Long COVID and Immune Dysfunction with Dr. Aristo Vojdani: Rational Wellness Podcast 294

Dr. Aristo Vojdani discusses Long COVID and Immune Dysfunction at the Functional Medicine Discussion Group meeting on January 26, 2023 with moderator Dr. Ben Weitz.

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Podcast Highlights

7:14  Between 1990 and 2000 those practicing medicine were facing a new disease that was called chronic fatigue/fibromyalgia.  These patients were fatigued and had trouble getting out of bed for a period of more than six months.  A number of organs were affected, including the gastrointestinal, pulmonary, muscular, skeletal, brain, and the immune systems.  Many articles were published in scientific journals and some felt that Epstein Barr virus was responsible for chronic fatigue/fibromyalgia, while others felt that cytomegalovirus or HSV1 and 2, or HHV-6, HHV-7, HTLV-1, Spumavirus, chlamydia, or mycoplasma infection were responsible.  These were also very similar to the symptoms displayed by patients with a history of exposure to toxic chemicals, molds, mycotoxins, or silicon breast implant.  It became clear that the cause of chronic fatigue/fibromyalgia was multifactorial. In 1999 in the Journal of Internal Medicine, Dr. Vojdani published a letter that a Single aetological agent may not be feasible in chronic fatigue syndrome.  Not much has changed since 1999 with chronic fatigue/fibromylagia, except that the name was changed to myalgic encephalomyelitis/chronic fatigue syndrome and now the SARS-CoV-2 virus may be playing a role as this condition appears to be part of long COVID. 

13:40  10-20% of individuals who had COVID may develop long COVID.  The majority of cases are those that had severe COVID, though not necessarily.  COVID may lead to the reactivation of EBV, HHV-6 and other viruses and this may contribute to the development of long COVID.  These reactivated viruses may produce super antigens in order to hide from the immune system and this may cause a disturbance in the gut microbiota.  By running the Lymphocyte Map test, clinicians can design treatment modalities.

16:12  Dr. Vojdani has published nine articles on COVID in the last few years, including two articles published in Frontiers in Immunology in 2021 and in Clinical Immunology in 2020 reporting their research that 20-25 human tissue antigens strongly reacted with monoclonal antibodies made against the SARS-CoV-2 virus, which is the best evidence of cross reactivity between SARS-CoV-2 and human tissue. This shows the extreme level of potential autoimmunity of the SARS-CoV-2 virus. [Reaction of Human Monoclonal Antibodies to SARS-CoV-2 Proteins With Tissue Antigens: Implications for Autoimmune Diseases, A. Vojdani, E. Vojdani, D. Kharrazian.]  Therefore, autoimmunity is definitely a component of long COVID. 

20:02  What is Long COVID?  According to the CDC, Long COVID is defined as a range of new or ongoing health problems that people can experience four or more weeks following the initial SARS-CoV-2 infection:  1. Shortness of breath, 2. Memory loss, 3. Fatigue, 4. Anosmia (loss of sense of smell), 5. Gastrointestinal distress, 6. Autoimmune symptoms, 7. other symptoms.  There are five major hypotheses: 1. Viral persistence, including in the GI tract and the brain that is not detected by blood tests, 2. Reactivation of latent viruses such as EBV and HHV-6, 3. The expression of viral superantigens in order to hide from the immune system, 4. Disturbance of the gut microbiome, and 5. Multiple tissue damage, immune disorder and autoimmunity. 

23:30   Viral Persistence.  Why does viral RNA persist after recovery from infection?  While we don’t know, there are a number of host factors that affect the immune function of the person.  The immune system should be strong enough to get rid of COVID a week or two later, but if there is an immune disorder or malnutrition, or a lack of exercise, the immune system may be too weak to clear the virus.

27:30  Reactivation of latent viruses, such as EBV, HHV-6, and CMV.  EBV and HHV-6 tend to infect most of us around age 2-4 and some children also develop infectious mononucleosis. EBV tends to become dormant in cells, esp. the B cells and if we suffer some kind of stress, or malnutrition or another viral infection and EBV can become reactivated and thus EBV can play a role in long COVID symptoms.  By age 3, 90% of Americans are infected by HHV-6 via the nasal cavity.  This virus persists in various tissues, including in glial cells. This virus may play a role in a number of autoimmune diseases, including multiple sclerosis, Alzheimer’s, Parkinson’s, myalgic encephalomyelitis, lupus, collagen vascular disease, encephalitis, epilepsy, thyroid autoimmunity, and Guillain-Barre syndrome.



Dr. Aristo Vojdani is the Father of Functional Immunology and he has dedicated his life’s research to helping us figure out what are the triggers for autoimmune diseases and many of the tests he has developed for Cyrex Labs are focused on this.  Dr. Vojdani has a PhD in microbiology and immunology and he has authored over 200 scientific papers published in peer reviewed journals. Dr. Vojdani is the co-owner of Immunosciences Lab in Los Angeles, which offers testing for various types of infections, including Lyme Disease. He is the Chief Science advisor for Cyrex Labs, whom he has developed all of the testing for, including the Lymphocyte Map test, Array 2 for Leaky Gut, and Array 5, The Multiple Autoimmune Reactivity Panel, and from Immunosciences, the Autoimmune Viral Trio Panel

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.



Podcast Transcript

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. Tonight we’re very happy to be joined by one of our favorite speakers, esteemed integrative immunologist, Dr. Aristo Vojdani, who will be telling us how to identify immune system imbalances related to long COVID. And you’ll have some ideas for what we can do about this. I’m Dr. Ben Weitz. I’m going to make some introductory remarks and then I’ll introduce our two sponsors, Integrative Therapeutics and Cyrex Labs, and then I’ll introduce our speaker for this evening.  I encourage each of you to participate and ask questions by typing in your question in the chat box, and I’ll either call on you or simply ask Dr. Vojdani your question when it’s appropriate. Dr. Vojdani usually likes to wait until the end for the questions, but I’m happy to stay as long as we have questions, so there’s no time limit, but Dr. Vojdani will probably talk for about 45 minutes or so and then we’ll do Q and A afterwards. So now I’d like to introduce Steve Snyder from Integrative Therapeutics, one of our sponsors for this evening to tell us some information about some of their products. Steve.

Steve:                                   Hi there. We actually have quite a few that are highly requested for the post COVID long hauler stuff. Rather than just blather on about them, I’m going to put them into the chat, so if anybody has any questions on them or wants to try something, you can reach out to me that way and we can get you taken care of. But thank you. I’m looking forward to hearing Dr. Vojdani’s talk. Thank you.

Dr. Weitz:                            Okay. Thank you, Steve. And now we have Heather Sunshine from Cyrex Labs and she’s going to take a few minutes to tell us about some of the Cyrex Labs.

Heather:                              Thank you, Dr. Weitz. Hello everyone. My name is Heather Sunshine, territory manager at Cyrex Lab. Cyrex is a functional immunology lab and our focus is autoimmunity. We have environmental panel since we understand the environment plays a huge role and is a contributor to autoimmunity. The role of foods and the extrinsic causes such as infections, toxins and environmental antigens are critical triggers of immune dysfunction. So we offer barrier testing. We understand a leaky gut can lead to a leaky immune system and a leaky brain. We also have an Alzheimer’s links panel, and I can’t stress enough early detection of environmental factors that contribute to the pathogenesis of Alzheimer’s disease is the most crucial for developing interventional programs that will slow down or stop the progression of the disease. But what I’m excited to share with you today is the lymphocyte map. The lymphocyte map measures the integrity of the immune system at the cellular level.

                                                We are using advanced flow cytometry method that combines laser technology with monoclonal antibodies to measure the properties of living cells based on size, shape, density and granularity. Therefore, providing high precision count of various lymphocytes subpopulations. It identifies the patterns of balance or imbalance of T-cells, B-cells, and natural killer cells detected in the blood. Learn more about our testing or to sign up for an account, you can visit us at visit@jointcyrex.com or you can email me at heather.s@cyrexlabs.com. Thank you Dr. Weitz, I mean for providing us such a educational and informative forum. I’ve always enjoyed you interviewing top clinicians and educators to help us navigate our health journey, and I’m excited to listen to our chief scientist advisor, Dr. Aristo Vojdani, speak tonight. Thank you.

Dr. Weitz:                            Thank you, Heather. So our speaker for tonight, Dr. Aristo Vojdani. He’s the father of functional immunology and he’s dedicated his life to helping us to figure out what are the triggers for autoimmune diseases. And many of the tests he has developed for Cyrex Labs are focused on this, including his newest test that Heather mentioned, the lymphocyte map. Dr. Vojdani has a PhD in microbiology and immunology. He’s authored over 200 scientific papers, probably 300 by now, published in peer review journals. He’s just informed me he’s published over nine papers just in the last year or so about COVID-19, which is a topic for tonight.  So we’re going to be talking about long COVID, and what are some of the factors, mechanisms for long COVID, how can we test for it, what can we do about it?   And Dr. Vojdani is the chief science advisor for Cyrex Labs who he’s developed all the testing for.  He also is a co-owner of Immuno Sciences Lab in Los Angeles, which offers testing for various types of infections, including his latest test, the Autoimmune Trio Test, that test for antibodies to COVID, Epstein Barr and HHV-6, which Dr. Vojdani will mention tonight. He’s also a professor in the Department of Preventive Medicine in Loma Linda University. Dr. Aristo Vojdani, my friend Ari, thank you so much for joining us tonight and honoring us with your presence.

Dr. Vojdani:                        Thank you so much Dr. Weitz, and thank you for all the participants. I was very happy to see some very, very familiar faces. So about few minutes ago I asked Dr. Weitz, where were you in 1990? And his answer was that at that time, almost two years into finishing my school and I started my clinic. So it’s interesting.  At the same time also, 1989, I started Immunosciences Lab while also I was associate professor at the Charles Drew UCLA School of Medicine.  The reason I brought this issue of 1990, because between 1990, all the way to year of 2000, those who were practicing medicine were facing or facing new disease in subgroup of their patients.  And then they call that chronic fatigue fibromyalgia.  These individuals, they could not get out of bed. They lost their daily activity more than 50% and again, they could not get out of bed more for more than period of six months.  In these individuals, different organs were on fire including gastrointestinal, pulmonary, muscular, skeletal, brain, and of course the immune system or the immune function. That’s why at even another name that was given to this disease was called chronic fatigue and immune dysfunction syndrome. CFIDS.  Then between these years, many, many articles published in different scientific journals, each one of them talking about different factors, some that were talking about, Epstein Barr virus is responsible for chronic fatigue/fibromyalgia. The other were saying no, it is cytomegalovirus. Some that were saying no, it is HSV1 and 2. And some were publishing about HHV-6, HHV-7, HTLV-1, Spumavirus, chlamydia, mycoplasma, and many, many more. In fact, in 1998 and 1999, I published several articles who looked at different patients with chronic fatigue fibromyalgia and found that mycoplasma ferment by PCR then by PCR was elevated in these patients.  Furthermore, we found almost similar symptoms in patients who had history of exposure to toxic chemicals, molds, mycotoxins, silicon breast implant. So everybody was talking about different factors and that’s why in 1999 in Journal of Internal Medicine, as you can see in here based on the several articles that I wrote, scientists from Italy wrote a letter to Journal of Internal Medicine saying that chronic fatigue is almost like Addison’s disease.  And so I had to answer him, and this is the letter that I wrote in 1999, so please bear with me and look at the title.  Single ideological agent may not be feasible in chronic fatigue syndrome.  And I’m not going to read the rest whatever is written in here, but if you’d like to have a copy of this letter, I’ll be very happy to share with you because in here I am saying that chronic fatigue fibromyalgia is multifactorial and therefore it is waste of time to look for a single factor being responsible for its induction and also it is in a waste of time to look for a single medication or remedy for its treatment.  [Here is Dr. Vojdani’s letter: Single aetological agent may not be feasible in chronic fatigue syndrome. Some people, they got really mad at me that a scientist, by saying that a scientist should not be this pessimistic, but I was realistic, I wasn’t pessimistic. So since then, really not much has been changed. We know that chronic fatigue fibromyalgia, which they changed the name to ME/CFS or myalgic encephalomyelitis chronic fatigue syndrome. So still it is multifactorial disorder. And now we see similar or significant overlap between chronic fatigue fibromyalgia with long COVID with only difference is that we know for sure in the case of long COVID, SARS CoV-2 is one out of many factors that playing a role. So let’s go ahead and discussing this issue associated with long COVID.

So based on statistic, 10 to 20% of individuals who had COVID may develop long COVID. Majority of cases are in individual with severe COVID, but not necessarily. Some of them could be, could have even mild COVID and may develop also long COVID.  So I’m going to talk about that. In addition to SARS-CoV-2, Epstein Barr virus, HHV-6 and other viruses may contribute to development of long COVID. Then due to these reactivated viruses, the viruses produce super antigens in order to hide from the immune system, but that the production of super antigens by the viruses causing reactivation of the immune system causing disturbance in gut microbiota. And this altogether could result in hyper inflammation and poly autoimmunity meaning many autoimmune diseases. By the way, I’m going to touch about the importance of laboratory testing including antibodies against SARS-CoV-2, EBV, HHV-6, and also we have to look at gut permeability and autoimmunity. And finally, the importance of lymphocyte map, as it was mentioned by Heather from Cyrex, is becoming very, very important in patient with long COVID. Why? Because based on lymphocyte map and based on their immune print, clinicians can design treatment modalities. So we’ll discuss all of that during the next probably 40 minutes. So let’s go ahead.

                                                Dr. Weitz was kind enough to mention that I did publish nine different articles, including the last one is coming up just this week in the journal called Viruses. But one of the most important article that I published in Frontiers in Immunology in January, 2021 and another one in December or October, 2020, published in Clinical Immunology. In these two, in this research project, we took monoclonal antibodies made against SARS-CoV-2, spike protein and nuclear protein and reacted that with about 60 different human tissue antigens.  And we found about 20 to 25 of those tissue antigens reacted strongly with SARS-CoV-2 monoclonal antibodies.  That is the best evidence of cross reactivity between SARS-CoV-2 and human tissue.  And here you see in this picture the major, major tissues which antibody made against SARS-CoV-2 reacted with.  So let’s right here, tight junctions, leaky gut, skin disorder, nervous system, many tissues, three or four of these 20 something tissue antigens were originated from the nervous system from the brain, thyroid autoimmunity, joint muscle, liver, cellular components such as ANA, ENA, mitochondria, smooth muscle, the muscle we have there.  And also finally, some of the antigens produced by neutrophil such as neutrophil cytoplasmic antigens. And this article so far downloaded by more than 200,000 individuals and most of the articles that I wrote in such a period of two or three years, the most that downloaded or read by different individuals was 3000, 5,000, 10,000. But this one is among the upper 99% of all the articles published in Frontiers in Immunology. So I’m very proud of that. So that’s about the autoimmunity. So now, because the reason I brought that up because autoimmunity you’ll see is a major components of long COVID or individual with long COVID may end up with autoimmune disease.  In fact, those patients which we met during 1990 through 2000, who did suffer from chronic fatigue fibromyalgia, and we tested them for antibodies, we tested them for cell mediated immunity. Unfortunately five years later, 10 years later, majority of them ended up with different autoimmune diseases. So we should not be surprised that autoimmunity is going to be a major components of long COVID.

So what is long COVID? So this is according to CDC, it is defined as a range of new returning or ongoing health problems that people can experience four or more weeks following the initial SARS-CoV-2 infections. And some of their symptoms includes shortness of breath, memory loss, fatigue, anosmia, GI distress, autoimmunity, and believe me, additional 90 different symptoms that I could not mention them in here, but these are the major symptoms.  But for matter of simplicity, I am going to talk about five major hypothesis about long COVID. You may ask why am I calling these hypothesis? Because really right now lots of research is ongoing. We cannot say everything is definite in relation to long COVID. That’s why we have to do more research. So these five major hypothesis, one of them is viral persistence in various tissues including GI, especially gastrointestinal, brain, those tissues that there are receptors for SARS COVID 2. Number two, reactivation of latent viruses such as EBV and HHV-6. I mentioned earlier that the viruses in order to hide from the immune system, they express super antigens. So that’s number three. You have to deal with that. All these together can disturb the gut microbiome. So therefore disturbance of gut microbiome is major component of long COVID and at least, I read at least about 50 different articles published in different scientific journals about the role of gut microbiome in long COVID.  And finally all of that may result in multiple tissue damage, immune disorder and autoimmunity. So we have to talk about all of this. So long COVID. So we mentioned about some of these factors, but we should not forget that the host factors such as obesity, type two diabetes, hyperactivation of the immune system and many other host factors, the exposome factors in general, what we are exposed on daily basis to play a significant role in development of long COVID.

So what is viral persistence? Instead of reading all of that, let me just in one sentence saying that most of us are lucky that when we get COVID five days later, one week later, two weeks later, the virus is gone, the immune system is strong enough to take up the viruses and get rid of them through the macrophages, dendritic cells and cytotoxic lymphocytes and natural killer cells.  So the body overcomes these viruses, but unfortunately in certain individuals due to immune disorder, due to malnutrition, due to lack of exercise, all of that together, which we call that lifestyle medicine, lifestyle in general, may not be able to clear the virus.  And the virus or its particles may stay in the tissue and then later on they may contribute this viral particles become full viruses and they divide and cause significant problem in these patients which may result in long COVID. So this is one of the drawings that we show that ACE two receptor, the SARS-CoV-2 bind into that injects its RNA into the nucleus, the viral nucleic acid RNA replicates itself and then becoming the RNA, becoming the virus and the virus get out of that and divides and finally spread and infect additional epithelial cells, whether they’re in the lungs or in the gut or somewhere else in the body. So infection, replication and spread.  So the question is why does viral RNA sometimes persist after recovery from acute infection? Again, we don’t have really the answer for that. I just touched upon that all depends on the host factors and the immune system and immune function of individual. So some are very lucky they can get rid of the virus and it’s RNA, but the others unfortunately cannot.

So to find out whether or not an individual is suffering from viral persistent, I recommend to do SARS-CoV-2 IgG against spike and nuclear protein. And if it’s significantly elevated, could be in relation to the virus which stayed in the tissue. But also you may ask me, I had four or five and six vaccinations maybe due to that, that I have high levels of spike and nuclear protein and that is definitely possible.  That was just couple of slides about viral persistent.

Now reactivation of latent viruses in long COVID, and I’m going to read this because it’s important. So studies have associated reactivation of viruses such as EBV, HHV-6, CMV with the severity and the length of COVID-19 symptoms viruses and their parts may under certain conditions survive the defensive response of the immune system and hide in tissue reservoir. These latent viruses may then be activated, and this reactivation facilitates the entry of the SARS-CoV-2 into the cells enhancing viral load and severity of the symptoms. So number one is Epstein Barr virus. Remember that I mentioned this virus also, its association with chronic fatigue fibromyalgia. So Epstein virus or herpes type four infects most of us around age two, three, and four.

                                                And some children also develop mono infectious mononucleosis. And these individuals produce high levels of IGM against VCA and EBNA. So however, following the acute phase, this virus loves the B cells and some other cells and become dormant in our cells, especially B cells. As long as our immune system is strong, they do not become reactivated. As soon as we suffer from some kind of stress, malnutrition, other factors, they become reactivated and contribute significantly to different disorders including long COVID. But also Epstein Barr virus, it’s known as one of the major viruses causing or involved in autoimmune diseases. And here I have about eight or nine or 10 of out of 30 different autoimmune diseases associated with Epstein Barr virus, so inflammatory bowel disease, lupus, rheumatoid arthritis, Churg-Strauss syndrome, MS especially, type one diabetes, polyneuropathy, thyroid autoimmunity, celiac disease and autoimmune liver disease or major autoimmune diseases associated with Epstein Barr virus.

                                                So as you can see this article from pathogens journal called pathogens, they’re investigating the role of Epstein Barr virus reactivation in long COVID. And in fact you see in blue this Epstein Barr virus could be involved in prevalence of long COVID symptoms. 30% of the symptoms, or in this case 30% of those who have long COVID may be associated with Epstein Barr virus. And when they measured antibodies against EBV EA-D or early antigen and EBV VCA IgM, as you can see in blue they say we found that 66.7% of long COVID subjects versus 10% of control subjects in our primary study group were positive for EBV reactivation based on what I mentioned. So EBV seems played a significant role in long COVID.

                                                And look at this conclusion, these findings suggest that many long COVID symptoms may not be a direct result of SARS-CoV-2 virus, but maybe the results of COVID inflammation induced by EBV reactivation. Very well said. Okay, so EVB. Next, human herpes type 6 also was among the viruses, which was evolved in chronic fatigue fibromyalgia also we are getting that around age three. And this virus labs many cells including glial cells and that’s why many patient with multiple sclerosis are having problem with herpes, human herpes type 6, very similar to Epstein Barr virus. This virus also is involved in many autoimmune diseases including Alzheimer’s, Parkinson’s, you see myalgic, encephalomyelitis, lupus, Churg-Strauss syndrome, collagen vascular disease, encephalitis, epilepsy, thyroid autoimmunity, Guillain-Barre syndrome and of course I mentioned multiple sclerosis.

                                                So here some articles supporting that measurements of antibodies against EBV HHV-6 to some degree also cytomegalovirus. So health risk virus infections and post COVID manifestations a pilot observational study. So they showed that EBV reactivation in about 43%, HHV-6 in 25%, which is very significant and combination of EBV and HHV-6 in 32.4%. So looking at EBV and HHV-6 is extremely important and measure IgG and IgM antibody against that in patients with long COVID is becoming very, very important. Okay. So therefore patients with post COVID syndrome and re reactivation of EBV and HHV-6 infections are at high risk of developing various pathologies including rheumatic rheumatologic diseases because we know these two viruses are involved in autoimmune diseases and therefore we should not be surprised why patients with long COVID may develop or will develop autoimmune diseases including rheumatologic diseases.

                                                Now some mechanistic explanation. Epstein Barr virus lytic replication induces ACE two expression and enhances SARS-CoV-2 entry into epithelial cells. So let me show you the pictures. So think about hand and the glove. Okay. So the glove is SARS-CoV-2 and the hand is… No, the hand is SARS-CoV-2 and the receptor is the glove. So by itself SARS-CoV-2 virus that attempts to match, but you see that only three fingers match, but the two others do not match. So this is partial match between SARS-CoV-2 and ACE two receptor. So I hope you are with me so far. Now in addition to SARS-CoV-2, EBV infects the epithelial cells. Now after five fingers, the gloves can fit with four but not with the fifth one. When HHV-6 comes along, you see now there is a perfect match between hand and the glove and therefore EBV and HHV-6 contribute significantly to spread of SARS-CoV-2 into the tissue. And together SARS-CoV-2, EBV and HHV-6 may contribute to long COVID and associated inflammatory and autoimmune disorders.

                                                So that’s for simplicity of mechanistic or mechanism of action. So at immunoscience lab we have this panel we call it Viral Panel Premier, where we look at EBV, CMV, HSV-1, HSV-6, Varicella-Zoster in some individuals also small percentage VCV contributes to long COVID. As you know, also, some individuals who had vaccines had or did suffer from recurrent of shingles, which is induced by Varicella-Zoster. So therefore we will come in this panel to detect the viruses. However, in order to save money, we put together these three viruses, which we call them autoimmune viral trio panel, SARS-CoV-2, EBV and HHV-6 as part of detection of long COVID. But you’ll see additional tests later on as well.

                                                Now let’s move on from pre reactivation of latent viruses to super antigens. What are super antigens? Antigens that are produced by some pathogenic viruses as a defense mechanism against the immune system. They express these super antigens which look like human super antigens, like human heat shock protein 60, 70, 90. So when the body looks or the immune system looks at the virus because they express something similar to human tissue, they may not go after the virus and the virus can divide and spread in our tissue. However, these super antigens may cause non-specific activation of T-cells. They induce polyclonal activation of T-cells, massive cytokine release that you have seen in patient with COVID resulting in excessive activation of the immune system, which may lead to autoimmunity multiple organ failures and unfortunately in some even may cause death. That’s why it’s so important to look at lymphocyte map that discussed by Heather on behalf of Cyrex Laboratories.

                                                So here some articles for example, you see in medical hypothesis about persistent SARS-CoV-2 infections that may contribute to long COVID. The virus super antigens could overstimulate antivirus immune responses and thereby induce negative feedback loops that paradoxically allow the virus to persist. I think earlier I explained that. So here in the same article medical hypothesis, they showed dendritic cells. Okay. Dendritic cells right here. And they take the antigen presented on major histocompatibility to T-cells and then the immune system react against that when we produce some antibodies and we call that balanced immune system, but when in addition, when super antigens right here on the right, when super antigens are presented by dendritic cells to T lymphocytes, they’re activating large subgroup of non specific and then they divide, they become over activated. And this over activated of immune cells can release many pro-inflammatory cytokines can cause damage and damage to our tissue may result in autoimmunity.

                                                So we started with viral persistent activation of latent viruses super antigens. All of these together may contribute to disturbance in gut microbiota in long COVID. And in the next slide you see that some articles about gut microbiota dynamics in a prospective cohort of patients with post COVID syndrome. And I’ll go right away to the next slide, is the good versus bad. Under normal condition we have balance between these two groups of bacteria, but instead of having balance, you see that these groups of bad bacteria are enriched and the good bacteria are depleted. And you see for example, enterococcus intra bacteria. That’s why we measure antibodies against lipopolysaccharides produced by e-coli, salmonella and more, which is part of Array 2 in many patients including long COVID. Also, these pictures may justify the use of prebiotic and probiotics for patients with long COVID. So this is the Array 2 intestinal barrier antigen permeability screen offered by Cyrex.

                                                I sincerely believe that in addition to those viral antibodies I mentioned before, looking at gut barrier dysfunction which is by Cyrex is extremely important to look at. And this should be part of assessment of long COVID. Now, overactivation of the immune system. So we go one step further, all of that together may contribute to overactivation of the immune system. So here I’m trying to explain about the beauty of the immune system. The immune system in people is as diverse as height, beauty, intelligence, and other human features. Our genomes, lifestyles, and exposomes can affect our immuno type. So believe it, depends on our immuno type. For example, I may be Th1 dominant and you are Th17 dominant. When we get exposed to the same virus, I may have one type of reaction and you’ll have different type of reactions and therefore we have to assess our immune system by lymphocyte map in order to help practitioners to design treatment modalities, one for Th1 and another one for Th17 dominance.

                                                So this is about the immune system and that is why so many people get exposed to the same environmental factors and each one of them have different symptomatologies or they exhibit different symptomatologies. So for many, many years in patients with chronic fatigue fibromyalgia, those who were exposed to toxic chemicals, those who were exposed to molds and microtoxins, those who had silicon breast and implant, we used to do the upper part only. Okay, meaning looking at T-cells, B-cells, CD4, CD8 and the ratio. And yes, many laboratories right now can do that for you, but believe me, I have seen many patients with absolutely normal CD4, CD8 ratio. But when you look at natural killer cells, three kinds, for example, NK/T-cell. NK/T-cell is not is a kind of natural killer cell, which is T-cell, but it regulates the immune system. And I was reading this article yesterday that Epstein Barr virus, for example, can activate NK/T-cell and NK/T-cell release certain factors, can activate Th1 and therefore I may suffer from Th1 dominance.

                                                And that only could be measured by this comprehensive immunophenotyping that’s done only at Cyrex. Many practitioners used to measure cytokines for Th1 or Th2, the same cytokine that you classify that as Th1 for example, interferon gamma could be produced by five different type of cells. So that by itself is not enough. You have to stain directly these cells based on the receptors under surfaces and accurately we can count the number of NK cell, cytotoxic cells, Th1, Th2, regulatory T-cells which keep the balance between different components of the immune system. And finally, T helper 17. This is the kind of panel that I recommend to be part of long COVID or for assessment of immune function and immune system in general. Now many doctors have used the lymphocyte map of Cyrex for many, many patients including for SARS-CoV-2, for long COVID.

                                                And during past year they asked me when we do lymphocyte map, how long we should wait to repeat the test again? My answer always was that six months in some cases, in other cases 12 months. And believe me, if you read this article that was published in Journal Allergy, they’re saying exactly that for mild cases repeated after six months and you see for severe cases repeated after 12 months. So if you do that before, probably you are going to waste your patient’s money. So I’m not here pushing, doing lots of laboratory testing as you can see. So the role of exposome, as I mentioned before, is extremely important in development or becoming Th1 dominant or Th2 dominant or NK/T dominant as you can see in here that if the exposome factor is reactivation of EBV or HHV-6, these two viruses can release super antigen called an enzyme dUTPase.

                                                And that enzyme has significant effect and the cellular components of the immune system can activate the macrophages and dendritic cells, can hyper activate T helper 1, can hyper activate T helper 17, can cause these regulation of regulatory T-cell, can increase NK/T-cell, can activate B-cells to produce too much antibodies. All that together may result in myalgic encephalomyelitis chronic fatigue syndrome and long COVID and overlap between both of them. I think this is a very good slide so far to explain what I mentioned until this point. So the exposomes are actually, the exposome definition is lifetime exposure to external and internal environmental factors. So food additives, preservatives, toxic chemicals, pollutants, bacteria, fungi can change our internal proteins cause oxidation, methylation, citrullination. Also, these exposome factors can change different cells involved in the immune system and the result of that could be inflammation, autoimmunities, allergies, and hyper sensitivities.

                                                That’s why using or ordering lymphocyte map is becoming so important for many patients with exposure to many, many environmental factors including viral reactivation of the immune system and induction of long COVID. So the last part is all that together may contribute to autoimmunity. So you see here that the auto, the wheels or the tires are Th1 one and Th17, okay? And the antibody is the driver. When the immune system is become overactive, the car which is supposed to drive 60 or 70 miles per hour is driving 200 miles per hour. And obviously the results of that will be an accident. And in this case the accident is autoimmunity. So the autoimmunity, there are many stages in autoimmunity.

                                                The green, you see it’s the healthy stage one or silent autoimmunity. You may measure antibodies against thyroid peroxidase, but patient doesn’t have any symptoms. Antibodies are elevated. So we call that the yellow, stage one or silent autoimmunity. But it is at this level that practitioners should detect it, intervene and prevent from stage one to become stage two, which is called autoimmune reactivity, where elevated antibodies with symptoms and loss of function but they are not severe enough to cause destruction of the tissue. If we will not stop autoimmunity at stage two, then it moves to stage three elevated antibodies, significant symptoms and signs and laboratories are abnormal imaging and all that result in significant loss of function, which really you may be able to maintain that patient’s overall health but you are not going to be able to reverse autoimmune diseases.

                                                So couple articles that just let’s review the titles that autoimmunity’s hallmark, post COVID. And believe me, at least more than thousand articles published in the past two, three years about contribution of COVID and post COVID to autoimmunity syndrome. So in the middle you see it’s written latent autoimmunity and poly autoimmunity were found in 83% and 62% are patients respectively. So autoimmunity is major component of long COVID and long COVID from rheumatologic perspective. So now specifically talking about rheumatological disorders and that’s why basic autoimmune panel, particularly anti-nuclear antibody, ENA extractable nuclear antigen, double stranded DNA, rheumatoid factor immune complexes particularly because many labs do not do that. Acting and mitochondrial antibodies, I think the price for this is about, I think altogether, I think it’s covered right there by around $200 something. Many laboratory charged for immune complexes $200. So this should be part of long COVID as well.

                                                And here I would like to share with you a case report of individual with long COVID viral infection and autoimmune reactivity. And this is 28-year-old woman with medical history of previous EBV infection with postviral fatigue. And in 2020 developed myalgia, anosmia and rash. And I’m going to move a little bit faster. And they did some blood testing and they found some abnormalities that I’m going to share with you. So first look at the lymphocyte map. In the lymphocyte map, lymphocytes are significantly elevated, total T-cell is elevated, cytotoxic T-cell is elevated. T helper cells are actually low. But with Th2 dominant, Th1 dominant that that’s very significant. Regulatory T-cells are elevated. They tried to maintain this imbalance. And of course NK/T-cell as I mentioned before, Epstein Barr virus can cause activation of NK/T-cell.

                                                They release certain factors and individuals becomes Th1 dominant. So this is a classical picture of an individual with COVID or long COVID, which based on practitioners try to fix some of these abnormalities. And we did classical autoimmune panel, we found ENA elevated but not 200%. It’s slightly elevated, but that’s significant. That’s why we have to detect the autoimmunity at stage one and not stage two or three. Rheumatoid factor 14, some may say, well that’s only twice higher than reference range. Immune complexes also borderline elevation, but it is significant. Smooth muscle antibody and mitochondrial antibody negative. So we see evidence of autoimmune reactivity in this patient. If we will not treat this patient five years later, that patient will have full-blown autoimmune disease. And then finally we measure SARS-CoV-2 antibody. As you can see significantly elevated, HHV-6, IgG is normal, but look at IgM, very, very elevated among probably 3% to 5% of those who we test on weekly basis have this kind of tighter of antibodies.

                                                And as you can see also there is evidence of EBV reactivation based on IgG against VCA, IGM against VCA, especially early antigen and IgG against nuclear antigen. So there are two items are here. Very significant. IgM against VCA and the early antigen together indicates that reactivation of HHV-6 and EBV and therefore we should not be surprised to see that kind of abnormal panel for autoimmunity. This individual had also abnormal Array 2 meaning Daptomycin is elevated, v is elevated, lipopolysaccharide, both IgG and IgA are highly, highly elevated. So this individual is suffering from leaky gut as well. And also this individual suffering may be from other gastrointestinal disorders including irritable bowel syndrome. And finally this individual had also problem with blood brain barriers. I have seen in 70% of the cases those who have problem with leaky gut also have problem with leaky brain. So all of that we found in this patient and if the doctor who treated this patient will look at the test result based on the test result will treat this individual.

                                                Hopefully after six months or a year we’ll be able to reverse the course of autoimmune disease. So finally in the last three slides I would like to conclude what testing I do recommend for long COVID, MECFS. And these testing are exactly based on the five hypothesis. Viral persistence. We have to measure antibodies against SARS-CoV-2 and nuclear protein. Reactivation of latent viruses. We have to measure IgG and IgM antibodies against EBV and HHV-6 or viral panel premier that is done at immunoscience lab. Completely lymphocyte immunophenotyping because a viral superantigen can activate the immune system and therefore we can detect that by complete lymphocyte immuno phenotyping or lymphocyte map by Cyrex Laboratories. All of that we set can cause disturbance in gut microbiome and intestinal antigen permeability meaning Array 2, which is offered by Cyrex Labs. And finally, multi tissue damage and autoimmunity. We have to look at biomarkers of autoimmunity, autoimmune profile or even Array 5 by Cyrex Laboratories or autoimmune profile by immuno sciences laboratories.

                                                So these are the tests altogether I do recommend for comprehensive evaluation of patients with long COVID, chronic fatigue and fibromyalgia, myalgic encephalomyelitis. Now in relation to treatment, there are many, many articles, but again you see there is no single treatment or modality for disorder which is multifactorial. I’m repeating the same thing that I said in 1998 or 1999. So therefore, based on laboratory testing we have to find, what are the abnormalities? Maybe in one patient is viral persistent, in another one is latent viruses, activation of latent viruses, in another one is disturbance in gut microbiota, in another one’s immune system abnormalities, in another one autoimmunity or combination of all the above. And so therefore you see in some cases we say monoclonal antibodies vaccination, NAD+, hydroxychloroquine, which there are lots of publication. These are all based on articles I read in scientific journals.

                                                Reactivation of latent viruses in a classical antiviral medications, NAD+, vitamin D, strengthening the immune system. And again, the same thing for viral super antigens and disturbance have gut microbiota. You can see some of these change of diet probiotics, prebiotics, acetate, [inaudible 01:05:58], propionate and more. And finally for multiple tissue damage and autoimmunity, identifying which tissue is under attack. Immunosuppressive medication, dexamethasone, vegan diet, highly recommended biologicals that eliminate the B cells that produce antibodies. But believe me, these are not the only suggestions for treatment. There are many more. The other day I was listening to presentation of Dr. Perlmutter, which with Dr. Bland next Tuesday, they’re also going to talk about long COVID and the role of mitochondria and immune dysfunction in long COVID. In one of his slides which I borrowed from him, he mentioned all of these for improved functionality and you can see hyperbaric oxygen therapy, high dose melatonin.

                                                Why? Because I didn’t have time to mention in sub patients with very similar to chronic fatigue fibromyalgia with long COVID, they have problem with hormone such as cortisol, they have low cortisol. I talked about Edison disease that the doctor wrote a letter to the editor. But yes, both of these disorders, patient with this disorders, myalgic encephalitis, chronic fatigue and long COVID, they do suffer from low cortisol and therefore maybe low dose melatonin and some others, and please do not forget here they’re talking about also fasting and exercise. I have two articles, one about fasting, second one is about exercise for prevention of long COVID. And again, don’t forget quercetin, metformin, berberine and many more. So depends on who is the speaker, who is the investigator. Some of them may say use this factor, the other may say use the others. But you have to use combination of all or above because multifactorial disorder could not be cured or managed by a single medicine or single remedy.

                                                So with that I would like to share with you the presentation that I made to you and if you want to read about those five hypothesis in depth, this article hopefully will be published this week. I’ll send a copy two Dr. Weitz and he will share it with you and hopefully you’ll read it and you’ll enjoy it. Thank you so much. This is my ninth article that I’m publishing in scientific journal and this journal is called viruses. Dr. Weitz, thank you so much for inviting me to speak here. It was my pleasure and honor to here.

Dr. Weitz:                            Thank you so much, Ari. Another awesome presentation. I’d like to start by asking a couple of questions. And the first question I have is we’ve heard a lot about one of the negative effects of COVID and also long COVID is cardiovascular micro clotting, a whole series of cardiovascular issues. And you didn’t really mention that.

Dr. Vojdani:                        Well, indirectly, I did mention that in one of the slides that I showed, I showed that monoclonal antibodies react with different tissues including active and striated and smooth muscle. Also, I showed that monoclonal antibodies-

Dr. Weitz:                            So hang on one second.

Dr. Vojdani:                        … fight against nuclear protein cross-reacted with first for lipids or cardiolipin.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        So hundreds of articles published. Yes, I agree with you that due to autoimmunity, to clotting factors and this cross the activity and immune reactivity may end up with some of the disorders that we are familiar with in patients with COVID and long COVID including myocarditis.

Dr. Weitz:                            So is the myocarditis an autoimmune phenomenon or is it just that the virus attacks the heart muscle/.

Dr. Vojdani:                        Myocarditis is an autoimmune disease, but you may say also it has some other components. Yes, but it is classical autoimmune disease that the body attacks the component of the heart cells. And cardiolipin for example, is one of them. And I was listening again to Dr. Perlmutter the other day. He was showing that cardiolipin is the major component of mitochondrial components of the cell.

Dr. Weitz:                            I listened to a presentation by Dr. Mark Houston at the Cassie conference in October and he was talking about a lot of inflammation of the endothelium of the arteries and that being a big factor. And then he had a protocol he recommended to try to treat that.

Dr. Vojdani:                        And also I think Elroy, my son spoke last year at F4N about inflammation and he emphasized all of that autoimmunity against mitochondrial and different components of heart and blood.

Dr. Weitz:                            Somebody asked about, when you talk about high dose melatonin, what dosage are you talking about?

Dr. Vojdani:                        That was the slide I borrowed from Dr. Perlmutter, which on Tuesday at 5:00 PM I think Los Angeles time, he’s going with Dr. Bland and two other speakers are going to talk about long COVID in relation to immunity and mitochondria. So I don’t know the answer, but definitely he knows.

Dr. Weitz:                            Right. Interestingly, the dosage for melatonin for sleep is often very low, three milligrams, something like that. 20 milligrams was the dosage that was popular for more serious conditions like cancer. But recently it’s become popular to use 200 to 300 milligrams of melatonin for things like cancer. So that’s now considered a high dose.

Dr. Vojdani:                        Thank you for the information.

Dr. Weitz:                            Somebody asked, is there any commercially available testing for micro clotting?

Dr. Vojdani:                        No, other than looking at antiphospholipid antibodies or cardiolipin antibodies and alpha beta-2 glycoprotein antibodies, which is related to the platelet antibodies, I think those two are giving some hint about that type of autoimmunity.

Dr. Weitz:                            Anecdotally just I’ve seen in some patients, I’ve seen an elevation of myeloperoxidase, MPO, on labs.

Dr. Vojdani:                        Yes. Yes. Thank you.

Dr. Weitz:                            Somebody asked what is latent immunity? How long a period of time are we talking about?

Dr. Vojdani:                        Six months or longer.

Dr. Weitz:                            Okay, let’s see. Somebody was asking is there any way to verify if somebody had SARS COVID infection or if the antibodies that are found would be coming from the vaccine? I think is what the question is.

Dr. Vojdani:                        I think impossible. Impossible. Honestly, I don’t think so because if we accept that injection of RNA or spike protein results in the production of spike protein in our blood and our immune system is going to take that and will make antibodies against spike protein will be impossible to differentiate whether that antibodies is produced due to infection with SARS-CoV-2 or due to vaccination?

Dr. Weitz:                            Well, the antibodies to the spike protein, but what if they have antibodies to the nuclear receptor? That would only come from the virus.

Dr. Vojdani:                        Yes, yes, you are right. Absolutely, yes. If you do antibodies against nucleo protein and you detect that, that could be due to the virus and not due to vaccination. Thank you so much.

Dr. Weitz:                            Somebody asked, this practitioner said that he’s not practicing in the US or Canada. Do you periodically hold any online discussion forums with other expert colleagues where practitioners can join and learn about Cyrex?

Dr. Vojdani:                        Oh, I think we have webinars. We have many activities with PLMI, Personalized Medicine Institute. We have with RUPPA. So for example, I’m going to have one I believe on April on behalf of RUPPA and immunoscience lab. Yes, we have some of these activities and if Heather is with us to take the name of that individual and when we’ll have such activities, we should invite that individual to participate. I appreciate that.

Dr. Weitz:                            Somebody asked about the use of a nutritional supplement Monolaurin in inhibiting viral infections.

Dr. Vojdani:                        I think there is some anecdotal evidence, but I haven’t seen articles published in the hardcore journals that talking about some of these factors.

Dr. Weitz:                            Is there any truth to the concept of viral shedding?

Dr. Vojdani:                        Yes, it is.

Dr. Weitz:                            Okay, what do we know about it?

Dr. Vojdani:                        I think the viral shedding is the three steps that I showed that infection, replication and spread of the virus is viral shedding.

Dr. Weitz:                            Okay. Well, can that also come from the V?

Dr. Vojdani:                        From what?

Dr. Weitz:                            From the V?

Dr. Vojdani:                        Oh, from the B-cell?

Dr. Weitz:                            No, the vaccine.

Dr. Vojdani:                        Ah, from the vaccine. Okay. If we are introducing RNA, you saw that in the mechanism that when the virus first injects its RNA into the cells and the RNA becomes the whole cell by being surrounded by the membrane and then divides and spreads. I haven’t seen anybody talking about that, but that mechanism is possible.

Dr. Weitz:                            I’m just going through the questions. Anybody has any final questions? Just put it in the chat. Otherwise, we’re going to wrap.

Speaker 5:                           May I ask a question?

Dr. Weitz:                            Sure.

Speaker 5:                           Hi Dr. Vojdani. I was just wondering since for example, COVID vaccine is a little different from other vaccines. It doesn’t have a live virus, but it only has the RNA structure of the virus. That’s what I think it has. Would that also cause viral shedding or is it only when the live virus in a vaccine is present?

Dr. Vojdani:                        Like I said, I really don’t know. I didn’t read anything about this.

Speaker 5:                           Okay.

Dr. Vojdani:                        But is it possible? I believe it is possible, but there is no evidence.

Speaker 5:                           I see. Thank you.

Dr. Vojdani:                        Pleasure.

Dr. Weitz:                            Okay. So I think that’s the rest of the questions. Thank you so much Dr. Vojdani. I’ll share that article with everybody and this is being recorded and it’ll be posted on Tuesday so you can listen to it on the audio version or go to YouTube and watch the whole presentation.

Dr. Vojdani:                        Thank you Dr. Weitz.



Dr. Weitz:                            So thank you everybody and we’ll see you next month. And thank you for making it all the way through this episode of the Rational Wellness Podcast. And for those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify and give us a five-star ratings and review. That way more people will be able to discover the Rational Wellness Podcast. And I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic and Nutrition clinic who, many of whom, most of whom we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases and various other cardiometabolic conditions.  And so I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health. And I wanted to let everybody know that I do have a few openings now for new clients and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111. And we can set you up for a new consultation for functional medicine nutrition, and we can get that going as early as the new year. So give us a call and I’ll talk to you next week.



Immune Reboot with Dr. Robert Silverman: Rational Wellness Podcast 293

Dr. Robert Silverman discusses How to Reboot Your Immune System with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

1:54  One of the biggest health problems is that Americans are unhealthy.  The average American consumes 160 lbs of sugar per year and sugar is deleterious, esp. to the immune system. 300 calories of sugar will decrease your immune system by 50% over a two hour period.  The average American consumes 146 pounds of wheat per year in gluten, and we all know gluten is damaging to overall health, especially our gut health where 80% of our immune cells are housed.  The average American also consumes 142 pounds of artificial sweeteners, which are extremely ruinous to gut and brain health.

3:50  We have had so much discussion during the pandemic about acquiring immunity to the virus, but to be able to get immunity requires your immune system to function properly. You can’t control the virus, but you can control the host.

5:20  We need to make the host inhospitable to the virus and other pathogens.  Dr. Silverman lives in New York blocks from where the pandemic had its most severe crisis in the United States, where hospitals were overflowing with the sick and the dead from COVID.  This is one of the reasons for Dr. Silverman to write this book.  The immune system has three levels of defense.  The skin is a barrier system that prevents entry of pathogens, but the surface of our gut is a vulnerable place for pathogens to get into our system.




Dr. Robert Silverman is a Chiropractic Doctor, clinical nutritionist, and founder and CEO of Westchester Integrative Health Center. His website is DrRobertSilverman.com. He is a respected and sought after international speaker on nutrition and his first book, Inside-Out Health was an Amazon #1 bestseller. The ACA Sports Council named Dr. Silverman “Sports Chiropractor of the Year” in 2015.  Dr. Silverman’s new book, Immune Reboot: Your Guide to Maximizing Immunity, Restoring Gut Health, and Optimizing Vitality, filled with science-based guidance for boosting immune health.  

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.



Podcast Transcript

Dr. Weitz:                            Hello Rational Wellness podcasters. Thank you again for joining us. Our topic for today is immunity. How does our immune system work, how to maximize immunity, and what to do when the immune system becomes dysfunctional? We’ll be speaking with my friend Dr. Robert Silverman about his new book, Immune Reboot: Your Guide to Maximizing Immunity, Restoring Gut Health, and Optimizing Vitality, filled with science-based guidance for boosting immune health. Dr. Silverman is a chiropractic doctor, clinical nutritionist, and founder and CEO of Westchester Integrative Health Center. He is a respected and sought after national and international speaker on nutrition, and his first book, Inside Out Health, was an Amazon number one bestseller. The ACA Sports Council named Dr. Silverman Sports Chiropractor of the Year in 2015. Rob, thank you so much for joining us today.

Dr. Silverman:                    Ben, it’s a pleasure to be here. I’m excited to talk with you and share some clinical gems.

Dr. Weitz:                           Good. So Dr. Silverman, what’s the number one health problem today?

Dr. Silverman:                    Wow. I mean, do we have three hours?

Dr. Weitz:                           It’s keeping secret documents in your house. No, I’m kidding. Just kidding, sorry.

Dr. Silverman:                    I think one of the biggest problems is without question Americans are unhealthy.

Dr. Weitz:                           Right.

Dr. Silverman:                    And we go through this all the time. The average American consumes about up to 160 pounds of sugar per year. Sugar is extraordinarily deleterious and especially so through your immune system. 300 calories of sugar will decrease your immune system by 50% over a two hour period. So I used to travel a lot and we all used to have to wear the masks and this is not a mask mandate conversation. I would be in the airport and everybody’s wearing a mask, but everybody’s drinking a frappachino, I mean, talk about something that was incongruent. The average American consumes 146 pounds of wheat per year in gluten, and we all know gluten is damaging to overall health, especially our gut health where 80% of our immune cells are housed. So if anything, let’s all have better gut health. What have you done for your guts lately? The gut communicates with the immune system. Again, the average American consumes 142 pounds of artificial sweeteners, extremely ruinous to gut and brain health. On and on and on. You and I have talked about it. We think that three stage pandemic is probably obesity, diabetes, and high blood sugar. Even though, did I miss one?

Dr. Weitz:                            I guess you could say heart disease.

Dr. Silverman:                    Heart disease, but we know that the other ones lead to heart disease. So Dr. Mark Hyman coined a phrase diabesity, where you have this parallel lines between obesity and diabetes. 93.2% of Americans are metabolically unhealthy. 7% of us are metabolically healthy. So I always ask my patients when they come in and a real, what I like to think is a pointed question, what have you done for immune support lately? What have you done for immune health lately?

Dr. Weitz:                            It’s kind of ironic. We’ve just been living through this pandemic, whether it’s over or it’s almost over or anyway, and there’s been just so much discussion of the virus and we’ve got to get immunity and nobody’s really talked about the immune system and most people really don’t know much about the immune system. All they know is, you got to get immunity to get protection. But a lot of it depends on the status of your immune system. Maybe we need to know more about the immune system. That’s one of the great things about your book is you go into this very, very interesting, well thought out explanation of how the immune system works. So give us some more information about how the immune system works.

Dr. Silverman:                    Love to. Love to. We’re only as young or healthy as our immune system is functioning. The interesting thing about our immune system is that it works 365, 24-7 and we never know that it complains till it becomes dysfunctional or we overwrought it. So what I like to say, and a lot of the immune system conversation obviously is pointed towards COVID-19 and viruses. So I always open up with most patients by saying, you can’t control the virus, but you can only control the host.

Dr. Weitz:                           Right.

Dr. Silverman:                    I can’t control that virus, Ben. There’s no way.

Dr. Weitz:                           Absolutely.

Dr. Silverman:                    We can control the host, we can make that host inhospitable, that host, our patients.

Dr. Weitz:                           Yep.

Dr. Silverman:                    Our friends, our family.

Dr. Weitz:                           Right.

Dr. Silverman:                    Inhospitable. So these pathogens, these bacteria, these viruses just can’t get in. And I agree with you. I was searching, and this is the reason that I actually wrote the book. I’m in New York, I’m in Westchester County, and the whole idea of the long COVID and everybody getting sick really occurred right outside of New York City, six blocks from where I live. So a lot of my neighbors, friends, and family got infected and I was searching like, who’s the immune guru? And there were some out there, but it was not like if we said who’s the blood sugar guru? Who’s the muscle guru? Who’s the gut guru? I mean, we have a lot of answers and we have a litany of people that we could look at.  But the immune system is fascinating in that there’s three levels of defense against disease causing organisms that we need to know. Number one, it’s our barrier system. It needs to prevent entry and that is our skin in our mucus membrane. Our largest organ in a body is skin. And an interesting thing about the skin, when we get a cut in the skin, we know to put a bandaid on it. If we get a cut in the skin that’s big enough, we know to stitch it. However, when we cut our gut, we don’t know always to put a band-aid on it or to stitch it up just as a little food for thought, if you will. Stomach acids and digestive enzymes-

Dr. Weitz:                            Let’s just stick on that point for just a second. I don’t think people realize that the mucosal lining of your gut from your mouth all the way down to your anus is this amazing interface with the outside world. We think of it as inside our body, but that’s how the outside world interfaces with it and the health of that mucosal lining is crucial for our overall health.

Dr. Silverman:                    Without question. It has been purported that the first time the outside world sees the inside world is when something goes through the small intestine, it gets digested and gets into our bloodstream, into our secondary immune system. It’s a great point. Getting back to some of the other things, to piggyback on what you just said, stomach acid and digestive enzymes are a critical element. Lastly, beneficial bacteria that live in the colon, our microbiome or microbiota is also a critical element. So I was talking to one of my colleagues who was a medical doctor and he made a great point. He said you know that first part, that barrier system is so strong because when you eat something that you’re not supposed to either comes up or goes back out because your body’s trying to correct itself from absorbing it. So it’s truly the first barrier.

Dr. Weitz:                            Right. So yeah, I mean if you don’t have a healthy, balanced, well-functioning immune system, you’re not going to create antibodies no matter what you do. So that’s something we’ve got to really understand more about. What are some of the best ways to stimulate the immune system? In your book, one of the things you mentioned is intermittent fasting.

Dr. Silverman:                    Yeah. Everybody gets excited about intermittent fasting and let’s have some definitions. I mean, I know everybody who listens to you gets high level information, so everybody knows what intermittent fasting is. But a cursory, you look at it is real simple. Intermittent fasting actually technically means taking off a day from eating. What we’re really referring to is time restrictive eating where you fast during a certain part of the day and you feed during a certain part of the day, but we’ll use intermittent fasting synonymously with that.

                                                So for me, intermittent fasting is perfect in that a 14 hour fast and a 10 hour feed. There’s other numbers like 16 and eight, I think that you may adhere to that. But the real key to intermittent fasting, why it’s so potentially powerful for immune health is because intermittent fasting stimulates something called autophagy, which won a 2016 Nobel Prize. Autophagy is the body’s own cleaning process of breaking down old cells, old macrophages, old immune cells, breaking them down and regenerating new cells. You’re actually allowed to get a term that Dr. Jeff planned coined immuno rejuvenation and it’s specific autophagy to immuno senescence cells, which are cells that die and become dysfunctional as you age that pertain to the immune system. So for me, a lifestyle hack for everybody and especially for a stronger robust immune system would be intermittent fasting.

Dr. Weitz:                            And of course autophagy is a key factor in longevity and a lot of people are doing things like intermittent fasting and other strategies to try to promote longevity.

Dr. Silverman:                    Absolutely. What turns on the longevity switch is autophagy. What turns on the autophagy switch is decreased sugar and starch in eating over a period of time.

Dr. Weitz:                            Great. Yeah. So let’s talk about one of the biggest health challenges today. You mentioned long COVID. How do we know when someone has long COVID? What is long?

Dr. Silverman:                    It’s funny, everybody always asks me. So here is basically a definition. It’s the continuation of development of new symptoms three months after the initial SARS-COV-2 infection with these symptoms lasting for at least two months with no other explanation. So your symptomology goes on for a period of time, and I know we’re going to dig in a little later on how do you diagnose it? Right now the best way unfortunately to diagnose long COVID is symptomology, but I think one of the biggest problems in pertaining to long COVID is the fact that we have a dysfunctional immune system. So piggybacking back to the question you asked about the immune system and the three levels, there were two that I wanted to dig into and that was the innate immunity. Everybody has it. It’s actually your security guard of your immune system. It’s a general surveillance, but man, when they have to go, they’re like Marines.

                                                Those white blood cells call neutrophils and macrophages, they engulf and destroy foreign I invaders and eat damaged cells very efficiently. Your innate immunity can then flick a switch. And by the way, if we want a little functional medicine factoid, dendritic cells are the cells that switch innate immunity into adaptive and acquired immunity. Now we use the term acquired because we acquired over a lifetime. It’s adaptive because it’s quite flexible. It’s a specific defense because they produce both B and T cells. You made a great point about antibodies and I’m going to dig into that in a second. T-cells traditionally come from the thymus glands. That’s why they call them T-cells. The problem with the thymus gland, it’s the first gland to go through involution in the body. It actually begins-

Dr. Weitz:                            It shrinks, yeah.

