How Chronic Illness Requires Multi-Layers of Healing

How Chronic Illness Requires Multi-Layers of Healing

In this talk with Judy Cho, Board Certified Holistic Nutritionist and Functional Nutritional Therapy Practitioner, we talk about how to get to the root cause of illness, omega-6’s, histamine, Lyme disease, and much more.

This transcript was automatically generated, please excuse any errors.

Hey guys, it’s Judy from nutrition with Judy.

Thanks for joining me today. While you’re here, please make sure to like, and subscribe. If you’re listening to this on podcast, please make sure to leave a review as this allows my content to get in front of more people. And thank you for that. My name is Judy Cho and I’m board certified in holistic nutrition.

I focus on root cause healing, and oftentimes I start with the carni cures meat, only elimination diet. Okay, so today I had the pleasure of sitting down with Dr. Bruce Hoffman, Dr. Bruce Hoffman focuses on so many things, and he really tries to get people that are suffering with chronic illness to root cause healing and truly heal people to a place that they could have a better life.

As you listen to this conversation, you’ll see that it gets very complex. There are layers of healing and he is not somebody that will sugar coat things in a sense. You just need to do this and therefore you will heal or you need to do that, or you need to take this magic pill. It’s not like that for him.

And he’s just very real in terms of chronic illness is difficult. Chronic illness can cost a lot. Um, it can take a lot of effort and time and energy, but. The point is that he says that there is hope and that you can heal, but there are certain things that you just need to go through and it takes time and diligence and the fortitude to want to heal.

Sometimes it’s working on our mental health and working on traumas from our past or even limbic system retraining and focusing our brains to not be as heightened in a immune response or a fight or flight. And it could even be deeper than that. And working on somatic retraining, I will put a lot of the stuff in the show notes, but this is a very important conversation, especially if you’re dealing with chronic illness, you’ve been to so many different doctors, you’ve done so many different modalities, tried different diets and nothing is fully working to get you better.

I talk a lot about SIRS as I spoke with Dr. Eric Dorner, and we continued from that conversation to talk about little nuances about some of the medication, as well as how it. Combines with limbic system retraining and other things. What I want you to really get out of this conversation is to understand that healing is very comprehensive, but if you want it enough, and if you try enough and you do these things, that there is a way to get to root cause healing.

I know that sometimes it may seem like our lot in life where illness is just prevalent, but it may sometimes be that we need to focus on healing our past traumas, as well as even the way that we are viewing the world. As Dr. Hoffman brought up, we often think about 60,000 thoughts in one day. How many of those thoughts are actually making you sicker or an unwell or in a negative state, that’s then bringing that into your life instead of healing and the belief that you can actually heal.

So while this conversation, isn’t the easiest, I think it’s the most real and most open and genuine that you will find in terms of really trying to heal chronic illness so that you can have a better chance at optimal health. Dr. Bruce Hoffman is board certified and he has a fellowship in anti-aging medicine, as well as a master’s degree in clinical nutrition.

He’s a certified functional medicine practitioner and in his clinical training, Dr. Hoffman has also studied with many of the leading mind, body and spiritual healers of our times, including Deepak Chopra, Paul OSHA Rames Baskar and John Katz. Dr. Hoffman was born and educated in South Africa and obtained his medical degree from the university of Cape town.

As you’ll see in our interview, Dr. Hoffman is a lifelong learner. He is always wanting to learn and grow and learn from other practitioners and just provide the best level of care to get people to healing with his patients. I’ve met many functional doctors and naturopaths and integrative doctors that really tried to consider the body as a whole, but Dr.

Hoffman truly takes it to a whole different level. And that was one reason why I wanted to interview him because I felt that he can provide more answers for some of the hardest cases that we may find in the Carver community. Let’s get right into the interview. Hi, Dr. Bruce Hoffman. I am so excited to have you on my channel.

I heard a lecture of yours and I was enamored because you were able to consider all different illnesses and understand that the body is really one body and how so many things are affected. And you talked about how chronic. Is just more than one thing and how everything is connected. So, um, I really wanted to have you on my channel.

I think so many people will benefit from your knowledge. I loved also that you knew about the carni diet. So that was a bigger plus to me. But if you can introduce yourself. Oh sure. So I am a south African trained MD, um, graduated from the university of Cape dun where the first heart transplant was done. And, uh, moved to Canada in 86 and first was a rural physician. And then. Started to be influenced and started to investigate all forms of healing. Um, having been originally exposed to Eastern philosophies and religions as a, as a teenager by my high school teacher, Roger. And so when I found myself a medical school, and then when I started to become a family physician, I started.

