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Chinese Medicine Approach to Acne and Rosacea with Dr. Antonia Balfour

Dr. Antonia Balfour discusses a Chinese Medicine Approach to Acne and Rosacea 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

 

 

 



Dr. Antonia Balfour is an acupuncturist and Doctor of Traditional Chinese Medicine, specializing in dermatology in Pacific Palisades in Los Angeles, California for more than 20 years. In her practice, Yin Yang Dermatology, she treats many patients suffering from acne and rosacea with Chinese herbal medicine. One of the strengths of Chinese herbal medicine is being able to customize herbal formulas to meet the unique needs of each person.  Dr. Balfour studied TCM dermatology with foremost expert, Mazin Al-Khafaji, for more than 10 years, and she is a contributing author of LearnSkin’s e-book – An Introduction to Chinese Medicine Dermatology.

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

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Keys to Longevity with Dr. Bruce Fong

Dr. Bruce Fong discusses the Keys to Longevity 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

 

 

 



Dr. Bruce Fong is doctor of osteopathy and a homeopathic practitioner. He is the medical director at Sierra Integrative Medical Center, where he uses alternative therapies for immune-related diseases like Lyme Diseases.

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 update, 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 how to promote longevity and whether using nutritional supplements to promote growth hormone and IGF-1 levels will promote longevity. Our guest is Dr. Bruce Fong, who’s a doctor of osteopathy, a homeopathic practitioner, and he’s the Medical Director at Sierra Integrative Medical Center where he uses alternative therapies for treating immune-related diseases, like Lyme disease, mold, et cetera. Dr. Fong, thank you so much for joining us today.

Dr. Fong:              Thanks, Ben. I really appreciate the opportunity to be on the show today and just looking forward to a great time with you.

Dr. Weitz:            Sounds good. So, Dr. Fong, what are some of the keys to longevity, and for that matter, how do we measure longevity?

Dr. Fong:              It’s an interesting topic because longevity is a term that can even come from even ancient Chinese texts or whatever. It’s not only the prolongation of our lifespan, but a prolongation of the quality of our lifespan. It’s not just about how many years you live. It’s about how you live them well. The ancient Chinese had a lot of different things that they could do for that, but one of the most critical ones was actually using deer antler. As we progress in our discussion, I’ll explain that, but even in traditional Chinese medicine where you go to the herbalist and stuff like that, they’ve always added deer antler typically to the mix of the different powders. I don’t know how familiar you are or the listeners are, but I grew up in San Francisco.

I’m a Chinese American, born here. I go to San Francisco in the Chinatown and I hated that smell back then. I’m going to be honest with you. That’s some really funky smells when we to go the places and they have all kinds of things all dried out in little containers. It’s freaky to a kid to walk in there. But now that I understand those things and I have a better appreciation of those things, what the herbalist would always do is that, hey, you go home to them like your regular doctor and you’d go, “Hey, I’ve got a cold or whatever.” They’d grab the various herbs or other freeze dried preparations that they had or preserve preparation, I say that they had.

Always it seemed like they would take the deer antler, which would be in a big glass enclosure, pull it out, and scrape the end of the antler into the mix that creates some powder. Then they use the old mortar and pestle to really grind everything together, put it together, put it in a little sachet and say, “Hey, make a tea out of this or sprinkle this on your food,” whatever. That’s how the things went. To this day, deer antler is probably the second most used thing in traditional Chinese medicine short of ginseng. So that’s how involved it is.

There are ancient Chinese texts that talk about this going all the way back, almost 3,000 years about it helps with healing of wounds. It helps with building body back after sickness. It helps to promote virility. It helps to promote vitality. It helps to promote the continued strength in the body, et cetera, et cetera. The list goes on and on. Like I said, we probably want to further discuss that as we go forward, but I just wanted to give you a historic background of what longevity really is about healthy aging, I guess, is the short answer. Sorry, I talked way too much on that one.

Dr. Weitz:            Yeah, no, no, that’s good. So, we’ll get to the deer antler in a minute. I’d like to focus a little more on some of the concepts of longevity. Do you measure longevity in your practice? Have you used telomere length or DNA methylation?

Dr. Fong:              Well, obviously, I’m very familiar with the telomere concepts. We used a lot of things actually for healthy aging. Just to give you my background, I’m an internal medicine doctor. I went through a three-year residency and I’m traditionally trained as an osteopathic physician, but before that, this is backwards. But before that, I actually worked at various levels at my parents’ integrative clinic here in Reno, Nevada. Yeah, I mean I started out as the guy that took the garbage out, but I worked my way all the way to the top, I guess.

One of the coolest jobs in undergrad college, by the way, I got to be a hyperbaric oxygen tech. I basically get the patients up to pressure, make sure they’re okay, and then you have to sit there about 90 minutes with a patient under pressure. Perfect time to study and reading occasionally. Pick up the phone and say, “Hey, you good? You’re doing good,” whatever. But I grew up in this form of medicine. As I grew and I understood things, these days we have all kinds of marker. You mentioned really good stuff about the telomeres. In case listeners don’t remember what that is, your DNA has little snippets on the end that every time you replicate your DNA, you lose a little bit of that DNA. So, those are the things called telomeres, and there’s an enzyme that cleaves off that little bit each time.

That’s what we think is responsible for aging. So, there are things that you can do to try to limit something called telomerase or the actual enzyme that snips the ends off. So, those are really cool things. We also do things that people are probably more familiar with as well. We measure hormone levels and we utilize a more integrative technique to both evaluate those levels. We don’t just go by laboratory values, which if you think about it in the laboratories, you do so many standard deviations above and beyond. But really at the end of the day, most laboratory values look at maybe like 80% of the population. So, about one in five of us sometimes doesn’t really fit that mold. Plus, we have what are called age normal in hormone values.

Okay, great, I’m 53 years old. This is normal for me for such and such, but I don’t feel good. Why don’t I feel good? Because I want to feel like I’m back when I’m in my 20s. So, the same thing and many of you probably understand that that’s what we’re talking traditionally hormones like testosterone and estrogen, progesterone, whatever. The other thing though is moving into the discussion of where deer antler fits in, we have human growth hormone. We have human growth hormone that stays at high levels and then gradually starts coming down, especially after we’re in our 30s or so. Everybody’s already heard about that point when you hit your 30s, your metabolism slows down and you get fatter or whatever.

I mean, there’s actually a shift in your hormones and you shift in things like human growth hormone. Now, human growth hormone, when we make it in our body, the primary thing that comes from it where it’s stimulates, deliverers, and produced is something called somatomedin C, the letter C. That really translates into insulin-like growth factor one or IGF-1. It’s the main motivator that repairs things in our body. When we overwork ourselves, we work out too hard, it helps to rebuild those tissues really quick and it allows us to put on muscle mass working out, et cetera, et cetera. It also regulates hormones. It regulates inflammation in the body, helps basically build us up and to maintain us.

Once we hit the age of 30, like I said, those levels start to go down so we don’t have as much human growth hormone, but also as a result, that stimulation to make IGF-1 starts to go down. That’s another way to think about aging. It’s not just about the years and the fact that we look more wrinkly or the fact that we have white hair or whatever. It’s about how we can maintain our bodies. Really most people before the age of 30 typically don’t have a lot of chronic medical conditions. So, looking at this from an internist standpoint, we start to screen for things probably in that decade of life.

And then as we get older, we start to notice things in the body, like increasing risk for cardiovascular disease, for instance, as we move forward. A lot of this can be directly correlated to the loss of these growth factors in the body, because we can’t maintain ourselves very well because we can’t continue to fight off the vestiges, if you want, of our toxic environment. We can’t keep ourselves as healthy and keep ourselves as optimal as we want.

Dr. Weitz:            Now I’ve been tracking longevity research, going to seminars, and listening to talks and reading books and articles. I would say 15, 20 years ago, there was a big push for using hormones, using growth hormone. There were quite a number of clinics that sprung up that were actually focused on using human growth hormone and new Issues with the FDA shutting some of them down and making it difficult. What do you think about that whole concept of actually using human growth hormone as a longevity concept?

Dr. Fong:              So the use of human growth hormone has actually been well proven to be, in the strictest definition, one of the best things you could do for longevity, but there’s two big factors here. Human growth hormone is one, extremely expensive. Two, these days to get your insurance to pay for something like that, you would essentially have to go to an endocrinologist to be evaluated and show by the strict guidelines of the endocrinologist to say, “You actually need this. The actual growth hormone levels are low. Your IGF levels have to be low,” et cetera, et cetera. You got to need all these criteria.

Dr. Weitz:            Even if the insurance is not going to cover it, still it’s not easy for physicians to prescribe growth hormone, right? Isn’t it tightly controlled?

Dr. Fong:              Yeah. Again, even outside the insurance realm, you can actually prescribe it, but again, you might get some feedback from a pharmacist or somebody else. Also, like I said, the cost is fairly prohibitive. I mean, you’re talking thousands of dollars in a month, so that’s not an easy thing to do. So, what else can we do for that really is shift to what the growth hormone produces in our body. One of the things that I mentioned earlier was somatomedin C or IGF-1 is the primary motivator of the benefits of the growth hormone. Again, healthy aging, like all the other benefits I mentioned earlier, but’s really the IGF-1 is the main factor for that.

Dr. Weitz:            Now, interestingly, the longevity antiaging research and a lot of the focus that I’ve seen from going to seminars now has shifted from trying to promote growth, trying to maintain muscle, more towards trying to prevent cancer, trying to prevent some of these other chronic diseases. So, there’s been a lot of discussion that higher levels of IGF-1 are actually associated with decreases in longevity. We have higher levels of IGF-1 potentially increasing cancer risk. Valter Longo has been very outspoken on this. He published a review on IGF-1 levels and longevity, and consequently, he’s recommended a lower protein, more vegetarian style diet to promote lower IGF-1 levels.  One of the factors that’s often brought up when discussions of whether or not IGF-1 is good or bad for longevity is the example of the Laron dwarfs. There’s approximately 300 of them. Most of them live in Ecuador. While they have normal growth hormone levels, they don’t have the receptors to bind the growth hormone. Consequently, they can’t make IGF-1 and they seem to be protected against cancer and diabetes and they tend to live a longer life. On the other hand, many of the larger people like professional body builders, we’ve seen a whole series of professional body builders the last couple of years die early. Professional football players are renowned to have a shorter lifespan.  Now it could be many reasons for that, just being bigger or potentially having higher IGF-1 levels. It hasn’t really been shown. But we also have examples of people with acromegaly or what are called giants like the professional wrestler, Andre the Giant, who died at age 46. So, there is this concept that higher IGF-1 levels are bad for longevity.

Dr. Fong:              So, there’s a lot of points to that question. So, yeah, let’s start with the Ecuador Laron dwarf guys. They are actually genetically set up to have that lifestyle. They’re genetically staying in a geographically isolated area. We’ve found multiple populations throughout the world that when they’re in the right conditions at the right times and the right places, yeah, basically, their cardiovascular disease risk is almost zero. They found villages in China and I believe in Japan that the people’s LDL levels, different argument, but for the same reason that these folks’ LDL levels, the low density lipids are the bad things that you’re trying to correct when you take statins and all those things, their LDL levels are below 40.  So, the conclusion of the study that was said is that and since these people have no cardiovascular disease risk essentially, it was a conclusion that was drawn from the study a few years ago that said that we should actually try to get all of our LDL levels below 40 or whatever it was. So, in other words, they were pushing for a goal of 39 or less for the LDL.

As many of, if you’re below 100, your doctor’s starting to think about putting you on a statin. Well, again, you’re talking about genetics and then trying to get people who are not in that genetic makeup to force them to go into something else. That doesn’t always work really well. In other words, if we put across the population, everybody have your LDL below 39, well, the only way to get there is to use this something like a statin. Of course, we don’t need to get into that, but there’s a high side effect profile with a lot of the statins.

Dr. Weitz:            Especially if you have to use a higher dosage, especially if you have to start adding a second medication to get it that low.

Dr. Fong:              Right. So, as a corollary back to the Ecuadorian, I hate to use the word dwarf, but the whole point is that they’re set up. Over the thousands of years that they’ve been there, they’ve adapted to their environment. They’ve adapted to that lifestyle. In other words, they’ve optimized and they’re in a place that’s really isolated. I think your listening population can understand that we’re in a bad world these days. Things are too polluted. We’re subjected to a lot of things that probably affect our bodies in a negative way. These guys probably don’t. They’ve adapted that environment that they live in.

There have been repeated studies showing that when you take somebody out of those perfect situations, I think it was ethnic studies that showed folks in Japan had these really long lives, once they left Japan and came to the United States, changed their diet, came to a different environment, they quickly slumped off and went right back into what the average of everybody else was, if not less. So, there’s plenty of evidence to say that these perfect niche situations, when you remove the person from that, that alone could actually throw it up. So, to put the conclusion that it’s just about IGF because the IGF was probably the main factor that there is dwarfism. To say that there’s a lower risk for cardiovascular disease or whatever else, I personally would question those conclusions.

I think that there’s a lot of different things we need to think about. So, the other end of the spectrum, big athletes, we talked about this quite a few times, but the folks that are really big and they push themselves really hard, the folks you always hear about unfortunately having a bad outcome, they were the ones that really pushed themselves above and beyond what their body can handle. I think that one of the critical things as I get into this particular IGF-1 product from Nutronics Labs is, there’s a big difference between that. Actually, taking pure IGF-1, there is definitely a risk because it stimulates growth across the board like you were saying. But the deer antler velvet product, that is what Nutronics Labs’ IGF-1 Plus is, it’s very different. So, let’s talk about that a little bit.

Dr. Weitz:            Well, hang on. Let’s just put that off for a few more minutes. I know you want to get to that, but I just want to have a little more discussion. I think the concept about longevity and IGF-1 centers on we have two balancing factors that we would ideally like to have happen as we get older. It’s loss of muscle, sarcopenia, loss of bone, osteoporosis, loss of immune system function, what we call thymus evolution. These are factors that commonly occur when you have less growth factors in the body. These are negative for longevity. People fall, break a hip. A lot of the consequences of weak muscles, weak bones, or weaker immune system is very, very negative.  On the other hand, things that stimulate growth may stimulate growth of cancer. So, I think that there’s some balance that needs to be struck here as we go through life to balance those out. I suspect that eventually, we’ll come to the conclusion that there’s an ideal range for things like IGF-1, not just that it should be lower or higher.

Dr. Fong:              Right. So, everything’s about a balance. Again, the deer antler velvet is actually the center of all this is. So, again, I want to emphasize the deer. This is not pure IGF-1. This is a complete growth matrix. So, really quickly, in case you don’t know it, deer lose their antlers every year. And then in the springtime, they actually have a rapid growth of these antlers. It takes about 110 days. They have these full racks that people, when they hunt the deer, sometimes treasure the racks and things like that. But really, if you actually understand that, I mean think about that, within 110 days, you go from little nubs to growing these full big racks of antlers. So, there’s definitely something there that has rapid growth, but a controlled rapid growth.

So, what was found is if you harvest the deer antler about halfway through the cycle, about 55 days or whatever ideally, the inside of the antler is this gelatinous gooey matrix that’s brownish in color. When you extract it and cold press it, you produce this brown liquid. When you analyze it, it’s primarily IGF-1, but there’s a whole myriad of other growth factors. There are other things like transforming growth factors, morphogenic of growth factors that actually check the IGF-1 and to help maintain healthy and specifically desired growth and to exclude any type of abnormal growth. So, again, this is a complete matrix.

So, again, I don’t make any secrets about it. I’m a Christian and I do believe that God created a really good system here. He peeled really a perfect system to grow stuff with and he adds the checks and balances. That’s why this product being a pure extract of the deer antler velvet and then being brought into the body gives you a complete growth matrix. So, then there’s your balance. There’s things that help to grow and there’s other things that also check abnormal growth. So, that that’s the critical part. And then of course there’s other things in here. There’s IGF-2. There’s neurotrophins, things to help grow nerves, help to grow bone, grow connective tissue.

The biggest thing, the main matrix, it’s collagen. So, there’s a lot of things we can discuss here which do add to that discussion you just said about maintaining all the various hormone levels, the growth factors, helping the body to maintain itself, reducing inflammation which could be dangerous in a long term basis. The bottom line is this is a complete growth matrix which is there to help establish and to maintain that healthy growth. So, I’ll let you take our direction next because there’s a lot to talk about there.

Dr. Weitz:            Well, I’ve seen deer antler supplements on the market used in the body billing context and in the testosterone raising supplements. Does deer antler raise testosterone levels?

Dr. Fong:              Well, that’s a very good question. So, deer antler, in specifically through the IGF-1 mechanism, increases gluttonizing hormone, which is the stimulating factor that actually creates increased production of testosterone and it also helps to build the other hormones as well. But again, that is a natural stimulation as opposed to say taking ridiculous amounts of testosterone, which is where some of those guys you mentioned who had passed away early, they were doing things like that. Again, remember the emphasis is that this is a natural product, this is a balanced product.

When you try to use something out of balance like IGF-1 by itself or testosterone in excess, which by the way, we have resulted now in that for the last decade and a half that testosterone is now a controlled substance was one of the reasons for it was people were abusing it. But the point is when you use this natural growth matrix, it is interacting with the existing systems in your body. In other words, it’s completely compatible with your body and your body has its own checks and balances of how much it’s going to be stimulated and to be able to make. So, in essence, the deer antler product or the IGF-1 Plus product of Nutronics Labs helps you to be, and forgive me, US Army, I’m not trying to infringe on a copyright, to be the best that you can be.

It maximizes your potential for healthy aging as we’ve been talking about. It helps maintain muscle mass, helps you to actually put on some muscle mass, and it helps to metabolize fat much more rapidly. So, from that standpoint, it’s very excellent. It helps to build various different types of muscle fibers, including the ones for endurance as well as the ones for quick strength. So, from a performance standpoint, that’s there. It helps to regulate the levels of testosterone, but again, it may not be 100% enough. Again, there’s so much that your body can only do when it’s being stimulated as opposed to throwing the end product in there.

Dr. Weitz:            Now, it’s generally thought that hormones like human growth hormone and most of the other hormones are not well absorbed if ingested orally. How do we know that any of the products in deer antler are going to actually have a therapeutic effect?

Dr. Fong:              So, two things I want to mention as I get into there. First, the Nutronics Labs’ IGF-1 product is the only product I know of with deer antler that has been assayed by a third party to confirm that if we say there’s 100,000 nanograms in the bottle, that that’s what’s in there. So, again, we have third-party assertions and studies to confirm that. I’m glad you asked this question. You’re absolutely right. All these growth factors and other products when taken orally and just simply ingesting it, typically stomach acid and/or the digestive enzymes tend to destroy them rapidly and the absorption is not fast enough to really get there. So, you’re playing a little bit of rushing your lead. Are you really actually getting anything?

All of the IGF-1 products from Nutronics Labs actually use a liposomal delivery system. So, that means it’s fact based, it allows for rapid absorption, and guess what? They don’t swallow them. You put them under the tongue. I’m sorry if I scared the listeners because bottom of my tongue’s up. It didn’t look so cool there. But anyway, the bottom line is that you put it under the tongue and it’s a sublingual delivery wrap. People are going, “Why would you put it under your tongue?” Well, most people have heard of people taking nitroglycerine if they have chest pain. The reason we use nitroglycerine is that it rapidly absorbs under the tongue and creates what’s called the vasal dilatation. Basically, it opens the blood vessels.

So, we need a rapid effect in case somebody’s trying to have chest pain, maybe going into a heart attack. You got to get it there. Traditionally, that’s what’s been used. Modern medicine has forgotten about the fact that under the tongue, we have a big, big capillary bed, which is an absorptive surface that gets things directly into the bloodstream if you have the ability to do it. Typically, the nitroglycerin gets absorbed very well. The liposomal or fat-based delivery system of the IGF-1 products actually rapidly facilitates this growth factor getting into the bloodstream.

Dr. Weitz:            A, are there randomized trials that actually show specific benefits of deer antler? B, other people make this claim about sublingual route of absorption. Do you have data showing that your product when ingested sublingually actually gets into the bloodstream, has a higher absorption level than otherwise?

Dr. Fong:              So it’s really interesting you asked that. I actually did a small trial here at my office with my staff primarily, and we were recording things. We actually left the catheter in their arm and we would actually draw blood measuring an IGF-1 level and very carefully labeled the tube as this is the pretreatment level. We applied the product sublingually and we actually checked the data from… I believe it was 15 minutes and then 30 minutes and I believe even 45 minutes afterwards.  We showed at 15 minutes that there was a noticeable spike in the level of IGF-1, but usually by 30 minutes, it was already gone. Meaning that these growth factors are rapidly taken up by the body via the bloodstream. And then those that we had in the trial that were being given a placebo, they had no spike whatsoever. So, again, I’ve got in clinical data that has that. I’ve seen other folks demonstrating the use of liposomal delivery systems for other products. So, it truly is a very good route of-

Dr. Weitz:            It’d be nice to have some published scientific data for that.

Dr. Fong:              Yeah, I know that we had a small trial, like I said. I think it might be in our website in Nutronics Labs. But again, if you look at a lot of the utilization of a lot of products sublingually, a lot of the… Also, I’ve trained in homeopathy as well and a lot of the products there are actually delivered sublingually and they’re meant to be delivered sublingually again shooting for that capillary bed.

Dr. Weitz:            No, I know. I just don’t think that there’s much published scientific data to substantiate that concept, right?

Dr. Fong:              Well, I mean again, look at the utilization of nitroglycerine. When people are utilizing, if it didn’t work, we wouldn’t be telling people to put it under their tongues. That’s the most rapid thing. So, there’s two forms of nitroglycerine you have, for instance. They’re rapidly dissolving 0.4 milligrams that goes under your tongue and then there’s a pill that gives you a sustained release in nitroglycerin throughout the day for people who have angina.  So, the reason you want to hit the one at the time, I mean people take several, if they’re having bad chest pain, they’re going to try to swallow that or put half that bottle of the nitroglycerin under the tongue. Sometimes it actually helps. The fact is that it is rapidly going into the bloodstream and there may not be a modern randomized trials for this thing, but honestly, it is an acceptable route. I mean even looking at conventional medicine that it is a normal route of the ingestion or utilization of the body.

Dr. Weitz:            Okay. Well, how about randomized trials to show deer antler having the effects that you’re claiming?

Dr. Fong:              So we have a lot of trials that are out there in regards to what specific effects like the IGF-1 and the other things have, and again, the IGF-1 being one of the main constituents of the deer antler. There have been a lot of published trials. Let’s talk about performance. Let’s see. I’m trying to remember the guy’s name. [inaudible 00:31:00] was a Russian maybe actually in the Soviet era. So, if I’m misnaming that, forgive me, but he was randomizing his control of IGF-1 in the performance factors of some of their athletes. He is recording his randomized trials and it clearly showed huge benefits in the endurance.

I believe these were swimmers, but endurance and the muscle development in those that were receiving the IGF-1 were much higher by at least 20% or more compared to those who were not receiving it. So, from a performance standpoint, we’re seeing that. The folks that in general have seen a lot of other performance parameters looked at through the years and that’s what generated, I guess, you would call it the craze that you called it 15 years ago. So, there’s a lot of studies in the sports physiology and the other journals in that direction about how this really can show its benefits.

Dr. Weitz:            Is deer antler approved for use by Olympic athletes?

Dr. Fong:              Unfortunately, anything that is considered a performance enhancer is supposed to be illegal. Now don’t take this the wrong way, but based on what I said in my little trial, the stuff disappears so quickly or so rapidly absorbed that unless somebody was taking blood like we were doing before they actually took the dose and within 15 minutes and rechecking it, you probably wouldn’t be able to detect it. So, again, I’ll leave that to whoever wants to take that news, whatever they want. There were some very famous athletes let’s say in the NFL and the Major League Baseball that were reported to be using some of these products. The major sports leagues had banded. We went on the air to try to fight that because we didn’t feel it was a dangerous enhancement thing.

Again, a growth factor is a stimulant in your body to produce the various things that you need. It’s not adding steroids. It’s not adding testosterone, which take you probably above and beyond what your body can handle. That’s where the danger thing you were saying about the folks dying early and everything. This is a natural stimulating product that helps you to grow better. It helps you to bring yourself out to the best that you were meant to be, maybe even beyond what you thought you could do, but still your body can handle it, but it’s not going to take you beyond that to a dangerous level and then throw you out of balance. Remember in traditional Chinese medicine, you always talk about the yin yang, the balance of things.

You don’t want to push so hard in one direction, the other direction suffers. Again, this got its own checks and balances within the product itself and it’s also checked and balanced within the body itself. So, again, you get the be the best you can be and there’s basically no danger with it. In fact, I believe it’s more than three decades of this product being available. There has never really been, as far as I know, any reports of people getting cancer from it, having any negative outcomes. I mean that really basically speaks for itself. So, I would put that out there for you.

Dr. Weitz:            Okay. So, what are some of the benefits you found for a patient?

Dr. Fong:              So again, in our particular practice, we see a lot of patients for a lot of chronic medical issues and a lot of times it involves a very deep history and physical. I usually spend about 90 plus minutes with my initial patients to really discover. I know as you show up here and saying, “I have chronic fatigue,” or “I have fibromyalgia.” I don’t stop there. I go deeper and deeper trying to figure out underlying causes for these issues and then we try to work those up properly. But a lot of times we find a culture infections like Lyme disease in a good number of patients, mold and mycotoxin toxicities, heavy metal poisonings, chemical sensitive. Even food allergies all play a role in these things.  So, we go there, we find our information, then we treat these patients. And then sometimes while treating them, they’re going to have a rough run because you’re getting rid of different things from their body, especially treating infections. They can wipe them out a little bit while doing that, because they have what are called Herxheimer reactions at times based on some of the therapies we use. And then basically, we’re detoxing them the whole time. Then afterwards, we want to help them to repair things.  Now that we’ve taken away the aggravating or the hurtful factor or the pathogen, if we will, then now is the time to enhance or encourage that body to repair itself. I’ve never found anything better than the IGF-1 product from Neutronics Labs to do that. I’ve seen patients who recovered much more quickly after these treatments with the product prior than the-

Dr. Weitz:            What is recommended dosage and length of time?

Dr. Fong:              So if you’re talking about my patients, typically, I can go with anything from a 10,000 nanogram per bottle dosing, which is a spray, or I can go as high as 100,000. The ones that are, shall we say, more sedentary, maybe a little bit older, I’d probably start with the lower dose just to get them where they are. I feel like if they’re making gains, they want to be even better, then I can always bump them up to a bigger dose. The people who are very active or who were very active prior to getting sick, I typically start them at about 100,000 nanogram per bottle dosing and that allows them to more rapidly repair. Because they’re trying to become more active, again, it helps to mitigate the stress factors about trying to work out sooner or trying to get back into the swing of things.

Dr. Weitz:            Is this is a liquid or a capsule?

Dr. Fong:              Okay. So, again, everything’s liposomally delivered. So, it’s always a liquid. The lower doses like the 10,000 are a spray under the tongue and starting at 100,000 and higher, I believe we have up to a 300,000 dosing now per bottle. Again, it’s not per drop or per bottle. Those are actually drops that you place under the tongue because they’re so concentrated and it’s not going to aerosolize like a mist as well. So, we put them as a drop still, liposomally delivered to that capillary bed under the tongue.

Dr. Weitz:            How long a period of time will patients do you recommend them take these for?

Dr. Fong:              Usually, we go for at least three months, but a lot of the patients like to just stay on it. It actually makes them feel better.

Dr. Weitz:            Are there any contraindications?

Dr. Fong:              Not that I’ve ever seen. Now, again, it is my professional opinion that the IGF-1 product from Neutronic Labs does not cause cancer in of itself, but if there’s any danger of a malignancy in your body, you should always get checked out by your physician before starting any product like this. So, again, that’s the only caveat.

Dr. Weitz:            So you would not use it if a patient has cancer.

Dr. Fong:              I would be very cautious about it. I would speak with the oncologist because you can make arguments either way with it, because it could actually maintain the rest of the body even though in and of itself, it should not cause cancer because of the checks and balances that are within that growth matrix. Though you can make an argument to prevent sarcopenia or the wasting away of the muscles and things like that of the body. If somebody’s on chemo or whatever else, it can help to maintain them. But at the same time, the oncologist who’s in charge should be the person that helps you to make that decision better. It really depends on the kind of cancer, how far a person’s progressed. That really should be taken by a case by case basis if you actually do have a malignancy.

Dr. Weitz:            Okay. I think that’s the end of the questions that I had prepared. Any other things you’d like to discuss with us?

Dr. Fong:              Well, I mean, again, I just have nothing but praise for this product. The origin of the product, the founder of the company was who was like my brother from another mother. He had a relative who had Lou Gehrig’s disease, ALS, and he was going fast. This product was quickly brought to him on an individual basis and it actually improved his quality of life. Unfortunately, the ALS still claimed him, but it improved his quality of life and he lived quite a bit longer than was expected by his doctors. That’s what began this journey more than 30 years ago.

Dr. Weitz:            I wonder about benefits for brain function such as in patients with dementia or Alzheimer’s.

Dr. Fong:              That’s a really good question. There was a study at… I always get these mixed up. I think it’s Cedar Sinai in New York. Forgive me if I misquote the place, but it’s one of the Sinais. But they actually did a study on mice who were genetically made essentially almost like they had-

Dr. Weitz:            I think in New York, it’s Mount Sinai.

Dr. Fong:              Thank you. You’re right. My apologies, Mount Sinai. But the bottom line is that they gave these mice IGF-2, which is in this product and other neurotrophins, which are also in this product. All these mice were genetically engineered to essentially have Alzheimer’s, essentially, basically a diminishment of the brain. So, they put these mice in a random maze and all of them initially couldn’t do the mace, but eventually, the ones that were being fed the IGF-2 and the neurotrophins, they actually were starting to learn to follow the cheese in the maze.  I mean they’re mostly successful, but not all of them found the cheese and the mice that were given no enhancement, no IGF-2 or neurotrophins, no change at all. So, basically, there is suggestive evidence there that it does help to improve long-term brain function. It helps to maintain neuropathways and things like that.

Dr. Weitz:            Interestingly, Dr. Bredesen, who we recently had on the podcast, he often recommends hormone replacement for patients with Alzheimer’s.

Dr. Fong:              That’s a really interesting take. Overall, I probably would agree with that. I think that when we lose our primary sex hormone, estrogen in females, testosterone in males, there is a significant change. You can make arguments about where it comes from blood flow or from maintenance of other tissues, but there’s a correlation, I might not say direct, but a correlation with the overall vitality of the brain and the ability to actually have better cognition. Here at our center, we do biodentical hormone replacement.

One of the big things we recommend ultimately is to do it through pellet technology. Meaning that there’s basically consistent delivery of those hormones across a several month basis because these things are actually implanted and they dissolve at a specific rate in your body. So, one of the things that throws the people off with hormones is that as you’re trying to correct their hormones, again, we use nothing but biodentical hormones, which have in every long term study have shown no significant increased risk of malignancies, but if anything have been shown significant benefits. The biodentical pellets being consistently delivered show a gradual increase of the person’s benefits with elimination of specific symptoms. They all do feel very well with this.

Again, as compared to like taking a pill in the morning or night or using a cream, sometimes you’ll feel better, but then it wears off. You go up and down with the thing. So, the pellet technology, which is relatively new, is a thing we do here at our center. Again, the benefits of having more balanced hormones can very well play a role with increased vascularity, increased ability to maintain the tissues by having a generalized and more balanced hormone picture in your body.

Dr. Weitz:            Great. So, let people listening know how they get in touch with you and how they can find out about this deer antler product.

Dr. Fong:              So again, my name is Bruce Fong. I’m a DO and I’m also in the Nevada, what’s called the Homeopathic Medical Doctors. My certification use integrative medicine. My main clinic is Sierra Integrative Medical Center. You can find us on the web at sierra, S-I-E-R-R-A, integrative, I-N-T-E-G-R-A-T-I-V-E.com. All one word, no hyphens. If you want to call us directly, it’s (775) 828-5388. Again, that’s (775) 828-5388. We’ve been talking about Nutronics Labs’ ultimate and greatest product, the IGF-1 Plus, which should probably holds the greatest potential benefit for anybody who wants to healthy aging and to maintain themselves and be the best they can be.

You can find more information about these products at nutronicslabs.com. That’s N-U-T-R-O-N-I-C-S, labs, L-A-B-S.com. Again, no hyphens, just small in one word. So, again, please check out the product. If you like what I’ve been saying, you want to come see me, please come see me. I promise you I’ll go through everything I can with you to help anything that you’ve got going on that you can’t get answers for. So, again, Ben, thank you so much for this opportunity to be on the show today.

 


 

Dr. Weitz:            Thank you, Dr. Fong. Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple Podcast and give us a five-star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So, if you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.

 

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Outside the Box Cancer Therapies with Dr. Paul Anderson

Dr. Paul Anderson discusses Outside the Box Cancer Therapies 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

2:08  Diet and Cancer.  Dr. Anderson believes that the balance between fat metabolism and muscle metabolism are two of the most important factors that diet affects and that impact long-term survival.  Fat metabolism is largely driven by insulin excess and insulin insensitivity.  The chemistry that comes from that insulin cascade is very inflammatory, is very pro cancer.  The metabolism of our muscles when we are moving and doing muscle work sends out the opposite signaling.  It is beneficial to get into ketosis whether that is with a ketogenic or other form of low carb diet or through intermittent fasting. Even if patients find it difficult to follow a ketogenic diet, nearly everyone can do a 13 hour intermittent fasting window and this alone results in 1/3 less breast cancer recurrence.  It is important while doing any form of fasting to drink plenty of water.

7:48  The next step is cleaning the junk out of the diet, which means not eating anything artificial, avoiding packaged foods that have preservatives and coloring agents, etc. and avoiding any foods that do not come from nature.

8:04  The following step is to remove simple carbohydrates, which means avoiding simple sugars and any fast converting carbohydrates.  We counsel patients to maximize vegetable content, esp. high fiber vegetables with color.  It is best to follow a low carbohydrate or ketogenic approach, so we counsel patients how to do this.  If patients are unwilling to do that, then we ask them to follow a modified Mediterranean diet, which is essentially a Mediterranean diet with the fast carbs and grains removed and a focus on fish and healthy oils and a lot of colorful vegetables.

12:15  The role of meat in cancer causation.  Meat is a good way to bring toxins into the body, especially commercially produced meat.  Such processed meat also contains hormones and preservatives and other chemicals.  Dr. Anderson believes that the association between meat and cancer that is seen in some of the epidemiological studies is more related to the quality and the cleanliness of the meat, which is what he tells his patients who want to eat meat.  His vegan and vegetarian patients he tells them about insulin resistance and her either recommends starting with a three day fast or a seven day raw vegan/low fruit diet with nothing cooked, both of which can improve their insulin sensitivity. 

15:32  Ketogenic diet for cancer.  Dr. Anderson explained that he will often recommend a ketogenic or low carb approach, esp. if the person has a very aggressive cancer, such as a stage four pancreatic cancer.  He will approach such a patient and frame a ketogenic diet as an intervention for their cancer or a prescription diet, rather than a lifestyle change. He will combine this with an aggressive supplement and IV supplement regimen as well. Stage four pancreatic cancer has a very low survivability with standard treatment of 2 to 5%, but Dr. Anderson has seen some of his patients survive using an aggressive diet and supplement program as adjunctive care.  Once the low carb or ketogenic diet is in place, then adding some exogenous ketones can be helpful to keep their ketone levels higher in their blood. Dr. Anderson mentioned that Xymogen has one of the better tasting ketone products. He likes to start them with 5 gm twice per day and work them up to 10 gm twice per day.  This ketogenic approach seems to work better with some of the aggressive cancers, like pancreatic, ovarian, colon, and glioblastoma.

19:33  Prostate cancer is a bit of an outlier when it comes to diet.  The prostate cancer tumor biology is unique and while keeping insulin levels low is important, there are certain other factors that need to be considered, including reducing choline intake from egg yolks, organ meats, chicken, and certain other foods.

20:21  Oral nutritional supplements for cancer patients.  Curcumin is one of the really important supplements to include because it has such an immune-leveling effect and it positively affects so many of the pathways involved in cancer formation and progression.  One of the forms of curcumin that Dr. Anderson prefers is a highly absorbable form of curcumin from Ayush Herbs that comes emulsified in a powder form with coconut oil and it can easily be added to a smoothie.  The other form he prefers is CuraPro, which is the BCM-95 form of curcumin, and the Curcum-Evail from Designs For Health is very similar.  Dr. Anderson will often start patients with 1,000 mg per day to start and then dose it 2-3 times per day for a total dosage of 2,000 to 3,000 mg per day.  Another herb that often goes with curcumin is boswellia, which also acts on those inflammatory pathways.  He will usually recommend 1,000 mg of boswellia per day.  The next oral supplement that Dr. Anderson often recommends is melatonin and he is now recommending a dosage of 100-300 mg per day.  Melatonin has over 15 different mechanisms by which it can help your immune system, so it is really important. 

31:48  Another important category of supplements that Dr. Anderson recommends is medicinal mushrooms.  A good resource for information about mushrooms is Paul Stamets, who is a mycologist and has the largest repository of research on mushrooms on his website, which is PaulStamets.com.  If Dr. Anderson is working with a patient with an active cancer, he will often start with a specific mushroom formula, such as Turkey Tail, and he will use a high dosage, like 2,000 to 3,000 mg and this is usually well tolerated.  Or he may use a concentrated mushroom extract, like AHCC.  Sometimes he will use a blend of shitake, maitake, and a few others.  Once the cancer slows down or goes into remission, he will switch to a maintenance strategy such as a blend of a number of mushrooms, such as MyCommunity.  We should not overlook the benefits of white button mushrooms, which at one time were considered not very beneficial like iceberg lettuce, but there is now a fair amount of research that demonstrates the benefits of white button mushrooms.  And Dr. Anderson said that they like to rotate the mushroom supplements. 

38:39  Other supplements that he uses frequently are Vitamin D and Vitamin K2.

42:21  CBD and THC.  The cannabinoids have a lot of potential anti-cancer benefits.  Dr. Anderson has found that if you mix CBD and THC you can get the immune benefit and you can also reduce some of their pain medications and cancer patients are often on some kind of pain medication, such as opiates, or medications for anxiety, such as benzodiazopenes.  He may recommend 50-200 mg of CBD maybe as an oil to take several times per day and then take a tincture of THC to take later in the day such as after dinner when they are not going to be working or driving.

45:12  Metatrol or Avemar or Oncomar.  Another strategy to take advantage of the metabolic effect of following a low carb diet is to add in Metatrol or Avemar, which is a very expensive supplement of fermented wheat germ extract that supports the mitochondria.  This product weakens the cancer cells and makes it harder for the cancer cells to work like our normal cells, which is what the low carb diet does.  This fermented wheat germ research has more and more research showing its benefits.  Here is a list of the Studies on Fermented Wheat Germ Extract

50:59  Continuing with this Warburg idea that cancer cells have trouble generating energy except through glycolysis, which is why the low carb diet makes it hard on cancer cells and why Avemar helps, the mitochondria in cancer cells is weak.  Therefore it makes sense to target the mitochondria of cancer cells with alpha lipoic compounds, including R-Lipoic acid, which should be dosed fairly high–more than 400 mg, and there are several augmented lipoic acid compounds like Poly-MVA. Poly-MVA contains palladium that holds the lipoic acid molecules together, which allows the lipoic acid to be sucked into the mitochondria faster.  

 

 



Dr. Paul Anderson is a Naturopathic Doctor, Medical Director & Founder of Anderson Medical Specialty Associates (AMSA). He is a recognized authority in the field of integrative cancer research and the treatment of chronic diseases, genomic conditions, and auto-immune and infectious disorders.  Dr. Anderson has written three books, Outside the Box Cancer Therapies: Alternative Therapies That Treat and Prevent Cancer, which he wrote with Mark Stengler, Cancer, The Journey From Diagnosis to Empowerment, and the recently released Cancer, The Journey from Diagnosis to Empowerment. Dr. Anderson also offers 80 different courses on a wide variety of aspects of a Naturopathic practice, including on biofilms at ConsultDrAnderson.comDr. Anderson also has a hub website, DrANow.com.

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

 



 

Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me. And let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. And today we’re going to focus on Outside the Box Cancer Therapies with Dr. Paul Anderson. As most of us know in the functional medicine world nutrition, lifestyle and nutritional supplements, taken both orally and intravenously, can potentially have an impact on the outcome of cancer patients, both in terms of symptomatology, as well as overall mortality. Dr. Anderson has spent many years researching such strategies, as well as decades of clinical experience. Today, we are going to pick his brain to get some clinical pearls on effective natural strategies to help in the prevention and treatment of cancer.

Dr. Paul Anderson is a naturopathic physician, medical director and founder of Anderson Medical Specialty Associates. He’s a widely recognized authority in the field of integrative cancer research and the treatment of chronic diseases, genomic conditions, autoimmune and infectious disorders. Dr. Anderson has written several books including Outside the Box Cancer Therapies and Cancer: The Journey from Diagnosis to Empowerment. Dr. Anderson also offers quite a number of different courses on a wide variety of aspects of a naturopathic practice at consultdranderson.com. Dr. Anderson, thank you so much for joining us today.

Dr. Anderson:                    Thank you so much for having me.

Dr. Weitz:                          Okay. So let’s start with diet. What do we know about specific diets or specific dietary strategies, that can help the body to prevent and get rid of cancer?

Dr. Anderson:                    Yeah, I think that’s a great place to start because one of the things that I’ve seen when we look backwards over time at people who did maybe a lot better than other groups of folks with the same cancer, is that diet is such a foundational part of the way our body and our metabolism works. That it’s critical that it’s part of any care plan. So I think it’s a really great place to start. And this has really evolved a lot over time and that’s a good thing I think, but one of the things I try and communicate with patients and actually other doctors too, is there’s a lot of ways into your diet to make changes in your metabolism and the way your chemistry works. And if we keep in mind, what’s the most important parts that a diet can reach into or effect, et cetera and can we design the type of diet that we’re going to eat to do that? That’s like the core.

Because clinically speaking, and we’ll talk about specific diets here in a second, but we had a lot of success with low carbohydrate or ketogenic diets, et cetera, in cancer. And there’s a lot of reasons we talk about that, for that. We had other patients who, that just either because of the way that they ate or for other reasons, they couldn’t do that fully, but we were still able to work with, I guess you could say the way that they ate and their food choices, in a way that kind of got us in the same direction. So what I would try and transmit to the patient is the two most important factors that your diet does affect are the balance between fat metabolism and muscle metabolism, is really a critical place. We now know that that balance is involved in long-term survival of people who’ve already had cancer, of people who may be trying to prevent cancer and even people with chronic illnesses.

And the bottom line of that is, because there’s obviously a lot of deeper chemistry, is that fat metabolism is largely driven by insulin excess and insulin insensitivity. And the chemistry that comes from that insulin cascade is very inflammatory, is very pro metastases, it’s just pro cancer in general. And the metabolism that our muscles have when we’re just moving and doing muscle work sends out kind of the opposite signaling. And so your diet really affects the fat and insulin metabolism side very, very heavily and then the muscle metabolism a little bit.

So for example, and we got to the point where at our clinic, we designed a graphic to help patients kind of see their way through this. And so we would get people that would say, “Well, I’ve looked at ketogenic diets and I just don’t think I could get there. I don’t think I could do that.” And sometimes that was just because maybe they didn’t understand that there’s a variety of ways to get into ketosis. If you can, and not everyone can do this, but almost everyone can, if you can do a 13 hour intermittent fasting window, regardless of what you eat it, the data now with breast cancer patients and some other places shows, I think with the breast cancer patients, they had about a third less cancer recurrence. Just doing that, they didn’t even change their diet. And then the next step up was to clean out just the junk from your diet, so processed food-

Dr. Weitz:                            Okay, let me just stop you for one second for people don’t know what intermittent fasting is. Really all you’re saying is, is let’s say you eat dinner at 6:00 the night before you don’t eat until say 7:00 AM the next morning. That would be 13 hours of intermittent fasting, correct?

Dr. Anderson:                    Yeah. And basically you drink plenty of water, so you stay hydrated. I’ve experimented with a lot of types of fasting. And almost every symptom I got during fasting was I was dehydrated. So we really try to have people drink water, but just no caloric intake during that time. And yeah, if you frame it that way and just say, “Okay, when do you normally have dinner. So after dinner is done, we’re going to have water and then sleep. Most of it you’re asleep for, and then in the morning, our breakfast is going to start 13 hours whenever you finish dinner.”

Dr. Weitz:                          So 13 hours is really not much sacrifice at all.

Dr. Anderson:                    It’s pretty doable. And I think somewhere between 12 and 14 hours is where they think the autophagy response, that sort of cell cleaning out response, turns on. But the other thing that the intermittent fast does, is it helps to reset your blood sugar and insulin release, so that your liver has a chance to clean out its stores and you start the day fresh. And they think that that’s a piece of why that works. So that was the foundation. So you can see that doesn’t, however I decide to eat after that, is a cherry on top. Obviously cleaning the junk out, which is easier for some people, harder for others, but we have them look for anything artificial, any obviously packaged foods that have preservatives and coloring and all the stuff that didn’t come from nature.

And then the next step above that is removing simple carbohydrates. And so that’s just simple sugars. Again, let’s say for example, somebody really wants to stay being a vegan or do a Mediterranean diet, you can still remove simple carbohydrates. That’s something that’s very doable and that keeps that insulin response low. And then the next step was, and almost regardless of the diet that they did with a couple exceptions, was to try and look at the non animal parts of their diet and maximize vegetable intake, high fiber vegetables with all the color. And then after that we’d show them, “Okay, so the top of the pyramid is what your specific diet is.” And we had a fair number of people who really resonated with say a low carbohydrate or ketogenic approach. And we would counsel them in a way to do that.

We also had other people that couldn’t get there, but we would do what’s called a modified Mediterranean diet. And I see with the Mediterranean diet is it has probably more research on it in health, in general, but in cancer, than any other type of diet. And I would tell patients, “All that means is we’ve researched it more. It doesn’t mean it’s better or worse. It just has a lot of research that’s positive.” So what we would do with the Mediterranean diet is basically remove the grains from it and then remove any fast converting sugar carbohydrate things. There aren’t a lot, but we’d focus on fish and healthy oils and a lot of colorful vegetables, that sort of thing.

Dr. Weitz:                          But say, take out the bread and the pasta and [inaudible 00:09:53]

Dr. Anderson:                    Take out the bread and the pasta and we would allow a certain amount of legumes, beans, and peas and things, but not an overly large amount. And basically you can get a very healthy diet by doing that. And a lot of people felt better with that. So the bottom line though, is if your diet can always be going in this direction of giving me enough fuel and enough nutrients, et cetera, let my body run, without making my insulin spike or triggering what 50% of North Americans have, which is their insulin resistance, without triggering that, you wind up with a lot healthier chemistry on the inside for your body’s immune system to resist the cancer.

Dr. Weitz:                          And is it your understanding that the insulin resistance is basically resulting from carbohydrates?

Dr. Anderson:                    Yeah. Well, I think there’s a lot of aggravating factors there. Toxicity is one and certainly there’s a spectrum of genetics that can make you a little insulin resistant or a lot. But I think the fuel for it, if we take away toxicity, I think the fuel for insulin resistance is how we eat. And it’s not fair, but somebody who has a high degree of insulin resistance built into their genes, they will achieve that insulin resistance faster the more carbohydrate they consume and also the less physically active they are. So those two go together.

Dr. Weitz:                          I have spoken to some vegan experts who claim that it’s fats that lead to insulin resistance.

Dr. Anderson:                    Yeah. I’ve heard that and I’m not convinced of that, personally. I will say though, that we do have some patients who come in and they’re already vegetarian or vegan and they really don’t want to consume animal products, which is fine. We’ve also modified diets that worked well for that group of folks. It’s just a different focus. What we would do, because you brought up vegetarians and vegans.

Dr. Weitz:                          Right. So maybe you should even address, what do you think about the concept that meat might play a role in cancer causation?

Dr. Anderson:                    Yeah. So I think there’s a lot of reasons why some of our patients don’t want to eat meat for whatever reason. And some are concerns about maybe meat is a good way to bring toxins into your body, so that’s one thing, especially commercially produced meat. There’s a lot of hormones, a lot of other junk and even Dr. Stengler and I got into it in the book a little bit and it was something that I almost felt like we should explain a little bit more, but you find that out after you write things. There are some associations with certain types of meat and more cancer. So whenever there’s a population association, you can’t say for sure that that’s causal, but it’s where’s there’s smoke, there’s probably fire. My assumption with that has always been the quality and cleanliness of the meat is probably more at issue than just meat quote, unquote, “itself.”  Also, if you look at the chemical changes, the amount of work your liver has to do, et cetera. If you were to eat a lot of processed meat versus fairly non-processed meat, it’s very different burden on your body. And to a lot of people, eating meat could be anything from preserve salami and lunch meats and stuff that’s got a lot of the junk in it we don’t need anyway. Or it could mean organically grown chicken or a fish or something like that. So what we would tend to do with folks, if they did want to eat meat is counsel them, that meat is a good entry point for toxins if you’re not careful how you source it. So we’d have them be careful there.

But to give equal time to our vegetarian and vegan patients, what we would tend to do with them is just explain this idea of insulin, insulin resistance. And a lot of that with a vegetarian or vegan diet has to do with the choices made of the plant material that you’re eating and also what fats you do and don’t allow in. So if people really, on the vegetarian/vegan end of the spectrum, wanted to really get a jump start on their metabolism. We would have two options for them if they wanted. One would be, if they want to do a three day fast as an induction fast. Anybody who wanted to do a three day fast on the beginning of a diet change, we would support them. A lot of people couldn’t do that or didn’t want to. So for the vegetarians and vegans, what we would do a lot of times is do a three day to maybe seven day raw vegan diet where they’re not even cooking anything. They’re just forcing their body to digest what they take in.  And that sort of a raw food diet can push your insulin sensitivity down to a nice level for a lot of people, especially if you’re not eating a high amount of fruit, it’s more vegetables, et cetera.

Dr. Weitz:                            So some of the promoters of a ketogenic diet for cancer talk about the Warburg Effect. I’ve interviewed Dr. Thomas Siegfried and that one of the real benefits you get from a low carb, higher fat ketogenic diet, is that you starve the cancer cells, because the cancer cells can only get energy from through glycolysis as opposed to our ordinary cells who can get energy either through oxidation or through glycolysis.

Dr. Anderson:                    Yeah. And that’s one of the reasons that we put it in context. If we had somebody come in say with a very aggressive cancer and they were pretty far along, say a pancreatic cancer stage four, something where we really had one chance to interact with their body. What we would tend to tell them is we would mention that about, say a ketogenic or a low carb diet and talk about the Warburg Effect and all that. And more frame it as, this is a very powerful intervention as a prescription diet, basically doing a keto or keto like diet. And we would combine that with supplement or IVs or some combination thereof, to reinforce that keto effect on their metabolism. And so a lot of people, even if they didn’t want to eat that way long-term, but they kind of had their backup against the wall with aggressive cancer, would understand that and they’d see it as a prescription.

And I’ve seen, for example, most people know or have heard, stage four, pancreatic cancer is very low survivability, standard treatment works three to 5% of the time. It’s a bad one. I’ve seen people do that with a keto diet and some metabolism support, et cetera, and essentially go into a remission with a pancreatic cancer, which is very difficult to see and I’ve seen it with other things. So we do certainly, as it is with patients, sometimes you have a broader group of options that you can do because they’re meeting the other criteria. But sometimes if you really have to get a hold of their metabolism and force the issue, we found that in that end of the spectrum, between a traditional low carb diet and a keto diet, if they could get there, we would then also use exogenous ketones with them to keep their ketone levels higher in their blood.

And what we would tell people, is the exogenous ketones are not to make it so you can eat other stuff or cheat a lot or any of that, it’s to just enhance what your diet’s doing. And so in our metabolic therapy protocol, the use of oral exogenous ketones is, we do that with everybody almost regardless of what diet they choose, but certainly a ketogenic diet can get you there. Now there are some cancers for which that approach seems to work a lot better and others it’s sort of like maybe, maybe not, it’s a little unclear. But definitely with, I would say, aggressive cancers and some of the big, bad ones we see a lot like pancreatic and ovarian, colon cancer, some of the other more aggressive things we would try and… 

Dr. Weitz:                          Glioblastoma.

Dr. Anderson:                    Yeah, yeah. Definitely, glioblastoma is, yeah, certainly

Dr. Weitz:                          Prostate seems to be a little bit of an outlier. There seems to be some other dietary factors that can play a role that seems to be a little bit different than some of the other cancers.

Dr. Anderson:                    Yeah. And the way I’ve seen that play out clinically with prostate cancer is I think maybe as opposed to one type of diet is really bad for prostate cancer and one’s really good.  I think if you’re staying in this zone of low insulin stimulation, a lot of nutrients and the right mix of protein and fat, prostate cancer kind of has a wider band where it can do well there.  It still is not served well by high sugar and high insulin levels and stuff like that.  But prostate cancer is, it’s very unique in that respect.  It doesn’t always behave like the other cancers.

Dr. Weitz:                          Yeah. There’s a few foods like egg yolks that seem to be problematic for prostate cancer and not for other cancers.

Dr. Anderson:                    Yeah.  And I think that a lot of that’s because prostate cancer’s biology, the tumor biology, is just so unique.  And I’ve been seeing and reading the research and counseling patients on let’s say eggs and choline, which comes from eggs and other stuff.

Dr. Weitz:                          Yeah, choline seems to be the big factor.

Dr. Anderson:                    To be careful with those things. Whereas in other cancers that doesn’t seem to really be a huge fuel, but that being said, all the basic stuff like the intermittent fast and cleaning the junk out, it’s still the same.

Dr. Weitz:                          Absolutely. Good. So let’s go into oral supplementation and then we’ll finish with IV supplementation. So there’s quite a number of supplements that you mention in your book on cancer, The Outside the Box Cancer Therapies. Maybe you could tell us what you think are the five or 10 most impactful oral nutritional supplements that can be beneficial for prevention and for cancer patients.

Dr. Anderson:                    Yeah. Yeah. That’s a great place to start. I think in the book between oral nutrients and botanical herbal medicines, that’s probably the largest portion of the book is dedicated to what we could take supplementally to our diet. That being said, the first thing about oral supplements, especially nowadays with the internet, you can find literally a thousand things that’ll say they’re good for cancer. And a lot of them probably are. And one of the problems that we all see, I think who see patients is, between family and friends and their own research and just things they run into. They might come in with 30 things, literally, or 20 or 10, and it might just be too much for their body to actually handle, to take all that stuff and get anything good out. Or the doses might be so low that they’re not useful. So I usually try and have people think of it from the point of view of, “What are we going to get the most.”

Think of it from the point of view of what are we going to get the most effect out of for your money and your resources and your time and your spending doing this, and let’s build a core for supplementing, and then we can work out from there. There might be something that comes along, for example, maybe a breast cancer, certain other types of cancers. We might use a real specific mushroom like turkey tail, which now people have heard a lot about because there’s a lot of research, whereas if we step back and maybe look at other cancers, we might use more of a mix of mushroom species, et cetera. So when I think of cancers and with almost no exceptions, the top few I’ll talk about I would probably use with almost every cancer because of their, number one, multiple effects from one supplement, which is always great, and also the amount of research and just what we see clinically. And obviously, if someone’s allergic to something, that’s not a good… We just don’t do that.

But barring allergy or some other odd reaction, for example, curcumin is kind of a hard one to leave out of a treatment plan because curcumin, regardless of the tumor type, has such an immune-leveling effect. It affects so many, literally hundreds of parts of our immune system. And cancer, part of the problem with cancer is… We talk about insulin pushing cancer along. Well, cancer gets momentum by keeping your immune system off balance, and then the immune system can’t really control it, and it can’t really stop it from growing, et cetera. So curcumin is a really great leveler to immune problems. It’s also why we use it in autoimmunity and other things. So curcumin is probably one of my top three or four that I like with people. Now-

Dr. Weitz:                            Do you have a preferred form, and could you mention potential dosages?

