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Kashif Khan discusses Functional Genomics with Dr. Ben Weitz.

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Podcast Highlights

Kashif Khan is the Chief Executive Officer and Founder of The DNA Company, where personalized medicine is being pioneered through unique insights into the human genome. The website is TheDNAcompany.com. With a background in business, Kashif dove into healthcare and functional genomics and he has a successful podcast, The Unpilled podcast, and an upcoming book being released on May 16, The DNA Way.

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

Podcast Transcript

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

                                Hello, Rational Wellness podcasters. Today, we will be speaking about personalized medicine based on your genetics. We’ll be speaking with Kashif Khan, who’s the chief executive officer and founder of The DNA Company, where personalized medicine is being pioneered through unique insights into the human genome. With a background in business, Kashif dove into healthcare and functional genomics. He also has a successful podcast, the Unpilled Podcast, and an upcoming book to be released on May 16th, The DNA Way.  Kashif, I recently heard you on Ari Whitten’s The Energy Blueprint, and I was blown away with the way you were able to couple explanations of various SNPs, DNA variants, and how they affected various metabolic pathways and how certain diet, lifestyle and supplement approaches might help to steer a patient towards greater health. Prior to this, I’ve spoken to other experts on genetics. And often, we get simplistic explanations like you have the C677T or the A1298C variant of the MTHFR gene, and therefore you need to take methylated folate and B12. And that’s pretty much the end of the story.

Kashif:                  Yeah. Something as complex and powerful as a human genome has been brought down to “Here’s a supplement you need because of one gene, and that’s all we’re going to talk about.” And I’m not saying that that’s not useful information, but the clinicians that are using these tools haven’t… So the tools are too difficult to use. Let’s start there. So when it’s too difficult to use, there’s one or two tricks up your sleeve that you stick to and that’s it because how much time do we have to reeducate ourselves? And so there is so much more, and that was part of our mission, is making it easy to use so it’s easy for people like yourself to implement. And there’s so much more we can do than just “Here’s your folate.” Right?

Dr. Weitz:            Right. And I just want to let you know that we have a fair number of healthcare practitioners and also educated consumers. So in our discussion, feel free to dive deep into the science if it’s appropriate.

Kashif:                 MTHFR.  Well, let’s use that as an example. You’re talking about a methylation gene. And just this morning, I was speaking to this influencer from the UK that calls herself the MTHFR guru or something. I said, “That in itself tells me you’re not a guru because you don’t understand methylation, that that’s one gene in a cascade that builds up a system.”  You have to first understand human biology, and this is where genetics is broken. A gene is not independent of the process happening in the body. It’s like looking at one link in a chain and then making a judgment on the whole chain, and they’re all different sizes and different qualities.  And so methylation is a cascade of a multitude of genes, six or seven of them. So if I tell you, “Your MTHFR is off. You’re not doing so well there,” you still don’t know where to intervene because it starts at B12 metabolic pathway B9. Is it folate or is it folinic acid? And what do you actually need? And if you know what part of the chain isn’t working, MTHFR means the cascade in itself is inefficient, but how and where do you intervene? So we can be a lot more precise and we can give someone exactly what they want. And then it’s no longer “This has a 80% chance of working.” It’s now “100% of the time, we’re going to get it right.”

Dr. Weitz:            And that’s an example of the difference between functional genomics and genetics.

Kashif:                 Exactly. Genetics is “Here’s what this gene does, and we’re going to speak about it independently.” Functional genomics is “Here’s how the body actually works, and let’s look at that first. And not only let’s look at the system, but let’s look at how several systems interlink.”  And I’ll use methylation as another example. Methylation is phase two of detox. If I only focus on that and don’t understand phase one first, methylation is like, “Here’s the door open to take the garbage out.” If I don’t understand who’s picking up the garbage and bringing it to the door, I’ve only solved half the problem, right?

Dr. Weitz:            Right.

Kashif:                 There’s glutathionization. There’s glucuronidation. There’s antioxidation.  There’s all these detox functions happening in the body.  And if I don’t pair them, I haven’t understood the full cascade.  What does my body do from the point that a toxin enters to the point that it gets out?  So first understand that, and there’s not one gene that does every single step along the way.  There’s multiple processes.  When you connect them and you have your full functional answer, you can then solve the problem fully also.

Dr. Weitz:            Yeah. Well, we don’t really need to do that because as soon as the person brings the garbage to the door, you just shoot them in the head. No, I’m just kidding.

Kashif:                 That works.

Dr. Weitz:            So when you were talking to Ari Whitten, Ari Whitten asked you a question about the BRCA gene. And I loved your answer, so I want to ask you the same question again. And he basically said, “If I’m a woman and I have the BRCA gene, should I have my breast cut off?”

Kashif:                  Yeah, so that’s exactly the… That paints a picture of genetics. So genetics is pharma and disease backwards. Here’s the disease, and how do we treat this disease? They’re asking the wrong question to begin with. If you have somebody’s DNA in hand, their human instruction manual that tells every cell in the body what to do, why are we waiting to treat a disease? Why don’t we ask, “Why does the disease happen in the first place?” and not have it? So when you ask the wrong question, you get the wrong answer.  And so the answer we now have is a certain version of BRCA means cancer risk. That in itself, by the way, is a false statement. BRCA doesn’t cause cancer. BRCA is a tumor suppressor. So when you have breast cancer, god forbid, BRCA’s supposed to come along and fix it. And if you have the wrong version, you just have a bad repair tool. So you’re more likely to die from breast cancer because you can’t come back from it. So we’re solving the wrong problem once again. Why did the cancer happen to begin with?   So I can give you one example, the same example I gave Ari, because I would say it’s the most prolific and easiest to deal with. Some women in their hormone pathway make a lot more estrogen. They’re estrogen dominant, and this is very easy to predict genetically the hormone cascade and how you go from progesterone to testosterone to estrogen. The genes that do each one of those steps, to what degree are they working efficiently or not efficiently? So some women just make a lot more estrogen. There’s a big pool of it every month. Step one of three.  Step two is when you have your monthly cycle, you’re not clearing estrogen. You’re clearing a metabolite. And there’s three options: 2, 4 or 16-hydroxy estrogen.

Dr. Weitz:            Right.

Kashif:                 Some clinicians listening here have done DUTCH testing and looked at these things, right?

Dr. Weitz:            Right.

Kashif:                 So 2 is the good, clean stuff you want. 4 and 16 are toxic. 4 has a lot of publications and education around its connection to breast cancer, but we still haven’t answered the full question as to why.  Then we look at functionally okay, I’m estrogen dominant. I make too much. The version that I make is a toxic version. I go down the four pathway. Well, let’s look at how well I detoxify it because again, how does the human body work? So you do look at glutathionization, antioxidation, COMT, which is the tail end of methylation, and you start to look at the jobs that your body does well or not so well. And you may understand that not only am I estrogen dominant, estrogen toxic, but I also don’t have the right detox genes kicking in to help me get rid of it.

                                So now you have the avatar, the profile of the woman who truly is at risk, but she still may not get sick. So what’s the difference between the woman at risk and the woman that gets sick is the epigenetics. You have to pair these two, and that’s another layer to functional genomics. It’s not just “Here’s your genes.” It’s also what are your habits? Because bad genes doesn’t equal disease. Bad genes equals elevated risk, right?

Dr. Weitz:            Right.

Kashif:                  You have to do something to create chronic disease. You’re not born with breast cancer or Alzheimer’s, diabetes. These things develop because of your choices that you make. One other [inaudible 00:09:04]-

Dr. Weitz:            Because of your diet, your lifestyle, et cetera.

Kashif:                  Exactly. And some of these things are obvious. Some of them are completely counterintuitive, that you would never think are related to the problem. So for this profile, now we say this woman’s bad choices may be that she goes on the birth control pill for 10 years and elevates that estrogen level. She goes on BHRT. Not that you shouldn’t take BHRT, but where do you intervene? What hormone are you taking? Is it estradiol? Is it estriol? Where do you actually plug in that hormone, and are you fueling that 4-hydroxy pathway or not? She may not understand the hormone disruption in her environment and what her Teflon-coated frying pan and her cleaning chemicals and her pesticides that make her lawn so beautiful are doing to her body.  So now, you have… The woman has a profile. She also has the wrong choices that are misaligned to that profile and what it’s capable of. And now, you get to the level where the genes can’t handle it anymore. There’s too much of that net 4-hydroxy causing too much inflammation.

                                So then last step, going back to biology, why is it that you typically see breast cancer around the menopause age? It’s not because that’s when BRCA magically creates a problem. It’s because at that age, you no longer have a menstrual cycle and you no longer have the ability to get rid of this toxic load that you’re making every month. And your body, to protect you because it doesn’t want your organs and your vasculature, your veins, getting damaged, will store it in fat. It says, “Hey, I’m smart. I’m going to get rid of this stuff and not cause inflammation. Let’s put it in fat.” And women have fat in their breasts, and in the breasts you have all these glands and ducts for which the cellular structure was not designed to deal with that level of inflammatory insult. Then you get cellular degradation, mutation, eventually cancer. And then if you have the wrong version of BRCA, you’re not going to fight the cancer so well.

Dr. Weitz:            Right.

Kashif:                  Right? After all of that. So now you name a chronic condition. It can be laid out in this manner so that we can understand how to prevent it. Why would it happen to me? And my why might be different than somebody else’s why. That’s functional versus genetics.

Dr. Weitz:            What is some of the important genetics related to cardiovascular disease? We know about familial hypercholesterolemia.

Kashif:                  Yeah, so that’s a perfect example. Cholesterolemia, to me, is a myth. It’s not a disease. It is the response to the true disease, which is endothelial inflammation.   So when we look at the genetics of heart disease, which is the number one killer, still number one drug prescribed is statins. Why is that so? Because most of us are not genetically designed for today’s reality. What does that mean? Our hardware, our endothelium, the actual inner lining of the blood vessel, most of us don’t have the best quality endothelium. We can actually predict that genetically. Is it stainless steel resilient or is it more paper thin, this papyrus that’s prone to inflammation, right?

Dr. Weitz:            Right.

Kashif:                  Most of us are walking around with that, the not so good stuff. So if that’s the case, and just like this breast cancer woman you happen to be breathing in the wrong stuff, eating the wrong stuff, having the wrong stress load, the wrong sleep load, et cetera, et cetera, et cetera, and you may also pair that with the wrong detox pathway or inefficient detox pathways that can’t support the inflammation being caused here, you’re going to get endothelial inflammation, which is the actual disease. Your body then responds with cholesterol as a hormone to reduce the inflammation. It acts like a Vaseline dealing with all these microabrasions and tears and inflammation and resolves them. The same oxidation and toxicity that caused the inflammation also oxidizes the cholesterol and causes it to harden and deposit because our body didn’t understand that our 200,000 years of caveman habits were going to be deposited in this industrial reality at some point. And so it hasn’t changed yet, and we still are not prepared for this.  So that’s the true why behind cholesterolemia. And if you understand this, not only can you predict it and prevent it, but if you have it, you can deal with the root cause and then prevent it. Or sorry, reverse it.

Dr. Weitz:            Right. Okay. How can our DNA blueprint help us to determine what type of diet might be best for each person?

Kashif:                  Yeah, there’s a lot that can be said there. Starting with the brain, and this is… What I’ll speak to is the unique things. There’s obvious things like there’s genes that tell you how you metabolize fats and starches. There’s genes that tell you how you break down chickpeas, lentils and “Should I actually be a vegan?” My primary protein sources, do I actually make the enzymes efficiently to digest them, or do I get bloated and not eat enough? Right?

Dr. Weitz:            Right.

Kashif:                  So those are the basics. Then there’s things that are a little more functional in nature. So how do we look at the human mind and determine why some people just perceive things differently? So do they not produce or bind enough dopamine, so it’s hard for them to experience pleasure? In which case, they may lean on food as a source of pleasure and overeat without even knowing it. Is their serotonin pathway dysregulated and they’re slightly more irritable?  It’s easy to dysregulate their mood because their serotonin receptors are a little too short and they can’t bind it efficiently. These people end up leaning on food as coping mechanisms because they’re constantly stressed.

                                There’s a gene called MC4R that determines the satiety of the palate. So as an ancestral trait, typically there wasn’t enough food. So we developed this desire to seek variety in our palate, a lot of us. And so it’s like, “Give me the crunchy. Give me the soupy. Give me the salty. Give me the sweet to make sure that I got enough nutrition.” And we’re still walking around with this trait and then going to the grocery store and filling our carts where it’s so convenient to overeat. And then when you get home and you have your meal, it’s not enough. You still need to graze to the pantry, the Doritos and the cookies, because you’re not satisfying the palate.  Same thing for the gut. There’s genes that determine how efficiently you feel full, that signal from the gut to the brain, and maybe your plate being appropriate just isn’t enough. You need to wait. Maybe you need a glass of water. So there’s a lot we can speak of these hidden areas when it comes to diet planning that go far beyond calories in and calories out.

Dr. Weitz:            Let’s talk about one particular gene, the APOE gene. And if a patient has one or two copies of the APOE4 variant, we know that they have an increased risk of Alzheimer’s. What does that tell us about what we can do about that?

Kashif:                  So another great example of how functional genomics can support that genetic question, so genetic… We do test for APOE and we do report on it, but there’s a lot more you need to know than just APOE. So APOE is how well do I, to keep it simple, transport lipids and more likely to develop amyloid plaque in the brain?

Dr. Weitz:            Okay.

Kashif:                  Which is highly connected to Alzheimer’s and dementia. So even then, people walk around with APOE34 and 44 don’t get sick. What’s the difference? Something has to trigger the inflammation.  Everything that we talk about that’s chronic in nature is typically rooted in inflammation. So if you do everything right, you could have the APOE 44 and have a better brain than somebody that has the APOE 33 that did everything wrong. All we’re saying is that this is a priority for you. This is a red flag. If you’re APOE34 or 44, you need to focus on this. What’s your health plan to make sure it doesn’t happen? What are the potential things you look at? Same thing as the breast cancer.   If you produce toxic estrogens, which is why, by the way, 80% of Alzheimer’s and dementia cases are in women. The vast majority are in women, and it’s much harder for women to reverse and deal with because they’re also dealing with the estrogen toxicity which leads to more inflammation.   A vast majority of today’s dementia is rooted in inhalation. What are we breathing? I spoke to a brilliant guy, Dr. Tom O’Bryan, that deals with a lot of [inaudible 00:17:39]-

Dr. Weitz:            Oh, yeah. I know Tom well.

Kashif:                 Yeah. So what he told me is that 66% today of what he sees is inhalation based, what we’re breathing.

Dr. Weitz:            Huh.

Kashif:                 One hour of LA traffic is equivalent to a pack of cigarettes.

Dr. Weitz:            Wow.

Kashif:                 So if that’s what you’re doing on your drive home every day and you’re creating that level of inflammation, if you have the APOE34, that may be the trigger that causes the inflammation for which you don’t transport the lipids that well. So again, go to the why. This is your… Genetics is red flag. You need to focus here. Functional genomics says, “Well, what do we do about it?”

Dr. Weitz:            Right.

Kashif:                 Right. “80% chance of Alzheimer’s. Good luck,” is not enough of an answer.

Dr. Weitz:            Do we know what kind of diet is going to be best for somebody who is APOE44?

Kashif:                 Well, it depends on what the actual trigger is. So if it’s-

Dr. Weitz:            Okay.

Kashif:                  So for example, if it is the inhalation-based, diet may not be their problem. Right?

Dr. Weitz:            Ah, okay.

Kashif:                  For a lot of people, it’s insulin based. So low insulin, low glycemic index. There’s some people that don’t metabolize fat so efficiently and [inaudible 00:18:50].

Dr. Weitz:            That’s exactly the question I was going to ask, because I know some people employing a keto diet to help reduce risk and other people are employing vegetarian, low-saturated fat diet to reduce risk. And you’re saying it depends on what other genes-

Kashif:                  Yes.

Dr. Weitz:            … are involved.

Kashif:                  There’s a lot of people we work with that got on to Keto and they felt amazing in the first three or four weeks. It’s impossible to not feel amazing because you start burning your fat as fuel and you get ketones firing in your brain. Everything feels good. But then you get five, six week in into it and you start feeling sluggish and like, “Well, what else do I need to change? There’s something…” Because you felt so good, you don’t blame it on the keto. But if your APOA2 gene, a different gene, is off, you don’t metabolize saturated fat so well. And five, six weeks into it, you’re going to feel horrible.  And that can actually drive an insulin response, by the way. We don’t think of fat driving an insulin response, but ultimately if you eat too much fat, it turns into glucose anyway and it can drive an insulin response. So yeah, we can be hyper precise on the exact plan.

Dr. Weitz:            Interesting. So fats can drive an insulin response. I’ve not heard that before.

Kashif:                  And the reason you haven’t heard that, and I’m going to poke fun at you for some time right now.

Dr. Weitz:            That’s fine.

Kashif:                  Medical research is all done on Western European white males. It’s designed for you. It’s not designed for my pigmented skin. It’s also not designed for women. This is why dark people and women suffer more in our healthcare system than Western European white men. So the truth is that the genetics of South Asian people, brown people, we get an insulin response from fat.

Dr. Weitz:            Interesting.

Kashif:                  It’s not spoken of anywhere. And it’s not just South Asians. There’s other ethnicities as well. So we have a global medical model that was designed on one cohort of people, which great. You’re going to do well. But the uniqueness, the bioindividuality is there. We’re not all the same, and we’re starting to understand that. That’s part of what we’re pioneering, is how do we make this thing unique to the individual? It’s not about one set of research for everybody.

Dr. Weitz:            Right. And it’s not even about one set of research for a race either. We don’t want to just make a simplistic conclusion and say all Asians should follow this program or something like that.

Kashif:                  Yeah. So China is not Asian and it’s not Chinese. There’s two races that make up China, and they’re very different. So if you look and… Picture this. People from China either look like Bruce Lee or they’re big like [inaudible 00:21:41] the panda bear. And that’s what you get. There’s nothing in the middle. And there’s actually two major races that make up China, these highly androgenized, testosterone-dominant, rippled muscle 90-year-old grandma walking around doing her own groceries or these big, thick people that have a lot of fat on them and big heads. Those are the two races.  So even between those two races, it’s not the same answer. And we’ve learned this genetically that the uniqueness of how people… And why. These people are highly estrogen dominant. These people are highly androgen dominant. Eventually at some point, they came together and formed China. So you can’t give the same answer to those two people even though they both think they’re Chinese.

Dr. Weitz:            Huh. It’s all based on their genetic differences.

Kashif:                  Yep. Exactly.

Dr. Weitz:            What about the relationship between genes and mood?

Kashif:                  Oh, huge. So that’s the first place we always start. It’s very hard to support someone in their health journey if they don’t understand how they think.   So first of all, the way they think things are happening and their perception versus what’s really happening, and there’s no good or bad to that. There’s just always a gap. Everybody has some unique perspective.

                                Also, as a coach or a healthcare practitioner, how do you actually guide this person? So how do they seek reward? What motivates them? Do they burn out? Do they procrastinate? Do they have highly reward-seeking tendencies, the opposite, where they may overdo it? Are they highly skeptical, and then do they only learn experientially? They need to go through it. You can’t just tell them, “Go do this,” and they’ll do it.

                                So everything about if… Let’s just say this. If I had your DNA in hand, I don’t ever need to speak to you to understand your personality and habits to a T. I can describe you and who you are, whether you should be an accountant or whether you should be an entrepreneur to a T, and it’ll blow your mind. Why? Because we spent three years clinically studying 7,000 people.

                                So one by one by one, we interviewed 7,000 people, sometimes a single interview to many months of work depending what they were dealing with, and we understand how the neurochemicals drive behavior. And it’s indisputable, because this chemical causes you to feel like this. And this is how you make it. This is how you bind it. This is how you clear it, so this is how long it lasts. I can now predict how you deal with that. And there’s multiple things we look at. And now all of a sudden, here’s your personality map. I know it. It’s very, very clear.

Dr. Weitz:            That’s amazing. I saw somewhere where you said the COMT gene plays a role in altruism.

Kashif:                 Yeah, so the COMT gene clears-

Dr. Weitz:            Does altruism actually even exist? I have my undergraduate degree in philosophy.

Kashif:                 Well, here’s what I believe about all mood and behavior and behavior traits. They are based on your context. So we are all wired to do something. We’ve inherited our ancestral genetic legacy. Take me, for example. I have what we call warrior genetics. I need to be on the frontline fighting. Whatever I did yesterday is not good enough anymore. And if you look at my ancestral lineage, it comes from Afghanistan from some level of royalty, let’s call it, that were constantly fighting for the throne. Right?

Dr. Weitz:            Okay.

Kashif:                  So stress was just part of life. Fighting was part of life. The status quo is not good enough. That causes depression for me because I can’t experience pleasure like the average person. I need to fight.  So when it comes to COMT, COMT clears your neurochemicals. Not all of them, but a couple of key ones: dopamine and noradrenaline. And so your ability to experience emotional recall is based on noradrenaline. And if you clear it quickly, you may be a little bit confused about what things actually mean and then what they feel. Your recall may be a little off. But the opposite is also true. If you clear it very slowly, you’re really deeply connected to the impact or the emotion that you had in any given scenario, and you use that as a tool moving forward. And that’s your filter.

                                So now when you’re dealing with people, you may have more empathy. You may have more EQ. You may be able to read them and understand exactly what they need and want, and then they perceive you as that person. And it becomes a superpower. But put it in a different context where, god forbid, there’s a car accident, every time you go down that street it’s trauma because you’re remembering the feeling, not just the information.

                                So this innate understanding of how you’re wired, whether we use words like anxiety, depression, addiction, is based on what context you’re using that tool in. The same thing that can cause depression for me can also cause addiction because my baseline ability to feel pleasure and reward is very, very low. So if I just go do the average thing, I’m going to be depressed. If I find the thing that gives me pleasure, I’m going to be addicted. If I find the thing that gives me reward, because dopamine powers both pleasure and reward, I’m going to achieve. And guess what? I’ve experienced all three of these things. So context is key. Understanding who you are first and what the ideal context is and knowing what the more deleterious context is and what may cause you a problem, then you can choose how you feel.

Dr. Weitz:            Interesting. We screen for vitamin D quite often with our functional medicine clients. I find most people, we have a tough time actually getting the vitamin D up to a really target level. So depending upon the person, 50 to 70, 60 to 80. And then yet a few people, we give them a modest amount of vitamin D. What I consider a modest amount, 5,000. All of a sudden, it goes over 100. And I saw an article where you were talking about how genes control vitamin D metabolism and why most people are vitamin D wasters.

Kashif:                  Yeah. So what’s going on there, of all the micronutrients, vitamin D has the most complex metabolic pathway, the genes that drive it. Because again, ancestral traits, our ancestors weren’t indoors on Zoom calls. They were outdoors most of the day. Agricultural. They were outdoors doing stuff, which means that they were overexposed to vitamin D so their bodies had to learn how to mitigate that exposure.

                                And so what do we do? The first gene takes D2 from the sun and converts it into D3 and gets it into the blood. Step one, I need to metabolize it and turn it into the active form that I can use. Then once it’s in the blood… And this is why the measure of what’s in the blood is not enough of a measure. That’s only step one. That’s only telling you how much the person metabolized.

                                There’s a second gene that then takes that D3 and transports it to the cell. So picture these little taxi cabs that are moving it along and getting it to where it needs to be. Once it gets there, there’s a third gene that binds it and gets it into the cell. And any one of these can be off.

                                So you might have somebody that metabolizes vitamin D really well, but they don’t transport and bind it really well. So that person needs multiple doses because if you give them 5,000 IU, they will only use 1000 of it. They just can’t efficiently get it there and fast enough and bind it fast enough.

                                The opposite could be true. They may be really efficient at binding and transporting, but they don’t metabolize. So they might need 10,000 IU. They might need a lot more, especially in the winter, depending where they live.

                                So you can be really precise. And of all the micronutrients, the number one priority is vitamin D. That’s where you need to focus. Of the 22,000 genes that make up your genome, all of these little instructions in your cells, 2000, so almost 10% of your biochemistry, is dependent on vitamin D. So these genes don’t express if you don’t have the right vitamin D, which is why it affects-

Dr. Weitz:            Wow, wow.

Kashif:                  … anything from mood to skin, everything. So it’s really more so… And you know this. It acts more as a hormone than it does a vitamin.

Dr. Weitz:            Yeah.

Kashif:                  And so it’s key to be precise there, and this is why we built that specific pathway because it really… My niece is a perfect example. She was almost being prescribed a anxiety pill. She was getting anxiety attacks and couldn’t breathe, and I figured out all it was is because she was being homeschooled during COVID when schools were locked down and she got zero vitamin D. She hadn’t been outside in five months.

Dr. Weitz:            Oh, wow.

Kashif:                 And her vitamin D pathway is horrible. And she just needed more vitamin D and a little bit of L-theanine to boost her dopamine levels. That was it. And she was being prescribed an anxiety pill, which she would’ve probably still been on today.

Dr. Weitz:            Right. That’s awesome. Couple more questions. How do our genes tell us about our ability to fall asleep?

Kashif:                 Sleep is… That’s one question, how do I fall asleep, then there’s also how do I stay asleep? And there’s also how do I sleep through the night and actually feel rested? [inaudible 00:31:23]-

Dr. Weitz:            How do I get quality sleep? How do I get good deep sleep? How do I get good REM sleep?

Kashif:                 And those are all different things genetically. So the first one is based on circadian rhythm. So how efficiently does my clock work? So if my clock… There’s two genes. There’s literally a gene called CLOCK, which makes a CLOCK protein which allows your body to understand what time it is. And then there’s BDNF, brain-derived neurotropic factor, which also heavily regulates circadian rhythm. And so if you’re not doing well there, then your body is going to need a very strict routine to be able to fall asleep on time, which means waking up at the right time, getting sunlight and vitamin D at the right time, pausing to breathe a few times during the day, some kind of light sauna or stretching type activity in the evening, no blue light, turning off the TV a couple hours before. We can be very precise about your sleep problem and why you can’t fall asleep, but that same problem doesn’t affect why you can’t stay asleep. That’s a different problem which is more based on serotonin and cortisol.

                                Those are very different problems where if your serotonin is dysregulated, which means your brain is more sensitive to stimulus, it notices everything. And you make your serotonin in the second half of the night in your gut, and your body uses serotonin to wake you up. And it’s literally waiting for sunlight to say, “Okay, time to get up. Let’s bind that serotonin.” But if your brain can’t prioritize stimulus because your serotonin pathway is off, then it’s responding to everything in that second half of night. When the temperature changes, when there’s a smell, when the hubby pulls on the blanket and it touches your skin, every little stimulus in that second half of the night your brain confuses for the sunlight coming through the window and you get up, go to sleep. Get up, go to sleep. Get up, go… So it’s a different problem to solve.

Dr. Weitz:            Right. Interesting. What are some of the strategies to combat some of those?

Kashif:                  Well, for the second one, so this is actually… All of these things that we see as problems are actually our ancestral superpower. So think about the caveman who had to not be eaten by a wolf while he was sleeping.

Dr. Weitz:            Right.

Kashif:                  Right? So the person who was able to have that hypersensitivity to stimulus would survive because they would hear that branch breaking far before the wolf arrived, right?

Dr. Weitz:            Right.

Kashif:                  So that trait is designed to wake you up, but our context is not aligned to the sleep cocoon we actually need, which means heavy weighted blankets so that your body feels safe. Head to toe, the skin is signaled. There’s this weight on me. It is sleep time right now.        Cooling of the mattress. So there’s mattress coolers you can actually get that mimic what it meant to sleep on a cave floor, right?

Dr. Weitz:            Yeah. We use one.

Kashif:                  You use one? Yeah. So it’s an amazing hack that completely changes your sleep because if you have the heavy blanket, a couple hours in you’re going to overheat. How do you mitigate that? You get the cooler, right?

