Methylation with Dr. Jess Armine: Rational Wellness Podcast 129
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Dr. Jess Armine discusses The Truth About Methylation with Dr. Ben Weitz.
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4:31 What the hell is methylation and why should we care about it? Methylation, which refers to placing a methyl group on a protein, is an important process in all points of DNA replication and in the actual turning on and turning off different genetic pathways. Methylation affects whether certain genes get expressed or not. This is the way our physiology gets regulated.
7:00 Dr. Armine says that sometimes he will get a call from a patient who is fearful because they found out that they have MTHFR, which is one of the genes that regulates the methylation pathway. The first two variants that were studied were the C677T and the 1298C, but there are actually 50 different variants. If you have one copy of one of these variants, you are said to be heterozygous and if you have two copies of one of these variants, you are said to be homozygous. If you are heterozygous for one of these variants–if the genetic report shows yellow–it means that the enzyme that that gene creates is working at about 60% of the way that it should. If you are homozygous for one of these variants–if the genetic report shows red–it is working at about 20% of the way it should be doing.
10:59 When you look at the folate pathway, which starts with FOLR1 and FOLR2 and then goes to DHFR, which goes to MTHFD1, until you get MTHFS, until you get to MTHFR. That pathway requires those genes and their enzymes to function, which requires NAD, vitamin B3. For MTHFR to work it needs at least B2 and B3 and if you don’t have enough B2 and B3 and you already have a 40% reduction due to a heterozygous SNP, then that is really significant. Other factors that can slow down the folate pathway are dairy antibodies, methotrexate, synthetic folic acid, large amounts of green tea, and grapefruit seed extract, among others. Synthetic folic acid is a problem because if there is a SNP, then it may not get conjugated and create the end product, 5,10-Methylenetetrahydrofolate. Therefore, synthetic folic acid if it is not properly metabolized can lead to an increase in homocysteine and a hypercoagulable state that increases the risk of blood clots, accelerated atherosclerosis, and miscarriage. Also consider that in contrast to the natural folate found in green, leafy vegetables like kale, spinach, arugula, and swiss chard, synthetic folic acid is added to many flours, breads, and to other processed foods, as well as in many multivitamins, including prenatals. Unmetabolized synthetic folic acid can also lead to an immune dysfunction through the dysregulation of natural killer cells, and potentially increasing the risk colorectal and other forms of cancer. [Here is one article on this topic: The hazards of excessive folic acid intake in MTHFR gene mutation carriers: An obstetric and gynecological perspective.] Dr. Armine explained that when managing a patient who may have genetic variants of the MTHFR gene, it is important to start with foundational lifestyle factors like drinking better water, breathing better air, managing stress, earthing, etc.
20:52 Dr. Armine may run a methylation panel, such as the panels from Doctor’s Data (Methylation Profile) and Genova (Methylation Panel), that measures some of the methyl donors like methionine, S-adnosylmethionine, and choline and plasma metabolites like homocysteine. He mentioned that it is now preferable to get the raw genetic data from Ancestry.com, since the 23 and Me panel now measures far fewer genes than they used to.
24:05 When you see Dr. Armine, he will take your raw genetic data and put it through a software analysis, such as Dr. Ben Lynch’s StrateGene and MTHFRsupport.com to be able to pull out the data that allows him to make specific recommendations for diet and supplements to improve your health. Dr. Armine also said that he likes to run an organic acids profile, which shows the results of the pathways. You can see indicators of mold, of candida, of SIBO, of clostridia. You can see the oxylate status, since high oxylates is a major reason for illness. High oxylates is secondary to candida. In the organic acids profile you can see the function of the Kreb’s cycle and you can see the neurotransmitter metabolites.
29:42 Dr. Armine talked about the importance of cell wall integrity and if you have inflammation, you have leaky cells, which is a lack of cell wall integrity or function. Dr. Armine wrote a book with Elizma Lambert, an Australian Naturopath, called Leaky Gut, Leaky Cells, Leaky Brain. Often we don’t look at the function of the cell wall and one way to assess that is with the Omega Quant test for omega 3 status.
31:32 The idea of methylation essentially is to create SAM-e. Some practitioners concentrate solely on giving methylated vitamins: methylfolate, methyl B12, dimethylglycine, trimethylglycine, or SAM-e. But there are some patients that respond negatively with methylated B vitamins, esp. those with anxiety. If patients do react poorly to methylated B vitamins, there are now multivitamins and B-complex products that use folinic acid or natural folate instead of 5-methylfolate and they have hydroxocobalamin and/or adenosylcobalamin, instead of methylcobalamin or the synthetic cyanocobalamin, which is very poorly absorbed, and patients usually don’t have a negative reaction to these.
39:35 If you have a patient with elevated homocysteine and you place them on a formula of methyl B vitamins to reduce their risk of heart disease and if they don’t feel well, then you have to look at the methylation pathways and see where the blockage is. This is when running a methylation panel and doing organic acids testing can be especially helpful. The transsulfuration pathway could be blocked up by CBS going backwards. Homocysteine goes down the transsulfuration pathway past something called cystathione B synthase to become cystathione, and then cysteine to eventually become glutathione, and then glutathione, when it gets used up and gets oxidized, gets recycled. So that whole big, long pathway can get blocked up, if you will, and if you think about it like a highway, it’s going to block up, and where it’s going to block may be one of the reasons for higher homocysteine. We have to look for reasons why you have inflammation in your body, which from a Functional Medicine perspective could be mold, heavy metals, other toxins, food sensitivities, nutritional deficiencies, leaky gut and other gut problems.
43:31 Overmethylation is not a good thing and could even increase risk of breast cancer. If you are taking methylated B vitamins or a multi with methyl B vitamins and you feel anxious or other symptoms of being overmethylated, the first thing you should do is stop taking the supplement and switch to a multi with hydroxycobalmin and Naturefolate. A first aid solution is to take plain niacin, the flushing kind, about 25 mg per hour and it will chew up the methyl groups. Keep in mind that if you are taking a large dosage of niacin, it can result in undermethylation and elevated homocysteine. But ultimately you need to discover and treat the underlying causes of inflammation using the Functional Medicine model.
