Environmental Toxins with Dr. Joe Pizzorno: Rational Wellness Podcast 231

Dr. Joe Pizzorno speaks about the Environmental Toxins with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on October 28, 2021.

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Podcast Highlights

2:53  GGT (gamma-glutamyltransferase) is an inexpensive lab test that used to be run to monitor for hepatitis, but it is a good way to monitor for toxins. GGT is the enzyme that recycles glutathione, so our bodies will elevate GGT to recycle glutathione faster as a way to protect us against a toxic load.  The normal range is 10 to 50, depending upon the lab and for women the range should be a bit lower, and the average of the people they surveyed was 30, but a GGT of 30 carries with it an eight fold risk of diabetes. And one third of the US population has arsenic levels that are high enough to cause disease.

5:31  When Dr. Pizzorno was in private practice in the 1970s he did not see many patients with diabetes because it was not that prevalent. Now, diabetes is very prevalent and the primary cause is not sugar but toxins, though high fructose corn syrup might be a contributor. 

11:03  Unimportant molecules.  Dr. Pizzorno gave a lecture at the IFM annual meeting this year and his thesis was that we decided that food contained about 42 or 43 vitamins and minerals and everything else was unimportant.  But now we know that there are perhaps 50,000 phytonutrients that are actually very important, but when you grow foods chemically, you have less of these unimportant molecules, these phytonutrients.  Arsenic contributes to up to one third of all cancers and the consumption of floratin has decreased dramatically and floratin is a phytonutrient that helps protect the DNA from the arsenic damage that leads to cancer. 

14:09  The arsenic gets into the water both naturally and from industrial sources such as arsenic in treated wood and from arsenic compounds in pesticides and arsenic until recently was fed to the chickens both to kill parasites and to make the chickens plumper. 

16:33  Testing for heavy metals and metalloids like arsenic.  Serum testing is accurate but it doesn’t tell you what’s in the bones or stored in other tissues in the body. The best way to measure heavy metals that may be stored in the body are to do a chelation challenge by having the patient take 500 mg DMSA and 300 mg DMPS and then collect urine for 6 hours.

20:25  Rice.  Rice has been shown to contain arsenic and people who eat rice have twice as much arsenic as people who don’t.  You should wash the rice thoroughly to remove arsenic and if you cook it for a minute and then throw out the water and then resume cooking, you can get rid of the majority of the arsenic. 

21:13  Besides arsenic, the other most problematic heavy metals are lead, mercury, and cadmium.  Dr. Pizzorno stated that while chemical toxins are a problem as well, these four metals are causing the majority of the disease in the country.  Did you know that there is a correlation between your arsenic levels and getting shingles?  Half of the myocardial infarctions in the US are from arsenic and lead. 

25:03  The upper limit for GGT should be between 15 and 20.  Disease correlations start around 20.

28:09  To reduce arsenic levels, you want to reduce exposure. One way is to filter the water in your house.  A whole house filter is best. If not, then filter the water you use for drinking and cooking. There’s a filter called ZeroWater that gets rid of most of the arsenic. Reverse osmosis and ion exchange both work well.  Berkey water filters do not get rid of arsenic.

29:39  Arsenic toxicity is difficult to diagnose without testing, but one clinical sign is a brownish pigmentation on the palms of the hands. 

30:52  To reduce arsenic, you should rinse your rice thoroughly in water and you can also cook it for one minute, pour the water off, and then resume cooking, which works well. 

31:27  Competing Minerals, Fiber, and DMSA. Besides avoiding arsenic exposure, the best strategies for promoting detoxification of heavy metals like arsenic, mercury, cadmium, and lead include supporting methylation, taking competing minerals such as calcium for lead and selenium for mercury, oral chelators like DMSA which can be taken 250 mg every third day, and increasing fiber intake.  Taking 500 mg NAC will increase red blood cell glutathione by about 30%.  Patients who have trouble metabolizing sulfur may have trouble taking too large a dosage of NAC, though for most people taking 2000-3000 mg of NAC per day has been shown to be safe.  For those who have trouble with sulfur, it would be better to give liposomal glutathione.

37:59  There are also problems with environmental toxins other than metals and one of the most significant are the bisphenols. While bisphenol A (BPA) is being used a lot less frequently, bisphenol S, F, AF, and Z are being used in its place and bisphenol S is the most toxic of these and it can affect fertility among other affects.


Dr. Joe Pizzorno is a transformational leader in natural medicine, one of the founding members of the Functional Medicine movement, and the founding president of Bastyr University, which was the first accredited institution in the field of natural medicine.  He is a Naturopathic Doctor, researcher, and educator, who has written or co-authored more than 12 books including, The Encyclopedia of Natural Medicine, which has now sold over two million copies, and The Toxin Solution, and his textbook Clinical Environmental Medicine, his two newest books.  Here’s the website to learn more about his The Toxin Solution book: http://www.thetoxinsolution.com/  You can also learn more about Dr. Pizzorno from his website: http://drpizzorno.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, I’m Dr. Ben Weitz and thank you for joining our functional medicine discussion group meeting tonight. And we are very honored to be joined by Dr. Joe Pizzorno who’ll be speaking with us about environmental toxins. I hope you’ll consider joining some of our other upcoming meetings, including November 18th, with Dr. Peter Bongiorno on an integrative approach to depression and anxiety. I encourage everybody to participate in discussion by typing questions into the chat box, and if you are not aware, we have a closed Facebook page, the Functional Medicine Discussion Group of Santa Monica, so you should join so we can continue the conversation.

I am recording this event and I’ll post it on my YouTube page, include it in my weekly Rational Wellness Podcast. And if you have not listened to it, please check out the Rational Wellness Podcast and subscribe on Apple Podcasts. And if you enjoy listening to this, please go to Apple Podcasts and give me a ratings and review. And now I want to thank our sponsor for this evening, Integrative Therapeutics. And so Integrative Therapeutics is one of the few professional brands of supplements that we carry in our office, and they have a number of products that can be helpful in detoxifying toxins.

Dr. Joseph 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 I dare say, almost everybody who’s involved in the world of natural medicine has a copy of that book in their bookshelf. The Textbook of Natural Medicine, Natural Medicine for the Prevention and Treatment of Cancer, The Toxin Solution, Clinical Environmental Medicine, and his newest book written with his wife, Lara Pizzorno, Healthy Bones Healthy You. And now we’re honored to be joined by Dr. Pizzorno. Unfortunately, I didn’t record the first couple of minutes of the discussion so we’re going to jump right into this conversation with Dr. Joe Pizzorno.

Dr. Pizzorno:                      Think about the GGT, which is so interesting. It was one of the enzymes we used to be as a standard measure for hepatitis. Because when the liver gets damaged, it starts leaking liver enzymes and high liver enzymes lead to hepatitis of some sort. So we stopped doing GGT because it just wasn’t as good and not necessary.  But the technology is all there, it’s a cheap test. What’s interesting about it, when you think about clicking an enzyme into the blood, what’s that enzyme doing?  Well, that enzyme recycles glutathione, and so our smart bodies when we’re supposed to toxic load starts recycling glutathione faster as a way to protect ourselves from the toxic load.  So it’s a nice indirect measure.  So not only does it directly correlate with toxic load, it also directly correlates with many diseases, particularly diabetes but also risk of death.  So the normal range depending on the lab is 10 to 60 or 10 to 50, just in that range, and women tend to be a little lower than men.  Anyway, so anything in that range is considered okay.  So the average for this particular group of people was about 30. Now, you might say, “Well, that’s fine.” But a GGT of 30 carries with it an eight fold increased risk for diabetes.  So as you might expect, I found a lot of insulin resistance in this particular group of people.  By the way, they’re mainly supposedly healthy men aged about 30 to 50.  Most of them were in that group, but we have some office workers and some women. So not people expected to have a lot of disease.  So I’m trying to figure out, why they have these high GGTs.  And I started talking to them.  One of the things we did was not to give people the advice, but then they fly us out into the field to meet with them.  So had one to one interactions with the real people we’re working with, not just numbers from a laboratory.  So it was a really good experience.  So I learned that a big chunk of them were working in the oil fields as a way to subsidize the family farms which weren’t commercially viable anymore because of mega farming.  So what do you think they were doing on their farms to compete with the mega farmers?

Speaker 3:                         Herbicides and pesticides.

Dr. Pizzorno:                      All those herbicides and pesticides I heard?

Speaker 3:                         Yes.

Dr. Pizzorno:                     I had this group of people were clearly going the direction of diabetes because of all these herbicides and pesticides. So I said, “Well, that’s interesting.” About five years ago I started diving into the research, just looking at, well, what are the correlations with these various environmental toxins and incidence of disease? And the first one I looked at was diabetes, because… I see some more gray hairs in here like myself, but when I was in private practice, way back in the 70s, you didn’t see a diabetic patient.  So obviously, I’m a bright guy, I was fully booked all the time.  I didn’t see my first diabetic patient until I was in practice for six months of full-time practice.  They just weren’t that common.  And now 10% of people are diabetic and one third will become diabetic. What happened?  Well, we didn’t change our genetics, and you might say, “Well, how about people eat too much sugar.”  Yes, people eat too much sugar.  It’s no correlation between sugar consumption and the diabetes epidemic. Although maybe the high fructose corn syrup might contribute.  I’m looking at that as another environmental toxin I should consider. But what does correlate with diabetes is the level herbicides, the level of pesticides, the level of bisphenols, the levels of pthalates, and things like that. So then a group of Bastyr grads to help me answer the question, if we can determine how much a particular toxin is increasing risk of disease, we know what portion of that toxin is in the general population, can we figure out what percent of that disease is due to that toxin? And we did that.  And by way, we weren’t making it up. That’s the standard Public Health math we used for figuring that all out.  We did all the standard stuff, it’s all referenced and best as I could tell 90% of the diabetes epidemic was due to environmental toxins.  And that’s why the researchers call them diabetogens.

Dr. Weitz:                           Which were the most significant diabetogens?

Dr. Pizzorno:                      No big surprises here. PCBs, phthalates, arsenic.  Is everybody aware that one third of the US population has arsenic levels that are high enough to cause disease?  One third.

Dr. Weitz:                           Wow.

Dr. Pizzorno:                      And that’s the whole population. You can probably assume most people in your offices are going to have too much arsenic.  First off, the basic idea number one is, wow, we have an incredibly toxic environment and it is really poisoning people.  It is the primary cause of chronic disease right now.  Well, by way might be saying, “Wait a minute, we all know obese people have way more diabetes than non obese people.”  Very true.  Here’s the kicker, this work done by Becky Lee in South Korea.  If you look at the amount of environmental diabetogens in their fat stores, and then you compare them to diabetes, it turns out those obese people with low levels obesogens don’t have an increased risk for diabetes.  It’s not the fat, it’s what’s in the fat that’s causing trouble.  Some people even hypothesized that some people are unconsciously overweight as a way of diluting these environmental toxins.  Because not all they calling them diabetogens, they’re calling them obesogens.  So for example, as a backdrop correlation between Bisphenol A levels and a person’s body waste, both men and women. Its just stuff everybody knows, or is it interesting? I need feedback.

Speaker 4:                          I’m very interested.

Speaker 3:                          Yeah, we’re just listening to you, so we’re enjoying it.

Dr. Weitz:                           By the way, I don’t know if this is appropriate time, but what’s the best way to test for heavy metals like arsenic?

Dr. Pizzorno:                      Okay, so let me talk about arsenic for a second and I’ll answer that question at the end, and give you an inducement for following me for a few seconds. Okay, so-

Dr. Weitz:                           We’ll follow you as long as you want to speak to us.

Dr. Pizzorno:                      Thanks.  Anyway, so one of the things I was wondering about is, everybody’s getting really excited about lead toxicity.  They did that quite some time ago and the good news is, we’ve decreased the body load of lead.  So congratulations to us, but nobody’s paying attention to arsenic.  And turns out, looks like arsenic is actually worse than lead.  So I’m working on a project right now in Flint, Michigan, where I wanted to bring natural medicine to an underserved population.  I was tired of all the politics and so, I don’t know about the politics, what I do know is how to help people be healthy.  And there’s a group of people that everybody knows about needs help because there’s a lead problem I said, “Let me go and see if I can help out.”  So here’s what’s really fascinating.  They have a bigger arsenic problem than they have lead problem, and nobody knows it.

So we got a sample from the state of the actual measurements of the drinking water people are drinking, 43% of them were above 10 micrograms of arsenic per liter of water. That’s the standard threshold, is 10. And by the way, I’m giving a lecture tomorrow on the latest research on arsenic for AIHM, that’s Academy of Integrated Health Medicines can start tomorrow, but you haven’t done it so you just consider it, and the lecture tomorrow on the latest arsenic research. I’m going to be making a really strong case that it has to be seven. But just using 10 as a cut off, 43% we’re above that cut off. So I was wondering, if there’s so much arsenic and 35% of the US population is about 10 micrograms per liter of urine, which is the arsenic cutoff, if it’s that much, why aren’t people paying more attention to it? So I’m curious, did any of you hear my lecture on unimportant molecules at this year’s IFM? I’m just curious if anybody heard that lecture.

Speaker 3:                          No.

Dr. Pizzorno:                      Okay. I’m not hearing anybody who heard it.

Dr. Weitz:                           I did.

Dr. Pizzorno:                      Let me tell you what my thesis was. So my thesis was that the research we did a hundred years ago to determine what nutrients were necessary for health, was limited to the research techniques and technology that was available at the time, and our understanding of physiology and of medicine. So we pretty much had to do primarily animal studies and we had to look at what made them die or live or not suffer some really severe disease, and to figure out these vitamins and minerals necessary for health, amino acids and fats and things like that.  Add them all together it’s about 43 molecules or 42 molecules.  Somebody correct my math on that one, I’ll go with 42 for now.  Okay, yeah and sometimes there’s obligate needs and add two, or three, or four, maybe even five, but it’s a small number. The next question is then, well, have you ever thought, how many molecules are there in food? We started looking at how many molecules in food, and it looks like around 50,000. So we decided that 0.1% of the food supply was important and everything else was unimportant.

Now, guess what happens when you grow foods chemically.  Now they call it conventional growing, let’s call it what it is, it’s chemically growing foods.  When you grow foods chemically, you can manage to almost maintain the vitamins and known minerals but when you then look at those other molecules, they’re either dramatically lower or they’re gone.  So I think, well, that’s interesting.  So one of the fun things about being associated with Bastyr is I sometimes get students say, “Hey, Dr. Pizzorno, can I work with you on something?”  So I said, “Yeah, I’ve got this idea.”  So I’m wondering, it looks like we’re seeing more arsenic toxicity now than we did in the past, and I’m also noticing that we have less flavonoids in the diet than we had in the past.  Would you look and see if there’s any use of flavonoids in protectants from arsenic?  And guess what, she did.  So it’s a situation, not only are we adding toxins to the environment, we’re removing many of our protective mechanisms without realizing.  So for example, I’ve got the study that shows one quarter or one third of all cancers are due to… Is or are, whichever, arsenic.  It turns out, the more arsenic a person has, the more cancer they have.  One quarter to one third of the major cancers that kill people are arsenic.  And guess what?  One of the flavonoids called floratin does, it helps protect the DNA from the arsenic damage that leads to cancer.  And if you look at the dietary consumption of that, it’s decreased dramatically.  The same thing with tomatoes where they grew tomatoes chemically, and they grow tomatoes organically, and organic tomatoes had 10 times as much of the floratin than the chemically grown tomatoes. They had just enough of the flavonoids to keep enough of their color, people recognize they were ripe food enough of the taste, but all the other stuff is gone. Okay, so that’s my thesis for today.

Dr. Weitz:                           So now, where’s the arsenic? Where’s it coming from? How’s it getting into the water?

Dr. Pizzorno:                      So there are two primary sources.  There was a third in the past, but they since have stopped.  Number one is, it naturally occurs in many water supplies.  So it turns out we humans are actually pretty good to get rid of arsenic. Half-life of arsenic in the body is only two to four days.  So as we evolved as a species, we came across arsenic and we’re good getting rid of it.. The problem is, we’re sitting one place and that one place has arsenic in the water, guess what? Now you overload the systems, now you start seeing all this disease pop up. So traditionally, the water supply is primary, but there’s two problems that have also happened. Number one is, we have had a fair amount of industrial exposure, and that to some degree continues to happen but it’s been decreased, but we have intentionally put arsenic compounds throughout our environment. So remember those old wooden climbing toys? They use arsenic compounds to keep them from rotting.  Remember that gypsy moth problem, when they’re spraying the environment, guess what they’re spraying the environment with?  It was an arsenical compound.  So we have intentionally put in a lot of our arsenical compounds into the environment.  So the environment is really quite contaminated.

Dr. Weitz:                           Right. And they used to feed it to chickens as well, right?

Dr. Pizzorno:                      They used to feed it to chickens. And actually I was just looking at some research on that, and it does looks like the arsenic levels of chicken have gone down. Now they’re not gone, but from…, and I’m not going at the farmers as they say, I saw one study say it was 50% lower now than it was 2015.

Dr. Weitz:                           Now why would they feed arsenic to chickens?

Dr. Pizzorno:                      Maybe have a farmer here who can tell us more about it. But my understanding is they give it to them to kill off the parasites and also makes them plumper?

Speaker 5:                          How is bottled water?

Dr. Pizzorno:                      I don’t have any information on that. Can’t answer that. So what do people think about my idea?  I mean it looks to me like we’re having so much disease.  I mean, realize we have the highest burden of chronic disease in every age group ever in human history, looks to me like it’s not just the environmental toxins. We’ve removed a bunch of protective mechanisms, which make these environmental toxins even more important, because when use natural medicines, if their systems are already poisoned, it’s hard for natural medicines to work. I’m sorry, I’ll stop talking. What people think?

Dr. Weitz:                           What it’s the best way to test for heavy metals like arsenic?

Dr. Pizzorno:                      So arsenic is not a heavy metal, it’s technically called a metalloid. With that, all you need to do is get… The standard the first morning urine, but they have to be in the normal environment. So you can’t have, for example I live in Seattle, you can’t have somebody who’s working on a farm in Eastern Washington where there’s arsenic contamination, decides to come to the big city to see this naturopathic doctor, and while he’s here they go for a movie and go for dinner, et cetera, et cetera, by the time he sees me, he’s been here for two or three days. Well, most of the arsenic’s gone.  So it’s got to be in the real environment. You use toenail arsenic, it’s a little trickier, that’s all.

Dr. Weitz:                           So what do you think about serum testing for metals?

Dr. Pizzorno:                      So the current standard accepted by conventional medicine is that blood and urine are accurate measures for heavy metal testing. And they are accurate for acute testing and I don’t think anybody disagrees with that. Where this community disagrees is yeah, that’s great tell us what’s in the blood, but it doesn’t tell us necessarily what’s in the bones, what’s in the deep tissue. So and everybody knows that for example, there’s way more lead in the bone than in the blood. And the kidneys are really good at getting rid of cadmium, but they can’t take cadmium out of blood, it just sticks right there in the kidneys at times higher. Half-life of cadmium in the blood is a couple of days, half-life cadmium in the kidneys is like 16 years.

Dr. Weitz:                           So is urine a better way to capture?

Dr. Pizzorno:                      There’s a better way of doing this with challenge testing. So you get people a chelating agent and collect the urine for several hours and see what happens. And just to be clear, it’s more accurate, but it has plenty of error in it. I actually did a study where I actually counted the number fillings in people’s mouths, measured the blood levels of mercury, measured urinary levels of mercury, game challenge testing and to see which correlate best. Because you expect the best test would be the one that correlated with the amount of mercury in their mouth the best. And what I’ll tell you is that the only one that correlated very well was the challenge testing. But the R value is 0.35. So it wasn’t very good, but was better than the blood or the unchallenged urine.

Dr. Weitz:                            So we used to do that DMSA and then collect six hour urine, but of course DMSA now is a prescription.

Dr. Pizzorno:                      That’s what I’ve done. I’ve done that in thousands of people. Again, 500 milligrams of DMSA and 300 milligrams of DMPS orally. Now the first one urine tells you the current exposure, given that this cocktail and they collect urine for six hours and determine what the body load is. And I found it’s worked for me really well over the years, and it’s directly correlates with clinical outcomes as well. Doesn’t mean it’s a great test. It doesn’t mean it’s perfect, just the best that seems to be available right now.

Dr. Weitz:                            But given the difficulty with getting DMSA, especially since those of us who are not medical doctors can’t write prescriptions, so what’s the second best alternative and then also-

Dr. Pizzorno:                      Just do the first morning urine, but just recognize you want to make your standards a little lower. Remember the standards not that lead anymore, I don’t know about the other ones exactly but the way the lead standard was set was the 95% rule. And that was, if you’re within 95% of the population, your level’s fine, if you’re the top 5% it’s toxic. You know what that level was when they said it, it was 60. So as research became available the number went from 60, to 50, to 40, to 30, and now it’s 10 and it’s down to five for children and they’re considering making it down to five for adults. So there’s no safe level of lead. So just cut your level levels down.

Dr. Weitz:                           Right. 

Dr. Pizzorno:                      Ben, you keep asking great questions, but please give other people a chance to talk. I want to hear what people think about what I’m saying.

Dr. Wasserman:                 What about rice, doctor? A lot of the world consumes a lot of rice and with the brown rice versus the whole around it causing with the arsenic ingestion.

Dr. Pizzorno:                      Yeah. So if you look at the research on rice consumption, people consume rice, have about twice as much arsenic to people who don’t. Now the good news is that if you wash it properly, there’s techniques, you can look for on the internet. If you wash it, you can actually get rid of… You just cook for like a minute and then throw out the water and start cooking again, you can get rid of the majority of the arsenic that way. So there’s techniques available on the internet.

Dr. Wasserman:                  Thank you.

Speaker 3:                           Good one, thank you.

Speaker 4:                           There’s a lot of arsenic in the water in Sedona, Arizona we discovered, so we put a whole house water filter on our second house there.

Speaker 3:                           Smart, very smart.

Speaker 5:                           Besides arsenic what’s the next one, two or three minerals or metalloids that are dangerous?

Dr. Pizzorno:                      So you catch me at a good time because just before this lecture, this talk, I was finishing my lecture for Australia, where my lecture this year for them is going to be four worst metal toxins. So if you look at the EPA, they have a center there that looks at what are the worst toxins in the country and they’ll list them in order, and four of the top seven are metals.  Arsenic number one, lead, mercury and cadmium.  So those things by themselves… The chemical toxins are a problem too, no question about that, but those four by themselves are causing most majority of disease in the country as nearest as I can tell. By the way, that’s the first time I’ve said that. Maybe because I just finished reviewing all the research. And what I’m finding was stunning. Okay, for example, herpes zoster, shingles. Did you know there’s a direct correlation with the probability of getting shingles in the level of arsenic in a person’s body?

Speaker 3:                           Oh, wow.

Dr. Pizzorno:                      I had never seen that before. Anyway, so I’m just finding this correlation after correlation. 15% of MIs, according one study I literally read this morning, 15% of MIs are from arsenic.

Speaker 4:                          What’s an MI?  [A MI is a myocardial infarction, aka, heart attack]

Dr. Pizzorno:                      And by the way, one third are from lead. So right there, half of your MIs the, MIs that kill people, half of them are from arsenic and lead as near as I can tell from the research.  Now maybe I’m wrong a little bit, but I’ll tell you not by much because I’m not making the numbers up. I’m just looking at those two studies and that study says 15% and that study says 33%. Pretty easy to add it up.

Dr. Weitz:                           So somebody asked about hair mineral analysis for heavy metals. Hair versus urine versus serum?

Dr. Pizzorno:                      So the hair ought to be good. There’s a couple of problems with it. Number one is, some people have a big problem getting rid of methyl mercury. And a primary way that one gets rid of methyl mercury is through the hair. I’m starting to research deeply so I’m just repeating what I’ve heard from people I trust. So apparently in autism, one of the things happens to these kids is they have trouble getting rid of mercury. So it doesn’t doesn’t show up on their hair. My own experience with that is I don’t use it as my primary diagnostic tool, but I find it useful to monitor what’s happening. And that’s why I really like GGT. Because with GGT, you can just monitor how well it’s going. Maybe it’s not perfect measure of what exactly is happening, but the good measure becomes the total picture. And you want the total picture to improve.  So I’m actually happy myself. When I first was aware of this research on GGT, I was testing on people in Canada, I did on myself too, and mine was 27. At the time I thought look, 27 is fine. But then as I looked more and more research, I realize it’s actually higher than I want it to be. So I started getting more serious about avoiding toxins and I did it again three years ago, I was down to 26, and I just did a couple months ago, I was down to 17. So that tells me that all this effort I’m going to in terms of avoiding these toxins is working it show up on my blood work. It’s got to be good for me.

Speaker 5:                          What does GGT stand for?

Dr. Pizzorno:                      Gamma-glutamyl transpeptidase.  I may have missed one symbol there somewhere.

Speaker 3:                          That’d be great if you could spell that out or type it in the chat so we could research that.

Dr. Pizzorno:                      May I say, just go to the internet and just put in GGTP.

Speaker 3:                          Oh, okay. Got you.

Dr. Weitz:                           Somebody asked if you could report what you think is the upper limit for the GGT?

Dr. Pizzorno:                      Yeah, that’s a very, very good question. I’ve been trying to figure that out. Right now my guess is between 15 and 20. I don’t think I want it too low because that would imply to me your body’s not able to get the job done. And I see the disease correlations all started around 20. So I’m thinking between 15 and 20 but that might change as more research becomes available.

Dr. Weitz:                           By the way, since we’re talking about liver enzymes, what do you think is the optimal level for ALT and AST?

Dr. Pizzorno:                      Good question. I don’t know the answer to that yet. It’s okay, but yes, both ALT and AST are useful, not as good as GGTP, it’s definitely more reactive, but they are useful. Also uric acid, uric acid goes up with PFAS exposure.

Dr. Weitz:                           So I’m assuming there’s probably a high likelihood that there’s going to be a correlation with non alcoholic fatty liver as well and toxins, right?

Dr. Pizzorno:                      I’ve been in medicine for literally over 50 years. So I’m seeing diseases now we never saw before. Non-alcoholic fatty liver disease, we never saw that before. ADHD, we never saw that before. I mean, all these diseases we’re having, we never saw them before. You all know about that. I mean, everybody knows about type two diabetes in children, but for people like me, it’s almost a disease we didn’t have before. Okay, anybody want to say anything, anyone want to ask a question, where would you like to go from here?

Speaker 5:                          Exactly what does these toxic minerals do in the body that causes the disease? I missed that.

Dr. Pizzorno:                      Great question. So there are a number of ways in which they cause trouble. And it depends upon which particular one. So we look at arsenic for example, it directly damages the DNA and it poisons the beta cells in the pancreas so pancreas can’t produce insulin as easily and it poisons some of the cell signaling mechanisms that the cells use to tell it wants to let sugar into the cells. So arsenic correlation about 25% of diabetes as near as I can tell, maybe as low as 20%, but that’s the rate 20-25% of diabetes due to arsenic. And those look like the three primary mechanisms.

Speaker 5:                          And what about the relation to cancer incidence?

Dr. Pizzorno:                      What I’m aware of at this point is the DNA damage. That’s very clear. But as I’ve studied cancer more thoroughly, and I’m actually working with state group right now, we’re looking at all the natural medicines for cancer. As I said it more thoroughly, more and more, it’s just a mitochondria. So mitochondria, they’re screening up more than it’s the DNA. Not that the DNA is not important, but there’s something, it may just be the mitochondrial DNA damage is the one that’s most important. But there’s something pretty important there yet. And I don’t know how arsenic fits into that. I would not be surprised. I would bet you that’s exactly the arsenic causing trouble, I just haven’t seen that research yet.

Dr. Weitz:                           So what are the best ways to reduce arsenic? What would be your recommendations?

Dr. Pizzorno:                      Avoidance.

Dr. Weitz:                           So how do we avoid it?

Dr. Pizzorno:                      So you can get a filter in your house. And so a whole house filter is the best way to do it. If you can’t do that, you can filter from your drinking and cooking water. There’s a product called ZeroWater. I have no commercial relationship with them. I found out about them because I was visiting some friends of mine in the mountains, they have a cabin in the mountains, and I always just really disliked the taste of their water. And they both got cancer, by the way, interestingly, and they got this filter called ZeroWater and all the bad case was gone. So I went look into research and sure enough, it gets rid of everything including arsenic.

Speaker 3:                          Good to know.

Dr. Weitz:                           What about reverse osmosis?

Dr. Pizzorno:                      Reverse osmosis works. Carbon block filters will get rid of some of it, but not all of it. I don’t recommend it because I don’t think they are [inaudible 00:29:01] enough for it. Reverse osmosis works, there’s ion exchange that works as well.

Speaker 6:                          How about Berkey Water Filters.

Dr. Pizzorno:                      In this particular study, they did not get rid of the arsenic. Now, maybe they fixed something since then, I don’t know but this particular study, ZeroWater was the only one of the eight that they tested actually got rid of the arsenic. And not surprising because arsenic’s to get rid of. It takes-

Speaker 5:                          So we don’t know if bottled water in restaurants for example is any better, right? You don’t have the research?

Dr. Pizzorno:                      No idea, I haven’t looked at that. Interesting question though.

Speaker 4:                         And it depends on where the bottler got the water from.

Dr. Pizzorno:                      Exactly.

Dr. Weitz:                          So somebody asked, what would make you see clinically, what would be some of the clinical signs and symptoms you might see if the person has high arsenic?

Dr. Pizzorno:                      See, that’s the big challenge. It’s not obvious. Looking back on my practice, I’m really pissed off because I remember seeing some patients who had it. So one of the early signs is some pigmentation that inexplicably pigmentation on the hands. I’ve had patients come to me with that not knowing-

Dr. Weitz:                           What kind of pigmentation?

Dr. Pizzorno:                      It’s kind of a brownish pigmentation. It looks like a really early sign of excess arsenic. Now everybody knows about the really severe ones, because you can get peripheral neuropathy and such, then you get this really peripheral rash. But just these brownish unexpected discolorations on the palms of the hands had a really strong correlation with arsenic, kind of interesting. So what I say is, I wrote an editorial in IMCJ about three years ago, where I recommended that the standard of care for all primary care practice, everybody should have their blood measured for lead and everybody should have their urine measured for arsenic. 

Dr. Weitz:                           Rice tends to be high in arsenic. Do you do you have any recommendations with regard to that?

Dr. Pizzorno:                      Right, so wash the rice. You got to wash the arsenic off.

Dr. Weitz:                           Will it wash off?

Dr. Pizzorno:                      Yes, most of it will wash off. So there’s a protocol on the internet with research supporting that. As I recall, you cook for cook it for like a minute, throw away the water and cook again the rest of the normal amount of time.

Dr. Weitz:                           Interesting.

Dr. Pizzorno:                      Now [inaudible 00:31:18] rice find only throwing away the arsenic, if there’s any other soluble minerals on that skin, they’re going to go too.

Dr. Weitz:                           Right. So besides avoiding ingesting arsenic, how do we get rid of arsenic from our bodies? What your favorite arsenic detox?

Dr. Pizzorno:                      It’s through methylation.  So support methylation, that speeds it up.  So for example, if you have somebody who has high homocysteine levels, well guess what? They’re to be more susceptible to arsenic toxicity. So get the methylation going well, so avoidance is what you got to do, make sure methylation is working well, and N-Acetyl Cysteine will help decrease some inflammatory activity. But those two things that–do just to stop the exposure and just get what’s left out.

Dr. Weitz:                           Is that the same recommendation you would make for other heavy metals like mercury?

Dr. Pizzorno:                      No, [inaudible 00:32:08]. Half-life of arsenic is only two to four days. Mercury, depends on your age, 30 to 90 days. Lead, about two years in the blood, about seven years in the bone. Cadmium, couple few days in the blood, 16 years half-life in the bone and the kidneys. So you got to work to get rid of those things.

Dr. Weitz:                           Okay. So what would be your recommendations for patients who have high levels of mercury or lead?

Dr. Pizzorno:                      So there’s two things. One is, you want promote the competing minerals. So lead after calcium for example, Mercury goes after selenium for example. So just look at what else competing minerals and make sure they’re at high levels. And then you want to make sure that they’re stopping their exposure. And if you want to get aggressive at it, what I use is fiber plus DMSA. Oral DMSA, I do 250 milligrams every third day, and it’s really good at getting rid of lead and mercury. A lot of people that works great.

Dr. Weitz:                           What about binders?

Dr. Pizzorno:                      I think there’s other binders that should be usable, but when I started looking for the research on them it’s hard to find. I just looked at a study on chlorella and mercury in mice, and that was pretty impressive. But they’re giving them 5% of their dietary consumption with chlorella. I don’t think a patient want to consume 5% chlorella.

Dr. Weitz:                           Other popular binders include activated charcoal, zeolite, modified citrus pectin. What do you think about some of these other binders?

Dr. Pizzorno:                      So here’s the key factor. Our bodies, let’s say our smart bodies secrete 1% of the bioload of mercury into the gut, through the liver every day. But then through intrahepatic recirculation, reabsorb 99% of what we just dumped. Okay, so why would our smart bodies do something so stupid? Well, because those systems evolve, when we’re consuming 150 grams of fiber a day. Now we consume 15 to 20 grams of fiber a day. Not enough fiber there to bind the crap that will dump it into the stools.  So I would expect virtually any kind of fiber is going to help.

Dr. Weitz:                           Okay.

Dr. Pizzorno:                      Now of course some are more effective than others, certain kinds of minerals and such. I find getting lost in minutia not that critical. The big factor is, people need to eat more fiber and fiber should come from the diet. Pills are great, for sure, should come from the diet. Remember those foods rich in fiber have all these other flavonoids and things that protect our bodies from damage.

Dr. Weitz:                           You mentioned NAC, what would be the dosage for NAC and what about liposomal glutathione instead of NAC?

Dr. Pizzorno:                      So the NAC about 500 milligrams of NAC will increase red blood cell glutathione by about 30%. So that does work. Now we do have some people who have trouble assisting into glutathione and they are the people who are very susceptible to environmental toxins. So those people getting things like liposomal glutathione where it’s already pre formed, it’s a good idea.

Dr. Weitz:                           But if you’re going to use NAC would you recommend 500 milligrams three times a day or once a day or more [crosstalk 00:35:22].

Dr. Pizzorno:                      As part of my healthy aging strategy, I take five hundred milligrams of NAC every night.

Dr. Weitz:                           What about somebody with heavy metal toxicity?

Dr. Pizzorno:                      So you can increase it.  There’s some long term-

I’m sorry, turn off the microphone. There’s the long term research on NAC is particularly used and people with cystic fibrosis. So the typical dose is 2000 to 3000 milligrams a day, and there have been multi year studies. They don’t seem to have trouble. Now having said that, I have seen some patients who have suffered metabolism problems run into when you give them NAC plus DMSA. And probably it was easy to recognize them because I did it to myself. So even though I was taking very reasonable dosages, my body’s always had trouble metabolizing sulfur compounds. So for example, garlic makes me sick. Now I’m Italian nature but garlic makes me sick. So I have a lot of trouble metabolizing sulfur compounds, so I overload myself by taking too much NAC and DMSA. That won’t happen very often, but you have to be aware it when it does happen. And by the way, taking molybdenum, which is a trace mineral will help, which is required for those enzymes that work better will help. So I’ve been taking molybdenum, and after taking molybdenum for about a year, I noticed I’m not susceptible to suffer overload.

Dr. Weitz:                           Okay. What about strategies to stimulate bile flow since a lot of these toxins end up in the bile before they get excreted? Such as bitter herbs.

Dr. Pizzorno:                      Right? [inaudible 00:37:01] and things like that. So let me be very honest. I’m aware of the research of those herbs for increasing cholesterol excretion.  I’m not aware of the research of increasing environmental toxins.  Now, almost anything that increases excretion of cholesterol should get rid of toxins as well, but I haven’t seen research that says that, so I don’t know if it is true. [inaudible 00:37:23] but I don’t know.

Dr. Weitz:                           What about infrared sauna?

Dr. Pizzorno:                      So the best I can tell from sauna is from talking to Dr. Steven [inaudible 00:37:31] who’s brilliant in this area, what counts as sweating. So whether it’s infrared saunas, Swedish sauna, running, doesn’t matter what it is, you just got to be sweating. You’ve got to be taking the sweat away from the body. And research is clear, sweat is full of toxins. What was so amazed about the research he did is he said, there’s toxins in the sweat that aren’t even in the blood or the urine. They’re so hard for the body to get rid of, they’re just stuffed into the sweat. It helps them to stay and not cause so much trouble.

Dr. Weitz:                           Now what about environmental toxins other than metals? What do you think is some of the most significant ones that we should be concerned about?

Dr. Pizzorno:                      Now, the big one I’m concerned about right now are the bisphenols. So you see all the study about bisphenol A3, good idea. But what they’ve done is they just substitute the other bisphenols. So bisphenol S, bisphenol F, bisphenol AF, and bisphenol Z, the ones I’ve written about the most, well, they’re just as toxic. Okay, they just have different kinds of toxicity, and particularly bisphenol S. If you have a male who’s infertile, you better look at his bisphenol S levels. Cause it turns out there’s a pretty strong correlation with bisphenol S levels and male infertility.

Dr. Weitz:                            Wow, is bisphenol S actually measured? Is that in any of the panels?

Dr. Pizzorno:                      No, that’s a frustrating part. We’re putting pressure on the labs to measure all the bisphenols. But they have not been able to do so so far, I don’t know why. Now, I’ve got a suspicion. My suspicion is that the plastic tubing in their equipment is probably contaminated. Now this is total speculation on my part, but my background happened to be analytical chemistry. So I’m thinking, why aren’t they analyzing that? Because I could see how you do it. I said, “Oh, I bet their equipment’s contaminated already.”

Dr. Weitz:                           Interesting.

Dr. Pizzorno:                      We’ll see what happens. I did not accuse them of that everybody, I’m just speculating why might that be happening. Maybe the promise is overlapping with another molecule. It makes it too hard to differentiate. I don’t know.

Dr. Weitz:                           Dr. Rabar who’s on the line, he does a lot of testing for environmental toxins through Vibrant America. Sam, do they include bisphenol s? Okay, well, at least he was on the phone.

Dr. Pizzorno:                      By way, if you find somebody who’s doing those other bisphenols please let us know because the environment medicine community really wants them.

Dr. Weitz:                           Right, yeah. We started using Vibrant America. They have a really good combination. You can do an environmental toxins, heavy metal toxins and mycotoxins and they’ll do all three of those panels for 400 bucks.

Dr. Pizzorno:                      Okay. Somebody said, let’s hear about the new book and have you come back, please. Oh, thank you. It erased before I saw the rest of it. So my wife Lara has been quite an instruction for me in many ways. Of course, all men know about that. But anyway, so every woman in her family died from complications of osteoporosis. So we assumed that since we’re living so much more healthfully than all the rest of them, that she would not have a problem. So in her early forties there was an inexpensive test available being shown at one of the conventions that showed bone ankle density.  So we looked at it, she was osteopenic. We were so surprised.  So then we went and got a more sophisticated DEXA test, and sure enough, she was osteopenic.  And so we said, “Okay, we better start doing something about that.”  So at that point, I applied my body knowledge on what to do about it and she kept losing bone.

Now remember, this was a while ago. And so at that point, I thought I was being really brave giving her 1500 units of vitamin D a day. But none of the things I was doing, giving her 2000 units of calcium, we made sure her hormones were balanced properly, we did everything we could think of. And then at one convention, there was the first testing available for DNA SNPs related to the VDR receptor sites. So it turns out Lara had every abnormal VDR receptor site that had tests for. So it turns out that in order to have vitamin D levels up to where they really needed to be, should take 14,000 units of vitamin D a day for two years before we got her vitamin D levels up. So we had her DEXAs going down, down, down, down, Ah, vitamin D three receptor sites her DEXAs started going back up. And then once she was doing some research, and what else you could do, she ran across a company called AlgaeCal. So Pardon me, I’m not paid by them but Lara is. She’s their science writer. Anyway, so she found this company and she said, “Well, I like the idea of all these trace minerals that you get in AlgaeCal.” She started taking that product, and she was going to hop up and then she shot up. And now, 30 years later, Lara has normal bones.  She now does not have osteoporosis and dying like her mother and her grandmother did, but she doesn’t have osteopenia anymore. So basically, that book is about her journey by figuring this out. Now the interesting thing for me was that whenever Lara would find some biochemical pathway that was important for bone health I said, “Well wait, well that biochemical pathway is important for the kidneys. That one’s important for the heart, that one’s important for the brain.” I was realizing everything necessary for the bones to work healthfully is necessary for the whole body. Which why we ended up naming it, Healthy Bones Healthy You, because is true. If you do what’s necessary for the bones, everything else starts working properly. Working better, I should say.

Speaker 5:                          I hate to ask a question of the subject at the moment, but do you see any relationship in the data about Parkinson’s with any of these toxins?

Dr. Pizzorno:                      Oh, of course. [inaudible 00:43:31]. So there’s two kinds of data I’ve seen. Unfortunately I haven’t looked at it deeply enough because I haven’t had a Parkinson’s patient lately, so I just haven’t doven into it. And so I saw two patterns. One is a direct correlation between neurotoxic pesticide exposure and Parkinson’s, no question about it. So if anybody’s living near, I hate to say it folks, if you’re living on a golf course, have your levels checked. That’s a little worried. You do a lot of travel, a lot of travel on airplanes, better check your levels. Had some friends of mine who are literally international globetrotters, they had the highest levels organophosphate pesticides I’ve seen anywhere. So now there’s another thing, and turns out if people who, when they’re detoxifying the organophosphates go through phase one too fast and phase two too slowly, they have an even more toxic reaction to the pesticides. So it looks there’s both the exposure component and a susceptibility component to it. And I haven’t finished going through the research figure that out yet. But there’s-

Speaker 5:                          About the airplane, I missed the airplanes. Why the airplanes?

Dr. Pizzorno:                      Airplanes?

Speaker 5:                          You said that flying a lot on airplanes, why-

Dr. Pizzorno:                      Oh, I’m sorry. People flying on airplanes. Well, so I’ll tell you this from personal experience. They heavily spray those airplanes for arachnoids and rodents and things like that. And particularly flying internationally like I was flying, those things are always sprayed before they get to a location or when they leave one country to another.

Speaker 5:                          And golf courses for all the pesticides, correct doctor?

Dr. Pizzorno:                      Yeah. All the pesticides being used.

Speaker 4:                          Wow, thank you so much. Gosh.

Dr. Pizzorno:                      So it looks like you’re mostly all still here. Do you like these ideas? Am I going wrong in some direction?

Dr. Weitz:                           Oh no, absolutely. We’re all very aware of the role of toxins and we just want more details as to exactly which ones to focus on, how do we-

Dr. Pizzorno:                      Start with arsenic. Seriously folks. Now [inaudible 00:45:42] where I get my book, clinical Environmental Medicine, gets you a lot of information about arsenic. But the good news is, once you detect it, all you got to do is stop the exposure and the body will take care of it. And one of the things I’ve noticed in my book for consumers I wrote called The Toxin Solution. I differentiate between persistent toxins and non-persistent toxins. So persistent toxins are those that have really long half-lives. They’re hard to get rid out of the body. Like perfluronates, they’re two to four year half-life to get those things out of the body. So yeah, great, you stopped using Teflon stuff, but stuff is still in the body, if you want to get rid of it. Anyway, so got those persistent ones, the PCBs half-lives 10 to 20 years. Really hard to get rid of lead long it years. Then you have the non persistence. The phthalates, arsenic, bisphenol A, things like the various kinds of solvents and things like that. Most of them have short half-lives, hours to days. To stop the exposure, get rid of them. To engage your patient to religiously stop their exposure to everything possible, they will feel better within two weeks. And that gets them engaged for the months to years-long process to do the rest of the job.

Dr. Weitz:                            Any clinical pearls for getting rid of lead?

Dr. Pizzorno:                      DMSA is still the best that I know. So actually, DMSA is actually better for lead than it is for mercury. And so what I find with my patients, I see mercury toxicity way more lead toxicity, but I may have to reconsider that. But anyway, it takes out the lead as well as the mercury. So you see mercury levels go down, the lead levels go down too. Works great. And very rare adverse events. I only see adverse events for people with [inaudible 00:47:23] sensitive, and that’s very, very rare.

Dr. Weitz:                           Have you found benefits to using EDTA for lead?

Dr. Pizzorno:                      I haven’t. Jerry Gordon did an interesting job digging up some research showing that five grams orally a day of EDTA was good at getting rid of lead from the body. And it was some pretty interesting research. That was on lead exposed people so that can skew the research, but it was pretty interesting.

Dr. Weitz:                           And any clinical pearls about Mercury? Because that’s a really common one.

Dr. Pizzorno:                      So you got to watch with the fish that you eat. The amount of mercury in fish is in general proportion to the size of the fish. So the smaller the fish, the better. And of course, cold water since it’s higher omega threes, and should be healthier. But yeah, eat small fish because there’s no question direct correlation between amount of fish eating and none of the mercury in the brain are shown in the urine and blood, but also deficits in psychomoter tests. Okay, so no question about it. More fish people eat, the more psychoneuro test deficits.

Dr. Weitz:                           But how many people are eating fish in place of other animal proteins because they think it’s healthier and the fish has plastic and-

Dr. Pizzorno:                      Smaller wild cod fish doesn’t. But it’s going to be hard for the world to sustain that. And unfortunately farm fish, not as bad as cows, corn-fed cows, but farm fish is not very good either. It’s got a very high toxic load as well.

Dr. Weitz:                           And if you eat out at restaurants, there’s very few restaurants that serve wild fish and there’s a lot of restaurants-

Dr. Pizzorno:                      Order wild fish salmon and order farm salmon right next to each other, eat them next to each other, and you know immediately which is which.

Dr. Weitz:                           Right. I know in LA a lot of restaurants are selling this Scottish wild salmon which is actually farmed.

Dr. Pizzorno:                      Well, and even if it’s wild caught, because the Ireland salmon is so polluted, it pollutes the Scottish salmon as well. So even the salmon wild caught is as bad as the salmon farm in the US.

Dr. Weitz:                           My understanding is the Scottish salmon that’s being sold, it’s in pens in the ocean and they’re saying that it’s wild because it they’re big pens or something like that.

Dr. Pizzorno:                      Yeah. Well, if they fed them the right food that’s fine, but it turns out the primary driver of the high toxic load in the fish is actually what they’re fed.

Dr. Weitz:                           Right, of course.

Dr. Pizzorno:                      [crosstalk 00:50:03].

Speaker 3:                          I have a question.

Dr. Pizzorno:                      Sure.

Speaker 3:                          Can I ask a question?

Dr. Pizzorno:                      Yeah.

Speaker 3:                          I’ve read a lot about detox baths that use Epsom salts, baking soda, bentonite, do those do anything?

Dr. Pizzorno:                      That’s a good question and I actually have not looked into that research. Now I am a person who likes soaking in a magnesium bath. I think it’s good for me, but I haven’t actually looked at the Iron exchange with environmental toxins. Good question, I will look into that.

Speaker 3:                          Okay, thank you.

Dr. Weitz:                           What is the toxicity of farmed trout?

Dr. Pizzorno:                      Well again, it depends entirely upon what they’re fed. They’re fed healthy food they’re okay. But if they’re fed the processed mass produced food them no, they’re not going to be okay.

Dr. Weitz:                           Right. Any thoughts on charcoal hemo filtration?

Dr. Pizzorno:                      It ought to be pretty effective. But now I’m not necessarily saying the whole procedure is totally validated, but conceptually I could see how it could work. That’s all I can say at this point.

Dr. Weitz:                           Somebody asked about homocysteine as a possible marker for arsenic toxicity.

Dr. Pizzorno:                      So the thing with homocysteine, as the homocysteine levels go up, and that’s indication of impaired methylation capability. So if you have an impaired methylation capability, it makes arsenic more toxic. When arsenic is detoxified, it goes through a two step process. It’s first methylated, just like arsenous acid anyway, it’s called methyl arsenic one methyl arsenic, which is actually way more toxic than inorganic arsenic, then goes through a second methylation stage and a second methyl, which makes it like four times less toxic than metal arsenic. Some people have a fast first phase, sound familiar? And a slow second phase. And those people actually get toxicity to arsenic more easily. Now, it’s only about 1% of population as near as I can tell has that. I’m not sure I’m confident about the GenX yet, but I saw that pattern and actually just had a patient with that pattern. So it’s going to be every interesting to see what happens.

Dr. Weitz:                           Somebody asked about homocysteine being too low, as far as I know, the lower the better for homocysteine.

Dr. Pizzorno:                      It’s a very good question. So I wrote an editorial on homocysteine entitled Homocysteine Friend Or Foe about six years ago, and actually looked at that question. And it turns out you can have too low homocysteine. When we think about it, we think about homocysteine as being evil molecule. Remember, the body produces all homocystine in the body, it’s not an evil molecule, body has a purpose for it. It becomes an evil molecule when we screw things up. So we think about, what does homocysteine do? Well, it’s a storage site for cystine, to go into good glutathione production as we need it. It transports methyl groups around. So homocysteine is actually a very useful molecule. So it turns out, we get below around four with some neurological dysfunction that starts showing up. So I look at homocysteine, I would guess the ideal is probably between six and eight would be my best guess at this point. But that’s subject to changes as I see more research.

Dr. Weitz:                           So when you say support methylation, for a lot of people that just means give methyl B vitamins and of story, but there’s more to it, right?

Dr. Pizzorno:                      Yes. So if you had a chance to listen to my lecture on unimportant molecules, there’s a fascinating. Now I have to give an hour and a half lecture tomorrow morning. I may be run out of voice. One more thing, I’m going to have to call it quits.

Dr. Weitz:                           That’s okay. We’re honored for you to have joined us this evening.

Dr. Pizzorno:                      Oh, you’re very kind. I actually just forgot your question. Sorry, it’s getting late for me. What was your question again?

Dr. Weitz:                           It was just about some of the details about how to deal with methylation issues besides simply recommending-

Dr. Pizzorno:                      Oh, thank you. [crosstalk 00:53:58]. So everybody’s aware of the MTHFR polymorphisms and how the that’s really unfortunate because folic acid can’t be metabolized for these people. So they have more higher homocystine and direct correlations with cancer and heart disease and dementia. I mean, the data is pretty clear. But here’s the kicker, there’s no folic acid in food, right? You have natural folates or what are they? They’re methylated folates. So they go right into the methylation function with homocysteine, they don’t need MTHFR. This whole MTHFR bugaboo that we’ve created, is only because we screw up our diet and lost one of the standard molecules from the diet which is folates. So good news is, have people eat real folates.

Dr. Pizzorno:                      Could it be one of the reasons why all this research on fermented foods always seems to find a negative correlation with virtually every fermented food in every disease? Well guess what? Fermented foods have lots of natural folates. So I think I put people on a diet now is a high arsenic, but now people don’t have much folates in their diet, so now we’re dependent upon folic acid. And for those who can convert folic acid to the methylated folates, well okay. A substantial portion of population doesn’t do that very well if at all. Well okay for them, but how about everybody else? Well, if you get a natural diet, it doesn’t matter. I’m going so much back to the old time ways. Eat real food, just uncontaminated and your body is remarkable, things will work out pretty well.

Dr. Weitz:                           Eat real food.

Dr. Pizzorno:                      Eat real food, and make sure it’s not contaminated. Remember these new denatured molecules and all these halogenated hydrocarbons, we’ve never seen them. We don’t know what to do with them. They just poison us. And yes, lead and cadmium and mercury were around, but they’re buried pretty deep. We didn’t get much experience with them. Got some experience with mercury, so we’re fairly going to get rid of mercury. Remember we’re talking about half-lives in months rather half-lives in years, and actually we came across all the time. So try to avoid that. But without those toxins, our bodies work just great. But with those toxins, they screw things up because our body doesn’t know how to deal with them. Remember we’re intentionally designed to be difficult to break down by biological systems. So of course they saturate the environment, saturate us. DDT was banned almost 50 years ago. Every fetus today has DDT in him or her. Okay, and that DDT is causing neurological damage. Okay, I got to call quits.

Dr. Weitz:                            Thank you, Dr. Pizzorno, thank you so much.

Speaker 3:                           Thank you so much.

Speaker 6:                           Thank you.



Dr. Weitz:                            And thank you to everybody. Look forward to seeing you next month. Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple 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.



Breathwork For Longevity with Niraj Naik: Rational Wellness Podcast 230

Niraj Naik speaks about Breathwork for Longevity with Dr. Ben Weitz.