Visit some of the ancient heating practices that are investigated as a teenager and some of the philosophies. And then all of a sudden fell across Larry DSY and Deepak Chopra and all the leaders in the field and went and met them and studied with them. And then just kept expanding my diagnostic paradigm and therapeutic paradigm wider and wider to incorporate as many levels and layers of the human experience as I could, and then fell into Ken Wilber’s integral theory of everything.

And once you start, and once you start looking at external and internal and, and individual and cultural, and you just start looking at all the determinants of illness, you end up with a very large roadmap, if you will. And I eventually ended up taking the, um, ive. Roadmap of the, the, the Ko, the bodies that people seem to have.

So if you look at the ancient tic text, they say, we’re not just a physical body where we a physical body, that’s constantly in exchange with the external environment. So we always exchanging atoms, you know, right. As Deepak lights to say, we’ve got, you know, a million atoms of Atel Jesus Christ and Hitler, you know, , we’re constantly exchanging information.

So, so the first level of the, of the paradigm I use is the external world of air and, and water and earth. And that incorporates all the toxicology because we in touch with that. And it, it interfaces with our second level, which is our physicality, our biochemistry, and our structure. And that’s what we do in traditional medicine and functional medicine chiropractic and, and.

All the therapies that to do with structure and, and biochemistry. And then the third level is to, you know, to do with the, um, energetic, the electromagnetic fields, as we’ve learned from Cal, uh, from Albert PA and, and others that are light emits from our body in a coherent form from DNA. So DNA S squeezes light and it emits, and there’s a standing wave around us, which is either coherent or incoherent.

And it also resonates with human resonance, which is the sort of resonance of the earth. But then you got all the manmade fields that are interposed deployment now, and then you have this dysregulation of that are own innate. Coherent electromagnetic fields and that’s correlated with the brain and the autonomic nervous system.

So I have a brain treatment center where I do Q EEGs and we do heart rate, variability studies and stress response testing. And that’s the sort of the brain and the autonomic nervous system is the, is the sort of gateway between our internal experiences and our external world. It all eventually comes through the brain.

The brain sort of records everything that our internal dialogue, our 60,000 thoughts a day, right? Our values, our perceptions are all run through the system. And we know that our thoughts and beliefs influence our biochemistry and our immunology and I sell receptors. So the fourth level. The emotional body.

So trauma plays a big role in that, as we know, and this is very real, uh, people with early developmental trauma attachment disorders, either neglect, trauma, or abuse, trauma, or disorganized attachment, they have much higher, um, negative sort of health outcomes. And they have a much more difficulty in self-regulation and self-regulation in the parasympathetic state is, is the healing state.

And if these, and if these individuals with, you know, early separation from mother or early neglect trauma, if they don’t develop a sense of self, they don’t have a ability to self regulate. And that sets these so-called HPA access in this heightened state of, of hyper vigilance and inability to self regulate, which then shuts down the VA tone and so forth and so on.

So that’s fourth level is the emotional level. And then the fifth is the ego based. The part of our, our reality that sort of gets us through life. Mm-hmm , you know, ego based. Um, ability to negotiate the slings and errors of life is based on the resilience or the fragility of our ego self, which is very much the first half of life drivers.

You know, we are driven in the first half of life by the ego to be a, you know, find safety with mother and father, find connection with other, and then find our way in the professional world, which is the three stages of development of the brain. You know, the reptilian brain, the limbic brain, the prefrontal cortex.

We are driven to develop that, you know, neurodevelopmentally so that in our thirties, we’ve now got a nice prefrontal cortex that can inhibit any fears or any, uh, trust issues we have from early developmental support or not. Uh, so that’s all to do with. With the fifth level, which is the, which is the egos, the ego drives and our defenses, when life gets to difficult, we develop defenses against certain things, right?

And people have very, sometimes very rigid defenses or very fragile defenses and are often not open or susceptible to the healing movement. They just, they defended against any further intrusion into their sacred innocence. You know, they’ll protect you. And so you’ll launch into a, a mold diagnosis you’ll launch into.

Marcel and Liam and whatever you want. You’ll be working at level two with toxicology and physicality. But if that person’s unconscious belief system is shutting out and defending them against any sensitivity or any vulnerability you can work until, you know, the cows come home. You’re not gonna penetrate that, that system, that person.

And you’ve gotta be subtly aware of defense structures, internal dialogue value systems. You’ve gotta know those subtleties, I think in order to best help that person. Because if a person’s sitting in front of you and they don’t trust you, you can work till you can run test all accounts. Come on.

Nothing’s gonna shift in that system. Well, the sixth level is the soul. Um, second half of life, the authentic self that we often leave behind in the first half of life pursuits. You know, we go out and find safety and companionship and educate and. Safety. And we slay the dragons, the drives, the, the Freudian drives, right?