Dr. Jess Armine is a Doctor of Chiropractic and a Registered Nurse and has been in healthcare for over 37 years. His focus is using a Functional Medicine approach to treating various neurological and immunological conditions in patients with a focus on taking a careful history, lab work, and also looking at genetics. You can contact Dr. Armine at his website DrJessArmine.com Dr. Armine offers new clients a free 15 minute consultation to see if he can help them and he does consultations via phone or Skype.
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 or go to www.drweitz.com.
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, Ration Wellness Podcasters. Thank you so much for joining me again, today. Please go to Apple Podcasts and give us a ratings and write a review. That would really help us. More people will find us when they do a search for alternative health podcasts. Also, if you’d like to see the video version, go to my YouTube page. If you go to my DrWeitz.com website, you can find detailed shownotes and a complete transcript.
Our topic for today is the truth about methylation with Dr. Jess Armine. Methylation refers to a chemical process involving the attachment of a methyl group, I know that sounds very scientific, which is a carbon and three hydrogen atoms joined together to our DNA, and this has received quite a lot of attention over the past several years, especially in the functional medicine world. DNA methylation is essential for normal development and for many functions in the body including DNA production, liver detoxification, controlling inflammation, hystamine metabolism, estrogen metabolism, immune function, energy production, mood balancing, among others. Methylation deficits have been associated with many disease states including various autoimmune diseases, autism, cardiovascular disease, depression, inflammatory bowel disorder, insomnia, fertility problems, among others.
On the other hand, over-methylation can also cause a number of health problems including increased risk of breast cancer, etc. It has now become common practice in the functional medicine community to … That’s Dr. Armine. He’s flying in from the East Coast. It’s now become common practice in the functional medicine community to assess methylation status by measuring a few genetic polymorphisms including the SNPs for MTHFR and COMT, and some practitioners will also measure homocysteine levels. There’s a tendency for those of us who think about methylation to concentrate solely on the gene aspect, but today we’ll discuss the significance of methylation, what it is, what it isn’t, how you can help the methylation process, and what pitfalls to be aware of.
Our interview today with Dr. Jess Armine, he is a doctor of chiropractic, a registered nurse, and he’s been a healthcare professional for over 37 years. He’s trained in chiropractic, methylation, genetic research, neuroendoimmunology, say that three times fast, functional medicine, applied kinesiology, and cranial manipulation. He’s one of the few specialists in the United States who’s an expert at correlating the genetic SNPs with the neuroendoimmunology. He also correlates this with acquired mitochondrial dysfunction and cell wall integrity, if you have any idea what that means, to identify hidden imbalances and hidden stressors in the body. Then he develops individualized treatment plans for patients. Dr. Armine, thank you so much for joining me today.
Dr. Armine: Thanks so much, Ben. I appreciate it. It’s a very good introduction.
Dr. Weitz: So I tell you what-
Dr. Armine: Whatever this is.
Dr. Weitz: What the hell is methylation, and why should we care about it?
Dr. Armine: Well I’ll tell you, methylation is a term that’s been bandied about very, very significantly for the past couple of decades now. Methylation is an important process in all points of DNA replication and in the actual turning on and turning off different genetic pathways.
Dr. Weitz: Okay, so let me just stop you real quick there. So what you’re saying is we all have these genes, we’re born with the genes. Essentially, they don’t change. However, some genes get expressed and some genes don’t get expressed. You could also refer to this as the gene is turned on or the gene is turned off.
Dr. Armine: That is correct.
Dr. Weitz: And what you’re saying is that when genes get methylated, they either get turned off or turned on. Is that correct?
Dr. Armine: Essentially, that’s correct because … If you really want to learn about methylation, honestly, you can go to YouTube and look for the simple … there’s a couple methylation raps, and some people do about a two or three minute video, and it gives you a general idea of what’s happening. One of my favorite sayings lately is that we can understand the body right down to the quantum level, but we can only intervene globally. The understanding of methylation should be as follows: number one, we’re not talking about the genome, we’re talking about the epigenome. You’ll hear the word epigenetics, and that means that set of genes that creates or encodes the enzymes that run our bodily processes. They are static as is our genome, but the environment and other factors can interfere, can alter, those enzymatic pathways. Without getting super, super technical, because super technical doesn’t help us. What helps us is understanding that methylating proteins, putting a methyl group on different proteins, in certain areas will turn things off, in certain areas will turn things on. Let’s think of it as balancing and regulating physiology because that’s what it does. The reason that we should look at it like that is to decrease the amount of angst and fear that I constantly hear from people. As you said, I’m an epigenetic expert. I’m one of the recognized in the world. I take that as a sacred trust. So when I get a call from somebody who says, “I just found out. I have MTHFR, compound heterozygous.” You can hear them sweating over the phone. My first question is-
Dr. Weitz: By the way, compound heterozygous?
Dr. Armine: I’ll explain it in a second.
Dr. Weitz: Okay.
Dr. Armine: I’ll simply say to them, “Look, were you sick yesterday?” “No, I feel fine.” “Then you’re not sick today.” MTHFR, that was my segue into MTHFR, okay? MTHFR is one of the quintessential genes that represents the methylation pathway. MTHFR, the big word is methylene tetrahydrofolate reductase. I always tell my patients, “When I say something fast, ignore it. Because I’m going to explain it.” What MTHFR does, really, is take the result of what we do with folates and turn it into the active five level folate. Which contributes to the creation of SAM-e, and SAM-e is what takes your methyl donors and puts them all around to different places. So the creation of SAM-e becomes a primary thing to do. But we think of the active methylfolate as being the thing that helps DNA repair, and it would be correct. Does the mechanism really make a difference? Not unless you’re a practitioner and you have to intervene, in which case then you should know the basics because you want to know how to intervene to the patient’s best benefit.