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


Podcast Highlights


Niraj Naik is known as the Renegade Pharmacist and he is a certified UK pharmacist turned wellness and breathwork expert. He is one of the world’s most sought-after spiritual ceremony facilitators and leads breathwork workshops around the world. His journey started in the midst of a “burnout” in his corporate career, when he found himself bedridden with chronic illness for more than a year. Healing himself using breathwork techniques and dietary adjustments, Niraj felt motivated to share his knowledge with others. Today, Niraj runs a global breathwork community and trains hundreds of breathwork experts through his SOMA Breath framework, and if you use the discount coupon Manifestation55 you will get a 55% discount. Also, if you would like to order some awesome colostrum that Niraj formulated, if you go to Shop.somabreath.com and use the Promo code RW20 you will get a 20% discount.

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 interviewing Niraj Naik. Naik, is that how we pronounce it?

Niraj:                     Perfect. That will do.

Dr. Weitz:            The renegade pharmacist and breathwork expert, Niraj Naik is a certified U.K. pharmacist turned holistic wellness and breathwork expert. He’s one of the world’s most sought after spiritual ceremony facilitators, and he leads breathwork workshops around the world. His journey started in the midst of a burnout in his corporate career, when he found himself bedridden with chronic illness.  Healing himself using breathwork techniques and dietary adjustments, Niraj felt motivated to share his knowledge with others. Today, Niraj runs Global Breathwork Community and trains hundreds of breathwork experts through SOMA Breath framework, which is also taught at numerous wellness centers in the U.S., Europe, and around the world. Niraj, thank you so much for joining us today.

Niraj:                   Absolute pleasure to be here, [Beitz 00:01:37], [inaudible 00:01:37]. How do I pronounce your name, Beitz?

Dr. Weitz:            Weitz.

Niraj:                   Weitz.

Dr. Weitz:            Right.

Niraj:                   Ah, so it’s a silent B. Got it. Cool.

Dr. Weitz:            Yeah, so Niraj, perhaps you can tell us how you overcame your health crisis, and how you … Tell us about the health crisis that you had and how you overcame it.

Niraj:                   Yeah, so I actually got a autoimmune disease years ago called ulcerative colitis, and this was after a run of a lot of stress, work-related stress. I got the symptoms of … Basically with ulcerative colitis, you get ulcers in your colon. You start bleeding from the bowels, and literally, you’re going to the toilet 40, 50 times a day. It’s horrific.  A few months into it, I had lost a third of my body weight. I tried all the conventional treatments. Nothing was working. I was faced with two options, either have my colon removed, or I go on a trial for an experimental drug that hasn’t even been used before. So, these are my options, and I was like, “Screw that.”  I was told also by a consultant who offered me these options that there’s no evidence that diet has any impact, and stress doesn’t have any impact. Basically, “Shut up. Take pills. That’s all we can do for you.” So, I was obviously very disappointed with that news, especially when, if you get ulcerative colitis, one of the prospects is you have to wear a bag, a colostomy bag, right?

Dr. Weitz:            Yeah. That’s not a fun prospect. I know for a fact that treating quite a number of patients with digestive disorders, that ulcerative colitis can be a very, very difficult condition to treat …

Niraj:                   Horrible.

Dr. Weitz:            … and can be life-threatening.

Niraj:                   So, I’ll summarize what I did then. Luckily, I had met an amazing yoga teacher, Swami Akhandananda, who said to me, “You’ve got a great gift here. If you can change your perception around this disease and look at it as an opportunity, as a gift, if you can fix this using …” So, she taught me some basic pranayama techniques, yoga, meditation, Ayurveda, “… you’d be an amazing role model for other people, and you can help inspire other people.” So, that changed my perception, because she gave me a bit more hope.

I also previously discovered Tony Robbins, at that time, and he always have his mantra of model success. So, the first thing I did [inaudible 00:04:38] was obviously is you do what most people do, they go in the forums, and they just see all this doom and gloom really horrific stories of people suffering with no hope. They’re on all kinds of meds. They’ve had their colons removed, blah, blah, blah. I decided to stop that and start looking at actually people who have healed themselves from this disease, and to model what they did.

I found there were some similarities. Through the Ayurvedic approach which I learned, you can actually find out a lot about yourself, and there’s no one size fits all, because we all have a unique energy blueprint, basically. Through this energy type that we all have, that’s different and individual, which you can find out through a series of special questions, I realized actually the diets that I was trying to use to solve this, which was raw vegan, because that was a big thing blasted all over the media at that time, was actually the worst thing for my health and made me much worse. Also, fruit-based stuff, as well, like fruitarian-type stuff.

Dr. Weitz:            So, were you following a raw vegan diet before you got ulcerative colitis, or you [crosstalk 00:05:46]-

Niraj:                     I had already made that transition to very vegetarian, very heavy on grains and things like that. That’s usually what happens when you go down that path. Not everybody does that, but when you’re first getting into this, get some carbs in there, you start doing that.

But then, I tried to use that same approach for healing, and I went really heavy on things like raw vegan diet, and lots of smoothies, and fruits, and things like that. None of that was working, and actually made me much worse. I checked in the Ayurvedic system that actually, people with ulcerative colitis, as my constitution, should have more grounding, warm, nourishing foods, and actually things like meats can actually be very beneficial. Actually, it was going to a completely paleo diet that solved the problem … well, a big part of the problem.

Also, I just started colostrum, which is an amazing medicine actually from … This is also an Ayurvedic treatment that’s been forgotten. It’s now becoming more popular these days. But colostrum is basically the first milk you consume when you’re born. It gives you your immune system, and it helps you create the gut lining that allows you to digest normal food.

So, if you’re deprived of colostrum as a baby, or if you go through a lot of wear and tear, like through life basically, drinking alcohol, and eating loads of processed foods, and taking prescription meds even, you destroy this gut lining. Children who don’t have enough colostrum get more often childhood diseases, and adults who destroy their gut lining, that means that all the toxins start seeping back through into the bowels, and they start getting leaky gut syndrome and things like that, which was what was happening to me, which then leads to autoimmune and all these other issues.

So, colostrum is an amazing substance, because actually, we can take bovine colostrum, which is a thousand times more potent than human colostrum, and it is actually, the cow produces four times the amount that the calf needs. So, the excess is used for human production, not … There’s no deprivation to the cow, to the calf, at all. Only the excess is used for humans. So, it means it’s done in an ethic way, which I knew that I wouldn’t go down that road if it wasn’t.

Actually, I started to test this out when I realized actually, this is actually one of the reasons why cows are considered holy in India. The Indian holy sweets were made from colostrum. So, in the monasteries and stuff, they would use colostrum quite often to make the sweets, which they give at the end of ceremonies and things.

So, I saw all of this amazing history behind it, which has all been [inaudible 00:08:55] about, and I started to use it. I’m not joking. Within a couple of weeks, the bleeding had stopped. But what was the real catalyst to getting really back to normal was that plus the breathing techniques. Pranayama is like a pharmacy of different breathing techniques, and there’s certain breathing techniques in there which just switch off stress like that, also helps you to change your conscious state so you can actually speak directly to the unconscious mind and change your operating system, which is our mind, which gets corrupted over time by life. So, it’s the first [inaudible 00:09:37] a lot of programming happens, and this can lean to an over-exaggerated sense of fear and hostility from the environment.

I was working in an environment that was already stressful, and there was a lot of fear and negativity in my environment, which is the pharmacy. Then, I ended up working in a corporation where you’re in kind of a room full of sharks, basically. Everyone’s gunning for your job, right? Everyone sees you as a threat. They’re so competitive in the environment. So, I had to deal with all of that, and what you have to do with autoimmune issues is, in my opinion, re-pattern, reframe fear and how we deal with fear.

So, a big part of the plan that I went through was basically rewiring, re-patterning the unconscious mind, and then restoring balance in those system, and using then colostrum as the foundation for healing the gut. So that, plus a few other things, which I created a system for with our SOMA Breath training, is what got me back to normal within a few months, but it has now been tried and tested through our community for many years now. We have so many success stories, countless amounts of success stories. People have had much worse cases than me who have recovered since, so it’s really … That was my driving motivational reason for doing this.

But actually, before that, I always wanted to be a music producer, a DJ. That was my thing, and I ran these big events and all this, so I always thought I was going to do that, go down that line. But strangely, it’s all gone full circle, because during that process of self-healing, I went back into making music, getting creative again, and I found that with music, you can actually make the whole breathing practices a lot more fun, but also effective, altering the brainwave states and getting into these deep physiological states. So, I started to make this therapeutic music, and that therapeutic music became my first online business. So, it became location-independent.

 I’ll tell you what. For most people, the reason why they’re sick is their environment that they live in. It could be that they’re in a relationship where they’re being bullied all the time, and that’s that relationship, that negativity, hostility that’s making them sick, or there’s this frustration that they’re not being true to themselves. It could be they’re in a career where they’re being treated badly, and then, they hate going to work. When you lose that enthusiasm for life basically, your soul wants to escape your body. It’s like, “I want to move into another place, a happier place.”

I think that’s where disease creeps in. Literally, that’s what is the Ayurvedic approach, which is most diseases, chronic diseases are spiritual disturbances. The problem with pharma is that it can never address a spiritual disturbance, something that is … drugs ain’t going to fix your environment. It’s not going to fix your relationship. It’s not going to fix your career.

Dr. Weitz:            Well, they try that with these drugs that increase serotonin production, or try to manipulate brain chemistry, except they’re, generally speaking, long-term, not super effective and very hard to get off of. I think brain chemistry is much more complicated than just increasing …

Niraj:                     It is.

Dr. Weitz:            … one or two neurotransmitters.

Niraj:                     They follow a reductionist scientific model which humans are not. We are completely irrational and un-linear, and therefore … We’re more complicated. Therefore, we need one-on-one customized solutions. Whereas pharma tries to make everybody the same, average, and they try and bring everybody to an average and normal, which not everybody fits into that same average bracket. If you go and get your blood pressure checked, they’re going to say that, if you’re above 120 over 80, or below it, you’re not normal, and therefore, you need some treatment to fix it.  But if you were take everybody’s blood pressure on the planet, you’ll find it’s like a bell shaped curve, right? It’s like this. You’ll have people who have very high blood pressure on one end and very low on the other end. 25% of people are going to have what’s called abnormal blood pressure, but for them, it’s perfectly normal. If I was to ask you, what was Gandhi’s blood pressure his whole life until he got shot with a bullet in his head, and he was like 80 plus years old. Do you know what it was?

Dr. Weitz:            What?

Niraj:                     It was 200 over 100 his whole life.

Dr. Weitz:            Wow. Wow.

Niraj:                   So, he had abnormally high blood pressure, but when they did the postmortem on his body, he had perfect health. None of his organs were affected. So, some people can live with very high blood pressure. Some people can live with very low blood pressure. That’s their normal, right?  But if you check that graph, 25% on each side is going to be a false positive when they go to the doctor for a checkup, because they’re going to be like, “Oh, you’re not 120 over 80.” So, they’re going to give you a medication, and then what’s going to happen is that they’re going to bring you to the normal of what they consider normal. The problem with that is, then you’re gong to get side effects. You’re going to get all these issues with your health, and that’s why we have so many side effects with medications. They use linear reductionist science, and it doesn’t fit the human being. We’re social people. We’re emotional. We are irrational. We don’t fit into a box like that. So, as a chiropractor, you know very well, you can’t just do that.

Dr. Weitz:            I think I should change the name of my podcast to Irrational Wellness.

Niraj:                   Yes. You got it. You got it.

Dr. Weitz:            At some point in your career, you created this infographic that become one of the most viral infographics of all time. I looked at it. It’s pretty cool. It’s called What Happens To Your Body One Hour After You Drink a Can of Coke. I wondered if you could talk about that for a couple of minutes.

Niraj:                   Yeah, yeah. That happened by accident, actually. One of the reasons why I got kind of sick in the first place actually was because I fought really hard to change my career. I wanted to get out of the pharmacy world. The way I started to do that, to make my job a bit more fulfilling, was I figured out a way to give people dietary advice through shopping lists, which I found … it came up through a Tony Robbins event, actually, where it was the first time I ever heard anyone talk about diet, nutrition, breathing, and things like that for health. In pharmacy, you don’t get taught any of this.

Dr. Weitz:            Yeah. He even talks about chiropractic adjustments as a [crosstalk 00:17:13].

Niraj:                   Yeah, he’s great. So actually, I was like, “Well, I’m gong to put Tony Robbins to the test. If he’s full of shit, I’ll find out pretty quick, because in my pharmacy, I’ve got loads of people coming in who are sick.” So, what I did was, I started to just change their diet to a, what I call, the simplest thing was a no factory diet. You’d be surprised that the majority of people consume mostly processed foods in the U.K. I don’t know how it is elsewhere. I’m sure in America, it’s everybody.

Dr. Weitz:            Oh, much, much worse in America.

Niraj:                   Yeah. So, what I started to do, I know there’s a huge correlation between processed food consumption and the amount of meds people are on. So, I started to just make a switch to the no factory diet, which would literally teach people how to make their own food, and just gave them a shopping list and directions to recipes.  Those who took my advice actually started to get better, and I got doctors calling me up going, “What are you doing? This is amazing. Keep going.” I even had lots of patients’ children, because they were older patients, going, “Oh my God, it’s amazing. My dad, he’s able to play again, and I see a smile on his face. I was really getting more job satisfaction, because I didn’t feel like I was doing anyone any favors as a pharmacist.

But then, basically, I got promoted. I had an office at one of the biggest corporations at the U.K., and that’s where I really saw … because I was going to do this healthy shopping service on a big scale. I really saw the level of consumption of fizzy drinks, in particular. You could just see, it was clear as night and day, that sugary drink consumption goes hand in hand with diabetes and metabolic syndrome, and all these issues.  I had amazing results in just the pharmacy getting people off diabetic medications just swapping their fizzy drinks with something else. Basically, some people would drink 10, 15 cups of coffee a day with three spoons of sugar in it, and they were on a whole list of meds. It was unbelievable. The doctor had never asked them, “What do you eat or drink?” It’s fascinating. So basically, when I healed myself and got [crosstalk 00:19:41], I had a lot of people-

Dr. Weitz:            I would say it verges on malpractice, to take somebody with diabetes, hand them a medication, and not do something significant to get them to change their diet and lifestyle.

Niraj:                   It’s unbelievable, yeah, that they don’t do it. So I then actually, when I got out of pharmacy, I had a lot of people asking me, when I healed myself, “How did you do what you do?” So, I made this website, The Renegade Pharmacist. I just put all my information on what I did for free on there. I put loads of advice on food, nutrition, all that.  I just put up … I saw this really cool timeline somebody had written about what happens when you drink a can of coke. I didn’t actually create that bit of content. I did the infographic based on that content, but I did my interpretation of it from my experience in the pharmacy as the article. I just put it up there to illustrate how bad fizzy drinks could be, and my experience with getting people off fizzy drinks.

 So, I just forgot about it, and then a few months later, somebody who had been following my site asked me to share it, and he shared it on a very popular website. Then, suddenly, I was waking up in the morning, and it was like Daily Mail, Huffington Post, Telegraph, Guardian, all these newspapers on my case asking me for permission for them to share it. Suddenly, it’s all over the world. Fox News made a whole show on it. It was just wild. I had several million hits to my website in like a week.

Dr. Weitz:            Wow.

Niraj:                   It was crazy. It blew us up. It made us quite popular. Yeah.

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.



Niraj:                     SOMA Breath is based on pranayama. Pranayama is the ancient Indian school of energy exercises, breathing, energy movement, and just things that manipulate the energy body. Pranayama actually means energy control. It’s revolves a lot around breathing because breathing is how you produce energy in the body, through respiration. Because that’s what I was taught, was pranayama from my Swami, I went down that rabbit hole, and I started to do as much research as I could to really gain as much knowledge about this as possible.

On my travels, I actually also, indirectly through the infographic, met Wim Hof and became good friends with Wim Hof, the Ice Man, who most people have heard of these days. I ended up making the soundtracks of the Wim Hof Method. He really inspired me. he was one of the few people that really put some science behind this stuff, and we shared some similar techniques and ideas. Then, I started to, when I went and found my home in Thailand, Koh Phangan, there’s a big spiritual community there, and breathwork was quite popular, like rebirthing, holotropic, and things like that.

So, what I decided to do was to start doing breath workshops, use these pranayama techniques, but I found with music, you can make the whole process really powerful and dynamic. But in pranayama, there’s this one method called Savitri pranayama, which is all about breathing in a rhythm. With music, you can time the breath perfectly to the beat. So, when you breathe in, you can breathe in for a certain number of beats, out for a certain number of beats, and you can create a perfect harmony with your breath.

If you’ve heard of [inaudible 00:25:03], they did a lot of studies on harmonic breathing, and rhythmic breathing, and coherence. So, what I started to do was this rhythmic breathing practices with music, and using breath retention, which is the stuff that my Swami taught me, it’s the stuff that Wim Hof is all about, to make these powerful experiences where it takes you into powerful, altered states of consciousness.

So, I found this amazing sequence that I put together with music, that became really popular in Koh Phangan and these workshops. We started with four or five people. Then, it turned into 40 people. Then, 150 people, and then eventually, I was going around the world doing these big workshops. People kept coming up to me, asking me, “[inaudible 00:25:56] do what you do?” Because I’m taking people into incredible peak states, like all these profound states of consciousness. People were having these crazy realizations and moments of inspiration, just … I mean, some people were getting healed of issues like chronic pain and inflammation, and things like that. So, I-

Dr. Weitz:            I don’t think most people realize that breathing strategies, techniques, exercises, can take you to an altered state of consciousness.

Niraj:                     No, exactly. It’s fascinating. Holotropic Breathwork by Stanislav Grof was actually one of the first ones to really go down that way, because he needed an alternative to LSD to treat … He was one of the first psychotherapists to use LSD in … He was a psychiatrist, actually.

Dr. Weitz:            What’s his name?

Niraj:                     Stanislav Grof. He found the hyperventilating-style breathwork with music was a way to create altered states of consciousness. Then, he created holotropic breathwork, which was kind of popular many years ago. Now, it’s revived a lot more popularity in recent times. Leonard Orr [inaudible 00:27:15] rebirthing, which is a similar profound breathing practice, circular connected breathing, which is a similar things.

But these are ancient yogic rituals and practices, as well. These techniques can take you into altered states of consciousness where you can actually release a lot of trapped emotions, unresolved emotions, and also have some self-realization moments. You get into these high gamma, peak gamma brainwave frequencies where you can connect to something higher than yourself, and it’s amazing.

I was doing variations of this but with another technique from pranayama called Kumbhaka, which is a breath retention. With breath retention, you can actually really alter your state of consciousness even deeper by lowering the oxygen for brief periods. When you hold your breath for a long enough period of time, you can get into very deep, very awakening, expansive states of mind where actually, your mind gets very still.

A stillness happens because thought is actually stimulated by breathing, all right? When you breathe in, you inspire. You get inspired. Inspiration actually comes from that word, of breathing in. Actually, expire is the last thing you do when you die, and it’s what you do when you breathe out, right? Inspire is the first thing you do when you’re born. You inspire. That’s when the first thought comes into your mind.

So, the yogis understood, there’s a direct connection between thought and breath. When you hold your breath after the exhalation, as you expire and hold your breath, you pause life for a moment. When you pause life for a moment, and long enough, what happens is, you actually can trick your brain almost into thinking that you’re dead, right? In doing so, it’s like a defrag for your whole nervous system, and it can actually clear all that noise out of your brain and in your mind, and actually clean the operating system.

But you could also use it as a way to actually still the mind so much that you can actually use visualization. If you’re a therapist, for example, you can actually use these techniques while somebody’s holding their breath in the same way to reprogram their operating system. You can also do it consciously with visualization yourself.

So, these are the therapies I started to develop, which was getting people into very deep meditative states using the breath retention, the pause, and through that, helping people to re-pattern their unconscious mind, which is the source of everything, your bad habits, your good habits, your immune system’s function, whether you have autoimmune or not, just your sense of wellbeing. A lot of it comes from … our sense of self comes from this unconscious mind.

So, if we can have a tool that can allow us to go in there and reprogram it, that’s like basically hypnosis on absolute steroids, man. That’s what we have developed now, and that’s what I train our therapists to do. Using these different techniques, you can actually alter brainwave states and help people to re-pattern the mind, the source of all things. Also, another benefit of all of this is that actually, when you hold your breath for a long enough period of time, you create this state called intermittent hypoxia, a lower than normal oxygen level for a brief period.

I met a yogi doctor in the Himalayas called Prakash Malshe, who’s one of my many mentors and teachers. He’s an advisor to our company. He wrote a book called the Medical Understanding of Yoga, and he really, the first time, gave me absolute clarity on the profound deep science of yoga and its medical applications. He really explains the benefits of intermittent hypoxia and why yoga itself, if you do traditional yoga, how it’s supposed to be done, not the stuff that you see in the mainstream yoga now, but traditional yoga where you’re holding each pose for long periods of time, doing breath retention, training yourself to be able to expand your breath retention times. What it does is it makes you very efficient adapted to oxygen. There’s a reason why we do that. The more efficient we are at using oxygen, the less we need to breathe.


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.

So, this product involves a water-cooled mattress pad that goes underneath your sheets and helps you maintain a constant temperature at night. If you’ve ever gotten woken up because temperature has changed, typically gets warmer, this product will maintain your body at a very even temperature, and it tends to promote uninterrupted quality deep and REM sleep, which is super important for healing and for overall health.

If you go to chilisleep.com and you use the affiliate code, Weitz20, that’s my last name, W-E-I-T-Z, 20. You’ll get 20% off a chiliPAD. So, check it out and let’s get back to this discussion.


Niraj:                   You bet.

Dr. Weitz:            I mean, we certainly have heard of people checking their oxygen saturation. Oh my God, your oxygen saturation’s going lower. You’re going to need oxygen. You can die if your oxygen saturation gets too low at night. You’re going to need a CPAP machine. It seems like we don’t need technique to increase carbon dioxide. You can simply just walk along a freeway, or smoke a cigarette, or do any of these other things in modern life that increase hydrogen, carbon dioxide, and decrease oxygen. So, explain why we need to intermittently decrease our oxygen.

Niraj:                     Okay, so basically, I have a device here. If you have a pulse oximeter, you’ll find that most people’s oxygen levels … I don’t know if it’ll show up, is around 99% at all times. [inaudible 00:34:49]. So, you’ll find that even just with a sip, like that, is enough to oxygenate the blood fully. If you see this, it’s just calibrating. I don’t know if you can see it.

Dr. Weitz:            It’s stopping right there. Yeah. It says 97%.

Niraj:                   It’s at 98%. That’s completely normal. 97, 98, 99 is perfectly normal. You just need a little sip, a little sip of air, and the oxygen levels go right up, okay? Now, that’s the measurement of all the cells. It measures your blood oxygen saturation, so this is your bloodstream. This is not to be confused with body tissue oxygenation, okay?

So, when you breathe in, you inhale, the oxygen binds to your red blood cells, and your blood cells drop off oxygen to the areas of your body that need the oxygen. So, every single organ in your body, every cell in your body is respiring, is breathing. It breathes in oxygen, breathes out carbon dioxide. Now, the most active areas of your body, like let’s say you do some weights, so you’re doing your dumbbells or whatever, these cells here …

Dr. Weitz:            [crosstalk 00:36:08].

Niraj:                     … are going to respire the fastest, okay? So, they’re going to be producing more carbon dioxide, and that carbon dioxide is the signal for telling your blood where to drop oxygen off. Otherwise, it will never know where to drop it off, and it will be a very inefficient method of transportation of oxygen. So, the carbon dioxide level signals your blood to drop off oxygen. The higher the carbon dioxide is, that’s where the oxygen is going to go, right? So, we’ve got this very clever system.

Now, what happens is, when it comes to oxygen efficiency and oxygenation, now the problem is, when you’re stressed [inaudible 00:36:54], we breathe at a faster rate than we need to. If you’re also eating the food that’s not good for you, if you’re not digesting food efficiently, you’re eating process foods, if you’re on loads of chemical medications and stuff, you hyperventilate and actually breathe at a faster rate than you need to, right? So, the faster you breathe, the more carbon dioxide you’re expelling, which means there’s less of that signal in your system telling the oxygen … your blood cells where to drop off oxygen.

So, the oxygen stays bound to your red blood cells, and what this causes, and Harvard have done the studies, is rusting internally. If you are not getting oxygen into your cells efficiently, you can create this internal rusting effect, which will lead to plaque formation, and then heart disease and things like that. But also, if you’re not getting the oxygen from your red blood cells into your tissue cells, the problem there is that your tissue cells needs the oxygen, so they start to get diseased.

Oxygen is also a constrictor. It constricts. It makes your blood vessels narrower. Carbon dioxide is a dilator, and it works with another key ingredient gas called nitric oxide, which is only produced by nasal breathing. So, when we don’t breathe through our nose, which a lot of people … you’d be surprised how bad that issue is actually, we have an epidemic of mouth-breathers, right? If you don’t breathe through your nose and just breathe through your mouth, you over-breathe. The mouth means you have too much volume of air going in and out. You’re not producing nitric oxide, you’re getting rid of too much carbon dioxide, and that then leads to phasic constriction, high blood pressure, but also leads to poor oxygenation of tissue cells. Eventually then, that leads to chronic disease, fatigue, all these issues.

So, when you learn to be able to raise your carbon dioxide totals, because carbon dioxide also is what tells your brain that you need to breathe again, to inhale. Now, if you have very weak carbon dioxide tolerance, if you can’t handle a decent amount of carbon dioxide in your system, you’re going to also chronically hyperventilate, meaning you will breathe faster than you need to. That chronic hyperventilation then again leads to the over-breathing problem. But if you can increase your carbon dioxide tolerance, which is very, very easy to do, it’s just a simple practice, you’ll be able to handle higher volumes of carbon dioxide, keep a good ratio between carbon dioxide and oxygen, meaning you get optimum oxygenation of your body tissue cells.

 This is what Buteyko discovered, but it’s been forgotten. Recently, it’s becoming more known like people like Patrick McKeown, Oxygen Advantage. He talks a lot about this stuff. But it’s still kind of shrouded in a lot of mystery, and doctors and all these people, most of them have no clue about respiration and breathing, and its link to inflammation and things like that. So, we’re doing a lot of reeducation. We have a lot of doctors coming to us to actually train again in respirational science, because they haven’t been taught the right stuff. It’s very simple.

This is what I was talking about. This is the big ah-ha moment for you, because yoga as a system was developed by studying animals in nature. Animals that actually live a very long time are elephants and turtles. They breathe very slow, right? Whales, for example, live over 200 years. They have a breathing rate of less than one breath per minute, and they can hold their breath for two hours at a time. You can only hold your breath for two hours at a time if you have very, very good carbon dioxide tolerance, right, and oxygen efficiency.

The other end of the spectrum, animals that don’t live a long time are rats and mice. They have very fast breathing rates, 150, 300 breaths a minute, right? But there’s a weird anomaly to this rule, and that is the naked mole rat. The naked mole rat basically lives primarily underground in a hypoxic environment. It can hold its breath for over 18 minutes, and it lives 30 years pretty much free of disease, and is really hard to give it diseases in the lab even. It’s a very robust animal.

So, there is a correlation in the animal kingdom between breathing rates, breath retention, and longevity, right? The father of oxidative stress and [inaudible 00:41:45] is Helmut Sies. He did the best studies on this stuff, and he says, although it’s very difficult to live without oxygen, it’s also very difficult to live with oxygen because of the problem of oxidative stress. That’s why we need antioxidants in our diet and stuff like that.

So, yoga as a system, if you do it properly, traditional yoga, the yoga asanas where you hold each pose for maximum effort, holding your breath in poses, is all designed to train your body to become very efficient at using very little oxygen, to adapt to a low oxygen environment. There’s a reason why yogis go and live at the top of the Himalayas, where the oxygen levels are very low, and yogis are famed for longevity, right?

So, I went back to those roots and decided to go through all of this. I made that system of yoga and pranayama a little more accessible, easier to use. The music all helps this. Add in the new, modern sciences coming in to then create a system that’s designed to improve oxygen efficiency in people, and that’s the metric.

If you can improve your breath retention time, like there’s a measurement you can do every morning, the morning BHT. This is what we [inaudible 00:43:05]. Do the morning BHT within the first 10 minutes. Breathe in through your nose. Breathe out through your nose. Hold your nose, and hold your breath. You don’t do any breathing techniques beforehand, just do this. Hold your nose and hold your breath until you get that first strong urge to breathe where you’re not gasping for air at the end of it. You’ve gone too long, if you’re gasping for air, but you inhale release as normal afterwards.

That’s your BHT, breath hold time. If you can bring that to 30 seconds and above, then you’re in good health. If you can go to 60 seconds and above, you’re like super yogi. But if you’re less than 15 seconds, less than 10 seconds, you’ve actually got probably some disease you’re trying to fight. Actually, if you’re five seconds and less, then there’s actually some real issues with your health that I you need to look into. So, that’s one of the measurements we do.

Dr. Weitz:            That’s sweet.

Niraj:                   Yeah.

Dr. Weitz:            Breath hold time, right?

Niraj:                   Yeah.

Dr. Weitz:            Interesting. I mean, we can use that as an exam technique for patients.

Niraj:                   Yes. That’s what Buteyko used to do. He would use that as a test for … Actually, a lot of doctors used to use this test. They would also use the forced hyperventilation test, where you hyperventilate for like a minute, and it would make sick patients more sick. Through that, he would be able to tell which organs are the ones that are sick through the symptoms that would get exaggerated. So, forced hyperventilation makes people more sick. You see, I’m talking a lot right now, and I’m actually hyperventilating. It makes me a little bit lightheaded.

But a lot of people who are working all day long, they’re sat down in a chair talking all the time on the phone, or to their colleagues or whatever, hyperventilating. Then, they’re eating processed foods. That’s make you breathe even faster than you need to. Then, you’re not doing any exercise. Exercise makes more efficient use of oxygen and all of this.

That builds up to then a problem with this gaseous exchange where they get poor tissue oxygenation. Then, that’s what makes people inflamed. It makes people have chronic pain, because the constriction leads to poor blood flow to your body, and to your tissues and organs. Then, that poor blood flow leads to chronic pain.

So, imagine, just by changing the way you breathe, your relationship with your breathe, learning to extend your breath retention time, slowing your breathing down, training yourself oxygen efficiency, which [inaudible 00:45:45] is probably the one that’s really good for you. What it will do is, it will help you with so many other areas of your life.

Then, once you’ve got that bit sorted, you can then go into the [inaudible 00:46:02] rituals, which are where you actually use hyperventilation as a way to get into profound altered states of consciousness. It’s controlled hyperventilation, which is what we do. We have instructors we’ve trained as facilitators. You can take people into these powerful psychedelic-like journeys where you have this connection with the Divine, and get rid of all these emotional traumas and baggage that’s built up from the past.

So, we have a system of doing this in a safe, effective way. One of the problems we see with breathwork today is that there’s too many people jumping straight to the hyperventilation because it gets you high, right? The problem with that, and if you get confused with that-

Dr. Weitz:            Is that what happens like in Wim Hof technique, is they tend to focus on that more?

Niraj:                   No. See, the Wim Hof technique is all about the breath retention. It should be, because it’s 20 breaths in an hour, fast breaths followed by holding your breath. Actually, that is the best method for getting into holding your breath for long periods, because what you’re doing is, you’re hyperventilating for a bit. That brings all the carbon dioxide out. Carbon dioxide is what tells your brain you need to breathe again. So, if you have less carbon dioxide in your system, you’re going to hold your breath for much longer than you normally can. What that does is, it lowers the oxygen levels for a brief period, and that creates this intermittent hypoxia.

We use a slightly different method. We use rhythmic breathing to the beats, so the breath retention’s slower, rhythmical. We use different breathing patterns. So, you have a four eight, four beats in, eight out, or two in, four out.

When you double your exhalation time, it does something else. It actually switches on the parasympathetic nervous system, because when you breathe in, you stimulate sympathetic. When you breathe out, you stimulate parasympathetic. Actually, when you breathe in a rhythm, when you’re breathing in and out at the same time, you balance the nervous system. With you breathe with a double the exhalation time, you turn on parasympathetic.

So, when we’re doing these psychedelic journeys, when you do that, actually people go into very deep parasympathetic, low theta brainwave states, which is very, very therapeutic and healing. It could be, for some people, the first time in their whole life that they’ve activated their parasympathetic for that long. So, people have these powerful healing experiences.

Dr. Weitz:            So, a longer exhalation period is better for stimulating parasympathetic?

Niraj:                   Yeah, and another way you can do that is just by humming. If you om, when you hum, you do a couple of things. You extend your exhalation. That sound, the vibration actually stimulates the vagus nerve, so that calms parasympathetic. It exercises parasympathetic.  But then, also the humming, when you hum and vibrate this area here between your nasal cavities, it’s called the paranasal cavity, the paranasal sinus cavities, what happens is you stimulate nitric oxide 15 times normal than if you were to just breathe normally. Om, this is the science of om, if you do om properly, like I just told you where you put the hum on the hum, you produce all this amazing nitric oxide. Nitric oxide is antiviral, antibacterial, nasal dilator, bronchodilator, also works with carbon dioxide to get that oxygen to your cells. So om, chanting om is one of the best things you can actually do for your health [crosstalk 00:49:55].

Dr. Weitz:            Fascinating.

Niraj:                   Yeah, man.

Dr. Weitz:            Amazing stuff, it really is.

Niraj:                   Cool.

Dr. Weitz:            Really, in the functional medicine world, we should really be incorporating breathwork more regularly into our patients’ treatment plans.

Niraj:                   Oh, 100%. It goes hand in hand with chiropractic. I actually have a few chiropractors where I’m in, in Spain right now, who are doing all our courses, and I’m hoping to work with more chiropractors. I think it just works so well with what you do, as well. It’s all about the energy in the body. [crosstalk 00:50:30].

Dr. Weitz:            So now, we, or our patients, can access your training programs online?

Niraj:                   Yeah. We have a website, Somabreath.com. I’ll give you a link as well, so you can give a discount to your listeners, if they want to take any of our courses. We have the SOMA BreathFit course, which I think is invaluable for people to build healthy breathing habits which will protect them from disease, prevent disease. I’m not going to say it’s going to cure things or prevent everything, but it’s definitely going to give you more energy, and a better experience and quality of life if you learn this stuff. What it is, is the best essence of Buteyko but made much more easy to do and follow.

Then, we have the 21 day course, which is a real deep dive into altered states using breath. It’s done as a group with an instructor online through Zoom and things like that. It’s really transformative, very helpful. We recommend people do both courses back to back.

 Then, we have the instructor training, which is great for professionals like yourself, like chiropractors, to be able to bring breathing techniques and powerful experiences to clients for transformation. Because with breathing, it can also be very fun. Actually, you can get into very good states of being, wellbeing, just with the breath, which creates great foundations for healing, right? So, that’s the different options.

We also have a YouTube channel, SOMA Breath, Facebook group, SOMA Breath, which is an amazing, buzzing community. I love the community we’ve created. It’s super high vibe. Everyone is helping each other out. I feel the community is the thing that’s really going to cure this world’s problems that we’re going through right now. [crosstalk 00:52:26]-

Dr. Weitz:            The website is S-O-M-A-B-R-E-A-T-H .com?

Niraj:                   Correct. That’s it. Yeah.

Dr. Weitz:            Awesome. Hey, great podcast. I really appreciate you spending some time with us and providing some great information.

Niraj:                   Yeah. Sorry if I’ve been talking a thousand miles per hour, because I’m trying to get as much info to you as possible.

Dr. Weitz:            I appreciate it. Yeah. That’s the way my mind works, too.

Niraj:                   Great.

Dr. Weitz:            When people talk slow, I have to speed it up when I’m listening to their podcast.

Niraj:                   Me, too. Me, too. Me, too. We’re very much on the same page.

Dr. Weitz:            Okay. Thank you so much.

Niraj:                   Cool.

Dr. Weitz:            I’ll send you a link when we post it.

Niraj:                   Perfecto. Much love, man.

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



Keys To Better Gut Health with Dr. Edison De Mello: Rational Wellness Podcast 229

Dr. Edison De Mello speaks about the Keys to Better Gut Health 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

1:27  Gut problems, including stomach pain, bloating, gas, diarrhea, and constipation, are extremely common today.  Gut problems exist because of our toxic environment, because of stress, and because most of us haven’t asked ourselves what our relationship with that food is. 

7:05  Bloating.  Bloating needs to be distinguished from swelling and from fat.  With bloating it comes and goes from one day to the next, whereas when you get fat, it continues to increase and doesn’t come and go.

8:57  Once we rule out the most severe pathological conditions, the most common cause of bloating is gut dysbiosis, which means an imbalance of the microbes in the microbiome.  There are various reasons why there is gut dysbiosis, including eating foods that inflame our gut, taking antibiotics for sinusitis that also kill the good bacteria, by eating on the go, by having your hormones imbalanced, or there may be overgrowth of bacteria or fungus.  There may be small intestinal bacterial overgrowth (SIBO) or there may be overgrowth of other bacteria in the colon like strep or prevotella.  There might be parasites or H. pylori or overgrowth of candida. We can do a breath test for H. pylori.  We can do the SIBO breath test.  Dr. De Mello orders his SIBO breath tests through Dr. Sam Rahbar, who is an integrative Gastroenterologist in Los Angeles and who assists in the interpretation. He also likes to order the 3 day stool test from Genova.

18:52  If the tests come back and the patient has multiple issues that might be contributing to gut dysbiosis, such as a positive SIBO breath test for methane and overgrowth of certain bacteria or fungus on the stool test, then Dr. De Mello will focus on the condition that he feels is the priority.  But he makes sure his patient is ready to be committed to changing his diet and lifestyle and he wants to make sure that he is not overwhelming his patient. He will ask his patient to make a list of the changes that he or she is willing to make, such as changing their diet, taking their supplements, sweating a lot, exercising to get these toxins out, etc.

22:32  Dr. De Mello feels that taking some specific herbal supplements is a crucial part of the treatment. He tends to use the herbal products–either FC Cidal and Dysbiocide from Biotics or Candibactin AR and Candibactin BR from Metagenics that were shown to be equally effective to Rifaximin or to triple antibiotic therapy (Clindamycin, Flagyl, and neomycin) in the John’s Hopkins study: Herbal Therapy is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth.  He may either recommend a low FODMAP diet or do food sensitivity testing with Cyrex Labs to see which foods should be avoided.  Or he may use the low FODMAP diet and also eliminate certain foods and then test them back over time. 

28:58  Dr. De Mello may also place the patient on low dose erythromycin 50 mg as a prokinetic to restore their intestinal motility, esp. if they have elimination problems.  He will typically treat SIBO patients for 90 days and then he will pulse it one week on, one week off.  When treating for SIBO he may also treat for candida with an herbal blend for candida.  If that doesn’t work, he will treat with nystatin for up to 3 mths as long as the liver enzymes are fine.

33:33  Dr. De Mello may order an Organic Acids test, esp. if there are no clear signs of what the cause of their gut symptoms are caused by. The other thing he finds may impact gut health are hormones.  For hormones, he prefers to test with blood and he asks women if they are still menstruating to run it between days 17 and 22 during the luteal phase, though he will sometimes use the dried urine DUTCH test.


Dr. Edison De Mello is a licensed psychotherapist and a board certified Integrative Physician.  Dr. Demello is the founder and medical director of the Akasha Center in Santa Monica.  His PhD dissertation was entitled “Gut Feelings – A Psychosocial Approach to Gastrointestinal Illness,” and he is committed to integrating the mind and a person’s emotional and spiritual health and body into his approach to health. Dr. Demello has recently published his first book, Bloated: How to Reclaim Your Gut Health and Eat Without Pain.  

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. I’m very excited to be interviewing Dr. Edison De Mello today, who’s our special guest. Dr. De Mello is a licensed psychotherapist and a board certified integrative physician. Dr. De Mello is the founder and medical director of the Akasha Center in Santa Monica. Dr. De Mello’s PhD dissertation was entitled Gut Feelings-A Psychosocial Approach to Gastrointestinal Health. He’s committed to integrating the mind and a person’s emotional and spiritual health into his approach to treating patients with digestive disorders. Dr. De Mello has recently published his first book, Bloated? How to Reclaim Your Gut Health and Eat Without Pain. We certainly need to know about that. Dr. De Mello, thank you for joining us today.

Dr. De Mello:                     Thank you for having me here, Ben, and thank you everybody out there for listening to us this morning.

Dr. Weitz:                          Absolutely. Dr. De Mello, why do people have so many gut problems these days, including stomach pain, bloating, gas, diarrhea, constipation, et cetera?

Dr. De Mello:                     Well, that’s the million dollar question, right? I know we’re dealing with a horrific epidemic right now, and I don’t mean to diminish, certainly, all the suffering, and all the death, and all the desperation of this epidemic, because I’m one of the physicians out there in the front lines, but there’s another epidemic happening.

Dr. Weitz:                          The epidemic within the epidemic, as I’ve heard Dr. Bland say recently.

Dr. De Mello:                     Exactly, exactly. As we know, health starts in the gut and we’ve heard this throughout our lives in medicine, that the gut is the carburetor of our health, basically. Without the gut, we wouldn’t be able to function. We wouldn’t be able to correctly metabolize our hormones. Because of lifestyle and because of the toxicity of the environment, because of stress, and because most of us have not really sat down and asked ourselves, “What is my relationship with food? How does my body receive this nutrient that it needs that is heavily necessary for our wellbeing?” If it’s not done correctly it can work against the very thing that we want to do, which is to be healthy.

Why do we have this epidemic? Again, I can go through a list of things with you, Ben, today, but I will start by saying we need to step back and ask ourselves, “Is what I’m doing in my life, is what I’m doing with my eating working?  Am I processing my food correctly?  Am I eliminating correctly?  Am I able to dedicate time to really allow my body to digest this food?” That’s where I start with my patients when they come in.  Certainly, the complaint that I hear most often, because of my double degree and the type of focus that I apply in my practice, the complaint is, “I don’t feel well.  I don’t feel comfortable. I’m embarrassed.” If it’s a woman, “I look like I’m pregnant.” If it’s a man, “I have a beer belly, even though I don’t drink that much,” and so the question is, what is your body telling you?  What is the message that the body has to tell you that something is off?

The first thing is, look at our lifestyles. Look at how we relate to the very nutrient that we need. The second thing is the ability to listen to the message that the body has for us. We are all about communication, and the body’s no different. The language of communication in the body to relate to us is called symptoms. Our job, as the host of this body, is to stop and listen and say, “Hmm. I keep hearing the same message. I eat and I don’t feel well. I eat and I cannot eliminate.” Or, “I feel bloated.” Or, “I don’t feel healthy.” What’s going on? When you pose that question, I think you have walked halfway into a possible answer.

Dr. Weitz:                          It’s amazing that we get all these signals and yet, most people are totally oblivious to those signals, partially because of all the noise, and all the things going on, and the messaging about eating unhealthy foods that just happen to be profitable. What I have found is a lot of people are not at all attuned to those messages.

Dr. De Mello:                     No. First of all, I think when we have symptoms or disease, we usually think of it as the enemy and we want to fight it off. When we do that, we spend so much energy on the symptoms, trying to fight it off, rather than stopping and saying, “What is the message?” Actually, as obvious as it may sound, as a result, okay, so this body, like I said before, is trying to tell me something. Let me take notice of it. The first thing that I do, Ben, when a patient comes in is try to figure out who this person is. Who is this person who happens to have a condition? Because when we connect with a person and we find out what his or her views of disease are, what the lifestyle is, what the relationship is with food, why now? Why bloating now?  When we stop and meet the patient, before we meet their diseases, again, I think there’s a great deal of information that we can get from those patients. As you know, being in that space of functional medicine yourself, that’s the cornerstone of integrative medicine, of functional medicine, is to meet the patient, is to let the patient be part of this incredible journey that we’re doing in discovering the message that the body’s trying to tell us.

Dr. Weitz:                          Your book’s about bloating. What do we mean by bloating? What is bloating? How is this different from gas? What’s the significance of bloating?

Dr. De Mello:                     Okay. Excellent question. In the book, I try to explain the difference between bloating and swelling, right? So-

Dr. Weitz:                          And bloating and fat, and bloating and a lot of things, right?

Dr. De Mello:                     Exactly. Bloating and fat, as you said. Bloating’s a condition where it’s gas, basically. It’s a lot of gas in your body, and there’s no rhyme or reason when it’s going to happen. Sometimes you eat, and soon after you eat, your belly extends where you feel like you have a watermelon sitting there. Other times, it takes a couple of hours. It can even take a day, which is a delayed hypersensitivity reaction to whatever you’re eating.

Bloating is completely separate from fat. You know fat takes a little while for you to build in your body when you we don’t eat healthy, when our hormones are not metabolized. It progressively increases and it gets worse and worse. With bloating, you have it one day, the next day you find a way to diminish. The next day, the day after that it gets worse. It’s this kind of ongoing battle, where there are days that you can close your jeans, there are days that you can’t. You ask yourselves, “I didn’t do anything differently.” Here’s a question that I hear the most, Ben, “But Dr. De Mello, I hardly ate anything yesterday. Why am I bloated today?” I say, “Well, let’s have a little talk with your gastrointestinal bacteria. Let’s talk to your microbiome and see what’s happening there.”

Dr. Weitz:                          Once we’ve ruled out some of the most severe pathological conditions, which we don’t see too often, like fluid from liver or kidney disease or congestive heart failure, what are some of the most common reasons for bloating?

Dr. De Mello:                     Yeah, so thank you for qualifying that for our great listeners out there. We have to, before we move into the bloating wagon, we need to rule out any potential medical reasons, physiological reasons for that. As you said, it could be anything from a liver condition, where you’re retaining water. It can be your kidney as well. It can be congestive heart failure. It can be a multitude of things that we healthcare professionals will focus on eliminating, starting with perhaps a simple imaging exam or imaging test such as an ultrasound and also looking, of course, at labs.  Once that is ruled out, the most common reason for people to have this bloating disorder, bloating condition is a dysbiotic gut, meaning your gut is out of balance. Here’s the interesting thing about bacteria that we all know. Bacteria is incredible, helpful, to our lives, from making our incredible wine, to making cheese, to helping with our gardening, to helping even clean our environment. Bacteria is, can be incredibly helpful to a very, very good lifestyle, but as I wrote in a paper once, called Bacteria: Friend or Foe? bacteria can also kill you. When you go into the hospital, you can have several reasons or several possibilities why bacteria has overgrown, from a simple cut that was not well taken care of, to a surgical condition that became a problem, to a multitude of other things that could lead to bacteria overgrowth.

The question is, “How do I look at this bacteria overgrowth? How do I balance my microbiome?” The first question, again is, “What am I eating? Is there a connection between what I’m eating and this bloating that happens?” Not only, “What am I eating?” but, “What have I been fed?” as well. For instance, we often say, “We are what we eat,” and I add a little bit more. I say, “And what we’ve been fed.” Because as kids, we don’t have a choice and sometimes, as patients, we don’t have a choice. We’re fed antibiotics, and for good reasons, a lot of the times, to saves our lives.  When we’re fed the bad foods, the bad antibiotics, the multitude of medical intervention meant to help us stay alive, in most cases, it does the job of helping us stay alive but also diminishes the overall function of our immune system because, as I said, health starts in your gut. Your gut is the seat of your immune system. The idea is to say, “Okay. If I need to take this antibiotic, or if I need to take this medication, how can I help my body break it down?” One of the most important things out there is probiotics. How many times do we hear in traditional medicine, when a patient come in to say, “My doctor put me on antibiotics for a sinusitis or for pneumonia,” and we say, “Did she or he tell you to eat a bit differently when you’re on antibiotic? Did he tell you to take probiotics, to exercise to sweat this thing out of your body? How about drink water?”  The idea is to really be able to support the body to be able to process those things out of your body, out of the body including some foods, including antibiotics, including even our vitamin and supplements. The idea is to allow the body to digest it better. How do you do that? You do that by, first of all, stopping to ask yourself, “Can I dedicate a specific amount of time to my eating, or am I eating on the go?” Then secondly, will say to yourself, “I’ve noticed that when I eat these foods, I don’t feel good. Can I do a process of elimination, and do elimination diet?” Third, you can say, “I wonder if my hormones have been checked, so let me talk to my practitioner about that.” Because if your hormones are off, so is your metabolism. You can go through a list of things that can help you get to this idea of, “Why am I bloated?”


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Dr. Weitz:                          Let’s say, and this question, let’s answer it both from the perspective of an educated patient as well as a practitioner. A patient has bloating. How do we go about the process of figuring out what some of the causes are? You mentioned dysbiosis. Of course, dysbiosis is somewhat of a diagnosis, but it’s kind of a general one. It means that there’s some imbalance in the gut bacteria. Within that general sort of larger diagnosis, we have small intestinal bacterial overgrowth. We have overgrowth of candida and fungus. We have other bacteria that could be overgrown like strep or Prevotella. We have parasites, we have food sensitivities, we have H. pylori. How do we now drill down, what sort of tests and procedures do we want to do to figure out exactly what is the cause of bloating in this patient?

Dr. De Mello:                     Yeah, so again, excellent question. I start with the big ones. I want to do a breath test for H. pylori.

Dr. Weitz:                          Okay.

Dr. De Mello:                     There’s a great deal of patients out there who have H. pylori and they don’t even know it. They have GERD or acid reflux. They have bloated, they don’t feel good. They feel the energy is much decreased than it used to be, so I do the breath test for H. pylori. Depending on the history, if the history is also the history where bloating just suddenly come, then I will also do a SIBO test. The SIBO test, as you mentioned, is small intestinal bacterial overgrowth. The SIBO test, it’s a breath test, and then we usually do it in the office or we teach our patients how to do it at home. Depending, of course, on the patient’s financial ability and insurance protocol, I will also order a stool test. I personally love the Genova’s three-day stool test.

Dr. Weitz:                          Okay.

Dr. De Mello:                     That is because I’m looking for not only an assessment of your microbiome, the patient’s microbiome, but I’m also looking for other microorganisms growth that is in there. I’m looking for digestive enzymes. I’m looking for the metabolites coming out of the patient. The three-days really yields a lot of more information, so those are the three big ones.

Dr. Weitz:                          This is the Genova GI Effects stool test, the three-day one.

Dr. De Mello:                     Yeah.

Dr. Weitz:                          Which SIBO breath test do you do?

Dr. De Mello:                     I work with Sam Rahbar, who’s a gastroenterologist.

Dr. Weitz:                          Yeah, yeah. He’s a good friend of mine. He’s been on the podcast a number of times. Yeah, yeah, yeah.

Dr. De Mello:                     I use his test that he-

Dr. Weitz:                          Oh, okay.

Dr. De Mello:                     The reason I do that is because I can call Sam when I get the results and I say, “Wait, wait, wait. Can you explain this to me here? The patients have this and this symptoms, but it’s not correlating with the results.” Sam being who Sam is, he gets right to it and say, “Okay, here’s why,” and so I’ve been doing that with him, using his lab for SIBO for a number of years.

Dr. Weitz:                          Okay, that’s great. Then, so let’s say you get some positive results. Let’s say the SIBO breath test comes back positive for methane SIBO, and the stool test shows some overgrowth of certain bacteria, or maybe candida, and maybe some issues with a lack of digestive enzymes. Where do you start? Do you treat multiple things at the same time? Do you try to prioritize? What’s your approach to treating gut issues?

Dr. De Mello:                     Yeah, I focus. I try to stay really laser-focused on what is this, what condition or symptom is disturbing the patient the most? Because, of course, when we are bloated there could be an N number of possibilities and a million things that we can do to get to the bottom of it. That alone can overwhelm anybody. It can overwhelm me when I’m looking at a patient and go, “There’s so many steps for him to take.” The first thing that I do, and it’s going to sound repetitious, but I meet the patient and I want to know, “Is this the right time for you? Are you ready to do this?” Because here’s what happens, as we know, and this is the psychologist hat that I’m wearing here right now, Ben.  As we know, we can set up our patients for failure without knowing it. Of course, we don’t mean that. We want to help the patient, but if we don’t know what his lifestyle is like, if we don’t know what his emotional life is like, the demands on him is like, and we say, “Okay. You have to do this, this, and this,” and he’s going to be looking at you because he respects you as a practitioner. After all, he came to see you. He’s going to say, “Yes, yes, yes,” and he’s going to go home and start pulling his hair out. Literally pull, not his hair but his head or his neck because there’s so much going [inaudible 00:20:51], and so I want to make sure that I’m not overwhelming the patient.

