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The Keto Code with Dr. Steven Gundry: Rational Wellness Podcast 258

Dr. Steven Gundry discusses how to Unlock The Keto Code 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

2:14  Dr. Gundry recommended a keto version of the plant paradox diet in one of his previous books for certain patients, though this was not a pure keto diet. Dr. Gundry previously believed that ketones are used in mitochondria to generate energy and that ketones make mitochondria more efficient and that you lose weight because you get less energy production out of less fuel and you become an efficient fat burner, which is why you lose weight.  Now he has figured out that that is the opposite of what happens in ketosis.

4:11  The original ketogenic diet started in 1930 at the Mayo Clinic as a way of treating childhood seizure disorders.  The original ketogenic diet was 80% fat, 10% carbohydrates, and 10% protein.  In the 1990s we discovered that you could give kids MCT oil, medium chain triglycerides, and achieve the same results as a high fat diet. Dr.  Cahill and Dr. Owen showed that even at full ketosis, the brain only gets 60 to 70% of its energy needs met by using ketones and 30 to 40% of the fuel needs of the brain are still glucose.  

 

 

So even at full ketosis, the brain’s needs, aren’t met by ketones. Are ketones doing something different than just being a fuel source? And it turns out that in fact, it is something different, and ketones are actually signaling molecules and they actually signal mitochondria to protect themselves at all costs and to actually tell mitochondria to become more inefficient at producing energy than efficient at producing energy. And this is actually something that’s been known about since the late 1970s in that ketones and other substances that I talk about in the book, actually tell mitochondria to uncouple oxidative phosphorylation. Briefly what that means, and I wish there was a better term, but it’s in the literature and we’re going to use it. Normally we… Oxidative phosphorylation, we couple oxygen molecules with protons to produce adenosine triphosphate to drive energy production. And that’s oxidative phosphorylation. That coupling can be stopped or diminished by what are called uncoupling proteins.

And it basically is like a pressure cooker. Pressure cooker is great at cooking food fast, but if the pressure gets too high, the pressure cooker blows up. So you have to have a way of popping off that pressure with a pressure release valve. Making energy is really damaging to mitochondria and mitochondria should have a pressure release valve. Then it turns out these are opening pressure release valves with uncoupling proteins. And it turns out that ketones uncouple mitochondria, and prevent damage to mitochondria. And if you like the mitochondrial dysfunction theory of Alzheimer’s disease, for example, then protecting mitochondria with uncoupling sounds like a really good idea.

Now we’ve known about mitochondrial and coupling again for a very long time. It turns out that when mitochondria are uncoupled, one of the side effects is producing heat and neurons actually love heat. They operate at a much higher temperature and operate more efficiently at higher temperature. So one of the exciting findings of the effective ketones on the brain is not so much that they’re great fuel, but they tell mitochondria to uncouple to protect themselves in the brain and produce heat in the brain. And it’s actually the heat effect that makes neurons relax and work better. Kind of fun.

 



Dr. Steven Gundry is a cardiovascular surgeon who has changed his focus to a Functional Medicine/Integrative approach. He is the director of the International Heart and Lung Institute in Palm Springs and the founder and director of the Center for Restorative Medicine in Palm Springs and Santa Barbara.  He is the best selling author of Dr. Gundry’s Diet Evolution, The Plant Paradox, The Plant Paradox Cookbook, The Plant Paradox Quick and Easy, The Longevity Paradox, and his latest book, Unlocking The Keto Code.  Dr. Gundry can be reached through his website, DrGundry.com or by calling his office at (760) 323-5553.

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 whether or not to keto and why with Dr. Steven Gundry. The keto genetic diet is one of the more popular diets in the functional medicine world. Being recommended for weight loss, diabetes, cancer, neurological diseases, like Alzheimer’s and a number of other conditions. But the ketogenic diet is a very controversial, and now we have Dr. Steven Gundry weighing in with what his take is on the keto diet. Dr. Steven Gundry does not really need an introduction, but he’s a heart surgeon who has changed his focus to nutritional and preventative medicine.  He is now internationally known, having made hundreds of TV appearances, and he’s all over the internet. He’s the director of the International Heart and Lung Institute in Palm Springs and the founder and director of the Center for Restorative Medicine in Palm Springs in Santa Barbara. He’s the bestselling author of Dr. Gundry’s Diet Evolution, The Plant Paradox, The Plant Paradox Cookbook, The Plant Paradox Quick and Easy, The Longevity Paradox, and his latest book Unlocking The Keto Code, which you can see to the right of Dr. Gundry. Dr. Gundry. Thank you so much for joining us today.

Dr. Gundry:        Hey, thanks for having me. Appreciate it.

Dr. Weitz:           So you’re one of the most prolific doctors in the functional medicine world, though I guess you have a ways to go to catch up with Mark Hyman, who has 11 books and Deepak Chopra who has 25.

Dr. Gundry:        I know, I just keep trying to catch them. I’m working hard at it.

Dr. Weitz:           So Dr. Gundry, at one point you recommended a version of the ketogenic diet, what you called the keto based intensive care program in your Plant Paradox book, but you’ve changed your view on the keto diet. Can you tell us why that is?

Dr. Gundry:        Well, if you actually look at the plant paradox, the keto version of the plant paradox diet, that diet that I recommend has a lot of what would appear to be carbohydrates that would be against the traditional ketogenic diet, and yet it worked extremely well in my patients. When I was writing my last book, The Energy Paradox, I like to back up what I say and recommend with science, whether it’s my research or others, and I was trying to explain how ketones are used in mitochondria to generate energy. And so I, like many people talking about ketones, was convinced that ketones were making mitochondria more efficient, that they were able to get more energy production out of potentially less fuel, and that you became an efficient fat burner, and that’s why you lost weight.  And in fact, when you look at the literature, human literature, primarily based out of Harvard and the NIH, you find that in fact, that’s exactly the opposite of what happens in ketosis. And so I said, son of a gun, this goes against everything most people have talked about, and I need to go down this rabbit hole and find out what the heck are ketones doing, if they’re not the world’s greatest fuel and if they’re not actually making your mitochondria efficient fat burners, and that’s actually what the book is about.

Dr. Weitz:           Yeah. Everybody really focuses on the brain and how ketones are… The brain works so much better when it can work off of ketones instead of glucose. And this is often recommended for patients with Alzheimer’s as Dr. Dale Bredesen includes it in his program and for patients after concussions. So why doesn’t the brain work well with ketones?

Dr. Gundry:        Well, the original ketogenic diet started in 1930 at the Mayo Clinic as a way of treating childhood seizure disorders. And that was before Phenobarbital and Dilantin, and they found that… Actually it was almost stumbled upon. They found that children who were having so many seizures, that they basically didn’t eat, because they were in this post ictal state, their seizures went away. And then when they started eating again, when they kind of woke up, their seizures came back and people said, Gee, when these kids aren’t eating, they’re in ketosis, they’re making ketones and maybe it’s the ketones that were stopping these seizures and are there other ways to make ketones? And in fact, a very restricted carbohydrate diet or a very high fat diet makes people make ketones. So the original ketogenic diet was 80% fat, 10% carbohydrates and 10% protein.

And lo and behold, kids on this diet actually had a remarkable diminution in seizures. So the initial thought process was that ketones suppressed seizures. Now, when drugs came out, the ketogenic diet for seizures pretty much fell by the wayside. It had a resurgence in the 1990s when it was found that you could give kids MCT oil, medium chain triglycerides, and achieve the same results as a high fat ketogenic diet, but give these kids more carbohydrates and more proteins and anyone who has children and now grandchildren know it’s pretty hard to deprive kids of carbohydrates. And in fact, it’s pretty hard to deprive adults of carbohydrates. So when people started looking at, well, what in fact were ketones doing that suppressed seizures, results particularly out of Harvard with Dr. Cahill and Dr. Owen showed that even at full ketosis, the brain only gets 60 to 70% of its energy needs met by using ketones and 30 to 40% of the fuel needs of the brain are still glucose.

So even at full ketosis, the brain’s needs, aren’t met by ketones. Are ketones doing something different than just being a fuel source? And it turns out that in fact, it is something different, and ketones are actually signaling molecules and they actually signal mitochondria to protect themselves at all costs and to actually tell mitochondria to become more inefficient at producing energy than efficient at producing energy. And this is actually something that’s been known about since the late 1970s in that ketones and other substances that I talk about in the book, actually tell mitochondria to uncouple oxidative phosphorylation. Briefly what that means, and I wish there was a better term, but it’s in the literature and we’re going to use it. Normally we… Oxidative phosphorylation, we couple oxygen molecules with protons to produce adenosine triphosphate to drive energy production. And that’s oxidative phosphorylation. That coupling can be stopped or diminished by what are called uncoupling proteins.

And it basically is like a pressure cooker. Pressure cooker is great at cooking food fast, but if the pressure gets too high, the pressure cooker blows up. So you have to have a way of popping off that pressure with a pressure release valve. Making energy is really damaging to mitochondria and mitochondria should have a pressure release valve. Then it turns out these are opening pressure release valves with uncoupling proteins. And it turns out that ketones uncouple mitochondria, and prevent damage to mitochondria. And if you like the mitochondrial dysfunction theory of Alzheimer’s disease, for example, then protecting mitochondria with uncoupling sounds like a really good idea.

Now we’ve known about mitochondrial and coupling again for a very long time. It turns out that when mitochondria are uncoupled, one of the side effects is producing heat and neurons actually love heat. They operate at a much higher temperature and operate more efficiently at higher temperature. So one of the exciting findings of the effective ketones on the brain is not so much that they’re great fuel, but they tell mitochondria to uncouple to protect themselves in the brain and produce heat in the brain. And it’s actually the heat effect that makes neurons relax and work better. Kind of fun.

Dr. Weitz:            Wow. Kind of interesting. It would seem at first blush, when you think about this uncoupling concept, you’re telling the body to waste energy. And if you think about evolutionary survival, the biggest threat to survival was not having enough energy, starvation, and the last thing you’d want to do is inefficiently waste energy.

Dr. Gundry:        That’s exactly right. At first blush, that seems like the stupidest thing you could do. But I was profoundly influenced by a paper that was written by a PhD, by the name of Martin Brand in 2000. And I really recommend everyone, your listeners and viewers to pull up this paper, it’s an easy read. It’s called Uncoupling to Survive, and Dr. Brand argued, and there’s subsequently tons of papers that prove he was right, that if in extremists, if you are starving to death, you’ve got to protect the mitochondria, which make energy from damage. Because if the mitochondria die, you’re done and you will waste every last resource to protect mitochondria. You’ll waste muscles, you’ll waste anything to protect mitochondria. So he argued that mitochondria should be told by ketones to uncouple waste fuel so that they don’t have to work so hard. That’s number one. Now that sounds dumb.

But the second thing is mitochondria are told by ketones to make more of themselves, mitogenesis. And the cool thing about mitochondria is they have their own DNA, and so mitochondria can divide within a cell without the cell dividing. And the example I like to use is let’s suppose we have a dog sled up in Alaska and we have one dog pulling the sled. Now, the dog could pull the sled, but you’re not going to go very fast and you’re not going to go very far before the dog gets tired. Suppose we add five more dogs to that one dog, and we have a 6 team dog sled.

Now you’re going to go a lot faster, you’re going to all go a lot farther, but you now got six dogs to feed instead of one dog to feed. And so you’re actually going to require more food. So the example is correct. What happens with ketosis is we tell each individual mitochondria to work less hard to protect itself, but to add more mitochondria, to share the workload. And when you start looking at that, one of the things that Brand showed was if you look at super old people who are thriving at 105, they have the most uncoupled mitochondria compared to anybody else.

And I bring up the example of birds. There’s a fun theory of aging called the cost of living hypothesis. And the cost of living hypothesis has been around for nearly 100 years, actually 100 years. And that is in general, the faster your metabolic rate, the shorter your lifespan and the slower your metabolic rate, the longer you live. And in general, that is pretty applicable. The exception to that rule is birds. Birds are remarkably small, but birds can live an incredibly long time. A parrot can live 80 to 100 years, a hummingbird in captivity, which was one of the highest metabolic rates there is. Hummingbird’s hearts can beat a thousand times per minute and hummingbirds in captivity can live 10 years. So what the heck is happening with birds, it turns out that birds have incredibly uncoupled mitochondria, and that explains the mystery of why these little creatures can live a very long time because they’re mitochondria are protected.

Dr. Weitz:            So I’m thinking that some of the proponents of the ketogenic diet and especially those who promote ketones as a source for energy, they might argue when the studies show that the brain can only get 70 or 60% of its energy from ketones, that might be because those people are not used to using ketones for fuel. They’re not keto adapted and that if they were to be using a ketogenic diet for a longer period of time, that they would be more efficient at using ketones.

Dr. Gundry:        Well, that research has been refuted by Cahill and Owens in human volunteers who are keto adapted.

Dr. Weitz:            Oh, okay.

Dr. Gundry:        And interestingly, so in ketosis, after about three days of ketosis, the muscles of humans actually prefer using ketones as a fuel, but as time passes muscles begin to much prefer free fatty acids. And in fact, keto adapted individuals only 30% of fuel from muscles come from ketones, the rests come from free fatty acids in glucose. Now that’s in absolute counter distinction to Vogel and Phinney’s results in human athletes that shows that there is a keto adaption period of up to two weeks, but with Owens and Cahill’s results, if muscles are using ketones as their preferred full at three days, we ought to see the exact opposite of what Kenny and Vogel say. And in fact, that’s not the case. And in racewalkers who are keto adapted, we know that racewalkers actually burn much more oxygen to sustain their ability than if they’re using carbohydrates as a fuel. So human studies actually suggest that much of what we believed about the ketogenic diet just isn’t based on human facts.



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:           In your book, Unlocking the Keto Code, one of the things you talk about is intermittent fasting or time controlled eating as one of the keys to getting the benefits of keto without necessarily doing keto. And every time I have a discussion of this concept, I always find it so interesting because when I got into doing nutritional counseling over 30 years ago, I recall having a lot of women clients and they all skipped breakfast and they had a light lunch and they ate a large dinner and the mantra was you’re overweight because you skip breakfast and it’s important to eat within an hour of waking up and you have to eat a meal or snack every three hours or your blood sugar’s going to be going crazy and you’re going to store fat.  And so the key was to have a meal, a snack, a meal, a snack, a meal, a snack. And that was the only way. And that would actually… Eating had a fat burning effect, and that was the only way you’re going to lose weight. And the worst thing you could do is to skip breakfast. And now the key to health is skipping breakfast.

Dr. Gundry:        Yeah. It’s funny when you look at hunter gatherers, then there are a few of them left. Hunter gatherers, don’t eat breakfast. There’s no storage system for food. There’re no refrigerator.

Dr. Weitz:          You don’t have Frosted Flakes.

Dr. Gundry:        No. They have to find breakfast. And most of these guys don’t eat until 10 or 11 o’clock in the morning when they’re out finding something, picking a berry or getting a tuber. And it turns out when you look at the history of breakfast, breakfast is really a modern invention. It was actually started in the industrial revolution in the late 1800s. And what happened, nobility got breakfast, because they had servants, and they had breakfast in bed. Churchill had breakfast in bed every day. But when people had to go to work in factories, what would happen is that men went to work in factories and men would go to work, they didn’t get a lunch break, they didn’t get breaks and they’d work all day and come home late at night. So women would give men before they went to the factory food and they work all day without, and then come home late at night and have their next meal.

And it was actually interestingly enough, the Ramadan diet. Ramadan you eat before sunrise and you don’t eat or drink again until after sunset. And so that’s where breakfast actually came from. The idea of fueling because you weren’t going to eat for a very long time. And it wasn’t until the Kellogg brothers invented Kellogg’s Cornflakes in the early 1900s that they’re advertising acumen actually convinced Americans, and then the world that breakfast is the most important meal of the day. And you ought to actually start your day with a predigested meal. And Kellogg’s cornflakes were actually first advertised as the world’s first predigested meal that would go instantly to work. And boy advertising works miracles.

Dr. Weitz:            So what are some of the other keys to unlocking the keto code? I know you talk about polyphenols.

Dr. Gundry:        Yeah. Let me just give one more example about the power of intermittent fasting. And so there’s an Italian athlete study that I’ve talked about in the book that I think really is important for all of us, particularly in sports and medicine. So they took Italian cyclists and they put them on a training table. Everybody had to eat the same thing for three months. All they changed was the time of eating. So one group of athletes had breakfast at eight o’clock in the morning. They had lunch at one o’clock in the afternoon and they had to finish dinner at eight o’clock at night. So a 12 hour eating window. The other group of athletes, same food. Had breakfast at one o’clock in the afternoon, had lunch at four o’clock in the afternoon and then had to finish dinner at eight o’clock at night. A seven hour eating window.

They followed them for three months, the group with the seven hour eating window, lost weight, even though they were eating the exact same amount of calories as the group with the 12 hour eating window, which didn’t lose weight. And the group with the seven hour window had identical performance on the bikes, but they’re insulin like growth factor, which most of us use is one of the best markers for mTOR activation, and aging plummeted in the group in the seven hour window and it didn’t change a bit in the 12 hour window. So it shows the power. Now why did this happen? It’s bec-

Dr. Weitz:            And by the way, if you took that seven hour window and instead of 12 to eight, if you made it eight to four, would it have made a difference?

Dr. Gundry:        Great question. And the question is the length of time that somebody is actually making ketones. So that’s a great question. Normally, if we have metabolic flexibility and sadly the average American does not have metabolic flexibility, even people with normal weight, only 50% of people have metabolic flexibility. And just to define our terms, metabolic flexibility is the ability of mitochondria to either use sugar as a fuel or use free fatty acids or ketones as a fuel. And we should be able to go back and forth literally instantaneously, almost like a hybrid car. If you’re overweight, 88% of people have no metabolic flexibility and if you’re obese, 99% of people have no metabolic flexibility. So going back to metabolic flexibility, if you have that and you stop eating, you finish dinner, you begin to make ketones about eight hours after you stop eating by 12 hours, you’re really beginning to ramp up ketone production.

So let’s look at the athletes. The 12 hour guys are just coming into their beginning sweet spot of making ketones and then boom, they eat and their ketone production stop. The guys who are eating breakfast at one o’clock in the afternoon now have an additional, basically five hours of ketone production. So they’re getting signaling from those ketones for another five hours. So to answer your question, if we started eating at eight o’clock in the morning and then stopped at two o’clock in the afternoon, we could get the same benefit as long as we aren’t eating the rest of the time.

And in fact, when I was writing the energy paradox and I’ve tried this with patients, I’ve toyed with people and I’ve done it myself, Hey, I want you to eat breakfast and lunch and then stop. Our lifestyles, particularly if we’re raising a family or if we’re married, for instance my wife and I kind of see each other from five o’clock on and that’s family time. Right. And so it’s so impossible in our culture to push away from the dinner time. That is just hard to do. But to answer your question, yeah, you can do it and it’ll work.

Dr. Weitz:          Yeah. That’s kind of what I do in my program three days a week, I eat my last meal at 02:00, but partially because I’m working till 08:00 and it’s easier for me not to eat anyway.

Dr. Gundry:        No, it’ll work fine. Just our culture is really hard.

Dr. Weitz:          Right. The family dinner. So let’s talk about some of the other ways to unlock the keto code. Polyphenols, which are these phytonutrient rich fruits and vegetables. A lot of people describe them as antioxidants.

Dr. Gundry:        They’re not. Yeah. And I joke about this in the book. For years, I’ve had the pleasure of presenting papers at the International Congress of Polyphenols, which usually meets every year in Paris. The last two years, it hasn’t met for obvious reasons. And the organizer of this conference is a doctor by the name of Marvin Edeas. Years ago I was talking to him and he actually opened a conference one year, this is literally 12 years ago. And he said, those of you who are here thinking that polyphenols are antioxidants, you may leave the room right now because I don’t have enough time to catch you up on what polyphenols actually do. And I went, what, what? Of course they’re polyphenols. What about the ORAC, the oxygen radicals absorbing capacity. And he says that has nothing to do with anything. And I go, well, teach me. I actually grabbed him backstage and went teach me.

Dr. Weitz:            Durk Pearson and Sandy Shaw are turning over in their graves. [I apologize that they are still alive]

Dr. Gundry:        Yeah. I said, teach me. He said they have no antioxidant capacity. And mitochondria have only two antioxidants, which I go into the book. And this was actually a revelation to me. There are only two antioxidants that work in mitochondria. One of them is shocker and it’s melatonin, the sleep hormone and I spend a lot of time in the book trying to convince people, the melatonin is not a sleep hormone. And number two, it’s glutathione, and these are the only two antioxidants that work in mitochondria. So if polyphenols aren’t antioxidants and I can assure you, they’re not, then what the heck are they doing? Why do they have a beneficial effect?

Dr. Weitz:            Don’t they contain vitamin C and other nutrients that are antioxidants?

Dr. Gundry:        Sure. But vitamin C is not an antioxidant that actually works in mitochondria. In fact too much vitamin C can be a prooxidant in mitochondria. Vitamin C is useful for recycling glutathione into glutathione after it’s been oxidized. But vitamin C has no place in mitochondrial antioxidant. So what the heck are polyphenols doing?

Dr. Weitz:            So you’re saying vitamin C can serve in the antioxidant capacity, but not in mitochondria?

Dr. Gundry:        Exactly. Exactly. Yeah. That’s not where it works. So same with vitamin E. It’s not an antioxidant in mitochondria. So what’s fascinating is plants have their own mitochondria. They’re called chloroplast. And again, we talk about oxidative phosphorylation, mitochondria take oxygen combine it with protons from carbon and make ATP and carbon dioxide. Those are the byproducts plants work exactly in opposite. They take carbon dioxide, they take photons from sunlight and they produce oxygen and glucose, the exact opposite. So these chloroplasts believe it or not, sunlight is very damaging to these mitochondria.

Dr. Weitz:            [inaudible 00:31:10]mitochondria also produce reactive oxygen species.

Dr. Gundry:        Correct. And those are what glutathione and melatonin are for.

Dr. Weitz:            Oh, okay.

Dr. Gundry:        To absorb that damage.

Dr. Weitz:            I thought those were free radicals, the vitamin C and the other antioxidants would[inaudible 00:31:29].

Dr. Gundry:        No, not in mitochondria.

Dr. Weitz:            Okay.

Dr. Gundry:        Not in mitochondria. Mitochondria only have two antioxidants. One of the things that shocked me when I was writing the energy paradox is that plants make melatonin, and you go, what the heck? Plants don’t need to go to sleep. What the heck is melatonin doing? Well, plants use melatonin to protect their mitochondria. Plants also use polyphenols to protect their mitochondria by uncoupling their mitochondria to prevent damage. What are polyphenols? So all of us have seen polyphenols every fall. As soon as the chlorophyll in leaves goes away, we see all these beautiful yellow, orange, red, magenta, purple colors in the leaves. Those are the polyphenols that the plant has produced to protect its mitochondria by uncoupling them. When we eat these polyphenols, we don’t absorb them very well, quite frankly, but our microbiome loves them. They’re actually a prebiotic food for our microbiome. The microbiome then transformed those polyphenols into absorbable compounds.  And the cool thing is that we then uncouple arm mitochondria from those polyphenols effect. It’s literally… Every time I talk about this, I start singing the Circle of Life from the Lion King. It’s like we eat the plants and we die and then we feed the plants and it’s a circle of life. And it’s hilarious. And it turns out that’s why these plant polyphenols are so good for us because they uncouple mitochondria.

Dr. Weitz:            Your favorite polyphenol foods?

Dr. Gundry:        Well I’m, I’m famous for saying the only purpose of food is to get olive oil in your mouth and olive oil is rich in polyphenols and surprise, surprise olive oil’s actually very rich in melatonin. The richest source of melatonin in food is actually pistachio nuts by far. Red wine has melatonin, coffee has melatonin, tea has melatonin. So these were produced by plants to protect their mitochondria, amazingly, not to put them to sleep.

Dr. Weitz:            What do you think about A, taking supplemental polyphenols and B, what about the idea of using high dose melatonin? Typically we recommend small doses of melatonin often in sleep products or for patients having trouble falling asleep. But a lot of times 20 milligrams of melatonin might be used in a patient that’s putting together an integrative program to help them with their cancer therapy. And some people advocate really high, even higher dosages of melatonin for some longevity effect.

Dr. Gundry:        Right. In fact, I profile in the book… I’ll just tell you an interesting story. I have a 17 year old female Labradoodle, big dog, 85 pounds. A year and a half ago now she couldn’t pee, strained to pee, took her in to the vet, get an ultrasound. The vet comes out and said, Gosh, I’ve got… Sorry to tell you. She has inoperable bladder cancer. I want to send her to an oncologist and we need to start her on chemotherapy, or we can put her into sleep right now. And I’m going well, shoot. I know a lot about cancer. I treat a lot of cancer patients. I’m going to put her on my program. So I put her on a lot of uncoupling agents, which included… She takes 48 milligrams of melatonin a day. She takes-

Dr. Weitz:            Did you come up with that number?

Dr. Gundry:        Well, so in my patients, I use up to 100 milligrams of melatonin in my cancer patient.

Dr. Weitz:            Really?

Dr. Gundry:        Yeah. Now you got to start slow. You got to build them up. But yeah, I’ll use 100 milligrams. So-

Dr. Weitz:            Now where did you get that number from?

Dr. Gundry:        Research.

Dr. Weitz:            Okay.

Dr. Gundry:        Yeah. There’s actually some surprising research that looks at high dose melatonin in at least slowing cancer progression. And if you like the metabolic dysfunction theory of cancer, which I like a lot, normally, as you know, we rely on mitochondria to produce ATP and they’re incredibly efficient at making ATP. One molecule of glucose will give you 32 molecules of ATP if you use mitochondria. On the other hand, fermentation, glycolysis is the other way of making ATP. But one molecule of glucose will only give you two molecules of ATP with fermentation. What’s odd, and this is what fascinated Otto Warburg was cancer cells, for some obscure reason, you couldn’t quite figure out why, prefer to use fermentation to make ATP.  He thought it was because mitochondria had a defect that they couldn’t make ATP and so the cancer cell fermented to make ATP. Subsequently, we know he was wrong that mitochondria can make ATP in cancer cells, but cancer cell chooses to use fermentation. You’re old enough to remember the original computers where we all ran Microsoft, and when something was going wrong with your computer, it would shut down or you’d shut it down and then it would come back on and it would say operating in safe mode.

Dr. Weitz:           Oh, of course.

Dr. Gundry:        Remember?

Dr. Weitz:           Oh, I remember having a DOS system.

Dr. Gundry:        Oh yeah, exactly, that was MS-DOS. So you could do a few things in safe mode, but until you figured out what you screwed up, it would operate there. So there’s this fascinating theory of cancer that I like a lot. That if the cancer cell… If the cell thinks that it’s damage, it will go into the primordial operating system prior to mitochondria. And the primordial cell before engulfing mitochondria bacteria, there’s a thing called contact inhibition where normally, in a high organism like us, when one sells growing and it runs into another cell, it stops growing because the… Nope, you can’t go any farther.

Primordial cells do not have contact inhibition. So if it’s growing and runs into another cell, it just keeps growing, and that’s a characteristic of cancer. So the theory is what’s happened is the cancer cell is operating in safe mode in this primordial system. And if you like the metabolic dysfunction theory of cancer, if you can get mitochondria back online, then the cancer cell can revert back into its normal operating system. And this is what I see in my patients and I see in my dog. Pearl is now a year and a half out. She pees like a race horse. She takes 48 milligrams of melatonin a day and along with a number of other mitochondrial uncouplers.

It’s not the placebo effect. I can assure you. Pearl doesn’t know she’s not supposed to have cancer anymore. And it’s rather humorous when I met with the oncologist actually two months into this and she said, Wow, she has inoperable bladder cancer and we can get her on chemotherapy this afternoon. And I said, well, no, no, no, you don’t understand. She’s peeing fine now, and don’t you want to know how I did it? And she said, oh this is just temporary. She’s not going to make it. I said, well, let’s suppose it’s temporary. How long do we have? She said, well, weeks. And I said, well, what’s a chemotherapy going to do for us. She said, oh, I can give you six months. And I said, well, then what happens? And she said, well, going to run out of effectiveness.

Well, so that was a year and a half later, and about a year into this, I called her office and said, Hey, the dead dog is still around. Would you like to know how I did it? And the receptionist said, Oh, yeah, I’ll go talk to her, and came back, said, no, the doctor doesn’t want to know. Have a nice day. Okay. Okay.

Dr. Weitz:           Kind of like when you first met Big Ed, right?

Dr. Gundry:        Yeah. That’s exactly right. You know, you can’t see unless your eyes are open. And I was blessed I guess, because I was a researcher all my life, going, this makes no sense. How did you do that? This is impossible, and how the heck you do that? And it turns out Big Ed has taken a ton of polyphenols. And as you know, at Gundry MD, one of the things that made me famous at Gundry MD is these polyphenol containing compounds. So now-

Dr. Weitz:           That’s interesting. I’ve talked to some of the leading proponents of that metabolic theory of cancer, like Dr. Thomas Seyfried and Nasha Winters, and of course they all recommend a ketogenic diet.

Dr. Gundry:        Sure. And sadly, we know that the ketogenic diet clearly has some positive effects, but when you actually look, cancer cells can actually use ketones as a fuel. So then you go, well, wait a minute, this goes against Warburg’s thoughts. So there’s a different effect that ketones are having, and that is this mitochondrial uncoupling. And I think, yeah, the ketogenic diet should absolutely be a part of a cancer therapy. But I think there’s more here to uncover, and that’s among other things where melatonin looks very interesting because it is, again, one of the two mitochondrial antioxidants.

Dr. Weitz:           Any other key nutrients you use in your cancer protocol?

Dr. Gundry:        Yeah. So I actually use a lot of uncoupling agents. I use sulforaphane, which is a broccoli extract. I’ll use turmeric as part of this… Which is, believe it or not an uncoupling agent. Interestingly enough, low dose NSAIDs, non-steroidal anti-inflammatories are actually uncoupling agents. And I write about in the book. When I first wrote The Plant Paradox, one of the things that was very obvious from pharmacologic research is that NSAIDs, like Ibuprofen, like Naproxen, Aleve, are incredibly damaging to the lining of the gut. They’re literally like swallowing hand grenades.

Dr. Weitz:            And kidney stress.

Dr. Gundry:        Oh yeah. And kidney stress. And it turns out that the pharmaceuticals knew this. In fact, I’m old enough to remember when these were introduced in the mid 1970s and they were prescription only, and they came with a warning that you could only prescribe these for two weeks because they were so dangerous. The pharmacologic literature is full of these papers. And now of course they’re the lightest selling over the counter drug there is, and people eat them candy, there’s children’s Advil. So when I was writing this book, I went back to that literature and I go why are these guys so damaging? And it turns out that these things are such potent mitochondrial uncouplers that at contact to the wall of the gut, they uncouple the mitochondria so aggressively that the cells die and that’s what creates the damage.

So you start going, huh, oh, maybe a little dab will do you. And in dog bladder cancer, use Pearl’s example, there was a sudden discovery of a very standard NSAID called Feldene, which is still around. Dogs with bladder cancer were given Feldene for pain relief. And surprisingly about 30% of dogs on Feldene had a spontaneous remission of their bladder cancer. And you go, wait, spontaneous remission of bladder cancer on Feldene? What’s the mechanism? And sure enough, it’s uncoupling mitochondria. So Pearl’s on Feldene and yeah, it’s cheap. So there’s a bunch of tricks. Okay.

Dr. Weitz:            Cool.

Dr. Gundry:        Yeah.

Dr. Weitz:            I have to have another discussion about cancer. Maybe a few more things about the keto code. You know, I love your recommendation for reverse juicing. That’s very creative. I usually just tell patients to make a smoothie instead of juicing, but-

Dr. Gundry:        Yeah. And I actually wrote about this in my first book, Dr. Gundry’s Diet Evolution, years ago. And so juice is really the most nasty, awful fructose laden stuff that you can eat, but fruits are loaded with polyphenols. And everybody’s got a juicer. I’ve got a Jack Lalanne Juicer. So what I like people to do is buy some organic fruit, preferably in season, and juice it, throw the juice away and take the pulp and then put it in goat yogurt or sheep yogurt, or put it in a smoothie or get a silicone ice cube tray and put it in the ice cube trays and freeze it and then throw it in. You can make ice cream out of it. I do goat yogurt ice cream with these polyphenols several times a week.

Dr. Weitz:            I’d like to interrupt this fascinating discussion we’re having for another few minutes to tell you about another really exciting product that has changed my life and the life of my family, especially as it pertains to getting good quality sleep. It’s something called the Chilipad, C-H-I-L-I P-A-D. It can be found at the website chilisleep.com, which is C-H-I-L-I-S-L-E-E-P.com. And so this product involves a water cool mattress pad that goes underneath your sheets and helps you maintain a constant temperature at night. If you’ve ever gotten woken up because the temperature has changed, typically gets warmer, this product will maintain your body at a very even temperature and it tends to promote uninterrupted quality, deep and REM sleep, which is super important for healing and for overall health. And if you go to chilisleep.com and you use the affiliate code Weitz20, that’s my last name, W-E-I-T-Z-20, you’ll get 20% off a Chilipad. So check it out and let’s get back to this discussion.

 

Dr. Weitz:       So goat milk, is it less allergenic? Is that why?

Dr. Gundry:        Great question. Yeah. It turns out that goat milk traditionally is called mother’s milk because goat milk actually has almost identical properties and proteins and fats as human milk. Cows milk has absolutely no relationship. So that’s part of it. But interestingly, if you look at cultures with extreme longevity, in fact, three of the blue zones, they’re real longevity comes from the fact that their goat and sheep herders, and that they eat a lot of goat dairy products, goat yogurt, goat cheese, sheep cheeses, sheep yogurt. And part of the reason is that MCTs are instantly turned into ketones in our liver and those ketones uncouple their mitochondria. So these guys have got uncoupled mitochondria just by having goat and sheep herds. But-

Dr. Weitz:            Interesting. I remember we had a functional medicine meeting with Dr. Bastani, and he said that camel milk was actually the least allergenic type of milk.

Dr. Gundry:        Yeah, that’s true. It’s really pretty hard to find camel milk. Donkey milk is also-

Dr. Weitz:            It just so happened, some guy stood up who was there, who’s like a distributor for camel’s milk.

Dr. Gundry:        Yeah. No, you can find it. Absolutely. Yeah.

Dr. Weitz:            Let’s see. Fermented foods. You’re big on fermented foods. And most people recommend fermented foods because of the fact that they contain probiotics.

Dr. Gundry:        Yeah. And that’s actually… Yes, they do contain probiotics, but most of those probiotics are actually destroyed by gastric acid and never make it into our digestive system. But what’s exciting is that fermented foods contain short chain fatty acids, which are like butyrate, like acetic acid, which is vinegar, and propionic acid. And it turns out that these short chain fatty acids are mitochondrial uncouplers and that’s actually how these foods work. That’s why apple cider vinegar, there’s no magical mystical way that it helps you lose weight. It actually is a potent mitochondrial uncoupler, and the more you uncouple your mitochondria, the more you literally do a caloric bypass on your mitochondria and you’ll waste-

Dr. Weitz:            Because you’re wasting energy instead of using it to store fat.

Dr. Gundry:        Yeah. Yeah. You’re wasting fuel. That’s kind of cool.

Dr. Weitz:            And you like hot and cold therapy as well.

Dr. Gundry:        Yeah. And again, it all kind of comes down to the same common denominator, cold therapy uncouples mitochondria, hot therapy uncouples mitochondria via heat shock proteins. I did a lot of research as a heart surgeon into heat shock proteins in protecting the heart.

Dr. Weitz:            Most in the longevity world talk about these things as being stressors that have a hormetic effect.

Dr. Gundry:        That’s because we thought that’s what they did. But now we have an actual underlying mechanism, which is mitochondrial uncoupling that explains hormesis. Yeah. I used to talk about hormesis all the time as that which doesn’t kill me makes me stronger. But now we know that everything that we classified as hormetic stressors actually uncouple mitochondria, and you’re right, you can overdo this uncoupling. And we talked off camera about this miracle weight loss drug in the 1930s, which was called 2,4-Dinitrophenol, DNP, and DNP was discovered because back in World War I, munition factory workers in France and Germany were noted to be incredibly skinny and eating huge amounts of food to keep their weight on, and they were always running a temperature. And after the war, researchers said, Hey, there’s compounds in munitions, one of which is called 2,4-DNP, that increases the metabolic rate. And that explains why these guys were so thin and they were running a temperature.

So a couple researchers at Stanford says, holy cow, we’ve got the ultimate weight loss drug. And so they actually wrote… 100,000 prescriptions for DNP were written in the 1930s. And it was miraculous, low dose DNP, you could lose a pound a week, high dose DNP, you could lose five pounds a week. Think about that. And you go, wow, that’s a miracle. Well, like any miracle, these people started running temperatures. They started developing thyroid issues. They developed cataracts. And this was actually before cataract surgery. And I make a joke, this is so great, but you can’t see yourself in your skinny dress because you’re blind. And then there were deaths. And so the FDA, the newly formed FDA in 1938, one of their first act was to ban DNP as a drug. And so we now know in 1978 it was discovered that DNP was actually the first known oral mitochondrial uncoupler, and that’s actually how it worked.

Dr. Weitz:            And the reason it was dangerous because it uncoupled too much.

Dr. Gundry:        Too much. Correct. It was uncoupling, but it wasn’t making extra mitochondrial to take up the slack. Yeah. And I talk about it in the book, a little dab will do you.

Dr. Weitz:            Right. If people don’t quite understand this concept, if you completely uncouple your mitochondria, you no longer produce energy and this is not compatible with life.

Dr. Gundry:        Exactly. Yep. That’s exactly right. There’s a Goldilocks rule. There’s a sweet spot where a bit is really good for you. Too much, you’re right, you’re dead.

Dr. Weitz:            Now you also recommend polymines such as found in aged cheese. And I would say cheese is probably not on the list of health foods these days too much.

Dr. Gundry:        Well, it turns out goat and sheep, cheese and aged cheeses ought to be one of the top foods in health lists and cheese has been maligned. I’ve maligned cheese in the past and I’m willing to say I was wrong, but-

Dr. Weitz:            Saturated fat causes heart disease, right?

Dr. Gundry:        Yeah. Not. You know that there are multiple theories of heart disease. I particularly do not like the cholesterol theory of heart disease. But if you like the cholesterol theory of heart disease, you got to oxidize-

Dr. Weitz:            The entire cardiovascular profession is built around that concept.

Dr. Gundry:        Yeah. And again, we always have to be willing to take a second or third look at our beliefs. And we always have to question conventional wisdom, including our own, as I talk about in my dedication. You always got to question your own beliefs and be willing to change.

Dr. Weitz:            I find it interesting that you like MCTs, medium change triglycerides, which are often recommended as part of a ketogenic diet and some people put them in their coffee. But you don’t like MCTs from coconuts, which is where most people get them from.

Dr. Gundry:        No, I like MCTs from coconuts.

Dr. Weitz:            Oh, okay.

Dr. Gundry:        But I don’t like coconut oil.

Dr. Weitz:            Oh, okay.

Dr. Gundry:        The problem with coconut oil is, yeah, it has a few MCTs, but coconut oil… The other saturated fats in coconut oil actually impair mitochondrial function, unfortunately. So there’s a difference.

Dr. Weitz:            Which saturated fats are…

Dr. Gundry:        So it turns out that there’s… Lauric acid is actually not as good as people think it is. Stearic acid is fairly benign in terms of cholesterol, but the big long chain saturated fats actually impair mitochondrial function. And I have a whole chapter that I won’t bore people with about how fats work, but there are great saturated fats and then there are not so great saturated fats.

Dr. Weitz:            So the story about saturated fats you’re saying is don’t lump them all together and let’s separate out 12 chain, 18 chain, 22 chain, et cetera, and are having different properties.

Dr. Gundry:        Correct. And there’s some exciting, new, very long chain saturated fats and some odd chain saturated fats that I go into. There’s a new one, recently discovered called Carbon 15, which is an odd chain saturated fat, which is present in milk products. But it turns out it’s an essential fat that we had no idea it was essential. And work actually out of the US Navy Dolphin Project actually identified this. I talk about it in the book. It’s a fun read. Yeah. There is an essential Carbon 15 fat that we didn’t know.

Dr. Weitz:            And outside of milk, for those of us who don’t consume milk, where else can you get it?

Dr. Gundry:        You can actually get it, and I have no relationship with this company. There’s a company called Fatty15.com. Cute name. And you can get it as a little capsule. It’s quite inexpensive. And yeah, so you don’t have to have milk to find Fatty 15.

Dr. Weitz:            All right. So now I got to add the omega 15s to my omega 3s and my omega 7s.

Dr. Gundry:        Yeah, yeah, yeah. Yeah. So check it out it, and it’s actually a wonderful website. And again, I literally have no relationship with them. It’s just a fascinating story that I talk about in the book.

Dr. Weitz:            Great. So there’s been a great discussion, Dr. Gundry, thank you so much. And closing thoughts and how can people find out about your programs?

Dr. Gundry:        Well, so they can find me at drgundry.com. My supplementary food company is gundrymd.com. I’ve got the Dr. Gundry Podcast, wherever you get your podcasts. I’ve got two YouTube channels I’m on Instagram and Facebook. And hopefully I show up in everybody’s email every day, talking to them and waving at them, or hopefully when you’re surfing the web, I’ll pop up and say hi, hopefully.

Dr. Weitz:            Thank you.

Dr. Gundry:        All right. And thanks a lot for having me. 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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Integrative Cancer Care with Dr. Paul Anderson: Rational Wellness Podcast 257

Dr. Paul Anderson discusses An Integrative Approach to Cancer at the April 28, 2022 Functional Medicine Discussion Group Meeting 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

12:55   While in early cancer care, conventional care has a reasonably high rate of success and the protocols are fairly standardized, in stage four cancer care there’s just as much experimentation and unknown in standard of care oncology as there is in Integrative cancer care.

14:00   We need to share with patients that while we don’t know how their case will go, we know a lot more and have a lot more tools to help patients with cancer, but being realistic is a difficult balancing act. When patients ask if he can cure their cancer, Dr. Anderson will typically answer that curing cancer is above his pay grade, but that we can help to improve your quality of life and when that is done, we often see cancer markers improve as well as cancer outcomes.  For patients with stage 4 cancers who kind of know how things are playing out, they want to have as much energy and they want to be on as little medication as possible.  For patients with curable cancers, they may have other outcomes that are important for them.

19:03  The patients who did the best with an Integrative Oncology approach have addressed the three main foundational pillars, which are the following:

1.  Food.  Your diet should be low glycemic and it should be as clean as possible. We also know that doing at least a 13 hour intermittent fast daily is associated with longer life and better survival in cancer patients.  

2.  Muscle.  For all chronic diseases, but especially in cancer, that I think we all realize now that whether it’s cancer or not, but especially in cancer, the more muscle metabolism you work yourself through and the less fat metabolism you work yourself through, the better your survival and the better your quality of life. And so this doesn’t mean the person has to be a power lifter. It just means they need to move their body.  

3.  Brain.  How you think about cancer and how empowered you are as a cancer patient will affect your outcome.   

The cool, high speed, high expense therapies like IVs, hyperbaric and hyperthermia will work better in the setting of these foundational things being attended to.

 

35:22  While chemotherapy and radiation will decrease the size of tumors in many cases, we know that in the long run, they are associated with the more likely return of more aggressive cancer. That might be months later, it might be years later, but we know that happens.  We need to be supportive to those therapies but also supportive to their normal tissue so that we don’t get recruitment of cancer cells by emboldening the cancer stem cells with the chemo and the radiation.  While cancer patients are undergoing active treatment, we often focus on reducing side effects, like mucositis, and enabling the patient to tolerate the therapies. Whatever we can do to improve their quality of life will be helpful on the back end.  What is done from an integrative perspective, unless you’re doing something really strange, you’re actually not going to interfere with anybody’s chemotherapy or radiation for the most part.  For every 100 units of concern that a radiation oncologist has or a medical oncologist has with you interfering with their very powerful therapies, there’s probably two or three units of actual concern that need to be had. Now, that doesn’t mean they’re going to buy that, but you need to have that conversation with your patient.

38:54  Antioxidants. The concern that most radiation oncologists and medical oncologists have is usually around antioxidants, since one of the mechanisms by which radiation and chemo kill cancer cells is using free radicals, there is concern that antioxidants will uncouple these therapies.  Often patients are told not to take any nutritional supplements because of this concern, even those that are not antioxidants, like glutamine and fish oil.  You might be best off having a conversation with your patient early on that there is a difference in world view between the oncologist and you, the Integrative practitioner, and that while the oncologist is going to be sure of what they believe, but that this information about antioxidants has a low level of scientific validity. Unfortunately, all doctors are not on the same page.  Dr. Anderson will often tell the patient that it is they who have the cancer, not the oncologist.  Radiation oncologists tend to be particularly hostile to the use of any nutritional compounds. Medical oncologists are on a huge spectrum and some are so extreme that they don’t want you to eat salads or any foods that have antioxidants, which makes no sense at all, while others do not have a problem with nutritional supplements.

42:19  During chemotherapy, Dr. Anderson tends to focus on using supplements that help reduce some of the side effects, like mucositis with L-glutamine and probiotics, as long as they have a good white blood cell count and demulcent herbs. During radiation, Dr. Anderson tends to use nutrients that help to potentiate the radiation, like milk thistle, curcumin, and boswellia.  Most of these nutrients would be taken daily several times per day.  The dosage for milk thistle is 400-600 mg 2-3 times per day.  Milk thistle is a really good is a radiosensitizer and a healing agent and it also keeps the vitamin C glutathione cycle really humming along.  He also like to use IV vitamin C on the Mondays of the week when they get radiation at a starting dosage of 25 grams and going to 50-75 grams.  

44:32  Is Glutamine contraindicated in cancer?  Unless the person is on a high sugar diet, glutamine is a non-issue in cancer.  Glutamine only becomes a fuel for cancer if they are on a high sugar diet.  And the same for glutathione.  What we know is that tumors can pump out glutamine and glutathione into the extracellular space, but this has nothing to do with the glutamine and glutathione that we might supplement these patients with. We should use glutamine during treatment, esp. if the patients have mucositis, 3 or 4 grams 3 or 4 times per day, but once their treatment is done and they start to heal, we back off on that dosage and discontinue.  The concern that some doctors feel warrants not using supplemental glutamine is that research shows that glutamine can feed tumors is based on glutamine feeding tumors that is produced by the tumors and not from ingested glutamine.

49:12  Fasting before, during, and/or after chemo or radiation. Even major cancer centers are recommending some sort of fasting or intermittent fasting around active treatment to reduce the side effects of treatment and also to enhance the effectiveness of the treatment. But you have to ask people what they are able to do. Some people can fast easily and like it, while other people might say that all that they can do is a 13 hour fast daily, which is still very helpful.  A good tool is Dr. Valter Longo’s Fasting Mimicking Diet, called Prolon.  It feels like they’re eating but it’s more like a fast. As far as diet, Dr. Anderson recommends either keto or low carb or modified Mediterranean. Low glycemic. Moderate in protein, since protein can be converted into glucose.  Lots of low glycemic vegetables.  Lots of herbs. Small amounts of low glycemic starches or none. Very small amounts of colorful fruit.  At least a 13 hour fast daily from dinner till eating the next day, while drinking a lot of water. Doing a short term water fast for one to three days is very helpful, such as one day prior to treatment, the day of treatment, and one day after. Or just fasting one day prior to treatment is still good. Dr. Anderson has a bunch of free articles and also paid courses on many of these issues, such as about vitamin C and other antioxidants and chemo and radiation on his ConsultDrAnderson.com website.  He also has some articles and courses on IV vitamin C and on how to detox after chemo.

55:03  During recovery from cancer treatment is a good time to reverse some of those things that chemo and radiation do, which is to make the cancer stem cells more bold.  During chemo and radiation the cancer stem cells go and hide and wait and are largely unaffected.  You want to make your normal cells more cancer resistant to keep the cancer stem cells from coming back.  You want to focus on healing from the treatments.  Do they have radiation burns?  Do they have leftover mucositis?  Do they have mucositis induced diarrhea that won’t stop?  Is their microbiome all messed up?  By cleaning up and helping to fix the quality of life issues, you also are actually getting at healing the normal tissues.  And the more you do that, the more you make them resist cancer stem cells.  It’s also important to bring back mitochondrial function, which will help to restore their energy.  Dr. Anderson has developed a radiation recovery formula via IV that includes nutrients and glutathione he developed for radiation burn patients, but this is after they’re done with radiation.

1:02:54   Will natural treatments or supplements interfere with some of the newer targeted therapies being used for cancer patients?  Some of the targeted therapies are synergized by natural substances, such as curcumin and melatonin and it is unlikely that natural supplements will interfere with these therapies. For melatonin for cancer, Dr. Anderson usually recommends 20 to 60 mg up to 300 mg per day.  Dr. Shallenberger has a good presentation on high dose melatonin: High Dose Melatonin Therapy.  Melatonin is particularly effective with breast and prostate cancer. 

1:09:00  There are three main theories of oncogenesis: 1. Genomic Theory, 2. Metabolic Theory, and 3. Cancer Stem Cell/Trophoblastic theory.  Each of these theories have a place and there is not one theory that wins. 

 

 



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.

Welcome everybody to the Functional Medicine discussion group meeting tonight on an integrative approach to cancer care. I’m Dr. Ben Weitz, and I’m very happy to be joined by Dr. Paul Anderson, naturopathic physician and expert on an integrative approach to patients with cancer. I’ll make some introductory remarks before introducing our sponsors for this evening, which are Integrative Therapeutics and Vibrant America. And then I’ll introduce our speaker. I encourage each of you to participate and ask questions by typing in your question in the chat box.  And then I’ll either call on you or simply ask Dr. Anderson your question when it’s appropriate. So thank you for joining the Functional Medicine discussion group meeting, and I hope you’ll consider attending some of our future events. On May 26th we’ll be speaking about functional maternity with Dr. Sarah Thompson. And June 23rd, we’re going to have Dr. Ali Rezaie, who’s one of Dr. Pimentel’s partners, and he’s going to give us an update on some of the new, exciting research on SIBO and IBS.

And he and Dr. Pimentel have just published a book. If you’re not aware, we have a closed Facebook page, The Functional Medicine Discussion Group of Santa Monica that you should join, so we can continue the conversation. I’m recording this event and I’ll include it in my weekly Rational Wellness podcast, which you can subscribe to on Apple podcast, Spotify or YouTube. And if you listen to a Rational Wellness podcast, please give me a ratings and review on Apple podcasts. And so now I’d like to introduce Steve Snyder of Integrative Therapeutics, to tell us a little bit about some integrated products. Steve?


 

Steve Snyder:                    Hello everyone. Just real quick. We actually have … this is a good topic for us. We have a line of products that were developed by Dr. Lise Alschuler, who’s a naturopathic oncologist and also happens to be a cancer survivor. And her idea on this was, there’s more and more people that are actually surviving cancer treatment these days. And they come out of this treatment and they’re trying to find the best thing for them, and their primary care doctor typically doesn’t have any clue. So they end up going to Whole Foods Market and some high school kid tells them to take this multivitamin.  And so her idea was to scour the research, come up with formulations for common issues that face, what she calls Thrivers, and that were sort of dual purposed to address the issue that they’re facing, as well as to have some chemo protective properties. The product line is called ProThrivers’s Wellness. There’s four products. There’s a multivitamin, that’s unique in what it doesn’t contain. So no beta-carotene, no copper, no boron, things that maybe generally the research suggests are not good for cancer survivors to be taking.

There is a product called the flavonoid complex, that is CoQ10, glutathione, resveratrol, green tea, theracurmin, and the alpha-glycosyl isoquercitrin altogether, kind of in a synergistic combination of antioxidant, anti-inflammatory ingredients, that people are probably taking multiple tablets to get to. And then there’s a couple targeted products. There’s a ProThriver’s sleep that uses a high dose melatonin, that’s typically kind of an antioxidant dose for cancer patients, that’s designed to help with people that come out of cancer treatment with insomnia. And then there’s a ProThriver’s brain formula that deals with chemo brain. And that has the Lion’s Main Mushroom, acetyl-L-carnitine, some citicholine. It also has theracurmin.  So those are really interesting products. If you’re treating patients that are survivors, these are really something you want to look at. We don’t typically recommend them other than the multi for people that are in treatment, but once they’re out, these are great options. And then the other one that comes up all the time is theracurmin. And almost every talk we have, theracurmin comes up, because the research is ridiculous. But there’s research on theracurmin in prostate cancer, biliary cancer, esophageal cancer, liver cancer. So it’s a really, really important product for people that are dealing with this stuff. So anybody have any questions, you guys know how to find me, but that’s just wanted to make sure everybody knew about those.

 


 

Dr. Weitz:                            Okay, great. Thanks, Steve. And Integrative Therapeutics is one of the few brands that we carry at our office. Now we have Margo Haswell of Vibrant America. Margo, are you there?

Margo Haswell:                 I am. Yeah. Thank you Dr. Weitz.

Dr. Weitz:                            Thank you.

 


 

Margo Haswell:                 Thanks for everyone for joining. So my name’s Margo, I’m the rep in Los Angeles for Vibrant America. We’re a full service lab offering functional medicine tests. Pretty much everything under the sun, under one roof. We’re CLIA certified. So our focus initially was on early diagnosis of chronic disease like Celiac, Lyme. We had some other tests as well. We’ve published several studies, validating our tests with the Mayo Clinic, Hopkins and Columbia University.

Recently, we’ve shifted our focus towards longevity. So specifically around reducing inflammation and oxidative stress. So we offer tests that look at toxic burden. We just came out with a new nutrigenomics profile. We offer testing for chronic inflammation, things like that. We do offer a $400 coupon, so you can try it out. You could do a clinical consult if you want, to basically try the test out on yourself and see what you think. So if you’re interested, I’m going to go ahead and put my email and my phone number in the chat. And I’ll go ahead and put our website as well, so if you want to open an account, we just need an NPI number. All right. Thank you.

 


 

Dr. Weitz:                            Thank you, Margo. And I vouch for Vibrant. We use their testing all the time. Everybody’s talking about, how do you coordinate all these different tests into some platform. You just have to get all your tests from Vibrant and they pretty much have everything. You can get all the full panels that you would get looking at cardiometabolic factors. They’ve got a great micronutrient test, that’s better than the old Spectracell test was. They’ve got the full Lyme testing. They’ve got the toxin testing, the mycotoxins. They got this great trio of toxin test, the toxic burden test through urine and it tests heavy metals, mycotoxins and environmental toxins. It’s really a killer test.

So our speaker for this evening is Dr. Paul Anderson, who’s a naturopathic physician, medical director and founder of Anderson Medical Specialty Associates. He’s a recognized authority in the field of integrative cancer research and the treatment of chronic diseases, genomic conditions, and autoimmune and infectious disorders. Dr. Anderson offers a large number of courses on his website, Dr.Anderson.com. So there are many aspects of naturopathic, functional medicine practice, including integrative cancer care. He’s an author of a number of books, including Out of the Box Cancer Therapies and his latest book is Cancer, the Journey from Diagnosis to Empowerment. Dr. Anderson, you have the floor.

Dr. Anderson:                    All right, well thank you. Thank you everyone for joining this evening. I know how these evening things are. So what we’re going to do, I’m going to switch the screen over. I’ve got some slides just to kind of keep me on track, just so you know kind of the direction we’re going, and then we’ll have some Q and A time obviously too. I really thought, because you talk about integrative cancer care and you could spend days, and days, and days speaking about it and we don’t have that.  So one of the things that I’ve done, especially now in the third decade of working with people with cancer, is in addition to my work doing research, cancer research with National Institute of Health Funding, I started to look backwards at just generally my cancer patients and what were the characteristics of the people who were more likely to survive, over the characteristics of their treatment pathways, et cetera?  And then that sort of led to a, what I think of as a nice overlay, a rational way to look at people in the cancer journey when you’re interacting with them. And so I want to come at the topic from that point of view, because I think gives a nice framework. And it also sort of informs what are the basics? And a lot of times we get people, as you all I’m sure have had, who everything is expensive everywhere, right? Everything that has to do with cancer and integrative cancer care can be very expensive.  And so I also looked at well, what were the things that really don’t cost people any more time or money to incorporate into their life, that are a base that we can work our way out from? And so I just want to talk about that as we go through. And then look at, there’s really four phases of interacting with a cancer patient, and that also can kind of help narrow down your approach and get focus for your patients. So I am going to go to share screen here. Now, also, Dr. Weitz, and I talked beforehand. Certainly just put your questions into the chat. If he has something that he thinks really fits right in, he’ll interrupt me. Otherwise, we’ll have time at the end as well. And so I’m good anyway you want to do it. So let’s get this moved over. All right.

