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.



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.



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.


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:


             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%.





       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.



            Exenatide ER/Bydureon 





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.




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.



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.



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.



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.



Integrative Cardiology with Dr. Howard Elkin: Rational Wellness Podcast 248

Dr. Howard Elkin speaks about Integrative Cardiology with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on February 24, 2022.

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


Podcast Highlights

6:29  February is Heart Month and heart disease is a disease of excess: Excess blood pressure, excess smoking, excess cholesterol, excess blood sugar, obesity, excess fat and a lack of physical activity.  Heart disease is still the leading cause of death and we have about 650,000 deaths a year in the US from heart disease.  This is considerably more than from COVID.  About 850,000 Americans suffer a heart attack each year and for 605,000 of them, this is their first even and they didn’t know that they had any cardiac problems. 45% of these events are silent.

8:05  Age and Family history are somewhat immutable risk factors, but about 70% of the risk factors are lifestyle dependent. Major Risk Factors: Hypertension is the number one risk factor, followed by smoking, elevated cholesterol, physical inactivity, obesity, and diabetes. Minor risk factors: Elevated triglycerides, elevated Lp(a), elevated homocysteine, elevated C reactive protein, periodontal disease, inflammatory markers that include Fibrinogen, Lp-PLA2, and Myeloperoxidase, genetic markers, environmental pollution, stress, and depression. 

9:40  Blood Pressure. The thinking about blood pressure has changed from 2003 when hypertension was not considered until you get to 140/90. Starting in 2017 we started to consider above 130 for systolic and above 80 for diastolic would be considered hypertension. Ideal blood pressure is now considered to be 120/70. Therapy for hypertension should be individualized and should include lifestyle, supplements, and medications.  Since blood pressure tends to be higher in the early morning hours, which is why some recommend taking hypertensive medications at night.


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

Dr. Ben Weitz is available for 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 to the functional medicine discussion group meeting tonight, and we’re very happy to have as our speaker, Dr. Howard Elkin, integrative cardiologist. So now, I’d like to introduce Steve Snyder from Integrative Therapeutics, our sponsor for this evening, to give us some information about some of Integrative products. Steve?

Steve Snyder of Integrative Therapeutics:                   Hello, everyone. Sorry, it’s dark in here so I look a little scary. We are excited to hear Dr. Elkin speak. I know in his little introduction he talked about metabolic markers and lab tests for that, and I just want to let people know about a couple things that we have. Well, they’re all three of these are our biggest or in our top 10, but we have a berberine that is at the study dose that is in all of the research for all these reducing or improving metabolic markers for lipids and cholesterol and all that. It’s important to differentiate.  There’s different kinds of berberine, and a lot of the brands try to make them interchangeable. The berberine extracts from botanical extract are more effective as antimicrobial agents, and the purified berberine that was in the research is a berberine HCl at 500 mg. That’s a different animal, I guess, and it’s important to make sure that you get the right one for what you’re trying to do. We have both, and our berberine HCl is unique in that it’s about 10 bucks cheaper than the other brands out there for the same 60 cap 500 mg bottle.

The other one I wanted to mention, I feel like I mentioned this every week because it’s so good for everything, is our Theracurmin, the high bioavailable curcumin preparation, and there’s some pretty good research showing that curcumin lowers lowers cholesterol and improves or increases LDL receptor mRNA. So with the high bioavailable like Theracurmin, you’re going to get blood levels that will give you the effects you’re looking for.

Then the last one is, again, this is one of our popular products, is Cortisol Manager. We all know how elevated cortisol can affect inflammation and lipid metabolism and belly fat. Typically, people use Cortisol Manager to help them fall asleep, but we do have a lot of people that use it for metabolic purposes and even the Los Angeles Dodgers use it to decrease belly fat, believe it or not. So all three of those we have samples of, and if anybody wants to try them this, let me know. We can get you set up.

Dr. Weitz:            By the way, we’re all practitioners listening here. If anybody hears this afterwards who’s not a practitioner, the samples are for practitioners only. Sorry.

Steve:                  Yeah. Forgot to mention that, but thank you.

Dr. Weitz:            Yeah. Absolutely. Thank you, Steve.

Steve:                  Yup. Take it away, Dr. Elkin.

Dr. Weitz:            Okay. So Dr. Howard Elkin is an Integrative Cardiologist with offices in Whittier and Santa Monica, and he’s been in practice since 1986. While Dr. Elkin does utilize medications and he performs angioplasty and stent placement and other surgical procedures, his focus in his practice is in playing natural strategies for helping patients, including recommendations for diet, lifestyle, nutritional supplements to improve their condition.  He also utilizes noninvasive procedures like external enhanced counter pulsation as a noninvasive alternative to angioplasty and bypass surgery. Dr. Elkin has written a book from both sides at a table, When Doctor Becomes Patient, and is that about to be published or did you just publish it?

Dr. Elkin:              Yes. It’ll be out within the next month or two. We will be announcing the launch, the preview.

Dr. Weitz:            Of course, I got that intro from another time you spoke. It was still soon to be published, but, Howard, you have the floor.

Dr. Elkin:              Okay. Thank you. Hi, everybody. Thank you so much for being here tonight, and I want to thank Dr. Weitz for having me speak again. So I’m delighted to be here. So this is my first time doing a little Zoom conference. Okay. Here we go. All right.

So integrative cardiology, what is it? I made my own definition. It’s going above and beyond. I want to make this distinction because there’s a lot of stuff on the social media these days, on Facebook, and certainly Instagram, and not so much doctor bashing, but bashing doctors who use drugs, statins are ridiculous. We call them the cholesterol deniers. There’s, “Why use drugs? You don’t need to.”  Whether it’s traditional cardiology or integrative cardiology … Anybody unmuted because I’m getting this … Okay. Good. So they’re not mutually exclusive. So traditional medicine needs integrative medicine, and we need one another. So that’s my point. I feel honored and humble that I do the whole gamut. I work with some of the old patients when I’m on call three times a month when I have to open up an artery heart attack to what I do on a regular basis with preventative medicine.

Why heart month? As you know, February is heart month, a special time of the year because heart disease is still so prevalent, and we call this a disease of excess. So it’s excess blood pressure, excess smoking, excess cholesterol on your diet or on your blood, excess blood sugar, obesity, excess fat, and a lack of one thing, and that’s physical activity.  So really, it’s the disease of excess. It’s still the leading cause of death. So we have about 650,000 deaths a year. That’s one out of four. You’ve heard a lot about COVID. Just to put things in perspective, in the two years that COVID has been happening in this country, we’ve lost about 900,000 people, which is a big deal, but that’s still small in comparison to what we see every year in heart disease. So one dies every 36 seconds of heart disease.

What about heart attacks? Okay. So about 850,000 Americans suffer heart attack on an annual basis. Now, 605,000 of those individuals, that’s their first event. They don’t even knew they had any cardiac problems beforehand. So it tends to be very dramatic, and 45% are silent. When I was a fellow gazillion years ago, there were 25% of heart attacks were silent, and all of a sudden, 45% silent. I personally think it’s because we have a older population and a lot of diabetics, and diabetics tend to have very unusual symptoms if they have symptoms at all. So simple important thing to keep in mind.

Now, we have these immutable first factors, age and family history. There’s nothing we could do about it, but yes, there is because people say, “Oh, okay. It’s in my genes,” and I think most of us in the functional medicine field who really believe in epigenetics will attest to the fact that about 70% of 30% of what happens to us in our life is probably genetically determinant, but 70% is actually lifestyle dependent, and that’s the whole epigenetic we’re looking for.  So even though you may have a positive family history doesn’t mean you’re going to come down with a disease, and that’s not true about just heart diseases, also with Alzheimer’s and other genetic disorders.

So let’s look at the major players. Hypertension is still the number one risk factor no matter how you slice it. So it’s very important. Then we have smoking, elevated cholesterol, which we will get into in a few moments, physical inactivity, obesity, and diabetes. These are the six modifiable major risk factors. What I mean major players, it’s unequivocal that these play an important role in heart disease, and all of them are modifiable or preventable. So it’s very important to keep that in mind.

Then we have the minor players, elevated triglycerides, elevated LP(a), which we will talk about later, elevated homocysteine, elevated C-reactive protein, periodontal disease, other inflammatory markers like fibrinogen, Lp-PLA2, and myeloperoxidase. Genetic markers, environmental pollution, which I don’t think has been really emphasized as much as it should be, and stress and depression.

So I just want to go over one thing about blood pressure because I want to make this point quite clear. If you look at the old GNC recommendations from 2003, hypertension really wasn’t considered much until you got to 140/90. Now, when I was a student many, many years ago, that was considered borderline. We didn’t even consider that hypertension, but from 2003, it was considered stage one hypertension.  Now, if you look at what’s happened, this is 2017, anything greater than 130 for the systolic and 80 for the diastolic is considered hypertension. So let’s say there’s a blood pressure of 131/81. That is considered hypertensive, okay?  I’m always asked this question. “What’s the best blood pressure to have if you’re 20 or 40 or 60 or 80 or 100?” It’s always the same. The ideal blood pressure is always going to be 120/70. Does it mean I look for that every patient? No, because I would be having patients on three medications or more, and I have to see them every three weeks. So depends on the patient. I individualize, customize therapy. Often see younger patients that are really interested in lifestyle. I’m going to do my very best to get their blood pressure down, but these are the recommendations that I do adhere to, and it’s not just some a right reading block to make people go in pharmaceuticals. It has been shown, without a shadow of a doubt, that patients with lower blood pressures do better with less heart attacks and strokes.

Dr. Weitz:            Howard, what do you think about the difference between nocturnal blood pressure versus daytime blood pressure?

Dr. Elkin:              That’s a great question. First of all, the way it usually works is that blood pressure tends to be higher in the early morning hours, and that’s really evolution at work. So the cortisol, epinephrine, norepinephrine, those messengers are higher in the morning when we awake, which is why we think there are more heart attacks and strokes in the early morning hours. As the day goes on, usually the blood pressure will drop in the average person unless you’ve had a very stressful day, and exercise, which helps to relax your arteries, usually blood pressure will be lower if you do a blood pressure about a half hour after.  So nocturnal is not the general rule. Usually, it is better at night. Now, the new thinking now is to give your antihypertensive medication at night versus the daytime. Even though, theoretically, it’s supposed to work 24 hours, it’s been shown that to cut down all those early morning hour heart problems, heart attacks, and strokes. So that’s the general rule of thumb. Okay.

So when I talk about treatment, lifestyle is always number one. So for those people that look down on traditional medicine, this is still number one. Lifestyle is number one and my book for everything, diet. So diet’s very important. Caloric restriction, caloric restriction, and I should say weight loss, and now the new thing is intermittent fasting, intermittent fasting is a useful way to lower your blood pressure. It’s also useful in lowering your cholesterol and your blood sugar, and you will lose weight, but it is helpful in lowering your blood pressure.

Now, for every pound you lose, you theoretically can drop up to one millimeter mercury of the systolic blood pressure. I don’t really know how true that is, but I will tell you in all my years of treating that if a person loses let’s say 10% of their body weight, so ;et’s say you’re 200 pounds and you lose 10% or 20 pounds, you have a significant drop in blood pressure.

So I never underestimate the role of diet and weight loss. It can be very, very helpful when it comes to treating hypertension and, of course, exercise. I’ve already mentioned that exercise helps relax the arteries. So there’s less constriction of flow, so blood pressure tends to come down. Okay.

Then we have supplementation. Okay. Potassium, it’s very, very important in lowing blood pressure. In fact, there’ve been studies recently shown that if you use this supplement called … Actually, it’s not supplement, it’s a salt substitute. I think it’s called Nu Salt, too. Anyway, that can be useful in lowering blood pressure. I don’t routinely prescribe potassium as a supplement because it’s so ubiquitous, especially in plant-based foods, but it’s a mainstay in lowering blood pressure as is magnesium.

Now, magnesium, probably about 65% of Americans are deficient in magnesium. It’s very important in blood pressure control and in other things as well. The other ones that I like that have additive effects on blood pressure, CoQ10, fish oil. Hawthorn berry can also be useful. Pressure-wise, that’s my own product, but the component is olive leaf extract, and that’s been shown in multiple studies, and this is the out of leaf itself extract, to actually lower blood pressure. It doesn’t work at everybody, but I’ve had some luck on several patients that just want to exhaust supplements before they go to medications.  So these are all possibilities, and you can add these together because you’re not going to get the same effect as you would get medication, but you will get a nice add of effect and goes very well with diet and exercise.

Dr. Weitz:            Howard, two quick questions on diet. Is there particular style of diet like the dash diet or is there a particular type of diet that you find to be more beneficial and certain dietary factors? What about the sodium question? Then somebody also asked a question, what kind of magnesium do you find most effective for hypertension?

Dr. Elkin:              Well, I don’t think it matters so much what magnesium is best. I like magnesium glycinate because there’s very low incidence of diarrhea, well-tolerated. That’s generally what I use, and I have not found the need to use anything else. As far as diet is concerned, the sodium question, in fact, there’s a slide coming up. You beat me to the punch here. Well, since I was a student, I mean, salt restricted. There’s no question that we can reduce your blood pressure in hypertensive people that are out of control by reducing their salt. Okay. That’s little question. There is no benefit, and having a low-salt diet if you’re normotensive. I mean, in fact, it could actually be dangerous.  We need sodium. It is a critical electrolyte. So when is it useful? First of all, if you’re a salt retainer, who’s a salt retainer? Well, it tends to be more in African- American population. They tend to retain sodium. There’s not a test for sodium retainers, but people should just know after a while, “If I ate this and my blood pressure is that, it’s probably diet related.”

The problem is about 80% of the sodium in our diet. It’s not from the salt shaker, it’s from all the processed foods. So that’s my number one rule. Avoid processed foods like the plague. Avoiding breads. Breads are very high and sodium, pancake mixes, waffle mixes. Any of those processed foods are generally going to be very high in sodium. TV dinners, I mean, anything process is the thing I stay away from. I’ve never really been that heavily … I don’t subscribe to a really low-salt diet unless it’s a patient of mine that has heart failure. Then I have to be more stringent or liver problems or kidney problems.  So those are the three or, again, salt retainers, but if you’re average person with hypertension, I don’t spend a lot of time on … I don’t subscribe to the dash diet. I don’t really think it’s necessary, but it’s something that we can add to what we’re doing to lower the blood pressure. Good question.

Then I think for completeness’ sakes, we have to mention medications, which I do have to use a lot. I want to emphasize this one point. If you need medication to lower your blood pressure, you should take it. This is one risk factor that I am just, there’s no question about it. We need to lower the blood pressure. It’s still the biggest risk factor for heart attack and stroke. So if you need it, you need it. I’m not a person that pushes a pill, anyone that knows me.  So ACE inhibitors and angiotensin receptor blockers are the class that I generally like. They’re good. Usually, it’s once a day. They’re very well tolerated with little side effects. Calcium channel blockers are actually vasodilators, and they can also be very useful. The one thing about calcium channel blockers, works very well in the African-American population, and also, they tend to work faster. If I start someone on a ACE or an ARB, it may take two, three weeks to really see the full effect. Whereas calcium channel blockers, you generally see a faster, a more rapid effect.

I didn’t put in hydralazine. That’s an old-fashioned medication. I still use it on very difficult management cases because it’s very kidney-friendly, but it has to be taken two or three times a day. Then beta blockers, which are very useful, I don’t really use them much for blood pressure, certainly not as a primary medication, but something secondary.

Sodium restriction we’ve already talked about. It’s going to always be there. Again, it really depends on the individual, and being your own medical advocate, you should begin to learn really, “Does sodium affect my blood pressure?” That’s really important, and for a lot of people, it doesn’t.

Dr. Weitz:            So basically, what you’re saying is if you’ve got a patient with hypertension, do a trial of a lower sodium diet. What level of sodium would you say would be appropriate in that case?

Dr. Elkin:              So the world health organization recommends you have two grams of sodium a day, which is five grams of salt, by the way, okay? Now, the American Heart Association came up with this 1.5, which is ridiculous. That’s really lower than you ever need to go. I think the CDC, it’s 2.5 milligrams of sodium. So you see, there’s a little bit of disparity between the three major organizations. I don’t usually count grams, but it’s always worth a trial, and I’ll add it to. If I have someone who’s difficult, I always ask about diet. So most of the patients that I see that are into functional medicine don’t eat a lot of processed foods, but a lot of people, most of the people in this country are not functional medicine people or patients.  So that’s why as a cardiologist I have to know all of this stuff because it’s really individual, and you really have to ask what are they eating, take a good diet history because, again, most of it really comes from the process.

Dr. Weitz:            Howard, somebody has a question about Celtic salt. So today, when we talk about salt, we’re not just talking about sodium iodide. So we have all these salts, especially in the functional medicine and natural health world, Celtic, salt, Redmond sea salt, Himalayan pink salt, and these different salts have different minerals, compositions in them. Do you have any thoughts about that?

Dr. Elkin:              Yeah. I really don’t. I think a lot of that is marketing hype. I don’t really think it matters, especially when you’re talking … There may be some advantages of Himalayan salt or Celtic salt, but most of what I’ve read about it, I don’t see there’s much data that is that advantageous. So I don’t make a big deal about it myself.

Dr. Elkin:              Okay. Advanced cardiac testing is really what separates the traditional cardiologist from what we do in integrative cardiology. So the components are complex lipid testing, inflammatory profile, metabolic profile, and genetic profile. So it’s not just about lipids. We have to put all this into consideration when we put together a plan for individual patients.