I love that saying, “You cannot feed a starving child a piece of steak,” because the child doesn’t have the metabolism for it, just been starving. If a patient is that full of symptoms and that overwhelmed in life, I want to know. I want to know, what is it that I can do? So I’m going ask him. First, I said, “Okay, so here’s the diagnosis. You have SIBO and it’s curable, but it will require your attention. It require that you really spend time deciding what you’re going to eat. We’re going to give you a protocol. Taking your supplements, sweating a lot, exercising to get these toxins out of your body. Tell me about your lifestyle right now. Is there something that you can do?” Then I will list the things to them, and so they will look at me and say, “Well, I think so.” I say, “Okay. Let’s make a list of the things that you can do.”

Dr. Weitz:                          “I don’t have time for all that. I don’t want to change my diet. Just give me something to take.”

Dr. De Mello:                     Exactly, exactly. I’ll say to them, “It won’t work. It’s only going to frustrate you. It won’t work,” and so I try … Then given their lifestyle, let’s say somebody who’s a single mom, and working during the epidemic and trying to keep the kids at home. I cannot tell her to go exercise every day, or to go into an infrared sauna and have the luxury of sweating out some of the toxins, but I can say to her, “Okay, so given those things on the list that you can do, pick three that you can do right now.”  Of course, one of them has to be a set of supplements and herbs that I can help the patient with. Once we determine the lifestyle and the question of, is the patient ready to do this? Then I will present the patient with the plan. The plan, usually, if let’s say if it’s SIBO, will involve what I refer to as the Johns Hopkins protocol. It’s the paper that came out about seven years ago that revolutionized the field. I know you’re familiar with it.

Dr. Weitz:                          Yes, of course. Yeah.

Dr. De Mello:                     Yeah. Where it showed that Rifaximin, Neomycin and Flagyl together was very helpful, but a set of specific herbs that they studied called FC Cidal, Dysbiocide and Candibactin from Metagenics was actually equally effective.

Dr. Weitz:                          Right.

Dr. De Mello:                     I put them on that protocol to start with. Three supplements in the morning, two of it, and then that makes six pills, plus at dinnertime. Then, of course, I will look at other physiological needs of the patient, including hormonal therapy.

Dr. Weitz:                          Let’s drill down for a minute on your specific protocols for SIBO. The patient, we’ve identified SIBO is their primary issue, so you’re going to put them on some of these antimicrobial herbs. Are you going to put them on, what type of diet? Are you going to put them on a low FODMAP diet?

Dr. De Mello:                     Yeah, depending on, again, the lifestyle of the patient. Let’s say it’s somebody who can do, who can follow the protocol. A FODMAP diet is the first diet that I start with, and I let the patient … I give them the guidelines, and I say, “Let’s see which food on this list you can, indeed, consume without having some of the bloating that you may have experienced in the past.” I’ll ask the patient if some of those foods have caused bloating. If financial means is not a problem, then I’ll also do a food sensitivity. I usually, I really like Metagenics … Excuse me. Cyrex.

Dr. Weitz:                          Cyrex.

Dr. De Mello:                     Yeah, using the food sensitivity, the leaky gut sensitivity. Because the worst thing for those patients is that we say to them, “Here’s the FODMAP list of foods,” only to later on find out that they have sensitivity to some of those foods. If they can do the test or afford the test, I’ll do the test. In some situations, they can’t. Then I do an elimination diet. I go through the list of foods that they know they have experienced a relationship to bloating, cause and effect, and I will remove those foods from the FODMAP list.

Dr. Weitz:                          Okay, so you’ll combine a low FODMAP and elimination diet to start with?

Dr. De Mello:                     Yes, yes. Again, because I want to empower the patient.

Dr. Weitz:                          Right.

Dr. De Mello:                     Right?

Dr. Weitz:                          Now, the low FODMAP diet already eliminates a number of foods that people would typically take out. It eliminates dairy, and gluten, and beans. What is some of the other foods you’ll eliminate in the elimination aspect of the diet?

Dr. De Mello:                     Well, I want to know if the patient, for instance, if the patient can tolerate oat, for example. I tell them oatmeal is a good source of complex carbohydrate.

Dr. Weitz:                          Well, let’s say they don’t know.

Dr. De Mello:                     Then I’d say to them, “Well, let’s, before we start you on this diet here, why don’t you eat this food for three to five days, and let’s see how you’ll feel once you’re at the end of three days.” I want to make sure that some of the foods that I’m going to give it to them, if they haven’t done the sensitivity test, that they know whether or not it’s one of those trigger foods for them. Right?

Dr. Weitz:                          Okay.

Dr. De Mello:                     I will involve them in their own elimination diet before I will give them the FODMAP, if they don’t have the food sensitivity test onboard.

Dr. Weitz:                          Right, okay. What are some of the other common foods, besides oats, that you see are problematic?

Dr. De Mello:                     Well, a lot of patients, believe it or not, even though they can have some fruit in the FODMAP, even some of the berries that we recommend, they have a hard time breaking down some of those fruit, including berries, for example, that I’ve seen. Again, I tell them, “What do you put in the berry? How do you eat the berry?” Because sometimes they think it’s the berry, only to find out that it’s the coconut milk that they put in the berry, but it was not the coconut milk. It was they added things to their coconut milk.  You can take this so far, so long down the road of trying to find out, through elimination diet, what the patient’s actually sensitive to. We know it’s not a food allergy because they would know, but food sensitivity’s so hard to detect, as you know.

Dr. Weitz:                          Right. And probably changes over time, depending upon leaky gut, and how often they’re eating it, and things like that.

Dr. De Mello:                     It does. It does, and that’s why I also think that it’s really great for patients to be able to design their own diet. It gives them power. I give them the FODMAP, for instance, the FODMAP guidelines. Within FODMAP, I want them to tell me which diet, number one, they can stick to and which diet they think, it’s going to work for them. In that regard, I become a consultant to the patient who is receiving the information from her or his body, and I’m only consulting with him or her based on what they’re saying. I think that empowering patient, especially with SIBO and bloating disorders, is essential for the success of the treatment.

Dr. Weitz:                          Now, some of the other strategies that some of the doctors in the SIBO world employ include addressing potential motility issues, because we know that there’s this potential autoimmune origin of SIBO, where you have this damage to the migrating motor complex, so some practitioners will use either prescription or natural prokinetic agents. Do you ever use those?

Dr. De Mello:                     Yes, yes. If the patient has elimination problem. If the patient has an elimination problem or it’s irregular, then I’ve tried a couple of natural ones out there, but the one that I really like right now that is bringing a lot of benefits to my patients is actually erythromycin, 50 milligrams. I found that it’s-

Dr. Weitz:                          Low-dose erythromycin.

Dr. De Mello:                     Low-dose, yeah. I have it formulated. Again, I feel that for most of my patients, they’re really able to respond well to that. To the point where, before I stop the erythromycin, usually, I’ll give them a break after 90 days because that’s how I treat SIBO, for 90 days, and then I try to scale back. Then I may even do erythromycin every other day. Including also the SIBO protocol, the so-called Johns Hopkins protocol the way I referred to it. If the patient is doing well after 90 days, I will not stop it, I will pulse it. I would do one week on, one week off, just to see how the patient does to try to get to the big question of bacterial seeding. It seeds there, it stays there, and so instead of stopping altogether, I like pulsing the medication.

Another thing that I think is important with these patients is even though they may test negative for candidiasis, I often assume that there’s candidiasis in there, even as you know, it’s one of the most difficult microorganisms to detect. Depending on the severity of the symptom, part of my protocol will include putting the patient on either a natural anti-candida protocol using oregano oil, using, really, a blend that I love, it’s called [gamma 00:31:35] oil, which it has olive oil, has a lot of turmeric, it has garlic, it has basil. It’s like this incredible combination of herbs. Really, herbs that have been studied for many, many decades out there in integrative medicine. I like using that. When it doesn’t work, then I will go to nystatin and start them on nystatin. Again, sometimes for three months, depending on the liver enzymes are good and everything points to that being a good thing for them, I’ll start them on nystatin and then scale back and put them on the natural ones.

Dr. Weitz:                          Now would that be concurrent with the antimicrobial SIBO treatment, or before or after?

Dr. De Mello:                     No, I usually do concurrently. I’ve spoken with a number of colleagues in the field, and people do it differently. Some people do it as part of the protocol. Some people do it after the protocol. I do it based on the symptoms of the patient. If the patient has symptoms that clearly indicate there is a candida element, some women with a lot of discharge, the coating on their tongues. I can also look at any rashes that they have that can become really beefy-red all of a sudden. There is the whole picture of candida that we can tell.  Also, a lot of people who may have negative test for methane, which gives the foul smelling to our gas, even though they may have test negative for methane, there’s a lot of odor to their elimination, I will think of candida and I’ll say, “Let’s try to see if we can mediate that with a little bit of an approach to candida.”

Dr. Weitz:                          Some practitioners do an organic acids test. They feel that that’s a more accurate way to pick up candida overgrowth.

Dr. De Mello:                     Yeah, the OAT Test. We use the OAT test a lot, especially because of the pandemic, but I use that when I’m not really clear, there’s no signs, Ben, and I’m kind of like on the fence about it, the patient can afford. As you know, it’s an expensive test insurance doesn’t cover. Sometimes I ask myself, “Will the OAT test change my approach? If the answer is yes, then I will do the OAT test. In most cases, it’s no, it’s not. The patient clearly has a symptom, and maybe a lab will show but maybe not so, “Let me try this kind of litmus test,” even for 30 days, and see how the patient respond.

The thing that I also think it’s missing in our field out there is trying to, once the patient starts feeling better, is really looking at the person’s hormone metabolism and see, how are their hormones working for them? Is it time for us to think about hormonal replacement therapy? Because sometimes, fatigue and not really feeling, not being able to digest the food, a lot of the symptoms of SIBO, as we know, become enhanced or gets worse when our hormones metabolism in addition to SIBO, of course, is not balanced.

Dr. Weitz:                          How do you prefer to test for hormones?

Dr. De Mello:                     Well, we blood test. It’s our go-to approach. For women, if they’re still menstruating, we try to do it between day 17 to 22 during the luteal phase. For men, we do it whenever he has the time to come in. I think a blood test is the best way to go. Sometimes we’ll also use the DUTCH test for, to see if there’s anything else going on with that. We may even do a urine test to test through urine as well. I think, especially with COVID, there’s so much going on in terms of really being able to get to a treatment that works for patients to patients as soon as possible, that I think the blood test offers the best and quickest approach to assessing hormone metabolism.

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Dr. Weitz:                          One more question on SIBO. Does your approach differ if the patient has hydrogen, versus methane, versus hydrogen sulfide SIBO?

Dr. De Mello:                     You know what? That’s a question that I was asked about a week ago also by another- [crosstalk 00:37:56]

Dr. Weitz:                          Oh, really?

Dr. De Mello:                     Yeah. For me, it really doesn’t because I have found that, in the years that I’ve been doing this, that the most people will have a hybrid of those two gases together. One may be more dominant than the other, and I equate this to looking at people’s hormone. A woman may be estrogen-dominant versus not, but the approach to treating their hormone balance will change, but not drastically. We’ll just have to pay attention to that other part. When it comes to SIBO, because it is so difficult to pinpoint a precise diagnosis, I will focus on what the lab is saying, methane-dominant, hydrogen-dominant, but I will actually, when I develop a treatment, I will treat both.

Dr. Weitz:                          Okay. Since your background in psychology makes you, in many ways, a unique practitioner, if you determine that in a given patient with bloating and other gut symptoms that mental and emotional issues are playing a significant role, and this question is probably more for functional medicine practitioners, what sorts of tools or strategies, other than simply referring a patient to a counselor, can functional medicine practitioners do when they’re treating a patient for gastrointestinal symptoms that have a significant mental or emotional component?

Dr. De Mello:                     Excellent question. I know how busy most of us are, especially with the pandemic, but the number one thing that I would suggest that we do is to listen, to listen to the patient, to listen to our own judgment that we may have. We all have it. The question is, how much? Is it a judgment? Is it a discernment? I think, listening to our patients, relating to the patient. Taking a step back and say, “How would my life be affected if I were that patient right now with SIBO, with not feeling good, having to take care of the kids, not feeling sexy. Feeling that, ‘No matter what I do, I failed”? Because a lot of patients come in with a multitude of steps they’ve taken before that either worked for a little bit and stopped or never worked.  The first thing that I check, and I do a self-assessment is, “Can I leave my judgment out the door, and can I be here with this patient, no matter what he looks like, what she looks like, what my feelings might be? Let me listen,” so listening to the patient and putting yourself in their shoes, I think, is the best step, the first step. The second step, and a very excellent question, Ben, is to say, “What is the purpose of this condition right now in this person’s life?” Not to say that I believe that people can sit down and basically muscle themselves into a condition, all the time. That is possible. It’s not common.  What’s common is that people come in with a condition that relates to a particular incident in their lives or particular situation. My job is to try to connect the dots with them, without depowering them, by not saying, by not letting them for one second think that I’m implying that it’s all in their heads. It’s not. Even when I don’t know why and it doesn’t meet my scientific evidence, I still want to let the patient know that I believe what she’s saying or that what he’s saying. The second step, for me, is to try to see what the connecting dots is.

About three weeks ago, I had a female patient who came in, very, very bloated. She had been to some of LA’s great doctors, some of whom are really good friends of mine and have actually become people that I look up to when I have questions. She felt very deflated. She felt that nobody was listening. She felt that everybody, the main question that people are asking her is, “Are you pregnant?” The book talks about a case, to use the book, it talks about a case like that. It became very interesting, quickly after that.  She’s a single woman. Her clock is ticking and she’s not pregnant. The question is, I had to be very careful in navigating is, “Would you like to have a baby?” The answer was, “Yes,” and so there’s this really discomfort in her psyche, this duality of her feeling really upset that people are assuming that she’s pregnant, but actually there’s a part of her that goes, “Oh, this is what I would look like if I were pregnant,” so we had to talk about that. We had to talk about this discord. If she is feeling upset about it, there’s a part of her that actually likes when she looks in the mirror and she sees her belly protruding out. Really helping her understand that those two things are not jiving in her psyche, that we need to go in and make peace with it, so that’s one case.

As we know, disease can have secondary gains. For her, the secondary gain was that she really wanted to get better, but she actually was dubious about the fact that, or was curious about the fact that she looked pregnant. Sometimes it’s like the feeling, so what is the secondary gain? A guy who is not happy at home, who doesn’t feel connected with his wife, who has a protruding belly. Is this an excuse for him not to be intimate? Is that another excuse? Let’s talk about that. We talk about SIBO. We do everything in the protocol, but let’s talk about what else is under the hood. This is if the patient wants to or is ready to talk about that.  I think exploring who the patient is, connecting with the patient, asking questions. “If bloating had a message for you,” I ask them … “This is going to sound weird,” I tell them. “It’s going to sound really weird, but if bloating had a message for you, what would the message be?” They kind of go, “What?” I say, “Sometimes, disease can have a message for us. If bloating could whisper something to you about why it’s there, what would it whisper?” Right?

Dr. Weitz:                          Right.

Dr. De Mello:                     Really looking at those pieces, I think it’s important. I understand that a lot of us don’t have the time to do that, so there were times that I didn’t have the time during the pandemic, the height of the epidemic in California that I had to see people for shorter amount of time, but I would pose those questions via email to them and say, “Okay. Here are the questions. Here’s what we found out. Here’s your treatment. Here’s the questions that I’d like for you to answer,” and so I would pose those questions. Some people, the posed questioning, writing was more comfortable than being asked right in the session.

Dr. Weitz:                          Right. Interesting.

Dr. De Mello:                     Did that answer your question?

Dr. Weitz:                          Yeah, absolutely. You’re an excellent writer and one of the things that makes your book very readable is the stories that you weave in-between, and really makes your book very human and not just like a medical textbook.

Dr. De Mello:                     Yes. Thank you, Ben. I had to really think about, how do I want to write it? What do I do to write a book about a topic that is so uncomfortable? Who talks about poop? We have a culture where that is a taboo. We don’t talk about it. When I ask my patients, “What does your poop look like? What is the texture?” I have to make a joke before we do that because otherwise, people feel a little embarrassed or a little funny, so I wanted-

Dr. Weitz:                          I noticed you put in the first chapter that research shows that humans fart 14 times a day.

Dr. De Mello:                     They do. It’s normal. They’re not the silent killers that we hear on an airplane, or that when we sit next to somebody on the airplane, we want to dash out the door. It happens. What I wanted to do, I wanted to make people with this condition understand that they’re not alone, and understand that it’s something that happens more often than they know, and that it’s just a matter of it exists in a spectrum. There are people who are really, really bloated beyond explanation, that we haven’t been able to move the dial, and those are people with severe gastrointestinal dysbiosis, SIBO, and there are people who have bloating occasionally. They eat something, they don’t feel good. They notice that, again, the jeans are not closing, but bloating is a condition that is an equal opportunity condition. It doesn’t discriminate. Whatever your socioeconomic background is, your ethnic background, your age, bloating is there. I see kids who are bloated. I see elderly who are bloated, so the two spectrums of the population.

What I think the book brought, where the book was successful is that it told people stories. Why do we go to the movies? We want to hear stories. Why do we read novels? We want to hear stories. Why we watch TV shows, especially during the pandemic? Why is Netflix now a multi-billion company? Because we want to hear stories that we can relate to, and that was my goal in the book. It was to create a sort of a manual, where people could go through. Basic to a lot of people who have already done this, but really important to people who have no idea where to start. I wanted to offer them some of those guidelines, while also telling them, “Look, let me tell you some stories that you may relate to,” and I had some good laughs during it, so …

Dr. Weitz:                          Do you know what? I just want to throw in one more question. I know we only have about three minutes left, and it might not be enough time to answer this, but we didn’t bring up probiotics. I’m sure that’s a question a lot of people would want to know. Some practitioners I’ve spoken to don’t believe in using probiotics because if there’s bacterial overgrowth, “Let’s not throw more in.” Some practitioners feel that probiotics are actually the first thing you should do, the primary intervention. Other practitioners do like to use certain probiotics along the way because as we’re killing the bad bacteria, we want to replace them with the good bacteria. What’s your feeling about the use of probiotics while treating patients for conditions like SIBO?

Dr. De Mello:                     Yeah, all of the above. Very simple.

Dr. Weitz:                          Spoken like a true politician.

Dr. De Mello:                     Yeah, I know, I know. Again, Ben, who is the patient and what is the symptom? Where does the symptom fall within the spectrum? What I will usually do with probiotics, I will get a history of whether or not probiotics have helped them. Most of the patients will have taken probiotics because their friends told them to, or another doctor told them to, so get a history. Has probiotic made it worse, made it better, or no difference? If, certainly, has made it worse, I’m not going to use it.

Dr. Weitz:                          Of course.

Dr. De Mello:                     If it has made it better, I will say, “Let’s do this. Let’s do one week, two weeks with the probiotics and two weeks without and see where you stand, where your body stand.” If it’s neutral, then I will do the same thing. I will start two weeks on and then stop for two weeks and see what happens. I think where I’ve made mistakes before, and I think some of my colleagues out there can relate, is when we try to put everybody on the same protocol like a pigeonhole.  The way I explain this when I speak is that, look, there’s eight billion of us on the planet and there’s eight billion fingerprints, so we cannot be treated the same. We have to be treated as unique individuals. That’s what I try to do, so that’s why I said, “All of the above,” because it depends on who the patient is, and I think probiotic is one of the most important approaches that we can use in trying to optimize the microbiome.

Dr. Weitz:                          That’s great, Dr. De Mello. Thank you so much for joining us. How can listeners and viewers find out about getting your book, and find about seeing you, or coming to your clinic, or doing consults with you or your colleagues?

Dr. De Mello:                     Thank you. The website is akashacenter.com. It’s A-K-A-S-H-A, akashacenter.com. You’re going to have a list of services and programs that we offer. The book, there’s its own landing page. It’s called bloatedbook.com. Just bloatedbook.com. You can also go to Amazon. It’s on Amazon, it’s on Barnes & Noble and Apple. On Amazon, you can just say, “Bloated by Dr. Edison De Mello” and it gives you an option of what kind of format you want, Kindle or paperback.

Dr. Weitz:                          Excellent.

Dr. De Mello:                     Yeah.

Dr. Weitz:                          Thank you so much, Dr. De Mello.

Dr. De Mello:                     Thank you for having me, Ben. I appreciate this hour with you.

Dr. Weitz:                          It’s been a pleasure.



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.




Probiotics For Diabetes with Dr. Colleen Cutliffe: Rational Wellness Podcast 228

Dr. Colleen Cutcliffe speaks about a new Probiotic that helps to manage Diabetes with Dr. Ben Weitz.

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


Podcast Highlights

0:30  Akkermansia mucinophila is a new probiotic on the market. Because it is an anaerobic bacteria, it is very difficult to manufacture it, since it needs to be produced in an oxygen free condition. If even a single molecule of oxygen is present in the manufacturing process, the whole batch of Akkermansia dies.  Pendulum Therapeutics managed to solve this problem by creating an oxygen-free manufacturing process.  They are offering a product that contains Akkermansia and several other probiotics and a prebiotic in a product called Pendulum Glucose Control, which has been shown to reduce blood sugar spikes and hemoglobin A1C in a clinical trial.  Improvements to postprandial glucose control in subjects with type 2 diabetes: a multicenter, double blind, randomized placebo-controlled trial of a novel probiotic formulation

8:57  Akkermancia has been well studied and has been shown to be beneficial for helping with inflammation, immune response, obesity, metabolic syndrome all the way through type-2 diabetes, and leaky gut.  It lives in the mucin layer in your gut and it helps to regulate that mucin layer and make sure it’s the right thickness so that all the small molecules being generated in your gut are staying where they’re supposed to be and that they can get access to the receptors that they need to bind to in the gut lining for the downstream signaling pathways to be operating properly. The challenge is to grow Akkermansia in an oxygen free process but make sure that you provide all the ingredients needed for this strain or probiotic to grow and thrive while not being attached to a mucin layer.  And you have to create a product that’s stable at room temperature so that you can sell the product and it needs to be functional in your gut as well.

16:50  Pendulum Glucose Control includes strains of probiotics that produce butyrate, including Akkermancia, as well as a prebiotic. It was reasoned that if you could increase butyrate production, you could help people improve their LGLP-1 response and their insulin/glucose control.  A placebo-controlled double-blinded randomized trial found that people who were taking Pendulum Glucose Control versus placebo had a Hemoglobin A1C lowering of 0.6% and a lowering of blood glucose spikes by 34%.

18:16  GLP agonists are drugs prescribed for diabetes patients and they are being looked at as potential longevity promoters. Butyrate production is upstream of GLP-1, so stimulating butyrate production can promote the release of GLP-1 agonists.

21:42  Non-alcoholic Fatty Liver (NAFLD) is a major health problem today and it is related to dysregulated glucose control and their study did show that Pendulum Glucose Control reduced the ALT and AST enzymes that indicate improved liver health.

22:14  The effect of Akkermansia probiotics on the gut. Nine out of ten people who took their product reported improved gut symptoms, though there has been no trial specifically on that.  Akkermansia may improve the health of the gut by improving the mucin layer, which is the gut lining.



Colleen Cutcliffe, PhD is a CoFounder and the CEO of Pendulum Therapeutics, which developed Pendulum Glucose Control, which is the first and only probiotic that lowers blood sugar spikes and hemoglobin A1C in a clinical trial.  Pendulum Glucose Control is a probiotic and prebiotic product that contains Akkermansia Mucinophila along with several other strains and inulin from chicory. You can get more information about Pendulum Glucose Control by going to PendulumLife.com and if you use the code WEITZ20 you will receive 20% off your first order.

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, our topic is about a new probiotic on the market for the first time known as Akkermansia muciniphila. Thanks to Pendulum Therapeutics. And we will be having a discussion with Colleen Cutcliffe, PhD and co-founder and CEO of Pendulum Therapeutics. Akkermansia muciniphila has been discussed as one of the more important bacteria that exists in the microbiome of the gut. But it has so far not been available to the public.

Akkermansia muciniphila is a bacteria that grows primarily in the mucous lining of the large intestine. And it plays a critical role in maintaining this mucous layer and in supporting a healthy gut lining and preventing leaky gut. Akkermansia reduces gut inflammation. And patients with Crohn’s and ulcerative colitis tend to have lower levels. Akkermansia is also one of the primary butyrate producers. And this strain of bacteria improves insulin sensitivity and may reduce diabetes risk. It may play a role in reducing obesity. And it may also improve the response of patients with lung or kidney cancer who receive immunotherapy.  The reason Akkermansia has not been available on the market so far is that it is an anaerobic bacteria. So, it can only live and be produced in conditions where there is no oxygen. This makes it very complicated and expensive to manufacture. If even a single molecule of oxygen is present in the manufacturing process, the whole batch of Akkermansia dies.  Pendulum Therapeutics managed to solve this problem by creating an oxygen-free manufacturing process.

Colleen Cutcliffe, PhD, is co-founder and CEO of Pendulum Therapeutics which developed Pendulum Glucose Control which is the first and only probiotic that lowers blood sugar spikes and hemoglobin A1C in a clinical trial. Pendulum Glucose Control is a probiotic and prebiotic product that contains Akkermansia muciniphila along with several other strains and inulin from chicory Colleen, thank you so much for joining us today.

Colleen:               Thanks so much for having me, Dr. Weitz. I feel like that whole intro, that’s it. You got the whole story. I don’t know if I can shed any new insights here.

Dr. Weitz:            The only scary thing is every time I say Akkermansia muciniphila, if you say muciniphilia, it sounds like some deviant sexual thing.

Colleen:               I’ll tell you the trick in our company. We just call it A [muke 00:03:19] just to solve all that.

Dr. Weitz:            There you go. Perhaps, you can tell us a bit about your professional journey and how you came to start Pendulum Therapeutics.

Colleen:               Sure. My background is in pretty hardcore science research. So, I have a PhD in biochemistry and molecular biology from Johns Hopkins. I did a postdoc at Northwestern’s Children’s Hospital. And then, I moved out to the Bay Area where I worked for a pharmaceutical company. We were developing drugs for Parkinson’s disease. And then, I moved to a company called Pacific Biosciences which was building a DNA sequencing instrument. And it was an early stage startup company, went through rapid growth and went public.  And on the other side of that IPO, I started Pendulum with two co-founders. All three of us worked at Pac Bio together. We’re all three very technical. I’m a biochemist. Jim is a biostatistician. John is a biophysicist. And, really, the three of us, what we saw in the technology space was that even though things like probiotics and yogurts have been on the shelves for decades, it’s been the same kind of set of ingredients that have been mixed and matched in all these different products.  There hasn’t really been any new invention until the microbiome science has really started to emerge over the last decade. And the reason that the microbiome can even be a science is because DNA sequencing technologies have enabled us to really understand what are the microbes, what are their functions, what are they doing.

And so, we were coming from a DNA sequencing instrument company and realized that we had all the tools and technologies to be able to take microbiome samples and to develop kind of these microbiome maps of people, and think of it like a systems biology problem where you have all these different pathways in your microbiome. How are they connected to each other? How are they connected to our body? And then, I’ll just share that not only was there sort of a technical expertise. But as I started to learn more about the microbiome, I realized there was sort of a personal connection for me which was around my older daughter.  So, my daughter was born almost two months premature. And when you have a baby that’s born that early, you kind of get to hold them for a few seconds. And then, she was taken away to intensive care where she spent the first month of her life actually hooked up to all these machines and monitors and receiving multiple doses of antibiotics.

And there happened to be a study that came out right when we were thinking about this company where they looked at 12,000 children and found that babies under six months of age were systematically on antibiotics were also systematically more prone to obesity and type-2 diabetes as they grew older and became teenagers. And so, I realized, “Oh, my gosh. We could create novel products that could help millions of people including my own daughter,” and that the microbiome is this really unique opportunity where if you develop products with the scientific and clinical method, you can create products that have the efficacy of a drug but the safety of a probiotic. And that was sort of the origin story and mission of the company.

Dr. Weitz:            Yeah. I think it’s interesting. There’s kind of been these two trends in some of the research that we’ve been discussing on the microbiome and probiotics. And one sort of argument is that probiotics, in general, have a beneficial effect. There’s certain categories. And it really doesn’t matter which strain you have. And the other the other way of looking at things is that each strain is very different, can have specific properties. And it’s very important that we stop just looking at research on probiotics.  In fact, I recall talking to Dr. Pimentel when we were talking about research on SIBO. And he kept saying, “Look, you can’t tell me that this is a valid scientific argument to say that probiotics are beneficial. You’ve got these studies. They’re all using different probiotics, different strains. And you’re blending it all together. Imagine if we took a bunch of different drugs and said drugs are beneficial. It doesn’t work that way. You’ve got to get more specific about this.”  And so, I think that some of the research that you’re doing and that’s being done on some of these species like Akkermansia are super important because I think we are starting to see that particular strains have particular properties and these are not just captured by taking broad spectrum probiotics.

Colleen:               You’re absolutely right. And I think we’re just starting to get a more sophisticated understanding of these different strains and their functions, and what impact they have. So, I’m sure you get asked a lot from patients, “What vitamins should I take? And what’s going to be helpful for me?” And you don’t say, “Just take vitamins.” You know specific vitamins for specific issues. And I think we’re just starting to get there with probiotics.

Dr. Weitz:            Right. Now, you mentioned the fact that we’re having stool tests that use DNA. And one of the important things is that a bacteria like Akkermansia would not be picked up by stool tests that cultured bacteria.

Colleen:               Absolutely right because if your stool test is culturing based, then, it requires you to be able to grow these trains. And that’s been a fundamental problem in why the field hasn’t been able to make as much progress as we would like. It turns out that where all the business is happening in the large intestines there, it’s anaerobic. There’s no oxygen there. So, they don’t grow in the presence of oxygen.  So, if you kind of try to culture them in a non-anaerobic environment, you’re going to lose kind of all the meaty guys. They’re not going to be able to grow there. So, it’s got to be a sequencing-based approach or a metabolic-based approach in order to be able to capture these key strains.

Dr. Weitz:            So, let’s talk a little bit about Akkermansia and exactly what it takes to manufacture it.

Colleen:               Oh, man. It’s a diva. So, Akkermansia has been quite well studied internationally and has emerged as important for many of the things that you mentioned, inflammation, immune response, obesity, metabolic syndrome all the way through type-2 diabetes, and this leaky gut concept where it’s just really important that you have the right gut lining. It’s even been implicated in gut brain issues.  And the finding has been that in all of these different disease states, people appear to be low or missing Akkermansia whereas healthy people have a vast abundance of it. And the underlying mechanism is that it is actually living in your mucin layer and helping to regulate that mucin layer so that it’s just the right thickness, so that all the small molecules being generated in your gut are staying where they’re supposed to be and that they can get access to the receptors that they need to bind to in the gut lining for the downstream signaling pathways to be operating properly.  So, to grow Akkermansia, you kind of have to take all those conditions into consideration because that’s its home. That’s where it likes to live and thrive. And then, we live and thrive out here where there’s oxygen. And we’re not attached to a mucin layer, and we’re trying to grow at scale.

And so, really the challenge has been how do you create an end-to-end anaerobic process where you don’t let any oxygen in. How do you give the ingredients needed for this strain to be able to grow and thrive even though you’re not putting it right up in a mucin layer? And then, also, there’s a temperature sensitivity to it. And so, how do you try to get it to be room temperature stable so that you can actually sell the product?  And the most important thing is it’s got to have viability at the end of this entire process. And so, we actually have three different assays that we use to measure viability. Not just is the strain alive, but is it able to produce butyrate? Is it functional at the end of all of this manhandling? And that’s really key because Pendulum Glucose Control is delivering on a promise of reducing A1C and blood glucose spikes. And so, it’s not just the strains are in there. It’s not just a CFU count. It’s are they going to function in your gut?

Dr. Weitz:            Now, there has been a paradox in all the data related to probiotics. And the paradox is the following, is that we can test the microbiome. We can see which species are low and high or absent, et cetera. We can take specific species. But pretty much, all the data has shown that none of the probiotics we take become permanent residents. They’re just temporary visitors. But yet we know they have these beneficial effects.

Colleen:               Yes, absolutely. Actually, it’s sort of interesting because in our study that was published in BMJ, we did a washout period where people didn’t take the formulation. And then, we looked at whether the strains were still there. And this has been reported for other probiotics. For the vast majority of people, they were gone. But a small percentage around 15 to 20% of people, they still had the strains in their microbiome. And so, of course, the million-dollar question is why? What is it about them that enable them to keep the strains?  And the hypothesis that we’re testing and many others are testing is that there’s something about your microbiome ecosystem. And it is an ecosystem. So, you have to know that there’s a bunch of other things in there that have to grow alongside it. Everybody’s microbiome ecosystem is either going to enable new strains to colonize or not. So, I like to think of it like a garden. You’ve already got a garden that’s got all these plants and flowers growing it. And you’re trying to introduce a new plant.  Some gardens are not going to allow that plant to flourish. And some gardens are. So, what are the kind of things that you can do to your garden to help these new strains flourish? You can change your diet and provide the prebiotics that are really going to help these strains grow. So, higher fiber diets tend to really enable Akkermansia to grow, high polyphenols and things like that.  But, generally speaking, it’s kind of hard to account for all the factors that lead you to have the microbiome that you have. Your microbiome gets depleted over time through things like just aging, stress, circadian rhythm. Every time you go to a place where you have to change your days and nights, for women, menstrual cycles and menopause, these all cause you to become depleted. Well, you can’t really do anything about those things. So, you’re-

Dr. Weitz:            Not to mention all the antibiotics and pesticides sprayed on food, and herbicides, and all these things that kill bacteria in our gut.

Colleen:               Absolutely. So, then to ask this plant to thrive in a garden that you’re constantly spraying with things that are going to kill it, it’s pretty hard to do.


Dr. Weitz:            We’ve been having a great discussion. But I’d like to interrupt this discussion for just a minute to tell you about a new nutrition product that is very exciting. We all know that there’s a lot more to health than just healthy eating. And there’s a lot more to nutrition than just calories. Having a healthy microbiome is also a key to better overall health. And diet can significantly impact our microbiome. Over time, people with type-2 diabetes tend to lose some of the gut bacteria that helps digest fiber and manage our blood glucose levels.  A new probiotic, Pendulum Glucose Control is the first probiotic that can help rebuild your microbiome and help you to manage your blood glucose and your A1C levels. Take control of your glucose levels today. Visit pendulumlife.com. That’s P-E-N-D-U-L-U-M-L-I-F-E.com to find out more. And use the promo code Weitz 20. That’s my last name, W-E-I-T-Z 20, for 20% off your first order. Once again, that’s P-E-N-D-U-L-U-M-L-I-F-E..com. Promo code Weitz 20. And now, back to the discussion.


Dr. Weitz:            Let me ask you a quick clinical question. I don’t know if you know any answer for this. But as we were talking about the mucin layer, and we’ll get right back to Akkermansia. Besides Akkermansia, do you know of nutritional products that can help enhance the mucous layer of the gut?

Colleen:               I don’t know that there have been really kind of validated clinical trials around that.  And I would say also that the gut lining is a hard thing to measure without actually taking a biopsy of somebody’s gut lining.  But I think that some of the studies have really pointed to anything that really helps is actually pretty much tied to Akkermansia.  Anything that helps Akkermansia grow does tend to have these clinical outcomes of improved GI, improved digestion, and things like that.  And so, on that front, things with polyphenols, so, grapes, cranberries, things like that, they tend to help boost the Akkermansia growth in the lining as well as things that feed the butyrate producers, so, inulin, anything with inulin and Jerusalem artichokes. You can actually buy inulin by itself. Those things also help.

Dr. Weitz:            Well, that’s good. What about mucilaginous herbs and or L-glutamine?  Can they be beneficial?

Colleen:               Oh, man. Now, you’re getting into territory that I don’t know.

Dr. Weitz:            Okay. No, I know. That’s clinical stuff. But I know since you’ve been digging into all this stuff. Okay. So, let’s move on. So, let’s talk about some of the therapeutic benefits of Akkermansia and, in particular, your Pendulum Glucose Control product which contains more than just Akkermansia.

Colleen:               Yes. So, our hypothesis around the consortia that’s in Pendulum Glucose Control is that if you could increase butyrate production, the metabolism of fiber into butyrate, and you could increase this mucin regulation, that you would help people improve their GLP-1 response, and then ultimately their insulin glucose response. And that was based on mostly correlative studies where we found that people with diabetes and pre-diabetes and obesity were lower in these particular functions.  And so, we basically identified strains that could produce butyrate. It’s a multi-step biochemical reaction to metabolize fiber to butyrate. So, we have all of those strains in there that do the two steps of that reaction, plus Akkermansia. And, really, what we found in our clinical data was that you did need this entire consortia. We had an arm where we only had a subset of them. So, you needed the entire consortium to get statistically significant data. And so, in a placebo-controlled double-blinded randomized trial, we found that people who were on product versus placebo had an A1C lowering of 0.6% and a lowering of blood glucose spikes by 34%.  And that’s a really meaningful product for somebody with type-2 diabetes as you know. But it’s all natural. It’s all these naturally occurring strains and a prebiotic in there.

Dr. Weitz:            Since GLP agonists now are being looked at as longevity molecules or potential longevity molecules, perhaps Akkermansia could be part of that mix.

Colleen:               Well, in fact, I think this theory that this whole thing is operating upstream of GLP-1 is that you get these butyrate producers when they combine to the right GPCRs, they then stimulate GLP-1 release. And we actually have in vitro data showing that we can do that. But our chief medical officer once we had this theory about how the product worked, we went and we grabbed Dr. Orville Kolterman who was previously the CMO at Amylin Pharmaceuticals that put out multiple GLP-1 agonists. That company got acquired for something like $7 billion from BMS. He was retired actually. And I met with him and I said, “If you want to really get in on the next frontier of diabetes therapeutics, it’s the microbiome.”  And he went up and did his own research and came back and said “All right. I’m in.” And he’s really guided all of our pre-clinical and clinical development. And you’re right these GLP-1 agonists are really showing up. I think at the core of it is that your ability to manage your blood glucose and to metabolize glucose properly is actually at the core of a lot of health issues that we previously didn’t know were related to each other. I don’t know if you have theories about how these systems are related to glucose control.

Dr. Weitz:            You mean how the gut is related to glucose control?

Colleen:               Well, if you have mismanaged glucose control, it can show up in a variety of ways beyond just type-2 diabetes. I don’t know if you have people talking about fatigue or-

Dr. Weitz:            Sure. But the only thing we really know about that I’ve heard people talk about is the way in which glucose molecules glom onto proteins in the body, glycogen storage stuff.

Colleen:               Yeah. Absolutely. And I think this is what happens is when you can’t manage your glucose response properly, we know this. You have these free sugars kind of floating around binding to red blood cells and all these proteins and…

Dr. Weitz:            Right. Like hemoglobin A1C is sugar molecules binding to red blood cells. And then, these sugar molecules bind to all these other proteins. And that accounts for a lot of the damage that occurs with diabetes.

Colleen:               Exactly.

Dr. Weitz:            So, anything we can do to reverse that is good. And especially for people in the natural world who are looking for ways to hack longevity and who are not that thrilled with the idea of taking medicines like GLP-1 agonists, some natural way of doing it is very, very appealing.

Colleen:               Yeah. And I’ll tell you this. I don’t have diabetes or pre-diabetes. But I take the pills because I actually feel that I have more energy throughout the day when I take them. And I actually wore a continuous glucose monitor on myself and saw that when I was on product versus placebo, of course, I’m a scientist so I had to run the experiment on myself, that actually it helped me with my sugar spikes and crashes. It helped just to minimize those. And for me, that shows up as sustained energy throughout the day, better workouts, and things like that. And so, I’m on it. My mom is on it. My kids are on it. My husband’s on it because it’s a natural product and being able to manage blood glucose is important for everybody.

Dr. Weitz:            Another thing you might look into is could this play a role in non-alcoholic fatty liver, which has to do with sugar storage in the liver.

Colleen:               Oh, you’re right on.  So, actually in the trial that we published, we did see that people’s ALT and AST numbers were improved, so, their liver enzymes.

Dr. Weitz:            Oh, interesting.

Colleen:               Yes. It wasn’t one of the primary outcomes. So, it’s kind of buried in the paper.  But, yeah, you’re right.  That’s something super interesting to look into.

Dr. Weitz:            Cool.  So, what about the effect of Akkermansia on the gut and gut conditions, say like, IBS?

Colleen:               Yeah.  Just to be clear, we haven’t done a clinical trial in IBS.  But what we found that’s interesting is that our customers who are taking the product, we have nine out of 10 people saying they’re getting lowered blood sugar spikes and lowered A1Cs.  But we also have nine out of 10 people saying they have improved GI symptoms.  And so, this isn’t something that we studied in our clinical trial.  But it’s something that we’re definitely hearing from people.  And, certainly, as you’re saying, there’s a lot of research to imply that Akkermansia might be doing that.  And so, you’re stepping into what we’re looking at next which is really IBS and things like that.

Dr. Weitz:            You’d have to pivot really quickly. But it would be interesting to see patients with long COVID symptoms that are GI related if this could be beneficial for them, because there’s a huge amount of inflammation in the gut that happens with some patients who get COVID.

Colleen:               Yeah. And I think understanding the role of Akkermansia in these inflammatory responses and these inflammatory miss-responses, I think, is going to be a really important part of discovery.

Dr. Weitz:            So, how does Akkermansia reduce inflammation in the gut?

Colleen:               Well, the idea is again that you have a mucin layer inside of your gut. And the thickness of that layer is relevant. And so, I think about it like a fence in your backyard. So, I have a wooden fence in my backyard. When we first moved in, oh, it’s beautiful. The planks were perfectly polished. What was supposed to be inside was inside. What’s supposed to be outside was outside. But what happens to these over time where you get sun and snow and just weather in years and times is that those-

Dr. Weitz:            And termites.

Colleen:               And termites, exactly. Those planks can start to deteriorate. And, sometimes, you might lose a plank or two. And then, all of a sudden now, all the outside things can come in. And the inside things are leaking out. And so, your gut lining is just like that fence. And the mucin layer is really like your planks that you’re trying to keep together to keep that solid gut lining. And so, when you lose that, the reason the inflammatory process gets stimulated is because now small molecules are not where they’re supposed to be, and your body responds to that. And that’s really kind of the underlying issue with not having the right gut lining.

Dr. Weitz:            Now, I was looking at some of the research. I was reading one of the studies. And there seemed to be some evidence that Akkermansia plays some role in the way that metformin works, that metformin is for most of you listening if you’re not familiar, is the most commonly prescribed drug for patients with type-2 diabetes. And yet, there’s been some controversy over exactly the mechanism by which it works.  And so, some of the evidence seems to indicate it has to do with its effect on the microbiome, and that Akkermansia may play some positive role in the way that metformin works. Can you talk about that?

Colleen:               Yeah. I think your use of the word controversial is spot on because basically there have been studies showing that I do believe that metformin is impacting the microbiome. I think that seems quite consistent. The way in which it’s impacting the microbiome is unclear. And you have publication saying it increases certain strains. And then, you’ll have publications saying it decreases the same strains. And so, I think it’s not clear. And, to be honest, there’s probably a little bit of a personalized component to this of what metformin is doing based on your microbiome and your ecosystem there. And so, I don’t think there’s any clarity on exactly what metformin is doing to the microbiome and what benefits, therefore, it could be conferring.

Dr. Weitz:            So, how can your product be used for type-2 diabetics? Is it better for patients with pre-diabetes with the beginning stages of type-2 diabetes? Does it matter. And then, how should it be administered and in what dosage?

Colleen:               So, the trial that we did was really in people with type-2 diabetes. And most of them were on metformin. And so, the efficacy is on top of metformin. It’s a bottle of pills that you store in your refrigerator. And you take two pills a day. And that really gets your microbes. And to your point earlier, it’s sort of an ongoing thing unless you’re one of those very special people that’s able to colonize it. You really do keep taking. And people can take microbiome tests to know whether things are colonizing or not.  And we really encourage people to do that. We give people free A1C testing because we want you to see the results. We’re not here to scam anybody. Actually, we have a money-back guarantee that if the product doesn’t work for you, we’ll give you your money back. We really believe in it. And we really want to help people.

So, the work is really done into type-2 diabetes. But as you know, metabolic syndrome is a sort of ongoing continuum from type-2 diabetes to pre-diabetes to obesity. And underlying all of that is the continued inability to metabolize glucose. And GLP-1 has been shown to be effective across those different states. And so, even though we didn’t do our trial and anybody other than people with type-2 diabetes, we certainly have a lot of customers who have pre-diabetes or obesity and are really using the product and seeing benefit. And so, that’s been that’s one of the benefits, I think, of the consumer route as opposed to the drug route.

Dr. Weitz:            And when should they take the two capsules? Should they split them up? Is it better to take it with the meal, without a meal, in the morning, in the evening?

Colleen:               Well, this is a kind of a big unknown. So, I’ll start with that. We don’t exactly know. But here’s what we do know, is that in trial work, we have people take one in the morning and one in the evening because we don’t know what people eat during the day. And we don’t really know what their schedules are like. And so, we were just trying to hedge to say, “If you eat breakfast that has fiber in it, this is great. If you eat a dinner that has fiber in it, we’ll catch you on either end.”  But the truth is actually we have a lot of customers including myself that can’t really remember to do something twice a day, we’re lucky if I remember something once a day. So, I take both my pills in the morning and call it a day. But the trial was really one in the morning and one in the evening to try to capture the effect of your diet on the microbiome.

Dr. Weitz:            And do you think it’s better with the meal or apart from the meal? It sounds like you’re saying it’s better with the meal.

Colleen:               Yeah. We’ve recommended people take it with a meal. The capsules are actually enteric coated so that they can get through the stomach acid and where they need to get to. But as you know, your stomach has a really low pH. And so, when you eat a meal, it does help to raise that pH. And so, the idea is that it will help those enteric-coated capsules not be dissolved in the stomach. So, although I’ll also admit this is terrible that I take my two in the morning with a cup of coffee. And I oftentimes skip breakfast. But what we do recommend people take it with a meal.

Dr. Weitz:            Well, you’re doing intermittent fasting.

Colleen:               Yes. Exactly. Exactly. I don’t want to mess up that part of my routine. So, you can’t take them on an empty stomach.

Dr. Weitz:            Right. Now, I did notice in your study that even though it lowered hemoglobin A1C that there was no change in fasting glucose. Why do you think that is? And did you also look at fasting insulin?

Colleen:               Yeah. That was a little bit of an anomaly. I think one of the things that’s been more interesting to us is actually the use of continuous glucose monitor technologies. It’s really hard with these fasting glucose numbers especially when you’re doing them in clinic because people don’t always fast before they come in and give you their fasting glucose numbers.  And so, wearing continuous glucose monitor enables people to kind of freely live their life the way that they want. And you can get that fasting glucose number before a meal is consumed which you can clearly see through a spike. We definitely have customers who have seen improvements in their continuous glucose monitor data and in their fasting glucose. So, we don’t really actually understand that phenomenon.

Dr. Weitz:            I think maybe in one of your future studies, you should consider measuring the level of butyrate that’s produced if that’s one of the mechanisms.

Colleen:               Oh, now, you’re really getting an all my secret bag of tricks. So, we just presented at the ADA conference data showing that in fact people who were on formulation had increased butyrate levels in their plasma. And so, that is data that has not been published yet.

Dr. Weitz:            All right. So, do you plan to come out with a separate Akkermansia outside of this formula? By the way, the other ingredients, the other probiotics in your formula, talk about those for a few minutes.

Colleen:               Sure. So, the other strains include anaerobacterium [inaudible 00:31:13], Clostridium butyricum, Bifidobacterium infantis and Clostridium beijerinckii. Now, you’re testing my ability to pronounce all of these strains. And so, again, these are really in that pathway of metabolizing fiber into butyrate. These are strains which we found to be kind of in vitro to have a lot of activity on that butyrate production.

And I would say that we’re not quite done yet because the product doesn’t work for everybody. And I think there’s an underlying belief that not all these strains are going to be able to have their functions in your microbiome versus my microbiome. And so, I think that the key thing is these functions and that there’s potentially new strains that we can develop that will help people that have different microbiome issues. And so, all of those strains really do function together along with we have inulin in the pill too. They really all function together to demonstrate efficacy.

Dr. Weitz:            What do we know about Akkermansia as a percentage of the microbiome in younger people versus older people, women versus men, people live in the United States as opposed to Africa or Europe or Asia? Do we know anything about that?

Colleen:               Yeah. I think that there’s still a lot of data being collected. So, it’s still emerging and trying to understand what are the trends with Akkermansia is certainly really an exciting place where there’s been a lot of discovery. So, I think one of the biggest trends that we’ve seen with Akkermansia is that healthy people tend to have a ton of it. It’s one of the most prevalent strains in the stool of people that are healthy.  But as you go down the line and you look at these different disease states from type-2 diabetes to Crohn’s disease to IBS to even autism and some neurological diseases, you see that there’s a depletion of Akkermansia. And so, it doesn’t appear to isolate to men versus women. But there does appear to be an aging component to it. So, as we age, unfortunately, I think many of us remember a time where we could eat and drink whatever we wanted to. We didn’t have to worry about anything.  And part of what happens over aging is you lose some of these key microbes including Akkermansia. And so, the question is if you give them back to your longevity question, if you give them that, will you now have a better functioning engine inside your body.

Dr. Weitz:            Are there similar benefits to taking supplements of butyrate? Do you know?

Colleen:               Interestingly, the butyrate supplements have really strong pre-clinical evidence in them. But there’s been a real struggle to show that butyrate delivery in humans actually has the same impact. And the theory is that because butyrate is used by all of the colon cells and we were discussing this earlier, but your colon cells are the only cells in your body that use butyrate instead of glucose for their sugar, for their energy source.

And so, every colon cell wants butyrate. And so, I sort of think of it like if I were going to give you, Dr. Weitz, a million dollars, would you rather me bring it to your door in a suitcase and hand it to you or would you rather me call you and say, “I let it go all over 101, the freeway. And you can go pick it up there.” The problem with giving butyrate is that you’re just like releasing this on the 101. And every car is going to stop, and people are going to grab this money before it ever gets to your house.

And so, this is why the strains that colonize in the right location in the microbiome produce the butyrate right next to the receptor where it needs to bind to is far more effective than just delivering the butyrate molecule to your colon.

Dr. Weitz:            What about the other short-chain fatty acids like propionate?

Colleen:               Yeah. Propionate and acetate are two other short-chain fatty acids that also are quite abundant. And I think there’s good emerging evidence that they’re also important. And in our hypotheses around butyrate production and having the different enzymes or the different bacteria that perform these enzymatic functions, now, you’re seeing my biochemist kind of bias emerging here. They’re strains, not enzymes. We do actually also produce acetate and propionate because as you know they can be upstream of butyrate. And then, one more modification turns acetate into butyrate. And so, I think trying to understand the role of those other short-chain fatty acids is still emerging. But butyrate has the most, I think, evidence behind it.

Dr. Weitz:            Are you looking into producing… There’s another keystone species that’s anaerobic called fecal bacterium [inaudible 00:35:48] that’s also not available on the market. Are you looking into possibly producing that?

Colleen:               Well, I can’t tell you what’s in our freezer that we’re working on producing. It’s definitely a strain of interest to many people.

Dr. Weitz:            Right. Okay. Great. I think those are my questions that I had. Any other thoughts that you’d like to leave our listeners with?

Colleen:               I think I would just say that as people are out there trying to do the right thing for their bodies and trying to be more healthy and standing in front of these shells filled with probiotics and prebiotics and whatever other marketing gimmicks are being thrown our way and trying to figure out what works or doesn’t work, that it’s really important that they talk to their healthcare professionals.

So, people like you, anybody that they’re seeking advice from to sort of really approach the microbiome more as a science about what are the functions and what are the strains that make sense for me. What is the problem I’m trying to solve? And I think it’s really important that you and the rest of the healthcare professional community starts to become at the leading edge of being educated and being able to guide people on not just probiotics, but what probiotics and what functions are their patients really trying to solve for and being that guiding light because you’re the only ones who can understand the clinical trial data. You’re the only ones who kind of know the problems people are coming at you. And being able to connect those is really in your arena. So, I encourage people to really go talk to their HCPs.

