.

Anne Margolis:    Yeah, it’s not supported as medical necessity.

Dr. Weitz:            Okay.

Anne Margolis:    They just feel pain. Now the thing is I’m not getting into the religion, like some religions-

Dr. Weitz:            Right, no, I know.

Anne Margolis:    I’m talking about medical circumcision in a hospital, unless the baby has a problem, there’s no medical need for it and babies feel pain, it’s traumatic, They tie the baby down and the baby is born a certain way. Why cut off part of it, you know?

Dr. Weitz:            Yep.

Anne Margolis:    Yeah, but I have some moms, for example … I would say now about 50% of my practice don’t circumcise. I have some moms that come to me, her husband is circumcised and she might have other kids that are circumcised and she doesn’t want the baby to feel funny or picked on in the locker room or something like that, but more and more and more boys now are not circumcised, so that won’t be an issue. I’ve had plenty of moms who have some circumcised from when they didn’t know about it and are not circumcised now, you know?  So I give them that decision. That’s their decision, but they need to know the pros and cons. I want that to be an informed decision. Unfortunately the baby can’t make that decision.

Dr. Weitz:            Great.

Anne Margolis:    They grow up and they’re like, “Why did you … ” ’cause babies remember trauma. It’s nonverbal memories, right?

Dr. Weitz:            Yeah.

Anne Margolis:    They can heal from that, but is a traumatic experience for the baby. They’re fully conscious, they’re fully aware.

Dr. Weitz:            Cool. This was great. A lot of really good information. I know you’ve written several books and you have at least one online course to learn about how to have a healthy, natural birth. Can you tell us about these and also how listeners can get a hold of you or learn more about you?

Anne Margolis:    I was interviewed on a podcast a few years ago and the woman who was interviewing me, she said, “I love your approach,” whatever, “Do you travel?” I’m like, “Well, if you’re in Hawaii.” We were playing, you know?

Dr. Weitz:            Yeah.

Anne Margolis:    She’s like, “Do you have a course? I would love if you would have a course.” I’m like, “I don’t,” and she says, “Well, you need to make one. How about if you come out to San Francisco. I’m into film and my sister is an editor and blah, blah, blah. I want to film how you bring people through your practice and we’ll make a course.” So that’s how the course started because when I started posting on social media when my daughter told me I should be on Instagram and I asked her, “What’s that?” She said, “Oh, you get all these great pictures and you’re so passionate and here’s the 101 and you like spreading the message of improving birth and mother-baby experiences and care.” So who knew. It became in a few years … it’s 81,000 or more followers on social media.

Dr. Weitz:            Wow, that’s great.

Anne Margolis:    So I’m hearing from people all over the world, asking me the same questions. So the course I thought was a great idea about how to prepare … I call it a home birth like experience in the hospital, in the birth center, in the home. A normal, natural physiologic birth and also how to embrace complications and embrace the cesarean birth if needed. But how can you rock your pregnancy in mind, body, heart, and soul and it’s how I prepare women in my practice except without the hands-on care. So that’s my course. I’ve poured 22 years of wisdom and experience of what really works to help a woman.  I actually took her up on it. We went out to San Francisco and we filmed the whole course. It’s 10 at least hour long videos plus a lot of downloads and then there’s an option of consultations with me. I have a book that’s called “Natural Birth Secrets.” It’s released on Kindle. It became a number one international best seller and it’s coming out on paperback.  Then I have another one, “Ask the Midwife” and then another one about trauma healing ’cause a big specialty of mine is so many women come to me traumatized. So 4.3 million women are giving birth in the United States and over a third describe it as a traumatic experience.

Dr. Weitz:            Wow.

Anne Margolis:    So I’m hearing from so many woman, how can I help them. They had a horrible, horrific, traumatic experience, kind of like I did, but everyone had maybe a little bit different details, but not that much different, and how can I help them heal and how can they have a better experience next time. That’s called “The Trauma Release Formula.”

                            So my website is called homesweethomebirth.com and my course is Love Your Birth and you can download when you go on that, there’s a free webinar about birth trauma and preventing it. You can download a little nugget of the course, which is about what I said, preparing a birth plan and all those 50 different things that can possibly happen and what you want to do about that. It’s important to know that and discuss that in pregnancy because if you decide that what you want is not in alignment with your provider in your setting, you can absolutely switch providers and settings and know that you have a choice and you have a voice. They are plenty of supportive obstetricians and hospitals and midwives. You just have to do some research. Unfortunately it’s not available … do I have time for a short story?

Dr. Weitz:            Sure, yeah.

Anne Margolis:    A woman took my course. She was in a very remote area and she only had access to an obstetrician who did cesareans, that’s all, that doesn’t even do natural birth, doesn’t do vaginal birth and that’s all she had.

Dr. Weitz:            Wow.

Anne Margolis:    She took my course and she found her voice ’cause I tell women that hospitals and midwives and doctors, we’re not law enforcement agencies. Actually we need to respect your autonomy. She developed knowledge is power and she developed her confidence and her belief in her body through taking my course and she said to him, “I don’t want a cesarean birth. I want a natural birth,” and he’s like, “I don’t do natural birth. I don’t even do vaginal birth.” She says, “Well, you’re gonna do that for me. That’s what I want.”  Well he agreed and she sent me a video. She had the most beautiful birth. Just think of the ripple effect. It changed him. How is that gonna affect all the other women?

Dr. Weitz:            Cool.

Anne Margolis:    So that’s where change comes is when we empower women and their families to speak up respectfully.

Dr. Weitz:            That’s great, awesome. Thank you so much, Anne. I know the listeners are gonna love this podcast.

Anne Margolis:    I’m so glad. I love talking about it. This is how we, I think, change the world, is helping, sharing our passions with the families to take back their health, to take back their birth.

Dr. Weitz:            Exactly. Excellent, perfect. Totally in alignment with my mission.

Anne Margolis:    Good.

Dr. Weitz:            Okay, talk to you soon. Bye.

Anne Margolis:    Thank you. Bye.

The Dental Diet with Dr. Steven Lin: Rational Wellness Podcast 056

Dr. Steven Lin talks about the Dental Diet with Dr. Ben Weitz. 

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


Podcast Highlights

2:05  Dr. Lin explains how he got interested in nutrition as a dentist.  He was becoming a little disillusioned with his dental practice when he was finding that dental disease was so common and he found kids with malformed jaws that didn’t fit their teeth and severe tooth decay and adults with gum disease that required extracting some many of their teeth. He took some time off from his practice and did some travelling and came across Weston A. Price’s book Nutrition and Physical Degeneration, which explained that dental disease is being caused by the modern diet.  He documented people who were in hunter/gatherer societies on islands or in remote forests who were not being impacted by the modern lifestyle and who were not eating the modern diet, who had no tooth decay, no crooked teeth, and no wisdom teeth extraction. Dr. Lin wants to help the dental profession move forward into the Functional Medicine perspective.

4:55  Dr. Lin explains how the modern diet impacts the growth of the jaw and this leads to a jaw that is not big enough to fit 32 teeth, which is why you end up with crooked teeth and having to have your wisdom teeth removed. When we eat a whole foods diet and chew a lot, with a diet that includes the nutrients that balance calcium in the body, and we breathe through our nose instead of our mouth, this stimulates the jaw to grow properly. In fact, throughout our lives, every meal contributes to how our jaw and our teeth are formed. 

9:45  I asked Dr. Lin about why we commonly have to have our wisdom teeth removed and we don’t think twice about it?  He explained that if the hand was not properly formed and we had to have a finger removed, we would be upset about this, but we don’t think twice about having your teeth pulled out. One of the biggest epidemics on the planet is that our jaws aren’t developing properly from children not eating right and chewing properly and not breathing right. We can intervene with a Functional Medicine model. 

10:50  Dr. Lin explains that breathing through your nose with a closed mouth and your tongue pushed to the roof of your mouth is the proper way to breathe and this allows the most efficient flow of oxygen and which mixes with nitric oxide in the nose. Mouth breathing, which most people do, delivers oxygen less efficiently and stunts the growth of the mouth. This also leads to snoring and can result in sleep apnea. 

15:50  Dr. Lin says that Upper Airway Resistance Syndrome (UARS) is on the spectrum of sleep apnea and what happens is that when you don’t have the jaws to support the volume of airway we’re used to so they end up with Respiratory Effort Arousal Efforts and they put the brain into sympathetic mode. They also tend to grind their teeth.  These people need to be taught to nose breathe.

18:50  We are more prone to tooth decay because most of us don’t get enough fat soluble vitamins, A, D and K2, which are important for the internal immune system withing the teeth.

20:18  Tooth decay also results from a disruption of the oral microbiome, which partially results from using mouth washes and tooth paste that contain antibiotics that kill bacteria in the mouth. Gum disease also results from an imbalance of the bacteria in the mouth and the gut, which then leads to destruction of the gums and the underlying bones in the mouth.  You don’t want to kill all the bacteria in the mouth.

25:39  Tooth paste with probiotics. Oil pulling is an ancient Ayrevedic tradition.  Eating is really the most important thing you can do for you oral health. 

28:07  Plaque is actually a good thing as long as you have the right bacteria in your mouth.



Dr. Steven Lin is a licensed dentist in Australia but he is a Functional Dentist and is dedicated to training parents to help their kids to prevent dental disease and to training other dentists in the use of diet for preventing dental problems. He has spoken at conferences and health summits around the world.  He can be contacted through his web site https://www.drstevenlin.com/ and you can you can buy his book, The Dental Diet, at Barnes and Noble https://www.barnesandnoble.com/w/the-dental-diet-steven-lin/1126612831?ean=9781401953171#/

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


Podcast Transcripts

Dr. Weitz:      This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to Rational Wellness Podcast on iTunes and YouTube, and sign up for my free 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. For those of you who enjoy this podcast, please go to iTunes and give us a ratings and review. So our Rational Wellness Podcast is focused on various functional medicine topics, and how we can use natural methods to help prevent and reverse various types of chronic diseases. Many of our discussions have been about the gut, and hormones, and metabolic conditions, autoimmune diseases, detoxification. But this same model of health can be applied to every area of the body. We’ve recently had Dr. Cates on to talk about a functional medicine approach to the skin and Dr. Ziegler talking about the health of the eyes.

                      Now, we’re going to apply the functional medicine model to the health of the mouth and the teeth. And I’m very happy that we have Dr. Steven Lin joining us today, who’s a functional medicine dentist, speaker, author of the number one Amazon best selling book The Dental Diet. Dr. Lin focuses on the understanding of dental disease through nutritional principles. His work has highlighted that crooked teeth and orthodontia epidemic are diet-based problems and the need for public health policy to prevent braces in the next generation of children. Dr. Lin, thank you for joining me today.

Dr. Lin:          Ben, such a pleasure. Thank you for having me.

Dr. Weitz:     So how did you get so interested in nutrition as a dentist?

Dr. Lin:         Yeah, it’s a funny story. I was actually practicing as a dentist years ago and I was beginning to become a little bit disillusioned with my day’s work. I was finding that there were very sick people in my practice with conditions that were very, very common. You know, dental disease is some of the most common we have in society today. And, whether it was kids with tooth decay or with malformed jaws that didn’t fit their teeth, or whether it was adults with gum disease where I was extracting, in some cases, teeth out of the forty and fifty year olds, their last teeth out of their jaws. And it began to play on me that I really didn’t have the answers as to why this was happening.

And so, I actually took some time away from my practice and I went traveling through Europe. And I was in a travelers’ hostel in Istanbul, Turkey, and there was a shared reading shelf there where I saw a book called Nutrition and Physical Degeneration by Weston A. Price. Now, I’d never heard of the book before and so I kind of picked it up and I was like, what is this? It had the words DDS on the title of the book, so it kind of got my attention even though I was trying to escape dentistry at the time. But I opened it and it was a world that I’d never seen before. You know, Price was a guy that went around the world in the twenties and thirties and documented over fourteen cultures around the world, and where the modern diet interfaces how people have been living ancestrally for thousands of years.  And he showed that modern dental disease doesn’t occur until we hit the industrial revolution, until we start eating modern diet and this was happening right up until the thirties, and people were living with absolutely absent of dental disease. So, that’s no crooked teeth, no tooth decay, but also no wisdom teeth impaction. When you think about how much a rite of passage that wisdom teeth impactions are today. And this whole perspective’s been lost, so it really kind of opened my mind to the idea that there was information from our ancestors that we’d lost and that we’d misinterpreted, and that our food today had a drastic impact on our mouth and that really, epigenetically and with modern science now, we can actually plug in the missing pictures that Price painted back in the thirties and it’s fascinating. That’s what led me to write my book, and try and help the dental profession move forward into it’s functional medicine perspective.

Dr. Weitz:     Can you explain how the shape of the jaw has changed due to the modern diet, and how this affects our teeth?

Dr. Lin:         Yeah, so probably the simplest way to put is that the most common way that people see the orthodontist is that, when you are a child of the age around ten to twelve to thirteen, your adult dentition has erupted and you go to the orthodonist to straighten those teeth. Sometimes they will extract teeth and sometimes they will just put braces on. The braces really only straighten the dentition and they don’t address why the malocclusion, which is crooked teeth, has occurred in the first place. And so, a child at twelve who needs braces is experiencing the same problem as a late adolescent or a young adult that has their wisdom teeth out.

Dr. Weitz:     Once again, this is kind of like the functional model, which is, what’s the root cause rather than just treating the symptom.

Dr. Lin:         Exactly. So, that’s exactly … so, with braces and wisdom teeth extractions are just treating a symptom, and the symptom is that our jaws aren’t growing and that we don’t have space now to fit 32 human teeth. And, in my career, I’ve seen very few people that have jaws that develop to house their wisdom teeth and a full straight dentition.

And so, when you look anthropologically, this doesn’t occur. And so, what we now have is a very, kind of … different areas of science have worked out why this happened. And so, we haven’t quite brought it together, which is why, for instance, the dental and orthodontic professions haven’t really applied this cause we don’t have a conjoined theory on this. But the idea is that, if you don’t send the signals to your jaw to grow, which include chewing, which includes the nutrients that balance calcium in the body, which include breathing factors, so being able to breathe through the nose and using the tongue correctly. All of these are functionable as to how the jaw grows during those formative years between ages zero to twelve, until you form the adult dentition and continues to grow until you’re twenty-one, and then right throughout life as well.  That’s one thing, Ben, as well, is that we can actually expand the adult palate and change both the upper and lower jaw in an adult in a slightly lesser way than we can in children, but we can always change a jaw. And every meal is really contributing to how our teeth are formed. And so, the teeth are just a symptom.

Dr. Weitz:     So, that’s fascinating. So, essentially, I think what you’re saying is that the modern refined carbohydrate diet with all this soft food that, you know, we woof down without even chewing. You know, we don’t have the fibrous, the types of foods that really require, the vegetable matter, the foods that really require a lot of work for our jaws, is part of the problem, right?

Dr. Lin:         Yeah, exactly. So your jaws are a musculoskeletal joint, funnily enough. And the anthropological studies show that, once we move into civilizations, people in hunter/gatherer situations, they don’t experience malocclusion as much as what we do as soon as we hit civilization. That’s when crooked teeth begin to occur. And so, the idea that chewing is a nutrient, is something that we don’t have in dietary recommendations, do we? And we are a society that tends to blend and juice things as much as we can, and that’s something that we really haven’t done in our history in terms of our nutrient intake. So I think that’s a really important one, that chewing is a part. It starts with breastfeeding, which begins to grow the child’s palate, and that’s really where we learn how to use the oral cavity as a musculoskeletal entity of the body.

Dr. Weitz:     Interesting. Maybe we shouldn’t even use forks and knives, you know, just use our teeth more.

Dr. Lin:         That’s an interesting … I actually … but you’re probably bang on there, that the way we’re kind of cutting things down. We’re taking some of that work away from the jaws. And you know, most anthropological kind of studies show people with very worn teeth and almost worn to the point where sometimes the enamel’s gone. And that just shows over their life, they’ve been chewing an enormous amount. And the amount of chewing, we just don’t probably go near anymore. So, that’s probably a good point, yeah.

Dr. Weitz:     So, in your book, when you were talking about the wisdom teeth, I think it’s amazing that you were saying that we just take it for granted that we’re removing these wisdom teeth. And you compare it to, if we were cutting off fingers or toes, people would be outraged, and we don’t even think twice about losing your wisdom teeth.

Dr. Lin:         You’d probably think twice if you had to cut off fingers–if your hand didn’t develop to fit your pinkie finger, and you had to have it cut off. That would seem weird, right? Well, we haven’t asked the same question for some reason about our teeth. And we just extract teeth without even a thought about it and it’s normal. But it really does kind of point to one of the biggest epidemics on the planet: that our jaws aren’t developing when we’re in these childhood years. And I see the effects of it. Children today are showing the effects of not developing, not breathing right, not eating right. And we can really intervene in this with a functional model.

Dr. Weitz:     What role does breathing through our nose versus breathing through our mouth play in this process?

Dr. Lin:         Yeah, that was a big factor of discovery for myself to learn that really oxygen is the number one nutrient for our body. And you think of how long you can last without water, for instance. Well, oxygen trumps water. You can only last minutes without having to keel over if you’re not breathing properly. But, we are a species now that doesn’t breathe properly nearly all the time and that is through the nose. With a closed mouth, with the tongue to the roof of the mouth, and what that does is, it delivers oxygen in a much more efficient way. It delivers oxygen in a way where we center the head over the spine, which you would be very familiar with Ben. So what mouth breathing does, when we learn not to breathe through the nose, we breathe through the mouth, which is a survival response. And so mouth breathing really doesn’t deliver the nutrient nitrous oxide, which mixes with air in the nasal sinuses, and it helps the body to extract oxygen and increase our blood flow to the lung areas in order to extract oxygen. When you breathe through your mouth, you don’t get this.