Dr. Elkin:              Okay. So let’s look at the cholesterol part of it. The standard lipid panel, and I want you to know that average cardiologist is still sticking to the standard lipid panel, total cholesterol, HDL, LDL, HDL healthy, LDL lousy, that’s what I call it., and triglycerides. You got to remember that in your standard lipid panel that most people, cardiologists included, order, the LDL is actually, it’s measured. I’m sorry. It’s calculated. It’s not measured. So if you have a triglycerides level that’s over 400, you can’t calculate it. It’s totally not something you can use.

Dr. Elkin:              Now, Boston Heart Lab, for example, will actually measure the LDL cholesterol, but most standard quests or lab core will not. So that’s your standard lipid panel that I don’t order. Then you have your advanced lipid profile, which is I think what separates men from the boys here. So why do we care about these advanced tests? Because 50% of coronary heart disease diagnosis occur at the time of sudden death. Can you believe that? 50% of people don’t know they have a problem until they die.

Dr. Elkin:              Most patients with coronary disease do not have cholesterol level disorder. 50% of people that have a heart attack have normal cholesterol levels. Okay. More people on a statin drug have an event than the numbers that actually prevent it from having an event. So statins are not the end all be all. There is clearly a role in secondary prevention, but it’s not the end all be all. Advanced disorders are more common than low density cholesterol, which we’ll get into a minute, and coronary disease. It’s a family disease.

So advanced cardiac testing, the advanced lipid panel, LDLP, that’s particle number. So what is particle number? How does it different from LDL? First of all, it’s measured and we’re measuring the number of particles in a given sample versus just LDL mass. So why is it useful? Because it’s been shown to be more prognostically significant. So an LDLP is since to give us more information than just LDL. Now, there’s a cheap way of doing this. If you take your LDL and add a zero to it, that’s where your LDLP should be. So let’s say you have an LDL of 94. Then you would expect your LDLP to be around 940, but let’s say it’s 1400 or so, then it’s not a good thing. That means your LDLP is greater than the LDL. As a general rule of thumb, you want LDL particle number to be certainly less than a thousand.

Now, here’s the one that I think is most important. That’s the LDL size, the size of the LDL particle. Again, traditional medicine, I don’t know, I’ve been doing this for over 20 years. I learned from Dr. Superko, who was with Berkeley HeartLab, who put this on the map. I spent two days with him several years 23 years ago. So LDL size is very important, and we’ll get into that in a minute.

Then it’s also LP(a). LP(a) is a fragment of LDL, and it’s sticky, it’s inflammatory, and it’s very atherogenic, and it’s totally inherited. You can’t reduce it by exercise or the usual medication, but we’ll get into that in a second, what we can do for it.

HDL functionality is a new test that Cleveland HeartLab does because we’ve known for years that HDL tends to be healthy, right? We thought the higher the number, the better off it is. Then we learned that people that have HCls of 100, 110, 120, maybe it’s not healthy. Maybe it’s dysfunctional HDL, and we’re learning that with this test that Cleveland HeartLab is now doing.

So if you want to have increased cholesterol efflux, it also tends to be less inflammatory and less thrombogenic. So that’s part of their panel now, and it’s very useful to be able to look at the functionality. Now, then Boston does a different test. They look at hyper producers versus hyper absorbers, and there’s two ways you can get cholesterol on your bloodstream. One is that you produce it from your liver. You cannot live without cholesterol. It’s essential for life. So your liver’s going to produce it no matter what. Some of us are genetically prone to make more than we want to make, and that’s liver, but about 20% of people are hyper absorbers, meaning they absorb more from their gut.

So there’s markers that Cleveland HeartLab uses to help distinguish this, and I believe they have a patent on this. So if you look at the slide here, the red are these two production markers, lathosterol and desmosterol. Those are production markers. If they’re high, then it’s telling you that patient tends to have high production, and the absorption markers, beta-sitosterol, campesterol are in the green, and that means their absorption level is low.

Now, here’s the opposite in which you have the production markers are in the green, which is good. The absorption markers are in the red, and it makes the difference in therapy, which I will explain in a minute. So lots of times, you will see a mixture of these. It’s not going to be just all green or all red. So this is an ideal world here. Okay. Now, how do we treat these? Diet, exercise. Back to the basics, right?

Now, this is a slide that I like because, as you know, back in the ’90s, some of us are practicing back then, everything was low fat and high carbs, right? Remember the Dr. Ornish trial? These a very low fat diet. I think it was 10% of your calories came from fat. So what happened is that country did not do well. First of all, people got fatter than ever, and diabetes became an epidemic. So it really was a failure.

So we have a couple of trials here. This is Women’s Health Initiative, a very large trial of close to 50,000 women. Actually, the low fat diet really had no effect on stroke or coronary artery disease. Really, what we’re interested in is the events, heart attack, strokes or death from heart attacks. The look ahead was a smaller trial and that actually was close early for a futility did not work, a lower fat diet, but the study that put on the map was a PREDIMED study, and it was published to the New England Journal in 2013.

This is a European study based mostly from Spain, 7,400 patients at risk for coronary disease, and they found, and there were different groups. One was with olive oil, one was with nuts. I have all the details in my book, but what you got to remember is that the study was landmark because it was the first time that a Mediterranean diet actually showed evidence for decreasing heart disease. No other diet has been able to show that, not even a vegan diet. People want you to believe that a vegan diet has been shown to decrease … Again, we’re talking not about cholesterol, we’re talking about events.

Dr. Elkin:              So the Mediterranean diet has been shown to actually produce less events, which is a very important landmark study. Treatment, diet and exercise. People are amazed when they say, “Aren’t you going to tell me to have low fat and low cholesterol?” “No. Go ahead have eggs. Eat egg yolks.”

Dr. Elkin:              Again, we’ve known at least, I forgot how many years now, that cholesterol in your food does not equate to cholesterol in your blood. So have egg yolks, have lobster, and have shrimp, but I’m also a moderate. I believe in eating in moderation. I’m not against saturated fat. I’m not a carnivore. I mean, I don’t think I could eat meat every day of the week. I don’t think anything in extreme is actually useful.

Dr. Elkin:              So I don’t spend a lot of time on … I had two patients in the last two weeks when I was on call that had heart attacks and I was able to open the artery during a stemmy and acute heart attack. The first thing they asked me, and they’re really interested, unfortunately, they’re going to remain my patients, “Well, should I cut down a meat? Should I cut down?”

Dr. Elkin:              I said, “Let’s get some blood work. Let’s do you’re Cleveland. Let’s do your Boston. Let’s get into some basic exercise and basic diet principles and so forth, and we’ll get into the particulars later.”

Dr. Elkin:              So I’m not into heavily reduced, I’m not into one diet or the other. I use a blend. I definitely believe that sugar and carbohydrates, starchy carbs are not great. We’ve known for years that sugar is extremely inflammatory. I tell people that eating sugar, eating starches is like spraying gasoline over a fire. We already know that coronary disease is an inflammatory process, and we need to cut that down on that. It begins with diet.

Dr. Elkin:              So I spend much more time, just much more time and effort to counseling people on a low-carb diet than I do on low-fat or low-cholesterol, and exercise goes without saying. For years, all the information was really placed on aerobic exercise, but also resistance training has been very useful in helping with lipid disorder. So there’s a role for both.

Now, supplementation. There’s a lot of things that I use, red yeast rice supplement. Now, red yeast rice actually is from a plant in China. In fact, the very first statin that came out in the ’80s, I think I was finishing my fellowship then, it was called Mevacor, a lovastatin, and it was derived from the red yeast rice plant, which is not unusual because a lot of botanicals, a lot of pharmaceuticals originally came from botanicals. Of course, then they changed it in the lab and things are different.  So red yeast rice, it’s still useful. The important thing and, Dr. Weitz, worth is up to me, is the dose. The dose on the bottle may not be a dose that you’re going to see results. So if it says you should have 1200, you probably did have what, Ben, about three grams?

Dr. Weitz:            2400 to 4800.

Dr. Elkin:              That’s not what’s on the bottle. So you have to remember if you want … We don’t just give up after you’ve had two at night. So I’m starting to do this myself. There’s a lot of patients that really want to avoid statins if they can. Now, you can still get some side effects of red yeast rice supplement. There are some patients that will still get myalgias. I’ve never seen any liver problems, but there are some people that are very sensitive may still get myalgias and so forth.

Niacin is very useful. I use a lot in my practice, actually, vitamin B3. However, when using the doses that we need to use for lipids, it becomes more like a drug, and it’s useful. First of all, it can help to decrease triglycerides. It can help increase your HDL and also augments your HDL functionality, and also can decrease LP(a). It’s really the only thing that we know of that can decrease LP(a) at this point. There are some biologics that are being worked on, especially at UCSD but they’re not available yet. So niacin can help, not in everybody, but it can help. The other really good thing about niacin, it can help to increase the size of the LDL particle.

Let’s get back to the LDL size. I always tell my patients, “If you remember one thing that I say, bigger is better.” The larger the LDL size, the better it is, the less likely it is to oxidation. Once an LDL particle is oxidized, it can easily get into the endothelium of the artery, and that’s when we start the pulmonary cascade. So we really want to cut down an inflammation. We want to make small into a large, and niacin can do that. It’s the only one that can do it. Fibrates may be able to help, but really, it’s mostly niacin that can help make a small into a large. Also, a lower carb diet can also help, low-starch diet.

By the way, saturated fat can also help to increase the size of the LDL particle, and also useful information. Berberine is interesting. It seems to have an effect on the LDL receptors. So I use that sometimes as well. Artichoke extract is useful in decreasing the absorption of cholesterol. So it’s very good for the hyper absorbers. Soluble fiber, which is psyllium, can be useful. Probiotics, I think, are important. Plant steroids have been used in the past. They’re not used that much today, and there’s some controversy about their use. My own product, CholesterolWise have bergamot in it, and bergamot is interesting. It’s from a citrus plant in Italy, in Southern France, and actually, it works on both the liver and in the gut. So it can actually decrease production and also decrease absorption. So these are supplements that can be very useful.

Dr. Weitz:            Howard, we got a couple of questions about niacin. People are asking what form. Do you recommend time release? Do you see a role for any D infusions? Somebody else asked, “Flushing, non-flushing?”

Dr. Elkin:              Yeah. Okay. First of all, non-flushing doesn’t work. It’s useless. Non-flushing niacin has been actually chemically altered. So yeah, you don’t get the flush and you don’t get the effect. Sinatra and I have talked about this many a time. Okay. When it first came out, immediate release was well popular, and you really get flush with that. I don’t think anyone use that anymore. The intermediate release is what I use in my office, and you take it two or three times a day with food. So you will flush, but as long as you take it with food, it’s useful. I don’t use sustained release, which there’s a pharmaceutical brand of niacin. I think it’s called Slo-Niacin. Anyway, you take it at night with a snack and then you wake up at 2:00 AM flushing. I don’t find that helpful, number one, and number two, it can be harsh on the liver. So I like the intermediate release or the time release, but not the sustained release that you take once a day, if that makes any sense.

NAD is really big now in the anti-aging world, mitochondrial regeneration. It’s got a lot of effects. First of all, it’s expensive. I don’t think it’s what you need. Nice and expensive, and it’s very useful. So I use plain old niacin, whether it’s zymogen or molecular, designed for health. They all make a very similar product that’s good. So basically, they call it sustained release, but it’s not long-acting or once a day.

Dr. Weitz:            Yeah. Another other supplement that’s pretty popular that somebody just asked about is citrus bergamot.

Dr. Elkin:              Right. So citrus bergamot is in my … I’m sorry. Yeah, that’s in my CholesterolWise product. That’s the product I was talking about. It’s actually a citrus fruit from Southern France and Italy. Yes. It’s useful. It could very useful. You have to have at least 1,000 milligrams. So that’s important to keep in mind, and also with berberine. They both require at least 1,000 milligrams to 1,500 milligrams a day. So that’s important on those two supplements.

Dr. Weitz:            Can I ask you about two more supplements? Have you worked with any of the nitric oxide stimulators like L-citrulline and/or beet root extract?

Dr. Elkin:              I haven’t. These are the ones I deal with mostly because they have a good track record with me. So I haven’t on the need to go outside of these, but it doesn’t mean they’re not useful. I just don’t have experience with them.

Dr. Weitz:            There’s also a product called Arterosil, which has been shown to help with the endothelium.

Dr. Elkin:              If you can hold that one until we get to the pulse test. It’s what I use for that. Thank you. That’s a great question. So these are the basic supplements. By the way, CholesterolWise is bergamot, just bergamot, but the medications we still use, ezetimibe, which is Zetia. It’s interesting. It’s now generic. It comes in one size, 10 milligrams. It is very well-tolerated, and it helps to decrease the absorption. So if I don’t get where I need to with probiotics and with artichoke extract, I may add Zetia. It decreases your LDL cholesterol by about 10% to 15%. So it’s not insignificant.  Cholestyramine is a bowel acid resin. It binds bowel acid and you excrete them. It was very useful many years ago. It’s a powder. It doesn’t taste very good, and it can be very constipating. You have to drink a lot of water with it. It’s really gotten out of favor because ezetimibe does as good a job, if not better, and with no side effects.

Statins have been around. Again, it started in the ’80s from Mevacor, which is the first one derived from the red yeast rice plant. There’s no question statins have their role. Despite what you may hear from people on Instagram and functional medicine, there’s a discrete role for statins, and that is in secondary prevention. If you had a heart attack or a stroke or a stent or bypass, we have a lot of coronary artery disease, there’s no question, and we’ve known this since the ’90s that statins can decrease, again, events, events. We’ve talked about events.

So I don’t understand the arguments about they’re bad for you or you shouldn’t be on them. It’s the patient we’re looking. Primary prevention is different than secondary prevention. So with secondary prevention, I don’t mess around. I use what I need to use to get these numbers down. Also, what we didn’t know about these medications years ago, we just thought, okay, they’re really good at decreasing LDL and cholesterol, but we learned, I forgot the name of the trial, but in about 15 years ago, there’s also an anti-inflammatory effect from statins that we didn’t really appreciate. We found that out with a trial with Crestor, which is rosuvastatin. I just can’t think of the name of the trial now. Anyway, so they have their role.

Fibrates are very useful in patients that have very high triglycerides. So a lot of your diabetic patients have very high triglycerides if they fail diet, which they shouldn’t, but a lot of them do, but we’re also talking sometimes triglycerides levels of over 1,000. You cannot mess around with that. These patients are high risk of pancreatitis, which can be life-threatening. So I do use fibrates for that. It can help with increasing the size of the LDL particle, but not nearly as effective as niacin.

The new kid on the block, which is not really new anymore, is the PCSK9 inhibitors. Those are biologics. They’re monoclonal antibodies. They’re given twice a month via injection. Patients get their own injections with the subcutaneous needle, and it works in the LDR receptors. It does a great job of decreasing LDL cholesterol. So let’s say this. If statins can get your LDL down, let’s say Zetia, 10% to 15%, statins, 25%. PCSK9 inhibitor, 50% to 60%, not in everybody.  I’ve had a few patients that basically failed, and they probably have some unusual genetic factor that we haven’t been able to determine yet, but I have several patients on PCSK9 inhibitors. These are my high risk patients that really do need it. So they are expensive. You have to get prior authorization, but normally, I’m pretty successful in getting that. So again, it’s another tool in my toolkit. Now, let’s look at the inflammatory profile because-

Dr. Weitz:            Howard, just real quick. Have you worked with bempedoic acid with your patients yet?

Dr. Elkin:              You know what? Yes. First of all, no one’s covering it. I think the reps have gone off the face of the earth. I mean, they gave me the medication, they gave me a briefing on it, and I have followed it. It’s an alternative to a statin. It’s not as effective as a statin, but it does work on the liver, but the interesting about … Actually, I forgot the trade name, but yeah, bempedoic acid, they don’t cause the myalgias, the muscle aches and pains, and the muscle weakness that statins do. I’ve had one or two people on it, but then when I try to get it through insurance, they won’t cover it.

I mean, basically, I can get a PCSK9 inhibitor, which is more expensive, than I can get that. Right now, there’s a war on branded drugs. It’s just impossible, but I do have some experience with it. It sounds good on paper. It’s not as effective, but it’s a good alternative, but the big challenge right now is to get insurance to cover it. Great questions.

So the inflammatory profile, what we’re interested, and we all know that all the diseases of aging are inflammatory base, whether it’s heart disease or cancer or immune disorders or Alzheimer’s. They all have that thing in common called inflammation. Everybody, everybody should know their C-reactive protein. It’s extremely nonspecific, and if it’s greater than one, one or greater, you’ve got inflammation going on. Fibrinogen is an acute phase reactant. So usually when CRP is elevated, fibrinogen will be elevated as well.

Then you have two that are more specific for vascular inflammation, Lp-PLA2, which is based on an enzyme and MPO, myeloperoxidase. Myeloperoxidase is actually, it’s released from white blood cells when you’re dealing with a vascular inflammation. They’re actually part of the release, foam cells from monocytes and also from polymorphonuclear leukocytes when they get into the area of the vascular system and initiate the inflammatory cascade.  Lp-PLA2 also affects the endothelium. So that also is telling me there’s a problem with the vascular. You can have a normal CRP and still have inflammation in the vascular level. So you really need to follow these patients about what’s going on.