MTHFR, when they first studied it, they studied two variants. You have to understand something about genes. It’s not just a gene. You have a gene with a whole ton of variance. For instance, MTHFR has got 50, count them five zero, variants. Generally speaking, the C677T and the 1298C are the ones that were studied at first. When they talk about heterozygous and homozygous in a gene, we’re talking about the estimate of its innate ability to function. You look at a genetic report, you see green next to something which is usually -/-. It means that the enzyme that that gene creates is going to work the way it’s supposed to, given nothing else going on. If it’s yellow, or heterozygous which is a +/- means that it’s working at about 60% of the way it should given nothing else. If it’s red, or homozygous, working about 20% of the way it should be doing, given nothing else going on. So when somebody has compound heterozygous, they are +/- or heterozygous for the 1298C and the C677T.
Dr. Weitz: So let me just stop you real quick. I often hear practitioners say, “Well, you’re heterozygous for that so it’s really no significance.”
Dr. Armine: That’s true. Here’s the-
Dr. Weitz: And the reports usually say that, too.
Dr. Armine: True.
Dr. Weitz: You only have one copy so it doesn’t mean anything, but you’re saying you can still have a 40% reduction of your ability to create that enzyme or for that process in the body to happen. So that could still be significant.
Dr. Armine: It can be. Let me ask you a question.
Dr. Weitz: I mean, if I told you you had a 40% reduced heart function, you’d want to know about that.
Dr. Armine: Well yes you would, but let me frame it in the way that it’s working. First of all, remember that you’re born like this. If you’re as a baby functioning well means that it doesn’t matter where the polymorphisms are. Now remember…
Dr. Weitz: There’s probably different genes that-
Dr. Armine: There are, but here’s the reality of the situation. Let’s take the folate pathway which starts from FOLR1, don’t worry about these letters, FOLR1 and FOLR 2, DHFR, and DHFD1, until you get MTHFS until you get to MTHFR. Don’t worry about all of that big stuff. That pathway requires those genes, those enzymes, most of them require NAD to work, B3. For MTHFR to work, it needs at least B2 and B3 to work. So for instance, if you don’t have enough B3 in your cells and B2, those enzymes are going to slow down significantly, and if there’s already a 40% reduction, wow. Now, there are factors that will slow down the enzymatic reactions. For instance, in the folate pathway, dairy antibodies, methotrexate, folic acid, large amounts of green tea, grapefruit seed extract, are some of the things that will slow those enzymatic reactions down. Now, I want you to think of the yellow or heterozygous variants…
Dr. Weitz: Now, you said folic acid. So you’re talking about something different than what is often recommended by a doctor like you-
Dr. Armine: Right.
Dr. Weitz: … which would be a form of folate versus folic acid-
Dr. Armine: Exactly.
Dr. Weitz: … which is the synthetic form, which is-
Dr. Armine: There’s significant problems with the synthetic form, and thanks for bringing it up because it’s true. It’s been used many, many years, but there are problems with the way that it’s conjugated. It doesn’t create the end product, which is 5,10-Methylenetetrahydrofolate that MTHFR, methylene tetrahydrofolate reductase turns into 5,10-methylenetetrahydrofolate or 5-methylfolate. Here’s the thing that I want people to understand, that let’s say that yellow is a four lane highway, red’s a two lane highway, and green’s an eight lane highway. If I had a bunch of yellows and everything’s running the way it should be because nothing wrong with me, but then I start blocking those areas by putting all of those factors in that slow it down, like the dairy antibodies and so forth, and then I don’t give my body enough B2 and B3, that’s like taking a four lane highway and putting a construction crew in there so that maybe one or two lanes are going by. That’s when you start getting symptoms. It’s the polymorphisms or the SNPs will give you an indicator of what a pathway may not work so well under an oxidated stress load or when other things are going on that would slow it down innately. By itself, it means nothing. Rather it gives you a heads up. Now if you’ve got a compound heterozygous, you start looking around on the internet, this is where I get the panicked calls. You have to realize-
Dr. Weitz: This is where you have … When you have a genetic variant, you can have one copy which is a heterozygous. So let’s say the normal is AA, and then you have an AG, which is one copy of a variant gene, or a homozygous whereas you have a GG instead of an AA, so you have two copies. So you’re saying if you have one copy of one gene, and then you have one copy of another gene involved in the same process that that’s what you’re calling a compound heterozygous.
Dr. Armine: Yeah, that’s a fairly commonly used term for heterozygous of the gene variants that are usually studied, the 1298C and the C677T. So you go to a LabCorp or you go to Quest, and they test MTHFR. Those are the two variants they’re testing, okay? They’re not testing the other 48 variants, and it’s hard to get a study where you can see a lot of those variants. Nevertheless, the thing that everybody needs to know, practitioner and lay person, is that when you go to those websites that say, “MTHFR, or SNPs of MTHFR, cause this,” and they’ll say, “cause blood clots, cause infertility, cause stillbirths,” and then if you’ve got compound heterozygous, oh my god you should jump off a bridge because this is a list of symptoms, list of things, you’re going to get it. Those are incorrect, and I’m going to tell you why.
When MTHFR was first studied, it was studied in relation to homocysteine. So they thought that if they looked at the SNPs of MTHFR, we could predict high homocysteine or homocysteinemia and that would be a predictor of cardiac disease. That didn’t work out so well. So anybody who had anything wrong with them started testing for these genes, and the erroneous conclusion, because a lot of people have polymorphisms, a lot of people have SNPs. They just do. It’s just the way our genome is, epigenome.
Dr. Weitz: It’s like 60% of the population has at least a heterozygous SNP for MTHFR.
Dr. Armine: Right.
Dr. Weitz: But homocysteine is still a recognized risk factor for heart disease.
