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Dr. Jack Wolfson discusses his Paleolithic approach to Cardiology 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

2:13  Conventional cardiology tells us that consuming saturated fats, such as found in red meat and butter, raises LDL cholesterol levels, which leads to cholesterol plaques forming in our arteries, which leads to heart attacks and strokes.  Dr. Wolfson believes that this view is completely wrong, since it is based on flawed studies that supposedly show that cardiovascular disease is caused by saturated that it can be cured with pills and procedures.

4:09  Advanced lab testing.  To diagnose cardiovascular disease, there are better tests than just the standard lipid profile.  Dr. Wolfson believes that HsCRP (High sensitivity C-Reactive Protein) is the most important marker to assess overall health, since it is the best marker for inflammation. But if it is elevated, you have to ask why are you inflamed and what can you do about it?  The reason that the body lays down cholesterol in the arteries as plaque is to protect the artery walls against inflammation, like putting spackle on the wall to make the wall smooth if there is a hole or irregularity. If we correct the reason for the inflammation, that is how we will end heart disease.

8:27  Dr. Wolfson does not recommend the coronary artery calcium scan, because he does not like exposure to radiation. He does like to look at advanced lipid analysis, lipoprotein (a), homocysteine, and uric acid. He also likes to test for intracellular vitamins and minerals and omega-3s, including intracellular vitamin K2.

10:02  Dr. Wolfson currently prefers using Vibrant America lab and some of the panels that he likes include the Leaky Gut Panel, which includes looking for gluten sensitivity, that includes the anti-actin antibody, which just shows that your immune system is attacking the actin protein found in all muscular tissue, and all cells that divide contain actin protein, including the smooth muscle of the arteries.  Dr. Wolfson also likes running the toxic testing (Total Tox Burden) that includes heavy metals, environmental toxins like pesticides, phalates, parabens, VOCs, and plastics, and mold mycotoxins.

Dr. Jack Wolfson is a board-certified cardiologist who’s office is Natural Heart Doctor in Scottsdale, Arizona.  Dr. Wolfson uses nutrition, lifestyle, and nutritional supplements, as well as his Cardiology Coffee, to prevent and treat heart disease. He has taught more than 10,000 physicians his natural heart health best practices and his book, The Paleo Cardiologist: The Natural Way to Heart Health, was an Amazon #1 best seller. His website is DrJackWolfson.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.

                                                Welcome Rational Wellness Podcasters. Our topic for today is Paleo Cardiology with Dr. Jack Wolfson. Dr. Wolfson is a board certified cardiologist whose office is Natural Heart Doctor in Scottsdale, Arizona. Dr. Wolfson uses nutrition, lifestyle, and nutritional supplements, as well as his cardiology coffee, to prevent and treat heart disease. He’s taught more than 10,000 physicians his natural heart health best practices, and his book, The Paleo Cardiologist: The Natural Way to Heart Health, was an Amazon number one bestseller. This book does contain a warning that the opinions in this book are not in agreement with the American College of Cardiology, the American Heart Association, or any other organization with financial ties to big pharma and corporate America. Dr. Wolfson, thank you so much for joining us.

Dr. Wolfson:                       Thank you so much, Dr. Ben, absolute pleasure. And I love the, I haven’t heard about the warning label in a while, so yeah, it’s totally true, because anything I’m going to say, it’s totally against the American College of Cardiology and the American Heart Association. I’m sure you feel this way at times too, Dr. Ben, that it seems like we’re always in opposition to what the mainstream is doing, and after a while it just becomes very cumbersome on all of us who are doing that, where it just seems like you’re fighting against everything that’s coming at you. But that’s the world that we live in, and again, it’s a pleasure to be on your program to share my truth.

Dr. Weitz:                            Good, good. So let’s start with what conventional cardiology tells us. So the conventional wisdom in cardiology today when it comes to coronary artery disease is that consuming saturated fats, such as found in red meat and butter, raises LDL cholesterol levels, which leads to cholesterol plaques forming in our arteries, which leads to heart attacks and strokes.

Dr. Wolfson:                       Yeah, that is the company line as established by big food and big pharma and big government, and nothing can be further from the truth. When it comes to all the different cardiology things, the conventional cardiologist, everything that they reach for is a pill or a procedure. It’s just the way that it is, it’s just the way that they’re trained. It’s not that they’re unintelligent people, they’re very intelligent people, but they think pharma and surgeries first, second, and third. And it’s kind of like, listen, if I went to France, and I’m trying to get around town and everybody speaks French, I’m going to look like an idiot, and people are going to say, “This guy’s an idiot.” But I’m not an idiot, I just never learned French.   The medical doctors, whether they’re at Harvard, Yale, Mayo Clinic, Cleveland Clinic, they only know what they’ve been trained, and they’ve been trained on pills and procedures. They’re briefly, not even trained on nutrition, it’s just, saturated fat’s bad. Okay, well, if American Heart Association said sat fat’s bad, it’s bad. Or flawed studies say that it’s bad, okay, then it’s bad. But really, I think when we look at health and wellness through the lens of common sense, it becomes crystal clear on the way to avoid cardiovascular disease and it’s not with pills.

Dr. Weitz:                            Okay, so let’s start off with looking into diagnosing cardiovascular disease, and maybe we can start by explaining, what is LDL? What are the best ways to test for heart disease? What test markers do we want to look at that give us the best risk?

Dr. Wolfson:                       Yeah, well I think that most people talk about cholesterol, and we’ll talk about that in a second, but to me the most important marker, if you can get one marker that would assess your overall health and wellness, it is the inflammation marker high sensitivity CRP. If you are inflamed you’re going to have a problem, and you better figure out why. The answer, of course, is not anti-inflammatories, and the answer, of course, is not aspirin or statin drugs, or any kind of procedure, it’s a matter of cause, why are you inflamed?   When I first met my wife, who is a doctor of chiropractic, and she opened up my eyes to all things health and wellness, she said, “Jack, you need to become a DC.” And I said, “Wait a second, I just spent 10 years becoming a cardiologist, and now you want me to become a DC doctor of chiropractic?” She said, “No, not DC doctor of Chiropractic, DC Doctor of Cause. You have to find out why people are sick.” So when we see inflammation, which is the most important marker, now we need to figure out why people are inflamed. As it relates to lipids, lipids are just trying-

Dr. Weitz:                           And I think there was a study not long ago stating exactly that, that CRP was a better measure than LDL for heart disease risk.

Dr. Wolfson:                       Oh no, and really, not only for heart disease risk, but for anything, whether it’s dementia, stroke, even cancer risk, when you have a lot of inflammation. So it’s a very important marker to have.

Dr. Weitz:                           By the way, what do you consider high HSCRP? Is it over one? Is it?

Dr. Wolfson:                       Yeah, I mean, certainly the higher the number is the higher the risk, and there is some linear nature to that. But normal should be less than one, and depending on the testing company and the different parameters that are used, there’s multiple different markers of inflammation and oxidative stress, again, that I think are infinitely more important than these lipid markers that we’re all trained to assess, because once we look at those lipids, then now it’s an easy sell regarding pharmaceuticals to lower the numbers down.  Chapter one in my book, The Paleo Cardiologist: The Natural Way to Heart Health, it’s about nutrition, it’s about lifestyle and everything else, but chapter one was all about cholesterol, and I talk about why cholesterol is so important. When people say LDL cholesterol, it’s not even a thing. LDL is a particle that carries many passengers, one of which is cholesterol that’s on there, there’s a lot of other things. So LDLs have a role, HDLs have a role, and a lot of their role is actually in the management of inflammation and oxidative stress. So when lipids are considered to be abnormal, we have to think about, well, why are they abnormal? It’s not because of a statin drug deficiency, it’s not because of any other pharmaceutical deficiency. If inflammation is there, if lipids are abnormal, we got to break down the why, and when you fix the why, that is how we end the number one killer in the world.

Dr. Weitz:                            So essentially what you’re saying, I think, is that the reason why the body is laying down cholesterol in those artery walls is to protect the arteries against inflammation or oxidation?

Dr. Wolfson:                       Yes, most certainly. So it’s like that, if you knock a hole in the wall and you put the spackle on there, someone else would come in who doesn’t know any better and think the spackle is damaging the wall. Well, the spackle is not damaging the wall, the spackle is there to protect the wall. The body’s not making mistakes, the body is doing things for a reason. And again, coronary artery disease is happening for a reason, and when you remove those reasons, now you’re not going to get coronary artery blockages, and certainly you’re not going to get erosion instability, plaque rupture, that will lead someone to suffer a cardiac event or dying.

Dr. Weitz:                            Are there other markers that you like to look at to assess cardiovascular risk? I’m thinking of lipoprotein (a), homocysteine, LDL particle size, number, things like that?

Dr. Wolfson:                       I think all of those are fantastic measurements, and I guess I’ll use this opportunity to say unlike many other even holistic doctors, I do not recommend doing coronary artery calcification scans. I’m anti-radiation, so I never used that test, I’ve never ordered that test. And I think what the markers do, when you talk about, like you just said, markers of inflammation, advanced lipid analysis, including lipoprotein (a) as you mentioned, homocysteine, uric acid as markers. We look at other things, I love testing for intracellular vitamins and minerals and nutrients and omega-3s, intracellular vitamin K2 I think is a wonderful, wonderful assessment, if we’re driving K2 intracellular, now we’re going to get it into the vessels and actually lead to plaque reversal with that kind of methodology.  So I think that we have enough markers we can use and test before and afterwards, and then by using those markers, that’s what we need, we don’t need coronary artery scans to tell us we’ve got coronary artery calcification. So I think you named some really good ones that we would use to follow to make sure that we’re on track.

Dr. Weitz:                           What is currently your favorite lab that you like to use?

Dr. Wolfson:                       I use most of my stuff from Vibrant, Vibrant America, Vibrant wellness. I love their panels, not only for intracellular nutrients, as we mentioned, which I think is critical, and a lot of people are taking vitamins and minerals, and they’re eating these foods and doing these various things. Well, that’s where, our methodology at Natural Heart Doctor is eat well, live well, think well, and then test don’t guess. And when you do the testing process, now you see where things are at.  But I also love the Leaky Gut Panel looking for gluten sensitivity, but also the components of leaky gut, which is a very interesting eye opening epiphany moment for me when my wife mentioned leaky gut and I laughed and I’m like, “Where’d you get this bogus diagnosis from?” And she said, “Well, why don’t you go learn about it, smart guy.” I went to go read about it, there’s not much in the literature. Over the last 15 years you and I both know the literature has exploded on the concept of leaky gut, and then now we’ve got the ability to test for it.

                                                So I love testing for it, it’s very cool and one of my favorite tests. Dr. Ben, inside of that analysis is the anti-actin antibody, which just shows that your immune system is attacking the actin protein found in all muscular tissue, and all cells that divide contain actin protein. So if your immune system is attacking the actin protein found in the muscle of your gut, propelling foods from your mouth to your rear, and your skeletal muscles, your biceps and triceps and quads and glutes, and it’s also found in the heart muscle, and it’s found in the smooth muscle of the arteries themselves. So if your immune system is attacking the muscular tissue, we’ve got a serious problem. And there is literature in this “science,” in that science has become a weird part of our lexicon these days because I believe that science has been totally co-opted by big pharma, et cetera.

                                                So in any case, I also love doing the toxin testing. So we look for toxic metals, we look for environmental toxins, like pesticides and phalates and parabens and VOCs and plastics. But the number one thing I think people need to look for from a toxicity standpoint is mold, and mold mycotoxins. I believe that mold is a, it’s been a scourge to mankind, as is written in the Bible in the book of Leviticus in the Old Testament, it is a 21st century crisis, to mold from water damaged buildings, what it does to the human is something that we need to bring out to the public much more so.

Dr. Weitz:                            I’m assuming you put patients on detox protocols if you find mold or other environmental toxins?

Dr. Wolfson:                       Well, the first thing is to work on getting out of the mold, or remediating the mold, depending on how sick someone is. So mold can cause any symptom and any disease, and I can make the case for it very easily from the literature.

Dr. Weitz:                            Sure.

Dr. Wolfson:                       So depending on how sick someone is, or how inspired someone is to get out of the mold situation, that’s going to be critical. But there are ways, certainly air purifiers, and things like that, that can help mitigate, and there are detox strategies, including binding strategies to bind up the mold mycotoxins so you excrete them more safely and effectively. And a lot of that literature really comes from the animal industry, where animals, your stereotypical grain-fed, corn-fed, soy-fed Nebraska cow is fed contaminated grains, contaminated with mold, and then they’re not going to all of a sudden turn them on grass, turn them on pasture and do the right thing, they’re going to try and bind up those toxins, and that’s where data on bentonite clay activated charcoal comes in, from the mold mycotoxin category.

                                                But it’s something where, again, where tests don’t guess. Don’t tell me you’re not living in mold, you got to prove it. If you want to be healthy, you got to prove it. And it’s one of those things where we talked about causation, why people have inflammation. If you are living in mold, then you are likely to show that in an inflammatory mechanism. And ultimately, again, test yourself and your urine from mold mycotoxins, there are home test kits that you can buy that can actually help you test your home, and it’s very unfortunate. I know you know this, it’s very easy to tell someone, “Hey, eat this food, get more sleep, get more physically active, do breath work, do meditation, get chiropractic care.” That’s all super simple, but wrapping your head around the toxicity of mold and doing something about it is extraordinarily difficult, but there’s really nothing more important.

Dr. Weitz:                            So you don’t like the coronary calcium scans, are there any other cardiology testing that you are a fan of?

Dr. Wolfson:                       Well, I’m definitely anti-radiation, so I do not like coronary artery calcium scans, I do not like CT angiograms, I do not like nuclear stress tests.

Dr. Weitz:                            Okay.

Dr. Wolfson:                       They are pure money makers, the whole business of CT, and coronary artery calcification scan is just to get people in the door. Insurance companies do not approve that scan, so therefore hospitals offer it for a cash price, and a very discounted cash price because it’s a loss leader. They may even give away the scan for free and say they’re doing you a benefit. But what happens is, is that now they get into the sausage mill, if you will. All of us, all people are considered meat, and the hospital medical system is the sausage factory. So what happens is that they identify coronary artery calcification, and that would lead to a stress test, often a nuclear stress test, which now will get insurance reimbursements.

                                                And now they have, it’s a case of a little bit of abnormalities, well now the stress test is a little bit abnormal, now we need to do an angiogram. Oh, the angiogram showed blockage, and now we got to do a stent or bypass surgery, and people go through that, even though they had no symptoms. And it was all a money play, and the patients are the victim because that whole process did nothing to prevent heart attacks, did nothing to save people’s lives, it’s just-

Dr. Weitz:                            Now the conventional thought is they had this blockage, it was discovered by the testing, now they remove the blockage so therefore the blood can flow freely and they’re not going to end up having a complete blockage,

Dr. Wolfson:                       Zero data that that is beneficial. And in fact, when you take the person who is either asymptomatic, or who has stable coronary artery disease, and you intervene on them, you actually increase the risk that they’re going to have a heart attack because you’ve taken a stable situation, angioplasty stent, you blew up a balloon, you’ve made the situation unstable, and now they’re on a bunch of pharmaceuticals that they weren’t on before. Unfortunately it’s just counterintuitive because you would think, well, wait a second, if I have a 30, 50, 70 or 90% blockage and you fix it, or you bypass it, I therefore am better. The reality is that you’re not, and ultimately you’ve never done anything to address the cause, and therein lies multiple, multiple problems. But again, that’s in the main literature, but it’s just standard of care often in cardiology, up to this point, is all about, hey, let’s do as much as we can, insurance will pay for it, and it’s a money driven business, and I was part of it for 16 years, so I think I know.

Dr. Weitz:                            So what exactly happens when a stent is placed in?

Dr. Wolfson:                       So stents and bypass surgery are for symptoms. If you are having symptoms, whether urgently, like I just woke up this morning and I’m having chest discomfort because I’m having a heart attack and therefore I need a stent, or every time I walk up three flights of stairs, by the third flight I got a pressure in my chest, or I feel short of breath, or my left arm hurts. Stents and procedures like that are for symptoms, they don’t prevent heart attacks and they don’t save lives. And that is part of studies we’ve known since the late 1990s, to 2007, and then most recently in 2020, the data is there in mainstream journals, but this is the way cardiologists and hospitals make money, so it’s still incentivized, it’s still being done. But as long as people understand stents are for symptoms, if you don’t have any symptoms, you 99.99% do not need any kind of intervention.   The rare situation would be somebody maybe with left main coronary artery disease that is spuriously diagnosed. It’s not common, it’s not common, and it’s not something that even is routinely picked up on CT scans. So my advice to people is eat well, live well, think well. Part of living well is avoiding electromagnetic fields and manmade radiation exposure. Radiation causes heart disease, cancer, and dementia, so even though it will be sold to us as a small amount of radiation, hey, no, radiation at that level is good, let’s avoid it.

Dr. Weitz:                            Okay, let’s talk about diet. What’s the best diet to prevent heart disease? I know from reading your book that you’re a big fan of the paleo diet, why the paleo diet? Other people propose different diets, the vegetarian diet. Some people feel that each person maybe needs a different diet.

Dr. Wolfson:                       Yeah, and I don’t think I’ll be able to solve the riddle for all your listeners, and stuff like that, because I know you get a whole smattering of people on here. I will say this, hopefully everyone in the health space can agree to eat organic food. To eat organic food, and as much unprocessed food as possible, everybody would be in that same space. Now some people would pay lip service to it, they’ll say it but they don’t do it. So Dr. Jack Wolfson, when you mentioned my cardiology coffee, or whatever, we only eat organic. We only eat food, and it doesn’t have to be certified organic, if we know the farmers and they’re not spraying, or we grow, I mean, my own food that we grow in our backyard is not certified organic. I know it’s organic, I know how we grew it, I knew the seeds where it came from, and how we watered it and fertilized it, and all that stuff.

                                                So hopefully we can all agree just to get the chemicals out of our food, and that will be monumental for so many people. After that, listen, I’m a huge proponent of eating wild seafood. People, the literature is very clear, the people with the highest levels of omega-3 as measured, DHA, EPA, they live the longest, they live the best, they have the least risk of everything. You can only get EPA and DHA from eating seafood, so that’s why we need to eat the seafood. We recommend nose to tail, grass-fed, grass-finished, animals, pasture raised animals, including the organs, liver, heart, et cetera. And then I also am an anti-gluten person, so I don’t really ascribe to eating gluten containing grains.

Dr. Weitz:                           Just did a podcast a couple of weeks ago with Jeffrey Smith and we focused on genetically modified foods and glyphosate.

Dr. Wolfson:                       Yeah, and it’s one of the beauties too of doing the Vibrant testing is you see people’s glyphosate levels, and understanding that glyphosate, just as most of these environmental toxins were not present on planet earth up until the 20th century, the human body was never exposed to these. And what’s funny about the lab testing companies, and I know, Dr. Ben, you check this as well, where the lab testing companies have an in range in the green, oh, you’re in the green zone for glyphosate. The normal level of glyphosate is 0.00, it’s a manmade poison.

Dr. Weitz:                           Right.

Dr. Wolfson:                       But to that end, we don’t need to eat the grain. Oatmeal, to me, is pure propaganda, and when I say that I get such blow back from so many people who love their oatmeal, and it’s their source of fiber, and they put their raisins in there and their walnuts in there and they had some raw honey to it, and they add some other fruits to it, and all the things you do to break it up.

Dr. Weitz:                           Well, they gave up their Kellogg’s Frosted Flakes.

Dr. Wolfson:                       I tell people that, and people are talking about the fiber, and I say, “If you want the fiber from oatmeal, just eat the box and you’ll get plenty of fiber, just eat the container that it came in.” To me, it’s all garbage.

Dr. Weitz:                           But you need this special soluble fiber that’s going to bind to the cholesterol and remove it.

Dr. Wolfson:                       Well, again, our body wants to reabsorb cholesterol because it is a vital thing that the body goes through a lot of trouble to make, and that’s why it wants to reabsorb it. So as far as fiber and all these, at the end of the day I guess I would say common sense approach tells me we are hunter-gatherers. We know that from the paleontology anthropology literature, we know it through three plus million years of human evolutionary biology, it’s just what we did. If you watch TV shows Alone, Naked and Afraid, Survivor, they are hunter-gatherers, hunter first, they’re hunter-gatherers, and if they don’t, they quickly tap off and they go off the show.  So my buddy Joel Khan, who’s a vegan cardiologist, if he tried to live in Paleo world, he dies. He doesn’t live, because there is no oatmeal for him, there are no bags of walnuts for him. There are no, again, bags of seeds, and all these things. And fruit is not always in season, so he doesn’t always have access to berries and whatnot. So those people, they quickly either change to hunter-gatherers, who are vegan who go on the show, or they quit the show. And it is a perfect example of why I recommend the foods that we eat and the lifestyle that we lead.

                                                But again, I’m not going to pretend to solve all these arguments on here, just go organic. But I think also that stems into our philosophy at Natural Heart Doctor, which is eat well, live well, think well, and all of them are just as important. So the live well component, we’re talking about sunshine, we’re talking about sleep, we’re talking about movement and physical activity, chiropractic care, holistic dentistry, avoiding the environmental toxins and pollutants that we just discussed. That’s just as important as the food story, and the think well is just as important as the live well and the eat well part of the story as well.

                                                Whenever I talk to people who have had heart attacks and I get the history, what happened before the heart attack, every single time stress was involved, every single time. And there’s nothing we can do about the past, and it’s not about trying to reexamine, but it’s about showing people, if you are under stress, if you are unhappy and living in fear, and have anxiety and anger and depression, if your relationships are lousy, if you don’t have a good community and you feel socially isolated, you’re in trouble. You’re in trouble not only from cardiovascular disease, but also from cancer. So we need to really get people to follow all these things of eat well, live well, think well, and we need to move on from the eat well debate, I think, and into these other categories if we’re really going to make a difference.

Dr. Weitz:                            As far as treatments go, I know you’re not a big fan of statins. Are there any of the conventional cardiology medications that you do use? I’ve talked to some integrative cardiologists who say they rarely use statin, or they use a very low dose and they add Zetia, or they try to use bempedoic acid and Zetia as an alternative to statins.

Dr. Wolfson:                       Yeah, I’m pretty anti-pharmaceutical except for emergency situations.

Dr. Weitz:                            Okay.

Dr. Wolfson:                       I learn a lot of this stuff from my wife, who is a doctor of chiropractic, and other people in chiropractic, and this goes along with a lot of this chiropractic philosophy, give the body what it needs, take away what it doesn’t. The body is not deficient in Zetia or statin drugs, and the body’s not deficient in aspirin. We are built perfectly, and this is another thing that I really love to discuss, is about genes, where the doctors say, “Well, it’s all in your genetics.” You know what, Dr. Ben? Our genetics are perfect. Our genetics are perfect.

Dr. Weitz:                            Well, we do have different genetics, right?

Dr. Wolfson:                       We have different genetics, but manmade poisons are what trigger our genes to do things we may describe as dysfunctional or being abnormal. So our genetics are perfect, but when you lay manmade toxins in certain families, that may mean an increased risk of breast cancer or colon cancer. Other families may have a higher risk of Parkinson’s, others may have a higher risk of cardiovascular disease or atrial fibrillation. But we can’t blame the genes, we have to blame it on the manmade poisons and toxins. But ultimately there are-

Dr. Weitz:                            Well, what about the patients that come in with these sky-high lipids and they’re typically diagnosed as having familial hypercholesterolemia?

Dr. Wolfson:                       So people with the familial hyperlipidemias, yes. And again, I don’t believe that those people are genetically designed to have heart attacks. I don’t think that’s the way that we’re built as humans, other things have to come into that model. And even though we may not be able to fix their lipids, which is often not the goal, the lipids are not the problem, the problem would be if you set up the situation where there is endothelial dysfunction, and now the lipids are called into the area to repair. Or you have a lot of oxidative stress which leads to oxidized lipids. The lipids are antioxidants. So why do we have oxidized LDLs? It’s because they are trying to limit the amount of oxidative stress.

                                                And now that we have these oxidized particles, well, that’s where the immune system comes in to try and deal with those, and that’s where they start to get incorporated into monocytes become macrophages and foam cells, and then those cells die, and then plaque rupture, and the whole process. But pharmaceuticals are not going to be the answer, and even the pharmaceutical data on that population is very, very weak. A lot of people ask about Repatha and the PCSK9 inhibitors, these injectables. The data on Repatha released in 2017 lowered numbers down tremendously, lowered it down to LDLs of 30, and you know what? More people died in the Repatha Group, 18 more people died in the Repatha group than the group that didn’t get Repatha. And there are plenty of people with these LDLs of 35 where they’re driving them down to non-sustainable for life levels, and people are still having heart attacks and dying. We are not [inaudible 00:31:12].

Dr. Weitz:                            I heard a very popular podcaster, I won’t name his name, but he basically said we can eliminate heart disease completely, we just got to get AOB below 40, or LDL below 30, or something. We just use whatever we need to use, use the PCSK9 inhibitors. If we just did that with everybody starting at an early age, there would be no more heart disease.

Dr. Wolfson:                       So what I would say to that is that first of all that is factually untrue in the sense that we have the data that shows when you drive LDL down to 30, many people still have heart attacks. And in fact, in that study, 3.5% of the population who had those low levels, they had heart attacks within two years. Now that’s probably better than where it used to be, but it’s still, it’s not root cause medicine. You know, Dr. Ben, I got the best solution where we can prevent heart attacks in everyone. I swear, Dr. Ben, this is the solution of how we prevent heart attacks in everyone.

Dr. Weitz:                            We closed McDonald’s. No.