Okay. So we’ll work up. What do you do about it? You got to look at the underlying cause. Is there any infections, chronic infections going on? Very important. Active cancer certainly would be … It can be inflammatory base. Periodontal disease is a big one. I’m maybe one of the few cardiologists that actually recommended my patients go get checked out by a periodontist if they have persistently elevated C-reactive proteins. We’re talking levels of three, four, and five, and above.

When I see persistent elevations, I get concerned. I let the patients know that I’m concerned and they go, “I go to a dentist,” or “I don’t have any bleeding,” or “I don’t have any pain.” That doesn’t mean anything. The average dentist, and I don’t mean to degrade dentists at all, but a lot of dentists will bypass a four and five pocket, millimeter pocket. I’ve had patients that go to a periodontist and they found six and seven millimeter pockets. That’s really bad. That’s deep pocket and just full of red bacteria ready to cause inflammation.

So about 70% of the American population has gingivitis, one degree or the other. These are a very important cause of ongoing chronic inflammation. One thing I didn’t mention here, well, let me see. Of course, dysbiosis and gut issues. So what I do in these patients that have chronic inflammation, I send them through a periodontist for a least an evaluation, and I will tell you that 80% of the time they’re going to have some major disease going on in their oral cavity. It’s that common, especially with the diet that people eat and the stress that they were under today.

Then, of course, fortunately, I have a nutritionist on staff here at HeartWise, and her specialty is the gut. So we do a GI map, and most of these patients have gut issues. So I don’t just give a bunch of fish oil and turmeric and say, “Okay. Don’t worry about it.” I try to look for underlying cause, and that’s what we do in functional medicine. That’s one thing I did leave out and I apologize both for hypertension and for inflammation and that sleep deprivation, especially sleep apnea, obstructed sleep apnea is definitely a cause for inflammation. I think sleep deprivation in itself is, but also sleep apnea can also be underlying cause for hypertension.

I had a patient several years ago, when I treated his sleep apnea, I could not control the blood pressure. Of course, he was overweight and wasn’t exactly compliant with diet, but once we had the sleep apnea under control, his blood pressure got much better. So very interesting. Okay. So that’s the workup.

Supplements, I’m pretty basic. There’s a lot of supplements you can use, but fish oil, turmeric, ginger, quercetin, these are the ones that I use most often in my practice. There’s a handful of others. Again, I’ll try to keep things really simple. Oops, sorry. Oops, I didn’t me to do that. Okay. I’m sorry.

Okay. Then we do the metabolic panel, which is extremely important. Keep in mind that 88% of the American population is metabolically unhealthy, okay? So for metabolic syndrome, waist circumference is greater than 40 for male, 35 for female, elevated triglycerides, hypertension, elevated fasting blood sugar, and low HDL, 88%. Okay.

Dr. Weitz:            Hey, Howard. Can you comment on insulin levels and what do you see as a goal for optimal insulin levels?

Dr. Elkin:              Well, these are the tests that I commonly order always when I do advanced panel. So let’s look at the A1C first. So A1C, as everybody knows, it’s a marker on the red blood cell. It tells me how the blood sugar has been managed in the preceding three months. So when someone comes in today, I say, “Okay. So we’ll redo this in three months? We’re going to see what’s happening from this day on.” Fasting insulin, my level, I like it to be under H, I really do.

Most that I see, if they’re not really attuned to diet, it’s going to be 10, probably 20 and 30, 40. I mean, usually the heavier they are, the higher their fasting insulin levels. So I do look at that. I try to get levels definitely below 10 if I can. Interestingly enough, of all the athletes that I have, the ones that do best with insulin levels, are body builders. They’re metabolically the healthiest people. They have low level insulins, healthy from that regard, not another regard.

C-peptide is another useful test. It tells me how hard the pancreas is working. The pancreas is really working hard pumping out insulin. With hyperinsulinemia, it’s going to be elevated. I tell patients this is a problem because your C-peptide eventually is going to poop out. Right now, I’m working up two patients that their A1Cs are very high, but their fasting insulin levels and their C-peptide levels are very low, which means they’re probably at the end of their game, which means they’re probably going to need to have insulin, and at which time I turn them over to endocrinologist because I don’t want to deal with insulin.

So you really want to follow these patients because you’ll see the numbers go up, and if they start to drop and precipitously drop, and the insulin level is really low, less than five we’re talking, and a C-peptide that’s low, that means school’s almost out, and there’s nothing more you can do with these patients as far as lifestyle, then they’re going to have to go to insulin, which is not what I like.

So the test that I like to use to really gauge insulin resistance is something called HOMO IR. That stands for homeostatic model for insulin resistance. It’s a calculated value based on your fasting blood sugar and your fasting insulin level. Boston Heart records this. Cleveland has something called the insulin resistance score. I’m not quite sure the difference, but they’re both are very similar and they’ve given you an idea of insulin resistance. So that’s the metabolic profile, and it should be a part of your workup if you’re really interested in cardio metabolic health supplements. Oops. That’s going wrong direction.

Okay. Genetic profile. So this is important. I do this in all my patients when I can because it gives me an idea of where we are. KIF6 stands for kinase something. It’s on the sixth chromosome. Anyways, it tells me if a patient is genetically prone to have premature coronary disease and if they have one or two alleles that are positive, not only are they at high risk, these patients tend to do quite well with statins, by the way. It’s been shown that they do well with statins. This is some of the original work with Dr. Superko at Berkeley HeartLab, who I worked with for a couple days several years ago.

9P21, that’s off the ninth chromosome. First of all, about 50% of the population has one allele that’s positive. If you have two alleles, that’s 25% of the population. So that’s not surprising because of how prevalent heart disease is. These patients are also prone to premature heart disease, coronary disease.

APOE, everybody needs to know their APOE level. First of all, what we use it for in cardiology, of course, is a measurement of cholesterol management. These patients tend to be hyper absorbers, by the way. So they tend to absorb a lot of cholesterol in the gut.

Now, the other thing is that is clearly a marker for Alzheimer’s disease as well. I do tell the patients this, although the lab printouts don’t say it. It’s very interesting. They don’t say anything about it, but all you got to do is go to the internet and read about it. So I do mention it to it. If you have one allele, I think two to three times more likely they have Alzheimer’s, and if you have both, it’s 12 times more likely to develop Alzheimer’s.

Dr. Elkin:              So I tell people it’s just a gene, but it’s good to be on the alert because let’s work now on diet, and exercise, and lifestyle, and supplements and so forth and so on. It’s a basis for … I have about three patients right now that I’m working with on this one thing.

Dr. Elkin:              4q25, these patients tend to have a higher risk for atrial fibrillation, which as many of you know, it’s the most common arrhythmia over the age of 70, but I’m seeing it on ages. I mean, two of my best friends had ablations in their early 50s, and I had one patient who’s 29 had an ablation a year ago, but there is a genetic basis for atrial fibrillation that we understand.

Dr. Elkin:              Factor V Leiden is a genetic factor and these people are prone to blood clots. So when you have someone that develops a blood clot, that should be definitely part of it, but I do it as part of my cardiac screening to see there’s no surprises.

Dr. Elkin:              MTHFR, methylenetetrahydrofolate reductase, 60% of us have one or two alleles. We’re poor methylators and in cardiology, what we’re most concerned about, this can lead to elevated homocystine levels, which is very common in my practice. So I mean, I have levels as 30 and 40, I mean, really high levels. Also, other things can cause it, and people that have renal insufficiency tend to have high MTHFR levels.

Dr. Elkin:              Again, I think it’s nice to know these markers. If could only pick two of them, I would be APOE and MTHFR. I think everybody should know those two because insurance probably won’t cover these, but if you’re with Boston Heart, they have a deal in which they will charge you $25 for each one of these markers, which is not bad. Okay. I forgot how Cleveland does it. So you can’t get these. It’s part of the profile and it’s pretty reasonable. I think they’re important.

Dr. Elkin:              Okay. I’m going the wrong direction. Okay. Okay. We’re fetching up soon. Coronary calcium scan, so it’s nice to know when you do these extensive testing. First of all, if you want to stratify your patient, do they have coronary disease? We’ve done all this testing. We know that they’re at risk, but what’s really going on? So we do a coronary calcium scan. It’s best done at Harbor-UCLA. I swear I sent all my patients to Dr. Matt Budoff. He’s been doing this for many years. Some of the best research in the countries out of that facility. So it tells me if there’s any calcified plaque in the coronary arteries. So it looks at all. It’s a five-minute scan doing on a fully clothed. So you’ll get a score. The perfect score is zero.

Dr. Elkin:              You know we have calcified arteries, right? As you get older, that’s unlikely. So we find out what your score is, and there’s three main coronary arteries and you’ll get a composite score, but the good thing about at Harbor-UCLA is that you’ll also learn, they have a database of 30,000 people. So they can say, “Okay. How do you compare to other 58-year-old men or 60-year-old women?” So they have a great database. “Okay. You’re in the 10th, 20th percentile. Not too bad. 40th to 50th, okay, average. 80th and 90th, that’s pretty serious.” By the way, you don’t have to have any symptoms. So it’s a useful test to have. I probably do it every two years or so on interested patients, people that are interested in being proactive.

Dr. Elkin:              I had one patient there. I’d tell you this funny story. So I did him and he had a level 1200 when I first did it. I said, “Holy shit!” Then I did it repeatedly every two years, and we kept on going up and up. He wasn’t compliant with diet. He was a diabetic. Finally, after 2,000 I said, “I’m done. I’m more nervous than he was. It took seven or eight years before he finally had a heart attack, but he had very, very high levels. So again, it doesn’t necessarily equate to events. Although if it’s a score over 800, it’s supposed to be very highly correlative, but obviously in this patient, it didn’t make that much of a difference. I mean, really, I saw this go up every year until I stopped ordering the test. So that’s one test that I do find useful.

Dr. Elkin:              I like the PULS test. PULS stands for protein, wait, protein. Oh, gosh! I hate these. Anyway, it’s a test. It’s an interesting test. Oops. That’s the company that does it, and it’s a very different test. I do the coronary calcified test. It’s telling me if there’s calcified lesions in the coronary arteries. It doesn’t tell me whether it’s a vulnerable plaque or stable plaque. We tend to think that calcified arteries are actually somewhat safe because they’re calcified. You’re not going to have a calcified lesion just break off and cause heart attack or a stroke. It would be unlikely.

Dr. Elkin:              It’s the soft lesions that we call the vulnerable plaque that we don’t see. We cannot pick up on a coronary calcium scan. So any information we can get from other tests are very useful.

Dr. Elkin:              There is a test that they’re working on now with artificial intelligence. Well, very few centers do it. There might be one. I’m not doing it. It’s $6,000 for this test minimum if you want to be able to really see what soft plaque looks like, but this quantifies damage at the endothelial level and identifies risk and predicts, most important, acute coronary syndromes.

Dr. Elkin:              So when I’m on call, I’m called to see someone, an acute coronary syndrome, meaning they’re either having a massive heart attack or not so massive heart attack, but they need to be admitted and they need to be studied. These are not stable patients. So it’d be nice if we can predict this before it happens. So it’s an interesting test.

Dr. Elkin:              The important thing that I’ve learned is that this whole disease process starts off at the endothelial level, which is the one cell thick that aligns all your arteries, small, medium, and large. As long as is that one cell thick is untethered and undamaged, I don’t care what your cholesterol is, I think it’s going to happen, but with age, genetics, stress, cholesterol, hypertension, smoking, environmental pollution to know there’s damage that takes place in that endothelial, which sets ourself for disease.

Dr. Elkin:              Okay. So this is what a-

Dr. Weitz:            Howard, I just wanted to maybe help if people are a little confused about the coronary calcium scan. Just to maybe put it in a different way what you said, which is that somebody can have … Look, it’s better not to have any plaque at all, but if you are going to have plaque, when you do the coronary calcium scan, it’s measuring calcified plaque, and if you had a choice between having calcified plaque and uncalcified plaque, calcified plaque is more likely to be stable.  So it’s when the plaque is unstable and breaks off, then it’s more likely to create an event. So therefore, just because you have calcified plaque, it doesn’t necessarily mean that you’re as much of a risk as if you had soft plaque, which doesn’t show up on a coronary calcium scan, unfortunately.

Dr. Elkin:              I tell the patients, just like you said it, there’s somewhat protective measures having calcified plaque, but it means you do have plaque. Okay? If it’s calcified, it’s probably been there for a while because calcium doesn’t just … If you look at plaque under a microscope, if you could do that, first of all, it’s endothelial damage, then you have oxide LDL getting into intima itself, then you have the cascade of events and foam cells and macrophages and blah, blah, blah, and eventually, you have cholesterol entering the area. Smooth muscle cells entering the area. Eventually, calcium is deposited. It’s probably meant to be a protective measure, but if you see it, it means you do have plaque, which means you’ve got coronary disease.

Dr. Elkin:              Now, with the PULS, we’re looking at nine different biomarkers here. Unfortunately, I don’t have a pointer, but this is what the port looks like. So everything in the red is bad. That’s above the line. Everything in the green is good. So there’s two that we don’t measure. Your age and your genetics are not really biomarkers. These biomarkers, I’ve never heard of before, interleukin 16, IGF, exotoxin, FAS, FAS ligans. I said, “What the hell?” It doesn’t matter because we’re not treating the individual biomarkers. We’re treating your risk.

Dr. Elkin:              The the way this was devised, and this test has been done by four different cohorts approved by FDA and on total number of 40 almost patients. So the history of PULS, if you ever want to look it up, go look at pulstest.com and you’ll see how this was derived. It was a carefully derived test.

Dr. Elkin:              So we’re looking at biomarkers that tell us, “There’s stuff going on in the endothelium now.” The calcium test tell me what’s been going on in the past. Who knows? It could have been that way for two years, but if you have an abnormal PULS scan, it’s telling me what’s happening now.

Dr. Elkin:              Now, look at this person. He’s high risk and his score is 9.02 if you look at the bottom. Now, if he was the same, I don’t know the age of this patient, but what his expected score for the age and sex is 1.19. So we look at the gap, which is 7.58, which is not good. That puts him at a high risk category. So you’ll end up with a high, moderate or low risk. Now, let me just go into the next slide. You’ll see what I’m talking about.

Dr. Elkin:              Okay. So this is a person who’s had two scans, two PULS tests. First one is 18.19, okay? Now, what I want a combination is … Okay. The first test doesn’t mean much to me. It just tells me that you’ve got junk going on in your endothelium. What I’m more interested is in your second and subsequent test because I want that number to go down. Now, in this patient, guess what? It went up. He went from 18.19 to looks like 30 something. That’s not good. We want the graph to go down not up.

Dr. Elkin:              So how do we treat it? So this is the area we get into. So I’m now treating these patients. Well, you mentioned Arterosil, which is a very good supplement. I use something from Ortho Molecular. It’s called Vascuzyme, and their proteolytic enzymes. What happens? These proteolytic enzymes help to get rid of unwanted proteins that chew up your endothelium.

Dr. Elkin:              I use two of those first thing in the morning. I’m taking it myself, actually. First thing on empty stomach in the morning, then I have another product they use, and I changed the title to EndoWise because it’s a very difficult title to remember. Basically, there’s three components, pomegranate extract, pine bark extract, and olive fruit extract. Those three together are very, very useful in building the integrity of endothelium.

Dr. Elkin:              So I’m using a double product approach to treat the endothelium. One, to get rid of one protein with proteolytic enzymes and the other is a compound that would help to maintain a stable endothelium. Now, I’ve been doing this for six months now and I don’t have a study yet, but I have seen my graphs go down in addition to lifestyle and other things that we’re doing because I have one patient, she’s a judge. Okay? Past family history, father had a heart attack at early age. Her LP(a) is elevated. She’s got cholesterol issues. I have her on niacin. Mild hypertension, and she’s early 60s.

Dr. Elkin:              I did a coronary scan. I’ve done two of them. They were normal. I said, “You know what? We should do a PULS test.” She’s high risk. You can have a negative coronary calcium scan and a high risk PULS scan, which tells me even though it’s not showing up at this time on a calcified scan, there is stuff happening at the endothelial level that we’re not aware of because we can’t visualize what’s happening in the soft plaque. So we put her on these two supplements. I mean, her graph has gone the other direction than this graph. So it’s just very interesting.

Dr. Elkin:              So I have not studied Arterosil, but I know it’s similar. It’s the same principle. We want to treat the endothelium because that’s really where everything starts. We’re not just looking at LDL cholesterol anymore. We’re not even looking at just the size of the cholesterol. We’re looking at by maintaining the endothelial function, can we actually decrease risk. I’m finding that. So I’m really enjoying doing this because it’s telling me a lot.

Dr. Weitz:            Howard, what was the name of that supplement from Ortho Molecular with the proteolytic enzymes?

Dr. Elkin:              It’s called Vascuzyme, V-A-S-C-U-Z-Y-M-E, Vascuzyme. So you take two of those first thing on an empty stomach. Those are proteolytic enzymes. The other one is one twice a day with or without food, and I forgot the name, but it’s Oxy something, but it’s pomegranate extract. If you look up Ortho Molecular, pomegranate extract, pine bark extract, and also olive fruit. Ortho Molecular has done some good stuff in the cardiometabolic field. That’s why I like them. Every company, these major companies have good supplements, but they’ve got a few good products that I really like that I use on my cardiometabolic patients.

So finishing up here, what about stress testing? We don’t ignore chest pain. If anyone, if you have a patient that’s complaining of chest pain, they should be worked up. Again, 45% of heart attacks are silent. We want to improve that. If it’s a diabetic patient, do not mess around. Refer those patients for a stress test. If it’s a woman, if it’s anything above the belly button, it’s heart until proven otherwise. A lot of women have unusual symptoms. They can have pain in the jaw, in the teeth, in the neck, no pain at all, fatigue.