So we can move past there. So with cancer, there’s always a few elephants in the room, and these are not surprising to anybody, but I think it’s good. Maybe it’s not the happiest thing, but it’s good to start out when we’re thinking about anywhere in oncology, standard oncology, integrative oncology, et cetera, to just remember that we have a lot of wins. We have a lot of people who, as was mentioned earlier, are thrivers. They make it all the way through. But we also have people who do progress and they do pass away. And one of the hard things I know early in my career, was not that I didn’t realize that, but just kind of coming to grips with the fact that the more cancer patients you deal with, the more people in the different parts of the spectrum you’re going to be working with.

And so in the standard of care world, they’re very clear with their statistics normally, even though they may not always share them appropriately. But it’s also good, I think to know, and this is coming from someone who’s both worked alongside and right with, and also in distinction to the standard of care oncology world, that they’re really, especially when you get to stage four cancer patients, there’s just as much experimentation and unknown in standard of care oncology, as there is in what we do. It’s just, they usually don’t call it that when it happens. Now, I do also want to just say, that while I have had patients of all over the spectrum in cancer, and as time went on, I certainly gained a lot of broad spectrum cancer care because of a number of things, probably time and practice, being associated with research and just being a referral center, my patients tended to be later stage aggressive cancer patients.

So I did not tend to get the people who had the more simple type cases. Occasionally, but not much. So one of the things that, I think that we have to come face to face with, is the fact that we actually now, especially if I look now versus say 20 or 30 years ago, we have a lot more tools than we used to have, a lot better understanding of how to use the tools. And I think that it’s incumbent upon us to share that with the patients, and in a positive way to let them know that we don’t know how this is going to work for you individually. But collectively over time, we certainly know a lot more and are a lot better, we’re better informed about how to deal with people with cancer.

And so, one of the things that I have seen, is being realistic is a balancing act. Not so realistic that some of my colleagues will say, “Well, you just don’t have enough evidence for what you’re doing, so you shouldn’t be doing any of it. Or you’re just taking people’s money.” I’m sure we’ve all heard that. Actually the bottom one is a quote from a relatively famous oncologist. He said, “I’m morally opposed to your oncology practice.” So I’ve heard all of these things. So I think we shouldn’t be really on that end of the spectrum, but also we need to understand that there’s a lot of realism that comes in with people who have cancer.

And I think what most of us come to, if you’ve seen more than zero or one cancer patient, is really with anybody, any patient, but especially cancer patients. When you get past the question that many people have, which is, can you cure my cancer? And I would always tell people, “That’s above my pay grade. I’ve seen cancer cured, but I cannot do that personally.” When you get beyond that, really what they’re looking for is the best quality of life, like we all are. And I think if you’re going to have that as a heart-to-heart with a patient and say, “Look, we’re going to do everything we can.” And a lot of times in striving for quality of life, you actually improve a lot of other cancer markers and a lot of other cancer outcomes.

It helps the patient get on the same page with you. And these are just some things I’ve learned the hard way over years. Good upfront discussion, find out what their real outcomes are that they want. Because you have people, it’s like, they kind of know how things are playing out, but they want to have as much energy and they want to be on as little medicine, and all this stuff as possible. And you get other people, at other places along the spectrum and they may have a very “curable cancer,” and they have many other outcomes that they’re looking for.

Dr. Weitz:                          Hey Paul, could I just interrupt you for a second?

Dr. Anderson:                    Yeah.

Dr. Weitz:                          On this topic of discussion and being realistic with patients as to what their prognosis is. Do you find that a lot of times patients are not really being given the proper information about what their prognosis is? And so I just had a patient this week and has a stage four cancer, that’s not very treatable. And they gave him a round of chemo and he thinks that he’s … they told him, “We don’t see any sign of cancer.” So he’s thinking, “Hey, this is great.” And I think it’s important for patients to be optimistic, but unfortunately it seems like a lot of times they’re not being told exactly what the truth is about what their treatment is. They’re getting palliative care and they think they’re actually getting curative care.

Dr. Anderson:                    Yeah. I think that kind of goes along with that theme, there is … it’s extremely common that what you just described happens, and part of it is the oncologist not being completely clear. Part of it is denial on the side of the patient. And you can usually sort that out, if you have a discussion with them about the difference between, you got a stage four aggressive cancer and they’re doing chemotherapy, there is no curative intent there. And they may be missing that.  I’ve also seen a fair number of patients with, again, aggressive stage four cancers who were on second, third, fourth, fifth line therapies, which are experimental at that point. And they still believe that there’s some curative intent. So there’s a lot of clarifying that needs to go on. And I think one of the most powerful things is, in your first visit or two, really just having the space in your conversation to have that discussion. Yeah. Because people are confused and sometimes it’s, they’re hearing what they want to hear. But other times also, they’re not hearing a good message or a clear message.

Dr. Weitz:                          Right.

Dr. Anderson:                    Certainly. This next section is real short and you’ll get the point real soon. But I just wanted to keep this in this presentation, because this really speaks to the basic things that I have seen over, and over, and over, over the years. That if these basics are covered, and this is something common to all of us who do integrative therapies, we often forget how important the basics are. And these are things that are part of our life, whether we’re doing other things or not.  And my real take home point from this, and I’ll kind of go through these slides fairly quickly, because they’re going to be obvious to you. My real take home point is, when I look backwards over those three decades, and I look at the patients where the treatments that we did really kind of stuck and made a big impact, they were attending to these core areas of foundational areas. And they’re that important. When I teach this to medical students, I use the pneumonic food, muscle and brain. And literally, if people are attending to these things, they shore up their physical foundation, so that whatever other treatments you’re doing go in and stick. And if they’re not, well, it doesn’t work out so well.

So it’s kind of like we use the analogy of a house and it has to have a foundation. That’s exactly what this is. And the idea is, so food is of course what you’re eating and your fuel, but it’s also how clean is the food and the drink that you’re eating? Are you taking in more toxins than you need to? Obviously there’s no non-toxic way to eat, but there’s lower toxic ways certainly. It also has to do with the timing of eating. We know now that at least a 13 hour intermittent fast daily is associated with longer life and better survival in cancer patients.  And then also your relationship to food and the way it affects your metabolism. So what way your diet is structured, beyond just the fuel, et cetera. Muscle is the fact that I think we all realize now that whether it’s cancer or not, but especially in cancer, the more muscle metabolism you work yourself through and the less fat metabolism you work yourself through, the better your survival and the better your quality of life.  And that’s true with other diseases, but with cancer, it’s very apparent. And that’s largely, I think because muscle metabolism signals the rest of the body that you are in the cytokine mode and your chemokines are such that they’re more resistant to cancer growth. Fat metabolism, which is largely but not completely insulin dominated is associated with proinflammatory cytokines and things that would tend to enhance growth. And so this doesn’t mean the person has to be a power lifter. It just means they need to move their body. They need to combine their diet, that has a low glycemic index, with their skeletal muscle moving to the degree it can. Real sick people, that might be standing up a few more times every day. People who are in recovery, it might be actually working out, getting the skeletal muscle working.

And then brain is the topic of my recent book, which is the Mind-Body Connection, how you’re thinking about cancer and really how empowered you are as a cancer patient. And so what I really see here, is if you look then above at step two and step three, you’ve got kind of foundational cancer supplementation and that’ll work better if you’re working on the dietary, and the food, and the fuel part, and the cleanliness. You’re working on getting your muscles to move a little bit. And then you’re working on the mind body connection.

And then all the, what I call the cool, high speed, high expense therapies, a lot of the things, like our clinics were set up to do IV, and hyperbaric, and hyperthermia, and all these cool things. They really do work longer at better in the setting of the other things being prepared and attended to. So I think you kind of get the idea. This is not new to people who are doing integrative care. But I was personally a little surprised when I look back at about 20 to 25 years of practice, and I started to see this pattern where the people, you have stage four cancer patients all doing the same other therapies. But the people that really hung in there and had the quality and length of life, were people who were doing these basics on top of the other things.

Now, the bulk of what I want to present is, again, something I kind found retrospectively looking back. I think we all do this intuitively, but I think it’s good to kind of call out the fact that the cancer journey can be divided into four discrete steps or areas. And the reason that’s important, is that your clinical focus and priorities, and really the patients, probably are different in each of these phases, because some of them, you have real high stakes things going on and you really need to laser focus on particular things. Others, you have a lot of background things going on and you have a lot of options as what to do. But those phases basically are primary prevention, where they don’t know they have cancer yet, which is we’d love to get everybody here. And we all make cancer cells every day.  We’d like to keep those from doing anything. So, that’s primary prevention. Then you get diagnosed. So diagnosis through active therapy is phase two. And this is usually where people are suddenly hit in the face with the diagnosis of cancer. They’re often, for good or bad rushed into cancer therapies. And they’re real confused and they’re overwhelmed. Now there’s an arrow that leaves here, because some people die during diagnosis and active therapy. We obviously don’t get everybody through all four phases.

Then there’s a very important part for long-term survival, which is recovery from active therapy. So this is when you get to the place where they say, “We’ve given you all the treatment we can. We did surgery, chemo, radiation, whatever, we’ve done all we can. So go and live a good life.” Well, this is a place where, every phase you can interact with people, but this is a place where we can really shine, because we can help people not only physically and mentally recover, but also strengthen their system to oppose cancer return or cancer aggression.

Post cancer return or cancer aggression. And, of course, there’s an arrow leaving there because some people don’t make it through that. And then there’s what was spoken of earlier as the thriver state. And we call that secondary prevention. That’s when you get to the point where you’re in either no evidence of disease or remission or stable disease, something where you’re not really having new therapies, you’ve recovered from the old therapies. And what you want to do is stay as healthy and anti-cancer as possible. So this is, like I said, just a way to think about your cancer journey and say, my patients coming in, where are they in this spectrum? And then that leads you to what things do I need to focus on, because I get this question all the time at conferences when I’m speaking and people say…

We might be talking about active cancer therapy where we’re doing some high level interventions and maybe they’re getting chemo and we’re trying to support the chemo and not have die from it and all that. And people say, “Well, why don’t you do these other things?” All of which are good. Well, the reason is that we only have so much time and resource to put into somebody in that phase. Whereas in the next phase, we have different goals, different objectives. And I’ll share these slides. You guys can have them and read them. They’re fairly straightforward.

Now, there are exceptions to this model, and those are usually when we get a patient who has a super aggressive stage four cancer, and we may only have one crack at doing something with them. In that case, we may throw a lot more at them. We may get very aggressive very quickly. And that’s fine too. It’s just that’s a unique circumstance. So primary prevention essentially is trying to keep your epigenome from turning your genome against you. And so primary prevention is doing everything you can to be anti-cancer before your cancer goes anywhere. So that is at the beginning on the left side of that scale there. And obviously prevention’s the best medicine. And your goal is to try and keep all your epigenetic signals in the mode of turning on your resistive genes and turning off your suppressive genes. More on that later.

This is something my staff named after me, because I kept preaching it to them for years. And so these are eight areas that we look at in primary and then secondary prevention just to try and clean the system up as much as possible. And I will not spend tons of time on them, because they’re fairly self-evident, although they’re labeled in an overly simple way. Self function means everything from your organelles working to the pH, to the input of good and output of toxins. And all that stuff includes your nutrigenomics and all of that.

Toxins, whether chemical or mold or metal, etc, always a problem, but certainly more of a problem as an epigenetic trigger when we have chronic illness in cancer. Biofilm and resistance factors, which include certainly biofilms as name, but also immune suppressive drugs, which a lot of our patients are on during their cancer journey and other things of that nature. The patient’s immunology becomes very important in primary and secondary prevention because what you’re concerned about there is, number one, you’re not engendering auto immunity, but also you have enough immune reserve so that when the immune system is called upon to fight with cancer, it can do that.

And so the big hindrances there beyond biofilm and resistance factors are chronic infections that are undiagnosed, auto immunity that is undiagnosed and those things that get in the way. The endocrine system is universally important through the whole process. The psychosocial obviously is huge. And then the whole digestive GI tract, which usually gets wrecked through treatment and it is going to need constant care. But because you have not only your GI neurology that goes on, but also your microbiome in your GI immune system, those are so critically important when it comes to cancer outcomes that the repair and maintenance of the GI tract becomes a constant project. And then physical and structural things.

So these are some explanatory slides about all that. But in primary prevention, I think it’s important obviously to think about your family history. Obviously you can be the first person in your family to have cancer. Not all cancers are certainly related, but if you have a family history of a lot of cancer, that does change. There’s something there in your epigenome that maybe is a little too friendly with cancer. And that means maybe we need to be a little bit more aggressive with cleaning the system up, etc. Looking at your determinants of health via those eight areas and really everything matters. But in primary prevention diet and GI tract health are easy to come first, because you can access the diet and there’s no cancer treatments or anything going on here.

Movement or exercise, and as we talked about the mental emotional space, people with chronic stress, people with certain types of neuro emotional disorders, etc, do have more cancer. And so getting after that and helping people find their way to empowerment becomes very, very important. Toxins, chronic infections and endocrine, these are all things in primary prevention you can clean up. You got time. So these are all great things to look at.

Then you move to initial diagnosis and therapy. And this is where you have usually… The sky’s the limit, but usually you’re trying to really focus what you are doing on the integrative side of things. So this is once the cancer is known and the patient’s going to do something about it. Now, that might be total standard of care and you’re going to do something to help out. They may, as Dr. Weitz was mentioning earlier, and one thing we see a lot is I will counsel people, especially if they have a stage four cancer, and I know that the standard of care is not very efficacious. If they haven’t already, I will ask them, ask your oncologist, number one, what the five year survival with the standard treatment is. And number two, if they personally would do this for themselves or a family member.

And in modern times, meaning not 20 years ago, but recently, I’ve seen more and more oncologists being a little bit more honest, not all of them, but more. And often they’ll say, “You know what? There’s less than 5% chance of a five year survival, and I’ve got 100% chance of giving you side effects. So I wouldn’t take those odds as an oncologist, you need to do whatever you want to,” because they don’t want to be put in the position of talking down on their care and limiting people with care. But if you’ve got cancers like that, it’s really good to know that because if you have somebody with an early prostate and early breast cancer and the survival at five years with treatment is 80 to 95%, you take those odds and we can do a zillion things to keep you healthy and help you in secondary prevention.

If you got aggressive cancer, that’s got under 50%, but certainly like under 20% survival rate with standard of care, as a patient, you have to decide, is it worth the side effects I’m going to get? And we have a lot of people who decide I’m not going to take a 5% positive risk. So that’s the idea there. We do need to remember during this phase that people are freaked out. They’re overwhelmed. Nobody wants to get a cancer diagnosis that I’ve ever met. And these people are overwhelmed in that situation. So we do have to walk them into their care carefully, add things as you go, like I said, unless you have a really aggressive cancer where you may only have one shot at it.

And one of the things that Mark and I wrote about in the first book outside the box cancer therapies, and to my knowledge, we’re the first book about cancer to put this into a book as opposed to being in scattered research. And that is that we are now pretty much 100% certain that while chemotherapy and radiation will decrease the size of tumors in many cases, we know that in the long run, they are associated with more return of more aggressive cancer. That might be months later, it might be years later, but we know that happens. And that’s for reasons I’m going to talk about later. But since we know that, what we have to do, if our patient, let’s say is getting radiation or chemotherapy surgery or some combination there, we have to be supportive in a way that is not only supportive to those therapies, but also supportive to their normal tissue so that we don’t get recruitment of cancer cells by emboldening the cancer stem cells with the chemo and the radiation.

So big thing is just being realistic with the patient what time do they have available? How much time do you and they have to work during this very intense time? They might be doing five days of radiation a week or a bunch of chemo or some combination there. They might need surgery and you may have little windows where you can interact with them. So you have to be strategic. How much energy do they have available? How healthy are they to put into doing things? You really have to prioritize here. Are there financial constraints? Everybody has them. It’s the rare person where money is no object, but it’s just something that needs to come up in my opinion, early. How are they tolerating the therapies? Should that be a big focus?  So a lot of times, during active therapy, especially if they’re getting a chemotherapy, especially old line chemotherapy regimens, we’re focusing on mucositis and the standard side effects of that, because that’s a giant quality of life thing. Well, it turns out that whatever you do, as I said for quality of life is also helpful on the back end. And it’s good to remind people of that. They might think, well, all I’ve got time, money and energy for is for you to try and lower my side effects. Well, that’s still a pretty tall order. That’s a pretty good thing to do.

Now, interactions between what you’re doing on the integrated front and surgery radiation and chemotherapy, for the most part, unless you’re doing something really strange, you’re actually not going to interfere with anybody’s chemotherapy or radiation for the most part, etc. For every 100 units of concern, for instance, that a radiation oncologist has or a medical oncologist has with you interfering with their very powerful therapies, there’s probably two or three units of actual concern that need to be had. Now, that doesn’t mean they’re going to buy that, but you need to have that conversation with your patient.

Dr. Weitz:                          That discussion in my experience is always around antioxidants.  Antioxidants are going to uncouple radiation, they’re going to uncouple chemo. And I’ve had oncologists say anything you give them, they shouldn’t take because it’s an antioxidant.  I just recommended glutamine for a patient and the oncologist said, “No, that’s an antioxidant, you can’t take that.”

Dr. Anderson:                    And I think what this really comes down to, there are times where you have to be judicious, of course.  But what I have found more important is if you have the chance and you can have eyeball-eyeball conversation with your patient and explain this difference in worldview and explain to them how and why the oncologist is going to be so sure of whatever they believe, and also how much of a low level of scientific validity that has.  It’s just a belief system for the most part.  And what I always tell patients is, look, it’s not the oncologist that has cancer, it’s you, it’s your body, you get to decide what you want to do with it.  I happen to be the expert with this end of oncology care.  And they happen to be the expert with that end.  And if you’re comfortable with it, why don’t we let them?  I don’t tell them how to dose chemo, I don’t give them the schedule to do radiation therapy, and they really don’t have a lot of business in my end of the world.  Most patients, if you explain it like that will come to some place where they understand what’s going on.  And I always just tell them, look, you’re never going to convince a radiation oncologist that anything is safe.  Medical oncologists are on a huge spectrum.  And most of them don’t even want you to eat salad. They don’t want any antioxidants in your food. They would like you to have a dead diet actually.  It makes no sense. There’s really no science behind it.  So if you’ll let me do my thing, I’ll keep you out of trouble here. We will let them dose what they’re doing.  And I find it’s a lot of… It’s like front end communication, because my experience has been, if you don’t tell them that, and then they come back and they think that you’ve been lying to them because the oncologist freaked out and said, you can’t take any of that stuff, you lose a lot of credibility.  So you got to really do it on the front end.  And they won’t understand because I think we aren’t all doctors on the same page. You just have to tell them no.  And there’s a lot of reasons.

Dr. Weitz:                          Can you clarify since there is a lot of controversy about this?  What is your position on patients taking antioxidant supplements while undergoing radiation or chemo?

Dr. Anderson:                    Well, the first thing is you can call probably 80% of the supplements that people take antioxidants in one way or another. And a lot of times they are. So that’s one of the things that bothers the oncology community.  During chemotherapy, I focus on basic nutrients.  I focus on opposing mucositis with things like glutamine like you did.  And as long as they have a good white cell count probiotics and demulcent herbs and things like that, if they’re just on chemotherapy, it depends on the chemotherapy.  Like if your basic nutrients they’re going to have some antioxidants in them, that is not going to block anybody’s chemotherapy.  Also, we do vitamin C IVs and other stuff like that.  That’s not blocking any chemotherapy either.  I don’t have people on oral mega doses of a lot of other things, because again, there’s only so much they can get in during chemo.  During radiation, it’s a little bit different.  I tend to do radio potentiating, things like milk thistle is very good, curcumin can be good, boswellia can be good, a lot of botanicals are very good in that setting.  If they can do (IV) vitamin C the beginning of every radiation week, they have far less trouble later on. And I’m going to give you some resources for that.

Dr. Weitz:                          Some of those things you just mentioned, would they take them on the same day as they get their radiation, before the radiation, afterwards? Does it matter?

Dr. Anderson:                    If they’re doing radiation, let’s say we’re doing milk thistle and their basic nutrients and whatever, they would do the oral things every day.  Yeah.  And if it’s no radiation, but there’s chemo, if that’s an appropriate strategy, a lot of times we use curcumin and boswellia right along with chemo, there’s just data on that.  And glutamine, even though you had that experience with the oncologist, that’s an everyday thing, because we’re just trying to keep their blood levels trucking along so that they can have the protection and the support together.

Dr. Weitz:                          Somebody just did ask a question about what about glutamine being contraindicated in cancer?

Dr. Anderson:                    Yeah. You can go on my website. If you look up glutamine, I think one of the first two or three hits will be glutamine and cancer. This is a rather long discussion. And I actually have a CE webinar about controversies in oncology, which goes into glutathione, glutamine, all these other things that we’re talking about. And it’s a pretty deep well. But the upshot of it is unless a person is on a high sugar diet, glutamine is actually a non-issue in cancer. It is thought to be contraindicated, but there’s no data for that. There’s no human data. It’s theoretical.  Now, if they’re on a high sugar diet, glutamine would become a fuel. And they shouldn’t be on a high sugar diet anyway, but here’s where the problems with glutathione and glutamine come in with cancer is probably well-meaning. And a lot of them are in the integrative medicine world. People don’t understand the tumor biology behind why glutamine and glutathione in the research appear to be associated with resistance. And that is that the tumor cells can make glutathione and they can pump out glutamine into the extra cellular space. That has nothing to do with the glutamine and glutathione that the patient is given if given rationally. And so they make the step that if the tumor cell does that for protection, then you giving those things must protect the cancer. And that’s actually not true. That’s not how it works.  A glutathione producing tumor or a glutamine influxing tumor will laugh at your glutathione or your glutamine. It’s not going to be enough to give it a big deal. Now, with glutamine, we do make sure that they’re on appropriate low glycemic diet at the very least. But the other thing is we use it during chemo and during mucositis, and then we back off on the dose. So if someone has mucositis, you might be giving them three, four grams three or four times a day, and once they start to heal you back off on that because they don’t need that much long term. So it’s a thought thing. And that is a very quick rendition of a real deep well there. Yeah.

Dr. Weitz:                            If you don’t mind, there’s one more minute. I spoke to one of the leading proponents of the metabolic theory of cancer. And he advocates a ketogenic diet. And he also recommends… His concept is that cancer can basically get its energy either from sugar or from glutamine. So he recommends a ketogenic high fat, low sugar diet. And then recommends taking a drug that blocks glutamine and pulsing it.

Dr. Anderson:                    Yeah. And there are times where that is like the blockade of glutathione or blockade of glutamine is appropriate. Most of the time, again, that’s a misappropriation of the tumor biology because the glutamine that is feeding the tumor is coming from those tumor cells is not coming from elsewhere. And so what they’re really talking about there with the blockade is if you’re going to do a metabolic therapy, you need to have them on a keto or a low carb diet to starve the tumor in that direction. And then what we do is we put them on things that force the tumor out of anoxic metabolism so that the glutaminolysis and the forcing of the glutamine out doesn’t happen. So that’s what he is talking about blocking the glutamine and all that, but really you’re doing that through their diet primarily.

And then things like we talked about earlier, the fermented wheat germ extract help in that area. There’s other metabolic shifting things that are very useful in that area as well. But also if you’re using glutamine therapeutically, it’s fine. You just use it appropriately, like I said, high dose when you need it, and then you take it away when they don’t eat it. So it’s not that cut and dried.

Dr. Weitz:                          Have you ever recommended fasting around radiation and-

Dr. Anderson:                    We’re getting to that. Yeah.

Dr. Weitz:                          Okay. Good.

Dr. Anderson:                    As a matter of fact here. So now I usually tell people I don’t put these University of California, San Francisco, Osher Center slides in because I think they’re so wonderful. I think they’re great people. But these are all things I’ve been telling people to do for a long time. And now we have a major cancer center telling people these are okay to do. And so I just find it’s nice to back up what we’ve been saying for a long time with the credibility of someone who’s on the inside, I suppose.  So I’ll share these slides. You can read it. This is a little short thing they do about fasting, but here’s the thing. And fasting is like diet change. You have to ask people what they can do. Some people can fast really easily and like it, other people they might say, I can do daily 13 hour fast, which is still very helpful, but I can’t probably do much more than that. Or they can do a 24 hour fast right before their chemo or their radiation and then fluids on the day of treatment and then go back to eating. Still helpful. Okay. And they go through here looking at different studies and saying, well, you could do up to a five day fast. Well, there’s less people to do a five day fast.

One of the things, and I’ve not used it a ton with people, but I think it’s a great tool is the fasting mimicking diets, and you can make your own up too, but Prolon is the famous one that Valter Longo helped develop. So you got people eating almost nothing, but it feels like they’re still eating and yet they’re actually fasting. If you can get people to fast, be right up to the time of treatment, and then the day of these don’t feel that great anyway and then go back to eating, not only does it lower side effects, but it tends to make things work better and more tolerated.

And so the red is eating whatever you want and the blue is fasting. And essentially these are side effects of this. In this case, this was chemo, but you could say similar for radiation. And so you can just see graphically that the blue is a lot lower than the red if the person is doing some fasting around treatment. Now, these are again from the UCSF folks. Pretty close to things that I tell people on the base. Anti-inflammatory diet. I would say colorful fruit in tiny amounts because you don’t really want a whole lot of fructose in a cancer patient, vegetables, you can get a low glycemic vegetables and other stuff, that’s fine, lots of herbs. Low to moderate carbon intake with low glycemic starches or none. We do a lot of keto, low carb and modified Mediterranean. All of them are in that direction. They’re very low glycemic. Protein, they make a good point. If you’re doing these things, you have to be careful with protein because one of the things that are going to happen with protein is when you cut the carbohydrates down, which you should, you can get glucogenic amines out of your protein. And if you have too much protein, you wind up with your blood sugar going back up. And this is a case where you really, in my opinion, if you’re really doing therapeutic diets beyond the good basics, you really want either you or somebody working with a patient like a coach so that they can eat this, not that, all of that.

Again, they reinforce the 13 hour fast every day. And basically I just tell patients when you’re done eating dinner, you can drink water all you want, but you don’t eat until 13 hours later the next day. Drink tons of water. I’ve done this for a long time, almost all of the side effects of 13 hour fasts are dehydration. So if they just keep drinking water, they’re fine. And then here they have short term water fast one to three days, very useful. And then prior to treatment, even one day prior to treatment is still good.

Oops, sorry. Wrong way. Now, as far as these are some free writeups that I’ve done about interfering with standard of care. So the first one is all about vitamin C and chemo and radiation. Next one’s about antioxidants and next one’s about leukemia specifically. And then the final one really gets to one of our next topics, which is detoxing after treatment. And so this is a area that some people also get kind of mixed up.

These are some very deep, if you do like vitamin C therapies, especially IV, there’s some kind of deep classes. So all the stuff here are writeups, these are free. Classes cost a little bit. And then you can just search the website there. So there’s that controversy oncology class. There’s off purpose or off label drugs. And then there’s one that’s on advanced cancer. Now recovery here, this is a time, I’ll just kind of tell the story and we get right past it here, but recovery from active therapy is actually a golden time for you to reverse those things I was saying that chemo and radiation do, which is make the cancer stem cells more bold. So really to simplify the way we want to think about this, and there’s a whole chapter in outside the box about this, or at least we talk about it in there.

You have the daughter cells, the cancer that we see, it’s usually bigger. Then you have the cancer stem cells. They are biologically opposite. So when you’re treating the cancer with chemotherapy or radiation, or you could say surgery too, but especially chemo, radiation, the daughter cells are heavily attacked by the chemo radiation. That’s why they shrink. The stem cells go and hide and they wait. They are unaffected by chemotherapy and radiation for the most part. And there is paper after paper after paper published that says this and everybody at the end of their paper says, “Well, this is true, but we don’t want to make a big deal out of this with the public because then they’re going to be afraid of chemotherapy and radiation.” And they’re hoping some day to come up with some magic fix for this. Well, the magic fix is actually taking care of the patient with the stuff we do.

The cancer stem cells retreat during therapy. When you’re in active recovery and in secondary prevention, you want to start to take care of the normal cells in a way where they become more cancer resistant. Because if you don’t, and you do what most people do, like you were saying, Ben, about your patient who they think, “Oh, the cancer got smaller and they’re really doing palliative therapy.” You can have the cancer get smaller and a patient thinks, “Oh, I’m cancer free,” which of course they’re not. And then they go about their life and they don’t do anything to clean up the system, the cancer stem cells will come back with a vengeance. They take advantage of that. So when you’re recovering from active therapy, there may be specific things such as surgical recovery where we’re given a more regenerative nutrients and things to help them rebuild, et cetera. Or it might be what is most common recovery after chemotherapy and radiation. And maybe this is the first time you see the patient.

So what we have to do there is first focus on the quality of life things. Do they have radiation burns? Do they have leftover mucositis? Do they have mucositis induced diarrhea that won’t stop? Is there microbiome all messed up? By cleaning up and helping to fix the quality of life issues, you also are actually getting at healing and getting on the road to healing the normal tissues. And the more you do that, the more you make them resist these cancer stem cells. Because everybody’s got cancer cells every day.  We probably have some cancer stem cells and everyone who’s survived cancer still has their stem cells. What we want, because there’s no way to make them go away-

Dr. Weitz:                          Are there natural methods that help to target cancer stem cells?

Dr. Anderson:                    Yeah. So yeah, I will elaborate.  What you want is to keep them asleep, okay?  There is no way to kill cancer stem cells for all intents and purposes. You want them to be so happy that they have nothing to do and you want your normal tissue and whatever’s left of the person after treatment to be so healthy that there’s no impetus for the stem cells to recruit in the stroma and the tumor micro environment, your normal tissue back to being cancer.  So we’ll get into that a little bit here.  So just psychologically, you have to remember this is a time where people are pretty happy usually because they’re finally done with chemo or radiation or whatever they were doing.  And so we need to support that, but we also need to support the idea that they need to work on things to clean up the quality of life stuff, which will decrease cancer stem cell activity.  And then we want to do things to heal their normal tissue, which also decreases cancer stem cell activity as well. there may be specific things like surgical healing.  There may be global things like I’m just fatigued afterwards, et cetera. You treat what you see and then you work your way down towards the epigenome.  The other nice thing about recovery from active therapy is this is usually a time where the oncology team says “Go and live your life. We’re not going to do any more chemo,” or “You’re done with surgery or radiation.”  And that often, if you’ve had a contentious relationship with the oncologist, that sort of takes the handcuffs off during that time as well.  During this time, a lot of our goal beyond side effects, which is a huge goal, is getting their mitochondrial function back. That helps to get their energy back, their recovery, getting their membranes working again. Detoxing usually can get started here and then repairing whatever else got messed up. Just during radiation, like I said earlier, orally, I use a lot of milk thistle during radiation and sometimes curcumin, but more milk thistle because as a radio sensitizer and a cell protectant, it’s hard to beat.

Dr. Weitz:                          What’s a good dosage of milk thistle in this case?

Dr. Anderson:                    If you get a like, and I’m doing this from memory so my apologies to Integrative Therapeutics, but they have a really good milk thistle product and it doesn’t have to be just milk thistle, but I’m usually going during radiation for about four to 600 milligrams two to three times a day. And that kind of keeps the silibinin levels level in the body.  And so that’s a really good one because a lot of people don’t have access to IV vitamin C or something.  But if you are going to do it, what I like during radiation is actually high dose vitamin C, at least on the Monday when they start their radiation-

Dr. Weitz:                          And what is high dose?

Dr. Anderson:                    Well, if they have a normal G6PD level, we start them at 25 grams and usually go to 50, 75. Can go higher. But during radiation, usually 50 to 75 is plenty for the average person.  After radiation, there’s a radiation recovery formula which is nutrients and glutathione and all kinds of other stuff that we develop for radiation burn patients but this is after they’re done with radiation.  And so that one is useful in that setting.  So obviously in recovery, you’re focusing on healing, kind of get them back into their dietary changes, muscle, brain, all those things.  And like I say, you’re looking at calming the epigenome down so that you don’t get this recurrence with the cancer stem cells. Now-

Dr. Weitz:                          We’ve been talking about whether or not some natural treatments might interfere with traditional chemo or radiation. What do we know about potential interactions between natural therapies and some of the newer targeted therapies, the immunotherapies and some of the other targeted therapies?

Dr. Anderson:                    Yeah. And again, that’s a three hour discussion at least, but-

Dr. Weitz:                          Oh, I know, I know.

Dr. Anderson:                    The upshot of it is, because now that we have more of those therapies, I teach about this a fair amount. Most of them are synergized by some of the things we use commonly, such as curcumin and melatonin. Those have some data with some of the targeted therapies. Vitamin C is very safe with them. There’s very few things that actually are going to block or inhibited most of the targeted therapies. Now-

Dr. Weitz:                          You just mentioned melatonin. What dosage do you like for melatonin?

Dr. Anderson:                    It very much depends. It’s interesting is 25 years ago, we commonly gave people a hundred or more milligrams when they had cancer and then we sort of, for whatever reason, went to 20 to 60 and now we’re giving people one to 300 milligrams of melatonin.

Dr. Weitz:                          Oh, okay.

Dr. Anderson:                    So it’s during either active treatment or especially in recovery, I think the higher doses make sense as a, again, that’s another real long discussion, but it’s also totally appropriate to do the medium high doses of 20, 40, 60 milligrams, which are still pretty darn high because they’re having a very therapeutic effect at those doses. It’s very different from say a low dose. If you’re doing therapeutic melatonin, actually free you can get the presentation. If you just search Dr. Shallenberger’s name and melatonin, he’s got a PowerPoint online all about high dose melatonin. And to my viewing, that’s probably the best resource for high dose melatonin. But regularly it’s very common for most people nowadays to do 20 to 60, even if they’re not doing the super high doses. But most of the targeted therapies, what I will normally do is if it’s something I know that are mainstream, so like curcumin or vitamin C or some of the other stuff, fine.

If I’ve got an idea to use something real specific and we get this brand new PD-1 drug or something like that. What I will generally do is do a search and I’ll do the drug class like PD-1 or NITNF or whatever it is and then I’ll put in the name of say the herb or the mushroom or whatever or the vitamin and I’ll just put in those two search terms and see if anything comes up. Occasionally you’ll find there’s research where they’ve actually tested them together and they’re okay and that’s even better. Once in a while, you’ll run into a study where maybe it looks a little shaky, but most of those studies that natural products are having a problem with biologics are like in vitro studies that may or may not at all match humans.  So there’s that.

Dr. Weitz:                            Okay.

Dr. Anderson:                    Now these next slides, I’m just going to tell you why they’re in here and then you guys can read them if you want to. There’s two concepts that are of paramount importance to keep you in remission or to do secondary prevention. One is keeping the tumor microenvironment calm. Like I say, you want your healthy cells to be as healthy as possible. You want the tumor cells that have died to stay dead. And then the other is the cancer stem cell milieu, which is right next door, and you want the stem cells to stay quiet and asleep. That’s what keeps you in remission. Now you’re fighting uphill because chemotherapy and radiation have made the stem cells stronger and more spunky. But what you can do, especially in this recovery or secondary prevention stage is the more things you do to clean up their environment of their body, so you’re starting to look at things like detoxification, look at their nutrigenomics and optimize those, get their gut healed up and working again, get their microbiome working again, not forgetting in your toxicity assessments. We think of metals, but chemicals and microtoxins are huge immune side liners.

And then kind of the opposite of the concerns early in cancer care, you really do want people to have really good antioxidant potential, which means that they have all of the compartments covered. You got vitamin E and omegas and phosphatidylcholine for the fatty areas. You got glutathione for cytosol and the plasma. You got vitamin C in the water soluble areas. They all back each other up. And of course, vitamin C is the weak link because we don’t make any in our body, but they all need some help. And then from there you can build other things on top.

One of the reasons I keep bringing up milk thistle is because we don’t talk about it as much as like curcumin, but milk thistle beyond being a radiosensitizer and a healing agent, it also keeps the vitamin C glutathione cycle really humming along, which is what you want. So these are theories of oncogenesis. They all actually have a place. So there’s not one theory that wins, they all have a place. But the bottom line is what they have in common between them, whether it’s metabolic or the stem cell theory, which we used to call the trophoblast theory, they’re the same thing, or the genomic theory, which is a small number of cancers, but they’re real. The crossover in keeping those things from coming back is your epigenome. And all that is is working on cleaning yourself up. Your hormones are balanced.

You don’t have any residual infections or other immune junk going on. You’re detoxing. You get rid of the junk from your system that’s all nasty proepigenetic triggering stuff. As I said, you’re healing the gut. You are doing all of those things with the whole body. This book is a lot about the how, like the targets and treatments during cancer, stuff like that. This book, as Dr. Weitz mentioned, this is a new one. This is more about the mental part and how to, you know, almost agnostic of how you’re treating your cancer. Your mind body connection is so important to healing up. So you can read through these. These are basically about tumor microenvironment and cancer stem cells. And these are some of the metabolic and biochemical reasons that the microenvironment gets either pro-cancer or anti-cancer return.

Dr. Weitz:                          Can I ask a question about that?

Dr. Anderson:                    Yeah.

Dr. Weitz:                          In terms of the metabolic theory of cancer, which is that cancer stem cells are primarily glycolytic and therefore a low carb diet’s going to be best, do you think that there’s certain kinds of cancer that are different? Like for example, prostate cancer seems to work somewhat differently and respond to different dietary factors like choline seems to be potentially a problem for prostate cancer whereas it’s not for other forms of cancer.

Dr. Anderson:                    Yes. Short answer is yes. Like I said, all of our therapeutic diets, we have an array of therapeutic diets. And the only thing that they have in common is that they all have a very low glycemic impact on the body. So there is no type of cancer that benefits from sugar. There are some types of cancer that are less impressed by low sugar diets, but you still remember sugar drives insulin metabolism and insulin metabolism is pro-inflammatory, it switches all of your eicosanoid fat metabolism towards inflammation. So even if the sugar is not really the part of it, keeping your insulin from bouncing around is a huge thing. And like you say, especially advanced prostate cancer, sort of its own little animal. And that’s because it has a lot of connection to toxicity and infections that other cancers do, but not as like prostate cancer literally concentrates those problems like we’ve been talking about.  So yeah, and it’s why many of the people I know who used to only recommend say ketogenic diets now really look more at the person’s metabolic flexibility. So like I say, none of the diets that we offer are high glycemic. None of them trigger a lot of insulin release. But there’s different ways to get into that depending on the person’s metabolic flexibility. And because that’s individual, we usually have people, if they really want to track what their diet is doing to their metabolism, we have them have a ketone and glucose meter and they check periodically through the day and they enter it into a chronometer program online and we track it. Because number one, most people who think they’re doing ketogenic diets aren’t. Really they aren’t because no one’s checking. And so people say, “Well, keto didn’t work” and they actually never were keto.

But then there are a lot of people where they can’t do a traditional ketogenic diet anyway. So yeah, diets are, you have to have the big picture, kind of your north star which is not a lot of insulin stimulation, a lot of good flavonoids, a lot of clean stuff in it. And then from there you build the macros to whatever. This is an odd representation of a human, but you have your cancer there in the middle, you have the tumor stroma which is the communication area between the cancer and the stem cells and normal tissue. And then they have most of your patient, which is actually non-cancerous tissue. The more quiet you can keep that middle ground by returning, you heal them up. As I said, everything you do for quality of life is in favor of anti-cancer.  So even if that’s all you do, it’s huge. Their diet, their movement, all that stuff is in favor of anti-cancer. And then you’ve got to get the rest of their cells and their tissues to have good antioxidant balance, to have low amounts of insulin going into trigger. And then that keeps your normal tissue from being pulled to the dark side and recruited by the cancer stem cells.

And there’s stuff in here you can read about all that, but that’s kind of the bottom line. I just put this in because it turns out that vitamin C, even at fairly low doses, pushes your epigenetics all in the direction that are anti-cancer. So beyond being helpful as an antioxidant or in high dose being a prooxidant, it has a lot of epigenetic strengthening that it does to your system. And so, especially in the healing and secondary prevention stages, vitamin C is cheap, it’s water soluble and we don’t have people on tons of it, but they’re taking one or two grams a day just to kind of keep the tank filled and that can be incredibly beneficial to their epigenome and also just their normal cells.

Dr. Weitz:                          Can I ask you about the alkaline acid?  Are you going to mention that concept?

Dr. Anderson:                    I don’t bring that up in here because mostly if you’re doing… Well, two things. One is if you’re doing a dietary intervention that doesn’t have a lot of insulin signaling, your movable pH balance is going to be fairly stable, which is what you want. Now, and there’s no slides on this, although many people talk about it, there’s actually a lot of decent research now that shows that especially with aggressive cancers, if you add in alkalinizing supplements. So there’s some clinics that have people take extra sodium bicarbonate orally, but what we find is if you use like the alkalizing minerals, there are those mineral products that are the-

Dr. Weitz:                          Potassium citrate.

Dr. Anderson:                    … yeah, the alkaline salts of potassium and mag and that. That way, they’re going to need the minerals anyway. And it turns out that that actually orally can, again, kind of keep the pH. And people always say, “Well, your pH is so tightly controlled. Does it make that much difference?” What we’re seeing now is, like I say, this is a moveable thing through the day, and you’re not looking at giant changes because you’d be dead. You’re looking at small changes and keeping the cell pH as alkaline as possible through the day over time. And that’s actually in kind of standard research now.

Dr. Weitz:                            I asked one of the other leading integrative cancer experts about this and she said that there’s really no benefit, that what’s observed is that cancer cells give off an acid, and so this idea that cancer thrives in an acidic environment is not really true.

Dr. Anderson:                    Yeah. I think it’s an oversimplification to say that, but if the folks listening want to look at a really well-informed person who lectures on this, and I think some of his presentations you can get online free. There’s a doctor in Portland, Oregon, named David Allderdice, A-L-L-D-E-R-D-I-C-E, Dave Allderdice, and he’s done presentations on acid/alkaline in cancer that are very much based in the current science. So what the person you’re talking about there was saying is this oversimplification of well, there’s acid and cancer thrives there. That actually does work. It just doesn’t work the way that people have talked about it for a long time.  So again, it’s a little hard of a concept to explain really quickly, but it’s not exactly that simple, but there is benefit in having alkaline forms, especially in minerals, going into your patient on a regular basis, kind of like vitamin C. It’s a base thing. Yeah. So you can read through that stuff. But I just want to end really quickly, secondary prevention, as was said at the beginning, we’re getting more people who survive and they’re in no evidence of disease or remission, or they have stable disease and their oncologists tell them, “Okay, go live a good life. Don’t get cancer again,” or something.

And now they’ll come to us and they’ll say, “Well, what do I do for secondary prevention?” And nobody likes the answer until you explain it to them and that’s that you have to investigate all of those areas, so all of those eight areas, whether it’s cell function, infectious and autoimmune and resistance factors, GI toxins, on and on and on, and people say, “Why is it so important in secondary prevention?”  Well, there’s a couple things. One is you could go into cancer treatment with no endocrine problems and come out with a ton of endocrine problems. If you don’t fix as many of those as you can fix, the person will not maintain their health. You can come out of cancer treatment very toxic. Most people go in very toxic and they don’t know it, but you can be super toxic when you come out. If you do not open up the bodies [inaudible 01:20:58] and get the toxins moving out, you will never keep that person in remission.

I have never tested a cancer survivor who didn’t have at least one, if not five infections, stealth infections, that they didn’t have any symptoms of. And the reason for that is either the cancer and/or the cancer treatment squelches their immune system so much that they’re growing all of these infections and they don’t know it. So you have to look at all. And like I said, the GI tract is this constant project you’re working on. So you’re always trying to repair that.

And then you got physical and structural and psycho-emotional, et cetera. So [inaudible 01:21:44] prevention literally is looking at everything and you don’t have to do it all at once, but you pick what’s the worst things you find. Do we want to work on endocrine first? Then do we want to go to toxic stuff? And then do we want to work on the leftover infectious things or should we really tackle the infectious things first and work our way down? Somehow you got to look at that as a constitutional holistic approach to the patient.

And that’s really these areas. Now, people say, well, which ones are usually messed up in people after cancer? The answer is they all can be. I’ve found all of them in people, but the most common are toxins, endocrine stuff, infections and gut problems. And obviously there’s going to be physical and structural as part and parcel. There’s going to be psychological issues that come up, there’s going to be other stuff. But those are the big areas that I find with people trying not to have cancer come back.

Dr. Weitz:                          Do you ask your patients to get a stool test at some point during the process?

Dr. Anderson:                    And a lot of this depends on if you’ve had them from the beginning, when they first got diagnosed and you’ve really been working on their gut, maybe you’ve really done a lot of work there, but a lot of times we get people later in the stage. And I really think that because the gut is so important and cancer treatment ruins the gut so much, some kind of a test to look at the gut integrity, the leftover infections. I like the ones where you’ve got a number of different laboratory type views in.  So that would be maybe some PCR and some culture and some microscopy of say the stool testing, also though there’s usually the membrane. The GI membrane is pretty inflamed. So you’re trying to heal that up. And obviously if they have sensitivities or allergies, that feeds into that, so I see definitely-

Dr. Weitz:                          Which stool testing you like best?

Dr. Anderson:                    Well, I’ve used a number, but not everybody. Okay. So the two I’ve used the most, and I forget their specific names from each company, but Doctors Data has one that has that combo of some PCR and culture and microscopy. And then also Genova has a similar one, but there’s others too. You just want something that kind of gives you as broad of a look into what’s going on with the microbiome as you can. Yeah. So this is kind of the, like I said, the focus is they need to know, look, you don’t have to jump on this all at once. This is a long term thing. We want to keep you alive for a long time. So let’s work on cleaning your body.  Most people can wrap their head around cleaning their body up.  And so if you check them and there’s not a lot of infectious stuff, move on. Usually you get to toxins and there’s a fair amount of toxic stuff.  And so you get them doing the basics, like saunaing and some glutathione.  And then if there’s metals, you use specific things there.  If there’s chemicals and mycotoxins, you do more binders.  And then the endocrine things, they can be pretty bad, depending on the type of cancer somebody’s had.

You give a lot of really slow thyroid and adrenal function [support] usually, just because they’re so worn out from the cancering process. And in almost everybody, you don’t want to overdo these things with the hormones, but you can bring the adrenals and the thyroid back up to good levels and that’s not going to hurt anybody’s cancer. In fact, it’s going to make them a little more resistant. If they have a hormonal type breast cancer or prostate, and it’s very hormonally active, then you have to be a little careful with the reproductive hormones.  That depends a lot on what they’ve got going on, but there are a number of things like as you clean up their system, a lot of their side effects from hormonal therapies, et cetera will just improve anyway.

And this is something I try and share with patients. And that is that the white crescents here are actually how much intervention the standard system has. And the gray is how much potentially we can do for them. So in primary prevention, there’s almost nothing in the standard system for primary prevention. There’s a few things.  Diagnosis and active treatment, yeah there’s little bit more because maybe they’re getting surgery or chemo radiation, something like that, but there’s still a lot. They’re not doing a ton with a person’s diet and their gut, not doing a ton with side effects, not doing a ton with even enhancing the other therapies. Recovery, again, not much that they’re going to do, and secondary prevention there’s almost nothing from the standard point of view.

All right. So whether we have time or not, I’m open for questions.   I’ll send you these slides.

Dr. Weitz:                            That’d be great. Yeah. You mentioned using glutamine for some of the side effects for the mucositis. Maybe a couple of other clinical pearls for helping with some of the side effects from chemo and/or radiation.

Dr. Anderson:                    Yeah. I think that certainly glutamine is one of the things we think about a lot. Also let’s say maybe you just don’t feel comfortable using glutamine. There are other things that I use in place of glutamine for the mucositis, et cetera, one which you can get from a number of supplement companies is called zinc carnosine. And so it looks like a zinc supplement, but it’s actually the carnosine that does the gut healing and it’s actually a bit anti-cancer, et cetera. So that’s a good replacement for glutamine. The other though are some of the gut repair powders that you might use that may have a little glutamine, but they’ll have like some demulcent herbs in them like slippery elm and marshmallow, things of that nature. Those aren’t going to do anything to the cancer and they’re going to be very healing to the gut.

As long as the person’s white cell count is not suppressed, so they’ve got at least 2,000 total white cells, I also give them human microflora type probiotics. During chemotherapy, I don’t use non-human strains. So I don’t use spore based and I don’t use other non-human strains. I might use them elsewhere, but during chemotherapy, I only want their gut to see what would normally be in a human. So the HMF types, human microflora strains. So as long as they have some white blood cell count, I have them do it, eat it in a little bit of yogurt or some applesauce or something. So a demulcent like let’s say slippery elm or marshmallow, or one of those powders that’s got it all in one thing and then throw the human microflora things in there.

The other thing that’s very helpful, if you can get the person earlier on, is like I said, probably in 98 out of 100 cases, you can have go-tos such as curcumin and milk thistle, and they will generally be very supportive to the chemo, but also supportive to keeping your normal tissue as healthy as possible through the process. Now, like I said, if you’ve got one of these new targeted therapies or something like that, what I do still to this day is I’ll look the targeted therapy up, the category like PD1 inhibitor or something. And then I’ll look up, I’ll say any data on curcumin and that, or the other. And usually you don’t find anything bad and then I’ll feel good going forward.  If you can get people early on and you’re doing melatonin, whether it’s a moderate dose or the 20 to 60, or even the super high dose, that pretty much doesn’t have anything it crosses over negatively with and so it’s easy go-to.

Dr. Weitz:                            And do you have them take all the melatonin in the evening or do you split it up?

Dr. Anderson:                    It depends a bit. I usually have them ramp their doses up to if they’re doing high dose because it can disrupt their sleep. And there are some people who are not sensitive in that way, so they could take their melatonin at dinner and after dinner and at bedtime and they’re not falling asleep on the couch. Other people are very sensitive and they have to take it closer to bedtime. I have them start and I usually give them a 10 milligram [inaudible 01:31:46] for a week, take this within an hour bedtime. Let’s see how you sleep. Let’s see how you do. If that goes well, we go right to 20 and then 40, and then 60. If they’re doing the super high doses, like an aggressive cancer, then we may split it up more.

Dr. Weitz:                          Dawn, do you have a question? Do you want to unmute yourself?

Dr. DeSylvia:                     Hi, thank you.

Dr. Anderson:                    Hi.

Dr. DeSylvia:                      Hi. So I have two quick questions. What’s your experience with SOT therapy? Do you use it and have you found it helpful in patients?

Dr. Anderson:                     I have to answer this carefully so I don’t get sued.

Dr. DeSylvia:                      Okay. Yeah. It’s maybe similar to my experience.

Dr. Anderson:                     SOT, so this is not sacred occipital technique. This is specific oligonucleotide therapy. So I’m not talking about occipital. So that therapy, if you look at it from the top down and the science around it, it has a big upside in future, I believe. The problem is at least what we have available right now in North America, it’s been only available through one company that I have personally and in groups I’m in with people who do a lot of this, not had good success with, but also not had good, reliable resulting from. And so because of that, I’ve not seen it really show out in a lot of people’s cases. [inaudible 01:33:40] people who do, but yeah, I don’t.

Dr. DeSylvia:                      Yeah, I appreciate that. And that’s been my experience, but again, it sounds so good on paper. So hopefully someone here-

Dr. Anderson:                    Patients really want it, and what I was telling them is it’s like it’s not ready for prime time and I wish it was. As soon as you start seeing more, if this happens, because the theory and the science behind it is actually fairly solid, as soon as you start seeing more people enter the SOT world from the laboratory point of view, I think that’s when I would maybe return back and look at it again. And I’ve experienced, so I consult for some hospitals outside of this country, and we have associations with real live big universities and their immunology departments and everything.  And we’re working on cancer vaccines and dendritic cell treatments and all this stuff. And what I know from working with the actual immunologists is all these things have a huge potential upside in the future, but anyone doing them now is doing them at like 10% of what they really could do, because we just don’t understand the tech. The technology is actually quite complex in these things. Yeah.

Dr. DeSylvia:                     Yeah. And thank you. And along those lines then, I have a lot of patients that ask for my advice of where to go. And I know you’re not seeing patients, but do you see a difference in Hope For Cancer or Integrative Cancer Centers of America? Or someplace else? Is there some center that you feel stands above the other ones or somebody who’s doing something that …

Dr. Anderson:                    I know some of those places and not others. I’ve had patients have good results with Hope For Cancer. There is a much lesser known smaller integrative center in Baja. And if you look them up, they would be under Nube Health, N-U-B-E. I believe it’s a Spanish word.

Dr. DeSylvia:                     Oh, great.

Dr. Anderson:                    Nube Health. And they do a lot of really interesting … They have a lot of doctors who consult and they do a lot of very interesting integrative treatments, including photodynamic therapies and IV and all kinds of stuff. I think of them, they’re a lot smaller than a lot of these other big places that you know the names of, but I’ve shared and consulted with them on patients that were in quite bad shape and they’ve kept them alive, which is usually, I mean, if anyone can do that, that’s a pretty good thing.

Dr. DeSylvia:                      Yeah. Yeah.

Dr. Anderson:                     So Nube Health, they’re also known as Baja Medgate, M-E-D-G-A-T-E. They’re worth looking at, and what I often tell patients is, I mean, if they’ve got time, I’ll say, look, give me the list of who you’re considering. I’ll tell you my top three or whatever. Visit two of them and see who you resonate with because they all do good stuff, but some do some stuff better than others. And quite frankly, some of them are way more expensive than others and that may take them out of the running too. Yeah.

Dr. DeSylvia:                       Thank you. That’s helpful.

Dr. Weitz:                            If I may, I’d like to ask you one more question. There’s a lot of medicinal mushrooms and it seems like for a while this mushroom was the most popular, it was AHCC, it was maitake D fraction. What do you think is the most powerful mushroom supplement for cancer patients?

Dr. Anderson:                    Yeah, I was going to bring that up earlier. Thank you. Well, the way I look at mushroom supplementation is it kind of depends where they’re at in the process. So I was not involved with it as much when we were doing the NIH research, but another part of our group was doing a lot of work with Cory Ellis, with turkey tail, which we hear a lot about. And there were a lot of tough cancers that they were actually having some good results with. And then they used it a lot in breast cancer and your common breast, colon, prostate, et cetera. So a lot of times what I would do with people would be during the active treatment phase, I would do specific mushroom things, such as turkey tail specific intervention or AHCC is another one you brought up. I use that a lot.

And then if we got past the active cancer and we were more in the prevention stage, often what I would do, and this is more based on looking at it from more of a botanical medicine point of view, I would often transition them off of the specific, where there was AHCC or turkey tail, something like that, or even maitake. I didn’t use that as much, but that would be one. And I would go to more of a blend, a mixture. And this is certainly not the only company, but it’s the one that comes to the top of my brain. Fungi Perfecti has one called my community, which is one we would transition people to when they were more stable.  And it’s just a mixture of medicinal mushrooms, because each of them, the reason you might use AHCC or maitake D or turkey tail or whatever at higher doses early on is they’re having a pharmacologic effect driving metabolism in one direction, which is great, but you don’t need that forever. So if the person gets over the hump and they’re in prevention, I like to broaden the mushrooms out and mostly that works pretty well.

Dr. Weitz:                          Awesome. Thank you so much, Dr Anderson. This was great.

Dr. Anderson:                    Thank you all. I’ll email you these slides. So you guys have them. So Dr. Weitz, I’ll just send them to you and you can do what you need to do.

Dr. Weitz:                          Great. Okay.

Dr. Anderson:                    And yeah, so at the bottom of all of my slides is my website and there’s hundreds of things you can search on there. They’re free. There are some courses, but do your search on there. There’s a ton. I have all my monographs that I wrote for cancer treatment and interactions and stuff like that, that we did for the research project that are free on there too.

Dr. Weitz:                          Great. Thank you. And thank you everybody and see you next month.

Dr. Anderson:                    Bye guys.

 


 

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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Type I Diabetes with Lauren Bongiorno: Rational Wellness Podcast 256

Lauren Bongiorno discusses Type I Diabetes 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

5:53   Some of the most important variables that we need to manipulate for type I diabetes are nutrition and exercise.  With respect to exercise, there is the type of exercise, the time of exercise, what your insulin sensitivity levels are, and what kind of food you have before exercise.  With nutrition, the combination of macros, timing of macros, and the timing of insulin are all important factors.  Also important are your relationship to food, your mindset to diabetes and your acceptance of it.  Your hormones, including the menstrual cycle, and cortisol are other factors that are probably more important for type I diabetics and all these factors have to be juggled at the same time. 

7:30  Monitoring glucose levels.  Lauren monitors her glucose with a continuous glucose monitor (CGM), the Dexcom, but this technology is not accessible to everyone, since it may not be covered by insurance and it is somewhat costly. Ideally every type I diabetic should have access to both a CGM and an insulin pump.  On the other hand, some people are perfectionist and they may obsess too much on getting their numbers perfect and using a CGM may drive them crazy, constantly living on their phones, watching the arrows and trying make decisions to control the numbers.  It’s also important to get to know your body’s patterns and to know what a higher or lower blood sugar feels like.

11:17  Maintaining blood sugar overnight.  Lauren does not feel that there is one way to help type I diabetics to maintain stable glucose levels throughout the night while sleeping. Some diabetics do well with a high carb, low fat approach, while others thrive with a keto style diet. Some do well eating some fat in the evening to keep blood sugar even, while others do better having a carb snack in the evening. 

