How to Improve Your Sleep with Dr. Damiana Corca: Rational Wellness Podcast 241

Dr. Damiana Corca discusses How to Improve Your Sleep with Dr. Ben Weitz.

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Podcast Highlights

2:50  What is good sleep?  It is falling to sleep within 10-20 min and sleeping for seven and a half to nine hours, depending upon the person and depending upon the season. Ideally you would like to sleep through the night, but it’s okay if you wake up once or twice briefly, such as to urinate, as long as you back to sleep pretty fast.  Our sleep typically happens in cycles of about 90 minutes and we typically have 5 or 6 of these cycles.  It is probably best not to wake up in the middle of one of these cycles.

6:34  There are very few people who only need 5 or 6 hours of sleep, despite claims from many that that is all they need.  Most of these people are just very driven for work and they run on the stress hormone cortisol.  But this is not that healthy.

10:18  Taking a 15 to 30 min nap is very beneficial, but take it no later than 1 or 2 pm in the afternoon. If the nap is too late, it might interfere with night time sleep.


Dr. Damiana Corca is a Holistic Sleep Specialist with training in acupuncture, Chinese medicine and functional medicine. She is committed to supporting people who struggle with sleep issues, by helping them discover the root cause of their sleep issue so they can get good sleep and continue to do so for the rest of their life.  Damiana has a local private practice in Boulder, CO and serves her clients worldwide through private telemedicine consulting and group sleep programs. She is the Founder of the Corca Sleep Method Program. Her website is DamianaCorca.com.

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

***Get 15% off your first month’s supply of Seed’s Daily Synbiotic by visiting  seed.com/drweitz 

or by using code DRWEITZ at checkout.


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 site, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today, we will be talking about sleep. We all know about the importance of sleep, and there are so many people have problems with sleep. In fact, it’s rare. when I talk to somebody who says their sleep is great and they never have any issues. Today, we have Dr. Damiana Corca, who’s a holistic sleep specialist, and she’s also trained in acupuncture, Chinese medicine and functional medicine. Dr. Corca is committed to supporting people who struggle with sleep issues by helping them discover the root cause of their sleep issue so they can get good sleep. Damiana has a local private practice in Boulder, Colorado, and sees clients through telemedicine and group sleep program. She’s the founder of the Corca Sleep Method program. Dr. Corca, thank you so much for joining us today.

Dr. Corca:            Thank you for having me.

Dr. Weitz:            So how did you come to specialize in sleep problems?

Dr. Corca:            The people let me know that they have trouble with sleep, and I started learning more and more about it and loved it, and eventually decided to focus on this to be able to serve people better. I remember my very first patient in private practice, I was living in Chattanooga, Tennessee and I believe she had fibromyalgia and also had some sleepy issues and I remember thinking, I’ll never forget that sensation in my body or not only a mental explanation of it that, “Oh, if I could just get her to sleep well, I think her pain will get a lot better.” Of course there are other components to this, her gut health and so on, but it was exactly that. And then little by little, I kept noticing, even if people didn’t come in with sleep issues as their main complaint, I noticed that if I just got them to sleep better, somehow everything got better. So eventually over the years, I just decided to focus on this and specialize in this.

Dr. Weitz:            Yeah, it’s really important to have a niche and it’s good to have a practice focus like that, and of course, sleep is so important for everything else. It allows our body to rejuvenate, our brain to heal and get rid of toxins and it’s just so important. Let’s start by defining what is good sleep?

Dr. Corca:            Yeah, good sleep I would say it’s falling asleep within 10 to 20 minutes, 30 minutes maximum and sleeping for seven and a half to nine hours, depending on the season, depending on the person and sleeping through the night ideally, but it’s okay if you wake up once or twice either briefly or just to urinate, as long as you go back to sleep pretty fast.

Dr. Weitz:            In fact, don’t we have these cycles of sleep throughout the night where we go at least into very light sleep?

Dr. Corca:            Yeah. We do that all throughout the night. Typically, a sleep cycle lasts about 90 minutes. It can be a bit longer. That’s why I tell people if we sleep five of those chunks at seven and a half hours, if you want to sleep longer, you don’t want to just increase by half an hour, ideally increase by an hour and a half. So you respect these sleep cycles. And the same thing if you wake up half an hour before the alarm clock, it’s best not to try to go back to sleep because you’re just going to wake up usually groggier or frustrated if you don’t fall asleep. If your body wakes up without any-

Dr. Weitz:            You mean because you’re in the middle of a cycle?

Dr. Corca:            Right, yeah. If your body woke up half an hour before the usual time, it’s doing you a service. It probably just ended a cycle. And it says, “Okay, it’s about time. It’s not quite, but it’s there. We don’t have enough time for another hour and a half of sleep.”

Dr. Weitz:            Now we’re going to get into the quality of sleep, but just for a minute to talk about the amount of sleep, most sleep experts say seven to nine hours. Is that what you think is a sweet spot?

Dr. Corca:            Yeah, I would say seven and a half just because it gives you five hour and a half chunks of sleep. So I see when people thrive, when people do well, they do seven and a half to eight and that’s because it might take a few minutes to fall asleep, you might be up for a little bit, so usually it completes that amount of cycle. So seven, I feel like it’s on the shorter side, and definitely we are told sometimes that nine hours is too much, but especially in the winter, if you can, it’s really wonderful. I’ve had a lot going on myself and I’ve noticed over the last month of two, I go to sleep at 9:00 and wake up at 6:00 and I feel amazing, So I just do that, which something of my patients can’t do, so that’s what I’m trying to help them with.

Dr. Weitz:            Now we know that taking too long to go to sleep is a problem. You were mentioning how long it takes to go to sleep, but apparently if you fall asleep right away, that’s not that good either. In fact, I’ve been tracking my sleep with an Oura ring in the last six months and I’m constantly finding out that I have low sleep latency because I fall asleep within one minute.

Dr. Corca:            Yeah. When we fall asleep within one minute, maybe you’re a little bit sleep deprived possibly, maybe we need a little more sleep. I tell people that it should take our body like five, 10 minutes to fully relax, to fully go into sleep, to like fully assess the environment, but if you are reading right before that, and you’re very relaxed and you’re so sleepy you’re just about to fall asleep and then you put your head down and fall asleep within one or two minutes, then that I wouldn’t say that’s a problem. That’s a good thing.

Dr. Weitz:            So what about people who say, “I sleep five, six hours. I’m fine. I don’t need more sleep.” What do you have to say to them?

Dr. Corca:            Well, I’ve only met, I think, a couple of people, two people, in the last decade when I talked to them, I questioned them, I came to the conclusion that yes, I think they might have some genetic variant and truly they do fine with six hours. They didn’t say five. I’ve never met anyone that I thought they just need five hours and that’s it and they’re very healthy.  Most people who run on five, six hours, they push themselves so hard and they run on the stress hormone cortisol and basically say it as kindly as possible, you’re basically lying to yourself. You’re so stressed and you’re pushing yourself so hard and maybe you are okay now, but it’s going to catch up with you. So it would be really wise to slow down because usually we get a lot more done actually, instead of putting all this physical and mental work, we can use our energy instead and life becomes a little easier. So then we don’t have to work so hard and keep telling ourselves that we only have so many hours in the day, we have to go faster and harder.

Dr. Weitz:            Yeah, I think unfortunately our society is very driven for work and more work and less sleep. I think that there’s a tendency to actually look down upon people who don’t work as many hours and it’s a different attitude in other parts of the world. I know in Europe, for example, it’s common for people to take six, eight weeks of vacation.

Dr. Corca:            Exactly.

Dr. Weitz:            Certain countries, I think Switzerland requires a week of vacation for every six weeks of work and here in the United States, you almost looked down upon for taking a vacation or taking time off or not working. Now, unfortunately, because of this work at home thing, it seems like people are being asked to work longer hours, like just keep taking phone calls and emails into the evening when normally you would be off work.

Dr. Corca:            Yes. It’s very important that we draw boundaries because otherwise there is always something to do. It never ends, truly, when you think like, “Okay, I’m all caught up on things and it’s all good,” and there is more and more and more, and of course at our place of work we can get asked to do more and more. So it’s up to us to draw boundaries.

Dr. Weitz:            So especially now where so many more people are working from home, do you have any advice for them, how do they draw those boundaries?

Dr. Corca:            Yeah. One of the most helpful things for my patients and people that I talk to and from my programs is to look at the day, to split it in 12 hour chunks. So if we have 24 hours, so let’s say 7:00 AM to 7:00 PM is more about activity and work. I’m not saying to work all of those 12 hours, but to fit everything that’s more active within those 12 hours, and then the other 12 hours to really slow down. We typically only slow down for seven or eight and maybe some of that we’re not even asleep. So that’s the first step, to have those clear boundaries and say, “I’m never opening my computer, unless I want to watch a movie or something, after 7:00 PM. I’m not going to answer some emails after dinner,” nothing like that. That’s one place.

The other thing that you can draw some good boundaries, especially if you’re at home, is when you take your lunch break after lunch to lay down for 15, 20 minutes. You are at home, you can lay in your bed, you can get cozy and you can just listen to a meditation. It’s so beautiful, so luxurious, can be so pleasurable and you can just feel your body relaxing. Many people in the past, they said, “Well, I don’t have time. I don’t have the space,” but if you are at home, this is perfect. Just take a break in the middle of the day.

Dr. Weitz:            So you think, for example, taking a 30 minute nap is good for sleep?

Dr. Corca:            It’s very good. It’s amazing. It’s actually-

Dr. Weitz:            See, I’ve heard other sleep experts say, “No, no, no. It’ll take away from the sleep at night.”

Dr. Corca:            I have done this with multiple, multiple people and for some of them has been life changing. The people who are very sleep deprived, say they can’t sleep at night. The problem when you sleep deprived and stressed, is that the more stress you are, the more tired you are, the harder it is to fall asleep. It actually takes the same amount of energy to fall asleep as to stay awake. So we feel as if falling asleep is this passive thing that happens, and it feels like that when we’re healthy and it’s easy to fall asleep, but actually it takes a lot of things that need to happen within our body and our brain to fall asleep.  So if you’re stressed, if you’re sleep deprived, taking that 20 minute nap, I tell people to just set a timer for half an hour, 40 minutes at the maximum and lay down. It does not matter if you fall asleep or not, just focus on resting and maybe listening to a guided meditation, anything along those lines works. If you do it at least about eight hours before your bedtime, so typically, 1:00, 2:00 and you keep it under half an hour, I have never met a person that impacted them negatively.  The problem arises when you sleep too long and too late in the day. People usually sometimes wait until they get really sleepy around 3:00, 4:00, 5:00. Well, that’s dangerous, that’s too late. Then the body feels like, “Oh, I took a good nap, now I have energy,” and then they have trouble falling asleep or [crosstalk 00:12:33]

Dr. Weitz:            So it’s good to take a nap, but try to keep it to, say, 30 minutes and no later, say, then 3:00 in the afternoon?

Dr. Corca:            Perfect.

Dr. Weitz:            Okay.

Dr. Corca:            Perfect and focus on resting, it’s okay. So many people, it took them weeks until… They said, “Oh, I can’t fall asleep. I can’t nap. That’s not a thing for me,” and I’m like, “You’re just focus on resting. Even if you’re just allowing to feel your breath, feel your body, it’s amazing the way you feel in the afternoon.” So it’s very valuable.

Dr. Weitz:            Great. So let’s talk about quality of sleep and particular, two of the things that I’ve been tracking since I’ve been using the Oura ring is deep sleep versus REM sleep. Can you talk, what’s the significance of deep sleep and REM sleep and what do we need to know about them?

Dr. Corca:            These devices are really wonderful in the sense that they’re able to help us track how we sleep, but-

Dr. Weitz:            By the way, what is the best device for tracking sleep or devices?

Dr. Corca:            The most important thing actually, is that we feel good the next day. That is the most important thing is how we feel. Do we have energy? Do we feel clear minded? Secondarily, if we have one of these devices, I don’t endorse any of these companies, a lot of my patients use the Oura ring and it looks beautiful, it gives really fairly accurate information, and this is fairly accurate in comparison with how they feel. I always warn everyone not to look at the data first, but rather see how they feel and then later look at the data because what we do, we look at it and then we decide, “Oh, it doesn’t look good. I should be feeling bad,” and you just want to like really feel, “How do I feel? I feel okay,” and then yes, we can look at the data. The Fitbit is good and there are a bunch of other ones out there that can be helpful.

Also, I ask everyone not to focus so much on how much deep sleep you have exactly, how much REM sleep. Yes, it’s important, but also these devices are not perfect. Also, some of us move a lot more and yes, that can tell us information in itself. So I have found that it’s important to look at the bigger picture. Now, if we don’t have enough REM sleep, deep sleep, it reasonably looks really low. Like let’s say you have friends and they have the same device and you’re like, “Whoa, I only have half an hour of deep sleep and you have an hour and a half,” we want to look at the bigger picture, what could be disrupting the function of the body and understand this. Functional medicine really looks at the whole body and take gut infections, just chronic low grade gut infections that don’t necessarily take you to the hospital or drive you into the doctor’s office, but something is not quite right. Maybe you feel bloated, maybe you’re restless at night. There can be things that can be improved, that can increase the amount of deep sleep that you have of REM sleep.

So we want to look at the whole function of the body, looking at the gut health, because as you know, like if you improve the gut health, you improve serotonin, production, 90-something percent of it is produced in the gut. So that’s the way I look and I ask everyone not to over focus on that data, but the data is very helpful, especially if you have been collecting data from the Oura ring, for example, and then you do things to change and then you can see the improvement. Then that’s really, really helpful.

Dr. Weitz:            So what is the significance of deep sleep?

Dr. Corca:            It helps with numerous, numerous functions in the body and memory consolidations and emotion processing. So with the REM sleep, it all has its own function. Even light sleep is very, very important and one thing that I want to point out is that we typically have more of the deep sleep at the beginning of the night and that’s important to remember because some of my patients come in and say, “Well, I don’t have any deep sleep later in the night. Is there something wrong?” And a lot of people know that you’re supposed to have that at the beginning of the night, some people don’t. And so you want to keep in mind-

Dr. Weitz:            And then the REM sleep seems to occur more in the last several hours, right?

Dr. Corca:            Exactly, and that’s also important to know because sometimes people say, “Well, I seem to be more aware of my environment in the morning,” and that’s partially because of that and also we have more dreams in the morning. So I like to bring some normalcy because when we have sleep issues, we build a lot of anxiety around it and then we attach meaning to everything that we’re looking at and how we feel.

Dr. Weitz:            So, yeah, anxiety seems to be a factor that decreases our ability to sleep well. It’s interesting how anxiety and depression, which are often linked as common mood disorders, but they sort of have the opposite, it seems, significance with respect to sleep, whereas it seems like even though a lot of patients have both, patients who are anxious have more trouble sleeping, whereas patients who have depression tend to sleep more.

Dr. Corca:            That can be true, definitely with depression, especially here where I live, because we have winter and less sun and colder days. Definitely environmental-

Dr. Weitz:            And you’re in Colorado?

Dr. Corca:            Yeah, in Colorado, the seasonal effective disorder, some people get more depressed, they sleep more. Unfortunately, some of those people who develop seasonal effective disorder, even though have depression, they can also develop insomnia, which makes the depression worse. And yes, with anxiety, we have this over activated nervous system being in fight and flight mode, and then it’s not safe to settle into sleep. If you think about it, in order to fall asleep and stay asleep, the body and mind and spirit has to feel fairly safe because we’re very vulnerable. Think about it. You’re laying there in bed, you’re not aware of your environment.

So a certain amount of deep safety, and I’m not even talking about safety in your room because we live in houses with doors that are locked, so there isn’t really… generally, depending on which neighborhood you live, of course, you’re generally safe. It’s more about the stresses from our daily life, and even these, as I mentioned, gut infections or hormonal imbalances or just not having enough nutrients or having a food sensitivity that’s constantly aggravating your body, all of those like stressors in the body as well.

So I just want to say that’s not only emotional stress because I work with people, they tell me, “But my life is so good. I just can’t sleep and have anxiety and I don’t understand why.” So partially that physiological aspect is very important, and of course there is trauma from the past as a result that people are not consciously aware, but it’s still residing in their body.


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Dr. Weitz:            How important is it to respect our circadian rhythm for getting a good night’s sleep? I know that as it gets darker and the light tends to become a redder light, if you look at the sun setting, it’s redder and that tends to lead to melatonin secretion, which helps sleep, and then in the morning when the light comes up, we get the white light, which has a blue light, which stimulates cortisol, which tends to wake us up. How important is the timing of our sleep to, in some way, try to coordinate with our normal circadian rhythm?

Dr. Corca:            It’s very, very important a routine signal safety to the body, having that chaotic schedule creates stress, so that’s very, very important and then in the evening, as I was talking earlier about slowing down after 7:00 PM, I like to call it life after 7:00 PM because it can be kind of a different life and something that you do for yourself, you want to have that slowing down process and then making sure that you dim the lights, that you don’t look at the screens as much. It’s okay to watch a movie or if you want to scroll a little bit on social media and such, but I would allow about 45 minutes to an hour or putting away electronics and having a dimer yellow light. There’s those blue blocking glasses that you can use as well, but it’s not only about the light, it’s also about the activity that comes at you.

 So you want to calm it all down, read a book, listen to some music, do a little bit of stretching if you want to, whatever brings you pleasure. I always tell people you don’t want this to become another things or another thing that you have to do in the evening in order to fall asleep, but focus on what feels good because if you think about it, if you focus on what feels good for half an hour or an hour, that secretes a lot of feel good hormones and decreases cortisol, and as a result of that, you sleep better, but you also feel wonderful in the moment and that’s amazing.

This is what living in the moment is, it’s experiencing how you feel right here, right now. So that’s for the evening and again, kind of going at the same time to sleep consistently is important, but more important is also listening to your body. So if you’re not quite sleepy yet when it’s 10:00 and that’s your bedtime, don’t push it. Maybe you read a little longer, even if you’re going to be in bed a little shorter, because if you go to sleep a little slowly and your body’s not quite ready, then you’re laying in there and you can develop anxiety. So you don’t want to do that. So listening to your body and making sure you’re groggy and sleepy is very important.

Now, when you wake up in the morning, I would say it’s very, very important to keep it consistent and at the same time and not sleep in. If you need extra sleep, I’ll always tell people wind down earlier in the evening and go to sleep earlier and wake up at the same time because if you wake up at the same time the sleep becomes very efficient. Talking about increasing the quality of your sleep, that will increase the quality of your sleep because we have an internal clock and it kind of knows. I don’t know if you’ve slept well most of your life and a lot of you, you notice that you wake up at the same time no matter what, and that’s a really good thing. You want to honor that.

Dr. Weitz:            What about your sleep window? What if you tend to go to sleep at 2:00 in the morning? Is that less than optimal, for example?

Dr. Corca:            It is less than optimal, but some people have night jobs, and if that’s what it is, making sure you have your routine and consistency is very, very important. You’re not sleeping in, not fluctuating when you wake up and then it doesn’t matter if you wake up at 6:00 or 8:00 or 10:00 AM, to wake up at the same time and expose yourself to light, taking a walk, having some movement, eating breakfast, plenty of protein, 20 to 30 grams of protein is very important. If you are like me right now, like in Colorado, there is not enough light-

Dr. Weitz:            Why is eating 20 to 30 grams of protein so important?

Dr. Corca:            Because a lot of people do the opposite. They eat too much sugar, and then they have blood sugar fluctuations and that messes up with the cortisol, the stress hormone. So eating protein really sets up your body for stable energy, fully waking up and keeping your cortisol level steady, and then more so for the cortisol is just to eat in the morning. I know we live in a world where intermittent fasting is really popular and that can work too, I suppose, but for people who have sleep issues, I tell them for the time being to have breakfast. It doesn’t have to be a huge breakfast.

Dr. Weitz:            Yeah, you’re referring to the fact that intermittent fasting right now is considered very trendy, especially in the functional medicine world for promoting longevity and a lot of people do it by skipping breakfast.

Dr. Corca:            Right, yeah. And oftentimes, we go, we’re stressed in the morning and I think black coffee is allowed, so we just get this immense kick. We force the adrenal to give energy, but it’s also stressful to the body, so it’s not the healthiest way to go about it. Now, if you still want to do that, then you could do collagen powder, MCT oil in the coffee, doing two scoops of collagen powder gives you about 20 grams of protein. So that could be a possible alternative.

Dr. Weitz:            Now why collagen powder?

Dr. Corca:            The collagen powder gives you about 20 grams of protein and [inaudible 00:27:30] so-

Dr. Weitz:            Could use why protein or other forms of protein?

Dr. Corca:            You can, yes. I often recommend collagen powder just because a lot of people have issues with dairy products and even whey protein, so then collagen feels like the safest, but yeah, and it could be pea protein if you’re okay with the peas. So there are several choices there that could be replacing the full meal, but I do like to… I have a regular meal for breakfast, just some kind of a fish or meat and lots of vegetables. That’s typically my breakfast and it’s very helpful. So the other thing that I wanted to say about the morning is that if you don’t have access to the sun in-

Dr. Weitz:            You mention you have meat or fish in the morning.

Dr. Corca:            Yes.

Dr. Weitz:            But for some reason when you talk to a lot of people at the out breakfast, they’ll say, “Well, that’s not breakfast food. I have to have breakfast food.”

Dr. Corca:            I know.

Dr. Weitz:            What’s breakfast food? “Breakfast food.  I have to have cereal or waffles or toast, or I have to have all these carbs in the morning.”

Dr. Corca:            I know, I get it and I certainly like I literally sometimes miss it, I think about it and I’m like, “Wouldn’t really nice to just have some waffles with some butter and some fruit. That sounds so amazing,” but especially for women and for myself… For men too, but more so for women, especially women who go through menopause, it just really causes blood sugar issues and then morning you are hungry again and you reach for more coffee, your energy drops and you might have some more sugar.

If you want to lose weight or have a steady weight, if you want to have good energy, if you have thyroid issues, and you have want to have good energy, just try. Just try for me, just for a week, try have that different kind of breakfast and see how you feel. Don’t take my word for it from my experience, but just try it and see if you feel amazing and crave less sugars throughout the day and feel more stable and energized and you reach less for the coffee and for the stimulants and even in the afternoon, then… And most people, when they realize how good it feels, then they just do that and have the occasional typical breakfast some days just as a treat.

Dr. Weitz:            One thing, I don’t know why this came to mind for me, but among the people who have… A lot of people have trouble with sleep, but it seems like there’s a certain group of people that I’ve noticed and for me it tends to be women over the age of 70. I know a number of them have just given up, “That’s it, I don’t sleep. I’ve tried everything. Even if I get five hours, I’m happy.” Why do you think women and especially older women tend to have more problems with sleep?

Dr. Corca:            Yeah. I think the functions on our body as we age, they’re just not working as well, they’re not optimized as well. Just, for example, the gut is not functioning as well, so maybe not enough probiotics to even make serotonin. They’re just, it’s just [crosstalk 00:30:48]

Dr. Weitz:            Do you think it’s a hormonal thing, lack of estrogen and…

Dr. Corca:            I think partially can be and partially neurotransmitters. I often do a neurotransmitter test, I look at GABA and serotonin and dopamine and histamine and all of that, and I think that’s partially what’s happening sometimes. I see those inflammatory kind of…

Dr. Weitz:            So when you run a test like that, what kinds of results do you get and what types of changes do you make as a result of the results?

Dr. Corca:            So to pick up on something that comes to mind, that this is a 70-something year old woman, I can’t remember exactly how old she is, one of the inflammatory markers that comes from the tryptophan kind of on the serotonin pathway, is very high, so that creates a certain amount of inflammation in the brain. I don’t think it allows us to sleep properly. So for her, I think just doing a high dose of procurement of active ingredient of Turmeric, it’s going to be really important, especially since she has pain as well.

Dr. Corca:            So I think spot on that would be helpful for her and I think it will impact her sleep. And she always said, she says, “I’ve gone through menopause for so many years and still I have a little bit of a temperature fluctuation at night.” We don’t want someone at that age to go on hormone replacement therapy, but a little of support with herbs, just a little bit to optimize the function of the body can move the needle a little bit.

Dr. Weitz:            So what kind of support will that be?

Dr. Corca:            Just herbs that support, it could be even for some women Black Cohosh. do different herbs, different combinations-

Dr. Weitz:            Okay. So many herbs that help with menopause?

Dr. Corca:            Exactly, yeah. Some of the combinations, I have Chinese herbs in them that can be helpful.

Dr. Weitz:            You used the rhubarb extract?

Dr. Corca:            Yes. Yeah, I believe. What is that company? I can’t remember the Metagenics who has that?

Dr. Weitz:            Yeah.

Dr. Corca:            That’s a wonderful, wonderful one. Also, the other thing that I tell people as they get older is-

Dr. Weitz:            Isn’t it amazing. I have some patients in that category too, that women in their 70s are still getting hot flashes or night sweats?

Dr. Corca:            I know, right? Because we’re told that like once [crosstalk 00:33:18] menopause you-

Dr. Weitz:            It can’t be because having big fluctuations in estrogen anymore. What is causing it?

Dr. Corca:            It’s in the brain, there is the temperature regulation, actually that’s… Like there is this little window and it’s too narrow and I think different kind of hormone levels helps to regulate that a little bit. So once that’s off, the ratio, the space to regulate it is too small, and then we go back and forth too easily.  The other thing that I really want to say about people who are any age, but really in the 70s and 80s, I think we’re told a lot like, “You’ve got to sleep. This is dementia prevention. Sleep is very, very important.” And yes, you can do various things as much as you can, but I don’t want people to obsess over it because that’s more stressful. If you just get a little short of sleep, but you feel wonderful, then I don’t want people to stress over that because the stress of it is literally worse. Again, I’m not saying not to do anything about it, but also not to [inaudible 00:34:21] for nine hours.

Dr. Weitz:            Right. Stressing over sleep is the biggest disrupter of sleep.

Dr. Corca:            Excuse me?

Dr. Weitz:            Stressing about not sleeping is the biggest disrupter to keep you from sleeping.

Dr. Corca:            Yeah. It’s all these ideas that we hear that are true in some cases, but there is more to it and, and it’s very important to, to understand these different aspects and not get anxiety over a particular idea, for sure.

Dr. Weitz:            So you mentioned temperature regulation. One of the things that I’ve incorporated into my sleep routine is using something called a Chilly Pad, which actually he cools me because sometimes in the middle of the night, we’re either getting Santa Ana winds or something, but it seems like the temperature will go up five, 10 degrees, and that will tend to wake me up. So if I have this constant temperature, that seems to make it easier to not wake up.

Dr. Corca:            Yeah. We have to have a lower body core temperature in order to settle into sleep. That happens naturally. That happens naturally actually a little bit in the afternoon and that’s why I believe we’re made for siestas, so that’s why I tell people to take a little nap.

Dr. Weitz:            Do you recommend something like that to maintain temperature?

Dr. Corca:            Yeah, it can be helpful. It definitely can be so helpful for people. I’ve heard a lot of good things about the Chilly Pad and there are other devices that are similar that can be truly a life saving, especially depending on where you live and the temperature of [crosstalk 00:36:02] for many people.

Dr. Weitz:            What are the most effective nutritional supplements for sleep? I know you’ve talked about a few already in terms of herbs that help to regulate some of the hormonal issues, especially that women have and we talked a little bit about cortisol secretion. Do you ever do like the cortisol testing and do you try to use supplements for that and what other kinds of sleep supplements do you find or effective, A, for falling asleep and B, for staying asleep?

Dr. Corca:            Yeah. So let’s talk about the cortisol. Yes, I do the saliva testing because it’s super helpful. It gives us valuable information. We don’t want to assume it’s always generally safe to take certain adaptogenic herbs like as Ashwagandha, Rhodiola, and Holy basil, but-

Dr. Weitz:            So for doctors who say, “Oh, there’s no point in doing salivary testing.” I just listened to somebody else’s podcast who said, “Oh, this is a complete waste of time and money. If the patients are stressed, just give them some adaptogens.”

Dr. Corca:            Yeah. I find value in testing because… Okay, let me think of another patient just a few days ago. On Friday, I reviewed the test with her and she’s very fatigued and then she has anxiety at night and I kind of assumed that probably her cortisol is too low in the morning and too high at night, but we don’t want to assume, because we want to look at the overall curve. It should be higher in the morning and then lower in the evening, but also we want to look at the total output because if, let’s say, we start clearing cortisol at night, it can backfire. If she doesn’t have enough of that total output, it clears it really fast and then the body says, “Ooh, we don’t have enough cortisol because cortisol is helping [crosstalk 00:38:00]

Dr. Weitz:            So let me stop you right there. So what you’re saying is, is let’s say, you assume, “Oh, this person’s stressed and they’re having trouble with sleep. So I’ll just give them some adaptogens that are going to calm their cortisol secretion, and I’ll have them take it in the afternoon or the evening and that’ll help their sleep,” but maybe don’t don’t know that they actually have a very flat cortisol curve. They’re not producing enough cortisol, and now you’re down regulating their cortisol production even more by giving herbs like phosphatidylserine that are decreasing their cortisol. You might need to use a different set of nutritional supplements that help the body to produce more cortisol, to get that curve the way it’s supposed to be and you wouldn’t know that unless you did the salivary cortisol testing.

Dr. Corca:            Exactly. That’s exactly right and if you use phosphatidylserine assuming their cortisol is high at night, but the total output is too low, then we need a certain amount of cortisol because it has a lot of different good functions and then the person will feel temporarily better and then hour later they’ll have more anxiety and be wide awake and they don’t know why. And also like-

Dr. Weitz:            Then instead of using those adaptogenic herbs, which some people say, “Well, you can just use these for everybody,” you might need to use a different set of supplements. For example, you might want to use an adrenal supplement that includes licorice root, or glandulars or some combination of herbs that are better at building up cortisol production instead of calming it.

Dr. Corca:            Exactly. Yeah, definitely. So there are all these different… Yeah, exactly, as you explained subtle aspects and there is really no… You can guess or you can make an educated guess, especially if you’ve done a lot of tests and have worked with people, but I like to test. It’s, what, $160, it gives us such valuable information and some of these tests, they actually even test in the middle of the night. If you wake up, you can take a sample, so then you can see is the reason why they wake up cortisol related or not and it’s not always. In fact, I find that more than half of the people, they’re not waking up or because of that, there is something else that wakes them up and [crosstalk 00:40:21]

Dr. Weitz:            Right. There you go. So the cortisol testing may lead you to not use an adrenal adaptogen, or it may help with the timing of it. So for example, I just recently had a patient who is having trouble sleeping and falling asleep and I was thinking maybe he’s getting a cortisol rise in the evening, but it turns out he’s getting this big spike in the afternoon. So I may have used the same adrenal adaptogens, but I timed it more in the afternoon rather than in the evening. So the timing of the use of supplements may change depending upon the curve as well, and that’s another reason why, in this case, testing can be beneficial instead of just guessing.

Dr. Corca:            Yeah and honestly, for sleep issues I don’t think I’ve never seen a perfect, maybe 1% of people they’re like, “I don’t have to do anything for your cortisol.” There is always something I can do, but it different degrees of it. So I always find it helpful. So yeah, the timing, the type of supplements, it’s so important and also having a baseline, it’s super crucial. So depending on that it can depend a lot-

Dr. Weitz:            What are some of the other important supplements for regulating sleep? I know it changes depending upon the underlying causes and that’s super important. So if we have blood sugar problems, we’ll maybe need to use supplements to regulate blood sugar, as well as the right dietary approaches, exercise.

Dr. Corca:            Yeah, exactly. We’re were looking at the gut, looking at the hormones that carry toxins, the liver, there are many things, but I do find myself often trying to supporting the calming neurotransmitters, like the serotonin and GABA, and for serotonin you can take 5-HTP, but that’s not always what I do. There are other things that sometimes, like supporting the gut, it’s very, very important, so I always do that, but [crosstalk 00:42:27]

Dr. Weitz:            How do you support the gut? Do you use probiotics? Do you use other supplements?

Dr. Corca:            Usually if there is a gut component, I’ll see what the problem is. Yes, I tend to use digestive enzymes if it’s needed, it the infection is cleared or the infections, if we need to do an elimination diet, do an elimination diet to food sensitivity [crosstalk 00:42:47]

Dr. Weitz:            How will you clear infections? You use like antimicrobial herbs?

Dr. Corca:            Yeah. So usually I do a stool test and so we look at the stool test, you probably do this as well, and we see what’s in there where the problem is and support that with herbs. Very rarely if there is a parasite or… Yeah, usually parasite is where I’ll recommend that maybe they get a short term prescription to support that, but in general, herbs and supplements seem to be super helpful to clear these imbalances and then support with probiotics and digestive enzymes and change the diet based on what they need. I try to not make it very restrictive because it’s hard on the people, but whatever I try to find whatever is the most helpful that moves the needle the most.

Dr. Weitz:            And if you make it too restrictive, that’s another source of anxiety.

Dr. Corca:            Exactly.

Dr. Weitz:            Yeah. So what are some of the best herbs or what are some of the best nutritional supplements for falling asleep? You mentioned five HTP. If you use five HTP, well how, how many milligrams will you use and then why will you sometimes use it and sometimes not use it?

Dr. Corca:            I tend to run this urinary test, [inaudible 00:44:07] he test, and that’s another test that if you look at some of the experts, they say, “Well, it’s not really representative of what’s happening in the brain,” and that’s true, especially because some of these, they get metabolized in the gut and the kidneys and all of that, but I have found it to be very helpful to give a general idea and I look at the trends rather than just taking everything literal.

Dr. Weitz:            Okay. So give me a couple of examples of results you get and then how will you supplement differently?

Dr. Corca:            Yeah. Like for example, this patient, I review the test just a few days ago. She had had dopamine, histamine and PEA, which is a neurotransmitter. They were all trending high and that told me that there is a methylation issue likely. And then we had another test where we could see that the B vitamins are a little bit off, which totally made sense. Now we need to help her body methylate better. She probably has a genetic mutation. So this is just a very complex process that happens in the body like, I don’t know, some huge number every second, every millisecond, so-

Dr. Weitz:            So what did you do to give support for methylation?

Dr. Corca:            I just gave her, to begin with, because she’s young and I think she’s going to respond well, just some B vitamins with TMG and a little bit of SAM-e.

Dr. Weitz:            Like a B complex or a-

Dr. Corca:            A B complex. I have Sam and TMG, so a couple of other nutrients that help make that-

Dr. Weitz:            Oh, what particular supplement would that be?

Dr. Corca:            Oh my gosh, I don’t remember the name, but-

Dr. Weitz:            Okay, but a particular supplement that has B vitamins with TMG and SAM-e.

Dr. Corca:            And SAM-e Yeah, that will help lower the histamine. It will help lower the dopamine. Dopamine is so wonderful to give you gust for life and having motivation, but if it’s too high, you will not feel well and you’ll get [inaudible 00:46:10]. So that’s one example and actually her serotonin was on the high end and she just so happens that she has gut issues. So if we have gut issues and bacteria, that imbalance is going to drive the serotonin high, which is also not good. We don’t want it to be too low or too high.

Dr. Weitz:            So there’s a case where you did this testing. You might have used a nutritional supplement help with sleep that included 5-HTP, but in her case, because she had high serotonin, that’s something you would not do?

Dr. Corca:            Exactly. Yeah, that person would say, “Oh my gosh, I did [crosstalk 00:46:45]

Dr. Weitz:            Another example where you would change your recommendations based on the testing because testing rather than guessing can be helpful?

Dr. Corca:            Yeah, exactly. And then I always take the testing and really think about the person. Like, does this make sense? If it doesn’t make sense, I do what makes sense at first and see how it changes and then we’ll go back and look at the results or retest and figure it out. So we take everything with the grain of salt, but I find testing super helpful and in time, the more you test you start, already seeing patterns before you even have the test-

Dr. Weitz:            Which urinary neurotransmitter test will you use?

Dr. Corca:            I use ZRT most of the time.

Dr. Weitz:            What’s it called?

Dr. Corca:            The ZRT lab. The lab called Z-R-T.

Dr. Weitz:            Oh, ZRT. Yes. Good.

Dr. Corca:            So I tried a few different ones and they’re pretty good, but that one is very complete and then also we get some neurotransmitter testing and the Dutch test we could do for hormones, and also we get the organic acid test. We get a little bit of data, but when I want to be specific, I go for the ZRT test.

Dr. Weitz:            Right. Organic acid test. Do you get that through ZRT or you get that somewhere else?

Dr. Corca:            From Great Plains laboratory.

Dr. Weitz:            From Great Plains. Okay. Great. So maybe a couple of other hints on sleep. What about patients who have trouble staying asleep? Will you tend to use certain supplements for that and what about melatonin? Does melatonin help? When do you use melatonin?

Dr. Corca:            Let’s see, I use melatonin when it shows more if I test it in the Dutch test and on older people, I do one milligram and see how they do with that. We don’t-

Dr. Weitz:            One milligram, that’s really low.

Dr. Corca:            I know. We only produced about, at the highest, as teenagers we produce 0.9 milligrams and then is adults around 0.4, 0.5, and then as we age even less. So I have the liposomal, where you can do drops and ask people to just do one milligram and then possibly increase to two or three.

Dr. Weitz:            So liposomal melatonin?

Dr. Corca:            Yeah. Quicksilver Scientific, they have a good product that I like, because then you can play with the dosages and also you can do it gradually. You can take one milligram, one drop at 9:00 and then another about a 9:30 if you want to do kind of a gradual. Yes, there is the time release one as well, but I like this one, it works really well. Also, when people travel using melatonin, I find that it’s helpful to help with the jet lag. As far as falling asleep and staying asleep, I would have to think about that. It almost doesn’t seem like they’re different necessarily.

Dr. Weitz:            Yeah. I guess I’ve heard people say, “Oh, melatonin is better for falling asleep. Five HTP is better for staying asleep.” You haven’t really found that to be the case?

Dr. Corca:            Not necessarily. Think about it. If you have no serotonin, you’re going to feel anxious and you might have to trouble fall asleep. What I do find though, is that people tend to have [inaudible 00:49:57] susceptibilities and tendencies. So like when people wake up around 1:00 or 2:00 AM, it’s more digestive issues, hormonal issues, more than anything. Yes, the neurotransmitters can also get affected, like serotonin and therefore use 5-HTP. And then when people wake up early in the morning, their there are certain patterns. It may be sleep apnea, it may be just a lot of emotional stress, it might be hormonals or digestion, it’s a combination of things, but it can vary and it comes down to that root cause that I’ve mentioned to you now, what exactly is happening with the person?

Dr. Weitz:            Yeah. I know we’re close to wrapping up here, but we haven’t really mentioned sleep apnea and I know this can be an important player in a lot of people with sleep.

Dr. Corca:            It is and I think a lot of us think that this applies only to people who are overweight and that’s so not true. Yes, it’s more likely people who are overweight, but if I have even the slightest possibility in my mind that the person has sleep apnea, I recommend that they do a sleep study. Nowadays they’re all done at home, it’s pretty easy, usually the insurance pays for them, but the very least I ask people to buy a continuous oxygen monitor. You can buy it online usually for around $150 and it’s not a sleep study, but it’s fairly good information. And with that, it measures your oxygen throughout the night. You can see if the saturation drops under 92%, and if it is, then you got to take steps in that direction because you can be working on various things from different angles, but you have to address that sleep apnea issue.

Dr. Weitz:            I think a lot of people are apprehensive about getting tested for sleep apnea because all they’re thinking is, “I don’t want to use that CPAP machine.”

Dr. Corca:            Yeah, it’s true, but there are other… Like in functional medicine, we always want to work on the inflammation and if it is that you have extra weight, we can decrease that, but at the root of it is inflammation and yes, it could be structural, and then as you age things get more slack around here, the tongue falls in the back of the throat more easily. If we have inflammation in that area or even gut inflammation, it can make it worse. So there’s things that we can do. Even blood sugar imbalance, then that can increase the inflammation.  So there are a lot of things that we can do. And then the CPAP is not the only thing. We also have these mandibular devices that can pull your jaw forward and that can be super helpful for many people. So there are alternatives. It’s better to find out and know and do something about it instead of suffering and having other health effects over the years that you really don’t want to.

Dr. Weitz:            And what do you think about drugs for sleep?

Dr. Corca:            I think they can be helpful at the right moment. I’d rather have a person not develop severe anxiety or end up in the ER because they’re in such a distress. I don’t recommend them for long term because you’re not really addressing the root issues and it could be a dependency, even if it’s just mental, and you just want to leave… Sleeping is such a vital thing, something that we need every night, ideally you don’t want to be completely dependent on something [crosstalk 00:53:25]

Dr. Weitz:            What about CBD and marijuana? I hear a lot of patients relying on these kinds of things for sleep.

Dr. Corca:            CBD can be helpful. Again, in my mind CBD is something that it can be supportive naturally for a little while, until you figure out what’s happening in your body. THC, I find sometimes that with inflammation and temperature regulation issues in people and I’m not a big fan of it, but CBD can be helpful, and again, I never tell people to take CBD. It’s more like, “Yes, that’s that works for now. Let’s figure out why you can’t sleep, and let’s address the root cause.”

Dr. Weitz:            Right. Great. Okay. Any final thoughts you have for our listeners and viewers about sleep?

Dr. Corca:            Yeah, it’s to focus on how you feel the next day and there’s a lot of things that we didn’t get to touch on. Like, I don’t know, caffeine and just various things. I actually have these three gifts that I want to offer to you. I just kind of summarize a few myths around sleep, things that we think they’re true, they might not be true and what’s true about that.  So if you go to damianacorca.com, D-A-M-I-A-N-A-C-O-R-CA.com/sleepmyths So that would be sleep M-Y-T-H-S, there is a wonderful handout that I have that I think would be further helpful. Those are kind of like some basic things that you can do immediately and make sure you’re aware off. So then I feel like if those basic things we don’t take care of, then you never know, it might be as easy as taking care of those things, like understanding really when to stop the caffeine and understanding like what’s enough good sleep for you. Simple things, like is it good to drink milk before bedtime? I think that’s a big one a lot of people ask me sometimes.

Dr. Weitz:            Drink milk.

Dr. Corca:            I know it’s funny. So I explain all of those things and it’s at that link at damianacorca.com/sleepmyths. Other than that, yeah, I’m happy to help if anyone has any specific questions. So can go to my website or email me at damiana@damianacorca.com. Do you have any final questions that come to mind for me?

Dr. Weitz:            You just brought up like five other things that we could have covered, like caffeine and alcohol, and there’s a bunch, but there’s a lot of stuff that impacts sleep. I think we covered quite a bit.

Dr. Corca:            Yes.

Dr. Weitz:            Yeah. Good. Great. So, thanks for spending some time with us and making us more knowledgeable about sleep.

Dr. Corca:            Great. Thank you for having me. I’m happy to be here with you.



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



Nutritional Deficiencies with Tom Malterre: Rational Wellness Podcast 240

Tom Malterre discusses Nutritional Deficiencies as a Cause of Chronic Disease with Dr. Ben Weitz.

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


Podcast Highlights

1:35   Testing for Nutritional Status.  Standard lab panels like a CBC with differential and a chemistry screen pick up broad issues that may be catastrophic, but they don’t pick up nuances. This allows us to see if a person’s ingredients for optimal cellular function are happening.  If you see that someone has estrogen out of balance, but you want to know why and this could be because their fatty acids are out of balance.  It could be because the co-factors that are used by enzymes that regulate estrogen levels.  Just looking at a thyroid panel or a hormone panel or even a gut panel, we don’t necessarily find out what is going on in your cells today and how to help that person.  Tom said that he believes as Dr. Sidney Baker taught us that all disease is caused by two primary things: 1. You’re getting things you don’t need, like toxins, pro-inflammatory foods and foods that you react to, stress, et. and 2. You are not getting enough of the things that you need, such as vital amines (vitamins), minerals, essential fatty acids or amino acids.  If you have arthritis, it can helpful to find out why you have a pro-inflammatory state?  Are you missing your vitamin C? Are you missing some of the things that stabilize complex 2 in your mitochondria? Are you missing fat soluble vitamins that might stabilize the membranes within your cells and therefore reduce the amount of oxidative stress and lipid peroxides?

5:55  The average person sees their doctor, who orders conventional lab testing that is very limited and does not tell us anything about nutrient status.  If we see that a person has diabetes, we never ask why they have diabetes?  Why does this person not metabolize their carbohydrates very well?  Are they having trouble metabolizing their fats?  If they cannot convert their glucose into acetyl-CoA, then they cannot use that glucose for fuel.  Are they missing some co-factors for the actual pyruvate dehydrogenase complex to work, so they can process glucose or fatty acids.  If people are doing a keto diet and consuming a lot of fat, we need to make sure that the fat is brought into the mitochondria via the carnitine shuttle and once in the mitochondria, it needs to go through beta oxidation, which requires specific nutrient co-factors.  But if they have loose stools and their stool floats, this may be a pattern of fat malabsorption and if they are following a high fat, keto type diet, then that diet is not working for them.  Maybe it’s because they need additional riboflavin or carnitine or perhaps they don’t make enough phospholipids, which means they are not producing enough bile that enables them to emulsify the fat and to be able to absorb it. If you have too much fat in the stool, this will draw with it fat soluble vitamins, so fat soluble vitamins will test low, as will essential fatty acids.

8:53  Vitamin D.  If a patient has a low vitamin D, that could be because they have fat malabsorption. This is why it is helpful to have fat soluble vitamins being measured, such as with ION 40 panel, which measures vitamin D, vitamin A, two forms of vitamin E, and CoQ10.  If all of these are in the first quintile, then we know we have trouble with fat digestion/absorption.  And vitamins D and A are important for immune system function. We also see that if glutathione levels go down, so do levels of immune cell function.



Tom Malterre has a master’s degree from Bastyr University, as well as advanced training in Functional Medicine from the Institute of Functional Medicine, where he is also part of the clinical faculty.  Tom has lectured on nutrition and supplementation across the country and he currently coaches doctors and health care practitioners on Functional Medicine protocols and he runs Whole Life Nutrition.  He has written The Elimination Diet and The Whole Life Nutrition Cookbook along with his wife, Alissa Segersten. 

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


Podcast Transcript

Dr. Ben Weitz:                   Hey, this is Dr. Ben Weitz’s 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 site, drweitzs.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, we have an interview with Tom Malterre on nutritional analysis, as part of an approach to helping patients overcome chronic health conditions. Our special guest today is Tom Malterre, who has a master’s degree from Bastyr University, as well as advanced training in functional medicine from The Institute of Functional Medicine, where he is also a part of the clinical faculty. Tom has lectured on nutrition and supplementation across the country. He currently coaches, doctors and healthcare practitioners on functional medicine protocols, in his progressive practitioner coaching program. And he also runs Whole Life Nutrition with his wife, Alyssa Segersten, and he’s written a number of books, including The Elimination Diet and The Whole Life Nutrition Cookbook. Tom, thanks for joining us.

Tom Malterre:                   Hey, Ben. Pleasure to be here, my friend.

Dr. Ben Weitz:                   Absolutely. We’ve been chatting a little bit on Facebook over the last several months, so I’m glad we finally put this together. So what are some of the benefits we can get from testing for nutritional status?

Tom Malterre:                   That’s a good question. So it’s interesting, I feel like I’m spoiled now. Anytime we’re trying to get an idea as to what’s going on with a person, we oftentimes rely on the person’s symptomology and we rely on conventional lab testing. And what I’m finding is, conventional lab testing, standard blood panels, don’t necessarily pick up nuances. They pick up broad issues that are occurring and whether or not it could be catastrophic. And when they don’t necessarily-

Dr. Ben Weitz:                   What do you consider, standard lab panels?

Tom Malterre:                   Just a standard blood count, maybe with differential, cholesterol, possibly some sort of vertical auto profile, like a Cleveland HeartLab type analysis, type thing. It tells us about what’s going on in a certain aspect of a person’s health. But the reality is, human beings are built up of organ systems, and organ systems are built up of tissues, and tissues are built up of cells. So the reality is, you want to make sure that a person’s ingredients for optimal cellular function are happening. So this is one of those things where you go out and you say, “Wow, look at this person’s estrogen levels.” And you say, “Well, why is the estrogen out of balance?” Is it possible that the substrates for the estrogen itself, like the fatty acids are out of balance?  Is it possible that some of the co-factors for the enzymes that regulate estrogen levels are out of balance? Is it possible that some of the co-factors for the enzymes that detoxify or bio transform the estrogen are out of balance? You want to know all those details. By looking far upstream, and looking at a thyroid panel, looking at a hormone panel, or even looking at a gut panel, we don’t necessarily find out how to help that person today. What’s going on in that cell today? How can nourish that person to metabolize, transform, to detoxify, to exist in the presence of certain bugs. You’re always wanting to create an environment of resilience in the cell. And how do you do that? The same today, as we’ve learned from Sidney Baker from the get go, which is, all disease is caused by two primary things.

One, you’re getting things you don’t need. Two, you’re not getting enough things you do need. So you’re getting too many irritants and not enough nutrients, you’re getting toxins from mold, from air pollution, whatnot. You’re getting stress, you’re getting some sort of anti, or I should say, pro-inflammatory food components, like oxidized, fatty acids or whatnot. But you’re not getting enough of the things you do need. And those things are vital amines, they’re vitamins. They are minerals. They are essential fatty acids. They are amino acids, which is probably the most under looked aspect of functional medicine that I would suspect, are amino acids. And we don’t analyze those things. They are the primary building box for neurotransmitters, for cell repair, for proteins, for everything. But we don’t look at them. So I’ve said, why not? I’m a nutritionist, one who nourishes.

I have both a bachelor’s and a master’s in science and nutritional sciences. I’ve been studying it since I’ve been 10. Why not? We go in and we get a doctor’s diagnosis, and they’ll look at a set of symptoms. And they’ll say to you, “Well, you have diabetes or you have arthritis, or you have osteoporosis”, but they don’t necessarily say, why. Why do you have arthritis? You have pro-inflammatory markers in your system, but why do you have pro-inflammatory markers? Are you missing your vitamin C? Are you missing some of the things that stabilize complex 2 in your mitochondria? Why do you have a pro-inflammatory state? Are you missing fat soluble vitamins that might stabilize the membranes within your cells and therefore, reduce the amount of oxidative stress and lipid peroxides? Why don’t you check these things? You just take it for face value, that you have an inflammatory state, but why? So I ask, why?

Dr. Ben Weitz:                   Well, I think one reason why, is because the average person is not really aware of all this. They go in and see their doctor and they say, “Well, all my labs were perfect. There’s nothing wrong.”

Tom Malterre:                   Right. Yeah. And that’s I think, where we run ourselves into little boxes. When you look at conventional lab testing and that’s all you know, or you look at a diagnostic code and that’s all you know, and you say, “I would like to treat diabetes.” Well, why does the person have diabetes? Does this person metabolize carbohydrates very well? Do they metabolize fats very well? Are they efficient with their mitochondrial energy function? It’s possible that this person cannot convert their glucose into acetyl-CoA. And if they cannot convert their glucose into acetyl-CoA, then they cannot use that glucose for fuel. Then that can cause a backing up of the system. They may have a lactate buildup. They may have symptoms of muscle pain and fatigue and whatnot. And they’ll have these blood sugar abnormalities. Why, what’s the chemistry?  How does glucose get broken down? Are we dealing with some sort of issue with the actual pyruvate dehydrogenase complex, missing some co-factors, to allow for the normal processing of glucose, or when it comes to fatty acids? I have a lot of people who are doing keto diets, carnivore diets, whatnot. They’re consuming a tremendous amount of fat and/or protein. And they’re not taking into consideration when they’re consuming the fat, that the fat has to be brought into the mitochondria, via carnitine shuttle. Once it’s in the mitochondria, it’s going to need to go through beta oxidation, beta oxidation needs specific nutrient co-factors. All these things are a chemical process.

Dr. Ben Weitz:                   This is so the fats can be converted into energy in their body, because they’re eating very few carbohydrates.

Tom Malterre:                   That’s exactly right. It’s interesting, right? You run these panels and you see people who have then, an inability to digest fat, and they’re eating tons of fat. So you’ll see low levels of fatty acid, whether it’s monos, saturates, essential fatty acids, and you’ll see low levels of fat soluble nutrients. And you’ll see on the intake form, a pattern of fat malabsorption. So they’ll say, “I have looser bowel movements. I have multiple bowel movements per day. They’re floating, they’re lighter in color.”  And you say to yourself, “Wait a second, keto isn’t working for you. Keto might be the best thing for you, metabolically, but it’s not the best thing for you currently, physiologically.” Why? Possibly, they have a carnitine deficiency. Why? Possibly, because they need additional riboflavin. Why? Maybe it’s genetic. Maybe they’re not making enough phospholipids, and the phospholipids aren’t allowing them to produce adequate bile. The bile is not allowing them to emulsify the fat and then allow them to absorb the fats efficiently. And they’re ending up with the fats in the stool. When the fats are coming in the stool, the fats then draw with them, all the fat soluble vitamins. So there’s these nuantic pieces that you want to put together. You can’t just-

Dr. Ben Weitz:                   Well, that’s a great point right there. You could have somebody with low vitamin D, and if the vitamin D is being pulled out of their body because of fat malabsorption, and then we’re giving them more vitamin D and we’re going, “Gosh, why isn’t this person’s vitamin D going up?”

Tom Malterre:                   That’s definitely a panel that you want to look at too, is constantly look at the vitamin D. The neat thing about these nutrient panels that include fat soluble vitamins, like the ION 40, they include the vitamin D. So you can look at vitamin D, you can look at vitamin A, you can look at two E markers, both the alpha and gamma tocopherols, and then you can look at coenzyme Q10, and you can form an image on these panels where you look at, across the board, they’re in Quintiles. So five little segments, and you can see if everything’s in the first Quintile, then obviously you have an issue. You have an issue with a person getting in enough, fat soluble vitamins. If they have that issue, then where’s the conversation about looking at additional ox bile or looking at lipase or looking at something that would help that person digest, and therefore absorb their fats and their fat soluble vitamins. Because if they can’t get the fat soluble vitamins in, then what’s the use of supplement?

Dr. Ben Weitz:                   Exactly. And we know vitamin D, among its many, many benefits, is immune system function. And we all know that right now, having a highly functioning immune system is super important.

Tom Malterre:                   Yeah. Well, that’s another aspect. It’s interesting. We’re seeing a lot of data coming out and I saw this through the Institute of Function Medicine, while studying toxicology. And when we saw that people were deficient in glutathione, and we saw their immune cell function went down. And when their glutathione levels go up, it appears their immune function improves. So you can track both, where the glutathione might be coming from, and the actual glutathione itself, indirectly, via some of these nutrient analysis. So if we were wanting to say, “Well, gosh, it’d be great if we could take a peak inside someone’s cell and determine if they’re taking their homocysteine and turning it into glutathione and keeping their glutathione levels up, and/or determining which specific amino acid substrates might be low in this person. This panel can’t look at cysteine, it oxidizes, but it can look at cystine, looks at homocysteine, looks at glycine and looks at glutamic acid.  So you can determine, am I low in all the substrates? Where is the metabolism going of these substrates? Am I producing enough glutathione. And we’ll see a imprint of that with pyroglutamic acid. So we can get a glimpse too, of what’s happening with the antioxidant detoxification systems, by looking in the urine and organic acids, by looking in the plasma, at amino acids or in some cases, the urine. But I always look at plasmas, it’s a longer picture of how long the amino acid levels have been low in the body, or high. Most of the time, people have low amino acids, not high. And in fact, once again, we have nine essential amino acids. Some are transitionally essential, and no one measures these things. These are the building blocks for all repair tissues.

You’ve got a person who’s got Ulcerative Colitis or Crohn’s, and they cannot seem to repair their intestinal tissue. And I run an ION panel on these people, and their amino acid levels are in the tank. Their phospholipid levels are in the tank, their magnesium levels in the tank, their zinc levels in the tank. They don’t have enough of the raw ingredients to help rebuild their own intestinal tract.  So when they’re actually getting injured by microbes, by food particles, by whatever it is, toxins, then they don’t have the ability to repair the tissue. So we know that the-

Dr. Ben Weitz:                   That right there, is a great clinical insight for patients with chronic gut problems. You could have a patient dealing with IBS, SIBO, one of the other forms of dysbiosis, and you might be taking the appropriate steps that, normally are supposed to work to help this person get rid of, or reduce the levels of the problematic microbes. And you could be giving them probiotics to build up their microbiome. But if they’re lacking essential nutrients to allow their intestinal system to function properly and to heal and to repair, none of those are going to be effective.  And we may be running down various wrong paths, looking for the next problematic microbe, when we have to go back to the basics, which is, looking at the importance of our nutritional status, which of course, is something that only us in the functional medicine world look at, because conventional doctors are not going to do this. They might run a vitamin D or a serum B12, but that’s about the end of it because all the other tests are not going to be covered by insurance. And they have a 10 minute office visit anyway, limited by what insurance pays.

Tom Malterre:                   Exactly, and it’s not just the intestinal lining, it’s the mucus layer. So you need specific nutrients for mucus. Ideally, we’d have optimal electrolytes. People don’t even think about that for mucus production. There’s so many different things when it comes to structure of the human body, that are all chemical. You need the actual chemical ingredients to build rebuild, repair, do anything you need to do, with a human cell. So if you’re not thinking of the nutrients, you’re not thinking of what’s the optimal health of a cell.  So that’s why I’m always trying to get people to run these panels. And when you have these panels, the interesting piece is, and a lot of people will say, “Well, I’ve run these things and there’s no validity on these. And there’s no science to back this up.” You got to be kidding. I have a textbook that I keep in my desk drawer right here, with all my supplements.  It’s the Laboratory Evaluations… Oh, you can’t see that, but Laboratory Evaluation for Integrative and Functional Medicine, 2nd Edition by Richard Lord and Dr Bralley.  I spent time with Dr Richard Lord over a decade ago. We hang out at all the Functional Medicine conferences. They’re wonderful people, the Bralleys’ and Dr Lord. They’re from Metametrix, that now got absorbed into Genova, right?

Dr. Ben Weitz:                   Right.

Tom Malterre:                   This crew was not wasting their time. They sat and buried themselves in scientific literature for decades, to come up with some of these evaluative tools. And then, the wonderful thing about this analysis is, there are checks and balances. So if you have a urinary organic acid, and it’s the only marker you have, like methylmalonic acid, for example, B12. And you’re like, “Well, gosh, does this person really have a functional B12 deficiency?” Well, the fatty acids that need to be transformed by adenosylcobalamin, into other metabolites that can be used for energy Succinyl-CoA at all, if they cannot be transformed, you’ll see a buildup in odd-chain, fatty acids on the panel. So you can see functional adenosylcobalamin deficiencies, via MMA and odd-chain, fatty acids. There are multiple, different ways throughout the test. Let me give you an example.  I had 46 year old female, just two days ago. And this 46 year old female has weight loss resistance. She has these immaculate standard panels. I’m working through another healthcare practitioner. I’m pulled in as a consultant sometimes, on cases.

Dr. Ben Weitz:                   Okay.

Tom Malterre:                   And this other practitioner shares these three different lab sets and they all look pretty immaculate, everything looks great on this woman. She’s fabulous, mentally, gut wise, supposedly everything’s great. How come she’s not losing weight, what’s going on? And so we look at essential fatty… Or excuse me, we look at essential amino acids. And all we see is these little things of this real big spike in valine real big spike in threeanine. And we’re like, “Huh, what’s the commonality between these two. Everything else looks relatively normal, straight down the middle.”

Well, those particular two amino acids need vitamin B6 in order to be metabolized. So you say, “Huh, okay. Let’s go down the list and look at alpha amino and butyric acid”, which is a marker of B6. And it’s skyrocketed. It’s huge. So immediately I can see, there’s this drastic need for vitamin B6. Well, B6 takes place in all these transaminase enzymes. So anytime you want to transfer one amino acid into a different shape amino acid, you have to have adequate B6. B6 takes place in the brain, when we’re transferring glutamate over to GABA. We need B6 as a specific co-factor, to calm down neuro excitability. B6 is needed all over the place. There are hundreds of different reactions, whether it’s a form of metabolism or metabolism itself, or for glucose or other things, B6 is everywhere.

B6 for tryptophan, B6 for the formation of melatonin, B6 for dopamine, it’s all over the place. So if you have a person who’s deficient in B6, you have a person who’s, malfunctioning across the board. And it’s interesting when you run nutrient analysis, one of the most common nutrient deficiencies I see in humans is B6. And it’s weird because you say, “Well, why B6?” Well, B6 can be wasted, via a certain gene analysis. You look at their genes and they might be having specific enzymes that allow them to either, use up or excrete or more B6. That’s one. Two is, certain medications will deplete B6. Come on, Ben, what kind of medication do we know in females all the time, is depleting B6? It’s oral-

Dr. Ben Weitz:                   Antidepressant.