So I think we’ve learned over the years, when I was a fellow, all the studies that I looked at were based on middle-aged men. Women were excluded. So we now have learned that women are different diagnostically and also treatment-wise, and they respond differently and they tend to be older.

So I do stress testing. Of course, I’m a cardiologist, I don’t have it in my office and I do imaging as well, but it’s very important to do that. There’s special considerations. A lot of your patients will complain of palpitations. When do you worry about it? I have a patient today that I did a monitor on him and he’s in atrial fibrillation 16.9% of the time, which is not great, but he had an episode that’s over five hours. He is getting worse because if you have an episode over eight hours, you’re high likely to have a stroke, 40% more likely to a stroke.

Cryptogenic stroke is a stroke that we don’t know why it happened, but we’re now thinking that most cryptogenic strokes are really from atrial fibrillation. So besides doing arrhythmia detection, you can also do what’s called a loop recorder, and I have a few patients that have that. They’re very small device. You put it under the skin. There’s no wires. It actually detects bouts of afib.

So that’s basically … The medical advocates take the high road. So I’m called the medical advocate because I learned by being a patient twice that I had to suffer to the plate and be my own medical advocate because I learned real quickly that traditional medical model was not the end all be all. So that’s what I hope for my patients and for all of you. So any other questions? I’m happy to take them.

Dr. Weitz:            Yeah. One other question somebody asked, “What is your approach to afib?”

Dr. Elkin:              Okay. Okay. That’s a great question. First of all, it should be treated. Now, here’s my thing. Sinus rhythm, normal rhythm is much more favorable than atrial fibrillation. So why? What do we worry about atrial fibrillation? The most important thing to be concerned with is stroke. Again, if you have an episode that lasts eight hours or more, whether it’s permanent or paroxysmal, there’s a high likelihood of a stroke. So these patients should be at a blood thinner. I got a patient say, “Well, I’m taking fish oil I’m taking ginger. I’m taking garlic.”

I’m saying, “That’s fine.” Nattokinase or serrapeptase, there’s no studies on those supplements. So I tell patients, “It’s probably nice that you’re doing that, but if you really want to prevent a stroke, you probably should be on something that’s definitely been approved and studied.” Sinatra and I have talked about this. He also agrees with me. You don’t mess around with afib because strokes tend to be big.

Dr. Elkin:              See, what happens when the part is pumping, when it’s beating irregularly irregular, little clots end up in the left atrial appendage and they can break off anytime and go up the order to the carotid and usually plug up a dividing point, a bifurcation. So the strokes tend to be big. They’re not small strokes. So you want to avoid that, number one.

Dr. Elkin:              Number two, I had another patient about years ago, he didn’t want to go through invasive testing. He already had a heart attack and stent, by the way. His heart rate was 110 doing nothing. I said, “Okay. I hate to break it to you, but you’re going to develop heart failure because your heart’s not going to be able to take this but so long.” So I finally was able to convince him to go on a beta blocker and his heart rate is less. So there’s a definite increase incidence of heart failure in patients with afib.

Dr. Elkin:              Then the other one is dementia. It’s now been shown recently that whether it’s permanent afib or paroxysmal afib, there’s a definite increase incidence in dementia probably because of the sporadic nature of the pumping of the blood going to the brain. We don’t know exactly why, but there’s definitely increased incidents.

Dr. Elkin:              Number four, which is more lifestyle, is that they feel like crap. I mean, if you don’t have the atrial kick, see what happens in afib, the atrium and the ventricles, and they’re not working in concert because you don’t really need the atrium. The ventricles are doing the major pumping whether into the right ventricle or the left ventricle into the aorta. You don’t really need to have the synchrony, but what happens when you lose the atrial kick, you lose about 15% or 20% of the cardiac oomph, the output, and that’s per beat. So these patients have a difficult time exercising. They get fatigued very easily.

Dr. Weitz:            A question came in about the myocarditis and pericarditis that could result after having a certain well-known virus.

Dr. Elkin:              It’s real. It’s real. I mean, I think it’s funny. Being on call as long as I have been during this entire pandemic, I’ve seen arrhythmias. I’ve seen a couple of heart attacks. I’ve seen one or two myocarditis. They tend to do okay. Now, the consensus of opinion, if you can believe it, is that people that have myocarditis as a young male post-vaccine, post-booster, I’m sorry, tend to do pretty well for the most part. Very few end up being hospitalized and very few have any residual symptoms or signs. The ones that are hospitalized with myocarditis is a bigger deal.  Now, I will tell you, if you were hospitalized, so let’s say you look at your COVID population, 80% never hits the hospital, 20% do. Of that 20%, at least 30% or 40% will have elevated cardiac enzymes, which means they’re having cardiac injury on one way level four. It could be a heart attack or it could be a myocarditis. So I have seen it.

Dr. Weitz:            What about from an integrative approach? If we have patients with that, what protocols have you found to be effective?

Dr. Elkin:              Okay. Well, if it’s acute, you’re going to do acute congestive heart measures like if they need diuretics, you give them diuretics, meaning intravenous diuretics.

Dr. Weitz:            Right, but let’s say in a chronic stage. Patients coming in our office still are having some lingering.

Dr. Elkin:              Got it. All right. So I use formation supplements for these patients, CoQ10. If they definitely have any significant heart muscle dysfunction or low cardiac output, you need high doses, at least 300 milligrams. By the way, both Cleveland Heart and Boston Heart will do CoQ10 levels as part of their profile, and you want patients with heart failure to have levels of over four if you can get it, okay? That’s going to be minimum of 400 milligrams a day of CoQ10. So that’s the mainstay.  

Then I also use d-ribose, which is the major energy substrate for every cell in your body, especially your heart cells. So you can have all the CoQ10 in the world, but if you don’t have enough d-ribose as a substrate, you won’t be able to really generate enough energy. So it helps with contractility.

I also use L-carnitine because it helps to transport fatty acids from the cytoplasm cell to the mitochondria, where energy is produced. So I use those three together, and I also use magnesium. So I use those in my heart failure. I mean, I try to get all my heart failure patients on supplementation. One thing I tell them, a failed heart is a starved heart, and the pharmaceuticals can be very good, but they’re not going to replete the nutrients that you need.

So definitely, I’m so glad you brought that up because I couldn’t talk about everything, but it definitely helps with my patients, whether it’s myocarditis. Now, a lot of myocarditis, I’ve had patients with myocarditis over the years, whether it’s COVID or not, they improved. Their [inaudible 01:13:57] will improve. Generally, if I can withdraw the drugs, I’ll probably keep them on supplements. I think it’s important, but a lot of my cardiomyopathies, good luck at the draw. Some don’t improve, and they were left with ongoing disease.

Dr. Weitz:            Does current research support the use of low-dose aspirin?

Dr. Elkin:              Good question. Now, I will let you know that from the very beginning I know I’ve been one of those cardiologists who say everybody with the age of 50 should be on low-dose aspirin. It’s controversial now. Here’s my thing on it. It’s a doctor’s decision to decide whether or not you should be on it. If you’ve had a stent, if you had a heart attack or a stroke, you probably should be on baby aspirin the rest of your life. If you are just a patient with coronary disease, and this is going to be extremely variable depending on your belief system. It’s always a benefit risk ratio. So I think the benefit is going to outweigh the risk. Yeah, I would probably do baby aspirin.  Again, I would be more wary of that in the elderly population. They’re the ones that get to be concerned most with the bleed as opposed to a younger person, but I still use aspirin, but I never use it universally, never. I’ve always done it on individual basis, but in-

Dr. Weitz:            So there’s been a lot of discussion in the literature, and for many years it’s been a consensus to you that low-dose aspirin is a good preventative for pretty much everybody, and then recently, after looking at the data and considering the fact that some patient is going to benefit from blood thinning and some patients are going to get worse from blood thinning because they may have bleeding events that in general it’s not recommended, but what you’re saying is individualized medicine. It depends on the person. If the person is more likely to have an issue with clotting, then it makes sense.

Dr. Elkin:              Especially if it’s a secondary prevention. Secondary prevention mean you’ve already had the diagnosis, you’ve had something happen versus just primary prevention. So again, really, it’s a benefit risk ratio, and I just customize my therapy, but I’m going to be doing a YouTube live on this in a few weeks because it’s so important.

Dr. Weitz:            An important supplement you didn’t mention is K2.

Dr. Elkin:              Oh, yes. I use it all the time. Okay. So here’s why I like to use it. K2, you all know about vitamin K. So there’s K1 and K1. That’s another one. K1 is important for blood clotting, okay? K2, it actually helps to shunt calcium from your gut to where we want it to go, which is two places, bone and teeth, but we don’t want to go to the heart, meaning the heart valves and the coronary arteries.

There’s some really good studies coming out talking about that. It also helps with decreasing the stiffness of the ventricle and it helps with diastolic dysfunction. So there seems to be more and more coming out now about vitamin K2. So yes, I use it. There’s a product actually by Ortho Molecular that I like, and it contains 5,000 of D3 along with 180 micrograms of K2. So Sinatra and I have just had this discussion. We think at least 150 of K2 would be important to take a day. You can take more than that, but that’s seems to be … Yes, I use it on almost all my patients that have demonstrable disease. I just go from D3, and it’s a combination. One capsule does both.

Dr. Weitz:            Somebody asked a question about blood pressure and what you said about blood pressure earlier about how blood pressure is typically lower in the afternoon and higher in the morning. What if the opposite? What if the patient has lower blood pressure in the morning and higher and later in the day?

Dr. Elkin:              It can happen. I’ve seen it happen. It’s the minority, but I’ve had some people who have these paradoxical rise in the evening. Okay. Then you got to be creative. Also, that’s why you have to really figure out what they’re eating, but assuming that their salt intake is not great, that they’re very careful, and their diet is pretty clean, I might need to add something. I might do a twice a day medication, which I don’t like to do. I like to do once daily, but sometimes I do have to use a second medication. So I may use hydralazine, which is a vasodilator, which can work pretty effectively. It’s an old-fashioned pharmaceutical. I mean, it was out when I was a student, but it’s still one of the best ones, and it causes less edema and swelling than the calcium channel blockers.

Dr. Weitz:            I would also recommend doing an adrenal cortisol stress test. If you see a rise in their cortisol level in the afternoon or evening, that’s where a product like Integrative’s Cortisol Manager can be perfect, and you can time it with when they have the rise in cortisol.

Dr. Elkin:              Yeah. I just had a patient today, actually. She had adrenal test, saliva test with CAR. Her CAR was 200% increased. She did great. She has a normal curve, but she has a very high anxiety going now. She want to go on an SSRI, which I didn’t really want to do. Anyway, so she’s got a normal curve, and then right when she’s going to bed there’s a jump, and that actually was effective. So yeah, she doesn’t have hypertension, so that’s a useful thing, but yes. It also depends. I think that’s a good point. Adrenal testing is always useful. Some people don’t don’t believe in it, but I do. We do a lot of adrenal testing.

Dr. Weitz:            Somebody asked about Boston Heart or Cleveland labs for a patient as a preventative test. So I think, basically, the question is, would you do advanced lipid testing for patients who aren’t necessarily heart patients? I would say, for me, I make that a part of every one of my patients that we’re screening for-

Speaker 4:           Sorry, Ben. I was actually asking if you had only one choice because this is for someone who you’re trying to optimize, who does not yet need a referral to a cardiologist. Does he like the Boston Heart or the Cleveland better?

Dr. Elkin:              Okay. Good question. I like them both. I am a spokesperson for Boston Heart, and they’re both very similar. Again, Boston Heart has a couple things that I really like like the hyper absorption, hyper producing test that they have. They have a patent on that one. Also, a genetic test that I didn’t mention called the Slow Code Gene. So you can actually find out whether a patient is a slow metabolizer of a statin, which is really important to know because if they are, either you want to minimize the use of a statin or you use a water-based statin that won’t be as nearly as potent. So those are two tests that they do.  They do a few other of tests. They do it. I like Cleveland Heart. They do the HDL functionality tests, which is new. So they both basically, and the genetic tests, both can do. They’re specialty labs, and I think they’re both very good labs to use.

Dr. Weitz:            What about insurance coverage for one lab over the other?

Dr. Elkin:              Okay. Well, Cleveland was taken over by Quest about three years ago, which is an advantage, for sure, because a patient can go simply to a Quest lab and get Cleveland drawn. Okay? So it’s very easy. Whereas with Boston Heart, you have to find a lab that will draw them. Now, we compound that, but I’m in your office. We can have your phlebotomist do the labs. When I’m in Whittier, we found a service that’s very good that will PULS, they’ll do Boston, they’ll do Genova, any of these laboratory tests. So insurance, Quest, I think it’s even large in lab core. So they have the monopoly when it comes to insurance coverage.  Now with Boston, they do accept Medicare, also Blue Cross, and the Blue Cross, they recently acquired that one. They also have Aetna, which is the insurance that I have. Blue Shield does not follow. They don’t have Blue Shield yet. So there’s more coverage with, for sure, with Cleveland because it’s Quest, but I think they’re both very good tests.

Dr. Weitz:            I just want to mention, we bring a little phlebotomist in the office usually every two weeks. If you have need of a phlebotomist, you’re welcome to send your patients over when she comes out because if we had more patients for her to draw, she’d give us a better deal, and if you want to, just feel free to call my office, which is 310-395-3111. Then Howard, how can everybody get ahold of you? Where’s your last slide with your information? There you go.

Dr. Elkin:              Oh, I didn’t know the music. Wait a minute. Oh, okay. Here we go. Heartwise.com is my website. Somehow, Instagram didn’t get on here, but I do a lot on Instagram. So it’s DocHElkin, D-O-C-H-E-L-K-I-N, and YouTube, I’m usually on every two weeks and it’s the Medical advocate, Howard Elkin, MD, and also on Facebook, and that’s HeartWise Fitness and Longevity Center. So I’m pretty active on social media. I have my books will be coming out in a couple months, but if you follow me on social media, you’ll be hearing about the pre-launch.

Dr. Weitz:            How often do you do the YouTube lives?

Dr. Elkin:              I do it every two weeks unless I’m out of town or there’s a holiday, for example, but I try to do it twice a month.

Dr. Weitz:            I guess one final quick question. Somebody said, “Does Medicare only cover an advanced lipid profile every five years?”

Dr. Elkin:              No limit. I’ve never had that problem. I mean, I deal with a high popular of patients or a patient that have abnormalities. I do it every three, four months if I have to. If I start a therapy, whether it’s lifestyle or supplements and/or medications, I want to know where it’s working. So I will repeat usually three months, sometimes four months. So there’s no limitation. I have not had that problem.

Dr. Weitz:            Okay. Thank you, Howard. That was great. Thank you to everybody. We’ll see you next month.

Dr. Elkin:              All right. Thanks.



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.



Blood Sugar Regulation: Rational Wellness Podcast 247

Cheri Bantilan discusses Blood Sugar Regulation 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

2:48  A continuous glucose monitor (CGM) is a device that place on the back of your arm or your abdomen and it measures your glucose through the interstitial fluid of your body every 5 to 15 minutes. The two main companies that make these are Dexcom and Abbott.

4:50  The most important values to look at with a CGM are fasting glucose, average daily glucose, and postprandial glucose, which is after a meal, typically for two hours, and finally there is glycemic variability. 

6:32  Fasting glucose levels should be between 70 and 90 for a healthy person and average daily glucose, which takes into account fasting levels, sleeping levels, and eating, is ideally below 105 for a healthy person.  We would not want to be a flat line.

8:16  After a meal, ideally we would like these postprandial levels stay below 140 and we would like to see values come back to normal within 2 to 3 hours.  If it is taking longer, this could be because there was a lot of fat in the meal, but having your glucose spike above 150 and stay there for 4 hours is not good and we need to make some changes.

9:38  Some Type II Diabetics can get their fasting glucose levels below 90 if they are properly managed



Cheri Bantilan is a registered dietician who works with Nutrisense, which is a company that helps patients to use a continuous glucose monitor and to interpret the data to optimize their health.  

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


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Dr. 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. Let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today, I’m excited that we’ll be having an interview with Cheri Bantilan from NutriSense, and we’ll be discussing the use of a continuous glucose monitor and how this tool can help us to better manage our blood glucose levels for optimal health. Obviously, this can be super important in helping to manage patients who are diabetic or pre-diabetic, but it can also be part of a program for optimal health, for longevity, as well.  As we know, there’s many studies correlating lower levels of insulin and better managed blood sugar with less inflammation. There’s even some data that we’ve discussed previously on the podcast, linking it with potential lower risk of cancer. For longevity purposes, better managing your blood glucose levels is an interesting thing to take a look at. It’s one of the reasons why eating a lower glycemic carbohydrates and perhaps some of the specialized lower carb diets have been shown to have some benefits for overall health.

Our special guest today is Cheri Bantilan and she’s a registered dietician who works with NutriSense and NutriSense is a company that helps patients to use a continuous glucose monitor and to interpret the data to optimize their health. A continuous glucose monitor is a device typically worn on the back of the arm or on the abdomen that monitors your glucose continuously all day and night. When interpreted properly, can help you to learn how your blood glucose levels respond to eating certain foot foods, meals, timing of meals, activities, exercise, stress, sleep, and this fits very nicely into the functional medicine model with aims, not just outpatients with their symptoms, but to use the right testing to get to the root cause of their health issues. Welcome, Cheri.