Dr. Anderson:                    Yeah, and I’ll use an example of a product that there’s analogs to. The form of curcumin that we tended to use was one of two things, depending on how the person liked to take things. So Ayush Herbs has a powder that is a very highly absorbable curcumin that comes with some coconut oil as an emulsifier and some other absorption helpers. But the fact that it’s a powder and we’ve had people put it in their smoothie, it absorbed quite quickly, to the degree that you’d even see the sweat a little bit yellow afterwards. So it really gets into people. So if they liked that and they could tolerate taking the powder, we like that Ayush curcumin powder. And that’s, of course, not its trade name. I forget the trade name, but it’s the only one Ayush makes. That was really good. We used that a lot with our inflamed people, orthopedic injuries and eczema and other stuff too. But with cancer, that was a really big go-to for us.

And then the other one was called CuraPro. And CuraPro has a couple of lookalike products from other companies. CuraPro is easy for people to source and things, so we would often use that. And then CuraPro has an exact or almost exact copy from Designs for Health, and it’s their curcumin. It’s basically the same stuff. With those and with the powder, we would go for a starting dose… We start people usually at 1,000 milligrams to just see their tolerance. And then we would try and have them dose it two or three times a day and get to around 2,000 to 3,000 milligrams. I think for cancer, if you look across the research, that’s probably a good place to be, 2,000 to 3,000 milligrams.  So whether you’re using CuraPro or the Designs for Health Curcum-Evail, is their trade name, that’s sort of the capsule version, or if you use the Ayush powder, you’re going for two to three grams once you get used to it. Curcumin does… You get to higher doses, you have to warn people that their stool will be curcumin colored and their sweat might and other stuff. So they just have to get used to that. But curcumin probably is the best go-to. And there’s people that are allergic to it and can’t do it. But broad spectrum.

And whenever I talk about curcumin, there’s another herb that often goes with curcumin, but we might tend to use it with more hyper-inflammatory cancers or things that are harder to get to, like brain tumors, prostate. And that’s boswellia, so the herb boswellia. And there’s even products that have those two together that makes it a little easier for the patient too. But boswellia is very… It’s also immune leveling, but it’s a little more potent in the anti-inflammatory end of the spectrum. And if you think about what drives metastases of cancer, a lot of it’s inflammatory, which is why we want to get the insulin down and all that stuff.  So boswellia is always a good one, especially, like I say, with brain, prostate, other cancers that might be hard to get to, or just things where there’s a lot of collateral inflammation in the body, bone metastases, et cetera. And with the boswellia, you often don’t need as much dose as you do with a curcumin. Usually, a total of 1,000 milligrams a day with a curcumin is plenty. But boswellia is good enough that if someone was allergic to turmeric or cumin, I would do their dose mostly with boswellia as their primary herb. So those two are really very broadly useful.

The next supplement that I probably recommend with most people is melatonin. So not an herb but a hormone actually. And what we’re seeing now is sort of interesting if you watch over long periods of time. I remember, gosh, it was probably 25 years ago now, melatonin used to be dosed in cancer 100-plus milligrams easily. We used to do that. And then for whatever reason, that kind of fell out of favor, and we dropped our doses and everything. And now there’s a lot more research coming out showing that, well, melatonin does so many more things than make you sleepy at night. We think of it as help me go to bed, right?

Dr. Weitz:                            Right.

Dr. Anderson:                    And you use three to five milligrams for sleep. Well, in cancer, melatonin literally has over 15 mechanisms where it may help your immune system. So common doses of melatonin in cancer are working people up from 10 to 30 to maybe 50 or 60 milligrams of melatonin. And some people now, and we’ve done it with some aggressive cancers, are even going back to the olden days and using 100, 200, even 300 milligrams of melatonin. And what’s interesting with that is that, again, there’s different tolerances to these things. You don’t go in and give them the full dose right away. You work up to it. Some people, actually, if they spread it through the day, they don’t get tired from it anymore. And some people are a little more sensitive. But melatonin is… It just does so many things, kind of like curcumin does. It’s got so many ways into the tumor biology. It’s tough to leave that out of a protocol, in my mind.

Then, if we start looking at other supplement type things, the category of medicinal immune mushrooms is very broad. If you look at… The person who has the biggest repository of research on medicine and mushrooms is Paul Stamets, who most people have heard of now. He’s a mycologist, and he has a website, and he’s got well over 50,000 publications linked there for different types of mushrooms and what they do and all that.

What we would often do with patients is if the cancer was, let’s say, very active and we’re getting in and we’re doing diet changes and all the supplements and all that stuff, we might use a more specific mushroom formula on the front end when the cancer’s active. So that might be, like we mentioned, a turkey tail, which is pretty hard to go wrong with. Turkey tail doses tend to be fairly high for cancer, 2,000 to 3,000 milligrams, but they’re very well tolerated. Most people tolerate turkey tail really well. Later, when we talk about IVs, part of the IV research I was involved in… Our group was also researching turkey tail and other mushrooms orally, and we had a lot of pretty remarkable responses from turkey tail therapy.

That being said, also, there’s some people where we would use a blend of a shiitake/maitake or maybe shiitake, maitake, and a couple other ones from that family. And that’s another good strategy, I think, during the active working phase of cancer, where we’re trying to get the cancer under control. What we would do a lot with maintenance, because there’s always… The concept usually is, if we’re really working hard and the cancer’s fighting back a lot, so we’ve got a lot going on on the front end, we want to maximize things, probably use higher doses. And then if the person goes into remission or the cancer slows down or some other good thing, they level out, then sometimes it’s good to change to a maintenance strategy. So their body kind of… It mixes it up a little bit.

So in maintenance, we would often use… There’s a common mushroom blend called MyCommunity. It’s M-Y Community, and it’s a play on Myco community, mushroom community. And it’s basically a blend of immune mushrooms that’s more leveling, let’s say. So instead of trying to drive with just one driver, like turkey tail or the shiitake blends or something, this is a little more let’s keep your immune system ready.

I will put a plug in for white button mushrooms. White button mushrooms in the past always got… They got the rap of like iceberg lettuce. Like, “Oh, they probably don’t do anything.” But there’s actually, in the last 10 years, really good research on white button mushrooms. I mean, they’re still a mushroom. And they looked first at just people who ate a fairly large amount of them in their diet, and they saw these… There was some cancer protection. There were some other things that they noticed. So now there’s actually research showing white button mushrooms, if you put them in your diet, that’s one thing. But there are supplements now where there’s the equivalent amount of the constituents from white buttons. And the research, I believe, is around some common… probably breast cancer and a couple others. But there’s no reason that that’s not going to work across the board.

So as we know, there’s kind of two parts to prevention. One is you’ve never had cancer and you’re trying not to get it. And we all make cancer cells every day. On that end, we usually just counsel people that that’s a good addition to their diet. If you’re on the other end and you’ve had cancer and you want to keep everything calm, that MyCommunity type of supplement, where it’s a mixture, or the white button mushroom things, we like to rotate them.

Dr. Weitz:                            What about some of the extracts like active hexose compound, AHCC, which you mentioned in your book?

Dr. Anderson:                    Yeah. So that’s something that we use with a lot of folks, especially during the active cancer-fighting phase. AHCC is… It’s sort of like taking the most potent part out of a mushroom and concentrating it. AHCC is a really good supplement to add for people on that front end. Now one of the things I’ve seen with AHCC, because it’s got a lot of the more pro-immune parts of the mushroom activity. So for instance, we use AHCC with people with chronic infections too, things like that.

The only thing that we would watch on that if we used it a little early is if the immune system got a little too wound up, people… That’s good because you’re going to be fighting with things. But people could get some side effects from that. So they might notice fevers or other things. And if they were manageable, that’s fine. If it was too much stimulation, maybe they got joint pain and fever and things, we might switch them over to turkey tail or a shiitake blend and then work them over to AHCC.

The way I think in my mind is the neutral blends and the white mushrooms and stuff are very broad in their actions. Then you get to the shiitake family and the turkey tails and that stuff, and they’re a little more specific, a little more weighted towards fighting, so to speak. You get to AHCC, and it’s weighted even more because it’s so concentrated. But AHCC is a very useful addition. I kind of think of it like in the middle of therapy. Yeah. So the whole mushroom world is always… That’s obviously more than one supplement, but there’s a lot of options in there. And I think nature gives us a lot of gifts, and mushrooms probably have the most breadth of offerings really when it comes to plant medicine. Now, other things that are fairly common, Vitamin D and vitamin K, especially K2.

Dr. Weitz:                            Sure.

Dr. Anderson:                    Now, a lot of times, it’s good to look at people’s labs up front and see where their vitamin D is, of course, and all that. So if we think about chronic vitamin D supplementation, we’re normally giving people D3 with some K2 in the balance, and that’s a maintenance dose. So for prevention, that works out really well there. Now, I think almost every supplement company now has a D/K2 supplement, and it’s always about the same ratio.

But in active cancer, what we often would do… Certainly, if a person’s vitamin D was low, we would be giving higher doses. But a lot of times, the D’s not bad, but they haven’t had any vitamin K. So vitamin K2… Menadione is its name, and so it has a precursor of MK. Well, the most common supplements are an MK-4 or MK-7. There’s obviously all the other MKs too, but that’s what supplement people have looked at. And in my opinion, they both work about the same. Obviously, the people who make one versus the other usually try and tell you that theirs is better.

But the idea with vitamin K2 is… So K1 is the stuff… If you ate a high vitamin K plant, like a dark green vegetable, there’s K1 in there, and that’s phytonadione. K2 usually comes from some metabolism of bacterial or fermenting metabolism, something like that. But, we can get it in supplements easy enough. So either an MK-4 or MK-7 supplement is very useful. Normally, with those guys, what we believe that they’re doing… So vitamin K, the reason we give it with D is it balances the calcium activity of vitamin D out. It helps the calcium go to the right places and not the wrong places. That’s K’s job. But vitamin K also activates a lot of enzyme systems. And especially if you’re getting the vitamin D levels up and you don’t have a lot of vitamin K, the K2 can be very helpful to that immune fight with the cancer. So like I say, if it’s maintenance on either side. For prevention, it’s probably just a standard vitamin D3/K2 supplement. If it’s during the active cancer process, they’re getting whatever vitamin D they need and then an MK-4 or MK-7.  And the only other difference there, which in the book I get into specifics, and I always get it turned around in my mind because it’s an interesting factoid. One of them is dosed in milligram doses and the other’s in microgram doses because they’re different. Although they’re both K2, one’s way more active. So you just have to look at what you’re getting there. So D and K, pretty important.

The other thing that I’ve found, especially in the last, I would say, well, 12, 15 years now… Time flies. We had early on in the state of Washington, where I practice mostly, the advent of medical cannabis prescribing. So before we had recreational or any of that stuff, we could recommend… not prescribe it, but recommend cannabinoids. So that allowed us… And that law passed when we were doing this cancer research. So it allowed us a lot of latitude of recommending things and just seeing what happened with people.  And if you fast forward till now, we know that there’s a lot of potential anti-cancer benefits to the different cannabinoids. The CBD forms from hemp, which are legal everywhere now because they’re not from the other cannabis family, those are used quite a lot. But what we found is if you could mix CBD and THC’s family together, you could not only get a lot of immune benefit, but sometimes a lot of medication reduction with people. So for example, we might have people on 50 to 200 milligrams of CBD as maybe an oil or something easy to take a couple of times a day. And then later in the day, where they weren’t driving or going to work or whatever, we might have them dose, say, a tincture, drops of THC. Because everyone’s tolerance is so different, we’d start with just a few drops at dinner and kind of work up.  But we had a lot of people where they were able to decrease or get off of pain medicine, anxiety and sleep medicine, et cetera, and/or only need those things like their pain medicine if they had breakthrough pain. And one of the things that you don’t think about, sort of a necessary evil with advanced cancer is most people are on some kind of pain medicine. If someone’s uncomfortable with anything, we don’t make them do it obviously. But we had a lot of people where they were tired of taking Ativan three times a day for their anxiety and their sleep and stuff, or they really didn’t like the side effects from their opiates. And we would titrate in the THC forms, see what effect we got, and they could either get on lower or even be off most of it. So I found that to be very useful over time.

Now, there’s a whole… Obviously, for every one herb we mentioned, there’s 40 other ones that you can go into. So there’s another because, and I think this is important because it sort of fits in with this metabolic approach to cancer we were talking about. So let’s say you’re doing a dietary approach like the low carb or a keto or something in that end of the spectrum, and maybe you’re even adding some exogenous ketones in. The thing that you want to do is to enhance what that’s doing at your cell level, at the cancer cell level specifically. So as you were saying earlier, most cancers, not all, but most, can really only metabolize in the cytosol through glycolysis. And that’s the-Metabolize in the cytosol through glycolysis, and that’s the energy they get. When you get to the mitochondria where our normal cells get most of their energy, the mitochondria in most cancer are dysfunctional. So if you can do something that takes advantage of that dysfunction, the nice thing is it won’t hurt your normal cells at all, because you’re just feeding them. But if you can take advantage of the metabolic dysfunction and your diet is in a direction like keto, et cetera, where it’s taking advantage of that in the Warburg effect, that’s a one, two bonus there. One of the things that we’ve used in that setting, which is very specific, is something, common name for it now is Metatrol, they used to call it Avemar, and they might still.

Dr. Weitz:                          Oh, yeah. Fermented wheat germ extract.

Dr. Anderson:                    Yeah. I think maybe the OTC is one name, whatever. That has a lot of immune effects, but when you look at the way it works, it supports what you’re trying to do with that dietary approach. So especially if someone’s working on that, we’re trying to really force the cancer cells to work like our normal cells, which they can’t do when they’re weakened the Metatrol or Avemar works really well for that. Now, it’s one where it’s many of these things are kind of your average supplement cost, et cetera. Some of these specialty things like AHCC, where they have to do a lot of work to it, or Avemar, Metatrol, those are a little more expensive, so we usually make sure somebody’s doing the dietary side first, before they spend the money on doing that. But Avemar or Metatrol are very, very supportive of that.

Dr. Weitz:                          I think we were using a version of it from XYMOGEN That was called OncoMAR and it was in capsules.

Dr. Anderson:                    Yeah. Yeah, and I’m sure there’s trade name reasons why they are using those.

Dr. Weitz:                          Yeah, it was fairly expensive, but you start looking into some of the animal research and it’s pretty impressive.

Dr. Anderson:                    Yeah. The compound in all those products, interestingly, has more and more research that is very compelling around it. I kind of have always thought it probably does work better if you’re also attending to the dietary side of the equation. Just because I’ve mentioned it a few times as I’m sure people are curious how much exogenous ketones we recommend to people, normally we have them do a powdered ketones salt. I’ve tried a lot of them. Ketones taste bitter, they taste like ketones, it’s not a great taste. So the company’s try and mask that the best they can.

We’ve used a lot of different ones, and what I would tell people is, “Here’s some options.” We’d have them try them, because obviously if you get a hold tub of something that makes you not want to eat it, you’re not going to take it. We used a lot of the XYMOGEN ketone powder, for example. I do remember, I did a conference a few years ago now and one of my co-speakers was Dominic D’Agostino who’s of the big keto and metabolic research guys. I was asking him, because he did some of the original research with ketone esters and the special forces and diving and preventing seizures and things, ketone esters are kind of hard to get and they’re quite expensive. And I said, “Clinically speaking, if we’re not working with people underwater for a long time, like his population, if I’m just looking at raising ketone levels, would keto salts work?” And he said, “Yeah.” He said, it’s basically going to get you the same direction. If you’re trying to avoid seizures, the ketone esters are better, but they’re hard to get.

The ketones salts, we would start people with 5 grams, which is usually one serving twice a day, and then get them up to about 10 grams twice a day. That helps to level out shifts in their dietary intake and things, because your diet drives keto generation. And so if your diet was not the same all the time, the exogenous ketones really helped. So usually start with 5 grams twice a day and go to 10 grams twice a day. You can take more, but that seemed to be an effective level.

But before we get off this, the Warburg idea and things like Metatrol, Avimar, that whole family of the same thing, you could think parallel like normal cells and they’re going to go through glycolysis and then into oxphos in your mitochondria, make lots of energy. Cancer cells, most of them get down to glycolysis and have to stop, and they make a little energy and they pump out a lot of lactic acid and other stuff that’s not good for you. And their mitochondria is weak. So the things like Avimar, Metatrol kind of help on the front end of that, so does the diet, and then if you’re targeting the mitochondria, there’s a number of ways into the mitochondria. Again, nice thing is your normal cells will only be helped by this and the cancer cells will be injured. So mitochondrial targeting alpha-lipoic acid compounds are the best known for mitochondrial targeting.

So if we’re going to do a real specific mito target with a lipoic acid compound, the R-lipoic acid is just the R non-racemic mixture, so it’s more potent. That’s the preferred one that we would use with folks. The dose there is usually 200 to 400 milligrams, whereas with a racemic mixture, we go higher. And then there’s other, I call them augmented lipoic acid compounds. We talk about them in the book. Again, just like Avemar, there’s a couple of trade names to these. Generically, they’re just called lipoic acid mineral complexes. So it’s usually two lipoic acids bound in a structure with electrolytes holding them together. Why would you do that? Why would you give R-lipoic acids? Because those forms of lipoic acid go right to the mitochondria very quickly. So, like in our chronic fatigue patients, we give them lipoic acid as a mitochondrial boost.  If you think of a cancer mitochondria that doesn’t process energy correctly, you put energy in the front end, it actually can damage itself. And then your normal cells, you put energy in the front end, they just get healthier. So the lipoic mineral complexes are a little more potent. One of the supplements is called Poly-MVA, and that’s in the book. There’s also a version called Rejeneril-A, which is the same thing, sort of like Avemar, there’s two or three companies with it. But that one specifically was developed for cancer, the mineral complex, so it’s a little more potent than R-lipoic acid, although they’re both very good.

Dr. Weitz:                          The Poly-MVA, my understanding was one of the essential parts of it is the palladium?

Dr. Anderson:                    Yeah. It has a couple of ions in it that hold the lipoic acid together, and it literally looks kind of like a V if you look at the molecular structure, and that’s because there’s palladium and a little rubidium and a couple other things. So yeah, with Poly-MVA or Rejeneril, whichever trade name you see, the structure is such that they have the two lipoic acid molecules that are held together like a V, and essentially the electrical effect of the minerals, like palladium and rubidium, et cetera, hold those big lipoic acid molecules together so they stay together.  The upside of it is, like Poly-MVA or Rejeneril, the lipoic acids actually protect your body from the palladium. Palladium is a heavy metal, and if you get palladium that’s free, it goes around and it does things you don’t want in your body. In a lipoic mineral complex like Poly or Regeneril, it’s stuck between the lipoic acid, so pre-chelated. So if you have some, we always warn patients about this, if they do a urine test for heavy metals, the palladium will look really high, but it’s not free palladium, it’s part of that complex, and the minerals like the rubidium and palladium and things are there to hold that all together. And then by holding it together, the lipoic acid that’s there sucks it, essentially, into the mitochondria faster.

Actually, there’s a lot of veterinary cancer research with that complex, Rejeneril or Poly, and some human. More of the human research is around mitochondria regeneration in non-cancer. So they’ve used it with cardiac decompensation and radiation damage with NASA and stuff like that. But the idea there is, you’ve got something up on top, you’ve got your diet kind of helping with the glycolysis part and the Warburg effect, you’ve got something like, say, Avemar, Metatrol, helping there, you get lipoic acid or Poly-MVA, Rejeneril at the mitochondrial part, you’re really trying to hit the cancer cell everywhere where it’s weak. And then your immune system can take notice of it and do more with it.  I would say one of the things, I put the early version of it in the book too, what we’re doing with patients, we developed this, we called it our combination metabolic cancer approach, so it of course included a dietary component to try and get into ketosis, it included exogenous ketones, and then it included things that would support the mitochondria in a way that makes the cancer weak and enhance a Warburg effect.

 Unfortunately, a number of the stronger non-supplement things, the drug-type things we’re using for Warburg effect, got the notice of the government and they made them not available, which is really unfortunate. Now, here’s the thing, just full disclosure. They made them not available to most people. They said, “Gee, these things work.” And so they made them available to drug developers. So, some of the things that I was using just as a compounded medication to help with the Warburg effect that have been around a long time and were in the public domain, the government took away from the public domain and gave them to cancer drug developers, which happens, unfortunately.  But there’s a lot of things. For example, the Avemar or Metatrol, et cetera, is a good replacement in that respect, and because it’s a supplement and it’s not a drug it’s regulated differently. The Poly-MVA or Rejeneril are a supplement, so that helps. Alpha-lipoic acid still is a supplement, so there’s that. But yeah, there was a lot of benefit with people with pretty aggressive cancers by combining all that. We had people with very aggressive blood cancers where that was really helpful. One of the first things we noticed with the combined metabolic thing was our leukemia lymphoma patients, which wouldn’t maybe respond well to other stuff, really responded to the metabolic treatments very, very well. And it seemed like the more we did to enhance the Warburg effect, if you will, to make the cancer cell play by normal cell rules, essentially, the better response we got for cancer.

Dr. Weitz:                          If I can, I’d just like to ask you about two more concepts. One is the artemisinin, which I’ve been told should also, in some cases, be used with iron to get it into the cells. Do you know about that?

Dr. Anderson:                    I do. Yeah. I did a lot of human research with Artemisia compounds. The one that, again, isn’t terribly available in the U.S. anymore, it’s legal, it’s just not available, is our artesunate, which is the injectable kind. So we would give that right before we gave IV vitamin C because they’re synergistic. There is a thought, because artemisinin is the wormwood plant family, and so Artemisia is all the compounds and then artesunate, some of them, et cetera, people kind of misconstrue the mechanism of that plant, especially artesunate and artemisinin specifically, because, kind of like high-dose C does, it has a redox step where, through a Fenton reaction, it flips some electrons around, it creates peroxide, which is irritating to cancer cells. So people misconstrue that you have to have a lot of iron to make that work. And that’s actually not true. It sounds really good. It sounds wonderful. But that step works through both copper and iron, primarily. So it’s not just iron.

The other thing that we found is we got just as much effect in people that had almost no iron in their body, as we did with people with a lot of iron. So it’s a good theoretical idea. One of the problems with preloading people with iron in cancer is, you can’t control once it goes in the body where it goes. And so, while it might make your high-dose vitamin C or your artesunate work a little harder, it’s also going to go and be very pro-cancer in other places. So we usually reserve preloading with iron for people who, they’re going to die if they don’t get more iron or something like that.

What I would tell patients, and this literally came from watching people who were so profoundly anemic from just years of cancer and all this, and watching them be some of the best people to respond to artesunate after that, I would just tell them, “Look, if you’re still alive, you have enough iron to do this little chemical thing that the artesunate needs to do.” It’s sort of similar, because they’re usually related therapeutically, high-dose vitamin C, people would think, well, okay, it does a Fenton reaction, and so maybe we should give iron or copper with that or something of that nature. There’s like one study from the ’70s where they gave a very, very specific type of copper that was bound intravenously with vitamin C and it did enhance the vitamin C effect. The problem is, that type of copper is not available. You can’t use it. And number two, copper is also very pro-cancer as well, so you have to be really careful with that.

Now, certainly, if, clinically, somebody needs iron, they get iron. That’s not a problem. Now, I do want to say though, the IV kind of stuff with IV artesunate nowadays, they have IV artemisinin, which is a little different but it works similarly. That’s one way to go.

The other way with cancer is oral. You can use oral wormwood compounds that are sort of a mixture of whole wormwood and artemisinin, or just an artemisinin supplement orally. With that, we tend to rotate it. So people have usually 3 or 4 days, they take it a week and then a break the rest of the week. So if you keep your artemisinin, wormwood oral everyday for a long period of time, it can drive severe anemia, and there’s some other things that can happen. So we tend to rotate it. And then it works really well in cancer. Now that it’s very hard to get artesunate IV, what we do with a lot of people getting high-dose vitamin C IV is we give them their artemisinin orally the night before their IV in the morning of, and then that they get the IV. So they get a similar effect that way.

Dr. Weitz:                            Interesting. One more question on the oral. I just want to ask about a few things related to breast cancer. Basically, we have some people recommending iodine, and then the controversy between indole-3-carbinol and DIM to help modulate estrogen metabolism.

Dr. Anderson:                    Iodine is interesting, especially with breast cancer. I believe, based on everything I see with breast cancer patients who have used iodine, I’ve never seen any problem from it, unless it was totally administered wrong or something, to the degree that a hospital I consult for in outside of the U.S., where you can do more things, for probably 20 years now has used various forms of high-dose iodine therapy with breast cancer.

And so, that being said, I think it’s useful, but what we’ve seen through the hospital experience is it’s probably a good synergist. It’s never been enough to really push someone to a remission or something like that. I know there’s people, and for legitimate reasons, they have concerns about iodine therapy, et cetera. A lot of the trouble with iodine therapy is that our bodies detoxify bromine chemicals when we take iodine, and if we’re not ready for that, you can get bad headaches and other symptoms. Actually, that’s fairly easy to fix. Either raising your dose of oral vitamin C will take care of most of that, and the other thing is if someone has a migraine from it, we give them a lot of salt because the sodium will go and displace the bromines and sent them out of the body.

But once you detoxify from the bromines in your body, iodine is pretty well tolerated. We did a lot at the hospital, where, with breast cancer, they would paint the iodine right on the breast, et cetera, for local absorption, which I think is not a bad idea for that. But I do look at it more as a synergist, really. The second part was? There was iodine.

Dr. Weitz:                          Indole-3-carbinol and/or DIM. Yeah

Dr. Anderson:                    Again, I think in a perfect world, I would use a supplement that had both of those in it.

Dr. Weitz:                          There are supplements like that.

Dr. Anderson:                    There are, yeah. Nowadays there’s a lot more, they have a mixture. They have different mechanisms of how they modulate estrogen, and you could even add to that group in a different mechanism, calcium D-glucarate, which works mostly in the gut to stop us from reabsorbing metabolized estrogen, which is a great thing. What I have tended to do is really, and obviously I could be wrong about everything I’m saying, but I kind of look at the DIM versus IC3 controversy kind of like I look at MK-4 versus MK-7, I don’t think we know enough to know that one is truly the winner. You’ve got a little bit different mechanisms.

I have tended to use mixtures to have them both in there. Because the idea is, especially with breast cancer, some thyroid cancers, et cetera, and really for prevention, men or women, you don’t want a lot of estrogen floating around in your system after your liver has metabolized it. You want it to leave. One of the big problems that we can run into with hormone-sensitive cancers is not so much the hormone we made that day, the primary hormone, testosterone or estrogen, et cetera, it’s what we do to not eliminate it. There’s a lot of steps in metabolizing estrogen and getting out of the body, and a lot of people with cancer have a lot of trouble at various steps along the way. Some of them are gut related, which is why I like calcium glucarate, because it works in that setting, and some are metabolism.

… great, because it works in that setting. And some are metabolism, internal-related, and that’s, I think, where [inaudible 01:09:07] come in. The first order of business with removing hormones is making sure you’ve got enough bowel movement frequency, enough fiber going through to bind up these things in your bile. And then after that, the supplements will round out your elimination.

And then you can get even more deeply into it now that we have these new tests that show us metabolites. I’ve seen in cancer patients where they probably have a genetic problem they get the estrogen metabolized to this point, and they can’t metabolize it further very well. So it keeps floating around their body. And then if the breast cancer receptors are sensitive to estrogen, those metabolites seem to be worse for the receptors. So anything you can do to speed up elimination is helpful.

Dr. Weitz:                          Are we okay on time to spend a few minutes on IVs?

Dr. Anderson:                    Yeah, we can do some IV stuff. Sure.

Dr. Weitz:                          Okay, yeah. Good. Obviously, intravenous vitamin C is probably number one on the list.

Dr. Anderson:                    Yeah. With IV therapy and cancer, historically, just if you look just by sheer volume, intravenous vitamin C is the thing. Almost every patient knows about it, or they’ve heard about it. It’s the thing people ask for the most. I think one of the benefits of intravenous vitamin C is now that we have more research and we know a little more about the way it works, there’s actually benefits both at lower doses and higher doses of vitamin C. They’re just sort of different benefits. For example, there are some people who can’t get high-dose vitamin C because of some genetic issues or other tolerance things. They can still benefit from low-dose vitamin C intravenously and orally because of the other mechanisms that it helps out with.

But the most commonly used in cancer is a high-dose intravenous vitamin C. That puts the vitamin C in your vein instead of through your digestive tract, so your levels raise quickly. What we’re going for there … We used to think that it was all about this oxidation effect, which is part of it. So like the artesunate helps with, where the vitamin C encounters copper or iron, the electron state changes, and it creates a peroxide surge. Now, peroxide, whether it’s created through the artesunate or admesinin, vitamin C, or both, is very irritating to cancer cells, and it also draws the immune system to look in that area.

But now we also know, like with vitamin C, at low or high doses, it has real positive effects on your natural killer cells, on a number of other immune factors that we didn’t used to know about. It also appears, at high dose, anyway, to help with the balance of the NAD system, so NADPH and NAD and NADH and all the intermediates. The reason that-

Dr. Weitz:                          When you say low-dose versus high-dose, what’s a low dose, what’s a high dose?

Dr. Anderson:                    In the IV world, high-dose is usually considered to start about 25 grams, 25,000 milligrams IV and up. Probably most effects start somewhere at 50 grams, but the first IV people usually get is 25. We tend on most people to treat them at 50 to 75 grams, or 50 to 75,000 milligrams. Some people more. It depends on body size. So low-dose, there’s about three or four, five research papers now on low-dose vitamin C and quality of life and natural killer function, stuff like that. Low-dose tends to be somewhere around like 5 to 10 grams. A real common low-dose infusion nowadays is 7-1/2 grams. It’s in the middle. That’s pretty common too. Yeah, usually low-dose is plus or minus 7-1/2 grams, so 7,500 milligrams, plus or minus. High-dose pretty much is somewhere around 50 grams to 100 grams for really most clinics. And we do believe if you’re going for that oxidative effect, you got to get up there in that range.

But the thing I’ll usually try and tell patients is, that’s sort of the famous effect of vitamin C at high dose. There’s a lot of other things that are very beneficial too, because if you think about it, you put all that in my vein, and the first four to six hours, I’ve got a lot of vitamin C floating around. That’s great. But my normal cells are sucking up the vitamin C and using it as an antioxidant and a support. So vitamin C is really … It’s like we were talking about with the Warburg effect. It’s supporting my normal cells, and it’s also irritating my cancer cells at the same time. So it’s really a wonderful multipurpose treatment. And I think that’s why it’s still the workhorse of IV therapy with cancer. Also, the people study it more. So now we have papers coming out showing it’s safe with certain chemos or helps certain chemos, et cetera.

Dr. Weitz:                            Okay. What would be the second most common IV therapy that you’ll use with cancer patients?

Dr. Anderson:                    With cancer patients, after vitamin C or the combination of artesunate and vitamin C together, then the field really broadens out. Nowadays a lot of it goes to, what do we have available? For instance, in the book, which we wrote in 2016, ’17, published 2018, we had more things available then than we do now, because of government regulations.

Dr. Weitz:                            Ah, okay.

Dr. Anderson:                    Back at that time, probably our second most common combination of IV things was actually to support the metabolic therapies and the Warburg effect, and for all intents and purposes, intravenously those things aren’t available. You can do the oral things we talked about, but the IV things are aren’t.

The other thing that we did, a small but very impressive group of things intravenously with very advanced cancers, was intravenous curcumin. It was a emulsion of curcumin. There’s different types of intravenous curcumin. And we had people with stage four advanced breast cancers and other things where they had metastases on their bones, and on imaging after a series of treatment with IV curcumin, the bone metastases would actually reverse themselves. And we believe it’s because we could put so much more intravenously of the curcumin than you could ever take by mouth. And also, curcumin, remember, dampens that chemical drive for metastases. So that was really good.

What is curious that happened with curcumin is, at the same time we were researching plain opensource sterile curcumin, there was a drug company that was making a curcumin analog so they could patent it. It looks like curcumin, but it’s a modified molecule. That was being developed as a cancer drug, okay? So we were doing our stuff at the same time, and as soon as we started to report that we were getting these results with curcumin in the public sphere, the sources for that were shut down in the US. And the drug, which I believe is still called Lipocurc, L-I-P-O-C-U-R-C, given at much lower doses than we were doing because it’s not safe at lower doses, that’s now, I believe, approved, or is almost ready to be approved as a cancer drug.

So there’s a lot of these things that have gone away from, say, the integrative oncology, naturopathic oncology world as an availability, but they’re not gone. They’re being given to us now by big drug companies, which, you know, that is what it is.

Dr. Weitz:                            [inaudible 01:18:15]

Dr. Anderson:                    Yeah.

Dr. Weitz:                            What about mistletoe? I’ve heard quite a bit about mistletoe.

Dr. Anderson:                    If you had to pick one, like in a sports analogy, utility player, it would be mistletoe. A nice thing with mistletoe, at least that we found clinically, was, obviously if you’re doing a oral protocol and a diet, you can do that at home with some guidance. If you’re getting IVs, you obviously have to go somewhere to get an IV. Mistletoe, we would often do IV, but it can also be, you can train the person to do it subcutaneously like you would inject insulin, with a little needle just under the skin. And there’s a protocol for it, et cetera, so the patient gets trained. But they can then do that at home.

Mistletoe, it’s thought of as an immune stimulant, but much like curcumin, it’s more of an immunomodulator. So it goes in and it helps to wake up the sleepy side of your immune system that’s not fighting the cancer very well, but it also helps to dampen the inflammatory side that’s probably pro-metastasis. I think mistletoe probably has 30,000 research papers on it. I mean, it’s a very … Anywhere else in the world, mistletoe in cancer is very commonly used, even in standard oncology elsewhere. And there’s actually some new research in North America that’s looking at, you know, maybe we should look into this.

Mistletoe is very, very useful. There’s a few cancers you have to be careful with it, because it is stimulating on the front end. But a real big benefit, whether the person was coming in IV and we added it to the IV protocol or not, was the fact that when they got to the point where they were doing maintenance, we could send them home trained how to inject it subcutaneously.

Now, people will often ask, because mistletoe, obviously, is a plant, “Could I just take mistletoe?” And you can. It can be poisonous at higher doses. But the problem with taking it by mouth is, the chemical structure of the mistletoe that needs to be present to do the immune work breaks down in your digestive tract, so you don’t get a lot of the good stuff on the … Now, you might get other effects, but you don’t get the good stuff on the other side. So it does have to be injected in some way.

Going back to nonavailability of IV substances, now I would say the order we would go in, vitamin C is still the most common, artesunate vitamin C if we can get it, very common. Mistletoe, probably number two. And then everything else after that.

Now, certainly there’s another aspect to IV therapy in cancer, which is quality of life enhancement. For instance, you have somebody that has a major surgery, a mastectomy or something, or a colon resection. We use a lot of nutrient IV therapy in their recovery to just help them rebuild and get healthy. We use a lot of nutrient IV therapy after radiation therapy to help with nerve damage and things like that. So there’s many other things you could do with IV therapy too.

Dr. Weitz:                            What about ozone? Is that a significant player in this?

Dr. Anderson:                    Yeah, I would say it’s probably right up there, maybe a triad nowadays, with availability issues, of ozone and vitamin C and mistletoe, because those are still quite available. A lot of people, ozone has a very similar effect to high-dose vitamin C, but it’s different, because it doesn’t have any vitamin C with it. With ozone, the way it’s different from vitamin C really is that obviously there’s no vitamin C in ozone. They both have an oxidative burst that they create. And that creates a couple of important things.

One is hydrogen peroxide formation around the tumors. The nice thing with peroxide formation is, normal cells have enzymes to break peroxide down, so it’s not dangerous to them. Tumor cells, many of them have low levels of the enzymes, or no enzymes to break peroxide down, so the peroxide damages the tumor cell. So that’s a big effect.

The other thing, though, is that as you’re infusing the ozone, whether it’s through a major autohemotherapy where they mix it with the blood and put it in, or some people do ozonated saline, and many other things, ozone gets in. As your blood is trying to deal with the ozone, it’s triggering pro-immune chemistry right there in your blood. So in addition to the peroxide formation, you get this nice burst of immune-stimulating chemistry. So it’s really helpful, kind of like with mistletoe, where it’s waking up the part of your immune system that can go deal with the cancer.

Dr. Weitz:                            Do you find it’s better to just inject the ozone, or take the blood and mix it with the ozone, or which strategy do you think is best?

Dr. Anderson:                    Well, yeah, we tend to … There’s a lot of different ways to do it. The one I don’t do is what they call direct ozone injection, because that could go too fast. There’s a lot of regulatory things of just getting the right amount and all that. Major autohemotherapy is usually where I start with people, because that’s mixing it with their blood. That can have quite a potent effect. It’s kind of like we talked about with some of the other things. You want to see how a person responds, because let’s … There’s a lot of cancer patients who don’t realize, for example, they have chronic infections that are smoldering. If you give them a big oxidizing treatment, like too much ozone or too much high-dose vitamin C, they’ll have a lot of die-off of these bugs they didn’t know they had.

So if we start with a major autohemotherapy at a moderate dose, make sure they don’t get big fevers afterwards, joint pain, stuff like that, then there’s a number of potential processes. One is to do more ozone in the major autohemotherapy. The other, you could ozonate saline and then run the ozonated saline in. Very useful. And then some clinics have access to multi-pass systems, where they might do one through 10 passes of ozone. And again, most of those clinics also will start low and work up, because a lot of people can’t handle too much.

So ozone is quite versatile. And because it relies on technology to create it, as opposed to buying it from a pharmacy, it’s got a little of … You know, right now it’s sort of protected in that respect from a pharmacy oversight or something like that. So as we have less access to some of the other things we used to use, ozone’s becoming much more popular, vitamin C is even more popular than it was, et cetera.

Dr. Weitz:                          Right. Great. Awesome, Paul. This has been incredible. We’ve really gotten an amazing number of clinical pearls. Thank you so much.

Dr. Anderson:                    Thank you.

Dr. Weitz:                          How can viewers find out more about your courses to go more in-depth into these and other strategies for helping patients?

Dr. Anderson:                   Yeah. The easiest way, if it’s a healthcare practitioner, is consultdra.com, Consult Dr. A dot com. And also if you put in my whole name, Consult Dr. Anderson, you’ll get there too. That’s a provider website, so there’s a lot of free searchable things where I’ve answered questions or written reviews, and then there’s a CE component that we have almost 100 one and a half to three-hour CE things on many, many topics there. So that’s the professional website.

There’s also a lot of content for the public, and there’s a hub website, just D-R-A-N-O-W, Dr. A Now. That has links to … Whether you want books or the podcasts or the YouTube channel, it’s all there. So you can just go there and do it. And the-

Dr. Weitz:                            And what’s your podcast and your YouTube channel?

Dr. Anderson:                    The podcast, which is on every pod burner I can think of, is called Medicine and Health with Dr. Paul Anderson. If you go to your Apple Play or whoever you use and search that with my name, you should find it. The YouTube channel is D-R-A Online, Dr. A Online, is the YouTube name. And now I’ve got enough YouTube content, usually if you search that, you get there. But if you get lost for anything, that Dr. A Now website has everything. And the book we were talking about is this Outside the Box Cancer Therapies. That’s available anywhere you get books. My website has links to it. And then I’ve got a couple other books there as well.

Dr. Weitz:                          For a clinician, a great, great reference for cancer. Thank you so much, Paul.

Dr. Anderson:                    All right. Thank you very much.

 


 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness podcast. If you enjoyed this podcast, please go to Apple Podcasts and give us a five-star ratings and review. That way more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office, (310) 395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.

 

 

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SIBO updates with Dr. Ali Rezaie at the Functional Medicine Discussion Group Meeting

Dr. Ali Rezaie discusses Updates on SIBO and IBS with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on August 25, 2022.

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

 

Podcast Highlights

4:00:  For years the definition of SIBO was bacteria count of 10 to the five cfu/ml or more, meaning that more than a hundred thousand bacteria in the small bowel.  But that was based on the data from the blind loop diseases from the 50s and 60s.  But what Dr. Rezaie and Dr. Pimentel have shown in the North American consensus and in the SIBO guidelines is that the cutoff is 10 to the 3 cfu/ml or 1,000 bacteria.

5:46:  Bacterial overgrowth is not an infection, but rather it is essentially a dislocation of colonic bacteria into the small bowel.  And Intestinal Methanogen Overgrowth (IMO) can happen in the small bowel, or the colon, or both, so it’s not necessarily a type of SIBO, because it’s not just small bowel related.  In the colon you have about a trillion bacteria/ml and in the mouth it’s about 10 to the 9 ml. 6:47  The way the bacteria count is kept low in the small intestine is with the housekeeper waves or the migrating motor complex phase three.  These peristaltic waves occur every two hours and they start from the beginning of the small bowel and go all the way to the colon and last in each segment for 5 to 8 minutes. Stomach acid is also important in reducing bacteria but less important than we thought it was in the past.  There are patients who have gastrectomy–have their stomach removed–who do not get SIBO because their housekeeper waves are normal.  Digestive enzymes and having an intact ileocecal valve can also help to keep bacteria counts low in the small intestine. There are patients with Crohn’s disease who’s ileocecal valve is removed and they do not get SIBO because their housekeeper waves are normal.

8:40  Causes of SIBO.  SIBO is a secondary and not a primary disease.  The causes of SIBO include a postsurgical blind loop. Adhesions resulting from either surgery or from endometriosis.  Any medication that slows down the gut, such as narcotics or anticholinergic medications, can cause SIBO. Chronic pancreatitis, because the pancreatic enzymes are not being produced, is very commonly associated with bacterial overgrowth.  Small bowel diverticulum is often associated with SIBO.  The most common cause is small bowel dysmotility, which can happen in the setting of connective tissue disease, diabetes and in the setting of post-infectious irritable bowel syndrome or post infectious anti-vinculin antibodies.  The most common bacteria involved in post-infectious IBS is Campylobacter, but E. Coli infection can also cause this and this affects the enteric nervous system, which affects the motility of the gut.  Also, whenever there is inflammation in the small bowel, such as in the case of Crohn’s disease or after radiation, you have an increased chance of SIBO.

10:30  Proton pump inhibitors (PPIs).  It is commonly thought that proton pump inhibitors cause SIBO by blocking HCL, but while some smaller studies seem to show this, the larger studies are negative and Dr. Rezaie believes this is because PPIs do not change the pH of the small bowel.  This is because when the chyme, which is a mixture of food with acid, enters the small bowel it gets neutralized by bicarbonate within 5 cm of the pylorus.  So PPIs do not change the small bowel microbiome.

12:29  The symptoms of small intestinal bacterial overgrowth include abdominal distention, bloating, esp. post-prandially, abdominal discomfort or pain, fatigue, brain fog, diarrhea and urgency, which is more common with hydrogen and hydrogen sulfide producing bacteria. Or they can have constipation, which is more common with IMO (methane producing archea), but there is some overlap in such symptoms and you see patients hydrogen sulfide bacteria that have constipation and patients with IMO who have diarrhea.  They can also have weight loss or weight gain.

13:25  The pathway of gas production shows that carbohydrates break down into carbon dioxide and hydrogen and that hydrogen can be used by archea to produce methane. Bacteria can produce acetone from hydrogen. They can produce hydrogen sulfide and they can produce nitrates. Our cells do not produce hydrogen or methane, so any hydrogen or methane found in the body is produced by the gut microbiome.

14:08  Patients with high methane (IMO) are 3 1/2 times more likely to have constipation and the higher the methane levels the more severe the symptoms are, esp. the bloating and abdominal distention since higher methane slows the GI transit more.

14:58  Diagnosis of SIBO.  The gold standard for diagnosis is small bowel aspiration.  But this can only diagnose hydrogen SIBO, since the methanogens that cause methane SIBO cannot be cultured after aspiration. So for diagnosis of IMO we have only breath testing. One of the problems with small bowel aspiration is that you have at least a 20% contamination rate of picking up some bacteria as you pass the scope through the mouth, the esophagus and the stomach on the way to the small bowel.  Dr. Rezaie and Dr. Pimentel have developed protected catheters that eliminate this contamination rate and increase the sensitivity and specificity of small bowel aspiration, that should be commercially available by next year.  The other problem with small bowel aspiration is that you can only sample the proximal section of the duodenum, which is the first part off the intestines and this does not properly represent the whole 20 ft of small bowel.

17:58  Breath Testing.  The way breath testing works is that as food goes into the small bowel, if there’s excessive bacteria, the carbohydrates in that food will be fermented and the gas that is produced will go into the lungs where you breathe it out.  Among the pros of breath testing is that it’s noninvasive and it can assess a longer segment of small bowel as compared to aspiration. By identifying hydrogen from methane from hydrogen sulfide producers, it allows providers to tailor the most effective antibiotic therapies.  Among the cons of breath testing is that if you have overgrowth of non-fermenting bacteria, then this will not be detected.  If you have ultrafast transit, such as occurs with some neuroendocrine tumors, the sugar will get to the colon quickly and you will miss SIBO.

21:09  For Lactulose breath testing the specificity is 85% and 95% in centers where they carefully control the diet 24 hours before and they calibrate their machines correctly. Glucose breath testing is more specific but less sensitive than lactulose breath testing.

21:50  There are asymptomatic healthy controls who test positive for SIBO with breath testing.  The conclusion is that they have asymptomatic dysbiosis.  One study by Allegretti, et al. showed that of people who received a fecal microbial transplant for a C-diff infection, some end up with IBS symptoms after.  If the FMT donor was breath test positive for SIBO, the chance of getting those symptoms was 50% as opposed to if the donor was breath test negative, which was 14%.

23:45  When we look at how to interpret a lactulose breath test, for it to be positive there has to be a rise of hydrogen of more than 20 parts per million prior to 90 minutes.  For glucose breath testing, they are proposing to change the level at the next North American consensus to a rise of 12 instead of 20 to be considered positive for hydrogen.  This 90 minute cutoff correlates with small bowel aspiration deep sequencing data, which shows that proteus bacteria are very abundant and firmicutes are very low.

 

So for methane though it’s the cutoff is well established. The cutoff is 10 part per million. And this is, as I said, it can be the small bowel or the column. So you don’t look at the rise, you look at an absolute number and this 10 port per million, it’s interesting that it also, it works both for glucose and lactose. And this is a paper we just published I think about six months ago, that it works both for glucose and lactose and also correlates with constipation gas and less diarrhea. More importantly, it correlates with the load of methanobrevibacter smithii, which is the main archaea in our body that produces methane and also positivity remains stable on repeated measurements if you don’t treat the patient. So that’s very important. Because one argument is that well is method is just a sign of a slow transit.

Well I mean the answer is not, is no because sometimes we give antibiotics to somebody with IMO and [inaudible 00:27:26] and methane drops and patient has less symptoms. So it’s not just a matter of trans. And another very cool thing that we showed is that if you treat the patient for 14 days and you measure methane every day, a fast methane and it’s actually very nicely you see a drop in the methane levels of with antibiotic therapy. This is very important because for example, if I see a patient that now after seven days responded to therapy, then next time that I treat patient I will do it for seven days. I won’t do a 14 day course. On the other side, if I see that okay on the day 14 a methane is still elevated, that means that I’m using the wrong antibiotic. So I will use a different antibiotic to or whatever modality you want to use the plant-based antibiotics or you want to do elemental diet. But regardless, whatever you did, you need to switch gears.

So how do you manage bacterial overgrowth? Essentially we think of it as three pillars. Number one is that, is there a modifiable underlying cause that you can get rid of in, for example, is there narcotics onboard and can you get rid of it or can you give antagonist to narcotics? Can you decrease the amount of inflammation in the small mouth? But unfortunately not many times you’ll find a modifiable cause of SIBO. So you need to do induction of remission, which you can do antibiotic or elemental diet or you can do maintenance of remission. That essentially includes diet MMC, sort of modulating drugs that people talk about and also counseling the patient regarding recurrence.

 



Dr. Ali Rezaie is a world renowned gastroenterologist and researcher with a focus on IBS and the gut microbiome. He’s the Medical Director of the GI Motility Lab at Cedars-Sinai Hospital. Dr. Rezaie has published over a hundred scientific articles in peer review journals and his works have been cited more than 6,000 times by other scientific journals. He’s also the Associate Editor of the Journal of Digestive Disease and Sciences. And Dr. Rezaie is a co-author, along with Dr. Pimentel of the new book, The Microbiome Connection: Your Guide to IBS, SIBO and Low-Fermentation Diet.

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:            Good evening, this is Dr. Ben Weitz and thank you for joining the Functional Medicine Discussion Group meeting. And tonight we’ll be speaking with Dr. Ali Rezaie, and he’ll be giving us an update on some of the latest research on small intestinal bacterial overgrowth, which is believed to be the main cause of irritable bowel syndrome, which is the most common gastrointestinal condition. Thank you for joining the Functional Medicine Discussion Group this evening. And I want to thank our sponsor for this evening, Integrative Therapeutics. So, Integrative Therapeutics is one of the few professional brands of supplements that we use in our office and they have several excellent products that can be beneficial for SIBO.

The first product I’d like to highlight is the Physicians’ Elemental Diet. And the Physicians’ Elemental Diet is a great way to starve the bacteria involved in SIBO. We have several different strategies for getting rid of SIBO. One of them is to kill the bacteria with antimicrobials or antibiotics. Another strategy is to starve the bacteria. And the Physicians’ Elemental Diet is food, essentially, that’s in the most elemental broken down form, so your digestive system essentially can rest. It doesn’t really have to work to digest any of the food. And another product I’d like to mention, is a product that they have, which is called Motility Activator, which is my favorite natural pro-kinetic. And I’m sure Dr. Rezaie will mention the fact that a big part of SIBO is decreased intestinal motility. So to reset the migrating motor complex in a natural way, Motility Activator is a great way to do that.

One more product I’d like to mention that you might not think of that can be very beneficial for SIBO, is Theracurmin. Theracurmin is their highly absorbable form of curcumin. One of the things that happens with SIBO, and I don’t know if this is something that Dr. Rezaie will mention, but some of the data indicates that you get a gut hypersensitivity. And that hypersensitivity increases the symptoms and curcumin is an excellent way to downgrade that gut hypersensitivity.

So now I’d like to introduce Dr. Ali Rezaie, who is a world renowned gastroenterologist and researcher with a focus on IBS and the gut microbiome. He’s the Medical Director of the GI Motility Lab at Cedars-Sinai Hospital. Dr. Rezaie has published over a hundred scientific articles in peer review journals and his works have been cited more than 6,000 times by other scientific journals. He’s also the Associate Editor of the Journal of Digestive Disease and Sciences. And Dr. Rezaie is a co-author, along with Dr. Pimentel of the new book, The Microbiome Connection: Your Guide to IBS, SIBO and Low-Fermentation Diet. Dr. Rezaie, you have the floor.

Dr. Rezaie:          Okay. Do you see what I’m presenting?

Dr. Weitz:            Yes.

Dr. Rezaie:          All righty, perfect.

Dr. Weitz:            Good.

Dr. Rezaie:          So I’m going to give a talk and I’m going to leave some time for questions and answer at the end, because there’s a lot of things about SIBO that you can’t just fit into a talk. I’m going to talk about SIBO, I’m going to talk about IMO and how to diagnose and treat both, essentially. For small intestinal bacterial overgrowth, one important thing is, what is the actual definition? For the longest time, the definition was 10 to the five, meaning that more than a hundred thousand bacteria in the small bowel.  But that was based on the data from the blind loop diseases. Before we had PPIs and we couldn’t control peptic ulcer disease. The only way to control a refractory ulcer was surgery. And one of the surgeries that we used to do, was Billroth II. Essentially, you take, similar to gastric bypass, you take the stomach out of the luminal continuance and that obviously left the bowel to have a blind loop. And bacteria overgrew in that area and that’s what we called it blind loop syndrome at that time. And this is from ’50s and ’60s.  At that time the cutoff that was chosen was 10 to the five, mostly because we used 10 to the five for UTI too. So they just said, “Okay, let’s use the same thing.” But after multiple healthy controlled studies that were done, it’s clear that having a thousand or more bacteria per ML in the small bowel, and granted that the aspiration is not contaminated, is the abnormal cutoff. What has been now shown that we showed in the North American consensus and also in the SIBO guidelines, that the cutoff is 10 to the three or 1,000.

Another thing is that, okay, bacterial overgrowth is not an infection. It’s essentially dislocation of colonic bacteria into the small bowel. And then talking about the intestinal methanogen overgrowth here as well, is that intestinal methanogen overgrowth can happen in the small bowel, or the colon, or both. So it’s not necessarily a type of SIBO, because it’s not just small bowel related. So that’s a disclosure. Another important thing here, is that if you look at the colon here, we have about a trillion bacteria per ML in the colon. And also when we look at the mouth, it’s about a billion, about 10 to the nine per ML.

And it’s fascinating that the small bowel has less than 1,000. The way it keeps itself clean, is through mainly housekeeper waves or migrating motor complex phase threes, which are the sweeping waves that start from the beginning of the small bowel, sweep through the small bowel and get all the way to the colon. And that cleans the small bowel from the excessive amount of bacteria. And they occur every two hours and they last in each segment for about five to eight minutes.

Also, stomach acid is important, but more and more we are understanding it’s not as important as the housekeeper waves. And in fact, we do have patients with gastrectomy, that as long as their small bowel is functioning well, they don’t get SIBO. The most important factor remains the housekeeper waves. Obviously, anti-bacterial effects of bowel and pancreatic excretion is also a factor and also the role of ileocecal valve as well. And again, we do see a lot of patients with Crohn’s disease, whose ileocecal valve is removed, but they do not get SIBO, simply because their housekeeper waves are normal. Meaning that again, when you have a normal housekeeper wave, you can essentially out-power the other defense mechanisms.  We do add traditional manometry and this is a high resolution one, that we place it into jejunum and we look at these contractions that you see. That the contractions happen about 11 times per minute and they last about five to eight minutes in each segment of the small bowel.

So there are a lot of causes for SIBO and it’s important to remember it’s not a primary disease. It’s a secondary disease that can happen in a setting of postsurgical disease that we talked about, the blind loop. And also, adhesions very commonly can happen. Adhesions can happen in the setting of the virgin abdomen, meaning that somebody who hasn’t had an abdominal surgery in the past.  The most common cause of that is actually endometriosis.  Any medication that slows down the gut, such as narcotic and anticholinergic medication can do this. Chronic pancreatitis, because the pancreatic enzymes are not being produced, is very commonly associated with bacterial overgrowth. And also small bowel diverticulum, fibrous bands, they are very commonly associated with SIBO. The most common cause, though, is essentially small bowel dysmotility. This can happen in the setting of connected tissue disease, diabetes, very commonly in the setting of post-infectious irritable bowel syndrome or post-infectious anti-vinculin antibodies.  So the most common cause of this is Campylobacter, but it can happen in the setting of E. coli as well. What happens is that these anti E. coli antibodies, they affect the motility of the gut by affecting the enteric nervous system, and then the migrating motor complexes become infrequent or sometime completely absent. So whenever there is inflammation in the small bowel, same story, you can have a super imposed bacterial overgrowth.

So how about the PPIs? So if you look at the literature, it’s actually quite, it’s [inaudible 00:10:41] to a fact that PPIs don’t change the small bowel microbiome. There’s some positive studies, but the bigger studies are actually negative, which is interesting and it’s probably because of the fact that PPIs do not change the pH of the small bowel. Within minutes the chyme, which is a mixture of the food with acid enters the small bowel that gets neutralized by pancreatic bicarbonate within five centimeters of the pylorus and no matter what the pH of that chyme is, the pH of the Duodenum remains constant at around five and a half to six.  So probably that’s one of the reasons.  Having said that, yes in somebody who has other comorbidities, even suppression, yes PPI can cause trouble, but generally speaking we are not seeing that a type of abnormality.  And I mean if you look at the deep sequencing data, you can see that it’s almost a perfect overlap between people who are on PPI and not on PPI, even based on culture.  It was not different.  But nevertheless, I guess what this points at is that as long as you have a healthy housekeeper wave, then you are good.  And our focus mostly should be on restoration of the bacterial balance and next restoration of moderate and motor complex is to help these patients. 