And so, what also mouth breathing does, is that it stunting the growth of the jaws. So kids that mouth breathe, so you’ll see them with their mouth open when they’re watching TV with their tongue hanging out of their mouth, they are, by definition, stunting the growth of their jaw. So they’ll have a narrow palate, they’ll have crooked teeth, and it’s due to a functional issue. And so that factor in both the idea of how we feed ourselves and how we get ourselves the nutrients that our body needs. You take twenty thousand breaths a day at a conservative estimation, so you really can’t undervalue how important breathing is.

Dr. Weitz:     And how does improper breathing lead to snoring, sleep apnea, teeth grinding?

Dr. Lin:         Yeah, so what’s really interesting is that our daytime postures, and this is really interconnected with your work Ben, it affects …

Dr. Weitz:     Yeah, we do a line of work with posture.

Dr. Lin:         Right, right. And so, how you hold your oral posture and your neck, and how you use your oropharynx controls how your airway is operated during the day. And so, when you go to sleep, all of those muscles relax and you only have the very deep and fundamental muscles really kind of keeping your airways open and your breathing. So, if we have a mouth open posture through the day, what will happen is, you’ll have a mouth open posture at night. So, that contributes to the loss of airway space that then causes a vibration, which is snoring. But then this goes on into a sequence of pathology, which ends in obstructive sleep apnea, and that’s where we’re having pausing of up to twenty seconds at a time that overnight, people can pause for minutes. So you count for twenty seconds, it’s quite frightening.

And kids today, are even being diagnosed with obstructive sleep apnea. And, at the base of it, is a breathing dysfunction. We’re not breathing right through the day. And then, through the night, we have this structure, both the jaws aren’t developed, we’re not using muscles right and we’re not learning to breathe through the nose, where we should.

Dr. Weitz:     Yeah, interesting. I’ve been learning how to breathe through the nose, taking coaching lessons with a breathing coach. And what do you think about taping the mouth at night? That’s a way to try to train people to breathe through the nose. I’ve heard other practitioners talk about that.

Dr. Lin:         Yeah, it’s an interesting one. The taping is a way to kind of … cause what happens is, we do develop a habit of the lips coming open. So it does help us to kind of make sure that you’re breathing through the nose. I’d recommend that people kind of acclimatize and do some training before they do something like that because some people do find that they get a claustrophobic feel out of it or they can kind of wake violently, if they’re not used to breathing through their nose. But I personally tape my mouth. I’ve had to train myself, as well. So it wasn’t something that I could immediately do. And it really depends on the dental manner too. If you have a high palate, it’s going to be hard. And, you know, you really should be doing some breathing, myofunctional therapy to reprogram your tongue to the roof of the mouth, to really kind of get your body used to being in that physiological posture.

Dr. Weitz:     Okay, in your excellent book, The Dental Diet, which I highly recommend to everybody, you talk about Upper Respiratory Airway Resistance Syndrome, right? Upper airway resistance syndrome and how this can relate to various types of digestive disorders and other health issues, including ADHD in kids. And, is it really true that learning to play the Australian didgeridoo can help with this?

Dr. Lin:         Yeah. Well, one study showed that people with obstructive sleep apnea, they had beneficial results from playing the Australian didgeridoo, which is the long kind of wind, you use deep diaphragma muscles to kind of make that deep sound, it’s really interesting.

Dr. Weitz:     Of course.

Dr. Lin:         But what Upper Airway Resistance Syndrome is, or UARS, it’s on the spectrum of sleep apnea. And so, people with obstructive sleep apnea diagnosed by a polysomnograph. And so, with upper airway resistance syndrome, they found at Stanford in the nineties that there is a set of people that had a similar set of symptoms but weren’t being diagnosed from obstructive sleep apnea. So they didn’t have the pauses in their breathing and they were having polysomnographs, and the researchers were saying, well these people don’t have this sleep disorder. Well, what upper airway resistance syndrome is, is where you go to sleep, your airways contract because one, we don’t have the jaws to support the volume of airway we’re used to, and we don’t also have the muscle function to support the breathing that we do either.  And so, what happens is these people go into a state of what they have, RERAs, or respiratory effort related arousal efforts. And what happens is that, these RERAs wake the brain up, not to the point where you wake up yourself but they push the brain into a fight or flight mode.

And so, it’s a feeling like you’re choking. And what happens is, that pushes you into sympathetic. And so the symptoms you have are that you’re tired all the time, you don’t feel that you get rested, digestive system isn’t working cause you’re constantly pushed into sympathetic, where it should be into parasympathetic mode. Depression is very common. Other issues like skin issues, but also teeth grinding. So one of the biggest signs is teeth grinding, where the jaw is coming forward to open the airway. So, that’s a response by the brain due to the decreased volume in the airways to push the jaw forward and open that airway.  And so teeth grinding and UARS is a big sign, and you will not be diagnosed with obstructive sleep apnea. However, you do have a sleep issue, and the underlying problem is the jaw growth but then, from that breathing dysfunction and retraining that breathing, is really important for these people.

Dr. Weitz:     Is it true that having cavities can be related to deficiencies of the fat soluble vitamins A, D, and K2?

Dr. Lin:         Yeah, so what we often don’t hear is that we have an immune system inside our teeth. And so, these little immune cells come from the bone marrow. And so these little stem cells from your bone marrow either become bone marrow making cells or immune cells, in very simple terms. But they also become teeth cells that sit in your dental pulp, so in the inside of your teeth. And they guard your dentin. And this is like an immune reaction your teeth have. And so, what they do is they respond, if you have any kind of bacteria that creeps down the dental enamel, they try and protect the dentin. They can actually prevent that. And so, they can cause an immune response.

Now, these cells, like your skeletal system, they run on vitamin D, vitamin A, and vitamin K2. So people that have tooth decay, and this is what Weston A. Price found, is that every ancestral culture had levels of fat soluble vitamins ten to twenty times what we eat today. And, if you don’t think about how much of these nutrients you’re eating, I guarantee you are deficient in them. And, what that means is, that we are susceptible to tooth decay. So, tooth decay is a model of lack of nutrients and its also an imbalance in the bacteria that live in your mouth as well.

Dr. Weitz:     So, essentially, its dysbiosis of the oral microbiome.

Dr. Lin:         Yeah, so that’s the other side of the picture. So, we’ve got the teeth with an immune system inside and then on the outside, we’ve got these bacteria. We’ve been scrubbing and killing bacteria for the last fifty years. But what we’ve missed is that we’re actually killing the diversity of the oral microbiome.  So there are trillions of bugs that live throughout the body and the mouth is really the first and connected version of your interface with bacteria. And so, bacteria in the mouth, you swallow thousands of bacteria every second, that’s trillions every day. And so that’s being communicated to your gut, which then forms your immune system, 80% of the immune system lies in the gut. And so, the mouth really is one of the key players in shaping how your body lives and reacts with bacteria.  And tooth decay, we’ve known as a bacterial disease for a long time but it’s not an infection, it’s a loss of probiotic material. And the same as gum disease as well, it’s an underlying gut problem that has a lack of probiotic species in the mouth to balance those bacteria, and then what we have is the destruction of the gums and bone structures in the mouth.

Dr. Weitz:     So we’ve been killing the bacteria by using antibacterial alcohol mouthwash and antibacterial toothpaste, right?

Dr. Lin:         Yeah, so one study last year showed that alcoholic mouthwashes can increase the risk of pre-diabetes by a certain set of populations. So that shows that you destroy the diversity in the mouth and you increase your risk of problems in the gut later on. But anthropologically, we’ve destroyed these bacteria by eating the wrong foods. Underlying everything is diet. And so, once we change the diet, we lose that diversity and then the diseases come as a result.

Dr. Weitz:     You didn’t mention it in your book but what do you think about fluoride?

Dr. Lin:         Yeah, I try to stay away from fluoride because its so controversial but, you know, fluoride … everything we’ve just talked about, the immune system inside the teeth and the microbiome, we have the capabilities in our body to completely prevent and be absolutely resistant to tooth decay. Fluoride addresses a very small slither of that equation. It’s incorporated into the tooth enamel to make it more resistant to acid. Now, if you stop the acid release and you give your teeth the immune building factors, which are the fat soluble vitamins, then you don’t need fluoride. And so fluoride is applicable in certain treatment situations where we have severe decay. But, it really doesn’t address the root cause and that’s a big issue. And where the functional medicine, functional dentistry kind of interface needs to join together to have a good conversation about it because it’s a big, big problem that links to everything throughout the body.

Dr. Weitz:     Yeah, what I see in America especially, is that functional medicine practitioners like myself who believe that fluoride is not good to be taken in, especially the type of fluoride that’s being put in, which is industrial waste product. And yet, dentists are still saying, yes, you need fluoride, yes you need fluoride, it’s a good thing.

Dr. Lin:         Yeah, it’s a bit of a problem because it’s one of the baseline preventative measures of what dentists are taught. You know, because of that mechanism of making enamel more resistant to acid. But it doesn’t make sense in a functional medicine perspective because we know so much more about the body now, we know so much more about the microbiome and we’ve really moved past the idea that fluoride is our underlying way of preventing. It’s a treatment. It should be seen as a treatment.

Dr. Weitz:     Yeah. And I think potentially harmful in terms of affecting thyroid and a bunch of other things in the body, potentially negatively. On top of the fact that the type of fluoride, let’s say, that’s being put into the water is not even a purified form of fluoride, its industrial waste from fertilizer industry that’s leftover.

Dr. Lin:         Yeah, the sources of fluoride, that doesn’t get discussed much either. So, I mean … and that would obviously play a feature because the idea of fluoridation came from mountain ranges that had a higher mineral content of fluoride. And this idea that we insert it in a chemical way, probably isn’t as effective anyway.

Dr. Weitz:     Can we measure the microbiome in the mouth?

Dr. Lin:         Yeah. So we’re getting there. Interestingly enough, the oral microbiome is one of the lesser studied parts of the microbiome and yet it’s the most successful. And I really think it’s going to be the future of medicine, where we take a little saliva sample and you can see your risk for all types of gut intolerances, autoimmune issues, right from the bacteria in your mouth, cause we have a communicative relation to the gut microbiomes from the mouth, and so you can also measure inflammation factors. I really think that, at the moment, it’s coming along, so we’re beginning to sequence the oral microbiome but, I think, it really is the future.

Dr. Weitz:     What do you think about toothpaste with probiotics in it?

Dr. Lin:         Also, a spot for the future. At this stage, there’s not many out there. But, it’s a good idea. Some prebiotics, probiotics, even collagen is an idea that popped up. I really find toothpaste and brushing, you know, it’s a very superficial way of looking after teeth. It’s great. Everyone should have an oral hygiene regime but eating is really the way that you provide your body those nutrients. So, I think there are some natural toothpastes out there that are really kind of showing that we can get away from these supermarket brands.

Dr. Weitz:     I mean, what should we use for toothpaste? I’ve heard recommendations that you should use baking soda and coconut oil.

Dr. Lin:         Baking soda and coconut oil is a good mix, yeah. It really is a personal preference. Some people really like that peppermint kind of hit but, yeah, it’s one that … the big factor is that you stay away from a daily antibacterial. You don’t want to be killing bacteria daily. Your natural substance is really a much more gentle for the microbiome.

Dr. Weitz:     Now they have toothpaste with clays and also with charcoal. What do you think about those?

Dr. Lin:         Charcoal’s … obviously it’s got a high absorption factor. It can be reasonably effective for whitening. I’d just be careful with it cause it’s quite abrasive. So I wouldn’t be doing it every day. Maybe if you do it every … once every two weeks, once every month. It’s a great way to kind of clean the plaque debris and staining from the tooth enamel surface. But, yeah, I wouldn’t do it every day.

Dr. Weitz:     What do you think about oil pulling?

Dr. Lin:         Oil pulling, it was an ancient aryurvedic practice, you know, it goes back many years. I think it has … the introduction of fat into the oral microbiome. The problems we have there is through simple carbohydrates. So, I think, there can only be benefits from that. In terms of studies, we don’t really know exactly if it has measurable clinical benefits. But what I tell my patients, eat more coconut oil. If you eat more coconut oil in your diet, you’re going to be introducing your body to this.

Dr. Weitz:     Okay. Is plaque on our teeth a bad thing?

Dr. Lin:         Plaque, the bacteria in your mouth actually need to live there too. So plaque itself isn’t bad. But it can be, if we have the wrong bacteria. So it builds up. After twelve hours, you’ll start to build plaque on your teeth. And so, if you eat the right foods, it’s actually fine. But, to prevent dysbiosis removing that plaque, will kind of help stop any kind of bad bacteria buildup.

Dr. Weitz:     You mentioned in The Dental Diet that, if you chew your food carefully, your salivary glands add enzymes to your saliva, which decreases the pH in the mouth. In the natural, even functional medicine movement today, there’s so much talk about trying to alkalinize your body by eating an alkaline diet, drinking alkaline water. I wonder if this is going too far since, both our mouth and our intestinal tracts actually do better with a slightly acidic environment.

Dr. Lin:         Yeah, I tend to agree Ben, actually. I’m not big on the whole alkalizing kind of … I think, in certain situations people are, bit I really think the body has its own pH kind of balance. And I find, in situations like SIBO and kind of reflux situations, where we see a lot of tooth enamel warn off, so they have a lot of dental erosion, the problem is that they don’t have enough acid in their stomach, right? So they need … they’re not digesting well and they’re having these burping kind of episodes because the food isn’t being broken down, and that’s a lack of acid. So I think there is a little bit a demonization of acid and it comes from a little bit of a dental context as well, because we see acid as such a problem. But it plays a role and acid, for instance, in the mouth protect against certain species. So lactobacillus species release acids that inhibit bacteria that cause tooth decay. So there’s a role for acids, I think, it’s all in balance and, I think, if we introduce the right species, they kind of control that for us.

Dr. Weitz:     Great, great. I think that’s most of the questions I had. Is there anything else that you want our listeners to know about in terms of the health environment in our mouth and our teeth and our jaws?

Dr. Lin:         It’s just, yeah, any sign that you see in the mouth is, it’s a signal from your body potentially that something is maybe going wrong. Bleeding gums, you know, I would really start to take that a message from your digestive system that something’s not quite right and that, really try and use our mouth as a way to kind of hear what your body’s feeling and experiencing.

Dr. Weitz:     So bleeding gums is not just a consequence of not flossing enough?

Dr. Lin:         No, absolutely not. The bleeding gums really is an immune reaction. So I think it’s the first signs of gut dysbiosis because you’ve got that immune reaction in the mouth. I think, it’s probably the first sign of leaky gut and so gum disease, I really think, I’m writing an article at the moment on leaky mouth and that the idea that gum disease really is a problem starting in the gut, and it’s that loss of interface both in the gut and mouth between your immune system and bacteria.

Dr. Weitz:     So I think we kind of all have it wrong, cause we all are thinking … I’m flossing and brushing to get that bacteria off of my teeth because that’s what’s creating all the problems.

Dr. Lin:         Yeah, the main thing you need to be thinking is introducing the good ones, the supportive ones. That’s the most important thing. You can floss and brush all you like. It’s going to have a very, very small impact on the bacteria in your mouth anyway because there’s trillions there. You don’t … your introduction of nutrition and your environment and stress, these are key factors for your mouth.

Dr. Weitz:     So what are we really doing with brushing and flossing then?

Dr. Lin:         Well, it’s a superficial way to address their teeth. It’s kind of a societal thing as well, you know. If you look at the photos from Weston A. Price, you’ll see these big white smiles. And you know, they didn’t brush their teeth. So, you know, it’s something we think … we’ve tried to kind of counterbalance the modern diet with brushing and flossing but, it’s a very superficial way to kind of address our teeth.

Dr. Weitz:     Oh, interesting. So, if we were eating a natural diet devoid of processed foods and sugar and all the other crap, there wouldn’t even be a need to brush your teeth. The fiber and all the roughage in the food would actually …

Dr. Lin:         Well, you still get plaque buildup, right? But, there’s no problem cause you’ve got the balance of species there. Yeah, it’s not an issue. Yeah, you get plaque in the mouth, you get plaque in your gut, in the villi of the digestive system. That’s how bacteria live. We live with bacteria, learning that we are symbiotic with these creatures really is, I think, the bigger message.

Dr. Weitz:     Great. So for listeners and viewers who want to get hold of you, or get hold of your book, how should they get more information? And your book is available through Amazon, Barnes and Noble, and other places?

Dr. Lin:         Yeah. So The Dental Diet, they can grab it on Amazon and in stores like Barnes and Noble. They can find me on my website drstevenlin.com and on social media @DrStevenLin.

Dr. Weitz:     Great, thank you so much Dr. Lin. It’s a very interesting podcast. I appreciate you’re spending the time.

Dr. Lin:         It’s a pleasure Ben. Thank you very much.

Dr. Weitz:     Okay.

Dr. Lin:         Bye-bye.


Improving Posture for Anti-Aging with Dr. Steven Weiniger: Rational Wellness Podcast 055

Improving your posture is an anti-aging strategy with Dr. Steven Weiniger, who is interviewed by Dr. Ben Weitz. 

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


Podcast Highlights

3:49  Dr. Weiniger talks about some of the negative consequences of poor or weak posture, including neck and back pain.

8:32  The key to posture is taking a picture of yourself and drawing lines and measuring how you stack up. Then make some changes and next year take another picture and see if you have changed. 

9:22  The invention of the smart phone on top of the computer now has led to about 90% of people in the US having weak, folded posture being bent over with rounded shoulders and forwards head.  This is an epidemic in our society that is getting worse. 

10:22  I pointed out that the more time people spend on social media, the more lonely they get, which increases their risk of chronic diseases and early death. 