Tom Malterre:                   Antidepressants, can be, and oral contraceptives. Well, guess what? This gal’s been on oral contraceptives for a couple decades. So it’s like, wow, she’s super deficient in the B6. Now, you partner that with a low tyrosine, she has a flat affect. She’s not really excited in life. And you say, “Oh, B6 is needed for dopamine metabolism.”

Dr. Ben Weitz:                   By the way, if that person were to get a serum B6, is that going to show us what we need to know?

Tom Malterre:                   Not always, interestingly enough. No, and you have this reflected here in a couple of different spots, but you’ll see it in the urinary organic acids, as kynurenate and Xanthurenate. And then you’ll see it again here, in the amino acids and alpha-Aminobutyric acid.

Dr. Ben Weitz:                   Now, why is it? I’ve seen a number of patients who, their serum B6 was actually high, but they needed B6.

Tom Malterre:                   Okay. Well, B6 is once again, needed all over the place. And so you’re not always going to find B6 just in circulation, where you want it to be. So if you’re using B6 intercellularly, if you’re using B6 in multiple use, and you’re looking in just one area in the serum to find out if your level is adequate, then you may not see what you’re looking for. Not only that, you need to transfer B6 into pyridoxal phosphate and if you’re looking at pyridoxine, and you’re looking at pyridoxine in the serum, you’re not necessarily going to determine if this person is utilizing the B6, in the bio available form because of their enzyme function, their co-factors for that enzyme, they may have insufficient magnesium, for example. And so they may not have functional use of their B6, even though they have B6 in circulation. So it’s not enough, right?

Dr. Ben Weitz:                   Right.

Tom Malterre:                   So anyway, so we find out right away, this gal has a B6 insufficiency. And then we look down the line and gosh, there’s all sorts of things. Her thiamin is insufficient. Well, what do you need thiamin for? Well, thiamin is going to be the primary determinant, to turn on pyruvate dehydrogenates. So when a person is taking glucose and they’re turning that glucose into acetyl-CoA, as we were talking about earlier, it has to pass through pyruvate and pyruvate has to turn into acetyl-CoA. Well, that complex, it’s a big protein complex, it has to have thymine first and foremost, to come in contact with that pyruvate and then break it down into multiple different steps, with the help of B2 and B3 and B5 for acetyl-CoA. And then we also have alpha-lipoic acid, which stimulates the whole response.

So if you’re missing a B vitamin like B1, the whole complex slows down, you can’t get the energy from the pyruvate. You also cannot get energy from your branched-chain, amino acids, your isoleucine and leucine, and valine. Those things need to go through alpha-keto acid dehydrogenase as well, which needs the thiamin. So you’re not getting energy from amino acids. You’re not getting energy from your glucose. Then all of a sudden, what happens? The system backs up. You have some issues. You’re not utilizing your energy from your foods. Now, partner that with one more thing, she’s eating mostly keto. And what do we see? We see that same scenario we were just talking about, where the fat-soluble vitamins are low. The coenzyme Q10, the vitamin A, the beta-carotene, the vitamin E, they’re low, the vitamin D was low as well.

And then we see monounsaturates low. We see saturates low, see essential fatty acids low. We see omega-6 low. So all of her fatty acids, all of her fat soluble vitamins, are trending low. So if these are all low, she may be on this higher fat diet. She may be trying to exist with keto. And she has a [inaudible 00:22:25] elevated, which is an indication of poor fatty acid metabolism. So we say, “Wait a second. Of course, she’s going to have fat loss resistance.” I don’t know if you’ve seen this, Ben, but I’ve run nutrient panels now, for 15, 16 years. And when I see people who are low in essential fatty acids, they hold onto their fat. The body, for some reason… I tell my own story here where I say, well, the body really needs these essential fatty acids.

And if it’s not getting the essential fatty acids, whatever fat it takes in, it will hold onto. It’s looking for that missing link. It’s wanting that piece. And so therefore, it has a difficult time letting go of the fat, until it receives the beneficial fats that make it function well. Now, if we looked at the fatty acid panel too, which is fascinating, we’ll see that she had a block on DPA, turning into DHA. We see she had some blocks from GLA to DGLA. Both of those things need elongase to work. And what does elongase need? Vitamin B6. So even some of her essential fatty acid, some of her prostaglandin forming, omega-6 fatty acids, they were out of whack, once again, because that B6 was missing. So there’s this wonderful story that gets told in your own chemistry, by looking at these nutrient analysis tests, but here’s the challenge-

Dr. Ben Weitz:                   So let me just stop you on this particular case. So then, how much B6 and what form of B6 did you give her? How did you know how much B6 to give her? And did you use… Which form?

Tom Malterre:                   Yeah, so the reality is, I’m usually using higher doses of B6 than the average bear. And I’ll usually use 25 milligrams throughout the day, three to four times a day. So up to a hundred milligrams of B6, depending on the response, and usually titrating up. What I find is that, B6 travels really well with magnesium. So I’ll do a magnesium-

Dr. Ben Weitz:                   Do you use the P5P form?

Tom Malterre:                   Yeah. Depends on the person. So you’ll see responses and tolerance in different ways. It’s weird, some people do not respond well to P5P and some people do not respond at all to pyridoxine. So I’ll usually start out with a P5P/magnesium combo. And if there’s any sort of negative response, then I’ll move over to pyridoxine. So just a standard facility.

Dr. Ben Weitz:                   Okay.

Tom Malterre:                   But magnesium, I’ll usually have the magnesium along with it. Now, the magnesium is especially important when it comes pyridoxine, because you need it to convert over to P5P, which needs-

Dr. Ben Weitz:                   How much magnesium will you use in a case like that?

Tom Malterre:                   Thank you for that, asking. I really appreciate it. So what I found with magnesium over the years is, number one, the magnesium receptor sites don’t really, optimally function above 200 milligrams per dose. So a lot of people who are doing single dosing of 400 milligrams or 600 milligrams at night for sleep or leg cramping or whatnot, I don’t see that works. I find that, when somebody does smaller dosing throughout the day, 125, 150 max, three, four times a day, that’s better, both absorbed and tolerance wise. And the reason people don’t tolerate magnesium is usually, they’re doing too high of a dose of a form that’s not well absorbed, that causes an osmotic gradient, draws the fluid out, causes the cramping. They flush out the content of the intestinal tract. So of course it keeps-

Dr. Ben Weitz:                   We sometimes use that for constipation patients.

Tom Malterre:                   Yeah. Well, a lot of people do. They’ll use a citrate.

Dr. Ben Weitz:                   Right.

Tom Malterre:                   Hopefully they’re not using an oxide or a sulfate, like the Epsom salts, but my goodness-

Dr. Ben Weitz:                   What’s the negative effects of using an oxide or a sulfate?

Tom Malterre:                   Oh, oxides are miserable. They usually cause terrible cramping in people. Sulfates can as well, it’ll clear out the gut pretty significantly. I have a tendency, not to want to draw out fluid from the intestinal tract like that as much as possible. I will look at motility issues. I will look at bacteriological issues, absence of growth of certain organisms. Lactulose is incredibly underused when it comes to constipation, it’s bizarre. It’s a sugar, it’s a disaccharide. And that specific sugar, not only increases motility like nothing else, but it’s also a prebiotic. It seems to feed, acid forming organisms that change the pH of the upper intestinal tract. They help lower SIBO. It helps to help repair the intestinal lining. It’s one of the few things that’s been used in the medical literature, to repair a leaky gut and lower liver enzymes.

Dr. Ben Weitz:                   Interesting. It’s only available a prescription now, though.

Tom Malterre:                   Yeah. There was a petition going around a couple months back, to make it a non-prescription.

Dr. Ben Weitz:                   It’s insane. We have a sugar that’s a prescription.

Tom Malterre:                   It’s a sugar. Yeah. Welcome to the United States. If you go to Canada or you go to Australia or you go to Europe, whatnot, it’s not. You can go up to a pharmacist, say, “Just hand this to me please.” And they’ll give you a big bottle. And when I used to be able to go across the border, that was an easy thing to do, but it’s crazy now. But I highly recommend considering things like that, as well as there’s probiotics, other prebiotics, dietary changes, essential fatty acids, which help. So instead of causing an irritation and causing something to flush out the contents of the intestinal tract, which will draw other minerals or nutrients with it, oftentimes I’m using secondary measures for normalizing bowel movements.


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Dr. Ben Weitz:                 Can you talk a little bit about, what we can tell about neurotransmitter imbalances from looking at amino acids? Because as you know, in this country, rates of depression and anxiety are really, super high. And over the last several years, have gotten much higher. And the conventional way of treating depression and anxiety is to, assume that this is a result of neurotransmitter deficiency and simply putting all the patients on SSRIs and similar drugs that say, increase serotonin levels.

Tom Malterre:                   Well, first off, one of the most under utilized therapies for anxiety I think is, recognizing that if a person is magnesium and B6 insufficient, they will be anxious. So I shouldn’t say they will be, the chances of them being anxious or having racing thoughts, the monkey mind, startling at loud noises, not being able to turn off their mind at night so they can get some rest, always being hypervigilant, what we call, wired and tired. So commonly Ben, so commonly is associated with a magnesium and B6 insufficiency.

Dr. Ben Weitz:                   So which form of magnesium should we use for these patients?

Tom Malterre:                   Ah, thank you. So if the person has cognitive decline issues, the three and eight might be good to get in the central nervous system. If they are not dealing with that, then a maleate or glycinate, anything could work just fine, Atorate for cardiac stuff, whatnot. There’s or an orotate, whatever. But I’m less concerned about that. They seem to work even a citrate can work if it’s low enough dose and doesn’t create bowel spasms in somebody. But the big thing is, just the smaller doses throughout the day.

Dr. Ben Weitz:                   Okay.

Tom Malterre:                   That’s the thing that seems to get people to where they need to go.

Dr. Ben Weitz:                   200 milligrams, what, two to three times a day, or even more?

Tom Malterre:                   Yep. Three to four times a day, if they have a big issue with it, especially if they’re quite anxious. But you ask questions. Do you have the eye twitching? Do you have the arm twitching? Do you have something going on that’s leading you to believe you may have a magnesium insufficiency? Are you startling at loud noises, whatnot? Do you have the leg cramps? Those are all telltale signs to show that you may have some extra need for magnesium. And if you do, then holy smokes, let’s go, let’s do it. And honestly, out of all the things that we see as patterns on these panels, after 16 years now of running these panels, what is it that I see? Consistent magnesium B6 insufficiency, consistent magnesium B6 insufficiency.

When I have people who are anxiolytic, when I have people who are having a hard time going to sleep, what is it that I see? Deficient magnesium and B6. So it’s one of the most solid patterns. So when I was trying to figure this out chemically, I looked of course, at this book that I have here, and it talks about the NMDA or the N-methyl-D-aspartate receptor in the brain, which is a calcium channel. And that calcium channel is stimulated by glutamate. And the glutamate basically tells the brain, alert and alarm, pay attention, remember, remember, you need to know what’s going on right now. This could be something that’s incredibly beneficial to you or potentially harmful. So you need to know this, you need to know this, that glutamate signal is turned on by toxins, it’s turned on by blood sugar abnormalities.

It’s turned on by all sorts of different stressors. And that glutamate will turn on. Well, once the glutamate turns on, it causes an influx of calcium into that channel. And that causes that neuro excitability. How do you then regulate that? How does the body regulate the NMDA glutamate excitability? Well, two ways, primarily. Well multiple, actually. But the two primary ways that I’m seeing chemically is, you can take that glutamate and you can turn it into GABA. Glutamate is excitatory, GABA is calming. How do you do that? Well, you do that through an enzyme, and that enzyme is a B6 dependent enzyme. So you have B6 in adequate levels, you can convert that glutamate to GABA. Fantastic, there you go. You get the exact opposite effect. You get a calming effect. The other way is, you have this [inaudible 00:33:51] which is calcium that’s coming in, and you have another [inaudible 00:33:53], which is magnesium.

So two positive charges, two positive charges. And you can have adequate magnesium that will sit in the middle of this calcium channel. And as the calcium will come in, it will electrically repel the calcium. So if you have adequate magnesium, it regulates the amount of calcium that actually can come into this receptor. So you have two primary things, stopping the calcium influx and turning the actual signal of glutamate made into GABA, that can help you regulate the anxiety response. So Mag-B6 for anxiety. I would hope more and more people would start thinking about that. Now the other piece is, of course, you have the normal pathways of dopamine. Dopamine’s going to coming in, via phenylalanine going to tyrosine, tyrosine going into dopa, dopa going into dopamine, and then dopamine going down into norepi and epinephrine. And if you have too much, norepi or epinephrine, because you have a zinc insufficiency or riboflavin insufficiency, and you’re not working on the aldehyde dehydrogenase complexes, and you’re not really processing your adequate dopamine or R epinephrine, you’re going to have some issues with neuro excitability.

The neat thing about these nutrient panels is, you can get clues. You can say, well gosh, do I have enough zinc? Well, yeah, the mineral zinc is here on this panel. Do I have enough B vitamins? Well, there’s a lot of different markers on here that would indicate sufficient or insufficient B vitamins. So you can get these clues all over the place. Plus, you can look at the neurotransmitter precursors. So you see phenylalanine levels, you see tyrosine levels, you see the ratio of phenylalanine to tyrosine. So you see if the conversion’s happening very well. And then you also see some of these things like VMH, VA that are actual end-products of, part of the metabolism of these neurotransmitters. So vanilmandelate, homovanillate, these are markers to show you, are they succeeding in going down the process of both, making the neurotransmitters and metabolizing them successfully?

So you can start telling yourself stories about the chemistry of whether or not this person’s metabolism is working. Now, if you partner this with a gene panel, and this is where the magic comes in, when you start looking at the actual precursors, and then you start looking at the end products, and then you start looking at, how are their enzymes? Are they able to actually process efficiently and effectively? And if they’re not, and they have the co-factors that are challenged, well, no wonder this person is anxious or no wonder this person doesn’t feel like they’re satisfied with life or rewarded or whatnot. So you can really start putting the biochemical pieces together, as to where the blocks may be in neurotransmitter metabolism.

Dr. Ben Weitz:                   Awesome. This is fascinating stuff.

Tom Malterre:                   Yeah. And it’s actually quite freeing, Ben, because when I see standard clients that have not had lab analysis, whether it’s nutrient panel or gene panel or both or whatnot. The more pieces of information you get, the more of a story you can tell. I worked for a Alzheimer’s company for a while, that would charge people $50,000. They’d run these massive brain scans and $10,000 worth of labs. And then I would sit with the lab material for a number of days, and I’d put all the pieces together and then come back with a protocol or a plan. And it’s incredible, how specific you can get when you have all these pieces of analysis. You’re no longer guessing, you’ve tested, so you know exactly where to go next.

Dr. Ben Weitz:                   Yeah. And Dr Dale Bredesen has shown in the last year, that we can use a functional medicine approach on patients with Alzheimer’s and actually reverse the condition, and actually make people better, as compared to that recent drug that got approved for Alzheimer’s that cost $60,000 a year. Causes bleeding and inflammation in the brain, and nobody got better.

Tom Malterre:                   Yeah. That’s a wonderful breakthrough. He has done some fantastic work. And the amazing piece about his work was this. If you start with one intervention, you get zero results. Well, not zero, you get minimal results for a shorter period of time. The more interventions you add, changing your lifestyle, your sleep processes, your exercise, your psychological wellbeing. And then he has a whole host of nutritional items that he recommends for mitochondrial function or gut function, or essential fatty acids or whatnot, amino acids. There are all these different things that he’s examined that say, you know what, for each one of these that you include, the chances of this person getting better, improve up to a 38 point protocol.

Dr. Ben Weitz:                   And by the way, I know they included the NutrEval in the analysis as well, among their lab testing.

Tom Malterre:                   Yeah. And once again, the NutrEval overlays the ION panel and vice versa. There are some slight differences. They’ve added a couple of new things like, oxalates and whatnot, to the NutrEval, but the ION 40 still has 20 additional amino acid markers. And it still has fat soluble vitamin markers that I enjoy looking at. So I’m old school. A lot of people like the NutrEval, because it comes out with this wonderful readout that tells you about all these algorithms. And it says, “This vitamin is low. This vitamin is low.” I’ve been doing this too long to want somebody else to tell me how to do it. I’ll look at it and I’ll say, “Well, if that’s going here and this is going there, wow, this person needs more glycine. So it’s a little different for me, but I really wish people would examine this.

And if they need assistance, they would somehow contact me and start a study group or whatever we have to do. But I would hope that people would understand, there are answers. There are clues, there are pieces of this investigation that you can add into your repertoire. You don’t have to just walk in and assume you know the diagnosis. Therefore, you assume you know the chemistry. I have to tell you, man, I’ve been so humbled by this, because I’ve been studying this for a very long time. And I’m reading the research and talking to colleagues and training colleagues and working on case studies with groups of people. And every time I run these, I’m always finding something that’s counter to what I thought it would be. So I think it’s smart for us to be humble and recognize, while we may have a whole plethora of things in our tool chest, without testing, we’re guessing.

Dr. Ben Weitz:                   Right. I love your test, don’t guess approach. And I also have found it very helpful in my functional medicine approach with patients. There’s an interesting trend in our profession, where some practitioners are out there saying, “If you run all these tests, then you’re treating the test and you’re overburdening the patient with excessive cost. And if the patient presents with these symptoms, just put them on this diet first. And if that doesn’t work, then use a couple of simple interventions. And most of the time that’s going to fix it. And all this other stuff is over testing and over charging and all this kind of stuff.”

Tom Malterre:                   Yeah, totally. I get it. And here’s what I would say. If you’re not up on it, you’re probably down on it. So this is what David Primler talked to me about a long time ago when I was talking to him at an AFMCP, years and years and years ago, he used to say, “People are down on what they’re not up on.” So if you haven’t run these for a number of years, they’re confusing. You look at them and you’re like, “Ah, chemistry. I don’t understand this.” But I’ve spent years, literally years going through the individual markers, reading the research on it, looking at the biochemical pathway, seeing how one biochemical pathway interacts with another biochemical pathway, and you see patterns forming. And you see that, well, yeah, this one’s not really accurate in this particular client because they’re gut’s so out of balance.

And this one’s not really accurate here, because they’re not digesting this amino acid very well, or I can’t really rely on this MMA value because they don’t really have adequate BCAAs. And so it’s not really going to tell me what their methylmalonic acid is looking like. So there’s a lot of little nuances that you have to gain with experience and time. And until you do, you’ll poo poo it. You’ll say, “There’s no validity to that. This doesn’t work.” This is an incredible tool, if you choose to understand what it is. You look at its limitations and you use it how you can, with limitations. But once you see the patterns and once you see it come out as hundreds of and hundreds, and now thousands and thousands of clients, you go, “Oh.”

This is one of many tools. And while I used to order these when they were $1,800. And now you order them and they’re $465. They have so much value, that I’ve never thought that I’ve wasted a person’s time and/or money, ever, not once. So I understand those arguments, and they’ll say, “You’re treating now, the lab.” Well, no, you look at the person’s symptoms. You look at the person’s history. You look at what they’re presenting with, right in front of you. You layer that with some of the information from this lab, and then hopefully you can get a gut panel and the gene panel and some other standard lab tech panels. And you start putting all those pieces together. And then you form the actual picture that determines where your plan or protocol is going to go.

Dr. Ben Weitz:                   This is brilliant, Tom. I am really enjoying this discussion. I wish we had two more hours, but mither you, nor I have two more hours available. So we’re going to have to wrap it here. I’d love to come back and discuss some of these issues in the future. How can listeners and viewers find out more about the programs that you have to offer?

Tom Malterre:                   Yep. So some are on wholelifenutrition.net. So there’s a functional lab analysis course that I was teaching for a number of years, that I’ve stopped teaching now. But if I have enough interest, I’m happy to coach people on that. And they can just shoot me an email at plantsarewise@gmail and say, “Oh my gosh, I got to know this.” And if you got to know this, I’ll teach you, we’ll make it happen.

Dr. Ben Weitz:                   Awesome. Thank you so much, Tom.

Tom Malterre:                   Pleasure, Ben. Take care of yourself.

Dr. Ben Weitz:                   Okay. Have a great day.

Tom Malterre:                   You as well, my friend. Bye-bye, now.



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



Menopause with Dr. Felice Gersh: Rational Wellness Podcast 239

Dr. Felice Gersh discusses Menopause with Dr. Ben Weitz.

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


Podcast Highlights

1:45  Menopause.  Is menopause a normal part of aging?  It is a normal part of aging, but a very negative one and it can lead to many of the diseases that we associate with aging. But it is also independent of age, since some women go through early menopause such as through surgical removal of their ovaries due to some disease.  “Nature is beautiful and wise, but also can be quite cruel.” The same nature that brings us beautiful sunny days also brings us tornadoes and hurricanes.

5:48  The first stage of menopause is Perimenopause, which is really the stage before menopause.  Menopause is defined as 12 consecutive months without a spontaneous period.  Menopause could also be called ovarian senescence, because it is marked by the ovaries no longer being able to produce estrogen.  Menopause is a natural, gradual process, but we should not ignore it nor embrace it. As humans we have a reproductive destiny and the prime directive of life is to reproduce and have healthy babies multiple times.  Every process in the female body is designed to support fertility.  The hormones, estrogen and progesterone, are the glue that glue all of the different functions in the body involving metabolic, cardiovascular, and immune function that go into pregnancy. When your ovaries can no longer function and ovulate and produce these hormones, all the systems in the body have this profound change.  It’s natural but it is a problem for women and once we understand that, we can create some viable solutions.

13:12  There is no definitive test that a woman is in perimenopause, though you could do a cycle mapping of female hormones, aka menstrual mapping. This test is available through Precision Analytical Lab as part of their DUTCH testing and also though ZRT Labs, where you have a woman measure her hormones daily using dried urine for 28 days or so.  This test is not done by conventional gynecologists, but it allows you to see the various phases of the menstrual cycle and you might see that they start to get a shorter luteal phase and the estrogen spike that proceeds ovulation will tend to be dampened down. Next you will start to see a dampened progesterone response as well.  The progesterone ends up being produced in a lower amount and for a shorter period of time.  This test can help with many conditions, such as fertility problems.

23:27  Phytoestrogens can help to manage some of the symptoms of perimenopause.  Eating organic, whole soy, which contains phytoestrogens, does not increase breast cancer risk.  This can help with hot flashes, night sweats, and sleep problems.  Estradiol has at least 3 different receptors–alpha, beta, and a membrane receptor.  Soy and flax bind to the beta receptors.  Beta receptors are in the cerebrum of the brain and in the cells lining the gut, so phytoestrogens help with brain and gut function, but bone is more alpha, so they don’t benefit the bone as much.  You can eat organic, whole unprocessed soy beans or minimally processed like tofu and include a couple of tablespoons of flax seed. Take Siberian rhubarb supplements, which is another phytoestrogen that is all beta.

37:10  One of the symptoms of perimenopause is mastalgia, for which Dr. Gersh recommends taking 100-200 mcg of iodine.  Also anti-inflammatory supplements like curcumin and fish oil, as well as eating an anti-inflammatory diet.

38:41  If the balance of the estrogen and progesterone tips and the progesterone declines first, chaste tree or chasteberry, aka, vitex can be helpful at a dosage of 200 mg per day.



Dr. Felice Gersh is a board certified OBGYN and she is also fellowship-trained in Integrative Medicine. Dr. Gersh is the Director of the Integrative Medical Group of Irvine and she specializes in hormonal management. Her website is IntegrativeMGI.com, and she is available to see patients at 949-753-7475.  Dr. Gersh lectures around the world, and she has just written her third book, Menopause: 50 things you need to know: What to expect during the three stages of menopause.  Her other two books are PCOS SOS: A Gynecologist’s Lifeline to Restoring Your Rhythms, Hormones, and Happiness and PCOS Fertility Fast Track and she has also published a very influential paper in the prestigious journal Heart, which is part of the British Medical Journal family of journals: Postmenopausal Hormone Therapy for Cardiovascular Health: the Evolving Data.

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


Podcast Transcript

Dr. Weitz:            Hey! This is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts, and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates. 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 our topic is the three stages of menopause, with Dr. Felice Gersh. Dr. Felice Gersh is a board certified OB/GYN. She’s also fellowship trained in integrative medicine.  Dr. Gersh is a director of the Integrative Medical Group of Irvine. She specializes in hormonal management. Her website is integrativemgi.com. She’s available to see patients at (949) 753-7475. Dr. Gersh lectures around the world. She’s just written her third book, Menopause: 50 Things You Need to Know, What to Expect During the Three Stages of Menopause.  Her other two books are PCOS SOS and PCOS Fertility Fast Track. She’s also published a very influential paper in the prestigious journal, Heart, which is part of the British medical journal family of journals. Post-menopausal Hormone Therapy for Cardiovascular Health, the Evolving Data.  Dr. Gersh, thank you so much for joining me again.

Dr. Gersh:           Well, it’s always a pleasure.

Dr. Weitz:            How should we think about menopause? What is menopause? Is it just a normal part of aging? Is it a disease? What is menopause?

Dr. Gersh:           It is definitely a normal part of aging, but a very negative one. It depends on how you want to look at all the diseases of aging. Menopause is not a disease, but it is a staging event that can lead to many of the diseases that we associate with aging.  In fact, that’s been a very big discussion, which has been very frustrating from me, when I was looking on from the sidelines. So many things that are attributed to just aging, like chronological age, have really been misguided because they’re missing that, I always say the critical ingredient of the hormonal ingredient, like what’s happening to women when ovarian function ceases and they don’t make any more estradiol and progesterone from their ovaries.  That is, of course, related to age, but it is also independent of age in that, for example, if a woman goes into a surgical menopause like, for example, her ovaries are removed for some disease entity, or she is unfortunate one of those women who has premature ovarian insufficiency, where her ovaries stop functioning at a very early age. Then all those conditions start to accelerate in their presence.

So, we definitely don’t want to think of everything that happens to women as just related to their chronological age. That’s why I really want to bring back the picture of menopause as natural, but negative. So I always say, “Nature is beautiful and wise, but also can be quite cruel.” The same nature that brings us beautiful sunny days also brings us tornadoes and hurricanes.  So, we just need to recognize the boundaries that we have in terms of what we can do about menopause and all of its subsequent negative effects, and what we can really take charge of. We can’t avoid menopause. I always said, Benjamin Franklin, who was very wise also, but a guy, he said something. To paraphrase, there are certain things in life that are never going to be done away with, and that was death and taxes.  I said, “Wait a minute. Just one minute here. What about menopause?” We can’t escape menopause. At least at this time, although I hear there are some people working on cloning ovaries, but that’s not happening quite yet for the market.

Dr. Weitz:            Right. It’s interesting, the discussion about whether or not menopause is a disease. There’s also a discussion in the longevity section of medicine, whether aging is a disease. A number of doctors are lobbying for aging to be a disease, so it’s easier to justify treatments for it.

Dr. Gersh:           I would probably draw the line of calling aging and menopause diseases, but I would say that we need to look at what is happening. I’m always into mechanisms. I know you are, too.

Dr. Weitz:            Theoretically, of course, we don’t want to see aging as a disease. But the way our healthcare system is, where we don’t do anything for prevention, you have to call something a disease before you can even justify treatment.

Dr. Gersh:           If we need a CPT or ICD9 code, I guess for menopause and aging so that we can actually get coverage for caring for people, then I’m for that. I have to be pragmatic, as well, so I’ll buy in.

Dr. Weitz:            Let’s go into the stages of menopause. The first stage of menopause is perimenopause, which is really the stage before menopause, but you’re approaching menopause, right?

Dr. Gersh:           I have to work with the existing vocabulary. If it were my choice, I would abolish the word menopause because it has really misguided so many people into viewing this process of ovarian aging, or ovarian senescence, as really about the end of periods. By arbitrary definition, menopause is defined as 12 consecutive months without a spontaneous period. That is completely arbitrary. There’s nothing in nature that points to that as anything other than that it’s part of the process.  Part of the reason I wanted to do three stages, I can’t get rid of the word menopause. That’s stuck. In medicine, we’ve tried to change words. The old word is just added to the new word, and everyone falls back to the old word, because that’s what we feel comfortable with. So I’m not going to abolish the word menopause, so I have to work within that context.  To try to show menopause as what it is, it’s ovarian senescence, and it’s an evolving process. That’s why I, somewhat arbitrarily, created the three stages of menopause, so that people would see that there’s the prelude to this arbitrary definition, and then there’s the first decade. I put the first part of menopause, after the pre-menopause is 10 years because-

Dr. Weitz:            Maybe you should come out with two versions of the book, and call one Ovarian Senescence, and call one Menopause, and see which gets the most attention.

Dr. Gersh:           Okay. You know what? That’s an idea. I’m going to hire you, marketer.  We have to stop thinking of menopause as, you cross a finish line and you’re there. The event has happened and I made it, and I’m still alive!  But to view it as what it is. Of course, aging, people always talk about the minute you’re born, you’re aging. But the bottom line is that there’s certain things that, we’ll say accelerate the negatives of aging, or the process of menopause. We need to understand this if we’re going to actually put into place some pragmatic ways of approaching it. Just because it’s natural, doesn’t mean we ignore it or embrace it. In fact, everything in medicine is about recognizing things that may be natural, but are negatives, and then doing things that are completely unnatural to try to get people back to that state of homeostasis.  Everything that is medicine, even going back to the days of a tribe, where you had the person who was in charge of healthcare in a tribe, they were incorporating natural things. I’ll call it green medicine. They were looking for plants that could reverse a fever, or a pain, or something.  So, everything is about harnessing whatever tools we have to reverse something that’s happening, that we don’t view as a positive, like all the stages of menopause, and all the symptoms I put in there, that people will often experience, and what we can do about it, and recognizing, really. The takeaway that’s so essential from the get-go is that menopause is not a one time event, and that it’s an ongoing process, and that it’s a gradual process involving the declining function of the ovaries, which actually does parallel the declining state of fertility. That’s not an accident.

Dr. Weitz:            Right.

Dr. Gersh:           Once you also, I keep telling people this, and I want it to really come home to roost. Every process in the female body is designed to support fertility. We don’t like to think of, our bodies are designed just to procreate. We just need to recognize that we, as humans, are so unique in that we actually try to determine our reproductive destiny. Whereas, no other creature on this planet says, “This is not a good year to have a baby.” That is just not happening. Or, “I think I’ll go on birth control for the next 20 years.” That doesn’t happen. We do that to our pets when we castrate them, but nothing happens naturally in nature that involves trying to control reproductive function.  Since the prime directive of life is what it is, it’s the most amazing thing of life. Remember, I’ve delivered thousands of babies and it never ceased to astound me that this is actually happening; a baby was coming out of another person. It’s like, “Wow. This is amazing.” That is really the prime directive of life, so every system in the female body is really designed to help to have a successful reproductive status, and have healthy babies, and do it multiple times.

Pregnancy is such a stress test of women. It’s such a challenge, too, with altering the cardiovascular system, and changing the immune system. All these systems in the body are so amazing. I say that the hormones; estrogen, progesterone; they are really the glue that glues all of these different functions in the body involving metabolic functions, cardiovascular, immune functions, everything in the body to the reproductive functions. In fact, all of the different enzymes, pathways, are actually reproduced in the reproductive tissues that are out there in the peripheral tissues.  So, it’s a sink or swim together body. That’s the takeaway. When you lose reproductive functions, when you go through this dynamic change and your ovaries are no longer going to be ovulating, putting out the eggs, you really can’t have babies anymore; all the systems in the body have this profound change that occurs in them because of the loss of this vital force in the female body, which are these beautiful rhythmic hormones.  We need to recognize that, and be honest about it, and then decide, “Okay, what are we going to do about it?” That’s really my mission is really to first educate, because you’ll never solve a problem if you don’t first define the problem. The problem, I call it natural but I call it a problem for women, that menopause is a problem. If you cannot define that problem, I can consider a premature death as a problem, too.  So, if you define a problem, then you can come up with viable solutions to that problem. But if no one even understands what is menopause, what is happening, what are the implications, then clearly, we’ll never have any viable solutions. That’s not going to help women everywhere.

Dr. Weitz:            So how do we know a woman is in perimenopause?

Dr. Gersh:           There is actually no test. It’s a clinical. We do have clinical. I can’t believe this, but I am actually a very old fashioned doctor. I observe. I take a history. I do an exam.  We know, 100%, since 100% of women are going to go through menopause, that at a certain age, it’s going to be a process of ovarian decline and fertility decline. Women will manifest the symptoms quite differently. There’s really a huge range. But every woman, once she hits the age of 40, is definitely going to be having serious fertility changes and serious changes in her hormonal production.  Now, we can do certain tests. I say there aren’t any, but you could do a menstrual mapping. It’s very interesting because I’ve done a lot of those tests. That’s not really mainstream at all. But if you take a woman, and what’s very classic for women as they are in the last decade before the end of cycles, we’ll call it, they will often have changes in their menstrual cycles, but they’re still having them.

So often, the cycle will become shorter. So then you think, “Okay, why is the cycle getting shorter? What’s happening?” If you do a menstrual mapping, then what you will often find is a shorter luteal phase. What happens is, the estrogen spike that proceeds ovulation is dampened down. Then you’ll see a dampened progesterone response.  So, the progesterone should have this nice, rounded little mountain, like a hill. Then instead of being like that, it’ll often be like this. It’ll have a little spike and then it comes down. You’ll actually see that the progesterone is produced in a lower amount, and also in a shorter period of time.  Of course, we know, everyone should know that progesterone is essential for the establishment of a pregnancy. That’s why in IVF clinics, they’re always giving progesterone to everyone for the first three months or so, because progesterone is essential for proper implantation. It works with the endocannabinoid system, so it’s all complex. If you don’t make an adequate amount of progesterone for a long enough period of time, and then allow the placenta to take over and so forth, then you’re going to have a miscarriage. Miscarriages are much higher in their incidents in women who are older, in their 40s and such.  The bottom line is that there’s not a test. You could do things like FSH-

Dr. Weitz:            By the way, on the cycle mapping, just for those listening who don’t know what that is. Can you just explain what cycle mapping is?

Dr. Gersh:           Sure. It’s a wonderful test that can help with many diagnosis, like is a woman having an inadequate spike of estrogen, or LH spike and they’re having fertility problems, they’re having PMS, and so on. What it looks at is through urine, by measuring urine multiple times during a cycle, you actually get a mapping.  So, if you’ve seen a menstrual cycle that’s been graphed out over 28 days, you see the estradiol, and it goes up, and then you have the big spike, and then it comes down, it dips and then it comes up. Then, if you’re not pregnant, it goes down. Then you see the LH, and it will have a big spike right after the estradiol spike, and then you see the progesterone coming up right after ovulation. Then, if you’re not pregnant, it goes down.  All of this gets mapped out on your graph. Then you get to compare it to an ideal one. Then you can see, “Oh, my gosh.” Now, it’s only telling you that one cycle, but hopefully, it’s a classic, typical cycle for that particular woman at that stage of life. What you can see is her estrogen, and the estradiol level is not right. Or you see the LH may be hovering too high because she’s perimenopausal and she has too much LH. Then we also see the progesterone, which often will be inadequate in its quantity and duration.  So, you can really help, a woman has PMS. Then you say, “Oh, yeah. Her progesterone level, or her estradiol level is totally inadequate.” Then we can, instead of just randomly giving people hormones and saying, “Here, I’ll just give you this hormone and see.” No, it’s a much more scientific approach to actually measuring, and then treating, and then seeing, monitoring for the effect.

Dr. Gersh:           So, I love to be evidence based. I hate to just be throwing hormones at people, which is done too often.

Dr. Weitz:            This cycle mapping is available through Precision Analytical. It’s part of their suite of DUTCH Labs, and also through ZRT. This is the kind of test that you might get from a functional medicine practitioner, gynecologist like yourself, which is not, you’re not going to get this from a conventional medical gynecologist, or hormone specialist.

Dr. Gersh:           No. It’s really, actually when you realize what you’re getting, and how valuable this information is, and how completely off the grid it is for the standard OB/GYN, it’s really sad.  So for those of you out there, this is very easy to interpret, and the labs will also help you to interpret them. They give a lot of examples. It’s really fascinating because I have found that so many women who have even regular cycles, when you look at their hormone production, it’s really not optimal at all. It’s very interesting when you see perimenopause and you see where, sometimes, they’ll have an overshoot of estradiol, and you have a really high sustained LH.  So these are really interesting. These are not standard, run of the mill kinds of approaches. Because in the standard, conventional world, they do not do anything for perimenopause. They don’t even really recognize perimenopause. They just mostly, I hate to say this, but they put women, very frequently, on SSRIs. That’s the go-to. Really, it is, because women are having a lot of symptoms and they always say, “Ugh, another crazy woman.” Then, “Why don’t you just go on some Prozac or Lexapro?”  This is standard of care, which is really frightening because that is not addressing, we talk about root cause. That is not the root cause.

Dr. Weitz:            Unfortunately, it’s part of a small bucket of drugs that are used for conditions where they don’t know how else to treat. So, SSRIs are used for perimenopause. They’re used for irritable bowel syndrome. They’re used for, sometimes chronic pain patients. When you don’t know what else to do, try an SSRI, or try a PPI, or try an NSAID.

Dr. Gersh:           Right. When you know that these hormones are very involved in every organ system, including the brain. They’re involved with both cognition and with mood. Now it’s been published that the majority of women, as they are going through the perimenopause, in their 40s, they will have mood swings, sleeping disorder, and also some brain fog.  So, the go-to is traditionally to go on an SSRI. Upwards of 25% of American women in their 40s are now being prescribed an SSRI. That gets back to my, let’s define the problem so we can get a better solution than that. Because SSRIs, I’m not-

Dr. Weitz:            By the way, these drugs are not benign. They’re very difficult to get off of.

Dr. Gersh:           Very.

Dr. Weitz:            We’re manipulating brain chemistry in a very narrow way. We really don’t have much of a clue as to what we’re doing.

Dr. Gersh:           It’s really interesting because during the perimenopause is when bone loss is actually accelerated. It’s not really well recognized because you don’t have the fractures, but you have that accelerated bone loss as the hormones are going down.  SSRIs increase the risk of osteoporosis, so I call these the crazy maker drugs. There’s a ton of them. They actually promote the very problems in this specific demographic that we’re trying to avoid. Then we go on a drug that actually promotes the very condition that we ultimately are trying not to have.


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

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



Dr. Weitz:            Let’s talk about some of the lifestyle factors and/or nutritional nutraceuticals that can help manage a woman with perimenopause.

Dr. Gersh:           I love phytoestrogen. Now, poor phytoestrogens have also gotten a bad rap, because people don’t understand them, and they think that somehow they promote all kinds of disease, when they actually are quite the opposite.

Dr. Weitz:            Like breast cancer.

Dr. Gersh:           Yeah. No, they’re actually not. If you eat organic whole soy, you’re not promoting breast cancer. It’s actually, these are actually agonist for the beta.  Now, we recognize plants are not estrogen. It’s a miracle of nature that certain plants can actually bind to our own receptors. We know cannabis binds to our endocannabinoid receptors. So, we have this miracle of nature where plants combine to our own receptors for our own benefit. There are a whole group of different types of plants. We can do plant extracts, as well, and utilize them for helping to maintain gut health.  There was actually a very interesting study that came out, maybe three to four months ago that showed that if you had an organic, soy based diet; a cup of organic soy like tofu or edamame; every day, that by the end of 12 weeks, hot flashes, night sweats, and sleep problems, which are so prevalent in this transitional time. Of course, it can go on for almost 20 more years. It can go on for a very long time, that something like close to 90% resolution of these symptoms, just by including these phytoestrogen foods.  Which is amazing, really, because they bind to the beta receptors. Estradiol has at least three receptors and variants now. There’s offshoot receptors, but the primary receptors are alpha, beta, and a membrane receptor. They have prevalence throughout the body, but in different proportions. They have different effects and they actually up and down regulate each other. They’re very interactive.

It turns out that certain foods like soy and flax seed predominantly bind to beta receptors. Beta receptors are in the cerebrum of the brain. So, it helps with that type of function, and as well, the gut lining cells are mostly beta. So, it helps with gut.  Now, unfortunately, the bone is more alpha, so it hasn’t been shown to improve bone health. It’s not a panacea. It’s not a panacea, and it’s not like having estradiol, but these are ways of harnessing nature’s gifts to us, to help us to feel better, sleep better, and all of those things are going to improve quality of life dramatically.  So, I recommend including organic, of course, if you have a food sensitivity, there are people that can’t eat some of the healthiest foods on the planet because of leaky gut and how their bodies have modified their ability to deal with them. But assuming you don’t have that problem, and you can do elimination diets and check it out, but assuming you don’t have a problem, and you can eat organic, whole, unprocessed soy, or minimally processed, like tofu, and include that on a regular basis, along with a couple of tablespoons of flax seed, that alone can have dramatic effects.  In terms of supplements, you can harness the Siberian rhubarb. The root of that plant is also a phytoestrogen that is all beta. That’s been well tested.

Dr. Weitz:            Let me just clarify for some that don’t understand. Phytoestrogen stands for plant estrogen. So, these foods like flax and soy contain these plant compounds that are very similar to the estrogen that’s in your body, and attach to those estrogen receptor sites.  Then the question is, do they have negative effects? Could they increase the risk of breast cancer, or some of the negative effects that can happen? Or are they more likely to have positive effects?  A lot of the data seems to show that most of their effects are very positive, that in some ways, they block out some of the toxic estrogens that are found from toxins in the environment, like pesticides and all these other chemicals. So, you’d much rather have phytoestrogens attached to your estrogen receptor sites than estrogenic substances coming from petrochemicals, or pesticides, or et cetera.

Dr. Gersh:           Yeah, plastics, right. Absolutely.  These, if you look at the chemical structure, a little bit of the molecule is similar enough that it can actually bind and have a positive effect. Then there are other foods that can also have that people don’t even realize, like pomegranates, which have been called a superfood, and people don’t realize that from pomegranates, you get urolithins. Urolithins are the breakdown from the different polyphenols; the aegisic acid and so on. These actually can also be phytoestrogen effects.  So, many of the foods that are called superfoods, when you actually find out about it, they’re actually phytoestrogens. So many so called superfoods actually do bind to estrogen receptors because, of course, men, I always say, should love estrogen, too. They have tons of estrogen in their body. They just make it locally, on site, in the different organs, from their testosterone. Because all estradiol is derived from testosterone. Men just do it on site. Women make it in their ovaries and then disperse it. Of course, we have different quantities, different ratios.  But in the end, these foods can also be beneficial. Breast cancer, by the way, is virtually always, when it says estrogen receptor positive, it’s working on the alpha receptor. Like soy, flax seed, they’re beta receptor. They’re more like estriol. They actually, we know that when you have a lot of beta receptor stimulation, it actually down regulates alpha. It’s an interesting thing.

So, it’s a little bit like taking raloxifine or tamoxifen, but better. These are drugs that have other interesting but not desirable side effects. It’s nature’s own way of giving these drugs that are actually marketed, like raloxifine, which is also called a SERM. The name SERM is not supposed to be used anymore, but like I said, nobody ever gets rid of the old words.  So, that stands for selective estrogen receptor modulator. But now you’re supposed to say estrogen agonist/antagonist. It means that depending on the location and the receptor, it either acts as a pro or a con. It stimulates or it blocks. So, that’s the new word, but we always say SERM anyway.  So, this is a drug, a pharmaceutical, raloxifene, and the brand name is Evista, that has an FDA approval for bone health, and to help reduce fractures of the vertebra, not of the hip. They haven’t shown hip. But in terms of breast cancer, it’s considered a prophylactic preventative, to help reduce the risk of breast cancer.  Well, duh. You could eat food and then you get all the other benefits of food, but those are natural ways of creating a similar effect to this pharmaceutical. So, I say go for the food.

Dr. Weitz:            What about topping off the benefits of the food by taking, say, genistein or diadzen supplements as well?

Dr. Gersh:           So, in terms of the isoflavone concentrates, I wish that the data was more robust in terms of its benefits. It hasn’t been as good as I would like. I don’t know of any real harm, but for those particular isolates of the isoflavones, you do better by eating the whole food.  So, I don’t actually push for those isolates. In terms of others, there’s been some extracts from what are called lignans, which are also phytoestrogen. Also, as I mentioned, the root of the Siberian rhubarb plant. That seems so arbitrary, but they figured that one out.  You’ve probably heard of black cohosh. Now, black cohosh has also not quite panned out as well as we had hoped. So, they’re just not really nature’s gift to the world as much as we’d hoped. So, I don’t really use a whole lot of black cohosh. I do use some of the others; the lignans, and I do use the Siberian rhubarb root. Then I use food. Of course, as an MD, I do use hormones.  That’s another thing that is not really recognized, that you can give a little bit of bioidentical estrogen, even to women who are cycling. That’s where, if you do the menstrual map, and you see that their estradiol levels are really sub-par, but it’s a crazy time, also mentioning the perimenopause, because there’s a lot of overshoot. That’s the one time when you can have actual estradiol dominance.  People always throw this term around, of estrogen dominance. I’m trying to get rid of it because people think of it as estradiol is evil, and that’s not what estrogen dominance is about. It’s about poor detoxification, endocrine disruptors. It’s not about, the ovaries are making too much estradiol. That’s not what it is about.  Except in one case, and that is when a woman is perimenopause, and she ends up having too little estrogen. The brain, which has a censor says, “Oh, there’s not enough estrogen being produced from the ovaries, so I will tell the pituitary gland to make more of its gonadotropins, LH and FSH, to then trigger the ovary to make more estrogen.”  Well, unfortunately, the ovary is now less responsive because it’s running out of eggs and it doesn’t really make the hormones as well. So, the gonadotropins, LH and FSH, are produced in higher quantities. When you still have some reserve, the ovaries are not completely done for yet, then you have this giant surge of LH and FSH. You can get a giant surge of estradiol, and you can also get multiple eggs coming out.  That’s why women in their 40s have the highest incidents of fraternal twins of any time in a woman’s life because they’re getting hyper stimmed. It’s like what they do when they’re trying to help women get pregnant, like in fertility patients. They give these medications to try to get them to ovulate. Then, sometimes, oops, now we’ve got too many.

Now, in the ancient days, they weren’t so careful and then people had octomoms, they got so many eggs out.  Now sometimes they’ll get twins. They’re very careful. They’ll just abort the cycle if there’s too high of a level. But in nature, nature can do that, and then you get twins. It’s like, “Oh, my gosh. I thought I was not even fertile anymore and now I’m pregnant with twins.”  That happens when someone’s 44. That actually can happen.  But women, because they’re going through this, I call it a roller coaster, where their estrogen is too low. Then they have this giant overshoot of gonadotropins, and suddenly their estrogen level is, I’ve measured sometimes, it’ll come out … A typical level for a woman would be around 100 or so, for picograms of estradiol. Then I’ll get a level of 800. It’s like, “Oh, my God!”  So, this can trigger horrendous migraines, and sleep problems, and mood swings, and breast tenderness. Suddenly they get really, really heavy periods.  You can just imagine how much uterine lining is made by all that estrogen.  Sometimes, if you give a little background, a little bit of estradiol, it’ll keep the brain from creating that giant overshoot of gonadotropins.  So it’s like, if you give a baseline of estradiol, the brain won’t create this roller coaster effect.  Sometimes that can really be a saving grace as women are going through this really challenging time because the conventional world puts them all on birth control pills.  I can tell you that.  But that has its own set of issues, as well.  So, we try to do it and let women still have real hormones, their own natural hormones. But we’re trying to tame the monster here a little bit, during that time when they can have this crazy overshoot.

Dr. Weitz:            Let’s go through some of the symptoms of perimenopause. I want to say, looking at the time, I don’t see how we’re going to get through all three stages because we’re still on stage one, but that’s okay. Let’s do a good job with what we’re doing.

Dr. Gersh:           Oh, they’ll have to read the book!

Dr. Weitz:            Exactly. Exactly.  So, you mentioned breast pain/mastalgia, and that’s often common in perimenopause. Why is that and what can we do about that?

Dr. Gersh:           Well, that’s because of this overshoot, often, of the estrogen. So, the best thing that you can do for that is to have a little bit of patience, and often to take a little bit of, I recommend a little bit of iodine can be helpful. Sometimes that’s a sign. We have massive iodine deficiency, so a little bit of iodine can be helpful. But a lot of patients can be really going-

Dr. Weitz:            When you say a little bit of iodine, you mean 100, 200 micrograms?

Dr. Gersh:           Yes. Yes. Always less than one milligram. So yeah, around 200 micrograms. I am not into massive dosing whatsoever.  Then you can do things that reduce inflammation because remember, pain is always inflammation. You can take some of the anti-inflammatory, herbals is very helpful.

Dr. Weitz:            I take curcumin or fish oil.

Dr. Gersh:           Yes. I love all of those things. Then having the anti inflammatory lifestyle. Really, it’s so important for women to know that this is just a stage, and that it’s not associated with breast cancer. Sometimes reassurance is the best medicine, rather than going on pharmaceuticals for something like that.

Dr. Weitz:            What about if the balance of the estrogen and progesterone is tipping, that the progesterone is starting to go lower, and maybe getting these spikes of estrogen? What about using something like chaste berry to help the body produce more progesterone?

Dr. Gersh:           Yes, absolutely. Chaste tree, also for the Latin name, vitex, is often referred to as the women’s herb. It has actually reasonable data that has been accumulated, showing that it can help with PMS and breast tenderness. Those are really key problems that often go together, actually, because it’s a hormonal imbalance. So yes, chaste tree, vitex is a very, very useful herbal for treating breast tenderness.

Dr. Weitz:            What dosage for that do you like?

Dr. Gersh:           Usually about 200 is a very good dose. For taking it, I always recommend just take the whole dose in the morning, just as a morning dose.


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Dr. Weitz:            So, fibromyalgia. That’s a not quite fully understood condition, seems to be fairly prevalent. Patients get pain throughout their body, up and down their spinal cord. How is this related to perimenopause and how frequently is this seen?

Dr. Gersh:           It’s seen all too often and it’s primarily in females. That’s why it’s been swept under the rug quite a bit, and treated a lot with Prozac in the past, and still treated with Cymbalta, which is duloxetine, which is in the SSRI/SNRI family. It’s interesting because some of the same centers in the brain that deal with pain response also deal with mood response.  So, in terms of pharmaceuticals, some of the drugs that are used are gabapentin. But we can do a lot without turning to the pharmaceuticals. So, understanding that there is a strong relationship to hormones. All of the hormones have a lot to do with balancing our endocannabinoid system and our opioids or natural endorphins. It turns out that these hormones are very involved, all of them; progesterone, testosterone, estradiol; in terms of the relationship of these different other systems of the body.  We have all these different interesting systems involving signaling agents. We have the peptides, and we have the fatty acids, which are involved with the endogenous opioid system, and the endorphins. We need to have proper hormones for transporting these molecules into the brain, for having them function properly in the brain, for balancing all of this.  We now know that, although fibromyalgia doesn’t typically have systemic inflammatory markers present, that they can actually be in the spinal cord. It still comes back to pain is inflammation and it’s going on in the central nervous system.

So, we still need a lot of research on fibromyalgia, but a lot of mind/body medicine can be helpful. Trying some balancing hormones, I find is actually very beneficial. Sometimes gentle body work, but not heavy, not pushing too hard. But gentle body work, lymphatic massage, mind/body medicine, and sometimes, short-term, some of the pharmaceuticals, and once again, all of the anti-inflammatory herbals. It’s amazing how we now know that without adequate vitamin D, you’re going to have more pain. Omega 3, you’re going to have more pain. We know that people have, often, very bad diets that are lacking in the antioxidants, the polyphenols.  So, just getting on a diet that is plant based, filled with different colorful vegetables, fruits, and proper fiber, because I’m sure there’s, we’d need more research, but there’s always a relationship to the gut microbiome. So, anything we can do to improve the gut microbiome, have proper short chain fatty acids like butyrate, that’s going to affect the brain.  So, we definitely have to work with lifestyle, mind/body medicine, and gentle exercise like stretching and yoga can be incredibly beneficial.

Dr. Weitz:            Some of the data seems to indicate that fibromyalgia is related to mitochondrial function.

Dr. Gersh:           Estrogen is also the under recognized, because a lot of people talk about aging is related to mitochondrial decline. Estradiol is essential for every single function that is involved with the production of energy in mitochondria.  Also, not just a production of energy. Most people in the functional medicine world know that when you produce energy through [inaudible 00:45:15], you’re also creating oxidative stress, like with superoxide. It turns out that estradiol actually is key to regulation of this very essential enzyme, superoxide dismutase, which helps to detoxify this toxic oxidative stress molecule, the superoxide. So, without that, you then have destruction of the cell and of the mitochondria.  The bottom line is that estradiol comes back to yes, you need estradiol to manage your healthy, functional mitochondria. Absolutely mitochondria, or the energy producing factories. If you don’t make energy, you’re not alive. In fact, everyone knows, if you flat line, that means you’re not alive. You need energy. That’s the spark of life. Estradiol is like the spark of life, by helping mitochondria to make that critical energy.

Dr. Weitz:            Certain minerals, zinc, coper, and manganese are precursors for SOD, so those should probably be included there.

Dr. Gersh:           Right. That’s why so many people have essential deficiencies of these key, I always say you can’t work the machinery of yourselves if you don’t have the right nutrients. That’s why everyone who comes in, and weight gain, we’ll have to come back after, but in terms of the gaining of the weight and the fat redistribution, which is so distressing to women. We know that this can also be very much related to declining estradiol levels, but we can do so much about that. Not just taking hormones, which is part of the equation, but doing proper stress management. There’s nothing that contributes to belly fat more than high phonic levels of cortisol. We’ve got to work on our stress and our sleep. Exercise revs up mitochondrial function. We know that you can have mitogenesis just by having great exercise.

So we have to work with what we have. I say, that’s why I dislike to the bottom of my heart, centers that are just hormone distributing centers. I’m not going to compare it to opioid distributing centers, which exist, where people would come in and get their dose of an opioid every month.  But just giving out hormones is offering false hope because hormones are just a piece of what makes women healthy or men healthy. You can’t just give hormones and expect that’s it. No. You have to do all these other things. You need to have stress reduction, sleep, and so on. Because this belly fat thing is so harmful to women’s self-esteem. Of course, it’s a metabolic poison and creates that chronic state of inflammation, creating that well known term, “inflammaging.”

Dr. Weitz:            Yeah, this whole concept of fat loss, and why different people gain fat in different areas; whether it be more in the abdominal region, more in the hips, more in the back, et cetera; it really hasn’t been studied that much. We know it’s related to these different hormonal balances.  I remember the late Charles Poliquin, who was not a medical doctor, but a very interesting practitioner of exercise and recommendations about nutrition. He would have these categories for, this is an insulin dominant person, this is cortisol, based on where their fat was distributed. That’s something I think really should be given some more attention and study.

Dr. Gersh:           Oh, absolutely. We’re always challenged, as you brought up earlier, with these ubiquitous endocrine disruptors that are really metabolic poisons. Then, when you don’t have your proper production of hormones, then what becomes the dominant hormone, if you can call it [inaudible 00:49:29] information.  So, once you recognize hormones are really the language of the body. There is multiple different languages, but these are the main language. They tell the cell what to do. They’re giving instructions. If you get endocrine disruptors, then you’re going to get the wrong instructions, and the cell will do the wrong thing; make the wrong protein, for example. If you have no information, then the cell goes into a default state, which is pro-inflammatory. The whole body goes into this default state of pro-inflammation.  It’s really interesting when you see estradiol as operating the switch. I think of it as a switch that turns the body from pro- or anti-inflammatory, back and forth. That’s why estradiol is an immune system modulator. That’s why it can be so confusing to people. It’s like, estrogen causes inflammation. Estrogen is anti-inflammation. It’s both because it’s modulating the immune cells.

So, that’s why when you get a pathogen that tries to get into your body, it’s estrogen in the form of estradiol that triggers the [inaudible 00:50:40] to become activated and the mass cells to become activated. So it basically revs up your innate immune system. Then later, it also triggers the production of antibodies, but then it dampens down. It flips the switch so that you go back into the homeostatic state where you have an anti-inflammatory state.  So, estradiol, when you have proper production, it modulates this entire immune system response. Which of course, is also activated if you have damaged tissue. Then, when you don’t have it present, you end up getting into this default system where you end up in a chronic state of pro-inflammation. That leads down the path to all the other things that happen in the other stages of menopause, like hypertension, and heart disease, and then really the fractures, and the disintegration of your joints, and then having the osteoarthritis.  So, all of these things stem from, really, loss of this modulation of the immune system that regulates how you’re either pro- or anti-inflammatory.

Dr. Weitz:            It’s hard to get my head around exactly how it affects immunity because we know that women tend to have stronger immunity prior to menopause. Yet, after menopause, they seem to have increased autoimmunity. So, if the estradiol is so crucial for immunity, and then the estradiol drops after menopause, shouldn’t they have less autoimmunity rather than more?

Dr. Gersh:           It’s interesting because it depends on, there’s different types of cytokines and the different immune cells, but every immune cell in the body has estrogen receptors. The dominant receptor on the cells that make antibodies is the beta receptor. The dominant receptor on the innate immune cells that make the inflammatory cytokines are predominantly alpha.  So, you have this balance between this whole immune system that is then lost. When you don’t have enough estrogen, and this has been shown, the innate immune cells will release their inflammatory cytokines at a lower threshold of stimulus. So, you get altered gut microbiome. This has been now shown. When you lose your estrogen, the microbes in the gut transform into a different set of population. Then you lose your protective mucus coating and you have the impaired gut barrier, or leaky gut.

As these endotoxins, the lipopolysaccharides cross between the lining cells into the gut associated lymphoid tissue where 70%, 80% of the immune system resides around the gut. These innate immune cells are triggered through the toll like receptors that activate them, that the little [inaudible 00:53:42] cells, they put their little fingers into the gut, and they communicate, they all line up.  Then you have this explosion of production of inflammatory cytokines. But as well, you have the connection between these innate immune cells and the lymphocytes that are in the peyer’s patches. These are segregations of lymphocytes that make antibodies that are embedded in the gut associated lymphoid tissue, and they make antibodies, and they communicate through these different types of toll-like receptors. So, they are then triggered into making antibodies.

When you lose estrogen, you actually lose a lot of your control over all these incredibly, critically important and very complex functioning immune cells, so you end up with that situation. We know, for example, when you’re exposed to a lot of endocrine disruptors, and I was trained in environmental medicine under Dr. Walter Crinnion, who I just miss every day. He’s an amazing pioneer in environmental medicine.  Basically, his foundational tenant of life is, most problems are due to pollution, and what is altering the ways our bodies are functioning, because we’re getting all these ridiculous toxic chemicals into our bodies, and that most of the auto-immunity that people are now facing in younger years is because these are endocrine disruptors that are interfering with the normal signaling.  So then, that promotes early onset, like Hashimoto’s, which is epidemic, and also lupus, and multiple sclerosis and such in younger people. Then in older women, rheumatoid arthritis becomes really prevalent. Of course, you can have endocrine disruptors that are contributing, but it’s really the loss of the control of the immune system’s homeostatic mechanisms, by loss of the estrogen.

Then the immune system goes into this crazy state of producing lots of inflammatory cytokines, and then communicating with the lymphocytes to make these antibodies. That’s why we now know that these autoimmune diseases, like rheumatoid arthritis are not just associated with joint damage, and motor disabilities, and pain, but also with cardiovascular risk. That because you have a systemic state of inflammation.  So, it’s affecting the immune system on multiple levels. That’s why you really want to be proactive, because we want to be helping women with both diet, lifestyle, and hormones, so that they don’t get rheumatoid arthritis, which is really incredibly prevalent, and really harmful in a myriad of ways. That tends to show up down in the later phases. But the precursors are happening in the perimenopausal years, when the immune system is starting to get this hit of lack of hormones.  Then of course, the immune system is everywhere, including in the brain. So women who have loss of the hormones have a much higher rate, and this sounds so politically incorrect, but I have to tell the truth. Women have two times the incidents of Alzheimer’s as men. It’s not an accident. It’s because their immune cells in the brain, which are these specialized macrophages called microglea, when they don’t have the proper estradiol to regulate their function, they too, go into this default state, like weapons of mass destruction. They produce enzymes. All these immune cells, these macrophages, produce enzymes that are designed to dissolve pathogens and damaged tissue and then gobble it up.  That’s our cleanup crew, our damage control mechanism. But what happens when they can produce and release these dissolving enzymes for no good reason. Then they dissolve our brain. That’s when the brain tries to have a healing mechanism. Then it produces the beta-amyloid. That’s why getting rid of the beta-amyloid doesn’t prevent Alzheimer’s, as I wished, because it’s a response to these out of control microglea, these immune cells that are producing all of this inflammatory response.  But this is what’s happening elsewhere. That’s what’s happening in our arteries. It’s a similar thing that’s happening in different organ systems. That’s why I love talking to you, to get the word out, because these are not in-solvable problems. Because it sounds so terrible, the future is so grim. But we can actually do so much to work out all of these issues.