Dr. Armine: Oh it is, absolutely. Absolutely, it was the relationship between MTHFR and homocysteine. So everybody started testing for it, and anybody who had anything wrong with them … So the erroneous conclusion was that they came up with these lists of things that MTHFR would cause. A gene doesn’t cause anything. So everybody got scared and said, “Look, if I have this problem, I’m going to concentrate on this.” Well, that’s wrong. You have to concentrate on the bigger picture. So yeah, it does have a relationship to homocysteine. High homocysteine is one of the ways you can test if you have problems with MTHFR and high homocysteine, now you know it’s expressing. Now you know what to do, okay?
Dr. Weitz: So any gene is just going to increase or decrease your tendency for something to possibly happen?
Dr. Armine: Exactly. Okay, and that is more basic … This is where we came up with foundational treatment, otherwise known as the framework…
Dr. Weitz: Right, it’s your environment, your lifestyle, your diet, your exercise, all of those things that will determine whether or not that genetic tendency get expressed and you actually have some issue in your body.
Dr. Armine: Hence, hence when you go to look at your MTHFR status and your practitioner does some testing to make sure that you’re not in any kind of danger, the beginning fix is to do exactly that, changing your lifestyle, drinking better water, breathing better air, managing stress. There’s a lot of talking about earthing these days, grounding, and so forth. I love on beautiful Cape Cod, except for the sharks. So I do a lot of walking on the beach. I don’t do a lot of swimming. They’re passing by. I know they’re only waving at me, but in the water let’s face it, I look like a seal. I don’t want to look like a seal in front of those guys.
Dr. Weitz: “Dr. Armine, come in the water.”
Dr. Armine: No. I’m like this, “Unless you’re a land shark, I’m staying here.”
Dr. Weitz: A little nibble won’t hurt you.
Dr. Armine: Yeah. On my phone, we have this thing called Sharktivity, so every time they see a shark, I kid you not, it goes off, and you see it’s plotted where all the sharks are. They close the beaches. Well, now it’s September. The sharks are still around, and there’s a lot of them around. I’m not going in the water, and they’re everywhere. I see some of them, they’re getting a little tired so they’re like on the highways going like this with their thumbs out, if they had thumbs, they’re like,… You know? Get back in the water. No, no, no, no, no.
Dr. Weitz: We need some better food. These fish are all loaded with plastic. We can’t eat them anymore.
Dr. Armine: The reason they’re here is because we have the national seashore, and it’s got thousands of seals. Thousands. And the seals protect themselves by swimming close to shore. So you see the great whites, we have videos of them, 10 feet off the shore, 15 feet off the shore. That’s not even waist deep, guys. You know? I’m not arguing with a great white shark. I went whale watching. There were whales all over the place. We saw dolphins, and then a great white came by saying, “How are you doing?” Okay. You know? We’re just waiting for one of those whales to bite. There was this big whale that was dead, and they were just all feeding off, they were having a good time. They’re not really aggressive. It’s just you don’t want to look like a seal.
Dr. Weitz: Right.
Dr. Armine: You know, like he looks like a seal.
Dr. Weitz: So let’s get back to methylation.
Dr. Armine: Well the sharks methylate too, I mean really.
Dr. Weitz: Of course.
Dr. Armine: Hey, we all need to methylate. You know, they’re like, “You know about methylation?” You know, like whoa. Okay, guys, just you know.
Dr. Weitz: That’s how you get over-methylated.
Dr. Armine: That’s right. You want to know about …, my other background it says the new thing you know, “Keep calm and swim fast.” You know? I’m sorry, I’m in trouble. Go ahead.
Dr. Weitz: Or use the buddy system. If you see a shark, give them your buddy.
Dr. Armine: Just remember, it’s like seeing a bear. I don’t have to outrun the bear, I have to outrun you. That’s true, you know. The same thing with the shark. I’m just going to lay there. You’re going to be flapping around. It’s going to go after you, not me.
Dr. Weitz: Okay, so if these genes that code for methylation tendencies …
Dr. Armine: Yes.
Dr. Weitz: So if we measure some of these genes, do we also want to measure serum levels of the substances that result from the expression of methylation? Like you mentioned, homocysteine. There’s some labs like Doctor’s Data that have-
Dr. Armine: A methylation panel.
Dr. Weitz: … a methylation panel and measure methionine and SAM-e, and some of these others.
Dr. Armine: Exactly.
Dr. Weitz: Is that what you want to do because that tells us whether the genes are getting expressed?
Dr. Armine: Exactly, and I’ll tell you why. First of all, if you have a genetic test, whether you get your data from 23andMe or from Ancestry.com. By the way, I wouldn’t suggest 23andMe anymore. Okay, Ancestry.com
Dr. Weitz: You don’t? How come? What’s wrong with 23andMe?
Dr. Armine: 23andMe has changed their … when you do a test, it’s run through a computer, and there’s a chip that reads the genes. It used to be the V2 chip, and it read 500,000 genes.
Dr. Weitz: Right.
Dr. Armine: And then they came out with the V4 which is 250,000. Now, they changed their chip, 23andMe, to read only the genes that they were utilizing for their purposes only. The reason 23andMe got so big was because people like myself were able to take the raw data and put it into different programs so that we could pull out what we wanted. Okay, for what we needed to see.
Dr. Weitz: That’s what we do in the office as well.
Dr. Armine: Yeah, but they’ve changed it. So what I’ve recommended to my patients, for whatever it’s worth, is to use Ancestry.com’s, their cheapest offering, and they still use a V4 chip. So wherever I put that data, I’m getting more data, and-
Dr. Weitz: What about the outside labs that do genetic testing? I know Diagnostic Solutions has … I think they just recently released a new genetic panel.
Dr. Armine: They have. I haven’t had the chance. I read what everybody sends me, but I have a … You and I have been in practice a long time. I’ve been in practice actually more than 43 years now. Okay, so we’ve seen a few things come down the pike, haven’t we?