So these are the symptoms you’re all familiar with.  The symptoms of bacterial overgrowth.  Most common thing are abdominal distension and bloating and obviously post-prandially.  Generally they’re the best in the morning and as the day goes on they get worse. They have fatigue, they have post-prandial brain fog.  They can have weight loss, weight gain, they can have diarrhea and urgency, which is more common with hydrogen and hydrogen sulfide like producing bacteria. Or they can happen to have constipation which is mostly in the setting of IMO. However, these are not universal rules. You’re going to see patients with IMO who have diarrhea, you’re going to see patients with hydrogen SIBO who have constipation. So it is just that people with IMO have a higher chance of getting constipation. That doesn’t mean that every IMO patient is constipated.

So this is a simplified pathway of gas production by microbiome. So the first step is as simple as you can put it, is that carbohydrate breaks down into carbon dioxide and hydrogen and that hydrogen can be used by archea to produce methane. They can, bacteria can produce acetone out of it, they can produce hydrogen sulfide and even produce ulcers. Remember our cells do not produce hydrogen or methane. So any hydrogen or methane found in our body is produced by gut microbiome.  So this is essentially what I was saying. So patients with IMO have three and a half times more likely chance of having constipation as compared to people who don’t have IMO, what tells you there is that, well IMO not every patient has constipation. Another important thing about methane is that the higher the methane, the more severe the uploading and abdominal distension. Another important thing is that methane like hydrogen is a hack, is an active gas transmitter, meaning that by itself it has physiologic effects. So if you infuse methane into the small bowel of dogs, it decreases the transit by 70%.

So how do we diagnose it?  So obviously the gold standard is small bowel aspiration.  So right off the bat, this is not for diagnosis of IMO.  We can’t culture methanogens at this point except for very specialized labs.  So for diagnosis of IMO, we are only left with breath testing. This is for diagnosis of non methanogenic bacteria in the small bowel. So what are the advantages? The advantages is that well antibiotic you can do the antibiotic sensitivity on whatever you culture and you do very directed therapy.  Also a diagnosis SIFO, which is commonly happened with small intestinal bacterial overgrowth. So in that scenario you obviously treat the patient for both. The problem is that we have 20% chance of contamination rate and that’s the data coming from ao.  But the problem is that this is done by the usual single lumen catheters that we do through the scope.  So you put the scope down through the mouth into esophagus, stomach, then small bowel.  While going through that the suction channel of the scope gets contaminated by the oral mucosa and also whatever stuff is in the stomach and the esophagus. So when you put a single lumen that the tip is not protected, some of that stuff goes into the catheter and you culture that as if it was in the small bowel and you aspirate from there. So you get contamination rate. So if you use those rudimentary catheters then you get 20% contamination rate.  Well hopefully next year there will be protected catheters available, not hopefully, there will be protected catheters available that will increase our sensitivity and specificity of small bowel aspiration.

Another issue is the sampling error.  So you’re sampling like 5 centimeters of small bowel and you’re hoping that that kind of represents the whole 20 feet of small bowel.  Well it won’t.  So there’s a sampling error there.  So there is that problem as well.  And we can’t culture all the bacteria and also it’s invasive and time consuming.  Okay, so as you can see it’s even though it’s called gold standard, it’s almost silver because it has some deficiencies.  And at the bottom is the catheter that I was talking about and these are the catheters that we are using right now.  What is still only at the research level.  So we don’t have contamination rate at our center. 

So breath testing.  So breath testing, essentially it’s when the food goes into the small bowel, if there’s excessive bacteria in there that gets fermented, the gas goes into the lungs and then you breathe it out. With the same concept, you could give glucose and lactulose and just monitor the levels of artificial methane that happens every 15 minutes to see if there is excessive amount of bacteria in the small valve. You also do measure zero two, adjust to or you are able to standardize each breath sample based on the alveolar level.  So what are the pros here?  Well it’s noninvasive. It can assess a longer segment of small bowel as compared to aspiration.  It’s hydrogen and methane are exclusive bio markers of microbiome and also it tailors antibiotic therapy as we will talk in the next few slides.  And also predicts response to antibiotic therapy.  So these traits are not found in the small bowel aspiration. Okay what are the cons?  I mean if the bacteria that is causing trouble is non-fermenting, which is not common but it does happen, then you can miss it out obviously. Sometimes if you have ultrafast transit such as like things go through your small bowel within 15 minutes in the setting of some neuroendocrine tumors, obviously you the sugar gets to the colon quickly and you miss it. One important thing is that the sugar gets to the colon, it takes 40 minutes, takes 40 minutes for the bacteria that is exposed to that sugar in the colon to produce a hydrogen to a level that is 20 parts per million detected in the breath.  So there is a lag there. The reason why I’m saying in this is that as some use a Scintigraphy to criticize a breath testing and saying that well by the time that 5% of the, and the medium is in the colon while 95% of the small bowel, now we are seeing a rise in the breath hydrogen. So this is coming from the [inaudible 00:20:37] from that 5%. But that’s a little bit of a flawed theory because well first of all, 95% of that medium is still in the small bowel. Number two is that the bacteria in the colon takes 40 minutes to produce hydrogen to be detected in breath and Scintigraphy does not account for that lag. It’s not an immediate phenomenon.  And because of that we use the 90 minute mark for the overgrowth.

This is a healthy control sort of study that we did while back on more than like 800 asymptomatic controls. So overall the specificity about 85%. But if it’s done in centers that they know what they’re doing, it’s about 95%. These are centers while they’re compliant with the patient’s diet, they ask the questions whether they compliant, they do the test correctly, they calibrate the machines correctly.  So in that scenario, obviously the quality of the test goes up and the specificity becomes about 95%.  But there’s no question that there is a group of healthy controls or healthy “people with no GI symptoms” and that their breath test is positive. Now the question becomes is that well is this a false positive or a true patients with SIBO that is just asymptomatic? Because remember, asymptomatic dysbiosis does exist. A lot of people with with dysbiosis are walking around with virtually no symptoms at all and asymptomatic bacteria can happen all the time, especially during pregnancy. So it’s not an uncommon thing. So this can happen. And one study that essentially proved that is the study by Joseph Allegretti that what did they did is that they looked at people who received a fecal transplantation for a C diff infection. So for people who C diff was eradicated but they develop IBS like symptoms, if the donor was breath as positive, the chance of getting those symptoms was 50% as opposed to if donor was breath as negative, which was 14%.

So that means that even though those individuals had no symptoms, their breath test was positive. So there is something wrong with their microbiome. So giving that microbiome to patients with C diff infection caused IBS, which is a fascinating concept. So if you want to do breath in your office or see whether the indications preparation and interpretation of breath is, you can use North American consensus as a guide for yourself that now it’s been five years since we published at.

So this is how a normal breath test looks like. So the patients fast overnight, they come in and we measure hydrogen methane adjusted based on CO2, every 30 minutes, every 50 minutes we measure it. And usually what we see is that if you do it for 180 minutes, you see a rise at the end. Sometimes you see a rise a little bit earlier. But what is positive is if you have more than 20 part per million of rise from baseline within 90 minutes, that means that there is excessive amount of bacteria in the small dial that is fermenting and repeating that up.  So just to give you, it’s interesting that that cutoff kind of correlates with deep sequencing data as well. So this is a small bowel aspiration data based on deep sequencing and very commonly proteus bacteria are very abundant and patients with SIBO that correlates with it. And firmicutes are actually low. So which is interesting. So in this patients we’re seeing and even correlated with energy metabolism of hydrogen production, pathways of bacteria. So seems like the 90 minute is almost the perfect cutoff for lactulose at breath testing.

For the glucose breath testing also we proposed a 90 minute cutoff.  Having said that because glucose gets absorbed within the first two or three feet of the small bowel, you probably can just look at the whole 120 minutes of data. One important thing about glucose is that, well there’s now debate and then probably we are going to change things in the next North American consensus that the cutoff probably for glucose should be lower because it doesn’t cover the whole small bowel. And instead of 20, the data, especially the data that recently [inaudible 00:26:01] proposed is that probably the best cutoff is 12.

So for methane though it’s the cutoff is well established. The cutoff is 10 part per million. And this is, as I said, it can be the small bowel or the column. So you don’t look at the rise, you look at an absolute number and this 10 port per million, it’s interesting that it also, it works both for glucose and lactose. And this is a paper we just published I think about six months ago, that it works both for glucose and lactose and also correlates with constipation gas and less diarrhea. More importantly, it correlates with the load of methanobrevibacter smithii, which is the main archaea in our body that produces methane and also positivity remains stable on repeated measurements if you don’t treat the patient. So that’s very important. Because one argument is that well is method is just a sign of a slow transit.

Well I mean the answer is not, is no because sometimes we give antibiotics to somebody with IMO and [inaudible 00:27:26] and methane drops and patient has less symptoms. So it’s not just a matter of trans. And another very cool thing that we showed is that if you treat the patient for 14 days and you measure methane every day, a fast methane and it’s actually very nicely you see a drop in the methane levels of with antibiotic therapy. This is very important because for example, if I see a patient that now after seven days responded to therapy, then next time that I treat patient I will do it for seven days. I won’t do a 14 day course. On the other side, if I see that okay on the day 14 a methane is still elevated, that means that I’m using the wrong antibiotic. So I will use a different antibiotic to or whatever modality you want to use the plant-based antibiotics or you want to do elemental diet. But regardless, whatever you did, you need to switch gears.

So how do you manage bacterial overgrowth? Essentially we think of it as three pillars. Number one is that, is there a modifiable underlying cause that you can get rid of in, for example, is there narcotics onboard and can you get rid of it or can you give antagonist to narcotics? Can you decrease the amount of inflammation in the small mouth? But unfortunately not many times you’ll find a modifiable cause of SIBO. So you need to do induction of remission, which you can do antibiotic or elemental diet or you can do maintenance of remission. That essentially includes diet MMC, sort of modulating drugs that people talk about and also counseling the patient regarding recurrence.

So it’s important to understand that if antibiotics have an efficacy of about 50%. So that’s very important to understand because just because one patient does not respond to antibiotic therapy, that doesn’t mean that patient doesn’t have SIBO. Most of the studies looked into hydrogen SIBO and the antibiotic study data on I’m not going into the plant based antibiotics because that’s not the area of my expertise. You guys know more than me about that. But the antibiotics that we have by prescription [inaudible 00:30:06] and flail has been tested and showed positive response. Data for Rifaximin is actually interesting because we know that refaximin is approved for IBS diarrhea. But the only determinant of response that we could find that determines the degree of response in IBS patients to refaximin is positivity of breath test. If breath was negative, the response was 26%, which is less than possible and if it was positive was 56%, if the response was that the breath became normal at the end of the treatment response rate was 76%.

So it’s determines a response in IBS patients. So how about [inaudible 00:31:13] are refractory to a lot of antibiotics. So what we need to do is to suppress the hydrogen produce a bacteria. So they can’t produce methane and also suppress the archaea. So usually we do that for example [inaudible 00:31:35] augmenting we anecdotally use. So that’s a achievement that we try. So Ben talked about the data on elemental diet. There aren’t many sort of formal studies, but documental data study 2004 that show that using yvan X at the trial of 93 SIBO patients, they had 66% symptom improvement after two to two or three weeks of elemental diet. And by elemental diet, I mean exclusive elemental diet, I mean they’re not allowed to take anything else other than water. They’re allowed to have black coffee. So at the response rate is actually for improvement and normalization of a breath.

This was actually 80%, which is even better [inaudible 00:32:39]. Also we know that elemental that it can works on Crohn’s disease, a CDI can even within [inaudible 00:32:49] gastroenteritis. So if you have a patient that has overlap of those, an intriguing option. Another thing’s that you should always tell your patients about chance of recurrence of disease to these patients because so they understand. So they’re not disappointed when the symptoms come back. I almost tell them you have about 50% chance of recurrence at one year. So they understand that it’s not like a UTI that you just treat and it’s gone. This is different.

So diet at Cedars, we use a low fermentation eating planning, which includes meal spacing plus a list of food that are not as a restrictive as other diets because of extremely restrictive diet eventually can lead to micronutrient and micronutrient deficiencies. So I use this as a maintenance of remission mortality. So what else do we use? We use migrated motor complex and modulating a drugs, for example, and [inaudible 00:34:08] at low dose and also low dose [inaudible 00:34:16]. There are other modalities, obviously you can do those. [inaudible 00:34:19] has been used, [inaudible 00:34:19] has been used, but unfortunately the number of promotility drugs out there are not a lot of them.

So this is essentially how the algorithm that I’ve followed generally for bacterial lower growth. So if I have hydrogen sulfide or hydrogen predominant of bacterial overgrowth, I treat them bit [inaudible 00:34:46] I mean also works on them. And also if you have excessive random methane, then I usually use [inaudible 00:34:55] for 14 days. And then I educate the patient about risk of recurrence and adopt this strategy for maintenance immersion, whether it’s diet or it’s a migrating motor complex modulating drug. And if symptom occurs, obviously I repeat this. In the meanwhile though every time I do this I always look at the underlying causes and whether there is something that I can change.

So these are the take home messages. So essentially it has myriad of symptoms, we can diagnose bacterial overgrowth and also EMO with breath testing and also a breath testing I showed you some data that helps tailoring antibiotic therapy and predicts response to refaximin and [inaudible 00:35:49] diarrhea patients. And then don’t forget the three pillars and revisiting them constantly when you’re managing these patients. And this is our team. And at this point I’m happy to answer any questions.

Dr. Weitz:            Let’s see, let me ask the first question here. Dr. Rezaie, I know with your elemental diet, I was looking at the description of it in the book and it’s somewhat similar to a low FODMAP diet. Now the low FODMAP diet has a certain amount of data to substantiate it. Why not go with a low FODMAP diet rather than the elemental diet?

Dr. Rezaie:          Well, I mean this would be a good question for a dietician. They’re not necessarily similar. The low fermentation is way more liberal, low FODMAP is way more strict. So that would be, so that’s essentially the difference. So the thing is that yes, you are right, low FODMAP diet is there’s a lot of data behind it. And because of that we know that it’s not healthy in the long run and you have to reintroduce food within one month, which doesn’t work in SIBO patients. Well, I mean you reintroduce things in one month while symptoms are back. So that’s the issue.

Dr. Weitz:            Now I know you’re not a big fan of probiotics. Maybe you could tell us why.

Dr. Rezaie:          Well, I mean the bottom line is that SIBO is not a primary disease. So as we discuss the main causes this motility and also a lot of other causes that leads to accumulation of bacteria. So pouring more bacteria in the small bowel is not going to fix that problem. And that’s the issue. In fact, actually patients with bacterial over growth can get worse with probiotics. I mean there is a very interesting study that can department did at temple that they give [inaudible 00:38:06] to healthy controls by the end of one month. The patients with [inaudible 00:38:17] started to have more bloating distension. But more interestingly, they started to have more methane, which is fascinating. So we started to give them EMO, which is fascinating because [inaudible 00:38:30] is a hydrogen producing bacteria.

Dr. Rezaie:          And on top of it, the data with fecal transplantation with IBS is nothing short of disappointment at this point. And there are a couple of studies that are not just negative, they’re showing that actually placebo is superior to [inaudible 00:38:50] meaning that patients are getting worse. So this, and if you think about it, fecal transplantation is the ultimate probiotics and we know it works in certain situations. There’s no question that they work in the senago C diff infection of the recurrence of it. But in this scenario yet to see any robust data that it helps and if anything, we have data that it may be even making it worse.

Dr. Weitz:            Now you mapped out the microbiome of the small intestines. So obviously there’s benefits to having a certain amount of bacteria there. And one of the rationale for probiotics is we often use the analogy of a parking lot and there’s only so many parking spaces, and if you can park some good cars there, you can keep the bad cars from taking up those spaces. So if you are using antimicrobials or antibiotics and you’re killing some of the bad bacteria, you might be leaving open parking spaces. And so that would be the rationale for potentially for using probiotics.

Dr. Rezaie:          I mean possibly that’s but clinical data is you is yet to pan out with that.

Dr. Weitz:            Right. Somebody asked if you could give that reference for the fact that colonic bacteria, it takes 40 minutes to produce hydrogen at a level that can be detected in a breath.

Dr. Rezaie:          Sure. This study is done by Read, that’s the first author. It’s in got and is published I think in 1985. So if you look at that study, they is actually infused [inaudible 00:40:58] and that led to rise in the hydrogen and it took about 40 minutes for the rise to reach a level of two department.

Dr. Weitz:            Let’s see, as somebody mentioned that there’s several studies that have shown, in fact, I’m pretty sure there’s at least one meta analysis showing that probiotics can be beneficial. And it’s been hypothesized that probiotics actually have an antimicrobial effect.  Let’s see, is SIBO really bacteria overgrowing from the large intestine or is bacteria coming down from above?

Dr. Rezaie:          No, it’s bacteria from the colon.  So these are the disruptors that we see in the small vowel overgrowth that we see. And as we get closer to the colon and SIBO patient is more similar to the colon and healthy controls is not.  So it’s coming from the colon.

Dr. Weitz:            Is the importance of a healthy ileocecal valve important?

Dr. Rezaie:          Yeah, IC valve is important.  And not surprisingly, not the patients with, IC valve resection, they will have higher chances of bacterial lower growth, but not all of them.  But it shows that if you have healthy migrating motor complexes, you’ll probably do well.

Dr. Weitz:            Given the fact that there are some patients who as a result of Crohn’s or some similar disease have had to have their colon removed, they no longer have a normal colonic microbiome and we know how important a microbiome is for health.  In that situation, is it preferable for the small intestine to have a higher amount of bacteria?

Dr. Rezaie:          Ask the question again.

Dr. Weitz:            Is there ever a scenario in which you might want the small intestine to have more bacteria?  In the example, in the case of a patient who no longer has a colon because it was surgically removed, they no longer have a colonic microbiome.  We know how important a microbiome is.  In a situation like that, is it beneficial for the person’s health to have higher bacteria?  In other words, should their small intestine become their new microbiome?

Dr. Rezaie:          No.  So the way colonic mucosa interacts with the bacteria and the small bowel or is completely different.  So you can’t really use small bowel as colon.  So I can’t think of a scenario.

Dr. Weitz:            Okay. Great. Well we really appreciate you showing up despite being sick with COVID and hopefully you’re going to recover quickly.  If anybody doesn’t have any other questions?  Then thank you very much Dr. Rezaie. 

Dr. Rezaie:          No, you’re welcome. All right.

Dr. Weitz:           And thank you everybody for joining and we’ll see you next month.

 


 

Dr. Weitz:            Thank you everybody for joining and we’ll see you next month. Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple Podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica White Sports Chiropractic in Nutrition Clinic. So if you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.

 

,

Integrative Approach to Parkinson’s Disease with Dr. Karin Duncan

Dr. Karin Duncan discusses an Integrative Approach to Parkinson’s Disease 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

5:34  Parkinson’s Disease is a neurodegenerative disease of accumulated motor dysfunction. Parkinson’s is marked by the accumulation of alpha-synuclein in the basal ganglia in the brain. It is usually classified by the hallmark symptoms of bradykinesia, or slow movement, stooped posture, masked face, and a tremor.  We are very late in diagnosing this disease and by the time most people are diagnosed, 80% of the dopaminergic neurons are depleted.  We don’t know what causes Parkinson’s, though there are theories that look at possible causes, including oxidative stress, environmental exposure, genetics, mitochondrial dysfunction, and gut dysbiosis. 

7:13  Dopaminergic neurons are unable to produce sufficient quantities of dopamine in patients with Parkinson’s. When these dopaminergic neurons, which are highly concentrated in that basal ganglia, as they die and they release their toxins and their cell debris, and this creates oxidative stress for their surrounding neurons.

8:35  Parkinson’s is a chronic disease, likely autoimmune in origin, that develops over decades. While we know that smoking, sedentary lifestyle, obesity and family history are risk factors for heart disease, most people don’t know that risk factors for Parkinson’s are anosmia (lack of sense of smell), REM sleep disorder and constipation, which are typically present for 10-20 years prior to a diagnosis of Parkinson’s.

 

 



Dr. Karin Duncan is a board certified Naturopathic physician with a focus on integrative neurology.  Dr. Duncan is a specialist in treating patients with Parkinson’s disease with an Integrative Approach.  Dr. Duncan works at Coeur d’Alene Healing Arts in Idaho and the website is cdahealingarts.com

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

 



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates, and to learn more, check out my website, DrWeitz.com. Thanks for joining me and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Our topic for today is Parkinson’s disease with Dr. Karen Duncan. And this is the first time we’ve covered Parkinson’s disease. Dr. Karen Duncan is a board certified naturopathic physician with a focus on integrative neurology. Dr. Duncan is a specialist in treating patients with Parkinson’s disease, using an integrative functional medicine approach.  Dr. Dale Bredesen has blazed the trail in developing a functional medicine approach to the prevention and treatment of Alzheimer’s disease, but there are not many in the functional medicine world who have a specialty of treating patients with Parkinson’s disease which is the second, most common chronic neurological disease after Alzheimer’s.  Fortunately, there is quite a bit of literature looking at the potential benefits of specific nutritional and lifestyle approaches to helping patients with Parkinson’s disease, as Dr. Duncan helped me to discover when I asked her to send me some references, and she was very kind to send me more than 20 papers to read. And of course, being the science geek I am, I read most of them. So Dr. Duncan, thank you so much for joining us.

Dr. Duncan:        Of course. Hey, you’re already doing better than me. I don’t know if I’ve read all of them.

Dr. Weitz:            So before we get started, I just found out yesterday that there’s this big scandal about the research related to Alzheimer’s disease. This researcher investigator did this careful analysis of the hallmark study that really seemed to have proven the hypothesis that beta amyloid aggregation in the brain was the cause of Alzheimer’s disease. And this was referenced in thousands of other studies as a basis for all these drugs, which haven’t worked. And it’s really a major scandal in the Alzheimer’s world.

Dr. Duncan:        That really caught me off guard when I heard about that, and thank you for sharing that information. And it’s an incredible jumping off point to our conversation today, just about research, really. What is research and what does that mean for our patients? And I think, you haring that with me, the very first thing that hits me, especially in this profession, is just overwhelming sense of grief for the patients and the caregivers and these people who invested time and energy and their healing potentials into these therapeutics that were founded on a scandal. And I think that’s really, really unfortunate for the whole profession too. So disappointing to say the least.  But really the biggest question that I’d like to ask, because I’m a curious, nerd science geek too, is how do we know what we know? And my mentor always used the example of scurvy. She says, “Hey, scurvy was around for 300 years before we learned that the vitamin C in limes was the biochemical feature that was treating this disease of vitamin C deficiency in our sailors.”  But for 300 years, we were able to treat and save lives with limes. Parkinson’s disease has been around for about 300 years. We still have no disease modifiable medications on the market. And what the conventional researchers want us to prove is, why does this work? And really what we want to ask is, what works? What’s working out there and not causing harm, and then how can we kind of figure out what’s in the lime? So to speak. How do we do that? Because meanwhile, these are humans, these are patients. These are people with Parkinson’s and their families who are going through this. [inaudible 00:04:18]

Dr. Weitz:            And we also have Dr. Dale Bredesen’s work, who’s shown for the first time that Alzheimer’s disease can actually be not just slowed down, but reversed using a full functional medicine approach. And none of the medications for Alzheimer’s disease has ever been effective at doing anything other than possibly slowing the progression. And yet we have a functional medicine approach that can reverse it. But of course, this is falling on silent ears in the conventional medical world.

Dr. Duncan:        Yeah. I mean, we’re trying to yell louder. And I think the big explanation there is it’s slowing progression, and that’s with Parkinson’s disease. Are we slowing progression or are we masking symptoms? And of course, symptom palliation is really important. We want to improve quality of life with that medication, and that’s levodopa. That’s “Oh, I love it, prescribe it. I’m on it.” But what are we doing to slow progression?  And like you started at the beginning, we actually have the data that conventional research wants to see with these nutraceuticals, with food choices, with exercise, with lifestyle that is showing slowing of progression of the disease.  So as that marches on, when we’re palliating symptoms, we’re actually doing interventions that can actually slow the progression.

Dr. Weitz:            So let’s start right there.  And perhaps you could define for the listeners, what is Parkinson’s disease and then how is it best diagnosed?

Dr. Duncan:        Well, Parkinson’s disease is a motor degeneration, neurodegenerative disease of motor dysfunction accumulation. I mean, now we’re going to start asking questions, you’ve already put that down my ear. But the accumulation of alpha-synuclein in the basal ganglia there in the brain, which is our motor nucleus. So it’s usually classified by the hallmark symptoms of bradykinesia or slow movement, stooped posture, masked face, and a tremor.  And that tremor has really taken the load of diagnostic criteria to get to Parkinson’s disease. The truth is Ben, we’re 10 to 20 years late on diagnosis. Parkinson’s disease is starting decades before patients show up with a tremor. And by the time they’re diagnosed, 80% of their dopaminergic neurons are deplete. So we’re just late to the game, and diagnosis in specific.

So when you ask what is Parkinson’s disease, and I stutter, it’s like, well, we don’t really know yet. We know what we’ve been told and we know what we’re seeing 20 years after it begins, but we’re still not sure what causes it. And the theories out there for Parkinson’s as oxidative stress is that environmental exposure, genetics, mitochondrial dysfunction, gut dysbiosis. We’ll go into some of these. And the answer is yes, yes, yes, yes and yes. We’re seeing all these as being correlative.

Dr. Weitz:            And of course you just mentioned the dopaminergic neurons. So maybe you could explain what happens there. So part of the process is, is that the person with Parkinson’s is unable to produce sufficient quantities of dopamine. Correct?

Dr. Duncan:        Right, yep. And that’s exactly it. These dopaminergic neurons that are highly concentrated in that basal ganglia, as they die and they release their toxins and their cell debris, it creates oxidative stress for their surrounding neurons. And therefore, we have this accumulation of neuronal death and inability to create dopamine, which then will create at some threshold, again, unbeknownst to us, will start to create these motor symptoms that then lead patients to seek care.

Dr. Weitz:            And what you’re saying about the fact that this long, gradual onset of disease, and by the time these symptoms help us to diagnose this condition it’s been going on for decades, is very common for the majority of autoimmune diseases, right? Of which I think Parkinson’s is believed to be one, right?

Dr. Duncan:        There’s definitely theories out there that this is a type of autoimmune disease that’s similar to Alzheimer’s disease. Is this a type three diabetes? There’s so many different system implications, but a ton of research on the autoimmune part.

Dr. Weitz:            So these chronic diseases are slowly developing for long periods of time. And we should really be focused on trying to see some of the underlying triggers and other factors that are slowly causing our brain not to function properly or to lead to brain neural inflammation and try to identify some of those and intervene, rather than waiting until the person has already severe damage to their central nervous system.

Dr. Duncan:        Yeah. You nailed it, Ben. I mean, if I were to ask you, what are the top three risk factors for heart disease? Anybody in the medical profession can list them off, rattle them off. We’re looking at smoking, sedentary lifestyle, obesity, family history. We’ve got those, and you see this combination of symptoms in your office and you’re like, “Whoa, let’s get going. Let’s prevent.” It doesn’t matter what modality you practice.  What if I were to tell you that the largest percentage of patients that are diagnosed with Parkinson’s had 10 to 20 years of anosmia or lack of sense of smell, REM sleep disorder and constipation. Now, you see those in your clinical practice as a patient who’s showing up in these ways, can we respond in the same way and say, “Hey, do we know for a fact you’re going to get Parkinson’s?” No, but can we do something right now to say that you won’t?

Dr. Weitz:           Let’s shine a little light on what you just said. So those three are early prodromal symptoms. And can a person have one or two of those or is it more likely that they have all three of those and are more likely to develop Parkinson’s?

Dr. Duncan:        Honestly, I don’t think there’s data that will show what percentage of people with Parkinson’s have one, two or three of these motor symptoms. And when you’re looking- [inaudible 00:10:27]

Dr. Weitz:           Lack of sense of smell, constipation and, let’s see-

Dr. Duncan:        REM sleep disorder.

Dr. Weitz:           And REM sleep problems. Interesting.

Dr. Duncan:        So the majority of people with Parkinson’s will present with all three of those if not, like I said, one or two. I guess my point is, if somebody shows up to your office at 40 years old, with this [inaudible 00:10:50], can you respond as quickly as you would with the risk factors for heart disease?

Dr. Weitz:           Absolutely not. No.

Dr. Duncan:        No, no. I mean, we’re giving MiraLax and [inaudible 00:11:01]. I mean, in all actuality, I mean, these people are getting treated for those things. And I think this recognition of what does this mean and what could this show us? And we get this data again, because we’re doing these patient reported outcome measures, these studies that say, “Hey, I’m going to survey this population of Parkinson’s,” which you’ve already mentioned is vast and say, “Hey, what do you got going on? What did you have going on? What’s leading up to your disease and what’s making this hard for you?”  And when we look at pre-motor or non-motor symptoms, I mean, the list is a mile long. And I want to get into that. That’s really, I think the meat of what we’re doing here. But addressing that tremor I had mentioned before has taken the cake as far as measurement of success in treatment of Parkinson’s disease.

My patients will come in and they’ll say, “Hey, I went to my primary neurologist.”  I said, “Great. What did you cover?”  “I did the chicken dance, the UPDRS score. How well can my fingers move?”  I said, “Awesome. How’d you score?”  They’re like, “I don’t give a shit. Here’s what’s bothering me. I have anxiety. I still haven’t pooped in three days. I’m drooling in public. I wake up to pee four times a I mean, you dive into these conversations and this, tremor is a hallmark of diagnosis of Parkinson’s, it really just needs to step aside.

Dr. Weitz:            Okay. So is there a definitive way to diagnose Parkinson’s or is it mainly by symptoms?

Dr. Duncan:        It’s mainly by clinical presentation. Yep. You’re going to see that we have a DaTscan out there. So there’s imaging of the brain that can… I treat it kind of, as it can confirm a positive suspicion of diagnosis, but it won’t always not confirm that it’s not there. So the false positives and negatives there are high. Working with a lot of the movement disorder specialists in the area, I’m really well integrated with the conventional side here and they don’t rely on it heavily for diagnostic criteria. So it really is constellation of symptoms, patient presentation, and physical exam can’t be minimized. Can we actually get in there, and is their cogwheel rigidity? What does the tremor look like? Are we checking DTRs? Because these things help us support what else is happening in the body, not just Parkinson’s [inaudible 00:13:19].

Dr. Weitz:            So give us some things that we can look for on a physical exam that would really alert you that this may be a patient with Parkinson’s.

Dr. Duncan:        I mean, you’re looking for tremor, drooling, the outward bradykinesia. You’re going to do your gate analysis and posture. What I want to say is, when we’re looking for these things on a surface level, can you dive three steps deeper? A lot of times, yeah there’s going to be gait abnormalities. Are you asking, was there injury, surgeries? What else is happening there? Are you checking leg length discrepancies on physical exam? When you’re doing your range of motion tests, are you doing active and passive? Are you doing resisted? Again, injury, surgeries.

So I think we’re quick to the diagnosis of Parkinsonism if I can say that, to be so bold. Because I think there’s all these things that we’re trained in medical school to ask. And then there’s layers underneath. Most of the patients who are presenting it, they’re 70 years old, that’s a lot of life lived.  And while it might appear to be Parkinson’s disease, really ensuring that you’re familiar with the human body and how it moves in their personal history is important. So yeah, the gait analysis, the lack of arm swing, and then so much of the physical exam then is going to be the interview. What are your non-motor symptoms? There’s widely published questionnaires out there, MNS questionnaires for PD. I highly recommend all clinical practitioners to at least do one round of that- [inaudible 00:14:46]

Dr. Weitz:            Which do you consider the most accurate questionnaires? And I’ve seen some discussion in the literature about questionnaires that are filled out by the patient and questionnaires that are filled out by the practitioner. What do you think is the most effective questionnaire or questionnaires?

Dr. Duncan:        The one that you do. The one that you ask. Again, I just, I’m seeing so few actually being completed. But [inaudible 00:15:16] one, it’s a very, I don’t know, PD NMS questionnaire. I’d have to give you the resource, I don’t have it sitting in front of me. But it asks very specific questions. Are these non-motor symptoms that you’re having, on a scale of one to four, how frequently are you having them? And then, how much are they impacting your quality of life? So again, a three tiered questionnaire.

Now another one that we’re using in our research and that I use in my clinical practice is called the PRO-PD, and it a stands for patient reported outcomes in Parkinson’s disease. And this is something that I have my patients fill out every six months under my care. And it’s a patient filled out subjective survey. And it’s a slider bar, which I really like instead of the zero to 10, because people want to say four and a half and you’re like, I don’t have that button.  And they fill this out. And why I think that’s beneficial is, you can see it on interview. They come in December, there’s four feet of snow on the ground. They’re cold, they’re depressed, it’s COVID, we’re isolated. And I say, “How do you feel?” “I feel terrible.” And you look at their PRO-PD and it’s actually kind of decent. And then six months prior in June, they’re in and it’s sunny and they’re going for walks and their PRO-PD is much worse. So it does hold that a little bit accountable for that objective and subjective asking of questions.

But the main point here is you can’t look at somebody and know how they’re doing. One of the most poignant things one of my patients actually told me is, “You keep asking me about my anxiety.” And he goes, “I don’t think it’s anxiety in the typical definition of anxiety. What you see on the outside, this tremor, is what I feel on the inside. It’s just discomfort but the only way I can express it is through anxiety.” So really getting to know what this feels like for people.

 



Dr. Weitz:            I’ve really been enjoying this discussion, but I’d like to take a minute to tell you about a new product that I’m very excited about. I’d like to tell you about a new wearable called the Apollo. This is a device that can be worn on the wrist or the ankle, and it uses vibrations to stimulate your parasympathetic nervous system. This device has amazing benefits in terms of getting you out of that stressed out sympathetic nervous system and stimulating the parasympathetic nervous system. It has a number of different functions, especially helping you to relax, to focus, to concentrate, get into a deeper meditative state, even to help you sleep, and there’s even a mode to help you wake up. This all occurs through the scientific use of subtle vibrations.

                                For those of you who might be interested in getting the Apollo for yourself to help you reset your nervous system, go to apolloneuro.com and use the affiliate code, Weitz10. That’s my last name, WEITZ10. Now, back to the discussion.

 



 

Dr. Weitz:            So let’s just mention the most common pharmaceutical approaches to Parkinson’s and why this approach is problematic, which is typically to take a combination of Levodopa and Carbidopa.

Dr. Duncan:        That is really the goal standard in the first line therapy for Parkinson’s disease. And to be quite honest, Ben, I support it. I think there’s the, again, kind of likening it to type one diabetes. Somebody who can’t make the hormone that improves their quality of life and physiological being, we need to supplement that.

Dr. Weitz:            So Levodopa and Carbidopa help the brain to make dopamine, correct?

Dr. Duncan:        Not necessarily. They’re just giving the body that dopamine that the body is missing. So that’s why it’s a palliative medicine. Because we can’t make the dopamine, we’re going to give you the dopamine. Now where it’s really helpful, the Carbidopa and this again, I don’t see really out there in the education that much. And I was like, the metaphor of a car. Carbidopa is the car, it’s the shuttle bus. We have Levodopa receptors throughout our entire periphery, but that Carbidopa really holds on to Levodopa until it gets to that blood brain barrier and then releases it. So it’s a higher concentration of efficacy in the brain.

So on that note, why I always prefer the synthetic medications of Sinemet or Rytary for my patients is because it’s really hard to standardize with something like mucuna pruriens, which is the natural source of levodopa. It’s highly concentrated and potent, but that potency can vary from capsule to capsule, manufacturer to manufacturer, bottle to bottle within manufacturers.

So we’re still working on really getting a standardized process there. And then we’re lacking the carbidopa part of that. So I’ll tell patients, “Hey, if you want to take mucuna, that’s great. Drink it with your green tea.” And they come back two weeks later, “I can’t drink anymore green tea. It’s a lot of green tea.” So when we’re looking for standardization and what dose is required, I’m definitely on the, “Hey, let’s get you some Levodopa. Let’s improve that quality of life for you by symptom palliation.” But with the explanation, we are not slowing the progression of the disease by doing this.

Dr. Weitz:            Right. And then one of the problems with these drugs is that after a while they stop working as well, isn’t that correct?

Dr. Duncan:        That’s a really popular theory that we continue to challenge, and in my clinical practice… So when I first started, I was like, “I challenged this. [inaudible 00:20:43]. I challenge this.” Being further into clinical practice, Ben, I’m sitting there like, “I challenge this.” And so many patients will come in and say, “I just got diagnosed. But my doc said not to start right away because I’m going to wear off in 10 years.” And we start to get into further workup investigation. “How’s your thyroid, how’s your gut function? Let’s just dive into gut function.” Ben, if somebody’s constipated and they’re having one to two bowel movements a week, do you think their medications are going to be effective?

Dr. Weitz:            Of course not.

Dr. Duncan:        [inaudible 00:21:13] Right. It’s enhancing your absorption capability, your bioavailability, your absorption rate, metabolism, all of these different aspects. So what do we do? We go to the doc, “Hey, I’m not seeing the relief I want.” “Well, let’s add some more. Let’s add some more. Let’s add some more.” Five to 10 years in, “Oh, you hit your max dose. Sorry, we got to do something else.”  Well, what if we got people pooping? What if we detox the system? What if we reduced environmental exposures? What if we started really working with how the whole body’s physiology is optimal, and then we see these medications drop off. And why I’m able now to stand on the rooftop and say, “I challenge that concept,” is because for most of my patients, we’ve been able to decrease their dose of Carbidopa Levodopa and reduce medications by 30 to 50% within a year.

Dr. Weitz:            Interesting. I was wondering what you were going to say about this question. I was thinking that maybe you were going to say, “Let’s do all the functional medicine stuff first and then only throw in the medication later.” But you’re saying if they get on the medication, which is going to help them with some of their symptoms right away, and we do all the functional medicine stuff, then that medication won’t have the drop off effect that it does in a conventional approach.

Dr. Duncan:        That’s exactly it. It’s the top down, bottom up approach. And let’s not forget the mental, emotional side effects of Parkinson’s disease. I mean, apathy being the top one. So here we are on your prescription pad, conventional doc. “I am so proud of myself, I’m prescribing exercise,” right? Well that patient [inaudible 00:22:46] emotionally to get up and to go exercise, and to want to do these things. This is an aspect of neurologic health. And so when you’re speaking to a patient and their care provider and the care provider’s in there, “I can’t possibly… Pulling out the hair, try to motivate him to go out and go to the gym anymore. I’m losing my mind. This is so hard.”

And so why would we expect somebody to be able to go do lifestyle changes if they feel terrible? If they’re apathetic. So yes, giving this Levodopa, giving this synthetic medication to supplement that loss at the very beginning is really what I think promotes the healing process. And like I said before, 80% of your dopaminergic neurons are gone. So if we can get the benefit of supplemental Levodopa for the rest of your life, I’m in. And then, okay, now we’re enhancing those other potential side effects of apathy and depression and anxiety. So then they’re more apt to go out and exercise and build up their vitality and health and really slow the disease down.

Dr. Weitz:            So let’s go through some of the most common environmental triggers that you found tend to play a role in patients with Parkinson’s. You just mentioned gut health. Let’s talk about some of the gut health factors and things that you often see in patients with Parkinson’s.

Dr. Duncan:        Yeah. How much time do we have here?

Dr. Weitz:            No, I know. But …

Dr. Duncan:        I’m going to tell you something. By nature, I’m one of those devil’s advocate people. I drive everyone nuts. So I sat through all of school and said, “I will not be that doc that says it all happens in your gut.” The flow of the tide, you go through naturopathic medical school, you’re learning functional medicine, you’re doing all these things and it’s, it’s in the guts, it’s in gut, it’s in the gut. And I’m just like, “I challenge this.” Again, I’m like, I’m not real loud, because I’m still in school. But I’m like, I’m not going to be that doc.

Lo and behold here I am, that doc, being like, “How’s your gut, what’s happening in there? Let’s take a peek.” And if I throw out a guess in my patient population, 90% of people with Parkinson’s that I’m seeing have gut dysfunction. Either small intestinal bacterial overgrowth or SIBO, we’ve got dysbiosis. I mean, one of the hallmark nonmotor symptoms is constipation.

And I’m not talking your run of mill constipation, I need to go take a laxative once a while. I’m talking patients coming into my office, doubled over in pain saying, “I couldn’t sit down and watch a movie with my family yesterday because it hurts so bad. I haven’t had a bowel movement.” So this type of gut dysfunction and dysmotility, we really need to address this in a, again, holistic approach. Of course, that’s what I do. So that’s the word that comes to mind.

Dr. Weitz:            What are some of the most effective ways you’ve helped patients with Parkinson’s with constipation and some of these gut disorders? Dysbiosis.

Dr. Duncan:        I’m going to say the very first thing is one, normalizing it for them. Letting them know they’re not alone in this. And two, letting them know this is a huge contributing symptom to their disease severity. Again, so many people come into my office and they’re scared and they’re grieving and they’re pessimistic. And I don’t place blame anywhere other than maybe higher up on the insurance realm. But they’ve been told, “Hey, you have a neurodegenerative disease. Here’s your medication, I’ll see you in six months.”  And that’s scary. And you see, “I have Parkinson’s disease and here’s what I’m going to go Google.” So they come in here feeling very fearful, and what are they doing? And so what I like to say is, “This is a package deal. There’s so many aspects to this. Let’s teach you about what happens when you’re constipated in your gut. If the goal of pooping is to literally get rid of toxic sludge in your body and you’re not pooping, what’s happening in your body?”  And they go, oh. You know, can see the light bulbs come on. I’m reabsorbing those toxins and here’s what’s happening in my bloodstream. And so you just, really trying to say, this is our goal, this is what we want to do. And you can see them relax and really start to understand and become in tune with their bodies. So the education piece is huge.

The second thing is, there’s population studies out there that show people with Parkinson’s have a decreased sense of thirst. Now, whether it’s a decreased sense of thirst or they just don’t want to drink because they’re so sick of peeing every five minutes and then they have to stand up to go pee, and their orthostasis when they stand up, and then there’s this whole conglomerate of things that we have to think about. But if you’re not drinking water, Ben, you’re not pooping. We know this to be true.  So I have these in-depth conversations with people every time they walk in my office about water and electrolytes and how do we move poop. What is pooping? So we talk a lot about poop. But the important thing is that people start to understand their bodies. And when there’s understanding, then we shift into that parasympathetic nervous system and we can come out of that fear and that fight or flight. And oh, lo and behold, that’s vagal nerve function. And now we’re having better gut motility and better digestive enzymes. So we’re teaching people how to masticate and how to swallow because now there’s trouble swallowing, and enhancing absorption by different nutraceuticals.

I mean, I have a whole six week protocol and it’s called the gut overhaul. How do we remove triggers, decrease inflammation, increase gut motility, increase absorption? And at the end of six weeks, people are coming in and like, “I never thought this was possible.” And you’re talking about people who’ve had a disease for 20 years and now they’re pooping for the first time. And oftentimes, constipation goes back to childhood. So I get a lot of [inaudible 00:28:02] about poop and I think it’s full circle karma for my attitude in med school saying, “I’m not going to blame everything here on the gut.”

Dr. Weitz:            Right, good. So I know heavy metals can play a role and I’ve even seen a couple of papers about manganese, which I guess you can have excess amount of manganese that creates a Parkinson’s like syndrome. And it’s just so interesting how some of these heavy metals like manganese, which are absolutely crucial for health, you can have deficiencies and that creates problems, but too much is a problem too.

Dr. Duncan:        Yeah. Manganese associated Parkinsonism is really commonly known within the profession. And we’ll run a heavy metal screen. I usually do it on hair. It’s the least invasive and it’s a pretty easy one to comply with, to get a start there. And oftentimes if we do see manganism. So I’ll say in my clinical practice or in my professional career, I’ve seen three total patients, which is a pretty big in comparatively to how many I’ve seen that were misdiagnosis with IPD. So idiopathic Parkinson’s disease that we got to switch that over to Parkinsonism, do a detox protocol and watch their health improve by a significant amount. Yay, victory. That’s wonderful.

Dr. Weitz:            Great.

Dr. Duncan:        Manganism is definitely, like I said, it’s really well known. And what we’re seeing a lot of is, manganese is actually, like you alluded to, it’s actually an the essential element. So it’s not even so much a heavy metal toxicity. We’re looking for aluminum and uranium and different heavy metals in the body, but manganese, we actually see deficiencies of. So I get a little bit of cross eyed stares when I prescribe manganese as a supplement. We manage that carefully of course not to go in excess, but as you alluded to manganese deficiency creates its own set of problems. [inaudible 00:29:47]

Dr. Weitz:            So what are some of the most common heavy metals that you’ll see involved with Parkinson’s?

Dr. Duncan:        Heavy metal, mercury and lead. I mean those are kind of your [inaudible 00:29:58] with neurologic conditions. So those are really common, especially when we’re talking about the generation that’s most prevalent to have the condition. How they were growing up, what they were exposed to, what we didn’t know back then that accumulates in the body. And we know postmenopausal women… We usually will diagnose Parkinson’s disease earlier in men, and then usually not ’til post-menopause with women. And there’s a couple different theories out there with that. But one of them that I look at the most when we’re talking about heavy metals is that’s when the process of osteoporosis starts to come in. We’re using our [inaudible 00:30:36] and our supportive mechanisms for our bone health and-

Dr. Weitz:            So these metals are stored in the bones. And then when the bones start breaking down, they release the heavy metals?

Dr. Duncan:        Exactly. Yep. So now we have an increased toxic burden, and whether it’s creating Parkinson’s or exacerbating Parkinson’s is still a question that needs to be answered. Along those same lines, heavy metals and toxins are stored in our adipose tissue. And again, one of the metabolic side effects of Parkinson’s disease or a movement disorder is increased weight loss. So now we have this osteoporosis happening and we have this weight loss happening where we’re breaking down fat and we’re just increasing this toxic burden to our body.

Dr. Weitz:            And I guess chronic viral infections like HSV and EBV can be factors.

Dr. Duncan:        I mean, they absolutely can be factors. And when we’re starting to really tap into this greater theory of … I’m a big metaphor person. And like I said, is your Parkinson’s disease a suitcase that you’re lugging around? Is everything that you have in your body associated with Parkinson’s disease? Or can we look at you from 20,000 feet up and say, “Oh, you have a little thyroid dysfunction and you have this toxic metal burden. Oh, you have this chronic viral infection in there and you’ve got dysbiosis.”

And now when we start treating these things peripherally that we are so quick to say, “Ah, that’s just a symptom of Parkinson’s disease,” it makes that load a lot lighter. And I say, can we take Parkinson’s disease as a diagnosis and throw it on like a backpack and go about with your day instead of lugging that thing around. So I think what you’re really getting at here is that concept. All of these things that we associate with the disease, yeah, they’re there, but again, our patients are 70 years old for the most part. [inaudible 00:32:20] got some, a young onset Parkinson’s disease, of course, but they’ve accumulated some health crises. They’ve done it, they lived. So of course there’s going to be things in addition to that, that we’re just really quick to say, “Oh, that’s Parkinson’s, you’ve got to live with this.” And again, that quality of life and that patient centered care staying in your focus just has to be that primary goal.

Dr. Weitz:            So you mentioned hormonal imbalances. I know that Dr. Bredesen often with patients with say, women postmenopausal, even though they perhaps are in their seventies already, will sometimes put the patients on estrogen replacement. What do you think about hormone replacement therapy as part of the treatment protocol?

Dr. Duncan:        I mean, I feel like everything that I’m saying to you starts with it depends, but it really does.

Dr. Weitz:            Oh, I know. Of course it depends. And it’s a complicated factor and there’s risk factors, et cetera.

Dr. Duncan:        It’s really, really helpful. It’s a really helpful tool, as long as you’re screening the risk factors and you’re doing all the things, but there’s a boatload of data on DHEA as neuroprotective. Right?

Dr. Weitz:            I saw a couple of papers, yeah.

Dr. Duncan:        And we labeled DHEA, I mean, who doesn’t want this? The spunk and vitality hormone, right? I want some. I’m raising a toddler here. I’m sipping on coffee. I want some spunk and vitality. So when we’re looking at DHEA levels, we’re looking, trying to get them above 100, and those will fall post menopausally. So like I said, there’s a ton of data and research out there about these specific hormones and the protective mechanisms they have on the brain. Now, the one thing that I want to bring up again, as that person who said, I wouldn’t always talk about poop, is hormonal imbalances are often secondary to gut dysbiosis and inflammation. So making sure also that you’re covering that liver. I hate, do you have cholesterol? I know you mentioned you’re doing something this evening with Dr.- [inaudible 00:34:24].

Dr. Weitz:            Yeah, a tribute. We have a YouTube tribute to Dr. Sinatra.

Dr. Duncan:        To Dr. Sinatra. So, I mean, when we look at cholesterol, again, you want to see some side eyes from my patients’ cardiologists, like, “You took them off what?” And I’m like, “Yeah, we want cholesterol, we’re packaging hormones.” And these are things that we’re starting to challenge the status quo a little bit here, because it’s also the padding in the brain for neuronal connections. So all of those factors play into yes, hormone replacement therapy can be a safe and effective option for our patients. And often vastly improves quality of life.

Dr. Weitz:            Is it possible to have a purely natural approach to Parkinson’s without pharmaceuticals? Have you had any patients who were successful in an approach like that?

Dr. Duncan:        I have, yes. So there are some patients who are just really set on, we have the whole conversation and informed consent, shared decision making, but, “Here’s what I feel about Levodopa.” And they manage, there are some patients out there, exercise and diet and mindfulness and social connections are really managing their disease well.  And again, that’s why we want to shift this research paradigm and say, “Hey, you’ve had this condition for 10, 15, 20 years, and you’re climbing mountains here in Seattle. What are you doing? Give us your secret.” Then let’s isolate those against different variables and things to see, can we reproduce this? That’s what research all is. Is it reproducible? So yes. I mean, a short answer to your question is yes, I’ve absolutely seen patients live with, in a very high quality of life, their Parkinson’s with just a natural approach.

Take the pharmaceutical entacapone, for example. It’s a pharmaceutical that we give in conjunction with the Carbidopa Levodopa to help its efficacy over time. Hey, this makes it more effective. You’ll see a greater benefit. We also see that with CDP-choline. So acidic choline, a natural supplementation nutraceutical. When dosed appropriately, we can see a 30% reduction in the need for medication in 30 days, Ben, in a month of taking [inaudible 00:36:36] supplement. So if you’re taking mucuna and you’re taking some CDP-choline, and you’re taking some fish oil, high DHA, and you’re exercising and working on your vagal nerve function, I mean, you’re slowing the progression of disease at a very organic level without- [inaudible 00:36:54].

Dr. Weitz:            So what dosage of CDP-choline?

Dr. Duncan:        We’re looking at 250 milligrams. And I’m going to double check that. 250 milligrams, I believe that’s twice daily.

Dr. Weitz:            Okay, cool. So I want to go into the nutraceuticals, but before we do, I want to ask you another question that I’m sure your answer’s going to be it depends, but what is the best diet for Parkinson’s disease? I’ve seen people advocating the ketogenic diet, autoimmune paleo, avoiding dairy. Let’s talk about diet for Parkinson’s.

Dr. Duncan:        Let’s talk about diet for Parkinson’s. You’ll get some hate mail on this. When you know this is one of those factors that people get pretty upset about. The overwhelming research and data that we have for diet for Parkinson’s is Mediterranean, MIND, whole food plant based, that those three kind of conglomerate, that’s what we’re looking for. And really the constituent that we’re looking for in those foods is the antioxidants. We’re looking for those flavanoids and the anthocyanins and the things that we’re getting from these freshly harvested, fruits, vegetables, and things like that. And then your healthy fats.  So when you start breaking that down, and this is what I love about my mentor, and I have to give her a shout out at some point in time through this, because I’m really just downloading her brain into my mouth and- [inaudible 00:38:18]

Dr. Weitz:            Who’s your mentor?

Dr. Duncan:        My mentor’s Dr. Laurie Mischley. So she’s really spearheading the integrative research for Parkinson’s disease globally. She speaks at World Parkinson’s Congress.  She’s fun funded by the Michael J. Fox foundation and NAAH. And she’s got a seat at the table anywhere she wants to go to really start bringing this to light.

So I like to just use that. I’m downloading her brain to my mouth and here it comes. So, it’s fascinating. Smatterings of my clinical practice, but she’ll ask the tough questions. Is a whole foods diet effective because of the food, or is it effective because now we have to go chop and prepare and cook and you’re smelling your food and you’re involved in the eating and there’s this whole other integration and intimacy with your food when you’re not just getting it frozen out of the freezer and heating it up in the microwave? So there’s a component of that there. But the overwhelming data then is that this Mediterranean style diet is the most beneficial for Parkinson’s disease. Now we’ve already- [inaudible 00:39:17]

Dr. Weitz:            I guess one of the reasons why people advocate a ketogenic diet is because it’s been shown to be beneficial, I believe for Alzheimer’s and because of the whole concept of insulin resistance in the brain and having a higher fat, lower carb approach and having the brain work off of ketones, there is an argument that the brain works better that way.

Dr. Duncan:        And like I said, I’m pretty well versed in that data as well. And when it comes to food, I’m definitely one of those practitioners, the best diet is the one that somebody’s going to eat, that they’re going to comply with. So if we can move towards ketogenic through the Mediterranean diet and that’s supportive and working well for them, and it’s in alignment with their quality of life, great. However, I’m not seeing the research really push it far enough over that I’m going to sit here and say this or bust, right? So I really like to take that into account.

The second thing that I just want to bring out, and I’d always be remiss if I didn’t and just a quick snippet, we’re talking about a population that’s not often identified as having disordered eating habits. We reserve that for our 16-year-old athlete girls. And that’s a huge number. When you get into the conversation about how these individuals were raised from the World War II, depression, parents, and stoicism, and you eat what’s on the table and here’s how you look and here’s how you act, the very different mindset that we’re in now, there’s a lot of disordered eating habits that I’m seeing in my practice.

So I just wanted to bring that to light a little bit too, to be really cautious when we’re talking about food with our patients and really establishing what that relationship is with them and food. Because that’s, again, we’re talking vagal nerve dysfunction. If I prescribe a diet for you that’s going to cause you stress and anxiety, screw that diet, right. That’s not what we’re going here for. But really, yes. So to just kind of get back to the thick of it there, that Mediterranean MIND diet is what we’re going for here. Some people do, I’ve had people come in and say, “I feel better on the carnivore diet.” “Okay, great. Let’s check your metabolic markers and make sure that you’re healthy.”

And this really again goes into the individualized care. We can prescribe diets, but we have to be considering insulin, other metabolic conditions, other thyroid conditions. And I have a patient who had esophageal cancer. Can you even digest animal proteins? So now we’re really, again getting into that it depends area, but the overwhelming research we share is that. And we have the data. I think I shared it with you, what foods all the way from frozen vegetables to canned vegetables, to fresh vegetables, what’s better? Which do you choose. So it’s there, it’s available.

Dr. Weitz:            And I guess there’s some data showing that dairy in particular can be problematic as a trigger.

Dr. Duncan:        I usually put up my desk shield when I talk about that with patients. And they’re like, “Does that mean cheese?” And it’s like, “Well, yeah.” And then they’ll say, “But what about this?” And the answer to that goes back to the initial conversations. There’s not going to be a randomized controlled trial, double blinded, placebo controlled with goat cheese versus sheep cheese versus cow cheese. So you choose, but we have overwhelming data that not only people who consume [inaudible 00:42:39] dairy have a higher incidence rate of developing Parkinson’s disease, but also those who have already been diagnosed have faster progression rates. So that is one thing that I kind of put my foot in the sand and say, this is, if you’re going to do anything dietary, do this, take this out.

Dr. Weitz:            Which forms of exercise are most beneficial?

Dr. Duncan:        I just wanted to add one more thing to dairy because it helps when it’s not taking away your food. We have found in the data that a higher uric acid level, so not gut levels, but above four in the bloodstream, it’s actually a potent antioxidant for the central nervous system. So uric acid does have a purpose, right? [inaudible 00:43:16]

Dr. Weitz:            Wait, wait a minute. So uric acid level above four? Below four would be really low though. Right?