 

 



Lauren Bongiorno is a health coach, a diabetes influencer, and the founder and CEO of Risely Health. Lauren has dealt with type I diabetes since she was 7 years old. She is challenging the current healthcare system and the world of diabetes management through her company’s innovative health coaching programs and online educational classes.

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



 

Podcast Transcript

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

Hello, Rational Wellness podcasters. Today. I’m excited to be talking about type 1 diabetes, which is not a topic we’ve spoken about very much on the Rational Wellness Podcast. We’ve had a number of conversations about type 2, but type 1 is a very important topic and type 1 diabetics need a lot of help from nutritional perspective that they often don’t get.

What is type 1 diabetes? Most of us in the functional medicine world see a lot more patients with type 2, and that’s because only about 5% of diabetics are type 1, but type 1 diabetes used to be known as juvenile diabetes, but it’s probably better described as insulin-dependent diabetes.  In this condition, the pancreas produces little or no insulin. Insulin is a hormone that signals the muscles to pull sugar from the bloodstream, to enter the cells used for energy. It’s generally understood that type 1 diabetes is an autoimmune origin, and while usually develops during childhood or adolescence, it can develop in adults. The cause of type 1 diabetes is controversial and we’re not going to go into all the possibilities, but there’s discussions about gluten and dairy and a bunch of other issues that may contribute to the causation of type 1 diabetes.

To lead the discussion this morning is Lauren Bongiorno. She is a health coach, a diabetes influencer, and the founder and CEO of Risely Health. Lauren has dealt with type 1 diabetes since she was seven years old. She is challenging the current healthcare system and the world of diabetes management through her company’s innovative health coaching programs and online educational classes. Lauren, thank you so much for joining us.

Lauren:           Thank you so much for having me. I’m looking forward to this discussion.

Dr. Weitz:       Great. Maybe you can start by telling us a little bit about your journey and when you just first discovered that you had type 1 diabetes.

Lauren:           Yeah, absolutely. It’s interesting, now, in our practice and in our health coaching company at Risely, we see people getting diagnosed with type 1 diabetes at 40 years old, 50 years old, 60 years old, but like you said earlier it is very more well-known that children get diagnosed. I was one of those children. I was …

Dr. Weitz:       Wait, by the way, why do you think more people are being diagnosed later with type 1?

Lauren:           Yeah, you know what? I think that in the past a lot of doctors have misdiagnosed adults as type 2. It just took a longer amount of time to get them the correct diagnosis, but COVID also, we saw a huge spike after and within the past two years of diagnosis after COVID and the stressors of either getting COVID and then having it afterwards, or just the life stressors with things changing in your routine and people dying in your life that maybe have potentially triggered it.

Dr. Weitz:       Interesting. There’ve been some discussion about viral triggers. You’re saying SARS-CoV-2 virus and/or possibly the vaccine may have triggered an autoimmune process that’s leading to type 1 diabetes?

Lauren:           Yeah. There’s more research coming out now about it. I think it’ll be something that over time, will have to be looked at, but there is definitely some kind of relation between it.

Dr. Weitz:       Interesting, interesting. When it gets diagnosed later in life, it can be confusing because there’s a type 1.5 diabetes, this latent onset, right? Diabetes that’s different than type 1.

Lauren:           Mm-hmm (affirmative). Exactly. Yeah. There’s many different types of diabetes. There’s more than type 1 and type 2.  I personally live with type 1, which is an autoimmune disease.  My body doesn’t produce insulin, which is basically the thing that helps take the sugar out of the bloodstream.  I was diagnosed at seven years old.  Your whole entire life from in that point is changed in the way that you’re living.  You hear from a very young age, if you don’t take care of yourself, hear all the terrible things that could happen to you.  As a child, you’re like, “Oh, that’s so far away, right?”  But it sneaks up on you.  I’m going on 22 years of living with it. I’ve been through many stages of living with my diabetes.  It’s way more complicated than just eat less carbs and exercise.

Dr. Weitz:       It must be pretty traumatic for a seven-year-old kid to suddenly have to start pricking your finger to measure your glucose levels and injecting insulin.

Lauren:           Yeah. I’d actually argue that it’s more challenging for the parents than it is for the child a lot of the time. I know that my parents and we also work with a lot of parents in our family coaching program at Risely, they went through the newborn stage already with their child or multiple children.  This is kind of that like second wave of having a newborn because you’re waking up multiple times in the night to check your child’s blood sugar. You’re constantly focusing on all these hyper decisions that need to be made that you shouldn’t have to think about as a parent, but you ultimately do when your child’s diagnosed.

Dr. Weitz:       What are some of the most important variables that we need to manipulate to help manage patients with type 1 diabetes?

Lauren:           Yeah. Like I alluded to earlier, many of what we, much of what we understand type 1 management to be is around nutrition and exercise. Just within those two categories, there is about 20 different factors that influence your blood sugars, right? There’s the type of exercise you’re doing. The time of exercise you’re doing, how long you’re exercising for, what your insulin sensitivity levels are, your resistance levels, where your starting number is at, what kind of food you have before it.  Then, with the nutrition, it’s the combination of macros, timing of macros, timing of insulin, right? All of these are different factors. That’s just one part of already what we know, but under the surface, there’s all these other levels. You can think of it as an iceberg, right? On the top of the water, you can see that most obvious things that you have to be looking at to manage your type 1 diabetes, but beneath the surface, you have things like relationship to food and your mindset to diabetes, how your acceptance level of it, right?  Your hormones, your background, cortisol levels, or for females, your whole entire 25, 26 to 34 day cycle that’s having, give or take, depending on your particular hormones but that impacts your blood sugars, right? There’s so many of these other factors where type 1 diabetes is not like type 2, where you can take Metformin, you can take a pill and it helps the majority of the symptoms. We’re very much juggling all these factors at any given time.

Dr. Weitz:      Interesting. How do you recommend monitoring the glucose? I’m assuming you probably recommend one of the continuous glucose monitors available today.

Lauren:           Yeah. They’re the two main leading glucose monitors are the FreeStyle Libre and the Dexcom G6. I believe the G7 just came out. This is for people with type 1 diabetes, the most popular, I wear, the Dexcom. The thing is that it’s not, the technology is not accessible to everybody. You always have the option to be finger pricking for you to see what your blood sugar is.  I wish, and it should be that these technologies and insulin pumps as well are available to everybody, but it’s just not the case, but it does make your life so much easier because you can just look down at your phone, in my case, on the Dexcom, see what the blood sugar is and make a decision based off of that.

Now, on the flip side of it, you have people who are highly perfectionist, who you’re never going to get your numbers perfect, and if you attach too much to it, it’s going to drive you crazy because if you’re constantly living on your phone, watching the arrows, trying to make the decisions, you’re not going to be living in the present moment.  I think it’s really important to balance that this is a long marathon and it’s not on a sprint and you have to develop sustainable habits with everything, with food, with nutrition, with mindset, all of it.

Dr. Weitz:      The worst thing you could do is get too stressed out over and have an increase in your cortisol levels, which will raise your blood sugar. Then, we also have to keep in mind that as high tech as these insulin, as these glucose monitors are, they’re not perfect.  For example, both of these monitors that you mentioned, the FreeStyle Libre and the Dexcom, they’re measuring interstitial fluid, which is not exactly the same as the glucose levels in a bloodstream. It’s close, but it’s not perfect.

Lauren:           Yeah. That’s a really good point. I think at the end of the day, what it comes down to is being able to know your body’s patterns and first without the technology, have a good relationship with what a higher blood sugar level feels like.  Right now, when people are getting diagnosed with type 1 diabetes, you are a lot of the time getting put on a CGM right away. For me, I was diagnosed at seven, I didn’t have a CGM for 15 years. I slept through the night, given my mom checked my blood sugar maybe once or twice in the middle of the night for the first few years, but there wasn’t that amount of data that we have today.  It was beneficial, in my opinion, because I now can look at my number and instead of just giving food for a low blood sugar that the CGM is saying, or giving insulin for a high that it’s saying, I can say, “You know what? That’s actually not the case. That’s not really what it is.” I can test my blood sugar on a finger prick, and then I can say, “See, that’s the right thing and I knew I was on the right track there.”

Dr. Weitz:       Yeah. Interesting. I just wanted to comment, one of the things that happens when you do podcasts is sometimes you have weird things happen with lights. I remember having one interview where the person I was interviewing had the light coming in through the tiny beads and you have shades that you use to block out the light on your window and there’s tiny holes and the light was coming out and going across his face. I see your [crosstalk 00:10:55].

Lauren:           Well, because my window, I’m backlit over here. You would not see me if I didn’t have a ring light over here.

Dr. Weitz:       I know. I have a ring light too, and sometimes it shines off of the frame on picture behind me. It’s all those things you have to deal with.

Lauren:           All of [crosstalk 00:11:14].

Dr. Weitz:      It’s interesting. Anyway, but you brought up something that people who don’t know about type 1 diabetes have no clue about and people with type 2 diabetes generally don’t have to worry about. I think this is a good time to talk about that is worrying about making sure that your blood sugar doesn’t drop too much during the night.  Normally, with type 2 diabetics, all we’re concerned about, or mostly what we’re concerned about is that fasting glucose in the morning, we don’t usually worry about problems with their glucose during the night, even though sometimes they can have problems there too, but for type 1 diabetics, it’s really crucial that their glucose, in particular, doesn’t drop too low during the night.  Do you have a strategy for trying to keep the glucose from dropping too low during the night? And this is sort of starting to our discussion of diet. I did have one discussion with another guy who was a health coach who talked about eating some healthy fat in the evening before bed. He actually has some product with a bunch of nuts and things like that in it.  What do you think about the best strategy to keep the blood glucose fairly even during sleep?

Lauren:           Yeah. Look, I’m here to change the narrative, I think, around a lot of what we’ve heard that is the best for anything, right? What’s the best strategy or way to eat for this or for that? There really is no best way and I’m not just saying that, right? You could have somebody who thrives on the keto diet, somebody who thrives on high carb, low fat, who thrives on this, vegan, whatever it is, but the truth of the matter is, you have to find what works best for your pattern in terms of what’s sustainable, but also for your blood sugars.  There is no one size fits all. It’s actually the main issue with the healthcare system is that they view too much all type 1s as a here’s what’s were going to work for all of you and that’s just not the case. You have one guy, I don’t know if he was talking about type 2 or type 1 or whatever.

Dr. Weitz:       He was talking about type 1. Yeah.

Lauren:           type 1, okay. You have somebody who’s saying that increased fats before bedtime are going to help you sustain without having a low, I can give you 20, 25 case examples in the next 20 minutes of people who would not benefit from that, right?  Because increased fats in their diet are going to actually sustain a higher blood sugar number over bed. It’s not exactly what is one size fits all, but hey, what happens to my blood sugars overnight? If it’s they’re going too high, they’re going too low, what needs to happen beforehand?  I can give you a personal example for me. If I had fats before bedtime, my blood sugars would be running high because that fat acts like a buffer and help and creates a little bit of resistance to my insulin, my basal insulin that’s coming overnight. For me, it’s actually more beneficial to have a carb snack if I want something for dessert. Let’s say a bowl of berries or an apple with maybe just a little bit of peanut butter, something like that because I can then give insulin for it. I know how it’s going to, what it’s going to do with my blood sugars in those two hours and there’s not going to be a prolonged effect on my blood sugars in that two to eight-hour span, which happens when you add some facts in.

Now, it depends on the amount of fats, the quality of the fats, all these different factors, but all to say in the end that it’s like, look at what’s happening to your blood sugars overnight and understand what certain foods do to your specific blood sugars and then make informed decisions based off of that.

Dr. Weitz:       Right, but I wanted to point out that, where is type 2 diabetics until a point at which they get to having to take insulin, the big issue is their glucose being too high and type 1 diabetics have to worry, not only about it going too high, but also about it going too low. I think the idea of using fat was to keep it from dropping during the evening.

Lauren:           Right, and I think that where the misconception is, and really understanding is so with type 1 diabetes, we have insulin that goes in our body 24/7 in all these different rates, right? Especially if you’re on an insulin pump, you have different insulin, every two hours it can be for different rates. Technically, if I didn’t eat for 24 hours, my numbers based on those insulin rates should actually stay stable and should not drop.  Now, if you’re on shots, which might have been the case for that past episode guest that you had on, that could be possibly a, well, I can’t change my insulin rates overnight time, so I have to use fats because my natural tendency is to drop. In his case, of his bio-individual body, those fats could be helpful for him.

Dr. Weitz:       What percentage of type 1 diabetics are on insulin pumps?

Lauren:           It really comes down to the accessibility issue that I said earlier. I would say that, I would have to guess a lot of people who have the option of doing, being on pump therapy or on CGMs, they choose to do that, I think it’s a larger percentage and the people who have the option based on insurance, and then say, I don’t want to go on. I just would rather be on shots. I don’t know the exact percentage, but I don’t know if it’s 50/50, I’m not really sure.

Dr. Weitz:       It’s based on cost and insurance coverage.

Lauren:           Cost insurance coverage and then of course, preference, right? A lot of people, there’s three leading pump companies. Two of them have wires, one of them, doesn’t. The Omnipod and that’s the one I’m on. If somebody doesn’t want to be on a pump and have something extra on their body, that’s another reason why they might not choose it.

 



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:      Let’s talk about diet. You already set up the discussion by saying that you’re here to prove that or make everybody understand that there’s no one best diet for type 1 diabetics, but given that, how should we figure out what to eat if you’re a type 1 diabetic, or how should we decide what to recommend if you’re coaching somebody who’s a type 1 diabetic?

Lauren:           Yeah. It’s a great question because we can’t just look at it and say, “Oh, well you have type 1 diabetes. Just eat whatever you want and don’t worry about the blood sugar strategy. Don’t worry about the insulin strategy, right?” There has to be some thought process to it.  Kind of my rules in how I like to think about this is, first of all, what I love about coaching is my job is not to replace a dietician, a nutritionist, a doctor, a certified diabetes educator, there is a place for all of us and where the coach fits in is really by putting the client and the type 1 diabetic in the driver’s seat and saying, “You know what? I have all this information coming at me, but ultimately I have to decide kind of what works best for me.” What you’ll see a lot of is people who look outwards to follow specific diets, and then they do it and it’s not sustainable.  I think the number one rule is find something that’s sustainable for you. Is it sustainable for you to never eat bread again? Probably not, right? Are you going to set yourself up for failure if you say that and then feel like, “Oh shoot, I can’t be successful,” and kind of go through that restrict binge cycle. That’s not good, right? It has to be sustainable.  The second thing is obvious, it’s what’s good for everybody, which is lead with whole foods, right? Lead with real whole foods, less processed ingredients, less inflammatory foods for people who have celiac, obviously less gluten. I think all type 1s, there’s been a lot of research on the benefits of drastically reducing dairy. That’s the case for a lot of people. What benefits people who are type 1 and not type 1. I would say that’s the second piece.  Then, the third piece is knowing that there’s an emotional component to food, right? That there’s a pleasure element to food. It doesn’t mean we’re having pizza every day, but to find a place for the foods that you love, that are part of your culture, part of your family, part of your enjoyment, and figuring out a way to have those foods and also be able to have the insulin strategies to meet it so that you don’t have to compromise blood sugars.

Dr. Weitz:       Of course, when you say we’re trying to eat foods that are going to lower inflammation, there’s many, many different thoughts about that. There’s a thought and some data to show that maybe animal products and saturated fats are going to raise inflammation.  There’s thoughts and some data to show that lots of fruits and vegetables, anything with seeds, anything with lectins, grains, legumes, that’s going to cause inflammation. Foods that you have sensitivities to, are going to cause inflammation. I’m used to, I’m not sure it’s so easy to know what is going to reduce inflammation.

Lauren:           Right. I think that you’re exactly right. There’s controversial opinions on what is the best diet. You can find books written on lectins being terrible and having certain fruits and vegetables that have those and being inflammatory and exactly like what you said about opposing theories.  I think ultimately, what it comes down to, is how does your body feel when you have those things? I know that when I have dairy, the next morning I wake up, my hands are literally swollen. I know that I’m never going to fully cut out dairy, but it’s not beneficial for my body. I’m puffy, I’m sluggish. I don’t like the way it makes me feel. It doesn’t help with my blood sugars. That’s enough data for me to make an informed decision versus having to go out and read all the research studies on if dairy is good or bad and then decide based on that. It’s really combining the inner wisdom with the outer wisdom.

Dr. Weitz:      Still when you’re working with, by the way, you mentioned how a health coach is different than a dietician versus a doctor, I’m a little confused about that. What exactly is the difference between a health coach and a dietician? Don’t they both put people on recommended foods and, I’m a little confused. What is the difference?

Lauren:           Yeah, it’s a great question. I think that the coaching industry in general, now there is, I’m a nationally board certified health coach and we are the National Board is under the medical board of examiners. This is something that is new in the past few years and even when I first became a coach, I’m coaching people in 2015 was very like, what is health coaching, right?  At the root, health coaching helps people prioritize themselves and get unstuck by helping them develop the tools and the strategies to become aware of what their blocks are, what their patterns are so that they can move towards the vision that they have for themselves. It ultimately pushes them in the, it puts them in the driver’s seat and helps them tackle behavior change more than just giving them a plan to follow.  Where when you see a dietician or a nutritionist, they’re going to say, “Okay, here’s how to balance your meal at lunchtime and here’s the plan. This is your goals to have eat exactly this, do exactly that.” We’re more of the mindset, behavior change, helping you identify your patterns of what’s working and what’s not.

Dr. Weitz:       Interesting. Okay. Let’s get back to, what are we going to tell this type 1 diabetic that’s coming to see you today, what they should be eating for breakfast?

Lauren:           Yeah. If they were to come to me and say, “Hey, my blood sugars are high after breakfast. What should I be eating?” My role is to not tell them, this is what you should be eating because then that’s saying that I know their body better than they do. Instead-

Dr. Weitz:       Well, I know my body works great when I eat frosted flakes and I pour some extra sugar on it.

Lauren:           Well, then they [inaudible 00:24:31], right. Then, they wouldn’t come to me and say that there’s a problem with it. Then, there’s no reason that they’re here. They’re here and while we’re working with them is because they’re saying, “Hey, this isn’t working what I’m doing. I need to figure out what is.”  Likely, the conversation goes, “I’m having Frosted flakes in the morning. I don’t know why my blood sugars are going high after.” Then, I can say, “All right, well tell me a time that you did have stable blood sugars after breakfast. What did you eat that was different?” “Oh, you know what? I had eggs and toast.” “Oh, interesting. You had carbs, but you also had some fat and protein. What does that tell you?” “Oh, it tells me maybe I had to have to add some fat and protein to my frosted flakes.” “Okay. Would you like to try that?” “Yes, I would.” “Well, let’s get curious and let’s see what happens after you do.” Right? That’s how the conversation starts and where it goes from there.

Dr. Weitz:       What would you recommend to eat for breakfast, if you’re a type 1 diabetic?

Lauren:           It’s something that’s pretty much, I mean, like I said, it’s not as specific-

Dr. Weitz:       Let’s say I came to you and I said, “Look, I want to be perfect. I’m a type 1 diabetic. I want to live a long life, which I’ll eat anything. I don’t care. If you tell me to eat dried hamsters with strawberries on it, that’s what I’ll eat.”

Lauren:           It’s not my role to tell them what to eat.

Dr. Weitz:       Okay.

Lauren:           I’ll stand by that, but what I will tell you is that I can give you one client that eats 70 carbs for breakfast of fruit and has perfect blood sugars after because they’re on a high carb, low fat diet, just a lot of fresh fruits, fresh vegetables. Then, I can have somebody who has stable numbers after breakfast and has eggs with two pieces of avocado, toast and have stable numbers.  It’s not about the food, it’s about that person’s body, how they metabolize it, how their insulin sensitivity levels and weigh more than just what the food that they’re eating is.

Dr. Weitz:       I do think that there’s a trend, especially in a functional medicine world, that diabetics, whether type 1 or type 2, should both be on a lower carb approach, but from reading some of the blog posts on your website, I think that’s something that you don’t agree with.

Lauren:           Yeah. I think that there’s people who, for sure, thrive on a lower carb diet. It’s definitely easier, right? When you take carbs out of the equation, it’s a lot easier to not see that initial blood sugar spike, but what you see and this isn’t my opinion, this is research and science fact, when you have a higher fat diet, there is a higher A1c correlated to that and a lower percent time in range due to insulin resistance.  There’s plenty of research that shows when you have a higher fat diet and you’re eating carbs at the same time, you’re going to have a little bit more elevated, than, if you’re eating even kind of moderate levels of everything, a little bit more moderation, there’s also tons of research that shows when people have a high carb diet and I’m talking 400, 500 carbs per day and a super low fat under 20% diet, they can have great A1c’s too. You can find the support, the research to support either one.

Dr. Weitz:       Yeah. I’ve talked to other coaches. I interviewed Cyrus Khambatta and Robby Barbaro, do you know them?

Lauren:           Yes. I know both of them.

Dr. Weitz:       They have Mastering Diabetes and they basically told me the same thing. I personally have not ever noticed that. Quite patients that I work with who have elevated hemoglobin A1c, I’ve never seen anybody who followed a low fat, high carb diet lower their hemoglobin A1c.

Lauren:           Yeah. They’re master in diabetes, Cyrus and Robby are great examples of that, where they’re saying, “Hey, we’re going to show you a different way to do it.” I have ate their diet before, and it’s not sustainable in my opinion, but there are plenty of people who it works for them and you can’t fight the results, right? They speak for themselves. You can’t fight the results of somebody lowering it by removing carbs. You can’t fight the results of people lowering it by increasing carbs and having super, super, super low levels of fat.  That, to me, you’re taking out oil, you’re taking out a lot of those that macro that helps other things of the body, like your skin and your hair and your nails and all that type of research, right? There’s controversy in so many different areas, but the point is, is that if it works for somebody, we can’t knock it, right? It’s a possibility.

Dr. Weitz:       I guess one of the concepts is that increased levels of either fats or saturated fats, or I have even heard people claim that animal proteins increase, decrease insulin sensitivity.

Lauren:           Mm-hmm (affirmative). Yeah.

Dr. Weitz:       Which of those? Do you think all of those or do you think it’s just saturated fats or [inaudible 00:29:19]?

Lauren:           Yeah, for sure. For sure, what we can see and we have let’s say 800 people that apply for our coaching programs per year. We have a lot of data in terms of type 1 diabetics and food and what works and what doesn’t for the majority of people. What we can tell is the higher the dairy and the animal fats, I don’t know, specifically saturated, [crosstalk 00:29:40]…

Dr. Weitz:      Yeah, and animal fats. Okay.

Lauren:           … animal fats, it’s contributing to the higher levels of insulin resistance. Now-

Dr. Weitz:      You’re measuring that by hemoglobin A1c?

Lauren:           Yeah, by hemoglobin A1c and also time and range. Time and range, I think, is even a better indicator than A1c.

Dr. Weitz:      Okay. What is time and range?

Lauren:           When you wear a CGM, oftentimes the doctor will say, your time and range, we’ll set your goal between 80 and 180. It’s how much, what percentage of the time are you staying between those numbers? You want that number to be higher.

Dr. Weitz:      Is that what the range is, 80 to 180?

Lauren:           Yeah. Pretty much. You can change it. [crosstalk 00:30:21].

Dr. Weitz:      180 sounds kind of high, huh?

Lauren:           For a type 1 diabetic, no. It’s not because it’s very unrealistic to say that for a type 1 where your body literally doesn’t produce any insulin and you’re in charge of monitoring every single thing, the expectations right, would drive people crazy if it was any lower than that.

Dr. Weitz:      Wow. Okay. Interesting. What about coffee for type 1 diabetics?

Lauren:           Interesting question. In the morning time on an empty stomach, you’re going to see most likely, depending on somebody’s tolerance for caffeine, how much they’re drinking it, frequency, all of that, you’re going to see blood sugar rise from coffee, even if there’s no sugar and there’s no cream, anything in it. That’s something that happens to me as well. I actually have to give insulin for black coffee.

Lauren:           Now, when you make a small shift of eating something before you have black coffee, a lot of people will see a decrease in their blood sugar response due to just that little switch.

Dr. Weitz:      Interesting. I wonder what about, have you looked at people who have more of a response from coffee or less of a response? I know there’s certain genes that correlate with that. Is it more because people get a bigger response from coffee, get more of an increase in adrenaline cortisol and that’s what spikes the sugar?

Lauren:           Yeah. In my opinion, what I have seen and what I’m seeing is that your cortisol levels are higher in the morning time period, right? They taper off [crosstalk 00:31:54].

Dr. Weitz:      They’re supposed to be, right.

Lauren:           Yeah. They’re supposed to be, exactly. If you’re adding caffeine on top of it when you’re waking up and you’re already a little bit dehydrated and you’re not, let’s say, drinking water and you don’t have any food in your system, there’s just a higher blood sugar response.  Sometimes I say, you don’t have to know the why, you just have to know the patterns. Whether that has to do with their, how frequently they’re drinking it, if it’s caffeinated, decaffeinated, all these different factors, if it’s happening, there likely has to be insulin being given for it.

Dr. Weitz:      For type 1 diabetics, are you recommending small frequent meals? Are you recommending any periods of time where they don’t eat as you know, one of these strategies for longevity these days is intermittent fasting.

Lauren:           Yeah. In our years of working with both men and women, we’ve seen more men benefit from an intermittent fasting than women have. I think it has a lot to do with relationship with food, with hormones, depending on where they are, in terms of what age they are. I think it can be beneficial for certain people and depending on what their goal is.

 

Dr. Weitz:      I’d like to interrupt this fascinating discussion we’re having for another few minutes to tell you about another really exciting product that has changed my life and the life of my family, especially as it pertains to you getting good quality sleep. It’s something called the ChiliPad, C-H-I-L-I-P-A-D. It can be found at the website, chilisleep.com, which is C-H-I-L-I-S-L-E-E-P.com.

Dr. Weitz:      This product, it involves a water cold mattress pad that goes underneath your sheets and helps you maintain a constant temperature at night. If you’ve ever gotten woken up because the temperature has changed, typically gets warmer, this product will maintain your body at a very even temperature. It tends to promote uninterrupted, quality, deep, and REM sleep, which is super important for healing and for overall health. If you go to chilisleep.com and you use the affiliate code, Weitz20, that’s my last name, W-E-I-T-Z 20, you’ll get 20% off a ChiliPad. Check it out and let’s get back to this discussion.

 

Dr. Weitz:      What about alcohol, like a glass of wine? How does that affect diabetics?

Lauren:           Yeah. Interestingly enough, let me ask you, do you think that alcohol raises or drops blood sugars over, let’s say a six-hour period?

Dr. Weitz:      I’ve done a little research into this recently and it’s common for people to say alcohol gets converted into sugar, but the reality is alcohol gets processed by the liver and it’s a long route until it gets converted into sugar. A number of studies show that alcohol reduces glucose response with the meal.

Lauren:           Yes, exactly. I was so curious if you knew that if you were familiar with that because a lot of people think exactly like you said, that it just raises blood sugar. Now, there’s certain types of alcohol, that if it has sugar in it, and you’re adding creamery [crosstalk 00:35:32].

Dr. Weitz:       Like a mixed drink that has added liqueur or something like that.

Lauren:           Right, right, right. Exactly. Your blood sugar is going to rise from it likely, but over time, over the next couple of hours, they’re exactly what you said is happening with the liver, you’re likely to see low blood sugar. It’s why doctors are very, very careful of telling kids before they’re going to college if they have type 1 diabetes, if you’re drinking, you have to have a plan in place for definitely eating before you’re drinking, and also being mindful of your numbers overnight, because that can become a really dangerous situation.

Dr. Weitz:       If the glucose drops too low while they’re sleeping.

Lauren:           Yeah. It’s a big source of type 1 deaths, where-

Dr. Weitz:       What do you think is the critical level that should not drop below?

Lauren:           I mean, I’ve seen more-

Dr. Weitz:       Sixty?

Lauren:           No, no, no, no. No, no, no. I mean, of course, yeah. Technically on paper, it shouldn’t drop below, let’s say 75, but I’ve woken up in the middle of the night with numbers in my 21 years of living with diabetes, I’ve woken up at 35, right? It’s not that it’s, the threshold is a little bit lower than 35 before you’re in kind of a danger zone, but yeah, you don’t want to, the goal is to not get anywhere near there.

Dr. Weitz:       Okay. Let’s discuss exercise for type 1 diabetics.

Lauren:           Okay.

Dr. Weitz:       Generally speaking, when I’ve worked with type 1 diabetics, recommended that the most important thing is to do approximately the same amount and the same intensity of exercise every day, if possible.

Lauren:           That consistency?

Dr. Weitz:       Right.

Lauren:           Yeah. I think, type 1 thrive in routine. We thrive with consistency, with everything across the board, from workouts to sleep patterns, to nutrition, but is it realistic? Maybe not always, but as close as you can, especially I think for exercise, the more consistent you are with your exercise, the more you’re going to know what your body’s pattern is.  It also goes to say, if you want to do a workout on Monday and a yoga class on Tuesday and a 5k run on Wednesday, it doesn’t mean it can’t be done, right? It’s just, you have to know what your body’s patterns are for that and you might need insulin before one of them. You may need 30 carbs with a snack before another one, just based on the anaerobic versus aerobic, whatever type of workout you’re doing because they have different blood sugar responses.

Dr. Weitz:       In general, maybe you could address that. What about the blood sugar response in the average type 1 diabetic with resistance exercise, with high intensity training, with longer distance cardiovascular training?

Lauren:           Yeah, that’s a great question. Generally speaking, exercise, that’s very start and stop like if you’re sprinting or if you’re doing heavy weight lifting, those are going to be things that are going to more likely increase your blood sugar than to drop it.  Things like a steady state run or a, let’s say swimming or playing soccer in a soccer field, that’s probably a combination of anaerobic and aerobic, but more of that where you have your heart rate at a lower rate, but for a longer period of time, you’re going to see more of a steady drop but it also depends on how much insulin you have on board, right? That’s a key factor as well, but that’s generally what you’ll see for the patterns there.

Dr. Weitz:       It’s not unusual for say somebody doing an hour workout of resistance training to see their blood sugar go up immediately after the workout?

Lauren:           Yeah, exactly, but knowing that, how can you get ahead of that? I’ll give you my personal experience, right? Everybody listening, if you’re type 1, don’t do this for your body, because this is my specific pattern, but when I do weightlifting in the morning time, I will give myself insulin beforehand because I know that my blood sugar is going to go up. Normally, if I didn’t do that, my blood sugar would rise, but maybe if I do that, my blood sugar is actually not going to go up because I was able to counteract it.

Dr. Weitz:       Right. Now, my understanding of this, this is another thing I read up a little bit about recently is that that’s because you’ve used up the glucose in your muscles and now your muscles are sucking up glucose, so the body’s trying to produce some more glucose to give it to the muscles. Maybe you don’t want to take insulin then and decrease that. Maybe that’s just a normal response of the muscles and it’ll settle down in a little bit.

Lauren:           Right. For me, my main priority is not going high because I don’t want to have to go high afterwards and then go into a breakfast meal where I’m already starting off high, then I’m going to go higher. You don’t feel good. You feel more lethargic. I cannot perform in the gym as well as if I’m high, than if I’m in range. For me, my priority is always having that lower blood sugar and keeping it stable.

Dr. Weitz:       You use an insulin pump?

Lauren:           Yes. I use the Omnipod insulin pump to administer insulin. Correct.

Dr. Weitz:       Does that administer the same type of insulin all day? Okay.

Lauren:           Yeah. There’s this background drip that’s called basal insulin, that’s for 24 hours giving me different rates of insulin based on what I set it to. At, let’s say 12:00 a.m., it can be giving me 0.4 where at 3:00 a.m., it’s giving me 0.55, and then I give insulin that is also for giving corrections to correct a high blood sugar number and to also give insulin before food.

Dr. Weitz:       Okay. Now, there’s another strategy where people will use a longer-acting insulin at certain times and a shorter-acting insulin at other times?

Lauren:           Yeah. That’s if you’re on a, if you use shots and you’re not on a [inaudible 00:41:28], so you have your long-acting, your Lantus, your placebo, whatever it is and then you have your fast-acting, let’s say Humalog. They have different release times. For the long-acting insulin, you’re giving it either once in the morning or a night, or you’re giving it a split dose of it. Then, you’re just giving the fast-acting every time you eat. It’s just a different strategy of how you’re administering it.

Dr. Weitz:       Have you found any nutritional supplements to be helpful for managing type 1 diabetics?

Lauren:           I don’t know if I can directly speak to direct correlations, but for me, and for everybody, sleep is really, really, really important in terms of your blood sugars the next day, in terms of curbing your sugar cravings and carb cravings the next day, and sleep is a priority. I take magnesium sometimes before bed and that helps my sleep. It almost like, that’s one that I can say for myself indirectly has helped my blood sugar control.

Dr. Weitz:       What type of magnesium do you take and what dosage?

Lauren:           Oh, goodness. Now, you’re testing me.

Dr. Weitz:       No. No. I mean, you know people-

Lauren:           It has a purple top.

Dr. Weitz:       No. I’m not trying to put you on the spot.

Lauren:           No, it’s okay.

Dr. Weitz:       It’s just, you know.

Lauren:           I would say, I don’t, maybe you can tell me what, I can see the bottle, it’s G-Y, G-Y-L.

Dr. Weitz:       Glycinate, mag glycinate.

Lauren:           Glycinate. Yes. I take and that is the one that I have. I believe it’s a thousand milligrams.

Dr. Weitz:       No, it’s a hundred.

Lauren:           No? A hundred milligrams? All right.

Dr. Weitz:       Okay.

Lauren:           I was one zero off.

Dr. Weitz:       Unless you’re taking 10 of them. Any other nutritional supplements? What about berberine? What about cinnamon? What about lipoic acid? What about other nutritional supplements that are known to help with insulin sensitivity or managing glucose?

Lauren:           Yeah, I think that those are really popular for more of like type 2. You can see more direct correlations with that. type 1, because of the nature and it’s just different. There’s not anything that I can say that is directly correlating to lower blood sugars or that at least I know of or I have seen and I can speak to.

Dr. Weitz:       Now, what about any new nutritional supplements that can decrease your risk of chronic diseases? We know that patients with type 1 diabetes may have an increased risk of chronic diseases like heart disease?

Lauren:           Yeah, absolutely. There’s a lot of comorbidities that happen.

Dr. Weitz:       I’m thinking of things like fish oil, vitamin E.

Lauren:           Yeah. To be honest, this sounds even more of your zone of genius or a dietician, or like you could probably speak to this way better than I can, but I would say the biggest thing is understanding what your deficiencies are and advocating, because you’re most likely seeing your endocrinologist and they might not be looking, doing a full blood panel workup, things like that. It depends on what diet you have. I’m a pescatarian.

Dr. Weitz:       Yeah. Your endocrinologist is not testing you for nutrient status. I can tell you that.

Lauren:           Yeah. Exactly. Exactly. I’ve been a pescatarian for 11 years now. For me, there are certain supplements like B12 that I take that overall health, going to be more helpful and yeah, I think it’s individual.

Dr. Weitz:       Okay. That’s great. I think that’s a wrap for today. Thanks for sharing some useful information, helpful information for us. How can listeners, viewers find out more about your programs and get ahold of you? I understand you have some courses, both for laypersons and for practitioners, is that right?

Lauren:           Yeah. We worked primarily with people that have type 1 diabetes and also families of children that have diabetes. We have coaching programs and courses and ton of free resources. You can connect with me on my Instagram, which is just my name underscore in between the first and last name. Lauren_Bongiorno or find Risley Health on Instagram, R-I-S-E-L-Y health.com also is the website. We’re everywhere. You can pretty much find us, but if you came from this podcast, definitely shoot me a note and I’d love to connect with you.

Dr. Weitz:      Okay. That’d be great. Thank you, Lauren.

Lauren:           Thank you so 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 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 White 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.

 

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Reverse Biological Aging with Dr. Christopher Shade: Rational Wellness Podcast 255

Dr. Christopher Shade discusses How to Reverse Biological Aging with Dr. Ben Weitz.

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Podcast Highlights

3:05  Dr. Shade said that his chronological age is 53, but his biological age is younger. This is now measured by looking at methylation patterns on CPG islands in your DNA. This is through epigenetic clocks, such as the Horvath clock, as found in the Tru-Age test from Tru-Diagnostics.  [Turning Back Time with Epigenetic Clocks.]  The clocks have been trained or correlated with IQ, grip strength, balance, facial aging, etc.  If you are aging at a rapid rate, if you have a faster loss of function, then your biological age might be 70 when you’re 53, or if the pace of your aging is slow, then your biological age might be 43.  Our goal is to reduce our biological age to extend our health span.

6:35  Dr. Shade and Quicksilver Scientific have conducted a study using their supplements for three months and measuring their biological clock using TruDiagnostic’s TruAge test and the preliminary results look very good.  They saw improvement in the Horvath clock and in the pace of aging.  They beat the results of a two month caloric restriction trial.  They also saw positive epigenetic changes in certain white blood cells–monocytes and natural killer cells. The first month was detox with support for Nrf2 and AMPK activity (70% Nrf2/30% AMPK).  Second month, they shifted to 70% AMPK, 30% Nrf2, and a lot NAD+ and membrane building and sirtuin activation.   So clear things out, detox, then build up metabolic strength. Then the last month, we kept going on that mitochondrial metabolic strength, and the results were very positive.  According to Chris, “you start with AMPK phosphorylation with this PGC1A promoter for mitochondrial biogenesis, but then you have to deacetylate it with sirtuins, which means you have to have enough NAD+ to do that, and then you get full activation mitochondrial biogenesis, which makes more mitochondria per cell.”

11:14  AMPK, Nrf2.  How to slow the aging process should start with AMPK activation and this often goes hand in hand with Nrf2. Nrf2 is a master switch for chemo protection and when it’s upregulated, it’s called a nuclear transcription factor which means that it’s outside the nucleus and something triggers it to go into the nucleus.  Nrf2 is part of the chemo protection family, which includes antioxidants, detoxification, protein regulation, getting rid of unfolded proteins, fixing damaged proteins, and this is all cleanup stuff.  For example, to get rid of heavy metals, you need to raise nrf2 to bring up the glutathione genes and get rid of toxins like heavy metals.  AMPK can be triggered by fasting, carb restriction, exercise, and various nutraceuticals and pharmaceuticals such as metformin, berberine, resveratrol, and quercetin.  Fasting and carb restriction triggers you to mobilize and efficiently use your own stored energy resources, like glycogen, old proteins, and stored fat.  You use old proteins through autophagy.  You can increase glucose transporters, and lower insulin resistance/increase insulin sensitivity.  You are also going to mobilize stored fat and turn it into ketones for energy.  You can burn the fat out of fatty liver, which is called lipophagy.  If you take old, damaged mitochondria, and recycle them, this is mitophagy.  If you use old golgi apparatus and old endoplasmic reticulum, this is endoreticulophagy.  It’s the inner detoxification for your broken inner parts. So Nrf2 is more taking away environmental toxins and AMPK is more clearing out your own accumulations of waste, and that also includes unfolded proteins.  When you are always building proteins, sometimes you don’t make them right all the time, and you store the ones made improperly in vacuoles.  Eventually, if you don’t get rid of them, then your cells fill up with garbage.  So Nrf2 is an environmental cleanup and AMPK is a biological cleanup, and this raises yourself up to a higher metabolic efficiency. 

16:30  This autophagy happens because the body senses there are not enough amino acids to make up the proteins the body needs. There is also a switch that is engaged with this, called mTOR, the mammalian target of rapamycin.  Rapamycin was the first cancer drug that might be good for you because it blocks mTOR.  mTOR has a forward direction that is pro-growth and anabolic and then it is blocked and it causes you to go inward and recycle your own amino acids and burn your fat. If you are in growth mode all the time, you’re prone to cardiovascular disease and cancer.  Insulin and branch chain amino acids drive the pro-growth signals, while keto and intermittent fasting and the nutrients in the AMPK Charge product that Quicksilver produces and metformin all drive AMPK.

20:02  Uric acid.  There is a primal switch when your ATP (cellular energy) gets low, you can either go down the AMPK route or the AMPD route.  AMPK goes in and mobilizes resources, cleans up, and gives you insulin sensitivity, while AMPD does the opposite. AMPD increases fat storage, it further breaks down ATP. You burn off the AMP into xanthene, and then xanthene oxidase turns into uric acid.  Uric acid comes back around and blocks AMPK and keeps you stuck on the AMPD pathway. This AMPD pathway generates more uric acid, which creates creating mitochondrial stress and free radical damage inside the mitochondria, and it’s heavily associated with cardiovascular disease and early onset dementia.  If you are eating high fat but not restricting carbs enough, then you might need more polyphenols, more vegetables, you might not be eating enough vegetables, you might be eating too much salt, having too much alcohol, or not drinking enough water. 

22:40  Does promoting AMPK reduce cancer risk or protect cancer cells?  The reality is that while promoting AMPK and the other longevity pathways can prevent cancer, if cancer is present, they can also protect cancer cells.  But this is no reason not to promote the longevity pathways.

25:21  AMPK.  The best ways to stimulate AMPK is through intermittent fasting and also by working out fasted.  Almost every plant chemical has AMPK activation activity, including adaptogens and spices. The really strong ones include Berberine, Resveratrol and Quercetin.  Quercetin is so multifaceted because it stimulates AMPK, Nrf2, and sirtuins and is also a senolytic.  Milk thistle is both a AMPK and a sirtuin activator of the liver.  Many of the products that have AMPK activity also stimulate the sirtuins.  Ben Greenfield says that HIT training is the best way to activate AMPK with alternating periods for 30 seconds of all out training alternated with periods of rest. Morning is naturally more AMPK than night is. You have already fasted over night and there tends to be more autophagy in the morning and more rebuilding at night while sleeping.

29:35  NAD+.  NAD+ is a signaling molecule that’s present in the body for energy production, cellular energy, and for DNA repair.  At it’s most basic level, it’s going back and forth between NAD+, the oxidized form, and NADH, the reduced form. NAD+ is taking the electrons from your carbs, becoming NADH and going into the electron transport chain and dropping the electrons into the high energy electron transport chain and leaving the proton there. That’s eventually going to be pumped across the membrane, form that proton gradient, and come back through ATP synthase, and drive ATP formation.  So it’s shuttling energy from the sun, which is what built your carbs and your lipids, and bringing it in to make ATP.  NAD+ is also a cofactor in sirtuins, which are deacetylases. Acetyl groups are turning on or off different proteins.  To turn on the good anti-aging things, you deacetylate them, and turn on the bad anti-aging things, you acetylate them. But why would you want to acetylate the bad anti-aging things?  It’s to stop cancer growth.  While substances like resveratrol and pterostilbene and quercetin are sirtuin activators, NAD is the initial activator and it fits right into this hole in the sirtuin and activates it. NAD is also essential for gene repair. As we age, we’re always having assaults on our genes from getting exposed to toxins and radiation, etc.  PARPs go in to fix the genes, but they use the energy of NAD in this repair.  There’s also CD38, which also known as cyclic ADP ribose hydrolase, which seals up tight junctions when you get leaky gut or leaky brain or leaky liver, and this sucks in NAD as well.  NAD is doing all these things in every organ and therefore NAD deficiencies can play a role in eye disease, in fatty liver disease, in heart disease, etc. The way to promote NAD is to take one of the precursors like nicotinamide riboside or NMN.  Ideally you might want to take both of these, but because different companies hold the license to each of these, it would be too expensive to put both into a product. 

NAD originally comes from niacin, vitamin B3.  This is the story of the B vitamins. And then there’s the decrepit, degenerate, benign folic acid that everybody hates.  And then there’s the glorious 5-methyltetrahydrofolic, and then some of these half losers in between like folinic acid.  So it’s the same game.  B3 works its way up to NR and then to NMN and finally to the glory of NAD.  If NAD runs everything in the body, what can you do if you are a hunter gatherer and you don’t eat any food with niacin in it?  You can make niacin from tryptophan.  If you can’t eat any tryptophan, then you can recycle some of your cells, spit out some tryptophan and make it that way. It just takes longer and it takes more energy.  The enzymes that facilitate the jump up to NMN can get knocked out by inflammation and by age, so taking NMN and NR are the best ways to boost your NAD.  But there is also a balance with methylation. After the high phosphate bonds in NAD are broken down, you are left with nicotinamide, which is the non-flushing niacin, which blocks your sirtuins. You need SAM-e to methylate nicotinamide. If you deplete your SAM-e, this creates SAH, which creates Homocysteine, which gives you cardiovascular disease, inflammation, and depression.  So if you want to support NAD production, you also need to take B2, B12 and TMG to stimulate methionine regeneration.

42:36  Sirtuins.  Resveratrol and pterostilbene are both good products to stimulate the sirtuins. Quercetin and fisetin can also stimulate sirtuins and fisetin is also a senolytic.  When David Sinclair originally tried to promote longevity just with resveratrol, it didn’t work because you also need NAD activation or you will get mitochondrial dysfunction and then you also need enough methylation factors as well.

48:33  Senolytics and senescent cells.  A senescent cell is one that has suffered a toxic insult or mitochondrial dysfunction that causes telomere attrition.  Then the mitochondria start releasing pro-inflammatory mediators that diffuse out through the cell and cause growth cycle arrest.  The cell stops reproducing and it just sits there, becoming a zombie cell and it releases pro-inflammatory mediators.  That’s one of the major causes of the propagation of all that inflammation that shrivels us up and makes us old and decrepit.  There are two ways to get rid of these cells. You can reverse them and put them back into growth again and have them repair their mitochondria by having good Nrf2 and AMPK activity that restores the milieu inside the cell and restores the redox potential.  The other way is to get rid of these cells with senolytics, such as with quercetin, fisetin, resveratrol, pterostilbene, or curcumin.  Measuring senolytic activity is a challenge because when you go in and start cutting up these cells, there is a burst of senolytic cytokines, so it looks like there are more senescent cells rather than less and it takes a while to show a decrease.  We can show that senolytics can reverse phenotypic aging, but we can’t measure a decrease in sensecent cells as of yet.

52:38  Spermidine.  This was first isolated from sperm, but now can be derived from wheat germ and other vegetable products. It has a lot of activity for autophagy and mitophagy and senolytic activity.

53:45  Dosages.  Quicksilver products are in a liposomal form, which increases absorption, but they often include much lower dosages of these longevity products than the studies show are effective. So how do we know that we will be getting the proper dosages in these products. Chris explained that their quercetin product has a 25 fold increase in absorption, so 20 gm is equivalent to 500 mg.  Because their BioAge Reversal study, which has yet to be published, showed that using their products for three months was able to reverse the biological aging process, so the dosages used must be effective.

 

 



Dr. Christopher Shade is the founder and CEO of Quicksilver Scientific, which has revolutionized the nutritional supplement industry with their innovative nanoparticles and liposomal delivery system, their heavy metal testing, and their detoxification protocols that have become the standard for many for reducing heavy metals and mycotoxins.  Quicksilver also offers a great suite of age optimization products, including metabolic activators, NAD+, and adaptogenic blends, as well as hormone support.

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. Very exciting today to be talking to one of my favorite guests, Dr. Christopher Shade. Today, we’ll be speaking about longevity. We will be speak about how to delay the aging process to reduce the likelihood of chronic diseases and how to live longer and better, how do we take that aging curve where we see that aging for many is this long slow decline in function and increasing onset of chronic diseases that starts in our 30s and 40s, and turn it into a big rectangle where we maintain a strong level of function for a long period of time, and then quickly drop off.

Today, we’ll be talking about some of the key metabolic pathways and processes that have been identified to play a big role in aging, including AMPK, Nrf2, sirtuins, NAD+, senolytics, as well as hormones and toxins. I recently heard David Sinclair, famed longevity researcher saying on his podcast that these longevity survival pathways are like the Pentagon, which is where the coordinated defense of our country is organized, and we’re trying to make a crank call to the Pentagon for them to send out the troops to defend the body even though there’s no immediate threat. That’s what we’re doing when we are taking nutraceuticals, using drugs off label like metformin, peptides, practice intermittent fasting, cryotherapy in order to stimulate these longevity pathways.

Dr. Christopher Shade is the founder and CEO of Quicksilver Scientific, which has revolutionized the nutritional supplemented in industry with their innovative nanoparticles and liposomal delivery system. They’re a heavy metal testing and they’re detoxification protocols that have become the standard for many for reducing heavy metals and mycotoxins. Quicksilver now offers a new longevity line. I also want to say that after listening to this podcast, you can get 15% off your next order of products from Quicksilver Scientific by using the affiliate code WEITZ15. Chris, thank you so much for joining me again today.

Dr. Shade:           Great to be here, Ben.

Dr. Weitz:            Good. So before we get into what we can do to live longer, what do you think is the … Let’s talk about what’s the difference between chronological age and biological age, and then what’s the best way to measure this.

Dr. Shade:           Yeah. So chronological age, we all know I am 53 right now, but what’s my biological age? There’s a lot of ways that they go about measuring it. For a while, they were looking at different blood markers, and then what’s grown to be the norm is looking at methylation patterns on something called CPG islands in your DNA. So these epigenetic clocks like the original Horvath clock have been used extensively, and it’s funny, they say that they train the clock with people at a certain age more or less function.  So they’re taking people and they’re relating IQ, grip strength, balance, facial aging, IQ all to biological age versus the chronological age. There’s also a new clock. So in fact, as we talk, we’ll talk about a 40-person study where we put them through the paces of one of our systems to detoxify, raise AMPK, raise mitochondrial strength, and we’re able to shift back the biological age in this cohort.

Also, there’s a new one called the DunedinPACE.  Who names these things? Dunedin, if you’re from New Zealand, you’d be like, “Well, yeah, that’s called Miami Beach.” Dunedin is this little beach town at the south of New Zealand. They don’t make Miami beaches there. They make Dunedins.  So they had calibrated this clock. It was between Duke and these guys at the University of Otago and one other place, maybe Oxford. What they did is they worked on the pace of aging. So it’s more of an instantaneous measurement of the pace of your aging, how fast these genes are shutting down over time. So time is this progressive loss of function, and if the loss of function happens faster than the chronological years, then you’re aging at a rapid rate. So your biological age may be 70 when you’re 53.  When the pace of aging is slow, then over the period of time of having a slow pace of aging, then you get to 53 and your biological age is 43 or one of my friends at one of my doctors who prescribes for me, she’s 54 and she registered a 30.

Dr. Weitz:            Really? Wow.

Dr. Shade:           She uses everything. Yeah. So there’s these measures, and what we’re trying to do is extend our health span. You brought it up, run as fast as you can and then quickly. Remember the Blues Brothers? It’s the Blues, and it just drives like mad, and it’s cruising down the highway and the cops are all crashing trying to catch it. It gets to the final courthouse where it’s supposed to stop. They closed the doors and it just falls into a pile of bolts and it’s all over. So that’s what I want it to be, and that’s what we try to have is to have a good health span.

Dr. Weitz:            Right. Exactly. Yeah. So have the results of that study that you did with the biological clock, the study’s been completed?

Dr. Shade:           Yeah. It’s been completed. We got the analysis back. We’re using TruDiagnostic, which is the go-to out there now.

Dr. Weitz:            Right. Yeah. I think I talked to Ryan Smith. He mentioned that you guys were doing a study.

Dr. Shade:           Yeah, yeah. So we finished that all up and the results were great. We got very significant changes in the Horvath clock. We had very significant changes in the pace of aging. We, actually, in three months there, we beat the results from the calorie trial, which was a two month caloric restriction trial. That’s the only thing shown to slow the pace of aging. They pulled back 25% on their calories for two years. They changed the rate of aging, but they didn’t change the absolute clock.  Then looking into subsets, we found really strong changes in immune, and when you’re looking at the genes that were differentially hypomethylated or hypermethylated, a number of these were related to immune cells. So there’s a significant change epigenetically in the monocytes, in the natural killer cells, and what was the other one?  I got it here on the screen behind me.  Coming on now. There it is. B cells. Yeah. Natural killer B cells were the most significant, and then monocytes after that.  So it was really exciting. It was a three-month program. The first month was a detox, but with AMPK activity to it, say 70% Nrf2, 30% AMPK. Second month, we shift to 70% AMPK, 30% Nrf2, and a lot NAD building and membrane buildings, sirtuin activation, getting the mitochondria really clear. So clear things out, detox, then build up metabolic strength. Then the last month, we kept going on that mitochondrial metabolic strength, and we got these great results. As we talk about this more, we’re going to see some of these things are hard to uncouple like Nrf2 and the AMPK. You think they’re separate, but they’re so coregulated.

Then AMPK and sirtuins.  Well, one is just a secondary level of the other.  A lot of this metabolic clarity, I like to call it cardiometabolic efficiency, begins at AMPK. Then if you have enough NAD, you encode that into sirtuins secondarily.  So like mitochondrial biogenesis, you start with AMPK phosphorylation with this PGC1A promoter for mitochondrial biogenesis, but then you have to deacetylate it with sirtuins, which means you have to have enough NAD to do that, and then you get full activation mitochondrial biogenesis, which makes more mitochondria per cell.  So there are almost like these interwoven progressive layers of encoding this higher level metabolism.

Dr. Weitz:            That’s interesting. You mentioned about the immune system function and that’s definitely one of the markers of aging is when we age, the immune system tends to have less and less function, which is why you see-

Dr. Shade:           Senescence.

Dr. Weitz:            Exactly. So I read the Fahy trial in which it was the first trial that they were able to reverse aging, and they also looked at something called thymus involution, which means shrinking of the thymus gland, and they were able to reverse that, and have it as an indicator that the immune system is actually getting stronger rather than weaker, and that’s super important. In fact, we just recently saw what happened during the pandemic to seniors who have a weaker immune system. They weren’t able to fight off the virus as well.

Dr. Shade:           Yup. Yeah. They were really wiped out and it was like, “I wish I could have done some of that thymus work.” I mean, they were imaging them and stuff. We weren’t really set for that, but I’d love to go in deeper and reproduce some of these things, get better blood markers. One of the things we tried to do is get some of the blood markers, but it’s so nascent right now.

Dr. Weitz:            You know what? You should talk to Vojdani about doing a lymphocyte map test because that’s the first test that actually maps out all the specific T cells.

Dr. Shade:           Oh, so Ari has that.

Dr. Weitz:            Yeah. Yes. He just came out with it.

Dr. Shade:           Oh, jeez! That would be great. I’m going to give him a call.

Dr. Weitz:            Yeah, yeah, yeah. So let’s get right to what do we need to do to slow the aging process and live longer. Why don’t we start maybe with AMPK?

Dr. Shade:           Yeah. Well, we have this conceptualization of it that we call the longevity wheel, and it looks like a Star of David. It’s a six point wheel, and it’s got pop, pop, pop, pop, pop, pop, and these are things that you can intervene in. The top spoke of the wheel is AMPK, Nrf2. That’s what we’re going to talk about. Just to fill in, then then the next spoke is NAD. Plus, the next is sirtuins. The next is telomeres. The next is senolytics or senescent cells, and then the neuroendocrine system.  Why is Nrf2 and AMPK at the top, and what are the two, and why do they go together? So Nrf2 we’ve talked about a lot. You and I have talked about it’s this master switch for chemo protection, which when it’s upregulated, well, first it’s called a nuclear transcription factor, and that means that it’s outside the nucleus, and something triggers it to go into the nucleus. Sometimes they just hit signalers on the wall of the nucleus that go in, but the signal gets in and it stimulates transcription or upregulation of genes that go with some family.  For Nrf2, that family is the chemo protection family. So it’s antioxidants, detoxification, protein regulation, getting rid of unfolded proteins, fixing damaged proteins. It’s all cleanup stuff, and that’s Nrf2. We always talked about that because that was always metal detox guy. So you got to raise Nrf2 to bring up all the glutathione genes and get rid of toxins like heavy metals.

Then we did a study or actually [inaudible 00:13:10] down in Houston. He’s a functional medicine doc, did study on our PushCatch liver detox system where he found 82% resolution of fatty liver in one to two months. Just really crazy. We’re like, “Wow! You move toxins out and it does that?”  “Well, no, not exactly. That’s part of moving toxins out, but even if you move all the toxins out at once, that wouldn’t totally happen.”