Dr. Weitz:            But it’s going to take a lifestyle program. It’s going to take more of an Integrative, Functional Medicine approach, and there’s not going to be one drug that’s going to solve it.

Dr. Gersh:           No, including hormones.

Dr. Weitz:            We’re going to have to wrap here. I was worried about getting through the three stages of menopause, but we didn’t get halfway through the first stage.  Buy Dr. Gersh’s book.

Dr. Gersh:           Well, now really, to give a slight plug, it’s not a book that you have to read from beginning to end. It’s like a little compendium, like a little mini encyclopedia. You can just pick out, one of my favorites because I see women all day long, and they look in the mirror because that’s what we do. We say, “What’s happening to my lips? Why are they getting so thin?”  This way you can say, “I don’t know why my lips are getting thin.” You can look it up in the book. Or, “Why am I getting breast tenderness,” like you said or, “What’s happening to my bones?” You can pick up any topic you want and look up the stage of menopause and what’s happening with that particular symptom, and why it’s happening, and then what you can do about it.  So, you don’t have to sit down and read it cover to cover. It’s a reference book.

Dr. Weitz:           Thank you, Dr. Gersh. How can listeners and viewers get a hold of you? Where can they buy the book?

Dr. Gersh:           It’s on Amazon. I’m actually in one of my exam rooms, so you can find me in my office pretty much every day.

Dr. Weitz:           Is the book available on other booksellers?

Dr. Gersh:           It should be, but right now, as you probably know, there’s a supply chain problem. I think they’re actually having trouble printing books. Isn’t that amazing?  So right now, it’s just on Amazon, because it’s just hard to get printers to print books. So we’re just limiting it to Amazon for right now. That’s what the publisher said anyway. I go with what they tell me.  My office is in Irvine, sunny southern, usually sunny. It’s a little cloudy today. We need some rain anyway. Southern California. I can do some telemedicine. I can do telemedicine throughout all of California. For people in other states, now that things are changing, I do have to see people once a year in person. Unfortunately, that’s the crazy laws that we have. But I can do other stuff remotely and usually we can manage, because it’s a great place to have a vacation to.

Dr. Weitz:            There you go. Thank you, Dr. Gersh.



Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness podcast. If you enjoyed this podcast, please go to Apple Podcast and give us a five star rating and review. That way, more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts.

I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So, if you’re interested, please call my office. (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.



Essential Oils with Dr. Eric Zielinski: Rational Wellness Podcast 238

Dr. Eric Zielinski discusses Essential Oils 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

2:43  Essential oils are neither essential, nor are they oils. Essential oils are volatile organic compounds that contain the essence of the flavor and aroma of plants.  They are volatile in the sense that they readily evaporate at ambient room temperature, which is in contrast to chemical air fresheners like Febreze, which you can smell 100 feet away 10 minutes later. 

12:53  Artificial fragrances are killing people every day and they are extremely common.  They are found as fake smells in every public restroom.  They are very strong if walk into a Bed, Bath, and Beyond or a Bath and Bodyworks store or if you go down the cleaning aisle in Walmart.  ((% of us are born in a sterile hospital environment and we go home with all these fake smells from Mama’s perfume to the smells on their clothes and their blanket.  What does that do to our sense of smell, to our brain. You wonder why autism and learning disabilities and dementia and Alzheimer’s are on the rise?  We’re causing brain inflammation.  This is why we should surround ourselves with essential oils instead of with fake smells.

16:52  Essential oils differ from herbal medicines in their much higher concentration.  No herbal supplement can compare to the therapeutic efficacy of essential oils due to their incredible concentration.  One or two drops of cinnamon essential oil are equivalent to two to three teaspoons of cinnamon bark powder at balancing blood sugar.

30:28  Sleep. Lavender is a good essential oil for sleep.  Vetiver and Roman Chamomile are also very effective, though a little pricey.  Geranium and clary sage are both good. You can also use the tree oils like pine, frankincense, sandalwood, and cedarwood. 

34:08  Essential oils for dementia and Alzheimer’s disease.  Dr. Zielinski wrote in his book that hand sanitizer contains chemicals that might damage your microbiome and might increase the risk of brain inflammation and of dementia.  Also, between the VOCs often emitted by your carpets and all the artificial fragrances and aerosols people have in their homes, when they spend so much time in their homes because of working at home and stay at home orders due to the pandemic, we are subjecting ourselves to a huge toxic burden.  Rosemary is an essential oil that is the herb of remembrance, so it can help with memory.  Cinnamaldehyde, which is the primary component of cinnamon bark is a natural acetycholinesterase  inhibitor, so it can help with Alzheimer’s disease.  And of course, cinnamon can help with blood sugar balancing. Basil also has similar activity.  Other essential oils with acetycholinesterase inhibitor activity include sage, thyme, lemon balm, also known as melisma, lavender, and bergamot.  Clove oil is a natural blood thinner as well as some of the highest antioxidant activity.


Dr. Eric Zielinski is a Doctor of Chiropractic, a natural health guru, and a best-selling author with his wife, Sabrina Ann Zielinski. Dr. Zielinski is the author of The Healing Power of Essential Oils, which has sold over 200,000 copies and he has a new book, The Essential Oils Apothecary.

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


Podcast Transcript

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

Today, we’re going to have an interview with Dr. Eric Zielinski on essential oils. And my goals for the podcast episode today are to learn a bit more about what essential oils are and how they can be used in the treatment of specific chronic diseases, like sleep disorders, Alzheimer’s, diabetes, osteoporosis, heart disease and even cancer, among others.  As Dr. Zielinski points out in his new book, The Essential Oils Apothecary, soothing remedies of anxiety, pain, high blood, sugar, hypertension and other chronic conditions, essential oils are neither essential nor oils. They are actually volatile organic compounds and they’re the components of the plant that are released into the air when you smell, say, lavender. But they are oil soluble compounds so they’re used in a carrier oil like olive oil. But we’ll ask Dr. Zielinski to explain more how essential oils are made and work and how they’re different than herbal supplements.

Our guest today is Dr. Eric Zielinski, who is a doctor of chiropractic, a natural health guru and a bestselling author with his wife, Sabrina Ann Zielinski. Dr. Zielinski is the author of The Healing Power of Essential Oils, which has sold over 200,000 copies.  Dr. Zielinski, thank you so much for joining us today.

Dr. Zielinski:                        Well, Dr. Ben, thanks for having me. I got to say I have big shoes to fill. Not many people can boast a hundred five star reviews. You don’t even have a negative review on your podcast here. So I better not screw up. If I screw this thing up, you take it out of my pay, right? How much are you paying me for this? No, no.

Dr. Weitz:                            Yeah. Fortunately, I have a hundred relatives and friends, but-

Dr. Zielinski:                        I love that.

Dr. Weitz:                            … just kidding.

Dr. Zielinski:                        How many wives and kids do you have?

Dr. Weitz:                            So-

Dr. Zielinski:                        That’s funny.

Dr. Weitz:                            … let’s start by explaining: What is an essential oil and how is it made?

Dr. Zielinski:                        Ah, I’m so glad you mentioned that. They’re not essential… funny.

Dr. Weitz:                            Oh, who would’ve thought of that question?

Dr. Zielinski:                        Isn’t that cute? You mentioned something, though, they’re not essential and they’re not oil. I mean, they’re named essential oil because they’re known as the essence of flavor and aroma of plants. So when you put your nose into a rose and those volatile organic compounds are being emitted from the rose, you smell it.  And just to go back to biochemistry for people who might forget, volatile or volatile, meaning readily evaporate at ambient room temperature.  So that means when you spray your Febreze a hundred feet away in a room and you smell it 10 minutes later, it’s because those particles are floating.

Dr. Zielinski:                        Well, organic, again, volatile organic compounds. Organic meaning carbon based and compound meaning [crosstalk 00:03:34].

Dr. Weitz:                            Floating particles. I’ve got to get my mask. No, I’m kidding.

Dr. Zielinski:                        Yes. Again, don’t get me started. And compound meaning there’s a lot of chemicals, meaning there are a lot of components to it. So I’m holding up a bottle that’s used, almost done, of my favorite blends here. And you’re looking at 150 to 200 different plant chemicals. And what do you mean plant chemical, Dr. Z? Well, you’ve heard of menthol, I’m assuming, right? Eucalyptus menthol. What’s in your Vicks Vaporub? What’s in your Bengay? What makes your pain relieving stuff good? Well, people focus on menthol. So they extract the menthol from the peppermint and they create a drug out of it. Same thing with Pinene, Limonene, Eugenol, Carvacrol and one thing, I mean, let’s call it the elephant in the room.  Drugs today, highly, are based off of the chemical constituency that we see in plants. It’s not like a chemist or a pharmacist wakes up in the middle of the night with a vision thinking, “Oh, if we combine carbons and hydrogens and oxygens in a certain way we’ll create this structure.” No. I mean, what we see is what we have in nature and that’s the basis for virtually every drug on the market.  And the best example is Willow. For years, thousands of years, our ancestors have used Willow bark for its analgesic pain relieving property. It is a potent anti-inflammatory. They made pulses and salves and creams and all kinds of stuff out of it. Well, there’s a chemical in it. It’s a salicilin in the salicylate family. If you extract that out, if you manufacture it, synthetically mass produce it, put some preservatives in a white, shiny coating, it’s sold as aspirin. It’s literally aspirin. Same thing with your antibiotics; same thing with your Metformin, your diabetes drug; same thing with your cancer medication.  I want to stress the importance here. I love aromatherapy for the smell and the feel and getting in the mood for me and my wife to enjoy a nice evening together. That’s all great. But what I’m talking about is medicine. Actual, let’s treat disease, let’s prevent chronic conditions. And that’s the basis for this recent book that we published, advanced strategies and protocols for chronic disease and conditions that are robbing people of the abundant life.

Dr. Weitz:                            Yeah. It’s interesting. You talk about all the different compounds. We just recently had a discussion on a podcast with Dr. Pizzorno, and he did a lecture at the IFM’s annual meeting on Unimportant Molecules. And he was talking about the fact that how we analyze foods and he came up with, say 45, different vitamins and minerals, and, basically, said, those are the only important compounds in food.  And now when you go back and you analyze all these phytochemicals, there’s 50,000 chemicals in food and many of them have health promoting properties. We have flavanols and we have carotenoids and on and on and on. And so when you have an essential oil, you have all of these phytochemicals.

Dr. Zielinski:                        They’re actually known as bioactive compounds.

Dr. Weitz:                            Okay.

Dr. Zielinski:                        And so a bioactive compound is a secondary metabolite. So the primary metabolite of photosynthesis and plant biology are your things that you need to live: Your vitamins, your minerals, your carbs. See, here’s the thing. That’s why they’re not essential, right? We should go back to our little … They’re not essential. You don’t need essential oils to live. You technically don’t need fiber to live. You don’t need antioxidants to live. You need carbs, proteins, and vitamins and minerals, or you will die.  Now, that’s the difference. Essential nutrient versus non-essential. But non-essential nutrition, including essential oils, including those  bioactive compounds, are what give you health. So imagine a life without antioxidants. Imagine a life without fiber. Imagine a life without polyphenols and carotenoids and all those thousands of chemicals. That’s where sickness and disease come into play.  So when you’re looking at a nutrition label it’s completely useless. The only thing I look at a label for is to let me know what the ingredients are. Everything else is useless, in my opinion. And so that’s where you start focusing on, okay, what really is important? So that going back to this bioactive compound mentality is this mindset, “Okay. What do I need to live?” I got that. You’re going to get that, basically, … You’re not going to become carb or protein or fat deficient living in America or most industrial countries. You’re going to get that stuff. You’re going to get your basic vitamins and minerals. Very few people are dying of scurvy and vitamin deficiency in our nation.

We could talk about the connection between vitamin deficiency and death, but I’m just talking at a core level. You’re going to get, basically, the stuff that you need, but what’s going to make you healthy? What’s going to make you be able to fight disease? What’s going to give you an immune system? What’s going to help you live an anti-inflammatory lifestyle so that when infection does come in, when you are exposed to XYZ virus or whatever it is that’s out there, how is your body going to respond?  And so, to me, I’m glad you mentioned that because, yes, we’ve majored on the minors and we’ve made ants out of molehills kind of thing. And it’s, okay, how do we get back to the basics? And when you look at plant chemistry, you realize, you know what? There’s a lot out there that we’re taking for granted.  And that … I’ll propose this. This is my big sales pitch in my books, in my blogs, in my classes. Here’s what I’m trying to sell. Again, I’m not a snake oil salesman. By the way, I don’t even sell these oils. That’s my secret. I don’t sell them. I just educate. So now I could be, as I was taught in public high school, an unbiased researcher, and that’s important to me. So I don’t sell them. I’m not going to peddle them. I’m not going to invite you to my multi-level marketing party. Bless their hearts. I love it. Some of my best friends are the top ranked representatives of these companies, making millions of dollars. Good for them.  But I’m just trying to teach you how to look at a lifestyle. And this is my big sales pitch here, to look at a lifestyle a little bit differently. And I want to propose an essential oils lifestyle. I want to propose, when you look at your life, what is your toxic burden? Are you inundating yourself to things airborne, topical, through what you eat that are causing a metabolic burden on your life? Are you poisoning yourself at a microscopic level, not even realizing it?  And once you start to look at your life and once you start to look at the things that you use and buy and consume, here’s something that most people don’t know, is that you are surrounding yourself and are surrounded by essential oils all day long.  For example, what do you think flavors your Coca-Cola?  What do you think flavors any processed food, whether it’s a natural flavoring or an artificial flavoring?  It’s either a synthetic essential oil or an actual essential oil.  What do you think is the aroma in your Febreze or your plugin or your Wallflower or your candle?  What do you think makes your cleaner so effective or your Goo Gone?  What’s in your body care that gives it the aroma?

Essential oils are everywhere.  And it’s, “Wow. I never thought about that.”  And once you start thinking about it, how ubiquitous they are, you start to look at what’s the true danger with synthetically manufacturing these plant chemicals and inundating our bodies with it?  And you start to realize here’s the dangerous thing about the essential oil and the synthetic version of it. Because we talked about them being volatile organic compounds, they’re lipophilic hydrophobic, meaning they’re fat loving, water hating. They will penetrate into your bloodstream within minutes and seep through into your cellular level. They will penetrate your whole life, your whole body. You inhale them, immediately your brain’s impacted. There’s no thalamic relay. What’s that? It’s a fancy way of saying when you smell something, it immediately impacts your brain, the smell, unlike the sensation of pain.  So go back to the last time you might have accidentally hurt yourself, stubbed a toe, cut your finger chopping carrots. Remember that split second of, “Did I really hurt myself? Ooh, I did.” There is no split second when you inhale something. There is no relay center and interpretation center in the thalamus, a part of your brain. So when you inhale something, it sends a direct signal. Your olfactory system sends a direct signal to your brain where your limbic system is, your mood, your memory, your emotions are housed there. Autonomic function is controlled there: Heart rate, breathing rate, which is smart.  When you look at it, as a Christian, it’s awesome. I say, “It’s God’s design. From the evolutionary perspective, it makes sense.” So when you smell smoke, you get in this fight or flight state, this sympathetic state, you get on a high alert immediately. You get out of Dodge. Well, that’s the power of smell.  But essential oils, when you look at that, have such an impact on the body that when you flip it on its head, you start to realize, what does the fake essential oil do to me?  What do the synthetic fragrances do to me?  And that is where I get shaken in my boots because artificial fragrances, Doc, are linked to neurological inflammation, Alzheimer’s, cancer, dementia, autoimmunity.  And, of course, the “minor things” like ADHD, learning disabilities, COPD, asthma. That’s the minor stuff, right? But you say that to someone who suffers with that, it’s debilitating.  Artificial fragrances are killing people all day long.  Artificial flavors are powerful.

Dr. Weitz:                            How common are artificial fragrances?

Dr. Zielinski:                        Everywhere. It’s everywhere.

Dr. Weitz:                            Right.

Dr. Zielinski:                        Everything you smell … And, see, you remember, you’re old enough and I’m old enough, don’t you remember when soap didn’t smell like anything. It was soap, right? People that have been around for a while … You remember when there weren’t all these fake smells everywhere.  And when’s the last time you’ve been to, let’s say, a restroom, a public restroom? And we frequent public gas stations because we travel a lot, right? So we’re traveling, my family and I take road trips up to Michigan, down to Florida. We live in Georgia. And I can’t tell you how many times I’m in the gas station restroom taking a pit stop with the kids and I hear this, “Psst. Psst.” And, “What in the world’s happening?” I look in the corner. “Oh, someone’s spraying me with an artificial fragrance that makes the pooh pooh smell good.”  They’re poisoning us. It’s fumigating in the bathroom. I can’t handle … But gag. You want a cool tip? People are, “Well, it’s okay. It doesn’t bother me.” If you are not bothered by artificial fragrances, if you could walk in the Bed Bath & Beyond or Bath & Bodyworks, if you could go into the cleaning aisle in Walmart and not get sick, not get a headache, if you don’t get a runny nose, if you don’t sneeze, that’s a problem. And that’s synonymous to having diabetic neuropathy where you don’t feel pain and next thing you know, you have a sore in the bottom of your feet that can end up with gangrene and can get amputated because pain is a sensation that tells you there’s something wrong.  If you put your hand into a fire and keep it there, it will burn off. And that’s exactly what’s happened with our sense of smell and we become desensitized to it. From birth, from birth, you’re born in a sterile environment with all these fake chemical smells at birth. 99% of kids born in the hospital and then they go home with all these fake smells. Mama is filled with perfume and all this beautiful stuff that makes her smell good. Wow. What does that do to our sense of smell, the primal sense that we have to protect ourselves? And what does it do to the brain?  And you wonder. You wonder why autism? You wonder why learning disabilities? We wonder why dementia and Alzheimer’s is on the rise? We’re causing brain inflammation. And that is why I’m trying to propose and sell everyone on this idea of this essential oil lifestyle is you are using and being and eating and surrounding yourself with essential oils all day long. You don’t even realize it.  Start to think about it and start to fix it where you’re replacing the fake with the real. And you’ll find your body will respond wonderfully.


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

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



Dr. Weitz:                            So how do essential oils differ from herbal medicine?

Dr. Zielinski:                        Simple word is concentration. You can’t find essential oils in nature. I think it’s important to recognize that they are a hundred percent natural, but they’re still manufactured. So, again, picking up my little bottle here. If you’re listening, you can’t see it, but I’m just holding up a bottle of essential oil. You’re looking at roughly three pounds of lavender flowers, steam distilled. Again, where are you going to see a pool of lavender in nature? You’re not. You’re not going to go into a rose garden, “Oh, there’s a beautiful rose essential oil. Let me touch it.” It doesn’t exist.  So I love herbs and I love herbalism. I love spices and we love supplements, all that stuff, but they’re very minor when it comes to the therapeutic efficacy. Essential oils have true pharmaceutical grade effect on the body. Nothing, no herb, no spice, no supplement, no food, can compare to the therapeutic efficacy that essential oils can have simply by virtue of their concentration matter.  And that’s important to realize because one drop will have the effect of, let’s say, your blood sugar. Let’s say, cinnamon. Great example. Cinnamon is highly effective at helping balance blood sugar, help increase insulin sensitivity. But just one or two drops, just drops of cinnamon bark essential oil has the same equivalency of two to three teaspoons of cinnamon bark powder. And how do you compare? So that’s it. It’s true concentration.  Very similar, but also a different chemical constituency because when you steam distill plant matter, you only get the volatile components. Again, those that evaporate. Those heavier components … Well, again, we’re getting deep in the chemistry and plant biology here, but there are chemicals that are too heavy. Those won’t go through the steam distillation process. And a perfect example is frankincense and boswellia, boswellic acids. A lot of people use boswellic acid for its pain relieving, cancer fighting property. A lot of supplements have BAs, boswellic acids in them. Your frankincense oil won’t have boswellic acid in it.  So what does that mean? As a researcher, as a consumer, you’re, “Okay, what essential oil do I want to use, let’s say, for …” Let’s throw out breast cancer? And you see a study that says, “Oh, frankincense has a property that could help with breast cancer and the researchers poll, “Oh, it’s because of the boswellic acid.” Well, that doesn’t apply to my world. And the reason why I’m sharing that is because there’s a lot of mismanaged and misappropriated research out there and very well intentioned bloggers that are saying, “Hey, frankincense is great for XYZ because of the boswellic acids,” but it’s, well, there are no boswellic acids in the essential oil.  So the reason I’m sharing that with you is because when you extract something through steam distillation or solvent extraction, you’re getting a different constituency. The plant is so … It has a myriad of different ways that we could use the plant, whether you use a bark or a leaf, whether it’s steamed distilled or solvent extracted, it’s wonderful. A cannabis oil is not the same as cannabis essential oil or CBD, completely different products, all oily based from marijuana plant, completely different chemical structures.

So that means you just got to learn what’s what and, quite frankly, most people aren’t willing to put the time and the effort, and I don’t expect them to, to dive into this stuff. That’s why I think so many people buy our books because I do the research. I’ve gone to aromatherapy school. I’ve laid it out. I’m, “Okay, this is what you use for this. This is what you consider for that,” and let’s try to make this a little bit simpler.  And I know your audience is, dare I say, a little more advanced or educated than the average so I’m talking in a way that I … Typically, don’t talk a lot because I understand, I’ve seen the previous guests and I know what you offer.  In functional medicine, we need to step up and we need to recognize one size does not fit all and we need to look at essential oils as a key part of this tool belt that we need to treat and help people.

Dr. Weitz:                            So before we get into specific conditions, would you say that, let’s say, we’re treating a patient for a specific chronic condition, would essential oils be something that we would add to our herbal protocol? Would you recommend using them in place of it? Would it be … It seems to me it would make sense to add it as an additional component in the treatment plan.

Dr. Zielinski:                        Yeah, it would be … What I would do is I would look at an essential oil before I would look at a pharmaceutical.

Dr. Weitz:                            Right.

Dr. Zielinski:                        That’s how I want people to look at it.

Dr. Weitz:                            [crosstalk 00:21:36].

Dr. Zielinski:                        So your herbs are always there. But that’s what I mean, your herbs are always there. Your supplements are always there.

Dr. Weitz:                            Right.

Dr. Zielinski:                        It’s just now, when in the protocol do you, “Okay, we need something stronger now.” That’s where the essential oil comes into play. And it’s a first step. If we were going to look at it first for people with minor issues, you could try herbs if you want. Or some people go right to the aspirin. The easiest thing is, my medicine cabinet has no pharmaceuticals in it at all. No over the counter. It’s filled with essential oils. That, to me, is the protocol in my life, is if I need something of that nature.  Otherwise, if I have … There is this compounding effect, going back to frankincense. I do want boswellic acids in my life. I do want herbs. I do want spices. I do want supplements. So you use them in conjunction with essential oils. Only, though, and here’s the thing, only if you want that level of therapeutic efficacy. And I think that’s important because I don’t use essential oils because I have to. I use essential oils because I want to currently because I’m not sick.   And let me clarify. I’m not taking a multivitamin of essential oils. I don’t take a drop of frankincense every day to prevent cancer. I don’t live like that. That’s not my philosophy. I use essential oils going back to my lifestyle approach. It’s in my body care because I don’t use the fake fragrances. It’s in my food because I don’t use the fake flavoring. I like it behind me in my diffuser because I don’t like the fake aerosols, and my body just loves it.

So we use essential oils all day long, but when it comes to actual preventing or treating disease, that’s where it’s, okay, it’s a different mindset. And, again, I don’t take cinnamon oil to balance my blood sugar because I’m not pre-diabetic or diabetic. But, if I were, then that’s when I would look at it in conjunction with herbs and other treatments.  A lot of people, quite frankly, they don’t even bother with … Once they reach a certain stage of their condition, the minimum efficacy that a supplement or a herb can have, they’ll go right to the essential oil because, again, you can’t compare. It’s just, who wants to take 15 pills of a turmeric when you can just have two drops of an essential oil? That’s how concentrated these are. And when you use them in a medicinal dose, then you understand it is that level.  So a lot folks, if they have low grade issues, they don’t even bother with the essential oil because they’re eating habits, they’re stress relieving habits or whatever there is, their supplement habits, protocols will help.  So, I guess, I just want to paint that picture is when it comes to ingesting, that’s the key. Ingesting essential oils. You only ingest essential oil medicinally when you want that true pharmaceutical grade punch.

Dr. Weitz:                            And so I know we’re going to talk about aromatherapy, which is our topic for today. But in terms of ingesting essential oils, are they, typically, put into a capsule or do you put some drops in a glass of water? Or what form are they ingested?

Dr. Zielinski:                        Yeah. And actually, let me … I’m glad you said that. Let me correct you. This is aromatherapy. See, isn’t that interesting? This is the misnomer. I’m so glad you said this. People think aromatherapy, they only think of smelling pretty stuff.  Aromatherapy is the therapeutic use of aromatic compounds. So how you use essential oils, depending on what method, will determine your aromatherapy response.  So aromatherapy is ingesting it. Aromatherapy is topical application. Aromatherapy is inhaling it. So that’s where we’ve got to get out of this mindset of, “Oh, I just go to the store to get something smelly and nice.” That is ancient aromatherapy because, quite frankly, and let’s be real, our ancestors didn’t have essential oils like we have them today. And how do I know that? Well, steam distillation wasn’t invented till the 9th Century A.D. by an Arab alchemist. So, again, my well-intentioned multilevel marketing friends who are Christian saying, “Oh, Jesus used frankincense and myrrh.” It’s Christmas time right now coming up here. Gold, frankincense and myrrh. You how many times I’ve been told people are convinced that Jesus used frankincense oil? No way. It was impossible. Why? There was no way for them to extract it.

So when you think about where we’re at today, traditional aromatherapy used to be burning leaves and incense. Cool. And then they got smart. Our ancestors started to put aromatic plants in oil. Actually coming from the Bible. God told Moses, “Hey, get this big old vat of olive oil, put some myrrh, calamus, cinnamon, cassia and just let that steep and hang out for a while.” A.k.a, he gave them an anointing oil recipe, which was a herbal extract, extracting out some of the essential oil in this wonderfully, beautiful aromatic experience that was aromatherapy.  And why would God do that? Well, I don’t know, but I’ll tell you. They were sacrificing animals, blood sacrifices. There’s a lot of risk for infection. And there’s very few things, by the way, that are antimicrobial like essential oils. This stuff kills MRSA on contact. I mean what kills MRSA? Antibiotic resistant bacteria. What kills anti-fungal resistant fungi? Essential oils. There is no known resistance to them, to anything on the planet.  That’s why researchers today are looking at Carvacrol, which is a primary component of oregano to help with COVID. Hey, this is very cool preliminary research. No one’s making claims that COVID’s going to cure the pandemic. But the researchers, medical researchers are saying, “Look, we know the benefits of using Carvacrol for destroying bacterial cell walls and also to kill viruses. We should look at Carvacrol a.k.a. Oregano oil to help with COVID-19.” The research is being done as we speak.

So this is pretty cool stuff when you look at it. So all that to say, when you ingest essential oils, there’s two primary ways of doing it. Going back to your Coca-Cola, your peppermint patties, your flavored ice cream, that’s what’s known as a culinary dose, very, very minor. One drop of oregano in your spaghetti sauce. That’s enough. But it gives you a nice minor … It’s like herbs. It’s just like using weed. That’s our substitution guide is, if a recipe calls for one to two, let’s say, teaspoons of a herb, a spice or a zest, a lemon or orange zest, just use one drop of oil. That’s a literal substitution in your recipe. But what it does, it has such a powerful antioxidant punch, antiviral punch, that the herb doesn’t have. And that’s the culinary dose.  But if you want a true medicinal dose, yes, you need a gel capsule. You need to have … I recommend a vegan gel capsule. If you’re treating the gut for those people … Excuse me … Who are trying to look at minimizing, managing, or even, hopefully, reversing the symptoms of SIBO, Crohn’s, irritable bowel, leaky gut, you need an enteric coded capsule, which is a fancy way of saying it’s a polymer time release capsule. So when you take the capsule, your body won’t digest it until it gets down to your intestines.

So that’s how you literally treat gut issues because the gut is distal colon. And there’s research sharing, suggesting, proving, three to six drops of peppermint essential oil, going back to peppermint, can help soothe the symptoms and help people with SIBO. And they’ve done actual research up to that level.  So in our book, we take what traditional aromatherapy has taught, we take what we know from the biochemistry, we take what we also know of the metabolic pathways of how drugs are metabolized and we share dosing requirements. And, typically, when you’re dosing internally, you’re looking at three to six drops in a capsule and it’s potent.  Topical, want to point out, topical aromatherapy is think transdermal patch, right? Pain patches now, nicotine patches. We’ve seen this for years. We know that chemicals seep through the skin and get into the bloodstream to have a therapeutic effect. The same thing with essential oils. So what we try to do is teach people the safe way of diluting them and making Sabs. Again, this is huge, different strategy than I want to smell good.  And, don’t get me wrong, our body care is all with essential oils. All of it, because we want to smell good but we also like that nice minor medicinal, just a happy, feely, good thing. But when something goes wrong, I have an infection or we’re trying to treat something or whatever it might be, a headache, a migraine, we know to up the dose to a certain level and now we get that therapeutic effect.

Dr. Weitz:                            Cool. So let’s start with sleep. How can essential oils be helpful in promoting quality sleep?

Dr. Zielinski:                        Yeah. Instantly. Instantly can put you in the parasympathetic state. Instantly.

Dr. Weitz:                            So what would you recommend for sleep?

Dr. Zielinski:                        Yeah. Traditionally lavender is a good start. Doc, one thing I love about essential oils, and, again, there’s a lot of things we do. I mean, we’re the granola, hippie, urbanite, yuppy people that give birth at home. That’s me and my wife and our family. There’s a lot that we do, but when it comes to it, a lot of the things that your other guests are sharing besides forest bathing, by the way, that was a great interview, essential oils are forest bathing, by the way. I mean that’s a whole … What do you think makes forest bathing so potent and so healthy and so helpful? Primarily the volatile organic compounds being made from the plants.

Dr. Weitz:                            Right.

Dr. Zielinski:                        So one thing that’s really important is that when you look at this discussion, you start to realize, “Okay, I need to find something that works for me and maybe lavender is a right approach. Or maybe I should try something else.” But I digress.  The one thing that I want to encourage people with is unlike … And, again, this is my sales pitch. I’ve got to do it. Unlike a lot of the things that we learned and a lot of the wonderful things that your experts and other guests have showed, what is easier, literally easier, and even cost effective than getting a 10 or $15 bottle of lavender putting two or three drops in a diffuser and press “On” right before you go to a bed? There is zero barrier to entry, right? Essential oils are the gateway to natural health, natural living, just like cigarettes are the gateway to drugs, right?  That is … I want to impress everyone how easy this is. So nothing on the planet is as easier or cost effective than getting a couple drops, putting in a diffuser, pressing “On.” Done. So that’s what you do. You get a water diffuser, 15/20 bucks on Amazon. Get a good essential oil. Again, I share with you how to find a good essential oil. That’s a whole another discussion, but there are a lot of fakes out there. There are a lot of counterfeits. You got to find the real deal. Once you get one, a couple drops of lavender. Wonderful.

Now, if you have a little more on your budget, and I want to recognize … We have five kids. I get it. Not everyone has a blank check. Vetiver Roman Chamomile they’re super effective, but they can get a little pricey. So what are other oils you could use? Well, geranium, clary sage, a lot of women like these oils. They’re the traditional women’s health oils. They’re wonderful for calm and peace. Again, when you breathe these in, these volatiles organic compounds and you automatically get in that parasympathetic state, it’s instant. So that would be a good way of starting.  Some of the … Going back to the tree oils and forest bathing, all those oils can help: Pine, frankincense, sandalwood, cedarwood, anything with a “wood” at the end of it. It’s a wonderful, wonderful way. And that’s just aromatic. That’s just through the aromatic compounds being emitted from the diffuser.  But if you really want to get into it and that doesn’t help you enough, that’s where you could use a topical application and giving yourself a neck rub or a foot rub. That’s where taking an actual lavender capsule can give you that. If you’re overdosing on a melatonin supplement just to get through the night, you might need something a little more, I don’t know, dare I say stronger? You might need a stronger approach at first until you’ll get so sensitive to just smelling lavender where it just puts you right there.

Dr. Weitz:                            So I want to ask next about the use of essential oils for dementia and Alzheimer’s. And I wanted to say before you answer that question, in your chapter on that, I noticed that you wrote that, “We should think twice before using hand sanitizer because it might increase the risk of brain inflammation because of damage to our microbiomes.” And all I could think is, “Boy, there very well might be a huge increase in the risk of dementia and Alzheimer’s as a result of the massive use of hand sanitizer in the last two years.”

Dr. Zielinski:                        Yeah, that was tough to get in the book actually. My publisher wanted to cut that part out. And I wrote this book in quarantine. It was the very beginning of lockdown quarantine in COVID 2019. Wait, I’m sorry. 2020. So when I wrote this book, I just … Again, my job’s easy. I’m not a practicing aromatherapist. I’m not a practicing chiropractor. I’m a researcher and I’m an author, I’m a speaker and I share what the researchers say. So this is the easiest thing.  Look, a couple of years ago in Oxford University Journal … Again, this isn’t … I love aromatherapists, but they have a stigma of being hippies that smell like patchouli. So the medical world and a lot of people just marginalize them, “Oh, that’s pseudoscience. We get that as chiropractors. It’s pseudoscience.” Oxford University isn’t pseudo science of any sort. It’s the premier university on the planet next to Harvard and Yale, whatever your ranking is.  There’s a journal called Evolution, Medicine and Public Health that found a strong link between over sanitized wealthier countries and higher rates of Alzheimer’s. They conducted this study over 192 countries, basically, the whole world and they found the more sanitized a country I, the higher the rates of Alzheimer’s like a linear relationship.  Now, no. I didn’t use the word. It’s really important. It’s not a play on words. I’m not trying to be smart here. I didn’t say “clean” I said “sanitary.” All right? Huge difference. Soap and water will get your hands clean. But if you want to quote, “Sanitize your hands,” you need something else. And the problem is we’ve over sanitized our life to the point where we’ve, literally, destroyed …. And the research has concluded. Why? It’s the lack of bacteria on your hands. This is really hard for some people to conceptualize. Please bear with me.

There is a gut microbiome. I know you’ve had a lot of your speakers talk about this in the past. There’s also a skin microbiome and there’s a brain microbiome. What do you think makes us who we are? So when we have a lack of bacteria on our hands because of hand sanitizer, it’s been linked to a poorly developed immune system, which puts your brain at risk for brain and neurological inflammation. I mean, are you serious?  Now, when you compound that with fake chemicals and toxic chemicals, cleaning products and artificial fragrances that directly put the brain in neurological inflammation, it’s no wonder that we’re in the cognitive state that we are. And we’re decreasing rapidly. Why? Because we spend a vast majority of our time indoors.  I mean, even before I wrote this book, the most recent research we had was a couple of years ago when the Environmental Protection Agency was clear and they said, “Look, we spend 93% of our time indoors.” And the reason they’re sharing that is the air inside of our houses are two to five times, some up to a hundred times, more polluted than outside. You’re better off breathing toxic smog in LA than you are in your house if you live in an apartment that you can’t control the airflow. No joke. It’s bad stuff. Bad News Bears in your home.  So why is the EPA talking like this? Well, they recommend having a HEPA purifier. Now HEPA air purifiers are COVID protocol for hospitals and nursing homes and schools and all that stuff. I actually bought air purifiers for our kids’ school. Every room in the school have them. It’s that important. But that research was done a couple years or ago before COVID and that was 93% of our time spent indoors.

What do we know about life since? I mean, we’re looking at 99 to a hundred percent of people’s time. Literally, a hundred percent. Some people haven’t left their home in two years. Is indoor. So what are we breathing all day long? We think about the airborne pathogens. Doc, I’ve been talking this way for quite a while, almost 10 years. And it took COVID to bring word awareness that I’ve been trying to preach for a long time, at least in my life, right? I’m 41 years old. Airborne pathogens. People think COVID. No. Think the VOCs that are being emitted from your carpet, your cleaning material. Think about the aerosols, the fragrances. Think about the stuff that’s constantly just around you. That is public enemy number one. That’s the stuff that puts our brain at risk for inflammation in our immune system, dampening, and puts us at a slew of host of toxic burden that could be linked to chronic disease.

So that, for number one, what’s the solution? Well, don’t use hand sanitizer. I mean, unless … Going back to my road trip lifestyle my wife and I take with our kids a few times a year, unless I’m in the middle of the road with no bathroom nearby changing a poopy diaper, I’m not using hand sanitizer ever, ever. It’s not part of my life. And you know what? I had to break up with hand sanitizer because I used to be an addict. And I’ll admit. I had an OCD years ago. Every time I touched a doorknob, every time I did anything, I had a hand sanitizer. Do you know what’s part of kids’ school supply list? Paper, pencil, erasers, markers, hand sanitizer. You can’t walk into school without a hand sanitizer.  So what we do is we make our own. Basically, an alcohol based with essential oil. Done. No toxic chemicals. And why this is even more important is not only what the research shares about brain inflammation and dampening the immune system, but how many more products does the FDA have to ban? It just happened again last month. Oh, another one. High levels of benzine, a known carcinogen. You better not use this hand sanitizer.  There’s dozens out there in the market that are just poison. And, finally, because so many people are using them getting sick and dying, the FDA is finally saying, “Hey …” But what about all the people that have been hurt? What about all the people that just got diagnosed with cancer? They have no idea why. And maybe it’s because a contributing factor could be the hand sanitizer that just got recalled.

 We need to think twice. And there should be no antibacterial products in your possession, zero. So, yes, this conversation … “Okay. Well, you just overwhelmed me. If they’re in my food, they’re in my air, essential oils, fake essential oils, whatever. What do I do? Where do I start?” Number one, you start with your hand sanitizer. And if you have to use it, if you work at a hospital or if your kids need it, make your own. Just get the highest proof alcohol you can. Whatever moonshine, vodka you could get at the store, get 15/20 drops of essential oil, get a spray bottle, bada boom, bada bing, you’re done. It’s so easy. That’s the best hand sanitizer, effective hand sanitizer. It will kill everything.

But here’s a cool thing. Besides some dehydrating aspect and, by the way, alcohol will dehydrate your skin, essential oils have what’s known as cell selectivity. And, again, I have an easy job as a Christian. When I don’t understand something, I’m, “Hey, it’s just the wisdom of God. It’s how God created it.” Well, the scientists can’t explain why, but essential oils target the pathogenic microorganisms and leave the good stuff alone.

 So we all know about probiotics, good, healthy bacteria. If you ingest essential oils, people are ingesting oregano to help cure and repair leaky gut, they’re ingesting essential oils, they’re putting them on their skin to kill the viruses and bacterial fungi. You don’t have to worry about ruining your microbiome. That’s pretty cool stuff when you think of it. Again, the wisdom of God. Science can’t explain it. So that’s if you need it.  But what else? What’s another good step. Well, think about your body care and think … Because, again, we’re talking Alzheimer’s, we’re talking dementia, we’re talking you’re 41 years old. I’m 41 years old. You’re 30. You’re 25. You could smell pretty. You could smell good. Guys, whatever, handsome, good looking, whatever, you could smell good and you don’t have to hurt yourself at the same time. No perfume, no cologne. Throw it away.

Start making your own. Start experimenting. Because what do you think are the basis for your perfumes and colognes? The perfumers are taking the essential oil and then they’re loading them up with chemicals and preservatives to give you this, ugh, toxic. I can’t even handle going down the perfume aisle like I used to. I used to love those Acqua di Gios and Armani’s expensive stuff. Couple drops of essential oil.

You know what’s funny? I’ll never forget speaking … A mutual friend, a colleague, Dr. Peter Osborne, functional medicine doc invited me to speak at a conference a couple years ago. And I flew into Houston on the way to Dr. Osborne’s office and the Uber driver, again, this big, burly Latino guy, he says, “Man, you smell good. What are you wearing?” And I’m, “Citrus oils.” He’s, “What?” Boom. Had a cool conversation. I get more compliments from dudes than I do how good I smell. It’s you smell good, you smell normal, you smell healthy, you smell like we should smell. You smell like nature. Just pointing out.

But you know when I do it, it moisture … My body care. Why am I saying that? Because it’s our body care. A little bit of coconut oil, a little bit of essential oil. Done. Yeah, you could get fancy. We got all the fun little SháSu [inaudible 00:44:00] recipes, all that cool stuff if you want to do it. But it’s so easy and your body responds so well. Everyone has olive oil or you should, or coconut oil in your kitchen. That’s it. That’s half the battle.

 So how are we treating, how are we preventing Alzheimer’s? It’s this life’s style? And another thing everyone should do, throw away the aerosols. No more pooh pooh sprays and plugins. Throw that trash … Oh, wait … And here’s the thing. If you’re like my wife, I’m sorry. You’ve just got to let go. Throw it away. When I hit my revelation, this was over a decade ago, I’m, “Sabrina, this stuff is bad for us. We can’t use this.” My wife said, “We can’t throw away …” The clean plate club, like my grandma who came from the Great Depression couldn’t throw away anything. She goes, “We can’t throw it away. We can’t. We got to use it and then we’ll transition out.” No. This is poison. We had a little bit … Because she wasn’t there yet, right?

By the way, if you’re a zealot like me, be patient with your spouse. If you’re a zealot like me, be patient, right? That’s the problem that we’re having right now, especially in the context of the pandemic. We have zealots on both sides of the fence. Be patient with your loved ones. Because, for me, it’s, “You know what? It’s not going to kill me. I know it’s harmful, but you know what? Breathing in this thing, isn’t going to kill me today and it’s not worth a divorce.”

I mean, hey, I’m giving marriage advice here, which helped me in a big way because if you’re gluten free and if your husband’s eating pizza and breads sticks all day long, that’s going to cause marital problems. That’s the number one thing we always get. How do I get my family on board? Because I’m there. And women listening are usually the spear headers. Women listening, most are … Just statistically, women are usually the caretakers of the home and they’re the ones who get this. It’s really hard for men, typically, to get this stuff, right? It’s a female dominated industry across the board.


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

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Dr. Weitz:                            So give me a couple of essential oils we can use as, let’s say, I have a patient on a functional medicine approach for dementia, what are some essential oils we can add to the protocol?

Dr. Zielinski:                        Yeah. Well, rosemary, the herb of remembrance. And going back to herbalism, a lot of those herbs and spices, rose for love, rosemary for, again, memory, there’s a reason, and our ancestors are very observant, very intuitive. So if you want to help cognitive function, rosemary. You can diffuse it, you can apply it topically, you can even adjust it. It’s safe.  But cinnamon, believe it or not … And I don’t know how much time you even have to get in depth with this, but the primary approach to Alzheimer’s treatment is using a drug known as an acetylcholinesterase inhibitor. So low acetylcholine levels, which is a neurotransmitter in the brain, low levels of acetylcholine is the hallmark sign of Alzheimer’s and dementia. And you need acetylcholine for brain synapses and cognitive function.  So what medicine has done is, okay, we have low levels of this neurotransmitter, so what we should do according to the pharmaceutical mentality, is let stop the natural breakdown of acetylcholine. Well, how do you do that? Well, there’s an enzyme known as acetylcholinesterase. Anything with an “ase” is an enzyme, right? So there’s an enzyme known as acetylcholinesterase that naturally breaks down the acetylcholine.  Well, why would that be? Well, because we’re on a cycle. Just like your skin, literally, regenerates itself every 28 days, everything is being used and built, used and built, used and built. And so what the drug approach is, is to stop the enzyme from breaking down acetylcholine so there’ll be higher levels of acetylcholine. Okay. The problem with that is (a), it doesn’t work. It’s not effective. It can’t cure the disease and the side effects are horrendous. I mean, bad stuff, including dizziness, vomiting, memory loss, which is ironic, and death.  Well, research has shown that cinnamaldehyde, which is the primary component of cinnamon bark, has an 80% efficacy against acetylcholinesterase. Wow. I mean, you’re talking ingesting and inhaling cinnamon bark oil can help my brain function? Wild, isn’t it? And there are other oils.

Dr. Weitz:                            It could also help with blood sugar control because-

Dr. Zielinski:                        Thank you.

Dr. Weitz:                            … a typical protocol for dementia, Alzheimer’s, is going to be a ketogenic diet to try to control blood sugar.

Dr. Zielinski:                        Yes. Yes. And you have basil. I’ll read a list. Other oils that are known for their acetylcholinesterase activity: You have rosemary again, sage, thyme, lemon balm, also known as melisma, lavender, bergamot and basil, and then others.  So, again, this is what I do. I go through the research. I share … Okay, this is preliminary stuff. I mean, we have admittedly, though, let’s be real, we have very little human trials over the course of many, many years to test therapeutic efficacy of oils versus drugs. I get that. So a lot of this is “theoretic,” a lot of this is experimental. But I’m telling you something, if used properly there are zero side effects to using essential oils, other than the rare case of some allergy. And part of that is knowing what drug interaction might occur if you ingest them.

And that’s what we include in the book. It’s actually the only thing that I think exists for the layperson. And even going through aromatherapy school, there is nothing as in depth and simple to look at as a chart. We have this drug interaction chart in the book that says, “A drug for Alzheimer’s, the drugs for diabetes, the drugs for insomnia or whatever,” says, “Look, you can’t ingest these essential oils or you can have an interaction.”  Most people don’t realize that clove oil is a blood thinner. So if you’re on Warfarin, you could cause internal hemorrhaging. And the problem is most multilevel marketing companies and other companies include clove in their “Immunity boosting blend.” Why? Because clove oil has some of the highest antioxidant compound ability than anything on the planet. The ORAC scale of clove is a million.

Dr. Weitz:                            Wow.

Dr. Zielinski:                        I mean, a million compared to wild blueberry’s antioxidant load of ORAC points of what? Five to 7,000. We’re talking a hundred or a thousand times more potent,-

Dr. Weitz:                            [inaudible 00:51:53].

Dr. Zielinski:                        … clove oil. So that’s what we’re dealing with.  Again, going back to your urban spice examples, this is highly concentrated stuff, but you got to be careful, though. If you’re ingesting oils, really make sure you’re working with a properly trained functional medicine practitioner, someone who understands, at the very least who could do a little bit of research and help you because if you’re on a pharmaceutical, again, be really, really careful with any potential interaction.

Dr. Weitz:                            In your chapter on Alzheimer’s you also talk about Anosmia, which is the loss of sense of smell that can happen with Alzheimer’s disease. And we also, as you know, have a virus around, and the infection with that virus can lead to a loss of sense of smell.  Is there an essential oil protocol that can help to return a sense of smell in either Alzheimer’s or in viral infections or both?

Dr. Zielinski:                        There’s no protocol other than the standard of care in this space is to be stimulating your olfactory nerves on a regular basis. That could help. Very similar to stimulating hair follicle growth to help if you’re losing hair. By the way, rosemary is wonderful at stimulating hair follicles, could help regenerate hair growth. So that’s what we try to do is … I hate to use the phrase, fake it till you make it, but the reality is if you have lost your sense of smell, you want to do what you’ve always done. You don’t want to stop. You don’t want to stop diffusing essential oils. You don’t want to stop.  And you might want to even be a little more targeted where you could get an aromatherapy inhaler. And let me pull one up here. You can go online, just type up aromatherapy, personal aromatherapy inhaler. And this looks like a lipstick or a chap stick tube. And it’s just a glass tube with a cotton wick that is saturated with essential oils. And this is concentrated essential oil, but it’s personal. It doesn’t affect the room. You could use this on the airplane, your neighbor next door or right next to you won’t smell this.  But this is a nice way of getting more concentrated, essential oil vapor. And this could help stimulate … You could plug one nostril, breathe in through the other. It’s also a wonderful meditative technique for people that are really trying to focus and relax and calm. Essential oils do wonders with and comes to mental clarity and focus and all that.

But the thing is, though, I’m glad you mentioned the Anosmia because even though you might not … And we didn’t even talk too much about mood or memory or emotions, but essential oils work primarily on the emotional level to stimulate memory. So when you walk into grandma’s house this Thanksgiving and you smell turkey and stuffing and cranberry sauce, that’s going to stimulate, hopefully, happy memories of holidays in the past because the smell triggers a memory in the brain. And you know what happens? You’ll, literally, manifest the same hormone and neurotransmitter production that you did when the memory was made. It’s wonderful. That’s why smelling something can bring you back right there. You’re a five year old kid sitting on Santa’s lap because you smell peppermint. He had peppermint stick smell on him.  Now, you won’t get that. You won’t experience that manifestation, the emotional benefit, of inhaling essential oils if you don’t have your sense of smell, but because essential oils work, regardless if you want them to or not, inhaling certain essential oils like orange, lime, grapefruit, will stimulate a production of dopamine or serotonin in the brain.

So what am I saying? You use essential oils if you can’t smell them because you know that your body’s going to respond, at least on a physiological level. So on a physiological level they will respond if you can’t even smell, you don’t have the sense of smell, but on a psychological level, you won’t have any benefit.  So, okay, okay. I get it. And it was a shame that so many people have been affected by COVID that way. My wife, even now her sense of smell has been dampened since COVID. I mean, at one point she couldn’t smell anything for a few months. Myself included. Mine went back really quick, thank God. Hers, she’s still at 75%. She’s not at a hundred percent yet, but we still do what we do.  And we’ve had wonderful, wonderful feedback from our community members and people that read our books. They follow this, “You know what? I’m not there a hundred percent, but I’m doing a lot better.” Because sense of smell is so important with flavor, with just experience of life, especially at the psychological level of enjoying aroma, it’s so key.

Dr. Weitz:                            So let’s maybe cover one more topic. I was thinking maybe cancer.

Dr. Zielinski:                        Yeah. Yeah. Very respectfully, bleach in a Petri dish will kill cancer cells. I think it’s important to recognize the studies that we have are virtually all in vitro cells in Petri dish or we’re dealing with tumors on animals. We have no studies, no studies on humans, and that’s my disclaimer. But there’s a lot of research, though, a lot. We’re talking about specific cancer cell lines and types.

And I actually have a chart in the book that covers the exhaustive … At a point when we wrote this in 2020, the exhaustive list of all the research done on what specific cancers. And you’d be surprised. You’d be surprised at certain … And maybe it’s just because that’s what the research has done. And that was just what the researchers felt they should try. But there are very specific oils that seem to have pretty potent efficacy on certain cancers.

And so that’s a thought is that I hope if this is something that you are facing … And, again, I don’t have an anti-cancer protocol because I don’t have cancer. I’m not there. But if you do, if you have been diagnosed, working with an integrative oncologist I think is so important. Someone, an oncologist, who recognizes that there are alternatives that could help.

And here’s the thing that I want to stress is that there is zero scientific rationale or zero research to suggest that people should not be using essential oils if they’re undergoing cancer treatments. And that seems to be one of the biggest misnomers in conventional oncology is oncologists by and large will just recommend against anything.

I was privileged and blessed to follow a beautiful young woman in her story overcoming breast cancer and we created a documentary. And one thing the doctor told her at one point was, “Don’t even take vitamin C.” And she’s, “Why?” And she’s, “Well, we don’t want anything to interact with the chemo and make it less effective. We are just going to put you in a state where your immune system is just useless.” It’s, God, what research? It was fear based. It’s all CYA covering their assets. They’re so fearful of malpractice and lawsuits.

And so what this woman did … And if you’re interested and if you want a movie that you’ll cry to tonight, I guarantee a tear, an emotional. This is a documentary. It’s won Film Festival. It was the most inspirational movie of 2020. Go to hopeforbreastcancer.com. Go to hopeforbreastcancer. Watch it for free. It’s my gift for the world. Just watch it. It’s a wonderful film and it’s a wonderful story.

But this woman, Angie, she started doing things without her oncologist knowing about it, “I’m going to use essential oils.” She started making her own capsules. She was telling me the story. Why am I mentioning this? Because this is where essential oils come into play. It’s not all or nothing. You should never look at your life, you should never look at health thinking, “I can only go natural or I can only go conventional.” There’s no balance in that. You have to do what’s right for you.

But here’s the thing, though, regardless of what you choose, you should, and I want to encourage you to have essential oils be part of something, because they should be part of everything, in my opinion. They should be part of it to help you, whether you’re on the all natural route, whether you’re on the conventional route or whether you’re integrative, in the middle.

So, Angie, her name was, from this story, she found herself … And I’ll never forget this … She walked into the chemo room because she took chemo, and she ended up stopping earlier on, she didn’t take the whole system, the whole round and all the … But at one point she walked in on her second or third treatment, and everyone around her, just pale, ash colored skin, they looked like death. I mean, even with her losing her hair, she looked good. Her skin was vibrant, she had the sparkle in her eye, she was not absolutely just annihilated. Yeah, she got sick and she had some side effects, but she just pointed out, it almost felt like she almost felt guilty. She was going through chemo like everyone. Everyone else was barely walking in.

And she accredits that to her natural lifestyle, the food she was eating, the supplements she was taking, the stress, mind, body, prayer, meditation, the essential oils she was using to help.

So that’s what I want to stress. We cover cancer very respectfully in the book. No cure all claims. I’m very much in tune. And I promote … Because here’s a quote. I want to actually quote this from my book, from Biomed Research International: “Essential oils have been reported to improve the quality of life of the cancer patients by lowering their level of their agony. EO [inaudible 01:01:39].” And just that alone. “Essential oils can be used for improving the health of the cancer patient and is a source of a novel anti-cancer compound.”

So why did I include this? Well, I hope some brave cancer patient will show this to their doctor and be, “Look, you can’t recommend me not to take frankincense. This research suggested it could help me.” So you might not want to choose that doctor if you have a doctor that’s just going to say flat out, “No.” We need to work with educated professionals who at least will support you in your decision to do whatever it is that you want to do.

With that said, and we glossed over this, there’s nothing that I know that has such a wonderful effect like essential oils on symptoms, everything: Nausea, headaches. I mean, again, going back to the Alzheimer’s chapter, we have this whole chart of symptoms that Alzheimer’s patients deal with, elderly patients, everything from aggression to bed sores to just stomach issues, you name it, just dry skin. Essential oils are wonderful at symptom based management.

That’s what we focus on in the book is helping people manage the symptoms related to cancer. And there’s a ton of them, and just what to do and how to consider … That way you’re not tempted to maybe go with some pharmaceuticals that will end up destroying your gut lining and making you more immune susceptible to disease and all that stuff.

So I feel it’s a very respectful approach. Again, no cure all claims, but we want to help you. If you’re losing weight, there are essential oils to help you. You want to eat more. I mean, that’s something most people don’t think about. Everyone’s in this, “I want to lose weight,” but if you’re cachexic, if you’re wasting away, if you are struggling to eat, going back to lavender, those oils that puts you in that parasympathetic state will make you want to eat, will help with hunger. So that’s something to think about. Same thing with bruising and swelling. We have a bruise cream. And constipation, all that kind of stuff.

So anyway, I just want to help your lifestyle and that’s it. At the end of the day we’d done … With that documentary, especially walking through and seeing and hearing these stories of these beautiful cancer patients going through what they’ve gone through, it seems to be the quality of life through the journey that really makes or breaks them.

And, yes, everyone wants to cure cancer. Everyone wants to avoid cancer. I get that. But what about the process? What about the day to day? And maybe your chemo or your radiation or your essential oil therapy, maybe it doesn’t save your life, ultimately, but if you could do something to give you an extra three or four or five months, would you not want that? And would you not want three or four or five months of good health and vibrancy and being able to enjoy your family and friends?

It’s a finite way of thinking to only focus on the end result when we lose today because all we are guaranteed is today. I can’t guarantee you to tomorrow. I can’t guarantee myself an hour from now. All I have is this moment. And that’s really the message, not only the documentary, but it’s the message of our whole ministry is to help people do better in the moment so that you have a more abundant life.

Dr. Weitz:                            That’s great. Thank you Dr. Zielinski.  And everybody get The Essential Oils Apothecary. I’m assuming it’s available at all the places books are available?

Dr. Zielinski:                        Yes, sir. Yes.

Dr. Weitz:                            So Amazon, Barnes & Noble, et cetera?

Dr. Zielinski:                        Yeah, everywhere. And for those people who want to take a deep dive, we cover 25 different chronic conditions in depth, everything from fibromyalgia to insomnia, to depression, substance abuse, even libido and erectile dysfunction. These chronic conditions that are robbing people of the abundant life. We go in depth and sharing everything with you that the research suggests on how essential oils can help.  If you pick up a copy, we have a gift. And you go to eoapothecary.com and you just sign up for our book bonus gift and you’ll get about six and a half hours of Masterclass videos for free and my wife and I show you how to make several of these recipes. And we cover these topics more in depth, like heart disease and other things that we just didn’t have enough space in the book to cover. So go there. We got charts, PDFs, downloads, all kinds of fundamental things. Go to eoapothecary.com.

Dr. Weitz:                            Excellent. Thank you so much, Dr. Zielinski.

Dr. Zielinski:                        Thanks for having me, Doc.

Dr. Weitz:                            [crosstalk 01:06:15] podcast.

Dr. Zielinski:                        Appreciate you.



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



Regenerative Medicine with Dr. Joy Kong: Rational Wellness Podcast 237

Dr. Joy Kong discusses Regenerative Medicine with Dr. Ben Weitz.

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


Podcast Highlights



Dr. Joy Kong is a UCLA-trained, triple board-certified physician, anti-aging and stem cell specialist, educator, CEO, and founder of the Thea Center for Regenerative Medicine in California.  Dr. Kong focuses on the prevention of aging, as well as chronic and degenerative conditions that are difficult to treat.  She runs the THEA Center for Regenerative Medicine.

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


Podcast Transcript

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

Hello, Rational Wellness podcasters, today, we have an interview with Dr. Joy Kong on regenerative medicine. According to Nature Magazine, regenerative medicine is a branch of medicine that develops methods to regrow, repair or replace damaged or disease cells, organs or tissues. Regenerative medicine includes the generation and use of therapeutic stem cells, tissue engineering, and the production of artificial organs.

These stem cells can be harvested from embryos, from bone marrow or fat cells of adults, from the umbilical cord blood from newborns or from the amniotic fluid. Dr. Joy Kong is a UCLA trained, triple board certified physician and anti-aging and stem cell specialist. She’s also the CEO and founder of the THEA Center for regenerative medicine in California.  Dr. Kong focuses on the prevention of aging as well as chronic and degenerative conditions that no one else has been able to heal. She believes that complete healing can only come from looking at the whole person, mind, body, and soul. Dr. Kong, thank you so much for joining us today.

Dr. Kong:             Thank you so much. It’s a pleasure to be here.

Dr. Weitz:            Absolutely. Perhaps you can start by telling us a little bit about your own personal journey and how you got into this type of work.

Dr. Kong:             Yeah. It’s definitely a unique and fun journey. I grew up on a university campus in Beijing, China. It’s a science and technology university. I spent my first 20 years in China. It was kind of, getting a taste of just how important food is, how your health it’s contributed to by many factors. Exercise was definitely emphasized. Then also, I was always impressed with the… I wasn’t impressed until I came to this country, realizing how Western medicine is dominating everything. Because when I was in China, my mom would have a medicine drawer and it would have Chinese medicine, Western medicine, everything is all jumbled together, and she would just ask me, “Okay, what are you dealing with? What’s the problem?” I’ll give her my symptoms, and then she would just reach into the drawer and she would dig out some, either Western medicine tablets or some Eastern medicine, whatever concoction it was.  Because it depends on the condition, depending on what you’re dealing with. Sometimes Chinese medicine work better, sometimes Western medicine work better. I grew up with the acceptance for this very inclusive approach to medicine. Then when I came here, of course, I love science and I was going to go get a PhD in neuroscience, because I loved the brain, which was probably why later on, I became a psychiatrist and then did some addiction medicine, because, I think the brain is the final frontier. It’s really fascinating.