13:00  We talked about Dr. Weiniger’s PostureZone app that allows you to take a picture and measure where their head, torso and pelvis is in space over where they are standing. Those are the four posture zones and the Posturezone app lets you measure the degrees of deviation from vertical of the poor posture zone.  This app both lets people become aware of their posture and allows professionals to measure posture and generate reports showing changes over time before and after treatment. 

23:20 Dr. Weiniger explained how we go about constructing an exercise program to improve posture with his strong posture protocols. He also mentioned that chiropractic manipulation is very important in helping to improve posture, as is proper nutrition.


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

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


Podcast Transcripts

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

                           Hey Rational Wellness podcasters, thank you so much for joining me again today. We’re going to talk about posture again and it’s such an important topic because it affects so many factors in our overall health. And as a chiropractor, I constantly see patients every day who come into the office and they say, “Doc, why does my back hurt? Why does my neck hurt? I didn’t lift anything, I didn’t do anything.” And so, in so many of these cases, posture is the unthought of, underlying cause and as somebody who’s into functional medicine, I always believe in trying to get to the root cause of problems. And the same thing for chiropractic, we can’t just correct your neck and back pain with a drug that’s gonna relieve the pain, we’ve gotta try to get to the underlying cause. And I personally have found that poor, bad, inefficient posture is a major factor, in not only the cause of their pain but also in your inability to heal properly from the pain. And the fact that, the pain is likely to come back.

                            By the way, all of you who enjoy the Rational Wellness podcast, please go to iTunes, or wherever you get your podcast and leave us a rating and a review. That will allow more people to find the Rational Wellness podcast. And so, our special guest for today is Dr. Steven Weiniger. Steve is a posture expert, he’s the author of Stand Taller, Live Longer, a tremendous book, the creator of the CPEP training program for professionals, helping people check their own posture with his PostureZone app that you can get on your phone, and he’s the chief posture evangelist of May. And May is posture month, and he’s the head of the posture month organization. Anyways, Steve, thanks so much for joining me today.

Dr. Weiniger:      Ben, thanks. Thanks for having me, I appreciate it. And the chief posture evangelist label came when we decided to do a public health initiative for a CPEP, Certified Posture Expert Professionals, and the label …

Dr. Weitz:           Hallelujah!

Dr. Weiniger:      Because basically, I’m going around and I’m talking to media. It was just a really cool thing that came out on CBS yesterday. We’ve been with them talking about posturing. I feel like I’m evangelizing. I’m cured. I’ve not been doing evangelical work, but it’s true because people … It’s something everyone knows about, but people don’t stop and really look at. And my job becomes making people talk about it and that’s why we’ve expanded posture month to not just CPEPS, but to anyone that’s worked with posture to be able to take a picture or to offer the public a picture of their posture to create awareness of what their posture looks like, because it affects your health in a tremendous way.

Dr. Weitz:           Cool. Can you tell us, what are some of the negative consequences of somebody having poor posture or inefficient posture?

Dr. Weiniger:     Well, there’s two sides to it. One is the health consequences and the other is the personal consequences. Beginning with the health that is one that’s most important even though it may not be the one that’s the most emphasized. It effects back pain and neck pain tremendously. A recent study found that 89 percent of primary care physicians, considered posture to be one of the primary causes of back and neck pain, which is not surprising because your body is not aligned, it puts more mechanical stress on your joints. Especially if you’re living on that all the time. But there’s other issues as well, because when your body is folded, it can affect how well you can breathe. It affects how different organs’ work and things like this don’t occur quickly, but especially if you want to get to the root core of the problems, if someone’s living with their body folded and they can’t take a deep breath … There’s been a lot of research that shows that breathing is really important for your health. If you don’t breathe, bad things happen.

Dr. Weitz:          And it’s important to breathe that way as I’ve learned, because I was always a mouth breather and recently, in the last six months, learned how to breathe through my nose with a help of a breathing professional. It makes a huge difference.

Dr. Weiniger:    And there are breathing professionals that work with posture as well, because it’s not just a reflex thing, when your head goes forward of your torso, it changes the muscle relationship in the front of your neck going to the mandible, the jaw bone. That effects the opening for the air coming down into the lungs. It’s easier to breathe with the chest than it is to breathe with the abdomen or the diaphragm. And once you’ve developed that habit, it becomes like any habit. It’s easier to move that way. Try this. Press your fingers like this. Look at which fingers are on top, the left one or the right one?

Dr. Weitz:         Which one’s on top?

Dr. Weiniger:    Yeah, when you’re looking at your thumb, which thumb is on top?

Dr. Weitz:         Oh, the right one.

Dr. Weiniger:    Okay, cross it the other way. Put the left one on top. If I asked you to cross your hands, things like this, a thousand times, how often would you do it this way?                                               Most people … If you worked with it your good. Most people I would do this, would find that …

Dr. Weitz:         Well, you see I play golf. So, actually this is my normal golf grip.

Dr. Weiniger:    In that case you’re not using it. But most people that do that, find that …

Dr. Weitz:         My wife is always reminding me that I’m not normal.

Dr. Weiniger:    No, you’re better than normal. You pay attention to your body. That’s the point. Once your body learns to move in a pattern, you keep on moving that way without thinking about it. And that stresses some muscles, stresses other ligaments and your body literally folds into that pattern. You think your moving one way, but a camera proves that you’re not moving that way and that’s why taking a picture so that you can see how you’re standing when you think you’re standing tall is one of the first ques to building posture awareness.

Dr. Weitz:         So, since you brought that up, how do people become aware that they have bad posture. Is it simply because they have neck pain and they go to a chiropractor and that chiropractor tells them they have bad posture?

Dr. Weiniger:    I really don’t like the phrase bad posture. Because no one’s posture … Unless someone’s body is perfect, their posture is not gonna be perfect. Your posture is bad if you’re having some symptoms from it and that’s for certain. But even if you might have symptoms …

Dr. Weitz:         How about if we call it inefficient posture? ‘Cause isn’t the key to posture, resisting gravity, and we can’t resist efficiently if we have a certain posture?

Dr. Weiniger:    Inefficient is a good way to look at it, especially from a sports point of view. The way that we talk about it would be what is weak posture. Because if your posture is inefficient your body is gonna be weak and it’s not about as being as strong as the strongest person in the world, or as tall as the tallest person in the world because that’s probably not most of our genetics. It’s about being as tall as your body should be, as strong as your body should be for what you’re doing. If you’re working your body inefficiently, your body is gonna get better movement inefficiently and that makes problems. So, the key to posture is just taking a picture of yourself and measuring. Not making a pathology of it, not making it bad, not making it a problem, but it make it just, when I’m trying to stand tall, this is what I look like. And looking at it, and then coming back next year and comparing it again and measuring your body as something your aware of. If you see your body folding from your one to two to three, if you look more and more like an old person, you’re gonna start feeling like an old person and having pains like an old person before you should be.

Dr. Weitz:         So Let’s say we call good posture optimal posture. Right?

Dr. Weiniger:    How about strong posture?

Dr. Weitz:         Okay, so, let’s say we call it strong posture. Can you say approximately what percentage of the population has weak posture?

Dr. Weiniger:    In our world …

Dr. Weitz:         Yes.

Dr. Weiniger:    There’s been this great invention that I don’t know that it was made by chiropractors, but if you wanted to invent something to have a device that you could put in front of people and then have them spend half their day hunched over with this over rounded forward typing on something, you’d have a hard time advising that business model, but it’s been great for chiropractors because we end up seeing and helping so many people walking around in pain. In our society, I’d say 90 percent are walking around with posture problems. One thing that I’ve noticed is when I travel, I’ll see families with kids, and sometimes the little girl looks like mom and the boy looks like dad, and usually when I used to see people like this, the kids had good upright erect posture and the parents were a bit more slumped forward in general. Now, the kids look worse than the parents. This is an epidemic going on in our society, and it’s getting worse.

Dr. Weitz:         So, this is negative health consequence of cellphones, on top of so many other health consequences. I was just listening to another podcast on my way in here and they were talking about how loneliness is a parameter that increases your risk of early death and chronic diseases.  The more people spend on social media, the more lonely they get. So you spend all this time interacting with other people, but not in a real way so, you end up decreasing your health as a result of that.

Dr. Weiniger:    And that’s a … I completely agree with that perspective. One of the things of that is, people spend a lot of time trying to curate the perfect image on social media so that they look really good. And when they then compare themselves to other people that look better, it becomes a competition of how well can I artificially make myself look good and if they compare themselves to other people. And it’s like a world full of barbies of people shaped in ways that no human being is shaped. Whereas if you and I are sitting together and we’re being comfortable and we’re opening up to each other, that’s a different kind of friendship than occurs online.

Dr. Weitz:        Yeah. That creates this unrealistic body image that people have when they see these people on Instagram and Facebook and Twitter and stuff, having these ridiculous looking bodies and they feel all worse about their own because they know nobody can look like that and those are not real images, unfortunately.

Dr. Weiniger:   And one thing that I’ve become more aware of personally is the old custom of breaking bread with people, we don’t talk about that, but when you sit down and you eat with somebody, it’s a more intimate thing where … People don’t show videos of themselves eating, they show videos of the meal because I can curate it, I can make it look right. I can put the glass to the left of it. I can arrange the silverware so it looks like the food they get are perfection. Whereas a video of somebody chomping away at something, that doesn’t look so good because that’s a more openness of how people truly are. And when you sit down and have a meal with someone, if you like them, that’s when you come away and you say, “We can have breakfast together. We can have dinner together.” The saying a long time ago was people breaking bread.

Dr. Weitz:        Yeah, interesting. So, how’s … Tell me about your app that lets people be able to take a picture and get a better since of how good or how strong or weak their posture is.

Dr. Weiniger:   Posturezone app is a free app that’s on iPhone, iPad, and Android. And it’s a way for everybody to take a picture of themselves and measure where their head, where their torso, and where their pelvis is in space over where they’re standing. Those are the four posture zones. And it’s not about trying to pathologies something with this is normal and this is not normal. I mean, if somebody is five foot five for male, and the normal population is 5’7 to six feet, does that mean that person that is 5 foot five is abnormal? Of course not. It means that’s the way that person is and there’s a population demographic. Normal means different things. You don’t want to confuse a normal population demographic with normal for that individual.

If someone’s 5’5, if they’re standing tall, they can have strong posture. If someone’s six feet and they’re slumped over down to five foot ten, they’ve got horrible posture. So it’s not about being tall, it’s about standing taller. So that’s the direction of that is aligning your head over your torso, over your pelvis, over where you’re standing. The more those four posture zones are vertically aligned, in a line, the taller the whole system is. The taller the person is. The more the person is flexing forward, the shorter they are, and what the Posturezone app does lets you measure the degrees of deviation from vertical of the poor posture zone.

Dr. Weitz:         Do you have it on your phone right now? Can you show us real quick how that works?

Dr. Weiniger:    Sure. I can show you on my phone. If this …

Dr. Weitz:         So this is an app. It starts out as a free app and then there’s advanced features that you can purchase on … You can put it on your phone, your iPad.

Dr. Weiniger:    You can put it on your phone, iPad. It’s 29 dollars for the pro version, which is for professionals. If you’re a professional watching this, you want the pro version ’cause it will let you take a comparison picture of somebody and compare it in a report over time. If you’re a regular user, the app will let you take pictures over time and compare them. You can just flip back and forth and look at your pictures and you can see the number, but you can’t create a report and you can’t keep things in tables to work with people. [inaudible 00:15:52] designed to give the consumer or the health enthusiast the ability to check their own posture and posture of friends, but if you’re doing it professionally, it cost 29 bucks, but it’s a one time thing. It’s not an all the time thing. The reporting is again, of the angles of deviation. It’s not saying this is normal, this is not normal. That’s like a fear based marketing thing that I don’t care for.

Dr. Weitz:         Hey … You ever done a study to validate this? Maybe with patients after whiplash?

Dr. Weiniger:    Working on it.

Dr. Weitz:         Okay.

Dr. Weiniger:    There’s a couple that are working on things that are working on exactly and there’s been other studies that have been done that point to the lack of validation of some other things that a lot of people talk about and that the most promising way of recepting posture is the head, torso, and pelvis over the gravity line, which is exactly what we do. Dolphins did a really nice study of that and that was the only thing that correlated with back pain. There are things like high shoulder or a high hip, really didn’t correlate though, it’s just … Over mechanical, as you put inefficiently, the more everything expands out, the more efficient mechanical advantage there’s gonna be but less energy is spilling, the less strain there is on muscles and joints.

Dr. Weitz:         Okay. Go ahead.

Dr. Weiniger:    So if you wanted to take a look at it, this is … My office is a mess, but if you … Don’t look at …

Dr. Weitz:         You gotta hold it … Right there, good. Okay.

Dr. Weiniger:    So basically … Oh, I’ve got a great idea. Don’t go away.

Dr. Weitz:         Okay, you gonna bring somebody in to help demonstrate it?

Dr. Weiniger:    I’m gonna bring Harry in.

Dr. Weitz:         Okay. Hi Harry.

Dr. Weiniger:    Harry is my posture [inaudible 00:17:38]. Okay we’re gonna see if we can do this. So basically, you want to take a picture and notice when I rotate this back and forth, the line turns green.

Dr. Weitz:         Okay.

Dr. Weiniger:    In the middle. When the lines green, it’s level. Since my screen is not level, this is gonna be a weird picture, but if I put Harry between those two lines, I can bracket him between those two lines and I’ve got a grid in the background that if I were smart, I’d have it setup where I could show you that grid, but that’s not today. That’s not gonna happen today.

Dr. Weitz:         That’s okay.

Dr. Weiniger:    Professionals will need the grid and if I took a picture of Harry, and this is not gonna be nearly level ’cause I’m not that coordinated, but if I can take a picture of Harry. Did we get it? I got it. Good, this is far from perfect, but I can then take … You don’t need to see this, but I need to set it up for side view or front view, I can take a side view. I can then move the brackets to bracket the head over the torso over the pelvis over where the feet are standing. And this is not well placed cause I can’t do this sideways very well, but I can then check that and it will measure the degrees of deviation the head over the feet, the torso over the feet, and the pelvis over the feet.

So just measuring how the body is balancing and what the body is going to be vertical. And this is what the free version does. If I wanted to add other lines, and let’s say that I’m a pitcher or a golfer, you can add another line. I can call that a golf line. And then I’d be able to make a line between my shoulder and my front foot for example if I wanted to add that measurement to see how my body aligns. When I think my shoulder’s right over my foot, if it’s really two degrees off, and I start working on it and then it’s one degree off, it’s going in that direction. It’s a way of bench marking the accuracy of your perception and of the way your body is to the truth of where your body is.

Dr. Weitz:                            Cool.

Dr. Weiniger:                     And you can then if you want to save it and I’ll just put it into a case, and hopefully this is nobody that I don’t want to show you.  Within that case, I can look at an image and compare Harry today to Harry yesterday. Or in the pro version, I can generate a report to compare that to prior images. No. Sorry, I can add that to prior images and move backwards. There we go. Where I can do a checkoff. You can see that and get a report and then I can generate that report … And the report disappeared. I can’t do this backwards very well. There it is. I can generate that report and that report that has those images as well as the deviations of where the body is in space. And the cool part for consumers, if you’re looking for a professional near you, on the bottom there’s a locator for CPEP so they can find somebody that’s in their area and now you know where I live, but where there’s a CPEP near them. And that is someone that if they want to work with a posture professional that can take a picture of their posture and help them to do exercises to strengthen their posture.

                    And that’s the idea behind posture month. People have to become aware of their posture ACE, A is awareness. Next part is C, control. Do exercise to strengthen your posture and professionals work with people from a clinical point of view, especially, really strong posture exercises to strengthen how people move. Other things like yoga, Pilates, are also what I call controlled motion exercises and they can help posture, but the external posture exercise have the advantage of being able to be very, very targeted to help someone’s weaknesses and strengthen their weaknesses especially when there’s been a problem that needs any kind of rehab.

Dr. Weitz:                            You know, another thought about using this and I just started to incorporate this app, is insurers, third party payers, want to see objective measurements of the improvement that we achieve with our treatments and we know our patients feel better, but simply having a patient who says, “I’m in pain.” And then saying, “Now I feel better.” That’s not very objective, of course, we use these zero to ten pain scales that the patients fill out and that’s a little bit of objectivity, but it’d be nice to have something like this that we can include in a report to either an insurer or on a personal injury case to show some objective improvement. So, I think this is pretty cool for that idea.

Dr. Weiniger:                     I’ve personally had adjusters that we’ve worked with and they said, “You know what, when you showed me the picture of what the person looked like the first time they came in and what they looked like a few weeks later after that, it makes it very real. People unlike online texts, that’s not real. A picture of you in eye when you see somebody talking that’s much more real.

Dr. Weitz:                          Yeah.

Dr. Weiniger:                     And then you have someone standing against an objective, that’s more real.

Dr. Weitz:                          Okay, so once somebody identifies that they have poor posture or once a practitioner whose maybe has gone through your program identifies somebody with postural issues, how do you go about correcting those?

Dr. Weiniger:                     The first thing you do is you take a picture so you benchmark where you’re starting from because it’s not necessarily correcting, it’s strengthening. My best review of this is almost certainly gonna be different because we have different genetics and we treat our bodies differently along the way. And your body is not gonna be balancing the exact same as somebody else’s, but having an awareness of how you’re balancing at the beginning. To strengthen balance you want to strengthen each of what are called the three elements of balance. How your body is aligning, how your body is balancing, and how your body is moving. And basically those words balance, alignment, motion or BAM, are what we talk about in my book Stand Tall and Live Longer and the posture exercises are what CPEPs and other professionals teach their patients and teach people and it’s often trainers and massage therapists that teach people how to do postural exercises.

For posture month, there’s a number of balance exercises we’re putting out every day and for each week, we’re going to be focusing people on one exercise. So week one, we’re focusing people on an alignment exercise, it’s really easy. Go to the wall, walk til your back’s against the wall. Remember when you were in school they told you that you should be able to line up your shoulders, your feet with shoulders, your feet, your butt, your shoulders and your head against the wall and be straight. Did they have that when you were in school?