Dr. Wolfson:                       Let’s remove everyone’s hearts and give everybody artificial heart. Let’s do it, guaranteed, guaranteed no one will ever have a heart attack again if everybody gets an artificial heart. When you say something so stupid, or you say something so stupid that we have to use massive amounts of pharmaceuticals to drive down the numbers, and oh, by the way, more people died in the aggressive group. When you show the data from SPARCL, high dose Lipitor study, more people died in the statin group versus placebo. When you show the original data app caps, text caps, the original statin trial where more people died in the statin group. When you show the ALLHAT data, ALLHAT LLC, where people over 65 who were randomized to statin versus placebo, 18% more people died in the statin group, if you were older than 75, 34% more people died. So what if, yes, we are reducing the risk of dying of heart disease, as you would in someone with an artificial heart, but you’re increasing the risk of death from everything else.

Dr. Weitz:                            Right.

Dr. Wolfson:                       And it’s likely going to be cancer, it’s likely going to be dementia. But fundamentally, and let’s go conspiracy here, the studies are ran and owned by pharmaceutical companies. Can you even believe them? Do you want to believe the science? Lipitor is the number one selling drug of all time, and the actual evidence-based benefits of Lipitor is this, it’s minuscule, it’s a joke, and hundreds of billions of dollars have been spent on that. And ultimately, I think, again, you give the body what it needs, take away what it doesn’t, eat well, live well, think well, test don’t guess, evidence-based supplements when needed, biohacking strategies, that’s the only way we’re going to win the game, we’re not going to win it with big pharma, you’re never going to be better than nature, you’re not, you’re not going to. And when we push people into the drug world without telling them the truth we’re doing them a disservice, because if they’re not sick from heart disease, they’re going to be sick from something else.

Dr. Weitz:                            What’s your approach to treating hypertension?

Dr. Wolfson:                       It’s just root cause medicine, and pharmaceuticals are really good at lowering numbers down. We can lower numbers down with lipids, very little benefit and outcomes, if any. In some cases, like I said, actually increase mortality. Same thing with blood pressure drugs, they can lower numbers down, but because they don’t address the root cause, there is very little benefit. You don’t get any awards, patients don’t get awards for having low blood pressure on pharmaceuticals. We want to know, does the pharmaceutical lower my risk of heart attack, stroke, and dying? And the answer is, in some studies, yes, by tiny amounts. But because, take three people, one person with high blood pressure, one person with normal blood pressure on pharma, and another person with normal blood pressure, they’re not the same. The person with normal blood pressure naturally is at much, much lower risk. So we go after it the same way, eat well, live well, think well, test don’t guess, evidence-based supplements, biohacking strategies.

                                                Chiropractic care in studies is proven to lower blood pressure by 17 over 10. That’s as good, or better, than any pharmaceutical ever invented for blood pressure control. Everybody with blood pressure has to be under chiropractic care. Everybody who has abnormal lipids, the problem with lipids oftentimes is not that we’re making too much, it’s that we don’t clear the lipids, and it’s a liver issue. So we need to decongest the liver. Does the chiropractic adjustment that influences the autonomic nervous system that controls hepatic function, if we adjust people, can we improve their lipids? Yes, we can. So ultimately, when it comes to high blood pressure, there are many holistic strategies. I’m not saying people never need pharmaceuticals for blood pressure, but it should be for emergencies, and it should be at the end of the game.

Dr. Weitz:                            What are the best natural supplements you find for helping with blood pressure?

Dr. Wolfson:                       Really, strategies to increase nitric oxide are always good. So we have a product called Heartbeat, which is our organic beetroot powder. Amino acids, L-arginine, citrulline, taurine, increased nitric oxide by plugging into nitric oxide synthase. Lot of conversation about magnesium, totally true. Potassium is another fantastic supplement for blood pressure as well. Lots of good literature on potassium supplementation. We need to be careful in people with kidney disease, mostly people with kidney failure and people who are on ACE inhibitors, angiotensin receptor blockers, that may be more prone to retaining potassium, but that’s just something simple to test on people to make sure we’re in the right direction.

                                                I love intracellular potassium testing, doesn’t matter what’s in the blood. Potassium exists inside the cells, you got to test intracellular, and that’s how you get your information there. CoQ10 has data on blood pressure reduction, there’s a lot of herbal remedies. Hawthorn or Arjuna, Rauvolfia serpentina is often found in a lot of these plant-based strategies, and then actually of course it became one of the first pharmaceuticals, which was Reserpine, which was a 1950s, 60s, 70s pharmaceutical. And because of its side effects, fortunately it’s out of the game, but you can find that in herbal processes as well. Garlic is a fantastic product. Big fan of a supplement called Arterosil as well.

Dr. Weitz:                           That brings up the endothelium. In terms of testing, have you gotten into any of the testing for the endothelial function?

Dr. Wolfson:                       Well, our mutual friend, Dr. Mark Houston, he’s a fan of the EndoPAT, and EndoPAT for vascular reactivity, it’s a great device, but it’s not practical. It’s a $30,000 device, you’re not going to find too many clinics offering that. So what I actually like are the nitric oxide test strips from Berkeley, check people’s salivary nitric oxide levels, get a very good determination from that to make sure that they’re on course with that.

Dr. Weitz:                           I just saw this new device, I think the guy who developed arterial cell, I think he left the company and now developed a different product, and if you go to that website, I can’t think of what it’s called, he’s got some new device for measuring the endothelium that you just put in the mouth. It looks pretty cool.

Dr. Wolfson:                       Yeah, the company and the product I think is called Endocalyx. I think that’s what the supplement’s called.

Dr. Weitz:                           I think that’s it.

Dr. Wolfson:                       And then as far as, yeah, what that device is where you actually can look at that, but I’m not overly familiar with it. I guess I would say I’m a little bit confused as to how it would necessarily work to visualize the glycocalyx because it is a electron microscope level of attention of details, I’m not sure how something put into the mouth would be able to assess that. But listen, any kind of diagnostic tech that is non-radiation based, I’m fine. If you want to have carotid intima media thickness by ultrasound, fantastic. You want have an echocardiogram, great. You want to do a routine treadmill stress test with just you versus the treadmill, great. You want to do heart monitors, such as the Zio patch and others, you want do a WatchPAT for sleep apnea, these things are all great, just get the radiation out of the equation.

Dr. Weitz:                            Right. For patients who do have established plaque in their arteries, do you have some recommendations for plaque reversal? And I’m thinking especially in terms of supplements.

Dr. Wolfson:                       Yeah, first of all, again, I just want to reiterate this for the 20th time, that it’s based on eat well, live well, sleep well, and also I think inside the eat well component is intermittent fasting. And not intermittent fasting like most people would say, well, I eat in a certain window. Well that’s time restricted feeding. Intermittent fasting to me would be more of this longer duration, 24, 36, 72 hour fast. And when do a 72-hour fast, your body is looking for food, and it’s not coming in through your mouth, so your body starts to break down components that it does not think are necessary. Well, obviously fat cells are the first things to start releasing their contents, triglycerides, to be utilized as fuel.

                                                But I think that what happens is, is that the body senses that coronary artery disease is just useless scar tissue, so why not start to mobilize some of that protein structure of what the coronary artery plaque is and use some of the proteins, use some of the fats, use some of those materials as energy. And I can’t say I’ve got a lot of data to support it, I think it’s theoretical. I do have case studies though of people who, against my wishes, they did a repeat CT scan and were seeing coronary artery calcification reversal.

                                                I do want to say this though at this time, for everyone who’s listening right now, whatever your coronary artery calcification level is at this moment, you can live with that level for the next 175,000 years, maybe even longer. Our goal is to prevent the plaque that’s there ideally from getting worse, to become symptomatic, but we want to prevent plaque erosion and rupture. And how are we going to do that? Mainstream cardiology would say statin drugs, aspirin, other things that they’re inventing, a PCSK9 inhibitors, and others in the holistic space, we’re going to say we’re going to use the natural strategies to avoid the causes of plaque erosion and instability, and that’s going to be the ultimate strategy to prevent it.  And incidentally, statin drugs, in multiple studies, are shown to increase the rate of coronary artery calcification. So if you think you’re going to take a calcium scan, start a statin drug and then check it a year or two later, you are more likely to have more advanced disease. So if that’s your strategy then, again, you shouldn’t plan on anything different than what I just said.

Dr. Weitz:                            Okay. I know we were speaking off-air before we started, I know Dr. Sinatra was a big fan of higher dosages of vitamin K. I know Dr. Houston is also a fan of that, as well as other things, like you mentioned arterial cell, some other products that a lot of people would incorporate, attempt to try to reverse plaque.

Dr. Wolfson:                       Yeah, and one of my favorites is Berberine, B-E-R-B-E-R-I-N-E, wonderful plant-based supplement. It’s been studied in thousands of studies from multiple indications. I think a lot of times integrative cardiologists, so they consider themselves, they like metformin. I’m not a metformin guy, I think it causes vitamin and nutrient deficiency, and then there’s other things inside of that little metformin capsule that can be problematic, like berberine as a biohacking supplement strategy. And I think that ultimately there are certain supplements that can help our antioxidant system perform, and really not even supplements, minerals. So what about copper? What about copper, zinc, selenium? And making sure all those things are balanced very well.

                                                A lot of people are taking megadoses of zinc and therefore become copper deficient, and copper is a metal that is involved in the main antioxidant in the body, the enzyme superoxide dismutase. So if we don’t give people and make sure they’ve got adequate copper status, and again, they would be deficient for a whole variety of reasons, then they will have suboptimal function of that antioxidant enzyme SOD, superoxide dismutase, and that leads to issues. And let me say this, my favorite supplement, if you will, is just an organ complex. So people are eating bison heart, liver, kidney, inside of a capsule. They should be eating the food, a lot of people won’t eat the food, so go ahead and swallow one of those capsules. I mean, that is nature’s multivitamin, the animal liver is nature’s multivitamin to give to man.

Dr. Weitz:                            Cool. So I think I’m about done, that was a great discussion. How can listeners, viewers find out more about you, get ahold of you if they want to seek you out?

Dr. Wolfson:                       Well, thank you for having me on, mate, and I appreciate the very intellectual conversation and I respect your depth of knowledge on the subject, so congrats to you.

Dr. Weitz:                            Thank you.

Dr. Wolfson:                       For opening up your eyes to holistic health and wellness and interviewing me. If anybody wants a copy of my book they can get it for free, just pay the shipping, freeheartbook.com, freeheartbook.com. Great place to find me, I’m all over social media trying to get the message out there. We got a lot of battles against pharma, against big pharma, big food, big hospitals, big insurance, but I think that especially after a pandemic-

Dr. Weitz:                            Yeah, I’m sure you must be on some lists.

Dr. Wolfson:                       Especially after a pandemic I think people are waking up right now and just saying, hey, you know what? This whole medical paradigm, it ain’t working. It didn’t work for my parents, and it didn’t work for my grandparents, and it’s not working for me, and they’re looking for people like us to really guide them and support them. So again, I appreciate the opportunity to be on your show, and again, thank you so much, Dr. Ben.

Dr. Weitz:                            And then what’s your website?

Dr. Wolfson:                       Yeah, you can find me at Natural Heart Doctor. We do see patients in Scottsdale and virtually, my company is Natural Heart Doctor, and that’s another place, Natural Heart Doctor all spelled out. But if you want to find me, if you want holistic health, you’ll find me. I’m out there, I’m not hiding.

Dr. Weitz:                            Great. Thank you, Dr. Wolfson.

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 discover the Rational Wellness Podcast.  And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. If you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

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Dr. Terry Wahls discusses how to Reverse Multiple Sclerosis 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

2:00  Dr. Wahls was diagnosed with Multiple Sclerosis 23 years ago, so she went to the best MS center in the country and saw their best physician and took the recommended latest drugs. Three years later she was going downhill and she was in a tilt, recline wheelchair despite taking the newest, disease modifying drugs, including Tysabri and Novantrone.  For her, these drugs did not help. She continued to worsen, as did the electrical face pains that she had.  She decided to dive deep into the research on her condition and she concluded that the mitochondria are the drivers of disability and she created a supplement cocktail for her mitochondria.  She changed her diet from vegan to paleo to provide protein and additional nutrients. She also discovered a study using electrical stimulation of muscles and added that to her physical therapy.  She then discovered the Institute of Functional Medicine and took their course on neuroprotection and developed a longer list of supplements.  Her condition was improving but she was not where she wanted to be. She then had an aha moment and decided to redesign her paleo diet to be able to get all of these nutrients in the supplements from her food. She did more research and then figured out the Wahls Paleo diet by December. At that point, she was so weak that she could only sit up for about 10 minutes in a regular chair before she had to be either in bed or a zero gravity chair and she could only take a few steps with walking sticks.  Her electrical face pain was much worse and she was beginning to have trouble with brain fog.  She started eating this way on December 26th. By the end of January, her pain is less, her brain fog is less, and her fatigue is also less. By the end of February, her physical therapist noticed that she was getting stronger, so he advanced her exercise. By the end of March, she was walking with walking sticks. And by the end of April, she wanted to try riding her bike and she had an emergency family meeting with her wife Jackie and her two children.  Her 13 year old daughter and her 16 year old son jogged along side on either side of her bike and she rides around the block on her bike and they are all crying.  And then every day she rides her bike more and more.  And in October, Jackie signs her up for the Courage Ride, 18.5 miles, which she completed.  This fundamentally changes how Dr. Wahls thinks about disease and health and it changes the way she practices medicine and it will change the focus of her clinical research.  She has now we’ve conducted seven clinical trials and she is now conducting her eighth clinical trial on multiple sclerosis. We’ve published over 70 peer reviewed posters, abstracts, scientific papers and nearly 30 of them in multiple sclerosis. And she has really made it her mission to let people know there is so much that we can do that can change the course of this disease. 6:50  Dr. Wahls was able to regain her health using a Functional Medicine approach focused on diet, lifestyle, and physical therapy.  Dr. Wahls noted that she is an academic doctor who believes in the best and newest drugs, technology, and devices. And she treated her disease very aggressively because she did not want to become a burden, but she continued to go downhill. When she read the package insert in the drugs she was taking, it said that she had a 2% risk of getting leukemia each time she took the drug.  She took Tysabri and it did not help, but her program of diet, targeted supplements, and electrical stimulation of muscles enabled her to achieve a remarkable level of function.  With the guidance of her neurologist, she was weaned off the drugs and has been off these disease modifying drugs since the spring of 2008.  She has continued to get stronger and she now jogs on her treadmill for 20 minutes a couple of times per week.

8:48  The mitochondria. Dr. Wahls explained that most of her colleagues in the MS world focus on the immune function and the relapses and exacerbations. But the slow, relentless loss of brain volume and loss of spinal cord volume is what drives neurodegeneration. Her interpretation of the basic science literature is that the driver of that disability is probably mitochondria.  The mitochondria are not generating enough ATP for the robust energy needs of the axons, of the myelin of the neurons. And that’s driving cognitive decline for dementia, for Alzheimer’s, in Parkinson’s.  She figured out that her mitochondrial supplements were making her feel better and when she didn’t take her supplements, she couldn’t get out of bed and go to work.  While they were helping her a lot, they weren’t getting her out of her wheelchair.  The magic really happened when she  redesigned her food around her supplements.

15:05  The most important nutrients. Low vitamin D is associated with more relapses and disability and worse quality of life.  Dr. Wahls recommends an ideal vitamin D levels of 60-80 ng/mL.  Omega 3 fatty acids important and low omega-3 fatty acids are associated with more relapses and more disease progression.  We do also need omega 6 fatty acids and arachidonic acid, but most of us do not get enough omega 3. We should have an omega 6:3 ratio of 4:1 and 3:1 is also good, but 2:1 may be too low.  But most Americans are at 20:1 or 30:1 or even 45:1. That level is very inflammatory.  We would like to see homocysteine levels between 4 and 7.5 and most people are much higher than that.  This is lowered by taking the right forms of B vitamins. With homocysteine above 10 there are higher rates of neurodegeneration as well as higher rates of heart disease.  We want to get plenty of carotenoids, including zeaxanthin, meso-zeaxanthin, and lutein that are present in green leafy and colored veggies.  There are many beneficial compounds in mushrooms that help to lower rates of anxiety, depression, and cognitive decline.  Both greens and beets can raise nitric oxide levels, which is really good both for blood vessel health, for cardiac health, and also for neurologic health.  Fermented vegetables like Kimchi and sauerkraut are also beneficial.  She also recommends nut milk and coconut milk kefirs.

20:45  Dr. Wahls prefers the paleo diet for neurodegenerative conditions.  She explained that while there are many diets out there: vegan, vegetarian, keto, paleo, fasting mimicking diet, fasting strategies and there are a variety of clinical trials testing these diets, a consistent finding is when you put people on a intervention diet compared to the usual diet, the dietary intervention always improves.  One of the reasons for that is when you have less sugar and less added processed foods, the quality of the diet improves. Dr. Wahls was a vegetarian following a low fat diet for about 20 years prior to her MS diagnosis and for her this was not the right diet. She had her remarkable health transformation following the change to the paleo diet and she has been using the paleo diet in her clinical trials and has been achieving remarkable success.  To follow the paleo diet means to try to emulate what our ancestors might have eaten in the region of the world where we live, which means to eat meat, poultry, fish, nuts, seeds, greens, tubers, berries and fruits.  It also means not to eat sugar, grains, legumes, and dairy because those foods were foods that humans added eight to 10,000 years ago.  While we do not have enough research to prove what the best diet is for humans or for each person, Dr. Wahls recommends to patients to pick a diet that speaks to your heart and give it at least three months.  If Dr. Wahls puts a patient on a paleo diet and their cholesterol goes too high, she may make it a lower fat version or she may put them on a Mediterranean diet.  If they are developing insulin resistance, then she may lower the carbs or use a ketogenic diet.

25:27  Insulin resistance.  Insulin resistance is an important for multiple sclerosis, just as it is with Alzheimer’s and Parkinson’s.  If Dr. Wahls has patients with insulin resistance, she may put them on a lower carb diet and she may even put them on a ketogenic diet. She may recommend intermittent fasting and she may use Prolon kits for 5 days per month. 

26:31  Protein.  The muscles are a vital endocrine organ for maintaining good blood sugar and good blood lipids. It’s really important to maintain muscle mass when facing a neuroimmune condition like MS.  You need to do strength training and building muscle requires protein and our protein requirement goes up as you get older.  Dr. Wahls said that she is eating more meat and more fish in order to hang onto her muscles.  Organ meat, such as heart, liver or tongue, is an incredible source of vitamin A, B vitamins, and minerals and Dr. Wahls recommends eating 4-8 oz. of organ meat per week.

30:00  Toxins.  Toxins can play a role in neurological and autoimmune diseases and flouride is one example of that that can play a role in demyelinating nerves.  There are 80,000 plus synthetic chemicals that are in our environment, and it would be very difficult for any of us to not have an abundant number of toxins, heavy metals, solvents, plastics, the forever chemicals stored in our fat.  The fatty guts of meat are likely to have the most stored toxins, so you should make sure to eat organ meat from an organic animal and not to overdo it.  Rather than routinely screening patients for toxins, Dr. Wahls assumes all of her patients are toxic, though she will sometimes test them for mold toxins.  To facilitate detoxification, she will recommend eating greens, cabbage family vegetables, and onion family vegetables to stimulate the production of glutathione and she may recommend taking glutathione or NAC and lipoic acid, which are glutathione precursors.

33:31  Dr. Wahls recommends 9 cups of vegetables per day: 3 cups of greens, three cups of sulfur containing vegetables in the cabbage, onion, mushroom family, three cups of deeply pigmented carrots, beets, berries, peppers, tomatoes.  This is for men and tall women. If you are smaller, then 6 cups might be appropriate. There is no reason to overeat beyond what your appetite will tolerate.  You should not be hungry. If you’re hungry, then eat more protein.  If you’re full, as long as you’ve had your 6 to 12 oz of meat and you’ve got proportionately the greens, sulfur and color veggies, then you’re fine. 

34:48  Exercise. Strength training is very important for MS and it should be hard enough that you can’t do 3 sets of 12 reps of an exercise.  You need to progressively increase the resistance either with more weight or more bands or it is with bodyweight, then doing it slower. You want to rotate which parts of the body you work on on different days. You should also do balance exercises so you decrease the likelihood of falling. Dr. Wahls said that when she showers she will stand on one leg and count to 50 and then do the other leg.  If you want to live to 120, then you need to have great balance in your 70s, 80s, and 90s.

37:17  Electrical Stimulation.  Dr. Wahls finds that electrical stimulation is very helpful for patients with MS to help regenerate the muscles. It makes recovering your strength easier and it also helped her mood and her mental clarity.  We now know from animal model studies and human studies that when you add electrostimulation to exercise, you make more nerve growth factors and muscle growth factors locally for your muscles, but you also make more nerve growth factors in your brain and you make more endorphins in your brain.  Dr. Wahls uses a 10 seconds on, 20 seconds off protocol for the electrical stimulation and she co-contracts her muscles at the same time.  The muscle contractions need to be really forceful to get results. 

42:58  Nutritional Supplements.  Dr. Wahls also takes some nutritional supplements and is constantly keeping up with the research and tinkering with different supplements and she reads about 200 scientific papers per week.  She takes vitamin D with K, fish oil, a variety of mushroom supplements, and she has recently added urolithin A.  She is taking bergamot, which she really likes. She takes lipoic acid, NAC, beet root, and curcumin.  She makes a smoothie with phosphatidylcholine, plasmalogen, omega-3s, omega-6s and a cocktail of spices, which she will rotate that may include beet root, inulin, curcumin, and ginger. 

46:10  Clinical Research.  Dr. Wahls has so far completed 7 clinical trials and these have shown that the diet, exercise, and lifestyle  approaches that she recommends are helpful for patients with MS.  She is now recruiting volunteers for a new trial that compares a ketogenic diet with a paleo diet and a usual diet.  They are looking at changes in fatigue and quality of life, but also at changes in walking function, hand function, vision function, and how well we think.  They are also looking at brain volume over time because patients with MS experience brain shrinking at 3 times the rate of other patients.  They will also be looking to see if there are reductions in brain fog, anxiety, and depression.  participants will need to come to Iowa at month zero, month three, and month 24.  She has already recruited 83 people but they still have room for 72 additional volunteers.  Dr. Wahl’s team has published about 70 abstracts and posters and 45 peer reviewed scientific papers of which 26 are related to the multiple sclerosis research.  Those interested should go to TerryWahls.com/MSStudy.

Dr. Terry Wahls is a clinical professor medicine at the University of Iowa Carver College of Medicine where she teaches medical residents and does clinical research and she has published over 60 papers.  She conducts clinical trials that test the effect of nutrition and lifestyle interventions to treat MS and other progressive health problems.  She is the author of The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions.

Dr. Wahls was a patient with relapsing remitting Multiple Sclerosis in 2000 and by 2003 she had progressed to secondary progressive multiple sclerosis.  She was in a wheelchair because her back muscles were too weak to hold her up. She was taking the standard of care medication, which included chemotherapy, and yet she continued to go downhill until she took matters into her own hands and started researching MS and she looked for vitamins and minerals that might help.  She created a list of nutrients for brain health and began taking them, which slowed her decline.  In 2007 she discovered the Institute of Functional Medicine and she developed a longer list of nutrients and then she redesigned her diet so that she could get these nutrients from food rather than just from supplements.  She also started to use electrical stimulation to help strengthen her muscles.  She restored her health and vitality and she now rides her bike to work and teaches and researches at the University of Iowa.

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. Our topic for today is multiple sclerosis with Dr. Terry Wahls. Dr. Wahls is a clinical professor of medicine at the University of Iowa Carver College of Medicine, where she teaches and does clinical research, and she’s published over 60 papers. She’s currently conducting clinical trials that test the effect of nutrition and lifestyle interventions to treat multiple sclerosis and other progressive health problems. She’s the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, the Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles, and the cookbook, the Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. Dr. Wahls herself was a patient with multiple sclerosis, first diagnosed in 2000, and by 2003, she was in a wheelchair and going downhill until she took matters into her own hands and started to employ a functional medicine approach to healing herself. I’ll stop there because I’d like to let Dr. Wahls tell us about her story herself. Dr. Wahls, thank you so much for joining us today.

Dr. Wahls:           Hey, thank you, Dr. Ben. It’s a privilege to be here.

Dr. Weitz:            Absolutely. Please tell us about your personal journey.

Dr. Wahls:           Yeah. I’ll tell it in real time. 23 years ago, out walking with my wife Jackie, a half mile from home, my left leg grows weak. Dragging it home. I see the neurologist. And while I’m going through the workup for the next three weeks, I think about the 20 years of worsening electrical face pain that I have, and I’m praying secretly for a fatal diagnosis. Now, three weeks later, I hear multiple sclerosis. Being a physician, I do my research, find the best MS center in the country, see their best physician, take the newest drugs. Three years later, I hear the words tilt, recline wheelchair.

Dr. Weitz:            Wow.

Dr. Wahls:           I take Tysabri, I take Novantrone. None of these drugs help. I continue to worsen. My electrical face pains continue to worsen. My 10 year old daughter hugs me as tears streamed down my face. And that’s when I asked myself am I doing all that I can. I go back to reading the basic science. I’m studying in PubMed night after night. I decide that mitochondria are the driver of disability and I begin creating a supplement cocktail for my mitochondria. I discover a study using electrical stimulation of muscles. I ask my physical therapist can I add that, and we add that to my physical therapy. And then I discovered the Institute for Functional Medicine. I take their course on Neuroprotection. I have a longer list of supplements. I add all of them.

                                And not a lot’s happened yet. Then I have a really big aha. And actually, Ben, I’m sort of embarrassed now about how long this took me to have this because I’d already been doing a paleo diet for five years. But now I think what if I redesign my paleo diet based on the supplement cocktail. If I get my nutrients from the food as opposed to from supplements. And so that’s more research. And in December, I redesigned my paleo diet. Now, at that time, I am so weak I cannot sit up in a regular chair like I am now. I can only sit up for about 10 minutes. I can take just a couple of steps using two walking sticks. Otherwise, I’m either in bed or in a zero gravity chair with my knees higher than my nose. My electrical face pain is much worse and I’m beginning to have trouble with brain fog.