AMPK then is this trigger, the AMP-kinase, and it’s triggered by certain things like running out of energy, and that would be fasting, carb restriction, exercise, and it also can be triggered by a bunch of nutraceuticals and pharmaceuticals such as metformin, berberine, resveratrol, quercetin. So when you trigger this, now remember, fasting, carb restriction, it triggers you to mobilize and efficiently use your own stored energy resources. So you’re going to mobilize glycogen. You can increase actually glucose transporters, and you’re going to lower insulin resistance, increase insulin sensitivity, and become a clean burning machine.  Then you’re going to reach into your fat. You’re going to mobilize fat. You’re going to turn it into ketones. This is how you go into ketosis and you’re going to use all that for clean energy. It’s why these fasting and exercise get rid of the symptoms of metabolic disease, and insulin resistance, things like that.  So AMPK is part and parcel of that cleaning up, but you’re going to your inner resources. You’re using your inner glycogens or sugar and fat. How are you going to use proteins? You get them through autophagy. So this is super, super important to both detoxification and longevity because what’s autophagy but self-eating. You’re going, you’re taking whole cells, you’re taking deposits. In fact, the burning of the fat out of the fatty liver is called lipophagy, so eating the stored lipids.  If you’re taking a old mitochondria that’s damaged, you do mitophagy. You could be breaking out of golgi apparatus and part of an endoplasmic reticulum. That’s endoreticulophagy, and you’re going to break all that down into its raw materials and you’re going to reuse it, and that includes amino acids and fatty acids, nucleic acids even if you’re taking whole cells. So it’s a recycling system. It’s the inner detoxification for your broken inner parts. So Nrf2 is more taking away environmental toxins and AMPK is more clearing out your own accumulations of waste, and that also includes unfolded proteins.

When you’re making proteins all the time, you don’t make them right all the time. And you store the ones that aren’t properly made in these vacuoles, and eventually, if you don’t get rid of them, it’s like taking the trash out of your house. Your house fills up with garbage. So Nrf2 is this environmental cleanup. AMPK is this biological cleanup, and this raising yourself up to a higher metabolic efficiency.

Dr. Weitz:            This happens because the body senses there aren’t enough amino acids around to make up the proteins they need. So that’s why the body starts recycling these other pieces of the cells.

Dr. Shade:           Yeah, essentially. Now, there’s this switch that’s intimately engaged in this, and this is mTOR, the mammalian target of rapamycin. So rapamycin was the first cancer drug that was ever really good for you because it would block this thing called mTOR. So mTOR has a forward direction and a blocked. The forward direction is anabolic and it’s pro-growth and it builds mass and it puts on mass, but we know if we just put on mass all the time, we’re going to get sloppy and messy and dirty. I mean, even weight lifters put on mass and then they cut it back down. All right?  So if you’re growing all the time, you’re prone to cardiovascular stuff and cancer and stuff. So you need a block to that. So when you block it, then you go inward and you recycle your own amino acids, you use your fats, you burn all that. So what drives it forward and what blocks it? So the things that drive it forward are insulin and branched-chain amino acids. The branched-chain amino acids are what goes back to you, sensing that you don’t have enough amino acids around and you start recycling old parts.

So when we’re eating carbs and protein all the time, we’re gaining mass. This is part of why keto was so therapeutic, where paleo, some people it worked and some people didn’t because they took in so much protein they didn’t get as much of the mTOR blocking, but then we have things like intermittent fasting. If we overlay some of these chemical triggers for it, maybe you’re using off-label metformin or maybe you’re using something like our product AMPK Charge or Keto Before 6, and even of our Liver Sauce, that’s why the Liver Sauce gets rid of the fatty liver so well.  Yeah, it was moving toxins and the Nrf2 upregulator, but the quercetin, the luteolin, the milk thistle, those were all strong upregulators of AMPK. So we can take these AMPK activators while we’re intermittent fasting and get this flush of activity. In fact, we used to call the product Keto Before 6 because you could be keto by day and they need carbs at night and then do it again the next day. So you’re getting some of both worlds.

Dr. Weitz:            You think about this argument because I was just talking to somebody about diabetes this morning and she was advocating for not eating a lot of fat because some of the data indicates that saturated fat reduces insulin sensitivity.

Dr. Shade:           I think it’s going to come down to what your blend of macros are, how much saturated, and are we talking about Crisco or are we talking about these beef tallow? Those are both saturated fats, and some are very strongly pro-inflammatory and some aren’t, and then there’s some other-

Dr. Weitz:            There’s a group of folks who are advocating, some of them are advocating a vegan diet, but they’re countering the lower carb diet, often advocated now for diabetics saying, “No, no. If you eat a higher fat diet, it impedes insulin sensitivity.”

Dr. Shade:           I think it’s going to come down to a couple of factors that they may not be looking at. Now, one of the subjects that’s coming up really hot and heavy right now is uric acid, and you’ll see Perlmutter is talking about. Rick Johnson is one of the masters of that. We’re going to have them here lecturing at our Colorado Functional Forum in April. I’m actually roping then into helping me prove out some of the products that we’re making for uric acid blocking.  So then this is going to bring our AMPK discussion back to this switch. You’ll see in Perlmutter’s book, Drop Acid, he talks about is this primal switch. When your ATP goes low, you can go one or two ways. You can go the AMPK route or the AMPD route. AMPK goes in and mobilizes resources, cleans up, and gives you insulin sensitivity. It gets rid resistance. AMPD goes exactly the opposite path. It’s made to get you fat. AMPK is taking off fat. AMPD is gaining fat. It’s breaking ATP down instead of regenerating it as in the AMPK pathway. You’re burning more energy to regenerate your ATP here. Here, you burn off the AMP into xanthene, and then xanthene oxidase turns into uric acid.  Uric acid comes back around and blocks AMPK and keeps you stuck on the AMPD pathway. Now, the AMPD pathway generating all this uric acid, the uric acid is creating mitochondrial stress and creating free radical damage inside the mitochondria, and it’s heavily associated with cardiovascular disease, and more importantly, early onset dementia.

So if you’re eating fat and other things that you’re doing like maybe you’re eating high fat but not restricting carb enough or you are prone to uric acid, maybe you need more polyphenols in your diet, you need more vegetables to block that path or you’re eating too much salt, you’re drinking too much alcohol, the biggest culprit is just not having enough water keeps you always down that path.  So the fat then is going to become inflammatory fat instead of clean burning fat, which is over here. So I think one of the things that I think I’m going to be advocating is that you got your uric acid meter, your keto meter, and your sugar meter, and you’re tuning yourself in so that you’re going down the AMPK side.

Dr. Weitz:            Interesting. I was going down the AMPK rabbit hole this weekend and I found one article that said that AMPK appears to reduce cancer risk by switching off cellular growth pathways, but if there is already cancer, the AMPK might be able to protect the cancer cells against stresses, such as shortage of oxygen or oxidative stress.

Dr. Shade:           Yeah. So is it going to protect against apoptosis? So it can keep you from going into apoptosis and maybe help the survival mechanism, but realize that it’s the biggest freaking trap in the world. Cancer and fear of cancer is the biggest impediment to health because every single thing that makes you live long makes cancer live long.  Now, just shut the damn argument down for a second, then bring it back and say, “What has cancer done that is genius? Cancer has immortalized itself. How does it immortalize itself? It upregulates glutathione. It upregulates NAD production. It upregulates growth hormone production. It controls AMPK and all these different pathways towards its longevity.  Then everybody’s like, “Well, what if I already have cancer? Then any of these things that help my longevity are going to help the longevity of my cancer.” Well, your cancer is going to show itself at some point and then you’re going to go after it, and it’s a certain way that you go after it, but having a healthy AMPK is going to prevent you from ever getting it in the first place. Then being afraid of doing these things that promote longevity, in case there’s some tumor somewhere in you, I don’t know, go get a big scan or something because it just becomes such a trap. Don’t you think?

Dr. Weitz:            Yeah. I’m sure. It’s also, I’m sure, the balance and the double edged sword of things that-

Dr. Shade:           Oh, hyaluronic acid, that’s another thing that cancer has a lot of. So all of a sudden, everything that immortalized cells have a lot of becomes a death trap. Yet, that’s all the stuff that makes you live longer. So yeah, that may be tactically true, but I mean, nobody is saying that when you’re taking berberine and quercetin and EGCD, I mean, there’s people using those as therapeutics for cancer. So I don’t think you’re in any risk of all of a sudden you’re going to go off the deep end.

Dr. Weitz:            So what’s the best way to stimulate the AMPK? What are the best strategies here?

Dr. Shade:           Yeah. So I love intermittent fasting. I think it’s a great thing. Some women it’s a little bit hard, but get as much fasting as you can, then workout fasted. Add in the AMPK activators. Now, here, as a broad brush, almost every plant chemical has AMPK activation activity to it, and including the adaptogens and all those plants that we love a lot of, spices-

Dr. Weitz:            We want to take the ones that are going to be most efficient and take the right dosage.

Dr. Shade:           Yeah, so some of the really strong ones, berberine, resveratrol, quercetin. Quercetin’s such a multicomponent for us and Nrf2, AMPK, sirtuins. It’s a senolytic. That’s a really, really good one. Then things like milk thistle. Part of that is AMPK and sirtuin activation of the liver. A lot of these things that are AMPK activators are also sirtuin activators.  So there’s this whole grouping of things that are really good for your metabolism. So you take those when you’re fasted or at least don’t have a lot of carb in you and maybe get some exercise in.  Ben Greenfield says the strongest AMPK activation are HIITs. He says 30 seconds as hard as you possibly can, and then I think he said four minutes of rest and then 30 seconds as hard as you possibly can, and then 30 minutes of rest, but anyway that you stack some use and exercise, lack of carbs and this and the AMPK activators together, you’re going to get a lot out of that.

Morning is naturally more AMPK than night is. We’ve just gone through the fasting, we’ve already got the fasting primed. Like in the skin, it’s more breaking down. It’s doing autophagy in the morning, and at night, you’re sleeping and it’s rebuilding everything. So I like to stack the AMPK activity into the morning and build up at night. So my carbs, those come at night and I intermittent the fast in the morning. Lunch, hopefully it’s salad and some protein and still low carb, but that varies a little bit depending on where I am. There’ll be times where I’m really cleaning up and then times maybe I just had stem cells or exosomes and I’m a little more anabolic, and then you’ll go more in.  I think understanding those two poles of the day, AM and PM are naturally that way a little bit, and then the pendulum of your life, “I’m trying to build a little bit, I’m trying to cut down and clean a little bit,” and I definitely go into times where I’m like, “Uh-oh. This baby is building up a little bit,” and then I really start fasting hard, and it cleans up really quick.

Dr. Weitz:            You just mentioned exosomes and stem cells. Have you gotten into those?

Dr. Shade:           Oh, yeah, yeah. I’ve gone offshore down to Columbia and done cord blood cells twice. I do exosomes every couple of months.

Dr. Weitz:            Which exosomes do you do?

Dr. Shade:           Which? I use Kimera. I mean, there’s not a lot of them out there. Kimera just shifted to doing only cosmetic. That window is closing a little bit in the FDA. So my freezer is filling up with them until there’s something else. There’s a lot of movement in peptides, too. Those are real good regenerative.

Dr. Weitz:            Sinclair was talking about he had some friends apparently who have a machine where they can manufacture their own peptides at their home.

Dr. Shade:           What? That’s crazy.

Dr. Weitz:            I don’t know. Probably very wealthy friends, but-

Dr. Shade:           Yes. Yes, very, very wealthy, “I have my peptide generator machine here. I got it used for $500,000 from Oxford University.”

Dr. Weitz:            So let’s talk about NAD+, which is this signaling molecule that’s present in the body for energy production, cellular energy, DNA repair.

Dr. Shade:           Yeah. So NAD is awesome, and it’s just the multiple levels at which it works are just crazy. There’s so many levels that are even understandable, but at its most basic level, it’s going back and forth between NAD+, the oxidized form, and NADH, the reduced form. It’s doing that by oxidizing your inputs of energy. That would be carbs and lipids. It’s taking the electrons away from them as your carbs make their way off to CO2 and at each little part of the citric acid cycle, all these different breakdowns. It’s NAD+. It’s taking to electrons, becoming NADH, and then it’s going into the electron transport chain, and it’s dropping the electrons into the high energy electron transport chain and leaving the proton there. That’s eventually going to be pumped across the membrane, form that proton gradient, and come back through ATP synthase, and drive ATP formation.  So it’s shuttling energy from the sun, which is what built your carbs and your lipids and bringing it in to make ATP. All right? So if it just did that, it would be a great molecule, but it does so much else.

So then it’s also the co-factor in sirtuins. So sirtuins are deacetylases, and acetyl groups are turning on or off different protein, and there’s the good anti-aging things and to turn them on, you deacetylate them, and then the bad anti-aging things, and to turn them on, you acetylate them. So when the acetyl groups are on, the sirtuin or a lot of the anti-aging things like FOXOs are off and things like P53, which makes more senescence, and why would you even do this stuff? It’s to stop cancer growth.  So a lot of the slowing down and winding down of the body is to make sure that cancer doesn’t take off and get on a run. So the sirtuins are shifting you over this cleaner building through this deacetylase activity. So we think about things like resveratrol and pterostilbene and quercetin and sirtuin activators, but actually, NAD is the initial activator and it fits right into this hole in the sirtuin and activates it.

Then there’s another hole where the sirtuin activating compounds. You’ll see Sinclair call them STACs. They fit into another part in the molecule and hyperactivated, and get it super wound up. So NAD is essential for having these sirtuins go on, and then it’s also essential for gene repair. So as we get older, we’re having assaults on our genes all the time and, say I get exposed to some radiation and it damages a gene. There’s something called a PARP that’s going to go in and try to fix it, and it has to use the energy of NAD to fix.  So it’s sucking anything that damages your genes, sucks a ton of NAD in there. Now, what’s that going to do? It’s going to take the NAD away from the mitochondria so the mitochondria can’t complete the electron transport chain, and you’re lowering energy. It’s going to take things away from sirtuins, so then the sirtuins aren’t going to be deacetylating the good genes, and so it’s sucking all this repair over there.

There’s also CD38. One of the good things that they do is seal up tight junctions when you’re getting leaky gut or leaky blood-brain barrier or leaky liver. So that’s sucking NAD into that activity, too. So there’s this hole, and then there’s some other ones that I don’t to understand as much into how it’s deciding which genes are turned on and off, so this epigenetic regulation of the epigenome, what we can turn on and what we can turn off. It’s basically, do we have NAD despair?  We’re going to turn on the good. Do we not?  We’re going to just hold our own.  We’re going to hold the fort down and make sure we’re at just default functioning.  When we’re in default functioning too long, there’s a lot of theories of cancer emerging from in that default functioning, this explosion or this overgrowth.

So NAD is doing all these things throughout every organ, and you could relate NAD deficiencies to eye disease, liver disease. I mean, you waste out your NAD, fatty liver is the first thing that you get, heart disease, every different organ. So NAD is really, really a powerhouse for driving the whole body and then driving what are the expressions of your genome. Remember, this is the consciousness of the body is deciding. You have multiple pathways, multiple possibilities for your consciousness to choose from in your physiological outcomes. NAD is right in that decision tree of what’s possible and what’s not possible.

Dr. Weitz:            A way to promote NAD is to take one of the precursors like nicotinamide riboside or NMN, and there seems to be two camps and debates as to which one is more effective.

Dr. Shade:           Yeah. Well, that’s just basically because humans like to be on this camp or the other camp. You’re a freaking liberal or you’re a freaking conservative, and you’re demonized either way.  It’s just, “Oh, are you NR or NMN?”  Look, where did all this still come from?  It comes from Sinclair.  Then he’s loathed to hear this, but his advisor, Leonard Guarente and him had a little rift.  So Guarente is all about pterostilbene and NR and has MLM product doing that, and Sinclair is all about resveratrol and NMN and had some shit on that.  So they got this little war like, “Which one is better?”  They’re both good.  Really, you want both of them probably in a product, but you can never get a license to get both of them because there’s intellectual property around it.  So we have a liposome of NMN. I made a liposome for Crominex of NR. It was freaking great, but they didn’t want it. So I can’t do that, and so I just do the NMN, but in the liposome, it’s freaking great. So the camp thing is silly there, but let’s get back to how you build that NAD and where does NAD come from normally? So NAD, nicotinamide adenine dinucleotide.

Dr. Weitz:            Niacin.

Dr. Shade:           Right, right. So this is the high level of B3 and you look at it like the story of the B vitamins. There’s the decrepit, degenerate, benign folic acid. Everybody hates it. It does nothing but lay vape to the universe, and then there’s the glorious 5-methyltetrahydrofolic, and then some of these half losers in between like folinic acid. So it’s the same game. B3 works its way up to the glory of NAD, and right before that you’re NMN, and right before that you’re NR.  So that’s where all this sequences, but as we get all, it’s hard to take the degenerate vitamins and make them into the glory. You’re just not as good of it, but then you think, if NAD runs everything in your body, what are you going to do if you don’t have some food, you’re a hunter gatherer and there’s nothing with niacin in it?  Well, you can make it from the de novo pathway where you make it from tryptophan.  If you can’t eat any tryptophan, you just recycle some of your cells, spit out some tryptophan, and you take it through a bunch of pathways. It just takes longer.  It takes more energy.  The enzymes to get up that last jump, it’s actually the jump up to NMN is that one gets knocked out by inflammation, knocked out by being old.  Anything that makes you sick makes that doesn’t work.  So coming in with NMN and NR are the best ways to instantly get you up to that NAD.

Then what people always miss is the balance with methylation. So NAD, all right, great, it’s going to activate the sirtuin, killer. What’s formed from that? It breaks down and all those high phosphate bonds are broken, energy goes into the system, and you’re left with nicotinamide.  Remember, that’s the non-flushing niacin. Well, nicotinamide blocks sirtuins. So you can’t build up this pool and nicotinamide need to drive it back up into NAD, but if you’re having a hard time doing that, then you’re blocking all your sirtuins.  So you got this circle called the salvage pathway, and it’s going down here and getting stuck.  So what happens then?  You pee it out, but to pee it out, you have to make it into methylnicotinamide. Where do you get the methyl group?  SAM-e?  So SAM-e methylates nicotinamide, you pee it away. You come in with a fresh NMN or NR and you keep driving this cycle, but you’re bringing constant input out and leaving stuff out the back. In doing that, you’re depleting your SAM-e and creating SAH, which creates then homocysteine. So if you keep driving that, you’re going to build up homocysteine and deplete SAM-e. Then what does homocysteine do? That gives you cardiovascular disease and you have lower methylation, and then you’re depressed and you’re inflamed and all this shit. So then you got to stimulate both the methionine cycle, which is going to regenerate methionine from homocystine and that’s interlaced with the folate cycle.  So you want to stimulate MTHFR, which you do with B2, and you want to stimulate the methionine regeneration. So basically, your co-factors you need, you need B2, you need B12, and TMG, and the pauper’s pathway to get there is just lots of TMG.  So if you’re going to drive NR or NMN, you’ve got to support methylation so those two are balanced.

 



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Dr. Weitz:            It’s interesting that you were talking about acetylation, and there’s so much focus on epigenetics as being all about methylation. I wonder if we just haven’t gotten to the research on acetylation and some of these other pathways.

Dr. Shade:           That’s histone acetylation. So there’s methylation and histone acetylation. Those are the two main epigenetic factors, and that’s actually probably how NAD controls so much of the epigenome, but it’s the methylation over time is the thing that is constantly increasing, and that’s the thing that you can do the clock with. They don’t have a clock with histone acetylation, and so they just ignore it, and everything’s about methylation. We all can run to one side and some people are worried, “Oh, my God! If I take too much methylation supplements, I’m going to methylate all my genome.”  In Kara Fitzgerald’s work, she’s a little worried about that, but there’s all this balance, and that’s great. I’m glad that you pointed that out because why aren’t we talking about that side of the whole deal because you look up epigenetics, those are the two fundamental ways that you turn on and turn off different gene sets. It’s important sometimes to shut things off and sometimes to open them up, and you’ve got the balance and you’re allowing both sides and allowing the enzymes to control all that. Then everything’s going to be great.

Dr. Weitz:            So in terms of sirtuins, you just mentioned resveratrol, you mentioned pterostilbene, there’s something called fisetin. What do you think about some of those different ways of stimulating sirtuins?

Dr. Shade:           I think they’re all good as long as you’re feeding in enough NAD. So resveratrol versus pterostilbene, I think they’re fundamentally identical. Pterostilbene has better data going through the gut because it’s got better absorption, but at a cellular level, I don’t think it’s any better. We’re going with nanoemulsions. I don’t really think it matters. We have a product coming out with both of them in it. Till now, we’ve been using mostly resveratrol because pterostilbene was so overpriced, but now it got better so now we’re using both.  Quercetin, I guess fisetin does it, too, but fisetin is also a senolytic. So then we’re going to talk about senolytics as well, but there’s all these things raise sirtuin activity, but if you don’t have enough NAD, here’s where there’s some conflicting data about resveratrol. Resveratrol, they tried to make that into a drug and they ran into phase two trials where some people were getting screwed up by it. Now, they were taking massive doses and trying to drive everything with that. They weren’t even thinking about supporting NAD. So here’s what happens. So I said that-

Dr. Weitz:            By the way, is this where … I remember years ago Sinclair was this guy who his big thing was … We know that caloric restriction seems to have this longevity benefit, but who really wants to live like that, eating 30% or 40% of your calories less than you should, and then the worst tragedy would be live that way like Roy Walford did and suffer, and have this miserable life and then die of ALS in your 70s, anyway, but I remember-

Dr. Shade:           So we’re trying to get to … All right. So he’s like, “Well, then we’re just going to pump the resveratrol in,” because, yeah, like Valter Longo, he points to these people who lived to 105, 110 in the mountains and they’re 4’5″, they’ve never smoked a pack of cigarettes, they had sex once in their life for procreation, and they don’t drink, and they eat a thimble full of food every day. He’s like, “Well, that’s not how I want to live.” So yeah, this is the grail. How do we get all this, right?

Dr. Weitz:            Right.

Dr. Shade:           True to anybody out of academia, let’s do a one hit wonder and cut to the chase. It’s going to take a couple of things all in balance. So he tried to just run it on resveratrol in the beginning, and then they had some studies that were like, “Ah, I don’t think this is working.”  Here’s what happens. If you don’t have enough … Remember I said the sirtuin that get activated has a place for NAD, which is the primary space, it’s necessary, and then it has a secondary space for a sirtuin-activating compound. Well, it turns out if you just jam in tons of sirtuin-activating compounds, it almost sucks the NAD in like a magnet. What does it do? It takes it away from the mitochondria. So then the mitochondria start misfiring. So you have all these sirtuins activating and you have mitochondrial dysfunction.  You can’t drive it with one. If you want to drive the sirtuin-activating compounds, you need to supply enough substrate to have NAD balancing it. Then if you’re going to do that, you need enough methylation factors to balance that, but that’s not that complex of an equation, but if you try to just press one of the damn buttons, it doesn’t work so well.

Dr. Weitz:            Right. Yeah. I think to this day Sinclair takes a gram of resveratrol a day.

Dr. Shade:           Yeah. Yeah, he does, and he takes a gram of NMN, and he probably takes some maltenes. So he’s got it all held up there, but in the beginning, they tried to do it just with the resveratrol. Notice, that was where all his work started. The last couple of years, he’s been all NAD. So he must have been like, “Yeah. What am I missing here?” and then he got all into NAD.

Dr. Weitz:            Yeah. I remember there was a point at which he was the guy who was going to solve this longevity problem, and then there was a point at which it’s like, “Yeah. That’s it. That didn’t work. Forget it.”

Dr. Shade:           Yeah, but don’t throw the baby out with the bath water, just what did we have to balance with that. I had this great paper I found that was biochemical archeology. They were talking about the balance between NAD and methylation, and they were talking about these different societies that grew up and which ones thrived and how the balance of methylation and NAD gave them this power. They were describing if you’re low NAD to begin with, you’re not going to get anywhere, but if you’re high enough NAD to get somewhere, then later in life, if you’re imbalance one way or the other, you get Parkinson’s either way, but there are different Parkinson’s. So there’s the high NAD low methylation Parkinson’s and the high methylation low NAD Parkinson’s, and then there’s the balance. When you balance the two, you raise the whole human potential up. I mean, that’s beautiful.

Dr. Weitz:            That’s beautiful.

Dr. Shade:           The language, spreading fields of proteinopathies, which are uncoupling electron flow from proton flow and spreading fields of proteinopathies leading to the metabolic diseases and degenerative diseases of cancer and neurodegenerative problems. Yeah, exactly. Balance that thing, raise them both up, and just hit hard.

Dr. Weitz:            Let’s talk about senolytics and senescent cells, they’re called zombie cells because they don’t function the way they’re supposed to.

Dr. Shade:           Yeah. So the senescent cell, now, it’s a mitochondrial dysfunction or a toxic insult that causes telomere attrition, that then progresses to mitochondrial dysfunction, and then the mitochondria start releasing these pro-inflammatory mediators that diffuse out through the cell. The cell stops, it goes into growth cycle arrest, stops reproducing, and it just sits there, and it releases pro-inflammatory mediators, which are spreading decaying inflammatory fields throughout the body, but they’re also recruiting other cells into this decaying inflammatory field.  That’s one of the major causes of the propagation of all that inflammation that shrivels us up and makes us old and decrepit. So the idea is to get rid of these cells. So there’s two ways. You can reverse them and put them back into growth again and have them repair their mitochondria, and that’s if they haven’t gotten too deep in, and that’s by having good Nrf2 and AMPK activity that restores the milieu inside the cell, restores the redox potential down to highly reduced, and it can come back on and reboot.

The other is to kill it, and that senolytics, senescent cell. Lysis is cutter. So senolytics, quercetin was the archetypal senolytic. Fisetin or fisetin came on as a really good one as well, but even things like resveratrol and pterostilbene and curcumin have some of this senolytic activity.  Now, measuring this is really a bit of a challenge. This is because when you come in with this, well, first, you’re measuring some of the cytokines, the inflammatory molecules that are coming out of these cells, but if you go in and cut a bunch open and kill them, there’s a burst of senolytic cytokines that come into the system. So the senescent marker actually goes way up when you’re addressing the whole thing, and then how long does it to take to come down?  So in our three-month trial, it went up and we were using tons of senolytics. It was quercetin and everything that we gave them, but we got the good shift in the genes. We just have to come up with more markers around that, but some of the trials that have been used with really high end design senolytics have really been able to reverse phenotypic aging in a lot of animals and in humans. So that’s a really exciting thing.  There’s a really cool question in there. Why the hell would you ever do that? Why would your cell ever do that? Well, one thing is for cancer surveillance. “Oh, my God! I don’t want to grow like mad with cancer. I’m just going to shut down the cell.” All right? So P53s do that, but then they don’t know how to get it out of there.

So then there’s acute versus chronic. Acute senescence say, “Boom! Ow! I just hit the edge of that desk there. I just broke a bunch of tissue in there.” All right? So now, there’s a bunch of cells in there that are going to go into senescence, and they’re going to sing the song of senescence really loudly all in concert. So it’s not just whispers of senescence. It’s like … and the immune system is going to hear the signal. It’s going to come in. It’s going to eat them.  So you can grow new tissue there. So that’s a programmed senescence to rebuild damage tissue, but when they’re spread all over the place, it’s just whispers, and the sound of inflammation may be loud, but the immune system can’t pinpoint where it came from and so it’s not going to clean up the mess. So that’s just one of the side effects of aging. So now we know that we can go in and clean out some of those cells and stop that inflammaging signal.

Dr. Weitz:            I guess there’s another compound now called spermidine that’s getting some play.

Dr. Shade:           Yeah. Spermidine, isolated from sperm. Hence, the name spermidine. You’re like, “Well, they must have got it from sperm whales. No, they got it from sperm, semen, and there’s a lot of spermidine in semen, and it’s-

Dr. Weitz:            Apparently, they can get it from wheat germ and all these other vegetable products, too.

Dr. Shade:           Well, that’s where they first got it. I mean, they’re not like lining guys up and-

Dr. Weitz:            Right. That’s where the name came from. Yeah.

Dr. Shade:           That’s where the name came from. Dr. Ruth Westheimer, remember, the sexologist, she said, “Oh, there’s so much good for things for you in sperm,” little Austrian voice, but apparently, she had the goods on spermidine.

Dr. Weitz:            It’s not as good for marketing, though.

Dr. Shade:           No, no. Every time I’m about to put in a product I’m like, “God, I’m going to have to listen to all this shit about this,” and it costs some fortune, but spermidine is really good for working on autophagy and mitophagy and senolytic activity. So I’m sifting through all the exact uses of that, but that’s looking like that’s going to be a really promising one.

Dr. Weitz:            Now, what about dosage? You read these studies and they say you have to have 250 milligrams of resveratrol, and your products, because they’re liposomal, have a lower dosage of a lot of these products. How do we know that’s the right dosage?

Dr. Shade:           Yeah. Our quercetin has a 25-fold increase in absorption. “Oh, there’s 20 milligrams of quercetin.” I’m like, “Yeah, multiply that by 25. That’s a lot of question.” The beauty of it is it goes right into the blood, and the levels in the blood, even at the 20 milligram level, you’re going to beat out 500 milligrams because it all goes in at once. It gets the peak dose in there. You think of a senolytic, it’s almost like chemotherapeutic. You need to peak dose to activate that, Nrf2, AMPK. Peak doses activate that. So it’s a beautiful way to do it.  Now, exactly what the right dose is? Even though, “Oh, you need 250 milligrams. This study …” we’re still really working that out. I know that the dosage schedule that we laid out in our Bio-Age Reversal works because I was able to shift the whole genome plaque back. So I know that’s working, I know that I saw the markers of senolytic activity go up that I was breaking down these cells, but it’s going to be a few more years of really getting the right assays, working out, what we really want to see to know exactly what it is, but I have people go on these little campaigns, “We’re going to detox for a while and maybe we’re taking 40 milligrams a day, 50 milligrams a day, I’m stacking a couple of things together,” and there you’re actually getting maybe a few hundred milligrams a day in these nano forms.  I know that we’re triggering it. I know we shift fatty liver. I know we’re upregulating Nrf2. I know we’re shifting the genome. So I know that these dosages are working, but will we get to more specific dosages, more clarity to them? Yeah, we definitely will, but I also did do sirtuin upregulation tests on people using peripheral blood mononuclear cells. So the white blood cells are the only blood cells that are really cells. Red blood cells, they don’t have a nucleus, they don’t have mitochondria. They’re not cells. They’re just oxygen transport. So you do it in whites.

This is really nice. We saw on a single dose of it was basically our AMPK charge, but it was a little bit different. It’s a product we’re going to come out soon. Single dose, over about two, three hours, the sirtuins upregulated about three, fourfold and they lasted 24 hours. So it was really nice because I like people to do these things in spurts and then take a couple day off, go a couple days, take a few days off because you’re stimulating the system, let it come back down, stimulate it, let it come back down.  So the way that we’re using these and we’re dosing them, we see the signals, we see the changes. We know we’re working well on them, but I want to get to a point where I’m like, “This dose for that, that dose for that, that dose for that.”

Dr. Weitz:            I also have a request. Is there a way that you could put your products in a capsule form as well as an alternative to some of the liquids?

Dr. Shade:           Yeah, and we did start doing that. They’re called SED systems, self-emulsifying delivery systems. So our CDDPN is that way. Micromanager, which is more for controlling microbial growth, but we are doing one that’s a sirtuin activator in a capsule and there’s more that capsule activity to come. In fact, maybe as we work out some of the senescent stuff, maybe we’ll do a senolytic in there as well.

Dr. Weitz:            Yeah, that would be great because some people prefer the liquids. Other people, they don’t like to taste and you have to go to the fridge all the time. So they don’t travel as well and stuff.

Dr. Shade:           Yeah. Yeah. So we are doing that.

Dr. Weitz:            Cool. Excellent. So any final thoughts and-

Dr. Shade:           No, we did good. We covered a lot of stuff.

Dr. Weitz:            Yes, we did.

Dr. Shade:           The only other thing we didn’t really talk about is membrane health, and the membranes are … We’re talking about phosphatidylcholine bilayers that are housing the cell, ones that are making up the mitochondria, ones that are making up the endoplasmic reticulum. Everybody loves the mitochondria, but the endoplasmic reticulum is this big, huge folded over just layer and layer and layer and layer and layer of membrane that are creating what I call the membrane potential, which is a power potential across, it’s a charge potential across a membrane that actually drives the number of the reactions or the little motors like ATP synthase that are in the membranes.

Then the membranous organelles all communicate one to another, and the quarterback of that is the endoplasmic reticulum, and they actually exchange signals and discuss between the mitochondria, the golgi apparatus, the endoplasmic curriculum with signals coming from the extracellular environment through the cellular membrane, all that decision making going into the nucleus and signaling which genes to be manifest within the nucleus depending on the availability of inputs and the extracellular compartments and the health of the intracellular compartments.

So it’s a really beautiful communication structure and building membranes with phospholipids like phosphatidylcholine is one of the best ways to build the health of the membranes, and that was my one fun thing when I went on to a retreat with Joe Mercola, Ben Greenfield, Robert Slovak, Emily Givler, Bob Miller, and a couple other people. Joe brought his bioimpedance meter that was for measuring membrane health and he measured everybody there. Then I was the last one to get there, and Emily was like, “Chris is going to win.”  Joe’s like, “Why?”  She’s like, “Membranes. PC. He’s the PC guy.”  Of course, I beat everybody and I had these great numbers there because everything that I take has phosphatidylcholine, and you can buy it directly. You can buy our Pure PC or our Membrane Mend or various ways to get PC, but building the membrane is the one thing, and that was in Europe. That was the first mitochondrial therapy was lipid replacement therapy. There was those old injectables, Lipostabil and capsules of PC.  So the membrane is a big modulator of the power of the system. So we’ve been talking about cleaning up, burning cleanly, powering up the system, the NAD, the sirtuins, getting rid of the senescent cells, and just having a high powered system and the transducer of the power or the capacitor of the power being the membrane.

Dr. Weitz:            So the main ways to stimulate the membrane is with phosphatidylcholine, fish oil. What else?

Dr. Shade:           Yeah, those good fats there. Those are the core, but where else can you get PC? So you can get it from lecithin, but don’t get cheap soy lecithin, even cheap sunflower lecithin. Go for the professional grades. We have it down into a nano form in the Pure PC and the astaxanthin, and then these really good carotenoids for protecting the membranes, and that would be like astaxanthins, zeaxanthin, lycopene, tocotrienol. Those are super good, and then other natural source. When I first started into this and it was watching a lot of Dietrich Klinghardt, egg yolk, organic egg yolks. Six of those give you a massive PC dose.

Dr. Weitz:            Interesting. There’s some cardiovascular literature to say that choline can raise your TMAO levels and that can be problematic depending upon your microbiome.

Dr. Shade:           Yeah. It’s all backward. Your microbiome turns choline into TMAO, but the TMAO isn’t actually what’s causing the cardiovascular disease. What gives you the biggest spike of TMAO of any food in our biosphere? Do you know?

Dr. Weitz:            Salmon.

Dr. Shade:           Yeah, fish. Fish are all at the top, and those are the heart healthy ones. So the thing is the heavy meat eaters get a microbiome that makes TMAO, but they make a whole lot of other things. That firmicutes/bacteroidetes blend goes in the wrong direction when you’re not eating enough plant matter, and there’s all these other things that happen that move towards the inflammation of the cardiovascular disease. TMAO is just a side player in that. I don’t believe it’s driving it at all. In fact, after that paper came out, there was a bunch of Swedes, I think, wrote a big response to it called Something Fishy About TMAO.

Dr. Weitz:            Right. Yeah. It’s never made any sense to me, but it is out there supporting membranes, and then you also talk about the importance of the hypothalamic pituitary adrenal access.

Dr. Shade:           Yeah. That’s coordinating mitochondrial health. That’s coordinating all of your hormone health. Yeah, we can do hormone replacement, but adaptogens are probably the best way to just make sure that all of that is working really well, whether you’re taking exogenous hormones or not. One of the things that’s cool about ginseng is it raises the receptor density for androgens and estrogens. So as we get old, our androgens and estrogens are going down, but if our hormone density goes up or our hormone receptor density goes up, the activity, the androgenicity is a interaction between the hormone level and the receptor density.  So if you double your receptor density, you double the reactivity to a given level of hormones, and that’s one of the beauties of the adaptogens. In fact, the adaptogens, all the good ones, the astragalosides, the ginsenosides, withanolides, which are from ashwagandha, gypenosides from gynostemma, all of them have the same steroid backbone of your hormones. So they’re obviously meant to be interacting with your hormone system and affecting receptor sites, and that’s why they work so good on that.

Dr. Weitz:            Yeah. I wanted to mention the Astragalus situation because I know there’s that TA-65 supplement out there, which is this, I guess, specialized form of Astragalus, but can we get that from other forms of Astragalus?

Dr. Shade:           So there’s is cycloastragenol. Now, that’s what’s come out. There was a freedom of information act request to get the formula there, and it was cycloastragenol. Now, there may be some synergistic factor in there, but cycloastragenol is the core. So in our Longevity Elite, we have all these ginsenosides, and we have special astragalosides. We have cycloastragenol and astragaloside 4. Astragaloside 4 upregulates klotho, which is a regenerative molecule you make in kidneys and brain.  The cycloastragenol works for telomeres activation to lengthen telomeres, but one of the things … Dr. Raffaele has been working with TA-65 a lot, and he thinks that … See, cyclo is also a killer senolytic, and he thinks that a lot of the senolytic activity is responsible for the regenerative capacity of TA and the astragaloside. So now, they used to have the market cornered. Now, there’s other ways to find cycloastragenol and astragaloside 4, but whether it’s working at a telomere level, a senolytic level or both seems to be good. That seems to be good is freaking great.

Dr. Weitz:            It’s interesting how hormones started out to be one of the first places a lot of doctors and researchers went for longevity because they send signals to the body that things are good, that things are strong to build, to get stronger. We know people get older, they get weaker, they can’t function, and now it seems like all we’re hearing is that anything that tells the body that things are okay is not good for longevity and all these pathways that tell the body that we’re lacking, that we don’t have enough is where we need to go, but somehow, I think there’s got to be a balance.

Dr. Shade:           Yeah. It’s a balance of the two. There is no doubt at all that hormones are increasing your health span, if not, your total longevity. I mean, that’s just to say that they will wipe the slate clean. Most of these things that helping longevity are hermetic, and there are little stressors and you respond and clean it. You can overlay those on top of the hormone signals, and they’re not going to cancel each other out. Doing both is where you want to go.

Dr. Weitz:            Let’s consider that Fahy, which we mentioned, publishes the first study to improve biological aging, and he used DHEA and growth hormone in his-

Dr. Shade:           Oh, yeah. No, absolutely. Growth hormone is absolutely correlated with decay. There’s so many guys who do test in growth hormone and it’s like, “God! I feel freaking great,” and that is regenerative. So these other things are cleaning up. So you come in, you have a little Nrf2 activity, and you have some AMPK activity, some sirtuin. That’s taking out the trash, but the power is coming through the HP everything system.

Dr. Weitz:            Great. Another awesome discussion, Chris.

Dr. Shade:           Yeah. It’s been a great one.

Dr. Weitz:            Yeah. Yeah. I’ve really enjoyed this. I think we hit a lot of interesting science.

Dr. Shade:           Yep. All right.

Dr. Weitz:            Okay. Well, thank you, and I’ll talk to you soon.

Dr. Shade:           Thank you. Take care, Ben.

 



 

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness podcast, and if you enjoyed this podcast, please go to Apple 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. 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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Breast Implant Illness with Danielle Valoras: Rational Wellness Podcast 254

Danielle Valoras discusses Breast Implant 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

1:40  Brief history of Silicon Gel Implants (from the FDA website). 

  • Silicone breast implants were introduced in the US in 1962.
  • In 1976 the US Congress passed the Medical Device Amendments to the Federal Food, Drug, and Cosmetics Act.
  • In the early 1980s concerns arose about the safety of breast implants, esp. silicone gel implants and the FDA published case reports identifying frequent local complications and adverse outcomes and they identified possible cancer and connective tissue disease in some women with breast implants.
  • In 1992 the FDA removed all silicone gel-filled breast implants from the market due to safety concerns.
  • In 1999, the Institute of Medicine released a report that concluded that while there were lots of local complications and health concerns related to silicone breast implants, like rupture, pain, capsular contraction, and infection, that there was no evidence of systemic health effects such as cancer or autoimmune disease.
  • In 2006 the FDA approved silicone breast implants, specifically Allergans and Mentors based on 3-4 year safety reports from the manufacturers, but the FDA also required the manufacturers to conduct 6 post-approval studies for a loner period of time.
  • In October 2021 the FDA ordered stronger warnings for breast implants, including a boxed warning in which the risks are reported on the package.  Some of the risks that the FDA highlighted in the report include capsular contracture, implant rupture, and possible silicone gel migration into surrounding tissues, systemic breast implant illness with symptoms that may include fatigue, memory loss, rash, brain fog, and joint pain, and breast implant-associated anaplastic large cell lymphoma, abbreviated BIA ALCL.

8:21  Danielle’s personal story is that at age 48 she looked at the research and she chose to get silicone breast implants.  Danielle already had an autoimmune disease–Grave’s hyperthyroid and anyone with autoimmune disease should be careful with implantable devices like breast implants. After the implants, Danielle had hair loss, connective tissue issues, she tore both menisci in both of her knees and she had swelling in her ankles.  Her symptoms kept getting worse.  She had both breast implants removed, including the capsules and she got about 70% better right away.  Removing the capsule can be very difficult because the plants are under the pec muscles and the capsule is up against the back wall of the rib cage and scraping them off the back wall risks puncturing the lungs and causing a pneumothorax.  But Danielle feels that it is very important to remove the capsule as well as the rest of the implant, esp. since the capsule also contains silicone.  Both the silicone and the platinum that is used in the implant are quite dangerous.  Danielle discovered that she had very high arsenic levels and her arsenic levels came down after the implants were removed.

14:25  The capsule is the catcher’s mitt.  It is the scar tissue that forms around the silicone breast implant. Not only is silicone potentially toxic to the body, but there is also platinum used to make the silicone more gel like and to hold it’s shape and be more solid.  We know that the silicone and the palatium can get through the capsule and into the body.  The outer shell of the implant and even the outer shell of saline implants is made of silicone, so silicone comes into contact with the body.

18:37  Some of the silicone doesn’t crosslink and some it comes off the shell and into our bodies and it disrupts our methylation system, our hormones, and causes an inflammation cascade. It can reduce your ability to detoxify.

20:23  Breast implants eventually will leak silicone and those who have implants are told that they will eventually need to be replaced.  But it is the shell that sheds and biodegrades and leaks into the body. Dr. Edward Fleury from Brazil is a radiologist who has studied silicone induced granulomas that can form within the breast implant capsule. This leads to either a B or T cell response and this can lead to autoimmune disease and it can eventually lead to cancer. The T cell response can result in BIA-ALCL, which is Breast Implant Associated Anaplastic Large Cell Lymphoma.

 

 



Danielle Valoras is a Certified Physician Assistant and the Founder and clinician of NavWell Rx, PLLC, an integrative health practice.  Danielle is the originator of the Breast Implant Health Summit and she brings over 20 years of experience in medical research and education to her clients. She specializes in Psycho-Neuro-Endocrine-Immunology, a burgeoning field that investigates the link between the nervous system, the endocrine system, and the immune system in relation to physical health. Danielle’s practice integrates western medicine, functional medicine, trauma response and clinical bodywork therapies. She treats autoimmune issues, CFS/ME, and implantable device-related illnesses such as Breast Implant Illness (BII).  

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



 

Podcast Transcript

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

Hello, Rational Wellness podcasters. I’m very excited to be talking about a new topic for Rational Wellness, which is breast implant illness. Now, for those of us like me, who are not really familiar with this topic, I decided to look a little bit into the history of breast implant illness. Does it even exist, and what do we know about it? So I decided to take a very conservative route. So pretty much everything I’m going to say now is coming from the FDA.

Now, to be objective, a lot of people feel that the FDA is a bit too chummy with the medical device industry given the fact that a number of members of the FDA have come from this industry and big pharma and have gone back to work in industry after being at the FDA. So just so you know that everything I’m saying now is coming directly from the FDA. So none of this should not be considered as controversial.

So silicone gel breast implants were first introduced in the United States in 1962. In 1976, the US Congress passed the 1976 medical device amendments to the Federal Food, Drug, and Cosmetics Act. Breast implants were considered moderate risk class two. Then in the early 1980s, concerns arose about the safety of breast implants, especially silicone gel implants, and the FDA identified frequent local complications and adverse outcomes and published case reports identifying possible cancer and connective tissue disease in some women with breast implants.  At that point, the FDA reclassified breast implants into class three high risk products needing pre-market approval and called the manufacturers to provide data demonstrating safety.  In 1992, the FDA removed all silicone gel-filled breast implants from the market due to safety concerns. In 1999, the Institute of Medicine released a report that concluded that while there were lots of local complications and health concerns related to silicone breast implants like rupture, pain, capsular contraction, infection, that there was no evidence of systemic health effects such as cancer or autoimmune disease.

So in 2006, the FDA approved silicone breast implant, specifically Allergans and Mentors based on three to four-year safety reports from the manufacturers, but the FDA also required the manufacturers to conduct six post-approval studies, which would take a longer period of time. In other words, the breast implants are approved, but because there’s a risk, they want the manufacturers to conduct these post-approval longer term studies for safety.  Recently, last October of 2021, the FDA ordered stronger warnings for breast implants, including a boxed warning in which the risks were listed on the packaging. Of course, how many women actually see the packaging on their breast implants? Some of the risks that the FDA highlighted in the report include capsular contracture, implant rupture, and possible silicone gel migration into surrounding tissues, systemic breast implant illness with symptoms that may include fatigue, memory loss, rash, brain fog, and joint pain, and breast implant-associated anaplastic large cell lymphoma, abbreviated BIA ALCL.

Interesting, we have the FDA at one point in time saying there’s absolutely no risk of cancer, and now we have a cancer that’s absolutely tied with breast implants. So it just goes to show you how science changes and evolves with changing evidence. So anybody who comes on TV who says, “This is what the science is. This is what the truth is,” needs to be humble and realize that’s based on what evidence is currently available and that evidence could change.

Danielle Valoras is with us today, and she’s a certified physician assistant, and the founder of NavWell Rx PLLC, an integrative health practice. Danielle is the originator of the Breast Implant Health Summit, and she brings over 20 years of experience in medical research and education to her clients. She specializes in psychoneuroendocrine immunology, which is a burgeoning field that investigates the link between the nervous system, the endocrine system, and immune system in relation to physical health, and since we talk a lot about gut health and we talk about the gut-brain-immune connection, this is actually not something that’s unusual for our listeners.  Danielle’s practice integrates Western medicine, functional medicine, trauma response, and clinical body work therapies. She treats autoimmune diseases, chronic fatigue, and implantable device-related illness such as breast implant illness.  Danielle, thank you so much for joining us today.

Danielle:              Thank you, Dr. Weitz. It’s a pleasure to join you, and I’ve listened to you for so long that I feel like my education came from here. So I appreciate you very much.

Dr. Weitz:            Okay. Well, I thank you for that. So we were talking off air a little bit and you said you’re working with the FDA. Can you tell us a little bit about that? Maybe can you comment about the introduction I just gave because you are much more of an expert at this than I am?

Danielle:              Yeah. I would say I am in communication with the FDA versus working with them.

Dr. Weitz:            Oh, okay.

Danielle:              Just for clarity.

Dr. Weitz:            Helping to supply them with some information.

Danielle:              Yeah, and hoping to move the dial further with different not disciplinary actions, but the black box warning or fully informed consenting and that type of partnership. There’s not just me, but a group of women behind this movement. As you can see, since actually 2018-2019, we’ve actually made some pretty significant strides, and we hope to have more in the next three to five years as well.  My background as a PA since ’99 is one thing, but I’ve also worked in the medical device industry as a field clinical engineer for class three medical devices. So my world merged and I look at the clinical study and the clinical evidence that we don’t really have for the breast implants, and it just pushes me forward to do more.

Dr. Weitz:            So perhaps you can tell us about your personal story related to breast implants.

Danielle:              Yeah. My personal story is I was 48. I lost 40 pounds. I was in the best shape of my life, and I saw myself in the mirror and I thought, “If there’s ever a time to get breast implants, now would be the time,” and so I did. I mean, I did some research. I looked at the FDA approval. There were no warnings. I looked at the 2006 SSED, which is the Summary of Safety and Effectiveness Data that goes along with it. This was part of what I had done for my full-time day job as a class three field clinical engineer for cardiology. So I thought I had it all together.  Then I chose a physician, a plastic surgeon to put them in. I put them in and literally, for me, it was like three to four months later, things just started to happen, and it correlated with the time I was studying functional medicine, and timeline and history is everything, and it pretty much-

Dr. Weitz:            By the way, did you get to see the label on a box?

Danielle:              No. That was before the label existed, but what did exist, so I have a thyroid disorder called Grave’s disease that’s been treated. So anyone with … Say?

Dr. Weitz:            Hyperthyroid.

Danielle:              Yes. So anyone with an autoimmune condition should be very careful with implantable devices, especially breast implants or even asthma, right? That’s in the labeling in very small italicized print on the manufacturer’s website, but you don’t know which implant you’re going to receive. It may be one company over another.  So that was never brought up in my informed consent. In theory, I should never have been implanted because of the autoimmune issue that I had, and I was.  Looking back, from hair loss to connective tissue issues, I tore both meniscus in each knee and swelling and the ankles.  I should send you pictures so you can see, and the hair loss, and the fatigue, and the acne.  It looked like autoimmune issues, but my antibodies at the time actually were normal, at least the ones we were measuring for.

Dr. Weitz:            Now, when you say you shouldn’t have had the implants because of autoimmune disease, does the FDA currently recognize that breast implants may cause autoimmune disease or exacerbate autoimmune disease?

Danielle:              I would say that they say autoimmune disease or history of is a risk factor, and breast implants should not be placed in that population.

Dr. Weitz:            Okay. So they’re recognizing that there’s a relationship with autoimmune disease.

Danielle:              Yeah. A correlation might be a more politically correct word. Well, I mean, I don’t want to necessarily speak for the FDA, but there is and they made the manufacturers list that on their websites as well. Actually, relatively recently, they now have to go through a pretty decent informed consent for everyone who will get breast implants, and if they fail to do so, then it’s against regulation and, hopefully, folks would be held accountable for that, but yeah. That’s a mouthful.

Dr. Weitz:            So can you comment about why breast implants were taken off the market and then approved? Oh, wait. Go ahead and finish your story. Yeah, yeah. Are you finished with your story?

Danielle:              Basically. So at the end of the day, my symptoms just kept getting more and worse, and we thought it was physical, the weight of the implants, the brachial plexus right here, the lymphatic system, all of the above, and then I removed them, removed the capsule as well, and I’d say I got about 70% better right away in that was-

Dr. Weitz:            Is that a significant factor removing the capsule? Is that not always done?

Danielle:              It is not always done. In my experience, self-experience as well as with clients, when they remove all the capsule, there’s a greater or a less inflammatory response, especially if there’s silicone in the capsule.

Dr. Weitz:            Why would they not remove the whole thing? Why would they not remove the capsule?

Danielle:              Well, if you think about it, and I wish I had a model, for under the muscle, you’ve got the ribcage like this and you’ve got the pec minor, and then you’ve got pec major here. So they’ll cut the pec major to make place for this implant, whatever size it is. Usually, that pec major has to be cut, and that sits right on your ribcage. So you’ve got ribs, intercostal space, ribs, ribs, intercostal space, and what’s right behind there are the lungs or maybe even pericardium, depending on which way they are displaced near the sternum.  So to scrape that off the back wall risks a pneumothorax, risks puncture, and it could be dangerous, especially if the plastic surgeon is not versed into getting the capsule off, right? There are plenty of experienced explanters out there that can do the whole thing.

I know we’re digressing a little bit, but this brings up a great opportunity to talk about the capsule, which is the scar tissue, which is the catcher’s mitt for whatever is in the device, in this case, a breast implant or whatever’s in the shell and whatever comes out of that from off gassing to silicone, to platinum, to whatever’s in that catcher’s mitt. That catcher’s mitt gets formed, and sometimes we don’t make a very good catcher’s mitt. There’s that theory, and then sometimes we make what they call a baker stage four, which is very, very thick and a robust catcher’s mitt, right?  So there’s so much in that surgery to remove it, and sometimes it can actually get up to the brachial plexus and way up to the collar bone. So there’s some delicacy in there, but that tissue being the catcher’s mitt, to remove that I feel is imperative because it is the catcher’s mitt.  Right now, all I know to do is focus on silicone, silicone and platinum, because I know that it can get through the capsule into the body. There’s enough literature on that to support that, but there are beliefs that maybe that’s not advantageous to remove for the person, but I do think that it’s important, and that’ll be an arm wrestle for the next three to five years.

Dr. Weitz:            Is it better not to have the implant under the muscle? Can it be over the muscle?

Danielle:              It can be over the muscle, and the capsule that forms is still a catcher’s mitt, and you’re still you’re still right here in a very innervated and lymphatic-rich area that you still have the consequences, but you don’t have the cut pec major, right?

 



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:            I heard you say in another interview that you ended up having very high arsenic levels and somehow this catcher’s mitt capsule affects why you had these high arsenic levels.

Danielle:              No. This is just a theory of mine. The implant definitely has metals, right? I mean, it’s listed, but the-

Dr. Weitz:            Right. Platinum is very common, right? Platinum is used in the-

Danielle:              In the crosslinking. Oh, yeah.

Dr. Weitz:            Why is platinum put in?

Danielle:              Because it makes the silicone more solid. It makes it more gel-like. It makes the shell, right? Oh, there’s so much to say. So there’s-

Dr. Weitz:            Right. It’s like making your paint, put the lead in the paint to give it real good textures.

Danielle:              Yeah. Yeah. Oh, I didn’t even go there, but absolutely. So you do this and some of the silicone doesn’t crosslink and you never have a perfect crosslink. So maybe instead of this, I feel like I’m doing an example of leaky gut right now, but instead of this, you actually get something like this, right? Then what comes off the shell is silicone, and plus or minus platinum, right?  So for me, I think the implants cause is our methylation system to disrupt, and I think that’s why I had high arsenic because as soon as it was removed, my arsenics went down. My arsenic level went down, right? Within two weeks, it was normal, but before, it was quite high. So I-

Dr. Weitz:            So your body’s detoxification capabilities to remove the normal amount of arsenic that unfortunately is contained in our food wasn’t filtered out.

Danielle:              That’s my belief. It just happened so fast that if it was something that was stuck in my system, it would’ve been deposited, and it was the fastest chelation if it was just from the breast implants, I think, but I do think it’s an endocrine disruptor, a methylation disruptor, and an inflammation cascade, right?  So depending, and I don’t even know that it depends on your genetics. I mean, it does. There’s some risk factors there, but I think that this is enough of a toxic load, especially over time for some that it will cause expression of the different genetics that we have.

Dr. Weitz:            We know that the silicone is eventually going to leak, right? Isn’t it the case that virtually every woman, if they have the breast implants for a long enough period of time, they’re going to have leakage, right?

Danielle:              Well, if I can, let’s back up just a minute because the shell is silicone of saline implants, of silicone implants.

Dr. Weitz:            Okay. So if you don’t get the shell out, you automatically have silicone that’s coming into contact with your other tissues.

Danielle:              Well, the shell of the implant and then the capsule, for sure. So every implant out there is made of silicone and people think, “Oh, I have saline.” It’s made of silicone, the outer lane.

Dr. Weitz:            So you’re saying the saline breast implants have a silicone on the outside.

Danielle:              Yes, a silicone-platinum crosslinking to hold everything together and in.

Dr. Weitz:            Oh, wow!

Danielle:              We’re finding evidence that it’s the shell that sheds. It’s the shell that biodegrades. It’s the shell that is the initial insult.

Dr. Weitz:            Okay. So even forgetting about leakage of the silicone gel, the shell is shedding silicone into your body.

Danielle:              Yes, and there’s something that Dr. Eduardo Fleury from São Paulo, Brazil, he’s a radiologist, MD, PhD, and he studies silicone-induced granulomas within the breast implant capsule. So whether it’s saline or silicone, you can see the silicone granuloma. So look up his research. It’s really wonderful.

Dr. Weitz:            What is a silicone granuloma?

Danielle:              It is basically silicone that’s gotten out of the shell of the implant and your body’s responding to it and your body is wonderful, right? So it attacks it, and-

Dr. Weitz:            The immune system response.

Danielle:              Yes, and I think specifically for most, it’s a T cell response. There are some B cell response to the breast implant that causes a different type of cancer, but T cell is BII, which is breast implant illness, and T cell response is BIA-ALCL, which is the lymphoma caused specifically by the breast implant. So it’s a granuloma, the immune responses. The immune makes a response and there’s attack to it. Then you’re dealing with this inflammatory cascade from the get-go.  Now, you have a catcher’s mitt, which is the capsule that your body formed around it, which three to four months, you should have some scar tissue in place, but also, when you have that inflammation, biofilm forms, and that changes your normal flora, and there’s a whole other podcast we can do on that, but it causes a cascade that the body has to handle, and can your body handle that inflammatory response? Does it have enough?  Chronically over time, toxicity in my world breeds deficiency, and sure, we can replace the deficiency or we can try, but it’s always going to be a load. It’s always going to be a load. If that was our only load other than glyphosate, other than all the leaky gut and the different things, maybe we would be able to handle it better, but-

Dr. Weitz:            Do we have a good test for silicone?