Dr. Duncan:        Right. And so four to six, we’re looking at to say, “Hey, we don’t want gout, but we want to keep this at a healthy level.”, And that it is a potent antioxidant for the central nervous system. So again, here’s something that we villainized, oh my gosh, uric acid is bad, but there’s a reason our body has uric acid. We have this sensical being to us that we still don’t understand. And while we know-

Dr. Weitz:            That’s interesting. Because lately with Dr. Perlmutter and the Drop Acid, his book, there’s been a big focus in the functional medicine world on trying to keep uric acid levels lower because it’s correlated with heart disease and other problems.

Dr. Duncan:        Right. And I can’t speak to heart disease, but what we know in the Parkinson’s population is that actually a higher uric acid level is beneficial, and the consumption of dairy inhibits uric acid production. So we have that, when people really come back with me about like, “Oh, I just don’t know about dairy.” I’m like, “Here’s a biochemical rational for you that shows what you can do.” And then if you’ve got a gout patient on the side with no allergy to dairy, bring on the dairy, right? How do we naturally bring [inaudible 00:44:32] your uric acid classic levels? [inaudible 00:44:35]

 



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Dr. Weitz:            So exercise, I saw a study on, I think you sent me a study on cardiovascular, aerobic exercises, being beneficial. What forms of exercise do you find most beneficial?

Dr. Duncan:        The form that you don’t know how to do. Something [inaudible 00:46:25]. Ballroom dancing is one of my favorite ones to recommend. Number one, I’m a huge advocate for caregivers, support partners, things like that. If you can find an activity that you can do together, it’s using both sides of your brain and you’re in this and you’re so worried about stepping on your partner’s foot, that you forgot you had a tremor for a minute, right? That’s the kind of neuroplasticity we’re going here. How do we support that neuroplasticity and growing new neuronal structures and learning how to do something new? Rock steady boxing is a phenomenal way to create community again, using both sides of your brain, being able to do some of that cognitive support with that as well. But really those things, Tai Chi has been really hugely studied in the Parkinson’s population, as far as that slow controlled movement and conjunction with your breath.

So cardiovascular exercise in general, yes, do it. But we do have some data. And I think it’s just the ones that they’ve selected to research. So biking and boxing and things like that. So again, it’s the one that you do and the one that’s new. So pick something new and then actually go do it.N.

Now, [inaudible 00:47:37] and really fascinating is, exercise is dose dependent. So when you have your prescription pad and you’re like, “Look at me, I’m so proud of myself, dabbling into this cam world. I’m going to prescribe exercise.” How were you doing it? What exercise are you prescribing and how frequent should patients take it. Put it in your orange bottle and actually give it directions. Because we have studies that show if you exercise fewer than four days per week, it doesn’t show any benefit at all. And then it’s an increase in benefit based on how many more days you do it. So six is better than five is better than four. So it is dose dependent, how often we’re doing these exercise routines and what type you’re doing.

Dr. Weitz:            I wonder if there’s been any data on strength training, because if you’re trying to do new, novel, different exercise movements, then strength training is something that would certainly lend itself to doing different exercises in different ways, on different equipment that would be a way to easily have a different movement that you’re bringing into your body on a regular basis.

Dr. Duncan:        I agree. And the very first thought that comes to mind on strength training is fall prevention, right? Practicality. How do we keep our fall prevention? The second thing that comes to mind is just thinking of myself when I’m lifting a really heavy weight. And what do you do? You grunt. You know, you use a big voice. We already know the [inaudible 00:49:03] program works for this minimal voice and some of these side effects. So I love it. I think there’s probably data out there somewhere that I’m not familiar with, but- [inaudible 00:49:14]

Dr. Weitz:            Let’s go into specific nutraceuticals for patients with Parkinson’s disease. And I would appreciate if you could be specific about dosages or even products that you like. The nutrient that I’ve talked to more doctors who feel that is the biggest game changer is intravenous glutathione. And yet I just saw a meta-analysis on glutathione that seemed to show that there was not necessarily any great benefits.

Dr. Duncan:        I mean, that’s a great place to start. Right off the bat, I practice individualized, personalized medicine. I do pride myself on that, and I can also say every person with Parkinson’s that walks through my door, walks out with a prescription for three natural medicines. And they’re the most highly studied and researched to either help with symptom management or slow progression. And that’s glutathione, high DHA fish oil, and Co Q10. And those have the data behind it to say it makes sense. And I’ll go into each one.

But to answer your question, I, glutathione. I mean, that research has been around since the ’80s. I want to say maybe even the ’70s, when they first did that study, you know, you walked down the hall, you get your IV and then we can watch you walk down the hall again. Again, it’s a very elementary like, “Hey, look at this guy walk better.”

The benefits are limited with IV glutathione. So it’s a high dose. It’s pretty invasive. They have to go twice a week to get the benefits of it, the long lasting benefit of it. And then it’s an IV. Like I said, it’s a little bit of an invasive therapy. The other thing it’s not accessible, it’s expensive. This isn’t something that insurance is covering right now. And the research that we have, it actually can show that either an internasal application of glutathione, or even an oral glutathione, and we do this through the buccal mucosa, has just as much benefit to our patients when they can take this on a daily basis from the home. It’s more cost effective and it’s showing benefit.

Dr. Laurie Mischley actually published a study. She got to phase two clinical trial, and I’ll tell you about why that kind of fizzled out after phase one. But the phase one was just overwhelming improvement in the UPDRS scores and handwriting. And this is well published out there on PopMed, with the use of intranasal glutathione.

So they moved it to phase two with the funding and people were so excited to be part of this study and to get, using this. And this is your double blinded randomized placebo controlled study that the placebos did just as well as the glutathione, which all [inaudible 00:51:50]. Yay, placebo. There’s so much more to medicine than just what we’re putting in our patient’s bodies about how we can get them excited for new therapies.

And again, alluding to my grief for these poor Alzheimer’s patients who bought into this theory that was a scam, but we have that power as physicians to get people really excited and hopeful about their therapies. But we are seeing benefit, especially in motor symptoms with the use of, like I said, oral or intranasal glutathione.

Dr. Weitz:            So tell us about the oral glutathione. Is there a particular product or products that you like, and is there a particular dosage that you tend to favor?

Dr. Duncan:        Yeah, so, I mean, I want to take this opportunity before we really dive into nutraceuticals, Ben, because I never thought that this was going to be one of my testaments as a practitioner. But because the supplement industry isn’t regulated by the FDA, it makes it really challenging for patients to navigate these waters. And it’s really frustrating as a healthcare provider to say, “Hey, that’s not a quality assured product, but I know that you don’t have access to maybe this or that.” So as often as you can, I just really advocate to share information, share resources, especially as our integrative care providers get out and do community chalk talks, get out and do webinars and podcasts and say, “This isn’t a thing that’s being done, but you can ask me questions. What are legit reputable sources for these supplements?”

Because they aren’t benign. They aren’t always safe. And just because your neighbor’s cousin’s brother’s dog saw benefit doesn’t mean you … And that’s where we’re really going in this healthcare field with so much research and resources on the internet and from your neighbor, that it’s really becoming harmful. And that’s what I’m seeing, patients unloading 30 to 50 supplements on my desk. “Look, Hey, this is what I’m taking.” It’s like, “No. I applaud your advocacy and resourcefulness, but here’s what we need to do for your body.” On that line, so for glutathione, we use a couple different brands. Quicksilver and Designs for Health have a really great oral liquid glutathione. I use the pump. It needs to stay refrigerated, and then it’s absorbed through the buccal mucosa. So I get a little bit of a bypass from the gut absorption dysfunction that we have.

Dr. Weitz:            And how many sprays do you like? And then how many times a day?

Dr. Duncan:        I dose that at two pumps twice a day away from food.

Dr. Weitz:            Okay.

Dr. Duncan:        Yep. And the side effect of oral glutathione is it taste like sulfur, which is not a fun taste. It’s a sulfur based compound. But I have learned that orange juice is a great chaser. So we find those to help with compliance a bit. The interesting thing about that is most of the studies that Laurie published were this intranasal application, right? Because we know we have a direct access to the brain through our nasal cavity. A little bit more challenging to do, not quite as cost effective. And what she did notice is that so much of it was draining down the throat anyway, but that’s kind of where it was going. So again, there’s a hierarchy of effectiveness of glutathione, and you do what works for your patient. And I found that an oral glutathione supplement is the most effective because people can access it for long periods of time and are compliant.

Dr. Weitz:            Okay. And then Co Q-10, I think I saw that you prefer MitoQ. Is that right? Or was that maybe in another article I read?

Dr. Duncan:        That might, I’m not sure which article it’s in. We usually do [inaudible 00:55:29] right, and activated Co Q-10 is a little bit more bioavailable. As far as brands go, we carry Protocol for Life here. There’s a lot of really great reputable brands of Co Q-10. I mean even Costco carries a really good one.

Dr. Weitz:            So you’re using Ubiquinol, and what dosage?

Dr. Duncan:        And that can be anywhere from 100 to 300 milligrams. And this is a really subtle effect that I tell patients, you’re not going to start taking this and in a month you’re going to be like, “Whew, I can go run a marathon.” But what we’re doing there, as you’re aware of, is we’re supporting the mitochondrial health. And mitochondrial dysfunction is one of the theories that is causative for Parkinson’s disease. But the big thing that I like to explain to patients in the education realm is if you have a movement disorder, and we know that the mitochondrial are really heavily populated in your heart your brain and your skeletal muscle, and you’re moving at a rate much more than I am, who can sit here still, then you’re utilizing a lot of that ATP. So we need to support this at a cellular level. Are you going to see this giant change? Not necessarily, but we are seeing in our population studies that people who do supplement with Co Q-10 have an improved quality of life. [inaudible 00:56:38]

Dr. Weitz:            And then you said you like a high DHA fish oil?

Dr. Duncan:        Yep. High DHA fish oil. And this part of the education comes in really important as well because one, the marketing, again, to go back to this regulatory body that we don’t have. You go look at the store. And I challenge a lot of my patients, say, “Go to the store and look at the dosing or look at the labels on the front. 3 million omega threes.” We’re blasting all of this on the front label, and then you turn it around and it’s, from other sources and here’s this and here’s that. And when you really break it down to the EPA and DHA, we’re at very few. And then you got to look at serving size, right? “Oh, you’re getting 500 milligrams of omega threes in four capsules.” Well, now we’ve got somebody who has difficulty swallowing and taking these giant horse pills and they’re getting a very minimal result.

So it is something that we as integrative healthcare providers have to be really well educated on to say, “Hey, I know this bottle of liquid fish oil costs three times as much as that one you’re going to get. Here’s why it matters. You have a higher D potency here. You have a less, it’s a teaspoon. You keep it refrigerated. Fish oil can go rancid, how it’s stored.” So that educational piece is really important. And we’re looking anywhere from two to four grams. So these aren’t milligram dosing, these are really high dosing. If you’re looking at somebody’s fish oil supplement, I’ll say, “Hey, go ahead and finish that bottle. And then don’t ever buy that again, because you’re going to finish it by tomorrow.” You’re taking 12 capsules a day to get the dose that you want.

Dr. Weitz:            Yeah. I saw some good data on vitamin D as being a factor.

Dr. Duncan:        Oh yeah. Vitamin D and neurodegenerative diseases across the board. We have this Venn diagram of Alzheimer’s and lewy body dementia and frontal lobe dementia and Parkinson’s disease and all these things. And they all kind of mishmosh in a lot of different symptom, presentations and theories of etiology and all these other things there. And then the nutrients that really support it. And vitamin D, as Dr. Bredesen has proven, has been hugely helpful in his Alzheimer’s protocol. So we definitely look at vitamin D status. I’m looking between 60 and 80 as a lab value. And I like to see your number be in the age decade that you’re in. You’re 75. Let’s keep you in the 70s. 68, let’s keep you in the 60s. Let’s just keep it in that range. And people really resonate with that.

Dr. Weitz:            That’s great. I saw lithium as being beneficial.

Dr. Duncan:        Lithium is hugely beneficial. And again, another side I write from the conventional. We know lithium is a medication for what condition?

Dr. Weitz:            Bipolar.

Dr. Duncan:        Bipolar, right. So when you’re dosing lithium, and you get these questions, lithium is an essential nutrient. It’s a cofactor for tons of enzymatic reactions and biochemical reactions in the body. And the most crucial one is it’s a cofactor for BDNF, it’s brain derived neurotropic factor. It’s how we grow new neurons. So we can’t grow new neurons if we don’t have lithium.

Now, there’s been studies again, since I want to say the ’80s or ’90s, and Dr. Laurie has published some of those as well, lithium deficiency as well as other minerals in our soil becoming deplete. People in the Pacific Northwest. It’s just all of the rain and the washout and everything else. There’s no lithium anymore. And there was actually even a petition a while back to lithianate the water, just like you fluorinate some water, to say, we need this in our body, and the incidents of mental health concerns in the Pacific Northwest. So we’re starting to see this correlation of lithium deficiency mental health concerns. And then we know that this is a treatment protocol. When you’re looking at lithium as the treatment protocol for bipolar, this is at a super physiologic dose. These are pharmacologic doses that we’re doing and we- [inaudible 01:00:23]

Dr. Weitz:            If we could just find some industry that has lithium byproduct as a part of their manufacturing process, so they can make profit off it. Then maybe it’ll be done.

Dr. Duncan:        We’ll just use the system as it … Yeah, I like your thinking. If it’s already in place and we’re causing damage, let’s have it. I like it.

Dr. Weitz:            So are you-

Dr. Duncan:        We’re talking [inaudible 01:00:47] doses of lithium. We’re supplementing. So there’s a big difference between natural medicine and-

Dr. Weitz:            So you’re using a low dose nutritional product.

Dr. Duncan:        I call it a physiologic dose. So I explain, there’s pharmacologic doses, there’s physiologic doses. And we’re supporting the mechanisms that are already existing in your body.

Dr. Weitz:            Resveratrol seems to have some potential benefit. Resveratrol is an incredible nutrient that seems to have all sorts of potential benefits for longevity, for cardiovascular disease and for brain health.

Dr. Duncan:        Right. Yeah. I mean just potently, potently, antioxidant, really phenomenal nutrient that we go for, and it’s food based, right? So that’s a really great one that you can say, you don’t have to go out and buy this or have it in a supplement of sorts. And that education is really helpful. I have patients come in again with all these things lined up and they’ve got a bottle of, “Oh, I have this Resveratrol.” I’m like, “Cool. How about we do this from food? These are some delicious sources. Hey, do you drink red wine? Great. What about dark chocolate and spices?

I mean, you can’t minimize the effect of spicing up our food. Us and our Western diet, man. The blandness of our food as a society is just sad in and of itself. But you use some curcumin and clove. My favorite concoction here in my coffee is a teaspoon of cinnamon and clove, and you get yourself a whole new ballgame with how do we have this loss of sense of smell, which leads to a loss of sense of taste. And so now we’re spicing up our food in a way that’s proving physiologic benefit and then increasing those taste receptors. And, oh my gosh, right now, now I’m salivating just talking about, how do we taste? How do we really engage with our food, which then creates the digestive enzymes that we need in our stomach and stimulates the hydrochloric acid secretion. So, okay, now we’re breaking down our food for better absorption and bowel motility and boom. Right ,here we go.

Dr. Weitz:            It’s interesting as you talk about loss of sense of smell and taste, and I think about the current viral situation we’re in, and you wonder about the long term effects in potentially triggering Parkinson’s.

Dr. Duncan:        Oh, yeah. I mean, think it’s a huge risk factor. And I have these conversations with people that this is something that we need to prioritize getting back online. Especially if I have some of these long term patients who are like, “Hey, I got the OG COVID and I still can’t smell.” All right, well, we’re going to have to work on that and really prioritize that. And if we can’t get the smell back, how do we substitute that cephalic phase of digestion, right, that thinking about food, the smell that elicits the whole process to start, how do we do that in different ways in the body?

And so mindfulness, gratitude, eating with community, harvesting your own food, cooking your own food. And then there is some smell retraining protocols that you can start working on as well. But you can’t substitute that phase of digestion. And we already know, and then we’re talking memory. So when you talk to me, I go in all these directions because it matters. Now we’re talking memory, right? The smell trigger is one of the first things we do for our memory retrieval. And now that’s gone, and oh, I’m having some cognitive impairment. Well, is there a link there?

Dr. Weitz:            Right? Absolutely. So one final question. I saw, and this is following up on the train of nutraceuticals. I saw Ginkgo, vinpocetine. And both of these are products that are often seen in brain formulas, neurotropics. Do you have a favorite neurotropic brain formula?

Dr. Duncan:        I do. I do. And of course, it’s individual. So botanical medicine is the heart of my practice outside of everything that we’ve done in research to treat the individual. Formulating a tincture for somebody with urinary urgency frequency, some neotropics, some cardiovascular support, some antidiabetic, some anti lipidemic. We can do these things with botanical medicine that helps the patient feel less like a pharmaceutical carrying case and more like they’re in tune with their body.

So I love those. My favorite neotropics, I mean, [inaudible 01:05:00] goes up there for sure. But I studied under the great Dr. Eric Yarnell, who is the naturopathic herbalist of all herbalists, and bacopa and gotu kola are really two of my favorites. Centella, and then there’s also rosemary. And so I’ll tell people, you can just do an essential oil and carry it around and sniff it as a neotrpic [inaudible 01:05:21] the time. And that actually stimulates blood flow to the brain. So there’s some really phenomenal new atropic herbs out there. And ginkgo really is the most researched one. Now there’s the environmental part of me that says we’re also losing our ginkgo trees at a rapid rate. So there’s other resources that are just effective for cognitive impairment and brain health.

Dr. Weitz:            I see. Interesting. Great. All right. So this has been a fascinating podcast. Thank you so much. How can viewers, listeners find out more about you? Get in contact with you?

Dr. Duncan:        Yeah, so I work at a practice called Coeur d’Alene Healing Arts. I’m here in Northern Idaho, Coeur d’Alene, and the contact info here is (208) 664-1644, or info@CDAHealingArts.com. I do offer discovery calls, so free 15 minute consultations if you just have some questions, concerns. I don’t offer medical advice, but I can share some more education and insight and see if we can work together, and I always offer resources. So patients and caregivers alike can reach out for support.

Dr. Weitz:            And what’s your website?

Dr. Duncan:         CDAHealingArts.com.

Dr. Weitz:            Excellent. Thank you, Dr. Duncan.

Dr. Duncan:         Thanks, Ben. I appreciate it.


Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness podcast. And if you enjoyed this podcast, please go to Apple Podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts.  And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition clinic. So if you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.

 

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How to Thrive in the 21st Century with Dr. Russell Jaffe: Rational Wellness Podcast 273

Dr. Russell Jaffee discusses How to Thrive in the 21st Century with Dr. Ben Weitz.

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

 

Podcast Highlights

1:38   Dr. Jaffe points out in his new book, Thriving in the 21st Century, that our healthcare system places very little focus on prevention other than getting vaccines, a colonoscopy, monitoring your blood pressure and taking a statin.

4:30  Dr. Jaffe said that we could save a million lives a year in three categories, the first of which is diabetes.  If you follow Dr. Jaffe’s recommendations for diet and lifestyle, you will achieve a hemoglobin A1C of 5 or less.  You should also measure levels of glucose, insulin, and fructosamine, as well as hemoglobin A1C.  You should not eat sugar or any sweeteners and you should shop around the perimeter of the market.  There is enough sugar in marinara sauce to qualify as dessert. If it’s a whole food, and it comes from a plant, like a vegetable, eat it.  If it comes from a processing plant even if it looks like or tastes like food, then you should not eat it.

14:12  Dr. Jaffe writes about avoiding anti-nutrients in food, which he uses loosely to describe sodium, fat, sugar, and artificial sweeteners, and at another point he uses it to refer to persistent organic pollutants, solvents, toxic minerals, mold, and radiation.  He also recommends avoiding eating grains but he prefers eating grasses, as well as lots of fruits, vegetables, fungi, sprouts, nuts, and seeds.  No grains, no cow dairy, no meat, no farmed fish.  Grasses include grasses quinoa, halophytes, buckwheat, and millet and they provide anti-toxic fiber that binds toxins that come out of your liver, that need to get bound up and eliminated.

17:32  Dr. Jaffee will not eat farmed fish and he will only eat fish that is line-caught, so it will be fresher and not frozen.

25:05  Dr. Jaffee recommends avoiding eating all oils, including olive oil.  He recommends naked salads without dressing.  Even though some research shows olive oil to be healthy, Dr. Jaffee says that it is almost impossible to get really healthy extra virgin olive oil since what is sold in stores in the US is not quality olive oil and is often already oxidized and rancid and contains other oils mixed in. Dr. Jaffee gets his oil from eating nuts and seeds.

29:47  Eating an alkaline diet is very important to reverse metabolic acidosis.  Metabolic acidosis means too little magnesium inside the cell. It means eating a diet that has too little magnesium and too much calcium, too much sodium and too little potassium.  If you take magnesium supplements with choline citrate, you triple the uptake of the magnesium and you correct the metabolic acidosis.  Correcting metabolic acidosis is a huge opportunity to feel and function better.  If you don’t neutralize those metabolic acids by taking in foods that are alkaline, you’ll end up with metabolic acidosis and all the cardiovascular cancer, autoimmune consequences of metabolic acidosis.  Dr. Jaffe recommends eating foods that make the body more alkaline, the most important of which are green leafy vegetables and certain seeds and nuts.  Acid forming foods are things like sugar, oil, grains, meat, and fish, so these things should either not b e eaten or they should be condiments.  There is a free chart that you can see that lists foods that will make your more alkaline on drrusselljaffe.com.  Dr. Jaffee recommends lots of GGOBE foods: garlic, ginger, onions, brassica sprouts, and eggs.  These foods should be staples in your diet.

 

 



Dr. Russell Jaffee is a MD, PHD, and the author of the new best selling book, Thriving in the 21st Century. Dr. Jaffe has both worked at the National Institute of Health, and he is a Certified Clinical Nutritionist, and he has also studied with a Taoist priest and acupuncturist for 7 years and he has taught acupuncture. He has contributed to the birth of the Functional Medicine movement and he wrote or contributed to over 100 scientific articles and reviews. Dr. Jaffe has developed the first lymphocyte response assay for food sensitivities and he continues to be the lab director of ELISA/ACT Biotechnologies and is the founder and chairman of a nutritional supplement company, Perque.  His web site is drrusselljaffe.com.

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

 



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

                                Hello, Rational Wellness Podcasters. Our topic for today is how to thrive in the 21st century, with Dr. Russell Jaffe. Dr. Russell Jaffe is an MD/PhD, and he’s worked at the National Institute of Health. He’s also a certified clinical nutritionist. He’s studied with a Taoist priest and acupuncturist, and he’s even taught acupuncture. He’s contributed to the birth of functional medicine. He’s one of the OGs, and he continues to lecture and teach. He wrote or contributed to over 100 scientific articles and reviews. He developed the first lymphocyte response assay for food sensitivities, and he continues to be the lab director for ELISA/ACT Biotechnologies. He’s also the founder and chairman of a nutritional supplement company, PERQUE. Dr. Jaffe has a new book out, Thriving in the 21st Century, your guide to adding years to life and life to years. Welcome, Dr. Jaffe.

Dr. Jaffe:              I’m glad to be here.

Dr. Weitz:            So one of the things you point out in your book, isn’t it a shame that in America our highly-touted healthcare system does not place any focus on prevention, other than getting vaccines and a colonoscopy, and monitoring your blood pressure and taking a statin. How much money we could save with prevention.

Dr. Jaffe:              Well, we could save a million lies a year in three different categories. We could save a trillion dollars a year to fund the transition from our current sick care system. We call it a healthcare system, but it’s not a healthcare system. Tom Harkin used to say, “We have the greatest sick care system in the world. We’re looking for a healthcare system.” Don Berwick, Elliott Fisher, other enlightened, aware, plugged-in people, very much … Don Berwick ran Medicare for President Obama, you know? Folks like that.

Dr. Weitz:            Yeah, Tom Harkin was a prominent senator from Iowa, a big supporter-

Dr. Jaffe:              Tom Harkin wanted to be president. Not only was he a senator and a very nice guy, and beloved by NIH because he got their budget through every year, but importantly he thought that healthcare and defense were the issues of his day. He ran for president on those two issues. He didn’t make it.

Dr. Weitz:            Yeah, but he was one of the big supporters of nutritional supplements and-

Dr. Jaffe:              Oh, Tom Harkin, to his credit … I know this little gem, this little anecdote. He called up the budgetary director of NIH and said, “Either I’m going to write in what now has become the Center for Integrative and Alternative Medicine, but I’m going to write it in to the budget, or you’re going to voluntarily start it.” They did. Anything Tom Harkin wanted, if it was within possible boundaries, they would do it because he got their budget. There were very few senators that NIH listened to. He was one, and he was a nice man. He was a gentleman. He had many of the qualities of a great public servant. I’ll get off the soapbox, but yes, unfortunately we train doctors in sickness care. We have a symptom-reactive system, which is really a sick care system. What we call prevention is prevention light.

Dr. Weitz:            Yeah.

Dr. Jaffe:              Okay, so I indicated that we could save a million lives a year in three categories. The first is diabetes. Diabetes kills half a million Americans a year. Diabetes costs, diabetes kills. Diabetes is a choice, a lifestyle choice.

Dr. Weitz:            You mean, diabetes is not caused by a deficiency in metformin?

Dr. Jaffe:              No. In fact, we have done the most successful outcome study in type 2 diabetes and in type 1 diabetes, starting from best standard of care. According to the American Diabetes Association, starting from best standard of care, we divided groups. One group was the placebo. That is, they followed the advice of the ADA. In the experimental group, we reduced the hemoglobin A1C by a full percent, which added 20 years to the lifespan of the participants, on average. We’ve done other studies in fibromyalgia. We have the most successful-

Dr. Weitz:            How did they lower the hemoglobin A1C?

Dr. Jaffe:              Oh, they followed our advice about what they would eat and drink, what they would think and do.

Dr. Weitz:            Good, and let’s contrast that with a recent study that I’ve got the name of it. I think it’s maybe called the ASSURE trial in which they lowered hemoglobin A1C more aggressively in type 2 diabetics, and they found that they actually had an increase in mortality. The reason why, because they did it with heavier dosages of more drugs, and not with diet and lifestyle.

Dr. Jaffe:              All correct, and according to the Health Studies Collegium, of which I’m a fellow, your best outcome value for hemoglobin A1C is 5%. If you-

Dr. Weitz:            Right, but that’s-

Dr. Jaffe:              Wait, wait, wait. If you follow my lifestyle advice, you like me will achieve a 5% hemoglobin A1C. When you try to do this pharmacologically rather than physiologically, I predict it will fail. So that study was a self-fulfilling prophecy, but it obscures the fact that your hemoglobin A1C shouldn’t be less than seven. It should be less than five. And since I lost weight … About six or seven years ago, I was 60 pounds heavier. I lost the weight, and I’ve lost it enough that I’m not going to find it again. My hemoglobin A1C for the last five years has been 5%. Now, it gets complicated. All of these issues get complicated. Sometimes you want to measure fructosamine rather than hemoglobin A1C. Sometimes you want to measure glucose or insulin along with hemoglobin A1C. But the marker of diabetic risk is hemoglobin A1C, or fructosamine. They’re measuring the same thing.

Dr. Weitz:            Yeah, because they’re both measurements-

Dr. Jaffe:              They’re measuring how much … They’re measuring how much sugar is stuck onto a protein. Dr. Paul Gallop identified this factor in 1967. I knew Paul Gallop. He was a mentor to Carl Franzblau, who was my mentor. So I’ve known about hemoglobin A1C since the 1960s, and it is now an all-cause morbidity/mortality indicator. Not just diabetes, but including diabetes and all the consequences of diabetes, including cardiovascular, et cetera.

Dr. Weitz:            And we ideally shouldn’t have any sugar glomming onto our protein molecules.

Dr. Jaffe:              Well, what I say is you’re sweet enough as you are. You don’t need to add sugar to your diet, and I mean that.

Dr. Weitz:            Right.

Dr. Jaffe:              And I mean that. I’m on the deck right now at my R&D center, in the kitchen, which is 20 feet away. You will not find any sweetener. Yes, we do have a little raw honey because occasionally someone comes by and in their tea, they want some honey. But you do not need to add sugar at all to your diet, which means you stay away from packaged goods. You stay away from boxed produce or items. You shop around the perimeter of the market, which is where the whole foods are. You eat whole foods. I eat quite well. I would say I eat quite well. I’m very happy with the garden that I have, and the Whole Foods Market that’s nearby, and I shop around the edge or the perimeter of the market. I very rarely go down the aisles. I look at the aisles. They’re very pretty, but there is enough sugar in marinara sauce to qualify as dessert. There’s enough sugar in CLIF Bars to qualify as dessert. These are thought of by most people as healthy choices. Well, we make marinara sauce but we make it from tomatoes.

Dr. Weitz:            Well, I bought my marinara sauce at Whole Foods.

Dr. Jaffe:              Well, buying at Whole Foods you still have to be careful.

Dr. Weitz:            I know.

Dr. Jaffe:              You must be an informed consumer, and what I say is the following. If it’s a whole food, and it comes from a plant, like a vegetable, eat it. If it comes from a plant, which means a processing plant that processed something into something that looks like something, that tastes like something, that’s not what I’m talking about. So I’m not a big fan of these meat replacements. In fact, I’m very critical of the fact that the people who are producing plant-based foods are producing it in a commercial production facility. And when you get into the details, you find that in order to do that you have to use a whole bunch of chemicals that are not good for you. But, you have to have shelf life. You have to have other considerations, and so forth and so on.

                                So the bottom line is, we’re on our own. We have to be informed as consumers, then we have to act on what we know. And what I know is that if it’s a whole food, I’ll eat it. I’ll eat a wide variety of foods in a wide variety of ways. But, if it comes from a company that makes it look like food, it looks like food. It fools you. It makes a fool out of you if you think that that is food. That’s not food. I’m going to get off my soapbox, but I’m very sure that if people ate the foods that they could digest, assimilate and eliminate without immune burden, and then they stayed well-hydrated and they moved around a bit, because in order for your fluids to reach the point that they need to get to, you need to move, which means walking so many steps. And something mindful, some relaxation response or meditative technique or mindfulness technique.

                                If you balance out those four, you can live and thrive in the 21st century. 80% of people today are in survival mode. They’re just surviving, getting by one day at a time. They don’t really feel very well. They’re not very nice to the other people around them, and they’re in survival mode. They base their decisions on the 20th or 19th century data. I’m telling you that the 21st century is much more intoxicated, therefore we need much more of the antitoxin nutrients, the vitamins, minerals, cofactors and et cetera. We need much more of that today to deal with the toxic burden.

Dr. Weitz:            Right, because-

Dr. Jaffe:              I think most people know-

Dr. Weitz:            Even eating around the perimeter, eating the whole foods, we also have to be careful that many of those whole fruits and vegetables are sprayed with pesticides and herbicides and other toxins.

Dr. Jaffe:              No, no. No, no. I should have been clearer. When I shop, I buy only the organic or biodynamic. I do not accept commercial celery or tomatoes.

Dr. Weitz:            Right.

Dr. Jaffe:              Because I know that the commercial whole foods are contaminated, and therefore I would have to take more supplements to deal with the toxins that are in the commercial food. So I amend what I said before. You eat organic or biodynamic, or leave it alone.

Dr. Weitz:            So in your book, you talk about anti-nutrients in our food. Interestingly, you use that term to … At one point, you refer to sodium, fat, sugar, biocides, artificial sweeteners you also describe as anti-nutrients, persistent organic pollutants, solvents, toxic minerals, mold, radiation. Now, I’m kind of used to hearing the term anti-nutrients used in the context of the paleo diet or Dr. Gundry, and they’re usually referring to lectins and phytates, which are typically found in grains and beans, and even vegetables with seeds.

Dr. Jaffe:              Well, as we outline and clarify in the book, you eat grasses. You do not eat grains.

Dr. Weitz:            Now, explain-

Dr. Jaffe:              No, no. Let me continue. Let me continue.

Dr. Weitz:            Okay.

Dr. Jaffe:              You eat low on the food chain. You eat lots of fruits, vegetables, fungi, sprouts, nuts, seeds. There’s a wide variety of low on the food chain. This is less expensive, so it helps fight inflation. It’s healthier, because the higher you eat on the food chain, the more you eat fish and meat, or cow dairy products or grains, the more problems you will have. So I solve this problem by saying, no grains, no cow dairy, no meat, no farmed fish. No farmed fish, which means you probably can’t eat in a restaurant because almost all the fish in the restaurant is farmed, for economic reasons, for a variety of reasons.

Dr. Weitz:            No, unfortunately that’s true. In fact, I recently went to a seafood restaurant and they didn’t have a single wild fish except Scottish salmon, which they were saying was wild even though it was grown in pens in the ocean.

Dr. Jaffe:              Right.

Dr. Weitz:            We had a whole debate as to how-

Dr. Jaffe:              No, no. Yes, I mean if you see-

Dr. Weitz:            It could be both farmed and wild at the same time.

Dr. Jaffe:              No, no. That’s a perfect example. You go to a fine restaurant. You want to eat well, but they’re telling you that the salmon is wild because it was in the ocean. Well, farmed fish are always farmed in the ocean. You don’t farm fish on land. You always farm the fish in pens. But worse, worse, fish will eat anything. So what they throw in is the spent waste, the nitrogenous … So it’s nitrogen-rich waste from the water treatment plants. So not only do you get the toxic metals, you get aluminum. Not only do you get that, you get fluoride, and so forth and so on, and it goes on and on and on.

Dr. Weitz:            Right.

Dr. Jaffe:             So the answer is-

Dr. Weitz:            Now, do they-

Dr. Jaffe:             That I eat well. I eat well, but I eat from my garden. I eat low on the food chain, and I eat a wide variety of foods in a wide variety of ways.

Dr. Weitz:            Right, so you have wild fish but not farmed fish, and-

Dr. Jaffe:             No, no. Here’s what I do. This is really what I do. I go to the store, usually the Whole Foods Market where they have on ice a whole bunch of fish. But the eyes of the fish are cloudy, which means they’ve been frozen and thawed. I say to the young person standing behind the counter, “Which is the line-caught fish?” Generally they don’t know, but they can go in the back and talk to the senior person who does know. Maybe one, out of all the beautiful fish, maybe one is actually line-caught. I want them to know that some consumers want line-caught fish, and are going to ask for it, so they should have two.

Dr. Weitz:            So what is-

Dr. Jaffe:              If the consumers ask for it, the business will follow. The consumers are the leaders. They think that they are reacting to the marketing pushes. That’s an issue. But the consumer really leads, and what the consumer seeks, like more fruits and vegetables, more seaweed, and nuts and seeds and so forth and so on, there will be more of that.

Dr. Weitz:            So tell our listeners what the significance of line-caught fish means.

Dr. Jaffe:              Oh. Oh yes, very important. In the Chesapeake Bay, which is near where I live, for the first time in history, they’re finding fish with cancer. Fish don’t get cancer. You may not know this, but fish do not get cancer. But there are so many biocides, there are so many hormone disruptors, there are so many solvent residues, there is so much toxic metal, et cetera, that fish like rockfish have … About one-third have a growth, a cancer. That’s very ominous. We should eat line-caught fish, never frozen, or leave it alone. You can eat something else.

Dr. Weitz:            So-

Dr. Jaffe:              If you try grasses … If you try grasses like quinoa, or halophytes, or buckwheat, or millet, you’ll find that they are delicious and they mix with almost anything. So no grains, lots of grasses. Grasses provide fiber. Grasses provide the anti-toxic fiber that binds toxins that come out of your liver, that need to get bound up and eliminated.

Dr. Weitz:            But don’t whole grains-

Dr. Jaffe:              Most people don’t eat-

Dr. Weitz:            Don’t whole grains have fiber as well?

Dr. Jaffe:              Oh, yes. Whole grains have fiber. They also have glyphosate, which is bad for you. They also have hormone disruptors. They have solvent residues; surprising, but they do, and toxic metals. And on top of that, other-

Dr. Weitz:            Well, wait a minute. Wait a minute.

Dr. Jaffe:             Other-

Dr. Weitz:            Let’s just play devil’s advocate here. How do they have toxic metals?

Dr. Jaffe:             It turns out the fertilizers that are used are measured for N, nitrogen, K, potassium, and P, phosphorus. But a farmer will spread the cheapest fertilizer that they can get away with. Even the organic fertilizer contains lead, mercury, arsenic, nickel and cadmium.

Dr. Weitz:            And some of those metals like … They’re in some of the soil, anyway.

Dr. Jaffe:             Also true, and in the air.

Dr. Weitz:            And they’re also in the water.

Dr. Jaffe:             In the air, in the air. Well, yes-

Dr. Weitz:            But isn’t quinoa grown with the same fertilizers and the same water and the same soil?

Dr. Jaffe:             No, it turns out that grains … All of the grains have been genetically manipulated. None of the grasses have been genetically manipulated. There is commercial reason why grains have been manipulated. There is commercial reasons why grasses have not. Grasses don’t sell as much as grains. But in my house, there are no grains because the grains are too contaminated, and I would have to take even more supplements than I now do.

 



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Dr. Weitz:             So in the book, you mention that in recent years, decades I guess, our heart health has improved. However, cancer has increased and this is particularly in the U.S. Why is this?

Dr. Jaffe:              Well, the main reason why heart disease decreased was fewer people smoke cigarettes. It turns out that that has leveled off, so we now have the second greatest killer is heart disease. The first greatest killer today is cancer. Do you know that everyone makes cancer cells every day, and should identify those cancer cells during restorative sleep? During sleep time, there are a few five-minute time windows when the pineal tells the pituitary to tell the glands and organs of the body what to do, including identifying through natural killer cells and cytotoxic T-cells any abnormal cells that have formed that day, and eliminate them by a process called apoptosis. It’s Greek, but it’s apoptosis. It means programmed cell death. A cell comes by and marks the cell as abnormal. Another cell comes by and injects into it something that kills it and prevents cancer. So, I get restorative sleep and I want my natural anti-cancer mechanism to protect me. I don’t need more than nature and nurture to protect me.

Dr. Weitz:            Right. So you recommend avoiding all oils, including olive oil.

Dr. Jaffe:              Yes. I know I … The sugar, I think we can agree.

Dr. Weitz:            You mean, I can’t use olive oil in my salad?

Dr. Jaffe:              No. No, naked salads. Naked salads, but in the salad, put in edible flowers. Put in some fruits.

Dr. Weitz:            I can’t eat the salad in my underwear? I have to be naked.

Dr. Jaffe:              No, you don’t have to be naked. You can try being naked. No, naked salads. We’ll get into the … It turns out-

Dr. Weitz:            The naked salad restaurant.

Dr. Jaffe:              No, it turns out-

Dr. Weitz:            That could be a new franchise.

Dr. Jaffe:              That could. It turns out that walking barefoot stretches out the very sensitive cells on the bottom of your feet. It turns out there are lots of nerves on the bottom of your feet. There are lots of nerves in your hands, and it makes healthy sense to walk barefoot.

Dr. Weitz:            Grounding.

Dr. Jaffe:              I live out in the woods. I don’t have to worry about other people. You have to decide how much clothes you wear, but have naked salads that are interesting, that have seeds and nuts and edible flowers, and maybe some seaweed and some this and that. So make salad the main part of your meal.

Dr. Weitz:            But isn’t olive oil really good? I’ve seen all kinds of studies on the benefits of olive oil in reducing cardiovascular disease and even cancer.

Dr. Jaffe:              Let me tell you the truth, and I’m going to tell you a story, but it’s a true story. One year at olive harvest time, we were in Tuscany. We helped shake the trees and knock the olives off, and then take these nets and schlep the olives to the oleandro. This is the place that makes extra virgin olive oil. It is viscous. It is green. It is aromatic. It is not, not what you buy in the store as EVO or EVOO. It turns out, I said to the man in charge of this oil processing plant, “How much? I want to buy some.” He laughs. He says, “We eat this. We don’t make enough of this to sell.” And to illustrate the point … There is a point to the story. In the morning, there was a mountain of spent olive mash outside the oleandro.

                                This big truck called Bertolli came by and picked up the olive mash, the spent olive mash. The first time they processed that, they were going to call it extra virgin olive oil. It turns out if you get deeply into the oil industry, you find out there’s a lot of malfeasance. There’s a lot of chicanery. There’s a lot of, it’s olive oil, but it’s olive oil with a whole bunch of other oils. Or, it’s olive oil that has been rejected by the true Italians, Greeks, Spaniards who know extra virgin olive oil. They know this. But I have tried diligently to find any place that sells actual extra virgin olive oil. I can’t. So, I’m afraid that there is a good reason … And this is now the scientific reason. When you separate an oil from a seed or a nut, immediately on exposure to air, the oxygen in the air goes after the delicate, unsaturated, beneficial oils.   So you have oxidation, which is called rancidity. Then they add chemicals to mask the rancidity. The rancidity doesn’t go away, but they add chemicals that make it seem to go away, and on and on and on. I have reached the point where I eat whole foods. I get my oil from seeds and nuts. I don’t use edible oils at all, because the more I learn about them the more contaminated and problematic they become.

Dr. Weitz:            Okay, so why is eating an alkaline diet so important, and what does this consist of?

Dr. Jaffe:              Yes, it’s essential to eat alkaline, which means that the acids of metabolism do not build up in your cells. We have an epidemic today of metabolic acidosis. Metabolic acidosis means too little magnesium inside the cell. It means eating a diet that has too little magnesium in it, probably too much calcium, maybe too much sodium and too little potassium, but I’m going to focus on magnesium. If you take magnesium supplements with choline citrate, you triple the uptake of the magnesium and you correct the metabolic acidosis. That’s a big deal. Correcting metabolic acidosis is a huge opportunity to feel and function better.

Dr. Weitz:            Okay, but isn’t acid really important? We need hydrochloric acid to bring down-

Dr. Jaffe:              Oh, no, no. Oh, no, no. Now, now let’s not … Let’s not get lost in the weeds. Yes, your stomach should have a pH of one. It turns out that people with ulcers lack stomach acid, and people with plenty of stomach acid do not have ulcers. So giving proton pump inhibitors is out of date, passe, should not-

Dr. Weitz:            Yet, one of the most commonly-prescribed classifications of drugs for almost any gastrointestinal problem.

Dr. Jaffe:              One of the most common, and I’m saying that it creates more problems. It shifts the problems. It doesn’t solve anything, and if you follow my alkaline way advice, your stomach will be acidic. Your intestines will be alkaline. Your microbiomes, of which you have hundreds … We talk about the microbiome of the gut, but there are hundreds of different microbiomes all over your body.

Dr. Weitz:            Yes, for sure.

Dr. Jaffe:              They are all optimized by an alkaline diet that neutralizes the metabolic acids. If you don’t neutralize those metabolic acids by taking in foods that are alkaline, you’ll end up with metabolic acidosis and all the cardiovascular cancer, autoimmune consequences of metabolic acidosis.

Dr. Weitz:            So, what are the most alkaline foods, and should I drink alkaline water?

Dr. Jaffe:              Well, with regard to the foods, we have produced a free chart that’s available through drrusselljaffe.com and other websites that we support. A chart of the food effects on body chemistry, not acid-ash residue, which is usually what is reported, which was fine in the 19th and 20th century. In the 21st century, you need to know the food effects on body chemistry. The most alkaline foods tend to be the green leafy vegetables, certain seeds and nuts. But go to the website drrusselljaffe.com, download for free the chart, which will tell you about the foods. Now, what about-

Dr. Weitz:            When you talk about … Hang on one second. When you talk about the acid alkaline residue, essentially what you’re saying is, is it’s not whether or not that food itself is actually acidic or alkaline. It’s whether or not it produces an alkaline effect in the body.

Dr. Jaffe:              Yeah, yes. Citrus fruits … Citrus is acid in the glass and alkaline in the body. So yes, it’s the effect on the body, not what the pH is in the glass.

Dr. Weitz:            Right. And then the most acidic foods are which?

Dr. Jaffe:              What I’m saying is that you want to eat alkaline. The acid-forming foods are things like sugar and oil and grains and meat and fish, so they should be condiments in your diet. Thomas Jefferson said, “Let staples become condiments, and let condiments become staples.” Now, what does that mean? That means you should have lots of GGOBE; lots of garlic, ginger, onions, brassica sprouts sprouts and eggs. They should be staples in your diet. If you have something high on the food chain, you should have a little bit. The amount that fits in the palm of your hand turns out to be enough.

Dr. Weitz:            Okay.

Dr. Jaffe:              So now very important, the question of water. Mineral waters are all alkaline, and they benefit because of the mineral content. You need to know the dissolved solids. You need to know the mineral content of the water. If the water was made alkaline by adding bicarbonate, that will impair your digestion. That will fool your body, and make a fool out of you.

Dr. Weitz:            Is that how most water is made alkaline?

Dr. Jaffe:              Well, first of all most bottled water comes in plastic. You should only get water in glass. If you get water in glass, the better waters … Pellegrino, Apollinaris, Mountain Valley, Gerolsteiner … They’ll be displayed. They’ll be present, and they’ll give you a choice of plastic or glass. You always choose glass, because plasticizer leaches out of the plastic into the water and harms you, so you don’t do that. In order to be in thrival mode, in feeling-good mode, you need to get hard, mineral-rich water in glass, or well water that is mineral-rich. Most tap water is greywater. Most tap water has too many chemicals and too little beneficial mineral.

Dr. Weitz:            What about purified water rather than well water?

Dr. Jaffe:              Well, I fortunately have a deep well in both of my homes, so that’s where we get our water is from the tap, but it’s well water.

Dr. Weitz:            But isn’t some well water high in arsenic or lead or other toxins?

Dr. Jaffe:              Well no, that’s a very good point. Even though we live out here in the woods, and are protected and so forth and so on, every six months I have analysis done. Thus far, it has come back that my water is so pure that I could sell it. [inaudible 00:36:47]

Dr. Weitz:            You live out in the woods, Doc? Where do you live?

Dr. Jaffe:              Oh, Vienna, Virginia.

Dr. Weitz:            Oh, okay.

Dr. Jaffe:              I’m 15 minutes from Dulles Airport, half an hour from the Capitol, but lost in the woods.

Dr. Weitz:            Okay.

Dr. Jaffe:              And we have a permaculture biodynamic food forest in our front yard. We have seven mushroom guilds in our back yard. We eat as much as we can from the garden.

Dr. Weitz:            That’s great.

 



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Dr. Weitz:            So let’s go into nutritional supplements. I think one of the more controversial things you mentioned are certain nutritional supplements that you do not recommend, and-

Dr. Jaffe:              Well, I do not recommend foolish or silly things. Unfortunately, there’s a lot of foolishness in very profound, important ways. For example, a vitamin you need a little of to activate enzyme catalysts in the body, but substrates … Substrates like NAD, like ALA, like taurine, substrates, you would need 10 grams or more a day to move the needle in regard to a substrate. There’s a lot of misinformation that abounds, including in professionals who don’t-

Dr. Weitz:            So you mentioned-

Dr. Jaffe:              Wait, wait.

Dr. Weitz:            Yeah?

Dr. Jaffe:              Professionals who know. They know what they are told. They know what they are told. Now, what they are told is wrong. As a biochemist, as a physiologist, I can tell you that what they say is wrong, and I’ll tell you specifically what I mean by that. But, supplements are essential in the 21st century. I take a dozen supplements a day, sometimes twice in a day, because I feel better and I function better.

Dr. Weitz:            Right.

Dr. Jaffe:              And I get exposed to much less toxic matter, but I’m exposed to some.

Dr. Weitz:            Sure.

Dr. Jaffe:              I take the supplements that help me thrive in the 21st century.

Dr. Weitz:            Yeah, I take about 30 twice a day.

Dr. Jaffe:              Okay.

Dr. Weitz:            So-

Dr. Jaffe:              So today, the 21st century is just very different than the 20th or 19th century. We can’t look back at the studies then and apply them today without understanding how limited is their applicability. You have too much bad and too little good in the diet. People tend to be dehydrated. Even one or two or 3% dehydrated is a terrible stress on your heart and kidneys. They don’t think properly, and they don’t act, move properly. You need to balance it all out. You can’t take two B6 to equal a B12. You can’t just think about exercising, and not move around and walk or exercise.

Dr. Weitz:            You can’t take two B6s to equal a B12.

Dr. Jaffe:              You can’t, but people try and do that.

Dr. Weitz:            So some of the supplements … I want to go into a few of the supplements that you don’t recommend. I also want … You mention NAD, so I want to hit that one, too. But in your book, you recommend or you explain that you don’t recommend silver, and some people use silver as an antimicrobial.

Dr. Jaffe:              Silver is an antimicrobial if you use it in your commode or sink.

Dr. Weitz:            What about-

Dr. Jaffe:              This is true. The silver that is sold as a supplement today was originally used by plumbers to prevent the water from being too contaminated. So silver is antimicrobial, but when you take oral silver, the silver is associated with other silver. Silver likes to aggregate with other silver. That means the size of the particles at the time you take them is too high to be absorbed.

Dr. Weitz:            Okay.

Dr. Jaffe:              You get what I’m saying? At the time you take the silver, it’s a placebo. At the time you take the silver, it has grown to a size that is no longer bioavailable. But the people who-

Dr. Weitz:            Doesn’t it depend upon the product you’re taking?

Dr. Jaffe:              Well, everyone says that their product is better and that the other products are verstunken. Everyone says that.

Dr. Weitz:            Oh, that’s shocking.

Dr. Jaffe:              Of course. But where is the evidence? Particle size is a known analytic tool. Eurofins can measure it. I actually do third-party post-production testing on every supplement we produce, because in addition to using the best vendors, in addition to using the best protocols, the least-contaminated protocols, all active ingredients … That’s different than most companies. We don’t have any binders, fillers, excipients, flowing agents. We have twice as much space to put active ingredients into the product.

                                So there’s a lot to be said about silver as an example of a placebo. I have looked at all of the literature that I can on silver, and what I find is that one-third of people benefit and that is exactly what you would predict for the placebo effect. It typically is 32 to 35% placebo, and hopefully the pharmaceutical or the thing you’re testing it against will be more than that. But it would be very easy to take 20 or 30 people and give them the silver, measure the particle size of the silver at the time they take it, measure the silver in the urine and stool. Measuring silver in the blood, very complicated, probably not routine. But in the urine, in the poop, yes. And what we have found … I will just mention this … Is that all the silver is in the poop. None of the silver is in the urine, because the silver didn’t get in the person.

Dr. Weitz:            Because it’s all too large molecular weight silver.

Dr. Jaffe:              It’s all too large, and the counterions that they use to keep the silver in suspension favor aggregation. They favor coming together. Really, yes they do. So if you use a smarter counterion, you would have less aggregation but you would still have the problem.

Dr. Weitz:            Okay, so another supplement you don’t recommend is zeolite, and that’s often in some of the binders we use to help eliminate heavy metals and mycotoxins and other types of toxins in the body.

Dr. Jaffe:              Well, let me jump to the conclusion. The best way to get rid of those bad things is to have enough ascorbate, enough garlic, ginger, onions, brassica sprouts and eggs, enough magnesium and choline citrate, enough omega-3 fatty acids, and enough zinc. Zeolite is another example of something that comes out of industry. The people that advocate zeolite, and I know them personally, do not want to tell you the truth because they want to sell you the product. The truth is, zeolites contain toxic minerals. So when you give a zeolite and then you measure in the urine toxic metals, and you find toxic metals coming out, it’s not because the zeolite bound them and eliminated them. It’s because the zeolite is contaminated with toxic metals. By definition a zeolite contains multiple minerals, especially large, heavy toxic minerals. I have not recommended zeolites. I have not recommended silver, because I know the biochemistry and physiology.

Dr. Weitz:            Okay. The next one on the list is curcumin, which is many of our favorite nutritional supplements for inflammation, for gut healing. There’s many, many curcumin products on the market, and everybody’s developing a particular formulation that’s better absorbed, better utilized. There’s water-soluble forms, there’s fat-soluble forms, there’s …

Dr. Jaffe:              Let me clarify the turmeric/curcumin issue. No. The reason I say it so simply and clearly is if you make a curry, the heat and the turmeric with the other components of the curry, including piperine from black pepper, make the curcumin bioavailable. If you take a curcumin supplement, you’re taking a placebo. If you take a curcumin or turmeric supplement, you are taking something that will not be absorbed, that will change the microbial ecology of your gut, and you’re doing an experiment that I wouldn’t do.

Dr. Weitz:            Okay. I mean, I’ve seen tons of studies showing the benefits of curcumin, even anti-cancer properties, modulate so many inflammatory factors in the body.

Dr. Jaffe:              Let me clarify for you, because I read that literature but I read it as a biochemist and a physician and physiologist and so on. What they present is the positive results of mostly in vitro, which means in the test tube, experiments. With regard to the human trials, almost all have failed. They don’t get published, but most of the curcumin, curcumin plus piperine, turmeric/curcumin/piperine bioavailable form … You can spin people around because-

Dr. Weitz:            Because you’ve got great … Let’s be honest.

Dr. Jaffe:              Wait, wait. No, many people [inaudible 00:49:13]-

Dr. Weitz:            None of the negatives-

Dr. Jaffe:              No, no, let me finish.

Dr. Weitz:            Okay.

Dr. Jaffe:              Let me, please. You can spin people around but turmeric, which contains curcumin, does not release the curcumin until it is heated in the presence of other things. So I advocate having a curry once a week as a healthy, anti-cancer food. I do not recommend taking turmeric or curcumin in any form, because the more they manipulate it the more contaminated it becomes.

Dr. Weitz:            And you also don’t recommend collagen, which is a very popular supplement these days.

Dr. Jaffe:              Collagen happens to be near and dear to me, because I did my PhD on collagen. The way you build collagen is from within. You have 50 billion dendritic cells. You have 50 billion cells that build collagen throughout the body where it’s needed, exactly as it’s needed. There are many different kinds of collagen. When you take a collagen supplement, it is probably type 1, or type 1 and type 3, and it’s a placebo. Collagen does not build … Taking a collagen supplement does not build collagen in the body. I know this for a fact. I have known this for a fact for 50 years. Right now, right now, collagen is in vogue. It’s very cheap to make, but it has too much glutamate. That means it’s called collagen, but it’s the skin and the bones and whatever is left after they render everything from the animal.

                                Which means, too much glutamate, too much proline, too much glycine, not complete protein. Collagen is not a complete protein. It’s a very poor protein compared to, say, egg protein or any other complete protein, like beans and rice make a complete protein. So collagen is near and dear to my heart. I know a lot about the synthesis and function of collagen, and I know that swallowing collagen is a placebo.

Dr. Weitz:            Well, for those who are still listening to this podcast who haven’t turned it off, another sacred cow-

Dr. Jaffe:              I want to [inaudible 00:51:43].

Dr. Weitz:            Another sacred cow that you’re about to kill-

Dr. Jaffe:              But I want to get to what I do. I want to get to what I do recommend, not be hypercritical. But unfortunately-

Dr. Weitz:            I’m sorry, I just-

Dr. Jaffe:              Unfortunately-

Dr. Weitz:            These are controversial views, and I thought that people should hear some of them.

Dr. Jaffe:              Well, they’re controversial if you don’t know the facts. What I’m saying is absolutely factual based on the evidence in the peer-reviewed literature. Nothing that I have said about other supplements … Nothing that I have said about other supplements is other than evidence-based. I know that this is correct. I know that this is controversial. I know that most people won’t like what I’m saying, but I’d really like to get on to what I do recommend, but we can talk about helping people avoid placebos.

Dr. Weitz:            Okay, let’s get on with some of your favorite nutritional supplements that you think can help us thrive in the 21st century.

Dr. Jaffe:              Well, the first is ascorbate. It’s not a vitamin. It’s called vitamin C, but it’s a substrate. You need a lot of it. The amount you need is based on the C cleanse. You need to do a C cleanse once a week. Just follow the directions. They’re available online. We’ll walk you through it. But you do a C cleanse once a week, and you adjust your daily intake of ascorbate to be three-quarters of the amount that causes the cleanse. You’d be surprised today how much ascorbate it takes to cleanse. It might be 10 grams. It might be 30 grams. It might be 50 grams. But we will explain to you how to do a C cleanse in a couple of hours, and then adjust your vitamin C dose on a daily basis to about three-quarters spread through the day. So you might, if you take a lot of vitamin C, you might get up in the morning, take a jogger’s bottle, take a quart of liquid, put the vitamin C in it, cap it, and sip on it throughout the day.