Dr. Weitz:                         Well I remember doing that after the air raid drills.

Dr. Weiniger:                   Okay, same thing.

Dr. Weitz:                         Like that will really protect you if a nuclear bomb strikes near your school.

Dr. Weiniger:                   In my school, they had us hiding under the desk.

Dr. Weitz:                        Oh, okay. Like that’s gonna help you.

Dr. Weiniger:                   What does help you is connecting your perception of your body with how it really is. Going to the wall, stepping one foot away from the wall with your feet parallel, leaning your butt against the wall and your shoulders against the wall, and then really lock in. Look straight ahead. Keep your head level. And try to keep your head level, that’s the must. And move it back towards the wall. If your head can’t touch the wall, and keep it level then that’s saying that you’ve got some distortion where your head, torso, and pelvis aren’t lining up ’cause if you take your feet away, you should be able to align head, torso and pelvis unless there’s something holding something forward. The strong posture exercise all use what’s called the must versus try killing. The must in this exercise, keep your head level. If someone says, “Yeah, I can touch the wall.” But the head’s not level, they’re not doing the must. And if you can’t touch the wall, the exercise is quite simple, go as far back as you can, but keep it level. Keep your head level as you pull it back.

It’s similar to the turtleneck that some people teach from an exercise point of view, but it’s more effective because if you take your feet away from the wall, you’re reducing some of the impact of the solace on the upper lumbar and lower thoracic spine and it makes easier to isolate the real cause for that particular posture distortion.  And so practicing keeping your head level, pushing it back and doing that with your breaths. So, doing it for what we call five slow breaths. Breathing in, letting your head come forward, breathing out, pushing it back to the wall. And you’ll notice by the third or fourth, you can get a little bit more play if you’re doing it right when you’re stretching the tight link of the chain. Doing that twice a day for a couple of days, you may find that you start to find it easier to keep your head level, which is what we’re trying to do, to open the body up, which opens up the second week of posture month, which is the first balance exercise.

And the first balance exercise is holding your best strong posture and balancing by lifting one leg up so your thigh’s parallel to the ground and holding it for five slow breaths, and then repeating it on the other side. And doing that just three times a day, just dialing in to standing tall and you can’t see me now, but I’m lifting leg up because if I lift my leg up, and my body is going like this and I’m twisting, I’m not strengthening the muscles of my posture. You want to first do alignment so you have an awareness of what standing tall feels like and then hold that feeling, lock that awareness in, and then challenge it by lifting one leg up. And as you know from a rehab exercise point of view, the way you strengthen something is by challenging it. That’s the second week. Do that a couple times a day, second week.

The third week of posture month, we’re coming out with the first motion exercise, sitting on a ball and just like you would sit at work, sitting really tall and trying to only move your pelvis. So instead having to focus the head, torso posture zone, we’re moving the focus back to the torso, pelvis posture zone. The key is moving the ball making three circles to the right, three circles to the left, but there’s two musts here. One must is don’t move your knees. The second must is don’t move your torso. So you’re sitting tall, you’re not moving your knees or torso, the only thing left to move is your pelvis. It sounds really easy, but it’s way harder than it looks, especially when you try to make a circle to the right, many people that have any kind of an issue will quickly notice that their circle isn’t round, but there’s a lack spot in their motion where they’re not able to control something actively in that arc. And what they’ll also find that if they make three circles to the right and three circles to the left, the inaccuracies of motion, the kinks, the things that are locked, that they didn’t know that were not moving, are not the same on both sides.  And it’s been not able to be recruited and used when you’re really focusing on it when you’re not focusing on it, when you’re doing a bunch of other things at the same time, you’re not gonna be using it and that’s why there’s this prior protocols that become so powerful that isolate and strengthen the weak link in each individual’s movement connect chain.

Dr. Weitz:                          What do you say to patients who say, “You know, why do I need to do these dorky exercises? I’m already going to the gym and I’m doing squats and deadlifts. I’m doing one of these other exercise programs where I’m lifting all these free weights. Why do I need to sit on a ball?”

Dr. Weiniger:                     Because exercise is good, but exercising effectively is far more important. If someone … I remember going to the gym and seeing guys that were bench pressing 250 pounds and they were doing it by lifting their head up, rolling their shoulders in, and bouncing it off their chest. And just saying, “I’m benching 250.” And especially, those guys, if you try to go over to them and say, “Try doing this with tight form.” Their response is, “I can’t lift as much, and the only thing that’s important is how much I can lift.”

Dr. Weitz:                          Of course.

Dr. Weiniger:                     And that’s not good. If actually, you’re a chiropractor and you want to take care of patients, it’s great for business, but it’s lousy for people’s bodies. All motion begins with your posture. All motion ends with your posture, and that’s why the awareness part becomes so important. If in your awareness, you think standing tall is standing like this, when you exercise all of your exercises is gonna be like that. If you’re a golfer, if you golf, golf begins with the address position where you’re getting set up, standing tall and then you’re … That’s what every pro that I’ve ever spoken to tells you to do. It’s when you think you’re standing tall in an address position, you really adapted in some subtle way like those silly ball things that we just talked about that you said, then you’re going to be taking those in asymmetries into whatever that larger motion is.  The only way you can strengthen the subtltees is to focus on only them. When you’re doing big macro motions, you can’t be aware of the small subtltees. Your body thinks in whole motions, not individual muscles. Start focusing on the subtltees and such incredible power, both from a pain point of view as well as from a performance point of view, as well as how other people see it.  Because the other part we need to talk about is when your training well, people look at you better.

Dr. Weitz:                         Are people actually making themselves worse by exercising in poor posture, and reinforcing that posture?

Dr. Weiniger:                    I’ll go back to what you said at the beginning. When a patient comes into you and they say, “Doc, why am I hurting? I’ve been going to the gym, I’m doing all this stuff, but this happened. What happened?” Because what you think you’re doing may not be what you’re really doing and everything that you do always begins with the posture. That’s why if you want to exercise effectively, you want to begin with effective posture.  And there’s been number of studies that have demonstrated that training bodies to move towards greater symmetry with greater accuracy makes a big difference in back pain. In fact, if you recall, last years guidelines both care of both acute and chronic lower back pain from the American College of Physicians said that surgery a lot of times is not good, opioids, not good, and they said things like Advil are not as highly recommended as they used to be and there should be alternatives like spinal manipulation, which chiropractors have been saying thank you very much, but also motor control exercises. That’s exercise really looking at the starting piece of motion. That’s precisely what the strength type exercise I designed to do.

Dr. Weitz:                          Okay, so do you tell somebody … Let’s say somebody comes in, and their posture is pretty bad. Do you tell them to stop all their other exercise until they can correct their posture or do you tell them maybe while they do their exercises, try as much as you can to get into a better posture?

Dr. Weiniger:                     And the better posture is what they’re learning to feel when they’re doing the strength posture exercises. Especially, if they’re working with a CPEP. But because if they’re coming in clinically, you want to be not creating more pain, not creating more tissue damage. So, you may possibly pull back from some of the exercise, and you may increase other exercises depending upon the person’s clinical story, the person’s exercise and their functional ability. That’s why we have the must versus try protocol becomes so powerful because we let you tailor it to their functional ability. The exercise is a test of what they can do functionally, which is then teaching them how to do in a way to strengthen the weak in their mechanic chain. So, in general, if you’re exercising, you want to work out quickly how to get the most benefit out of your exercising. That’s what a professional can help you do.

Dr. Weitz:                          Now, you talk about strengthening and balance, but what about stretching? So Let’s say you have this sort of rounded shoulder, forward head posture that you see in a lot of people and certainly strengthening the romboids and the middle and lower trapezius and some of the intrinsic neck muscles are important, but don’t you need to stretch out some of these shortened muscles in the front as well?

Dr. Weiniger:                     Absolutely, and that comes back to the point at the beginning. It’s not one thing, it’s everything. It’s like which tire on the car is most important? The left front, or the back rear? You’re going 60 miles an hour on the highway, you don’t want any of them to blow out. And if one blows out, the whole system doesn’t work the way its supposed to. In terms of correction, very very commonly someone’s gonna have a short pectoralis, more likely a short pectoralis minor, coracobrachialis, which the muscle underneath that is another really, really common shortness that’s missed because if you think about it, if there’re different layers of muscles, which there are, if the superficial muscles are tight, then other parts are gonna move differently. If the short muscles are tight, the muscles closer to the center of action of rotation of each joint, then nothing around that is gonna be able to move and you can stretch the superficial mussels out all day long, but you’ve gotta also get the deep ones. That’s why the pattern can be really different for different people.

And it’s what you just did, it’s not just open up what’s on front, it’s simultaneously strengthening what’s in back, but it’s not just the front and the back because when we did this, we also unfold the torso pelvis a little bit. We lean towards the back. So, if there’s an imbalance between torso and pelvis, that’s gonna keep on pushing it forward and you can try to open this up, but you’re gonna have to do something else to compensate. Posture is a whole body phenomenon. It’s not just your head, it’s not just your back, it’s literally how you balance your body. And that’s why the balance exercises are so key to strengthening posture.

Dr. Weitz:                            And what’s the role of chiropractic in this?

Dr. Weiniger:                     Tremendous. Chiropractic’s main goal of focus began with spinal manipulation, which is working on the segments of the spine, the vertebrae of the spine to restore motion and to allow more normal neurologic function because the spine houses the spinal column and that connects the brain to the muscles and then the nerves. And if those are not moving well, if there’s not accurate information coming to the brain, it means the way that you think you’re moving is even less likely how you’re moving. From a biomechanics perspective, if there’s a locked link in the chain, so my hands should be moving like this, and my fingers are not moving, it’s gonna move like that. That’s gonna put more stress on one joint, more exercise on one joint, and less on others. The same thing happens in the spine where one spinal segment is working more, breaking down more, getting more exercise at one level, and less at others and that imbalance then drives how everything else is moved. So the combination of chiropractic spinal manipulation with strong posture exercise is like this.

Dr. Weitz:                            Right. For those in the audience who aren’t really familiar with what chiropractic does is, one of the core factors treatments of chiropractic that really no other professional really does effectively is the manipulation or adjustment and it sounds like your understanding is similar to mine, is we’re trying to find those particular joints in the body, whether they be spinal, or extra spinal, in the shoulders or elbows or knees or wherever, and making sure all those joints are moving freely in all those different directions that they’re supposed to move in. For example, your spinal joints are supposed to bend forwards and backwards and side to side and rotate and we’ve gotta make sure they’re doing all those motions so that you actually can attain the type of posture and maintain that type of posture.

Dr. Weiniger:                     Exactly, and I talked about the spine, because you said where chiropractic began, but from a perspective of postural rehab perspective, we also want to be … A good chiropractor to me addresses all of the links in the kinetic chain because if you’ve got a problem with your big toe. I drop a cinder block on your big toe, your posture when you walk is gonna go to heck ’cause it’s gonna hurt and you’re gonna adapt to it. So a good chiropractor should be able to address all the links in what we call the kinetic chain. It’s the body how to move symmetry, how to move with greater symmetry. In other words, a chiropractor unlocks motion, stimulates neurology to function more accurately, but if you don’t retrain the body to move more accurately, it’s gonna keep ongoing back to the old patterns. The chiropractor unlocks and restores motion, strong posture exerciser retrains that motion. They both fit together.

Dr. Weitz:                          One more question. Is there a role for nutrition in promoting posture?

Dr. Weiniger:                     Oh, absolutely. If your body doesn’t have the materials that you need from a biochemical basis to function, it’s gonna function adaptively. Everything from enough water, which is something that is one of the underrated issues with a lot of people with lower back pain, to enough calcium, to other things like functional medicine that you can use to stimulate or to decrease how different things are functioning to address it. Our bodies are not just biomechanical, it’s not just nutritional, it’s both working together.  As well as, biopsychosocial or attitudinal or mind or emotional, however you want to phrase it. Your head space, your attitude, will affect your posture and effect your health, and effect your biochemistry. They’re all together as mind, body, and spirit, which is kind of how chiropractic began once upon a time and it’s cool seeing more things go in that direction now.

Dr. Weitz:                          There you go. That’s kind of a evangelical saying from the posture evangelist. With a prayer here.

Dr. Weiniger:                     It’s funny because as you’ve noticed, I’ve got … I wear a number of different hats, and I’ve been at different boards and I didn’t want it to sound stuffy. I wanted to make it more of a fun thing to engage people and that was literally put out there as a kidding around and some people started banting it around and it became kind of what it is, but it’s true. Posture can make a big difference in your life. The posture month. Be aware of your posture, take control, engineer for a strong posture environment and next year recheck and see how you’re doing. And all the time, do basic posture exercises. You have a problem, see someone that can help. And the Posturezone app lets you check it and will help you find somebody.

Dr. Weitz:                          Cool. And so for listeners who want to get a hold of you, what’s the best way for them to contact you or get ahold of your book and learn about your programs?

Dr. Weiniger:                     From a public point of view, Stand Taller Live Longer, is the website for the book because that’s the name of the book. From the public point of view, Bodyzone.com, is where public information is. In the professional point of view, Posture Practice is where we teach people how to be CPEPs to strengthen people’s posture and from everyone’s point of view, download the Posturezone app. And all of those sites have ways to contact us that they can get a hold of me.

Dr. Weitz:                          Sounds great. Thanks, Steve. Keep spreading the word.

Dr. Weiniger:                     I appreciate it. I very much enjoyed it. Thank you.

Dr. Weitz:                          Okay, I did too. Talk to you soon.


Heavy Metal Detox with Dr. Christopher Shade: Rational Wellness Podcast 054

Dr. Christopher Shade discusses how to test for and remove heavy metals from the body with Dr. Ben Weitz.

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


Podcast Highlights

2:25  Dr. Shade talked about how he got interested in studying mercury and developed a way to separate different forms of mercury as part of getting his PhD. 

3:35  Dr. Shade explained that he tried heavy metal chelaters like DMSA and DMPS and these made him much sicker, which led him to design better supplements for detoxification.   

5:45  I asked Dr. Shade to explain why his tests for heavy metals are more accurate than other tests on the market?  I then asked how serum testing can be that accurate, since it only reflects recent exposure and not metals that have been stored in the tissues for months and years?  This is why we do oral chelation challenge and collect urine for six hours to detect metals that have been stored in the tissues and are now being released through the urine.  Dr. Shade challenged that view and explained that chelaters like DMSA do not go into the cells and cause metals to dump into the urine.  What they actually do is pull metals from the lymph and the red blood cells and bind it out into a form that’s easily filtered out through the kidneys.  And serum reflects the body burden. And urine also is somewhat reflective of body burden and urine has a baseline level of metals, in contradiction to the assumption that there is no baseline of metals until the chelation challenge. Also, after the serum levels rise due to a recent exposure, such as eating some fish, it takes 45 to 60 days for the serum levels to go back to the previous level in a healthy person and up to 300 days in an unhealthy person.   

10:51  Dr. Shade described how organic methylmercury from fish is represented very well in the blood, while inorganic mercury from dental amalgams doesn’t represent itself very well in the serum.  But inorganic mercury is seen much better in the urine, provided that the kidneys are functioning properly and the kidneys can become damaged by mercury.  Quicksilver Scientific offers the Mercury Tri-Test, which separates out the inorganic from the organic mercury and measures mercury in blood, hair, and urine.  Hair is only reflective of organic (from fish) mercury and you can have a mouth full of almagams and it will not show up in the hair.  Quicksilver also offers the blood metals panel.  Here is a link to Quicksilver’s website with more information on their testing, including why urine challenge testing with oral chelators is problematic: https://www.quicksilverscientific.com/testing/clinical-metals-testing 

20:19  I asked if Dr. Shade ever measures antibodies to metals and he said that he is interested in looking at that and thinks that it may show patients who become symptomatic with metal exposure. 

22:18  Dr. Shade said that undiagnosed Lyme Disease may become symptomatic when treating the metals because raising the glutathione levels reboots the immune system. If you then send them out for more Lyme Testing they may then test positive when they were negative before. So you need to focus on controlling the infection with antimicrobials before you can effectively complete your metal detox program. 

22:58  Dr. Shade explains his approach to removing toxic metals from the body.  You can use the same approach for mercury, cadmium and arsenic, while the approach for lead is a little different.  Mercury is detoxified well by glutathione, but you also need glutathione S-transferase and transmembrane transporters and also magnesium. So if we want to build a system of detoxification, we need to build glutathione levels. We need to turn up the activity of the transferase, and we need to turn up and support the activity of the the transport proteins. And when it gets down to the GI tract, we need to grab it before it gets reabsorbed.

25:40  Liposomal glutathione is better absorbed and someone with mold toxicity or Lyme disease are sick and will have a tough time making glutathione from NAC. Taking liposomal glutathione is better than taking NAC in a diseased person.  Dr. Shade mentioned a study showing that 600 mg liposomal glutathione produced a 30% increase in glutathione levels in six hours while 600 mg IV glutathione only produced a 15% increase in six hours. 

30:15  Dr. Shade explains what a liposomal formula is and how it works.  You are creating a fat soluble bubble with phosphatidylcholine and tucking the glutathione in it, so it gets absorbed like a fat would and it passively absorbs into the upper GI tract.  Dr. Shade also explained that by making his liposomal products small enough, some of them will pass through the oral mucosa and directly into the capillaries, so you should hold the liposomal products directly in your mouth for 30 seconds before swallowing. He explained that all of his products are between 20 and 80 nanometers since below 100 they get much better absorbed but you also don’t want them to be too small or you have problems with nano particles toxicity. 