Danielle:              We do not. The best test is an MRI. It’s a breast MRI with or without contrast. I would say with contrast gives you the higher yield to see if you have that silicone-induced granuloma. It’s not quite for silicone, but we have blood tests that you can look for silicone, but the molecules in which they’re testing for isn’t necessarily the breast implant.  Now, if you have a frank rupture, maybe this would capture that. We do have silicone sensitivity tests that we can do, but in my patient population, I’ve never seen anyone positive with the sensitivities for silicone. For other things that are in the breast implants like when you do the environmental toxins and stuff, you can see those all high, but silicone never registers for these people, and they are very sick.

Dr. Weitz:            What about urine? Same?

Danielle:              Same, same, right. You can test. We see people doing a lot of heavy metal testing. Those will be disrupted because I think of the methylation more than what is in. What is in the implants causes this cascade of disruption. I don’t know that what you’re measuring is because of the breast implant like mercury is for fillings. So there are tests that I use to help get methylation in the Krebs cycle, really, in the mitochondria are more robust and that’s an organic acid test for me. I tend to use Great Plains because they show the oxalates. Vibrant Health also shows oxalates.  What I find actually is that we are more deficient, significantly deficient in B6 and B1, and adding those over the folate and the B12, move the dial more better, different while you are opening up the drainage pathways. That’s key. Get things moving.

Dr. Weitz:            Now, you’re talking about treatment for patients with breast implant illness.

Danielle:              Yeah. Yeah. I think there might be a little bit more to say about the capsule, making sure the capsule’s removed and then the silicone granuloma. So testing for illness, Dr. Tervaert-

Dr. Weitz:            Now, let’s continue to talk about how breast implants cause illness. How do breast implants lead to autoimmune disease? What is the immune system reacting to that’s causing cross-reactivity?

Danielle:              That’s a great question, and if I knew that specifically, it would be or I could retire, but what I know is that there is reaction-

Dr. Weitz:            Calling Dr. Vojdani, we need your help.

Danielle:              Yup. Silicone and platinum seem to be the biggest foes and the two components of the breast implants that we know cause a certain cascade, right? So the cross-reactivity, I don’t know. I’m sure there’s more and I hope he does call.

Dr. Weitz:            No. We do know that breast implants cause cancer, this specific form of cancer, anaplastic large cell lymphoma.

Danielle:              Yeah, and that’s a T cell cascade, specifically to the silicone. What you’ll find interesting in the literature by Fleury and Susan Turner is if you look at their work and you extrapolate the T cell, what you’ll see in Fleury’s work is he finds the silicone-induced granuloma before BIA, BIA-ALCL, before the lymphoma, and also before the BII, right? So what we don’t know is what causes the T cells to proliferate to make lymphoma and what causes the T cells to stay in a certain way for BII, right?  Now, they’re going to say that the literature is based on textured implants for the lymphoma, but you see the same granuloma and on MRI before, and with BIA-ALCL and BII.

Dr. Weitz:            When you say BII, for everybody, she’s talking about breast implant illness versus the breast implant associated cancer.

Danielle:              Lymphoma, and let’s be specific. That’s just one of them associated with the textured implants, but there’s sarcomas, melanomas. There’s many other cancers that are linked to the breast implant.

Dr. Weitz:            What are some of the other common cancers that are linked with breast implants?

Danielle:              Melanoma and sarcoma.

Dr. Weitz:            Okay. Sarcoma of bones or soft tissues or what?

Danielle:              You see the granuloma and the biopsy shows that it’s a sarcoma-related tissue. That’s in the literature, for me, right? It’s within the breast implant capsule and you can see … Oh, so remember how we were talking about the shell?

Dr. Weitz:            Right.

Danielle:              So once you have these openings, things can get out as well as in. So I think that’s where the irritation and the granulomas begin, and how it deforms I don’t know.

Dr. Weitz:            Okay. Okay. So go ahead. So sarcomas, and what other kinds of cancer?

Danielle:              I’ve read on melanoma. My patients haven’t had the sarcoma or melanoma.

Dr. Weitz:            Okay. I heard you talk about some of the gastrointestinal symptoms related to breast implant illness and how this can be a cause of leaky gut. I personally treat a lot of patients with IBS and SIBO and leaky gut. I wonder if this could be one of the reasons we don’t consider for patients who don’t improve as much as we had hoped.

Danielle:              If anyone has an implantable device and they have GI issues that we try and we try, I think we need to dig further. The question should be for every patient, “Do you have an implantable device?” Some people don’t consider IUDs as an implantable device, right? Some patients don’t remember they have a dental implant or they’ve ever had a root canal or things like that, but they definitely are inflammatory, and if that person doesn’t have enough reserve to handle inflammation, total inflammation, it’s hard to move the dial.

Dr. Weitz:            So, unfortunately, though, it sounds like from what I’ve heard and read so far that if somebody like me is working with a patient with gut problems and we suspect that there might be a breast implant related factor, there’s not one definitive test I can do to say, “Yes, we know your breast implant is part of the problem.”

Danielle:              Correct, but I think as practitioners we should be knowing what is in the person’s body, in their history, right?

Dr. Weitz:            Yeah, no, I mean, we’ll have to decipher from history and suspect that possibility.

Danielle:              There’s something called the Bradford Hill criteria, and there’s a Dr. Jan Tervaert out of Canada who just published a paper on how he diagnoses breast implant illness and the evidence for it. If someone comes to me with breast implants or they just come to me because they’re tired and we take a full history, I now for the past four years have been asking, “Do you have an implantable device? Do you have breast implants? Do you have a penal implant? Do you have dental implants? Let’s go down the list. Do you have a pacemaker? Do you have a fake hip, fake knees?” We’d go through it all. There’s some of those that are things you can do about, and there’s some that like a pacemaker would be really hard to remove, right?  So at least we know that if you have a mesh, oh, that’s a whole other conversation, that inflammatory cascade is very similar to breast implant cascade as well. If we’re going for the low hanging fruit at first, we’re going to decrease inflammation, oxidative stress, all of that, and work with the gut, right?

Dr. Weitz:            So you find that these meshes, which are, say, for example, common in hernia surgeries and some of these other surgeries where-

Danielle:              Pelvic.

Dr. Weitz:            Pelvic surgeries, yeah.

Danielle:              Yeah. They also can cause, well, let’s just call it an inflammatory cascade for now, and it’s so embedded in the tissue just like some of the breast implants and the capsules are embedded into the tissue, and the granulomas that occur with them are of concern, right? Some of these procedures are elective. So we are now putting devices in people that cause inflammation, and our first job is to do no harm. So yeah, my brain just went in five different directions on what else do I want to say about meshes, but meshes can cause the same issues, for sure.

Dr. Weitz:            Meshes don’t have Silicon, right? They’re just made from plastic of some type.

Danielle:              They are made of … What are they made of?

Dr. Weitz:            Polycarbonate or something like that, I believe, some of them.

Danielle:              Yeah, and I think they’re-

Dr. Weitz:            I mean, I had one put in for a hernia in 2000.

Danielle:              What are your symptom? No, just kidding. No, but if you can, again, toxicity breeds deficiency. So I have women who come to me who have all the signs and symptoms and even have SIGBIC on MRI, and they’re not ready to remove them. They may never be ready to remove them.

Dr. Weitz:            SIGBIC is silicone-induced granuloma breast implant capsule.

Danielle:              Yes. So sorry.

Dr. Weitz:            That’s okay.

Danielle:              They want to keep them. “Okay. So let’s empower you. Let’s be totally informed, and let’s see what we can do to help you have vitality in life,” right?

Dr. Weitz:            So let’s go over how you could treat from a functional medicine or integrative perspective a patient who comes to you with some illness related to breast implants or even other implants.

Danielle:              Yeah. Number one is ask what they have inside their body, right? We ask them the supplements. Some of the women who come I can’t tell that they have implants, but they’ve had them in for 20 years, right? So if they’ve had a breast implant set or second set in for 20 years or over seven to 10, we’re having the conversation that they don’t last a lifetime, and there’s something to be considered for changing them out or at least getting imaging to see if they’re ruptured, right? So I start there.  So then if they get the imaging and they don’t have SIGBIC, let’s say their implants have been in for three years but they’re still feeling crummy and they don’t have SIGBIC, then it’s an informed conversation of we don’t see the granuloma yet. By the time we see the granuloma, we know that silicone is outside of the implant, into the capsule, and potentially has migrated through the body. Then as we know, your body may or may not create antibodies to this and you don’t know where this cascade of silicone will land, right? Then we’ll take another MRI in a year or in two years and we’ll follow it that way.

Now, if they have SIGBIC, the conversation is, “You have inflammation in your body. The breast implant is leaking. We know this because of the SIGBIC, and now what do you want to do about it? Do you want to go for explant? How do you want to have vitality?” So we’ll do an organic acid test. We’ll sometimes do a DUTCH test and a stool test and see what we’re dealing with. We’ll do the Lyme and the EBV.

Dr. Weitz:            Okay. What sorts of things might you find on those tests and what will that tell you, and then what do you do about it?

Danielle:              Oh, you see a toxic load usually, and you’ll see methylation issues. If anyone doesn’t see a low B6, I would like to see that because I haven’t seen that yet. You’ll see low B6. You’ll probably see oxalates. You’ll definitely see candida. You’ll see, going down the list, plus or minus. A lot of these people-

Dr. Weitz:            Why would you see candida?

Danielle:              For me, I think people want me to say metals, but the methylation disruption and the inflammation, now, it’s a very overwhelmed body. It’s a great environment for it to grow. Now, this is organic acid, right? So this is in the urine even. Sometimes you see mold. You see mycotoxins for some of them. I see that a lot with specifically saline. I’m going down the organic acid test.

Dr. Weitz:            Why do we get mycotoxins with saline breast implants?

Danielle:              Yeah. That’s a great question because it’s not necessarily, “Is it being introduced? Is it inside? Is it introduced during the surgery? Is it inside the implant? Is it in the body?” We don’t know it. In some places it grows. I don’t have the answer. I wish I did, but I don’t, but you do see it, right? Sometimes maybe that’s where it lands because they’ve had mold exposure before, right? Some of these women have been exposed to Lyme. There are co-infections, and a lot of people have EBV or mono, and that gets reactivated, right? So a lot of the functional med.

In the beginning, I was just treating that and treating that and not considering the implantable device, and didn’t really make much headway with that. Oh, there’s so much to say. The people who I see have mold and have that sensitivity like a mast cell, a histamine response, they can’t eat too much, they can’t take supplements, their nervous system is just off the charts, those are the tough ones. I need more practitioners to share are their stories how they help these patients. I don’t see those patients being able to not explant.

 



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Dr. Weitz:            Is there a way to detox silicone or some of the other things associated with breast implants? Is there a silicone detox program?

Danielle:              Open up all the drainage pathways. Keep it moving. Heat.

Dr. Weitz:            How do you like to open up drainage pathways?

Danielle:              Lymphatic drainage massage. I use something also, to instruct the patients to use something like block therapy. So in my practice, I do osteopathic manipulation. So we’ll do visceral. We’ll keep that moving, flush the liver, and manually do that, do heat with sauna, make sure you’re able to sweat, breathwork, all the drainage pathways, breath, liver, kidneys, urine, feces.

Dr. Weitz:            Yeah. Some doctors talk about using herbal bitters to get bile flow. Some doctors talk about there’s this-

Danielle:              [inaudible 00:43:03]

Dr. Weitz:            Exactly.

Danielle:              It’s all of it. Most everyone under this chronic stress for some length of time have decreased HCL. There’s things like if they have edema, that HCL is going to really or some other kinds of enzymes that could really help that patient. Opening it up from the mouth to the stomach, to the liver, the bile duct. The gallbladder is usually a mess when you look at their organic acid, most of them, but I think this is true for many of our chronic, well, autoimmune patients is their amino acids are so low and either they’re not taking them in or they don’t have enough of what it takes to break it down, right? So you just start with the basics. Open it all up and that tends to help.

Dr. Weitz:            Okay. What else can we do to help patients with breast implant illness besides detox?

Danielle:              Yeah. So the nervous system and listen to the patient. Create a safe space for that patient because by the time they found a functional medicine practitioner, they’ve probably been to at least five to 10 others, right? They’ve been to the ER so many times. So just to listen and to create that safe space for them, I think that provides so much healing. Replace the deficiencies. I tend to start mitochondrial Krebs cycle first, and that seems to move the dial quite well.

Dr. Weitz:            What does that mean practically? Exactly which-

Danielle:              B6, B1. I don’t do B complexes because you need so much more than what that can offer, right? I mean, the magnesium, the electrolytes, these people are adrenal fatigues so you go that route as well. I’m assuming people who are listening know how to beef up their adrenals, take away the stress. Breathwork is amazing. The rest is the full functional medicine profile.

Initially, explant has proven to decrease the symptoms. For me, I call it nutrient-riching and opening up the drainage pathways. That moves the dial the most. You just had Todd Watts on not too long ago. When I added the Cell Core products to these women, we’re actually going to do a clinical study, a feasibility coming up, the carbon technology just shifted things to faster.

Now, the people that have very high sensitivities or mast cell got to go really slow, but following their opening up the drainage pathways, addressing viruses, addressing parasites and different things has really impacted the health of the BII population quite well.

I’d like to say I had it really good before, but I added this and it’s even better. So I’m going to start a HOPE clinical trial, and it’s called How to Optimize Post Explant. We’ll be doing 20 women. It will start in 2022. I think we’ll be doing it at two plastic surgeons offices who explant so we can track everything that we know to track today and we’ll see the people who have not improved at the three month marker, they will see if they meet the inclusion/exclusion criteria, and those who have explanted before and end of a year.

So we’ll get this population that wasn’t all the way helped and they still have symptoms post-explant, and we’ll see if we can move the dial with what we’re talking about here and, hopefully, give other practitioners, “Okay. I’m going to do it this way,” at least a correlation if we can.

Dr. Weitz:            Okay, cool. So you said you would use some products from Cell Core that help to detox and clear out parasites and you found this really helpful.

Danielle:              Yeah, and even their phased approach, right. I think that it makes sense to open up the exit door before yelling, “Fire,” right? Otherwise, you think about that for estrogen, right? You give dim, dim, dim all day long, and you don’t have any amino acids and the different things, and you’re not going to have what you need to succeed in that. So doing the same approach I think will work in implantable devices for the women.

So the problem with silicone on the periodic table is that it’s right underneath carbon. So I think one of the things that Cell Core has is it’s carbon technology. So silicone will bind to a carbon site, and how do we release it? Well, the only way you can release it is to fold it. How do you fold it? Maybe heat it, change its oxidative state. We don’t know this information. I wish I could say, “Oh, take an inositol and that’ll do it,” but it doesn’t, right?

So you need to unbind it in many of the cases, and then you need to make sure carbon binds with that while you’re pushing the silicone along. So that’s why moving lymphatic, breathwork, exercise, sauna, you’re heating it, we’re doing everything we can to change our own oxidative state. I don’t know necessarily how to impact that bound silicone and change its oxidative state, but I can heat it with sauna. I can do some red light therapy. I can manipulate it, but there’s not full data on that. That’s just what I’ve clinically found that works.

Dr. Weitz:            Great.

Danielle:              It’s suffocating.

Dr. Weitz:            No, it’s great. A lot of stuff to think about, and it’s hopeful that we’re getting more information about some of the health effects of these silicone and saline breast implants, and that there are some strategies that are helping women with these and potentially similar problems with other people who have other sorts of implantable devices, including mesh.

Danielle:              Yeah. Yeah. That’s going to be interesting cascade, for sure.

Dr. Weitz:            Have you had hernia patients with-

Danielle:              Yeah. Yeah. More like fatigue and dampen symptoms. By the time breast implant, people have autoimmune. It’s been. We went through the whole autoimmune trajectory. I mean, you’re not diabetic today, but you weren’t yesterday, right? So there’s this behind here.

Dr. Weitz:            There’s this long, long, long pathway. Yeah.

Danielle:              I don’t know that mesh leaks like the shell of the implant. So I think it causes irritation and inflammation and depending on how you build the scar tissue, but it doesn’t have the same structure as a breast implant shell does. So while it does cause issues, I don’t know that it will impact. I think it would impact less, but we don’t know.

Dr. Weitz:            Then of course, we have an individual response. You have four people in a house with mold and one of them gets really sick and one of them gets mild symptoms and the other two never have any symptoms.

Danielle:              Yeah. One of the things we’re going to look at in the HOPE clinical study is we’ll do a full DNA panel and we’ll see if there’s, I mean, everyone talks about, “Oh, I’m MTHFR.” What about GST? What about all these other things? I think we’re going to find correlations there. So for people with mesh, I would look at the same thing and see, and then at the end of the day, all we have is choice to optimize, and there are some things like pacemakers and they had polyurethane leads and silicone leads and platinum tips or platinum iridium tips, right? So we’re not going to remove them, but how do you optimize that patient, but knowing what this can cause may help. Is it inflammatory? Is it oxidative? Is it that? That I think is Functional Medicine 102, right?

Dr. Weitz:            Great. So any final thoughts for our listeners and viewers as we wrap this up?

Danielle:              Yeah. If there are practitioners out there that see breast implant illness or related complications from PTs, functional medicine, we host every other year a breast implant health summit. This year will be October 20, 2022. I’m looking for more practitioners to speak what they do because it takes a collaborative team to, if we can heal these people more better, different, faster, that’s the goal. So if people would like to either have more information on the breast implant health summit or present at the breast implant health summit, then please connect to me through the breastimplanthealthsummit.com and that would be a great way to connect.

Dr. Weitz:            Excellent. Thank you, Danielle.

Danielle:              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.  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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Integrative Diabetes Care with Dr. Mona Morstein: Rational Wellness Podcast 253

Dr. Mona Morstein discusses An Integrative Approach to Diabetes at the March 24, 2022 Functional Medicine Discussion Group Meeting 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

8:28  95% of cases of diabetes are Type II and it is related to obesity, among other things. There are about 8 billion people on earth and about 2 million are overweight.  In the US, statistics on obesity are staggering, and even 15% of children are obese.  Over 37 million people in the US have diabetes and another 100 million have prediabetes, so one out of every three Americans have diabetes or prediabetes.  Close to 50% of those over age 65 have diabetes in the US.

11:02  TYPES OF DIABETES:  

1. Type I Diabetes, which is our classic Pediatric Autoimmune disease.  It typically does not start below one and half years and fades out around age 25.  There is an ongoing trial called the TEDDY trial, which stands for the Environmental Determinants of Diabetes in the Young, and they are looking at figuring out what the triggers are, including diet, nutrient deficiencies, vaccinations, infections, stress, etc..

2. Latent Autoimmune Diabetes of the Adult, LADA.  This condition tends to start after age 35 and most are in their 40s and 50s and they are insulin dependent.  Many of them get misdiagnosed with type II diabetes, since many physicians are not knowledgeable about LADA. This type I can be very slow onset where they may not need insulin at first, or they may just need a small amount of insulin, sometimes for decades, or they need full blown insulin from the start.

3. Type II Diabetes. This is the most common form of diabetes and it is insulin resistance driven. Most patients with Type II Diabetes are poorly controlled and many of these will go on to eventually need insulin.  But insulin dependent Type II Diabetes is still Type II.

4.  Mature Onset Diabetes of Youth, MODY.  This is related to genetic mutations where people either are unable to secrete insulin or are unable to receive insulin.  Athena Diagnostics offers testing to measure 1, 2, 3, 4, 5, and 8 of the MODY genes. For this group, sulfonylureas, which are not really good drugs for most of us, work really well for this group.

18:34  Complications of Type II Diabetes:  1. Hypertension, 2. Chronic Kidney Disease, 3. Impaired vision, 4. Neuropathy, 5. Amputation, 6. Pregnancy complications, and 7. NAFLD.  The majority of our cells have an insulin receptor and this allows them to grab glucose and pull it into the cell and turn it to fat and store it or burn it. But there are four cells in the body that don’t have insulin receptors, which are the eyes, the kidneys, the nerves, and the endothelial lining of the blood vessels.  When glucose gets into these cells, there is no insulin to process it, so if your blood sugar level is 300, then the sugar in your eyeballs will be 300. The cells in these tissues therefore become damaged if your diabetes is uncontrolled. If your diabetes is uncontrolled, you have a 4-6 times increased risk of dying from cardiovascular disease. Diabetes is the number one reason people wind up with end stage kidney disease. It’s the number one reason adults go blind. It’s the second most common reason for amputations and there are 356 diabetes amputation every day in the US. Diabetes can lead to non-alcoholic fatty liver disease.

22:05  Laboratory Analysis of Diabetes.  Labs should include CMP, CBC, lipids, Ferritin, which can help to detect anemia and it is an early indication of fatty liver. If there is indication of fatty liver, you do an ultrasound. GGT, which is another liver detox enzyme.  If someone is injecting insulin, then measuring insulin is no longer accurate. C-peptide is a better indication than insulin.  To assess heart disease risk, a standard lipid panel is bogus, so you need an advanced lipid profile and you need to include Lp(a), APoB, Oxidized LDL, Homocysteine, Fibrinogen, HsCRP.  You should check random micro-albuminuria at least once a year, which can show early kidney damage. The diabetic antibodies to diagnose LADA include GD65, insulin antibodies, Islet cell antibodies, Tyrosine phosphatase, and Zinc transporter 8. If it’s type I, then you also want to look at Celiac and thyroid antibodies.  Hemoglobin A1C. There is a .5 variability with this test.  In general, the lower the A1C  the better.  An A1C over 5.5 is already beginning to cause damage in the body such as to the eyes. [Association of A1C and fasting plasma glucose levels with diabetic retinopathy prevalence in the U.S. population: Implications for diabetes diagnostic thresholds]  Over 6 it’s causing kidney damage. [Poor glycemic control in diabetes and the risk of incident chronic kidney disease even in the absence of albuminuria and retinopathy: Atherosclerosis Risk in Communities (ARIC) Study

30:00  A Hemoglobin A1C of 5 translated to an average blood glucose of 100, six is 126, seven is 152, etc. You can have two different patients both with a A1C of 6 but one patient can have good, steady control with only mild ups and downs and another patient could be at 50 for half a day and at 150 for the other half and that patient could also have a A1C of 6.

31:44  There are certain cases where the A1C is inaccurate, including with patients with genetic hemoglobinopathy, like sickle cell anemia, you can’t really use A1C, you’d have to use fructosamine, instead. The only problem with fructosamine is that it doesn’t translate to a glucose number.  If the patient has serious liver or kidney disease, the A1C will be inaccurate and will appear lower. It can be too low if they have serious bleeding or high if they have iron deficiency anemia.

32:36  There are a few studies, including the ACCORD trial where they had patients eat whatever they want and they lowered the A1C below 6.5 by using some very strong medications, including the sulfonylureas, which cause weight gain and water retention, the TZDs, which cause weight gain and water retention, and insulin, which causes weight gain and water retention, and they had more patients dying. They concluded that lowering the A1C below 6.5 is not a good idea because it will cause heart disease and this has led some doctors to recommend not trying to get the A1C below 6.5. But all the ACCORD trial showed is that lowering your A1C below 6.5 without dietary changes and only using very strong medications will increase your risk of heart disease.  If the patient is able to lower the A1C to 5.4 with diet, supplements, and Metformin, they are not going to have a high risk of cardiovascular disease.

34:25  The American Diabetes Association has set the following glucose goals for diabetic patients, but they should be more stringent:

1. A1C below 7

2. Fasting glucose 80-130 mg/dL

3. Post-prandial <180 mg/dL 

Dr. Morstein feels the following goals would be better guidelines:

1. A1C below 6.

2. Fasting glucose <110 mg/dL  Ideal <100 mg/dL

3. Post-prandial <120 mg/dL  Ideal <110 mg/dL 

 

34:50  Diabetic Medications:

1. Insulins:

       A. Basal:

             Long-Acting: Levimir/detemir, Lantus/Toujeo/Glargine/Basaglar, Tresiba/degludec 

             Intermediate-acting: NPH (Neutral Protamine Hagedorn)

      B. Bolus/Corrections:

             Short-acting: regular insulin 

             Rapid-acting: Novolog/aspart, Humalog/lispro, Apidra/Glulisine,

             Very-rapid: Fiasp/aspart

2. Oral Hypoglyemics: 

       A. Biguanides: Metformin HCL, and there is an extended release  

       B. Sulfonylureas, which are problematic drugs because they cause water retention and weight gain and there is a high risk of hypoglycemia:

             Glipizide

             Glyburide, which is the worst one for low blood sugar,

             Glimepiride, which is the best in this group

       C. Mitiglinides, which nobody uses 

       D. Thiazolinediones (TZDs)

             Rosiglirtaxzone (Avandia)

             Pioglitazone (Actos)

       E. Sodium Glucose Transporter 2 Inhibitors–these are not bad drugs, but the sugar can cause bladder infections or jock itch or vaginal infections

             Canagliflozin  (Invokana)

             Dapgliflozin (Farxiga) 

             Empagliflozin (Jardiance) 

             Ertugliflozin  (Steglatro)

       F. Dipeptidyl Peptidase 4 Inhibitors (DDP4 inhibitors)–these seem to be fairly safe, though they are fairly weak.  And at their highest dosage they have a lowering of the A1C of like 0.5, while just taking out grains from their diet will lower A1C by 3.3%.

             Januvia/sitagliptin 

             Tradjenta/linagliptin 

             Onglyza/saxagliptin 

             Nesina/alogliptin

       G. Glucagon Like Peptide-1 Agonist–These are really good drugs that are fairly effective, and they may help patients lose weight, they reduce their appetite, but they are quite expensive.  There may be some nausea as a side effect.

            Dulaglutide/Trulicity 

            Exenatide/Byetta 

            Exenatide ER/Bydureon 

            Livaglutide/Victoza 

            Lixisenatide/Adlyxin 

            Semiglutide/Ozembic/Rybelsus 

            Albiglutide/Tanzeum

38:30  With respect to Continuous Glucose Monitors, there is the Dexcom and the Freestyle Libre from Abbott and Dr. Morstein finds the Dexcom much more accurate than the Freestyle Libre.

39:50  Diet for Diabetes.  In 2013 or 2014 the American Diabetes Association acknowledged that low carb diets may have value for diabetics. If we look back 100 years ago, there were not that many type II diabetics and the type I diabetics were dying pretty awful deaths until we invented insulin. Then diabetic patients were able to live longer, but they all eventually died of cardiovascular disease, so it was thought that this meant that their fat was too high, so the whole country started preaching eating low fat. Everybody started eating more carbs and things went downhill from there.  Only in the last few years have the ADA turned around and endorsed a lower carb diet for type II diabetics.

41:42  For Prediabetes the PREDIMED study showed that the Mediterranean diet works well.  [Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet]  Compared to the low fat diet, the Mediterranean diet reduces diabetes by 52%, which was more beneficial than putting patients on Metformin.  However, the low carb diet performs better than the Mediterranean and leads to most lowering of the A1C.

42:48  There is an outlying diet known as the MA-PI2 Diet, which is the high carb, plant based diet for diabetes.

 

 

 



Dr. Mona Morstein is a Naturopathic Doctor who practices at Arizona Medical Solutions in Tempe, Arizona. Dr. Morstein: has a practice focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid, and gastrointestinal disorders like SIBO and IBS.  She is the author of the best-selling book, Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type I and Type II Diabetes and she lectures frequently at medical conferences.  Her website is azimsolutions.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 drweitz.com. Thanks for joining me and let’s jump into the podcast.

Welcome everyone to the functional medicine discussion group meeting tonight on integrative approach to diabetes care. We’re very happy to be joined by Dr. Mona Morstein. I’m Dr. Ben Weitz and I’d like to make some introductory remarks before making some remarks about our sponsor, and then I’ll introduce our speaker and we’ll get started. So I encourage each of you to participate and ask questions by typing in your questions in the chat box. Then I’ll either call on you or simply ask Dr. Morstein your question when it’s appropriate.

So I hope that you’ll consider attending some of our events in the future. April 28th, we have Dr. Paul Anderson speaking on an integrative approach to cancer. May 26th, Dr. Sarah Thompson will be speaking about a functional approach to maternity. Then the next meeting after that will be June 23rd and that’s yet to be determined. So if you are not aware, we have a closed Facebook page, the Functional Medicine Discussion Group of Santa Monica, that you should join so we can continue the conversation when this evening is over.  I’m recording this event and I will include it in my weekly Rational Wellness Podcast, which you can subscribe to on Apple Podcast, Spotify or YouTube. If you do already list into the Rational Wellness Podcast, I’d very much appreciate it if you could go to Apple Podcast and give me a positive ratings and review.

 

So now I’m very happy to tell you about this evening’s sponsor, which is Integrative Therapeutics. I’d like to take a few minutes to tell you about a few of their products. One of their most popular products is Cortisol Manager, which is an excellent combination of several adaptogenic herbs and phosphatidylserine, which helps to modulate cortisol levels, which can be helpful in modulating blood sugar levels since cortisol surges due to stress can cause blood glucose levels to rise, which I’m sure Dr. Morstein will mention.

Another excellent product in the Integrative line is Berberine, which has quite a bit of research to back up its benefits in helping to control blood sugar and to improve insulin sensitivity. In fact, some studies show that it is equally as effective as Metformin, and can also be used concurrently with Metformin and has been shown to improve Metformin’s efficacy. This Integrative Berberine product is Berberine HCL, which is not an extract of Berberine from Berberine containing herbs, which is in their Berberine complex which is better for use as an antimicrobial for gut health.  In other words, if you’re using Berberine for managing blood sugar or helping with lipids, then you want to use the Berberine HCL. I personally use Integrative’s Berberine product for my patients because of its quality, both for blood sugar management, for control of lipids, and also as a longevity agent since it’s an activator of AMPK. One of the reasons why he Integrative’s Berberine and their other products are such high quality is because the company uses a manufacturing facility that’s a drug GMP facility rather than a dietary supplements GMP, which means that they test every line. They do bio-validity testing, stability testing for up to two years past the manufacturing date, et cetera.

So Dr. Mona Morstein is a naturopathic doctor in Tempe, Arizona who’s a practicing functional medicine doctor at Arizona Integrative Medical Solutions, which has a focus and her practice has a focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid and gastrointestinal disorders like SIBO and IBS. She’s the author of the bestselling book, Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes. I got to tell you, this is one of the most impressive, comprehensive, useful books that you would ever want to have and everybody should have this on your shelf for help with managing patients with diabetes. Dr. Morstein, thank you so much for joining us. You have the floor.

Dr. Morstein:                     Thanks very much, Ben. I really appreciate the intro and I hope everybody can see the lecture, the slides okay. I wrote kind of as a joke an abbreviated diabetes lecture, because it still is like 70 slides. but I try to extract. I’ve taught a lot of diabetes webinars to physicians and it’s usually a kind of a weekend affair, all day Saturday and all day Sunday. So we’ll try to touch upon a lot of things right now today. I also know I’m speaking to physicians, so you’re already coming with a fairly high level of comprehensive knowledge of this condition.

Okay. He just mentioned me. This is me. I will say this, I don’t think we talked talk about this enough in medicine because it’s embarrassing, but I got into diabetes because literally way, way back when, I mean 30 years ago, I missed the I missed a diagnosis of a type 2 patient in kind of an acute crisis of diabetes. So that really shook me to the core. I was a new doc, just starting out in Montana, and it made me doubt if I was a safe, responsible physician.  So the end result was that I just decided to never miss another diabetic patient and I really immersed myself in this condition. So it was nice to take one of the most worst moments of my medical career and turn it into a real growth trajectory that makes me feel very comfortable treating all types of diabetes and kids and adults and so forth to this day. So anyway. Ben already showed the book. You can get it on Amazon. It’s pretty good book. I’m proud of it. Thanks.

Anyway, let’s dive in. There are some statistics just to know about. We’ll talk a little bit about type 1 and of course type 2, but most diabetes is type 2, 95% of diabetes is type 2, and it is related to many things which we’ll talk about, but obesity and being overweight and this abdominal, visceral fat is a big part of it. As we can see the U.S. statistics on obesity are staggering if we’re going to choose any appropriate adjective. Even kids, 15%, that’s so sad.

 Then in the world, right now, we got 8 million people on planet earth, about 2 billion are overweight. It’s not a good thing. With 650 million, about twice the population of the U.S. are obese. So this is not a good thing worldwide, and it’s certainly is feeding into diabetes statistics. So in the U.S. right now, when I did this lecture say when I started 60 years ago, it was only 29 million, so it’s now up to 37 and a little over million people actually have diabetes. Pretty much one out of every 10 people in the mall, or you are going to see has diabetes. Prediabetes is almost another 100 million.

So if we add that up, it is clearly one out of every three Americans have either prediabetes or diabetes at this point in time. With those senior populations, 50% of them have diabetes. You can’t even really wrap your mind around it. So it’s really not a good thing. It’s a huge burden for these people, for the health, for our healthcare system and for the economics of our country as well. In the world, we have right now over 500 million people in the world have diabetes. You can see the deaths and how many pre-diabetics there are. So if you add a pre and diabetes, really 1 billion out of eight people have either prediabetes or diabetes.

Now, the types of diabetes. There is type 1. This is our classic pediatric autoimmune disease. Doesn’t really tend to start below one and a half years. Then even though we call it kind of pediatric, really, the bell curve is going to fade out around age 25, so older than our 18 year old cutoff, but we still consider that’s all that initial pediatric type 1 type condition, right? It’s an autoimmune disease. In my next slide, we’ll talk about that TEDDY trial.

The other type of type 1 is called latent autoimmune diabetes of the adult, LADA. Generally, it’s kind of kicks in from age 35 on, but the vast majority tend to be in their 40s, about 40 to 60 is where we’re going to see that bell curve the most. Now, the big thing with this is that the vast majority of them are misdiagnosed as type 2. I’ve rediagnosed literally dozens and dozens of patients who came to me lean, always been lean, they have type 2, and it’s clearly type 1, right?

So just be aware of that. There are still many physicians that are not knowledge about LADA and are not aware of type 1 happening in adults. This type 1 can be very slow onset where they may not need insulin at first, or they may just need… I have one gal who’s just needed two units of a basal insulin for a decade. She hasn’t progressed. Or these people can come on just as rapidly as a pediatric type 1 and need full blown, full insulin from the get go. So you’ll just have to be able to figure that out with your own patient.

This is the TEDDY trial, stands for The Environmental Determinants of Diabetes in the Young, so TEDDY. So this is a trial that’s still ongoing where they’re following kids and the diets and their vaccines and et cetera, and they’re looking at all of these factors as triggers for what seems to really be an actual trigger that they can clock and start saying, “This is a determined trigger for type 1 diabetes.” So they are looking at a very broad based way of things from nutrient deficiencies to vaccinations and getting sick and psychological stress, all of these things.

So when they are able to quantify it and really put it together and put it out, they put out little bits here and there, but they haven’t yet put the whole thing together. I think that’ll be helpful to all of us to really be aware of what we need to watch in kids early on to help prevent them to not get type 1 diabetes.

Then of course the last type, right? Well, not the last, third of four, is type 2 diabetes, which is the number one diabetes. It’s insulin resistance driven. Gestational diabetes is an insulin resistance type diabetes. These are pretty well known etiological factors, and I’m going to talk about them more in the further slides to come, but all of these things can be factors with developing and also potentially having trouble controlling type 2 diabetes.

Dr. Weitz:                          By the way, doc, if a type 2 diabetic ends up being insulin dependent, has that type 2 now become a type 1 or is it-

Dr. Morstein:                     Yeah, that’s a good question. So, no. So type 1 is relegated to autoimmunity, and both you’re going to be able to pick up for the vast majority. There are always a very, very small percent of antibody negative type 1 patients. That just happens. But the vast majority will have a positive antibody or several positive antibodies. Type 2 diabetes is generally poorly controlled. These people will become insulin dependent type 2 diabetes. So they stay type 2.  There’s a lot of patients who need insulin with type 2 diabetes. For me, unless the patient is literally completely in denial and refuses to change anything about their diet or their lifestyle. There are some patients like that. But for a lot of them, they’re just given misguided information from the physicians they go to. Easily, the vast, vast, vast majority of type 2 diabetic patients never need to be insulin independent.

The last one is a relatively unknown one called MODY, mature-onset diabetes of youth. These are just genetic mutations. These you tend to see, well, grandpa had diabetes and dad had diabetes and Timmy at 16 gets diabetes. But it’s not that bad and they don’t really need insulin. This is mild elevations. Their blood sugars are around 140 or so. These are genetic defects. For example, they make insulin, but there’s a genetic defect in their ability to secrete it, or they can secrete it, but there’s a genetic defect on the receptor that it doesn’t acknowledge the insulin.  So these are generally can be dealt. Most of them have to do with secretion. So sulfonylureas, which are not good drugs that we don’t really like, for this group of people is a good drug, right? If they just take a sulfonylurea, they’ll be fine for pretty much the rest of their life. So there’s one lab, Athena Diagnostics, that does measure all of them, they measure 1, 2, 3, 4, 5, and 8 of the MODY genes, right? If you feel a child needs to be investigated that way.

Just to put it together, a little chart of MODY type 1 and type 2, non-insulin dependent or parents affected and so forth, Acanthosis Nigricans, et cetera, and racial groups, right? Certainly we know with type 2, obviously many Caucasians get it, but Pacific Islanders, Native, right? We’ve been studying the Pima Indians with type 2 diabetes since the ’50s. Definitely Hispanic populations, our African American, very high risk for type 2.

So diabetes, but controlled, nobody has any problems with diabetes when it’s controlled. But when diabetes is not controlled, right? Physiologically, the vast majority of our cells do have an insulin receptor. When this pancreas secretes insulin, it lands on the receptor, sets up this phosphorylation chemical, and then that initiates the glucose transporters, particularly 2, to reach out, grab glucose and pull it into the cell, turn it to fat and store it or burn it as well. But we know insulin is called the fat building hormone. Its idea is to store food for later.  So the problem is there are four cells in the body that don’t have insulin receptors and the glucose is just going to… Osmolarity just walk into those cells. So those cells are your eye cells, kidney cells, neuro cells, and the endothelial lining of the blood vessels, which is why those are the ones that get damaged with uncontrolled diabetes. Because if your blood sugar is 300, your eyeballs are 300. Meanwhile, your fat cells and muscle cells and liver cells, they’re like, “Forget it. I’m not taking you in. I’m going to be resistant.”

So they’re not getting the glucose in, but it is getting in these other cells that by the nature of survival never want to be without glucose so there’s nothing blocking glucose from entering those cells. But this is why the majority of people with diabetes have hypertension. When you have diabetes, considering if you’re just getting regular treatment and you’re not really well controlled, you have a four to six time increased risk of dying from cardiovascular disease, which is not a good thing because everybody dies of cardiovascular disease in America, so you are really at risk.

Chronic kidney disease. Diabetes is the number one reason people wind up with endstage renal disease. It’s the number one reason adults go blind. The first reason people get amputations is trauma. The second reason is diabetes. So pregnancy and fatty liver, most fatty liver, which in America is still called non-alcoholic fatty liver disease, in Europe and probably within a year or two in America, it is going to be called metabolic associated fatty liver disease, because that is a vast majority of fatty liver, right? So diabetes has outstandingly devastating complications.  This is like a daily diagnosis. We have 4,000 people a day diagnosed, 356 amputations a day due to diabetes. About 160 people wind up with endstage renal disease, et cetera. Literally, the amount of money we spend on diabetes in this country is very scary and could really become an economic burden for our country in the future.

Now labs. So this is like one page of labs to consider. Obviously, the basic CMP, CBC with different lipids obviously. I always draw Ferritin. I include Ferritin on every lab, a yearly lab that I do. Ferritin, one, it’s the first way to catch anemia. Before the CBC is affected, you’re going to see low Ferritin. So you can catch people before it gets very serious. But even more so, it’s the number one lab that shows, that indicates a person has fatty liver. When Ferritin is elevated, of course, you’ll do iron panel and look at trans saturation, and as long as it’s not over 50 or so, they don’t have hemochromatosis, and most people don’t have hemochromatosis, about 2% of the population, but when that’s negative, then you can do your ultrasound and see the echogenicity. So… your ultrasound and see the echogenicity. Ferritin is the number one blood lab. When it’s high, that indicates as, and that’s as a liver, acute phase inflammatory marker. The second one is elevated GGT.

Dr. Weitz:                          By the way, Doc, on ferritin, are you using the lab range over 400? What are you using as high?

Dr. Morstein:                     I am. Well, it depends on the lab. Some labs are over 250, some are over… Yes, I am using for high, I am using high. Yes, I am using high. If the lab range was 400 and they were at 380 and you wanted to test for fatty liver, because they have a adiposity as a body type. There’s nothing the matter with that. I’m saying, literally, you’re going to get a great deal of your overweight or obese pre-diabetic or diabetic patients will have elevated ferritin. You’ll do the ultrasound and they’ll have fatty liver.

Dr. Weitz:                          By the way, Doc, I don’t know if you’ve noticed, but recently, some of the lab ranges have gone up. I had a patient last week with ALT of 65 and I said, “Oh, your liver enzymes are up.” Then it said normal. It was an asterisk underneath. This was a UCLA lab. New reference range, it’s now up to 70 is normal.

Dr. Morstein:                     I don’t think anybody who’s a real… I Just did a webinar series with a hepatologist and things on liver conditions. They’re not going to agree with that.

Dr. Weitz:                          Well, this is the normal range is the average American as a result of two years of pandemic drinking.

Dr. Morstein:                     Yeah, of course. Totally. Absolutely. I once called Sonora Quest because they’re postprandial insulin range was from 29 to 89. Now, when you look at studies where they are measuring postprandial insulin, pretty much the cutoff was around 30 where they said that it should be not higher than 30. I called Sonora Quest to research, how did they get their range? Do you know? Sonora Quest said, “Oh, well we just took 50 of our healthy employees, measured their postprandial insulin and got the range.”  That’s literally how they set up the lab value. That’s measuring millions of people. The lab ranges, we do have a right to be a little question them at times. I agree with that. The other ones that you can see are fairly standard. Remember that as soon as someone injects insulin, you cannot measure insulin. You have to measure the C-peptide. Anyway, C-peptide is a better reader than insulin, I think, anyway.

You can’t measure insulin once if they’re a type one diabetes because, they’re going to probably have insulin antibodies. Or once you inject insulin, you’ll make insulin antibodies. We want to switch to C-peptide. The cardiac risk panels, because we know cholesterol is pretty bogus to judge cardiovascular disease risk. The other panels are, these are better. Random micro-albuminuria, you’ll want to check at least once a year, if it is elevated, showing early kidney damage, you can repeat it every three months. Those are the diabetic antibodies.  The classic one for LADA is GAD65, but I would just do the whole diabetic antibody panel. Because sometimes it’s not, GAD and it is a different antibody and you don’t want to miss it. Then of course, celiac, and Hashimoto’s, at least once a year with your type one diabetic patients, you’ll want to check Hashimoto’s if they’re literally gluten free, you can’t really measure for celiac. If for some reason they’re just going to eat gluten, then you’ll want to check that every year as well.

Dr. Weitz:                          What about the new kid on the block, uric acid?

Dr. Morstein:                     Oh, yes, uric. Well, so uric acid going back, yes, uric acid obviously, elevated uric acid, not just gout, but it is an indicator of also risk of kidney disease, even heart disease and patients with diabetes. I don’t do uric acid that much because I already know their risk. What’s their A1C, what’s their et cetera? I don’t do a lot of uric acid. I will do them, I’ll do the micro albuminuria. I’ll do other things. Yes, it is an indicated lab. If you just want to throw that in, for sure. Thanks Ben.

Now, just to say, this is the conventional A1C lab reference ranges, pre-diabetes and then diabetes 6.5% and higher. The problem is, is with A1C, one, it always has a 0.5 variability. If you get a six, it could be from 5.5 to 6.5. There’s always this little variability. Now, we do know the lower the A1C, these old studies are still referred to this day. The DCCT and the UKPDS done in the 90s, type one and type two, showing that literally lowering A1Cs from nine to seven, based on basic and then aggressive control, made huge differences in the occurrence of complications.  We still need A1Cs to be as low as we can. Unfortunately, even though they don’t count person being pre-diabetic until it’s at 5.7, studies will show that an A1C over 5.5 is already beginning to cause damage in the body, such as to the eyes. Or over six, it’s causing kidney damage. In the pre-diabetic range, people are already having damage. This is a problem, because people, “Oh, it’s five, seven, whatever. That’s not that bad.” Well, okay, it’s not that bad, but it is causing damage. We do want to get people under controlling and get them protected.

Dr. Weitz:                            I think there’s a misunderstanding of what hemoglobin A1C is. I think a lot of people don’t really think about it too much and they just say, “Oh, this is three months of average blood sugar.” Really, this means that proteins in your body are being damaged by sugar.

Dr. Morstein:                     Well, yeah, I mean the A1C is a protein on the red blood cell. What we’re measuring is what percentage is covered with glucose. An A1C of five is 5% of those proteins are covered with sugar and 6% is 6% of it. It doesn’t seem like much, but of course we can translate this to blood sugar numbers and they go striking each number decimal higher is about 26. Five is 100, six is 126, seven 152 and up. There’s a fairly exponential rise per percentage of this glucose bound to the A1C protein on the red blood cell. I do have this slide just showing, there’s different ways.  You can get an A1C of six. You can have steady, good control, or you can be up down, up and down all day with an average of six. If you are at 50 half the day and at 150 half the day, you could get an A1C of six. We have to be aware that you always want to monitor blood sugar, not just take an A1C, because we don’t know what the blood sugar is doing to get that A1C. Then here’s a very, very busy slide, just saying when the A1C can be inaccurate. There are different races have different A1Cs.

Of course, the genetic hemoglobinopathies, if you do have a patient with a genetic hemoglobinopathy, like a sickle cell, you can’t really use A1C, you’d have to use fructosamine, instead. The only problem with fructosamine is that it doesn’t translate to a glucose number. It’s just low, normal, or high, but we can’t translate it into glucose like we can in A1C. Then different, depending on how, if they have serious liver, then the A1C can lose efficacy as well. Liver, kidney, iron anemia, et cetera. Last, the problem with the A1C also was these studies.  These studies, particularly the Accord. The accord was a study where they had people eat whatever they want. Because why would we ever deal with the diet in measuring medicines? They had people eat whatever they wanted, their goal was to get them less than 6.5% of an A1C. As a result, they had to use a lot of strong medicines, which was sulfonylureas, which caused weight gain and the water retention. TCDs, which cause weight gain and water retention, and insulin, which causes weight gain and water retention. They had a high amount of people dying.  As a result of this study, I can’t tell you the amount of patients who come to me and say, “Oh, my doc doesn’t like that. My A1C is at 5.8 and literally wants me to eat more carbs to get it higher, so I don’t have cardiovascular disease because of the accord study.” The accord study, that’s all we, and then the advance, these studies use the worst drugs that we have. This accord study is what took the TCDs off the market.

Now, they’re back on, but very rarely used. Probably all of you have also heard patients say, “Oh, my endo doesn’t want me to get less than 6.5, because I’ll get heart disease.” This is ridiculous. It’s solely based on the accord. If I get a person on a diet and supplements and maybe Metformin down to 5.4, trust me, they are not going to have a high-risk of cardiovascular disease. Just to be aware. The ADA has these glucose goals. I think we all want it a lot more stringent.

Because we can get it with the way we’re doing it versus the way the ADA tends to do it. Getting everything down back to as much normal as possible is the goal. These are the diabetic medications, there are insulins, they’re basically split to basal, which is covering the fasting glucose, which is either long-acting or intermediate. NPH is the worst insulin we have. Certainly, by far, has the highest rate of hypoglycemia. Very hard to deal with. Some people need it twice a day. Some people need it three times a day. It can last for eight hours.  It can last for 15. It’s a difficult insulin, but it is super-cheap. That’s why we’re seeing a little resurgence of it now in patients who can’t afford insulin as it’s priced now. Although I order a lot of insulin from Canada, it’s much cheaper there. Or people I have patients just drive down twice a year to Mexico and get their pens from nothing, just walking into the pharmacy. Then there’s the bolus, which is meal or correction. We have short-acting, regulars by far are the best for meals, but isn’t used very much nowadays for a couple of reasons.  The rapid-acting, and then the very rapid-acting, which acts within five minutes. These are our insulins. We have the oral hypoglycemic. There’s nothing the matter with Metformin. You’ve got Metformin, and then you’ve got the ER, because some people who can’t handle Metformin in the gut, the ER, they will be able to handle the extended relief. The sulfonylureas are problematic drugs, they do cause water retention and weight gain. They have the high-risk of hypoglycemia.

Glyburide is the worst one for low blood sugar, so we’d want to stick with Glimepiride. The mitiglinides, nobody uses. Why would we use this? I could take a sulfonylurea maybe once a day for 24 hours. Why would I want to take a tiny sulfonylurea with every meal? Nobody uses them. The TCDs, I just saw a patient on one for the first time in nearly a decade. The sodium glucose transporter to inhibitors, not bad drugs, except the sugar can cause bladder infections or jock itch or vaginal infections, but most people don’t have this recurrently.

You can get a euglycemic DKA in type twos, which sucks. You have to be like, people be aware of that. Then you have the DPP4 inhibitors, which don’t seem to be a problem very much. It’s just that at the highest dose, they have a lowering of the A1C of like 0.4, 0.5. Frankly, just taking out their grains will lower them 3.3%. They’re fairly useless drugs. They don’t do very much. Then we have the Glucagon-like Peptide-1 agonist, these are good. These are great. Patients like them. Most of them can handle them, even with the nausea. Once a week shot, they can lose a little weight.

Their appetite is better. Their blood sugar is better. These are well, good drugs. They’re just spendy, and so people have to hope their insurances will cover them. Otherwise, people are using for insulin, vials and syringes or pens or pumps, and then the CGMs. Dexcom is pretty good. FreeStyle Libre for the type twos, is pretty inaccurate. People get it, but it is not the best CGM.

Dr. Weitz:                          Dexcom is more accurate than-

Dr. Morstein:                     Yeah, Dexcom is 100% more… I was trying to go backwards. There we go. Dexcom is 100% more accurate than a FreeStyle Libre, absolutely.

Dr. Weitz:                          I know Dexcom usually recommends wearing it on the abdomen. I’ve seen some people put it on in the back of their arm. Is that acceptable? Do you know?

Dr. Morstein:                     Yes. That is acceptable. Also, back here in the back, is also acceptable. it’s just subcu. For example, this is probably the most common area people wear their Omnipod pump, which is in the back here. People love wearing their Omnipod here, and it’s the exact same technology and depth. With the Omnipod here, you can have your Dexcom here.

With diets, so in 2013, ’14, the ADA did acknowledge that low-carb diets have value in working with diabetic patients.  Now, if we go back, what happened with the ADA is that, diabetic patients say that needed, type one diabetics 100 years ago before Banting and Best were inventing insulin in Toronto. We didn’t have many type twos and the type ones would die pretty awful deaths where they just ate themselves. We invented insulin and diabetic patients were able to live longer until they all died of cardiovascular disease. They’re doing autopsies on all these patients with diabetes and they had cholesterol in their arteries. If you go back to the 70s, that meant their fat was too high.  That was 1978 was when the country said, “Wow, we should all eat low-fat.” Everybody started eating all these carbs and things went downhill from there. The ADA said, “Yeah, we’re seeing all this fat in these autopsies, so we should have a huge amount of carbs in our patients with diabetes and not much fat.” This has been going on for decades until recently, just in the last years, they’re turning around, which is something for them to do. They started acknowledging low-carb diets is, a physician could do this in an acceptable way.  

For prediabetes, this PREDIMED diet is very well known where they did Mediterranean diet versus low-fat and even Metformin. The Mediterranean diet, which is really just a super-healthy, non-processed food, omnivore type diet. Here’s the study and, the Mediterranean diet with olive oil or nuts and no calorie restriction reduced diabetes incidents by 52%, which was higher than putting people on Metformin. In other words, just eating a healthy Whole Foods omnivore diet with good oils can prevent diabetes.  This is what pretty much everybody was eating until they invented fast foods and candy bars. This has been a diet for humanity for centuries, and it works to not get diabetes.

Now, this is an outlier, I think we need to discuss, which is the MAPI2 diet. This is the high-carb plant-based diet. There is a company there. Actually, I wrote a book, Master Your Diabetes, but the mastering diabetes folks are doing this diet. They’re doing this high-carb, plant-based diet.  There is actually good studies on this diet. They did a six-month study of this diet. Now, this was all men. This was all type-two diabetic men who had pretty high A1Cs, and this was the typical diet that they ate. Now, the mastering diabetes people aren’t doing macrobiotics. This diet was what we classify as macrobiotic. You can see just all kind of foods that we wouldn’t think people with diabetes should eat. The results were outstanding in every area. The A1C from 12 to 5.7, pretty amazing.  Things like HDL went up, LDL went down. C-peptide actually raised a little bit. This is their lipids, the onset. After months, from acceptable, there was only 31%. After the six months, almost 94% of the patients had acceptable triglycerides and pretty good stuff. They had weight loss, they lost hip circumference.  Their BMIs went down, their muscle mass gained. This is everything we want to see, eating this diet. Now, these guys were fed this diet. This is a hard diet for people to put together, but in the study, they were delivered their meals. They just got everything fed to them. Now, this is kind of, I copied and pasted. This is from the Mastering Diabetes Group, and you can see what they want you to eat a lot of, which is, grains and legumes, veggies and fruits.  Then what they want you to eat just a little bit of, which is, things like pastas, avocados, because they’re worried about too much fat, especially saturated fat. Nuts, which is too much fat. Then there are other things that they don’t want you to have at all, which is meat and poultry. Part of this is the idea that animal protein, I think interpreting this, I went to a lecture from Dr. Joe Pizzorno, who’s a naturopathic physician. Brilliant. He did one of the best lectures I’ve ever seen, which was on cellular acidity, right? Now, in reality, our blood doesn’t really change alkaline or acid because tiny changes are so devastatingly bad, but the cell, we’re looking at intracellular, there can be acidic changes. And animal protein and salt are two of the main, main, main foods that cause the acidosis and that is causing insulin resistance. So in this diet, removing all the animal products is really pulling out that whole thing. The problem is you can’t eat half this diet and half of the other and have it all merge. This diet will work 100% its way or low carb will work 100% its way, which is what we’re going to talk about right now. Right?

So low carb, for diabetes, we’re usually looking at 40 or less carbs a day. Okay? The studies on low carb, there are a lot of studies on low carb, but this one that I want to show you, if you look at the authors on this study, first of all, Richard Bernstein, Richard Feinman, huge low carb, there are some really well known low carb researchers, Westman, Eric Westman, big keto guy. And so they did this study showing being a dietary carbohydrate restriction, first approach in diabetic manage, and this is what happens when you are doing a low carb diet, pretty much everything we want to have happen for people with diabetes. So this was with type two diabetics.

Then managing type one diabetes with very low carb diet, this was published in pediatrics. This wasn’t a study so much as it was a survey. And they surveyed a group on Facebook called type one grit, which is a very, very passionately low carb group for type one diabetes. Notice Bernstein and Westman are in [inaudible 00:48:45] these same people. Dr. Richard Bernstein, by the way, was my mentor. He wrote the book, Dr. Bernstein’s Diabetes Solution. He was the one who brought low carb diet to diabetes. He also was the one who taught us how to use insulin better. For example, using insulin to cover carbs, to cover protein and to figure it out in a completely different way than conventional care. And that works a lot better. David Dikeman, he’s a big low carb guy.  So they did this survey of parents of type one. And here’s the exceptional glycemic control of type one diabetes without adverse effects was reported by these people and their kids on a low carb diet with type one, with the reported mean of A1C at 5.6, which is pretty outstanding. So low carb diet is what most of us work with and what most of us want to do. But if one of my patients really wanted to do mastering diabetes, 100%, I don’t mind. The studies are good. They’ve been replicated. But you’ve got to choose one extreme or the other. So it’s total carbs minus fiber. It’s not the amount of sugars on the label. It’s total carbs minus fiber, right? That’s what a label should be. And these are the low carb nos, pretty much, right? The big groupings of foods that we’re taking out of the low carb diet, right? Which you probably know about.

And then Bernstein set up the idea of six grams of carbs at breakfast, 12 at lunch and supper because of the Dawn phenomena at breakfast raising our blood sugar innately. And so having less carbs at breakfast, and then as we’re up and moving around lunch and supper, we can have a little more then. And fat is a free for all. And protein is also weighted a little bit as well. We don’t want to overdo protein. We do need people getting in calories though and having energy and so forth. So we do a little. The protein is one gram per kilogram versus 0.8 for adults in general. And then we allow fat to make up many calories too.

I mean, obviously you all know how beneficial exercise is to people with diabetes with metabolic syndrome, prediabetes, people who are overweight and et cetera. It does pretty much everything we need it to do to help reverse that in patients. And then we can put it obviously aerobic. Resistance does burn 19 times the glucose that aerobic does. Now, I’m not talking if you’re going to decide to do a 10 mile hike with 3000 foot elevation, then the aerobic is going to work pretty well. But if you’re a half hour on a treadmill versus a half hour of lifting weights, you’re going to burn more glucose with the weights, right?