Dr. Silverman:                    Yeah. Shrinks as a teenager. And our B-cell come from our bone marrow. They’re our antibodies. So we have IGE, which we’re probably really not going to talk about it because that’s an allergic reaction. IGA, which is very big in functional medicine. It’s secretory at the gut lung, mucosal membrane levels. IGM, which is early, and of course IGG, which is the most populated one. It’s very small. IGG is interesting because it passes the placenta and gets to the fetus. But the big thing about IGG is it has a lot of properties of protection because it actually blocks the docking of ACE-2 receptor sites.

                                                Unfortunately, you should have a normal response to infection, which you don’t during COVID, the normal response would be inflammation. We’re supposed to raise inflammation, we’re supposed to stimulate our innate immunity, we’re supposed to get some specific immunity, we should get resolution and we should get a memory. And that memory is in those antibodies. The problem is it becomes too high with COVID. And now we have something and everybody who’s listening, this is one thing to write down. We have something that’s going on in our bodies called immune imprinting or original energetic sin.

                                                It’s a phenomenon in which the body preferentially repeats its immune response to the first variant encounters despite being alerted to a new variant. So essentially we take a picture of the first virus that attacked us, but these variants, these mutations, we’re taking the same antibody picture. And that’s one of the reasons why when we get infected the second time and certain things don’t work as well, is because of immune imprinting. MIT and Harvard actually did over a hundred patient study to look at neurological long COVID symptoms and found they had inflammation of the brain with cognitive defects. What they truly found was an underwhelming amount of antibodies to COVID, but an overwhelming amount of antibodies to the coronavirus. So you asked me about the definition of long COVID, I kind of segued into some other areas and I’m sorry, one more fact about long COVID-

Dr. Weitz:                            Wait, wait, what did you mean by antibodies to COVID versus antibodies to the coronavirus?

Dr. Silverman:                    Well, coronavirus, there are coronaviruses that were colds before.

Dr. Weitz:                            Right.

Dr. Silverman:                    This wasn’t the first coronavirus. This is a very specific, unique, gnarly virus. And that’s the problem. For me, I like to call it the prober or it’s the magnifier of what’s going on inside. And it looks, seems to find our immune weakness where other viruses may not looking in that same manner. This is a nasty guy. I mean unfortunately, but one thing I wanted to hit you with, and it’s a wow for me, estimates have shown that long COVID has cost the US economy three point trillion and still growing. When you compare and contrast it with the great recession of 2000 and 2007 to 2008, it’s the same money and we’re still going. So we have a healthcare dilemma coupled with a healthcare cost dilemma. Nobody better suited than the people on this podcast to help the current population.

Dr. Weitz:                            You mean functional medicine practitioners in particular?

Dr. Silverman:                    Functional medicine practitioners in particular because if they look at the body from the inside out, they’re willing to adhere to alternative protocols in conjunction with other protocols. And I think that their eclectic ness and getting to the root cause resolution really enables them to have a more optimized outcome.

Dr. Weitz:                            So what are some of the symptoms that alerted us that a patient might be suffering from long COVID or is suffering?

Dr. Silverman:                    Well, it’s interesting how they’ve changed with the different mutations, but the typical ones that we see are fatigue. That’s number one. And if we dig into that, it’s a fascinating reason why. Number two is post exertional malaise. So those are one and two. So you’re tired and then you try and exercise and you’re tired. So obviously that poses an issue. Diarrhea is a big one, and I know we’ll talk about it a little later. Diarrhea typically comes from the vagus nerve. Some other typical ones are cognitive dysfunction, sensory motor symptoms, headache, memory. And now what we’re getting a lot of is a lot of respiratory issues, a lot of cold like things. And hopefully we’ll get to dig in as I seed you, hopefully we can talk about some obvious things and people that talk about the loss of sense of smell and taste and things of that nature.

Dr. Weitz:                            Right. So is there a way to diagnose long COVID other than the symptoms?

Dr. Silverman:                    There is no single diagnostic tool. And it’s a great question, but the symptomology is the driver. There are some serum tests that have been shown to be elevated. So we get into the cytokines. We’ve got our interleukin one beta, we got our interleukin six, we got-

Dr. Weitz:                            Right. I know Bruce Patterson and certain researchers are looking at cytokine tests. I know diagnostic solutions has a cytokine test.

Dr. Silverman:                    All great.

Dr. Weitz:                            And Dr. Vojdani and Cyrex have the immune test as well.

Dr. Silverman:                    Right. Interleukin 17, TNF alpha. So that’s great, I mean these things are elevated, obviously your immune system’s on overdrive. So some of the other things that you could look at, and I actually wrote it down on a piece of paper here because I wanted to make sure that I didn’t forget what it was and well figures the paper’s not, ah, there we go. I wrote it down. I knew-

Dr. Weitz:                            By the way, I can’t help but when we describe the symptoms of long COVID, the first thing that jumps out is, hey, this is chronic fatigue. We know often has a postviral [inaudible 00:18:00].

Dr. Silverman:                    But it looks like chronic fatigue. And that takes us to another thing. So let me hit you with, you could look at white blood cell differential, C-reactive protein, you may look to get into your immune system, vitamin D, zinc, iron, ferritin, magnesium, B vitamins, and vitamin C. But to talk about fatigue, that’s a great point. And let’s dig in. I mean, you’ve treated people with COVID. Everybody’s tired.

Dr. Weitz:                            Right.

Dr. Silverman:                    Everybody complains about fatigue. And the reason is the mitochondria is not functioning well. And that poses a tremendous issue. But more so than that, I believe that long COVID actually exhausts the body. So there’s four factors for increasing the risk and decrease in immune system and leading you to this mitochondrial dysfunction. Number one is high levels of viral RNA during an infection.  So you and I may be out, there could be 500 people, 200 people have the infection. So we’re susceptible to a bigger load. In addition to that, you look at the presence of autoantibodies. Now we talked about antibodies before, doc, right?

Dr. Weitz:                            Yeah.

Dr. Silverman:                    So antibodies protect us from a pathogen and antigen. Autoantibodies attack ourselves. So they are proportion of molecular mimicry and they lead us down a path of autoimmunity, which is a tremendous byproduct of COVID and leading us into long COVID. And you talked about fatigue. One of the things that we’ve got to bring up is the reactivation of Epstein-Barr. I mean, I was sitting here about 16 months ago taking everybody’s blood, an Epstein-Barr, and everybody post COVID was elevated. And I’m like, everybody’s 50. I mean everybody’s got the kissing disease mononucleosis, was I missing something that was going on in my neighborhood? I mean like what’s going on?

                                                But the reactivation of viruses, and this is a clinical gem, viruses lay dormant in your body, in our central nervous system because we’re both originally chiropractic just now, we’ve added things to our armamentarium. That said the reactivation of not just Epstein-Barr, but herpes and other viruses really become very fatiguing to our overall body. And another thing, and we touched on it before, having type two diabetes also exhausts the body. So ultimately these long COVID patients have an immune dysfunction, circulatory problems, and you want to talk about fatigue. How about brain fog?

Dr. Weitz:                            That reactivation of dormant viruses, that’s a major thing people don’t realize is every virus you’ve ever had, usually some remnant of it exists in your body in a dormant state. And it’s interesting how the SARS virus, SARS-COV virus can reactivate some of these dormant viruses and that being a major factor in some of these long COVID symptoms. And that’s something that we’ve looked at before as a factor in chronic fatigue. So it’s not that surprising that this might happen again with this particular virus.

Dr. Silverman:                    Without question. And again, I think at some point we’ll dig in about why the mitochondria poses an issue, but it looks like chronic fatigue. Now the real question is it the decrease in dysfunction of mitochondria because of COVID? Is it the elevation of Epstein-Barr or is it the combination of the two? And that’s a question that the doctor has to ask.

Dr. Weitz:                            Sure. And the in inability of our immune system to keep these inactivated viruses inactive.

Dr. Silverman:                    It isn’t it amazing that we’re standing here? I mean when you think about it, a virus’s sole goal is to infect us, stay with us and have me share it with you and me get it again.

Dr. Weitz:                            Right.

Dr. Silverman:                    And people unfortunately were perishing because they weren’t in a physical state to hand this gnarly virus. And that’s why if you believe in the idea that it actually has some sort of intelligence, it’s mutating to become more contagious but not as detrimental.

Dr. Weitz:                            Yes.

Dr. Silverman:                    But again, waking up a virus with the Epstein-Barr, the shingles, the herpes, and all these other viruses at the cell level order immunity, man, it is not a fun trip and it’s not just the flu. So we as practitioners need to really segue into building up that wall, that immune wall and also understanding once they get it, what they need to recharge those batteries.

Dr. Weitz:                            And you also mentioned molecular mimicry, which is what many of us know is one of the main mechanisms leading to autoimmunity. And maybe you could explain what molecular mimicry is.

Dr. Silverman:                    Yeah, molecular mimicry. The way I like to share it with my patients and my other docs is it’s a molecule that mimics another molecule. So having said that, there’s something called a motif or a protein sequence. And when the protein sequence of a foreign body is close to something in the body and the immune system is a little overrun or dysfunctional, it attacks that part of the body.   So one of the classic things that we use is gluten, because gluten has a similar motif or protein sequence to the cerebellum. So the same thing happens, but it is a dysfunction in our immune system. So we all talk about longevity, we all know the big names that bring on longevity books. Longevity is the matching of health and lifespan and it’s great stuff. David Sinclair’s done some great work out of Harvard. Dr. Mark Hyman without question has a new book, Peter Attia, and all that. But the bottom line is if your immune system isn’t robust and resilient and versatile, you’re not going to have great longevity. So molecular mimicry is the backbone of why we get autoimmunity. Interestingly enough, people ask which immune system or which part of the immune system leads you to autoimmunity? And that’s the adaptive and acquired one because of those antibodies. It’s not the innate.

Dr. Weitz:                            Right. And we know that patients with certain chronic health conditions, like we already talked about, obesity, heart disease, diabetes, tend to do worse with long COVID, and why is that?

Dr. Silverman:                    Well, first off, one of the reasons that it does worse, it’s really simple is we’re not as healthy if we have these pro-inflammatory conditions. So you said obesity, well we really should call it cov-obesity. So you have an increased incidence of COVID if you have obesity and if you get COVID, you typically gain some weight. We’ve all heard of the freshman 15. Well COVID-19 has put anywhere from 15 to 50 pounds on people because they’ve been so sedentary post COVID. Some of the other factors like you said, and when you hear the list you really understand they’re all inflammation based. Cardiovascular disease, diabetes, hypertension, obesity, we talked about metabolic syndrome. Age unfortunately is also a problem because as we get older, immune system isn’t as resilient, as strong, we lose our thymus gland, any kind of pulmonary disease, liver, kidney disease. Obviously if we have pre autoimmune conditions, we have a dysfunction in our immunity. Chronic neurological diseases, any problems with brain, heart and or lungs. And the big reason is fat cells. And that’s what your fat cells expanded when you’re obese is the depository for toxins. So again, you’re pre inflamed.

Dr. Weitz:                            You, you know what just occurred to me, it would be interesting to start screening patients for their thymus gland status. We now can do functional MRIs of the brain and we see patients suffering with dementia. The brain shrinks. Well, if we know the thymus gland can shrink with age and that’s a mark of decreased longevity, maybe we should come up with a scan for the thymus gland that we do as another marker of longevity status.

Dr. Silverman:                    I agree. I think that would be fabulous. I mean those are the T-cells. Then we always get to the argument, do you want to test the antibodies? Do you want to test the T-cells?

Dr. Weitz:                            Right.

Dr. Silverman:                    And it’s a great question because with the current population having most people, I think it was 97% of people, it was a Harvard and Yale study, people had antibodies. Now they didn’t differentiate did they have antibodies to the virus, to the vaccine or both. But basically everybody has antibodies. We’re still getting reinfected at a unfortunate rate. Maybe we need to look at that T-cell and that thymus because that is what’s recognizing that intruder because we all know that we’re getting that immune imprinting. We’re taking that picture of that original virus and we’re not adapting. And even though we have antibodies, the antibodies, if they’re not the exact right antibodies, more of a pawn in the game versus being a queen that’ll protect the king, if you will.

Dr. Weitz:                            I see. So we have antibodies to an older variant and a newer variant, somewhat eludes those antibodies.

Dr. Silverman:                    Yeah, I mean when you think about it, we have antibodies, which is a good thing, but it’s not the perfect thing that we’ve seen. We have auto antibodies, which is not good. And then COVID makes these anti ideotype antibodies, which are antibodies that attack our own set of antibodies and make them and turn them into the antigen or mirror the antigen to our immune system. And that’s a no bueno. That’s when chaos and mayhem goes on. The problem is, and I know I’ve said it and I’ll probably say it a few more times, please forgive me for being redundant, we have a dysfunctional immune system in the large portion of the American population and our lifestyle, our food and our environment can make an indelible mark of improving our outcomes if we just get our patients to change.

Dr. Weitz:                            Yeah, we’ve got to recognize that all those factors that you mentioned like food and exercise and our environment can lead to inflammation. And if we’re already inflamed going into an infection when we need our inflammatory levels to up-regulate, then we’re increasing the possibility that we have this runaway inflammation, which with COVID is called the cytokine storm.

Dr. Silverman:                    Yeah, the cytokine storm. What a great conversation. I know you were prefixing that question to have me jump in on that. Cytokine storm. So is it the storm or is it the cytokine drizzle that we’re worried about? So the cytokine storm, the way I explain, I’ve been drinking water out of this mug. So think of cytokines as the water in the mug. If everybody’s pre inflamed, they already have water in the mug, and then you get sick, you pour more water in and it flows over the side and you have this storm, you have this mass of water.

                                                However, if you’re in good condition and there’s no water, ie metaphorically cytokines, you’re not going to have this storm. However you get the storm because of a drizzle, because you and I both talk about it all the time. The one thing that we want to do, our credo is to manage and modulate inflammation and to decrease it because we don’t want it to go too high. We don’t want it to last too long. So a constant low level of inflammation or pre inflammation is like a cytokine drizzle which leads and adds to the storm. So it’s not just one isolated incident where immune system overworks, it’s probably something building up to that. And then it goes over the top, if you will.

Dr. Weitz:                            Right. Which is one of the reasons why these chronic diseases, which really are the major killers today, I don’t know how many people realize this, but despite the number of people who died from COVID, more people died from heart disease in 2000 and 2001. So these chronic diseases that create this chronic level of inflammation are what we really have to pay attention to getting under control.

Dr. Silverman:                    I agree. Chronic disease, I think 60% of Americans have one chronic disease and 40% of Americans have more than two. And I think that really segues into poor immunity. So let’s put this together in a nice tight bow. There was a study that came out where it compared the US population and the Japanese population, and let’s go through some numbers. COVID cases in the US were 12 times higher than in Japan. Death was 17.4 times higher than Japan. The American man is 7.4 times greater propensity towards obesity and the American woman is 10 times greater. So where, where’s the crux? Where’s the nexus? Well, diet.  So we eat more saturated fat and obviously it’s going to be bad saturated, probably coming from grain fed animals, less fish oils than in Japan. We also consume more beef, 400% more beef. Sugar and sweeteners, 235%. The Japanese population eats more fish, a little more rice only like 11.5% and they also consume 55% more green tea. 2020 March, there was a study that came out when COVID just really came to the forefront and it was on EGCG green tea and they had 18 nutrients and drugs. Some of those drugs were drugs that they use now to help attenuate much of the symptomology of COVID-19. And a lot of the nutrients were things in my protocols that I’ll share with you. Green tea was the best at blocking the docking of the ACE-2 receptor sites with the nasty spike protein.  So when you look at those numbers, you realize, hey, guess what? They’re not as heavy. They’re eating better. They didn’t get as many positive tests and death rate was lower. We’re 4.24% of the world’s population here in the US, yet we had 15% of the world’s death. So I believe that food plays a role that makes us unhealthy and predisposed to COVID-19.

Dr. Weitz:                            And by the way, the Japanese have much longer longevity. In fact, they have the best longevity statistics, whereas the US ranks like 25th or 26th. And this is the reason why is this chronic disease epidemic that we’ve got to start focusing on.

Dr. Silverman:                    I agree. And I think it all starts with lifestyle.

Dr. Weitz:                            Yes.

Dr. Silverman:                    I think our medical doctors are great. I mean we’ve seen things that they’ve done recently that has just been stupendous and I think they’re able to add to our lifespan. I think what we all need to get together and really discuss is how do we get the health span to equal our lifespan? And I think one of the missing links is clearly immunity.

Dr. Weitz:                            Right. And getting those chronic diseases under control, the best way is not to do it by taking the latest GLP-1 inhibitor and eating a bunch of processed junk food.

Dr. Silverman:                    Processed foods. I’m sorry. 63% of our caloric intake come from ultra processed food.

Dr. Weitz:                            Yeah. Associated with increased mortality and we’ve got to focus on that. We’ve got to get people eating healthy and exercising and sleeping and taking basic nutrients.

Dr. Silverman:                    Absolutely. With the idea of mortality on processed food, ultra processed food, for every 10% increase in calories in ultra processed food, it’s a 14% increase in mortality, just like you said. The numbers speak volumes for what we need to do.

Dr. Weitz:                            How can our listeners support their immune system?

Dr. Silverman:                    Well, number one, there was a study in Frontiers Public Health in February of 2022. Nutrition could play a key role in the management of post COVID syndrome and stimulating the immune system. So that would be number one. Number two, let’s talk about interesting stuff like controlling the host. We talked about you can’t control the virus, but you can control the host. Let me give you some easy lifestyle tips or hacks. Number one, let’s avoid certain foods. I’ve got a couple acronyms I’ll share with everybody, and it’s in my book. Number one, GPS, no gluten, no processed food, no added sugar. And y’all, thank you Dr. David Perlmutter who talked in Drop Acid about fructose. Let’s decrease the amount of fructose that we consume also. Another acronym, DNA, no dairy, no nicotine, no artificial sweeteners, no deep fried foods.   And guys, when you go out to eat, the number one oil that they use is canola oil. I mean, if you want something damaging to your body, consume canola oil. So I walk in and they always ask, are you allergic to something? And I go, yes. And they say what? But I say very simply, no gluten, no dairy, no vegetable oils. Now the gluten they can do because everybody’s, even when I go on the Delta lounge, they’re gluten free now. The cheese and the dairy, they move around. The vegetable oils, they’re scrambling because they don’t know what to do. Most places don’t consume or cook with olive oil. And in that you can say it’s olive oil if it’s 51% olive oil and still 49% canola oil. So we want olive oil.

                                                My wife and I, I’m going to admit this, she’s going to kill me, but what the heck? You know she’s married to me long enough. I get a couple of demerits, she’s not going to toss me. So we walk around with avocado spray in the areas that we eat and we ask them if they’ll use this. And they’re very happy to, I’m not telling everybody they should do that. That may be over the top. Follow an anti-inflammatory diet. Control your glycemic index and load, eat lower carbohydrate foods. [inaudible 00:36:39] who was a chiropractor once said, if man makes it, I won’t eat it.

Dr. Weitz:                            Right.

Dr. Silverman:                    Michael Poland, I think his name is.

Dr. Weitz:                            Yeah, Michael Pollan.

Dr. Silverman:                    Right. He said, if it’s made in a plant, no good. If it comes from a plant, it’s great. Same thing. And for me, one of the hidden issues or drivers of inflammation would be avoid food sensitivities coupled out with environmental overloads. Eat a clean, healthy diet. Eat more organic foods if you can. And if you’re going to choose proteins, go for wild SMASH fish. Another acronym, SMASH, salmon, mackerel, anchovy, sardines, herring. Consider a plant-based or really a plant forward diet. Tom Brady’s got it. 80-20, not bad. Fruits, some fruits, low sugar fruits, lots of vegetables, grass-fed meats, high fiber, nuts and seeds, bone broth. And by the way, if you’re going to drink coffee, it’s got to be organic and it’s got to be organic in a filter. Obviously intermittent fasting, we talked about that before-

Dr. Weitz:                            And if you can use a brown paper filter rather than white because then you avoid the bleach.

Dr. Silverman:                    There you go. I mean, when you think about it, hello, Mr. And Mrs. Patient, just switch to organic coffee. And a good filter. Will make a tremendous mark in your health. Just that. Just take some gluten out. Watch your sugar. Prepare food at home. 50% of Americans spend their money eating out.

Dr. Weitz:                            Right.

Dr. Silverman:                    We spend 9% as Americans on our food of our total income. Europeans spend 20, and I’ve been in Europe, their restaurants are no more expensive than us. We’re choosing poor foods. Get that sleep, exercise. Hey, chiropractic care, why not? Low level laser therapy, big thing to help mitochondrial function. Modify your stress and consider supporting your immune system. And one last thing on that section, the time to repair the roof is when the sun is shining. JFK said that. So for me to extrapolate it, he was saying, please be proactive with your health. Don’t be reactive.

Dr. Weitz:                            So one of the issues with COVID and long COVID is patients have a tendency to lose their sense of smell and taste.

Dr. Silverman:                    Oh my God.

Dr. Weitz:                            What can we do about bringing that back?

Dr. Silverman:                    You know what? That is the number one thing. Right now, a third of long COVID patients suffer from persistent smell loss. It was up to 80%. You talked about a functional MRI. The protocols that I’m going to share have had really good responses. However, if they don’t respond in 30 days, you may want to get a functional MRI and see about the brain mass in the frontal lobe. So I use essential oils to determine what’s your sense of smell. I use that as a baseline. So my nutritional protocol is alpha lipoic acid for 600 milligrams, zinc for 60 milligrams, pro‐resolving mediators over a 30 day treatment protocol.

Dr. Weitz:                            Okay.

Dr. Silverman:                    And that would be just a sense of smell. It’s worked like a champ. I also use some laser the cranial nerves. Very interesting thing. The higher your interleukin six, the worse the loss of sense of smell. So if that 30 day period doesn’t work, you better go buck wild on decreasing that interleukin, those inflammatory markers. Loss of taste, which isn’t as common. That’s actually more involved because you need restoration of mucosal epithelial integrity, restoration of nerve endings, removal of cellular aggregates, inhibition of inflammation, and of course decrease of interleukins. So here you go, glutamine, 2.5 grams, NAC, 500 milligrams astragals, about a gram, glutathione, the master antioxidant, a preferred form would be liposomal about 500 milligrams, Omega-3 fatty acids, EPA and DHA preferably from salmon oil, four grams and curcumin one gram.

Dr. Weitz:                            Why preferentially from salmon?

Dr. Silverman:                    You know what a lot of people consume a lot of fish oils. Those who are consuming it and they’re getting some food sensitivities. And sardines is one of the high food sensitivities, even though it’s in my SMASH fish. Salmon and of course wild salmon is not.

Dr. Weitz:                            Interesting. I always worry-

Dr. Silverman:                    I mean, I got popped.

Dr. Weitz:                            I always worry about fishing out the salmon now.

Dr. Silverman:                    Right. And one thing is we all know that the farm raised salmon is one of the, to most toxic foods that we can eat, we go into a sushi place, that’s a question I ask everybody-

Dr. Weitz:                            Especially now that they have genetically modified farm salmon.

Dr. Silverman:                    Yeah, I mean they’ve, they’ve taken it from farm to GMO. So forget it. If it’s not wild salmon just I pass on it.

Dr. Weitz:                            Right. It’s really hard to get wild salmon, it’s really hard to get wild fish in any restaurant. And just for our listeners, in case they don’t know if you see wild Scottish salmon, it’s not wild. It’s grown in pens in the ocean and they’re claiming it’s wild because it’s grown in the ocean, but they’re in pens are being fed, cornmeal and things like that. And it’s not wild.

Dr. Silverman:                    And that’s a great takeaway away for everyday lifestyle. And like I said, that’s the beauty of functional medicine. It’s these little additives that we share that really help the body to heal.

Dr. Weitz:                            What is the role of gut immunity?

Dr. Silverman:                    Wow. Well, to me, the epicenter of your health is your gut. 80% of your immune cells are in your gut. It’s where your macro and micronutrients are absorbed. And it kind of makes a lot of sense because what is under siege the most daily but your gut, because look at the tons and tons of food that we eat and everything gets flushed through your gut. So critical element. By the way, most people where there was always this discussion on shedding the virus. Well, where do you shed the virus? Memo, you shed the virus through the gut. You have particles that come through your nose and your mouth, but you shed the virus through the gut. There was the most viral reservoirs in people’s guts.

                                                Now there’s a direct correlation between leaky gut and hyper infection and inflammation in COVID-19. So essentially if you add a leaky gut, it makes a lot of sense that this virus that you were trying to shed that had already infected you was going through this leaky gut and getting into your bloodstream and you’re starting on that hamster circle again.

                                                There’s new data that indicates an elevation or an expansion of B-cells. Antibodies does not allow the gut to heal because it doesn’t allow epithelial and stromal cells to come together, which are critically needed to knit up to prevent leaky gut. Zonulin, which is a tight junction marker that you know well has been shown to be increased during COVID. As a matter of fact, studies have shown dysbiosis, an unleveling of good and bad bacteria in the gut, has been seen one year after COVID-19. So without question, if you’re going to do anything, you may start thinking about keeping your gut healthy. Because once again, for me, the gut is the epicenter of your health. And that’s why I spent a whole chapter in my book on my super seven R action plan. Now everybody knows the Rs. Dr. Bland started with the four Rs and we’ve evolved up to seven and eight Rs.

Dr. Weitz:                            It’s interesting. Diagnostic solutions offers a COVID stool test. I’m wondering how many of these patients with long COVID might still test positive for COVID in their stool because they have those residual viral particles in their gut.

Dr. Silverman:                    I mean, that’s a great test to do. What I’ve been doing in my office, I’ve been testing the barrier. So my suggestion to practitioners is, here’s the question. Have you had Mr. And Mrs. Patient COVID-19? Have you had it recently? Recently, in the last three years, so obviously that’s a timeframe. If they have, I really believe everybody would benefit and behoove themselves to test the gut barrier. Because if your gut, obviously if your gut is leaky, if you have increased intestinal permeability, if you have an overgrowth of candida, if you have dysbiosis where you have this overgrowth or over abundance of parasitic bacteria, you’re not going to function well. Your immune system isn’t going to function well. So that’s a standard for me as well as the CBC, et cetera, et etcetera.

Dr. Weitz:                            So you’re testing Zonulin in the serum versus the stool?

Dr. Silverman:                    I much prefer the Zonulin in the serum. I do Zonulin, I do occludin.

Dr. Weitz:                            Okay.

Dr. Silverman:                    LPS is also a great thing to test for, but I know we didn’t want to get into the depth of the gut today.

Dr. Weitz:                            Lipo polysaccharides, which are toxins secreted by certain types of bacteria.

Dr. Silverman:                    Yeah, LPS. If that harbinger’s out of the gut and gets onto any one of your organs, it’s just a bad day. So again, you have to have a compromise at the gut level. And when you really test people, you’re going to realize that there’s a percentage of people that do have leaky gut and there’s a percentage of people that have an unleveling in their ecosystem. So real quick, on the left side, you’re supposed to have symbiotic bacteria in the gut. These are type of bacteria that can really populate, almost multiply. The bulk of it is commensal and commensal I like to refer to as real estate. Then on this side, you’ve got that parasitic. As long as that parasitic is below 15%, all is well.

                                                I like to use an analogy, I’m a basketball guy and I loved Dennis Rodman. He’s a little crazy. If one Dennis Rodman’s on the team life is great because he does all these things that nobody wants to do and he drives the other guy crazy. So he is like the parasitic bacteria, if you will. However, if you have three Dennis Rodmans on the team, it’s chaos and you have dysbiosis in your ecosystem, in your gut.

Dr. Weitz:                            Yeah, Draymond Green is the same type of player. I was just listening to his podcast this morning.

Dr. Silverman:                    My type of player. Absolutely. Yep, you got it.

Dr. Weitz:                            So what is your role of the vagus nerve in immune health, in COVID, in gut health?

Dr. Silverman:                    Vagus nerve, cranial nerve number 10 goes from the medulla oblongata down through the transverse colon. The key nerve that allows bidirectional communication between the gut and the brain and the brain and the gut. The anatomy’s very interesting because when it attaches to the transverse colon, it actually attaches to something called a neural pod. So here’s your gut. This is the inside, this is the outside of your gut. This is a clip. This clip is a neuro pod. This finger is the vagus nerve. Because it’s attached to the neuro pod, it is able to sense what’s going on inside your gut and communicate in a millisecond with your brain. So therefore it’s sensing what’s going on in your gut. 80% of your immune cells are in your gut. It’s communicating with your brain. But they found that in long COVID, there were symptomologies linked to vagus nerve.

                                                The vagus nerve was thicker. You had trouble swallowing because that’s one of its functions and you had some impaired breathing. So when you really dig into it, I said earlier one of the bigger symptomologies was diarrhea. 66% of people had a vagus nerve issue, had a diarrhea problem. However, studies have shown, and this is not chiropractic studies, these are medical journals talked about the idea of increasing vagus nerve tone. So we know vagus nerve is captain of the ship of the parasympathetic nervous system. So there’s sympathetic and parasympathetic. They’re like volumes. They’re, they’re like a seesaw. So when your sympathetic system goes up, you’re in a fight or flight, you’re excited, digestion is shut off. Vagus nerve is a rest and digest nerve. And your vagus nerve also communicates with your central nervous system. So when you’re able to up the tone of your vagus nerve and decrease the tone of your sympathetic system because of the parasympathetics go, you’re getting a balancing. Stimulating the vagus nerve increases acetylcholine, reduces inflammation, has shown to improve outcomes in rheumatoid arthritis and actually inhibits cytokine storm. Studies have shown that increasing the tone of the vagus nerve leads you down a path of decreasing the symptomology of long COVID.

Dr. Weitz:                            How do we stimulate the vagal nerve?

Dr. Silverman:                    Well, for me, in my office, I use a low level laser. I found that a low level laser with multiple wavelengths with multiple colors like red is a 635 nanometer. The violet is a 405 nanometer, works in a one to three minute manner. And how did I find that out? I tested with heart rate variability. There’s some also everyday things that I suggest. Something that a guy that we talked about a lot, Andrew Huberman, he talked about a physiological sigh. So a physiological sigh, it’s kind of like when I get excited or anybody gets excited, it’s too short, breaths, hold, and one long breath. Gargling also helps. And there’s some nutrition that works really well. Omega-3 fatty acids, L citraline, intermittent fasting, vitamin D, and getting some good rest and exercise will help level both the sympathetic and the parasympathetic nervous systems. That vagus nerve now is one of the biggest conversation pieces that you’re going to have in any kind of medical or alternative medical journal.

Dr. Weitz:                            Good. So I think we’re pretty much out of time. Do you want to, any last final thoughts you want to leave us with?

Dr. Silverman:                    Yeah, you know what I did, I wanted to share with everybody, I know you wanted me to close up and I truly-

Dr. Weitz:                            Oh no, that’s fine. Yeah, go ahead.

Dr. Silverman:                    Yeah, no, I wanted to share something. I wanted to talk about why is the mitochondria, I want to finish with that. Why is the mitochondria shut down? It’s something-

Dr. Weitz:                            By the way, for everybody who’s listening, the mitochondria are the energy producing organelles of the cell.

Dr. Silverman:                    Right. They’re your power plants, your batteries. They make ATP, everybody knows ATP from high school biology. So what goes on? Well, interestingly, mitochondria originates from the gut and bacteria, so it still communicates and it’s a cousin and a sister to the gut. Having said that, interestingly enough, they also have a secondary function other than producing ATP in power. And that second function is to help with the innate immune system. So when you infected with COVID, your immune system is an energy drainer, it drains up to like 55% of your overall energy. And your mitochondria says, wow, it sees this drop in energy. The mitochondria senses this as a threat. It results in the mitochondria changing its primary function from energy production to cell defense. This switch, this button is called cellular danger response. And you get tired.

                                                So you’re typically tired when you’re sick, but you come more tired when you get sick with COVID and then you’re not responding. So you’re out. I mean, you’re just there. And people have called me and said, I can’t get off the couch. I’m too truly fatigued. However, that’s a button that switches off. The button to switch on, goes through a whole process. It’s like a circle process. It’s three parts. So I ask everybody, what have you done for your mitochondrial support recently to help turn your mitochondria on? And therein lies the rub and therein lies why so many people are suffering from fatigue because their mitochondria shuts off, but they’re not in shape to get their mitochondria to turn on in an efficient, timely manner.

Dr. Weitz:                            What’s the best way to turn the mitochondria on?

Dr. Silverman:                    Well, I would tell you to turn it on by exercising, but if you’re tired, that’s not going to work. So I’m a big proponent, yeah, it’s just not going to work. Here would be my protocol to help with fatigue and turn the mitochondria on. B vitamins, coenzyme Q10, acetyl L carnitine, [inaudible 00:53:40] acid, glutathione, magnesium, zinc, selenium, vitamin C and if you can get some NAD plus, and if you wanted to balance your immune system, let’s talk about one last thing. Let’s get some mushrooms in there.

Dr. Weitz:                            You’re talking about immune strengthening mushrooms, yeah.

Dr. Silverman:                    Yeah, I guess I should’ve said that.

Dr. Weitz:                            You’re not talking about doing some psilocybin.

Dr. Silverman:                    Right. Apologize for the Freudian flip.

Dr. Weitz:                            Thanks Rob. How can our listeners and viewers get ahold of the book and find out more about you or contact you if they want your help with health problems?

Dr. Silverman:                    Well, I’m here in New York. We do do telehealth. Thank you for the shameless ability to plug, drrobertsilverman is my website. It’s all my social media. My name of my book is Immune Reboot. You can go to immunereboot.com or go on Amazon and get it. Let me know what you thought about the podcast. Let’s talk about getting the message out there. I’m all about that. Remember Jim Rome once said, take care of your body. It’s the only place you have to live.

Dr. Weitz:                            That’s great. Thanks, Rob.

Dr. Silverman:                    My pleasure.

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way, more people will be able to discover the Rational Wellness Podcast.  I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic and Nutrition Clinic, who many of whom, most of whom we’ve been able to help with a range of various health conditions, from various types of gut disorders, to thyroid and hormonal issues, autoimmune diseases, and various other cardiometabolic conditions. I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health.  I wanted to let everybody know that I do have a few openings now for new clients. You can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111, and we can set you up for a new consultation for functional medicine, nutrition, and we can get that going as early as the new year, so give us a call. I’ll talk to you next week.


Become Your Own Medical Advocate with Dr. Howard Elkin: Rational Wellness Podcast 292

Dr. Howard Elkin discusses Becoming Your Own Medical Advocate with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

2:05  Dr. Elkin had trouble admitting to himself that he was experiencing the symptoms of a heart attack after being a cardiologist for 25 years. He had no risk factors for heart disease and he had no family history, but even though he was experiencing chest pain, he went to work out anyway.  He went through his weight lifting session without problem but after he did feel a heaviness in his arms.  After calling his own doctor, Dr. Elkin decided to drive himself to Cedar’s Sinai Hospital Emergency Room, but not until after stopping for a cup of cappuccino.  Dr. Elkin did suffer a minor heart attack even though two years earlier he had a coronary calcium scan with a score of zero.  But the limit of this test is that it only detects calcified plaque and not soft plaque and soft plaque may be more problematic. 



Dr. Howard Elkin is an Integrative Cardiologist with offices in Whittier and in Santa Monica, California and he has been in practice since 1986. His website is HeartWise.com.  While Dr. Elkin does utilize medications and he performs angioplasty and stent placement and other surgical procedures, his focus in his practice is employing natural strategies for helping patients, including recommendations for diet, lifestyle changes, and targeted nutritional supplements to improve their condition.  He also utilizes non-invasive procedures like External Enhanced Counter Pulsation (EECP) as a non-invasive alternative to angioplasty and by-pass surgery for the treatment of heart disease.  Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient 

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.



Podcast Transcript

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. Thank you so much for joining me again this week. We’re here today with my good friend, integrative cardiologist, Dr. Howard Elkin. Dr. Elkin’s written a new book, and we’re here to talk about heart health, and we’ll also talk about some of the personal health challenges Dr. Elkin has had to deal with, that he discusses in his new book, and especially, we’re going to talk about the importance of being your own medical advocate when you are a patient. We’ll also talk about Dr. Elkin’s philosophy on how to avoid heart disease and how to live a long, healthy life.  Dr. Howard Elkin is an integrative cardiologist with offices in Whittier and in Santa Monica, California, and he’s been in practice since 1986. While Dr. Elkin does utilize medications, performs angioplasty, and stent placement, and other surgical procedures, the focus of his practice has been to employ natural strategies for helping patients, including recommendations for diet, lifestyle changes, and targeted nutritional supplements to improve their condition.   Dr. Elkin has written an excellent new book, From Both Sides of the Table: When Dr. Becomes Patient, that has recently been published and is available on Amazon, in both e-book and softcover. Dr. Elkin, thanks for joining us today.

Dr. Elkin:             Thank you so much. It’s always a pleasure to be here.

Dr. Weitz:            Dr. Elkin, tell us about your experience as a heart patient after being a cardiologist for 25 years.

Dr. Elkin:             Yeah, well, it caught me by surprise. If you read the first chapter of my book, which it’s Denial, It Ain’t Just a River in Egypt, because I didn’t have any risk factors for heart disease, no family history. Basically, I ignored my symptoms. I woke up one morning at like 2:00 a.m. with heartburn, and then it came back a few hours later. To make a long story short, I just, “This couldn’t be my heart.”  I went to work the next day, or that morning, and actually by like 10:00 in the morning, I broke out in this cold sweat, had an EKG taken, since I am a cardiologist, and it was totally normal, so I did the next great thing, and that is … I only worked half-days on Tuesdays, Thursdays back then, so then I went to Gold’s Gym to work out. I figured I’d be on the West Side if I need to be hospitalized, because my doctor’s at Cedars.  I went through my workout just perfectly, and then afterwards, I was on one of those ubiquitous ab benches doing crunches, and my arms felt like they were 50 pounds each. I ended up calling my best friend, Barry. I said, “Barry, my arms feel like they’re 50 pounds each.” He says, “Howard, your arms are 50 pounds each.” I said, “No, Barry. This is serious.” He said, “You should be calling your doctor, not me.”  I called my doctor, Gary Cohan at Cedars, and he said, “Howard, I think you should get to the emergency room at Cedars right away.” I said, “Do you think it’s really important?” He said, “It would look really stupid for a cardiologist to drop dead of a heart attack before being evaluated.” If you want to read how I got to the ER, you have to … If you want to see how I got to the ER, you have to read my book, but-

Dr. Weitz:            I did read your book. I can’t believe on your way to the ER that you stopped for a cup of cappuccino and a cookie.

Dr. Elkin:             It was like, it was an out-of-body experience. It was like it was happening to someone else other than me.

Dr. Weitz:            I can’t believe you even drove yourself in.

Dr. Elkin:             I know. Listen, the first phone call I made was to my daughter, and she said, “Dad, are you driving?” I said, “Yeah.” She said, “Get off the road and call 911.” I said, “I’m not going to do that.” I did all the wrong things, and I write it in there because, hopefully, people are laughing with me, not at me because this is typical for a lot of men, and even doctors. I’m a doctor with 27 years experience back then, and I just figured this couldn’t happen to me.  Rule number one, know your body. I was not a medical advocate at that time. I thought I was in great shape. I wasn’t overweight, I never smoked, I ate healthy, I worked out. I did all the right things, and I just figured it couldn’t be happening to me, but it did happen to me. Fortunately, I’m alive today to tell the story, and it really empowered me to come forward and write a book.  I wanted to write a book as early as first part of the century. I had even a name. It was called, Reclaiming the Soul of Medicine, because I wasn’t happy with the current medical paradigm. I saw what was happening and I knew then that changes need to be made, but it’s like I had to actually … I came to an impasse. I had to actually become a patient to really write this book. I saw the pitfalls of the medical system as a patient, so it was really an eye-opener for me.

Dr. Weitz:            We’ll get into the medical advocacy thing in a couple minutes, but I would like to talk about your particular case as a learning experience for why some people have heart attacks. Now, it’s my understanding that most patients who have heart attacks have an atherosclerotic blockage in one of the coronary arteries, and that occludes the blood supply to that part of the heart, and that’s what elicits a heart attack, but you didn’t have cholesterol plaque, you had a blood clot.   How often does that occur? What are the risk factors for getting a blood clot? We’ve talked a lot, and we could talk more about the risk factors for atherosclerosis, but what do we need to know about the potential for having a blood clot like this?

Dr. Elkin:              Great question. When I was a fellow back in the ’80s, we didn’t know about inflammation. It never even came up, so we just thought, you have this blockage, which is 50%, then 60%, then 70%, then 80%, then 90%, and then you eventually have a heart attack. That’s how little we knew about the natural history of coronary artery disease-

Dr. Weitz:            Coronary artery.

Dr. Elkin:              … and that’s based on the atherosclerotic model.

Dr. Weitz:            Perspective, right.

Dr. Elkin:              Exactly, so what happened, I did have a degree of atherosclerosis, but here’s what you have to understand, here’s what the audience needs to understand.

Dr. Weitz:            What degree of atherosclerosis did you have?

Dr. Elkin:              Like 40%, which is really- [inaudible 00:06:52]

Dr. Weitz:            Okay.

Dr. Elkin:              But here’s the thing, and I want you to know that prior to that, I had a coronary artery calcium scan two years before, which was zero. I had a zero score.

Dr. Weitz:            Zero.

Dr. Elkin:              Yeah.

Dr. Weitz:            Okay.

Dr. Elkin:              But because … That’s a very important test, and I employ it in a lot of my practice, but it also detects calcified plaque.

Dr. Weitz:            Right. So non-calcified plaque, which could mean more unstable, is typically not going to show up on that test.

Dr. Elkin:              That’s what I wanted to bring to your attention, is that there is stable plaque, and there’s unstable plaque. Now, here’s the million dollar question. When does stable plaque become unstable? We don’t really know. It’s not like there’s always a warning sign, so what I do in my practice is do appropriate testing, first of all, to assess one’s risk factors, and then another type of testing to help me prognosticate what’s going to happen, let’s say, in the next five years.

Dr. Weitz:            Let me just stop you one second. For those who aren’t familiar, there’s a test called a coronary calcium scan. A lot of people use this test to basically find out if there is any plaque in their arteries, but as you just pointed out, that test is only going to see calcified plaque, and if you get a zero score on that test, it doesn’t mean you don’t have any plaque, I hate to tell you, unfortunately. It’s a great test. It’s good to know if you have calcified plaque, but you still could have uncalcified plaque. In fact, the calcified plaque may be more stable than the uncalcified plaque-

Dr. Elkin:              Exactly.

Dr. Weitz:            … and that’s an important factor, so how can we find out if the person has uncalcified plaque?

Dr. Elkin:              Well, it’s a good question. First of all, what I do is I do specialized lipid testing, so there’s Heart Lab, there’s Boston Heart Lab. I pick a lab that really specializes in advanced testing. I’m not just looking at your total cholesterol, triglycerides, or HDL, and LDL. What I’m interested in is your particle number, your particle size, and we can get into that later. You and I’ve discussed that on a former podcast.

Dr. Weitz:            Right. Now, those are all risk factors for plaque, but they don’t necessarily tell you whether or not you have plaque.

Dr. Elkin:              No, no. Okay, so then let’s say I do have a coronary calcium scan and it’s zero. I might be a little more lenient with regard to treating these risk factors, but then there’s a new test called PULS, P-U-L-S, and that actually, it’s not a visual test like the coronary calcium scan, but what it does, it’s a biochemical assay, and it just requires two tubes that lets me know … It looks for nine different biomarkers, most of which you and I have never heard of before, but we’re not treating biomarkers. We’re treating an individual’s risk.

Dr. Weitz:            Right.

Dr. Elkin:              Based on this test itself, basically, you have high-risk, medium-risk, or low-risk. That’ll also help tell me what direction to go to. There isn’t a perfect test at all, but there is something coming out that you need to know about. The name of the company is called … I don’t know if I should be saying this, Cleerly, C-L-E-R-L-Y. They’re doing some preliminary work now at Harbor UCLA, which is where I send all my patients for coronary calcium scan, so Matt Budoff is doing this right now. This is going to be an amazing test because it’s utilizing scanning, CT scanning along with artificial intelligence.

Dr. Weitz:            Right.

Dr. Elkin:              We’ll be looking at, like instead of looking at, what’s your cholesterol? What’s your HDL, your LDL, your particle size and particle number? We’ll be looking at your plaque morphology. We can look at a plaque, whether it’s hard or soft, and be able to detect things from that which will help prognosticate your situation, so I’m hoping that will bridge the gap between stable and unstable plaque and-

Dr. Weitz:            Is there an MRI or anything else that can detect unstable, noncalcified plaque?

Dr. Elkin:              I recently looked into this. MRI is very useful for the heart, but it’s really not that useful right now for coronary artery disease.

Dr. Weitz:            Okay. We really don’t have a test, other than an invasive test where they go inside your artery and look.

Dr. Elkin:              Correct. Right, that’s the gold standard.

Dr. Weitz:            Right, which is a … What is that called again? It’s …

Dr. Elkin:              Angiogram.

Dr. Weitz:            Angiogram, right.

Dr. Elkin:              But here’s the important thing. You can use … Excuse me. I’ll often do coronary calcium scans like every two or three years on a given patient if they’re high-risk, and I want to see if their numbers are escalating. This is the important thing that the audience needs to know. If left alone, I can promise you, coronary artery disease is going to progress. It’s kind of like a cancer. It’s not just going to stay at bay, unless you do something proactive about it, which is where you and I come in, that we’re being proactive about this.

Dr. Weitz:            Now, what about the blood clot that you had? Where does that come in?

Dr. Elkin:              Well, that’s part of the making of an unstable plaque, or who knows? It’s called a plaque rupture. Here’s the important thing too. Most heart attacks are not 90% blockages that we thought when I was a fellow. They’re actually 40, 50%, 60% blockages that are stable, and then all of a sudden, for unclear reasons, they rupture. They rupture, and then a blood clot develops, and then you’ve got a heart attack.

Dr. Weitz:            Okay, so the assumption is, do we know that, that the blood clot that you had came from a ruptured plaque?

Dr. Elkin:              We can pretty much bet that it did.

Dr. Weitz:            Okay.

Dr. Elkin:              I had a 90% … The blood clot occupied 90% of the lumen of the artery. I mean, 10% more, I would have been dead.

Dr. Weitz:            Right. Now, when you ended up in the hospital, they removed the clot. Did they have to remove the rest of the plaque in the artery?

Dr. Elkin:              No. What they do … We don’t really have a Liquid Drano right now for coronary plaque, so what we do, if there’s a big enough clot, and believe me, mine was huge, we do what’s called a thrombectomy. We actually take a catheter and we aspirate the blood clot. Then we put in a stent to secure the patency of the vessel. I mean, and here’s-

Dr. Weitz:            They don’t actually Roto-Rooter the inside of your artery. They just put this stent in and it pushes out and keeps the artery open.

Dr. Elkin:              I was on call this weekend for my hospital, so I had a patient come in with an acute heart attack. He had a total, 100% blockage. He would have died, had we not intervened successfully. Then when I brought … The next day, I said, “Okay. Now the work begins. What I did, by putting in that stent, did save your life, okay? But I can promise you, if left to its own devices, and you don’t make any changes in your lifestyle, this is going to progress.” I tell people, “Now the work begins, and it’s all about lifestyle, prevention.”

Dr. Weitz:            Right. Now, tell us about some of the things that happened when you had to advocate for yourself as a patient. I’d like to see, maybe, if we couldn’t take the discussion to another level and maybe talk about, what might be some of the problems with the healthcare system? I have a couple of thoughts for, maybe, things we can do.

Dr. Elkin:              Well, let’s see. We’ll start with the first hospitalization-

Dr. Weitz:            Okay.

Dr. Elkin:              … when I had the actual heart attack. Here I am in the hospital and I felt fine. The doctor comes to see me at the very end, on the day of discharge. This doctor was probably about 10, 15 years younger than me at the time. He was young and very overweight, very overweight. Said, “Dr. Elkin, I don’t know what to tell you, but I will never be in the shape that you are in now, so when it comes to rehab, you’re on your own.” I said, “Okay. I can handle that. I’ve put together cardiac rehab programs before.”   Then, he said something that I will never forget to this day. He said, “You know what? You got a new stent in there, and everything’s going to be great. You have a new stent. You’re going to be fine.” As he left, I said to myself, “Okay. This BS is absurd because if I’m going to be fine with this great new stent, why did this happen to begin with and what’s to prevent a reoccurrence?”

Dr. Weitz:            Right.

Dr. Elkin:              I knew right there and then that it was up to me to-

Dr. Weitz:            Let’s not just talk about medical interventions. Let’s talk about root cause. Let’s talk about prevention. Let’s talk about lifestyle.

Dr. Elkin:              Exactly. If you read my book, you’ll see that I outline all these risk factors, both the major players that I call them, and the minor players. I really didn’t fit any of them, except for the part about stress, and I researched stress and its affect on coronary disease and also cancer. It’s well-outlined. It’s a whole chapter in my book, and then I also outline-

Dr. Weitz:            Yeah, I read that chapter. I think it’s interesting. There’s a whole series of psychosocial causes of heart disease. Stress, depression, even unhappiness, lack of connection with other people, all these things are factors for heart disease, and I think they’re really underappreciated.

Dr. Elkin:              Yes, I totally agree. I think, in my case, that played a big role. I really do. What I worked on, as an outpatient, was I really had to employ some … I’m the kind of person, give me all the problems in the world, I got big shoulders, I can take care of it. Once you read that, what I was going through, you’ll see I was going through above and beyond the amount of stress, and frankly, I wasn’t handling it all that well, so meditation became a big part, and also slowing down and smelling the roses.  I have to work on that today. I tend to be an overachiever, and there’s good and bad to that, but you can drive yourself crazy with it, and so I really had to learn to … Every morning, the first thing I do, I don’t even get out of bed. I sit up in my bed and I do 20 to 30 minutes of deep breathing, visualization, and meditation, and prayer. I’m not a religious person, but I do have a spiritual practice, and I believe that carries me through.

Dr. Weitz:            Right. Let’s get back to the medical advocacy thing. I think the thing that you emphasize in your book is how patients can often get swept under the system, moved on, not get the proper care, not get the proper testing. A lot of this is, I think, because the insurance companies are the ones driving the boat in healthcare, for the most part. I’m not sure that everybody realizes that. I think, a lot of times, people think, “Well, the doctors are running everything,” and that’s not the case, right?

Dr. Elkin:              I’ll give the perfect example, is my second hospitalization when I had back surgery that was, basically, botched up. They didn’t really correct the problem, number one, and number two, I ended up with permanent nerve damage. Here I am on, I think it was the third day post-op, and they wanted … My insurance, the nurse … There’s a discharge planner, and his or her job is to get you ready for discharge, be it home, or rehab, whatever.  She says, “Doctor, we tried everything we could, but your insurance won’t let you go to rehab. They want you to go to a nursing home.” I said, “Are you freaking kidding me? A nursing home at my age?” “Well, we tried everything we could.” I said, “No you didn’t.” I spent the next three hours on the phone, doped up on opiates with pain, fighting-

Dr. Weitz:            This is after your back surgery.

Dr. Elkin:              Yeah. Like two, three days later. I pleaded with them and I just said, “Under no uncertain terms. I will sue you,” so the next morning, I was wheeled over to rehab. Now, I had to do that on my own, and I’m a doctor. Can you imagine, the average person would be-

Dr. Weitz:            Oh, I see patients all the time, they have to wait months and months to get to see a specialist, tests are denied. I’m a chiropractor who treat patients for lumbar cervical disc problems. To get an MRI for the lumbar spine, from most insurance companies, they require X-rays, which are usually worthless, and at least six weeks of chiropractic or physical therapy, and then only if the patient meets certain criteria will they consider paying for an MRI.

Dr. Elkin:              It’s crazy, yeah. I could give you … I advocate for my patients as much as I can. There’s several medications that are extremely expensive in the cardiovascular field. Okay. What I have to do to get these things approved is ridiculous, and I’m talking to … I talk to a peer-to-peer … Let’s say I’m going to get a stress echo or a nuclear stress test on a patient, and my nurse can’t do it, then they do, what you do is called a peer-to-peer.   Now, that doesn’t mean I’m talking to a cardiologist. I could be talking to a gynecologist, pediatrician, but they call that peer-to-peer. I have to explain to them what I want to do and why I’m doing it. Then if it doesn’t meet their little script, I’m going to have problems. Now, because I’m so like a pit bull, I’m successful in probably 95%, 96%.

Dr. Weitz:            Right, but this forces you to spend an incredible amount of your time and energy, your staff’s time and energy just to get tests that are medically indicated by a specialist, and they’re not being denied by another cardiologist who’s assessed the case and decided they don’t need it. This is just some insurance company that’s trying to save money, and that’s all they care about, and they have some unqualified person on the phone reading from a script, telling you that you can’t get test A or B.

Dr. Elkin:              Bingo, you got it. That really is a problem.

Dr. Weitz:            Or approve drug A or B.

Dr. Elkin:              Yeah. It’s not getting better. In fact, it’s gotten worse.

Dr. Weitz:            Okay. I want to get on my soap box for a minute here. It’s not going to get better, and here’s the reason why. What matters are, number one, patients. Patients have very little power in the healthcare system. Now, you screamed and yelled, and you got some of the things you needed, and patients need to do that, but unfortunately, patients are pawns. Doctors, unfortunately, are pawns too. They have very little control in the healthcare system. They are controlled by insurance companies, and most medical practices … Your practice and my practice are exceptions, but most doctors these days are practices owned by a hospital system, and the hospitals are running it to try to make a buck.  I understand that, but it affects the quality of care. It affects what tests they can do. It affects what procedures they can perform. It affects what drugs they can prescribe. It affects how they can refer out. The key, the big players in the healthcare system are the insurance companies, the hospital systems, and big pharma. It’s the insurance companies, number one.  The insurance companies’ goal is to maximize their profit over the short term. In order to do that, they want to provide the least amount of care and charge you the most for premiums. That’s completely opposite of what the patients’ needs are. The patients’ needs are to get the best quality care at the most reasonable price, and those interests are completely opposite each other, and they won’t ever be aligned unless we transform insurance companies, make them non-profit, get rid of insurance companies. What the problem, in my opinion, is the insurance companies.

Dr. Elkin:              Absolutely. I could not agree with you more. When I wrote my book, and it was a 10-year process, it was really, yeah, I could get my story across because I set the stage by leading by example, how to be my own medical advocate, but it’s also I want to educate, and inform, and hopefully, inspire people, but it’s taken on a different … I’m on a crusade now since I launched it in October, and that is, wow, well, whose job is it?  Because, and I tell people on social media, I said, “We can’t expect our legislators, the government, Medicare, HMO, PPO, corporate-level doctors that are owned by hospitals, and chain pharmacies to take care of us, so who’s going to do it?” I say, “It’s an inside job.” We have to be more involved.