The psychiatry discipline, as interesting as it is, it’s really be a dichotomy between psychotherapy and drugs. You are either going to the route of talking to people about their childhood experiences and how they’re dealing with life or you’re going into diagnosing somebody to fit them into DMS-5. Once you put them in a category, that makes everything easy. Once you put someone in the box, then you know exactly what medications used in that box.  It’s all about matching the symptoms and the drug. The problem is that you’re omitting a bunch of steps in the middle. Between the symptoms, never mind why you’re having the symptoms, between the symptoms of the drugs, there could be so many opportunities that were missed. The opportunity to check, was there toxicity involved? Was it heavy metal? Was it some organic toxins? If you don’t get rid of toxins, that’s a problem.

If you are not looking at certain hormones like thyroid hormone, male or female hormones, you’re not optimizing the signals your body’s receiving. A simple hormone like thyroid is a master hormone governing so many things and it governs how your mental state is. That was barely checked. The only thing psychiatrists checked is the TSH, which is just not very helpful, because it just shows a very, very little piece of picture and missed majority of people who have thyroid problems.

All these missed opportunities, nutrition. We were not trained in anything that can help prevent or can help optimize a person. We jumped into medication right away. I did psychiatry with the training, altogether, that was 11 years. In the process, I was trying to incorporate Eastern wisdom or a holistic approach to health.  I found it very exhausting when no other psychiatrist was trying to do that, and I was the only one who was trying to understand everything about the patient and I was still given half an hour for follow up visits. I come home exhausted and just… I had to do a lot of self-care to just keep up my spirit.

Dr. Weitz:            Essentially, you were trying to practice Functional Medicine approach, but within an allopathic model.

Dr. Kong:             Right, in the dark and with no assistance, and no language to put it together. When I found the discipline was called anti-aging medicine, which is just an off shoot of functional medicine or integrated medicine, it’s just a different name to the same thing. You’re looking at the body from a diverse, many, many angles and each angle you can address it by very, very detailed, very fine tuned tools, whether nutrition or hormones or detoxification or microbiome, there’s so many ways that you can address it.  All of a sudden there’s a language to what we can do to bridge the gap between symptoms and drugs. There’s so many things we can do. By the time you did all these things, probably drugs would not be necessary at all. We missed the entire, I would say, probably 96%, 97% of psychiatry probably practiced that way, which means you missed so much opportunity to optimize a person’s health, and I think that’s a disservice to people.

Dr. Weitz:            When you’re talking about the brain, what percentage of patients do you think actually have a brain? No, I’m just kidding.

Dr. Kong:             Or how many doctors? Oh my God, where do our brain go? Go catch it. My job is to help more doctors find the part of their brain that actually is open to improvements in their thinking. Because I see so many doctors, probably I’m going to offend a lot of doctors, but probably 95% of doctors, till this day, because I hear from patients of how stuck the doctors’ frame of mind was. That they’re so stuck that they’re not open to see evidence outside.  Whatever they were taught in medical school and whatever they learned during conferences, which are all sponsored by drug companies, by the way. Anything beyond that, they are not open to it. If it’s 95%, then where do people go? Where do patients go? We see that every day. I’m sure, you do functional medicine, you’ve done it for a long time, that’s what you see-

Dr. Weitz:            Absolutely. Here’s a perfect example, I was just talking to a patient who went to see a doctor in Florida at the Cleveland Clinic, and they didn’t run the Cleveland Heart Labs because they have this very narrow, Western focus. Even though they work for the Cleveland Clinic, which has pioneered some of the more detailed, advanced lipid profiles that a lot of functional medicine doctors do, they don’t even do those tests, because they’re too complicated, they’re too long, and they just want to get to the point, here’s your elevated LDL, here’s your stat, et cetera.

Dr. Kong:             Oh my God. Yeah. It’s sad. It’s sad that I started telling people, I said, “Us doctors, us physicians have become very efficient killers. We’re the third leading cause of death. So, be careful when you go see a doctor, just remember, it could be as dangerous as cancer or heart disease, just be aware, fire be aware.”

Dr. Weitz:            I think it’s great that you see regenerative medicine, stem cells as part of a functional medicine approach to a person’s overall health and prevention of chronic diseases, as well as trying to get to the root causes of these conditions and reverse them, and not just treat symptoms.

Dr. Kong:             Yeah. Regenerative medicine, really, that was part of the whole anti-aging medicine, functional medicine, it’s in the framework because it’s really tapping into the body’s own healing capabilities. It’s human cells, and especially when you tap into certain cell types in younger cells, they have tremendous ability to send out signals for your body to heal.  Instead of throwing one drug, that’s targeting that one A to B linear relationship, we’re sending you cells, which contains intelligence that can send you hundreds or thousands of these cell made molecules, and that each molecule can affect 100 different mechanisms and actions. All of a sudden, you have this global healing that’s going on.  That is really exciting. Of course, it’s exciting on paper, and what excited me more was actually hearing stories of how people were healed. Just because something sounds great, doesn’t make it great. But when you actually see it at work, that’s what’s really inspiring. I started seeing that, which was incontrovertible evidence.  Then, I was like, this is just too amazing, and I was learning about the science and looking at the safety, which was incredible safety data, and efficacy. Then I started doing it for my own patients. That’s when it became really fun. When somebody-

Dr. Weitz:            Let’s get into the nitty gritty about stem cells. Teach us about stem cells. What are the best types of stem cells to use in therapy?

Dr. Kong:             I would say there’s no one stem cell that cures everything. Different types of stem cells in our body, they all have their own functions. Otherwise, they wouldn’t be there. Our body is very-

Dr. Weitz:            Maybe you can define what a stem cell is.

Dr. Kong:             A stem cell… All of us started in life as one stem cell. The fertilized egg is one stem cell and that one stem cell has such an incredible potential, it can form any cell in the body. The cell continue to divide and it will retain that kind of potent potential, up to a certain stage. When they use embryonic stem cells, they were actually harvesting the cells at day five to seven of the embryos. Embryo, which is a little ball.  In that ball, those cells are highly potent. Any of those else can form pretty much all organs and tissues of the entire body, except for the sperm and egg. That’s the only difference. They can form just about anything. But they will further differentiate.  The ball will get a bigger and more convoluted and more complex and then they will become other stem cells. All those cells, that’s derived from them are still stem cells, but they lose certain potentials, they become more specialized stem cells, and they can still form, maybe a particular region or a particular tissue type of the human body. So, they keep dividing. It’s almost like a continuum. There’s no, this is first generation staff of cells, second generation, there’s no. There’s a continuum… It’s 1.5, 1.55, it’s continuing as they lose their potential and they earn their specialty, so they start to specialize.

In our human body, we have all kinds of stem cells in our body. For example, the hematopoietic progenitor cells, which can form all the blood cells in the body. That’s a stem cell. We have mesenchymal stem cells. Some people doesn’t believe is a stem cell, but it’s certainly of incredible potential, and in the Petri dish, you can make them into, especially from umbilical source, you can push them into different directions, including bone, fat, muscle and neurons or liver cells. There’s a diverse potential that they can’t become particular cells.  But at certain point, then you become a very specialized cell. You can’t become anything else, but that cell. That’s a progenitor cell that you can sit there and that’s what’s called tissue specific stem cell. For example, in your liver, you have liver stem cells. So, if you liver get damaged, those stem cells who can only become liver cells get activated and they will divide and they will replace the damaged tissue.  There are all these different levels of stem cells. When it comes to therapy, what do we use? One stem cell type that’s really popular, probably the most popular is the mesenchymal stem cells. This is a very, very fascinating type of cells, because they are everywhere in our body. Anywhere we have blood circulation, you have these cells.

The way they are is that, think of a gecko, holding on this tube, which is a blood vessel. They’re holding onto it and they’re sensing what’s going through that tube, all the blood and the signals, and they’re also communicating with the neighboring cells. They’re sensing things and they are also figuring out what’s going on locally and they will either secrete certain molecules based on what they sense or if they’re needed, they’re going to actually going to squeeze themselves into the blood vessels.  They have this very fluid role that they can, what I call like a conductor of the symphony of regeneration. They have this fluidity. They’re everywhere in our body. The benefit of using this type of cells is first of all, these cells are such type of a master cell. A master in the sense that it’s controlling things. It’s able to sense things and then send out appropriate molecules to make changes.  It can send out things into the bloodstream to make overall changes, or it can travel to a specific site and start to secrete different molecules and tell the immune system to bring certain cells to come and clear-

Dr. Weitz:            Where do we get these mesenchymal stem cells from?

Dr. Kong:             There are definitely people who get it from a person’s own. You hear about bone marrow. Unfortunately, bone marrow has 0.1% to 0.01% of mesenchymal stem cells, and has a low percentage of the hematopoietic stem cells, but it has a lot of immature, early immune cells. The bone marrow transplant is one way to get it, even though the amount is minuscule.  A place that has higher percentage is the fat derived stem cells. It sounds counterintuitive, but what’s interesting is they’re not getting it from the fat, they’re getting it from all the blood vessels that are supplying the fat. That’s where the cells are. If you can separate the cells from that tissue, from the blood vessels, that’s where you can get them.

The beauty of these cells is that they work with your immune system. There’s very little potential for rejection. Of course, you don’t have rejection issues with your own cells, but if you are giving transplants, they tend to modulate the immune system, so that immune system is not super amped up. It tends to shift the body from an anti-inflammatory to anti-inflammatory status. Is actually being used for organ transplant. You can transplant an organ, and if you also give the person mesenchymal stem cells, it’s more likely for the organ to survive, instead of being rejected. It has that kind of function.  That makes it very, very, very easy to use, because you’re not going to get different kinds of reactions. The problem is… A person will say, well then of course I want to use my own. Unfortunately, as you grow older, you have less and less of them. Just to give you stats, when you were born, every one in 10,000 cells is a mesenchymal stem cell.  When you reach your teenage years, it becomes one in 100,000, it’s tenfold less, right? Then when you reach your 40s, is one in 400,000. When you reach your 80s, is one in 2 million. You’re running out of the stem cells and the stem cells you do have in your body are a lot less potent. They’re just not working as well, and they lose some of their intelligence.

Dr. Weitz:            We want the stem cells from younger people.

Dr. Kong:             I’m sorry, unfortunately that’s the truth. I was trying to figure out whether or not that’s true. That’s when I delved into all this literature and start to just look at what works better? What works better? People are paying a lot of money for these treatments. I need to give them the best. Apparently, no one has really looked at all the research that’s been out there, because I’ve been presenting this information at different conferences and still, very few doctors really understand the differences.  When you look at all the research that’s been done, for at least 10 years, comparing these different tissue sources. I actually have the lecture online, it’s called Are all MSCs Created Equal? It’s a 40 minute lecture that goes in great detail.  After you watch a lecture, you look at the evidence, none of them was my opinion. All I presented was evidence. Then you can draw your own conclusion. To me, it was very obvious what is a superior source, which is the birth tissue source. We’re not going into the realm of fetal cells or embryonic stem cells, which are not even legal in this country. I think they have their own issues.

Dr. Weitz:            It reminds me of clinics overseas that put the blood of young people into older people as a form of anti-aging.

Dr. Kong:             Yeah, there are a lot of things floating in the blood. We can get those similar elements from the birth tissue.


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

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



Dr. Weitz:            Now, is there rejection issues when you’re using stem cells from somebody else?

Dr. Kong:             I wouldn’t call it rejection issues. Depending on what kind of cells you’re using, if you’re using high percentage of mesenchymal stem cells, I have not seen rejection. There are once in a while, I would say maybe one in 200, 300 people, there may be somebody that has a hypersensitivity type of constitution, hyper histamine reaction that they may break out with half the food that you and I can’t eat or half the medications that we can take with no problem. Those are the only people I’m a little bit more cautious about. But the vast majority, I’ve never seen any issue.

Dr. Weitz:            Okay. How do stem cells work to heal tissues?

Dr. Kong:             The stem cells, if we’re talking about mesenchymal stem cells, I’m just going to stick with mesenchymal stem cells, because that’s what we’re looking at these days, for most research. These mesenchymal stem cells, they are attracted to signals. We talked about how they… I always think the image of salmon swimming upstream, because they’re sensing the density, probably of the signals. So, they’re following the signals.  Once they get to the area, then they have all these different actions. It’s really fascinating. First of all, they can send out certain molecules in the vicinity where they can bring in different immune cells. Immune cells, one is that they can clean up the damaged tissue. You need macrophages, you need neutrophil, you need things to get things gobbled up and cleared away, or if there’s infection, kill them off, and you take away what the damage is.  Then the cells also has ability to communicate with the local stem cells. It’s not the mesenchymal stem cells themselves, that becomes to replace a tissue. That was misconception, that’s what people thought a while ago. But really the way it does, is that it talks to your local stem cells and tell the local cells, “Hey, wake up. Stop being dormant. Come out and fill up this tissue, replace it with healthy tissue.”

That’s one part of the function. That’s called paracrine effect. So, sending out signals. But has some other really direct effects. For example, has direct antimicrobial effect. It actually S antimicrobial peptides, and then it also has what’s called anti-apoptotic. It actually saves tissue. Let’s say you have some tissue that’s damaged either, can be by heat, by radiation, by whatever, the damage.  When tissue is damaged, they actually leak out calcium, leak out all these signals that tells neighboring cells to die. Things are not dying just from being damaged, but also from the signals from the damaged cells. What stem cells can do is to prevent the neighboring cells from dying, so they have a protection kind of a mechanism.  Then they also have apoptotic… They can be anti-apoptotic, so preventing programed cell death when necessary, but they can also cause programed cell death when it is old, senescent cells or cancerous, precancer cells, because they can recognize, there’s something wrong with the cells. So, I’m going to tell the cells to die. It also can promote… These mesenchymal stem cells can promote angiogenesis, or promoting blood vessel formation.  It doesn’t do you a whole lot of good to have a lot of cells, but with no blood supply. Also, there’s another thing that they do, that’s really fun, they’ve caught that on electro microscopy, what’s called mitochondria transfer. These new young cells actually can transfer their healthy, vibrant mitochondria into the host cells. In a way, injecting some life force into the host. There are a lot of different mechanism of actions. It’s pretty exciting.

Dr. Weitz:            Okay. What are some of the mesenchymal cell conditions that stem cells can really benefit?

Dr. Kong:             Okay. First of all-

Dr. Weitz:            Can they be a viable alternative for patients who say, are in need of a knee or hip or shoulder replacement?

Dr. Kong:             Yeah. Let me just do a disclaimer, since the FDA, it’s very much watching out for consumers and I’m watching out for consumers as well. We cannot make any claims because so far, with the one exception of blood disorders that stem cells are indicated for, there’s been no other FDA approved indications. Let’s say somebody has blood disorder, they can give them a bone marrow transplant, or even umbilical cord blood transplant, and that can help replace their bone marrow supply and help regenerate their entire hematopoietic system.  That’s good. That I can say, yes, stem cells can treat that. Everything else, I cannot use the word treat. When we talk about conditions, it’s really about the mechanism of why the condition happens and then how stem cells can help assist repair.  I have seen that happen over and over and over in my clinic. Of course, I also founded an academy, which is called American Academy of Integrative Cell Therapy. Our mission is to educate healthcare providers on how stem cell therapy can help with different conditions.  There’s actually course when doctors take the course, they actually take away over 300 published articles, they’re all categorized by organ systems and disease categories. There are research, very active research into many, many disease categories, showing really encouraging results. That’s what I’m trying to show to doctors so they can help their patients.

Dr. Weitz:            Do you have patients who’ve seen you, who had severely degenerative knee who were told they needed a knee replacement, that you treated them with stem cells? Then also, when is it a good idea to use PRP versus stem cells, or when do you use PRP with stem cells?

Dr. Kong:             Okay. What you said, you just described my first stem cell patient. My very first stem cell patient, he was 69 at the time, now he’s 74. He had bilateral arthritis, which he went the two orthopedic surgeons who both told him he absolutely needed bilateral knee replacement. He didn’t really want to do that, he wanted to see if stem cells could help him.  At the time, I did give him an IV treatment because the outer one third of the cartilage of a knee joint is nourished by the blood supply. The inner two thirds is nourished by the synovial fluid. I wanted to attack from both angles. When I give it through IV, it can help nourish the outer one third of the cartilage, and injecting into the knee joint, that helped provide the stem cells to us right there, because it’s very difficult to get the stem cells from blood, into the joint space.  What’s fascinating was that… First of all, this is five years later, he’s walking about four miles every day, his knees are doing fantastic. He doesn’t even think about it very much. What’s really interesting was the next day, he told me, he said, “Hey, I slept through the night. I haven’t slept through the night for decades, because of my shoulder injury.”

When he was late teens, his car rolled over, damaged his shoulder, and it never, I guess, never fully healed. Every time when he turns around, turns in his bed, the sharp pain will wake him up. I never touched his shoulder, I didn’t even know about the problem off his shoulder. I just gave him a simple IV injection, and then one injection into his knee. This is five years later, his shoulder was fixed. I never touched his shoulder. That just shows you the intelligence of the cells that they can find where you need repair. That’s one thing. Then you asked about PRP. The way I do injections-

Dr. Weitz:            Hang on one second, let me just ask you about that patient with the knee. Did you go back and do maybe another imaging, maybe another MRI? If you did, would we see that the cartilage was regrown, do you think?

Dr. Kong:             I didn’t do it on this patient, but there was another patient, which I did not even inject into the knee, I just gave her IV treatment and she did have a pre-injection MRI, and then post, a few months after. It showed her knee cartilage has regrown, which shocked her orthopedic surgeon who had never seen anything like that, because they didn’t know about stem cells. Of course, you don’t see regrowth of the knee.  The body is incredible. If you just give the right signal, it can do amazing things. I want people to feel hopeful, to realize, your body is this incredibly intelligent machine. We can’t even make a single cell. Our human mind can’t even make a cell, let alone this entire body. There’s incredible intelligence that you are walking around with.  Anyhow, as far as the PRP… PRP is obtained from a person’s blood. You take the blood and you spin it out. You get some more growth factors from the platelets, because platelets do secrete a lot of growth factors and help promote healing and all that. It is very helpful. I almost never use PRP alone, I can. But it’s like when you have the best tool in the world, why would you use the second rate?  Yes, maybe because it’s a lot cheaper. But you get much longer lasting results. For example, erectile dysfunction, a lot of people do PRP, inject PRP into the penis. For people who have done it for a long time, specialty clinics. The feedback I got was PRP injections, the effect may last, two to three months. But when you do stem cells, it lasts at least six months, six to 12 months.

There’s a difference in the potential of the cells, because when the cells can keep secreting these beneficial factors and they actually help repair DNA, which I haven’t mentioned because stem cells will secrete exosomes. It will respond to environment and secrete the correct combination of molecules into the exosomes. Exosomes contain micro RNA. These micro RNA can actually get into cell nucleus and help repair DNA.  That’s what causes the long term benefits. I believe that some of the antiaging benefits has a lot to do with that. When you make the DNA younger, when you make it function better, then you are dialing back the clock. The PRP has potential, but it’s shorter lived and it doesn’t nearly have as much potential as the stem cells. But I do like using it because you’re giving extra… I use it with stem cells for all kinds of injections. We can inject into the penis, or any joints and muscle, tendon repairs, or hair, face restoration.  I do use PRP in all those cases, because I like the extra growth factors, and the fact that they do nourish the stem cells and help the stem cells work even better. That’s my philosophy on-

Dr. Weitz:            For regrowing cartilage in joints, or helping patients with degenerative needs to feel better. Do you recommend specific foods or nutritional supplements to help facilitate that? I’m thinking about things like glucose [inaudible 00:35:13]-

Dr. Kong:             Those are great. Those are good.

Dr. Weitz:            Yeah. Collagen supplements, SPM, fish oil, et cetera.

Dr. Kong:             Absolutely. We do advise our patients with all that, and also, I incorporate peptides as well. There are good peptides that help with muscular skeletal healing, like TB-500.

Dr. Weitz:            Which are your favorite peptides?

Dr. Kong:             BPC-157 and TB-500 are two of my favorites. Very-

Dr. Weitz:            What do you think about the oral BPC-157?

Dr. Kong:             I haven’t tried it. It’s supposed to work well, but I don’t… Have you tried it?

Dr. Weitz:            Yeah. We’ve been using it. We find it’s very helpful for leaky gut and it does help with some musculoskeletal injuries as well.

Dr. Kong:             Yeah, right. Great for gut healing, just overall fantastic anti-aging agent.

Dr. Weitz:            Let’s see, let’s talk about degenerative neurological conditions like Alzheimer’s.

Dr. Kong:             Things like Alzheimer’s, I really believe, whether or not it’s Alzheimer’s or Parkinson’s or MS, these are all kinds of different names for the same problem. Like autoimmune disease, whether or not you manifest in the gut or in the brain or in your muscles, it’s really the similar pathophysiology. We still don’t know exactly why yet, although we know there’s rampant inflammation. There are a lot of different theories. But I think, no matter what the cause is, the final funnel is inflammation.  If you can help reduce the inflammation, you can definitely help reverse some of the processes. But as far as helping with these conditions, I’ve definitely helped people with Alzheimer’s, with MS, with Parkinson’s. Definitely, I’ve seen improvements. Improvements, probably no medication has been able to achieve, but did I get them to be 100% back? No. I wish I did. I did get a person 100% back, that he’s on the brink of death, who had liver cirrhosis, which was really shocking to me, because he was already in hospice. That traditional medicine, there’s no remedy. That’s it.

Dr. Weitz:            It’d be interesting to take patients who are going through the Bredesen Protocol, as you probably know, Dr. Dale Bredesen is actually helping to reverse Alzheimer’s in patients. He just published the first study with 25 patients using a full functional medicine approach. It’d be interesting to add stem cells to his protocols.

Dr. Kong:             Absolutely. Absolutely. I remember my first dementia patient, she was very, very late stage. When she came to me, she came with her husband, she was singing and she was asking me if she could marry me. She was completely just not… She’s in her 60s, her mind is very far away from her. She also had not been feeding herself for two months, that she might be hungry, but there’s no volition, there’s no ability to just pick up a knife and fork and just eat.  What’s interesting was the next day, after the stem cell therapy, about 10 o’clock, she had, again, a plate of food in front of her and she just picked up a knife and fork and just ate. Her husband was looking at her in shock. Then she looked at her husband like, what’s your problem? Why are you staring at me? It was really interesting, and I do believe that’s the acute anti-inflammatory action that her brain pathways has been so clogged up, that the communication was stopped, signals could not get across. Once you calm the inflammation, all of a sudden, you got the brain pathways actually are communicating.


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Dr. Weitz:            How do you administer stem cells for a patient with a degenerative neurological condition? Are they injected into the brain or are they just put intravenously?

Dr. Kong:             I do it through intravenous. I know there’s some doctors who inject into the brain, which you can do as well, but there’s more, inject into the spinal canal or into the ventricles, which is even more high risk, But even injecting into spinal canal, you’re talking about much higher risk. But one thing I love about doing IV treatment is that, I still believe that all these neurodegenerative conditions, they’re still a systemic issue. They’re just manifesting the brain.  When you can repair your body, all of a sudden your brain can function better. This is all one entity. It’s, blood brain barrier, whatever. It is all one continuum. You want to treat everything. That’s my philosophy.

Dr. Weitz:            What about stem cells for patients with cardiomyopathy for congestive heart failure?

Dr. Kong:             There’s some good research supporting the benefits. Definitely-

Dr. Weitz:            I think in those cases, it’s typically injected directly into the heart.

Dr. Kong:             Not necessarily. Intravenous is fantastic because, if you think about intravenous administration, the first place to go back to is your heart, and then get to come to the lungs and go back to your heart. If your heart has a lot of need, the cells are going to be attracted to those inflammation, those screaming signals.

Dr. Weitz:            How are stem cells beneficial for antiaging?

Dr. Kong:             I actually did a presentation at a few conferences, particularly about this subject, because I realized, because I’m interested in this and I want to help people to live longer and more vibrantly, but what are the evidence? I started looking up, what kind of evidence there has been. It’s really fascinating.  Yes, it has shown beneficial anti-aging effects in humans, but there’s probably more convincing evidence in animal because you can actually observe lifespan. When they did experiments in mice and rats, it’s pretty consistent, the lifespan extension is about 30%, with regular IV infusions of young stem cells. So, young mesenchymal stem cells.  It is really cool. I think one experiment started giving these old mice, young stem cells and these old mice are so old that they’re the human equivalent age of 75 years of age, where half of their peers have died. That’s how they started the treatment point.

They give it to one group, just sham, like a placebo. The other group, they gave them real stem cells. The group that got real stem cells, I think was like monthly infusion, they actually, from the time of the experiment, to the time they died, it was three times as long as the group that got placebo. Not only they live longer, but they’re moving better, they’re fast better, their cognition is better.  Then there’s other studies that were actually looking at acetylcholine levels, growth factor levels of both the muscles and the brain, and it was really incredible because when they gave the older animal younger cells, all these measurements have gone back to the younger level. That’s pretty incredible evidence. What you can measure actually went back to younger level or even better than younger. It was really fascinating. You can imagine how it helps with maintaining physical health, the muscle mass, and then your brain health, just from those things they measured.

Dr. Weitz:            What about patients with diabetes? Can stem cells potentially cause them to be able to regenerate those pancreatic beta cells?

Dr. Kong:             Yeah, absolutely. This is another thing that’s really exciting, because not only type 2 diabetes, it can help reverse, but also type 1 diabetes. We’re seeing of regeneration of beta cells in the pancreas and actually endogenous secretion of insulin.

Dr. Weitz:            Do we have cases of patients who were type 1 who are no longer insulin dependent?

Dr. Kong:             I don’t have those patients, but certainly people have done studies on patients and published results.

Dr. Weitz:            Interesting. Now, what about cancer? First thing, when I think of stem cells and cancer is since stem cells cause cells to grow, you might not want to use them in patients with cancer, because you might cause the cancer cells to grow as well, right?

Dr. Kong:             Yeah. That was my original hesitation. I used to not treat patients who had cancer within the last three years. But what’s interesting was, as I delve deeper into the science and the research, what I saw was yes, if you’re using cells from your own body, from your own fat or bone marrow, boy, you’re taking a risk. Because when they put… For example, this one study, when they put this brain tumor cell, very virulent glioblastoma, when they put the brain cells next to the tumor cells, next to the mesenchymal stem cells, that’s extracted from fat, the tumor actually grew.  But what’s interesting was that when they put mesenchymal stem cells from the umbilical cord next to the tumor cells, the tumor shrunk. They did the same experiment, putting the cancer cells, transplanted it on the animal, put it on the animal body and then put the mesenchymal stem cells either from the fat or from the umbilical cord next to the cancer cells, the same thing happened.  If it’s next to mesenchymal stem cells from the fat, the cancer grew. If it’s next to MSCs from the umbilical cord, the cancer shrunk. We can’t just lump all stem cells together, because when you have young stem cells, they have capabilities that you no longer have when you get older. There’s degeneration. There’s degeneration of life, that’s why we die.

The cells, all the stem cells in your body have lost its capacity, lost its original capacity. It’s not as vital, and that includes the capability to detect cells that shouldn’t be there and have the ability to destroy it. Somehow, as we get older, we lost that ability. I would be very, very, very cautious with somebody that uses their own stem cells. If they have any proclivities for cancer. Of course, the problem with embryonic stem cells is that they can become a tumor themselves. They can just go crazy and wild and start to become all kinds of tissue called teratoma. That is something that doesn’t happen with umbilical cord-derived MSCs.  It’s almost like the umbilical cord-derived MSCs are still very vital, very young, but has lost some of this wildness. So, it’s not going crazy anymore.

Dr. Weitz:            With a cancer patient, if you were considering doing regenerative therapy, you wouldn’t want to take embryonic stem cells, because they might have too much growth potential. If you take cells from your own body, they may already have an oncogenic potential. So, better to take stem cells from a younger person who’s past the embryonic stage and potentially they may have more anti-cancer fighting properties?

Dr. Kong:             Right. The cells from your own body, it’s not so much they have oncogenic potentials, is that they are indiscriminately telling everybody to grow. If you have existing cancers, then these cells are not going to be able to tell the difference, and it’s just going to tell everything to grow, and then that’s going to promote your cancer growth. That’s the part to be very careful with.

Dr. Weitz:            Right. What about the cosmetic stuff, like care growth and skin?

Dr. Kong:             Yeah, that’s the really fun stuff.

Dr. Weitz:            I’ve seen pictures of these vampire facelifts. It’s pretty gross looking.

Dr. Kong:             It’s pretty incredible. I have pictures of my patients just plastic-

Dr. Weitz:            You take this spiny roller and you make little holes in their face.

Dr. Kong:             I inject stem cells into the skin, and then I do micro needling on top, and the results are just incredible. Even with one treatment, drastic, drastic improvements in skin. It’s amazing what these cells can do. Same thing with hair. The hair is going to take a little longer because the hair follicles, the way they come out, every six weeks, they’re not all at once, they’re not active all at once. You can target one group, but then there all these other group are still dormant. So, you have to do it again.  It takes about three sessions. But we’re seeing great results. If you’re completely bald, if it’s shiny, I’m sorry, we can’t do it. But if you’re just thinning, it’s like great, I can help you.

Dr. Weitz:            Cool. Okay. I think those are the questions that I had prepared. Any final thoughts you want to leave our viewers and listeners?

Dr. Kong:             Yeah, sure. I’m all about full health. I really truly believe that one can only achieve a real health and happiness by taking care of yourself physically and mentally, which is understanding why you do the things you do, and what has affected you in the past, and spiritually, all three are very important. That’s probably another reason at clinic, we start doing ketamine treatment.  I find it transformative, and I do think spirituality has a lot to do with it. It lets you out of your own little ego and tap into a whole different realm and capabilities. It’s actually really helpful for chronic pain, but it’s great for depression, anxiety, PTSD, addiction. I want to help people heal fully. That’s something I’m really excited about, what we’re doing in the clinic. Again, that’s Western medicine, that’s an anesthetic, but it happens to be tremendous in what it can do in promoting brain regeneration. That’s another huge tool.

Dr. Weitz:            Ketamine, is that similar to the low dose psilocybin type treatment?

Dr. Kong:             It is not low dose, what we do.

Dr. Weitz:            Okay.

Dr. Kong:             I guess people can do it low dose, but the way we do it is an IV infusion. So, it takes about an hour.

Dr. Weitz:            Ketamine, is it a psychedelic?

Dr. Kong:             Well, it wasn’t developed as a psychedelic, it was developed as an anesthetic, so you can do surgery on people at much higher dose. But what they realized is that at much, much, much lower dose people have a psychedelic experience, but they also get healed of their depression, and the PTSD. A lot of these things go away at the same time. That’s how it got started. It’s a much, much lower dose than anesthetic dose, an extremely safe… It’s actually one of the safest anesthetics in the world. It is one of the essential medications on WHO’s list.  It’s an extraordinary medication, but now we’re using it. Right now is the only FDA approved psychedelic medication.

Dr. Weitz:            Okay. That’s great. How can listeners get a hold of you? What’s your clinic information, your website?

Dr. Kong:             Our clinic is in the greater Los Angeles area. Right now our clinic website is THEA CRM. So, THEA Center for Regenerative Medicine. You can just look up THEA, T-H-E-A-C-R-M.com. They can also look me up on YouTube. I have a lot of interesting videos on YouTube, just my name, Joy Kong MD, that’s the channel. I go into more about different types of stem cell treatments and just a lot of nitty gritties that people don’t talk about.

Dr. Weitz:            Thank you, Joy.

Dr. Kong:             You’re so welcome. It’s fun talking about all this, getting the information out.

Dr. Weitz:            Absolutely. Thank you for sharing some interesting information.

Dr. Kong:             Yeah. Thank you for being willing to learn and join the excitement.

Dr. Weitz:            Always learning. That’s one of the great things about doing a podcast.

Dr. Kong:             Yes. Okay.

Dr. Weitz:            Okay. Thank you.

Dr. Kong:             You’re welcome. Take care. Bye-bye.



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



Healthy Bones with Dr. Joe & Lara Pizzorno: Rational Wellness Podcast 236

Lara Pizzorno and Dr. Joe Pizzorno discuss how to Promote Bone Health and Reverse Osteoporosis 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

2:31  An acid forming diet like the Standard American Diet (SAD) contributes to bone loss by leaching calcium out of the bones to restore your pH to the right alkaline balance.  This concept of an alkaline diet affecting the pH of the body has been criticized by medical researchers because they measured people’s blood pH before and after an alkaline or acid diet, and they found no difference in blood pH, so they criticized this whole idea. But the body works very hard to maintain the blood pH in a very narrow range but that process may involve the kidneys excreting more acid, which increases risk of kidney stones, and it may involve the body taking calcium out of the bones to help alkalinize the blood. If you want to prevent and reverse osteoporosis, the first thing you need to do is to alkalinize the diet by eating fewer animal products and by reducing salt consumption.  If people consume too much salt, it puts so much load on the kidneys that the kidneys can’t get rid of acid as well. You need to add more vegetables and fruits, which are generally more alkaline.  Even though you may want to reduce animal protein, it is still important to get enough protein, say at least 65-70 mg per day, but you need to balance out this protein with enough calcium, say 1200 mg of calcium per day.  Calcium can come from broccoli, spinach, and dairy other than milk, provided that you can tolerate both the lactose and you don’t form antibodies to milk protein.

12:22  The high sugar and carbohydrate content of the Standard American diet (SAD) cause blood sugar and insulin spikes and this creates inflammation.

12:50:  Unhealthy fats like saturated and trans fats can negatively impact bone health. The healthiest fats are the Omega 3s, which should be in a proper balance of 4:1 with Omega 6 fats.

13:29  But are saturated fats really unhealthy?  If the saturated fat is from grass fed animals, then it is healthier than from animals that are fed corn.  Beef that is pastured will have conjugated linoleic acid, CLA, which is anti-inflammatory and beneficial. Also, if animals are fed corn, then their fat will have high levels of arachidonic acid, which may be causing the problems that are being blamed on saturated fat, according to Dr. Pizzorno.  The other thing to consider is that animals store toxins, like heavy metals in their bones, so bone broth may not be a good idea.

18:05  Flouride.  According to Lara, flouride in small amounts may be beneficial, but in the US excess flouride–flourosis–is very common in younger people, so we are probably best avoiding toothpaste with flouride and avoiding flouride in the water.  Flouride replaces the calcium in the bones and the teeth but it makes for a different bone structure, which is not as well connected. 

20:53  Heavy metals.  Heavy metals can play a negative role in bone health, esp. cadmium, lead, and mercury.  Cadmium causes damage to the bones and the kidneys.  Our kidneys are really good at scavenging cadmium and clearing it out of the blood, but it can get stuck in the kidneys and poisons the kidneys.  The kidneys are responsible for converting  1-hydroxy vitamin D into 2-hydroxy vitamin D, which is the active form. Cadmium also poisons the osteoblasts in the bones, which are responsible for laying down new bone.  Studies done in Seattle show that 20% of the osteoporosis of women was coming from cadmium that came from eating soy products.  If lead is present in the bones, pregnant women’s bones will release the lead to go into the bones of the baby, unless plenty of calcium is included in the diet.

25:32  Lara found out in her early 40s that she had severe osteopenia after taking a DEXA scan at a trade show. She was shocked.  But everybody in her family has had osteoporosis, so she has a genetic tendency. She discovered that her vitamin D level was low and at the time the recommended amount was 400 IU, but she  found that she needed 10,000 IU per day to bring her level up.  She also started taking vitamin K2 MK7, which is required to activate the Gla proteins (Osteocalcin, which pulls calcium into your bones, and Matrix Gla protein, which prevents calcium from depositing in your soft tissues like your blood vessels, your kidneys, your breasts and your brain).  Unfortunately K2 is not present in many foods. It is found in small amounts in certain cheeses but the only good food source is a fermented soybean product called Natto, that smells like dirty socks, so supplementation is necessary.  You should get 100-200 mcg of MK7 and you should have equal amounts of vitamin A and D.  If you have cardiovascular or kidney damage, then take 360 mcg of MK7.  Lara also take B complex. She had a H. pylori infection in her gut, which can decrease hydrochloric acid production and HCL is need for calcium absorption.  She took triple antibiotic therapy, which cured her H. pylori.  Now at age 73 Lara has healthy bones with no osteopenia.

37:21  Drugs that interfere with bone health.  There are a number of prescription drugs that can interfere with bone health, including statins, certain blood pressure medications, and even antidepressants.  Statins, esp. at higher dosages are bad for bone by interfering with cholesterol production and we need cholesterol to make our hormones that are good for bone health.  Cholesterol is used to make vitamin D and to transport vitamin K.  Dr. Pizzorno feels that cholesterol has been overly villified as the use of statin medications has been promoted as the answer for preventing heart disease. Dr. Pizzorno wrote an article, The Vilification of Cholesterol for (Profit ?) about this topic.  Some blood pressure medications interfere with bone health. Thiazide diuretics protect bone, while loop diuretics and calcium channel blockers harm bone.  SSRIs, which are antidepressants, promote bone loss. They increase the production of serotonin and serotonin binds to a receptor on the surface of newly formed osteoblasts and stops them from developing, so your bone building cells don’t develop.

44:44  Calcium.  Some studies that have shown a negative effect on heart health with calcium supplementation did not also give vitamin D and vitamin K. You need all three of these nutrients working together.  And magnesium should be taken with calcium in a Calcium: Magnesium ratio of 2:1.  With respect to types of calcium, despite a lot of claims, calcium hydroxyapatite is not a more effective form of calcium and it contains phosphorus, which is bad for bones, for cardiovascular disease, and for kidneys.  Calcium citrate can be a good choice, since citrate is an alkalinizing agent and it can be absorbed without producing a lot of stomach acid.  Lara recommends consuming about 1,200 mg of calcium per day from both diet and supplements with no more than 500 mg at a time.  It is best to take calcium supplements with a meal since the hydrochloric acid produced for the meal will make it easier to absorb the calcium. She also recommends taking strontium citrate to promote greater bone density.  Strontium has a bad reputation because of a pharmaceutical version of strontium ranelate that was developed that was toxic because of the ranelic acid.  Strontium is a natural bisphosphanate.  It acts through several different mechanisms both to increase osteoblast activity and to increase calcium absorption.  There are also some other trace minerals that are synergistic with calcium, including potassium.

58:11  Boron. Boron is very helpful for bone. It slows down the activation of the 24-hydroxylase enzyme that breaks down estrogen and testosterone. Boron is even used in cancer treatment.  Most people should consume 3 mg boron per day and those with with degenerative joint disease like osteoarthritis would benefit from 6 mg per day.  Research shows that 6 mg of boron per day prevents bone loss. Here is a paper that Lara wrote about boron, Nothing Boring About Boron.  



Lara Pizzorno is the co-author of the newly released book, Healthy Bones, Healthy You!, which she co-wrote with her husband, Dr. Joe Pizzorno.  Lara is the best selling author of a previous book on bone, “Your Bones: How you can prevent Osteoporosis and have strong bones for life-naturally” .  Lara is also the editor of Longevity Medicine Review and the senior medical editor for SaluGenecists and Integrative Medicine Advisors. 

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


Podcast Transcript

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

I’m very excited today to be getting the opportunity to speak with Lara and Dr. Joe Pizzorno on bone health. Lara Pizzorno is the bestselling author of a previous book on bone health, Your Bones: How You Can Prevent Osteoporosis and Have Strong Bones for Life Naturally, and she is now the co-author of this newly released book, Healthy Bones, Healthy You, which she co-wrote with her husband, Dr. Joe Pizzorno.  Lara is also the editor of Longevity Medicine Review and the senior medical editor for SaluGenecists and Integrative Medicine Advisors. Dr. Joe Pizzorno is one of the most important naturopathic doctors, educators, researchers, and one of the founding members of the functional medicine movement. Dr. Pizzorno has written or co-authored more than 12 books, including the Encyclopedia of Natural Medicine, which has now sold over two million copies and pretty much everybody who has an interest in natural medicine has a copy on their bookshelf, the Textbook of Natural Medicine, Natural Medicine for the Prevention and Treatment of Cancer, and The Toxic Solution, among others.  Thank you so much for joining us today on the Rational Wellness Podcast.

Dr. Pizzorno:                      Good to be with you. Thanks for the invitation.

Dr. Weitz:                           Before we get into the questions, I wanted to tell you that this new Health Bones book is really a great read and it goes into incredible depth about so many aspects of bone health that are often not discussed, such as, how heavy metals negatively impact bone health, how common chronic diseases such as heart disease, kidney disease, IBS and hypothyroid impact bone health and what to do about it. I think both laypersons and practitioners will learn a lot from reading this book, and not just about bone.

Lara:                                   Thanks.

Dr. Weitz:                           You guys did a great job. Lara, let’s start by talking about some of the factors that cause bone loss in our US culture including the standard American diet? How does a diet that’s high in acid-forming foods contribute to osteopenia and osteoporosis?

Lara:                                   Well, when the overall pH of the body is not in good balance, your body will constantly try to reestablish that healthy balance because many cellular activities can’t happen properly, the enzymes won’t activate, unless they’re at a certain pH level, so when you lose that level, your body instantly tries to reestablish it, and the way that it does that is by making you, typically you’re more acidic and so it tries to withdraw alkaline compounds from your bones, namely calcium, to restore the alkaline balance, and if you’re chronically doing that, you just keep pulling calcium out of your bones and eventually that results in bone loss.

Dr. Weitz:                           Right. Now, I agree with you, but some folks criticize this whole concept of alkaline balance because they say that the blood levels, your pH in your blood, is always going to stay in a very narrow range no matter what, so it’s not really that relevant.

Lara:                                   Okay. I’m going to let Joe do this one because he’s on PubMed with papers on this issue.

Dr. Pizzorno:                      This is my topic.

Lara:                                   Yeah.

Dr. Pizzorno:                      Dr. Weitz, one of the things I enjoy about my life right now is I get to go back and look at age-old natural medicine concepts from the perspective of modern science. I suspect you’ve had this experience, as well. If you look back and read the writers of 100 years ago, they had some great clinical insights but they were limited by the science and technology of the time, their understanding of medicine at the time. They started to notice that people who ate what they thought was an acid-forming diet seemed to be less healthy than people who ate an alkaline-forming diet. They started advising people to eat a more alkaline-forming diet.  What the MDs said was they went through and said, “Oh, well, let’s see what this idea is valid.” They measured people’s blood pH before and after an alkaline or acid diet, and they found no difference in blood pH, so they poo-pooed the whole idea. Okay. Well, there’s two problems with that. Number one, as you well know, since you’re medically trained, the body works really hard to maintain the pH over a very, very, narrow range, because, as Lara said, our enzymes require an exact pH. If you vary on the pH, they don’t work very well, so by making it the very narrow range, so when a person’s eating an acid-forming diet, that means that the foods that are eaten are metabolized to form more acid. Not that the food itself is acid, but it’s how it’s metabolized, the body has to adapt.

The first thing it does is the kidneys start excreting more acid compounds, and which makes you have more kidney stones, by the way, but kidneys adapt. As long as a person has good kidney function and is relatively younger, not too much trouble.  But as people get older, their kidneys don’t function as well. They’re now less able to get rid of excess acid. Now the body has to adapt in other ways. What’s it do? It takes calcium out of the bone to normalize the pH, so it looks like the body’s just fine because the blood pH hasn’t changed, but we look at what’s going on in the bone to adapt to the excess acidity, it’s bad.  And it turns out that, and the research has been, taking older, post-menopausal women, with osteoporosis, don’t give them vitamin D, don’t give them vitamin C, and calcium.  You just alkalize their diet, and they start rebuilding bone. Now, of course, we do way better than just alkalizing, but it’s part of the picture. I think you’ll hear from Lara again and again, you have to deal with the whole picture, not just one piece of it and expect that to fix it.

Dr. Weitz:                           How do we alkalize their diet? What do we take out? What do we put in?

Dr. Pizzorno:                      You want to decrease the acid-forming things and increase the alkaline-forming things, so what causes excess acid?  Sulfur-containing amino acids account for about one half of the excess acidity in the diet. Okay, so, you have to eat less sulfur-containing amino acids which tend to mean less animal products. The other half is really surprising. It sure surprised me, is excess salt consumption, because when people consume too much salt, it puts so much of a load on the kidneys, the kidneys can’t get rid of the acid, as well.  And then in terms of the alkaline side, fruits and vegetables. A plant-based diet is alkaline. Just, once again, a plant-based diet is more alkaline.

Lara:                                   Also calcium. There have been studies done on people with post-menopausal women with bone loss, and the ones who are getting written, because protein is a big issue, and meat is a really good source of protein, and so you don’t want to skimp on your protein, but you have to have the calcium to balance the effects of the protein, and when they looked at people who were consuming at least 1,200 milligrams of calcium daily and 65, 70 grams of protein a day, they did better than the people who were consuming less protein and less calcium, and of course the people who consume a lot of protein and not much calcium really tanked. Not a good outcome.

Dr. Weitz:                           What are the sources of calcium in the diet? Is dairy a good source?

Lara:                                   Well, of course Dairy’s an excellent source and there are many vegetables that are good sources of calcium. In the book, I have a whole table of the common sources and what a serving provides and so forth. There’s dozens of them. If you like broccoli, broccoli’s a good source, spinach.

Dr. Weitz:                           Yeah. Now, dairy’s a controversial one, especially in the natural medicine, functional medicine movement. I think a lot of us have sort of soured on dairy in the sense that the dairy proteins are highly allergenic and difficult to digest, and then most of the dairy products are homogenized and pasteurized and there’s problems for a lot of people in breaking down the lactose in dairy, so I think that dairy is not as popular these days among natural doctors and practitioners.

Lara:                                   I think that’s true. I also think that the key issue with dairy, if someone reacts to casein, to dairy protein, then they need to avoid dairy. It’s going to cause inflammation, and anything that chronically causes inflammation will excessively activate the osteoclasts, which are the cells that break down bone, but if someone is not reactive to dairy, then dairy foods can be very beneficial. The issue with dairy, the one thing that you really have to avoid if you’re going to have dairy is milk. Things that are fermented, the cheeses and so forth, they’re very low lactose content, and even in the quote, unquote, lactose-reduced milk or lactose-free milk, all they do is apply lactase, which is the enzyme that breaks apart lactose, to the milk, so you still have the components of lactose which are glucose and then another sugar called galactose, and galactose is an incredibly inflammatory sugar.  It is used in research to prematurely age animals, and the amount that is used in the research to have this effect is comparable to what you would get if you drank two glasses of milk a day. You can get away with one, but more than that, you do not want to have. Outside of that, milk has whey. It’s a very anabolic protein. If you can tolerate milk, I mean, dairy products, fine, just don’t have a lot of milk.

Dr. Pizzorno:                      Yeah. I think if you can-

Dr. Weitz:                           What do you think about raw milk versus pasteurized milk, and then, a lot of other people in the natural medicine world have moved away from cow’s milk to sheep’s milk or goat’s milk or camel’s milk.

Lara:                                   I’ve never tried camel’s milk.

Dr. Weitz:                           According to Dr. Vojdani, it’s the least allergenic of all the animal milks.

Lara:                                   Yeah. I don’t think it’s readily accessible in the US.

Dr. Weitz:                           There is one company that distributes it.

Lara:                                   Well, if you can get it and you like it, okay, but again, I think it will still have lactose in it. You’d have to check the lactose content of the milk.

Dr. Pizzorno:                      I think also, Doctor, as long as there’s not an analogy, fermented dairy products, we’re okay with, but the raw dairy products in terms of raw lactose, as Lara said, we see problems with it.

Dr. Weitz:                           Right, so, essentially, you’re talking about cheeses and yogurt, right?

Lara:                                   Right, and there are some cheeses that have high content of vitamin K2, which is incredibly protective for bone and the cardiovascular system.

Dr. Weitz:                           Right. Right. Yeah. I definitely want to get into the vitamins in a few minutes. Other aspects of the standard American diet that contribute to bone loss. You talk in your book about a diet that’s high in sugar and refined carbohydrates. Why is this bad?

Lara:                                   Because those cause insulin spikes, and when sugar is in the bloodstream and it’s not absorbed well into the cells, it’s very inflammatory.

Dr. Weitz:                           Okay, and what is the role of unhealthy fats in bone health and which fats are healthy and which fats are unhealthy?

Lara:                                   Well, the healthiest fats are the Omega-3s, properly balanced with Omega-6s which are also helpful when they’re in no more than 4 to 1 Omega-6 to Omega-3 balance. Both types are healthful. The unhealthy fats are the too much saturated fat, and of course the trans fats are extremely unhealthful in any amount, and those are really in processed foods, primarily, so you want to limit trans fats as much as you can.

Dr. Weitz:                            Now, I think the trans fat is uncontroversial, but some in the natural medicine movement have come to see saturated fat, in some cases, as not necessarily unhealthy or maybe a healthier source of fat, and as I’m sure you know, a lot of people recommend grass-fed butter and other sources of saturated fats. What do you think about, or coconut oil which also has a fair amount of saturated fat?

Lara:                                      I think it depends on the life of the animal from which the meat or fat or anything else was derived. Animals, beef, that’s pastured, will have, in the fat, is going to have a compound called conjugated linoleic acid, CLA, which is extremely anti-inflammatory and highly beneficial, and then I don’t think it’s as much of a problem. We need fat. Our bodies need fat. 25 to 30% of the diet, at least, should be fat, but the type of fat that’s consumed is what the issue is, I think.

Dr. Pizzorno:                      I’d like to add a little nuance to this. I wonder if you see this, as well. Whenever a new idea comes out or another new fad comes out, I was try and step back and say, “Okay, now, how does that match up with nature?” Somebody comes out and says, “Well, this food source that people have been eating is a major cause of disease,” well, I look at, first, has something been done to the food to make it bad, or is it a valid concept, and so many of these times, what they’re doing is they’re making a mistake. For example, this whole thing about saturated fat. Now, yes, at high enough dosages, could be a problem, but in most situation, the saturated fat research came from animals fed corn, so that they have high levels of arachidonic acid.  There’s a direct correlation between arachidonic acid and saturated fat. It’s not the saturated fats causing the problem, it’s the arachidonic acid.  And arachidonic acid is only a problem because, rather than feeding cows grass, getting all this better balance of fats, well, we’re giving them corn. Not only giving them corn, but we’re also giving them medicine chemicals that are poisoning them. It gets in their milk, so we’ve actually gone from a relatively healthy food in a natural environment, particularly fermented, at the milk part, or even as the meat, eating the meat when it’s wild, to now this domesticated thing which has all the wrong fats in it, all these toxins in it, and it’s not healthy food.

Lara:                                   Animals store toxins in fat.

Dr. Pizzorno:                      Yes. All these toxins are fat soluble.

Lara:                                   Bones and fat. I’m not a big fan of bone broth because toxins get stored, and heavy metals in particular get stored in bone, then you make a nice, big broth of that and drink it all up. Not a good idea.

Dr. Weitz:                           Right. I guess you’re probably not a fan of liver either, huh?

Lara:                                   Well, if it’s a healthy animal that was pastured and not exposed to a lot of garbage, the liver should be healthful.

Dr. Pizzorno:                      On the other hand-

Lara:                                   Yeah, Joe?

Dr. Pizzorno:                      The liver’s where the toxins are detoxified.

Dr. Weitz:                           Exactly.

Dr. Pizzorno:                      Think about what that means.

Lara:                                   Yeah.


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Dr. Weitz:                            You mentioned fluoride in the book, and so is fluoride good or bad for bone? I know most dentists are highly tout fluoride as good for your teeth because they do these studies and they see the fluoride gets incorporated into the teeth. What do you think about fluoride?

Lara:                                  In very small amounts, it’s fine. In larger amounts, it’s an oxidant, and it’s a very, very powerful oxidant, and they’ve now shown that in the United States, fluorosis, you know the brown kind of pitting on the teeth, is extremely common now in younger people who’ve been exposed to it and in the water and everything. I think we’re just getting too much, so it’s like many, many things. In smaller amounts, it’s beneficial and useful, but when the intake is excessive, it can be harmful, and so that’s what I think about fluoride.

Dr. Weitz:                          Yeah. I think the fluoride just replaces the calcium and it’s actually a poorer mineral to be incorporated into the teeth and bones.

Lara:                                  It makes a different bone structure, yes, and it’s not well connected.

Dr. Weitz:                          The fluoride we’re getting in the water is not even some really clean source of fluoride. It’s coming from the fertilizer industry and it’s this toxic byproduct that they’re throwing in our water, and then, as you say, we’re getting excess fluoride from all these other sources, like people who use these Teflon pans and the PFOAs and the PFOSs that have seeped into the water supply all over the country, so those are also toxic sources of fluoride.

Lara:                                  This is Joe’s area, if you want to elaborate.

Dr. Pizzorno:                      Yes, of grave concern. I thought the fluoride was coming from, it was aluminum manufacturing, aluminum production-based products.

Dr. Weitz:                           What kind of manufacturing?

Dr. Pizzorno:                      I thought the fluoride came as a waste product in aluminum manufacturing production.

Dr. Weitz:                           Is that right?

Dr. Pizzorno:                      That’s my understanding.

Dr. Weitz:                           I thought it was coming from fertilizer manufacturers or something.

Dr. Pizzorno:                      You may be correct. I don’t know. I’m aware that-

Dr. Weitz:                           Anyway, we know it’s a toxic form of fluoride that’s being dumped into the water.

Dr. Pizzorno:                      Yeah. This is a great example of a small amount of a naturally occurring element has been negatively associated with cavities, which is great. Doesn’t mean we put in a bunch of a different form of fluoride into our water supply and saturate people with the water supply, with toothpaste, with getting their mouth washed by dentists. Now, we’re way overloading our systems for fluoride, and there’s some pretty worrisome research on fluoride. I don’t want to get into that, because we’re getting beyond the scope of this book, but people need to-

Dr. Weitz:                           That’s one of the great things about this book, is you mentioned some of the concepts like heavy metals that most people don’t think of as being associated with poor bone health, but you got to take all those into consideration if you’re really going to take a functional medicine approach to bone health, and those can be some of the keys, and just taking vitamin D and calcium’s not enough. You mentioned other heavy metals that play a potentially negative role on bone health.  You mentioned, in specific, lead, cadmium, and mercury.

Dr. Pizzorno:                      Right. Well, this is the area of the book that I had the most involvement with, so [inaudible 00:21:33] why I’m missing so much. Let me give you kind of a big statement first, then I’ll get into specifics. As Lara’s writing this book, and the previous one, she would comment to me about what she’s working on or ask me questions with my medical background. Now she’s getting her master’s degree in nutrition, which is exciting, so she won’t have to ask me as many questions, I guess.

Lara:                                   No. He’s teaching me chemistry now. We’re doing organic chemistry together. It’s very entertaining.

Dr. Pizzorno:                      Not that that’s going to be important to bone health, I think, oh, wow, that’s interesting for heart health. Then she’d talk about something else, and I’d say, “Well, that’s important for the kidneys.” Then she’d talk about something else, I said, “That’s important for the brain.” I started to realize that all this physiology she’s trying to normalize in the bones was the same physiology everywhere in the body, so when we’re writing this new book, the people who are helping us try to figure out what name to give it, when they say, “Healthy bones, healthy you,” when they first said that to me, I said, “Wow. What a great idea,” because the things we do to make the bones healthier make everything else in the body work better, as well.

Cadmium is an example.  Cadmium causes a lot of damage, and a lot of that damage is in the bones and the kidneys, so our kidneys are really good at scavenging the cadmium.  It gets all the cadmium out of the blood within a day or two.  It’s really good at it.  The problem is, it gets stuck in the kidneys and it basically poisons the kidneys.  Why is that important for bone health?  Well, the kidneys are responsible for converting 1-hydroxy vitamin D into 2-hydroxy vitamin D, and that 2-hydroxy vitamin D is the most active form. Happens in the kidneys. The kidneys are poisoned by cadmium, the cadmium conversion, and then directly in the bones themselves, well, it turns out the osteoblasts are responsible for laying down new bones after the osteoclasts have taken them out.

Well, cadmium poisons the osteoblasts, so it can’t form new bone as well, so cadmium is really bad on bone. There were studies done here in Seattle where they determined that 20% of osteoporosis in women in Seattle was due to cadmium and the cadmium was coming from eating soy products that were conventionally grown, because conventionally grown soybeans with high phosphate fertilizers, they’re often contaminated with cadmium. Cadmium goes right into the soybeans, you eat the soybeans, it goes right into our bodies, poison the kidneys, poison the bones.

Lara:                                   It’s not just soybeans that are soaking up cadmium from the high phosphate fertilizers. it’s conventionally grown foods. They all have more cadmium in them now. Another thing with cadmium and the other nutrients is that when there’s a heavy metal around and there’s also a nutrient, like a mineral that you want to absorb in the soil, you’re going to absorb more of the heavy metal if you don’t have enough of the nutrient around. They compete, and so, one example is lead and calcium.  They’ve done studies where they’ve given young pregnant women extra calcium because that way they’re releasing less lead from their bones as their pregnant, because, you know, you’re withdrawing calcium from your bones to help form the bones of the baby, and so if you have lead in your body, that lead is coming out, and it can get into the child, so they’ve done studies where they’ve looked at making sure that young pregnant women have plenty of calcium because it will interfere with that release from the bone, so there is a balance.  People take vitamin D, and as you know, vitamin D helps us absorb calcium. If calcium isn’t around, vitamin D is going to help you absorb cadmium and lead and mercury from the food that’s conventionally grown.

Dr. Weitz:                            Well, maybe we should segue into your story, which I know involved finding out that you needed a lot more vitamin D, maybe you can tell us about your story about bone health.

Lara:                                    Sure. Well, I was in my early ’40s. I’m now 73 and I have really great bones, but when I was in my early ’40s, we were at a medical conference and we went to the exhibit hall and they were showing a new piece of equipment that doctors could have in their office that was reasonably inexpensive for clinicians, and it would check your bone mineral density in your ankle. This was, what, like, 30 years ago now, and so, DEXAs were being used, but they weren’t as frequently being used and there was less awareness. The machine for the doctor’s offices were so much less expensive, they were selling it to say, “Get this in your office, and then if someone tests badly on this, then you make sure you get them into the big DEXA X-ray, so we went over, and I got checked, and I just, I’m healthy.

I follow everything that this man tells me to do, and I’ve been very healthy and even though everybody in my family had osteoporosis, I thought, “Oh, no, not me. I eat right. I exercise, et cetera.” I already had severe osteopenia. I was about 45, so this was well before menopause, so that’s what started our little adventure into trying to figure out what on earth was causing this, and for me it turned out to be genetic, which actually isn’t surprising. I mean, if some disease runs in a person’s family, chances are they have a genetic susceptibility that increases their risk for developing that condition.  For me, it turned out to be vitamin D. At that time, I think the recommendation for vitamin D was, like, 400 IU a day. It turned out that for me to get my vitamin D levels up into anywhere resembling normality, I needed over 10,000 IU every day.

Dr. Weitz:                            Yeah. I remember, at the time they would tell us how dangerous the fat-soluble vitamins were and could be really toxic if you take too much vitamin D or vitamin A.

Lara:                                    Yeah. Our friends thought I was going to turn into a pillar of calcium, like Lot’s wife, with a vitamin D genetic susceptibility, but I didn’t and I started to rebuild bone, finally. Also, we live in Seattle, so it rains here all year long. The sun comes out for a couple months a year and you just can’t make a lot of vitamin D here. It’s not easy, so the combination of my genetic susceptibility plus living in Seattle really was causing my bone loss, and that was the start. Then, after we identified that, I started to very slowly regain some bone, and then I was the editor of a medical journal called Longevity Medicine Review, which I think is still up, some of the issues are still up online, and i was asked to write a paper on vitamin K, and so I started reading all the research on vitamin K and I thought, wow, this is really important, especially vitamin K2 which pretty much no one knew about.  I started taking vitamin K2 and that helped. Do you want me to talk about why that helped?

Dr. Weitz:                            Sure.

Lara:                                    Vitamin K2 is required to activate what are called the Gla proteins. I call them the glamorous proteins, because they really make you glamorous in terms of not having cardiovascular disease and not having bone loss, because these proteins, one of them is called osteocalcin and it pulls calcium into your bones, and the other one is called Matrix Gla protein, and it prevents calcium from depositing in your soft tissues like your blood vessels and your kidneys and your breasts and your brain, so vitamin K2 is really important. It’s not present in … Blue cheese has a fair amount of it, but outside of that, in the western diet, there are a few cheeses that supply a little.  It’s very, very tiny amounts of vitamin K2 are available, and you really have to eat a Japanese fermented soybean product called Nattō. Yeah. It’s slimy, gross. Smells like dirty gym socks.

