Functional Neurology with Dr. Ken Sharlin: Rational Wellness Podcast 264
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Dr. Ken Sharlin discusses Functional Neurology with Dr. Ben Weitz.
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3:43 How he found his way to Functional Medicine. Dr. Sharlin was in the early years of his medical career and he got into cycling and even did some triathlons and got into the science of how to improve his cycling performance from sleep quality to nutrition to heart rate variability. Then he listened to Ben Greenfield’s podcast where he discussed the science of exercise performance and Ben interviewed Integrative Neurologist Dr. Dave Perlmutter, who talked about the work he did with the Institute for Functional Medicine. This for Dr. Sharlin was like the gates of heaven opening and he attended the IFM hormone module and then their flagship course, the AFMCP. He got certified in Functional Medicine and he made connections with Dr. Perlmutter, Dr. Dale Bredesen, Dr. Terry Wahls, and people like that.
9:58 Dr. Sharlin practices both conventional neurology, which is an insurance based practice, and Functional Medicine Neurology, which is a direct pay model. He asks patients who enroll for Functional Medicine to make a big commitment, since it is not just one visit, but involves seeing the patient over multiple visits for months and years. It involves changing your thinking and your behavior and not just taking a pill. Dr. Sharlin points out that while Functional Medicine allows us to address some of the underlying triggers, we still need to know what disease we are dealing with. Parkinson’s, ALS, Alzheimer’s, and Multiple Sclerosis are complex, chronic diseases and even when we are able to slow them down or reverse them with a Functional Medicine approach, it does not mean that they no longer have the disease. He treated a number of the patients in the Dr. Bredesen paper, Reversal of Cognitive Decline, 100 Patients, and while they reversed their disease process, they still have Alzheimer’s disease. And Dr. Terry Wahls who reversed her MS, still has MS and when she eats eggs she will still get trigeminal neuralgia, which is a facial pain syndrome, because she has a sensitivity to eggs.
21:48 Diet for cognitive problems like Alzheimer’s disease. Dr. Sharlin has developed his healthy brain toolbox and a ketogenic diet is one tool that can be helpful for some patients with cognitive problems. However, it is crucial to make sure that the diet provides the nutrients that the body needs and the ketogenic diet can be very restrictive, so he tends to focus more on a nutrient dense diet and if he uses a ketogenic diet in some patients, it must have a large variety of vegetables. Dr. Sharlin also believes in intermittent fasting, time restricted eating, and giving your gut a break to do the other things it needs to. While some patients with Alzheimer’s do well with a ketogenic diet, patients with ALS do not do well with it, esp. since ALS is a hypermetabolic disorder and progressive weight loss is a predictor of rapid demise. For patients with Alzheimer’s disease, it is important to have patients stop eating inflammatory foods and to go on a low carb diet, but not necessarily a ketogenic diet. We want them to eat lots of green leafy and cruciferous vegetables, so they get the fiber they need to feed the butyrate producing microbes in their microbiome, though it is a good idea to limit the higher glycemic, refined carbohydrates. Dr. Sharlin has most patients follow a modified Mediterranean diet that limits or eliminates grains and higher sugar fruits and focuses on mostly plants, high quality protein, fatty fish, good fats, avocados, and nuts and seeds. He would rather have his patients do some intermittent fasting and even some one day fasting rather than being in ketosis all day long.
30:20 Testing for a patient with Cognitive issues like Alzheimer’s Disease. APOE, which is a genetic marker that is most associated with the risk of late onset Alzheimer’s disease. MTHFR status. Vitamin B12, choline, MMA, inflammatory biomarkers, vitamin D, omega 6 and 3, arachidonic acid, HsCRP, oxidative stress markers, vitamin C, E, glutathione, CoQ10 are all critical to understanding how to support our mitochondria. For labs, Dr. Sharlin will use some big commercial labs like Quest for some things and Vibrant America for most other things.
33:10 Hormones are critical for brain function and women who use bioidentical hormones can significantly reduce the risk of neurodegenerative diseases. The brain goes through changes from the pre to the post-menopause years and there is a growing body of literature that suggests that women who use bio identical hormones, really optimize their levels, can significantly reduce the risk of all neurodegenerative diseases, including Alzheimer’s. But, men shouldn’t be left out of the picture. Dr. Sharlin has 80 year olds on hormones and they have done very well. This is controversial, since some data indicates that hormone replacement therapy can increase the risk of breast cancer and heart disease unless taken immediately after menopause, but we have to consider that we are treating them for debilitating, progressive neurological diseases like Alzheimer’s.
35:57 Toxins and chronic infections. Dr. Sharlin will screen patients for heavy metals through serum and also for chronic infections like Lyme, Herpes simplex virus (HSV). and for Epstein Barr virus EBV). For patients who test positive for HSV he will typically prescribe Acyclovir or Valacyclovir for 30 days. These viruses can hide out in the nervous system and go to the brain. He tests for mercury, cadmium, arsenic and lead through blood and he does not do provocation testing because that might cause more damage. For removing toxins, Dr. Sharlin may use oral chelators and he will support the normal biological and physiological detoxification processes through hydration, fiber, regular bowel movements, urination, sweating, and cruciferous vegetables to raise glutathione levels.
43:57 Nutritional Supplements:
- Vitamin D, often low in patients. Dr. Sharlin aims for the 60-80 ng/mL range.
- EPA/DHA at least a gram per day and up to 3 gm per day.
- Turmeric and other natural anti-inflammatories, esp. after a concussion.
- Methylation support–methylated folate, B6, B12.
- Medicinal mushrooms, including Lion’s mane. He frequently recommends Lion’s mane in coffee with MCT oil.
- Ashwaganda has been shown to reduce amyloid protein.
51:05 Drugs for Alzheimer’s Disease. The newest approved drug, Aducanumab or Aduhelm, has been very controversial. It is the first FDA approved monoclonal antibody targeting amyloid beta 42 in the brain, which is thought to play a major role in Alzheimer’s disease. There is a lot of attention given to some well known side effects of this class that are called ARIA or amyloid related imaging abnormalities. And these manifest as essentially two different findings on MRI. One is a small area of swelling in the brain or edema. So, it’s called ARIA-E and the other one is a little area bleeding or staining in the brain from blood products called ARIA-H or ARIA-hemosiderosis or micro hemorrhage. The important thing to understand is that, the vast majority of people who experience these ARIA type changes are completely asymptomatic and that in most cases, these changes resolve on their own, by withholding the drug. That’s not to say that it never is a problem, but it’s far less of a problem than the news media made it sound. There are several other similar drugs in the pipeline: 1. Donanemab, 2. Gantenerumab, and 3. Lecanemab, all of which may slow the progression of the disease over time somewhere between 22 and 30%. So in the ideal perfect world, if somebody is going to use a monoclonal antibody, the best situation is to first remove inflammatory drivers through a functional medicine approach. If you makes those changes first and then use one of these drugs to get rid of the amyloid, you will likely get a much better benefit.
1:03:37 Advanced strategies for neurological disease. There is a lot of experimentation with using different forms of energy for improving brain function, including electricity, light, sound, and electromagnetic fields. There is a lot of interest in the Vielight. Things that stimulate the vagus nerve can be helpful. Dr. Sharlin is using mesenchymal stem cells that are harvested from the bone marrow of patients and then the stem cells are separated and then introduced directly into the spinal fluid. After the injection, the patient is positioned in the trendelenburg position for two hours with their legs higher than their head to encourage these cells to migrate toward the brain.
1:11:42 Amyotrophic Lateral Sclerosis, aka Lou Gehrig’s disease. (ALS). Dr. Sharlin has had some success with with this very rapidly progressive and usually deadly disease within 2 to 5 years. Using a Functional Medicine approach, Dr. Sharlin has some ALS patients who are alive well beyond five years and doing well.