Dr. Weitz:                          Hey, Doc. Can I just ask you question about the diet, just to go back for a second?

Dr. Morstein:                     Oh, yeah. I’m sorry. I didn’t need to. If I’m-

Dr. Weitz:                          No, that’s okay. Yeah. So the low carb program you’re outlining, less than 40 grams. That’s very, very low carbs. Can you get a reasonable benefit with, say 50 to 100 grams? A lower carb program reduces the high glycemic carbs, takes out the refined carbs, but say the person has maybe a slice of gluten-free toast in the morning with their eggs and they have a yam with their dinner, and maybe they have some beans with their salad at lunch.

Dr. Morstein:                     I mean, they’re going to see elevations in their blood sugar. It just depends on how much, right? But generally, no, if you’re following low carb, those are not on the diet for low carb. Now, why not have a piece of base culture bread. Or if you go to a dietdoctor.com, dietdoctor.com has amazing recipes. They have these rolls, which are six ingredients. You mix them together. You bake them. You get these super tasty rolls that are two grams of carbs per roll. So the idea is there’s low carb bread, there’s low carb tortillas. You can make your own low carb rolls. Birch Benders has low carb pancakes. You can get Shirataki noodles.

So the idea is when you’re working with patients this way, here’s the deal, for every 20 seconds you spend taking some food or food group out of a patient’s diet, you want to spend about five minutes adding in the alternatives, because otherwise their psychology starts getting narrower and narrower and narrower. And it’s not like they have to live. They could have base culture. A slice of base culture bread is four grams of carbs and four grams of fiber, which is going to even further reduce the carbs that they eat. So if they have a sandwich at lunch with base culture bread, that’s eight grams of carbs, eight grams of fiber-

Dr. Weitz:                          What kind of bread are you saying? It’s not something I’ve heard of.

Dr. Morstein:                     Oh, it’s called base culture. B-A-S-E culture bread.

Dr. Weitz:                          Okay.

Dr. Morstein:                     So I’m saying that there are breads that people can eat, that will work for them without it being Dave’s Killer bread, which you can’t have. No, you can’t have this, you can’t have Ezekiel bread, but try this bread or try this granola. I have a reference sheet that once I go through, I have a eight or 10-page diabetes handout for the diet. So we go over everything. Then I have a reference sheet with recipe books, 300 15-minute low carb recipes. Oh, you want maple syrup? Well, guess what? Nature’s Hollow has it, Birch Benders has it, Lakanto has no carb maple syrup made with monk fruit, right? So if you give people some of these alternatives, so the diet isn’t this whole change, they can still have some things they really like, but it’s low carb and it’s going to do what we want to have done, that’s how this is a successful protocol for them, right? That’s how they buy in. And that’s how they have success with it.

Dr. Weitz:                            So in your opinion, you want to have success with the type two diabetic, it’s got to be super low carb or you’re not going to be successful.

Dr. Morstein:                     Yeah. That’s how I work with patients. Yes, yes.

Dr. Weitz:                            Okay.

Dr. Morstein:                     Now, otherwise, the rest of the exercise, I’m sure you had plenty… The only thing with exercise is that if they’re insulin-dependent, I have a whole lecture on doing exercise with insulin-dependent diabetics, because depending on the intensity, the length, so forth, you are going to have to figure out how to deal with their insulin before, during, and after. So you can get pretty good at it. You just need a little data to make these decisions, but that’s the most difficult patient to work with initially, are the insulin-dependent who are starting to really dive into exercise.

Dr. Weitz:                            So Dr. Watson [inaudible 00:57:44], you showed some slides about the Mediterranean diet as being helpful in preventing diabetes. But now you saying no way.

Dr. Morstein:                     No, no, no, no. That’s if you don’t have diabetes.

Dr. Weitz:                            Oh, okay. That’s preventing it from happening.

Dr. Morstein:                     That is preventing it. Now, if you have it, that you’ve stepped over that line and now we got to yank you back a little more tighter. So yeah. Now, I just have some things with blood sugar and exercise. It doesn’t matter where the blood sugar is when they start in terms of how well they’ll be able to exercise. The golden is I don’t agree with this 65 to 180. I tell patients to mostly be around maybe 80 to 170, if they start exercising around there, they’re going to have better effect. And the same with where their insulin levels are, if they’re on insulin and how it’ll affect their performance. So I’m working right now with a 16-year-old teen, who’s a cross country skier and has desires to get into the Olympics and so forth. So we’ve been getting really good at figuring out his food and his insulin before and after his races. So you just need a little data a couple times and you can figure this out if you have some aptitude with insulin and work with patients who are also athletes.

Dr. Weitz:                            Do you recommend a insulin pump?

Dr. Morstein:                     I’ll let patients decide what they want to do. Some patients for sure, do not want something embedded in them, 24/7. They just don’t. Other patients love it, because they don’t have to inject themselves five times a day. And you can have good control or bad control with any system, right? And you can also have success with any system. Now, pumps do give us a better control of basal insulin because we can direct the basal all throughout the day, exactly how that patient needs it versus I just inject in the morning and I just inject in the evening and there you go, it’s set. So pumps are the best for basal. They’re not good for meals. You can’t use the pump to decide what meal your insulin you’re going to do because they’re just doing the typical conventional figuring out of glucose, which is not a good way to do it.

So you’re going to have to still figure out your insulin for the meal and then tell the pump what to inject. But it is good for basals. It’s just that you can’t demand a patient get a pump and not every patient wants them. So you’re going to have to work with the basals else-wise, right?

In terms of stress. So this was an interesting study. It was stress management. Everybody was a type two. They had treated, which was one and a half hour groups for eight weeks. And in the people that got stress training management, look at their drop in their A1C. I mean, this is ridiculous. That’s better than any medicine, any oral hypoglycemic, or even better than a GLP-1. The stress management is dropping better than any of those medications versus the control, which had really no statistically significant drop. And the thing with stress is that stress can worsen diabetes, but diabetes can worsen stress. So we have to be aware of the psychology of having diabetes. “What am I going to eat? I have to check my blood sugars. I thought I ate right and yet now I’m at 170, this sucks, blah, blah, blah. I’ve been exercising more. My A1C is still 6.6.” I mean, it’s an intense condition and it’s 24/7.

So we want to be there always for patients. We always want to be finding everything positive that we can, giving them support, acknowledging when they get burnt out and helping them work through it, right? But the arrow is both ways. With the microbiome, again, its own lecture, but we have seen that with type one diabetes, they have found elevated Zonulin and Occludin in patients who have positive type one antibodies, but have not yet had the clinical disease show up. Right? So, that’s interesting. So we also know that short chain fatty acid, right, so fiber fermented by the Firmicutes bacteria family turns to short chain fatty acid, which is really, it’s the food of the colon cells. But it does a lot of things systemically. One is help produce GLP-1 from the intestines, which will help us monitor our blood sugars better.

So are people eating enough fiber? In fact, even with a low carb diet, we do need to make sure they’re getting enough fiber in. They may need a fiber supplement because low carb diets have been shown to decrease the amount of the Firmicutes family, which are the fiber eaters and short chain fatty acid producers. So we do need to make sure that they’re getting good fiber in on the low carb diets.

Dr. Weitz:                            Yeah. There’s a company that’s now producing [inaudible 01:04:09] and they have it in a product that’s been shown in a study to help manage glucose.

Dr. Morstein:                     Yeah. All right. That’s good. Yeah.

Dr. Weitz:                            That’s one of the [inaudible 01:04:19] producers.

Dr. Morstein:                     I will admit I’m very wary of any one probiotic really working systemically if everything else isn’t coming together. You know what I’m saying?

Dr. Weitz:                            Sure.

Dr. Morstein:                     Now, the lipopolysaccharides, so these are associated with type two diabetes, insulin resistance and fatty liver. So having a healthy gut on many levels, fiber that makes short chain fatty acids, it’s not leaky. It isn’t overproducing the lipopolysaccharides. These are all gut oriented ways. We know that gut tumor necrosis factor alpha can get into this systemic system and go to our muscle cells and produce insulin resistance. So the gut is pretty, really important. Having a very healthy gut is… Here’s another study with endotoxins and diabetes. So type ones who had the macro-albuminuria had higher LPS. They had higher LPS in patients with diabetes and hypertension.

So it’s amazing how these gut problems can cause havoc so systemically. And then with environmental detoxification, even the World Health Organization wrote that lead and arsenic causes insulin resistance and an increased risk of diabetes. Mercury as well. Now the PCBs, the PCBs are very well studied for gaining weight and becoming diabetic. The phthalates, which I may have spelled wrong. I don’t know. It’s hard to spell the word phthalates. And then they study the Canadian Aboriginals with their high risk of diabetes, a much higher body mass of environmental chemicals. There is this organization, diabetesandenvironment.org, it’s a nonprofit created by a researcher woman whose son developed type one diabetes. And she collects all the research on environmental impacts on type one and type two diabetes. And she has a free newsletter that you can get, I think it’s every week or at least every month.  Sarah, somebody, I forget her last name. But I think one of the most important studies was this bottom one that I made red. So they had two groups of obese patients that were equaled out in age and smoking and drinking, all of that was the same. And then they had, one group had diabetes and one group didn’t though they had the same obesity. And what they found that was different in this group with diabetes was this significantly higher levels of persistent organic pollutants in their fat through fat biopsies. So you’ve got overweight people. Who’s going to turn into a diabetic? Likely the one that has more environmental chemicals in them, such as POPs, PCBs, et cetera.

So it’s pretty frightening given how much people use these at home and it’s on our food. And if you walk into a store, I mean, they’ve been spraying toxins for bugs and stuff. We can’t get around it. You see this fantastically horrific statistic that newborns have almost 300 chemicals now in their cord blood. It’s crazy. So we do want to detox patients, getting their house clean, no fragrances at all. Have all their supplies and body stuff being clean, using natural weed killers or pulling them. Here in Arizona, there’s an exterminating company that’s all organic. I used to use them now [inaudible 01:08:47]. Yeah, I had a big ants problem. The ants suck in Phoenix. But they would come and they’d spray peppermint oil, literally. Not in the house, they never sprayed in the house, but outside they would go and- They never sprayed in the house, but outside they would go and they would spray peppermint oil. But honestly now diatomaceous earth works fantastically. We got to retrain people to not have all these chemicals around in their own homes and then to detox.

Now sweating, there’s loads of studies with sweating. I have them, I didn’t put them on the slide, but sweating releases chemicals, heavy metals, even micro toxins like okra toxin has been found in sweat.  When I went to medical school, when we did dead lab, just working on cadavers, it was in an old RV that didn’t have any ventilation. It was disgusting. Of course all the formaldehyde. And so what we would do is, of course we wore onesies of plastic and whatever, but nonetheless, as soon as dead lab was over, we’d run to our gym, which had a sauna. So I’m in the sauna, maybe 20/25 minutes after class and I could taste the formaldehyde coming out of my skin. I could literally taste it, in the sweat. It’s crazy.  So people don’t sweat in America because it looks, oh my god, I have an arm thing. So we want to teach patients always sweat, wear enough clothing so that when you exercise, you sweat, get a sauna, sweat in it, go out and sweat, just sweat, it’s so detoxifying.

And then there’s many other things with detoxification that I’m already probably boring you in overtime, but I don’t have time to do it, but you guys already probably know how to detox mold or chemicals, heavy metals. All of these can be a problem for diabetes. But number one, if someone’s finances are limited, you definitely want to do chemical testing. That’s number one for sure.

Last, this is my last section, is supplementation. Supplements do everything from better mood to antioxidants. Now, diabetes causes damage through oxidative pathways. That’s what it’s doing. There’s the hexosamine pathway, there’s a browning pathway. There’s many pathways of pro oxidative damage going on in the body, that’s causing diabetic damage. You always have to put people with diabetes on antioxidants, aside from other ones, I will always put people on a multivitamin. I always put people on a fish oil, but the next thing is antioxidant protection so their blood sugars will not cause damage in that regard. And not only that, but you can reverse neuropathy, you can reverse kidney damage.

 I have an obese guy who went off the wagon over the last couple of months, on his diet. He had positive random microalbuminuria. And so I have him on some antioxidants and I have him on this great tincture, it’s from Heron Herbs, it’s called Two Treasures. It’s a such a great kidney protection formula. And so he’s on it. And so even though his A1C went up, his kidneys remarkably got better because of the antioxidants and the herbs, which was amazing and surprising, but beautiful to see. His kidneys really got a lot better. So our antioxidants and our supportive products really can make a difference in these patients.

Dr. Weitz:                            What would be your full program for a patient with kidney disease as far as supplements?

Dr. Morstein:                     Well, let’s go through some of them, and I’ll give you a [crosstalk 01:13:20]… I have a supplement summary [crosstalk 01:13:23]…

Dr. Weitz:                            Okay, good.

Dr. Morstein:                     Now for Type 1 prevention, fish oils reduce risk and so does vitamin D3. There’s no reason an infant can’t be on 1000 IUs a day. And if his breastfeeding mom can take fish oil, which mom should, because fish oils are really good at preventing postpartum depression, for her to take it during pregnancy and afterwards, or I would just do that through the breast milk for a breastfeeding newborn.

But as they get older putting them on fish oils and vitamin D, this is just a good thing. Especially if there’s, God forbid, any autoimmunity in their family. Now, if they develop a honeymoon, there are studies that showed these niacinamide alone or with vitamin E actually can help prolong the honeymoon. Now you might also want to throw in a pancreatic glanular, you might also want to throw in a Gymnema Sylvestre, an herb that has been shown to help revive the pancreas and even increase the C-peptide and it is not niacin, it’s niacinamide. But you can see it doesn’t prevent people from getting diabetes but if the kids enter a honeymoon period, this can help extend it. And honeymoon periods, they can go for years. I have worked with kids who had seven year honeymoon periods. It can also just last for weeks, so we don’t ever really know. But we want to try to extend that as long as we can, if the child initiates it to begin with. We never really see it in our Type 1 adults.

Now supplements. So if you’re adding supplements you’re not going to have to adjust the insulin, it’s not that extreme, so don’t worry about that, okay?

Benfotiamine, if that’s how you pronounce it, is a fat soluble fireman. Now this kind of twists us, because we usually think fat soluble is a little harder to absorb than water soluble, but not benfotiamine, it’s much more absorbable. And you can see the biochemistry where it’s becoming the cymene pyrophosphate, it increases transketolase activity and that blocks glucose damage. It prevents that browning glucosylation of sugar landing on protein, and so that’s what it’s blocking and this is amazing and it’s very good. The therapeutic dose is around 450 milligrams. And there’s studies in protecting neuropathy, retinopathy nephropathy. Well, that’s what we’re looking for, right? So it’s totally safe.

 I have a product, this is totally proprietary formula, but I made a product called Diamend and it has benfotiamine in it at therapeutic dose, but even if you’re just doing it by itself, it’s a really good product, mixing it with alpha-lipoic acid or just giving alpha-lipoic acid and particularly R alpha-lipoic acid, because the S alpha-lipoic acid is not active in the body, but the R is. So, this is also shown to normalize AG formation, advanced glycosylated end products, hexosamine is an oxidative pathway. So it’s really helping people.

Dr. Weitz:                            What dosage of lipoic or R lipoic acid…

Dr. Morstein:                        You’d want to do at least three to 600 milligrams a day of R. Now, if you’re doing just alpha-lipoic acid, which is half R and half S, then you’d want to be around 1200 so you get that 600 of the R and you could throw out in your body the 600 of the S.

Other supplements, vitamin C preventing the aldose reductase pathways in your eyes. So when you have a blood sugar of 200 and your eyeballs get 200, that’s too much stuff in your eyeballs, so it starts off shooting off a lot of antioxidants to keep the osmolarity from I guess, your eyes from blowing up. So, meanwhile then, that’s turning to sorbitol and the antioxidants are thrown out and we get fructose, and then we get cataracts, we get retinopathy and so forth.  Now, vitamin C and bioflavonoids inhibit that initial pathway. The problem is we have to watch vitamin C with people with diabetes no more than 1500 a day, because it looks like glucose, and it can raise glucose levels on some glucose meters. We know that when we give IV glucose, usually people need to have a snack, because that can kick out their insulin and lower it when we are giving vitamin C. So, a little C and bioflavonoids are fine. The alpha-lipoic acid, NAC, N-acetyl cysteine does a lot of stuff for people with diabetes. Of course, we always think of it producing glutathione and liver and lung protection, but it does decrease insulin resistance, and of course, a very good antioxidant in general. So [nic-taurine 01:19:43], good for the eyes, especially with retinopathy, it’s the number one amino acid in the heart. Of course, it does help make a bile salt in the gallbladder, but that doesn’t tend to be necessarily a big thing with diabetics. The fatty liver could make a gallstone however.

The acetyl-l-carnitine at 1500 to 3000 milligrams. Even Diabetes Care Journal, which is from the ADA journal has good studies showing how it reduces peripheral neuropathy. A very good safe one.

Magnesium tends to be the number one nutrient deficiency in patients with diabetes. So maybe checking their red blood cell magnesium as well.

The Gymnema Sylvestre, which is called Gurmar in India, sugar destroyer, decreases cravings, helps increase pancreatic functioning. Here’s a really great thing for your patients who have very little willpower, particularly around the holidays, is that if you have Gymnema Sylvestre in a tincture, I used to do this when I was at the medical school and saw students, we would eat a little organic raisin, so sweet, then put a couple of dropper fulls of Gymnema tincture in your mouth for about a minute and then swallow, and you can’t taste anything sweet for up to one and a half hours. So you put raisins in and they’re these disgusting things you can’t taste, you have to spit them out.  So for patients who cannot control their cookies at the holiday parties, put some Gymnema in their mouth and swallow it and they can’t taste it, they’ll have to spit it out. You can’t eat it, it’s really intense. Very helpful.

And then of course, curcumin just awesome, tumor necrosis factor alpha, as I said, is an insulin resistant factor. It’s an antioxidant, it’s an anti-inflammatory, we know it reduces Alzheimer’s in diabetic patients. Ben already did all the talk about berberine. I do have the method of action [crosstalk 01:21:58].

Dr. Weitz:                            By the way, do you have a favorite form of curcumin?

Dr. Morstein:                     Oh, curcumin for sure. I think the best is Designs for Health Curcum-evail; that stuff kicks butt, I think, so that’s the one I use, it’s Curcum-evail by Designs for Health. And then here’s the berberine method of action, it’s just like he said, the AMPK, everything it does. Green tea, blueberry. If I had to choose between Gymnema and bitter melon, I will always choose Gymnema myself. Of course, we have the old cinnamon studies, like the one, the two and the six grams a day, how it helps, it doesn’t hurt anybody to do cinnamon. They have done a lot of studies on it.

Dr. Weitz:                            Doc, what dose of Gymnema Sylvestre?

Dr. Morstein:                     Oh, with Gymnema, anywhere from three, in my product there’s a thousand, but anywhere from 400 to 2000 is a good safe dose, and you should see some effect. So, if you have patients who have proliferative diabetic retinopathy and you’re going to lower the blood sugar, you could cause them to have a bleed. And you cause them to have a bleed because when the blood sugar goes down, the insulin goes down, but then insulin like growth factor comes out and that causes angiogenesis. And that causes a bleed.  So I did cause a bleed in a patient with PDR early on, and that was horrifying because they needed laser, it was a fiasco. You feel terrible. But then I decided to not have that happen anymore with patients who had PDR. I know it looks like a lot. They only need to be on this for a month or two with the initial lowering of the blood sugar.

But, in two other patients with PDR, they never had any problems with their eyes. It was very stable. Now I put everybody on a multiple vitamin and fish oil. I will use my diabetic product, which means it contains alpha-lipoic acid, it contains bilberry and NAC and benfotiamine, so that product contains that stuff. So I would add in taurine and a little selenium, and you’re going to protect these eyes so they don’t bleed with the sudden drop of the blood sugar in their eyes.  But before you do a low carb diet, patients are like, I haven’t been to the eye doctor for a couple of years; you’re like, okay, you go and when you’re done, come back, because I’m not going to put you on a protocol until I know what’s going on with your eyes.

So this is basically a multiple vitamin, mineral, fish oils, comprehensive diabetic product, or breaking it down individually, probably some vitamin D3. I use vitamin D3 complete, from allergy research, that comes with vitamin A, because you need vitamin A, because the vitamin D receptor is bound to an RXR receptor, a retinoid X receptor. So if they don’t have enough vitamin A, their vitamin D receptor won’t work and the whole process doesn’t work. So you have to throw in a little vitamin A, K and so forth. So, that’s my lecture. I’m sorry if it went too long.

Dr. Weitz:                            No, no, it was awesome. Can you mention that herb that helps with kidneys?

Dr. Morstein:                     Yeah. I can write it. Should I write it in the chat?

Dr. Weitz:                            That’d be great.

Dr. Morstein:                     So it’s from Heron. So it’s Heron Herbs, which is owned by Eric Yarnell, who is a master herbalist. And his specialty is men’s health and kidney health. And so he made this product called Two Treasures and it’s a tincture. And so that’s what I use, I use that with patients who are on lithium, people who have kidney damage for whatever reason, it’s a really [crosstalk 01:26:45].

Dr. Weitz:                            Yeah. If you have a patient with chronic kidney disease, what would be your full program, what else would you put them on?

Dr. Morstein:                     Well it depends. If it’s a IGA nephropathy, I’ll do food sensitivity, testing of IGA, not IGG, but IGA. I use Alletess and they have an IGA option. They have IGG. So I would do that tidy up the diet. Fish oils are great for the kidneys, Ginko and salvia miltiorrhiza is great. This Two Treasures is great because it has a lot of the other herbs, the [Peristeria 01:27:28], the rhubarb, all of the other herbs that, we have science, I have a whole lecture, I think I might talk about it in my book, but I have a lecture on treating, more specifically, complications in patients with diabetes. And I go over the science and the herbs and so forth with them, but you’d want to do cordyceps. There’s a naturopathic physician, Jenna Peterson who had kidney disease and that’s her whole practice, is treating kidney disease. She wrote a [inaudible 01:28:03] article and said for sure cordyceps with kidneys as well.

Dr. Weitz:                            [inaudible 01:28:10] data on astragalus?

Dr. Morstein:                     Well, she specifically said cordyceps.

Dr. Weitz:                          Okay.

Dr. Morstein:                     But, when is astragalus going to hurt anything.

Dr. Weitz:                          And of course, we have modified citrus packed in.

Dr. Morstein:                     Yeah. I don’t use that for the kidney very much, mostly I use to prevent cancer metastases, but I haven’t used it… Oh, thanks. Thank you. So, I actually haven’t known to use that for the kidneys.

Dr. Weitz:                          Yeah. Apparently it prevents fibrosis, chronic kidney disease, there is some data on it.

Dr. Morstein:                     Luckily so does the alpha-lipoic acid and the benfotiamine.

Dr. Weitz:                          Okay.

Dr. Morstein:                     So for sure.

Dr. Weitz:                          Excellent. Okay. Well, that was awesome doc.

Dr. Morstein:                     Thank you. Thank you. Thank you everyone, I appreciate that. Thank you.

Dr. Weitz:                          Absolutely. And thank you everybody. See you next month. Thank you, Mona.

Dr. Morstein:                     Okay. Take care, Ben.

Dr. Weitz:                          Okay, bye.



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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Longevity with Dr. David Haase: Rational Wellness Podcast 252

Dr. David Haase discusses Longevity and Regenerative Plasma Therapy with Dr. Ben Weitz.

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

 

Podcast Highlights

4:17  When dealing with a patient with memory problems or other signs of cognitive impairment, we need to understand that dementia is accelerated aging of the brain and dementia literally means un-braining.  Alzheimer’s is a process rather than a disease. Often patients with dementia are in denial, which is understandable. But denial makes it difficult to get help. And the other side of the coin is despair, which is also not helpful. Unfortunately, once patients are having symptoms of dementia, they are already at an advanced stage of their disease.  Our brain has amazing resiliency and is overbuilt so that we can handle an injury or trauma and if it slowly degenerates, we can keep compensating and compensating until symptoms become apparent. In Parkinson’s Disease, we may have lost almost 90% of the neurons in the substantial nigra before we start having shakes.

9:12  Conditions that are precursors for neurodegenerative diseases are all the degenerative medical conditions like diabetes and prediabetes, heart disease, depression, and also head injuries.

17:47  Regenerative plasma therapy.  This is a form of apheresis, which is when you take the blood out of the body, do something to it and then put it back in the body. What Dr. Haase is doing is separating the plasma, the liquid part of the blood, and replacing it with young plasma.  There are compounds in the plasma of older individuals that are perpetuating aging that you will be removing.  When you take the stem cells from an old mouse and place it in the plasma of a young mouse, the stem cells start behaving young again. Dr. Haase is running the largest, free standing outpatient plasma exchange center in the US and they are providing this plasma exchange for patients with neurodegenerative diseases as well as for longevity and wellbeing.  The AMBAR trial was published in July of 2020 [Boada M, Lopez OL, Olazaran J, et al.  A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer’s disease: Primary results of the AMBAR Study.] and they did plasma exchange on patients with Alzheimer’s disease and they showed that over 14 months in individuals with moderate Alzheimer’s disease, they had a 60% decrease in the rate of progression.

36:25  Where does the new plasma come from?  It is a pharmaceutical plasma. They take plasma from plasma donors and they separate out the albumin and then heat it for about 160 degrees for a full day, which kills off anything that could possibly be hanging in there and that albumin is no longer a tight bundle of an amino acid chain. This means that the albumin can now function like a biological sponge again.

 

 



Dr. David Haase is an Integrative Medical Doctor from Vanderbilt and MayoClinic.  In his MaxWell Clinic in Nashville, Tennessee he is innovating in the fields of nutrition, genomics, systems biology, apheresis, and brain assessment to help his patients slow the aging process and live longer and healthier lives. One of the techniques that Dr. Haase has been pioneering is the use of is Regenerative Plasma Exchange.  He wrote a book, Curiosity Heals the Human and his website is MaxWellClinic.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 and cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates, and to learn more, check out drweitz.com. Thanks for joining me. And let’s jump into the podcast.

Hello, Rational Wellness podcasters. I’m very excited today to be having a discussion with Dr. David Haase on longevity and brain health. Dr. David Haase is an MD from Vanderbilt and Mayo Clinic and in his Maxwell Clinic in Nashville, Tennessee, he’s innovating in the fields of nutrition, genomics, systems biology, apheresis and brain assessment to help his patients slow the aging process and live longer and healthier lives.  He’s written a book, Curiosity Heals the Human. And one of the innovative techniques that he’s been pioneering is the use of regenerative plasma exchange, which we’ll be discussing in our talk today. So welcome, Dr. Haase.

Dr. Haase:           Ben, thanks so much for having me on. We appreciate it.

Dr. Weitz:            Absolutely. So let’s see, I listened to your Ted Talk and your Fireside Talk and I wanted to say, I relate to the fact that like you, I did not get into functional medicine because I was suffering some disease that I needed to heal, but just wanted to help others.  And it just seemed like a really good way for me to do it by trying to get to the root cause of some of the problems.

Dr. Haase:           Gall-Lee, right? I love the title of your podcast, Rational Wellness. I mean, to me, that’s exactly right. It’s like some of it just, why are we doing this?  When that question doesn’t have a good answer well, you get to start looking deeper, so.

Dr. Weitz:            Right. When you have Alzheimer’s, why are we going to prescribe a drug that costs $60,000 a year that doesn’t make anybody better?  There’s one example. Why not use it a functional medicine approach, which has been shown to reverse the aging process and restore brain health?

Dr. Haase:           Yeah. It really is a challenge, especially when we’re dealing with unique humans. And we have a system that doesn’t really acknowledge or support individual variability because the whole realm of the blockbuster. The blockbuster is what our economic world and the pharmaceutical schema is based on to have one intervention that’s going to fix everybody. And-

Dr. Weitz:            Really?

Dr. Haase:           And it’s never been the way humans have kind of worked, right? The way you raise one child doesn’t work for the way you have to raise the next two or three or four or five. Right.

Dr. Weitz:            Exactly. So when you give one of the patients that drug and they don’t respond, then we conclude, they had a side effect, instead of that drug was never going to work for that individual patient. It’s their unique physiology and biochemistry and everything else.

Dr. Haase:           Mm-hmm (affirmative). Mm-hmm (affirmative). Yeah. Yeah. So it’s interesting. I think honoring individual is for really what each one of us want to do. It’s also what makes us have fun in healthcare. I mean, I love what I get to do. I love practicing medicine. I love teaching other clinicians. And I think that’s because, like I said not plugging my book, but I did write a book called Curiosity Heals the Human. And I think that’s the first step is just to be curious as if what you’re doing right now isn’t working for you. Then the first step is to be curious about why that might be, and then dig in further, so.

Dr. Weitz:            Yeah. Good, good, good. So why don’t we start, maybe with, let’s say a patient comes into your office, how would you work them up? What sort of questions would you ask? What tests would you give them? What panels might you run? And maybe we can start with a patient who is concerned about their memory or has signs of cognitive impairment.

Dr. Haase:           Mm-hmm (affirmative). Yeah. Wow. That’s a big question.

Dr. Weitz:            I know.

Dr. Haase:           Yeah. You got-

Dr. Weitz:            Let it go wherever you want it to go.

Dr. Haase:           You got a couple weeks to answer that one, so. I think-

Dr. Weitz:            Just looking for a couple of clinical pearls.

Dr. Haase:           Well, I would say a couple of the clinical pearls are really important thing when dealing with somebody with dementia is to recognize you really have three goals and helping patients recognize this is really helpful. That really, we have a… That’s because dementia is really accelerated aging of the brain, it is dementia literally means un-braining. And so that’s where name a process rather than actual disease. I like to say that, hey, people are Alzheimering rather than have Alzheimer’s.  And that’s actually really useful for patients to recognize that, wow, I don’t have a disease. I am involved in a process. And if that’s the case, then there is the possibility of saying, “Well, how might I understand this process and change my trajectory in that way?” So I think that, and if you recognize that aging is essentially having more damage in any period of time than you have regeneration. More injury versus repair, that’s what aging is.

Dr. Weitz:            Right. Because we’re constantly in this process of building up and breaking down and it’s a question of which way the balance is tipping.

Dr. Haase:           Right. Right. And how much have we accumulated in that way? So I’d say one of the first things I do with patients is I step back and I really ask what is their understanding about their present condition? What do they understand about dementia? And that’s really useful because a lot of people are caught in either, just a cage of a denial. So the family member has brought them in and they’re trying to say something. And if they’re in denial, man, they’re doomed.  Denial is the worst comorbidity when it comes to neurodegenerative disease. Because, and I think it’s rational to have denial because we’ve lived in a world that we’ve been preached at for so long that, well, there’s nothing you can do about it when your brain’s going well, just, there’s nothing to do. So kind of a rational course of action would just be to deny that it’s a problem.

So you have this quality of life. You don’t worry about those things, but denial is a problem. But also the other side of that is despair. So if people are just realizing that they can’t do anything about it, that’s going to be the other side of the coin. So either denial or despair, the two polar opposites kind of have… I think of them as two valleys that you can fall into. And we have to ride this ridge in between the two valleys of being proactive and rational in the assessment.  And it’s just really helpful to talk to people about how are they feeling denial and how are they feeling despair. And especially when we’re in this endeavor, golly, it’s a big deal to try to deal with neurodegenerative disease, because when people first start having symptoms, they are in an end stage of the disease.

I mean, that’s not something people like to hear, but when you first start having a symptom, because our brain is built with such amazing resiliency and we have so much… Our brain is overbuilt so that we can handle an injury or a trauma, but, and if it slowly degenerates, we can keep compensating and compensating and compensating until we can’t compensate anymore. And that’s when we start having symptoms.  Well, in Parkinson’s, we may have lost almost 90% of the neurons in the substantial nigra before we start having shakes. And people don’t understand that. And as a result, they come in with their first symptom, they think, “This is early. This is the first symptom I’m having.” And it’s a challenging and sad thing to have to orient them to say, “Yes. I’m really happy you got in when you did and we’re already behind the ball here. So it’s a full court press moving on.”

Dr. Weitz:            Just back up for a second, what would be some early signs before they’re advanced, where we might be able to identify somebody who’s starting down the road towards Alzheimer’s or Parkinson’s?

Dr. Haase:           Yeah. Well, gosh, name a degenerative medical condition, because they’re kind of all a pre dementia. I hate to say it that way. So if you think of diabetes we already know that Alzheimer’s we’ve thought of it as like type 3 diabetes in some cases, because there’s insulin dysregulation. So just me having insulin dysregulation is a predisposing factor to this multi-system degeneration. Individuals that have depression, a lot of depression is inflammatory based. So if we think about neuro inflammation as another pathway towards moving towards depression, that’s something that should be paid attention to.

What about having a head injury? That’s a predisposing factor. And even I’m always amazed by just how much resiliency comes from people having more education, right? So individuals who don’t work their brain are going to have more likelihood of progression on towards dementia. Now, I went way back there. You were asking me, “Hey, what are some of the early signs?” I didn’t list out symptoms that you would think would be neurodegeneration, but neurodegeneration really is a multi-system failure. That’s how we get to where we are. It’s why it’s so challenging to treat.  It’s not as simple as early insulin resistance or diabetes you can start changing the diet and exercise and see massive transformation in the process. But if you already have neurodegeneration there’s problems with your mitochondria, with lysosome function, with intercellular aggregates of abnormal proteins, of extracellular aggregates of abnormal proteins, you have senescent cell accumulations. There’s so many pieces of dysfunction that accompany neurodegeneration.  That’s why it’s been very frustrating to the pharmaceutical industry to have a single pill for an ill because you can only address one or two things in that process.

Dr. Weitz:            Yeah. I mean, pharmaceutical industry has been focused on the one pathway and the one drug that interrupts that pathway. And when you have a multisystemic condition, it’s not going to work.

Dr. Haase:           Yeah. You mentioned my Ted talk and I just noticed my background here I have my tensegrity structure. So I have had… And yourself in the chiropractic background, you’ve seen some tensegrity structures, but most of my medical colleagues have never seen one of these things. Right. And aren’t they fun?

Dr. Weitz:            Yeah. Cool.

Dr. Haase:           I think everybody should have one to play with. I really do. I do because, it’s this beautiful representation of a complex dynamic system. You’ve got a whole bunch of components that don’t seem to be linked to each other, but those are the items of integrity like the bell rods. And then you have all of these rubber bands that are the tensioners. So you have a tensegrity system and this is a great model of biology. It’s not just a model of structure. It’s actually a model of how hormone structure can work. If you affect one part of the system, the entire rest of the system will adapt and change if it’s healthy.  But if it starts getting stuck, you get this integrity structure that starts getting tied onto to itself and twist it around if you start putting a stressor onto it can’t adapt. It can’t bounce back. And I think that’s so much the cause of so aging is a multifactorial process and that’s one of the reasons why it’s not any type of intervention that kind of only does one thing. I don’t hold a lot of hope for it. Finding that one gene that’s going to turn off aging, good luck.

Dr. Weitz:            There was the hope that the mapping the human genome was going to be the key to curing all human disease. And that hasn’t really worked out.

Dr. Haase:           Yeah. But hasn’t it taught us just how miraculous we are. I mean, wow, wow. Our ability to self heal is just profound. I think that’s what I always anchor back on is that the body is really designed to heal. We cut our hand, it knows how to knit itself back together. That knowledge, the body is way smarter than I am is actually what inspires me all the time to say, “What are those factors that I could find to open the body to healing and yep.”

Dr. Weitz:            Yeah. I mean, what are the things that are interfering with our bodies innate ability to heal? And then what are the things the body doesn’t have enough of that it needs to heal?

Dr. Haase:           Mm-hmm (affirmative). And then I put two more categories in there. What dysfunctional cycles is the body caught in that it needs to be retrained out of. And also what type of a damage needs to be repaired. So for me, it’s remove, replenish, retrained and repair. Because and that when it was start getting-

Dr. Weitz:            A variation on Jeffrey demands for our program. Yeah.

Dr. Haase:           Well, I think it’s from the wonderful law of the tax. If you’re sitting on attack it takes a lot of aspirin to feel better. That was Sid Baker. Sid Baker said, “Well, the foundation of functional medicine was really to rid and get. What bad things you need to rid, what things do you need to get.” But as you start traveling into longevity medicine, we need a couple of more categories. We really have to think about what are we stuck in that we need to retrain? And then also if it’s damaged, we’re going to need to repair or regenerate.  And that is a… And especially if we have lost our internal resiliency and we have accumulated a lot of damage. We just keep getting… It’s like a spiral. Health is either a spiral up as people get better or more commonly, it’s a spiral going down as we keep losing capacity that causes an acceleration of our decline down. And that’s why the repair starts becoming more and more important.

 



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 what are some of the most important ways to repair our bodies?

Dr. Haase:           Well, to talk about is our regenerative plasma exchange that we’ve been doing. But I think the why, behind this is super interesting. So let me say what it is first of all. So regenerative plasma exchange is a type of apheresis. Apheresis is when you take blood out of the body, do something to it and then put it back in the body.  And we had a conversation before starting this recording you can apheres out LDLs, you can remove out cholesterol and help turn back heart disease. Or you can use apheresis to remove cancerous cells or to treat a certain subset of cells. Or you can even use apheresis to remove red blood cells in a sickle cell patient and then replace them with a transfusion of healthy cells.  What we’re doing is plasma apheresis. And that means the blood is pulled out of the body. We process it live in such a way that the plasma, the liquid part of the body gets separated from all the rest, the cells and the platelets, and then the cells and the platelets are recombined with a clean replacement fluid. And then that gets put back into the body and that’s done continuously and that’s not done in a small amount. So if you were sitting in our chair, we’d remove about three liters of your plasma in a single setting. That’s what the plasma exchange is really about, but the, why behind it becomes really interesting, so.

Dr. Weitz:            Is this similar at all to, I heard discussion at some seminar years ago of some clinic overseas where you get young blood.

Dr. Haase:           Yeah. So actually, if we go back to the rationale behind this, it does go back to this idea of young blood. Young blood is such an interesting story. I mean, this goes back to Russians on the battlefield taking in-

Dr. Weitz:            Oh, boy. Are you talking about Russians on a battlefield.

Dr. Haase:           How about that? Yeah. Bad timing.

Dr. Weitz:            On the day of World War III.

Dr. Haase:           I mean, well, bad timing for that to come. But anyway, so there’s somebody who actually experimented by taking the blood of some other youth and infusing it and thinking that was going to help them. Well, they eventually died from that practice because that’s a challenging thing to do. They didn’t know a lot about immunology 80 years ago. But there’s all this idea that’s the health is in the blood. The health is in the blood. Studies were done called parabiosis. So they took this into the research laboratory. And they took mice that were clones of each other and they’d have an old mouse and a young mouse and they’d actually sew them together. They’d sew them together so that they had a little flap of skin in their abdomen that connected them.  And low and behold after about a week an amazing thing started to happen that the old mouse that was connected to the young mouse started to turn young, multi tissue, regeneration started to occur. The skin cells started to become healthier. Fatty liver started to reverse, bones started to become thicker again from osteoporosis. The sense of smell improved, T cell and B cell function improved.  I mean, it was really quite remarkable and that young mouse got stunted by exposure to the toxin of old, cause old is toxic. I mean, I hate to say that, it’s not a popular thing to say, but there are compounds in the bloodstream of an aged individual that are perpetuating aging that are actually moving aging forward. That’s a remarkable insight. But anyway, if you separate these mice, there’s no harm done to the young mouse. And there may even be some age extension in the old mouse.

Not a lot of those studies have been done, but it’s really remarkable. So then they went to start looking at stem cells. Well, we know that cells in culture grow better when they’re in a healthy culture media. That’s just something we’ve known. We’ve been growing cells at every university ever. And we know that the culture media makes a big difference as to the health of the cells. Well, no, duh, because that’s the same way it is in our body. Our cells are deeply terrain dependent. Our cells are deeply dependent on the habitat that they live in.  What they did is they took the plasma from a young mouse and they put it into a Petri dish that had stem cells from an old mouse. And those old stem cells started to behave young again. So if you change the environment, the stem cells will change their behavior. That’s very interesting. That’s very interesting. So everybody got really excited about all this and said, “Hey, let’s start infusing plasma from young individuals.”  And I think that still holds promise. That’s not done in the United States yet. Or I mean, that can be done, absolutely can be done. And I actually did the first young plasma exchange, or that’ll actually going to be published soon. And through a American Association of Blood Bank certified, a blood bank and such, and actually pretty remarkable results in an individual with Alzheimer’s disease. Now, that’s not something that’s widely available, but that can get distracted, because people can think, “It’s all the good stuff in young plasma that’s actually there.”  Turns out it’s not so much this good stuff that’s in young plasma, which I think there’s plenty there. It’s the bad stuff that’s in old plasma that needs to be removed. So anyway, it’s so interesting to me, Ben, because this whole field of plasma exchange is proving what we’ve been talking about in lifestyle integrative functional medicine forever.  If you have healthy plasma as a result of living a healthy life, your cells are going to behave healthier and going to live longer. Anyway, so it’s a really fascinating story. And I think it’s one of the most exciting stories in all of longevity medicine.

Dr. Weitz:            And that’s why there’s so much focus now on fasting and intermittent fasting because that stimulates this process where we get rid of old broken parts of the cells. We know clearing out broken junky parts of our metabolism, our cells, proteins that are tangled and not working well is an important part of longevity.

Dr. Haase:           Yeah. So if you think about this, so what’s a very important human trial that supports a lot of what we’re doing because we have the largest free standing outpatient plasma exchange center in the United States. And we are providing this plasma exchange service for people with neurodegenerative disease, as well as individuals that are looking for improving their wellbeing and longevity, we’re tracking longevity markers. Lots of interesting fun stuff there.

Dr. Weitz:            Are you looking at DNA methylation as part of that?

Dr. Haase:           Yeah. We’re looking at DNA methylation, glycan patterning, telomere lengthening. Actually doing additional studies in large throughput single cell RNA transcriptomics. I mean, we’ve got all kinds of… We’ve got a couple of IRBs that are out and it’s fun because I really think this is at the cutting edge of what’s going to happen because if you can clean the blood, the body and brain work better. I mean, that’s just pretty straightforward. But what’s interesting, anyway, so there’s a human study that really backs up what we’re doing and that’s called the AMBAR trial.  AMBAR trial ended up being published in July of 2020. I’ve been tracking this study for the last five years. And it’s where they looked at individuals with Alzheimer’s disease and they did this plasma exchange procedure on them. It was a multinational, double blind, randomized, placebo controlled, sham controlled trial and done in the United States and Spain.  And they looked at about 350 or so individuals with Alzheimer’s disease, mild or moderate disease. And what they were able to show is that over the course of 14 months in individuals with moderate Alzheimer’s disease, they had a nearly 60% decrease in the rate of progression, 60% decrease in-

Dr. Weitz:            That’s great.

Dr. Haase:           The rate of progression with this therapy and that was doing a plasma exchange once a week for six weeks and then a monthly plasma exchange after that. And so they had highly statistically significant findings in functional improvement and just missed a statistical improvement in their primary measure of cognitive performance. But they did have several secondary measures of improvement in cognitive performance that met secondary criteria, but they also showed that the CSF of these individuals with Alzheimer’s disease normalized when they had plasma exchange.  They also did FDG-PET scanning, and they showed that there was less cellular death in the brains of individuals at had a plasma exchange compared to the ones who had placebo. So all of that together is like that was really profound to start taking a look at one of the worst degenerative diseases that exist in Alzheimer’s disease could be that the trajectory could be shaped differently based upon this cleansing intervention.

Dr. Weitz:            And I’m assuming this would just be part of a functional medicine protocol for you.

Dr. Haase:           Yeah. For us, yes. I mean, I was like when we talk about plasma exchange, plasma exchange is standard of care for severe autoimmune diseases. And we treat those patients as well. And we’ve actually had some wonderful success with scleroderma. We’re looking to run a trial on that, but we are also… See, plasma exchange think about it. It’s a little bit like a snowblower. I grew up in South Dakota, so I know snow and I went to did residency at Mayo clinic.  So Rochester, Minnesota has lots and lots and lots of snow. And so when it snows a whole lot, and I think of snow is all these dysfunctional problems. These extracellular aggregates, these oxidative molecules, these amyloid beta proteins that are building up, if those are built up and built up, and it’s amazing, you can take in with plasma exchange and really clean it out.  But the problem is if you’re not addressing how much it’s snowing, it’s not going to work as well. So I really think that this is a wonderful adjunct therapy and we have several functional colleagues that are sending patients to us for this. And they’re doing all the additional supportive care, but I mean, I think it’s always important to treat people as comprehensively as we can. But what’s interesting is even without all of that, even without the functional medicine approach, this still had a larger effect size than any other intervention that’s ever been documented at large scale.  So it’s anyway, pretty exciting stuff. Hey, I got a quiz for you. So what component in the blood has the most antioxidant potential? What component in the blood is your most important antioxidant? Nobody gets this Ben, so don’t feel bad.

Dr. Weitz:            Well, which is why I’m not going to mention any the obvious ones. So I’m going to guess platelets, how about platelets?

Dr. Haase:           Okay. Any guess is a good guess, but by far it’s albumin. Albumin, the actual main protein that it floats in the bloodstream has huge antioxidant potential. As it’s floating around, it is constantly scavenging all kinds of reactive oxidative species and toxins that are electrophilic and it’s going around and it’s absorbing amyloid beta to itself. And it’s becoming glycated so albumin has a limited functional lifespan. So as you get older, the fresh albumin your liver makes doesn’t take very long for it to get fully polluted as it’s-

Dr. Weitz:            Well, it sounds like it’s a chelating agent, a natural chelating agent.

Dr. Haase:           There you go. Yes, exactly, it is. You look at calcium levels in the bloodstream, they’re highly dependent upon how much albumin is there. You have a free calcium level or a total calcium or iodide calcium. And it depends upon how much albumin is there. So albumin is so important, but it’s like the water we swim in or wait a second. It’s the water that swims inside of us and…

Dr. Weitz:            Essentially it’s a finding protein, right?

Dr. Haase:           God, that does so many things. It can’t be put into a box. And so this whole idea that if we remove the old albumin and put in albumin that is essentially fresh and clean, or has less of this impairment, is that going to be a benefit? And that’s what the whole AMBAR trial was based on. So it’s really, there’s so much to learn here. Every good answer brings up an additional three or four questions, so.

Dr. Weitz:            Yeah. It sort of reminds me of some of the research that Dr. Perlmutter is doing with fecal microbial transplant and putting in a new microbiome.

Dr. Haase:           Yeah, exactly. Because think of what that does. It changes the plasma. So listen, it all comes back to plasma, Ben. I have now developed a bias. I have developed a bias. I’m proud of it. But plasma is the great interface between the outside world and your innermost parts. If you really think about it, if you breathe something in, or if you put it on your skin or it’s absorbed through your gut, how does it get to your brain? It has to go through the plasma. Unless of course, you breathe in, it goes straight through your olfactory system. There’s exceptions, but the plasma is the great river.

Dr. Weitz:            Now, what about treating a blood with ozone, like a lot of functional medicine practitioners there?

Dr. Haase:           That’s really not part of the protocol that we do here. I mean, I’m very familiar with that. We’ve used that as a therapy. And I think that, again, what role does each of these interventions play? The reason I love our regenerative plasma exchange so we can really stay on the shoulders of really good research and make sure that moves forward. But I think each one of these tools has different utilization, but here’s the interesting thing. I want to come back to the plasma exchange because stem cell therapy is almost synonymous with talking about longevity.  And I’m always been a little bit reticent to really dive into stem cell therapies because you’re taking cells from another person’s body and injecting them into you. And I think it really has some purpose, but what stem cells are the most important? The stem cells that are in your own tissue. You have stem cells in every organ of your body, everywhere in your body.

And when you cut your skin, it is those stem cells. So there are those multi potent cells that activate and then heal that tissue. So what’s fascinating is what we found in the mouse study is that when you do an albumin exchange, with regenerative plasma exchange, you get body wide stem cell activation, body wide. So the stem cells all over in your system, because the environment has gotten healthier, start to act healthier. Now, there’s lots of science and wonderful stuff we need to figure out, but it’s really exciting to think that we can get our native stem cells to function better. And that’s part of what happens when you’re doing fasting.  So with fasting, you’re turning on stem cell activity, super important, wonderful intervention. But if you think about fasting, fasting may actually just be really a mini version of what a plasma exchange is. You’re just, you’re decreasing the amount of stuff from your gut that is going into your plasma and you’re getting an opportunity to clean out more than you are polluting. So I had lots of questions to answer, but it makes sense.

Dr. Weitz:            And then when you clean out the plasma and you put new plasma in, where’s that plasma coming from?

Dr. Haase:           Yeah. That plasma is a pharmaceutical plasma. So plasma from plasma donors. And it’s very interesting process about how albumin is actually made. So most of the albumin is coming through the same process that people get IVIG. So IVIG is used for pandas and used for many their autoimmune diseases those come from plasma donors. And then immunoglobulins are one of the proteins that are in plasma. And then this albumin is the other protein that’s in there. That albumin is separated from the antibodies and then it’s processed in some unique ways. And the unique ways almost always involve slightly heating that albumin.  Matter of fact, beginning it up to about 150, 160 degrees for a full day. And that’s what ends up happening. It kills off anything that could possibly be hanging in there. And it partially causes not full denaturing, but a slight shift and so that albumin is no longer a tight bundle of an amino acid chain, but it loosens up. And when it loosens up all that stuff, that’s hanging on the outside falls off. So you can start refreshing the albumin in a way that helps make it be more of a biologic sponge again. So there’s a really interesting idea here. It’s like, wow, how-

Dr. Weitz:            Can’t we do that with sauna?

Dr. Haase:           Well, I don’t think you can handle that much sauna. If you can hang out at…

Dr. Weitz:            No, but you can do 130.

Dr. Haase:           Absolutely. You can. But the problem is if anything would denature, it would shrink right back and you wouldn’t have removed the junk that was there to begin with, but great heat shock protein in activation. I love sauna, love sauna. I think that’s amazing intervention, but not quite the same thing here.

 



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Dr. Weitz:            So let me ask you a question about diet and longevity. What style of diet do you personally follow? What have you seen that makes the most sense, and that might be impactful in terms of let’s say style of diet?

Dr. Haase:           Yeah. Yeah. So I’m largely a vegan who cheats and who does a lot of who does a lot of fasting and intermittent fasting. So I really think that the plant forward is always a great thing. My favorite food component is fiber. I mean, if you want to really get bored, just bring up fiber to me, because I love fiber in all it’s many forms. Because fiber does so many things. One of the interesting things fiber does is it it converts into butyrate in the gut, but why do we care? Because butyrate is one of the most important triggers for LL37 or cathelicidin induction.  LL37 is probably our most important innate defensive peptide. So it is a antimicrobial that goes against viruses, bacteria, fungi, and LL37, also complex with some of the amyloid beta. It can actually decrease the aggregation of amyloid beta. And matter of fact, it may be the lack of our bodies producing LL37 that causes our body to make the backup protein amyloid beta.

So anyway, but that all goes back to fiber. So lots of plants. I say a vegan who cheats because I think I look at the mouth and it’s pretty plain we’re omnivores. Our dental structure is meant to be able to handle anything. And then I think fasting is one of the most amazing interventions that exist. And once a month I will do about an 80 hour water fast. And it’s incredibly easy. I think that’s one of the things people just…

Dr. Weitz:            And you come up with 80 hours.

Dr. Haase:           Well, and about 80 hours, you have what I think from the literature is the most induction of intestinal stem cells, immune stem cells, muscular, skeletal stem cells. And you’ve already started a neurologic stem cell activation. And then at about 80 hours is when growth hormone that typically escalate during the first 80 hours starts to drop off. I cut it off at 80 because I don’t want to have atrophy. I don’t want to have a protein breakdown occur, but I think if there’s adequate testosterone present and you’re not doing your fast for too long, I think that 80 hours is really where I cut it off.  I really would not recommend one going over a 100 hours. If what you’re trying to do is maintain your lean body mass, which I think is super, super important. That’s why I don’t extend it out further than that. And I fast, well. It’s not easy for everybody, but for me, it’s no problem to say, “Fine, not eating good. One less thing I have to think about today, so.”

Dr. Weitz:            Get more accomplished. You mentioned peptides. What about the role of peptides in a longevity practice?

Dr. Haase:           Boy, that’s a big open question. There’s so many peptides.

Dr. Weitz:            You know there are.

Dr. Haase:           And so many and the FDA has not made it easier for us by decreasing access to peptides in clinical practice or by improving access. I have several patients who are just getting their peptides online going on an internet forum and injecting themselves with one thing or the other. And I’m like, “Wow, that would sure be something I would love to-“

Dr. Weitz:            I have a few patients that are doing that too. What’s the status of… What’s the FDA current… What is their stand these days? What can you prescribe in terms of peptides?

Dr. Haase:           So what happened in 2019 at the end of December in the omnibus bill, they basically declared everything that was greater than 40 amino acids in length that was now equals a drug. And which is really fascinating. They just declared, this category of molecules are now drugs. For instance, there are not many peptides that actually are in the list of… So they’re not FDA approved peptides. Physicians, it’s just a big gray area at this time. If you’re asking me for actually what’s the latest update, I can’t really tell you the details of that.  I can tell you a whole lot about the science behind peptides, but the FDA has made it very difficult to operate in this and those are discussions best had in a doctor-patient relationship, I think, so.

Dr. Weitz:            Nice. Okay. How about the role of prescription drugs or specifically nutritional supplements for longevity purposes? Maybe you can talk about some of your favorite substances.

Dr. Haase:           Yeah. Yeah. So I mean, you can’t open up, you can’t do an internet search on longevity without seeing Metformin pop up. Oh my gosh, I was kind of chuckling. It was like here’s this popup telemedicine service. “Hey, here, call us and prescribe Metformin for your longevity.” Some little vertical that somebody has built. Anyway, I think what’s-

Dr. Weitz:            We have the natural version, which is berberine.

Dr. Haase:           You beat me to the punch there, you beat me to the punch, Ben. That was exactly where I was going. Exactly. That probably works by a slight amount of complex one inhibition of the mitochondria and what makes us stronger is our challenges. So Metformin and berberine probably work to a degree by giving an extra challenge level to the mitochondria, making it a little harder to make cellular energy, therefore inducing PGC-1 alpha and causing mitochondrial replication and mitophagy and improve mitochondrial functioning.  So I think that, absolutely, anything that can improve your mitochondrial density and number is going to be tremendously important with regard to longevity. One of the things that I think the whole field of antioxidants has been, I’m glad that it’s been blown up. Always annoyed me when people are saying, “Take more antioxidants. They’re good for you.” And because we have direct antioxidants like vitamin C and vitamin E and you need enough of those around. Absolutely. But I’m always amazed like the indirect antioxidants, the compounds that are in plants that can be so powerful.  One of my very favorite is [inaudible 00:47:51] and glucosinolate. I really think that compound, that is in extract typically of broccoli seeds or broccoli sprouts, there’s some certain forms that have more of it than others, but it does such a great job of inducing NRF-2. And we’ve been watching oxidative stress levels come down with the utilization of that particular compound. I think that has a lot important part to play. Gosh, the list is so long when you start thinking about…

Dr. Weitz:            What do you think about NR or NMN?

Dr. Haase:           Yeah. So nicotinic or riboside it’s great if you’re a mouse and you can drink about 10% your body weight NR, then it looks like there’s an effect. But I think I’ve been greatly disappointed with the oral forms of NR as a therapeutic endeavor. I think that there’s a lot of… Because there’s two ways to look at the whole fact that in the body NAD diminishes as we age. That’s well established. Sinclair’s work on that is great. But if you really think about it, when we exercise, what occurs? We see a change in the ratio of NAD to NADH. So NADH is the energized molecule. We exercise, we use up our NADH and our NAD rises. When our NAD rises, it turns on mitochondrial activation.  It turns on along with the sirtuin gene, it starts to promote all types of components towards longevity. What happens when we fast? When we fast, we run out of NADH, we raise NAD a little bit. That’s fascinating. If you give somebody IV NAD you’re jamming up that NAD level really high. And I think what it’s doing is it’s tricking the body into thinking that it is energetically depleted and therefore it’s inducing the genetics that cause mitochondrial activation to occur.  So taking NAD as a supplement, probably doesn’t have anywhere near the same effect as getting it as an IV or doing the things that are going to cause NAD elevation naturally in the body. Really looking forward to seeing positive studies come out from NAD and NMR. But they’re thin at the present time, so.

Dr. Weitz:            Right. Yeah. You mentioned there are two ends, I guess, a similar story for resveratrol, which seemed very promising, but maybe has some benefit, but maybe not as much as we thought, unless you get some huge dosages.