Dr. Weitz:                            [crosstalk 00:30:03]. Yep.

Lara:                                    Yeah. It’s bad, so basically people need to take vitamin K2 to get enough, and I started doing that. That made a big difference. Do you want me to go along the odyssey of some of the other things? There have been a number of them.

Dr. Weitz:                            Absolutely. Yeah. No. [crosstalk 00:30:19].

Lara:                                    I am truly the poster person for osteoporosis.

Dr. Weitz:                            Because, I’ve talked to a number of people who said, “Well, I did all the natural stuff. I took my vitamin D and the calcium and so therefore there’s nothing you can do,” and it’s like …

Lara:                                    No. Vitamin D helps us absorb calcium. That’s it. It does nothing to determine what happens to the calcium once it’s in your bloodstream. That’s the job of vitamin K2, and if you don’t have it around, chances are your calcium’s going to go into your blood vessels.

Dr. Weitz:                            By the way, what about MK4 versus MK7, since we’re on the topic?

Lara:                                    Yeah. MK7 is far more potent and the reason why is that, in your liver, the MK7 is put into cholesterol, and cholesterol travels around the system for three or four days before it’s eliminated, broken down. The MK4 version goes into triglycerides which are cleared within six to eight hours, so when you take MK7 you can take a really small amount. Typically 100 micrograms or between 1 and 200 micrograms is enough for most people because it’s building up in your system, in your cholesterol, and so it’s always available for you to use, whereas the MK4 version, you have to take 15,000 micrograms every six hours to have that stay available for you, so it’s a difference of 45,000 micrograms a day versus about 180 micrograms a day, so I think MK7 is a better choice for most people.  There are a few genetic polymorphisms that make some people very, very effective at using vitamin K, and they’re recycling it more quickly and so on, and so for those people, there are some people who do fine on MK4, but it’s a very small number of the population, and you can have that checked, easily.

Dr. Weitz:                            The dosage of MK7 that you recommend for most people?

Lara:                                    Well, it’s 100 to 200 micrograms is enough for most people but it really depends on, there’s a balance that you want to achieve between vitamin K, vitamin D and vitamin A. They all work together. Your intake of vitamin D and vitamin A should be pretty comparable. They balance each other, and then vitamin D actually increases your production of the proteins osteocalcin and Matrix Gla protein that you need to have vitamin K2 around to activate, and so if you’re taking more vitamin D, you need a little more vitamin K. There’s a chart in the book where I say, “If you need this much of vitamin D, you need this much vitamin A and you need this much vitamin K,” but typically it’s 100 to 180 micrograms for vitamin K2 in the MK form.  If you already have chronic kidney disease or cardiovascular disease, then in the research they’re using dosages of 360 micrograms per day. It’s extremely safe. There’s not even a tolerable upper limit set for vitamin K2. It’s so safe.

Dr. Weitz:                            Good. Yeah, so let’s hear the rest of your story. What were some of the other key factors in helping you overcome your bone issue?

Lara:                                      Okay, so there was K2, and then, I grew up in Florida and I’ve developed lots of pre-cancerous skin problems, basil squamous skin cancers, and I finally realized that I wasn’t getting enough vitamin A. You need the comparable amount of vitamin … The vitamin A and vitamin D balance each other’s activities, and you really need both of them. We don’t eat meat, so that liver you were talking about, we don’t do that. There aren’t a lot of other really good sources of vitamin A, and beta carotene is not vitamin A. About over 80% of people do a lousy job of getting beta carotene into vitamin A, which I also hadn’t known about.

I wrote a couple of review articles on vitamin A and I learned all this stuff, then I started taking vitamin A. That was another thing that I learned. I try to take as much, comparable amount of vitamin A to vitamin D, and because we do not eat meat, I need to take it as a supplement, and then, the vitamin K. You want that to be in balance, as well, so that was kind of the next thing. Then, I discovered that magnesium is a really important mineral for bone, and if you do not activate vitamin B6 into its form of P5P, pyridoxal-5-phosphate, you have a lot of difficulty getting magnesium into yourself, because that’s the job of P5P, so that’s another snip I have.  I don’t do that very well, so I take a little of that. Actually, I take a B complex, because all the B vitamins work together, and just taking one can kind of mess up the pachinko game that goes on among them all. I think those are kind of the biggest ones, the B vitamins, but, yeah.

Dr. Weitz:                            I think you mentioned having a H. pylori infection, as well.

Lara:                                    Oh, yes. Yes. Sometimes, I think that I have experienced many things so that I would know what to do about them. H. pylori was certainly one. For years, I never knew when I would be six. Joe is the president of Bastyr University. We had many formal evenings and dinners and things and I never knew when I would be so six to my stomach I couldn’t stand up from the dining table and leave, so that was an adventure, and I’m old, so this was back when Barry Sears discovered helicobacter pylori. Before this, I had gone to doctors who had told me, “You just need to breathe deeply. You’re not relaxed and that’s what’s causing all of this,” at which point I had control myself from ripping out their throat.  I did refuse to pay for the consult, but, yeah, so, we discovered that.

Dr. Weitz:                            How did you the H. pylori?

Lara:                                    We did triple antibiotic therapy. Oh, yeah.

Dr. Weitz:                            Triple antibiotic therapy.

Lara:                                    Yeah, and I remember, shortly after that, Joe was invited to China to set up reciprocal programs with some Chinese medical schools for students to come here and our students to go there, and here we are in China where conditions aren’t particularly sanitary, and everybody else in our group got sick except for me. I was the only one whose digestion was fine after getting rid of my H. pylori. Many, many older adults have h. pylori. It’s extremely common and it disrupts your ability to digest your food properly because it interferes with stomach acid production, and then you lose bone, and that’s a very, very easy thing to check, and it can make a huge difference for someone.

Dr. Weitz:                            Now, one of the things you mention in your book is how a number of conventional drugs interfere with bone health, and you mentioned high dose statins, certain blood pressure medications and even antidepressants. Perhaps you can talk about those a little bit.

Dr. Pizzorno:                      Wait for a second. Dr. Weitz, thank you for reading our book. I’ve written a lot of books, and so many times I’ll be interviewed very politely by somebody who didn’t bother to read my book, so I appreciate the invitation, but it would be nice if they read it. You clearly read it.

Dr. Weitz:                           Absolutely. I consider that my obligation for having the opportunity to getting to speak with you.

Dr. Pizzorno:                      Okay.

Dr. Weitz:                           Yeah. Let’s start with high dose statins are bad for bone-

Lara:                                   High doses, quite a bit more than, what is it, milligrams a day.

Dr. Weitz:                           Milligrams of Lipitor, or, yeah.

Lara:                                   Yeah, so, at that level, it actually seems to be protective for bone, but when you start going to the higher levels, it can help promote bone loss, and part of the reason why is that statins interfere with cholesterol production, and if you’re really excessively producing cholesterol, that’s a good thing, but if you take so much that you’re significantly suppressing your ability to produce any cholesterol, you know, we use cholesterol. We use it to do things like make hormones like estrogen and testosterone and so forth, and we need those hormones for our bones.

Dr. Weitz:                           They make vitamin D and transport our vitamin K2.

Lara:                                   Exactly. Yeah, so, again, it’s one of those balance things. A little bit might be helpful, but if you have to take a really high dose, you need to make sure you’re getting checked and do everything you can to mitigate against the adverse effects of it.

Dr. Pizzorno:                      This is one of my pet peeves. I wrote a [inaudible 00:39:23] paper about three years ago now, and you can go to PubMed and read it if you want, entitled Vilification of Cholesterol for Profit. You may recall a newscast came out that basically said, “50% of people over the age of 40 should be on a statin drug because they’re so safe and they’re only beneficial,” and they quoted a very large study, 10,000 person double blind, consumer controlled study. Well, that’s pretty impressive, and here’s where there’s a problem when you look at the abstract versus reading the study.  You look at the abstract, wow. That’s pretty impressive. I guess statin drugs are safe and they have benefit, but when we actually look at the data, the way they did it was this 10,000 person trial started with an open label trial. What that means is everybody got the statin drug, then anybody who had an adverse reaction was removed from the trial and then those where left over, half got statin drug, half got placebo, and they found 1% adverse drug reaction to the statin drug. Well, that sounds pretty good, but you need to ask yourself, “Now, how many people did they remove from the study?”  Out of that 10,000, they removed 3,000, so 30,000 of people had a reaction. Now, of course, some of those could be placebo and not real, but then when you do the post-marketing surveillance on what percent of people have an adverse reaction to statin drugs, guess what? It’s 25 to 30%, so they basically, from my perspective, created a study designed to produce the result they wanted, rather than valid information.

Dr. Weitz:                            Those of us in the natural world here seeing patients have known this. We see so many patients who complain about the muscle aches and the brain fog and all the other side effects they get from statins, and meanwhile they’re publishing these results, as you said, showing 2% of the people have these side effects.

Dr. Pizzorno:                      [inaudible 00:41:22] it’s not true, but they make money, so they keep doing it.

Dr. Weitz:                            Absolutely, absolutely, and they even talked about the poly pill which was going to be given to every single person for prevention, and it would contain a low dose statin, as well as, I think it was going to have a blood pressure medication and maybe metformin or something.

Dr. Pizzorno:                       Yes. That was exact. That’s what they were doing. Metformin, statin, and a blood pressure [inaudible 00:41:47].

Dr. Weitz:                            Certain blood pressure medications actually can interfere with bone. Can you talk about which ones?

Lara:                                    If I can remember which ones off the top of my head.

Dr. Weitz:                            Yeah. I took-

Lara:                                    Well, they use [crosstalk 00:42:02] to help lower blood pressure.

Dr. Weitz:                            This is how you can tell that this was such a good book. I’ve got this pad of notes I took while I was reading it, sitting on my back porch drinking a glass of organic red wine. I’m glad that you said small amounts of alcohol are good for bone.

Lara:                                    Small amounts of alcohol are really good for you. Yeah.

Dr. Weitz:                            You said that Thiazide diuretics protect bone, while-

Lara:                                    Right. Loop diuretics cause bone loss.

Dr. Weitz:                            Calcium channel blockers harm bone.


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Dr. Weitz:                            You also mentioned that SSRIs, antidepressants, promote bone loss.

Lara:                                    Yeah. It’s interesting how they do that. That one, I do remember. What happens is they-

Dr. Weitz:                            Those are so commonly prescribed.

Lara:                                    Very commonly prescribed, and they increase the gut production of serotonin and then that serotonin binds to a receptor on the surface of newly forming osteoblasts, and stops them from developing, and so, your bone building cells don’t develop, and that’s a problem.

Dr. Weitz:                            Yeah. I certainly understand. Let’s talk about calcium supplements, and we’ve known for a long time that calcium is beneficial, but of course, when a few of these studies came out showing that calcium increased risks for heart attack, everybody freaked out and now it was like, no, no, you can’t take calcium. Just take vitamin D. If you’re going to take calcium, just take a little bit, because if you take a lot it’s going to calcify your arteries, so what do we know about the truth about calcium? How much should we be taking? How much is it safe? What form?  I noticed you talked about some of the forms that we’ve been told for years, like hydroxyapatite are the best forms of calcium, actually not as beneficial as we thought they were, or maybe not beneficial at all, so tell us about calcium supplements.

Lara:                                   Okay, so, the first thing is the papers that came out, they were primarily written by a group headed by Boland and his team in Australia, and they looked at studies where only calcium was given or calcium and vitamin D were given, and no vitamin K, okay? As I mentioned before, vitamin D helps us absorb calcium. It does nothing to control what happens to that, and if you don’t have vitamin K available, you’re not going to activate the proteins that pull that calcium into your bones where you want it and prevent it from depositing in your arteries where you don’t, so that is essentially the answer to that issue.  You’ve just got to have … The nutrients work together, and you need the team, not just one or two of them.

Dr. Weitz:                           By the way, one of the reasons why they did some of these studies is because earlier studies had shown that people who consumed more calcium had a lower risk of heart problems.

Lara:                                   That’s interesting.

Dr. Pizzorno:                      [inaudible 00:46:36] calcium, magnesium.

Lara:                                   Yeah. Maybe it was magnesium, as well, because those two have to be in balance, too, and that’s another big problem in the modern world.

Dr. Weitz:                           Let’s finish with the calcium first.

Lara:                                   Okay. Okay. On types of calcium, the reason the hydroxyapatite is not more effective, two reasons that I really don’t like hydroxyapatite. One, it’s hyped. It’s really expensive. It’s overpriced calcium, and when you consume it, in your stomach, your body is going to break it apart, okay? The calcium ions, if you produce any stomach acid, the calcium ions are going to be released from whatever their partner is, and then you’ll absorb the calcium ions. You do not absorb it as a blob. You absorb calcium ions and then the apatite is very, very high in phosphate, phosphorous, and high phosphate levels are one of the problems with the American diet, largely because of phosphate additives in all the processed foods.  I wrote a review paper on this, and it’s on PubMed, entitled Canaries in the Phosphate Toxicity Coalmines, which is what we are. The latest research has shown that they’ve known about this for people with kidney disease for a long time, but now they’ve discovered that high phosphate intake is causing cardiovascular disease in everybody, not just people whose kidney function is impaired.

Dr. Pizzorno:                       It increases the rate at which the kidneys degenerate.

Lara:                                   Right, so I don’t think adding more phosphorous phosphate to your, taking that as a supplement, is really a good idea, so I don’t suggest taking that. If you do not produce any stomach acid, then calcium citrate is going to disassociate, even without any stomach acid present, but it has a lot less calcium ion in it than calcium carbonate, and they’ve done many studies showing that people who produce stomach acid, calcium carbonate is fine. In fact, the research that they used to initially show that calcium carbonate was a problem and that calcium citrate was so much better, they took a group of older people who were hypochlorhydric, meaning they did not produce much stomach acid, and they tested them before breakfast, when they were fasting.  They gave them a supplement. They didn’t produce stomach acid in response to the supplement. They didn’t absorb any calcium. They took the same group of people, and they didn’t report this part of the study, and they gave them breakfast, and guess what, they absorbed their calcium just fine. I think there’s a lot of misinformation. Studies have been used to promote various products in a not very truthful way.

Dr. Weitz:                            [inaudible 00:49:30], you know calcium citrate probably has the added benefit of citrate being sort of an alkalizing-

Dr. Pizzorno:                       Alkalizing agent.

Lara:                                    Absolutely.

Dr. Pizzorno:                      [crosstalk 00:49:38]. Yes.

Lara:                                    Yeah.

Dr. Weitz:                            But how much calcium in supplements is it safe to take? At one time we were doing 1,500, even 2,000 milligrams, and then after those studies, everybody pulled way back. Now people say just 500, 800. What do you think is for, if you’re working with a woman with osteoporosis, how much is safe, and then how important is it to take it at certain times of the day, to split it up, et cetera?

Lara:                                    You want to be getting about 1,200 milligrams of calcium per day. In some of the research on post-menopausal women, some people have benefited from as much as 1,500 milligrams per day, but that’s total. It’s not just from a pill that you’re taking. You’re supposed to be eating real food that has calcium in it, and you’re supposed to look at what you’re getting from your diet and then supplement the additional, so the company that I work with, am I allowed to mention a company name or anything?

Dr. Weitz:                            Of course. Yeah. [crosstalk 00:50:41].

Lara:                                    I work with a company called AlgaeCal. In their product, it provides 720 milligrams of calcium. Because the research shows that the majority of people in the US are consuming between 450 to 600 milligrams of calcium daily from their diet, which is way less than you actually need, so if you take the supplement, which is 720 milligrams over the course of the day, you divide it into 2 servings of 350 milligrams each, and the total from your diet and the supplement comes out to between 12 and 1,500 milligrams daily. The fractional calcium absorption, which is how much of the mineral you’re actually going to absorb from what you swallowed, tops out at 500 milligrams.  After you have consumed 500 milligrams of calcium, the transport mechanisms, the compounds in your gut that help you absorb the calcium, will be maxed out. They can’t carry anymore.

Dr. Weitz:                            Don’t consume more than 500 milligrams of calcium-

Lara:                                    … at a time. At one time, yeah, and then you need three or four hours for things to reestablish themselves and for those transporters to be available.

Dr. Weitz:                            Better with a meal? Better in the evening? What do you think?

Lara:                                    Definitely better with a meal. You cannot release the calcium ions from the food matrix or from their stabilizing partners, like calcium bound to carbonate. It won’t release without the presence of stomach acid, and we produce stomach acid in response to a food intake, so definitely with a meal. Whenever you eat.

Dr. Weitz:                            Now, the reason for taking it at night is because some of the studies seem to indicate you lose bone while you sleep.

Lara:                                    Well, that’s why I suggest that people take strontium at night. Bone renewal is a housekeeping function, right? Just like all the repair functions, and those ramp up at night when we’re not busy doing a lot of other things, so it’s best to, I suggest that people, if they take strontium, they should take it at night. They’ll get the most benefit from it at night.

Dr. Weitz:                            Okay, so, calcium with meals, maybe split it up. No more than 500 milligrams at a meal, and then, let’s get into strontium because that’s a controversial compound and I’ve talked to other bone experts who were very negative on strontium and you write in your book that that’s partially because some of the studies of this prescription form of strontium, strontium [inaudible 00:53:24], or strontium ranelate were-

Lara:                                    Ranelate, right.

Dr. Weitz:                            … were potentially harmful.

Lara:                                    Right. When Servier, the company that created strontium ranelate, developed it, they did so because they look at over 100 years of research showing that many, many different natural forms of strontium were beneficial and caused no adverse effects. Then, for some reason that I wish I-

Dr. Pizzorno:                      … to make it [inaudible 00:53:52].

Lara:                                      … to make it … Well, yeah, but why they picked ranelic acid, which is a toxin, to combine it with, God only knows. I so wish they’d put it with something that wasn’t toxic, because it would have been a fabulous drug and a lot of people would’ve benefited, but they combined it with this toxin, and when you consume that, just like for calcium, the strontium ions disassociate from the toxin, and the claim was that ranelic acid wasn’t going to be absorbed and it wasn’t going to do anything. Well, that wasn’t true, and there’s now been research that shows that it’s absorbed and it has adverse effects, and it’s part of the group of aromatic compounds that cause things like rashes, DRESS syndrome, blood clots and all that, all those things that are the adverse effects of strontium ranelate, but in the research on natural forms of strontium, there have never been, in more than 100 years, none of these forms of strontium have caused any of these adverse effects, and strontium is so beneficial for bone.  It acts through so many different mechanisms, both to increase osteoblast activity, increase calcium absorption. There’s even a special calcium receptor that only responds to strontium. It’s activated by strontium and helps you absorb more calcium, and then strontium also helps lessen osteoclast activation, those cells that break down bone, so it’s a really incredible-

Dr. Weitz:                            It’s a natural bisphosphonate.

Lara:                                    Well, bisphosphonates only poison osteoclasts. That’s all they do.

Dr. Weitz:                            Right. Okay.

Dr. Pizzorno:                       That’s a good point. [inaudible 00:55:47].

Dr. Weitz:                            Strontium citrate is the form you like, right?

Lara:                                    Right, and again, the citrate is alkalizing, so that’s helpful-

Dr. Weitz:                            What’s the ideal dosage?

Lara:                                    Well, it depends, just like everything else. If someone has frank osteoporosis, then they would probably benefit from the typical dose, which is 680 milligrams per day, but if someone’s bones are in good shape or they only have osteopenia, they can do a half a dose and they’ll still get benefit from it. There have been studies showing benefits from that. Once my bones were in good shape, I stopped taking strontium. Until I wrote the big review on strontium and I learned all the ways that it supports healthy bone renewal, so I started taking a half a dose, and that’s what I do.  Also, strontium also helps you sleep better. It helps tune down some brain activity that would keep you awake, and I find it really helpful for that.

Dr. Weitz:                            Okay, and now we should have magnesium in a two to one ratio, calcium to magnesium. You recommend that in the book?

Lara:                                    Yes, and that is a big problem because everybody’s taking calcium and vitamin D with nothing else. The standard American diet is really depleted of magnesium because of the way food is grown. You want to talk about that? Then, that balance is off, and when it’s off, it promotes lots of bad things, like cancer as well as bone loss, so it’s really [crosstalk 00:57:26]-

Dr. Weitz:                            I talked to one doctor who’s an expert at bone, and he said that he looked through all the literature and he couldn’t find any literature that substantiated this two to one calcium, magnesium ratio.

Lara:                                    If you send me his email I’ll send him a bunch of papers.

Dr. Weitz:                            Okay.

Lara:                                    I mean, it’s there, for sure.

Dr. Pizzorno:                       Yeah. Actually, I was [inaudible 00:57:48] about that, as Lara’s digging into it, that I’d always heard two to one, but I actually had never saw any research. When Lara actually dug up some research on it, I was quite intrigued. Now, I’m surprised, it was actually two to one.

Dr. Weitz:                            Two to one calcium and magnesium, and then what other nutrients are synergistic?

Lara:                                    Well, a lot of trace minerals. If you skim the book, you saw a whole list of them.

Dr. Weitz:                            You mentioned boron. How important is boron?

Lara:                                    Oh, boron is my favorite trace mineral. I actually wrote a paper on that, too. It’s on PubMed. It’s called Nothing Boring about Boron.

Dr. Pizzorno:                       Mention how many citations, how many research [crosstalk 00:58:25]-

Lara:                                    Yeah. I’m on ResearchGate, and every week they send me, “You had X number of people read this article that you wrote.” Over 3,000 doctors have read boron now.

Dr. Weitz:                            Wow.

Lara:                                    Yeah. A lot.

Dr. Pizzorno:                       Nothing Boring about Boron.

Lara:                                    Yeah. There’s nothing about it.

Dr. Pizzorno:                      [inaudible 00:58:42].

Lara:                                    It’s so helpful in so many ways. After I read all the research on boron, I started on boron. One of the things it does is it slows down the activation of the enzyme called 24-hydroxylase enzyme, that breaks down estrogen, testosterone, so you keep it around longer, but it’s not harmful. It doesn’t make you keep around so much that it would increase cancer risk. In fact, they use boron in cancer treatment, it’s so beneficial, but that’s one of the things it does, and so you get more benefit.

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

Lara:                                    You need at least three milligrams, but then there’s a bunch of research showing that six milligrams, particularly for people who have osteoarthritis or degenerative osteo, what?

Dr. Pizzorno:                       Yeah. Degenerative [inaudible 00:59:38].

Lara:                                    Yeah, degenerative joint disease of any kind. They’ve done a number of studies using six milligrams of boron. They’ve had a lot of success with it, and there have been several studies just on bone loss and it helped to prevent bone loss.

Dr. Weitz:                            Now, you also wrote that phytate-rich foods are actually protective of bone.

Dr. Pizzorno:                       Not what we were taught 50 years ago.

Lara:                                    Yeah, well, phytates bind things in the colon that you really want to have leave, and if they don’t leave and they get re-absorbed, they’re inflammatory, and again, anything that promotes-

Dr. Weitz:                            Dr. Gundry’s not going to agree with you on this.

Lara:                                    That’s okay. I’m happy to disagree with him.

Dr. Weitz:                            Let’s hit one final topic, which is exercise. What is the most effective form of exercise to improve bone density? I’ve looked into some of the data on the type of exercise that’s beneficial, and most people recommend some form of resistance training or weight lifting, and yet, a number of the studies really didn’t show much benefit and some of the studies have shown that ballistic or high impact loading is necessary to really turn around bone and stimulate bone building. I know that this is controversial. Do you really want to take somebody who’s older with osteoporosis and have them do ballistic training and suffer compression fractures?  This has also led Dr. John Jaquish, who I interviewed previously, to create his OsteoStrong centers where he has these machines that load your bones to supposedly four times your body weight. I know there’s a lot of controversy. What do you think is the best way for us to exercise to strengthen our bones, and what’s safe for osteoporotic patients?

Lara:                                      Well, I think the most important thing is weight bearing exercise every day for an hour. This stuff of, come into my facility and in 20 minutes once a week, you’re going to rebuild your bones. Uh-uh (negative). Not happening.

Dr. Weitz:                            [crosstalk 01:02:12] 10 minutes.

Lara:                                      Yeah. Bones need stimulation. When the muscles are stressed and the torque is applied to bone, the type of cell and bone, which is actually the most prevalent type of cell and bone, they’re called osteocytes, and they’re machanosensors, and they start the bone renewal process, and they don’t start it until they’re activated, and they’re activated by weight bearing exercise, so exercise is just critical. Really, the best type of exercise is something you’re actually going to do every day for an hour, and there are several types. The having somebody to do the things where they did the pull ups and then people dropped to the floor-

Dr. Weitz:                            That was the LIFTMOR trial.

Lara:                                      I don’t think so. The people survived it and they didn’t get any broken bones, but I wouldn’t want to chance it with patients that I try to help. I think some of these people are very fragile, and you don’t want to do things that is possibly going to cause a fracture, so there are three types of exercise that I really like that people can do in their own home, easily, with very little equipment. Yoga for osteoporosis, I think is an excellent one. It was a protocol created by a doctor, by Dr. Loren Fishman. He’s an MD at Columbia and he teaches a course for, people can be trained to become certified, and I have done his course. People who do a lot of yoga, I know, take the training, so that’s an excellent one.

It’s a series of 12 poses. They can be done at home. You can access the videos for them online for free. There’s books out, and he has proven in peer reviewed, published research, that it is effective, and what happens is you do these poses and they put torque on certain areas and you hold the pose and it’s isometric, and it really puts torque on the muscle and it signals those osteocytes and they build bone. I’m also a Stott Pilates instructor. I love pilates. It’s very safe form of exercise, can easily be adapted so that you don’t do any of the C curve type things that could cause compression, but you can get really good core strength and it helps people stand up more erect and carry their body properly.  It can really work the muscles, and then my favorite is Bar 3, which is a combination of pilates, bar, and yoga. You get all three types of exercises. It’s an hour a day. There are 40 minute classes or 30 minute classes. It’s very accessible online. All you need is a mat, and you can do it in your own home, so I think people need to find something that they enjoy enough that they’ll do it.

Dr. Weitz:                            If they’re willing to do anything, ideally, would it be better to do an hour of weight training?

Lara:                                    Well, if they’re doing it with someone who’s watching them at least until they really understand how to move the weights, and all, I think an hour of weight training will be helpful, but part of it is when you’re, and Dr. Fishman talks about this, say you’re on a machine and you’re doing a leg press and you kind of lie back on the machine and you do the leg press. That’s not functional movement. That’s not how we live in our life, and I think the exercises that allow us to do the type of functional movements that puts stress on the muscles and the ligaments and activate the osteocytes in the bone that we actually do in our life, is probably the best approach.

Dr. Weitz:                            Squats and dead lifts more so than leg press.

Lara:                                    Yeah.

Dr. Pizzorno:                       Exactly.

Lara:                                    Yeah. In Bar 3, I probably did 50 squats today with weights, as part of Bar 3, to music. It was fun, sort of.

Dr. Weitz:                            Great. Thank you for spending some time with us and giving us some great information. Any final thoughts for listeners and viewers?

Lara:                                    You’re a terrific interviewer. I’m astounded at the great questions and how you really looked at the book, and I think you pulled many of the most important things out of it, and I greatly appreciate your help in doing that. I hope it will be helpful for people to hear this interview, and thank you.

Dr. Weitz:                            Get this book. The name of the book again is Healthy Bones, Healthy You, and it’s available, Amazon, Barnes and Noble and everywhere else, right?

Lara:                                    I think so.



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




Integrative Approach to Anxiety & Depression with Dr. Peter Bongiorno: Rational Wellness Podcast 235

Dr. Peter Bongiorno speaks about an Integrative Approach to Anxiety and Depression with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on November 18, 2021.

[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

9:45  Let’s start with what’s going on right now in the world and how the current global pandemic has impacted mental health in the US.  Because of COVID we are seeing incredible increases in both anxiety and depression up to 8 fold.  Drug use has also quadrupled, as have suicide rates.

13:42  The neurotransmitter theory of depression and anxiety.  This is the theory that low serotonin or low dopamine or low norepinephrine is why someone is depressed or anxious or is suffering with other mood disorders and that prescribing medications that increase the levels of one of these neurotransmitters, such as SSRIs like Lexapro or Zoloft or Prozac.  In the case of anxiety, these drugs work maybe 60 or 70% of the time but for the treatment of depression they work maybe 30% of the time, which is only slightly better than placebo.  And such drugs are addictive, tend not to work over time, and they have various side effects, such as sedative effects, gastrointestinal effects, and sexual dysfunction. Why wouldn’t you try a natural approach? 

16:03  And even if it really is a neurotransmitter issue, why are these neurotransmitters low or out of balance?  What stressors does that person have that might be playing a role in their mood?  What is their environment? What are their toxicity levels?  What is the inflammation in their body? How is their gut working?  Are they getting enough sleep?  What’s their hormonal balance?  What foods are they eating? What is their mitochondrial function, and is that a part of why maybe their brain and their mood is suffering? What are their genetic makeup, and is there anything we can learn from that that can help us get a better idea of how we can support their body and the pathways in their body? Are they exercising?  So even if the neurotransmitter theory has some relevance, we still should ask, what is the underlying cause of the neurotransmitters being off?”  And there are clearly a percentage of patients where neurotransmitters are not a major factor and, other than counseling, conventional psychiatry has no other tools to help these patients.  That’s where Functional Medicine can really shine.

23:19  Dietary Factors.  The first dietary factor is blood sugar dysregulation, which can play a role in triggering depression and anxiety.  If patients are insulin resistant, their pancreas will tend to make a lot of insulin and they’ll have wild fluctuations of their blood sugar. This can play a direct role in triggering anxiety and depression and it can also trigger other hormones, such to trigger changing levels of cortisol, which can also stress their bodies and cause anxiety and depression.  Such patients should be eating a good amount of protein, healthy fats and some complex carbs regularly throughout the day.  Such patients may not do well on intermittent fasting. And the Standard American Diet is very pro-inflammatory and that is going to change what is going on in the brain and in the hypothalamic/pituitary/adrenal axis.  What we eat will greatly affect how our brain communicates with the nervous system, the hormonal system and the immune system.  While each individual’s diet should be different, in general, a Mediterranean diet tends to reduce inflammation and this will help with anxiety and depression, as Dr. Sanchez-Villegas showed in the early 2000s. (Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean Dietary Pattern With the Incidence of DepressionThe Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) CohortArch Gen Psychiatry. 2009;66(10):1090–1098. doi:10.1001/archgenpsychiatry.2009.) Here is another paper that reviews this topic in detail published in 2020:  Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review.

26:11  Vegans.  Vegans can manage their blood sugar by including beans and nuts and seeds, which contain protein. They can do smoothies with vegan protein powder. And some people do not need as much protein.  When it comes to histamines, some people with high histamines will have more anxiety, so they will do better with a lower protein diet.  Dr. Bongiorno finds that 10-15% of the time histamine is a problem with his patients.  He will include serum histamine in his lab work.  Sometimes patients will mention that they take Benadryl at night and this indicates this person may have high histamine.

28:48  The microbiome and gut health are very important for our moods.  The microbiome plays a strong role in the production of neurotransmitters both in the gut and immune signals that go to the brain to make neurotransmitters.  When there is a lot of inflammation in the gut that modulates neurotransmitter levels, the microbiome can help to modulate that inflammation.  A researcher in the thirties or forties published some studies on how clams can keep their muscles working so continuously to keep their shell closed and they discovered a chemical that they called enteramine, with entero standing for the gut. They learned that enteramine is what helped change motility in the gut and this was later renamed serotonin and then they found that it also happens to be in the brain and plays a role in our mood.

Some say that since the neurotransmitters produced in the gut don’t make their way into the brain, that gut neurotransmitter production has no effect on mood.  But research indicates that the enteric nervous system (the part of the nervous system that surrounds the gut) sends out a lot of signals through vagal nerve stimulation that affect neurotransmitter production in the brain.

32:53  Iron. When Dr. Bongiorno was a student he recalls a patient with depression and the clinician ran an iron panel and found out that both the serum iron and the ferritin were very low. He gave her some iron and within a month she was off her antidepressants after being on them for many years.  Iron is the center of the  hemoglobin molecule that allows you to carry oxygen in your blood. If you don’t have as much iron getting to your cells, your brain will shut you down so you don’t use as much oxygen, which leads to higher rates of depression and anxiety.

34:27  It is very difficult to get off of antidepressants, esp. if you have been on them for some time.  One reason is because if you have been taking antidepressants for a period of time, the receptors become down regulated. The other issue is that you deplete the precursor molecules that you need to make neurotransmitters.  This is also why these drugs tend to have poop out syndrome, which means that they work for while and then they stop working.  It is important to fix the underlying reason why they stop working whether it be low iron or low vitamin D or low B6 or not enough sleep, etc. it is much harder for people to get off these drugs.  You would never want to just take a patient with depression off their medication, because they will likely feel much worse. It is best to work on these underlying issues and get them feeling the best they can on medication before even considering having them slowly wean off their medication, but only with the prescribing physician participating.  Make sure that you work on the underlying issues first. Make sure they are getting good, quality and quantity of sleep. Make sure they are exercising, managing their stress, going to therapy, doing some relaxation work, and eating a healthy diet.  Dr. Bongiorno likes to do a fair amount of testing, including looking at iron levels, red blood cells, B12, vitamin D, B6, inflammatory markers, histamine, hormones, melatonin, glutathione, etc. We may want to do an elimination diet or do food sensitivity testing. We will want to do a good stool test and other gut testing. Dr. Bongiorno has been using the GI Map stool test lately, though he also likes the stool tests offered by Genova Diagnostics and Vibrant America labs.  We want to get the gut as healthy and balanced as possible.  We may want to put patients on amino acids to support some of the neurotransmitters. We may want to put people on blood sugar supportive nutrients to help stabilize blood sugar or whatever the underlying issues are. 

38:39  When it comes to trying to wean off medications, you might not want to do it in the winter, when the days are shorter and darker and serotonin levels are at their lowest.  This is why it can be helpful to use a light box in the winter.  As animals, we’re designed to hibernate and sleep longer in the winter.  It might be better to wean off medications in the spring when the light is longer and the light gets brighter, which stimulates serotonin levels.  This should only be done with your doctor.

40:42  Circadian Rhythm.  Dr. Bongiorno will use either salivary or urine tests to look at cortisol levels throughout the day.  Depressed patients may have very high or very low cortisol levels.  You may have some patients who can’t get out of bed in the morning but are wired at night and can’t sleep. Circadian rhythm is very important to mood disorders and getting people in balance with nature and with the day is a great idea.  You should avoid having a lot of bright lights at night when you should be winding down to go to bed.  You should also avoid eating late, since this also stimulates cortisol.  Most people need 7 1/2 to 8 hours of sleep per night. People who get a lot less or a lot more tend to have more anxiety and depression. 

45:18  Coffee.  People who suffer with anxiety will tend to do better with less coffee. Coffee will usually make them more anxious.  On the other hand, people who drink 2 to 4 cups of coffee a day will have lower depression rates while 7 to 8 cups will increase rates of depression and anxiety.  But it is better to build up their adrenal glands so they have natural energy, rather than overstimulating them with coffee.

51:15  Lab Testing.  While recommended lab testing is different for each patient, some of Dr. Bongiorno’s favorite labs include Hemoglobin A1C, fasting glucose, insulin, RBCs, WBCs, a liver panel incl. GGT, iron panel incl. ferritin,  full thyroid panel, inflammatory markers, including erythrocyte sedimentation rate, C-reactive protein, and Interleukin-6.  Fecal calprotectin on a stool test.  Celiac panel. Amylase and lipase. Vitamin D, zinc, zinc to copper ratio, RBC magnesium, B12, methylmalonic acid, which is marker for B12, and an advanced lipid profile.  Estrogen, testosterone, progesterone, pregnenolone.  While high cholesterol can cause problems, lowering cholesterol too much can be harmful since the body may be unable to make these important hormones that are crucial for the brain and for good mental health.

55:11  Hormones.  Hormones are critical for mental health.  Estrogen plays an important role in the levels of serotonin in the brain and whether serotonin is being made in the areas of the brain that need it.  Higher estrogen levels change the amount of monoamine oxidase to keep serotonin levels high. Progesterone does the opposite.  This is another example of the nice yin and yang balance between estrogen and progesterone.   Men also should have a certain level of estrogen and they have six times the level of estrogen in the brain that women have. Progesterone supplementation for men has not been shown to be helpful.  If Dr. Bongiorno is working with a postmenopausal woman, he will typically work on the basics like sleep, exercise, diet, stress reduction, because those things oftentimes will help. Secondly, we want to support the liver because the liver is what processes the estrogens. And oftentimes when the liver and the microbiome are out of balance, we’re going to see improper levels of estrogen. For example, if there’s beta-glucuronidase levels are out of balance, that’s going to change estrogens and there’s going to be a lot more recirculation of excess estrogens.  If there’s a lot of candida, candida acts as false estrogens, so that’s going to change the balance of estrogens.  So we want to fix all of those things.  So without even touching hormones, we can oftentimes fix the hormones.  After all that, if we want to tweak the hormones it is better to start with a touch of pregnenolone or DHEA, which can feed the rest of the pathways.  If progesterone levels are low in relation with estrogen, then the herb, vitex, (aka Vitex agnus-castus, aka, chasteberry,) does a great jobat a dosabe of 220 mg once or twice per day.  There are studies in premenstrual dysphoric disorder showing it works really well. There’s other studies in perimenopausal depression showing that it worked just as well as SSRIs.  Also, rather than using an SSRI drug if needed after lifestyle hasn’t gotten to where you want to get, it is better to see if tryptophan (500 mg twice per day) or 5-HTP (50-100 mg a day) might be a better way to stimulate serotonin production.

1:02:27  A diet that is too low in carbs can also cause problems with anxiety and depression by lowering serotonin levels.  Also, while gluten can be problematic, since patients with mood disorders are often sensitive to gluten, but if you place them on a gluten free diet too quickly, their symptoms may actually worsen, so they should be weaned off gluten slowly rather than all at once. 

1:04:32  Supplements.  Here are some of the most effective nutritional supplements for anxiety and depression:

1. Essential Fatty Acids.  Fish oil is very powerful and alone can sometimes cure depression or anxiety if people are deficient in them.    

2. SPMs.

3. GLA.  While omega 3s are so important, omega 6s are also beneficial and this is an omega 6 fatty acid that helps the body to make its own prostaglandins and this can help with mood. Patients who use alcohol to feel happier, GLA can often help.  

4. Probiotics.  Probiotics can help to improve gut health and to create a healthier microbiome, along with fiber and fermented foods.  There are studies showing that if you take a fecal microbial transplant from an animal who’s not depressed and give it to an animal that’s depressed and you can lift their mood and depression.  

5. B vitamins.  B vitamins are important for mitochondrial function for producing energy in the body, for methylation, and to break down our neurotransmitters and hormones properly.  Some B vitamins like folic acid may be able to help patients with schizophrenia.

6. Vitamin D.  If vitamin D is a neuro steroid and if it is low, it will be harder for the body to make serotonin and other neurotransmitters. If vitamin D is higher, there will be lower levels of anxiety.  

7.  Magnesium.  Magnesium is very relaxing and important for mental health, including for GABA levels in the brain and it helps with benzodiazopine receptors.  

8. Zinc.  Zinc is a cofactor for so many different reactions in the body as well as for gut health. The zinc to copper ratio is very important.  

9. Nutritional Lithium.  Dr. Bongiorno just wrote a paper about Nutritional Lithium in Natural Medicine Journal. CLINICAL APPLICATIONS OF LOW-DOSE LITHIUM, MENTAL HEALTH, COGNITION, AND MORE.   Nutritional Lithium (Lithium orotate) is great for teens with impulsivity, including for kids age 5 to 10 with anxiety in drop doses. It is very supportive to the brain. Research shows it may be protective for Alzheimer’s disease.  You can start with 5 mg for adults and 1 mg for children and for adults you can go up to 20 mg per day.

10. GABA.  Some say that GABA can only help if you have a leaky gut and leaky brain, because it is very difficult to get it into the brain.  But rather than trying to figure out if you have leaky brain, it is best to just dose it higher, such as 500-1000 mg 2-3 times per day.  You can also give GABA along with theanine and either lithium orotate or CBD oil.  Liposomal GABA seems to work well, but so do chewables.  

11. St. John’s Wort.  St. John’s Wort is very good for mood, esp. for depression.  It has gotten a bad name in recent years, since it affects the cytochrome P450 Liver detoxification pathways involved in the detoxification of certain medications and making them less effective, including Antidepressants, Birth control pills, Cyclosporine, certain heart medications, incl. Digoxin, some HIV drugs, some cancer medications, incl. Irinotecan and Imatinib, Warfarin, and some statins.  While it can decrease the effectiveness of some antidepressants, it can amplify the effects of SSRIs and MAOs and can lead to a dangerous elevation of serotonin called serotonin syndrome that can produce elevated blood pressure, fever, agitation, rapid heart rate, perspiration, diarrhea, and muscle spasms.  Patients who take St. John’s wort while on birth control may find that they are more likely to get pregnant.  But it is also a very good antiviral. It’s an anti-inflammatory and is great for mood.

12. Rhodiola.

13. Lavender. 

14. Saffron.

15. Berberine.  Berberine is an incredible herb that is beneficial for cholesterol, blood sugar, gut health, and it also helps with neurotransmitter production in the brain. Here is a good paper on this: Pharmacological effects of berberine on mood disorders.

16. NAC.

17. Neurologix. This is a product by Integrative that includes saffron, spearmint and a branded citicoline that helps with memory, focus and mood.


This is a powerful closing statement from Dr. Bongiorno:

“Yeah. I mean, to the clinicians out there, when you have a patient who, especially if it’s a challenging patient, always double down on the basics. Make sure that those are all taken care of. And just really look for the other underlying factors that maybe you haven’t looked into yet because there’s some reason why a person is feeling the way they’re feeling. And it’s really up to us as clinicians to kind of look at all those factors and really put it together because there’s practically always a way to help to get people to feel better. If not get them off medications, at least get the medication doses lowered which often could be a win, especially in things like bipolar. You’re creating so much less toxicity in the body.  And to any listeners there in the public who are suffering from anxiety, depression, mental health, just know that there’s still a lot of tools out there, and find a practitioner who just really cares and is listening and wants to look into those underlying factors because there’s always something else that can be done. And just don’t give up hope, and don’t give up thinking that you can feel better and feel like your best self.”


Dr. Peter Bongiorno is a Naturopathic Doctor and Acupuncturist and he is the co-director of InnerSource Natural Health and Acupuncture, with offices in New York City and on Long Island. He also works with clients via phone and Skype. He’s written a number of books, including Healing Depression in 2010 and Holistic Solutions for Anxiety and Depression in Therapy in 2015, targeted for physicians, and How Come They’re Happy and I’m Not, and Put Anxiety Behind You: The Complete Drug Free Program, both for patients. His website is DrPeterBongiorno.com.

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


Podcast Transcript

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

Thank you for joining our functional medicine discussion group meeting tonight with Dr. Peter Bongiorno on an integrative approach to depression and anxiety, and I hope you’ll consider joining some of our upcoming meetings.  December we are not going to have a meeting, but January 27th, Dr. Aristo Vojdani will be joining us on why we should test the immune system, and I’ve yet to fill out the rest of the schedule for next year, so I’ve got to get going on that.  I encourage everybody to participate in the discussion by typing your question into the chat box, and then I’ll either call on you or simply ask Dr. Bongiorno your question when it’s appropriate.

If you are not aware, we have a closed Facebook page, the Functional Medicine Discussion Group of Santa Monica, that you should join so that we can continue the conversation when this evening is over.  I’m recording this event, and I’ll post it on my YouTube page, and I’ll include it in my weekly Rational Wellness podcast.  If you haven’t listened, please check out the Rational Wellness podcast and subscribe on Apple Podcasts, and if you enjoy it, please go to Apple Podcasts and give me a ratings and review.  I want to thank our sponsor for this evening, Integrative Therapeutics, which is one of the few brands of professional supplements that we use in my office, and so I’d like to welcome Steve Snyder from Integrative Therapeutics to talk to us a little bit about a few products. Steve.


Steve Snyder:                    Hi, everyone. Thanks, Dr. Weitz. I’m so excited because finally the topic is something we actually have something that’s pretty unique. Not the only time it’s ever happened, but this is really good. So the Zoom is telling me that you’ve disabled the sharing thing.

Dr. Weitz:                            Oh. Oh. Here. No. Let’s see. Here you go. Okay. You should be able to share now.

Steve Snyder:                    Okay. So just real quick, we actually have a product called Lavela that’s an oral lavender essential oil, and it’s got some really pretty impressive research in anxiety.  What’s unique about this is it was developed by our parent company in Germany, and if you know anything about supplements in Europe, you have to do some pretty significant clinical research to actually sell something over there, and this happens to be a lavender that we grow ourselves.  You can see from the name here, WS 1265. The WS is for Wilbur [Schuaba 00:03:09], and he happens to be one of our owners and also a pretty smart guy.  So he developed this… Lavela is what we call it in The States. Silexan is the trademark name, and it’s got some really, really great research in anxiety.  So it’s significant anxiolytic efficacy comparable to lorazepam and Paxil, so we’ve seen some great benefits associated with anxiety disorders, disturbed sleep, and other somatic complaints, stuff like that. It’s nonaddictive, non-sedative. There really are no side effects other than people tend to burp lavender.

That’s supposed to go away, but it is a thing. There’s a school of thought that maybe that olfactory part is part of the efficacy. Some people like it. Some people don’t, but it tends to go away.  Kind of here’s some of the… These are kind of the two big studies we’ve talked about, and it’s probably hard to see for you guys, but basically the one on the left is comparing Lavela with lorazepam, and this was 77 subjects over six weeks.  You can see we basically had a similar reduction in symptoms, and we had a similar response rate as well. So as you know the benzodiazepines and some of the other pharma stuff doesn’t work for everybody. We see about a 75% response rate with Lavela, so when it does work, it’s awesome, but it doesn’t work for everybody.  The subject on the right is compared to Paxil, and that one was with 539 patients, so a pretty big study at 10 weeks, and we saw the same thing. Similar results. No side effects.  People always asked, “How does it work?” This is one of those things. We’re not 100% sure, but what we believe is that it helps modulate the presynaptic calcium channels, so it’s regulating the release of neurotransmitters, and sort of modulating that response, and lowering anxiety through that mechanism.

We see typically one to two caps per day is all you need. We like to let people try it for about a week if we’re going to do a trial. Some people they say they feel it right away. Like I walk into offices all the time where they say, “Oh. I just took a Lavela. I feel great,” and that’s awesome. I’m not going to argue with them, but it really doesn’t work like that, but if they feel better, that’s good too.

So if people want to sample this product, we do let people try it. We have boxes that have 10 caps in a blister pack, and that’s typically what we have them give a patient, so we want to make sure somebody gets a response before they spend the money on it.

Then there’s a whole bunch of studies on it. It’s about over a thousand patients now, so everything from those studies I just showed you to, again, placebo. There’s also some open-label dose, 80 mg versus 160 mg, so it’s a pretty heavily clinically studied product, and so far it’s one of our flagships.  People ask how much. It wholesales for $35 for 60, so for some people that’s two months. For others, it’s one month, but still relatively inexpensive, and it’s available everywhere.  We love Emerson and Fullscript, but we also sell it direct, and again, if you want to try it, you can email me at steve.snyder@integrativepro.com, and we can send you some trial boxes. [This is for paractitioners only]

So that’s the Lavela, and then the other one I really quickly wanted to mention was Theracurmin, which is our high bioavailable curcumin preparation. It’s essentially a water-dispersible curcumin, so we get really high blood levels very quickly that last for a long time, and the reason I bring it up in this context is there was a recent study done at UCLA where they looked at men with age-associated memory decline, and they weren’t really looking for mood response, but the metric they used to check the memory also had a mood component to it, and they noticed a significant improvement in mood over the course of the study in these guys.  Theracurmin is kind of… There’s a lot of claims being made about curcumin out there. We call it the curcumin wars. We happen to have something that we can back up where a lot of people will say stuff, and then they can’t back it up, so that’s another one we’ll let people try.  There’s all kinds of clinical studies now on it because the pharmacokinetics is pretty well established, so everything from mood, to skin health, to liver function, to cardiac function. We’re trying it everywhere, and we’re putting it in a lot of stuff because with a lower dose, you can get some clinical results. That’s pretty much it. Thank you.



Dr. Weitz:                            Thanks, Steve. So now I’m going to introduce our speaker. We’re very happy to have Dr. Peter Bongiorno speaking with us this evening, and he’s a naturopathic doctor and acupuncturist in New York City. He also works with clients via phone and Skype.  He’s written a number of books including Healing Depression: Holistic Solutions for Anxiety and Depression in Therapy which is this book here, and this is like an incredible resource, really dense, with tons of information, so I refer to it regularly when I have patients with depression and anxiety.  He’s also written How Come They’re Happy and I’m Not and Put Anxiety Behind You: The Complete Drug-Free Program, both for patients.  His website is drpeterbongiorno.com. That’s D-R-P-E-T-E-R-B-O-N-G-I-O-R-N-O.com. So Dr. Bongiorno, you have the floor.

Dr. Bongiorno:                   That’s a long name. I started getting bored while you were reading it. Thank you. Thank you so much for having me here. It’s really a pleasure. Thank you.

Dr. Weitz:                          Good. Good. Good. Good. So how do you want to get started?

Dr. Bongiorno:                   Oh, gosh. I mean, we could start with the… Let’s start with what’s going on right now.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   I’m actually…

Dr. Weitz:                          Is there anything going on right now?

Dr. Bongiorno:                   Well, not really. It’s pretty-

Dr. Weitz:                          Nothing to be worried about?

Dr. Bongiorno:                   No. No. In fact, right now I’m actually preparing a talk for… I don’t know. Do you come to the Integrated Healthcare Symposium in New York City?

Dr. Weitz:                          I haven’t been to that one yet.

Dr. Bongiorno:                   Haven’t been to that one?

Dr. Weitz:                          Yeah.

Dr. Bongiorno:                   So it’s one of the biggest integrated medicine conferences.

Dr. Weitz:                          It’s in February? Is that right?

Dr. Bongiorno:                   Yeah. It’s in February in New York City. Maybe Steve will be there.

Dr. Weitz:                           Okay.

Dr. Bongiorno:                   And Integrative ITI will be there.

Steve Snyder:                    We’ll probably have an army there.

Dr. Bongiorno:                   Great. I’m sure you guys will.

Steve Snyder:                    Yeah. 

Dr. Bongiorno:                   Yeah. You definitely need to be handing out Lavela and some cortisol manager while you’re over there.

Steve Snyder:                    Yep.

Dr. Bongiorno:                   So actually I’m preparing a talk right now for that conference, and it’s going to be about COVID and mental health because it’s just extraordinary what’s been going on in the past couple of years, the incredible increases in both anxiety and depression, like six, seven, eight-fold.  I think it was at its high point in January of last year or up to 42% higher rates of depression and incredibly higher rates of anxiety.  It’s lowered a little bit, but still way, way above …  Oh. That’s okay. So really anxiety, depression has skyrocketed. Drug use has absolutely quadrupled. Suicide rates. There’s so much to be done, and you could say, “Well, it’s the stress of COVID,” and I think that was a part of it, but I also think it was a testament to just the disease in our population, the unhealthy lifestyles and just the general inflammation that’s already been in our bodies, and then something like this comes up and just is sort of the straw that breaks the camel’s back, so for people who are already predisposed, it’s going to really increase these rates.  That’s something, especially in New York, that I’ve been seeing a lot of, practicing in New York City. It’s been phenomenal. It’s been quite an education.

Dr. Weitz:                            Yeah. And I think that’s something a lot of us in the Functional Medicine integrative world have been talking about which is not getting talked about a lot which is the fact that so much of our population is so unhealthy to begin with with poor diet, and lack of exercise, and the incredible high rates of people being overweight, over 70%, and high rates of diabetes or prediabetes and hypertension, and on, and on, and on, and those are the things that can play a role in predisposing us to depression and anxiety and also increase the likelihood we can have a worse case of COVID if we catch it. Low vitamin D levels. Lack of sunlight. Of course, keeping everybody inside, and not exercising, and not getting exposed to the sun, and etc., etc., unfortunately probably makes the situation worse.

Dr. Bongiorno:                   Yeah. Yeah. No question about it, so that’s one of the things that I’ve been working on right now is really putting together the information regarding the factors involved in why we’re seeing these incredible increased rates of anxiety and depression, suicide, drug use, domestic violence, and all of these things.

Dr. Weitz:                            Right. So I’d like you to talk a little bit about the neurotransmitter theory of depression and anxiety, and as we know there’s huge numbers of people on these medications.

Dr. Bongiorno:                   Yeah. So when you work with a conventional psychiatrist, and let’s say you have depression, and you go in there, and maybe you start crying, or you’re emoting some kind of thought, usually a psychiatrist will think to themselves, “Okay. Well, there’s probably low serotonin. Maybe low dopamine. Maybe low norepinephrine, so let’s give a drug, and let’s try to increase those levels of those neurotransmitters.”  In the case of something like anxiety, it works a higher percent of the time, maybe 60%, 70%, possibly 80% of the time when you give drugs like that.  Of course, as Steve had mentioned earlier, those drugs are addictive, and they tend not to work over time, and they can have sedative effects and other problems, which is the reason why if you have something like Lavela, which has been shown to be as beneficial without those kinds of effects, it’s certainly worth trying something like that. Right?

And then you have depression which antidepressants, especially SSRIs which are the mainly prescribed antidepressants, work maybe 30% of the time. Maybe a hair above what placebo’s been shown to use, and then we do have natural remedies, things like St. John’s wort, saffron, curcumin which also Steve mentioned earlier as well, and those have actually been shown in individual studies head-to-head with those medications to work equally as well, at least.  Now, of course equally as well still only means like 30%, maybe 35% at the most, so the question really that I have and what I think about when I work with patients is if it is a neurotransmitter issue, and those drugs work, why are the neurotransmitters off?  And the other question is in the percentages of patients that they don’t work, 30% to 40% are anxiety patients, upwards of 70% for patients who are depressed, what else is going on? That’s really, I think, what I’m interested in and what I work on with my patients.  

So when we want to look at neurotransmitters that’s fine, and if we can work with them and use some natural, less toxic things to help them balance, that’s good, but that’s still not getting to the underlying cause of why they got out of balance to begin with, if that even is the issue, and that’s where I like to think about, “Well, what are the other factors?”  So we want to take into account, of course, a person’s stressors which can certainly play a role, what their environment is, what their toxicity levels are, what the inflammation is in their body. How is their gut working? Are they getting enough sleep? What’s the hormonal balance that’s happening. What foods are they eating? What is their mitochondrial function, and is that a part of why maybe their brain and their mood is suffering? What are their genetic makeup, and is there anything we can learn from that that can help us get a better idea of how we can support their body and the pathways in their body? Are they exercising?

So even when we think about neurotransmitters and the neurotransmitter theory, which I think has some relevance and some credence, we still have to say, “Well, what’s the underlying cause of the neurotransmitters being off, if that’s even it?”  And then for that other percentage of patients where it’s maybe not playing as much of a role, what are the other factors because in conventional psychiatry, if it isn’t a neurotransmitter issue, and the drugs don’t work, there’s no other tools. There’s no other choice, and that’s why I love natural and functional medicine because there are so many other tools because we understand that there are so many other factors involved, and that it’s probably just not one or two factors that are contributing to the mood issue. It’s probably a number of factors that are contributing in small ways that synergistically is creating this syndrome that maybe we’re calling depression or calling anxiety, for example.

Dr. Weitz:                            Exactly. It sort of reminds me with the issues we’re having trying to deal with some of the chronic neurodegenerative problems like Alzheimer’s, and conventional medicine keeps looking for this one pathway and coming up with this one drug that affects that one pathway, and after just hundreds of billions of dollars of research, they’ve come up with nothing, and now we have this new drug that was just approved that does nothing to make anybody better. Best case, patients get worse more slowly, and 30% of the patients get swelling in their brain, and the first patient just died from this drug.  Yet we have a Functional Medicine approach which Dr. Dale Bredesen has finally published his study showing that patients actually improved. They didn’t just get worse at a slower rate, but it’s complicated, but that’s the beauty of a Functional Medicine/integrative approach looking at a number of different factors.  Not only do you end up improving your brain health, but you improve your overall health, and the same thing with a Functional Medicine approach for depression and anxiety.

Dr. Bongiorno:                   Exactly. Yeah, exactly. And Dale Bredesen who did that amazing work with the Alzheimer’s understands that it’s multi, multi-factorial, and that you have to look at a number of factors at the same time and work with as many as we can.  I think what the conventional care model when it comes to drugs doesn’t understand that there’s a lot of… That the body has a lot of redundancy in a sense, so when you give it a drug that works on a single mechanism, the body’s really smart at saying, “Okay. This is foreign. I don’t know what it’s doing, but we’re going to start working around it.” You know?  And so you need to give higher doses than is probably even healthy, so you end up with more side effects and less beneficial effect, and that’s the problem with the medications in general, and then I certainly see that with mental health, and it’s certainly seen in neurology when it comes to Alzheimer’s as well.

Dr. Weitz:                            And apart from all the other factors that we’re going to talk about that affect mental health from sleep, to diet, to exercise, etc., etc., even the neurotransmitter theory is just looking at one neurotransmitter like serotonin. It’s just a huge oversimplification about the way our brain and moods work. There’s a whole plethora of different chemicals that are all interacting in a very complex way.

Dr. Bongiorno:                   Right. Of course. As far as depression goes, if I had to pick a drug that probably did work the best for depression, it was tricyclic antidepressants, and those are the old antidepressants, and what they did was they kind of raised a lot of the neurotransmitters. They raised dopamine, and serotonin, and norepinephrine, and acetylcholine.  The problem with those drugs is that they were very… They were kind of toxic. You can’t give them to seniors because they’re especially toxic to older people, and again, even when they work, they work for a while, and then they kind of stop because like I said, the body figures out that it’s hand is being forced, and it doesn’t like that, so it kind of starts to work around these drugs.  So that’s why we need such a full, integrative, and holistic model that really just looks at the whole person.

Dr. Weitz:                           Now, we’ll get into your testing and theories, types of testing that you think is beneficial, but just on the neurotransmitters, do you think that’s a valuable thing to do to do the urinary neurotransmitter testing?

Dr. Bongiorno:                   Yeah. I mean, urinary neurotransmitters, I think, has some value. Interesting, in New York it’s very hard to get these neurotransmitter tests because of the laws in New York, so I don’t actually use them very much.

Dr. Weitz:                           Oh, really? Wow.

Dr. Bongiorno:                   Yeah. New York is a little toughie when it comes to a lot of these functional medicine tests, so I’ve actually kind of worked around them a bit, but the fact of the matter is is that there are neurotransmitter tests that I think can give you some clues, but you still really need to back it up with clinical relevance, and finding out how is this person feeling to really understand what’s going on. Urinary-to really understand what’s going on. Urinator transmitters, I don’t think give you a full picture of what’s going on in the brain, but they can suggest to you what’s happening in terms of breakdown and metabolites. So yeah, the more information we have the better.

Dr. Weitz:                           So let’s talk about some of the important dietary factors that can play a role in triggering depression and anxiety.

Dr. Bongiorno:                   Well, the first one that I see is just blood sugar dysregulation, especially when people have high insulin levels, insulin will drop your blood sugar. So people whose pancreas tends to make a lot of insulin because they’re insulin resistant, they’ll have these wild fluctuations and blood sugar, and that certainly plays a role in anxiety and in depression. That’ll play a role in triggering other stress hormones, changing levels of cortisol, and that can be very hard on the body and create a lot of stress and cause a lot of anxiety as well as depression. So, that’s the first thing I think about when it comes to it, so I like to make sure people are trying to stay away from simple carbs so that their blood sugar doesn’t go up and then come way down, and then making sure they’re eating a good amount of protein, healthy fat, and some complex carb regularly and throughout the day.

And I know sometimes for weight loss and metabolic health, that sometimes we need to do things like intermittent fasting, where we don’t have people eat for a number of hours of the day. For sometimes for people who have anxiety and depression, that doesn’t work for them, and you need to kind of have them do more of a grazing approach where they’re eating little bits throughout the day to keep their blood sugar stable. Everybody’s different. So what’s appropriate for one person isn’t appropriate for somebody else. And then as far as the foods themselves go, as we know, the standard American diet is really a disaster when it comes to for our health. It’s a very pro-inflammatory diet and inflammation is going to change what’s going on in the brain, change what’s going on in the middle of the brain, which is the hypothalamic pituitary adrenal axis.  So what we eat will greatly affect how our brain communicates with the nervous system, the hormonal system and the immune system. And that’s going to make a lot of changes in what goes on with our mental health as well. So I always recommend people have, if I don’t know a person and I don’t know what their individual needs are, and I had to just make a blanket recommendation, I would probably start with something like the Mediterranean diet. Sanchez-Villegas, in the early 2000s, did a number of studies out of Spain, which showed how the Mediterranean diet can prevent and even treat anxiety and depression as well as lower things like CRP and other inflammatory markers in the blood. So people who eat that kind of diet typically have lower anxiety, lower depression, less inflammation in the body. So, that’s a great place to start.