Dr. Ken Sharlin is a board-certified neurologist, Functional Medicine practitioner, Assistant Clinical Professor, researcher, and author of the #1 best-seller The Healthy Brain Toolbox: Neurologist-Proven Strategies to Improve Memory Loss and Protect Your Aging Brain. He practices both conventional neurology, is involved in research on drugs for neurological conditions, and also utilizes a functional medicine approach for neurological disorders, depending upon the patient, which he calls Brain Tune Up. His practice is in Ozark, Missouri and his website is Sharlin Health and Neurology.
Dr. Ben Weitz is available for Functional 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 and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, the topic is functional neurology with Dr. Ken Sharlin. Conventional neurology basically involves looking at symptoms, performing a neurological exam and testing to determine what the diagnosis is. Let’s say the diagnosis is multiple sclerosis, and then we figure out which is the appropriate drug that might help to modulate those symptoms. In some cases, if the condition is an autoimmune disease, then a medication that suppresses some portion of the immune system, such as methotrexate or Humira may be prescribed.
In the words of Dr. Ken Sharlin, if you’re affected by neurological disease, you got to think about what traditionally happens. You go to the doctor, the doctor makes a diagnosis after taking a good history and physical, and generally recommends a treatment. And that treatment by and large is a medication. Sometimes it’s surgery, sometimes it’s therapy, but generally it’s medication. But the problem is that, the medication is going to be prescribed generally for the rest of your life. And I would add, for the most part, those medications are not going to change the course of the condition, they’re not going to reverse it and they’re just going to help manage the symptoms, which likely will get worse over time.
Functional neurology, on the other hand, attempts to investigate what are some of the root causes of the condition and it’s not just untreating the symptoms. A more detailed history, going all the way back to how you were born and using more extensive testing to discover some of the triggers for the condition and evidence for sources of inflammation, such as from food sensitivities, unhealthy diet and lifestyle, toxins, chronic infections, hormone imbalances, the microbiome and nutritional status. With functional neurology, there’s an emphasis on changing diet, exercise, lifestyle and nutraceutical supplements. And cutting edge technologies to promote neuroplasticity, to treat patients with neurological conditions ranging from headaches to dementia to MS, ALS, Alzheimer’s and Parkinson’s.
Dr. Ken Sharlin is a board certified neurologist, functional medicine practitioner, assistant clinical professor, researcher and author of the number one best seller, The Healthy Brain Toolbox, neurologist proven strategies to improve memory loss and protector aging brain. Dr. Sharlin practices conventional neurology. He’s also involved in research on drugs for neurological conditions and he also utilizes a functional medicine approach for neurological disorders, depending upon the patient, which he calls brain tuneup. His practice is in Ozark, Missouri. Dr. Sharlin, thank you so much for joining us today.
Dr. Sharlin: Thank you doctor. It’s a pleasure to be joining you. Thank you so much for having me.
Dr. Weitz: So as a neurologist, how did you find your way to functional medicine?
Dr. Sharlin: It’s probably goes back to about 2005 or six, when my wife who worked for a large healthcare system in our area and was the director of a wellness program for seniors, for older adults. This was… When I say wellness, we might use this extremely broadly, meaning she might take them on a trip to see a play, but then they might go for walks in the park. Or, at that time she wanted to start a bicycle club. And I’m of that generation, we always hear about this all the time on social media that, we’re of that last generation of kids who just don’t go play outside, don’t come back till it’s dinner. I’d ride my bike to school, I’d ride my bike home, ride my bike to my friend’s houses. I loved riding bikes, but then life happens, you get married. I went to medical school training, et cetera. And so, the last time I had ridden a bike had been several years. But she said, “Hey, I’m starting a bike club. We need bikes.” Said, sounds reasonable. We went to a local bike shop and I kind of went into shock, because I didn’t know bikes cost thousands of dollars. So at any rate, we did start that bike club. And, I must admit that my desire to go inexpensive on the bike was quickly overridden by my desire to have a better bike. So, it led to a bike addiction. We can talk about that later. But ultimately, I got pretty serious about cycling, started doing those long rides as, what they call century rides, things like that. The MS ride, MS150, then we started doing triathlons.
Dr. Weitz: Wow.
Dr. Sharlin: And, that was a whole other situation where I was now running and swimming. And I love the science behind things. So, kind of long story short, I was thinking, well, it’s not just about a good workout getting me ready for the next race, it’s about sleep quality, it’s about nutrition. It’s about your mindset. Maybe even your heart rate variability when it comes to training. And so, as I sort of geeked out on all of this science and was seeing my body change and ultimately completed three iron man triathlons-
Dr. Weitz: Wow. Congratulations.
Dr. Sharlin: … I was joining the office and I was seeing kind of what you were describing. I was making the diagnosis, prescribing the drug and the drugs are not… They have a place. They certainly have a place, but they aren’t the be all and end all. And, they certainly don’t reverse most of the diseases that I treat. And so, I would watch my patients just get worse and worse over time, which meant either more drugs or higher doses. And it’s just a very, very unsatisfactory situation for both my patients and myself. And I thought, “Well, if I’m doing this stuff on my own, why can’t I find a way to help my patients make changes in their lives, so that they don’t have to do an Ironman triathlon, but you and I both know that we have diseases like diabetes, adult onset diabetes, it’s a completely reversible disease. It doesn’t have to be that way. Well, I was fortunate to be a fan of the Ben Greenfield Podcast at the time. You may know Ben. I’ve gotten to know him just a little bit.
But at that time, I loved the fact that he was doing a lot of triathlons at the time and he would always open his show with scientific articles, journal articles, all about sports physiology. And I thought, that was coolest thing, because I’d never heard people talk about these things before, talk about things that we consider recreational, cycling, but talk about the science. How does the body change? What is the physiology that’s going on? And of course he had a podcast. And so, he’d bring on different guests. And one of his guests was the great Dr. Dave Perlmutter. And, Dr. Perlmutter was talking about the work that he did with the Institute for Functional Medicine. I had no idea what that was, but I thought, “Well, this is great. He’s talking about diet and exercise and Alzheimer’s disease. And this thing called functional medicine.” So, we still had Google. It wasn’t that long ago, but I looked it up and it was like the gates of heaven opening. I heard the horns, I saw the angels. I said, I have a lie. I’m here. And it really got to the point where I was considering leaving my profession altogether. It was a pretty dark time. There are a lot of burned out physicians, but my wife encouraged me to go take the first available course at IFM, which I did. It was their hormone module. And I thought it was the greatest thing in the world. I’d never been to a medical meeting where there was so much joy and there was so much humanity and I was absolutely hooked. And the next thing was, their flagship course called AFMCP, Applying Functional Medicine Clinical Practice. Before you know it, two years later taking the test, et cetera. Getting certified in functional medicine, making connections to people like David Perlmutter, people like Dale Bredesen and Terry Wahls, making sure that I was surrounding myself with the thought leaders that really were focusing on the kind of medicine that I wanted to practice. And I was successful in doing all that. So, that’s kind of how… That’s the longer story of how I got here, but it really was a transformation from kind of a dark time in my life, knowing that I had to be helping my patients in a different way and then finding that way.
Dr. Weitz: Very cool. So, my next question is really one that practitioners would probably be the most interested in. Which is, how practically do you combine functional medicine and conventional neurology into one practice? I know a lot of conventional doctors who just switch their practice over to functional medicine, or they just try to incorporate a little bit into their conventional practice, which is very difficult. And some of the issues are, when you’re practicing conventional medicine, you’re often reimbursed by insurance and insurance is controlling the tests. You can order the amount of time you can spend with the patients. And, it’s a different model than the functional medicine model. And so, you have patients undergoing one or the other, or both, how do you practically combine them into one practice? And, I know that’s a big question. So, take it wherever you want.