Dr. Weitz:            And you recommend ascorbate rather than ascorbic acid.

Dr. Jaffe:              Oh, oh, oh. Ascorbic acid is almost always synthetic. Ascorbic acid should never be consumed as a supplement. Yes, it should always be fully buffered, fully reduced, L-ascorbate.

Dr. Weitz:            Okay.

Dr. Jaffe:              Then, then we get to the next category which is polyphenolics, which goes along with the ascorbate, specifically quercitin dihydrate and soluble OPC. You take that as a supplement, then you move on to magnesium with choline citrate. This triples the uptake of the magnesium. It corrects the choline deficiency that most people have, and the citrate is alkalinizing and works to resolve metabolic acidosis, not cause it. So when you see supplements, and the supplement has a chloride or a sulfate or a carbonate or something like that, which is very common, or an oxide, that’s very common and very profitable, and near two, three, 4% bioavailable. The maximum bioavailability uptake of magnesium or calcium, but we’ll focus on magnesium, is one-third through the ion channel. That’s a fact.

                                We have discovered how to get magnesium in through neutral pores by making nanodroplets, and we do. That’s why we give choline citrate every time we take magnesium. Then, almost all of us take in too much omega-6 fatty acid and too little omega-3. So I recommend an omega-3 index to find out how much omega-3 you have. But aside from the test, you should supplement with three to six grams a day … I actually take nine grams a day, of EPA and DHA.

Dr. Weitz:            Right.

Dr. Jaffe:              There are some people who say, “You only need EPA.” Other people say, “You only need DHA.” They work for the companies that sell an algae product that’s just DHA, or an EPA derivative. You need both. You need EPA for body and brain. You need DHA for brain and body. You should take a supplement that is micellized in a soft gel, that is high quality. That means distilled under nitrogen to avoid interoxidation and to get rid of the toxic metals that were in the fish oil, because the fish was swimming in the ocean. So, distilled under nitrogen, omega-3 fatty acids as EPA/DHA, three to six grams a day, maybe a little more.

                                Then zinc; men need zinc, women need zinc today either as a lozenge or as a capsule. We have devised novel delivery systems. They’re called tabsules; everything you like about tablets and capsules, nothing that you dislike about tablets and capsules. A unique delivery system called the tabsule, which includes all active ingredients. We have 40 active ingredients in our multivitamin. We have a triple detoxifier. There’s phase one, phase two and phase three. You want to have all three detoxifying working for you. I recommend a diet that has plenty of fiber, but you might take some additional fiber which should be unprocessed. Denis Burkit taught us that you need 40 to 100 grams of unprocessed fiber a day. You need 40 to 100 billion probiotic organisms a day, and I would add to that the symbiotic of recycled glutamine. Glutamine with PAK recycles 10 times, so you take much less and you never build up glutamate but you get the benefit of glutamine as an energy source to repair your gut.

Dr. Weitz:            What was that, recycled glutamine?

Dr. Jaffe:              Recycled glutamine. This is glutamine which contains pyridoxal alpha-ketoglutarate, PAK. The PAK recycles the amine that comes off the glutamine, and puts it onto another glutamate from which you can extract energy 10 times.

Dr. Weitz:            Interesting.

Dr. Jaffe:              So we recommend a gram and a half of glutamine with PAK, not 15 grams as Judy Shabert or Doug Wilmot recommend. Because if you take 1=50 milligrams you do get an effect, but you imbalance the arginine/glutamine ratio, and other things become pharmacologic not physiologic. We favor physiology and are rewarded for that, so we use recycled glutamine.

Dr. Weitz:            Just one more thing I’d like to hit on really quick is, you mentioned NAD precursors. I think you just mentioned that the amounts that people take are not really going to be effective.

Dr. Jaffe:              Well in the body, in the cells, there are buckets. There are gallons. There’s a lot of NAD. If you take a supplement that has 250 milligrams, that’s a high dose.

Dr. Weitz:            So by the way, just real quick for people listening, NAD is a super-important molecule for longevity. People who are trying to promote longevity often recommend taking either NR or NMN, which are HAD precursors.

Dr. Jaffe:              There are people who sell products because they’re profitable. The people who advocate for the kinds of products you’re talking about know at some level … At some level, they know they’re selling a placebo. Because in order to measurably, which you can do … In order to measurably influence the NAD or NAD precursors in the human body, you’d have to give at least five to 10 grams.

Dr. Weitz:            Of either of the precursors?

Dr. Jaffe:              Of any of the precursors, because there is so much in the body that you’re diluting the little bit you are taking into. It’s a substrate. We have a profound lack of understanding of biochemistry and physiology. If it’s a vitamin, you need a little bit to activate an enzyme. If it’s a substrate like NAD and FAD, it’s a placebo. Joe Bellanti did an open-label trial, and he’s often quoted. He’s my friend. He’s a very good guy. He did an open-label trial. It seemed to be promising. Then he did a placebo-controlled trial and proved that NAD or its precursors are placebos.

Dr. Weitz:            All right, Dr. Jaffe. I think that about wraps it for me. Any final thoughts for our listeners and viewers?

Dr. Jaffe:              Well, I just want to leave you with the fact that you can thrive in the 21st century if you’re intelligent about what you eat and drink, and what you think and do. It’s a combination of all of the above. I would like to be a good representative, to show you how well I function and feel. By most measurements I’m a 35-year-old, but in fact I’m more than twice that on my birth certificate.

Dr. Weitz:            Okay.

Dr. Jaffe:              You can feel and function like a young person at any age, and you should.

Dr. Weitz:            Have you had your biological aging measured?

Dr. Jaffe:              I do it every six months, and I’ve been getting progressively younger.

Dr. Weitz:            And are you using the DNA methylation?

Dr. Jaffe:              No, DNA methylation turns out to be massively misunderstood. There are 10,000 enzymes that influence methylation. If you measure the methionine to homocysteine ratio, you know about methylation. If you take a methylating form, as a methyl (E)-12 form, you will induce hypermethylation which is not recommended. I recommend physiology before pharmacology. Giving methyl forms of B12 is pharmacology, not physiology.

Dr. Weitz:            Oh, no. I’m talking about like some of the testing that’s now available where they measure the-

Dr. Jaffe:              Oh, well yeah-

Dr. Weitz:            Like the true age test, where they measure biological age via the extent to which-

Dr. Jaffe:              Let me-

Dr. Weitz:            Hundreds of thousands of sites on the DNA are methylated or not.

Dr. Jaffe:              Let me jump in on that. 92% of your lifetime health is lifestyle. 92% is lifestyle.

Dr. Weitz:            Right.

Dr. Jaffe:              92% is about what you eat and drink, think and do.

Dr. Weitz:            Right.

Dr. Jaffe:              8% is genetic. Now I’m going to switch to be Eric Lander. Eric Lander was advising President Biden. He now runs the Broad Institute at MIT. He’s a wonderful human being, and he points out that if you measure the entire genome, all the DNA, all the RNA, all the different RNAs, you can influence a result. You can change the trajectory by 10%. Let’s talk about diabetes, which is the best-studied condition genetically. He will point out that you can gain or lose about 10%. This means 8% of the population currently has diabetes. If you know that you have a 7.2 or an 8.8% chance of having diabetes, what are you going to do differently? Eric is very clear that people doing gene probes are looking through a glass darkly, and confused. I measure functional metabolic products; hemoglobin A1C, hsCRP, homocysteine, omega-3 index, vitamin D levels, 8-oxoguanine, that’s a urine test that’s a little unusual, but it’s the measure of stress in your DNA. So I get all the information without the confusion.

Dr. Weitz:            Excellent.

Dr. Jaffe:              So, no I don’t.

Dr. Weitz:            Okay.

Dr. Jaffe:              I don’t measure all of these, because I know a lot about methylation. It’s very important that it flow … That it flow physiologically, not be driven by a hypermethylating compound.

Dr. Weitz:            Right. Sounds good, Dr. Jaffe. How can everybody get a hold of your book and find out about your supplements?

Dr. Jaffe:              Oh, thank you.

Dr. Weitz:            Can you tell me?

Dr. Jaffe:              Drrusselljaffe.com is the website. There’s also a YouTube channel called Dr. Russel Jaffe. The book is available as a Kindle, as a print, and very soon as an audio book on Amazon, Barnes & Noble, and wherever books are sold. And yes, please take a look because if you’ll invest 72 minutes a day, you can save your life.

Dr. Weitz:            Excellent. I’ll put all those links in the show notes, and there will also be a complete transcript so you can go and if you want to review anything that Dr. Jaffe taught us today. Thank you, Dr. Jaffe, for another excellent podcast.

Dr. Jaffe:              Thanks for having me.


Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple Podcasts and give us a five-star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition clinic. So if you’re interested please call my office, 310-395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.

 

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Toxic Mold Illness with Dr. Jill Crista: Rational Wellness Podcast 272

Dr. Jill Crista discusses Toxic Mold Illness 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. Crista started treating patients with Lyme in Wisconsin and she did the physician training in 2012 and she used naturopathic principles.  Most of her patients were getting better except a small group and one of these patients they found toxic mold in his home. He couldn’t sleep, his gut was a mess, his joints were hurting, he had ear ringing and pelvic pain. At one of the ILADS conferences about Lyme she got some training in mold from Dr. Lisa Nagy and Dr. Crista for the last 10 years has been working with lots of patients with mold and she developed her own protocol.  And then she and her family got hit with mold at their home.  And then she realized she needed to write a book about mold illness.

5:32  When you have environmental illness, as we change our environment and our environmental practices, the illnesses tend to change as well.  When Dr. Crista was practicing in Wisconsin, there were two lead mines an hour away, so a lot of her patients had lead toxicity. One thing that makes us more susceptible to mold illness is the common use of Roundup and glyphosate, as well as the pervasiveness of EMFs.  Glyphosate, which is the active ingredient in the herbicide Roundup, damages our microbiome and leads to secreting mycophenolic acid (MPA), which is extremely gut toxic.  Mold makes mycotoxins to compete out other molds. Mycotoxins are made to harm another biological living thing, so it should not be surprising that mycotoxins can harm us.  When mold remediation experts come to clean your house, they focus on removing spores and spore fragments but they don’t pay much attention to mycotoxins and to chemicals like MPA.  Roundup is also sprayed on crops before harvesting as a desiccant, but this messes up the microbiome of the plant and increase the likelihood of this food becoming moldy in storage. We need to push to limit the use of RoundUp/glyphosate on crops.

11:35  We also construct homes super tight, which can keep moisture in, and we often use cheaper materials and we build right through rainstorms. Many building materials like concrete that once wet can take a long time to dry out.  If you have construction going on with your house be there every day and make sure that they follow the building codes and not cut corners. If it does rain during construction, it is important that they cover up and then dry things out as quickly as possible, including any concrete, such as if there is a basement. In fact, finished basements are not a great idea, since even it it doesn’t rain, concrete can wick and soak up moisture.

14:18  Dr. Crista believes that exposure to mold makes fungus that already native to your body act pathogenically.  We all have a certain amount of fungus, as well as bacteria that make up our microbiomes, and we have a microbiome in our large intestine, our sinuses, our mouth, our vagina, and all the mucus membranes in our body.

 

Dr. Crista:            So what happens is that our normal … We have a microbiome for every part of our body, so the sinus microbiome-

Dr. Weitz:            [inaudible 00:14:44] everybody thinks about the large intestine, but the sinus, the vagina, all the mucus membranes.

Dr. Crista:            Yep. And you would think this is really close to each other, a mouth and a nose. They have different little species that are in when they’re happily living, commensal. So I think of a microbiome as a commensal biofilm, because that’s kind of what it is. We have fungus, we have bacteria, we have viruses. We have things that are there to keep us in balance. When you start to breathe in the mycotoxins, they send a message, which is, “I am intending to harm you.” So you get that mycotoxin exposure to your sinuses, and then when you swallow down to your gut, to our mouths, that is a message that’s soaking in that is, on contact, harming our microbiome of the area. So the sinuses become a really, really important part of treatment and rebalancing, because that’s our first interface. But when they see their buddies getting attacked, they start to act defensively. So that changes from a commensal, sharing, collaborative environment to, hmm, I don’t know that we’re safe. I might need to start acting a little bit more in my own interest. And it’s very interesting to see that reflection in the human species right now as well. So then they have to start-

Dr. Weitz:            [inaudible 00:16:14] the fungus in the body, like the candida?

Dr. Crista:            It’s fungus, but because it comes from a fungal source, then the body suspects the fungus as the problem, and the fungus becomes the scapegoat for the issue. So candida becomes a scapegoat, and then it overgrows. So this whole commensal microbiome starts to act defensively to defend from these mycotoxins, and the message in the mycotoxin is, I’ve come to kill. Fungus has come to kill and take over.

Dr. Weitz:            Interesting.

Dr. Crista:            And that’s my theory. And that’s what I base my treatment off of, but this was developed in my mind, because I was like, why am I having to use antifungals on people? When it’s a mold exposure, why does their body need antifungals? I get the toxin part, and I get-

Dr. Weitz:            [inaudible 00:17:09] is that the mold that’s growing inside my body?  No, it’s the candida that was there already that’s now acting differently.

Dr. Crista:            And then gone on long enough, if you have immune suppression, especially if you’re exposed to the living mold, those chemicals, then mold can move into your body, and we get something called colonization. So there’s sort of the spectrum that happens where you’re exposed to maybe the spores. That creates an allergic reaction.  That’s going to spend a lot of your immune system. That’s going to increase mast cell migration. Then you have fragments. So you get this initial kind of inflammatory response.  But then if it goes on, then you start to get the suppression of the chemicals that mold secretes and the mycotoxins. And that over time suppresses the immune system so then mold can move in, because now it can colonize you. And that can get severe enough to where they now want to invade. So it’s an invasive candidiasis.  At that stage, we get mast cells again in droves, compared to the spore ones that are just local inflammatory reactions. Now we get mast cells that are in droves that go to the brain, the vagus nerve. Everything is affected, the immune system, skin, gut. And that’s when you start to see things like mast cell activation. For me, mast cell activation is a sign that the fungus is winning at invading and becoming an infection.

 



Dr. Jill Crista is a naturopathic doctor and the author of the best selling book, Break the Mold: 5 Tools to Conquer Mold and Take Back your Health.  Through her popular physician training program she has trained over 600 doctors to become mold literate. Her website is Dr.Crista.com.  Her mold training course for practitioners is Mold Training for Medical Practitioners.

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



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates. And to learn more, check out my website, DrWeitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today, I’m excited to revisit mold illness topic again, since this is such an important issue for many patients. I’ve found the longer I practice, which is like 33 years now, I found that it increasingly affects more and more patients. I’m not sure if we’re just noticing it or if it’s more common. And so I’m excited to have Dr. Jill Crista join us today. She’s a naturopathic doctor and the author of the best selling book Break the Mold: Five Tools to Conquer Mold and Take Back Your Health. And Dr. Crista is widely recognized in the functional medicine world as one of the top mold illness experts, and she also has a very popular physician training program to become mold literate. So let’s see what we could do to become a little more mold literate in the next hour. Dr. Crista, thanks for joining us.

Dr. Crista:            Thank you so much for the invitation. I’m so glad our schedules finally aligned.

Dr. Weitz:            I know, I know. It’s so hard to coordinate sometimes. We’re all trying to cram in as much as we can.

Dr. Crista:            Right.

Dr. Weitz:            So we usually start with, how did you get interested in mold?  And I don’t know.  How do you want to start this?  I know that you had some issues with mold and you’ve had patients with mold.

Dr. Crista:            Yeah, I can make it very short.  I started in the Lyme world.  I found myself in Southern Wisconsin, and I knew a little bit about Lyme disease, but I knew that it was an East Coast thing.  And here I am in Wisconsin saying, these people are doing all the naturopathic things.  We have the hardest working patients ever. Functional medicine, naturopathic doctors, people come ready for homework, and they were doing all the things and not getting the responses that I was seeing with other patients.  So there’s this little group of patients, and I thought, what in the world is going on?  And then I started to learn about Lyme disease and how it’s bigger than Connecticut, and I got trained in that and did the physician training in 2012.  So again, using naturopathic principles, when you find and treat the cause, people get better, except this small group of people that were doing all of the things and not getting better. And one of those patients, they found toxic black mold in his home, and that’s when it started.  The Pandora’s box opened for me as I hit the research. I thought, “Oh, my gosh, mold is why this guy can’t sleep. His gut’s a mess. His joints are falling apart.  He has ear ringing.  He has pelvic pain.  It was just like all of these things started to come together, and it was all animal research. And so here I was trying to translate with my training and comfort in nutrition and in herbs, translating animal research, and then put it into practice.  And those Lyme patients started to get better.  And that’s when I realized while mold is a big, big, big deal.

And finally at one of the ILADS conferences … It’s the Lyme organization that I’ve done my training with. They had a doctor, Dr. Lisa Nagy, I don’t know how to say her name correctly, but she’s one of my heroes. She got up and she was like, “Mold, mold, mold. This is mold. This is mold. We have to expand our thinking from Lyme to mold. And so I’ve just, in the last 10 years, just worked with patients with mold, developing my my own little protocol.  And then mold hit us in our own home. It was hidden and got to me. And when the flood finally revealed itself … It was one of those slow drips that finally saturated, and then it was very evident we had a water damage problem. And I went, oh, this is mold. And I knew my favorite inspector, my favorite remediators. I had done lots of home visits with my patients because I wanted to learn. So I know enough about the building stuff to be dangerous. And then I knew what to do for protocol and get my family and our pet and everybody going on mold treatment. And that’s when I was like, I need to write a book.

Dr. Weitz:            You talk about the chronic patients who don’t get better, and at the same time, I have a number of patients who are suffering with mold illness. And I know it’s a real deal, but part of me in the back of my head is saying, is this just the latest illness that explains chronic disease?  And over the years, we’ve gone through one illness de jour after the other. And one time everybody had adrenal problems, and then everybody had thyroid, and then everybody had parasites, and then everybody had candida, and everybody has Lyme and everybody has mold. Part of me wonders, is there a bit of that too? This is the latest train to jump onto.

Dr. Crista:            Yeah. And I think that’s a normal thing when you have environmental illnesses, what you were just going through. Now everyone has adrenal fatigue. Well, we also went to where we lit up the sky all night long. So then people had sleep problems, which presented as adrenal fatigue. So I think as we change our environment, we have epidemic or pandemic low lying environmental expressions that highlight a practice that we’re doing that isn’t good for us. When I first moved to Southern Wisconsin, I had two lead mines an hour away, two different ways. A lot of my patients had lead toxicity.

Dr. Weitz:            Oh, wow.

Dr. Crista:            So it’s just one of those things. It can be regional, but it also can be our environmental practices. I think that mold is coming to the fore because of how we’re building our buildings and because we have a double whammy critter or chemical of Roundup and glyphosate. So that sets the stage for people to be very mold susceptible, and now we’ve added EMF into it. So now we have all of these things that are sort of … It’s making mold come to the fore. It’s not necessarily a trend, although it is getting a little trendy I noticed. And that’s kind of a funny thing.

Dr. Weitz:            Well, how does glyphosate make people more susceptible to mold illness?

Dr. Crista:            Yeah. So glyphosate is horrible on our microbiome, and so too is mold. So the mold makes these mycotoxins. It also makes chemicals as part of its normal metabolism. There’s something called MPA or mycophenolic acid. When we see that on a lab, we know that someone’s being actively exposed to growing happily living metabolizing mold. That chemical is extremely gut toxic. We actually use it, and it’s immune toxic. So we use that chemical in medicine. It’s a drug called CellCept for people who’ve had organ transplants so that they don’t reject the organ. We impair the immune system so they don’t see it as a foreign body. And you could be getting that just by breathing moldy air. So we have MPA that’s happily [inaudible 00:07:37]

Dr. Weitz:            Is that the primary way in which mold suppresses the immune system?

Dr. Crista:            That’s one of the ways, if you’re exposed to actively living mold. And then if you have old mold that was living and was in a wet … Or I don’t want to say wet. I want to say moist because people think it has to be a flood. It can be just moist air. Florida is a very moldy state. Whether you’ve had water damage or not, you’re not managing your indoor humidity, mold is going to grow. So if you have a current or past mold problem where there’s enough moisture that many molds want to live there, then they start competing and they start making mycotoxins to compete out the other mold. Those mycotoxins are made with the intention of harming another biological living thing. And so we of course are impacted by that.

Dr. Weitz:            Let me stop you for a second. So the mycotoxins … I heard you say this in one of your interviews … are secreted by mold to fight off other molds, which might try to cram into their territory.

Dr. Crista:            That’s right. They’re made in a competitive environment with the intention of creating death to another living thing. For me, that’s a big deal, and in a lot of the remediation world, they’re still not really looking at mycotoxins. They’re still very focused on particulate. This is spores and spore fragments. The other thing is mycotoxins and these chemicals like MPA that’s so immune toxic. It’s also gut toxic, but it’s extremely immune toxic. Then you add mycotoxins, which are toxic to, you name it, every system in the body, glyphosate messing up the … And that’s Roundup for those that don’t know yet. That will change the microbiome.

Dr. Weitz:            Which is an herbicide, which is sprayed on the majority of wheat and corn and soy in this country, basically. It’s not organic it’s. If it’s genetically modified, it’s often genetically modified to be resistant to Roundup.

Dr. Crista:            Yeah. And even if it’s not genetically modified, they still use the Roundup as a desiccant just before they harvest. So two weeks before harvesting, they load it with this to dry it all up so that they can harvest it more easily and get it into storage. That also sets the stage for that food becoming moldy in storage, because it’s just messed up the microbiome of the plant as well. So we have a lot of reasons why mold is becoming a problem. And there are a lot of things that we could do in changing policy and changing how we do things that can make mold not be a problem. This is a very preventable problem.

Dr. Weitz:            So we’ve got to try to push, if it’s possible, to limit the use of glyphosate on crops.

Dr. Crista:            Absolutely, a hundred percent agree. That’s one of the biggest features in my upcoming book on PANDAS and PANS. Glyphosate is the number one environmental bad guy for that condition.

Dr. Weitz:            Wow. I see people around my neighborhood now that everybody’s trying to have a grass free lawn.  They want to make sure the grass doesn’t come up.  And one of my neighbors, I just saw him walking around on what used to be his grass yard, spraying Roundup to make sure the grass doesn’t pop up.  And he’s walking across the gravel and stuff, and then of course he’s tracking it into his house.

Dr. Crista:            It’s kind of like the fable of bringing in the cats to eat the mouse problem, and then you end up with the elephants.  This is where we are, and we could be growing sustainable, native plants that we normally associate as weeds.  So I think policy change all around, and it’s going to have to be a little bit different for every region.  There are some things that have made mold a big problem globally.

Dr. Weitz:            What other things?

Dr. Crista:            Well, just growing food. We make uber tight houses. We use cheaper materials now, and we build right through a rainstorm. We just had a massive rainstorm in my neighborhood, and I wanted to get my umbrella and get out there and just take a picture of this. The house is all closed up on the sides and no roof yet, because they didn’t get to that, and it’s just pouring rain down into that. And their basement is just filling up with water. We don’t allow … A cement slab can soak up water that will take 30 years to get rid of. [inaudible 00:12:11]

Dr. Weitz:            Is that right?

Dr. Crista:            Yeah.

Dr. Weitz:            Wow.

Dr. Crista:            Yeah. So the fact that like they vacuum it up with a shop vac and call it good and then close up the house- that’s not going to necessarily

Dr. Weitz:            Wow.

Dr. Crista:            … that’s not going to necessarily [inaudible 00:12:26]

Dr. Weitz:            … projects, and they maybe cover a few walls with plastic. It rains, and then they just continue.

Dr. Crista:            Yep. And there’s another one in my neighborhood, not a great builder. They have a bad reputation in my area. They did put all of the moisture barrier on the outside. And then because of the supply chain issue, it took a long time for the siding to get there. And a lot of that moisture barrier just ripped off in a windstorm, and they just went ahead and put the siding up. They didn’t reapply the moisture barrier. And I was just like, oh my gosh, they’re going to be so sick in that house because now there’s no … They did do due diligence, but I was taking a walk, and I was watching them just put the siding back on. So I think if you are in a place where you’re building your own home, be there every day, and be that irritating client and make sure things are done right. Even normal building code needs to be followed.

Dr. Weitz:            Well, what do you do if they’re in the middle of doing a remodel or something and it does rain? What can you do then?

Dr. Crista:            Yeah. Well, and I think that the idea is dry it out and dry it out as quickly as possible. And I am not a building expert. I’m just going to be really clear. I know enough to be dangerous, like I said. But I’ve done this a while, and I am one of those people that loves to go do the home visit so I can learn more. But I think dehumidification is a key part of managing a healthy home.

Dr. Weitz:            But I don’t think anybody thinks about drying out the concrete.

Dr. Crista:            Don’t cover up concrete. I mean, that’s the idea, especially if you have a basement. Finished basements are a no-no. They just are. Even if you don’t have wet concrete, it will wick. The best way, in a survival situation, to find water is to dig a hole, because water will fill in. Why are we finishing basements? I don’t understand.

Dr. Weitz:            I heard you say that exposure to mold makes fungus that’s already native to your body act pathogenically.

Dr. Crista:            Yes. Yeah.

Dr. Weitz:            That’s fascinating.

Dr. Crista:            [inaudible 00:14:33] isn’t it? It’s super fascinating.

Dr. Weitz:            Explain what you mean by that exactly.

Dr. Crista:            So what happens is that our normal … We have a microbiome for every part of our body, so the sinus microbiome-

Dr. Weitz:            [inaudible 00:14:44] everybody thinks about the large intestine, but the sinus, the vagina, all the mucus membranes.

Dr. Crista:            Yep. And you would think this is really close to each other, a mouth and a nose. They have different little species that are in when they’re happily living, commensal. So I think of a microbiome as a commensal biofilm, because that’s kind of what it is. We have fungus, we have bacteria, we have viruses. We have things that are there to keep us in balance. When you start to breathe in the mycotoxins, they send a message, which is, “I am intending to harm you.” So you get that mycotoxin exposure to your sinuses, and then when you swallow down to your gut, to our mouths, that is a message that’s soaking in that is, on contact, harming our microbiome of the area. So the sinuses become a really, really important part of treatment and rebalancing, because that’s our first interface. But when they see their buddies getting attacked, they start to act defensively. So that changes from a commensal, sharing, collaborative environment to, hmm, I don’t know that we’re safe. I might need to start acting a little bit more in my own interest. And it’s very interesting to see that reflection in the human species right now as well. So then they have to start-

Dr. Weitz:            [inaudible 00:16:14] the fungus in the body, like the candida?

Dr. Crista:            It’s fungus, but because it comes from a fungal source, then the body suspects the fungus as the problem, and the fungus becomes the scapegoat for the issue. So candida becomes a scapegoat, and then it overgrows. So this whole commensal microbiome starts to act defensively to defend from these mycotoxins, and the message in the mycotoxin is, I’ve come to kill. Fungus has come to kill and take over.

Dr. Weitz:            Interesting.

Dr. Crista:            And that’s my theory. And that’s what I base my treatment off of, but this was developed in my mind, because I was like, why am I having to use antifungals on people? When it’s a mold exposure, why does their body need antifungals? I get the toxin part, and I get-

Dr. Weitz:            [inaudible 00:17:09] is that the mold that’s growing inside my body?  No, it’s the candida that was there already that’s now acting differently.

Dr. Crista:            And then gone on long enough, if you have immune suppression, especially if you’re exposed to the living mold, those chemicals, then mold can move into your body, and we get something called colonization. So there’s sort of the spectrum that happens where you’re exposed to maybe the spores. That creates an allergic reaction.  That’s going to spend a lot of your immune system. That’s going to increase mast cell migration. Then you have fragments. So you get this initial kind of inflammatory response.  But then if it goes on, then you start to get the suppression of the chemicals that mold secretes and the mycotoxins. And that over time suppresses the immune system so then mold can move in, because now it can colonize you. And that can get severe enough to where they now want to invade. So it’s an invasive candidiasis.  At that stage, we get mast cells again in droves, compared to the spore ones that are just local inflammatory reactions. Now we get mast cells that are in droves that go to the brain, the vagus nerve. Everything is affected, the immune system, skin, gut. And that’s when you start to see things like mast cell activation. For me, mast cell activation is a sign that the fungus is winning at invading and becoming an infection.

 



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Dr. Weitz:            So if mold takes up root, say, in your gut, would a stool test pick it up?

Dr. Crista:            Not necessarily. [inaudible 00:20:02]

Dr. Weitz:            Mold is not candida, right?

Dr. Crista:            Mold is different than candida. Mold is not a yeast. However, by having mold exposure and enough of the chemicals in the mycotoxins, now you can get suppression of the gut. We do see … On some biopsies, you can see aspergillus and things like that in a gut.

Dr. Weitz:            [inaudible 00:20:24]

Dr. Crista:            More in the lungs. The lungs are more hospitable, if you want to call it that, easier to infect, the lungs, for aspergillus, than the gut because of our stomach acid.  But if you’re on an acid blocker [inaudible 00:20:35]

Dr. Weitz:            Interesting. We do see a lot of the mold patients have increased likelihood of candida overgrowth, of parasites, of bacterial overgrowth.

Dr. Crista:            When you’re in a water damaged building exposure where it’s enough that you are getting mycotoxins, you’re usually also getting endotoxins, because a water damaged building hosts mixed microbes, and they even have quorom sensing within that water damaged building. It’s really fascinating.

Dr. Weitz:            And then it’s hard to know which is causing the symptoms. Or are they all contributing? And then do we treat them all at the same time? Do we try to treat one and then the other?

Dr. Crista:            Right. So because of that, think of it as a microbiome disruption, which is not just bacteria. And that’s why [inaudible 00:21:29]

Dr. Weitz:            Which we often referred to as dysbiosis.

Dr. Crista:            Right, yeah. And that probably has some fungus, even in a person who is bacterially effected. Let’s say someone takes an antibiotic and they have dysbiosis after that. Well, think about what an antibiotic is. It’s a mycotoxin. So penicillin is the mycotoxin from penicillium species mold.

Dr. Weitz:            Right.

Dr. Crista:            So we can kind of understand what colonization might look like. Just look at somebody who’s taken antibiotics and then they have a candida infection. It’s like, how did that happen? So [inaudible 00:22:05]

Dr. Weitz:            I just saw a study published on that last month, about how patients who take antibiotics are increased risk of actually dying from candida overgrowth.

Dr. Crista:            Oh, wow. So repopulation of the bacteria helps reestablish that, but also there’s a reason why, in a short term antibiotic situation, there’s a reason why using Saccharomyces is also beneficial, because it also addresses that fungal piece. But in a mold sick person, I’m very careful with Saccharomyces boulardii because that, for my patient base, just creates sugar cravings. It just gives them more fungal burden, and they’re already fungally burdened. So then I’ll use more a spore based probiotic. So your question about which one do we target, all of them, because it’s going to be a mixed microbe mess.

Dr. Weitz:            Right.

Dr. Crista:            And it was actually Dr. Brewer’s study in 2013 or ’14. When I read that study, that’s when it was just like, oh, I get it now. This is colonization, and we must be treating the sinuses because they’re seeding the whole problem. And that study was where they looked at people with chronic fatigue syndrome that had a known water damaged building exposure, and then healthy controls. And what they did is they sampled sinuses. They sampled lung tissue, gut tissue. I think they even sampled brain. And they found that everybody has fungus in their sinuses. Everybody has fungus in their gut. So that wasn’t the big a-ha. The big reveal was sick people had mycotoxins in their nasal washings and their gut washings and their lung washings. Healthy people did not. So that’s when I was like, oh my gosh, something shifts in the microbiome of the human because it’s not the presence of this species.

Dr. Weitz:            We need a nasal microbiome, a nasal mycotoxin test.

Dr. Crista:            Yeah. That would be cool. What a good idea. Oh my gosh. We’re swabbing everybody anyway [inaudible 00:24:08]

Dr. Weitz:            So how often do you treat the nasal cavity in mold patients? Is it just when patients have nasal sinus type symptoms, or are you treating everybody, their nasal cavity?

Dr. Crista:            Everybody.  And it may be a probiotic.  It may be the Latilactobacillus sakei that helps to rebalance. So it might just be [inaudible 00:24:32]

Dr. Weitz:            And you’re talking about putting that into the nose, right?

Dr. Crista:            Into the nose, yeah. Because again, as a reversal of exposure, if the gut’s a mess, obviously you need to treat that, but you also have to stop seeding the gut by treating the nose. And so I will do nasal treatment of some form, whether it’s probiotics or [inaudible 00:24:53] acid, which are more rebalancing, if it’s a healthier person that doesn’t really have a lot of sinus symptoms, all the way to the pharmaceuticals, if they have significant sinus symptoms, because they have a massive biofilm there.

Dr. Weitz:            So will you use pharmaceuticals in the nasal cavity?

Dr. Crista:            Mm-hmm, if needed.

Dr. Weitz:            Which ones?

Dr. Crista:            So we can use … That’s where a gut test is kind of nice because if we also see other species like Klebsiella in the gut, then I know they need tobramycin in the nose. So there are some species that we know that we … Klebsiella and Pseudomonas seem to be kind of pond scum of biofilm. They are very hard to get rid of sometimes. So if I’ve used herbals and I’m not seeing what I need to see … And then there’s [inaudible 00:25:42] spray. A lot of people aren’t doing the gentamicin part. They’re just doing [inaudible 00:25:45] spray. So there are just lots of different … Dr. Brewer actually revolutionized this for me as well by using nystatin. He said that he was getting much better results with less adverse events by using nystatin. So I think, about five years, we’ve done that when needed as well.

Dr. Weitz:            Nystatin in the nose?

Dr. Crista:            Intranasally. And that’s all through a compounded pharmacist.

Dr. Weitz:            I see, interesting. What about the silver intranasally?

Dr. Crista:            Sure. Yep. And silver I use in conjunction with antifungal essential oils or an antifungal mix. There are lots of wonderful mixes out there already done for you. I actually have a handout if anyone wants to email my assistant, because you’ll get it faster, at support@DrCrista.com. I have something called nasal options for mold. And I’m going to do a quick video on that because I think that really would help people know what all is out there. So you can use things like tea tree. There are are premixes with tea tree, and that addresses the antifungal part. And then at another time of the day we can use silver, and that will help address the bacterial parts such as MARCONS and MRSA. A lot of these people have MRSA.

Dr. Weitz:            Cool. So we didn’t go over the symptoms of mold illness, but there’s so many symptoms, right?

Dr. Crista:            Yeah. I mean, I’m not Shoemaker trained, but Dr. Shoemaker is well known for saying that this is a multisystem, multi symptom condition. It looks a lot like Lyme disease. I remember having a conversation with Dr. Horowitz, and I said, “What if we created a questionnaire for mold that would help diagnose it?” And he said, “It’ll look just like the Lyme one. So I was like, “Okay, that’s a challenge.” So I tried to use his MSIDS Lyme questionnaire as a basis. And I created a questionnaire so that people could get a score. And they’re in three different categories for commonness to uncommon or selected more toward mold. And each one is weighted a little different of the three categories. So that questionnaire’s on my website if anybody wants to grab it. It’s in my book. And I honed it with all of the patients, like, does your score of saying not mold, probable mold, possible mold, does that match what I know of your mold testing? And so we’re working to scientifically validate that. We’re putting together [inaudible 00:28:10]

Dr. Weitz:            That that would be great.

Dr. Crista:            And then people can just take the questionnaire, because there are so many. But in practice I use that questionnaire also as a tracker, because people will forget how sick they were as you get them better. And so every three months or so or anytime we’re retesting mycotoxins, I have them fill out the questionnaire. And then when I see them again, I’m like, “How are you doing?” They’re like, “Oh, I’m just not any better. Can I get off this nasal stuff?” all kinds of [inaudible 00:28:38] “Can we start busting biofilm? I’m getting antsy,” all the things. And then I say, “Let’s look back at the first one,” and people will actually say, “Oh, that’s right. I couldn’t leave the house until 10:00 AM because I never knew what my gut was going to do. Or I had migraines. I kind of forgot I had migraines. I’m like, how do people forget they had migraines? But they do. I mean, you forget how sick you were.

Dr. Weitz:            Any time patients are dealing with chronic symptoms, chronic pain, they tend to wait for the point at which they’re not going to have any pain. And as long as they still have pain, sometimes they think, oh, this is not working. I still have pain. So that’s where you need questionnaires. You need pain scales. You need things like that so you can quantify it so you know that seven or eight pain is now a three or four. So even though it’s still there, you show an improvement, and you’re going in the right direction.

Dr. Crista:            And stay the course. I mean, that’s the thing. It’s like, we’re not trying to discount that you’re still in pain or that you’re still having symptoms. But the answer is what you’re doing is working. So stay the course and there will be that time because our body has an amazing innate healing ability. We will get there.

Dr. Weitz:            Can patients who consume mold in their food get similar symptoms to those exposed to environmental mold?

Dr. Crista:            Similar, typically not as severe. In the US, [inaudible 00:30:03] Westernized kind of cultures, also I would say South America where they’re using the same kind of farm practices and that kind of thing. However, there are areas of the world where they are storing grain, peanuts, soy, where they have a big problem with their food source. So that can happen. And you’re going to see things that are more linked to immune deficiency and kidney, the organs of detoxification. So we see liver cancer, kidney cancer, autoimmune diseases, that kind of thing. In a typical US, there have been review studies of the studies of food that is typically going into the US market. Eating a normal standard American diet, which already is not a great diet, it definitely can cause illness. But just eating that amount of ochratoxin, in my experience, doesn’t create the degree of illness that I see with a water damaged building exposure. However, if you know you have water damaged building exposure, getting rid of those mycotoxin laden in foods really speeds your healing process. So is it good for us to eat mycotoxins? But are we and have we evolved doing that for eons? Yeah, we have. We’re a little tiny bit mycotoxin obligate, I think. We’ve developed some detox to handle a tiny bit.

Dr. Weitz:            How accurate is urinary mycotoxin testing? And what is it telling us? Because it’s telling us that they’re screening mycotoxins, which obviously it’s better if they’re not having any mycotoxins. But if there are mycotoxins, we’d certainly rather have them excrete it then have them just sit there.

Dr. Crista:            Right. This is a question that I take 45 minutes in my doctor course to answer. I’ve done many, many, many split sample testings. I have identical twins myself, and I have a very good friend with identical twins. And they actually didn’t have mold. So I was able to test healthy, identical twins, and then they did have a mold problem. It was almost like we called it in, and I always feel bad about that. So when my kids and I were living in our moldy building, I did a lot of split sample testing to compare what I was doing with each one or what each one was willing to take, to be more honest.

So I had this very unique genetically identical, same exposure, same diet situation. So I learned a lot in that process of, what are the strengths, and what are the weaknesses? Because every lab test is going to have that. And I love your question, what is it telling us? When people ask me, should we provoke or shouldn’t we provoke? Which test do you like? And I always say, that’s the wrong question. Which test is best to answer the question you’re trying to answer for the patient in front of you? Because that’s going to be different. That might mean serum antibody testing for mycotoxins, not just for molds spores. There’s My Myco Lab. They have an antibody test for mycotoxins. The things you run through Quest and Labcorps, that’s just mold spores. So that’s not going to tell you anything about the mycotoxins. That is one of the few tests on the market, the IgE, that helps to answer the question, am I being exposed right now?

Dr. Weitz:            And what is the name of a company that offers that test?

Dr. Crista:            My Myco Lab. And all of these labs, because they’re not [inaudible 00:33:33]

Dr. Weitz:            [inaudible 00:33:33] not covered by insurance, right?

Dr. Crista:            Yeah. We’re not able to use the resources, the insurance resources. So that’s why I want to develop a questionnaire for the people who can’t afford, but still need to know if it’s mold. So My Myco Lab test, IgG and IgE do a number of different mycotoxins. The IgE tells me that they’re being exposed to a significant degree to affect their immune system, to tweak their immune system, basically, in the last two weeks. And Dr. Campbell who’s the medical director for that lab, he said, “We can even stretch that to a four week period when it comes to toxin based illnesses.” But I don’t know the science on that. So I’m using the rules of antibodies and infection because it really doesn’t matter, two weeks to four weeks. If I have a patient that’s in their safe home or in their current home and saying, “Is this mold?” and we see a positive IgE, I’m like, “You’ve got to get out of there.” And then we can test them when they’re out, challenge them when they come back, and that answers the question.

Urine mycotoxin testing doesn’t answer that question as well, but it does tell us what they’re treating, like you said. It can also tell us that they can’t excrete very well, and that’s informative as well. So you have somebody who knows they’re exposed to mold, does a urine mycotoxin test, and we see nothing or little to nothing. We have a very toxic person, and in my experience, a very high risk for developing dementia, bone marrow related issues, cancer. And I don’t mean to scare people, but that to me is an alarm. That isn’t like, oh, this test sucks. To me, it’s like, that’s telling us some information. And then also to provoke or not to provoke is always the question, and that’s different for each method. There are two different methods used for urine mycotoxin testing. One is ELISA, which is an antibody based test.

And the other is mass spect, so liquid chromatography, mass spectrometry. That one is an actual direct test. In other words, they look at the urine, and if they see a particular molecule, then they say, “Yep, it’s here.” Whereas the ELISA based urine is asking a little bit of the antigenic side, a little bit of the immune side. So each one has their positives and negatives for what you’re trying to answer. If you have a patient with kidney issues, then you’re going to want to choose a certain one so that you’re maximizing the strengths of that test. So there’s all these things. If you have a person with immune issues and you’ve tested their immunoglobulins and they’re low, then the serum one probably isn’t the best test for you. Then you need the urine one. So they’re all needed and necessary and to be used for the patient in front of you to answer the question you’re trying to answer.

Dr. Weitz:            Now I’ve talked to some of the labs like Great Plains, and they highly recommend not challenging with glutathione because that they said that could decrease the amount of mycotoxins that you see secreted.

Dr. Crista:            That was based on my testing.

Dr. Weitz:            Oh, really?

Dr. Crista:            Yeah. I shared that data and presented it for them. And ever since then, they’ve been saying don’t provoke. Because I had identical twins, two sets, and I had had another set of twins that weren’t identical, but that we did split sample testing on. And my child who was taking glutathione but was sickest and had the worst exposure in his bedroom, his mycotoxins were … A number of them were lower, and one was a little bit higher than his twin brother who was in the next bedroom who was not taking glutathione. So I think I would love to see the labs take some of their income and do some of this testing, because I’m not questioning their technique. I’m questioning, what do we do with the patient before we send the sample in? I think that’s the big unknown. And if anyone says you provoke this way with this lab, and this is the way to do it, we just don’t have the data. We can’t be that strict and religious about it.

Dr. Weitz:            [inaudible 00:37:42] really need more science about this because it wasn’t too long ago, maybe 15, 20 years ago that labs were shut down for even testing for mold toxins.

Dr. Crista:            Oh, yeah. Yeah. I think that was more political than-

Dr. Weitz:            Well, of course it is. But it also shows you how long it takes for the conventional medical world to accept new ideas.

Dr. Crista:            That’s right. And in defense of science, mycotoxins … I get medical doctors who want to take my course, and then they say, how many randomized clinical trials do you have in your resources? And I say this many. Do you know why? Because of medical ethics. We can’t poison people with known toxins and poisons to figure out what gets them better. The number one treatment of toxin based illnesses is avoidance, is don’t [inaudible 00:38:37]

Dr. Weitz:            You can ask them, how many randomized clinical trials do they have for surgical procedures?

Dr. Crista:            Sure, right. The sham knee surgery and [inaudible 00:38:48]

Dr. Weitz:            … surgery, right?

Dr. Crista:            So in defense of that, I understand why there’s resistance, because our standard of how we assess conditions and treatments doesn’t fit for toxin based illnesses. So we’re left to do translational research to animals. And again, let’s change policy so that this isn’t even a problem. We’re manifesting this problem.

 



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Dr. Weitz:            So let’s get into some of the treatments. In your format, you break down the treatment into different categories or phases, and you have avoidance, fundamentals, and protect, and then you have repair, and then finally fight. So can we just start with the protect phase? And one of the treatments that everybody knows about is binders. So I have questions about binders. The binders that you list are things like flax seeds and chia seeds. I’m used to seeing recommendations for clay and charcoal and zeolite and modified citrus pectin and things like that. So I’m wondering why you aren’t recommending binders like that. And then also, is there any reason to think that specific binders can be a benefit to different types of mycotoxins or different types of mold?

Dr. Crista:            Absolutely. Yeah. Oh, we could talk for hours on this one. So the binder story. First, we have to understand [inaudible 00:41:59]

Dr. Weitz:            The binder story.

Dr. Crista:            What are we binding? So what we’re binding, in a water damaged building exposure where you’re breathing it or you’re taking it through your skin, is we are binding bile. So the path of the mycotoxin is you breathe it in. It goes into the lungs, or it can seep in through your nasal tissue. It can seep in through your skin. These are lipophilic, meaning they can go through fat. They don’t have to have a protein doorway, no toll-like receptors, no nothing. They’re fat soluble. They can just, blip, right through the cell membrane. They can get into the bloodstream, which is why we can test it on urine, because then when it’s in the bloodstream, it takes one of two paths, to the kidneys to get peed out and detoxed, which works for all except ochratoxin. Ochratoxin doesn’t work like that. Or we can have the liver package it up in bile, send it to the colon and to be pooped out.

The problem is bile is really kind of designed more as a preservation of our fat soluble nutrients and as a detergent. So it’s supposed to get some of our stuff out, but we recycle about 93% of our bile. So if you think about that, we’re recycling that toxin. We bring it back up to the liver, and the liver’s like, I already handled this. So it has to re-detoxify the mycotoxin it just packaged up and sent in bile and then sent down to the intestines to be pooped out. So that can happen. I call it the detox insanity, the definition of detox insanity, is the bile is like, here it is again, here it is again, here it is again.

So what we’re trying to do is grab bile. And one of the best ways to grab bile is all the things that also grab cholesterol. And we have great studies on this for people who have bile dump diarrhea syndromes, who are missing their gallbladder. By the way, you make bile from your liver. So if you’re missing your gallbladder, you can still get better from mold. So I get that question a lot. They’re like, oh no, I don’t have a gallbladder. People without a gallbladder tend to do better, actually, with this condition, which is very fascinating. So we’re grabbing that bile with things that grab bile and cholesterol, because bile is made up of cholesterol and phosphatidylcholine. So we look at the studies of how to grab bile from these bile dump diarrhea syndromes or how to lower cholesterol very, very efficiently is insoluble fiber. So when we think about what I’m trying to do is I’m trying to grab bile with things that have been proven in other studies in other conditions in randomized human clinical trials that answer the same or get to the same end as grabbing bile and cholesterol. Does that make sense?

Dr. Weitz:            Yeah. But I’ve heard from people who are very knowledgeable about the biochemistry of this that things like flax seeds are just not going to work, that you need charcoal, clay, zeolite, that there’s some specific way in which those work much better.

Dr. Crista:            Right. And we learned that from animal studies. So when you’re eating mold … So in animal studies, they know they’re going to be feeding animals moldy feed, which let’s start with one policy change. Let’s not do that. What they do is they feed the animals moldy feed on purpose, and then they add different things to the food to see what minimizes that animal’s burden of mycotoxins. So a big part for me of the whole binder story is bowel movement and motility. So using insoluble fiber doesn’t work if somebody is really constipated. Using any binder doesn’t work, because it’s an absorption. It’s like two magnets. It’s not like Velcro. So if they’re constipated, that can denature right off of that bile, and now you have a mycotoxin problem in the gut. And a lot of times you have a mycotoxin problem in the gut anyway from the colonization. And that’s where the work, sorry, of Dr. Nathan, who I work with a lot and Beth O’Hara and Emily [inaudible 00:45:53]. I think that they kind of got together on, how do we detox each mycotoxin? What binds each mycotoxin? And that’s based on animal research, and those are all real, yes, effective things. They also bind a lot of nutrients. And do I use them? Yes. But I use them very selectively, and I use them in short term. And that again is from animal-

Dr. Weitz:            They have to be taken away from food and other supplements, et cetera.

Dr. Crista:            So I’ll use charcoal more commonly than the others. I like to just use the good cheap $5 activated charcoal, whole bottle. It doesn’t cost you much money, and it’s very effective. That one you can use a little longer term in my experience without affecting the nutrient ability, but using any binder, like a pharmaceutical one, Dr. Shoemaker uses [inaudible 00:46:44] things like that because it binds bile, because it binds cholesterol. It’s the same thing as the insoluble fiber. In my experience, that also is binding vitamin A, vitamin D, vitamin E, CoQ10, essential fats. These are all things that you need to protect your nervous system. So that’s part of the protect section also is DHA because we have to get … If this is a fat soluble, oil soluble toxin, we have to also provide the things that are going to be replacing that lipid or that oil.

So if they’re constipated, I don’t use any binders. I use pre-binders. I get the motility going, because if you’re not pooping, that’s the lowest part of that detox cycle. We’re just going to be doing detox insanity if you’re not going to the bathroom. So that’s the first thing we do is pre binders are things that make and move bile, and that’s going to be things that taste bitter. And then there are certain plants, herbs that can do that. So if they’re not going to the bathroom two times a day, we don’t even talk about binding because we’re just going to force recycling of those toxins. So, yes, I do use charcoal. I like Takesumi Supreme. It’s carbonized bamboo. If I know either they’re going to be really exposed, they have to go meet their insurance person at their water damaged building or something like that and they’re going to be totally blasted after, or I do it just before we’re about to do the antifungals because that’s a predictable time to get a lot of spillage and mycotoxins. But I don’t use them over long periods of time because, in my experience with my patient base, insoluble fiber, you have to go high, go two grams, three grams does a very efficient job of not only binding, but also feeding the microbiome and assisting the detoxification process, preserving our fat soluble nutrients, all the things.

I’m very careful with clay and zeolite. Zeolite is clay. First of all, they can be very lead laden. They can be contaminated with lead. So using specific medical grade clay is very important, but in animal studies and the farmers in my area, if they put young people on clay or young kids, so goats and dairy cattle and things on clay, they’ll have dental problems and bone growth problems. So I think it’s a little too aggressive of an absorber. So they also will see in dairy cattle, if you’re on clay too long, they’ll stop producing milk. So I’m very careful and selective about how I use clay. It’s kind of a perks recovery, not a daily thing. And I’m very different than … I know that I work with Neil Nathan in a mentorship, and it’s so much fun because we all do it a little bit differently, like you said in the beginning. And we’ve come to realize this because we all uniquely, as practitioners, attract people that align with us. So we’re all seeing a different patient base. And it’s also because we don’t have randomized clinical controlled trials. We’re not collecting the data on treatment, which we’re working on, so that there isn’t standardized care with this. Because everybody’s an individual, and they’re affected by mold differently.

Dr. Weitz:            So in order to move the bowels, are you using things like … What kinds of things are you using for moving the bowels? Are you using magnesium? Are you using ginger and artichoke? What sorts of things?

Dr. Crista:            Good question. So for mold, we’re trying to move it at the small bowel. So things like laxatives, they may help, but they’re going to wear out. So this is a classic picture of a mold sick person, that they have been constipated for a long time. They finally discover that the … And it’s usually many legs of a stool that gets someone to go to the bathroom. They start with magnesium, and that works, and then it starts to not work. So then they add high dose vitamin C to get a bowel flush, and that works, so magnesium, vitamin C. And then that starts to not work. So then they add senna, and that starts to work. Now they’ve got magnesium, vitamin C, senna, and then that starts to not work. And so they add stool softeners, and then they add bile salts. And so, finally, they’re moving up the tube to where the problem is, and the problem is in the trigger to make stomach acid and bile.

So if I have somebody who’s on all of those things, now we know we’ve ruled those out. I don’t have them take away those things. We add then things that go higher up the tube, like a stomach acid, [inaudible 00:51:12], bile salts, and then the cholagogues and [inaudible 00:51:16], which are very bitter, like [inaudible 00:51:20]. Typically, if they’ve been constipated a long time, bitters alone aren’t going to do it. They’re going to need some bile. [inaudible 00:51:27] bitter orange, all the things that … And when you taste bitter on the tongue … I could go on about bitters forever. 50% of the drugs on the market target the bitter taste receptor. And you could be getting that benefit just by putting bitter on your tongue before you eat.

Dr. Weitz:            So putting it on the tongue more so than just ingesting it is going to be more [inaudible 00:51:50]

Dr. Crista:            Yep, exactly. You have to engage those better taste receptors. And if anyone’s listening who’s a practitioner, go look at [inaudible 00:51:58] and these taste receptors. It’s fantastic and amazing what they’re doing for the body. So you have to taste it. And so if somebody is like, oh, I just can’t, I can’t do it. I need a capsule. I’m doing this liquid thing, or I’m traveling. I can’t do liquid. So then I have them just take one of the capsules of a bitters formula and dump it into the bottle and then shake up the bottle because then there’ll be a little bit. And all we need is a tiny bit to get going.

Dr. Weitz:            So better to use something that you drop in your mouth or a spray or something like that for the bitters.

Dr. Crista:            Yeah. Always better to taste it. And that could be, Angostura bitters from liquor store. It doesn’t have to be inaccessible, like woo-woo. I mean, there’s a reason why liver toxic people trend toward drinking Manhattans. It’s very fascinating to me. I love to ask people, what’s your favorite cocktail? It tells me a lot

Dr. Weitz:            Interesting. And so we’re running out of time, and I only have about 3,000 more questions. But I know that you use glutathione in part of your protocol. That’s in your fight phase. Is that right? Or where is it?

Dr. Crista:            No, no. Glutathione is going to be in the repair because it’s [inaudible 00:53:27] repair the detoxification systems. And some people can’t do glutathione. I mean, really, I just proceed cautiously with that, and we’ve done the avoidance, the fundamentals, kind of set the stage so the body could handle glutathione. And in the protect phase, we’ve done things to help the body handle the more mycotoxins that are going to be coming out. Because once you start poking the bear with mold, once you start going to the fight phase … That’s why it’s the last phase for me. I learned by making my patients sicker, like, oh, this is mold. This is fungus. Here’s this candida formula. And ear ringing goes through the roof. I had one Lyme mold patient that went into seizure by giving her an antifungal pharmaceutical. So I was like, oops, this needs to be the last thing that we do.

Dr. Weitz:            So you do things like … You’ve got milk thistle and other nutrients to help support the liver.

Dr. Crista:            And milk thistle makes our own innate glutathione. So if somebody can’t handle glutathione … I kind of tiptoe into the glutathione with the dosing because some people it’s just too much. Detox is too much. And all of these things are just temporary. Even the diet is part of a therapeutic diet to get someone rehabbed, because it can happen. You can get better from mold. So things like milk thistle, turmeric get the body ready. And then you can go for the more nutrient focused alpha-lipoic acid, glutathione that are really trying to go down one pathway. And glutathione I use because the whole body becomes low in glutathione. That gets a little confused. Some people are like, oh, well this mycotoxin that I have doesn’t go through the glutathione pathway in the liver. That’s fine. That’s why we’re using the other things that do glucuronidation like resveratrol and Curcumin. But we use glutathione because every mitochondria in the body gets affected by mycotoxins, and they all get low in glutathione. So it’s more like a mitochondria rehab.

Dr. Weitz:            I see. I’d asked already a little bit about how to treat different molds or different mycotoxins differently. And I guess the interesting thing about the mycotoxins … And then you test the house for the mold and trying to correlate those. That’s kind of a complicated mess.

Dr. Crista:            That’s crazy making. Yes, because the person could have been made sick from their college housing 20 years prior. They could have been colonized at that point. And now they are the sick building. So it does become crazy making … Because you’re going to excrete different mycotoxins as well. They almost excrete like sedimentary layers. There are some that go really fast and easily, and then some are more persisters, like ochratoxin. Ochratoxin is a persister toxin because it binds to albumin so tightly. So we have to do things [inaudible 00:56:12]

Dr. Weitz:            That’s interesting. So it binds to albumin.

Dr. Crista:            It has a very high affinity for albumin, which is why it’s kidney. We could have probably predicted that. You get kidney cancer and kidney damage, IgA nephropathy, all of these things from ochratoxin because of how it binds.