Dr. Weitz:            Yeah.

Kashif:                  Zero light leakage. If there’s light, that’s signaling serotonin to bind. And depending where you live, the light may start at 4:30 AM, which is not the right time. So zero, zero light leakage, potentially an eye mask.  You potentially may have a separate blanket from your spouse. You cannot have that stimulus. So those are the things to consider. How do you make that sleep cocoon?   And now if we know that serotonin is the gene pathway is off, you can also modulate serotonin with the right supplements. So 5-HTTLPR is the gene. There’s a supplement called 5-HTP which helps regulate your serotonin level so you can take one before going to sleep. You know?

Dr. Weitz:            Right.

Kashif:                  There’s things you can do, these adaptogen type things that help you get into a deeper sleep state. So there’s a lot of things available. You just need to know, again, what your body needs. Where do I start?

Dr. Weitz:            Right. Let’s see. One more question. What about our genetics and weight control?

Kashif:                  There’s so much. We need an hour just for that.

Dr. Weitz:            And obviously, obesity is such a big, big risk factor for chronic diseases, or maybe is a chronic disease itself.

Kashif:                  Yeah. So let me give you the fast bullets.

Dr. Weitz:            Okay.

Kashif:                  Hormones is one of the areas that is where people get stuck. So I’m going to the gym. I eat properly. Why can I not lose these last 20 pounds? Hormones. Are you estrogen dominant? Are you androgen dominant? Maybe you don’t have enough fat or enough muscle. You can’t get bigger. You can’t put on the muscle. Maybe not enough of the estrogens. So hormones is a first area, and it’s very easy to use basic supplements to change these gene pathways and change your body.

                                Second one is your brain perception and what you think you’re eating versus what you’re actually eating. Your addictive tendencies, your binging tendencies, your emotional eating tendencies, and these things that never get counted in your calorie count. So that’s another big one.

                                Then there’s actual gut and mouth brain connection, which we talked about a little bit earlier, and understanding your ability to actually feel satisfied and how to hack that. So if you are the person that has the palate need of variety, you have to create it. Give yourself a little bit of cheese, dark chocolate, nut, grape, all the textures and varieties right when you’re with done your meal so that you hack your brain to get the variety it’s desiring. Another big one that nobody looks at is-

Dr. Weitz:            Or you just take Ozempic.

Kashif:                  Or you take Ozempic. Yeah, that’s another way around. And then you get off Ozempic and you balloon up like never before. Yeah. And-

Dr. Weitz:            We’ll call that the Ozempic balloon.

Kashif:                  Yeah. It’s sad, but the federal government went on 60 Minutes and said like a week before Ozempic was released, coincidentally, that 80% of obesity is genetic.

Dr. Weitz:            Wow.

Kashif:                  That’s what they said. They said it’s not lifestyle. This was on 60 Minutes. I don’t remember the name of the person, but it was some health advisor for the Biden Administration went on and said that “We believe that obesity is 80% genetic. It’s not lifestyle or nutrition based.”

Dr. Weitz:            Pharmaceuticals will solve all our problems.

Kashif:                  Yes. A week later, Ozempic gets released. Pure coincidence.

Dr. Weitz:            Yeah.

Kashif:                  Right? So now, yes it’s true that 80% of it is genetically driven if you’re making all the wrong choices, but it’s absolutely false that you don’t have control and that it’s going to happen, that it’s innate. There are genetic conditions like sickle cell syndrome. There’s a gene that’s broken, and you have it-

Dr. Weitz:            Right.

Kashif:                  … [inaudible 00:38:25]. Obesity is not something that you have. It’s something that’s caused. There are some people that have genetic obesity. That’s a tiny fraction of the people that are actually obese.  So the other big one, sorry, I was going to say is environmental toxins. So we’re so overburdened by environmental toxins, what we breathe constantly, that our body is storing fat as a place to deposit the toxins. So if somebody that goes for a run every day in Manhattan that can’t understand why they can’t lose that little bit, because you’re running and breathing in pollution every day and you might not have the right detox pathways to deal with that. And so your body’s trying to protect you by storing fat to deposit that toxin to keep it away from your organs.

Dr. Weitz:            Interesting.

Kashif:                  And that may be your number one thing. That could just be the one thing you have to work on.

Dr. Weitz:            Right. Great. So how can patients get your DNA test done? Is there an option for practitioners to become providers or is this a direct to consumer, or are both options available?

Kashif:                  Yeah, for sure both. So we do work with functional medicine, chiropractors, naturopaths, everybody in that sort of wellness space that thinks the way we think, and a few MDs that have learned about life and what they need to change. So we do work with practitioners. It’s very easy. You open an account. We send you some kits. There’s training if you want. There’s free training. There’s paid training, depending how deep you want to dive.

                                And then for consumers, it’s thednacompany.com. You simply go there. The test is called the 360. The way it works is you get shipped a kit. You spit in a tube. You ship it back to the lab. We extract your DNA. A few weeks later, you’re going to get an email to access your reports, and the reports are very, very easy to use rather than “Hey, you have this gene, the MTHFR CC.” Nobody knows what that means. It’s more like, “Here’s how your body deals with cholesterol and inflammation. Here’s how you deal with anxiety. Let’s speak in the context you actually can apply this stuff.” And there’s recommendations built right in. So where do you actually supplement? What do you actually change in your diet, et cetera?

                                Beyond that, there’s some people that have the need for clinical support. I have breast cancer and how do I deal with this? So we do have functional genomic-certified coaches that can take on patients and help them through programs, and we can also train practitioners to do the same. So all of the above.

                                So it’s thednacompany.com, the 360 test. And to work with us as a practitioner, you can also send us an email through there. You can find us on Instagram if you’d like. It’s my… K-A-S-H-K-H-A-N official. A lot of news and stuff that we put out there. Think about things like Ozempic. So you can keep learning. Yeah, but all of the above. We’re here to support.

Dr. Weitz:            What if the patient already has their DNA run by 23andMe or Ancestry? Can they send that in, or are your tests more extensive or different?

Kashif:                  We would love to be able to do that because there’s 80 million people out there that have done those tests, and business wise it would make a lot of sense. The challenge is that they don’t test for what we test for.

Dr. Weitz:            Oh, okay.

Kashif:                  So remember, these are data collection companies. Their business is sell something on the front end that’s infotainment and then sell the data on the back end to a pharma company. That’s where they make their real money. So they have to build the product in a way that serves that customer, the real customer which is a mass data dump, a bunch of SNPs for the practitioners that are on here. It’s the spelling mistakes in genes.  When it comes to the major pathways that we need to understand, there’s things called copy number variations, where it’s far more complex than a SNP. It’s like, “Do I even have the gene? Am I completely missing it?” You have to test for that separately.

                                When it comes to things like APOE, I can’t tell you how many customers have called us and complain and said, “I have my 23andMe done, and your APOE result is different. And you guys are a scam.” And then we have to explain to them that APOE, we sequence the entire gene. We treat it as an independent test because it’s so complex. So there’s one thing to look for a SNP, and there’s one thing to look for all 20,000 letters in that gene. We test for a lot less, but we are going a lot deeper in those genes that actually are meaningful, the functional genes that drive the main pathways.

Dr. Weitz:            I don’t quite get that one on the APOE. So aren’t you just either an APOE34 or 33 or 44? What else is there?

Kashif:                  The way you determine that is not as simple as it seems.

Dr. Weitz:            Oh, okay.

Kashif:                  And have you heard of Dale Bredeson?

Dr. Weitz:            Yeah, of course.

Kashif:                  [inaudible 00:43:30].

Dr. Weitz:            I’ve had him on the podcast.

Kashif:                  Yeah. So in his book on reversing Alzheimer’s, he says something like, “23andme is something like 65 or 70% accurate,” and that’s why he refuses to use genetics, because genetics isn’t as simple as run a test and get a result. There’s a lot of science behind what that result actually means, and that’s why you see variability between different testing companies.  So what we do, again, we test for less. We’re not looking for thousands and thousands of genes. We’re looking for the 100 that actually matter that are functional, but we go a lot deeper on each gene to make sure it’s accurate and that we inform more. It’s not just a SNP. It’s a copy number variation. It’s also the indel. An indel means that a whole paragraph might be missing or there’s a extra paragraph, not just a letter or a variant. We’re deeper on what matters, and APOE’s a perfect example. You can assume by looking at certain markers or you can sequence the entire gene from beginning to end and be certain, and that’s what we do.

Dr. Weitz:            Fascinating.

Kashif:                 Yeah.

Dr. Weitz:            Awesome. Okay, thank you very much.

Kashif:                 Oh, It’s a pleasure. Good talking to you, man.

Dr. Weitz:            Nice talking to you. Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way, more people will discover the Rational Wellness Podcast.   And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

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Dr. Izabella Wentz discusses her Adrenal Transformation Protocol 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

0:37  Adrenal fatigue as a concept was first proposed by Dr. James Wilson in 1998 in his book of the same name.  This concept was dismissed by the medical world but embraced by the Functional Medicine community, but now it has been discredited and seen as invalid even in the Functional Medicine world since the adrenals never lose the ability to secrete cortisol.  On the other hand, there are many patients with symptoms like fatigue, brain fog, intolerance to exercise, feeling overwhelmed, etc. and salivary cortisol testing often shows reduced cortisol levels or cortisol not being released at the proper time, which we will call adrenal dysfunction. 

3:15  Dr. Wentz suffered with Hashimoto’s thyroiditis and she got off gluten and dairy and started taking thyroid medications T4 and T3.  This made her feel better, but she still struggled with brain fog, fatigue and anxiety, and unrefreshing sleep even though I was sleeping a lot after having made these changes.  She had heard about adrenal fatigue and had heard that it didn’t exist as a condition.  Eventually she tried the recommendations for adrenal fatigue and they helped her to feel better.  Her brain fog and fatigue improved and she started to have refreshing sleep. Her anxiety also improved due to balancing her adrenals. Most patients with Hashimoto’s (hypothyroid) have some degree of adrenal dysfunction where they either have too much cortisol, cortisol at the wrong times of day or not enough cortisol.

8:12  The adrenal/thyroid connection.  Patients with hypothyroidism will generally break down their cortisol slower.  Cortisol may supply some of the energy that the body lacks from the lower thyroid hormone levels.  Or patients who get put on thyroid meds may feel better at first but then may crash and this may be because they start clearing their cortisol quicker and now they have too little cortisol.  Dr. Wentz noted that about 60% of those tested for adrenals with Hashimoto’s have a low cortisol level all day long.  You should also measure reverse T3, since higher levels of stress and cortisol can lead to T4 being converted into reverse T3 instead of into T3.  Some of these patients will do better with a natural desiccated thyroid that contains some T3 as well as T4.   

18:18  Recommendations for adrenal dysfunction.  Patients should follow a paleo-like diet by getting rid of the most common inflammatory foods, including gluten, dairy, soy, as well as grains.  This diet should be higher in protein and fat and perhaps a few more carbs at night to help lower cortisol to help with sleep.

19:25 Nutritional Supplements.  Dr. Wentz offers a minimalist approach to help patients with adrenal problems turn their health around in a short period of time.  To help with digestion, she sometimes recommends sea salt to stimulate digestive enzyme production or thiamine to stimulate digestion and hydrochloric acid production.  Dr. Wentz does recommend adrenal adaptogens, magnesium citrate, saccharomyces boulardii, and myo-inositol. As far as adrenal adaptogenic herbs, the ones she likes the most are Ashwaganda and Rhodiola. Ashwaganda can also help normalize thyroid hormone.  Maca and Shatavari are two herbs that can help with libido. She also recommends B complex and vitamin C.  Dr. Wentz also recommends magnesium citrate, which can help with anxiety, with sleep, for pain, and for constipation.  Magnesium can also help us to produce GABA.  Dr. Wentz also recommends saccharomyces boulardii as a probiotic to improve gut health and improve our natural defenses and help to clear out candida, protozoans, and some pathogenic bacteria.  Myo-inositol is another important supplement that Dr. Wentz recommends for adrenal issues at a dosage of 600 mg. and it can also help with thyroid, blood sugar, anxiety, and obsessive compulsive disorder.  The final supplement that Dr. Wentz recommends for patients with adrenal problems is L-carnitine at a dosage of 2000 mg per day and this helps to relieve brain fog. It can also help to remove ammonia from the body.  

Dr. Izabella Wentz has a Doctor’s of Pharmacy degree and she is an internationally acclaimed thyroid specialist.  She has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s thyroiditis in 2009. She is the author of three books on Hashimoto’s: Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto’s Food Pharmacology, and Hashimoto’s Protocol, which became a #1 New York Times bestseller. Today we’ll be discussing her new book, ADRENAL TRANSFORMATION PROTOCOL.  Her website is Thyroidpharmacist.com.

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

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Welcome to our podcast interview today with Dr. Izabella Wentz, where we’ll be discussing her new book on adrenal dysfunction.

                                This is a topic that has been much debated within the medical community for some time. The idea of adrenal fatigue was first proposed by Dr. James Wilson in his book of the same name in 1998. However, the concept was initially dismissed by traditional medical doctors who said that if you had low functioning adrenals and low cortisol levels, you had Addison’s disease. And if your adrenal glands produced too much cortisol, then you had Cushing’s syndrome, and there was nothing in between.  This concept of slightly underperforming adrenal glands, which Wilson discussed, was taken up by functional medicine practitioners. And then in recent years, the idea of adrenal fatigue has been widely discredited as an invalid concept since the exception of Addison’s disease, which is rare. The adrenal glands never truly lose the ability to secrete cortisol.  Despite this, many patients continue to experience fatigue, brain fog, intolerance to exercise, feeling overwhelmed, and other symptoms, ensure reduce cortisol levels or cortisol not being released at the proper time on saliva testing. That is typically performed a number of times a day.  Today, we’ll be diving into this topic with Dr. Wentz and exploring the nuances of what we call adrenal dysfunction and its impact on our health.

                                Dr. Izabella Wentz has a doctor’s pharmacy degree, and she’s an internationally acclaimed thyroid specialist. She has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s thyroiditis in 2009.  She’s the author of three books on Hashimoto’s, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, which by the way is the most incredible book on thyroid and I’ve got it underlined and highlighted, and I’ve referred to that book so many times. Hashimoto’s Food Pharmacology and Hashimoto’s Protocol, which became a number one New York Times Bestseller. Today, we’ll be discussing her new book, Adrenal Transformation Protocol. Dr. Wentz, thank you so much for joining us.

Dr. Wentz:          Thank you so much for having me, Dr. Ben. It’s a pleasure to be here with you.

Dr. Weitz:            Great. So since so much of your professional focus was on thyroid, why did you decide to focus on the adrenals in this new book in your new program?

Dr. Wentz:          I felt called to really focus on adrenal health because healing my adrenals was part of my thyroid journey. I initially got on thyroid meds, which were helpful, so we want to make sure we’re optimized on T4, T3. That’s a big game changer for people. I got off of gluten and dairy, which was life-changing for me as well, and I recommend that for others with Hashimoto’s and hypothyroidism. Sometimes the condition can go completely into remission when we just do these things, but I still struggled with brain fog, fatigue and anxiety, and unrefreshing sleep even though I was sleeping a lot after having made these changes, right?

Dr. Weitz:            Right.

Dr. Wentz:          So I kept hearing the term adrenal fatigue, adrenal fatigue, and being like a skeptical pharmacist, I looked up the term and then I saw that it didn’t exist. It doesn’t exist, and I was like, “Okay, so I don’t have this.” I went about, tried other things, and finally it was like the 15th person that mentioned adrenal fatigue to me and I was like, “Okay, I will give this a try.” And sure enough, I tried the interventions for it and they helped. So I had this thing that didn’t exist and nothing was going to help, even if it did exist. And then the things that these crazy people were recommending. And then I felt so much better.   So the brain fog improved. The fatigue was so much better. I could wake up in the morning and be full of energy, and I also had refreshing sleep, and I didn’t need to sleep so much. My anxiety was gone. Haven’t had a panic attack in 10 years, and they used to be a very frequent, unwanted part of my life prior to balancing my adrenals. And it’s like, “I can’t believe it’s been 25 years since Dr. James Wilson was talking about this condition.” And people are still saying, “It doesn’t exist. It doesn’t exist.”

                                I’m like, “Can we please just stop gaslighting the people that are going through these very real symptoms and help them get the help that they need?” In my experience, just about everybody that I’ve worked with, with Hashimoto’s has some degree of adrenal dysfunction where they might have too much cortisol, cortisol at the wrong times of day or not enough cortisol produced. And there’s a way to get into balance from that.  It’s not Addison’s disease. It’s not Cushings. It’s not a disease per se. This is a very predictable way that the body responds to stress. And not just people with thyroid issues, but other people who are struggling with all these symptoms. They’re presenting with this as well, and they’re walking around without a diagnosis. They think they’re crazy or lazy or just really anxious, edgy people.

Dr. Weitz:            It sort of reminds me of the issue with diabetes, where medical doctors, your blood sugar could go from 80 to 90 to a hundred to 110. Everything is fine. Everything is fine. All of a sudden it hits 125, now you got diabetes. Maybe it was a gradual process where you weren’t handling glucose quite as well as you should have. And if you had recognized it earlier, you could have helped some of these people not end up with frank diabetes.

Dr. Wentz:          I mean, yes. And it’s like the same with the thyroid gland. It’s like sometimes the person will have the reference range is 4.5 for TSH, and they’ll have a 4.4. Your thyroid is fine, right?

Dr. Weitz:            Right.

Dr. Wentz:          With really a healthy person should have a TSH somewhere around 0.5 to two if they don’t have a thyroid condition. And with the adrenal glands, it’s the same thing. So you don’t manifest with Addison’s disease until 90% of your adrenal glands have been destroyed. And you can also have other reasons for inadequate cortisol production, and part of it could just be this stress adaptation. So your adrenals may be perfectly healthy. You may not have an autoimmune response against your adrenals, but because your body is overwhelmed by stress, there’s going to be a disconnect between the hypothalamus and the pituitary and the adrenal glands and the hormones they secrete.  It’s like the boy who cried wolf. You go enough times and say, “Okay, we’re stressed, we’re stressed, and more cortisol please, more cortisol, please.” Eventually the body is going to adapt and say, “We just can’t have this much cortisol produced at this high level all day every day. We really need to start shutting down production. And this is what happens with receptors when they get overwhelmed by certain messaging, they become desensitized to the message.

Dr. Weitz:            Absolutely. So let’s talk a little more about the connections between thyroid and adrenals and how adrenals affect thyroid and thyroid affects adrenals.

Dr. Wentz:          It’s definitely a two-way street. So in my experience, people who have hypothyroidism will generally break down their cortisol slower. So they end up with more cortisol in their body and more cortisol metabolites. It’s a protective mechanism. So the body is like, “Oh, you’re not making enough thyroid hormone? Let’s help you out by keeping cortisol around a little bit more.” And then you end up feeling more edgy and wired, but you get your cortisol kick from the adrenals, which isn’t the best type of energy, but it’s energy, right?

Dr. Weitz:            Right.

Dr. Wentz:          And end up getting a diagnosis of maybe hypothyroidism. You get put on thyroid meds, which can be incredibly helpful if you’re hypothyroid, but they can also uncover a low cortisol issue that maybe you didn’t know when your body was compensating because then your cortisol clearance normalizes. So that means it increases if you had been hypothyroid.  And then a person will say, “I felt better at first with the thyroid meds, but then all of a sudden I crashed.” And I’m like, brain fog fatigue, all of that got worse. What is happening? And many times it’s like this uncovered low cortisol state. About 60% of the people that I’ve tested with Hashimoto’s that were symptomatic were actually in the low cortisol state where they had low cortisol all day long, and most of them were on thyroid meds.  In this situation, it’s not more thyroid to overcome the fatigue, it’s less support to your adrenals to get back into balance. Now, the other part of the pathway, and I always ask people, what was going on in your life before you got sick? And usually they’ll say, “I was on a period of a lot of stress.” Stress can make us produce a type of thyroid hormone we don’t want. It’s known as reverse T3. Again, this is the body’s feedback loop where. The body is like, “There’s too much of this. We need to slow down this.”

                                Reverse T3 is the inactive thyroid hormone where that will sit inside of our thyroid receptors and block them instead of activating them. And then this usually goes along with low levels of active T3. And so people will say, “I take thyroid medications that are supposed to be converted to T3. The active hormone, levothyroxine is T4 and the less active thyroid hormone that normally should get converted into T3 in the body, but it doesn’t for a variety of reasons.   So people will say, “I’m taking this medication, but it’s just not working.” And sometimes they do better on a natural desiccated thyroid that contains some of the three directly, and that’s because of that stress and cortisol component that drives up the reverse T3 production. This can even happen in people without a thyroid issue. So you can have a perfectly healthy thyroid without the immune system messing with it, but you just have all this cortisol and stress on board, and you’re going to end up with hypothyroid symptoms because of that reverse T3 blocking your thyroid receptors.

                                This has been a subset of my clients as well as as some friends reaching out to me that said, “Izabella, I have all these symptoms. I know you help people with Hashimoto’s that have these symptoms. I don’t have Hashimoto’s. Right?” But they can definitely have these symptoms and this is where something like a reverse T3 test or testing free T3 would be-

Dr. Weitz:            And most of them probably haven’t had a reverse T3 test because that’s not a test that’s typically done.

Dr. Wentz:          It’s not typically done. And if a person comes to me with Hashimoto’s, I’m not necessarily going to do it because I’m like, “I already know you have a thyroid problem and I already know you have an adrenal problem,” so let’s not-

Dr. Weitz:            Get right to the treatment.

Dr. Wentz:          Yeah. Let’s go right to the treatment options. We don’t need to feed the vampires with all this blood, but with a person who maybe has these symptoms, then I’m really looking at what’s going on in your body. And if they were open to doing testing, I would do something like an adrenal saliva test or maybe a Dutch test and some reverse T3. But also in my book, I just talk about the symptoms people can utilize to assess themselves because the testing is not always accessible. Sometimes the functional test can take weeks to get back. And by that time you could have really worked on your health.

Dr. Weitz:           Typically, a couple of weeks to get test results back for functional medicine testing.

Dr. Wentz:          Right. And the protocol can work in four weeks where within a… I’ve had patients and clients, and I’m sure you’ve had them too, where you give them a test and they’re like, “Yes, I’ll take this test.” And then three months go by and it’s like the test is still sitting at home and it’s collecting dust on a shelf.

Dr. Weitz:           For sure. We make those calls all the time. You got to do the test.

Dr. Wentz:          Yeah, absolutely. So I wanted to give people more of a streamlined approach where they can really get to know their symptoms and learn about what their body is trying to tell them and how to care for themselves to get themselves in the best state. So whether they’re working with a practitioner, hopefully they are, they found somebody really good to work with that can support them. Or even if they’re trying to do things on their own for their own health, a lot of the strategies are safe and effective. We’re not talking about using hormones in my book, we’re really focusing on solid lifestyle things people can do.

Dr. Weitz:           Right. I noticed in your book you talk about the relationship between cholesterol and adrenal function. And right now in health, we seem to be focused on trying to drive cholesterol levels as low as possible to stop heart disease and we’re constantly being told that, “That’s fine. There’s not going to be a problem with the brain function or anything else because all those other tissues make whatever cholesterol they need.”

Dr. Wentz:          So cholesterol is responsible for making our hormones. And from a pharmacist perspective, it is a category X for women who are pregnant because their body is needing to have hormones, and it can be associated with a lot of damaging effects when we suppress what the cholesterol lowering drugs are. So when we suppress cortisol… Sorry, I’ve been talking about cortisol all day. When we suppress cholesterol production too much, we can potentially suppress the production of other hormones.   And it doesn’t happen to everybody, but it can be something to be on the lookout for.  The other thing to consider is cholesterol, high cholesterol actually can be a symptom of hypothyroidism and even low T3. So part of how we make hormones out of cholesterol is utilizing thyroid hormones, specifically T3.  So getting your thyroid hormone in check and your adrenal glands in check can be a way to optimize your cholesterol levels. It’s like your body can drive up… Your body is like, “Okay, we’re under stress. We need to make more cortisol.” So cholesterol sits at the top of the pyramid and it turns into pregnenolone which is our mother hormone that gets turned into progesterone and cortisol and DHEA and our sex hormones and all these beautiful hormones downstream. But if the body’s like, “I need more cortisol because I’m in a lot of stress,” cholesterol can be gone up.  And when we balance that stress response, that need for cortisol, that need for these other hormones, then we can actually help with balancing cholesterol levels as well.

Dr. Weitz:            Cool. You talk a lot about helping your body to feel safe in order to heal and how to send safety signals to your body. What’s the importance of this concept?

Dr. Wentz:          One of the reasons why people get stuck in this adrenal dysfunction is because their body gets the message that we’re under stress or we’re in the presence of a threat right now. We have these beautiful ancient bodies that respond to modern signs of normal life and they’re still interpreted by our caveman, cavewoman genes. So if we’re doing things like over exercising or overworking to a caveman or a cavewoman, they wouldn’t be doing that. Right? So it gets interpreted as in some cases, as stress. And if we get too many of these stress and threat signals, we shift into that survival mode.  We shift into our sympathetic mode where we are in our fight or flight system. We’re in a catabolic state where the body is breaking itself down for fuel rather than being in our parasympathetic state where we are resting, digesting, healing, and thriving. We do need a balance of both. I’m not saying one is good and bad. We do need to spend time in both of these systems, but what can happen when people with adrenal dysfunction, they’re spending more time in that catabolic fight or flight state, rather than having a good balance of breaking your body down and building it back up.

Dr. Weitz:            Right. Because the adrenal gland is our major stress gland, and that’s where adrenaline and cortisol comes into play that are secreted by the adrenals?

Dr. Wentz:          Exactly.

Dr. Weitz:            So let’s talk about the recommendations for how to feel better with adrenal dysfunction. Let’s start with diet. What’s the best nutritional approach?

Dr. Wentz:          I really love focusing on a paleo-like diet. So we’re getting rid of the most common inflammatory foods, gluten, dairy, soy, as well as grains because they can be problematic for blood sugar issues. This is a 30-day plan and generally people can introduce some of the foods if they feel okay with it, such as the grains after a time period. But a lot of people do find that they feel significantly better. We’re generally going to be doing more protein and fat than the average person, a bit lower carb throughout the day, maybe some more carbs at night.   Carbs can lower cortisol, so that can be helpful for people to getting to sleep. And then we’re also utilizing a lot of nutrient dense foods. One of the issues people can have when they’re in that stress response is they can have trouble digesting foods. So I utilize a lot of smoothies in the morning.

Dr. Weitz:            Okay. What about digestive enzymes? I guess that’d be another way to get around that.

Dr. Wentz:          Absolutely. It’s a four-week plan that really focuses on kind of a minimalist approach to get the maximum dose of improvement. And that’s those four short weeks. I use sea salt as a way to stimulate digestive enzyme production. But the back of the book also has advanced strategies such as using digestive enzymes or using thiamine to help drive energy production as well as hydrochloric acid production. It depends on the person. There’s so many options for ways to heal the body, and I didn’t want to give people sure too many choices at first, because I know one of the main symptoms of adrenal dysfunction is overwhelm. So I wanted to create a very straightforward and easy to do plan.

Dr. Weitz:            Sure.

Dr. Wentz:          And the whole second part of the book-

Dr. Weitz:            You don’t want to overwhelm them with 20 supplements to take.

Dr. Wentz:          Exactly. But I do have a section in the third part of the book on additional things to consider, such as doing more testing or additional deficiencies in what symptoms may indicate that you may need additional support.

Dr. Weitz:            Right. You talk about targeted supplements and the supplements that you focus on are adrenal adaptogens, magnesium citrate, saccharomyces boulardii, myo-inositol. There’s adrenal adaptogens are these herbs that can help modulate adrenal and other function in the body, but there are a lot of them. Which ones do you think are the most important?