                                Start this new way of eating December 26th. By the end of January, it’s clear that my pain is less, my brain fog is less, my fatigue is also less. By the end of February, my physical therapist is saying, “You know what, Terry, you’re definitely stronger.” And he advances my exercise. And by the end of March, I’m beginning to walk with walking sticks. And by the end of April, I’m telling my family I really want to try riding my bike. Now, I haven’t ridden my bike in six years. We have an emergency family meeting because on Mother’s Day, two weeks later, I really want to ride my bike and Jackie tells my son, who’s 6’5″, “Zach, you jog alongside on the left,” my daughter Zeb, who’s 13, “You jog alongside on the right,” and she’ll follow. And we all get in a position, we push off and I bike around the block. And that big 16 year old boy, he’s crying. The 13 year old, she’s crying. Jackie’s crying. And when I talk about that now, I begin crying. And then every day I bike a little bit more. And in October, Jackie signs me up for the Courage Ride, 18.5 miles.

                                And once again, when I cross that finish line, my family’s crying, Jackie’s crying, and I’m crying. And this fundamentally changes how I think about disease and health and it will change the way I practice medicine and it will change the focus of my clinical research. And now we’ve conducted seven clinical trials. We’re doing our eighth clinical trial. We’ve published over 70 peer reviewed posters, abstracts, scientific papers. Nearly 30 of them in multiple sclerosis. And I’ve really made it my mission to let people know there is so much that we can do that can change the course of our disease.

Dr. Weitz:            That’s amazing. Able to regain your health without really drugs, using a functional medicine approach, diet and lifestyle. It’s amazing.

Dr. Wahls:           And I’m a academic doc. I certainly believe in the best technology, the best drugs, the newest devices, the newest technologies. And I treated my disease very, very aggressively because I didn’t want to become a burden. And despite that, I continued to go downhill. And I was taking drugs that when I read the package, insert 2% risk of getting acute leukemia each time I took the drug. So I was all in. I treated my disease very aggressively, but it didn’t help. I even took Tysabri. Did not help. And then what was remarkable, I used my diet, targeted supplements, electrical stimulation of muscles, and I recovered a remarkable level of function. And when I walked into my neurologist’s office, he was very excited and I said, “I really would like to go off my disease modifying drug treatment.” He goes, “Yes, I think that’d be fine. We need to taper you off because you have made this dramatic recovery. The toxicity of the drugs are substantial.” And with his blessing then in the spring of 2008, he weaned me off my disease modifying drugs, and I’ve been off disease modifying drugs since. I continue to get stronger and in fact, I now jog on my treadmill 20 minutes a couple times a week.

Dr. Weitz:            That’s awesome.

Dr. Wahls:           It’s been a journey. Absolutely. A big journey.

Dr. Weitz:            So why is the mitochondria so important for understanding autoimmune diseases like MS?

Dr. Wahls:           Well, most of my colleagues really focus on the immune function and the relapses and the exacerbations, but you have a relapse and you recover function. Most of it. That slow, relentless loss of brain volume, loss of spinal cord volume is what drives neurodegeneration. My interpretation of the basic science literature is that the driver of that disability is probably mitochondria. The mitochondria are not generating enough ATP for the robust energy needs of the axons, of the myelin of the neurons. And that’s driving cognitive decline for dementia, for Alzheimer’s, in Parkinson’s. And when I was reading the basic science early in my MS journey, I had very few relapses. It really had a degenerative process, and so I was like mitochondria are key. And I did figure out early on with my mitochondrial supplements that I felt a little bit better taking my supplements. When I didn’t take my supplements, I really couldn’t get out of bed and go to work. So they weren’t getting me out of my wheelchair, but clearly they were doing a lot for me. And then it is pretty interesting when I redesigned my food around my supplements, that is when the magic happened.

Dr. Weitz:            And do you think that’s because you got additional phytonutrients that maybe we haven’t even figured out what the benefits are that are present in the fruits and vegetables that-

Dr. Wahls:           Absolutely.

Dr. Weitz:            Aren’t necessarily present in the capsules?

Dr. Wahls:           I think if you focus just on what’s in the capsules … And it’s a great way to do animal model studies. It’s a great way to do basic science and to move our understanding forward. So they’re very helpful. But food is very, very complex. We have easily 80,000 food molecules that are really important to our health, probably many more than that. And so all of those molecules have a role to play in my chemistry, in your chemistry. And so I think it’s very hard to create a molecule by molecule nutrient program that’s good for us. But our ancestors over the 200,000 years that we’ve been homo sapiens and over the 150,000 years that we’ve been out of Africa, humans have been eating a wide variety of food stuffs as we go into all these different ecological spaces. So anyone says there’s only one food that is correct or one nutrient that is correct is wrong. Our evolutionary history would say there are a lot of foods that work, there are a lot of different foods that work, and so there’s only one food that we know is really terrible for us and that’s the standard Westernized diet.

Dr. Weitz:            Correct. And then we are certainly not going on the right path when it comes to pharmaceuticals for treating these neurodegenerative diseases. I’m sure you’ve probably seen the recent research that came out, I think last week, that the leading drugs that shrink the amyloid plaque for Alzheimer’s actually lead to a shrinkage of the brain. So not only are-

Dr. Wahls:           I saw that.

Dr. Weitz:            They not making people better, they’re making them worse.

Dr. Wahls:           Correct. An amyloid is sort of like the sticky fly paper. So I think there’s some protection for amyloid and I’m not sure that we’re going to find these dementia treating drugs in the end to be very useful.

Dr. Weitz:            It may be, and Dr. Bredesen has mentioned, is that maybe if we do all the functional medicine stuff first, if you eliminate the reasons why the brain is laying down the amyloid plaque and you get rid of the inflammation, the toxins, you balance the nutrients, you do all the other things to improve the health of the brain, maybe at that point if you were to remove the amyloid, it might be beneficial, but not until you’ve done all that.

Dr. Wahls:           Correct. And we don’t know. We don’t know. And I have variations of this debate for MS. We have 20 different drugs that are really great and they have to be great at reducing the number of enhancing lesions, therefore also they often reduce the number of relapses and that’s how you get FDA approval. So they’re very good at that, but they’re not at all good at slowing the rate of brain volume loss. They aren’t really good at reducing anxiety, depression or fatigue. And I think that yes, we absolutely want people to stop having the enhancing lesions, the relapses, I agree, but you have to do all of the diet and lifestyle stuff so you can address brain volume loss, address anxiety, address depression, address fatigue. And that’s what our programs have been very good at.

Dr. Weitz:            So what do you think are some of the most important nutrients, vitamins, minerals, phytonutrients for brain and nervous system health?

Dr. Wahls:           I think the research is really excellent. When we do network meta-analysis in terms of combining multiple studies, we see consistently that low vitamin D is associated with more relapses, more disability, worse quality of life. So making sure your vitamin D is certainly above 40, and in my clinical practice, I want to see that in the top half of the reference range.

Dr. Weitz:            So you’re talking about 50 to 100? Is there an ideal target?

Dr. Wahls:           50 to a 100 and 60 to 80 would be my ideal.

Dr. Weitz:            60 to 80. Okay.

Dr. Wahls:           But 50 to 100 I think is certainly acceptable. Below 30, that’s definitely a big problem. And below 20, that’s a severe problem. Then the next nutrient that I’m thinking a lot about is the omega-3 fatty acids. Again, low omega-3 fatty acids are associated with more relapses, more disease progression. And people want a badmouth arachidonic acid and omega-6 fatty acids. However, if your arachidonic acid and omega-6 acids are low, that’s a problem too because we also have a lot of arachidonic acid and omega-6 fatty acids in our brain as well. They are also important in myelin formation. So you need both omega-3 and omega-6, but you want them in about the same ratio, or I should say a ratio of four to one. Four omega-6 to one omega-3. Three to one is okay, two to one is getting a little bit low. But many of us, because we have so much fast food that is deep fried-

Dr. Weitz:            We’re at 20 to one or 30 to one.

Dr. Wahls:           20 to one, 30 to one, 40 to one, 45 to one. That is definitely very inflammatory.

Dr. Weitz:            Do you like to see a higher DHA omega-3 for neurological?

Dr. Wahls:           Yeah, I’d rather see a little higher DHA. Although interestingly, some of my psychiatrists would rather see more EPA. So it may depend on what conditions you’re trying to treat.

Dr. Weitz:            Okay.

Dr. Wahls:           Then I’m thinking about homocysteine levels and I’d like to see that homocysteine between four and 7.5.

Dr. Weitz:            Wow, that’s really low.

Dr. Wahls:           Yeah. I’d rather have it in that range. Now, some people may go up to nine, may go up to 10. Ten’s, I think, high. Certainly above 10, you’re going to have higher rates of neurodegeneration, higher rates of heart disease. And I want to have plenty of carotenoids, total carotenoids. Zeaxanthin, meso-zeaxanthin, lutein. These are the greens in green leafy vegetables. And we know in my retina, those are the compounds that protect me from the ultraviolet light that is coming into my eyes when I’m out in daylight. And it turns out that those same compounds are really good at protecting me from cognitive decline. So green leafy vegetables, really good. Then there’s all these compounds in culinary mushrooms and those are the mushrooms we can eat without being poisoned by eating poisonous mushrooms. So those things we’re beginning to understand a little bit more what are some of these molecules. From a epidemiologic basis, we know the more mushrooms you eat, the lower the rates of anxiety, depression, cognitive decline.

Dr. Weitz:            I picked up some lion’s mane mushroom just today at the co-op to add to my eggs tomorrow.

Dr. Wahls:           Oh my God, they are so tasty. And then having more greens, having more beets. We’re beginning to realize that that stimulates my nitric oxide, which is really great for blood vessel health. We’ve known that is really good for blood vessel health, cardiac health. Now we’re beginning to realize that nitric oxide is very important for neurologic health as well. So I think that’s another reason why greens and beets are so good for us. Fermented vegetables. Kimchi, sauerkraut. We’ve known for some time that if you eat more fermented vegetables, you have less influenza, you have less pneumonia, you have fewer colds, and you’re less likely to be hospitalized during this coronavirus pandemic. So I like to have people eat fermented vegetables, and I also encourage fermented keifers and yogurts, preferably nut milk and coconut milk keifers and yogurts.

Dr. Weitz:            Okay. So you like the paleo diet for neurodegenerative diseases. Why the paleo diet? Some would say why not the vegan diet?

Dr. Wahls:           Oh, yeah. There are many diets out there, vegan, vegetarian, keto, paleo, fasting mimicking diet, fasting strategies, and there are a variety of clinical trials testing all of these diets in a wide variety of clinical studies. I think a very consistent finding is that when you put people on a intervention diet compared to the usual diet, the dietary intervention always improves. I think some of the reasons for that is when you have less sugar, less added processed foods, the quality of the diet improves. Historically, I have my own personal health transformation using the paleo diet. I’d been a vegetarian 20 years. I followed a low fat diet for that, and so this would’ve been considered a really phenomenally great diet. For me, it obviously was not good for me. I had a remarkable transformation. It’s the diet I’ve used in my clinical trials and we’ve had remarkable success.

                                From an evolutionary standpoint what the paleo diet does is it says, given your locale where you are in the world, we want you to try and emulate what our ancestors would’ve been eating in your region. So eat meat. Poultry, fish, nuts, seeds, greens, tubers, berries and fruit that’s in your area. Don’t eat sugar, grains, legumes, and dairy because those foods were foods that humans added eight to 10,000 years ago. And from our evolutionary history when we separated from primates six million years ago, when we became a distinct species 250,000 years ago, and when we got out of Africa about 150,000 years ago, those were the kinds of foods that we ate. We didn’t start adding grain, legumes or dairy until recently. Now, I think there are many, many versions of the paleo diet that you can find in Europe, Scandinavia, in Asia, in Africa, in the US, that will all be a little bit different because hopefully we’re all adapting that to our local region.

Dr. Weitz:            Yeah. I guess one of the typical arguments I hear against the paleo diet is even though that’s the way humans ate for hundreds of thousands or millions of years, that doesn’t necessarily mean it’s the best diet for long-term health.

Dr. Wahls:           Well, that’s true, and we have no idea what is the best diet, and nor do we have any idea what’s the best diet for Ben Weitz or for Terry Wahls. What I counsel everyone to do is pick a diet that speaks to your heart, paleo diet, vegan diet, vegetarian diet, a ketogenic diet, and try it out and see how you feel. If you feel like your health is improving, that’s fine. Stay with it. If your health is not improving, then I invite you to give it at least three months, but do it really well. Then talk to your physician, talk to your family, and decide, okay, I tried the paleo diet, it’s not really working for me. I want to try a ketogenic diet, or I want to try a Mediterranean diet. Then go ahead and try that.  There will not be one diet that is great for everyone. In my clinical practice sometimes I will recommend a paleo diet. Their cholesterol is going up too high. We make modifications to make it a lower fat diet, and I may make further changes. So I may even put them on a Mediterranean diet in response to what I see happening to their lab values if I’m not pleased. Or I may put them on a ketogenic diet because I’m worried about them developing insulin resistance. You want to have a starting point, assess their response, follow the labs, and make adjustments.

Dr. Weitz:            I know how important insulin resistance is for working with patients with Alzheimer’s and Parkinson’s. How about for MS?

Dr. Wahls:           It’s very important. People with MS and other neuroimmune conditions, we have higher rates of insulin resistance than the general public at the same weight. And so is that part of the same disease processes?  Likely yes.  And so I want all of my MS patients to have a blood sugar and an insulin level, so I can see are they developing insulin resistance?  If they are, I put them on a lower carb diet and we continue to monitor things. And I may in fact put them on a ketogenic diet. I may put them on a program of intermittent fasting. I may even use Prolon kits, one kit every month to try and improve their insulin sensitivity.

Dr. Weitz:            How important is it to have high quality sources of protein like animal protein and organ meats for maintaining and regenerating neurological tissue?

Dr. Wahls:           Well, let me come back a couple things. My muscles are really a vital endocrine organ for maintaining good blood sugar and good blood lipids. And so it’s really important to maintain muscle mass. So please do strength training even if you have MS or a neuroimmune condition to maintain those muscles. And the more strength training you do and the more male you are, the more protein you’re going to need in your diet than a female who’s not strength training or a petite individual. As you get older, and you see I have some gray hair, I’m now over 65, my protein requirement has gone up, and so I’m eating more meat and more fish, because I really want to hang on to my muscles. I’m spending more time strength training. I mentioned earlier that I’m jogging just twice a week because I’m strength training more because I so value those muscles.

Dr. Weitz:            That’s great. And how about organ meat?

Dr. Wahls:           Organ meat. Our ancestors valued organ meat as the highest, much more valuable than the steaks and the muscle meat. Brains were the most valuable, then bone marrow, then heart, liver, testicles, kidneys, lungs, and then muscles. So if there was a lot of meat around, a lot of carcasses, they would take the organs and leave the muscle meat behind. And they’d take the long bones. So traditionally, about a third of the animal carcass is what we’d consider organ meat. And when we do an analysis of the nutrients of the B vitamins, the minerals, its highest in the heart, liver and organ meat, higher than in the muscle meat. Having said that, as much as I love liver, I think it’s a delicious meat, I still want you to have only, me, about six ounces of liver a week. You can have about eight ounces a week.  A petite person would be maybe four ounces a week. Because it has so much vitamin A in it. Super good for you. Heart, tongue, also super good for you and super, super delicious. Brains used to be a delicacy that was tremendously valued. I have my great-grandmother’s Compendium of Cookery and Modern Book of Knowledge from 1889, and she’s got recipes in there for brains and eggs that look like that would’ve been really quite delicious. But I can’t tolerate eggs because it triggers my face pain. And of course, no one’s going to feel comfortable eating brains anymore because of some of the prion diseases in brains.

Dr. Weitz:            Jakob Creutzfeldt’s disease. Mad Cow disease. So a liver contains a lot of toxins, and we know toxins can play a role in neurological and autoimmune diseases. Dr. Perlmutter had a dentist on, and he was mentioning how fluoride can actually play a role in demyelinating neurons, and demyelinating nerves. And-

Dr. Wahls:           Yeah, fluoride is not good.

Dr. Weitz:            So I’m sure there’s got to be a lot of toxins in everyday life that are playing a role.

Dr. Wahls:           There are 80,000 plus synthetic chemicals that are in our environment, and it would be very difficult for any of us to not have an abundant number of toxins, heavy metals, solvents, plastics, the forever chemicals stored in our fat. And I want to correct something. Your liver processes through phase one, phase two reactions, the synthetic chemicals that we have, and then excretes it into the bile. It goes into the gallbladder. And then as we eat fat, the gallbladder releases bile into the small intestine. We absorb, digest the fat and recycle the bile. So eating liver isn’t going to give you a higher toxin load. Eating your bacon, however, might because the fat is in the bacon and if you fry things in lard and duck fat, the toxins are really in the fat much more so than in the liver.

Dr. Weitz:            I see. So good to eat liver from a healthy animal, not-

Dr. Wahls:           From a healthy animal.

Dr. Weitz:            Maybe to eat a liver from a standard American diet eating person with fatty liver.

Dr. Wahls:           Correct. So I certainly want you to have liver from an organic animal. I don’t think you have to be afraid of liver. Six to eight ounces is okay. The fatty cuts of meat, the bacon, it’s the fat that has the toxins. So you have to be worried about the fat.

Dr. Weitz:            Right. Do you screen patients for toxins?

Dr. Wahls:           Well, I assume everyone is toxic. So in my VA clinics, we assumed everybody was toxic. I put them all on a protocol to reduce their toxin exposure and to make it easier to excrete their toxins. In my clinics, again, I assume everyone is toxic and we do the same. Now, depending on their clinical circumstances, I may screen them for mold toxins, for-

Dr. Weitz:            Heavy metals.

Dr. Wahls:           Heavy metals. And we may have a more specific program for them.

Dr. Weitz:            What about incorporating glutathione to help with detoxification?

Dr. Wahls:           Well, certainly you would like to make sure they have plenty of sulfur containing amino acids, such as NAC, N acetyl-cysteine, lipoic acid. You may give them some glutathione. You could also stimulate the production of glutathione by eating these radical things known as the greens, the cabbage family vegetables, the onion family vegetables, because those foods will up-regulate my glutathione synthetase.

Dr. Weitz:            Now your recommendations for diet, I believe include nine cups of vegetables a day.

Dr. Wahls:           Nine cups of vegetables a day. So it’s three cups of greens, three cups of sulfur containing vegetables in the cabbage, onion, mushroom family, three cups of deeply pigmented carrots, beets, berries, peppers, tomatoes. And the way you can think about that is if you take your dinner plate and you cover it so you can’t see the bottom, that’s three cups of vegetables.

Dr. Weitz:            Okay. And that’s for the average weight person?

Dr. Wahls:           And you might think about that. That’s for men, tall women. I’m six foot tall. If you’re a petite woman or a petite man, then maybe six cups would be appropriate. There’s no need to over consume beyond what your appetite will tolerate so I just want to be sure that you’re not hungry. If you’re hungry, eat more protein in those greens, sulfur and colors. And if you’re full, as long as you’ve had your six to 12 ounces of meat and you’ve got proportionately the greens, sulfur and color, then you’re fine.

Dr. Weitz:            Okay. So which forms of exercise are most beneficial? You mentioned strength training and there’s particular recommendations, parameters for strength training?

Dr. Wahls:           So ideally you want to have things be hard. Hard enough so that you can’t do three sets of 12 of that exercise times three. If you could do that, then you could advance the rigor of that exercise. Either more resistant bands, more weights, slower version if it’s a body weight exercise. And you want to do your arms, your core, and your walking muscles. And ideally I rotate so I’m doing arms one day, core one day, legs another day so that I’m getting my whole body trained. I’m also doing balance exercise. Because as we age, our balance declines. And so I don’t want to fall. So I’m doing exercises and I teach people how to maintain balance. And you might start, get my hands out there, so that your feet are wide apart and you gradually get them closer and closer. Then you gradually get so you’re standing on one foot and toes down, then eventually just on one foot.  And when you can do that, then you turn your head side to side. And then when you can do that, then you can close your eyes. In that way you can gradually improve your balance. So routinely when I shower, I’ll do standing on one leg counting to 50, and then I do the other leg counting to 50, and I take turns drip drying so I can maintain my balance. Because falling becomes increasing hazard the older we become. And my goal is to be 120 and thriving so I want to have great balance in my 70s, 80s, 90s, and 100 plus.

Dr. Weitz:            That’s great. Great job of multitasking, getting your shower in, your balance training. Put the cold water on, you can get your cold water immersion at the same time.

Dr. Wahls:           Absolutely.

Dr. Weitz:            So how important is electrical stimulation? It sounds like it was very important for you to help regenerate some of those muscles.

Dr. Wahls:           It was super helpful. Fortunately, I had gone to a physical therapist who had an athletic practice and physical therapists who treat athletes have been using electrical stimulation for decades to help their athletes recover from injury more quickly. And at that time, remember, I could not sit up more than 10 minutes. I could do just a 10 minute very basic mat exercise program. We added electrostimulation to my mat exercise program and gradually increase that and that let me grow muscles more quickly. We now know from animal model studies and human studies that when you add electrostimulation to exercise, you make more nerve growth factors and muscle growth factors locally for your muscles, but you also make more nerve growth factors in your brain and you make more endorphins in your brain. And I could certainly tell very early on that the electro stimulation did great things for my mood and my mental clarity, and it I’m sure accelerated my recovery. It’s not a requirement. It’s simply a way of accelerating the speed of recovery, particularly for people who have severe disability. So people who need a cane, a walker or walking sticks, or in my case, the tilt, recline wheelchair.

Dr. Weitz:            Now I’m very familiar with the electrical stimulation. As a sports chiropractor, we use electrical stimulation in the care of the patients. Specifically for neurological diseases like MS, can you talk about particulars? What is the protocol? How many seconds of contraction? How many seconds of rest? How many reps? Do you use contraction by moving the joint at the same time?

Dr. Wahls:           So when you’re using electrical simulation, one of the things that it will do is you’re going to get current going through the pads into the motor nerve, into the muscle driving contraction. And it was used originally for people with spinal cord injury who were never going to walk. And it was a great tool to reduce the harm of inactivity. To improve blood sugar control and blood lipid metabolism. And then we did it on me and my athletic physical therapist said, “Terry, we don’t know if your brain’s going to be able to talk to this muscle so you have really got to build this connection. When that current is going, you contract your muscle as hard as you can. It’s going to be 10 seconds on, 20 seconds off. You got a two second ramp up and ramp down and dial it up to as much pain as you can tolerate.” I’m a former athlete. By God, I was going to leave nothing on the table, so I would dial it up. I would be in a sweat from the intensity of the current.

                                And I was doing all this, Ben, not to get better because I knew I couldn’t get better. I knew I had progressive MS, that functions once lost were never coming back. I was doing all this to slow my decline. But I was getting stronger. And they said, “Okay, 10 minutes, twice a day. 15 minutes, twice a day, 20 minutes twice a day, 30 minutes twice a day.” And then he goes, “Well, Terry, it’s 45 minutes a day to build stronger muscle. You’ve got a lot of weak muscles. How much time you have in the day, go ahead and stimulate.”

Dr. Weitz:            So 10 seconds contraction, 10 seconds rest you said?

Dr. Wahls:           No, 10 contraction, 20-

Dr. Weitz:            20 rest. Okay. And then for what? 10 reps?

Dr. Wahls:           Well, I can’t remember. He gave me a set of exercises to do. It was 10 minutes. And I don’t remember what we started with at that time because I did belly, then I did back and butt. So there was three sets of muscles that I did at first. And so it was probably just 10 reps at first. And then it was 10 reps times two, then 10 reps times three. And then I am like, okay, if I’m going to get my electrodes here and here, so I had a two channel machine, I’m going to do isometrics for 30 minutes. So 10 second isometric on, 20 second off. And so I’d have my machine with me at work and I’d have 10 seconds of … Okay, I can work now for 20 seconds. 10 seconds of …

Dr. Weitz:            Hard to record a podcast like that.

Dr. Wahls:           And so if I was staffing residents, I had to dial the current back so I could have a conversation and no one would know that I was stimming. But if I wasn’t staffing residents, then I could dial it all the way up.

Dr. Weitz:            Cool. Now, I know you’ve tried to get everything you can from food, but do you still employ some nutritional supplements?

Dr. Wahls:           Yeah. Actually I take a bunch of supplements. I feel better when I’m taking my supplements. And then I continue to read the basic science and I tinker. I see a new interesting study and I’m like, okay, what would that do? And plus, it’s interesting, I probably go through about 200 different papers every week, maybe 250 to scan, see what looks interesting to try out.

Dr. Weitz:            So what nutritional supplements are you taking right now?

Dr. Wahls:           Well, I’m certainly taking vitamin D, fish oil.

Dr. Weitz:            You take D with K?

Dr. Wahls:           Yeah. I always take D plus K. I’m taking a variety of mushroom supplements. I’ve recently added urolithin A. That’s been very interesting. And then I-

Dr. Weitz:            Are you doing NR or NMN?

Dr. Wahls:           I am not.

Dr. Weitz:            You chose not to or?

Dr. Wahls:           It’s not hit the top of my list yet of things to try.

Dr. Weitz:            Okay. Okay.

Dr. Wahls:           I’m taking bergamot. I like that a lot. I like lipoic acid.

Dr. Weitz:            NAC?

Dr. Wahls:           Oh, we take lots of NAC.

Dr. Weitz:            Tocotrienols?

Dr. Wahls:           I have in the past. I’m not currently.

Dr. Weitz:            Okay. Other antioxidants, polyphenols?

Dr. Wahls:           Well, I certainly am taking beet root. I’m taking a variety of mushroom products. I am taking curcumin and I take a-

Dr. Weitz:            What’s your favorite form of curcumin? Because that constantly changes. Which one is best or the latest?