Dr. Weitz:            Now, can practitioners and we have a fair amount of practitioners that list listen, can we get a professional account with your company and sell these to our patients or how do we get these to our patients?

Colleen:               Absolutely. And, actually, this is something we’ve just started with different physician groups and naturopath groups, people who really kind of do understand the microbiome and understand what these trains are doing. And we are absolutely thrilled to get to work with healthcare professionals. And so, anybody can contact us. You go to our website, pendulumlife.com. We can get discount codes specifically for you and your patients. And we have programming set up to also educate you as well as things that you can handle your patients on what to expect. And so, we’re really excited to get to work with healthcare professionals to bring this product to life.

Dr. Weitz:            So, can we buy this product at wholesale and store it in our office and sell it to our patients or not?

Colleen:               If you contact us, we will sell it to you wholesale, and any of your colleagues that’s excited about that. Yeah. I mean we’re an early stage startup company. So, we’re just starting to delve into this.

Dr. Weitz:            Okay. I see.

Colleen:               But we are selling it wholesale to a few partners. And I think that that’s a really big opportunity. I mean you’re seeing patients and you have the ability to really influence them on what they should be doing. So, we want to enable you. And so, the answer is yes. Just reach out to us.

Dr. Weitz:            Sounds good. So, we go to the website or can we call? What’s the best way for us to contact you?

Colleen:               Yeah. If you go to the website and just put something a note into the contact us, it’ll immediately get shunted to our marketing and BD teams that can help set that up immediately. And so, we’re very excited about that. And you had asked earlier if we had thought about selling an Akkermansia-only product. And so, I will tell you that we literally just launched this product a couple of days ago. And so, yeah, You should come work for us because you got all the ideas and the next things to do.  And so, if people are doing these microbiome tests and they’re finding that they’re low in Akkermansia and they just want Akkermansia, we now sell that. And so, we can also distribute that wholesale to physicians as well.

Dr. Weitz:            And so, the website, one more time, is what?

Colleen:               It’s pendulumlife.com.

Dr. Weitz:            Excellent. Thank you, Colleen.

Colleen:               Yup. Thank you so much. And one more thing is that all your listeners get a discount code Weitz 20 for them to try product. And that’ll apply to also the Akkermansia-only product.



Dr. Weitz:            Oh, that’s great. Thank you. Thank you. Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple podcast and give us a five-star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts.  And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica 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.



Update on SIBO and IBS with Dr. Mark Pimentel: Rational Wellness Podcast 227

Dr. Mark Pimentel provides an Update on SIBO and IBS with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on September 23, 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

6:52   The REIMAGINE study is the project in which Dr. Pimentel and colleagues mapped out the microbiome of the small intestine.  The Human Microbiome project was published in 2007 and they declared that they had mapped out the microbiome of the gut, but it was based on stool studies, so it did really only represented the microbiome of the colon.  [Here is the first paper published by Dr. Pimentel and others on this REIMAGINE study:  Mapping the Segmental Microbiomes in the Human Small Bowel in Comparison with Stool: A REIMAGINE Study.]  This study required a lot of work and resources to be able to collect accurate samples and sequence the microbiome of the small intestine.  It is difficult the sequence the small intestine for a number of reasons, including that the mucous is so thick that they had to add mucolytics to liberate the bacteria and they had to develop special tools and validate them before conducting the trial, so it took years to prepare and then to conduct it.  And they discovered that the microbiome of the small intestine is quite different from the colon.  They also discovered that the small bowel is fairly uniform from the duodenum till the end of the ileum, whereas it was thought previously that you had more and more bacteria as you get closer to the colon.

9:28   Now we know that the bacteria in the small intestine have not overgrown from the colon up into the small intestine through an incompetent iliocecal valve, as was previously believed by some SIBO researchers. The small bowel contains more proteobacteria and much less bacteroidetes than the colon.  What happens in SIBO is that because of damage to the motility of the intestine, E. coli and Klebsiella grow like weeds and crowd out many of the other commensal bacteria.

12:13  Ehler’s Danlos Syndrome (EDS).  There was a thought that patients with EDS who have ligamentous laxity have hyperlaxity of the ileocecal valve leading to an increased risk of SIBO.  Dr. Pimentel explained that what happens with patients with EDS is that they have visceroptosis, which means that their gut sags into their pelvis, which creates bends and twists in their small bowel, creating obstruction, leading to SIBO.

13:48  Dr. Pimentel’s group published data from the REIMAGINE trial that shows that PPIs (proton pump inhibitors like Prilosec) don’t cause SIBO, though they are a risk factor for C. diff colitis.  They also published a paper showing that in postmenopausal women, their microbiome gets shifted in a very bad way, but if they’re on hormone replacement therapy, their microbiome in their small intestine looks like they’re premenopausal.

15:24  This data that PPIs don’t cause SIBO means that taking PPIs will not likely affect the results of the SIBO breath test.  On the other hand, PPIs by reducing stomach acid will reduce methane production, since methanogens feed on hydrogen that is contributed by hydrochloric acid.  You should stop probiotics for about a week before taking the test.  Patients should not take laxatives within 24 hours of taking the SIBO breath test. This also goes for herbal laxatives and magnesium. Patients should also stop antibiotics and antimicrobial herbs prior to taking the test.  On the other hand, if the patient is still bloated with whatever they are taking, then we can conclude that it’s not working and likely will not affect the test result.

23:00  About 25% of those who have a flat line on a two breath test, which we previously diagnosed as being positive for hydrogen sulfide SIBO, are positive for hydrogen sulfide on the three breath test.

23:50  The organisms that cause hydrogen sulfide SIBO is more complicated than those that cause methane SIBO.  With methane SIBO we have Methanobrevibacter smithii, Methanobrevibacter stadmenii and then a couple of other minor methanogens, and we’ve actually shown that M. smithii correlates with constipation, correlates with the methane on the breath test, and so forth.  Dr. Pimentel said they have shown that M. smithii correlates with constipation, correlates with the methane on the breath test, and so forth.  In the case of hydrogen sulfide, though, there’s multiple organisms that can produce hydrogen sulfide, including pseudomonas, Fusobacterium, Desulfovibrio, and Bilophila.

26:16  Dr. Steven Sandberg-Lewis, who spoke at our meeting a couple of months ago, he said that he’s been finding a number of patients with hydrogen sulfide SIBO positive with constipation.  Any time you have a patient that does not fit the pattern, such as a patient who is positive for hydrogen sulfide SIBO who has constipation, Dr. Pimentel recommended that you work them up with a colonoscopy or a CT scan to see if they have a tumor or a blockage in their colon.

27:49  Treatment for hydrogen sulfide SIBO often includes bismuth, which dates to a study from 1998 from a gastroenterologist, Michael Levitt, who wrote an article in the New England Journal of Medicine about flatus and how bismuth inhibits sulfate reduction pathways, thus reducing gas production.

29:24  Biofilms.  Some of the microorganisms that cause SIBO, like Methanobrevibacter, reside in the mucous layer, which is essentially a biofilm, so busting this mucous layer a bit may be helpful in erradicating them and maybe bismuth is helping with this.

30:54  Hydrogen SIBO.  The organisms that cause hydrogen SIBO are mainly E. coli and Klebsiella and sometimes Aeromonas. 

32:10  Methane SIBO.  Dr. Pimentel explained that they will be publishing how many methanogens are found along the small intestine in different sections, as well as in the stool. In terms of treatment, he recommends rifaximin and neomycin based on the double blind study, rifaximin with metronidazole as a substitute. He also finds Allicin to work well and he also still likes lovastatin, and the veterinary literature is strong, but the problem is that it gets absorbed, so he is still working on a formulation that will not get absorbed.

33:23  While the type of E. coli that causes hydrogen SIBO is not the pathogenic, E. coli that has the gene for CdtB endotoxin, there are still lipopolysacharides (LPS) that other chemicals that may be getting released that can cause inflammation and pain.

37:02  Dr. Sam Rahbar is an integrative gastroenterologist in LA and he’s recently published on some patients who have tick-borne illness such as Lyme disease and it often seems to be correlated with patients with methane SIBO or IMO.  Dr. Pimentel said that they have not analyzed the genetic material that they found to look for spirochetes or other parasites yet.  Dr. Pimentel also said that he agrees that sometimes fungal overgrowth (SIFO) is a factor in IBS, but it is not as common as bacterial SIBO and he refers to Dr. Satish Rao, who is part of his research group, who has done more work on fungal overgrowth. 

39:48  Are elevated levels of Methanobrevibacter on a stool test indicative of IMO?   Yes, as long as the levels are above 10 to the 4 and they are associated with constipation. 

41:06  Lovastatin has been used successfully by some doctors off label for IMO at a dosage of 30 mg at bedtime.

42:24  Some doctors have suggested using 120 minutes as the cutoff time for evaluating a breath test instead of 90 minutes for patients with slow motility, such as those with constipation, but the problem is that if the patient has gastroparesis or is a narcotic user, you don’t know what their transit time is and even 120 minutes may not be enough.

43:26  Mycotoxins. 

45:26  The relationship between IBS and IBD, (Inflammatory Bowel Disorder like Crohn’s and Ulcerative Colitis).  Dr. Pimentel thought at one time that IBS was a possible precursor to IBD, but he doesn’t think that anymore.  Food poisoning causes IBS but they’re not associated with IBD.  Patients with IBD may have SIBO but they rarely have IMO and if they do, it is because of strictures and other structural blockages.



Dr. Mark Pimentel is a Gastroenterologist who is head of the Pimentel Laboratory and Executive Director of the Medically Associated Science and Technology (MAST) program at Cedars-Sinai, which is focused on the development of drugs, diagnostic tests, and devices related to condition of the microbiome, with a focus on IBS. Dr. Pimentel has published over 100 scientific papers and he speaks around the world at conferences, esp. about SIBO and IBS. Here is a list of some of Dr. Pimentel’s key publications: https://www.cedars-sinai.edu/Research/Research-Labs/Pimentel-Lab/Publications.aspx

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.


Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading 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.

Welcome, everyone, and thank you for joining our functional medicine discussion group meeting tonight, and we’re very excited to have Dr. Mark Pimentel joining us for a discussion on the latest updates on small intestinal bacterial overgrowth and irritable bowel syndrome.  I’m Dr. Ben Weitz. If you have any questions, please type them into the chat box and I’ll either call on you or ask Dr. Pimentel when it’s appropriate. If you’re not aware, we have a close Facebook page, The Functional Medicine Discussion Group of Santa Monica. I’m recording this event, and I’ll post it on my YouTube page, and I’ll also include it in my weekly Rational Wellness Podcast.  If you’ve not listened to it, please check out the Rational Wellness Podcast, subscribe on Apple Podcast or wherever you listen to podcasts. If you joined, please go to Apple Podcast and give us a ratings and review.

We have two sponsors for this evening, Integrative Therapeutics and Vibrant America Testing. I know that the representative from Vibrant is here. So go ahead and tell us a little bit about Vibrant America Testing.

Margot:                                Hi. My name is Margot. I work at Vibrant America in Los Angeles. We work with Dr. Ben Weitz. So Vibrant is a CAP and CLIA-certified full service lab in Northern California with everything from basic blood panels to autoimmune diagnostics. So today, I wanted to bring up one of our most popular panels. It’s the Total Tox-Burden. It includes 31 mycotoxins, 20 heavy metals plus 39 environmental toxins all for under $400. So if you guys are interested in learning more, please email me at margot.h@vibrant-america.com or you can check out our website at www.vibrant-america.com.

Dr. Weitz:                            Okay. Thank you. It looks like Steve Snyder is not here. So let me tell you something about Integrative Therapeutics. They’re one of the few professional manufacturers of high quality nutritional supplements that we carry in our office. They’re sold through practitioners. They have some great products for SIBO. They have the leading brand of the elemental diet, and they have it in the dextrose and non-dextrose version. That’s one of the treatments for SIBO. If you’re not aware of the elemental diet, you should definitely find out more about it. You can talk to Steve Snyder from Integrative Therapeutics.  They also have a great natural pro-kinetic motility activator, which is a really excellent product and we use that all the time. So I want to thank Integrative Therapeutics and Vibrant America very much for helping sponsor tonight’s podcast, tonight’s functional medicine meeting.

Now, I want to introduce Dr. Mark Pimentel, who’s head of the Pimentel Lab, an executive director of the Medically Associated Science and Technology Program at Cedars-Sinai. Dr. Pimentel really needs no introduction, but he is a prolific researcher having published over 150 scientific papers. His lab researches the microbiome and the irritable bowel syndrome. As most of us know, irritable bowel syndrome is probably the most common gastrointestinal condition affecting between 10% and 15% of people in the United States and around the world.  For many years, prior to Dr. Pimentel’s research, IBS was thought to be a diagnosis of exclusion. Once inflammatory bowel disorders, Celiac disease, parasites, and all the conditions that could be diagnosed with a stool sample or looking through a scope, you are then left with IBS. IBS was and still is seen by an unfortunate number of gastroenterologists as a condition of either unknown cause or caused by stress or anxiety. In fact, antidepressants were once one of the most popular medications to treat IBS.  Dr. Pimentel is the first researcher to demonstrate that small intestinal bacterial overgrowth is a cause of IBS in the majority of cases, and that SIBO could be diagnosed with a lactulose breath test. Dr. Pimentel also pioneered the use of rifaximin, a non-absorbed antibiotic as a treatment for IBS. He’s developed an autoimmune model of IBS being caused by an episode of acute gastroenteritis. He’s developed a blood test looking at antibodies vinculin and cytolethal distending toxin to diagnose this autoimmune cause of IBS.  He’s discovered that the methane-producing organism, Methanobrevibacter, causes constipation. Dr. Pimentel and colleagues have recently renamed the methane version of SIBO as IMO, which stands for intestinal methanogen overgrowth. Most recently with his REIMAGINE study, Dr. Pimentel for the first time ever has mapped out the microbiome of the small intestine, which is a monumental achievement.  Most importantly, Dr. Pimentel has given hope to millions of patients with IBS that they might be able to feel better and stay better. So thank you, Dr. Pimentel, and thank you for joining us tonight.

Dr. Pimentel:                     It’s my pleasure. Thank you for inviting me.

Dr. Weitz:                          Absolutely. So how do you want to start?

Dr. Pimentel:                     Well, you tell me. You usually do an interview? Is that what you’re hoping to do tonight?

Dr. Weitz:                          Sure. Absolutely. That’s just fine.

Dr. Pimentel:                     I got to tell you, you always ask the best questions. So I love this podcast for that reason. You’re always well-prepared.

Dr. Weitz:                          Exactly. Well, thank you, thank you. So let’s start off with your mapping out the microbiome of the small intestine. Why don’t you tell us about how you were able to do that and what’s some of the latest information that you’ve gotten out of that?

Dr. Pimentel:                     Well, the human small intestine, what I’d like to say is that the Human Microbiome Project was published in 2007. One of their declarations was, “Well, we published the Human Microbiome and this is what the gut represents based on stool studies.” I was always shocked by that because I felt like, well, stool is stool, but what about the small intestine? What about other parts of the gut? Maybe it’s different. It took us a decade to start to get our act together in terms of getting the REIMAGINE study off the ground because we needed a lot of resources and some of the sequencing equipment. Now, we’ve got everything here at the MAST program.  The problem with the small intestine is it’s not easy to sequence. The mucous is too think. So we realized you couldn’t do what you do with stool. You couldn’t process the stool the same way or the small bowel the same way as stool, and we have to add mucolytics and other things to liberate the bacteria before you get their DNA, but we did all that. We’ve published validations of how you’re supposed to handle the small intestinal microbiome.

While we found a ton of stuff since starting, we found bacteria that produce all sorts of things that humans produce manipulating the human body, and you’re going to see some of that. There’s a paper, again, September, sorry. Ben, I can’t tell you things, but next week there’s a paper coming out. I feel like I’m teasing you too much, but there’s a paper coming out that is the next iteration.  Your point was last year we published and made the cover of the journal what the small bowel looks like. The small bowel is completely different than the colon. A couple of pearls. It’s interesting. The duodenum, jejunum, the ileum, they look identical. We used to think, “Oh, the closer you get to the colon, the more dirty it is, the more colonic it looks like.” It wasn’t what we saw. It was, literally, duodenum, jejunum, ileum looked the same. Then it’s like a cliff. The microbiome completely changes once you hit the colon. I think that’s really so poignant. We have other pearls like people don’t-

Dr. Weitz:                          Can’t I ask you a question about that fact?

Dr. Pimentel:                     I’ll do it for that one.

Dr. Weitz:                          So I want to get right back to it, but does the fact that the level of bacteria you’ve seen throughout the small intestine, does that tell us anything about whether the bacterial overgrowth comes from below up or from above down? In other words, we originally were thinking that the bacteria from the colon were overgrowing into the small intestine. Does the fact that there’s not more bacteria at the distal part of the ileum, does that indicate that that’s not the case?

Dr. Pimentel:                     So all of this notion, believe me I’m guilty of saying the same thing, all of this notion that overgrowth is the colon bacteria coming up into the small intestine is from older data that says, “Well, if the ileocecal valve is incompetent then the stool is reflexing into the small bowel and that contaminates the small bowel,” but as the REIMAGINE study is telling us, that’s not exactly how it happens.  What happens is the small bowel contains generally more proteobacteria than the colon. The small bowel contains no bacteroidetes, hardly at all, but that’s half of what’s the colon. So it’s the composition that’s different, but what we find with SIBO, in sequencing I mean, is that there’s weeds that develop, E. coli and Klebsiella. When they start growing because the flow of the small bowel is not correct, then you get SIBO. E. coli and Klebsiella are just rampant. They run up like weeds and then they crush everything else around them. So it’s not really that the colon bacteria are coming up. It’s that E. coli and Klebsiella are taking the opportunity to become those weeds that they want to be.

Dr. Weitz:                          Is this largely because of decreased motility? We still think that’s one of the main factors?

Dr. Pimentel:                     Yeah, decreased motility. One of the slides I finally added to my new slide deck is there’s a paper that came up because people were saying, “Well, you say, Dr. Pimentel, that adhesions slow motility and maybe you get SIBO from adhesions, but where is the paper that’s published that shows this?”  Well, a paper just came out with sequencing the small bowel, again, in patients with partial bowel obstructions, and sure enough, it’s E. coli, it’s proteobacteria, and so SIBO in that. The point of that paper is anything that slows the gut down, we are correct, it does generate SIBO and allows these E. coli and Klebsiella to take the opportunity to be the weeds.

Dr. Weitz:                            So along the same lines, we sometimes see patients with Ehlers-Danlos syndrome and they have a higher incidence of SIBO, and we would think now it was because of laxity, maybe, in the ileocecal valve. I wonder why patients with that condition looking at hyperlaxity would have an increased risk of SIBO if it’s not coming up from below.

Dr. Pimentel:                     Yeah. So I mean we published one paper on EDS where we’re looking at visceroptosis. So I don’t know if you know the term visceroptosis, but it means that the gut is sagging into the pelvis, and by doing so, it creates all sorts of bends and twists in the small bowel. So I think physically, it creates impairment like your hose bent in the garden and the water doesn’t flow through it. I think that’s what’s going on is just everything is crushed on top of each other down on the pelvis.  That’s a characteristic sign. So the way you do a visceroptosis is you give the barium, you get them to stand up and take a picture front and all the bowel should be nice all over the place, but in the Ehlers-Danlos, it’s all flat down on the pelvis. It’s sad to see it because it’s not a pleasant thing to have for the future for that patient.

Dr. Weitz:                            Okay. If you want to continue on your telling us about some of the findings from the REIMAGINE study.

Dr. Pimentel:                     This is what I get excited about every day. Well, what I was going to tell you is that one of the other things we published, so not everything is in September and I can’t talk about it, but we did publish that PPIs, proton-pump inhibitors, don’t cause SIBO. The sequencing data does not support that, but PPIs do do something really interesting. They reduce clostridial species in the gut. You probably know this, Ben, but PPI is a risk factor for C. diff colitis.  So it’s like you have this neighborhood that’s supposed to be full of clostridium but for some reason, PPIs make those clostridia go away, but that gives an opportunity for some houses to be support another type of clostridia that isn’t good and that might be C. diff. So anytime you leave an opening, other organisms take the opportunity to come in there and take over. So maybe that’s why C. diff grabs hold in these PPI-treated patients. So there’s that paper.

We showed in another study presented at DDW that women who are postmenopausal, if you look at their small bowel, postmenopausal women, their microbiome gets shifted in a very bad way, but if they’re on hormone replacement therapy, their microbiome in the small bowel looks just like they’re premenopausal.  So it’s stuff like that that we’re finding. Again, another paper next week that will get some press, I think, that’s going to be another impactful paper on just getting the knots and bolts of what’s going on in the microbiome.

Dr. Weitz:                            So you mentioned PPIs don’t affect SIBO. That brings up, I’ll jump to a question, which I wanted to ask you about. How important are the pretest procedures before somebody gets a breath test and what are the recommendations? Does that patient stop taking PPIs? Does that mean that’s no longer important?

Dr. Pimentel:                     Well, this paper suggests you shouldn’t have to worry about it. So now, there’s a caveat to that. Patients with methane, for example, when you reduce acid in the stomach, you’ll reduce methane production. We showed that in another paper. We don’t see a lot of methanogens in the upper duodenum. So we can’t actually see that methanogens are being affected by PPI in that PPI study. So there’s reasons for not being on PPI, but to be honest with you, I don’t think PPIs do much to the breath. That consensus was three years ago, so we didn’t have the luxury of that data at the time.

Dr. Weitz:                           Interesting. So does that mean possibly for functional medicine practitioners supplementing with hydrochloric acid for patients with methane SIBO or IMO might be beneficial?

Dr. Pimentel:                     The opposite because methanogens can use hydrogen of any sorts.

Dr. Weitz:                           Okay. Okay. Okay. Okay.

Dr. Pimentel:                     Yeah. So it’s possible that you could be making or putting more gas on the fire with acid.

Dr. Weitz:                           Okay. Yeah, yeah, yeah. So since I asked the question about pretest procedures, what other pretest procedures do you think are most important to get an accurate result and what things need to be stopped over what period of time? How about probiotics?

Dr. Pimentel:                     Yeah. I think most probiotics that you take don’t produce hydrogen, but we generally recommend not beyond those for about a week before the test. Where we get into trouble, and this is a question I got earlier today on another call is, “What about my constipated patient taking laxatives, “Are you telling me I can’t take a laxative for a week before the breath test? I’ll die,” because it’s really hard for these patients.  The North American consensus is meant to be a rule of thumb. It’s not meant to be a gospel, but it is true that I have patients where they come in, I was sure they had SIBO, they do the breath test, it’s negative, and then I talk to them and they say, “Yeah, I had a massive diarrhea the morning of the breath test just before I came to the office to do the breath test because I took all my laxatives last night.”  So if you flush the gut, you’re going to have a negative breath test and that screws up the test, obviously. So you just got to be careful in some of these patients with constipation that they didn’t just take a monster amount of laxatives the night before because they were worried about how bloated they get with the breath test.

Dr. Weitz:                          Okay. So they’re supposed to stop laxatives.  What about herbal laxatives?  What about magnesium and vitamin C? Is that the same thing?

Dr. Pimentel:                     Vitamin C, not as much, but, yeah, herbal laxatives, I mean, anything that’s going to cause you to be purging within 24 hours of the test can have an influence, for sure.

Dr. Weitz:                          Including magnesium citrate.

Dr. Pimentel:                     Yes. Yes. Absolutely.

Dr. Weitz:                          What about herbal antimicrobials?

Dr. Pimentel:                     Yeah. Well, any herbal antimicrobials are antimicrobials, but the way I deal with that is, for example, if a patient says, “I’m still bloated with whatever I’m taking,” then they’re still bloated with whatever they’re taking.  A, it’s not working and B, they must have SIBO.  So it shouldn’t affect. Then the other thing is a lot of times patients will do a breath test after antibiotics to make sure it’s gone.  So I have no problem.  You don’t have to wait a month to do a second breath test.

Dr. Weitz:                          Now, has the new Trio breath test, which measures all three gases, has that recently been recalibrated so that fewer patients would test positive?

Dr. Pimentel:                     So the new breath test is the sensors are supposed to be more accurate down to 0.1 or 0.2 parts per million. If you look at the readings and how it’s reported, you don’t just get 49, you get 49 point something because the sensors are certified to be sensitive to that level, not that you need that extra sensitivity, but the bag system is designed to retain all the gases very well and it’s validated that those bags filled with your air, your lung air, can last a week and hold hydrogen sulfide, methane, and hydrogen correctly as it was on day zero.  So that’s all certified by the CLIA Lab. So in that sense, you’re getting a more accurate result.  Also, the CO2 tends to be higher than other testing because of the way the system works.  So it’s a closer to true alveolar gas and, therefore, you could say you don’t have to adjust the gas.  The biggest problem with breath testing is when you get a bad sample and you get a low CO2 and you have to … So what you do is you correct the CO2 up to 5.5. If you have to correct it from one to 5.5, then you got to multiply every number by five and a half. The more you correct, the more error you impose on the breath test. So it’s important that you get good samples.

Dr. Weitz:                          Has the test been changed? In other words, were they getting too many positives and did they have to change the calibration of the test?

Dr. Pimentel:                     I don’t know.  For hydrogen, methane, hydrogen sulfide?

Dr. Weitz:                          No, for hydrogen sulfide, yeah.

Dr. Pimentel:                     Well, no.  So hydrogen sulfide, okay.  So I understand your question now. I’m sorry.

Dr. Weitz:                          Yes.

Dr. Pimentel:                     So hydrogen sulfide, so when we did our first validation of hydrogen sulfide, we selected functional chronic diarrhea patients. The functional chronic diarrhea patients were finding that their hydrogen sulfide was over five parts per million compared to constipation, compared to healthy.  Just recently, and this has not been published, but it’s been used for validation of the test. We completed a group of D-IBS patients. So you have D-IBS and then the diarrhea patients who are functional diarrhea. So they’re more severe. They’re having diarrhea every single day. Whereas DIBS is on again off again diarrhea. The DIBS is almost often over three parts per million. So now that we have that data, it drives a change in what we think is positive, so anything over three now because constipation is almost always less than three. So as data come in, the science dictates how you interpret the test. It’s the same thing as … Sorry. Was somebody asking?

Dr. Weitz:                          No. I just didn’t mute them as they were coming in.

Dr. Pimentel:                     Okay.

Dr. Weitz:                          Okay. Let’s see. What was the question? Have you gone back and seen if patients who got a flat line on the two breath tests, does that correlate with a positive result for hydrogen sulfide on the three breath test?

Dr. Pimentel:                     Yes. We’ve shown that up to a quarter of patients. Up to a quarter of patients are testing positive for hydrogen sulfide in general, and we’ve seen that, but what I mean is up to a quarter of patients with flat line are testing for hydrogen sulfide. There are still some flat liners that could be unexplained as either poor transit, gastroparesis, maybe even bowel. There’s many reasons why you could have a flat line besides hydrogen sulfide, but, yeah, about a quarter of patients are hydrogen sulfide.

Dr. Weitz:                            Can you talk about the organism Fusobacterium varium that you have found to be … This is a question that Alison asked me to ask you. That appears to be linked with causing hydrogen sulfide SIBO.

Dr. Pimentel:                     Yeah. Thanks, Allison for that question.  So the methane story is simpler.  The methane story is you have a couple of methanogens, Methanobrevibacter smithii, Methanobrevibacter stadmenii and then a couple of other minor methanogens, but we’ve actually shown that M. smithii correlates with constipation, correlates with the methane on the breath test, and so forth.  In the case of hydrogen sulfide, though, there’s multiple organisms that can produce hydrogen sulfide. For example, pseudomonas can produce hydrogen sulfide.  Fusobacteria can produce hydrogen sulfide.  Desulfovibrio can produce hydrogen sulfide, and there’s Bilophila can produce hydrogen sulfide.  So there’s a little bit of a laundry list of hydrogen sulfide producers.  I think Allison is referring to a study we did where we took Fusobacterium and we gavaged or inserted it into the bowel of rats in a rat study.  The purpose for this study was to show putting a bacteria that makes a lot of hydrogen sulfide, will in the animal create the animal to produce hydrogen sulfide and we can detect it.  So we were able to detect an increase in the animal’s production of hydrogen sulfide in their body.  The second part of it is as they grew this Fuso in their body and produced hydrogen sulfide, the animal started to have diarrhea, but then the animal, because this organism wasn’t natural to them, eventually cleared the organism.  The hydrogen sulfide resolved. The diarrhea resolved.  So it’s essentially trying to fulfill Koch’s postulates of cause and effect.  An organism that produces hydrogen sulfide, you put it in, it produces hydrogen sulfide, you get the diarrhea, the organism goes away, the hydrogen sulfide goes down, the diarrhea goes away.  So we’re just trying to prove the point that hydrogen sulfide production causes diarrhea.

Dr. Weitz:                          Now, Dr. Steven Sandberg-Lewis, who spoke at our meeting a couple of months ago, he said that he’s been finding a number of patients with hydrogen sulfide SIBO positive with constipation.

Dr. Pimentel:                     So anything we do has an overlap. There’s no black and whites in medicine. So if you were to look at our graph with a dot plot, you have patients who are constipated, for example, that have, and I could show a graph, but there are occasional constipation patients where their hydrogen sulfide is high and we don’t understand why, but just remember this that if I put a blockage in my colon, let’s say I had a tumor in my colon, and the bowel is obstructed. I would be constipated, and then bacteria in the colon would build up. If you happen to have sulfate-reducing bacteria and they build up, you’d get hydrogen sulfide, but you’re constipated because you have a tumor in your colon.  So anytime in my practice when I see something that doesn’t fit, outliers like that, I go to further workup to be honest, something doesn’t fit, because 90% of people with hydrogen sulfide don’t have constipation. So if I see a constipator, I’m going to work them up further, maybe a colonoscopy, maybe other things.  So these are all clues to something else possibly affecting them.

Dr. Weitz:                          So what do we know about, since we’ve been talking about hydrogen sulfide SIBO, what do we know about treatment for hydrogen sulfide SIBO? I noticed that you tend to use bismuth as part of your protocol and I’ve talked to a number of functional medicine practitioners who also use some form of bismuth. Why do you think bismuth might be helpful?

Dr. Pimentel:                     Well, it was a study from 1998 from a guy, Michael Levitt. I don’t know if you’re familiar with him, but he was a gastroenterologist in the ’70s, ’80s, and ’90s, and he has a New England Journal of Medicine article on flatus. If you can imagine a bunch of flatus article on New England Journal now unless COVID causes flatus, then you’ll get that published.

Dr. Weitz:                            … or if vitamin D causes flatus then that would get published, too.

Dr. Pimentel:                     Yeah, but to be honest, what he was studying was intestinal gas production and it was seminal work at its time. He actually described what he thought was the mechanism is that it inhibits sulfate reduction pathways within the organism and then that reduces their energy and they can die from that. So it was paper of 1998 that I use in my presentation that describes that, but, yeah. I mean, this is all we got to go on at the moment, but stay tuned for more studies that are coming.

Dr. Weitz:                          So here’s some speculation. I think that there’s some data to show that bismuth may be helpful in breaking up biofilms. Have you, in looking at the bacteria in the small intestine and SIBO, have you seen biofilms present and do you think that might be a factor when we treat SIBO?

Dr. Pimentel:                     Yeah. So I mean, the difficulty with biofilms is the way we see it in the REIMAGINE study is you’ve got a layer of thin liquid right on top, then you’ve got mucous, and then when you biopsy the mucosa in between the villi, there’s another layer of mucous. So there’s various biofilms, and each of those layers has a different microbial composition, but we see some of those organisms in the deeper layer.  So, for example, Methanobrevibacter loves the mucosa. So we don’t see a lot of the Methanobrevibacter up in those higher layers of the liquid layers, but busting the biofilm or the mucous can help you in treating some of these patients. So maybe bismuth is working by busting up the mucous and helping you get at these organisms, but we haven’t layered out H2S yet. So I can’t give you an honest answer as to where H2S organisms are residing most commonly.

Dr. Weitz:                          So let’s go to hydrogen SIBO. Which organisms are primarily involved with hydrogen SIBO?

Dr. Pimentel:                     Oh, this we know a lot about. So the REIMAGINE study, we did publish last year a very important paper and we’ve had these debates on these calls as well previously, but E. coli and Klebsiella, those are the two weeds in the garden, but we also showed that the breath test correlated with all the sequencing, and that the hydrogen production pathways are increased in the small intestine of patients with hydrogen SIBO because of the E. coli and Klebsiella.  The reason that’s important is because there are people who said, “Oh, the hydrogen is coming from the colon. It’s coming from colon bacteria and lactulose getting to the colon.” What that paper showed was that that’s not the case. This is happening in the small intestine, and it’s E. coli and Klebsiella. You remember those two, and a little bit of Aeromonas, which I’ll sprinkle in there because we do see a little Aeromonas going up as well.

Dr. Weitz:                            What was I just going to say? I can’t remember what I was just going to say. So I had a thought there. So when it comes to methane SIBO or now it’s called IMO, what’s the latest? What have we learned from the REIMAGINE study on that?

Dr. Pimentel:                     Yeah. So the one thing we’re going to be presenting or submitting to DDW in December is now what we’re doing is we’re mapping intestinal methanogens along the entire intestine. So we’ll show you how much is in the duodenum, the jejunum, the ileum, and then subsequently in stool, and we’ll be able to map it out. In terms of treating IMO, things haven’t changed all that much. We still give rifaximin and neomycin based on the double blind study, rifaximin with metronidazole as a substitute.  Obviously, there’s no FDA-approved drug for IMO because it doesn’t work that way, but that’s what the data and the literature supports at the moment. There are other treatments. Allicin is another product from garlic that seems to work well with reducing methane. We still like lovastatin. Lovastatin, the data in the veterinary literature is very good, but it’s tricky with lovastatin because it gets absorbed.

Dr. Weitz:                            Oh, I know what my question was now with the hydrogen. So do you think that E. coli can produce endotoxins? We know endotoxins are produced by Campylobacter with food poisoning that can often be the cause of SIBO to start with. Do you think that endotoxins secreted by the bacteria that cause hydrogen SIBO or the other forms of SIBO are playing a role in some of the pain and symptoms patients are experiencing?

Dr. Pimentel:                     Yeah. So okay, first of all, hydrogen is something we’ve looked at for years. Hydrogen, no matter how high it is, doesn’t predict the severity of the symptom, whereas hydrogen sulfide does. So the higher it is, the more diarrhea you have, the more pain you have and the more urgency you have, but in terms of the toxin, I think you’re referring to the CdtB toxin.

Dr. Weitz:                          Yeah.

Dr. Pimentel:                     E. coli, pathogenic E. coli has that gene for CdtB, but native E. coli to the gut, which is what’s producing the SIBO, it generally doesn’t. It’s not a pathogen. It’s more of a colonizer, and now it’s blooming, and that’s what’s causing the SIBO, but Campylobacter definitely has CdtB and that’s what triggers your antibody production, CdtB antibody, and then the anti-vinculin antibody, which is the blood test for IBS.

Dr. Weitz:                          Okay. So we don’t think that endotoxins is playing a role other than the endotoxins from Campylobacter that leads to the autoimmune reaction.

Dr. Pimentel:                     I wouldn’t say it that way. I mean, I think I know where you’re going with this, but, for example, E. coli has lipopolysaccharides and other things, other wall chemicals that don’t make you very happy. So having all that E. coli and Klebsiella around does create a bit of an inflammatory response, we think, and in addition to the hydrogen and all these gas dynamics that we’ve been talking about for the last little while.  What lipopolysaccharides or these endotoxins are doing exactly is unclear. Again, we have a study that we just finished. It’s a very large animal study and we see a lot of effect of these endotoxins on the cytokines in this animal, but, again, I can’t really talk about it at the moment, but you’ll see some of that data in a few months.

Dr. Weitz:                            Somebody asked a question about the biofilms. So in the functional medicine world, there are various compounds, nutritional compounds that we’ll use to try to break up biofilms, and some of them are enzymes. There are some products that use a combination of bismuth with some other substances. If we were to use agents that we think might help break up biofilms, would that be something that we would do prior to using antimicrobials or at the same time or what would you think would be the timing of the use of that protocol?

Dr. Pimentel:                     I think some of the data we have that’s published on E. coli is that a lot of these E. coli and Klebsiella are swimming through the mucous. So breaking up the mucous is something we’re very interested in in terms of trying to improve our treatments.

Dr. Weitz:                            Okay. Okay. Good. So let’s go back to IMO. So Dr. Sam Rahbar is an integrative gastroenterologist in LA and he’s recently published on some patients who have tick-borne illness such as Lyme disease and it often seems to be correlated with patients with methane SIBO or IMO. I wonder in your research, have you seen any evidence of spirochetes or other parasites in the small bowel?

Dr. Pimentel:                     So the REIMAGINE study, we have the genetic material from the small bowel. We haven’t actually done this. You have to take the sequences and throw it in a database that looks at parasites or fungi or other things. So we haven’t don’t the parasites yet, but, I mean, there’s data from Sweden and other countries in Europe on the role of spirochetes, for example, in IBS specifically, and they’re finding increased spirochetes in the colon, but the connection to IMO, I don’t have any data for that yet. I’d be curious to see exactly what the data looks like from Dr. Rahbar.

Dr. Weitz:                          Okay. A lot of us have found that the methane SIBO or the IMO is more difficult than hydrogen SIBO, and a lot of times when the patients don’t resolve, we try using different antimicrobials. We look for other possibilities. I think Dr. Rahbar has also spoken at the fact that sometimes he’ll see fungal overgrowth. So the question for you is in your data, did you see candida or other fungus in the small bowel related to IMO?

Dr. Pimentel:                     I think Satish Rao is the ultimate expert on this from Georgia. He’s published a lot of the work on this, but we do see fungal overgrowth occasionally, maybe a handful of times a year in my practice. Dr. Rezaie sees it in some of his refractory patients also. So where he thinks it’s overgrowth or bloating, he treats them, they’re not getting better, and then uses an antifungal and it seems to be effective. He’s also cultured candida in some of these patients as either part of the REIMAGINE study or through the clinical lab and then treated them. So it’s definitely there. It’s definitely present in some of these patients, but I would say it’s not as common as the bacterial SIBO, for sure.

Dr. Weitz:                          Okay. Since IMO occurs throughout the entire digestive tract not just in the small intestine, right?

Dr. Pimentel:                     Right.

Dr. Weitz:                          So would elevated levels of Methanobrevibacter on a stool test could just possibly be indicative of IMO?

Dr. Pimentel:                     So Methanobrevibacter smithii in a stool test, if you go back to a paper we’ve published now a number of years ago, 10 to the four, up to 10 to the four or 10,000 smithii per milliliter is considered physiologic, meaning you don’t have any symptoms, you don’t have constipation, but anybody over 10 to the four was constipated. Anybody over 10 to the six then you start to see it in the breath.  So, yeah, there is some merit to doing stool M. smithii, but you have to use that trial, but we’re getting better at evaluating M. smithii in the stool using QPCR and some of the new refinements are going to have some surprising results, but the point I’m trying to make is, if you see M. smithii in the stool, often that’s normal as long as it’s very low in number.  So you just have to be careful how you interpret those stool tests.

Dr. Weitz:                          Okay. Somebody asked a question about using lovastatin. It sounds like she’s considering possibly using lovastatin.

Dr. Pimentel:                     Yeah. I mean, the dose we use for lovastatin, again, it’s an off label use, is 30 mg at bedtime, and we do see methane reduction, but it’s a little bit, it’s challenging because if you just use plain old lovastatin, there’s always a risk of muscle aches and other side effects of lovastatin.

Dr. Weitz:                          I’m not sure where that echo is coming from. Have you looked into the use of red yeast rice as a possible alternative?

Dr. Pimentel:                     I haven’t personally used it, but I know some people who have and have gotten some decent responses from it because red rice yeast does have lovastatin, natural lovastatin in it.  So that could be effective.

Dr. Weitz:                          Yeah. There’s actually products on the market that we tend to use that make sure that there’s no lovastatin, but they seem to have the same effect, and we see much lower side effects of muscle problems using it versus statins.  So for patients with slow motility such as those with constipation, should we consider a cutoff of 120 minutes instead of 90 minutes for interpreting a positive test?

Dr. Pimentel:                     Yeah. The problem is you don’t know who and what they have. So, for example, there are patients who might have diabetes for a few years and for all intents and purposes they just have bloating. You do the test and they have gastroparesis and you see a flat line because the lactulose or glucose never left the stomach. So it’s those things that create trouble because you don’t know they have gastroparesis and then you get a flat line test, but waiting 120 minutes, waiting three hours, you don’t know how long to wait for each of those individuals because you don’t know what their transit is. Narcotic users have the same issue.

Dr. Weitz:                          Okay. A number of us in the functional medicine world who have difficult to treat IBS slash SIBO patients sometimes will look at the possibility of mycotoxins or exposure to mold and we have found a certain amount of benefit from this pursuit and have had, I know personally have had a number of patients with difficult to treat SIBO who got better after we looked at the possibility of mycotoxins, found that they had some exposure to mold. Do you think that there might be in some way that SIBO might make patients more likely to experience either be more sensitive or to experience symptoms with exposure of mycotoxins?

Dr. Pimentel:                     Yeah. So I mean, my understanding of the literature of mycotoxins is very limited, so I’m going to have a very muted response to that because I don’t know enough about it, but what we are seeing and Mike Camilleri from the Mayo Clinic just is publishing a paper now where there is increased intestinal permeability in some of these patients and in IBS patients.  So the worry is that you have some increased permeability to whether it’s food, food allergies, food antigens. There’s another nature paper that came out of Europe saying that patients with IBS, for example, are more susceptible to allergens maybe because the tight junctions are more open.  So as we start to see maybe the anti-vinculin antibody is allowing these tight junctions to be more open, all of that work needs to still be done, but the pieces are coming in to place. We just don’t have all the answers yet.

Dr. Weitz:                          What about the relationship between IBS and IBD, inflammatory bowel disorder?  I know I’ve seen patients with IBD who also had IBS, and when we treated the IBS, their IBD improved.  What do you think might be the relationship?

Dr. Pimentel:                     I’ve had an on and off relationship with IBD in the sense that there was a period of time where I thought IBS may be a precursor to IBD or maybe even SIBO was a precursor to IBD, but I actually don’t think so anymore. I think IBD and IBS are completely separate entities. I’ll give you the evidence, I think, and things change with time, but from what I understand currently, food poisoning causes IBS. Anti-vinculin, anti-CdtB antibodies are associated with irritable bowel syndrome, but they’re not associated with IBD. So understanding the pathophysiology of that host infectious IBS tells me, “Well, that develops IBS and SIBO,” but we’re not seeing that in IBD at all, not like that.

The other thing is I would challenge you to find me an IBD patient with IMO. They don’t happen almost ever. We did a study where we looked at breath test in IBD patients and out of a huge list of IBD patients, only three had IMO and all three of them when you called them, they were constipated. They weren’t having diarrhea. They weren’t having IBD-like symptoms.  So I don’t know, but what we do see with IBD is that if they have strictures, they’ll have stasis, and if they have stasis, they’ll have SIBO, and if you treat the SIBO, they will get better, but the reason for the SIBO is not IBS. The reason for the SIBO is a mechanical issue due to the strictures and the narrowings and other things that the IBD produce. So that’s how I see it currently.

Dr. Weitz:                          Many of us will use a low-FODMAP diet for SIBO and I know you have the low-fiber diet from Cedars-Sinai. Do you think that there should be a different diet for patients with hydrogen versus methane versus hydrogen sulfide?  A number of practitioners will use a lower sulfur version of the low-FODMAP diet for patients with hydrogen sulfide, for example.

Dr. Pimentel:                     Yeah. I’m getting this question a lot, and I’d like to enthusiastically say that the future is we might have three different diets, but I don’t think we worked out what those diets are yet. I have encouraged some of my hydrogen sulfide patients to go on a low-sulfur diet, but I’m not sure that’s the whole story for them in terms of making them better because I’m giving them antibiotics as well.  So we need more data, more time to unravel that, but what is clear is that from studies done in the past is that people with hydrogen sulfide in their gut that low-sulfur diet does reduce that. That’s been published. So I would imagine that that would, but I don’t have any objective data since the breath test has become available to be able to say, “Aha! This is your diet that you should be on.”

Dr. Weitz:                          Have you seen fasting to be a benefit for patients with SIBO?

Dr. Pimentel:                     I love fasting for my SIBO patients. That’s for sure. I mean, the longer they’re fasted, the more opportunity they have for cleaning waves. The more likely they can naturally clear their bacteria out and so to keep things going. So yeah, I mean, skipping breakfast is something that some of these patients do on their own, but the longer they fast between meals is also part of the low-fermentation diet we developed because it’s not just a diet.  It’s trying to make sure you don’t eat between meals constantly keeping your gut with food and bathing the bacteria with food. It’s not how we used to eat. I mean, thousand years ago, we kill the buffalo, ate the buffalo before it rotted on the field. We didn’t have a refrigerator. We didn’t have potato chips or 7-Eleven. So you eat and then you don’t eat for three days. That’s how life was. Anyway, it’s just-

Dr. Weitz:                          Have you ever recommended patients do an extended fast, maybe a couple of two, three days of water only or something along those lines to calm it down?

Dr. Pimentel:                     I’ve seen patients do that on their own, and that sometimes does work for them, but I don’t generally ask patients to do that because it’s pretty tough.

Dr. Weitz:                          What about the use of the elemental diet? Are you still using that on some patients?

Dr. Pimentel:                     Oh, absolutely. I mean, I’m the one who published that fist trial on elemental diet showing it’s more effective even than antibiotics. So I really like the elemental diet. I think the challenge of the elemental diet is that it is hard for patients to do, but look, we’ve done thousands of patients on the elemental diet, literally. So if we would hit a wall and we want to get rid of the overgrowth, the elemental diet has been quite effective for us.

Dr. Weitz:                          Do you typically do it for two weeks?

Dr. Pimentel:                     So in the study, we have in the past done one, two, and three weeks. So by two weeks, you get your maximum effect and you gain a few percent if you do an extra week, a third week, but I can tell you that there’s two time points in the elemental diet treatment that patients hate me, the first two days and the last three days because in the last three days, they’re like, “I can’t wait till this damn thing is done,” and the first two days, they can’t believe they’re doing this. So the dartboard with my face on it is at the beginning and the end.   You know at the end, what we see is a dramatic response, and then patients, I mean, I have patients who do this three times a year and they just love it. They have the fortitude to do it and it makes them feel better than antibiotics. So it’s not all negative. I don’t mind being the face of the dartboard if it makes the patient feel better.

Dr. Weitz:                          Do you ever see patients who started out maybe as hydrogen SIBO and end up as hydrogen sulfide SIBO or switch from one form to the other?

Dr. Pimentel:                     So we’re still early in the hydrogen sulfide part of things, but I have almost never seen somebody switch from hydrogen to methane, but I have seen if we get rid of methane all of a sudden the hydrogen goes way up because it was always there. It had to be there to make the methane. So I have seen the flip side, but never going from hydrogen as their baseline after treatment to methane, almost never. Maybe one in 10 years that I saw that happen.

Dr. Weitz:                          We got a couple of questions about the elemental diet.  Are you using the integrative product or what product are you using for the elemental diet?

Dr. Pimentel:                     Yes, I’ve used sometimes the integrative diet.  Sometimes I use Vivonex.  So those are mainly the two products.  Peptamen because it’s almost elemental, it may be more palatable for some patients, but those are the two products I mainly stick with.

Dr. Weitz:                          With the elemental, they have a version with dextrose and one without dextrose.

Dr. Pimentel:                     I don’t think it matters to me the dextrose because I think it gets absorbed so quickly it doesn’t really affect the situation. I do have patients who ask me about whether they could have coffee while they’re on it. I always answer, “Well, the study was done with no coffee. If you do coffee and you don’t get better after, don’t blame me,” because I don’t know. I mean, it’s neutral. It’s calorie neutral, but they always ask me all sorts of questions.

Dr. Weitz:                          When I put patients on the elemental diet, I usually give them herbal antifungals because of the possibility that they’re eating a high-sugar diet that can fuel the growth of candida or other fungal organisms.

Dr. Pimentel:                     Yeah. Well, I for sure see candida especially thrush in their mouth on the Vivonex and elemental diets. So, yeah, that’s not an unwise thing.

Dr. Weitz:                          Okay. So I’ve seen where you had a chart of what the microbiome looks like in patients with SIBO and there’s real limitation of a lot of the healthy organisms and you end up with overgrowth of proteobacteria and Firmicutes in particular seem to be really suppressed in patients with SIBO.

Dr. Pimentel:                     Yeah. That’s correct. That’s exactly what we see in the small bowel.

Dr. Weitz:                          So does it make sense to use certain types of probiotics to take up that space that’s been vacated so that we make it more difficult for the proteobacter to continue to occupy the small intestine?

Dr. Pimentel:                     I would love for that to be developed, but I don’t have any evidence to suggest that that would work at this point. The evidence suggests it could work, but I have no evidence to suggest that it does work. One of the things that we’re seeing in another paper is that lactobacillus is a disruptor of the small bowel. It’s doing things like E. coli is doing. So you look at lactobacillus, “Oh, it’s good for your colon. It’s good for your colon.” It’s not good for your small bowel I can tell you that now and you’ll see some data coming out shortly on that. We’ve already talked about that previously. Lots of new things coming in and I’ll be adding that to my slide shortly.

Dr. Weitz:                          Yeah. There’s some new probiotics on the market. There’s now an Akkermansia muciniphila, which is one of the important Firmicutes, which had to be produced in a non-oxygen environment, very difficult, and they finally brought it to market. I wonder if that would be something that would make sense to try to regrow the Firmicutes.

Dr. Pimentel:                     Well, if I know Akkermansia well, it also makes a lot more mucous. So are you making more environment for proteobacteria to hide or I don’t know. I’m not criticizing. I think we have to do more work. I think it’s interesting. I think having it gives us the opportunity to look at those kinds of questions, but, yeah, I’m still not clear yet.

Dr. Weitz:                            Yeah, because I mean, even if we kill the E. coli or the other organisms, we still want to regrow the healthy bacteria in the small intestine. So I wonder if maybe prebiotics would be beneficial.

Dr. Pimentel:                     Yeah. I mean, all of that is on the table. So, again, Ben, I’m not pushing back. I just won’t know what the cocktail will be, but what I think I show and I think the slide you’re referring to or the depictions you’re referring to is the network analysis that we did.  The network is not one organism. It’s not three organisms or five organisms. It’s 100. So what I would love to do is to see the 100 come back and not in a fecal transplant because feces are not the composition of small bowel, but we should do a small bowel to small bowel transplantation, and then we might be talking this stuff. I wish we have that because I think that might be the trick, but single organisms, I don’t know. I have to see.

Dr. Weitz:                          Yeah. Is that something you’re working on?

Dr. Pimentel:                     Not small bowel transplant, not yet. No.

Dr. Weitz:                          Okay. So what’s the best way to reset the motility of the gut?

Dr. Pimentel:                     I really like using prucalopride Motegrity to push motility when it’s down. You can also use low-dose erythromycin. That’s what we old school did. Low-dose naltrexone does some of that, too. I know some people use that, but I like Motegrity now. I’ve had a lot of good success with it in the last couple of years.

Dr. Weitz:                          What do we know about patients who have histamine intolerance and SIBO?

Dr. Pimentel:                     Well, I mean, there are histamine-producing bacteria in the gut. So we have to find those characters and characterize them. Histamine is a really difficult thing. The histamine chemical has a very short half life, hard to measure. So we’re trying to track those characters, but we’re not having a good success with that yet. Stay tuned. We are trying to get at them, though.

Dr. Weitz:                            Okay. I think that’s pretty much all the questions I have. Let me just look through the questions that people have asked here. FODMAP diet, let’s see. Somebody asked, “If you were to use rifaximin plus allicin, would you only do it for two weeks?” which is the way you typically use rifaximin versus when we use herbs, we typically use them for four to six or eight weeks.

Dr. Pimentel:                     So I do use allicin in the form of Allimed is what I generally use. Usually, by itself, and I get some good success with methane. The problem with the allicin is over time the methane returns. Sometimes I keep them on it indefinitely to try and keep it down, but then methane still breaks through. It only goes down for a while.

Dr. Weitz:                          Have you used Atrantil?

Dr. Pimentel:                     I have a few patients on Atrantil and some success there. I don’t use it routinely, but, yeah, I have a few patients who benefit from it.