Dr. Wentz:          I list out a few of them in the book, and some of my favorites are Ashwaganda. They can be very, very helpful for people with thyroid issues. They can actually normalize TSH in some cases. So I always recommend checking your thyroid hormone when taking that one. Rhodiola is another one of my favorites. It’s been studied in anxiety and depression.   Then there are ones that such as Maca and Shatavari that may be especially helpful for libido issues. So I would say those are some of the more common ones I use. I really like Reishi for people, especially in the evenings. It can be very helpful for giving people a little bit more energy, but also for helping them sleep well at night.

Dr. Weitz:            I’m assuming you’re using some formula that contains a combination of these?

Dr. Wentz:          Generally, for the average person that’s not sensitive to supplements, I may recommend something that contains adaptogens, B vitamins, and vitamin C in it so that they can have a really kind of just one supplement to take. For nursing moms or people that tend to be more sensitive to supplements, then I might recommend utilizing one adaptogen at a time like Holy Basal or Tulsi tea is a really fantastic adaptogenic herb that can be utilized by nursing moms. Although I always recommend checking in with a midwife or a lactation consultant.

Dr. Weitz:            And mag citrate?

Dr. Wentz:          This is going to be something that can be incredibly helpful for anxiety, for trouble sleeping at night, for pain in the body, for constipation. And generally, magnesium is involved in so many processes in our body, and it can be helpful for producing neurotransmitters for helping us produce GABA, which is our internal chill pill for helping us produce L-tryptophan so we can rest and sleep better at night. It is something that works so well for attention and cramps in the body.

Dr. Weitz:            And then saccharomyces boulardii, so this is a healthy yeast probiotic product.

Dr. Wentz:          This is one of my tweaks because a lot of times one of the triggers for getting in that stress response, not a lot of people are aware of, but it’s actually having gut infections. Whenever we’re stressed out, our secretory IGA in our gut is lowered. This is our natural defense layer in the gut. So saccharomyces boulardii helps to raise that natural defense naturally.   So then we can overcome these infections that are there. We can become less sensitive to the foods that we’re eating. We’re not as likely to catch infections. It’s helpful for candida. It’s helpful for various protozoa. It’s helpful for clearing out mold out of the body as well, and some pathogenic bacteria.

Dr. Weitz:            And then myo-inositol.

Dr. Wentz:          Myo-inositol is something that’s been really making the headlines in the last few years.

Dr. Weitz:            I typically have always thought of it as something for PCOS.

Dr. Wentz:          It has been used in PCOS, and it can be very helpful for that. In recent years, it’s been studied for people with thyroid issues as well. So it’s been shown to normalize TSH levels and get Hashimoto’s antibodies into remission. Now, not everybody, and it’s not going to happen for everybody, but it is such a profound effect that I always recommend testing if you are already taking thyroid meds. Because in some cases, especially in the early cases of hypothyroidism, this can help with normalizing that TSH.  It is something that can balance blood sugar, and that’s why it’s so helpful for adrenal issues, which are oftentimes correlated with blood sugar swings. It’s helpful for anxiety. It’s helpful for obsessive compulsive disorder as well. Generally, people will say they take it and they sleep better throughout the night because they’re not having as many blood sugar swings. So this is something that it’s become a recent favorite of mine. And there’s been a lot of incredible studies with all the benefits of this nutrient.

Dr. Weitz:            What is the dosage that you like for myo-inositol?

Dr. Wentz:          Around 600 milligrams for the adrenal purposes. There’s been doses higher than that, that have been used for things like obsessive compulsive disorder. For the purposes of the program, I’ll use about 600 milligrams. And that’s the dose. 600 to 700 milligrams has been studied in hypothyroidism.

Dr. Weitz:            Okay. I know for PCOS, a lot of products have a combination of myo-inositol and D-chiro-inositol.

Dr. Wentz:          Absolutely. I have a little bit of a note in my book that talks about utilizing that for PCOS too.

Dr. Weitz:            Oh, okay. Let’s see. You also mentioned L-carnitine.

Dr. Wentz:          Yes. Yes. So L-carnitine is a mitochondrial supporting supplement. It is incredibly helpful for people who have brain fog. It’s been studied in thyroid fatigue, about 2,000 milligrams per day or so is what we’re dosing it at. A lot of the people in my program, I’ve had about 3,500 people go through it. We have about a 92% relief improvement in brain fog in just those few-

Dr. Weitz:            That’s fantastic.

Dr. Wentz:          A lot of people do credit the carnitine for that because what it does, it does a lot of things, but it helps to move fatty acids into our mitochondria. So the mitochondria can produce energy. It helps us remove ammonia from the body. A lot of times we can have ammonia buildup from gut infections, from constipation, from gut dysbiosis, certain gene variations. And ammonia can be incredibly neurotoxic and cause brain fog. Carnitine can help with clearing that out of our bodies.

Dr. Weitz:            I listened to your interview with Hyman and that’s the first time I heard about ammonia as being an issue. That’s interesting. In Los Angeles, we not only have chlorine in our water, we have ammonia. It’s chloramine. If we’re drinking tap water and not purifying it like I do, we’re actually drinking ammonia. So I wonder if that could be a big issue as well.

Dr. Wentz:          Oh my gosh, I had no idea. I’ll have to look into that. I know it can be generally definitely produced internally, but potentially external sources. I always do recommend filtering water because you never know what’s going to be in your water supply.

Dr. Weitz:            You’re right. All the stuff we don’t know about, but that’s when they actually tell us they put in. You talked about mitochondrial support, and I noticed that the acronym of your book is ATP, which I’m sure is not by accident.

Dr. Wentz:          Oh yes, absolutely. So ATP is our body’s energy source, body’s energy exchange, how our mitochondria makes energy. Right? So this book is all about transforming your energy, all about transforming your life, creating vitality in your life. It’s a new take on adrenal. So I really focus on a lot of the nutritional aspects, some of the foundations that I’ve taken from old adrenal protocols, but I also have a big piece of mitochondrial support that I utilize.  And then transformational, personal growth techniques that really help us rewire that stress response. So we can take all the supplements we want and we can eat a super healthy diet, but if our mind is still stuck in survival mode because of past trauma or some of our wiring then we’re just-

Dr. Weitz:            Or if you spend all day on Twitter or in social media.

Dr. Wentz:          Or watching the news, right?

Dr. Weitz:            Right.

Dr. Wentz:          You’re going to be constantly getting this source of stress and danger, and that can be just from your own mind or from your own habits. So I really wanted to have a comprehensive plan for people to truly transform their stress response. So I have had adrenal dysfunction three times myself and I don’t want to have it again. A big part part of that has been really transforming my brain function and supporting my body and my mind.

Dr. Weitz:            That’s great. How can listeners find out more about you, your book, and your programs?

Dr. Wentz:          My books are available on Amazon, and Barnes & Noble, wherever fine books are sold. And then my website is thyroidpharmacist.com. I have a ABC’s guide for adrenals guide if people go to thyroidpharmacist.com/abc that I’d be happy to share with everybody.

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

Dr. Wentz:          Thank you so much for having me, Dr. Ben.

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way more people will discover the Rational Wellness Podcast.  I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica White Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

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Jeffrey Smith discusses The Dangers of GMOs and Glyphosate 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

2:27  Jeffrey Smith has been dedicated to speaking out about the potential dangers of genetically modified organisms since he heard a lecture 27 years ago by a genetic engineer who was blowing the whistle on Monsanto that was about to release its first genetically modified crops into our food supply.  Jeffrey runs the ResponsibleTechnology.org website and if you go to ResponsibleTechnology.org/takeaction before May 21 you can take action and add your voice to the discussion in the U.S. Department of Agriculture about how to regulate genetically modified organisms so we can prevent an apocalypse. Now Jeffrey is also speaking up about the dangers of GMO 2.0, which is the subject of the documentary Don’t Let the Gene Out of the Bottle, which is a 16-minute film, which happens to be at the website above.

6:26  GMO Foods.  Traditional GMO foods have a gene from another species transferred into that plant, but we now have have GMO 2.0, which utilizes the new gene editing tools to knock out genes or gut the genome in a place or two and hoping that when the thing gets reattached, it either adds what you want in or leaves out what you want and doesn’t bring anything in extra that you don’t want.  This involves a lot of wishful thinking and obviously a lot could go wrong.  Jeffrey has a six minute film at responsibletechnology.org/takeaction that discusses some of these dangers: Seven Reasons Why Gene Editing Is Dangerous and Unpredictable.  The biotech industry has been licking its wounds because the movement to limit and ban GMO foods has been successful at informing consumers, and doctors that it is not safe that we have been able to contain it to 12 genetically engineered food crops as opposed to Monsanto’s stated goal by this time to have 100% of all commercial seeds genetically engineered and patented.  What’s even scarier is that it used to take a long period of time and was expensive to genetically engineer foods, but now you can buy a gene editing kit from Amazon for a few thousand dollars and create your own GMO every day.

9:41  Monsanto convinced the White House that GMOs were safe and that GMOs were going to increase US exports and domination by the US in world food trade and they should be allowed on the market.  Monsanto were able to get a former attorney of theirs–Michael Taylor–into the FDA to create a pro GMO policy.

Jeffrey Smith is a global thought leader on the health dangers of genetically modified organisms for over 27 years. He has written 2 bestselling books, Seeds of Deception and Genetic Roulette, directed 5 documentaries, the most recent of which is Don’t Let the Gene Out of the Bottle in 2023 and Secret Ingredients in 2018. Jeffrey has given thousands of lectures all around the world and has counseled world leaders on six continents.  He is the founder and CEO of the Institute of Responsible Technology and he is now sounding the alarm not only about about GMOs and glyphosate but about GMOs 2.0.

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 dive into the topic of genetically modified foods and glyphosate, which are topics I’ve been wanting to discuss for a while, but did not have the right guest and now will be joined by the most prominent voice talking about the potential dangers of genetically modified organisms, Jeffrey M. Smith. Jeffrey is a global thought leader on the health dangers of genetically modified organisms for over 27 years. He’s written two best-selling books, Seeds of Deception, and Genetic Roulette. He’s directed five documentaries, the most recent of which is, Don’t Let the Gene out of the Bottle in 2021 and Secret Ingredients in 2018. Jeffrey has given thousands of lectures all around the world and has counseled world leaders on six different continents. He’s the founder and CEO of the Institute of Reasonable Technology.

Jeffrey:                Responsible Technology.

Dr. Weitz:            Oh yeah, Institute of Responsible Technology. Yeah, sorry. He’s now sounding the alarm not only about GMOs and glyphosate, but about GMOs 2.0, which I’ll explain. Genetically engineered foods have had their DNA changed using genes from other plants or animals. Scientists take the gene for a desired trait in one plant or animal, and they insert that gene into a cell of another plant or animal. Currently, in the US the main GMO crops are soybeans, corn, sugar beets, canola, and cotton. There are currently two approved GMO animals, the AquAdvantage Salmon and the GalSafe pig. Jeffrey, thank you so much for joining us today.

Jeffrey:                Thank you. Thank you, Ben. Great to be here.

Dr. Weitz:            What is your background, and how did you get involved in this particular field?

Jeffrey:                Well, I’m going to first say that a number of times during our conversation, I’m going to talk about some short films that we did and things that people can do to take action. So right at the top, I’m going to give the URL so that people can go back and realize it’s at the beginning.

Dr. Weitz:            Absolutely.

Jeffrey:                You don’t have to find it in the middle. So responsibletechnology.org is the mothership website, and if you do a /takeaction, then you’ll find out why I’m going to ask you to take action and what’s there, and there’s some films there and there’s some ways that we can prevent a apocalypse, things like that. All right. So you asked me the question, how I got into it. 27 years ago I was in a lecture by a genetic engineer who’s blowing the whistle on the technology Monsanto was about to release it in our food supply officially, and the genetic engineer said, “There is no way that Monsanto or any scientist on Earth could predictably genetically engineer anything and put it in the food supply without possibly causing allergic reactions, toxins, nutritional problems. There’s just no way. In addition, once you release it outside, it’ll cross-pollinate, and you have no way to recall it so you have just changed the gene pool forever. This technology is not ready for prime time and will not be any time in the seeable near future.”  So I decided to chip in a little and help with messaging and education and marketing and strategy, which is where I like to contribute. 27 years later and speaking in 45 countries and training 1500 people to speak on it, I contributed a little, and I continue to. We’re going to talk not only about what you introduced terms of GMOs and health and the environment and also glyphosate, but GMO 2.0 and how that actually puts us at risk in a cataclysmic way. I mean, way beyond anything that I’ve been talking about for 25 years. That’s a subject of Don’t Let the Gene Out of the Bottle, which is a 16-minute film, which happens to be at responsibletechnology.org/ takeaction.

Dr. Weitz:            I went there and I watched it.

Jeffrey:                Okay. Now I am ready to go deep. When I say deep, I mean, when I’m speaking at a medical conference, for example, or even at just a general health conference, and it’s a breakout session. So you get to choose. A lot of people go, “Well, I know GMOs are bad. I don’t need to go and hear about that.” If I am in a keynote and everyone has to hear what I have to say, then it’s like, “OMG, I had no idea. I thought I knew the dangers of GMOs. I thought I knew that they were bad, but I didn’t know this bad.” So we’ve convinced tens of thousands of practitioners to prescribe organic diets. We’ve had tremendous, tremendous impact. But it’s not like, “Oh yeah, GMOs, that’s another thing that could go bad.”  We’re going to look at some charts today that I’ll describe for those that are listening just by audio, and it’s going to be like, “I had no idea that switching to organic was the number one, the number one step for getting your health together,” and far distant from number two. I mean, we’re going to talk about all these very popular diseases that everyone’s getting and talking about and how they may be directly linked to your consumption of GMOs and the glyphosate, which is the chief poison in Roundup, in your food. So we’re going to raise some eyebrows today for people that haven’t heard this.

Dr. Weitz:            I just talked briefly about what genetically engineered foods are. Maybe you could put some more meat on those bones. Explain what genetically modified organisms are, why they were first developed.

Jeffrey:                Sure. First of all, you mentioned transferring genes from one species. That’s the traditional way, but there’s another GMO in town, and it’s gene editing. You don’t have to be transferring genes from other species. They’re still GMOs, but you’re going in there and you’re knocking out genes or cutting the genome in a place or two and hoping that when the thing gets reattached, it either adds what you want in or leaves out what you want and doesn’t bring anything in extra that you don’t want. So there’s a lot of wishful thinking. Another film, which is just six minutes called, Seven Reasons Why Gene Editing Is Dangerous and Unpredictable is also at that one page, responsibletechnology.org/takeaction because right now, just as an FYI, the biotech industry was licking its wounds because we have been so successful for these 25 years convincing and explaining to consumers why this stuff was not safe, and to doctors, to consumers.

                                People realized, half the world’s population realized that GMO foods were not safe, and it contained to about 12 genetically engineered food crops as opposed to Monsanto’s stated goal by this time to have 100% of all commercial seeds genetically engineered and patented. We’ve been able to keep it that way through education. So they come along and say, “Okay, squirrel, look the other way. We are using gene editing, but it’s not GMOs. In fact, we don’t use any foreign genes. We put it in there and it’s safe, it’s predictable, it’s even natural. In fact, it’s just what nature would do automatically, only we do it better.”   This concept that gene editing should get a pass has been the subject of a multi-million dollar gang-up lobbying campaign that convinced the American government, the British government, the UK, convinced Japan, convinced India, Australia, convinced Brazil, Argentina. They’re trying to create that same situation in the EU.   So all of the incredible benefits and successes that we’ve had over 25 years are at risk because … Now here’s an interesting thing, Ben. It used to take so long to genetically engineer and expensive and a lot of expertise. You can buy a gene editing kit for $2,000 and create your own GMO every day. We’ve given the keys to the kingdom to virtually everyone. Now, I’m getting a little ahead of myself.

Dr. Weitz:            I heard you say that. I’m still in shock over that possibility. I can’t believe that that’s legal. How is that legal?

Jeffrey:                Because of lies. I mean, if you go back, all right, we’re going to go back to the original GMO 1.0. Okay. How is it that something which, and I’m going to explain how it’s related to so many diseases that, I mean all the major diseases, how it’s possible that they could have allowed that on the market. Same question you asked just now.  It turns out Monsanto convinced the White House … They had a lot of friends there … That GMOs were going to increase US exports and domination by the US in world food trade. So the White House told the regulatory agencies, “Allow GMOs on the market very, very quickly. In fact, here what you’re supposed to do, FDA is bring in this man called Michael Taylor,” Monsanto’s, former attorney who had the plan. They created a new position for him. They never had a position of the Deputy Commissioner of Policy. They created it for Michael Taylor. When he was in charge, he was to create the GMO policy. He also created the FDA policy on Monsanto’s bovine growth hormone. So he created basically, fox in the chicken house.  The policy that the FDA created that’s still good today or still bad today, is that the agency isn’t aware of any information showing that GMOs are different than non-GMOs. Therefore, no testing is necessary, no labeling is necessary, and companies like Monsanto could put GMOs on the market without even telling the FDA. If they do tell the FDA, there’s a meaningless exercise at the end of which the FDA writes a letter and reminds them, “It’s your job to determine if your foods are safe, not ours.” So that is the policy created by Michael Taylor based on that sentence saying, “We know no difference.” That was all a fraud.  We realized … The policy came out in May 1992, and in 1998, my friend, Steve Druker, pioneered a lawsuit against the FDA. They were forced to turn over 44,000 secret internal memos. Then we realized that the overwhelming consensus among the scientists working at the agency was exactly the opposite. That GMOs were different, were dangerous, needed to be tested and should never have been approved.      Their predictions came true, their predictions that in fact this stuff is very dangerous and that people would just have the expectation that it’s been done 1000 times before, so no one really needs to test it, and that’s all the current situation. So we have gathered all the evidence that we could, and it’s like a smoking shotgun of evidence showing that GMOs and the Roundup sprayed on them … I’ll explain that in just a minute … Are probably driving tremendous number of diseases in the United States. We know that when people switch to organic, which doesn’t allow either, they get better from the same type of diseases.

Dr. Weitz:            Yeah, I went to the FDA website. This is what the FDA website states. “GMO foods are carefully studied before they are sold to the public to ensure they are as safe as the foods we currently eat. These studies show that GMOs do not affect you differently than non-GMO foods. Further,” the FDA website says, “GMO foods are as helpful and safe to eat as their non-GMO counterparts. Some GMO plants have actually been modified to improve their nutritional value. An example is GMO soybeans with healthier oils that can be used to replace oils that contain trans fats. Since GMO foods were introduced in the ’90s, research has shown that they’re just as safe as non-GMO foods. Additionally, research shows that GMO plants fed to farm animals are as safe as non-GMO animal food.”

Jeffrey:                This is basically fiction. This is a fictional story. Chapter one, once upon a time … Let me tell you what the actual FDA scientist said. We have the memos. This was from Linda Kahl, the Compliance Officer, summarizing the experience of the 17 scientists that were handpicked to create the policy on GMOs, which was overruled by Michael Taylor. She said, “The process of genetic engineering is different than conventional breeding and according to the technical experts at the agency leads to different risks. By trying to say that it’s the same is forcing a square peg into a round hole.”   Then Louis Pribyl, a microbiologist from FDA, when he got back the latest version from Michael Taylor, said, “What’s become of this document? It’s basically a pro-industry document that doesn’t address any of the side effects. It’s what do I have to do to stay out of trouble type document.”

                                Then the toxicological evaluation, the head of the toxicological department said that it’s justified to have at least a partial human toxicological studies on every GMO. Charles Guest, who was the head of the Division of Veterinary Medicine said, “The milk and meat from animals fed GMOs is different and can have specific unique risks.” Talking about bioaccumulation and things like that. They were very specific. What happened was even this completely sanitized pro-GMO version written by Michael Taylor, ignoring all the science, was sent up to the White House, the Office of Management and Budget, and the White House Counsel and another person came back and said, “No, no, no. It raises too many issues. It has too many pages dedicated to the environmental issues. We should emphasize that GMOs are safer.” As it went up the political chain of command, GMOs got safer and safer until we end up with this complete absolute moronic fiction.

                                I mean, I can give you some examples that are … I mean, when I speak to medical conferences, I’ll start off at the beginning and say, “Okay,” or any conference, “Tell me what percentage of organic foods you eat. How many, zero to 20, 20 to 40,” and I get a chance to see everyone’s hands up. For the practitioners, I say, “How many of you prescribe organic diets?” Very few people usually raise their hand. So at the end of 40 minutes of pictures of rat tumors and this thing and that thing and epidemiological evidence and plausible causative pathways between GMOs, Roundup and different diseases, I say, “And now, what percentage of your diet will be organic going forward? Zero to 20?” No one raises a hand. “20 to 40?” Everyone’s like 60 to 100%. “How many of you will prescribe organic diets?” All the hands go up.

                                I went back to some conferences where the doctors had actually started prescribing organic diets, and they said it worked. Our patients got better. I went to their offices, interviewed the patients, and it worked. Went to the farmers who took their pigs and cows off of GMOs and their animals got better. I looked at veterinarians both in terms of livestock and in terms of pets, and we also have the animal feeding studies.  So we have a bunch of diseases, which I’m happy to introduce at any time that we think are related to GMOs and Roundup, and we have a bunch of individual reports and clinical trials, clinical experience of people getting better from these same diseases or their precursors. We have the animal feeding studies and the experience of the vets and the doctors. I can describe why we think GMOs and Roundup are driving diseases like nothing else, and the main thing is switch to organic.

Dr. Weitz:            Right. So let’s go into that. My understanding is a lot of these genetically modified foods are, like the corn and the soy, are genetically modified to be resistant to Roundup so then they can just indiscriminately spray this herbicide all over the food.

Jeffrey:                Yeah, let me explain that. Well described. Roundup kills virtually all the plants. It also kills a lot of microbes. It’s an antibiotic. If you were to spray it over your field of soybeans or corn normally, you’d kill it all. So you have to spray it before the emergence of the crop or just spot spray it on weeds. But Monsanto’s patent on glyphosate, which was the chief poison in Roundup, was going off in 2000. They wanted to maintain sales so they genetically engineered seeds, soy and corn, then cotton, canola, sugar beets and alfalfa to create plants that would withstand and not die when sprayed with Roundup. So they call them Roundup Ready. So the Roundup Ready soy, as a farmer, you buy the seeds, you sign a contract, “I’ll only use Monsanto’s glyphosate based herbicide.” So they ended up continuing their domination of glyphosate even though it’s off patent.

                                Now the farmers can weed really easily. They can weed after their crops are growing, and then new weeds come up and they just spray right over the top. One application, two applications, three applications. Now, glyphosate by itself is not as toxic as Roundup because Roundup has all sorts of other things, including a surfactin that drives it into the tissues of the plants. Now, it also drives it into human skin. It also can drive it through clothes, even through boots.

                                In fact, Monsanto was required to turn over evidence of how much absorption into human skin was taking place. So they took the human cadaver skin and they put Roundup on it, and they found it was over three times the allowable level of absorption. So they threw that information away, hid it illegally from the EPA, and then they decided to do a Monsanto version of a study. I love how Monsanto science is. This is typical. This is typical, Ben. Monsanto took human skin from a cadaver and baked it in an oven. Now you know what happens when you bake meat? It gets harder and harder and harder. It wasn’t good enough. They probably tried it. It wasn’t good enough. They took this baked, overcooked human skin and then they froze it.  Then they took this leather-like result of human skin and applied Roundup, and there was hardly any absorbed. So they reported those numbers to the EPA, omitting that, I don’t know, that inappropriate fact that they had baked and frozen human skin before they applied the Roundup. That was hidden. They never mentioned that there was no asterisk, by the way, this has no resemblance to human skin. So this is a Monsanto type study.

Dr. Weitz:            So it potentially would not have even gotten approved if they-

Jeffrey:                Oh, no. Oh, no. There’s so many ways that they manipulated data that none of this stuff would’ve gotten approved. So now you spray it over the crop and it drives the glyphosate poison into the soybean plant. Then it gets 15% or so in through the roots, damaging the soil below, and about 80-85% that stay in the plant, mostly in the food. Now, we eat that food. Now, glyphosate is no friend to the human body. Now you’re a physician, and I’m going to describe some of the things that glyphosate does, and you’re realizing that I’m actually checking off a checklist of the foundations of health and that any one of these could lead to many diseases, if not a vast number.

                                Glyphosate was originally patented as a chelator to descale industrial boilers and pipes. So it grabs onto minerals and doesn’t let go. So the first thing it is is it deprives our body of minerals. Second, it creates leaky gut. Third, it kills off beneficial gut bacteria, but not the nasty stuff. Four, it can block the production of serotonin, melatonin, and dopamine. Next, it can damage aromatase, which sets the balance between the estrogen and testosterone. It can damage and collapse the structure of mitochondria, which are the energy centers in our bodies. It can cause gap junctions, which is the way cells intercommunicate. It knocks that out by 50%. It blocks the detoxification pathways of the body, both the NRF2 going down 30%, and the P450 cytochrome pathway, CYP enzymes that operate in the liver. It causes damage to the microvilli in the intestines. It blocks the production of, not completely, but it suppresses the production of enzymes in the gut to break down food. It causes birth defects, oxidative stress, and genotoxicity, and is declared a Class 2 carcinogen by the WHO.

                                Now, that’s like you name a foundation of health, and it’s taken care of by this Darth Vader chemical. It is just slashed and burned. So now when you’re spraying soybeans or corn, Roundup Ready corn, with Roundup and you feed it to rats like Monsanto did, and there was 50 statistically significant changes that they said, “Oh, they’re not a problem,” and it was only 90 days and they sent it to Europe. This guy, Seraline, who was reviewing for France, said, “This is a lot of problems, and these show preliminary evidence of damage to liver and kidneys and preliminary evidence of a lot of things.” But they cut the study off in 90 days, and they didn’t do all the tests that they should have done to see if these things were serious. In fact, they did pretty superficial studies.

                                So he took the same type of rats, the same rat size group, the same amount of GMOs in the food supply sprayed by Roundup and fed them for two years. They had multiple massive tumors. The tumors started at 120 days right after they finished the 90 days, the first tumor started. So they had multiple massive tumors. Some of them were like 25% of the body weight. They killed the animals because it was considered suffering after that point. They had organ damage and they died early. Now, was it the corn, the Roundup Ready corn or the Roundup? They figured out before they even started to have more than one experimental group. So one group were fed the Roundup Ready corn sprayed with Roundup. Another group was the Roundup Ready corn that was never sprayed with Roundup. A third group, actually, many groups had just Roundup at varying levels in the drinking water, eating natural corn, and then they had a control.

                                It turns out all of the groups had multiple massive tumors, early death and organ damage, whether it was the Roundup alone, the GMO alone, or the two together. The only group that didn’t was the control group. So we understand more about how Roundup does the killing and whatnot because there’s more research on it, all those things I just described. For GMOs, because the FDA said we don’t need any testing, there’s just a handful of studies. But that handful of studies show potentially pre-cancerous cell growth in the digestive tracts, smaller brains, livers and testicles, partial atrophy of the liver, damaged immune system changes in virtually every organ and every system studied. So we have an idea. So what I’d like to do, Ben, with your permission, is walk us through some of the evidence.

Dr. Weitz:            Absolutely.

Jeffrey:                All right.

Dr. Weitz:            Please do.

Jeffrey:                So I’m going to share a screen in just a moment, and this is a amount of Roundup sprayed on soy and corn in the United States in a graph showing the slope. Other slides that I’m going to show, it’s both the amount of Roundup sprayed on there, and also the amount, what percentage of GMO soy and corn there are because it’s basically the same. You only spray Roundup on soy and corn if it’s GMO, at least the volume that we’re talking about.