Dr. Weitz:                          How do you work with vegans or vegetarians given the importance of getting enough good quality protein?

Dr. Bongiorno:                   Well, it depends on the patient, as always.

Dr. Weitz:                          Of course.

Dr. Bongiorno:                   If we’re working with a vegan or a vegetarian, there’s beans, there’s nuts, there’s seeds.  We can also do smoothies with it, so it depends on the person.  Some people don’t have as much need for as much protein, and actually when it comes to things like even histamines, right, if people are very high histamine and they have a lot of anxiety then typically I’ll put them on a lower protein diet to lower levels of histamine. So, that could actually be helpful.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   So, it just depends. We have to strategize individually where people are going to get their protein from.

Dr. Weitz:                          How often do you find histamine is an issue?

Dr. Bongiorno:                   I would say a good 15% of the time, maybe 10 to 15% of the time.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   I do run histamine on practically every patient and I’ll do, as part of my intake, ask them a number of questions to find out. Sometimes I’ll have people who’ll come in and I ask them how they’re sleeping and they’ll say, “Oh, I’m sleeping great.” And then I’ll ask them, “What do you take? Do you take anything over the counter?” “Oh, yeah. I take some Benadryl at night. It really helps me sleep.” Great.  That’s kind of a clue that they’re probably high histamine, because Benadryl is an antihistamine.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   If you don’t have really high histamines, it won’t affect your sleep too much, but if you’re high histamine, boy, you get the best sleep with that stuff. So I’m not recommending it as a plan, but I’m just saying it’s a-

Dr. Weitz:                           Right.

Dr. Bongiorno:                   So that could be a kind of a clue to find out as well. Plus if people have a lot of rashes and itching or urticaria, you can write on somebody’s arm and write your name on it with your finger. That’s how you know their histamines are pretty high.

Dr. Weitz:                           And will you use a specific low histamine diet?

Dr. Bongiorno:                   Yes. Yeah. So there’s a number of food that will either release histamine in your body or actually have high histamines in them. So it’s a little handout that I’ll give people and I’ll have them start with the foods that they tend to eat a lot of. And sometimes it’s even healthy foods, it could be even things like avocado, as well as typical ones that people know about are wine and cheese. But even there’s some healthy foods, fish can be high in histamine. So, I love people eating fish. It can be so healthy for you, but if they’re high in histamine, then that might be something we might want to limit.

Dr. Weitz:                          And so we often see patients with histamine problems who come see us with other gut disorders. How important is the microbiome and the gut for overall mental health?

Dr. Bongiorno:                   Yeah, so the microbiome plays such a strong role in the production of neurotransmitters, both in the gut and the signaling through the cytokines, the immune signals that go to the brain and help the brain also make neurotransmitters in different areas of the brain. So when there’s a lot of inflammation in the gut, that’s going to typically change levels of neurotransmitters in the brain as a result. And the microbiome will play a strong role in modulating that inflammation.

Dr. Weitz:                          Now given that the neurotransmitters in the gut don’t make their way into the brain, how important is the neurotransmitter production in the gut?

Dr. Bongiorno:                   Well, neurotransmitter production, that’s actually something that’s being hotly debated right now.

Dr. Weitz:                          Okay.

Dr. Bongiorno:                   And I’m reading the research on that. So there’s some researchers believe that it still does get into the bloodstream, and it also is in the enteric nervous system, right? So the enteric nervous system is that vast amount of nervous system that surrounds your gut and through vagal nerve stimulation, sends a lot of signals that go to the brain and then affect what goes on in the brain in terms of production of neurotransmitters and even inflammation.  So there’s seems to be a relationship between the production in the gut and the production in the brain, even though you’re right, directly… I remember when I first learned about most of your serotonin is produced in your gut and that’s what changes mood. And then as I learned more about it, I did learn, “Oh, no, it actually doesn’t get to your brain though. So how does it affect it?” But we think it’s through those other pathways, that it’s not maybe a direct relationship, but it does have an influence, a pretty strong influence.

Dr. Weitz:                            And it turns out there’s a huge amount of serotonin receptors in the small intestine. And in fact, stimulating those serotonin receptors actually helps improve gut motility. And so interestingly, patients with IBS for years were, because nobody really understood about CBO-

Dr. Bongiorno:                   Right.

Dr. Weitz:                          So IBS was seen as a psychological disorder, so patients were put on antidepressants and it turned out that the antidepressants actually did have some benefit by stimulating the serotonin receptors in the small intestine and helping patients overcome constipation and stimulate motility.

Dr. Bongiorno:                   That’s right. Yeah. I think it was actually in the thirties or the forties, I’m blanking on it. It was a female researcher that had published some studies on how the clam clench down and keep that muscles so strong, day in, day out. And what she found was basically what led researchers to what they called enteramine, which is serotonin. So entero stands for gut, right? And they found that entermine in the gut was what helped change motility in the gut. And they later renamed it serotonin and they found that it also happened to be in the brain and that it was a part of mood, but for a long, long time, the thinking was that serotonin’s main job was working in the gut for motility. Yeah, exactly.

Dr. Weitz:                          What about the importance of iron, for example?

Dr. Bongiorno:                   Yeah, so iron, I remember when I was a student, so this must have been about 24, 25 years ago. One of the very first patients I saw was this woman with depression. And I was talking to her after her visit because she was very, very happy, and I wanted to find out what the clinicians do for her. You know, I was a young, secondary clinician just learning for the first time. And she said, “Oh,” she goes, “Well, I was on antidepressants for many, many years. And the head clinician there had run an iron panel and looked at her serum iron, looked at her Ferritin, which is iron storage, and found her iron storage to be very, very low and her serum iron to be very low. And they gave her some iron, and no one had ever really looked at it, they gave her iron and within a month, she was off her antidepressant after being on them for years.

Dr. Weitz:                            Wow.

Dr. Bongiorno:                   And that was the first time I had ever heard that there’s an association between iron levels and mood. And of course, it may makes perfect sense, right? Cause iron is the center molecule of hemoglobin and hemoglobin is the molecule in your blood that you use to carry oxygen. So of course, if you can’t carry oxygen adequately, your body and your brain is going to kind of shut you down and say, “Okay, well, let’s lower that mood. Let’s shut that person down. So that this way, they’re not going to want to use as much oxygen.” So there’s much higher rates of depression when iron levels are low, and anxiety as well.

Dr. Weitz:                          Now you just mentioned somebody who was on antidepressants for a long period of time and got off. And that’s one of the issues with these drugs, is the difficulty of getting off of them once you’ve been on them.

Dr. Bongiorno:                   Right. Right. And I think that’s twofold, one is because when you’re on the drugs for a long time, the receptors for that particular neurotransmitter, they down regulate because your body knows there’s too much around than it would be doing on its own. So it down regulates some of the effects. So, that’s one issue. The other issue is that it does deplete a lot of the precursor molecules that you need to make the neurotransmitters. And that’s another issue.  And that’s why these drugs, and this is actually a medical term, they call it poop out syndrome. And that’s why these drugs are known to have poop out syndrome, meaning that they work for a while, and then they tend to stop working. And if you don’t fix the underlying reason why the neurotransmitters are off, maybe it’s iron, maybe it’s low vitamin D, low vitamin B6, not enough sleep, all these other issues, it’s very hard for people to get off these drugs because we haven’t fixed the underlying issues. When I have a patient come in and they’re taking medications, especially if they’re not having side effects, then the first thing we don’t want to do is just take them off medication, because they’re probably going to feel even worse than they already do. So what we want to do is, is leave them where they are and start working on the underlying issues and get those as well as we can, get them feeling a hundred percent with the medications they’re taking. And then we can start to have the conversation about how to healthily and slowly wean off the medication.

Dr. Weitz:                          And then what are some of the strategies for that?

Dr. Bongiorno:                   Well, let me preface it by saying, anyone listening should definitely not do this on your own and make sure you work with a practitioner who’s very knowledgeable and certainly don’t just get off any kind of antidepressant or mood stabilizing medications, just blankly get off them because that’s generally not safe. So having said that, like I said, the first step is to really work on all the underlying issues, making sure sleep, exercise, stress, maybe going to therapy, doing some kind of relaxation work, changing the foods, and then doing a fair amount of testing. We want to find out what’s going on with iron, red blood cells, B12, vitamin D, B6, inflammatory markers, histamine. I like to look at hormone levels as well, melatonin levels, glutathione levels.  There’s so many things to look at and what I’ll find is that many of them will be just fine, but that there’s going to be a number of factors that are out of balance. So then we want to start working on those things, and that’s where we can use maybe a different approach with foods, especially if there’s food sensitivities. We want to heal the gut, lower the inflammation, maybe put people on amino acids to start supporting some of the neurotransmitters, put people on a blood sugar supportive nutrients to help stabilize blood sugar, whatever I think the underlying issues are. I do a lot of gut and stool testing, and if the microbiota are really out of whack or if there’s a lot of candida and yeast issues, we may want to work on those things.

Dr. Weitz:                          What are your favorite gut and stool tests?

Dr. Bongiorno:                   I’ve been using GI-MAP tests lately. I think that’s a good test. I think there’s a number of them out there. I think the Genova testing seems to be very good as well. Vibrant America has good testing.

Dr. Weitz:                          Yep.

Dr. Bongiorno:                   Yeah. And so looking at all the testing, trying to adjust the factors that we find that are out of balance, and then once people are on that plan and they’re doing better and better and better, then we can start to have the conversation about how do we wean off the medication? Is this a good time? We’re going into December here in New York, it’s pretty dark. It’s getting pretty dark here in New York and serotonin levels are at their lowest. So maybe right now isn’t the best time to start thinking about getting off SSRIs, if we don’t need to. If there’s a need, then certainly we can. But maybe if we can wait till the spring, that’d be good. So, so seasonality might play a role there too.

Dr. Weitz:                            Maybe you could explain how seasonality affects serotonin and mood?

Dr. Bongiorno:                   Yeah. So generally as the days get shorter and darker, serotonin naturally goes down. I think, as animals, we’re designed to hibernate. We’re designed to go to bed earlier and sleep longer. And that’s the interesting thing about the holidays, right? The holidays put us into needing to be more outgoing and more active than ever at a time when our bodies are looking to be the least outgoing and the least active. So, you combine low serotonin and the stressors of needing to do all those things, and you end up with rates of suicide and depression that are much higher during those times of the year than other times.  And then as the light becomes longer during the day and the light gets brighter and light gets more direct in the summer, that also stimulates higher serotonin levels. So generally people will have much higher serotonin levels in the summer than in the winter. That’s one of the reasons why light boxes can be very helpful in supporting people. And I have many of my patients that I’ll send little reminder calls in August saying, “Hey, make sure your light box works, because we’re going to want to start using that in a couple of weeks.”

Dr. Weitz:                            And so circadian rhythm, it has a lot to do with cortisol and melatonin. And can you talk a little bit about that? And do you ever do the salivary cortisol testing to take a look at that?

Dr. Bongiorno:                   Yes. Yeah, I do either salivary or urine tests to look at cortisol levels throughout the day. And in many patients who are depressed, they might have very high cortisol levels or they might have very low cortisol level, or actually the levels might just be very dysregulated where maybe they’re very low in the morning and very high at night. So you’ll have these people who can’t get out of bed in the morning and then they’re tired and wired at night and they can’t sleep at night.

Dr. Weitz:                            Right.

Dr. Bongiorno:                   And the whole idea of circadian rhythm is very important to mood disorder and getting people in balance with nature and in balance with the day is a great idea. It’s interesting because right now it’s ten after ten here in New York and I have this bright light over here right next to me that’s on. What a disaster for melatonin levels, talking about my circadian rhythm.

Dr. Weitz:                            Absolutely.

Dr. Bongiorno:                   But so that’s not a really great decision on my part, right? To have a bright light in the evening when I should be really winding down and having just maybe these amber lights or orange lights on, telling my body, “This is the time to go to bed.”

Dr. Weitz:                            Right.

Dr. Bongiorno:                   So one night it’s okay to do that. But if you do that many nights-

Dr. Weitz:                            Right.

Dr. Bongiorno:                   …then you start to set a poor circadian pattern and then maybe add eating late, right? Cause eating also stimulates cortisol. So, it’s funny, I got a dog for the first time about three years ago, and I never had a dog before and I brought it to a vet and the vet said, “It’s really important for the dog, that you feed the dog the same time every day. And that you take the dog out to poop the same time every day, because that’s going to make it feel confident. That’s going to make it feel safe. And it’s going to keep its system calm.”

And I thought to myself, “Gosh, that’s exactly the same with us human patients,” right? Us humans need a regular circadian rhythm, when we eat, when we go to the bathroom, when we get up in the morning, when we go to bed at night, when we shut the lights. All of those things, not only are good for general overall health, but they’re really important for our mental health.

Dr. Weitz:                          Now is the quality of sleep equally as important as the amount of sleep?

Dr. Bongiorno:                   Well, both are certainly important. The amount of sleep is going to vary depending on person to person. Generally most people do need, I think a good seven and a half to eight hours. And I think that’s been shown. It’s also been shown that people who get a lot less sleep or people who get a lot more sleep, tend to have more anxiety and depression as well. So there does seem to be a sweet spot, for most people, around seven and a half to eight hours.

Dr. Weitz:                          And somebody asks, what light box do you recommend and how do you suggest they use it?

Dr. Bongiorno:                   Oh gosh. I don’t remember the exact name of the light box. I usually send people links to it. And to tell you the truth, I don’t remember. I could tell you though, in general, I recommend a 10,000 lux light box. So lux is L-U-X. So 10,000 lux, which is the intensity at 30 inches. So if you look for a light box, 10,000 lux at 30 inches, or feel free to send me an email and I could send you the links, my emails is peter@drpeterbongiorno.com. What was the next question?

Dr. Weitz:                          Oh, is coffee- Oh, there’s another question for me. Somebody just ask a question, do you see people who are on antidepressants who are more apt to develop seizures?

Dr. Bongiorno:                   Do I see people on antidepressants who are more apt to develop seizures? Well, people who are on Wellbutrin would be a little more apt to develop seizures. That Wellbutrin has been shown to increase seizure rate and sometimes creates first seizures and people have never had seizures before. I don’t know. I haven’t seen that with the other medications.

Dr. Weitz:                          Is coffee good or bad for mood?

Dr. Bongiorno:                   Well, generally it depends on the person, right? So people who are anxious, for the most part, tend to do better with less coffee. It will make them more anxious. And people who are typically anxious who are affected by coffee, usually have a genetic polymorphism that you can even look at to see how well they break down coffee and how long it probably lasts in their system. But the research on depression is fairly clear that people who drink two to four cups of coffee a day will have lower depression rates than people who drink no coffee to maybe one or two cups a day. So depression-.

There’s no coffee to maybe one or two cups a day. So coffee seems to be protective when it comes to depression rates. Although that effect does start to change around seven to eight cups of coffee and actually increases rates of depression and anxiety. So seven to eight cups, that’s a lot of coffee. I don’t recommend that. One to two cups, I mean two to four cups a day for people who are depressed and the research seems to be good. Now having said that, as a naturopath, as a functional medicine practitioner, I also think about somebody’s adrenal glands, because when you drink coffee, it’s sort of like squeezing those adrenal glands a little bit. So you’ll get more norepinephrine, Ativan, you’ll get the brain to make more dopamine. But if people’s adrenals are very, very weak and already depleted and you keep pouring coffee in them, even for depression, that’s actually I think in the long term, might be more problematic.  So I personally with my patients, if I run the adrenal test and I see the cortisol is very, very low and their no epinephrines really, really on the floor, I don’t want to just give them coffee to kind of boost them up. I want to actually them nutrify them and give them things that’ll actually nutrify their adrenal so that they get the natural boost that we’re looking for. So if they’re not very, very depleted and then I think some coffee can help with the depression. That was a long-winded answer.

Dr. Weitz:                           That’s good. No thoughtful. Why does it seem like young people are just epidemic with anxiety in particular and also depression?

Dr. Bongiorno:                   Young people, what ages are you referring to?

Dr. Weitz:                           I’m referring to teenagers, but even young adults.

Dr. Bongiorno:                   Well, I think there’s a couple of reasons. So one is the sleep schedules, I was reading some research about teens and it seems like teens actually have a different circadian rhythm than the rest of us.

Dr. Weitz:                           Really?

Dr. Bongiorno:                   Teens would do better to wake up later and go to sleep a little later. And unfortunately the schedule is really designed to get up really early. So you have a teen who really naturally wants to get up later and they have to get up earlier and then in the evening they don’t want to go to sleep. Because it actually feels too early for them. So a lot of teens are very sleep deprived as a result.

Dr. Weitz:                           Now why would teens be programmed in that way?

Dr. Bongiorno:                   I don’t have the answer for that, but I’ve been doing more work on circadian rhythms and that’s one of the things that I learned and I can’t tell you why, but it’s something developmentally that when we’re younger, the kids tend to go to bed early and get up early. But then when they get a little older in their teen years, they tend to want to go to bed late and then want to sleep late and it’s not just a habit, it’s actual physiology. And then as we get into adulthood, that starts to shift and we start to want to go to bed a little earlier. So unfortunately these teens at these very critical years of growing are especially sleep deprived in general and then even more sleep deprived for their natural circadian rhythm.  So I think that’s one issue.

I think another issue is deplorable nutrition. There’s a number of studies now that show that the much higher rates of impulsivity, much higher rates of anxiety, depression in teens who eat fast food and eat a lot of poor quality foods versus teens who eat better quality food under the same circumstances.  I have a couple slides and some lectures where I talk about that and the really interesting studies that clearly, clearly show that. I also think in my opinion, the screens that we’re using and social media is also playing a strong role. And there’s a fair amount of research that’s showing that. I mean, look at all the stuff going on in the news right now about Facebook, sort of keeping down some research about the effects it does have on teenagers, especially Instagram, when it comes to self worth and looking at themselves and comparing them to somebody else and what the ideal person should look like and act like, and how many likes should they have.  It’s a lot, a lot of pressure. And plus I think just staring at these screens and the blue light that’s coming from them at night is further exacerbating that sleep issue.

Dr. Weitz:                            Do you think the EMFs might also be playing a factor?

Dr. Bongiorno:                   I’m sure that does play a factor. I mean, more and more research is coming out, showing how strong the electromagnetic frequencies are, especially from iPhones which so many teens have. Very little to no protection on the screen the whole time or having it right on their body somewhere most of the day, if not all the day.

Dr. Weitz:                            Right. So let’s go into lab testing. Let’s talk about in detail a little bit, what you think is a good panel to start with for the average person you’re seeing. And I realize everybody’s different and we’re going to focus on different things depending upon the history and-

Dr. Bongiorno:                   It’s tough. I do in my books, I do have a page where I give the panels that I generally like to see, because it is important. I’ll tell patients, or my readers, if it’s a page you can take out of the book or copy and hand it to your doctor and hopefully he or she will be able to run most of those. It is different for everyone. When I think about running labs, I like to look at blood sugar. So hemoglobin A1C, insulin, fasting insulin I think is very important.  Red blood cells, white blood cells, a liver panel, GGT, which can look at can be a surrogate marker for toxicities as well, and a full iron panel as we with ferritin, as we talked about before. A full thyroid panel, including thyroid antibodies, inflammatory markers. So things like erythrocyte sedimentation rate, C-reactive protein, Interleukin-6, especially if there’s depression. Looking at gut markers. Looking at things like fecal calprotectin. If I suspect there’s colitis, looking at celiac panel as well. Amylase and lipase, if I think there’s pancreatic involvement and then looking at vitamins, vitamin D, zinc, the zinc to copper ratio, red blood cell magnesium, vitamin B12, methylmalonic acid, which also looks at B12 in a different way. So there’s so many vitamins. We could go on and on.

Dr. Weitz:                          With the importance of lipids looking at detailed lipid panel.

Dr. Bongiorno:                   So detailed lipid panel, especially if I think there’s a lot of cardiovascular involvement and lipids. Not only to check to see if cholesterol’s high, but oftentimes to see if cholesterol’s too low, especially if people are on statin medications, because cholesterol is the precursor molecule to pregnenolone, which I also check on labs. And pregnenolone is the precursor molecule to all our important, other important steroid molecules. Cortisol through one pathway and progesterone and then DHEA and testosterone and estrogens through another pathway. And so I do worry for so many patients when the cholesterol’s too low, that they’re not going to have the ability to make all of those other hormones that we really need for good mental health.

Dr. Weitz:                          And there’s a big push in cardiology to get the LDL.

Dr. Bongiorno:                   Lower lower lower. 

Dr. Weitz:                          As low as possible.

Dr. Bongiorno:                   Right, because we look at one pathway and one mechanism and we don’t think about everything else.

Dr. Weitz:                          And yet they say there’s no research to show that statins have any negative effect on brain health.

Dr. Bongiorno:                   It doesn’t make sense. And I think what happens is when ideas are new, kind of the pendulum swings one way and then as more and more research comes aboard and we start to see, maybe this isn’t the right way we’re thinking about it. I mean, how many times have we seen this? We’ve seen this when they demonize fats, we see this with the margarine, when margarine was supposed to be so healthy for us. Things like that. And then we kind of go, it’s not really working out as well as it could have.

Dr. Weitz:                          What about the importance of the hormones?

Dr. Bongiorno:                   So hormones are critical to mental health. For example, estrogen levels really play an important role in the levels of serotonin in the brain and where the serotonin is being made in the brain areas that need it. When estrogen levels are high, it changes the amount of monoamine oxidase to help keep serotonin levels high. Progesterone actually does the exact opposite. So that’s why estrogen and progesterone have a nice yin and yang to them because they kind of balance each other. So looking at not only estrogen levels, but the balance of estrogen and progesterone in a woman is very important. Estrogen levels are actually important in men. Men have six times the level of estrogen in the brain that women do. So sometimes when we think about depression and serotonin and we also want to check on estrogen as well.

Dr. Weitz:                            So let’s talk out estrogen levels in men. Is there a number, do you like to see estrogen above 30 or is there a certain number you like to see? And is there any importance of progesterone levels in men?

Dr. Bongiorno:                   Progesterone levels in men there isn’t a whole lot to research on. It’s something I’ve thought about. And I do know when men are supplementing with progesterone, typically it’s not beneficial. That’s what I’ve seen so far, but it’s an interesting question. And I think it needs a lot more explanation and exploration. As far as estrogen levels, the way I think about it is we want to look at levels of cholesterol, pregnenolone, DHEA, then testosterone and then estrogen. And basically that whole pathway to kind of feed each other very nicely up until the estrogens. And if that pathway looks healthy in general, then I think we’re on the right path with men and women.

Dr. Weitz:                            Right. What about if you have a menopausal woman who’s having a tough time with depression and anxiety, do you ever recommend hormone replacement therapy?

Dr. Bongiorno:                   Possibly. I don’t typically like to start with hormone replacement therapy. So first we want to start with, obviously if someone’s really suffering and the hormones are so out of balance and they need something to help them feel better faster, then I would certainly consider hormone replacement. But in general, first we start with all the basics. Sleep, exercise, diet, stress reduction, because those things oftentimes will help. Secondly, we want to support her liver because the liver is what processes the estrogens. And oftentimes when the liver and the microbiome are out of balance, we’re going to see improper levels of estrogen. For example, if there’s beta-glucuronidase levels are out of balance, that’s going to change estrogens and there’s going to be a lot more recirculation of excess estrogens. If there’s a lot of candida, candida acts as false estrogens, so that’s going to change the balance of estrogens.  So we want to fix all of those things. So without even touching hormones, we can oftentimes fix the hormones.

Dr. Weitz:                            By fixing the gut.

Dr. Bongiorno:                   Right, exactly, by fixing the gut. And then making sure a woman is having bowel movements every day to making sure everything is getting out that needs to get out from the liver. And then if those things aren’t enough, then we can test hormones and see where they are and then make a decision about whether we want to tweak hormones a little bit. If pregnenolone is low and all the other hormones are low, then maybe start with a touch of pregnenolone and that can help feed the rest of the pathways. Or if we see that cortisol levels are actually normal or normal high, but the other side of the pathway DHEA is low, then maybe start with DHEA and see if we could feed the pathway.  So I try to feed the pathway earlier so that the body has more ability to make the decisions it needs to make.

Dr. Weitz:                            Right. So you might start with pregnenolone versus estrogen progesterone.

Dr. Bongiorno:                   Possibly. And I did want to say there’s an herb that I might try before either of those, especially if progesterone levels are low related to estrogen and that’s Vitex, also known as chasteberry, which does a beautiful job. There’s studies in premenstrual dysphoric disorder showing it works really well. There’s other studies in perimenopausal depression showing that it worked just as well as SSRIs. Although it does seem that, that the Vitex seems to work better for the physical symptoms along with the depression. Whereas the SSRI, at least in this one study, showed it was better. The SSRI was a little more helpful when it came to the mood symptoms versus the physical symptoms. So oftentimes when I’m using Vitex, I’ll use Vitex along with tryptophan and I find we can get both the mood and the physical symptoms in balance. So Vitex is a brilliant herb. It’s really wonderful.

Dr. Weitz:                            What kind of dosage do you find effective for Vitex and also for tryptophan?

Dr. Bongiorno:                   Sure. So for Vitex, I think it’ll depend on what kind of, if it’s an extract or what kind of preparation it is. Typically, it’s a capsules around 220 milligrams, so I’ll usually start with one or two of those a day and I’ll do it every day. I won’t dose it with the cycle, but I’ll just dose it every day. And then as far as tryptophan goes, if it’s tryptophan, I’ll usually start with 500 milligrams twice a day, and 5-HTP, maybe start with 50 to a 100 milligrams a day.

Dr. Weitz:                            In which do you find more effective, 5-HTP or tryptophan?

Dr. Bongiorno:                   That’s a great question. And it’s interesting because theoretically 5-HTP should work better. It’s a little further down-

Dr. Weitz:                            It’s a little further down downstream. Right.

Dr. Bongiorno:                   It’s a little further down on the pathway. And especially if there’s inflammation, it should be harder for your body to make serotonin from tryptophan than it should be from 5-HTP. But having said that, I find different patients respond differently. Oftentimes I start with tryptophan because I think I find it does work better, although not in every case. And especially for sleep, for helping people stay asleep, I tend to use more tryptophan. So having said that I’m always open because everyone’s different.

Dr. Weitz:                            Dr. Wasserman asks a question about diet and I think what he’s asking is, you mentioned somebody having too many simple carbs, but can a low carb diet also increase problems with anxiety and depression?

Dr. Bongiorno:                   That’s a great question. That’s absolutely true, because we need carbs to help make serotonin as well and a very, very low carb diet and someone who’s susceptible, can send them into anxiety and depression by lowering their serotonin levels. Some people who aren’t that affected, they can go very low carb, do a keto diet and their brain’s doing wonderfully. But you’re absolutely right that we have to be careful, especially people who teeter on depression and suicide. To put them on a low carb diet can actually lower their serotonin levels more and put them more into that mood disorder than they already are. The other thing I’ve seen in relation to that is gluten can also play a role in mood and people who come in depressed are often sensitive to gluten.

Having said that if you take them off gluten, gluten also creates these kind of morphine like compounds in the body and they affect the brain. And sometimes if you put people on a gluten-free diet very quickly, it’s almost like some taking somebody off of morphine and when they go through withdrawal, their symptoms will actually be even worse. So I do find if people are depressed or they have pretty significant mood disorder and we decide to take them off gluten, I do it slowly. I don’t have them come off of gluten right away all at once. I have them do it slow and I treat it like any other drug that they might be addicted to because I know we’re going to have withdrawal symptoms as well.

Dr. Weitz:                            Interesting. Interesting. That’s a good clinical pearl right there. I’m mean there’s been tons of clinical pearls tonight already. So let’s go into the most effective supplements for depression and anxiety. And I know you’ve mentioned a number of them already, but let’s start with fatty acids.

Dr. Bongiorno:                   So essential fatty acids. I think fish oil by themselves I don’t think can cure depression or anxiety in most cases, unless people are just so genuinely deficient in them, which a lot of us are. There’s a study that came out last August in one of the psychiatry journals showing that patients who are treatment resistant to SSRIs tended to do much better when they took fish oils. And now that also made me think, well maybe you could have just gave them the fish oils and didn’t even need this SSRIs. I mean certainly, essential fats play such a strong role in creating healthy membranes and healthy membranes in the nervous system are going to play such a strong role, an important role in mental health. So to me, fish oil is one of the basics.  When a patient comes in for a first visit, I had a young woman who came in today with anxiety, she doesn’t prefer fish. She doesn’t like to eat fish and we’re going to run some tests and do some of the things that we talked about. But I already put her on fish oil, unless I know a person’s allergic to fish, if they’re not really eating any fish and they’re not taking any fish oil, that’s an easy one to have them start taking some fish oil. Because I know in the long term that’s going to help.

Dr. Weitz:                            What do you think about SPMs, which are those derivatives from fish oil that help to reduce inflammation?

Dr. Bongiorno:                   Oh, those are resolvents? Is that the same as resolvent?

Dr. Weitz:                            Right. Exactly.

Dr. Bongiorno:                   That is a lot of intriguing information about that and my understanding is, and I haven’t used them a lot, so I don’t have firsthand experience with them yet. I just actually started bringing them into the practice. And I’m going to be taking them myself because I like to try everything first. But my understanding is not only does it help with inflammation, it also helps with the healing process as well, which I think is amazing. I’ve been reading the literature on them and I think there’s some substantial information then I could see why a number of companies have been working on bringing those out.

Dr. Weitz:                            GLA?

Dr. Bongiorno:                   GLA. Yes, so I talk about in my books, the importance of GLA, especially in production across the glandins, those are all also feel good molecules that our body naturally makes. And there’s a number of studies in people who are alcoholics. Alcoholics generally drink alcohol because it increases levels of PG2, which helps them temporarily feel happier and giving people GLA can be an important part of helping the body make its own prostaglandins and helping mood as well. So for example, when I see patients who have a strong alcoholic intake and that’s one of their drugs of choice to feel happier temporarily, I will start them on GLA.

Dr. Weitz:                          I think GLA is an interesting example of not throwing the baby out with the bath water. It’s been so much focus on Omega-3’s and the fact that Omega-6’s are too high. So we got to get the Omega-6’s low and I’ve talked to doctors who said why would you ever prescribe an Omega-6? And of course, GLA and evening primrose oil, these are Omega-6’s but they have important benefits too.

Dr. Bongiorno:                   In fact, typically the ratio of Omega-6 to Omega-3 should be three or four or greater something like that. So a healthy diet does have more Omega-6’s in the diet than Omega-3’s. I think so many of us are so deficient in Omega-3.

Dr. Weitz:                          There’s some debate as to what the ideal is. Some labs say under four. I know some people say it should be under two. There’s discussions of the cave men were really one to one.

Dr. Bongiorno:                   It’s funny. I’m scrolling right now. I’m reviewing a book for a friend of mine, who is putting out a book, a medical doctor’s putting out a book on skin health.  Was putting out a book, medical doctor was putting out a book on skin health, and I was just reading the section on omega sixes omega 3 and he put out the latest research. Dr. Mark Tager, I don’t know if you know him, wonderful guy. And he’s got a book coming out on skin health and yeah, I don’t know if I can find it offhand. But I was just reading that on the train coming back, looking, reviewing his book, so.

Dr. Weitz:                          Okay. So what about probiotics?

Dr. Bongiorno:                   So probiotics, it’s again, the first step to a healthy gut is certainly reducing stress, getting enough sleep, exercising, eating the right foods, eating enough fiber. Right? So probiotics by themselves can be helpful, especially when therapeutically if there’s diarrhea, if there’s high levels of a C difficile, for example, using individual probiotics can be useful for balancing things, but overall to really create a healthy microbiome, we want to do all those other basics first.

Dr. Weitz:                           Now you know of course there’s probiotics on the market that are marketed as specifically being beneficial for depression and anxiety.

Dr. Bongiorno:                   Right. Yeah, and there are a couple of studies. And I remember when those first ones came out, there was a company that came out with a line and there was one study. And I tell you, I mean, the research on the microbiome, the microbiota and probiotics have just exploded in the past couple years. So, yeah, I think there’s more and more coming out about that. I mean, and now there’s studies that in animals, if you take an animal who’s depressed and you do a fecal transplant from an animal who’s not depressed, that you can actually lift their mood and their depression.

So there’s definitely something there. There’s no question about it. Whether we can get all the strains into a capsule that we can take in and actually help repopulate, I think that still remains to be seen. But if we can get some of the Keystone strains in there and get the right fibers and again, work on people’s stress and all the other basic factors, I think, yeah, I think it does make a difference. And I certainly use probiotics as part of the regimen when I work with my patients.

Dr. Weitz:                           And some of the keystone species are starting to become available. I interviewed researcher company, Pendulum Therapeutics has, I think it’s the first anaerobic Akkermansia.

Dr. Bongiorno:                   Yeah, I saw that. Yeah. And that’s interesting to me. And again, is giving an individual one like that the most beneficial, maybe. I think of the microbiota as kind of like a garden in there. And so we have tomato plants and we have zucchini and we have peppers and maybe some cucumbers on the bottom. And then, we have the weeds, maybe the ones we don’t want in there too great a level. And some of those we can put in a capsule and give to people, and some of them we just can’t. Right. So we have to do it through fermented foods and we have to do it through just making sure people getting.

Dr. Weitz:                           Fiber and probiotics.

Dr. Bongiorno:                   Yeah. Right. So there’s so much we need to learn, but I think it’s really fascinating. And I’m interested.

Dr. Weitz:                           How about the importance of B vitamins, including folic acid?

Dr. Bongiorno:                   Yeah. So B vitamins, especially for mitochondrial function, for producing energy in the body, for methylation which we nee to make neurotransmitters, which we need to break down neuro transmitters, and break down hormones properly. So we need those B vitamins and in different levels. And they’re certainly worth checking as well. And if I know somebody’s very, very stressed out, it’s usually a safe bet to put them on a low dose B complex at least start because you know they’re burning through those B vitamins.

Dr. Weitz:                           I remember there being some research on folic acid maybe helping patients with schizophrenia. By the way, have you found it effective to use a functional medicine approach for patients with schizophrenia?

Dr. Bongiorno:                   Yeah. I mean, absolutely. Probably even more so because in conventional care, schizophrenia is really about just lowering levels of neurotransmitters. Right. So if we could understand what are the blockages of why maybe people aren’t breaking those things down in their own brain and using that information then yeah, absolutely. So the first step is, again, all of the basics. There’s research now in schizophrenia is also showing a lot of mitochondrial dysfunction. A lot of psychotic mental health disorders may have to do with the mitochondrial dysfunction. So that’s certainly a place I think about when I think about working with patients who have schizophrenia.

Dr. Weitz:                           And what are your first thoughts about trying to improve the mitochondria?

Dr. Bongiorno:                   I guess I want to first think about, well, why is their function impaired? Right. So we think it could be toxicity, it could be heavy metals, could be too much iron in their body. It could be very high insulin levels due to high blood sugar. It could be high adrenaline, high, norepinephrine and epinephrine levels due to stress. There’s a number of reasons why mitochondrial dysfunction can start. Too much inflammation in the body can certainly contribute as well. So we want to look at all of those factors and key in on which one of those are probably most likely for that particular person.

There can be genetic influences too. Although and so when I think about people who have had mental health concerns since they were very, very young, like 3, 4, 5 years old, then I think, well, maybe it’s more of a genetic component in terms of mitochondrial function. Not that we can’t help them, but that it’s probably less environmental and more genetic. But if it’s people who the mental health concerns started happening in their late teens and certainly in adulthood, then I think about it more as a secondary mitochondrial function, based on those other factors.

Dr. Weitz:                           What kind of testing for heavy metals and/or other environmental toxins have you found helpful?

Dr. Bongiorno:                   Well, I mean, the first place to start is a blood test to look for things like mercury and cadmium and arsenic and lead and aluminum and things like that. And the problem with blood tests is that you’re not really seeing what’s going on with body burden. But you are seeing what’s going on acutely. So if you find high levels acutely, then you know you have to start working on that. And then you could do urine tests, provocated urine tests to try to find out what really the body burden is after that.

Dr. Weitz:                           For years, I know we used to use the DMSA and do provocation testing, and now that that’s prescription only, it’s a pain. Is there a workaround? Have you found anything? Can you use glutathione or anything like that?

Dr. Bongiorno:                   I mean, I really, haven’t. Not something I think I know would be really reliable. So I’d be interested if anyone listening has, but I haven’t. Yeah, no, still DMSA, that seems to be the DMPS seems to be the best way to go.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   Yeah, it was nice when the supplement companies had them. Right. We just used it. Check kidney function first. If that’s okay then do a provocated urine.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   Right. They’re making it harder and harder.

Dr. Weitz:                           Importance of vitamin D.

Dr. Bongiorno:                   Yeah. So vitamin D has so many pleiotropic effects in the body. It’s needed for serotonin production, certainly. So when vitamin D levels are lower, it’s going to be harder for the body to make serotonin and other neurotransmitters. And then it’s very important in how we balance inflammation in the body. So that’s another point. It’s a neuro steroid. So the neuro steroids pregnenolone, DHEA, and vitamin D, when any or all of those are low, there’s some really fascinating research that shows the communication between the amygdala, which is the fear center of the brain and the prefrontal cortex change significantly and creates a lot more likelihood of anxiety and depression. So when neuro steroid levels are high enough like vitamin D should be, then there’s going to be a less likelihood of things like anxiety.

Dr. Weitz:                           Minerals, like magnesium, zinc, lithium?

Dr. Bongiorno:                   Yeah. I’m for them. I’m for all of them. So yeah, some magnesium is very relaxing. It’s important. Has so many levels of importance, if I had to pick one in terms of what we’re talking about, GABA levels in the brain. It helps with the benzodiazepine receptors. Zinc, the zinc to copper ratio, looking at zinc levels as a co-factor for so many different reactions in the body, certainly for gut health as well. And then, oh, you mentioned lithium, nutritional lithium.

Dr. Weitz:                           Right.

Dr. Bongiorno:                   Actually I just wrote a paper on nutritional lithium that was published in the Natural Medicine Journal. I’d be happy to send it to anybody.

Dr. Weitz:                            Oh, that’d be great.

Dr. Bongiorno:                   If anybody would like a copy of it. And also anyone listening, please do join me on Facebook and Twitter and Instagram as well.  And if you want to be on my newsletter, feel free to send me a note. I’m putting out a mental health newsletter, so I’d be happy to send it out. Won’t be selling you anything, just purely research as I read it, things that I’m excited about, I like to send to my friends.

Dr. Weitz:                            That’s great.

Dr. Bongiorno:                   Yeah. So nutritional lithium, I found very, very helpful in my practice. I’ve probably been using it for about eight years now, nine years. And it’s great for teens with impulsivity, even younger kids in the five to 10 age group, it can really be helpful for anxiety in drop doses. Very supportive of the brain. Now there’s even research showing it may be protective for Alzheimer’s later on. So I do use a fair amount of it with patients, and I’m finding good results.

Dr. Weitz:                            So this is the lithium orotate, right?

Dr. Bongiorno:                   Lithium orotate. Yep.

Dr. Weitz:                            And what kind of dosage do you find effective?

Dr. Bongiorno:                   I usually start with five milligrams for an adult, maybe one milligram for child. Yeah. Up to 20 milligrams a day in an adult.

Dr. Weitz:                            What about GABA?

Dr. Bongiorno:                   GABA the supplement?

Dr. Weitz:                            Yeah.

Dr. Bongiorno:                   Yeah. No, GABA can also be helpful. Some people theorize that GABA is only useful if you have a leaky gut and a leaky brain, because it’s very difficult to get into the brain. And, I haven’t seen enough leaky gut patients versus non leaky gut patients that I’ve tested to know for sure whether that’s true. My theory is if you give enough, hopefully some of it will get through. So usually at least 500 to 1000 milligrams, two or three times a day. So if I’m using GABA I tend to dose it high. I find low doses don’t typically do a whole lot by itself. I’ll often give it with theanine and maybe with something like lithium orotate or a CBD oil. So usually I’m using a few things together. But I do find, especially for patients who are very susceptible to the side effects of benzodiazepines, you really want to think about using other gentler things like GABA. And oftentimes you can even find a better result because it’ll help calm people down, but you won’t have the side effects.

Dr. Weitz:                            And there’s a few different forms of GABA on the market. I know there’s GABA chewables. There’s GABA that supposedly is better absorbed.

Dr. Bongiorno:                   Yeah. I’ve been using liposomal GABA, the kind that you can kind of spray.

Dr. Weitz:                            Okay.

Dr. Bongiorno:                   And I’ve been finding good results with that. I’ve heard chewables can be useful too. I haven’t used them but I guess it’d be the same effect, right. Using a chewable, you’re kind of getting it into the oral cavity and getting absorbed through there. So that would make sense to me.

Dr. Weitz:                            I guess, yeah, theoretically, if you kept it under your tongue, and let it dissolve there. What about any of the other herbs? And then I think we’re going to wrap it up in a couple of minutes.

Dr. Bongiorno:                   Okay. Yeah, other herbs, I mean, I know it sounds cliche at this point, but St. John’s Wort is a very good herb for mood, especially for do you know?depression. And it does work for anxiety.

Dr. Weitz:                            Why has it been given an almost a bad name, do you know?

Dr. Bongiorno:                   I think because it’s known to affect the liver and its ability to process other drugs. So I’ve done some formulations for companies, and I have one formulation to support neurotransmitters and for depression. And I purposely didn’t put St John’s Wart in it because I know it won’t be used. So when I use it in my practice, I actually use St. John’s Wort separately with it, because it does affect a lot of drugs more than others. So I think a lot of practitioners tend to stay away from it. I had one patient who came in, she took St John’s Wort while on birth control. And she got pregnant because it stopped. So there is a reason. It turned out she had twins and was very happy about that in the end so it worked out great.

Dr. Weitz:                            So St Johns Wort makes it easy to get pregnant.

Dr. Bongiorno:                   But I like St John’s Wort, especially now in the time of COVID, because also, it’s a good antiviral. It has anti-inflammatory effects plus it’s really great for mood. It’s a beautiful herb.

Dr. Weitz:                            And you mentioned using lavender. You also listed rhodiola saffron in your book.

Dr. Bongiorno:                   Yeah. So saffron, especially when there’s a lot of digestive issues. I have another formulation that I put together, and it has chromium, saffron, turmeric, berberine in it, and a little bit of rhodiola. And the idea of that is to kind of address blood sugar, gut inflammation, hypothalamic pituitary, adrenal access. And the berberine to kind to help promote neurotransmitters in a healthy way as well as helping the gut.

Dr. Weitz:                            So how does berberine promote neurotransmitters?

Dr. Bongiorno:                   So berberine, it’s not something that’s well discussed, but berberine actually binds to Sigma one receptors which help this pathway of chaperone proteins. It’s also helped neurotransmitter production in the brain too. So it is known to help.

Dr. Weitz:                            Berberine is an incredible herb.

Dr. Bongiorno:                   I mean, yeah. Cholesterol, blood sugar. Yeah, gut health.

Dr. Weitz:                            I mean, it’s a natural form of Metformin, so I use it for antiaging purposes as well.

Dr. Bongiorno:                   Yeah. I remember learning about it in school again, 25 years ago. And the only thing I remember learning about it was that it was a good natural antibiotic and kind of helped the gut heal at the same time. Yes. And now it’s just so much more. It’s great.

Dr. Weitz:                            And probably the other wonder nutrient is NAC which you mentioned in your book and seems to be beneficial for almost everything.

Dr. Bongiorno:                   Yeah. And NAC is so good that Amazon has taken it off their website. That’s how good it is.

Dr. Weitz:                            So, well…

Dr. Bongiorno:                   It tells you it’s pushing some buttons. Right?

Dr. Weitz:                            Well, I think the reason they did it is because when it was first approved, it was approved as a drug.

Dr. Bongiorno:                   Right.

Dr. Weitz:                            So hopefully the FDA’s not going to take it off the market. I mean, even though Amazon… To be honest with you, if Amazon said they were going to take all the supplements off of Amazon, I’d be quite happy.

Dr. Bongiorno:                   That’s fine with me. Yeah.

Steve Snyder:                    Can I just pipe in on that for a second on the NAC thing. We think it’s not a thing. We are not stopping making it. We will continue to make it.

Dr. Bongiorno:                   Great.

Steve Snyder:                    There was one study, like in the early sixties that they’re trying to say is the reason that they think it might be a drug. But they haven’t changed any regulations or any classifications or anything like that. It was just a bunch of warning letters last fall. Amazon, because they’re a forward facing, a retail facing company, that’s why they did it. And then Whole Foods Market is owned by Amazon so they did it. And then Thorne is kind of the supplement company that got caught up in it because they pretty much only do Amazon now. So that’s where it kind of the ball got rolling, but it’s another one of those mostly it’s an internet thing. And we are selling it like crazy. We can’t literally can’t make it fast enough, something to the tune of about 5,000 bottles a month.

Dr. Bongiorno:                   Wow.

Steve Snyder:                    So yeah. But it’s not going away. We were not worried about it at all. And we have a great one. It’s super inexpensive, 600 milligrams per cap. Check it out.

Dr. Bongiorno:                   Hmm, great.

Dr. Weitz:                          Maybe come up with a strategy to get Amazon to take more supplements off their website.

Dr. Bongiorno:                   I just wanted to say Steve, I really love the cortisol manager. I find it also works quite, quite well for my patients. And cortisol levels are high and something I’ve been using for a number of years is really good success too.

Steve Snyder:                    Thank you. It’s by far our biggest selling product. It also happens to be natural partners, biggest selling product and probably Emerson too. So it’s definitely our flagship for sure.

Dr. Weitz:                            And you guys also have a brain product that has saffron in it.

Steve Snyder:                    Yeah. So that one’s pretty new. It’s called Neurologix. I don’t know if you’ve seen it yet, but it’s a combination of spearmint, saffron, and and a branded citicoline. So it’s a pretty big anti-inflammatory part. The spearmint and Citicoline part work functionally and structurally, but the saffron is kind of an added thing because we feel like the mood is part of all of that. And individual ingredients have been shown to like it’s working memory, sustained attention, focus, some pretty impressive studies on this stuff. So it’s not cheap, because it’s one of the ones that doesn’t have caffeine in it. So it’s not a stimulant, but i blows people’s doors off. And that’s another one we have seven day trial bottles of, and people will notice it after seven days. And we are happy to let them try it because we know it works so, Neurologix.

Dr. Weitz:                            Okay. Thanks, Steve.

Steve Snyder:                    Yep.

Dr. Weitz:                            So Peter, this has been incredible. You’ve provided us with so much great information. Any closing thoughts?

Dr. Bongiorno:                   Yeah. I mean, to the clinicians out there, when you have a patient who, especially if it’s a challenging patient, always double down on the basics. Make sure that those are all taken care of. And just really look for the other underlying factors that maybe you haven’t looked into yet because there’s some reason why a person is feeling the way they’re feeling. And it’s really up to us as clinicians to kind of look at all those factors and really put it together because there’s practically always a way to help to get people to feel better. If not get them off medications, at least get the medication doses lowered which often could be a win, especially in things like bipolar. You’re creating so much less toxicity in the body.  And to any listeners there in the public who are suffering from anxiety, depression, mental health, just know that there’s still a lot of tools out there, and find a practitioner who just really cares and is listening and wants to look into those underlying factors because there’s always something else that can be done. And just don’t give up hope, and don’t give up thinking that you can feel better and feel like your best self.

Dr. Weitz:                            Thank you.

Dr. Bongiorno:                   Yeah. Thank you. Thank you so much for what you do and bringing these forums to people.

Dr. Weitz:                            Great. Thank you. And we’ll see everybody in the new year.



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




Dead Bodybuilders with Dr. Howard Elkin: Rational Wellness Podcast 234

Dr. Howard Elkin and Dr. Ben Weitz discuss Why Bodybuilders Are Dying Young but How Weight Training Promotes Health.

[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

0:27  Quite a number of professional bodybuilders have been dying recently at young ages due to anabolic steroid use/abuse, including the death of the 2018 Mr. Olympia Shawn Rhoden, who died of a massive heart attack at age 46 several weeks ago.

7:48  The goals of this podcast are 1. to describe the health risks of anabolic steroids for those bodybuilders who are taking them and who are not aware of the risks, and 2. to explain why weightlifting promotes health, so those who hear about bodybuilders dying are not discouraged from weight lifting.

9:20  Weightlifting promotes longevity by allowing you to gain muscle and strength.  Muscles support and stabilize your joints including your spine.  Maintaining muscle strength allows you to maintain your mobility as you get older.  Loss of muscle is called sarcopenia and this can lead to loss of mobility as you age.  Seniors with sarcopenia are more likely to fall and break a hip, which can be catastrophic.  You are much more likely to die in the next few years after breaking a hip.  If seniors end up on the ground, they often cannot get up without help due to them being too weak. In fact, being able to get up from the ground without help has been shown to be a predictor of longevity. (De Brito LBB, Ricardo DR, de Araújo DSMS, Ramos PS, Myers J, de Araújo CGS. Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology. 2014;21(7):892-898. doi:10.1177/2047487312471759) On average, after the age of 30, we lose about 1/2 lb of muscle per year unless you do weight training and this loss of muscle accelerates after age 50.

12:38  Weightlifting promotes bone strength.  As we age, the loss of bone, osteopenia or osteoporosis, can lead to fracture, sometimes catastrophic.  Weight training can not only strengthen your muscles, but your bones as well by placing controlled amounts of stress on your bones. Weight training not only loads the bones but also as the muscles contract, they pull on the bones, leading to both better bone density and bone strength.

15:47 The cardiovascular benefits of weight training. Weight training improves your cholesterol and lipids. It increases blood flow, dilates your blood vessels and helps keep the arterial walls compliant and reduces their stiffness. Most studies show that weight training lowers your levels of LDL (“bad” cholesterol) and cholesterol and raises your HDL (“good” cholesterol). (Sheikholeslami Vatani D, Ahmadi S, Ahmadi Dehrashid K, Gharibi F. Changes in cardiovascular risk factors and inflammatory markers of young, healthy, men after six weeks of moderate or high intensity resistance training. J Sports Med Phys Fitness. 2011 Dec;51(4):695-700.)

18:09  Weight training also helps with weight loss, since it raises your metabolic rate, which is the rate at which your burning calories all day long even when you are not exercising.  The more muscle you have, the higher your metabolic rate.  And obesity certainly increases your risk of heart disease.

19:39  While both cardiovascular and weight training reduce epicardial fat, only weight training reduces pericardial fat. (Christensen RH, Wedell-Neergaard A, Lehrskov LL, et al. Effect of Aerobic and Resistance Exercise on Cardiac Adipose TissuesSecondary Analyses From a Randomized Clinical TrialJAMA Cardiol. 2019;4(8):778–787.)  

21:02  Weight training will lower blood pressure. While your blood pressure may rise temporarily during weight training, such as while doing a leg press, performed consistently it will lower blood pressure.(de Sousa EC, et al. Resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive individuals: meta-analysis. Hypertens Res. 2017 Nov;40(11):927-931.)

22:22  Weight training can also help to reduce the risk of diabetes.  Weight training reduces blood glucose levels and has been shown to reduce hemoglobin A1C, which represents a three month average of blood sugar.  As you use the muscles around the body, they use their glycogen up and then glucose will be pulled from the bloodstream into these muscles, thus lowering blood glucose. And having more muscle gives you more storage for glucose.

25:58  Professional bodybuilders are dying at a young age due to anabolic steroids and other drug use.  What are anabolic steroids?  All our hormones are steroids due to their molecular structure and this includes estrogen, progesterone, and testosterone. But only testosterone is considered to be “anabolic” or growth promoting.  Therefore, anabolic steroids refers to both testosterone and various synthetic derivatives of testosterone that have been designed by chemists to have the muscle growth promoting properties of testosterone without some of the negative effects of taking high levels of testosterone. These drugs have names like Dianabol, Primobolan, and Deca-durabolin.

33:12  Liver damage from taking anabolic steroids.  We may see elevations of liver function on lab testing, esp. AST, ALT, and GGTP levels.  Various things can cause liver function tests to elevate, including drinking alcohol and taking Tylenol and other medications.  Patients who consume a lot of processed carbohydrates and other junk food and who drink soda and eat a lot of sugar can get Nonalcoholic Fatty Liver Disease.  The oral anabolic steroids are the ones that are more likely to damage the liver.  Anabolic steroids can cause a condition called Peliosis hepatitis, which are blood-filled cysts in the liver.  There are also reports of bodybuilders who develop various forms of liver cancer.

36:28  Cardiovascular damage from anabolic steroids.  A lot of these bodybuilders that we have been reading about dying young have been dying from heart attacks and blood clots and heart failures.  They usually have an unhealthy lipid profile. One of the most characteristic features is that they tend to have an extremely levels of HDL, which is the good cholesterol. And it can be extremely low, such as under 10, when it is supposed to be over 50.  And their LDL (bad cholesterol) tends to be mildly elevated.  Having an unfavorable lipid profile means that they’re more likely to develop atherosclerosis which is the buildup of cholesterol plaques in their arteries which can block the flow of blood to their heart. So, it’s increasing the risk of both heart attack and a stroke.

38:46  Bodybuilders tend to develop an increase in their hematocrit levels because they are producing so many red blood cells. Their blood gets thicker, which increases the risk for clotting. This must be treated by getting a therapeutic phlebotomy.  In addition, anabolic steroids tend to promote platelet aggregation, which also leads to the risk of more blood clotting. And platelets play a significant role in heart attacks. We used to think that what happened with a heart attack was that you get a plaque that gets bigger and bigger and occludes the artery and causes a heart attack. But what we know now is that the plaque, which may only occlude the artery by 50%, becomes unstable and ruptures and then platelets come to the area and form a platelet plug, which stops the blood flow to the heart, causing the heart attack.

42:03  Kidney damage from anabolic steroids.  Anabolic steroid users tend to develop high blood pressure, which means the heart is stressed and has to work harder to pump blood around the body, causing the heart to hypertrophy (become enlarged). This also puts stress on the kidneys and causes kidney damage, and kidney damage leads to more high blood pressure.  There are quite a number of professional bodybuilders who have had kidney failure and have ended up on dialysis and had kidney transplants.  The kidney stress is made worse by the common usage among many bodybuilders of nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen.  And this thickening of the heart’s walls leads to difficulty with the ability of the heart to relax during diastole and this leads to congestive heart failure at an early age.



Dr. Howard Elkin is an Integrative Cardiologist and he is the director of HeartWise Fitness and Longevity Center with offices in both Whittier and Santa Monica, California. He has been in practice since 1986. While Dr. Elkin does utilize medications and he performs angioplasty and stent placement and other surgical procedures, his focus in his practice is employing natural strategies for helping patients, including recommendations for exercise, diet, and lifestyle changes to improve their condition. He also utilizes non-invasive procedures like External Enhanced Counter Pulsation (EECP) as an alternative to angioplasty and by-pass surgery for the treatment of heart disease.  Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient, that will soon be published. He can be contacted at 562-945-3753 or through his website, HeartWise.com.

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


Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and 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.

Why are there so many dead bodybuilders today? I recently read about the death of the 2018 Mr. Olympia Shawn Rhoden at age 46 dying of a massive heart attack and I was saddened. And then I thought I need to call my friend Dr. Howard Elkin, integrative cardiologist, because I think it’s important for some health care professionals to speak up about why so many professional bodybuilders are dying.  And I think that both myself and Dr. Howard Elkins are uniquely qualified to talk about this particular topic. And that’s because we’re both health professionals. Both of us have treated quite a number of professional bodybuilders in the past. And both of us have also competed at bodybuilding at a substantial level in the past.  So, let me introduce myself. I’m Dr. Ben Weitz. And I am a sports chiropractor. And I’m also a functional nutritionist. Howard, perhaps you can introduce yourself.

Dr. Elkin:              Thank you. Thank you, Ben. It’s always great to be with you on these podcasts. I’m Dr. Howard Elkin. I’m an integrative cardiologist and also anti-aging medical specialist. So, I’ve been doing cardiology for 35 years and anti-aging medicine for about 21 years. So I’ve done a lot with hormone replacement in general and, of course, dealing with body builders as well. So, I’m glad we’re here together today.

Dr. Weitz:            Yeah. I am, too. Thank you, Howard. So, both of us have been reading about, it seems like a recent run of quite a number of professional bodybuilders, former professional bodybuilders dying at a relatively young age, largely from cardiovascular but also from liver and kidney disease. I mentioned Shawn Rhoden. Several weeks before that, before the Mr. Olympia, George Peterson died.  There’s just been a whole plethora of professional bodybuilders who have been dying in their 30s, 40s, even 50s. And it’s quite upsetting to me that these men and women who look like the pillars of health are dying early.

Dr. Elkin:              Right. I totally agree. And I think 2021 has been a really bad year for competitive bodybuilding on the professional level, and also the high amateur level. I mean, I did a little research on this. And there’s 16 deaths that I have noticed in 2021 alone. Shawn Rhoden, of course, being the most famous because he was Mr. Olympia. In fact, he was the oldest Mr. Olympia to get the crown.  And so, it’s disturbing and what comes to my mind after reading these people are dying in their sleep, okay, people are having strokes, heart attacks, death of amputation of a limb, these are not things that happen to healthy individuals in their 20s, 30s and 40s. You would expect, like Dr. Weitz, just mentioned that these people are like the pillars of health. But inside, things are happening that are anything but.  And you just saw here these deaths in young people that are healthy. And I think this was like the final straw with Shawn Rhoden. It’s like, “Okay, something’s got to stop here,” because this is not looking good, 16 deaths in less than a year. And I think there were three in October or September. So it’s excessive. Deaths among bodybuilders is not unusual. We’ve dealt with this for years but lately, it’s out of control. And I think we need to address the reasons why.

Dr. Weitz:            And I suspect for every professional bodybuilder who makes the news, there’s 20 amateur bodybuilders. And so, one of the reasons why we both felt that it was really important to speak out is as a professional bodybuilder, you may need to do some things that put your health at risk. Unfortunately, today, this sport of professional bodybuilding, the way it is right now, requires the competitors to take performance enhancing drugs, i.e. anabolic steroids and some take a host of other drugs as well.  And these definitely put their health at risk. I’m not sure everybody’s aware of that. But if you choose to do that as a professional bodybuilder with money and fame on the line, you may decide to make that calculation. But as somebody working out in a gym who just wants to get bigger and stronger, maybe hopes of being a professional bodybuilder one day, those are the people we really want to speak to and make sure they understand what are the specific risks to their health, particularly to their cardiovascular system, to their kidneys, to their liver, on top of a bunch of other, unhealthy side effects that may not be life-threatening but are not happy from taking anabolic steroids.

Dr. Elkin:              I just want to interject one thing. You’re absolutely right at all this. I think what bothers me is that we’re dealing with a lot of young people that looked at these big professional bodybuilders as heroes. Even when I went over all their … the scanty information I could find regarding their death was like, “Oh, we honor these people ourselves.” Of course, anytime anyone passes away, it’s a very sad thing.  Sometimes it’s almost like we honor these people, and yet these death I think in my opinion, a lot of them could have been prevented, avoided. But we’re sending a bad message to the youth. You probably heard Richard Piana, he was a big, massive guy, put tons of stuff.

Dr. Weitz:            Yes, I remember seeing him at Gold’s Gym. When he walked in, it was like a cartoon. I didn’t even think he was a real person.

Dr. Elkin:              Between the tattoos and the size. And he knew he was going to die before 50 and he did. He led up to his own self-fulfilling prophecy. He did excessive stuff. He had a huge, here’s my point, huge amount of followers. A lot of young people think, “Oh, wow, this is really cool. I want to get big. I want to get strong. I want to look like this person or that person.”  And so, although I love it bodybuilding, we’ll get into all those good things that we like about it in a minute, it’s just scary to me because the youth of today are seeing this. And they think that it’s an almost aspiration to be like this. And that’s what really frightens me.