Dr. Sharlin: Absolutely. Well, you’re right. Functional medicine. There are occasionally practices here and there that might be able to utilize some insurance for functional medicine, but by and large functional medicine has a direct pay model. And it is so in my practice. Now beyond that, so we do ask people to pay for functional medicine and we ask people to make a big commitment because, it’s really not a one off, it’s not a consult. I was listening to… My wife is a health coach and a life coach. And, she’s so into what she does. She’s constantly listening to audio books and podcasts and training. So I get to listen all her stuff too. At any rate, one of the individuals who she was listening to one day said, doctors are really essentially consultants. We give advice. We say, “I think you have this. I think you should do this. This is my recommendation.” Right?
A coach takes things from a totally different angle because, a coach is really about connecting with someone at a very deep level, almost a spiritual level. Because, you have to get a person to align themselves with their life, with their trajectory in a completely different way. And ultimately, have to encourage different ways of thinking about things, so that behaviors follow. Behaviors change because you change your thoughts. So, it’s really about a journey that the coach takes with their client. And so my point is that, when we do functional medicine, it is a journey. It is a change. It is a process. And so when people say, “Can I just see you?” Yes and no. You definitely can see me, but let’s be clear about what our goals are, because functional medicine is not going to happen in one visit.
It’s going to be over the course of a year. And then, we’re going to continue to make a connection, whether that’s once every three months or six months or what have you, but you need to make sure you’re not falling off the wagon, which is not uncommon. So going back, we still have to recognize, these are very complex diseases. Parkinson’s, ALS, Alzheimer’s, multiple sclerosis. And the first thing we try to do from a conventional standpoint really is, make sure we’re identifying the problem correctly. If somebody comes to you then and says, “I’m having trouble with my memory, I’m having brain fog”, that’s a legitimate complaint. We want to find out why. But, not everybody who comes to you with a memory complaint necessarily has Alzheimer’s disease. So, we have to identify the problem correctly, do the appropriate diagnostic testing. This is a disease centered approach in this stage of the game. We have to identify the problem. Sometimes I refer to something called quantum super position, and I am not a quantum physicist, but I like the concepts of quantum physics in the sense that…
Dr. Weitz: You are getting a little Deepak Chopra-ish.
Dr. Sharlin: Right. They can talk about a particle being in two places simultaneously. It’s like the cat inside the box or whatever. What’s actually happy, you don’t know until you open the box. But the point is that, when we’re dealing with chronic diseases, there is so much that can be done on the functional medicine side, which is the patient centered, the person centered side. But, we still have to understand the disease. Because, sometimes that disease has kind of a life of its own and is associated with certain patterns, that as a practitioner, we have to be able to recognize. We love using terms like reversal of cognitive decline. And that is true. And, I contributed a very large proportion of the patients in the Dale Bredesen paper, Reversal of Cognitive Decline, 100 patients. We had a full third of all of those patients in that paper. We had patients who had Alzheimer’s disease, who instead of getting worse over time, they were getting better. Now, does that mean that we cured their Alzheimer’s disease? The answer is no. We didn’t cure their Alzheimer’s disease, but we sure can do things from the functional medicine perspective that are going to dramatically improve their function. I always say that’s the operative word and their quality of life. So, our dear friend, Dr. Terry Wahls, famous for her MS reversal, sometimes I have to remind my patients who are very enamored as I am by her story. She’s wonderful. She has a wonderful hero’s journey. She’s…
Dr. Weitz: Yeah. For people who don’t know Terry Wahls has MS, she was in a wheelchair, she couldn’t walk, she was going downhill. And now as a result of her own functional medicine program, which she figured out for herself, she walks, she lectures, she teaches, she’s fully functional. And, this has been going on for more than a decade. Right?
Dr. Sharlin: That’s right. But, she does still have MS. We have to remember that. It’s there. And, she’s the kind of person, if she eats eggs, because she has an egg sensitivity. She will get trigeminal neuralgia, which is a facial pain syndrome. So, it’s really important going back to your original question and when it comes to functional medicine and neurology and that sort of reference to quantum physics, we have to understand that, we have to know the person, we have to know the disease. The problems that I encounter are, conventional medicine is so disease focused and it leaves the person completely out of the narrative and it’s their narrative. It’s their story. Functional medicine can sometimes be very guilty of forgetting. Wait a minute, this person has a certain disease. We have to remember that. These are complex, chronic diseases. This isn’t some SIBO, that we’re just going to get better, because we change our diet and work on our stress. This is Alzheimer’s, ALS, Parkinson’s. So, the problem with… I’ve had patients go to Johns Hopkins University, great institution, and then come and see me. And, I don’t do the work that Johns Hopkins does. But the point is that, they’re disappointed because they’re so disease focused that the patients don’t feel like they’ve gotten any personal attention they’ve gotten. Really no hope. They only are offered a drug, a pill. Versus when they come to see me and say, “I can prescribe that medicine. And if it’s appropriate for you, we’ll talk about it.” And you might do that. I’ll suggest what I think is appropriate here. If you don’t want to do it, that’s totally fine as well. However, what are we not paying attention to, if we’re only focusing on the medication? There’s so much more…
Dr. Weitz: And we’re missing the whole concept that these chronic diseases like Alzheimer’s, like cardiovascular disease. These are processes. It’s not like, one day you break your leg and now you have it. It’s Alzheimer’s. By the time patients are diagnosed with Alzheimer’s, this process has been developing for decades. So, they’re Alzheimering. And so, if we can see the process and see that it’s projecting one way or the other way, and if we can intervene earlier, is always better. And, if we can move them back on the timeline, then we may not necessarily yes or no. Now you no longer have Alzheimer’s. But, the important thing is where you are on that trajectory?
Dr. Sharlin: 100% true. Absolutely agree. And, it’s interesting that, in medical school, the first year is sort of everything that’s normal. Anatomy, physiology, microbiology. Second year is everything that’s wrong. So you go to pathology and you study disease processes, infectious… But the thing is that, there should be a year one B, because nobody in medical school ever talks about how you get sick, why you get sick. Just well, or you’re sick. Well, functional medicine is the framework for understanding why we get sick in the first place. And if we can have that illuminating experience, then it goes back to what I was saying about health coaching and all that. Then, you can have that aha moment and you may be much more willing to adopt the changes necessary to go from what we call pre contemplation, where it’s not even in your world to, “Oh, that might be something to, you know what? I think I’m going to do that to I’m doing it now, starting now. Ready to go.”
Dr. Weitz: I noticed also from your website that, you tend to offer packages for functional medicine. Like the Bredesen Alzheimer’s approach, the Terry Wahls Parkinson’s program. Is that kind of how you do it?
Dr. Sharlin: Yes, more or less. Dr. Wahls and I are very close and she doesn’t actually really see patients. She does do some group things, but by and large, she has a complex case, she’ll say, “Go see Ken Sharlin.” I’ve known Dale Bredesen for a long time, now several years. He was very instrumental his concepts, in shaping my thinking about Alzheimer’s disease in general. Ultimately, quite frankly, some of that is also there because, we have people in need who are looking for solutions. And while they may not have initially heard of Dr. Ken Sharlin, they may have heard of Dr. Terry Wahls or Dr. Dale Bredesen. So, as they start looking for a Bredesen trained practitioner, where a Wahls trained practitioner, they can easily find me. But ultimately, it is our brain tune up program.
Dr. Weitz: Right. Okay. So, let’s talk a little bit about cognitive problems like Alzheimer’s disease. So, how about when we start with respect to say, diet for brain health. I know that Dr. Bredesen recommends patients follow a low carb, generally a ketogenic diet. And, I listened to an interview you did. I can’t remember on what show, but that you’re not necessarily a fan of keto.