Dr. Weitz:            Can you measure that in a blood at all?

Dr. Crista:            Not really easily with a blood test, that we’re seeing a ochratoxin binding albumin complex or anything like that. But there are some tests that we can do that are more fine tuned to see, if someone is eating something that is challenging their kidneys, you can see increased protein in their urine and things like that.

Dr. Weitz:            Let me try to wrap this up. Let me ask you two last questions, both of which will probably take an hour each to answer. And one [inaudible 00:57:11]

Dr. Crista:            … try to be fast.

Dr. Weitz:            What’s what’s your favorite antifungal, and what’s your favorite biofilm buster?

Dr. Crista:            Good. Antifungal is thyme. And the reason for that is that it has a very unique ability to shut down mycotoxin production in fungi and yeast and yeast growth. So it manages the yeast as well as fungi. It’s also antimicrobial, antibacterial.

Dr. Weitz:            [inaudible 00:57:38] volatile oil form or-

Dr. Crista:            Even as the whole plant. The essential oil has more of that ability, the killing ability, but the whole plant or an extract of the plant can shut down the mycotoxin. So what I will do is preload with some thyme before we really do the launching into the fight phase, because then it shuts down the ability for the mold to fight back.

Dr. Weitz:            Is there a favorite product on the market that you like for that?

Dr. Crista:            There’s a combination, which is kind of strong. I usually start with thyme tincture, but if they’re tolerating the thyme tincture for a couple of weeks, then we shift to the … Integrative Therapeutics has one called Y Formula. It has oregano, which would be my second favorite. So thyme, oregano, peppermint, and it’s got some other things so the gut doesn’t get so disrupted.

Dr. Weitz:            And it’s called a what formula?

Dr. Crista:            Y formula. It used to be called yeast formula. Then the FDA-

Dr. Weitz:            Okay.

Dr. Crista:            No claims made, so it’s just Y Formula now. That’s a lovely one. Ortho Molecular has a nice one as well, but I start with single because these people are really sensitive. I start with just a single thyme glycerate or an herbal tincture that they just add to a little bit of water and drink. And if their body is handling that, then we can kind of move into stronger stuff.

Dr. Weitz:            [inaudible 00:59:01] That’s a pretty strong one. What’s your favorite biofilm buster?

Dr. Crista:            Biofilm buster, if we can do it, is ozone. So that would be one of my favorite, and then just enzymes.

Dr. Weitz:            Blood ozone or [inaudible 00:59:17]

Dr. Crista:            [inaudible 00:59:17] ozone, intranasal ozone, rectal ozone, any way to get the ozone. Unfortunately though, that can raise some other critters if the body isn’t ready. So we do ozone very selectively. So for normal people that can’t do ozone, I like Lumbrokinase, particularly for mold sick people, because the other enzymes are a fermented product. They’re acquired through fermentation, so your typical … What am I thinking? Like the enzyme formulas for sore muscles or for inflammation. Those are gained through fermentation where Lumbrokinase is roundworm. It’s just a worm. So that one my patients tend to handle better because it’s not fermented.

Dr. Weitz:            Interesting.

Dr. Crista:            But it’s a stronger one.

Dr. Weitz:            Awesome. Awesome. Great information. Thank you Dr. Crista. Tell everybody how they can find out about your course and learn more information about you, your website.

Dr. Crista:            So my website is DrCrista.com. That’s D-R-C-R-I-S-T-A.com. And my book is Break the Mold. I have a practitioner training. It’s 10 hours, deep dive. Become mold literate certified. You have to pass tests and the whole thing. So then you will get put on my website as a … And that’s for primary care trained practitioners. You’ll get put on my website and referral, and we get many, many, many hits a day looking for practitioners who are mold literate, so if that interests you.

And then for the public, I’m rolling out a series of courses I can get them done. The first one that’s out is nine things to know if you’re still in mold. So a lot of people are being told by their doctor, they’re mold literate doctor, which frustrates me, oh, we can’t treat you until you get out. That’s not right. They can do a lot of things while they’re still in mold, so that they’re not as sick when they leave. And then my upcoming course for the public is mold and kids because that’s a whole other … My book is pretty much for adults. And so there are different things you need to do with kids. And it’s a little harder to get things into kids if it’s in a capsule. So we have to find ways to get it into kids in different ways.

Dr. Weitz:            And what about the practitioner training course?

Dr. Crista:            Practitioner training course is called. Are you missing mold illness? That’s the 10 hour training.

Dr. Weitz:            Great. Excellent.

Dr. Crista:            And in there I’m slowly translating all of my scribble notes of the individual mycotoxins and putting them into tech sheets. So if you do see a certain mycotoxin, you can just go to the tech sheet and know what to do about it.

Dr. Weitz:            Oh, cool.

Dr. Crista:            [inaudible 01:01:48]

Dr. Weitz:            Great. [inaudible 01:01:52]

Dr. Crista:            … list, right? [inaudible 01:01:54]

Dr. Weitz:            Oh, I have many, many.

Dr. Crista:            I can imagine.

 


 

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness podcast. And if you enjoyed this podcast, please go to Apple Podcasts and give us a five star ratings and review. That way, more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office, (310) 395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.

 

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Alzheimer’s Research Controversy with Dr. Dale Bredesen: Rational Wellness Podcast 271

Dr. Dale Bredesen discusses Alzheimer’s Disease Research Controversies 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

0:35  Alzheimer’s disease is the most common form of dementia and it’s the most common neurodegenerative disease, and numbers are increasing.  Conventional medical research has not produced any successful drugs or treatments.  Last year a controversial drug–Aduhelm (aducanumab) was approved for the treatment of Alzheimer’s disease, but it actually failed 3 of the 4 clinical trials that were conducted and while it reduces amyloid plaques in the brain, patients with Alzheimer’s disease do not actually improve but only get worse at a slower pace. And 35% of patients get painful brain swelling and some also get bleeding in the brain.

1:45  On July 21st in Science, an article was published that blew the lid off of the Alzheimer’s disease research.  It was revealed that images were likely falsified that were included in the landmark study published in 2006 by Dr. Sylvain Lesne, Karen Ashe, and others that was supposedly the first to proved that beta amyloid is actually the cause of Alzheimer’s disease.  This study was referenced in over 2000 other studies and is the basis of hundreds of millions of dollars of NIH and drug company research.  Therefore, this is perhaps the largest scandal in the medical research field and appears to me to call into question the 30-year-old beta amyloid Alzheimer’s disease hypothesis.

2:40  Another important paper, with Dr. Dale Bredesen as the senior author, was also published online in July in the Journal of Alzheimer’s Disease that demonstrates for the first time that a precision medicine approach, (a Functional Medicine approach) can actually reverse Alzheimer’s disease.  [Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project. Toups, Kat et al.]

4:03  I asked Dr. Bredesen what the significance of this science article that alleges fraud that appears to have been committed by Dr. Lesne and possibly others?  His answer is “The Titanic that is mainstream medicine is sinking right before all of our eyes, having crashed into the iceberg that is chronic illness and that is the problem.” Alzheimer’s Disease, like diabetes and lupus and heart disease and cancer, is a chronic disease that is not going to be properly addressed by simply prescribing a drug.  Alzheimer’s disease researchers have developed many drugs to remove amyloid–bapineuzumab, solanezumab, gantenerumab, crenezumab, aducanumab, donanemab–but they don’t reverse the condition and at most slow down the progression a bit.  While Western medicine can effectively treat many types of infections, it is not effective for complex chronic illnesses like Alzheimer’s disease. 

6:27  Dr. Bredesen used the following analogy to explain why the reductionist approach of conventional medicine fails when dealing with complex, chronic diseases: “imagine that you took your jets from all the different jets that are flying, from all the different groups, from Delta, United, American and so forth and so on, and you took them in for servicing, but you said you can only limit it to one prescription. You give one thing, you can either fill it up with gas or you can fix the oil, or you can look at the engine, but you can only do one thing. These jets would be crashing left and right.”  If you see a patient with hypertension and instead of asking why that patient has hypertension and all you do is write a prescription that prevents your body from doing what it’s trying to do.  This is an outdated way to practice.

7:27  To be fair to Dr. Lesne and Dr. Ashe and the other researchers involved in this scandal, it should be pointed out that this started with an investigation into a drug being developed by Cassava Sciences, and Martin Schragg, the neuroscientist who discovered the falsified images, was being paid by a financial firm that was shorting the stock to make millions of dollars, so this is quite questionable and likely illegal.

9:01  One of the issues with Alzheimer’s research is that while we know that amyloid has something to do with the condition, it is not the root cause, which is why drugs that reduce amyloid do not make patients better.  Amyloid is more a mediator than a cause.  As Professor Rudy Tanzi has shown, amyloid is an antimicrobial peptide that results from infections in the brain among other insults.  What Dr. Bredesen’s research has shown is that there is often a network insufficiency, so you may need more energetics, more mitochondrial function, blood flow, oxygenation, and keytones.  You need growth factors like NGF and BDNF, hormones like estradiol and testosterone and nutrients like vitamin D.  On the negative side are various toxins like mycotoxins, inorganics, organics, air pollution, inflammation… etc.

15:03  The pandemic created conditions likely to increase the risk of Alzheimer’s disease over time.  Citizens are ordered to stay in their homes and everybody is very stressed out.  Many people ate poorly and did not exercise since gyms were closed and the average person gained 29 lbs. And we have a virus ravaging the country that we know penetrates the brain.  Many patients after COVID end up with brain fog as a part of long COVID.  We don’t know, but in some cases this may be one of the earliest stage of Alzheimer’s and there have been several people who have developed Parkinson’s disease from COVID.  The first period you’re asymptomatic but you can pick up changes on PET scans and spinal fluid.  Then you have Subjective Cognitive Impairment (SCI), which lasts about 10 years.  During this stage, you know something is wrong but you may score normal on standard cognitive testing.  The third stage is Mild Cognitive Impairment (MCI), which is actually a relatively late stage of the disease.  And then the fourth and final stage where you’ve now begun to lose activities of daily living is, of course, what we call Alzheimer’s.

17:38  Dr. Bredesen just published a paper online in the Journal of Alzheimer’s Disease and it will be published in print this month (August):  and just basically showing that with a proof of concept trial, we made 84% of the people actually better:  [Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project. Toups, Kat et al.]  84% of patients got better and had improved cognitive scores and their gray matter in their brains got larger on mri.  This trial uses a functional medicine approach looking at inflammatory markers, various metabolic pathways, pathogens, toxins, nutrient levels, etc.. 

22:18  Dr. Bredesen’s approach is not being well received by the conventional neurology community because they have been trained to practice 20th century medicine and they are reluctant to give up that approach.  We need to teach 21st century medicine (precision medicine, functional medicine, integrative medicine, P4 medicine) in medical school.  Instead of just asking what is it and then writing a prescription, we need to ask why is it?  What are all the things that contributed to the current state of affairs?  We need larger data sets and we need to look at how we can address all of the different contributors to neurodegeneration. 

23:48  Two Contrasting Studies.  We need to get the word out about these 2 contrasting studies. One study with aducanumab, where they are trying to argue for efficacy, when it’s clear that this drug did not really have a significant impact, and the other study using a precision medicine/Functional Medicine approach where it’s clear that there were more improvements.  To do justice to a Functional Medicine approach we need a new model for scientific studies. According to Dr. Bredesen, “So we’ve got to find a better way to do our trials. And again, we have to match up the way we do with trials with what the science is telling us. The science is telling us this is not a single variable problem. This is a network insufficiency. And to get best outcomes, we’re going to need to address different parts of that network.” 

29:03  The best benefit for patients with Alzheimer’s and other chronic diseases is to intervene as early as possible.  For Alzheimer’s disease the early signs break down into an amnestic and a non-amnestic presentation. Amnestic patients typically have problems with short term memory like remembering where they left their keys or what they had for breakfast.  The other, non-amnestic presentation patients will have problems with executive function and will have problems with planning. They also have trouble with word finding, what’s called primary progressive aphasia or it’s trouble with recognizing shapes and faces, what’s called posterior cortical atrophy.  They can have trouble with calculations, another parietal lobe problem. Dr. Bredesen said that when he sees patients with a non-amnestic presentation, especially if they’re relatively young, they’re in their fifties, for example, they are strong candidates for toxin associated cognitive decline, often related to biotoxins such as mycotoxins. 

31:48  Cognoscopy. Dr. Bredesen recommends that everybody who is 45 years or older get a cognoscopy, which includes very detailed lab testing much beyond the limited labs included in a typical annual exam, a simple online cognitive assessment, then if you have symptoms or score poorly on the cognitive exam, an MRI with volumetrics, such as a Neuroquant. If this is the case, then you want to get on active prevention.  There is a tendency for neurologists to see mild forms of cognitive dysfunction as part of normal aging and to just wait until things get bad and then you take a drug that doesn’t help much. The goal is to keep everyone sharp until 100.

33:47  Conventional neurologists also do not recommend that patients check their APOE status, which is the most common gene association with Alzheimer’s.  If you have no copies of AOE4 your lifetime risk of Alzheimer’s is 9%. If you have a single copy of APOE4, it’s about 30%. And if you have two copies, it’s way over 50%, so most likely, you will get Alzheimer’s.  You should check your APOE status early and get on appropriate treatment and prevent yourself from getting Alzheimer’s disease.  A cognoscopy will look at many sources of inflammation, including leaky gut and even the oral microbiome, since these pathogens can get into your brain. And if pathogens do get into the brain, it coats them with amyloid to kill them and bar them from getting to the rest of the brain.  Some people are lowering their oxygen to their brain due to sleep apnea. For some people, it’s more vascular, so it’s important to know what and why your risk is.

36:22  Nutrient status.  Mainstream medical doctors will tell you that supplements are not a cure for Alzheimer’s and of course, they are not, but as part of a program that involves diet, exercise, and lifestyle changes, appropriately chosen nutritional supplements can play a positive role.  Part of preventing Alzheimer’s is to eliminate network insufficiency.  Take vitamin D, which interacts with so many receptors around the body. It enters the nucleus of the cells and affects hundreds of genes so that it changes your immune system, your response to COVID, your heart disease related problems, your calcium metabolism, and your cognition.  Vitamin B12 deficiency has been associated with cognitive decline and we need not to just have enough to get to normal limits. You can have normal levels and die from having too little B12. You need to get your B12 levels at least 500 and 300 is not optimal.  Omega 3 is important, as are resolvins, their cousins. Magnesium is essential. Studies are showing nutritional levels of lithium are important both for behavioral problems and for cognition.  And poor diet can contribute to Alzheimer’s, though diet alone will not cure Alzheimer’s. Dr. Bredesen recommends a plant rich, mildly ketogenic diet and he likes to see people have a 1.0-4.0 millimolar betaydroxybutyrate on a blood test and 10-40 for acetone on a breathalyzer test.

40:25  Dr. Bredesen’s favorite neurocognitive assessment tests are CNS Vital Signs, which is best for SCI (subjective cognitive impairment) and MoCA (Montreal Cognitive Assessment), which is best for MCI (mild cognitive impairment).

 

 



Dr. Dale Bredesen is a neurologist and an internationally recognized expert in the mechanisms of neurodegenerative diseases like Alzheimer’s Disease and the Chief Science Officer at Apollo Health. He is the author of the best selling books, The End of Alzheimer’sThe End of Alzheimer’s Program, and The First Survivors of Alzheimer’s. Dr. Dale Bredesen’s career has been guided by a simple idea: that Alzheimer’s as we know it is not just preventable, but reversible. Thanks to a dedicated pursuit of finding the science that makes this a reality, this idea has placed Dr. Bredesen at the vanguard of neurological research and led to the discoveries that today underlie the ReCODE Report.  Dr. Bredesen offers training for doctors and practitioners in his ReCODE system at his website at ApolloHealthco.com.

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



 

Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the rational wellness podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today, we’re going to be talking about a controversy in Alzheimer’s disease research. Alzheimer’s disease is the most common form of dementia and it’s the most common neurodegenerative disease, and numbers are increasing. It’s crucial that we make some progress on preventing and treating this horrific condition, but conventional research has not been all that fruitful and has centered on the role of beta amyloid protein plaques that are found in the brains of most patients with Alzheimer’s disease. No successful drugs or treatments have been developed based on this amyloid theory of Alzheimer’s prior to the approval of Biogen’s Aduhelm last year.  But this drug was approved with much controversy. Since it failed three of the four phase three clinical trials conducted by Biogen and three of the scientists on the FDA advisory board resigned in protest over this drug being approved. While at Aduhelm does reduce amyloid plaques in a brain, none of the patients get better, but only get worse at a slower pace. And 35% of patients get painful brain swelling and some also get bleeding in the brain.

And then on July 21st in Science, an article was published that blew the lid off of the Alzheimer’s disease research. It was discovered after a six month investigation by Science Journal, that the results were falsified. In the landmark study published in 2006 by Dr. Sylvain Lesne, Karen Ashe and others that supposedly was the first to prove that beta amyloid protein was actually the cause of Alzheimer’s disease.  This is perhaps the largest scandal in the medical research field and appears to me to call into question the 30-year-old beta amyloid Alzheimer’s disease hypothesis. Since this study was referenced in over 2000 other studies and is the basis of hundreds of millions of dollars of NIH and drug company research.

On the other hand, another important paper on Alzheimer’s disease was also published in July, this in the Journal of Alzheimer’s Disease, the paper that demonstrates for the first time that a precision medicine approach, what I would describe as a functional medicine approach can reverse Alzheimer’s disease. Though, interestingly, it got much less attention than the other article that I just mentioned.  No presidential medal of freedom, no noble peace prize nomination. The principal author of this study is Dr. Dale Bredesen, who’s joining us today. Dr. Bredesen was the chief resident in neurology at the University of California, San Francisco and he’s the founding president and CEO of the Buck Institute Program on Aging. Dr. Bredesen has published over 200 scientific papers and he’s written a number of books, including The End of Alzheimer’s, The End of Alzheimer’s Program and The First Survivors of Alzheimer’s. Most importantly, he has developed this precision medicine program that he calls to ReCODE protocol that he’s teaching other doctors and practitioners that is the only treatment that has ever been shown to reverse Alzheimer’s disease. Dr. Bredesen, thank you so much for joining us today.

Dr. Bredesen:                    Great to talk to you, Ben. Thanks for having me.

Dr. Weitz:                          Excellent. So what do you think is the significance of this science article that demonstrates that this alleged fraud was committed by Dr. Lesne and possibly by others that he worked with?

Dr. Bredesen:                    Yeah. Great point. And you know, let’s pull back to the most important point here that you touched on a minute ago. The Titanic that is mainstream medicine is sinking right before all of our eyes, having crashed into the iceberg that is chronic illness and that is the problem. Whether you talk about Alzheimer’s, frontotemporal dementia, Louie body disease, ALS, autism spectrum disorder, late stage cancers, lupus, just go right down the list. We as physicians have been very successful at simple illnesses, pneumococcal pneumonia, TB, even HIV, which took three drugs, instead of one. These are the sorts of things we’ve been very successful with. We have not been successful, as you know, over 40 billion has now been put into Alzheimer’s research and drug development with nothing that really moves the needle. And so what happens is people keep going back to the idea, okay, can we remove the amyloid? Is that going to make you better?  And the answer time, after time, after time, bapineuzumab, solanezumab, gantenerumab, crenezumab, aducanumab, donanemab. Oh my gosh. But because there are hundreds of billions of dollars in the offing, if you can just get past the bar and the bar is very low, it’s not even make people better, it’s not even keep people steady, it’s can you slow the decline? And in the case, as you mentioned, in aducanumab in one trial at one dose, it slowed the decline by 22%. That’s it. And that was set to make hundreds of billions of dollars, but the problem is that unlike these simple illnesses where we know what causes COVID 19, we know what causes pneumococcal pneumonia, and in those cases, as long as we get after that main pathogen, we do pretty well. Unfortunately, Alzheimer’s is not that simple. It is a complex chronic illness.

It’s so interesting to me it’s as if imagine that you took your jets from all the different jets that are flying, from all the different groups, from Delta, United, American and so forth and so on, and you took them in for servicing, but you said you can only limit it to one prescription. You give one thing, you can either fill it up with gas or you can fix the oil, or you can look at the engine, but you can only do one thing. These jets would be crashing left and right. And it’s time for all of us to recognize that human beings are complex organisms. So this old fashioned idea that, oh, you have hypertension, we’re not going to ask why you have hypertension. We’re just going to write you a prescription that prevents your body from doing what it’s trying to do.  And this is really barbaric and it’s really outdated and this is just the latest. We’re watching that next piece of the Titanic going down mainstream medicine. So we need to look at larger data sets.

And so to be fair to Dr. Lesne and Dr. Ash and I’ve known Dr. Ashe personally for almost 40 years now. She is a brilliant neuroscientist and neurologist, MD, PhD from Harvard. I have no doubt that she was doing the right thing. I don’t know about the postdoc. I don’t know him personally. And there have been some questions about other data that he has published as well, so the jury is still out. As you know, this actually came from looking into a company that had used their data to go the next step and this was to create a drug.  This was Cassava Sciences to create a drug called simufilam. And the idea was it looked as if some of their blocks were questionable. And so there was a question raised about data coming out from both of those groups. And as you probably know, the Department of Justice is actually now looking into the Cassava Sciences situation. Now you can argue about whether it’s appropriate to criticize a study when you own the stock and you’ve shorted it purposefully to make many, many millions of dollars. It seems like that probably should be illegal. It’s a little bit like insider trading. You’re going to go short the stock, and then you’re going to go complain about the company and make lots of money, so that’s a separate issue, I think. It’s more of an ethical issue and legal issue, but there’s no question. And of course, others have been interviewed on this very topic.

There are some red flags in the research coming from both of those. And one of the issues here is people have gone, as you mentioned, just gone after, hey, this is an amyloid disease. Let’s get rid of the amyloid and let’s make it better. Unfortunately, that still hasn’t happened. So we have to now update our thesis. Amyloid is clearly involved in some way, potentially as a mediator, but it is not the upstream cause. And when you get rid of it, it doesn’t make things better. And so the work we’ve done in the lab, as you mentioned, we published over 200 papers on this and what we see is that amyloid is indeed just as Professor Rudy Tanzi and Robert Moir said several years ago, it is a response to various insults. And as they showed, it is an antimicrobial peptide. So what our research showed over the years is that the fundamental nature of the disease that we call Alzheimer’s is actually a network insufficiency.  So you have all these different factors and it’s basically four big groups. It’s energetics, you need enough energetics, mitochondrial function, blood flow, oxygenation, keytones all of those. You need enough trophic support and that’s growth factors like NGF and BDNF and that’s hormones like estradiol and testosterone and that’s nutrients like vitamin D. So those are the first two groups. And then the other groups which are on the negative side are the various toxins, so things like mycotoxins, inorganics, organics, of course, air pollution. A lot of this has been an issue with the air pollution and of course, the California fires. We are at increased risk. And then finally, anything produces inflammation and you can literally trace the molecular biology as NF-kappa B gets activated, for example, and changes your production of amyloid goes literally from a growth and maintenance mode, over to a protective downsizing mode.

And it really is a beautiful story. It’s very much like what we saw in our country that happened with the pandemic. We were all told shelter in place, socially distance, don’t go to work, do your meetings on zoom and what happened? We go into a recession. So that’s the same thing your brain is saying, okay, I’ve been exposed to various toxins, various pathogens, and I’m going to go into a protective downsizing mode. And the amyloid is part of that. Now, unfortunately, yes, amyloid causes you to lose synapses. And so there are multiple forms of amyloid and each one has its own effect, but ultimately these things impact your mitochondrial function. They impact your insulin signaling. And so Dr. Ashe, I believe, in her papers was going after is there one predominant form that is the toxic form and they did beautiful work.  Now we’ll see if it holds up, but they did beautiful work to show that there’s something called a beta star 56, one particular form that seems to be quite toxic. Now my argument would be, yeah, it’s part of the downsizing and let’s face it, all the other ones have some degree of toxicity as well. Now, a number of other labs have tried to repeat that work. It’s not been clear. That hasn’t been held up as, yes, this is the obvious thing. This is the only thing that causes the problem.  And again, I would argue that this is more of a mediator, just like tau is also a mediator. These are mediators rather than the upstream cause. And that’s important because when you go after them, if you’re just going to remove that, but you don’t remove the cause, you’re going to have long-term problems, of course. So there are all sorts of theories. It’s herpes, it’s type three diabetes. As you know, theory, after theory, after theory, none of them has led to an effective treatment for this disease.

Dr. Weitz:                          Right, because they’re using this stripped down analytical, there’s got to be one pathway with one drug. I want to make a couple of points. One, just to wrap up what we were saying about the study is one of the things to say is that the original researcher, this Schrag guy, he was working for a hedge fund that could solve a drug, but the data that’s been reported in science was Science Magazine took his data and then they did their own six month investigation without any sort of hedge fund involved or anything else and hired several doctors, several experts at imaging and took six months to really investigate this before they actually reported their findings. So I think we should be pretty confident that those findings are free from influence.

Dr. Bredesen:                    Absolutely.

Dr. Weitz:                          And then second of all, one of the points that you’re making is we always have to think about the human body and the wisdom of the body and if the body is laying down a protein in the brain that’s damaging us, we’ve got to ask ourselves what’s going on? Our body doesn’t just lay down proteins to cause damage, to harm us. There’s usually a reason why. The reason why the body’s laying down cholesterol in the arteries is not to cause us to die of heart disease, it’s to protect the arteries from inflammation. And so therefore, the point you’re making about the brain is that the amyloid is actually helping to protect the neurons from infections, Rudolph Tanzi found out for the first time that, actually, pathogens like bacteria and viruses, and maybe even fungi can penetrate the brain and then also heavy metals and other toxins and all these things can cause damage to neurons. And the amyloid is originally the body’s attempt to try to protect us.

Dr. Bredesen:                    All these things.

Dr. Weitz:                          Oh yeah. The other point about the pandemic. If we ever wanted to have a situation that’s liable to increase the risk of Alzheimer’s disease, let’s close all the gyms. Let’s cause everybody to stay inside. Let’s have them stressed out. Average person gained 30 pounds. And then on top of that, we have this virus ravaging the community, a virus that we know penetrates into the brain. All the conditions are there the last two years. It’s not going to surprise me if we have an increase in Alzheimer’s disease.

Dr. Bredesen:                    Yeah, no. And that’s been one of the big concerns. As you know, there are all sorts of factors that influence us and just for perspective, let’s point out that there have been over a million Americans who have died from COVID 19. Of the currently living Americans, about 45 million of us will die of Alzheimer’s, so it actually dwarfs the COVID 19 pandemic, unfortunately. It’s just that, of course, it goes more slowly. So yeah, absolutely, there is a concern. There’ve already been a couple of people who developed Parkinson’s, as you know, associated with COVID 19. Fortunately, it’s only been a very few, so time will tell whether that… And I think what’s happening so far is that we’re seeing much more brain fog, especially in the long COVIDs, where people just know something is not quite right. And this may be the earliest stages because I think it’s important to point out that you don’t get Alzheimer’s overnight. You really go through four phases.

And what we call Alzheimer’s is literally the fourth and final phase. So you have a period where you’re asymptomatic, as you know, but you can already pick up changes on PET scans and spinal fluid. Then you go through SCI, subjective cognitive impairment, which actually lasts about 10 years, surprisingly, where you’re still able to score normally on standard cognitive testing, but you know there’s something wrong. And then the third of four stages is called MCI, mild cognitive impairment. That’s an unfortunate name because it’s a relatively late stage of the disease. It’s like telling someone don’t worry, you only have mildly metastatic cancer, very unfortunate term. And then the fourth and final stage where you’ve now begun to lose activities of daily living is, of course, what we call Alzheimer’s. So if everybody would come in the first two stages, prevention or early reversal, instead of the last two stages MCI or Alzheimer’s, which is the typical story, then we really could make this a rare disease, which is what it should be.

Now, you mentioned the paper we just published and it’s actually coming out in print this month, but it came out online in July in the Journal of Alzheimer’s Disease and just basically showing that with a proof of concept trial, we made 84% of the people actually better. They improved their cognitive scores, didn’t just slow their decline, improved their scores. And it was, of course, a functional medicine approach, going after what’s causing the problem, looking at their inflammatory markers, their various metabolic pathways, pathogens, toxins, all these sorts of things.  And we showed in that paper that, in fact, we improved the metabolic profiles of these patients. And in association with that, now we don’t know if it’s causal, but in association with that, not only did they improve their cognitive scores, improve their partner’s assessment of, oh, how well are they doing day-to-day? So there’s really real world improvement. But in fact, we actually improved their MRIs as well, so that their gray matter actually got larger. So just striking effects on these people. And we’re using those data to start a larger randomized controlled trial.

Dr. Weitz:                          That’s great. How many people are going to be in that trial?

Dr. Bredesen:                    This new trial, actually, we proposed initially a hundred, the statisticians came back to us and said, no, you’re having such big impacts on these people, you don’t need a hundred. The reason for these 1500 person trials that the drug companies are doing is because the effect is so small. You can’t get a statistically significant difference unless you do thousands of people. So for the effects we’re getting, we only need to do 72. We’ll have 48 of these in the treatment group initially. And then 24 in the control group that will get standard of care. Then after nine months, the control group, if they would like to, will then have six months of free treatment with the approach that we’re taking, the precision medicine approach. So everybody will ultimately be treated, but of course, it’s important to compare it to standard of care.

Dr. Weitz:                          That’ll be really interesting to see a group that gets standard of care and then does get some of the care, but a shorter period of time and then the other group.

Dr. Bredesen:                    Absolutely. And I should say, I’m really honored to be working with three absolutely outstanding physicians in the first paper and now six outstanding physicians for the second paper. We have Dr. Kat Toups from the East Bay here near San Francisco. We have Dr. Ann Hathaway, who’s right here in Marin County. We have Dr. Kristine Burke, who’s from Sacramento, Dr. David Haase from Nashville, Dr. Craig Tanio from Miami and Dr. Nate Bergman from Cleveland. So really excited to be working with six now absolutely outstanding physicians. We had three for the first group, and I should mention Deborah Gordon as well, who is in the first study, but is actually just retiring now.

Dr. Weitz:                            That’s great. That’s awesome.

 



 

 

Dr. Weitz:                            We’re having a great discussion, but I’d like to interrupt our talk for a few minutes to tell you about our sponsor for this podcast episode, Integrative Therapeutics. This is one of the few professional brands of nutritional supplements that I carry in my office. I’d like to highlight some research with Integrative’s highly bioavailable and absorbable form of curcumin called Theracurmin.  A study was conducted at UCLA for 18 months with elderly men with memory decline, though not Alzheimer’s disease. And the study showed that this regular dose of Theracurmin, which is two capsules a day, resulted in significant improvements in memory and in mood. They also did PET scans of 67% of the subjects in the study and noted a significant decrease in amyloid tangles and Tau proteins in the Theracurmin group. A second study was completed in 2021 and published in current Alzheimer’s Research using Theracurmin and they looked at Alzheimer’s patients in this study with mild cognitive impairment, and they gave them Theracurmin for six months, the typical dosage of two capsules a day. And while they did not see a reversal of impairment, they did observe that the Alzheimer’s disease stabilized and cognitive decline was completely halted, which is an awesome result, much better than any of the leading Alzheimer’s drugs. And now back to our discussion.

 



 

Dr. Weitz:                            How well is your information being received by the conventional neurology community?

Dr. Bredesen:                    That’s a great point, not well at all. And so this is the problem. What we’re saying is guys, you’re all sitting on the Titanic, writing in prescriptions as it’s going down because of the chronic illnesses. You need to change course. You need to do something completely different.  The problem is when your whole medical school experience, when your whole career has been about 20th century medicine, you’re very reluctant to give that up and to say, okay, this is actually going in the wrong direction. It’s very hard for people to admit, hey, this is going in the wrong direction.

So I do think in the long run, we need to teach in medical school more modern medicine, more 21st century medicine, more precision medicine, functional medicine, integrative medicine, P4 medicine, whatever you like to call it, where instead of asking the question, what is it? Is it lupus? Is it RA? What is it? And write a prescription, we need to ask, why is it? What are all the things that contributed to the current state of affairs? Human beings are complex organisms. There’s no question about it, especially when you’re trying to treat their brains. And so we need to have these larger data sets and we need to look at how we can address all of the different contributors to neurodegeneration.

Dr. Weitz:                            Yeah. I think what we just said about these two contrasting studies, that’s got to be common knowledge that conventional medical model is just not working for chronic diseases that are the main problem that we’re facing in medicine today. And just finding the one cause and the one drug is just not going to work for any of these conditions without addressing lifestyle and diet and exercise and sleep and exposure to toxins and nutrient status and all the other things that affect our bodies.

Dr. Bredesen:                    Yeah. I mean, you mentioned before, really, people have tried to ignore the fact that we just published, hey, for the first time, here’s something you can do about this disease. It’s not just anecdotes. And these clinical trials, they have a CTAD, which is clinical trials and Alzheimer’s disease meeting. This is a tale of two CTs. So two clinical trials, one with aducanumab where they’re trying to argue for efficacy, when it’s clear to anyone that they didn’t have an impact. And then here’s one where we’re using much more of a precision medicine approach where it’s clear that there were improvements. Now, one of the, I think, fair criticisms is you need to do a larger study and you need to do a control, where we used historical controls, in part, because when we first went to the IRB with this, they would not allow us. They said, look, this isn’t standard of care yet. So you got to start with an observational trial. If that works, then okay, now you go through more of a standard randomized controlled trial. Okay. Fair enough.  So we’ll get there, but at the same time, we know what happens to patients with Alzheimer’s and MCI. They don’t typically get better. Yes, a few people with MCI may see an improvement, but I think to me, one of the best meters for comparison here is that we worked with a trial expert, Dr. Kat Toups, and she did dozens and dozens of trials during her career. And she never saw improvement. So she was part of this trial that we just published. In fact, she was the lead author on the trial and she has never seen results like this before, so that gives you someone who did lots of trials with standard of care.  And now is doing a trial with a functional medicine approach and can see the much better outcomes.

Dr. Weitz:                            I’m sure one of the criticisms is going to be that what’s the acceptable model for study is that you just change one variable. Everything has to stay the same in both groups and one group gets one thing different and that’s because that’s the way you study drugs and anything else is not considered state-of-the-art research.

Dr. Bredesen:                    Exactly. Yeah. So we’ve got to find a better way to do our trials. And again, we have to match up the way we do with trials with what the science is telling us. The science is telling us this is not a single variable problem. This is a network insufficiency. And to get best outcomes, we’re going to need to address different parts of that network.

Dr. Weitz:                            Eventually, the whole medical model needs to change if we’re truly going to have a 21st century medicine that’s addressing the chronic diseases of today. This idea that the insurance companies are controlling the healthcare system and doctors are limited to this very short office visit where they can go in, figure out what the diagnosis is, write a prescription for a drug and that’s the end of the visit is just not going to work for these chronic diseases like autoimmune diseases, like Alzheimer’s, like diabetes, et cetera, cetera, that require a systemic of functional medicine or broader approach that involves changing diet, lifestyle, et cetera. So somehow the medical model has to change.

Dr. Bredesen:                    I couldn’t agree more. We as a society must decide if healthcare is ultimately about incomes or outcomes. The problem is it’s all been about incomes. How do they make more for this drug company? How do they make more for the healthcare model? And that’s why things are falling apart. We have to look more at outcomes. Can we get people to improve from these various diseases? Then we figure out how best to get them the appropriate protocol and what healthcare system will offer this. Those are the sorts of things, but we’ve gone down this blind alley and we’re now stuck at the end of it.  Not to mix too many metaphors here, but we’re stuck at the end of this blind alley and it’s just not working. As everybody knows, medicine is broken. And you look at people who are practicing functional medicine. Oh my gosh, they’re getting better outcomes with cognition. They’re getting better outcomes with things like autism. They’re getting better outcomes with things like autoimmune diseases and you just go right down the list. And so we really need to be looking at how do we change medicine for the advantage of the patients instead of the companies.

Dr. Weitz:                            So the best benefit for patients with Alzheimer’s, just like it is for all these other chronic diseases, these autoimmune diseases, that there’s this long, long, slow progression towards disease. And how do we intervene as early as possible? So what are some of the most important early warning signs that somebody’s brain is going the wrong direction?

Dr. Bredesen:                    That is a great point. As you know, you can basically break it down into two groups, about two-thirds of people that are starting to have cognitive decline and ultimately down the road will have Alzheimer’s disease will start with what we call an amnestic presentation. So they’ll have problems with memory. And it’s typically short-term memory, it’s consolidation. It’s basically remembering what you had this morning for breakfast, remembering where you left your keys. And, of course, so commonly people say, well, I can’t remember this or I can’t remember that. And of course everything is backward because there hasn’t been a good treatment. So people will say, “Don’t worry, it’s probably not Alzheimer’s.” Well, that doesn’t help. What you want to do is fix whatever it is and make sure that you don’t get Alzheimer’s. Then the other one-third about of people will come in with a non-amnestic presentation and that is executive function, so planning problems.

I always ask people if you had to get a bunch of stuff together, throw it in a suitcase and get out the door in one hour, could you do that? And they’ll say, “Oh no, I can’t do that anymore.” They’ll have trouble at their jobs because they just can’t organize things the way they used to or it’s trouble with word finding, what’s called primary progressive aphasia or it’s trouble with recognizing shapes and faces, what’s called posterior cortical atrophy. Things like that, problems with calculations, another parietal lobe problem. So those are the non-amnestic presentations. And what we’ve found is that in general, as a general rule, when you have someone that has a non-amnestic presentation, especially if they’re relatively young, they’re in their fifties, for example, we see this now all the time, they are strong candidates for toxin associated cognitive decline, often biotoxins.  So please look carefully at the mycotoxins. If someone is coming in in the fifties, they’ve got a non-amnestic presentation, especially if they’ve had some depression in association with it. This is something that I did not see way back in the eighties when I was a resident in neurology. And now it’s one of the more common presentations. And as you indicated, this is going on for years.

So we recommend everybody who is 45 years or older, please get a cognoscopy, just like we know you get a colonoscopy when you turn 50. And my wife and I had his and hers colonoscopies on Valentine’s Day when we were in our fifties. So we’re like, look, let’s get this over with and then we can relax a little. So everyone, please get a cognoscopy if you’re 45 or over, that’s some blood tests that look at these various things and things looking at the stuff that your doctor typically isn’t looking at.  Second part of a cognoscopy is a simple online cognitive assessment. Everyone should have one of those to know where you stand because this can sneak up on you. And then the third part, if you have symptoms or if you score poorly on the cognitive exam, please also get an MRI with volumetrics, but if you did well and you’re just there for prevention, don’t need the MRI. And then, get on active prevention or the very earliest reversal I just had a group that contacted me the other day, husband and wife actually where they’re both physicians and the wife said, “Well, my husband is having problems and we took him to the neurologist and he said, oh yeah, this is just normal aging.” This guy had gone past phase one, past phase two, past phase three and now was in early stage of dementia, but he was told by his doctor, his neurologist, that this was just normal aging. And actually this guy turned out to have hydrocephalus.

So, oh my gosh, this should never be missed. Please, please get in early. The reality is Alzheimer’s should be a rare disease. We should keep our cognition. The goal is to keep everyone sharp to a hundred. And this idea that the current standard of care, you just wait for things to get really bad. And then you go in and get a drug that doesn’t help much. That is barbaric.

Dr. Weitz:                          So how did this neurologist miss that? Did he not give him a cognitive assessment test?

Dr. Bredesen:                    No. Well, what he did was he said, “This is just normal aging, so I don’t need to do anything more.” The other thing is, the foundations are hurting us, because one of their recommendations is you don’t need to check your APOE status. This is the most common gene in association with Alzheimer’s because there’s “nothing you can do about it” don’t bother to check it. Now, three quarters of the population is APOE4-negative. Typically, it’s a APOE33, which is the most common or APOE23, which is relatively resistant. Now, if you have no copies of APOE4, your chance of Alzheimer’s during your lifetime is about 9%, not too high, but it’s not zero. If you have a single copy of APOE4, it’s about 30%. And if you have two copies, it’s way over 50%, so most likely, you will get Alzheimer’s. Now the reality is none of these people should be getting it, check it early, get on appropriate treatment and prevent yourself from getting Alzheimer’s disease.

Dr. Weitz:                          Yeah, a similar situation exists with lipoprotein (a), LP little a, for cardiovascular disease because there’s no drug that’s presently approved to reduce it. Doctors don’t want to do the test. The insurance companies don’t want to pay for it. And of course, they’re working on a drug in a couple of years and once that drug’s available, then they’ll do the test, but the reality is, we need to know if this person has this atherosclerotic risk and there are things we can do naturally to reduce the risk.

Dr. Bredesen:                    Yes, exactly. So many things. And, again, if you get a cognoscopy, then you can actually get a report that looks at different pieces of this and says, here are your major risks. And so that people can know, ah, because some people it’s more about inflammation. It’s about specific pathogens or it’s about leaky gut. Of course, oral microbiome, as you indicated, these pathogens can get into your brain. And of course, what does your brain do in response? It coats them with amyloid to kill them and to bar them from getting to the rest of the brain, to cordon them off. That’s what amyloid does. And so you can get these things and you can look also some people it’s more atrophic. They don’t have enough support for their brain. Some people they’re lowering their oxygen. It’s more energetic. They lower their oxygen at night, for example. Some people it’s more vascular, so it’s important to know what your risk is and why your risk is.

Dr. Weitz:                          Can you just talk for a minute about how certain nutrients like vitamin D or omega-3s or some of these other nutrients, some of the B vitamins are crucial for brain health because you hear from a lot of the conventional primary care doctors that all the studies show that there’s no benefit to taking nutritional supplements.

Dr. Bredesen:                    Yeah. It’s so silly. It depends, of course, on how you couch the question, if you say, okay and what’s typically said is by the mainstream doctors, supplements are not a cure for Alzheimer’s. Of course, they’re not, nobody’s saying they are. And yes, to be fair, there are silly commercials that make claims where they haven’t supported them, when you’ve actually had a trial that gives you some support for, yeah, this actually helps. So you need to do that. But when you look at improving your neurochemistry and again, this is about a network insufficiency, so you got to find out what’s being insufficient. Is it because you’re asking too much because you got a lot of inflammation? Is it because you have low nutrient? And of course, poor nutrition is everywhere. We see it all the time with things like metabolic syndrome.

And of course, NASH, non-alcoholic liver disease, NAFLD, all this stuff. So, this is an issue and yes, as you indicated, vitamin D is a great example, one among many. Vitamin D, of course, interacts with its receptors. It enters the nucleus and affects hundreds and hundreds of genes so that it changes your immune system, changes your response to COVID changes your heart disease related problems, of course your calcium metabolism, but also your cognition. So that’s an important one. Of course, B12. B12 deficiency was shown and has been shown four years to be associated with cognitive decline. And it would always amaze me that, in what we call within normal limits, at the low end of that, you could literally die from B12 deficiency, but it was still being called within normal limits. You could be normal and die from having too little B12.

Again, we urge everyone get to that midpoint or above there. You want to be more in the 500 to a thousand range. You don’t want to be at the 300 or the 280 or any of that sort of stuff. And then there are others, as well. As you indicated, omega-3, resolvins, which are cousins of the omega-3s. Of course important, when you get inflammation to resolve that. As professor Charles Sirhan from Harvard showed a number of years ago, and you can just go again, on and on down the list. Magnesium, of course, there are studies suggesting lithium is also important, especially for behavioral things, but also important for cognition. And so yes, having appropriate nutrition and that starts with getting an appropriate diet. And again, I get it. Diet is not a cure for Alzheimer’s, nobody’s saying it is, but poor diet is certainly a contributor to cognitive decline. There’s no question about that. And we see it all the time.

So what we recommend is a plant rich, it doesn’t have to be exclusively plants, but a plant rich, mildly ketogenic diet. We’d like to see people 1.0 to 4.0 millimolar beta hydroxybutyrate if you do a blood test. If you want to blow in to a breathalyzer, like a Biosense, that sort of thing, then you want to be 10 to 40 on their “ACEs scale” for your acetone, so, yeah, sometime during the day. So plant rich, mildly ketogenic diet with appropriate periods of fasting, 12 to 16 hours, because critical things happen there with reducing inflammation and with cleaning your brain, appropriate autophagy. So phytonutrients are key. Appropriate fiber is key. All of these things are helpful for your cognition.

Dr. Weitz:                          That’s great. What’s your favorite neurocognitive assessment test?

Dr. Bredesen:                    Yeah, there are a number of these. I tend to like to use CNS Vital Signs because it tests various things, and we use that in our trial with MoCA scores. MoCA is great because it’s very quick, SLUMS, same idea. These are both zero to 30 point scales. MMSE is another one with a zero to 30. The only issue with MMSE, it’s more for people who have dementia. It’s not so good for picking up the earlier ones. So MoCA is good for MCI, which is, by the way, why it was developed. MMSE good for dementia, and then CNS Vital Signs good for SCI. Those two together give you a nice dynamic range. And we’re interested, by the way, in looking at people who have very low scores. I would call this the “Sarah trial,” severe Alzheimer’s reversal attempt and we’re looking at that down the line, but right now we’re focused on this RCT that I mentioned earlier.

So I like CNS Vital Signs, but, of course, there’s Cambridge. There’s a group out of University of Texas that has another very good one. So different people like different ones, but whatever you use, you want to have something. First of all, don’t take people four to six hours. Some of these older ones are just horribly long and very stressful. Stress is not good for these people, especially the ones who have toxin associated cognitive decline. So make it easy on them and use something that can be done online and fairly quickly and that tests various areas of the brain. You want to look at the verbal memory. You want to look at the spacial memory. You want to look at the executive function. You want to look at spatial recognition, things like that.

Dr. Weitz:                          And should we be considering using an MRI that looks at the volume of the brain as a screening tool as well? Maybe that would be something that everybody who’s really into longevity and prevention should get.

Dr. Bredesen:                    And as you know, people have done total body scans as part of the longevity studies. I think it’s fine. My only point is if you want to keep it simple, you don’t have to do that if you truly are for prevention, but if you prefer to do that, absolutely. And certainly if you are there and you’ve already got symptoms, you absolutely should do an MRI with volumetrics and the volumetrics add a lot because you’re looking at what is the hippocampal volume? What is the gray matter volume? What is the parietal lobe volume? Temporal lobe volume? Do you potentially have some normal pressure hydrocephalus? Is there in fact, a chronic non-malignant brain tumor, like a meningoma or a minimally malignant one that might have been missed. So all of these things are very helpful to know.

Dr. Weitz:                          Is the MRI with volumetrics NeuroQuant? Is that an example of that? Or that’s-

Dr. Bredesen:                    So there are two different groups, NeuroQuant and Neuroreader, they both work very well.

Dr. Weitz:                          Okay. Excellent, excellent. Good, good. Always a pleasure to talk to you, Dr. Bredesen, excellent information. I’m very excited for more people to learn about your work and for practitioners to start figuring out how we can really reverse Alzheimer’s disease by taking this systems approach.

Dr. Bredesen:                    Thanks so much, Ben, for having me on and I appreciate the fact that when you do your various interviews, you don’t have any fraud. You don’t fix the interviews, you don’t change the words coming out of the mouth, you don’t to have Science Magazine go after you and say there’s no cure from Alzheimer’s and you change their words, [crosstalk 00:44:15] And the here’s the problem. We appreciate that.

Dr. Weitz:                          Don’t give me any ideas. So can you tell people how especially, I guess, practitioners about your training programs?

Dr. Bredesen:                    Yeah. Great point. So we have a training program. We’ve trained now over 2000 physicians in 10 different countries and all over the US. This is so called ReCODE 2.0 training and it’s also available for health coaches, for neuropsychologists, for nurse practitioners, in all of those groups as well and hopefully to get them, to look at the right things and to have a strategy that will help to get the best outcomes. And you can look at ReCODE 2.0 training. You can look at Apollo Health. We set this up with Apollo Health Co. And so any of these to give you more information, also have a Facebook Dr. Dale Bredesen, so you can follow there or on Twitter or on Instagram.

Dr. Weitz:                          Awesome. Thank you, Dr. Bredesen.

Dr. Bredesen:                    Yeah. Thanks so much, Ben. Great to talk to you.

 


 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica White Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.

 

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The Gut Health/Autoimmune Disease Connection with Dr. Tom O’Bryan: Rational Wellness Podcast 270

Dr. Tom O’Bryan discusses the Gut Health/Autoimmune Disease Connection with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on July 28, 2022.

[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

 

 



Dr. Tom O’Bryan is a Doctor of Chiropractic, a best-selling author, and an internationally recognized speaker focusing on food sensitivities, environmental toxins, and the development of autoimmune diseases. His 2016 book, The Autoimmune Fix won the National Book Award and the docuseries he released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You  has been seen by over 500,000 people worldwide. He also organized The Gluten Summit – A Grain of Truth. His website is www.theDr.com  His second book You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had was also a best seller.

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. If you do listen to the Rational Wellness Podcast, please give me a ratings and review on Apple Podcast.



 

So our sponsor for this evening is Integrative Therapeutics, and so I’m going to read a little bit about a few products from Integrative Therapeutics. Integrative Therapeutics is one of the few professional brands of nutritional supplements that we carry in our office.  So one product is a Physician’s Elemental Diet, this is an aggressively hypoallergenic short term gut boost or reboot for any kind of autoimmune flare up related to permeability, and it works excellent for SIBO and most other gut problems. It’s typically a two week deal, but it’s been shown to be as effective as Rifaximin or the other leading strategies for SIBO. Another excellent product that we use a lot is Theracurmin, and this is their water soluble curcumin, and it has the highest bio availability and studies show you end up with the highest blood levels of all the forms of curcumin on the market, and there’s actually been quite a number of scientific studies using this particular product, and another great thing about it is, the therapeutic dosage is two capsules a day, and then one more product from Integrative is Glutamine Forte, and this product contains five grams of glutamine per scoop with Theracurmin added as well, and it’s a great tasting powder that allows for dosage flexibility.

 



 

Dr. Weitz:                            Our speaker for this evening, Dr. Tom O’Bryan, is a doctor of chiropractic, a bestselling author, a professor for the Institute of Functional Medicine and an internationally recognized speaker who focuses on gluten, food sensitivities, environmental toxins, and development of autoimmune diseases. His 2016 book, The Autoimmune Fix won the National Book Award and the docu-series he released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You, has been seen by over half a million people. He also organized the highly successful, The Gluten Summit. His website is thedr.com. His second book, You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity and Sleep You’ve Ever Had, was released in 2018, and it was another huge hit. Tom, thank you so much for joining us tonight.

Dr. O’Bryan:                        Thank you, Ben. Thanks so much, it’s really a pleasure. And thank you all for being here, I know it’s been a long day at work, probably, and appreciate your taking the time for this. I have found that my entire life, where I have shined the best is at a catalyst and in thinking about a bigger picture and in my practice, it was always that way, and that’s where I got the most juice, and certainly tonight’s going to be another example of that. I’ve got some ideas here to share with you that I think may not be new, but may have been put in the back corner of our awareness and I want to make sure they’re right in the front for everyone. Dr. Weitz, I need to be able to share my screen.

Dr. Weitz:                            Oh yes. Sure.

Dr. O’Bryan:                        And I’ve got way too many slides, I’m told that…

Dr. Weitz:                            Oh.

Dr. O’Bryan:                        I’m told that I speak faster than Jeff Bland and have more slides.

Dr. Weitz:                            Oh boy.

Dr. O’Bryan:                        So, sorry about that. And we’ll pause at some point, but put your questions in the Q&A, as Ben suggested, and we will get to them and I’ll stay with you guys as long as you want, or until my voice goes. So, here we go, let’s just get started. Fire in the hole, that’s a term that just resonates for me, that when you read the science on so much of what we’re dealing with from the gut and it’s contribution just across the board, I remember the old combat television show and other shows where they say, “fire in the hole”, and everybody dives down really deep, that’s what we’ve got going on in chronic inflammatory diseases.

I’m going to show you this. I’m just putting a clicker here on my computer, so I don’t have to keep hitting the button all night, it’ll take just a moment to get that up and running and see here if I can make it work. So let’s just move on here. Lots of gratitude to Ben for doing this, by the way, whoever the sponsor is tonight, the company that Ben referred to, he’ll put the email address for the rep for that in the chat room, could everyone just take a moment and copy it, paste it into your email box, send the guy a little thank you, “thanks for doing this, I really appreciate your company doing this.”

I mean, those people are working hard just like we are and they’re a business and they want to know that their investments make a difference, and I’m really grateful for Ben and the thankless job of what he does to host these events and people that do this all over the world, and I come to these events and give my time and really happy to do that because a rising tide lifts all boats, lifts all ships that as we all learn some of these topics, we can make an impact on humanity. So the sales rep for this company is doing it in his way, Ben’s doing it his way, I’m doing it my way, you’re doing it your way, but take a moment and just send a little thank you to that rep, it’ll surprise them and they’ll be happy with that.

All right, let’s move on here. This is my first mentor, Dr. George Goodheart, the founder of Applied Kinesiology and I had over 450 hours with George by my second year in practice, when I was still in school I began studying with him and we called him, The Great Wazu, that his knowledge base was just jaw dropping for us, and his presentations, his 10 hour weekends were at the Marriott Hotel at the Detroit Airport. So, people fly in from all over the world and we’d just hang out all weekend and celebrate, and the stage that George would stand on was a wooden stage in the room, and he would do this so many times in a weekend, he would lift up his right leg, cock his right leg up in the air, lift his right arm, and he would slam his foot down, “why doctor?”

And he’d slam his foot on that wood stage, and we’d all get startled by it. Some of you who may have seen one of his events will remember that, that was his signature. “Why? Why does the patient have what they have?” And he’d say, “you have to look with eyes that see, listen with ears that hear”, and I was a young stud and I’d say, “yeah, whatever”, I didn’t know what it meant, now I know what it means. That as we look a little deeper and as we look at the contribution of the mucosal lining of the gut in the development of rheumatoid arthritis or multiple sclerosis or Parkinsons, it doesn’t matter what disease you talk about, and if you put your consciousness inside the lumen of the small intestine, you do an OMG, it’s like, “oh my God, all of that is going on. Wow. That explains why…”

And there’s just more understandings that come up. Why was the question again and again, and again, look with eyes that see, doctor. Listen to the patient with ears that hear what they’re saying, and it formed my way of looking at patient mechanisms, where did all this come from? So between Dr. Goodheart and I attended my first Jeff Bland talk in Chicago in 1978, it was his first talk in Chicago, and I’ve been listening to Jeff ever since. So between George Goodheart and Jeff Bland, that formed my consciousness about asking questions internally, “why is this happening to this person? Where’s it coming from?” So what’s the most prevalent pathology at the root of practically every disease? Well, one of the most important medical discoveries of the past two centuries is that, it’s the immune system creating inflammation not just for a few select disorders, but for every chronic inflammatory disease, the immune system gets activated.

So the question is, what is it trying to protect you from? If your immune system is the armed forces in your body, the army, the Navy, the Air Force, the Marines, the coast guard, IGA, IGG, IGE, IGD, IGM, and then the innate immune system with all the cytokines, if it’s the armed forces trying to protect you, what is it trying to protect you from? Chronic inflammatory diseases are recognized as the most significant cause of death in the world today, and they dominate present day morbidity and mortality. Yes, okay. We know from the CDC that 14 of the 15 top causes of death today are chronic inflammatory diseases. Everything except unintentional injuries is a chronic inflammatory disease, which means, when you go down and when I go down, it’s going to be because of a chronic inflammatory disease, most likely.

And if it’s a chronic inflammatory disease, and I keep saying it that way for a reason, but if it’s a chronic inflammatory disease, chronic means it’s going on for a long time, and if you’ve heard me talk before, if you’ve read my books, you understand that you can identify the mechanism of rheumatoid going on 14 years before a person gets diagnosed with MS, and Hashimoto’s, seven years before they get a diagnosis, they’ve got elevated antibodies. With diabetes, 11 years, 11 to 14 years with diabetes, and that’s called predictive autoimmunity and read my book, The Autoimmune Fix and you’ll say, “oh my God, I didn’t know that”, and that was the formation of Cyrex Labs. I was privileged to be a part of the initial team at Cyrex, that’s why I moved from Chicago to California in 2010, was to open Cyrex.