Dr. Weitz:            Well, I think, I totally agree with you, given the present system, that it’s the individual that has to do what they can. I think that it’s the job of people like you and me to educate some of the legislators and the public that what’s happening behind the scenes, because they don’t know why they’re not getting approved, a drug, or a test, or why the doctor’s in and out of the office in five minutes and doesn’t have time to answer their questions. We’ve got to let everybody know that it’s the insurance companies who are controlling things.

Dr. Elkin:              Exactly.

Dr. Weitz:            They’re deciding what’s going to be covered, how much they’re going to pay, what kind of quality care you’re going to get, and so I don’t think everybody understands that.

Dr. Elkin:              I’ll give you another example. My hospital, we now call … They don’t just buy out practices. They absorb them. I’m not quite sure what that word means. Anyway, so I’m one of the few lone rangers, dinosaurs.

Dr. Weitz:            Right. You have an independent practice. You haven’t let your practice be purchased by the hospital.

Dr. Elkin:              No, not at all, but I do admit patients there and I do procedures there, so I’m an active member of the staff. The difference between what I offer and the offer, they have to see … Because I have four or five colleagues in that hospital as cardiologists. They say, “We can only spend seven minutes with a patient. The nurses are knocking on our door, ‘You have to get out.'” Seven minutes, face-to-face with a patient.  Now, I don’t have a time limit. Sometimes, I spend seven minutes. Sometimes, I spend 10 minutes. If someone’s lost his spouse or significant other, it may be 15 minutes. Part of what I do is display my humanness in taking care of patients, spiritually, emotionally, as well as physically.

Dr. Weitz:            But you also have an integrative practice, and you have a broader philosophy.

Dr. Elkin:              Right. It employs different tactics in order to-

Dr. Weitz:            One of the reasons why you go to see a doctor and you leave with a prescription in five minutes is that that’s the easiest way to get in and out of the room.

Dr. Elkin:              Right.

Dr. Weitz:            For a doctor to go in a room and engage a patient in a complicated discussion, start letting the patient talk, and actually listen to them takes time. The easiest thing to do is find out what their main complaint is and write a scrip, and then you get to leave.

Dr. Elkin:              I think the biggest … I see this all the time. Let’s talk about statins for a second. I’m not downplaying statins. There is definitely a role for statins in the cardiology world, but I think there’s over-statinization, a little term that I made up. Because it’s easier for a doctor at a very busy corporate-level practice to say, “Hey, your cholesterol is really high. Take Lipitor, take Crestor.” What they’re really saying, “We know you can’t do this on your own, so take this pill.” What we’re doing is we’re disempowering patients versus getting them involved with their own care. It happens all time.

Dr. Weitz:            Right. We’re not even going to ask you to change your diet because we just assume you’re not going to do it.

Dr. Elkin:              Which is go low-cholesterol, low-fat.

Dr. Weitz:            Right.

Dr. Elkin:              Which was the thinking 25 years ago.

Dr. Weitz:            Let’s go, let’s spend a few minutes talking about, right now, the focus in cardiology is pretty much on LDL cholesterol. HDL doesn’t seem to be quite as important. All the controversy about LDL cholesterol seems to have fallen away, and there seems to be pretty much a unanimous thought that the goal of cardiology is to lower LDL cholesterol as much as possible. Lower your LDL to 70, lower it to 40. Lower it as much as possible and that will decrease arthrosclerosis, which is a major killer. What’s the problem with that thinking?

Dr. Elkin:              First of all, it’s kind of like one-size-fits-all, which is one of the many problems I see in traditional medicine today and the corporate world, because I have to look at the risk. Now, do I ever want to go below 70? 70, okay, 70 is kind of the approved level.

Dr. Weitz:            We’re talking about for LDL.

Dr. Elkin:              LDL. LDL, sorry. The lousy one. HDL, the healthy one.

Dr. Weitz:            Right.

Dr. Elkin:              It’s been this way for a few years now. We want to get people that have had coronary disease, history of coronary disease, have had stents. I’m one of them. Or a heart attack, or a stroke. The aim is to get the LDL in the 70 range or so, and that’s not new information. We’ve known that since the ’90s with the Forest study and other studies, so-

Dr. Weitz:            I’ve heard prominent doctors saying the goal should be 30 or 40.

Dr. Elkin:              Okay, but now … Thank you. With the advent of a new class of medication, it’s called PCSK9 inhibitors, which is basically Repatha and Praluent, which came out within two weeks of each other, now, they can decrease your LDL cholesterol by as much as 50 to 60% in as little as four to six weeks. Now, if we combine the two, we can get your levels 20 and 30, and below.

                                There’s a very prominent lipidologist, I won’t use, say his name, who advocates this. They even came out with a study saying, “Well, we’ve got two-year studies, and this can affect the brain.” Okay. People are on statins for years, possibly for life, so I don’t know what the long-term studies are on mental … We know the LDL cholesterol plays a positive role in neuroplasticity and also in building myelin sheath, which helps to protect the nerve cell, so LDL isn’t some bad, horrible villain. It actually is necessary, and especially in the brain.

                                I tell people, I don’t want a good heart with a bad brain, so I don’t go for the 20, 30. Now, do I ever go lower than 70? Yes. Now that I’m using the PULS test, if I’m finding people that are still at high risk despite doing all that we can, I may inch it down a little bit lower, but not 20 and 30. I don’t feel comfortable with that because there’s no long-term studies, and I do believe there’s a role for, that we do need LDL cholesterol for the brain, and most people in the functional medicine world agree.

Dr. Weitz:            We also need cholesterol for hormone production.

Dr. Elkin:              Hormones, Vitamin D, bile acids, several things.

Dr. Weitz:            Yeah, Vitamin D, Vitamin K, CoQ10. There’s a whole series of nutrients-

Dr. Elkin:              Absolutely.

Dr. Weitz:            … that are produced by that mevalonate pathway that statins and PCSK9 inhibitors block that won’t be produced by the body anymore.

Dr. Elkin:              It’s just so easy to give a drug, as opposed to really, like you say, take the time out to educate the patient.

Dr. Weitz:            Yeah, so-

Dr. Elkin:              It’s not that hard to do. I’ve been doing it for a long … You and I have been doing this for a long, long time, but the average doctor, if you got to get them out in seven minutes … By the way, they’re typing the note while in there, so you’re not really … I’ve tried that before. I cannot type, and look at the patient, and have my thoughts together.

Dr. Weitz:            Yeah, Now, the other thing we need to touch on is that the connection between LDL cholesterol and heart disease is nowheres near as strong many doctors today are claiming that it is.

Dr. Elkin:              I think, well, again, we’re looking at primary prevention versus secondary prevention. Secondary prevention, or in those patients that we know they have coronary disease. They’ve had a heart attack, they’ve had a stroke, they’ve had a stent, they’ve had bypass surgery, or they have high calcium scores. Now, I will tell you, in mainstream cardiology, this is from Cedars-Sinai, there are controversies in cardiology, that I go to every year. Last year, they were saying that if your calcium scan is greater than zero, you should be on a statin. I swear to god.

Dr. Weitz:            Right.

Dr. Elkin:              Can you imagine? I have a patient-

Dr. Weitz:            Well, they would do, remember the polypill that’s been discussed?

Dr. Elkin:              Yeah.

Dr. Weitz:            This is a pill, so this is the idea of mainstream medicine’s prevention is-

Dr. Elkin:              Hypertension.

Dr. Weitz:            Yeah. Is not, eat a healthy diet, exercise, stress-reduction, sleep, take supplements as needed. Their idea of prevention is take this one pill that includes a statin, metformin, a blood pressure medication, and maybe one other thing.

Dr. Elkin:              My question is-

Dr. Weitz:            They want everybody to automatically take this.

Dr. Elkin:              I know. How do you know what’s working, what isn’t when you have a combination pill? I like to know what’s working and what’s not.

Dr. Weitz:            People have discussed putting statins in the drinking water.

Dr. Elkin:              Yeah. When statins are in children … I even get adolescents with hereditary problems. It’s just too easy, and because less time is spent in patient care, it’s more reliance on drugs and procedures.

Dr. Weitz:            “Please give me some statins with my fluoride and my chlorine.”

Dr. Elkin:              Right, right. We could talk about this forever, and this is a problem, so that’s why the book is really … Yeah, my story just is a starter, and the meatiest part of the book is the fourth part, portion, which I actually go over, first of all, what is a medical advocate? But nutrition, and supplementation, and exercise, and stress management, and also aging in today’s world. [inaudible 00:33:37]

Dr. Weitz:            Oh, let’s talk for another minute about this LDL cholesterol.

Dr. Elkin:              Yes.

Dr. Weitz:            Outside of statins, we also have something called diet, and so what kinds of recommendations you make for diet? Now it’s pretty much not only gospel that LDL cholesterol is a cause of heart disease, but LDL cholesterol is caused by eating meat and saturated fat. What do we know about the studies, the research that saturated fat is actually the cause of arthrosclerosis?

Dr. Elkin:              Okay. That thinking dates back to the ’50s and ’60s. They were really flawed studies, and it was really made big-time in the ’70s, in which the culprit was saturated fat and heart disease. I want you to know that no studies have shown that saturated fat by itself causes death from heart disease or death from any cause. Yet, this has been promulgated forever. The Heart Association still recommend this.

Dr. Weitz:            By the way, nobody has ever come up with a mechanism by which saturated fat will raise cholesterol levels in the body or lead to arthrosclerosis because saturated fat doesn’t necessarily contain cholesterol, and most of the cholesterol in the body is produced by the liver, not coming from the diet.

Dr. Elkin:              Right. Saturated fat isn’t always the villain either. It can actually help decrease the size of the LDL particle, which we haven’t gotten into. It could increase your HDL, the healthy one.

Dr. Weitz:            And we have the Minnesota heart study, which was one of these several large-scale studies where they actually looked at a very large number of people. These were patients in a mental institution, and they were able to give them specific foods to eat so they could carefully control. It turned out that the patients that had … Some patients were given saturated fat, and some patients were given, I think it was corn oil or canola oil.  It turns out that not only did the patients who were consuming saturated fat not have an elevated risk of heart disease, but the patients who were consuming the omega-6, corn oil, I think it was, or safflower, or canola oil, one of those omega-6 fats, actually had an increased risk, and they also had an increased risk of cancer.

Dr. Elkin:              Which is, now those of us in this functional-

Dr. Weitz:            They had higher problems with mortality.

Dr. Elkin:              Right. Because those seed oils are pro-oxidant. Now that we know that inflammation is the real culprit behind coronary disease and all the diseases of aging, by the way, we now know that is a no-no, but yet the Heart Association is still touting canola oil as a very good, heart healthy.

Dr. Weitz:            Right, so-

Dr. Elkin:              We could watch a three-minute video …

Dr. Weitz:            … let’s emphasize that, is these polyunsaturated oils, which everybody is touting as a way to promote health, are very easily oxidizable. They have lots of free spaces where oxygen can combine with the hydrogens, and so you’ve got to be really careful of consuming these polyunsaturated oils. If they get oxidized, it’s the oxidation and the inflammation associated that is going to cause these fats to build up in the arteries, and saturated fats are less oxidizable.

Dr. Elkin:              Right. This is what your doctor won’t tell you, maybe because they don’t really know it themselves. They haven’t been taught this. See, doctors are really good at … I think the average doctor wants to help their patient, but they’ve had a skewed education in how to get there, and I’m not-

Dr. Weitz:            Well, I will say, studies on diet are so difficult to do. You know?

Dr. Elkin:              Right.

Dr. Weitz:            We’re relying on these studies from the 1960s because today, it’s very, very difficult to conduct these studies. Pretty much all the studies on diet now are simply asking people what they ate over-

Dr. Elkin:              The last few days.

Dr. Weitz:            … the last week, or month. 90% of people are horrible at remembering and being able to relay what they ate or how much they ate. I think studies show that like 90% of people underestimate the amount of calories they consume, the amount of carbohydrates they consume. People don’t know portions, so it’s hard to get the data from the dietary studies.

Dr. Elkin:              It’s true. Another thing that I really emphasize in my book on the section on supplementing … patient, because there are a lot of purists today that will still say, “We get everything we need from our diet.”

Dr. Weitz:            Right.

Dr. Elkin:              Well, the diet of today ain’t like the diet of 20 years ago.

Dr. Weitz:            Exactly. Factory farms that are overutilizing the soil, that are fertilized with industrial fertilizer. The soil is lacking in minerals. Food is stored in frozen containers. It’s cooked, it’s processed, so it’s very, very difficult to get the amount of nutrition from a diet that we used to be able to get. Most of the fruits and vegetables are raised in a hybrid fashion, so they’re sweeter, so they have less blemishes, and they often have less nutrition.  We need to try to, as much as we can, increase the nutrient density of our food by eating more organic fruits and vegetables, and pasture-raised meats, and wild fish, and nuts, and seeds. We need to make sure we get those nutrients so we can have enough antioxidants so we don’t have this extreme amount of free radicals and oxidized LDL, but that’s hard to do from the diet, so doing some reasonable nutritional supplementation, it makes a world of sense.

Dr. Elkin:              I’ll just give you an example. I was talking with Dr. Kara Fitzgerald, who’s very big now in longevity. She wrote the Younger You, Me book. Anyway, she was just saying about Vitamin D, also is a fact that I didn’t really know about. It can help improve not just your immune system, but actually longevity, has a positive affect on longevity. I wrote her back and said, “Yeah, did you see this story that came out about three or four weeks ago on Vitamin D, that we really don’t need it, that you don’t need to draw levels?” She said, “Yeah.”  We talked about how deeply flawed that study is, and that’s a problem with these peer-review articles on supplementation. They’re deeply flawed, and people need to know that. What happens, you walk away saying, “Well, I guess, there’s no sense in taking supplements, so I should wait until I get sick, and then my doctor will give me drugs.” I don’t think that’s necessarily the point, but that’s what people walk away with.

Dr. Weitz:            Yeah, no, Vitamin D has an amazing array of benefits for the human body. One thing, the first study that was, actually, been able to show that we could reverse epigenetic aging, the Fahy study, the primary interventions were growth hormone, DHEA, and metformin, but it also included Vitamin D and zinc, and those could also be significant players there, and they were able to reverse epigenetic aging. Of course, Kara Fitzgerald conducted her own study, and also with a nutrient-dense diet, she was able to reduce epigenetic aging. Also, with certain targeted supplementation.

Dr. Elkin:              This is the take-home information is that you have to go above and beyond if you want vibrant health. It’s not just … We have focused on sick care, the medical profession. We do a pretty good job of it, but let’s face it. We spend all this money on the last two years of life, last two years of life.

Dr. Weitz:            Right.

Dr. Elkin:              We spend more on gross national product than any other civilized country. I think we’re like number 28 or 32 on the list as far as … We don’t do well.

Dr. Weitz:            No, we don’t.

Dr. Elkin:              As a nation, we’re not performing well.

Dr. Weitz:            Yeah.

Dr. Elkin:              It’s not getting better, I think. I also just read that the longevity is going down in this country.

Dr. Weitz:            Absolutely. There is no doubt.

Dr. Elkin:              We’re going in the wrong direction, folks.

Dr. Weitz:            Yup, absolutely. Yup. Oh, yeah. Especially the last three years since the pandemic, and people staying home, and the average person gained 30 pounds. When you consider that people like me, who continued to work out through the pandemic and didn’t gain any weight, that means if the average is 30, a lot of people gained a lot more than that. Alcohol usage shot up.

Dr. Elkin:              Right.

Dr. Weitz:            I was looking at a set of labs from a patient who went to UCLA. I was looking down at their liver enzymes, and one of their liver enzymes was, I think it was their ALT was 65. I thought, “Wow, that’s elevated.” Then I looked at the reference range, and it said, “70.” There was an asterisk at the bottom and it said, “New reference ranges,” so what that means is-

Dr. Elkin:              It’s supposed to be 35.

Dr. Weitz:            Exactly, exactly, but because so many people have been overeating and overdrinking, and not exercising, and not breathing in oxygen through their mask and everything else, that the health of the population’s getting worse, so they just changed the lab ranges.  When you go and get labs done, you need somebody with a keen eye like you or me, who could discern what an optimal level is, and not just look at the lab range, because those lab ranges simply reflect the average person. Because the country’s gotten unhealthier, we simply increased the lab ranges, so now you’re normal.

Dr. Elkin:              People, the first question they ask me, they expect me to talk about low-fat and low-cholesterol. When I immediately go into sugar, the most inflammatory thing you can ingest, they’re like, “Well, my doctor never told me this.”

Dr. Weitz:            Right.

Dr. Elkin:              All these metabolic issues, nonalcoholic fatty liver disease, which is now the number one cause of liver transplant. This problem is escalating because people are so metabolically unhealthy. It’s a shame.

Dr. Weitz:            People, unfortunately, assume if you eat fat, cholesterol’s fat. Eat fat, get more cholesterol. That’s what causes heart disease, and the fact is, is 90% of the cholesterol in the body is manufactured by the liver. The liver manufactures cholesterol from glucose.

Dr. Elkin:              Right, right. Yeah, it’s a problem because this is what is still, is promulgated in the country, and that’s why-

Dr. Weitz:            Another big part of changing the healthcare system is not only changing the way healthcare is driven by for-profit insurance companies, and mind you, I understand. I’m sorry I’m hitting this multiple times, but I’ve been waiting for an opportunity to talk about this. Yes, the capitalist, for-profit motive is a great motivator for people to work hard, and I totally understand that, but when it comes to the companies that are controlling the healthcare system, that particular motivation is running contrary to what the needs of the public are, and so we need to change that.  We need to start putting a focus on prevention, and the insurance companies are not going to do that. People go, “Well, doesn’t my insurance company care if I get heart disease in 20 years?” I’m sorry, they don’t. They want to maximize their profit this quarter, so the stock can go up, so the CEO can get his bonus.

Dr. Elkin:              Right yet again.

Dr. Weitz:            In 20 years, who knows? In a year, you might be with another insurance company, you might be on Medicare. They don’t care at that point.

Dr. Elkin:              Right. That, kind of where I end up being the crusade with the book because I figured, okay, for you and I, we practice this kind of medicine. We believe in functional medicine. We believe in trying to find the actual root of the cause, of the cause rather, and employing lifestyle is number one, except in the case of emergency.

Dr. Weitz:            Right.

Dr. Elkin:              Yet, it’s not what’s happening globally, so I figured, okay, how many people can I possibly get on a one-on-one basis? Because this is what I teach all my patients.

Dr. Weitz:            Right.

Dr. Elkin:              It’s not unique to just one or two. Everybody that comes to me, they come to me because this is the way I practice, but how many can I possibly do on a one-on-one? It ends up being a great reason to have the book because they could at least read about a different way of life.

Dr. Weitz:            You can reach thousands and thousands of people that way. Absolutely.

Dr. Elkin:              You have to search for a medical provider that has your same interest. If you believe in supplements and they don’t, that’s a conflict of interest right there. There are plenty of people that are practicing functional medicine. You have to do a little research to find them, but we’re out there. I’m not the only one.

Dr. Weitz:            Right.

Dr. Elkin:              You know, so …

Dr. Weitz:            Yeah, and unfortunately, when it comes to supplementation, you can’t necessarily blame medical doctors for not understanding some of the benefits of supplements. The problem is that the leading medical journals, and I don’t know why this is, but they have a tendency to only publish the negative studies on supplements. You know?

Dr. Elkin:              Right. It’s not just like- [inaudible 00:48:12]

Dr. Weitz:            10 recent studies on Vitamin D, eight out of 10 have positive results. One of the two that didn’t show positive results, that’s the one that’s getting published in New England Journal of Medicine or the AMA Journal, and so that’s what conventional doctors are being fed, “Oh, there’s no benefit to fish oil. Oh, there’s no benefit to Vitamin D. Oh, there’s no benefit to …”

Dr. Elkin:              Also, Ben, what you’re talking about is that most-

Dr. Weitz:            Red yeast rice. Right? You saw that study showing that all these nutritional supplements that modulate lipids have no benefit.

Dr. Elkin:              When you are in medical school, you really aren’t taught to think. You’re not taught to be an independent thinker, so you really, unless … Doing the fellowship helps because you do what’s called Journal Club, and you learn to scrutinize studies, but when doctors are in practice, they don’t have time. They forgot how it was to scrutinize a study, so if the study has the negative result, that’s what sticks in their mind and that’s what they tell their patients.

Dr. Weitz:            Yeah, and unfortunately, a lot of doctors are not necessarily reading the journals.

Dr. Elkin:              No.

Dr. Weitz:            Even if they do read their journals, they tend to have very few positive studies on supplements, but most of them are not reading the journals because they’re so busy having to write in charts, and deal with insurance companies, as well as see a zillion patients. Then, a lot of their information comes from pharmaceutical reps who drop by the office with the latest information about the latest drug.

Dr. Elkin:              I have this thing. When a pharmaceutical rep comes, I’m very nice, but I’m going to ask … They don’t know that I’ve already researched the drug before they come in the door. Then, I have a series of questions. They say, “Hmm. That’s a really good question. Let me speak to my research division and we’ll get back with you.” It happens all the time.

Dr. Weitz:            Why don’t we touch on one more topic, and then we’ll wrap this up? You mentioned hypertension or elevated blood pressure. What is the ideal elevated … What is the ideal blood pressure, optimal blood pressure, and what level would make you feel like you need to prescribe medications? What dietary factors can move the needle on blood pressure?

Dr. Elkin:              It’s a very timely question. I want people to know that hypertension is still the number one risk factor for heart disease. I always label it number one. I did in my book and I do when I speak, because it affects the endothelial health, which we’ll talk about in a minute. I believe whether you’re 20, 30, 40, 60, 80, or 100, the ideal blood pressure is 120 over 70. Do I get that in every patient? Absolutely not. Because I would have to use multiple drugs and-

Dr. Weitz:            What about 110 over 70?

Dr. Elkin:              That’s even better.

Dr. Weitz:            Okay.

Dr. Elkin:              That’s even better, but here’s what people need to know. I think this is 2016. I forget when the new blood pressure standards were released. Anything greater than 130 for the top number or the systolic number, or 80 on the bottom, which is diastolic. Let’s say you have 131 over 81. That’s hypertension. That is hypertension, so lower is better in this case.

Dr. Weitz:            Yeah. I think it used to be up to 140 over 90.

Dr. Elkin:              When I was a student, 140 over 90 was considered borderline.

Dr. Weitz:            Right.

Dr. Elkin:              That clearly is not borderline. That is hypertension. 130 over 89 is considered borderline, so you’re right. We want it to be lower. People worry about low blood pressure. Believe me, there’s no concern about low blood pressure, unless you’re symptomatic. I think lifestyle is important. I think minerals, potassium, magnesium are very important in helping to lower blood pressure. This whole thing about sodium, it’s just been controversial since I was a student, about sodium restriction. It seems to bounce back and forth all the time. It really depends if you’re a sodium, if you’re a salt-retainer.

Dr. Weitz:            How do you know that?

Dr. Elkin:              Well, if you eat a lot of salt, you have to play around with your diet and experiment. I would say if you’re eating a lot of processed foods, that’s going to have a lot of salt. Anything processed has salt and sugar.

Dr. Weitz:            What you’re saying is, give sodium restriction a try. Bring your sodium levels … When you do decide to try sodium restriction, what amount of milligrams of sodium per day do you recommend, 2,500, 1,500?

Dr. Elkin:              Yeah, I think the CDC and the American Heart Association have two different standards, but yeah, 2,500 to 3,000 is enough. I don’t usually go much different than that. I might even go as high as 5,000. It depends on the individual. Certain diets require salt. If you’re on a ketogenic diet, you need to have salt. Then, certain people actually need salt because they have dysautonomias. They have autonomic nervous system problems, so again, it’s not one-size-fits-all, but I do, CoQ10 I find to be useful, fish oil. These all have an additive effect. These are the ones I try to use much, I try to use first.  Exercise is essential. Exercise actually relaxes the arteries. There’s less pressure for the heart to pump, so that will lower your blood pressure. Not just aerobic exercise, also resistance training on a regular basis will also do the same. Again, it starts off with lifestyle. Do I use medication? I do use medication if I can’t get it down with these simple measures, but because I do think blood pressure control is still the number one risk factor, and I want to make sure we do it. And sugar. Sugar also has a positive role on blood pressure. No one even suspects that. They always think it’s salt, salt, salt.  Modest salt restriction, if you’re hypotensive. If you’re not, I don’t care how much salt you eat, so modest salt restriction. Plenty of potassium, which is going to be found in fruits and vegetables, and other foods. And magnesium’s important, CoQ10, and fish oil.

Dr. Weitz:            Okay.

Dr. Elkin:              There’s a few other things. Olive leaf extract. I have my own product called PressureWise, which has olive leaf extract, quercetin, and grape seed extract. There are other supplements out there that can be additive as far as lowering blood pressure.

Dr. Weitz:            Cool. Thank you, Howard. Let’s wrap it up. How can people find out about you, and having you help them with their health journeys, and where can they get the book?

Dr. Elkin:              Here’s my new book. You can see this.

Dr. Weitz:            Okay.

Dr. Elkin:              If you want to read about it, I have two websites. One is heartwise.com. That’s my practice website, but the one that really is solely about the book is beyourownmedicaladvocate.com. It’s a big name. Beyourownmedicaladvocate.com. You’ll read about the book. You’ll read about, I did a pre-launch with people that read the book and reviewed it beforehand. That takes you directly to my Amazon page where you can buy the Kindle version for 9.95, and the softback for 18.95. Please get the book, share it with your friends, and if you would be so kind as to write me a review, I would appreciate it.

Dr. Weitz:            Then they can contact you, if they want your help, from your website, heartwise.com?

Dr. Elkin:              Yes, yes, of course.

Dr. Weitz:            Okay. Thank you, Dr. Elkin.

Dr. Elkin:              All right. Thank you so much. It was great. Always a pleasure.



Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way, more people will be able to discover the Rational Wellness Podcast.  I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic and Nutrition Clinic, who many of whom, most of whom we’ve been able to help with a range of various health conditions, from various types of gut disorders, to thyroid and hormonal issues, autoimmune diseases, and various other cardiometabolic conditions. I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health.  I wanted to let everybody know that I do have a few openings now for new clients. You can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111, and we can set you up for a new consultation for functional medicine, nutrition, and we can get that going as early as the new year, so give us a call. I’ll talk to you next week.



Geranylgeraniol, the Latest Anti-Aging Molecule, with Dr. Barrie Tan: Rational Wellness Podcast 291

Dr. Barrie Tan discusses Geranylgeraniol, the Latest Anti-Aging Molecule, with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

6:25  Geranylgeraniol (GG).  GG is part of the mevalonate pathway, which is the pathway by which the body produces cholesterol and which is inhibited by statin medications.  But statins also inhibit the production of GG, which is required in the synthesis of CoQ10 and also in the synthesis of skeletal muscle protein, which is why statins can lead to myopathy.  Therefore, if you are taking a statin you should consider taking at least 100-200 mg CoQ10 and also 150-300 mg of GG.

14:45  Statin drugs like Lipitor have been shown to reduce the severity of COVID-19 by inhibiting the entry of the COVID virus into the cell.

16:15  GG is found in small amounts in food, but the foods that it is found in the largest quantity are castor oil, flax seeds, carrots, tomatoes, and olive oil.

18:30  GG can help us to build muscle.  GG is required for the synthesis of skeletal muscle and as we grow older, don’t make enough GG and if we take statin drugs, we will inhibit GG further.  Dr. Tan is planning a study to test the use of GG to build muscle and muscular power and performance.

25:55  GG can also increase testosterone levels, which was discovered by Japanese scientists.  Dr. Tan noted that they have a clinical trial in Florida to see if GG improves sexual health in men and women.



Dr. Barrie Tan is a PhD in chemistry and he is world’s foremost expert on vitamin E.  He is credited with discovering tocotrienols, a form of vitamin E, in palm, rice, and annatto, with annatto being the most efficient source, since palm and rice also contain substantial amounts of tocopherols and alpha tocopherol inhibits tocotrienols. He produces an Annatto Tocotrienols and a Geranylgeraniol product through his American River Nutrition company.  He is also the Chief Science Officer for Designs For Health.  Designs For Health supplements are professional supplements sold through licensed doctors and practitioners like myself.

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.



Podcast Transcript

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, I’m very excited to be having another discussion with one of our favorite guests, Dr. Barrie Tan, and today we will be talking about geranylgeraniol, I hope I pronounced that right. We had Dr. Tan on a recent podcast, in episode 284, and we planned to discuss both tocotrienols and geranylgeraniol, or GG, but we only had time for tocotrienols because the research and data on tocotrienols are so fascinating and complex. But I really want to learn more about this interesting new compound geranylgeraniol and what implications there are for our health, so Dr. Tan is back.

Dr. Tan:                Thank you. Thank you for inviting me. I’ve always enjoyed being at your show and able to explain things that are mutually helpful for our wellbeing and health, so this is very exciting. Looking forward to the GG discussion we didn’t get to have in the first round.

Dr. Weitz:            Exactly. Hey, Dr. Tan, why don’t you introduce yourself? Tell us what the listeners should know about you.

Dr. Tan:                Oh, thank you for asking. I started my career 40 years ago as a chemistry professor at the University of Massachusetts, right here in Amherst, and I’m still here in the next town over where our factory is in Hadley, Massachusetts. It’s about two hours inland from Boston and an hour north of Hartford, so cold New England, classic New England place, so here’s where we are. In the time that I’ve taught chemistry, I noticed that there’s a tug in my heart to take me to the area of nutritional health, as opposed to other chemical aspects that other people start study. Then, somewhere in the passage of time, I already had gotten to study tocotrienol at the time, this special Vitamin E. I went to South America to look for a plant called marigold for lutein and zeaxanthin, good for macular degeneration, everybody know that. And then fate has it, literally 30 feet away from me, I found this beautiful plant called Annatto. You can see that if I pretend to scratch it, it stains the finger. Those red color is for coloring cheese, if you ever go to Trader Joe’s or Whole Foods.  It’s not a strange plant, it’s just not grown in the US that we are familiar with it. However, I should qualify, not grown in the US, correct. If you go to a botanical garden on the warmer side of the US like Southern California, Florida, you’ll probably see this Annatto plant and it’s popularly nicknamed the lipstick plant like that. If you, however, have the chance to vacation in Hawaii and you just ask anybody, “Where can I find Annatto plant?” They’ll show you. But most of our Annatto, we got from South America, which was my fateful trip that I found this plant. That was 25 years ago and ever since then, I’m lockstep into committed to study the tocotrienol. Now, how is that connected to GG? This is actually true. Yes, I am a scientist, very passionate, but sometimes, luck travels the path of those who are conscious studier. I extracted from this thing here, first, I removed the color and then I found out that the antioxidant that protects the color is tocotrienol.   Sure enough, I got it, then I thought, oh, this is good enough for me to have discovered something in the Amazonia like that, but at the bottom of the pot, I still see about 1% to 2% something else. I’m a chemist, I’m curious, hey, that 1% or 2% is not the color, is not the carotene, then by golly. It’s an oil, light yellow-orangey color, I need to know what it is. And then I did and I said, “What is this compound called geranylgeraniol?” It was really not like somebody said, “I have always, from day one, studied GG,” it’s not like that. It was in the bottom of my pot and I said, “GG, geranylgeraniol, what in the goodness is this?” Then I found out that GG, it is the last common step between the plant and the animal, which means the mammal. This is really cool, in the plant kingdom, now, we are careful-

Dr. Weitz:            Dr. Tan, not only are you brilliant, but you are the most enthusiastic scientist I have ever met.

Dr. Tan:                Thank you. Let me finish up and then we’ll get to the [inaudible 00:05:30] side. In the plant kingdom, every day, you eat your vegetables, that orangey-yellowish color, the fall foliage in New England, the color in carrot and the color in tomato, those are carotene. Every carotene needs two GG molecule to start making it, in the plant kingdom. Chlorophyll, what plant is it without green color?  Chlorophyll has GG in it, so it is essential for GG in the entire plant kingdom.  Now, you’re going to say, “Okay, Dr. Tan, I got it, so tell me something about human beings.”  How about this?  You’re going to ask me questions, then I say, “Why is GG essential in the human body?” I just told you about the plant.  I don’t want to steal your question, as you ask me, I’ll try to answer them.

Dr. Weitz:            Well, GG is a part of the mevalonate pathway and a lot of people talk about GG in this context, so I thought it would be important for you to explain what is the mevalonate pathway, which, by the way, is the pathway by which human beings produce cholesterol in the liver and it’s also the pathway that is inhibited by statin medications.

Dr. Tan:                Yes, I like to explain this this way, Dr. Weitz, if you think of the mevalonate pathway as Interstate 95, I purposely do that. I know we have a lot of interstates, but no interstate in United States is more traveled than 95 from Maine to Florida, because most of American lives on the East Coast, so it’s obvious like that. But cholesterol synthesis is ultra important. The only hypercholesterolemia we are dealing with that because of arteriosclerosis, otherwise, every cell in a body requires cholesterol to live and to survive, enough that about 9 to 12 Nobel Prizes were given to cholesterol and how cholesterol worked. Now, come inhibiting cholesterol, because of arteriosclerosis and plaque, you think of using statin. I purposely use Interstate 95, statin inhibit cholesterol in Boston, that juncture. If you inhibit it in Boston, cholesterol synthesis is in New York, so downstream from Boston and then at New York, you pluck it up in Boston and then the cholesterol synthesis is not able to mix so much in New York City and hands the cholesterol drop. That is what you desire, you block it in Boston like this.   Now, that is what statin does. Few people ask the question, “If you block it like that, what about in Washington DC?” Now, in Washington DC, it’s a unassuming compound called geranylgeraniol, or GG, it is part of the mevalonate acid pathway on the Interstate 95. It’s not going to change, it is there, so then the audience asks, “What’s the big deal if it inhibit GG on the Interstate 95 in Washington, DC is like that? What is a big deal if you inhibit in Boston and cholesterol drop?” Well, let me tell you the big deal. As alternative as we are as a health professional, we have heard many a time when you inhibit cholesterol synthesis using statin, CoQ10 drop. You can even buy a CoQ10 in Costco that say, “CoQ10 drop as you take statin, it go up.” The public even directly know that.

                                Why do I say that? Because GG is required in the synthesis of CoQ10, so if you inhibit GG with statin, CoQ10 drop, that is known. Next, the doctor who gave you statin, he or she cares. He said, “Mrs. Jones or Mr. Jones, do you have any back pain, muscle problem?” They’re fishing for myopathy, some muscle problem. That is because GG is required in the synthesis of skeletal muscle protein and they’re fishing for any muscle problem like that. There you have it, so if you use statin to inhibit at Boston, then cholesterol reduction in New York City and GG is reduced in Washington DC and for GG, it bifurcate in different direction. In this direction, CoQ10 drop, because it’s needed and in this direction, myopathy on muscle drop, so there you have it. That’s the reason why people who take statin drug should consider taking CoQ10 and in addition, should consider taking GG, CoQ10 because it directly inhibit CoQ10 drop and GG so that they will block any possibility of muscle problems.

Dr. Weitz:            This is a little bit off-course, but I sometimes think of things. Wouldn’t it be better, and I know this is not part of the GG, necessarily, to come up with a way to block cholesterol synthesis more downstream, because the statin is so upstream that it affects all these other things? Right now, statins are enjoying this huge increase in usage and people are saying they’re the answer to everything from heart disease to cancer, but because it’s so far upstream, it has all these negative effects. You mentioned myopathy, we’ve got blocking CoQ10, we’ve got blocking Vitamin K, we’ve got possibly interfering with Vitamin D, we’ve got all these other negative effects affecting mitochondrial function, et cetera, et cetera. Ideally, when you look at that pathway, wouldn’t it be better to have a more downstream compound that blocked cholesterol?

Dr. Tan:                Yes, people have explored it. That’s a very good question. For example, probably 20 years ago, Bristol Myers Squibb had a project they inhibit… Here is Boston and here is New York City and here is Washington DC. Actually, it is like that. Between Boston and New York City is New Haven, so they decided that how about we block New Haven? They tried that and that’s called squalene synthase inhibitor. Squalene is required for the synthesis of cholesterol, but it is not quite yet a cholesterol, so they inhibit squalene. It did work, however, it did not work as dramatically and as powerfully as a statin drug, even though the statin drug was much higher.  That means the ability of statin drug to inhibit something so far up and so far down, you still experience cholesterol to drop, GG to drop, and as a consequence, CoQ10 and muscle problem happen, it’s because they could not find a drug that is as effective as statin enough that now, all the statin drugs are out of patent, so they’re kind of inexpensive. Now, the fancier drug doesn’t work on the mevalonate acid pathway, instead it works on the receptor, how to receive the cholesterol. If you nail down the receptor and therefore, the cholesterol is not accepted well and then the cholesterol drops precipitously and one of them, I’ve forgotten them what the name is, you directly inject into your intramuscular and then it drop and it is applied once a month or something.

Dr. Weitz:            The PCSK9 inhibitors.

Dr. Tan:                Yes. That is not directly working on a mevalonate acid pathway and you have to endure injection rather than a pill and it’s quite expensive like that, so still, people stay with the statin usage. You mentioned statin is used pleiotropically. Besides cholesterol lowering, you can go to the American Diabetes Association, they ask that it would be beneficial on all diabetic to take it, not necessarily addressing sugar, to take it so that they’ll reduce cardiovascular event in diabetics, so you have another subset of people.

Dr. Weitz:            Unfortunately, it increases diabetes.

Dr. Tan:                Right. I agree, it increases diabetes, which is just an oxymoron. And then, now, I’m not pushing any agenda, but I encourage the health professional listener to do this, after 20 or so small molecules are tested to help reduce the severity of COVID-19, the one that is head and shoulders above all else is statin drug. You will be surprised, the ability of statin drug to inhibit cholesterol synthesis is inhibiting the entry of the COVID virus to go into the cell. I’m not putting any funny monkey business on this. You should go online… In other words, for every 20 papers published on COVID and statin, they are probably all the other 19 small molecules published, so it is head and shoulders. Right now, they have shown that those who take statin drug reduce in-hospital severity, reduce in-hospital death. All that to say the amount of possibility of people taking statin drug would even grow much higher and balloon more, which means a way to address the cause of myopathy is not there, and it’s a simple endogenous molecule called GG that would help to reduce the severe muscle symptoms.

Dr. Weitz:            We’re going to get into all the different potential benefits of GG, but anytime we have a discussion about nutritional compound, some people are always asking, “How can I get it in food?” Now, I’m already sold, I’ve already added GG to my nutritional regimen as far as supplementation, but maybe you can talk about what foods GG are found in.

Dr. Tan:                The good news is GG is found in most food, the amount is very small. Why is it small? Because GG in the plant is well-conserved. There are very few plant where GG, you can find it. One is not really a food amount, it’s called castor oil. You use castor oil as a replacement for mineral oil in the car, so you can’t consume it, it is found there. And then, of course, I stumbled onto this Annatto-

Dr. Weitz:            Don’t eat castor oil because that’s where they make ricin from, which is one of the most toxic poisons.

Dr. Tan:                Yes. You asked me so that… I think that in other foods, foods where you see the natural color, like carrots and-

Dr. Weitz:            I think flax is reasonably high in GG.

Dr. Tan:                Yes, flaxseed. Carrots and tomato, where you see color-

Dr. Weitz:            I think olive oil, also.

Dr. Tan:                Yes, thank you, olive oil, flaxseed oil. If you look at South American fare, they use Annatto, you pound them, you can see it. Usually, vegetable oil will contain a small amount. How small is small? Probably one to three, at most, five milligram, like that. Most of the activity that we have seen that would work would be approximately 115 milligrams.

Dr. Weitz:            Let’s go into all the various potential health benefits of GG.

Dr. Tan:                The first one, let me just reiterate it and then we go to the other two, and that would be that GG is required for the synthesis of skeletal muscle protein, just leave it like that. In other words, approximately 30-40% of a human weight is skeletal muscle like that. Sometimes I like to say this, in order to make it clear, people take heap full of amino acid and heap full of protein so that we can gain muscle. There is a place in it, but it’s kind of naive to say that if you take this protein and amino acid, it magically will become the protein in your body. Protein in a body is very specific.  Let me give you some simple illustrations. The average molecular weight of an amino acid is 120. The average molecular weight of a protein is 120,000. Of course, I purposely do that so therefore, if your average molecular weight of a protein is 120,000 and amino acid is 120, so every protein will have 1,000 amino acid, that’s a average one. We’re not going to do that big average. Let’s say a very small protein, insulin, insulin has a molecular weight of 6,000, it is considered a very small protein. If you think of the amino acid in the body in a tick… I’m dragging you back to biochemistry.  We have 20 essential amino acids, so if you have a tiny, tiny amino acid that have 20 amino acids stitched together to make a protein, the way in which that 20 amino acid will be stitched together, the probability of it is 1:20 to the power of 20.  20 to the power of.  20 is much larger than the number on Google, if you Google the number like that.  Therefore, when we make protein, the body uses our nucleic acid DNA and RNA to make those nucleic acids. As this big protein albatross is being made, an unassuming compound, it’s called GG, which is not even an amino acidic, it hooked onto the protein until the protein is fully made and then the protein is delivered. That kind of protein, typically a GG, is used for a skeletal muscle protein.  As we grow older, we don’t make enough GG and therefore, we are unable to make adequately skeletal muscle and that is called sarcopenia.  If we further take statin drugs, that will induce even more muscle problems like that, so that would be the muscle piece. Another one-

Dr. Weitz:            Wait a minute, Doc, this could potentially be huge for sports medicine, for so many benefits in terms of skeletal muscle synthesis. GG could be the next big sports supplement taken by people who work out, right?

Dr. Tan:                Yeah. We are trying now how to design a study on sports medicine? We are not yet started on that, we are trying to design how to do this. We hope that in the next year, 2023, we might be able to engage in something like that, the second half. This kind of thing takes approval, time, and these procedures to do, so we’re working on that. The reason we are this excited, Dr. Weitz, is because American River, an R&D company right here in Massachusetts, we are the first company in the world making GG, so right now I’m trying to figure out how can we prove what GG is used for an advantage in the human body?   That is a very powerful one to help the elderly in retaining muscle mass loss. Of course, exercise is still important to do that and if they take drugs like statin and then it’s a double whammo, they will do more. Can you imagine if you’re 60, 65 years old and then you’re losing muscle mass and you’re taking statin to mitigate cholesterol, you have Type 2 diabetes and the doctor asks you to take, then this will be a special case in which this is good. On the other extreme, if you are a 20-year-old exercise sports medicine and that can also increase muscle, power, and performance.

Dr. Weitz:            Do we know what the mechanism is, how GG leads to skeletal muscle synthesis?

Dr. Tan:                GG helps skeletal muscle synthesis in that as the DNA is putting one amino acid onto the protein, one amino acid at a time, it is specific. If you think of a protein having 20 amino acids and we have 20 essential amino acids, you put them one at a time, so when the protein is half-made, it is already about 50,000 molecular weight. It is already looking like an albatross. When the protein is half-made, something is hooked on to the entire half-made protein. That hook that holds it to is GG, so it’s actually holding the partially synthesized protein until it’s fully made, it detaches, and then it’s shipped to the site of activity. It is actually like that. There are no other thing there, it’s just a hook that is holding onto the protein as it is being synthesized in the DNA.

Dr. Weitz:            I know we were going to get into this later, but right now, just for the sake of skeletal muscle synthesis, what would be your best guess for a good recommendation for the amount of GG that could be taken in supplemental form for that purpose?

Dr. Tan:                I think that for that purpose, it is somewhere in the range of 150 to 300 milligram, no more than that. Currently, two of our current trials that we have, one group is 150, the other group is 300, it did not include exercise signs. We don’t see a reason higher than 300 currently. It looked like, from all the animal studies that I have gathered and then if I translate the human study, they all [inaudible 00:25:43] to somewhere between 150 to 200 milligrams, so I deemed that somewhere 150 is a good starter and 300 is the higher ones that I can imagine.

Dr. Weitz:            Since we’re talking about sports medicine and GG helping with skeletal muscle synthesis, GG could be a double whammy because it also plays a role in testosterone synthesis, isn’t that correct?

Dr. Tan:                Yes. That finding was first disclosed by Japanese scientists probably about three to five years ago and then they are helping the elderly population to have thrived. As you know, when the testosterone is high, they’re able to retain muscle mass in the elderly, so they have thrived, as they were, because of the elderly population there. Encouraged by that, we have a clinical trial in Florida where we have given one group 150 and the other group 300 milligrams to see if this would increase in the men’s sexual health and in the women’s sexual health. When do we expect that result to come out? Probably in the new year, in the first quarter of 2023, so it will be coming soon. Keep in touch with me and send me an email, I’ll let you know what the outcome is. But we have waited and designed that study all of 2022. A lot of these studies takes time. It is a three-month study, but it took us a while to put it all together.

Dr. Weitz:            Wow, very exciting.

Dr. Tan:                Thank you.

Dr. Weitz:            Let’s talk about how GG can be a good adjunct to somebody who’s taking a statin medication by preventing the decrease in CoQ10 and the decrease in the other factors that can result from statins, like a depression of cellular energy and impaired mitochondrial function.

Dr. Tan:                Let’s touch the CoQ10 piece. I’m going to just step aside so that the audience can see the video. When I step aside, if I’m fading, let me know, on the voice. In the front molecule, that’s the molecule of GG. The red color on that place, that is the oxygen and OH group, so the black color is the carbon backbone and the white color is the hydrogen, so therefore, that’s GG the body makes. On the backdrop, that is a large albatross molecule of CoQ10. See that? If I put this forward, that’s CoQ10 in the background and the antioxidant is way on the other end there, there’s antioxidant here. You see the long background here? That entire background-

Dr. Weitz:            Doc, when you go too far to that side, we stop being able to hear yet. There you go.

Dr. Tan:                Sorry. The entire tail of CoQ10 is from GG, like that here, so therefore, GG is used in the human body for the biosynthesis of CoQ10. Now, as the audience listening, we all know the famous CoQ10, we probably never heard until now that GG is required for the synthesis of CoQ10 in the human body. Now, remember, before you take CoQ10, CoQ10 is made in the body. If our body does not make CoQ10, we cannot live because it’s required for the ATP conversion. Magic didn’t happen because we have CoQ10 in the business world to sell, magic happened because our body makes CoQ10. The piece that I want to add for the audience to know is GG is required for the synthesis of CoQ10. This is a first-time GG molecule and that’s to show you that. If you take GG, then understandably, whatever you know about CoQ10, then GG is good because GG makes CoQ10 for the mitochondrial function, also helpful in people with dementia, because GG is in the brain and have good CoQ10 and CoQ10 is able to support brain health.

                                But there’s another piece that I’ll put on now that also touches on the brain health and bone health. I’ll use another metaphor here. When you take green leafy vegetable, we get Vitamin K. That’s the Vitamin K that would go in the body and seals the tear so that it would clot, say if we have a tear inside our artery, then it would clot, you need Vitamin K. The two scientists that discovered them got the Nobel Prize in the 1940s. Later in the 1970s, another Nobel Prize was also given to Vitamin K because those scientists were further able to explain the way that Vitamin K worked was it had to go to a certain process and then it create a protein, so it’s Vitamin K-related protein synthesis, and that is able to nail it to make the clot. In the same passage, that Vitamin K that makes the protein also traps the calcium and takes the calcium to the bone, so therefore Vitamin K is also connected to strong bone health.   Now, the audience is probably saying, “Wait, wait, wait a minute, Dr. Tan, isn’t that supposed to be Vitamin D?” Yes, Vitamin D is related to increased bone health, but Vitamin D does not have the power, the charm, or the explanation and the beauty of the Vitamin K explanation. Man, without the protein made that is caused by Vitamin K, that protein is not made and the calcium is not moved to the bone, so that’s a Nobel Prize, the Vitamin D help like that. Let me go back-

Dr. Weitz:            Moving the calcium to the bone also is removing it from the artery, so it reduces arterial calcification.

Dr. Tan:                Amen to that, but let me say how that is done. You take dark green vegetables like kale, like spinach, like broccoli, intentionally, I’m going to do it, that is Vitamin K1, green color [inaudible 00:32:22]. Now, if all the Vitamin K we take is consumed, let’s say the person is a vegan, completely eating food like rabbit food, you would think that they would probably clot to death. Vegans do not clot to death because they will consume so much Vitamin K, when they don’t. The reason is because at the gut, we have hemostasis, a fixed amount of Vitamin K goes in, so where does the other Vitamin K go? Just follow me through with this, this will be really beautiful. You look at this, right at the gut is hydrolysis, hydrolases enzyme, they cut that off, this is both from the plant and the tail, which is saturated from K1 which flushed away.  This is not from human being, it’s too green color. This ring goes inside the body and it locates 25 to 30 organs, this is really magical. It look for this molecule, intentionally red because it’s in human body. It’s the same length as the tail, exactly the same as the tail, but it is partly unsaturated, that is GG in 25 to 30 organs. This was from Vitamin K and they stitched together, they’re called transferase enzyme. I purposely make the sound, that’s it. This is MK-4. This is MK-4 and this is not going to change. It is not molecular biology, not nutrition, it is pure biochemistry and it should be in the textbook. This Vitamin K2, ladies and gentlemen, is MK-4. This MK-4 is supposed to be in a body to sweep the calcium away from soft tissue, like in the artery that Dr. Weitz talked about, and sweep this to the bone. Approximately 90-95% of calcium is found in the bone. Yes, the soft tissue needs calcium, but only a small amount, the balance is 95 to 5.   It’s very easy to go out of kilter and then you will have arteriosclerosis, kidney stone, or gallbladder stone like that, we need this to go there. How do you sweep the calcium to go to the bone where you can have strong bone, particularly when you grow older? This is the molecule, MK-4, it makes the protein and sweeps it to the bone and a lot of study on this. Where do you get this compound? You get this compound by this guy here, that GG. Without the GG, it cannot step onto the ring, you cannot make MK-4. However, truth be told, the ring, the human body cannot make. That’s why this is a very unusual compound, the half piece is from the plant and the other half piece is from the human body. But as we grow old, we don’t make enough this guy and this guy, we will forever be thankful to the plant, our human body cannot make it, this guy. I hope that this is a take-home message, MK-4 is synthesized in the body.

                                Now, the audience is now drawing a little bit and say, “Dr. Tan, are you telling me that menaquinone is made the human body? I thought I was told all menaquinones are made the gut by fermentation? I can tell all kinds of things, Japanese nattō, cheese, blah, blah blah, kimchi, this and that. Yes and no. Yes and no. When you think of fermentation in the gut, they make much longer tail like MK-7, MK-9, MK-11 and 13, that is good for the gut health like that. There is an MK-7 supplemented in our body to shuttle the calcium to the bone, yes, but keep in mind the only menaquinone made inside your body not because of fermentation, exclusively, I may say, is MK-4. Because the human body make MK-4, I implore the audience, please find out why the human body makes MK-4 exclusively, that is never going to change. Yes, in the gut, MK-4, 7, 9, 11 and 13.  Agree, no argument, but the body, in at least 25 to 30 organs, makes MK-4. Because of that, I think that there is a unique place for GG that is made and once we grow older, we simply don’t make enough GG, so if I may say so, I would say GG is, until now I’m going to purport, is a true anti-aging endogenous nutrient. If I will have one take-home message for this holiday season it’s I’m going to walk away with the understanding GG is a true biological and biochemical anti-aging endogenous nutrient.

Dr. Weitz:            We need a new song, Deck the Halls With GG. It sounds like we have a marriage between Vitamin D, Vitamin K, and GG, and it sounds like it makes sense for all of those to be taken together.

Dr. Tan:                Yes, I take them together. Designs for Health sells a product for the GG and the tocotrienol, I think they call it Annatto-E GG because they’re both from Annatto. For the piece, if somebody is taking statin drug, you know they inhibit GG and you know that when you take statin drug, CoQ10 drop. Designs for Health has a product called CoQnol, where you have ubiquinol plus GG, so that combination would be particularly and specific for someone that’s taking statin. Then, say, for example, Ben, my parents are elderly and then they have sarcopenia. They don’t otherwise taking statin, then if they’re sarcopenia, they simply have loss of muscle mass, then taking GG would help them improve and thrive and maintain any muscle mass loss, so it will be that piece.  On the MK-4 one, if any of us have calcification of the artery, kidney stone, gallstone like that, if we take GG to induce the making of MK-4, then more calcium will be swept to the bone, or taking a combination. I believe they are companies out there, Designs for Health have a product called Tri-K, which is a menaquinone product with some GG in it and Vitamin D in it. If you look online, you’ll see it, and other companies do. Or if they don’t have it, take a combination of menaquinone plus GG and then that will be able to ensure that the calcium is going to the bone and not [inaudible 00:40:13] in other parts of your body, like the artery.

Dr. Weitz:            Cool. For preventing statin-induced myopathy, what would be the best dosage for GG?

Dr. Tan:                I would say that if a person is taking a statin drug probably and have no complaints of muscle problem, then 150 milligram would suffice.  If a person that takes statin drug and the cardiologist’s imploring them that they have to stay with it and then they’re experiencing muscle pain or myopathy… By the way, you can Google online and study this, it’s called SAMS. S-A-M-S. It simply means statin-associated muscle symptom. If you just type in statin-associated muscle symptom, the audience can go online and look and see all this cluster, sometimes the cardiologist downplay it, but the patients themselves know. If you have SAMS, then consider taking 300 milligram. When you do take the GG, just take it with a meal, it’s oil-soluble, as is with the tocotrienol and as is with the CoQ10, these are lipid-soluble. If you take it with a meal, it emulsifies and absorption is increased.

Dr. Weitz:            Now, not only can GG reduce some of the negative effects of taking statins, but I understand that GG can also reduce some of the side effects of bisphosphonates, which are medications taken for osteoporosis, including reducing osteonecrosis of the jaw, which is a horrible side effect where you lose the bone in your jaw as a result of trying to increase your bone density by taking Fosamax and other bisphosphonates.

Dr. Tan:                Thank you, Dr. Weitz, for bringing this up, I nearly forgot it. Now, of course, in the class of people taking statin compared to the class of people that take bisphosphonates, there’s a big difference. A lot more people, men and women, take statin and largely women take bisphosphonates. Also, bisphosphonate is used for tumor metastasis, for people who the cancer have metastasized to the bone, they take bisphosphonate to kill the tumor inside the bone. When people take this bisphosphonate, it is true, bisphosphonate, again, go back to the mevalonate acid pathway, bisphosphonate inhibits precisely at New Haven. Now, statin inhibits in Boston, bisphosphanate specifically inhibits at New Haven. When bisphosphonate inhibit at New Haven, then, once again, in Washington DC, then GG is inhibited. It really is like that, I know I say it cartoonically. When you inhibit in New Haven, it’s inescapable that it inhibit in Washington DC and once again, when it inhibit there…  But then this is very specific, it happened in the jawbone. In other words, when the bisphosphonate entered to the bone thing in the jawbone, it actually inhibits the GG synthesis in the jawbone. The GG is required for the protein synthesis of the jawbone, so if you inhibit the GG there, then there’s no available GG for making the protein in the jawbone. What’s the consequence? The jawbone begins to die, necrosis means death, so therefore is BRONJ, bisphosphonate-related osteonecrosis of the jaw. If the audience are taking bisphosphonate, please go online to read for yourself, BRONJ, and then you study and read how often this is happening to people. How about you assume that you don’t take anything Dr. Tan said? I’m not offended. You will Google online, please do that, you go BRONJ and GG, or geranylgeraniol, and you will be surprised, you’ll come to your own conclusion on how GG has been decimated by bisphosphonate that causes BRONJ.