Dr. Sharlin: Well, yes and no. I think, a ketogenic diet is a tool. It’s a tool in the toolbox and my book is called healthy brain toolbox and sometimes that tool comes out. However, I of course don’t know what your exact experience is, but mine is that, by and large, shooting through the middle if you will, the bigger concern that we observe here with our patients is nutrient density is, are you really getting in the kind of food, the kind of nutrition you need to support your biology? And, most of the time the answer is no. So, the problem that we can run into with a ketogenic diet and on occasion, is it can be so restrictive or at least it’s easy to misinterpret the ketogenic diet as being highly restrictive. That, before we sort of replace the nutrients that the body desperately needs, we’re suddenly withholding nutrients. So, that can be a problem right there. So, I’m all about intermittent fasting, time restricted eating, giving your gut a break to do the other things it needs to, I have a dietician that just, it makes her crazy when she sees these other dieticians tell people to eat multiple small meals through the day and things like that.
Dr. Weitz: Well, that was the thing for years. I’ve been doing this for over 30 years. And it’s funny how, when I first got into it, the story of why people were overweight was because, people were too busy, they skipped breakfast and they ate a big dinner. And so the mantra was, you have to eat within an hour of waking up, you have to eat a small meal or snack every three hours to maintain an even blood sugar. And if you did that, you would lose weight.
Dr. Sharlin: Yeah, no. Now, a ketogenic diet again is a tool. It’s right for some people, it’s probably not right for others in one group that has to be especially cautious about that is, our folks with ALS. ALS is a hypermetabolic disorder. We know that progressive weight loss is a predictor of rapid demise. And this is a disease that even half the people affected by the disease, don’t even make it. Two years as a 20%, five year survival. So, that’s a sort of a different beast together. But again…
Dr. Weitz: A tricky disease to diagnose at the beginning, isn’t it?
Dr. Sharlin: It can be. And we should make sure that person is seeing a neurologist and getting the appropriate testing, including nerve conduction, EMG testing. But there are formal criteria called the gold coast criteria.
Dr. Weitz: Okay.
Dr. Sharlin: It’s devastating. But, it is… Ketosis has its role. I think that most people would probably be better off doing intermittent fasting and some time restricted eating or even say, taking one day a week and just doing a fast, than trying to be in ketosis all the time.
Dr. Weitz: Well, I guess some of the concepts behind using a low carb or ketogenic approach are, A, we know that problems with blood sugar and insulin resistance also occurs in the brain. And so, this is why some people call Alzheimer’s type three diabetes. And two, the brain apparently works better off of ketones than off of glucose, or at least that’s the story.
Dr. Sharlin: Well, the brain works off of either. But in the case of some people with Alzheimer’s disease, certainly insulin resistance is a major factor and they may do better. Ketogenic diet is on the table, so to speak. I don’t want to leave any of your listeners with the impression that it isn’t a valuable tool in the right person…
Dr. Weitz: So, what type of diet do you tend to prefer for patients with Alzheimer’s or cognitive issues?
Dr. Sharlin: First and foremost, we have to meet our patients where they are. If they’re eating a bunch of inflammatory foods, we have to explore those concepts with them and really ask them, what do they feel like their first steps might be? Because ultimately, we want long term success. We don’t want, “Hey, I’m going to do this for a week and get so sick of it that I drop the whole thing all together.” So, we can’t take the person who’s been eating the standard American diet and suddenly put them on a ketogenic diet. We kind of have to do a little negotiation, a little back and forth. What steps do they feel comfortable taking. The nutritional approach that I most often recommend is still a very low carb approach. It’s still between maybe 50 to 70, up to maybe a 100 grams of carbs a day.
And when we talk about carbs, or we talk about limiting carbs, we’re talking about limiting more refined, higher glycemic load carbohydrates. Not limiting vegetables, not limiting green leafy vegetables or cruciferous vegetables, where we’re getting the fiber that feeds those microbes in the gut and are butyrate producing microbes. Which again, is another potential downfall of the ketogenic diet if you’re not feeding your gut what it needs, then we also have a problem with the brain. So, that’s sort of what we might sometimes call a modified Mediterranean diet, where the grains are very limited or removed. We’re limiting the higher sugary type fruits, but we’re focusing on mostly plants, high quality protein, fatty fish, good fats, avocados, et cetera, some nuts and seeds. And our patients do pretty well.
Dr. Weitz: I’ve really been enjoying this discussion, but now I’d like to pause for a minute to tell you about the sponsor for this episode of the Rational Wellness Podcast, Vibrant America. Vibrant America is an awesome functional medicine focused testing company. And they offer awesome testing, very reasonable cash, discounted prices, no insurance billing. But of all the other companies that offer discounted lab testing, their prices are the best, the highest quality and they offer everything. I’ve set up some great panels for all the basic stuff that I want, including advanced lipids, hormones, full thyroid panel, micronutrients, omega three, vitamin D, et cetera, et cetera, for very reasonable prices. Plus they have all the advanced labs that you could ever want from a functional medicine perspective. Everything from a very awesome micronutrient test, they have a version called the NutriPro that also includes genetics. They offer great Lyme testing. They have testing for mycotoxins, they have some awesome panels for going deep into various food sensitivities for autoimmune issues. So, I highly recommend Vibrant America for functional medicine testing. And, I appreciate their sponsorship of this episode and let’s get back to the podcast.
Dr. Weitz: So, tell us about some of the testing that you would recommend, say for a patient with Alzheimer’s?
Dr. Sharlin: And to be clear, that testing is really the same, whether we’re treating, whether we’re approaching someone with Alzheimer’s, Parkinson’s, ALS, MS, et cetera, because again, this is that patient-centered approach so what we’ve found in general is what, or let’s rephrase that question, what rocks do we need to look under? So, most of my patients do get APOE testing. That is a genetic marker that is most associated with the risk of late onset Alzheimer’s disease, particularly when they’re positive for APOE4. Although, if you do a quick literature research, you can find some associations with other chronic neurological diseases. We do look at methylation. So that means, understanding things like their MTHFR status, B12, full AB6, choline, methylmalonic acid, et cetera. We can take a deeper dive into that if necessary, but methylation is obviously very important. We look at inflammatory biomarkers. That would include things like vitamin D, omega six and omega three fatty acids, your DHA, EPA, and then arachidonic acid. So, we’re looking for a six to three ratio, somewhere between two and five, by and large. So, most people are getting too much arachidonic acid or omega sixes, not enough omega threes. A marker like high sensitivity CRP would also fall into that category. We’re going to look at oxidative stress markers. So, vitamin C, vitamin E, glutathione, coenzyme Q, those are all critical to understanding how supporting our mitochondria among other things.
Dr. Weitz: When you’re talking about some of these nutrients, are you running serum tests? Are you doing micronutrient tests or Nutra-Eval or something like that?
Dr. Sharlin: Yes, we’re actually using right now a combination of Quest for certain things. The big commercial laboratory all around the country. And then, Vibrant America, Vibrant Wellness.
Dr. Weitz: So, you use the micronutrient test?
Dr. Sharlin: We do. Yeah. We have a custom panel that we developed with them, but they do run those labs.
Dr. Weitz: Oh, okay. So, you have a custom panel for all your… You said you use it for all your neurology patients or just for Alzheimer’s or…
Dr. Sharlin: That would be all functional medicine patients.
Dr. Weitz: Oh, all your functional medicine patients. Okay.
Dr. Sharlin: Right.
Dr. Weitz: Cool.
Dr. Sharlin: Right. Hormones are critical. You’ve touched on glycemic control. We certainly look at that, insulin levels, hemoglobin A1C, glucose, et cetera. But all those hormones, this is a whole other discussion. But as you probably know, hormones are critical for brain function. And, if you look at Alzheimer’s disease, two out of three people affected are women. The brain goes through changes from the pre to the post-menopause years. And there is a growing body of literature that suggests that women who use bio identical hormones, really optimize their levels, can significantly reduce the risk of all neurodegenerative diseases, including Alzheimer’s. But, men shouldn’t be left out of the picture.