Dr. Weitz: Yes, we have.
Dr. Armine: Chromium picolinate, ahh. Then all of a sudden, “It’s just chromium,” you know? I remember when GHB was a weightlifting drug, and now it’s a date rape drug. I wait, okay. So when I see … No, seriously. Come on, how many things have you seen come down the pike? CoQ10, the greatest thing since sliced bread, right? No, it only helped a few people here, but in Japan it was helping a lot of people because their diet was deficient in it.
Dr. Weitz: Right, well DHEA was going to be the almighty …
Dr. Armine: Right, exactly.
Dr. Weitz: DHEA was going to reverse everything.
Dr. Armine: Right, and that’s the way it always comes down. So when something new comes out, I read it, I wait, and usually some patients will bring the test to me, I’ll read it, and after I read several of them, if I see that what I’m looking at correlates with their symptoms then I’m going to start believing the validity of the test. It’s just too early with that one.
Dr. Weitz: Okay, so you don’t have a favorite panel right now.
Dr. Armine: The two panels I tend to use are StrateGene, which a new version is supposed to be coming out this month, which is going to be more robust, and I use MTHFRsupport.com, although that’s gotten top heavy lately because there’s too much information in there, and unless you’re a practitioner it’s hard to pull out what’s important. Although, if you wanted to see every pathway like nobody’s business, it’s all going to be there.
Dr. Weitz: Is that analysis software, or that’s testing?
Dr. Armine: That’s analysis software. The testing, you would use either the Ancestry or the 23andMe
Dr. Weitz: Oh, those are the only two panels you use? You haven’t used any of the other panels?
Dr. Armine: I haven’t used any of the other panels. I’ve read them. I haven’t recommended them, but people come to me with all different panels from all different places, and I can read them. That’s not a problem, but when I’m looking at … Somebody says, “What do I do with this data?” I give them the options of one of the two, and it works because what you have to do is correlate what you’re reading with their particular symptom complex, and with a good history you’re going to figure out what. You have your genetic tests in front of you, and then you have a suspicion based on their symptom complex of what might not be working, and if you want to confirm that, things like the methylation panel. They are really strong on the methylation issue. The methylation panel is great. Things like the organic acid tests are great. There’s another test-
Dr. Weitz: So what can you get out of an organic acids panel? What will that confirm for you?
Dr. Armine: The organic acid panel is measuring organic acids, which are the result of the pathways. So in the typical organic acid test from let’s say Great Plains, you’re going to see indicators of mold, of candida, of SIBO, of clostridia. You’re going to see the oxalate status which is really important because high oxylates is one of the major reasons for illness. It’s secondary to candida, but you’ll see it there. You’ll see the function of the entire Kreb cycle, how you create your energy. You’ll see the neurotransmitter metabolites. You’ll see the functioning of glutathione and many other things, and you’ll see the levels of the various B vitamins and some minerals. So you can have a really good idea of what’s going on physiologically because you’re not measuring serum levels, you’re measuring the organic acid that is a result of the intracellular functions. So what they’re dumping out of the cell is what you’re measuring. So you can extrapolate the cellular function.
Dr. Weitz: It’s gone through metabolism, it’s being processed, and that’s what the body’s getting rid of.
Dr. Armine: Right. So you can really extrapolate easily if you just think of it like that.
Dr. Weitz: Okay.
Dr. Armine: Everything’s got a couple of glitches, but once you know how to read it, it’s not a big deal.
Dr. Weitz: So organic acids panel. Any other tests you like to use?
Dr. Armine: I don’t use the methylation panel too often because I treat methylation on a more basic level.
Dr. Weitz: Do you measure homocysteine levels?
Dr. Armine: I do. It depends on the individual. If they’re in the States, they usually have insurance that will cover LabCorp requests, and I can write them a script for that, and then I can get those, like vitamin D 25, 125, yadda, yadda, yadda. I can get those tests that way. There’s another-
Dr. Weitz: You ever do a full nutritional status panel like the SpectraCell Micronutrient Test or the Genova NutrEval test?
Dr. Armine: Concerning NutrEval, NutrEval and the GPL OAT, when I weigh the both of them I lean towards the GPL OAT. The SpectraCell Micronutrient analysis is really wonderful because you can see the status of what’s going on inside the cell, and you’re looking at a six month status. You know how a hemoglobin A1c measures your sugar for the past three months?
Dr. Weitz: Supposedly, yeah.
Dr. Armine: Well, roughly. It’s never an exactitude, but you can see generally speaking what’s been going on.
Dr. Weitz: Right.
Dr. Armine: Okay, because of the glycosylation of the proteins, but since the SpectraCell test measures what’s going on inside the white blood cells and they generally last around six month, you can get a bigger view. So instead of seeing what happened over the past couple of days, you’re seeing what’s happening over the past couple of months. Plus, they measure and they test the function of the immune system and the function of the antioxidants, okay? So that’s really valuable. There’s another type of testing, functional diagnostic testing, and on the status quo, the ODX which is a massive panel that you can do that covers … it’s a blood test, and it covers, oh my god, so many different areas.
Dr. Weitz: If you do the SpectraCell micronutrient test, if you throw in the cardiometabolic panel, you’ll get blood sugar, lipids, hemoglobin A1c, it’ll include homocysteine as well.
Dr. Armine: Oh, cool.
Dr. Weitz: It’s pretty reasonably priced.
Dr. Armine: That’s good.
Dr. Weitz: When you order the micronutrient test, you can throw that one in.
Dr. Armine: Okay, thank you. I didn’t know
Dr. Weitz: And oh, it also includes omega-3s.
Dr. Armine: Wonderful.
Dr. Weitz: Yeah.
Dr. Armine: Yeah, I measure omega-3s through something called OmegaQuant, but if there’s a single test. I like
Dr. Weitz: Yeah, they include it in their cardiometabolic panel, the 6:3 ratio and all of that.