Dr. Weitz:            Absolutely. So, really what we hope and expect to be able to accomplish with this podcast video and we’re both going to be writing articles that we’re going to publish very soon on our websites is, A, make sure all these folks who are taking or are considering taking anabolic steroids know what the risks are. And, B, we also don’t want people to hear about these bodybuilders dying and say, “You know what, I don’t think I want to do weightlifting because it’s unhealthy.” They need to understand that lifting weights, resistance training, weight training, however we want to describe it, is one of the most beneficial activities you can possibly perform to promote your health.

Dr. Elkin:              Absolutely. I’m about to address this whole issue on one of my YouTube blogs coming up about why bodybuilding, that’s the question. And it’s probably the singular best thing we have to fountain of youth if you don’t really have as we age. And I tell everybody regardless of age, we’ll talk about this together, but it’s like muscle is your greatest ally, I don’t care if you’re a woman, a man, what age you are.  I think in your article that I was just recently reading, yeah, studies have shown that people in their 80s and 90s can still gain muscle.

Dr. Weitz:            Absolutely. And muscles are super important, not just for appearance, much more important because they support and stabilize your joints including your spine. Muscles are what allows you to be mobile and active. You need your muscles to fire at an appropriate time to maintain your stability so you can get around.  And one of the things that really jeopardizes our longevity is the loss of muscle. In fact, it’s given a name, sarcopenia. And that’s a health condition. And loss of mobility is a major factor for older people. In fact, there are seniors who cannot get out of bed simply because they lack the strength to do so. And this is really sad. It doesn’t have to happen. There are people whose digestive systems don’t work because they didn’t have enough muscle tone in their abdomen to keep everything in place.  As we get older, if we lose our strength, people fall. They break a hip, just breaking a hip significantly decreases your lifespan. You’re much more likely to die in a few years after breaking a hip.

Dr. Elkin:              End up with a pneumonia. It’s a vicious cycle. When I tell people, “If you don’t have enough strength to open a jar, close a window, shut a garage door, then those are called activities of daily living.” And a lot of the elderly can’t do that because they haven’t prepared for it.

Dr. Weitz:            Absolutely. A lot of seniors, my mom included, if they end up on the ground, on the floor, maybe they bend over to pick something up, they can’t get up. They simply lack the strength. And that’s because on average, after the age of 30, we lose about a half-a-pound of muscle per year unless you do weight training. And this loss of muscle accelerates after age 50.

Dr. Elkin:              I usually call it use it or lose it.

Dr. Weitz:            Exactly. And so, it’s super important for maintaining your muscle that we do some form of resistance training, weight training. And studies show that even men and women who perform regular weight training can gain muscle even in their 70s and 80s.

Dr. Elkin:              Right, absolutely. So, both Dr. Weitz, we promote resistance training, weight training. And in fact, it may be the single most important exercise you do. Cardio is very important but … and also in all fairness, resistance training has not gotten the attention it really deserves. It is now starting to. But for years and years when you read about exercise and the many benefits, they basically talked a lot about cardio, walking, running, jogging, swimming, cycling, etcetera, etcetera, and all of which are good.  But resistance training was relegated to the back bench for some reason. But things are changing. And I think most of us that deal with sports medicine and longevity realize the benefits. We’re trying to really impress that everyone as they age. You’re never too old to work on strength.

Dr. Weitz:            Absolutely. So, we just mentioned the importance of maintaining muscle. But not only does weight training strengthen your muscles, it also strengthens your bones. And as we age, loss of bone, mass quality strength often referred to as osteoporosis is a major factor that affects your ability to get around and your longevity.  So, the way you maintain your bone density is by putting stress on your bones. Your body reacts to controlled amounts of stress by getting stronger. You put controlled amounts of stress on your muscles and you muscles get stronger. You put controlled amounts of stress on your bones and your bones get stronger.

Some people think that you have all the bone density you’re ever going to have when you’re young, but that’s not true. There’s a constant ebb and flow. There are, throughout your life, osteoblastic cells that are building new bone. And you also have osteoclastic cells that are breaking down bone. And why would they be breaking down bone? Because during even normal activities without any weight training, some of the bone gets broken down. And we need to clear out those junky bone cells so we can make way for new healthier cells, just the way you upkeep your house.

Dr. Elkin:              And just one other point, too. It happened to me last week. I had one of my patients who is a master swimmer, I mean, great shape. And so, we did a bone density scan. It was pretty severe osteoporosis. Why? Because swimming which is an excellent, excellent aerobic activity and also for many, many other reasons, also cycling, there’s no real impact.  Listen. So, these people are very … they may be cardiovascular-wise very healthy, but their bones haven’t benefited because there’s no pounding. So that’s why I tell these people, the swimmers and cyclists, you need to implement weight training. Because just doing the aerobic activity that you do alone is not going to make it.

Dr. Weitz:            Absolutely. I am totally on the same page with you. In fact, if I’m talking to a patient and they have an hour to exercise, I’m going to encourage them to do at least 30 or 40 minutes of weight training, and maybe 20 minutes of aerobic or cardiovascular activity because the weight training is so important. And the way that weight training stimulates the bones is that, A, you load the bones. The body feels that stress in the bones and says, “We’ve got to make these bones stronger.”  And also, when you contract the muscles hard, they’re pulling on the bones because muscles are attached through tendons to bones and joints. And they pull. And that pulling stresses the bones, strains the bones, puts torque on the bones, and the body needs to make sure those bones get stronger so they can resist that.

Dr. Elkin:              Absolutely.

Dr. Weitz:            So now, let’s get into the cardiovascular benefits of weight training which I think are generally not that well-known.

Dr. Elkin:              Right. And one of the things you can do which we didn’t know until recent years is that it actually improves your cholesterol, the whole lipid milieu. We thought, “Oh, well, we know that cardio does.” But what is weight training does is it has a beneficial effect. Also, it has a beneficial effect on your circulation in general. When you do load the muscle and the bone, like Dr. Weitz has mentioned, you’re bringing blood to the area. So, an increased blood flow is important.

Dr. Weitz:            You’re dilating those arteries. You’re exercising the arterial walls, keeping them compliant, allowing them to expand and contract.

Dr. Elkin:              Right. Because as we get older, what we see instead is arterial stiffness.

Dr. Weitz:            Yes.

Dr. Elkin:              From the heart going all the way to all your vessels, your big arteries, your small arteries and everything in between. So, weight training has one advantage that we didn’t really appreciate until recently.

Dr. Weitz:            Absolutely. We all know that diet plays a huge role in our cholesterol metabolism, but most people don’t realize. And of course, the studies are mixed, not all the studies are consistent on this. But generally speaking, it appears as though for most of the data that I’ve been looking at that resistance training improves your lipids.  One of the most significant effects is that it raises your levels of HDL which is your healthy cholesterol, your good cholesterol that produces reverse cholesterol transport. And studies also show that it reduces your LDL and total cholesterol.

Dr. Elkin:              Absolutely. And we didn’t really appreciate … I mean, 10 years ago when I was researching exercise, we didn’t really know much about weight training, what did it really do?  But it’s really on par with cardio or aerobic training as far as what it can do for your lipids.  So, it’s really exciting news for me because that’s how we can inculcate the importance of all this to our patients.

Dr. Weitz:            And one factor that affects our overall health, our cardiovascular health in particular, is obesity. And if people want to help fight weight gain, if they want to lose some weight, probably the most beneficial thing you can do is weight training. Now, of course, aerobic training is a great way to burn fat. However, the most significant factor is raising your metabolic rate. That’s the rate at which you’re burning calories all day long even when you’re not exercising.  And in a 24-hour-a-day, even if you’re doing super intense aerobic exercise, the rest of the day, if you don’t have a significant amount of muscle mass, you’re going to have a lower metabolic rate and you’re going to be burning fewer calories at rest.

Dr. Elkin:              I can’t agree with you more. And this comes up all the time especially when I deal with women, “I don’t want to get big, I don’t want to get bulky.” It’s like, “Believe me, it’s not going to happen. You’re not going to look like a bodybuilder unless you do the strange things that bodybuilders do.” A muscle is your greatest ally.  And like Dr. Weitz says, the metabolic rate is so much better. I think we look at a pound of fat versus a pound of muscle. I mean, I think it’s like a difference of … it’s quite a difference. I can’t remember the exact numbers now.

Dr. Weitz:            Yeah. It takes a lot of energy to maintain muscle where essentially fat is relatively inert. Now, one of the interesting things that we learned recently about weight training that’s really unique to it is that while both cardiovascular and weight training reduce epicardial fat, only weight training has been shown to reduce pericardial fat. Perhaps, you can explain what those are.

Dr. Elkin:              Okay. So, if you’re dealing with fat and obesity or visceral fat we call which is a scary kind of fat that as people get older, the middle-aged brother gets bigger and bigger and bigger. We used to think years ago, “Oh, fat is fat.” It’s inert because it has such a poor blood supply. Well, that’s not really true. Fat is really very metabolically active but in a very negative way, because you’ve heard of cytokines, these things that happen during COVID.

And so, there are so many cytokines with the abdominal fat and the visceral fat that actually it promotes inflammation, and it’s not a good thing. So, the same thing happens here in the organ. It’s not just visceral fat. Your liver gets fat. Your pancreas gets fat. And your heart gets fat. So pericardial is the area … peri- means around from the Greek. So, it’s around the heart. And yeah, I’ve seen these hearts at autopsy. They’re not pretty.  They look like a bunch of fat encasing the heart. So, this is new information which is really exciting. I didn’t know that myself until I recently read it.

Dr. Weitz:            And lifting weights reduces blood pressure. Even though while you’re performing a heavy exercise, let’s say you’re doing a set of leg press, for the 30 seconds that you’re doing a leg press, your blood pressure may shoot up. And when done consistently, weight training lowers blood pressure.

Dr. Elkin:              And I’m so glad that resistance training is getting the attention it deserves now because it really was like the back … it’s actually by the back seat for a long, long time. Because everything was based on cardio, cardio, cardio, aerobic training, which still has its role. And I think it’s important, I think you mentioned this, too, Ben that if you take a person that’s the same age as Dr. Weitz and myself, the same size and everything, okay, yeah …

Dr. Weitz:            Two men in their 30s.

Dr. Elkin:              Right. Copy that. Well, if we’re both sitting down watching a football game or something, we’ll lose more fat just sitting there than the other person will.

Dr. Weitz:            Yes.

Dr. Elkin:              Our metabolic rate being higher because of the muscle.

Dr. Weitz:            I have to eat over 3,000 calories a day or I will lose weight. And I’m not trying to lose weight.

Dr. Elkin:              Right, it’s true.

Dr. Weitz:            So, one more thing I wanted to mention is the benefits of weight training for preventing and actually managing diabetes because weight training is actually super beneficial in reducing blood glucose levels, and has been shown to reduce hemoglobin A1c. When your muscles contract, they’re using up the glycogen that’s stored in those muscles. And then that allows the glucose in the bloodstream to go into those muscles.  And because with weight training, you’re not just say using your legs like you might do when you’re running, you’re using your chest muscles, your back muscles, your arm muscles, your leg muscles, your torso muscles. All of those muscles will have need for more glycogen and they’ll pull in glucose. And having more muscle also gives you more storage for glucose to get it out of the bloodstream to reduce inflammation, to reduce it from building up in the liver and the other organs.

Dr. Elkin:              Absolutely. I mean, everything you said is correct. And something I thought but it escaped my memory for a second. But anyway, I’ll tell you about the diabetes thing. One thing I have to say about bodybuilders and I’m not talking about the excessive ones, but bodybuilding in itself and all my patients that are bodybuilders, they’re extremely insulin sensitive which is a great thing, because as we get older, insulin resistance seems to be the, it’s quite known, it seems to be what happens as we get older.  Why? Because we’re less active, we put on fat, muscle does not turn to fat, fat doesn’t turn to muscle. But because we’re inactive and our muscle cells shrink in atrophy, it’s easier to put on weight because we’re not doing anything. But people that work with weights that are bodybuilders and on any level, they tend … and I measure insulin levels in almost all my patients so I see this. They tend to have really low insulin levels and they’re always metabolically healthy.  And only 12% of the adult American population is really metabolically healthy. So, that’s another very good aspect of bodybuilding and resistance training in general.

Dr. Weitz:            Right. And I have quite a number of patients over the years I’ve talked to who don’t like doing weight training. And I just wanted to say one thing about that, is often people who come in my office, they’re very flexible, they can wrap their legs around their head. And when I ask them what kind of exercise they do, “Oh, I do lots of yoga. I don’t like weight training.”  Well, one of the reasons why they like to do yoga is because they’re really good at it. Unfortunately, if you’re really good at it, you probably don’t need it. It’s probably not going to help you as much as doing weight training. And one of the reasons you probably don’t like to do weight training is because you’re not good at it. And this is a case where doing things that you’re not good at are good.

Dr. Elkin:              And I’m sure in your line of work as a chiropractor, you’ve seen a ton of yoga-related injuries.

Dr. Weitz:            Absolutely. People think that stretching is always the way to solve injuries. And the fact is we need a balance of mobility, flexibility and stability. And stability comes from muscle strength.

Dr. Elkin:              Right, absolutely.

Dr. Weitz:            So, let’s talk about why these professional bodybuilders are dying which essentially really has nothing to do with the weight training. It has to do with the drugs that they’re taking.

Dr. Elkin:              Right. So, keep in mind that weight training itself is not going to like tear your aorta or cause a massive heart attack or anything like that. Like I said, we’ve outlined the advantages and why it’s so important. So now, we can focus on what happened to these unfortunates and others. These aren’t the only guys that die. These are the well-known professionals and high-level amateurs.

Dr. Weitz:            Right. Just to give people a little description, I want to mention a story about bodybuilder Andreas Munzer. Yes, I know he died in 1996 but he was a well-known professional bodybuilder. He had extremely low body fat. In the bodybuilding lingo, he was ripped. But he died at age 32. And when he died, he was having internal bleeding and his liver and kidneys failed.  Now, on autopsy, they found within his body 20 different drugs. His liver had a consistency similar to plastic. He had multiple tennis-size tumors in his liver. His kidneys were swelling to immense proportions. And his heart was so enlarged that it was a double the size of a normal heart. And this is basically due to all these drugs that professional bodybuilders take. The most important of which, for what we’re talking about, here are anabolic steroids.  Can you explain what anabolic steroids are, Howard?

Dr. Elkin:              First of all, steroid isn’t some horrible kind of term. I mean, it describes a ring-like structure of hormones. And by the way, besides testosterone being a steroid, estrogen is a steroid, progesterone is a steroid. So, it describes the structure of these hormones. So, we all normally produce testosterone, both men and women, men to a much greater extent. And the same thing with estrogen.  But what happens is that these guys take these performance-enhancing drugs, most notably steroids to get that added edge, to get faster, stronger and whatnot. And it’s when these become excessive that we start seeing these problems.

Dr. Weitz:            So, these guys are taking testosterone which is an anabolic steroid. By the way, that’s one of the differences between testosterone and estrogen is testosterone is anabolic meaning producing-muscle growth. And then they take synthetic derivatives of testosterone. And these are basically designer anabolic steroids. They’ve been around for a long time. The reports show that the Germans first produced Dianabol in World War II to make their soldiers stronger and more aggressive.  And basically, these synthetic testosterone derivatives, these anabolic steroids are designed to enhance the muscle-producing properties of steroids and decrease some of the other properties that are less desirable.

Dr. Elkin:              It’s got to do with the protein synthesis. So the more you can increase protein synthesis within the muscle cell, you’ll have bigger muscle.

Dr. Weitz:            And these drugs, some are taken orally, some probably more often are injected intramuscularly. Howard is an anti-aging doctor and both of us understand and appreciate and support the idea of hormone replacement therapy for men and women, women after menopause, men after andropause who have low levels of hormones, who are taking a physiological dosage to maintain their health and vitality. And we both believe that this can be done in a healthy manner if they were taking the right amount in the right way.  But what these bodybuilders are taking is hundreds of times higher dosages than would be used for hormone replacement.

Dr. Elkin:              Yeah. As opposed to like 100 milligrams of testosterone, they’re talking 1, 2, 3, 4 or five grams a week, I mean, out of sight.

Dr. Weitz:            Right, thousands of milligrams. Yup. And often, they’re taking growth hormone.  Sometimes to facilitate the growth hormone usage, they’re taking insulin. They’re taking diuretics. They’re taking antiestrogen drugs, thyroid stimulants like clenbuterol. So, there’s a whole plethora of drugs. But really, we want to focus on the potential negative effects of anabolic steroids.  And when we look at anabolic steroids, there’s a bunch of side effects that are annoying like acne and water retention, acceleration of male pattern baldness, testicular atrophy, not a great attribute, gynecomastia in males, that’s where the breasts actually … they grow female breasts. Some men have actually been known to squirt out milk, not a pretty sight, sexual dysfunction, voice deepening, clitoral enlargement in women, muscle and tendon tears, violent behavior, etcetera, etcetera.  But what we want to focus on are the negative aspects of anabolic steroids that impact your life which is cardiovascular disease, kidney disease and liver disease.

Dr. Elkin:              Right, those are the three main ones. And one quick segue into oral anabolics. So there’s oral and there’s intramuscular. And actually, oral is much more dangerous because anything oral has to go what we call first pass. So, it goes from the gut to the liver and that’s where the problem is because as they get to the liver, it’s toxic. So the liver has to work very hard to detoxify or make a less toxic substance or metabolite.  And in doing so, the liver takes a brunt. It takes a big brunt. And I can’t tell you how many bodybuilders I’ve seen with liver dysfunction.

Dr. Weitz:            And this is also a reason why women who are taking hormone replacement therapy should not take oral estrogen.

Dr. Elkin:              Right. We don’t use any oral estrogens in dealing with bioidentical hormones with women. So that’s really important, too.

Dr. Weitz:            So, why don’t we start with the liver since you brought that up? And one of the first things we’ll see is liver function tests like AST, ALT. They’ll start to go up.

Dr. Elkin:              Right, exactly. And there’s another one called GGTP which is very specific for the liver.  ALT is specifically for the liver as well.  SGOT could be liver and muscle. But when we start seeing those go up, and now there’s other things that will cause it to go up, drinking alcohol, of course. And a big one that we’re seeing in this day and age, of course, is this entity called nonalcoholic fatty liver disease. That’s a whole different entity.  But steroids themselves and the doses that are being used by these competitors can certainly cause liver injury especially if it’s anything oral. And I can tell you, these guys are taking oral stuff. The women definitely take oral stuff. And the men do, too, to get level because the oral stuff is more of immediate. And along with oral anabolics, you get a lot of water retention. And a lot of water retention, you get a big surge in blood pressure.  And these people go to doctors, most of them don’t. I mean, I get some that do. And the ones that do relatively, I wouldn’t say totally unscathed, but they do okay.

Dr. Weitz:            Yeah. One of the conditions that is seen in anabolic steroid use is a condition called Peliosis hepatitis which are blood-filled cysts in the liver. And this is an extremely unusual condition. And so, this is something that can be directly traced to anabolic steroids.

Dr. Elkin:              Right. And there have been some reports that can you develop liver cancer or what we call … we used to call it hepatoma. Now, we just call it a liver cancer which is not a good cancer to have. I think there have been some reports. I tried to do some research on that. I couldn’t … as a direct quote. I mean, I think any kind of toxic substance like hepatitis C can eventually lead to liver cancer.

Dr. Weitz:            People need to understand when these liver function tests are positive, it often means that there’s damage occurring to the liver. And consider that the liver and the kidneys are your two main organs that are filtering out toxins. And the more you burden those organs, the more you stress them constantly over time, stressing a tissue excessively is something that can lead to cancer.

Now, a lot of the things we’re talking about, unfortunately there are not large randomized clinical trials of double-blind placebo. So, a lot of these are coming from case reports but nobody is going to do a multimillion dollar double-blind placebo-controlled study on anabolic steroids because they’re not used legally in this country. And nobody’s going to pay for that. But there’s certainly plenty of anecdotal reports that both of us have seen about liver damage.  Let’s get into the cardiovascular damage because a lot of these men and women that we’re hearing about are dying of heart attacks and blood clots and heart failures.

Dr. Elkin:              Yeah. So the first thing that comes to my mind always is the lipids, the blood fats. Okay. So, what we characteristically see is really a low … HDL I’ll say is high density, but basically I call it healthy and LDL is lousy just for ease of remembering. But it’s a little more complicated in that. But what we characteristically see in these folks that the LDL tends to be elevated. That’s the bad cholesterol. And HDL tends to be low. And I don’t mean low, I mean real low.  I have seen women competitors that are just doing like the mild steroids but they’re oral, they’re oral. And they have single-digit HDL, it’s like under 10.

Dr. Weitz:            Wow, that’s incredible and interesting. If they weren’t doing weight training, it’s probably even lower.

Dr. Elkin:              Right, exactly.

Dr. Weitz:            And having this unfavorable lipid profile means that they’re more likely to develop atherosclerosis which is the buildup of cholesterol plaques in their arteries which can block the flow of blood to their heart. So, it’s increasing the risk of both heart attack and a stroke.

Dr. Elkin:              For example, I have a 38-year-old bodybuilder. I always like giving stories. Talented guy, he wants to go pro. But he does come to see me. And he’s putting a limit on, “If I don’t do within a year-and-a-half, I’m out.” But okay, in the last year-and-a-half, his blood pressure has gotten super … he’s put on tons of muscle, tons of weight.  So, in the last year-and-a-half, he’s become hypertensive. He’s got sleep apnea. His HDL is in the toilet. He’s now on a statin. The same thing, it’s crazy. So, he was pretty healthy before he was none of these medications. Also, he’s got to get regular phlebotomies because the hematocrit, hemoglobin are too high which we’ll get into.

Dr. Weitz:            Why don’t we talk about that? So, bodybuilders have their blood gets thicker because they’re producing so many red blood cells. So, your blood is made up of this liquid part called plasma. And then there’s also these red blood cells. And there’s a certain percentage of red blood cells you’re supposed to have in a certain liter of blood. And this hematocrit measure is something we measure through blood testing. And when that hematocrit goes up, what that means is you’ve got too many red blood cells which means your blood is thicker.  Now, cyclists who compete in the Tour de France, they encourage this and sometimes do it for a short period of time because it allows them to have more oxygen going to their muscles so they can win the race. But this is very dangerous state to be in.

Dr. Elkin:              Yeah. It’s called doping. And I got to tell you, it’s a major problem. And my folks, a lot of my folks that are on physiological replacement doses, we’re talking low doses like 100 milligrams or less, but some actually still have that tendency to produce too much red blood cells. And now keep in mind, that’s one of the pluses. I mean, we want to have some increased red blood cells because it increases our oxygen-carrying capacity. So you have muscular endurance, improving the muscular endurance.  However, the double-edged sword of that could also … it could be overly done. And even with normal physiologic doses, so I [inaudible 00:40:28] watch all my patients on testosterone and I carefully watch their hematocrits. And if they get too high, we’d have to stop it or they have to do bloodletting. So now, that’s just with regular physiologic replacement doses. Can you imagine these massive doses? And who knows …

Dr. Weitz:            When you say bloodletting, Howard, essentially what you mean is they have to go and donate blood.

Dr. Elkin:             Right, yeah. Either donate blood or you can go to a hospital in your insurance and they’ll … it’s called a therapeutic phlebotomy. You’re actually giving up blood.

Dr. Weitz:            Right. And there’s another factor which is that bodybuilders tend to get increased platelet aggregation. So not only is your blood thicker but it’s more likely to clot because the platelets are the components in the blood that lead to clotting.

Dr. Elkin:             Right. In fact, platelets are usually the final thing that led to this a heart attack. We used to think that with cardiovascular disease, coronary disease that you get a blockage that gets bigger and bigger and bigger in 30 years and eventually just get a heart attack. No, that’s what we thought when I was a fellow many years ago. Now, we know that’s all inflammation. That most of the heart attacks that take place are blockages like probably 50% at most.  But what happens, there’s a rupture. The plaque becomes unstable, it ruptures. And then platelets come to the area and they form what’s called a platelet plug, and then you have no blood flow, and they have a heart attack. So already, just when you have an aggregation … when you have platelet problems and they’re sticking together and coming together, that’s a great that … all you have to have is an unstable plaque and you got a heart attack ready to happen.

Dr. Weitz:            And you mentioned the bodybuilder that you’re seeing who has hypertension, increased blood pressure. And now, that also means that’s putting more stress on the heart because when the heart pumps the blood, if the blood pressure is up, it means that it’s harder for the heart to push the blood around the body. And so, then the heart has to work harder, the heart tends to hypertrophy.  This stresses out the kidneys. You tend to have kidney damage from this. People with kidney problems, that tends to lead to more hypertension. And you have this vicious cycle.

Dr. Elkin:              Yeah. This yin and yang thing because the kidneys respond to the heart, the heart responds to the kidneys. And it’s a big deal. As you know, there are several pro-level bodybuilders that have ended up on dialysis in the past. Even a couple of renal kidney transplants.

Dr. Weitz:            Many, many, many kidney transplants.

Dr. Elkin:              Also, in all fairness, they also take a lot of NSAIDs, nonsteroidal anti-inflammatory drugs like ibuprofen and Aleve. And they’re taking big doses. And they’re taking it every day which is very renal damaging. But like Dr. Weitz has said, it’s that the hypertrophy of the heart, the heart has to work harder, the kidneys sense that. It is a vicious cycle.  And I think also with this hypertrophy thing, I’ll take it one more stage. So, with years and years of hypertrophy, the heart’s getting thicker and thicker and thicker, because the heart’s a muscle. So you’re stimulating your skeletal muscles and also your heart muscle because the heart is a muscle. But when it gets so thick, then it has a difficulty relaxing.

And there’s these two phases of the cardiac cycle. One is we call it systole which the heart contracts. And then we have one called diastole in which the heart relaxes. And actually, the energy needed to relax the heart is actually more than it is to contract, probably because it’s longer. It’s almost twice as long. So that’s what’s impaired. So the relaxation phase, the diastole, is impaired because the heart is so thick, how can it relax?  And by the way, this can lead … as we see now with older people especially in women, diastolic heart failure is seen in more than 50% of cases that hits the hospital with congestive heart failure. Now, we’re seeing it in bodybuilders which we should not be seeing it at such a young age.

Dr. Weitz:            And this could also be partially related to massive dosages of growth hormone that many of the guys take at the same time with anabolic steroids which can lead to growth of the internal organs, correct?

Dr. Elkin:              I don’t know if you … I’m sure you’ve noticed and we all have noticed. I mean, I don’t go to bodybuilding shows anymore. Why? Because I don’t like the looks. I mean, these big bellies. I mean, you see these big bellies, yet they are ripped because they’ve used so much growth hormone and insulin together that the kidneys get bigger, the intestines get bigger, all the internal organs get bigger, the heart gets bigger. This is like not a good thing.  And guess what. This will never go away. Once you’ve enlarged your organs, that’s how it’s going to be.

Dr. Weitz:            The only thing that doesn’t get bigger is the brain.

Dr. Elkin:              Right, unfortunately.

Dr. Weitz:            Yeah. So, let’s just touch on one more topic which we’ve already talked about which is how anabolic steroids negatively affect the kidneys.

Dr. Elkin:              Okay. Well, I think we’ve mentioned one, the interplay between the heart.

Dr. Weitz:            Well, we could start with the fact that the oral steroids go through the liver, but the injectable steroids make their way into the kidneys.

Dr. Elkin:              Right. And I think it’s a dose-related thing. I’ve never seen a problem with many people on physiologic replacement doses, never. I’ve never seen a kidney problem ever or liver problem because we’re using injectables and we’re using low doses. But well, it could be … some of these are more kidney toxic and others. There’s one called trenbolone. I don’t even know … it’s a synthetic form of testosterone. I don’t really know much about it.  But I can tell you that if you take that for more than six or eight weeks, you are definitely putting your kidneys at risk. It’s directly kidney toxic. And I think probably could be with any of these antibiotics that are overdone. There’s a direct toxic effect on the kidney. And here’s you got to remember, the liver has some ability to regenerate which is … unless you …

Dr. Weitz:            A remarkable ability to regenerate, yeah.

Dr. Elkin:              Kidneys do not regenerate. Once your kidneys damaged, it staged. It does not get better.

Dr. Weitz:            And there’s a particular condition that’s been related directly to anabolic steroids. There’s a condition called focal segmental glomerulosclerosis which is a development of scar tissue in the filtering structures of the kidneys. And I’m not saying that anabolic steroids are the only thing that causes, but it’s been directly linked with the use of anabolic steroids.

Dr. Elkin:              Yeah. I didn’t know that until I read it from you. So, the glomerulus is the part of the kidney … well, there’s millions and millions, but that’s where it all begins. So, that’s where the blood has to filter through this big cap. I call it the big cap of capillaries in order to enter the kidney itself, the nephron to go through the filtering process.  So, if you have less and less glomeruli because of this necrosis we’re just talking about or sclerosis is that then you already having diminished renal function. So yeah, that’s a new one. I mean, I didn’t hear there’s direct effect but the kidneys, yeah. And then if you add the drugs that they use to help with all their pain, like I said, all these nonsteroidal anti-inflammatories, it’s adding insult to injury.  And I mean, some of these bodybuilders I’ve heard, the doses are … it [inaudible 00:48:06] you if you know how much they were taking. And then you add diuretics which dehydrates them which makes the kidneys even worse.

Dr. Weitz:            And then guys, getting ready for shows not only do diuretics, they don’t drink water for sometimes days on end. And that’s stressing your kidneys out, too.

Dr. Elkin:              I have to give you a funny story. Well, it wasn’t funny. But my first matches.

Dr. Weitz:            Bodybuilding contests.

Dr. Elkin:              Matches which is in 2001. And so, I’m on stage. And this guy just passes out. Now, there’s like six of us. I don’t know how many were. So of course, I’m the only doctor so I have to do something. So I had to maintain my form as I went down there. And back then, they didn’t have paramedics there. We called for them and then they came and then looked at the EKG, it was normal. It was dehydration and he uses like because I see this, he uses diuretics.  The same thing happened at my last show which I think was 2012 or ’13. And guy passed out. I said, “What is this? So I had to break … this time, we had paramedics but still they knew … they’re like, “Can you read his EKG?” He was okay.

Dr. Weitz:            That’s great.

Dr. Elkin:              My firsthand bodybuilders collapsing. Thank God it was … didn’t have a heart attack but they could have.

Dr. Weitz:            Yeah. I wonder if there’s more use of diuretics now because when I competed, it was back in the ’80s, in 1985. I won the Mr. LA. I won the Hawaii-Western Open. And I eventually won the Natural Mr. International. But I don’t remember a lot of guys collapsing, but maybe they weren’t using as many drugs or some of the drugs that they’re using now.

Dr. Elkin:              It’s the combination of so many different substances. It’s just excessive.

Dr. Weitz:            Okay. Howard, I think we’ve done a great job with this topic. I think we’ve given people a lot of really useful information. Perhaps, you can tell our listeners and viewers how they can get ahold of you and also let them know about your YouTube Live.

Dr. Elkin:              Okay. So, my website is heartwise.com H-E-A-R-T-W-I-S-E dot com. And then I’m on Instagram under dochelkin, D-O-C-H-E-L-K-I-N. And then on Facebook, it’s Heart Wise Fitness and Longevity Center. I do a YouTube every two weeks. And my next one will be next week. And we’re going to be probably talking about bodybuilding.

Dr. Weitz:            And what time and date is it and how they can get to your YouTube page?

Dr. Elkin:              Okay. So basically, it’s The Medical Advocate Howard Elkin MD, The Medical Advocate, Howard Elkin MD. Well, just have that at the search button. If you subscribe which I suggest that you do, you’ll be getting an alert so you’ll know exactly when I’m going to do it. It’s generally every two weeks. It would have been this week but it’s Thanksgiving. So we’re making it next week. But generally it’s every two weeks, 7:00 p.m, Pacific Standard Time.  And it’s fun. I pick a topic. I talk about 12 minutes and the rest is chat time. So people can ask questions in the chat box. It’s a lot of fun.

Dr. Weitz:            And I’m Dr. Ben Weitz. You can get ahold of me at my chiropractic office in Santa Monica by calling 310-395-3111. And we can see you for chiropractic. We can see you for functional nutrition consultations. If you go to my website www.drweitz.com, you can find links to my podcast and blog posts and more information about my practice.  This is part of my Rational Wellness Podcast which is available on Apple podcasts, Spotify, also my YouTube page Weitz Chiro. And if you enjoy this podcast, please go to Apple podcasts and give me a five-star ratings and review. And look forward to seeing everybody next week.

Dr. Elkin:              You’re a very prolific guy.

Dr. Weitz:            Thank you, Howard.

Dr. Elkin:              All right guys, thank you so much, Ben. We’ll see you soon. Take care.



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



Microbiome in Food Allergies with Dr. Tom Fabian: Rational Wellness Podcast 233

Dr. Tom Fabian speaks about the Role of the Microbiome in Food Allergies with Dr. Ben Weitz.

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


Podcast Highlights

1:30  Food allergies vs Food sensitivities vs Food intolerances.  Food allergies are mediated by Immunoglobulin E and mast cells tend to play a role.  Patients with true food allergies may have very severe reactions such as anaphylaxis and they are immediate after eating that food.  Food sensitivities are typically  mediated by IgG and they tend to be delayed reactions. They can also be mediated by IgM and IgA, though these are less well defined.  Secretory IgA, which is reported on the GI Map stool test from Diagnostic Solutions, is known to play multiple roles in the gut both in terms of reacting to things thought to be threats, but also a protective role in terms of commensal bacteria in which IgA binds to these commensals and by binding to normal food antigens, it helps to reduce or prevent over-reactivity from the immune system.

7:13  A Food Intolerance is a non-immune mediated reaction to a food, such as a carbohydrate intolerance or a histamine intolerance, which can be mediated by a lack of diamine oxidase enzyme, which keeps you from breaking down histamine.

8:46  A healthy microbiome can play a role in our oral tolerance to foods that might otherwise be harmless. Our immune system has a balance of pro-inflammatory and anti-inflammatory. Immune tolerance is a mechanism by which the immune system restrains overreaction, which applies to food allergies, and involves Treg cells. There are a number of products from the microbiome that promote Treg cells that promote immune tolerance and the one that has been best studied is butyrate.  Certain commensal microbes seem to be especially important. In the small intestine, the important microbes are Lactobacillus, Bifidobacterium, and Prevotella, esp. a particular species, Prevotella histicola, which has been shown to protect against food sensitivities. 

15:46  Leaky Gut. If you have leaky gut or increased intestinal permeability, then you can more easily get food antigens across the epithelial lining of the gut and react with the immune cells in the intestinal mucosa. If you have overgrowth of inflammatory type bacteria, such as E. coli, Klebsiella, or Ciotrobacter, this can cause leaky gut.  Certain microbes can modify how antigenic a protein is. Pseudomonas, which is common resident of the small intestine, can break down certain proteins, such as gluten in a way that makes it easier for the gluten to get through the leaky gut. Then the gluten doesn’t break down enough till it is broken into individual amino acids, which is the ideal situation, since amino acids usually do not cause immune reactions. It’s the larger proteins that cause immune reactions. This is one of the reasons why hydrochloric acid is so important to break down proteins and a lot of people do not have enough hydrochloric acid. 




Tom Fabian, PhD in Molecular, Cellular, and Developmental Biology. Tom is also a certified Nutrition Therapy Practitioner and he specializes in the microbiome and how it relates to digestive, immune, brain, and metabolic health. Tom offers a Microbiome Mastery course through his website, Microbiomemastery.com. Tom also works with Diagnostic Solutions helping to interpret the GI Map stool test. https://www.diagnosticsolutionslab.com/

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


Podcast Transcript

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

Hello, Rational Wellness podcasters. Today, I’m very excited to be speaking with Dr. Tom Fabian on the role of the microbiome in promoting and preventing food allergies, food sensitivities, and food intolerances. Dr. Tom Fabian has a PhD in Molecular Cellular and Developmental Biology, and he’s a certified nutrition therapy practitioner. Tom specializes in the microbiome and how it relates to digestive, immune, brain and metabolic health. And he offers a microbiome mastery course through his website, microbiomemastery.com. Tom also works with Diagnostic Solutions, helping clinicians to interpret the GI-MAP stool test and educate practitioners about stool testing and the microbiome. Tom, thank you so much for joining us today.

Dr. Fabian:          All right. Thanks so much, Dr. Ben, it’s great to be here again today.

Dr. Weitz:            Excellent. Excellent. So I was thinking, before we get into trying to understand how a healthy microbiome can play an important role in reducing the risk of food allergies, sensitivities, can you explain, what is the difference between a food allergy, a food sensitivity, and a food intolerance? Because I’m not sure most people are really aware of what those differences are.

Dr. Fabian:          Sure, yes. And the lines are actually somewhat blurred a little bit with some new information that’s come out from research, plus they often coexist for some patients. So that’s just one of things to keep in mind, it’s not always a case where something fits in a nice, neat and tidy box. But generally, food allergies are caused by or mediated by immunoglobulin E in particular. They often have, of course, involvement of mast cells, so mast cells tend to play a key role in terms of food allergies. So typically, what happens is patients become sensitized to certain antigens through various mechanisms potentially, so that the immune system next time it recognizes that antigen, so the next time a patient consumes that food, they can have a pretty significant allergic reaction to that. So a lot of that’s mediated by mast cell release of histamine, for example, so they’ll often have histamine related symptoms, and of course, it can be pretty severe in the terms of anaphylaxis. So that’s the main concern with food allergies that are severe.

Then there’s the food sensitivity category, which is a little bit less well defined, but certainly we all know that, that tends to be mediated by a different immunoglobulin, which is immunoglobulin G. Again, the mechanisms are similar where patients become sensitized to particular antigens, and then instead of having an IgE anaphylactic type response, they’ll have a more subtle response typically. Again, it ranges across a broad range of significance and often it’s more delayed, so instead of having a more immediate type reaction, it’s something that can happen hours later, sometimes even days later. So it’s a little bit more of a chronic type issue or just longer term issue in terms of the symptoms manifesting.

Dr. Weitz:            And I guess it could be IgM or IgA mediated as well, right?

Dr. Fabian:          Potentially. Again, those are a little less well defined. So IgA is a mixed picture. It’s thought that Secretory IgA plays multiple roles in the gut, both in terms of responding to things that are thought to be threats, especially pathogens, but it also plays more of a protective role for things like commensals where we don’t want to overreact, and also just normal food antigens, we don’t want to overreact to those either. So it’s thought that Secretory IgA binds to these normal commensals, binds to normal food antigens, and by binding, it’s thought that, that’s part of how that helps to reduce or prevent overreactivity from the immune system.

So it’s partly a physical thing whereby binding these antigens or microbes keeps them away from the epithelium. So again, usually closer the organisms or the antigens get to the epithelium, the immune system can detect that and may start to overreact. So they’re still learning some of these features of IgA. It’s pretty fascinating that it plays so many different roles, but a lot of it is protective to help reduce the actions. But of course, if we overreact to certain things, that can be another reason why there might be an elevated Secretory IgA. So for example, on the GI-MAP test we have anti-gliadin one the markers, and that is generally thought to be a marker for gluten sensitivity, gluten reactivity. So it’s not always easy to tell when you have a positive result with IgA, is that a protective response? Is that more of a response [crosstalk 00:05:44]?

Dr. Weitz:            So interesting.

Dr. Fabian:          Yes.

Dr. Weitz:            Because I know like Cyrex testing often includes IgM, and IgA, as well as IgG.

Dr. Fabian:          Exactly. Yes, so I think it’s important, if possible, to get the more complete picture of what’s going on, because all these different immunoglobulins serve different roles. So I think that’s an evolving picture, we don’t have all the answers yet, unfortunately.

Dr. Weitz:            And is there a sense that food allergies are more longer term or even permanent than food sensitivities which can come and go?

Dr. Fabian:          That’s a great question. So I can’t say I have a really good answer for that, I’m not as familiar with the research on the comparative longer term picture with those different immunoglobulins. But definitely, there is evidence that, that can change over time, whether it’s an outright allergy or a sensitivity, depending on lots of factors. If you’re just not exposed to the antigens for a long time, the immune system may not be as responsive after a certain period of time. And again, we do see that with certain immunoglobulins like IgA. And referring back to the anti-gliadin IgA, if patients haven’t been exposed to gluten for, say, the last three to six months, that may go back down to normal ranges, indicating that there may be less responsiveness over a period of time.

Dr. Weitz:            And then what is a food intolerance in contrast to a food allergy and a food sensitivity?

Dr. Fabian:          So food allergies and sensitivities are immune mediated reactions, whereas food intolerances are defined as non-immune mediated. Again, newer research indicates that those lines are a little bit blurred now, but classically, food intolerances are things like carbohydrate intolerance, so there’s usually no significant immune mediated reaction there, but patients essentially don’t digest and absorb these well. So they end up going lower down to the GI tract, often the colon, where the microbes then ferment these into gases and other products that then can provoke symptoms. Similar scenario to histamine intolerance where normally we have an enzyme in the gut called diamine oxidase that helps to break down histamine. So if you have a lack of diamine oxidase due to a genetic deficiency or possibly due to damage in the small intestine, inflammation in small intestine, that can reduce the DAO enzyme, and so then you’re not able to break down histamine. So if you consume high histamine foods, for example, that can provoke a histamine related reaction. And there are others as well, like oxalates, lots of different components of food potentially are things that certain individuals can react to. So broadly speaking, those would be intolerances.

Dr. Weitz:            Cool. So let’s talk about how a healthy microbiome and healthy commensal bacteria play a role in the risk of food allergy, sensitivities and intolerances.

Dr. Fabian:          So there’s a lot of research that started coming out in the last, say, 10 years or so on defining the role of the microbiome in oral tolerance. So that’s the concept where typically the harmless foods, day to day foods that we’re eating, of course, we don’t want to react to those from an immune standpoint. And it turns out that the immune system of course has a balance of pro-inflammatory and anti-inflammatory, to keep it simplistic. The anti-inflammatory response is similar and overlaps with the immune tolerance response. So basically, immune tolerance is a mechanism by which the immune system restrains overreaction, and that applies to food allergies, respiratory allergies, et cetera. And mostly that involves what are called Treg cells.

So it turns out a lot of the recent research shows that various products from the microbiome can promote these Treg cells that promote immune tolerance. And probably the best study of these is butyrate, so that’s made primarily by butyrate producing bacteria in the colon from fiber. And lots of studies have shown that in various scenarios, whether it’s autoimmunity, whether it’s allergies, sensitivities, that the butyrate may often be deficient, butyrate producers and the butyrate itself in the gut may be deficient, and then that can lead to a deficiency in Treg type responses. So that’s really thought to be the main mechanism. It depends where you’re talking along the GI tract. So the colon is probably the best study, again, that mostly involves butyrate producers, but also other products produced by the microbiome. And that list is growing as they do more research.

So generally, the commensal normal microbes tend to promote immune tolerance, which makes sense because they’re normal residents of the gut and they don’t want to provoke an immune response, because obviously, then they wouldn’t thrive in the gut. But in the upper GI tract, in the small intestine, they’re starting to define some of the normal microbes there, and among the main ones would be things like Streptococcus, which actually is a normal microbe in the small intestine, Prevotella species are pretty common in the small intestine, of course Lactobacillus, Bifidobacterium to some extent, although Bifido is mostly resident of the colon from what we know, but especially Lactobacillus is important.

And then there’s a particular species of Prevotella that’s been studied recently and they’re actually looking at it as a potential probiotic, similar to Akkermansia where it’s not easy to grow because it’s more of an anaerobic type species, but it’s called Prevotella histicola. And that one has been shown to help protect against things like food sensitivities, et cetera, so it helps to reduce overactive immune responses in the small intestine.

Dr. Weitz:            Interesting. Yes, it’d be nice to have some tools besides simply avoiding foods that people are sensitive to.

Dr. Fabian:          That’s really the whole point of this research is for years that’s been the paradigm in addressing food sensitivities is to run a food sensitivity test or just to approach it with a standard elimination diet or both, and just see what people are reacting to, and then of course eliminating those. Which poses a lot of problems, I mean, that’s difficult to maintain long term, people of course don’t want to give up their favorite foods, plus there’s always the chance that, depending on how restrictive the diet is and what’s being restricted, that can lead to nutrient deficiencies, and of course we all want to avoid that scenario as well. And of course, we’ve known that of these different categories, allergy, sensitivities and tolerances and so some of them can be addressed, such as the lactose intolerance is the classic one, that can be addressed to some extent, of course, by avoiding lactose containing foods, but can be addressed to some extent by taking the enzyme, lactase, et cetera.

The immune response mediated reactions, so allergies and sensitivities, are a bit more challenging to potentially address their protocols that allergist use for desensitization that may be effective in some cases. But the recent research because of these insights about the microbiome … and I think this is really the key concepts on this whole topic is, as we learn more for research, we’re learning the ones that promote the immune mediated type reactions, sensitivities and allergies, and then the ones that basically help protect against. So when you have an imbalance where you start to lose some of those species or they decrease that help protect, and then you have an overgrowth of some of the ones that promote, that’s the classic imbalance that’s thought to be a key factor in driving the immune responses. So a lot of interest in research now in figuring out what these species are and then what they’re doing, and how that may be applied, of course, therapeutically.


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

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Dr. Weitz:            Now, the one concept that we’ve used for years is this whole leaky gut concept, and I think a lot of us have explained food sensitivities partially in terms of leaky gut, especially we get one of these food sensitivity tests back and the patient has a huge number of food sensitivities, and the usual explanation is, well, you have leaky gut, because the leaky gut, these proteins are getting into the bloodstream and creating immune reactions. And so if we just heal up the gut, reduce the leaky gut, then we won’t have as many food sensitivities. But after reading so many articles you sent me and watching your webinar, it’s way more complex than that and there’s all these other mechanisms which I’d like you to start going into.

Dr. Fabian:          Sure, absolutely. I mean, the leaky gut thing is still certainly applicable, just one of the factors, and it’s actually related to the whole picture of immune imbalances and microbiome imbalances. So as you can imagine, that concept of when you have leaky gut then these antigens can more easily get across the epithelial lining. And certainly, once something gets across that epithelium where they’re not supposed to be, then that usually is an alarm signal for the immune system where they can detect that and then basically react to that scenario.

Dr. Weitz:            For those who don’t understand, the epithelium is the lining of the gut, and if food particles, proteins cross that lining making it directly into the bloodstream.

Dr. Fabian:          Exactly. And they can also react to just the immune cells that are already present in the intestinal mucosa that are just underneath the lining.

Dr. Weitz:            Right.

Dr. Fabian:          And then once the immune system gets going, that can further exacerbate or promote leaky gut, so it’s this vicious cycle scenario. But we know from recent research that, once again, microbes can influence a lot of the different steps in that process. So one is, of course, just general idea of overgrowth of inflammatory type bacteria, such as Escherichia or E. coli, Klebsiella, Citrobacter, these types of more inflammatory bacteria, if they’re overgrown for any reason in the gut, especially mostly in the small intestine because that’s where, of course, these food antigens are first starting to be broken down as part of digestion, that, that can basically then set the stage, when you have inflammation, inflammation then can also cause leaky gut. So it’s a general concept.

But new research actually shows that even the antigens themselves, the state of the antigen or how antigenic a protein is, can be modified by microbes. So there are certain microbes that have been shown to actually break down certain proteins such as gluten. In this case, there’s a lot of research on Pseudomonas, for example, which is a common resident of the small intestine. So when Pseudomonas is overgrown, it can release certain enzymes that break down gluten in a way that makes it easier for the gluten to get through the leaky gut essentially. So then it doesn’t break them down enough to get to a point where they’re no longer stimulating the immune system. If you have good digestion, that’s really efficient, the idea is that you’re going to break down proteins all the way to their component amino acids, and then amino acids are not going to be stimulating the immune system, usually it’s larger structures that stimulate immune response. But because-

Dr. Weitz:            And it probably the reasons why hydrochloric acid is so important, because that’s super important for breaking down proteins and a lot of people end up not having enough hydrochloric acid.

Dr. Fabian:          Absolutely. Yes. And that’s pretty common and we do see that clinically very often. I’m sure you see that as well that a pretty high proportion of patients seem to have varying degrees of low stomach acid, poor digestion in general.

Dr. Weitz:            It’d be nice if there was an easy to do task for stomach acid.

Dr. Fabian:          It would. The classic definitive test is invasive.

Dr. Weitz:            Right.

Dr. Fabian:          There are these ways to approximate that with experimenting with Betaine HCL supplements, the bicarbonate tests, et cetera.

Dr. Weitz:            Right.

Dr. Fabian:          So that’s really important, but overall digestion is important because, as I mentioned, if the whole digestion process goes efficiently, then you break those proteins down generally pretty efficiently into amino acids so they’re less likely to cause an immune reaction. Some proteins are harder just naturally harder to break down like gluten, so that’s one of the reasons why it’s thought to be more of a problem. But then you have these microbes that can interfere with that process in a way that makes the antigens more available to the immune system to react to. But it’s all about balance. So again, research indicates that various types of probiotic type species, the beneficial species, like Lactobacillus also can break down gluten as well but they tend to break it down more efficiently to smaller components, essentially, that don’t stimulate the immune system.

So it’s thought that it’s not necessarily just the bad guys but the balance of your bad guys to the good guys. And that’s the classic concept of dysbiosis. So oftentimes, just overgrowth alone can be a problem or lack of beneficial bacteria can be a problem, but oftentimes it’s both. And there’s a few other examples of that, but probably the best studied is the Pseudomonas and Lactobacillus scenario, that balance is likely to be pretty important. So that’s really where the interest is in probiotics, for example, and fermented foods, because that helps potentially increase these beneficial Lactobacillus species. And also some of the Bifidobacterium species, like certain strains of Bifidobacterium longum, also produce factors that can actually inhibit some of those enzymes produced by the bad guys that break down gluten in a way that make the gluten more inflammatory.

Dr. Weitz:            Now, do we know if those strains of, say, Lactobacillus, if the Lactobacillus that are growing in our microbiome produce those? Do we know if Lactobacillus strains that we consume in probiotic capsules, do they necessarily have the same effects, especially since they’re only temporary visitors?

Dr. Fabian:          As far as we know the answer is yes. So some of the strains that have been studied are native to the gut, others are more probiotic strains, and sometimes they’re both, because some researchers, of course, over time have isolated some of these native species and then they’ve been able to cultivate those and now products are available. So one of the best studied Lactobacillus species overall is called Lactobacillus reuteri, R-E-U-T-E-R-I, which is available in a number of probiotic products. There’s quite a bit of research suggesting that Lactobacillus in the small intestine produces factors that help inhibit overreaction of the immune system. So they promote those T regulatory type responses. So again, that’s thought that promoting the native bacteria, of course, can be helpful, we don’t necessarily know all the different ways to do that, we have some clues, but that can be difficult for some people to try to get their native Lactobacillus to come back just through diet, et cetera, and that’s really where probiotics and fermented foods come into play.

There’s actually a recent research article that just came out comparing the benefits of fiber to fermented foods. And this study found that fiber was a little bit more heterogeneous, some people it was anti-inflammatory for the majority, and a subset of people certain fibers may have more of a pro-inflammatory response, probably depending on which microbes those are promoting. Whereas the fermented foods that they studied basically had largely anti-inflammatory effects. So-

Dr. Weitz:            Yes, I think there’s a dilemma of, with clinicians, do we recommend more fiber for patients who come in, say, with gut disorders or it seems at least a certain subset of patients do better when they avoid fiber, avoid certain types of fiber, like say fermentable fiber by being on a low FODMAP diet?

Dr. Fabian:          Absolutely. Yes. So it’s a complicated picture as always when you get into the details, but I thought this study was very interesting and I think that’s pretty well noted clinically by a lot of functional medicine clinicians that fiber is not always beneficial in terms of symptoms, sometimes it just exacerbates what’s going on, and yet we have this concept that fiber is just always something that you want to try to get more of. So probably it has to do with the combination of the microbiome that, that patient has and how that microbiome reacts to the fiber, but also the type of fiber.

So just a quick aside is that a lot of research has been done on different types of fiber and their effects on the microbiome, and to some extent, in certain conditions like IBS. And so the FODMAP diet, for example, that restricts mostly short chain, so of course, monosaccharides, disaccharides and oligosaccharides, those are all pretty short chain type fermentable carbohydrates. Typically, for patients that don’t do well with those, then they end up getting over-fermented, they rapidly go through the GI tract in some patients, and then they arrive in this high concentration to where the bacteria are that ferment them, and that can create a pretty big spike in things like gas production and other products that might provoke symptoms.

Whereas the longer chain fibers, so psyllium, for example, has been well studied and is actually suggested even in conventional medicine as a possible treatment that can help with IBS symptoms. And so, one study showed that inulin, which is a shorter chain fiber, can cause higher levels of gas and provoke symptoms for some patients, but when you add psyllium to it, it draws that process out so you don’t get this big spike, you get a more gradual increase in gas, et cetera, that can be more tolerable. So the types of fiber and including these longer chain fibers for some patients, may actually be good even though they might react poorly to FODMAPs. So it’s really, I think, opens up some possibilities here because we don’t necessarily want to completely restrict FODMAPs, because patients can end up with a very restricted diet.

Dr. Weitz:            Sure.

Dr. Fabian:          And then they have beneficial effects, they promote short chain fatty acids, et cetera. So if you have the right mix of types of fibers, then that may work for certain patients.

Dr. Weitz:            Yes, I think the concept that a lot of us have been using, is if we have a patient who has overgrowth of certain bacteria that shouldn’t be there in those levels, we’ll restrict the fiber, is restrict the low fermentable fiber and will starve them and then maybe we’ll use, at the same time, other supplements or antibiotics. A lot of us in functional medicine world will use antimicrobial supplements like oregano oil and Berberine and things like this in the idea of killing or reducing some of these bacteria while we hold back their food. And then once we can get that cleared out, then we can restore it and we store those foods back, and then we’ll have a healthier microbiome.

Dr. Fabian:          Yes. And I think you hit on this key phenomenon that we see clinically, but also there’s a lot of research coming out that supports this idea that we all know that sometimes antimicrobial protocols, they might work temporarily, but then the symptoms come back at some point, so patients relapse or they just don’t respond that well at all to that approach. And it’s thought that part of that has to do with the diet and also part of it has to do with, again, digestion. So we see this quite a bit with advanced stool testing where you get some markers for the microbiome, for digestion, et cetera, and oftentimes I see results for patients that were treated with antimicrobials, but basically the patients just didn’t respond well to that. In many cases, you’ll see evidence for reduced digestion, so things like lower last days, which is an indicator of pancreatic dysfunction.

And then I think there’s also a couple other things to keep in mind. So there’s some really interesting research coming out about particularly food intolerances, so the carbohydrate related symptoms, so things like FODMAPs, et cetera. A couple things there, I think, that are really important for clinicians to note that’s new information, one has to do with the types of carbohydrates. So we talked about different types of fibers, but it turns out that one of the brush border enzymes called sucrase-isomaltase, that’s an important brush border enzyme that actually appears to be deficient in a pretty high proportion of patients with IBS, for example. So it turns out that some of that can be genetic, there’s some common snips that can reduce that enzyme, but also anything that causes inflammation, even minor damage in the small intestine, infections, et cetera, overgrowth, those can inhibit those brush border enzyme.

So recent studies indicate that up to 35% of patients that have IBS-D actually have reduced sucrase-isomaltase that may be contributing to their symptoms. So there’s also additional studies following up on that showing that patients that don’t respond well to low FODMAP diet, it may be because they have low levels of this sucrase-isomaltase enzyme, so they actually do better by restricting starches and sucrose sources. So again, I think this is really where the Precision Medicine personalized diet aspect comes into play where we have these standard approaches that we start with, like low FODMAP diet, but if those don’t work, we need to be aware of this other mechanisms so we can say, okay, well that didn’t work, maybe we’ll try a low starch diet or low sucrose type diet.

Dr. Weitz:            How can we know if patients have low deficiency of these brush border enzymes?

Dr. Fabian:          That’s a good question. So the snips are being defined and so certain genetic tests may contain that information, so that’s one route to go is potentially doing a genetic test to see if patients have the snips. It’s not really common yet in clinical practice to really assess brush border enzyme activity directly, that’s an invasive process, but potentially indirectly through like a sucrose based breath tests, there’s various types of carbohydrate malabsorption breath tests that can be done, fructose, et cetera, lactose, and sucrose is available. That’s not something I’m really familiar with, but potentially, that’s an option for people. And then, of course, just the elimination diet approach, just restricting those sources for a while and seeing if symptoms improve, which is usually the most straightforward.

Dr. Weitz:            And then how do we rebuild these brush border enzymes? I know there are supplements of brush board enzymes we can take.

Dr. Fabian:          So it’s a combination thing. So yes, I mean, that’s the replace option from the five bar protocol that when you’re deficient in something, replace that from a supplement standpoint. So there are various options out there that are either supplements that have just the brush border enzymes, plus there are a broad spectrum digestive enzyme products that have the pancreatic enzymes, brush border enzymes, and then sometimes other things like [inaudible 00:32:46] and some supplemental acid, for example.

So those products can be helpful, but they don’t necessarily address the cause, of course. And ultimately, in terms of medicine, root cause is really something you want to try to address if possible. So as I mentioned, genetic snips can be part of the picture, but also just anything that damages or causes inflammation in the small intestine. There was a great review article that I include in some of my webinar slide presentations that’s this table from a review paper showing a lot of the different factors that can affect the small intestine, so that includes infections, including even things like H. Pylori, so it’s not well known that H. Pylori can also infect the upper small intestine, duodenum, and in some patients that can have a negative effect on the brush border, but also things like Giardia, Cryptosporidium, and probably various types of dysbiosis. So as I mentioned-

Dr. Weitz:            If we see H. pylori either elevated or maybe just above the detectable level in that zone where it’s not flagged as high but it’s higher than it should be, and maybe there are not any of those … what are the factors called that they react to?

Dr. Fabian:          Virulence factors?

Dr. Weitz:            Yes, there’s no virulence factors, when do we think that, that could be a problem or should we always be concerned about it? Because there’s a lot of controversy over H. pylori and whether it’s actually a beneficial microbe, et cetera.

Dr. Fabian:          Exactly. Yes. So it is something that is very common, worldwide it’s present in I think at least 50% of the population and the vast majority people don’t have obvious symptoms from it. And it is known from just endoscopic studies, et cetera, that patients that have H. pylori can be completely asymptomatic even though they might have low grade or low level inflammation in the stomach, so low grade gastritis. And it’s not clear that, that’s necessarily a problem. Even long term, in most cases, it doesn’t seem to lead to any progression to things like cancer for most patients. And that’s really where the virulence factors come in, because there’re various strains of H. Pylori. So that’s important information to take into account, because if there are virulence factors that suggest the strains that are present may be more aggressive and more likely to contribute to worse gas gastritis, for example, and that can set the stage for ulcers, cancer, et cetera. So the levels, keep in mind that in stool testing.

So PCR is a very sensitive technique and can pick up things at very low levels, which is great especially when you’re detecting something coming all the way from the stomach, so by the time it gets to the colon obviously the levels may be lower than what’s detected directly in the stomach. So the low levels that we see on PCR tests like GI-MAP, for most patients if they’re not high, that’s usually consistent with patients not having significant symptoms related to H. pylori. But because it’s not a completely linear relationship, for some patients, again, that’s really where the assessment comes into play where you have to really focus on symptoms, focus on the rest of the picture. So clinicians sometimes do treat when H. pylori levels are not high and they do often find that, that can be helpful from a system standpoint. So it’s a mixed picture, and again, I think clinical judgment is really key there when it’s not an obvious situation, you have to be careful and make sure you’re assessing the situation properly.

Dr. Weitz:            So when I watched your webinar, two things that came out that seemed to be significant that stuck in my mind, and one was the importance of promoting the way in which a healthy microbiome and healthy commensal bacteria can promote T regulatory cells, which seem to blunt these adverse immune reactions like food sensitivities. Can you talk more about that? And then what are some of the strategies we can do to promote that?

Dr. Fabian:          Absolutely. Yes. So, certainly there’s a lot of growing evidence that butyrate can be helpful in helping to promote T regulatory cells. So we don’t know all the mechanisms, but it’s thought that one of the key ones is that … so butyrate can basically act on immune cells in various ways. So they have receptors on the outside of the cell that can detect butyrate and then you can have reactions, responses of those immune cells based on the interaction of butyrate with those receptors. But it’s thought that the main way that butyrate affects the function of immune cells, whether they become more pro-inflammatory or antiinflammatory, so of course, butyrate tends to promote the antiinflammatory development path of those immune cells, is through epigenetics, so basically altering long term gene expression.