Dr. Weitz: Yeah. Now, on that issue. So probably, one of the trickiest things is, let’s say you have a woman in your office who’s 65 years old and she’s not been on hormones since menopause. What about putting somebody, recommending somebody like that to go on hormone replacement biodentical?
Dr. Sharlin: There’s no doubt that, that question is one that is not fully sorted out. And I find in general, hormones are an area where you’re either saying, and I would say, this is more our conventional colleagues that, they’re dangerous and they cause strokes and heart attacks.
Dr. Weitz: Because of the Women’s Health Initiative from 2001. Right?
Dr. Sharlin: There’s been some literature to suggest that there’s sort of a therapeutic window after menopause. Some say it’s 10 years, whereby women should start their hormones then. My personal practice has been… Look. We’re talking about Alzheimer’s disease and things. All these bad chronic diseases, let’s give it a shot. Let’s give it a try. Let’s not completely dismiss the role that these hormones can play. So, I do put my patients… I have 80 year old patients on hormone replacement therapy. Who’ve done very well.
Dr. Weitz: And, you find it’s one of the things that helps move the needle?
Dr. Sharlin: I certainly believe so. As the expression goes that we need more studies, there are very few multimodal or multivariate studies that really look at diet, exercise, hormones, treat the infections, et cetera. They might look at diet alone or exercise alone, but we really have to see the big picture that it’s really a constellation. It’s what Dale Bredesen calls the 36 holes in the roof. We’ve got to pay attention to all the things.
Dr. Weitz: Do you screen for toxins like heavy metals and mycotoxins?
Dr. Sharlin: I do. Lyme. The other microbe that has gotten a lot of attention in Alzheimer’s disease has been herpes simplex virus. Been several papers, quite a few people in the research arena looking into this. The most impressive study came out of Taiwan in 2018, looked at over 30,000 subjects. About a quarter of them had been exposed to herpes simplex virus. They used a measure of risk called the hazards ratio. And, I think it was 2.6 or something along those lines for the development of dementia, including Alzheimer’s. But, those had been treated with commonly available inexpensive, well tolerated, safe, anti herpes virus medications for as little as 30 days. As little as 30 days. Dramatically reduced that hazards ratio down to 0.092 or something along those lines. It was very dramatic. So, the benefit really plateaued at about 30 days in that paper. And so, all our patients who test positive, who have never been on one of these drugs, it would be Acyclovir or Valacyclovir, they get a 30 day prescription.
Dr. Weitz: Are you testing for the virus or for the antibodies?
Dr. Sharlin: We have to test for the antibodies.
Dr. Weitz: Okay.
Dr. Sharlin: So, these viruses hide out in the nervous system. They go to the brain. So, it’d be difficult. I’m not aware. There may be an antigen test, of course, but we’re mainly looking at whether or not they have antibodies to the virus. And, we don’t do follow up antibody testing, which are positive, you’re positive. But I say, many people test positive and they don’t know they’ve ever been exposed. They don’t recall ever getting a cold sore or a blister or anything like that. But they have that virus. And, most of us have had chicken pox. Chicken pox is varicella zoster. It’s in the herpes virus family. Most of us know that as bad as chicken pox is as a kid, what’s even worse is if you get shingles as an adult. That same type of virus hides out in the body. And when the immune system is weakened due to a variety of factors, it comes out as shingles. And that shingles might be across a dermatome in the skin, could be on your face. It could be in your eye, it could be in your ear. It’s terrible, terrible disease. So, that’s just one herpes type virus that we can use as an analogy to say those viruses don’t go away. Epstein-Barr virus is the same thing. One minute you get mono, then you have chronic fatigue, or you might have multiple sclerosis. Very strong association. So you have to remember, these viruses can do their damage inside. As you were saying, that Alzheimer’s, you’re Alzheimering for a long time, while those viruses are there doing their thing for a long time before you actually get sick.
Dr. Weitz: You mentioned Epstein-Barr. How will you treat Epstein-Barr if you find it?
Dr. Sharlin: So, there are of course, a variety of practitioners who feel that they have direct treatments for Epstein-Barr virus and then using, I think Chinese herbal approaches and things like that. My approach by and large has been that ,we need to sort of treat the vessel. We have to treat the person, meaning that we have to make sure that the immune system is in a place where it can keep that virus in check. So, it really circles back around. Number one, it does begin with an awareness. We talk about root causes. Somebody has MS, they test positive for Epstein-Barr virus. Chances are, that has played a major role. But as you know, the one phrase, I’m sure you use it all the time. We haven’t mentioned it quite yet in this interview, it is about chronic inflammation. So, what we’re ultimately doing with these patients, is addressing the factors that drive chronic inflammation. And we can tip that balance back into an anti-inflammatory state, than the virus is far less of a problem. But in the conventional medicine world, there is no antiviral agent for Epstein-Barr virus.
Dr. Weitz: So in terms of screening for toxins, do you use the urine test?
Dr. Sharlin: I do blood testing and that I picked up… I have done urine testing, but I do serum testing, red blood cell mercury. Some of the others are serum and that I picked up from Dale Bredesen. And when my patients test positive, depending on the degree of severity, they’re either support that we either… We always are supporting “Detoxification through more natural approaches.” I use that quote unquote, optimizing glutathione levels, et cetera, but I will give some of those patients DMSA. What we don’t do here is provocation testing. And, I know that’s been very popular the way I was taught provocation testing, both through IFM and through some of my mentors is that, there is a concern about redistribution of some of these toxins and the potential that they can cause more damage through provocation testing than any benefit that there might be from the testing in the first place. So, we still need to test for those metals. And those for me are mercury, cadmium, arsenic and lead. So, they’re not necessarily all the other things that are in the panel. But I would have to say, Ben, the most important thing that I would like to share is that, ultimately what we’re telling our patients as a narrative. We’re telling them a story about what creates health? How do they get there? What does their journey have to look like? So no matter what, we have to support the processes that allow for normal biological or physiological detoxification. It’s hydration, it’s fiber, it’s regular bowel movements, urination, sweating. It’s cruciferous vegetables, et cetera, to get your glutathione levels up. Those natural built in to us human being processes, really override any treatment out there. In the end, if we don’t address the reasons why this happened in the first place and have a willingness to change the direction things are going, they’re really ultimately not going to change.
Dr. Weitz: Your neurology patients that have some gastrointestinal symptoms, will you do stool testing?
Dr. Sharlin: Yeah, definitely I will. Now, I occasionally see things like parasites. But mostly what we see is, a lot of sort of… I believe you, I’m kind of make up this term here a little bit and it’s not totally true, but I say, non-pathological dysbiosis. Now, dysbiosis almost by definition is pathological. But what I mean by that is, that the narrative is that, that abundance and diversity of the microbiome is not there and we have to teach our patients that the only way we’re going to get there is to make changes in our diet. Ultimate. That’s the most powerful thing. Sleep, movement, stress, work on the stress resilience are also of course critical, but we have to change the diet. Probiotics, support, prebiotic support, eating fermented foods, absolutely excellent as part of that overall plan. But if the only thing I’m going to do, if I’m not going to change my diet, but I’m going to take a 30 billion colony forming unit probiotic, probably it’s not going to do anything for me.
Dr. Weitz: So, since you mentioned probiotics, what are some of the most impactful nutritional supplements for brain health that you might use in your practice?
Dr. Sharlin: The most common things that I see over and over again, of course, low vitamin D, extremely common. High arachidonic acid, low…
Dr. Weitz: By the way, do you have a target level for vitamin D that you like to shoot for?
Dr. Sharlin: I really at a bare minimum, like to see my patients in the mid 50s or so. I really say 60 to 80, but some of these coming back, they’re 55, it’s okay. That’s not really that bad. But, we’re really aiming for that 60 to 80 range. So, vitamin D extremely common, see low zinc, low levels of EPA and DHA, the omega three fatty acids, very, very common. There are some people are on an omega three, omega fatty acid supplement, generally needing at least a gram a day.