Dr. Wahls:           Well, what I do is I’ll make a phosphatidylcholine, plasmalogen, and a omega-3, omega-6 fatty acid smoothie. Then I’m adding curcumin in a cocktail of my favorite spices and I just rotate through which spices I’m adding. I’ll add beet root and some inulin, curcumin, ginger, and I’ll make that into a smoothie. Then I’ll add chia seed, and I will have that in a quart jar. And I will have that once a day. And I eat every other day. I’ll have my PC smoothie blend every day. And I’m not calculating how many calories are in that. And then-

Dr. Weitz:            What’s the PC smoothie?

Dr. Wahls:           Oh, that’s the phosphatidylcholine, plasmalogen, essential fatty acids. The various spice blend, curcumin, ginger. I’ll put together.

Dr. Weitz:            Can you tell us about some of the ongoing research you’re doing about MS?

Dr. Wahls:           Okay. We’ve done seven clinical trials and so far they’ve all consistently show that people can implement the diet and the study protocols that we use. That if you’re overweight, you lose weight generally without being hungry, getting back to a healthy weight. Fatigue is reduced. Quality of life is improved in 75 to 80% of the individuals. Now think about that. That is really remarkably effective. Even the very best drugs for everything, including infections, generally don’t have 70 to 80% rates of helping people. We have a new study that I’m super excited about. The efficacy of diet on quality of life. We’ll be comparing a ketogenic diet, a paleo diet to usual diet. And we’ll look at changes in fatigue, quality of life. And those are our primary outcomes. But we’re also looking at changes in walking function, hand function, vision function, and how well we think. And what I think will be the most interesting part of this study, Ben, is we’re looking at brain volume over time. Because people with MS, our brains as a group are shrinking three times as fast as what happens in healthy aging. So it’s about 1% per year, which is why we have much higher rates of anxiety, depression, cognitive decline, early frailty, early need to quit our jobs, go to assisted living and nursing home care. Even as very young people.

                                And because clinically we’re so effective at reducing brain fog, reducing anxiety, depression, I’m very optimistic that we’ll be able to get a significant number of our folks back into the healthy rates of brain aging. And although it’s not the primary outcome, so it’ll be one of those other manuscripts that we add, but I predict it’ll be groundbreaking. It’ll be very, very exciting. Because while disease-modifying drug therapies have to show that they can reduce the number of new enhancing lesions compared to control, and therefore they often reduce relapses compared to control. And so they’re very good at inflammation, but they don’t address neurodegeneration. They don’t address mitochondria. And therefore they don’t have much impact on anxiety, depression, cognitive decline, or brain fog.

                                So I don’t know what we’ll find, but I am super excited. People need to come to Iowa at month zero, month three, and month 24. We have 83 people that we’ve consented and are in the process. That means I have room for 72 more. And I expect that we’ll finish that recruitment in the next 12 months. And so really it’s three more years of steady activities to get all this stuff going. And so it’s ’23, that means in 2026, we’ll be wrapping things up at the end of the year. In 2027, we’ll be analyzing the data and presenting it at the MS Scientific meetings. And then the papers will start coming out. Now, in the meantime, my team has published about 70 abstracts, posters. We have 45 peer reviewed scientific papers of which 26 are related to the multiple sclerosis research.

                                And I’m really a unique, Ben, because I do the research to change the standard of care, but I know what it’s like to be facing terrible prognosis, terrible disability, and I am committed to at the same time that I’m doing the research to change the standard of care, to teach other clinicians how to think the way I think, and to teach other patients like me that there’s a whole lot you can do that can change your disease course. And yes, talk to your physician about how disease-modifying drugs fit into your care plan. But whatever you decide, we should all be working to improve our diet, asking for physical therapy, asking for stress reducing practice, making sure we’re sleeping well and being connected with our friends and family.

Dr. Weitz:            And what’s even more remarkable is that the disease modifying drugs that are available don’t reverse the condition, don’t actually make people better. At best, people get worse at a slower rate.

Dr. Wahls:           Exactly. At best, all they need to show is they have fewer lesions in the MRI. They don’t really have to show any change on anxiety, depression, mood, clinical function. And it’s wonderful that they’ve done this. They’ve taken the time from diagnosis to wheelchair and have moved it out five years. And for everyone with MS, those five years … It’s great to get five more years away from the wheelchair. But wouldn’t it be even better to never have to need the wheelchair? Wouldn’t it be even better to have no anxiety, no depression, no cognitive decline? I can now jog on my treadmill.

Dr. Weitz:            Right. That’s one of the amazing things is none of these disease modifying drugs can actually give you any hope of going from a wheelchair to not being in a wheelchair and yet the functional medicine approach that you’re pioneering has that potential.

Dr. Wahls:           And so we see people. I think it’s really important to stop the decline, use the functional medicine approach to stop the decline, and then find a practitioner who has a very close relationship with a rehab center, rehab minded physical therapist who will work on that rehab potential. I have close relationships with folks who are big champions of electrical stimulation of muscles. They treat our patients like athletes, recovering athletes. We work hard, we have big goals, and we realize this is going to be a several year process for those people who are like me, profoundly disabled and wheelchair dependent. But we have other wonderful stories. It’s not just me getting out of the wheelchair. But the people who are most successful are the former athletes and the people who are willing to say, “I’ll treat this athletic training. That I realize this is a long row that I’m going to be hoeing and I’ll be doing it the rest of my life. And I am down for that journey.”

Dr. Weitz:            That’s awesome. And so how do they contact you to find out about the getting involved with the study?

Dr. Wahls:           The simplest way to do this is go to terrywahls, that’s T-E-R-R-Y, Wahls, W-A-H-L-S.com/msstudy. There’ll be more information about the study, a short little video. There’ll be a yellow box. Click there to take the survey. You’ll put in your contact information, answer a few questions, and then we will begin the process of confirming your diagnosis, putting you in our patient registry. Because we’ll have more studies that we want everyone to hear about. And then for those who are eligible for the study, we will contact you and begin the process of confirming the diagnosis, telling you in more detail what’s involved in the study in getting you enrolled. So 72 folks. We’d love to help get you in the study and help transform your life.

Dr. Weitz:            And I understand that all your studies are privately funded. You’ve yet to have the National Institute of Health provide funding.

Dr. Wahls:           Correct. We’ve been funded by individuals, by family foundations, the MS Society, which is a nonprofit. They have funded us. And so we’re very grateful for them. A grateful patient whose life we transformed is funding the really big study, the Carter Chapman Shreve Family Foundation. And my university, which at first thought I was a bit eccentric, a bit odd, now they’re like, “Dr. Wahls is a rockstar.” Because I’m getting funded through the grateful patients at a level that is really quite extraordinary.

Dr. Weitz:            That’s awesome. Thank you for the work you’re doing, Dr. Wahls.

Dr. Wahls:           Well, I am so grateful. In 2007, I had such a terrible future. Bedridden, demented, in continuous electrical pain. That was the future that I thought I was facing. Now I’m pain free. I consider my trigeminal neuralgia a gift because I know if my brain’s inflamed moment to moment. I don’t have fatigue, I don’t have mental clarity. I’m traveling the world. And I just am so grateful that I have this amazing future.

Dr. Weitz:            That’s awesome. And others can potentially have that future too, if they make the right diet, lifestyle changes as well as doing the standard of care.

Dr. Wahls:           Correct. Correct. So we’re not anti-drug. That’s a great conversation to have with your treating specialist. We just want to be sure that you have support to do all that you can of the things that we control. Our actions, our diet, our self-care routine.

Dr. Weitz:            Do you have training programs available for practitioners who want to-

Dr. Wahls:           Yeah, we certainly do. We train physicians, chiropractors, physical therapists, registered dieticians, health coaches. Anyone with a health related license or certificate. The training is online. We also have sessions via Zoom. Once you’re trained, it’s about 20 hours worth of training, there’s a test that you’ll have to pass. And then we have monthly calls with me discussing cases. Sometimes I bring in a guest lecturer as well. And we have people, I believe, in 24 different countries around the world. And because we do this online, my mission, we want to train as many clinicians as I can so we can make this way of taking care of people more readily available around the world.

Dr. Weitz:            And do we go to terrywahls.com to find that practitioner training?

Dr. Wahls:           To find that you go to terrywahls.com/certification.

Dr. Weitz:            Okay. That’s great. Thank you so much, Dr. Wahls.

Dr. Wahls:           And thank you for all that you are doing.

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 discover the Rational Wellness Podcast.  And I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardio metabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

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Dr. Fiona McCulloch discusses Managing a Healthy Menopause at the Functional Medicine Discussion Group meeting on April 27, 2023 with moderator 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

5:35  Perimenopause usually starts around age 39 till 55 or so and this is when we start seeing irregular cycles and lots of symptoms and increases in chronic health risks.  Perimenopause is a time of fluctuation.  Women are born with all of the follicles in their ovaries for their entire life. the follicles house the eggs and each egg is housed by cells that make hormones.  Over the lifespan the pool of follicles decrease and when you get to the end of the reproductive years, there are far fewer follicles and hormones are released abnormally and inconsistently.  During a normal menstrual cycle the granulosis cells in the inner follicle make estrogen and when the egg comes out, it ovulated and the shell of the egg makes progesterone for two weeks.  During perimenopause we have follicles on their last legs and they make estrogen all the time but not in a normal pattern and there is almost no progesterone.  The adrenals do make small amounts of progesterone but the ovaries make massive amounts of progesterone.  Perimenopause is marked by wildly fluctuating wild estrogen levels up and down and pretty much no progesterone for the majority of the time.

10:37  Diagnosis of Perimenopause. The pituitary gland is involved with the complex control of ovulation.  When estrogen levels start to drop, the pituitary senses that and then sends FSH down to the ovary to make an egg and then you get increased estrogen.  When estrogen levels get irregular but generally higher, the brain will stop making FSH, so some measure FSH as a way to diagnose perimenopause. But FSH is not consistently low, so it is not a good way to diagnose perimenopause. The best way to diagnose perimenopause is not to test hormones but based on age and that the menstrual cycle gets shorter, irregular. Women will get insomnia, have mood changes, etc.  Testing can be useful for treatment but not for diagnosis.  Menopause is easy to diagnose, since it is diagnosed when it has been 12 months since the last period. 

14:32  Stages of Perimenopause.  During the first stage of perimenopause, the cycles become shorter because there are less follicles and they make less anti-müllerian hormone, which slows them down from ovulating too early.  In the later stages of perimenopause we see highly unpredictable cycles and lots of heavy, long bleeding. Some of the common symptoms that may occur in menopause include hot flashes, insomnia, anxiety, depression, low libido, vaginal dryness, autoimmunity, insulin resistance, loss of bone density, increased cardiovascular risk, and increased Alzheimer’s risk.   

20:12  Hormone testing.  Different modalities of testing are more or less effective for different reasons. Serum or blood spot is the most common form of hormones testing and it is good at picking up topical estrogen, oral and vaginal hormones.  Topical progesterone is not seen very well in a serum test, but it is seen in a blood spot or in saliva testing.  Urine testing is good to look at the metabolites of estrogen and cortisol and Dr. McCulloch will typically use DUTCH testing.  But urine testing is not as good to monitor topical hormone replacement therapy or vaginal HRT, since this can end up in the urine directly.  Saliva is helpful to look at the diurnal rhythm of free cortisol and is good for picking up topical progesterone.  For saliva and blood spot testing she will use ZRT Labs.

24:28  Other labs that Dr. McCulloch will often order besides hormones include the following: 1. Lipids, 2. ApoB, 3. Homocysteine, 4. HOMA-IR, 5. HBA1C, 6. Glucose, 7. OGTT with insulin, 8. Liver: AST, ALT, GGT, 9. CBC, 10. Ferritin, 11. Iron panel, 12. Thyroid, 13. Cortisol, 14. AMH may be useful in differentiating irregular cycles from PCOS, 15. FSH and LH.

28:33  Diet.  Dr. McCulloch often recommends a low glycemic Mediterranean diet with lots of cruciferous vegetables that helps with estrogen metabolism and preventing breast cancer. They also contain antioxidants like sulforaphane that helps with CVD, insulin resistance, cellular overgrowth, and cancer prevention. Lignans and flax seeds and sesame seeds can mimic estrogen and have other benefits. Women should avoid processed foods, alcohol, and high glycemic carbs.  Calcium, magnesium, vitamin K2, and boron can help to prevent osteoporosis. 

29:51  Dr. McCulloch feels that soy is healthy as along as it is organic and non-GMO and the person is not sensitive to it. 

30:25  The Women’s Health Initiative study, which was first published in 2002, Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal WomenPrincipal Results From the Women’s Health Initiative Randomized Controlled Trial.  When this study was published it pretty much scared all women and doctors from using Hormone Replacement Therapy because it increased the risk of heart attacks, blood clots, and cancer.  One of the problems with this study is that they used oral, conjugated equine estrogen and synthetic progestins.   Another problem is that the average age that these women started to take it the hormones was 63 years of age.  Another issue is that 50% were current and past smokers, 35% with hypertension, 70% were obese, and there was no control for atherosclerosis.  And the group of women who took this dangerous kind of estrogen–the conjugated equine estrogen–without the synthetic progestins had no increased risk.  It’s the synthetic progestins that really increase the clot risk and these are in birth control pills, Provera and Depo-provera. They are orders stronger than natural progesterone and they don’t act like progesterone anyway. We are not sure why initiating hormones 10 years after menopause, but it may be because such women will tend to develop plaques once the estrogen drops and then when they start taking hormones, estrogen may soften some of these plaques and increase the risk of an event.

33:12  What we know now from research is the following:

1. Topical estrogens (patches, gels, creams) are safer than oral estrogen. We have known for years that oral estrogens cause blood clots. 

2. Topical estrogen and progesterone (even synthetic progestins) do not increase breast cancer risk up till 5 years after the last menstrual period.

3. While synthetic progestins increase the risk of clotting, this does not occur with micronized progesterone.

4. While starting hormones more than 10 years after menopause may increase the risk of cardiovascular disease (CVD), especially in those who are obese, smokers, or have high blood pressure, initiating topical estrogen and natural progesterone within the first 10 years after menopause  is protective against CVD.

41:33  Topical estrogen. Many doctors recommend a compounded form of topical estrogen called Biest that includes both estrodial and estriol, with the thought that estriol is a weaker but safer form of estrogen.   The trend used to be to recommend 80/20 with 80% being estriol, but then you have to give higher dosages to control symptoms, so 50/50 Biest is best.  Dr. McCulloch will titrate the dosage to the amount of estradiol being absorbed, since that is the estrogen that modulates the symptoms, while estriol is essentially there to possibly mitigate risk.

43:15  Vaginal hormones.  For women who may be at increased risk for breast cancer or who are afraid of that possible risk, but who would like to improve vaginal dryness and atrophy, is it best to use vaginal estrogen or can vaginal DHEA work as well or even vaginal testosterone?  Vaginal DHEA has been shown to work really well. In the US, the Bezwecken DHEA Cubes work really well and these are over the counter, though they are not available in Canada. The other option is to use vaginal estriol plus hyaluranic acid, which also retains water and helps to lubricate the vagina. 

45:50  The clinical differences between estrogen and progesterone. 

Benefits of bioidentical estrodial: 

1. Very effective at reducing hot flashes, while progesterone can help with hot flashes, but not that much.

2. Estrogen has the most effect on vaginal dryness and atrophy.  If vaginal estriol with hyaluranic acid or DHEA don’t work, low dose estradiol vaginally works amazingly.

3. Improves bone density.

4. Promotes better mood/less depression.

5. Libido is primarily driven by estrogen and not by testosterone, as is commonly thought. 

6. Cognition.

Over replacement.

Taking too much estrogen or having too much estrogen because the ovaries are still putting out some can result in breast tenderness, mood swings, sadness, crying, irritability, acne, spotting, bleeding, weight gain around the waist and hips.  Using Canadian units at the beginning of the cycle, the estrogen’s about 100 and at ovulation it’s about 800.  In the Luteal phase, it’s about 400.  When we use topical bioidentical estradiol we are putting women’s estrogen somewhere around 150-250.  But if they are in perimenopause, sometimes their ovaries will bust out an egg and estrogen levels might surge to 1500, which will cause overreplacement symptoms.

Benefits of Bioidentical Progesterone: 

1. It opposes estrogen and it thins the lining of the uterus and prevents endometrial cancer. You don’t need to use progesterone if they don’t have a uterus.

2. Menorrhagia. Progesterone is amazing at reducing heavy menstrual bleeding. 

3. Sleep. It improves the depth of sleep, though it doesn’t help with the hot flashes that can wake women up as much as estrogen does. Progesterone turns into allopregnanolone, which crosses the blood brain barrier and it improves calmness, stimulates GABA production, and promotes sleep. This is also why oral progesterone should be given at night.

4. It also improves bone formation.

5. It improves cardiovascular disease and promotes the health of the arterial endothelium. It is anti-inflammatory and reduces coronary artery disease.  

Over replacement.

Too much bioidentical progesterone can make women feel groggy, drowsy and retain water. 

52:58  Synthetic Progestins, like MedroxyProgesterone, Norgestrel, and Norethindrone, are not Bioidentical Progesterone.  Synthetic progestins all behave differently but some can cause clotting and proliferation of breast tissue, while bioidentical progesterone does not cause these.

53:52  Androgens.  Menopausal women may have a relative increase in androgens because while androgens will slowly decline with age, estrogen and progesterone levels will drop drastically.  Thus the androgens tend to become more dominant and they can cause hair loss on the head and hair growth in other areas and exacerbate symptoms for patients with PCOS.  Progesterone is actually anti-DHT, so it is an anti-androgen. It can lower LH, so this will tend to lower androgens.  There are also some herbs like saw palmetto that can help.  On the other hand, some patients can benefit from taking testosterone or DHEA, esp. if their levels are really low.

55:41  Herbs.  The first category of herbs are the Endocrine Adaptogens.  These herbs help the endocrine system to adapt to change. Some herbs are androgenic herbs, including maca, tribulus, Panax ginseng, damiana, epimedium, bacopa and Gotu kola.  These herbs tend to help with low libido, fatigue, and energy and they tend to stimulate testosterone. There are other herbs that are estrogen and progesterone types of herbs, including Shativari, black cohosh, wild yam, siberian rhubarb, red clover, Vitex agnus castus, kudzu, Dong quai, and hops. Shativari is an Ayurvedic herb that is helpful during perimenopause for mood, skin, hair, hot flashes, and for energy. Black cohosh is famous for both perimenopause and menopause. It used to be thought of as being a phytoestrogen, but now we believe it works in the brain. We often think of wild yam as mimicking progesterone, but it has to be converted into progesterone in a lab, so just taking the ground herb will not convert and it actually has more estrogenic effects in the body.  Siberian rhubarb, Estrovera from Metagenics, is the top recommendation for hot flashes besides taking estrogen.  Red clover is another phystoestrogen.  Vitex is often thought to be progesteronic, but it is not, though it can encourage ovulation in certain situations, which increases progesterone. Vitex actually acts on dopamine and prolactin in the brain. Vitex can be especially helpful if the patient has amenorrhea and stress, which is usually related to high prolactin. Kudzu is another phytoestrogen that is quite strong and can also help with hot flashes. Hops is also a phytoestrogen. Dong quai is from traditional Chinese medicine and it is a tonic that is similar to shatavari.

1:01:00  Adrenal Adaptogenic Herbs.  Adrenal adaptogenic herbs include Ashwaganda, (Withania somnifera), Holy basil, Eleutherococcus, Rhodiola, Panax ginseng, and sage.  Ashwaganda is a good herb to be given in the daytime for anxiety and irritability. It is also a very calming herb that can be given at bedtime to keep people from waking at night from a cortisol spike.  Holy basil is a good mood booster in perimenopause and it also has nice effects on skin and hair.  Eleutherococcus is an adaptogen that helps to manage stress and it helps energize patients. Rhodiola is a very uplifting herb that can help with low cortisol or depression or fatigue, dopamine problems.  It can also help with attention, brain fog. Panax ginseng actually is quite similar as it is an uplifting, stimulating herb.  Sage is really good for mood, energy, and overall cortisol balance.

1:02:55  Sleep and Mood. Supplements that can help with sleep in perimenopausal and menopausal patients include magnesium, melatonin, valerian, skull cap, passionflower, Zizyphus, and ashwaganda.  Dr. McCulloch likes the Ayur-Ashwaganda from Douglas labs 2 caps before bed is really helpful for preventing the 3:00 AM wake up.  For mood, esp. for anxiety and irritability, GABA, threonine, phosphatidylserine, taurine, Ashwaganda, St. John’s wort, and Vitex can all be very helpful.  It should be pointed out that you can’t combine St. John’s wort with SSRIs.

Dr. Fiona McCulloch is a board certified Naturopathic Doctor and founder of White Lotus Integrative Medicine in Toronto Canada, serving thousands of women with hormonal conditions since 2001. Dr. Fiona’s best selling book 8 Steps To Reverse Your PCOS, offers well-researched methods for the natural treatment of Polycystic Ovary Syndrome. Fiona is also a medical advisor to and developed the nutrition methodology for the OpenSourceHealth PCOS project which analyzes molecular, genetic, metabolic and hormonal markers in women with PCOS. As a woman with PCOS herself, Dr. Fiona feels fortunate to serve as a guide, providing trusted information that empowers women to manage their own health.  Her website is DrFionaND.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:                            Okay. Hello, everybody. I’m Dr. Ben Weitz and welcome to the Functional Medicine Discussion Group Meeting tonight. We’ll be discussing the health challenges and successful strategies and treatments that functional medicine practitioners like us can employ to help women with women’s health expert, Dr. Fiona McCulloch. I want this meeting to be interactive, so please participate by typing your questions into the chat box, and then I’ll either call on you or ask Dr. McCulloch your question when it’s appropriate. May 25th, we have Dr. Mark Pimentel and we’ll be discussing SIBO and IBS. I’m working on June 22nd. I’m thinking about possibly doing one in person. Details still to come on that, probably on adrenal.

                                                July 27th, we have Dr. Dale Bredesen on Alzheimer’s disease. If you’re not aware, we have a closed Facebook page, which is for practitioners only, the Functional Medicine Discussion Group of Santa Monica that you should join so we can continue the conversation when the evening’s over. I’m recording this event and I’ll include it in my weekly Rational Wellness Podcast, which you can subscribe to on Apple Podcast, Spotify, or YouTube. If you enjoy listening to the Rational Wellness Podcast on Apple Podcasts or Spotify, please give me a five-star ratings and review. The latest podcast is an awesome interview with Jeffrey Smith on the dangers of GMO foods and glyphosate and it’ll really blow your mind, so you got to listen to that one. That’s out now.

                                                I want to thank our sponsor for this evening, Integrative Therapeutics. Usually, Steve Snyder’s able to join us, but he’s not able to. He’s attending a naturopathic conference, so I want to tell you about a few Integrative products. Integrative offers several products that help with estrogen metabolism, including Indolplex, which is an enhanced absorption form of DIM. They also have a very good formulation of calcium D-glucarate. They also have a very good quality and reasonably priced Vitex Extract. Finally, Integrative now has an even more advanced form of curcumin with even greater absorption than their Theracurmin, which is currently my favorite form of curcumin. This new product is called Curalieve, and it is an amorphous, solid dispersion of curcumin.   Apparently, curcumin forms crystals, and that’s one of the reasons why it’s difficult to get absorbed. So, this is a solid, amorphous form. I’m not even sure what that is and apparently has way higher absorption rates.

Dr. Fiona McCulloch is a naturopathic doctor and founder of White Lotus Integrative Medicine in Toronto, Canada, serving thousands of women with hormonal conditions since 2001. Dr. Fiona’s best-selling book, Eight Steps to Reverse Your PCOS, offers well-researched methods for the natural treatment of polycystic ovary syndrome.  I’ve referred to that book a lot when dealing with patients with PCOS. It’s really an awesome book. Dr. Fiona is also a medical advisor too and developed a nutritional methodology for the Open Source Health PCOS Project, which is a women’s health technology platform. All the way from Canada, Dr. Fiona McCulloch.  Thank you so much for joining us.

Dr. McCulloch:                   Thanks so much for having me. I always love being on your podcast and presenting. Of course, I love everything about hormones, so I’m really excited to present on this topic.

Dr. Weitz:                          That’s great.

Dr. McCulloch:                   Yeah, so I’m just going to start off talking about perimenopause and menopause. I always find it very hopeful to differentiate between these two, because they’re actually quite different and they need different support, but they both cause lots of different issues. Sometimes perimenopause is actually worse and is often missed altogether. So, yeah, I am Dr. Fiona McCulloch. I’ve been practicing in the area of hormonal health for 22 years in Toronto. I’m a naturopathic doctor and I’m a board member of the Endocrinology Association of Naturopathic Doctors. So, I’ve prescribed lots of hormones. The majority of my practice is polycystic ovary syndrome, menopause, thyroid, adrenals. So, yeah, I really love this topic.

                                                So, first, I just want to talk about the different stages that we see in the lifespan in women. So, the first stage is premenopausal. This is when patients are having regular cycles. It’s generally from the time they have their first period up until usually around 40 or so. Some people have this a little earlier, but for the most part, it’s around this age that we see perimenopause happening. So, around age 39 to 55 is usually perimenopause. We start seeing irregular cycles, changes in cycles, and that’s when lots of symptoms begin as well. Menopause is defined as 12 months past the last menstrual period, and this is where we see a lot of the chronic health risks rising. So, they’re both very important times. They have different sets of problems to deal with.

                                                So, the first thing to know is that perimenopause is a time of fluctuation. So, its very nature is change. It is very chaotic hormonally. I’ll show you what goes on there and why it is so challenging. A lot of the time patients will come in unaware that their symptoms are from perimenopause, because they’re still having periods. A lot of patients believe that until they actually stop having periods that it can’t be related. So, this is something that can be missed a lot of the time. A lot of these patients are diagnosed with anxiety, depression, and things like that. Meanwhile, they’re actually in perimenopause. So, it’s really important to be able to figure out if that’s what’s going on here. So, what is it that causes that to happen hormonally?