33:15  Once you get glutathione into the cells, then you need to up-regulate the transferase and get those membrane transporters working by invoking NRF2 by using Lipoic acid and polyphenols. You can also use sulfurophanes from crucifers and garlic oil.  The best polyphenols to use are green tea extract, pine bark extract, red wine extract, grape seed extract and haritaki. 

34:55  Dr. Shade explains that to get the transporter proteins working well, you need to stimulate the liver-gall bladder system and promote the flow of bile. The transport of toxins into the bile tree is synonymous with and linked intimately with bile transport. The two transporters that move bile from the hepatocyte into the bile tree are the bile salt export pump and MRP2, the multidrug resistance pump number 2. The MRP2 is the is also the toxin transport and thus it moves both toxins and bile salts.  These transporter proteins get up-regulated and down-regulated together, so cholestasis is toxostasis.  Thus, if you move bile, you move toxins.  If you don’t move the toxins from the liver into the bile, they get dumped into the brain and you get inflammation in the brain, the kidneys, you get lower back pain, skin rashes.  He likes to use herbal bitters to get bile and toxins flowing and also phosphatidylcholine to help solubilize the bile to keep it flowing. Then, when the toxins are moving through the GI tract, you want to use binders like thiol-functionalized silica, charcoal, clay, zeolites, and chitosan, so these toxins don’t get reabsorbed.

39:28  Dr. Shade explains why modified citrus pectin is not a good binder for toxins, though it helps remove toxins by reducing inflammation.



Dr. Christopher Shade is a PhD researcher and a recognized expert on mercury and liposomal delivery systems. He has lectured and trained doctors in the U.S. and internationally on the subject of mercury, heavy metals, and the human detoxification system. He founded Quicksilver Scientific and Quicksilver is an industry leader in blood metals testing and the development and production of superior liposomal delivery systems. Quicksilver Scientific is the only company to offer advanced mercury speciation testing (the Mercury Tri-Test), which comprehensively assesses for the body burden of mercury. Here is more information about the metals testing: https://www.quicksilverscientific.com/testing/clinical-metals-testing  Quicksilver Scientific is dedicated to producing superior nutraceutical products tailored at supporting the human detoxification system for the optimization of health. https://www.quicksilverscientific.com/home

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


Podcast Transcripts


Dr. Weitz:          This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition. From the latest scientific research, and by interviewing the top experts in the field.  Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free 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 us again today. For those of you who enjoy this podcast, please give us a ratings and review on iTunes.

                          Our topic for today is heavy metal toxins. This is a very important topic. We recently had Dr. Joe Pizzorno on talking about toxins, and now we’re going to focus in on heavy metals, mercury, lead, all the other heavy metals. And these are incredible important, can have all kinds of effects for our health, can play a role in various chronic diseases. And I’m very excited that I’ll be speaking with Dr. Christopher Shade, who is a PHD researcher and the founder and CEO of Quicksilver Scientific, a heavy metal testing and nutritional supplement company. Quicksilver Scientific is known especially for its detoxification products and its unique supplement delivery systems, and it’s patented mercury speciation test. Christopher, thank you for joining me today.

Dr. Shade:         Thanks, Ben, it’s a pleasure to be here.

Dr. Weitz:          Good, good, good. So can you tell me a little bit about your background and how you became interested in mercury and heavy metal testing?

Dr. Shade:         Oh, sure thing. I’ve a very circuitous background to get here. Grew up a scientist in an academic family. Got a little disillusion with reductionist science, went out into the woods, I was an organic farmer for a long time, sort of a Thoreau summer starting farms and stuff. And then one thing or another led me back into getting a graduate degree around pollution in the environment. I was looking at agricultural pollution and I got a masters in that.

Dr. Shade:         Then when I went to do my PHD, I didn’t really find the research that was going on there that interesting, but I found this guy who was specializing in global cycling of mercury as a toxin in the environment. And I ended up working with him. And they needed new analytical developed, new systems for separating different forms of mercury, which is really crucial to understanding their movement through the environment and movement through the body. And so I developed that, patented that, and graduated and started a company around that testing, originally doing environmental testing and then switching over into health and wellness. Because I wanted to get back to this human focused look at toxins in the environment and health in the environment, and cycle it back into looking at personal health.

                         And I brought this testing in, showed it to people like Hal Huggins and Dietrich Klinghardt, original pioneers in mercury toxicity. And they really liked that, but you know you bring up a problem, you gotta bring up a solution. And at the time, everybody was working with chemical chelators for getting rid of mercury and other heavy metals. And I thought I would do testing in conjunction with people using chelators, and so I tried all those chelators on myself and I got myself really into a hole. I really blew out my adrenals, I blew out my neurological balance, my immune system.  And while I was in the middle of just being in this dark night of my biochemical soul, I was watching these functional medicine meeting lectures here in Boulder County.  I was watching Bob Roundtree and Nigel Plummer from Pharmax, and they were talking about GI health and the GI system calling the shots in so much stuff. And I realized that a lot of amalgam toxicity was having so many metals in the GI tract.  And I was trying to push things through the kidney, but I should clear out liver GI functioning first.

                          And that led me to make my first detox supplement, which was kind of a chelator for the GI tract. It was like taking a clay or an activated charcoal and making it specific for metals. And as I did that and cleared everything out of my GI tract, I just opened up all my problems, I just cleared everything away. And introduced that product, which is now known as IMD, or Intestinal Metals Detox.  I introduced that to Huggins and Klinghardt and it filled a big void in everybody’s tool chest and it led me to research why it worked, and that led me to understand all the processes of the glutathione system and how the body’s naturally supposed to get rid of these metals. And that metal toxicity is not a deficiency of chelators, it is a deficiency of your own chemo defense system. And then when we optimize that, we can get rid of all these metals and at the same time make us resilient or resistant to other toxic insults. And so my whole life work became developing systems for optimizing all of that in people.

Dr. Weitz:            Cool. So can you explain about your heavy metal testing and why it ends up being more accurate than so many other testing?  And I keep coming back to whenever I look at serum testing I always think, you know, that’s only going to give us current levels of metals and so that’s why we’ve tended to do the oral challenge and then collect urine for six hours afterwards, with the idea that we’re going to liberate some of these metals, mercury, that’s been stored in the body, sometimes for months, years, maybe decades at a time. So how can you get a sense from testing of stored metals as well as what’s circulating and has come into the body recently?

Dr. Shade:           Right. But this is all … What did you just say to me? You said, “Well I think that this is only what’s circulating.”  Why do you think that? Did you do the primary research? Did you figure out why you think that?  Or are you just parroting what the guys who did chelation testing told you? Answer the question.

Dr. Weitz:            I have always been told that certain testing is only-

Dr. Shade:           Exactly.  Always been told is the problem there.

Dr. Weitz:            Including by the way some of the companies that do certain testing will tell you that as well.

Dr. Shade:           This is just what became the dogma of what’s going on. And the reality is that 20, 30 years ago we didn’t have really good testing to look at baseline levels. Like in urine, if you extended your discussion you’d say, but in urine there’s no metals in urine so I challenge it. That’s not true at all. There’s always a baseline of metals that are going on in the urine. And they are a filtrate of what’s happening in the whole blood, which is the plasma and the red blood cell. And the plasma and the red blood cell are in a steady state with what’s in the tissues.

                           Now for that whole argument that you brought up to be correct, that would mean that the chelators would go into all the cells and take a representative amount out into the serum and then make it go into the urine. But if you look at DMPS and DMSA, all the data around that says that they don’t do that. All the data around it says that they never cross the blood brain barrier, they don’t go into the cells. What they do is take what’s in the lymph and the red blood cells and bind it out into a form that’s easily filtered out through the kidneys.

                           And in a very famous paper that was done in Sweden in the mid-’90s, they were trying to look at DMPS and if it really reflects long term body burden, or if it’s just amplifying what you can already find in the body.  And they took acutely exposed workers who work with mercury directly, they took dentists with a long term burden, and then they took people with amalgams and people without amalgams.  And they looked at inorganic mercury in the plasma, and inorganic mercury in the urine before and after taking DMPS, 300 milligrams IV.  And what they found was that the mercury in the urine is linearly correlated with mercury in the plasma, and mercury in the urine after the challenge was linearly correlated with mercury in the urine before the challenge, and with mercury in the plasma before the challenge.

                          You’ve got these compartments and there’s a back and forth between them all. It’s not that the mercury comes in and goes into the tissues and sticks there and then leaves the blood. What happens, like if we went out for dinner tonight and we eat swordfish, a high mercury meal, we’re going to absorb that mercury in there and it’s going to peak between 12 and 18 hours after we eat. And it’s going to be much higher than our baseline is. So from our baseline let’s call it, let’s just give it a number. Say I’m at 5. I’m going to eat this meal, my peak is going to go up through maybe even 10 or 15, and then over 2 to 3 days it’s going back to this next baseline. And let’s call that 6.  And from the time to get from 6 back to 5, the original baseline, how long is that? It’s 60 days, 45 to 60 days in a healthy individual. As many as 300 days in an unhealthy individual. It’s not 2 to 3 days. The 2 to 3 days story was about a bolus that goes in, it goes up and peaks and comes back to a new baseline, and then it comes back.  But where people were kind of throwing their hands up with what’s urine mean, what’s blood mean? What’s going on here?  Methylmercury represents itself very well in the blood and will give you high levels.  Inorganic mercury from dental amalgam doesn’t represent itself very well.  It works on a lower scale.

                       Now why is that? It’s because of the distribution between the blood and the tissues. There’s always more in the tissues, which the prevailing wisdom is right about. There’s more in the tissues than the blood. But there’s a ratio between the two. And maybe it’s 10 fold more in the tissues for methylmercury and 30 to 50 fold more for inorganic mercury. And so dental amalgams and blood levels didn’t seem to correlate very well. But fish and blood levels did correlate well. But dental amalgams correlated pretty well with urine, and fish didn’t so well. That’s because methylmercury you find a lot in the blood, inorganic mercury, small amount in the blood. In the urine it’s all inorganic mercury. And so it’s reflective of the inorganic mercury levels in the serum, if the kidneys are transporting correctly.  And this comes down when we talk about detox we’re going to talk about pathways in the liver, you have the same pathways in the kidney. And when they get damaged, and they’re easily damaged, then that urinary representation of the blood blows out and you have low urine, high blood. Alright, but if it is working, then urinary mercury’s an inorganic mercury exposure.  Hair, you have Naturopaths going through all these soups to explain what hair meant compared to blood or intake. Hair is only fish. You can have a mouth made out of dental amalgam, if you eat no fish you have no mercury in your hair.

                     So there was all this improper, imprecise understanding of the pools of mercury, the compartments, and the interactions between them all. And so we just said, we’ll take the chelator, boom, a bunch comes out through the urine and we can compare people that way. And you can, but it’s not a very sophisticated way to go. And humans always do this, in order to justify that, they create this whole story that the mercury’s never in the blood except for like the last two days, and it’s all in the cells and the challenge pulls it all out of the cells and gives you this long term mercury number. But I pulled five or six different papers out of the literature where they examine that, and none of it worked.

                    Get this, one paper on DMSA, they took a grouping of people who had worked in the Chlor-Alkali factory, you sit there with a pool of mercury and stir it, and it’s an electrolysis cell, to split sodium chloride into sodium and chlorine. It’s the highest exposure you can ever get. So they all worked there and then they stopped working there for either one year or three years, but that’s the highest level of burden you can take into your body there is.  And then they took the general population and they measured urine before and after DSMA chelation.  Before DMSA chelation the guys who worked with the pools of mercury before were higher than the mainstream. But after chelation, the differences leveled out totally. There was no statistical difference between the two and there’s a reason for that. Because DMSA is really no good on inorganic mercury, which is what you get for that vapor form. But it’s pretty good on methylmercury. So this is a measure of how much fish these two groups ate. And it’s the same, because they were just a cross section of the population for methylmercury exposure, but one of them had significant inorganic mercury exposure.  So there’s all these papers showing the failure of the challenges to show long term burden. The exception being EDTA challenge and bone lead versus blood.  EDTA challenge is better correlated with bone lead than blood is, but blood’s still not bad.  You just have to take these scales, you’re looking for these huge, big scales, you’ve focused them down, and key for us for mercury, you separate methyl and inorganic mercury.  Give them their own reference ranges in the blood. Then once you have that inorganic mercury separated away from the fish-based methylmercury, that’s supposed to correlate perfectly with urine. And when it doesn’t, then you see it building up in the blood and you know where the damage is. It’s to transporters in the proximal tubules. It’s not even related to glomerular filtration. And you know when you treat them you have to focus on that. So there’s the whole story.

Dr. Weitz:      Yeah, so to sort of highlight a couple of points that you’re making is number one, the oral chelators like DMSA, they’re not effective at removing mercury and heavy metals from the tissues like we think they are.

Dr. Shade:     No, they remove from the blood plasma, maybe a little bit of soft tissue, lymph, and then the metals redistribute from the cells into the blood. And that’s when it’s important to have things that up regulate the chemistry that dumps out of the cells into the blood. Like lipoic acid. If you go to the Cutler theory, Cutler thought that DMSA was clearing the body and lipoic acid was clearing the brain. And he would start with DMSA and then he would move to DMSA and lipoic acid. DMSA clears from the blood and then lipoic acid gets the cells that dump into the blood. And then the DMSA can take it.

Dr. Weitz:      Interesting. So the first point is the oral chelators are not effective at removing the metals from the tissues. And two, the serum testing is actually effective for measuring mercury that’s in the body for up to 300 days.

Dr. Shade:     Yeah. And as long as you have the right testing. If you go to Labcorp, they’re not measuring low levels, and they’re not separating the two forms of mercury. So once you separate the two forms and you can measure really, really low, then everything’s good.  For instance, if say we’re measuring you and you have a lot of dental amalgams, but you never eat fish. Your total mercury in the blood might be say 0.5 parts per billion. Now the limit of detection for Quest is 1 part per billion. And some labs it’s 0.5. And so you’ll like less than the detection limit, less than 1. And they’ll say you have no mercury. But all of it is inorganic mercury. If you look at our reference ranges once you separate methyl and inorganic mercury, 0.5 parts per billion if inorganic mercury is the 95th percentile. It’s a very, very high amount.

                      And if your urine to blood ratio is good and your kidneys are working well and if you measured your urine, your urine would actually be fairly high. And so it was just, oh, we’ll measure serum. It only shows a little bit of one story. We’re measuring urine, only shows a little bit of story. You gotta put all this stuff together with the right technology. And there’s a beautiful story about the disposition of the metals and your excretion ability all in that one test.

Dr. Weitz:            So your company offers this tri-metals test that measures mercury through serum, urine, and hair.

Dr. Shade:           Yeah, that’s called the Mercury Tri-Test. Those three, blood, hair, urine.

Dr. Weitz:            And then there’s another test that measures multiple metals, and that’s a serum test.

Dr. Shade:           Yeah, that’s our blood metals panel, where you’re looking at nutrient metals and toxic metals. So the nutrients, you’ve got classic calcium, magnesium, copper, zinc. Most are really important because they have to be in a certain ratio. When you have high copper and low zinc, you’re synergistically toxic with all your other metals and it’s a marker of a serious dysfunction. So is calcium:magnesium.  Then you’ve got co factor detoxification metals like selenium, molybdenum, which is crucial for sulfur cycling, and you’re taking a lot of sulfur compounds when you’re detoxing. And lithium, which is a big one for B vitamin cycling.  And then in your toxics you’ve got the major four, arsenic, cadmium, lead and you have mercury but just as total mercury. If you’re just looking at somebody who’s a big fish eater and you want to know is it high, is it low, it’s sort of a good first cut.  A lot of people think, well if it’s high there then I’ll go do the Tri-Test. But if you have a patient who has dental amalgams but doesn’t eat fish, you’re not going to see anything in the total mercury blood. You need to go to the test that separates the two and looks at inorganic separate from methyl. It’s like they’re two totally different metals.

Dr. Weitz:            So ideally, if you have somebody that you suspect has serious metal issues, you really need to do both tests.

Dr. Shade:           You do both and you have a map of everything then. Both functional excretion capacity, sourcing, and your whole metals map, nutrient and toxic all together.

Dr. Weitz:            You ever measure the antibodies to metals?

Dr. Shade:           No, but every time I hang out with-

Dr. Weitz:            Dr. Vojdani?

Dr. Shade:           Yeah.

Dr. Weitz:            He spoke at our meeting last month so I got to hang out with him, it was great.

Dr. Shade:           Yeah. And so hopefully I hired guys to be in charge of a clinical research program here, and we’re starting to really crank out a lot of stuff. And so that’s on our list is to reach out to Dr. Vojdani and get a bunch of patients. Because he had said to me, “Well I think when you see the levels are high you’re going to see antibody response.” My take is very different.  When you see an antibody response, that’s going to mean that a certain level of metals is infinitely worse than maybe a higher level with no antibodies. So the antibody and the levels together will correlate with symptomology. And we’ll see, because you’re going to find a lot of people who are super symptomatic at low levels, and it’s this diffused whole immune dysregulation and neurological dysregulation. And the amount of mercury is really hard to justify that that’s doing it alone. But if they’re allergic to that mercury, then that can give those symptoms.

Dr. Weitz:            Yeah, boy, those can be some of the toughest patients, some of these chronic patients, and you’ve been doing mercury protocols and years later they’re still sick. Those are the toughest patients.

Dr. Shade:           Yeah, they’re very difficult. It’s very multifactorial, why did the immune system turn on it. There’s usually layers and layers of stuff going on.

Dr. Weitz:            Yeah, in one of the discussions you were having with somebody else, you were talking about how when you’re trying to get rid of metals or mercury, at a certain point sometimes that will increase some of the infections and you’ll have to stop and fight that off, like SIBO will recur.