Dr. Haase:           Yeah. And think about, but I also think that we’re not necessarily using them rhythmically, like we should. But because what if you’re fasting? If you’re fasting, taking a whole bunch of maybe NR and resveratrol at that time may have a whole different effect. It may have a real augmentation effect at that time, whereas taken with a regular diet, it won’t. I mean, I think that fasting and our contextual metabolism is something we have to pay a lot more attention to because if you think about supplements as just a, here’s a replacement for a pharmaceutical rather than, here’s a natural compound that fits inside a very complex biology and a person’s behavior and a person’s diet and lifestyle, we’re missing the boat.  So I mean, even what time of day that we take these compounds. So I think there’s… What a great feel to be in, to be continually thinking about when is the best time. I haven’t yet figured that out. For me clock genes like when exactly you want to have resveratrol, there’s some pretty good arguments both in the morning and the evening. I think you needed around if you want your clock jeans activated effectively.

Dr. Weitz:            I see, what about rapamycin?

Dr. Haase:           Again, I mean, I’m not utilizing rapamycin in my patients the present time, but if you really think of mTOR inactivation, it’s kind of the opposite effect of what you’d see with alpha lipoic acid. So alpha lipoic as you think of AMPK and mTOR are the opposite of each other. So I haven’t actually used rapamycin, I think there’s some really good and exciting opportunity in rapamycin. But at the same time there’s some case reports of people being harmed by rapamycin. So it is not a negligible substance. It needs to be respected as a pharmaceutical and basically a poison because that’s what all our drugs are. They’re well dosed poisons and…

Dr. Weitz:            It’s designed to suppress the immune system, right?

Dr. Haase:           Yeah, yeah. It is. Yeah, it is. But again, what is exercise? Exercise suppresses the immune system in the short term. If you’re over exercising that becomes a toxin. We are wave-like dynamic beings that are highly complex. And I love the idea of having a high amplitude life. High ups slow downs and training for recovery in everything we do. So, and I think that’s probably a good place to pull this together, because that’s what longevity is really all about. It’s how do you have a high quality life, a life that has a lot of resilience to it because it’s inevitable that we’re going to be hit with challenges that we didn’t expect. So the best thing that we can do is to train for those, do everything possible to give ourselves healthy challenges and surround ourselves with people that we love and love them well in return, so.

Dr. Weitz:            That’s the best exercise for longevity.

Dr. Haase:           Yeah. It is. Love is the answer, really the answer. It is. And otherwise, if you don’t have days worth living, why have more of them? Of course. So definitely engage that question has to be answered first. Some people I’ve worked with, I will say this, we’ve had some people that we’ve gotten to work with in the longevity space that realized that they wanted longevity because they really hadn’t figured out why they’re here yet.

And no, it was beautiful. It was absolutely beautiful. And by engaging people in a wholesome conversation, you asked about, well, hey, what kind of evaluation do we do? We ask them what do you want your health for? What do you want your health for? Why are you doing this? And why would you invest your limited time, money, energy and effort in this kind of an activity? What’s your why? And if you can really get to the depth of someone’s why, you often make different treatment decisions, number one, but you also have the possibility of seeing them actually enjoying their life focusing on the things that matter again. And wow, what a great privilege to be get to be in a space like that with people.

Dr. Weitz:            Great. I think that’s a great way to bring this interview to a close. Any final thoughts and then how can folks get a hold of you if they want to find out about regenerative plasma therapy or some of the other things that you offer?

Dr. Haase:           Sure. Well, I would say you’d find us at maxwellclinic.com. That’s M-A-X-W-E-L-L clinic.com. That’s really the single best way to find all the things that we do and…

Dr. Weitz:            Do you have practitioner training programs as well?

Dr. Haase:           Yeah. We’re developing those because I think that I’ve been probably the most experienced individual in our corner of the field and in this apheresis space and we’ve actually built a center here so that we can enable training and all those things are in process. So please, if anybody has interest in that just contact our clinic, we’re always looking for how we can help individuals to make a difference in the world.  And when we’re looking at longevity, I would say one last thought. One of the things that really drove me forward in looking into the longevity space is this desire to see more wisdom in the world and wisdom is really held to a great extent in elders. People that have been around the block I think of eldership as something that we don’t honor enough. And it’s not something that we talk about enough, that it is a goal in life to get to the stage of being an elder and to take one’s life experience and be able to transmit that to the next generations in a way that helps our species move forward in a beautiful way.  To me, a major reason why I work in longevity is I want to see more wisdom in the world and that means healthy elders. So I would encourage everybody out to seek wisdom and hug an elder, so.

Dr. Weitz:            Thank you, David.

Dr. Haase:           You bet. You bet.

 


 

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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Food Frame with Risa Groux: Rational Wellness Podcast 251

Risa Roux discusses Food Frames 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

0:55  Risa Groux has written a book FoodFrame, which details her approach that recommends one of six different approaches to diet, including paleo, keto, autoimmune paleo, vegan, low FODMAP and low lectin. 

5:32  Detoxification.  Risa likes to start many of her clients with a two week detox program to help to clean out the liver and open up the detoxification pathways both phase one and two.  A lot of patients’ symptoms go away after the detox, including itching skin, headaches, insomnia, acne, stool regularity, bloating, gas, and indigestion.  The detox also helps to set up weight loss.  On her detox, patients consume two collagen shakes that include protein, fat, and fiber.  And they eat animal proteins, unlimited organic veggies, good fats, eggs, nuts, and seeds.  They can have some sweet potato.  No processed or inflammatory foods.

13:14  Weight loss is a function of being healthy.  Those who are overweight but claim to be healthy likely have underlying inflammation that can be seen on lab tests or on stool testing.  For inflammation, Risa will look at CRP and Homocysteine.

15:08  In order to help reverse her Hashimoto’s autoimmune condition, Risa started on the Autoimmune Paleo diet and now she follows the paleo approach.  She said that she is now only 10 points away from reversing her condition, as measured by her TPO antibodies and at one point she was in the 1400s.  When you work with a patient with autoimmune disease like Hashimoto’s, the first thing to do is to reduce systemic inflammation.

 

 



Risa Groux is a holistic and functional nutritionist based in Newport Beach, California. She believes in treating the root cause of health problems and she believes that if she promotes the health of her clients with a Functional Medicine approach, weight loss will be a side effect of wellness. Risa has written a book Food Frame.  Her website is RisaGrouxNutrition.com.

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



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates and to learn more, check out my website drweitz.com. Thanks for joining me. And let’s jump into the podcast. Hello, Rational Wellness podcasters. Today, we have an interview with nutritionist, Risa Groux on the FoodFrame approach to health. Risa Groux is a holistic and functional nutritionist based in Newport Beach, California. She believes in treating a root cause of health problems, and she believes that clients that need to lose weight, if they promote their health with a functional nutrition approach, weight loss will be a side effect of wellness. Risa has written a book called FoodFrame, which details her approach that utilizes six different dietary approaches depending upon the person’s symptoms and health concerns. These include paleo, keto, autoimmune paleo, vegan, low FODMAP and low lectin. Risa, thank you so much for joining us.

Risa Groux:         Thank you for having me.

Dr. Weitz:            So, perhaps you can start by telling us a bit about your personal health journey and how you became so interested in nutrition and functional medicine.

Risa Groux:         I have always been interested in nutrition from the time I was a little kid. I just remember growing up in a house where my mother was always on a diet. My grandmother was on a diet. I remember my grandma would always go, she would call it the fat farm once a year, which I later found out was Canyon Ranch Spa that she would go to every year. And there was always these words in my house called fattening and, “Oh, I can’t have that. It’s too many calories.” And I was always wondering why are foods different and what makes us fat and how do we gain weight and how do we lose weight and why are people always on a diet? So, I was always interested in food from a very, very early age and then slowly but surely I ended up never had a weight problem as a kid, and then started to develop some symptoms of a low thyroid. Didn’t really know what they were, just thought they were kind of normal. And I was able to conceive my first child without any problems at all.  And then I could not conceive my second child. I was having a tough time conceiving, and then I would have several miscarriages and finally went to an infertility specialist where they tested me and said, “You have a thyroid problem? Take this pill.” And I said, “Oh, how long do I take the pill for?” And he said, “Every day.” And I said, “No, no, no. For how long do I take the pill for?” And he said, “Oh, for the rest of your life.” And I was just astounded at that. I thought how could I be taking a synthetic for something that my body was actually born to produce?  So, shouldn’t we back up and say, why is it not producing this hormone?  And what can we do to fix it instead of-

Dr. Weitz:            That’s not a question conventional medicine usually asks.

Risa Groux:         Exactly. But that’s where the birth of it came for me, the curiosity, I have an innate curiosity. I’m always wondering why? Why is it? Do I have a deficiency in Synthroid because I have these symptoms. And I realized, no, I don’t have a deficiency in medication. And then-

Dr. Weitz:            And you a deficiency in lisinopril and you have a deficiency in statins and NSAIDs.

Risa Groux:         Statins. Yep. And pressure medications and Zoloft and so on and so forth. So, I realized that these are just wonderful band aids that we have in Western medicine and great for a momentary relief, but they really shouldn’t be taking long term. I have a sheets and sheets of all these side effects of all the medications, not just the effects of the body, but the blocking of nutrients that take place when you’re having these medications day in and day out. So, I always say, we’re going to plug the hole at the top of the boat, right. And cover the water there.

Dr. Weitz:            So, how did you manage to get your thyroid fixed and get off of thyroid medication?

Risa Groux:         So, I did a deep dive and was on the Synthroid for a bit and researched. This is way back when, before a lot of internet, so I did a ton of research and then was later diagnosed. I did everything. I did herbals, I did acupuncture. I did just everything I could naturally. And then, was later diagnosed with Hashimoto’s. And at that time, when I was told I had Hashimoto’s, I did not have one direction. Nobody told me to take out gluten, soy, dairy. Nobody gave me any dietary guidance. I didn’t have any medication guidance. I really didn’t have any guidance period. So, I did a ton of research and I thought, why is it that I have this autoimmune disease attacking my thyroid gland? So, I couldn’t find at that time a checklist of everything that could be a root cause to autoimmune.  So, I put one together after years and years of researching, I eventually assembled a list of root causes and put it in my book, FoodFrame, because I think it’s really important for people to know how you get autoimmune disease and how you can treat it and perhaps reverse it.

Dr. Weitz:            Cool. So, I noticed you like to start some of your clients with a two week detox.

Risa Groux:         Correct.

Dr. Weitz:            Why do you do this? What is your detox program consist of?

Risa Groux:         So, there’s a couple reasons why I do it. The first reason is because it puts bumpers on the situation for people, right. So, they come in, whether they’re drinking tons of coffee with lots of chemicals in their coffee, whether they’re having wine or alcohol frequently, and they’re eating bread, sugar, dairy, alcohol, they’re eating out of the bounds, it kind of puts bumpers on it and says, “Okay, here’s what you can eat and here’s what you can’t.” And so, it gives you those boundaries, which I think is really good. Instead of doing it slowly, it’s just a very structured, this is what we’re going to do for 14 days.

The second reason I do it and the primary reason I do it is to clean out the liver. The liver is the key to the castle. So, it really help the liver perform more optimally and help us with everything, any excess estrogens that are stored in the liver, it helps to take those out. It really balances out the blood. It opens up the pathways one or two, so that we are effectively able to detoxify. If somebody has a high level of homocysteine, it helps with that. It just helps stabilize things. The other reason I do it is because a lot of symptoms that people walk in my door would go away- itching skin, headaches, inability to sleep. Acne is a big one, regularity, bloating, gas, indigestion. A lot of those things will fall by the wayside in two weeks.

And then of course, people love it because there is weight loss. Everybody does lose weight on my detox, but it isn’t a weight loss program. I say that all the time, it is not a weight loss program. And as you mentioned, weight loss is a side effect of wellness and we’re just focusing on wellness, but I’m always curious to know how much we can get done just with food and detoxifying, which usually tends to be a lot. And the last reason I do it is because it’s my data gathering time. So, I’m ordering blood tests, I’m ordering stool tests. And by the time they’re finished with the detox, I really have a good idea. I have a roadmap now. I can see what the issues are. I know what your health status is. So, at that point I can springboard from there.

Dr. Weitz:            And so what is your detox program consist of and what is it that you’re detoxing?

Risa Groux:         So, my detox is 14 days. There are two collagen shakes every single day. So, the protein is collagen, which is great, very little carbs, lots of good collagen, which is great. I call it grout for leaky gut. It’s really helpful for hair, skin and nails as well, joint pain, any inflammation. And it’s a gut healer. I’m all about protein, fat and fiber. So, you’re having protein, fat and fiber in that shake twice a day. And then you’re eating basically paleo foods. So, you’re having animal protein, unlimited vegetables anyway you want them except for deep fried. And then you’re having good fats. So, eggs, nuts, seeds. And then you can have some sweet potato [inaudible 00:08:33]. So you should not be hungry. It has nothing to do with starvation. I’m just trying to clear out the liver and the toxins.

The unfortunate statistic here is that the FDA has currently approved 86,000 chemicals for us to use, 86,000. That’s the current number and that’s a new number and it really doesn’t matter who’s in the White House about 2000 a year, get approved. And most of them, which is the sad fact are not even tested. So, we have to be really diligent because we have more chemicals than any other country on the planet. And so we have to be diligent about really reducing our toxic load. So, that’s another thing that the detox does is, it decreases your toxic load. We’re eating mostly organic and non processed foods. We take out the processed oils and take out a lot of the inflammatory foods.

Dr. Weitz:            But how does your detox program facilitate liver detox? What does it do?

Risa Groux:         In addition to the collagen, there are an antioxidants and amino acids that are designed to help open up pathways one and two for efficient detoxification. Your liver numbers improve, your inflammation numbers improve. I see it all the time.

Dr. Weitz:            And during the detox, are they eating or they’re just taking the shakes?

Risa Groux:         Yeah, no they’re eating. So, it’s today and one meal and if you’re hungry, then eat a snack. If you’re really hungry, eat two meals. I have some professional athletes. I work with those people having two shakes and two meals, but I always say, “Eat when you’re hungry. Not when you’re not.” And it really helps that lectin that’s that hormone that tells us that we’re full and ghrelin that tells us we’re hungry. Sometimes people come in and they’re so dysregulated that they are not even functioning. We don’t know if we’re hungry and we’re just always eating because it’s either that time to eat or just because it’s in front of us or we’re afraid we might get hungry. And I always say to people, “It’s okay. We will not die if we’re hungry for an hour or three. We really won’t. Three hours. You’re good.” So, I don’t know what it is, but when I was a kid, I remember it’s like, “Wait till dinner time.” Now it’s, “Let’s eat before dinner.” So, it will tide you over.

Dr. Weitz:            Well, things have kind of shifted as they frequently do in the nutrition world. So, I’ve been in this a long, long time. And so, when I first started, the thing we had to tell everybody, you have to eat breakfast, because everybody would skip breakfast and maybe eat a light lunch and a big dinner. And that’s why everybody was fat because they skipped breakfast. And then the key was you had to eat breakfast and you had to have a snack or meal every three hours to keep even blood sugar. And so, the big thing, if you want to lose weight, you have to eat more because that’s going to stimulate metabolism. You have to eat within an hour of waking up and then you have to have a snack in two hours and then you have to have a meal and you have to have another snack. And unless you do that, your blood sugars going to go crazy and you’re not going to lose weight.

Risa Groux:         Right.

Dr. Weitz:            And now we’re back to skipping breakfast is good for you.

Risa Groux:         Yeah. But that’s where my methodology comes in as it’s not one size fits all. So, if you have a blood sugar issue and you are low blood sugar, I am not going to recommend intermittent fasting for you for sure. Conversely, if you have diabetes, intermittent fasting would be a great thing for you to do. It would help with blood sugar regulation.

 



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Dr. Weitz:            So, you say that weight loss is a function of wellness, but some people claim that they are fat, but healthy. What say you?

Risa Groux:         So, I appreciate that point of view, but I’m all about numbers. I’m very science rooted. So, I like to see facts. And the fact is that when we carry extra weight, it really is equivalent to having inflammation. So, those people, I don’t know how they define healthy, but for me there are foundational issues and they come in two categories. One is systemic inflammation, which we know is the driver of disease. And we know now with COVID that people are dying from third stage inflammation, which is usually blood sugar related, right? Then we look at gut health and gut health is incredibly important. So, those are the two foundational issues I look at. So, that person who says, “I might be fat or overweight and or obese, but I’m healthy.” I don’t know how they define healthy. So to me, I’m looking are your inflammation numbers low, because that to me, defines healthy. And is your gut healthy? Is it intact? Do you not have all these overgrowth of bacteria? Are you not dysbiotic? And things like that.

Dr. Weitz:            What are the most important inflammation factors you look at?

Risa Groux:         So, I look at the CRP, the C-reactive protein that is very related to cardiovascular. And so that usually is a good indication of systemic inflammation. And then the other one I look at is homocysteine and homocysteine has a lot to do with methylation, but it is a major driver of inflammation. And if it gets very high, I’m talking over 12, which I see from time to time, it could lead to dementia. It could lead to cardiovascular disease, macular degeneration, lots of health issues. So again, those are the root causes. Those are the driver of disease.

Dr. Weitz:            Right. So, of the six dietary approaches that we listed, which one do you personally follow most of the time?

Risa Groux:         So, because I have Hashimoto’s, I’m about 10 points away from reversing it, which I started in the thousands and now I’m like 10 points away, which is crazy.

Dr. Weitz:            So, when you say 10 points away, what are you talking about?

Risa Groux:         So, when officially Hashimoto’s are diagnosed with autoimmune for thyroid, you’re looking at thyroid peroxidase antibody, TPO and you’re looking at thyroglobulin antibody. So, I never register positive for thyroglobulin antibody. So, I have registered for thyroid peroxidase antibody. And when I was tested positive, originally diagnosed years ago, I was in the 1400s and the lab now says you should be less than 34. So, I’m at 44. So, I’ve got about 10 points to go to reverse it completely. I follow a paleo program, but when I was first diagnosed, I was on the autoimmune protocol. Or I shouldn’t say when I was first diagnosed, because it really wasn’t invented. But, I originally took out gluten dairy and soy because those are really the major offenders. They have what’s called molecular mimicry to antibodies that attack the thyroid. And when you are in a state of autoimmune, those antibodies basically are what’s called inflammation. You’re in a systemic inflammation. Your Th17 gets activated, you’re in a cytokine storm, your NF-kappa B is involved and you have just systemic inflammation. And in this case and in the case of Hashimoto’s, you’re attacking your thyroid gland.

So, the first thing you need to do with an autoimmune patient is you just decrease that systemic inflammation. So, I have my fab five or now it’s my essential six that are supplements to help quell that inflammation. So, I diligently take those supplements every day, day in and day out. I have removed gluten dairy and soy from my diet completely. And then I do have sheep’s milk or feta very rarely, but occasionally it’s a different type of casing, different type of protein that I can tolerate. And then I started the autoimmune protocol AIP, which is a very restrictive form of paleo. So, it’s paleo, but you’re taking out eggs, nuts-

Dr. Weitz:            Seeds [inaudible 00:17:29]

Risa Groux:         And so, I did that for about 90 days and then I now follow a paleo program myself.

Dr. Weitz:            Okay. So, I noticed of the dietary approaches that you list, there’s one popular one, in fact, including popular and functional medicine [inaudible 00:17:51] that you don’t list here and that’s a Mediterranean diet. Why is that?

Risa Groux:         Yeah. I thought about that when I was putting together the book and I realized I really don’t promote that diet in my office and I don’t really recommend it even though there’s tons of studies that show it’s very heart healthy. And I think the reason that it’s very heart healthy is it’s very focused on olive oil, which is really a great oil to have its great fat. And the reason I don’t really stick by that is because it adds a lot of grains and legumes and I’m a former vegetarian or vegan myself. And I noticed that when I was vegan, I ate a lot of beans and a lot of grains, quinoa, gluten free grains, not a ton of rice, but a little bit of quinoa and millet and occasionally amaranth. But I sustained myself on that because you need to get your protein from a source. So, it’s going to come in the form of nuts, beans or seeds and grains.

And so, I noticed every time I did my blood work, my blood sugars were escalating and I’m thinking, “How could this be? I’m not eating any sugar at all.” And I was eating gluten-free bread and my products were gluten free. I wasn’t having any dairy and I wasn’t eating any sugar. I really was eating very little berries, but I was having berries. And, when my hemoglobin A1C got to 5.6, which just for reference range 5.7 is pre-diabetic, I said, “That’s it. This is not working for me.” And I stopped that diet and I went completely paleo. And I took out all the legumes and grains that are carbohydrates at the end of the day. They’re filled with great properties of great fiber polyphenols. All those things are really, really great, but at the end of the day, they’re carbohydrates and that just doesn’t work. And in my opinion for everyone.  Some people can, if you’re an elite athlete, I’m going to say you probably need more carbohydrates, but most of us are not elite athletes. Me included, even though I work out all the time, I’m not an elite athlete, so I don’t need that many carbohydrates. And so, I do recommend it for some people some of the time, but I don’t think that there’s a major population that thrives on a Mediterranean diet.

Dr. Weitz:            Agree to disagree on that.

Risa Groux:         Your thoughts on that?

Dr. Weitz:            I do think that a low glycemic version of the Mediterranean diet can be really good. And I think something like autoimmune paleo is a really difficult diet to stay on for a long time. It’s very, very restrictive. And, it depends on a person like you’re talking about athletes, like somebody like myself, even though I’m 63 years old and you know, I’m working in an office still. I’m getting about 20,000 steps a day. And if I don’t consume 3,500 calories a day, I’m going to lose weight and I’m not trying to lose weight. So, it’s really hard for me if I don’t have some legumes or healthy grains in my diet and I avoid gluten like you do and dairy, but I do find that judicious use of properly cooked and prepared grains and legumes and sweet potatoes is necessary for me to get the calories I need to make my body [crosstalk 00:21:25]

Risa Groux:         And I fully agree. I fully agree the if you’re having 20,000 steps a day regularly, you need more carbohydrates for sure. Especially if you don’t want to have weight loss. And let me just clarify, I’m not against legumes, especially if they’re sprouted or they’re soaked-

Dr. Weitz:            Soaked overnight, yeah.

Risa Groux:         Exactly. And certain grains like quinoa, which actually isn’t a grain, it’s a seed, but millet, quinoa, amaranth. So, I’m totally good with that in small doses. I have people who just say, “No, please, don’t take my hummus away.” Well, fine. Have some hummus. You’re not having a container of hummus every day. If you want some hummus and vegetables, have it, just watch your portions and you should be fine, but there’s tons of benefits in those legumes, but not somebody with SIBO or with IBS, right. That person I’m not going to tell, “You have some legumes.”

Dr. Weitz:            Right. Because they’re high in FODMAPs and I notice you have the low lectin diet. So, why do you have the low lectin diet in there?

Risa Groux:         So, low lectin-

Dr. Weitz:            I guess we could call it the Dr. Gundry Diet, right?

Risa Groux:         Dr. Gundry diet. Yes. He really highlighted the dangers of lectins. And for your listeners who don’t know, lectins basically fall under the category of anti-nutrients. And they basically are what I call a hard candy shell around the bran or the seed or the germ of a plant, because we all have our way of protecting ourselves. Humans, if we’re in danger, we can flee, bite, kick, scream, yell and call 911. Plants don’t have that ability, right. So, they have this protective coding on them that says, “If you try to eat me or destroy me, I’m going to do my best to sustain myself and procreate because those are our two main goals as living organisms.” And so, they’re very hard to digest for people.

So, not everybody, those people who have SIBO and IBS and some people have autoimmune, they’re going to have a difficult time breaking down those lectins, especially if you’re not having any digestive enzymes, you’re not taking any digestive enzymes or you’re not producing digestive enzymes, you are going to have a horrible time. And those are the people who come in and saying, “I had three garbanzo beans and I was bloated all night or I had hummus and I just wanted to die. My belly was like a balloon that needed to be popped.” Those people cannot break it down. So, low lectin is great for, I think for it’s an anti-inflammatory diet, it’s another anti-inflammatory diet and it’s really good for people with autoimmune. So, it’s very similar to paleo or AIP, but they’re different. It’s really more centered around lectins. And some people do really well with a low lectin diet.

Dr. Weitz:            Yeah. It’s, it’s pretty restrictive because I mean, there are so many vegetables that contain lectins, including cucumbers and tomatoes and squash. It’s very, very restrictive.

Risa Groux:         It is very restrictive and again, that’s why not everybody does well with it. But some people do.

Dr. Weitz:            Now on a practical level, as a dietician, you put somebody on a low FODMAP map diet or autoimmune paleo diet, what kind of guidance do you give them? Do you simply say, “Here’s a list of foods not to eat. Here’s the food you can’t eat.” How do you make this work? Because I’ve noticed some patients need more handholding. And do you have some way of giving them more detailed guidance in your practice?

Risa Groux:         Sure. So, in my practice I test everybody because what I do basically like… I watch a movie on HBO and then it tells me all these other movies I might be interested in. I listen to a song on Spotify and it tells me all these other songs that I would be interested in, right. We don’t have anything to tell us what kind of food that we are customized to eat. So, I’ve created that because it’s crazy that in this day and age, we’re not customizing our food to our health status. So, the first thing we have to do is find out our health status. So, if I’m working with you in my office or we’re working through zoom, I’m going to find out because I’m ordering your blood test and your stool test. So, I’ll find out what your landscape looks like?

Dr. Weitz:            What sort of blood test or stool test you’re going to order?

Risa Groux:         So, I order a comprehensive bioscreen and that tells me all 10 markers of your thyroid, not just the two or the one that your doctor orders, but all 10. And it tells me all four markers of your blood sugar. So, I’m looking for insulin resistance, I’m looking for prediabetes. And then it tells me inflammation markers. And then it gives me a breakdown of your white blood cells. And it gives me a ton of information, iron which is a big factor and all your liver enzymes. It gives me a very full picture. And I look for viral patterns. I look for bacterial patterns and then I order a stool test. And that tells me about 84 pathogens, fungus, yeast, worms, parasites. It tells me how much digestive enzyme, pancreatic enzymes you are producing, tells me how you do with fat malabsorption if you have a fat malabsorption issue, tells me about your immunity because so much of our immunity is produced in our gut.

A lot of people come to me with a lot of sex hormone imbalance and that gives me a good indication of beta-glucuronidase. If that is high, then that will likely be the factor that is dysregulating hormone. And then I look for leaky gut and inflammation in your gut. So, I can really see what’s going on. I can find out if there’s SIBO, bacterias, all that stuff. And so then, I am educated. I’ve got my data. I can say, “This is what your landscape looks like. And this is the eating lifestyle that best suits what your health status is.”

If I’m not working with you in my office or via Zoom and you just go on my website, you’re going to take the FoodFrame quiz and it really is an expeditious way to pretty much figure out what eating type is best for you. And then you go from there. But, I also have a course coming out on thyroid health. So that people can learn how to read their thyroid labs and ask their doctor what to test for and find out if they do have a thyroid issue or if their thyroid medication isn’t working. So, we just need to educate people on how to do this for themselves.

Dr. Weitz:            Okay. But practically, let’s say you select the low FODMAP diet. How do you get them to follow it?

Risa Groux:         Right. So, I give them a handout and I give them all the foods to enjoy and I give them a list of foods to avoid. And then I usually work with these people. So, I give them a food log and they’re kind of judging how they’re doing in a low FODMAP case. I would say, “Give me evaluation of how your bloating is or your constipation, your chronic diarrhea.” So, I have some assessment way of assessing-

Dr. Weitz:            So, they write down what they’re eating and then they write down how they’re feeling.

Risa Groux:         Exactly. And we’re starting to relate that, “Oh, if I have a quarter of an avocado, I’m good. But if I have more than a quarter, if I have a half an avocado, I have bloating or I have diarrhea.” Whatever it is. And so, we start to make those correlations of what food is affecting them. And then I work with people. So I have that ability to say, “Okay.” And then usually a lot of those lifestyles that are on there, like low FODMAP and AIP, those are a temporary elimination diet. So, that’s 30 to 90 days. Once you’re done with that, then I say, “Okay, let’s look at the landscape and see where do you go from here?”  So in AIP, they would typically either go to AIP… I’m sorry, they would go to paleo. So, they’re opening up a few more things or reintroducing things, or they would go low lectin, but usually they go paleo. And then with somebody with SIBO or IBS, I would recheck their stool test to see if their inflammation is gone. We’ll know because their symptoms will have gone away. And then we treat that whatever is in there and we look at the root cause and address it.

 



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Dr. Weitz:            So, once they’ve been on one of these specialized diets for a period of time, do you try to introduce all the foods or do you keep certain foods out permanently?

Risa Groux:         I always like to have diversity in the microbiome, right. So, we now are knowing about short chain fatty acids, which is really the food for the colon, the end of the line, right. And I have a product-

Dr. Weitz:            Butyrate and propionate.

Risa Groux:         Exactly, exactly. And I have what’s called post BioMax, which is a postbiotic. They’re now called postbiotics, not prebiotic, not a probiotic, but a post. And it is those Butyrates and all those things that creates the diversity of the microbiome. So, always want to do things through food. And if you don’t have to take a pill, I’m always saying, “Let’s do it through food.” But as if I were to say to you, “I want you to go into the market and go into the produce section and buy every single food in there that you have no idea what it is. You don’t know what country it gotten from. You’ve never had it before, put it all in your basket, bring it home, put it in the blender, whip it up and drink that.” That’s going to create that diversity of the microbiome.

Risa Groux:         But unfortunately, we all eat about the same 20, 40 foods day in and day out in different forms or shapes. And so, we don’t get that diversity of the microbiome. So, especially if you’re on a restricted diet, I always want to say, bring in some more colors for sure. And more things. So, it depends on what you are. So, if you’re autoimmune, I’m not going to say to you, “You should have some gluten.” That wouldn’t be good for you. But if I’ve tested you and I’ve looked at your anti-gliadin on my stool test, and I say, “You really don’t show up high for gluten.” Then I would say to you, “Once we take care of the autoimmune, you can start bringing in gluten in every now and then.” Or if you wanted to have gluten, if you’re going to Italy, I’m going to say, “Have fun. Here, take some GlutenFlam with you, so you can mitigate the effects of that gluten. And it’s not going to cause major habit for you.”

Risa Groux:         Now, if you’re celiac, I’m not going to say that to you. You’re not going to have gluten. But I try not to say ever, never forever, but some cases that is the case. And every now and then a cheese might be okay with you, but I’d have to know what your specific circumstances in your health status is.

Dr. Weitz:            They say that saturated fats are among the healthiest fats, but don’t saturated fats promote atherosclerosis and heart disease?

Risa Groux:         Certain ones do. Yes, absolutely. If they’re from the wrong sources, for sure. So, saturated fats and coconut oil or coconut products as we know, are good for you. We know that they’re antimicrobial, they’ve got lauric acid and caprylic acid, really good for gut. Really good for skin.

Dr. Weitz:            It is controversial, but…

Risa Groux:         Yes.

Dr. Weitz:            I think for a lot of people, they probably are.

Risa Groux:         Yes. Now, would I tell you to have the saturated fat and Twinkies? No, I wouldn’t. Those are the ones that are going to cause you some issues, right.

Dr. Weitz:            The Twinky fats.

Risa Groux:         Yeah. Twinky fats are probably not really recommended. at least I don’t recommend them. But, if you think about it logically, I mean, think about it. I say to every patient I work with, “I want you to imagine that your body is just like a sneaker factory. You’ve got all the equipment to make sneakers. I know if I give you some leathers, some rubbers, some canvas, we’re going to get a sneaker at the end, right. May change in shape or size or color, but it’s going to be a sneaker. And if I say let’s put some cell phone parts in your sneaker factory, what would you say? Hopefully you would say no, because if we did that, what would happen to our machinery? It would break.” So, I use that silly little example because it’s a great visual. If you think about the Nike factory, it’s not the same as the iPhone factory, right. Fully different equipment, fully different parts.

And so, I use that example for, because whoever created us, whenever that was, all of a sudden, there were these things crawling on the ground and spreading from the earth that we could eat. And again, sustain ourselves and procreate are two main goals of living organisms. So, I’m trying to take out the cell phone parts. Twinkies were not on the planet when we were created. Pop-Tarts, Big Mac, Doritos, you name it, anything that really has a label on it, is not really food from the farm. So, if we eat food from the farm mostly, then we’re in pretty good shape. So, if we think about it that way, all the fats that came from the farm, we’re in good shape with. Those were what we’re meant to eat. Not a lot. Our plate shouldn’t be this much animal protein and this much vegetables.

We should have 60 to 70% of our plate living foods, whether they’re cooked or not, it doesn’t matter. But foods from the ground and then some protein, because we all need protein. And then we have some sweet [inaudible 00:35:45] some carbohydrates, right. That are good for us. We can’t forget about the good fats because we need good fat.

Dr. Weitz:            Why is sugar so bad?

Risa Groux:         Why is sugar so… How much time do we have? So, sugar is the devil. We really don’t glean any nutrients from sugar, unfortunately. And we like sugar. Everybody’s addicted to sugar and it makes us feel good immediately, but it doesn’t do well for us. And I’ll just give you a few of my things on my list. Sugar makes us fat. Why does it make us fat? Because it makes the pancreas pump out some insulin and it converts it into glycogen. And then we send it to every cell in the body and we use that for energy, right. It gets into there. If your receptors are open and it goes into the mitochondria and that’s our energy factories, right. We’re making energy. But any excess we have, if we can’t fit into the cell, it just parks it in storage, right. We just keep putting it in the storage unit.

And if your receptors on your cells are closed, that’s insulin resistance. We’re going to park it into fat tissues and fat cells. So, that’s number one. And we know that fat creates inflammation, which is the driver of disease. Second thing is, it causes fatty liver. It will really congest our liver, our gallbladder. It doesn’t help us there. It feeds cancer cells, right. It’s the nutrition for cancer cells to replicate. So, anybody with cancer should not be having any kind of sugar at all.

Dr. Weitz:            Yeah. We had Dr. Thomas Seyfried on the podcast.

Risa Groux:         Awesome. We [inaudible 00:37:20] a lot about that, I bet. It eats up white blood cells. Our white blood cells are our immune powerhouse. They are our protectors. So, even one tablespoon of sugar, table sugar can affect our immune system by 50% within one hour. So, I don’t know about you, but I’m going out in this world, especially with COVID with all my army with me. I’m not putting anybody on vacation. Everybody’s with me. I need as many troops as I can possibly have. Another reason why we don’t like white sugar at all is it causes fatigue. We spike and then we drop, we spike and then we drop. So again, I want my A game. We can drink sugar, right. Alcohol wine especially is a great resource of drinking sugar and it ruins our sleep. So, if you’re waking up between 3:00 and 4:30 in the middle of the night, you’re most likely having sugar plummeting and you probably have some blood sugar issues.

 So, it provides brain fog and fatigue. And gosh, I can keep going, but it’s not good for our skin. We get acne from sugar. We don’t glean any nutrition from it. And I talk a lot about eating for survival and eating for support. And I just want to be very realistic. It’s best that we eat for survival, but there’s always going to be support eating. Even me. I have to have my gluten free pizza every now and then. I don’t have it frequently, but I like it. And I want chips and salsa. Now, there are Siete chips or cassava flour and now I’m making my own salsa and I’m making my own guacamole, but every now and then, I would like to have some of that. So, we do.

Dr. Weitz:            What’s your favorite meals?

Risa Groux:         I have a few favorite meals, but I’m a big, huge fan of salads. I love a really good salad with some good fats, good animal protein. I’ve been making recently. I’m a little obsessed with this because it’s like literally in 10 minutes you can just whip this up. I do sauteed veggies with mushrooms and onions and kale and Bok Choy or whatever green I have or broccoli and then I throw in some chicken or some fish and then I love miracle noodles, konjac noodles. They don’t have any carbohydrates in them. There’s really nothing in them except for just a hair of fiber. And then I put coconut aminos. I have a sesame ginger recipe on my website that I basically do with a coconut aminos, which is a soy sauce, substitute almond butter, fresh ginger and Sesame oil. And it is so good and I sprinkle black and white sesame seeds at the end. And it’s packed with protein, fat and fiber, and even my 20 year old son, he loves it. So, it’s good.

Dr. Weitz:            There you go.

Risa Groux:         I love that. I do a lot of cauliflower rice with coconut curry. I like that a lot too.

Dr. Weitz:            Right, cauliflower rice. Yeah.

Risa Groux:         Easy. Really easy.

Dr. Weitz:            Yep. You basically cook it like rice.

Risa Groux:         Exactly. Just heat it up and-

Dr. Weitz:            Make a stir fry. Yeah.

Risa Groux:         Exactly. Yeah. Protein, fat and fiber. And I’m all over that.

Dr. Weitz:            Good. So, any final thought you want to leave us with? Did you want to maybe give us a case history maybe of somebody that you worked with?

Risa Groux:         Sure. I have a great story that came in this morning. She was my first client this morning. I’ve worked with her for a few years and she’s very shy and private, but I said to her, “I wish I could showcase your family.” Because she’s married to a surgeon. And she came to me a few years ago and she was exhausted. She napped every day, she had this constant congestion and she went to the doctor and her husband’s friends and they were giving her steroids and she just wasn’t feeling good. Her stomach didn’t work. And I did the detox with her and then we found out she had Hashimoto’s and she had a very, very high levels of ferritin. So, she was storing a lot of iron and she didn’t have hemochromatosis, but it was an acute phase reaction to inflammation.

Dr. Weitz:            What her ferritin levels [inaudible 00:41:37]

Risa Groux:         They were 600 something.

Dr. Weitz:            Okay.

Risa Groux:         So, we like them about a hundred and women usually fall between 40 and 70. So, she was 565, something like that. 600, somewhere around there. And she was prediabetic. We just found out all these things that was going on and we took her off gluten, dairy, sugar. We detoxed her. I think I detoxed her for about a month. In just less than a year, she lost 72 pounds with me. Every single solitary symptom was gone. Her husband ended up coming in. And the great story about him is that he’s an MD. So, he didn’t realize any of this. He wasn’t aware of anything with food and he added a garden in his house and he started planting and he came in after working with me for 12 weeks. I ordered all his lab work for him because he couldn’t do it at his hospital. And he also had some prediabetes and his iron levels were really high too.

But, he came in after 12 weeks and he said, “I have to tell you something. “I said, “What is it?” And he said that, “He had been wearing a hearing aid for the last two years, which I was unaware of.” And he said he went to the audiologist in his hospital and the audiologist said to him, “I don’t know what you’ve been doing, but you do not need a hearing aid anymore.” So, I was stunned because I haven’t seen that. I’ve seen a lot of miracles in my office, but not that. And I said, “What do you think it is?” And I had my idea, but he said exactly what I thought that it was systemic inflammation because all of his inflammatory numbers were really high. And so, they brought in their two daughters who just suffered from severe fatigue, two teenage daughters, they’ve lot on their plate with school and activities and things. But it turned out, they both had a pretty high case of Epstein–Barr virus. We treated that and they have been thriving ever since.

So, the woman came into my office a few months ago back in, she’s been doing great and had a full body rash and went to the doctor and they wanted to put her on all these steroid creams and everything. And so, I said, “Well, let’s do a stool test.” And we did. And sure enough, she had a pretty good case of geotrichum, which is a type of fungus and we treated it and we did a food allergy test as well. Her eosinophils were elevated. So, we did a food allergy test. She’s been so diligent, she came in this morning. She goes, “Please tell me I can eat more food.” Because she’s really restrictive. So, it’s been more than 30 days, so we started just adding it back today. So, we’ll see how she’s doing. Rashes are hundred percent gone. Everything [crosstalk 00:44:06]

Dr. Weitz:            And how did you treat the fungus?

Risa Groux:         I have what I call natural antibiotics that I use and a [inaudible 00:44:16] oil and garlic oil and a myriad of all natural herbs that I treat. Unfortunately, it’s not a 10 day script. It’s a little bit longer, but it works and it’s clearly worked.

Dr. Weitz:            And which ones did you use for her? Did you use combination products or you use several individual products?

Risa Groux:         There is a packet that I use from Apex Energetics that I use to treat this pretty much with almost everybody I work with and it kills. It just kills bacterias and yeast and fungus and H-Pylori, things like that. So, I’m always looking at the underlying cause, we found it and she came in today and she said the rash is fully gone. She feels amazing. And now we’re going to open up the gate so she can eat all these other foods again.

Dr. Weitz:            And so you use this Apex Product, what’s it called?

Risa Groux:         It’s called GI Synergy.

Dr. Weitz:            Oh, okay. Yeah.

Risa Groux:         Yeah. And I tested her zonulin also and she had leaky gut. So, I’ve given her my gut reboot, which is really, really good. I give it to everybody with leaky gut, anybody with autoimmunity. I do it every day in my shake and it has L-glutamine and Slippery Elms, Marshmallow Root, Zinc-Carnosine, everything to heal the gut.

Dr. Weitz:            That like a GI revive type of product.

Risa Groux:         Exactly. Very similar. Yes.

Dr. Weitz:            Okay, cool. Very good. So, how can listeners and viewers get a hold of you? Find out more about you if they want to work with you?

Risa Groux:         Yeah. So my website is risagrouxnutrition, it’s R-I-S-A, my last name is G-R-O-U-X nutrition. And I work with people all over the world. Instagram, Pinterest and TikTok even. I have all those things at risagrouxnutrition and then look for my Achieving Optimal Thyroid Wellness is launching March 11th and only open for a short period of time, but it’s a deep, deep dive into thyroid and then FoodFrame, we actually sold out our first run, but it should be back up on Amazon and Barnes and Noble and our website as well any day. So, FoodFrame and it explains everything that we really talked about in great detail.

Dr. Weitz:            Cool. Thank you.

Risa Groux:         You’re very welcome. Thank you for having me and I hope everybody learns something.

Dr. Weitz:            I’m sure we did.

Risa Groux:         Okay.

 


 

Dr. Weitz:            Thank you. 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 three-one-zero three-nine-five three-one-one-one 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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Hypothyroid with Dr. Mona Morstein: Rational Wellness Podcast 250

Dr. Mona Morstein discusses Hypothyroidism with Dr. Ben Weitz.

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

 

Podcast Highlights

3:20  Autoimmune diseases like Hashimoto’s thyroiditis, the most common form of hypothyroid in the US, are more common in women.  This may be because estrogen tends to stimulate the immune system, which is also why estrogen levels tend to be suppressed during pregnancy, so that the immune system is down regulated during pregnancy so that the mother’s immune system will not attack the baby as a foreign substance.  For this reason, some women will have their autoimmune condition go into remission during pregnancy.

5:15  Lab Testing for Thyroid.   1. TSH–this is the signal from the pituitary to the thyroid to make more thyroid hormone. 2. Free T4.  97% of what the thyroid produces is T4, which the cells of the body can convert into T3 as needed. Free T4 is more important to look at than Total T4, since only the free hormones are active in the body. 3. Free T3. 4. TPO antibodies 5. TGB antibodies.  For some reason, some doctors are only ordering TPO and not TGB antibodies, but you need to order both. Reverse T3 should not be run most of the time because many things can elevate reverse T3, including too much thyroid hormone, depression, infection, illness, heart failure, eating too few calories, medications, including Metformin, birth control pills, and beta blockers.

13:37  Thyroid binding globulin could be a valuable lab if you look at both total T4 and free T4 and total T3 and free T3 and want to see if the free thyroid hormone is low is it because you need more thyroid or could too much be getting bound?

15:20  You should avoid taking supplemental biotin, such as in a multivitamin or a hair formula or a B complex, for 24 hours before running your thyroid labs, since the machines that run the tests use biotin in the process.

16:35  It is also best to run the thyroid labs fasting and not take thyroid medication till after drawing the blood.

19:25 TSH level controversy.  The American Academy of Clinical Endocrinologists has set the normal range of TSH at .4 to 4.5 mlU/L, whereas the National Academy of Clinical Biochemists has set the upper limit of TSH at 2.5, since 95% of people with zero thyroid disease have a TSH of less than 2.5.

23:29  Subclinical hypothyroid.  This is when you have an elevated TSH but free T3 and free T4 are within the normal range.  Before considering placing such patients on thyroid medication, we should try to heal their thyroid. 

26:32  We need to investigate some of the possible causes of Hashimoto’s with detailed history taking and specific labs.  There are specific nutrients that affect thyroid regulation. There are heavy metals that affect the thyroid.  There can be food sensitivities. There can be microbiome imbalances. Infections can lead to inflammatory reactions and Yersinia is an infection found in the gut that is associated with autoimmunity with the thyroid, so doing a stool panel is a good idea.  And ask your patient to fill out a diet diary for a week.

30:26  Iodine.  Iodine is very controversial with some doctors claiming that most patients with hypothyroid need much larger dosages of iodine and other research that indicates that patients with Hashimoto’s should not take iodine.  If we look back in history we see that in the US and many other countries we used to have a lot of people with enlarged thyroids known as goiters.  In fact, an area of the country was known as the goiter belt, which was a region across the midwest of the US where goiter was very common because soil in those states had lower levels of iodine and those people had lower intake of iodine.  Then we added iodine to the salt supply and we saw levels of goiter drop precipitously and levels of autoimmune thyroid (Hashimoto’s) rise precipitously.  On the other hand, many people have moved away from using iodized salt and have switched to sea salt and Himalayan pink salt and we do know that iodine is crucial for thyroid hormone production.  But Dr. Morstein does not find that patients with hypothyroid do well with taking higher dosages of iodine, such as the 12.5 mg Iodoral product on the market. Some Functional Medicine doctors were using an iodine loading test where patients consumed a 50 mg loading dose followed by a urine test and expecting 95% of it to be present, but this is a stupid test because humans are not designed to absorb such a large dose of iodine at one time.  Unfortunately, we do not have an accurate way to test iodine status at this time.

39:55  Halogens.  There is a row in the periodic table of elements that contains Flourine/flouride, Chlorine/chloride, Bromine/bromide, and Iodine and Flourine, Chlorine, and Bromide can all compete with Iodine and cause an Iodine deficiency. Flouride is often added to drinking water and in many toothpastes, while chlorine is also often added to drinking water, found in bleach, and chloride is in salt as sodium chloride. Bromide is often added to bread and other packaged products such as almond milk as a preservative.  We should drink filtered water and use filters on our showers.

42:05  Foods.  Rather than take certain foods out of the diet that might negatively interact with thyroid, such as gluten or dairy or soy, Dr. Morstein believes in doing food sensitivity testing and she likes to use Alletess testing and taking all of those foods out that test positive for one to two months or so and build up the gut and then when they start feeling better you start putting these foods back one at a time.  No one should be taken off eating gluten without first testing if they have celiac disease, but unfortunately this is done a lot.  If they have celiac disease, then they should avoid gluten more intensely.  And there is this triangle connection between celiac and Hashimoto’s and type I diabetes. There have been a lot of trials on soy and thyroid and Dr. Morstein does not think that you should live on soy and eat crappy soy like soy turkey and soy hot dogs, etc. But there is nothing wrong with eating some good organic soy tofu a couple of times per week. And there is also nothing wrong with eating vegetables from the brassica family, like cabbage, cauliflower, broccoli, radish, kale, esp. if they are cooked. They don’t seem to be a problem for thyroid, despite them being labeled goiterogens.  There is a case of a 88 year old woman who ate two pounds of raw bok choy every day for months and wound up in huge hypothyroid crisis.

 



Dr. Mona Morstein is a Naturopathic Doctor who practices at Arizona Medical Solutions in Tempe, Arizona. Dr. Morstein: has a practice focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid, and gastrointestinal disorders like SIBO and IBS.  She is the author of the best-selling book Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type I and Type II Diabetes and she lectures frequently at medical conferences.  Her website is azimsolutions.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 I’m excited to be discussing Hashimoto’s hypothyroid with Dr. Mona Morstein. Dr. Mona Morstein is a naturopathic doctor in Tempe, Arizona. She’s practicing functional medicine at her clinic, the Arizona Integrative Medical Solutions, with focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid, and gastrointestinal disorders like SIBO and IBS. She’s the author of the bestselling book, Master Your Diabetes, and she lectures frequently at medical conferences.

Our topic for today is Hashimoto’s thyroiditis, which is an autoimmune disease in which thyroid cells are destroyed via cell and antibody-mediated immune processes. It’s the most common cause of hypothyroidism in the U.S. and other advanced countries that supplement the population with iodized salt, while in developing countries, the most common cause of hypothyroid is the lack of iodine. Hypothyroid or low thyroid is when the thyroid gland is sluggish and not functioning as well as it should.  On lab tests we’ll typically see TSH levels go up and T3 and T4 levels go down. And this can result in a number of symptoms, including fatigue, sensitivity to cold, constipation, dry skin, muscle pain, depression, irregular or excessive menstrual bleeding, memory and brain fog problems, high cholesterol, hair loss, brittle nails, weight gain, and a number of others. The conventional medical approach is to simply prescribe thyroid medication. Whereas in the functional medicine world, we want to address the underlying autoimmune condition as well as help to normalize the thyroid function with appropriate medication and nutritional supplements.  But there are lots of controversies with respect to Hashimoto’s, including the significance of the level of antibodies, the proper range of TSH, which other test’s the most appropriate to run and monitor, whether to use natural versus synthetic thyroid, whether to use T3 as well as T4, whether to increase our intake of iodine or to restrict it, the role of gut health in regulating thyroid function, whether gluten or dairy or soy negatively affect thyroid function, and whether eating broccoli is bad for your thyroid among other issues that Dr. Morstein: is here to help sort out. Dr. Morstein:, thank you so much for joining us.

Dr. Morstein:              Thank you. Thank you, Dr. Weitz. Thank you.

Dr. Weitz:                   Okay. So Hashimoto’s is an autoimmune disease and we know it’s much more common in women. Do we know why autoimmune diseases are more common in women than men?

Dr. Morstein:              Well, many autoimmune diseases are more common in women than men. There are ideas of estrogen leading to them. For example, many women with some of the musculoskeletal autoimmune diseases actually can get into a remission during their pregnancy and then after their pregnancy, their condition can reaffirm itself. So obviously that’s one of the most interesting aspects is the estrogen connection, since men don’t really have that to any substantial extent outside of insulin resistance or something like that.

Dr. Weitz:                   And we think that that probably has something to do with some level of… Not dysregulation, down regulating over immune system that occurs during pregnancy so that the mother is less likely to reject the baby as a foreign substance, right?

Dr. Morstein:              So the main estrogen during pregnancy is estriol, which is a little weaker than the estradiol and estrone that is going to be needed and generally higher during the cycling. And yes, there is also the idea that there is this fetus in the woman and the immune system has to not reject that fetus as something foreign. And then that may trickle over to settling down the immune system in other manners, less inflammation and less attacking itself in other ways it might naturally be doing.

Dr. Weitz:                   So what are some of the most important lab tests to look at for diagnosing Hashimoto’s hypothyroid?

Dr. Morstein:              Well, to start with, basically TSH, thyroid stimulating hormone, which comes from the pituitary and stimulates the thyroid to make its hormones such as T4. Now, around 97% of what the thyroid produces is T4, just because T3 is so strong that the thyroid says, “I’m going to make T4 and then the rest of you cells in the body, the intestine cells, the liver cells, all these cells, you decide how much T3 needs to be converted to run all of your cells.” So there is levels of total T4, but the most important one is free T4. Total means T4 that’s bound and then that’s free. And the only hormones that are active are the free ones. Then that’s going to go into the cell. And then we have total T3, but also free T3. And that’s the active form of T3.  So a TSH of free T4, a free T3, will give us good ideas about the hormones that are made from the thyroid and converted into the active T3. For diagnosis of Hashimoto’s, of course, we have to add in too, antibodies. And I want to say too, because there’s this really, really bad idea out there. I see so many patients come to me with labs where just thyroid peroxidase antibodies were a measure and not antithyroglobulin antibodies. And you have to do both. One or the other maybe elevated.

And I don’t know why lately there seems to be a thing where, “Well, let’s just do TPO,” but that’s not complete enough. So it has to be both of those antibodies to see if an autoimmune disease that we diagnose Hashimoto’s is being instituted, where the body’s own white blood cells are now attacking the thyroid in two separate areas, right? TPO is the enzyme attaching iodine to the tyrosine. And the antithyroglobulin antibody is attacking thyroglobulin, which is like the foundational protein upon which we put tyrosine and what we attach iodine to. So there can be autoimmunity in both of those areas.

Dr. Weitz:                   I think part of it’s because there’s confusion among practitioners about which tests to run, because some out there are saying you have to run like 15, 20 different tests, you got to do free T3, and you got to do total T3 and total T4 and free T4. So let’s try to sort this out so we know exactly for sure which tests we should do. So everybody agrees, you should do TSH. And some practitioners say that’s all you need. And I think that’s where we end up not realizing that the patient has autoimmune hypothyroid. So we definitely have to do these thyroid antibodies. And I totally agree, we need the TPO and the TGB, and there may be some others because 10% of the patients are negative for TPO or TGB that have Hashimoto’s. But what about doing total T4 and total T3 as well as free T3 and free T4, is there any reason to do that?

Dr. Morstein:              If people want to just see what’s the total or what’s the conversion to free T3, I suppose they can. You could see how much is bound. For myself, I personally don’t feel it’s necessary to do the total T4, the total T3. And also another thing that’s a very problematic lab that in general should not be done, which is going to make me sound like a [inaudible 00:09:41], it’s reverse T3.

Dr. Weitz:                   Right. It’s very common in the functional medicine world especially.

Dr. Morstein:              Yes, it is. But it’s not really beneficial. Reverse T3 is kind of the way we throw out thyroid, right? It’s the end product, right? So we have T4, which is named T4 because of it containing four iodines. And then T3 is the removal of one of those iodines and in the right now. So you can have T3 made by selenium, enhancing the deiodinases enzymes, or if you don’t have that selenium in that, then we’ll pull it out in the outer ring and make reverse T3. Now, this is a huge problem because rT3 can… So they’re looking to see if it’s elevated, right?

Now, many, many, many things can elevate reverse T3. You could have just too much thyroid hormone. And then the body’s just trying to get rid of it, all kind of life stressors, infection, illness, just having a reaction to something or even medications, like for example, Metformin, birth control pills, beta blockers. Common medications can raise reverse T3, even depression. A posttraumatic stress disorder has been shown to raise reverse T3. Not getting enough calories in, especially carbs and proteins or lab error, right? It can happen, especially if there’s an autoimmune thyroid disease, it raises, for no reason at all, it can be found elevated in literally completely healthy people with completely healthy thyroids and no Hashimoto’s. Chronic heart failure can raise it, right? So you can do it, but you have no way to interpret really what’s going on with it being elevated. So it’s really not a helpful lab value of people really understand reverse T3 and really know what affects it.

 



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                                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:                   What about thyroid binding globulin, is that a valuable test?

Dr. Morstein:              So obviously that’s valuable, especially if you’re looking at the total T4 and then the free T4, and trying to understand how much is bound. There are things that raise that, like birth control pills, for example, can raise that. So if you really want to go to that level, that’s fine, but I will say there is…

Dr. Weitz:                   In other words, let me just stop you for a second. So what you’re saying is, maybe birth control pills can raise this level of binding globulin. And if too much of your thyroid hormone is bound, not available for the cells, you might be producing enough thyroid hormone, but you don’t have enough free thyroid hormone to actually do the job?

Dr. Morstein:              Yes. That is definitely something you can look at in regards to the THG and total T4 and free T4. And then the total T3, which is bound by the same thing and free T3. So you can certainly use those to try to understand, is there something blocking the formation of the free, right? That is certainly an analysis in regards to, do we need to deal with the blocking or do we need to deal with more medication to try to overpower that if something is happening, that we may or may not be able to identify?

Dr. Weitz:                   Right. So I looked at your PowerPoint from your talk. You mentioned that when getting your labs done, you should avoid taking biotin for eight to 12 hours. The biotin’s a B vitamin, and we’ve learned over the last several years that certain labs use biotin as part of their process in running-

Dr. Morstein:              The machines use it.

Dr. Weitz:                   The machines use it in running the lab, and we don’t really know which labs use it and which labs don’t, is that right?

Dr. Morstein:              Yeah, that is true. And I would actually say, avoid biotin for at least a day or one or two days.

Dr. Weitz:                   Is that enough time? Is one day enough?

Dr. Morstein:              I think so. Because our nutrients don’t float around our bloodstream.

Dr. Weitz:                   Right. And it’s water soluble and-

Dr. Morstein:              Right, exactly. So this is going to be used up or excreted as necessary.

Dr. Weitz:                   So for the average person, this means for one day, don’t take your multivitamin, if you’re taking a B complex or-

Dr. Morstein:              Or a hair product will have biotin…

Dr. Weitz:                   Hair product that often have high biotin. Okay.

Dr. Morstein:              Yeah. We want them to search everything and just do that. And then in general-

Dr. Weitz:                   And you also mentioned that your thyroid labs should be done fasting?

Dr. Morstein:              Yeah. So there is a study that showed that people fasting had more accurate labs than people that had eaten before them. And so the idea is many, many people take their thyroid first thing when they wake up and wait at least a half hour before eating. By the way, taking thyroid at bedtime is a great time to also take it. But what we do then is generally have people schedule the earliest lab, wake up, not take their thyroid, do the lab, and then take their thyroid. We know that T3 is very rapidly absorbed, and we can get an artificial elevation of T3 if people have taken their thyroid within say five hours of the lab test. And that can throw off interpretation obviously.