Dr. Weitz: At least a gram a day. Yeah. I was going to ask. Because there’s some studies have used significantly higher dosages.
Dr. Sharlin: Yes. So for example, if somebody comes in with a post-concusive syndrome, that would be one scenario. And, would have to be careful when making that kind of, giving that kind of medical advice, because there are some situations where there could be some drug interactions or bleeding, of course. But in general, I might put them on three grams a day would not be out of the question along with some turmeric and some other things that are going to support that anti-inflammatory approach to calm the neuroinflammation of concussion down. Vitamin D being another one. But zinc, very much a need. Kind of touched on hormones. Those aren’t supplements, although DHEA is used… I use a lot of DHEA. I’m very interested in what I think is, we use more modern terminology now, but we used to call it your adrenals. Now we think the HPA axis and so forth. But I think that is absolutely critical to understanding neurological disease and health in general. So, we always do a four point salivary cortisol with DHEA and make sure that gets lots of attention.
Dr. Weitz: Do you use choline?
Dr. Sharlin: I do. There’s lots of choline. Absolutely. We use some methylation support and methylated folate, B12 with B6, that kind of thing. So, choline or the betaine that’s typically seen in a methylation support product, that is used quite a bit as well.
Dr. Weitz: Have you used some of the mushrooms like Lion’s mane?
Dr. Sharlin: I have. Now, I don’t keep that in my office. I get a lot of questions about that and I encourage people to eat mushrooms, to eat diversity in mushrooms, not just Lion’s Mane. But I think, mushrooms are very, are very powerful food, kind of a food as medicine. So, certainly there are many ways to enjoy Lion’s Mane mushroom. I have frequently put it in coffee with a little MCT oil.
Dr. Weitz: What about some of the herbal products that have been shown to help with brain health?
Dr. Sharlin: I use some ashwagandha in my practice. There’s some data on ashwagandha and beta amyloid protein. Of course it’s an adaptogenic. So, it can be very helpful in people where they’re modulating stress. But I find… I follow Selye’s general adaptation syndrome model to explain stress and the adrenals and cortisol and so forth to my patients. And, if you’re… I’m sure you’re quite familiar with that but, he describes three stages from alarm to resistance to exhaustion. The reality is that, some people can be really high at one point in the day and then just sort of bottom out at another part of the day. It isn’t always just all high or what I call the roof caving in. And so, I find things like ashwagandha can be helpful, when there’s sort of a mixed pattern. Because it’s adaptogenic sort of in both directions. I do use some herbal supplement blends from [inaudible 00:48:34] molecular for the more classical patterns or some of these very high or very, very low. And we do use… Some of them have some Bovine, adrenal concentrate in them where occasionally I give people hydrocortisone.
Dr. Weitz: Nice. May have low cortisone. Have you used peptides?
Dr. Sharlin: Very interesting. I haven’t prescribed peptides as of yet. I’ve had some resistance, I suppose, maybe for the wrong reasons. But, I do a lot of clinical research which you mentioned and all of these studies that I’m involved with, I essentially have to be… They’re all FDA approved studies. We could get audited by the FDA. I have to be… These are not my exclusive studies, but some of them are billion dollar studies that are multi-center studies. And our site is a very important site for some of these study sponsors. So, we have to be extremely careful. I have been hesitant about… To me, a peptide is a drug. I have already said, there’s nothing necessarily wrong with a drug. But we have to remember that peptides being chains of amino acids, they still bind to a receptor. They still modulate cellular function. Many of them are targeting hormone receptors. But at any rate, I have to be very careful about non FDA approved things in my practice and how I communicate about them or how I use them. Now that being said, I kind of gave in a little bit and I said, “I’m just going to have to go learn more about these peptides. There’s been a little evolution in peptides in the last year or two, mostly due to the FDA getting involved and not allowing peptides beyond a certain length. I think it’s 40 or 42 amino acids. But at any rate, for the listeners, many of the peptides currently used by practitioners are in fact FDA approved compounds. They’re just be instead of using a brand name, they may be compounded by a compounding pharmacy, but they’ve still been studied. So, we may be using some of them very selectively, but we also have to be clear that they are not approved for treatment of specific diseases.
Dr. Weitz: Speaking of drugs, what do you think about that new drug for Alzheimer’s, Aducanumab?
Dr. Sharlin: Aducanumab or Aduhelm. I just do want to say one thing real quickly about pep. Some peptides are approved for treatment of certain diseases. Ozempic, for example, for diabetics. But when people are using the sort of compounded, non-branded version of Ozempic, often they’re prescribing it for weight loss, things like that. So when we talk about these things, it’s very important to understand is this approved? What is it approved for? There’s another one that’s approved for female sexual arousal. But people are using it really just to go on weekend joints with their partners and have a good time. Not necessarily for that pathological diagnosis or the disease diagnosis that would say go through insurance. There are other things. I’m picking on one or two things. But Aduhelm or Aducanumab was the first FDA approved monoclonal antibody targeting amyloid beta 42 in the brain, which is thought to play a major role in Alzheimer’s disease. And, it was met with a tremendous amount of controversy because of the way that it was approved. It was approved through something called accelerated status, which had nothing to do with its benefit in Alzheimer’s. It had to do with this mechanism of action. That is a purported major theorized mechanism in Alzheimer’s disease. Furthermore, unfortunately there was a lot because it became so political. And these days, so much of public opinion is driven through social media and news reports that aren’t entirely accurate. There is a lot of attention given to some well known side effects of this class that are called ARIA or amyloid related imaging abnormalities. And these manifest as essentially two different findings on MRI. One is a small area of swelling in the brain or edema. So, it’s called ARIA-E and the other one is a little area bleeding or staining in the brain from blood products called ARIA-H or ARIA-hemosiderosis or micro hemorrhage. The important thing to understand is that, the vast majority of people who experience these ARIA type changes are completely asymptomatic and that in most cases, these changes resolve on their own, by holding the drug. That’s not to say that it never is a problem, but it’s far less of a problem than the news media made it sound.
Dr. Weitz: So, let me just clarify. It came out that, this drug, which reduces amyloid plaque in the brain, which is the presumed mechanism for what causes Alzheimer’s and some significant percentage of patients, something like 30 or 40%, and it was reported end up with either bleeding in their brain or it’s swelling. Right?
Dr. Sharlin: Focal swelling or focal bleeding. Yes. And again, I know this sounds very alarming and I don’t dismiss it at all, but it’s important to understand that these were completely asymptomatic in the vast, vast majority. Although, APOE were carriers were twice as likely to develop these changes and they resolved withholding the drug. Now these drugs are definitely not a panacea. And I say drugs, because there’re at least three others out there that are in different positions in terms of FDA approval. There’s Donanemab, there’s Gantenerumab. I may be saying that wrong and Lecanemab, which is also a Biogen product. But, they may slow progression of the disease over time, somewhere between 22 and 30%. That’s the data we have right now. This is not dramatic. But if you have a 10 year disease, you might think of it as giving you three better years, over 10 years, which is not a nothing. But I’d like to remind the listeners, the podcast, that I am old enough to remember when the first drugs from multiple sclerosis came out. And that is the one major neurological disease where we have a lot of treatments in the toolbox that are not symptomatic, that actually modify the natural history. They alter the natural history of the disease and people can live very normal lives. Not always, but often when they’re on these medications. So, they’re really important. Not everybody needs them. And if you use a functional medicine approach, maybe they’ll get off the drugs. But my point is that, the first drug that came out is called Betaseron. That was 1993. It slowed the relapse rate in multiple sclerosis by about 30%. There was so much demand for this drug that there was actually a lottery, because there was not enough drug for all the people that wanted it. And that outcome is very similar to these agents for Alzheimer’s disease right now. And does that drug have side effects? It absolutely does. I wouldn’t want to be on it personally. But has it helped people? It has helped people. So, it’s kind of a double edged sword. In the end my opinion is that, the way drugs work is as you put it, there many factors that cause Alzheimer’s disease and they are going to converge on a point, say the development of this protein, that’s where the drug is going to target. What we want to do in functional medicine, we want to work backward, we want to address all those things that are driving this. So in the ideal perfect world, if somebody is going to use a monoclonal antibody, the best situation is, let’s remove all those inflammatory drivers through a functional medicine approach. And then okay, we’ll get rid of the amyloid, if it hasn’t already dissolved and gone away itself, we call it insoluble amyloid. So chances are, it hasn’t. But let’s get rid of the amyloid. What doesn’t make sense. It’s almost like, if you have an infection and you treat the infection with an inappropriate dose of an antibiotic, the infection’s going to come right back. So, how much are we really helping people by removing amyloid when we’re not addressing the things that drove that amyloid in the first place?