Dr. Shade:           One of the things that we see a lot is that with lyme, undiagnosed lyme, when we start treating the metals we bring the glutathione levels up, it reboots the immune system and it starts reacting to the lyme and they feel horrible. And then you send them out for more lyme testing and then they show positive on their Western blots, and then they have to take a side road and get some antimicrobial therapy before they can come back and just do the metals. Although there’s still detoxification support for that. So in the complex cases I would say there’s a sort of pendulum between microbial focusing and toxin focusing.

Dr. Weitz:          So can you talk about your strategy for helping to remove metals, and how much does it change depending upon the metal?

Dr. Shade:         Oh, good, good question. And I’ve gone to a more broadly focused detoxification strategy, but let’s just look at mercury now. And mercury, cadmium and arsenic are playing by basically the same rules, and lead plays by a different set of rules. And then cadmium a little bit straddles the fence between the two. So mercury is the classic glutathione dependent detoxification. So if we’re in a cell, say there’s a cell here and we got a protein and there’s a mercury stuck to it, we gotta get the mercury off of the protein because mercury’s blocking the function of the protein. So you’re going to have glutathione floating around in the cell. But it doesn’t just go and grab the mercury on its own. You need glutathione S-transferase. Glutathione S-transferase is part of the phase two detoxification proteins called transferases, where they link something you make, like glutathione, onto something you want to get rid of, like mercury. And so that transferase would be me, and it changes the bond structure on the mercury so it can come off the protein and go with the mercury. 

Dr. Shade:         So then we got a mercury glutathione complex in the cell, we gotta get it out. Now it doesn’t just passably diffuse out. There is a series of transmembrane transporters that depend on magnesium and ATP, meaning you need to energy to turn them over and you need magnesium. And they actively push that complex out of the cell.  Okay, so the cell’s free, but it’s out in the body. And it’s in the extracellular environment and then that’ll join in to the blood flow and then how do we get it out from there? In the liver you got another transmembrane transporter that’s feeling around for these things, grabs it, pulls it into the hepatocyte, and another one that’s another one in these family of transporters that dumps it into the bioflow. And then from the bioflow goes down to the GI tract and out to fecal excretion. That’s when everything’s working well.

                        So if we want to build a system of detoxification, we need to build glutathione levels. We need to turn up the activity of the transferase, and we need to turn up and support the activity of the the transport proteins. And when it gets down to the GI tract, we need to grab it before it gets reabsorbed.  So we like to bring in liposomal glutathione for building glutathione.

Dr. Weitz:        Now how much is glutathione actually absorbed? Those of us in a Functional Medicine world have it in our heads, we’ve been told glutathione’s not absorbed, you gotta take NAC, that’s the only way to do it. If you end up in the emergency room with acetominophen toxicity, they’re going to give you IV NAC, so NAC’s the way to go. But now that we have these better forms of glutathione, like liposomal, how much is actually absorbed?

Dr. Shade:       Right, and so in … These total amounts absorbed in kind of vary and we’re doing a lot of research to show how much goes in and how these different approaches compare. But first, why would we do … Let’s just assume we get the liposome in and then we’ll come back to how well liposomes are absorbed, and what’s required for a liposome to be absorbed, because all liposomes aren’t the same. It’s like all cars are not the same, all wines are not the same. There’s a vast range of quality.

                       But first just assume that it gets in there. Why would you use that instead of NAC? Now in the cases of really compromised individuals who are very sick, people with lyme disease, mold toxicity, things where there’s actually blockages of the enzymes that are synthesizing glutathione.  For instance, there was a paper done using ready liposomal glutathione in cell cultures and they took immune cells from HIV patients, which are notoriously poor at making glutathione, and they’re getting all these infections because of the low glutathione. And that’s one thing that people miss about glutathione is it’s an essential factor for proper immune response, it’s not just about detoxification.  So they found in these cells, they were challenging them with the tuberculosis culture, they culture the white blood cells, the put tuberculosis in, and for the cells to be able to handle the tuberculosis, they needed to raise the reduced glutathione levels. And then the cells could deal with this. And they tried two ways to do it.  One was NAC, and the other one was liposomal glutathione into the cell cultures. And they needed 5,000 times more NAC to raise the glutathione levels up the way that the liposomal glutathione did. 5,000 times. Because those enzymes are epigenetically being blocked by disease states. So when you’re sick, just pouring NAC in, it’s hard to get the levels up. You’re healthy, that’s a good way to go. If you have snips for poor glutathione production, then you want to think about both as differing strategies.

                      Then liposomes, what gets in, what doesn’t. We’re actually in the middle of a study right now where we’re measuring all the different liposomes on the market and the factors that go in to getting these into absorption. And we just got a study back from our Japanese partners, we’ve got a bunch of Japanese doctors who use our stuff, they wanted data on glutathione, I didn’t have it yet, so they went and got Doctors’ Data, blood glutathione test. They took 10 people, measured baseline, gave 5 of them IV and 5 of them liposomes, 500 milligrams each. And then they measured them six hours later. To see not right away, if you do an IV you spike up, but often you spike right back down. So they said six hours later, what’s the effect on this system?  IV six hours later there was a 15% jump above baseline. Liposome, a 30% jump. Anything that gets you a 30% jump is awesome. But the fact that we just beat the IV, because the IV has no mechanism for really interacting with cells. Glutathione’s not really good at getting in the cells. But the liposome showed its ability to raise the levels for an extended period of time. It was a beautiful piece of work. But in all the other data that we’ve got on liposomes, the membranes have to be right and the size has to be right.

Dr. Weitz:       And by the way, liposomal basically means putting it in a fat soluble form, right? Essentially combining it with phosphatidylcholine.

Dr. Shade:      Well what you’re doing is using phosphorylcholine to make a little bubble that’s sort of watery on the outside, fatty on the inside. And you’re making like a little cell and you’re tucking the glutathione in there. And so it absorbs like a fat would. It passably diffuses across the upper GI. So that’s why they say it’s like it’s like fat soluble, because it absorbs like a fat.

                       But if you make them small enough, they pass right through the oral mucosa into the capillaries in the oral mucosa. In fact in the blood uptake studies that we did with vitamin B12, we had a very significant bump in the blood levels in two minutes after holding it in the mouth. That’s why with our liposomes you take them orally, you swish them around your mouth, you let them hold in there 30 to 60 seconds and you swallow. The uptake begins there. Even if … You get to the stomach acid and the bile salts, you’re starting to beat on those liposomes. So the faster you start that journey, the better.  And that journey only begins that far up in the GI tract when they’re really small. We call them nano liposomes because they’re below 100 nanometers. And all of our products are between 20 and 80 nanometers. This is not a threat, don’t worry about nano tech. Because when you’re absorbing fats in your diet, you make something called a chylomicron. It’s triglycerides surrounded by phosphatidylcholine with a couple of apolipoproteins that you use as delivery vehicles to bring the fatty acids to the cells to use them. And those range down to 70 nanometers in size. So those are lipidnanoparticles, and you have a whole enzyme system for dealing with phospholipid based nano particles to take them apart, use the phospholipids in your cells, in your membranes. You can use them as fatty acids for energy, you can make acetylcholine.

                    So this delivery system is really good but it only worked when we got it below 100 nanometers. And all this other stuff on the market is selling you the dream of the liposome but they’re 2, 3, 400 nanometers, and I just don’t see any evidence that they’re working. So we’re really spending a lot of money and a lot of time working out exactly what works and what doesn’t work. Alright, so that’s the glutathione story.

Dr. Weitz:     What about the idea of spraying some in your nose, because Dr. Vojdani was talking about how there’s a route of entry from the nose for bacteria directly into the brain.

Dr. Shade:     No, that’s a great idea but it’s not a dietary supplement, then it’s a compound pharmacy product. Because a dietary supplement has to go through the GI tract.  Don’t think I don’t have a couple of nasal applicators here in my office. I did that, but I can’t do it on the market. So there’s the story there.

                     So back to our detox story, we got glutathione in, and now we need to up-regulate the transferase and get all those transporters working. So now we want to invoke NRF2, which is the little switch, the protein inside the cytoplasm that when you activate it, it goes into the nucleus and turns on all the chemo protective genes. It’s like the light switch for all the protection genes. So you want an NRF2 up regulator. So the things that do that, lipoic acid is probably my favorite. There’s a number of compounds from crucifers, like sulforaphane is very well known but there’s some drawbacks with those. There’s things from garlic that work very well. And don’t get deodorized garlic because it’s actually the stink of the garlic that works, it’s garlic oil that does it.  Then polyphenols, I love polyphenols.

Dr. Weitz:     Resveratrol.

Dr. Shade:    Well resveratrol’s not a great NRF2. It’s more in the SIRT 1 activation, so mitochondrial up regulation. But it is a polyphenol. And then people say curcumin, and that’s not the best either. The good ones are green tea extract, pine bark extract, red wine extract, grape seed extract. The Ayrevedic polyphenols from haritaki is one I use a lot. So all of those are really good NRF2 up-regulators.

                     And with that comes glutathione S-transferase. There’s also a bump to glutathione synthesis in there. So that’s working, and there’s also a bump to the transport proteins. But to really get the transport system working well, I like to work from the GI–gallbladder–intestinal axis here. Why am I talking about that? Because the biggest transport system that’s happening here is from the hepatocyte into the bile ducts. And that transport of toxins into the bile tree is synonymous with and linked intimately with bile transport.  There are two transporters that move bile from the hepatocyte into the bile tree. And it’s the bile salt export pump and MRP2, the multidrug resistance pump number 2. The MRP2 is the toxin transport, it moves toxins and it moves bile salts, and obviously the bile salt pump moves bile salts. These guys get up-regulated and down-regulated in unison. So cholestasis is toxostasis. If you move bile, you can’t move -toxins.

                   So what happens to the toxins that are in the liver when you can’t move them into the bile? There’s another door out of the liver back into the blood. It’s a pressure release valve. When you wind up a bunch of toxins in the hepatocyte, and the hepatocyte can’t deal, it can’t move them out fast enough, it dumps them back into the blood.  Where do they go from there? Brain, neuroinflamation. Kidneys. Lower back pain. Skin, rashes and things coming out through the skin. These are all the classic detox reactions, and they’re all caused from a failure to continue to move bile. So we’re taking our cues here from the early 1900s and the prohibition time when bitters was the medicine for everybody because it was the only way to drink, but it also cured half of what ails you, because stuck liver was what was going on. And when you open up liver, bitters activate those transporters, and when you open that up and you dump bile, you dump toxins and you start feeling better. So we use a lot of bitters.  We use a lot of phosphatidylcholine just on its own, not even in liposomes, because PC is always being donated from the hepatocyte cell membranes into the bile flow because it helps fluidize the bile flow. People talk about thick bile, PC is what’s solubilizes it. And it actually forms little mixed micelles with the bile salts so that the bile salts, which are a detergent, don’t dissolve the bile tree.  And the reason you have pressure release valves from the hepatocyte is when bile salts build up in there, they dissolve the hepatocyte. And so you’re dumping those back into the blood and then bringing them up when you can use them. So when you’re always moving out, you’re always moving toxins out of the system.

                 But what else are you doing? You’re cleaning the upper GI tract. Everybody’s talking about SIBO and SIFO, like it’s a new infection. Do you really believe that you have an infection in the small intestine that has to be treated? Why do you have an infection? It’s not like a creature came in and is living there in a classical infection sense. It’s crawling it’s way … It’s just bacteria in your lower GI tract crawling their way into the upper GI tract. Because the upper GI tract is supposed to be washed by bile. The antimicrobial detergent that washes the upper GI tract and acutely brings glutathione along with PC into the upper GI tract as part of the metabolism in the upper GI.  Upper GI is doing mostly chemical reactions. Detoxing things in food, and pulling things out of blood and dumping them into that GI tract, and then the microbes start growing further on down. And in fact, in people with congenital intrahepatic cholestasis, meaning you’re not able to move bile salts from the hepatocyte into the bile tree, those people are statistically higher cases of SIBO, and when you treat them, it keeps coming back.

                 So this bile flow, this keeping things moving out, is a crucial part of keeping the transport chain open, keeping the liver open, and then coming in with binders to bind these toxins in the GI tract so you don’t absorb them. And that’s binders like our IMD, which is thiol-functionalized silica for metal, or charcoal. Clays and zeolites, Chitosan, those are all grabbing different parts of the toxin pool and we blend those all together-

Dr. Weitz:            What about pectins, like modified citrus pectin?

Dr. Shade:           Now modified citrus pectin, I don’t buy into that at all. So remember my … No, I buy into it’s use therapeutically, I don’t buy into the idea that it can bind toxins. Because remember my PHD is in mercury chemistry. I designed the whole analytical system we use to model out what molecules bound mercury as it moved from the sky to the rain to the bacteria to the plankton to the fish to the people. We know this stuff really, really well. And there ain’t nothing in modified citrus pectin that’s going to be a good toxin binder.

          But remember this, inflammation blocks detoxification. When inflammation is down, detoxification gets blocked because detoxification’s part of the antioxidant system and inflammation is pro oxidant. So they just go like this. And modified citrus pectin is a very nice immune modulator, especially in the GI tract, and it turns down inflammation in the GI tract. When you turn down inflammation in the GI tract, you release a stuck immune system and allow it to detox more. And I believe that that’s why modified citrus pectin has a therapeutic value in detoxification. And it probably does bind a lot of other toxins that are made, maybe it binds an endotoxin, maybe it binds some of the other dysbiotic toxins, maybe it gets a little bit of mold toxin. It does have a therapeutic thing but arguing for it mechanistically as a mercury binder is not a good path for the argument.

Dr. Weitz:            It’s interesting because it’s in a lot of products that are designed for removing heavy metals.

Dr. Shade:           Yeah. And again, I think therapeutically it works but not in the way that they’re describing. And my whole goal, my whole path here has been one of shedding light on the path, and the light is on the light of the mechanism that things are working. I am big into empirical medicine and knowing what’s worked and what hasn’t. But until you reduce that to mechanism, you can’t take the next step of effectively bringing together the best players for a different problem, and designing a higher order of natural medicine.

Dr. Weitz:            Right. Just a word on the SIBO. You know part of the theory about one of the reasons for SIBO, apart from decreased bile secretion, is that you get decreased motility and you get a blockage of the migrating motor complex which causes these peristaltic waves to happen in between eating that helps to clear out the small intestine.

Dr. Shade:           Flush, clean, flush, clean, flush, clean. You’re right. And so it has two sides to it. How do they get blocked, are they poisoned, is it a microbe, is it a toxin? But somehow they get locked down.

Dr. Weitz:            Well there’s that whole cytolethal toxin theory of Dr. Pimentel’s, and they even have a blood test for it.

Dr. Shade:           And what are those called?

Dr. Weitz:            It’s a cytolethal-

Dr. Shade:           [crosstalk 00:42:43] toxin?

Dr. Weitz:            It’s an endotoxin secreted by a campylobacter jejune or some form of food poisoning that secretes a toxin that then damages the nervous system of the small intestine.

Dr. Shade:           Yeah. And when you go into the body and you look at what really amplifies toxins-

Dr. Weitz:            It secretes a cytolethal toxin distending toxin.

Dr. Shade:           Cytolethal distending toxin.

Dr. Weitz:            Yeah, Dr. Pimentel has a test for it, I think it’s called the IBS check test.

Dr. Shade:           Okay, cool, I’m going to look more into that. Because things like endotoxin amplifies all the toxicity through the body because it’s pro inflammatory. And there’s papers looking at the damage of mercury alone and mercury plus endotoxin and it’s synergistically higher. And I was talking about those transporters that are moving the bile salts and the toxins. Well what blocks them the best? Endotoxin. And it actually causes the transporters to be pulled out of their membrane and internalized into a little vesicle in the hepatocyte. And you really want to damp the inflammation, get those transporters back in there to drain everything out.  And it was great, we put a paper, Carrie Decker and I wrote a paper in Townsend Letter about all these pathways and nutraceuticals work on these things. And one of the interesting things about milk thistle is that it actually preserved the transporter’s ability to stay in the membrane during the stress of high toxicity.

                           But another thing that blocks that is excess estrogen. And something that opens it up is progesterone. So there’s estrogen progesterone balance, estrogen dominance actually locks up your gallbladder. And in the brain estrogen dominant winds up the glutamate system which gives you anxiety, it makes you sympathetic dominant. But the gallbladder’s also para sympathetically innervated, so it’s working against you on so many different levels. So stress, estrogen dominance, leaky gut and endotoxin, all this is blocking your ability to detoxify.

Dr. Weitz:            And Dr. Vojdani at Cyrex Labs has a test, it measures anticytolethal distending toxin and also vinculin. That’s the part of the small intestine that gets damaged and they have a test for that.

Dr. Shade:           See me writing all this down. Distending toxin, I like that. Alright.  See, this goes back to understanding mechanism. The more we understand mechanism, the more we can reach out to other people that are working in different fields and say let’s bring this together and really let’s lock this down. And it’s an amazing time in the whole history of natural medicine where you go into PubMed and you see that there’s research being done all over the world on all the different natural compounds and the genes they hit, the proteins the express, interactions between the two. We’re getting all of the mechanism of all these transporters all down. This is a brilliant time where we can design the most powerful natural medicine systems.

Dr. Weitz:            That’s great. This has been an awesome discussion, Dr. Shade. So for listeners and practitioners who are interested in getting some of this testing done, or getting a hold of your products, are the testing and products available to laypersons or should they just go through functional medicine practitioners like myself? How does it work?

Dr. Shade:           Yeah, so Quicksilver Scientific is dominantly a professional company. We’re offering the testing to the practitioners, they pass it through. You guys buy the supplemental through wholesale, you pass them through. You use our protocols or individual products. But there’s such a world of hyper informed self medicators out there, and they’re dying for this stuff and I gotta give it to them because that’s me, too. And so we do sell direct to consumer all but some. Like there’s some real pro-grade stuff, like the EDTA, that’s practitioner only. But most of the other stuff is available. Even the testing, but but that’s state by state, about half the states allow direct access testing where you can buy a kit from us, go to to a clinic, get the blood draw done and send it back.  But it’s always good to go through a practitioner, because they’re going to bring a wealth of experience of all the other things that they’ve seen. And they’re going to button up the whole protocol and they’re going to put the little extra things you need in there. There’s “Oh no, did you think about doing this and this?”  So both are available, but we’d like people to work with practitioners.