Dr. Armine: Yeah, because that’s how you tell what’s going on. You also need the AA:EPA ratio.
Dr. Weitz: Yeah.
Dr. Armine: You talked a little bit about cell wall integrity, what does that mean? You have to remember that the cell wall is not just a wall. The cell membrane is what determines what goes out of the cell, what’s being allowed into the cell, and it’s being called, recently but it’s gaining speed, it’s being called the master of the cell more than the nucleus. When you have chronic inflammation, you have a lot of problems, people talk about leaky cells. What that means is a lack of cell wall integrity or cell wall function, which can come from a lack of phospholipids or a whole lot of other things, and when that happens your cells aren’t going to work. And if your cells don’t work, nothing-
Dr. Weitz: Because the cell wall essentially is a phospholipid membrane.
Dr. Armine: It is a phospholipid bilayer, exactly.
Dr. Weitz: Right.
Dr. Armine: Okay. I wrote a book with Elizma Lambert called Leaky Gut, Leaky Cells, Leaky Brain which went through it really, really well. It’s a simple book, it’s an e-book, and I made a very, very large point very easily … because when I write…
Dr. Weitz: Send me an email with a link so I can put it in the show notes, please.
Dr. Armine: Oh, absolutely I will. Absolutely. We spent two years on it, and I think it’s kind of a masterpiece because it’s so easy to understand.
Dr. Weitz: Great.
Dr. Armine: Nevertheless, when we talk about cell wall integrity as being part of considering how to look at somebody’s condition, you consider the epigenetics, you consider the relationship between neurology, endocrinology, and immunology which is known as the NEI supersystem, you consider the function of the mitochondria, and what many people don’t do is look at the function of the cell wall, and that particular omega test is one of the ways you look at it.
Dr. Weitz: Okay, cool.
Dr. Armine: So when you’re talking about methylation, what the idea of methylation is is to create SAM-e, which goes around putting the methyl groups where it belongs. When everything is properly methylated, physiology works the way it was intended. It gets a little crazy about how the DNA wrapped around histones and it gets a little nuts. And it’s true, it gets nuts, but the reality is if you get methylation to work correctly, it’s going to be a big contributor to you recreating and maintaining your homeostasis. Now, how hell the do you do that? How the heck do you do that? A lot of people concentrate solely on giving methylated vitamins: methylfolate, methyl B12, dimethylglycine, trimethylglycine, or SAM-e itself. That’s okay. There are plenty of products out there.
Dr. Weitz: Yeah, for example what if somebody was out there either a patient or a practitioner who was thinking, “You know what? Instead of doing all of this testing, why don’t I do the following? I’ll avoid any foods or supplements with folic acid, and I’ll just take methyl B vitamins, and aren’t I covered?
Dr. Armine: Usually, yes. Here’s the thing that people should know. First of all, my particular practice is made up of people who have been here, there, and everywhere that aren’t getting success out of their treatments. So obviously I have a very focused population. There are a certain percentage of people that respond very negatively to the methyl vitamins. So, well let’s just talk methylfolate for a second.
Dr. Weitz: Okay.
Dr. Armine: There’s loads of reasons for this
Dr. Weitz: So we have methylfolate which is B9, we have methyl B12 which is methylcobalamin, and then we also have the … I don’t think they’re methyl forms, right? Of B2 and B6, they’re activated forms, right?
Dr. Armine: No, they’re activated. They’re B2 and B6 would be P5P, B2 would be Riboflavin 5′-Phosphate. Like you said, there are loads of products out there that will put together, and they usually will make a big advertising point about it, and they usually put all the active/methylated vitamins together. This is my advice to everyone who takes this kind of stuff. Do an experiment with yourself. Do yourself a favor, especially if you’ve had some really nasty chronic illness for a long time, especially if it’s associated with any kind of anxiety or what I liked to call neuroexcitation. Only because the reaction to the methyls, they’re going to up-regulate that which is very uncomfortable. Either take the product you’re going to use or use one methylated product like methylfolate which you can like anywhere, start with a quarter of a dose or a half dose, and over a period of two weeks work your way up to a full dose.
Here are the four reactions you’re going to see: One, if you start taking it and you feel bad, do me a favor: stop. I can’t tell you the people who will say, “I can only take a little crumb of methyl B12.”
I said, “Why are you taking it?”
“I need the methyl group.”
“No, you don’t. If you’re not taking a therapeutic dose, what’s the sense?”
Dr. Weitz: I would like to give a caveat since I’ve been doing the functional medicine stuff like you for a long time, and a lot of times when people feel really crappy and whatever it is they ate or what they took, they automatically assume that that means, “I can never eat that food again,” and… Probably try it a few times in a row before you decide for sure the fact that you’re feeling crappy right now has directly to do with that.
Dr. Armine: It’s a tough one sometimes to figure out where it is, but often the second scenario is where people get confused because the reality is is some people will start taking the, I’m just going to say the methyl vitamins, the methyl vitamins, and they feel, okay they don’t feel, you know whatever. Then within about two weeks they start feeling bad, and it’s very hard to realize that they’ve blocked up all the pathways, if you want to look at it like that, and they need to stop the methyl vitamins. That’s the second scenario, and if you have an ear for it you’ll say, “Okay, just simply stop what you’re doing and see in a few days if you don’t feel better because if that is, then you know what caused it.” Three-
Dr. Weitz: You know, a lot of multis now have the methyl B vitamins in it.
Dr. Armine: Yeah, it’s a big deal. It’s a big deal. Methylation, you really need to understand, is big business. This is why before, when we first started-
Dr. Weitz: Well, everybody’s doing it because we don’t want to give people unmetabolized folic acid, so.
Dr. Armine: That’s true. That’s true, but when we first started everybody’s like, “Methylation, no big deal.” Soon as the companies grabbed onto the fact that methylation was important, everybody was testing for everything in their trimethyl groups, and it became hard to find a vitamin that didn’t have it. So in the third scenario-
Dr. Weitz: Are you saying the average person should take a multivitamin that doesn’t have methyl forms of B vitamins?