Dr. Weitz: Right. So, let me make two points here. The first point is that, this drug may be disease modifying in the sense that it reduces the rate at which people get worse, but it doesn’t make people better and it doesn’t reverse the condition. As opposed to the Dale Bredesen Functional Medicine approach, which in some cases has been shown now in research to actually reverse the course of disease and actually make some patients better, which is obviously much preferred to just not getting worse at a slower pace. And then number two, the whole mechanism concept. We know that patients with Alzheimer’s have amyloid protein. And, we know that there’s tau is another protein. But the question is, why is the amyloid there? And I think, one of the things that we’ve learned in recent years is that, amyloid is actually a way for the body to protect the brain against things like infections, inflammation, toxins. Correct?
Dr. Sharlin: Correct. But some people have developed this insoluble amyloid as opposed to say, if you have a bad night of sleep, we do a PET scan, an amyloid PET scan on your brain. We’ll see a build up of amyloid, but then you get seven or eight or nine hours. You catch up whatever the next day, that amyloid is gone.
Dr. Weitz: Interesting.
Dr. Sharlin: Some people, they’re building up this amyloid that eventually is associated with the destruction of nerve cells. And when that happens, you have that tau protein also building up in the brain as well.
Dr. Weitz: Right. So what we’re trying to do with the functional medicine approach is, identify some of the triggers for this amyloid. And if we can identify as many of those as make sense and make changes to the patient’s diet, lifestyle using targeted supplements and remove those various triggers, at that point, if you were then maybe to add this drug to remove some of the amyloid, it would likely be way more effective than trying to remove it while the body’s still adding more.
Dr. Sharlin: Yeah, absolutely. And so, that’s what we really encourage if our patients are willing to use that drug. Now, using that drug has gotten a lot more difficult, now because of a national coverage determination by Medicare. Whereby, the only people that have access to even Aduhelm at this time are those participating in clinical trials. So, the average doctors now could be able to go out and prescribe that. I have a limited experience directly with Aduhelm. I have much more experience with Donanemab from Eli Lilly and company, does not have a trade name. We have several subjects in a large clinical trial for that. And I have to say, who knows it’s a blinded trial, but I’m not seeing miracles yet, regardless. But also, we have to set up appropriate expectations for functional medicine because, what people like the Dale Bredesens and the David Pulmutters have done is, they’ve done a fantastic job of getting our attention and they’ve definitely offered a framework for us. But when I get the adult child bringing the mother, the father to my practice and dad’s been in a nursing home for five years and their Montreal cognitive assessment score is a two out of 30 and normal is 26 to 30, this is not reversal of cognitive decline. We have to catch people in the high teens and the low 20s and that’s where you can see remarkable work happening. Now, does that mean that we have nothing to offer to a person with more advanced dementia? No, it does not mean that. There are many things that can be done. There’s some wonderful work. The body is still… We still need to feed the body. Nutrition, movement, purpose, even in advanced dementia, that person who feels they have no connection, no purpose, does not thrive. And there’s some wonderful work that was done by a gentleman named Cameron Camp, who’s used the Montessori concepts of discovery and engagement with Alzheimer’s patients and nursing homes, getting them involved and they thrive. And so, we do a lot of work across the board, we just have to set the expectations appropriately.
Dr. Weitz: So, that’s the type of behavioral therapy you’re talking about?
Dr. Sharlin: I suppose it’s behavioral therapy. It’s really about engaging people. And the simplest explanation, maybe you have a person who’s sick, there’s a caregiver. They’re like, “Don’t worry about doing that. I’ll take care of that. I’ll fold the clothes. I’ll make the meals. You just sit there, you watch TV, I’ll take care of everything.” But what happens to the person who’s that unplugged? Or the only thing they’re given an opportunity to do is sit around and watch TV? They will wither. They will wither. But if you say, “Hey, come over here and help me chop these vegetables, or let’s get on the floor and play with the kids”, they’re doing it in a way that supervised, they’re doing it in a way they’re not going to harm themselves or anything like that, but they feel much more connected. They feel needed. They will actually… The lights in the brain will turn on and they will do much better.
Dr. Weitz: Besides the diet and the lifestyle and some of the other things we’ve been talking about, are there some advanced techniques, strategies, technologies that you can use that you might use in your office, ways to directly stimulate the brain, ways to maybe flush out Alzheimer’s from the blood? Or have you used some of these other strategies?
Dr. Sharlin: I have. I’ve had for a while a tremendous interest in the role that different forms of energy, whether that’s electricity, light, sound, electromagnetic fields have on the brain. There’s tremendous amount of data. Now with things like transcranial direct current stimulation, TMS, which is already FDA approved for things like depression, there’s a lot of interest in the Vielight, although I’m not as crazy about that. Because really in the end, you can use sound that generates a frequency that drives gamma rhythms in the brain for a lot less expensive than a Vielight. But in the end, those technologies are fascinating. Things that stimulate the vagus nerve, we do a lot of work with vagus nerve stimulation in our practice with epilepsy, for example.
But what we’re doing now, which may be the most exciting is, we’re doing work with mesenchymal stem cells and we’re harvesting bone marrow from patients and we’re separating out their own stem cells. So, we refer to this as autologous concentrating those cells, and then introducing them directly into the spinal fluid, where the spinal fluid actually is a sort of a biologically active medium. It receives signals from those cells and it in turn signals those cells to express growth signals, neural elements, et cetera. And we believe that, we know that these cells play a major role in healing and being anti-inflammatory, anti apoptotic and repairing injured tissue. And, there was just another paper published very recently on progressive MS and autologous MSEs. And, it was a phase one study, but it was very, very, very promising showing good disease stability. And in some cases, improvement in the measured score of disability with that disease called the EDSS.
Dr. Weitz: Can you tell us a little more about that? So you’re taking stem cells from the patient’s own body and injecting them into the cerebral spinal fluid?
Dr. Sharlin: Correct. So, we’ve gotten this process down to really can do it in about 90 minutes in terms of the procedure itself. So, it takes a little preparation. Our patients come in a day early, they’re often they’ve been doing functional medicine with us as well. They get very well hydrated, they get pre-medicated for their comfort, for the procedure. They come in the next day, we use ultrasound guidance to identify the area on the pelvic bone called the posterior superior iliac spine. We’re using technology that is FDA cleared for the specific purpose of aspirating bone marrow and separating out those mesenchymal stem cells from the rest of the bone marrow cells. This is what’s called a closed system, so we don’t need a hood. We don’t need a biologist there who’s separating cells in the open air. There’s virtually no possibility of infection.