Dr. Weitz:            That’s great. And for those who want get more information, where should they go?  

Dr. Shade:           Quicksilverscientific.com. And we have a whole new website being launched in about two weeks. Right now Quicksilver Scientific, if you’re buying as an individual, it will move you over to Quicksilver Life, our second website, which is a retail website. But they’ll all be merged together as Quicksilver Scientific in about two to three weeks. And there’s different things, it’ll be one site with different things available to you depending upon your journey in there, there’ll be more stuff available to the practitioner.

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

Dr. Shade:           Great, thank you so much, it’s been great hanging out here with you, Ben.

Healthy Skin with Dr. Trevor Cates: Rational Wellness Podcast 053

Dr. Trevor Cates discusses how to create healthy, glowing skin with Dr. Ben Weitz.

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


Podcast Highlights

1:50  Dr. Cates talked about how the typical dermatology model of looking at skin is that it is something to be suppressed, which is why topical steroids and antibiotics are often prescribed. Skin is really a great indicator of what is going on inside the body and of our overall health. If you’re breaking out or have dry skin or rashes, these are all signs that something in your body is out of balance. You want to find out what the root causes are and these are usually the same root causes of most chronic diseases. 

5:48  Dr. Cates talks about how the skin is permeable and things that you put on your skin can make their way into your body.  That is one of the reasons why we use nicotine patches or topical hormone creams.  So can some of the products we put on our skin like parabens, which are preservatives used in many skin care products, have also shown up in breast tumor tissues.  Many of these chemicals found in skin care and other personal care products are endocrine disrupting chemicals that can disrupt our hormones. Dr. Cates pointed out that when women get older they tend to use more skin care products when they are also struggling with hormonal issues related to menopause and hormone disrupting chemicals will only worsen these problems. These endocrine disrupting substances can bind to hormone receptor sites and either mimic hormones or interfere with the way that they’re supposed to work. They cause a number of health issues including infertility, early puberty, hypothyroid, and even certain types of cancer like breast and prostate. 

10:42  I asked Dr. Cates to mention some of the other chemicals we should be looking to avoid in our personal care products. One type of chemical is the pthalates that are present any time you see “fragrance” on the label. Pthalates are endocrine disrupting chemicals.  Better to go with products labelled fragrance free or use essential oils. This is why Dr. Cates created her own skin care line, The Spa Doctor’s skin care line. We also talked about how some companies will take out a chemical that has been publicized as being bad, like BPA, but substitute something like BPS, which is probably equally as bad but isn’t on the list yet of harmful chemicals. 

13:48  Dr. Cates talked about formaldehyde releasers that are put in products labelled formaldehyde free. She lists many of the harmful ingredients to avoid in skin care products in her book Clean Skin From Within. She recommends the skin deep database at the Environmental Working Group, ewg.org. 

17:03  Dr. Cates explained that our skin does best with a mildly acidic pH of 4.5-5. This also helps with the skin microbiome. Water has a neutral pH and soap that has a high pH will disrupt the pH of the skin. You want mildly acidic skin care products, which Dr. Cate’s products are.

21:56  Acne may be related to hormonal changes, nutritional deficiencies like zinc, to food intolerances, and to blood sugar imbalances. Dr. Cates often find that high glycemic, high sugar foods are both frequent triggers for acne.  When the blood sugar spikes it increases insulin secretion and this triggers excess sebum production, the oils in our skin, as well as androgen activity, which can trigger acne breakouts. She also finds that dairy is a frequent trigger for acne.  Also eggs can be a trigger for acne. She also likes her patients to do an elimination diet and besides gluten, sugar, dairy, and eggs, she likes them to cut out caffeine, alcohol, corn and night shade vegetables. 

28:01  Dr. Cates talked about the importance of decreasing inflammation and she likes people to take omega 3 fish oil to help with this.  It is difficult to get omega 3s from vegetable sources like flax seeds since there is a poor conversion rate of ALA into EPA. You also want to get plenty of fiber and avoid sugar. Eating cruciferous vegetables, like broccoli and cauliflower, helps with estrogen excretion and hormone balance. Making sure to get enough zinc is also very important, along with a little copper. B vitamins are also helpful, esp. niacin.  Niacinamide can be used topically. 

34:00  Dr. Cates explained how to treat eczema.  


Dr. Trevor Cates is a nationally recognized Naturopathic Doctor, aka as The Spa Doctor, and you can learn more about her and her all natural skin care line by going to her website, theSpaDr.com  She specializes in a Functional Medicine approach to clean skin.  You can get a free copy of Dr. Cates’s book Clean Skin From Within  and you can take her free skin quiz by going here:  http://theskinquiz.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 his Santa Monica office 310-395-3111.


Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.

                             Please subscribe to the Rational Wellness Podcast on iTunes and YouTube. And sign up for my free ebook on my website by going to drweitz.com.

                             Let’s get started on your road to better health.  Hey, Rational Wellness podcasters. Thank you again for joining us today. And today, we’re going to talk about the skin. And this is the first time we’ve talked about the skin and yet, it’s such an important topic, affects every system in our body. And essentially if you look at the skin as an organ, it’s the largest organ in the body.

                             And our interview today is with Dr. Trevor Cates. Dr. Cates is a naturopathic doctor and she also has a masters degree in spiritual psychology. Dr. Cates worked as a nutrition and wellness coordinator for the Waldorf Astoria in Park City, Utah. And she is now known as the spa doctor. And her focus has been on helping patients achieve glowing skin and vibrant health. She has a weekly very popular podcast known as the Spa Doctor. And she’s in private practice in Park City, Utah.

                            Dr. Cates, thank you for joining me today.

Dr. Cates:            Thank you. It’s great to be here.

Dr. Weitz:            Good, good. So I was reading one of your blog posts and you said that you have found holistic skin discoveries. Can you talk about what those are?

Dr. Cates:            Yeah absolutely. And I talk about all these in my book, Clean Skin From Within. But I think some of the most important ones are the way we look at skin. And a lot of times, the way people typically view skin because of the typical dermatology model is to look at skin as something that needs to be suppressed. And so, a lot of the typical convention approaches are topical steroids or antibiotics that are just designed to suppress the symptom at hand.

                            But the way I encourage people to look at skin is that your skin, as you mentioned, is our largest organ. It’s right on the surface of our bodies. It’s actually giving us information about our overall health. And it can be used as a tool to help us see that. Because it’s on the outside, we don’t need special imaging equipment to see it. We don’t need to do any specific lab tests to try and find out. It’s just right there and it’s giving us all this information.

                            If you’re breaking out, is your skin dry? Is it more dull? Do you have eczema or rashes or all these different things. Those are signs the body is giving that something is out of balance. And so, it’s really about getting to the root causes. What is behind the skin issue? Because here’s the thing. When you address the root causes, it’s not only going to help your skin but those root causes are usually the same root causes that are related to most chronic diseases, most disease processes.  So if skin is your only issue or maybe your skin is not optimal and you address those root causes, you can prevent a number of other health problems. And then, if you have other health issues, you can also when you’re addressing the root cause, you can help overcome those health challenges more quickly by using your skin as a tool.

                            And as a doctor, it’s something that I’ve been using in my practice. I’ve been in practice for 18 years. And I’ve always looked at my patient’s skin as giving great information. It’s part of the physical exam is what signs is it showing? And so, instead of just covering it up, let’s figure out what sign is it trying to give us? Let’s get to the root cause, address those, and then help heal the skin from the inside out.

Dr. Weitz:            Yeah, that’s great information. I think those of us in the functional medicine world sometimes have forgotten about doing physical examination. And we’re so quick to do all these lab tests and look at numbers and really looking at the person, looking at their skin, looking at their posture. Some of those things can give us so many cues about their health.

Dr. Cates:            Absolutely. And it gives you information about what is coming up and then also, for functional medicine practitioners as they’re treating a patient, how well is that going? And skin is one of those key indicators.

                            So one of the reasons why I’ve started focusing on skin is I was working at the Waldorf Astoria Spa in Park City. And I was doing a two week weight loss program for the people there. And it’s at the end of the two weeks, what they would say is I’ve lost weight. I have more energy. All these great things that we’re used to saying and hearing. And then, the thing that surprised people was their skin. And what they would say is I didn’t even know my skin could look this good. I just assume that eczema was that thing that I have. Or acne, I’m just going to have acne breakouts. Or I’m at this age so my skin’s going to look more dull.

                            But at the end of the two weeks, they realized I didn’t realize that my lifestyle impacted my skin this way. And so, I just keep encouraging the public, the patients, as well as practitioners to use this as a tool. It’s right there and it makes it so much easier for us.

Dr. Weitz:            In those holistic skin discoveries, you also talk about how products you put on your skin end up getting into your body and affect your internal health. And I’m not sure everybody’s aware of that and the importance of being careful about what you put on your skin.

Dr. Cates:            Yeah, absolutely. And I think a lot of times that’s one of the big misconceptions out there is people will think that whatever they put on their skin is just going to stay on the surface. Or not even really thinking about it because they’re not eating it, they’re not thinking about how it’s going to get in internally.  And of course, if we eat something, if we put something in our mouth, we do absorb it differently than if we put it on the skin. It’s a different absorption. But our skin is permeable. And it’s one of the reasons why we use nicotine patches or hormone cremes or topical medications because we know that it’s going to get absorbed to a certain extent.  And so the products that we’re using on a day to day basis also can get into our bloodstream. And the research is definitely showing this. Things like parabens which are a preservative used in a lot of skin care products. You see paraben at the end of the word. And where we’ve found is that parabens …

Dr. Weitz:            Things like methylparaben and …

Dr. Cates:            Propylparaben, butylparaben, all of those. That parabens have shown up in breast tumor tissues. And so, we know that gives us really great … And other studies have shown us it shows up in the urine and other places too. So we know that what we put on our skin. It’s getting absorbed in our body and can get taken up into tissue. And with this particular study, it’s really disturbing that it can actually be taken up into breast tumor tissue.

                                So we need to be careful because also many of these ingredients have hormone disrupting effects so they’re endocrine disrupting chemicals like parabens. Parabens are known to have estrogen mimicking effects. And that’s really the last thing we want to be doing. But as we … especially for women as we tend to get older, we tend to use more skin care products to try and reverse the signs of aging or slow down that process. But many of these have these hormone disrupting chemicals and can actually throw off hormones when we’re at a place where that’s the last thing we want to be doing.

                                And I know that manufacturers say that we only absorb a small amount. Only a small amount gets into circulation. But my concern is that we are exposed to these endocrine disrupting chemicals now more than we ever have been. And they are in our air, our water, our food, and our personal care products. And because of the endocrine disrupting chemicals that have been made in the past and that maybe they’re banned to be made anymore but they still exist in our environment.

Dr. Weitz:            Things like PCBs, yeah.

Dr. Cates:            Yeah. And then also in countries like maybe in China, something is still manufactured there. Those chemicals can actually travel in clouds from China and rain down into our own environment. So it’s still … These are continuing to exist and then, all of these new chemicals are being developed. And so we are now getting exposed to more than we ever have. And so, and I don’t want to say this to scare people but we want to make choices to reduce our overall exposure. And one of those places we have control is through the personal care products we use.

And on average, people use nine … This is according to Environmental Working Group, ewg.org. They say, on average, people use nine personal care products a day which exposes them to 126 unique ingredients. That’s a lot of different ingredients and some of that we have research and information on and some of that’s still unfolding.

                                And then, there are the concerns of how do all of these chemicals react with each other which is not being studied. So our bodies become this soup of toxins and these endocrine disrupting chemicals and so the endocrine disrupting chemicals what that means is that these will bind to hormone receptors and either mimic hormones or interfere with the way that they’re supposed to work.

                                So we’re now seeing that they can create a number of different health issues from infertility, from early puberty onset, to thyroid disease, to certain types of cancer like breast cancer, prostate cancer. There are a number of different things. Really if you think about endocrinology and what … all the different ways that hormones can be impacted, it really can impact us in so many different ways.

Dr. Weitz:            That’s great. Can you mention some of the other chemicals we should be looking for that might appear in our personal care products?

Dr. Cates:            Yeah, absolutely. And I think it is really important for us to be looking at these. We look at food labels as educated consumers and practitioners, we look at labels to make sure that our food is clean. We look at our supplements to make sure that they’re the right ingredients and the right combination and there are no fillers and binders and all those kinds of things. So we want to do the same thing with skin care products.

                                And so, unfortunately though, it can be a little confusing. It is one of the reasons why I decided to create my own skin care line because I wanted to be able to provide something for my patients, my followers, that is trusted that I know the source of these things and where they come from and that they’re not only clean but I formulate them in a way that actually help improve the health of the skin, the pH of the skin, the skin microbiome and all of that.

                                But with ingredients, one of the big ones that is in so many products and that people aren’t aware of the potential downside of it is fragrance. And fragrance is actually not an ingredient. It’s a whole group of ingredients. But with personal care products, all they have to do is put the word, the manufacturers just put the word fragrance on there. They don’t have to disclose all the different chemicals that are in there.

                                And so there are actually a lot of endocrine disrupting chemicals that can be hidden in there. One of the examples that you won’t see on the label but is in fragrance, most fragrance is diethyl phthalate. And diethyl phthalate, DP, is type of phthalate. And phthalates are known as plasticizing agents. And phthalates, including GEP are known hormone disrupting chemicals, EDCs. And so, it’s best to either go with a fragrance free product or find one that’s naturally scented with essential oils.

Dr. Weitz:            One of the things that I noticed is they tend to take out the chemical that everybody knows about like DPA and they stick it in BPS which isn’t on the list yet but probably will be in five years. And I’m seeing some of these personal care products where they take out the sodium lauryl sulfate and there’s some other chemical that sounds very much like it and I suspect it probably would have the same properties.

Dr. Cates:            Right. And that’s why it’s best to go with a natural skin care line that is really used to making natural and organic products. Not just one that … you know, a company that has a natural line but one that specializes. Then because they really know and they really care and they’re going to try and find … continue to use those natural ingredients instead of just saying well, we’ll take this one out because the public is aware of it. A lot of companies are now trying to go paraben free.

Dr. Weitz:            Great.

Dr. Cates:            Yeah, and so they’re taking those out. But they’re still loaded with a lot of other harmful ingredients that people might not be aware of. Things like formaldehyde releasers. And formaldehyde releasers are one of those … It’s a really confusing ingredient because they’ve got really long names and there’s a variety of names that they can come from. And it doesn’t say formaldehyde on the label. It doesn’t say formaldehyde releaser. It will say things like DMDM hydantoin which you would have no idea that you put these ingredients on your skin, when you rub them on your skin it releases formaldehyde into the air around you. And we know that formaldehyde is a carcinogen. We know it’s toxic when it’s inhaled. And the manufacturers say it’s just such a small amount. It’s not going to be an issue. And that’s why it hasn’t been banned as well by the FDA.

                            But again, when using all of these things on a regular basis, it’s the products that we’re using day to day that are the biggest concern. If you use a product once every now and then, your body probably can do okay getting it out of your system. But most of us have these habits and rituals of skin care/personal care practices whether you’re a man or a woman. You know, deodorants and shampoo, conditioner, lotions, sunscreens, all of those things that we use. We’re using them every day or every other day. And so, those are the ones you really want to be careful with.

Dr. Weitz:           Yeah. I just read this report about a woman who had a Brazilian blowout and she was using a formaldehyde free product except that it contained this chemical that as soon as you heated it, it turned into formaldehyde. She had this acute reaction, was hospitalized, had this horrible autoimmune reaction and her whole health was just completely destroyed.

Dr. Cates:           Yeah, it’s one of those things where sometimes it’s hard to know so just again, using a trusted source. Again, that’s one of the reasons why I created the Spa Doctor skin care line is because my patients were asking me who do I go to? How do I know? And even I, as I was trying to do research on different companies and trying to find out more, a lot of this stuff is hidden and so I wanted to create something that people could trust. People don’t have to worry … One less thing for people to worry about because that’s … Really, it’s just not something that we want to spend a lot of time doing.

                           But there are great resources for people. My book, Clean Skin From Within. I do talk about all the different ingredients to avoid, the top ones to avoid. I have a whole list in my book. And why and the research behind why and then alternatives. Like instead of fragrance, choosing essential oils and which ones and that sort of thing. Then, there are also websites like I mentioned Environmental Working Group, ewg.org. They have a skin deep database. My skin care products on there are on there as a verified skin care line. And that’s … EWG can be a great resource for people finding cleaner products.  Also there are even apps that you can get on your phone that you can scan the barcode on the product and it’ll rate the level of toxicity of the ingredients and why it’s rated that way.

Dr. Weitz:            Cool.

Dr. Cates:            Mm-hmm (affirmative)

Dr. Weitz:            You talked about the pH balance. What pH should our skin be? Should it slightly acidic? Should it be slightly alkaline?

Dr. Cates:            Yeah, no our skin does best with a mildly acidic environment. Our skin has this mild acidity that actually helps protect it because it is our outer surface. Our epidermis has that barrier function, that’s a big important part of the function of this organ of our skin. So that mild acidity actually helps protect the skin.  The thing that’s really interesting about this is that I think a lot of people don’t know this about the skin because when we talk about health and wellness, there’s a lot of talk about higher pH.

Dr. Weitz:            Yes, that’s all everybody talks about. Be as alkaline as possible.

Dr. Cates:            Right, but when we’re talking about the external, externally on your skin, it actually needs to be 4.5 to 5, in that pH range which is that mildly acidic range. And if it’s really a lot lower than that, if it’s really acidic, that’s also harmful for the skin.