Dr. Weitz:                          Okay. I think that’s all the questions. Thank you so much for your time, Dr. Pimentel. Any final thoughts you want to leave us with?

Dr. Pimentel:                     No, Ben. You always challenge my brain with the most difficult questions, but I love it because there’s still a lot to learn, obviously, and I can only tell you what I know and I hope that in three months I’ll be able to tell you a lot more of what we’re finding this month and next month and just keep you guys informed, but thank you for all you guys do. I think it’s a challenge to treat these patients, and I know we’re all working together to try and find better treatments.

Dr. Weitz:                          Absolutely. Thank you everybody for joining and we’ll see you next month. Thank you so much, Dr. Pimentel.

Dr. Pimentel:                     All right, Ben. Thanks again. Take care.



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



Cavewomen Don’t Get Fat with Esther Blum: Rational Wellness Podcast 226

Esther Blum speaks about Why Cavewomen Don’t Get Fat 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

1:09  Esther had mercury toxicity in her 20s, which damaged her thyroid.  She gained 20 lbs and developed terrible IBS.  It took several years to find the right doctor who diagnosed her mercury toxicity and put her on a detox protocol that included Captomer, a binder from Thorne, lecithin to protect her brain, omega 3s, trace minerals, and liver support like Spanish black radish. It is important to see a Functional Medicine doctor and to make sure to heal the gut and to protect the brain while removing the mercury. As a child, Esther was frequently sick with ear infection and she was placed on antibiotics almost every month.  They also took her tonsils out. She ended up with Epstein Barr and/or Lyme and she did a plant-based diet to help kill it off, along with a bunch of supplements.  She took silver, lysine, barley grass powder, spirulina, trace minerals, Cat’s Claw, and Lauric acid.  Esther had a lot of neuroinflammation and insomnia.  Esther also had some mold problem, so she did a few rounds of cholestyramine, along with binders like GI Detox and Saccharomyces probiotics along with glutathione, either liposomal or patches. She had a moisture issue in her garage.

15:09  What is the best diet?  It should start with real food, which are foods on the outer aisles of the grocery store.  Fruits and vegetables. Things you can grow in your garden. Chicken, eggs, meat, pastured, grass fed lamb, buffalo, elk, and venison.  If you tolerate diary, you can have cottage cheese or yogurt.  If you have a lot of gut problems, you may have to limit certain vegetables and be on a low FODMAP diet.  Root vegetables, potatoes, sweet potatoes, and winter squash are all nutrient dense foods. If you tolerate beans and other legumes, eat them after soaking and sprouting and properly cooking. If you tolerate grains, then rice and quinoa can be great foods. It depends upon the person and their tolerances and their condition.  There is no universal best diet.  Esther noted that she personally needs at least 140 gms of carbs per day or she cannot sleep. She has found that most women do best with about a cup of fruit a day and anywhere from half to one and a half cups of cooked starch.  The best fats are coconut oil, olive oil, avocado oil, butter, and grass-fed butter.  Man made seed oils like sunflower oil, sunflower, safflower, soybean, canola, grape seed should be avoided entirely.

21:20  Some of the simple ways that women can change their diet to promote better health include adding things in that are good to displace the less good.  Esther will often have women add in some protein so that they can maintain or gain some muscle.  Protein also sustains your blood sugar for 4-6 hrs.



Esther Blum is a best selling author, integrative dietician, and health coach. Esther beat mercury, mold toxicity, battled Epstein-Barr virus, and debilitating insomnia in order to get her health back and to build a successful practice. She is the best selling author of Cavewomen Don’t Get FatEat, Drink and Be GorgeousSecrets of Gorgeous, and The Eat, Drink, and Be Gorgeous Project

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. To learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Today, we will be speaking with Esther Blum, who’s a bestselling author, integrative dietitian, and health coach. Esther beat mercury, mold toxicity, battled Epstein Barr virus, and debilitating insomnia in order to get her health back and to build her successful practices. She’s a bestselling author of Cavewomen Don’t Get Fat, Eat, Drink, and Be Gorgeous, Secrets of Gorgeous, and The Eat, Drink, and Be Gorgeous Project. Love that gorgeous word. Welcome, Esther. Thank you for joining us today.

Esther:                 Thank you. Thank you so much for having me.

Dr. Weitz:            So please tell us a little bit about yourself and your own health challenges and how you overcame them.

Esther:                 Yeah. Well, I have no doubt in my mind that these were put in my path to just help make me a better practitioner and help more people. So in my 20s, I developed a whopping case of mercury toxicity. I was a hospital dietitian, and there was a lovely vendor who sold these amazing tuna fish pita pockets that I was eating every day for about a year and a half. Really, all of a sudden in three months my thyroid died. It had had enough, and I put on 20 pounds.  Now, bear in mind, I was 5’3″ and I was 120. So for me to go from 120 to 140, I had never been that much in my life. I was lifting and very lean and working out. So all of a sudden, I couldn’t fit in my clothes overnight. I had no idea what’s happening to my body. I developed terrible IBS. I started going to different doctors and no one can help me or was helping me.  It took about three years to find the right doctor to diagnose me and he was like, “Oh, you have mercury toxicity.” He put me on a detox protocol, and in six months, I lost 10 of those 20 pounds, so I joke them the girl who never lost less 10 pounds and lived happily ever after, but, certainly, my brain function returned. My gut returned to normal within two weeks of treatment. So that was really helpful, and then-

Dr. Weitz:            By the way, what kind of mercury detox protocol did you use?

Esther:                  At the time, I was put on Captomer, which was a binder. It’s a product by Thorne. Again, I don’t advocate you do this on your own at all. I have the protocol in my first book, Eat, Drink, and Be Gorgeous, but I was taking a lot of lecithin to protect my brain as the mercury is pulled out. I was put on omega-3s. I was put on trace minerals, liver support like Spanish black radish. So that’s just what my body needed at the time. That worked very well for me, but I send people to functional medicine doctors for the detox because you really want to make sure you protect that blood-brain barrier. I see a lot of products out there with chlorella, and I know chlorella is advertised as binding mercury, but it pulls it into the bloodstream, but it can still cross the blood-brain barrier and make you feel like garbage.  So you really have to be so careful with finding a protocol. You can get, I mean, now you can get IV drips. You can get IV vitamin C and glutathione, which is very important antioxidant for the body. The key is really to be put on binders, too, and probiotics and adrenal support, too, because mercury lives in the gut. So you really have to make sure you heal the gut. Then my husband and I did another mercury detox before pregnancy just to make sure that we got out as much as we could from our systems before carrying a child.

Dr. Weitz:            Cool, and then you also battled mold and Epstein Barr.

Esther:                 Yeah. So the Epstein Barr, as a child, I was terrifically sick every month and was put on antibiotics. My grandfather was an ears, nose, and throat surgeon. So he took out my tonsils because they were just always every month. My mom joked it was like me getting my period. Just every month they put me on all these antibiotics. I had terrible ear infections.

Dr. Weitz:            They’re an extra organ, anyway. We don’t really need those organs.

Esther:                 Yeah. So yeah. That was, again, and my parents, my dad was a physician, my mom was a nurse. So it was just full tale antibiotics, which really set me up at a disadvantage. I’m still always working on my gut because of that.  So yeah. I had my tonsils out, and then after childbirth, though, that beast got reignited and I was very sick with Epstein Barr and/or Lyme. We’re not exactly sure. I’m still undergoing testing for Lyme now, but, yeah. So again, I did, at the time, I actually did a plant-based diet for quite a while to help kill off the Epstein Barr and took a lot of supplements. I took silver, I took lysine. I was juicing a lot of celery, and I took … Oh, my goodness, barley grass juice powder and spirulina, and I took lots of trace minerals and cat’s claw, and lauric acid to really kill off the Epstein Barr.  So I had a lot of neuroinflammation and insomnia. So that got better, but it really just took my body a long time to ride itself after childbirth. It really did. Then mold, we’re still undergoing. I’ve done two mold detoxes. Clearly, my home still has something in it. So I just did another test this week. So it’s ongoing, but my body and my mind have become much more resilient in the process because I know where I got that from, so I don’t fear it or have anxiety around anymore. I just work with really good practitioners and know how to treat it. That’s really-

Dr. Weitz:            What did you do for your mold detox?

Esther:                 So the mold detox, I did a couple rounds of cholestyramine, again, lots of binders like GI detox and Saccharomyces probiotics, again, glutathione either in patch forms or liposomal forms, but with mold, it’s really tricky. If you don’t get it out of your … We’re still trying to figure out is my body pulling it out and that’s why my levels aren’t budging or is it in my home. So I just did a retest literally last week where I took, it’s called an ERMI test, E-R-M-I, and you get cloth samples and you just wipe them on the surfaces.  We did have a moisture issue in our garage, which we remediated, but I can tell still something isn’t right. So the question is, do we remediate again or do we move? We’re just waiting to see what happens. So stay tuned.

Dr. Weitz:            Yeah. Mold-

Esther:                 Again, I’m doing this all with the help of functional medicine doctors. I do not treat myself ever because you can’t and it’s really beautiful as a practitioner to surrender and let someone else take care of you. That’s really the beauty of it all and to go through the experience to work with a good practitioner who listens to you, takes your needs into account, and who inspires you.  Most of my practitioners have been sick with Lyme or mold or some other form and they’ve gotten to the other side. So you need to see the inspiration. In spite of my challenges, I mean, I still work. I still see my patients. I’m going to start another book. I don’t stop. I feel tired at times, and I just go and grab a quick nap and get on with my day. So you can’t surrender to what you have to keep going.

Dr. Weitz:            That’s actually, I think, really important. I think there are some patients that do surrender and end up owning their condition.

Esther:                 Yeah. You can let it define you. I did that early on. I mean, when I have the Epstein Barr issue, I mean, I couldn’t even get out of bed. I had such severe insomnia. I was getting maybe two to four broken hours of sleep per night. I was in a very bad state of brain fog. So I took a little time off work because I just physically couldn’t get out of bed.  Once I could and then I took the ball and ran with it, and I also decided at some point, I was like, “I don’t give a crap if I’ve had two hours sleep. I’m moving on with my life and my day,” and I’m ignoring it until my body catches up. So the mind is the most important thing in your healing journey because people can live with all sorts of stuff going on their bodies, but it’s how much power we give to our illness. If you surrender to it and let it overtake you, it’s very dangerous.  There’s two types of patients, right? There’s the kind that totally handover their diagnosis and say, “Oh, I’m sick. That’s it,” and then there’s the other kind that say, “No. This is not going to own me or take over, and I will let my body lead me and tell me what it needs, and I will treat my body with love and kindness, and plant medicine, and herbs, and pharmaceuticals when necessary, and a clean diet, and good rest, and take care of my spiritual and emotional health, and that’s it.” You move on with your life and-

Dr. Weitz:            So how do you help your clients with the mental, emotional aspects of their conditions?

Esther:                 I do not let them fall into that victim mentality and I keep questioning the narrative that they have in their head. This is even for people who are … I treat many individuals who are very obese and think that they can’t exercise or they don’t make time to exercise. I’m like, “This is absolutely not true.”  We go through their day and we find that, “Oh, no. They’re just lying around in the evenings. Oh, they have plenty of time to exercise and watch Netflix and be on Instagram.” So no. So I call them out on it, but also I help get them really connected to their why, why they’re doing it, “Why are we here? What do you really want? What’s that carrot that’s going to dangle in front of you?”  So one of my clients was like, “Well, I want to retire in the next five to seven years.”  I’m like, “Well, guess what? If you don’t lose this 100 pounds, you’re not even going to be around to do that.”

So she’s type two diabetes, which her own doctor didn’t even pick up on. I picked up looking at her labs. So I have her wear a continuous glucose monitor. I have her exercising. I have her text me every day her workout logs and her blood sugar and her eating.  She sees on the glucose monitor readings, we have seen a dramatic shift in her blood sugar just since adding in 20 minutes of elliptical every day. I said, “This is just another dose of metformin for you. Just think of your exercise that way.” I’ve been working with her a long time and it’s taken me this long to breakthrough to her. It’s a long, long … She keeps renewing with me, but wasn’t making progress.  The other thing I did was I finally got her to switch to a functional medicine doctor. Man, I was like, “You see now. You have a team supporting you versus just a regular doctor,” who didn’t even diagnosed her diabetes. I was like, “Has she even looked at your glucose or your A1C?” It was medical malpractice in my opinion.  So I really fight and advocate for my patients. They know they have a partner and they know I’m with them the whole way. So I think just having that level of support and emotional support, and not in a judgmental way, just celebrating their victories along the way and getting them to clear out their stories and excuses is paramount.

Dr. Weitz:            Isn’t it a shame that the typical way type two diabetic patients are treated is they’re simply given a prescription for metformin or metformin and another drug or eventually insulin, and there’s no serious attempt to get them to change their diet, and their lifestyle, and exercise, and get proper sleep, and all the things we know that is why they have type two diabetes.

Esther:                 Oh, well, it gets even better. She wasn’t even prescribed metformin. I’m the one who told her to get some from her doctor. She wasn’t even prescribed it. Nothing, nothing was done. I was like, “This is so unacceptable.”  So then she began to realize, “Okay. I need to go to another doctor.”


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Dr. Weitz:            So I think this is a good segue into the next question, which is, what does a healthy diet consists of, and in particular, which are the macro nutrients that we should be emphasizing? I’d like to make a comment before we start this discussion. It seems to me that there’s a lot of issues with what our diet should really consist of, and it seems as though emphasizing any one of the three macronutrients can have potential problems.  So we have fats, carbs, and proteins. If we consume too many carbs, we tend to have metabolic blood sugar, insulin resistant problems. If we consume too much protein, especially animal protein, we may see our IGF-1 levels rise, which some data indicates reduces longevity and increases cancer risk. If we consume too much fat, we may have increased risk of cardiovascular disease. So what do we do?

Esther:                  Well, A, it depends on what kind of fat and protein you’re eating that is going to lead to inflammation and disease. So first and foremost, you want to start with real food, and what is real food? That is food that has one ingredient in it or I say five or less ingredients, but foods on the outer aisles of the grocery store or just shop the produce section, right? Your meat-

Dr. Weitz:            It doesn’t come in a box or a package or a container.

Esther:                 That’s right or that you can grow yourself in your garden, you can produce chickens. So chicken, poultry, eggs, meat, ideally pastured, grass-fed, lamb. Some people like pork. You can have buffalo, bison, elk, venison. If you tolerate dairy, you can have cottage cheese or yogurt. Those are all quality proteins that are nutrient dense that your body can understand and break down into proteins, sugars, carbs, fats.  So also produce. Again, it depends on what you read, right? For some people with severely compromised gut function or severe autoimmune, you have to be careful with veggies, certain veggies. I have a lot of clients I treat with SIBO. That’s small intestinal bacterial overgrowth. So they have to be on low-FODMAP vegetables that are easy on the digestion. If someone has a lot of bloating, I have them have more cooked vegetables than raw.

In terms of fats, well, let me actually circle back to starches. I love root vegetables. They’re very grounding and easy to digest. So potatoes are actually tubers, which are easy to digest, then there’s sweet potatoes, butternut squash, acorn squash, spaghetti squash, right? Those are all nutrient dense.  If you tolerate beans and legumes, they don’t give you gas and bloating or if you tolerate them soaked and sprouted, then those are all a great form of resistance starch, which takes a long time to be broken down. Any starches that are cooked and cooled like white potatoes, potato salad, very high in resistance starch, has a much lower glycemic index.  Again, if you tolerate grains, then rice, brown rice, quinoa, which is a seed not a grain, but not all my clients have to go gluten-free. I have some people that tolerate gluten and dairy and do absolutely fine. Then I have others that need to be on an autoimmune protocol and really don’t do well with gluten and dairy or can tolerate some dairy depending on the age, more aged cheeses where the lactose is broken down.

So there is no universal diet. I have some clients that are plant-based. I have some clients that are hardcore carnivore, some that are paleo, in between. I personally do well on more carbs. If I don’t eat about 140 grams a day, I don’t sleep at night. So, I mean, who would have thought, right?  So it’s really individual. I can’t say exactly what every single person should eat, but I can tell you this, real food that’s nutrient dense, low sugar. I mean, really, sugar is not something anyone should be eating a lot of. You really have to earn your carbs. When I wrote Cavewomen Don’t Get Fat, I wrote it because it’s a paleo diet book for women. Most paleo diet books speak to men. Most research on paleo diets are done on men and intermittent fasting and keto, all done on men.

So with women, I really teach them to find their own unique carb tolerance, and I do this by doing a two-week cleanse where you get your carbs from fruits and vegetables, and then slowly adding in half cup of cooked starch per day from, again, potatoes, sweet potatoes, winter squashes, and then slowly ramp up.  So what I’ve found over 26 plus years of practice is that most people tolerate about a cup of fruit a day and anywhere from half to one and a half cups of cooked starch. That’s the way it goes per day, and they can divide that up or they can have it all at once.  Then fats, again, you want fats that are low in inflammatory compounds, so coconut oil, olive oil, avocado oil, butter, grass-fed butter. The rest, sunflower oil, sunflower, safflower, soybean, canola, grape seed are usually manmade oils. They’re very high in inflammatory compounds and should be avoided. They’re seed oils, so they should all be avoided. They’re not safe to consume.

Dr. Weitz:            Okay. So what are some of the simple ways women can change their diets to make strides towards better health?

Esther:                 Yeah, by adding things in, adding in the good to displace the less good. So adding in protein is where I start because for women, the women who come and see me are mostly in the perimenopausal to menopausal range. I do treat men and I do treat younger women, but primarily, those are my people.  So as we age, we lose muscle mass. It’s called sarcopenia, right? It’s age-related muscle loss. So you want to make sure that you are building muscle or maintaining muscle, especially through menopause when your estrogen and progesterone drop. I see a lot of weight gain happen in a very short period of time.  So you want to make sure that you’re getting … I have people aim for one gram per pound of body weight, of ideal body weight.

Dr. Weitz:            Look at all the weight gain that happened in the last year because of stay-at-home orders.

Esther:                 That’s right, and people not going to gyms.

Dr. Weitz:            Not going outside.

Esther:                 Not going outside, yup, which, by the way, can I also-

Dr. Weitz:            Working at home right next to the refrigerator and ordering junk food in.

Esther:                 That’s right. That’s right. Can I suggest for all of you who are still at home or just not going to the gym, there’s a lovely website called YouTube, which has thousands and thousands of free workouts that you can do with your own body weight. So no excuses there, but, yeah.  So protein is where I start because protein does the following. Number one, it protects skeletal muscle and bone density. One of the largest dangers of aging is bone breaks due to poor bone density. So you want to make sure that you’re eating a good amount of quality protein, a gram per pound of ideal body weight. To just break that down into simple math, that works out to about four to six ounces three to four time a day of protein.  Protein also sustains your blood sugar anywhere from four to six hours after you eat it. It’s the only nutrient that chucks off hunger in the brain. So when someone increases their protein, they actually dramatically decrease calories because they’re not hungry and they’re not craving. Their sleep improves because the sugar is balanced during the day and their insulin, so they’re not waking up with low blood sugar in the middle of the night. It also prevents that 3:00 PM crash so you’re more productive, you’re less irritable. So protein is amazing.

Dr. Weitz:            By the way, I read your Cavewomen book and I need to ask you, what is goat protein powder? You mentioned that in-

Esther:                 Yeah. It’s protein powder made from goat milk instead of-

Dr. Weitz:            I mean, I’ve seen that before.

Esther:                 Yeah. You can find it. It’s a little hard to find, but you can find it. Yes. Yes, or you can goat cheese.

Dr. Weitz:            There’s always cricket protein powder as well.

Esther:                 There is cricket protein powder, yes. I’m telling you, stay tuned, people. We’re all going to be eating crickets one day. Oh, my gosh! It’s true.

Dr. Weitz:            So what are some of the most important health issues that women struggle with?

Esther:                 I would say gut health. Again, as we go through menopause, the integrity of your gut lining, your small intestinal lining really shifts as your levels of estrogen and progesterone decline. You can get a lot more leaky gut, bloating, gluten and dairy intolerances, gastroparesis where food just doesn’t move through your system so much, constipation. So you really want to make sure you’re fueling the good bacteria and you’re cutting the inflammation in your gut and just eating a lot of real food.  Something else I saw during the pandemic is alcohol intake increased so dramatically with a lot of people, and the stress of trying to balance the needs of family members, kids who are home doing online schooling, plus keeping up with the workload of jobs is tremendously stressful. So alcohol intake shot way up. I think it’s become a really big coping mechanism and people need to understand of the other ways to handle stress like exercise, fresh air, time in nature, meditation, journaling, just quiet time, even if it’s five minute a day. It’s really important that we recondition ourselves not to just reach for alcohol when we’re stressed.

Dr. Weitz:            Yeah, or sugar. I remember seeing the CEO of-

Esther:                 Sugar.

Dr. Weitz:            … one of the big cereal companies and he was on the financial channel. He was talking about how great it is that people are eating cereal for dinner and isn’t that a great thing?

Esther:                 Oh, God! Oh, God! No. Just no, people. Just no. Don’t. Kids, too. My son would always say, “Why don’t we have cereal in our house?”  So I told him about this study I learned about when I was doing my nutrition training where there was a study done. I swear. It was mice and one group was given Cheerios and the other group was given the box. I swear, the group eating the box lived longer. The cereals are really heavily sprayed, especially the oats. I mean, they’re heavily sprayed with roundup and chemicals and kids are having really high levels of glyphosate, which does a number on their brains and their guts.  So if you love your kids, give them overnight oats organic, gluten-free oats or give them just eggs and some bacon, and avocado and they’ll do a lot better or we give my son protein shakes or his staple breakfast with wild blueberries, which really support brain function.

Dr. Weitz:            Since we’re talking about menopause, what do you think about hormone replacement therapy for a lot of these negative effects? [inaudible 00:27:43] gut and everything have to do with the falling estrogen and progesterone.

Esther:                 Yes. I have seen tremendous transformations in my women who I treat who go on hormone replacement therapy. I do-

Dr. Weitz:            Bioidentical.

Esther:                 Bioidentical, of course. Yeah, I do what’s called a DUTCH Test. It’s a dried urine test for comprehensive hormones. So that helps. Even if someone is in menopause, a lot of people say, “Oh, you shouldn’t test women in menopause because their estrogen is you get surges. It’s like a roller coaster ride. You get surges and then you get massive drops.” However, I can look at your adrenal health. I can look at your methylation patterns or your detoxification patterns and make sure that your estrogen is moving down the right pathway. So I have seen-

Dr. Weitz:            Two, four or 16 hydroxyestrone pathway.

Esther:                  Exactly right or the 4OH pathway as well. So you want to make sure. Again, I can specifically know, are they a better candidate for DIM versus broccoli extract, versus brassica family. So it really-

Dr. Weitz:            Versus calcium D-glucarate.

Esther:                  Yes. It really depends on their pathways, but, again, I can really help them methylate well, and I continue to test as they’re on hormones and get their blood levels of estradiol check once they are on hormone replacement. They go from not sleeping, having complete brain fog, irritability, depression, low libido to sleeping, happy mood, they’re not crying and in tears every day or completely irritable with themselves or their family. They’re actually interested in sex again, and it corrects vaginal dryness as well. There’s so many amazing delivery systems, right?

Dr. Weitz:            What have you seen that the women that you work with, what forms do you find that seem to work the best and also if you could comment about the way progesterone is administered whether in a cyclical fashion or in everyday fashion.

Esther:                  Yeah. Well, okay. So first of all, with menopause, you can give some hormones during perimenopause like progesterone and/or testosterone, but usually I wait until people have had a full year without a period to give progesterone and/or testosterone, but you can start with DHEA, which is oral, comes in a micronized pill. That’s a form of hormone replacement therapy. It’s very gentle. It gives adrenal support, supports fat burning and energy. Progesterone, I always give orally.

Dr. Weitz:            By the way, what’s a typical dosage you might start a woman on for DHEA?

Esther:                  Oh, I start very low. I start five milligrams and just slowly titrate the dose up as tolerated. I don’t even have to necessarily go that high to get good results, but 20 is probably the upper limit of what I do. Now, some practitioners go a lot more intensely. I try to take a gentler approach and go with just what your body needs.

Dr. Weitz:            You ever use pregnenolone?

Esther:                  I do on occasion, yeah. I mean, pregnenolone is amazing, too. It’s the mother load of all hormones. I do work with oral progesterone. It can be taken in a capsule. It can be taken in a troche or a troche depending on how you … It’s a dissolving form that you put under the tongue at night. If someone is still having a menstrual cycle, I give progesterone only days 14 through 28, but if they’re fully menopausal, you could take progesterone every night.  So why do I use progesterone for sleep and mood? Progesterone is a precursor to GABA, which is a very calming neurotransmitter and, again, quiets the brain, quiets that ruminating, chattering brain and just helps knock you out and get more restorative sleep, helps control that nocturia that you tend to get at night with menopause also.  Estrogen is wonderful also for clearing brain fog, for bone density, for hot flushes, vaginal dryness. So estrogen I like to use in patch form, but you can also give estradiol as a vaginal suppository to correct vaginal dryness. You can also give DHEA intravaginally for vaginal dryness and libido.


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Dr. Weitz:            What form of estrogen have you seen is supported by the data? Does the data seem to show it’s better to use estradiol or a combination of estradiol and estriol, which is the Biest creams?

Esther:                  Yeah. Those are much weaker. The Biest creams are a weaker form. I tend to use a patch of estradiol, but estriol, intravaginally, yes. So a couple of different forms, but I like the fastest, most efficient delivery system and a patch is great. You only have to change it every three or four days, and it’s waterproof, so it’s great. You just slap it on. You don’t even think about it. Then testosterone-

Dr. Weitz:            Right. Absolutely. Some of the practitioners who uses combination of estradiol and estriol are doing it because estriol is a weaker estrogen and maybe more protective against breast cancer.

Esther:                  Yes. Really, I’m not, I mean, I work with doctors for this very reason because I’m not a doctor. I refer people to hormone specialists who can prescribe because I’ll say, “This is what I think,” but, ultimately, they sometimes override or see things that I don’t see. So I always partner with a team because I’m not a physician.

Dr. Weitz:            Right. Listen to the two recent podcasts I did with Dr. Felice Gersh, who’s a huge defender of estradiol not estriol.

Esther:                  I mean, I primarily work with estradiol for that reason. Again, after six to eight weeks, you do need to get your blood levels checked and you need to redo your DUTCH and make sure that you are-

Dr. Weitz:            So actually, you do the DUTCH Test. What is it that you’re going to look for and then which changes are you going to make in their protocols?

Esther:                  Well, first of all, I mean, let’s just finish the hormone if we can. So testosterone also, I was going to say I use as a topical cream. This is where I differ from a lot of doctors. A lot of doctors are using pellets. What I see is in my men and women, those pellets aromatize to estrogen. So I don’t like it because it’s also really inconsistent dose. You spike up in the beginning and then it drops down. I want consistency.  So creams are great. Again, you’ve got to rub them in and don’t have contact with your partner. Wash your hands after. Don’t have contact with your partner for an hour after so it’s really dissolved.  Okay. So the DUTCH Test, what do I use it for? Well, I use it for, first of all, to determine your production of hormones and then your detoxification of hormones. I want to make sure that they’re going down the right pathways, okay?  I use it also to determine … It helps me figure out if you’re on thyroid medication. I can look at your cortisol patterns and see if you’re blowing through your thyroid meds too early like by mid afternoon, and if so, do you need to tweak your thyroid meds? I look at-

Dr. Weitz:            Wait. Hang on. So what is it that you see that indicates that as far as cortisol patterns?

Esther:                 Yeah. It depends on the individual, and I also look at their blood test, too, of their thyroid, but in some patients you can see if their … Again, this isn’t a blanket statement for everyone, but for some people, if their cortisol is low in the afternoon, they could be blowing through their thyroid meds early or metabolizing them too quickly. They’re maybe not in the right dose.

Dr. Weitz:            When you say low in the afternoon, it’s supposed to decline over the course of the day.

Esther:                 It is, but if it’s lower than normal, if it’s below the curve and flat lining-

Dr. Weitz:            Below the curve, okay.

Esther:                  … then, again, they may also need some DHEA. They may need some adaptogens and adrenal support. Licorice will raise and sustain, licorice extract not Twizzlers, will raise and sustain your cortisol to make it more even throughout the day. So it’s so multifactorial. I can’t just make blanket statements on it.

Dr. Weitz:            Yeah. No. I’m just trying to get some pearls of wisdom.

Esther:                 Yes, yes, yes, yes. Then I also look at … Oh, my gosh! I’m having a brain blank. Please forgive me. I look at neurotransmitters. I look at organic acids and see what is your production of serotonin.

Dr. Weitz:            So you’re doing a DUTCH complete test.

Esther:                 I’m doing a DUTCH complete, yeah, because I want to make sure, are you making your neurotransmitters? Are you making serotonin? Are you making melatonin? The interesting thing is with that is I see a lot of people who come to me on antidepressants. A lot of the times, the neurotransmitters aren’t great even on antidepressants.  So I’ll say to them, “How long have you been taking these?”  They’re like, “20 years.”  I’m like, “You can come off them.”  I work, again, with their psychiatrist, with a good amino acid protocol, and we wean them off, and they feel fine. So a lot of the times they don’t need it when we correct their nutritional hormones.

Dr. Weitz:            How can a drug that’s designed to keep more serotonin in the brain work when you’re not producing enough serotonin to begin with?

Esther:                 That’s it. That’s it. So I really want to make sure everyone’s optimized, not on medications they don’t need to be on, and that we correct the balance because no amount of antidepressants will fix your menopause. I do see antidepressants prescribed during menopause because women are depressed. Well, they’re also depressed because they’re low in estrogen and especially progesterone. So menopause is not a Prozac deficiency. It’s really not. It’s a nutrient and hormone deficiency.  The thing is a lot of people are very nervous about hormones, and not everyone is a candidate, but many, many people are. I always say, “This isn’t your mom’s hormone replacement therapy. We’ve come a long way with the delivery systems. We test. We make sure you’re methylating properly and your nutrition is good.”  One thing people don’t realize is that you should not be drinking a lot of alcohol when you’re on hormone replacement because your blood alcohol levels will also raise your estradiol for the same amount of time that your blood alcohol is elevated. So you don’t want to be in this estrogen-dominant state. You want to be in an estrogen-balanced state.  So that’s something I put out there as a caveat to everyone who goes on it is watch the booze. Do not think that you can still continue your lifestyle of drinking wine every night while you’re on hormones. That’s not a safe practice to do.

Dr. Weitz:            Good point. Well, let’s try to get one more clinical pearl out of this DUTCH thing.

Esther:                 Sure.

Dr. Weitz:            So what do you see in hormone metabolism and estrogen metabolism that would make you recommend one thing over another?

Esther:                 Again, I usually partner with doctors on the DUTCH interpretation for this reason. I’m still trying to learn it myself. Before COVID, I would have gone to conferences on this, but I usually partner with a doctor on the interpretation.

Dr. Weitz:            Yeah. If you look at my YouTube page, you can see the presentation by Dr. Carrie Jones.

Esther:                 Yeah. She’s the best. Yes, she’s amazing. I regularly listen to those. It’s usually the 4OH versus the 16OH pathways of estrogen that really help me determine DIM versus calcium glucarate versus BroccoProtect.

Dr. Weitz:            Well, when will you use BroccoProtect versus DIM? DIM is derived from broccoli seed.

Esther:                  Yes. Again, it’s usually when I partner with a physician. I don’t always make all the calls myself. I’m forever the student and when I don’t know something, I always defer to a doctor to help me.

Dr. Weitz:            Sounds good. There’s nothing wrong with staying in your lane.

Esther:                  Yes. Yes. Well, that’s it. I mean, I’m like, “Okay. I can meal plan till the cows come home,” but full disclosure and transparency, I’m not an expert yet. I’m forever the student.

Dr. Weitz:            Right. Forever the student, too.

Esther:                  Yes. Yes.

Dr. Weitz:            It’s one of the reasons why I like doing this.

Esther:                  You’re asking brilliant questions. I’m still trying to learn this myself.

Dr. Weitz:            I’m not trying to put you on the spot.

Esther:                  Yeah. No. It’s good. It’s good.

Dr. Weitz:            So talk a bit about how you treat the person instead of the illness.

Esther:                  I treat the person by doing a really complete history. The first appointment with a new client is an hour and a half. So I really spend time knowing who they are as a person, finding out their psychosocial standing. Did they suffer abuse as a child? What’s their relationship with food? Were they fat chained? What’s the perspective and the story that they bring to the table? Because that influences people. If they were fat chained as a child, the last thing they need is judgment. Of course, I don’t practice in judgment anyway. I really come at it from a place of education and empowerment, but somebody might need some more hand holding.

 I have some clients that just take the ball and run and they’re like, “I got this. I’m measuring my body fat. I track my macros.” They know. They just want accountability, but I have other people that truly have never been educated before on the effects that foods has on their body or they’ve never made the connection between food and mood. So I help them gently but powerfully make those connection so they can really have a sense of, “Wow! You know what? I had a really stressful fight or conversation with someone who triggered me, and I went right for that bag of potato chips and do the face plan in it.”

Okay. That wasn’t helpful. So we talk through. We talk through the binges and we talk through the stress eating and the behavioral eating. For a lot of people, my clients, the hardest thing for them to give up is alcohol. It’s even harder than sugar for people. I get that. I mean, please. I always joke I’d be like a smoking alcoholic if I could. I mean, I don’t really care for smoking, but I love drinking, but I don’t really often because it’s just a big no-no for my body. It wrecks my sleep and my mood and my mental focus. I don’t even crave it really much anymore.

So that’s how you treat the whole person, and then you teach them to nourish their body with real food and to focus on what they’re putting in versus just restricting all the time. It’s just adding foods in and abundance, creating a real abundance mindset around food. Then they see like, “Oh, my God! My sleep is so much better. My mood is better. My monthly cycles are better. I lost weight. I’m getting compliments on my glowing skin.” All of those help empower someone so that they are connected to their food, they want to put good things in their body and they feel confident about their choices. They’re not afraid.

“Oh, my God! I had some ice cream the other day.”

All right. So what? So you adjust your carbs that day or the next day and your balanced and fine. The world doesn’t end. So that’s the other piece I really focus on is building pleasure into your eating and making it fun, not about restricting. People come in to see me very scared that I’m going to take away everything. I’m like, “No. That’s not it. The key is for you to figure out how you will have that chocolate cake when you want it, but how are you going to be satisfied with three bites instead of the whole thing? How will you listen to your body of whether your body even wants it in the first place?”  So it’s a lot of deep programming and unlearning and then turning their direction or compass saying there’s a new way. You can actually have total freedom. It’s all in the mind, though. So much of it is in the mind.

Dr. Weitz:            Right. So I think that’s pretty much a wrap. Do you have any final thoughts you want to leave our viewers with?

Esther:                 Yeah. I want to give your viewers a couple of gifts. A, you can follow me on Instagram, @GorgeousEsther. That’s E-S-T-H-E-R. You can receive my three-day video training on how to crush your cravings so you can eliminate your cravings really in as little as 24 hours. So if you go to estherblum.com and just enter your email, you will receive that. Then lastly, for five of your listeners, I’m going to gift, I’ve open up my calendar, for five consultations that are complementary, and they are for action takers and people who really know that they want to solve a specific problem, be it weight loss or sleep or hormones or gut health. They will receive a 30-minute consultation with me where they will be gifted with three customized takeaways to help them reach that goal.

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

Esther:                 You are welcome. They can go to estherblum.com/call, C-A-L-L.

Dr. Weitz:            Great. Thank you, Esther.

Esther:                 Thank you so much.

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple Podcast and give us a five-star ratings and review, that way more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. 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.



The Survival Paradox with Dr. Isaac Eliaz: Rational Wellness Podcast 225

Dr. Isaac Eliaz speaks about The Survival Paradox with Dr. Ben Weitz.

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


Podcast Highlights

3:45  The Survival Paradox is that what helps us survive is also what shortens our life.  Inflammation is often referred to as the cause of chronic disease, but what really causes inflammation?  Inflammation results from our survival response, which is our sympathetic nervous system response, our fight or flight reaction.

7:48  Our biochemical survival response centers around a group of proteins called alarmins, of which the driver is Galectin-3.  Galectin-3 is expressed within minutes from tissues under stress and it has the ability to bind to different carbohydrates and it can bind to sugars, to glycolipids, to oxidized lipids, to heavy metals and other toxins.  Galectin-3 is involved with every chronic disease.  Short term inflammation is good because it promotes healing, while long term chronic inflammation can be problematic.  Galectin-3 is a more upstream molecule, while many of the other inflammatory mediators like Interleukin-6 and TNF alpha are downstream molecules.  This is why just neutralizing Interleukin-6 may not work. By addressing galectin-3, we cut down the whole inflammatory process.

10:12  The survival paradox is our whole experience of life. It’s how we treat ourselves, our microbiome, our family, and our community. It’s how we treat people who don’t agree with us. It doesn’t work when we fight.  The architect of the Survival Paradox is Galectin-3 and it can be blocked with modified citrus pectin.



Dr. Isaac Eliaz is a medical doctor and acupuncturist and he has been a pioneer in the field of integrative medicine since the early 1980’s. He is a respected researcher, formulator, author and clinician. He has published dozens of scientific studies, esp. related to Galectin-3 and modified citrus pectin, the nutritional compound that he developed that can inhibit galectin-3.  He has a busy private practice in Santa Rosa, California, the Amitabha Medical Clinic with a focus on cancer, Lyme disease, and other chronic illnesses and he has just published his new book, the The Survival Paradox: Reversing the Hidden Cause of Aging and Chronic Disease

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 speak to Dr. Isaac Eliaz about his new book, The Survival Paradox: Reversing the Hidden Cause of Aging and Chronic Disease. When we are facing threats to our survival such as trauma or disease, this triggers our stress response, which is also our survival response. This does allow us to run from a lion, but it doesn’t help us to marshal our immune response to fight off cancer or heal from many of the other inflammatory chronic diseases that are the major killers for today. This stress response triggers inflammation, and the activity of galectin-3, which is an inflammatory protein that can harm us if it is not controlled.  Dr. Eliaz refers to galectin-3 as our survival protein, and research shows that it is involved in quite a number of chronic diseases, including Alzheimer’s disease, arthritis, heart disease, diabetes, chronic kidney disease, liver fibrosis and metastatic cancer. Fortunately, there is a way to get rid of and control galectin-3, and that’s this incredible nutritional compound that Dr. Eliaz developed, known as modified citrus pectin, and known as Pectasol-C. Dr. Isaac Eliaz is an MD, an acupuncturist and he’s been a pioneer in the field of integrative medicine since the early ’80s. He trained in Tibetan Buddhism for decades. He’s a respected researcher, formulator, author and clinician. He’s published many scientific papers, especially related to galectin-3 and modified citrus pectin. He has a busy private practice in Santa Rosa, California, the Amitabha Medical Clinic, with a focus on cancer, Lyme disease and other chronic diseases.  He’s advanced the use of plasma apheresis, as well as other groundbreaking treatments for cancer and other inflammatory conditions. Most importantly, Dr. Eliaz is a wonderful human being who cares deeply about his family, his patients, and the planet, and he’s been contributing to promoting the interests of all of them. Isaac, thank you so much for joining me again today.

Dr. Eliaz:              Hi, Ben. It’s so good to talk to you again. I love our talks, and thank you for the warm introduction. I really appreciate it.

Dr. Weitz:            Absolutely. It’s always a pleasure to speak to you. Congratulations on getting your book, The Survival Paradox, published.

Dr. Eliaz:              Thank you, thank you. I’m very excited about it. It actually launched today, so I’m so glad to talk to you on launch day.

Dr. Weitz:            Now, I think this book is a long time in the coming, right?

Dr. Eliaz:              Yes. This book specifically, I worked on it for three years, with the help of a lot of people, but it expresses decades of studies, of contemplation, of clinical work as a clinician, as a doctor, as a Chinese medical doctor and as a healer. Together with decades of training in meditation, and it kind of all came together in the realization of The Survival Paradox. It’s something, it’s that’s hard to wrap our head around it. It’s actually what helps us survive, is actually what shortens our life. But this is really what paradox is, right?

Dr. Weitz:            Right. Tell us a little more about what the survival paradox is.

Dr. Eliaz:              There are different angles to look at it, but I actually want to take an angle that you like, because you like biochemistry. We recognize now that inflammation is a driving force for every chronic disease, right?

Dr. Weitz:            Yes.

Dr. Eliaz:              So in integrative medicine, we know it for quite some time. I mean, I have been referring to it in an intense way for about 30 years, and people in the last 20 years, and now I think the uncontrolled inflammation cytokine storm has come to the forefront. But is inflammation really the cause? It’s really not the cause. Inflammation is a result, so we are stuck with treating the result without looking at what caused the inflammation. Well, what causes inflammation is our survival drive.  And so that’s the first major contribution of the book, is I take the audience, the biohackers, longevity people, or the mind-body people, the people with chronic diseases, the doctors, the healers and I now say, “Okay. We know about inflammation, but this is just a result. That’s really an expression of what? Of our survival drive.” How can it happen? We are innately built to survive, it’s built within us. It’s our ego clinging, it’s our identification and it has been like this forever. Every living being wants to survive, and if it’s true, it has to be automated, and we can’t control it, and that’s the case.  We have an automatic survival response too, and from your work with your patients you know it so well through your autonomic nervous system. The sympathetic response is the survival response, it happens in milliseconds, and we get a sympathetic flow. Then when we get out of survival mode, the body relaxes by being balanced with the parasympathetic, so survival response sympathetically is either fight response, with changes in breathing, in heart rate, in circulation to the digestive system, bladder, sweat, et cetera. We don’t need to go into the details. And then we either fight or we run away. When we run away, we move into survival metabolism, we move into glycolysis. That’s why short-term sprinting doesn’t use aerobic metabolism, it uses glycolysis.

Or we go into fear, we hide, we shield ourself. Ideally, we respond and then we can relax. In ancient time, we were in danger, and then we got out of danger, we relaxed in our hut, around the fire and the parasympathetic system now is just… This is not the days. We are now at the sympathetic flow all the time, because we get text messages and radiation and cosmic radiation and computers, and people want us to respond in seconds. We are in total sympathetic flow. This by itself degrades the immune system, degrades our whole being. It’s profound, but then… But we still have a chance to balance relatively quickly. If we go on the weekend and relax, we feel the difference.  We can talk a lot about it, why it’s so hard to come back from a vacation.  Why we get exhausted when we come from vacation, why everybody experience it.  Because we change our receptor ratios on the surface between parasympathetic and sympathetic.  We’re not ready to the sympathetic heat, but that’s a side topic.  If you want, I’ll revisit it. But then we got our biochemical survival response, and the driver of the biochemical survival response is a group of proteins called alarmins.  The driver is galectin-3.  And why?  Because galectin-3 is like the bus, like the train, like the skeleton. It gets expressed within the minutes from the tissue that is under stress, and it has the ability to bind to different carbohydrates, or it can bind to oligosaccharides, to glycoprotein, protein with sugars, to glycolipids, oxidized lipids that carry also heavy metals and toxins and to different growth factors. It carries them to wherever the body wants, so we’ve got this basic structure that is so versatile, it can affect every possible disease. Indeed, galectin-3 is practically involved with every chronic disease.

Dr. Weitz:            But you’re also seeing that there’s some benefits to galectin-3 in the short term.

Dr. Eliaz:              Absolutely so.

Dr. Weitz:            Just like there is with inflammation. Short-term inflammation is good because it promotes healing. It’s the long-term, chronic inflammation that can be problematic.

Dr. Eliaz:              Absolutely, so the long-term sometime is 10 minutes, it’s already long-term, the response. Galectin-3 indeed, it starts the injury repair, but it doesn’t turn off. Now, galectin-3 is really the upstream molecule and all the cytokines follow down, so a lot of treatment that try to neutralize interleukin-6 remove cytokines, they’re not working, it’s too late. If we look at changes in the level, if somebody’s at the top of the arrow, you don’t need to… Right here, Ben, there is a very small change. Look, from here to here, it’s a tiny space. But look what happens when we go down, now we got this amount of space, so galectin-3 will go up by 50%. Sometimes will double, few reactive protein interleukin-6, TNF alpha will go up a thousand times, because these are downstream… These like a whole waterfall, whole cascade.  By addressing galectin-3, we cut down the whole inflammatory process. That’s the physical biochemical aspect of a survival product. It’s only one aspect, survival product is our whole experience of life. It’s how we live our life.  It’s how we treat ourselves.  It’s how we treat our microbiome.  It’s how we treat our family, our community. It’s how we treat people who don’t agree with us.  It’s all the Survival Paradox.  It doesn’t work when we fight, it never worked and never will work, it’s a short term solution. Understanding this, we start to get a deeper glimpse of the Survival Paradox.  In the book, really I take the reader through the whole journey.  What is the Survival Paradox?  Who is the architect of the Survival Paradox?  Galectin-3. The effect of a survival response.  How it’s created, and then how it affects inflammation and fibrosis. How to block it with modified citrus pectin.  Then I talk about the pivotal chapter in part one, is the heart of survival. How is the survival of the heart is our key to transformation, because the heart survival energy, the heart survival role is to transform the survival role. It’s built within us, that’s the beauty of it. Otherwise, what’s the point of writing a book if there are no solutions? Then I go… So people, it’s like a wow. I’ve had people who are practitioners for decades, or people who are medical writers who have had chronic disease for decades and they tell me, “Isaac, I didn’t really realize it until the book was done.”  They tell me, “No, Isaac, I’ve been in this field for 30 years. I’ve been treating my problem for 30 years. You turned my whole thinking upside down, I was totally off. I didn’t get where the problem is.” Then I take this, and I go through every serious disease. Of course, I do a lot of cancer work, so the biggest chapter is cancer. Then I go about heart disease and kidney because they are related in Chinese medicine, water and fire. As a side comment for anybody studying or practicing Chinese medicine, this book has jewels of Chinese medicine. From decades of esoteric studies of Chinese medicine, and I kind of sprinkle them through the book. Then I go, liver, and lungs, so I cover the basic organ system. I go through the metabolic system, which I know you’re so interested in. I go through the neuro inflammatory system.  I go through the immune system and I go through the microbiome. Then I start talking about solution.  I present detoxification in a much bigger picture, much broader understanding than just eat this or do that.  Then I go to maybe my favorite chapter, or the three favorite chapters.  Is the healing our scars of survival, how we heal our scars, our physical, mental, emotional, psychological, psycho spiritual. Our scars and discover the full ancestors. Genetic and more important, epigenetic. I really go through what a cell goes through, because a cell is a living creature. It has boundaries, it decides what comes in and what goes out, and it can make some decisions. Sometime good decisions, like it wants to play with the environment and be in harmony, and sometime it goes into survival paradox mode and wants to survive.  It doesn’t care about the environment, it creates a micro environment. It doesn’t communicate with the system, it becomes more aggressive. How do we call it? We call it cancer. 

I talk about how to heal scars and I give my own story. Being a holocaust family from a Holocaust survivor, how my grandmother responded, how my grandfather responded who named after. My mother, then how I by healing my Holocaust trauma which wasn’t mine, was from my grandfather which I didn’t know but I’m named after, took away all my symptoms after 60 years. And how my mother healed without knowing that I healed my own, it’s a beautiful story. Then I go to the real depths of transforming the survivor paradox, at least from an understanding. It takes years of practice. Is a survival response really the cause? Not really.  What causes the survival response? What causes survival response is the survival response. We cannot accept that everything changes. That everything that is born, everything that expresses itself is going to fall away, a very basic Buddhist principle. We don’t accept impermanence, we solidify our experiences. That’s the essence of survival, we don’t want things to change.  How do we change it?  Through the book, the emphasis from modified citrus pectin, from lifestyle, from specific advice in the light of survival, so whatever for the practitioners, you’ll do the same stuff you do. But you love a different flavor, you love a different understanding, different eyes. Then I go through the major transformative organ, and we are built to transform our Survival Paradox, is the heart.  Through the book, I give dozens of stories of my heroes and of my patients, how they healed. Sometimes they healed and the disease went away, and sometimes they healed and they died, but they still healed. These are very inspiring stories, and it was hard to choose who to put in there wasn’t space for everybody. But I got the vast majority of my heroes in, and so it’s inspiring, it’s really. The book is alive and I really think it’s almost like a manual that you can read. It’s very con… On one level, it’s an easy read. It’s very, because my precious daughter, Lily, really upgraded the writing and editing. She’s a brilliant writer and it comes from my heart, you can feel it. But it really has, it really has a lot of valuable information.  Then at the end, I provide close to 80 pages of valuable appendices, so practical, detox protocol, diet protocols, what supplements for which conditions, what dosages. I give them practicality, but I don’t exhaust the reader with the details. I want to teach the reader how to change things, instead of just giving them five steps for this, eight steps for this. In this sense, yeah I think the book can really help many people. That’s the feedback I’m getting from… Sometime, it’s almost shocking to me.


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:            Every time I talk to you about galectin-3 and modified citrus pectin, this whole story is so amazing and I always come away from the conversation going, “This is amazing. This is so important and I’m just shocked that nobody else is talking about it.”

Dr. Eliaz:              Well, it’s a little bit my life journey. I’m kind of always ahead of the curve. It’s a very lonely journey. I’m used to it, I like it. I’m used to it, but really the only person often you can talk to is yourself, and then get back to-

Dr. Weitz:            I talk to myself all the time.

Dr. Eliaz:              I know, now look I talk to doctors, I can understand their language. I understand they can’t really understand how I think most of them. If I find somebody who does, my God, I’m rejoicing. My family can. And they both say my precious wife [Gillen 00:19:26], my daughters, one with a spiritual teacher Lihui, and one who is finishing medical school in UCSF.

Dr. Weitz:            That’s great.

Dr. Eliaz:              They have this kind of understanding. But you know… We talked about chronic disease, but what we have realized in the last few years, is that galectin-3 is a driver of acute disease, myocardial infarction, but most important sepsis. So actually-

Dr. Weitz:            Wait a minute. The galectin-3 is a driver of myocardial infarctions?

Dr. Eliaz:              It will make myocardial infarction worse.

Dr. Weitz:            Okay.

Dr. Eliaz:              And yes, but for example, If somebody goes and get… When we look at acute damage to the body, the most important organ that affects our whole health despite the heart when it stops working, it’s our longevity organ, in Chinese medicine is the kidneys. Very often we in sepsis, in crises, in circulatory problems, we get what is called acute kidney injury, AKI. Very common, completely overlooked and as a dear friend of mine, really a giant in nephrology, Dr. Prof. Glen Chertow. He’s the head of Stanford nephrology. Says, “You know, Isaac, people die because of AKI, not with AKI.” He’s been trying to say it for decades, and this has been my observation, not being a nephrologist, and galectin-3 drives it. I’ve published two really important papers with great authors.  With the person who is the most well known, critical care doctor in the world ranked number one, with John Kellum and other very well known doctors. We showed that when a patient comes to the intensive care unit with sepsis, with no pre-existing conditions, they got a blood infection, the level of galectin-3 at the time of admission will determine who will get acute kidney injury and who will die during the ICU, it’s insane.  No other markers is better.  A patient did get a coronary artery bypass, people don’t know.  One of the reason and the fears of doing coronary artery bypass, is acute kidney injury, 10% to 30%, 5% to 10% get serious kidney damage and 2% to 5% die.  None of them should die, because most of the surgeries are elective surgeries.  You find there the problem and you do the surgery.

The level of galectin-3 before admission to the surgery, will determine who will get AKI in this study we published. The level of galectin-3 when you leave the surgery and go to the intensive care unit, is the best marker in who will get AKI [inaudible 00:22:14]. And in the most acceptable animal model, both for sepsis and for circulatory injury, acute kidney injury, when we gave Pectasol for a week before the procedures, the animals that got it had a dramatic decrease in AKI and mortality. Another thing that I’m developing galectin-3 apheresis, when we took animals with the septic model and we filter the blood with a specific antibody that removes galectin-3 from [inaudible 00:22:48], eight out of nine of animals where the column was empty, shame column what we call fake column.