Dr. Weitz:            I just want to say to all the listeners. Anybody who’s listening to this on your phone, when you get home, go to YouTube and watch a YouTube video and go to my Weitz Chiro page and you can see the slides.

Jeffrey:                These are plotted against rises in specific diseases. So for those who are not going to see it, and I haven’t started showing it yet, the correlation is pretty tight. A perfect correlation is one. These correlations are like 0.9. I’m looking at one like 0.93, 0.97, 0.96. It looks like the two are sloping up together. All right, so let me share my screen.

                                What we’re seeing first is inflammatory bowel disease. You could see this is the discharge rate per 1000. Now, I’m going to go through a lot of charts very, very quickly. I’m going to name the disease, and you can just look at the slope. For those that are not looking, I’m just going to name the disease. Your friends watching, their jaws are dropping going, “OMG.” Just acknowledge that these things do look like they’re related.

                                Here’s deaths from obesity, anxiety, diabetes, deaths from Alzheimer’s, deaths from Parkinson’s, deaths from high blood pressure, autism in six-year-olds, insomnia, celiac disease, acute kidney injury, death from kidney failure, kidney and pelvic cancer, liver cancer, liver and bile duct cancer, thyroid cancer, that’s from acute myeloid leukemia, breast cancer, that’s from intestinal infection, deaths from disorders of lipoprotein metabolism, peritonitis, hepatitis C, dementia, deaths from senile dementia, ADHD, schizophrenia, suicide by overdose, birth defects, and there’s a lot of birth defects here, heart defects, newborn metabolic disorders, newborn genitourinary disorders, skin disorders, newborns with lung conditions, eye disorders, blood disorders, plus general [inaudible 00:29:28] anemia, lymph disorders, deaths due to stroke. In this final slide, and I’m going to come back to this in just a minute because I want to introduce this, so first of all, all of those charts are devastating, but they don’t prove causation.

                                You can run two things together and say, “Hey, see. A causes B,” but you can’t tell that A causes B. So you need other information. If we just have that, it would be kind of weak evidence. It would be stunning in its coincidence, in its correlation. But you can look at those particular disorders, and we can find supporting evidence from animal feeding studies showing often the precursors to those when animals are fed GMOs and Roundup. You can find plausible causative pathways. What is it about GMOs and Roundup that are causing that? For example, you saw insomnia. Insomnia is often governed by the amount of melatonin you have. Melatonin comes from the amount of serotonin available. Serotonin is created by L-tryptophan, which is produced by your gut bacteria in a metabolic pathway called the shikimate pathway. The shikimate pathway is disabled by glyphosate. Straight line. Straight line.

                                If you don’t have enough serotonin, that could explain some of the ADHD and the anxiety and all that stuff. When we talk about digestive problems, there’s probably 40 or 50 things influencing that. Speaking of digestive problems, in 2009, I went to the American Academy of Environmental Medicine. I’ve been speaking there every year. The GMOs and Roundup influence on different diseases. Each year they focus on a different disease, allergies, cancer, and I was just basically putting all the evidence together, showing is it possible that GMOs and Roundup might affect those diseases. Sure enough, there was a lot of evidence. So a lot of these doctors started prescribing non-GMO diets, and they’re the ones that first told me this was influencing people. Before then I was, I’m embarrassed to say, I didn’t really believe people when they came and said, “I can notice if I’m eating GMOs or not.”

                                But these doctors are saying, “Oh, no, it’s quick.” In fact, this one doctor, Dr. Emily Lindner, had put 5,000 patients on non-GMO diets and said, “Yeah, anxiety and depression goes away kind of right away. Asthma and allergies, three to seven days. Digestive disorders within about two months, and then you have to rebuild it. So maybe two years for the digestive.” I was blown away, and I interviewed some of her patients. So I started getting bold. Around 2012, when I came out with Genetic Roulette, I started asking audiences, “Okay, how many of you who are in the 60 to 100% non-GMO, how many of people noticed changes in your health?” A bunch of hands went up. Almost everyone in that category. All right. “What did you notice?” People would tell me, “Oh, I got acid reflux that went away,” or less weight or kidney disease.

                                I’d always say, “All right, who else noticed a change in this area?” I’d get a sense of the number of hands. In 150 lectures, including about two dozen medical conferences where they were referring to their entire practices’ results, the number one result was always digestive disorders. The number two was always the combination, I’d say increased energy and reduced brain fog, always number two. There was about 28 different conditions that I tracked. So I wrote it up in a survey and sent it out to … At the Institute for Responsible Technology we have subscribers, and 3,258 people responded.

                                This particular screen that I’m now to share is the summary of what we found in those 28 different conditions. 85% reported improvement in digestive problems. This was peer-reviewed and published in the International Journal of Human Nutrition and Functional Medicine. 60% said reduced fatigue, 55 reduced obesity, 52 reduced brain fog, 52 reduced anxiety and depression, 50 food allergies and sensitivity. Then below 50% going down to just 1.4, you have memory and concentration at 48, joint pain, seasonal allergies, gluten sensitivity, insomnia, skin conditions other than eczema, hormonal problems, musculoskeletal pain, autoimmune disease, eczema, high blood pressure, asthma, menstrual problems, diabetes, mental disorders other than anxiety and depression, underweight, cancer, kidney disease, infertility, autism, Alzheimer’s and Parkinson’s.

                                So it’s interesting that many of these are the same ones or similar to the ones that are on the rise in the US population now. That’s basically the general population that eat more than their body weight in GMOs every year going up with the increased use of GMOs and Roundup in the United States. These are people who opt out of that experiment and get better from many of these same disorders. Then we have veterinarians like Barbara Royal, who’s Oprah’s vet, she said when she went to veterinary school, they didn’t even talk about dog cancers or dog allergies. Now it’s all over the place. One out of every 1.6 dogs have cancer, I’m told. She said, “I got a sense that maybe it’s the food and the GMOs and the Roundup. So very tentatively, I’m kind of scared. I put the animals on a organic diet, and now everyone goes on an organic diet,” or at least the diet that doesn’t have GMOs and Roundup, and she said, “80 to 90% are all managed by the next visit. They don’t even need anything.” 40%-

Dr. Weitz:            That’s incredible.

Jeffrey:                Completely healed. What I’m saying is if people don’t know whether what they’re experiencing, and that they may have been part of this disease list, maybe they’re not, if you switch to organic, you may be fixated on, “Oh, I want to lose weight,’ or, “I’ve got diabetes, so I’m going to check my blood sugar,” or, “I’m going to check insomnia.” You may be focused on one thing. I suggest that you focus on everything by taking notes. Get a spreadsheet and start with what percentage of your diet is organic. Start today, zero or whatever it is. Put your energy level, your mood, one to 10, and all your symptoms, the date. Then the next day, percentage organic everything, Move right along. Three or four weeks, see what happens.  Some people will notice that if they go on vacation and they cheat and they go out to eat, things go back. In the movie I did with Amy Hart, Secret Ingredients, these doctors say they got excited when their patients cheat because then their autoimmune disease symptoms come back, their joint pain comes back, and then they don’t cheat again because they realize that was the reason. So you don’t have to get to that level. You can just do it and see what happens. I would say that is one experiment where the payoff is huge.

Dr. Weitz:            Not only when you consume these genetically modified organisms, corn, soy, et cetera, but they spray Roundup on a lot of crops just to dry it out before we eat it.

Jeffrey:                Exactly. So that’s why, Ben, I used to say to people, “Eat non GMO, and if you can, eat organic because you’ll avoid the other poisons.” Now I say, “Eat organic, and if you can’t, at least eat non-GMO, but also avoid the foods that are sprayed with Roundup heavily that are not GMO.”

                                So let me unpack this. I think it was about 2006, Monsanto was looking to sell their Roundup herbicides to other farmers. They said, “Okay, wheat farmers. Spray your wheat three to five days before harvest.” Now guys, we’re spraying something that’s going to kill your wheat, but it’s going to kill it slowly, and it’s first going to dry it down. So when you dry it down, it actually helps in terms of not getting moldy, but also the plants start to die and they say, save our kids, send all the energy to the kids, which is the grain. So it forces the ripening of the grain. So it fast paces the ripening, it dries down the harvest, it kills all the weeds for next year. It’s called staging, and then you just harvest it and feed it to people with a massive amount of glyphosate in the wheat.

                                So right now, wheat is not GMO, except there’s a crop that came out of Argentina last year. Don’t eat Argentinian wheat unless you know it’s organic and non-GMO. But in other cases, it’s not been GMO, but it often is sprayed with Roundup. One of the worst is oats because it’s like a sponge. Then you have the lentils and the mung beans and the chickpeas. Don’t eat hummus unless it’s organic. You see, organic does not allow either GMOs or Roundup to be used, so that’s why I keep emphasizing organic. If we just said non-GMO, you’d still be having bread and oatmeal and hummus and things like that that could be loaded with Roundup. If you go organic, you also avoid other things like atrazine and all these other nasties.

Dr. Weitz:            I did a little research, and not only is there glyphosate, but there’s also heavy metals like arsenic present in Roundup.

Jeffrey:                Oh, yeah. The surfactin is about 1000 times or maybe 10,000 times more toxic than glyphosate alone. Some of these other co-ingredients are hormone disruptors and are toxic. Yeah, it’s pretty nasty stuff. I mean, the impact of glyphosate alone though cannot be understated. They had parts-per trillion that caused non-alcoholic fatty liver disease in rats. This was the most sophisticated research showing that it was causal. Not like it suggests, but glyphosate causes non-alcoholic fatty liver disease, and at tiny amounts. So tiny in fact, that if you calculate the amount per body weight of these rats per day, the EPA allows 437,000 times that amount in our water supply.  So we’re eating it. Now 30, 35% of the US population has non-alcoholic fatty liver disease, and they have glyphosate in their urine. Those that have the worst version of the non-alcoholic fatty liver disease have more glyphosate in their urine. That’s another study.

Dr. Weitz:            Wow. We’re expecting Americans to have a tsunami of liver failure as a result of this increase in the non-alcoholic fatty liver.

Jeffrey:                Absolutely. And liver cancer, cirrhosis, all that stuff. It’s a pretty remarkable world that I live in because I hear, maybe more than anyone, people with such a variety of diseases and disorders coming to me saying, “Guess what happened to my,” whatever. “My restless leg syndrome went away.” heard that. It was like someone says, “I can tell there’s a change in my urine just whenever I eat a GMO. I could see the bubbles.” It’s like the veterinarian could see the difference in the processing of his kidneys when he eats a GMO or not, and instantly.

                                So yeah, I mean, I’ve heard this from so many people, and I would say, you don’t have to understand the details. In fact, I don’t go slow enough in an hour-long conversation with you so that people can rationally expect to understand all the details if they understand the patterns and they see the plausible causative pathways between the shikimate pathway and the neurotransmitters, and they see the pathway between the genotoxicity and the oxidative stress and the leaky gut and the gap junctions and cancer. All those are cancer-causing.

                                You see, and we know, for example, Non-Hodgkin’s lymphoma is deeply connected, and that’s from the bone marrow, and that’s where the glyphosate residues end up and hang out there for a long time. So we can break it down. My main point is I’m not trying to give people the ability to give a talk on it. I do do that, and it takes eight hours to really understand it all. I just am wanting to give people enough information to go, “Oh my God, did you hear that? We have to make a change in our diet.” The number one convincer is the movie, Secret Ingredients at secretingredientsfilm.com. That shows people who are on the spectrum, who are no longer on the spectrum or infertile, who now have kids, who were overweight, who had brain fog, who had allergies, and they transitioned out and they went, it was organic A to B. Boom.

Dr. Weitz:            I learned from your website that I remember back in the ’80s when the FDA took tryptophan off the market and it’s still off the market, and that was actually a result of genetically modified, the way they produced a tryptophan.

Jeffrey:                Well, it is back on the market. But here’s an interesting thing. The FDA, if you look at the documents that were made public because of that investigation, they were trying to promote pharmaceutical drugs and tried to suppress the sales of competing herbs and amino acids and other things. So they were wanting to get tryptophan off the market, but they couldn’t. Then along comes a genetically engineered variety from a company called Showa Denko KK out of Japan that caused about 5,000 to 10,000 people to fall sick, and about 100 people died from this horrible disease. It was only that company’s brand that was causing the disease, and only that company was genetically engineering the bacteria that was producing the tryptophan. So what did the FDA do? They blamed it on all tryptophan. When they testified before Congress, they never mentioned that genetic engineering was involved.

                                Tryptophan was used for calming and insomnia. That was taken off the market. Then comes Prozac, or I think that was the thing that came in at that time. Sales come up heavily, and the FDA took it off the market saying, “Oh, that was causing the problem.” They didn’t even take it out of baby formula or IVs. It was like, if it’s going to really cause problems, you’ve got to really take it off the market. So it was even a bad coverup. They never got the strains and brought them over to the US to see, because there was five to six contaminants that were found that were between 0.1 and 0.01%. I mean, we looked at that. In fact, one of my friends who passed away, Bill Crist, was the chief investigator for years and turned over all of his notes to me before he died. I published that in my book, Seeds of Deception, and then summarized it in Genetic Roulette. What’s interesting here, Ben, and I do want to jump to the GMO 2.0 before we run out of time.

Dr. Weitz:            Yes.

Jeffrey:                But what’s interesting is, it was causing an epidemic, and it was an epidemic with 5,000 to 10,000 falling sick. The only reason that it was discovered was because the disease had three simultaneous characteristics. It was fast-acting, it was acute, and it was rare. Now, if any of those things were not in place, if it was not fast-acting, if it took months to show up, no one would link it to a food supplement on the market. If it was not rare, someone just got more colds or something, kidney disease, something that’s already out there, they were just treated. People don’t say, “What supplements are you taking?” They don’t pay attention.

                                It was acute and it was serious, so it forced people to go to the hospital or to doctors, and this had all three. It was a absolute disastrous disease that caused paralysis that progressed, pain that was off the charts, and no one had ever seen it before, and it was still almost missed because no one was talking about in the literature. It just happened to be that one doctor had two patients with it. That coincidence. They checked everything they were taking. There was one thing that both were taking, and that was L-tryptophan. In fact, if one of them had an L-tryptophan from a different company, they wouldn’t have gotten sick.

                                But anyway, that was what caused the investigation to identify it. So that means that the foods that are on the market, the GMOs and whatnot, may be causing diseases and have been just as was predicted or concerned by the FDA scientist, massive diseases, all this whole list of diseases could be going up because of GMOs and Roundup, but it’s not fast-acting, acute and rare. These are common diseases that are happening. So it’s not that it’s easy to figure out the cause when it’s a food, because when you go to the doctor and say, “I have cancer,” they don’t say, “Oh my God, what have you been eating?”

                                They don’t look for that. There’s a certain set of circumstances that will then cause an investigation, and then research and then additional research. There’s a certain way that it becomes epidemiologically identified. But if it’s simply in the food supply, it can be missed forever. So the main takeaway of this L-tryptophan is that that demonstrated that genetic engineering might cause serious diseases and that they can be missed.

Dr. Weitz:            I’ve been preaching organic for years, and people say, “Well, can I really trust organic?” My answer’s usually, “Look, I’m sure it’s not perfect, but it’s going to be a lot better.”

Jeffrey:                I would say that is an excellent, excellent answer. There is occasional fraud. But if you go to responsibletechnology.org, you can actually see a glyphosate residue report. The FDA tests all the insecticide and herbicide residues on foods except for glyphosate because they’re friends in Monsanto convinced them that it was harmless. So we have to basically take our studies and other NGO studies, non-profit studies, we put them all together in one database, go to our site, and you can look at all at the foods. Those that are organic are almost always very slight amounts of glyphosate or non-detectable. Now, why would it be slight? Because there’s so much glyphosate being sprayed. It’s in the air, it’s in the water, it’s in the rain. The US Geological Survey founds glyphosate in 60 to 100% of the air samples and rain samples in the Midwest. In Mississippi, it was 75%. So you can’t avoid it completely, but you want to minimize it.

Dr. Weitz:            Very, very scary. So let’s go into GMO 2.0.

Jeffrey:                All right. Now I think we have given the problem and we’ve given a solution, and the solution is eating organic. This has been the focus of our institute to get consumers to realize-

Dr. Weitz:            And also try to contribute and lobby to have genetically modified foods taken off the market and be labeled, et cetera.

Jeffrey:                Right. That’s in addition. But for those listening, the first thing is protect yourself and your family. If you have energy left over and time and money, contribute to the cause, et cetera. So that was sort of the messaging for 25 years. Then along comes GMO 2.0 and it’s given a free pass by all these governments.  One of the examples of 2.0 is gene editing. You’ve heard of CRISPR. Now CRISPR may ultimately be useful for clearing off a defective gene for someone that has a genetic disorder. It has all these side effects, so much so that the prominent journal, Nature, called the side effects chromosomal mayhem. I mean, massive damage, and they’re going to try and fix it, and maybe they will. I’m not against the use of this when it’s applied to an individual with consent who’s aware of the dangers. Sometimes human gene therapy does work, and sometimes it kills people.

                                But we’re now using the same accident-prone technology … The most common result of genetic engineering is surprise side effects … And we’re putting it into the food supply. We’re putting organisms into the environment where they cannot be recalled. Now gene editing is so cheap, it’s like a gene rush, Ben. We know what a gold rush is. You have all these people going out in a Wild West scenario. Now we have all these individuals, companies, students, well-wishers, wanting to genetically engineer things, to patent them and to solve problems of nature. The thing is, if you multiply all of this enthusiasm into actually giving people these kits and these labs, and you give them the keys to the kingdoms and they change the gene pool, then eventually maybe this generation, we will have fully corrupted nature’s gene pool, replaced nature, and no future generation can inherit the products of the billions of years of evolution. But instead a hybrid somewhere between nature and manmade constructions. Now, this is a potential catastrophe.

Dr. Weitz:            Yeah. Very, very scary.

Jeffrey:                Of all of the organisms that you can genetically engineer, I’m going to ask you a question, which do you think are the most dangerous?

Dr. Weitz:            Well, I don’t see what could go wrong if we were to modify the DNA of a virus.

Jeffrey:                Yeah. Why not?  All right, so let’s make it even a broader class. Let’s talk about microbes. So we take microbes. You know and many of your listeners know, they hear the word microbiome and they go, “Oh, that’s important. That’s the thing. That’s the in thing now.” We’re discovering after the millennia of our history that this micro Jedi army inside us is largely responsible for the state of our health, whether we’re fat or skinny, even some of our desires, our moods. 80% of diseases I’m told by my friend Karen Christian, who’s an expert, comes from changes in the microbiome. It turns out Roundup kills off beneficial stuff in the microbiome in such a way that I went through these same 28 different conditions with Karen Christian. I said, “Can the changes that you saw in the human gut from Roundup explain any of these?” All of them. All 28 of them.

                                So now we realize the microbiome is mission-critical for humans. When there’s less microbes in the brain when we reduce them, IQ goes down according to my friend Dietrich Klinghardt. Now, the microbes in the soil sequester carbon, promote health, create nutrient density. Algae’s a microbe. It produces 70% of the Earth’s oxygen. That’s a lot. The fungi on the soil shuttles nutrients between trees and allows the small trees that don’t have sunlight to grow because the mother trees give them the nutrients. How? Through their friends, the fungi, which are microbes. The microbes are amazing. Now, they have co-evolved with us so much that we actually have a situation where in the second trimester of humans, milk-digesting bacteria move into the birth canal to inoculate the newborn, and then a lot of the milk that comes from the mother is indigestible by the infant. It’s designed to feed the microbes, and the health of the baby is reflected in the salivary microbes, which feedback through the breast to the mother, which change the formula.

                                I mean, it is so important that these nuanced changes are mind-blowing, and I haven’t even gotten into some of the details. So this co-evolution is such that we have outsourced 90% of our everyday metabolic and chemical functions to these critters. We can get away with a measly 23,000 genes, less than earthworms because we use the genetic information of 3.5 million genes in the microbes living inside us. There’s 10 times more than, actually more than 10 times, compared to the cells inside our body.

                                Now, along comes a high school student, a high school student who has a CRISPR lab in his biology class, and he can order from 10,000 different microbes online or 120,000 different targeted gene sequences to tell the CRISPR where to cut. Or he can order his own gene sequence, or he can pick up microbes from his own gut or his own poop. Or he can take it out of the swamp near his house. Then he can CRISPR it and then take it for a walk. Now, let’s suppose it survives, lives long, thrives, multiplies. First of all, they replicate faster than cows. They replicate very, very quickly. They travel. We know that. We didn’t need a pandemic to know that microbes travel and mutate.

                                Most people don’t realize that microbes also exchange genes. They’re very promiscuous. Just bacterial sex. It’s actually this flow of genetic information through the microbiome that allows the entire microbiome to adjust and adapt to support ecosystems and to be supported by them. So the same random act of weirdness by a high school student now ends up in 10,000 different types of microbes and 100,000 different ecosystems, including inside human bodies, making changes that were never part of the co-evolution, causing possible human health issues or collapsing ecosystems in the environment.

                                Then you have companies like Bayer Monsanto … Bayer bought Monsanto, whose joint venture with Ginkgo Bioworks is creating nitrogen-fixing microbes for the soil. Now, there’s many reasons why you don’t want to release genetically engineered nitrogen-fixing microbes. Now, one is, what happens if it gets washed into the Mississippi and then it transfers those nitrogen-fixing microbes into algae, and now you have algae that can produce its own dead zones? We don’t know if that’s a possibility, but we may end up with nitrogen-fixing microbes inside us. Or what about the survival mechanism built into those nitrogen-fixing microbes, which probably kill off other microbes and have antibiotic resistance so that they survive? That’s like a tank. So you put the trait inside the tank, now the tank gets transferred inside our gut bacteria, and now it’s surrounding a pathogen killing off other bacteria, resisting the death by antibiotics, and you’ve now changed the population of our pathogens in our gut because of this nitrogen-fixing microbe.

                                Now, it gets worse. If you go to, guess what that URL is, it’s responsibletechnology.org/takeaction. If you go to, Don’t Let the Gene Out of the Bottle, as you saw, there’s some well-meaning scientists that said, “Let’s take a natural soil microbe that’s on the roots of every plant on the planet and turn it into a alcohol production factory and give it to farmers so they can rake up their crop residues and put it in tanks with the genetically engineered bacteria and turn it into alcohol to run their tractors and put the nutrient-rich sludge on the bottom on their fields.” Well, as you’ll see, I’m not going to be a complete plot spoiler, but according to a scientist involved, if it hadn’t been stopped by research results of her graduate student, that seemingly well-meaning thing might have ended terrestrial plant life on planet Earth. I hate when that happens.

                                But we don’t know if it would’ve happened. We don’t know if the other one mentioned in there would’ve altered weather patterns forever, but it’s potentially there. So now what I’m talking about is if every high school has a CRISPR kit and all these college students use CRISPR and all these entrepreneurs and organizations use CRISPR, and they’re releasing these microbes in the environment, millions of varieties each year, what’s going to happen to our nature? What’s going to happen to our health? Right now on responsibletechnology.org/takeaction, we have a response to the USDA’s draft guidance on how to get a permit to genetically engineer microorganisms. Their take on what’s considered to be safe is so 50-year-old science. Maybe, all right, I’ll give them the benefit of doubt. 20-year-old science. Maybe.

                                They have a comment period, and I want to suggest that everyone go there and add your name to the comments so they see it’s not just the Institute for Responsible Technology, but it’s 1000 of our closest personal friends or 10,000 of our closest personal friends, and we’re going to send you also after that updates and other action steps because we have even bigger fish to fry because we’re now starting a new global movement to protect the microbiome. We’re going to have various opportunities for people to use their networks to support us, et cetera. I do strongly recommend people make a recurring donation. For the healthcare practitioners who are listening, very shortly, maybe by the time you visit the site, we will have a healthcare practitioner program. So you support us and we give you all this information, train you how to speak, give information for your practitioners.

                                If you’re a company, we have a way of getting information out to your customers. You can be part of [inaudible 01:01:20]. We have all sorts of things we’re working on now, and we’re just held back right now by the amount of staff we can afford. So we need a little more money to get a little more staff so we can get a lot more money, so we can get a lot of staff, so we can get a big global movement. Now, here’s the good point, Ben. Which movements out there might be good allies to us? Which movements and campaigns are needing a healthy microbiome? Certainly human health, certainly regenerative agriculture, certainly carbon drawdown for climate change, because most of the heavy lifting are the soil microbes, certainly all the environmental groups including the oceans. Even the Indigenous people who think GMO means God Move Over, they are on our side.

                                Even national defense is freaking out about the availability of CRISPR kits and the ability for some purposeful or random accident. So we have an opportunity to create a movement of movements at a time just after microbes wreaked havoc on the world population and economy. The receptor cells of the planet are open just at this time when we need to lock down GM microbes and say, “Not on our watch.” In fact, never should we allow the random release of GM microbes in the environment knowing what we know about the nature of microbes, the nature of microbiomes, their supportive ecosystems, and the accidental and unpredictable nature of genetic engineering.

Dr. Weitz:            So what’s the possibility that we could stop letting all these groups and individuals have their own CRISPR technology?

Jeffrey:                Well, I’m guessing, Ben, that in the last 12 minutes, when I started talking about, maybe even eight minutes, when I started talking about the microbes, that nearly everyone who was not distracted by driving in traffic understood what I was talking about. They’re like … In my day, there was a TV commercial, the Memorex commercial, where someone would listen to Memorex and their hair was going straight back like they were in a windstorm. I could see people after hearing this, they’re like, “Oh my God, we’re doomed.” But the thing is, one of our greatest assets is that it’s so easy to explain. It’s not as hard as climate change. It’s not as hard as DET, glyphosate. It’s like microbes are running the universe here. They run our health. You release a microbe, it may change it in ways that are unpredictable. We don’t even know what 99% of the trillion microbes out there are doing, and yet we’re going out to make permanent unrecallable changes. Probably not a good idea. That took a minute. Right, right. Here’s an example of something that almost took us down.

Dr. Weitz:            And that’s if the humans that have this CRISPR technology actually have good intentions. As we know, human beings would never try to harm each other.

Jeffrey:                Oh, no. Well, fortunately, we’re all well-meaning people that are ethical. Maybe Monsanto may … Anyway, so the point is, we have to go after the governments to make changes. If it’s me knocking at the doors of government and it’s Monsanto Bayer with its massive lobbyists, I’m not going to get very far. If it’s these movement of movements with popular culture supporting and school curriculum enlightening the children and creating an awareness of this, then we get to make a change in human collective consciousness, which is absolutely necessary right now. As a physician, you are most clearly aware that sometimes a very serious diagnosis or prognosis becomes the wake-up call that turns into the person’s biggest blessing.

Dr. Weitz:            Correct.

Jeffrey:                This is one of those. This is like guys, we have now reached that inevitable time in human civilization where we can irreversibly redirect the streams of evolution for all time, ending biological evolution as we know it. Even a single one of us who goes to high school can make the wrong move and cause the cataclysm. So now that we realize that we have that capacity, it means that we have a new responsibility. That new responsibility means we have a new relationship with nature. We can’t just be going side by side saying, “Yeah, whatever. Just continue.” We have to be stewards. We have to be protectors. We have to protect it in such a way that it becomes a permanent feature of human civilization.   That’s why I talk about curriculum, so that just like every child reads about pollution and climate change, now every child needs to know about we cannot play with the gene pool in this haphazard way. We have to protect nature. So this is an opportunity to influence collective consciousness. I don’t believe that consciousness is linear or local. I think that we’ve seen times in human history where civilization jumps up, leaps forward with new inputs and a certain number of people getting it. I think it’s happening quickly right now, and I think this is an example of something where we need to leap forward. So all of a sudden, in some short time people say, “Oh, remember that time when we were simply allowing anyone with a CRISPR kit to introduce an organism? Wasn’t that silly?” We haven’t gotten there yet, but that’s what we’re going for.