Dr. Weitz:                   Right. So do you usually recommend if they’re already taking thyroid medication and not take their medication before the labs?

Dr. Morstein:              I do. I do. And now just a lot of people, especially getting older, might wake up and have to urinate at night. They can certainly take it then. In fact, the thyroid’s natural biorhythm is coming out around 2:00, 3:00 or so in the morning. So taking it at bedtime actually matches the natural output of thyroid and then leaves you open to get your blood work done anytime the next morning-

Dr. Weitz:                   Well, that negatively affects sleep?

Dr. Morstein:              No. So it doesn’t, right? So that’s because… This is a common question, right? We are putting enough thyroid in just to get you to normal. So at least with my patients, I don’t see anybody saying, “Wow, I took that and now I can’t sleep.” Like for example, that may happen for some people with B vitamins, not a good thing to take before bed for many people, but the thyroid doesn’t really seem to do that. I actually have some patients who say it actually helps them fall asleep. So it’s interesting.

Dr. Weitz:                   So can you explain what subclinical hypothyroidism is?

Dr. Morstein:              Yeah. So subclinical hypothyroidism basically is a term we use when the TSH is elevated beyond what we feel comfortable with. And we can talk about those. [crosstalk 00:19:20].

Dr. Weitz:                   Why don’t we do that real quick? Because we just finished the lab testing. Let’s just talk about TSH for two minutes here.

Dr. Morstein:              So there’s two different organizations that have chimed in about where the TSH level should be. And one was this [inaudible 00:19:40] study, which studied that TSH, they said, had this upper limit of 4.5 mlU/L and this was what they’ve decided, the American Academy of Clinical Endocrinologists, they chose that study to say that the TSH up to 4.5. So generally it’s like 0.4 to 4.5 is within the norm. Now, this other organization called the National Academy Of Clinical Biochemists, they said, “You know what? In our research, like 95% of people who have zero thyroid disease have a TSH of less than 2.5. And so while conventional MDs have gone with that TSH to 4.5 is good, almost every naturopathic functional doc has gone with the NACB and believes that TSH should be less than 2.5 for maximum numbers of truly healthy thyroid. So there is this disconnect and we all know on our lab that on our lab reference, they’re all going to 4.5. So then we have to have-

Dr. Weitz:                   And in fact, when we think about lab reference ranges, most people don’t realize this, but they really reflect the average American. And in many ways, I certainly don’t want to make my goals to be like the average American or for my patients.

Dr. Morstein:        I once called a lab, I called a lab once and said, “Where did you get your postprandial glucose readings?” Because they were not following what the research said that really… I mean, see, the postprandial insulin. So the postprandial insulin should be, in all the research I read, was like 30 or less, but they had it going up to 89. And this lab, which is a famous lab, if I mentioned it, everybody would know this lab. They deal with millions of people probably a day. They said, “Oh, we just took 50 of our healthy employees and measured it.” And that’s the lab value that they use now to measure millions of people. And their postprandial insulin goes to like 89. So when we look at these reference ranges, we have to understand that we have a righteous allowance to not always agree with them.

Dr. Weitz:                   Absolutely. And that’s the danger of just looking for the things that stand out in red. I had a patient in last week and we were looking at her liver enzymes and her ALT was 65. And I said, “Whoa, your liver enzymes are up.” But it was normal. And I looked, and there was a little star, this was from UCLA. And the reference range is now 70.

Dr. Morstein:              Oh my God, that’s terrible.

Dr. Weitz:                   So I think what that means is as a result of two years of pandemic and everybody staying home, eating junk food and drinking more alcohol, we’ve seen liver enzymes go up. So now we’re just raising the reference range with what people, that’s what they consider good, but it’s not.

Dr. Morstein:              It’s not. That’s not good.

Dr. Weitz:                   So let’s go into subclinical hypothyroid.

Dr. Morstein:              Right. So subclinical hypothyroidism, now, again, depending on functional docs would likely say over 2.5, conventional docs would say likely over 4.5. So we have this elevation of the TSH generally with at least the free T3 and the free T4 being still within the normal range, which is where the thyroid is able to make hormones, but the pituitary is starting to have to yell at it to do so. And so the reason is, why are we now starting to have to yell? What is blocking the natural flow and rhythm of the thyroid that the normal just make thyroid isn’t working and the pituitary is now having to start speaking much louder to it? And there’s many reasons that could be happening.

Dr. Weitz:                   So should patients with subclinical hypothyroid be treated? And if so, how?

Dr. Morstein:        Okay. Right. So for me, I don’t necessarily agree that every person on the planet needs to be on thyroid medicine. And to me, I look at that like, okay, so my patient presents with constipation. They have two bowel movements a week. So do I just put them on laxatives or do I try to look at their diet and their exercise? And do they need more… What’s going on with their colon, that they can’t have a daily bowel movement? And with the thyroid with subclinical, I’m going to be looking at the thyroid and saying, “What’s blocking this natural flow?” Let me spend a few months trying to heal the thyroid before just automatically putting them on thyroid medicine.

And the other thing is this, if you automatically put them on thyroid medicine, that underlying imbalance is still there. Nothing was fixed that the body is talking to us and we can just overshadow the body and say, “I don’t want to listen, here’s your thyroid.” Or we can say, “You know what? This is subclinical hypothyroidism. Let’s try to heal your thyroid.” And all my patients are all like, “Great, that’s a great idea. Let’s look into what could be blocking it.” And then we can be retesting your thyroid every five or so weeks. And seeing now, I have been able to heal loads of patients with subclinical hypothyroidism. So that’s why I like to start in that area because you know what? You can always stick them on thyroid, but do we have to every single person, right?

Dr. Weitz:                   Absolutely. So as functional medicine practitioners, we want to look at the root causes. How do we go about figuring out what are some of the underlying triggers and root causes for Hashimoto’s?

Dr. Morstein:              For sure. So for me, that depends on many things, right? So there’s so many-

Dr. Weitz:                   We look at their history. We want to consider-

Dr. Morstein:              Yes. We want to do particularly obviously labs. It is nice to know you can have Hashimoto’s and still have either a completely functional thyroid still, or a subclinical hypothyroidism too. Hashimoto’s does not automatically completely destroy a thyroid and immediately require medication. So obviously it is nice to add in the labs just to make sure is this subclinical hypothyroidism just in and of itself or does it also have among potential other reasons, an autoimmune component? So that is good to know. So there’s a lot of factors that do affect the thyroid. There are many nutrients that affect the thyroid regulation. There are potential heavy metals that affect the thyroid. There can be with food sensitivities, there can be gut microbiome imbalances. So there’s a whole-

Dr. Weitz:                   Chronic infections.

Dr. Morstein:              Yes. And well, infections can affect that depending on what the infection is. But yes, that can certainly lead to a lot of inflammatory reactions in the body [crosstalk 00:28:28].

Dr. Weitz:                   Including certain well known viral infections. And when it comes to heavy metals, we really got a series of environmental toxins in addition to heavy metals that can also be triggers.

Dr. Morstein:              Yes. The liver and kidney can be involved as well. So it is a huge thing just to look at step by step with patients and to take the time to go over what they may be most sensitive to or do full investigation of all of these things.

Dr. Weitz:                   So what are some of your favorite panels or other ways to investigate some of these issues?

Dr. Morstein:              So I am a big, huge… I do a lot of food sensitivity. I’ll do that with every autoimmune disease. I do like to look at the gut microbiome. There are certain bacteria like Yersinia, for example, that has an association with autoimmunity in the thyroid. So a stool test, culture, PCR, we can discuss those, but just looking to see if there is a dysbiosis that has association, or even not enough beneficial bacteria, just not enough healthy microbiome to see. So looking at the gut, because that is so related to the whole entire body, I will always do a diet diary, on every single patient will do a week long diet diary. And there are some labs, labs are… I’m sure we’ll be talking about, for example, the huge problems with iodine labs. There a huge problems with those, but you could do, there are other nutrients-

Dr. Weitz:                   Why don’t we go into iodine right now? So that’s a good segue because this is a big discussion and there’s many directions we can go in no matter what we do, we’re not going to cover all of it, but let’s go into iodine. Iodine is very controversial.

Dr. Morstein:        It’s very controversial.

Dr. Weitz:                   One of the reasons why is because if we go back in history, the United States, like many other countries, had a lot of people with goiters, these big and large thyroid glands. And the main reason for hypothyroid was a lack of iodine. And we had the Goiter Belt, and we started adding iodine to the diet by adding it to the salt. And we saw levels of goiter drop precipitously and levels of autoimmune thyroid rise precipitously. And we’ve seen the same pattern in country after country around the world. So we know iodine is crucial for thyroid function and yet do we need extra iodine? Especially since maybe people are moving, especially natural health enthusiasts are moving away from iodized salt. And we’re using Himalayan pink salt and sea salt and things like that. And so we have most multivitamins will have a modest dosage of iodine. We’ve seen iodine possibly being beneficial in preventing breast cancer. And then we have actually one really well known functional medicine doctor who advocates very high dosages of iodine.

Dr. Morstein:        Yeah. I’m not really a fan of that at all. Look, my view, high dose iodine is not just a bad idea, it’s dangerous. I can’t tell you how many patients. So we have one doc who invented a supplement called Iodoral, which is 12.5 milligrams. I don’t know… And that was a very, very big thing around 10, maybe 15 years ago where there was this test. However, in my opinion, it [inaudible 00:32:45] stupid it was that people would take 50 milligrams of iodine and then had to recover 95% of it in their urine or they were judged deficient.

When studies on cows, when they did the exact same test, showed that 90% of the iodine of course was in the stool. Because when your body is designed to absorb 150 micrograms a day, you cannot put 50 milligrams in the intestine and expect the gut to absorb it. Just like you can’t say, “Well, you should get 300, 400 milligrams of magnesium, why don’t we just put 2000 milligrams of magnesium?” Well, that’s going to cause diarrhea. Too much vitamin C, that will cause diarrhea. And vitamin C is one of our most massively easy things for our body to absorb, and yet you’re going to get diarrhea. So these tests and everything are a problem. Now, [crosstalk 00:33:39].

Dr. Weitz:                   This was called the iodine loading test.

Dr. Morstein:              It’s iodine loading test and it makes no sense. So please never do it. So that’s Dr. Mona Morstein, that’s my opinion.

Dr. Weitz:                   What about doing serum iodine or other-

Dr. Morstein:              No. So no, that’s mainly the one of the problems with iodine is that there are no real good tests for it. Serum iodine pretty clearly is going to reflect your previous meal and how much iodine may have been in it, but it has nothing about stored iodine in your thyroid or on your thyroid hormone. The World Health Organization will do spot urinary testing. This is not designed for an individual’s analysis of their thyroid level. This is designed to do maybe 1000 people in a village, perhaps undeveloped village to see, on average, where do we feel iron levels are in a bigger population in that regard? Now, it’s not designed that one urine that’s going to tell you where your iodine stores are, right? So serum is not listed in studies as a good measurement. There is this 24-hour urine ironary collection, but day-to-day iodine intake is so variable that these… It’s amazing, we can put rover on Mars and take pictures and we can’t figure out really how to measure iodine in any typical patient that’s walking in our door.

 



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Dr. Weitz:                   Generally speaking, for patients with Hashimoto’s taking 100 or 200 micrograms of iodine in their multivitamins, probably fine, but any more should definitely be avoided.

Dr. Morstein:              I mean, when that was big and people were, if they are still taking these massive doses of iodine, this is actually in the literature that it can cause hyperthyroidism. And I’ve seen almost two dozen patients who develop Graves’ disease solely as a result of taking these enormous doses of iodine. So I feel it’s a very unsafe and unstudied way of working with patients.  So yes, we don’t want iodine… Look, I’m a naturopath, you’re functional, we don’t mind that you’re taking higher doses of B12, RDA, six micrograms a day. Do we care that people are taking 200?  No. Do you need to take 1000 a day?  No, but we don’t mind going over, like RDAs like vitamin C.  Of course we want people to take 1000 or so a day. But iodine…

Dr. Weitz:                   The RDAs are based on what’s going to prevent scurvy and things like that, and that’s not our goal anyway.

Dr. Morstein:              Exactly. But the iodine is a narrow range and it really needs to be a narrow range. Now, if you follow someone like Alan Christianson with the Thyroid Reset Diet, who feels that when we look at these studies of iodine deficiency from where it was in the 1990s to where it is now, there’s huge decrease in iodine deficiency.  And like you said, but so much more autoimmune disease and the association that where countries had deficiency and low autoimmune disease, and now they’re putting all of this iodine in salt and promoting it and supplements, that what comes with that is more Hashimoto’s thyroiditis.  So we have to really understand that minerals in general have tighter okay limits than… I mean, you can say 25 milligrams of zinc is fine, but if you take 100 every day, likely, given a couple few months, you can get copper deficient. Minerals are just different factors, right?  And iodine is one of them. I mean, I was chair of nutrition at a naturopathic medical school, and iodine, I think, needs a very tight reign.

Dr. Weitz:                   So there are certain minerals called halogens. Yes. And these are in the same row in the periodic table. And these are often found in the diet. They’re controversially generally not good for us for a number of reasons. And the reason we find them is that chlorine is often added as an antibacterial in drinking water. Fluoride is often added supposedly to help our teeth, but it’s a great way for chemical companies to dump some of their toxins into our drinking water and have us pay them for it. And bromide is often found as an additive in many food products.

Dr. Morstein:              Breads, a lot of breads as an emulsive. And of course bread is not only that, but remember chloride is sodium chloride, right? So you get this combination in bread and I’m not anti-grains, but just saying bread is our highest source of sodium chloride in our diet. And of course has the bromine in it for processing of it.

Dr. Weitz:                   And so these halides compete with iodine.

Dr. Morstein:              Yes.

Dr. Weitz:                   So is that something we should be concerned about or not?

Dr. Morstein:              Well, I think generally of course. I think most of us would want people to have a good filter on their water that they’re using to drink at home. And also shower filters. Like I have a filter in my… I have a water softener and it has a filter, but that filter is pretty old by now. And you can’t really change those. So the shower filters, the water filters, this is a good start in that regard in terms of blocking it. And then obviously just salt is vital, but maybe we don’t need five or six grams a day of it in our diets, right?

Dr. Weitz:                   Right. So which foods might negatively interact with thyroid? A lot of people talk about gluten. I’ve seen some articles where people recommend avoiding dairy. I’ve seen some articles about soy. Which of these foods potentially are going to be negative or is it just depending on the person?

Dr. Morstein:              So for one thing, I don’t think we should ever do kind of lazy medicine. I do a lot of food sensitivity testing. And I do that with every person with autoimmune disease. And let me trust you, not everybody with Hashimoto’s seems to be sensitive to gluten. It could be corn or eggs or dairy or soy. We need to work with each body’s individual needs. Now, gluten [crosstalk 00:42:57].

Dr. Weitz:                   My guess is like you with me, a lot of patients that come in to see us, we’re not their first doctor. And so they’ve already taken gluten and dairy out. So I don’t know if those tests are actually going to be helpful, because you don’t want to tell them to start eating gluten if it’s going to make them feel bad. Those tests are not going to detect gluten sensitivity if they’re not eating it.

Dr. Morstein:              Yeah. But I mean, that’s fine. I mean, obviously if people already know that gluten affects them, why would you… But I would say one thing, before any doctor or any patient stops eating gluten, they must absolutely be tested for celiac disease. You cannot tell patients, “Well, just stop gluten” without first testing them for celiac. This just should never be done. And unfortunately I think it’s done a lot. And so we’ve got to check that first, since we know celiac and Hashimoto’s, type 1 diabetes, have this triangle connection. If someone has celiac disease, their avoidance of gluten has to be so much more intense and exponentially severe. Then you have non-celiac gluten, and neuropathy. But a lot of my patients, they do come to me first, they’ve had or they haven’t had a testing or they’re not avoiding this or that.

So it’s not like every one of my patients coming to me isn’t eating gluten or dairy. I don’t really necessarily think dairy and thyroid… I think that would be its own entity. Now, soy, I mean, there’s been a lot of studies on soy, many, many trials on soy on the thyroid. I lived in Japan for a year as an undergrad. Obviously soy was part of every meal to some extent. And in general, if a person has enough iodine in their body, soy should not really be a problem for them. Now, this doesn’t mean you should live on soy, but you shouldn’t live on bacon either. But to say that you can’t have soy tofu or [inaudible 00:45:23] a couple times a week, that that’s going to harm your thyroid, that’s not true. That really isn’t true, if you’re looking at meta-analyses of really looking at soy.

So don’t just live off of soy, don’t be a vegan and eat soy chicken and soy turkey and all of this crappy soy, but to naturally include good soy, organic soy in your diet a couple times a week or so forth, that isn’t going to hurt your thyroid at all. And neither will the brassica family. So the brassica, your cabbage, cauliflower, broccoli, radish, kale, these really when they’re cooked, they really don’t seem to be a problem for the thyroid at all. And goitrogens in them are going to be inactivated when they’re cooked.

Of course, there is this very, very, very, very famous 88-year-old woman, God bless her, who ate like two pounds of raw bok choy a day for months, and wound up in a huge hypothyroidic crisis. Like even mixed edema, things that we just never really see in America, because we can catch things so early. So that was one woman eating… I don’t know how much two pounds is, but it’s got to be a lot of bok choy every day. So don’t do that. But cooking these, these are not a problem. You don’t have to restrict them. They’re so good for the body in so many different ways.

Dr. Weitz:                   Unless of course that person happens to be sensitive to them. And if they’re sensitive to them, they could form IgG or other types of antibodies, and those antibodies could cross react with thyroid tissue, right?

Dr. Morstein:              I don’t see it too often. And remember, when we do a food sensitivity test, maybe if you’ve got like 20 or 30 foods, they’re not really sensitive to those foods. The best way to do a food sensitivity test is if you do it, you spend a month pulling out, you build up the leaky gut because you’re having leaky gut to have all of those reactions. And leaky gut is totally associated with autoimmune disease. And then in a month or so, they’re feeling a lot better, whatever is going on. And then you can start adding foods back one at a time. It’s a misnomer that if you get this food sensitivity test, like for the rest of your life, you can never eat these foods again. That’s not an appropriate way, at least the way I do it, of working with these food sensitivity results that we see.

Dr. Weitz:                   So you’re saying do food sensitivity panel, any particular panel that you like?

Dr. Morstein:              Yeah, for sure. I have no financial association, but I’m a huge advocate of Alletess, which luckily, they have the website, foodallergy.com. So they must have gotten it right when the internet was invented.

Dr. Weitz:                   And so you do a food sensitivity panel-

Dr. Morstein:              I do.

Dr. Weitz:                   You pull out the foods that they’re highly sensitive to?

Dr. Morstein:              No, that’s another mistake. You pull out all the foods, one, twos and threes. No, you pull out every positive food. You don’t screw with the one, twos and threes because that’s in the lab. Their ones may be their worst foods and their three maybe something they can add in and it’s not a problem at all.

Dr. Weitz:                   Oh, interesting. Okay.

Dr. Morstein:              So clinically, it doesn’t always [crosstalk 00:49:10].

Dr. Weitz:                   Pull all those out and then work on healing the gut and-

Dr. Morstein:              And then within one or two months, there’s usually a substantial improvement and then they can start adding foods back in one at a time, see what re-initiate a symptom, that would be on the no list long term, but all the others can be added in and the patient won’t have a problem with those. We’ve been able to isolate just the one or two that’s the real problem.

Dr. Weitz:                   What are some of the other important thyroid nutrients? I’m thinking about zinc, you mentioned selenium, vitamin D, iron.

Dr. Morstein:              Yes. So obviously zinc is super important. It regulates the hormone from the hypothalamus to the pituitary, the pituitary to the thyroid. It regulates the deiodinases, so their activity, which is taking T4 to T3.

Dr. Weitz:                   Right. The conversion of T4 to T3, because if that doesn’t happen… Yeah.

Dr. Morstein:              That needs selenium as the nutrient co-factor but overall it’s regulated by zinc. And then vitamin A. So the thyroid receptor in the body is what we call an RXR receptor, a retinoid X receptor. And these are honestly very common receptors. For example, vitamin D uses an RXR receptor. And the retinoid means that vitamin A has to be part of that, to have the receptor acknowledge the thyroid and set up the DNA and the mitochondria and everything. So this is why so many pills will have vitamin D with vitamin A, because you need the vitamin A for its receptor and the same with the thyroid, you need vitamin A to activate and keep their receptors working well too.

Dr. Weitz:                   Cool. So how much vitamin A do you advocate?

Dr. Morstein:              5000 or 10,000.

Dr. Weitz:                   Okay. Typical.

Dr. Morstein:              Just very typical. Yeah.

Dr. Weitz:                   Right. Vitamin D is also super important, right?

Dr. Morstein:              Yes. Vitamin D is important. Vitamin D, we say vitamin, but it’s actually kind of a hormone regulator as a whole, blood sugar, other hormones, it’s amazing.

Dr. Weitz:                   Cardiovascular, [crosstalk 00:51:49].

Dr. Morstein:              Yeah. Cardiovascular. So mood of course, great for the mood. So obviously that’s an easy thing for us to check in the labs and then to dose accordingly. I don’t think anybody needs more than 10,000 IU a day, so anywhere generally, depending on a patient, generally from two to seven or eight is my typical doses for patients, because I live in a very sunny area too.

Dr. Weitz:                   I’m in Southern California, you’re in Arizona, but we still see quite a large number of patients that are-

Dr. Morstein:        [crosstalk 00:52:31]. Yeah, why is that?

Dr. Weitz:                   [crosstalk 00:52:31] less than optimal levels of vitamin D.

Dr. Morstein:              I mean, probably of course it’s hard to get in the diet, but also we live in very sunny areas where people step outside and smother themselves with sunscreen. I don’t use sunscreen for almost 30 years now and it doesn’t seem to be aging me too much, but people will go outside immediately, if your SPF is over eight, you’re going to block vitamin D.

Dr. Weitz:                   And we’re all trying to get our cholesterol levels as low as possible to prevent heart disease. And [crosstalk 00:53:05].

Dr. Morstein:              That’s a controversy [crosstalk 00:53:06].

Dr. Weitz:                   The conversion of sunlight into vitamin D occurs through cholesterol.

Dr. Morstein:              Right. Exactly. True. True. Absolutely. Yes. Although it should be high enough to do that unless it’s maybe less than 100 or over 100, 125, vitamin D should be [crosstalk 00:53:30].

Dr. Weitz:                   Right. But we’ve got new medications on the market and they’re picking LDL targets of below 40 as the goal.

Dr. Morstein:              I know. It’s crazy. It’s crazy.

Dr. Weitz:                   So in a few minutes left, what are your favorite herbs or botanicals to help with thyroid function?

Dr. Morstein:              So that’s good. There’s a lot of like, that’s what I use in products like with subclinical hypothyroidism where just trying to stimulate the thyroid. Now, of course, most people know about, of course, that we used to call them seaweeds, but that’s not cool, so now they’re sea veggies. So sea veggies are good, but again, the problem with sea veggies is that we don’t know how much iodine is in those sea veggies. And so you have to just deal with sea veggies to get… If you’re using that for an iodine source, very judiciously. Like if you’ve got a little Costco iodine sea vegetable little cup, maybe just have four or five slices a day, because little amounts can have quite a bit of iodine. So we can include sea veggies, particularly the brown sea veggies, which are a little more like bladder rack, for example, very well known vegetable used in thyroid medication.

So we’re going to do… So ashwagandha is a really good herb that can be… Well, ashwagandha, I mean, it’s so good for everything, but that’s another good herb to consider with patients where you’re trying to balance them, obviously doing nutrients as well, making sure that they have everything in it. Other ones are blue flag, an herb called [inaudible 00:55:50], so that’s been shown to help increase T3. Other adaptogens, Eleutherococcus, Centella, maybe even of course, thyroid glandulars are used very commonly, probably have a little iodine in them, but definitely are used in many products to stimulate the thyroid. Like we use adrenal glandulars and ovarian glandulars to stimulate these end organs. So those are some other ones to consider if there’s… To settle down antioxidants, like if there’s Hashimoto’s, things like licorice or I love curcumin, I use a particular product, a very anti-inflammatory just to help balance some of the autoimmune damage that could be happening, working with the gut, for sure. So just a comprehensive in those regards.

Dr. Weitz:                   Great. So I think that’s a wrap there. I’ve got a nine o’clock patient. So this was great information. How can listeners and viewers find out about you and your book and getting in contact with you?

Dr. Morstein:              Thank you. My website, drmorstein, M-O-R-S-T-E-I-N.com. And so that they have my clinic contact and everything, my book, Master Your Diabetes, which is I’m super proud of, you can get that, just Google Master Your Diabetes and Morstein on Amazon and that’ll come up. It’s just really good. And so those are best ways to get a hold of me, I think.

 


 

Dr. Weitz:                   Great. Thank you. 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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Clinical Use of Immune Testing with Dr. Elroy Vojdani: Rational Wellness Podcast 249

Dr. Elroy Vojdani discusses the Clinical Uses of Immune System Testing with Dr. Ben Weitz.  You might consider this a follow up podcast to the presentation by Dr. Aristo Vojdani in episode 244 where he explained the new immune system test that he developed for Cyrex Labs called the Lymphocyte Map test.  

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

 

Podcast Highlights

3:15   The Lymphocyte Map test is a technological leap in the ability to understand the current state of the immune system.  Prior to this test, the only way to measure immune system imbalance is through measuring cytokines, which are the chemical messengers that these immune cells release. But the Lymphocyte Map test directly measures the different type of lymphocytes, including the amount of Th1, Th2, Th17, natural killer cells, etc.

5:09  Two of the best times to use this test is for patients with autoimmune and inflammatory conditions and also when there is immune dysfunction and mitochondrial dysfunction associated with aging.  As an example, Dr. Vojdani may have a patient come to see him with some vague symptoms like joint pain, brain fog, gut issues, etc. and he may discover that they have some sort of autoimmune disease, like rheumatoid arthritis or lupus or ankylosing spondylitis and then the challenge is how to make this patient feel better and to arrest the disease process. You start working on discovering and modifying the root causes and then the Lymphocyte Map will give you a different picture that is complementary to the root work. It lets you understand exactly what sort of immune imbalance is occurring and provides some clues for interventions to modify things while the longer term root work is occurring.  It gives you an opportunity to improve patients in a shorter time frame.

7:40  With the Lymphocyte Map test we can identify the particular proinflammatory subtype of immune imbalance, which has typically been there for a long period of time prior to the onset of the autoimmune disease.  You can see how much of a Th1 or a Th17 or a natural killer cell problem do we have. You can also get a sense of whether this condition will be amenable to diet, lifestyle, and nutraceuticals, or will medications be required?  If someone has a Th1 or Th17 that is beyond the detectable levels, there’s not a lot that diet and supplements can do.  On the other hand if they are 20% or even 40% elevated, as long as you choose the right targeted nutraceuticals and improve diet and lifestyle, you definitely improve them.

10:47  The two main branches of T cells are CD4 and CD8 suppressor and helper cells.  The three main branches of CD4 include Th1, which are responsible for killing different pathogens and play a role in autoimmune disease, Th2, which are responsible for allergies, and Th17, which is responsible for specific intracellular pathogens, like stealth infections.

13:02  If you are treating a patient who has an autoimmune disease, such as rheumatoid arthritis, and who is on an immune modulating drug, such as methotrexate or hydroxychloroquine or Humira, the Lymphocyte Map test can provide some very useful information that the rheumatologist didn’t know it was possible to get.  You can find out if that dosage of that drug is actually doing what was intended to modulate the immune system without over suppressing it.  Humira is the number one drug in the US and it is a monoclonal antibody against TNF alpha, which is a very broad proinflammatory cytokine.  Rheumatologists are typically prescribing the amount they expect will help and then raise it if needed to control symptoms, but they don’t really know if it is the correct amount, other than symptoms.  They are flying relatively blind.  Now, with this Lymphocyte Map test we can see if they are not taking enough or if they are taking too high a dosage and the patient is in danger of being immunocompromised.  If you take someone with a massive amount of T cells and they go to zero T cells, then they are vulnerable to a virus or cancer, so this is not in anyone’s interest.

20:02  Long COVID.  Figuring out exactly what long COVID is is a work in progress and probably will be for the next 5 or 10 years. Long COVID is probably many things and each individual appears to have their own version of it, but there is without doubt an autoimmune version and an inflammatory version. The inflammatory version may have dramatic imbalances of Th1, Th2, and Th17 that don’t resolve the way a virus normally would. We don’t yet know if this is because there is a stealth component with some lingering amount of SARS-CoV-2 virus still in the body. But we can identify that there is a proinflammatory T cell imbalance and then try to push them in the right direction and see clinical resolution of their symptoms.  A T cell imbalance such as a proinflammatory Th1 and Th17 dominance is also often an indicator of a mitochondrial imbalance, since the mitochondria communicate directly with the T cells and there are really no direct reliable markers of mitochondrial status.  And we know that there is often a mitochondrial component of long COVID with symptoms like fatigue being very common.

26:44  Dr. Vojdani discussed a patient with long COVID, who got sick during the big winter wave of COVID in Los Angeles in 2021 before vaccines were available and he was experiencing chronic digestive issues, almost like a post-infectious IBS, as well as significant fatigue, esp. morning fatigue, and brain fog. The leaky gut workup was negative as was the blood brain barrier testing. Adrenal testing was also normal.  A Lymphocyte Map test, however, showed massive elevations of Th1 and Th17. He gave the patient a blend of anti-viral supplements and he tried to counter the Th1 dominance by pushing the TReg cells, which included serum bovine immunoglobulins, short-chain fatty acids, large amounts of probiotics, including spores.  On the antiviral arm, he had a low natural killer cell count, so he used andrographis, L-lysine, vitamin C, Monolaurin, and olive leaf extract.  He also gave him a peptide, BPC-157 for healing the gut.

31:18  The Lympocyte Map test can be helpful for managing patients with autoimmune diseases. Dr. Vojdani has a patient who had a long history of joint disease who was seen by a number of doctors and given different diagnoses because most of her tests were negative.  When Dr. Vojdani worked her up she had intestinal permeability, she had strong antibody response to multiple mold species, and her Lympocyte Map test showed extreme elevations of Th1, Th2, and Th17, indicating extreme aggressive T cell activation. While Dr. Vojdani worked with her on lifestyle factors, to clear mycotoxins, heal her gut, but he also called her rheumatologist, who prescribed Humira, which after three months balanced her T cells.  Her T cells were so highly activated that no natural approaches would have worked and Humira makes more sense.

 

 



Dr. Elroy Vojdani is the founder of Regenera Medical, a boutique Functional Medicine practice in Los Angeles, California. Dr. Vojdani began his medical career as an Interventional Radiologist, diagnosing and treating complex, late-stage cancers and other extremely debilitating diseases but wanted to prevent these chronic conditions, so he embraced Functional Medicine and went into private practice. Dr. Vojdani has coauthored over 40 articles in the Scientific literature and he continues to play an integral role in research related to Autoimmune, Neurodegenerative, and Autoinflammatory conditions. Elroy has just published his first book, When Food Bites Back and his website is RegeneraMedical.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. Let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Today I’m excited to be speaking with Dr. Elroy Vojdani about a new test called the Lymphocyte Map test. The Lymphocyte Map test is a new test by Dr. Vojdani and his father, Dr. Aristo Vojdani, to determine specific immune system imbalances. Dr. Aristo Vojdani spoke to our functional medicine discussion group in January and informed us about this exciting new test.  This is Rational Wellness episode number 244, if you want to go listen to that. If you want to see the presentation, you can go to my YouTube page, Weitz Chiro. We’ve known that patients with autoimmune diseases often have immune system imbalances, but it wasn’t so easy to find out exactly what these imbalances were. Now we have one test that can help us to really understand this.  This Lymphocyte Map test helps us understand what specific lymphocytes are elevated or depressed. Then we can take specific diet, lifestyle, and nutritional supplements to change them, hopefully in a positive direction.

While Dr. Aristo Vojdani gave us a lot of detail of what this test is, since he’s a researcher, not a clinician, this is why I wanted to speak with Dr. Elroy Vojdani to help us with some clinical insights for how functional medicine practitioners like myself might utilize this new test offered by Cyrex in clinical practice.  Dr. Elroy Vojdani is the founder of Regenera Medical, a boutique functional medicine practice in West Los Angeles, California. Dr. Vojdani began his medical career as a interventional radiologist diagnosing and treating complex late-stage cancers and other extremely debilitating diseases, but he wanted to prevent these chronic conditions so he embraced functional medicine and went into private practice.  Dr. Vojdani has co-authored over 40 articles in the scientific literature, probably more than that. He continues to play an integral role in research related to autoimmune, neurodegenerative and autoinflammatory conditions. He just released a new book, When Food Bites Back. Elroy, thank you so much for joining us.

Dr. Vojdani:                        It’s my pleasure to be here, Ben.

Dr. Weitz:                           To begin with, for those who perhaps have haven’t listened to the other podcast, can you explain what the Lymphocyte Map test is and why you and your dad developed this test?

Dr. Vojdani:                        Yeah. Lymphocyte Map testing represents a technological leap in the ability to understand the current state of the immune system. Essentially what we’re doing with this test is tagging and quantifying all the different branches of the adaptive immune system. We’re getting information about B cells, T cells and more specifically their subtypes and also natural killer cells.  Not only are you seeing quantification, but you’re also seeing balance and ratios, and the immune system really thrives on relationships between different populations of cells. This is really the first time that you get a hands-on objectively quantifiable look at the immune system.  Prior to this, getting a sense of where immune system balance came from was all done by looking at cytokines, so chemical messengers. The problem with chemical messengers is that they go up and down quite a bit over time, and they’re not specific to any particular branch. As we’ll get into, there was a lot of discussion in the past about Th1 and Th2, Th17 subtypes of CD4 T cells, which are incredibly important T cells.  We never really had a way to say, “Well, how much Th1 is there? How much Th2 is there? How much Th17 is there?” You would only be able to look at the intermediary chemical signals, which were not specific to that branch. Now we get to go to a specific direct quantification, and with that specificity we have a lot more power.

Dr. Weitz:                            Okay. Great. When would we use this type of test in a functional medicine practice? Considering that most functional medicine testing is out of pocket and trying to be judicious as possible with our patient’s out-of-pocket costs, is this a test that we would use for routine screening for patients? Is this a test that we’re going to use more specifically with patients who already have existing autoimmune disease? When’s the most judicious use of this test?

Dr. Vojdani:                        I break up that into two big buckets. Bucket number one is the autoimmune inflammatory bucket, which is a big part of what comes to us in the functional medicine world. Then let’s talk about Lymphocyte Map testing in another very popular bucket, which is immune dysfunction associated with aging, or maybe even mitochondrial dysfunction. Those are the two main areas where I find this very useful.  I’m not using this as a screening tool. I think this is meant as when you’ve done the work, you know what’s going on with the patient, or you have some suspicion as to what their underlying issues are. You now go to that next step of quantifying specifically where the immune function is so that you know specifically where can you can rebalance things.

A very good example for patients that typically come into my practice, they’ve got these vague symptoms, joint pain, brain fog, insomnia, gut issues, some of the usual things that we find. Sometimes as you’re working that patient up, you’ll discover that they have a known … or they have a direct autoimmune disease. They’re planting their flag in the ground.  They have lupus, or they have rheumatoid arthritis, or they have ankylosing spondylitis. Okay. Well, you’re making a disease diagnosis there and that doesn’t really stop you from doing the work that you really were intended to do. Now, you need to say, “Well, what am I going to do to make this person feel better? How am I going to balance their immune system?”  Of course, in functional medicine, we’re looking quite a bit at the root which is incredibly important. To me, the Lymphocyte Map gives you a different picture. It gives you the picture of today. It complements that root work and gives you an opportunity or a window to clinically improve them in a shorter timeframe while the root is taking its time to do the work.

Dr. Weitz:                            Okay. Let’s say we have a patient with some sort of inflammatory or autoimmune condition, let’s say we see a significant imbalance on a Lymphocyte Map test, do we know if that is a result of their inflammatory or autoinflammatory condition, or is that one of the causes?

Dr. Vojdani:                        I think you’re asking is the proinflammatory immune subtype the thing that leads to the autoimmune disease, or does the autoimmune disease lead to the proinflammatory subtype?

Dr. Weitz:                           Correct.

Dr. Vojdani:                        Right. The proinflammatory subtype typically leads to the autoimmune disease. You can imagine if let’s say their Th1, Th17 elevated, they’ve been that way for five or 10 years. Yeah. I think that’s the really important thing about autoimmune, is it requires that proinflammatory subtype for a very long period of time.

Dr. Weitz:                            Yes. Then, do we know if we take some of the interventions that might be effective at modulating the immune imbalance, let’s say we’re lowering Th17 and maybe increasing Treg cells using certain nutritional supplements, diet, exercise, do we know if that will affect the autoimmune condition?

Dr. Vojdani:                        Yeah. I think this is where the personalization of this immune workup really comes into play and really where it shines the most. Let’s say you’re working somebody up, you discover that they have an autoimmune disease, or they had an autoimmune disease prior to coming into you, you want to be able to have some discussion about what you can do to help them with their symptoms set.  Then the first thing that the Lymphocyte Map or immunophenotyping test is going to do is tell you what areas should you be looking into. Then, because you’re getting a quantification, you’re not just getting a qualitative output, you’re seeing on the scale how much of a Th1 problem do I have? How much of a Th17, how much of a Th2, how much of a natural killer cell problem do I have?  You can get some sense of how much of this is within my grasp and how much of this is not? I think those are very important distinctions. You can kind of give yourself a window into the three or six-month future that person and guide them very much as to what they can expect.  If you have somebody who is beyond the upper limits of detection limit for Th1 and Th17, as much as we think that we can make dramatic improvements, there’s not a lot that diet and supplements are going to do. On the other hand, if they’re 20 or 30 or 40% elevated, as long as you use the right targeted nutraceuticals, while also working on lifestyle, you can absolutely make that style of change.

Dr. Weitz:                            You mentioned Th1 and Th17, for those who aren’t aware is those are particular lymphocytes that tend to be associated with proinflammatory conditions.

Dr. Vojdani:                        That’s correct. These are all subtypes of CD4 T cells. Let’s break up T cells into their two most important branches. We’ve got CD4 and CD8 suppressor and helper cells. The CD4s have three big branches, Th1, Th2 Th17. Th1 is responsible for killing of different organisms and as well autoimmune disease. Th2 is the allergic part of the T cells. Then Th17 is responsible for a specific intracellular type of pathogen, a difficult to find, or maybe a stealth pathogen.

Dr. Weitz:                           Interesting.

 



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Dr. Weitz:                            Now, a typical Functional Medicine practitioner, say like myself, I may have a patient come in, say with rheumatoid arthritis, who’s being co-managed by a rheumatologist and let’s say, they’re on methotrexate, or they’re on some other immune-modulating drugs. I heard your dad say that methotrexate will help to change the Lymphocyte Map.  Then I run a Lymphocyte Map, how do I interpret that in a patient and who has autoimmune disease, but who is also taking immune-modulating drugs?

Dr. Vojdani:                        All right. This is, to me, a huge golden opportunity to make an intervention on that patient that they otherwise would never have and an opportunity to give the rheumatologist data that they didn’t know was possible to get.

Dr. Weitz:                            Both.

Dr. Vojdani:                        Both the patient and the rheumatologist will thank you for this. All right? What you’re really looking for, for somebody who’s on methotrexate or hydroxychloroquine, or whatever first-line immune-modulator is how successful has it been? Right? Is it creating balance between Th1, Th2, Th17 or on the flip side, is it may be overcorrecting and creating imbalance on the other end?  What you need to remember is that when we, as physicians, rheumatologists, whoever, are prescribing this medication, oftentimes it’s relatively blind. You’ve got a diagnosis of the autoimmune disease. You’ve got the clinical features. Maybe you have some basic blood work, but you don’t have these specific Lymphocyte Maps done.  You’re saying, “Well, for the majority of people with this clinical condition, methotrexate at this dose works, and if it works at this dose, let’s go up a little bit until we get to wherever.” Right?

Dr. Weitz:                            See an improvement of symptoms.

Dr. Vojdani:                        Exactly. You don’t know if that means immunological balance, homeostasis. You can look at the Lymphocyte Map and say, “Well, no, we still have quite a bit to go, or the methotrexate isn’t really touching this or you know what? We’ve actually created a bigger imbalance than we started with on the flip side.”

Dr. Weitz:                            Right. Meaning you’re now putting the patient in an immunocompromised situation, in which case, if they happen to come into contact with some virus-

Dr. Vojdani:                        Exactly.

Dr. Weitz:                            … or some other pathogen they’re particularly vulnerable.

Dr. Vojdani:                        Exactly. Let me take that and run with it a little bit because these are specific experiences that I’ve actually had with patients in interacting with rheumatologists. Humira is the number one drug in the United States, has been for quite a period of time. For those who don’t know what Humira, it’s a biologic. It’s essentially a monoclonal antibody against TNF alpha, a very, very broad proinflammatory cytokine.  Starting with rheumatoid arthritis or ankylosing spondylitis, or going down the chain, it gets used in more and more and more autoimmune diseases as time goes on because it’s incredibly effective because it’s working on this very, very central proinflammatory cytokine. The theory behind makes a lot of sense because typically people with these dramatic autoimmune conditions have humongous amounts of Th1, Th2, Th17.   The only way that you’re going to get them under control is by using something that blocks the chemical signal. But no one is doing follow-up afterwards to make sure that you haven’t bottomed out the immune system in its entirety. If you take somebody with this massive, massive amount of T cells, and then they go to zero T cells, they’re going to have a problem down the road, right?

Dr. Weitz:                            Right.

Dr. Vojdani:                        T cells are responsible for viral clearance, as you mentioned, they’re also essential for cancer clearance.

Dr. Weitz:                            If you’re trying to develop antibodies to protect you against a virus, it’s going to significantly impact the likelihood of that occurring.

Dr. Vojdani:                        Exactly. If you want to know, is this person really immunosuppressed on Humira? The only way to look is to do a Lymphocyte Map and find out Th1, Th2 Th17. You have done again, everyone a service, including the rheumatologist who is theoretically prescribing the Humira there. Maybe they can make dose adjustments.  Maybe they could figure out another solution, but clearly it’s in no one’s interest to be T cell depleted. That’s not the goal. Until this test, you could never look. You had no idea.

Dr. Weitz:                            Cool. Let’s say you had a patient, let’s pick an autoimmune condition. Maybe you can tell us about a case and maybe a case of rheumatoid arthritis or whatever, pick an autoimmune condition. Then let’s say you work them up. Would you run this test at the beginning?  In a functional medicine approach, let’s say the patient’s already diagnosed by a rheumatologist with a particular autoimmune condition. Let’s say rheumatoid arthritis. They came in to see me. I would start looking for what might be some of the underlying inflammatory triggers. Based on her history and any other testing she’s had done, we’d want to consider, does she have food sensitivities?  Does she have some issue with toxins? Are there underlying chronic infections? What’s her gut health like? I might run a stool test. I might run panels to look for possibilities for food sensitivities or toxins or infections. Where would the Lymphocyte Map test fit in? Would this be done as part of the initial screen or maybe second line or after we’ve worked on some of the root causes?  Where in a package of investigation would you think it would make the most sense in that type of a scenario? Maybe you can tell us about a case that you’ve had.

Dr. Vojdani:                        Yeah. I think for probably the majority of cases that come through the doors, it’s going to be used as a troubleshooting tool when you’ve worked on or looked at the basics or worked through what you expected you needed to work through and then maybe you find yourself up against the wall. You need some specific information to get you through to the next step. That’s probably, to me, the primary use for using a Lymphocyte Map, right?

Dr. Weitz:                            Okay.

Dr. Vojdani:                        I’ll give you examples of where I’ve used Lymphocyte Map in those situations. Actually long COVID tends to be one of the areas where I look at this the most.

Dr. Weitz:                            Oh, great. I’d love to talk about long COVID because a lot of people realize that there’s often … I don’t know, always, but at least often an autoimmune component. Then how do we work that up?

Dr. Vojdani:                        Yeah. Long COVID still, although we should say for everybody is a work in progress. There’s probably for the next five or 10 years endless amounts of work that are going to be done to try to really figure out what long COVID is. I think in reality long COVID is probably many, many, many different things and each individual’s going to have their own version of it. There is an autoimmune version of long COVID without doubt.  I mean, there are papers that have come out, out of Cedars. Then my dad and I have a paper coming out very shortly, hopefully in a very big journal that we just submitted to looking at the autoimmune propagation that occurs after COVID, but that’s not true for everybody who has long COVID. There also is this-

Dr. Weitz:                            What do you think about some of the other causes besides autoimmune?

Dr. Vojdani:                        I think they could strictly be proinflammatory as we’re talking about Th1, Th2, Th17 imbalances, but very dramatic versions of those imbalances and very dramatic versions of those imbalances that don’t self-resolve as a virus normally would.  The question I think is, is that because there’s a stealth component to some lingering amount of SARS-CoV-2 in the person’s body? Or, is that just because they had a bunch of inflammatory issues prior to their infection and now their inflammatory cytokine storm or response is just propagating on its own? Those things we don’t really know, but to me there’s an autoimmune bucket and then there’s this proinflammatory T cells imbalance bucket.  The only way you’re going to know essentially which one of those you’re dealing with is to test. In today’s world with so few tools for long COVID, doing something that’s very detailed, but basic, as far as an immune system is concerned, like doing a Lymphocyte Map, gives you that information hands on like, “Hey, what is happening to this person’s T cells, they’re three months, six months out from the infection, they should have rebalanced, but all of a sudden this is up or this is down.”  You can put your hands on those imbalances and try to push them in the right direction and see clinical resolution of the symptoms along the way.

Dr. Weitz:                            A number of patients have either clotting or cardiovascular aspects to this, would that fit into one of those two buckets, or would that be a third bucket?

Dr. Vojdani:                        That fits into the proinflammatory side?

Dr. Weitz:                            Okay.

Dr. Vojdani:                        I think that the clotting, endothelial activation, that’s all a proinflammatory portion of this, I think.

Dr. Weitz:                            Would the Lymphocyte Map be beneficial in those proinflammatory conditions?

Dr. Vojdani:                        That’s I think where you’ll find that if you do a bunch of testing before that comes out negative, let’s say you’re doing an ANA and you’re doing all of these antibody tests to try to find out if there’s an autoimmune component, comes back negative. All of a sudden you see a very positive Lymphocyte Map, you say, “Oh, aha, that’s the problem.” You know?

Dr. Weitz:                            I see.

Dr. Vojdani:                        Let’s not forget that there is a very large mitochondrial component with long COVID. The interplay between mitochondria and T cells is very intimate. Kind of going back to one of the first things we talked about, what are the two buckets where I use Lymphocyte Map? The second standard non-COVID bucket where I use it is in the overlap between aging and mitochondrial dysfunction.  That’s because the mitochondria themselves communicate directly with T cells. When there is mitochondrial damage, the T cells will actually transform themselves into a proinflammatory state. We don’t have, in my opinion, very good testing for the state of the mitochondria.  I mean, there are some labs that dabble in this and try to do it, but I mean, in reality, really reliable mitochondrial status markers are not available. If you go to the part of the body that communicates directly with the mitochondria, which are T cells and see the imbalance there, you can make inference that the mitochondria themselves are damaged too.

Dr. Weitz:                            How do you identify these patients as potentially having mitochondrial issues? Is it based on the fact that they have unexplained fatigue or?

Dr. Vojdani:                        Yeah. I have a long clinical screening process with them to try to quantify the extent of the fatigue. I think you also probably have to rule out other common contributors to fatigue, difficulty sleeping, adrenal fatigue, whatever you want to go through. Essentially if they have the T cell makeup of somebody with mitochondrial issues, which is by the way, Th1, Th17 dominance, proinflammatory response and there are clinical symptoms that matches that, then you know that the mitochondrial issues are there.

 



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Dr. Weitz:                            Tell us about a case of a patient you had with long COVID. What did you find and what did you do for them?

Dr. Vojdani:                        This was a case that came very early on, I think when Lymphocyte Map was first available. I think we’re talking probably around summer of last year, that would be July or August of 2021 for those that are watching the podcast later. Individual had had COVID during the big LA wave of winter. We had our own Alpha LA variant here. We had a very big winter surge. Lots of people were infected.  Nothing like Omicron, but definitely a very big winter surge at the time and vaccines weren’t available yet. There were a lot of COVID injuries that happened at the time. He was experiencing chronic digestive issues, so almost having like a post-infectious IBS picture, but this time related to a viral infection, very significant fatigue, predominantly morning fatigue, so feeling like they could never really get out of bed no matter how much they slept.

Then brain fog, this kind of cognitive issue that comes from long COVID was still lingering. This was six or seven months following the infection. The issues were still there. At the time I did my usual workup. My dad and I six months earlier had released a paper looking at COVID antibodies, having an issue with zonulin. Did the leaky gut workup, did the blood brain barrier workup on them. Nothing.  Everything looked totally normal, especially with the gut issues. It seemed quite strange to me. Adrenal testing was normal, surprisingly, and then I did a Lymphocyte Map and some massive, massive elevations of Th1 and Th17 for the patient. He’s in his 30s so it was very unusual to find that, especially six months after the infection.  I gave him a blend of different antiviral supplements, and then also looked to try to counter some of the Th1 imbalances by pushing the Treg cells themselves, so I went very gut-heavy. I did serum bovine immunoglobulins, short-chain fatty acids, large amounts of probiotics. I also used spores on him as well too. That to me was the Treg portion to try to push the Th1/Th2 balance back to where it should be.

Then on the antiviral arm of the immune system, he had a low natural killer cell count so I used andrographis, and then I gave a lot of L-lysine, vitamin C, Monolaurin and olive leaf extract. We did that for, I think maybe two or three months. By the end of it, he was clinically back to normal. Repeated the Lymphocyte Map and it was normal afterwards.  That’s an easy case, I think one that was pretty straightforward. There were definitely more complicated versions out there where they require, I think, a lot more calibration on the fly to get them in the right direction. Typically, that’s the way they look.

Dr. Weitz:                           Have you had to use any sort of exotic therapies on patients with long COVID?

Dr. Vojdani:                        Exotic therapies-

Dr. Weitz:                           Any-

Dr. Vojdani:                        … may mean many things in our world, Ben.

Dr. Weitz:                           I know. I’m always hearing about a new thing, you know?

Dr. Vojdani:                        I think I gave him BPC-157 for the gut portion of it. I don’t remember-

Dr. Weitz:                           Okay. Which is a peptide for people who are not familiar.

Dr. Vojdani:                        Yeah. Body protective compound-157 is a peptide. I don’t remember that it had any healing effect on him though. I think that’s probably something that works way better for people with intestinal permeability or some actual physical breakdown of their gut lining, which he didn’t have, surprisingly, despite all the symptoms. No. I don’t think I used anything else fancy for him.

Dr. Weitz:                            Okay. Just clinical pearls, is BPC-157 something you often use for leaky gut patients?

Dr. Vojdani:                        I go through waves. I think when I used it initially when I first learned about it quite a while ago, I was very impressed with it. Then you learn other things along the way, and maybe you need to lean a little bit less on it. I think the problem with it is sourcing it and also cost.  As sourcing got more difficult and costs went up a little bit, I use it in selected cases now where again, I’m up against the wall and I’m not getting gut healing the way that I want to, but I find it a very helpful compound in those situations.

Dr. Weitz:                           Great. Maybe you can give us one more clinical case about specifically how you managed a patient with some autoimmune condition and how the Lymphocyte Map played a role and then what may be some specific treatments that you utilized, if you don’t mind.

Dr. Vojdani:                        I’m going to give you an example of one in which I had interplay with the rheumatologist.

Dr. Weitz:                            Okay. That’d be great.

Dr. Vojdani:                        It wasn’t treatment that really helped this patient at all. It was my relaying of information and utilization of a test that hadn’t been done for this patient before, okay?

Dr. Weitz:                            Okay.

Dr. Vojdani:                        I want everybody to understand that sometimes we can be helpful not by picking the supplement or picking the lifestyle, but by being an advocate for people.

Dr. Weitz:                            Right.

Dr. Vojdani:                        This 50-something-year-old woman, she had a very chronic history of joint disease going all the way back to her teenage years. Some people had called it JRA, juvenile rheumatoid arthritis. Some people had called it adult RA. Some people had called it ankylosing spondylitis. All of her antibody tests were negative.  She was seronegative, HLA-B27 negative as well too so she didn’t fall into any particular bucket, but her clinical symptoms were screaming autoimmune joint disease, but nobody knew what it was. She had seen virtually every rheumatologist in town and everybody was kind of throwing around the idea of a different medication to use just to try it and see if it sticks essentially. That didn’t sit well with her.

I understand why, because she wanted some specifics. I did my workup as far as the usuals, gut health, environmental toxins. She did have intestinal permeability and she had a very strong antibody response to a multiple mold species and ended up having a large mycotoxin issue. I identified those and at the same time I ran Lymphocyte Map on her because she had been suffering for so long.  I mean, like 30 plus years of having debilitating joint disease is horrible. She had extreme elevations of Th1, Th2 and Th17. When I say extreme, they were off the upper limit of detection on all three of them across the board. B cells were normal, natural killer cells were normal. She’s got extreme aggressive T cell activation. I’m looking at that and I’m saying, “Okay. Well, I’m going to work on what I’m going to work on with her.”

There’s always a role to be played for lifestyle. It’s always better for her to clear out whatever microtoxin she was exposed to. It can’t be good for her to have those in her body. I’m going to do that part, but for this person to feel as good as they can, they need a bigger weapon, and I’m not the doc to prescribe Humira.  I got her rheumatologist on the phone, talked to him and said, “Hey, listen, I ran this test. We did T cell mapping. This is her Th1 count. This is her Th2 count. This is her Th17 count.” The rheumatologist literally on the phone said, “Oh my God, this person has ankylosing spondylitis. Humira is the right drug for her.” I agreed.  I said, “As much as I would love for supplements to take this person to clinical resolution, it’s not going to happen. They’re too far in that direction. This is the right person for medication.” She started on Humira. She called me a week later after she started it, completely different person, no pain, no fatigue. All the symptoms went away.  Then I said, “Okay. Great. After you’re on Humira for three months, we’re checking your Lymphocyte Map again, because I want to make sure that you’re not going overboard.” Repeat Lymphocyte Map. T cells balanced across the board, not low, not high, just like perfect Th1, Th2 balance. I said, “You rest easy. Your T cells are functional the way that they should. The dose of the medication is correct and it was the right medication for you.”  To me, that’s a huge intervention. I didn’t do anything other than run the test and then relay the information to the doc who should be prescribing it. I think it was life-changing for her.

Dr. Weitz:                            Seems to me another potential benefit of this test is anybody who has autoimmune disease, especially anybody who’s getting treated with one of these drugs who’s maybe … maybe they feel okay, but they’re kind of nervous, “If I get COVID, am I going to potentially have a bad case because of my autoimmune disease, because of my immune status?”  This Lymphocyte Map test would be something that would potentially give us some knowledge to help that person potentially have a more balanced immune system.

Dr. Vojdani:                        For sure. I mean, I think nobody wants to see completely depleted T cells in a dysfunctional adaptive immune system because they’re on a biologic. Then again, as I mentioned, that’s not the intention of the medication. It’s the fact that it’s being used relatively blindly that people end up in that situation. That’s because tools like this didn’t exist before.  They exist. We learn about them. We execute them. Hopefully they start becoming a more regular part of everyone’s care. Everyone’s outcome becomes better when we can put the personalized data to their case. That’s what this represents.

Dr. Weitz:                            Right. That’s what we do in functional medicine, is try to deliver individualized care to the right patient. It’s-

Dr. Vojdani:                        And we try, we do our best.

Dr. Weitz:                            We try. Yeah.

Dr. Vojdani:                        We try.

Dr. Weitz:                            It would be nice if that approach was applied more widely instead of just finding one approach to treat patients with a certain diagnosis and applying that to everybody.

Dr. Vojdani:                        Well, Ben, we’re talking here today. It’s my second time on the podcast. I think in the years, since my first appearance and now doing this now, your podcast has grown in popularity, which it deserves definitely, but that’s also because people are more interested in this. I think more and more clinicians will become more involved in this as time goes on, because it simply means better outcomes for everyone.  It’s certainly more time-consuming, but it’s worth the time consumption because outcomes are better. In the end, that’s what everybody needs.

Dr. Weitz:                            Right. That’s great. Thank you, Elroy. Another great podcast. Can you tell everybody about your practice and about your book and where’s your book available?

Dr. Vojdani:                        Yeah. Absolutely. The practice is Regenera Medical. We’re here on Wilshire and Federal in West LA. It’s me and a nurse practitioner. The book is called When Food Bites Back.  It is meant to be a resource for the public to try to understand first how the environment affects the immune system, and because food is the thing in the environment we are most in contact with, why that’s the most important thing to pay attention to when it comes to the immune system. It’s available on Amazon. Just search When Food Bites Back and you’ll find it there. I hope everybody likes it.

Dr. Weitz:                            That’s great. Thank you so 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 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. 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.