Dr. Armine: No, what I’m saying is that when you take your vitamins, be cognizant of the fact whether they have the methyl B’s in there, and if you start taking that vitamin and you feel bad, it’s most probably that, and simply stop taking it.
Dr. Weitz: Okay.
Dr. Armine: If you start taking the vitamins and within two weeks you feel bad, then stop. Okay?
Dr. Weitz: Okay, sounds good.
Dr. Armine: If you start taking the vitamins and it’s like you start feeling better, and better, and better, you hit the nail on the head. If you start taking the vitamins and you don’t feel better or you don’t feel worse, it means your body is accepting it, but it’s not the answer to your symptom complex.
Dr. Weitz: Now, is the amount in a multivitamin typically enough to create negative reactions in more than a small number of people?
Dr. Armine: Yeah, it is, and a lot of times the amount of folate is limited because of the FDA restrictions. You’ll usually see B12 at reasonable amounts. You’ll always know that you’re getting a bad form of B12 when it says that you’re being given 1,667% of the percent daily value. It usually means you’re getting cyanocobalamin, which is very poorly absorbed. These days, that doesn’t exist, but if you do have a problem with the methyl Bs, there’s a ton of vitamins out there that have things like folinic acid or natural folate, and they have hydroxocobalamin and/or adenosylcobalamin. People usually don’t respond … we don’t negatively react to those. The reason I’m- The reason I’m making the point is because if you do have a reaction to it, it’s usually in the excitation, anxiety, or if it’s a child increase in hyperactivity, and you’re looking at it, and the mindset is, “I need this for his methylation, yet I’m going to just fork my way through it, and this …” Remember that if you give somebody substrate and you give them what they need to metabolize it, they’ll create the methylfolate. Maybe a little slower than the next person, but they’ll create it. There’s usually loads of reasons why you’re not creating it, and that includes lack of B2, lack of B3, lack of substrate, lack of folate like the person doesn’t eat green vegetables at all. Those are the reasons that you don’t produce it. Now, you can give somebody the problem, give somebody the vitamin, but you also remember what we have to do is find out how they got there in the first place. Because they can take vitamins for the rest of their lives, but that’s not fixing anybody. Yeah, we all need a good multivitamin and multimineral, but we’re talking the bigger picture of having to actually fix things and reestablish normal homeostasis which starts at that basic stuff that you were talking about before: good food, good water, good stress relief.
Dr. Weitz: Well let’s say you have a patient that has elevated homocysteine levels and you want to reduce their risk of heart disease, and you give them a methyl B formula, a homocysteine oriented, product. Something designed to help lower homocysteine levels, and they don’t feel well on it. What other choices do you have?
Dr. Armine: Well remember, the presumption is their high homocysteine is causing symptoms.
Dr. Weitz: No, no. Let’s say they’re not having symptoms, but they want to reduce their risk of having a heart attack.
Dr. Armine: Okay…
Dr. Weitz: And their homocysteine is 15.
Dr. Armine: If their homocysteine doesn’t come down, then you definitely want to do the methylation panels, you definitely want to do the organic acid test, and you want to find out where the pathway this is being backed up, if you will, and it could be down the transsulfuration pathway. It could be blocked up by CBS going backwards. There’s loads of reasons, but this is where a good history and reasonable testing comes in. I agree with you, most doctors that I know-
Dr. Weitz: But what is CBS going backwards mean?
Dr. Armine: It just means that if CBS is … I said that…
Dr. Weitz: If NBC goes backwards, is that the same thing?
Dr. Armine: Homocysteine goes down the transsulfuration pathway past something called cystathione B synthase to become cystathione, and then cysteine to eventually become glutathione, and then glutathione, when it gets used up and gets oxidized, gets recycled. So that whole big, long pathway can get blocked up, if you will, and if you think about it like a highway, it’s going to block up, and where it’s going to block may be one of the reasons for higher homocysteine. Nevertheless, what happens is if your homocysteine’s not coming down, it’s telling you you’ve got chronic inflammation somewhere, and your practitioner needs to start investigating that, but when you investigate that, you’re going to find out the reason. It’s like looking at TSH, thyroid stimulating hormone. A lot of times I’ll see that up, I’ll see poorer thyroid function, but the thyroid antibodies are not there. That’s generalized chronic inflammation. I better start looking for reasons for that whole person to have inflammation and that’s usually under chronic inflammatory response syndrome, and maybe…
Dr. Weitz: And from a Functional Medicine perspective, typically we start looking for possibilities like mold, heavy metals, other toxins, food sensitivities, leaky gut and other gut problems, etc, right?
Dr. Armine: Exactly. This is why…
Dr. Weitz: Other nutritional deficiencies.
Dr. Armine: This is why functional medicine and allopathic medicine should actually work in concert with one another. Because the allopaths are really, really good at finding out the gross pathologies. You don’t want to miss those. Okay, you don’t want to miss those. But once they don’t find a gross pathology, the typical joke, “All your tests are negative. You’re fine.” Nope. Okay, if you’re still hurting the functional medicine doctor simply goes back, looks at it from a wider point of view, takes care of the basis of the body, the cell wall function, the absorption of nutrients, the absorption of vitamins and minerals, all that stuff, and then starts looking at it from the point of view of, “What could possibly be contributing to this?” And the functional medicine doc never sits there and says, “That can’t happen.” What they say is, “Well, it’s happening. Why may it be happening?”
Dr. Weitz: Right.
Dr. Armine: That’s why we find things that other types of practitioners don’t, so we know what to do. If the normal stuff doesn’t work, that’s where we shine. Okay?