                                Full disclosure, everybody that has studied BRONJ with GG, I don’t know them. I only know them after they published their work, so they have zero influence for me. Since then, they have come to know about me and they asked me for GG to continue their research. But yes, to the subset of people who are taking bisphosphonate, there is a chance of this BRONJ. It was first discovered by a dentist in 2003, it was not so long ago when this was discovered. For people who have a bone metastasis, they have to take much higher amount of bisphosphonate to kill the tumor in the bone, because you can’t operate on the bone like that, and for them who take a high dose, then this will be much higher incidents of BRONJ. The solution is the use of GG to mitigate the destruction in the jawbone. It’s a very peculiar and unusual and dangerous type of side effect. Thank you for bringing it up, Ben, I had forgotten about this.

Dr. Weitz:            Now, I read about another potential benefit of GG in increasing insulin sensitivity, especially in cases of statin-induced diabetes.

Dr. Tan:                Yes. It is now known and it is established that when people take long-term use of statin drug and then increasingly, they have a side effects of Type 2 diabetes. Which is ironic for the statement because about 15 years ago, American Diabetes Association said, “All Type 2 diabetic should be taking statin.” Now, I don’t think that they intended harm. The reason they asked all Type 2 diabetics to take statin is because it reduced cardiovascular events, that was the reason, but right now-

Dr. Weitz:            Especially since some of the drugs for diabetes increase your risk of heart disease.

Dr. Tan:                I know, this is just such a oxymoron. Now, if you fast forward today, for people, whether they are diabetic or not, if they take statin drug to lower cholesterol, then the sugar is slowly creeping up like that of a Type 2 diabetic. They’re now able to explain the reason being this statin drug got to the mitochondria and is making the mitochondria dysfunctional. When the mitochondria become dysfunctional, the ability to handle sugar and energy making will also become uncontrolled. When they become uncontrolled, the sugar begin to go up. We actually have animal study where GG is added back and they make the mitochondria improve its mitochondrial function.

                                That has been shown by a study in China, it has been shown by study somewhere in the middle of our country in Detroit, and more recently, we have given our GG to a university in Texas and they just published it a month or two ago, where they are more like Type 2 diabetic, high carb, high fat diet, and then they gave them GG. GG is able to in increase the respiration of the mitochondria. And then the second one, I was quite impressed they have to harvest the mitochondria from the muscle to do this. You know what they found? They found that when they increased the GG, this is the mechanism, when they put in the GG to the muscle where they harvest the mitochondria from the animal that have Type 2 diabetes, two things.

                                One, they improved the function of the mitochondria to do respiration for ATP conversion, which you expect because that’s what the mitochondria is doing. One, they weren’t able to connect if that has to do with the CoQ10, but they can connect that is able to improve the mitochondrial function, and two, in Type 2 diabetes, some of the mitochondria is already damaged, it’s already dysfunctional. You know what the GG does? The GG is helping to remove damaged mitochondria. Man, that is as good as can… Let me finish it. If you have damaged mitochondria, you cannot refix the mitochondria, you have to get rid of it. If the mitochondria is not get rid of, then now, you have bad problem in the whole muscle. In 2019, a Japanese scientist was given the Nobel Prize for autophagy. That means that to remove damaged organelles like that.

Dr. Weitz:            Yes, that’s where I was trying to go.

Dr. Tan:                This one here, if you want a special word, it’s called mitophagy. It’s just a clever thing, it is removing the mitochondria for autophagy, like that. And then I said. “Wow-“

Dr. Weitz:            So, GG is a new anti-aging compound.

Dr. Tan:                Amen to that. We have already shown the delta-tocotrienol, which is a tocotrienol to remove autophagy. Now, that one is the in the cancer cell.

Dr. Weitz:            We need the NR with GG longevity supplement now.

Dr. Tan:                Yes, yes, yes. I think that as a simple anti-aging thing, for no other cause of any disease thing, people should take Annatto-E GG, because the Annatto-E has already been shown to increase the telomere to increase the lifespan of worms. We have studied that. We have also studied in cancer cells, the mitochondria in the cell is growing like mad, so when you give them tocotrienol, it actually caused autophagy of the mitochondria of the cancer cell. For the cancer cell, you want it to die, but in the diabetic cell, you wanted the GG to help to remove the damaged mitochondria, which is what it’s doing, and then grow new mitochondria. I think that for that, that have a strong implication for muscle health. We hoping that the second half of 2023, we might be able to engage in a study on exercise and performance power on younger people.

Dr. Weitz:            One more topic, because GG is so fascinating, what about GG and cancer? I started looking into some of the research and most of the research seems to show that GG seems to be beneficial. There was a study that it may have activity against prostate cancer, it was an in vitro study. There was data showing that GG may induce apoptosis of several forms of cancer, including leukemia and colon cancer. But there was one paper where they were saying that it may block the activity of certain statins, such pitavastatin, which is used to fight ovarian cancer.

Dr. Tan:                You said two things there, I will say the first one. Yes, that first study shows, if you look carefully at the study, they used GG and then they compared with tocotrienol. Hands down, if it is cancer, tocotrienol is probably the best. We have six clinical trials in Denmark and in Florida and we can definitively, unequivocally saw tocotrienol work to bring death of the cancer cell and to be anti-angiogenesis, we don’t see the power of GG to do it on the cancer piece. That in the vitro study, we saw that the tocotrienol is approximately 5 to 10 times more potent than GG in the anti-cancer piece. On the pitavastatin thing, it is a very strange study and we have written to the professor, that study was using pitavastatin to kill the cancer. My general take is that to use statin to kill cancer is a long shot and it’s probably never going to go there, because the amount of statin you need to use to kill cancer is about 10 to 20 times higher than for using for cholesterol reduction.

                                At that level, it is going to emaciate the cancer patient, because the loss of muscle mass will be severe. But yes, there was that study. In that study, they show that GG is helping the animal to revive the tumor. What is the offshoot of that? If you were to take that study seriously, the offshoot of that would be if you are taking pitavastatin to kill cancer, you essentially have to commit the rest of your life to eat entirely synthetic food, entirely, you’ve got to listen to me careful, synthetic food. The moment you eat natural food, you’re going to get GG, because I said at the beginning of your talk, all plants must have GG. Without GG, they cannot make carotenoid, cannot make chlorophyll, so if you were to take that seriously, you have to quit eating all things natural. I think that that is ludicrous. I personally think that’s ludicrous like that. But GG is not strong enough, vis-a-vis tocotrienol, to kill cancer.

                                Let me add this piece that you may not chance to ask. I believe GG have a strong component in cognitive and behavioral health of the brain, that I want to say strongly. Let me tell you how this is shown. In Texas, and you should Google that, Dr. Weitz, GG and brain health. I have to figure out how to think about it. First, in the learning animal, when they gave them GG, that GG is able to learn better, so that piece published and then it stopped. We have another professor, another 20 years after, she is continuing to study in Texas also, she found that you can train and cognitively improve the rest how to figure out the spatial arrangement so that they can recognize things better if they are given T3, the tocotrienol acid group, or GG acid group. Then, separately, in Japan and also in Tufts University, they found that, first, let me state in the brain, the only Vitamin K in the brain is MK-4. There is no phylloquinone, Vitamin K1, there is none other menaquinone except MK-4.

                                And then they studied elderly people, centenarians, that pass away that have given consent, so their brain tissue. For those that died that have no dementia, higher MK-4 in the brain. For those that died and they had dementia, they have lower MK-4, so that’s a strong smoking gun. In another study, this is all published this year, another study of living elderly people, the blood level of MK-4 are higher for those that have normal cognition and the intermediate for mild dementia and for those that have Alzheimer’s disease have the lowest amount of MK-4, so MK-4 have a place inversely proportional to dementia and mental and cognitive health. I’ve just explained to you earlier how GG is the VPs in the synthesis of MK-4, so I’m trying to figure out how to design a study to do it. I am not yet there, I’m trying to design a study how that can be. We have animal data, though, when we have GG and tocotrienol, it is able to help in the synaptic communication and therefore, able to explain this, so it is still relatively new. Having said all of this-

Dr. Weitz:            If you were going to speculate right now, if you were treating a patient with dementia or early signs of Alzheimer’s disease, what would you think would be the best recommendation for supplementation for Vitamin K, Vitamin E, and GG?

Dr. Tan:                I would say that the person should take a combination of tocotrienol and GG, they are not, though, E GG, that would be maintain mental health. Separately because they may not have all of these in one fell swoop, that you can separately take Vitamin K, a combination of K, sometimes phylloquinone, sometimes some of the menaquinone, and many company add Vitamin D in it and then I know Designs for Health add GG in it. If you already have GG in it, then you just take separately tocotrienol. If you have a company that don’t have GG in it, then you take the Annatto-E GG, so you have this combination of product to maintain a healthy brain function and cognitive thing. I’m pretty confident that this is a strong thing. If you send me an email-

Dr. Weitz:            What about dosage for this particular purpose, for brain function?

Dr. Tan:                For GG, 150 milligrams, for tocotrienol, 300 milligrams, and for Vitamin K2, MK-4, probably more like 10 to 20 milligrams, they are rather expensive, and Vitamin MK-7, they are even lower dose, I saw out there about 400 micrograms. MK-7, 400 micrograms, MK-4, 10 to 20 milligrams, Vitamin D, probably about 2,000 IU, like that, and then tocotrienol, 300 milligrams, and then GG, 150 milligram, so some combination thereof. I’m sure, Dr. Weitz, you can advise many people, you can use this combination, they should be able to help to a very strong, healthy mind.  I am grateful, I’m probably the only one standing alive that have taken tocotrienol longer than anybody standing. I started taking it about 30, 35 years ago, because I was doing this. For GG, until we succeeded in making the product, I’ve been taking GG roughly for the last two years or so, before that, there were no GG. I was working on GG, but I couldn’t make the product and now I have, so I’m personally taking it. I will be 70 years old come next year, so all grateful. I know that nutritional supplement is not God, I have other things, but I’m very grateful that I found this. And then I’m trying to say good things and help other people to be blessed by this, so that as we grow older we also have the quality of life to age with it. Wouldn’t that be a benefit? That would be a great new year of 2023.

Dr. Weitz:            Absolutely. Interesting, so you’re still recommending MK-7 as part of the mix?

Dr. Tan:                I would say less of MK-7.  I only mentioned MK-7 to this, currently, they have a dozen of MK-7 studies out there, clinical trials, say that they improve mental health, they improve the bone calcification, if you look, you can find them.  They are approximately about 400 micrograms per day, so it’s very small amount, 0.4, probably because this compound, MK-7, is very expensive to make, so 0.4 milligrams.  I sometimes struggle with how so small an amount would work, MK-4, however… Now, truth be told, in Japan, I didn’t say this, in Japan, 45 milligrams MK-4 is a pharmaceutical drug, but isn’t that curious?   Nattō, which is this Japanese, a thing that we eat, make MK-7, everybody mumble that, but MK-7 is not a drug. MK-4 is a pharmaceutical drug in Japan for anti-osteoporosis. Now, you go figure, you go figure, you can Google 45 milligram. I think that there is a strong suit, how in the US, MK-4 is not an anti-osteoporotic drug as in Japan, it is a supplement, so we recommend people to take GG because GG converts in the human body. Why did I say MK-7? Only because of the half a dozen clinical trials out there at 0.4 milligrams or something like that.

Dr. Weitz:            Excellent. Thank you so much, Dr. Tan. For those who want to know more about GG or who want to purchase GG, where should they go?

Dr. Tan:                If you go online, probably the best known company to do that, we are very proud to partner with them, is Designs for Health. Of course, Dr. Weitz already highly recommends their product. They’re really sincere and try to put the kinds of products out there. I told them, “You’ve got to make this denomination,” they go make it. Sometimes they have bite the bullet to do it, because I didn’t want them to come up with something and it ain’t working for people, that’s not good. Or if you want to buy from other sources, if you come to our website, American River Nutrition, or my name Barrie Tan, spelled B-A-R-R-I-E, Tan, T-A-N, and then you come to a place that buying a supplement, we don’t sell finished product and it will list all the companies selling this product.  If you wanted to be sure that the product is actually made by our factory here in Hadley, for the GG, we simply call GG-Gold, that means it’s made here, right here in Hadley.  If it is tocotrienol from our tocotrienol from Annatto, then it would be DeltaGold because of delta-tocotrienol, like Delta Airline, DeltaGold.  And then if it is the CoQ10, ubiquinol plus GG, for people who take statin, we call it DuoQuinol, D-U-O, because it duo, ubiquinol and GG, DuoQuinol.  I think Designs for Health simply call it CoQnol. If you look at the bottle, it will say, “DuoQuinol,” it came from us.  GG-Gold, DeltaGold, and DuoQuinol, so like that.  If you further have any question, send us an email, my website has an email, to the extent possible, I will try to answer.

Dr. Weitz:            What’s your website, Dr. Tan?

Dr. Tan:                Oh sorry. Americanrivernutrition.com, just a continuous word, www.americanrivernutrition.com. Once you go there, you can also download all the white papers that we have there. If you want to follow through with us, every time when we publish a paper, we announce them. Currently, we have about 15 to 20 published papers on clinical trials on tocotrienol. Hands down, man, everybody should be taking tocotrienol. GG, the research is coming, the testosterone one will be the next one, the myopathy will be following, and probably the exercise one will be following in the years to come. And then you can also download a white paper on DuoQuinol, why the combination of GG and ubiquinol, so you can come on the website. Until we talk again, have a wonderful holiday, be blessed, and we can start the new year with good health and do good things.

Dr. Weitz:            Thank you so much for your contributions to humanity.

Dr. Tan:                Thank you, Dr. Weitz.



Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review, that way more people will be able to discover the Rational Wellness Podcast. I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic and Nutrition Clinic, most of whom we’ve been able to help with a range of various health conditions, from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases, and various other cardiometabolic conditions.   I very much appreciate you and I’m excited about going forwards helping you to improve your health on your journey towards optimal health. I wanted to let everybody know that I do have a few openings now for new clients. You can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111 and we can set you up for a new consultation for functional medicine and nutrition. We can get that going as early as the new year, so give us a call, and I’ll talk to you next week.



Controversies on Vitamin K with Cristiana Paul: Rational Wellness Podcast 290

Cristiana Paul discusses Controversies on Vitamin K with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

4:44  Cristiana Paul has been digging into the research on vitamin K since 2010 when we first learned of the effects of vitamin K beyond clotting. The three forms of vitamin K that are on the market are K1 and two forms of K2–MK4 and MK7, which is a patented form that is claimed to be more effective.  But the Japanese have been doing a lot of research on MK4 for at least 30 years and found that it is very effective for osteoporosis at very high levels, such as 45 mg per day.

7:50  We know that MK7 has a longer biological half life than MK4 and it has been claimed that this is why MK7 is more effective, but just because we see a higher level in the blood stream does not mean that it is more effective.  We often measure certain nutrients in the blood, such as calcium, but this does not tell us if the calcium they are taking is effective. What matters is the amount of the nutrient in the tissues and not in the bloodstream.  And just because MK7 persists longer in the bloodstream doesn’t mean that it is more bioavailable. In fact, it may persist in the blood longer because it is not readily taken up by the tissues.

11:14  While vitamin D status is accurately assessed by serum tests, many serum tests of vitamins, such as serum calcium, are not good measures of calcium status in your tissues like your bones.  While serum vitamin K tests may have some value and levels do go up after supplementing, but since vitamin K1 and K2 are transported by triglycerides and by lipoproteins, levels of triglycerides may affect the test results.  And you would certainly not want to use serum tests of vitamin K1 to guide coumadin levels and in fact you should not supplement with vitamin K if you are taking coumadin, which is a blood thinner used sometimes to reduce clotting.

15:54  How vitamin K affects bone formation both in young people and also in post-menopausal women and older men, esp. those who see a decrease in testosterone levels, who tend to see a decline in bone health.  The average intake in the US of vitamin K1 is only 90 mcg, which is not even enough to meet the minimal amount of 120 mcg needed for clotting.  And research indicates that we need a lot more to support the rest of the body, including the bones, the arteries, and the brain.  There is a protein–Osteocalcin, whose job it is to bring the calcium into the bones. Matrix GLA is a protein which is supposed to prevent the calcium from going into the soft tissues like the arteries.  When these proteins are activated, this is called carboxylated. When we have enough carboxylated matrix GLA from having enough vitamin K, we will prevent heart valve calcification, kidney stone formation, and even the lungs can become calcified and have lower elasticity.  We tend to focus on preventing the calcification of the artery walls, which is different than the calcification of the plaque.  It would be good if we could measure uncarboxylated osteocalcin and uncarboxylated matrix GLA, but these tests are not currently available in the United States.  With bone, the calcium is built on a collagen matrix, so proper collagen synthesis is also very important for bone health.

21:02  Vitamin D.  Vitamin D works closely with vitamin K to transport calcium from your intestines into the blood and into the bone. To optimize bone formation you need optimal levels of vitamin D, vitamin K, calcium, magnesium, and phosphorus, all of which are deposited in the bone.  And bone is built on a matrix of collagen, which is like the steel rebar that makes the concrete stronger, so we should optimize the intake of collagen and all of the above vitamins and minerals.  This can be helped with collagen supplementation as well as vitamin K, which stimulates collagen synthesis. The collagen does not increase bone density but it makes the bone stronger and more resistant to fracture and bone fragility can be measured with quantitative ultrasound.  Studies that have show reduced fracture risk have used K1 at 5 mg and MK4 at 45 mg.  Designs For Health offers 1 mg of vitamin K1 and 1 mg of MK4 in their Vitamin D Supreme product and then if you are older or have increased risk of bone loss, you can add the 2 caps of Tri-K that adds an addition 4 mg of K1 with 1 mg of MK4 and 35 mg of geranylgeraniol, which is equivalent to 45 mg of MK4.

27:09  Both K1 and MK4 have some positive benefits in bones and arteries and both K1 and MK4 can carboxylate (activate) osteocalcin and matrix-GLA.  Eventually in most tissues all forms of vitamin K, including MK7, are converted into MK4 for storage, though this depends upon the organ.  For example in the arteries, 25% of vitamin K is stored as K1 and 75% as MK4, and in the brain 90% of vitamin K is stored as MK4, though in the heart 90% is deposited as K1 and only 10% as MK4.  There are a few rat studies where they were flooded with the equivalent of 60 mg of MK7 and this dosage overwhelms the capacity of conversion, so a lot gets deposited as MK7, but this is not a normal physiological condition.  When we give MK7, the uptake is slow because it is slowly converting to MK4, which we thought was beneficial, but then we saw the results of the studies with MK7 that did not do better than the interventions with K1 and MK4 and MK7 is 50 to 100 times more expensive than K1, so it is not worth it. It is better to provide K1 and MK4 and then add some GG, which the body uses to convert K1 to MK4.  From an evolutionary point of view, we have consumed about 1 mg of K1 from fruits and vegetables and a smaller amount of K2 from meats and fermented foods. 

31:23  Some would argue that the reason that the Japanese have better bone density than in the US is because they consume natto, which contains MK7.  Only some of the population consumes natto, since it is not a very tasty food. The average K2 intake from natto was about 57 mcg of MK7 and natto not only contains MK7 but also genistein, which is a phytoestrogen that stimulates the estrogen beta receptors and can be beneficial for bone health. So the genistein may be at least partially responsible for the bone building properties of natto. Studies that have looked at using 180 or 360 mcg of MK7 did not show positive results.  One study using 180 mcg of MK7 did show a slower decline of bone density than placebo, but we are looking for a way reverse the loss of bone density and not just slow the decline.  unfortunately a number of the studies that have looked at vitamin K for bone density have not provided enough vitamin D or enough calcium or magnesium and few studies have included resistance exercise.  One study that used vitamin K in Greece did use 1000 mg of calcium and 393 mg of magnesium and vitamin D and there was an increase of 1.3% in bone density.

36:10  Cristiana recommends for bone health to supplement with a minimum of 1 mg (1000 mcg) of K1.  If there is osteopenia or osteoporosis, she recommends 5 mg of K1 along with some MK4 and GG or you can use the Japanese approach and take 45 mg of MK4.  In addition, you should supplement with vitamin D, an absorbable form of calcium, magnesium, vitamin C, zinc, silicon, sulfur, and collagen.  You should also follow an alkaline diet and do resistance exercise.   

39:48  Vitamin K can reduce cardiovascular disease, including arteriosclerosis, which is the stiffening of the arteries due to a deposition of calcium in the arteries. Interventions with 2 mg of vitamin K1 have shown reduced arterial calcification by 45%.  Studies with MK7 have not shown a reduction in arterial calcification, while studies with MK4 have shown a 18% reduction in arterial stiffness and one study with MK7 showed reduced arterial stiffness by 6%.  The mechanism by which vitamin K can reduce arteriosclerosis is by carboxylating MGP, but we do not have a commercially available test for uncarboxylated MGP in the United States.  We do not have studies showing whether K1, MK4 or MK7 are better at carboxylating MGP.  The recommendation is for reducing arterial calcification is to supplement with at least 2 mg and up to 5 mg of K1 and then you would want to add some GG to help with the conversion of K1 to MK4, which is the form it is stored in in the arteries.  We need to point out that this arteriosclerosis is separate from the atherosclerosis from the calcified cholesterol plaques that build up in the artery walls. This process involves the penetration of oxidized LDL  and foam cells, etc. There is a form of vitamin called tocotrienols which have been shown to reduce arterial plaque and there is a supplement that contains rhamnan sulfate that can reinforce the arterial wall called Arteriosil.  By reinforcing the layer of the endothelium called the glycocalyx, we can reduce the penetration of the oxidized LDL and it may even cause regression of the plaque.                        





Cristiana Paul has a Master’s in Nutrition Science from Cal Poly Pomona and she has extensive experience in clinical practice and reviewing nutrition research.  Cristiana wrote chapters on omega-3s and vitamins K forms, in the 2012 and 2020 editions of Textbook of Natural Medicine, edited by Dr. Joseph Pizzorno and Dr. Michael Murray.  Cristiana is the author of peer reviewed papers on topics such as inositol’s roles in insulin resistance/PCOS, a new view of collagen protein in human nutrition, nutritional approaches to managing inflammation, and metabolism of B12 forms in the setting of various genetic polymorphisms.  She is currently working on a paper exploring the rationale for supplementation with Nicotinamide Riboside to support healthy aging.  She is an independent researcher and has been a scientific consultant for for the past 20 years for Designs for Health, a professional line of nutritional supplements, where she has contributed to position papers as well as helping to develop products and nutritional protocols. Designs For Health supplements are sold through licensed doctors and practitioners like myself.

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.



Podcast Transcript

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.

                                So hello, rational Wellness podcasters. I wanted to let everybody know that while many of my podcasts involved a discussion of scientific and medical research, this episode is going to go really deep into the science of vitamin K. If you find the level of scientific detail challenging, please check out the show notes on my webpage, dr weitz.com, where you can find a summary of some of the important points discussed as well as a full transcript. And I’ll also include some of the references. So I’m very excited today that we’re going to be interviewing Cristiana Paul on vitamin K.

                                Everyone has heard a lot in the last five years, or at least many of us have, about the potential benefits of vitamin D. But the new kid on the block, vitamin K is getting increasing attention as a super important fat soluble vitamin. The research and potential benefits of vitamin K is fascinating from promoting bone health to reducing the progression of arterial calcification to a whole host of other potential benefits. But there are some controversies concerning vitamin K, including how much and which form is best to take, K1 or the two commonly commercially available forms of K2, MK4 and MK7?  I have been convinced that the MK7 version of vitamin K was the best form to take since it is known to have a longer biological half-life than MK4 and several prominent integrative cardiologists have recommended this form, including Dr. Steven Sinatra, who recently passed, and who recommended taking up to 360 milligrams of MK7, I think micrograms of MK7 for reducing arterial calcification.  I recently attended the Cassie Education Conference sponsored by Designs for Health, where Dr. Barry Tan spoke and mentioned that we should stop taking MK7 and that MK4 was a more natural form. So I had to learn more why he said this and what the truth is based on the latest scientific research, which is why I have asked Cristiana Paul, product development consultant for Design for Health and expert on vitamin K research, to join us today for a discussion on vitamin K.

Cristiana Paul holds a master’s in nutrition science from Cal Poly Pomona and she has extensive experience in clinical practice and reviewing nutrition research.        Cristiana wrote chapters on Omega three and vitamin K in the 2012 and 2020 editions of the Textbook of Natural Medicine edited by Dr. Joe Pizzorno, who’s a member of the board of directors for the Institute of Functional Medicine and who we have had on the podcast multiple times. Cristiana is the author of peer reviewed papers on topics such as the role of inositol in insulin resistance in PCOS, a new view of collagen protein in human nutrition, nutritional approaches to managing inflammation, and the metabolism of vitamin B12 in the setting of various genetic polymorphisms.  She’s currently working on a paper exploring the rationale for supplementation with nicotinamide riboside to support healthy aging.  Cristiana is an independent researcher and she’s been a scientific consultant for the past 20 years for Designs for Health, a professional line of nutritional supplements.  There she has been contributing to position papers as well as its development of products and nutritional protocols.  Cristiana, thank you so much for joining us today.

Cristiana:             You’re welcome. I’m excited to be here and share my opinion on research. This research and all nutritional research is fast evolving, as we all know. It’s hard to keep up with all of it. I used to be in clinical practice for about 10 years, but then I shifted into just doing nutrition reviews because that’s a full-time job for sure, and I can’t even say that I’m an expert in every topic, but I did dig into this topic. I started in 2000, about 2010, 11, when all of a sudden we became aware of the effects of vitamin K beyond the clotting.   We all knew that we need a little bit of vitamin K in multivitamins, in the diet to ensure that we have adequate clotting. And at that time, MK7, it was kind of a new kid on the block promoted by manufacturers that had had a patent on it. And so it was a branded form of vitamin K, MK vitamin K2.  Although the research on MK4 has been going on in Japan for at least 30 years, but we were just not as much aware in US of how the Japanese were using MK4.  Actually at very high doses for osteoporosis.  So that knowledge…

Dr. Weitz:            What do we care what the Japanese are doing, we’re Americans.

Cristiana:             You know what, it’s amazing how advanced they are.  And also collagen, it’s interesting because I read and now we know collagen is involved in bone strength and it works together with vitamin K, and they were advanced in that realm of research as well.  So I dove into it because MK4 and K1 are not branded ingredients.  Nobody’s really promoting them as heavily because there’s no patent on them necessarily.  So I had to review all the research.  I published the 2012 review, but at that time we didn’t have enough intervention studies on all these forms.  So 2020 review I feel is much more comprehensive.  And then since then there’s still more studies published on vitamin MK7 and so on. So today we’ll try to outline what we know today and then you see in the market, a lot of companies are using just MK7 or just MK4 or combination of two or three of them. And as I advised Designs for Health the last 10 years, the formulas have changed based on what we’re learning.

Dr. Weitz:            So we have K1, we have MK4, we have MK7.  There’s a lot of confusion as to which is the most important one.  Should we be taking all three of them?  Should we be taking mostly K1?  Should we be taking mostly MK4, MK7?  We know that for example, vitamin K1 plays, or at least as it’s been told, that vitamin K1 is the main form of vitamin K related to clotting.  We’ve been told that MK7 has a longer biological half-life, so I think that’s where some of the thinking that vitamin MK7 is going to be more effective if it’s sticking around longer.  But interestingly, there are nutritional compounds that are not in the body very long and actually are extremely important. And I recently learned that nitric oxide is actually a gas and is only around for seconds and yet has this incredible amount of biological activity.

Cristiana:             Yeah, you’re right. And we have to really understand the basics. Let’s say doctors measure plasma calcium, and that’s a typical blood test. But if I measure plasma calcium, that doesn’t tell me if this person has good bone density, if they’ve been taking calcium for a while, if they have good calcium in their muscles for contraction. So if I took plasma calcium and I measured plasma levels, they’re not going to stay high for very long because the body has a way to take the calcium into the tissues. And also there’s hormones like parathyroid hormone and so on that regulate levels of calcium. So it’s the same thing with vitamin K. You can take vitamin K, all three forms, and we can follow what happens. How long would K1, K2, whether it’s MK7 or MK4, how long would they last in the bloodstream?  So which means when you look at bioavailability, because people worry about is this supplement bioavailable? Well I see that it’s absorbed right away, but then it’s also taken up by the tissues. So after one time administration, yes there was a study show that MK7 lingers longer, but that doesn’t mean it’s more bioavailable. It almost looks like it’s harder to being taken up by the tissues. But regardless, I mean I don’t judge the effectivity of vitamin K forms based on plasma levels. I also need to tell everybody that I looked at studies after supplementing for months with all three forms and plasma levels do go up. It’s kind of an indicator. These studies looked at plasma levels almost to see compliance, that people were taking these vitamins. But they measured other markers of vitamin K status, which I’m going to explain.

Dr. Weitz:            And by the way, Cristiana, I’d just like to point out for those who aren’t aware, this is pretty common that there are a number tests you can do to measure serum levels of, you mentioned calcium, you mentioned a number of vitamins. And for the most part these serum tests are really worthless. That’s why researchers have come up with much more complicated ways, more functional tests to measure the status of these vitamins. Vitamin D test, the serum is an exception, but for the most part, serum calcium tells you nothing about the calcium status in the body. The person could have osteoporosis and they could have a normal serum calcium. So if you’ve been to your doctor and he says you don’t need calcium because you have a normal calcium serum level, it means nothing. And ditto for serum B12 and a whole bunch of other vitamins.

Cristiana:             Right.  So unfortunately these tests are new. The tests for vitamin K status, which I’ll explain what that is, they’re new and labs like Quest and so on, they’re not performing those.  We need to go to specialized labs for vitamin status.  And that’s why that whole idea of the way the vitamin MK7 was promoted, there’s more quote-unquote “bioavailable” based on plasma levels.  It’s not a valid argument.  And it’s not even true after you supplement longer with these vitamins. It is an indicator.  And also keep in mind that these vitamins, vitamin K1 and MK2 are transported by triglycerides and by lipoproteins.  So if somebody had higher levels of triglycerides, it’s going to look, like K1, let’s say it’s higher, so you would have to in research divide by K1 to get a sense. Now some doctors that monitor patients on Coumadin, which is working to block vitamin K, they do those measurements to get an idea maybe of how much vitamin K the patient takes. They have to be careful with vitamin K from diet and supplements. So we’re not going to really go into management of patients on Coumadin because that is a very, very tricky situation and you have to be monitoring INR with a doctor and with the conditions.  So we’re not recommending that those patients take vitamin K supplements unless the particular doctor that monitors them with whatever tests, and I think some of the tests would be plasma K1 at Quest let’s say. But if they decide to supplement with a little bit, maybe a hundred micrograms. The idea was to keep the plasma levels more levels so that you don’t have to be affected by greens that contain vitamin K1 because it’s a pity to tell the patients not to take those healthy foods. So that is a complicated situation. We’re going to talk mostly about…

Dr. Weitz:            Okay, Cristiana, let me just clarify for everybody in case you didn’t follow what she just said. There are some patients who are being prescribed Coumadin. These are typically patients who have blood clots or at risk of blood clots or who’ve had a stent. And they’re worried that there’s going to be a clot. Sometimes patients with arrhythmia, they’re often prescribed a blood clotting medication. And for many years Coumadin or warfarin was the most commonly prescribed one. Doctors are starting to use Coumadin or warfarin less frequently. But the way that drug works is by blocking vitamin K and that’s how it reduces clotting. And so then the issue is if you’re taking a drug to block vitamin K, why would you want to take vitamin K at the same time? That’s going to uncouple the effectiveness of the blood thinner.

Cristiana:             And then there’s alternative blood thinners that promote the idea that you don’t have to be worried so much about vitamin K from foods and possibly from supplements. But then again, we’re not going to talk today so much about those situations. We want to talk about how vitamin K affects healthy people, younger women, younger men and teenagers obviously that need to build bone. And also in the later stages of life where women have an increase in bone breakdown due to lack of lower hormones, whether they take hormones or not, you have an increased breakdown of bone and that balance between bone breakdown and bone rebuilding is tilted towards bone breakdown. And in case of men, some of the men have a decline in testosterone and that affects the bone health as well. And also exercise weight training that sometimes is not done properly as we get older due to various reasons and that’s going to affect the bone as well.

                                So I would like to start by saying that the average intake in US of vitamin K1 is 90 micrograms. And it’s in a range from 30 to 222 micrograms. We need for clotting, we need about 90 or 120 depending on the body size of female, male. Let’s say 120. This tells me that maybe half the population doesn’t even take enough vitamin K1 to support adequate clotting. Basically the liver stores, as you take vitamin K1, stores vitamin K to activate the clotting protein. So there’s a deficiency there for that.  But all the research points to the fact that we need a lot more to support the rest of the body. The rest of the body, the bones, the arteries, the heart, the brain, the testes been shown to store a lot of vitamin K.  And the question is why?  And we found out some of the facts, we don’t know all of them, but the research is trying to figure out what is the optimal amount of vitamin K1 and/or K2 to support all these proteins that do a very important job.  One protein is to bring the calcium into the bone, that’s called osteocalcin.  I’m going to call it bone transport protein.  Then there’s other proteins, they’re called matrix GLA, that’s the chemical name, I’m going to call them guardians of the arteries, guardians of the galaxy.  They make sure that there’s…

Dr. Weitz:            By the way, there’s a new Marvel movie coming out called Guardians of the Arteries.

Cristiana:             So what they do is they keep calcium from going in the wrong place.  For some reason if they are not armed with the weapons and the weapons are actually these claws made by vitamin K, you can think of their swords.  So the more swords they have from vitamin K, the more efficient they are to keep calcium from going into the arteries, into the heart valves because the heart valve gets calcified, into the kidneys.  Kidney stones.  Now we think that even the lung is affected also calcified and lower elasticity when you don’t have enough vitamin K.  So we focus on arterial calcification because that’s such a common concern as we get older and it’s the calcification that occurs inside the arterial wall. That’s not the calcification of the plaque. There’s two areas where calcium goes in and causes issues. So vitamin K at about one milligram, I’m going to make the case from studies, it’s probably pretty good amount to completely activate those bone transport proteins.  It’s like an excavator that has teeth, right? And if you have more vitamin K, you have all your teeth on that excavator. If you don’t have enough teeth on the excavator, you can’t grab enough calcium from the blood to put it into the bone. So it’s activating these proteins, the more you have. So we can measure that in the blood. That’s called the level of carboxylation. It’s basically the level of activation of these bone proteins. Same thing with the guardians of the arteries. They also have these swords or claws that they keep the calcium and they are also activated. We can measure that. Unfortunately that’s a test only available in England right now for the MGPs. But osteo calcium and carboxylate osteocalcin was at least available from one lab. I’m not sure if that’s still available, but maybe other labs will pick up that test in the US. And that is truly telling you if you have enough vitamin K in your body.

                                Vitamin D works closely with vitamin K. Vitamin D helps with transport of calcium from your intestines into the blood. It also vitamin D upregulates the making of these proteins. So how many of these bone transport proteins you have and how many guardians of the arteries you have is determined by your vitamin D level. So you have to supplement, you try to optimize your intake of vitamin D and also vitamin K, also intake of your calcium, magnesium, phosphorus, all these are deposited in the bone. So unfortunately the studies did not optimize vitamin D. We look at all these studies and we know that vitamin D awareness is relatively new. Some of the studies they just gave vitamin K but they didn’t, they barely gave 400 IUs of vitamin D. So it’s hard to achieve a result when you don’t give enough.  The Japanese with their studies have given some vitamin D, but at the time D3 was not available in Japan. They were giving the active form of D as a drug. So that’s unfortunate. So again, in our clinical practice we tried to optimize all these factors. And on top of it is collagen story. When you have concrete walls built, you put rebar, you put a mesh of steel or a bone to support that concrete. So the bone is not just bricks piled onto each other, they are supported by this collagen mesh. And so now we became aware of collagen supplementation, but also the fact that MK4 stimulates the formation of collagen. So in the bone and in somewhere else in the body possibly. So we have to look at the big picture, as practitioners you have to look at all these aspects, the intake of calcium, the intake also…

Dr. Weitz:            Cristiana, let me stop you for a second. So you mentioned how vitamin K stimulates collagen synthesis. Is this one of the reasons why some of the studies on the benefits of vitamin K for bone seem to have a stronger effect on reducing fracture than they do on increasing bone mineral density?

Cristiana:             Absolutely right. Very good point. Because when we measure bone density, we don’t get the whole story. As you know, biphosphonates could possibly increase or maintain bone density because it shuts down the bone breakdown. But it doesn’t support bone buildup. So some people actually measure bone elasticity through bone ultrasound. Some tests are out there for that. And at the end of the day what you worry about is risk of fracture. So we’re looking at what studies and what forms of vitamin K have shown reduced risk of fracture. So we have that with vitamin K1 at five milligrams and we have that with MK four at 45 milligrams reduction in fracture.

Dr. Weitz:            Now by the way, both of those numbers you just mentioned are quite a bit higher than the amount of K1 or K2 that most people supplement right now, isn’t that correct?

Cristiana:             Yes and no. So vitamin K1, for example Designs for Health, is offering a foundational formula with K1 at one milligram and then MK4 at one milligram, in addition to vitamin D.  Because that’s your foundational supplement.  And when you are younger and your hormones are good and exercising, you don’t maybe need to take those higher doses.  When you are older, that’s when the higher doses come in and they act a bit differently.  I mean in addition to activating those bone transport proteins or the guardians of the arteries, we have an effect from MK4 on a pathway that’s known as HMG co-a where cholesterol medicine acts and where bisphosphonates act, where CoQ10 is made. So when we act on that pathway, we have an additional ability to reduce bone breakdown. So that’s why we need the higher doses. Now instead of using the 45 milligram of MK4, also the Japanese have pointed out that it’s really the geranyl component of MK4 that may act at that high dose.  And so that would be equivalent to about 30 milligrams of geranylgeraniol, which is available as a supplement from Designs for Health. And it was added to the additional Tri-K formula. The idea was younger people that are in good shape, it can take their vitamin D plus the one milligram of K1 and one milligram MK4 because K1 converts to MK4 to a certain extent. But when you’re older, on top of that you may want to add another four milligrams of K1 and another one milligram of MK4 and the geranylgeraniol at 30 milligrams or 75 milligrams, the double dose.

Dr. Weitz:            Now let me just stop you one second again. Sorry for keeping interrupting you.

Cristiana:             No, you can interrupt me to clarify.

Dr. Weitz:            So you’re mentioning vitamin K1 and you mentioned how it converts a lot of times into MK4 because MK4 is the most common storage form in most of the organs in the body, except for the liver.  Now do we know, is K1 actually having the beneficial effects on bone and arteries or is it MK4 that is being converted?  Is K1 converting into MK4 that’s having the effect or are they both having an effect?

Cristiana:             That’s a very good question. And the thing is both. If you test it in vitro, both K1 and MK4, they carboxylate these proteins, they activate these proteins. When it comes to absorption, when you absorb K1 or MK4, the body converts some of it. Let’s say 25% of K1 stays at K1 and is deposited in the bone. 75% is deposited as MK4. We don’t know, I mean they both carboxylate, we don’t know why that each tissue has its own ratio. In the heart, for example, 90% is deposited as K1 and 10% as MK4. In the arteries we have the 25% K1 and 75% MK4. So it’s interesting that in the brain…

Dr. Weitz:            And is MK7 also converting into MK4?

Cristiana:             Yes. So what studies have found at the doses that were given, equivalent to the nutritional doses, the body attempts to convert all vitamin K2 forms. It’s MK6, 7, 8, 9, 12. They are converted to MK4 before being deposited in the tissues. If you flood the system like some rat studies gave the equivalent of 60 milligrams of MK7, it overwhelms the capacity of conversion and is deposited as MK7. But for our purposes, when we look at deposition of MK7 given at the level of 180, 380 micrograms per day, those are most likely just converted to MK4. But it’s converting it slowly. The uptake is slow, it’s converting it slowly. Is that necessarily a benefit?  We thought so maybe a long time ago, but when we saw the results from interventions with MK7, they did not do better than the interventions with K1 and MK4.  And it’s a much more expensive ingredient, about 50 to a hundred times more expensive than K1.  So why use that ingredient when you can achieve all the other goals with K1 and also you provide MK4 in case there’s not enough conversion from K1 to MK4, you provide also the GG molecule which the body needs to convert K1 to MK4.  So that’s the thing.  We don’t know which one does it.  And sometimes people say K1 is the most, MK2 is the most important.  You can say it’s most important because 90% of the body deposits K2 as MK4.  But K1 seems to be preferred in some tissues and we don’t know and that’s why we want to supplement, it’s less expensive.  And also from a physiological, evolutionary point of view, throughout evolution our bodies were exposed to K1 and K2, but K1 at a level about one milligram per day from fruits and vegetables.  And K2, some from meats and so on, fermented foods.  So in a way you are supporting what the body is adapted to.  And I’m a firm believer in evolutionary medicine, evolutionary nutrition.

Dr. Weitz:            Now some people would argue that when you look at the Japanese that consume fermented soybeans known as natto, which contains MK7, they have better bone density and that is part of the argument for MK7.  What say you to that?

Cristiana:             So yes, I looked at those studies. The average intake was about 57 micrograms of MK7. Only certain people consume natto because it’s not a very tasty thing. And the range was, I mean, the total vitamin K2 was about 61 micrograms. Some people ate as much as 200 micrograms, the intake in Japan. But natto is a very high source of genistein, which is a phytoestrogen. Because it’s formative from soy and rice. And we know from studies with genistein, that that alone has a tremendous effect on bone health, improving bone density or delaying bone loss during menopause, because genistein acts kind of like estrogen on estrogen beta receptors, not alpha. Which makes it safer when it comes to worries about breast cancer and other gynecological cancers.

                                But we have that component that people don’t mention, you know, you can’t attribute the high bone density just to the 57 micrograms of MK7. And when we did interventions with 180 and 380 micrograms of MK7, we did not see good results. For example, two studies show that used 360 micrograms and 370 micrograms of MK7 did not slow down bone density decline compared to placebo. They had one study with 180 micrograms of MK7. One showed that the decline was a little slower than placebo and the other study showed that it was the same. Now even if I slow down a little bit the bone loss, that doesn’t mean it’s a solution for me. I don’t want any slowdown. I want to hopefully go back, I mean maintain or increase it back. So it’s possible that these studies also were flawed because they didn’t provide enough vitamin D and K and so on. It’s interesting that one study used a hundred micrograms of K one and also compared with 100 micrograms of MK7.  This was a study performed in Greece where they had higher intake of calcium, about a thousand. And then they gave magnesium, which very few studies did. 393 milligrams of magnesium. They gave vitamin D, but in Greece they like to go in the sun. So they have higher levels of vitamin D probably in the blood. And they exercised. Very few studies imposed exercise. So that study achieved an increase in what, 1.3% in bone density. But that also shows you that K1 and MK7 did the same. So why should I use a much more expensive vitamin if I can achieve the same with vitamin K1? And that doesn’t tell me though that I only need a hundred micrograms of K1 because I know that for complete carboxylation I need about a thousand. It’s great that they achieved that particular result. But looking at all the other studies, we advocate a thousand micrograms, which is one milligram of K1.  Another issue that came up in the news a lot was when you take vitamin D and calcium, you’re going to increase arterial calcification. People were saying, well you have to choose between your arteries and your bones. If your bones are bad, then take calcium. If your arteries, don’t take it. We don’t have to choose because they forgot about vitamin K. Right? So there was a beautiful study where they gave vitamin calcium and vitamin D, but they gave one milligram of K1 with it. And it showed that it did not increase arterial stiffness. Which is kind of a surrogate for arterial calcification. And then we have studies that looked at arterial calcification with K1 and also with MK7. MK7 did not reduce the progression of arterial calcification.

Dr. Weitz:            So let’s just finish up on the bone part first. What would you say would be an optimal set of recommendations? Obviously every person’s different, diet, other factors, but just some kind of general guidelines for a program to improve bone health, say in a postmenopausal woman who has osteopenia.

Cristiana:             So she would have to take vitamin D, obviously, to an optimal level and that’s debatable, but let’s say middle of the reference range, upper zone of that reference range. In addition, I would say a minimum of one milligram of K1. But if the situation is bad and we need to reverse osteopenia, osteoporosis, I would recommend the full five milligram dose of vitamin K1.   So you would take, let’s say one milligram from your base formulation and additional four milligrams. That gives me confidence that I have complete carboxylation and I have a chance to reduce bone fracture. Now when it comes to MK4, you want to provide some MK4 preformed, but you can take the GG, which is the active portion of that MK4, at at least 70 milligrams, and then you could choose to do the 45 milligrams MK4 as an alternate because that was the Japanese approach. It’s more expensive. So doing it the other way with GG is a more affordable way to try to achieve a similar effect on reducing the excessive rate of bone breakdown. That’s what we’re trying to affect both sides of the equation. We’re trying to build bone, support everything that brings calcium in and also reduce bone breakdown.

Dr. Weitz:            And would you think that the data would also support a certain level of supplementation of a highly absorbable form of calcium as well as magnesium?

Cristiana:             Yes, absolutely. Yeah. The chelates seem to have a much better absorption. They absorb on the amino acid pathway, they’re not affected by other components in food and it will not cause constipation or diarrhea and so on. So the chelates are a better option supplementing with collagen. Now collagen metabolism, just because you provide collagen doesn’t mean the body’s going to deposit the right amount because you need vitamin C for collagen formation. The hydroxylation, you need silicone and you need as well other components, even zinc and sulfur. So the vitamin C and silicone are crucial for collagen formation and having adequate amount of collagen as part of your diet based on your body size. And then of course, fruits and vegetables to make sure you have an alkaline diet. Exercise. Very important, to the type of weight resistance exercise.

Dr. Weitz:            Let’s focus for a little bit upon the cardiovascular aspect of this discussion. How vitamin K can help to reduce the potential for cardiovascular disease. And something you just happen to mention that I think most people probably missed is you said there’s a difference between calcification of the plaque and the calcification of the artery. So let’s make sure we include that in this part of the discussion please.

Cristiana:             Yes. So as most people know that as we get older there’s an increase in blood pressure, increase in arterial stiffness. The blood vessel don’t dilate very well, which makes it harder for the heart to pump blood. And it’s called idiopathic increase in blood pressure. And so why is that happening? It’s that deposit inside, if you think of the artery, it’s layers of muscles and collagen. And so inside there, there’s a deposition of calcium, which is inadequate. And if we have adequate amount of vitamin K. Now, is it K1 or K2? It’s not clear which one is more important, but we know that the interventions with vitamin K1 at two milligrams have reduced arterial calcification progression by 45%. It didn’t stop it, but it reduced it by 45%.  If you only gave 500 micrograms of K1, it reduced it by 6%. So the two studies with 360 of MK7 did not show a reduction in arterial calcification. The blood test would be very useful because if we see the levels of, it’s called MGP, decarboxylated dephosphorylated MGP, that level, you want it to be as low as possible. The more vitamin K you give, and now we have evidence for K1, the better we are to lower the inactive soldiers, so to speak. Right?   So unfortunately we don’t have studies with MK4 for that particular blood test. I hope they will do them. What they showed with 45 milligrams of MK4, they reduced arterial stiffness by 18%. And then MK7 had one study with reduced arterial stiffness by 6%. So not as much. So again, if I were to choose to reduce arterial calcification, improve arterial stiffness, I can go as high as two milligram of K1 based on studies. I could go to the five milligram, which I’m using for bone anyway, right? There’s no toxicity to vitamin K1. And then you want to add the GG to help with that conversion from K1 to MK4, which we see in the arteries and in the heart. There’s different ratios between K1 and MK4.

Dr. Weitz:            Now can vitamin D also play a role in reducing coronary calcification of coronary plaque?

Cristiana:             Vitamin D helps to upregulate the expression of these guardians of the arteries, right?

Dr. Weitz:            No, no, I meant vitamin K, I’m sorry.

Cristiana:             Oh, vitamin K.

Dr. Weitz:            Yeah. Because you’re talking about how it reduces calcification of the arteries and you’re saying that’s different than calcification of the…

Cristiana:             Of the plaque.

Dr. Weitz:            The calcified plaque, the atherosclerosis.

Cristiana:             Yeah, yeah. In rats, yes, they’ve shown some effect of very high doses, but we haven’t seen that in humans. And the arterial plaque is a very complex process and it involves the penetration of oxidized LDL and oxidized and causing the foam cells and so on. I think we have many other nutritional tools for that. Vitamin K may help a little because it reduces inflammation. So it’s possible. But we have, for example, a special form of vitamin E called tocotrienals, which had some studies that showed a reduction in arterial plaque. And also we have a very novel new intervention on the glycocalyx of the arteries. This is something that, it’s very exciting, a new way to look at the health of the arterial wall. And if we reinforce that arterial wall with things like rhamnan sulfate, it’s a seaweed that’s now offered as a supplement called Arteriosil.  If we offer that to constantly reinforce that endocalyx, that layer, some studies have shown that reduces the penetration of oxidized LDL, the progression and some even case studies showed regression of that plaque. So I don’t know that the vitamin K has a huge role in that part of calcification and arterial plaque. And then the discussion is more complex because we talk about the vulnerability of the plaque.

Dr. Weitz:            Right, stable versus unstable plaque and yeah…

Cristiana:             Inflammation…

Dr. Weitz:            Yeah. Yeah, we’ve been using that arteriosil product for a bit in the office here. And yeah, there’s actually some controversy in there can be an argument that in some cases having calcified plaque makes the plaque more stable and less likely to cause a heart attack or stroke.

Cristiana:             I know there’s that controversy, but if you address this process where…

Dr. Weitz:            Bottom line it’s better not to have any plaque, of course.

Cristiana:             Any plaque and then, yeah, I don’t know that vitamin K affects that particular calcium. Another issue with the statins, because statins are advocated as stabilizing plaque and lowering cholesterol and all those lowering inflammation and so on. But a problem with statins is that it blocks the formation of geranylgeraniol this molecule that helps the body convert K1 to MK4. It’s similar to what happens to co-enzyme Q10. Everybody knows that when you teach patents you reduce coQ10, same pathway…

Dr. Weitz:            And you reduce vitamin D and you reduce a whole series of things.

Cristiana:             And so they found studies where a correlation between taking statins and increased arterial calcium scores. And again, where is that calcium? Is it in inside the arterial wall or is it in the plaque? Right? Because when you do a calcium score, you can’t separate. Now there are some arteriosil planning study in China. There are some university based studies where they look at the plaques separately. It’s kind of like an MRI of the plaque so we can see exactly what kind of plaque you have. Is it calcium there? And so you can separate the calcium from outside the artery from the inside the wall.

Dr. Weitz:            And one study that just came out recently showed that statins actually increase lipoprotein A levels, which is a particularly atherogenic particle. And so even though they lower LDL by raising lipoprotein A levels, they may actually play a role in plaque risk as well.

Cristiana:             And actually tocotrienol administration was shown to reduce lipoprotein, interestingly enough. So you’re right, the story with the statins is interesting, but I think that by supplements…

Dr. Weitz:            Also maybe we shouldn’t put it in everybody’s water.

Cristiana:             Yeah, I would try all the natural supplements first before going there. I know it’s interesting now that we have this tool to add GG, even if you were to take a statin, if a doctor doesn’t want to take a chance and gives patients a statin. By adding that GG to the regimen, it’s not going to affect cholesterol levels. But then it gives you the opportunity to make intracellular levels of CoQ10, which may even be more important than exogenous supplementation of CoQ10. And it gives you the opportunity to affect at least the calcification inside the arteries. Which can be good because if you have stiff arteries, you have higher blood pressure, more risk for stroke and so on. So maybe the calcium in the plaque may be protected but the calcium inside the arterial walls is not good.

Dr. Weitz:            And stay tuned to the Rational Wellness podcast because in a few weeks we’ll have Dr. Barry Tan on and we’ll be discussing GG.

Cristiana:             That’s great, that’s great. It’s a very exciting new molecule to consider for many aspects of health, mitochondrial health and so on.

Dr. Weitz:            So let’s talk about some of the other benefits of vitamin K. There seems to be some data that maybe it could play a role in reducing the risk of kidney stones.

Cristiana:             Right, right. Because it’s the same type of molecules. MGP are involved in how calcium is metabolized there. So now when you look at studies with nutritional supplement interventions for kidney stones, magnesium is very important. Drinking enough water, the balance of calcium and magnesium is important and we know how deficient most people are in magnesium. But yes, vitamin K, when you optimize it everywhere in the body, everything works better.  You were interested in maybe brain effects and nerves. For some reason there MK4 is deposited at much higher levels than K1. And they had a study with rats where they gave K1 or they gave MK4 preformed. And it turned out that the supplementation with K1 increased MK4 brain levels better. And why is that? You would think… Because MK4 is not all taken in and deposited unchanged. For some reason the body breaks down K1 and MK4 to a water soluble molecule. The core molecule, menedione, which is called vitamin K3.

                                And that water soluble molecule is able to get in through the blood-brain barrier. And there the body makes MK4 from this K3, which means it needs GG. so if you are taking a statin or bisphosphonate, you are going to be deficient in GG. And I think there was some association with statins and dementia and so on. So MK4 is important for nerves, for myelin production. It seems to have an anti-inflammatory effect in some autoimmune conditions in some animals.

Dr. Weitz:            Yeah. You mentioned that MK3, it’s kind of interesting, I guess some of the MK1 gets converted to MK3 and then into MK4, right?

Cristiana:             Right.. For some reason you can think of vitamin K as like a key chain. The core chain is the molecule that carboxylates, but it has various, we call them ligands. So you can have various tails, various keys on this chain. So there’s a key specific for K1, there’s a key for MK4, it’s four units length of isoprentanol units. We don’t need to go into the chemical names, but the MK7 molecule tail is a little longer. So that’s why we call them MK6, 7, 8 to 12 because they have longer tails. But the body has a way, even when you absorb these vitamins, to clip off these keys from the key chain and the core is K3. Some of it you will find in the blood as K1, MK4, MK7, but some of it you will find K3 in the blood and in the urine.

                                So we know after taking these vitamins, they measured urinary levels of K3. We know that this is what is happening during metabolism. This K3 goes into all the tissues in the body and then the body seems to prefer to make MK4. 90%. But some of it stays at as K1 or some MK4 stays unchanged. It’s very complex. And then your gut bacteria makes all these different Mks. So it’s very important to consider the bottom line, the clinical effects. We may not know all the conversions. And again, looking at plasma levels is not important because it’s not indicative of the effects. But what is important is to look at the clinical effects, long-term effects in bone density, bone elasticity, if we can measure it. We can look at arterial stiffness. There are some office level tests for arterial stiffness.