                                                So the first thing is that women are born with all of the follicles in their ovaries for their entire life, and the follicles basically house eggs. So, each egg is housed by different cells that make hormones, and these follicles basically are ovulated. There’s an ovulation that occurs every month from one of the follicles. Over the lifespan, the pool of follicles decreases. As you get to the end of the reproductive years, there are far less follicles. When that happens, we start seeing some irregularities. These follicles don’t behave normally. There’s less of them. They release hormones abnormally, and many times they don’t ovulate. So, these are basically the end of the road of the ovulation process, and we’re seeing a lot of inconsistent hormone production as a result of that.

                                                So, if we look at what actually happens on the left side in a reproductive cycle, on the left, this is a normal healthy menstrual cycle where we’re seeing the very beginning of the cycle. A lot of people are not that aware that the estrogen is actually made from the follicle during the process of ovulation. So, at the very beginning of the cycle, over on the left side here, there are these very tiny follicles and they’re not really active. They’re sitting there quite mostly dormant, and the brain will then start to grow a follicle to get ready for ovulation. The inner part of this follicle makes estrogen. That’s called the granulosis cells, and the outer part actually makes estrogen and the estrogen actually will spike up quite high as the follicle enlarges.   So, it makes a lot of estrogen that stimulates the process of ovulation. The egg comes out, it’s ovulated, and then the shell of the egg makes progesterone for two weeks. This is where the vast majority of our progesterone comes from. If you look at the beginning of the cycle there, see how there’s so little? That’s the amount that comes from your adrenal glands. It’s almost nothing compared to how much comes from the ovary. The ovary makes massive amounts of progesterone. The adrenal makes tiny amounts of progesterone. So, throughout the reproductive lifespan, we have large amounts of progesterone for two weeks, very little progesterone for two weeks, but then estrogen goes through this lovely pattern where it’s up and goes up in that pattern to ovulation and then another little bump around the gluteal phase.

                                                Perimenopause, what we see over here is that we have all these follicles. They’re not really functioning normally because they’re old. They’re on their last legs and they’re about to sputter out. So, basically, they just randomly make estrogen. They make estrogen all the time, but they don’t make it in a normal way. Sometimes they make a lot, sometimes they make none. It’s up and down and all over the place. Progesterone only happens when you ovulate. So, you have this little bit from the adrenals, but then that large amount is just not there most of the time. Only when ovulation occurs, two weeks of progesterone are made. That’s random in perimenopause and when it does happen, sometimes it’s way less than you would see. So, you’ve got all this estrogen, almost no progesterone, definitely not that normal half and half pattern that we’re used to having. So, that’s a huge change that we see in perimenopause. So, the two big things are really fluctuating wild estrogen levels up and down and pretty much no progesterone for the majority of the time. We do get some sometimes, but unpredictable.

So, let’s talk about why these wild fluctuations happen in the first place. If we look at what the pituitary gland does, the pituitary gland is involved in very complex control of ovulation.  Whenever your estrogen levels are very low, the brain sees that and says, “Oh, we need to make an egg. Let’s grow an egg.”   It basically sends FSH right down to the ovary, starts to grow the egg, and that’s what makes the estrogen. So, basically the stimulus to grow an egg is low estrogen. Whenever estrogen’s low, the brain’s like, “Push an egg.” So as you can imagine, that drop will make the brain push out an egg. Then we get a big burst, and then maybe that exporters out drops. So, now we get this back and forth, up and down between the brain and the ovaries. So, once the estrogen goes up to the brain, then it stops making FSH. So, sometimes the FSH will be low, sometimes it will be high depending on what’s happening at the time. So, it’s quite random. This shows you what happens when there’s high estrogen. So, high estrogen, the pituitary gland will shut down FSH.  Basically, we don’t need to make an egg. We already have one. The times that that occurs are really right around ovulation. We wouldn’t be growing an egg at that time because we’re already ovulating. We wouldn’t be doing that in the luteal phase, second part of the cycle, it’s already lots of estrogen. So, at those times, we don’t want to grow an egg and that’s totally normal. If someone is pregnant, also, high estrogen, don’t need to grow an egg. In perimenopause though, it’s high randomly all the time. So, basically it’s up, the brain is like, “No FSH,” then it’s down, and then the brain’s like, “Yes, FSH.” So it’s basically up, down, all because of these eggs that are really burning out and not able to do their normal function of ovulation.  So, this is basically this back and forth process, up and down estrogen. Basically, it’s a very bumpy ride. It’s very unpredictable. The reason I’m showing you that is sometimes people test FSH to diagnose perimenopause. That often can be very misleading, because sometimes it’s high, sometimes it’s normal, sometimes it’s low. It’s just all over the place. It’s totally random. So, it’s something to consider, but I certainly wouldn’t say, “Oh, that person has normal FSH, they’re not in perimenopause.” So these are really important things just to understand diagnostically. So, yeah, perimenopause, we see this up, down of these hormones, very random, up and down of FSH, up and down of estrogen.

                                                So, how do we actually diagnose perimenopause given that we can’t actually test these hormones and know if that’s the cause? Really, it’s very easy to tell. So, you use clinical case taking basically if a patient is between 40 and 55 years old and they’re really having persistent changes to their menstrual cycle. So, they’ve always had a 28-day cycle. Now they’ve got a 25-day cycle. Now it’s a 24-day cycle. They have insomnia, they feel different, they feel weird, they’re having mood changes. This is perimenopause. That’s really all you need to know. There’s no test that will tell you more than that. It’s the age range and these symptoms and these changes to the cycle. Menopause is very easy as well. It’s 12 months since the last period.  But in menopause, we do have a very consistent testing to look at. So, the FSH knowledge are extremely high, usually over 30 for FSH.  Estrogen, progesterone will be very, very low. So, yeah, in menopause, you can use these tests. However, it’s also very obvious because the person’s not having periods. So, testing is useful for treatment, but not for diagnosis, because you can diagnose it just by talking to somebody and figuring out what’s happening.

The next thing is that there are different stages of perimenopause to know about, and the first stage can be a little bit subtle. What usually happens is the cycles become a little closer together. So, if somebody had a 28-day cycle, now it’s 25, 24, 23 days, that often goes on for a few years before the next stage of perimenopause.  This whole thing can last around 10 years, but the first stage can be quite long actually, where those cycles are shorter. Then ovulation is occurring early in that first stage. The reason for that is when there’s less follicles, they make less of a hormone called anti-müllerian hormone, which is basically something that slows them down from ovulating too early. So, you just start ovulating earlier and earlier and there’s just less regulation inside the ovary. It just starts pumping out eggs that are maybe working sometimes, maybe not at other times. We also in the later stages, start seeing highly unpredictable cycles. So, the cycles might be months apart. They might be two in a month. They might be bleeding for three weeks straight.  It’s just so unpredictable and chaotic, but definitely, we see a lot of the heavy, heavy long bleeding in this stage and that can be very problematic. That’s where a lot of patients in the old days would be given a hysterectomy, second stage of perimenopause, because unfortunately, they didn’t have treatments for that which we have now. Sometimes it’s still done, but there’s so much more that can be done now. So, we don’t have to have a hysterectomy just because of this last stage of perimenopause. So, the symptoms in perimenopause, if we think about perimenopause as the left side of this graph where the right side is menopause, perimenopause still has estrogen. So, you’re not going to have constant estrogen deficiency symptoms.

                                                They’re going to be fluctuating, but you’re also going to have a bit of chaos and mayhem in how people feel. They feel up and down, mood swings, insomnia. It comes and goes. We see lots of autoimmunity happening here, because the immune system has to respond all the time to these up and downs of hormones, especially estrogen really causes a lot of changes to the immune system. So, migraines, it’s almost like PMS times a million all the time. It’s just up and down, all over the place. So, yeah, a lot of patients come in this stage and they’re like, “I just feel really tired. I have anxiety, I have depression. Something is wrong.” Then nobody ever brings up that they might be in perimenopause. So, this is often misdiagnosis, something else in this stage.

                                                But just to keep an eye out for these imbalance symptoms where heavier periods, irregular cycles, mood changes, sleep changes, a general change in how people feel. It’s all very common. I am sorry, I don’t know why it has gone back there. One second. The menopause stages are really estrogen deficiency symptoms. So, this is where if we’re looking at that right side. There’s really no more estrogen. That’s where you really start seeing things like hot flash. I mean you can have them in the first stage, but in the second stage, the hot flash is really stark, because there’s no more estrogen, insomnia, anxiety, irritability, depression. But these symptoms tend to improve gradually, those top three a little bit as time goes on.

                                                They find in menopause, women, generally, their mood gets better if they’re given a little bit of time compared to perimenopause. But some of the symptoms and risks actually start accumulating from the lack of estrogen. So, that would be things like cognition, cardiovascular risk, insulin resistance, bone density. So, all of those things just continue and get worse over the years, and those are really caused by estrogen deficiency. We also sometimes see androgen excess symptoms like hair growth on the face, hair loss from the scalp. I’ll show you why that happens, because a lot of people are confused in that the testosterone’s actually quite low. So, why is this happening? There’s actually some reasons for that and everyone’s a little different. It depends on their predisposition there.

Dr. Weitz:                          Can I ask, do we understand why hot flashes occur from low estrogen?

Dr. McCulloch:                   So they don’t 100%, but some of the thinking or the newer information is suggesting that people who have high estrogen previously have more hot flash and they don’t 100% understand why that is.

Dr. Weitz:                          I mean, what is the body trying to do or compensate for?

Dr. McCulloch:                   They don’t actually know unfortunately. Yeah, it’s neurological in some way and there’s some pre-programming related to estrogen, but they haven’t been able to figure it out. It’s like a neurological circulatory element. Yeah, there isn’t really good answers on that unfortunately, because some people just have them like their whole life and it’s interesting. But I definitely see it in the patients that have high estrogen. Once they go through the final stages, they often have bad hot flash. It’s a different treatment process to go through those stages. The types of hormone testing that we can do. So, in perimenopause, although we cannot really diagnose it with testing, we certainly want to do testing to understand how we can help these patients because everyone’s a little bit different.  Everybody has different aggravating factors and I find that people’s predispositions are always worse in this phase. So, whatever they have already, it just gets worse.

So, there are different types of testing. I just want to briefly review them. There’s all different possibilities for tests. I mean some of them have pros and cons and it really depends. Sometimes it’s convenience. Sometimes it’s a combination of different tests that will make you choose between one or the other, but blood spot and serum testing is definitely probably the most common type of testing that’s done. It is really good at picking up endogenous hormones.  So, hormones that we make in the body naturally. It is also good at picking up topical estrogen, oral and vaginal hormones. We just have a lot of data on that and what those levels look like in serum. Topical progesterone is not seen very well in a serum test, but it is seen in a blood spot test, because it’s found in capillary blood more so. If you ever do progesterone cream and you run a blood test, you’re not going to see it much there at all. You’re going to see a tiny bit, but if you do capillary blood spot or saliva, you’ll see the progesterone cream.

Dr. Weitz:                          Wow, that’s an interesting pearl right there.

Dr. McCulloch:                   Yeah, it’s one of those things that they don’t actually know how it’s actually absorbed, but they believe might be lymphatic and that’s why it’s showing up that way. But nobody’s actually studied that properly to find out because they believe the progesterone cream isn’t absorbed. So, they won’t study it, but it is. You can pick it up in these tests. So, it is observed and I see that it is different. They’re just different forms. I think in the future, hopefully, that will be studied more so, but urinary metabolites are also very useful. Those show something a little bit different. So, those are going to pick up excretion and break down products of hormones. It can help us understand metabolites.

                                                So, if somebody has a risk of breast cancer, we can understand, “Do they make harmful metabolites of estrogen?” It’s not as good for a topical HRT assessment, because it is excretion and vaginal HRT, it can actually land in the urine. So, those are not really good. It’s not really a good way to assess how is the level in the person’s system, but it’s extremely helpful for adrenal issues because you can understand metabolites of cortisol, total cortisol free. You can do diurnal rhythm. So, it’s a great test for cortisol really, and saliva. So, saliva is interesting in that it’s very good at picking up topical progesterone. It can give you an instant measurement of adrenal free cortisol. It’s easy to do at home, so you can do diurnal. So, yeah, so that is basically saliva.

Dr. Weitz:                          For urinary, do you have a preference for dried urine versus 24-hour urine?

Dr. McCulloch:                   Yeah, I usually do dried urine. Yeah, I usually do that, but I have done 24-hour, just like if some patients don’t want to do the whole dried urine thing. I’ve done that, but I just find that’s good for just total cortisol.

Dr. Weitz:                          In Canada, do you have some of the same testing companies that we have here?

Dr. McCulloch:                   We do.

Dr. Weitz:                          You have the DUTCH testing. Okay.

Dr. McCulloch:                   Yeah, that’s what we use for, this is primarily the DUTCH test. We use ZRT also, but mostly the DUTCH test for the urinary metabolites.

Dr. Weitz:                          Okay. What about for saliva and bloodspot?

Dr. McCulloch:                   For saliva and bloodspot, I use ZRT. They have great tests actually. I really like ZRT. So, yeah, they have a lot. They’re adding more and more too. So, really good company.

Dr. Weitz:                          Cool.

Dr. McCulloch:                   Yeah. So, yeah, it really depends on what you want to know, which tests to do. There’s just many different reasons to choose each one. Lab panels, so these also would be selected for the patient and their risks. So, basically whatever you’re seeing here, don’t get too stuck on it. I see sometimes people doing the DUTCH test and they’re like, “Oh, you have no estrogen,” and then the person’s having periods not regularly, but they are. So, obviously, they have estrogen, but then it has to be understood that these hormones change all the time and that’s normal.  If it’s low, it’s low, but that tells you that sometimes it’s low. That’s all tells you. Other times, it might be high. If they’re having periods, they have estrogen. So, it’s really this understanding, you can look at it under, get a snapshot, but knowing that it changes is very important.

Dr. Weitz:                          Have you used the cycle testing where you test it every day of the month using DUTCH?

Dr. McCulloch:                   I have. I also have the fortune of working with a lot of fertility patients who go through cycle monitoring at fertility clinics. So, I get that, which is really cool, because then it’s repetitive. They’ll do a bunch of them, so I get to see that too. We do the cycle testing, so it just depends, but a single cycle’s really only a single cycle too. So, sometimes it just depends on what I’m trying to learn from that. Sometimes it is useful to figure out what’s going on. So, yeah, the estrogens, progesterone. So, the strong estrogen is estradiol. The other estrogens are estrone and estriol, and then there’s progesterone. So, all of these can be measured in blood spot and metabolites. The androgens can be measured.  I often do that in patients who have PCOS, because there’s a group of patients with PCOS whose androgens actually go up in perimenopause. Their DHEA shoots up through the roof and they get high testosterone and then they have all kinds of problems. They’ll lose all their hair or something like that very suddenly. So, those patients, I always test their androgens. Other patients, usually they’re going to be low, but there’s this category of PCOS patients where it goes up quite high actually, which is not fun for them, because they’ve gone through their whole time and now again, they have to deal with this problem. So, it’s good to make sure that’s what’s happening.

                                           The cardiovascular elements, I always test that, lipids, ApoB, CRP, homocysteine, insulin resistance, so HOMA-IR, A1C, glucose. Oral glucose tolerance test with insulin or even just fasting insulin can be really helpful. Liver enzymes to look for fatty liver, especially ALT, can be quite sensitive for that. Iron panels can be really helpful too in understanding fatty liver and then iron deficiencies in perimenopause are very common with the heavy periods and a full thyroid panel because a lot of people develop Hashimoto’s in this phase. Cortisol is really important. I really do like to do the diurnal cortisol whenever possible. Sometimes I’ll just screen it if the patient doesn’t want to pay for that test, but I’ll screen it with serum.

                                                Metabolites are really useful for someone with a complex condition. Other considerations, anti-müllerian hormones. So, sometimes say if a patient’s 36 years old, they’re too young for menopause, but they’ve had regular cycles, now of a sudden they’re irregular. If you want to find out, “Are they in perimenopause early?”, you can run AMH and that will tell you they have a very low egg reserve. They’re probably having those symptoms from perimenopause. FSH and LH, again, they’re high in menopause. In peri, they’re up and down all the time. Sometimes they look totally normal and sometimes they look really high, but they just move around. So, yeah, the labs are all very individual.

So, nutrition generally, of course like anything, a lot of different nutrition plans can work.  I don’t believe in any particular nutrition plan. I’m like, “What works for this patient that’s the healthiest way that they can eat according to their lifestyle?” But a Mediterranean low GI diet or an adaptation of that is often very helpful in this category for cardiovascular disease. Cruciferous vegetables, lots of those will help with estrogen metabolism, preventing breast cancer, but also antioxidants with sulforaphane, that really helps with cardiovascular disease, insulin resistance, cellular overgrowth and cancer prevention. Lignans and flax seeds, sesame seeds, they mimic estrogen.  They can have some really good benefits. CalMag mineral formulas are really critical. So, many patients will start to develop osteopenia as soon as their estrogen starts dropping. So, these are really important. Usually, they should have all the minerals and vitamins that go along with calcium and magnesium, like vitamin K2, boron. So, all of these micronutrients are really important.

Dr. Weitz:                          Steve asked about soy. What do you think about soy? Soy?

Dr. McCulloch:                   So soy, if it’s non-GMO and organic and the person doesn’t react negatively to it, is not sensitive, I’m actually fine with it. I think what the research shows is it’s beneficial. As long as it’s not GMO and not sprayed with tons of glyphosate. If it is, you don’t need it. Yeah, it’s sprayed with a lot of glyphosate, conventional soy. Still controversial though, right?

So the next thing I’m going to talk about is this study, the WHI 2002 study. Probably everybody remembers this study because they ring the alarm bells. They stopped this study. It was all over the news. HRT’s going to kill you, give you a heart attack and give you breast cancer and we need to stop it right away. I remember that very well. I remember being afraid of it and being shocked, because I had just graduated school at that time.  “Oh, wow, this is really dangerous” was my thought at the time. That thought has persisted. So, basically, it was the oral estrogen and synthetic progestins were reported to increase the risk of clot and cancer. However, what they said was HRT will give you heart disease and cancer. What we know now is that the statistical analysis and breakdown of that and the updated research has showed us that that was quite unfounded and also that there are very specific things to know about HRT that really are involved in that risk that we saw, but something to consider is that in that study, the average age was 63 years old. 70% of the patients were aged 60 to 79, 10% were aged 50 to 54.  It was using conjugated equine estrogen, which is synthetic oral estrogen, and synthetic progestin, which is oral hydroxyprogesterone. These are very different than what we use now. 50% were current and past smokers, 35% with hypertension, 70% were obese, and there was no control for atherosclerosis. So, so many flaws, just to say across the board. This causes heart disease. No, this is a very confounded study with lots of things that weren’t controlled for. So, even just looking at that alone tells us that needs more analysis. But if you want to go through this chart later, this is the breakdown of those studies and actually what the conclusion was.

                                                What you’ll see if you look through that is that really, even with these CEE estrogens, the most dangerous kind, there really isn’t an increase in the risk unless the progestin was added to it. So, that’s very important to know in that even the worst kind of estrogen did not have that risk in particular. Now, we just know so much more even that we would never use that estrogen now. So, I’ll show you the breakdown of what we know as a summary. So, this is just a summary of everything. All the research that we have now, topical estrogen, so transdermal patches, gels, creams, these are much safer than oral estrogen. The oral estrogen turns into metabolites in the liver that cause clot and thrombosis. We see that with birth control pills.  We’ve known that for many years that they cause clot and thrombosis. So, it’s really not a surprise that the oral estrogens cause that. Transdermal does not seem to cause this. So, this is really good news. Transdermal estrogen and progesterone together, and this is using a synthetic progestin because they haven’t got enough research yet, even on micronized progesterone, natural progesterone. But even that combination does not increase breast cancer risk up to five years past the last menstrual period. Synthetic progestins clearly increased clot risk. We’ve always known that. They’re in birth control pills, Provera, Depo-Provera. All these things we’ve already known, they increased clot risk. So, it’s absolutely no surprise that they do that in menopause and they’re very strong.

                                                Compared to natural progesterone, they’re like orders stronger. So, it’s not necessary to take something like that. Plus, it doesn’t act like progesterone anyway. But we don’t see that risk with micronized progesterone. They have not found any thrombotic risk with that. We do need more research to understand long-term safety, but so far, it really looks quite safe, which makes sense considering this exact form our body makes. Initiating HRT after age 60, so this would be not being on any HRT at all, going completely with no hormones for maybe 20 years. Sorry, not 20 years, maybe something like 10 years. The average age is about 50, 51.  If they were to initiate it 10 years later, there was an increase in cardiovascular disease, breast cancer in obese, smokers, and hypertensive people. Why is that? We don’t know 100%, but what we think is that those people have a lot of plaques on their arteries in particular. They just develop lots of plaques in that time and then the estrogen softens those plaques and that can cause a risk. So, for that group of people, it does seem to be a bad idea to start it after 10 years. That being said, we still need more evidence on that, but for those people, it’d be best for them not to wait. They might just be accumulating so much risk. Oh, I am sorry about that. I do not know why.

Dr. Weitz:                            So interesting. So, you’re saying in particular women who have calcified plaque might potentially be at more risk because the estrogen might make the plaque less stable.

Dr. McCulloch:                   Yes, it softens it. So, if they initiate it within 10 years, though we don’t see that risk. It’s only if it sets in for that time and it’s only in these risky groups. So, they already have a lot of plaque and then they’re probably rapidly getting a lot of plaque in that 10 years and then the estrogen softens it and may cause an event.

Dr. Weitz:                            So I wonder what you would think about a woman who’s suffering with the beginning stages of Alzheimer’s, let’s say she’s 65 or something and has not been on hormones and now we think that perhaps going on hormones might be beneficial. I guess you have to weigh both factors.

Dr. McCulloch:                   You’d have to weigh it. What I expect to see is that we will learn how to do that. There’s probably a way to initiate it or a dose to initiate with in people with cognitive, but it’s hard to know. If they don’t have those other risks, maybe it will be fine for them. It’s just like for the safety data, it’s going to take time to get that. Yeah, I personally think for cognition, it’s going to be continued quite a long time once we get the data on that.

Dr. Weitz:                            Yeah.

Dr. McCulloch:                   Yeah, initiation within 10 years of the last menstrual period is protective against cardiovascular disease. So, it actually reduces the risk of cardiovascular disease across the board. So, it’s a great idea to go on anytime within that 10 years. That’s quite a long time. Obviously, if you can go on it immediately, that’s great, but you don’t have to. So, lots of protective effects there. In patients with a uterus, it’s very important that whenever there is estrogen, there absolutely must be progesterone added as well. It has to be oral or vaginal, because transdermal progesterone is not strong enough to consistently deal with the lining and reduce the risk of endometrial cancer.   So, it has to be something like oral micronized progesterone or vaginal progesterone. I tend to use vaginal progesterone in patients with extreme heavy bleeding in perimenopause because it works really well. Outside of that, I would use oral micronized progesterone just because it’s great for sleep.

Dr. Weitz:                            Do you cycle the progesterone two weeks and in two weeks now, or do you have women take it every day of the month?

Dr. McCulloch:                   So I always cycle it in reproductive age women. In perimenopause, if their cycles are highly irregular, I find cycling it actually causes more bleeding problems off and on. So, I just tend to do it continuously, especially if they have heavy bleeding. In menopause, once they’re past full that full year, unless the progesterone’s helping them, you can do it 12 days a month. If they feel good on it though, you can do it every day. If they’re like, “I sleep better on the progesterone,” they can do it every day, but a minimum of 12 days, we’ll deal with the lining risk.

Dr. Weitz:                            Steve is asking, “Do you use ultrasound to check uterine lining thickness if on progesterone?”

Dr. McCulloch:                   Yes. So, I do. Because I deal with a lot of patients with PCOS, I have a lot of patients who’ve had endometrial hyperplasia and cancer in my practice. In perimenopause, most of the time that there’s bleeding, it’s not endometrial hyperplasia, but if a woman is past menopause and you see a bleeding, that is not normal. So, definitely do an ultrasound. I always do a baseline ultrasound anyway, just to have a good look and make sure nothing else is going on, especially if they have just dysfunctional bleeding. But I find in perimenopause, once they’re on really consistent past three months, you don’t really see a lot of dysfunctional bleeding.  As long as they have estrogen in their body naturally and their eggs can have any capacity to make them, you will still see spotting, bleeding. So, yeah, peri and menopause are a little different that way, but yeah. Contraindications and this is from North American Menopause Society, undiagnosed vaginal bleeding. So, obviously, if somebody’s just hemorrhaging and you don’t have an ultrasound, it’s important to do an ultrasound just to make sure nothing is wrong. So, obviously, before starting estrogen, if somebody’s having three-week long periods, do an ultrasound. First, diagnose. It doesn’t mean that you can’t give because progesterone will solve that problem for a lot of people. Yeah, but do the ultrasound first.

                                                Suspected or known BRCA genes really should not be taking any estrogen. Estrogen dependent cancers of any sort should not be taking estrogen. Acute liver disease, this is more for oral estrogen, but it’s implied in the packaging. It doesn’t mean that somebody can’t take this if they have fatty liver disease, for example. This would be something where the person is actually very sick at the time with something and then venous thromboembolic disease. It’s just a contraindication. So, that’s somebody with like a DVT or a PE at the time really.

Dr. Weitz:                            What about particular types of topical estrogen? So for example, estradiol versus estriol. Some people feel that estriol is safer, has less risk for maybe somebody who’s at higher risk for breast cancer.