                            So there is this interesting natural balance and it does vary a little bit from person to person and different areas of the skin. But this also helps with the skin microbiome. And I know there’s a lot of talk right now in the health and wellness community about the gut microbiome and the importance of that. And the skin also has it’s own balance of microorganisms that live on and protect it.

                            And so, our gut microbiome has a direct connection to our skin microbiome. And there’s a lot of great research coming out about the gut/skin connection, even the gut/brain/skin connection. And so, from the inside out there’s a lot we can do to help promote the skin microbiome. But also, what we’re putting on externally on the skin can impact the skin microbiome. So using those antibacterial soaps and things like that. That definitely disrupts the skin. And then, the pH of the products that we’re using can also disrupt it.

So for example, even water has a neutral pH of seven. And some people will say I’m going natural. I just rinsed my face with water and I’m going to use a little coconut oil. Well, just using water is not going to help support the skin with that natural pH. And then, using a bar of soap that lathers up, that actually has a high pH so it’s going to further disrupt.

                            Now if we’re in a really optimal state of health and we’re rinsing our face with water, our skin will probably just bounce right back and reestablish. But especially if people are struggling with their skin or they’re struggling with their health, that ability to bounce back is not going to be as good so it’s good to support the skin with naturally, the mildly acidic skin care products.

                            And that was one of the big keys with creating my skin care line because when I was looking into natural skin care products, people would … my patients before I created my line, people would ask me so why are these natural skin care products not working? I’m using clean products but the natural skin care products I’m using aren’t working. And what I realized is that a lot of these companies were missing out on that pH of the skin and that the support that we use with the pH of the products was one of the really key things that helps with the health of the skin.

Dr. Weitz:            You know, that point that you made about the pH, I think is really important. And a lot of people are not aware that this same thing goes with parts of the gut. Everybody assumes that they know that your stomach is supposed to be acidic but then they assume that the rest of the gut is supposed to be as alkaline as possible. But in order for optimal gut microbiome for acidophilus to flourish in your colon, you need more of a slightly acidic environment.

Dr. Cates:            Yeah, so it is important to put an environment there that supports the healthy microbiome. And I do think that a lot of times people are quick to be like what probiotic can I take? Or is there a probiotic I can put on my skin? But you can also look at what helps support your body in developing its own healthy balance of microorganisms. And I mean, really probiotics are also really beneficial but you want to do both. It’s not always just about a magic pill or a magic product. You know?

Dr. Weitz:            Yeah, you need your garden to be healthy. If you get these great seeds, they’re not going to grow if you’re trying to grow them in a lousy garden. And that’s what your body is, a garden that you’ve got to try and make it as healthy as possible to encourage the growth of all these healthy bacteria.

Dr. Cates:            Yeah.

Dr. Weitz:            So I saw one of your discussions where you talked about acne which is the most common skin condition. What is the cause of acne? What’s the root cause of acne?

Dr. Cates:            With acne, it does vary somewhat from person to person. But looking for the root cause is important. And when we look at why someone is developing acne you want to look at a number of different factors. Does it change … For a woman, for example, does it change at different times of the month? That’s a big one. A lot of times women will notice right before their periods, they will break out more. And then we’re looking at a hormonal connection there. So we want to look at the root cause about what kind of hormonal imbalances are occurring that are causing the person to break out more.

                            Also we know if we’re talking about a teenager and they’re going through puberty, obviously there’s a hormonal component here. And then, there are also nutritional things that can lead to more acne breakouts like zinc deficiencies for example are one of the things that can trigger. Also certain foods that people are eating. If people … it can be a sign of a food intolerance or food sensitivity, allergy, if they’re starting to break out more.

                            I often see people breaking out more around their mouth. That can be from the foods that they’re eating. And some of the big ones for acne in particular and food is sugar or foods that turn to sugar. So the glycemic role and the glucose role in acne breakouts because when we eat sugar or foods that turn to sugar, a high carbohydrate diet also would do this, is it will cause our blood sugar to rise and this increases insulin. And then with increased insulin, that triggers excess sebum production, the oils in our skin, as well as androgen activity. And we know that those are some of the big things that do trigger acne breakouts.

                            So certainly balancing your blood sugar, being careful about not eating a lot of sugary foods or foods that are going to spike your blood sugar. That’s really an important one. Also, I find that dairy is another big trigger for acne for some people. Not everybody but…

Dr. Weitz:            Now what’s the connection with dairy?

Dr. Cates:            Now with dairy, it seems to be more … A few reasons. It’s more of a pro-inflammatory food and so anything that … I call it skin-flamation. Anything that triggers inflammation internally can trigger skin inflammation, inflammatory conditions. Also, there are just the nature of dairy is that it comes from a lactating mammal which means that there’s going to be hormones in dairy products. And so, that could be playing a role as well. So that could be part of it.  And then, dairy products tend to be one of the top allergenic substances or foods that people are sensitive to. So they do tend to be one of the big trigger foods for that. So there are a number of different reasons.

                            And then, another food that is … I’ll have people say I’m cutting back on the sugar. I’m really not eating much sugar. And I’ve cut out dairy. And maybe they’ve even cut out gluten and a few other things, but they still can’t figure it out. And they know it’s something that they’re eating but they can’t figure it out. And that tends to be eggs. And I know that surprises a lot of people because we think of eggs as being this really healthy food, just like people a lot of times think of dairy as one of those foods that we thought was really healthy for us.  But eggs, for some people, are a big trigger for acne. So I would say it you struggle with acne and you’ve tried giving up these other things, try giving up … try cutting out eggs and see if that may be the missing piece.

Dr. Weitz:            You ever run food sensitivity panels?

Dr. Cates:            Yeah, I definitely do a lot of those. Because I have a book and I try and keep it really simple for people. In my book, I talk about the top 10 foods for people to eliminate and then reintroduce after two weeks to try and identify it themselves. But certainly if people work directly with me, then I do like to run food sensitivity tests. What I would say about that though is what I’ve found in my practice is it’s really important to first address any gut issues before doing a food sensitivity test because if you run food sensitivity tests on someone who has leaky gut or really a lot of microbiome imbalances, then you’re probably going to see that a ton of different things come back as reactant.

                            And the patient is just frustrated and they don’t know what to eat and it’s just frustrating for everybody. And so, when I see somebody that apparently has a lot of gut issues going on, definitely address those first. We want to at least get them on the healing journey with that first and get that inflammation under control in the leaky gut healed and then do the food sensitivity tests.

Dr. Weitz:            So if you do that 10 food elimination diet, could you just real quick go over those 10 foods. So besides dairy, what are the other nine foods?

Dr. Cates:            Yeah, I think some of the things might surprise people. I mentioned sugar and I mentioned gluten and dairy. Also, when I have people do this diet, I like them to cut out caffeine and alcohol. They just tend to be … especially, this is a time to help support the detoxification pathways so cutting out any of these kinds of things is good to do. And then, I mentioned eggs.  I also find that corn tends to be one of the trigger foods as well as the nightshade family so peppers and tomatoes and potatoes. Those are also big triggers.

Dr. Weitz:            Okay, cool. So what else can you do for acne besides changing your diet?

Dr. Cates:            Certainly we want to decrease inflammation because that’s one of root causes of what can you do with your diet not only avoiding the trigger foods but also eating foods that decrease inflammation. Things like getting omega-3 fatty acids that are antiinflammatory. Those types of things are really important. Making sure that you’re getting plenty of fiber in your diet to help with balancing blood sugar.

Dr. Weitz:            And by the way, on the omega-3s, it’s important to get it from fish, right?

Dr. Cates:            Yes. I do think that fish is the best source and I think that it’s hard to get the level of omega-3s through just eating with your diet. A lot of times, people need to take a high quality omega-3 fish supplement to get the benefits if they’re really trying to address that inflammation so I think that’s good.

                            Now I know that sometimes people for philosophical reasons, they don’t eat animal products.

Dr. Weitz:            They just want to have flax seed oil or something like that.

Dr. Cates:            It makes it a lot harder because the body then has to do that conversion and so, it’s not ideal. I do still have some patients that just for certain reasons they won’t. But I really do try and encourage people to even if they don’t like the taste of fish to try and take an omega-3 supplement.

Dr. Weitz:            Yeah, because you’re looking at between 1-10% conversion rate of alpha linoleic acid into EPA and DHA.

Dr. Cates:            Right. It’s just not going to be the same. So certainly it’s a lot easier to do it that way.

                            Yeah, so certainly anti-inflammatory diet because we’re reducing inflammation. Also what can we do to help balance the blood sugar because that’s one of the big root causes so eating more fiber, watching your sugar intake, making sure you’re eating balanced meals. And then, also if we’re looking at balancing the hormones, what can we do to support that? And it really depends upon if we’re talking about a man or woman, what stage of life they’re in and what kind of hormone imbalances we’re talking about. But doing things to help support that even if it’s lifestyle things like stress management. I mean, even that alone can … that plays a role. Our stress hormones play a role in our hormone balance.

                            The foods that we eat, eating for women in particularly, eating cruciferous vegetables helping with estrogen metabolism and hormone balance. All of those kind of things might be beneficial to do. And then, also getting in certain nutrients like zinc, I mentioned, as I mentioned before. Certainly eating things like nuts and seeds that are high in zinc, oysters. Not that we want to be eating those every day but that is something that’s high in zinc. Also maybe getting it in the form of a supplement and then … But if you’re doing that as a supplement, you want to make sure you’re not just taking zinc. You want to also get a little copper with that or part of a balanced multivitamin/mineral supplement.

Dr. Weitz:            Yeah. The zinc/copper ratio. Besides those are there other specific supplements. I saw some discussion of niacin as being beneficial.

Dr. Cates:            Yep, yep. Niacin, B vitamins in general can be particularly helpful. Niacin, and what’s interesting about niacin is that it can be used both internally and externally. So I will have my local compounding pharmacist make up a topical that includes niacinamide in that topical because of the soothing and antiinflammatory benefits that it tends to have for people with acne.

Dr. Weitz:            Yeah, I saw some products online with niacinamide they seem to have in it.

Dr. Cates:            Mm-hmm (affirmative). Yep.

Dr. Weitz:            Boy, huge difference in price. One product was $6. The other was $84.

Dr. Cates:            Right. Well, it probably depends on the amount of niacin. You really want to get at least 3-4% in there. And if it’s not, then it’s probably just marketing.

Dr. Weitz:            Okay, interesting. Let’s see. In that article where you were talking about or it was a podcast where you were talking about acne, you mentioned eating cruciferous vegetables for liver detox, but to be careful if somebody has a thyroid problem.

Dr. Cates:            Yeah. And I think it’s good to … If we’re talking about cruciferous vegetables just because of the goiterogenic component in those vegetables that people especially if you know you have a thyroid disease, thyroid imbalance, that you just want to lightly steam those vegetables first before eating them. And I generally just say that …

Dr. Weitz:            For people who are not familiar with that, there’s this concept that certain foods negatively affect the thyroid. And they’re referred to as goiterogenic. They inhibit thyroid function, right?

Dr. Cates:            The idea that they can actually help … I mean, that they can worsen the condition, yeah. So that’s why just to be safe, I think it’s good to just lightly steam. And it doesn’t … When I say lightly steam, it’s even just a couple of minutes just to put a little hot water in there for a couple of minutes and steam it lightly because if you overcook vegetables, then you lose a lot of the nutritional benefits so it’s a little balance there.

                            I grew up with family members who thought you had to cook things for hours. Vegetables had to cooked in lard and for hours and hours to have any flavor to be palatable.

Dr. Weitz:            Yeah, I did too.

Dr. Cates:            That’s rarely the case.

Dr. Weitz:            I grew up eating canned vegetables. So one of the other common skin conditions is eczema. How do you handle eczema? What specific things do you do for that?

Dr. Cates:            Yeah, that is another common skin condition. It’s actually what my … what led me on this journey is I had it as a child. And I had a lot of allergies and eczema, hives. Those were a lot of my skin issues. And I really struggled with it as a child and that is what finding natural medicine is what led me on the path to becoming a naturopathic physician. So I know that really well of how intense that can be to have the itching and the rashes and the eruptions and how intense it can be. But I also know that you can overcome it.

And so, part of that is that inflammation. Addressing the internal inflammation, looking for triggers that might be causing it. So definitely supporting the body internally. Gut issues tend to be a big trigger for that. Gut microbiome, addressing any imbalances with that. And leaky gut where you’ve got the gut lining is more permeable than it should be so then food particles actually slip through and the body actually creates this immune response which someone will flair up allergic. Or any kind of immune type reactions. Anybody that has eczema tends to have an overactive immune system anyway and so we want to do things to help calm that down.

                            And you know, I’m talking a lot about this internal stuff but you also want to do things externally like I mentioned before. And this is true for acne too. When we get acne or eczema, our skin microbiome gets out of balance. And part of restoring that is from the inside out. But part of it is also … And I think it’s probably 80% is from the inside out.

                            But then, there’s still this 20%. And this is one of the things that shifted for me in my practice when I started doing a lot of research on topicals and skin care products was that realizing that this was a piece that I was missing of what can I do externally to help support the skin.

                            Because it’s still, you get patients, and they get them to a certain point and they would be really improving but there’s still this imbalance in the skin on the outside and so, using products with the correct pH. That’s key to help support the skin. And then also, I use my compounding pharmacist a lot to help create topicals that have natural ingredients that help support the skin and help it get to that balance back.

Dr. Weitz:            Like what kind of topical products?

Dr. Cates:            I mean, for the acne, I mentioned niacinamide. So that can be a great one. That one can also be really helpful for people with rosacea. And so, there are things like that. There are certain herbs that can be antiinflammatory and supportive. Even something as simple as aloe can be soothing to the skin and helping restore it. There are tons of ingredients that we can use. It’s just a matter of what … I really individualize that part for the person but the thing that across the board that is helpful are things … There are certain ingredients like aloe and also the pH of the product that can be really supportive to the skin.

Dr. Weitz:            I saw where you said that sometimes for psoriasis, you’ll use apple cider vinegar topically.

Dr. Cates:            In combination with other products.

Dr. Weitz:            Okay.

Dr. Cates:            I wouldn’t use just apple cider vinegar. But yeah, it can be soothing. It also could be disrupt the pH of the skin if you’re just using it straight. So I would be careful with using that directly, yeah.

Dr. Weitz:            Okay, great.

Dr. Cates:            But you know, also things like …There are also really simple things for eczema. We were talking about for eczema is an oatmeal bath.

Dr. Weitz:            Okay.

Dr. Cates:            And you can put oats in a bath and just soak in that. And the oats on the skin can also be very soothing.

Dr. Weitz:            Cool.

Dr. Cates:            And I share a lot of that information in my book, Clean Skin From Within.

Dr. Weitz:            Okay, great.

Dr. Cates:            So I have a lot of that and I even have tables explaining here are all the different things you could add internally and externally to help support the root causes that are behind the various skin issues.

Dr. Weitz:            Great. And that book’s available from Amazon and Barnes and Noble?

Dr. Cates:            Yeah, it’s available, yeah, Amazon and Barnes and Noble. I have all of that on my website thespadoctor.com.

Dr. Weitz:            Okay, great. I’ll put that all in the show notes.

Dr. Cates:            Great.

Dr. Weitz:            So thank you Dr. Cates. This has been a very informative podcast. Thank you for sharing some information with us.

Dr. Cates:            Great. It’s been great to be here.

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

Dr. Cates:            Okay.

Toxins with Dr. Joe Pizzorno: Rational Wellness Podcast 052

Dr. Joe Pizzorno speaks about how to remove toxins from your body and improve your health with Dr. Ben Weitz. 

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


Podcast Highlights

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

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

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

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

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

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

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

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

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



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

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


Podcast Transcripts

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

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

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

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

                                          Dr. Pizzorno, thank you for joining us today.

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

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

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

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

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

Dr. Weitz:                           Yeah, shocking, shocking.

Dr. Pizzorno:                      Very worrisome.

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

Dr. Pizzorno:                      Yup, everywhere.

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

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

Dr. Weitz:                           Sure.

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

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

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

Dr. Weitz:                            Wow.

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

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

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

Dr. Weitz:                           Wow.

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

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

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

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

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

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

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

Dr. Weitz:                            Huh.

Dr. Pizzorno:                      Which I find a little worrisome.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                           He developed a lot these tests.

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

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

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

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

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

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

Dr. Weitz:                           Like chlorine and stuff?

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

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

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

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

Dr. Weitz:                           Okay.

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

Dr. Weitz:                           Okay.

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

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

Dr. Weitz:                           Bless you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Pizzorno:                      Those are better.

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

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

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

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                           Yeah.

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

Dr. Weitz:                           No.

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

Dr. Weitz:                           Okay.

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

Dr. Weitz:                           Oh, cool.

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

Dr. Weitz:                           Do you like infrared sauna?

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

Dr. Weitz:                           Cool.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                           Right.

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

Dr. Weitz:                           Right.

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

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

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

Dr. Weitz:                           Is it like a urine test?

Dr. Pizzorno:                      A urine test, right.

Dr. Weitz:                           Okay.

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

Dr. Weitz:                           Right.

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

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

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

Dr. Weitz:                           Okay.

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

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

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

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

Dr. Weitz:                           Wow, very cool.

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

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

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

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

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

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

Dr. Pizzorno:                      Right.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                           Oh, okay. Cool.

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

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

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

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

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

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

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

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

Dr. Weitz:                           Oh, okay. Cool.

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

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

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

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

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


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

Dr. Pizzorno:                      Great, happy to help.

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

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

Dr. Weitz:                           Right.

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

Dr. Weitz:                           Okay.

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

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

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

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

Dr. Pizzorno:                      Okay.

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

Dr. Pizzorno:                      Great chatting with you.