Dr. Weitz:            Yeah, we’ve got to put the gene back in the bottle soon too.

Jeffrey:                Absolutely.

Dr. Weitz:            Well, this has been awesome, Jeffrey. Thank you so much.

Jeffrey:                Ben, I’m passionate. Can you tell?

Dr. Weitz:            I can tell. [inaudible 01:07:18] you.

Jeffrey:                The thing is, I’m also very optimistic. I mean, when I started off on the GMO issue in 1997, no one wanted … Actually, it was ’96 … No one wanted to talk about the health dangers. None of the NGOs. It wasn’t a consumer thing. They were all talking about environment and whatnot. I’m saying, “Guys, this is really important.” Now 48% of the world’s population, 51% of America at a minimum, believe that GMO foods are unsafe. We’ve built a movement, we’ve seen the impact. We are enormously successful, and now we have to build a whole new movement, but we don’t have 27 years to wait.

Dr. Weitz:            Right. So everybody go to … What’s your website again?

Jeffrey:                It’s responsibletechnology.org/takeaction, and please make a donation. Sign up, give your name, support the comments to the USDA. That will also put you on our list unless you tell us not to, and we can give you updates and more information, ways that you can support us by getting the word out, giving you more knowledge, et cetera. Then please make a donation, ideally recurring so we know it’s coming each month. So that gives us the confidence to say, okay, we have a budget to this and this and this. We were able to get by with so much less money when it was a consumer education campaign, but now we have to change governments, create international treaties, national laws, and that’s expensive.

Dr. Weitz:            Right. Awesome. Thank you so much, Jeffrey.

Jeffrey:                You’re welcome, Ben. Safe eating.

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way more people will discover the Rational Wellness Podcast.  I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. If you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

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Dr. Tania Dempsey discusses Mast Cell Activation Syndrome 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

0:30  Mast cell activation syndrome.  Mast cells are immune cells found throughout the body that contain granules that contain various chemical mediators, including histamine and heparin.  Mast cells are involved in allergies and in various inflammatory and immune functions, including wound healing, angiogenesis, immune tolerance, and defense against pathogens. In mast cell activation syndrome, mast cells are inappropriately and excessively release chemical mediators, resulting in a range of symptoms that are grouped into cardiovascular, dermatological, GI, neurological, and respiratory in nature.  These include flushing, hives, a reddish complexion, itchiness, burning, lightheadedness, dizziness, arrhythmia, diarrhea or constipation, stomach pain, nausea, acid reflux, difficulty swallowing, headaches, fatigue, lack of concentration, and other cognitive problems, congestion, coughing, and even anaphylaxis.

2:47  Dr. Dempsey first started to focus on mast cell activation syndrome (MCAS) when researching trying to understand a patient who had a flare of this condition.  She spoke with Dr. Lawrence Afrin, who was a recognized expert on mast cell activation syndrome, who explained the mechanism for this condition.  She recognized that patients she had treated in the past probably had some elements of this condition as well.

12:05  MCAS is a multisystemic process and the most common symptoms include genital urinary complaints, hormonal complaints like endometriosis, painful periods, and excessive bleeding, migraines, interstitial cystitis, pain syndromes, high or low blood pressure, etc..

13:36  Diagnosis of MCAS.  One test that Dr. Dempsey will do with patients is to take a tongue depressor and scrape it across the back of the patient.  If there is a skin reaction, that indicates that mast cells are releasing histamine and that the patient may have MCAS.  This is called dermatographism.  The lab testing for MCAS is tricky, since some of the mediators that can be measured are very short lived, so she has a refrigerated centrifuge in her lab to be able to specially process the samples.  There are a number of markers but there is no one marker that is definitive for making a diagnosis. Tryptase, histamine plasma or whole blood, chromagranin A, and C-reactive protein are markers that can be measured.  If the patient has had an endoscopy or colonoscopy, we can biopsy a sample of the intestinal mucosa and see if there are more than 20 mast cells in the field. You may see elevated eosinophils.

21:52  The QEESI is a validated questionaire that Dr. Dempsey recommends, that stands for The Quick Environmental Exposure and Sensitivity Inventory that is available here: QEESI.

Dr. Tania Dempsey is an internationally recognized expert in chronic disease, autoimmune disorders and mast cell activation syndrome.  Dr. Dempsey received her MD from Johns Hopkins and she is Board Certified in Internal Medicine and a Diplomate of the American Board of Integrative and Holistic Medicine.  Dr. Dempsey is the founder of the AIM Center for Personalized Medicine, in Purchase, New York, where she practices with Dr. Lawrence Afrin.  Her website is DrTaniaDempsey.com.

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

Podcast Transcript

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

                                                Hello, Rational Wellness Podcasters. Today we’re going to be speaking about mast cell activation syndrome with Dr. Tania Dempsey. What are mast cells? Well, mast cells are immune system cells found throughout the body that contain granules that contain various chemical mediators, including histamine and heparin and a bunch of others. Mast cells are best known for their role in allergies, but they’re involved in various inflammatory and immune functions, including wound healing, angiogenesis, immune tolerance, and defense against pathogens. In mast cell activation syndrome, mast cells are inappropriately and excessively release chemical mediators, resulting in a range of symptoms that are grouped into cardiovascular, dermatological, GI, neurological, and respiratory in nature.  These include, among many others, flushing, hives, a reddish complexion, itchiness, burning, lightheadedness, dizziness, arrhythmia, diarrhea or constipation, stomach pain, nausea, acid reflux, difficulty swallowing, headaches, fatigue, lack of concentration, and other cognitive problems, congestion, coughing, and even anaphylaxis.

                                                Dr. Tania Dempsey is an internationally recognized expert in chronic disease, autoimmune disorders, and mast cell activation syndrome. Dr. Dempsey received her medical degree from Johns Hopkins, and she’s board certified in internal medicine and a diplomat of the American Board of Integrative and Holistic Medicine. Dr. Dempsey is the founder of the AIM Center for Personalized Medicine in Purchase, New York, where she practices with Dr. Lawrence Afrin. Dr. Dempsey, thank you so much for joining us.

Dr. Dempsey:                    Thank you for having me.

Dr. Weitz:                          Great. Let’s jump into how did you first get involved in mast cell activation syndrome as an area of focus for you?

Dr. Dempsey:                    My interest was always in understanding patients whole being, right, and I always looked at patients in a holistic manner, and I always spent time with patients, even when I was doing straight internal medicine, and I was always interested in the why, why a patient had this symptom, why a patient had that symptom, how these different symptoms fit together. And the more that you think about those things, and the more time I spent with patients, trying to understand how all the pieces fit, the more you start to question, is there some root cause that we haven’t thought about before? Is there something that could explain these constellation of symptoms that are multisystemic? And what was that?  So I was on a hunt.  I had one patient in particular who really sort of had what I would call a major flare. I started seeing her when she was relatively well, and then she had a flare, which we then later realized was consistent with past flares, but it was before I knew her, but all we always saw was an acute episode of her getting worse and not understanding how all the different symptoms she had fit together.        And so one day, I just spent hours, like I typically do, I’m very invested in my patients and I will research until the nth degree to figure out what’s wrong with them. And so I was on PubMed, I was on Google, I’ll admit it. I was trying to figure out how I can put this together, and I remember seeing something about this condition, this relatively new condition at the time, mast cell activation syndrome. So some of the publications about it were coming out around 2012, when it was really starting to be recognized and there were people looking at how to diagnose it. So this was, this patient, it was about 2014, 2015. And so there was stuff, just new stuff, the buzzwords. And I remember talking to her and saying, “I think this could be this mast cell activation syndrome, and in fact, if this is what you have, then I think a lot of my other patients probably have this, too. So let’s figure this out.”  And so it was sort of serendipity. She somehow knew someone who knew Dr. Afrin and he was in Minnesota at the time, Lawrence Afrin and I got on the phone with him and I said, “I want to hear everything about mast cell activation syndrome. How can I help my patients?” And I think we spent an hour on the phone and I was hooked because everything he said just resonated with me, made me understand that these patients, that some things help. There are different modalities that we’ve tried and they get better, but they don’t fully get better. That’s where I started thinking about, okay, I think this is the tip of the iceberg. I think this is a bigger issue than we’ve ever recognized. And I think what’s really interesting for me is that I really started my career in the women’s health arena, looking at polycystic ovarian syndrome and the like.

                                                And what I was noticing, back then, 20 years ago, that these women also very often had allergic-like phenomena. They could have asthma, eczema, they often had things like irritable bowel syndrome or interstitial cystitis, endometriosis. So I always understood that these women had this collection of other disorders that were being affected, but I didn’t understand what the connection was. And then once I started to understand MCAS, then I was able to look back at my career of 20 years and saying, “Oh, intuitively, I’ve known this all along, but now I understand that the root is really in this dysfunctional mast cell.”

Dr. Weitz:                          So I just wanted to point out, you mentioned MCAS, and that’s an abbreviation for Mast Cell Activation Syndrome, M-C-A-S.

Dr. Dempsey:                    Thank you. Yes.

Dr. Weitz:                          So how would you describe, I know I gave a definition, but how would you describe what mast cell activation syndrome is?

Dr. Dempsey:                    Yeah, I think you did a great job. That was perfect.

Dr. Weitz:                          Okay.

Dr. Dempsey:                    Yeah. Mast cell activation syndrome is a syndrome of abnormal mast cells that are reacting at baseline abnormally. So they are releasing these various mediators abnormally, and then when there’s additional triggers, there’s more activation, more release of mediators. So everyone has mast cells, everybody has mast cells that respond to infections or other triggers. If someone gets COVID or the flu or something, the mast cells get activated. It’s part of your innate, your primitive immune system, but the problem really is in patients who at baseline, their mast cells are already not working well, they’re maybe more reactive in releasing some of these inflammatory mediators, these chemicals at baseline. So they’re inflamed at baseline, and then they’re faced with an infection or a trauma or some other stressor, toxin, mold, and then their already-dysfunctional mast cells become more reactive, releasing more chemicals, and then they go into a bigger flare.  So that’s essentially what MCAS is, and it’s really a multi-system disorder. It’s not, and I think this is important to note that it’s not the patient who has allergy, let’s say, and only has allergy, but has nothing else. They don’t have mast cell activation syndrome. So it has to be multiple organs, at least two different systems involved. And so the mast cells can be reactive in different ways in different parts of the body.

Dr. Weitz:                            And so is mast cell activation syndrome something they just had, or it sounds like you’re saying that they got an infection or they got exposed to some toxins or mold and that triggered this over-activation. Is that what happens?

Dr. Dempsey:                    Well, it could be either, actually, or both. And so the vast majority of people who have this syndrome, MCAS, have a genetic potential. I would put these people in what I would call like an idiopathic, this is idiopathic MCAS. Primary MCAS is that if there’s a genetic vulnerability, and then there’s some process trigger that makes it evident in them. And then that’s all they have. And so yes, they can have other triggers, but their root cause, the root problem is that they were born with dysfunctional mast cells, and that’s primary. Secondary is when someone has normal mast cells, but then they have a major trigger that makes their mast cells react, and then their mast cells continue to react, and they don’t reset until you take away that trigger. That’s what we call secondary.   And theoretically, in secondary MCAS, when you take away that trigger, the mast cells go back to normal. Idiopathic is like that combination probably of both, where there’s a genetic vulnerability, there’s a trigger, but even if you remove the trigger fully, they won’t return to normal. They’ll return to a different baseline because their mast cells were already, I use the term mutated. In a sense, that’s what happens.

Dr. Weitz:                          So a percentage of these patients, and I don’t know if we know what percentages-

Dr. Dempsey:                    Yeah.

Dr. Weitz:                          … likely will never have normal mast cell reactivity.

Dr. Dempsey:                    Well, look, the number I can give you was based on some literature, some publications out of Germany in 2013. Gerhard Molderings published on the fact that the German population had about 17% incidents of mast cell activation syndrome. And if we assume that their population is similar to our population, 17%, which probably is an underestimate, so let’s say it’s maybe even closer to 20%. So one in five people have MCAS in some form. At one end of the spectrum, they may not even know they have this. They have mild symptoms that they’ve lived with. Maybe they have migraines, maybe they have and they deal with it. They take a pill. Maybe they have women suffering from painful periods, but they go to the gynecologist and they get a birth control pill. But underlying it is probably mast cell activation syndrome.  On the other hand of the spectrum are people who are really debilitated from it. So the reality is it’s hard to know how many people are really sitting at the mild end and how many are at the more severe end, but one in five people have the potential and possibly even the full spectrum of this disorder.

Dr. Weitz:                          So what are the most common symptoms that alert you to the fact that this patient sitting before you may have MCAS?

Dr. Dempsey:                    For me, it’s really not just about a particular symptom. It’s about a multisystemic process. So if I’m talking to the patient and I’m getting a sense that there are multiple organ systems involved, they have GI complaints, they may have respiratory complaints, they may have genital urinary complaints, they may have endocrine hormonal complaints. And once I start to see that it’s multisystemic, then this is going to be on my radar.  Women’s health issues, certainly there are some buzzwords. I hear endometriosis, I hear painful periods, I hear excessive bleeding, things like that. They sort of make me K kind of go in this direction. Migraines, interstitial cystitis, pain syndromes in general, people with pain and sometimes with unknown origins to me, always make me think that this could be it. But really it’s about the fact that these patients often have multiple things going on. They might have high blood pressure and they don’t know why. Sometimes it’s high, sometimes it’s low, sometimes it’s dizzy. Sometimes their heart rate goes up. And then when they say that these are the patients that come in and say that no one else can figure them out, then I know that this is one area that I have to look at.

Dr. Weitz:                          So in terms of trying to diagnose patients with MCAS, I saw some doctor on YouTube and he took a tongue depressor and rubbed it on this guy’s back and it was a profound skin reaction and that he felt was an indicator that the patient might have MCAS.  Is that something that makes sense?

Dr. Dempsey:                    It’s not diagnostic for MCAS.

Dr. Weitz:                          Right.

Dr. Dempsey:                    It’s diagnostic, it’s a called dermatographism. That’s what the dermatologist would call it.  And that reaction basically is stimulating mast cells in the skin to release histamine.  So if you can see it in other mast cell issues like allergy and eczema, you can see it in mast cell activation syndrome.  So when I do that test in patients, and I do it when I see new patients-

Dr. Weitz:                          Okay.

Dr. Dempsey:                    … if they don’t have this reaction, it doesn’t mean they don’t have MCAS. And if they have the reaction, I’m thinking it could be MCAS, but I might think allergy, I might think other things as well. So it’s an interesting response. It does suggest that the mast cells are releasing histamine, but not everybody with MCAS has a histamine problem, so you may not see it.

Dr. Weitz:                          So what’s the best way to diagnose mast cell activation syndrome?

Dr. Dempsey:                    Yeah, that’s the million-dollar question, actually, because it’s a little complicated.

Dr. Weitz:                          Yeah, the lab testing seems to be very problematic.

Dr. Dempsey:                    It can be. I mean, the good news is that we have figured out, Dr. Afrin and myself, we have figured out how to get the testing done. We have found the labs that need to be used for this. We have a refrigerated centrifuge in our lab that we’re able to process the samples specially. So we have, we’re in a very good position, but I think for a lot of others who are out there trying to do testing, it can be problematic. The way, basically, what you’re doing for MCAS is you’re trying to find the mediators that the mast cells make. That’s how you’re trying to justify the diagnosis. Mast cell activation syndrome means that the mast cells are activated. So in order to have this syndrome, you have to have an abnormal level of those mediators, either in the urine or the blood.

Dr. Weitz:                          But there’s a number of these, so you know, you can test for histamine and that may not be the mediator that they have.

Dr. Dempsey:                    Correct. Correct. So you test for what we know you can test. And there’s several in the urine. There’s several in the blood. And the other thing we should mention is that there really are kind of two schools of thought on the diagnostic criteria. So I published, along with I think it was like 41 other co-authors, on the diagnosis of cell activation syndrome using a consensus criteria that we put together called the consensus-2. So what I’m talking about is based on what we’ve published, but there are other publications on other ways that others use to diagnose it. So it’s still not quite clear. We don’t use tryptase as the only mediator to diagnose MCAS. And there are groups out there that are using tryptase as one of the mediators to identify activation. And unfortunately, it’s not a great measure, so we do measure it. We just don’t rely on it fully for the diagnosis.  And then lastly, quite honestly, probably the best way to make the diagnosis is so many of our patients have had endoscopies or colonoscopies. So you can look for mast cells on biopsy samples, and if they have more mast cells in certain areas on these biopsies, then that is a very good indicator that they may have mast cell activation syndrome. So if I can get a biopsy sample, they’ve already had had biopsies, if I can get them stained in a certain way, we call it CD117 staining, and if we can see that there’s more than 20 mast cells in this field, then we can use that as one point of support for the diagnosis.

Dr. Weitz:                          I’m assuming your typical gastroenterologist is not looking for mast cells.

Dr. Dempsey:                    Correct. They’re not. So they’re doing these biopsies and they’re looking-

Dr. Weitz:                          And what happens when you ask them to do it?

Dr. Dempsey:                    Well, it depends. So the GI docs that we work with, we have a form that we usually give them, and they’re already aware that they’re going to talk to the pathologist. It’s really not up to the GI doctor. They’ll do the biopsies, but the pathologist has to be the one, they’re the one that stains it. So we have a form that we usually give our patients that if they’re going to go for a procedure, we want to make sure that they can do the staining right away. But let’s say the patients already have done the testing, the GI doctor said everything looked great. What we do is we request the slides, they have to be unstained, and we have a pathologist we work with, we’ll send her the slides, and we’ll say, “Now stain them for CD117 and see if you find mast cells.” And then these are normal results that they’ve gotten from their GI doctor. And then we get it back and we see, with a special stain, we see all the mast cells light up.

Dr. Weitz:                          Cool. Okay. So are there any, for a conventional doctor who doesn’t want to try to do these complicated labs that require having a centrifuge in the refrigerator and getting these samples to the lab chilled and kept chilled the whole time, and the likelihood of a conventional lab actually handling it in the right way is not that great?

Dr. Dempsey:                    Correct. Correct.

Dr. Weitz:                          Are there any just conventional indicators on labs that might give you an idea? Like does a CBC tell you anything?

Dr. Dempsey:                    Yeah. Yeah. So again, it wouldn’t maybe give you the full diagnosis, but could it give you a picture? Absolutely. You can see hemoglobin’s high, hemoglobin is low. You can see eosinophils. Sometimes they have eosinophillia. If they don’t, it doesn’t mean that they don’t have MCAS, but these are some things that I could look at. You could check out plasma histamine. That’s a really easy test. You can even do a whole blood histamine. Yeah, if histamine is one of their issues, you might find it. Chromogranin A also is a very-

Dr. Weitz:                          But the plasma histamine, the sample has to be kept cold, right?

Dr. Dempsey:                    It does, but it’s not as sensitive as some of the other-

Dr. Weitz:                          Oh, okay. Okay.

Dr. Dempsey:                    So it’s still worth testing.

Dr. Weitz:                          Right.

Dr. Dempsey:                    Heparin in the blood is more problematic. That’s going to be really another conversation, but histamine, chromogranin A, and tryptase, just in case the tryptase comes back, that you can look at the blood counts. I think C-reactive protein is not specific for MCAS, but we certainly see in some patients because they have inflammation, sometimes the inflammation translates to an elevation in inflammation markers, sometimes it doesn’t, surprisingly.

Dr. Weitz:                            Okay.

Dr. Dempsey:                    But those are some things that I think, look, there we have an MCAS questionnaire that’s been validated in the literature. So docs can give the patients the questionnaire or fill the questionnaire out with the patient, and it asks specific questions about certain types of symptoms and certain types of testing that they may have had done. And then they can do some of this rudimentary testing so they have an understanding of the patient’s symptoms, where they fall on the questionnaire.  I also encourage the use of the QEESI questionnaire, the Q-E-E-S-I questionnaire, which is a chemical sensitivity questionnaire that’s also been validated. And since we’ve published on the association between mast activation syndrome and chemical intolerance, you can give them this chemical intolerance questionnaire, you can give them the MCAS questionnaire, you could use some blood work, and then sure, you could do that scratch test on their back and see if they get a red line. And then I think you can make a case for whether they have this or not.

Dr. Weitz:                          So this MCAS questionnaire has been validated?

Dr. Dempsey:                    Yeah, it was published. Gerhard Molderings published this along with Dr. Afrin in 2015, I believe.

Dr. Weitz:                          Okay.

Dr. Dempsey:                    And it is in the literature. We’ve taken it, we produced it for our patients. It’s easier.

Dr. Weitz:                          Would you be willing to share that with me that I can put in the show notes?

Dr. Dempsey:                    Absolutely.

Dr. Weitz:                          Sure. That’d be great.

Dr. Dempsey:                    Absolutely. Yeah, of course. And the QEESI questionnaire, which people can get at queesi.com, I think, or qeesi.org. Oh, it’s qeesi.org. And that questionnaire is readily available and I encourage people to take that one as well.

Dr. Weitz:                          And that you said is for chemical toxicity.

Dr. Dempsey:                    Correct.

Dr. Weitz:                          What kind of chemical toxins do you find that are most associated or that come up a lot?

Dr. Dempsey:                    Yeah-

Dr. Weitz:                          Obviously we’re in a society awash with chemicals.

Dr. Dempsey:                    We certainly are. Claudia, Dr. Claudia Miller, who has really done, has been a pioneer in this realm, she has published on the association between organo phosphate pesticides and the impact on the development of chemical intolerance, and then really what we now understand is mast cell activation syndrome, so I think that’s a huge problem. But all the petroleum stuff, all the plastics, all the stuff that people are exposed to at some point, I think the fragrances, the scents, the disinfectants, we saw an uptick in chemical intolerance and mast cell activation syndrome during COVID, I think, partially, from COVID, like I think people, we were seeing that association between MCAS and COVID.

                                                So maybe people who had COVID or long haul COVID might have had underlying MCAS, but also because of the amount of disinfecting solutions that were used, people were more heightened. People were noticing they were going to the grocery store. Even with the masks, they were still being exposed. So it’s a problem. And for people who don’t have any issues with their mast cells, they might smell it, it may not be great, but when the mast cells are already probably at baseline, a little dysfunctional, but maybe they’re still okay, exposure to these chemicals can certainly bring it out fully.

Dr. Weitz:                          So you’re saying that drinking bleach probably wasn’t good for their health.

Dr. Dempsey:                    Right. No comment.

Dr. Weitz:                          Just kidding. Let’s get into some of the treatments-

Dr. Dempsey:                    Sure.

Dr. Weitz:                          … for MCAS.

Dr. Dempsey:                    Yeah.

Dr. Weitz:                          I know that I’ve heard Dr. Afrin in talks talk a lot about the use of antihistamines. Do you tend to use antihistamines as part of your treatment approach? Do you tend to use natural supplements or diet or a combination of all of the above?

Dr. Dempsey:                    Usually a combination because my background is integrative medicine, but I think the number one thing, and he’ll say, Dr. Afrin will say this as well, the number one thing is to eliminate the triggers. So if you are being exposed to something, if you have an infection and that’s run your mast cell, you’ve got to peel that layer away.

Dr. Weitz:                          Treat that infection.

Dr. Dempsey:                    You got to treat the infection. Or let’s say you’re taking a medication that has a dye in it and you’re dye-sensitive, and maybe that’s kicking things up, that has to be eliminated. So there’s a process that we go through with patients to educate them about their different triggers and what may be continuously making them sick. So that’s first, before you even treat them, you need to eliminate the triggers. Then we go through a process of going through what makes the most sense for the patient. Sometimes it makes sense to try Vitamin C or quercetin. Sometimes it makes sense to go right to an over-the-counter H1 blocker, antihistamine, and sometimes it makes sense then to go onto the H2 blockers that we use.

Dr. Weitz:                          Let me just point out. Vitamin C is often considered a natural antihistamine. Quercetin is considered a natural mast cell stabilizer.

Dr. Dempsey:                    Correct. Correct. They don’t always work for everyone. Some patients react to it, sometimes they react to something mixed in it in a supplement. So I want to be very clear that my suggestions have to be really personalized and individualized. Every patient is different. So what I’m starting with is going to depend on what I think they may react better to initially. Honestly, I think the antihistamines are a great way to start, a little bit more bang for the buck, the way I look at it. They usually do respond, especially if I know there’s histamine involved. It might take some trial and error to go through the different antihistamines to find the one that’s right for them, but I think it’s absolutely a great way to calm things down for some patients.

Dr. Weitz:                            And are you typically using one or several different antihistamines?

Dr. Dempsey:                    I’ll start with one. There’s a trial period, so they’re going to start one. They may increase the dosage depending on how they do. If they don’t do well with that, they go on to the next one. So we have four, let’s say, main ones over the counter, Loratadine, Zyxel, Zyrtec, Allegra, those are the brands. And then we have Benadryl. This is a fifth one, which is a more short-acting type of antihistamine. And then there are prescription ones available, too. But you could start with what’s over the counter, one at a time, trial them.

                                                Do I have patients who wind up needing two different antihistamines at the same time? Yes, but rare. Usually we try to find one antihistamine that’s going to accomplish the job. Adding an H2 blocker, so this is essentially an antihistamine that works in the gut, but by binding the H1 receptors from the regular antihistamines and then binding the H2 receptors with these other drugs, doing that together has a synergistic effect. So an example of an H2 blocker would be something like Pepcid or the old Zantac when it was on the market, Tagamet.

                                                So we can use them together to help to provide even better stabilization of the mast cell, but that doesn’t always work. And so then we have next in line and lots of different things to try. And what I’ve learned is that you have to keep going because you never know when you’re going to find the thing that’s going to help. And at the same time, I’m always looking at other root causes. I’m looking at their gut microbiome, which is a huge potential trigger for MCAS. We see so much candida in the gut, parasites, just dysbiosis, just bad bugs in the wrong place, not enough good bugs. We have tons of mast cells in our GI tract, so they’re going to be alerted to the mess that’s going on. And so, yeah, I can give all the mast cell drugs in the world, it’s not going to get better.

Dr. Weitz:                            So a lot of us who are treating these functional gut disorders, like SIBO and acid reflux and some of these other conditions, and most of us have found that some of the conditions resolve very well to simple treatment programs. Others are more complicated and take a long period of time and continue to recur. And that’s where we might start wondering, could mast cells be a factor in this functional gut disorder? And if that’s the case, what would be our first step? And then, how would we want to change our treatment plans?

Dr. Dempsey:                    Yeah, it’s a great question. Well, I think everything has to be happening almost simultaneously, but-

Dr. Weitz:                          Let’s say I have a patient with SIBO. I’ll just make up an example.

Dr. Dempsey:                    Yeah, give me an example.

Dr. Weitz:                          Patient saw a GI doctor, tested positive on a SIBO breath test, did two weeks of rifaximin, didn’t really help that much, came to see me. We also did a functional stool analysis and I put her on a protocol for reducing the bacterial overgrowth and, in my case, using basically herbal supplements, maybe some other digestive support, a natural prokinetic, maybe a digestive enzyme, a few things like that. And maybe they got better and they recurred in a month. And now I’m wondering, could mast cells be a problem? Because I think a lot of us are looking for the answer. Is it really fungal overgrowth? Did I miss the fungus? Is it just that there’s layers of bacteria and we got through one layer and we got to get through the next layer? Maybe the bacteria are encased in a plaque and we’ve got to break through that. What is the thing I’m missing? When would we think, okay, this might be mast cells and if we do think it’s mast cells, what do we do next?