Dr. Weitz:            You know what’d be interesting, there’s a test that’s done through serum called the pulse test that looks at a bunch of markers that correlates with plaque stability. It’d be interesting to see if patients who took vitamin K had a better score on that test, indicating less unstable plaque.

Cristiana:             Yeah, it’d be interesting to see those. I think that arteriosil and tocotrienol has a good chance of showing great effects on those types of tests. But I don’t doubt that having adequate levels of vitamin K in the body through its anti-inflammatory effect. And we know that inflammation is so core to so many detrimental effects that happen, osteoporosis and cardiovascular disease.

Dr. Weitz:            And potentially vitamin K could be beneficial for osteoarthritis as well, especially since it plays a role in collagen.

Cristiana:             Yes. And the osteoarthritis involves the bone part next to the joint, and then you have the collagen is the tissue, the connective tissue, whether it’s cartilage, whether we have tendons and ligaments that are starting to get frayed. It’s very likely that we don’t have human studies right now, but some studies suggest that. And again, inflammation controlling with omega 3s, huge problem with the US intake of omega 3s, especially the preformed EPA and DHA. I always recommend that test the EPA, AA ratios, the amount of individually looking at EPA and DHA, not just some of them. Because they seem to have different effects on inflammation, and also brain.  So yes, I think vitamin K is very exciting to optimize overall body function. Unfortunately, RDA is stuck at that 90-120 micrograms just for clotting. And by the way, taking more vitamin K1 is not going to increase your clotting. It just saturates the ability to support normal clotting. When you take a thousand micrograms of K1 versus a hundred, right, you’re not going to clot any more efficiently. The particular situations where people need anti-clotting medications are very separate than supporting a healthy state.

Dr. Weitz:            What do we know about vitamin K and cancer?

Cristiana:             Yeah, that’s a very interesting topic and I think it has to do again with the effect on that [inaudible 00:57:35 medalanite] pathway. The Japanese have noticed that they gave for 20, 30 years, the 45 milligrams of MK4 for osteoporosis. They’ve noticed that those women that had hepatitis C virus did not develop liver cancer. That was an interesting side benefit. So why do we think that is? Again, it’s something to do with inflammation and that pathway that produces cholesterol, coQ10 and all those things.

                                Some people tried intravenous vitamin K3, probably to cause oxidative stress for the cancer. Those are experimental things that are very hard to test. Do we think that it will help in general with cancer risk? Possibly. They tried also vitamin K1 at 40 milligrams I believe. I don’t know that that’s your main approach to reduce cancer risk and treat cancer. It’s interesting to know that K3 is given to animals as a source of vitamin K, a very cheap source of vitamin K. Because their bodies are converting obviously K3 to MK4, just to give them enough to support clotting. They’re not supporting their health because they don’t live long enough to worry about long-term diseases. But yeah, K3 is not accepted as a human supplement.

Dr. Weitz:            And you mentioned something to me before we went on air that there may be a role in vitamin K in reducing calcification of the lungs.

Cristiana:             Yeah, so during covid, obviously we became aware of vitamin D status being very important and they saw that people with low vitamin D status had higher mortality when hospitalized and so on. And then they started testing vitamin K status through MGP. The un-carboxylated MGP, which we use for arterial calcification. But let’s keep in mind that the lungs actually are an elastic structure. Collagen and elastin. And they hypothesize that if you have adequate vitamin K, you’re not going to have as much calcification. Just like with the arteries, you’re going to have more elastic lungs, which obviously it’s a critical feature when you’re fighting covid, when you have fighting that inflammation during covid exacerbation.  So it’s an interesting correlation there. And again, the question is, what is your best supplement to improve vitamin K status? I think K1 at one milligram, at least one milligram. Add in some MK4 in case people are on statins and add GG. Because we want to make sure that that conversion occurs between K1 and MK4, wherever the body wants to do it. Each tissue has its own preference. But yeah, the story from vitamin D optimization has to be changed to vitamin D plus vitamin K optimization. It’s just that the tests for vitamin K status are not as well known and as well used and not as affordable.

Dr. Weitz:            Right. Okay. I think those are pretty much the points that I wanted to discuss. I think one more thing, a minor point, but you mentioned to me in one of our discussions that infants are given an injection of vitamin K, and if the mother has adequate vitamin K status, then there’s really no reason for this.

Cristiana:             Yeah, I mean, I’m afraid to go against the medical advice.

Dr. Weitz:            Right, right.

Cristiana:             Even for a friend.

Dr. Weitz:            No, nobody should take anything they hear in this podcast as medical advice. You should check with your doctor, et cetera, et cetera.

Cristiana:             What I say is this. Again, average intake in US of K1 is 92 milligrams, but then we have a reference range of 30 to 220. So half the population doesn’t get enough vitamin K for clotting for the mother’s body. If you have an infant to support, then you probably need more vitamin K to make sure that the fetus has enough vitamin K, right? So if the mother’s deficient, you’re not going to get probably sufficient vitamin K in the fetal tissues. So I hypothesize that if a mother takes at least two to 300 or one milligram of K1. Let’s say she has a great diet of greens and so on. In Europe, the highest intake is 991 micrograms. So it’s possible from a diet high in fruits and vegetables, or you take the supplement, to have a good status. So the likelihood for the fetus is much lower to have issues with clotting.

                                Then breastfeeding starts. They have found that MK4 is the dominant form of vitamin K in the milk. Nature puts out these vitamins in the milk for a reason. And I’m pretty sure that a deficient mother, a mother that is deficient in intake of vitamin K1 and/or K2, or if she’s on a statin, she can’t convert to MK4 very well, it’s likely that her infant would be deficient. So that’s kind of what I’m hypothesizing. Each patient has to talk to their doctor and figure out. I think there are tests that they can do on the infant. They don’t want to maybe spend the money, but you can test clotting ability in an infant and the lab is right there. You can do it probably pretty fast to see, does this infant really need this injection? That’s what I’m fantasizing about, but I don’t know what they’re doing in the…

Dr. Weitz:            It’s probably cheaper to just give them the injection than to do the test.

Cristiana:             Yeah, it’s unfortunate. But yeah, well, tests are so important and are evolving and we have to advocate for them and that’s how…

Dr. Weitz:            That’s a big part of functional medicine. As many of us say, test, don’t guess. So to kind of sum up this sum up part of the important points of this discussion. As far as vitamin K goes, there seems to be some incredible benefits for vitamin K, for bone health, for arterial health, for other benefits in the body. And that consuming lots of green leafy vegetables is super important as a source of vitamin K1. And then as far as supplementation goes, vitamin K1 is probably the most important form to get a really good adequate dosage of which would be at least a thousand micrograms or one milligram and possibly up to five. And then to add some MK4 at probably a similar amount. And that if you take an MK7, there’s nothing wrong with that, but probably not as efficient as taking K1 and MK4. And that adding GG with the vitamin K as well as vitamin D is super important.

Cristiana:             Yes, I totally agree with these conclusions and we hope to keep monitoring the research and updating formulas and protocols based on what we learn.

Dr. Weitz:            Absolutely. Thank you, Cristiana.

Cristiana:             You’re welcome. Thank you.


Dr. Weitz:            And thank you for making it all the way through this episode of the Rational Wellness Podcast. And for those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review. That way more people will be able to discover the Rational Wellness Podcast. And I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic and Nutrition clinic who, many of whom, most of whom we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases and various other cardiometabolic conditions.  And so I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health. And I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my White Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111. And we can set you up for a new consultation for functional medicine nutrition, and we can get that going as early as the new year. So give us a call and I’ll talk to you next week.



Raising Healthy Chickens with Tyler Dawley: Rational Wellness Podcast 289

Tyler Dawley discusses How to Raise Healthy Chickens with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

3:54  Sustainable or regenerative agriculture does not have an exact definition, but Tyler understands it to be paying attention to the entire chain of our ecosystem.  If you are a conventional row cropper you might just grow corn, pour fertilizer on it, and expect a good harvest.  But as a sustainable rancher, you have to think about the mycorrhizal fungi, which are all the little fun things that grow in the soil.  You should worry about how much leaf cover there is and how much solar energy is being captured.  If you are a sustainable animal raiser, then you have to think about how to use these animals to graze the grass and brush without destroying it. If animal graze too long in the same area, they will degrade the land. In nature, the wildebeest get chased around by lions or coyotes, so they never graze too long in one area.  It is up to us to make sure they move around to different areas so the grass and brush can regrow. We want to pump more life into our soil, which is the foundation of all life on earth.

8:57  It is a benefit to have multiple animals on the farm and it would be more regenerative to have multiple animals and it is not in keeping with our climate for the meat case in California to look like the meat case in New York state or Florida.  All these meat cases have a lot of beef, a lot of chicken, a medium amount of pork, and no lamb or goat. In California, we have a Mediterranean climate, which means cool, wet winters and hot, dry summers. One of the reasons for some of the fires in California are that we don’t have goats and sheep that graze down the chaparral zone, so it becomes a bigger fire hazard.  Some are now bringing in goats to graze down brush and the blackberry bushes in the creeks.  People have not had good goat and lamb to eat and that’s the only reason why they don’t eat it because it’s delicious.

12:55  The way they raise chickens on Big Bluff Ranch is different from commercially raised chickens, where the chickens live in barns in controlled environments and never see the light of day. These regenerative chickens are out on the pasture from day one and they have no walls. They have complete access to the outside and they can go in and out as they please.  They are fed certified organic, locally grown, no corn, no soy ration.  The chicken manure helps to fertilize the grass. Such animals don’t need antibiotics because they are not crowded together and they are not stressed out.

18:56  Other chicken farmers also use antibiotics because they make the chickens grow faster.  The birds at Big Bluff grown slower but they are healthier.  Conventional chicken farmers often have birds that are called flippers because they grow so fast that their muscles grow faster than their organs and their heart can’t pump enough blood around and they die of a heart attack and flip onto their backs.  In Big Bluff they have no flipper deaths.

21:35  Some chickens are referred to as free range and this means that they live in a conventional, huge, crowded barn but they have pop out doors leading to a small patio area.  But chickens are very much creatures of habit, so once their habits are set and then you open those doors, they just don’t really go outside. However, pasture raised chickens are living on grass moving outside and inside as they wish from the beginning of their lives.



Tyler Dawley is an organic chicken farmer who also cares deeply about regenerative agriculture, animal welfare and sustainability. He lives at and runs Big Bluff Ranch, specializing in organic, pasture raised chicken.  The website is BigBluffRanch.com.  The phone is (530) 529-2291 and you can order the chicken directly from the ranch.

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.



Podcast Transcript

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, we have an interview with Tyler Dolly on sustainable regenerative agriculture and farming practices and how to raise healthy chickens. Most of us have seen some of these horrible vegan documentaries that show factory farm chickens being raised in horrible conditions in cramped cages, all crowded together, given antibiotics, given feed with arsenic and other chemicals, and then eventually slaughtered in some horrific manner. It’s also claimed in a lot of these documentaries that the poultry industry has a negative impact on the environment. But we’ll be speaking with Tyler Dolly who is not only an organic chicken farmer, but he also cares deeply about regenerative agriculture, animal welfare and sustainability. Tyler, thank you so much for joining us.

Tyler:                   Thank you. I appreciate the intro. I feel pretty special and smart now.

Dr. Weitz:            So, how do you become interested in sustainable agriculture and farming practices?

Tyler:                   I won the genetic lottery, what it came down to… This is the family ranch, I was born and raised out here.

Dr. Weitz:            Okay.

Tyler:                   And in the early ’80s when I was still very short, my dad had to change the course of the ranch that we were not big enough to succeed in the conventional manner. So, he just started exploring stuff and he ran across a guy named Alan Savory, who is a… Depending on what world you live in, he is either a big celebrity or a minor celebrity, but he is a Rhodesian philosopher, wildlife biologist, who figured out… He’s a cool guy. Look him up, he has a TED Talk, had multiple millions of views, and his essential thesis is that animals should be moved just like the will to beast in the Serengeti would move. They would be chased by wolf or lions or whatever. And so, my dad started doing this, but we don’t have wolf. Well, we do have wolves now, but we used electric fences.  That’s how we control our animal’s grazing. So, we move our cattle at the time around on different pastures and be very aware of the regrowth of the plants and long fun story. But then that led us into taking care of our cows, changing the genetics of our cattle, that grass animal, very type animal. And for us, that meant a short, wide cow, which so happens to finish well on grass, which means that we had good genetics for grass-fed beef right around when I graduated college in 2000. So, we started going to farmer’s markets with our grass-fed beef and that led us to some lamb that led us to goat. And eventually threw a long series of unfortunate events, we ended up growing a lot of chicken. And now, we are one of the probably top one, two, three producers of pasture poultry here in California.

Dr. Weitz:            Cool. So, what does sustainable agriculture mean?

Tyler:                   Right. So, this is a new trend and people are, to some degree, defining it individually and they’re coming up with their own answers for it. So, I’ll share you with you my answers, but just understand that there’s no set definition. So, what I say is regenerative or sustainable, womeone else might say, “Oh, that’s complete BS. He’s wrong.”  But ultimately, producers who are in this space of regenerative or sustainable, what they’re really paying attention to is the entire chain of our ecosystem, that you can’t just pull out one aspect of it and only care about that.  So, if I were a row cropper, I can’t just grow corn, pour fertilizer on it and expect a good harvest.  No.  If I’m a sustainable rancher, I’m thinking about my mycorrhizal fungi, which are all the little fun things that grow in the soil. I’m worried about how much leaf cover I have, how much solar energy am I capturing?   And then if I’m an animal guy, I’m starting to worry… Not worry. I’m starting to think about, “Well, how am I going to use these animals to graze these plants?” Plants were evolved to be grazed by animals.  Animals were evolved to graze plants, but Mother Nature has her own process for doing this, and it’s a great process, but it’s a very hands-off process.  And when we get in there with our conventional thinking, we muck it all up and we have degradation of our range lands. So, regeneration or sustainability is really to understand Mother Nature’s process, which is what I talked about, the Serengeti and the wildebeest being chased around by lions that we want to take that sort of passive management that Mother Nature would use and then add our active management to it.

So, we don’t want to rely on just wolves chasing away or coyotes or whatever.   We have to actively move the cows and we’re moving them for a very specific reason. We’re paying attention to the grass and how it’s re-growing. The time of year, we’re looking at our rain forecast and we’re playing with all these factors that Mother Nature can passively do, and she does it really well. But because it’s passive, it’s slow. So, when we’re doing it actively, we’re getting in there and we’re being, “Okay. This grass, this pasture is recovered pretty well. Time to put cows in. Okay, we’re done with our growing season. How much grass do we have until our next rainfall? Oh, we have too many cows,” or, “We have not enough cows. Let’s change our animal herd size to fit what we actually grew.”  And so, my definition of regeneration is to pump as much life into our soil, the very foundation of all life on earth. If you ignore the oceans, of course.  All life on earth, and then draw forth what life you can and then just keep it growing and getting bigger and more synergistic that the fertility that used to exist in our landscape before European management processes came in is just it’s hard to imagine how fertile our landscape used to be.  And we can get back to it in decades, not thousands of years.  And we just need more and more people to be thinking about how to put life back into the soil.

Dr. Weitz:            And is that because-

Tyler:                   It’s not like-

Dr. Weitz:            … is that because when we farm, we grow the same crops over and over again until all the minerals and other nutrients are sucked out at that soil?

Tyler:                     Yeah, yeah. I mean, to some degree, think of your soil as a bank of fertility of life, and that in over thousands of years that Mother Nature’s put a lot of fertility in there and it grows with a compounding interest. So, if you come with your plow and you plow up 5,000, 10,000 years of fertility, you’re going to have an amazing crop of corn and you’ll probably have a pretty good crop of corn the next year and the next year. But what you’re doing is you’re basically drawing money out of your stock portfolio. You’re losing all of your compound interest and eventually you got nothing left. So, to some degree, it’s a tortured metaphor right now, but to some degree it’s the, the fertility in your soil is a stock market. You want to be living on the interest of your principle, not living off the principle itself. So, in our case, the principle that a farmer is trying to put into his landscape is vitality. And you do that through green leaves and all sorts of stuff like that.

Dr. Weitz:            Right. And, I guess, it could even be a benefit to have multiple animals on the farm at one time.

Tyler:                   Oh yeah.

Dr. Weitz:            I remember reading the Omnivore’s Dilemma and Michael Pollan talks about how one animal would do one thing and another animal would do another thing and-

Tyler:                   Oh, it’s a hundred percent true. So, one of the things that I am leaning into here on the ranch is, I don’t have a great term for it yet, but like a California meat case that when you go into your grocery store, you look at the meat case and it’s going to look exactly like the meat case in New York state or Florida, you’re going to have a lot of beef, a lot of chicken, a medium amount of pork, and no lamb or goat, and it’s the same everywhere. But then you step out of this mythical grocery store and you’re like, “Wait a second, it snows in New York City. In our part of California, it doesn’t snow.” I mean, just right there alone, why are we eating the exact same meat? So, getting back to Mother Nature and different species that here in our particular part of California, we’re in a Mediterranean climate, which means we have cool wet winters and hot dry summers.

Dr. Weitz:            Where are you guys located?

Tyler:                   We’re in Red Bluff. So, we’re in the Sacramento Valley, a couple hours north of Sacramento. Four hours-ish north of the Bay Area. And so, we have hot dry summers and there’s a lot of really fascinating stuff about it that I won’t bore you with, but if you want to know, just ask me because I will tell you. But what it comes down to is that we have hills and we have brush out on our ranch. Hills and brush are not what cows want to eat, but they’re exactly what goats and sheep want to eat. So, this is where it gets really exciting. You know what? California, we’ve been burning five of the biggest fires ever been in the last five year. Well, what are they burning? They’re burning brush. It’s brush.  Short shrubby stuff that’s burning. Well, ecosystem has been growing because through management we have removed fire. I mean, that’s a whole separate story, fire controlled burns. But also we’ve removed animals from that environment. There are no elk out there anymore grazing this stuff down. There’s not big huge herds of deer grazing this sort of forage down anymore. So, it just grows up. And the bigger and older it gets, the more flammable it comes and then, poof, it burns. So, what we’re doing, so in California, because we’re a Mediterranean climate that grows really good goat and sheep, we should be eating goat and sheep because those goat and sheep are going to graze down our chaparral zone. That’s a huge higher fire hazard. Even you’re seeing this now, there’s brushing crews, you see them all the time. It’s really fun.

                                People are bringing in 500 groats goats to graze down the fuel load around their housing community or blackberries in the creeks. I mean, there’s a booming industry. And so, all I’m saying is what we’re trying to do is take that idea of grazing with multiple species, because different species eat different things. There’s a specific set of species that we should have here on Big Bluff Ranch. So, with the right species, we’re taking care of our landscape, we’re making it better, we’re soaking in more rainfall. And then we’re also creating really delicious, nutritious, wholesome food at the end of the day that takes care of us so we can take care of them. And people just haven’t had good goat and lamb, that’s the only reason they don’t eat it because it’s delicious.

Dr. Weitz:            Oh, okay. So, tell us how the way you raise your chickens is different from the commercially raised chickens. And I’m sure most people have seen these videos where the chickens are crowded into these little tiny cages in horrible conditions.

Tyler:                     Right. Right. So, I’ve definitely talked a lot about ruminants, and grazing, and haven’t really talked about our chickens at all, but that’s what we specialize in right now. So, you’re exactly right that the conventional chickens live in barns. There’s a very extremely controlled environment and those birds really never see the light of day. Their airflow is regulated, their feet is regulated, their water is regulated, the square footage that they live in gets regulated, and it’s really designed to create cheap food, and it does a really good job at that. But there’s a lot more out there that should be done than just having sheep chicken. So, I’ve talked a lot about taking care of the soil and taking care of the animals. And one aspect of taking care of animals is to allow those animals to be their natural selves. So, for instance, we don’t feed our cows any sort of grain cows aren’t really meant to eat grain.  It actually messes up their gut. Chickens are not meant to be inside. It messes up all of their hormone system. They need the sun, they need vitamin D, they need to see the sun go down, they just need to see the sun come up, they need to eat grass, they need to eat bugs. So, that’s what we do.

So, our chickens are out on pasture from day one. So, they have no wall… Well, they have walls, but they have complete access to outside. They can run outside if they want to, they run inside if they want to. We feed them certified organic, locally grown, no corn, no soy ration, because that is a ration that California can grow well. And then they’re fertilizing the soil, the soil’s growing grass, the cow, chickens are eating it.  And then we harvest them from that spot, move them on to the next spot. And a new set of birds are on a new set of pasture. All that fertility that we left behind with the chicken manure, we let the plants and the soil microbes absorb it and lock it in and just keep that. It’s so fun when you get into it because if you really just start, it just… One thing gets better here, that means that thing gets better. If this is getting better than that’s getting better. It’s this huge ball of synergism. It’s fun. It’s really fun when it works.

Dr. Weitz:            So, chickens can pretty much be raised on grass?

Tyler:                   Well-

Dr. Weitz:            Is that what they eat or they [inaudible 00:15:43]?

Tyler:                   … they get a lot of nutrition from grass.

Dr. Weitz:            Okay.

Tyler:                   But chickens are not vegetarians. So, when you see vegetarian fed labels in the grocery store, that’s really not a diet. A chicken is meant to eat. They are omnivores and they are very happy to eat meat and high protein and you don’t really get that out of your pasture. It’s a salad. So, they need the protein portion of their big ass salads.

Dr. Weitz:            Which is wet bugs and-

Tyler:                   Bugs and stuff and like that. But, ultimately, we end up supplementing them with a no corn, no soy ration, just to make sure that they never hit any deficiencies from what our pasture would provide them. So, I can’t really give percentages, but they’re definitely out there on the pasture and they’re definitely eating some supplementation and it works out just fine. They’re very happy, very healthy birds.

Dr. Weitz:            Right. And then how do you avoid giving antibiotics and some of the other chemicals that are given commercially raised chickens?

Tyler:                   Right. Well, see, this is another part of that synergism that I got outside and then [inaudible 00:16:53].

Dr. Weitz:            Yeah. And/or any antibiotics given partially because they make them fatter?

Tyler:                   They’re phasing that out pretty aggressively now in the conventional industry, but until probably the last five to 10 years, that’s what they would do. Sub-therapeutic levels of antibiotics to grow the chickens faster, which is where people… You’re starting to hear about superbugs that there are some salmon-

Dr. Weitz:            Antibiotic resistant bacteria.

Tyler:                   Yep. Yep. And then a lot of people are pointing out the problems with this sub-therapeutic use of antibiotics for animal production. So, the thing is that they need those antibiotics because they are stressed out, a stressed animal, not living… Imagine yourself. If you are stressed, you’re inside too much or whatever, you can tell when you’re worn out, you tend to get sick, right? You’ve depressed your immune system because you’re not taking care of yourself. Well, just imagine yourself stuck in a football stadium with all those other people, but that’s what you do for your entire life, you’re going to have pretty high stress levels. You’re probably going to need some antibiotics to keep yourself going.  So, to take that metaphor, get out of that football stadium, and once you have space around, you have the sun, you have fresh air, you can engage with your friends on at the right level.  You’re back to a normal, happy, healthy thirst person and you’re not going to get sick. That’s the same thing with what we do with our chickens is that we provide the environment that they’re not going to get sicken. They get shade when they want it. They get shelter when they want it. They get the grass, they get the sun, they get all their friends. They have no pressure from predators because we have guard dogs out there with them. And if you’re a happy, well taken care of person, you don’t get sick. It’s the same thing for chickens. You give them the right environment and they’re good to go. You don’t need the antibiotics. It’s only when you stress them that you have to go to the pharmacy to make your living.

Dr. Weitz:            Right. And how do you get around the fact that they use the antibiotics to make them grow faster? You just take longer for the chicken to mature?

Tyler:                   Yeah, exactly. And then so, that is, yes. Our birds grow a little bit, grow out a little bit longer than conventional birds, which is really a good thing because not only does that mean we can avoid antibiotics and any other stuff like that. We raise a breed called Cornish Cross, which is the same genetics you’re going to buy from the grocery store and it’s really, actually, an amazing breeding. There’s no genetic modification, it’s just really strict controlled breeding for decades. And they’ve gotten these birds to grow so fast that it’s actually, they’ve been bred where their muscles can grow faster than their organs in an ideal situation.  So, the industry has a term they’re called flippers that basically the heart can’t pump enough blood around and they die of a heart attack and they flip right on their back. And what we do, we raise the exact same genetics, but we don’t have any flipper deaths, just doesn’t happen. And that’s because our birds grow a little bit slower. So, the organs develop in relation to the muscle and so, they’re just healthy, happy birds. So, some people have some issues with the Cornish cross and it’s not unguided, but that you give them the right environment and they don’t have issues. So, that’s-

Dr. Weitz:            Now, aren’t there commercially grown chickens where they say they’re grass fed, but really all that means is they let them out of the cages for a short period of time and they go back in,

Tyler:                   Right. Yep. Yep. So, the term for that, at least in the chicken world would be free range, free range chicken, free range eggs. And that is a-

Dr. Weitz:            Okay. So, if we see that term free range chicken, free range eggs, what does that mean?

Tyler:                   I’m just going to… Hey, George, I’m on the phone. I’ll be right back. Okay? Sorry about that. The kids just got back from school. Yeah. You ready?

Dr. Weitz:            Yeah, yeah. That’s fine.

Tyler:                   Okay. So, free range is a legally defined term. It’s like organic. There are a set of guidelines that you have to meet to qualify for free range. And depending on if you’re looking at meat birds or layers, they’re a little bit different. But, ultimately, it comes down to outdoor access is the term. And so, what that means is you have just the same exact conventional barn, it’s like a football field sized barn. But instead of being completely enclosed, like most conventional barns, they will have these little pop-out doors leading out to a little tiny patio area. And different free range certifiers have different requirements for the outdoor square footage, but it’s not very much. And the other thing is that chickens are creatures of habits. They do the same thing over and over and over again. You ever heard the saying, “Your chickens always come home to roost”?

Dr. Weitz:            Right.

Tyler:                   That’s a real thing. Chickens sleep in the exact same spot. They are creatures of habit. So, by the time they get around to opening those doors and those free range barns, their habits are set and they just don’t really go outside. So, it sounds good. So, if you talk to someone like me, I get this all the time like, “Oh, you’re a pasture-raised person or pasture-raised poultry.” You must be free range then. I’m like, “Well, yes, but we are so much more than free range because the image in people’s mind is free range, red barn farmer and overalls, green grass, a few chickens here and there.” That’s what free range conveys in the term, but the actual practices are very, very far from that. If you want that image, you need to be looking for a pasture raised chicken. That’s the only type of chicken that’s going to be out there on grass. The majority of its life.

Dr. Weitz:            So, if it says pasture raised, that means it’s got to be free to roam around, it’s pretty much its entire life till the end?

Tyler:                   Pretty much, yeah. There are different… Yes. The answer is, yes. If you see someone saying free or pasture raised, you’re going to be very happy with that chicken. There are some different styles of how you do pasture raised chicken, but I don’t want to split hairs. Go, go. If you see pasture raised that gets the stamp of approval.

Dr. Weitz:            And we’ve heard reports about chickens being feed with arsenic in it. And what was that about? Is that still being done?

Tyler:                   Well, I don’t know the exact arsenic story, at least I can’t recall it off the top of my head.

Dr. Weitz:            I’m trying to remember. It was some sort of arsenic related chemical that had to do with… I think it, once again, it was to somehow they would grow faster or something.

Tyler:                   Yeah. I Think it’s a growth promotion, that rings a bell. So, I don’t know that specifically, but I don’t think it’s been outlawed. So, there’s no reason that a conventional guy couldn’t be doing that. But I would just say that anyone who is taking care of animals, they are trying to do the best job they can. No, I don’t. I’m not pointing fingers at conventional farmers at all. They’re just doing the best they can with the systems and knowledge that they have. And that one of the things I like to tell people is that you get to vote for the future. Three times a day, you’re voting with your food dollars.  I know I’m stealing that quote from someone else, so I’m not that smart. But if you don’t like how those chickens are raised or how those farmers are treated, just buy some different style chicken. Buy an organic chicken. Is it as good as pasture raised? No, but it’s a lot better than a conventional chicken. And you will eventually, through your dollars and your food choices, create the food system that you want. That these big companies are not evil, they’re just profit driven. So, signal to them with your dollars that, “Hey, this is where I want to spend my money.” And they’ll turn as fast as they possibly can. And there’s actually-

Dr. Weitz:            Yeah. I-

Tyler:                   There’s a lot of examples of that happening.

Dr. Weitz:            Okay. I eat purely organic pretty much 90% of the time, but then I read these reports about how these big companies have gotten into organic and then they get the rules changed so they can add this and add that, and it still qualify as organic.  So, my conclusion is organic is better than not organic, but it’d be even better if they weren’t allowed to get in and say, “Well, we can add this chemical and because that chemical originally comes from seaweed, then it’s okay, and this is okay.”

Tyler:                   Yeah, I totally agree. I mean, that always happens when you have a third party auditor, third party certifier, that all of a sudden you have standards and guidelines and then all of a sudden that means that there becomes loopholes. It’s a nature of the beast. And I totally agree with you that organic is better than not organic, but is organic as good as organic should be? No. No. But it’s directionally right. More and more people are buying organic, now you’re starting to see that higher level of organic. There are actually regeneratively certified organic products out there. It’s a standard we’re looking into, which again, is that as good as what we do? Are we getting all the credit for what we do? Not necessarily, but again, it’s another higher level and we can just keep moving the food system forward by voting with our dollars, taking the best step you possibly can.

                                I think that’s just really important. I mean, for us personally, when you buy a chicken from us, you’re keeping us in business and all the things that we’re doing for our landscape, it’s a very one-to-one exchange like, “Oh, you bought a chicken. Yay. I can go buy food now or whatever.” So, your dollars matter. I realize when you go to the grocery store, you’re like, “Eh, so what?” But actually it’s a very powerful thing. And if you buy straight from a farmer, like from us or from another farmer, local farmer, it’s dramatic. You’re like, “Wow, you are literally keeping people in business.” So, just to give you that sense of empowerment like, “You are really, really important. We love you.”

Dr. Weitz:            Right. Cool. So, what about the way your chickens are slaughtered, and what are the conditions, and then how are the chickens treated after they’re killed? We’ve heard reports about chickens being bleached, and put in all kinds of chemicals, and the processes that are used to end their lives are torturous and horrific.

Tyler:                   Right. Right. It’s definitely a conventional chicken houses process, something like 5,000 birds an hour. It’s insane how fast they do. And when you’re going that fast and that corners have to be cut. You just can’t do everything right. When they’re literally going so fast you can’t count them, it looks like a [inaudible 00:29:11]. It’s really, really fast. So, we don’t go to a processing plant like that. We go to a small processing plant not too far away from us. All of the slaughtering is done by hand, which means that mistakes don’t happen because it’s done by hand. Every single bird is hand slaughtered.

Dr. Weitz:            And are the birds slaughtered pretty quickly after they go there?

Tyler:                   Oh. Yeah. Yeah.

Dr. Weitz:            Okay.

Tyler:                   Yeah. So, for us, in particular, we catch our birds after the sun goes down, so chickens fall asleep hard, man. If it’s waking up a teenager, it doesn’t happen like, “Ugh.” And then we get them there before dawn. And then, so basically, they go to sleep and then they never wake up. So, for us, we have a really great way of getting this done. And our processing plant, they hold them in a right room with blue lights so they don’t wake up and they go into the kill room, which has red lights, so they don’t see all of the blood if they might even look around. And then they go and get plucked and gutted and it’s all done by hand, which is much cleaner and safer than these big automatic machines. It means, our processing costs are a lot higher, but it’s a lot better of a product.

                                And the real thing that we are super fortunate to have is that you are talking about the chlorine bath. So, in many, many, many chicken or processing operations, the way they chill the birds down, because you need to take that normal body temperature and get it down to a food safe 40 degrees pretty rapidly, I think you have four hours to do it. The most cost efficient way of doing that is to put it in water. You have a really good thermodynamic exchange, it draws down the temperature really quickly. Well, but as soon as you start doing that, you’re putting 5,000 birds an hour into the same puddle of water. If one bird is sick, all the other birds are going to have that salmonella or whatever. So, the way they get away or to stop that to mitigate that risk is they chlorinate the heck out of that water.  So, one of the things that happens as well, they’re in this heavily chlorinated water to keep them from cross contaminating each other. As the meat cools down, it actually absorbs in this chlorinated water. So, if you look on some chicken packages, you will see a little asterisk that’s talks about added water, that’s the added water that they’re talking about-

Dr. Weitz:            I see.

Tyler:                   … the chlorinated cooling water.

Dr. Weitz:            I see.

Tyler:                   So, we don’t do that. Our processor doesn’t do that. They do something called air chilling, which is much better. So, basically, it’s hang a chicken and it goes into a big old freezer and comes down to tap. So, never touches anyone else, it never touches water. So, to some degree it’s like dry aging of beef that you’re actually pulling moisture out. Water is wonderful, but it doesn’t have any flavor. So, you take the water out and you concentrate the flavor of the bird itself. Plus you’re not cost contamination, you’re not extra weight of water. And it’s an amazingly delicious way of processing your chicken. And then they come out of the chill chamber, hand packaged flash frozen, and then off to someone to eat it.

Dr. Weitz:            Cool. Do you have some reports from people telling you how much healthier they have, they feel, or even reports of health conditions improving from eating your quality chickens?

Tyler:                     Yeah. Yeah. I mean, that’s one of the best things about being a direct to consumer type operation, that if you ordered chicken from us, you’ll probably talk to me either on the phone or on email and I’ll be shipping it to you. I’m not like some corporate mucky muck and I have flunkies below me. I’d like to have flunkies, but I don’t, it’s me. You’ll be buying from me. And so, we’ll talk and it’ll be a lot of fun. And I get feedback all the time. My current favorite compliment is, “Tastes like grandma’s chicken.” Because chicken right now the joke is, “It tastes like chicken.” Means it tastes like nothing, it’s bland.

                                Well, the reality is the reason chicken tastes bland now is because it’s fed corn, it’s fed soy, man, and it’s literally watered down. Of course, it’s going to be bland. And they have no exercise. Our birds are outside in the sun, they’re hormones are working. They’re getting some exercise and then they’re treated really well through the processing process. And so, I mean, we raise grandma’s chicken. So, if you want to impress anyone with like, “Hey, this is how my grandma used to cut chicken. Her recipe is really good, don’t get me wrong.” But the real star ingredient was the fact that she had it in her backyard. So, if you want that style chicken, you look for us or look for someone else doing pasture race chicken.

Dr. Weitz:            Right. Cool. So, I think that’s the questions that I have. Anything else you want to tell us about?

Tyler:                   Oh. Well, I mean, we only have what? Another two hours now. I’m just joking.

Dr. Weitz:            No.

Tyler:                   No. We’ve covered a lot of stuff. I really appreciate the time. I mean, if anyone-

Dr. Weitz:            No. I mean, we’re fine with time if there’s anything else you wanted to tell us about what you’re doing.

Tyler:                   No, no.

Dr. Weitz:            Okay. Okay, good.

Tyler:                   I think that feels pretty good. I mean, if you have any more questions, I’ve got time. I don’t need to cut off, but we can start wrapping it up if you’d like.

Dr. Weitz:            Yeah. That sounds good. I don’t really have any other questions prepared. So, how can people listening or watching this podcast find out about ordering some chickens from you?

Tyler:                   Right. It’s pretty simple, bigbluffranch.com. There’ll be a big old shop now button and order some chicken. Shoot me an email if you want to ask any questions or want some more information.

Dr. Weitz:            And so, does the chicken come frozen?

Tyler:                   Oh. Yep, frozen. It’s frozen. So, it’ll be shipped frozen, it’ll be on in… Well, right now it’ll be in an insulated cooler. We hope to get a better packaging, but right now it’s a styrofoam cooler dry ice or gel ice, and we’ll ship it FedEx, and it just shows up right at your door. We’ll have tracking numbers on it so you can make sure that it is where it’s supposed to be. And, no, it works out great, especially in the winter shipping is no problem.



Dr. Weitz:            Right. Okay, cool. Big Bluff Ranch. Tyler Dawley, thank you for your time and look forward to talking to you again in the future. And thank you for making it all the way through this episode of the Rational Wellness Podcast. And for those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify and give us a five-star ratings and review. That way more people will be able to discover the Rational Wellness Podcast. And I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic Nutrition Clinic, most of whom we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases, and various other cardiometabolic conditions.  And so, I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health. And I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111. And we can set you up for a new consultation for functional medicine nutrition and we can get that going as early as the new year. So, give us a call and I’ll talk to you next week.




Cytokine Testing with Dr. David Brady & Tom Fabian, PHD: Rational Wellness Podcast 288

Dr. David Brady and Dr. Tom Fabian, PhD discuss Cytokine Testing with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

4:10  Cytokines are small proteins that are produced primarily by immune cells and their role is primarily in cell signalling and cellular communication.  Cytokines promote different aspects of immune cell development, immune cell function, and coordinate between the innate immune system and the adaptive immune system.  For example, if you ingest a pathogen though the digestive tract, there are certain receptors on cells that detect these pathogens and that leads to cytokines being produced that initiate an immune response.  This usually starts with the innate immune response.  Some of the classic cytokines that are involved in the inflammation response are IL-6, TNF alpha, IL-1 beta, and Interferon gamma

7:41  There are a number of difficulties in testing for cytokines, including that cytokines are very short lived and they tend to be unstable, so it is important that the sample arrives at the lab frozen, which is best accomplished by shipping with dry ice.

11:44  Cytokine level testing has been used in critical care medicine, such as analyzing patients with severe COVID-19 whether they are having a cytokine storm, which led to using certain interventions that modulate certain cytokines when used in patients with autoimmune diseases.  For Functional Medicine practitioners, cytokine testing can help to assess the immune system status, the level of inflammation, which can be re-assessed after using certain interventions to see how well we have been able to modulate the inflammatory process.

26:30  Cytokines and gut health.  It is recommended that patients that have cytokine testing also do the GI Map stool test, since the gut plays a big role in immune system function and in autoimmune diseases.  For example, Hashimoto’s hypothyroid has a significant gut component and certain bacteria like Yersinia have been associated with Hashimoto’s and there is a characteristic cytokine pattern for this.  We also know that 70-80% of the immune system is in the gut, so we know that, that’s really going to have a huge effect and it’s also a great place to intervene.   



Dr. David Brady is an internationally known speaker, Doctor of Chiropractic, and Naturopathic Physician. He’s also a Professor at the University of Bridgeport and the Chief Medical Officer for both Designs For Health, Inc. and Diagnostic Solutions Labs, LLC. Dr. Brady is a prolific writer, having published a number of scientific papers, contributed chapters to various textbooks, and he’s written several books, including his latest, The Fibro-Fix, published in 2016. His website is Dr.DavidBrady.com.  Patients seeking the Cytokine Test should contact a Functional Medicine practitioner and practitioners who would like to run the test should contact Diagnostic Solutions Lab at DiagnosticSolutionsLab.com or they can call 877-485-5336 to inquire about the CytoDx panel.

Dr. Tom Fabian, PhD has a PhD in Molecular, Cellular, and Developmental Biology and he is a certified Nutrition Therapy Practitioner.  Dr. Fabian specializes in the microbiome and how it relates to digestive, immune, brain, and metabolic health and he offers a Microbiome Mastery course through his website, Microbiomemastery.com. Dr. Fabian serves a consultant and science advisor with Diagnostic Solutions Laboratory, and he is also a Science Advisory Board member with Designs for Health.

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.



Podcast Transcript


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, I’m excited to be talking about cytokine testing with doctors Dr. Fabian Fabian and Dr. David Brady.  I’ve certainly have known about cytokines, but since COVID, and we heard about the cytokine storm that played a role in a lot of people’s demise and made the symptoms more severe, cytokine have been talked about quite a bit. And Diagnostic Solutions offers a cytokine test, and I’m curious to learn more about how this may be a new tool for functional medicine practitioners to be able to help our patients. And my mission is to spread this information to practitioners, and also to the patients, so we can improve the overall health of our country, and the world, actually.

                                So, cytokines, what are cytokines? They’re a group of small proteins, peptides, and glycoproteins, and their main job is cell signaling, communication. Many of these cytokines are secreted by immune cells like macrophages, B and T lymphocytes, and mast cells.  Cytokines made by lymphocytes are known as interleukins. You may have heard the term IL-6, et cetera. These cytokines are very important for the immune system, and they modulate the balance between humeral and cell-based immune responses. They also regulate the maturation growth and responsiveness of particular cell populations. Cytokines are important in many responses in the body, including immune responses to infection, inflammation, trauma, sepsis, cancer, and reproduction.

                                Dr. Fabian is a PhD in molecular, cellular, and developmental biology, and he’s a certified nutrition therapy practitioner. Dr. Fabian specializes in the microbiome and how it relates to digestive, immune, brain, and metabolic health. Dr. Fabian offers a microbiome mastery course through his website, microbiomemastery.com. Dr. Fabian also works with Diagnostic Solutions, helping clinicians to interpret their various tests including the GI-MAP stool test, and the CytoDX test, which is known as the cytokine response profile.

                                Dr. David Brady is an internationally known speaker, doctor of chiropractic and naturopathic physician. He’s also a professor at the University of Bridgeport or, at least, I know he was at one time, and the chief medical officer for both Designs for Health and Diagnostic Solutions Labs, which makes the GI-MAP stool test, which is my favorite stool test. Dr. Brady is a prolific writer having published a number of scientific papers, contributed chapters to various textbooks, and he’s written several books. And his latest book is The Fibro Fix, which was published in 2016. I recently listened to Dr. Brady give a very helpful presentation on how to treat patients with long COVID at the CASI Conference in Orlando, Florida.  So, welcome, gentlemen, for a discussion on cytokines.

Dr. Brady:            Thanks, Ben. It’s good to be back on your podcast.

Dr. Weitz:            Absolutely. Thank you. I love having scientific discussions.  Dr. Fabian, maybe you could start by giving some little more information about what a cytokine is.  Why should we care about cytokines?

Dr. Fabian:          Absolutely. Yeah. I think you gave a great introduction overview. So, these are generally small proteins. We tend to think of them as produced primarily by immune cells, and that is essentially their main function overall, is to promote different aspects of immune cell development, immune cell function, coordinate between the innate immune system, the adaptive immune system, and on and on.  We all know that the immune system is fairly complex, and these play a really central role in essentially regulating those various functions of the immune system. I think another important aspect of cytokines for everyone to be aware of is, they’re not necessarily just produced by immune cells, they’re primarily produced by immune cells. But they can be produced by epithelial cells, for example, adipocytes, IE fat cells. And they can also influence these different cells. So, that’s a big part of this immune crosstalk…

Dr. Weitz:           Right.

Dr. Fabian:         With our whole system, really.   They generally also tend to be fairly short-lived, for the most part. So, they’re really meant to be a way for the immune system, initially, to kind of alert… Actually, for even the epithelium to alert the body to what’s going on. So, if you take a typical example in the gut and say a pathogen, you ingest a pathogen, there are certain receptors on cells that can detect these pathogens, and that sets in motion the production of cytokines that can initiate an immune response.  That often starts, of course, with the innate immune response, and then they play a role kind of in this cascade effect. Then, when those initial cells produce certain cytokines, that initiates a second set of responses, and that kind of gets the whole immune cycle going, and they play a role throughout the entire immune cycle. So, really, from inflammation through resolution of the inflammation, and then the healing process as well.

Dr. Weitz:            What are some of the more important cytokines that we should be aware of?

Dr. Fabian:          That’s a great question. Of course, as always, in research, we’re learning more and more about cytokines and some of them are starting to take center stage that we didn’t know that much about a few years ago.  But the classic ones that we think of is the key signs of what we call, classic inflammation. This is largely involving, at least, initially, the innate immune system, that would be… Cytokines like IL-6, which plays a really wide range of roles in terms of coordinating the immune system, initiating immune responses, something called tumor necrosis factor alpha or TNF alpha. Lot of these are produced, for example, by macrophages. Lot of these are sitting there in the mucosa, just monitoring what’s going on, produced by dendritic cells, also sitting kind of at these barrier sites, skin and mucosa. So, they’re really kind of these initial players in the immune response.  Third one would be, IL-1 beta, which is interleukin-1 beta, it’s another major inflammatory cytokine. Then, interferon gamma. So, those are kind of the big four, so it’s important to really understand what that means when you see those particularly elevated in a patient’s cytokine profile.

Dr. Weitz:            I read a bit about a bunch of issues related to the difficulty of testing for cytokines, so maybe you could talk about how we test for cytokines, and what are some of the issues related to trying to test for these?

Dr. Fabian:          Probably, nearly the top of the list is the fact that not only are they short-lived, for the most part, but also they tend to be unstable. So, it’s really important we have this release, spelled out in our instructions to make sure that they’re kept cold.   We specify that they need to stay frozen through the whole transit, so that they arrive at the lab frozen, because they’re very sensitive to room temperature.  So, if they arrive at the lab thawed, then obviously, that can affect the results of the test. So, that’s part of the picture, is a sort of technical-

Dr. Weitz:            So, after the blood is drawn, it should be put in a freezer for a period of time before it shipped?

Dr. Fabian:          Frozen. And then, ideally, sent, if at all, possible with dry ice.

Dr. Weitz:            Dry ice?

Dr. Fabian:          That will help keep them frozen.

Dr. Weitz:            Wow.

Dr. Fabian:          If they’re going to arrive at the lab really quickly, that may not be necessary. But these days, of course, we know there have been some issues with transports, et cetera. Things can get held up a bit, so dry ice really helps to ensure that they arrive at the lab. So, that’s more of just a technical issue to be aware of.

Dr. Weitz:            How would a practitioner actually get dry ice?  If I drew it on one of my patients here, we’d have to get dry ice to ship it?

Dr. Brady:            Ben, I’ll jump in.  The lab recommends you send it back on dry ice.  It could be sent back frozen with a conventional ice pack, but we do recommend for the best fidelity, dry ice.  And dry ice you can get at your local supermarket.

Dr. Weitz:            Oh, you can?

Dr. Brady:            So, if you’re going to be a practitioner that thinks they might be using these types of tests, it’s probably good just to find some dry ice at a supermarket, locally, and then just keep it in your office in the freezer, so that you have it available to send it back.  There are some cytokine tests out there that it just says, send it back, not frozen, just room temperature. And when you look at the range and the fidelity that they’re stating, they’re trying to achieve, which is a challenge in cytokine testing to… And we’ll talk about that to get down into the ranges where we would play clinically, because we’re not dealing necessarily in acute care medicine in overt cytokine storms, we’re looking for more subtleties.

Dr. Weitz:            Right.

Dr. Brady:            So, it’s half of the function-

Dr. Weitz:            [inaudible 00:10:18] of medicine community.

Dr. Brady:            Right. So, you have to get down to a level of fidelity. That makes sense for us trying to use these tests. And we think the best way, in fact, as far as our laboratory science, people that really control the quality control in the methodology and really, really understand how the sausage is made, basically, on how to make these lab tests very, very reliable. Suggests that, it’s just not virtually impossible when you’re sending it back at room temperature that they’re too fast to decay, they’re too unstable at those types of temperature.  So, while it is a bit of a hassle to do the whole dry ice thing, once you’re used to doing those tests and you find out where to get, it’s not a big deal. But there is a barrier of entry. And the other barrier of entry for functional and integrative providers a lot is simply that, it involves phlebotomy, it involves a blood draw, it’s serum tests, so you can’t do it in your end and you can’t do it in these non-invasive type of samples that people are used to.

Dr. Weitz:            Yeah. We usually bring a phlebotomist in to do functional medicine testing. I just didn’t know anything about dry ice. It sounds scary, maybe.

Dr. Brady:            Yeah, I know. I didn’t know much about it either until we were confronting this issue, and then it turns out it is very readily available because people are sending food stuffs and things like that all the time. So, it is more available than you would think.

Dr. Weitz:            Sounds good.   What does looking at cytokines tell us, specifically, about the immune system? And I guess, we can tie in the gut microbiome as well.

Dr. Fabian:           I was actually glad to stay there.  David, do you want to go first?

Dr. Brady:            Yeah. I’ll let Dr. Fabian dig into this. The real granular side of things in the science side, because he’s more knowledgeable than me about that kind of stuff. I’m just a clinician, but…   From a clinical standpoint, if you remember back… First, it was in chiropractic school, then it was in medical school. You learn immunology, you learn about all these cytokines, right?  And you learn everything that we said in the opening, and then you go into residency, you go practice, and you pretty much don’t use them, you forget it, you forget about them.  They’re not routinely ordered tests, but yet they’re so critical in our understanding of immunology.  Well, that’s not necessarily the case in critical care medicine, right? In critical care medicine, they’re dealing with life and death by the minute situations, and they have to utilize cytokine testing all the time. So, a lot of our understanding from a clinical utility standpoint with cytokine testing does come from critical care medicine with people, actually going into overt cytokine storms, whether it’s in multi-organ failure, whether it’s in sepsis, whatever it may be.

                                When it came down to COVID, COVID is one of these, in certain people, in susceptible people, and have the right set of circumstances. As we know, it can progress very rapidly. And end up in this cytokine storm, that can be, actually, the thing that takes you out, that drowns you in your own lung fluids and so forth.  So, they figured that out right away. And of course, they turned to some of the agents and the different types of interventions that they had used successfully in other reasons for cytokine storms, including non-infectious reasons. Some of them worked, some of them didn’t. And when they worked, they only worked to a degree, and they often only work to a degree.  But what we were able to learn from that experience is that, listen, if they can use them when the fire alarm’s screaming, and it’s really, really a serious situation, maybe we can use those in another way in chronic care medicine or in ambulatory care medicine, even, to try to fundamentally determine where does someone’s immune system, where’s it sitting from the standpoint of how inflammatory is it, how activated is it, how imbalanced is it? And what the cytokine testing can tell you, particularly, if you get away from just looking at one cytokine in isolation, when you look at sort of groupings of them, there’s sort of a bucket of what we would consider pro-inflammatory cytokines, and a bucket of cytokines that we would considered anti-inflammatory calming cytokines.  And we actually grouped them in that way, in our tests, so you can see, “Hey, I got a whole cluster of inflammatory ones that are above the normal situation you see in a normal person, right, person without overt disease or any obvious reason that would be driving cytokines to be elevated.” And then, you can look at what is their status in the ones on the opposite side of the seesaw, and you can start getting a picture in a more objective way of your patients. In addition to what they come in and tell you, “All my joints are inflamed” or “My ulcerative colitis is flared up” or “I have long-haul COVID symptoms.”   Well, that’s very valuable information, but wouldn’t it be nice to be able to actually baseline them and get where they are on this seesaw of inflammatory, anti-inflammatory immune balance, and then be able to, from there, figure out what you’re going to try to do to help them. And you intervene in whatever way, whatever your therapeutics may be. And then, serially assess them downstream, so you can monitor, “Hey, are their symptoms getting better? Are they saying they’re feeling better?” Or other maybe standard laboratory serum markers, functional markers, metabolomics, things like that. Are they changing in a positive direction or not? But you can also come back to cytokine testing and see, are they indeed now less inflammatory and less of an inflammatory stance than they were before I started. That’s the goal of it.

Dr. Weitz:            Right. Okay. Interesting. I’ve done a couple of the… Dr. Vojdani developed this lymphocyte MAP test, and that’s a way to map out the various parts of the immune system. And I was trying to figure out what the cytokine testing tells us compared to that. And I was thinking, in my mind, maybe we’re investigating a crime, and then we go to the scene, and we see who’s there, and then we want to hear the conversations between who’s there, intercept those phone calls, and the cytokine testing is telling us what’s going on, the communication, right? Is that a way to think about it?

Dr. Fabian:           Yeah.

Dr. Brady:            It’s actually a good analogy. I think I’ll let Dr. Fabian follow up. But basically, knowing what population of cells and their relative abundance and the things is an important thing to know, it’s a good thing to know. But those cells have the ability to do different things in different scenarios.   So, the fact that certain cell populations in different variations or different iterations in different relative levels can be important, but it’s nice to also know, functionally, what are they doing?    So, the cytokines and the things that they’re releasing in their chatter, like you said, in their conversation, contextualizes, not only who’s there but what they’re doing while they’re there, right?  Dr. Fabian, you can maybe expound upon that, in a better way.

Dr. Fabian:           Yeah. I do think that’s a great analogy, because different cell types, immune cell types, as David noted, can perform a bit differently in different contexts. Kind of the class example, sort of an extreme example would be, like macrophages. We know there’s pro-inflammatory and anti-inflammatory macrophages that have totally different roles, even though it’s the same cell type. So, they’re going to produce different types of cytokines under those circumstances.  You can think, overall, of the cytokine profiling approach. It’s kind of almost like a tiered view of the immune system. Your first question is, do we see a systemic, elevated systemic immune response? That’s important to know because sometimes, you can just have a local issue, local infection that’s not really at the level that’s going to impact things systemically. So, you’re not going to necessarily see a significant signature in serum. But if you have a big enough immune response, say in an autoimmune flare, for example. We see this all the time in various autoimmune diseases, infections, et cetera, inflammatory scenarios. You can certainly often see a pro-inflammatory response.

                                So, that’s kind of the next level is, do you see a generally pro-inflammatory response? And then, what are you seeing with this compensatory anti-inflammatory response? And we know from research, and we see this clinically, that you can have an extensive pro-inflammatory response, but not a sufficient anti-inflammatory response to bring that back down. That’s really the idea. You think of the classic infection, you want that immune response to ramp up, deal with the infection, and then you want the anti-inflammatory part to kick in and help bring things back down to homeostasis. So, that’s a big part of it.

                                And then, the next level down, which I think speaks to some of the information in this other test is, we often characterize immune responses based on these T-cell types. You’ll hear Th1, Th2. We think of Th1 with antiviral chronic inflammatory scenarios, autoimmune conditions. Th2 is more the allergic type scenario, typically, although there’s some nuances there.  You can often see a characteristic pattern with that. We definitely see that with, for example, type 1, type 2 diabetes, inflammatory bowel disease. You’re going to see, oftentimes, those predicted patterns that we know from research.  So, it helps you sort out what the details of that response is, especially important for patients that have multiple things going on. A review cases for patients that had multiple conditions. Sometimes, it’s a little bit hard to understand what’s going on. You look at these cytokines, you can see what’s the overall picture here. What’s elevated is that, they’re innate, immune response elevated, as if they’re adaptive, and then you can start to piece it out from there. From there-

Dr. Brady:            I’ll follow up on just what Dr. Fabian said in that, you have these two sides. And in looking at both sides is often important and not just looking at, “Hey, are the inflammatory cytokines high?” Well, that’s good to know. But also, are the anti-inflammatory cytokines kicking in as a compensatory reaction? So, when you look at some of the data coming out on trying to build an immune profile or an immune signature in something like long-haul COVID, which is a very complicated thing that unfolds over a long period of time.  Various studies have come out. There was just one I presented at CASI, Ben, was from mucosal immunology, and it was looking at, truly, a sticky imprinting of an aberrant immune response or an immune signature, five months, six months, eight months after you had acute COVID. And this is multiple papers showing this. And they didn’t only show upregulation of pro-inflammatory cytokines and eicosanoids, 5-lipoxygenase, and things like that. But they also concomitantly showed a downregulation of the production of pro-resolving factors and anti-inflammatory cytokines.