Patient is then, the actual cell separation procedure, which involves centrifugation takes about 20 minutes. In the meantime, patients move to a different treatment room. They’re positioned on their side, being an experienced neurologist I can’t tell you how many thousands of lumbar punctures I’ve done in my career. So, it’s very simple. By the time their positioned, their skin is clean, the needle is inserted at the L four, five interspace. My assistant is handing me a syringe full of mesenchymal stem cells. They’re injected directly into the spinal fluid, patient is repositioned in what we call trendelenburg, with the legs higher than their head to sort of encourage those cells to migrate toward the brain up toward the spinal cord. Bear in mind, we’re injecting below the spinal cord, so they are trendelenburg for about two hours. And then, we have them stay locally for the next day or two. They come back the next day for a follow up, make sure everything’s okay, generally going home the day after that. So, we’ve done quite a few of these procedures, again, focusing on the role of these cells in inflammation, in tissue repair, in apoptosis. And we think that, it is a very promising procedure.
Dr. Weitz: Interesting. Have you used any other procedures that increase oxygen like ozone or the oxygen tanks, I forgot what’s called.
Dr. Sharlin: Hyperbarics.
Dr. Weitz: Hyperbarics. Yeah.
Dr. Sharlin: I’m very supportive of that. I don’t personally own a hyperbaric chamber in my practice. Maybe one day, but certainly people want to use those. There is some really fascinating, if you’re involved at all in stem cells or a little bit knowledgeable, you may know that many of the practitioners doing joint injections use an ultrasound device to activate stem cells as part of the procedure. They really have multiple mechanisms of action. But, the same company that makes one that’s used on joints called stores medical out of Germany, they have a neurolith device, N-E-U-R-O-L-I-T-H. And, that has been approved for Alzheimer’s disease by the European union. And if you review the mechanisms, which are right on the website for the technology, it’s very clear that this technology would complement those cells that are injected into the spinal fluid that migrate toward the brain. So, we’re hopeful that one day we’ll be able to utilize a combination of the two technologies to help our patients. Right now, those machines run about $150,000. So, I need to put a few more pennies in the piggy bank before I buy it.
Dr. Weitz: And now, what’s the status of using stem cells these days?
Dr. Sharlin: It’s a technology that is absolutely not going away. There are several FDA approved clinical trials going on. The one that gets the most attention is the brainstorm cell therapeutics neuron trials. This company has one technology called neuron, also sometimes referred to as MSC-NTF. Their most advanced trial was their phase three ALS trial. It’s a whole other discussion about that. It has not been approved yet by the FDA, but the FDA has granted an extension trial to brainstorm cell therapeutics. So, ALS patients continue to be treated with neuron. They had a successful phase two trial with progressive multiple sclerosis. They have other approvals for the FDA to investigate the role of their technology in Parkinson’s and other conditions. So, it’s very, very promising. It is not going away. I’m not going to say that our approach is identical to brainstorm cell therapeutics, but there are some comparables in the sense that it’s autologous bone marrow drive, intrathecal treatments.
Dr. Weitz: Cool. Have you had success with ALS patients with a functional medicine approach?
Dr. Sharlin: Yes. And again, it’s really important to understand this is going back to that quantum physics analogy. This is a very serious disease. Some people are rapidly progressing. Those are a lot more difficult to really intervene on. But those ones that are more on that five to 10 year trajectory, it simply makes sense. And you almost don’t… I’m very science oriented when I say, you almost don’t need the science. But what I’m really meaning is that, who wouldn’t say that optimizing nutrition isn’t going to help someone with ALS? Who wouldn’t say that making sure that person’s having a therapeutic restorative sleep is not going to help someone with ALS. So, if we go back and pay attention to those foundations and we can build upon them, we can do the functional medicine testing, we can do the adjunctive technologies that you’re referring to and I use. But we still, we go back to those foundations, it makes a huge difference.
And so, we use something called the ALS functional rating scale, which is the standard measure of where a person is with that disease. And what we find is, the people who apply these principles, if they have a say an ALS functional rating scale score of 40, which is impaired, but not severe, the highest score you could have is 48, that’s essentially almost stay symptomatic. But they’re 40 and they come back a month or two later and they’re still a 40, and a month or two later they’re still a 40 and maybe a month or two later, they’re maybe 39, but it’s taken them six months to go down one point. To me, that’s an achievement because by and large, the trajectory of that disease is, you’re going to go down about a point every five weeks if it’s an absolutely linear trajectory in most cases. So, I always see those as victories.
Dr. Weitz: You have some patients with ALS who are around years later?
Dr. Sharlin: Yes I do. One of them is a very prominent individual. So I probably can’t name him, but he even has a… He’s got a foundation and has done very well and been a large spokesman. I don’t see him anymore, but I am quite sure… He’s kind of moved on, but the principles that we taught him have made a huge difference in his survival and he’s well beyond five years and doing well. And we have others who continue to do that.
Dr. Weitz: And, you used the functional medicine approach with him?
Dr. Sharlin: Oh yes. We just can’t, we got to eat. The crazy thing is, if you had a patient, you said, “Hey, listen. I’m going to help you with your condition. But the most important thing you got to remember is, don’t eat. Just don’t eat at all.” A person will do a 180 and walk right out of your office say, “That doctor is a quack.” So why is it then will we actually say, do we? Let’s focus on the food quality, let’s focus on the nutrient density, let’s make sure your body is getting absolutely what it needs, because that’s a major driver of inflammation that anyone would be skeptical. I had through a patient, so I didn’t hear this directly. Had someone come to me and say, “Look. I tried to talk to my other neurologist about nutrition and how I could support my body with my MS. I have MS.” I don’t have MS. That’s patient. And he said to me and I said… Well, the patient said, “Well, I just asked him. I said like a Mediterranean diet. Is that good for my MS? And this doctor actually said, no. It’s good for the heart, but it doesn’t make any difference for the brain.” What?
Dr. Weitz: Makes no sense.
Dr. Sharlin: And that’s not the Wahls diet or the… That’s like the most generic, just eat real food.
Dr. Weitz: Yeah. Okay. Great discussion, Dr. Sharlin. So, how can patients who might be listening to this who want to seek out your care or your help, how can they get a hold of you?
Dr. Sharlin: Best thing is to go to our website, functionalmedicine.doctor, and that’s spelled out all the way. So, functional medicine, all one word dot D-O-C-T-O-R, lots of information there and they can answer a little questionnaire and have a free telephone consult with our coordinator. Very knowledgeable individual. She’s actually Wahl’s certified as a health coach, knows our approach inside out and backwards, and to really help that individual get aligned with how the different services we offer best fit them.
Dr. Weitz: How’d you get that website functional medicine doctor?
Dr. Sharlin: Well, I guess I had a marketing person who was brilliant enough to see if that was available at the time and it was so.
Dr. Weitz: Wow. That’s great. Do you have programs for practitioners?
Dr. Sharlin: In the works. I’m actually going to be speaking the keynote speaker at the WorldLink Medical Conference, their annual conference in September. I’ve previously spoken for them about reversal of cognitive decline. But what if anybody knows that organization, Dr. Neal Rouzier is sort of the face of that organization and he and his associate Dana Burnett approached me about coming back and really, it’s that kind of expression that we all have, “What are you going to do Monday morning?” kind of thing. You go to the conference, you want practical information, it’s definitely been on our trajectory to be able to train other practitioners. So, we’re going to move forward and develop a… It won’t be like a certification program, but it certainly will be a beta test of, how can we teach others to do what we do. So, hope everybody comes to WorldLink.
Dr. Weitz: What conference is that? Would you say it’s called?
Dr. Sharlin: This is WorldLink Medical. And, I think that is their website as well. WorldLink Medical, it’s a pretty substantial organization. It’s more oriented toward regenerative medicine. They’re affiliated also with the age management medical group or AMMG. There’s a lot of overlap with them. But a lot of practitioners who do bio identical hormone replacement have trained under Dr. Ruzier.
Dr. Weitz: Okay. That’s great. Thank you so much, Dr. Sharlin.
Dr. Sharlin: Thank you. Appreciate you having me. Great conversation.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. And, if you enjoyed this podcast, please go to Apple Podcast and give us a five star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And, I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica, White Sports Chiropractic and Nutrition clinic. So if you’re interested, please call my office (310) 395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.
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