Eight out of nine died, compared to only one out of ten, is the one who got one single apheresis. And try, because when you remove galectin-3 very early on, an hour after the injury, interleukin-6 goes down and kidney damage goes down and survival goes up. This shows us, how is this survival response uncontrolled, and it’s all happened in an hour. Long term is not two weeks. You know, the burden is a massage and relax. Babies know how to do it. When we get a cut when we are babies, it heals right away. But our bodies we have more injuries and we have more traumas, and our metabolisms changes. We lose our resilience, our flexibility and this loss of flexibility affect our injury repair. But not only physical, emotional, psychological. We see it in medicine.  I will study a certain area in medicine whatever belief system, and then three years later I will see something that is different than this, I let go of the other thing, that’s okay. Doctors usually cannot handle it, they feel threatened. Why do they feel threatened? Survival response. This is a survival part of… Ben, is deep, it’s really who we are. It can really transform our life, it can connect us with our heart because their heart is the organ that is built to transform the Survival Paradox.

Dr. Weitz:            It’s interesting. I was just talking to another doctor about a patient who has acute rhabdomyolysis and his creatine kinase went high and doctors are saying that if it doesn’t come down right away, he could have acute kidney injury. Would galectin-3 also be a factor in his condition?

Dr. Eliaz:              Usually yes, because of the acute. But the problem here, that the kidneys are bombarded with rhabdomyolysis, that just blocks the nephrons. It’s like a filter that is full of stuff and can’t filter anymore. But yes, you have to reduce the inflammatory response and definitely, but it’s a little bit more of like an unusual reason. The most common reason for AKI is sepsis and perfusion injury, blood is not getting to the place.

Dr. Weitz:            Yeah, this was just from somebody over exercising.

Dr. Eliaz:              Exactly, very important. In the book, I talk about over exercising. That is not a good thing, and it’s very interesting. Then I kind of made my statement melaware. But that’s exactly, when we exercise too much, we put strain on our system and the changes the metabolism. Wow, that’s quite something from over exercising. This person must have really over exercised, my gosh.

Dr. Weitz:            Is galectin-3… Is it contained in our diet at all?

Dr. Eliaz:              No, galectin-3 is a protein produced by the body.

Dr. Weitz:            Okay.

Dr. Eliaz:              It’s produced by macrophage, it produced at the tissue level, but we have to remember, we are not the only ones who want to survive. Cancer wants to survive, so it will use galectin-3 to shut down the immune system. For example, cancer patients getting immunotherapy, if their galectin-3 level is high, they will not respond to immunotherapy, it’s well known, it is very expensive treatment. But infections also want to survive, our microbiome wants to survive. When we tweak our microbiome well with harmony, then microbiome serves us. It even activates chemotherapy in cancer, it activates immunotherapy. When we attack our microbiome with inappropriate diet, with stress, with antibiotic, the microbiome will respond with a survival response. How will it respond?  By utilizing galectin-3 to dock into the lining of the gut and create a biofilm. Galectin-3 is the skeleton of the biofilm. Here is an example of a relationship between us and the microbiome. Now, obviously we are in this insane pandemic where COVID wants to survive. The spike in protein of the COVID is practically identical to galectin-3, identical okay. Galectin-3 blockers will play a huge role in preventing severe COVID, because that’s the same survival drive. There a lot of galectin-3 receptors in the lungs, highest amounts in the body. For example, a large study from Mexico City from a very good day. The last author is a very good researcher and physician who I published with, I kind of turn it on into galectin-3 when she was in Harvard, and she helped with my apheresis study, brilliant woman. They did a study in the emergency room checking COVID patient coming to the emergency room. The level of galectin-3 in the ER, regardless of the amount of involvement of the lung, at the time of admission, determine the severity of the disease and who will die.

Dr. Weitz:            Really? What was the cutoff for severe COVID?

Dr. Eliaz:              For them, it was 30. But you know, I wouldn’t jump on it. It’s a big issue, because there’s so many different kits and methods, and that’s a very important message for the clinician. Now we’re moving more into galectin-3 in a way with the Survival Paradox. Don’t tailor your treatment of using modified citrus pectin, to the level of galectin-3. Galectin-3 levels, are very complicated, in the diagram if I can find it quickly while we talk. If you can look at here, you can see that galectin-3 can be in pentamers-

Dr. Weitz:            Right.

Dr. Eliaz:              Five, and monomers.

Dr. Weitz:            Okay.

Dr. Eliaz:              The antibodies that detects galectin-3 and the diagnostic counts this as one. Because it binds here, it comes this is one. People have more monomers will have higher level of galectin-3, and it’s a genetic MMP-9 effect. There’s a total balance between the two, so you really give modified citrus pectin, based on the health of the person. That’s why, who needs to address galectin-3? Anyone that is breathing. I’m not exaggerating okay, Ben? Anybody above the age of 30 has to start taking modified citrus pectin daily. It’s the most important supplement, not because I developed it. Again, all the research was done on Pectasol, we have now 72 papers. It’s because galectin-3 drives every chronic disease, some of them you don’t see the effect.

You can use your supplements, and you can use your herbs and you can use your drugs, you can do chiropractic adjustments, you can do acupuncture, MCP will help the results, because it allows the medicine, whatever you’re doing to get into the problematic tissue. It reduces inflammation, it stops the fibrotic process, it regulates immune response and it removes heavy metals, and toxins and mold toxins. It’s really this gift from nature, and when we started the journey, I collaborate with Dr. Avraham Raz, which is really the person who discovered the galectin-3 and the use of modified citrus pectin in the early ’90s. Then I discovered a lot of the uses of modified citrus pectin, and we published one very important paper recently together and we work together. We always say to each other, it’s amazing.

We never thought 30 years ago, 25,26,27 years ago for me, that galectin-3 would be so big. It was really all about cancer metastasis, again, survivor of the cancer. Malignancy helped it metastasize and attack. Then it affected the primary tumor. But I started observing in the late ’90s, an anti-inflammatory effect. Joint pain, memory, blood pressure getting better and I made this very important discovery that in inflammation and fibrosis, people thought I’m crazy. 10 years later, it became known and now it’s the focus of so many universities. A lot of [inaudible 00:31:46] science after my work, but it’s fine. It’s nice when other people follow what you discover. But it’s a fundamental supplement in every program, and I’ve been very bad in putting it out. The ratio between research and how known it is, is not good. There’s so much research and people are not aware of Pectasol. It’s a must.

Dr. Weitz:            Right.

Dr. Eliaz:              For people who are sick, they really need to take 15 grams a day. We see it with joint pain, with digestion, with Lyme disease, mycotoxins, protection especially chronic kidney disease. People who have deteriorating kidney disease, unless they’re really close to a total failure where they have a problem with what they’re taking, they should take a lower dose if their EGFR is under 15. They got to use modified citrus pectin. It will most probably slow the process, stop it and some people it completely reverses. I’ve people were like, “Were deteriorating quickly. We’re already stage three chronic kidney disease.” They just added Pectasol and they completely reversed, which is unheard of.

Dr. Weitz:            Purpose it would be like 15 grams a day?

Dr. Eliaz:              Yeah, until you get to the late stage, full dose. Because guess what? Also it protects your heart. It protects your brain. It protects your circulation. The kidneys are not an isolated event, so our focus with apheresis for example, isn’t sepsis and acute kidney injury. We really believe that if we take out galectin-3, we know it from the studies, we show it now in the animal studies. If we take galectin-3 from a septic patient right away, they will not die. You know how many? Hundreds and hundreds of thousands of people a year die from [inaudible 00:33:39]. Millions, 11 million over the year die from sepsis.

Dr. Weitz:            Right. Your apheresis is when you take the blood out, filter it out, like in this case, filter out the galectin-3 and then put it back in?

Dr. Eliaz:              Yeah. Again, this is in development. We’re three four years away if we raise enough money. But you know, we own a favorable path. We got committed people working with us, and so it’s very exciting. Meanwhile, in the clinic I use a different device, an LDL apheresis. It just pulls out oxidized lipids and inflammatory compounds, kind of like the downstream effects. But we are still seeing very significant benefits. But in my opinion and again, I’m a cancer guy. But now I’ve accumulated enough patients, that practically almost everyone with chronic kidney disease is benefiting. It’s insane, people don’t notice. You ask Reagan and Fuller, can you improve Chronic Kidney? I can… It’s possible to improve chronic kidney disease. I’ll tell you, listen. Did you drink a bottle of vodka last night? It’s impossible. What are you talking about?


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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If you go to chilisleep.com and you use the affiliate code, Weitz20, that’s my last name, W-E-I-T-Z, 20. You’ll get 20% off a chiliPAD. So, check it out and let’s get back to this discussion.


Dr. Weitz:           Is galectin-3 affected by non-steroidal, anti-inflammatories, corticosteroids, any of the other anti-inflammatories, curcumin. Do any of these things affect galectin-3?

Dr. Eliaz:             The one below galectin-3, but when inflammation gets better, over time galectin-3 will go down. We have to understand, I published a very interesting case report on a cancer patient who had an autoimmune disease. As I was helping your autoimmune disease and the cancer was still growing in preparation for chemo, the galectin-3 actually came down while the OC125 went up. But then she had this insane response to chemotherapy because she wasn’t inflamed anymore. Yes, so it’s a result again. Inflammation, it’s a result of reduction in inflammation. Inflammation is very tricky, because you can have over inflammation very common, but you can have under inflammation. One of the group of people with inflammatory response is in appropriate and they go more into fibrotic response is Lyme patients.

You can see in Lyme patients that C-reactive protein will be very low, almost universally. TGF beta 1 if fibrotic marker stimulated by galectin-3 will be very high. And galectin-3 will be very low, because they lost their repair capacity. You give them modified citrus pectin, or you do apheresis, you regulate it. CRP goes up to normal, so from undetectable it will come to 0.2. TGF beta will come from 20,000 to 5,000, 6,000 and galectin-3 will go up from three or four, which is under to 6,7. It’s very important for practitioners, and holistic doctors know this. When you look at the blood test, forget the norms. Because standard or standard, standard is very loud. The standard here is very different than standard here. Sometimes blood tests are illusionary, just like the cause of diseases.

You can see a cancer patient with no inflammation. You do apheresis, nothing comes out. How exciting? No, I know it. I’ve experienced it. I look at every filter, I can see the patient, it’s a insight. The disease is so anchored, that the body is not releasing it. Or it’s very, it’s very deep and the body cannot reach it. You treat the patient, suddenly the markers change, they come into the middle range. Now they’re expressing, suddenly they start pulling all the toxins until they begin the apheresis. MCP, Pectasol and addressing the Survivor Paradox, addresses it. We have to peel off this shell, this protection and then the body can make its changes, and that’s the depths of the Survivor Paradox. Again, modified citrus pectin is one very important essential part, it’s only part of the picture. The real transformation of the Survival Paradox is connecting with our heart, which I would like to explain unless you have another question.

Dr. Weitz:            Sure, go ahead and explain that.

Dr. Eliaz:              If we look at our body and really unlike it… every time I think about it. We have about… I like to round it to 50 trillion cells. Some people say 37.5, I have no idea why they got to this number. 50 trillion, okay so not million. Million times a thousand is billion. And a billion times a thousand is trillion. 50 trillion cells. Each cell, Ben, can have between hundreds of thousands to 1 million reactions a second. A second, okay?

Dr. Weitz:            Right.

Dr. Eliaz:              We got 50 trillion cells going through 1 million reactions, okay. So it’s 10 to the 13, times 10 to the 6. So it’s 10 to the 19, almost Avogadro number. Almost like like you know… It’s insane, almost infinite. Reactions, every second okay? All of this in our body, plus 100 trillion organism in our microbiome, and we all function and we are alive. If you don’t call this a miracle, I don’t know what is a miracle. It’s a miracle of life. We have to really appreciate it. How can it happen? Because of mutual support. Because each cell understand, it’s a part of a bigger system. When this falls away, when we get trapped in the Survival Paradox, that’s when cancer starts, autoimmune starts, stress and suffering starts, fight starts and it affects everybody.

The cell knows that it’s a part of the system, but it still wants to survive by itself. How does the cell does it? It chooses what to take in, and what to take out. It has a semi permeable membrane round it, it as receptors. Now, of course the receptors can be affected by the environment and the cell doesn’t have so much choices. By default, the insulin receptors are blocked. There is no normal glucose metabolism. AMPK get blocked until one goes out. You’re going to glycolysis. You either get metabolic disease or you get aerobic glycolysis Warburg effect in cancer, so the cell is part of the environment. The cell has to take care of the environment as it can’t care for itself. But the cell excretes what it doesn’t want into the environment.

Then suddenly, we’re in a tissue and liver and I would love to give the kidney example. If the kidney feel that it doesn’t get enough blood, doesn’t get enough oxygen, it just goes into survival crisis. What happened when we can breathe? We go into survival crisis. What does the kidney does? It says, get me more blood. This happens whenever we have sclerosis in the kidneys, or you have renal artery stenosis. What does the kidney do? It excrete vasopressors to increase the blood pressure. The heart now pumps blood at pressure. What does it do? It increases the damage to the kidneys. The kidneys get less blood, eventually the kidney will go into failure, the most common cause of kidney failure and that will happen doing [Keber 00:43:01], during surgeries when you shut down the circulation.

And eventually the body will die. Every organ is for itself, except one organ in the body, our heart. Our heart’s survival, it takes dirty blood from all over the body. Whatever other cells don’t want, the heart accepts with an open heart. it doesn’t say I’m going to take blood only from the liver, but not from the lung, or not from the brain, or not from your right foot, it takes everything. Remember, from a timing point of view, anything getting to the heart belongs to stuff from the past, that was released from the cells and let go. All this stuff we’re letting go from the past so it can be a molecule that the cell got an hour earlier and it doesn’t want. But it can also be a carbon molecule, that the cell got 30 years ago while the body was going through trauma and now the cell released it like during detox, so the heart takes all of it.

Instead of fighting, saying no, I’m not going to give it like a cell can shut down, arterioles can contract and expand. The heart simply connects to the universe through the lungs, through the breathing. The lungs really is the role… is to serve the heart, it’s the only role. We let go of our volatile toxins of carbon dioxide. Our drama, is nothing for the environment as long as we take care of the environment. If we don’t care take of the environment, we’re not going to get clean air. If you think about it philosophically, anybody listening to this. The molecule of air in your mouth, or in your nose, the moment it gotten comes in, it’s connected to you and it’s connected to the whole universe, right? It’s one big space.

Dr. Weitz:            Right.

Dr. Eliaz:              That’s the connection we have. Now we take air that comes into the lungs, the lung contract and it sends blood everywhere without discrimination. Aorta is a rigid artery. It can’t contract and expand. It send blood up, down, left, right. It’s downstream that we start playing monkey business who gets blood, who doesn’t get blood. And who does the heart nourishes first? It nourishes itself through the coronary artery. The beauty of this for me, wow. I mean, I’ve never heard this description until it came to my mind, I was meditating. The heart nourishes itself, in order to nourish other organs so it can contract, do its work. It nourishes itself is part of nourishing everybody. When our heart is open and we give love, compassion, nourishment to others, we can also give love, compassion, nourishment to ourselves.

That’s the healing of the Survival Paradox. But if we just want to love ourselves and focus on ourselves, it’s called narcissism, it’s very different. The heart is the only organ who knows itself after it finished its work. Think about it when it finished its work, in the gets the blood. It’s connected with the universe. It got oxygenated, it sends a blood all when it’s out of the heart, totally selflessly takes care of itself. This means that we have built-in to do this and that’s why certain meditation techniques, they take in suffering and transform into love and compassion. [Tonglin 00:46:45] is a classical meditation. It’s so easy to learn and so profound, because we are built to do it. We don’t have to experience… It’s who we are. That was the how it does.

We do it physiologically anyway, we just connect with it on a mental meditative level, emotional level, psychological level and suddenly we don’t have the same reactivity. When we do this, things change. That’s why there’s so many studies on the healing power of love and compassion. But the heart also has a greatest electromagnetic field in the body, a hundred times greater than the brain. The electromagnetic field of the heart is a few yards. Which means that we heart-to-heart connected. People around us, we are connected heart-to-heart, that’s why we can feel people around us. But more than this, the heart electromagnetic field is touching every cell in the body in every single second. This is what I call this, and is the topic of my next book, Open Heart Medicine.

When we open our heart, we connect with our infinite healing power. Because the essence of transforming the Survival Paradox, is recognizing the impermanent for people who are more [inaudible 00:48:10] illusory quality of our experience. If everything is changing all the time, then anything and everything is possible. That’s why one of my favorite saying that I know I probably told you before is, not everybody is going to be a miracle, but everybody can be a miracle, and that’s tapping into our infinite healing potential. That’s the transforming and freeing of the Survival Paradox. This is really based on a certain vision I had many years ago when I was in the mountains for months on my own, that gave it to me in a very esoteric way related to some Tibetan studies.  But then I realized, my God forget about this. This is practical, it’s who we are. We have this in each of us, because it’s all in our heart and it’s a life journey. I mean, I’m just a beginner myself. But it’s a journey and then I think as His Holiness Dalai Lama says, “There is no limit to love and compassion.” It always can grow and open and open, and that’s a different level of healing. That is beyond just physical healing, it’s beyond the physical disease. But when we put it together with blocking galectin-3, we’re changing our lifestyle with proper exercise. Then we get amazing physical benefits of course.

Dr. Weitz:            And of course, with respect to the heart. Galectin-3 is a major factor in heart failure, with which resulting in fibrosis and also plays a role in aortic stenosis.

Dr. Eliaz:              Huge and interesting, and you are really well versed in the Galactin-3, the literature. Galectin-3 plays a specific role in what we call ejection fraction preserved. In the worst heart failure, which is a one man’s. The heart doesn’t become too big, the heart becomes stiff, fibrotic. Why? Because galectin-3 drives fibrosis. But if you think about a fibrotic heart that doesn’t contract, there’s a beautiful song in Hebrew that was written about the Western Wall, the Wailing Wall of the Temple. It’s about the big stone. They said, there are stones, which are like a heart, and the heart of people which are like stone. So when we have a stony heart that doesn’t want to give, we get fibrotic. We get aortic stenosis, and I’ve seen patients like this. Where they are self focused, they can’t give. [inaudible 00:50:49] are not a ware that they can’t give. They will get fibrotic heart and when you start changing it, the heart will get better. That’s the beauty of the mind, body. It’s so intertwined, it’s like wow.

Dr. Weitz:            Right. So you’ve written about galectin-3 playing a role in Alzheimer’s disease and playing a role in the formation of amyloid plaquing.

Dr. Eliaz:              Right, a lot because the amyloid plaque is the Alzheimer plaque. The galectin-3 concentration is 20 fold compared to the normal in a central nervous system tissue in the microglia, the astrocytes, are driven to become inflammatory through galectin-3. The microglia are very similar to the macrophage in the body, they clean up the mess and they need to be there. But when they go out of control, just like in the body, then it affects. Rights, I discuss all of this in the book and I really want to emphasize. I mean, people will see this later on, but people are saying it today. During this one week of September 21 to 28 starting today, the eBook, The Kindle is available for only 99 cents, my publisher is making it available. Really, because my goal is just for people to just really… I’m really showing my heart in this book, so I put the time, I put the effort, I really want as many people to really read it and-

Dr. Weitz:            Have you talked to Dale Bredesen or some of the doctors in his group about incorporating this into their protocol for reversing Alzheimer’s?

Dr. Eliaz:              No, I was in touch with the Buck Institute a few years ago. But the guy who wanted to start the research left it.

Dr. Weitz:            Okay.

Dr. Eliaz:              But yes, of course there is… Now we realize that Alzheimer is a vascular metabolic disease. It really is, I mean it’s… I mean, I think about a dear relative of mine who had Alzheimer’s and she was getting better. She was taking a lot of vitamins, she was getting better but a family member of her got so upset at her and made her stop and she really deteriorated. [crosstalk 00:53:07].

Dr. Weitz:            Yeah. Medicine Now for the first time has published a study showing reversal of Alzheimer’s in 25 patients and how they’re getting ready to [inaudible 00:53:17].

Dr. Eliaz:              Absolutely. Alzheimer’s is a reversible disease. Big, absolutely. I mean, it’s not easy-

Dr. Weitz:            But only with functional medicine approach.

Dr. Eliaz:              Only with functional.

Dr. Weitz:            Because the conventional medical approach really has nothing to offer at this point in time.

Dr. Eliaz:              Yeah, right definitely.

Dr. Weitz:            [inaudible 00:53:36], perhaps you can tell us a story about how you developed this modified citrus pectin?

Dr. Eliaz:              Yeah. I’m a native of Israel and I’m 62 years old, It was 1971, and I was 12 years old and we took a walk to our neighbor, [Theuthan and Leoco 00:53:52]. Both of them had PhDs in organic chemistry, were the pioneers in the citrus industry in Israel. Israel in the early 20th century, all the way too late, was pretty much, most of the open land was citrus orchards, so they were experts. Then Ruth out of the blue, she turned to me and she say, “Isaac, one day they will find a cure for cancer from the citrus fruit.” It stuck in my mind and 24 years later when the first study and NCP came out with Avraham Raz, I called her. I told her, Ruth it’s Isaac. I’m calling from San Francisco, my mother got her number.  You probably don’t remember, I remember what you told me when you were 12 years old, and she put me in touch with the key pectin researchers in Europe and they helped me to develop modified citrus pectin, and since then I can say comfortably that modified citrus pectin, Pectasol have added tens of thousands if not hundreds of thousands of years of life to people. It’s really such a privilege to have the opportunity to make such a contribution. Really Ruth is the one who spiked this in my mind. But it’s really important. If I was caught in a box that it’s only cancer, I wouldn’t see the other indications that the sometimes I get emails from researchers. “Hey, you got to check these.” I don’t know, well guess what? We already published or we already discovered or yeah.

It’s a very growing field, but we don’t want to get lost in the details. In medicine, it’s easy to get lost in the details. Because we know so many details. It’s important to remember the big picture. The big picture is that Survival Paradox shortens our life. You want to know what is a proven anti aging treatment, blocking galectin-3 using modified citrus pectin. Because galectin-3 drives aging. Drives chronic diseases, there is no argument about it. You really understand how when we finish Survival Paradox, our longevity improved not only from a point of view of the length of time, but from the quality of our life.

Dr. Weitz:            Galectin-3 really should be part of a longevity program.

Dr. Eliaz:              Blocking galectin-3 absolutely. The first supplement you take, because it works in logistically with so many others.

Dr. Weitz:            Do we know if modified citrus pectin affects AMPK, or any of the-

Dr. Eliaz:              Of course, absolutely. Definitely it does. Of course, because galectin-3 blocks insulin receptor, shuts down AMPK and mTORC1 goes up. That’s why, but-

Dr. Weitz:            A similar way to Metformin?

Dr. Eliaz:              Yeah of course, but for me it works intracellularly. For example, it’s with a great combination, but from a natural product, I use MCP with Honokiol, because Honokiol will enhance AMPK, and block [ENTO1 00:56:53], and block AKP and block [HIF 00:56:56] I don’t have a diagram here and I think in the book, I took it out. It’s my favorite diagram, but I didn’t want to make the book to medical. It’s the oil factors that will block PDH, Pyruvate Dehydrogenase that will shut down normal metabolism in the mitochondria. Honokiol with MCP and we’ve demonstrated enhanced synergistic anti-inflammatory, antioxidant effect. We have multiple patents on this. We published a number of papers on this, and we at some point we’ll develop a newer inflammation product based on this combination.

Dr. Weitz:            Oh yeah. Definitely you should be testing that on rats or dogs.

Dr. Eliaz:              Yeah, we are. We’ve already published a number of papers on this one I think.

Dr. Weitz:            What about using MCP with berberine which is [inaudible 00:57:40].

Dr. Eliaz:              Oh yeah, of course. Berberine is very similar.

Dr. Weitz:            [inaudible 00:57:44].

Dr. Eliaz:              I prefer Honokiol because it is has a more wider range of benefit. It also changes glutamate into GABA, so it reduces excitatory effect, so it’s very relaxing. It has more of an ever inflammatory effect. It’s synergistic with practically every cancer treatment, because the same mechanism, so we use them together. MCP, Honokiol is a great combination for glioblastoma is for example, for brain cancers. Yeah, definitely.

Dr. Weitz:            Interesting. What would the dosage MCPB? Would that be 15 or 20?

Dr. Eliaz:              Yeah. No, it would be 15. If the galectin-3 is high, you can go up to 20. Then Honokiol, you can go up to one gram three times a day. The main side effect is diarrhea sometimes, so it stop and it goes away.

Dr. Weitz:            For galectin-3, what should be the target? What’s considered low? What’s considered high? What’s optimal, if I wanted to be on an optimal longevity program.

Dr. Eliaz:              Ideally, optimal will be eight to ten, eight to eleven. It’s lower now, because they are both platform which is what is used, give lower numbers. Again, it’s another problem, but it’s definitely. If you look at normal blood based on the BGM manual kit, they will say under 17.8 is normal, something under 22. If you look at the Framingham Offspring Study, 8,000 people with microalbuminuria already have a problem, the average is 10.9. The 20%, the 40 lower point quintiles, they were like nine or ten, compared to the highest one which was 15.6 only, three times all cause mortality in 12 years, three times.

Dr. Weitz:            Wow.

Dr. Eliaz:               It’s 15.6. Somebody will think it’s normal. Yeah, so basically, when it comes to modified citrus pectin, you should take it based on your condition. If you’re totally healthy, like you don’t have inflammatory condition or not a problem, and your galectin-3 is low, it’s at ten, eleven. Then you can take five grams a day. If you’re over 40, go up to 10. If your galectin-3 goes to above 14, you need a full dose already. Why? Because there’s more galectin-3 to handle. It’s not user, not user. Just more galectin-3, so you need more you MCP to actually block it.

Dr. Weitz:            Is there any benefits to recovering from a long term viral infection?

Dr. Eliaz:              Oh, yeah, because of course you want to get the post infectious fibrotic effect. Of course same with virus and with radiation, same with surgery. Same principle of course. You want the healing like-

Dr. Weitz:            So it’s like long term symptoms after a viral infection? This could be an important part of the protocol.

Dr. Eliaz:              Very important. It’s like I write about it in the book. There is this Buddhist concept of writing in water or birds flying in the sky, then it disappears, that’s how you want your healing. With no scarring, with no remnants. What causes the remnants, what causes the scarring is galectin-3. It drives the scarring process.

Dr. Weitz:            As a chiropractor, I treat many musculoskeletal [inaudible 01:01:01] like herniated discs and tendinitis. I’m assuming that galectin-3 is probably playing a role in those conditions and the modified citrus pectin.

Dr. Eliaz:              Absolutely, and you will see effect. The other supplement that is amazing for this chronic inflammation, and especially for dental health, almost a miracle is Padma Basic. Anybody with gingivitis, with root canals problem, with periodontitis, Padma Basic three twice a day.

Dr. Weitz:            What is it?

Dr. Eliaz:              Padma Basic. Padma basic is a Tibetan based herbal formula.

Dr. Weitz:            Okay.

Dr. Eliaz:              It’s really not concentrated in the herbs themselves, but it’s an approved drug in Europe since 1965 for circulatory problems.

Dr. Weitz:            Oh, okay.

Dr. Eliaz:              It’s very important during COVID times because it reduces inflammation. But the really amazing things, is dental problems. It’s insane. Nothing like it for dental problems. And of course, Honokiol and modified citrus pectin are very important for dental problems. And there’s much higher level of galectin-3 in the plaque, in periodontitis and so these are all important [inaudible 01:02:20].

Dr. Weitz:            Interesting. Some of the longevity, researchers are looking at periodontitis as sort of a marker of aging.

Dr. Eliaz:              Of course. I mean, I send every patient of mine gets an [inaudible 01:02:32] beam just to look at pockets of inflammation. It’s a much bigger problems than mercury in the teeth. Yeah, definitely and it will reduce it. Padma Basic, I mean all the three compound Padma Basic, modified citrus pectin and honokiol, but Padma Basic is insane. Of course to improve your circulation, open up. It has meta-analysis clinical trial, drugs don’t have it. But for the dental, I’ve just realized because of multiple patients recently. My God, the community needs to know this. We have something, they published a study on chronic pulpitis, which is really inflammation, infection of the root of the tooth where you need root canal, and 80% daily root canals, and pains went down in days. I’m seeing this clinically in patients.

Dr. Weitz:            Really?

Dr. Eliaz:              Yeah, and only three twice a day.

Dr. Weitz:            Wow.

Dr. Eliaz:              Amazing tuff there. Really a gift from nature, a gift from the Himalayas.

Dr. Weitz:            Oh, I’m going to have to look into that. That’s something that I’m not-

Dr. Eliaz:              Yeah, I’ll send you. Send me an email, I’ll send you the study.

Dr. Weitz:            Okay.

Dr. Eliaz:              Very cool, yeah.

Dr. Weitz:            Great.

Dr. Eliaz:              It regulates immune response with the cytokine storm, yeah.

Dr. Weitz:            Oh, cool, awesome. Okay thank you, Isaac.

Dr. Eliaz:              Thank you and for… Yeah, and everybody’s book is available on amazon.com, or you can go to survivalparadox.com. We have a really nice landing page with information and yeah again, we’re making it so affordable, the book. Because it has a really… It really has a unique message. I think it’s time to take our approach to medicine to in different vibrational level, tradition awareness level.

Dr. Weitz:            Yeah, it’s about time we start focusing on health and not just disease.

Dr. Eliaz:              Yeah, and beyond inflammation, what’s beyond inflammation.

Dr. Weitz:            Right.

Dr. Eliaz:              Thank you, I love talking to you. I’m looking forward for the next time.

Dr. Weitz:            Absolutely, thank you so much.

Dr. Eliaz:              Thank you, yeah. Bye, Ben.



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.



Preventing Coronary Artery Disease with Dr. Shilpa Saxena: Rational Wellness Podcast 224

Dr. Shilpa Saxena speaks about Preventing Coronary Artery Disease with Dr. Ben Weitz.

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Podcast Highlights

3:23  The reason why cholesterol plaques form in our arteries is because many of us live poor lifestyles.  We consume more calories than we burn off and not the right kind of calories. We are overly stressed and we don’t the amount and type of restful sleep that we need. This results in too many cholesterol molecules travelling through inflamed blood vessels.  This results in the cholesterol becoming oxidized. The body doesn’t want this oxidized, inflamed cholesterol floating around, so it stores it under the endothelial layer of the arteries.  If you continue with poor lifestyle choices, this oxidized cholesterol plaque will continue to build up.

5:32  The relationship between diet and heart disease.  Any foods that inflame your body, including processed foods, foods that spike your blood sugar and insulin, foods that you are allergic or sensitive to can all irritate your immune system and create inflammation, increasing heart disease risk.

6:31  Diet needs to be individualized for each person. This is also the case for eating fats. Some people do great eating a higher saturated fat diet, while others do not.  Whether or not saturated fat contributes to heart disease is controversial and individual.  Some people can eat a lot of coconut oil and they feel good and their lipoprotein levels look good, but others do not. And certain types of saturated fats, such as the types of saturated fat that comes from coconut or avocado, is higher quality than saturated fat coming from animals.  We need to see for each person if eating certain foods, say like bacon and eggs, 1. do they feel good?, and 2. how do their labs look?  And if both of these are positive, then that is a good way for that person to be eating.

10:41  In terms of general recommendations for diet, the Mediterranean diet is the most studied diet for the prevention of coronary artery disease.  The Mediterranean diet is more plant-based with less animal protein, though with an emphasis on fish, and less sugar, with occasional wine, and healthier fats like olive oil. Dr. Saxena recommends that the carbohydrates that you include be whole grains and lower glycemic impact carbs so that you control blood sugar and insulin levels. Insulin resistance that develops from eating high glycemic carbs and sugar will result in your cholesterol being oxidized and turning your cholesterol into small, dense LDL particles, which increases plaque risk.

19:35  Advanced lipid testing.  Dr. Saxena prefers to do advanced lipid testing that includes small, dense LDL, oxidized LDL, Lp(a), HsCRP, myloperoxidase, and Lp-PLA2. Lp-PLA2 is a measure of the ooze ability of arterial plaque.  ApoB is another test that you can order, esp. if you can’t do a full lipoprotein panel because either the patient can’t afford it or the insurance won’t cover it.  And we need to look at metabolic factors like glucose, insulin and hemoglobin A1C.



Dr. Shilpa Saxena is a board-certified family practice physician whose passion and purpose come to life through sharing her innovative patient education and practice management solutions in her classic “keep it simple” style. She serves as faculty with the Institute for Functional Medicine and the Andrew Weil Center for Integrative Medicine. She also serves as the Clinical Expert for the CM Vitals Program at Lifestyle Matrix Resource Center. Dr. Saxena is currently practicing in Tampa Florida at Forum Health at 3820 Northdale Boulevard Suite 107-A, Tampa, FL 33624 and the phone is 813-269-2700. Her website is DrShilpaSaxena.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 talked to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today, we will be talking about coronary artery disease, what causes it, the latest in advanced lipid testing, what is the role of diet and lifestyle, what we should think about statin therapy, the most commonly prescribed medications for managing coronary artery disease, and the role of nutraceuticals in modulating the risk of cardiovascular disease. Coronary artery disease is the most common form of heart disease in the United States, and it refers to the buildup of cholesterol plaques in the artery walls that supply blood to the heart called the coronary arteries.  As these arteries become narrowed, they can partially or completely block the blood flow to the heart, which is referred to as a myocardial infarction or a heart attack. This process of plaque buildup is often referred to as atherosclerosis.

I’m very happy that this episode of the Rational Wellness Podcast is being sponsored by Lifestyle Matrix Resource Center, which provides clinical resources, patient education materials, and marketing tools to help healthcare practitioners successfully implement functional medicine into their practice.  With these resources plus access to their knowledgeable implementation support team, you can quickly become the go-to expert in your community on a variety of health topics like GI health, immunity, and stress. Learn more at lifestylematrix.com. Exclusively for Rational Wellness listeners, Lifestyle Matrix Resource Center is offering a cardiometabolic case study download, so visit lifestylematrix.com/rational-wellness-download.


Dr. Weitz:            I’m very happy that our special guest today is Dr. Shilpa Saxena, who is a board-certified family practice physician.  Dr. Saxena’s passion and purpose come to life through sharing her innovative patient education and practice management solutions in her classic keep it simple style. She serves as faculty with the Institute of Functional Medicine and the Andrew Weil Center for Integrative Medicine. She also serves as the clinical expert for the CM Vitals Program at Lifestyle Matrix Resource Center. Dr. Saxena is an expert in the Group Visit medical model, creator of Group Visit Toolkits, and co-author of The Ingredients Matter: India.  Dr. Saxena, thank you so much for joining us.

Dr. Saxena:         Thank you for having me.

Dr. Weitz:            Great. So let’s start with what do we know about what causes coronary artery disease, or to put it another way, why would our bodies lay down layers of cholesterol plaque in our arteries that can narrow the blood flow and kill us?

Dr. Saxena:         Isn’t that just the ringer that like, “Why would our bodies do this to us?” The first myth I’d love to bust is your body’s not out to get you. Your body is doing the best it can with what you are creating for it. So for example, the reason why plaque starts to form is because many of us live poor lifestyles. We give our bodies way too many calories, not the right kind. We don’t burn it off with great physical activity. We generally are more stressed than we were intended to be. We may not be resting, so what you have is the makeup for too many cholesterol molecules that are traveling around an inflamed blood vessel.  When these molecules or particles, as we call them, become inflamed, they become oxidized. Just think of it as like burnt oil on your stove. You pour in some olive oil on the pan, and then it gets burnt. You’re not going to use it anymore. The body feels the same way. If you’re on fire and you’ve got some extra oil going around in your blood vessels, and it gets burnt, what it does is it looks in the blood vessel for places to hide it or store it. It doesn’t have a garbage can, so your blood vessels can be leaky.

Just like maybe you’ve heard of leaky gut, you can have leaky blood vessels, so those leaks are perfect places to hide the oxidized LDL, and so it just goes under that skin, if you will, of the blood vessel and it stores it there because it knows traveling through the bloodstream, it’s no good for you. It’s not useful to you to burn for energy. And so after a while, it’s just assuming you’ll stop this behavior, and unfortunately, we don’t, and it’s cued to keep cleaning up, so it’s not an unintentional thing that it’s creating plaque. It’s just resultant from what we’re giving it to manage.

Dr. Weitz:            Yeah, poor diet and lifestyle. Let’s talk about the relationship with diet and which types of foods may contribute to making this process worse or better.

Dr. Saxena:         As we mentioned, anything that turns your body on fire or inflames it, right, so things that are, number one, inflammatory in nature, processed foods, packaged foods, things that have a high glycemic impact, meaning that they cause your blood sugar and blood insulin to spike and many times crash after that, that’s going to turn on inflammation. Foods that you’re allergic or sensitive or intolerant to can inflame your body, so those foods you might want to identify and eliminate. Those are the things that really just are, if you will, irritating foods. And anything that irritates the immune system or just plain doesn’t belong in the body, your body will say, “I don’t want it,” and then it’ll figure out a place to put it.

Dr. Weitz:            Let’s talk about one of the controversial areas, which is that saturated fat has often been called the major contributor to increases in LDL cholesterol. Is this really the case? And if it is, do we know what the mechanism by which saturated fat contributes to increasing LDL?

Dr. Saxena:         Thanks for pointing out it’s controversial. The first thing that I’m going to say, which is probably quite obvious, and yet we sometimes overlook it, and that is we don’t have one answer that fits all bodies. We’re all biochemically different. So for one person who has some real genetic vulnerabilities to saturated fat, saturated fat can be problematic if in a high quantity or a poor quality. Then you have people whose bodies really do well with more fat, and that’s just the basis of genetics and biochemical aspects, so I don’t want you to think there’s this one-size-fits-all answer about saturated fat. That’s number one.  Number two, the rule that you can say is that good saturated fat is better than bad saturated fat. So for example, an avocado would be a better source of fat than trans fats, which are man-made fats.

Dr. Weitz:            Now, let me just stop you there. Most of us don’t think of avocados as saturated fat.

Dr. Saxena:         Well, plants can create saturated fat. I know most people just flip to animal protein thinking that it’s like a big hunk of beef, that saturated fat, but no, plant foods are great sources of healthy saturated fats. But as you might remember, there was this coconut oil craze where everybody was slathering in it, adding tablespoons to it.

Dr. Weitz:            I don’t think it’s over.

Dr. Saxena:         Well, I think a certain population does well with it in a certain population, when I was checking their lipoprotein panels, their plaque and inflammation risks skyrocketed. Again, there’s nothing wrong with coconut oil. It’s your body’s relationship to it. I mean, here’s my funny joke if it makes sense. Water, you think that water would be good for you, but it’s your relationship to it that matters. So if you’re drowning, water is not good for you. So in and of itself, anything is not necessarily good or bad with few exceptions. It’s your relationship to it or your body’s relationship to it that really matters.

Dr. Weitz:            Essentially, I think what you’re saying is rather than saying, “What’s the best diet for everybody,” there’s a different diet for each person. I’m assuming that you’re thinking along the lines that I think, which is in order to determine what’s the best diet for you, we’re going to measure, for example, your advanced lipids, and see how you’re doing. And if the way you’re eating is contributing to a unhealthy profile, then that’s not the right way for you to eat.

Dr. Saxena:         I have this thing that I say. You said in my bio I like to keep it simple. I don’t treat paper. I treat people. So if you start a diet and you feel great, that’s wonderful. That’s step one. You should feel better, and number two… You should have more energy. You should probably be less inflamed looking, less swollen, less itises bothering you. And then number two, your labs should show that your inflammation number has gone down. Your particle numbers or these advanced lipid numbers are improving over time that they’re not causing plaque.  So if those two criteria are met, that you feel good and your labs look better, you’re on the right track with picking the diet for you, or if we may say, the food plan for you. Conversely, if you feel awesome on bacon and eggs, but your labs are like, “Nope,” well then, we just might need to reassess, because clinically, there may be some benefit to some saturated fats, but the relationship to them is not working for your coronary arteries.

Dr. Weitz:            Now, I totally agree with everything you’re saying, but what about if you’re asked to make general recommendations for groups or society, then what do we say about saturated fat?

Dr. Saxena:         Well, I would say that the most studied diet for coronary artery disease is the Mediterranean diet. What we’ve done in functional medicine is take it a step further. The Mediterranean diet is kind of an assortment of diet profiles inherent to the Mediterranean area. So in general, they tend to be more plant-based with less and less animal protein and less and less sugars with occasional wine, but really focusing in, if you will, on the food part with plant-based proteins and the ratio against animal protein, if you will.  Saturated fat does play a role, but it’s healthier fats like olive oil or what you might find in a fatty fish. Of course, red meat is allowed, but in much smaller proportions, maybe two times a month.

Dr. Weitz:            Isn’t olive oil basically omega-9 rather than saturated fat?

Dr. Saxena:         Right. It’s not a saturated fat, but I’m just speaking to fats in general [inaudible 00:11:55] speaking it.

Dr. Weitz:            Right. Gotcha.

Dr. Saxena:         It’s fat, but when people start thinking fats, I don’t think they really go into saturated and polyunsaturated, monounsaturated. They many times clump it all together. So I always like to say there are good oils, and then there’s saturated fats that for sure we want to optimize the quality and then optimize the quantity. The Mediterranean diet is where I would start, and then I would say, “Hey, take it a step further. When you’re doing your grains, have them be whole grain so that they have a lower glycemic impact, because we do know one of the silent killers of people is not just cardiovascular disease, but cardiometabolic disease.”

What that means is that if you get a standard cholesterol panel, and your numbers look good, you actually haven’t screened for a hidden risk, which is called insulin resistance. So when you take the Mediterranean diet, and you add in the low-glycemic impact version of it, you’re addressing the hidden insulin resistance aspect. And if you’re taking in saturated fat while you’re insulin resistant, I don’t think that’s a great combination, because it’s oxidizing those fats, turning them into what we call small dense LDL, and that increases plaque risk.  One thing that I might say is this, “If you want to know how to intake saturated fat, first, be sure that you are not insulin resistant and inflamed.”

Dr. Weitz:            And then don’t take it in with a lot of carbohydrates either.

Dr. Saxena:         Right. Well, remember, I’m going to say not a lot of refined carbohydrates, because there’s definitely-

Dr. Weitz:            Right, or high-glycemic carbohydrates.

Dr. Saxena:         Right. Right. We use the word carbohydrate, but broccoli is a carb, so I want to teach people fats aren’t bad. It’s bad fats that are bad. Carbs aren’t bad. It’s bad carbs that are bad. You know what I mean?

Dr. Weitz:            Right. Gotcha.

Dr. Saxena:         I think people are so… They’re so used to villainizing a macronutrient, and we don’t want to villainize them. There’s good versions of fats, proteins and carbohydrates. We just need to choose those more often.

Dr. Weitz:            What about foods that are high in cholesterol like eggs? Is it okay to eat eggs every day?

Dr. Saxena:         Well, I guess you’d want to check your profile. I think it’s the same answer, but nice… I think these are funny questions, and I think they’re common questions that people have. It’s like almost people are negotiating. It’s the same answer. It depends. If you are, first of all, sensitive to eggs, no, it’s going to create… Let’s just say it doesn’t even create a cholesterol problem, but it can create inflammation that will create still a secondary risk, so we want to make sure…  Eggs, it’s not just the fat that they have. You want to make sure eggs is one of the top eight allergenic foods. Make sure you’re not allergic or sensitive to it as well too. But if you’re… Again, people always say things in moderation. That’s the place to start Mediterranean, and then check your insulin resistance, inflammation markers with these advanced lipid panels that you’ve been mentioning.

Dr. Weitz:            I was going to ask you about the best diet. You basically said low-glycemic Mediterranean diet. Recently in the news, it’s been mentioned in several studies, there’s a diet called the portfolio diet, which has been touted for reducing cholesterol and heart attack risk. What do you think about that?

Dr. Saxena:         I don’t know about the portfolio diet. If you wouldn’t mind sharing a little bit about it, I’m happy to tell you my opinion.

Dr. Weitz:            It’s a diet that, I think, is somewhat plant-based, but includes four food groups, which is nuts, soy, plant sterols, and soluble fiber like oat bran or oatmeal.

Dr. Saxena:         This is very much based on some of the nutrition guidance that Dean Ornish and his crew have shown, and also Caldwell Esselstyn that a plant-based diet that’s high in fiber, low in saturated fat, low in oil content in general can be useful for certain populations. So I would say the higher-

Dr. Weitz:            Well, this was a… I don’t think the portfolio diet is necessarily low in fat, but…

Dr. Saxena:         Oh, it’s not?

Dr. Weitz:            No, I don’t think-

Dr. Saxena:         Where do the fat come from?

Dr. Weitz:            I’m not sure exactly, but I think the main thing was that you make sure you add these four foods that are all been shown to reduce unhealthy LDL.

Dr. Saxena:         You know why, it’s the nuts that might be the healthy fats, so-

Dr. Weitz:            Nuts have been shown to reduce LDL. I think soy beans have also in some studies, and then there are some studies have shown that the plant sterols… I forgot where the plant sterols come from. Then there’s also been studies showing that the soluble fiber, it was really big at one time, right? All these people were eating oat bran muffins and stuff.

Dr. Saxena:         I think that people go… They’re looking for… Many people are looking for the trend that solves the problem, but I would tell you, for instance, intermittent fasting, I think it works tremendously for many people. I tried it, and my lipid profiles went up. Fasting, for me, causes my blood sugar to spike, so I think I’m going to keep… I mean, I’m so going to be boring here and say try it out. See if you feel well, and see if your numbers pre and post look different.  But I think the more you try, not you, Ben, but people try to just make one diet better than the other, the more confusing our approach to medicine will be. We believe in personalized medicine. Personalized means that you’ve got to find your answer, and it’s going to be different than mine and different than Ben’s.

Dr. Weitz:            Is it healthy for some people to eat a carnivore diet?

Dr. Saxena:         Yeah. I have found people. I have some people who really do not do well with plant protein. I would say it’s a small group of people that they don’t either metabolize or respond well to the lectins and food. There are people who do much better on a carnivorous diet, but I want to make sure that they also have an anti-inflammatory version of these animal proteins, happy animals, the stress hormones from there. The other thing that I really think is important is to never take a diet out of the context of your entire lifestyle.  There’s many people who may come to see me that come from a third world heritage, the so-called third world, so they’re used to eating a diet high in, let’s say, corn or rice or grains, and a big proportion of it might be so. So when they say, “Well, listen, we’ve always eaten this way, and we’ve never had heart disease,” I would generally say, “Yeah, but you likely didn’t have as much stress 200 years ago, and you likely did eight hours of physical toil out in the hotter or sweating and detoxing.” You can’t take a diet from 200 years ago, and transplant it into modern society, so you got to take the diet.    If you’re going to eat that way, then you got to work out that way. Burn those carbs off like your great, great grandparents did. So just remember, when we start… Going back to history, if you want to eat paleo, okay, that’s good, but you might want to act like a paleo person and move a lot more too.

Dr. Weitz:            Unfortunately, I’ve seen too many people who act like paleo people.

Dr. Saxena:         Yes.

Dr. Weitz:            Let’s talk about advanced lipid testing. Which markers do you feel are the most significant contributors to heart disease?

Dr. Saxena:         Well, I think there are some core ones that generally tell me the news. I will get a standard cholesterol panel just because that’s, it’s almost for me, to show people how unreliable it is, especially in the phase of insulin resistance, so I usually will get what we call an advanced lipoprotein panel. That’s available through insurance-based lab companies as well. That’s wonderful. We can do this inflammation and lipoprotein testing. I’d like to order a lipoprotein panel, where I’m looking for small dense LDL. If you can find oxidized LDL, that’s great.

I love to make sure that we have an hs-CRP. If you can also… That’s a measure of total body inflammation, but specifically cardiac if you have no other confounding variables like an infection or trauma. Then the other thing I like is Lp-PLA2. This is a measure of, if you will, the ooze ability of your plaque, because what is commonly known to cause heart disease is plaque that just builds, builds, builds, and causes a blockage and then the blood can’t flow, but the other mechanism that causes heart attacks and strokes is when your plaque is actually not rigid and slowly clogging up the plumbing.  But when it’s gooey like a zit, if you will, and this zit volcano blows because it’s vulnerable to rupture, and then the body in the blood vessel’s like, “Oh no, there is a cut,” and so it sends a clot to patch it up, and it’s the clot that can then obstruct the flow of the blood to the heart or to the brain, and cause the heart attack and stroke. Lp-PLA2 tells us the ooze ability, if you will, of the plaque. I think it’s also good to know myeloperoxidase if you have a high-risk person, because if they have an elevated Lp-PLA2 and an elevated myeloperoxidase, together, those can confer a significant risk for cardiac event in the next three months.

Apo B is another test you can order if you can’t do a full lipoprotein panel. I think those tend to be… Oh, and LP little A, this is the genetic predisposition to clot. So remember, you’re not just looking for cholesterol. You’re looking for everything in that environment of blood vessel that makes problems, and you want to modify each one of those variables to reduce your total risk, and then that’s not even talking about the insulin, hemoglobin A1C, that kind of stuff.

Dr. Weitz:            Right. What about HDL? Where are we in terms of the significance of HDL? I know for a while, we were looking at HCL particle sizes well, and it seems like the emphasis now is more on HDL functionality.

Dr. Saxena:         HDL, sometimes people call it like your pickup trucks that go into the plaque, and pick up like it’s an efflux mechanism to clean plaque. I definitely think that that can make a big difference. However, just as you were mentioning, people can have high levels of HDL cholesterol, but very dysfunctional HDL particles, so they look good on the… Like great trucks on the outside, but they don’t actually clean up, and so we do want a functional test of HDL. What I’ve found clinically taking care of thousands of people is that there’s definitely a handful of people that have gorgeous HDL particles, and it can make up for a moderate mess they’re making with their LDL particle numbers, but that’s not as common as people making a big mess with their LDL particle issues.

Most people are bigger plaque generators than they are cleaner-uppers. How do I know who’s winning the war between who’s making plaque, the LDLs, versus who’s cleaning up plaque, the HDL? Many times, we’ll look at the Lp-PLA2, and get a sense of who’s winning the game. Because if they look, if you will, ugly on the LDL particles side, and they look really good on HDL, but I see their Lp-PLA2 looks good, and hs-CRP is down, I’m going to say, “Hey, they’re cleaning up quicker than they’re putting the plaque down.”

That tells me if I’m just still optimizing lifestyle and nutraceuticals that they could be, if you will, safe. Nobody’s guaranteed safe, but it looks good, and they could be more comfortable in proceeding with that functional medicine approach.

Dr. Weitz:            I think what you’re saying with the Lp-PLA2 is that if that number is high, it refers to plaque that’s less stable. Is that what you’re…

Dr. Saxena:         Yeah, it’s more rupture prone, and the easiest way patients get it is it’s oozy like a volcano.

Dr. Weitz:            Right, as opposed to maybe plaque that’s calcified.

Dr. Saxena:         Right. Well, you want your plaque to be stable, but what can happen is that as it starts calcifying… I mean, that could be good in one sense if your plaque is relatively low. But as you get more and more plaque if you calcify it, then that’s a little bit harder to reverse out, and that’s why people will get stents and the Roto-Rooter version of opening up the lumen or the blood flow.

Dr. Weitz:            Right. What about homocysteine? Is at another marker you look at?

Dr. Saxena:         Yes. I mean, I could list a bunch of markers. Homocysteine is definitely an elevated homocysteine, and that would be above nine for me on most of our American-based metrics and insurance-based labs. Above a nine tells me that I need to look at methylation, and start looking at other aspects, nutritional aspects. I also look at an omega index to see, “Hey, what’s going on with their fat intake? What’s the omega-3 to omega-6 ratio?”

Dr. Weitz:            What is your target for optimal omega-3 index?

Dr. Saxena:         So interestingly, I aim for like… If you want to get an A+ in my classroom, I go for an 8.0, where normally, 5.5 is the cutoff that is provided in the labs. The way that I say it is like, “If you want to be 100-year-old with a rocking brain and a rocking body, you want to be so uninflamed, so you want to get your number to 8.0. 5.5, you got a solid maybe B- with me.

Dr. Weitz:            No, definitely, at least eight. I sometimes aim for 10. What do you think about the role of coronary calcium scans?

Dr. Saxena:         I think that’s actually a wonderful new way for us to get a better indicator, because when we’re doing these labs, they’re short-term indications of what’s going on. And if you want a longer story, you don’t just want one chapter view of what’s going on in the timeline of your artery, a coronary artery calcium score could really be useful, because then I can see what’s happened to the artery the decades prior. Whereas sometimes when I’m looking at labs, I might get some clues, but if they look, if you will, ugly on their labs like, “Whoo, these don’t look good.”

Dr. Saxena:         Then I say… Then they seem to have the risk profile like a stressed-out male who’s obese and does the wrong things, if you will, I might order that coronary artery calcium score to see, “Do I need to get you over to a cardiologist to get stress testing sooner rather than later?”