Dr. McCulloch:                   Yeah, so compounded HRT is often called Biest, which is a combination of estriol and estradiol. The trend before used to give a large amount of estriol, so 80/20 where you were giving a lot of this estriol and the thinking was that estriol is protective against cancer. Estradiol is the bad estrogen and it’s going to cause cancer. But now, we actually have learned differently in that if you give too much estriol, it can block the receptors for estradiol and then you have to give more estradiol and you’re ending up giving much more than you need to. You’re just basically giving way too much.  So, now, mostly, they are 50/50 if you’re doing Biest. So, usually 50/50. I always target though to the estradiol when I’m looking at the dose, because that’s the one that makes the person feel better is generally estradiol. The estriol is there to mitigate risk and it can possibly help with some symptoms, but it’s very subtle compared to estradiol, which has a massive clinical effect for people. They used to have Triest, which was estrone, which is now not a good thing at all. Yeah. So, things have changed quite a bit with that.

Dr. Weitz:                          Well, in the category of women who are nervous because they feel like they have an increased risk of breast cancer, what about women who are afraid of taking estrogen, but they want to do something about the vaginal dryness and atrophy and stuff and they want to do something topically?  Some people have recommended topical intravaginal DHEA, intravaginal testosterone versus intravaginal estrogen and estradiol versus estriol. What do you think about what is the best and safest?

Dr. McCulloch:                   Yeah, those are all great. Actually, I have a slide on this. One second.

Dr. Weitz:                          Okay. Sorry.

Dr. McCulloch:                   No, I’m going to bring it up now because it’s like a perfect time too. But yeah, the DHEA actually is really a great option for vaginal tissue. So, it really can be used vaginally. It definitely can make a difference. The other thing is you can do just estriol with hyaluronic acid. That is a really good combination I use a lot. It’s very moisturizing, the hyaluronic acid. So, it retains the water and fluid. Then the estriol does have an effect in the local area. There’s also low dose vaginal estrogens like Vagifem, the very tiny amount. That works amazingly well. So, if it’s really just vaginal atrophy, dryness, that can be great. So, any of these can be awesome.  I think there’s the brand, they’re called something cube, I’m sorry. It’s in the US. We don’t have it here, but I wish we did. There’s these cubes. I think they’re called something cubes, and they have DHEA progesterone. I’ll get the name for you, but you can order them. They’re all vaginal, Bezwecken. They’re called Bezwecken Cubes. So, they have all these different types of vaginal treatments that are basically a variety of these different types of options that don’t have estradiol in them.

Dr. Weitz:                          Are those over the counter or those prescription?

Dr. McCulloch:                   They’re over the counter.

Dr. Weitz:                          Wow.

Dr. McCulloch:                   In the US. Yeah, they are. So, they’re really cool and they’re quite popular. Patients will say they’re very good. We just don’t have them in Canada, but I’ve heard a lot of the US patients tell me about that.

Dr. Weitz:                          Cool.

Dr. McCulloch:                   Yeah, so if I go to this slide, I just want to talk about the difference between estrogen and progesterone clinically and what you would expect to see because they have actually different effects. So, the estrogen, what you can expect to see that have an effect on hot flash, it’s like the best thing for hot flash by far. Some people will say progesterone helps with hot flash and it can, but not that much. It’s estrogen that really helps with hot flash. When someone is on estrogen, their hot flashes go away. It’s very intense on in its effect that way, even not at a very high amount. So, it really does help with that.

Dr. Weitz:                          Maybe you’re going to get to this, but what about supplements that might be beneficial for hot flashes?

Dr. McCulloch:                   I do have. Yeah.

Dr. Weitz:                          Okay. Well, hold the question there.

Dr. McCulloch:                   There are certain ones that are really good for hot flash.

Dr. Weitz:                          Okay, we’ll hold it.

Dr. McCulloch:                   Yeah. The vaginal dryness, really estrogen is the one for vaginal dryness, but you can do local estrogen like these Vagifem or these cubes or suppositories. You can do estriol. If estriol and something like hyaluronic acid or one of these other ones doesn’t work, you can try the low dose estradiol vaginally. So, vaginal dryness, it works amazingly. Bone density, same thing. So, mood is a big one. Estrogen really lifts the mood. It’s helpful for depression especially. So, a lot of people will feel their mood is so much better and they have more energy.

                                          I should have mentioned in this section two, libido in women is primarily driven by estrogen. A lot of people think it’s testosterone, but it’s actually estrogen that drives a lot of the libido in women. So, sometimes with the patients, you’ll give them testosterone or DHEA or something, because in women, DHEA turns primarily into testosterone. They don’t have any change, but you give them estrogen, all of a sudden, their libido’s amazing.

Dr. Weitz:                          Where does that myth come from that women’s drive comes from testosterones?

Dr. McCulloch:                   I mean, I think part of it does, but I think more of it is from estrogen.

Dr. Weitz:                          Steve says that’s because information comes from men.

Dr. McCulloch:                   Right, yes. That’s probably part of it. But if you think about estrogen rises at ovulation, that’s when you have a massive spike of estrogen. Right at ovulation, there’s a little rise in testosterone, but a massive rise in estrogen. It’s like that combination is probably what does it. So, yeah, but I always bring that up because sometimes people don’t think of estrogen that way. Then cognition, for us to say with 100% certainty, it does help that. We don’t have enough evidence, but there was another study that came out. It really looks like it is going to be a big thing for preventing Alzheimer’s and improving cognition. Too much estrogen replacement will cause breast tenderness, mood swings, sadness, crying, irritability, acne spotting, bleeding, weight gain around the waist and hips.

                                                So, those are over replacement. That being said, when you’re using topical estrogen in these amounts, which are not very high, it’s not that common to have that. Often, it’s just that you haven’t balanced it properly with the progesterone. Sometimes the high estrogen is actually coming from the person’s ovaries. The estrogen replacements we do in our Canadian units. I’m sorry, I don’t know the US conversion, but I’ll use the Canadian ones. Say at the beginning of the cycle, the estrogen’s about 100. At ovulation, it’s about 800. In the luteal phase, it’s about 400. So, when we’re using these topical estrogens, we’re putting people’s estrogens somewhere about 150 to 250. So, they’re nowhere near any of these reproductive levels.

                                                They’re at a low level, but sometimes their ovaries bust out an egg and makes a 1,500 of estrogen. That’s what causes those problems more so rather than these replacements. So, that’s where you’ll see it. It’s endogenous estrogen in perimenopause. Progesterone is essential with estrogen in anybody who has a uterus. If the person has their uterus removed, you don’t need to use progesterone. It’s not necessary to prevent the cancer risk. However, also, it has a lot of benefits. So, the first thing is it does oppose the estradiol. So, it thins the lining and prevents endometrial cancer. It is amazing for heavy bleeding. This is my top treatment for heavy bleeding. I use it all the time. It works so well.

                                                Vaginal or oral micronized progesterone and this is in perimenopause, I’ll often start with that and using a high enough dose that it’ll eventually stop the bleeding or turn it into light spotting. Once that happens, then you can start looking at estrogen if it’s needed, but it’s so amazing for menorrhagia and can prevent so many patients from having surgical procedures or going on other types of treatments. So, it’s something I use all the time. It’s great for sleep. It improves the depth of sleep. There’s a metabolite it turns into called allopregnanolone that can cross the blood brain barrier, and it does improve calmness, GABA, sleep. It’s very relaxing. So, a lot of patients will say, “Oh, I just slept so much better.” It doesn’t deal the hot flash as well as estrogen that wakes people up, but it definitely is very calming.

                                                So, the combination can be amazing for sleep. It does increase bone formation. Estrogen does a little bit more that way, but it definitely does that too, cardiovascular disease. So, it is really good for the endothelium. It’s anti-inflammatory. It also prevents coronary artery disease. Because of its anti-inflammatory effects, that’s most likely. So, it’s actually the opposite of synthetic progestin, which increases the risk of all of these problems. Over replacing bioidentical progesterone, it’s very interesting. The first month that you give somebody this, there’s something called crosstalk. If they have a high estrogen and they’re going to have more symptoms in the first month, that’s because their hormones…

                                                I always just explained to some that your hormones are ironing themselves out. They’re resetting. Hormones are complex because they’re all made by the ovary. These eggs have been going through different things ongoing. You have to wait for them to burn out and for the next stages to start. So, the over replacement symptoms are not often actually over replacement. They’re just initiation of progesterone in a high estrogen state. Secondly, too much progesterone could cause that in certain people, but we always give progesterone at bedtime, because consistently, oral progesterone makes people feel groggy and tired. It’s just the metabolites it turns into. So, vaginal does that far less and so does cream, but oral is quite likely.

                                                But when it’s given that bedtime, people are sleeping, so that’s great, they just sleep better. Then water retention sometimes, but that tends to resolve in time as patients get used to it as well. Then I just want to mention one more time that progestins are not the same as progesterone. There’s something called hydroxyprogesterone that sounds like progesterone. It really does, and even pharmacists can be confused about this. So, it’s really absolutely not the same thing as micronized progesterone. Very different altogether. So, always just make sure that it is actually micronized progesterone. Synthetic progestins, they all behave differently depending on the kind they are.

                                                Some of them actually proliferate breast tissue, and whereas natural micronized progesterone does the opposite. So, many of them increase the risk of clot. So, they’re all different, but they’re just substances that basically will thin the lining in the same way, but will not really improve the other elements that progesterone does. Androgens are a little complicated. So, because a lot of my practices in polycystic ovary syndrome where people have high androgens throughout their life, I actually see a lot of these patients who go through menopause. But what you’ll see is a lot of menopausal patients, even if they don’t have PCOS, they start to get androgenic symptoms. The reason for that is testosterone does decrease with age, but it’s gradual. Whereas these other ones, it is just like blam, none at all really compared to before.

                                                I mean, there’s a little bit left, but not much at all. But the testosterone’s still there. So, it becomes a more dominant hormone in the skin, for example, where it can exert things like hair loss or hair growth here. So, sometimes patients have this relative excess of testosterone, and sometimes you need to treat the DHT in the skin or treat it another way. Interesting thing is that progesterone is anti-DHT, so it is an anti-androgen. It can lower LH, which tends to encourage more testosterone. So, if a person has a lot of those types of symptoms, you can use progesterone as one of the treatments or things like saw palmetto, other types of herbs like that. But then there are some people who really do benefit from androgen replacement, DHEA, especially if they have very low DHEA, very low testosterone.

                                                If they don’t have these side effects, they can do really well with it. So, it just really depends on the person I find. I don’t want to be it too high in testosterone compared to the other hormones generally. The next one here was the DHEA. So, we already chatted about that, but this is a study, if you’d like to read it, just about DHEA and vaginal tissue. I’m just going to go into some of the herbs. There’s a category of herbs that I like to call endocrine adaptogens. So, that means that they basically help the endocrine system adapt to change. So, just adaptogens with the adrenals that help us adapt to stress and changes in cortisol, we also have herbs that either mimic hormones, fit into hormone receptors, or have hormone effects.

Dr. Weitz:                            If you don’t mind taking a question, Rosita is asking, “If a patient complains about weight gain when starting HRT, what can be done?”

Dr. McCulloch:                   Oh, yeah. So, normally, people lose weight when they start HRT. So, I would say I would look at what they’re taking firstly and be like, “Are they on a synthetic progestin?” Because that causes weight gain for sure. For most people, Provera causes weight gain guaranteed for almost everybody, like 10 pounds. Birth control pulls are the same. So, I would be like, “What’s their progestin? What kind of estrogen are they taking? Is it transdermal? Secondly, do they have something else going on their thyroid, for example?” Because estrogen affects the thyroid quite a lot. When you give estrogen, it binds thyroid. Thyroid binding globulin goes up when estrogen goes up. So, sometimes just the menopause and then going out of it will bring up that element.  So, I would just assess every single thing and see why that might be happening. Because normally, they should actually lose weight on estrogen, especially. Yeah.

So, these are our endocrine adaptogens. These affect our hormones. So, the sex hormones primarily, estrogen, progesterone, testosterone, these ones here. So, the left-hand side, these are androgenic herbs. They have androgen promoting effects primarily in women, which are different than in men. So, some of the herbs that we’ll see for men and women are just a little bit different because androgens can have dimorphic effects. So, they’re like maca, tribulus, Panax ginseng, damiana, epimedium, bacopa and Gotu kola. These tend to be more like stimulating testosterone types of promoting herb. So, people who have low libido, fatigue, energy.   On the right side are the kinds of estrogen, progesterone types of herbs that really help with these symptoms related to those problems. So, hot flashes, vaginal dryness, menstrual symptoms, insomnia and mood, any symptoms of estrogen deficiency. So, shatavari is tonic generally from Ayurvedic medicine. It’s a really great herb I find for perimenopause, for mood, skin, hair, hot flash energy. Black cohosh is very famous for perimenopause and menopause. It used to be thought of as being a phytoestrogen, but now, actually, they believe it works in the brain and not as a phytoestrogen. Wild yam, dioscorea is often thought of as mimicking progesterone, but it actually has to be converted into progesterone in a lab.  It can be, but it is not progesterone. In fact, it seems to have effects on estrogen primarily. Siberian rhubarb is one of the phytoestrogens that is most effective for hot flash. So, that is my top one that I usually recommend for a hot flash right now. So, I really like Estrovera by Metagenics for this, and they actually have a guarantee. If it doesn’t get rid of the hot flashes within two months, I think it’s two months, they’ll give you your money back or reduce them. It does work, I find, not as well as estrogen, but for people that can’t take it, I find this extract is pretty good for hot flash. Red clover is another phytoestrogen. Vitex is probably one of the most misunderstood herbs. It’s thought of as being progesterone, but actually, Vitex is not directly progesteronic. It’s those that research is because it can encourage ovulation in certain situations, which increases progesterone. But for the most part, Vitex acts on dopamine and prolactin in the brain. So, if somebody has amenorrhea and stress, often they have high prolactin. If they have hypothalamic amenorrhea, this is a helpful herb. So, if there’s like a mood component and a change in cycles, it can be helpful, especially with prolactin being high. Kudzu is another phytoestrogen. It’s quite strong, I find. So, for hot flash, it can be useful. Dong quai is from traditional Chinese medicine, Angelica. I find it similar to shatavari. It’s like a tonic generally. Hops is another phytoestrogen.

                                                Okay, and the next section is the adrenal adaptogens. I like to include these because they’re super important. They’re just a little bit different than the endocrine adaptogens. The first one is Ashwaganda, Withania somnifera. This is my favorite adaptogen for stress and sleep and for anxiety. It’s a very calming adaptogen. It takes it down a few notches. It’s great to give it bedtime, to keep people from waking up in the night from a cortisol spike. So, that is my favorite way to use Ashwaganda, or I also give it in the daytime for people with anxiety, irritability. Holy basil is a really nice herb because it really is a good mood booster in perimenopause. Plus, it has some really nice effects on skin and hair. So, a lot of patients like it.   Eleutherococcus is a really great adaptogen. I always think of it as a stress shield. So, if life is stressful and you’re on eleuthero, you will not feel the stress as much. It gives energy. It’s a really good tonic. It’s great for people who want to start working out. So, I do really like an eleuthero. Rhodiola is a very uplifting herb, so I find it’s very good for people with low cortisol or depression or fatigue, dopamine problems. It can help with attention, brain fog. Panax ginseng actually is quite similar to it’s uplifting, stimulating. For people who have more anxiety, it might not be the right fit, but for people with a lot of fatigue and low testosterone, it’s a really good one. Then sage is really good just for mood, energy, overall cortisol balance.  So, often it’s added into formulas, herbal formulas.

                                                  The next slide, sleep and mood. So, sleep and mood, I want to include some of the natural treatments here because it’s probably one of the most common complaints. So, on the left side, I have some of the treatments I tend to use for insomnia. Now, of course, HRT is going to have the biggest impact on this because it just resolves it so well for so many people. So, I always start with progesterone if they’re open to it because it helps so much. But magnesium, melatonin, these melatonin with sleep onset. Magnesium is just something that is one of those general supplements that everybody should be on if they’re having a sleeping problem because most people are deficient in magnesium and the herbs.  So, there are many herbs that you can use for sleep, valerian, skull cap, passionflower. Zizyphus is one of my favorite herbs for sleep. It’s often not even considered, but it’s a great herb from traditional Chinese medicine for sleep. Then Withania, so Ashwaganda. So, I use that a lot at bedtime. I really like the Douglas Labs’ Ayur-Ashwaganda, so I just find that extract really good. Two of those at bedtime is really helpful for preventing the 3:00 AM wake up. Anxiety and irritability, so of course there’s so many options here too, but we’re looking at all of these nutrients like GABA, threonine, phosphatidylserine, taurine.  Again, Ashwaganda, St. John’s wort, which you can’t combine with SSRIs and Vitex actually helps quite a bit with irritability and anxiety and other kinds of mood effects. That is all that I have presenting to present today. So, do you have any questions? I’m happy to answer.

Dr. Weitz:                          Yeah, no, that was great. Excellent. Good information.

Speaker 3:                         I got a question, Ben.

Dr. McCulloch:                   Yes.

Speaker 3:                         My wife is on 0.0125 Vivelle-Dot estradiol, and she’s on compound microdose pharmacy 100 milligrams of progesterone. She’s been on that since menopause. She’s doing fantastic. The question is about pulsing that. Some people say not to, some say to do it. We haven’t done it. She’s doing great as she is. Is there any problem with that Vivelle-Dot? She’s doing great.

Dr. McCulloch:                   I don’t think that there’s any reason that we’ve ever learned that it should be pulsed. Sometimes that makes people bleed and spot. So, they used to be like, “Oh, the receptors.” But what we know is that reproductive age women always have estrogens. The receptors don’t go away just because the estrogen is at a certain level. When the estrogen goes away, the receptors go away. So, keeping the estrogen there is probably better for the receptors, but they’re very-

Speaker 3:                         How long will she have to be on this, the rest of her life far as I’m concerned? I mean, when she’s 95, we’ll stop it.

Dr. McCulloch:                   Well, right now, what we know is that it’s safe up to 10 years. It’s safe up to five years after the last period with progesterone if it were a synthetic progestin. We don’t have enough data to say that natural progesterone is safe past that, but it probably is because it’s never been shown to cause clot. So, they’re going to have to have the research to show that it’s safe to 10 years like estrogen and then we don’t know beyond that point actually.

Speaker 3:                           Wow. So, she’s going over 10 years. Oh, wow.

Dr. McCulloch:                   There’s lots of people on it past 10 years and they’re generally doing very well. I think this is just the research has to be done.

Speaker 3:                         Thank you.

Dr. McCulloch:                   Yeah. When I graduated school, there was doctors doing HRT in our city and they have had patients on it for decades doing well. So, yeah.

Speaker 3:                         Thank you.

Dr. Weitz:                          What about, is there value in tracking the estrogen metabolites through the urine testing to see how they’re metabolizing it and then using particular supplements to try to influence that to make sure that they’re metabolizing it along the safest possible pathways?

Dr. McCulloch:                   Yeah, exactly. So, I think you can do the DUTCH test, take a look at what’s happening there, if there’s anything risky. Breast cancer is complex. It’s not estrogen. It’s the entire situation and then estrogen just feeds it, but that can be done. Then just the dose is generally so small in these groups. We don’t use large doses. The older people get, the less these large doses are ever going to be needed. So, it’s like a tiny baseline just to prevent the receptors from going away and give that little bit of stimulation. So, there’s probably lots of ways to make it very much safer.

Dr. Weitz:                          I mean, I know there’s a concern that as women go through menopause, there’s an increased risk of bone density. Do you recommend particular strategy, supplements during that period to maximize bone density or limit bone loss?

Dr. McCulloch:                   Yes, 100%. So, the HRT definitely is a huge thing that is the top thing. Then a really good bone mineral formula, something that has the whole array of nutrients, something like we have here, Ortho Bone, but there’s so many other products like this out there. I know we have a lot of Canadian products, but one of those bone formulas that has a good quantity. Then exercise is critical. I recommend exercise for everybody. Even if someone isn’t that mobile, there’s also whole body vibration that’s been shown to have a lot of effect on osteoporosis.  Anyone can do that really. You can get the plates at home. Even somebody who’s disabled can do that. So, there’s lots of things like that that can be done and phytoestrogens might help, but it’s not a lot not compared to estrogen.

Dr. Weitz:                            Rosita asked about using DIM for estrogen dominance or PMS symptoms.

Dr. McCulloch:                   DIM is a really good supplement to lower high estrogen. So, somebody consistently has high estrogen and perimenopause, it can be really good. It can also direct it down a less harmful pathway to be eliminated. Making sure no constipation is very important too, so that it doesn’t get reabsorbed back in the gut. You can use calcium D-glucarate to make sure that that happens too, because it keeps it from breaking down basically in the gut and getting reabsorbed. So, someone has a gut issue, high estrogen, you probably want to deal with constipation and add D-glucarate with the DIM too.

Dr. Weitz:                          Now, I have talked to some doctors who say every time they put women on HRT, they automatically give them DIM and calcium D-glucarate and iodine or something like that.

Dr. McCulloch:                   Yeah. I don’t tend to do that because DIM lowers estrogen. So, sometimes that can be not a good thing and that you’re giving it and it’s going out. So, you have to know what’s the reason for that. Because DIM as a concentrated supplement is very different than eating those vegetables that have I3C. So, I usually do that in a response to something very specific I’m seeing.

Dr. Weitz:                          Right, yeah. Treat each case specifically. Allison is asking about AMH levels in perimenopause.

Dr. McCulloch:                   So AMH levels in perimenopause are always low. They’re never going to look good unless someone has PCOS. In some cases, they actually still have really good AMH, so they tend to go through menopausal later. But for most people past age 40, there’s really not a lot of point of testing AMH because it’s just going to look low. You can already tell from their age and their pattern of their cycles if they’re in perimenopause, but in a younger woman, sometimes you can’t tell that’s what’s going on. It might be they have stress, they lost weight or something else.  It’s causing the cycle irregularity. In perimenopause, it has a pattern like it’ll shorten and it’s consistent. It doesn’t go back. It just continues that way, marching along towards the end. So, you can do it and it just depends on the situation. If you’re really not sure, you can definitely do it, but it should be very low.

Dr. Weitz:                          Okay. So, I think we’ll conclude. Thank you so much, Fiona. It was awesome.

Dr. McCulloch:                   Thanks. I’m glad it was helpful.

Dr. Weitz:                            Yes, absolutely. Thanks, everybody, and we’ll see you next month. 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 discover the Rational Wellness Podcast. I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So, if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

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Dr. Dominic Brandy discusses Natural Insights into Cancer 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

2:25  Dr. Brandy explained that his journey started in September 2017 when he and his wife were on a Viking cruise and he read the book, How Not To Die by Dr. Michael Greger.  How Not To Die has lots of scientific references and shows that eating a plant based diet is associated with lower rates of cancer and other chronic diseases, including diabetes, cardiovascular disease, and dementia. Gregor also discusses the Blue Zones where Dan Buettner looked at regions in the world where people lived the longest, including Loma Linda, California, where most people are Seven Day Adventists and they are vegetarian, don’t drink alcohol, and exercise a lot. The average woman there lives 10 years longer and the average man lives 14 years longer than the average American.  Dr. Brandy started right then to eat a plant based diet.

6:25  When Dr. Brandy came home the last week of September he was doing a surgery case and he felt a pop in his right collarbone.  This pain then got worse and worse and on November 10th he went to pick up a container of water and his clavicle cracked in half.  He went to the Urgent Care center and got an x-ray. Then he got an MRI and his orthopedic surgeon told him that he either had multiple myeloma or a cancer metastasis. He had a biopsy and lab work, which confirmed IgA multiple myeloma free Kappa chain. Dr. Brandy’s oncologist recommended a triple drug regimen of a common medication for myeloma, a corticosteroid and Velcade, a proteasome inhibitor. Dr. Brandy accepted with the first two medications but rejected Velcade, because its common side effects include peripheral neuropathy, which is bad for a surgeon.  Then Dr. Brandy researched every thing he could do from a diet, lifestyle, and nutritional supplement perspective and started employing them.  He started taking various herbs, employed exercise, stress reduction, sleep, intermittent fasting, detoxification, and every month his numbers kept getting better and by six months he was in a complete remission.

Dr. Dominic Brandy is a plastic surgeon and anti-aging expert, but after being diagnosed in 2017 with multiple myeloma, an incurable blood cancer, he plunged himself into cancer research. He is now coaching cancer patients.  In addition to conventional therapy, he has adopted a natural approach to fighting cancer that includes a whole food plant based diet, daily exercise, and targeted nutritional supplements.   And now he has written a book, Beat Back Cancer Naturally, and he wants to share his approach with patients looking to prevent or treat cancer.   His website is NaturalInsightsIntoCancer.

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. I’m very excited today that we’ll be speaking with Dr. Dominic Brandy, and he will be giving us some natural insights into cancer. Dr. Brandy is a plastic surgeon and anti-aging expert, but after being diagnosed in 2017 with multiple myeloma, he plunged himself into cancer research. In addition to conventional therapy, he’s adopted a natural approach to fighting cancer that includes a whole food, plant-based diet, daily exercise, and targeted nutritional supplements, and he’s written a book, Beat Back Cancer Naturally, and he wants to share his approach with patients looking to prevent or treat cancer. Dr. Brandy, thank you so much for joining us today.

Dr. Brandy:          Hey, great being here. Thanks for the invite.

Dr. Weitz:            Absolutely. Cancer’s such an important topic. Perhaps you can tell us a bit about your personal journey.