Dr. Dempsey:                    So with that patient, right, I would’ve already screened for other symptoms because these patients are not just having gut symptoms. They’re also potentially having other symptoms. So if I already know that I’m treating SIBO and I’m treating their gut issues like you are, but I also know that they have other systems involved, so I’m going to be alerted already and I’m going to still do-

Dr. Weitz:                          So if they’re not having a lot of other symptoms, you would be less likely to think that this might be a mast cell issue, right?

Dr. Dempsey:                    Yeah, less likely, but sometimes I think patients underestimate what their symptoms are or they don’t feel like they’re that important or they’ve had them for so long, so they’ve really not even thought to talk to a doctor about it. And this happens all the time, which is why, with my patients, often I will repeat their history with them over and over and over again, especially if I haven’t figured out what’s going on. And I’ll say to them, “I know. I know you told me this whole story, but we’re going to do it again because I feel like we’re missing something.” And sometimes the truth really does come out, things that they hadn’t thought about because it’s been such a part of them. So my guess is that if they’re having SIBO that recurs or symptoms that recur, more likely than not, there’s something else going on elsewhere in the body that they haven’t mentioned. But let’s just say that-

Dr. Weitz:                          That’s an interesting clinical pearl. I remember being at a Institute of Functional Medicine seminar and one of the older doctors who started the Institute of Functional Medicine talked about how sometimes he would leave the room and come in and say, “Now I’m Doctor Somebody-Different,” and go through their history again and would end up with different answers.

Dr. Dempsey:                    Yes, yes, and I see this all the time. And so I have history, history, history. I cannot emphasize that enough because I have taken that same history on the same patient for a year until I figured out something that they didn’t say. This happens unfortunately more often than you would think. So the point being is that I would bet money that if they have recurrency that there’s something else there that they’re not talking about or that’s not in the front of their mind. They have so much discomfort from their GI tract, they’re not even thinking about the neuropathy or the migraines or visual issues or skin rashes. They’re not thinking about it because they’re just so focused here.

                                          So that’s the first step, is just to understand what else is going on elsewhere, and then understanding what else is going on there I think is important. I think I have a very similar approach to you. We’re thinking about, yes, did we miss the fungus? Did we miss the biofilms? Did we miss that… Absolutely. I do that all the time. But also the other part of it is that if I think there’s MCAS and I’ve, let’s say, I’ve diagnosed it or I’m close to diagnosing it, I might start a more mast cell targeted therapy regimen while I’m also trying to fix the other things because I might get further along with that approach.

Dr. Weitz:                          So how about diet? How often do you use specific dietary approaches considering that food sensitivities may also be triggers? Do you typically use a low histamine diet, another type of diet, and when in your protocols do you approach diet?

Dr. Dempsey:                    So, look, I think diet is critical. I think that food is medicine. There are lots of cliches about it, but I really think you are what you eat, that kind of stuff. So I think food is important, but I don’t think there’s one diet that works for everybody. And so I’m very always a little reluctant to say to patients, “You need to be on the low histamine diet. You need to be on the low FODMAP diet. You need to be on this diet,” because every patient’s going to be different and some patients are going to respond really well to one diet or another, and some patients are going to need some combination of them. So it’s a very personalized approach.

Dr. Weitz:                          So do you try the low histamine diet, see how that works? If not, try the low FODMAP diet or-

Dr. Dempsey:                    Sometimes, sometimes, but probably not alone. I usually don’t say, “Here’s a low histamine diet and you’re going to do that for a month and then we’re going to follow up.” Usually what I’m doing is saying, “Let’s go through your diet that you’re eating now. Let’s figure out if there are potential triggers in what you’re eating.” If the diet already is low histamine, then lowering it even more is not going to help. But if I think that too many carbs, if I think that they have insulin resistance, which we see quite frequently in MCAS, and I think it’s MCAS driving insulin resistance in insulin resistance in insulin issues, metabolic issues driving MCAS. So for them, it may not be the specific food, but it may be a food group, like carbohydrates, simple carbohydrates are not good for their body, or gluten or something else.

                                                So again, I take a very, very, very personalized approach, and it’s really trying to understand for the patient what is really going to be best to eliminate or to eat more of for that matter. Sometimes, and I’ll tell you, sometimes it’s not elimination. Sometimes it’s you’re not eating enough protein. Protein’s the number one thing that patients don’t eat enough of. They need it as they get older. They need it for their skeletal muscle, they need it for lots of enzymes and lots of metabolic functioning, fat also, but fat often you can get when you eat protein. So sometimes it’s just like you’re not getting enough nutrition. Let’s just get more food into you.

                                                And sometimes, and I’ll make a point, there are definitely patients who are exquisitely sensitive. They might only be able to eat three foods. That’s what their mast cells are allowing them to do, right? That’s a different scenario. I’m not going to eliminate anything. I’m going to try to figure out how to calm things down so that I can introduce more foods. So again, every patient is going to be very, very different.

Dr. Weitz:                          Let’s go through some of the natural strategies that might help move the needle. I’m just going to throw some out there. What about using DAO, which is a enzyme that helps to break down histamine?

Dr. Dempsey:                    Right, diamine oxidase-

Dr. Weitz:                          Right.

Dr. Dempsey:                    … is one of the ways that the body processes histamine and absolutely can be a great tool, especially if I think histamine is an issue for them. You lower the histamine load a little bit and yes, for some patients, I had one patient whose interstitial cystitis got better with DAO enzyme. It’s beautiful when it works like that, but the patients who don’t tolerate it for various reasons, and it doesn’t always work, especially if histamine is not their issue.

Dr. Weitz:                            What about some of the natural antihistamines? You mentioned Vitamin C, I know there’s stinging nettle, I know people have used bromine. Are there any natural antihistamines that you find can be helpful?

Dr. Dempsey:                    Well, in addition to the ones you mentioned, resveratrol, skullcap.

Dr. Weitz:                          Okay.

Dr. Dempsey:                    There are different types of skullcap, but sometimes it’s the Chinese skullcap, sometimes it’s-

Dr. Weitz:                          Right.

Dr. Dempsey:                    … the other one. Then ,off the top of my head, I mean they’re just like, I use a lot of herbs in general.

Dr. Weitz:                          Right, okay.

Dr. Dempsey:                    Some of these herbs have very, very-

Dr. Weitz:                          I think in one of your articles you mentioned ginger, thyme watercress, turmeric.

Dr. Dempsey:                     Correct.

Dr. Weitz:                          And then, of course, we got mast cell stabilizers, like quercetin and I think resveratrol would fit into there, too. What about Vitamin D? Is that something that can be helpful for mast cell patients?

Dr. Dempsey:                    Yeah. I’m so glad you brought that up because I think that’s really important. It’s probably my number one. Actually, I should say, “What do you do for your mast cell? Number one, vitamin D.” Because mast cells have the Vitamin D receptor on their surface and that’s part of what they react to. Those receptors help them read the environment. And so if they don’t have enough Vitamin D, that can be a trigger, absolutely. And you give them Vitamin D, you get them to good levels. And that alone could be mast cell stabilizing for some patients.

Dr. Weitz:                          I was just at a Chris Shade seminar and he happened to mention that mast cells express endocannabinoid receptors. So what about CBD?

Dr. Dempsey:                    CBD, PEA.

Dr. Weitz:                          Right.

Dr. Dempsey:                    Palmitoylethanolamide. Palmitoylethanolamide also binds the endocannabinoid receptor. So yes, sometimes the CBD seems to be better with THC. Sometimes it’s better without. It really depends on the patient’s mast cells. But yeah, the expression of a lot of these receptors really can change and dictate what direction you go to for treatment.

Dr. Weitz:                          What about LDN, low dose naltrexone?

Dr. Dempsey:                    Yeah. Yeah. And actually, LDN probably works through a few different mechanisms, and it may be modulating the immune system outside of its interaction with the mast cell. But yes, for some patients, it can be helpful. Yeah, there’s a whole host of natural and synthetic things that we use to-

Dr. Weitz:                          What are some of the other synthetic things you use? We went through the antihistamines.

Dr. Dempsey:                    Yeah, well, ketotifen is an interesting drug. It’s a partial H1 blocker. So it has some antihistamine properties, but it is also a mast cell stabilizer and it’s available, it has to be compounded to take it orally, but that can be a very helpful for a subset of patients. Cromolyn is another one, which is not absorbed, actually. It’s taken orally, usually in a liquid form or compounded in a capsule, and it works in the gut, so it can be helpful for the gut mast cells. But interestingly, I think the gut mast cells are talking to other mast cells and so many of these patients also have a reduction in some of their neurologic symptoms. So those are some quick go-tos that are pretty easy to get.

                                                And then yes, they’re a host of these other, I’ll call them a little more heavy duty. I don’t love to use these drugs, but some of my patients needed and have done well. Benzodiazepines, those are tranquilizers essentially, but the mast cell has receptors for them. And very small dosages can be helpful to stabilize things. And again, I can keep going. There are lots of things that we can try that, again, very often it’s about either blocking the things that are its making. So another example would be Singulair, which is a drug used for asthma. Ziflo is another drug, Accolade. There are few of them that block leukotriene. That’s another mediator that mast cells make.

                                                So if you test, the reason to test is that if you can measure and you know they have high leukotrienes or they have high prostaglandins, then you might target their treatment a little bit differently. Mast cells have COX receptors, COX-2 receptors, and COX-1 actually. So NSAIDs, anti-inflammatory drugs, can help. I think there should be some research, not yet, but I’m suspecting that it will be helpful, specialized pro-resolving mediators, SPMs, probably have some role here. Things like the drug formulation, Celebrex, Mobic, these are COX-2 inhibitors, they may have an effect as well. So again, the list goes on. And ideally, I’m working on the root causes and maybe I’m using herbs, maybe I’m using supplements. For some patients, maybe I can’t even do those things yet because they’re so sensitive now. And others, I’m combining.

Dr. Weitz:                            And maybe if patients, you mentioned chemicals, toxins playing a role in being triggers, maybe putting them on a detox to get rid of some of those chemicals might help reduce the mast cell over-activation.

Dr. Dempsey:                    I think you have to be careful with the term detox with these patients, especially the patients that I’m seeing.

Dr. Weitz:                          Okay.

Dr. Dempsey:                    Detoxing them could actually make their mast cells worse, could introducing that process. It’s a stressful process, detox, depending on what kind of detox you’re doing. So I’m always a little cautious about saying detox. There may be things that I’m doing that are in a way I know are helping with detoxification, but I’m also trying to understand how that particular patient is going to react to that. So they’re going to be patients who they cannot tolerate any C glutathione, any of the phase one or two supplements, you’re just not going to get them that way. But maybe you can get a binder into them if they have molds, maybe. Right? Or there are patients who thrive on glutathione and actually they feel like it helps their mast cells and they feel like when they detox with it, it’s better, but they may not tolerate something else. So yeah, it’s very complex.

Dr. Weitz:                          Interesting. What about the use of sauna or even exercise?

Dr. Dempsey:                    Yeah, well, theoretically, and I’m a big proponent of those things, and I’ve written articles on infrared saunas and things like that, but the problem is that some of these patients have heat intolerance. Their mast cells actually get worse with heat. Some patients it gets worse with cold, so they may not be at a stage where they’re ready to tolerate that. Or maybe they start with a minute, maybe they go to two minutes, maybe they do it slowly. Maybe they realize that it is helpful, but for some patients it’s going to take a long time to get them to the point where they could do that.

                                                Some of these patients have post-exertional malaise. They may have an overlap of ME/CFS, chronic fatigue. So post-exertional malaise, if I push them too much, if I say, “You know, you need to get outside and get vitamin D and walk,” but then the next day they spend the whole day in bed and they feel awful, then I’m not getting anywhere with them. So again, figuring out where they’re coming from, you know, you have to meet the patient where they are really and understand when you can really pull out the big guns, I call them.

Dr. Weitz:                            So now most of the patients that you put on antihistamines, are they eventually able to get off these or do they end up having to take these for their long periods of time?

Dr. Dempsey:                    Yeah, I think it depends. There are certainly patients that are in a flare, an MCAS flare, at a particular time in their life. And I think women are great examples because it does seem to be a little more prominent in women. And women have a cyclical nature to their life cycle. They get their period at a certain time, let’s say, then they may get pregnant, they go through menopause. So there are these certain time periods where the hormones are involved and we know mast cells actually have receptors for estrogen and progesterone, testosterone. So the changes in the hormones may trigger women more. So let’s just say that in a particular time in a women’s life, let’s say, at 13 when she gets her period, she is more reactive and she needs antihistamines and maybe she needs some other things to control her.

                                                She may actually get to a point where she has a good portion of her life where she’s fine. Again, maybe it’s 10 years, maybe it’s more or less, and maybe she doesn’t need anything. And then maybe she goes into another flare. Maybe she still hasn’t figured out she has MCAS, but she realizes some of these things work. So some of the patients have figured it out over time that there’s some things that they need. There are other patients where the flares are going to be longer and they’re never really going to go out of a flare 100%.

                                                They come down to a lower baseline, but they’re never back to their full lower baseline. So they might still need some support. They may need more support during a flare. So I never like to think that patients have to stay on medications for the rest of their lives. And then that’s not how we go about this, but if I think that staying on this medication is going to reduce their risk of going into a major flare, if I think it’s going to help them deal with their life and their environment better, then I say, yeah, maybe they do need it. But again, I think it needs to be looked after each patient.

Dr. Weitz:                          That’s great. So I think that those are the questions that I had prepared. Are there any other things you want to tell our audience about? Any thoughts you have about mast cell activation syndrome?

Dr. Dempsey:                    I think the most important thing really is just generally that patients listen to their body and they advocate as much as they can for themselves. And if they’re not getting the answers, I mean, that’s why people are listening to you. You’re putting out this information, which is amazing. It’s about people should try to educate themselves as best they can and try to find practitioners that will work with them to really get to the root cause and not accept the conventional way, which is sort of like, I don’t know how to help you. This is what a lot of these patients are told, that the doctors don’t have answers and they don’t know what to do with them.

                                                There’s always an answer. It may take a long time to figure it out. We may not have all the answers with our current medical technology, but we’re going to get there. But I think finding the help and continuing to look and trust your gut about your own health, I think is critical. And that’s the one thing that I see so much that patients need to be validated. I hate how some patients are treated in the medical profession.

Dr. Weitz:                          That’s great.

Dr. Dempsey:                    [inaudible 00:51:31] medical profession.

Dr. Weitz:                          Thank you. Okay, thank you, Dr. Dempsey. And how can listeners find out more about you and what you have to offer, your programs, et cetera?

Dr. Dempsey:                    Yeah, so I’m on social media, Facebook, Dr. Tania Dempsey, Instagram, drtaniadempseymd. Twitter, I think is DrTaniaDempsey. I don’t do a lot of tweeting, but I have a couple of websites, drtaniadempsey.com. And then my center, AIM Center for Personalized Medicine, is aimcenterpm.com. And what else? We’re in Purchase, New York.

Dr. Weitz:                          Okay. And I’m assuming you see patients remotely as well?

Dr. Dempsey:                    Yeah, we do. I mean, we do prefer to see patients for the first visit in person and then continue telemedicine after that. So we see patients from all over the world and country, and we’ve built a really nice center here. I’m really proud of what I’ve done. I have Dr. Lawrence Afrin with me, and we’ve been publishing papers. We have another publication about to hopefully be accepted and we’re going to be doing some research, maybe some phase two trials here. And I have another colleague that joined me two years ago, Dr. Colin Renaud. He’s a PA, but also a chiropractor by training, and he is doing good work here, too, so.

Dr. Weitz:                          That’s great.

Dr. Dempsey:                    [inaudible 00:53:06]

Dr. Weitz:                          Sounds good. Thank you.

Dr. Dempsey:                    Thank you. Thanks for having me.

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. That way more people will discover the Rational Wellness Podcast.  And I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues, like gut problems, autoimmune diseases, cardio-metabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

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Dr. Karin Duncan discusses How to use a Functional Medicine Approach for patients with Parkinson’s disease at the Functional Medicine Discussion Group meeting on March 23, 2023 with moderator Dr. Ben Weitz.

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

Podcast Highlights

6:17  What is Parkinson’s disease?  Some define it as the degeneration of the substantia nigra in the brain and the loss of the production of dopamine.  There are four symptoms that are usually seen in Parkinson’s and those are the bradykinesia, the stooped posture, the masked facies, and the pill-rolling tremor.  The research shows that it can actually start 10-20 years prior to the motor symptom presentation.  This degeneration of the dopaminergic neurons in the brain is a long term process and by the time the motor symptoms show up, the substantia nigra is already 70-80% depleted of its ability to produce dopamine.  The early symptoms that show up years earlier are the loss of a sense of smell (anosmia), constipation, and REM sleep disorder.  The question is if we identify these patients early and help them with these conditions and reduce the underlying inflammation, will we prevent Parkinson’s?  We don’t know the answer to that, but it makes sense to try.

10:25  Constipation indicates some gut imbalance or dysbiosis and for patients who end up getting Parkinson’s, it usually is extreme.  When the intestines are inflamed, they release a protein into the blood stream called alpha synuclein and patients with Parkinson’s have misfolded alpha synuclein protein aggregated in the substantia nigra.  If we want to help patients with Parkinson’s disease with their brain function, we need to help them with their gut. If they are taking oral medication and they have a dysfunctional gut, they will likely not be absorbing it as well and when we improve their gut health, we see a drop in the need for Sinemet or Carbidopa/Levodopa by up to 30-50%.

15:19  Cholesterol.  Lower levels of cholesterol and taking statins increases the risk of Parkinson’s disease.  Research indicates that total cholesterol should not go lower than 150-175.

18:48  Environmental toxins.  Trichloroethylene (TCE) is a dry cleaning chemical that was also used as a solvent including at Naval shipyards and military bases that is linked with a drastically increased risk of Parkinson’s disease. [Solvent exposures and Parkinson’s disease risk in twins.]  Pesticides and glyphosate can be triggers for Parkinson’s disease.  Mycotoxins from mold may also play a role.  Dr. Duncan likes using Great Plains lab to test for environmental toxins and mycotoxins.  If a patient is 80% deplete in dopamine, they are likely 40-60% deplete in glutathione.  When cells die, like the dopaminergic neurons, they go through apoptosis and they release their toxins, which causes oxidative stress on neighboring cells that leads to progression of the disease. This is one reason why supplementing with glutathione can be helpful. 

23:42  Reactivation of Viral Infections.  Viral infections like Epstein-Barr virus (EBV) or Herpes Simplex virus (HSV) can be triggers for Parkinson’s disease. So can Lyme disease.  If you test for EBV you need to make sure to test for EBNA, Epstein-Barrr nuclear antigen, which is more indicative of reactivation than IgG antibodies.

28:57  Lab testing.  Dr. Duncan has a standard lab panel that she runs for most patients with Parkinson’s disease that includes a CBC, a metabolic panel, glucose, insulin, Hemoglobin A1C, fructosamine, an iron panel plus ferritin, an extended thyroid panel, folate, vitamins B6 and B12, vitamin D, DHEAS, HsCRP, uric acid, F2-isoprostanes, and a fatty acid profile/omega check.  Higher levels of iron tend to make Parkinson’s disease patients worse.  Higher levels of uric acid are actually protective of Parkinson’s disease. Dairy inhibits uric acid, which is one of the reasons Parkinson’s patients should avoid dairy.  Inosine is a supplement that’s commonly used with Parkinson’s that can boost uric acid levels and alleviate some symptoms.

31:58  Pharmaceutical approaches.  The most familiar drug is Sinemet or carbidopa and levodopa. When Dr. Duncan has patients who don’t want to take any drugs and just want to use natural supplements, while there is Macuna Pruriens that increases dopamine levels, the dosages cannot be standardized even from pill to pill within the same bottle. It makes sense to take synthetic carbidopa and levodopa, which can slow down Parkinson’s disease and allow patients to perform normal functions like preparing food and eating and exercise.  There’s also an extended release form, called Rytary.  You slowly increase the dose till you reach the max and it tends to stop working as well after about 10 years, though when you use a Functional Medicine approach, you often get an extended benefit from synthetic dopamine.  When we take care of vitamin B12 deficiency, help with restoring gut motility, make sure that you are producing enough hydrochloric acid, that you are taking it with protein, that you are not taking magnesium at the same time, that you are taking CDP choline, and that you are taking vitamin C with it. Another medication that can be helpful is Rasagiline or Azilect, which is a novel MAO B type inhibitor.  This is the only drug that has shown some slowing of disease progression.  By the way, turmeric is a natural MAO B inhibitor.  There is also Imbrija, which is an inhaled form of levodopa, that allows you to bypass the gut, that can be used as a rescue medicine. 

33:07  Previous head trauma has a relationship with most neurological issues, including Parkinson’s disease.  Patients with Parkinson’s who have a history of traumatic brain injury or CTE tend to have a fast progression of their condition and tend to be medication resistant.  Dr. Duncacn may recommend Deep Brain Stimulation for such patients.

34:43  Neurological testing.  You want to look for cogwheel rigidity. You also want to check the gait and have them turn around as fast as they can and have them walk heel to toe.  Parkinson’s patients often have a lack of arm swing on one side and may have a head tilt to the side that’s affected.  You should also learn the tests that are included in the UPDRS. You should have them stomp and move their feet as fast as they can. The finger to nose test will test intention tremor and coordination. You should have patients sign their name on a piece of paper, and just look if they’re having that agraphia to see if their handwriting has gotten smaller.

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

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

Podcast Transcript

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

                                Welcome, everybody. I’m Dr. Ben Weitz. Welcome to the Functional Medicine Discussion Group meeting tonight. I’m very excited that we have Dr. Karin Duncan, joining us for what should be a fascinating discussion about a functional medicine approach to Parkinson’s disease. We have all probably heard quite a bit about a functional medicine approach to Alzheimer’s disease with Dr. Dale Bredesen, Dr. Kharrazian, Dr. Perlmutter speaking and writing about this, but I feel that Parkinson’s disease is a forgotten neurodegenerative condition. This is why I’m so excited to take a deep dive into how we can help patients with Parkinson’s disease with the natural approach.  I want this meeting to be interactive, so please participate by typing your questions into the chat box, and then I’ll either call on you or ask Dr. Duncan your question when it’s appropriate. I hope that you’ll consider joining some of our future meetings. April 27th, Fiona McCulloch is going to join us from Canada for a discussion on menopause and hormone replacement. May 25th, Dr. Mark Pimentel will join us. He apologizes for missing last month’s meeting. He’ll be joining us for a discussion on SIBO and IBS. We haven’t figured out June, but July 27th, Dr. Bredesen will be joining us for a discussion on Alzheimer’s disease.

                                If you’re not aware, we have a closed Facebook page, the Functional Medicine Discussion Group of Santa Monica, that you should join. If you’re listening out there, this page, it’s just for practitioners, so we can continue this conversation when this evening is over. I’m recording this event. I’ll include it in my weekly Rational Wellness podcast, which you can subscribe to on Apple Podcasts, Spotify, or YouTube. If you enjoy listening to the Rational Wellness Podcast, please give me a five-star ratings and review.

Now, I want to thank our sponsor for this evening, Integrative Therapeutics.  Steve Snyder, who normally comes and tells us about a few of their products, is unable to join us, because he got tickets to go watch UCLA in Las Vegas. I’m jealous, but I want to tell you about a few Integrative Therapeutic products. They have a great brain formula called Neurologix, which is a non-stimulant neurotropic supplement for enhanced cognitive performance. It contains neumentix, spearmint extract, which contains phenolic compounds for sustained mental focus and to support working memory. It contains cognizin citicoline to support brain energy and metabolism, enhanced frontal low bioenergetics, and increase ATP levels in the brain, and saffron extract, which supports positive mood.

                                They also have a great highly absorbable curcumin product, Theracurmin, which is a water-soluble form. There’s actually been a lot of research done using this particular product. One of the advantages is you get a therapeutic dosage with only two capsules a day, and there’s studies showing that it reduces dementia, and promotes brain health. Our speaker for this evening, Dr. Karin Duncan, is a board-certified naturopathic physician with a focus on integrative neurology. She’s a specialist in treating patients with Parkinson’s disease using an integrative functional medicine approach. Dr. Duncan practices at Coeur d’Alene Healing Arts in Coeur d’Alene, Idaho. Dr. Duncan, thank you so much for joining us.

Dr. Duncan:        Thank you for having me, Ben. Thanks for being here, everyone.

Dr. Weitz:           Absolutely. So, how did you first become interested in treating patients with Parkinson’s disease?

Dr. Duncan:        Well, my mom used to tell me as a kid, “18 words or less,” because I was a chatterer. So if I get going here too, just throw something at me. Long story short, I actually became a caregiver at the age of 14 for my dad who had a neurologic condition, and for 25 years, advocated for him in the conventional realm, and worked with physicians, and had this really deep passion for neurology. Then, when I went to school, I knew I wanted to focus on it, and I met Laurie Mischley. She is really the one out there spearheading the research. She’s funded by the Michael J. Fox Foundation, NIH. She presents at the World’s Parkinson’s Congress every year.  So at the beginning of every talk, I always want to say I don’t have any conflict of interest. I just have this incredible relationship with this woman who’s really spearheading the integrative approach for Parkinson’s. She invited me to be a part of the Parkinson’s disease summer school through Bastyr University, my alma mater, and Kenmore. On day one, I said, “Hey, Laurie, I don’t know how you do what you do. All you see is people with Parkinson’s. Don’t you get bored?” She was just like, “Give it a week.” At the end of that first week, I went up to her with tears in my eyes. I’m like, “This is what I want to do.”  It was such a profound experience for me to witness these people come in, share their stories, recognize that no two people were the same with Parkinson’s disease. There’s so much promise in the therapeutics that we’re doing, so it was exciting to join the team. Then the longer I do it, the more I enjoy it. Neurology has been in my blood since I was young, and here I am.

Dr. Weitz:            That’s great. So, what is Parkinson’s disease? How is it defined? How do we diagnose it?

Dr. Duncan:         Oh, well, really, I’d love to take this opportunity to open up to the crowd. If anybody wants to tell me what they think Parkinson’s disease is, I’d love to hear somebody else’s definition.

Dr. Wasserman:   I guess the simple degeneration or lack of dopamine, the substantia nigra, and any disease or entity can affect that. That’s my very light definition.

Dr. Duncan:        I like that one. What you’ll hear in most conventional terminology, or if you Google Parkinson’s disease, it’s your four symptoms, the bradykinesia, the stooped posture, the masked facies, and the pill-rolling tremor. When I talk to my patients or when I talk on these lectures, I always like to say when Parkinson’s disease is diagnosed dependent on motor symptom presentation, because we’re diagnosing it based on motor symptom presentation, but the research is showing that Parkinson’s disease can start as early into 10 to 20 years prior in the human body.   So, it is in short the degeneration or the death of dopaminergic neurons, but the symptom presentation that we’re looking at and how we’re defining it by autopsies is really far off. I think Ben and I have talked before. Until we redefine what that looks like for people so we can recognize it earlier, we’re going to be stuck in this hamster wheel of being too late to the diagnosis.

Dr. Weitz:            I think the most common symptom people think about is the tremor. That’s actually not something that always occurs, and sometimes occurs quite late, right?

Dr. Duncan:        Absolutely. I mean, what we’re recognizing is that by the time of diagnosis, depending on motor symptom onset, the substantia nigra is 70% to 80% depleting dopamine already. So by the time the motor symptoms show up, we’re so late to the game.

Dr. Weitz:            Right. Now, what are some of the common symptoms that happen early? Patients often have constipation. I understand that’s a big thing. I was thinking about the fact that one of the other early, early symptoms is a loss of taste. Now, we’ve got all these patients out there who’ve had COVID, and they have a loss of sense of smell and taste.

Dr. Duncan:        That one bit me in the ass, Ben, because I was lecturing and raising awareness about… Actually, the loss of sense of smell is what we recognize in people with Parkinson’s, not so much-

Dr. Weitz:            Oh, the sense of smell, I’m sorry.