Dr. Weitz: Right, so I just want to pull out, you mention I think is a really good clinical pearl. If you have a patient and they’re taking a modern multivitamin, say from a practitioner or some of these professional brands, pretty much the majority of them have switched over to methyl B vitamins, and they’re not feeling well or they’re feeling anxious, some of the symptoms that might happen from being over-methylated. Then you should try to find a multivitamin that instead of having methylcobalamin has hydroxocobalamin because you don’t want to take cyanocobalamin because that’s small levels of cyanide, right? You want something called NatureFolate as opposed to 5-methylfolate, and they won’t typically have the same reaction.
Dr. Armine: True. True.
Dr. Weitz: Okay, good. So what else-
Dr. Armine: The way you would know that is simply by stopping the vitamin that you’re taking.
Dr. Weitz: Right, so what else can happen with over-methylation? What are some of the other dangers? Isn’t there a danger of increased risk of cancer?
Dr. Armine: In the long-term, in the long-term. Over-methylation as well as under-methylation, remember too much and too little in the body is just as bad. It’s easier to understand if something is too low, if you have DNA hypomethylation, if you will, there’s no sense in even using the terms. When you have too little methylation, you know it makes sense that things won’t work. If you have too much methylation, often if you have an acute over-methylation, you’re going to be … And by the way, if that should happen because you’ve taken too many methylated vitamins, you get regular niacin, you know the cheap stuff, nicotinic acid, the one that causes the flush, and you take about 25 mg an hour, and within a few hours that will calm down because it chews up the methyl groups. Okay?
Dr. Weitz: Oh, interesting.
Dr. Armine: It’s the first aid for over-methylation. The other thing is you have to realize that if you are taking B3 and you’re taking a large amount, you may be causing the under-methylation. You might be causing the hypomethylation because you’re chewing up the groups. Nevertheless, hypermethylation, over-methylation, just like hypomethylation can cause different things. Sometimes it’s contributing to breast cancer or any of the estrogen loving cancers. I really would advise people to look for normal methylation function rather than concentrating horribly on over or under methylation, just trying to normalize it. The over-
Dr. Weitz: How do we know if we’re over-methylating, assuming you don’t have symptoms?
Dr. Armine: It’s really tough because some people have related it to the histamine levels and so forth. I haven’t seen the correlation with that. If you’re not having symptoms and you are feeling well, for the most part you’re not over-methylating or under-methylating. If you have a high homocysteine and you add methyl groups … Remember, if you’re really having problems with the methylation system, you’re going to have multisystem symptoms. That’s why methylation is important, to treat or at least consider it. It’s not going to be a thing because the DNA production, protein production, is going to be off which is what’s going to cause problems with histamine and metabolism, neurotransmitters, detoxification. You’re not going to have one problem.
If you just have a high homocysteine, usually it’s the simple things that will fix it. Yes, you can use the methylated vitamins, but remember, think about why it got there. If you really are under-methylated, if your methylation’s not working, you’re usually going to be sick. You’re usually going to have chronic fatigue. You’re going to have a whole mess of different things going on, and the effect of the root cause, or the effect of what caused that, causes problems in the methylation system. So yeah, you want to treat it. You want to get that person’s homeostasis as stable as you can, but you want to look for the root causes also. Otherwise, it’s just going to come back.
Dr. Weitz: Okay. You’ve provided us with …
Dr. Armine: Been very confusing.
Dr. Weitz: We could go on for hours, but …;
Dr. Armine: Yes, we could.
Dr. Weitz: I do have a patient coming up, and-
Dr. Armine: I know,
Dr. Weitz: … we’ve talked about a lot of things. We’ve talked about the connection between great white sharks and methylation, and we’ve talked about the problems-
Dr. Armine: It’s an important point. Let’s face it, it’s an important point.
Dr. Weitz: I think…
Dr. Armine: Especially to the shark.
Dr. Weitz: This is probably the only podcast that has covered the connection between MTHFR and great white sharks.
Dr. Armine: If you think about it, it could be shark defense also. You get the methylated vitamins, they’re coming at you, you throw them this way, they’re like, “Ahh,” and they go after them. Like, “All right, thanks. That’s what I was looking for.” I’m like, “I know. I’m out of here.”
Dr. Weitz: Oh, no. I got methylated before Dr. Armine jumped in. So we’ve talked about some of the ways to test our genes, and to look at some of the methylation pathways, and some of the things to look at, and then some of the dangers of over-methylation. How can our listeners, patient and practitioners, get a hold of you and find out about some of your programs?
Dr. Armine: You can go to my website which is DrJessArmine.com. You can contact my office of Dr. Jess Armine, or call that number, and I’d be happy … I offer a 15 minute get acquainted session. So you can schedule that, and we can have a chat to see if I can help your particular condition. Practitioners, I also run mentoring groups. I do personal mentoring, but I do group mentoring which seems to work out very, very well. I run those on Tuesdays and Thursdays, and they are 12 week courses where we get together every week as practitioners, go over tough cases, and then take the learning points from those cases and talk about those subjects. So, we find out what the group’s issues are, what they want to learn about, and I guide them through that. So I usually can take a practitioner who is not as familiar with functional medicine, and within 12 weeks have them really, really very functional within it without taking an overt amount of formalized courses.
Dr. Weitz: When is your next group starting? Maybe you could send me a link for that that I could put in the show notes.
Dr. Armine: I sure will. I’m going to England starting Sunday until October 3rd, so probably the middle of October, but I’ll send you a link for it because yeah, I appreciate that. I’d like to get out most of my groups are in England, and I would like to have some American groups because I know those are a necessity here. Especially for the younger practitioners who are watching who have got all of this knowledge and simply can’t put the puzzle pieces together, which is what I do. If you want to be the master healer and you want to learn how to put the puzzle pieces together, I’d be very happy to be your guide. Plus, it’s cost effective because what I charge for person to person type stuff borders on the silly. Group is much better.
Dr. Weitz: Right. Sounds good, doc. Thank you so much.
Dr. Armine: Thanks, brother. Thank you for having me. I really appreciate it. Take care.
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