And we talked about all of the markers to use and which one should be on which test and why this one and why that one and Cyrex Array number five, the autoimmune panel looks at 24 different antibodies to self, and when you get these elevated, and I did this test myself in 1999, when it was still in the research phases and I got my test results and I called the lab, I said, “what is this? This is a mistake”, because I was in my early forties doing triathlons and scoring the top 10% of the 30 to 35 year olds, I thought, “I’m a stud, I’m healthy”, but my test came back and I had three antibodies elevated to my brain, myelin basic proteins, cerebellar peptides and gangliosides, and I called them and I said, “this is a mistake.” “No, it’s not.” “To do it again.”

“We did. We know it’s you. We did it again. Sorry.” And that’s when I learned about predictive autoimmunity and that these mechanisms go on for decades sometimes before you ever have any symptoms, killing off cells, killing off cells, killing off cells. So a chronic inflammatory disease is chronic. By the time they get symptoms, the body can no longer compensate for the insult and the inflammation killing off cells, killing off cells, killing off cells. I love this drawing, because at the center of every chronic inflammatory disease is systemic chronic inflammation, well, that makes sense. So what’s turning the wheel of systemic chronic inflammation? Well, it’s disbiosis and obesity and physical inactivity and chronic infections, bacterial and viral and food selections and chronic stress and stress hormones, lack of sleep, xenobiotics, that turns the wheel of the chronic inflammatory cycle that manifests wherever the genetic weak link is for the person. Type two diabetes, non-alcohol product liver disease, cardiovascular disease, the list goes on and on, but it’s not just the genes, don’t ever say genes cause disease. No, they don’t. You pull it a [inaudible 00:15:10]

There are some like cystic fibrosis and down syndrome, those are unfortunate, and if you carry those genes, it’s a really difficult one to quiet down, but with all of the other genetic vulnerabilities, the goal is to dim down those genes from expressing themselves, you do not turn genes on or off, so please stop saying, “let’s turn those genes off for [inaudible 00:15:35] four for Alzheimer’s”, they don’t turn off. They operate on a dimmer switch and you can dim down that function and ramp up the genes of anti-inflammation. So tell your patients about dimmer switches, and every time they cheat, they’re ramping up the genes of inflammation, and that helps them to understand and be more successful in applying the recommendations that you’re giving to people.

So what present complaints in your practice are not inflammatory? Well, accidents, they’re the only ones that are not chronic inflammatory conditions. Shifts in the inflammatory response from short to long live cause a breakdown of immune tolerance and lead to major alterations in every tissue in organ, as well as normal cellular physiology, which increase the risk for various non-communicable chronic inflammatory diseases.

Understanding both the internal and external processes that foster chronic inflammation may provide important insights into why people develop their chronic inflammatory diseases, and I put that in here because many of us forget about the endogenous triggers of chronic inflammation, the heavy metals, the pesticides, the insecticides, the list goes on and on, you have to explore that with every patient that’s got a chronic inflammatory disease, of course their diet, everybody knows, you put them on a gluten free diet and they start feeling better some way or another, usually that happens, but what’s inside has to be addressed also, all of the organal phosphates, the altered microbiome, you have to address that also. A complex balance exists in the intestinal ecosystem, highlighting is mine, that if disrupted, compromises the function and integrity of the intestinal ecosystem and is the trigger for chronic systemic inflammation. So, if 14 of the top 15 causes of death are chronic inflammatory diseases, when do you think the chronic nature of the inflammation begins for the person that’s presented in your office with symptoms? It’s years and sometimes decades before they develop a symptom.

So chronic inflammatory disease develop over time. I’m just going to breeze through this, I’m sure most of this is quite familiar to all of you, and for those that are not, it’s elaborated on in great detail in my book, The Autoimmune Fix, but here is the paradigm shifting article by Melissa Arbuckle in the New England Journal of Medicine, in 2003 we knew this, she went to the VA and she looked for people with lupus. She found 132 people with lupus in this one VA center. Now she knew that if they’re in the VA center, they’re veterans, if they’re veterans, they were in the armed forces, if they’re the armed forces, they had their blood drawn many times over the years when they were in the armed forces and healthy. What most people don’t know is that the government’s been saving almost all of their blood since 1978, they’ve got tens of millions of samples of our service people’s blood frozen.

Well, Melissa Arbuckle knew this, so she went back and asked for permission to look at the blood in storage of the currently diagnosed lupus patients when they were healthy in the Marines or the Navy, she got permission, and what’d she find? That auto antibodies for lupus, and there are seven antibodies to lupus, there’re all elevated years before there’s ever a symptom, and that the elevation follows a predictable course, and this is the drawing that she did, these are the seven antibodies to lupus and the zero line is the normal reference range, not that they don’t have any, but that they’re within the normal range, anything above the zero line means they’re elevated.

And you see every single antibody is elevated five years before they ever have a symptom, and some of these antibodies were elevated 11 years before they ever had a symptom, and there’s a predictable course of elevation every year that occurs, killing off cells, killing off… By definition, if you’ve got elevated antibodies, that means you’re killing off more cells than you’re making, that’s what elevated antibodies means. So when you get a test back that looks at 24 tissue antibodies, and you’ve only got three that, “oh, don’t worry, Mrs. Patient you’ve only got three”, nonsense, you can’t have any elevated, because you’re killing off more tissue than you’re making.

And this was a summary that she did that six years beforehand, every one of these antibodies were began at 50% above normal range, and then they just went up, up, up, up, up, and she did this bar graph or this drawing and she made it up, you have a normal level of antibodies, if you do a thyroid antibody test, why is there a normal level of TPO antibodies? When is it normal to have antibodies to your own tissue? Well, it’s because for cellular regeneration, “you have an entire new body Mrs. Patient every few years, every cell regenerates.” How does that happen? You have to get rid of the old and damaged cells. How does that happen? By antibodies, and by cytokines, they get rid of the old and damaged cells, so there’s a normal range of antibodies, but when you have elevated antibodies, you’re killing off more cells than you’re making.

So Dr. Arbuckle shows here, the normal level of antibodies, then they have what she referred to as benign auto immunity, it’s not benign, they’re just no symptoms, but it’s killing off cells, and then you have pathogenic because now you have symptoms and then you finally get a diagnosis.

And she identified the environmental factors and genetics were the two triggers that determine the progression of this cascade, and she was right on the money, this was back in 2003, almost 20 years ago. And this is the prodromal period where you can turn this around pretty easily usually, it’ll take time, but if you’re comprehensive, you can arrest the development of autoimmune diseases, and that’s what the book’s all about, and that’s what the scientists say, they use the word, arrest. So the prodromal period means before symptoms, it comes from the Greek word prodromal, which means precursor, and this is the prodromal period in the development of chronic inflammatory diseases across the board, and individuals at risk to developing autoimmune diseases should be advised to refrain from activities and lifestyle that endanger their health and quality of life, that’s our job, is to advise them, so to identify the activities and the lifestyle.

PART 1 OF 4 ENDS [00:23:04]

Dr. O’Bryan:                        … advise them, so to identify the activities and the lifestyle, which endangers our health and quality of life. And so many studies on this now, that we know, that if you have any of the antibodies to lupus elevated, you have a 94% to 100% positive, predictive value. You’re getting lupus in seven to 10 years. Scleroderma’s 100% within 11 years, rheumatoid 52% to 97%, 14 years. And you see for every one of the autoimmune diseases, how these manifest. Hashimoto’s, primary biliary cirrhosis, type one diabetes, Addison’s, Crohn’s, celiac, they all have the prodromal period. And this is the test that I referred to, that we came up with in 2010 and started testing people. And it’s jaw-dropping to see how many people have elevated antibodies to their own tissue.

And this is the Neural Zoomer Plus, which looks at 53 markers of inflammation to tissue of the brain and the central nervous system. So technology’s improved quite a bit, as we were saying before we started the presentation, but it’s the same concept, looking for the prodromal period before the development of a diagnosis of Alzheimer’s, or Parkinson’s, or schizophrenia, or bipolar, doesn’t matter, the diagnosis. That they have brain inflammation, chronic brain inflammation.

So, if we agree that chronic inflammation is the fuel in the fire for the vast majority of our patients, how critical is it to educate our patients? It’s bottom line, 101 critical. We have to educate them on the lifestyle that’s causing the problem. And just like we know cigarette exposure as a well-established cause of various health conditions, everyone explains that now, or everyone knows that now. But many, many different conditions have the accumulation of toxins creating endotoxin, this accumulated debris inside our body, that’s leeching out into circulation, creating this loss of tolerance that we get. We can’t tolerate it anymore and then our immune system gets called out to protect us. What’s it trying to protect you from? That’s the million dollar question. What is it trying to protect you from when you have an activated immune system? It’s not an immune system that’s gone crazy, it’s an immune system that’s trying to protect you.

So the question is, what’s it trying to protect you from? And eventually they lose tolerance and here comes the activated immune system, causing the collateral damage that it does as Arbuckle showed us, occurring years, 10 years or more, before they have any symptoms.

When the burden within an individual reaches a threshold, the immune system provokes a low grade systemic inflammation with substantial changes in the cytokine profile. I didn’t put the study in here, but I’ll just tell you this one as an example. This is just an example, and this is in JAMA, that they looked at couples going to assisted fertility centers and the editors of JAMA commented on the study. And they said, “This is an elegant study, with sophisticated biomarkers to prove their very sensitive point.” The editors of JAMA don’t do that very often. They’re giving their stamp of approval to this study. And what did they do? They looked at couples at assisted fertility centers. They’re spending tens of thousands of dollars trying to get pregnant and have a healthy pregnancy.

Well, they isolated all of the different factors that may impact on success and they isolated and compared people eating conventional fruits and vegetables and people eating organic fruits and vegetables, and they ruled out all the other factors. They divided them into fourths, the lowest, the second, the third and the highest four. And then they compared the two highest groups, the conventional to organic, eating the highest amount of fruits and vegetables, which we think is great. The Mediterranean diet. Oh, great, lots of fruits and vegetables.

Well, what they found when they compare the couples eating the highest amount of fruits and vegetables, conventional, versus the couples eating the highest amount of fruits and vegetables, organic. The couples eating the highest amount of fruits and vegetables conventional had an 18% less likely of achieving pregnancy, 18%. And they ruled out all the other factors. But if they got pregnant, it was a 26% less likelihood of having a live birth. Did you hear what I just said? Eating the highest amount of fruits and vegetables, but conventional, 26% less likelihood of a live birth, meaning the babies died or they miscarried.

But wait, they’re eating lots of fruits and vegetables. How could that be the factor? It’s the pesticides, the insecticides, the fungicides, and the rodenticides that are endotoxins accumulate in the body over years and change the microbiome, creating a chronic inflammatory microbiome. It’s like, what? You could do a PhD thesis just on that topic. But I throw it out here for you just to, as an example of how much there is to learn on this.

Where is the low grade systemic inflammation coming from? You have to educate your patients over the course of many visits on successful detox protocols. You do a little video series on your iPhone, “Hi, it’s Dr. Tom O’Bryan and this is episode number three of detox. I’ve got a list of things to tell you. You can’t learn them all at once. So let’s talk about number three today. Let’s talk about apple sauce.” And then you go to town and your staff, you just write it on the route slip. And the patient goes up to the front desk and the receptionist says, “Oh, I see doctor wants you to have video number three. I’ll be sending it to you to be in your inbox by time you get home.” And you just start working this out. You can’t keep talking about this to every patient. You don’t have time to do that. So use the tools at your disposal to get the education out to them.

This hypersensitive state magnifies and responds to inciting exposures with the re of a cytokine storm, these cell signaling and sometimes gene-regulating molecules, what do they mean? Well, how do you turn the dimmer switch up or down on your genes? It’s the environmental triggers you’re exposed to, whether it’s what’s on the end of your fork, or what’s already stored in your body that’s activating the genes of inflammation, or activating the genes of anti-inflammation. The abnormal immune … it’s not abnormal. It’s a normal response trying to protect you. Might be triggered by foods, inhalents, chemicals and even electrical incidents.

Everyone needs to know that if you’ve got patients with any type of brain dysfunction, any type of ear dysfunction, recurrent sinus infections, pink eye, sore throats, strep infections, anything in the head and neck area, you teach your patients how to clean their shower heads because of the biofilms of pathogenic bacteria that accumulate in all shower heads. Just read about it and it’s in my book, it’s in You Can Fix Your Brain, it’s in that book, and the studies, and how to clean the shower heads and all of that.

Application of appropriate interventions to avoid these triggers and facilitate elimination of the toxic burden, reverses the toxic induced loss of tolerance and consistently results in remarkable recovery from sensitivity-related illnesses. So, what are the mechanisms in the production of excessive endogenous and exogenous molecules? So let’s talk about our friend Alessio Fasano, who we think will win the Nobel Prize because he and his team are the ones that identified in 1997, the protein, zonulin and the mechanism in the creation of pathogenic, intestinal permeability. And he talks about the perfect storm in the development of chronic inflammatory diseases.

Dr. O’Bryan:                        This is so critical to understand. If 14 of the 15 top causes of death are chronic inflammatory diseases and there’s a perfect storm that creates chronic inflammatory diseases, do you have to understand the perfect storm as a physician? Well, of course you do. And there are five factors in the perfect storm. Your genetics, can’t do anything about that. Your environmental triggers that activate, have their hands on the dimmer switch of your genes. You can do a lot about that. Altering your microbiome, creating dysbiosis, you can do a lot about that. Creating intestinal permeability, you can do a lot about that. Allowing the macromolecules to get through the leaky gut, into systemic circulation, activating your immune system, to protect you from these macro molecules, creating systemic immune response.

Dr. O’Bryan:                        This is what they’re teaching at Harvard Medical School right now. So, the new gastroenterologists coming out will be very familiar with all of the minutia of this. You’ll need to understand the minutia. You need to understand the mechanisms here, the big picture of the perfect storm. And these are the three that, as clinicians, we have control over.

Dr. O’Bryan:                        Although there are dozens of environmental triggers that have contributed to the individual specific inflammatory state, what’s the big kahuna? Well, Professor Fasano tells us that it’s LPS and gluten, are the two most powerful triggers. Once again, this is what they’re teaching at Harvard Medical School. And that when zonulin gets activated, it’s to flushed out what it thinks is a bug, a bad bug. And so it impacts on the microbiome ecosystem.

Dr. O’Bryan:                        I underline this because it’s the ecosystem inside the gut. When you get down inside the gut and just envision … if you can give an elevator speech to your spouse of what’s happening inside the gut of your patient with MS, if you can do the elevator speech in everyday language, you’ve got this down. Until you can do that in your own language, everyday language, the elevator speech means you got 30 seconds to talk about the mechanism of where’s this person’s depression coming from? For every one message from the brain, going down to the gut, there are nine messages from the gut going up to the brain. It was Michael Gershon in 1999 that told us that from Princeton in his book, The Second Brain. So, you need to be able to do the 30 second elevator speech of what’s going on inside the gut with whatever chronic inflammatory disease they’re presenting with. And when you can do that, you’ve got this down.

Dr. O’Bryan:                        So, it’s the internal environment of the microbiome ecosystem that sets the stage for zonulin activation and the gateway to systemic inflammation. Yes, big, big picture here of minutia, which then gives you the paradigm to talk to your patients, and they stay with you long term because you don’t rebuild a gut in two weeks. It’s going to take a year to two years to turn around a gut that’s developed over 30 to 40 years.

Dr. O’Bryan:                        Let’s take a look at the LPS contribution to this microbiome ecosystem. This study just had us drooling back in 2010, when we were putting the test together at Cyrex. This study was so incredible because the macaque monkey, I’m not sure if I’m saying that correctly, but the macaque monkey has a similar gut to humans. So, lots and lots of studies on medications, pharmaceuticals, physiology uses macaque monkeys to understand human disease. But they had a problem, that the pigtailed macaques always had like leaky gut, always, that it seemed endemic to them. And they didn’t know why at the time, they found out why, but they couldn’t use pigtail macaques for healthy guts because they didn’t have them.

Dr. O’Bryan:                        What did they find? Let me back up. Yeah. Uninfected pigtail macaques have increased damage to the tight epithelial barrier and high levels of LPS in the lamina propria, meaning it’s gotten through the tight junctions, into the submucosa. In order to determine if these breaches in the tight junctions of the epithelium correlated with the observed increase in microbial trans location, meaning LPS, they studied the colon sections of these monkeys. And what did they find? That the monkeys, the macaque monkeys, had increased levels of LPS compared to the rhesus macaque monkey. The pigtail macaque monkey is the one, they’ve always got intestinal permeability, and this is what it looks like. The rhesus macaque doesn’t.

Dr. O’Bryan:                        Now you can give them intestinal permeability, but you can’t use a pigtail macaque to see what causes permeability, because they’ve already got permeability. That was really interesting, but they looked at these monkeys and they stained to see how much LPS has migrated from the lumen inside the tissue. And what they found was that 13% of the pigtail macaque monkey was composed of LPS, 13% of the tissue. Whereas in the rhesus macaque monkey that didn’t have intestinal permeability, it’s 0.274%.

Dr. O’Bryan:                        13% of the tissue is saturated with LPS. What do you think that does to the immune system? So, this is what it looked like in terms of the numbers. 13% in pigtail macaque monkeys, when they’ve got intestinal permeability, LPS migrates into the system, and they found LPS in the peripheral blood mononuclear cells, in the spleen, in the axillary lymph nodes, in the inguinal lymph nodes, in the mesenteric lymph nodes, the duodenum, the jejunum, the iliums, the cecum. The monkeys were saturated with LPS through their entire body.

Dr. O’Bryan:                        Damage to gut epithelium results in systemic, microbial translocation that correlates with immune activation. The term bacterial translocation is the passage of viable indigenous bacteria from the GI tract to extraintestinal sites, like the mesenteric lymph nodes, the liver, the spleen, the kidney, the peritoneal cavity, the brain and bloodstream. It’s known that bacterial translocation often leads to a progressive and catastrophic condition known as multiple organ dysfunction syndrome. The systemic inflammatory response triggered by bacterial endotoxin affects many organs and leads to death.

Dr. O’Bryan:                        Once again, this is way back in 2010 we were talking about this, and why it’s so important to test for LPS, and of greater importance are the infectious complications that in that may be initiated by LPS getting through a leaky gut. Whatever the source, exposure to endotoxin induces a systemic inflammatory response that involves many interconnected cellular and plasma mediators. They may be self-limiting or the cascade can proceed to shock, organ failure and death.

Dr. O’Bryan:                        And I love this drawing because this is the development of systemic, chronic inflammatory diseases. Some of you know, 1.7 million people a year are diagnosed with sepsis in the US, of which over 250,000 die. It’s the number one cause of death of elders in hospitals, is sepsis. And this is the mechanism in the development of sepsis.

Dr. O’Bryan:                        First, you have a healthy gut, then you get intestinal permeability. So, you get bacterial translocation, let me back up. Bacterial translocation into systemic circulation. Then you get the systemic inflammatory response syndrome. Then you get sepsis, then you get shock or multiple organ dysfunction, and then you die. And this is going on in systemic chronic inflammatory diseases.

Dr. O’Bryan:                        That’s why when you test with the Wheat Zoomer, they also put in there the markers for intestinal permeability, which include antibodies to LPS, translocation of microbial products and the resulting immune activation of not only consequences within the GI tract, but are also associated with systemic dissemination of LPS. When microbial products translocate from the lumen of the colon into lamina propria, it can result in local and systemic immune activation. These data define the degree to which microbial translocation can stimulate the immune system locally and systemically.

Dr. O’Bryan:                        And if you can imagine us in 2010 with this article, sitting around the table, just drooling at how important it is to get this information out to clinicians, that this is the mechanism in the development of systemic chronic inflammatory diseases, of which 14 of the top 15 causes of death are systemic chronic inflammatory diseases and this is the mechanism. We were so passionate to get this information out to the world. And as you can tell, I’m still passionate because most of us can’t do the 30 second elevator speech as to where their lupus came from, or where their rheumatoid came from, or where their chronic depression came from. We can’t do the 30 second speech and we’ve got to practice that to get it down.

Dr. O’Bryan:                        This increased microbial translocation correlated with high levels of immune activation and frequency with IL-17, here comes the autoimmune cascade. This data highlights the relation between mucosal damage, microbial translocation, and systemic immune activation and underscored the importance of microbial translocation. That’s why Fasano, who is so careful about everything he says, published the paper I showed you in the beginning two years ago, all disease begins in the gut and it’s number three of the five categories of the perfect storm.

Dr. O’Bryan:                        Number three is dysbiosis. That’s where you can make the greatest impact, change the environment inside the lumen of the gut. Next month’s talk is really important about SIBO, you have to change the … You need to get down inside that lumen of the gut and understand everything that’s going on in there. All the inflammation and be overwhelmed, like the miniature man in those movies, just tiny little guy. So, you get down in there. You’re looking, “My God, look at the look … Wow, wow. Look at all that klebsiella over there. Wow, that’s why my stool analysis says I’ve got klebsiella pneumonia. Wow and that’s causing … Oh, there’s so much more leaky gut there, so much inflammation. There’s so many more tears in the cheesecloth there, that’s … Wow, I get it now. Oh, the yeast over there, they can’t … Yeah, I got to get to that too.”

You have to be able to get in there to understand all of this if you’re wanting to address systemic, chronic inflammatory diseases. LPS activates Toll-like receptor 4, lowers protein … I put an example in here for you of one tissue in the body, outside of the gut, and that’s your muscle. This is where sarcopenia comes from. And here’s the drawing in this article, of LPS and its deposition and chronic inflammatory conditions that develop, eating away at the muscle. Massive infection of CD4+ T cells, which is our immune response to LPS early in antigen infections is directly associated with inflammation and breakdown mucosal integrity. This allows microbial products to translocate from the lumen of the GI tract into peripheral circulation. And the effect on healthy aging of this bacterial translocation? I just found this study in my notes today and I said, “Oh, I’ve got to throw this one in here too.”

So, look at the title, “Serum zonulin and endotoxin levels in exceptional longevity.” These are people that live over 100, centenarians. Translocation of LPS from the intestinal lumen into circulation can occur through transcellular or paracellular pathways with the ladder being regulated by zonulin, okay? Following specific stimuli, such as LPS …

PART 2 OF 4 ENDS [00:46:04]

Dr. O’Bryan:                        … following specific stimuli such as LPS and the wheat protein gliadin. Zonulin reversibly disassembles tight junctions leading to increased permeability. We’ve all read The Blue Zone, if you haven’t, you have to read The Blue Zone. That’s where the pedal hits the metal. That’s the groups all over the world that live into their 90s, over a 100, and they have no diagnosed diseases, and they’re not on any medications. I’m going to show you a reason why here.

Dr. O’Bryan:                        So they looked at three groups, these are Italians. Disease-free centenarians, non-diabetic patients less than 40 years old who’d experienced acute myocardial infarctions. These were sick people, and healthy young volunteers matched to those that had an MI for age and sex. All subjects were Caucasian whites of Italian descent in Northern Italy. Disease-free centenarians had significantly lower levels of zonulin and LPS than the healthy young people who had, had a heart attack and lower concentrations of LPS than the healthy young people that were healthy. You’re over 100 years old, but you have less zonulin. That they’ve got healthy guts, and here’s the numbers. I’ll give you a moment to look at that.

Dr. O’Bryan:                        That’s my goal, to be over 100 years old and have the poop that I’m going to sell for fecal transplants. How’s that for a goal? All the centenarians were free of major age-related diseases. They didn’t have cognitive impairment, clinically evident cancer, coronary heart disease, renal insufficiency or severe physical impairment. LPS levels significantly lower in disease-free centenarians and healthy young controls. Zonulin levels significantly lower in centenarians. Intestinal permeability may cause endotoxemia which in turn leads to inflammation, insulin resistance, atherosclerosis, hypercoagulation.

Dr. O’Bryan:                        Our data suggests that serum levels of zonulin and LPS emerge as potential novel biomarkers of exceptional longevity. Our data coupled with the fact that aging per se is typically associated with elevated zonulin, endotoxemia, inflammation, insulin resistance and atherosclerosis suggests that measures taken to decrease permeability and LPS translocation may help to reduce the risk of coronary heart disease and contribute to a healthy lifespan. This is really where the pedal hits the metal. Everybody wants this. That’s the LPS contribution to the microbiome ecosystem.

Dr. O’Bryan:                        What about the gluten contribution? Gluten’s misinterpreted by zonulin pathways, a potential harmful component of a bug. This is a paper from Fasano. Look at the title of the paper, All Disease Begins in the Leaky Gut, so let me back up to that for a minute. So the protein structure of peptides of wheat, poorly digested wheat, the protein structure looks like the protein structure of the surface of pathogenic bacteria. Gliadin activates the zonulin signaling pathway in normal intestinal epithelial cells. The cellular response observed only a few minutes after gliadin exposure characterized by cytoskeleton reorganization with the redistribution of actin filaments. Look at the date on this paper. We knew this 20 years ago, that gliadin does this. And then in 2006 in the Scandinavian Journal Gastroenterology, they told us again, gliadin activates zonulin resulting in immediate reduction of intestinal barrier function.

Dr. O’Bryan:                        This process is independent of any genetic predisposition. This is not celiac, this is non-celiac wheat disorders. Every human has this happen when they eat wheat, and this is what it looks like at the actin level, in the scaffolding of our cells in the gut. This is what happens when you’re exposed to wheat. And Maureen Leonard at Harvard, famous gastroenterologist, did a literature review in 2017 and published it in JAMA. Look at the title, Celiac and Non-Celiac Gluten Sensitivity, and she says, “Previous studies have shown that gliadin in wheat causes immediate transient increase in permeability. This process takes place in all individuals who eat wheat, all humans irrespective of how they feel. That’s why every new patient needs to do the Wheat Zoomer. It’s the most accurate test out there, and it includes the markers for LPs and intestinal permeability because this occurs every time they eat wheat. Gliadin has been identified to activate toll-like receptor 4.”

So I just put a couple of slides in here so you understand the mechanism by how does all this occur. Toll-like receptor 4, they’re throughout our body to identify any bugs they get in pathogens, and in the proximal part of small intestine, their screening all the food coming out of the stomach. And they look at it, “Oh, look over there. It’s a bug. It’s a bug.” No, that’s gliadin from wheat. “Oh, look over there. It’s a bug. It’s a bug.” No, that’s amylase trypsin inhibitors from wheat. But Toll-like receptor 4 gets activated because the amino acid sequence of these peptides of wheat look like the shell of pathogenic bugs, so Toll-like receptor 4 gets activated, and this happens within five minutes, so watch what happens in this video. This is a video of five minutes worth of still shots in the gut when people are exposed to wheat, and these were failures to… And you see the white coming out towards the surface, this is a camera inside the gut looking in at 1 o’clock you see that the dye is leaking out into the gut and more that’s occurring when exposed to wheat.

And this occurs within five minutes of wheat coming out of the stomach into the proximal part of the small intestine. This is leaky gut in reverse. This is exactly what it looks like, and that happens within five minutes of wheat and it happens to all humans. So it’s LPs and wheat that activates zonulin, so who would you not test for LPs and a loss of tolerance to wheat? If they have present with a chronic inflammatory condition, who would you not test? Where to begin and feeding a healthy microbiome? So over the past few decades, let me check my time here and see where I am. Over the past few decades, thousands of studies have talked about fruits and vegetables and our friend Deanna Minich coined the term, the rainbow diet, and she’s guided us in this. And the ability of these polyphenols in our vegetables to produce clinical effects may be due to a bidirectional relationship with the gut microbiota.

These polyphenols feed the probiotics in your gut, critically, critically important to encourage the good guys to become dominant. They impact the composition of the gut microbiota independently associated with health benefits and gut bacteria metabolized polyphenols into bioactive compounds that produce clinical benefits. And Deanna’s handout or not her handout… Her article, we give this to patients on the rainbow diet. There’s three pages. We tell them to print it out, put on the refrigerator because these are all the fruits and vegetables they need to be reminded to include in their diet, and because people don’t think about it. And the goal is to develop the lifestyle habit for 50 different foods a week. It’s not hard when you start, it’ll take you a month or two months to do this, but you just start slowly, and this is page two and it’s 50. That’s the goal Mrs. Patient. Right now, you’re at 12 according to your diet recall that we looked at for the last week, and we want to bump that up quite a bit. So we just give them the handout.

You can download it, just Google Deanna Minich rainbow diet, and the article’s there. Give it to your patients, just email it to them and let them put it on their refrigerator as a reminder. At IFM, we started giving this handout out in 2011, 2012, and we’ve updated it a few times just to encourage our patients to get more colors into their diet. This may be gluten free, but it sure as hell is not healthy. This is a whole other ballgame, and this is the kind of direction we want to go in with our food for everyone. That’s a nice breakfast or a component of your breakfast. So I put these studies in, this one in here about akkermansia. That it’s a critically important probiotic in the gut. It’s depleted in people suffering with a variety of diseases, obesity, metabolic syndrome, diabetes. It often is not even identifiable, and when you’re low in akkermansia, you get intestinal permeability because you get a dysbiotic gut.

And here’s the study on black raspberries, on how they increase akkermansia dramatically, so that’s one of the foods you include, Mrs. Patient is black raspberries. Because akkermansia increases butyrate production, and butyrate helps to heal a leaky brain, and you’ve got depression. So we want to heal the leaky brain, and so including black raspberry, and patients get this and they’ll start. But this is where you have… And all this is in my book, You Can Fix Your Brain, all these studies and the foods are in there, that you can use and fasting mimicking diets. Fasting mimicking diets increase stem cell production in the gut, so you increase and regenerate, healthier younger cells. So you have to learn about fasting mimicking diets.

Now, I love this, that it’s a myth. You’re supposed to eat three meals a day, and unfortunately, how we’ve been raised since infancy with this concept is that we’ve become dependent on it, and so our blood sugar is so way out of balance and our insulin resistance is high because of all the carbs and garbage we’ve eaten over our childhood, teenage, young adult years, that we need to feed ourselves more often to keep our blood sugar stable. But over the course of time, as you educate your patients, they need less food and their blood sugar will stay more stable. They’ll develop more insulin sensitivity, and they eat more complex food so that it lasts longer and gets into the bloodstream slower. But I just wanted to throw this in here that three meals a day is not what our genetics encourage at all.

So periodic fasting and fasting mimicking diets promote a rejuvenation process in tissues, organs and cells. There’s a lot of great science on this now. You just have to take the time to learn about it. It doesn’t happen overnight. And our microbiota is much reduced size and diversity in comparison with our ancestors and indigenous tribes that still live closer to the earth than we do. We must focus on rebuilding a non-inflammatory protective microbiome. That is the key to every chronic inflammatory disease. It’s not the only thing you do, but you sure as hell better include this anytime you’re dealing with a diagnosed disease. Now, about wheat, not everything in wheat is bad for you. It makes up about 80% of the prebiotic in the average Western diet. Now, a preliminary study, they took 10 healthy people, they did on microbiome analysis. They put them on a gluten-free diet for a month, and then they did another microbiome analysis.

Every single one of them had dysbiosis, a reduction in the beneficial bacteria on a gluten-free diet, an increase in pathogenic bacteria on a gluten-free diet and an altered microbiome creating dysbiosis. Why? Because they did what most of our clinicians do, is encourage people, “Well, it’s okay to have the gluten-free pasta. It tastes pretty good nowadays. It’s not like it used to be. It doesn’t taste like cardboard anymore, and here’s a recipe or here’s some really good gluten-free cookies,” that we encourage people to eat this garbage, to buy this white pace that is not enriched. It has no prebiotics at all.

So if 80% of the standard American diet gets their prebiotics from wheat and you take wheat out of their diet which is a really good thing to do, but you don’t guide them in how to substitute with healthy alternatives, and they eat gluten free crap and they develop dysbiosis. You’ve made them worse, and that’s why mortality is increased on a gluten-free diet. You see the science that drops your jaw. Everyone needs to take my course. I’ve got an online course called Certified Gluten Practitioner.com, Certified Gluten Practitioner.com. And you’ll learn, you put people on a gluten-free diet, you increase their mortality within a year. 86% increase risk of dying from a cardiovascular incident in the first year after diagnosis with celiac disease. 3.84, no 3.87 fold increased risk of death in the first year from a malignancy after diagnosis with celiac disease.

Why? Because these people are put on gluten-free diets. What else? Nothing. So they’re eating gluten-free garbage, and so when you take away the source of prebiotic and you don’t replace it with healthy sources, you starve the probiotics in the gut because they’ve become dependent on wheat. And when you starve them, you reduce their numbers and the pathogens rear their ugly head. Now, you’ve got a huge dysbiotic problem in the gut, and you increase mortality within year. I’m writing a paper right now on this topic, and you see the studies on this, it just drops your jaw. That’s why everyone needs to take the CGP course. I’ll talk a little about that later. When the growth of beneficial bacteria is not supported due to reduced supply of their main energy source, for people it’s been wheat their whole lives, other bacterial groups, opportunistic pathogens overgrow leading to dysbiosis.

So if it’s necessary to eliminate wheat, you have to give them highly fermentable carbohydrates to replace that, to feed the good bacteria. And Mrs patient for a few months, I want you to take a supplement of prebiotic while you’re changing your eating style just for a couple of months so that we don’t miss out here because we want to increase the good guys in your gut, and giving a prebiotic does that. And I love this drawing because it’s the prebiotics that are nondigestible that feed the good bacteria in your gut, and the good bacteria and your gut produce these short chain fatty acids. Now, we know that 36% of all the small molecules in the healthy human blood are the metabolites of the microbiome. It’s the exhaust of the bacteria in your gut. That’s 36% of everything in healthy blood. They’re the messengers that go to your brain and to your heart and to your lungs and to your liver to get them to function normally.

They’re the guiding posts. They have their hands on the steering wheel of how your body functions, 36% of everything. Now, you put them on a gluten free diet and you cause dysbiosis, and then now, you start to understand why mortalities increase after a diagnosis of celiac disease. So the beneficial bacteria, you feed them, and then their exhaust gets into the bloodstream and it goes to the targeted organs to increase insulin sensitivity, decrease inflammatory markers, decreased lipogenesis, increased tight junctions. And the result of all of that, you decrease glycemia, insulin resistance, fat mass, all of it. You guys can read this and you know much of this already.

So here’s a pearl, Mrs. Patient, I want you to eat… When you go shopping, buy a couple of every root vegetable in the store. Always buy organic, but get turnips and rutabagas and parsnips and carrots and sweet potatoes… Not too many white potatoes because of the glycemic index but everything else. And you eat one root vegetable every day, and if you don’t know how to cook turnips, just look online. They’re so easy to do, and everybody’s been to a nice restaurant where they shave radishes, raw radish and put it on your salad. It’s not hard. You just have to try it. In my books I’ve got great recipes for all that stuff, and then go on Google and type out list of prebiotic foods. Or better yet Doc, make a list for them and have your front desk send it to them, and every day you have two from the list.

A banana’s prebiotic. Garlics are prebiotic. Onions are prebiotic. You have two from the list and one root vegetable every day, and here’s an example. This one dropped my jaw when I saw this, that this guy came from China, he got a PhD in Microbiology, focusing on the microbiome, but he gained a lot of weight because he didn’t take care of himself and ate a bunch of fast food garbage. And so he remembered his grandmother told him about bitter melon and Chinese yams. He started eating bitter melon in Chinese yam every day, and his blood pressure, heart rate cholesterol levels all came down, he lost 20 kilograms. Fecal bacterium which is supposed to be 14.5% of the total gut bacteria, was undetectable when he began this, and he kicked it back up over two years, he lost 20 kilograms, that’s over 40 pounds.

Dr. O’Bryan:                        He lowered his cholesterol, he lowered his heart rate, he lowered his blood pressure just by eating a little Chinese yam and bitter melon every day. And look in two years, this is what’s happened by adding a prebiotic into his diet. You put people on a gluten-free diet and you starve the probiotics. Now, you understand where mortality comes from because this is mortality in reverse, a much healthier guy right now. And give them a supplement of prebiotic for a couple of months because there’s lots of benefits to it, and we recommend this one, but there are many good ones out there that you can use. Next, rebuilding, a healthy protective mucosa. Mrs. Patient one cup of bone broth every day. Why? Because bone broth is high in gelatin tannate which forms a protective barrier in your damaged gut, so when you’ve got leaky gut, it looks like this.

When you take in bone broth, you put like a bandaid over the leaky gut to protect it. The gelatin tannate does that, which helps it to heal quicker, and the result is, you get a healed intestine. Bone broth helps to heal a leaky gut. Next, Mrs. Patient, here is a supplement you take for a couple of months while you’re transitioning into this whole process. Next, Mrs. Patient, to increase the diversity of the good guys in the gut, I want you to eat tablespoon of fermented vegetables every day, so buy five different types of fermented vegetables. Get kimchi, get sauerkraut, get miso, get fermented beets, get curry flavored, whatever you like. But every day you have a tablespoon, just every day a tablespoon. Because fermented food, their microbiota is so enriched with so many good guys, one of them is conjugated linoleic acid.

I’d learned it long time ago, you take a little CLA every day and you lose one pound of fat a month within a year, about 12 pounds in a year of fat, your body mass index change because of CLA. Well, CLA is produced by the fermentation of vegetables in your gut… I’m going to skip the CLA stuff. The largest study of the association between fermented food consumption, the human gut microbiome, 7,000 individuals over a hundred individuals across four weeks of sampling. Consumption of fermented foods not only provides macronutrients, it also delivers large numbers of potentially beneficial microorganisms to the GI tract. When you do a tablespoon a day, you increase a number of good guys that you’re putting into your gut 10,000 fold over the average diet. So you’re inoculating your gut with the good guys, and this is a great book to read on the topic. I wrote the Forward to this book, and so when I said these bacteria sound like something out of star wars-

PART 3 OF 4 ENDS [01:09:04]

When I said, “These bacteria sound like something out of Star Wars,” with names like Akkermansia, Allobaculum, eubacterium, Clostridium, you don’t know whether to feed them or to shoot them. Are they saying, “We come in peace,” or have they come to conquer? It’s foreign language to patients so you laugh with them about it. But you give them this book, tell them to get this book, because Susanne Bennett is seventh generation Korean healthcare practitioner. So it is in her genes about kimchi and how to make kimchi. It’s just a great, great food to eat.

I’m going to skip the rest of this on kimchi, it’s just another great food to eat. Once again, 36% of all the molecules in your bloodstream are the metabolites of your microbiome in the gut. That’s why it’s so important. And we include a spore-based supplement for a couple of months. We tell patients, in rebuilding your microbiome as a patient, as you develop the lifestyle habits, a couple of months of taking the supplements is good. So it’s going to protect you from having any complications or problems that come up with this. Yeah, we’ll skip about this spores, everybody knows about the spores.

And in terms of supplements, vitamin D is critical. And when you look at the kissing joints of … Let me back up to this drawing, this is really important. On B here, that’s a photo of a tight junction between two cells. MV means microvilli. And when you blow up that circled part of the tight junction, this is what you see, the kissing joints. This is like the Suez Canal or the Panama Canal, that what happens is the tight junction strand opens, zonulin opens the tight junction strands at these kissing joints, and it allows … Here’s the kissing joints. And one opens up, the gates open up, the food particles go down between, the gate closes, the immune system checks it out. The next kissing joint opens, the tight junction strands open by zonulin and few other proteins, and the food goes down. The gate closes, the immune system checks it out.

Well, what I want to show you about all of this is vitamin D controls the opening and closing of the gates. That’s why it’s so important that you have adequate levels of vitamin D. And because of that, we recommend a vitamin D that is … Here’s all the different components of the tight junctions that vitamin D regulates. This is like, what? So when you’ve got this visual and you start to understand it, you understand how important it is. And I give a capsule or a tablet of vitamin D for this, I don’t do the liquids. I do the liquids when I want systemic increase in vitamin D, but I want the vitamin D around the tight junctions. So we make sure to give them 5,000 units of vitamin D a day when we’re working on healing a leaky gut.

And I’ll skip that science. Curcumin, we give curcumin. And you guys know all about curcumin. I’m running out of time so I’m just going to go past this. All of the benefits of curcumin that we’ve all heard about many times before. And this is the dosing on different studies for curcumin between one to four grams a day, 100 milligrams daily in another study. And you see all the benefits that occur when you include curcumin as part of your anti-inflammatory profiles.

And these are all of the genes that are regulated to turn on or turn off to create an anti-inflammatory index with curcumin. And these are all the diseases that benefit from curcumin. And these are all the ones that are autoimmune. Oh, I have to do that one again, because you see the sluggishness there of the thyroid trying to get up there. I always have to create a little joke here. I mean, that slide took over an hour to make. But when would you not include curcumin?

And glutamine, we all know about glutamine, how important it is. And 30 grams a day of glutamine reverse ulcerative colitis in every, every patient, but diseases exasperation return when they stop the treatment. Why? Because glutamine deficiency is not the cause of ulcerative colitis. If you don’t stop throwing gasoline on the fire and deal with the environment in the inside of the lumen of the gut, the microbiome and the dysbiosis, giving them glutamine is temporarily going to help, but it’s not going to fix anything.

And fish oils, we know the anti-inflammatory index of fish oils is very high, activating genes to calm down inflammation and maintain the integrity of the intestinal epithelium. Good studies on including fish oils in there. And you can see what happens when you don’t have enough fish oils. LPS producing bacteria increase, mucus layers decrease, more gram-negative bacteria, and fish oils help to reverse that. And here’s the drawing of … The Omega-3s will favor the beneficial bacteria. And you know all this about … I’m going to skip through this geeky stuff here.

And enhancing the function of the gut barrier, increasing intestinal alkaline phosphatase, arguably the most important enzyme in the gut, IAP. And it’s why an apple a day keeps the doctor away, because intestinal alkaline phosphatase is produced in the apical membrane of the inner lining of the gut. It detoxes LPS, it activates genes of anti-inflammation. It activates genes to heal the gut, and it modulates beneficial bacteria.

It prevents bacterial translocation, we’ll skip that one. And I like the drawings, pictures always help. And the higher your IAP level, the lower LPS infiltration and into your gut. I like this one, it’s really simple. You see that when you’ve got enough IAP, LPS just goes out with the poop. It doesn’t get to toll-like receptor 4 to activate toll-like receptor 4. But when you don’t have enough intestinal alkaline phosphate, LPS gets down on the surface of the inner lining of the gut, activating toll-like receptor 4 and here comes the entire inflammatory cascade.

And alkaline phosphatase will reduce a hundred-fold reduction in the toxicity of LPS. That’s like, what, what? And why am I telling you about LPS? Because it significantly increase with apples. Apple sauce, the pectin in apple sauce. So we tell patients to start making apple sauce, because it’s one of the phenols that have such a beneficial impact on creating a healthy gut environment. So this slide, I just like going through it again, but now we’re looking at it from apple sauce.

Dr. O’Bryan:                        Now, the other thing is that apple-derived pectin modulates gut microbiota and replaces the fructans from wheat-derived arabinoxylan oligosaccharides. So including apple sauce when you give a gluten-free diet is an important tool, because the arabinoxylans in wheat that their microbiota became dependent on, the oligosaccharides from wheat, are replaced by the pectin in applesauce.

Dr. O’Bryan:                        So Mrs. Patient, you take 10 to 15 apples, chop them up, wash them. Always organic. Get rid of the seeds. Throw them in a pot and whatever the height of the apples in the pot, add water to about a third that height. Throw those cinnamon in there, a handful of raisins if you want. Turn it on high, boil for 11 to 15 minutes. You got apple sauce. You don’t peel it because a lot of the pectin’s in the peels. I like to, or my wife does, I don’t do it. My wife puts it in the blender and blends it up so it’s really creamy. I like it a little rougher because I like the fiber taste, but either way.

Dr. O’Bryan:                        And you have a tablespoon a day of homemade apple sauce. The commercial stuff won’t work, it has to be the homemade. And it’ll last you four or five days. And have your kids help you make and that way they’re really interested in eating it. Apple-derived pectin modulates gut microbiota, attenuates metabolic endotoxemia and inflammation, suppresses weight gain and fat accumulation. And of course organic, because the phenols in there are 34 to 54% higher than conventional. Always organic. Okay. And so we’ll skip all that. One tablespoon of homemade apple sauce a day.

Dr. O’Bryan:                        Mother Nature’s way of healing intestinal permeability is colostrum. Nothing activates healing intestinal permeability like colostrum. It activates more genes than in any other product possible. It recolonizes with the bowel with friendly bacteria. There’s nothing that is as powerful as colostrum. And for those that have a dairy sensitivity, what we say to them, “Mrs. Patient, we just found out you have a dairy sensitivity.” There’s no lactose in here. There’s about 0.6% casein, and most colostrums have two to 6%. This one has 0.6%. You’ll find it on my website.

And it is the colostrum that three countries of Africa licensed as their treatment of choice when a patient’s diagnosed with HIV because it calms down the inflammatory cascade in the gut. It’s just an incredible product to use. It’s the best known remedy. It contains growth factors, hormones to repair damage to the lining, restore a gut integrity. There are numerous One Milk products lighting the shelves of health food stores to stimulate the immune system and heal the gut, only colostrum plays the entire symphony.

I will tell patients, to Mrs. Patient, “I’m going to recommend you try some colostrum for a couple of months. Now if you have any symptoms like bloating or gas or diarrhea or cramping, anything at all, just stop the colostrum right away. But it’s worth a try ,because if you don’t have any symptoms, then let’s do it for a couple of months so that we can get all of those benefits that outweigh any other product that’s out there. And then we’ll get the colostrum out of there, but let’s see if your body will take it.” This colostrum is the most sensitive of all that I’ve ever found.

So add a colostrum product, and this is the one we use, GS Immuno PRO. It’s just incredible. My friend, Dr. Andrew Keech, was born and raised on a dairy farm. And he learned right away, if you don’t give those calves colostrum they die. You can’t give them milk, they die. Then he learned that when humans got sick, they drank some of the colostrum, they all got better. So he dedicated his life to making the best colostrum in the world, and he’s done that. And so that’s the one that we recommend.

And so in rebuilding a healthy gut, fasting [inaudible 01:21:13] diet, rainbow diet, strict avoidance of all wheat exposure, absolute necessity of working with a certified gluten-free practitioner, registered dietician, nutritionist, trained health coach. Rebuild the microbiome with a comprehensive gut restoration program. They have to work with the coach or a CGP because you don’t have time to talk to him about all this stuff, about food selections. So you want someone to do it who knows what they’re doing.

Rebuilding gut restoration with a daily applesauce, bone broth, numerous prebiotics, probiotics. Supplementation for a few months with prebiotics, spore-based probiotics, colostrum, vitamin D, glutamine, turmeric, Omega-3s. These are just the basics, there’s a whole lot more you can do. This is all outlined in detail in my book, You Can Fix Your Brain. And for those of you that don’t read English, you can get in any of these languages if you want.

And with that, please, please, please rebuild the diverse, healthy microbiome as a first response to any and every chronic inflammatory condition. Please consider the Certified Gluten Practitioner program. It’s online, it’s about eight to 10 hours. You’ve got three months to do it. You take a quiz after each section. If you don’t pass the quiz, it comes up and say, “Go back and look at slide 48 again.” And they say, “Oh right, okay.” And then you go back, and then you answer it and you’re fine. You don’t have to memorize this stuff, I just want you to be familiar with it.

And I give all of my CGPs new articles every month or two months that I think are important. I send them a clean copy and a highlighted copy, because most people don’t have time to read the articles. So here’s the bullet points, like the cliff notes. And they get PowerPoints of my presentations. It’s a really nice community, and they’re all over the world now, so please consider this. And if you do consider it, use this code, a promotional code, because you’re functional medicine practitioners. And I want a world of you out there that just have all this information in 30-second elevator speeches that you can deliver. So use this code, CGP Gift, for it.

Thank you all so very much. Take care of yourselves. Make sure to tell those important to you how much you love them, and thank you for your kind attention. And now we will go to the questions.

Dr. Weitz:                            Dorothy, you have some question or several questions about wheat. Why don’t you unmute yourself and ask Tom.

Dorothy:                              Hi, Tom. That was really amazing. And I don’t know how to get my video back on, but anyway. The study out of Harvard said that everybody reacts to wheat gliadin.

Dr. O’Bryan:                        Right.

Dorothy:                              What is the purpose of this Zoomer test? And also, you had mentioned that one of the Blue Zones, the Italians who lit the longest, I mean they are eating pasta every day. So explain this to me if you could.

Dr. O’Bryan:                        You bet, of course. So the test is the Wheat Zoomer. It comes out of Vibrant Wellness. How is it that the Italians who eat pasta … Their microbiome is healthy. That when you look at Maureen Leonard’s literature review from Harvard that all humans have transient intestinal permeability, the key word there is transient. That their gut heals, because they’re exposed to something that causes permeability, but their microbiome is a healthy, diverse microbiome.  It certainly is possible to eat wheat and thrive, it’s possible. But when you think of the JAMA study and at assisted fertility centers, people eating whole lots of fruits and vegetables, 26% less likely of a live birth. Why? All the pesticides and insecticides and rodenticides and fungicides that are in their gut have created this pathogenic microbiome that developed over 25 years. Nobody’s going to change that microbiome in two weeks. It takes years to rebuild a healthy microbiome that developed over 30 years. Years. Show me the evidence of anything other than that. Yes, of course symptoms go down because you activate an anti-inflammatory protocol, but it’s going to take a while.

So these Italians, they didn’t have pesticides, insecticides, rodenticides. Now see, I think what’s happening, and actually we’ve seen some preliminary evidence of these Blue Zone cultures, that the numbers of people living to those old ages is going down rapidly. That these papers came out 10, 15 years ago, most of them. Or the centenarians now, they’re born 100 years ago. They haven’t been exposed to all of these toxins that we’re exposed to. So I think that we’re going to see a drastic reduction in these cultures.  The answer to your question is, it’s the healthy, diverse microbiome that heals the transient intestinal permeability that you get when you’re exposed to wheat.

Dr. Weitz:                            Tom, I want to mention. Among the great clinical pearls you mentioned tonight, one was that if you wanted to take a vitamin D supplement and you wanted to act locally in the gut, better to use a capsule or tablet rather than a liquid. A lot of people like to use liquids because they hate swallowing pills. But for this purpose it makes a lot more sense.

Dr. O’Bryan:                        Yeah, yeah. And we use Micellized liquid vitamin D as a supplement when I want to boost levels. I use liquid because it’s absorbed really well and it has five times better increase in blood values than emulsified. But when I’m dealing with the gut, I want it down in the gut. I will give systemic also, but I want it down in the gut.

Dr. Weitz:                            And, Bernie, you had some questions about what testing that Tom recommends.

Bernie:                                 Yes. What’s the best test to show one’s inflammation level?

Dr. O’Bryan:                        Well, that’s really a good question. And in my experience, we don’t have a panel. Although Vibrant has come out with an inflammatory panel. I’m sorry, I have to correct myself there. They’ve got an inflammatory panel now that’s most comprehensive one that I’ve seen.  Cyrex has a nice panel looking for the effectiveness of natural killer cells and a few others. Vibrant’s panel, and I don’t remember the name of it because I don’t use it myself, but it would be a valuable test to do, that’s the one that I would look at, is from Vibrant.

Bernie:                                 And also, Dr. O Bryan, you didn’t talk about foods and immunity and immune responses to foods, based on the other Vibrant tests.

Dr. O’Bryan:                        Right, right. That’s all in the CGP program. I had 90 minutes, so there’s only so much I can talk about. Yeah, the Vibrant tests are incredible, and rarely are people sensitive to just one food. It’s very, very common. I mean the studies say celiacs, 50% of celiacs have molecular mimicry with dairy. And we find it’s more than that with wheat-related disorders.  That’s why we put everybody on a gluten-free, dairy-free, added sugar-free diet on day one. And then when their test results come back, we may tweak it a little bit, but we always include dairy-free. But corn’s extremely common. That’s why there are people out like my friend, Dr. Peter Osborne, that talks about grain-free diets, because so many people have cross-reactivity and sensitivity.

Bernie:                                 Okay, thanks.

Dr. Weitz:                            Yeah. The other thing, Bernie, you can get a stool test that will include fecal calprotectin. And that’s a good measure for inflammation in the gut.

Dr. O’Bryan:                        That’s correct.

Bernie:                                 Okay. Thank you.

Dr. Weitz:                            Okay. Any further questions? Tom, thank you. That was incredible. Awesome, awesome presentation.

Dr. O’Bryan:                        Thank you, Ben. It’s really a pleasure. And thank you all. Come back on screen to say goodbye so I can see who I’m dealing with. Oh, thank you. Thanks, Lori. And thanks everybody. It’s nice to see you all.

Dr. Weitz:                            Okay.

Dr. O’Bryan:                        And thanks for taking the time. And God bless to all of you.

Dr. Weitz:                            Thank you, Tom, and thank you everybody. We’ll see you next month.

 


 

 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple Podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition clinic. So if you’re interested, please call my office, 310-395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.

 

 

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Tribute to Dr. Stephen Sinatra

Dr. Ben Weitz, Dr. Howard Elkin, Dr. Jonny Bowden, and Dr. Drew Sinatra pay tribute to Dr. Stephen Sinatra, Integrative Cardiologist.

[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

2:04  Dr. Stephen Sinatra was a conventionally trained cardiologist, but he discovered natural healing and became one of the great innovative integrative cardiologists integrating nutrition, mind-body medicine, and other alternative therapies.  Dr. Sinatra wrote over 20 books, including The Coenzyme Q10 Phenomenon, L-Carnitine and the Heart, Lower Your Blood Pressure in Eight Weeks, Reverse Heart Disease Now, and The Great Cholesterol Myth

Dr. Sinatra got us to think differently about cholesterol and its role in the atherosclerotic process. After the Lyon Diet Heart Study was published in 1994, which showed that a Mediterranean-style diet could reduce cardiovascular disease by 76% in high-risk patients without significantly changing their total or LDL cholesterol, this spurred Dr. Sinatra to question that saturated fat intake leads to elevated LDL cholesterol, which leads to atherosclerosis hypothesis.  He also became more skeptical of the benefits of taking statins to reduce the risk of a heart attack. He observed that some of his patients with high cholesterol had clean arteries, while some patients with low cholesterol died from heart attacks. In The Great Cholesterol Myth by Bowden and Sinatra, they write that, “There is not evidence that supports a direct relationship between saturated fat and heart disease, and cholesterol is a relatively minor player in heart disease and a poor predictor of heart attacks, and the primary cause of heart disease is inflammation.”

Dr. Sinatra also observed patients who took statins had complained of memory and other cognitive problems, depression, muscle pain, and low libido due to the depletion of coenzyme Q10. Dr. Sinatra was one of the first to recognize and promote the importance of CoQ10 for heart health. He pioneered the use of specific nutritional supplements to help the heart to reverse heart failure, including using CoQ10, as I just mentioned, L-Carnitine, magnesium and D-ribose. 

5:28  Dr. Mark Houston was unable to join us but he gave me this statement to read:  “Steve was a dear friend and one of the best physicians that I have known. We loved working together at meetings and on our two books that we edited. He was a pioneer in cardiology and was never afraid to tell the truth about heart disease. He has been proven correct in many of his early ideas that were not initially accepted by the traditional cardiology community. He was admired by everyone who knew him.  He was kind, compassionate and caring as a man and as a doctor. He was loved by his patients, friends, family, and all his associates. He was a mentor to me,  and I learned enormous amounts of information from him. I will always remember our good times. I will miss him. I send my regards, love, and prayers to all of his family. Steve made a difference in the way we now practice cardiology and will be remembered as a master and one of the most influential of our time.” That’s from Dr. Mark Houston.

8:31  Jonny Bowden explained that Dr. Sinatra was “a gracious, kind, generous, spirited human being”.  Jonny and Dr. Sinatra both stumbled on the Lyon Heart Study and both had an epiphany that the data on heart disease does not support what we’ve been told about the cholesterol hypothesis.  When they wrote The Great Cholesterol Myth together they spent one third of the book talking about HeartMath and about community and relationships and sex life. They talked about the gut, walking in nature, getting sunshine, etc. Jonny had had some success with writing and had written The 150 Healthiest Foods on Earth and the publishers wanted a bunch of sequels, including 150 ways to lower your cholesterol and Jonny instead wanted to write a book questioning the cholesterol hypothesis.  His publisher told Jonny, who is a nutritionist, that they would only publish it if he wrote the book with a cardiologist and it had to be a world-renowned cardiologist. So Jonny called up Dr. Sinatra and said, “Steve, you want to write a book that’ll blow the lid off the whole cholesterol thing?” He says, “I’m in.” That’s how that book got done, and it wouldn’t have gotten done if he hadn’t signed on as a co-author.