Dr. Brandy:          Well, just to give your listeners a little background about me. You mentioned I had a plastic surgery practice. It was a plastic surgery slash med spas slash anti-aging center, had it for over 40 years. About three years ago, we had a venture capital group come in and they made an offer to buy the practice.  At that point, I had over a hundred employees.  We were ranked number five in the country by our  Botox. So it was quite an operation. We had four different clinics, one in the Columbus, Ohio, and three in Pittsburgh.  So since that point, I have devoted my life to cancer lifestyle coaching, and the way I got into that, you mentioned, I was diagnosed with multiple myeloma about five and a half years ago. It was November 10th of 2017. Actually, my journey, interestingly, started in September of 2017, which was two months before that. My wife and I were on a Viking cruise. It was a two-week cruise. I’ve read well over 300 books on health and nutrition in my career because I have this anti-aging center, I was always interested in it.  So when I’m on vacation, first thing I do is I look for a health and nutrition book. So the first book I pulled up was How Not To Die by Michael Greger. I don’t know if you’ve ever read it, but it’s a phenomenal book. If anyone’s ever read the hard back, I mean, it’s literally two inches thick and about an inch of it are scientific references. I don’t know how many scientific references are in there, but there’s got to be over 6,000 or 7,000. Being a medical doctor, as I was reading this, that was the thing that really super impressed me.   What the science was showing over and over again was that cultures and research cohorts that ate more of a plant-based diet had much lower incidence of cancer, cardiovascular disease, type two diabetes, dementia, and really all cause mortality. Then he got into the Blue Zones where these are the five areas of the world where people lived the longest. Ikaria, Greece, Sardinia, Nicoya, Costa Rica, Okinawa, Japan, and right here in the United States, Loma Linda, California, and that’s where there’s a predominance of Seven Day Adventist, and they are either vegan, vegetarian, they don’t drink alcohol, they exercise a lot.  What’s interesting about Loma Linda, and I always like to use them because they’re in our culture. Some people will say about the Blue Zones, well, that’s a different culture. It’s not like the United States, but in Loma Linda, the average woman lives about 10 years longer than her American counterpart, and men actually live 14 years longer, which is interesting, but if you look at all the Blue Zones, they all eat anywhere from a 90% to 95% plant-based diet, and if they do eat meat, it’s usually the size of a deck of cards. They might have it once to four times a week.

                                Recently, really, I started reading a book called Healthy at 100. It’s by John Robbins. You should read it. It’s really interesting. Dan Buettner is the one that wrote the Blue Zones book, but Dr. Alexander Leaf, he was the Dan Buettner in the 1970s, and National Geographic put him to the task to find the longest living areas of the world, and he looked at the Acacians, the Vilcabamba, they’re in Peru, and then the Hunzas, you probably have heard of them, and then the Okinawans.  In fact, I was reading it last night, it was interesting. They had the breakdown of their diets, and the Hunzas, their diet is 99% plant-based. They eat 1% animal products. They eat about on average about 10% to 15% protein and anywhere from 10% to 15% fat, but that’s about how the other ones are too. Once again, when he did his research into these areas, they were basically anywhere from 90% up to 99% plant-based. So I always look at that as the preponderance of evidence along with a lot of the scientific studies.  So anyway, I’m on this cruise and I tell my wife two days in, “Trina, I’m going to start eating whole food plant-based,” and she thought I was out of my mind because we’re on this cruise, there’s all this meat and dairy and desserts, I mean, you name it, but I’m one of these people type A personality, “Hey, you know what? I’m just doing this.” So from September till now, I have been totally plant-based.

                                So when I came home, this was the last week of September, I was doing a surgery case and I remember feeling a little pop in my right collarbone. I didn’t think anything of it, but then it just kept getting worse and worse. Then by the time I got to the last week of October, it was starting to keep me up at night. I literally asked my wife, I said, “Trina, do you think I have bone cancer?” and she said, “Oh, you’re the healthiest person. I know you’re fine,” and I kind of slapped it off, but on November 10th, which was about a week and a half after I said that to my wife, we were watching TV, I accidentally knocked over a container of water, I lunged for it and my bone just cracked right in half.   Went to the urgent care center, it was completely displaced. Went to a friend of mine who’s an orthopedic surgeon. I said, “Hey, what’s going on here?” He said, “We need an MRI.” So that happened, I cracked my bone on a Sunday, he called me on a Friday evening and he goes, “Nick,” Nick’s my nickname, he said, “Nick, I think you have a tumor in there.” He said, “It’s either multiple myeloma or some kind of metastasis,” and I must tell you, I was totally blown away. I’m sure you deal with cancer patients, but I don’t think anybody can predict the way they’re going to react to it because your world is totally rocked.

                                So anyway, from there, I had biopsies. They did all kind of blood studies, and they came up that I had what’s called an IgA multiple myeloma free Kappa chain. If you go on the internet, there’s three different basic types of myeloma. There’s IgA, IgG, IgM, and myeloma, for your listeners, is a cancer of the plasma cells. So they’re the cells that make your antibodies. If you look through the research, IgA, the one that I was diagnosed with, is definitely the most aggressive. Because of that, when I went to my oncologist, he wanted to put me on this triple regimen of two oral medications, and then there was a drug called Velcade, which is a proteasome inhibitor, where I would have to go into the hospital every week and get an injection into my abdomen.  As I was researching this, I was learning that just about everybody that gets this drug gets a pretty bad peripheral neuropathy. I’m a surgeon, I didn’t want to risk that. Told my oncologist, “Hey, listen, I don’t think I want to do the Velcade.” He was upset. He pulled me into a side room. There was a patient over there that actually finished the Velcade treatment. He tried to get him to talk me into it. In fact, that guy’s actually a good friend of mine now, we go out to lunch all the time, and he calls me when he has a question about his treatment and so forth, but I came back to my oncologist.

                                Remember, at this point I had already been eating whole food plant-based for two months, and I was 100% sure it was going to help me in this battle. So I told my oncologist, I’m not doing it. He said, “I don’t think you’re going to get into remission.” He was upset with me, but we just went ahead. I would just take these two oral medications, 21 days on, seven days off.  At this point, I started to do a deep dive into the scientific literature. I wanted to know every single thing that I could do from a lifestyle perspective. I researched every herb that I could possibly take. I looked into exercise, stress reduction, sleep, intermittent fasting, getting rid of toxins, how all these things would affect my final result. Well, every month, my numbers just kept getting better and better, and by the sixth month, I was in a complete remission and my doctor was blown away by it. He never thought I was going to get there, and to get there in six months, he was totally befuddled, but I really wasn’t because I knew everything that I was doing was helping.

                                So a year after I started treatment, I started treatment January of 2018. January of 2019, I decided I was going to give a lecture at one of the local hotels because I was learning all this stuff and I said, “I need to share this with people, especially cancer patients.” So I scheduled a hotel and I’ve given a lot of interviews in Pittsburgh with various news stations for plastic surgery, anti-aging, med spa. There was one anchor that I’ve gotten to know really well, Michelle Wright, and I gave her a call. I said, “Hey, Michelle, can you do a little story on all the different lifestyle things I’m doing, my cancer diagnosis, and so forth? I’m doing this lecture. Maybe we can get some people there.”

                                So she did it. In fact, that whole interview is actually on my website, naturalinsightsintocancer.com. So it was a really great program that she did. We figured we were going to get maybe 50 people there. So we opened the doors and these people are flooding in. I mean, we were pulling chairs out of the restaurants. It was crazy. We ended up with 125 people, which was amazing.

                                So I gave this lecture. I thought it was going to be an hour. It ended up being two hours. People kept asking me questions as I was giving the lecture, and then afterward, I had a standing ovation. I’ve never had a standing ovation for anything in my life. I don’t know if it was because they felt sorry for me because I had cancer or it was because they thought the lecture was good, which I don’t think was that great, but I thought it was pretty good, but I think the reason they gave me that standing ovation is that there were a lot of cancer patients out there, and I think they felt that they were at the mercy of surgery, radiation, chemo, and there really wasn’t anything else that they could really do.

                                In fact, I had quite a few people come up to me after the lecture. One I remember very vividly, she was a multiple myeloma patient, and she was definitely overweight. I would say probably even obese. She said, “Hey, Doc. When I talked to my doctor, I asked him, ‘Should I change my diet?’ and he said, ‘Oh, no, just keep eating the way you are. You’ll do just fine.'” She told me, she said, “I just knew that wasn’t right, that that could not be right,” and I think that’s how a lot of these people felt.

                                So I think when I gave that lecture, I really empowered them. From that point, I had monthly meetings in one of my med spas, and we would pack anywhere from 50 to 100 people in these little med spas. We had these chairs. People were standing and I’d bring other speakers in and people started asking me then, “Hey, Doc. You need to write a book. You have so much knowledge.”

                                So on Memorial Day, this was 2019 or 2018, I’m sorry, every morning I would wake up and I would write for one to two hours, and by Labor Day, I had the book completely done. I mean, I had to do a lot of research and so forth. I had it on Amazon first week of November. I had a book launching the second week of November, and I developed a website, Natural Insights Into Cancer, an Instagram site, Cancer Veggie Doc, and I started doing virtual consultations for people to help them, when they have cancer to get through it, how to make different lifestyle changes. I make supplement recommendations and so forth. So that’s how I got to this point. I know it was a little long-winded, but I think it’s important for your listeners to understand how I actually got to this point.

Dr. Weitz:            Absolutely. Thank you for sharing your story with us. So let’s start with how you got to the plant-based diet as the best anti-cancer diet. So I’m going to challenge you a little bit on that. I think the idea that fruits and vegetables and herbs contain these powerful anti-cancer phytonutrients, I think is without question, and I’ve been looking at the research on that. I think absolutely no doubt at all that there are many powerful health-promoting anti-aging, anti-inflammatory, anti-cancer factors in fruits and vegetables, herbs, maybe nuts and seeds.   The question is, should we include some animal protein in the diet, and what about things like grains and beans and et cetera, oils, I guess? So fat’s a whole issue. I’ve interviewed a number of people in the cancer world, and Dr. Thomas Seyfried wrote the Metabolic Theory of Cancer, and he advocates a ketogenic diet due to the fact that cancer cells predominantly produce energy through the glycolytic pathway through sugar, and so therefore, if we’re on a ketogenic diet, which gets the carbohydrates as low as possible, we’ll starve cancer cells of their source of energy.

                                I’ve also interviewed Al Danenberg, Dr. Al Danenberg, who was diagnosed with multiple myeloma in 2018 and he was given a few months to live, and he’s still alive using his carnivore diet. So I guess one of the questions would be, can there be different anti-cancer diets for each person? So anyway, let’s see where we go with that.

Dr. Brandy:         Well, once again, I look at the preponderance of evidence. Once again, when I went through Dr. Greger’s book, I mean, and I advise everyone to read that book because there’s thousands of scientific references. There’s a journal article, the British Journal of Cancer, where they looked at people’s eating habits in England over a 10-year period, and they found that people that ate more plant-based had much lower incidence of cancer, especially blood cancers. That was the one that was … Then there was another one in JAMA Internal Medicine. It came to the exact same conclusion, and there’s a lot.  In fact, recently in 2017, there was a meta analysis of many different studies, and they found that those that ate plant-based had much lower incidents of cancer. Also, the EPIC-Oxford study, the AHS-2 study showed exactly the same thing, that people that ate more plant-based have much lower incidence of cancer.

                                So what I always tell patients to start off, just to get rid of all the esoteric crap. The National Cancer Institute recommends nine servings of fruits and vegetables, and they recommend it for a reason. The studies show over and over that people that eat more fruits and vegetables have much lower incidence of cancer. So what I tell patients, “Listen, if that’s what the studies show to prevent cancer, if you have cancer, you should be eating a hell of a lot more than nine servings of fruits and vegetables per day.”  In fact, this weekend on Saturday, I’m giving a lecture at one of the wellness expos, and I have a couple lectures on my website about the synergy of these phytochemicals. The way they work is that when you combine … Two plus two doesn’t equal four. Two plus two equal seven. I go through several studies that show this remarkable synergy with these phytochemicals.  For instance, there was one study that was done with breast cancer cells where they applied a grape extract that killed about 25% of the cancer cells. Then they did onion extract, killed about 50%. Then you would figure if you would do a combination of both, you’d get maybe 35% destruction of the cancer cells. No, it was 75%.  There was another study with carotenoids. It was a tomato extract with turmeric, and then vitamin E, which vitamin E, actually, the cancer actually grew faster with the vitamin E. It was against prostate cancer cells, but when they combined the three, it increased the anti-cancer activity by almost 10 times.

                                Now, one of the things that I stress in my lectures and in my book at the beginning, I talk about my philosophy on how cancer gets started. I personally think it’s the accumulation of DNA mutations over your lifetime. When I first got diagnosed, I read an article in Nature by Nikhil Munshi. He’s a world renowned myeloma researcher. This article actually upset me because he found that by the time you are diagnosed with multiple myeloma, you have about 5,000 DNA mutations in that cancer cell, and by the time you relapse, you are up to 12,000.

                                I think a lot of those mutations are probably from the chemo drugs. There’s a lot of free radical activity that’s causing a lot of DNA mutations. If you look at plant foods compared to animal products, plant foods have 63 times the antioxidant power compared to animal products. So if I have a patient in remission, and I can honestly say at this point, I was on a podcast and someone asked me, I never really thought about it. I have never had a patient that was in remission that came to me that came out of remission.

                                I really think one of the reasons is we’re increasing their antioxidant activity. What I recommend for supplements, they’re almost all herbal supplements, I do not recommend individual vitamins. If I do, I do it as a drug. For instance, vitamin D is really more of a hormone. I think everybody should take that. I really try to get people up to 80 to 100 nanograms per mil. If you’re eating whole food, you have to take a vitamin B12 supplement. I mean, that is really a given, but we know that there are over 100,000 phytochemicals in whole food plant foods.

                                I listened to a podcast, Simon Hills podcast with Jed Fahey, and Jed Fahey is a world renowned expert on phytochemicals. I mean, he actually feels there’s over five million phytochemicals in edible plant foods. We have only studied about 150 of them. When we study these phytonutrients, and there are things like curcumin. People have heard a lot of these things, daidzein, isoflavones. When we studied these, they all have four common elements. They have very powerful antioxidant activity. They have very powerful anti-tumor activity, very powerful anti-inflammatory activity, and they have an amazing epigenetic effect that is really mind-blowing.  In fact, on my lecture, I have this one diagram where I have all these different phytochemicals and the way they either upregulate or downregulate certain genes. For instance, curcumin is one that I show in my lecture, and there’s an arrow that goes up to the BRCA gene. BRCA gene is a DNA repair gene for the cancer cell. Angelina Jolie made that famous, the BRCA DNA repair. Well, curcumin actually upregulates the BRCA gene through epigenetics, so does soy.  A lot of people think you shouldn’t take soy with breast cancer, but it’s the exact opposite. There are many studies that show that women that actually intake a cup of soy every day over a five-year period actually have about a 36% lower chance of relapse. The the way it works, soy works, it actually, the breast cancer actually methylates the BRCA gene, which it downregulates the BRCA gene. So it’s not working as well, can’t repair the DNA. With soy, it actually methylates it. So now the BRCA gene is working properly.

                                So these phytochemicals, and then the other thing I show how it downregulates, for instance, the P53 tumor suppressor gene when it’s mutated. So for your listeners, what basically happens with cancer is that you get all this free radical damage. We have three innate antioxidants in each one of our cells. We have catalase, glutathione peroxidase, superoxide dismutase, and they can pretty much keep free radical damage under control, but most of us overload the system.  I mean, smoking’s probably the worst thing you can do, but all the pesticides that we eat, [inaudible 00:23:27] radiation, pollution. I mean, there’s so many, the water that we drink, there’s so many things that we do that create excessive free radical activity that a lot of times our body just cannot neutralize these free radicals. So these free radicals damage, remember I talked about that P53 tumor suppressor genes, proto-oncogene. So a proto-oncogene is supposed to protect you from cancer. You get enough DNA mutations of that proto-oncogene, it actually becomes an activated oncogene. So instead of protecting you, it actually promotes cancer growth.  So the turmeric, the curcumin actually downregulates that activated oncogene, so it’s not as active as it was before. So the bottom line is I try to get as many phytonutrients in the patient as possible. I document all the ways that phytonutrients work. I mean, turmeric alone has been shown to disrupt 80 plus cancer cells signaling pathways.

Dr. Weitz:            Yeah, no, I’ve seen some of the charts with all the different arrows on all the different cancer pathways. Curcumin’s amazing.

Dr. Brandy:         Sometimes I take 30 plus herbal supplements, and when I-

Dr. Weitz:            I do too. It’s interesting. You and I, even though I don’t have cancer, have similar regimens except that I also include some animal protein in my diet.

Dr. Brandy:         Yeah, I mean, that’s fine. Like I said, the people in the Blue Zones eat 90%, 95% plant-based. I try to use the word, for people that don’t have cancer, I like to use the word plant strong, plant predominant because-

Dr. Weitz:            Rather than use the word vegan, which is politically charged to say.

Dr. Brandy:         I don’t use the word vegan at all because I think vegan is more of a political term. Most people that use the term vegan, they’re usually animal rights activist or they believe it’ll cure climate change, whatever. I really don’t go there at all. I talk about the health benefits. In fact, I don’t know if you’ve ever read The Starch Solution by Dr. McDougall.

Dr. Weitz:            I have not.

Dr. Brandy:         He has a character called the Fat Vegan, and it’s somebody that’s eating potato chips all day, Doritos, muffins, frosted flakes, drinking Coke all day.

Dr. Weitz:            Absolutely. I have had more than a couple of vegans come in my office who were overweight for nutrition and were eating very few vegetables.

Dr. Brandy:         I mean, honestly, that diet is the … I’d rather somebody eat a carnivore diet than eat that to be honest with you because that is the most unhealthy diet that you could eat. So I always use the word whole food plant-based or whole food plant strong. When you use the word plant strong or plant dominant, it really doesn’t freak people out as much. It’s like, “Hey, you know?” Why don’t we … In fact, when I take people that are eating like the average American, which is about 65% processed food, 25% animal products, and probably anywhere from 5% to 10% fruits, vegetables, whole grains, legumes, et cetera, I tell them, “Listen, if we can take you from maybe 10% to 30%, why don’t we start there? At least I’ll be tickled pink if we can do that, and then if we can get you up to 60%, that’s even better.”   So I try not to freak people out too much, but I think we know, and like I said with the National Cancer Institute, the studies show that the more plant foods you eat, it definitely has an anti-cancer effect. The way these phytochemicals work, and I’ve done a lot of research on this, not only do they affect the cancer cells signaling pathways, they actually fragment DNA, they inhibit angiogenesis, which is the blood vessel growth that these cancers need to progress. It’s a proteasome inhibitor like Velcade, the drug that I was supposed to inject in my abdomen. In fact, turmeric is a very potent proteasome inhibitor, so the cancer cell can’t get rid of unwanted protein, so it actually dies because it’s all infested with all these abnormal proteins, but it affects the cell division, the cancer cell division at varied phases of the cell cycle.

                                I get into all these. It really helps chemo and radiation actually work better and it prevents chemo resistance. So I document all of this in the book. The big thing, I think, is the fact that we really need to keep the amount of free radical activity minimized. Like I said, plants have 63 times the oxidant power.  The other thing about these carnivore diets, and I will just tell you this, in fact, I just did a post on Instagram a couple days ago, and I have these two studies actually in my book. I really try to alkalinize these patients. I mean, we know that the pH should be between 7.35 and 7.45. Your body just keeps it there automatically, but I really like people to be leaning more towards 7.45. So I have a chart, it’s actually in my book, and I send it when I do a consult, I send it to all my patients. It was done by Dr. Jaffy. That was really the work that he did for his PhD, and it’s really the best alkaline base chart I have ever seen.

                                I actually came across this. I was at an anti-aging meeting, and I came across it and I’ve really kept it and I give it to everybody, but cancer really struggles in an alkaline micro environment. Cancer loves high acidity, it loves high inflammation, and it likes an environment of low oxygen. So I have this chart, and basically, it has the most alkaline foods, it has the most acidic foods, and has all these in between. I try to get people started with eat 70% on the alkaline side, and they’re most all plants. On the acidic side, it’s mainly meat, sugar products, but there are whole foods that are more acidic, legumes, carrots, corn.

                                So there’s certain foods. I just tell patients, “Look at this. Try to memorize it.” For instance, before I go to bed, and I know this would freak your people out to do these carnivore diets, but before I go to bed, I actually eat pineapple and watermelons, They’re two of the most alkaline foods. So they would probably think, “Oh, man, he’s going to have all these cancer cells going out of control.” I’ve been in remission for 5.5 years, and I take very low doses of those two drugs. Myeloma isn’t curable, so I’m likened what they call a functional remission, but I live a very, very full life. I exercise every single day. I do resistance training every day. I ride my bike every day.

                                We can get into exercise because that’s probably the second most important thing next to a whole food plant-based. In fact, exercise, in one of the studies, I think it was into cancer research journal, it showed that exercise actually increases oxygen in the microenvironment, the cancer microenvironment. So the anti-inflammation in the cancer microenvironment, we take care of that with more of a whole food plant strong diet. The alkalinity, we increase that through eating more foods on the alkaline inside. I do have my patients check their urine pH every morning. I really like it to be between 6.5 and 7.5. As soon as I wake up in the morning, that’s what I do. I have this little strip. You can get it on Amazon and patients just pee on it first thing in the morning, and it should be pretty green. When people start, they’re usually about 5.5. I mean, I am consistently 7.2, 7.3.

                                Then we want to keep the oxygen content up, and that’s really, really daily exercises, so, so critical to that, but these people eating these carnivore diets, I mean, their pH is so acidic. I’ve never measured it on somebody with a carnivore diet, but I will just tell you, it’s got to be, if they check their urine pH, it’s probably 4.5 or something, and that does have a negative effect on your bones. Your bones will release certain minerals to try to neutralize some of that acidity, and it’s really hard on the kidneys. These animal proteins cause what’s called hyperfiltration, and it really is very stressful on kidneys. It’s really the branched amino acids in animal proteins that cause that hyperfiltration, and it’s also the branched amino acids that actually send a signal to the liver to release IGF1, which is a very potent growth stimulator.  I mean, we know that IGF1 is a growth stimulator in patients that have cancer. Remember I talked about how the DNA mutations increase with age? You do not want high DNA mutations when you’re 50, 60 years old and be having all of those DNA mutations exposed to a gross stimulator like IGF1 or mTOR. That’s just a recipe for disaster. mTOR-

Dr. Weitz:            Right, but in terms of longevity, we know that being able to maintain levels of growth in the body so you can repair and regenerate cells and tissues that have broken down, you want to maintain your bone density, you want to maintain your muscle mass, you want to maintain your strength, your balance because all those things can affect longevity. So it’s not necessarily the case that we want to drive the IGF1 levels as low as possible, right? We need a certain amount of growth still occurring for us to maintain our health, don’t we?

Dr. Brandy:         I don’t know if you’re familiar with the work of Dr. Valter Longo.

Dr. Weitz:           I am.

Dr. Brandy:         I don’t know if you’re familiar with the Laron dwarf syndrome.

Dr. Weitz:           I am, yeah, I’ve read about that.

Dr. Brandy:         Laron dwarfs, their IGF receptors are screwed up. So they really don’t have IGF1 levels, and there’s never been a reported case of Laron dwarf ever having cancer. If you go through the literature, high IGF1 levels in adults is actually correlated with increased cancer incidents. In fact, if you look at Valter Longo’s work, and I try to keep people’s IGF1 levels between 120 to 160. Remember, we’re talking about cancer patients. I’m not talking about somebody that’s a body builder or wants to be. I probably eat about 100 grams of protein per day, and I work out every day. I mean, I’m 70 years old and my muscles are like when I was 25, 30 years old. You do not need excessive protein to build muscle. In fact, once you get over 30 grams of protein per meal, your body doesn’t even utilize that. When you get to about 30 to 50, it starts to plateau, but the first 30 grams are really what’s utilized for protein synthesis.

Dr. Weitz:            I would totally agree with that, but it’s not easy to get 30 grams of protein eating just a plant-based diet without any animal proteins.

Dr. Brandy:         It’s so simple. I’ll just give you an example. I don’t know if you Dr. Joe Mercola. I follow his website. One day when I read it, he talked about what he had for breakfast, and it was a 12-ounce steak with six eggs, and there was ghee butter and all this saturated fat. I was befuddled by it, to be honest with you. Then a month later, he was talking about how he has to blood let every month to get rid of the excess iron. I mean, actually, he tried to keep my ferritin levels really … My ferritin’s about 11. I want to keep that low because that is definitely a pro-oxidant.  So what I did is I compared what he has for breakfast compared to me. So he was eating, just with the steak and eggs, he was eating 1300 calories. There was 1,550 milligrams of cholesterol. There was 30 grams of saturated fat, there was zero fiber, zero phytonutrients. There were high levels of carnitine. We can get into carnitine and choline because that’s a whole another issue with TMAO and-

Dr. Weitz:            By the way, I’m pretty skeptical about that whole concept, but yeah, let’s keep going.

Dr. Brandy:         No, I tell you what, there was a recent study came out at Cleveland Clinic. If somebody comes into the ER with chest pain, if you do a TMAO level, you can pretty much predict that they’re going to have heart attack in 30 days.

Dr. Weitz:            I’ve also read a meta analysis saying people who eat a vegetarian diet had much higher levels of TMAO than people who eat meat.

Dr. Brandy:         That’s definitely not true. I don’t know where you got that information, but that’s definitely not true.

Dr. Weitz:            I’ll send you this.

Dr. Brandy:         It’s the hungatella bacteria that, in fact, I don’t know if you’re familiar with this article. It was really a land breaking article in Nature 2014 where they put one group on a completely carnivore diet. They put another group on a plant-based diet. They evaluated the microbiome and they wanted to see what kind of changes were going to occur. Very quickly, the microbiomes started … After five days, it was dramatic, but each day they could see a dramatic difference. So the people that were eating carnivore diet, the more pathogenic bacteria was increasing. The prevotella and their subspecies were decreasing in the plant-based group. The prevotella good bacteria in their 500 subspecies were increasing and the pathogenic bacteria were decreasing.  The one bacteria that started to increase immediately was hungatella, and hungatella is the one that primarily converts choline and carnitine to trimethylamine. It goes to the liver, it’s converted to trimethylamine oxide. The studies show that trimethylamine oxide definitely is correlated with cardiovascular disease, type two diabetes, really all cause mortality. It just increases your inflammatory levels extremely high.  I told you about the study about the people that come in with chest pains. Choline is higher in eggs, seafood, and cheese, and vegans get plenty of choline. You get plenty of choline and now carnitine is made in your liver. So you don’t need more choline or carnitine. When you’re eating meat products, you’re actually getting an excess of those, and that’s really what we don’t want in this situation, but everybody has a different view. I think I’ve done a lot of research on this. I think I’m very knowledgeable on it.