Cheri:                   Thank you. Thank you so much for having me here. I’m super excited to be here.

Dr. Weitz:            Excellent. Can you explain what a continuous glucose monitor is and which of the devices on the market do you find the most helpful or accurate?

Cheri:                   Great question. The continuous glucose monitor or CGM as we like to call it for short, is a small device that you basically put on the back of your arm or your abdomen, as you mentioned. It’s painless to insert there. If people are familiar with checking their blood glucose levels, they’re probably really familiar with glucometers where you have to use a needle and prick your finger and check your blood in that sense. No needles are involved.  You basically insert the device on your arm and depending on the device that you have, it measures your glucose through the interstitial fluid of your body every 5 to 15 minutes. Therefore, you get this nice plotted line of continuous data, which is really nice. It’s pretty insightful. It’s like having real time data for yourself. As I mentioned, there’s a couple of devices out there.

The two main companies that make them are Dexcom and Abbott. There’s a FreeStyle Libre, which is what we use at NutriSense. Then, there’s the Dexcom. Then, there’s various different devices between those two companies but our company currently uses the FreeStyle Libre. Both devices are very accurate in assessing changes in real time for your glucose. Each company has their own calibration system. At our company, we do find that many members have a fasting glucose lab value or a glucometer home. We also have a feature where you can manually calibrate your sensor to those metrics as well.

Dr. Weitz:            Interesting. When do you think of the most important times to look at for understanding our glucose levels? People often talk about the fasting level, which is when you get up in the morning prior to eating, the postprandial level, which is two hours after eating, other diabetics check it prior to eating meals. When do you think is the most significant, important times?

Cheri:                    That’s a really good question. There are three major trends that we actually like to follow. As you mentioned, one of them is fasting glucose value. I would also like to tag on average daily glucose value on that and kind of keep them in the same realm. Then, the next one would be, so that would be any, so fasting glucose would be anything without food or drink for at least eight hours. Typically, it’s in the morning for most people.

The next one would be postprandial responses, which is after meal responses. We like to look at what your pre-meal value was and then that two-hour period after you eat. We’re looking at all those metrics within that time. Then, the last one, which is actually very unique to wearing a CGM would be glycemic variability or standard deviation.  You can actually only get this metric if you are wearing a CGM. If you have a glucometer at home, you can’t get your standard deviation just because you don’t have that continuous data, but those are the three metrics. The standard deviation is more of a metric that comes over time. It’s not like a one stamp time type of metric. It’s really useful for measuring your glucose fluctuations or swings.

Dr. Weitz:            I’m pretty familiar with what we see as a good level or an optimal level for the fasting glucose. That’s typically what we measure when we do lab testing. How does that compare with average glucose levels? We typically think of somewhere between 70 and 90. I know there’s different ranges that people consider optimal for fasting glucose levels. Well, first of all, what do you consider optimal for fasting glucose levels, I guess for healthy person versus maybe a pre-diabetic or diabetic? Then, how does that compare with what we see as average glucose levels over the course of the day?

Cheri:                    Yes. We agree, for optimal values for a healthy person, we like to see fasting level values between 70 and 90 majority of the time. Obviously, we know that glucose fluctuates and there’s reasons why it may be higher or typically higher for some people, depending on various influencers but typically we do want to see them between 70 and 90 most of the time.  Now, daily average glucose would be something that takes into the count your entire day. That would take your sleep average and the rest of the day. We like to see those values below 105. Just a little bit higher, you’re kind of taking into account the rest of the day while you’re eating. It’s very normal when you’re eating for glucose to go up. We don’t expect it to be a flat line ever. We don’t want that. Average glucose, we like to see below 105.

Dr. Weitz:            Okay. What should be the highest level we should see glucose levels rise after a meal and ideally how long should it take to come back to the previous baseline level?

Cheri:                    Yeah, this is a really great question. This is one of, probably my favorite things to kind of look at and assess is different meal responses. It can vary depending on the meal content, meal timing, what you did before and after. It’s pretty interesting to see, but in general, we like to see, again, for a healthy individual, we like to see postprandial responses stay below 140 the majority of the time. Then, we also look at how long it takes for your values to come down.  We like to see values return back to baseline or back to your pre-meal value between two to three hours. If it’s taking longer than that, there are nuances. Maybe you had a lot of fat in that meal. It’s just taking the glucose longer to digest and be absorbed. That fat is prolonging that response, but there’s different reasons why a response would stay longer. What we don’t want to see is having your values spike to 150 and staying up there for four hours. That would be something that we would be like, “Okay, let’s look at this. Let’s dive deeper into this because maybe there’s something else going on.”

Dr. Weitz:            Would you say with the two type two diabetics that you manage, do their levels typically go back to fasting levels or is that sort of once they start eating, it’s always a little bit above that?

Cheri:                    It depends on their health history and how well their diabetes is being managed. If it’s pretty well managed, yes, we do actually see values come back down and whether that’s through lifestyle factors or medication, it’s being managed and you’re seeing those values in that normal curve that we like to see. For individuals who don’t have their diabetes managed that well, it takes a long time for their values to come back down.  That’s when we would try to intervene through lifestyle interventions, with diet, exercise, sleep and stress levels, making sure all of those components are coming together to make sure that their body is working as efficiently as possible.

Dr. Weitz:            What you’re saying is for a type two diabetic, it’s really not unreasonable for us if they’re properly managed, if they’re really taking care of all the lifestyle and other factors that we know can play a significant role that their fasting glucose levels should consistently be below 90?

Cheri:                    That’s tricky. I think that depending on where they are, it is very possible. It is very possible. I feel like a lot of the times when people come to us and they have a diagnosis of type two diabetes, they’ve been dealing it with for a long time, they feel like that is the end result. However, we can reverse this. We know that insulin-resistance can be reversed. It does take time just as it took time to have it progress. It takes time for it to reverse. It does take time, but it is possible.

Dr. Weitz:            Okay. That should be the goal. We shouldn’t like say, “Well, because you’re diabetic, if you get it to 105, fasting, that’s probably the best we can do.” I mean, we might have to accept that after a period of time, but.

Cheri:                    Yeah. Depending how long they have been dealing with this and how long it’s been unmanaged. There may be nuances where maybe we may never see it go below 90, just because there is a history of damage there physiologically, but that doesn’t mean that you don’t try for optimal. It doesn’t mean that you can’t achieve something close to it.

Dr. Weitz:            Right. There’s something that most people have heard of called the glycemic index or the glycemic load. This is basically a measure of how quickly different carbohydrate foods are going to cause your blood sugar to spike. Of course, this is an average. The glycemic index is based on a 50-gram sample. That’s why it came out with a glycemic load, which maybe is more going to reflect the amount of the carbohydrate that somebody might eat in a meal but from your experience working with hundreds, maybe thousands of patients, how much variability is there in the glycemic index when we see that say, sweet potatoes are low glycemic, how often is that, how often do you see patients respond differently to different carbohydrates…

Cheri:                    Yes. It’s fantastic.

Dr. Weitz:            … than we would expect from the glycemic index?

Cheri:                    Yeah, absolutely. It’s quite impressive at how everybody has a unique response, truly. People often use a glycemic load or glycemic index as maybe like a first next step just maybe they’re just trying to get used to navigating a low carb diet or whatever it may be but I always say to test it out.  Everybody has their own unique response. Don’t guess, just test, that’s our little slogan that we like to use because it is so true where everybody has a unique response. Yes, people may have different health backgrounds and different situations where other factors may come into play but it’s really very fascinating to see how one food, for example, for me bananas, they spike me. I can’t eat a banana without spiking me, without a huge, huge spike, but for a colleague of mine, she eats bananas and it’s totally fine.

Dr. Weitz:            Hey, I heard her say that.

Cheri:                    Yeah, and it’s totally fine.

Dr. Weitz:            I think [crosstalk 00:14:14] Dr. Ruscio’s podcast.

Cheri:                    Yes. I’m jealous. No, it’s fine. It’s really, it’s not a big deal but it’s just shows it’s very interesting how there’s two people who are around the same age, very similar backgrounds that we just have different responses.


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Dr. Weitz:            I don’t know if you’ve looked into this, but do you think or have you seen that the way people eat and/or digest your foods matters? If you eat quickly, maybe you don’t have good digestive enzymes, hydrochloric acid function. Maybe you’re not going to break it down as quickly or somebody who chews their food for a longer period of time in a more relaxed manner, have you seen that that makes a difference in glycemic response?

Cheri:                    Yes, absolutely. It’s actually very interesting. If somebody, for example, rushes through their meal, we tend to see or I have tend to see a lot of people actually have higher responses because it’s rushed. They’re not relaxing during their meal. Maybe it’s more of a stressful environment. They tend to have just more, I don’t want to say aggressive, but just larger response to this versus someone who’s taking their time, having a relaxing moment and similar, this is maybe [crosstalk 00:16:53].

Dr. Weitz:            Do you think that’s more likely related to say, cortisol levels or stress or is it have to do with how much you’re breaking down the food as compared to not breaking down the food particles?

Cheri:                    I would say that in that moment, if someone’s rushing, it would probably be more related to stress. If somebody has a history of any GI issues, maybe dysbiosis inflammation, that would be something that’d be related to more on that side of the spectrum where it’s maybe a little bit more physiological versus, well, stress is physiological too, but something that’s a little bit more physical in the terms of something else is going on in your body versus a stressful moment and it’s more acute.

Dr. Weitz:            What about GI motility? Would we expect patients with SIBO, for example, to have a higher glycemic response or would we expect SIBO patients with diarrhea to have a different glycemic response than SIBO patients with constipation?

Cheri:                    Yeah, that’s a good question. We do know that there is some research out there that indicates were GI issues such as SIBO does have an impact on glucose. Typically, with issues like this, it does end up being where glucose levels are higher and they have higher responses. Again, that’s just more of an issue with malabsorption or things that should be regulated and working efficiently and it’s not. Yes, all of that comes into play, it’s very, yeah.

Dr. Weitz:            Like with slower GI motility mean they’re going to… I have seen some data that correlates SIBO with constipation or IBS with constipation with gaining weight, because of the slower motility, you absorb more of the calories from the food. Would it be the case that you also absorb more of the carbohydrates and see more of a blood sugar spike?

Cheri:                    Yeah. I’m not sure on the specifics on that particularly. SIBO in itself is like another, a whole another ball game I feel like and the different types of SIBO, right?

Dr. Weitz:            Right.

Cheri:                    There’s different, like hydrogen-dominant, methane-dominant, hydrogen sulfate, right? There’s so many different types. In general, if they’re not able to break down, I guess what your question is, if they’re unable to break down their food, would that cause a higher response? Is that [crosstalk 00:19:32]?

Dr. Weitz:            If they have a slower motility, would they absorb more of the carbohydrates from the food?

Cheri:                    Yeah, that’s actually a good question. I haven’t really looked into that specifically, but from what I’ve found working with SIBO patients, I will say more that they tend to have higher glucose values. The actual mechanism, I’m not too sure, but yeah it’s a good theory.

Dr. Weitz:            When eating a meal, does it matter what part of the food you eat first? If you’re having a meal with protein and vegetables and maybe some starchy carbs, I’ve always eaten like the protein first and then the vegetables and then the sweet potatoes thinking that I want to get the good stuff in there first but do you think that affects the glucose response?

Cheri:                    Yeah, absolutely, 100%. We’ve done numerous experiments with this with our own numbers. Then, even on top of that, there’s a ton of scientific articles on that, where meal timing or meal content does matter. Having your protein first, and then maybe having, like you mentioned, your non-starchy vegetables or something, maybe with fiber and then your carbs. We tend to tolerate carbs a lot better as a second or third thing to eat in.

Dr. Weitz:            Cool. Let’s talk about glucose changes that occur with working out. Let’s say, I go to the gym and I have a pretty intense workout for an hour, mostly lifting weights, how does that affect my glucose levels?

Cheri:                    Yeah. It’s very common to see a lot of people they’re exercising pretty intensely. You can see your glucose spike an increase pretty high, actually. Sometimes we see levels all the way up to 160 and it can be completely normal. You really only [crosstalk 00:21:26].

Dr. Weitz:            Are you’re talking about during the workout or after the workout or when?

Cheri:                    During the workout.

Dr. Weitz:            Okay.

Cheri:                    During the workout, we’ll see a big spike and completely normal. What we want to avoid is any, we don’t want to frequently hit levels above 180 because that’s when you may be actually causing vascular damage, but if it’s spiking to anywhere below 180, and it’s a pretty intense workout, very, very common, it’s likely, what’s happening is it depends.  If you’re working out in a fasted state, liver and muscles are likely breaking down glycogen to provide better energy for your workout. If you’re working out in a fed state, you’re likely using that food that you just ate for your energy instead, but it in general if anytime you see a spike from a very intense exercise, it’s probably twofold. It’s probably just overall the stress on your body, but to your energy demands are exceeding energy availability so your body is just using those mechanisms in place to provide that energy needed.

Dr. Weitz:            It’s actually a good thing because you have these stored carbohydrates, your muscles need the glucose right then to function. It’s mobilizing that glycogen. It’s getting into the bloodstream. That’s why you’re seeing this spike, but then the muscles are utilizing it, so over a longer period of time, that’s a good thing, right?

Cheri:                    Yes, exactly. We’ll see that transient increase during exercise, but then overall a lower pattern for the remainder of the day. Just a side note on that, when we see these exercise spikes, it’s not the same mechanism. It’s not the same mechanism, I should say, as a glucose spike from food. The majority of glucose spikes and the glucose disposal that we see from exercise is noninsulin-mediated, while with food, we do need that, the insulin. It’s a little bit different mechanisms there as well.

Dr. Weitz:            Potentially, that’s beneficial because while all peptides, hormones are complicated and have probably beneficial and negative effects, in general, you don’t want a lot of insulin around because it tends to be inflammatory?

Cheri:                    Correct. It’s one of those things where you want enough of it to get the job done, but you don’t want too much of it. Correct.

Dr. Weitz:            Right. Right. How do different forms of exercise affect glucose levels? Let’s say, we have heavyweight lifting, we have high intensity interval training, we have lower intensity cardiovascular training.

Cheri:                    Great question. Typically, for any type of zone two training, thinking about this is something like a walk, something that’s pretty leisure, we may see glucoses either stay the same or have a slight dip. Think about anything low intensity, that’s kind of what you’ll see, a level or maybe a little bit of a dip for strength workouts. That’s something that’s a little bit more intense.

We expect to see a slight increase in glucose for something that’s high intensity depending and it all depends on the duration as well, but for something that’s short, high intensity, we do expect to see maybe more of a moderate to large spike and then anything that’s really long and very high, for example, maybe like a 45 minutes and above type of workout. It depends on the person. It depends on what type of fueling they did before.

I usually recommend for people to just test what they usually do out, and then we look at the glucose data and then we can kind of adapt from there and figure out meal timing from there because what we want to do is make sure that for these long workouts, their energy is sustained and they’re able to have these quality workouts. They’re not as bonking, so to speak, but we’re also not overfueling as well, right? It’s always that tough balance.

Dr. Weitz:            Right. Typically, when glucose levels go up due to a higher intensity workout, how long do they usually take to come down?

Cheri:                    It’s actually not very long at all. It almost looks like a meal response. It’ll typically come down. It’ll peak maybe right at the peak of their workout and it’ll come down within the next hour or so. It doesn’t last long at all. It looks very similar.

Dr. Weitz:            An hour after they finish the workout, it’s probably back to normal?

Cheri:                    It’s probably back to normal, I would say like one to two for the-

Dr. Weitz:            One to two hours?

Cheri:                    Yeah. For the CGM, there is like a, because it measures interstitial fluid, there is a little bit of a delay between actual blood glucose, usually 15 to 45 minutes. It’s like to give that-

Dr. Weitz:            Interesting, 15 to 45-minute delay.

Cheri:                    Yeah. There is a little bit of a delay. We’ll always like to give that buffer, but in general, yeah, it comes back down fairly quickly. If it is prolonged, I would probably look deeper into maybe recovery, maybe the recovery tips or whatever they’re doing for recovery isn’t as they need to kind of tweak that a little bit.

Dr. Weitz:            Right. Let’s talk about stress and glucose levels. I know one of the things I’ve seen sometimes working with some diabetic patients is sometimes they’ll see their fasting glucose levels higher than they should be based on everything they’re doing in terms of their diet and sometimes stress will be a factor.

Cheri:                    Yes, absolutely.

Dr. Weitz:            We’ve correlated it sometimes with the bigger increase in cortisol levels in the morning.

Cheri:                    Yeah. That’s often referred to as the dawn phenomenon where you see this rush of hormones, cortisol, adrenaline, all these kind of things. It’s kind of like your wake up hormones, but for individuals who have diabetes, what happens is those hormones are released, it causes a release of glucose, but then it just stays elevated. That is very common in the diabetic community, but stress does play a huge role in anyone. It can have a huge or very profound impact on your levels. The body copes. If you think about what the body is doing when it’s under stress, it’s increasing your glucose output. It’s releasing all that from the liver. Then, at this same time, insulin sensitivity is also reduced.

These two things combined cause glucose to stay in the blood and it’s very important if we’re running away from like a lion or something, but we were not really doing that anymore. We’re kind of sitting at our computers as maybe we have a stressful meeting, but we’re not running away from anything. It’s helpful, but acutely, it doesn’t have too much of an issue. There’s not much things that we can do about it, but what we get concerned about is those chronic stressors because that’s when it’s just, it can get dysregulated.