                                As they build these signatures, they’re using these things. And they’re not just actually looking at a PDF of lab results, I’m talking about studies where they’re looking at hundreds of biomarkers, whether they’re serological markers, whether they’re cytokines, whether they’re other types of compounds. And they’re using non-biased, naive, computers machine learning to try to figure out, what are the patterns you see in this constellation of results in people that meet the clinical criteria or have the clinical presentation of someone having a long-haul syndrome versus people who are normal, versus what it looked like in acute COVID, or what did it look like if they had immune dysregulation that, apparently, was from having COVID itself, versus having an immunization to COVID, let’s say.  So, they can pick this apart and at pretty high levels of detail. And actually, they’re starting to use this kind of machine learning with cytokines and other testing, metabolomics and so forth, to actually finally be able to pick apart, what is the signature of chronic fatigue in me? What is the signature of long-haul COVID from the virus? What’s the signature of long-haul COVID from a vaccine? What’s the signature of, I don’t know, fibromyalgia? Right?  So, they’re trying to build these with very complex digital modeling, but you can do that on a little bit more of a simplistic level. But still, really good way to do it with objective information by looking at a cytokine panel.

Dr. Weitz:            Is it the case… And this might be an oversimplification, that if we look at a cytokine panel, that if we see certain inflammatory cytokines high, or certain anti-inflammatory cytokines low, or maybe just a pattern that we have specific diet lifestyle supplement interventions, that can modulate those?

Dr. Brady:            Well, they’ve looked at some of these advanced models, like I was telling you. If you look at Pat Bruce Patterson’s work and in other groups. In other groups, there’s group at Yale, there’s groups looking at these signatures. And they’re not only looking at these cytokine signatures and other types of biomarkers from the standpoint of who has it? Do they have it or not? From a diagnostic standpoint.  But what drives a lot of their work is trying to figure out, “Okay, let’s answer if they have it.” Number one. But let’s say, they have this pattern that seems to correlate with, I don’t know, let’s pick one long-haul COVID.

Dr. Weitz:            Okay.

Dr. Brady:            What are, then, the therapeutic approaches that we’re going to take, that’s informed by this laboratory data?   If you look at groups, like Patterson’s group, many people may be aware of some of the different approaches being used in, let’s say, long-haul syndrome. One of them is this combination of a low-dose statin and maraviroc, which is an antiviral part of an HIV cocktail, but it’s used in an off-label way, and it’s a combination of a low-dose statin and maraviroc.  They didn’t just pick those agents out of thin air, they pick those agents because they have specific modulating effects on the precise cytokines that they found elevated in the signature of those patients. Maraviroc, for instance, is a will downregulate CCL5 or RANTES, and that’s one of the cytokines that has been most correlated. Not the most correlated one when you look across the broad literature, but it’s the one that, for instance, Patterson, really, honed in on early that this RANTES CCL5 was elevated. I believe it is an HIV, and he comes out of HIV research world. So, it makes sense. He applied an agent he knew from the HIV work to downregulate RANTES or CCL5. And it has some value in long-haul COVID.  It’s not a panacea, it doesn’t just fix everything. But they’re not only trying to figure out, what kind of testing can we do to answer the question, do you have disease A, B, or C or not? But then, what do we need to do to try to treat it?

Dr. Weitz:            Okay. Why don’t we go into a little bit about how cytokines can help us to better understand the gut, and how it might correlate with, say, stool testing.

Dr. Fabian:                      Yeah. We actually do strongly recommend, if at all possible, to try to do a stool testing in conjunction, really, for two reasons. Because of course, as we all know, the gut certainly plays a big role in influencing the immune system, and it’s often thought to be involved in a variety of different chronic conditions. Even if those diseases are primarily take place elsewhere. For example, hypothyroidism or Hashimoto’s affecting the thyroid, we know that there’s a significant gut component there, based on the research.   You often see a characteristic cytokine pattern. It is always one of the things to keep in mind when you’re looking at… And learning the cytokine pattern and combining that with gut testing is really understanding those general patterns. Is it a Th1 dominant scenario? Which is what you’d expect in an autoimmune condition? Do you see a lack of the compensatory anti-inflammatory response, which is, again, pretty common?

                                It’s actually often driven in part or influenced strongly by, what’s going on in the gut? For example, we know your commensal bacteria, your normal beneficial bacteria produce a whole range of factors. Probably, the best known would be short-chain fatty acids. Butyrate is obviously the most famous of those. Butyrate is known to have an anti-inflammatory effect. Pretty significant studies show that it can actually kind of downregulate the activity of many different types of immune cells, and shift that profile, like we talked about, more towards an anti-inflammatory type pattern.

                                So, we often see a deficiency for patients in their normal bacteria. That can mean that they don’t have this stimulus to produce enough of these anti-inflammatory factors. And that’s actually widely characterized in a very long list of diseases and conditions. Everything from autoimmune disease, chronic inflammatory disease, allergic disease, et cetera. So, you can kind of [inaudible 00:28:41] this balance, so you need to have a sufficient amount of these normal bacteria cranking out these homeostatic molecules that keep the immune system from overreacting.  But also, at the same time, you’ll often see overgrowth of some of these opportunistic bacteria. Commonly, the more ones. So, things like Klebsiella, Citrobacter, that many of you may be familiar with, Proteus, Fusobacterium. A lot of these are implicated in chronic diseases, autoimmune disease, et cetera.

                                We see those same types of imbalances noted now in long COVID studies. For example, low butyrate producers, especially low faecalibacterium is probably the most commonly noted factor in these various studies. So, that basically says that, that could be a contributor to these chronic inflammatory scenarios that you see associated with long COVID, because you don’t have that ability to bring those cytokines and those immune cells back down. So, very, very important connections there.   There’s a lot of details we could get into, in terms of specific microbes. Microbes that produce LPS, et cetera. But that’s kind of the general idea is, this balance in the gut. We know that 70-80% of the immune system is in the gut, so we know that, that’s really going to have a huge effect. So, it’s a great place to intervene as well.

Dr. Weitz:            Now, one of the things I always find fascinating on the GI-MAP test is the potential autoimmune triggers, and managing a lot of patients with autoimmune diseases. We’d also like to try to prevent them. It’s fascinating to consider that some of these gut bugs can play a role in becoming triggers for autoimmunity.  And I wonder if there’s a correlation like, if you see an elevation of a potential autoimmune trigger bacteria, and we see a certain cytokine pattern cannot reinforce the potential or the relationship with some autoimmune disease that’s either existing or might exist in the future.

Dr. Brady:            There’s different levels of linkage in some of these organisms. If you look on a GI-MAP, you’ll see there’s a section, I think, on the latest revision of the test. Well, I have one here. What do we call it? It’s like, autoimmune inflammatory triggers. And it’s in the opportunistic organism section. I thought I had one here somewhere, but… Anyway. But as Dr. Fabian mentioned, you see things like Citrobacter, and we’ll look at the species level or the genus level, and sometimes down to the species. Klebsiella, in general. But Klebsiella pneumoniae, for instance, is not only linked from an association standpoint. An association relationship, as you know, means if you take… Let’s say, people with rheumatoid arthritis, and then you test subjects without rheumatoid arthritis, and you do microbiome analysis, you have a higher prevalence of finding Klebsiella in those with rheumatoid arthritis.  And you can spin it around the other way. People with elevated Klebsiella have a higher propensity of having rheumatoid arthritis. It doesn’t mean if you find Klebsiella pneumoniae or if you find Citrobacter freundii, that the person will get rheumatoid arthritis. Other things have to line up, genetics and other factors and so forth. But there is this association.

                                Now, in some organisms, there’s actually beyond association data. With prevalence, there’s actually causal understandings of how this can actually cause an autoimmune response. Some of these organisms, like Dr. Fabian mentioned, Hashimoto’s, right? Above Yersinia enterocolitica, it has been shown to have proteins expressed on its surface that look structurally very similar to TSH receptors on the thyroid. As your immune system says, “Hey, this Yersinia shouldn’t be there, I’m going to attack it.” It can get confused and latch onto to TSH receptors, and you get a inflammatory immune erosive thing going on against your thyroid, and inflames your temporarily hyperthyroid, you eventually go hypothyroid. And that’s when you usually get diagnosed, right?  But that’s an actual cause of relationship. In that case, it’s molecular mimicry. In other cases, some of these organisms produce enzymes which modify host proteins, turn them into a hapten, and then you’re off to the races because now it’s an abnormal protein. So, the immune system goes at it.  There’s multiple ways by which this can happen, but the dominoes, really, often, do start to fall in immune dysfunction systemically in the gut, in mucosal immunology. And some of it is mediated through these responses of these organisms, whether it’s structurally or whether it’s through messaging molecules.

                                There was a paper that came out post-COVID on the microbiota regulation of viral infections through interferon signaling, so we know that different microbes can actually alter interferon responses, and how you produce interferons, and how you’re able to fight viruses or not. And you saw during COVID, that the status of the microbiota in the gut was one of the predictive factors on whether you did well or did not do well or you actually perished from it.  The paper I was talking about, in particular, also looks at important commensals, Bacteroides fragilis, certain clostridia, bacillus species, lactic acid producing bacteria, including lactobacillus and strep, promoting the production of antiviral interferon, including interferon beta, specifically, and bolstering that antiviral defenses of the host. And if you were devoid of those things or you had lower levels, you didn’t have that protection.  So, we’re still just trying to unravel all this, and you were probably just scratching the surface on it, right? In 50 years, we’re probably… If someone watches this podcast, I’ll probably bust out laughing, right? Because they’ll know a whole lot more. But it is interesting stuff. But the connections are just wild. They’re just wild.

Dr. Weitz:            Are there certain cytokine patterns that, if we see that and we see that they have these potential autoimmune triggers, would that change our clinical strategies?

Dr. Brady:            I think if you actually have cytokine expression leaning toward the inflammatory side, that is a functional marker telling you, there is an upregulated immune response, and there is inflammation. There’s got to be a reason for it. It doesn’t tell you it’s from rheumatoid arthritis or it’s from this or that, but there’s something going on.  It’s like, getting an ANA, right? Unfortunately, you have doctors now telling females, mainly females, “Oh, ANA. But everything else is negative. That’s normal.” It’s not normal, it’s common. It’s not normal. It’s not normal to make antibodies against nuclear, right?  Same thing here with the microbiota. You can have someone that comes back and they have higher DNA catch for Klebsiella or Citrobacter, or Prevotella, or Proteus or what have you. But clinically, they have no signs or symptoms of an autoimmune disorder. It may, though, mean that, if that is left there to fester, eventually, with other things combined in the whole ball of wax, they would be more likely to progress to eventually end up with an autoimmune disease.

                                But if the cytokines are already raging, something’s already going on. So, it’s almost like our conversation about the cell test versus the cytokine test. It’s almost like, what is potentially going to happen, and then what’s actually being expressed? Another analogy is, when you do genomics and you look at snips, it’s predilections toward things. It’s not anything is necessarily happening or not, but when you do things like metabolomics organic acid, proteomics, you’re actually measuring something that’s functionally occurring, you’re me measuring the downstream effects of actual biochemistry and metabolism. So, they make great one two punches, for sure.

Dr. Weitz:            So, you mentioned thyroid issues, Yersinia, et cetera. Let’s say, we’re managing a patient with Hashimoto’s thyroiditis, which is an autoimmune condition that leads to a decreased function of the thyroid.  From a conventional perspective, even though, sometimes, thyroid antibodies are measured, conventional endocrinologists and physicians don’t really pay any attention to that because there’s really no strategies to do anything about it, so they basically just forget about it. But from a functional medicine perspective, we’re measuring thyroid peroxidase antibodies and thyroid globulin antibodies. And we’re trying to see, what are some of the underlying triggers that might be leading to this hypothyroid, Hashimoto’s, and those could be gut dysbiosis, and they could be food sensitivities, and they could be chemical toxins.   Let’s try to get a little more clinical here. We have a patient who has Hashimoto’s, they have elevated TPO antibodies of 500, and we also see a cytokine test that indicates a more pro-inflammatory profile. How can that help us? How can that, potentially, change our clinical judgment?

Dr. Brady:            Well, it’s a multifactorial thing. In autoimmune thyroiditis, you bring up a particularly interesting one because we see it all the time. Number one. It’s extremely prevalent.  And you’re right. I mean, the medical management is, well, let’s just watch it until it gets out of… They may look at antibody levels, but they do them to figure out, when do we need to oblate the thyroid and get it out of the picture and use HRT? We’re looking at them often more serially to figure out, how autoimmune active in this patient? Are they trending better or worse, or what have you? And you got to take some of that with a grain of salt on minor changes, because these antibodies are variable, but you can see big changes in trends over time.  But in something like autoimmune thyroiditis, we know about these hooks to changes in the gut ecology, so we’re going to look for things like Yersinia, we’re going to look for things like Citrobacter, Klebsiella, all the inflammatory things. But just general dysbiotic state, leaky gut, barrier function problems, digestive problems. I mean, because you mentioned foods, we know certain foods are correlated with autoimmunity, including autoimmunity to thyroid.

                                Great people with Graves and Hashimoto’s have about 20 times the rate of… Or I should say, the other way around. For instance, celiac disease patients who clearly have a problem with gluten, a major food peptide, have 20 times the rate of autoimmune thyroiditis than non-celiac patients. So, we know that people don’t have celiac disease, but they have non-celiac gluten sensitivity, also have a higher propensity of having autoimmunity.  Some of that might be permeability of the gut, not digesting it, so we look at markers like elastase-1 and make sure… We need to get them digesting their proteins. We need to get their barrier function better. We need to treat dysbiosis, if it’s there, particularly if there’s these autoimmune inflammatory ones.   Then, your job’s not done because you mentioned other great stuff. Environmental stuff, a lot of these pesticides and flame retardants and all of that, they glob on thyroid receptors.

Dr. Weitz:            Bisphenol A, et cetera, et cetera, and Teflon.

Dr. Brady:            And then, viruses, I mean, probably, the most common triggers, Epstein-Barr, reactivation with long-haul COVID, tons and tons of thyroid autoimmunity that crops up because one of the biggest things it does… And multiple speakers talked about this at CASI, CASI reactivates EBV, right? So, if your EBV is reactivated or CMV or any of those ubiquitous stealth viruses, it can drive an autoimmune response.   They’d love to hang out in the thyroid, and it’s called the bystander effect. They go to the thyroid to hide out, and then the immune system attacks them there, and the thyroid gets obliterated because it’s the battlefield, essentially.  So, it’s interesting, but the more ways you have to triangulate on this and look at objective markers, it can push you toward the right types of therapeutics.

Dr. Weitz:            Let me bring up another case on the same thyroid topic. Let’s say, we have a patient who has, what some people call, subclinical hypothyroid. Meaning, the person has an elevated TSH, maybe they’re T3 and T4, within range, and they have elevated antibodies.  And the question is, is this somebody who should have an intervention? Does this person need to take thyroid hormone? And let’s say, we see a pro-inflammatory cytokine pattern. Does that change the way we might handle this patient?

Dr. Brady:            Dr. Fabian, do you want to go first, or me? I can give you my clinician’s perspective on that. But if you have [inaudible 00:42:58] first.

Dr. Fabian:           Just because we do see that gut immune connections so often… If they’re not quite at the point where they necessarily need the typical clinical treatment, they don’t have the outright meet the criteria for the outright disease, obviously you can often still see some of the underlying causes starting to trend out of balance.  That really is where focusing on the gut is very helpful, because you can typically see in many of these scenarios. And a lot of people run GI-MAP, just from more of a preventative standpoint. So, you can start to see some imbalances already in people that may be preclinical, subclinical, et cetera.  So, I think it can give you really valuable information and specific targets that you can act on, particularly based on the gut testing.

Dr. Brady:            Yeah. I think you got to clean up all the stuff we already talked about in that scenario. If they don’t have overt, medically, defined primary hypothyroidism, so-

Dr. Weitz:            Yeah. Let’s say, they don’t have fatigue, they don’t have weight gains-

Dr. Brady:            [inaudible 00:44:01] aren’t overtly low, their TSH isn’t above the normal. But we know those are wide ranges, right? You got to be pretty screaming hypothyroid of your TSH go above the range now.  But we see them up in the threes and in the fours. T4s hanging in the normal range are usually midpoint or lower, but then the T3 levels are way lower. So, the total T3 and the free T3s are often right at the rock botDr. Fabian of the normal range or even reported overtly low. And-

Dr. Weitz:            I have patients who are men where the TSH, maybe they’re in their sixties or seventies, and the TSH is even seven or eight. And they’re still there. T3 and T4 is in a normal range.

Dr. Brady:            Yeah. Well, in those cases, if their TSH is really high, but all their hormone fractions are within the normal range, find out where they are in the range. Or usually, in the lower end of the range. And I would look at their autoantibodies. This is a phenomena you see much more in females, biological females, than males.  And there’s various hypotheses why that is, that involve estrogen receptors, that involve a lot of other things. The differences in the immune response of females versus males, because they have potential to carry the fetus, and they have to have a more dynamic immune system. But in the end, you clean up all those things. And we all know the things from clinical nutrition on trying to promote the 5 crime deiodinase enzyme is what converts T4 to active T3, and its sister enzyme, the 5-deiodinase will convert it to reverse T3. You can look at those balances and so forth.

                                And we know that certain things suppress the deiodinase enzymes and imbalance them, cortisol, stress, steroids, things like that. But lots of environmental toxins. So, you clean up everything you can, you do the best you can, you serially assess them. But if you have someone who clinically is hypothyroid, they’re tired all the time, they’re slow bowels or constipated, hair falling out, all that kind of stuff, body composition changing, you do everything you can to rebalance it itself.   But usually, if they’re past a certain point, particularly if there’s autoimmunity and they’ve had destruction of enough of the thyroid gland itself, therefore it’s functionality. Usually, we’re talking, usually a female, usually in that forties and up, particularly if they’re postpartum, they’ve had a couple of kids, all of a sudden, boom, this thyroid immunity hits like crazy, autoimmunity.

                                Oftentimes, they do need to optimize their metabolism, and get them to feel like they didn’t get hit by a truck. I think, top them off on the T3 side with something with T3 or a combo T4, T3 kind of compound it, HRT, just to optimize them in the normal range, never to make them too hyperthyroid. But you don’t want them hanging right down on the bottom of the ranges, if they really feel bad.  Caveat to that is, do all everything you can to self-correct them. But oftentimes, you’re dealing with someone that’s tipped over that line, where you’re never going to get their metabolism optimized if you don’t backfill the thyroid a little bit directly.

Dr. Weitz:            Just to hit on the cytokine thing, again, let’s say we get a pro-inflammatory cytokine pattern. We take some interventions from a functional medicine perspective, we take out gluten and dairy and soy, et cetera, we clean up the gut, we create some of the dysbiosis that we saw there on a GI-MAP, maybe we give them some antimicrobials, some other nutrients, et cetera. And then, we see the pro-inflammatory pattern on a cytokine test, become less inflammatory. Does that tell us, for example, that we are potentially on the right pattern at helping the-

Dr. Brady:            Yeah, it’s-

Dr. Weitz:            … underlying-

Dr. Brady:            Yeah, it’s really good assessment. If you change your diet, now you’re using curcumin or… Whatever you’re doing, whatever your interventions, we all know a million natural anti-inflammatories and how to have a less inflammatory, less autoimmune stimulating diet and so forth. Yeah. You should serially assess and see those things coming down, just like you would look at a A1C or a blood glucose in other circumstances where you’re trying to improve their glucose tolerance. Yeah, exactly. That’s the exact intention.

Dr. Weitz:            How about with autoimmune gut conditions like Crohn’s and ulcerative colitis? Can cytokine testing give us an idea of what’s going on, as to the state of their autoimmune condition?

Dr. Fabian:          Yeah, absolutely. I’ve seen a number of cases of both Crohn’s and ulcerative colitis. We know, in research, that they’re a little bit different, in terms of their cytokine profile. Crohn’s tends to be generally more sort of Th1 dominant, some Th17. Ulcerative colitis, actually, has a bit of a Th2 component to it, which we normally associate with allergies and things like that.  So, there’s a bit of a different immune response that you may see there. And same with what’s going on in the gut. I mean, you can connect those dots, if you have that data, and you can see how they correlate on this.  One thing I would note is, it’s can get a little complicated in terms of correlating what we know by the immune system with the gut. And I would just certainly advise everyone who is trying this, initially, Diagnostic Solutions Lab does have these 30-minute consultations which, when you’re first getting going, can be really invaluable to help understand and help you connect those dots, because it can be a little daunting. I think that’s one of the barriers, for some clinicians, in adopting this type of testing is, they see this panel of 18 cytokines. They’re not used to working with those cytokines. So, it can be a little challenging at first, and that’s really where our resources and our consultations can be so helpful.

Dr. Weitz:            Does that different cytokine pattern, in ulcerative colitis versus Crohn’s, does that give us any ideas about clinical treatment strategies?

Dr. Fabian:           It can, yeah. I mean, the classic picture is, with Crohn’s, you tend to have more in the guts of a inflammatory microbiome dysbiosis pattern. Actually, we often do see. Ulcerative colitis can have a combination of an overgrowth of normal commensals. Long-

Dr. Weitz:            So, how might we treat those differently? What does this tell us that clinicians can use, practically?

Dr. Fabian:           I think, to David’s point, certainly, when it comes to the gut, I mean, having that comprehensive picture, we know that there are all these upstream factors that can contribute to downstream displaces [inaudible 00:51:12] that sort of downstream. In optimizing digestion, for example, can be very important, especially for addressing that overgrowth type of pattern.

Dr. Weitz:            What do you mean by optimizing digestion? What does that mean?

Dr. Fabian:           Of course, when we think of digestion, the common pieces would be sDr. Fabianach acid, hypochlorhydria is pretty common. We know that H. pylori, for example, is one of the contributors to low stomach acid. So, C high H. pylori patient also has some symptoms of hypochlorhydria, not only can improve their hypochlorhydria, also improve some of that downstream dysbiosis.  Optimizing pancreatic function-

Dr. Weitz:            Let me just stop you, real quick. So, you’re saying, if you see H. pylori, maybe use herbs that we know can reduce H. pylori. If you don’t, maybe supplement with HCL.

Dr. Fabian:           Certainly, the herbal approach is the most common, especially mastic gum. Based formulas, those are really popular, and those seem to work quite well.  Typically, they’ll do that in conjunction with some other things like [inaudible 00:52:18], for example. And then, the use of HCL with H. pylori is kind of controversial. Certainly, with significant gastritis, you wouldn’t necessarily want to go that route. When it’s kind of a low level infection, some clinicians… It’s really a clinician judgment. Some clinicians do use HCL supplementation, others may just strictly avoid it until they have already eliminated a reduced HCL.

Dr. Brady:            Well, I mean, we use a full digestive enzyme complex, a full pancreatic enzyme that mirrors what the exocrine output of the pancreas. And oftentimes, those products, some have, some don’t. And you can make that differentiation in your recommendation, whether they have any hydrochloric acid or not.    Some of them have enough to activate the enzymes, but not like a super heavy payload, like if you were taking a separate betaine HCL.

Dr. Fabian:           Right.

Dr. Brady:            And I think some of the decision comes down to, if they have frank ulcers, if they have frank gastritis, duodenitis, you’re probably not going to use hydrochloric acid. But if you find H. pylori, that’s sort of a resident population’s been around a long time… I know, way, way back, when this H. pylori thing first emerged, I was in school, right? And the thought was, the H. pylori dig in, they make you overproduce all this stomach acid, and it rips your stomach apart, and can cause… Oh.   And what Dr. Fabian said is right. Actually, the story is unfolded very different than that. A longer term chronic H. pylori infection can actually down-regulate the production of your endogenous hydrochloric acid, so you end up in a hypochlorhydric place. And if you give a little stomach acid, as long as there’s not exposed tissue, it can improve everything about the digestion, it can kind of treat that upper dysbiosis, if you want to call it SIBO or whatever you want to call it. A lot of that is a function of pH not being right. And a lot of that is a function of not enough hydrochloric acid.

Dr. Weitz:            Okay. Let’s get back to, where were we. We were talking about how… I forgot what we were talking about. Ulcerative colitis or Crohn’s, right now.

Dr. Brady:            Exactly. Yeah. We were talking about H. pylori.

Dr. Weitz:            Right.

Dr. Brady:            And then, you were asking, does testing the cytokines change what you’re doing clinically?

Dr. Weitz:            Right. Right

Dr. Brady:            Sometimes, it does. Sometimes, it doesn’t. To me, it’s just more objective evidence that I have someone that’s in an inflammatory posture, immunologically, and I need to take action steps to reverse that.  And some of those action steps will be determined by, what I figure out, is the driver of their inflammatory status in the gut, right? I’m going to treat them different, if they’re long-haul COVID, versus if they’re ulcerative colitis, or if they’re… It’s not just an easy O. When that cytokine is high, give this, it’s not that linear. Right?

Dr. Weitz:            Right.

Dr. Brady:            But it’s just another tool to serially assess, am I really getting this person better or not, objectively? Versus just them saying, “Oh, yeah. Well, I’m having less flares or… I’m a little less fatigued.” I mean, that’s fuzzy around the edges, right? It’s hard for us.

Dr. Weitz:            For sure. Yeah. Maybe you can talk a little more about long COVID and how cytokine testing can help us to assess, what’s going on and what we can do about it? And I guess, the new term that I’ve seen in some of these studies is post-acute sequelae of COVID 19-

Dr. Brady:            That PASC-

Dr. Weitz:            … PASC. Yeah.

Dr. Brady:            Post-acute sequela of COVID-19 infection or of SARS-CoV-2 infection. Yeah, that’s the fancy medical term for long-haul COVID. They couldn’t name it the same thing as the patient’s name. They have to have some fancy acronym that no one understands. That’s just medical ego at play, but it is what it’s… Right. So, PASC is long-haul COVID.  And I mentioned some of this research that has been done by multiple investigative groups at CASI. We had Bruce Patterson, his group is one of the ones who’ve done that, that have tried to typify these changes that occur in long-haul COVID patients. And actually, even different variants of long-haul COVID patients. And they found typical suspects, inflammatory cytokines like IL-10 and IL-6, TNF alpha, TNF gamma. VEGF is another big one that they find the RANTES or CCL5 that I talked about.  And then, that paper in mucosal immunology, I reference… I have it here, actually. They show elevated expression of interferon beta, interferon gamma, IL-6, and various other cytokines. But the biggest thing that popped out most for them in this study was pretty big group was, IFN beta or interferon beta. So, they’re still working on it and figuring it out, but there’s definitely patterns that are associated with long-haul.

                                Actually, Patterson’s group have… I think they have IP on an algorithm, that they use a computer model to look at cytokine testing, and come up what’s called, a long-haul or index. And that’s a mathematical calculation using things like CCL5 or RANTES and VEGF, and some of these other cytokines.  I can say, clinically, I’ve had patients with long-haul syndrome, no doubt. I mean, it’s just in your face, the definite long-haul COVID syndrome. No other thing it can be. And it’s hit or miss, whether they hit on that long-haul index or not. So, I don’t use it as a binary, “Yes, they have it. No, they don’t,” kind of thing. It’s not there.   But certainly, they generally have a more than one, a multitude of these inflammatory cytokines high when you cytokine test them.

Dr. Weitz:            And is that a questionnaire?

Dr. Brady:            What? The long-hauler index?

Dr. Weitz:            Yeah.

Dr. Brady:            No, it’s-

Dr. Weitz:            Oh, it’s a computer.

Dr. Brady:            … it’s a computer algorithmic output based on the laboratory assessment behind the scenes. You know what I mean?

Dr. Weitz:            I see. Okay. Okay, good. Yeah. All right. Any other things we want to talk about, how cytokine testing can help clinicians?

Dr. Brady:            Well, I mean, a big part of the understanding of cytokine testing and what ended up turning into these commercial cytokine analysis and testing… A lot of it came out of, like I said, critical care medicine, but also out of cancer research. Because with precision personalized medicine in cancer therapeutics, where they’re trying to phenotype the cancer, and then give very specific agents that modulate the immune system in very specific ways based on the person’s genetics and the cell line’s genetics, all those drugs were pretty much proved out with very advanced cytokine analysis, all the way through the process. It was part of the drug approval process. In fact, one of our main science brainiacs at DSL, actually ran the largest CRO lab that did a lot of the cytokine testing for the approval of a lot of these different biologicals, if you will, right? Response modifiers.  So, when they’re considering using PD-1 checkpoint inhibitors and things like that, they’re using cytokine analysis to make those calls in a lot of different situations. So, there’s a lot of use for this throughout many different phases of medicine, especially at the highest levels of precision medicine and cancer therapeutics.  But I think there’s definitely a role for it in functional integrative medicine, because when it’s all said and done, as you know, we’re dealing with all these complicated downstream issues that are fundamentally creating very common, a common set of physiological responses. And usually, it evolves around inflammatory and immune responses.

Dr. Weitz:            Okay. Great. Any final thoughts, Dr. Fabian?

Dr. Fabian:           Yeah. I would say, the clinical utility, to me, has been pretty phenomenal in many ways, for a lot of patient cases. So, you can really zero in on what’s going on in the immune system for certain patients. And again, especially if you combine that with gut testing… I’ll just give you a couple of quick examples. One would be, patient that had a chronic Bartonella infection. It was really just not doing well, pretty sympathatic. I’m certainly not a Bartonella expert, so I can’t comment…

Dr. Weitz:            By the way, for those who don’t know, Bartonella is a common co-infection often related to Lyme disease.

Dr. Brady:            Also, very commonly flared up in long-haul patients.

Dr. Fabian:           Yeah. And so, one of the things that you can potentially see is this classic ideas. You might have an overactivity of the pro-inflammatory side and insufficient anti-inflammatory. But in some cases, you have the opposite. So, you have a chronic viral infection, and ideally your immune system wants to try to deal with that.  But on some of these patients, I’ve seen patterns where they don’t have a detectable pro-inflammatory pattern, and they have elevated IL-10, interleukin 10, which is a really well-known anti-inflammatory cytokine. And I looked in the research on that when I reviewed that patient’s case, and there’s a fair amount of research on these various chronic bacterial viral infections that many of them can actually cause an upregulation of your anti-inflammatory response, that then kind of blocks this antiviral function.   So, that gives you some key information, because normally, what comes from the gut standpoint, you might want to work on an inflammatory scenario, increasing those beneficial bacteria, trying to increase that IL-10. But there may be cases where that may not be the best strategy. So, this really speaks to precision medicine. And knowing these details can really help influence your overall strategy. One other quick case would be-

Dr. Weitz:            Hang on. Just one quick second. Let me just give a little extra information to those listening, who aren’t familiar with what we’re talking about is, you’re pointing out something which is really important which is there’s a tendency to think of inflammation as all bad, and the more anti-inflammation you can get is better.  But inflammation is also a marker of immune system function, and we need a certain level of inflammation to fight off microbes and help us heal from injuries, et cetera. So, it’s not as simple as inflammation is bad.

Dr. Brady:            It’s how much how long what’s causing it, and is the response in appropriate for what’s going on. And is it becoming too persistent in locked loop.  And even what Dr. Fabian just pointed out was interesting. One of the things you do see a lot on, let’s say, a long-hauler population is IL-10 being elevated. And you might go, “Well, hey, that’s anti-inflammatory.” Right? Well, sometimes, it’s… When you look at a cytokine test, it’s not only important to see that someone has upregulated inflammatory cytokines. Sometimes, upregulation of anti-inflammatory cytokines is telling you, they’re trying to react to it, they’re trying to fight something. So, you need to look at it from both directions.  And so, again, it’s not as draw this line linear, as you think. You got to kind of think your way through it a bit.

Dr. Fabian:                      Yeah. And I’d say, just to kind of add to that picture a bit more, and again, really, the precision medicine approach and parsing out what’s going on, I’ve seen a number of cases where patients with autoimmune conditions that are on biologics, they are highly targeted to suppressing certain inflammatory cytokines.  So, anti-IL-6 is a pretty common class. Anti-TNF alpha is another common class. Remember one particular case where this patient is on the biologic. We looked at the cytokine profile results, and that particular cytokine was not detected. So, that’s telling us the biologic. It did appear to be working. Patient was still very sympomatic. We saw all kinds of other pro-inflammatory cytokines lighting up. So, that’s telling us that, that was effective in a narrow way, but not really effective in generally suppressing that overactive immune response.  So, that gave the practitioner digital information that there’s more work to do, to try to find out, what’s causing this inflammation, and what can they do to compliment this biological therapy.

Dr. Brady:            Or they might need an entirely different response modifying medication, because it’s just not hitting the optimal target.

Dr. Weitz:            This brings up a really interesting example. Imagine that you’re managing a patient with autoimmune disease, who’s on one of these biologics and you do a cytokine test. It may be that, immune modulating drug is actually not working. Maybe that cytokine that’s supposed to be suppressing is elevated, and you might actually be able to interact with their rheumatologist and say, “Hey, look, this interleukin-6 suppressing drug, actually their interleukin is elevated. They probably need a higher dosage of that. Or maybe the opposite. Maybe they’re taking-

Dr. Brady:            Or they’re using IL-6 targeted drug, and they’d be better off with a TNF alpha. And you can show that on the cytokine analysis.   And while they may use this kind of testing in a very precise way, in many cancer therapeutic situations, generally, I don’t find that’s the case in standard rheumatology. I think they’re just clinically working up a patient, maybe doing rheumatoid panel or what have you, but not advanced cytokine testing. And then, saying, “Well, we’re just going to use the drugs we use, so we’re going to try a TNF alpha or we’re going to try in IL-6.” Well, they’re not testing it to that level, they’re just not doing it.

Dr. Weitz:            Yeah, that’s really insane. Imagine that you were going to put a patient on a drug for diabetes, and you don’t test his blood sugar to see if it’s working or not.  So, I think we just pointed out something that’s really, really crucial for managing autoimmune patients.

Dr. Brady:            Yeah.

Dr. Weitz:            Okay, great. Thank you so much, guys.  Dr. Fabian, why don’t you tell us how clinicians can… These tests are available for clinicians, right?

Dr. Fabian:          Correct. Yes.

Dr. Weitz:            Right. So, you can either contact a functional medicine practitioner, like myself, you can go to find a practitioner from the Institute of Functional Medicine. Or if you’re a clinician, you’re a practitioner, to tell us how we can order the cytokine test and the GI-MAP stool test.

Dr. Fabian:          So, you can either call our customer service. Just go to our website to get the contact information. You can either fill out the form, call customer service. If you want, just more information about these tests, we have a lot of great information on our website about the test and specific information there on how to order.   And if you’re just kind of wanting to know a little bit more before you do place an order, we do have a lot of educational information that can help you better understand utility of these tests, clinically.

Dr. Brady:            All of that is on the website at diagnosticsolutionslab.com. So, Diagnostic Solutions Lab. Or again, just Google Diagnostic Solutions Laboratory and you’ll find it.  And the tests are orderable, also, through a lot of the big lab distributors, whether it’s Rupa or Evexia, or any of those as well. So, it depends how the clinicians order their diagnostic testing, but if they have the authority for ordering diagnostic laboratory testing, they can come right to DSL as well.

Dr. Weitz:            Great. Thank you, guys.



Dr. Weitz:     And thank you for making it all the way through this episode of the Rational Wellness Podcast.  And for those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify, and give us a five-star ratings and review. That way, more people will be able to discover the Rational Wellness Podcast.

                                And I wanted to say, thank you to all the patients that we’ve been working with us at our Weitz Sports Chiropractic and Nutrition clinic who, most of whom, we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases, and various other cardiometabolic conditions.  And so, I very much appreciate you, and I’m excited about going forwards helping you to improve your health on your journey towards optimal health. And I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition, Santa Monica office at 310-395-3111, and we can set you up for a new consultation for functional medicine nutrition, and we can get that going as early as the new year. So, give us a call and I’ll talk to you next week.



Bioidentical Hormone Replacement Therapy with Dr. Anna-Marie Wysynski: Rational Wellness Podcast 287

Dr. Anna-Marie Wynsyski discusses the use of Bioidentical Hormone Replacement Therapy in Women with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

4:03  We learned from the 2001 Women’s Health Initiative that the use of synthetic hormones including estrogen made from horse’s urine and synthetic progestins might increase the risk of heart disease by forming clots that can block the arteries in the heart. In particular, it is the synthetic progestins that are dangerous, since in the estrogen only arm, there was no increased risk.

9:10  The Benefits of Bioidentical Hormones, in contrast to synthetic hormones, are that they significantly reduce all cause mortality, which means the risk of dying from any cause, in both men and women when used at the appropriate time.

10:19  Dr. Wysynski prefers to prescribe estrogen creams rather than oral estrogen or in other forms.  She prefers not to use oral estrogen, since it tends to raise LDL cholesterol, but she will sometimes use it if the other forms don’t work for that woman.  She prefers the Biest cream that contains both estradiol and estriol.  She will sometimes use a vaginal route. She is looking into bringing pellet therapy into her clinic, but the difficulty with pellets is that you can’t easily adjust the dose.  With Biest cream it is easy to adjust the dose.  There are patches that are bioidentical, but they are synthetic rather than natural.  Dr. Wysynski prefers to use the Biest creams, which mimic the fact that the naturally occurring forms of estrogen are estriol and estradiol in an 80:20 ratio.  Sometimes a higher amount of estradiol, such as 50:50 is necessary to calm down perimenopausal or menopausal symptoms. 

15:27  Some doctors in the hormone replacement field feel that estradiol is the preferred hormone to recommend and that estriol is the hormone that predominates in pregnancy and it does not provide the benefits of estradiol.  In allopathic, conventional medicine, we give women estrogen in the form of estrogen patches or EstroGel as hormone replacement and if a woman does not have a uterus, we do not offer any form of progesterone or progestin.  But that doesn’t make any sense to Dr. Wysynski, since when women are in their 20s, progesterone is typically a hundred or more times higher than estrogen. In perimenopause, progesterone falls faster and greater than estrogen.  Progesterone falls about 70-75% whereas estrogen only falls by about 30%.  When estrogen levels are higher than progesterone, this is referred to as estrogen dominance and this estrogen dominance leads to the typical symptoms of menopause.  If you give estrogen only, this exacerbates estrogen dominance and high levels of unopposed estrogen can makes things grow.  It is not physiologically correct to give estrogen without progesterone. And in terms of the form of estrogen, a woman naturally produces 80% estriol and 20% estradiol, so using a 80:20 Biest cream is physiological.

18:34  Dr. Wysnyski likes to recommend slow release oral progesterone compounded, though some women prefer topical creams.  She customizes each patient’s hormone recommendations for each woman depending upon her presentation, her needs, and her hormone testing, such as saliva testing.

19:49  Dr. Wysynski leaves it up to her patients if they would like to have their cycle return, then she will cycle the progesterone. If not, she will have them take it daily and perhaps take it 6 days per week and skip one day or perhaps take a lower dose on day six or seven.  Progesterone is a brain chemical, a natural antidepressant, helps with water bloat, it’s a diuretic and it is an anti-anxiety hormone as well as a sleep hormone, so it is very beneficial for women. 

23:14  Testosterone for women.  While Dr. Wysynski will recommend testosterone for women if they need it, she feels that it is not so much a driver of libido in women as it is commonly thought.  She feels that when you restore the estrogen/progesterone balance, women’s libido usually comes back without needing additional testosterone.



Dr. Anna-Marie Wysnyski is the Medical Director of her clinic, Dr. Wysynski Bespoke Functional Medicine in Burlington, Ontario. She is certified in Functional Medicine from the Institute For Functional Medicine and she has completed a post graduated fellowship in Anti-Aging Functional and Regenerative medicine from the American Academy of Anti-Aging Medicine.  She is a hormone expert and has provided bioidentical hormone replacement therapy for peri-menopausal and menopausal women since 2006, which is our topic for today.  Her website is TorontoBioidenticalHormones.com.

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.



Podcast Transcript

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 we will be discussing the use of hormone replacement therapy in postmenopausal women with Dr. Annmarie Wysysnki. Today we’ll be discussing the potential benefits and drawbacks of recommending hormone replacement therapy in postmenopausal women. After menopause, women often experience a number of symptoms including hot flashes, night sweats, sleep problems, vaginal dryness and atrophy. Post postmenopausal women also have an increased risk of heart disease and osteoporosis. It was common for MDs to prescribe hormone replacement therapy prior to the Women’s Health Initiative, which in 2001 reported that postmenopausal women who take hormone replacement therapy have an increased risk of heart attack, stroke, and breast cancer.  After the WHI study was published, many MDs stopped prescribing hormones to postmenopausal women. However, additional analysis of this study has led quite a number of doctors and researchers to conclude that these results may only apply to women who take estrogen derived from horse urine and synthetic progestins, and who don’t start taking hormones until an average of 10 years after menopause. The American College of Obstetricians and Gynecologists, I went to their website, and so they currently recommend that taking unopposed estrogen increases the risk of endometrial cancer while taking combined therapy estrogen plus progestins slightly increases the risk of breast cancer. They also state that combined hormone therapy may reduce the risk of colon cancer. On their website, The American Collagen of Obstetrics and Gynecologist’s website also states that combined hormone therapy is associated with a small increased risk of heart attack for older women.

                                                Now, they also state that this risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy. Some research suggests that combined hormone therapy may actually protect against heart attacks in women who start combined therapy within 10 years of menopause and who are younger than 60 years, and this benefit may be even greater for women taking estrogen alone. However, I will say that I’ve seen guidelines from other nations, other countries, and they come to different conclusions. Anyway, we’re going to discuss all this. Dr. Annmarie Wysysnki is the medical director of Dr. Wysysnki Bespoke Functional Medicine, formerly Vitality Anti-Aging Center in Burlington, Ontario. She’s certified in functional medicine from the Institute for Functional Medicine, and she’s completed a postgraduate fellowship in anti-aging, functional and regenerative medicine from the American Academy of Anti-Aging Medicine. She’s a hormone expert and has provided bioidentical hormone replacement therapy for perimenopausal and menopausal women since 2006. Dr. Wysysnki, thank you for joining us today

Dr. Wysysnki:                     Ben, it’s my pleasure. Thank you very much for hosting me.

Dr. Weitz:                           Absolutely. What did we learn from the 2001 Women’s Health Initiative?  Did it tell us that hormone replacement therapy increases the risk of breast cancer and heart disease in menopausal women?

Dr. Wysysnki:                     It did tell us that, Ben. In fact, we know that when there are different hormones used, specifically the synthetic hormones as you spoke about, it can increase risk of heart disease by you forming clots that block the arteries in the heart, and it could increase the risk of stroke as well. What we learned, and this is very difficult in the literature, is that we’re very inaccurate when we talk about hormones. When we talk about bioidentical hormones, for example, we know that those are identical chemically to the body hormones that are made when we go into reproduction starting in puberty. However, the studies have been used with pharmaceutical drugs that are made from synthetic chemicals and specifically, as you said, estrogen from horse urine.  Over 50% of that estrogen is not identical to what we make, and we know that that may or may not propose problems. But where the biggest issue came with the WHI study, the Women’s Health Initiative, or the WHI study, is we know that there are synthetic progesterone-like compounds called progestins. This is where the greatest issue came. When the study was stopped because of increased risk of heart attack, stroke, and breast cancer, the arm of estrogen only continued, and they found that that was not as egregiously dangerous and not dangerous at all, frankly, compared to when we combined estrogen with synthetic progestins. This is a really key important point when we’re reading the literature as healthcare providers to differentiate between progesterone and progestins, but it’s not always clear.  If we’re not clear what’s happened in a study, how do our patients differentiate what they’re getting versus what they are reading in the common literature and what they’re hearing from their doctors?

Dr. Weitz:                            I think another important factor is that on the average, these women didn’t start taking hormones until an average of 10 years after menopause. If estrogen is protective against heart disease and these women go 10 years without estrogen, which means during that period of time they’re at increased risk of heart disease and then you incorporate the hormones, well, obviously they’re liable to have more of a risk of heart disease because they went for 10 years without that protection.

Dr. Wysysnki:                     Absolutely. One of the points that’s really salient here is that when women are at 40 years old and not in any menopausal state yet, because menopause can start as early as 35, but as an example, as a cohort, when we look at women who are at 40 years old who still cycle and have their natural hormones being made, compared to men at 40 years old, women enjoy 10 year protection against heart disease. However, when we go to 50 and within the one year when a woman’s menstrual cycles wind down and she ends up losing her menstrual cycles, by the time that year anniversary of no period, which is called the date of menopause, when that happens, she catches up to her male 50-year-old cohort equivalence.  We already enjoy extra protection when we’re cycling and you’re right, that 10 years is usually the time period in which we start seeing things happen like plaquing, early heart disease symptoms, angina, et cetera. When we try and reestablish these hormones and then add a progestin that is synthetic that is known to be embolic, meaning it causes clots, in a population that’s already lost their hormones, lost their protection and has accelerated disease over 10 years, of course we see increased risk.

Dr. Weitz:                            This whole risk of women and heart disease is kind of an interesting topic because I think in general, women tend to get undertreated for heart disease and under screened for it.

Dr. Wysysnki:                     I agree with you in the heart disease, but in general, women’s health still is not well addressed. This is why I become passionate about helping women worldwide deal with menopause and their longevity protection. Because typically when we look at studies, and previous to medical school, I was a PhD researcher where I did these types of studies. I was in pharmacology where we would do drug development and typically because we want to keep all these factors controlled, so what that means is we have identical animals with identical genes with identical daylight cycles, et cetera, we don’t want to have female animals in that experiment because when they get their estro cycles, which is the equivalent in animals of the period for women, it confounds or it creates an unknown factor in the studies. Typically all research is done or almost exclusively done on male animals or men when we do human population studies, and then we just extrapolate to women. Not only is heart disease underrepresented, women’s reproductive health and everything about women’s health is underrepresented in the literature.

Dr. Weitz:                            Right, absolutely. Let’s talk about hormones. What are some of the benefits of taking bioidentical hormones? Then also tell us what types of bioidentical hormones you prefer to use.

Dr. Wysysnki:                     Absolutely. The advantage summed up in a sentence is when men and women replace their hormones at an appropriate age or developmental reproductive stage, they statistically significantly reduce all cause mortality. That means any disease that we could think about acquiring and dying from or causing disease and leading to earlier death is reduced not only just experientially, but in the literature that real key word of statistically significant. When I use bioidentical hormones, I like to use natural hormones. Most of them are derived from wild yam. Stabilized in the lab, they look identical to what our body makes. There’s no additional groups added to it. There’s no additional chemistry or different picture. If we took our natural hormones and our bioidentical ones that we replace, they marry each other in chemical structure and function.

Dr. Weitz:                            Let’s start with estrogen. Do you prefer creams, patches, pellets? Some women are still taking oral estrogen.

Dr. Wysysnki:                     Right. Thank you for that. I prefer creams for estrogen for a variety of reasons. We know that oral estrogen does increase certain risk factors for heart disease. For example, it will actually increase the bad cholesterol or the LDL that we try and control in people to produce heart attacks and strokes. Oral estrogen would not be off the table, but it would certainly not be my first choice. In fact, it would sort of be my I have nothing else to offer a woman and that’s all she could take. I believe it was 2018, there was a great book called Estrogen Matters that was written by a radiation oncologist in California. His name is Avrum Bluming. So Estrogen Matters by Avrum Bluming and he went back to the ’40s when synthetic oral estrogen was discovered. In his meta analysis or grouping together of all these studies and looking at the literature, he actually showed that it’s quite protective to still just have oral estrogen. So that wouldn’t be my choice.

                                                I really prefer to have compounded two estrogens, estradiol and estriol called Biest. We can achieve bioidentical estrogen replacement with patches or EstroGel, but again, those are synthetic. From a chemical point of view, they’re made in the lab from chemicals. They don’t have the same energetic potential, if you might, as natural hormones. I tend to go with natural hormones. Sometimes we’ll use a vaginal route. Oftentimes we can use the topicals, as I said, and then pellets are just coming into fashion here in Canada, quite popular in the United States, and I’m actually looking to bring that into my clinic shortly. I will be an independent provider of pellet therapy soon.  The difficulty with pellets is it’s hard to adjust dose. With the creams, we can actually adjust doses. For example, if I give somebody, let’s say, 0.4 milligrams of estrogen and it’s not doing well for them, I can actually have them double the dose by giving more than one or two pumps or turns of a container. Or if it’s too much, I can actually have her alternate one pump and two pumps every alternate day, for example, and that would actually give me an average dose over 10 days that would be in between the dose that I’ve prescribed. They’re very flexible. Custom compounds unfortunately are not covered on most drug plans, which is a drawback, however.

Dr. Weitz:                            Now, aren’t there prescription patches that are bioidentical?

Dr. Wysysnki:                     They are bioidentical but not natural. They are synthetic. For example, patches EstroGel are created in the lab from synthetic chemicals. They are not derived from yam.

Dr. Weitz:                            How much does that matter?

Dr. Wysysnki:                     I think it matters a lot. If you take a vitamin pill, for example, a vitamin C tablet, and you take one that’s made from synthetic hormone, it will fit into the receptors, so that’s like putting your key into a lock. However, from a natural point of view, if you were to take natural vitamin C, there’s actually energetic auras, if you might, or energetic potential. I would rather eat a natural orange than to take a vitamin C synthetic tablet. For me, it is more dogmatic than it is scientific, but certainly I would rather go with a fully naturally derived hormone rather than a synthetic one.

Dr. Weitz:                            Then explain why you like the Biest cream, which is a combination of two different forms of estrogen, estradiol and estriol, and what percentage of each do you prefer?

Dr. Wysysnki:                     Thank you. I prefer to combine the estrogens because when we talk about estrogen, we talk about it as if it’s one hormone in the body and it’s not. It’s a group of hormones. We know specifically the most information about three: estrone, estradiol and estriol. Why I like to balance the estradiol in the estriol is that that’s how it naturally occurs, usually in an 80:20 percentage. So 80% estriol, 20% estradiol. However, it depends on the patient and their situation. I can custom compound that percentage to be anything I want. I’ve done 70/30, I’ve done 60/40. My greatest success is with 50/50 because we know that there’s a little bit of bioconversion between estriol and estradiol and it keeps the percentages healthy.  Estrogens make things grow, but estradiol is actually extremely healthy and safe, so much so that in Europe, estriol is given to women to treat breast cancer. We know, again, as you said, different countries have different consensus guidelines and there’s different uses for these. When I look at the biochemistry of a woman and how she produces her estrogens and what proportions, I’d like to replace a mere identically to our natural levels. Although when women are having symptoms in perimenopause, sometimes a little bit more estradiol to tone down the receptors actually works better.

Dr. Weitz:                            Let me just bring up a challenge from another doctor who I’ve spoken to a number of times who’s a big proponent of estradiol, and she argues that estriol is really the hormone that’s secreted during pregnancy and is not really … it doesn’t really provide all the benefits that estradiol does, so that’s really not the natural way to do it.

Dr. Wysysnki:                     Two things I’m going to comment on. In allopathic medicine, which is non-functional medicine, as you know, it’s pharmaceutical oriented medicine, we give women estrogen in the form of estrogen patches or EstroGel as a hormone replacement. Specifically if one does not have a uterus, we do not offer any form of progesterone or progestin. That doesn’t make sense to me because, and I’m just going to use my hands, I don’t have a chart. When we’re 25, progesterone is typically a hundred or more times higher than estrogen. In perimenopause, as things decline, this is what happens. Progesterone falls faster and greater than estrogen. Progesterone falls about 70, 75%. Estrogen only falls about 30%.   By definition, estrogen is higher in menopause than progesterone, a state that we call estrogen dominance. If the natural hormones are progesterone higher than estrogen at our peak reproductive ages and our peak wellness ages, why would we give more estrogen to a woman who’s in estrogen dominance and that estrogen dominance is what leads to the typical symptoms of menopause? What happens in allopathic medicine, as I was trained, you give a woman estradiol and it forces that estrogen higher and higher and higher. Why don’t they get more symptoms?  Because we have locks and keys. The hormones are the key, the receptors are the lock.  When we have too much signaling, it’s too much noise. The body doesn’t want to hear the noise, so eventually the receptors come out of circulation, and now you have unopposed high estrogen.  Estrogen makes things grow.  It is not correct physiologically if we’re going to create a balanced hormone picture to give estrogen. If we look at resources like standard gynecological and physiological textbooks or resources in the medical literature, we know that a woman naturally produces 80% estriol and 20% estradiol. Why is that? Estroiol is very weak. It’s produced in large quantities. Estradiol is produced intermediate quantities, and it is higher potency. We don’t need that much estradiol to balance the system.

Dr. Weitz:                           Sounds good. In what form of progesterone do you like to recommend?

Dr. Wysysnki:                     It depends on the woman and what her situation is. Particularly if women are having mental health issues, mostly anxiety or sleeplessness, I often prefer to have slow release oral progesterone compounded. But some women prefer to have topical creams. Many women are under the impression based on what they read in the popular literature that if you put creams on, it doesn’t go through your liver. We call this first past metabolism where things go through your liver. Anything oral goes through the liver. Sometimes I want to capitalize on that because with an oral progesterone, I can get metabolites formed in a woman’s body that crosses a blood-brain barrier, gives her a sense of a calgon moment or a wusha, reduces daytime anxiety, helps her sleep better, where some women who don’t have those sleep or anxiety provoking or mental health symptoms may not need oral estrogen. When I rebranded the clinic, we called it Bespoke Functional Medicine for a reason, because every treatment is customized specifically to the woman, her presentation and her needs, as well as her biochemical tests, like her saliva testing for example.

Dr. Weitz:                           Do you like to cycle the progesterone or give it every day of the month?

Dr. Wysysnki:                     It depends on the woman. Most of my women almost exclusively do not want to cycle. I have one woman in my practice who’s over 70 who wants to cycle.

Dr. Weitz:                           By the way, for those who are listening who aren’t aware of what we’re talking about, some doctors recommend giving progesterone in a similar way as your normal menstrual cycle. By giving it for a period of time and then not giving it, women may start bleeding and getting their menstrual cycle back.

Dr. Wysysnki:                     There are different philosophies and different approaches how we do this.  One of my women wanted her menstrual cycle back, and she’s still in her ’70s, has a five-day light period requiring light protection, feels fantastic on it.  Most women don’t want the bother. Oftentimes what I will do is if the woman wants … and again, depending on her symptoms, if she responds well and if she sees me in perimenopause where there are still periods, I will cycle the progesterone in various doses at different times of the cycle in order to support her periods.  If we see women who are starting to get scanty, irregular periods or flooding periods, let’s say at age 52, we know the literature shows that if women’s cycle naturally or with hormone support till 55, it is very protective.  I will push that envelope for a woman trying to keep her cycling as long as possible without having side effects.  If a woman’s very symptomatic, sometimes we need standard dose progesterone, and sometimes that looks like days three to 28, sometimes that looks like day one to 25. I don’t like that cycle because I think if you go to day 25, give them five days off, they get too much instability. As well, I may actually give them progesterone six days a week with one day off. Sometimes my approach will actually help to keep sensitized receptors so they don’t get used to the dose. Sometimes they need a break because they, I don’t know, work shift work or they have other needs. Progesterone actually sensitizes the estrogen receptor as well. It needs to be there even in a hysterectomized woman who’s lost her uterus. Progesterone is in all of our tissues. It is a brain chemical, a natural antidepressant, helps with water bloat, it’s a diuretic and it is an anti-anxiety hormone as well as a sleep hormone. We need that and the women’s needs will tell me how they want to be cycling.