Dr. Weitz:            Fish is actually the highest source of TMAO, and we know that fish is consistently associated with lower risk for cardiovascular disease.

Dr. Brandy:         I recommend a fish oil supplement for all of my patients. In fact, I take about six grams of EPA/DHA. I recommend that for all my patients. I do check their omega-6, omega-3 level. Here’s the problem with fish. I would say a hundred years ago, fish was great. I think the waters are just so contaminated right now that when you eat fish, you are getting a crap load of toxins. In fact, there was an article-

Dr. Weitz:            What water do you think is being used? What water is being used to water the plants? It’s the same water. Our planet is polluted.

Dr. Brandy:         Oh, yeah, but there was an article in the International Journal Environmental Research, and what they did, and this study blew my mind, they took wild-caught salmon outside of Seattle and they wanted to see what kind of chemicals were bioaccumulated into the fat tissue. I mean, it was mind blowing. They were birth control pills, antidepressant sedatives. I don’t believe all the stuff that’s in there, and then they’re loaded with these microplastics right now. So I don’t recommend that.  In fact, Dan Buettner, who wrote the Blue Zones, who I very much respect, he did a post probably about a month ago, and he’s basically saying what I said. He goes, “I just stay away from fish products.” They have some of the highest PCB levels also of any animal product. So I do think you need the EPA/DHA. I think that’s one area where vegans or whole food plant-based people don’t get enough of that. When I say fish oil to them, some of these vegans freak out.   I don’t think algae supplements are adequate because they’re high in DHA and they’re very low in EPA. The fish oil supplements are high in EPA and a little bit lower in DHA. So I think they’re really good. The one that I take new age I think is really good. Each one has about 900 milligrams of the EPA/DHA. So I take three of those in the morning, three at night, and I always take those before I take my turmeric because you really do need fat to be able to absorb all the phytonutrients in the turmeric.  Hey, one thing about turmeric that I do want to mention, I’ve listened to some of your podcasts and I think everybody agrees that you need to take some fat with your turmeric. One of the things I don’t do, I actually look for turmeric supplements that are not standardized for 95% curcumin. There was a study, I think it was in Cancer Research Journal, where they compared curcumin versus turmeric, the whole root. They actually looked at it against seven different cancers. What they found at every single cancer, the turmeric actually worked better than the curcumin.   It gets back to that synergy effect that I was talking about. There’s over 300 phytochemicals in turmeric. So there’s turmerone, zingarone. There’s all these different phytonutrients in there, and they all work synergistically. So I think that’s why you get a greater anti-cancer effect. So when I recommend a turmeric supplement, I use one by Carlyle. All the supplements that I recommend you can get on Amazon. I do heavy research on these. I go to consumerlab.com. I don’t know if you’re familiar with that website.

Dr. Weitz:            I am, yeah.

Dr. Brandy:         Yeah, but I always try to go there to see what the deal is. That’s a good thing for your listeners to know about because, for instance, I was doing olive oil. My wife and I were doing this Carapelli olive oil, extra virgin olive oil, and I thought it was a good olive oil, and then I went on there. I found out 25% of it was rancid. There wasn’t even any olive oil in the olive oil. So we use a Lucini organic now. That was their top pick, but in soy milk, Silk was their top pick. So I go on there a lot when I’m looking at supplements, but when I recommend turmeric, I recommend actually a Carlyle supplement. Each capsule has one gram of turmeric. So I have people do four of those in the morning, and I have them do four in the evening with the fish oil. Those do have a little bit of the BioPerine, the black pepper extract, which increases the bioavailability. Some people that might upset their stomach, but I think that’s such a low dose, it doesn’t. I do have them do a black pepper extract on top of that to increase bioavailability. I have them do 20 milligrams of a Carlyle supplement with-

Dr. Weitz:            Yeah, I’m constantly reading about some-

Dr. Brandy:         Some people get stomach upset from that, so you have to watch that. If they do, you just cut it.

Dr. Weitz:            Yeah, that’s interesting topic. I’m constantly reading about a new form of curcumin or turmeric that’s better absorbed because it’s in a fat soluble form, in a water soluble form mixed with certain other things. So everybody’s trying to find a way to get turmeric or curcumin at a higher absorption rate since I think naturally has a low absorption rate.

Dr. Brandy:         I actually go to the study that, I don’t know if you’re familiar with the study that Golombick and group did in Australia on MGUS. So my type of cancer goes from MGUS to smoldering myeloma to myeloma. I probably had MGUS 20 years ago, I didn’t even know it. So MGUS and also early prostate- 

Dr. Weitz:            What does MGUS stand for? That’s an acronym I’m assuming.

Dr. Brandy:         Yeah. I think it’s myeloma of undetermined origin or something like that. It’s something like that, but 3% of the population actually has MGUS. So if you have MGUS, you have a 1% chance every year that you’re going to turn into myeloma. So there’s a ton of people walking around with MGUS, they don’t even know, and they’ll probably die with it. In fact, my dad was 91 years old. He had MGUS. He died with MGUS. My brother actually has a IgM MGUS. So they say it’s not genetic, but when I told my oncologist that, he was like, “Hey, boy, that’s interesting.”  [MGUS stands for Monoclonal gammopathy of undetermined significance]

Dr. Weitz:            It is interesting.

Dr. Brandy:         The three men of the family have-

Dr. Weitz:            Exactly.

Dr. Brandy:         … a plasma cell issue, but what Golombick did, she did an interesting study, and the reason I used eight grams is because that’s what she used in her study. She gave these people, and she did two different studies and they both came out the same way. It was eight grams per day of turmeric, and they had a 33% drop in their M spike. So the M spike measures the amount of this paraprotein that’s released by this abnormal plasma cell. Also, the free Kappa chains came down and also their bone density biomarkers improved, but most people with myeloma really get severe osteopenia or osteoporosis due to the fact that nobody really knows exactly how it happens, but myeloma, it downregulates your osteoblasts, the cells that actually make bone and it upregulates your osteoclast, the cells that actually break down bones. So that was an interesting study. I always go over that.  The other good study that people need to know is really a landmark study in the Journal of Urology. Dean Ornish did it. I think it was in 2005. He did it with Elizabeth Blackburn, who’s a Nobel Prize winner, and they basically took people with early prostate cancer. They put them into two different groups, plant-based group, and then the standard American group, and then they looked at their PSA levels over a year.

                                The plant-based group, their PSA levels came down 4%. Standard American group, they went up 6%. Then what they did through heat map technology, they looked at the epigenetics that we were talking about before, and they did it through heat map technology. What they found was there were 48 good genes that were upregulated and there were 453 bad genes that were downregulated. Then five years later, they looked at the telomeres, and this is Elizabeth Blackburns claim to fame. That’s how she won the Nobel Prize. They wanted to see what happened to the telomeres. With the people that in the plant-based group, the telomeres actually got a little longer, and then the standard American group, the telomeres shrunk significantly. So I mean, that was some really interesting-

Dr. Weitz:            As I recall it, in addition to the plant-based diet, I believe they also had them exercised and do some stress reduction.

Dr. Brandy:         Yeah, there was lifestyle.

Dr. Weitz:            It was a whole lifestyle program. Yeah.

Dr. Brandy:         Yeah, and that’s what I recommend to people. My whole thing is a whole food plant strong or plant-based diet. I think for cancer patients, if they can lean a little-

Dr. Weitz:            What’s the best form of exercise for cancer patients? Is there a best form?

Dr. Brandy:         Well, I do think resistance training is really important. I recommend aerobic something, brisk walking. For instance, there’s one study in my book just to show the power of exercise, even brisk walking. In this one study, these were breast cancer patients and women that just did brisk walking even five days a week, they lowered their relapse rate by 24%. If they jogged two-thirds of a mile per day, they decreased their relapse rate by 40%, and if they ran 2.3 miles per day, they lowered it by 95%. I mean, I don’t think a chemo drug can even do that.   So it has this amazing effect on your immune system. I have in my book, there’s an article that I researched where just fixed minutes of exercise increases your natural killer activity by 50%. So anytime a patient tells me, “I don’t have time to exercise,” I go, “Do you have six minutes? Go through a little break.”

Dr. Weitz:            I remember being in 2015, IFM had a cancer conference, and Keith Block was there, and he showed a picture of a patient hooked up to a chemo IV on a treadmill.

Dr. Brandy:         Yeah. Well, one of the reasons he may be doing that is exercise actually makes your innate antioxidants more efficient. So it makes your superoxide dismutase, your catalase, your glutathione peroxidase actually more efficient. I know you’ve had some other people on your podcast that talk about fasting before chemo treatments. I do think that is really powerful, and not everybody can do it, but I do. Right now, I’m dealing with a bunch of patients that are in a metastatic stage four cancer and they’re getting chemo, and I really try to encourage them, “If you can at least calorically strict one to two days before you get your chemo treatment and then the day of the chemo treatment and then the day after,” and they can even do Valter Longo’s fast, mimicking five-day program through prolonfmd.com if they wanted to get that that way, that they’re at least eating something. I think it’s about 600 calories per day. It’s a plant-based keto, essentially.

                                What he’s shown, he started with rodent studies and he found that as he fasted them before they got the chemo, the results are dramatic. In fact, I have the graph on some of my posts on Instagram. I mean, they’re actually mind-blowing. If you just fast even, cancer cells really struggle because they need a lot of nutrients to keep multiplying at this incredibly fast rate. If you just fast, it can have a negative effect. Then if you’re fasting and then all of a sudden you give chemo and they’re struggling, those cancer cells are going to be more in a weakened state and they’re going to have a chance of getting eliminated a lot easier if they’re more in a fasted state.

Dr. Weitz:            Yeah, absolutely. There’s some integrative cancer experts that for quite a period of time have done insulin potentiation, where they’ll actually give the patient insulin to drive their glucose really low before their chemo and find that that’s beneficial as well.

Dr. Brandy:         Yeah. I’ve read that. That is something that you could basically do. In fact, one of the things that I really try to do with all of my patients is try to make them more insulin sensitive. We were getting into exercise. Resistance training is really the most important thing for developing insulin sensitivity because as you lose muscle mass, your cells definitely do not accept insulin as well. The receptor doesn’t work as well. Then you’ll get accumulation of sugar and you’ll also get accumulation of insulin.   I don’t know if you know this, but insulin is the most potent growth factor. So that would be the one thing that I wouldn’t like, giving insulin while you’re getting chemo, because insulin is the most powerful anabolic hormone in your body. In fact, when they do studies with cancer cells growing in a Petri dish, to get them to grow faster, guess what they add to it? They add insulin and they start going totally out of control.   So we really need to keep insulin sensitivity. There are four supplements that I always recommend for people to really keep their insulin sensitivity high and keep their blood sugar levels low. I will tell you, I eat whole food plant-based. I eat a ton of whole grains. I eat a ton of legumes. I think they’re the most important two that you should eat. I know paleo people don’t eat those. I mean, the longest lived people, like the Hunzas for example, I mean, whole grains are a major part of their diet, and whole grains do not cause glucose spikes.

                                Actually, before, I get blood work every week, every month, I’m sorry, but before I go in, I actually drink a giant smoothie. My fasting blood sugar’s never been over 80 when I go in there. It just never has because the fiber actually slows down the absorption of the sugar. There’s four supplements. Amla is one that really helps keep the sugar down. Berberine, I think every cancer patient should be taking berberine. I think it’s super, super important. Gymnema sylvestre, I don’t know if you’re familiar with that, but that’s a supplement that definitely has a very potent effect on blood sugar, and then garlic.

                                I like to do the whole herb. I get it through. I think it’s called herbal roots. I recommend that for patients. Once again, when I recommend herbal supplements, I usually like the whole root rather than something that’s standardized for a certain chemical in the herb because of the synergistic effect. In fact, one of the things I do that it’s in my book, I am really big into freeze dried powders. In fact, first thing I do in the morning, and I do time-restricted eating, I eat my last meal at eight and I don’t eat until noon. In fact, right now it’s noon, I still haven’t had breakfast yet, but I woke up at 6:00 this morning, I have a special coffee drink that I do, and I put 12 different freeze dried powders in there.

                                I also put about 20 shakes of cinnamon. I put a couple little shakes of clove. I always put baking powder in the sugar because coffee is very acidic and cacao is the main thing that I put in there to give it a hot chocolate taste. Then I put soy milk in there. I also had a little scoop of a protein powder. It’s called So Clean So Lean, which is a really great protein powder or vegan protein powder that I put in there.

                                What I tell patients to do is look at the blueberry freeze dried powder. It has a 50 to one ratio on there, and what that means is one gram of that freeze-dried powder, blueberry powder is like eating 50 grams of blueberries. So the ones that I do are blueberry, blackberry, raspberry, strawberry, goji berry, cranberry, acai berry. There’s a 10 mega mushroom that I put in there.

                                So I put all these together. I use a 247 ounce coffee cup. That takes me up about a quarter of the way up. When I do my coffee, I do an organic light roast. Takes me about halfway. Then I do a cup of soy milk, and then as I do my work in the morning, my research, my writing and so forth, I’m drinking that. I sip it during the day.

                                Now, the way that I look at that, I talked about all the different ways that these phytochemicals actually kill cancer cells. I still consider that I’m still in my fasted state. So way I look at it, I’m in a fasted state at that point, and I’m drinking all these phytochemicals. I look at it like it’s almost like a chemo infusion that I’m doing while I’m doing that first thing in the morning, and then when I get ready, take a shower and get ready and so forth, I have a five concoction tea that I do. It’s camomile, dandy lime, hibiscus green tea and red clover, and I put those all together. I add some organic lemon juice, organic lime juice. I put a cinnamon stick in there. Cinnamon has amazing anti-cancer activity, by the way, and cinnamon also has significant blood sugar lowering effects. That was the fourth thing that I really recommend for lowering the blood sugar.

                                Then I fill that cup all the way up, and then I basically sip that as I’m getting ready. Then when I take my supplements, I basically take a handful of nuts and I do 12 different nuts. I know this sounds obsessive compulsive, but it gets into that synergy thing. I do 12. I do two walnuts, two almonds, two pecans, two cashews. I do all these different, and there’s studies that I have in my lecture where I show the most potent nuts against a cancer. There was a study done at Cornell University. They looked at the 10 most common nuts in which one had the most potent effect against liver cancer. Walnuts and pecans were definitely by far the most potent.

                                Then there was another study that actually looked at antioxidant activity, and it showed that pecans and almonds had the highest antioxidant activity also. I don’t know if you’re familiar with some of Keith Block’s work with molecular probe technology, but he actually showed that when an antioxidant gets into a cell in the environment of high iron and high copper, which most cancer cells have very high iron and high copper levels, it actually turns into a pro-oxidant through the fenton reaction. It actually kills the cell through free radical damage. So it’s interesting that the higher the antioxidant food, the more potent its anti-cancer activity. I think maybe that’s even the way IV vitamin C works when they give it to patients.

Dr. Weitz:            100%, yeah. IV vitamin C has a pro-oxidant effect, absolutely.

Dr. Brandy:         Yeah. So it actually becomes a pro-oxidant once it gets into the cell in the environment of high iron and high copper. So it’s really interesting. So I take my supplements actually with that tea and I get about halfway, I put it in the fridge, I cover it, and then in the evening before I go to bed, I take all my supplements. In fact, I take my supplements with my Revlimid. I get in arguments all the time with oncologists. They say, “Oh, you shouldn’t-“

Dr. Weitz:            That was going to be my next question. Patients taking ongoing chemo and the oncologist is telling them, “Whatever you do, don’t take any antioxidants couple with your chemotherapy.”

Dr. Brandy:         Yeah, I get in arguments all the time with these guys, and it is a knee jerk reaction. It’s not based on any science. Keith Block wrote a really good meta analysis. He looked at 965 articles, and these were people that were taking antioxidants with chemotherapy or radiation. What he found was that it actually made the patients finish their treatments better, they had less side effects, they actually got better results. There was only one side effect. One person overdosed on vitamin A, which is a fat soluble vitamin. If you’re taking a fat soluble vitamin, you need to make sure you monitor it so you’re not getting overload. There was another study, I actually have it in my book, did the same thing, looked at 280 studies. It was a meta analysis, and they came up with the same result.

                                The other thing I always … There’s a drug called Amgen. I don’t know if you’re familiar with it. It’s an IV antioxidant that was approved by the FDA 20 years ago, and it was approved so that it could prevent damage to the normal cells when people were getting radiation in certain times of chemo. What they found in that study, and there were many clinical trials for that to get FDA approval, that it had no negative effect on the final treatment and it did protect a lot of the normal cells that were around the area of radiation.

                                So anytime an oncologist gives me a hard time with that, I go, “Well, you know what? Why did the FDA approve this IV antioxidant that’s way more potent than any antioxidant in turmeric or vitamin C or green tea?” I mean, it’s not even close. So that whole thing is really, I really feel it’s a total knee jerk reaction because you know as well as I do, most medical doctors know nothing about nutrition. Zero. I mean, we get two weeks in medical school and honestly, it’s like a junior high school health class. It’s like if you don’t get vitamin C, you’re going to get scurvy. If you don’t get vitamin D, you’ll get rickets. I mean, even fruit loops is probably fortified with vitamin D. People don’t get scurvy nowadays.  I really do, talking about these phytonutrients, I think a lot of these people in these carnivore diets and so forth, nobody ever talks about this, but we don’t have any acute deficiencies. But I think a lot of these people over time are going to have phytonutrient deficiencies that develop over time.

Dr. Weitz:            I would totally agree with that. Even Paul Saladino, I think, didn’t Paul Saladino changed and start incorporating some vegetables or something now?

Dr. Brandy:         Yeah, and you know what? I don’t know if you’re familiar with the American Gut Project by Robert Knight. He’s the premier microbiome researcher in the world, and he has the American Gut Project. You basically send your stool sample in with all these … There’s a questionnaire, ask you all these different questions, and they’ve analyzed over 10,000 stool samples at this point. What they’ve found is people that eat 30 or more different plant foods in a week have the most diverse, healthiest microbiome compared to people that eat 10 or less. The people that eat 10 or less have some antibiotic resistance bacteria. The people that eat 30 or more didn’t have any.

                                It’s probably because the people that are eating 30 or more per week are probably plant-based. People who are 10 or less probably are eating maybe paleo or keto and they’re getting some of these antibiotic resistant bacteria from the animal products that they’re eating, but that’s one thing I stress, and it’s really not that hard to do. When I’m doing a consult, I show people the salad that I eat every day. I really never knew how many vegetables I had in there until somebody asked me. I actually count. I had 25 different vegetables in that salad.

                                So I tell people, “Listen, when you eat a salad, don’t put a bunch of greens in there and then maybe little carrots and onions and a tomato, but two radish, put two broccoli, put two cauliflower, put some corn in there, put some peas, and get that diversity in that salad.” Then as far as getting up to 30, the Blue Zones kitchen and I give patients probably about 15 different cookbooks and websites that they can go do to get some amazing recipes.

                                My wife is an amazing whole food plant-based cook. She’s always in different cookbooks, but there’s some really good ones in the Blue Zones kitchen, some really good soup. So just in that soup, there’s usually 15 different vegetables, legumes. So if you make that in a big instant pot, put them in some little mason jars, you can just pull that out. You do the same thing with your salad. You just put them in little mason jars and you just pull them out. It’s really not that hard to do. Then supplement that with fruits, whole grains.

                                Every morning, I start with steel-cut oats, with all the berries. I put cinnamon and I put soy milk with that alone. I was telling you by Joe Mercola, what he eats in the morning. I compared what he was eating to what I was … So with that, I was getting, I think it was like 680 calories. I was getting 25 grams of fiber just with that one breakfast. I will tell you, with that drink that I do in the morning, I’ve calculated what I get just with that. I actually get 25 grams of protein and 12 grams of fiber just with that drink that I do in the morning.

                                People think, “You don’t get enough protein.” I probably get 1.5 grams of protein per kilogram. Honestly, I really don’t even want to be that high, but I am very active. I do think the more active you are if you’re doing resistance training and so forth, you need to get above that 0.8 grams per kilogram, but I looked at what I was doing, I’m getting thousands of phytonutrients. I was getting about 25 grams of fiber. In that, I was getting almost 40 grams of protein just in that morning breakfast that I’m eating because I’m using that soy milk, that Silk soy milk. One cup alone has eight grams of protein and two grams of fiber just in the soy milk. That’s why I like Silk. I think that is the best brand.

                                I’m getting all these phytonutrients and I’m getting all this plant diversity with that. Dr. Mercola was getting zero fiber or he is getting zero phytonutrients. He’s not getting any plant diversity in there at all. He’s getting a ton of saturated fat. He’s getting, as I said, 1,550 milligrams of cholesterol. What I was surprised at, it was 1,600 milligrams of sodium. I was surprised by that, and then 130 grams of protein, animal protein.

                                As I told you, once you get over 30 grams of protein, it’s really all it’s doing is really acidifying your pH, putting a heavy load on your kidneys. It’s creating very high iron levels, which are very pro-oxidant. In fact, I told you he actually blood lets himself every month. So I just think that people that are eating these carnivore or Paleo or keto diets really got to be careful because the preponderance of evidence does not show that that is going to have long-term results. You might have some short-term results, you might feel better, but long term we know you have to look at the preponderance of evidence over many years, you have to look at the Blue Zones, you have to look at the work the John Robbins did with Be Healthy at 100.

                                The preponderances evidence is that people and cultures and research cohorts that eat more plant-based definitely live longer and they have less lower incidents of cancer. In fact, I don’t know if you’ve read Fiber Fueled, you really should read that book. In fact, you should get him on your podcast, Will Bulsiewicz. He’s a board certified gastroenterologist, and his book is amazing, and he’s a great podcast host, if you ever get a chance, and I think he’s really amenable to doing podcast interviews, but he went over a study that came out, Lancet 2019. They looked at 185 prospective studies, 58 clinical trials. It was a meta analysis, and it was 135 million people years. They found the highest fiber consumers compared to the lowest fiber consumers actually lived 30% longer.  So we know that when you eat more fiber, you’re healthier. In fact, there was a 2014 study. It looked at 1.7 million people, I think had followed them over 14 years, and they found for every 10 grams of increase in fiber, you lower your mortality by 17%, premature mortality. 10 grams of fiber, just got to give you an example, if you eat a half couple lentils, that’s 10 grams of fiber. If you have a cup of navy beans, that’s basically 10 grams of fiber. So it’s really not that hard to do, but the average American only gets 15 grams of fiber.  If you look at the NHANES report, men 30 to 50, 0% eat 30 grams of fiber, 0%. In women, it was 3%. So the American diet is really sorely deficient in fiber, not protein. I’m not worried really about protein. If you’re getting enough calories, you’re getting enough protein. That’s my feeling. Now, if you’re doing a lot of weight training and you want to increase muscle growth, you’re probably going to need a little bit more protein, but I will tell you, when I look at eight grams per kilogram, it’s about 52 grams. I mean, I always get over 100 grams. I’ve checked on consecutive days. I don’t really want to be that high, but it’s really not that hard to get up to 100 grams on a whole food plant-based diet. With the nuts and seeds I do, I eat legumes every day, I eat whole grains, have a lot of protein. I do a lot of whole grains. I do Ezekiel bread this morning, I had it with walnut butter with a little bit of jam. So I think whole grains are extremely important.

Dr. Weitz:            Sounds great, Doc. This is a fascinating discussion. I’m really enjoying it. However, I’ve got a patient here, so I’ve got to run.

Dr. Brandy:         You got to take care of that patient, man.

Dr. Weitz:            Tell everybody how they can get your book and learn more about you, your website, et cetera.

Dr. Brandy:         Yeah. My book is called Beat Back Cancer Naturally. You can get it on Amazon. It’s in hardback, paperback, audio, and in Kindle. You can also get it on my website. My website’s naturalinsightsintocancer.com. If you get it there, I do give you a signed copy, and it’s about the same price as if you go on Amazon. I have a Instagram site. It’s called Cancer Veggie Doc, and I have over 36,000 followers on there. I make sure I do a post every single day. In fact, the post I did last night was how a ketogenic diet. It was a study in cell cycle. It actually increased breast cancer by 2.5 fold. So you can take a look at that. I’m always looking at studies on different diets and how they affect cancer growth, but that’s basically the best ways to get me.

                                Then if they want to do, I do extensive lab testing. I do 70 plus biomarkers request. I check all the vitamin levels, mineral levels. I check C-reactive protein, heavy metals, the omega-6/omega-3 ratio, hemoglobin A1c. I always check their IGF1 levels. I think it’s really important. What I find, and I will tell you this, almost every single person has messed up mineral levels. I mean, I’ve never had anybody had a normal molybdenum level. So I do recommend people take a liquid colloidal mineral supplement every day because our soil is just so messed up right now. In fact, I was reading a book last night and I guess 50 years ago, our top soil was about 16 inches thick and now it’s 20% of that. So our soil is really super depleted.

                                Then I also do microbiome testing through Doctor’s Data, and I check 173 different toxins from the urine through Great Plains Laboratory. So they can get all that on my website. They get a virtual consultation there. I also have 24/7 availability to me through email, text, and phone, and patients absolutely love that. I have a lot of these patients going through metastatic stage four cancer and I’m in contact with them almost every day through text message because they’re nervous, they’re scared, they’re reading articles. So I’m with them day in and day out. I mean, I get enundated with text messages.

Dr. Weitz:            That’s awesome, Doc. I do have to run. I really appreciate it.

Dr. Brandy:         Okay. All right. Take care, Dr. Ben.

Dr. Weitz:            Thank you. Thank you.

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 discover the Rational Wellness Podcast.  I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way, and that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective.  So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.