Dr. Duncan:        Some anosmia early on. When COVID happened, I’m out there lecturing saying, “If you have this triad of non-motor symptoms, constipation, anosmia, and REM sleep disorder, we need to treat you as if we would treat somebody who is at risk for heart attack. You’re sedentary. You’re a smoker. You’re heavy overweight.” So, when I started lecturing about that, and then COVID happened, you should have seen the messages, “Oh my God, I lost my sense of smell. Am I going to get Parkinson’s disease?” But yes, when we look at that, those are the triad of symptoms that we’re really trying to stand on the rooftop and say, “If we are all aware that this triad of non-motor symptoms predates the diagnosis by up to 10 to 20 years, and we do something about it, could we actually cure Parkinson’s disease?”  I mean, that’s the big question, right? If we can slow those inflammatory processes down, and treat those, would it continue to degenerate?  Of course, we don’t know the answer yet, because we’re not doing it. It’s a huge passion of mine. I have, I would say, five to seven patients in my practice right now that I’ve identified, and actually had that conversation with, and said, “Hey, you’re meeting these risk factors.” Most of them have somebody in their family who’s had Parkinson’s or a neurologic condition. We’re seeing vitamin D deficiencies.  So, as things are piling up in the investigative work, I’m sitting them down and saying, “I want to be really upfront with you, because I’m passionate about this. I’m not saying you’re going to get it. I don’t have my crystal ball, but here’s what I know, and I’d be doing a disservice if we didn’t address this.”

Dr. Weitz:            One of the really interesting ones is the constipation, which indicates that there’s some gut imbalance, gut dysbiosis. What have you found is something that might make sense as an intervention? Do you find some of these patients have methane SIBO, or what would be the intervention that might make a difference?

Dr. Duncan:        Can I just say yes? Yes, any, and all. I mean, we’re finding so many GI dysfunction and inflammatory conditions in people with Parkinson’s, and they’re extreme. They’re really severe. I have a patient who he can’t sit down and watch a movie with his family just because of his gut inflammation and pain. So, to roll back, because as I understand it, Ben, these are all medical professionals here on this call, correct?

Dr. Weitz:            Yes. Yep.

Dr. Duncan:        Yeah, so I’m going to get a little nerdy here for a second.

Dr. Weitz:            Great.

Dr. Duncan:        The inflammation in the intestines, when the intestines are inflamed at ages studied as young as five years old, we’re seeing when the intestines are inflamed, they release a protein into the bloodstream. The name of that protein is alpha synuclein. If you’re familiar at all with the pathology of Parkinson’s disease, and autopsies of the people with Parkinson’s, we’re finding this misfolded alpha-synuclein aggregated in the substantia nigra. So, all of these pharmaceutical targets are how do we get rid of alpha-synuclein? How do we get rid of this? But really, the question is why is it there to begin with?

                                It’s an intentional compensatory response mechanism from the intestines saying, “SOS, we’re pissed. We’re going to send out alpha-synuclein.” Then anybody who wants to yell out to mute, what’s the nerve that connects the gut in the brain? We know the vagus nerve is doing that. There’s a huge hypothesis being accepted in the conventional world that that protein can travel up, and then the vagus nerve originates near the substantia nigra, and deposit there. So, when we’re looking at gut health and PD… We could take the rest of the hour talking about it, and I’ll try not to. So, throw something at me if I just keep going.

Dr. Weitz:            I would definitely. That’s a rabbit hole I would like to travel down as well.

Dr. Duncan:        Well, it is. I pump the brakes, and so many people will come into me, and say, “Hey, I want to work on my Parkinson’s disease. What meds should I take? What do I do for my brain?” I say… I think I told you this before, Ben. Excuse me. I consider it borderline malpractice to prescribe somebody an oral medication that they cannot absorb. If their gut is that inflamed, and they’re resistant to the use of oral medications, then I pump the brakes. As frustrating as it may be for patients to hear, “Wait, I’m not seeing an improvement in my symptoms yet,” I will say, “Hey, stand by.” What I’m noticing in my patient population is once we treat the gut, whether it be SIBO or IBS, Crohn’s, I mean, IBD, Crohn’s, things like that are just your run in the mill low gastric motility, because of autonomic dysfunction.

                                We are actually seeing a drop in the need for Sinemet or Carbidopa Levodopa by up to 30% to 50%. So, operating well, lower symptom presentation with a lower dose of the medicine that their neurologists are pretty much maxing them out on and saying, “You’re done. This is the end of the efficacy.” So, that gut health, it has to be first, because that’s where we’re getting all of the effect of our medicine and our nutrients.

Dr. Weitz:            I got to get my mega phone. Researchers on Parkinson’s, before we spend the next 20 years spending billions and billions of dollars developing drugs, blocking the formation of this Alpha-synuclein protein, take a look at the research on Alzheimer’s. Even though they have drugs that clear out the amyloid plaque, it doesn’t cure Alzheimer’s, and a lot of the patients get worse. So before we make the same mistake with Parkinson’s, and spend billions and billions of dollars trying to block this one protein…

Dr. Duncan:        Understand why the body’s making it.

Dr. Weitz:           Exactly.

Dr. Duncan:        I mean, in the beauty of the human body, when you really sit there and think about, it’s this gorgeous process that the body’s saying, “We’re putting out our distress signal. Why aren’t you listening?” We’re like, “Let’s kill your distress signal.”

Dr. Weitz:           Somebody asked about Alpha-synuclein, the protein I just mentioned. Dr. Duncan just mentioned that some of the drugs for Parkinson’s are designed to clear out this alpha-synuclein protein. It sounds very much like the Alzheimer’s story in that sense.

Dr. Duncan:        They’re already billions in, Ben, honestly.

Dr. Weitz:           Oh, I’m sure. Now, it’s interesting. You mentioned that we should be treating this like heart disease in terms of prevention. I was digging through some of the research on Parkinson’s today in between patients, and I saw several articles showing that lower levels of cholesterol are actually related to increased risk of Parkinson’s, and taking statins seems to increase the risk of Parkinson’s. So, maybe we don’t want to treat it the way we treat heart disease.

Dr. Duncan:        No, I don’t want to take a similar approach. You could pick anybody off the side-

Dr. Weitz:            No. No, I know. I know what you’re saying.

Dr. Duncan:        [inaudible 00:16:04].

Dr. Weitz:            I just wanted to point that out that that’s really interesting that cholesterol, which I think most of us in the functional medicine world know is super important for brain health. Yet, the conventional cardiology world would tell us that cholesterol is… that lowering cholesterol through taking statins has no effect on brain health at all. I recently heard a very popular podcast host who talks a lot about cardiovascular disease saying the goal should be to get ApoB or LDLC down to 30 or 40. Just drive it as low as possible using whatever pharmaceuticals are necessary, and claiming that there’s no problem with brain health, because the brain produces its own cholesterol.

Dr. Duncan:        You can get even more detailed than that, but the cholesterol levels are really important. I’m a huge proponent of collegiality. I’ve reached out to cardiologists time and again, and I’ve only gotten pushback once, to be honest. So, I really want to be a sounding board, just saying, “Bridge the gap. Have the conversations. Alleviate patient advocacy. Pick up the phone and call the team.” It’s such a great way to connect with that patient’s team. I’m a huge proponent of patient advocacy, but when I talk to this cardiologist, I’m saying, “Hey, here’s what the research is showing here. I respect what you’re doing. I understand what you’re doing. Can we set a goal?”   In the labs research that we’re finding, the cholesterol goal of 150 to 175 is really as low as we want to go. So, when you set that goal out there… Like I said, I’ve only had pushback once, and it’s, “Hey, let’s set this goal. Let’s lower the risk for statin. What are you doing over there?” We’re doing diet and lifestyle, and we have red rice on board, or we have some other botanicals and, “Hey, can we recheck in six months, and then collaborate and see if you feel comfortable with the plan?” It’s a really effective conversation. Like I said, I just don’t get pushback.

                                They’re most of the time… I’m not taking anything away from they prescribe it, and then they refill it, and then there’s not really that follow through. So when you bring their attention to it, “Hey, patient A’s cholesterol is at 110, and they’re really declining here.” We need to reduce that. Then when you talk about cholesterol in the brain, and fat and everything like that, that’s really what we want to be supporting and supplementing with if we need to.

Dr. Weitz:            We know that there’s lots of environmental triggers that can trigger the onset, or make Parkinson’s worse. What are some of the most important environmental triggers?

Dr. Duncan:        The ones that are proven as a dry cleaning agent, and then there’s a toxin. I think I stumbled on this last time you asked me. You think I’d be more prepared, but the toxin in the Navy that was used in navy yards and on navy ships, that has been a known causative now. It’s not even correlative for Parkinson’s disease. Other factors, pesticides, glyphosate is out there. There are some theories on mycotoxins. There’s a lot of theories on mycotoxins. I just… Anybody want to send me a link for a lab that true blue and accurate and hasn’t changed their reference ranges in the last two years, I’d love to see it, because those are tough ones to test. Then you repeat testing in the lab, change their reference range or what is normal.  So with that, there’s… But there’s a ton of-

Dr. Weitz:           What lab do you like for toxins and mycotoxins?

Dr. Duncan:        I’ve most consistently used Great Plains.

Dr. Weitz:           Okay.

Dr. Duncan:        That’s usually the one that I’ll use for that one. Environmental, or, sorry, elemental toxins, or when I’m looking at the essential toxins or toxic minerals, I’ll use the Doctor’s Data.

Dr. Weitz:           We’ve been using Vibrant. They have a total tox burden that includes 20 heavy metals, a bunch of environmental toxins and mycotoxins all through urine.

Dr. Duncan:        Great. No, I’d love to learn more about it. Testing is… There’s so many out there. Just trying to know what’s best, but that’s what we’re looking at there. An interesting thing on the toxin thing, Ben, I think I told you this too, but back in school, you take this environmental medicine class, and everybody leaves like, “I’m not touching anything. I’m not going to breathe the air. I’m not going to go out of my… I’m going to be bubble boy.” I was a little older. I went through med school. I had been in the military, and I was like, “Well, I’m screwed. I got every toxin out there that I-

Dr. Weitz:            Toxic think burn pits.

Dr. Duncan:        So when I’m looking at it, I’m saying, “What can we do to enhance the terrain of the body to eliminate toxins?” A really interesting fact is, like I said, by the time of diagnosis, because of motor symptom onset, if we’re 80% deplete in dopamine, we also have evidence that shows we’re 40% to 60% deplete in glutathione. Glutathione is the primary antioxidant of the central nervous system. So, in layman’s terms, what I tell my patients is, “If you have this degenerative disease because of the death of dopaminergic neurons, and we know that when cells die and go through apoptosis, they release their toxins into the environment or the debris, which causes oxidative stress on neighboring cells, that creates a domino effect or a faster progression of the disease.”   Now, we don’t have the dump truck. We don’t have the thing that’s going to come clean it up, so it’s perpetuating that pathophysiology there, if you will. So, when we talk about toxic burden, it is really important to recognize what each patient has, one for diagnosis confirmation, because there’s been a handful of people that I’ve undiagnosed with IPD to Parkinsonism based on heavy metal toxicity or toxic burden, but also for treatment. Many of the people with Parkinson’s that walk into my practice aren’t vital or resilient enough to even go through the detox process if they are burdened. So, it’s nice to know, but it’s also, in my opinion, more important to boost up that vitality and the resilience of the patient and their physiology.   Say, “What’s your glutathione levels? How can we help your liver support?” Of course, that brings us back to the GI, right? “Are you pooping? If you’re not getting rid of your toxic waste products, then we need to work on those emunctories first.”

Dr. Weitz:            Those are part of most functional medicine detox programs anyway.

Dr. Duncan:        Right. Exactly, but I’ve seen… I’ve had patients come in who’ve been through detox protocols, and they just weren’t ready for it yet, and they get really sick, and it can aggravate Parkinson’s. It’s inflammatory, so we have to be really cautious with this population, how hard we go into any treatment. I mean, even something as relatively benign as SIBO can really put that dent in the Parkinson’s symptoms, and when it’s degenerative, we want to avoid that risk very carefully.

Dr. Weitz:            I think the strategies that are going to tend to really make patients worse are when we’re using these oral chelating agents or IV chelating agents. I think the more modern approaches use liposomal glutathione and maybe some binders and liver support and things to support bile production,

Dr. Duncan:        Broccoli and selenium, Ben.

Dr. Weitz:           There you go.

Dr. Duncan:        I mean, don’t underestimate those types of things too, that can really help with that removal of those toxins.

Dr. Weitz:           Now, I’ve also seen some data that viral infections like Epstein-Barr can be triggers for Parkinson’s. Interesting, now coming back to that, we’ve been through this pandemic, and we’re finding that reactivation of dormant viral infections like Epstein-Bar are very common for patients as part of the long COVID process.

Dr. Duncan:        I mean, in my opinion… I won’t dive into the long COVID thing, because that’s a whole another podcast. But in my opinion, what I am seeing is that’s what we’re missing, in the biggest sphere of medicine in general, is we’re missing what else? Once we get to a diagnosis… I do this lecture to my patients so many times in online forums is, “Once you get this diagnosis of Parkinson’s, we’ll stick to that.” It’s really easy then for everybody to grab this big umbrella, and say, “Oh, you’re not pooping. That’s Parkinson’s. Oh, this is happening. That’s Parkinson’s.” Let’s just dump it all in this Parkinson’s bucket, because that’s a lot easier.   The same thing I think happened with the pandemic. When we start to say, “Oh, the body’s capable of having more than one disease or more than one dysfunction, and teasing that out,” what I tell people is, “If we diagnose you with hypothyroid, and some sort of food sensitivity, and B vitamin deficiency, now the diagnosis of Parkinson’s becomes a lot lighter and smaller, and we’re managing these other symptoms.” So, when we’re talking about EBV, just in general comorbidities, it’s really important to test for those, especially if we’re seeing the lab values show up that way.   We do have a history of seeing low lymphocyte values in people with Parkinson’s disease. If that continues to show up in monitoring, then that’s the next step I take is say, “What else is affecting your nervous system? EBV. Is it Lyme? Is it HSV?” There are so many potentials out there.

Dr. Weitz:            Absolutely.

Dr. Duncan:        With EBV, the last thing I want to say is knowing how to test is really important. I’m definitely not the end all be all, but I dove in really deep on this one, because so many people come and say, “I have EBV. I’m on all these supplements. I can’t afford.” It’s just it’s this long rigamarole, and I’ve never seen a reactivated EBV panel run. So, remember when you’re running EBV panels to do the thorough panel, and remember that if they’re IgG antibodies, and that’s not necessarily indicative of a reactivation unless you’re running that EBNA, and that one, if that’s showing up, is more indicative of reactivation, but not 100% specific there.

Dr. Weitz:            Can you tell everybody exactly what that test is you’re talking about, because I think a lot of us are relying on IgG?

Dr. Duncan:        Yep, they do. There’s the IgG, IgM for the viral capsule-

Dr. Weitz:            IgA.

Dr. Duncan:        There’s one more IgG, but then there’s a whole other brand, and it’s the Epstein-Bar nuclear antigen, the EBNA. That has also an IgG test, but if that’s elevated, that’s more indicative of a reactivation. The other ones are more indicative of a past infection. So, to determine whether or not you’ve had been exposed or not to whether or not it’s actually reactivated in your body, that fourth lab test is pretty important.

Dr. Weitz:            Right. Now, one of the things I’ve been seeing and some other practitioners have been talking about is a immune system dysfunction. We’ve been running some tests to look at immune system function like the… Cyrex has the lymphocyte map test, and then their cytokine test. That seems to be one strategy to helping patients with some of these reactivated viruses by trying to support the immune system in whatever way it’s imbalanced.

Dr. Duncan:        Right. There’s theories out there that Parkinson’s even originates as an autoimmune variant. What I tell, again, most of my patients, if they have the diagnosis, is that you’re technically under the classification of immune compromise by nature of your disease for whatever reason and however you reflect. It’s something to understand for themselves and their family that their immune systems are more vulnerable, and need to be protected.

Dr. Weitz:            Steve asked about have we seen an increase of Parkinson’s since COVID? I think in general, we’ve seen an increase in autoimmune diseases, haven’t we?

Dr. Duncan:        In general… I mean, in my clinic, I can speak to that for sure. I don’t know the epidemiology of Parkinson’s since COVID. I haven’t looked at that data, but Parkinson’s has spiked into being the leading disease in the population. I think that’s just by age as our boomers get into that generation, and the risk factors have increased in our society, I think.

Dr. Weitz:           Right. Dr. Vojdani has published a paper showing that COVID is the most autoimmune reactive virus that exists.

Dr. Duncan:        I haven’t been in practice long enough to know that, to be honest, because the flu’s really old but-

Dr. Weitz:           No. No, he’s actually done a study to show the number of different… What are some of the most important lab tests for us to do when we’re assessing potential patients with Parkinson’s?

Dr. Duncan:        I have a standard lab panel for most of my people at Parkinson’s. You’re going to do your blood count and your metabolic panel. I usually pair an A1C with insulin. Rarely do I run an A1C by itself anymore. I’ll always do A1C with insulin. Again, in the aging population, we tend to see numbers of your hemoglobin and red blood cells. There’s a lot of inflammatory anemia happening. So if you need to back up the blood sugar regulation with the fructosamine, that’s also something I add on. There is some theories out there, because it’s metabolic in nature that Parkinson’s being a type three, similar to what we’re saying about Alzheimer’s disease type three diabetes.  An iron panel plus ferritin, iron is hugely correlated with Parkinson’s disease, development of, progression of, so always running a full iron panel with ferritin. I do an extended thyroid panel.

Dr. Weitz:            By the way, iron generally increases risk, right?

Dr. Duncan:        Yes. An elevated iron increases risk. I have four now in my practice that I’ve diagnosed with hereditary hemochromatosis for the first time in their life. So, it’s a non-standard lab, and it’s just essential for not just neurologic health, cardiovascular health, and liver health for sure, but then we’re looking at expanded thyroid panel. I do an expanded thyroid panel, and everybody who comes in as a first patient, if it’s good to go, then we can cool it from there. I look at your B vitamins, B12 and B6, and your folate.  We know that the use of levodopa can deplete the body of folate and b12, so looking at those for sure, vitamin D.

Dr. Weitz:            Do you prefer-

Dr. Duncan:        I’m walking through my lab for vitamin D and then DHEA with a high sensitivity, CRP, uric acid, F2-isoprostanes, and an omega check. That’s my standard, and then of course, patient specific add or subtract.

Dr. Weitz:            Uric acid, we’ve learned from Dr. Perlmutter That even slightly elevated uric acid levels above 5.5 are associated with metabolic disease. But for Parkinson’s, elevated levels of uric acid are actually protective. Isn’t that right?

Dr. Duncan:        They are. Yeah, it’s really fascinating, and we see that when we avoid dairy. Dairy inhibits uric acid. We actually get an increase in uric acid levels, which are protective for Parkinson’s disease. We have to be a little bit careful, of course, patient specific, because they can be inflammatory. Inosine is a supplement that’s commonly used with Parkinson’s disease that can boost uric acid levels, and alleviate some symptoms.

Dr. Weitz:            Interesting. Is that one that you use?

Dr. Duncan:        On occasion. I don’t have a ton. Mostly, I joke most of my patients in the aging population have plenty of uric acid. I’m not seeing a big depletion here.

Dr. Weitz:            Let’s talk about some of the most common pharmaceutical approaches. Oh, somebody asked, can you repeat dairy inhibits? Did you say something about dairy?

Dr. Duncan:        Dairy will inhibit uric acid and with… There’s twofold there. Dairy is one of the major food groups that we do recommend avoiding for people with Parkinson’s. When I first started in my practicing, you learn it, and you’re gaining ground here. I was like, “Let’s try to avoid dairy, and here’s what we know.” Now, my poor patients, I’m like, “Nope. Dairy done. Get it out.” We have so much evidence to show it’s a risk factor for development of and progression of Parkinson’s disease. Then everybody wants to ask about goat and sheep.

                                My answer there’s they’re never going to do a randomized control trial of cow’s milk dairy versus goat milk dairy. So, go plant-based if you can, and boot it out of the house. Those are pieces of information we’re not going to know. Again, we know uric acid is protective, so it’s a twofold reason to avoid dairy. We want to boost up those uric acid levels, and we have these independent clinical evidence to show the progression [inaudible 00:33:07].

Dr. Weitz:            Actually, let’s pause on the drugs. We got a few questions, I think, we should try to address. Bernie asked about the relationship between head trauma and Parkinson’s, and most neurological diseases, Alzheimer’s including.

Dr. Duncan:        Bernie, I appreciate that question. Yes, head trauma definitely has a relationship to Parkinson’s. It makes it very challenging to treat. A lot of my people with Parkinson’s who have a history of TBI or CTE are either medication resistant, or their progression is quite fast that it’s hard to catch up with. So in that realm, we get a huge team on board neuropsychiatry. We have a functional medicine doctor that’s working on neuroinflammation. We’re doing trials of different Parkinson’s medications. Then if it’s a motor symptom prominent presentation, then I’m usually recommending DBS for some of those folks, but it makes it really challenging when there’s confounding neurologic trauma happening there.

Dr. Weitz:            On the testing, Steve asked about do you run organic acid testing?

Dr. Duncan:        On occasion. Yep, so I will check for metabolite function or presence in the urine. If I do, I use great… Hold on. Do I use? Yes. No, I use Dutch. I use the Dutch test for that one. Great Plains at PD summer school. But yes, we will run OATs testing on occasion to see how some of those metabolites are functioning.

Dr. Weitz:            Sherry asked, “What are the best neurological tests to run?” Now, we’re talking about the neurological exam part, which is separate from the lab testing.

Dr. Duncan:        Oh, like for physical exam?

Dr. Weitz:            Yes. I assume that’s what you mean, Sherry, right? Okay. So, you’re seeing the twitching-

Dr. Duncan:        I’ll answer that one. Your neurologic test is going to be really important. I always look for Cogwheel rigidity. I think that’s one that’s missed a lot in the diagnosis. They can actually show up a little bit before motor symptoms. So, people are diagnosed, but they’re not really strong in the motor symptoms, the tremor. You’ll often see that Cogwell rigidity in their shoulder or elbow joints. Then the gait analysis is really huge. Gait analysis, people get diagnosed on their walk all day every day by neurologists.   So, having them turn around, walk your normal gait away from me, turn around as fast as you can at the end of the room, come back heel to toe. You can do the shin slide, but making a really thorough gait and posture analysis. I will check gait. I will-

Dr. Weitz:            What are some of the most common gait abnormalities you’ll see?

Dr. Duncan:        Shuffling a little bit later on, but that lack of arm swing on one side is really the most early sign there, and then a head tilt, believe it or not. Oftentimes, people will have that head tilt to the side that’s affected when they’re doing their gait analysis. DTRs are always going to be important, that repetitive rapid alternating movements. If you really want to dive in, you can go to the MDS website, and learn the UPDRS, or just a few tests from the UPDRS. You don’t have to be qualified to do the entire test. I nickname it the chicken dance, but it’s really this.  Can you stomp and move your feet as fast as you can, so you can check those movements? The finger to nose test will test that intention tremor and coordination. I mean, those are really the big ones. Oftentimes, they’ll have people sign their name on a piece of paper, and just look if they’re having that agraphia to see if their handwriting has gotten smaller.

Dr. Weitz:            Some of you guys-

Dr. Duncan:        I also use that for signs of improvement. Hey, I need you to do sign again. Let’s see if these things are helping and if we’ve gotten better control of your motor symptoms.

Dr. Weitz:            Now, is there a quantitative score patients can get on that neuro test, or any-

Dr. Duncan:        The UPDRS is very detailed. That’s what movement disorder specialists are using for diagnostic and prognostic testing. It’s a very useful test when not used in isolation. I think the frustration is they’ll go in, and they’ll do excellent at the test, and they’ll be feeling like shit. They’re like, “Hey, my neurologist said I’m doing great. I don’t need anything else, but I haven’t pooped in four days, and my anxiety’s through the roof. Here’s how I’m really feeling, but my UPDRS was great.” So, again, taking that all into consideration.

Dr. Weitz:            Right. Always treat the patient. Somebody asked about isoprostane labs. Is that… Did you mention it?

Dr. Duncan:        Yeah, F2-isoprostane is a urine lab. As my mentor told it, it tells us how rancid somebody is, and it truly will tell you if there’s rancidity in the body, and if it’s in that toxic state. That can lead me to say, “Okay, we need further testing maybe on the toxic levels, heavy metals or mycotoxins if there’s something else at play here.” I also correlate that with the omega check. Are we getting enough of the omega-3s? Are we getting these anti-inflammatories? What is the burden there?

Dr. Weitz:            When you look at the omega levels, what are you looking specifically? What do you focus on the most? Do you just look at the omega-3 index? Do you look at the Omega-6:3 ratio? Do you look at the arachidonic acid omega-3 ratio, the EPA, the DHA levels? What do you think is most significant to focus on?

Dr. Duncan:        Yes. No, really, the big one… All of those things, of course, and you’re looking at those levels to be in favor of the omega-3, the anti-inflammatory markers. The DHA is really what most highly studied in people with Parkinson’s. I always say for DHEA or, I’m sorry, DHA, it’s the four Ds, and we’re looking between two and four grams of DHA at a daily dose to help with these things. The four Ds we’re looking for with Parkinson’s disease is depression, dementia, dyskinesia, and death. Those are four big Ds that you really want to address.   So, I have three nutrients, natural medicines that most everybody in my practice will get prescribed at some point in time early on. That’s one of the biggest ones is because, again, the brain’s made out of fat. The DHA is the prominent fat in the brain, and we really want to promote those high levels there.

Dr. Weitz:            What lab do you use for the F2-isoprostane?

Dr. Duncan:        I run mine through LabCorp, and it’s a urine lab. That’s the big thing to remember is that’s urine. You’re not going to find it on a blood panel.

Dr. Weitz:            Okay. Steve, you’re asking about CoQ10. Hold that. We’re going to go into drugs, and then we’ll go into diet and then supplements, if that’s okay. Can you talk about pharmaceutical approaches to Parkinson’s?

Dr. Duncan:        Yeah. Give me one second here. My son’s nest just went off or hatched. If anybody knows what a hatch is, then you know. Pharmaceutical approach to Parkinson’s disease, it’s growing. There’s many, many out there that are available. The biggest one that you’re most familiar with is Sinemet or carbidopa levodopa. My approach to that, I always like to take a couple minutes, and talk about it. As a naturopathic doctor, as a functional med physician or practitioner, I’m sure you get most of your patients come and say, “I don’t want to take drugs. I don’t want to take meds. Give me anything.”

                                Then the conversation ensues of, “If you have somebody who has type one diabetes, and their pancreas cannot make insulin, the most natural thing, an effective thing that you can give to these patients is insulin. You have Parkinson’s disease, and your body cannot make dopamine. The most natural and effective medicine that I can prescribe to you right now is dopamine.” So, we have those conversations, and there are natural supplements for dopamine. We’re talking about Mucuna Pruriens. Unfortunately, with the supplement industry not being regulated, we are seeing that that dosages cannot be standardized sometimes even from pill to pill within the same bottle.

                                So when I’m starting somebody on a medicine, I really do promote the use of synthetic carbidopa levodopa, because, I mean, we’re trying to fill up a bucket blindfolded. We don’t know how empty it is, and when we’re repeating the body of dopamine, what I’m seeing the most is that it’s not so much the medicine taking care of the symptoms of Parkinson’s disease, but it’s aiding in their ability to do the things they need to do to slow down Parkinson’s disease, so again, the non-motor symptoms like apathy, lack of motivation to do what they can, pain, anxiety.   When we give these patients the dopamine that they need, then they can start to overcome some of those, and go do the exercise, and eat and prepare their food, not to mention the huge effect it has on motor symptom presentation. So, there’s a couple different varieties up there, your immediate release, your extended release, controlled release, Sinemet, Rytary, generic. That’s really the first one that we come to the table with. [inaudible 00:42:21].