Dr. Weitz:            Right. What have you found are the most beneficial ways to deal with that sort of issue?

Cheri:                    For more chronic stress, we really rely on creating a really good stress management plan for many people. For example, I work with a number of surgeons and obviously they have a very high stress job. It’s really interesting to see that every time they go into surgery, they’ll note it and you can see that when they start the surgery, their glucose levels will go up sometimes by 30 points and it’ll stay elevated for several hours. Then, as soon as their surgery is done, it’ll go back down. While, again, one of those things where they can’t [crosstalk 00:29:24].

Dr. Weitz:            Somehow, I can’t see all these surgeons popping cortisol manager capsules before or during their surgery.

Cheri:                    Meditating during their surgery, exactly. Those are more edge cases where it’s very acute and we know what the stressor is. Oftentimes, it’s taking away the stressor, that’s what’s the biggest, the most helpful thing. However, it’s their occupation. A little bit of a different case, but for most people it’s figuring out what the stressor is and trying to find some type of technique, whether it’s breathing techniques, meditation, yoga, going outside, going for a walk, it works. Something’s different for everybody. Whatever sticks is what’s going to be helpful long term.

Dr. Weitz:            What about when people sleep? What is typically their glucose pattern?

Cheri:                    Yeah, sleep is pretty interesting. We do know that poor glucose control or elevated glucose values impact sleep, and it’s a bidirectional relationship. Poor sleep also impacts glucose values unfortunately. Poor sleep could be from anything, right? It could be from chronic stress. It could be from maybe not getting enough sleep, maybe it’s disrupted sleep, like you having more fragmented sleep. Those are all stressors that can impact an affect glucose values.  Again, it’s one of those things where you have to, there’s things that we can do from a nutrition perspective where it’s worth timing, right? Meal timing and so if we find that your values are elevated overnight, and that’s what’s causing you to have poor sleep, let’s play around with the macro NutriSense content of the meal, let’s move the meal up earlier. Let’s do things like maybe go for a walk after your meal so we can get those glucose levels down.

If it’s more of for other reasons, sleep hygiene tips are always helpful and implementing that is always helpful. We can, we often discuss that with our members just to make sure they have a good wind down and sleep hygiene routine. It’s all these things are cumulative effect. I feel like a lot of times people undermine sleep and stress, but it has such a huge impact. Really taking the time to dive deep into these is best for longevity, not just your health, but for longevity.

Dr. Weitz:            Sometimes if you’re working with, say diabetics, especially diabetics who are taking insulin, whether they’d be type two or type one, sometimes the glucose level’s going too low during sleep is a problem as well.

Cheri:                    Yeah, absolutely. At our company, we actually don’t take any members who are actively taking insulin, but absolutely we do have a lot of members that aren’t on insulin, but have issues with hypoglycemia at night. Again, so it’s kind of the flip side, right. We’re working on, again, same things, macro content, meal timing, and how we can make those levels steady so you’re not waking up at night. There’s a lot of people that don’t realize that they’re waking up because their glucose levels are low. We see both sides, yes for sure.

Dr. Weitz:            How does drinking a glass of wine affect blood glucose levels?

Cheri:                    That’s a great question. Yes, it’s not uncommon for people to, of course, have a glass of wine on a Friday night. Oftentimes, when they do that, the next morning their values are elevated. They’re very surprised about that. I always like to remind members that it’s completely normal. It happens. Basically, your body, in a nutshell, your body, there’s no place for your body to store alcohol. It’ll always prioritize breaking down alcohol before other substrates. It’s very common to see elevated values the next day with any type of alcohol that you drink [crosstalk 00:33:08].

Dr. Weitz:            But you’re saying the next day, right?

Cheri:                    Typically, it depends. Yeah. Typically, it’s the next day.

Dr. Weitz:            Right? Because I think what’s in common thought patterns out there, what I hear people say is, “Well, alcohol turns into sugar.” I think they’re thinking that you’re going to get this rapid rise, but it turns out alcohol, I mean, unless the alcohol you drink can contain sugar, it actually doesn’t turn into sugar. It gets metabolized differently, right?

Cheri:                    Correct. If you’re having something typically like wine and anything, that’s hard liquor, we do actually see a dip in glucose. Then, we see those elevated levels of that the next day. For things that are like sugary cocktails, because as you mentioned, there’s actual sugar and things added in there that would impact your glucose very quickly.  We we’ll sometimes see like those higher levels and then the dip and then higher levels but it depends on the type of alcohol. Wine is very common. One that we see people drink or beer is very full of carbs. Typically, beers also drinking with other high carb foods like beard pizzas are very common combination. You’ll see elevated values probably right after the meal and overnight and into the next day,


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Dr. Weitz:            Now, explain physiologically why you would see elevations in glucose levels the following day after drinking a glass of wine with your dinner?

Cheri:                    Great question. As I mentioned, it depends on the alcohol that you’re drinking but many people will see that glucose elevated because your body is basically prioritizing down that alcohol over normal glucose production. The studies that we have on this show that alcohol temporarily impairs the normal functions in the liver to moderate normal glucose levels. It balances that insulin and glucagon.  It appears that what happens is when you drink alcohol, it temporally interferes with liver gluconeogenesis, which is making more glucose and glycogenolysis, which is breaking down stored glucose. What happens is the liver prioritizes breaking down that alcohol over other normal homeostasis functions because the alcohol doesn’t have a place to be stored in the body.

Dr. Weitz:            This has been described in some articles as drinking a glass of alcohol prior to a meal reduces postprandial glucose response as possibly a positive thing but you’re saying it’s actually a negative thing?

Cheri:                    Yeah, it’s a funny. I have seen things like that and I have seen people thought processes in that way as well. I will say that everybody has a different alcohol threshold. I wouldn’t use drinking alcohol as prior to a meal, as a technique or tactic to [inaudible 00:37:36] your values but some people get away with it.

Dr. Weitz:            Now, the reason why the glucose levels go up the next day is because it took that long to process the alcohol or it’s because it wasn’t processing the carbohydrates until later?

Cheri:                    Yeah. Basically, everything is pushed back, right? Your body is prioritizing the alcohol, it’s breaking that down. Then, you have all this leftover glucose in your body from eating, whatever you were eating, maybe you’re eating pizza. You have all that leftover glucose in your body. It’s just hanging out there. That’s what we’re seeing, right? Your body’s just wasn’t able to prioritize that because it was prioritizing alcohol.

Dr. Weitz:            In a functional medicine world, and I’m sure, a lot of consumers as well, we often use specific nutrients to help with the management of glucose insulin levels like berberine, cinnamon, chromium, vanadium. Have you seen, looking at patients with a continuous glucose monitor that any of those specific nutrients have a particularly beneficial effect?

Cheri:                    Great question. The one that I, the supplement that I have seen have the most impact would be berberine for sure. I typically, if individuals are pre-diabetic or they’re having really high values, and we’re doing all the lifestyle factors and they just need that extra push, we discussed that with their physician as well to see if they’re a good fit but that is the one that I see to be most effective majority of the time.  There are some studies that show that like cinnamon, ALA, chromium, things like all that, all those things, bitter melon is another common one. There’s less studies on that. I haven’t seen, also probably like a dose factor. A lot of people, the effective dose of cinnamon for impacting glucose people probably aren’t consuming. You have to kind of keep in mind-

Dr. Weitz:            Right. Meaning, maybe some of the studies show two to three grams and people are probably consuming milligrams.

Cheri:                  Yeah. They’re probably sprinkling it on their coffee. They’re not eating a ton of it.

Dr. Weitz:            Right.

Cheri:                  The other one that people do often, and I have seen it’s kind of a mixed bag but this one is apple cider vinegar. Sometimes people will use that as a tactic in their salads. It’s common. It’s easy to add. That has shown some impact as well for some people, but it’s not, the most effective one that I’ve seen consistently is berberine.

Dr. Weitz:            On the berberine, can you comment about dosage and frequency?

Cheri:                  Yeah, absolutely. Therapeutic dose would be about 500 milligrams, two to three times a day. The most common, majority of the studies on berberine are done in type two diabetics. I always like to make sure that the member who is doing it is aware of that. The most common symptom with taking berberine is just some GI upset. If anyone ever experiences that, that means just it’s a sign that you just need to back up a little bit on the dosage and you should be taking it with food as well.

Dr. Weitz:            Do you recommend before or after the meal, with the meal, and do you ever go to a 1,000 milligrams or higher dosages and have you seen a beneficial effect with that?

Cheri:                  Yeah, that’s a good question. I typically only recommend staying around that 500 milligrams, two to three times a day, just because of the GI issues that a lot of people do experience with higher dosage and yes, always with meals. It doesn’t matter if it’s before or after, as long as you’re not taking it on an empty stomach.

Dr. Weitz:            I’ve seen studies that show that A, that berberine has a similar effect to metformin. I’ve also seen studies showing that taking berberine with metformin actually enhances the effects. Can you comment about that? Have you had any experience with type two diabetics who are taking metformin also taking berberine?

Cheri:                  Yeah, that’s a good question. You are completely right that the mechanisms are very similar. Berberine has very similar mechanisms to metformin, which is why it seems to work so well. Also, a side note on that, sometimes if anyone is taking it out there and they’ve been taking it for a couple days, sometimes it can take a couple weeks for it to show any type of effect.  With that being said, I always, always double check with the member that they’re touching base with their physician, if they’re taking metformin and berberine just because it’s two medication/supplements that have the same effect. We want to make sure that, we want to have glucose levels manageable, but we don’t want it to be dipped too low as well. I always refer to the physician in terms of medication and if it’s okay with them, and they can take berberine at the same time, then I’m all for it but I never recommend taking it at the same time without touching base with their physician.

Dr. Weitz:            [inaudible 00:43:04] the same, of course, we always want to check with their physician and patient should always check with their physician before taking any supplements, even if their physician doesn’t know anything about them. Sometimes, I’ll include a paper that they can [crosstalk 00:43:25] their physician.

Cheri:                  About what it is.

Dr. Weitz:            Okay. Let’s see. I think those are the main questions I had. I often use berberine as part of a longevity program as well because metformin’s often used off-label for longevity purposes as well.

Cheri:                  Yeah.

Dr. Weitz:            Can you explain a little more about what your company does exactly?

Cheri:                   Yeah. NutriSense is a company that where you can get CGMs from. Basically, historically, CGMs are only used in the diabetic population, but we have found that it’s a very great tool to be used for optimizing health and for preventing progression of specifically insulin-related diseases as well.

Dr. Weitz:            You’re saying for the average patient out there, they can’t just buy one at the pharmacy?

Cheri:                   Correct. You cannot get this over the counter. You do need a prescription. What our company does, it takes care of that prescription for you. You go to our website, there’s a form that you fill out to make sure that you meet certain criteria. Our team looks at that. Then, we take care of that prescription for you. The CGM is sent right to your door. Every person, every member that has a plan with us, will get a dietician, a complementary dietician for one month. And so you have to [crosstalk 00:44:54].

Dr. Weitz:            Do you have to have blood sugar problems or pre-diabetes or diabetes to get one?

Cheri:                   Nope.

Dr. Weitz:            Okay.

Cheri:                   You don’t have to have any of those … We have exclusion criteria, which is basically you can’t be actively pregnant. You have to be over the age of 14. You can’t have actively be on any type of cancer treatment. Those are the basics of the exclusion criteria but other than that-

Dr. Weitz:            Right. Biohackers qualify.

Cheri:                   Yeah. Biohackers, if you are interested in wanting to, I don’t, there’s a lot of people that are interested in meal timing with exercise, enhancing their exercise performance and they don’t have any type of health history. All types of people we work with.

Dr. Weitz:            That’s cool.

Cheri:                   That’s fun.

Dr. Weitz:            Okay, great. How can our listeners and viewers find out about your company? I don’t know if you want to give them your contact information as well.

Cheri:                   Yeah, absolutely. To sign up, you can just go to www.nutrisense.io and all of our plans are listed on the website. You can definitely choose one. Then, from there you’ll fill out the form. It’s pretty self-explanatory and it’ll be shipped right to your door and you’re paired with a dietician. Of course, if you want to work with me or want to work with somebody that you’ve heard of, [inaudible 00:46:17] you can always request that as well but other than that, it’s pretty easy. The website’s pretty easy to follow and you can-

Dr. Weitz:            Yeah. How does your company interface, say, with functional medicine practitioners?

Cheri:                   Yeah. Great question. A lot of the dieticians that we have, have a functional background. In fact, I want to say majority of them have a functional background. We are very-

Dr. Weitz:            What about functional medicine practitioners who don’t work for your company?

Cheri:                   Yeah, absolutely. We do have affiliates and we do work with them. If that’s something that you’d like to provide like a code for your members or for your clients, we can definitely set that up for you and we can get a code for you. We can touch base with our marketing team and get that for you and your clients.

Dr. Weitz:            How would that work out exactly?

Cheri:                   We would just give a code. At checkout, it would be probably like your last name and then that when they check out they get like a 20% discount or something like that. It depends on what it works out to be, but-

Dr. Weitz:            Would we be involved in the recommendations that they get?

Cheri:                  The member or the client has always, if they want to share it with you, they can definitely share it with you. Then, if they want, as far as like the dietician working with the functional medical practitioner, we don’t have an interface with that at the moment, but usually what happens is the member or the client is that medium between the two.

Dr. Weitz:            Right. Yeah. You might consider that in the future.

Cheri:                  Yeah. Yeah.

Dr. Weitz:            Okay, great. Thank you Cheri, for joining us.

Cheri:                  Thank you so much for having me. It was really fun.

Dr. Weitz:            Yeah. I had a good time too. I’ll send you links to the podcast when we posted it in a few weeks.

Cheri:                  Okay. No problem.

Dr. Weitz:            Hopefully, you can share that with your followers.

Cheri:                  Yeah, absolutely.

Dr. Weitz:            Thank you.

Cheri:                   Absolutely. Thank you so much.

Dr. Weitz:            Have a nice day. Okay.

Cheri:                   You too. Bye.



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 nutritional consultations for patients at my Santa Monica, Weitz Sports Chiropractic in 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.



Hashimoto’s Thyroiditis with Dr. Angela Lucterland: Rational Wellness Podcast 246

Dr. Angela Lucterland discusses Hashimoto’s Thyroiditis 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

4:15  Hashimoto’s thyroiditis is the most common autoimmune disease and in the US it accounts for about 95% of cases of hypothyroid. [Hakuru Hashimoto was a Japanese MD and researcher who discovered Hashimoto’s Disease and published a paper on it in 1912.]  In general, the conventional medical profession diagnoses hypothyroid via an elevated TSH and prescribes thyroid medication, typically synthetic T4.  If you don’t test the antibodies, then you will miss the diagnosis of Hashimoto’s and taking thyroid medication will not fix the autoimmune component.  Antibodies are often present 10 years or longer prior to enough tissue damage for someone to feel it, which gives us a huge opportunity to treat it with a Functional Medicine approach.  A full thyroid panel should include TSH, Free T3, Free T4, reverse T3, and TPO and TGB antibodies.

6:03  It is important to run both of the thyroid antibodies–both the TPO and the TGB antibodies, even though high TPO antibodies are more common.  Ideally we would like to see their labs improve, their symptoms improve, and also see their antibodies go down, then we know that they are improving.

7:05  Dr. Lucterland considers a TSH above 2 or 2.5 to be significant, though it may be useful to measure the TSH several times, since there can be some fluctuation of TSH levels.  Also if you take vitamins with biotin, it can affect the measurement of TSH levels, so you should probably avoid taking multivitamins or other vitamins with biotin for a week prior to testing. 

11:31  For patients that require thyroid medication, Dr. Lucterland feels that most patients do better with natural thyroid, like Armour vs synthetic T4 like Synthroid, since these natural products have not only T4, but they also include a little T3, which usually makes patients feel better.

13:37  Besides giving thyroid medication, since Hashimoto’s is an autoimmune disease, we need to restore barrier function and restore self tolerance.  We need to remove environmental toxins and pathogens. 

14:45  To get an idea of barrier function, Dr. Lucterland likes running a comprehensive stool analysis and she includes zonulin, which is a marker for leaky gut, though it is marker that tends to fluctuate quite a bit.

19:15  Before she runs the stool test, Dr. Lucterland will do a month of Lifestyle Intervention, so she will often start with the paleo diet


Dr. Angela Lucterland is a Doctor of Chiropractic and a Functional Medicine practitioner with a specialty in treating patients with autoimmune diseases like Hashimoto’s thyroiditis. Her website is AngelaLucterland.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 have an interview with Dr. Angela Lucterland on Hashimoto’s thyroiditis. Dr. Angela Lucterland is a doctor of chiropractic and a functional medicine practitioner with a specialty of treating patients with autoimmune conditions. Dr. Lucterland, thank you so much for joining us today.

Dr. Lucterland:                 Thanks for having me.

Dr. Weitz:                         Great. So before we get into the topic of this discussion, perhaps you can tell us a bit about your journey and how you came from being a chiropractor to getting into functional medicine.

Dr. Lucterland:                 Yeah, so everyone has a unique journey and mine just happened to be on the way to medical school like a lot of people that wanted to be in healthcare and help individuals. And there was this moment of truly applying to school and deciding to leave where I was like, I don’t want to prescribe meds every day. I don’t know what I’m going to do. I actually thought public health may be an avenue for me. So I joined the Peace Corps. I went to West Africa and did public health initiatives over there. And when I was over there, I had a dear friend of mine that went to college with me that got cancer for the second time. And it’s one of those things where you get that message and then you look around and you’re like, nobody here has an autoimmune disease. Nobody here has cancer.  They may die of an infectious disease and lack of antibiotics or trauma or something like that, but it’s a very different world, right? And it started me thinking. And when I went back to the United States, I obviously had a very big road ahead of me to say, “How am I going to influence the health of individuals moving forward?” I’m not in Africa, it’s not an infectious disease problem. It’s a chronic disease problem, basically ruining our quality of life. And I was introduced to a chiropractor and gave he me a book on the philosophy of root cause medicine. And that was the rest of the story.