Dr. Weitz:            Right. So let’s get to what can we do about some of these problems, and why don’t we first mention pharmaceuticals? Statin medications are often the most commonly prescribed medications to reduce heart attack risk. What do you think about statins?

Dr. Saxena:         I think there’s a time and a place for most everything. It’s the relationship with it. I definitely don’t think you’d take a statin, and then have your ice cream and trans fats. I think that if you are at a high-risk situation, where you need some immediate reductions with some anti-inflammatory signaling from the statin, and you might be able to reduce some significant LDL, it might make sense, and you really do have to think about medical legal considerations when you’re in this market. You at least offer the statin, and document it’s the standard of care, and then if the patient refuses, if they don’t want to, because there’s definitely a growing group of people who are statin refusers or statin intolerant.

 I think that there’s a group that are definitely at high risk, especially some that have genetic familial hyperlipidemia. They have LDLs in the 400s, and they’ve been having it. They’re due for a heart attack in their 30s and 40s, so that would be a little bit of legal suicide not to offer a statin to that person or not refer them to a cardiologist. But otherwise, I think most of the people who are coming to see me who will say our primary prevention, they’re trying to prevent their first heart attack or stroke. Not that they’ve had one, but they’re preventing their first one.  Most of the time, we’re not dealing with people who would not qualify for a trial of therapeutic lifestyle change and nutraceutical with early repeat lab testing as well as BMI and waist circumference checks and all these types of things. I would never go, “No statin. Here’s some lifestyle stuff. See you in six months. Hope it works well,” if they showed some moderate risks.

Dr. Weitz:            Right. I think the data on primary prevention is much thinner than the data on secondary prevention, right?

Dr. Saxena:         Correct.

Dr. Weitz:            Now, there’s a number of studies it seemed to show that statins have no negative effect on brain health or testosterone levels or muscle dysfunction, but I think most of us in the functional medicine world think quite a bit differently based on our experience with patients. What do you think?

Dr. Saxena:         I would say that there is definitely a group of people. And if you just look at the physiology of statins, they’re HMG-CoA reductase inhibitors, so they’re just going to downstream reduce your CoQ10 production. I mean, you just can’t argue that CoQ10 is necessary for certain tissues to function well, including the muscle, the liver. Then the other thing that you mentioned about low T or hormones, low T I’ll just say because many times, it shows up as low T, low testosterone, excuse me, in men. Some of the targets that people are just pushing for LDL cholesterol are lower than necessary.

It’s almost like, “Hey, just in case, let’s drop it to 70 LDL cholesterol,” meaning drop it below 70. There’s definitely a group of people that may need that for secondary prevention or higher-risk conditions. But if you just take the average male with average risk for primary prevention drop his LDL down to 70 or below, you’re likely reducing the precursor that he needs to make his testosterone, so he can make muscle mass to keep himself lean. I do think it’s a vicious cycle that we have tunnel vision about the cholesterol that we forget that cholesterol is necessary in the body.

Dr. Weitz:            They’re lauding a target of 40 for LDL cholesterol with some of these newer drugs.

Dr. Saxena:         Right. I just think it’s not a balanced view. It’s not definitely an integrative full functional view, a systemic view of the body, and then we know, just as you mentioned, that the brain needs good fats, and LDL is not bad. It’s just the relationship to it. So when it’s oxidized, when it’s too much or too little, that’s going to affect the health of our total system. I’ve seen data that talks about the association between statins and dementia, statins and diabetes. I do think it solves one problem, but in a laser way sometimes, but it doesn’t take into account the impact in other departments, and so we have to look at the total benefit risk package before we just slap somebody on with a statin, and drop them to a 70 or 40.

Dr. Weitz:            Right. By the way, for those who don’t know, what does LDL even mean? What is LDL?

Dr. Saxena:         It stands for low density lipoprotein. What that basically means is when you eat fat as a macronutrient, there’s different kinds of fat, and they can compartmentalize as high density lipoprotein, HDL, which I call healthy happy HDL. Then it can turn in sugars and carbs, many times turn into terrible triglycerides, and then they can also turn into lousy LDL, the low density lipoprotein. And terrible triglycerides and lousy LDL cholesterol, they don’t actually travel separately in the bloodstream. They actually join forces, and the ratio between the trigs and the LDL determines the size of the particle they make.  We call that still an LDL particle, but it can be small, medium, or large based on that ratio, and the smaller it is or the more dense it is, the more prone it is to oxidation. What you eat and how you move determines the size of that particle and its vulnerability to be oxidized and then turn into plaque.

Dr. Weitz:            Right. Let’s say you have a patient, and you think they’re at some risk, and they don’t want to take a statin. When do you consider using alternative pharmaceuticals as opposed to diet and nutraceuticals since now we have a number of alternative pharmaceuticals for affecting heart disease risk like, say, Zetia, and then we have bempedoic acid?

Dr. Saxena:         I would just tell you that the most commonplace I go to if someone does not want to use a statin is not an alternative pharmaceutical. I go straight to lifestyle and nutraceutical, because I do think that they hit at the core root cause better than the Zetias and some of these targeted therapies. In the functional medicine approach, when you address inflammation, which one of the common sources is the gut microbiome, when you reduce inflammation through improving lifestyle, whether it’s stress, movement, diet, sleep, and when you address insulin resistance and some of the immune dysfunction through lifestyle and targeted nutraceuticals, but these targeted nutraceuticals are not targeted like pharmaceuticals are.  They’re targeted towards a big systemic biology issue like inflammation or insulin resistance, right? So if you replace vitamin D, it helps all branches of your tree of life. It’s not just this one branch, whereas Zetia is only working, if you will, in one branch in terms of absorption, so I always like to go-

Dr. Weitz:            One narrow pathway as opposed to affecting multiple pathways.

Dr. Saxena:         Right. Exactly. Functional medicine is all about modulating many pathways softly versus one very strongly.

Dr. Weitz:            So what are some of the best things we can do nutraceutical wise to move the needle on, say, somebody who has an elevated LDL particle number?

Dr. Saxena:         Great question. So the first thing I’m just going to say out loud to make sure it’s crystal clear is you don’t get to have… I’m going to use a little French here. I think you’re from up north just listening to your accent. I’m from Queens, New York originally, too.

Dr. Weitz:            I was actually born in The Bronx.

Dr. Saxena:         I was born in Flushing. What I’d say is you can’t nutraceutical your way out of a crap lifestyle, okay? Number one, you don’t get to eat junky, sit, stress out, not sleep, and then think that nutraceuticals are going to make up the difference, so lifestyle is number one. Then to compliment and to make up for what it takes lifestyle sometimes a little time to clean up is when we bring in these nutraceuticals, so I’ll put them into a couple of different camps. Number one is the camp that will reduce inflammation.  Many times, we’re doing omegas. You might take, for instance, a berberine to be able to help reduce inflammation at the level of the gut microbiome. You might take a bergamot, which is going to help with LDL particle number, and the LDL particle size is what I’ve seen in my lab profiles as well too. It’s not just the number, even though the original study was looking at a cholesterol panel against rosuvastatin.

Dr. Weitz:            So it will increase LDL particle size?

Dr. Saxena:         Yeah. Well, what I see… Right, exactly. I see my small dense LDL number reduce, so it fluffs them as well as reduces the quantity.

Dr. Weitz:            What dosage of Bergamot do you find effective?

Dr. Saxena:         We usually use a 500 milligram and use two of them at bedtime, and that honors the Eastern philosophy of the circadian rhythm of organs. Your liver is most active in the evening, so feed it the bergamot because it’s really acting to support the liver as it regulates LDL sizes.

Dr. Weitz:            Okay.

Dr. Saxena:         So bergamot, berberine, vitamin D3 plus K2, so D3 alone definitely signals the body to use up calcium. But if you use D3 alone, calcium can be told to get out of the bloodstream, and you’re assuming it’s going to the bone, but it’s actually been shown that it can go into plaque. We don’t want that. We don’t want to calcify plaque. So what we do is we give D3 a bodyguard called K2, and we say, “Hey, make sure when you’re telling calcium to get out, to make sure it goes to the bone and not the plaque,” so D3, K2 is a huge…  I used to at least get it above 50. I like 60 to 80 as a level for vitamin D 25-Hydroxy OH.

Dr. Weitz:            What dosage of K2 do you like?

Dr. Saxena:         What I do is a lot of these companies will have paired D3 and K2. Do you believe that I am blanking right now because you’re asking me on the dose? I want to say 45 twice a day or 90. Somewhere around 90 to 180 micrograms is what I’m thinking off the top of my head if I remember correctly.

Dr. Weitz:            I think the average vitamin D product maybe has 50 and some may have 90, but some of the integrative cardiologists have recommended 180 to 360 K2 a day.

Dr. Saxena:         I don’t… Definitely, more is good in most… I’ll say… No, I’m going to say in most situations. K2 and vitamin D3, being liberal with it, I think, is generally safe. Toxicity is not common. Again, I like to track and then always double check that we’re not treating everybody. We’re treating you, so let’s see how you look when you take these doses.

Dr. Weitz:            Right. What about red yeast rice?

Dr. Saxena:         Ooh, then that’s a little bit controversial. I think red yeast rice can… What I’ll tell you is that red yeast rice definitely acts similar to a statin, right? Similar. It has a similar mechanism, so it’s going to affect the same pathway, but it won’t press as hard if you will. The debate has been, “Well, if you’re going to use red yeast rice, should you not just use an FDA-regulated statin because you don’t know what you’re getting?” There are some arguments that would say that if you don’t know the supplier of your red yeast rice, you might be getting actually the statin anyway, so you might as well use a regulated form. So what I think-

Dr. Weitz:            Right. Yeah, but certain manufacturers will make sure that there’s no lovastatin in the red yeast rice, and yeah.

Dr. Saxena:         So yes, and then I just want to make sure our people know to do their due diligence on the good companies that are doing their homework on their sourcing of their red yeast rice. I have a group of people who definitely are pro red yeast rice, but just be careful. You want to make sure that you replace the CoQ10. I generally get a lot of traction from bergamot and berberine, and then I don’t have to worry about them actually spending on CoQ10, because sometimes CoQ10 can get expensive.

Dr. Saxena:         We do have to admit that these things cost money, and people have an X amount of discretionary income.

Dr. Weitz:            Oh, for sure.

Dr. Saxena:         Then, you know what, but if they have a mitochondrial defect, I want to make sure I get that CoQ10 in to cover my bases for something else that could be beneficial.

Dr. Weitz:            I just want to get out there. For some reason, I’ve talked to quite a number of people who are taking red yeast rice, and very few of them are taking the recommended dosage. Sometimes these are even the integrative physicians who are recommending it, and they’re taking one or two capsules a day, and the therapeutic dosage for red yeast rice is 2,400 to 4,800 milligrams a day. Typically, that means four to eight capsules a day, not one or two.

Dr. Saxena:         They could be doing some therapeutic doses. I’ll just tell you what I tend to do. I tend to… The other thing that I will do for patients, especially when I’m looking for cost savings, the half life of rosuvastatin is actually quite long, so I might do twice weekly, five milligram rosuvastatin. Sometimes that little touch of statin helps me with some of my moderate-risk patients. Now, I’m not telling you not to do red yeast rice. I’m just telling you if that’s covered, and they can’t afford the CoQ10 and then this and that, because just as an aside, I take insurance.  You may not have that population, but if you do, money does matter at times. I also want to talk about niacin. Niacin, for sure, is something that we use to be able to help, especially with the insulin resistance, triglyceride, HDL metabolic dyslipidemia. Just be careful with your patients with liver dysfunction. Many times, I like to do blends so that they’re not getting any one thing, any one signal too strong. So, if you could do blends of a low dose of a fish oil and bergamot and berberine, niacin, you can create these blends that make a bigger difference for people.

Dr. Weitz:            Niacin is one of the most effective things to move the needle on LP little A, also increases LDL particle size.

Dr. Saxena:         That’s right.

Dr. Weitz:            What form of niacin do you like?

Dr. Saxena:         I like the form that does cause a little bit of flush, I will tell you, and what-

Dr. Weitz:            [inaudible 00:42:41] flushing form is totally ineffective.

Dr. Saxena:         Well, right, and so one of the things that I like to do is actually go a little slow, and I like to use things synergistically, because I do find that my patients with niacin, if they get the flush, and they get it in their head that they’re allergic or sensitive, then it’s hard for me to capture the niacin for long term. You can mix it with quercetin, which really helps. I try to use it at bedtime. I’m not really pushing aspirin these days with some of the new data, so I think when I blend the niacin in and I keep it at a lower dose, I like that better for my patients I’ll say.

Dr. Weitz:            What dosage is that?

Dr. Saxena:         500 to 1,000 is plenty for many of my patients as long as I don’t use it as monotherapy. If I use it with a good fish oil, and I’m using it… I’m telling you berberine and bergamot are some of my favorites, because they’re just such a low side effect profile.

Dr. Weitz:            Right. Of course, berberine works on a similar mechanism as metformin, so super beneficial for blood sugar and diabetics, and may also have longevity anti-aging benefits.

Dr. Saxena:         Without the B12 depletion, right?

Dr. Weitz:            Right. Talk about-

Dr. Saxena:         There was a recent study that came out just interestingly, and I’m sure it applies to statins, because I want to say there was a study about it. But within three months of somebody being prescribed metformin, compliance drops down quite a bit, so I do think that sometimes, we give people pharmaceuticals, and we’re not paying attention to the nutrient depletions, and then they get secondary symptoms and or they’re just not feeling well, whether it’s GI or energy or muscle pains or something with metformin, so using these other tools and then tracking their labs and showing them, “Look, they made a difference with little side effects,” and if anything, beneficial to other parts of their body, right? Berberine’s helping inflammation everywhere.

Dr. Weitz:            What are some of the nutrient deficiencies that occur from statins? You mentioned-

Dr. Saxena:         CoQ10.

Dr. Weitz:            … CoQ10, but there’s actually a bunch of others, right?

Dr. Saxena:         Oh yeah. Selenium is another big one. If you deplete the selenium, then you can start to see thyroid dysfunction. Have you seen that quite a bit?

Dr. Weitz:            Yes, and vitamin D, vitamin K. There’s a bunch of nutrients that are really depleted by statins.

Dr. Saxena:         That’s something that I think has been quite compelling. I’m actually the chief medical officer for Forum Health, and we work in my office. We have an alliance with a college of osteopathic medicine and the pharmacy team. What they routinely do is nutrient depletion checks on all pharmaceuticals that the patient is taking, and they submit that to us as the clinical team. Patients are just astounded with how their routine medications are depleting nutrients.  I think it’s a great exercise to just do a nutrient depletion check on some of your patients, and not only would that be useful for them to know, but it would give them more buy-in for taking their nutrient therapy if they have to take a pharmaceutical.

Dr. Weitz:            What’s your favorite testing for nutrient depletion?

Dr. Saxena:         My favorite testing, you mean like what, my favorite company?

Dr. Weitz:            Well, I mean, we know that serum testing for a lot of nutrients is not particularly accurate, right? I mean, it is providing a D, but not for a lot of others.

Dr. Saxena:         For everything. I mean, I’m really… Are we allowed to say company names here?

Dr. Weitz:            Oh, sure.

Dr. Saxena:         Got it. I like Genova’s NutrEval quite a bit, but that’s… I am not… Because I started as an insurance-based physician, I learned many times using history and physical exam to be able to get a sense, “Do you have a functional nutrient depletion?” Dr. Michael Stone at the Institute for Functional Medicine is just an absolute wiz in the nutrition-oriented physical exam. If we just get back to some physical exam skills, and take a good history and just research some of the depletions from a pharmaceutical, you can do a lot.  I save a lot of money for my patients doing it that way. Now, of course, it’s nice to have testing, but if it’s not possible, I’m just making sure that all of our practitioners with different populations have an answer.

Dr. Weitz:            Right. What if a patient, they have a coronary calcium scan, and they have plaque, and they said, “Put me on the best program to reverse my plaque,” what would you put them on? Let’s say that money is no object. [crosstalk 00:47:20].

Dr. Saxena:         I’d have to… Well, first, I would do a timeline analysis, and get a sense of what are the things that I think that led to their plaque. Is it… If heavy metal’s a part of it, would I then include some plaque X, some chelation with it? Do I have to really work on heavy metals? Is it really just horrible lifestyle? Is it just gut inflammation? Is it genetics? I would… I don’t know. I don’t have a program as much as I just identify and address their underlying causes, if that makes sense.

Dr. Weitz:            Okay.

Dr. Saxena:         Yeah? I don’t know. What’s your answer? I’d like to know what your answer is.

Dr. Weitz:            Well, Dr. Mark Houston has this plaque reduction program, and it’s 10 different products with some of the things you mention and aged garlic and tocotrienols and Arteriosil, the product that improves the endothelium. It’s a whole series of different nutraceuticals.

Dr. Saxena:         I do think that all of those have merit, but for me, I would… I tend to be the person who doesn’t do all of it at once, because I find that compliance. It’s a special person who can take 20 supplements. I have this thing that I say like, “You, knowing these things, meaning one person knowing these things is very different than them doing it.” You can give them the handout that says, “Do all these supplements, and do, do, do, do, do, do, do.” And if they go like, “I understand that,” and they don’t do it, it’s useless. Who cares about the program?

Dr. Weitz:            Of course.

Dr. Saxena:         There’s so much engagement that has to occur so that they can… What I do is I whittle away at the thing that I think will take the biggest chunk of risk out, and then I negotiate, and then we reassess. It’s so important, in my opinion, that we recheck with the patient data that is compelling to them, whether it’s the number on the scale, or it’s their LDL particle number, but I got to figure out like, “What makes you tick, and what makes you want to do the next thing?”

Dr. Weitz:            Right. I think once you’ve ruled out toxins and heavy metals and some of these other issues that are creating inflammation in their body, and ruled out food sensitivities, getting on a good, healthy diet, making sure they’re exercising every day or almost every day, getting good sleep, and then things like vitamin D, fish oil, and then niacin, citrus, bergamot, a few things like that, you’re probably a good way there.

Dr. Saxena:         Berberine.

Dr. Weitz:            Berberine [crosstalk 00:49:51].

Dr. Saxena:         Magnesium. There’s just some real simple things that can make a big impact in my opinion.

Dr. Weitz:            Sounds good. All right. So any final thoughts for our listeners and viewers?

Dr. Saxena:         You know what? I’m going to tell you that action is the most important thing to get a result. You having listened to this podcast is amazing. If you do nothing after it, you’ve done nothing for yourself. So take something that was said here today, and do it, because it’s the only way you’re going to get a different result, right? Don’t just intellectually have fun. Get in action about anything or more about what you learned here today.

Dr. Weitz:            Sounds good. Just do it.

Dr. Saxena:         Just do it.

Dr. Weitz:            Thank you, Dr. Saxena.

Dr. Saxena:         Thank you. Take care.

Dr. Weitz:            Thank you, listeners, for making it all the way through this episode of the Rational Wellness Podcast. Please take a few minutes and go to Apple Podcasts, and give us a five-star ratings and review. That would really help us, so more people can find us in their listing of health podcasts. I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111.  Take one of the few openings we have now for a individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.




Measuring Biological Aging via Epigenetic Methylation with Ryan Smith: Rational Wellness Podcast 223

Ryan Smith speaks about Measuring Biological Aging via Epigenetic Methylation with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on August 26, 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

5:36  Epigenetic methylation.  DNA methylation is essentially inactivating of a gene transcription.  When a methyl group is placed on a particular gene, that gene typically gets turned off. This occurs especially at the CPG islands, which are the sections of our DNA when we have cytosine and guanine based pairs repeated over and over.  This process is related but separate from situations where you find out that patients have polymorphisms in the MTHFR and/or the COMT genes and who may require supplementation with methylated B vitamins like methylfolate and methyl B12.

10:30  While epigenetic methylation is used to measure aging, it is also being used for other things, including detecting cancer, including a new test known as Galleri from Grail, which is a liquid biopsy that is able to detect cancer very early, including at stage zero before it’s able to be found by any other method.  It can detect over 28 different types of cancer.

12:37  Ryan and the TruAge test are focused on using epigenetic methylation to measure biological aging. Dr. David Sinclair in his new Lifespan book talks about aging as a disease.  And to slow down and reverse aging we need to prevent cancer and other chronic diseases like heart disease and diabetes. Approximately 80% of adults in the US over age 65 have at least one chronic disease.  And if we reduce aging, then chronic disease risk will drop.  Prior to epigenetics (methylation clocks), telomere length has been validated as a way to measure biological aging, but it has low predictive capabilities. Epigenetics is both highly validated and highly predictive. The lower your biological age, the longer you are going to live.  70% of all cancers occur in people 65 and up.  For every one year you are older biologically, you increase your risk of getting cancer in the next six years by 6%.  If you are two years older biologically, you have a 12% increased risk of getting cancer in the next six years and you have 34% increased risk of dying of cancer in the next five years.  If we can reverse your biological age by seven years we can cut disease in half.  If we can slow biological aging by 20%, the US would save over $3 trillion dollars in healthcare spending.  We can also tell you how old your immune system, how many CD8 and CD4 T cells you have, how many granular sites you have. And if you reduce your aging rate, you can reduce all of these different aging phenotypes.  Aging should be treated as a disease.

44:12  Interventions to reverse aging.  While the first published intervention trial to reverse aging, the TRIIM trial (TRIIM stands for thymic rejuvenation and immunorestoration) by Dr. Fahy and others, used growth hormone, Metformin, DHEA, zinc, and vitamin D, most of the longevity researchers including Dr. Sinclair and Dr. Longo have found that lower growth hormone levels are associated with better aging.  Despite the benefits seen in this trial, the data does seem to show that higher growth hormone and IGF-1 levels are negative for longevity.  And data on Laron dwarfs show that they have a growth hormone deficiency and they tend to live longer.  Some of the recent data indicates that it may be DHEA that most consistently correlates with longevity of the three interventions in this trial.  When you look at Dr. Horvath’s original algorithm, which looks at 353 spots on the DHA over 80 of those spots are located at or near glucocorticoid receptor elements.  This means that the more cortisol you have, the more stress you have, the more it might impact your epigenetic aging and DHEA can mitigate the effects of cortisol.  Here is the TRIIM trial:  Reversal of epigenetic aging and immunosenescent trends in humans.



Ryan Smith is the co-creator and vice-president of TruDiagnostic which offers the TruAge test, which uses an epigenetic methylation clock to measure biological aging.

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 talked 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 on epigenetic methylation in aging and disease with Ryan Smith.


I want to thank our sponsor for this evening is Integrative Therapeutics, which is one of the few high quality professional brands of nutritional supplements that we carry in our office, super high quality, very innovative. I’m just going to mention a couple of their products. They have a specialized form of curcumin called Theracurmin. There’s been a fair amount of research on it. It’s a water dispersible. And for two capsules, you get the full dosage, which makes it a lot easier and more convenient than some of the other leading forms of absorbable curcumin.

Another one of their products is a product called Heartburn Advantage, which we use a lot for gut patients. And so this is a product that includes a natural prokinetic that improves motility of the gut, and also includes deglycyrrhized licorice and zinc carnosine for soothing and healing the lining of the gut. So it’s great for patients with reflux. And we also use it for SIBO patients.


Dr. Weitz:            Tonight, our topic is epigenetic methylation in aging and disease. I’m sure most of us know what epigenetics is, which is essentially, and Ryan will give us a much more detailed explanation. It’s a set of triggers and switches that turns our genes on or genes off. Put it another way, it’s the factors that result in whether our genes are expressed or not.  Methylation can be tracked and correlated with aging. And methylation clocks are what the latest research is showing us is the best way to measure biological aging as compared to chronological aging. And this is very applicable to those in the functional medicine community who are advising our patients in diet and lifestyle programs to promote longevity.

My goals for tonight are to learn about how to test for biological aging, how to interpret such testing and how to touch on some of the latest research on interventions to promote longevity. Ryan, this is Ryan Smith, co-creator and vice-president, TruDiagnostics or for the TruAge tests. Ryan, maybe, you can give us a little bit about your background.

Ryan:                    Yeah. Absolutely. So first and foremost, thanks so much for having me. I’m excited to talk tonight. I am always excited to talk about this topic and introduce it to new people, because I think it’s always something a little bit sci-fi, something a little bit different than sort of the clinical application that they probably know about methylation right now.  I definitely have a PowerPoint. I don’t know if you’d like me to show it or not. I’m happy to, but I can’t show it at the moment–I can’t present at the moment. And so it might be good if you can allow me to share it and maybe the host, I’d be happy to do it, but yeah,… 

Dr. Weitz:            Please mute yourself…. Okay. Okay, good. I guess we should be good.

Ryan:                   Excellent. Yeah. Again, thanks for having me. My background is a little bit diverse, biochemistry undergrad. I went to medical school at the University of Kentucky. Passed step one. Did really well, but got to the clinical stuff and just hated it. So shortly thereafter, we created a compounding pharmacy that sort of specialized in peptides and proteins called Tailor Made Compounding. We had a lot of success. But as we were doing new and innovative pharmaceuticals and molecules, one of the things I always wanted to know is how is this having an effect on the long run? How is it affecting health span, life span outside of the immediate benefits you might have from a day-to-day basis?  And so I’d always been really interested in this as a diagnostic when I first heard about it, particularly because it was able to predict things like death, predict things like the age of your body. And as we know, aging is the number one risk factor for all chronic disease and death.  And so knowing that was a modifiable factor and one that we could now manage was really, really exciting to me. And so, we decided to create TruDiagnostic because I saw there was a really big need in this epigenetic methylation space for really good clinical algorithms. And so we started this company and doing commercial test in July of 2020, and we’re over a year old now. We’ve tested over 12,000 patients, have one of the largest private epigenetic databases in the world and in some of the most robust testing algorithms in the world.  And so we’re really excited to talk about everything and go through and give an introduction into methylation. And so, yeah. So just to go ahead and get started, for those of you who aren’t familiar, I would love to just quickly go through epigenetic methylation. And here’s some of the things that I want to try and go over today, right? What is it? How can you use it clinically? How does methylation relate to aging. And then, how can you use these algorithms in your current practice?

And I always like to start off with this quote, but it says” Five to 10 years from now, the health system that doesn’t use this data to help improve their medical delivery is going to be deemed archaic.” That’s how quickly that this is coming, right? This is even anticipated by some people to overtake blood testing in the next 20 years. And so this is something that if you don’t know about it yet, it will affect your clinical practice. It’ll affect your clinical practice in the next five to 10 years greatly. And that is a great thing.  And this is some of the mission and goals of us at TruDiagnostic, but we really want to improve patients’ lives by helping them make the right decision at the right time and by leveraging this new biomarker to be able to make those decisions. And so I think you gave a great explanation of what epigenetics is, right? It is every cell in your body has the exact same DNA structure, but obviously, the genes which are turned on and turned off in your skin are greatly different than the genes that are turned on and turned off in your heart.

And in the way that they do those sort of changes of turning things on or off are through these types of epigenetic modifications. For the purposes of what we’re going to talk about today, we’re really going to talk about DNA methylation. And DNA methylation is really thought to be that inactivating of a gene transcription. So usually, whenever it’s placed on a particular gene, that gene is turned off, whereas histone modifications like acetylation, on the other hand, are really turning on genes. And so we’re able to measure these things in our cells on our DNA, and then correlate them to outcomes.

And so just to give a little bit more terminology, one of the big terminology points I’ll use often are called CpGs. And these are cytosine and guanine islands where those sort of base pairs are repeated and repeated. That is actually where we’re looking for most of these methylation-related signatures. And so you might hear me talk about that quite a bit, and that’ll be a term that we use because that’s what we’re really measuring. Is methylation on or off those genes. And this is a process by which we methylate our DNA. We attach those methylate groups to cytosines in the DNA.

And to do that, we use a supplement actually that a lot of you might be familiar with, SAMe or the S-adenosylmethionine. So many people, you might be familiar with using it to help treat depression or osteoarthritis or many other things. And I think it’s also important here to separate this from a methylation that you might have already used clinically things like, for instance, MTHFR or COMT genes. It’s sort of a similar biochemical process, but how we’re sort of looking at these and addressing them are completely different.  And so I think it’s also important to say that so that the two separate processes and I think it’s important to make that distinction. And so whenever we talk about this, it’s important to know that this is a very, very new biomarker, really the first time-

Dr. Weitz:              Are those two processes similar? For example, is it the case that if you take a lot of methyl B vitamins, folate, and B12 that you can increase the methylation of the DNA?

Ryan:                     Yeah. Absolutely. They are connected. For instance, we know that some people who have polymorphisms in that MTHFR gene have actually worse biological ages because of it. And so they’re related, but the biochemical process of if you’re able to have the co-factors to methylate will affect the DNA methylation, but the DNA methylation itself is sort of the cause, the root cause I would say, of what genes are turned on and off. And therefore, what we’re expressing in our DNA.  And so they’re related, and they affect each other, but probably not the way that you’re thinking clinically where supplementation with B vitamins or 5-methylfolate or CME are going to have the same effects that you would imagine would be a good thing. And so they’re related processes, but still at the same time, very vastly different from a clinical approach.

And I think we can even sort of talk about that when we talk about some of the treatments, which were to reversing the aging process. And again, not to bury the lead, that is what we can do, is we can. Now that we have an objective way to manage this aging process, we do know ways to sort of to change it. And so before I go into the aging aspect, which is, I think, probably the most exciting, I also want to go talk about some of the other things that epigenetic methylation is used in clinically because although aging is a big part of it, it goes way beyond that.  And so many of you might be familiar with a relatively new test, just came out in the past 10 weeks, called Galleri from GRAIL who was just bought by a woman. And this is a test much like IVG [inaudible 00:10:50] if you’re familiar with those in the past. It’s called the liquid biopsy, which is able to detect a cancer at very, very early stages, even stage zero before it’s able to be found by any other method.  And this is probably the biggest growing area of sort of the commercial market, because cancer is obviously so prevalent. And you want to catch it early so that you can then treat it. And this test can detect over 28 different types of cancers with a single blood test. And so that is a very exciting development and probably one of the biggest areas of epigenetics.  In addition to that, there’s a lot of new drugs, which are being approved that treat different types of things, particularly cancer via epigenetic mechanisms where they can sort of take a drug to turn things on or off from your DNA expression. And so this is another big area as well. And again, I won’t go over it a lot today, but you’ll probably see a lot of this in the future, particularly the GRAIL Galleri test is now becoming widely popular, even though it was only released a few weeks ago.

And so those are other applications which are really, really exciting, but I just want to again stress that this is a new biomarker. Being able to actually get the information whether it’s part of your DNA is or is not methylated is a relatively new thing. Really in 2009, we only could read right around 80,000 of those markers at a time.  And there’s over 26 million for every cell in your body. Even towards 2017, we only had right around 450. Now sort of the baseline for most standard research testing is 850 to 900,000. And that is what we’re doing here. So we’re now finally able to read this data at a large scale. And that’s what sort of making all these developments so much more relevant and what will continue to sort of change medicine.  And so the real application for this epigenetic testing that I want to talk about today is biological age measurement. And many of you might be familiar with this sort of renaissance in the aging community. I always like to point this book out, Dr. David Sinclair’s Lifespan book, because in it, he sort of talks about this idea of aging as a disease and sort of bringing the light to this whole idea of treating aging before it happens.  We talk about those things like cancer. But cancer, one of the biggest risk factors for cancer is actually age. And so with those liquid biopsies, we’re trying to detect it. But if we can address age, maybe we can even prevent cancer from happening or prevent all of those age-related diseases, which is every chronic disease, diabetes, heart attack, stroke, you name. It is usually an age-related disease.  And so even though the national community is picking up on this with now the World Health Organization has added an ICD-10 extension code for age where you can sort of say that these diseases are caused by age. And even things like Alzheimer’s and hypertension weren’t even considered diseases in and of themselves at one point in time. They were considered sort of a sequelae of aging.  And so we know that aging is an important and really at TruDiagnostics, we definitely think that aging is a disease. And some of these statistics even show that 80% of adults have at least one chronic disease if they’re over 65. And you can see that the percentage of population with these chronic diseases over 65 are prevalent. And so we know this. And as I mentioned with cancer, by the time you reach 60, your risk of getting cancer doubles from when you were 50.  70% of all cancers occur in people 65 and up. And so again, aging is a disease and definitely sort of treated like it. But the good news though is that if we’re able to treat aging, we can have massive impacts on population level health.

So for instance, if we’re able to reverse your biological age, so the age of your body, by seven years, we would be able to cut a disease in half. 50% of the people in the world would no longer be sick. In addition to that, if biological aging could just be slowed by 20%, the US would save over $3 trillion in healthcare spending. And so what we are really trying to do is quantify the aging process, let everyone know where they’re at, so they can make the changes to reverse that aging process and improve their health and prevent all of these health outcomes. And we always say, “You can’t manage what you can’t measure.” So what we’re trying to do is give an appropriate way to measure that.  And so when it comes to aging, I also think it’s important to say why chronological age is not a very good measure. Chronological age is obviously everyone knows their chronological age. But everyone probably also knows people in their 70s who looked like they were in their 50s, and people in their 40s who looked like they’re in their 80s. People all age at different rates and that’s this phenotypic variation where depending on how well you take care of yourself, you can change the way that you age.  And so chronological age is still the biggest risk factor for chronic disease. But biological age can be even more predictive and even a bigger risk factor. And so biological age, they’ve been trying to find a way to look at this for a long time way better than chronological age.

And there’ve been a lot of different postulations for the best measurement. These are some of the criteria that American Federation for Aging Research created. But beyond that, most of you are probably familiar with what has been clinically used for the past couple of years, really the past decade, for the best measurement of biological age, which is typically telomeres. And so I won’t go into that a lot. But obviously, most of you are familiar with this, right? Those in caps on your DNA that when replicating solely gets shorter and shorter and shorter and shorter.

And when they do, that’s correlated to this aging process. And so this has sort of been the standard for a long, long time. But it’s probably not the best. And the reason being is that I always love to show this sort of summary from 2017, I should say, which compared all of the different ways to measure biological age. And telomeres, although it’s been the standard methylation related biological age testing is now becoming much more accurate and much more predictive.

One of the big problems with telomeres is that even though it is correlated to age, if you have low telomere length, it doesn’t necessarily mean you’re going to have any type of age-related outcome. It’s sorts of, as this study puts it, briefly telomere length is extensively validated, but it has low predictive capabilities. And really, what we’re trying to do with this aging is to predict the outcomes of disease.  And so telomeres have never been the best. And I always like to show this as well, where this hazard ratio, telomere really definitely has the most studies done on it. But it’s by far the least predictive if you look on this graph. It has the lowest hazard ratio, whereas epigenetics is highly predictive and highly validated, which sort of shows us it is the best way to measure age.

And so, that’s what we do. We use this biological age to give you, essentially, we test your DNA, and we give you an age, how old your body is. And this is a process which is relatively complicated. This is actually the process which we do it. We sort of collect just a few drops of blood. We can do it with just a fingerstick blood test, where then we extract the DNA. And then, we sort of look at all of the different copies at all of those CpG spots. We look at number 900,000 locations to really get an idea of is that location methylated or is it not.  And we sort of sum up all of that to get a percentage of methylation at each location in your genome. And we measure, as I mentioned, a lot of spots. And we’re getting a lot of data. This is sort of what we see at every different location that we look at over 900,000. And so what we essentially get at the top at each of those 900,000 locations is a percentage of methylation. Out of all the copies of your DNA, what was the percentage that was methylated?  So if we’re looking at, for instance, we were talking about maybe an MTHFR-related gene, we can say, “How much of those are methylated?” 80%, 20%, whatever it might be. And then, we plug it into these mathematical-derived algorithms, which are listed below. This is actually one of the first ever biological-age algorithms that came out from Dr. Steve Horvath at UCLA who’s really the worldwide expert in this.  And what did this is able to do is to take those percentages and then to turn it into something that’s clinically useful like age. And these things have been created in sort of another thing. So we’ve talked about how the bio-marker is really new. And really, we now are the first time we’re able to look at it at scale. But the other big development is computer learning and artificial intelligence, where we’re able to use these really large datasets and turn it over to computer for it to tell us these insights. And so that’s exactly how these clocks are created. We sort of train this dataset and these artificial intelligence algorithms to give us a mathematical way to predict an outcome, in this case, age.

And so just to give a little bit of history, the first of these clocks came out in 2013, really the first really accurate clocks. And the first clocks were trained to predict chronologic age. And so the first time that they were used was actually not in relationship to medicine at all. It was used in relationship to things like crime scene investigations, where they would be able to tell how old someone was at a crime scene or to date refugees and see if they were over or under 18 and therefore eligible for asylum.  And so they were used for things way before they were used clinically because the first clocks were just trained to output chronologic age, so, trying to predict your age. And as I mentioned before, chronological age is not the best metric. And honestly, it’s not great to have a test score because if you really want to know clinically how old someone is, you can usually just ask, right? So the second generation clocks, as they call them, started to train against something a little bit different, which was those age-related outcomes, all of those diseases, which are associated with age.  And as a result, they created these algorithms, which were incredibly predictive for age outcomes. And beyond that, they even train them to predict things like death. In the case of GrimAge from this graphic with Dr. Horvath where he’s actually able to predict when you might die, very, very accurately.

And so the idea is that these clocks can be trained to predict just about any outcome. If you want to train it to predict how fast you might run a mile or predict how much hair you might have in your 50s, these things can be trained for that if you have enough data. And so I’ve included some of these things for you to look at, and also the difference between those chronologically trained clocks, the first-generation and the biologically age clocks, the second generation.

But overall, I think that the one takeaway from this is that the lower age you have biologically, the better you are. You’re going to live longer. You’re going to have a better health span. And there are many classical examples of this. One of my favorites to mention is in the instance of cancer, where for every one year that you are older biologically, you would increase your risk of dying or getting cancer within the next six years by 6%.  So for someone who’s two years older, biologically, they might be 50 chronologically and 52 biologically. They’d have a six… or sorry, 12% increased risk of cancer over the course of the next three years. And then, they would have essentially a 34% increased risk of dying of cancer over the next seven years… Five years. Sorry. So again, these things have massive impacts on to our risks. And so, we really want to be able to treat this as a disease and to really measure it.

But even since then, this is a really, really fast area of growth. And so just to show you, so all of the things that we already can do now, we can do a lot more than that. So we can obviously tell you your biological age. But we can also tell you how old your immune system is. We can tell you what your immune cell subsets are, how many CD8 T cells you have, how many CD4 T cells do you have? How many granular sites you have? We can tell you your telomere length, actually, in a way that’s more accurate and more predictive than traditional telomeres length measurements. And we can tell you your instantaneous rate of aging. At this moment, how fast are you aging?  And so all of these things can be used clinically, because if you reduce the aging rate, reduce the aging process, you can reduce all of these different aging phenotypes. And that really is the power. And so that is a little bit of a history. But I also want to talk about how [crosstalk 00:23:02].

Dr. Weitz:            Are you going to go into more detail on these? And if not-

Ryan:                   Yeah.

Dr. Weitz:            Yeah. Okay, good.

Ryan:                   Absolutely. I definitely want you to know. I know that you’ve obviously had some experience, so we’d love to, obviously, for you to guide me as well. But I want to talk about sort of how it’s used clinically. What type of results do you get whenever you run this testing? And then also, what’s a good result? What’s a bad result? And what can we do about it? And so I will go into that.  This is sort of our first report. This is the first one we ever did. And this is an interesting report. And you can see on the left, it gives you your biologic age versus your chronologic age. It gives you where you stand out in the population. And this is actually a very big report. It’s over 78 pages because it provides a lot of context. One of the things that we don’t want patients to do is to get scared, right?

Talking about the biggest risk factor for all of their age, and the fact that everyone knows where they should be at, right? If someone comes back older, they oftentimes get scared. And one of the things that we try and do is add context for that value. What are some of the things that might’ve increased your score at baseline, decrease your score at baseline or up to 40% of this metric is heritable.  And so some of it is within your control, and some of it hasn’t been. And so we try and give some background to those things to change it. But what I really want to focus on today is even some of those other impacts. Clinically, my favorite aging algorithm is what I want to stress the most today, which is this probably the introduction to this. Do you need a pace of aging algorithm metric?  And so this is my favorite. It’s actually considered the third generation algorithm. So it was recently created actually even in 2021 of this year. And what this sort of reads out to you is an instantaneous rate of aging. So it takes a look at you right now and says, “How many biological years per year are you aging?” It’s like a speedometer for your aging.  And one of the reasons this is so great is because it separates what you’ve done in the past versus what you’re doing now. So for somebody who’s lived a lifestyle that might’ve been stressful or unhealthy, you can still get an idea of what behaviors you’re doing right now, and then how to change it. You and I both might take Metformin. But my response might be significantly different from yours. And this allows us to do that personalized medicine to see sort of how we’re changing.

But I also want to go into how this metric was created and how predictive it is. And so this algorithm will never, ever be replicated because of how it was created. The study to create this algorithm started in New Zealand in 1975. And it started with over a thousand three-year-old children. Sorry. And so over a thousand three-year-old children.  And the idea was that they were going to measure across the lifespans of these children their aging rates. And so Duke actually propose this. And the National Institute of Aging actually said “We’re not going to fund you because if you do detect a rate of aging, it will not be significant to these health outcomes.” However, it ended up being very, very significant. And this is just one of the ways we’d like to demonstrate it.  So as of 2019, all of these patients were now 45 years of age. So they tracked them since three to age 45. And every year, twice a year, they took all of the age-related biomarkers you can imagine. They did everything from telomeres length to MRIs of the brain, to retinal imaging scans, to dental imaging scans. They did DEXA body composition scans. They did every type of age-related metric you can imagine.

One of the other things they did was facial aging. And so these people you see on the screen, they’re all the same age. They’re chronologically all age 45. But even on the outset, how their faces look changes due to the rates of aging. You can see on the left, there’s the slowest aging members of the cohort. And on the right, the fastest aging members of the cohort. Again, all of those people are age 45. But it looks like there’s 20 years of difference between those two people, those two groups.  And in fact, there is because they’re aging at different rates. They’re biologically different ages. And so this is just one of the ways that we can sort of show it. But there’s many other ways as well. Particularly, we do believe that actually aging occurs early in life. And that leads us to all of these types of disease, disability, and frailty.

Here are some really good examples. So if you look at the bottom, the X axis, you can see that we plot the pace of aging against the scores on these testing. And as you can see, the faster that you age, the worse you perform on your balance testing. And not just balance, but also on grip strength. And this also holds up things like sarcopenia and body composition. The faster you age, the worse your body count and the worst your balance, the worst your physical performance, the worst, actually your cognitive decline, right?  So the faster you age, really the more IQ points you will lose, the slower that you’ll process that mental speed. And again, all of these things that I’m reporting on now are things that are actually quality of life metrics, health span, not just lifespan. And I think that that’s important to note as well. When we treat aging as a disease, we don’t have to think about living a long time and being super unhappy while we’re doing it.

We also get to think about how we improve our quality of life. And those things are not sort of mutually exclusive. So, if we improve our rates of aging, we improve the appearance of our base. We improve our risk for Alzheimer’s, cognitive disease, grip strength, body composition, physical function measurements. This again is just an example of the differences in facial aging appearances.  It also affects our brain, like, with things like cortical thickness and surface area. And so this is one of my favorite algorithms because it is the most predictive. And you can really take a test now. Take a test in really eight weeks after you implement some type of therapy to see if that therapy is working for you.

And so the goal with this whole algorithm is really to keep that biological aging rate, that rate of aging below one. You want to be aging less than one biological year for every chronological year, because that means you’re essentially aging in reverse, right? If for every one year that you lived, you’re going to be younger sort of biologically.  And even if you’re slightly above one, this carries heavy risk. So, for instance, even if you’re aging at a rate of 1.01 biological years per year, you would increase your risk of death in the next seven years by 56% and increase your risk of a chronic disease in the next seven years by 54%. And those are incredibly high risks. And so again, the idea is we want to treat aging before it happens and really start with a lot of these procedures.

And so a lot of those questions that might come from this is what do I do about it? And quite frankly, that’s one of the hardest questions to answer because this is such a new diagnostic. With that being said though, we’re finding out ways to reverse this process all the time. One of the ways that we know reverse this process is actually caloric restriction.  And so this is a good example of a sort of data from the calorie trial. The calorie trial had sort of two treatment groups, which was a 20% caloric restriction group who basically added a calorie deficit every day for two years. And they were on the right. And you can see their change in biological age was less than half a year, over two years compared to the group who did not do caloric restriction, who aged anywhere from really one year to over two years.  And so we know that caloric restriction is absolutely one of the things that changes this, which probably is intuitive for anyone who’s been paying some attention to things like ProLon and Fasting Mimicking Diet and caloric restriction. And so that is absolutely one of the things that we know can change. But we know a lot about these other metrics as well. And so before I go on to maybe some of the other things we can tell and the other algorithms we can learn, do you think that there’s anything else I might be missing to introduce this topic as a whole?

Dr. Weitz:            No. I mean it’s a vast topic, and there’s tons of things that… I have tons of questions. But I’m going to hold them back till I see exactly where you’re going with this.

Ryan:                   Perfect. Yeah. No. I think the biggest thing is that when you were approaching this from a clinician standpoint, you want to encourage everyone to get these metrics as low as possible. But the younger you are, the better you’re going to live, the longer you’re going to live. And so that’s sort of the idea. But the other idea is that methylation can tell you a lot more things than just your age.  One of the things it can tell you is actually telomere length. And so, via the same mechanism of DNA methylation, we can actually predict telomere length. And again, the correlation for telomeres length to age, it has an R squared value of around 0.35 at a maximum whereas the correlation for this measurement is double that with age. So it’s more highly correlated to age. But in addition to that, it’s much more predictive of outcomes. It’s better at predicting time to death. It’s better to predict time to coronary heart disease and time to congestive heart failure. So in addition to all the other reports we do, we’re actually even able to look at telomere length and predict that as well.

Dr. Weitz:            And if methylation clock is a better predictor, why do we care about telomere length?

Ryan:                   It’s a very good question. And the answer is you probably don’t. But with that being said, it does capture a different part of aging than just the biological aging process we get through methylation. So, I actually just did a presentation about this before this. And one of the things I like to say is that by combining all of these things together, you can get an idea. You can actually explain more of the variance between phenotypic age. So you can sort of explain why someone might age quicker than someone else.  And so it’s an important feature. It’s still one of those hallmarks of aging. But in terms of its predictive capability, these biological age markers, these age clocks tend to be a little bit better than telomeres length completely. That’s a definitely a good question. But again, methylation can tell you just about anything you want, if you have the right data.

And so one of the things we actually look at is the immune system. So we have these things called deconvolution methods, where we essentially are able to predict the types of cells that we actually see in your testing. And so what that looks like for us on its output is we actually read these, if you can even see. I know it’s small texts. We’re actually able to tell you your percentage of lymphocytes, neutrophils, granulocytes. And also, we sort of culminate with this thing called the CD4 to CD8 ratio, which is that ratio of T-cells, which can be incredibly informative about your health status or immune health status.  And for this, you want that range to right one and four. If it’s under one, that means you might have some type of immunosuppression. So we’ve diagnosed things like HIV or chronic lymphocytic leukemia by seeing CD4 to CD8 ratios less than one. We’ve also been able to diagnose hyperreactivity events like auto-immune disease with CD4 ratios above four, which might signal a sort of a reactive immune system.

And so we can learn a lot about your immune system. And it just to sort of show you, there are many, many diseases which are associated with CD4 to CD8 ratios below one. And so that’s what we’re able to do. We’re actually able to use these sort of extrinsic gauge reports to get the age of your immune system but also sort of the overall health of your immune system. And this is obviously something that is very important as we consider COVID-19 or this pandemic where our immune response can greatly affect how much at risk we are.  And again, aging is a part of the immune process. It’s why as we get older and undergo that immunosenescence process, we have the worst immune systems, which is why older individuals are recommended for the vaccine first, because they’re at highest risk.  And so again, this is that idea, the thought process that aging affects all of our risks of all of these other diseases. And so this whole picture together, we can start to say, “How old is your body? How old is your immune system? How well is your immune system functioning?” How is your instantaneous pace of aging? And then, once we get that idea, we can sort of all compete with ourselves to get this as low as possible.

But I should also mention methylation in the case of what we already talked about it in terms of cancer diagnostics, but even beyond that, we can find out insights from low-site specific report. I mean, so this is where we look at individual areas for different disease categories. So we can actually even predict diabetes up to seven years earlier than fasting insulin and HBA-1C.  And so this can be a really early diagnostic to say, “Hey. Should I put my patient on some type of interventional treatment, something just a diet or maybe it’s Metformin, or maybe it’s a GLP-1 or an SGL2 inhibitor.” So the idea is you can even learn these things much like detecting stage zero cancer before you can detect it anywhere else. We can actually detect insulin resistance and diabetes risk before we can in any other metric. And so that’s exciting as well. We can actually-

Dr. Weitz:            Is that part of the TruAge report? Is that just-

Ryan:                   It is. Yeah. So already, we’re able to report out your risk of becoming diabetic. And really, we look at two different markers. If you’re in the risk range for both of those, then, we would highly recommend that you take some type of intervention to prevent the onset of diabetes. Unfortunately, it’s a very, very, I would say, specific test. But it’s not always the most sensitive, meaning that some people who have type-2 diabetes might read as no additional risk. But if you do read additional risk, that means you’re almost certainly likely to do that if you don’t have any other outcomes.  It’s not just diabetes. It also we can do it with obesity. And I’ll sort of fly through these because I want to spend as much time as possible sort of just discussing. But we can actually even predict if you’re likely to become obese. We can predict if you’re likely to lose weight with caloric restriction. We already talked about caloric restriction being great for the aging process. But a lot of patients also want to lose weight with it to improve their body composition. We can actually tell you if you’re going to, before you even do it. We can actually tell you how much you’ve smoked-

Dr. Weitz:            Ryan, is there an intervention if you find out that you have certain genes that are playing a role in while you’re obese? Can you either methylate or undermethylate them? Is there some way to have that happen?

Ryan:                   Unfortunately, the answer is almost certainly yes. But unfortunately, we don’t know yet. And that goes to the biggest disadvantage for this testing is that we’re not sure what interventions are going to change this yet. But we’re very, very quickly learning. There are new studies published about this every week with interventions. And so right now, we, 100%, know ways to reverse your aging. We also know ways… or I should say behaviors, which are correlated with changing those other types of reporting.  But we don’t know about particular interventions to change that risk of obesity or, I should say diabetes yet. But the idea is that they’re already great interventions to change both where your diet, exercise, nutrition, all those things and knowing that you’re at risk you can then make those changes a little bit ahead of time. But that also brings up a great idea, which is that what comes first, the behavior or the outcome?

It’s sort the chicken or the egg thing. And that’s the other great thing about the methylation marks in your DNA. It also presents a history of where you’ve been or what you’ve done your entire life. So we can actually look at, what they call, this exposome. So sort of the history of exposures that are actually found in your DNA, we can actually tell you how much you’ve smoked across your entire lifetime. We can tell you if you’re a former, never, or current smoker. We can actually do the same thing with drinking. We can tell you how much alcohol you’re currently drinking. Are you doing a moderate, mild, or a heavy amounts of alcohol?

And we can do that with more and more things as well. We can actually even predict your response to the medication. So, we can do pharmacoepigenetics. We can, for instance, predict if you’re likely to respond to Metformin from an HbA1c. Are you going to actually reduce your HbA1c or are you likely to have side effects?

In this particular study that we now have an algorithm that predicts if you’re likely to respond to Metformin, or if you’re likely to have those side effects. And for those patients who we know, I would say are, at risk, we might then not suggest Metformin. We might go to another type of intervention. And that’s just the beginning of what will happen.

And as I mentioned with the exposome as well, I wanted to mention we can actually tell you how much mold you’ve been exposed to over the course of your entire lifetime. We can tell you how much lead, mercury, arsenic, plastic, all of these environmental sort of toxins, we can actually see in your DNA. We actually just did a study on COVID-19, where now we don’t even need to take your antibodies to tell you if you’ve had COVID-19. We can see it in your methylation signals.

And so those things are all, I think, very, very exciting. And it leads to this idea of how do we change it, which is sort of found in this sort of diagram where we know all the dietary and societal things, which might increase or decrease the different types of aging processes. And I won’t go into intrinsic versus extrinsic epigenetic age. But it’s another way to even know more about your entire system.