Dr. Weitz:                            That’s interesting you mentioning six days a week and one day off on the progesterone. That’s the first time I heard that recommendation.

Dr. Wysysnki:                     I use that very often. This is called a combined continuous dosing schedule and giving a break in the cycle or sometimes if a woman finds that she can’t sleep on that one day off, or often what happens is, let’s say she takes a break on a Saturday night and has to be back in the office on Monday, because she’s not slept Saturday, it will actually catch up with her about 24 to 48 hours later, and she may go into the boardroom or into the office or into the hospital, wherever she works, not be very functional in terms of word recall, et cetera, et cetera. We will actually give her a lower dose on day six or seven rather than no dose. Again, very customized dosing for the woman.

Dr. Weitz:                           Interesting. Do you often recommend testosterone for women as well.

Dr. Wysysnki:                     If they need it, absolutely. Interestingly, Ben-

Dr. Weitz:                           How do you decide if they need it?

Dr. Wysysnki:                     Through their testing and their symptoms. It’s interesting that, for example, we think that women need testosterone because they have low libido or desire, and I sort of separate libido is up in here and libido down there, right? Desire and libido. To tease it out because sometimes the dysfunction is a desired dysfunction, libido is fine, sexual arousal is fine. Sometimes sexual arousal is difficult, but they desire intercourse. It’s kind of interesting. Again, here’s where that gender bias comes in. Men make all three hormones too, progesterone, estrogen, testosterone, but their main hormone is testosterone in high levels. Testosterone drives the sexual function of men, but not so much in women. In my clinical experience of now over 17 years, I have found that once we restore the estrogen progesterone balance to that 25-year-old level or close to at least 10 years earlier, women’s libido comes back very nicely.

Dr. Weitz:                            Interesting, interesting. I thought it was pretty much accepted that testosterone was a big factor in women’s sex drive.

Dr. Wysysnki:                     I think it’s overstated.

Dr. Weitz:                            Do you ever recommend pregnenolone?

Dr. Wysysnki:                     100%. Pregnenolone is a hormone that I’ve used of late in my practice in the later years. As my population and my patient population has evolved, so have their needs. Pregnenolone can be really, really helpful in cases of head injury, for example, past traumatic brain injury, for weight shifting, sometimes we could get really nice effect. But when I am working up a woman for menopause, I’m also looking at their cortisol and adrenal function and oftentimes we need those upstream chemicals of pregnenolone and/or DHEA in order to cause effect with the adrenals. Because when a woman stops menstruating, the majority of her hormones that are still produced in low quantities come from the adrenal glands, which also produce our stress hormones.  If we live in the world, period, I used to stay in North America, but if you live in this world and you’re a woman or a man, you have stress. The bottom line is we all think that we handle it well, but chronic stress is a really good indication. When I’m seeing those DHEA levels or those cortisol levels being depleted or over overstimulated, I may use pregnenolone specifically to help those downstream chemicals replete.

Dr. Weitz:                            I want to ask you about one or two other hormones, but let’s go into testing since that seems like that would make sense right now.

Dr. Wysysnki:                     Sure.

Dr. Weitz:                            What’s the best way to measure and monitor hormone levels in women? Do you prefer serum, saliva, urine?

Dr. Wysysnki:                     That’s a great question, and I think that qualifies with depends what you are looking for. When I was a bench scientist, I was taught very keenly if you want to prove your hypothesis, if you want the answer to your question, ask the right question.

Dr. Weitz:                            Of course.

Dr. Wysysnki:                     I extrapolate that into my medical practice. If I want to know what the hormones are doing, look in the right compartment. If I want to know what’s available, I will look in the blood. Now, blood is still standardized because it is in the literature. Most of the studies are done on blood. However, various factors will affect blood hormones including the way that they’re carried through the body, whether they’re free or bound, et cetera. It’s not always a clear picture and here’s why. Many, many women worldwide have gone to their doctor and said, “I think I’m in menopause. I have hot flashes. I’m disinterested in sex. I’m yelling and screaming all the time. I feel like I’m going out of my mind. My vagina is dry, sex hurts. I can’t sleep. I’m having hot flashes, night sweats,” et cetera and they’ll do a battery of blood work and hold up the paper and go, “No, you’re fine.”  Well, you can’t be fine if you’re symptomatic. Right? If we had somebody with cancer who came in and said, “I’m fatigued all the time, I’m losing weight involuntarily. I have profused night sweats,” which is classic symptoms of potential cancer and we just said to somebody, “You’re fine,” you’re not fine. When we look in the blood, it can be beneficial to see certain aspects of the hormonal cycle. For certain protocols, for example, the one where a woman will choose to use different doses to produce and keep her cycle going, that often tests better on blood. However, the reason a woman is symptomatic is that the tissues are not being bathed in the right amount of hormone. When we use saliva testing, the blood bathes the salivary gland, the hormones go into the salivary gland and are secreted through the salivary gland into the saliva, similar to what’s going on in our bone, our brain, our breast, our uterus, our ovaries, our heart.

                                                This becomes a proxy measure for what we term intracellular or in the cell levels. That’s what I want. I want to know what the end target is doing. Some people like to dose on urine. For me, when I use urine, I see the potential for dosing on urine. I’ve had a great success record with using saliva to guide my dosing. I prefer to look at urine when I need metabolites. What’s coming through the kidneys? How is it metabolized? For example, we talked about the two estrogens, estradiol and estriol. We haven’t really talked much about estrone. Estrone is very important. How it breaks down in is metabolized in the body to different pathways, metabolic pathways, the urine sample for me is ideal for that ideal. Ideal.  When I’m worried about somebody potentially having breast cancer or family history, breast cancer, estrone has been implicated in breast and uterine cancer in susceptible individuals. When we look at the pathways of how that estrone is broken down, I could see if a woman needs metabolic support or biochemical support to enhance or tune down different pathways that may or may not be favorable in terms of producing her metabolite outcomes from estrone.

Dr. Weitz:                           We’re talking about the 2, 4, 16 estrogen pathways, right?

Dr. Wysysnki:                     Exactly. The methoxy and the hydroxy pathways of 2, 4, 16 metabolites.

Dr. Weitz:                           You’ll do a urine test like a DUTCH test or something like that?

Dr. Wysysnki:                     Exactly. I would look at a urine metabolite test, such as DUTCH or other companies out there do provide those tests as well. If a woman’s history, again, a bespoke approach depending on her family history or she’s highly concerned about breast cancer, then I will offer a DUTCH test or a similar test, a urinary metabolite test to see how she’s breaking down her estrone. It does not predict breast cancer. It does not predict who’s at higher risk. When we look at the ratios of how the metabolites of estrone are broken down, as you said in those 2, 4, 16 pathways, there were a few small studies, particularly off an isle of France called Guernsey where they noted that women with certain patterns of estrone breakdown or metabolism had up to 30% protection against developing breast cancer. I can’t say a woman won’t get breast cancer. I can’t say she will. All I could say is that her ratios are or are not favorable based on these studies out of Guernsey and if we optimize her pathways, it appears to confer some protection.

Dr. Weitz:                            For those of us who are familiar with this in working with women, there’s a lot of controversy over which pathway is most important and we used to look at the 2 to 16 and now some people place a lot more importance on 4 pathway. What do you consider the most significant pathways and what do you like to see, and then what sort of nutritional strategies do you use to optimize things?

Dr. Wysysnki:                     Absolutely. The 2/16 ratio I still look at specifically. When you ask me what pathway, they’re all important to me. Because just like when I’m looking at my salivary tests, I’m looking for not only absolute numbers, I’m looking for relative ratios. When I’m looking at the urinary metabolite tests for estrone, I’m looking at relative ratios like the 2/16 pathway where the methoxy metabolites are, because those are known to be unstable and to cause DNA adducts. I’m looking at their COMT profile, I’m looking at their methylation profile to see exactly what is going on in her body.

                                                Then depending on what pathways I’ve used, and in men as well, I’ve used grapefruit to bring up some pathways and increase enzymatic reactions, cruciferous vegetables, diindolylmethol or methane or DIM or I3C, indole-3-carbinol, those are all part of the pathways that are derived from cruciferous vegetables and those are provided as supplements. Sometimes I will recommend those. Sometimes it’s as easy as having somebody stop smoking or decrease their alcohol intake, increase flaxseed. There’s multiple pathways and multiple mechanisms and again, it depends if somebody doesn’t like to take pills, which most of us don’t, even though they are supplements, a woman won’t adhere to that therapy. But if she will add a tablespoon of flaxseed to her diet and incorporate a cup of green cruciferous vegetables, then that’s the way we’ll go.

Dr. Weitz:                            Do you ever use iodine as something that might be protective?

Dr. Wysysnki:                     Absolutely. Iodine is a nutrient, I think, that is very misunderstood and underutilized. We know that table salt had been iodized because of goiter, but we also know that iodine is useful in conditions like polycystic ovarian syndrome and in fibrocystic breast disease. I just recently had a patient who did not have optimized thyroid levels, and so I added a little bit of iodine to her diet through a supplement, liquid supplement, and to optimize her deiodination of her T4, really her less active thyroid hormone, but also because she had lumpy painful breasts and I had her taking a little bit by mouth and then also applying it to the breast tissue works beautifully to relieve fibrocystic breast pain.

Dr. Weitz:                            Interesting. Applying it directly to the breast tissue?

Dr. Wysysnki:                     Yes. Of course, it’s going to be messy and stain that iodine brownish color. She wasn’t concerned about that because her breasts were so tender, she didn’t care.

Dr. Weitz:                            Now what about calcium DG gluconate?

Dr. Wysysnki:                     Calcium DG gluconate is great for getting rid of some of those estrogen metabolites and lowering estrogen levels. I can use it if I need to. Oftentimes women don’t need a whole bunch of estrogen. Typically, my doses are not high. We see women getting six, 12 milligrams of estradiol. Mine are not near that high, and I get great outcomes with the women.

Dr. Weitz:                            Cool. You mentioned DHEA. When you do a serum lab test, what level of DHEA do you like to see in women?

Dr. Wysysnki:                     I don’t do serum. I collect that on their salivary tests. I can test it on serum and actually my preference, and not all labs offer this, is to do the DHEAS. We could do both. DHEA is great as an anti-aging hormone, the higher the level, the better, but DHEAS also tells me a lot about the cortisol response and what’s going on with their adrenals. I like the DHEAS from a stress response. Again, if you want the answer to your question, ask the right question. What DHEA form are you using? How are you testing it? What are you looking for? If I’m looking for adrenal health, I will look for it in the saliva, ideally as DHEAS, although DHEAS and DHEA levels in saliva tend to be parallel as they do in blood. If DHEAS or DHEA were robust, the other one will be as well and you can almost use that as a assumption that the other is just as robust.

Dr. Weitz:                            Are you typically doing the adrenal cortisol stress test where you measure the saliva at different points during the day?

Dr. Wysysnki:                     Correct. Okay. I don’t really like people to wake up in the middle of the night to take a test because, of course, that pops their cortisol up, it breaks their melatonin cycling, but we will do at least a four point cortisol. For monitoring, when I know my patients are stable, I’ll look at least at the morning cortisol because things change.

Dr. Weitz:                            Right. We’ve been having a bit of an issue trying to get women to do the CAR part, the first two parts, especially if they have to fill up this tube with saliva and they’ve just woken up and they haven’t drunk any water and it’s really hard to fill that thing up.

Dr. Wysysnki:                     I know. I know. Not only from a patient point of view, but from a personal point of view. I know.

Dr. Weitz:                            It’s interesting that you like to use saliva, and I know a number of functional medicine doctors who do, but there are a number of doctors who say, “Well, look, saliva’s just not accurate. It really hasn’t been standardized.” What do you say to that?

Dr. Wysysnki:                     NASA uses saliva testing for its astronauts. If it’s good enough for astronauts, it’s probably good enough for us docs and our patients.

Dr. Weitz:                            There you go. That’s a good one. I hadn’t heard that before.

Dr. Wysysnki:                     But again, if you want the answer to the question, ask the right question. We tend to overdose our patients in blood because it’s just an available level at the time. There are diurnal variations and we know that. Especially when people are on hormones, if I ask them to put hormones on their skin and go down to the lab and get a blood draw, I’m probably getting a whole whack of hormones that are residual on the skin or that are in those skin cells as the needle goes through and the circulating levels are not necessarily as accurate as I would like them to be. I’m using more blood now than I ever have, which is a teeny minuscule amount of serum testing for various reasons. Sometimes when women aren’t getting the response that they want, or if I’m finding that saliva levels are just astronomically off the charts, I’ll check again in blood. You can’t always compare them and almost never do I see them correlate.

Dr. Weitz:                            Interesting. One more hormone. It’s a minor hormone, but I’ve read a little bit about it recently, is oxytocin.

Dr. Wysysnki:                     Oxytocin is amazing. One of the things for oxytocin, there is a rule for oxytocin in functional medicine. The difficulty with oxytocin, it’s about $600 a month. It is very, very expensive, at least here in Canada and probably in the US it’s a lot more. Oxytocin is the hormone that’s released from the pituitary gland, typically when a woman is going into labor. That’s what increases the onset of labor, that rhythmic contraction of the uterus, et cetera, et cetera, and primes the cervix for delivery. But we can use oxytocin in many instances. Oxytocin can be very, very effective for chronic pain, fibromyalgia type pain, arthritic pain. Also, I have prescribed oxytocin when somebody was in a situation where desired human interaction and human affection, but were very shy and withdrawn from being in that human interaction to get the emotional support that this patient wanted.

                                                Unfortunately, one of my patients with pain used oxytocin and has a very complex pain situation. As a single approach, she did not find it overly beneficial and my other patient with the emotional disconnection from humans but desiring human affection was not able to afford oxytocin. But yes, oxytocin is a pretty interesting hormone.

Dr. Weitz:                           You get it compounded, is that the form?

Dr. Wysysnki:                     It actually comes in as Pitocin. It is synthetic.

Dr. Weitz:                           Oh, so you use it as synthetic pitocin?

Dr. Wysysnki:                     Right. I don’t know that there is any actual raw material. That’s a great question because I haven’t needed to look at that. But the Pitocin itself is what we would’ve used as a sublingual spray or other methods, and it can work just beautifully.

Dr. Weitz:                           Right. Great. Let’s see. Those are the questions that I had prepared. Is there any other things that you would like to cover?

Dr. Wysysnki:                     I think women need to be knowledgeable and know that there are options out there. It’s not the standard one size fits all approach. At least that’s the approach that my clinic takes and I think many functional medicine doctors do. Just because your doctor may want to do a saliva kit doesn’t make them wrong or if they want to do serum analysis, it doesn’t make them wrong. What it means is that that’s their comfort level in the art of medicine. Remember we say the science and art of medicine. I’ve had great success with saliva testing. Also understanding the role of adrenals helps me use that saliva test to the patient’s benefit because I really do want to know what’s going on with the adrenals. In allopathic medicine, we don’t pay any attention to the adrenals unless they’re not functioning at all or over functioning to create disease, and there’s a whole spectrum in between them.

                                                So if a physician or practitioner, functional or not, doesn’t know how to deal with adrenal dysfunction well, then it may not be beneficial. Yes, things are costly, but the cost of not being well and functioning well and being at our best is also very expensive. It doesn’t count in dollars and cents, but our ability to stay well, avoid diseases, we know that through functional medicine and hormone replacement as well as other modalities and functional, we know that we could keep patients well. We know we can reverse disease and continue to longevity, whatever our natural lifespan is, without illness and disability. That’s really important to me is to support women in that. I also treat men, but my ability to support women because this is such an under-recognized and undertreated area of medical science for women is really important.

Dr. Weitz:                           That’s great. For those who are listening, who would like to seek you out to possibly have you help them or find out more about you, where would they go?

Dr. Wysysnki:                     Right now the best place to go is by email at info@drwizz.com. It’s I-N-F-O @ D-R-W-I-Z-Z for those south of the border or D-R-W-I-Z-Z for those of us north of the border dot com. Our website is currently under construction, so that should be coming soon, probably launching in the new year. Also, Ben, for those women who can’t afford or are in countries where bioidenticals are not available, I have written a 12-week menopause 911 coaching program that will also launch early in the new year so people can look forward to seeing that as well.

Dr. Weitz:                            Okay, that’d be great. Do you see patients remotely as well?

Dr. Wysysnki:                     I do. I am also licensed in one state in the United States, but across Canada, certainly I do telemedicine and can see patients coast to coast.

Dr. Weitz:                            That’s great. Awesome. Dr. Wysysnki.

Dr. Wysysnki:                     Thank you so much, Ben.



Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify and give us a five-star ratings and review. That way more people will be able to discover the Rational Wellness Podcast. I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic Nutrition Clinic, most of whom we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases and various other cardiometabolic conditions.  I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health and I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111, and we can set you up for a new consultation for functional medicine nutrition, and we can get that going as early as the new year. Give us a call and I’ll talk to you next week.



Integrative Approach to Autism with Patricia Lemer: Rational Wellness Podcast 286

Patricia Lemer discusses a Functional Medicine Approach to Autism with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

4:05  The rates of autism are rising rapidly.  Some of the experts claim that we are just diagnosing autism more frequently, but today everyone knows someone with autism and when I was growing up, we never heard of anyone with autism.  According to Patricia, “Did those people used to hide in the attic and in the basement so we didn’t see them? Or didn’t they exist? And are we just more aware?” And those of us who are in the field don’t believe that’s true, though this is a new phenomenon as kids in our world get sicker and sicker.  In the 1980s we were seeing one kid in 10,000 with autism, while today the rate is one in 23 children.  And kids with autism could not have been confused with kids who simply failed to develop normally and are mentally handicapped, since kids with autism typically are seen to be developing normally until one and half years or two and then in a matter of a few days undergo a radical transformation and stop communicating, sit in one place, and bang their head against the wall and perform other repetitive actions.

9:53  Patricia explains autism with the total load theory that she borrows from engineering that explains why a bridge collapses.  When a bridge collapses, we seek to find out who’s to blame.  Was it the engineer who designed the bridge?  Was it our terrible weather that rusted out the moorings of the bridge?  Rather, it is a combination of things over time that overload the tensile strength of the bridge.  Kids with autism have a threshold of health they hover under and different load factors are added to the child until they go over their threshold and then start getting sicker and sicker.  Children used to be born with a lot of room under the threshold, so they could be exposed to a few toxins, such as painting the room or spraying for termites and they would be fine. But today because families are having kids later in life, the mother carries a bigger toxic load, and we have all these other chemicals and toxins that are bombarding our baby and lead to them overloading their threshold till they start experiencing symptoms such as autism.

And so kids used to be born and way, way, way down here and we could have a few toxins. We could paint the room. We could spray for termites. And the kids still had a lot of wiggle room there. But because of a couple of factors, like families having babies later, the mother carries a bigger toxic load herself, which nature has her dump into her unborn baby. And then we have all these other chemicals and toxins and environmental things that are bombarding our baby, that are adding up, adding up, adding up to where the bridge collapses.  Along with this autism epidemic, we also have an epidemic of infertility and miscarriages.  We need to start working with the parents for a good year prior to conceiving to get them healthy, so they can have healthier kids. 

14:05  Environmental Toxins.  One environmental toxin to avoid is antimony, which is contained in the flame retardant chemicals that are sprayed on most mattresses, furniture, and even clothing.  You should buy all natural, toxin-free bedding, since we spend a third of our life in bed.  The bedroom should be for sleep and sex and nothing else.  And we want to avoid EMFs, which are more pervasive since 5G.  Patricia has a canopy over her bed to repel EMFs.

17:10  Heavy Metals.  Mercury is commonly associated with autism.  Mercury can come from amalgam fillings and from coal fired power plants, which spew mercury into the atmosphere and that falls into the oceans and gets into the fish.  The big ocean fish like tuna have the highest levels of mercury. The best fish to eat are the smaller fish like sardines and anchovies and high fat fish like salmon.  Aluminum is latest metal that many are concerned with from cooking in aluminum pans, to using aluminum foil on our food, to aluminum in the air from chemtrails.  One person with autism that Patricia knows who when he was a kid had pica syndrome where he kept eating dirt and he was poisoned by arsenic from the playground that was built out of railroad ties that have arsenic in them.  Arsenic can also be found in well water and rice and sometimes in chicken.

27:30  Cerebral folate deficiency can be a factor in autism and antibodies to dairy can block the absorption of folate.  Unfortunately, kids with autism tend to eat mostly foods with wheat and dairy like macaroni and cheese, pizza, cereal with milk, bagels and cream cheese, and pizza.  Most kids with autism are reactive to both casein and gluten and an elimination diet can help show this.  We need to have kids with autism to eat real food like fruits and vegetables, animal products and fish, beans, and good quality fats. Cheez doodles and Goldfish crackers are not real food.



Patricia Lemer is a Licensed Professional Counselor (LPC), and practiced as an educational diagnostician for over 40 years. Patricia wrote several books, including her most recent, which is Outsmarting Autism, Updated and Expanded: Build Healthy Foundations for Communication, Socialization, and Behavior at All Ages (2019).   Patricia was co-founder and Executive Director of Developmental Delay Resources (DDR), an international, non-profit organization for 20 years which merged with Epidemic Answers in 2013.  Patricia’s books on Outsmarting Autism are a part of the curriculum for the Epidemic Answers Health Coach Training Program, in which she delivers 3 modules.  She also has a podcast, Autism Detective.

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.



Podcast Transcript


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 we’re going to have a discussion about how to outsmart autism with Patricia Lemer. Autism or autistic spectrum disorder is a developmental disability marked by deficits in social communication and restricted repetitive behaviors. Autism typically begins before the age of three years. While there is a range of levels of severity, people with autism tend to behave, communicate, interact, and learn in ways that are different than most other people. Some patients with autism experience an improvement in their symptoms over time, while some never improve. Some of the most common symptoms include reduced eye contact, differences in body language, lack of facial expressions, not engaging in imaginative play, and repetitive gestures or sounds among others.   Rates of autism are increasing rapidly with levels reported by the CDC of autism in the year 2000 being one in 150 children. And one in 44 in 2018, according to the CDC. And one in 23, according to the National Institute of Mental Health. Autism is four times more common in boys than in girls. Clearly, autism incidence has been increasing, though it appears that the consensus in the conventional medical mental health and medical community is that autism is not more prevalent, but that it’s simply being diagnosed more often, especially with patients who might have previously been diagnosed with other mental disorders, which also corresponds with the societal trend to stop institutionalizing people with mental disorders. And then there’s another factor, which is that if a child gets diagnosed with autism, then insurance coverage might kick in, that will pay for behavioral and other therapies that can be quite costly.

                                Patricia Lemer is a licensed professional counselor and she practiced as an educational diagnostician for over 40 years. Patricia wrote several books including her most recent, which is Outsmarting Autism, Updated and Expanded: Build Healthy Foundations for Communication, Socialization, and Behavior at All Ages, published in 2019. And I read it and there is just a ton of great information there. A great reference for anybody who wants to know more about autism. And it’s available through Amazon and I’m sure other book sellers.  Patricia was a co-founder and executive director of Developmental Delay Resources, an international non-profit organization for 20 years, which merged with Epidemic Answers in 2013. Patricia’s books on outsmarting autism are a part of the curriculum for the Epidemic Answers Health Coach Training Program in which she delivers three of the modules. She also has a podcast, Autism Detective. Patricia, thank you so much for joining us.

Patricia:                Thank you, Ben, so much for having me. That was a long introduction. And I appreciate you covering so much of the history of autism, and what’s going on in today’s world. Because no matter where I am, and if I’m meeting new people and they say, “Well, what do you do, and what is your field?” When I say I work with kids with autism, people with autism, inevitably someone says, “I have a family member with autism.” My grandchild, my brother’s child, my next door neighbor’s child. Everybody knows somebody today with autism. And we didn’t growing up.

Dr. Weitz:            Right. Yeah. I don’t recall knowing anybody with autism.

Patricia:                And so what you said is, “Did those people used to hide in the attic and in the basement so we didn’t see them? Or didn’t they exist? And are we just more aware?” And those of us who are in the field don’t believe that’s true, though this is a new phenomenon as kids in our world get sicker and sicker. This is what’s happening. You see more and more autism diagnoses.

Dr. Weitz:            It’s shocking though, the rapid increase in rates. My understanding is, is back in the 1980s, we’re talking about one in thousands.

Patricia:                Yes, like 10,000.

Dr. Weitz:            Right. Wow.

Patricia:                And I’ve been in this field, not the autism field, but the field of children with disabilities since the late ’60s. And because I was working with kids with other disabilities, when autism reared its ugly head in the late ’80s, I was an instant expert because I’d seen one kid with autism and nobody else had seen any. So that’s how I fell down the autism rabbit hole. And because I was always a questioner with, “Well, why does my child have a learning disability? Why does my child have ADHD?” I could apply those out-of-the-box thinking ideas to this new phenomenon called autism.

Dr. Weitz:            What I’ve heard from other doctors is some people feel that there were kids with mental disabilities. We used to call them something else, retards or whatever terminology they used to use. And some people feel that we’re just reclassifying them now as autism. But it sounds like you feel that was something different, a different form of mental disability.

Patricia:                It was. Those kids who… And I did diagnostic testing on those kids and we had horrible categories like imbecile. And it just was horrible how we labeled those children. But they presented differently. First of all, they were kids who many of them had birth injuries. Second of all, they were kids who had classifiable syndromes that we could identify. And most importantly, those kids were not developing normally and typically and looking like they were doing well for a period of time before they regressed. And not all kids with autism have a history of regression, but many do. And because today’s parents have video cameras and cell phones, they can document this. They can show that this kid waved “Hi, mommy” at this first birthday party. And by his second birthday, he’s kind of sitting there not even noticing the candles on the cake. And so it is documented. And so that’s very different from those kids who were cognitively impaired in the past.

Dr. Weitz:            And it’s quite shocking for parents showing these videos and to see a kid that seems by all measures to be completely normal, communicating, developing, learning, acting normal, going through normal developmental stages, and then all of a sudden over a day or a few days or weekend does stop talking, sits in one place and bangs its head against the wall. I mean, it’s just unbelievable how this sudden change can happen.

Patricia:                Right.

Dr. Weitz:            Now I do recall, I either read an article, was speaking to or maybe listened to a podcast where some doctor claimed that there’s no way all these environmental things that happen are really causative factors because we can actually see something going on in the brain during in utero, even though you don’t notice it until age one and a half or two or something like that.

Patricia:                I don’t think so.

Dr. Weitz:            You don’t think so?

Patricia:                And the theory that I borrowed from engineering was something called total load theory. And total load is an engineering term that explains why a bridge collapses. And I live in Pittsburgh where we have over 400 bridges and one of them just ended up in the park. And when that bridge collapsed, we said, “Well, who’s to blame? Was it the engineer who designed the bridge? Or was it our just terrible weather that rusted out the moorings of the bridge?” But kids with autism are similar. I think we all have a threshold of health and we hover under that threshold. And when we add different load factors, we get sicker and sicker. And at some point when you add too many, you go over your threshold and all a sudden the grandma says, “What happened to my grandbaby?” “Oh mom, he has ADHD or he has a learning problem, or he has autism.”

                                And so kids used to be born and way, way, way down here and we could have a few toxins. We could paint the room. We could spray for termites. And the kids still had a lot of wiggle room there. But because of a couple of factors, like families having babies later, the mother carries a bigger toxic load herself, which nature has her dump into her unborn baby. And then we have all this other chemicals and toxins and environmental things that are bombarding our baby, that are adding up, adding up, adding up to where the bridge collapses.

Dr. Weitz:            Right. And we use the same analogy all the time when we’re talking about a functional medicine approach to analyzing autoimmune diseases.

Patricia:                Exactly.

Dr. Weitz:            And you have food sensitivities and toxins and all these things that add to immunological insult. And once you get to a certain level, you end up having problems.

Patricia:                Right, right. And that’s what we’re seeing with our kids. And so for those who are listening and thinking about having a baby, I want to get with a young couple a good year out because healthy parents have healthy kids. And work with moms and dads with allergies and moms with low thyroid and looking at their environment and saying, “What are the toxic products around here that you need to remove?” And clean up this environment, get some sleep, get rid of the computer in the bedroom. There’s all kinds of things we can do to get these moms healthy so that they can carry a healthy baby. And along with this autism epidemic, we have an epidemic of infertility and miscarriages.

Dr. Weitz:            Yes.

Patricia:                And these are not viable pregnancies that of course we mourn, but they are nature’s way of saying, “Honey, this isn’t a healthy environment. Your womb cannot grow a healthy baby.” This is the way nature works. And so clean it up and then we can have a nice healthy baby.

Dr. Weitz:            Right. Absolutely. And a lot of the toxic chemicals are endocrine-disrupting chemicals. And this is one of the reasons why we’re seeing lower levels of testosterone and sperm counts, and it’s playing a role in fertility and also in autism.

Patricia:                Right, right.

Dr. Weitz:            So let’s go into some of these environmental toxins that you mentioned in your book. One that I had not heard about before that you mentioned in your book is antimony which is often contained in flame retardant chemicals, which if most people are not aware are most mattresses, furniture, even clothing, sleeping gowns are sprayed with flame retarding chemicals.

Patricia:                Right. So we want to buy all natural bedding. We spend a third of our life in bed. And we want that bedding to be as natural and toxin-free as possible. And that bedroom to be a sleep sanctuary. It is for sleep, period. It is not for reading your book. It is not for watching television. It is not for being on the computer. It’s not for talking on a wireless phone. It’s for procreating, having sex, making babies, and sleep. And it has to be toxin-free for us to get good quality sleep. And the latest boogeyman are these 5G towers that are sprouting up everywhere and bombarding our homes, from the church down the street, that got paid to put up a cell phone tower. And so I now have a canopy over my bed that gets rid of, that repels some of these electromagnetic frequencies.

Dr. Weitz:            Interesting.

Patricia:                So this is so important. And it’s especially important if you want to get pregnant and if you want to have a healthy baby.

Dr. Weitz:            Yeah, yeah. It’s probably a good idea to use an environmental expert to come and inspect your home and see where the EMFs and other electrical fields are that may be affecting your bedroom and your home.

Patricia:                I had somebody come to my home, he has a little Geiger counter. When he got near the bed, it went… and said, “How old’s that clock radio?” And he said, “You don’t want that next to your head.”

Dr. Weitz:            Right. Even the wiring in the walls can be…

Patricia:                Exactly.

Dr. Weitz:            … discharging electrical signals.

Patricia:                Right.

Dr. Weitz:            So let’s go into some of the other chemicals. Let’s go through some of the heavy metals. We’ve got mercury, lead, aluminum, arsenic.

Patricia:                Yeah. Well, mercury is the big bad metal of autism. And of course lead was the metal that most people know about. And lead is old news. Then mercury is newer news. And how do our kids get mercury? Well, the first way they get it is a mother who has silver amalgams in her teeth, which off-gas into her unborn baby. And so that’s one of the things that we want to do is to have the mother remove those amalgams safely prior to getting pregnant if she has some. There’s also mercury in power plants and we can’t do a lot about those.

Dr. Weitz:            Yeah, basically coal fired power plants are spewing hundreds of tons of mercury into the atmosphere and that’s what eventually falls into the oceans and gets into the fish.

Patricia:                Right, right. And so that’s the next thing is our food. And so the rule to follow is that the larger the fish, the more mercury it has. It’s the top of the food chain. So medium-sized fish eat baby fish and big fish eat medium-sized fish. So our big fish like tuna fish, which could weigh hundreds of pounds, are probably the least desirable fish for our diet. And I can’t tell you how many mothers of kids with autism tell me, “Oh, I ate tuna fish every day in my pregnancy because I heard fish was good for you.” So the choice should not be tuna.  And so we want smaller fish, these little babies like sardines and anchovies, and fish that is high fat. Because even if it has a little bit of mercury, the higher fat content is protective because our nervous system is myelinated in this fatty sheath, which is like the protective cover on an electrical cord. And that protects our nervous system from all kinds of attacks. So we want to eat good quality fat, and the best omega-3 fats come from fish.

Dr. Weitz:            Right. And then we have all these other chemicals like PCBs and bisphenol A.

Patricia:               Right. Yeah. Well, let’s go. Let’s finish… I can do a little more on the metals.

Dr. Weitz:            Okay, let’s finish with the metals.

Patricia:               Yeah, because aluminum is the newest boogeyman. So we went from lead, and everybody knows about lead testing, mercury, and now aluminum. And aluminum is… We’re cooking with aluminum pans and there’s aluminum in the air from the chemtrails. And so we’ve got to protect ourselves from aluminum.

Dr. Weitz:            Some people use aluminum to cover their food. They make a turkey and they cover it with aluminum foil.

Patricia:               You’re right, you’re right. And so that gets in…

Dr. Weitz:            The holidays are coming. They have those aluminum pans that you throw away that a lot of people use for cooking your Thanksgiving meal.

Patricia:               So people say, “Well, what am I going to use?” Well, the best thing to use is parchment paper. Parchment paper’s very, very benign. So that’s not a problem. But we want to avoid aluminum. And aluminum has been implicated in Alzheimer’s and dementia too, not just in autism. And then the arsenic. I know one child who’s now… He’s not a child. He’s 30 years old with severe autism who was poisoned by arsenic from the playground where they built the playground out of railroad ties.

Dr. Weitz:            Oh, yes.

Patricia:               And he had pica, which is eating dirt. And kids who have pica are looking for minerals. Their bodies are craving minerals, but he got the wrong one. He got arsenic. And there are common signs of arsenic poisoning that I put in my book that most people don’t know, like calluses on your hands. And the mother of this young man often said to the pediatrician, “He has these giant calluses. What is that?” And this doctor said to the mother that this autistic boy, “Maybe he’s playing too much basketball.” She said, “I don’t think so.”

Dr. Weitz:            Interesting. I’d never heard that about the calluses. How does arsenic lead to calluses?

Patricia:               I don’t know what the phenomenon is. But he also had rainbow-like skin, sort of iridescent skin on his back. And that was another sign of arsenic poisoning.

Dr. Weitz:            And arsenic can be found in chicken. It can be found in rice.

Patricia:               Rice. And that’s where this boy also got it. They were macrobiotic at the time, eating a lot of rice. And rice from China is particularly heavy in arsenic. So you just have to be really careful about food in particular. And our food is… When we talk about GMO foods and glyphosate, Roundup being used to grow our wheat and our corn and our soybeans. If you don’t buy organic, you’re getting a taste of glyphosate or this Roundup in every bite of food. So that’s really important to watch for too.

Dr. Weitz:            So what do we do about all these heavy metals?

Patricia:               Well, there are ways of getting them out of the body. There’s a process called chelation that is used in Europe a lot.

Dr. Weitz:            You’re talking about intravenous or are using oral chelators?

Patricia:               You can do it with a doctor, with IVs and specific oral chelators. But one of the things that Dr. Dietrich Klinghardt, who I have followed for years, recommends is a substance called chlorella. And chlorella is a natural seaweed that is very, very high in minerals and is able to chelate naturally. And it comes in little pellets that look like M&M’s. And he likes people, pregnant mothers to chew on chlorella. He likes kids to chew on chlorella. I don’t know how you feel about that as kind of a natural chelator.

Dr. Weitz:            Mm-hmm. Interesting. What about using liposomal glutathione and other binders?

Patricia:               Yep, yep. So glutathione is really important because it’s our natural substance that we have that can chelate out the toxic metals. And if you’ve depleted your glutathione by using too much Tylenol, then you can use liposomal, which means it’s carried by fat and you use it through your skin. So there’s lots of products that you can buy that can help get rid of some of the metals. But if you’re seriously mercury toxic or aluminum toxic, you have to work with a doctor to do proper chelation.

Dr. Weitz:            Right. So glutathione is actually one of the nutrients that kids with autism are often deficient in. And deficiency or insufficiency of specific nutrients can be a major factor in autism. Isn’t that correct?

Patricia:               Absolutely correct. And one of the autism world’s heroes, Dr. Bernie Rimland, who founded the Autism Research Institute, was one of the first people to discover these nutrients and minerals that kids are deficient in. And he has a son, Bernie’s gone, but his son Mark is still alive. I think he’s in his 60s now. Bernie started supplementing Mark with vitamin B6 and magnesium with terrific results. And he did studies with families with autism and found that magnesium was just a marvelous benefit to many, many of our kids.

Dr. Weitz:            Right. And I understand that cerebral folate deficiency can be a factor. And I understand that sometimes antibodies to dairy can block the absorption of folate.

Patricia:               That’s correct. And so if you look at the diet of so many of our kids with autism, it’s almost like they’re colluding. Like they’re getting on the internet and say, “Let’s only eat foods that have wheat and dairy in them, okay?” And so they live on macaroni and cheese, pizza, cereal with milk, bagels and cream cheese, and pizza. And even though these have different names, then they’re basically the same thing. They’re combinations of wheat and dairy and wheat and dairy. And our kids are reactive to the casein, which is the protein in the dairy, and gluten, which is the protein in the wheat.  And if we put them on an elimination diet that takes away these products, some of them improve markedly. And you can test for it to see if they have gluten sensitivity or casein sensitivity. And sometimes doctors are willing to do that and sometimes not. But if you can just do it by elimination and then have for two weeks or so, and then have kind of a glutton day where you eat nothing but these combinations, you’ll see your kid could have this going on.

Dr. Weitz:            Yes. So when you recommend an elimination diet, what foods particularly do you take out? Do you just take out gluten and dairy? Do you also take out other foods, peanuts? How do you do your elimination diet?

Patricia:                Well, first and foremost, you only want to do one thing at a time. If you do more than one thing at a time, you don’t know what the problem is.

Dr. Weitz:            Well, typically what people in the functional medicine world do is they pick six foods or eight foods or something. They take them all out and then they test [inaudible 00:30:00] one at a time.

Patricia:                That’s a good way to do it too. Yeah, yeah. But something like peanuts, if a child has a peanut allergy. Most parents are pretty aware of peanuts because their child has anaphylactic type, life-threatening maybe, reaction.

Dr. Weitz:            Right. But we’re really talking about sensitivities, not…

Patricia:               Correct, correct, correct. So those six foods are dairy products, wheat products, soy products, corn products, eggs. What’s your sixth?

Dr. Weitz:            It all depends. Some people would take out seafood. Some people would take out soy. They would take out…

Patricia:               So my clue is always what the child’s eating the most of.

Dr. Weitz:            Right, right.

Patricia:               And then the mother goes, “Ah! He’s going to starve to death.”

Dr. Weitz:            Right.

Patricia:               So I will tell you, I’ve never seen a child starve.

Dr. Weitz:            Here’s the pizza food group and here’s the McNuggets food group.

Patricia:               Right. So kids do not starve, but parents have to be stalwart. They have to be a Nazi and say, “I’m sorry, you can’t have that today.” And I tell them to blame me. “I met this crazy lady who told me, ‘You might do better if you didn’t drink four glasses of milk every meal.'” And for the older kids, I would bribe them. I would pay them not to eat those products.

Dr. Weitz:            There you go. A number of people have proposed specific diets for autism. I went through your book, and in there you mentioned the low oxalate diet, the yeast-free diet, the low glutamate diet, the Feingold diet, the REID diet.

Patricia:                Yep, there’s a huge chapter on dietary dos and don’ts. And these are down the line. You start with eating real food. If you eat fruits and vegetables and animal products and beans and fish and good quality fats, you don’t need a special diet because you’re not eating processed food. You’re eating real food. And real food is very rarely the problem.

Dr. Weitz:            Right.

Patricia:               And so that’s really hard from families today who don’t cook, who are in a hurry, who eat out, who order in. They drive-through. You want to eat real food. And those are the diets that kids prosper on. And occasionally we will find a child who’s allergic to garlic. But the garlic or the onion or the egg isn’t making him autistic. It’s these additives, this processing, the way the food’s grown, that is the problem.

Dr. Weitz:            The pesticides, the…

Patricia:               Oh my God, yeah.

Dr. Weitz:            … toxins, the herbicides, the fungicides, the way we grow our fruits and vegetables. And then when they get made into processed food, all the chemicals that are added, it’s just unbelievable. It’s not relieving food at that point.

Patricia:               It’s not. And I have a slide when I present this, that the heading says, “Are Goldfish crackers food?” And the answer is no.

Dr. Weitz:            Right.

Patricia:               And shame on you if you buy them, because you can’t live on Cheez Doodles and Goldfish crackers because they aren’t food. And this chapter of my book, the Dietary Dos and Don’ts, has just been republished as a standalone booklet in Greek, Spanish, German, and I think French. No, in Italian. And so they’re also available as e-books. I don’t know if you have an international audience or not, but those are available if you need something not in English.

Dr. Weitz:            Yeah, we do have people from other parts of the world. I get that little map showing and it’s like, “Oh, 14 people in Iceland have listened to my podcast.”

Patricia:               Oh, that’s great. So this is the number one thing is the lifestyle issues. Before you go on and do expensive therapies and pay out of pocket or ask your insurance, this is in your hands what you’re feeding your children, what they’re eating, what they’re drinking, what they’re breathing. This is necessary to do prior to any kinds of other therapies. And we can get in about 80% by changing the diet, by making it more nutritious, by adding in good fats, by taking away some of these potentially problematic food sensitivity foods. We can get better behavior, better eye contact, better learning, better sleep, better everything.

Dr. Weitz:            Right. And eat organic and start to work on reducing your exposure to some of these toxic chemicals…

Patricia:               Absolutely.

Dr. Weitz:            … the metals, the other… And maybe do some testing and find out what chemicals you are getting exposed to. Are there mycotoxins in your home?

Patricia:               Right, right. And some of the tests are fascinating. For instance, some doctors… I don’t know if you use a hair test. There’s some very interesting hair tests that we look at what metals are coming out in the hair. And they did this with kids with autism, and they found that many of them weren’t showing mercury and aluminum in their hair. And the first conclusion was that they didn’t have any. But then they did a challenge test with a chelator and the mercury poured out into the hair. So it wasn’t that it wasn’t in there, it was that the kids were not detoxifying it.

Dr. Weitz:            Right. That’s one of the tricky parts about testing for some of these toxins, like some of these heavy metals, is if you look at… The typical physician is going to order a serum mercury test, but that’s only going to discover the mercury that’s floating around the bloodstream. If it’s stored in some of the organs or in the bones or the fat, it’s not going to be circulating around. There’s not going to be high levels in the serum necessarily, so.

Patricia:               Right, right. And so you have to be a good detective. And that’s why I named my radio show The Autism Detective. And it’s so much fun to interview these parents who had to be a detective, what happened to their child, to these therapists, to the functional medicine doctors. I have several functional medicine doctors who I have interviewed who talk about, well, like you, where do you start? What do you start looking at when you have a child with autism? How do you peel that onion to figure out what is the most important thing that is affecting this child? And my old Autism Detective episodes, about 65 of them now are on Spotify. So you can go there and find them.

Dr. Weitz:            Cool. Yeah. Well, one of my favorite tests these days is this urine test from Vibrant called the Total Tox-Burden. And you can do 20 different heavy metals, a bunch of different environmental toxins and mycotoxins. And so…

Patricia:                Interesting.

Dr. Weitz:            … it’s a really good initial screen for toxins.

Patricia:               Who makes that test?

Dr. Weitz:            Vibrant America. Are you familiar with them?

Patricia:               I’m not.

Dr. Weitz:            Oh yeah, check out Vibrant America. It’s a premiere testing for functional medicine practitioners in particular.

Patricia:               That’s great.

Dr. Weitz:            Yeah. So another type of toxin is endotoxins. And these are often coming from bacteria that are found in the gut. And we know that gut health has a major factor in autism. So maybe…

Patricia:               Absolutely.

Dr. Weitz:            … you can talk about that.

Patricia:               Yep. Well, the word microbiome, which is who we are living with, because we’re only 10% human, it’s all the gut bugs that live in our intestines and in our belly button and on our skin. And those critters that we share our body with can be friendly and helpful, or they can be problematic. And one of the reasons I had to revise my Outsmarting Autism book was because of the research that was done on the microbiome. And that’s a brand-new word, only a little over than 10 years old. And it’s just we have ways of now evaluating our microbiome through a stool test or a urine test, and we can look at what our ratio of good bugs to bad bugs is. And we know that we need a balance. We have to have the proper balance. And our kids with autism have an imbalance, which is called dysbiosis. That’s just a fancy word that means they have more bad guys than good guys, right?

Dr. Weitz:            Yeah.

Patricia:               Yeah. And so by using probiotics and some supplements, which we know the good guys like to eat, and then they can proliferate, we can change the balance in the gut. And by doing that, we miraculously change the behavior and the focus and the ability of this child to be present and learn.

Dr. Weitz:            Great. So gut health is super important.

Patricia:               Absolutely.

Dr. Weitz:            And we do stool testing all the time. And then when we see an excess of fungus or pathogenic bacteria. Or sometimes you just have bacteria that are supposed to be there, but they’re overgrown so it throws things out of balance. One of the things that we’ll use are particular herbal antimicrobials.

Patricia:               That’s great. So people say, “Well, how did we get so much fungus in the gut?” And typically these are kids who’ve had a lot of infections. And the infections in the first two years of life were treated with antibiotics. And we know now that antibiotics have gotten stronger and stronger and stronger, and they wipe out everything. And they wipe out the good guys and the bad guys, except that the fungus are hardy and they hang around.

Dr. Weitz:            And some antibiotics like penicillin are actually fungi themselves.

Patricia:               That’s true. That’s true. And so we need to use some counteractions to these antibiotics and be more vigilant about when we use antibiotics. And most women who’ve had a yeast infection know what that’s like. It’s not good. And it often happens after you’ve taken antibiotic.

Dr. Weitz:            Right. So what about the V word?

Patricia:               What about it?

Dr. Weitz:            Is that playing a role in autism?

Patricia:               Probably, and in most kids. And I didn’t know how much you wanted to talk about that.

Dr. Weitz:            I’m not sure how much I want to talk about it either, but.

Patricia:               How safe it was to talk about it, so you can lead me.

Dr. Weitz:            I’ve been very vociferously avoiding that word.

Patricia:               Okay. So the V word is important because of what’s happened between my generation and your generation and today’s generation. And we are much more heavy-handed than we used to be.

Dr. Weitz:            Yes.

Patricia:               And so our kids today are heavily inoculated. And we don’t know what this is doing to their systems. And the inoculations also by necessity have what’s called adjuvants or additives in them, which are put there on purpose to stimulate the immune system so that they don’t have to put so much of the pathogen in. And those adjuvants are just as bad as the chemicals in our food, in our personal care products, on our furniture, because they are the same ones. They used to be mercury and that’s gone, but then they added more alumina and propylene glycol. And if you’re a kid who can’t detoxify those things, your body has to deal with them and has maybe an autoimmune reaction. But if the V word was implicated in as the number one cause of autism, every kid in America would have autism. So we know that some kids are higher risk than others. And we just want to be cautious about how we use those Vs. We don’t want to ever do it with a kid who is sick or on antibiotics because that kid is vulnerable.

Dr. Weitz:            Absolutely.

Patricia:               Yep. And we don’t want to do too many at a time.

Dr. Weitz:            Exactly. Now that’s more convenient for the doctor and big pharma if we can load up three, four, five at one shot. But that’s a lot for a kid’s immune system to deal with.

Patricia:               It is. It is.

Dr. Weitz:            And then if they have side effects, what do we do? Give them some Tylenol, which further decreases your detoxification abilities.

Patricia:               Right. So this is very hard to discuss with the mainstream. And there’s not allowed to be any controversy anymore. And it’s really important, I think, that parents educate themselves, that they read both sides, they understand what they’re doing so they can make educated, informed decisions.

Dr. Weitz:            Right. And I don’t think you have to be for or against. I think you can recognize the benefits of some of these, but yet do it in a manner that might be more safe for your particular kid.

Patricia:               Right, right. Every kid is different. And we don’t want a one-size-fits-all schedule.

Dr. Weitz:            Right.

Patricia:               Yeah.

Dr. Weitz:            So let’s talk about some of the beneficial nutritional supplements that kids with autism might be on.

Patricia:               Well, the B6 and magnesium are really important. My number one supplement for everybody, autistic or not, is vitamin D.

Dr. Weitz:            Yes. And now vitamin D with K?

Patricia:               Now vitamin D with K. I live in Pittsburgh. We have 50 days of sun. That’s not very many.

Dr. Weitz:            No.

Patricia:               And the way your body makes D is through sunlight. So if you can’t make it, you’ve got to take it. And there are lots of ways of taking it. And you want to take a high-quality pharmaceutical grade vitamin D with K, so it’s absorbed. And so you want to get your numbers up so that… It’s very protective. And from the reading I’ve been doing, I believe that it is very protective in COVID [inaudible 00:48:55].

Dr. Weitz:            Oh, a hundred percent. Not even controversial, in my mind.

Patricia:               Yeah, mine either. And those people who go down with COVID are the ones with the lowest vitamin D levels.

Dr. Weitz:            Right.

Patricia:               So I think the FDA or CDC says that a level of 25 is adequate. You want twice that. You want a good 50 or 60, would you agree?

Dr. Weitz:            Oh yeah, absolutely. 50 to 70. Yes, absolutely. Yeah. I mean, there’s plenty of data now. I know there’s still controversy. But there was a really good paper that came out a few years ago showing that women, if their level is 60 or above, their risk of breast cancer is reduced by 30%. I mean, there’s very few…

Patricia:               And colon cancer.

Dr. Weitz:            Yes.

Patricia:               And colon cancer.

Dr. Weitz:            Right.

Patricia:               Very, very protective of all kinds of things. So the best way of course is to live in Florida or Arizona.

Dr. Weitz:            I just got back from Florida. Not a big fan of living in Florida. It’s a big old swamp.

Patricia:               Right. So that’s why we have to take it.

Dr. Weitz:            Yep.

Patricia:               And again, because D is a fat-soluble vitamin, you want it with fat. So liposomal D.

Dr. Weitz:            By the way, I apologize to anybody who lives in Florida. It’s just not the place for me.

Patricia:               Yeah, nor me.

Dr. Weitz:            Yes, absolutely. Take your vitamin D when you consume fat. So you’ll have those fat enzymes that will help you to absorb it at a higher rate. And then we got the B vitamins.

Patricia:               All the B vitamins, especially B12. And James Neubrander has helped so many kids with IV vitamin B12. Very, very important with our kids. And then the B6 I mentioned earlier, the B vitamins. And it’s important to look at the B vitamins separately. They make these B50, B100 compounds, but they’re not in the ratio of what your body needs.

Dr. Weitz:            Right. And somebody else who’s an expert on autism, Greer McGuinness, who I interviewed a number of months ago. She pointed out that some of these kids can’t properly metabolize the methyl B12. And so in some kids, if that’s the case, the methyl B12, which is now the preferred form, will actually over excite these kids. And so those kids are actually going to do better on the [inaudible 00:51:54] or the hydroxycobalamin.

Patricia:               Very interesting.

Dr. Weitz:            Yeah, based on some of those methylation genes. So we also have acetyl-L-carnitine, which is kind of an interesting compound for brain health.

Patricia:               I’m not so up on that to be able to talk about that.

Dr. Weitz:            Okay, okay. So you have a chapter in your book on hormones, and I thought that chapter was really interesting because you talk about some hormones that most people don’t talk about. And you talk about oxytocin, which is generally only talked about as the hormone that’s involved in orgasm. But it has a number of other important roles in the body that you talk about and may play a role here in autism.

Patricia:               It’s the bonding hormone. It is what allows a child to bond with a mother. And with our hormone disruption, with our pesticides in our foods, we are seeing many, many, many kids who are hormonally disrupted and autistic. And that was the hardest chapter in the book for me to write. It is the cascade of hormones of how one turns into another, which begets just a couple of others is so complicated that I needed several people to help me write that chapter. It actually was the last chapter that I wrote. But oxytocin is a big one. And if you can stay away from these hormone-disrupting foods, that’s really important.

                            But the one hormone that is often seen as deficient is the thyroid hormone. And the thyroid is the master gland. And many of these kids are born to low thyroid mothers. So back to healthy parents have healthy kids. I want a mother to have her thyroid tested and balanced and made sure that it is strong enough and efficient enough to get her through the pregnancy and to have a child with adequate thyroid hormone. And you’re the doctor, you know about thyroid testing. Our typical thyroid testing isn’t complete enough.

Dr. Weitz:            No, of course not. Typically, all they do is TSH.

Patricia:               Right.

Dr. Weitz:            Nobody’s looking at the free T3 and the free T4. Occasionally they do. And then nobody looks at the antibodies, whether you have antibodies to your thyroid.

Patricia:               So if you’re thinking about getting pregnant, if you have one child with autism, you want to be sure that you get a good thyroid test from somebody who really understands all the different aspects of thyroid.

Dr. Weitz:            Yeah, you need to go to a functional medicine doctor because…

Patricia:               Absolutely. Yes.

Dr. Weitz:            Unfortunately, insurance doesn’t really want to cover that. Vasopressin was another interesting hormone that people don’t talk about that you also mention is a factor. You write in your book that it enhances muscle tone, peer bonding, and even plays a role in brain function.

Patricia:               So many of these kids have low tone. And I just had the privilege of observing twin girls. And they’re fraternal twins. They look very different. And one is like a little fire plug, and the other, I tried to pick her up, it was like picking up a noodle. And low tone is a big problem. We have to have good tone in our face to be able to talk. We have to have good tone in our hands to be able to pick things up and later to write. But the biggest area regarding tone is our digestive system. Our intestines are just one giant muscle.

Dr. Weitz:            Absolutely. Gut motility is a key factor. Alterations and gut motility is a major cause of IBS, which is the most common gastrointestinal condition.

Patricia:               And our kids are notoriously constipated or they have diarrhea, or they alternate constipation and diarrhea. And so part of it, not all of it, part of it’s what they’re eating, part of it’s that they’re not moving. But part of it is that this muscle tone in their gut is weak. And so that’s something that needs to be looked at thoroughly.

Dr. Weitz:            Another thing that I saw in new chapter on hormones, which I thought was kind of an interesting clinical pearl is you mentioned DHEA, which is another hormone that typically is not measured by doctors. And that low DHEA leads to low tryptophan, which leads to low serotonin, which we know is one of the essential neurotransmitters in the brain that can lead to depression and anxiety and all sorts of other brain issues.

Patricia:                And guess where they’re made, in the gut. And so you have a damaged gut, you’re not going to be able to produce those, and absorb your food properly, and then your hormones are off. So we’re back. We’ve gone full circle now. The proof is in the gut. We’ve got to be able to heal the gut. And functional medicine doctors are really the best at doing that work.

Dr. Weitz:            Right. Now, we just talked about oxytocin, and I just found this discussion of oxytocin so interesting. You also go into the book how it’s very common during the birthing process for women to be supplemented with Pitocin in order to induce labor, which is a synthetic oxytocin. And this may actually turn off the oxytocin production in your baby.

Patricia:               That’s right. And who thunk it?

Dr. Weitz:            Here we are injecting all these hormones going, “Oh yeah, it’ll be fine.”