Dr. Weitz:                         Great. So that’s before you became a chiropractor or are you-

Dr. Lucterland:                 Yeah.

Dr. Weitz:                         Okay.

Dr. Lucterland:                 Yep. That was between undergrad and then going to my doctorate, I spent some time in Africa and as a chiropractic student, I did clinical rounds in Vietnam for a while. So same thing. We’re going to talk about some thyroid conditions, but you see goiters and stuff when you go to these types of developing countries and what is the intervention over there versus what is the intervention over here? And a lot of it has to do with, what does the lifestyle look like for these people? What are you actually dealing with? And it’s just different in a developed country, for sure.

Dr. Weitz:                         So you went into chiropractic because you wanted to get into Functional Medicine?

Dr. Lucterland:                 Always. Yes. And at that time, I mean, now there’s tons of programs and things you can do to get certified, but at that time, chiropractic was probably the most recognized alternative healthcare profession that I was aware of at that time.

Dr. Weitz:                         Right. Great. So you actually never practiced musculoskeletal-

Dr. Lucterland:                 I did.

Dr. Weitz:                         Oh you did. Okay.

Dr. Lucterland:                 I did. I did for about seven years, I did them both, which that’s tricky. If you can figure out how to do them both, great. But I’ll tell you, when I moved from doing both to just doing functional medicine, I was having some of my old chiropractic patients show up and need functional medicine for things. And I’m like, “Why don’t you tell me about this three years ago?” And they see you as a musculoskeletal doctor many times.

Dr. Weitz:                         Right.

Dr. Lucterland:                 Yeah.

Dr. Weitz:                         Yeah. I’m doing both. I treated 20 chiropractic patients before we did this interview today. So let’s talk about Hashimoto’s thyroiditis.

Dr. Lucterland:                 Okay.

Dr. Weitz:                         Who’s Hashimoto?

Dr. Lucterland:                 I don’t know. I don’t know. It sounds like a-

Dr. Weitz:                         I think it’s some Japanese scientist, or maybe it’s a town in Japan or something like that. Anyway, it’s the most common autoimmune disease. How do we determine if someone has Hashimoto’s?

Dr. Lucterland:                 Yeah. So this is a huge deal and I’m sure your audience knows this, but it’s worth repeating. Most, most hypothyroid conditions are actually Hashimoto’s undiagnosed.

Dr. Weitz:                         Most conditions in the United States. Yes.

Dr. Lucterland:                 Yeah, yeah.

Dr. Weitz:                         Maybe like 95%, right?

Dr. Lucterland:                 Correct. So many people. And I mean, if all I had to do was niche down and do one thing every day for the rest of my life, and I had all the tools available to me, it would be hypothyroidism because this is such a big area with such a big impact for so many people, especially women, especially women who have children, and what happens is conventional medicine is testing TSH. They’re using an abnormal range for what is normal for that. And they’re just saying, “You either are hypothyroid or you’re not,” and prescribing some type of thyroid medication. And when you start to dig further, you realize many times that’s not solving the problem. TSH isn’t thyroid in general. And if you’re not testing the antibodies to the thyroid, you’re completely missing the diagnosis of Hashimoto’s and thyroid medication will not fix Hashimoto’s. So when you think about antibodies being readily identifiable for 10 years prior to enough tissue damage for someone to feel it, we’re missing a huge opportunity to really intervene for these people.

Dr. Weitz:                         So what do you consider a full thyroid panel?

Dr. Lucterland:                 So obviously TSH gives you some indication, but then your free T3, free T4, reverse T3, I don’t always run it, but it is a good marker to figure out whether or not someone has inflammation and oxidative stress playing a part in it, TPO antibodies and thyroglobulin antibodies.

Dr. Weitz:                         Okay, great. So between the TGB and the TPO antibodies, which one of those do you think are more significant and what levels are you looking at that really spark your interest?

Dr. Lucterland:                 I think just like any lab, I don’t know what is perfect for one person. So I’ve seen people be out of range, but actually be very stable and fine above what would be considered abnormal for both of those antibodies. And I’ve also seen the opposite. So I tend to run the test, identify whether or not they’re in range, couple it with their symptoms, and then I look for patterns in progress. So if they’re feeling better and their antibodies are going down, we know we’re moving the needle, right? So I wouldn’t say that I am super specific to which one matters more than others, I would say most people would probably say TPO in the case of Hashimoto’s, but I’ll tell you, sometimes those are completely normal and the thyroglobulin antibodies are the problem. And if I didn’t run both, I missed it. Right.

Dr. Weitz:                         Right. So once we find out that somebody has Hashimoto’s what’s the typical form of treatment?

Dr. Lucterland:                 So-

Dr. Weitz:                         And let’s start with a patient who has some of the symptoms of hypothyroid and what, by the way, when it comes to TSH, what do you consider the optimal range? Or what do you consider to be out of range that would warrant potentially taking thyroid medication? Because there’s a lot of controversy over what the TSH range should be like 2.5, I mean, 0.5 to 3.5 to 2.5 to 4 to 4.5, it’s all this controversy over what’s considered the normal range.

Dr. Lucterland:                 Right. And again, the person in front of you is going to give view an idea of how they feel, which you can never discount that. I will say sometimes I have people that their TSH is higher than I would like to see it. And they’re telling me that they feel normal. Now, TSH fluctuates constantly. So just like a lipid panel, you got to take that into consideration. If you do have an abnormal reading, which I would consider anything above 2.5 to be abnormal, however, people usually feel their best 2 or less, obviously not too low, but for Hashimoto’s, I would say anything above 2, 2.5 would be my upper limit. And if they’re not telling you that they feel bad and they’re actually above that, if you ran it again, you may find that it’s a fluctuation. So sometimes if that’s not correlating with one another, I will rerun the test.

Dr. Weitz:                         Right.

Dr. Lucterland:                 And I have to say this, because I think sometimes educated people, especially now that you can do lab testing on your own in many regards or doctors that are unaware, if we’re giving our patients supplements with biotin or B vitamins, so your prenatal, your multis, your B complex, because they’re tired, all of this stuff, something for their hair because it’s been falling out, it impacts not the actual thyroid function, but it impacts the testing assay. So it will give you abnormal readings if they’re on biotin. So I usually tell people don’t take any supplements for like a week before you run your labs, just to make sure that the labs that we’re getting are accurate to your physiology and there’s not any interventions with the assay.

Dr. Weitz:                         Yeah. I’m aware of that, but it’s not clear to me, do we know exactly which tasks are impacted by biotin and which labs, is it any lab that’s running thyroid? Or is it just a certain methodologies that…

Dr. Lucterland:                 That’d be a great question for the labs to answer, but my understanding is it’s TSH pretty much across the board.

Dr. Weitz:                         Okay. And do we know if they’re taking biotin, would the TSH go up or down?

Dr. Lucterland:                 I think it goes up. It goes up.


Dr. Weitz:            Interesting. 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:                           When it comes to patients who need thyroid medication, do you have an opinion about what’s the best type of medication that typically works?

Dr. Lucterland:                 I do. It’s a little bit biased just from my own clinical experience, but I feel like a marriage between T3, T4, like an Armor or Nature-Throid is usually what people feel-

Dr. Weitz:                         A natural thyroid. Right.

Dr. Lucterland:                 Yes. However, if somebody doesn’t have conversion issues like in their liver, if that’s all working great and they don’t have high levels of inflammation and they have nutrients, sufficiency of vitamin A and iron and all of that stuff, they may do okay with something like synthroid or levothyroxine. I just find that most people feel the best if they have a little bit of T3 in there. Now if it sends them into palpitations and sweating and whatever, then you know, okay. Maybe you’re a different one.

Dr. Weitz:                         And by the way, these natural formulations like Armour or the other formulations Westhroid, et cetera, they not only have T4 with some T3, there’s some T2, some T1, there’s some other nutrients in there that may be beneficial as well.

Dr. Lucterland:                 Yeah. I think as natural as possible, right? And I heard someone say this and I wish I could remember who it was so I could give them credit, but I did think it was a good analogy for people to think about. Like when we think about taking medication for cholesterol or something like that, we’re really taking a medication that’s blunting something or changing the physiological process of creation or something like that. But with thyroid, it’s sort of like taking vitamin D in the sense that you are supplementing something you don’t have enough of, but you’re not really interfering with physiology. So they can be a good adjunctive intervention, while you’re are trying to clear up immune system dysfunction. I mean, with Hashimoto’s, you’re really trying to address the immune system, but it’s sort of like giving them a natural thyroid medication in the meantime, until we can get theirs fixed and the immune system quit attacking it and all of that kind of stuff, it’s really not doing any harm long-term.

Dr. Weitz:                         Right. Okay. So besides giving them thyroid medication, what are the other important things we want to do to help effectively manage patients with Hashimoto’s thyroiditis?

Dr. Lucterland:                 I would say it’s not specific to Hashimoto’s, it’s just pretty much any autoimmune disease that you have. You need to restore barrier function and restore self tolerance. There’s two things you need to think about when you’re doing that. One is the removal of any toxicity, which could be something like environmental toxins, pathogens, something we call PAMPs, pattern recognition receptors will go crazy over those molecular patterns, but then also creating sufficiency. So this is where diet becomes such a big deal. If you don’t even have the building blocks to create the hormones or to be the co-factors for the enzymes to convert them and all of that, then you’re really never going to get anywhere. So sufficiency, removal of toxicity in order to restore barrier function and self tolerance in my opinion have been the two biggest things. I have a couple other opinions too, but those are big.

Dr. Weitz:                         Okay. So why don’t we start with barrier function? What are you talking about?

Dr. Lucterland:                 So I love comprehensive stool analyses for this. However, I would say that comprehensive stool analyses are really just about a 20% snapshot of accuracy of that actual microbiome of what’s going on, but it does give me markers that always change. And I’m big on like trying to predict, oh, I think this person has this or that. Wrong. And I’ll tell you every single time I run one, I do something a little bit different than if I hadn’t run it. So for me, it gives me information, whether it be a pathogen or an imbalance in the microbiome or digestive issues, eosinophil protein X, or secretory IGA or something like that gives me some type of information. Even beta glucuronidase is a big deal, right? You can run zonulin on a comprehensive stool analysis. So I do it, I will say though, I don’t love it. It’s another marker that fluctuates constantly, and I feel like it doesn’t always correlate to what I already know.

Dr. Weitz:                         By the way, for those who don’t know, zonulin is a marker for leaky gut. And so, barrier function, you’re referring to leaky gut, you’re referring to hyper permeability of the intestinal tract.

Dr. Lucterland:                 Exactly. So your cell lining in your gut is one cells thick and they touch each other. And for them to open up and let appropriate nutrients through and whatnot, zonulin regulates that opening. Now, I will tell you, some leaky gut or permeability is completely independent of zonulin. So you can have things just go straight through an enterocyte as well. So there are pitfalls to running zonulin, and I would say the gold standard, if you’re really looking at barrier function or tight junction structures, you would run something like antibodies, maybe to LPS. So LPS is lipopolysaccharides, which is a portion of a gram negative bacteria wall. Now, the reason that’s important is because it happens to be probably, I hate to say definitives, but one of the most immune stimulating compounds that exists, sometimes they add it to vaccines and whatnot as an adjuvant, we give it to rats to study autoimmune disease in them. So it is a potent immune stimulator and it’s very big. So when you-

Dr. Weitz:                         Is that a test that you run?

Dr. Lucterland:                 I don’t do a ton of it. This is why I’m saying, if I make the assumption that anybody that I have identified as an autoimmune patient has lost barrier function. If someone-

Dr. Weitz:                         Meaning, i.e., they have leaky gut.

Dr. Lucterland:                 Yes. If somebody wants to have more definitive markers around that, I would say run something with antibodies against actin, myosin, all of the tight junction structures and potentially antibodies to LPS. That will tell you. LPS should never be in the bloodstream. So if you’re seeing antibodies to LPS, you know a huge molecule has gotten through these tight junctions, even in a leaky scenario. I mean, it’s huge. So that’s very definitive, but for me, I’m making that assumption with autoimmune patients that that’s the case, because that’s how the inappropriate immune response of self tolerance has happened.

Dr. Weitz:                         Who offers antibodies to LPS?

Dr. Lucterland:                 I believe Vibrant does, Cyrex does. And for Cyrex, it’s array 2. I think it’s the Wheat Zoomer, Gut Zoomer with Vibrant.

Dr. Weitz:                         Okay.

Dr. Lucterland:                 Yeah. So I think gut testing is my favorite. If all I did though-

Dr. Weitz:                         And what’s your favorite gut test or stool test?

Dr. Lucterland:                 I like the comprehensive stool analysis, the GI Effects from Genova. And like I said, it’s because it gives me a good picture of tons of things that I can intervene on. Everything from digestion to inflammation to potential pathogens, not just confirming leaky gut.

Dr. Weitz:                         Right. I tend to use the GI Map.

Dr. Lucterland:                 Okay. Yeah. People really like that too.

Dr. Weitz:                         Similar. Okay. So-

Dr. Lucterland:                 Although does that one have beta glucuronidase?

Dr. Weitz:                         Yes.

Dr. Lucterland:                 Okay. Did they add that?

Dr. Weitz:                         It’s been available for at least several years.

Dr. Lucterland:                 Okay. Okay.

Dr. Weitz:                         Yeah.

Dr. Lucterland:                 Yeah.

Dr. Weitz:                         So we’re looking at leaky gut. We’re going to do a stool test, try to improve the health in a microbiome, try to shore up the leaky gut. So we’re going to use some protocols there. What else do we want to do to try to intervene to the underlying potential root causes of this autoimmune condition?

Dr. Lucterland:                 I would say before I even run a stool test, I do a good month of lifestyle intervention. And the reason I do that is because it’s sort of like in the musculo-skeletal world, if you hurt your back from deadlifting or something like that, you can’t just go back the next hour and do more deadlifts to an injured back. You have to remove the offender or the trigger. And for many people, a chronic source of immune trigger is dietary proteins or inflammatory compounds or toxins in their food. So there’s got to be, in my opinion, an overhaul that gets me at least to a foundational set point where when I run a stool test now, which changes in the matter of 24 hours, when you eat something different, right? I want it to tell me what’s happening in you when you’re already eating appropriate things. I don’t want to know what your microbiome is when you’re eating crap. I already know it’s crap. You know what I’m saying?

Dr. Lucterland:                 I want you to take away some of the triggers and start to eat some nutritious and healthy food. And then we’ll take a picture of what your microbiome’s doing, because literally within 24 hours, you can change your microbiome just by changing what you eat.

Dr. Weitz:                         So how do you decide for each person what’s the best diet?

Dr. Lucterland:                 I always start with a paleo diet. I’m partial to that simply because the removal of gluten and dairy and just processed foods in general, many people have heard of the Whole30. That’s another really great one with tons of resources if you’re looking for just like a programatized thing to do and it’s doable, right? When I first started doing this, it wasn’t common for there to be gluten free foods in the aisles and all these cookbooks and things like that, but it was doable to say, just eat meat, vegetables and fruits, nuts and seeds. That’s it. Like, that’s all you got to eat. When you get more intricate into the AIP or the autoimmune protocol, it’s a more strict version of that. I will say in Hashimoto’s I don’t like people to go super low carb because thyroid function does somewhat rely on carb thresholds, the conversion of T4 to T3 does.

So I find that when people go super low carbs, so that’s one adjustment I sometimes make, but that’s a good standard one. Now, if we were talking about Crohn’s today or ulcerative colitis, I would choose a different one just because the nature of where it’s occurring. But for Hashimoto’s and most thyroid or most autoimmune disease, I would say paleo is a good start.

Dr. Weitz:                          Some people recommend avoiding certain foods that are called goiterogens.

Dr. Lucterland:                 Yeah. I don’t subscribe to that. So I’ve been doing it a long time and I know it was something that was thrown around in the media for a while and then people got really scared about eating broccoli and cauliflower or broccoli sprouts. And quite frankly, I think it’s been disproven quite a few times, but I just never saw it clinically being an issue either. And if it was, I mean, you would have to just eat so much. It’s ridiculous. And there’s too much benefit to having sulfur compounds and raising glutathione status and things like that that I just, sulforaphane, I just wouldn’t have people stop eating those.

Dr. Weitz:                          What do you find are the most common food sensitivities that trigger Hashimoto’s?

Dr. Lucterland:                 I don’t love food sensitivity testing, simply because if you have a leaky gut, you’re going to come back with 50, 100 foods. So that maybe that’s the poor man’s version of a leaky gut test, right? If that’s what you run. And you’re like, “Oh my gosh, I got to avoid all these things.” It’s really not that you’re sensitive or allergic to all these things. It’s more of an indicator that tons of food proteins have actually gotten into the bloodstream where they should have never been in the first place and your body responds appropriately and says, “Hey, you shouldn’t be here. Let’s make an antibody.”

Dr. Weitz:                          So fix the leaky gut.