So butyrate results in turning on and turning off certain genes. So essentially, turning off the more pro-inflammatory type genes and then promoting the primary functions of Treg cells. So in the development process from what’s called a naive T cell that’s not yet become a Th1 or a Treg cell, et cetera, butyrate influences that progression so they more likely to become Treg cells. And then Treg cells secrete various things, especially cytokines that then act on other cells in the immune system to basically quiet them down so they’re less likely to be inflammatory.

Dr. Weitz:            So it sounds like one of the real keys is promoting the growth or health of butyrate producing microbes.

Dr. Fabian:          Indeed, yes. So main ways to do that tend to be, of course, generally fiber, but it does depend to some extent on the type of fiber. And again, that’s likely to be somewhat specific to the types of microbes that an individual has, so certain microbes respond to certain fibers. So in general, probably the best studied fibers for promoting butyrate production would be inulin, so the combination of FOS, fructooligosaccharides, and inulin, those are often together in various products. Resistant starch, I mean, that’s certainly a very well studied group of fermentable carbohydrates that can promote butyrate-

Dr. Weitz:            So for those who don’t know what resistant starch is, can you explain what resistance starch is?

Dr. Fabian:          Sure. So basically, starch contains different subtypes of starch. So there’s the type of starch that’s more easily broken down just in the small intestine into sugars and then absorbed, then there’s a type of starch that’s much harder to break down by our digestive enzymes, so then that basically travels down into the colon just similar to fiber, basically, it’s like a type of fiber, then the microbes have additional enzymes that we don’t have that can further break that down. And then once they break it down, then they can take up those component sugars, and then they can basically metabolize those into producing butyrate and other short chain fatty acids.

Dr. Weitz:            And what are the best sources of resistant starch? I’ve certainly heard about eating cold potatoes and things like that.

Dr. Fabian:          I can’t say that we necessarily know overall what are the best sources, there are certainly some that are more convenient than others. So there’s a growing amount of products out there that contain things like potato starch, green banana or plantain starch, those are probably among the most common.

Dr. Weitz:            And there’s something about the potato starch that after you cook it and then cool it down or put it in the fridge, and then you eat it, that it becomes more resistant, right?

Dr. Fabian:          Right. Yes, somehow that changes the structure a bit into the more just resistant type starch so that our enzymes can’t break it down as easily, and again, more of that ends up in the colon to fuel the growth of these butyrate producers.

Dr. Weitz:            But this is probably not a good excuse for eating day old french fries or any french fries.

Dr. Fabian:          No, because it’s all in the balance, and of course, those types of foods have a lot of bad things in them that can disrupt the microbiome and promote inflammation, so it defeats the purpose.


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Dr. Weitz:            So what are some of the other sources of resistant starch besides potatoes?

Dr. Fabian:          That’s a good question. So pretty wide range of foods have some levels of resistant starches, and I can’t say that I’m familiar with all of them.

Dr. Weitz:            Okay.

Dr. Fabian:          There are some that are more natural. So as you mentioned, you can cook rice and let it cool and then a fair amount of that if you eat it cold instead of reheating it, then it will retain that amount of resistant starch. So that is how some people get their resistant starch, whether it’s potatoes or white rice, and so those are pretty common. Then when it comes to supplements, again, green banana powder, plantain powder, and then typically potato starch are all pretty common as well.

Dr. Weitz:            Okay.

Dr. Fabian:          Those are the ones that I’m most familiar with.

Dr. Weitz:            Okay. And what are some of the other strategies for promoting butyrate producing bacteria in our gut?

Dr. Fabian:          So it’s mostly looking at the big picture. In terms of foods and supplements, we know that polyphenols in general help to promote beneficial bacteria and at the same time typically help inhibit bad bacteria, so they’re good balancers. Research indicates that they’re often synergistic with fiber. So along with getting more fiber in the diet, which of course is typically from things like fruits and vegetables that happen to also contain polyphenols, that’s probably, of course, one of the key reasons why those foods tend to be very health promoting.

And then in terms of supplements, there’s a pretty wide range of different types of supplements that have these polyphenols. And it’s a broad category, so examples would be things like curcumin, quercetin, resveratrol, green tea extract, those sorts of plant extracts that we typically think of as more antiinflammatory and antioxidant.

Dr. Weitz:            Okay.

Dr. Fabian:          Generally, most of those that have been studied, so curcumin, quercetin, resveratrol, grape seed extract, pomegranate extract, those are among the best studied sources of polyphenols that have been shown to help balance. But even things like chocolate tea, cocoa extract, there’s a growing list of things that have been studied. So polyphenols in general, especially in combination with fiber. And then there’s also supplementing with butyrate directly, and there are a variety of different types of supplements out there. There is quite a bit of research on butyrate supplementation and a wide range of health benefits. In addition to promoting those Treg cells, butyrate can promote a lot of other beneficial functions. So it helps-

Dr. Weitz:            So are butyrate supplements absorbed? I’ve heard some controversy about this.

Dr. Fabian:          So it’s a bit of a mixed picture, and to my knowledge, it’s not as well studied as it should be at this point, but there are some products that are known to be more likely to reach the colon. From what I understand, that would include products that include butyrate in the form of tributyrin, but also some of the products basically, I don’t know technically how they do it, but basically the butyrate is bound or attached somehow to the probiotics. So essentially, the butyrate isn’t released until the bacteria in the colon start to break down the fibers and then release the butyrate. So there are various ways to deliver it and I think that’s an ongoing effort in the industry to look at the best ways to deliver butyrate.

But one thing I would mention is, some release of butyrate in the small intestine may not be a bad thing, because there is evidence that some butyrate is produced also in the small intestine. So one of the species that’s pretty common in the small intestine is called Fusobacterium, which is another one of these, it’s a good guy and a bad guy, depending on the circumstances. It can produce hydrogen sulfide, for example, which can-

Dr. Weitz:            Yes, Dr. Pimentel mentioned that. Yes.

Dr. Fabian:          And in the small intestine it’s normal. On our tests we do have Fusobacterium on GI-MAP, and virtually everyone has detectable Fusobacterium. And we know from research that it’s normally present from the oral microbiome down to the small intestine, sometimes in the colon where it’s not really supposed to be as much, but it produces butyrate.

Dr. Weitz:            So do you think taking supplements of butyrate would be more likely to be effective or I know there’s at least one or more products on the market that contain the other short chain fatty acids, acetate and propionate as well?

Dr. Fabian:          Exactly. Butyrate definitely is the best studied as far as on promoting immune tolerance, et cetera. The other ones are a little bit more of a mixed picture, but propionate would probably be a close second, a lot of research does show that, that can have similar effects to butyrate. There’s a little bit of concern about overdoing propionate just due to some early research on possible links with things like autism. I don’t know where that research has headed in the last few years. That was earlier research from five to 10 years ago. But there are quite a few studies showing that propionate does have beneficial effects under certain circumstances, especially on metabolism and things like glucose regulation.

Dr. Weitz:            And then what about probiotics, prebiotics?

Dr. Fabian:          Absolutely. Yes, so there are quite a few that have been studied that have been shown to have key beneficial effects. So we know that things that can predispose are involved in food reactions. Of course, we mentioned leaky gut, we mentioned overactivity of the immune system, we mentioned dysbiosis and there’s other factors as well. So a lot of different probiotic species, Lactobacillus and also some of the Bifidobacterium species are known to promote a healthy intestinal lining, part of that might be through cross-feeding. So Bifidobacterium tends to promote acetate and the butyrate bacteria can then take the acetate and make butyrate. Also Lactobacillus, of course, produced lactate, and then some of the butyrate producing bacteria can take the lactate and produce butyrate. So that might be one of the ways in which they can help promote a healthy gut environment, healthy intestinal lining. But they also have a positive effect on the immune system as well.

Dr. Weitz:            How important is it that we take specific probiotic strains versus just blends of probiotics? Because right now there seems to be quite a bit of confusion in the probiotic market and there are some prominent practitioners out there who simply group probiotics in a few different categories and we basically just talk about Lactobacillus-Bifido blends as though we can’t really distinguish. On the other hand, there’s a lot of promotion of specific strains, some strains that we know are more specific for being butyrate producers. How important do you think it is that we take specific strains of probiotics?

Dr. Fabian:          That’s a really great question, I think that leads to a lot of confusion in the field. So on the surface that’s the ideal scenario to be able to use a particular strain that has a lot of research backing up that it has these particular demonstrated positive effects. So generally, that would be the recommendation is it has to be as much as possible evidence based, but the challenge there is, once again, the individual scenario where based on the patient’s microbiome, based on how they would react to that particular strain. And of course, any bacteria produces multiple products, so just because they produce certain beneficial things for some patients, they may produce things that don’t work well for them. The classic example for Lactobacillus species is some produce a form of lactate called D-lactate. So even though they might be anti-inflammatory, for example, some of them might also produce D-lactate that some patients may have some issues with.

So I think that’s part of the picture. So a lot of clinicians that have tried to do the targeted approach by using well researched strains, they found that in some cases those don’t work, of course, for all patients, so they end up having to still go back to the drawing board and try other probiotics. So you’ll hear that a lot in our field that some clinicians feel it’s more of a trial and error type of approach where you try to go with the well researched products first, because they have good evidence basis, but if they don’t work for a patient, ideally, you have some backup products that you can try, and hopefully they respond well to one of those products. So it’s still a bit of not a full science yet, you still often involves a lot of trial and error to see what works.

Dr. Weitz:            Has Diagnostic Solutions considered adding butyrate and short chain fatty acid levels to the test results?

Dr. Fabian:          That’s a great question. So I’m not aware of an immediate upgrade to the test that will include those. We do have some of the key butyrate producers currently on the test. We do get great results in terms of scenarios where you expect those to be low inflammatory conditions, they’re low, et cetera. So what we see with our existing markers does reflect well what we see in the research. And there are some concerns about measuring butyrate in stool. So generally, it can be useful information, but just keep in mind that short chain fatty acids, the vast majority of them, estimates are more than 95% are already absorbed by the colon before they reach the stool. So what you’re seeing is just a small remnant, so you have to know how to interpret that properly and then even the techniques that are used to measure those can be important. So it’s a little bit less straightforward than I think we assume, it’s not always directly measuring production, because there’s that absorption aspect that can affect the results.

Dr. Weitz:            So what would be the recommendation for which probiotics we should recommend to patients if we want to try to reduce food sensitivities?

Dr. Fabian:          Great question. So among the best studied species, as I mentioned, is Lactobacillus reuteri.

Dr. Weitz:            Okay.

Dr. Fabian:          Now, I think that at least some strains of that species may produce D-lactate, so it may not be something that works for everyone.

Dr. Weitz:            Okay.

Dr. Fabian:          But there is good evidence indicating that, that can help reduce. And there are specific strains that have been studied that I’m aware of in certain products, so there are products that reflect the specific strains that have been studied.

Dr. Weitz:            So there’s a specific strain of Lactobacillus reuteri that we know is more likely to be beneficial?

Dr. Fabian:          Probably more than one strain, yes, because different studies have used different strains. And I’m not aware of all the ones that are commercially available, but that would be one that I would say is well study, plus a number of the Bifido bacteria strains also, so at least a few within the Bifidobacterium longum species, those have also been studied for helping to improve aspects of food sensitivities. And again, you’d have to really drill down into the specific evidence, some of those are, for example, just studied in the context of gluten, doesn’t necessarily mean they’ll help with other food sensitivities. So it really depends on what you’re targeting there.

Dr. Weitz:            And now, I think I mentioned here earlier, I just interviewed Colleen Cutcliffe from Pendulum Therapeutics, and they’ve just been able to develop the first commercially available anaerobic probiotic supplement that contains Akkermansia muciniphila, and we know this is a type of bacteria that produces a lot of butyrate.

Dr. Fabian:          It actually primarily produces propionate, but it can help with the butyrate scenario.

Dr. Weitz:            Okay.

Dr. Fabian:          So the research indicates there’s potential cooperation between Akkermansia and some of the butyrate producers. And especially one of the more proposed … I mean, again, this isn’t necessarily something that’s completely proven yet in research, but supporting evidence is out there suggesting that Akkermansia is also a keystone species, which means it’s plays an outsized really important role for the ecosystem. So one of the proposed ways in which it does that, so it consumes mucus as its main food source, and mucus basically is a protein that has sugars attached to it, sugar chains, so there’s-

Dr. Weitz:            So it consumes mucus, interesting.

Dr. Fabian:          Yes.

Dr. Weitz:            So it helps break up mucus layer?

Dr. Fabian:          Right, but it produces factors that can in turn stimulate mucus production, which makes sense because that helps it grow in the gut.

Dr. Weitz:            Okay, interesting, because when I was talking to Dr. Pimentel a few weeks ago, I was asking him if he thought that taking Akkermansia might be beneficial for SIBO. And he said that since some of the organisms involved in SIBO live in the mucus, anything that increased the mucus might be make it more difficult to get rid of them?

Dr. Fabian:          Well, I think it depends on the detail. So Akkermansia is mostly known to be a resident of the colon.

Dr. Weitz:            Okay.

Dr. Fabian:          The colon has two layers of mucus, the outer mucus layer is a thinner mucus layer that actually is where most of the mucus consuming bacteria in the colon live.

Dr. Weitz:            Okay.

Dr. Fabian:          So some of them break down the mucus sugars and release the sugars, and so it’s thought that, that’s actually how Akkermansia helps support the ecosystem. So in between meals, for example, when you don’t have fiber available to the fiber degraders, they have to exist on something, so it’s known and really well established and research that mucus actually serves as that interim food source directly for the mucus degraders like Akkermansia, but indirectly because they’re releasing the sugars and essentially sharing them with the ecosystem. And so it’s thought that, that’s one of the ways in which they help support the butyrate producers.

Dr. Weitz:            Interesting. Boy, it’s such a complicated picture.

Dr. Fabian:          It is, but that is my main area of study.

Dr. Weitz:            [crosstalk 00:58:32] And then what about specific prebiotics that facilitate the growth of the butyrate producers?

Dr. Fabian:          So those again would be the things like inulin-FOS.

Dr. Weitz:            Okay, the fibers. Yes.

Dr. Fabian:          But then you have to think of it in the bigger picture of cross-feeding, that’s a big aspect of how the ecosystem works. So even though you may not be necessarily supplying directly what the butyrate producers need, you can supply that potentially indirectly, and as I mentioned, that’s where the probiotics can come into play because they produce factors that then can be used by the butyrate producers to produce butyrate.

Dr. Weitz:            Is there a role for some of the other typical nutritional products that are included in gut healing supplements like L-glutamine, and mucilaginous, herbs and things like that? Do they play a role in this or could they?

Dr. Fabian:          Yes. I mean, so I’m less familiar with the research around the mucilaginous herbs and their effects, but glutamine certainly is thought to be pretty beneficial for the small intestine, the cells align the small intestine because that’s one of their key energy sources. And I’d like to promote the idea which is emerging from research but also it’s really how we operate in functional medicines, is to take the bigger picture, the integrated picture into account when you think of the gut as this domino effect. So if you’re promoting health of the upper GI, so the small intestine, for example, by gut supporting supplements and include L-glutamine, for example, then you can help support these brush border enzymes in the overall digestion absorption process, so then you’re going to have less undigested food getting into the colon and throwing things off. So everything is interlinked as you can imagine. There’s even a lot of research now on oral dysbiosis that then contributes to dysbiosis downstream.

Dr. Weitz:            Right.

Dr. Fabian:          But again, it complicates the picture a bit but I think the good news out of all that is there’s ways that we can intervene that we hadn’t thought of before, that actually making sure oral health is where it should be might actually help have a positive impact on gut health.

Dr. Weitz:            Cool. Well, that was a very thought provoking, Tom, you gave us a lot of useful information about the microbiome and the more we learn about this, the more we’ll be able to develop effective strategies to help our patients.

Dr. Fabian:          Absolutely.

Dr. Weitz:            So any final thoughts for our listeners or viewers?

Dr. Fabian:          I think some of the key take homes in this topic of food sensitivities, allergies and intolerances are definitely think, as I just talked about, more the big picture integrative. And we do know a lot now about dysbiosis in the small intestine, for example, or in the stomach with H. pylori overgrowth that can affect digestion and absorption, which then can cause dysbiosis downstream and can affect the balance of butyrate producers, for example. So really thinking big picture. And I would say, probably one of the key take homes just based on both the research and what we’ve seen clinically with stool testing is that reduced digestion does seem to play a really big role in dysbiosis and then symptoms across a pretty broad range of conditions, not just the food allergies, sensitivities and tolerances, but other conditions as well. So really focusing on that as being a key component.

I think that’s often overlooked when clinicians see dysbiosis and their first thought is, antimicrobials, which certainly can be helpful, but that may not be the full picture. I think, we all deal with situations where there’s a lot of complexities, complex patients that aren’t really responding the way we expect, and when we have those scenarios where we’re clinicians have gone down those paths and then they do a stool test to see, what does digestion look like? What does the dysbiosis look like? What does the immune system look like? Then you can start to piece that picture together a bit more and see that maybe we haven’t really addressed the digestion picture fully yet, or we haven’t looked at H. pylori, we were looking at something else.  So I think that’s where the whole precision medicine idea comes from as well, that you’re trying to look at all the different factors and see, which ones are likely playing a role for that patient? And then you can target it more specifically to what’s likely causing the problem or in a root cause type picture. So that would be my overall take home on how to take this complicated information and put it back together.

Dr. Weitz:            Great. Thanks, Tom.

Dr. Fabian:          All right. Thank you so much, Dr. Ben. It was a pleasure.

Dr. Weitz:            Same here. Talk to you soon.



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



Cortisol and the HPA Axis with Mark Newman of Precision Analytical: Rational Wellness Podcast 232

Mark Newman of Precision Analytical speaks about Cortisol and the HPA Axis 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

2:04   The adrenal glands release cortisol, which is your stress response.  This is directed by the brain. The hypothalamus in the brain releases Cortisol Releasing Hormone (CRH) that goes to the pituitary gland, which releases ACTH and both the hypothalamus and the pituitary are in the brain.  ACTH then finds your adrenal gland and it stimulates the release cortisol, as well as aldosterone, DHEA, and your catecholamines like adrenaline.  Cortisol secretion is an important component of our normal circadian rhythm along with melatonin. ACTH starts going up before you wake up and when you wake up and the light hits the back of your eye, that is the signal to make ACTH, which make cortisol. Waking up is is a stress event, so you get the stress hormones secreted.

5:17  When testing the salivary cortisol upon awakening and throughout the day, if you are not making enough cortisol, it could be related to COVID. The antibodies for COVID can cross react and attack your ACTH and make it more difficult to produce cortisol.   And this could persist for a long period of time, which could be one factors in the symptoms that long haulers with COVID have, such as fatigue and brain fog.

8:47  Supporting the adrenal glands could be an important component of helping people recover from COVID.  We know now that the adrenal glands never actually become fatigued and unable to produce cortisol. The problem has to do with the signaling from the brain to the adrenal glands that gets disrupted.  This has led the conventional medical community to dismiss this concept of adrenal fatigue caused by long term stress, first described by Dr. James Wilson in his book Adrenal Fatigue. Allopathic medicine tends to see Addison’s Disease if you don’t make any cortisol and Cushing’s Disease if you make excessive levels of cortisol and nothing in between, but this is not true and this dysfunctional stress response is what those of us in the Functional Medicine community are helping patients deal with.

13:11  Salivary cortisol testing. To test for adrenal function, serum testing is not very helpful. This is why salivary testing for cortisol that can be done at various parts of the day is much more accurate and helpful.  The comprehensive DUTCH complete test includes not only cortisol testing at various parts of the day, but it also looks at the sex hormones, since if a guy has low testosterone, that can cause fatigue. And this test also looks at a marker for B12, and a B12 deficiency will cause fatigue. 




Mark Newman, MS is a recognized expert and international speaker in the field of hormone testing. Mark spent nearly 25 years developing and directing urine, blood, and saliva-based hormone testing along with other biomarkers like organic acids. His unique experience led him to pursue a revolutionary way to test hormones; so Mark began his own lab, Precision Analytical Inc., to create the latest innovation in hormone testing, the DUTCH Test® (a Dried Urine Test for Comprehensive Hormones).  The website is DUTCHtest.com. 

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


Podcast Transcript

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

Hello, Rational Wellness Podcasters. Today, I’m excited that we’re going to have an interview with Mark Newman about cortisol and hypothalamic-pituitary-adrenal axis. I know that’s a mouthful of words, but we’re going to put some meaning to that and explain it a bit better once we get started. Mark Newman, Masters of Science, is a recognized expert and international speaker in the field of hormone testing. Mark spent 25 years developing and directing urine, blood, and saliva-based hormone testing, along with other biomarkers like organic acids.

His unique experience led him to pursue a new revolutionary way to test hormones, so Mark began his lab, Precision Analytical, which offers the Dutch Tests, which stands for Dried Urine Testing for Comprehensive Hormones. In order to develop the most accurate evidence-based testing practices, Mark has written multiple peer-reviewed research papers highlighting the accuracy and clinical utility of dried urine hormone testing. Mark’s primary educational goal is to find and communicate truths about hormone replacement therapy monitoring to help providers care for their patients. He understands why each form of testing has its own strengths and weaknesses, which is why he encourages clinicians to follow the evidence, even when lab testing isn’t clinically helpful. Thank you so much for joining us, Mark.

Mark:                    Thanks for having me. Good to be here.

Dr. Weitz:            Great. So to set up the discussion for listeners who are not really familiar with what the adrenal glands are and do and what would be the point of testing for cortisol as a measure of adrenal function, perhaps you can give us a little information about that.

Mark:                    Sure. My area of expertise is really limited to reproductive and adrenal hormones, and when we focus in on the adrenal hormones, a lot of what we’re talking about is just your stress response. You’ve got stuff that goes on in your brain, CRH getting released from the hypothalamus, which goes to the pituitary, which we’re still in the brain there, which releases ACTH. And ACTH, is that stimulating hormone that cruises around in your blood, and when it finds most tissues, they don’t care. But when it finds your adrenal gland, it stimulates the release of among other things, cortisol. So it’s also involved in aldosterone and DHEA, and your catecholamines like adrenaline. But that’s a big part of the story is getting cortisol to do what it’s supposed to do, which is you want to make a whole bunch of it, but not too much in the morning, and then it comes down fairly rapidly. So you get this up and down, up and down pattern from day to day if things are functioning properly, and-

Dr. Weitz:            So, let me just stop you for a second. So what you’re saying is, is that this cortisol secretion is a really important component of our normal circadian rhythms, our wake/sleep cycle, along with say melatonin?

Mark:                    Yeah, so yin and yang for cortisol and melatonin. So, we want to make melatonin when it’s dark and we want to make cortisol when it’s light. And it’s literally the light is involved in when the light hits the back of your eye, that is the signal. And it’s a pretty amazingly complex system that I’m still learning about where you’ve got ACTH that stimulates the adrenal gland, but ACTH starts going up before you wake up.

Dr. Weitz:            So what is ACTH?

Mark:                   ACTH is the stimulating hormone that I’d have to spell it out to actually get the name exactly right.

Dr. Weitz:            Okay.

Mark:                   It’s the hormone that your brain makes that is the signal to the adrenal gland that it is time to make cortisol. So when you get stressed you make ACTH, and that helps you make cortisol. And when you wake up in the morning, waking up is actually the same biochemistry goes on when you wake up as when you get stressed. So essentially, like awakening and arousal for the day is your first stress event of the day so that your brain starts making ACTH. It’s this really fascinating biochemistry where the brain is making the ACTH, so you say, “Well, make cortisol.” Well, not yet. There’s this sort of braking mechanism that the body has to wear the ACTH builds up. And as soon as the light hits the back of your eye, it sort of releases the brake, and boom, you make a whole bunch of cortisol right when you wake up so that you’re moving from being awake to being alert. And light, actually, is the mechanism or the trigger that sends that on its way.

And that’s a lot of what we do is measuring cortisol at those different time points to say, “Hey, is this functioning the way that it’s supposed to?” And if it’s overfunctioning and you’re making too much, you’re going to have issues. And if it’s not functioning enough, which we’re starting to see a lot of, interesting little fact that I just learned from reading some papers on COVID is that the antibodies for COVID can recognize ACTH and sort of steal that from you, which can become part of this issue of not making enough cortisol as you’re recovering from COVID. So it’s pretty relevant to our lives every day and-

Dr. Weitz:            Well, hold it. Explain that quickly.

Mark:                    So the antibodies for the COVID virus can actually reduce your ACTH. So your brain says, “Time to make cortisol.” ACTH gets released. It’ll have to find its way to the adrenal gland. And this hasn’t actually been proven yet. It’s been shown with the other SARS. So, SARS-CoV-2 is COVID. With the other SARS viruses, we know that those antibodies actually recognize ACTH, and they can sort of steal that away from your cortisol production biochemistry.

Dr. Weitz:            So this is like a cross-reactivity phenomenon.

Mark:                    Yeah. Right. Right. And so one of the things that we see sometimes in COVID cases where they’re recovering and struggling to do so is a lack of cortisol production. And part of that story, which it’s early for COVID, right? There’s still research going on all over the place to try to figure out exactly why do some people become long haulers? Why do some people not? But part of that story can be a lack of cortisol production. And part of that story, is this interesting interaction between the antibodies from a SARS virus, and how much ACTH you have to stimulate cortisol production, so-

Dr. Weitz:            Interesting. So this could account for the fatigue and maybe the brain fog and some of the other symptoms related to long COVID symptoms?

Mark:                    Yeah. And it’s I don’t want to overstate that because it is a complex story that is still being told, and it’s they have to piece it together. Some of it’s old research from other SARS viruses, and some of it’s more specific to COVID, where we do see a fraction of those people even up to a year later are still struggling to make cortisol, and the why of that probably has something to do with that, but that’s still being kind of worked out by people who are knee-deep in COVID data.

Dr. Weitz:            So, but that might indicate that part of a workup for a patient with long COVID would be to do cortisol stress testing as offered by Precision Analytical or other labs.

Mark:                    Yeah, I just went back through a handful, couple dozen patients now that we’re getting beyond COVID for people by number of months, and just looked at people eight months out and 12 months out, and then looking at what the literature is saying. And yeah, there’s a subset of those people that’s pretty sizable, that struggle to regain their normal stress response, their normal cortisol production. So if you have people struggling with COVID, it’s not that well defined yet what the causal factors there are, and goodness knows it’s probably more than one thing, but not making cortisol as they used to.

Dr. Weitz:            Supporting the adrenal glands. Yes, supporting the adrenal glands could be an important component in helping people recover faster.

Mark:                    Well, yeah, and I think that’s as we were talking about before, I think the language that we use it depends if we want to speak very generally for the sake of our patient to make it simple, but when we’re studying it from a scientific standpoint it’s brain signaling is probably the bigger factor than… And that’s been this long going sort of, I don’t know if it’s a debate, but in our industry that we’re both in is that there’s this catchy phrase, adrenal fatigue, that really well describes what patients feel, which is that they don’t have enough of the hormone that their adrenal gland makes. And for years, our industry, I think without discriminating very well, used the phrase adrenal fatigue, but as we’ve really gotten into the biochemistry and figured out, “Okay, adrenal fatigue tells me a story about a gland that’s on top of my kidney that is really tired of making cortisol and it cannot.”  And when you really get in and look at it, what’s going on in most of those cases is that their adrenal gland works just fine, but it’s that brain chemistry that gets messed with in terms of your negative feedback and all of that, that is typically sort of at fault when the stress response gets screwed up is that it’s more of a brain issue and less of a… Adrenal gland is a little bit more like your knee when you hit the patella tendon there, it responds. And usually when you hit the adrenal gland with ACTH, which is its go signal, it goes. Making that cortisol…

Dr. Weitz:            But I think that concept maybe comes from diabetes and the pancreas and constant consumption of sugar and other things that stimulate the pancreas to produce insulin. Over time, the pancreas gets burned out, the cells can’t produce it, and then at some point, diabetics end up needing injections of insulin. And I think that concept has been applied to the adrenal glands.

Mark:                    Yeah. And I think not rightly so. I mean, it’s a reasonable theory, but I think when people went in and really looked at the biochemistry, it’s not actually what’s going on. The challenge is in on the scientific side you start talking about things like allostatic load, and all of these, resilience and some of these words that, let’s be honest, they’re just not as interesting to Google in terms of like being sticky. And that phrase, adrenal fatigue, it was sticky.  And Dr. Wilson, who’s a good friend of mine wrote the book on adrenal fatigue, and it really got the concept that if your cortisol is low because of long term stress, that’s an issue and we should deal with it, right? Because allopathic medicine tends to say, “Listen, you have Addison’s disease if you don’t make any cortisol. You have Cushing’s disease if you’re making gargantuan levels of cortisol that never come down. And everyone in between, you’re fine, have a nice day.” Right? Which is that’s why you’re in business, right? Because it’s not true. And so-

Dr. Weitz:            Oh, yeah. Absolutely.

Mark:                    …dysfunction in the cortisol space outside of disease is an issue. And the phrase, adrenal fatigue, brought that to the forefront. The problem is when you want to go and have credibility with what you’re doing to allopathic peers, and just generally, right? We want to be right. The phrase is actually it’s not correct in terms of what’s going on. And it does matter because when you look at Dr. Wilson’s work, who I have a lot of respect for, one of just the random things you’ll find is that the adrenal gland needs a lot of vitamin C.  So part of the solution for adrenal fatigue is a lot of vitamin C.  And I’m not saying you do or don’t need a lot of vitamin C, but if you’re fixing the wrong problem, you’re probably not going to have a lot of success.  And when you really look at the biochemistry, the stress response and the things that go on in your brain that help regulate that, that is where your dysfunction lies in most people who have a cortisol issue. And if we’re going to fix that problem… And fixing the problem is not my expertise. When you start talking about adaptogens and things, hopefully we’re starting with lifestyle, but fixing a problem, I’m more on the analytical side of how do we well-define this problem? And that’s why we developed our testing, is to say, “Listen, this is a complex problem. And if we want to well-define the patient’s dysfunction, we need more data than just…” And then that depends on how you fill in that blank. If you go all the way back to a serum test, I mean, serum works really well for a lot of hormones. It’s the default, right? But for cortisol, it’s not a great tool.

Dr. Weitz:            Right. Which is why we’ve been using salivary cortisol testing.

Mark:                   Right.  And a lot of traditional doctors will just sort of shrug and be like, “Well…”  Actually I spent last week at NAMS, which is a very conventional group, and we were talking to them about some of our research as it relates to hormone replacement.  But when you talk to those types of people about cortisol, it’s just like, “You know what, I look at the patient, I see what’s wrong with them.  I know what’s going on.”  And I’ll tell you what, when you do that and then you start testing, and you see how often that story that’s going on with their stress response does or doesn’t match up, there you can guess wrong a lot because there’s such an overlap, right?  That’s why we’re in the game of comprehensive testing with what we do is if you take something like fatigue.  Well, we have a number of stories that intersect with that, right? As a guy, if your testosterone is low, that’s going to be an issue. We’ve got a B12 marker on our DUTCH Complete and our DUTCH Plus. If you have an overt B12 deficiency, you’re going to have some fatigue. And but also, if your cortisol is low, you’re going to have fatigue, and certainly if you have a combination of those things. But we want a well-define what’s going on with that patient. And with cortisol, you really can’t do that with blood testing. The best example I always give people is that if you look at the studies where people are healthy, like a woman’s healthy and then she gets on birth control. The cortisol and serum will double as women get on birth control without anything happening to their stress response, because the birth control happens to stimulate the binding protein that gobbles up cortisol. Your body responds by making more cortisol. But the free cortisol that’s able to do something, those levels just hang out in the same level.

So when you’re looking at urine-free cortisol like with our DUTCH Complete, or salivary cortisol like with our DUTCH Plus, those things don’t change unless your stress response changes, unless your cortisol truly changes. But the serum cortisol, you can double it, again, just by putting a woman on birth control and then letting things resettle. So stress will double your cortisol, and that doubles your cortisol, but it’s not a meaningful change, right? Then what we’re looking for, the words I like to use with lab testing is we’re looking for meaningful differentiation. And serum does not meaningfully differentiate people with cortisol dysfunction and people without. And then beyond that, we want to look at the up and down patterns-

Dr. Weitz:            Because you’re seeing total cortisol levels versus free cortisol levels, correct?

Mark:                   Right. And when you look at things like estradiol, progesterone, testosterone, it’s not as important of a distinction. But when you look at cortisol, that up and down pattern of free cortisol is so much more differentiating between function and dysfunction. And so, for us, we look at that up and down pattern. So we can look at that in urine, and we can look at that in saliva. The reason that saliva is the king of cortisol when it comes to free cortisol is that you can measure the cortisol awakening response, which is something we all ignored until I don’t know, six or seven years ago, when the data just became overwhelming that that is another variable that’s important for us to look at, which is that rise you see in the early morning. And you can really only see that from looking at saliva.


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

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



Dr. Weitz:            What you’re talking about is for a number of years, the way we would measure the salivary cortisol is we would measure it in the morning, noon, afternoon and evening. And was not necessarily right when they got up, it was sometime in the morning. And then the cortisol awakening response is that response that occurs in the first 30 minutes after waking up, right?

Mark:                   Right. I’ve got an interesting… For those of you that are actually viewing maybe I’ll show you this here. Let me share it.

Dr. Weitz:            Mark’s going to show us a slide to illustrate this, the cortisol when you’re waking.

Mark:                   We did a really neat test on this with our assistant medical director, bless her heart. So when we look at… So I’m showing you now the data we published that shows that the up and down pattern in urine from our dried urine samples and from saliva are statistically very similar. The up and down pattern that you see. But when you look at urine, the first two samples that we measure, that’s not a cortisol awakening response, because cortisol awakening response is right when you wake up and 30 minutes later. And right when you wake up in saliva is right when you wake up, but right when you wake up in urine is of course what you’ve been collecting all night.  So it’s an interesting measurement. It’s a good measurement, but it doesn’t help you with the CAR. So the CAR is saliva right when you wake up, right? And then 30 minutes later. So let me show you. This is called a mini-stress test a lot of times. So, what you’d like to have in your office is a bear, right? You could test your patients’ cortisol and then let the bear chase them, and then you could test them 30 minutes later and you’d know their response to a stress, right? But that obviously doesn’t work very well. So here’s what we did is my-

Dr. Weitz:            Yeah, it turns out that feeding the bear is very expensive, and you got security issues.

Mark:                   That’s the whole reason why we don’t do that, right? Is that’s too expensive. So, but this is the thing, waking and a stress response are the same biochemistry. So what I had Dr. Rice do is we went to the IFM Conference, and they have this slide where I’m showing a picture of it here, where you stand and the floor drops out from under you, right? And so if you don’t like heights, it’s sort of an unpleasant experience.  So I had her do a cortisol panel throughout the day. So what I’m showing now is when she woke up, her cortisol went up by about five, and then it comes back down. So then on this alternate day, in the middle of the afternoon when her cortisol has already gone down, she collected a saliva sample, she bravely got up on the death-defying water slide apparatus, and down the slide she went. And then she collected another saliva, and then another one a half an hour after that, and so on and so forth. What you can see is that the response to stress for her, it doesn’t always work out exactly this well. But her response to stress was five, and her response to waking was five.

So basically, when we freaked her out, her stress response kicked in, and that’s just not a practical test to do, right? But that’s the whole magic, if you will, of the cortisol awakening response is testing within five minutes of waking, catches you before you rise. And then catching you at 30 minutes says how dynamic is that stress response? And the word resiliency is used a lot when we talk about this is… And I’ll stop sharing my screen. I just wanted to show you that. I thought it was kind of fun data.

Dr. Weitz:            By the way, can I just ask a quick question?

Mark:                   Yeah.

Dr. Weitz:            The question has come up from patients doing this test, “I hit the snooze on my alarm. So I rolled over, I hit the snooze, and then I went back to bed. Does that mess it all up?”

Mark:                   I think it’s important that your waking time is normal-ish, because you got to remember, your cortisol starts to go up around 2:00 or 3:00 AM, right? So if for example, you wake up at 3:30, and you normally wake up at 7:00, then your CAR can be exaggerated because it’s got to makeup that ground a little bit, right? So you want to wake up at a normal time, but it really is the light that is the trigger for the cortisol awakening response. So you can get away with that. It’s probably better to just get up and do it, but what happens is the light hits the back of your eye, the change is rather instantaneous, but it takes five minutes for that change to find its way into your saliva. So you’ve got this five minute window.

So what’s best to do is I mean, if you can spend some money and get the test, I’d get your butt out of bed and get the light on, get your sample collected within five minutes, and then get the other one right around half an hour. And that’s going to give you some really good data. And I think you don’t have to do it perfectly, but the more you screw around with the collection, then the more sort of ambiguity can come into those results. So we do want it to be as precise as we can, but it is the light. So that would be why you also wouldn’t want to collect your sample, and then sit up in bed in the darkness and then wait half an hour. You want to get up and be active and get up and see what happens to my chemistry as I move again, from awake to alertness? That’s that whole point of that going on in our chemistry is to get us ready for the day.

Dr. Weitz:            And we should point out that the way your company tests the saliva is beneficial because other labs you have to spit into this tube, and sometimes when you first get up in the morning that alone can be a stressful event.

Mark:                   Well, it’s honestly it’s people asking too much of what you’re trying to do. So here’s the challenge is we test all the sex hormones in urine because I think they’re more accurate that way. We’ve published data that shows the serum correlation is really nice with estrogen and progesterone, et cetera, right? The challenge is if we use cotton swabs for cortisol because you can get a collection easily within two minutes.

Dr. Weitz:            So, in other words for those who don’t know, you just put this cotton swab in your mouth, get it wet, and then you stick it in a tube?

Mark:                   Yeah, you chew on it lightly a little bit. When I do it it takes me about 60 seconds, but it would never take you more than two minutes, right?

Dr. Weitz:            As opposed to spitting, because spitting can be-

Mark:                   Right. The challenge is if I want cortisol, and I want my sex hormones out of saliva, I have to give you a whole bunch. The problem is those cotton swabs absorb progesterone. So if you try to have a test that does cortisol and progesterone at the same time, you cannot use the cotton swabs. And as soon as you can’t use the cotton swab, then I have to ask you for two to three milliliters of saliva before you’ve even had any water to drink. And it just becomes a little bit of a nightmare, because if it takes you 15 minutes, guess what? Those second five and third chunk of five minutes, your cortisol has already doubled, right? Potentially. So you’ve just sort of screwed up the mechanism of how it works.  So it’s better to get the cortisol out of saliva. And then for us, we get all the sex hormones and their metabolites out of urine, where it’s a lot easier to measure accurately. I mean, measuring that’s a whole nother story, but measuring estrogen in saliva is just not a very good idea because it’s hard to do analytically, and then you can’t look at the metabolites. So for us, we’re using saliva for the cortisol. And then in the urine we’re measuring sort of everything else. So if you want just a urine only test, you can do the cortisol in urine also, you just don’t get the CAR, but you get everything else.

But for us, the reason we want to use the urine is A, it’s better for sex hormones. But the other thing is getting back to the adrenal picture is… And this was actually what led to our entire company is realizing that measuring cortisol without looking at its metabolites can really lead you in the wrong direction a lot of times. So we’re measuring cortisol, which is free, active, the most important thing you can measure, but then we’re also measuring the metabolites, which is essentially like it’s the bucket that catches all the cortisol you make so that you know how much glandular output you have. Which at first glance sounds like, “Well, I already know cortisol because I have free cortisol,” but as we’ve looked at the research, and looked at so many cases, it adds a dimension of understanding that really is helpful in a lot of cases.

Dr. Weitz:            When I hear that only 5% of the cortisol that’s produced is free, meaning not bound to proteins like cortisol binding protein. Why would the body produce all this cortisol and only leave a small percentage of it to be active?

Mark:                   That’s an interesting question. Because 5% is probably the highest quote you’ll find.

Dr. Weitz:            Oh, okay.

Mark:                   Most of them are around one to 2%. And some will say as high as five. I mean, that’s on the high end. So you’re right, most of it is free. And then there’s the whole hormone cascade that comes after that. So it’s a complex system and it’s fascinatingly complex, but it makes it difficult because it’s sort of like we want easy two dimensional pictures, but it’s this three-dimensional thing where you’ve got this up and down pattern of free cortisol. But then if you say, “Okay, that tells me my stress response,” true. But then when you say, “That tells me how much cortisol I quote, produce,” that’s actually not true. Well, in some cases, it’s not true, right? You need the metabolites to tell that part of the story.

The place I found that first that was so interesting is in obese people. In obese people you’ve got this, essentially, this organ of fat or gland or whatever. It’s this whole thing. It’s a whole system, and it loves hormones. And so cortisol, as you make it is going to get sucked up by fat. And then it gets metabolized and ends up in a toilet and your adrenal gland’s like, “Oh, well, I guess I’ll make a little bit more.” And as you get into obesity, the difference there is massive. So you’re making literally, to keep your stress response and that salivary cortisol in the same place, a skinny person and an obese person will make three times, like three times more cortisol in an obese person to sort of keep up with that sequestering metabolism excretion. And that’s where the story gets kind of complicated, and you can go in a lot of different directions with that, but we want to tell that story well.

And so there are a number of factors that can impact how the cortisol is cleared. So thyroid is probably the biggest space where we see that, where… And I’ve got a nice example of a patient who had low free cortisol, and then high metabolites. But see, that doesn’t finish the conversation because you have to ask why? Because usually that’s because they’re obese. And you say, “Oh, that makes sense. You have your free cortisol just is what it is, and the metabolites are going to move as you gain weight, and so that’s interesting.” But in this case, the person wasn’t obese and you continue to ask questions and say, “Okay, well what else makes me get rid of my cortisol at a fast rate?” Well, hyperthyroidism. Well, this person’s hypothyroid. Well, okay, that doesn’t make sense.  And then you keep digging and realize, “Oh, hold on now. We have our blood testing that shows the thyroid results are high. So this patient’s being overdosed. Oh, okay.” Now you keep digging at the problem and you realize that hyperthyroidism makes your body just zip through cortisol. So you get this gargantuan amount of metabolites and low free cortisol, and this story starts to make sense. So before you go fix a cortisol problem, obviously, you don’t want a patient hyperthyroid on accident, right? So with this patient, they said, “Oh, well drop the dose.”

I had a friend who had that same exact scenario, and it turned out the doctor said, “Here’s your medicine, take it once a day.” And she heard, “Here’s your medicine, take it morning and tonight.” And so she was inducing hyperthyroidism just by not following instructions. And so once they tapered that dose back, the thyroid results came where they belong. And now there’s no longer this imbalance of essentially burning through your cortisol faster than you’re supposed to. And the free cortisol went from low to high. So it’s like all this cortisol she was trying to make that her body was just zipping through. And she actually had a stress response, a stress situation that was hyper, but because of this concurrent thyroid problem, it just created this really complex situation. And that’s kind of our mantra is that complex problems need comprehensive solutions.

And so for cortisol, we want to see the up and down pattern, yes, but we also want to see the metabolites because we really don’t know the full story until we see both of those things so that we know what’s your stress response? And then but also, what is your cortisol production? When they tell the same story, it’s boring. You got a guy who’s on fire, he’s inflamed, whatever. His free cortisol is high, his metabolites are high, and you say, “Yeah, well, the metabolites didn’t help anything, but to confirm,” right?  And I can look at another case where a person has low cortisol, low metabolites, all it’s doing is confirming. And in that sense, you have more confidence, but it hasn’t really told you anything new. But when those things tell opposite stories where free cortisol is low, metabolites are high, that’s interesting. When it’s the opposite, that was actually one of the early cases I found in the literature, is that when you look at cortisol and anorexia in the literature, you get opposite stories depending if you’re looking on a urine story or a saliva story, right?

So there’s a nice paper where they show that the metabolites of cortisol are half in an anorexic patient. You say, “Okay, half the metabolites means half the production.” And then there’s a paper published the next year that evidently didn’t read that paper that looked at salivary cortisol, and the saliva was the opposite. The saliva was elevated for cortisol in anorexic patients, which was a problem for them, right?  But there’s a paper clear back the year I was born in like 77, that says that anorexic patients don’t clear their cortisol very well because they end up with a thyroid problem. So you end up with this really complex situation where you have high free cortisol. So now you’re going to struggle with things like depression because of high cortisol. But if you tell yourself anorexic patients make too much cortisol, you’re wrong. What’s going on is they have sluggish clearance of cortisol because of a concurrent, likely a concurrent thyroid issue because of the anorexia, and so they don’t get rid of their cortisol very well to the degree that their free cortisol is high.

So if you want to go in and fix that problem, the first thing is understanding it well. If all you’re thinking is, “I’m making too much cortisol,” you’re barking up the wrong tree in terms of solving that problem. It’s just more complex than that. And we see those types of cases all the time where it’s just there’s a complex thing. And you’ve got to get as much information as you can before you start shooting bullets at your problem. You want to define it really well because you really can run confidently in the wrong direction so easily when you’re just basing it off of a simple serum cortisol or even when it’s just salivary cortisol. There’s a broader story there, and that’s what we’re all about is digging into those complex stories and trying to figure out as much as we can about them so that you go to the right solution for those patients.

Dr. Weitz:            I know that treatment’s you’re not a treating doctor and that’s not one of your specialties, but still to just think through some of the potential treatments that might be effective for patients with cortisol abnormalities or adrenal dysfunction. So, and I have two thoughts. One is even though the brain may be what’s not telling the adrenal glands to produce enough cortisol in the case of hypocortisolemia, it still might be beneficial to nutritionally support the adrenal gland to make more cortisol even if the problem is not that… Even if the problem is that it’s not getting the signal from the brain, because that may be easier than fixing the brain. I don’t know if we know yet exactly how to fix the brain, except maybe to work on the gut. And that may validate some of the treatment approaches that functional medicine doctors have done where they support the adrenal glands.

Mark:                   Right. Well, I mean I think, look, if you have an overt nutrient deficiency, the odds of success are probably low. So I think if you’ve got basic nutrient deficiencies, those are definitely worth fixing. And there is some good research on some of the adaptogens that people use working in the brain. Pregnenolone is a really interesting one because pregnenolone is this neurosteroid, right? And if you take it for HPA axis dysfunction, people have had success. But some people have had success with that for let’s see, how would you say this? Mistaken, it’s sort of lucky that they got it right kind of a thing, because part of this thing that goes along with adrenal fatigue in terms of this nomenclature that we use, is there’s also this concept of progesterone steal and pregnenolone steal. And if you-

Dr. Weitz:            For those who are not really familiar when you look at the whole cascade of the production of male and female hormones, at the top of the chart is pregnenolone, and it’s often considered the mother of all hormones.

Mark:                   Yeah, let me just pull that steroid pathway up. And then that way, if people want to stare at it, they can. Oh, shoot, I didn’t advance my slides here. Because this has led to a lot of confusion in our industry.

Dr. Weitz:            Yeah.

Mark:                   Let’s see. Are you seeing that there?

Dr. Weitz:            Yeah. Yep, steroid biochemistry.

Mark:                   Okay. Okay, so if you look at this, you’ve got cholesterol and then pregnenolone. And then downstream, you have progesterone. And then you take a right hand turn and then another right hand turn and you get cortisol, right? So, people will assume that then if you’re stressed, the cortisol is made from the circulating hormones that sit above that. And this, I’ll show this, but I’ll describe it for those of you that are just listening. So ACTH is made in the brain, right? It circulates, and then it find its way into the adrenal gland, into the cells in a particular location in the adrenal gland.  Then ACTH knocks the StAR hormone into cholesterol within the cell. Now cholesterol can go into the mitochondria inside the adrenal cortex cell. The cholesterol right there then gets turned into pregnenolone. That pregnenolone is your substrate. That goes outside the mitochondria and into the endoplasmic reticulum, and it gets turned into progesterone. That progesterone is your substrate for making cortisol. So now if you pause right here, and say, “Okay, I’ve taken ACTH. I’ve taken cholesterol into my mitochondria. I’ve made both pregnenolone and progesterone.” At this point, if you start taking supplements: progesterone, or you start ovulating, or you get pregnant… And do pregnant people make more cortisol because they have all this progesterone? No, because it isn’t in the adrenal cell.

So the steroid cascade is really helpful for us, but it also has been misleading for people because they see it as this sort of, “If I just get the precursor.” So for example, if you give a woman DHEA. Yeah, she’ll make a little testosterone out of it. And a guy? Yeah, he’ll make a little testosterone out of it. You will never rival testicular production of testosterone by shoveling precursors at men, because it’s the same thing. Cholesterol because of LH gets pulled into those cells within the testes, right? And in that little cell, they have the machinery to make testosterone out of cholesterol. You will never rival that by giving supplements of upstream hormones.

The same thing with cortisol is progesterone. And just to finish this animation if you’re watching it. Progesterone then turns into deoxycortisol. It’s so complex. It then goes back into the mitochondria. Turns into cortisol. Now I have cortisol which can leave my adrenal gland, right? And then it’s going to go out and circulate. So the point is when you look at the steroid cascade, and you look at what’s upstream, and we think, “Oh, that’s what I make it out of.” So if I steal cortisol because I’m stressed, my woman will no longer make progesterone. Yes, there’s a relationship between stress and reproduction, right? When you’re getting invaded by the northern invaders, it’s not time to make a baby, right? So your body is smart in that when you’re stressed you might stop ovulating, you might become anovulatory, you might not reproduce when you otherwise would. But it’s not this simple biochemistry mechanism of thinking that there’s a cortisol drain that gets opened, and all your pregnenolone and other hormones just filter into it.

So here’s what happened in our industry is people looked at that steroid cascade and said, “You’re stressed. Oh, my gosh, you don’t have enough cortisol, I’m going to give you pregnenolone, and it will go where your body needs it.” And that is not true. But what pregnenolone was doing, was going into the brain and acting as a neurosteroid and actually helping the HPA axis from a neurohormone standpoint and helping people in their cortisol dysfunction. So that’s why I say people succeeded by accident.  But we can’t stay there. We have to move forward in understanding why these things are working, which is why doctors will use things like ashwagandha, rhodiola, like some of these adaptogens that people package into supplements and sell them. I’m not telling you which ones you should buy, but there is good research that shows that those things can actually help modulate that stress response at a brain level. And that’s where our further advancement is, is understanding that chemistry and what’s going on. And in order to do that, my point being that concept of adrenal fatigue, and that concept of cortisol steal, or if you want to call it pregnenolone steal, or progesterone steal, people call it different things. But the idea that making one hormone is at the expense of another does not work the way that story was sort of originally told.  Now, it pushed us in a good direction, right? Because people need to explore this, but we have to follow the literature and follow the science to where it’s going, which is to a more I think full understanding of that. And again, our whole thing is the more of that data you’re looking at, the more of that picture you have visibility on, then you understand what’s going on a little bit better, and then your solutions you’re going to pick are going to be more likely to be the right ones.

Dr. Weitz:            Another follow up question on potential treatment strategies is when it comes to say male hormones, if I have a male patient, and his testosterone’s a bit lower, and maybe has some issues with libido, and his sex hormone binding globulin is high. We know that’s tying up some of his testosterone.

Mark:                   For sure.

Dr. Weitz:            And so there’re certain strategies we’ll use, herbal and otherwise, to try to lower the sex hormone binding globulin. And I wonder if there’s strategies to manipulate the cortisol binding globulins to free up free cortisol?

Mark:                   Well, we know some things that induce them, like birth control, right? If you take birth control you end up with a lot more binding proteins, which is the same binding protein I believe that binds progesterone. But I could not speak intelligently to how that works because I think when you look at the birth control literature, your body for cortisol adjusts to that pretty well. But it’s possible that in a subset of patients, that it sort of overwhelms their ability to continue to make cortisol, but I couldn’t speak to specifically how that could be done. But I do know there are good strategies with SBG that do impact your sex hormones. And birth control is another good example. I mean, one of the reasons birth control is… One minor reason that it’s effective is because it increases sex hormone binding globulin, and now girls no longer have their testosterone and they’re really not interested in making babies. So to manipulate that can definitely be part of your practice.

Dr. Weitz:            And that’s because testosterone plays a significant role in women’s sex drive?

Mark:                   Right, exactly. Exactly.

Dr. Weitz:            Interesting. Interesting. So, talk a little more about cortisol and thyroid and how they’re related. You talked about having higher levels of thyroid, either taking too much thyroid or having hyperthyroid increases the clearance of cortisol, right?

Mark:                   Yeah, there’s a direct relationship between… I can show you the data here. I’ll just do it that way. So you can see on the X-axis on that left graph is thyroid, like three to four, right? And on the Y-axis is cortisol metabolites. And the reason that I show you that is just to show you how strong that relationship can be, that thyroid essentially helps you get rid of cortisol. So when you have a picture of someone not getting rid of their cortisol, that’s something to think about. I mean, I think if you’re going to be comprehensive in someone’s hormones, you’re definitely going to want to look at a thyroid panel. And thyroid and cortisol, the adrenals, they talk to each other at multiple levels. TSH and cortisol and T3. There’s a lot of crosstalk between those. And one of those is that the thyroid helps cortisol to clear the way that it’s supposed to.  So you definitely want to look at those things in concert, which is why for our testing, it isn’t everything, right? This urine-saliva combo that we do is a lot of information on reproductive and adrenal hormones, but serum testing is still really necessary to get some of those staples of thyroid panels and blood chemistries, and all of those things, as well as things like as SHBG. So I think those don’t necessarily compete with each other, but complement each other really well. But it also points out the fact that if you want to know how the relationship between those is working, you need to see not just…  This is that case I was showing you where if you’re looking at your screens, fix the thyroid problem. Now, boom, the free cortisol bounced back like crazy. And for me, it’s not about teaching about thyroid and adrenals, and all of that, that would be someone else could speak more clearly to that. My point is if you want to define what’s going on in the patient really well, that you need to see this three-dimensional picture. Free cortisol all up and down, that’s two-dimensions. And the metabolites is this third dimension. And if you work without one of those dimensions, you can get it right some of the time, but it’s significantly easier to get the story wrong.

Dr. Weitz:            Right. So that metabolites cortisol that you collect through urine is essentially a way to tell the total cortisol levels?

Mark:                    Glandular output, yeah. And again, when it tells the same story as the free cortisol, you just move along because it confirms your story. And when it’s really different, then you slow your thinking and go, “Okay.” This is the functional medicine thing, right? You start asking why questions, like why would this pattern be in this patient? And you think about those things that are related. Some of the chronic fatigue literature shows a story of getting rid of your cortisol very rapidly, meaning you have higher levels of metabolites that says, “You’re actually making cortisol here, but your free cortisol that hits the brain and does what cortisol’s supposed to do is relatively low.” So in some of those cases, seeing that full picture can be really helpful.


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Dr. Weitz:            How does cortisol interact with melatonin which is a hormone that tends to get produced when it gets dark and helps us get ready for bedtime? And then I wonder if the hypothalamic-pituitary-adrenal-thyroid axis should be expanded to include the pineal gland as well?

Mark:                    Right. Right. Because those cortisol and melatonin are going to oppose each other. So in an ideal world, as soon as the lights go out, you make melatonin and it helps you sleep. And we know your gut makes a lot of melatonin as well. And then when you wake up, if your melatonin hangs and stays up when you’re supposed to be awake, you’re going to have issues and that does correlate with issues. But ideally, it’s going to drop down as you reach your waking time, and then cortisol is going to rise up. So you get this up and down natural rhythm between the two.

And that’s why for us… So for us, for melatonin what we do is we take the… This is why we collect four samples throughout the day. One, we can see that cortisol pattern if you want to get it out of urine, but I don’t really want to know your 24-hour melatonin, I want to know what you make at night. And so they did this nice little study where they measured people’s serum melatonin while they slept. They added all those numbers up, and then they collected a urine sample right when they woke up. And adding all of those up or just looking at a waking urine measurement of the melatonin metabolite correlates really nicely.

And it’s good to note that it’s completely useless when you’re on melatonin therapy, because you just get big stupid numbers in urine when you take melatonin orally. But to get a baseline value on asking the question, do you make sufficient amounts of melatonin? That’s included in our DUTCH panels, so that you can look at the big cortisol picture, melatonin, and all the other things that are related there. Again, the name of the game for us is comprehensiveness when it comes to those hormones.

Dr. Weitz:            I wonder if you have some insight as to normally when we think about hormones, if you take an exogenous hormone, if you take testosterone or any other hormone, your natural production will tend to decrease? And it’s often said that that doesn’t happen with melatonin. Is that really true?

Mark:                    That is definitely true for testosterone. So we have on our… Our panel’s got this kind of fun marker. Fun if you’re a hormone nerd like me, called epitestosterone, which is that so your testes make testosterone, and its, let’s call it its impotent twin epitestosterone. So they’re both up here, and then but your testosterone level’s lower, so your gonads aren’t making testosterone anymore. And then you go, “Okay, I’m going to take some testosterone.” So let’s say you take an injection, so testosterone is going to bounce up. And then you say, “Well, how much is that for my testosterone that I took? And how much am I making?” You don’t really know, right?

Well, this other cousin of testosterone is also made by the gonads, so it will drop to zero if you take an injection. So it’s a marker of endogenous gonadol androgen production. And so we measure both of those so that you can see… So for example, if you take a 50 milligram gel, testosterone will go up a little, and the epitestosterone will only go down a little. But if you take 200 milligrams or you take an injection that’s really big, you’ll see that complete suppression of LH from the brain, and then the testicles stop making testosterone. And of course, long term your testes will shrink up because they’re not doing anything.

With melatonin, it’s a more complex thing than that, and I’m not entirely sure, I don’t know how you’d ask the question of whether you still make a little melatonin when you take it. The question of whether long term production of melatonin is suppressed by exogenous melatonin is a really good question. I couldn’t speak to what the literature says about that. I’ve always had a little bit of hesitancy with my kids of if we’re traveling or something, giving them some melatonin, great idea. But because that’s that same pathway that makes serotonin and all of that, I’ve always been a little hesitant to give it to them long term because I don’t understand how that pathway continues to function in the presence of exogenous melatonin. It’s a very good question, but I wish I had a better answer, but I don’t know what the literature has to say about that.

Dr. Weitz:            Do we know anything about potential negative effects of high levels of melatonin?

Mark:                    Gosh, there are people who’ve studied that at a higher level than I have. And some people take doses that make my jaw drop.

Dr. Weitz:            I know one doctor, and he takes 50 milligrams every night, and he takes it for longevity purposes. There was one study that seemed to show some benefits. He says he feels great from it.

Mark:                    Yeah, I mean, I think the safety profile for melatonin is good, but I couldn’t speak specifically to if you’re taking two milligrams versus five, versus 50, that’s a boat load of melatonin. And especially in this COVID world, it’s got that… It’s a powerful antioxidant. And when you get that inflammatory response from COVID, I think there’s probably some use for it there. But I wouldn’t want to give medical advice to the masses on that because that’s a specific area of expertise, and it’s not mine, so I wouldn’t say too much about that.

Dr. Weitz:            Interesting. I was just wondering if that’s-

Mark:                    Yeah, it is. It is.

Dr. Weitz:            Yeah, great. So I think that’s the questions I had prepared. Great discussion. A lot of interesting information. Tell us about how practitioners or patients can access the Precision Analytical DUTCH Testing.

Mark:                    So you can go to dutchtest.com to get some information from us. We do encourage patients to work through providers. This stuff is complex, the solutions. We love lifestyle, but oftentimes, there might be some sort of pharmaceutical hormone-type intervention that requires a doctor’s help. But we definitely encourage people to get a doctor’s help in terms of understanding it. We have a Find a Provider on our website, but you can get a test as a patient through our website at dutchtest.com.

As a provider, if you go to our website and just sign up to become a provider, it takes a little while to really integrate this into your practice. So we always offer new providers to us up to five kits at half price. So you can take advantage of that as a new provider. What I always encourage providers to do is just get a couple of those, try it out. And then we have a team of 12 doctors on staff that can help you understand this because there is a… This sort of intellectual bridge to get over in terms of understanding not just the hormones, but their metabolites and how they interplay between those.

So we have a team of really good clinicians that use the testing themselves in their own personal practices that can help sort of mentor you to figure out where this fits in your practice. For me, I think it’s the best all around HRT monitoring tool. And we have some videos on our website that can speak to different scenarios. But because all tests have their advantages and their limitations, and we try to be really upfront with where DUTCH really works well, and where you might need other tools. And serum testing isn’t going anywhere, you’re still going to need that in your practice, but this can be a pretty powerful tool, particularly in those complex cases. So, if you just go to dutchtest.com there’s lots of information there about the testing.

Dr. Weitz:            Great. Thank you so much, Mark.

Mark:                    I appreciate your time.



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