Dr. Weitz:            Now, something you told me last time we spoke, which I thought was really fascinating is it’s common for patients to be told by their neurologist. Let’s hold off on starting to take dopamine or carbidopa levodopa, because it will stop working after a certain period of time. You have found that when you use a functional medicine approach, that doesn’t happen.

Dr. Duncan:        I’m not going to say it doesn’t happen.

Dr. Weitz:            Well, it doesn’t happen as often.

Dr. Duncan:        Yeah. I mean, the goal is… Like I said, when we are taking a whole person approach, the theory out there is that carbidopa levodopa has a 10-year shelf life in the body. You’re going to keep increasing the dose until you hit max dose, and then it’ll start to wear off, and not be useful anymore. So, what I talked to people about is, one, “You can get 10 good years out of this. Do you want to take it?” I would. Let’s give it 10 good years, and let the researchers go do their job to see what else they can come up with in the meantime. Two, the majority of the time, what I see is in that line of thinking or philosophy, let’s prescribe this, and let’s keep increasing the doses.

                                Symptoms worsen and worsen and worsen without thinking of, “Hey, are you taking magnesium? That interferes with levodopa? Hey, do you have a B12 deficiency? Do you have slow gut motility? Are you taking it with protein? Do you have CDP choline on board? Are you taking it with vitamin C? Do you have enough hydrochloric acid?” The list goes on and on and on how we can make this medicine more effective for our patients. When that’s left out, then we’d need more, and it runs out of efficacy. When it’s brought in, that’s what I was mentioning before. We see the need for that medicine decreased by up to 50% while still managing symptoms.

Dr. Weitz:            That’s awesome.

Dr. Duncan:        It is. It’s incredible. I mean, I said, I’ve taken people right off the ledge. I’m at max dose. They’ve got nothing else. They’re on four or five different anti Parkinson’s meds, and we… Let’s pull this back a little bit, and they’re managing really well.

Dr. Weitz:            Awesome.

Dr. Duncan:        The other medicine I really want to hit on that comes right out of the gate from naturopaths office, which often astounds people, is Rasagiline or Azilect. It’s an NMAO B type inhibitor. Why I prescribe that or promote that is it’s the only pharmaceutical on the market right now with some research to show that it slows disease progression. All of the pharmaceuticals at this point in time are there for symptom management. This is the only one that actually shows a slight improvement in disease progression. So, again, I look at every single patient.  Is it me? Is it my mom? What steps do I want to take to slow this disease down, and buy all of us idiots over here more time to do the research, and figure out what else we can do?

Dr. Weitz:            Great.

Dr. Duncan:        My least favorite pharmaceutical, I’ll just go right into that if you want me to keep rambling, are the agonists. The agonists are tough. They’re effective, but they have a laundry list of side effects that I would say most patients experience. So, impulse control, behavioral changes are really pronounced when we’re using those agonists. They’re most often prescribed for people who have restless leg syndrome or the REM sleep disorder symptoms. As you all know, I mean, we’ve got oodles and oodles of tools to use for those symptoms.

                                So, again, if we can take those out of the Parkinson’s bucket for a hot minute, and address those in a different way, then we don’t necessarily have to use those medicines as often. Some non-standard medicines that I really am loving using, especially when we have GI issues, are Inbrija. It’s an inhaled levodopa. I use that as a rescue medicine. Then you have your new ProPatch, which also bypasses the gut, and can be helpful for managing symptoms of Parkinson’s.

Dr. Weitz:            Steven asked if ARBs like Cozaar are neuroprotective.

Dr. Duncan:        That’s a good question. I honestly don’t know. I’m sorry. I can do some research on that if you ever want to email me, and I can get back to you, but I don’t know right offhand if that’s a direct correlation.

Dr. Weitz:            Can you just repeat that med that you said is your favorite?

Dr. Duncan:        Dopamine.

Dr. Weitz:            No.

Dr. Duncan:        Sinemet, but the one that shows disease progression growing is Rasagiline or Azilect.

Dr. Weitz:            Yes. Thank you.

Dr. Duncan:        Interestingly enough, as a MAOB type inhibitor, just fun fact, turmeric has properties of an MAOB inhibitor too. So, all the other lovely things that we all love turmeric for also shows properties of the MAOB. So, I usually want-

Dr. Weitz:            Awesome.

Dr. Duncan:        Some form of turmeric in there.

Dr. Weitz:            One of the most amazing nutraceuticals for sure. So, what about diet? What are the most important dietary considerations?

Dr. Duncan:        The most important dietary consideration, as I mentioned to you before, Ben, is a healthy relationship with food. I’m a huge proponent of screening for disordered eating habits, body image dysmorphia. I don’t know off the hand… Of course, I don’t have these, but I would say probably 50% of my male and female patients over the age of 65 have battled with some disordered eating, whether it’s back in their teenage years or in their 40s or… Men aren’t exempt from this. Body image for men tends to be this very deep shame issue, so don’t not ask. Ask first.  If they laugh at you, then great. Move on, but those conversations are really important, because when we’re talking about neurologic disorders, anxiety and vagal nerve dysfunction are hugely important in the healing process.

Dr. Weitz:            We need the restrictive diet specifically for Parkinson’s. We need to be able to tell patients, “Don’t eat broccoli and cauliflower.” No, I’m kidding.

Dr. Duncan:        No, eat… Those exist. Once you pass that gate of, “Can you eat these healthy, and it’s not going to create stress and anxiety for you?” Because my motto is if eating the food or not eating the food causes you more stress than the food itself, then eat the food. We can do things to detox the food, but that stress and vagal nerve dysfunction is important. But when we’re looking strictly at diet, most of the research is coming back to that Mediterranean mind diet that we’re really aware of that’s been published over and over again.  I have a colleague who’s a MDS over in Seattle who’s hugely promoting a vegan diet. I don’t necessarily see that to be true in all of my patients. So, we ease our way into it. If they’re really willing to go there, then absolutely, especially if there’s cardiovascular risk, but I really start talking about what to avoid and what to focus on. So, my patients will leave my office with, “Here’s your goal. I want seven to nine servings or fruits and veggies. I want you to eat mushrooms. I want you to focus on wild caught salmon.”   By the time they get through the list of what I want them to focus on, they’re full. So, it’s less about restricting, and it’s more about, “Let’s make your grocery list. Let’s make your meal plan with these foods that we really want to get in your system. That way, it doesn’t feel so restrictive,” but dairy is the big one. Pork, red meat definitely has been shown to increase the progression. The other thing that I like to talk about is smoothies. What we’re asking people to do with the nutrient density and low protein is, “Can we put it all in a smoothie?”  There’s a lot of people with Parkinson’s who have dysphagia, difficulty swallowing. So, can we get some of your medication and your supplements in your smoothie with you? How can we make this easier for you to get and assimilate your medicine, and promote healthy bowels and water? Let’s add some water to your smoothie. Now, we can really amp it up. Diet’s a huge, huge aspect of health for people. It’s just it’s really touchy and really important, so tread with caution.

Dr. Weitz:           There’s some interesting data on the benefits of exercise for Parkinson’s.

Dr. Duncan:        Yeah.

Dr. Weitz:           Aerobic exercise, there’s some data even for strength training.

Dr. Duncan:        The most important thing I think for exercise is it’s dose dependent. So when I tell my patients that… We always joke that if I had a pill bottle to give you that said exercise on it, you would take it, but going out and doing it is much more difficult. So, when I tell them, “This is dose dependent. It’s dose and frequency dependent is how much you do exercise, how much benefit you’re going to get from it.” It’s a huge motivator for folks. We are seeing the evidence that if you exercise less than three days a week, there is no benefit in the slowing of progression. So, it is a three plus days a week where you’re seeing an increased benefit in symptoms and disease progression.

                                The most studies exercise is for Parkinson’s disease is going to be things like boxing. There’s rock steady boxing programs all throughout the nation. It’s a phenomenal program. It’s utilizing both sides of your body. It’s a great community the instructors that are familiar with Parkinson’s disease, so they know how to challenge and work with people. Then as I always like to say, as a former amateur golden glove boxer, you get to hit the shit out of something, and get out all your frustration. So, it’s a really great exercise to go into.

                                Tai Chi is deeply studied. Cycling and dancing, those are the top ones that you’re going to see in the research, but what I tell people is find something you enjoy to do that challenges your brain, because it’s something new. Get that BDNF going and flowing, and do something new, and do it regularly.

Dr. Weitz:            Going back to diet, Bernie asked about what do you think about gluten?

Dr. Duncan:        Oh, gluten, it’s going to be… Again, it’s going to be patient dependent. I often try to tell people to avoid gluten. It’s going to be under my recommendation to take that out as best as they can. If we need to do deeper studies, I have diagnosed a few people with Parkinson’s with celiac disease, again, in their sixth and seventh decade. I know we all know the stories, but you’re talking GI inflammation, and that’s been going on for that long. So, we do try to eliminate or avoid gluten as best as we can. Then if something where you can’t do it, then I will often prescribe a digestive enzyme to help break that down.

Dr. Weitz:            Bernie also asked about Pilates as a form of exercise.

Dr. Duncan:        Yes. I mean, there’s not really anything I’m going to say no to as long as it’s safe and effective. But one of the… As practitioners, do you get somebody with Parkinson’s in? What I really do want to say is help them build their team. One of the very first referrals that anybody should get with the diagnosis is to a Parkinson’s specific physical therapist. Strengthening those intrinsic muscles, reducing the risk of fall, even if they’re not there yet, is going to be really, really important for everybody.  I think as we recognize that, we need to build this team for our patients. That’s one of the very first referral. “Hey, do you have a referral out for PT? Have you done it?” “Nope.” “Okay, let’s get you one. Let’s get going on this building of your team and resources.”

Dr. Weitz:            Let’s go into nutraceuticals. What particular nutritional products have you found to be helpful in slowing the progression, and modulating some of the different factors involved?

Dr. Duncan:        What I like to say is people walk into my office with Parkinson’s disease. They’re typically going to walk out with three natural prescriptions, and that’s glutathione, high potency DHA fish oil, and CoQ10. What we’re seeing with glutathione, the research states back to the ’80s. I already touched on the deficiency that we’re seeing by the time of diagnosis based on motor symptom onset, and as the primary antioxidant of the nervous system. We really need to be proactive in getting that repleted in the body, help with the detoxification system in supporting neuroinflammation.

                                I typically don’t rely on NAC as a precursor to glutathione. Most of the evidence is showing, “Just give them straight up glutathione.” IV glutathione has been researched, like I said, since the ’80s. It’s not accessible. It’s invasive. It’s painful, and the effects aren’t always long-lasting. My mentor, Laurie Mischley, did some studies on intranasal glutathione. We are seeing a larger increase in… I guess a larger decrease in symptom presentation patient reported when we use intranasal. The tough part about intranasal is that it’s also not as quite as accessible.

                                You have to do that through a compounding pharmacy. Then patients aren’t always compliant. It tends to burn a little bit. They have to lay on their back for a couple minutes, and they’ll report half of it goes down their throat anyway. We like intranasal. It’s a direct route to the brain. So when possible, it’s a really great tool to use. Otherwise, I’ll use a liposomal oral bucally-absorbed glutathione to get that process going for my patients. The hiding… Oh, go ahead.

Dr. Weitz:            How did they get the intranasal? You said use a compounding pharmacy, and then is it use one of those machines to put it in?

Dr. Duncan:        They do that. I send you the compounding pharmacy, and then they send him home with the inhaler and the spray bottle and everything like that.

Dr. Weitz:            Oh, okay, so they put it in an inhaler.

Dr. Duncan:        Yeah.

Dr. Weitz:            Then as far as-

Dr. Duncan:        Never in my-

Dr. Weitz:            Do you have a particular brand and dosage for the liposomal glutathione that you prefer?

Dr. Duncan:        Dosage is going to depend patient to patient. I tend to use designs for health. The pump, that’s the one that’s been most well absorbed for people, but I use consumer lab reports to run my natural medicines through. So, again, as a functional or naturopath or integrative provider, I think I mentioned to you this before, Ben, I never thought my epitaph was going to be safely prescribed natural medicines, but I cannot say it enough. We have to be the gatekeepers of these medicines. They are not always safe. They’re not always indicated, and they contraindicate with pharmaceuticals.  I mean, I don’t know how many of you knew that magnesium will inhibit the absorption of levodopa, and the very first thing we want to give somebody for constipation is mag oxide, right?

Dr. Weitz:            Right.

Dr. Duncan:        So, really knowing these interactions, and understanding your nutraceuticals is really important. The DHA fish oil, again, I tend to go liquid on that, because you can throw it in a smoothie. It’s really beneficial. I like Pharmax and Genestra. Those tend to be one to two teaspoons a day to get that high potency dose.

Dr. Weitz:            What’s the dosage you like?

Dr. Duncan:        Two to four grams. That’s really what we’re looking at.

Dr. Weitz:            Of DHA.

Dr. Duncan:        Of DHA. Yeah, DHA, so really understand it’s when you look at the front of the bottle, they don’t have to meet label potency, right? Again, this is my epitaph that I didn’t ask for, and, again, patient specific, right? Fish oil’s a blood thinner, so we have to be aware of all those of different contraindications there. Then CoQ10, we’re all recognizing the mitochondrial effect of Parkinson’s disease. How I like to frame it to my patient is you’re burning a lot more ATP than I am just sitting here, because you have a motor disease, a motor… What am I looking for? A motor disease.

                                You’re going to burn that fuel a lot faster. There’s a ton of other research about CoQ10 and mitochondrial health and Parkinson’s disease that when I’m talking to a patient, this is how I like to say it, “Let’s keep your gas tank full. If you’re going to use it, let’s give it to you.” It’s really hard to make that much, but then we also know that membrane stability and providing those resources for the mitochondrial. There’s been studies with CoQ10 ubiquinol. Up to 900, 1,000 milligrams a day, and the evidence to show symptom improvement isn’t there to match, and it’s really expensive. So, I typically stay between one and 300 milligrams, and I like-

Dr. Weitz:            Did you say ubiquinol versus ubiquinone?

Dr. Duncan:        I usually use a ubiquinone instead of the CoQ10 just for the bioavailability aspect.

Dr. Weitz:            You said 300 milligrams?

Dr. Duncan:        Between one and three.

Dr. Weitz:            Between one and three, okay. By the way, I think the design health glutathione is private labeled from Quicksilver for whatever that’s worth, but… What else?

Dr. Duncan:        Somebody asked me, my youngest patient 41, just wanted to answer that on the chat, but it was too late to write 41, so I didn’t know if they would know who that was the answer for.

Dr. Weitz:            Oh, okay. What about vitamin D?

Dr. Duncan:        Vitamin D, we like those ranges to be between 40 and 60. I don’t get super scared of high vitamin D. I’m always checking that calcium. You can double check at PTH, but really ubiquitously. You look at the Venn diagrams of neurodegenerative diseases, and vitamin D is implicated in all of them. It’s really come out as a shining star after the pandemic too for immune health. So, absolutely, vitamin D is something that we check and supplement with patient specific.

Dr. Weitz:            You mentioned B12. We all know that B12 is super important for brain health, but I personally have found that serum B12 levels are not particularly accurate, and tend to rely more on homocystine and methylmalonic acid.

Dr. Duncan:        Same. Those are… Sorry, and I didn’t even include those. Those are in my lab order, the very first ones. I do run an MMA, and I run a homocysteine. Absolutely. We know there’s B12 in the blood, but are we using it is the question. So, we want to check this homocysteine levels. We know homocysteine elevation. The interesting thing is I actually have a lecture up if you go to either my website or Northwest Parkinson’s Foundations, where I did a lecture just on lab values and reference ranges. We take these standard reference ranges that are made for white man age 40 to 50, and say, “It doesn’t apply,” maybe to you Ben, but doesn’t apply to most of us or most of our patients.

                                So, we narrowed in those reference ranges based on the clinical data that we have to say, “Here’s what our goal is.” In the literature, we know that homocystine above 11 can be neurotoxic. Yet, the reference range on most labs is 14, 14.9, so the goal for people with Parkinson’s is below 10.

Dr. Weitz:            I just had a patient yesterday with a homocysteine of 90.

Dr. Duncan:        Ooh.

Dr. Weitz:            I know.

Dr. Duncan:        You don’t even have to test MTHF on that guy, right? That’s-

Dr. Weitz:            Right.

Dr. Duncan:        You’ve got homozygous there. We’re definitely… Those B vitamins… Interestingly enough, like I talk about, we all know if you prescribed Metformin, you dose B12. These are things that aren’t happening. If you’re going to prescribe levodopa, you prescribe B12. We know that it depletes the body of B12. Other things that can elevate homocystine levels, not just B12 and folate, but B6 and betaine. There is a product out there that I really like called homocysteine factors. Super easy.

Dr. Weitz:            I use the designs for health product homocystine supreme, but there’s a lot of similar products out there.

Dr. Duncan:        It’s great, but be cautious with your B12. Again, neuropathy is a really common symptom of people with Parkinson’s and too much B6, because a lot of our patients come in on these… They’re self prescribed medicines can actually cause that as well. So, checking labs, making sure that you’re not putting everything in this one box. There could be a lot of different aspects at play. There’s a lot of clinical research out there about high doses of B1. I wanted to hit on that. I have had four patients who went into some trials with that. Only one saw benefit.  I’m not dogging it. I’m just… I don’t think it’s going to do a whole lot of harm, and people often will burn out from not seeing the effects, or maybe have a few side effects from it, but I’m really interested to see what else comes down the pipe about high dose thiamin supplementation.

Dr. Weitz:            Low dose lithium has some data.

Dr. Duncan:        Oh my gosh, lithium has so much data, either hair or urine test. I prefer a urine test for lithium, but that is definitely something to test. There was… What am I thinking? Not a protest, but a motion to actually lithinate water in the Pacific Northwest at one time like we do.

Dr. Weitz:            Oh really?

Dr. Duncan:        Yeah, because there’s so much deficiencies, and if you look through the literature, low lithium levels are correlated with a lot of neurologic diseases including schizophrenic and bipolar disease, so the list goes on. But yes, low lithium levels are often implicated with people with Parkinson’s, and lithium is an important co-factor for BDNF, the brain drive neurotropic factor. So, we like lithium. I prescribe lithium. You’ll often get a side eye from your conventional counterparts. How I usually phrase it to patients and put it in their notes, “This is a physiologic dose of lithium. This is not a pharmacologic dose of lithium.”   You can always check their blood levels or their urine levels again. It also has evidence to show that helps with dystonia or that muscle cramping and pain that can happen in off periods. I really like lithium. I would say after my top three, that’s probably my next most prescribed nutraceutical.

Dr. Weitz:            I looked up other nutraceuticals. There was some data on resveratrol and also lycopene.

Dr. Duncan:        I haven’t actually heard about the lycopene thing to be honest, but antioxidants, if you put a big umbrella there, the antioxidant use is going to be huge, those bioflavonoids. I really like resveratrol. You can prescribe that. You can really dive into food. Once they start meeting some of those food goals, they’re going to be getting some of those nutrients naturally, and spices. We really can’t pass up the importance of spices in our life, and how they affect our health. That’s where we can get a really good healthy dose of resveratrol. So, I like spices.

Dr. Weitz:            You’ve talked about inflammation. We know that’s a really important factor. We’ve been using the SPMs, the fish oil derivatives for inflammation. What do you think about those?

Dr. Duncan:        I haven’t used those before. It’s a good question, but I’d like to learn more. So if you can shoot me a message about that, probably, I’d love to learn more about that.

Dr. Weitz:            You got it. What about some of the supplements that are specifically for brain function? You did mention citicoline. Do you have a dosage you like for that?

Dr. Duncan:        Yeah, and it’s interesting. The Neurologix is a product that I use you mentioned by IT-

Dr. Weitz:            Oh, okay.

Dr. Duncan:        They also have a product called ProThrivers Wellness, and that has lion’s mane in it. I really like their ProThrivers Wellness Brain brand. Again, I have no conflict of interest here. I’m not sponsored, but the formula there, lion’s mane has a huge batch of research behind it for cognitive support and immune function. Then the CDP-coline that’s involved in that formula is at two caps twice a day, so you’re getting 250 milligrams. That’s a really great proponent to use. We’re using that for cognitive function anyway. A lot of people are supplementing with it.

                                What we are seeing with people with Parkinson’s specifically in this population is when we dose citicoline with carbidopa levodopa, we’re seeing enhanced efficacy of the medicine. So, again, another way that we can reduce dose or the need for dose, and expand that 10-year timeframe out, and with continued use of citicoline, we’re actually seeing an improvement of 30% to 50% efficacy in four to six weeks. So, it’s pretty great evidence there in support.

Dr. Weitz:            Wow. In what dosage?

Dr. Duncan:        250 milligrams.

Dr. Weitz:            Okay, twice a day.

Dr. Duncan:        I’m going to say twice daily.

Dr. Weitz:            Twice a day. What about some of the other specific brain formulas? There’s vinpocetine. There’s a whole bunch of them out there.

Dr. Duncan:        There’s a chance that we’re talking cognitive function and DLB, things like that that are starting. Now, you’re diving into a whole different approach, I would say, in that realm, so really diving into the mushrooms, into the nutrients. You can do some intermittent fasting, and those are… I take a way more aggressive approach with those folks for sure. I often will use a proteolytic enzyme for somebody who has DLB or any inflammatory aggregates if it’s safe, something like nattokinase. That’s going to help with some of those inflammatory markers.

                                But some of the other, what did you say, cognitive, I’m a big herbalist gal. I love my herbs. They work really well. So, the ginkgo, rosemary, and bacopa, gotu kola or Centella, those herbs are powerful. They’re robust, and they’re multifaceted. But when you’re talking neotropics, in my opinion, you can’t get much better than herbal medicine for some of those functions.

Dr. Weitz:            Just [inaudible 01:07:39].

Dr. Duncan:        Then we can customize formulas then, right? We can use those, and we can add in some cardiovascular tonics and some anxiolytics like kava or skullcap, and help with urinary frequency. So, it’s really fun to formulate on that level, and make sure that we’re getting those herbs in there. Then you get your adrenal support. When we’re talking cognitive function, now, you’re diving into that vagal nerve dysfunction. How’s your dysautonomia? How’s your blood pressure? How’s your stress response? Are you screening for ACEs? Have you talked to your patients about their adverse childhood events or traumatic history?

                                A huge portion of my people with Parkinson’s will come into my practice. I say, “Hey, when did this start?” “I got diagnosed five years ago.” “No, when did this start?” “Well, I got divorced 15 years ago, or I lost my mom 20 years ago,” or there’s this trauma in their life, and then they can start to see how their health declined. We can trace it back to something like that. So, when we’re practicing root cause medicine, even if we can’t change the root, it’s important to address it, and have that conversation.

Dr. Weitz:            You mentioned vagal nerve several times. In my office, we’ve been experimenting with using a laser to stimulate the vagal nerve. Somebody came by my office today, and demonstrated this electrical stimulation machine that’s been shown to work on the vagal nerve, and have therapeutic benefits. Have you experimented with anything like that?

Dr. Duncan:        I’ve prescribed a couple vagal nerve stimulators. I use the earlobe technique with the Stim machines, but really, I follow Dr. Stephen Porges in his polyvagal theory and tracing our breath work. We know that when we exhale, we stimulate the vagus nerve. Vagal nerve function is not passive. It’s intentional in the body. We could cut it and survive. So when I tell people that the intention to stimulate it, and put yourself in the parasympathetic nervous system is intentional, and our exhales are going to stimulate that vagus nerve. So, doing a four, seven, eight breath technique, humming, gurgling water, contrast hydrotherapy, contrast showers can stimulate the vagal nerve function.

                                There’s a lot patients can do in their lifestyle that doesn’t necessarily add to their plate of go do this, or put this buzzer on, or take a supplement or something like that. Then finding a biofeedback practitioner if it works, finding a counselor really addressing the mental emotional aspect of Parkinson’s. Again, I mean, you guys all know as well as I do in this field of medicine, people walk in and say, “Oh, my doc said it’s all in my head.” I said, “Cool, your head’s attached, right? Let’s work on that. Let’s do something about that.”  More often than not, you talk about this hypervigilance or amygdala overactivation. Once we start working on that too, we see gut motility improved. So, there’s so much that we can do as functional medicine or integrative medicine providers that supports a patient’s wellbeing and quality of life with Parkinson’s disease.

Dr. Weitz:            Wendy asks, “Are you accepting new patients out who don’t live in Idaho?”

Dr. Duncan:        Yes. I do telemedicine, and I accept patients from wherever they want to come from.

Dr. Weitz:            That’s great.

Dr. Duncan:        I’m going to put my website on there.

Dr. Weitz:            Those are pretty much the questions that I had prepared. Is there anything else you wanted to talk to us about?

Dr. Duncan:        Oh, we;;, that’s-

Dr. Weitz:            I think we pretty much covered it.

Dr. Duncan:        Are we going to be here till midnight for some of these folks then?

Dr. Weitz:            Okay, great.

Dr. Duncan:        No, I mean, really the biggest thing I want to say, Ben, is the biggest thing I say is I’m passionate the more people we have with information to treat Parkinson’s. I don’t want all the referrals. I want everybody to have the information. Laurie Mischley has an online training program that you can go on through-

Dr. Weitz:            How do you spell her name?

Dr. Duncan:        Mischley, M-I… I’ll put it in the chat box.

Dr. Weitz:            Okay.

Dr. Duncan:        I can type it better that I can spell it. Laurie Mischley. There’s a ton of resources out there. If it seems like too much to take on somebody with Parkinson’s, then find somebody who is familiar with it, because we are trying to create this whole group of people who understand the integrative approach and who want to do more research on it and more boots on the ground as Laurie likes to call it. So, if you’re seeing these people, and you have questions, I mean, reach out to me. I’m happy to share my email, my website.  I’m collegial. I’m nice. I like to think I’m charming on occasion, so reach out. Ask questions-

Dr. Weitz:            [inaudible 01:12:12] myself.

Dr. Duncan:        Present cases. That’s why I said when I make bad jokes, I need to see if people laugh or not. So, please reach out.

Dr. Weitz:            Awesome, thank you so much. This was a awesome presentation. You put your website, which is cdahealingarts.com, how people can contact you, right? That’s the best way.

Dr. Duncan:        It is. Ben, just really quick, I see that Bernard wrote a couple times here, “Summarize the causes of PD.” I can summarize it really quick. We do not know, unfortunately. The Parkinson’s diagnosis is IPD, idiopathic Parkinson’s disease, so there’s a lot of theories from autoimmune to metabolic, obviously genetic, environmental toxicity. What I’m seeing in my practice with the hundreds now of people that I’ve accumulated is a combination of all of it. So, as much as I wish I could say, “Here’s the causes,” if I did, I’d be a Nobel Peace Prize winner, and I wouldn’t be sitting here talking to you guys.

Dr. Weitz:            Thank you.

Dr. Duncan:        Of course. Thank you all for being here. Please reach out, ask questions, send emails. Thank you for the work you’re all doing.

Dr. Weitz:            Great. We’ll see everybody next month.

Dr. Duncan:        I’m excited for Dr. Bredesen.

Dr. Weitz:            Great. I’ll make sure to add your name to the mailing list.

Dr. Duncan:        Please do. You got some big names there. Man, I was sweating when we started. I was like, “What? You’re talking to Dale Bredesen. What am I doing here?” Man, this is-

Dr. Weitz:            This is awesome. Thank you.

Dr. Duncan:        Got home, took a shot of whiskey before I signed on.

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify, and give us a five-star ratings and review. That way, more people will discover the Rational Wellness Podcast. I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity, and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing. We’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So, if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.