Dr. Lucterland:                 Fix the leaky gut and you fix the food sensitivities. The ones that never really go away though often, which this is where people have the question, is this a lifelong diet for me or whatnot? I would say, if you have an autoimmune disease, you should probably avoid gluten and dairy forever. And I’m just saying that because if you don’t, then you could have a relapse or a flare. I mean, you already have susceptibility to that in your genetics, and once you’ve started the roller coaster, sometimes you’re on it. And while it can be managed, it’s just one thing that why would you introduce a trigger?

Dr. Weitz:                          You mentioned, when we were talking off air before we got started, that you often find certain chronic infections to be triggers for Hashimoto’s. Can you talk about that?

Dr. Lucterland:                 Yeah. I love the idea of molecular mimicry, which is just really an amino acid sequence, where there’s only, like what? 20 amino acids to choose from. When you think about molecular mimicry and amino acid sequences, they can overlap between food, our own tissues, infectious agents, like bacteria, viruses, et cetera. And so I know that there’s known overlap with some specific organisms, but I don’t think we’re there yet to be saying that these infections mean this is a likelihood. I know H. Pylori is a common one that people talk about, but I would say any infection in general is a driver of immune response and addressing any infection is going to be good practice just for inflammation levels and everything.

Dr. Weitz:                          Do you do any testing when you suspect there might be an underlying infection, either test for infections or test for antibodies to infections?

Dr. Lucterland:                 I do run testing. Sometimes I find potential pathogens within the GI tract. So that’s on a comprehensive stool analysis. Sometimes I run antibodies or titers for things like Epstein–Barr, obviously H. Pylori is something a little bit different too, but you can do that a million different ways. Sometimes antibodies are tough because it means you have immune memory of something doesn’t mean activity currently.

Dr. Weitz:                          Right.

Dr. Lucterland:                 Right? So.

Dr. Weitz:                          If you find some evidence of some chronic infections that you think might be playing a role as triggers for their autoimmune condition, how will you typically address these?

Dr. Lucterland:                 So if it’s bacteria or virus or potentially a parasite or a fungus, you use a little bit different compounds. In the world of natural medicine, a lot of antimicrobial compounds are antimicrobial to all of those things. So it can be an easy choice to use things like, goldenseal and uva ursi and berberine and that sort of thing.

Dr. Weitz:                         Okay.

Dr. Lucterland:                 But if you’re using a pharmaceutical, then obviously you’ve got to make a decision based on the type of pathogen, right? I’ve even used phages. I don’t know how much you’ve used phages in practice.

Dr. Weitz:                         I did a few years ago, but I kind of fell out of it. You like those phages?

Dr. Lucterland:                 I do sometimes, when you find gut pathogens. It was the original antibiotic, right? You have to have a specific phage for a specific infection. So it doesn’t have quite broad [spoff 00:26:34] like an antimicrobial agent, like thyme, oregano or something would, but they can be helpful.

Dr. Weitz:                         So which particular products are you using?

Dr. Lucterland:                 Oh, wow. So I love Candicid Forte as an antimicrobial in general. Obviously the name suggests that it would be antifungal, but I do really like that nutrient profile as an antimicrobial. Ortho Molecular has another one called Paracid Forte. So that’s a really a mixture of antiparasitics. And they have a product called Intestin-ol too, which is a combo of thyme, oregano and one other essential oil, which if someone has recurring or chronic infections, sometimes there’s a biofilm component to that. And if you don’t sort of get through the biofilm when you’re treating, then they can have these quiescent cells there at the bottom, but then just kind of reinfect in its new cycle. So I do like those products. I use one actually from Body Ecology called EcoPhage for the phages personally, but those are some I like.

Dr. Weitz:                          Does that-

Dr. Lucterland:                 Biocidin is always a good one.

Dr. Weitz:                          … Does that have more than one phase or?

Dr. Lucterland:                 Yes. Has four, I think.


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Dr. Weitz:                           What about environmental chemicals, like BPA or heavy metals? Do you find that these are sometimes triggers for Hashimoto’s?

Dr. Lucterland:                 So I care about all kinds of toxins for various reasons, but I would say I’m a super stickler for things that compete for binding with iodine and things of that nature. So things like fluoride is a big one, and you can find fluoride in tons of things, not just toothpaste or at the dentist, it could be in your water, it could be in black tea, it could be in medications. I mean, there’s a laundry list of medications that actually have fluoride on them, which is crazy, but that type of thing is important to address.

Dr. Weitz:                          Yes. Certain antibiotics and et cetera.

Dr. Lucterland:                 Yeah.

Dr. Weitz:                          So the reason why you’re concerned about fluoride is because it’s in a category of substances known as halogens, which also includes bromine and chlorine. And all these substances compete with iodine, which is a necessary ingredient for thyroid hormone.

Dr. Lucterland:                 Exactly. And so this is where it starts to become a large topic. And when people hear it all and they’re unfamiliar, they go, “Oh my God. Well, what do I focus on the most? Like, what’s the most important.” And I always say, “The one that’s causing you the problem.” And it’s impossible to know until you try to get yourself at a reset. Now, if you tell me you never use fluoride, you have your water filtered and you don’t go in chlorinated pools and whatever, well, then we can rule maybe that being a huge deal for you. But the one that matters the most is the one that’s causing you your problem. So you’ve got to kind of go down the laundry list with them. What are your hormones like? What’s your stress like? What’s your diet like? Do you have infections? What’s your [nuity 00:31:14] product regimen? What’s your environment? And you have to kind of then hone in on the areas that they are telling you have a bunch of red flags.

Dr. Weitz:                         Right. So what do you think about iodine for patients with Hashimoto’s?

Dr. Lucterland:                 Way to be controversial. I go both ways. Sometimes I find that it doesn’t matter at all really in the presence of selenium. And I don’t notice that it causes any abnormal or deleterious impact in my patient. And sometimes it does. And if it does, then we avoid it. Although I’m not shy about using it in the beginning, I guess.

Dr. Weitz:                         You’re talking about typical dosages, like 100, 200-

Dr. Lucterland:                 Yes. I wouldn’t mega dose. I would not mega dose. Yes. But just typical, like 200 micrograms in the presence of adequate selenium. Lots of times, I see people okay with that.

Dr. Weitz:                         Right, yeah. I actually have some Hashimoto’s and never had any thyroid symptoms. And I tried to high dose iodine and it’s… For several years, my TSH was like seven or eight and then one year it went up to nine. So I decided to try to high dose iodine. It went up to 25, so.

Dr. Lucterland:                 Wow.

Dr. Weitz:                         So I stopped the high dose iodine, bumped up my selenium, my vitamin D, my zinc and did some gut work. And I got it down to 4.5, but I tried the 12.5 milligram iodine, because some people claim that might be beneficial. I never recommended it to patients and I never will.

Dr. Lucterland:                 Right. Yeah. No, that is probably a no for me, but-

Dr. Weitz:                          I always like to try everything on myself first.

Dr. Lucterland:                 Me too. And I get a bunch of flack for that because it’s like, “Well, you don’t fit the patient demographic.” I said, “I know,” but what I wouldn’t do for myself, I wouldn’t do for anyone else. And N equals one means N could equal many, for many people. So something’s really great, and this is where the art of medicine comes in. You’re not going to have the perfect protocol, you’re not going to have the perfect person telling you the exact thing that works for everyone. It just doesn’t work like that. So people have to be willing to work with their doctor and the doctor has to be willing to experiment, when something isn’t working, with options.

Dr. Weitz:                          What other nutritional supplements have you found to be helpful for Hashimoto’s patients?

Dr. Lucterland:                 Well, they mostly focus on either restoring gut barrier function. So that’s a lot of the things you hear about probiotics, glutamine, immunoglobulin. So as I mentioned, LPS is one of the most potent immune stimulator. And If you’ve got leaky gut to the point where LPS is turning it on, just binding LPS in the gut lumen with something called serum-derived bovine immunoglobulins can have a profound effect on allowing that patient’s immune system at the barrier to just settle down enough to heal.

Dr. Weitz:                          So SBI Protect?

Dr. Lucterland:                 I like SBI Protect. Yep. And so that’s sort of like a borrowed immune system in the same way colostrum is, but there’s no dairy to it. So if these people are trying to avoid dairy for the immunogenic effects we spoke about, then using a serum-derived version of that. And the binding capacity studies show that it binds to way more than LPS, right? If toxins, H. Pylori, tons of different components. So it can be a safety net for people. So that type of intervention with gut healing. And then the one that I find that many people overlook, at least when I’m working with clinicians is mitochondrial support. So mitochondria are integral in immune function and even T-cell differentiation or how you see a pathogen and respond to it. And then whatever you tell your T-cells to turn into, are they turning into TH1 or TH17 or whatever. All that to happen appropriately requires mitochondrial function. T-cell surveillance requires mitochondrial function. So if you’re not supporting the mitochondria and filling up metabolic reserves for them to do their job, then I feel like you kind of maybe miss some of the modulating impact that they-

Dr. Weitz:                          So what are some of the key nutrients for mitochondrial support? Obviously we have CoQ10.

Dr. Lucterland:                 CoQ10. I would say ALA, acetyl-l-carnitine, because that shuttles the free fatty acids in for use, and acetylcysteine, which we all know more about that now that we ever imagined we needed to, but those are important. I was going to-

Dr. Weitz:                          Actually NAC seems to be… I think if we have a nutrient of the year, maybe zinc is the nutrient of the year, but other than that, NAC, it’s amazing how many benefits NAC has.

Dr. Lucterland:                 Yes.

Dr. Weitz:                          And yet apparently the FDA is considering taking it off the market.

Dr. Lucterland:                 They’ve been saying that stuff forever. I don’t buy it. I mean, I know some people have taken it off of their selling platforms out of fear, but until there’s a letter, I don’t, a real letter, I don’t see it, but. Well, yes-

Dr. Weitz:                            Well actually, if we could figure out how that happened, we should do that with all the nutrients. I’d be happy if Amazon stop selling everything.

Dr. Lucterland:                 Right? That happened because, do you want to know how it happened? So somebody was selling it for hangovers. Well, in the supplement world, you can’t use a structure function claim that says it’s a drug that treats something. So they got in trouble for saying that it treated something. And that caused them to send a letter. And the letter then trickled into anyone selling it for drug related purposes will be shut down and whatever. And obviously the platforms have a lot invested in people purchasing through them. And so they was like, “No one sells NAC now.” But really it came from somebody saying it treats hangovers.

Dr. Weitz:                            But apparently the information I’m getting now is that the FDA has reviewed NAC and they’re saying that it was approved as a drug. The supplement industry need to prove that it was in common usage prior to that approval use as a drug. Otherwise, it’s going to be taken off the market and only used under prescription.

Dr. Lucterland:                 Yeah. And that’s the game, right? How much has something been used before you altered it a little bit or used it as a drug? Are you going to say the same thing about fish oil, now that SLSs can be sold as a prescription?

Dr. Weitz:                          Well, there are certain vested interests that would be very happy to have all those nutritional supplements taken off the market and only sold as prescription drugs.

Dr. Lucterland:                 Right. And until then, they can tell everyone that they don’t work.

Dr. Weitz:                          Yes.

Dr. Lucterland:                 So yeah. I think-

Dr. Weitz:                          When’s the next JAMA article that’s going to tell us how vitamin D, fish oil and magnesium are all bad for you?

Dr. Lucterland:                 Yeah. But so from mitochondrial perspective, I do think NAC, ALA and acetyl-l-carnitine as high dose as a trio. I don’t know if you’re familiar with Dr. Kaiser’s work. He used to work with HIV patients and he was trying to figure out how to restore CD4, CD8 counts in them. And he used a dosing of those big nutrients. There was another set of nutrients that were just foundationally-

Dr. Weitz:                          Right. Did hear about this. Yeah.

Dr. Lucterland:                 Yes. And within 12 weeks, he was able to restore immune markers through this mitochondrial cocktail, if you will. I actually think it was covered by insurance in some states because it was so successful.

Dr. Weitz:                          Wow.

Dr. Lucterland:                 Yeah. So-

Dr. Weitz:                          And what do you think about selenium for hypothyroid, specifically Hashimoto’s?

Dr. Lucterland:                 I think that’s a no brainer. And I think people should start asking like, I can always supplement with something, but where do I find these things in nature? Because when you find them in nature, you get added benefits, right? So if I tell you to take a selenium supplement, that’s fine. But I don’t then get the added benefit of certain fatty acids within Brazil nuts, I don’t get the additional nutrients that are in there. And if you get calories in your body that also come along with these nutrients you need, then it’s cheaper. And I have never claimed to be smarter than nature. Like, I’m sure there’s a ton of things that we don’t know yet that works synergistically together. And I bet you, we find out they’re packaged in foods together. So I always encourage patients that if we’re going to talk about you getting iron or selenium or whatever, we’re going to talk about, where can you get these in your diet? And we’ll supplement as needed. But think about that first always.

Dr. Weitz:                            Yeah. My approach is to try to do both. And the reason I want to do both is I want to cover my bases, I want to get all those other nutrients we don’t know about that are say found in Brazil nuts, go along with the selenium, and I’m definitely a big believer that food is the best way to go. But the problem with Brazil nuts is any given Brazil nut could have this much or this much or more or less, or you have a handful and now maybe you’ve got a really high dosage or maybe you’ve got a low dosage in this particular sample because of where they were grown. So I’m going to typically recommend a modest dosage by supplementation, because that way I know we’re getting a specific form and a specific dosage that’s going to guarantee that person’s at least getting a minimal amount and then also recommend food sources, like say, for selenium, Brazil nuts.

Dr. Lucterland:                 Exactly. And I think that’s a good approach. It’s a good approach with anything, especially if you’re trying to replete something, you’re not going to get enough in food to replete something in any type of fast rate at all, but it is good for the patient to remember where do these things come from and what can I do? What do I have control over that can help support that?

Dr. Weitz:                         Absolutely. Are you familiar with the group out of Brazil that has shown that using infrared laser over the thyroid causes positive changes in thyroid tissue for patients with Hashimoto’s?

Dr. Lucterland:                 I’m not. But it wouldn’t surprise me. Do you use laser in your clinic?

Dr. Weitz:                         We do.

Dr. Lucterland:                 Okay. So, chiropractors and body work people have been using lasers to improve cellular function in tissues for a really long time. So it doesn’t surprise me. Same thing with infrared saunas and just the ability to have red light or whatever, all of the things that the biohackers do these days have some cellular impact that… But even yoga in inversions. So bathing the thyroid with blood when you’re upside down is oxygenating. Is it going to cure your Hashimoto’s? No, but there’s a ton of things built into healthy practices that are beneficial.

Dr. Weitz:                         That’s great. So any final thoughts you want to leave the listeners with about Hashimoto’s or your approach to treating thyroid conditions?

Dr. Lucterland:                 I would just say that if you are not feeling right, listen to yourself and get a full thyroid panel, first and foremost. From there, find a functional medicine doctor, because a functional medicine doctor is going to help you navigate which areas to focus on and help you fix your lifestyle factors in conjunction with some of the ancillary things that you can do to make yourself feel better in the meantime, like potentially a medication or a supplement that could boost thyroid function, et cetera, but functional medicine is where it’s at with autoimmunity, in my opinion, because you’re not going to find someone that’s looking at all of those things and actually uncovering and peeling back the onion, unless you are working with someone who takes that approach.

Dr. Weitz:                         Absolutely. And this is not a knock on conventional medical doctors, but since you’re not essentially dealing with lifestyle and diet and the things that we deal with in the functional medicine world, they don’t really have the tools to deal with these underlying triggers for autoimmune disease. So if you see a conventional doctor, they’re going to most likely supplement you with thyroid medication, which may make you feel better. And however, at the same time, it’s important to have, in my opinion, a functional medicine practitioner who can help you deal with the underlying triggers for this autoimmune condition. Because if all you do is add thyroid medication, you’re not dealing with this underlying autoimmune condition that is leading to your immune system attacking your own tissues. And over time, the likelihood is that more of the thyroid gland in this case will end up being damaged, destroyed, and you may need more thyroid medication, you may end up with another autoimmune condition. Statistically, if you have one autoimmune condition, you’re much more likely to have another.  So I think most patients would be well suited to have a conventional doctor and also have a functional medicine practitioner who can help them deal with the underlying causes. And they think that way everybody will get the best of both.

Dr. Lucterland:                 Absolutely. And I tell everybody the same thing, don’t give up your conventional doctor, because I’ve had so many patients that once they’re autoimmune disease, whether it be their gastroenterologist for Crohn’s or the rheumatologist for RA or whatever, see what’s possible, then they start going, “Wow, what did you do?” And they start learning. And then all of their patients in the future benefit from the journey that you were on. So I love having both parties.

Dr. Weitz:                         And patients know that most of the time you’re going to do better doing both, just because you see a functional medicine practitioner who takes you off of gluten and dairy and does some of these other natural things, that doesn’t mean you want to stop your thyroid medication.

Dr. Lucterland:                 Right. Yep.

Dr. Weitz:                         So great. So how can listeners, viewers find out more about you and your program?

Dr. Lucterland:                 So you can find me on Instagram or Facebook, Dr. Angela Lucterland is the handle in both of those. I do have a blog which has articles and sort of functions like a website and whatnot. But I might say those are probably the easiest ways to get ahold of me. So if you Google Dr. Angela Lucterland, it’ll pop up. There’s probably years and years worth of posts. I don’t even want to Google myself.

Dr. Weitz:                         Thank you, Angela. And when I post this in about three weeks, I’ll send you links that you can share with your followers.

Dr. Lucterland:                 Okay. Perfect.