And so these are all the things that we can develop with methylation already. Eventually, it will be one test that reads all of these different metrics. It’s probably a test that can read out your protein levels in your blood, your micronutrient levels in your blood, your hormone levels in your blood. So really, you can do almost all of the testing that you would want to do clinically with one test, if you have enough data and the correlations are tight enough.

And so that is really what we’re hoping for. But I think that the bigger picture is that although this platform is really exciting, being able to treat and quantify aging is even more exciting because you’re able to then prevent the biggest risk factor for all chronic disease and death. And that’s really what we’re trying to do. And so to work with us, it’s really easy to do again, you just order a kit from us. You take a few drops of blood from your finger. You send it back to us. And within two weeks, we give you all of these different reports. And so always happy to talk about that a little bit more. But would love to answer any questions. I know I went through that very, very quickly. And there’s a lot of information. But I’d be happy to answer any questions.

Dr. Weitz:            Can you discuss more about the immune findings and what does that tell us? And how does that help us with our patients?

Ryan:                   Yeah, definitely. So the immune system obviously is highly connected to aging in general. But these immunity convolution methods are essentially like doing flow cytometry testing on your patients to see what percentages of cells they have and how well their immune system is functioning. And so the CD4 to CD8 ratio is just the start. But with that, you can be able to tell if your patients have sort of immunosuppresses or if they have a hyperreactive immune system.

And so what that can generally tell you is, unfortunately, you might need to do some followup testing, right? You might need to say, “Oh, hey, if we see this low CD4 to CD8 ratio, we might want to do some other follow-up testing for things that might decrease the immune response, like, cancer, like HIV, some of those other things, or if you see a hyper-reactivity, you might say, “Hey, I want to start getting some metrics on, if they’re having an auto immune response.” I might want their ANA. I might want some of those other inflammation markers to see if they’re having inflammation.

And so it’s sort of like, I would say, an overall view of how well your immune system is functioning. But we also are able to read the age of your immune system, right? Immunosenescence is a big problem and one that can be helped by taking things to activate the immune system. But we give you the age of your immune system through that extrinsic age measurement, which is able to use a sort of population level data to say where your immune system is in the course of the lifespan.

Dr. Weitz:            Do these results correlate with senescent T cells?

Ryan:                   So, great question. Absolutely great question. And the answer is yes. So, recently, there was a great paper actually published this year from Rutgers University by Dr. Herbig which was really one of the first ways that they sort of quantified senescent T cells across a lifespan. And we’re hoping that we can then create an epigenetic deconvolution method to predict senescent cells. We actually just wrote our APR’s application to the National Science Foundation a week ago. And so that is absolutely something we’re doing, is we’re helping to quantify senescent cell burden with this testing. And we think we definitely can.

Dr. Weitz:            In terms of interventions to reverse the aging process, let’s go into some of that. The first question I have is there seems to be a little bit of a dichotomy between some of research right now. On the one hand, the first intervention that was actually been shown to reverse aging was the TRIIM trial by Dr. Fahy and others. And it used an intervention of growth hormone, Metformin, DHEA, zinc, and vitamin D. And so the thing I want to focus on is the growth hormone component.  And so, the concept is that as we get older, we tend to lose function. We tend to lose muscle. We lose bone. We have less mobility, and that definitely affects quality of life and even biological aging. And that all makes sense that growth hormone would be beneficial except that everybody, including Dr. Sinclair and Dr. Longo, and a lot of the top people doing research on longevity right now are saying that you want lower growth hormone levels. And specifically, they’re looking at IGF-1 levels, which my understanding is tracks with growth hormone. And so therefore, they’re recommending lower protein levels because they say that that leads to lower cancer levels.

Ryan:                   Yeah. So, absolutely great question. And there’s, again, a lot of conflicting viewpoints here. But I will say that for years and years and years, growth hormone and IGF-1 levels have been correlated to shorter lifespans.  And so there is a good body of data on that looking at even Laron dwarfs who have this growth hormone deficiency and they tend to live longer.  And so with that being said, the first trial was looking, that Metformin growth hormone, DHEA trial, that TRIIM trial was set up. Actually, TRIIM stands for thymic rejuvenation and immunorestoration. So the whole thought process, I think there, was using some of [inaudible 00:46:41] work to rejuvenate the immune system, particularly by rejuvenating the thymus.  And they thought that they could do that through growth hormone. And so that was why they chose growth hormone as the main product. And then they started thinking, “How can we reduce the insulin side effects, the insulin resistant side effects that typically come with growth hormone?” And that’s why they included the DHEA and Metformin.

And so the idea there was that they’re going to regenerate thymus, and they absolutely did. Over the course of that one year and a half year, they were able to sort of improve that thymic fat-free fraction, improve lymphocyte to monocyte ratios. They really did enhance the immune system. And then also, they did see improvements in biological aging.  However, if you were to talk to Dr. Horvath who was also an author on that paper, he would sort of tell you now that the data show that, again, higher growth hormone, higher IGF-1 actually do correspond to lower… Or actually, the higher biological agents.  And so it is looking like the more data that we have that maybe growth hormone is not reversing the age like it should. And so actually in our own trials, we can actually see that we see something similar where growth hormone might not be a super positive effect. And so that leads us to ask questions about Metformin and growth hormone, or it’s just Metformin and DHEA. And in our studies, we actually don’t even see that big of a change with Metformin, which is unfortunate because we’re really big proponents of Metformin was really on track to be one of the first drugs approved for anti-aging benefits.

So for us not to see a change in epigenetic age is a little bit disappointing. But one of the things we do see a change and a substantial change with is DHEA. DHEA was sort of an afterthought and I think that drug cocktail. But it seems to be one of the things that’s best to reversing that epigenetic aging process in our datasets. And one of the hypothesized reasons for that is due to the impact of stress on the epigenomes or on this epigenetic aging process of Dr. Horvath’s original algorithm, 353 spots in that original algorithm.  Over 80 of those spots are located at or near glucocorticoid receptor elements, meaning that the more cortisol you have, the more stress you have, the more it might impact your epigenetic aging and DHEA can mitigate the effects of cortisol. And so out of all of those three drugs, we are actually thinking that DHEA is having the best effect. But also Greg Fahy and Intervene Immune and the Clock Foundation are actually now expanding that trial to the TRIIM-X trial, where in the first trial, they only had nine patients. And they’re hoping to, I think now, it’s expanded to 50 or a hundred.  And so hopefully with that improved dataset, we’ll be able to learn a little bit more. But it was a great question. I think the growth hormone might have given us some unfortunate results in that TRIIM trial. There may be not indicative of its overall effect on longevity.

Dr. Weitz:            Let’s see. So with respect to DHEA being beneficial for longevity because it counters cortisol, what about other methods that functional medicine practitioners use to mitigate cortisol, including lifestyle factors, focusing on sleep, breathing, a series of things? What about supplements that modulate adrenal function like phosphatidylserine and adaptogenic herbs? Would those have a similar effect as DHEA?

Ryan:                     So we don’t know. We’re not even sure that DHEA is having an effect through cortisol mitigation. We think that is. But we’re not certain. And so, unfortunately, we don’t have a lot of that data sets. Just look at people who’ve taken this testing and then essentially done these interventions and taking the test and again. In fact, they’ve only been applied interventional trials published.  Actually, to answer that question though, one of the most recent trials published was actually the work I think that you and I have already talked about by Dr. Kara Fitzgerald which actually did look at some of those adaptogens as well as a probiotic and did things like sort of mindfulness and stress management as a way to maybe even impact that change.  And although her trial was in only eight weeks of time, she was able to see improved results with a significant age-related change over the course of just eight weeks. And so that might add more data to say that stress management might be one of those things that is having an effect. I would say, in our datasets, that is a reoccurring theme, although we don’t know exactly.

Dr. Weitz:            Yeah. She actually didn’t use specific adaptogens for adrenals. She essentially used this greens type powder that contains a bunch of healthy phytonutrients.

Ryan:                     Absolutely. Yeah. I believe that’s a Metagenics product and I think the same with the probiotic. But, yeah, absolutely. But I think the idea was that creating sort of a diet nutrition program along with exercise, sort of a whole lifestyle program to reverse the aging process. And again, we welcome any of those new studies, which are coming out. And we have a couple that are coming out as well. One of the ones that we’re actually just finishing this week is one on some Quicksilver-related products and supplements.  We’ve also looked at things like senolytics such as dasatinib and quercetin. And so as these things start to come out over the next few weeks, we’re going to get them out and information to everyone so we can start figuring out what’s going to change these markers for the better, because again, if you change them, then you’re going to improve your health significantly.

Dr. Weitz:            Since growth hormone is potentially correlated with worse outcome, what do we know about some of the other hormones like estrogen, testosterone?

Ryan:                     Yeah, unfortunately, woefully little. And that is not probably surprising to most people because the way that we’re getting these datasets is via big institutions, things like the Framingham Heart Study, some of these big cohorts that have had samples tested 50, 60 years ago.  Unfortunately, a lot of those same data sets don’t do hormone levels. They don’t even measure them in some of these clinical investigations. And so those data sets are hard to come by. The good news is that the majority of the data sets that we’re getting, most of those people are on hormone replacement. So we’re building those data sets. But unfortunately, we don’t know much right now about estrogens, progesterones, androgens although I will say that we are starting to see an unfortunate maybe negative trend for people who have high levels of androgens particularly over the, I would say, the typical standard reference range by significant amounts. It looks to be increasing or accelerating the aging process. So bodybuilders in particular, I would say, we get some really advanced ages for those people who use significant androgens.

Dr. Weitz:            So we have hormones. What do we know about in terms of food, in terms of… I know you’ve mentioned something about a Mediterranean diet. I’m interested in a lot of times when it comes to discussions about diet and nutrition, one of the issues comes up in terms of what types of macronutrients should we be recommending in particular? And we only have three macronutrients. And so we know that sugar and carbohydrates can be correlated with diabetes and cancer.  And yet, there’s some information that especially Dr. Longo seems to talk about this a lot and Dr. Sinclair did that protein is associated with increased cancer. And saturated fat has been associated with heart disease. So what do we really know about longevity and macronutrients?

Ryan:                     Yeah. So again, as it relates to epigenetic methylation, not a lot. The majority of the research that has been done there has been done by a Stanford researcher, Dr. Lucia Aronica, who did a study called the Diet Fit Study, which compared sort of those low carb diets versus other diets. And so, I think that that data has not been fully analyzed yet. But I do think that we probably tend to see a trend in our datasets to show that the ketogenic diets are positive.  And so, I would say low calorie is definitively good. We already talked about that caloric restriction trial. Low calorie and periods of caloric restriction to then possibly increased autophagy, I think, are highly effective. But as it relates to Dr. Longo, here we’re actually doing a study with the ProLon fasting mimicking diet as well right now, to see how that works. And I think that in our initial data, what we’re seeing is that the prolonged fasting mimicking diet does indeed work or over time.  We’re seeing that caloric restriction absolutely worked. But we’re not seeing the same data, the same positive data for actually time restricted feeding. So people might like to eat between those six-hour windows. And unfortunately, we’re not seeing the same benefit unless they’re also, by doing that, doing some type of caloric constriction.

And so we don’t know a lot about the macronutrients yet. Soon, we actually think that we’ll be able to diagnose or to tell you how much of each macronutrient you’ve actually had by just looking at your methylation. But we’re not sure how it affects longevity. And so I will say that caloric restriction is the only thing we know from a diet perspective that’s great. And in the Mediterranean diet as well can reduce that aging process.  And as you might’ve saw on one of those big slides, if you’re trying to improve your aging rates, consumption of at least one drink of beer or wine per week is great along with more consumption of fish, where if we try and change the intrinsic, we would suggest at least eating poultry two or three times a week. And so I would say that, in and of itself, protein doesn’t look to be bad as long as it’s not in excess.

Dr. Weitz:            Interesting. I recently talked to Dr. Antoun from L-Nutra who works with Dr. Longo. And he said that their data shows that fasting and the fasting mimicking diet are beneficial, but that caloric restriction is not. And I’d also like to point out that Dr. Walford, who was the guy who really put caloric restriction on the map is the professor from UCLA who participated in that. What was the name of that trial where he was locked in that space in Arizona for two years?

Ryan:                   Yeah. I don’t recall the name. But I know the one that you’re referencing.

Dr. Weitz:            The Biosphere 2.  And so it turned out that they weren’t able to produce the right amount of food. And so everybody got a lot less calories. And he looked horrible when he got out, and it turns out that he actually didn’t live that long. I think he died of ALS in his later 70s. And so some people point to that as an indication that a caloric restriction might not be that beneficial obviously and N of one, it doesn’t really mean that much but-

Ryan:                   Exactly. And that’s why I love the calorie trial so much is because it’s over the course of a long period of time, two years. It’s mild calorie restriction. It’s 21%.

Dr. Weitz:            What is… 10%?

Ryan:                   20% caloric restriction. And it’s done in several thousand patients. And so it is one of the first and largest studies of its kind on caloric restriction. And I’ll throw it up here again in case it’s helpful. But again, this goes to show you over the course of 24 months the change in biological aging for caloric restriction, which again, if you’re starting here at baseline, you can see that they’re going even less than half a year, versus those who were not, who are in fast agers aging over two years and in slow agers aging a little bit less.  And so again, this is, I would say, just to start of the data analyzing that’s going to happen as a result of the calorie trial. But we do know that it slows aging and extends lifespan.

Dr. Weitz:            What do we know about exercise and its effect on biological aging?

Ryan:                   Again, woefully little. But we do know a couple of things, which is that there is probably a sweet spot which is that people who over-exercise, marathon runners, even professional athletes tend to maybe have worse biological aging. And we think that’s because they have so much reactive oxygen species. They’re sort of over-training. But we also understand that people who don’t exercise essentially then might also have the reverse. And so for most things, even as I mentioned with alcohol, there seems to be a sweet spot where some is good, but too much is bad.  You’re trying to really bind those. It can be difficult. But, again, I don’t think that that diminishes anything of the testing, particularly, even things the DunedinPoAm pace of aging allow you to do those investigations on the one person that matters for it which is you. You can take a test. You can implement some type of intervention. Let’s just say you want to try caloric restriction. And then retest to see how your pace of aging is going.  And we know that by changing that metric, you change those phenotypic outcomes. You change IQ. You change your sarcopenia risk. You change your risk for dementia or cognitive impairments. And so that we know. And so we also know that is a very precise test, which has a lot of the accuracy between samples. So even over the course of eight to 12 weeks, you can get a good idea of how it’s affecting you personally. And that’s really what I encourage everyone to do, is to start getting that information on yourself and then making the necessary changes to reverse your aging process.

Dr. Weitz:            So you can make an intervention and retest in two to three months and see a significant change potentially.

Ryan:                   Absolutely. And the algorithms are becoming even more accurate. We always talk about the sensitivity. Even with things like telomeres, people wouldn’t use the recommended within a period of a year. And for some of the algorithms, we definitely don’t recommend it over a period of year. But the Dunedin pace of aging in particular is very, very accurate. And so for that one, even over the course of just a few weeks, you can see a significant amount of change.

Dr. Weitz:            And what do we know about rapamycin?

Ryan:                   Yeah. So a good bit, actually. So we’ve done a rapamycin trial. And, unfortunately, we haven’t seen any changes or much changes in blood-based methylation. It’s been significant. We’re still increasing our numbers for those investigations. But we do see a change in other types of tissue, which I think is one of the other things about methylation, which is really, really important is that every cell is going to have a different methylation signature. They’re also going to have different aging rates.  If we were to test your brain, we would get much, much lower ages than if we tested your blood. And if we tested your breast tissue, we would get a much, much higher ages. So all that to say that the tissue type is important. And so for rapamycin, we don’t see changes in blood. But we do see changes in saliva. And part of the reason being is it in saliva, we have epithelial tissue that we don’t have in blood. And so we are seeing positive, beneficial changes in rapamycin. But only in saliva and not in blood, which is interesting.

Dr. Weitz:            Is biological aging correlated with mTOR?

Ryan:                   So unfortunately, we don’t have the data. I should say, as I mentioned, in some tissues, particularly liver and epithelial tissue and in skin tissue, the answer would be yes. Rapamycin as an mTOR inhibitor would then decrease the aging of all of those tissues. And so, we do know that mTOR expression levels when inhibited tend to reverse that aging process in most tissues and in most animals.  But again, that’s really the only mTOR inhibitor that’s been looked at. We’re also doing a couple transplant-related studies who have been on immunosuppressive drugs. A lot of mTOR inhibitors are, hopefully, are going to be able to use that for more data as well.

Dr. Weitz:            What do we know about nutritional supplements to promote aging?

Ryan:                   So not probably unsurprisingly, vitamin D is one that has a massive impact, particularly in overweight individuals that can reverse epigenetic age by 1.8 or 1.9 years over the course of just 16 weeks at a concentration of four to 5,000 IU per day. We’re seeing positive things with things like in NAD-related therapies. All the data still needs to be built out. We’re seeing positive things with methylation support supplements like for instance, L-methylfolate or methylcobalamin in people with certain genetic polymorphisms.  We’re seeing that polyphenols and things like ECGC or citrus bergamot, some of those flavonols can actually help as well. And so we are learning a lot more about those nutritional categories and actually about to publish too a very interesting sort of supplement trials in the near future, which I can’t speculate on now, but are very, very exciting.

Dr. Weitz:            Do we know about fish oil?

Ryan:                   So, yeah. Actually, one of, I would say, probably the best second generation algorithm, GrimAge, is the one that is able to predict death. And in that algorithm and some of those datasets, they were able to correlate higher levels of omega-3 to essentially better response or lower biological agents although in other datasets, they haven’t seen that relationship. And again, there’s been more data coming out now that says, “Maybe, it will not increase your life span.”  I think that we still don’t have enough data, particularly because there’s so much variation even between fish oil supplementation. How much bioavailability you have? How much EPA to DHEA? So unfortunately, that standardized study has not been done. But the GrimAge did report a positive association with fish oils and omega-3s.

Dr. Weitz:            What about supplements that increase NAD production?

Ryan:                   Yeah, so, as I mentioned, we were seeing positive correlations between people who are taking nicotinamide riboside, nicotinamide mononucleotide and/or doing NAD infusions. And so that’s in our dataset where we’re sort of looking at people who do versus people who don’t, which is not, again, the best study. It is informative. But it’s not the best study because probably a lot of those people who are taking NAD-related supplements are also those who were probably the most interested in their own health. So it’s a big confounding factor. But we are seeing a positive relationship between those people who were taking NAD-related supplementation and having sort of a better biological age.

Dr. Weitz:            Do we know anything about NR versus NMR? And do we know anything about dosage?

Ryan:                   Not at all. And I think the doses of NMN are sort of all over the place. And the nicotinamide riboside is a little bit more concrete. But we still don’t know anything about bioavailability. And so without some of that knowledge, it’s going to be hard for us to control and to compare the two back-to-back. And so I’m really hoping a lot of those companies like Tru Niagen and anyone doing NMN will start to get that bioavailability data.

Dr. Weitz:            What about that form of Astragalus that’s supposedly promotes longevity.

Ryan:                   So we don’t know, I should say.

Dr. Weitz:            The TA-65, I think.

Ryan:                   Yeah. TA-65, in particular, is supposed to increase telomerase and telomeres length. And we actually reached out to them for a study to see if we might be able to test their product with some of our telomeres length measurements. And I don’t think we had any interest. But we’d be interested to know as well.

Dr. Weitz:            All right. We have any other questions. Somebody was asking, do you have any special offers for a webinar participants to take the test?

Ryan:                   Unfortunately, we don’t have one now. For any of our practitioners who want to get started though we give sort of a big discount on their first orders. And so if you have any questions or would like to get started on our testing, please reach out to us directly at support@trudiagnostic.com or reach out to me atryan@trudiagnostic.com.  And we’ll hopefully get you started. And I think the best way to sort of see all the benefit is to go through it yourself. And so we’d love to have you do that. Please reach out to us and we’d love to help you.

Dr. Weitz:            And so, what is the process? Can you explain what the process is? Basically, we have the patients go online, register, and then they get sent the kit, or do you send us kits or-

Ryan:                   Yeah. So we can do either. We can drop ship it to the patient, or we can ship it to a clinic. And so if you don’t want the patients to use a finger stick blood spot test, you can collect a purple top EDTA tube from a venous puncture or you could even extract blood from another tube and put it into our tube. And so there’s a lot of ways that you can do it. It’s a really easy collection process for the patient, just takes usually about five to 10 minutes. Then, you drop it in the mail. And then, we’ll send the results back to you in right around two weeks. And so those actual, those boxes, which are kits contain everything you would need. They’re about the size of an iPhone box. So you can easily store it in your office and then give it to patients whenever they have interests.

Dr. Weitz:            Okay, great. And your website is-

Ryan:                   It’s going to be trudiagnostic.com. T-R-U Diagnostic. And again, if anyone wants to reach out to me via email, my email is ryan@trudiagnostic.com.

Dr. Weitz:            Awesome. Thank you so much, Ryan. That was awesome. A lot of very useful information. Thank you to everybody for joining, and we’ll see you next month.

Ryan:                   Thanks so much. Bye-bye.



Dr. Weitz:            Thank you, listeners, for making it all the way through this episode of the Rational Wellness Podcast. Please, take a few minutes and go to Apple podcasts and give us a five-star ratings and review. That would really help us so more people can find us in their listing of health podcasts.  I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111. And take one of the few openings we have now for a individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.



Mold Related Illness with Dr. Jasmine Talei: Rational Wellness Podcast 222

Dr. Jasmine Talei speaks about Mold Related Illness with Dr. Ben Weitz.

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


Podcast Highlights

2:08  Certain symptoms exhibited by her patients make Dr. Talei suspect that there might be a mold related illness: fatigue, constipation and GI discomfort such as gas and bloating, and  abdominal pain that are otherwise unexplained.  There might be bloating even after drinking water. There might be skin rashes or hives, joint pain, chronic yeast infections, female hormone disruptions, chronic headaches, fatigue, nasal congestion, dry eyes, heart palpitations, anxiety, etc.  Dr. Talei has seen a significant correlation between women with breast implants and mold related illness due to the buildup of fungal based biofilms that can develop around the implants.  Urinary mycotoxin testing can identify such patients.

12:22  Dr. Talei will use Great Plains mycotoxin test to determine if there is mold in their body.  Before having her patients take the urinary mycotoxin test she will have them do an avoidance diet 48 hours prior to taking the test. She will have them eliminate foods that have fungus, such as blue cheese or mushrooms or fermented foods, cheeses, and peanuts.   Great Plains does not require this, but she feels that you will get a more accurate test result this way.

17:32  Treatment.  Dr. Talei uses a very naturopathic approach to treatment that respects the body’s ability to heal itself. First, patients need to avoid mold and figure out if there is mold in their home or work or car and get them tested and then have the mold remediated. They should also avoid any foods that feed yeast and foods that contain mold, like peanut butter and coffee.  Dr. Talei will provide patients with a list of foods to avoid and to incorporate.  You want to protect the liver and the other organs of detoxification.  You want to make sure that you’re having regular bowel movements, so that you can excrete the mold toxins.

20:10  Constipation. Since mold toxins will be removed into the stool, it is important that you are having regular bowel movements.  If the patient is cosnstipated, Dr. Talei will use magnesium citrate and she will add freshly ground flaxseeds and other forms of fiber. The patient needs to stay properly hydrated. She recommends herbal bitters to stimulate your digestion and bile flow.  She likes to incorporate bitter vegetables into the diet.  It is also important to bring in things ike glutathione, which is the master antioxidant in the body.  She likes to use liposomal glutathione by Readisorb one serving twice per day.  She will also recommend supporting the brain and the mitochondria, so she will give supplements like L-carnitine, CoQ10 and high DHA fish oil, like the Nordic Naturals product, ProDHA 1000. 

25:28   Dr. Talei often uses additional liver support, including milk thistle, sulforaphane from brocolli sprouts, and vitamin C to bowel tolerance.



Dr. Jasmine Talei is a licensed Naturopathic Doctor in Beverly Hills, California who specializes in the skin-gut connection, autoimmune conditions, and mold-related illness.  Her website is BeverlyHillsNaturalMedicine.com and her office number is (310) 853-3513.

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. Thank you for joining us again today.

Our topic for today is mycotoxins and mold-related illness, which is a very hot topic in Functional Medicine today. Our special guest is Dr. Jasmine Talei, who is a California licensed naturopathic doctor. She completed her undergraduate degree in political science and film studies at UCLA, and she received her doctorate in naturopathic medicine from Bastyr University.  Dr. Talei focused her clinical training on the skin-gut connection, auto-immune conditions, and mold-related illness. She is currently running a successful practice in Beverly Hills, California. Dr. Talei, thank you so much for joining us today.

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

Dr. Weitz:            How often do you see mycotoxin or mold-related illness in your practice?

Dr. Talei:              A few times a week, I would say.

Dr. Weitz:            Okay.

Dr. Talei:              Yeah. It shows up pretty often. A lot of times, the patients that I see have been to every specialist out there and then they find me, I don’t know how. But basically, they’ve been to every specialist, they’ve run every single lab that there is. Everything is normal, but they’re still very sick. Then they come to me and we run specialty labs, and a lot of times we find out that there is some kind of mold-related illness going on.

Dr. Weitz:            Right.

Dr. Talei:              So this is something that I’m definitely familiar with.

Dr. Weitz:            What’s the first thing that makes you suspect that there might be a mold-related illness?

Dr. Talei:              It’s an accumulation of so many different symptoms where the cause is just unknown, [crosstalk 00:02:23]-

Dr. Weitz:            What are some of the most common symptoms you see?

Dr. Talei:              Yeah. So definitely fatigue. And then there’s constipation or some kind of GI discomfort, whether it’s bloating, gas, abdominal pain, and all unexplained, a lot of times. It’s like bloating after even drinking water sometimes. And then, it’s also hives or rashes, a lot of times heat rashes, like just being under the sun and then getting rashes, joint pain, chronic yeast infections. A lot of females that present with some kind of recurrent infections over and over again, their hormones are fine a lot of times, although sometimes that can be shifted also because of the mycotoxins that act as an endocrine disruptor.   Just an accumulation of symptoms that really haven’t shown up elsewhere as… There’s no pathology for it. And then, we do urine test or something like that and figure it out based on that.

Dr. Weitz:            When you’re taking the patient’s history, what other things are you looking for that might make you wonder if they might be exposed to mold?

Dr. Talei:              An entire review of systems, pretty much from head to toe. So like chronic headaches, fatigue, nasal congestion, dry eyes, heart palpitations, all the GI stuff that we talked about. Anxiety is a huge one. They feel anxious, but there’s no logical reason to it a lot of times. Another thing that I ask about is whether this patient has had a history of breast implants, because this is how I got into this whole field of mycotoxins and mold toxicity, was because I was seeing a lot of patients who had a breast implants at one point, and explanted, and we couldn’t figure out what’s going on with them.  They’ve been to every doctor, they’d been put on SSRIs. They’ve been told it’s all in their head, and nothing shows up. I’ve seen a huge correlation between those women that have had breast implants and then taking them out, still not feeling well. Then their mycotoxin levels, when they do the urine test, is skyrocketed. It’s unlike any other test that I’ve seen compared to any other population. So that’s also how I started getting into this field of mold-related illness, was because I saw a lot of patients who had explanted and still didn’t feel good.

Dr. Weitz:            Is there something about having breast implants that might make them more susceptible?

Dr. Talei:              It could be a controversial topic. A lot of people say breast implant illness exists. A lot of people say it’s nothing, but everyone can agree that biofilms accumulate. If not done properly with the breast implant, whether it’s saline or silicone, biofilms accumulate, and a lot of times those biofilms could be fungal. A lot of times, after you take out the breast implant and you do the capsulectomy, you take out the whole capsule, they send it to pathology and mold doesn’t show up, which is interesting.  So it’s not something that has been proven. It’s something that I’ve just seen in clinical practice over and over again. And I wonder if it is because of those biofilms accumulating on those breast implants. Maybe they’re old. Maybe they’re ruptured. Maybe something has gone on with them, or maybe they had this exposure to mold previously and didn’t know about it. And once they put that in, their body reacted to it. So it’s actually-

Dr. Weitz:            So you’re suspecting that the mold is growing inside their body, not the-

Dr. Talei:              It could be or it’s something that’s triggering that.

Dr. Weitz:            And exposed to mycotoxins-

Dr. Talei:              Yeah.

Dr. Weitz:            … in their arm or something.

Dr. Talei:              Honestly, at this point, it hasn’t been proven. It’s just clinically what I’ve seen. There’s definitely some kind of correlation between those two. I don’t know if it’s accumulating. It’s possible because they say biofilms accumulate. So maybe it is accumulating. But maybe it’s just some kind of past exposure and this breast implant, it’s triggering that. I don’t know exactly what the mechanism of action is right there, like exactly what’s happening, but it’s definitely something interesting that I keep seeing over and over again.

Dr. Weitz:            Do you ask them questions about their home or office, if they might be getting exposed to mold?

Dr. Talei:              All the time. My questions are basically, “So do you have any known exposure to mold?” Most people say, “Not really.” And then I tell them, “Well, let’s think back to when you grew up, the home that you grew up in. Were you in an old home? Were you in an apartment where maybe you weren’t in charge of knowing whether there was mold, like you didn’t have much say over it? Or maybe you were in a school that was old and you were maybe in the library studying. Maybe that had a lot of mold.  Maybe you drive an old car, and every time you turn on that air conditioning, the mold spores are just blowing at you, or a place of work. So I walk them through that and try to determine if there’s any possibility that they’ve had this past exposure to mold. A lot of times, I’ll ask about family history and also determine if they have some kind of genetic susceptibility, which it’s important to know as a doctor. But also to determine maybe there’s someone else in that household that they grew up in, who all has some kind of unexplained symptom.  Oftentimes, I will hear about that. I’ll hear, “Oh yes, we lived with our grandma. Our grandmother always had migraines, and we have no idea why. She always just had these migraines. So it’s interesting to see like, oh, if anyone else in that family or anyone else in that same household had any kind of symptoms.


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Dr. Weitz:            Cool. And then, how do you recommend they test their home if they suspect that there could be mold there?

Dr. Talei:              I think it’s most ideal to hire someone, have them come in and do all the tests. There are many different tests that you can do. I wouldn’t say I’m an expert in this. But they do the air sample, and then there’s one that they take a piece of the place or they check for not dew, but just the dampness. Yeah. There’s experts that come in and do this, but then people who don’t want someone else coming in, you can always buy a kit off of Amazon for like 10 bucks.  A lot of times, it’s an air sample. You open it up, you put it in to let’s say your bathroom for a few hours, you close it. It comes with instructions, and then you send it off to the lab. They check it to see if there’s any kind of mold in that air sample. So there’s definitely many options out there, but just because if you have this mold-related illness and you have the susceptibility, I never really encourage people to do it themselves because, well, what if that creates more problems?  I do tell people that if they do bring in someone and they want to take a piece of that to test their… Like they want to break down a piece of the wall, don’t do it unless they’re going to fix it immediately because you don’t want to just leave this open space, this open wall, where if it is mold, all the mold spores are just going around everywhere and you’re breathing that in and it’s going to just worsen everything.

Dr. Weitz:            Yeah. I think you’re probably better to start with some of those tests you get from Home Depot, and then the ERMI tests where you sample the dust and send it in. That way, if you find that there’s mold, then maybe you can go to the expense of hiring somebody.

Dr. Talei:              Yeah.

Dr. Weitz:            How do you test the person to see if they’re having potential mycotoxins? I think you mentioned that you do the urinary mycotoxin test?

Dr. Talei:              I do. I do urinary mycotoxin test.

Dr. Weitz:            Which lab do you use?

Dr. Talei:              I’ve used a few different ones in the past. Right now I mostly use Great Plains. I like that one a lot. It shows you the most, I guess, popular mycotoxins. It doesn’t test for all of them, but it does test for those big bad guys and basically see-

Dr. Weitz:            The downside right now is they’re taking five weeks to get back-

Dr. Talei:              They’re taking so long. Don’t even get me started on that. But yeah. But they’re a good company. I do like to use them for… It tests for different metabolites of mold for these mycotoxins. Before doing that test, I always put patients on an avoidance diet to make sure that it’s as accurate as possible. Now, Great Plains doesn’t require this, but I just want to be as thorough as possible with the patients that I see, to make sure that they’re not ingesting some kind of fungal food, like they’re not having blue cheese, or mushrooms, or fermented food right before, and then they take the urine test and they pee it out and then it’s a false positive. I also-

Dr. Weitz:            What is that diet that you put them on?

Dr. Talei:              Before, it’s just basically a few foods to avoid, and that’s like certain cheeses, peanuts, mushrooms, certain from fermented foods. And this is only 48 hours prior to the test. I always tell patients, “Based on your symptoms, and based on your history,” like we got a good history, “this is most likely some kind of mold going on. And this test can’t always 100% determine that you have this mold related illness.”  That’s always an important thing to keep in mind with people, because if they’re not able to excrete, then it won’t show up on this urine test, because this is basically based on your ability to excrete these mycotoxins. So a lot of times, we do that to determine, okay, maybe certain mycotoxins will show up and we want to address those. But I also always explain that it’s not 100% that you don’t have this mold-related illness if this comes back negative. It’s just based on your excretion.  We can always retest. We could do some treatments, see if your pathways of excretion are working better, like you’re able to detox, and then we’ll do the test.

Dr. Weitz:            Okay. Are there any other tests that you recommend?  Do you ever run the serum tests for CIRS?

Dr. Talei:              I don’t. I don’t think it’s necessary.  Sometimes I’ll do serum tests that check for Stachybotrys, or through Cyrex, do an array 12, or one of those things that check your blood, to see if you have some kind of antibody against these molds.  But when it comes to diagnosing, I don’t think it’s necessary to do all these other tests, unless the patient wants to, which I completely respect because a lot of times you want to run these labs.  That’s totally fine.  But I usually try to do the least amount of tests because it also gets very costly.  I just don’t think it’s always necessary.  But with that, yeah, I don’t usually do that one.

Dr. Weitz:            Right.  Yeah.  I understand.  I think even at a discount cash lab, the series of those serum labs that are typically recommended, it’s going to run about 800 bucks.

Dr. Talei:              Yeah.

Dr. Weitz:            What is the relationship between fungal overgrowth and mycotoxins?

Dr. Talei:              Mycotoxins are a fungus. A lot of times, like talking about testing, if I do a mycotoxin test, I might couple that with doing an organic acids test. Organic acids test, especially if you do Great Plains, checks for these metabolites of fungal bacteria neurotransmitters. On those, the metabolites of fungus, sometimes you’ll see that it comes up positive for candida. Well, for arabinose, which is the metabolite of candida.  And then you’ll see that they also have high levels of mycotoxins in their mycotoxin tests. So there’s definitely an overlap, and that’s why when it comes to treatment, a lot of the treatment is very similar. You’re fighting off that fungus. You’re starving the body from fungus. So there’s definitely a huge correlation between the two because mold is a fungus.

Dr. Weitz:            Right? Let’s talk about treatment. What are your treatment approaches?

Dr. Talei:              I’m extremely, I would say, extremely naturopathic in my approach. I always say it’s very noninvasive compared to a lot of things out there. That’s just because I really believe in the body’s ability to heal itself if given the right tools. First and foremost, I make sure that patients are avoiding mold. First thing, get your house tested. If you suspect it’s your car, get that tested. If you feel like it’s a place of work, figure that out.  It’s so important to know, because that is the biggest obstacle to cure, is being in a place that is full of mold and you’re just inhaling it. So whatever you do, you’re protecting yourself, you’re still being exposed. And then also avoiding it in your food. So I put people on a very strict diet and I tell them, “This is not forever. This is only until we can fight this. So it’s not a life sentence,” because I know otherwise it is, it’s a difficult diet to follow through with, but it works.

That’s basically avoiding any foods that feed yeast in your body, so any fungus in your body. But also foods that contain mold, so like peanut butter. Peanuts are huge. I believe it’s Aspergillus, I forget the name. But basically, peanuts are grown in a very moldy environment. And so, if you’re having peanuts all the time, you’re not helping the situation. Coffee, so many coffee brands out there are full of mold, but there’s a lot of other ones that are tested for mold.

So finding out which foods are mold free as well and going about it that way. I give patients a whole list of foods to avoid and then foods to incorporate. Foods to incorporate into your diet include a lot of colorful vegetables that provide your body with nutrients, but also help with the whole detoxification process, because that’s what you’re trying to do. That’s first step, diet and just making sure you’re not in a moldy environment.  Then protecting just your overall body, your liver, your organs of detoxification. So your liver, making sure that you’re sweating, making sure that you’re having regular bowel movements, more than two a day. A lot of people that struggle with mold-related illness tend to be constipated. So getting those bowels going so that you can detox these toxins from your body.

Dr. Weitz:            What do you do if the patient’s constipated? What’s your go-to strategy?

Dr. Talei:              I start slow. I start off with things like magnesium citrate, which has an affinity for the GI system. I do flaxseeds, freshly ground flax seeds, or some kind of fiber. I make sure the patient is staying hydrated, drinking lots and lots of water. I do a lot of bitters. I do this in tincture form, doing bitters before you eat. 10 to 15 minutes before you eat, having bitters to stimulate your digestion, to basically tell your body it’s time to eat throughout those enzymes, those digestive enzymes, so you can break down your food, digest, and absorb it.

Dr. Weitz:            It also stimulates bile flow, which helps clear toxins.

Dr. Talei:              Exactly. It’s so important. Also vegetables that are bitters, incorporate those into your diet. But a lot of times, honestly, it’s just as simple as just drink more water. Water helps so much. And then, if still we can’t get it going, still having constipation, then bringing in some kind of herbs like aloe that are a laxative, but not long term because your body does create some kind of resistance or just dependency on these laxative herbs. So just bringing these in for a short period of time.  I’m a huge fan of green tea for getting your bowels going, but also for all the properties of green tea, like anti-fungal, anti-bacterial. It’s just so good for so many things. So incorporating that into the diet. I work with the individual to see what it is that they’re doing exactly and how we can make little tweaks to really get them flowing. And by flowing, I mean just having bowel movements.  Yeah, so that is extremely important. And then bringing things in for detoxification. So like things such as glutathione, master antioxidant in the body. Really just helping with detoxification. A lot of times people can react to that if you bring it in too fast. With mold, it’s so important to bring in things slowly because these patients are patients that are extremely sensitive.  So you want to bring in things one at a time and really pay attention to how that patient is feeling, because sometimes it’s unpredictable. You can’t always tell.

Dr. Weitz:            What’s your favorite glutathione product and how much do you tend to use?

Dr. Talei:              I use a teaspoon of that liposomal glutathione by Readisorb. I would say I like it a lot. But in general, glutathione’s so sulfur. That smell and taste, I can’t say I love it. But it works and it’s great. Sometimes I will recommend for patients to nebulize glutathione. I set them up with a nebulizer and the glutathione, and they will nebulize it daily or a few times a day. That really helps to get into the system. And then-

Dr. Weitz:            The oral glutathione, how many milligrams and then how many times a day?

Dr. Talei:              The oral one, I do twice a day. I forget the milligrams off the top of my head, because I’m so used to saying… I always go to that brand and I say a teaspoon.

Dr. Weitz:            Okay.

Dr. Talei:              Yeah. But it’s the Readisorb one.

Dr. Weitz:            Okay. And then what else do you use?

Dr. Talei:              And then I also protect the brain, protect mitochondria. Just give patient energy. So doing things like L-carnitine, CoQ10, protecting the brain with supplements like DHA. So omega 3 fatty acids, but high in DHA because that supports cognition and eye health. That’s so important for people that have some kind of issue with maybe memory, doing things like phosphatidylcholine.

Dr. Weitz:            What’s your favorite high DHA omega supplement?

Dr. Talei:              I use the Nordic Naturals one, the ProDHA 1000.

Dr. Weitz:            Okay.

Dr. Talei:              I believe it’s 940.

Dr. Weitz:            Okay. What’s the dosage you use?

Dr. Talei:              I do two gel caps.

Dr. Weitz:            Okay.

Dr. Talei:              Yeah. Daily, but in general. But then it could vary per patient. That’s why our medicine, it’s so individualized for each person. Like sometimes I might want to do more. Sometimes I want to do less. Sometimes I might not even do that at all. But in general, I would say just the two gel caps.

Dr. Weitz:            Right. Do you do any other liver support?

Dr. Talei:              Yes, I do. I’m huge with milk thistle at a high dose, like 900 or even higher than that.

Dr. Weitz:            Okay.

Dr. Talei:              Because it’s so important to support that liver. I’m a huge fan of milk thistle just because it has so many benefits for the liver, and people don’t seem to react to it as much.

Dr. Weitz:            What about sulforaphane?

Dr. Talei:              Sorry, what was that?

Dr. Weitz:            Sulforaphane?

Dr. Talei:              Sulforaphane is amazing. Broccoli sprouts all the way.

Dr. Weitz:            So what-

Dr. Talei:              Just make sure you clean them well.

Dr. Weitz:            Yeah, it’s actually a whole issue to make broccoli sprouts.

Dr. Talei:              It is. I think it’s E. coli that they’ve been finding all the time if you don’t clean it well enough.

Dr. Weitz:            Right. Yeah. Maybe how do you clean it? Some people recommend cleaning it with bleach, and that doesn’t sound very good.

Dr. Talei:              Right. No. I wouldn’t use bleach for that. I do vinegar for certain veggies, just white vinegar to-

Dr. Weitz:            What’s your favorite milk thistle product?

Dr. Talei:              That one always varies. Honestly, it just depends on what’s in stock. I wouldn’t say I have a brand favorite. I’ve used Gaia. I’ve used DaVinci. I’ve used Pure Encapsulations. I’ve used so many different things. And then, sometimes I want to mix it with something else. So I’ll look for something like maybe with dandelion or something like that. That one always varies. And then, doing vitamin C. I do vitamin C until bowel tolerance.

Dr. Weitz:            Oh, okay.

Dr. Talei:              Yeah. And then I tell patients to back off from that. But usually, in… Or if they don’t want to experiment, then two grams per day, two to three grams per day. I also do Celtic sea salt. Well, any kind of sea salt in your water, just a teaspoon.

Dr. Weitz:            Okay.

Dr. Talei:              To just make sure that you’re getting minerals, especially because a lot of times, I’ll tell patients to do things like sauna therapy that can deplete your body of those minerals. So making sure that you’re staying hydrated and you’re having those electrolytes, those minerals from that salt. And then, a lot of times we’ll see, okay, hormones are affected. So working on hormones at the same time, because a lot of times you’re just so miserable, so you work backwards in some way.  You meet the patient where they’re at, saying like, “Okay, this patient can’t fall asleep. So maybe their progesterone levels are low. So let’s start off with doing some kind of progesterone,” or something like that, to just help with quality of life first. And then, from there you get them to sleep, and then you work one at a time. Talking about sleep, huge fan of melatonin also at high doses, so 10 to 20.

Dr. Weitz:            10 to 20. Okay.

Dr. Talei:              Because of that antioxidant effect. There’s some studies about that fighting specifically addressing ochratoxin A and a few other mycotoxins as well. So I do like to use that. If there are [crosstalk 00:28:55]-

Dr. Weitz:            Do you find some patients get nightmares at 20 milligrams?

Dr. Talei:              I wouldn’t say nightmares, but some people say they have more vivid dreams. Some people, no complaints at all. It doesn’t even affect their sleep, like they fell asleep easily, before, with three milligrams, but now we’re just upping to adjust for that antioxidant effect. So it really just depends on the scenario.

For patients that have, let’s say, high cortisol levels at nighttime, like all of a sudden they’re awake and they feel anxious and there’s so much going on, I might do certain adaptogens that bring down that cortisol level before going to sleep and giving that patient the calming effect to get good sleep, because regulating that whole circadian rhythm is so important to be able to function, and just-

Dr. Weitz:            What are some of your favorite products there?

Dr. Talei:              For cortisol lowering?

Dr. Weitz:            Yeah.

Dr. Talei:              I would say ITI, Integrative Therapeutics, Cortisol Manager.

Dr. Weitz:            Right. Yeah.

Dr. Talei:              Huge fan.

Dr. Weitz:            [crosstalk 00:29:58] product too.

Dr. Talei:              Yeah. I’m a huge fan of that one.

Dr. Weitz:            Okay. And then, what about binders?

Dr. Talei:              So binders, I try to start with flax. I try to start with fiber, things like that. Just very easy going. I’ll use activated charcoal once in a while. It’s never my go-to, only if I think it’s necessary because some patients are already… They have this issue of malabsorption because they have GI dysfunction. There’s something going on. So why a lot of times I don’t want to get rid of the nutrients that they may be having through supplements and stuff like that. So I don’t always go to activated charcoal right away. If I think it’s necessary, then I’ll bring that in and then tell them to take that away from other nutrients, food and things like that.


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Dr. Weitz:            Have you used Ultra Binder or some of the other binders on the market?

Dr. Talei:              What does Ultra Binder have in it?

Dr. Weitz:            It’s the one from Quicksilver. It has a whole bunch of stuff. It has a pectin, and it has charcoal, and it has [inaudible 00:32:43]. Yeah. I forgot there’s a whole bunch of products that are designed to help with metals and mold.

Dr. Talei:              Yeah. I haven’t used that one.

Dr. Weitz:            Okay.

Dr. Talei:              I use Quicksilver sometimes for mercury toxicity or just heavy metals in general. Quicksilver is amazing with detoxification protocols. They have some great stuff out there.

Dr. Weitz:            Right. Okay. With your typical patient with a mold toxicity, how long do you find treatment usually lasts for?

Dr. Talei:              This can vary. There are some patients, they go on the diet, they’re completely fine. That’s it. They’re good.

Dr. Weitz:            Okay.

Dr. Talei:              But then we still… We support the liver. We get bowels moving, things like that. We might want to do a stool test, work on GI function and just make sure that this is not causing a problem later on. And then, there’s other people that it takes a while. It can take a few months to years. It really depends on the person and the environment that they’re in, the support system that they have, their ability to cope with stress, how much they’re willing to actually implement what I tell them. It’s very, very individualized.

Dr. Weitz:            Would you say on average, how long does it take for the average person to clear mycotoxins?

Dr. Talei:              I would say six months until you feel a difference, on average.

Dr. Weitz:            Oh, okay. Six months till you feel [crosstalk 00:34:22]-

Dr. Talei:              And that’s-

Dr. Weitz:            … completely better. You’re just feeling some level of improvement.

Dr. Talei:              Yeah.

Dr. Weitz:            And then, on the average total treatment, a year?

Dr. Talei:              Yeah. I would say a year.

Dr. Weitz:            Okay.

Dr. Talei:              On average. But it could be way less and it could be way more. But I would say yes, on average a year.

Dr. Weitz:            Of the patients that you treat for mycotoxins, what percentage of them get complete resolution?

Dr. Talei:              I would say a majority of them.

Dr. Weitz:            Okay.

Dr. Talei:              Yeah.

Dr. Weitz:            When they don’t resolve, what do you usually find is the issue.

Dr. Talei:              They’re not really doing what I ask them to do.

Dr. Weitz:            That’s the case with all the protocols, right?

Dr. Talei:              Right.

Dr. Weitz:            “Yeah, I’m doing exactly what you asked and it [crosstalk 00:35:12]-

Dr. Talei:              No, and then I tell them to… Exactly. I tell them to come in and they’re like, “Oh, I eat this and this and that.” Well, I’m like, “Well, this was step one.” But I get it. It’s not easy. It’s not easy at all.

Dr. Weitz:            “Are you taking your glutathione?” “Oh, yes, definitely.” “Well, do you need more?” “No, no. I have plenty.” “Well, you had a two-week supply and it’s now six weeks later.”

Dr. Talei:              Right.

Dr. Weitz:            Okay.

Dr. Talei:              Yeah.

Dr. Weitz:            Let’s see. I think those are the main questions I had prepared. Do you have any other comments or thoughts you want to talk about?

Dr. Talei:              I don’t think so. Yeah.

Dr. Weitz:            Okay. Good, good, good.

Dr. Talei:              Oh, I guess a lot of… We didn’t talk about skin. I said like hives and-

Dr. Weitz:            Sure. [crosstalk 00:35:59].

Dr. Talei:              … heat rashes. But a lot of times, we’ll see like chronic acne or eczema, just a lot of issues that appear in our skin. Or really hives for absolutely no reason. Things like that can really tell us there’s something going on, especially when you can’t resolve it. Like you go to a dermatologist and they give you this steroid or this cream and nothing works. And it keeps coming back, whether it’s year after year or it’s newly onset. Just being observant of your skin health tells us so, so much about what’s going on.

Dr. Weitz:            When do you start thinking a patient with eczema might have mycotoxins?

Dr. Talei:              Depending on their other symptoms as well. I’ve yet to see a patient present with only one symptom. There’s always something else going on.

Dr. Weitz:            Right. Let’s say you get a patient. They come in. They have some of these gut symptoms and they have eczema. Do you start by working on their gut, doing a stool test, and then you end up with mycotoxins? Or is mycotoxins in a back of your head as a possibility off the bat?

Dr. Talei:              It’s always in the back of my head off the bat, just because I see it so much. But I might not always say like, “Okay, let’s do a mycotoxin test.” I might say, “Okay, let’s do a stool test,” or, “Let’s do an organic acids test,” because I’m thinking at the same time, your stool test might show us if there’s some kind of fungus going on. If there’s some kind of fungus, then maybe we can…

Even if I’m not diagnosing you, I’m not telling you that you have this mold-related illness, I’m still treating you for that fungal overgrowth. And by treating you for that fungal overgrowth, which is very, very similar, we’re still getting the results. So it’s not necessarily important to me to tell you that you have this exact thing, unless that’s something that the patient wants. For me, it’s important to just get the patient better.

I don’t think we need to do all these like test after test after test. Unless that’s what motivates the patient, then I completely understand it. Or if we do an organic acid test and we see all this bacterial overgrowth, but then we see like arabinose is high in that whole first page with the fungal and the yeast markers. All of those are high, then I just think, “Okay, this is a huge fungal issue,” because also a lot of times when there is fungus, you see high levels of bacterial overgrowth.

You see things like SIBO happening because if this fungal overgrowth is occurring, you’re not able to create that good bacteria. You’re just bad on top of bad. Basically it’s like a whole domino effect. So my treatment-

Dr. Weitz:            What is some of your go-to protocols for treating fungal overgrowth?

Dr. Talei:              It’s very similar to mycotoxins. So, so similar.

Dr. Weitz:            Okay.

Dr. Talei:              But depending also on their symptoms. So, oh, okay, if they’re constipated, getting them going, supporting their liver, just getting things working. I do things like glutathione, but then I do herbs that are antifungal, antibacterial-

Dr. Weitz:            [crosstalk 00:39:20].

Dr. Talei:              Oh, okay. So things like oregano. Huge oregano fan. Caprylic acid is a big one for a fungus. Maybe that’s the difference. I don’t always use that for mold. For mold, I use more like oregano and other herbs, thyme and all sorts of different things. And then, Pau d’arco, like mim, things like that. But then when it comes to fungus, I might do a combination with the oregano, and the barberry, and then all of this, but then caprylic acid in there too.

Dr. Weitz:            Do you have a favorite combo product or a couple of combo products?

Dr. Talei:              I have a few. I like CandidaStat, I think by Vitanica. There’s also SIBOtic. I know it’s for SIBO, but I like the herbs in there.

Dr. Weitz:            Okay.

Dr. Talei:              Yeah.

Dr. Weitz:            Is that the one from, what, Priority-

Dr. Talei:              Priority One.

Dr. Weitz:            Yeah. Okay.

Dr. Talei:              Yeah.

Dr. Weitz:            Okay, cool. Great. How can our listeners, viewers get ahold of you and find out how they can see you and do a consult with you, or find out more about what you have to offer?

Dr. Talei:              Yeah. My website is beverlyhillsnaturalmedicine.com. Email, all that information is there. Or on Instagram at drjasminetalei.

Dr. Weitz:            Okay, great. Excellent. Thank you so much for joining us.

Dr. Talei:              Yeah. Thank you so much for having me. This has been great.



Dr. Weitz:            Thank you listeners for making it all the way through this episode of the Rational Wellness Podcast. Please take a few minutes and go to Apple Podcasts and give us a five-star ratings and review. That would really help us so more people can find us in their listing of health podcasts. I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations.  If you’re interested, please call my office in Santa Monica at 310 395 3111. That’s 310 395 3111. Take one of the few openings we have now for a individual consultation for a nutrition with Dr. Ben Weitz. Thank you and see you next week.