15:08  It is now in the news that the the results were falsified in the landmark study that showed that the cause of Alzheimer’s is a buildup of amyloid plaque.  This concept is the basis for much drug development, including last year’s new drug approval for Aducanumab, which is a monoclonal antibody against beta amyloid, but it does not make anyone better.  This is a good example of why we should question the status quo in medicine when things don’t all add up.  Jonny explained that Alzheimer’s disease can be considered to be type III diabetes and we have an epidemic of a metabolic condition called insulin resistance, which predicts heart disease better than any other metric.  Dr. Elkin pointed out that only 12% of adults in the US are metabolically healthy, meaning that 88% have some form of insulin resistance.

19:26  Dr. Stephen Sinatra changed our thinking about the role of cholesterol in heart disease and he emphasized that we have been measuring cholesterol incorrectly.  Jonny explained that cholesterol is a fat that cannot float around in the bloodstream, so it must be contained in a lipoprotein like LDL or HDL.  These lipoproteins are the boats and the cholesterol is the cargo.  The problem with heart disease is that the containers, the LDLs that get caught in the endothelial wall and cause plaque and heart disease.  When it comes to testing, we should not focus on the amount of cholesterol, but on the number of these boats, the LDL particle number that is part of an advanced lipid profile, and not just on the estimated LDL, which is what you get from standard lipid panels.

22:40  Dr. Sinatra was also big on measuring Lp(a) as part of the lipid panel.  Lp(a) is a very atherogenic particle, but it is not easy to change it and there is not yet a specific drug to lower it.  You can get about a 30% reduction with niacin and another 10% or so with L-carnitine. 

25:31  Dr. Sinatra was a big believer in the value of the Mediterranean diet for preventing and reversing cardiovascular disease.  It is the most studied diet for cardiovascular disease and the Lyon Heart Study and the PREDIMED study were two of the most important studies showing it’s value.  Jonny prefers a lower carb approach to diet and he was always trying to get Dr. Sinatra to eat a higher fat/lower carb version of Mediterranean with less grains and more nuts, etc..  Drew related that his dad was paranoid about saturated fat in the 80s and for about 10 years his family ate not meat and they would eat a lot of grilled swordfish and his family was probably very mercury toxic.

 

 

Dr. Sinatra:                          Yeah, he loved Mediterranean diet. I think, for him, being Italian, it was probably hard to get off the pasta. That’s sort of like a staple of the Italian diet, or at least we think it is, and so my father always enjoyed a nice Italian meal with pasta. He did believe that olive oil was really like the secret sauce, and I do think that he was onto something with the olive oil. I do believe that olive oil can help drive a lot of these positive things that we see with Mediterranean diet, and agree with Jonny and all you about, in terms of reducing carbohydrates and that sort of thing.

Dr. Bowden:                         Let me tell you a story about the olive oil.

Dr. Sinatra:                          Mm-hmm.

Dr. Bowden:                         The particle test, this whole thing we’ve been talking about with the particle test, I have a personal story about that. Because my LDL, HDL numbers were perfect, perfect for decades. Any doctor would look at it and, “Your LDL’s ridiculous. You’re just doing fine.” Then when I became a functional nutritionist and learned about this, and saw that that was a bogus test and got the real test, I find that I’m in the high-risk zone for particles, and I’ve got the worst kind of size. I’ve got the pattern B which is, as somebody mentioned earlier, the little-

Dr. Weitz:                            Small, dense, yeah.

Dr. Bowden:                       Yeah, the Small dense ones. I’ve got this. I am an example of how the test … of being undertreated. In other words, I was a false negative. They said, “Oh, yeah, there’s no problem whatsoever,” and in fact, when you looked under the hood with the right test, I had very high particle size. I have all these wonderful, amazing functional cardiologists in my network, starting with Steve, and I asked their opinions, “Guys, what do you … I’ve got a serious particle problem. What should I do?” I’ll be honest. One of them said, “I know you’re not crazy about the statins. I think we should try, maybe, five milligrams of Crestor.” Others said, “At your age, it’s absolutely not necessary to do.”

I went to a cardiologist at Scripps who gave me certain supplements. I got a little stricter on my diet. Here’s what Steve’s advice was. Steve said, “Before you go on the statin, I want you to take a quarter cup of olive oil every day for three months, and then let’s remeasure,” so I did. He literally prescribed olive oil, and I do it to this day. If I had the bottle, I’d show you. I literally swig it from the bottle, as a medicine. Every day, it’s one of my supplements, and I did that. I can’t say it was just that, but that, the supplements that Dr. Triffon at Scripps Institute recommended, the stricter adherence to the higher fat, lower carb diet. My particles went from 2,200 to 1,600, and my particle size went from B to A.

 



Dr. Howard Elkin is an Integrative Cardiologist and he is the director of HeartWise Fitness and Longevity Center with offices in both Whittier and Santa Monica, California.  Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient, that will soon be published. He can be contacted at 562-945-3753 or through his website, HeartWise.com.

Dr. Jonny Bowden has a PhD in Nutrition, speaks around the world and has written a number of books, including Living Low Carb, Smart Fat with Dr. Steven Masley, The 150 Healthiest Foods on Earth, and The Great Cholesterol Myth with Dr. Stephen Sinatra. His website is JonnyBowden.com.

Dr. Drew Sinatra is a Board Certified and Licensed Naturopathic Doctor, addresses and treats the underlying causes of chronic disease. Specializing in gut support, lyme disease, mold illness, and autoimmune disease. His practice is in Mill Valley, California and he can be reached at 415-388-5520 and his website is DrDrewSinatra.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. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.

Okay, great. Welcome everybody. We’re here today to honor one of the giants in the world of functional medicine, integrative cardiologist, Dr. Stephen Sinatra, who died on June 19th. I’m Dr. Ben Weitz, doctor of chiropractic and functional medicine practitioner, and the host of the Rational Wellness Podcast found on Apple Podcasts, Spotify, as well as on YouTube. I’m joined by Dr. Howard Elkin, integrative cardiologist at HeartWise in both Whittier and Santa Monica, California. Dr. Elkin participated with Dr. Sinatra on a study on the benefits of grounding for heart health, and they published a paper pertaining to that.  We’re also joined by nutritionist and PhD, Dr. Jonny Bowden, who co-wrote the book, The Great Cholesterol Myth, with Dr. Sinatra. We’re also joined by Dr. Drew Sinatra, a naturopathic physician, and he’s also the son of Dr. Sinatra. They worked together on quite a number of projects. Unfortunately, Dr. Mark Houston, who was an associate of Dr. Sinatra and a close friend, was unable to make it because of some last minute scheduling problems.

While I did not know Dr. Sinatra personally and never had the honor to interview him, I certainly knew of him, listened to him speak, and read some of his books and articles. Dr. Stephen Sinatra was a conventionally trained cardiologist, and at one time, was the chief of cardiology at Manchester Memorial Hospital in Connecticut. He discovered natural healing and became one of the great innovative integrative cardiologists integrating nutrition, mind-body medicine, and other alternative therapies.

Dr. Sinatra was a great educator, lecturing frequently, and he wrote or contributed to over 20 books, some of which include The Coenzyme Q10 Phenomenon, L-Carnitine and the Heart, Lower Your Blood Pressure in Eight Weeks, Reverse Heart Disease Now, and The Great Cholesterol Myth. He also published over 45 peer-reviewed papers and wrote hundreds of blogs and other articles on various topics in natural approaches to cardiology.

As a bioenergetic psychotherapist, Dr. Sinatra used mind-body medicine to help his patients to heal, including looking at how unexpressed negative emotions such as anger and sadness could contribute to hypertension and heart disease. Dr. Sinatra got us to think differently about cholesterol and its role in the atherosclerotic process. After the Lyon Diet Heart Study was published in 1994, which showed that a Mediterranean-style diet could reduce cardiovascular disease by 76% in high-risk patients without significantly changing their total or LDL cholesterol, this spurred Dr. Sinatra to question that saturated fat intake leads to elevated LDL cholesterol, which leads to atherosclerosis hypothesis.  He also became more skeptical of the benefits of taking statins to reduce the risk of a heart attack. He observed that some of his patients with high cholesterol had clean arteries, while some patients with low cholesterol died from heart attacks. In The Great Cholesterol Myth by Bowden and Sinatra, they write that, “There is not evidence that supports a direct relationship between saturated fat and heart disease, and cholesterol is a relatively minor player in heart disease and a poor predictor of heart attacks, and the primary cause of heart disease is inflammation.”

Dr. Sinatra also observed patients who took statins had complained of memory and other cognitive problems, depression, muscle pain, and low libido due to the depletion of coenzyme Q10. Dr. Sinatra was one of the first to recognize and promote the importance of CoQ10 for heart health. He pioneered the use of specific nutritional supplements to help the heart to reverse heart failure, including using CoQ10, as I just mentioned, L-Carnitine, magnesium and D-ribose.  Dr. Sinatra, as I mentioned, was unable to make it. Dr. Sinatra is a very prominent expert on an integrative approach to cardiovascular.

Dr. Bowden:                       You mean Dr. Houston.

Dr. Weitz:                            Dr. Houston. Dr. Houston, sorry. Dr. Houston was unable to make it, but he did give me a statement that I’d like to read now to get things started. “Steve was a dear friend and one of the best physicians that I have known. We loved working together at meetings and on our two books that we edited. He was a pioneer in cardiology and was never afraid to tell the truth about heart disease. He has been proven correct in many of his early ideas that were not initially accepted by the traditional cardiology community. He was admired by everyone who knew him.  He was kind, compassionate and caring as a man and as a doctor. He was loved by his patients, friends, family, and all his associates. He was a mentor to me,” to Dr. Houston, “And I learned enormous amounts of information from him. I will always remember our good times. I will miss him. I send my regards, love, and prayers to all of his family. Steve made a difference in the way we now practice cardiology and will be remembered as a master and one of the most influential of our time.” That’s from Dr. Mark Houston.

I thought, before we get into the science of some of Dr Sinatra’s innovations, I’d like to go around and ask each of you to mention something that you recall that Dr. Sinatra said or did that would tell us something about who he was as a person. Howard, would you like to go first?

Dr. Elkin:                              I think, my first meeting with Sinatra was very memorable. This was maybe 12, 13 years. I was doing my A4M membership, American Academy of Anti-Aging Medicine. We had an afternoon of cardiology with Dr. Sinatra, so it was great. We had like three or four hours with him. I kept on asking questions, and I kept on raising my hand because I knew the answers. Finally, after about 45 minutes, he says, “May I ask you what your specialty is?” I said, “Cardiology.” Everybody laughed because I was the only cardiologist in the room other than me and him, so, “I want to see you afterwards,” so we met afterwards. I ended up participating in an infomercial that we did here in Los Angeles, where I met his wife, Jan. Then he got me interested in earthing, which is another great topic of his. I was extremely interested in it, and we did a study together on the effects of blood pressure.

He was a wonderful teacher and I’m most proud and honored that he wrote the forward to my book that’s coming out after Labor Day, so it’s precious to me that he wrote that forward and he did an excellent job. I’m indebted to Dr. Sinatra because I was always a thinker outside the box, but I finally found someone in my field who was successful in what he did, so I didn’t have to feel alone anymore. I owe a lot of … I have a lot of gratitude, and I honor him tremendously. I’m glad to be here tonight.

Dr. Weitz:                            Thank you, Howard. Jonny?

Dr. Bowden:                       Gee, I don’t even know where to start. I owe so much to Steve. He was such a gracious, kind, generous, spirited human being that infused every interaction you had with him. In no particular order, he and I both stumbled on that Lyon Diet Heart Study that you mentioned, completely independently, and had the same kind of epiphany. That data does not support what we’ve been told, and we both started wondering about it, and we had so many other things we found in common. We both did postdoctoral work in psychology. I have a master’s in psychology. He was trained as a bioenergetic psychologist. I think it really informed the way we looked at disease in general.  We devoted, in the revised version of The Great Cholesterol Myth, we spent one-third of the book not talking about diet, exercise, supplements, or anything. We talked about HeartMath. We talked about community. We talked about relationships. We talked about sex life. We talked about the gut, all of these things. Walking in ecotherapy, walking in the greenery and getting sunshine and how all of these things had powerful, powerful effects on our physiology, on our hormones, on our immune system, on all of these things. He realized that so profoundly when no one was talking about mind and body.

Also, when you were listing his books, one that you didn’t mention was so influential, not just for me, and so prescient. It was Heart Disease for Women. He was one of the first people to shout out, “The emperor has no clothes,” when it comes to all the studies that have been done on heart disease that used only male patients. He was one of the first, even pre-woke, to say, “Heart disease presents differently in women. It’s different symptoms, it’s different … They’re different creatures. They respond differently to pain. You got to look at this as a whole other thing.” People, now they talk about that, but they forget that that was Steve, I don’t know how many years ago he wrote that book, Drew. It must have been 15 years ago. He was on to a lot of this stuff very, very early on.

I had some writing successes before I met Steve. I had a bunch of books, the food book and stuff, but if he hadn’t agreed to write that book with me, and I’ll tell you exact, if you’re interested. I had a book deal with Harper because I wrote The 150 Healthiest Foods on Earth, and they wanted a whole bunch of sequels to that because it was a hit, so Die Hard you want Die Hard 5, Die Hard … Well, that’s what they do, so we had 150 Best Ways to Promote Your Energy, and 150 Best Ways to Live Longer. They came to me with this idea. They said, “We think the next great book will be, how about The 150 Best Foods to Lower Your Cholesterol?” I said, “That’s a wonderful idea, but it’s certainly not for me.” They said, “Why?” I said, “Because I think that’s the wrong target for heart disease, and I think we’re just moving in the wrong direction.” They said, “What are you talking about?”  It led to a discussion, and I presented my case. I sent them studies and they were afraid to publish a book that questioned the cholesterol hypothesis. Finally, after much debate, and I was very persistent, and I sent all the studies, they said, “Look, we can’t publish this by some cockamamie nutritionist who’s a …” I’m left-wing of things, anyway. Said, “We will publish this if you can find an MD to co-author it, but it can’t be just an MD. It’s got to be a cardiologist. It can’t be just a cardiologist. It has to be a world-renowned cardiologist. You got one who will endorse this, we’ll do it.” I call up Steve, I said, “Steve, you want to write a book that’ll blow the lid off the whole cholesterol thing?” He says, “I’m in.” That’s how that book got done, and it wouldn’t have gotten done if he hadn’t signed on as a co-author.

Dr. Weitz:                            What a great story.

Dr. Sinatra:                          I love that.

Dr. Weitz:                            Drew?

Dr. Sinatra:                          Gosh, I’m like Jonny here. I don’t even know where to begin with a story. I think seeing my father evolve from a conventional cardiologist into the man that he was two months ago was such a beautiful journey to see him move along with. This guy had a health food store that he opened in, I think it was like 1987. I was 10 years old then. Just, I remember all the food on the shelf. He had this thing called, something like the Roger Buffalo cookie, which was just like the first PowerBar ever out there. Maybe PowerBar was there at that point, but there was no other bars on the market.

Dr. Bowden:                         Tiger Milk bars.

Dr. Sinatra:                          What’s that?

Dr. Bowden:                         They had Tiger Milk bars.

Dr. Sinatra:                          Yeah, exactly. He was just a pioneer in the thinking ahead. It’s like, “People need food on the go. Let’s develop this bar that people are going to quickly eat.” Look at the bar market today. It’s massive.

Dr. Weitz:                             Right.

Dr. Sinatra:                          He was always a thinker. He was always ahead of his time. It was such a beauty watching him evolve and develop supplements that I started taking when I was a young teenager. My friends made fun of me because I took all these vitamins and such, but I’m so grateful that he got on that path because then it really put me on the path of becoming a naturopathic doctor.

Short story here with the cholesterol is I think I went to the Manchester Memorial Hospital, which you mentioned, Ben, where he was chief of cardiology. He gave a talk on statins, and it was just the coldest energy in the room. All the fluorescent lights were flickering. I looked out in the audience, and all the doctors just were unhappy. They just weren’t happy, and they were very angry that he was presenting another side of cholesterol, which was, “Hey, be a little cautious in your prescribing. You don’t want to just give this stuff out like candy like we’ve been doing for the last decade.”

I saw that and I really looked up to how much courage he had to stand up to these doctors and say, “Hey, we’re basing this on a theory right now. This is only a theory, and we should take it as that. Let’s have more evidence come in before we just willy-nilly put everyone on a statin.” Then the doctors were mad. They were furious. They said, “How can you do this? This is against standard of care.” The thing about my dad is he didn’t get angry. My dad never got angry. He just said, “Okay.” He’d walk away, and I could tell that he would think to himself, “Well, when these guys are ready, maybe they’ll join on and look into the theory of heart disease in terms of cholesterol.” I could go on and on, but I just had to share that story about the cholesterol and Manchester Memorial Hospital.

Dr. Weitz:                            That’s great. It’s interesting. You guys both brought up the idea of questioning conventional thinking. In the news, just in the last day or two, is this revelation that the landmark study that showed that the cause of Alzheimer’s is a buildup of amyloid plaque, it turns out that, according to this analysis, that study was falsified.  Yeah, it’s a huge shock to the whole medical establishment, the research, and very, very interesting. They’ve been developing drugs for Alzheimer’s based on this concept, and of course, the drugs don’t do very much. That’s why we had this big controversy last year over that aducanumab, or I’m sure I didn’t pronounce it properly, but this new drug, this first new drug for-

Dr. Bowden:                        Oh, I know [inaudible 00:16:10]

Dr. Weitz:                            … Alzheimer’s. That was-

Dr. Bowden:                        Terrible drug.

Dr. Weitz:                            Exactly.

Dr. Bowden:                        Terrible.

Dr. Weitz:                            30% of the patients get inflammation and swelling in their brain, and nobody gets better. They just get worse at a slower rate. Anyway, it’s all based on this concept of what the cause of Alzheimer’s is, and now that whole concept is now in question. There is a perfect example of wanting to question orthodoxy.

Dr. Bowden:                        Can I interject something here?

Dr. Weitz:                            Of course, go ahead, Jonny.

Dr. Bowden:                        Tie something in with Steve’s message and with what you just brought up. I think it’s so important, and he would kill me if I didn’t make sure that we all knew this. Because you had mentioned earlier that one of our theses is what really causes heart disease is inflammation and oxidation. Alzheimer’s, as you guys know, and maybe some of the people in the audience do, Alzheimer’s is now being referred to as type 3 diabetes.

Dr. Weitz:                            Right.

Dr. Bowden:                        The reason for that is that we have an epidemic of a metabolic condition, which underlies not just diabetes and pre-diabetes, and hypertension, and obesity, and heart disease, but also Alzheimer’s. It is the same metabolic condition and it is called insulin resistance. It also, coincidentally, underlies the three major comorbidities for COVID as well as the ones I mentioned, lung disease, kidney disease, and liver disease. We have this insulin resistance. This is epidemic.  When Steve and I, we did The Great Cholesterol Myth, when we went back and did the revised edition and looked even more deeply into the research that had been done since 1970, we found that insulin resistance predicts heart disease better than any other metric, except possibly lung capacity and volume. It is a fantastic predictor for every chronic disease that we care about.  It’s been my passion and my message, especially since Steve died, but really since the book came out, to get that message across to people that insulin resistance is where the action is. That’s what we should be looking at, and insulin resistance can be turned around, it can be prevented, it can be reversed by diet, fasting, and lifestyle. That was the message of our book, and Steve believed that. Since you brought up Alzheimer’s, I think it’s only appropriate to bring that up because that’s central to all of those kind-

Dr. Elkin:                             Problem is not gone by any stretch. In fact, a research study came out … I knew from a study about two and a half years ago that only 12% of the adult American population is metabolically healthy.

Dr. Bowden:                       That’s what I’m … What does that mean? What does that mean?

Dr. Elkin:                             [inaudible 00:18:42] 3% of the adult American population is metabolically healthy. More women than men. This just came out about a week and a half ago.

Dr. Bowden:                       Yeah, and that study, the one you were talking about, which came from the NH, NHANES data-

Dr. Elkin:                             Right, correct.

Dr. Bowden:                        … that says only 12% are metabolically healthy, they are talking about insulin resistance. 88% of us have some degree of this insulin resistance. Guys, if you don’t know what that is, it is an inability of the body to manage the carbohydrate load that you’re giving it. That leads to inflammation, oxidation and slowly but surely, heart disease. Alzheimer’s, pre-diabetes and the whole gamut of metabolic diseases, and Steve knew that.

Dr. Weitz:                            Right. What else should we say about the role of cholesterol and heart disease, and what other things did Dr. Sinatra revolutionize in terms of the way we think about LDL?

Dr. Bowden:                        I think that he was as passionate as I about saying that we are measuring cholesterol incorrectly, that we are still talking cholesterol. Can I just, two seconds of background for those who don’t-

Dr. Weitz:                           Absolutely. Go ahead, Jonny.

Dr. Bowden:                       Cholesterol is carried in a container, and the reason for that is the molecule itself is hydrophobic. It can’t live in water. It’s oil and water. It doesn’t mix, so it has to go in the bloodstream in a container. The container is the lipoprotein, the L in LDL.

Dr. Weitz:                           Right.

Dr. Bowden:                       Some lipoproteins are low density, which means that they float. Some are high density, which means that they’re heavy and they sink. These lipoproteins are the boat, the cholesterol is the cargo. Somewhere in 1963 or so, when they figured out that cholesterol travels in two basic kind of containers, and they gave them the idiotic names of good and bad, we got into this notion that there’s a different kind of cholesterol that travels. It’s all the same cholesterol. It travels in two containers. What we have realized in the last 20 years, that the mainstream profession does not get, is that the containers are what the problem is. It’s the containers, the LDLs that get caught in the endothelial wall and cause plaque, and heart disease, and all the rest of the stuff. The new tests for cholesterol look at the number of boats in the water.

Dr. Weitz:                           The LDL particle number.

Dr. Bowden:                       Yes. That is the test that we should be using. Any prescription that’s given based on the old test is about as valid as a prescription given on the Cosmopolitan horoscope of the day. It’s completely magical thinking. We need to know how many boats are in the water. That’s the message of the book, and it was Steve’s message. When people tell us, “My cholesterol’s high,” the first thing we always ask is, “By what test?” If they say, “Well, the LDL and HDL,” we stop talking. “Go back and get the real test. That’s a fake test.”

Dr. Weitz:                           Right. Because that LDL number is the estimated-

Dr. Elkin:                            [inaudible 00:21:45] happening in the real world right now. You’re absolutely-

Dr. Bowden:                       What?

Dr. Elkin:                            I’ve been doing specialized cardio lipid testing for 20 years. If you’re dealing with Medicare, Bluecross, Blueshield-

Dr. Bowden:                       Forget it.

Dr. Elkin:                            They do not like me. They do not like a doctor that orders specialized lipid testing.

Dr. Bowden:                       I’m with you. I understand.

Dr. Elkin:                            It is unbelievable what my staff has to go through just for the labs to get paid because we have to send records, why I ordered it. It’s crazy, so there’s so much work that needs to be done.

Dr. Bowden:                       So much work.

Dr. Elkin:                            The doctor’s ordering the right test. It’s getting these things to be paid because they just want us to do a simple lipid panel. That’s all they care about.

Dr. Bowden:                       I know. 

Dr. Weitz:                           For my take, you’re never get to get anywhere with insurance companies. The key is, is maybe some point in time, we’ll stop insurance companies from running the healthcare system.

Dr. Bowden:                       Well, that would be very nice, wouldn’t it?

Dr. Weitz:                           Yeah.

Dr. Elkin:                            It’s expensive testing you’re talking about. It ain’t cheap.

Dr. Weitz:                           Yeah.

Dr. Sinatra:                        Well Jonny, correct me if I’m wrong here, but I know my dad was really big on Lp(a) lipoprotein (a), and making sure that was added on to any sort of lipid panel.

Dr. Bowden:                       Yeah.

Dr. Sinatra:                        That can be a more atherogenic lipid particle.

Dr. Bowden:                       The NASH use of the LDL particles. The thing about Lp(a) is that there’s really no way of changing it, and that’s kind of the dirty secret. I think Steve had a couple of supplements he thought might make a difference with that like nattokinase and stuff, but it’s a really hard number to change, so once you know your number … I don’t get it tested every year.

Dr. Sinatra:                         Yeah.

Dr. Bowden:                       I think that might be why it doesn’t get as much attention. There’s no drug that can bring it down. I mean-

Dr. Weitz:                           That’s exactly why. Yeah, yeah. By the way, there will be a drug in a couple of years and then everybody will be testing it.

Dr. Bowden:                       Right, exactly. Then they’ll tell you how important it is. Right now, it’s not important because [inaudible 00:23:32] paying for it.

Dr. Weitz:                           Niacin can move the number some. L-Carnitine can move the number some. There are some things that can move the needle.

Dr. Bowden:                       Oh, good to know. Okay.

Dr. Weitz:                           Yeah. You can get about a 30% reduction with niacin.

Dr. Sinatra:                         Yeah, that’s the biggest mover, but nattokinase, Boluoke, all those, I haven’t had great success with those.

Dr. Elkin:                             Neither have I. Neither have-

Dr. Bowden:                       It’s like raising HDL. I mean, they tell you, “Exercise.” No, it doesn’t. Come on. Nothing gets HDL higher, in my experience, and I’m not even sure it matters that much.

Dr. Weitz:                            Right. Then we not only had the LDL particle number, but the particle size. The fact that the small, dense LDL is much more atherogenic than just the amount of LDL.

Dr. Bowden:                       The size is also a very good stand-in for insulin resistance. If you’ve got a small particle size, and you got a high triglyceride to HDL ratio, you almost don’t even need to be tested for insulin resistance because that’s a great surrogate right there.

Dr. Weitz:                           By the way, that’s one of the unfortunate problems with statins is they don’t do anything to improve LDL particle size.

Dr. Bowden:                       Nothing, nothing.

Dr. Elkin:                            Well, they have an anti-inflammatory effect, which we were not aware of when they came out in the ’80s when I was a fellow. We just thought, “Oh, it lowers LDL cholesterol. It does it quite nicely.” We later learned, years later, 15, 20 years later, that it actually does have an antiinflammatory effect.

Dr. Bowden:                       It also, as Steve used to point out all the time, it tends to thin the blood slightly, so it turns, what he called, ketchup into red wine. Those are important values of statins. As Uffe argues, statins would probably be better medicines if they didn’t lower cholesterol and they just did that. I would argue that though they may have a slight benefit as being antiinflammatory and slightly thinning the blood, you can do both of those things with zero side effects with ginkgo, Vitamin E, or fish oil.

Dr. Sinatra:                          Mm-hmm. Well said.

Dr. Weitz:                            Okay. Next topic is Dr. Sinatra’s contribution to the importance of a healthy diet for preventing and reversing cardiovascular disease. Howard, do you want to maybe start us off?

Dr. Elkin:                              Yeah. The whole thing with, already been mentioned is the Mediterranean diet, and it started with Lyon Heart Study in the ’90s. Then the PREDIMED Study came out in 2013, which was actually primary prevention. The Lyon Heart Study was really based on secondary prevention. It showed whether you combine olive oil or nuts, whatever, that Mediterranean diet actually with … It’s no other diet’s been shown thus far to be as effective in decreasing heart disease, so it put that on the map.  That’s my take, and I know that Sinatra and I have had many talks about the Mediterranean diet. There are lots of different aspects to it. Some people think it’s too much carbs, too many … I don’t imbibe on cereals. I don’t think there’s a healthy cereal out there, but I think the basic premise behind Mediterranean diet is quite good and we have research behind it.

Dr. Sinatra:                          [inaudible 00:26:41]

Dr. Bowden:                       Yeah. I don’t think Steve and I 100% agreed on the Mediterranean diet thing. I was always trying to get him to eat a higher fat version of it with less grains. The thing is, he came from that world where the Mediterranean diet was the dietary answer, and epidemiologically, there’s great evidence that it’s associated with all kinds of great things. I’ve always been much more of a skeptic. There are 22 countries in the Mediterranean. They don’t all eat the same diet. There’s Turkey, there’s North African countries. They don’t. When I was writing Living Low Carb and looking into the Mediterranean diet as a thing, I looked at menus that are currently available at all of those countries in the best restaurants, and every one of them has meat on it.

I think that there’s a variety of ways to eat Mediterranean style, I think, and Steve and I agreed on this. It’s not just the diet, it’s the lifestyle. They spend time in the sun. They take naps, they talk to each other, the men express their feelings. There’s a lot of differences between the way they live in the Mediterranean and the way we live here, so it’s not really just this one thing. Definitely, that style of eating, if you will, or the things that has in common. The higher amounts of nuts, and the good fats, and all of that stuff is a very good place to start. I would tweak it a little with less grains and a little more fat, but that still, that doesn’t make it any less Mediterranean.

Dr. Sinatra:                          Right. Well, let me lead into this with a story, and that my dad was paranoid about saturated fat in the ’80s, and so guess what we did for 10 years? We had no meat. Okay. He just didn’t buy meat, and instead, we had swordfish steaks on the grill all the time. I can’t even tell you how mercury toxic my whole family probably is, but that’s how, at the time, he was thinking to himself, “Hey, I’m giving my family fish. There’s omega-3s in there. It’s got to be good for you.” Then, all of a sudden, we learn about tuna, and swordfish, and all the other different larger fish in the sea that are mercury toxic, and so I thought that was kind of funny because I can still taste what swordfish is like.

Dr. Bowden:                         Wow.

Dr. Sinatra:                          Yeah, he loved Mediterranean diet. I think, for him, being Italian, it was probably hard to get off the pasta. That’s sort of like a staple of the Italian diet, or at least we think it is, and so my father always enjoyed a nice Italian meal with pasta. He did believe that olive oil was really like the secret sauce, and I do think that he was onto something with the olive oil. I do believe that olive oil can help drive a lot of these positive things that we see with Mediterranean diet, and agree with Jonny and all you about, in terms of reducing carbohydrates and that sort of thing.

Dr. Bowden:                         Let me tell you a story about the olive oil.

Dr. Sinatra:                          Mm-hmm.

Dr. Bowden:                         The particle test, this whole thing we’ve been talking about with the particle test, I have a personal story about that. Because my LDL, HDL numbers were perfect, perfect for decades. Any doctor would look at it and, “Your LDL’s ridiculous. You’re just doing fine.” Then when I became a functional nutritionist and learned about this, and saw that that was a bogus test and got the real test, I find that I’m in the high-risk zone for particles, and I’ve got the worst kind of size. I’ve got the pattern B which is, as somebody mentioned earlier, the little-

Dr. Weitz:                            Small, dense, yeah.

Dr. Bowden:                       Yeah, the Small dense ones. I’ve got this. I am an example of how the test … of being undertreated. In other words, I was a false negative. They said, “Oh, yeah, there’s no problem whatsoever,” and in fact, when you looked under the hood with the right test, I had very high particle size. I have all these wonderful, amazing functional cardiologists in my network, starting with Steve, and I asked their opinions, “Guys, what do you … I’ve got a serious particle problem. What should I do?” I’ll be honest. One of them said, “I know you’re not crazy about the statins. I think we should try, maybe, five milligrams of Crestor.” Others said, “At your age, it’s absolutely not necessary to do.”

I went to a cardiologist at Scripps who gave me certain supplements. I got a little stricter on my diet. Here’s what Steve’s advice was. Steve said, “Before you go on the statin, I want you to take a quarter cup of olive oil every day for three months, and then let’s remeasure,” so I did. He literally prescribed olive oil, and I do it to this day. If I had the bottle, I’d show you. I literally swig it from the bottle, as a medicine. Every day, it’s one of my supplements, and I did that. I can’t say it was just that, but that, the supplements that Dr. Triffon at Scripps Institute recommended, the stricter adherence to the higher fat, lower carb diet. My particles went from 2,200 to 1,600, and my particle size went from B to A.

Dr. Sinatra:                          Wow.

Dr. Bowden:                         I think the olive oil … It may not have been the whole story, but that’s the way Steve was. He’s, “Hold the medicine. Try the olive oil. Let’s see what that does.”

Dr. Sinatra:                          That’s great.

Dr. Weitz:                            Yeah. I know Dr. Houston’s very big on olive oil too.

Dr. Bowden:                        It’s a great food. It’s a medicinal food. There’s no doubt.

Dr. Weitz:                            Yeah. You got to get the right olive oil.

Dr. Bowden:                        Yes.

Dr. Weitz:                            Yeah. It’s got to be extra virgin, organic. It should all come from one country. You should name the specific type of olive that’s there. If it has a bitter taste, that means it’s going to be higher in the polyphenols.

Dr. Sinatra:                          There you go.

Dr. Bowden:                        Yeah. By the way, I don’t know if anybody knows this, a little trivia. There was a book written not too long ago by the food writer and expert, and he said the four most faked foods in the world, Kobe beef, Parmesan cheese. I forgot the third, and the fourth was extra virgin olive oil. It is so … They lie about that on the label consistently, so you got to be really, really careful. Steve had his own olive oil company.

Dr. Weitz:                            Yeah, be honest with you, most olive oils don’t even say on the label what type of olive, where they’re from.

Dr. Bowden:                        A lot of them are mixed and compounded with other oils, and-

Dr. Weitz:                            Right.

Dr. Elkin:                             They’re tainted, they’re tainted.

Dr. Bowden:                        They’re tainted.

Dr. Weitz:                            Yeah, yeah. I had an olive oil expert on the podcast, and one of the things he emphasized is it should say what country and it should name the specific type of olive, like koroneiki olives from Greece.

Dr. Bowden:                        Yep, yep, yeah.

Dr. Weitz:                            Next topic. Let’s talk about the importance of some of these nutraceuticals that Dr. Sinatra pioneered like coenzyme Q10, L-Carnitine, magnesium, D-ribose.

Dr. Bowden:                        He called them the awesome foursome. Drew could probably talk about it just as eloquently. I mean, he-

Dr. Sinatra:                         No, you go ahead first, Jonny. Go ahead.

Dr. Weitz:                           Yeah.

Dr. Bowden:                       Well, these were the four nutrients that he felt were really powerful for heart disease. Carnitine because it transports fat into the mitochondria, so it can be burned for energy. Magnesium, because it’s just needed for 300 different biochemical operations and it lowers blood sugar and it lowers blood pressure. Coenzyme Q10, he was one of the biggest proponents of coenzyme Q10, which basically is a nutrient that helps your heart make more ATP. It helps everything make more ATP, but the heart never takes a vacation, so it was a very, very heart-healthy nutrient. D-ribose is something we’re using to this day.

It’s so funny, because he was prescient about that one as well. D-ribose is a naturally occurring sugar, which has a number of incredible properties that he realized, way before the rest of us did, number one, it helps the cells to make ATP. It does this by turbocharging an enzyme called AMPK, which is a master metabolic controller. It’s like the air traffic controller of the cell. It is responsible for making the cellular bitcoin, which is ATP. That’s the stuff you need to do absolutely everything from talking, to waving your hands, to dancing the Mambo, to blinking your eyes, you need ATP, and coenzyme Q10 helps you make that. I’m sorry. D-ribose helps you make that.

What we have found recently about D-ribose … I use it in my coffee because it’s just such a great way, at the cellular level, to help make energy. I wondered myself. I thought, “This is awfully sweet-tasting.” It’s really fantastic if you like stevia, or monk fruit, any of that stuff in your coffee. This is just as good, but it’s got to raise your blood sugar, right? No. The miraculous thing about this naturally occurring sugar that’s good for energy is it actually has been used in diabetes treatment, and it actually helps lower your-

Dr. Elkin:                              It’s a five-carbon sugar versus a six-carbon sugar like glucose and sucrose.

Dr. Bowden:                       Exactly.

Dr. Elkin:                              That’s the difference.

Dr. Bowden:                       Exactly. That was one of his awesome foursome and to this day, I use … I would never be without magnesium. It’s one of my three basic supplements for everybody, and D-ribose is right on my counter, right now to this day, and coenzyme-

Dr. Weitz:                            That’s great.

Dr. Bowden:                       [inaudible 00:36:02] my vitamins.

Dr. Sinatra:                          Yeah. I’ll add to this that I think my dad pioneered it with cardiovascular disease and supporting heart, circulatory system, and all that. He wrote his book, Metabolic Cardiology, which was all about using these supplements, and talked about heart failure, helping with hypertension. I believe now that, just with things, we’re going, we’ve learned that, hey, you could use this protocol in someone with migraines. You could use this protocol in someone with chronic fatigue, or fibromyalgia, or someone that’s suffered with a long, chronic illness like Lyme disease, for example. It’s multifactorial in what we can use it for, which is beautiful because it’s not just for the heart, but it’s for the whole body, charging up every cell, like you were saying, Jonny.

Dr. Bowden:                       Yes.

Dr. Sinatra:                          I just feel like my dad really … Especially CoQ10. I really feel like CoQ10 was like his baby. He really nourished that baby and brought it to life. I believe it was 1986 that he had that on formulary at Manchester Memorial Hospital.

Dr. Bowden:                       Wow.

Dr. Sinatra:                          Think about that. 1986. I think I was around six years old when that happened. That just blows me away that he was just so advanced in his thinking back then of CoQ10, and then all these others were brought onboard. It was sort of, CoQ10 was really the beginning. Then I think it was magnesium next, and then it was L-Carnitine, and the last one was really the addition of D-ribose. It was really just so beautiful to see the evolution of the awesome foursome over time, and how it can not only support the heart, but the rest of the body as well.

Dr. Bowden:                       Getting CoQ10 into the formulary, I can’t emphasize how important that is. My mother died of congestive heart failure in the late 1900s. I went there and I said, “Can we put her on a couple hundred milligrams of coenzyme Q10?” They said, “What is that?” I said, “It is an enzyme that is used to make energy for the heart. It’s used in Japan as a prescription medicine for congestive heart failure. There’s major research on it.” We didn’t have the internet then. I printed out pages and pages of stuff. I brought it to them. Didn’t matter. Wasn’t in the hospital formulary. They never heard of it. Do you realize-

Dr. Elkin:                              It is still not in the formulary.

Dr. Bowden:                       … what Steve did-

Dr. Elkin:                              It’s still not in the formulary.

Dr. Bowden:                       Huh?

Dr. Elkin:                              It’s still not in the formulary.

Dr. Bowden:                       Getting it in the formulary in Manchester General was, people-

Dr. Sinatra:                          It was huge.

Dr. Bowden:                       Hats off, man. That’s just incredible.

Dr. Weitz:                            Well, one of the things that not everybody may realize is that the heart, unlike all the other organs, is the most dense with mitochondria-

Dr. Bowden:                       Of course.

Dr. Weitz:                            … which is what produces the energy, and coenzyme Q10 is so crucial for mitochondrial function, so it makes a huge amount of sense. I know, Dr. Elkin, you use those nutrients in your practice as well.

Dr. Elkin:                              Well, I have a very active practice, and a lot of patients with cardiomyopathies. They all, everyone with cardiomyopathy gets all four of those. I do CoQ10 levels. People that have cardiomyopathies and congestive heart failure really should have levels of four or five, and so I go by levels. Usually, they go on at least 400 milligrams a day. It’s also been used for Parkinson’s patients, for Parkinson’s as well. The L-Carnitine, and the D-ribose, I’ve used it in chronic fatigue. I’ve used in other states like that.  It’s funny. Now, I do have patients on statins because I have a lot of patients with confirmed coronary disease that have stents and bypasses, so I don’t just have preventative. I mean, I have primary prevention, and I have secondary prevention. People need to know that in secondary prevention, it hasn’t really changed. Still, the standards are pretty strict because patients that are on statins generally do better. Anyway, anyone that goes on a statin in my practice automatically goes on CoQ10. It’s a must. I tell them right and then there.

Dr. Bowden:                       Where do you stand, just as a side, on the ubiquinol versus the standard-

Dr. Weitz:                            Ubiquinone, yeah.

Dr. Bowden:                       Ubiquinone.

Dr. Elkin:                              That’s funny. Because I asked that question more than once to Steve, and he didn’t think it made a difference.

Dr. Bowden:                       I did too.

Dr. Elkin:                              I specifically said that patients are saying ubiquinol because they see it in the Life Extension Foundation, right?

Dr. Bowden:                       Yeah.

Dr. Elkin:                              Well, I asked Steve about it. Do you know anything, Drew, about that?

Dr. Sinatra:                          No, the same thing. I kept asking him over and again, and he basically would say that they’re equal, and that there was a big marketing push out there to get-

Dr. Bowden:                       Huge.

Dr. Sinatra:                          … ubiquinol a better product, but it really was the same.

Dr. Bowden:                       Yeah.

Dr. Elkin:                              Right.

Dr. Bowden:                       Yeah. He told me that there may be cases in which, for some reason, the person doesn’t absorb the standard one as well, and there may be an advantage in those cases, but he was very squishy on it. He thought, basically, that as he pointed out once, there’s like 18,000 studies using ubiquinone before ubiquinol even came out and we had pretty good results, so it was …

Dr. Elkin:                              Checking levels do help. Cleveland does it. Labcorp does it. Boston Heart does it. They will do CoQ10 levels.

Dr. Sinatra:                          Well, Howard, thanks for doing that because I know my dad measured levels way back in the day, and thank goodness you’re carrying the torch there and continuing with that, because just a reminder, I don’t do that with my patients and I probably should.

Dr. Elkin:                              Thanks.

Dr. Sinatra:                          Yeah.

Dr. Bowden:                       I’ve never had my levels measured. I may come to you and get them measured. That’d be an interesting metric to know about.

Dr. Weitz:                            Yeah, yeah. It’s also included in the Micronutrient test from Vibrant.

Dr. Bowden:                       Ah, good.

Dr. Weitz:                            Which is-

Dr. Sinatra:                          Oh, okay.

Dr. Weitz:                            Yeah. They’ve done the old SpectraCell Micronutrient test quite a bit better. Let’s talk about the role of emotions in heart health, which is something that Dr. Sinatra was probably one of the few cardiologists ever to talk about.

Dr. Elkin:                              Stephen gave me his book.

Dr. Bowden:                       Heartbreak. I’m so glad you brought that.

Dr. Elkin:                              I started reading it. I said, “Steve, this is amazing.” He said, “Howard, that book was written 20 years ago.” I thought it was … I said, “Are you kidding me?” Because I related to it so much, because I’m a body-mind kind of doctor. I believe, whether it’s cancer or heart disease, they’re correlates.

Dr. Sinatra:                          Yeah.

Dr. Elkin:                              Yeah, so I totally support his work in this. This book was [inaudible 00:42:21]

Dr. Weitz:                            Are there certain insights you got from Dr. Sinatra’s thinking about this that have helped you with some of your patients?

Dr. Elkin:                              Yeah. Specifically, it’s interesting. My cancer patients are a little different than heart patients. Because heart patients, they have a type A personality, which has changed over the years. Competitive, and blah, blah, blah. I’m type A, but I’m not cynical and I’m not angry. Those are the two, those are bad characteristics. Cancer patients are a little different. They tend to repress a lot of their feelings.

 He talked about that in this book, and I see that a lot. I do talk a lot … In my practice, I teach patients how to breathe. Meditation is an important part of what I do. I teach it, and about getting emotions out. I talk about it in my book and I practice it every day with my patients. They have to get it out. I think this book was just revolutionary for me, and I’ve said it to my patients as well.

Dr. Weitz:                            How about yourself, Jonny?

Dr. Bowden:                       Well, I was just thinking about, as I mentioned earlier, we had both had training in psychotherapy, and we’d both been patients of psychotherapy, so we both really felt this way about the connection and the bimodal communication between heart and mind, and brain and body. What’s striking to me is how much the research has supported his intuition. They’re writing now about, we all know, maybe people who are listening might not know, there’s this major thing in the body called the vagus nerve, and its job is to do communication from the back of the brain all the way through. It has outposts in the heart, in the immune system, in the gut. There’s really no more debate about body and mind, and separation in the vagus. That’s why all that, gut feeling and stuff like that, where so much, 80% of your serotonin is made in the gut, and all of that information flows back and forth, and the science is supporting that.

Dr. Bowden:                       There’s a new book that just came out by a professor of medicine at Harvard, who also has a divinity degree from Princeton, and it’s called Cured. They looked into some of these cases, remarkable cases of remission that are not medically explained, but are documented and stuff. It seems that the thing that all of them have in common is that these patients somehow figured a way to tap into their parasympathetic nervous system and calm themselves down.

Dr. Bowden:                       A lot of them got stage 4 diagnoses. They quit their job. They moved to Costa Rica, and miraculous … Without thinking that was going to happen, they did what Steve always talked about, which is to tap into that natural healing that the parasympathetic system does, the rest and digest system, and to be able to get off that treadmill a little bit. That’s all about emotion. It’s all about stress and anxiety, and about finding stillness, and finding calm, and taking off-

Dr. Elkin:                              Drew, I think you see a lot of this as a naturopath. My last YouTube Live was on this very thing, the parasympathetic nervous system, and using the vagal maneuvers, and so forth, but we are so sympathetically overdriven.

Dr. Bowden:                       Overdriven.

Dr. Elkin:                              Look what’s happening in the world right now. Besides our health issues, just look at the world, how divided we are in this country. Everybody’s tense. I’ve never seen such a tense world before. No wonder disease is rampant right now. It’s terrible, so we need to really calm and do these vagal … That was one of the things that’s interested me about earthing and being grounded is it actually helped get back to your normal circadian rhythm and increase the parasympathetic tone. Very fascinating. Stephen taught me that.

Dr. Sinatra:                          Yeah. I’m guessing, I’m feeling called to share these stories tonight.

Dr. Weitz:                            That’s great. We appreciate it.

Dr. Sinatra:                          My dad was a storyteller. When I used to shadow him when I was a teenager, and I think in my early 20s, I did a lot of shadowing of him, which I’m so grateful for at this point now. What I loved about the way my dad handled his patients was that he listened. He let them tell their story, and a lot of emotions would come up. Sometimes, the patients felt rushed, but he’d always give them the time and the space to allow them to tell their story. That in itself was the medicine, listening to the story. Because a typical doctor’s visit is what, six minutes, when you go see a conventional doctor? What do you do? You just go in, you got hypertension. You come back with an ACE inhibitor, whatever it is, but my dad was different. He had a little bit of a longer visit, and he allowed that space for transformation and for storytelling of the patient, which they needed.

Dr. Sinatra:                          That’s primarily why I became a naturopathic doctor, because I was so interested in counseling. Really, he was doing counseling the whole time, the psychoenergetic training that he did. That blew me away with his patients because he sometimes wouldn’t even have to recommend something. He would listen to them, and, all of a sudden, they’d give him a hug at the end, and ah, that was the medicine they needed at the time. I think my dad just had that uncanny ability to be present and to listen with compassion, and open ears. Patients really, they came to see him for that.

Dr. Elkin:                              I think, now with large medical groups and HMOs, the medical world is so corporate. I still have my own individual, solo practice. I’m a dinosaur, I guess, but patients really appreciate this. The number one complaint, if you look at surveys with patients, they feel they are not being heard by their doctor. They don’t feel heard. My mother, who’s 96, said, “Yeah. They got one foot out the door, one foot in the door.” It’s a complaint. People, they don’t feel heard.

Dr. Sinatra:                          Yeah.

Dr. Weitz:                            Yeah. Unfortunately, it’s the system. It’s hard to blame doctors because they’re part of the system. I know on the West Side, there aren’t too many physicians who are independent. Most of them have become part of a group, and the group’s been bought out by a hospital. The hospitals come in and run the show. They prescribe to them how many people they need to see, and so they’re caught in the system.

Dr. Sinatra:                          Yean.

Dr. Weitz:                            Let’s talk a little bit about earthing. I know that that’s something that Dr. Sinatra pioneered. I know you worked with him on that earthing study, Howard. What is earthing and what role can this play in heart health?  I think this is the remarkable. It’s basically using the negative electrons from the Earth’s surface. First of all, if you look at free radicals, they’re positive though. How do you squelch them? Well, free radicals, it’s the Earth’s surface, and I did this. I’m not doing it as regularly now as I used to. When I would do earthing every single day, grounding in my front yard, and so forth, I would literally feel tingling from the ground within. I really felt that sense.

Dr. Elkin:                              Stephen and I did it. We wanted to see the effects on blood pressure. We know it helps to decrease viscosity. We know it’s antiinflammatory, antiaging, but hinted, it also had an effect on blood pressure. We did a small study. Unfortunately it was a grassroots study, so we didn’t have a lot of patients. It was just me and a nurse that did this, but we did find a very positive correlate. You had to make sure the patients were grounded for at least 10 hours, which is hard to do.

Dr. Bowden:                       How did you ground? How did you do-

Dr. Elkin:                              We had grounding mats. We had grounded sheets. We encouraged … They had to report it, and they came in once a month. I set this up with Stephen and Guyton Chevalier, I think, and we had a whole protocol set. It wasn’t easy to do, believe me, it wasn’t, because you’re dependent on people. It was difficult, but patients loved it and they felt more calm, and they got … Here was the best thing. They felt they got more rested sleep. In some of these patients, we weren’t testing for this, the C-reactive protein, which is a marker for inflammation, came down-

Dr. Bowden:                       Wow.

Dr. Elkin:                              … in several of these patients, which is a marker of inflammation, so it’s fascinating. I wanted to, we talked about doing a bigger study and more studies, and we talked to Clint Ober. We never got around to it. I think that the reports on earthing, being grounded are significant. They’re phenomenal, but for the medical world to appreciate this, we need to have more studies. That’s just it.

Dr. Sinatra:                          Yeah, no, agreed. My dad was really big into understanding when this started to occur when we weren’t grounding anymore, and it was really when we started to wear these shoes that were rubber-soled, which connected you from the Earth. If you ever met my dad at any point, he probably came walking through the door in these radical cowboy boots. He had ostrich cowboy boots, and all these snakeskin ones, crazy ones. Those cowboy boots were grounded. They had a leather sole, and he, I think, maybe unconsciously, was moving towards the realm of grounding, even though he didn’t really know it.

When he stumbled upon this, I believe it was like 2007-2008, as I remember we were first talking about this idea, concept of grounding and earthing. It really blew his mind. I believe too, that it was great, because I saw him bring the science of it into effect, meaning like you were saying Howard, this free flow of electrons into the body helps with free radical stress, et cetera. I saw him finally connect to the Earth, and that was one thing that made me really happy, because my dad was always such this busy guy. He’s like go, go, go, go, go. Always there for someone. Traveling a lot, working a lot.

It was so good to see him ground out, as we called it, and connect to the Earth, and not only get the physical benefit of this free flow of electrons into your body, but also this connection with Mother Earth that I saw him evolve with over time, and it was great. It was great to see that. He’s such a strong believer in grounding, I can’t tell you. Every time we’d do something or go somewhere, he’d say, “Son, ground out.” We’d fly in an airplane, “Go ground out.” Every time, just, “Go ground out.” It’s imprinted in my mind, and now I do it with my kids too. I’ll be like, “Kids, take off your shoes. Go ground out.”

Dr. Elkin:                              He’s right.

Dr. Sinatra:                          Yeah.

Dr. Weitz:                            That’s great. Maybe, Jonny, do you want to add anything about the grounding?

Dr. Bowden:                       No. There were times when we were doing the cholesterol book tour, and we were doing appearances and stuff, and he was really into it. I had the crisis of conscience that I felt it was outside the Overton window for our audience. We were already taking on the medical establishment with such outrageous claims, “Saturated fat doesn’t cause heart disease, and cholesterol is being measured wrong, and it’s not the …”  It was already a little bit outside, and when he started talking about grounding, I was just worried. The Overton window, it’s like, “Dude, it’s a little too much. Maybe just don’t talk about it on the Dr. Oz show, because I don’t think that they’re going to quite get it.” I was always trying … I thought he was on to something, but I was fearful that because it was such a radical, new concept and so easy to characterize … You know how conventional medicine would … You know what they … I wanted, not to silence him, but I wanted him to keep it private because I was afraid it would dilute or make it easier for people to dismiss our message about heart disease and the stuff we’ve been talking about for the last hour.

Dr. Elkin:                              The thing I remember about Steve is that he was so passionate and energetic. He could have sold me on anything. When we had this luncheon and talked about grounding, would I be interested? I jumped at the chance because I felt somewhat protected by him because I wasn’t paving the way. He’d already done it, or was doing it. I was just riding on his dovetail, you know?

Dr. Bowden:                       Mm-hmm.

Dr. Elkin:                              I was honored to be able to participate. It was great.

Dr. Weitz:                            Maybe we could wrap up by saying something about what we should all focus on to help carry on Dr. Sinatra’s legacy in the world.

Dr. Elkin:                              Gosh.

Dr. Weitz:                            Howard?

Dr. Elkin:                              I think we’ve all said it, but I think, because I’m in an active practice, I am living it every day. I give him a lot of credit for how I practice, really, because I don’t think I’m a maverick. I learned from him and I gleaned from him, and so it just seems natural to me, because I’m a thinker too. I don’t just pass out pills. His memory remains indelibly within me, and as long as I practice, as long as I live, I’ll always remember the role that he played and how he helped me. I’m very grateful, having known him.

Dr. Sinatra:                          Yeah. I want to say that my dad was a phenomenal cardiologist, no questions about it. He was also an amazing heart doctor. There’s a difference there and that is-

Dr. Bowden:                       Good. Good one.

Dr. Sinatra:                          … he had such a high level of compassion and unconditional love for himself, his patients. He had dogs, guys. He had two or three dogs, sometimes in the office, come in with him. What doctor does that? What doctor does that? That, in a way, protected him, actually, energetically, from some things that would go down with patients.  Also, gosh, he just had such an open heart, and he shared that love with everyone, and that’s what attracted people to him. Just his level of compassion is just, it’s infinite. That’s the message I want to go out to people, is that we live in a very difficult time now. There’s a lot of stress, and it’s very easy to be judgemental of others, but maybe open your heart more and allow love to come into your heart so that we can live more in peace in this world and not so much anger.

Dr. Elkin:                              Beautifully stated.

Dr. Weitz:                            That’s great. How about you, Jonny?

Dr. Bowden:                       I’m reminded of a parable I heard, something I heard once to describe the difference between Eastern and Western medicine. I think it describes the way Steve practiced. It said that in Western medicine, we look at the symptom that the patient has in front of us. In Eastern medicine, they ask, “Who is this person in front of me?” Steve didn’t practice by lab tests. He practiced by treating patients, not numbers, not metrics. I think that’s probably the biggest message, the biggest tribute I can give him. He saw the person, the whole person, their story, everything about them. The lab tests and the symptoms were just part of that. They weren’t what he treated.

Dr. Weitz:                            Awesome.

Dr. Sinatra:                          Well said.

Dr. Weitz:                            Yeah, I don’t think I have much to add, other than to say that some of the most important messages I’ve heard from you guys is the importance of questioning orthodoxy and thinking outside the box. Even though medicine is a science, there’s also an art to it, and listening to your patient, which is just so sorely needed, and to have compassion for your patients, and do everything with a passion for what you do.

Dr. Elkin:                              I want to thank you, Ben, for bringing us all together.

Dr. Bowden:                       Yeah. Thank you, Ben.

Dr. Elkin:                              This was Ben’s idea, and I jumped at the chance.

Dr. Bowden:                       Thank you, Ben, and thank you, Howard, and thank you, Drew.

Dr. Elkin:                              It was really a pleasure.

Dr. Weitz:                            Okay. Well, thank you, Howard, Jonny, Drew. Thank you for everybody who’s watching it live, and who’s going to watch it on the recorded version.

Dr. Elkin:                              All right.

Dr. Bowden:                       Goodnight.

Dr. Weitz:                            Okay, goodnight.

Dr. Elkin:                              Bye, guys. Bless you.

Dr. Sinatra:                          Thank you.

 


 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple Podcasts and give us a five-star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. If you’re interested, please call my office, 310-395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.