Patricia:               Right. It’ll be fine. And doing these birthing procedures that do not enhance later development and post-birthing procedures. I have a whole chapter on reflexes and the importance of primitive reflexes and how our body is like a computer that’s programmed with over a hundred different reflexes. But if the baby isn’t come down through the birth canal and is taken by C-section, that is a bad situation for future reflex development, which is the pattern for talking, for looking, for reading, for standing and sitting and rolling over, all these things. So the reflex integration has been affected by the hormones…

Dr. Weitz:            Fascinating.

Patricia:                … by the birthing process.

Dr. Weitz:            Wow.

Patricia:               It’s all interrelated.

Dr. Weitz:            One more reason to avoid a C-section if at all possible.

Patricia:               Absolutely.

Dr. Weitz:            Not only is there increased risk to the mother, increased risk to the baby, increased cost, but you lose out on the development of the microbiome because the baby develops the bacteria from the mother’s womb as it’s passing through. But it also affects the primitive reflexes.

Patricia:               Right. And we’re now, thank goodness, we’re swabbing babies with mother’s vaginal fluids if they’re born by C-section. So that’s a good thing. But the better thing would’ve been to be born that way. But then we have this back to sleep movement where we’re putting babies on their backs to sleep when they’re neurologically upside down. When a baby’s on his back, his eyes are up there somewhere. When he is on his tummy, he sees his hands and he can move and he can look left and look right and look up and lift his head and use the strongest muscle in his neck to lift his head. When he is on his back, he’s like a beach whale.

Dr. Weitz:            Well, this is all an attempt to try to stop sudden infant death syndrome, that’s why.

Patricia:               Yes. Yeah. Well, guess what, we’re back to that V word where many people can correlate the timing of that sudden infant death syndrome to 24 hours prior a baby having some kind of inoculation.

Dr. Weitz:            Wow.

Patricia:                And what is sudden infant death syndrome, really? It’s probably a V reaction. And in Japan where they stopped doing that with young babies, there is no sudden infant death syndrome. And I quote that research in my book.

Dr. Weitz:            Interesting, interesting. So what do you think about using… You mentioned using the oxytocin supplementation for kids with autism. And I guess there’s also a homeopathic version.

Patricia:                There’s a homeopathic version of everything. There’s even a homeopathic version of some of the pathogens that we inoculate against. And so for those who know about homeopathy, it’s an energetic version of animal, vegetable or mineral. And so when you energetically introduce it into the body, when the pathogen comes along, the body… It’s not a foreign substance to the body. So the body says, “I know this, I can deal with this.” And that’s what homeopathy does. And for some kids, homeopathic oxytocin is enough to get their bodies awake, just as it is for some of the other things that we do use homeopathy for. And homeopathic detoxification, I talk about in the book. And that is one of the most exciting ways of getting kids back to themselves in a very gentle, sequential fashion.

Dr. Weitz:            Cool. Another hormone you mentioned is that some of these kids may have high testosterone, and that can result in aggression and some of the other symptoms.

Patricia:                Right. And testosterone…

Dr. Weitz:            And that could be…

Patricia:                What?

Dr. Weitz:            Yeah. That maybe is one of the reasons why it’s more common in boys.

Patricia:                That’s what I was just going to say. That testosterone and mercury are a bad combination because it potentiates the problem and that’s what looks like aggression. And so the doctors, Geier, G-E-I-E-R, Mark, and can’t remember the other one’s name, they were using Lupron to lower the testosterone in boys. And they were accused of castrating their autistic patients. But they were very, very successful by lowering the testosterone and chelating the mercury to bring down the aggressive behavior. And the girls with autism typically have high testosterone levels…

Dr. Weitz:            Interesting.

Patricia:                … which is fascinating. They’re more masculine in their features and their levels are too high. And estrogen is protective from some of the metals and from some of the chemicals and the viruses. So we want to, again, and this requires very careful management. This is not something you go and do yourself. This requires a doctor who really understands these hormones.  This chapter that you have focused on doesn’t happen to be my area of most expertise, but I’m glad you did it because it’s really, really important for parents to understand how complicated this autism picture is. It’s not just about one thing. It’s not about poor speech and not having friends and not having eye contact. It is biological. And the biology of autism is where our important functional medicine doctors are going. And this started with Martha Herbert. She would be a great one for you to have on your show. Martha Herbert wrote the book The Autism Revolution. And she was one of the first doctors to talk about, “This is a biomedical problem. This is not a psychiatric disorder.”

Dr. Weitz:            Right. You have a chapter in there about structural work, and you mentioned chiropractic, and I’m a chiropractor, so I thought that was kind of interesting.

Patricia:                Right. And you know that the birth process causes all kinds of issues if it’s not clean and easy. And so many of our kids with autism have a history of traumatic birth. And many chiropractors want to be present at birth. They want to catch that baby. They want to do teeny-tiny little manipulations to balance out anything that might have gone wrong during that birth process if there was use of vacuum aspiration or forceps. Those are absolute necessities to have a good chiropractor on your team.  And there are so many other methods that chiropractors use, like craniosacral techniques or myofascial techniques that some of them are done just by chiropractors. Some of them are tools in the tool chest, say, of occupational therapists or physical therapists or other medical practitioners who can help balance this out, some structural issues. And some of them may be obvious, like a head tilt or a child who is walking crooked. But some of them may not be obvious to a parent or a teacher. And it’s important that you have a good structural evaluation of a child with autism.

                                And some of them, some of chiropractors work with optometrists. And I have gotten particularly interested in vision on my website, which is my name, patricialemer.com. There are several long interviews like this about vision, and I’ve titled most of them, Vision Is More Than Meets The Eye. And what happens if the two eyes are not working together, if the brain and the eyes don’t work together, if a child is having double vision or is not using the eyes well together, it may not be obvious. And a good developmental optometrist can work collaboratively with a chiropractor to do therapy that can help this child use vision more efficiently. And I don’t mean eyesight, I don’t mean the clarity. I mean something conceptual, organizational. When you say someone has vision, you’re not talking about the prescription in their glasses. You’re talking about something, about thinking, that is missing in many of our kids with autism.

Dr. Weitz:            Cool.

Patricia:                Yeah.

Dr. Weitz:            There were a couple of other things when we spoke before we started that you wanted to make sure we covered.

Patricia:                Besides vision and other sensory areas. Many kids with autism see occupational therapists. And the occupational therapist works on sensory issues. Temple Grandin, who’s probably the most famous adult autistic, she talks about her sensory issues, her tactile, her olfactory, her auditory sensitivities. But vision gets its own chapter. And again, an OT and an optometrist should collaborate.  And the other area that this book has, that my book Outsmarting Autism has that is often neglected, is the dental area. If you look at kids with autism, many of them have overbites. They have very narrow and high-arched palate and they’re not getting good breathing and good oxygen to the brain. So a good functional, holistic dentist who doesn’t use fluoride, who understands why our palate should be wide, is an important member of the autism team because they can put expanders in the jaw and open it up, which will help breathing, will help speech, which will help get more oxygen to the brain for thinking. And so I have a whole chapter on that, which is another really important piece of the autism puzzle.

Dr. Weitz:            Yeah, that’s super important. And proper breathing techniques like learning how to breathe through the nose and not through the mouth, and maybe even using mouth taping or other techniques.

Patricia:                Yep, the mouth is for eating, the nose is for breathing.

Dr. Weitz:            Excellent. Excellent, Patricia. So we’ve covered a lot of great information. So any final thoughts? And then let people know how they can find out about your book and get in touch with you.

Patricia:                So as a final thought, I told you early on, where I really have made a difference is helping people understand the sequence of working with a child and why sequence matters. And my book is written in sequence with five steps of how to get your child better functioning. And it has to start with the biology of autism. It has to start with lifestyle, with diet, with sleep, with hydration, and with movement. Those are the way we function best when all of those are on par. And people don’t want to start there. They come to you or me and they say, “My child’s not talking.” Well, I can’t get him to talk if he’s living on Twinkies and Coke. It just doesn’t work that way. He has to have good gas for his car to be able to talk. And he’s not going to talk if the muscles of his tongue and his lips and his cheeks aren’t working, and if those mouth and eye and facial reflexes aren’t working. So you’ve got to be patient for talking.

                                “And he doesn’t have any friends.” Well, socialization is the end product of all these things coming together. And that’s why the subtitle of my book, Outsmarting Autism, is so important. Build Healthy Foundations for Communication, Socialization, and Behavior at All Ages. And we didn’t talk about ages, but it’s never too late. It’s never too late for some of these young adults today to start using communication skills. Some to be able to be more independent, to eat better. Their lifespan is… we’re getting it to be longer and longer by helping them eat better, sleep better, and have better health.

                                And so all of this is in my book, Outsmarting Autism, which is available, as you said, on Amazon. It’s in a 600-page paperback with the world’s best index and also comes as a Kindle that you can read on a tablet. And there’s also an audiobook, which I do not read. They hired a professional actress to read the book. And you can go also, I have two websites. I have patricialemer.com, and my last name is spelled L-E-M-E-R, one M. And I have outsmartingautism.com. And both of them have lots and lots and lots of information on them.

                                And then I’m on Facebook, Patricia Spear Lemer, S-P-E-A-R. And Outsmarting Autism also has its own Facebook page. And you’ll see that I travel all over the world and I like posting on Facebook. And I often post what I’m doing related to autism. And that my Autism Detectives podcast is… I post every time. I have a new podcast, which is the second and fourth Tuesday of the month at 1:00 PM Eastern, 10:00 AM Pacific. And it’s on something called healthylife.net, which is a web streaming radio station. So you can listen live. But the best way is to find it on Spotify and I post it like a day or two after I’ve done it live. So there’s tons of those to keep you busy if you want to know everything there is to know about autism.

Dr. Weitz:            There you go. Excellent, Patricia. And are you still working with clients?

Patricia:                No, I’ve retired about 15 times. If you have questions though, I’m happy to answer them. My email address is developdelay@gmail. And that’s D-E-V-E-L-O-P-D-E-L-A-Y, developdelay@gmail.com. And that’s the way I work with clients. It’s best for me if I don’t have to go through what’s in my book. And I realize that every parent has a great story. I’m gotten too old to listen to the long story, so I’m not a good listener. But I sure would be happy to help you find resources and figure out the best sequence to helping your child if you want to email me.

Dr. Weitz:            Excellent. Thank you so much, Patricia. Fact-filled podcast.

Patricia:               Well, Ben, this has been fun. I really appreciate the opportunity to be on your show.

Dr. Weitz:            You got it.

Patricia:               Thanks so much.

Dr. Weitz:            Thank you. Thank you.

Patricia:               Okay.



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.



Functional Medicine Approach to Depression and Anxiety with Dr. Michael Gruttadauria: Rational Wellness Podcast 285

Dr. Michael Gruttadauria discusses a Functional Medicine Approach to Depression and Anxiety with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

2:24  Dr. Gruttadauria first saw a patient with severe depression six years ago. He was 23 years old and he seemed to have a lot going for him but he was severely depressed. He had been to see a number of doctors, was going to talk therapy, and had been on multiple medications and nothing was helping him.  He had a good job, had a girlfriend, and was in a band that had just signed a record deal. He was also working out five days per week and was eating a healthy diet. And he did not have any childhood trauma and had a great childhood. Dr. Gruttadauria concluded that this patient’s depression must be physiological rather than psychological.  He ran a series of labs and looked at stool testing and epigenetics. This patient had MTHFR, gut dysbiosis, food sensitivities, and issues with nutritional deficiencies. After correcting these things with a diet, lifestyle, and nutritional supplement approach, his depression was gone in six weeks.

6:34  The Neurotransmitter theory of depression.  Patients with anxiety and depression are often prescribed medications that typically increase serotonin levels in the brain, such as the SSRIs, since the hypothesis is that depression is caused by a deficiency in serotonin in the brain. This hypothesis that mood disorders are caused by deficiencies or imbalances in the neurotransmitters not only is not true, but even if it were, it doesn’t get to the root cause, which is why do they have a neurotransmitter imbalance?  There is a concert of neurotransmitters that function in the brain. Glutamate gets the brain excited and GABA calms the brain and then there are all these dimmer switches, which are serotonin, dopamine, acetylcholine, glycine, and all these other neurotransmitters.  All of these neurotransmitters are made from amino acids contained in protein foods. Tyrosine makes dopamine and tryptophan makes serotonin. But you have to go through a series of biochemical steps to make that happen. So, if our epigenetics are skewed, which we all have these epigenetic weaknesses called SNPs, you may have a genetic predisposition to make a little less serotonin or dopamine than somebody else might. Or if your diet’s deficient in protein, or you have a gastrointestinal issue and you’re not digesting and absorbing protein, you’re not going to have the building blocks for these kinds of transmits, or you have nutrient deficiencies that affect your ability to methylate, this will keep you from producing these neurotransmitters.  And if you don’t produce enough serotonin, then an SSRI medication will not have much effect.

17:06  When we look at the underlying physiological triggers for mood disorders, first we need to understand that inflammation is an underlying factor in all chronic illness, including mood disorders. Depression is essentially an inflammatory disorder, essentially chronic neuroinflammation. Over time, neuroinflammation will become neurodegeneration and we end up with Alzheimer’s and other neurodegenerative diseases.  We need to look for the some of the underlying triggers for inflammation, which includes diet, toxins, and gut function. If we don’t assess the gastrointestinal system, we are missing the boat.  There is such a connection between the gut and brain that if the gut is on fire, the brain is on fire.  One of the things that happens is a change in our nervous system from parasympathetic dominance to sympathetic dominance, which slows down the motility of the gut, which adversely affects the microbiome.  Dr. Gruttadauria prefers using the GI Map stool test to assess the microbiome and gut health.  By treating the gut, we are not treating depression but restoring health, which results in less depression.

23:37  Diet.  If the patient is starting with the Standard American diet and they are eating junk food and drinking 3 cokes a day and they live on Ring Dings, then just taking away all that processed food will be a massive shift.  And getting people to drink water is a big shift for a lot of people. Many people only drink soda, coffee, and juice. Reducing chronically elevated blood sugar is an important thing. We also need to remove food sensitivities.  The dietary approach that Dr. Gruttadauria feels is best is a paleo style diet with lots of plants and significant amounts of protein. If we can get people to eat vegetables and lean proteins and we can get them to drink water and go out in the sun and exercise 20 to 30 minutes a day, probably we’d knock out 50% of the depression and anxiety.

25:15  The importance of Sleep and Circadian Rhythm.  The brain has two pacemakers. One is driven by movement and the other is driven by light. We have receptors in the back of the eye called melanopsin receptors that pick up light, transcribe it, and drive the hypothalamus. And it drives an area of the brain called a super charismatic nucleus, which generates this day night cycle.  Most of us have overexposure to blue light due to indoor lights, due to looking at our phones and computer screens, and due to staying up and watching TV till late.  This can dysregulate our cortisol melatonin rhythm, and that changes everything about our brain.

30:23  Nutritional Supplements.  Nutritional supplements are recommended that testing shows they are low in, such as vitamin D, omega 3, vitamin B12 or magnesium. Dr. Gruttadauria likes to use herbals to reduce bacterial overgrowth in the gut, followed by gut healing protocols.  If patients have a lot of inflammation, he will use fish or krill oil. He will also use anti-inflammatory nutritional products like Boswellia or Inflammatone by Designs For Health.  He likes protein shakes like MediClear by Thorne, which is a pea based protein with a lot of vitamins and minerals. Dr. Gruttadauria also often recommends free form amino acids. He often recommends magnesium threonate, which does a good job crossing the blood brain barrier.  He also likes the product NeuroCalm by Designs For Health, which helps with anxiety.  Of course, chiropractic adjustments are also very helpful in normalizing the nervous system.  He will sometimes recommend low dose lithium orotate at a dosage of 5 mg per day, which can be very helpful and is quite safe at this low dosage.


Dr. Michael Gruttadauria is a Doctor of Chiropractic with a Board Certification in Chiropractic Neurology and he is on the Advisory Board of Functional Medicine University.  He is the CEO and Director of The Optimum U, which is his private practice in New York.  Dr. Gruttadauria is also the Founder of the SameHere Global Functional Doctor’s Alliance, which is an international mental health non profit dedicated to spreading the word about mental health and not just mental illness. Practitioners interested in joining this alliance can send him an email to dr.mike.gruttadauria@gmail.com.

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.



Podcast Transcript

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, we have an exciting discussion on a functional medicine approach to anxiety and depression with Dr. Michael Gruttadauria. Dr. Michael Gruttadauria is a doctor of chiropractic with a board certification in chiropractic neurology. He’s on the advisory board of Functional Medicine University, and a CEO and director of the Optimum U. Rates of depression and anxiety in the United States were already quite high, but then the pandemic hit that we’ve just lived through since 2020, and we’ve seen an increase in the rates of these disorders by approximately 28 and 26%.             Depression is a mood disorder involving feeling sad, that is distinct from normal mood swings and short term emotional responses to the daily challenges of life. Depression can be dangerous to your health, especially if it’s severe. It can result in the depressed person suffering and being unable to perform well in school, work, and social life. Severe depression can even lead to suicide. And every year, over 700,000 people die by suicide in the United States. Anxiety involves fear or uneasiness of future situations and problems and can lead to behavior that avoid situations that might trigger this anxiety. This can also affect job, academic, and personal relationships. And 62% of Americans report feeling anxious at some point in their lives. Dr. Gruttadauria, thank you so much for joining us. I hope I pronounced your name correctly.

Dr. Gruttadauria:            Yes. You did a really, really good job. I’m very, very happy to be here, and I really appreciate you having me on.

Dr. Weitz:                        So, how did you get interested in treating patients with mood disorders?

Dr. Gruttadauria:            Oh my goodness. About probably six years ago, I was in my office and I had a patient call me up and say, “One of my friend’s sons is really in trouble. Can you see him?” And I said, “Sure, I’ll be happy to see him.” And she goes, “No, can you see him tonight?” And I said, “Yeah, what’s up?” And she said, “He’s tremendously depressed. He’s at the end of his rope. He’s been to every doctor. He’s been on every medication, and he needs to meet with you.” So, I said, “Sure.” So after hours, in walks this young man and his mom, and just this handsome, vibrant, young 23 year old man. And I sit down and we start talking and he’s telling me about his life. And he says, “I graduated from college and I have a great job. I moved back in with my parents. I work with my dad on the weekends. I work out five days a week. I eat a healthy diet. I have a girlfriend. I’m in a band, a rock band, and we just got signed to a record label.”

Dr. Weitz:                        Wow. Sounds like he’s got everything going for him.

Dr. Gruttadauria:            I said, “It sounds to me like you have the perfect life. What am I missing?” And he said, “Every morning I wake up with this overwhelming feeling of dread and loss of energy and lack of motivation, and I just have a hard time going on, and I’ve had some really dark thoughts. And I’ve been on multiple medications and nothing has helped me. I’ve been in therapy.” And I said, “Tell me about your history. Have you ever been traumatized, emotional, physical, any kind of trauma?” He said, “No, I had a great childhood. I’ve never experienced any real trauma.” And that’s when the light bulb went on. And I said, this is physiological. Something is wrong with this young man. This isn’t… And I’m going to challenge the idea that depression and anxiety are diseases, because they’re looked at as… These labels are given to people, and it’s almost as if it’s a disease, but we can’t send somebody for an MRI or a blood test to look for depression or anxiety.  They don’t exist, because really, depression and anxiety are the culmination of a series of dysfunctions that happen in the nervous system as a result of what’s going on emotionally, what’s going on in our environment, what’s going on epigenetically, what’s going on with our diet. All these factors all play in, and the perfect storm comes together to form what we label as anxiety and depression. So, I went on to do a whole series of labs and we looked at his stool testing and we looked at his epigenetics. And of course, he has MTHFR and he has gut dysbiosis and he has food sensitivities, and he has multiple issues with nutrient density and so on. And literally within six weeks, this young man’s depression was gone. And I said, “It’s amazing that you’ve been feeling this way for three years.” He goes, “No, I told you it was three years, but I never told anybody. It’s been eight years that I’ve been suffering with this. I just never wanted to tell anybody.”

                                                So, we have an epidemic of these issues, these anxiety and depression. But again, we really need to start looking at mental health and not just looking at the disorders. Because what that does is it creates a barrier. It says Americans constantly promote the fact that one in five people has a mental health disorder, anxiety, depression, bipolar, whatever it might be. But what that infers is that 20% of people have this problem, and the rest of us 80 percenters are fine. And that’s just not true because we’re all impacted by stress. We’re all impacted by lifestyle challenges. And the fact that we’re sitting down and lying down 90 plus percent of the day, and we don’t get enough sunlight exposure, we eat food that’s toxic, and all of the different challenges that we have in American living, and it’s no wonder that we have such a high rate of mental health challenges. And we just need to start talking about it because we hold it in. And as a result, it only gets worse.

Dr. Weitz:                        So, his depression wasn’t caused by a deficiency of Prozac?

Dr. Gruttadauria:            Exactly, exactly. And it’s funny. It’s great that you say that because I use that term all the time. You certainly do not have a Prozac deficiency. And it’s incredible because they’ve actually just recently come out and said, “Well, that whole serotonin hypothesis where we have a serotonin deficiency really isn’t true.” So, for the last 30 years we’ve been giving people SSRI medications, literally hundreds of thousands of them every year, and they give people some relief, some-

Dr. Weitz:                        But that’s a predominant theory of depression and anxiety, is that they’re caused by neurotransmitter imbalances or deficiencies.

Dr. Gruttadauria:            So, then the question from our perspective, from a functional medicine perspective is, why does somebody have a neurotransmitter deficiency?

Dr. Weitz:                        Right.

Dr. Gruttadauria:            I mean-

Dr. Weitz:                        What’s the root cause? Yeah.

Dr. Gruttadauria:            What’s the root cause? Why? I mean, we know that serotonin and dopamine, modulatory neurotransmitters. We have… The brain gets turned on by glutamate and it gets turned off by GABA. Those are the on and off switches. And then we have all these modulating, if you think about it as almost like dimmer switches, serotonin and dopamine, acetylcholine, glycine, all these other neurotransmitters, and they’re made from protein. They’re made directly from amino acids. Tyrosine makes dopamine and tryptophan makes serotonin. But you have to go through a series of biochemical steps to make that happen. So, if our epigenetics are skewed, which we all have these epigenetic weaknesses called SNPs, you may have a genetic predisposition to make a little less serotonin or dopamine than somebody else might. Or if your diet’s deficient in protein, or you have a gastrointestinal issue and you’re not digesting and absorbing protein, you’re not going to have the building blocks for these kinds of transmits, or you have nutrient deficiencies because we know that methylation, this process called methylation is involved.  So many different pieces of the puzzle that are just not being looked at. You walk into a psychiatrist’s office and you tell them that you have depression, and within 15 minutes, you’re pretty much walking out with a prescription.

Dr. Weitz:                        Right. Now, interestingly, they’re often walking out with a prescription for SSRI, which is designed to increase serotonin, but there’s actually one medication on the market that decreases serotonin and seems to have equal efficacy as the medications that increase serotonin.

Dr. Gruttadauria:            It’s crazy because actually, what they’re doing is… An SSRI medication is actually designed to make the serotonin that your body has in the synapse between the nerve cells stay in there longer.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            The uptake inhibitor, and it stops it from being taken up into the following cell. But what if your body’s not producing as much as it should to begin with?

Dr. Weitz:                        Right.

Dr. Gruttadauria:            You get the label of treatment resistant depression.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            Because you’re resistant to the treatment we’re trying to give you, which is the standard of care, well, now you have treatment resistant depression, and we don’t really know what to do with you. Maybe TMS, maybe we’ll try ketamine next, maybe we’ll try electroconvulsive therapy. And you have all these other things that are trying to kill the depression, which is, again, the symptom that happens as a result of all these others.

Dr. Weitz:                        Yeah, it’s interesting that ketamine and low dose hallucinogens are the new treatment for depression.

Dr. Gruttadauria:            Right. And that’s the whole thing. If we step back and we think about the word treatment, what are we actually treating if we can’t see it? We’re treating the symptom and we’re never really looking for the root cause.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            That is the biggest challenge that we face in a functional health environment, is working with people that have these mental health challenges and helping them to understand and make changes to their lifestyle when they feel at they’re worst. So, it’s not that easy.

Dr. Weitz:                        Right. So, when you have a new patient who’s coming to you, say, with depression, how do you assess them? How do you decide what testing to do?

Dr. Gruttadauria:            So, I’m very lucky to be working in an environment where I work very closely with psychologists and psychiatrists. So, a lot of times, they’re in counseling, because as a functional medicine practitioner, I want to make sure that they have the emotional support that they need. And we look for integrative psychologists, people who are looking to do breath work and who are really open to the ideas of functional medicine, as well as yoga and all these other techniques, because we need to rearrange the way the brain is working. It’s not just about talk therapy. It’s a great modality, but it’s one of many. What I do then, because I have this background in neurology, I always want to assess the brain because these are really neurological issues. And what we see is, and there was actually just an article recently in Psychology Today, can concussion cause depression? And the answer is yes. And actually, this happened to me, Ben. When I was in graduate school, I was in a car accident, and I went through a windshield, believe it or not.

Dr. Weitz:                        Oh wow.

Dr. Gruttadauria:            And after having head injury, neck injury, and about three months of rehabilitation, I was back and everything was fine. And one day I’m driving in my car and I have this massive tunnel vision, my heart starts to pump, and I’m having what I thought was a stroke at 22 years old. And meanwhile, I was in the best shape of my life, I was competing in body building, I had the great… Everything was fine. And I get to the hospital and they tell me I have a panic attack. And I said, well, I just went through a windshield. And they said, no one thing has nothing to do with the other. And for about five years, I had emotional dysregulation, up and down, up and down, and everybody just wanted to throw drugs at me. And I said, I know that this is due to my head injury. I smashed my head.  And they didn’t want to know about it. So, from a functional neurological perspective, we look at brain stem issues and we look at eye movements and we contract them and videotape them. We look at computerized balance assessments. So, we really need to get an idea of what’s going on in the brain. Then we need to look at blood, urine stool, food sensitivities, toxicology, all these different things. And everybody’s different, so we don’t have to run every test on everybody, but it really starts with the questions. Tell me about your life. What’s happened to you? Tell me your story. And that brings me to really this amazing organization that I work with, which is called Same Here Global.  A few years ago, I was posting all about depression on my Facebook page and I get on one of the posts from a gentleman that I really never met before.  His name’s Andrew Pleener.   And he reaches out to me and says, “Listen, I’m an integrative psychiatrist in Florida and I work with a gentleman named Eric Cuson who started an organization called Same Here Global. Can you tell us why you are working with people with depression when you’re not a psychiatrist or a psychologist?”  And I gave them the whole overview of the functional medicine, functional neurological approach, and then I put together a presentation.  And they said, “We want you to build a network of like-minded doctors.  We want you to find functional medicine, functional neurology, integrative medicine, anybody who is interested in helping us to get this message out.”  And really, the story behind Same Here was that this gentleman, Eric Cuson, was a big time executive in the sports world.  He was on his way to becoming the the CFO of a major basketball franchise, one of the NBA franchises.  And at 38 years old, wakes up and basically has a nervous breakdown. Had no idea why. Everything was great in his life. And he started the merry go round of going to the best doctors. And literally 52 medication combinations later and two and a half years, had to move back in with his parents because he was unable to function.  And he was told by the doctors at Cornell in Manhattan, “Your last resort is electroconvulsive therapy.”  Nobody ever did any blood tests on him.  Nobody looked at his stool, nobody did epigenetic testing.  Nobody did anything but prescribe medication for this guy.

Dr. Weitz:                        Of course.

Dr. Gruttadauria:            And afterward, he ends up in an integrative psychologist office because nothing worked. He was just as bad as he was. He was worse. And they said, “Tell me about your story. Tell me about your life.” And it was really interesting to him that they didn’t just say, “Tell me about your depression,” because he realized that it wasn’t just about the label. And he tells the story… He’s much better at telling it than I am, but essentially when he was a little boy, he had an older brother. His older brother ended up getting cancer, and his family was in this tumultuous, crazy situation for years, multiple years. Eventually pulls out of it. Then, so it was like his life was upside down for years, tremendous amounts of stress as a young kid. Then the same brother was in the back of a Jeep when he was in high school. And the Jeep gets into an accident, he has a head injury, he goes into a coma.

                                                Again, the whole family is in total, total upset. And then in college, the brother ended up having a relapse of his cancer. So, it was literally like a decade of massive amounts of stress. And the way the psychologist explained it was, imagine you were at a mud wrestling event and you’re in the front row. You’re not wrestling, but every time somebody throws somebody down, it splashes onto you. So, time the event is over, you are just as covered in mud as the person in the wrestling match. And that hit me so hard. I thought that was the greatest analogy. And that stress causes changes in us. It causes changes in our brain, in our nervous system function. We end up in a constant fight or flight mode. We end up with changes in our adrenal glands, neurochemistry. Everything changes as a result of stress. And unless we get to the bottom line and help people to not only understand what’s going on in their bodies, we can actually reverse these things. And that’s what we do.   And it’s like magic when you get to help somebody that nobody else has been able to help, because we’re really just looking at a common sense approach to restoring health versus treating illness.

Dr. Weitz:                        So, let’s go through some of the underlying physiological triggers and things that you might see coming back from testing that’s going to help you treat patients for these mood disorders like depression and anxiety. List off some of the most important factors. One thing I want to touch on is blood sugar balance.

Dr. Gruttadauria:            Yes. So, inflammation is… And I know you’ve talked about this hundreds of times on your podcast. Inflammation seems to be an underlying factor in all chronic illness, including mood disorders. Depression is actually an inflammatory problem. So, when we have chronic inflammation… Inflammation is essentially a chemical and cellular response to injury, and it’s normal. It’s a very healthy response. It’s part of the immune system. But when it becomes a chronic problem, then it changes our biochemistry overall. And when chronic body inflammation gets to the brain, it causes something called neuroinflammation. Now, the brain has its own immune system, and we have these things called microglia, which are these supportive cells that react in such a way that it creates this ongoing chronic neuroinflammation. Eventually, that newer inflammation causes changes in brain function, so people show up with brain fog, chronic fatigue, anxiety, depression, headaches. All those things are all as a result of changes neurologically. Eventually, that neuroinflammation will become neurodegeneration and we end up with other things like Alzheimer’s disease and other neurodegenerative diseases.

                                                So, we need to understand what is somebody’s inflammatory load? Where do people get inflamed? They get inflamed through their diet and toxins, through many different factors. But one of the biggest things really is gut function. And that that’s really almost the foundation for everything. If we don’t assess the gastrointestinal system, we are missing the boat. There is such a direct link between the gut and the brain that actually, in functional medicine, and I’m sure you’ve said this a million times, the gut’s on fire, the brain’s on fire. They work together. There are more neurons, more nerve cells in the gut than there are in the entire spinal cord.

Dr. Weitz:                        So, how do you assess the gastrointestinal function?

Dr. Gruttadauria:            Yeah. So, one of the things that we know happens is when we have these issues, we usually have a shift in nervous system function toward sympathetic dominance. So we have a sympathetic and parasympathetic nervous system and they work opposite each other. When sympathetic systems high, parasympathetic is low, and vice versa. We’re only supposed to be in sympathetic mode one 10th of 1% of the time. It’s really like an emergency mode. And we’re supposed to live in a parasympathetic dominance, meaning rest and digest. Our body’s supposed to be at rest and we’re supposed to have this normal digestion. But when we’re in this hyper stress mode where we’re in the sympathetic dominance, we can test for that. We can look at heart rate variability, we can look at pupil diameter. We can look for all these other things that tell us about sympathetic nervous system function.

                                        But what ends up happening is we have a shutdown of the gut. So, if we slow down secretions in motility of the gut, now we have changes in what we call the microbiome. And the microbiome is this bacterial colony that we found in the late two thousands that we didn’t even know existed. We used to think that all bacteria was bad, so we got crazy about antibacterial soap and Purell and taking antibiotics every time we had a sniffle. Now, what we realize is for decades, we’ve been damaging this amazing organ that we have called the microbiome, which is a collection of bacteria and other microbes that actually have a relationship with us and live inside of us.

Dr. Weitz:                        Just think about all the damage to the collective microbiome from the use of 20 zillion tons of hand sanitizer over the last couple of years.

Dr. Gruttadauria:            Just think about it, right? And again, we are so vigilant about this-

Dr. Weitz:                        And Lysol and all these other chemicals.

Dr. Gruttadauria:            I mean, it’s crazy because we’ve been brainwashed into thinking that all bacteria was bad and we need to sanitize everything. I remember as a kid, mom used to spray my whole room with Lysol. “Sleep on that pillow.” I’d be like, “This pillow smells like Lysol.” [inaudible 00:21:41] that in every day. Sorry, mom. But as it turns out, we are exposed to so many chemicals, so many.

Dr. Weitz:                        How do we assess the microbiome? How do we assess the gut? Is it a stool test? Is it other testing? What do you [inaudible 00:21:56]?

Dr. Gruttadauria:            Stool testing is number one.

Dr. Weitz:                        What’s your favorite stool test?

Dr. Gruttadauria:            I’m a big fan of the GI Map.

Dr. Weitz:                        Okay, yeah, that’s what I use too.

Dr. Gruttadauria:            Yeah, so the GI Map is really… It gives us a really good appreciation for what’s going on in the gut. So, we have this whole healthy bacterial colony. We know that we have other bacteria that can live inside of us, just at low levels. It’s okay. Our body can handle it. But sometimes we have an overgrowth of bacteria and we have an undergrowth of healthy bacteria. We can end up with parasites and yeast and just functional disconnection in how the gut is supposed to function. And then next thing you know, you have reflex back to the brain because the communication between the microbiome, the immune system and the nervous system is so powerful that everything changes as a result of the gut. So, it’s an amazing test. I mean, I tell all my patients, five years from now, this is going to be standard of care. Right now, we’re the only ones doing it.

Dr. Weitz:                        I think maybe 15 years from now, because how long it takes for conventional medicine to change.

Dr. Gruttadauria:            Yeah, it’s really a shame, but I think people are amazed when we have this initial conversation about how we’re going to approach this. And again, I’m not treating depression. I’m restoring health to people.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            And it’s a huge distinction between those two things. And they really understand that that’s what I want. I want to feel good, I want to feel healthy. And what we need to do is figure out where the imbalances are. And at a very basic level, what you and I do is we take away what’s hurting people and we give them what we’re missing.

Dr. Weitz:                        Yeah.

Dr. Gruttadauria:            The body does the magic. We’re just facilitating it.

Dr. Weitz:                        So, let’s talk about diet. What’s the best dietary approach for depression and anxiety? And I’m sure it depends on each person.

Dr. Gruttadauria:            Well, of course, but it really depends on what’s going on with that person’s diet when they start. So, if you have somebody come in and they have the standard American diet and they’re eating fast food and drinking three cokes a day and five coffees and they live on Ring Dings, I mean, just taking away that stuff is a massive shift.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            Blood sugar, elevated blood sugar, chronically elevated blood sugar causes chronic inflammation. So immediately, their whole body shifts. Getting people to drink water, which is a shocking thing. We take that for granted, but it’s… You’d be surprised… I’m sure you’re not, but many people would be surprised that people do not drink any water.

Dr. Weitz:                        Absolutely.

Dr. Gruttadauria:            Soda, coffee and juice, and that’s it. No water. So with somebody like that, it’s real easy. We just got to do a cleanup. But sometimes people have challenges to foods that they think are really good for them, but their body’s reacting negatively, so long term gut dysfunction creates changes in actually the intestinal lining and we end up what’s commonly called is leaky gut, which is an intestinal permeability problem. Now, people can react to foods that are usually good for people, but it might be terrible for them. They have a sensitivity to eggs or dairy or common foods, and that’s creating this chronic immune system dysregulation. And again, the immune system and brain are one in same. They worked so hand in hand.

Dr. Weitz:                        How important is sleep and circadian rhythm?

Dr. Gruttadauria:            Oh my goodness, I’m so glad you brought that up. The brain has two pacemakers. One is driven by movement. So every time we move, signals is sent to the brain and it powers it up, and the other one’s driven by light. And we have receptors in the back of the eye called melanopsin receptors that pick up light, transcribe it, and actually drive the hypothalamus. And it drives an area of the brain called a super charismatic nucleus, which generates this day night cycle. And we know that this rhythm that we were born to have on a regular basis is so imperative to normal brain function. But if you think about the overexposure to blue light that we have due to technology, due to indoor lights, due to staying up and watching TV till two o’clock in the morning, it disregulates our cortisol melatonin rhythm, and that changes everything about our brain. We have so many challenges to live in a technological-

Dr. Weitz:                        What do you about restoring circadian rhythm for your patients?

Dr. Gruttadauria:            The number one thing is, again, depending on what their lifestyle is like… I mean, you have people that work the night shift. And we know, I mean, studies are very, very clear that people who work the night shift disrupt the circadian biology and they have poor health outcomes over the long term. So, one of the things that I do is I have people wake up when the sun comes up and sit outside for 15 minutes and watch the sun come up. I know if people are like, “Oh my god, that’s so early.” Listen, do you want to get your brain back? These are the things you need to do. And then after dark, we have them wear blue blocking glasses. So, you could get inexpensive pair of 100% blue blocking glasses on Amazon for 20 bucks. But it’s really, really important that they wear it to reduce the amount of blue light.

                                                So, in any room, in any room that we’re in right now, we have this white light, but white light really is made up of all the colors of the rainbow. But in order to make a computer screen or an iPhone stand out against the rest of the room, it has to be very powerfully driven with blue frequencies. And those blue frequencies are very damaging when overexposed. It’s like eating… They’re fine when it’s combined with everything else in white light, but if you just have blue, it totally messes us up. And I’m sure these studies are never going to come out because there’s so much money being made in technology that nobody’s ever going to admit that we’ve been really messing up by having this massive overexposure to technology.

Dr. Weitz:                        And what about the importance of sleep?

Dr. Gruttadauria:            Well, I mean, we need to restore sleep. That’s when the brain regenerates itself. So, I think when we help people to get their circadian rhythms back, then their sleep becomes restored. But again, how many people come in when they have these chronic mental health challenges and they’re on six to 10 different medications? They’re on medications for pain, they’re on medications for sleep, they’re on medications for stomach problems, they’re on medications for the anxiety or the depression. So, I mean, at what point do we realize these medications and this particular combination of drugs has never been studied in this particular person’s chemistry and their epigenetics. So, how much of that is contributing to their problems? Another study that came out that said they tested a thousand different medications and realized that 25% of all of the common these thousand common medications have antibiotic like effects on the gut microbiome. So, even though they’re not antibiotics, 25% of all drugs damage the microbiome.

Dr. Weitz:                        Wow.

Dr. Gruttadauria:            Crazy.

Dr. Weitz:                        There’s a clinical pearl for you. So, I asked about diet, but is there kind of a dietary approach that you think this is… Forgetting about the person who’s just following a standard American diet and you’re going to clean it up, let’s say you got somebody who comes into your office and they’re suffering from some level of depression and they want to optimize their health. What kind of dietary approach do you think might be best?

Dr. Gruttadauria:            After years and years and years of doing this, what I feel is the best approach is a paleo style diet. People have a plant based diet with a significant amount of protein. And I’m big fan of eggs and meat, and so on. And so I really feel like people need to be getting at least one to one and a half grams of protein a day per pound so that they’re able to maintain it. Because it’s not how much protein you take in, it’s how much you digest and absorb that really matters.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            So, we have to make sure people are digesting appropriately, so sometimes we’ll use digestive enzymes. We have to heal the gut. That’s a big, big piece. So, we have that dysbiosis and that inflammatory issue. But I mean, if we can get people to eat vegetables and we can get eat lean proteins and we can get them to drink water and go out the sun and exercise 20 to 30 minutes a day, probably we’d knock out 50% of the depression and anxiety.

Dr. Weitz:                        Right. There you go. I recommend a similar approach. I would call it a low glycemic Mediterranean diet. You’re calling it a paleo diet, but sounds very similar.

Dr. Gruttadauria:            Yeah, very, very similar. Exactly.

Dr. Weitz:                        So apart from diet, we have nutritional supplements, and some can be of real benefit for depression and anxiety. Maybe you can talk about some of the benefits of specific nutritional supplements.

Dr. Gruttadauria:            Okay.

Dr. Weitz:                        Obviously, it depends on the person.

Dr. Gruttadauria:            Depends on the person, and a lot of times based on their labs. One of the things that we want to make sure is that they have a proper zinc copper balance, because that plays a big role in what’s going on neurologically.

Dr. Weitz:                        Now, do you measure serum zinc and copper or do you measure plasma?

Dr. Gruttadauria:            Yeah, pretty much in every patient?

Dr. Weitz:                        Okay. Serum versus plasma? Okay.

Dr. Gruttadauria:            And then the other piece is, a lot of times, especially if they come back and their high sensitivity CRP or ESR elevated or we find dysbiosis, we want them to be on an anti-inflammatory hype supplement program. So, we’ll use fish oil, krill oil. We’ll use Boswellia or Inflammatone, or other kinds of herbal supplements that we know can help with inflammation.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            Really good. And then I’m a big fan of the herbals to try to restore the gut. And then remove whatever we need to remove, and then eventually work on healing the gut. So, from a very straight point of view, I think… I don’t want to over supplement people because I feel like don’t want to use supplements in exchange for pills and medication.

Dr. Weitz:                        Right. Of course.

Dr. Gruttadauria:            Our goal is to restore health.

Dr. Weitz:                        Yeah, we’re talking about once you’ve established more healthy diet, you’ve got them exercising, you’ve got them sleeping.

Dr. Gruttadauria:            And I’m a big fan of protein shakes. So, I think that they’re a great meal replacement. I really am a big believer in intermittent fasting because we need to kick in this process of autophagy. Autophagy is like self-cleaning.

Dr. Weitz:                        What’s your favorite protein shake?

Dr. Gruttadauria:            I’m a big fan of MediClear by Thorne.

Dr. Weitz:                        Okay.

Dr. Gruttadauria:            Yeah, it’s a pea based protein and it has a lot of different supplements in it. So, when people are taking that, they get so much supplementation just from having to shake that they don’t really need a lot of extra, especially vitamins and minerals. I’m a big fan of amino acids, because again, we have to make sure that we’re getting a sufficient amount and that they’re in their free form. So, everybody’s different. Of course, we have this biochemical individuality, which is the premise of everything about functional medicine. But I mean, when we can approach a patient that has these kinds of challenges and we just apply some common sense and we break it down and restore the things that we know are out of balance, they all improve. And when they’re working with a good therapist and they start working on their lifestyle, it’s incredible what happens to people.

Dr. Weitz:                        What about magnesium for patients with anxiety in particular?

Dr. Gruttadauria:            Yeah, that’s a great one. Magnesium threanate, which is seen shown to be crossing the blood brain barrier, I’m a fan of that. And you can take one during the day, two at night. There are other things that you can take. There’s something called NeuroCalm by Designs for Health, which is an herbal supplement that has a lot of different herbs to ease anxiety. So, yeah, we can definitely use those to try to handle symptoms, especially in the beginning. And then again, eventually, we kind of wean people off of that. We don’t want them to be dependent on supplements. We really want them to be able to have their body working efficiently so they can get what they need from food. I’m a big fan, obviously, of chiropractic. If somebody wakes up and their elbows stuck, they run right to the doctor. We have 20, 24 vertebrae in the spine and we don’t know if they’re moving or not appropriately, and the only way we do know is if we get an evaluation by a chiropractor.  And what ends up happening is each time we move our body, we powerfully the brain and the receptors in the spine have… We have more receptors in the spine than in any other part of the body. So, that’s really responsible for a lot of brain function. So, evaluating somebody’s spine is also central to overall brain health.

Dr. Weitz:                        Great. I’m glad you mentioned that. That’s super important, and most people are not aware of that.

Dr. Gruttadauria:            Yeah. So, we have non-constant receptors in the body. Our eyes, ears, nose and tongue are non-constant, meaning we can close our eyes and our eyes don’t work. But because gravity’s always working on us, our balanced system, our vestibular system and our musculoskeletal system are always active because we always need to resist gravity. So as a result, those are the two most powerful drivers of brain function. In fact, those are the two systems that allow for brain development in children. And we can see as children develop, they go from that lying on their back, and then we flip them over and they get some tummy time and they start lifting up their head. As they stand up and they resist gravity, the amount of receptive potentiation they get from having to resist gravity is what drives brain expansion. And then it’s not by accident that when they stand and walk, they also talk. So, it’s pretty incredible when we think about brain development and the musculoskeletal system.

Dr. Weitz:                        What about supplements like 5-HTP, Mucuna that help the body to naturally produce neurotransmitters?

Dr. Gruttadauria:            So, I think that they all have their place. If somebody… We’ll run an amino acid panel and if they have really, really low levels of triptophan to fan tyrosine, I might use those particular things in addition to their shake to give them extra just those two. But as long as they’re taking it with… I never really want to put people on individual aminos because it creates imbalances. But if you add that in with an already established protein meal or shake, it gives them an extra boost because those are directly linked to the creation of these things. But methylation is a big deal, using something called 5-MPHF, like methyl folate, because you need methyl folate to drive conversion of these amino acids into neurotransmitters. That can be really helpful. So, there’s so much that we can do. Our toolbox is gigantic. And I think that when we step back and we look at the totality of the situation, we are able to apply individualized approaches to each patient.

Dr. Weitz:                            Are there any specialized products that sometimes you use to put things over the top? I’m thinking about maybe things like low dose lithium, saffron. There’s a number of supplements.

Dr. Gruttadauria:            You are the best, you are the best, Dr. [inaudible 00:36:59]. Yes. Yes. Those things are outstanding. Lithium orotate, five milligrams of lithium orotate is… People hear the word lithium and they flip out because lithium carbonate at 300 milligrams is a drug, a very powerful drug.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            Lithium orotate is a mineral.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            There have been studies that show that people who live in areas that have low levels of lithium in the drinking water have much higher levels of depression, whereas people who live in areas that have higher levels of lithium in the drinking water have lower levels of depression. So, that’s definitely a good one. These are all really very interesting things that, again, go back to where we live. Where do we live on the planet too is-

Dr. Weitz:                        And then of course, some people have high levels of arsenic in their drinking water and that that’s a big negative for health. And maybe you could talk about heavy metals and some of the toxins that can be problems.

Dr. Gruttadauria:            Yeah. I mean, it’s incredible just the fact that we continue to have amalgam fillings in people. And amalgam fillings are 50% mercury.

Dr. Weitz:                       Those are silver fillings for people.

Dr. Gruttadauria:            Silver fillings. So, people who are probably over maybe 35.

Dr. Weitz:                       Most dentists will tell you that silver fillings are not a problem.

Dr. Gruttadauria:            I know, and that interesting. Well, they’re not a problem because they’re actually really good at keeping the teeth healthy, keeping the teeth together from not breaking, but the fact that every time you drink something hot or eat something hot, it liberates mercury gas and then you inhale it is probably not that good.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            Mercury toxicity is a real deal. And usually, the only way we get to see it is by doing challenge testing on people where we give them like DMSA or EDTA and we look at a urinary challenge test.

Dr. Weitz:                       But DMSA is prescription only, right?

Dr. Gruttadauria:            Right. Right. So, you’re working with integrative docs who can get these things done. But what’s interesting is sometimes you see a patient who has a mouthful of these amalgam fillings and I’ll run a mercury level and I’ll be astounded that it comes back literally two and three times the upper limit, which really tells you about how toxic they really are, because the body just can’t stand toxic metals in the bloodstream. It pulls it out of the blood and stores it in bone and fat. So, if it’s high in the blood, unless it’s a really acute exposure, that means that that patient is so burdened with metals that it just literally suppresses all function. It’s neurotoxic.

Dr. Weitz:                       So, what do you do about high levels of metals?

Dr. Gruttadauria:            So, again, I’m a big, big fan of using binders.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            Binders are really, really important to help carry out things out of our system.

Dr. Weitz:                        Ultra Binder or something like that.

Dr. Gruttadauria:            So, apple pectin and activated charcoal and the different types of clay.

Dr. Weitz:                        Right.

Dr. Gruttadauria:            All these things, they’re all really great binders. And as long as a patient is moving their bowels regularly, because you can never ever want to detox a constipated patient. So, [inaudible 00:40:00] is getting everything moving, and then eventually using binders to help pull this stuff out.

Dr. Weitz:                        Use liposomal glutathione or something like that as well?

Dr. Gruttadauria:            I work in an integrative practice, so a lot of times we’ll use IV glutathione, which is really neat. But liposomal… Yeah, I think all these things are all very, very beneficial. I’m a little on the fence about the glutathione only because I would love to see studies showing the amount that actually makes it into the bloodstream because it’s a small protein that a lot of times will just get digested by stomach acid.

Dr. Weitz:                            Well, originally years ago, we were told that glutathione could not be taken orally, was all going to get broken down, but supposedly that data has changed, and if you get the right liposomal formula, supposedly, it does get absorbed.

Dr. Gruttadauria:            Yeah. Yeah. I mean, I’ve taken it myself, but again, I’d like to see that literature, because people are really smart these days. They want to know why they’re taking something and I want be able to tell them, “Here’s some literature.”

Dr. Weitz:                        We often measure glutathione levels as well.

Dr. Gruttadauria:            That’s great.

Dr. Weitz:                        It’s included in a neutra eval or we’ll do it as part of micronutrient test.

Dr. Gruttadauria:            Right. Right. Yeah, I mean, it’s a powerful antioxidant and absolutely essential for overall health and wellbeing.

Dr. Weitz:                        So, how important are hormones for mood disorders?

Dr. Gruttadauria:            Well, we have two regulatory systems in the body, the brain and the endocrine system. So, when the hormonal system is not working well, obviously you can have changes in mood. We can see that with people who have… When women go from having a regular menstrual cycle to having abnormal menstrual cycles, their mood can change. And we’ve had patients like that. And a lot of times what we see is disregulation in the menstrual cycle and something like PCOS, polycystical ovarian syndrome, can radically change mood. So, yeah, I mean, it’s important to see that, and then, again, figure out why is this person having this dysregulation in their system? And I always go back to light because the master gland and the hypothalamus that that’s kind of running the whole endocrine system is driven by light, and an abnormal light environment is going to cause hormonal dysregulation,

Dr. Weitz:                        Thyroid, how important is that for mood disorders?

Dr. Gruttadauria:            Very. And we always have to be cognizant of the autoimmune thyroid because when people have these chronic health issues and their immune system becomes dysregulated, and now all of a sudden they have thyroid problems, there’s a direct relationship between mood and thyroid hormone. And unfortunately, the standard of care in most doctors’ offices is to really just check TSH or TSH, and free T4. A lot of times you’re missing the [inaudible 00:42:58] because you’re not really seeing the whole picture. Somebody could have a normal TSH and free T4 and have very low conversion, and the T3 can be extremely low and nobody’s really even picking that up.

Dr. Weitz:                        Right. And to assess whether or not they have a autoimmune thyroids, you got to look at the antibodies as well, the TPL and the TGB.

Dr. Gruttadauria:            Yeah. Yeah. And when people have chronic inflammation, a lot of times they end up with an elevated reverse T3. So, you have this inactivated thyroid hormone secondary to chronic inflammation. The other thing about chronic inflammation is it can actually cause tryptophan to go down a different pathway and not converted to serotonin. So, again, there’s so many interconnections between what’s going on with the overall health of the patient and what’s actually going on in their brain and their mood.

Dr. Weitz:                        Cool. I think those are most of the questions that I had prepared. Any other things you want to talk about?

Dr. Gruttadauria:            No. The message that I really want to convey is that we’re all affected by stress. Every single one of us has different levels of stress. And not only do we have different levels of stress, we handle it differently. And we all have experienced trauma. There’s all different levels of trauma, and those traumas stay with us. We know that the body keeps the score. And so when we have trauma that builds up and we don’t know how to mitigate it, to release it, we don’t work on exercise and we don’t have a therapist or a coach that we can talk to, or we’re not really doing things to actively reduce that stress, it builds up and it shifts the nervous system. And then that nervous system controls and coordinates the rest of the body, and then it shifts your biochemistry. And you combine that with a lifestyle that’s really not conducive to health or an indoor over exposure to lighting or a lack of exercise or not drinking enough water.

                                                I mean, these are all such common, common issues, and we really need to be able to talk about it. And I think that’s really the main message, is that we really want to get out and educate people as to we need to have this conversation about mental health. And you see… I mean, all of a sudden, you see out of the blue, all these stories about all these professional and collegiate and Olympic athletes having to take time away from their sport to handle their mental health, singers and all these different performers having to take time away because now they’re actually feeling emboldened by the fact that they want to tell people that this is going on because it’s the same thing going on with all of us. We are not immune. We’re all potentially affected by stress, and it’s important that we get that message out. And that’s why the Same Here Global organization is growing so rapidly.  And I know that you reach out to a lot of doctors. And if there are functional doctors out there that would like to be involved in the Same Here Global Doctors Alliance, I would love to have a conversation with them.

Dr. Weitz:                        How did he find out about that?

Dr. Gruttadauria:            You can go to samehereglobal.org and maybe you can put my email in the comments section and [inaudible 00:46:15]

Dr. Weitz:                        You got it. Actually, I have one more question. You were talking about drinking water. What about drinking coffee and alcohol? Are those negative or positive, or what do you thin their effect might be for patients with either depression or anxiety?

Dr. Gruttadauria:            So, as a stimulant, coffee can actually create anxiety. But if people are okay with it and it’s part of their routine and they use it in moderation, I usually don’t have an issue with it. Alcohol is a depressant, and a lot of times people self medicate with alcohol. So, it’s incredible how we search for things to help us feel good. So when somebody has anxiety and they find alcohol, all of a sudden they realize, “Wow, this makes me feel normal,” which is really a shame because their body’s out of balance and they need to have alcohol to bring them down to a point where they actually feel like they can communicate, they can be out in public, and things like that. So, it becomes very addictive. The same thing when somebody has depression and they drink, they withdraw even more a lot of times. And so these things become really, really bad for us, obviously. It’s never a good thing.

Dr. Weitz:                        So, how can viewers, listeners get ahold of you, find out more about what you have to offer?

Dr. Gruttadauria:            So, I mean, people can reach out to me on… They could see me on Instagram or on they my website, which is theoptimumu, the letter you, .com. And that’s probably always the best way to find me. And I would love to be able to continue this conversation at some point because there’s so many new things going on all the time in the mental health field. And I think that we as functional medicine docs are really at the forefront of the charge because we’re seeing it from a totally different perspective. And people are more aware these days. They don’t want to just take more and more medications. They don’t want to be on three different drugs at a time. They don’t want to be on that merry go round of, “This didn’t work, I feel like a Guinea pig. It’s just trial and error. Let me try to find the root cause of why I feel the way I feel.” So, I really am… I feel very fortunate that you asked me to be on your podcast and I want to really thank you so much.

Dr. Weitz:                        Absolutely. And one of the great things about the functional medicine approach, not only is there mood disorders likely to improve, but their overall health as well.

Dr. Gruttadauria:            100%.

Dr. Weitz:                        Okay. Thank you, Michael.

Dr. Gruttadauria:            Thank you very much. I appreciate it, Ben.



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 rating and review. That way, more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts. And I want it 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.