You know, the bitterness drives the Adlerian drives to power, but Carl Yung came along and said, the real drive is to know yourself. And that only sort of starts the surface in the, in the second half of life, when all the machinations and twisting of your psyche to get your needs met in the first half of life, you leave your authentic self behind in order to get seen and met and, and to get educated.

But then in the second half of life, you gotta go and reclaim all the parts you left behind.  right. In order to get where you are going. So that’s soul driven and the soul is. Personal and collective, uh, and families, the family soul. We now know from early, you know, family in constellation work that is initiated by ber Heminger and, uh, and, and taught by others, including mark Warland, who does fantastic work in this area that we, when we born, we not only get exposed to our parental influences, which have a, the whole set of determinants in the fourth level, but we also inherit, um, epigenetically, right?

The experiences and emotions of our ancestors. And so you’ve gotta like diagnose and treat ancestral inheritance of early experiences. And that’s another whole subset that we look at. And in union psychotherapy, we look at the individual soul. What is, what, what is the most authentic and instinctual. Core of this human being that’s sitting in front of you.

What is being asked to manifest? Because symptoms, as I’ve said in other webinars, symptoms are not, they don’t fall out of the sky. You know, they, they teleological, they have meaning and intent and sometimes symptoms, whatever silent in the system in, in your psyche will often show up as some form of illness or tragedy or bankruptcy or betrayal or whatever you want.

And symptoms are like that. They they’re often pointing to that, which is unseen in your evolution. So if you lose symptoms, it’s just things to get rid of, you know, suppress the mild cell, press the, my cell response.  um, as opposed to why the, my cells active is it because the child was never safe with mother.

So she, they developed my cell activation as a means to, to keep people at a distance with the skin rashes and the eczema IM not worthy of being touched. So I will keep my defenses. So sometimes that can be teleological in that. And if you don’t ask that question, you often miss the boat. And then the seventh level is everything beyond the ego-based pursuits.

You know, we in the infinite universe, the evidence for our insignificance is rather overwhelming and, uh, And so sometimes we have to sort of give up our hubris and arrogance and, and know that in the vast scheme of things, just give thanks because we really don’t know what’s going on. You know, there’s something, there’s some divine intelligence that’s manifesting that we need to be humbled to.

You know, I, I love that. And so I’m sure the people that are listening it’s it makes sense. A lot of what you said, it’s, it’s really everything. That we have experienced, but it’s also a lot of what we don’t know. And, and it includes the brain. It includes mindset. It, it could include religion and even just ancestrally a lot of the things as well.

The question becomes then, I mean, we, or Western medicine is all about, like you said, it’s you have a symptom. It’s how do you alleviate that symptom? And most of the people listening to this and watching this know that that’s not good enough, right. We need to figure out why do I have pain so that I don’t have to take that anti-inflammatory medication.

But beyond that, then we go to naturopaths and functional doctors and they say, it’s an autoimmune or it’s thyroid related. And again, it’s treating a certain thing without considering all of the things that you just mentioned. Yeah. So if we are, for example, struggling with chronic fatigue, how do we start?

Like where, where do we journey and how do we start getting to root? Cause because most people that are consuming this information, understand, we do need to get to root cause, but it gets confusing. Do I need to treat the limbic system first, do I need to get out of the environment? That’s um, I’m struggling with mold, you know, where do I start?

Because I really just wanna heal and I don’t wanna waste my money in this journey, but from everything you’ve said, it’s it’s complex. Objection. It’s complicated. So I, I can only tell you what I do. I don’t know if this is correct. I don’t, you know, it just works most of the time with P I’m sitting in my office here, and three feet for me is where patients sit or six feet and I take history.

So I, you know, I have a methodology of doing that. So I have a 70 page questionnaire and I ask, and I read everything on that. And I take the history from that. And my question is like, is set up so I can quickly go through what I do is ask, first of all, what are your top symptoms? And I write them all done, and I go through fatigue, cognition, sleep dentistry, and then all the systems.

And then I look at hormonal issues of male, female diet, um, psychological development, uh, family systems, uh, spiritual practices. So I grow through all of those and I, I. Try and do it as quickly as I can. It takes two to two and a half hours to take a history. And then what, but the thing is to attune to all the UN unsaid cues, you gotta, you gotta, you gotta limbically relate with the individual in front of you and you gotta look for hidden cues and symptoms.

Cause it’s not just knowledge, you know, it’s, it’s, it’s limbic resonance. It’s it’s you can’t only use your thinking function. You gotta use your feeling function as well. If you look at the Myers Briggs type and so you take this history, you feel into it, but you also use left brain didactic reasoning.

And then once you’ve taken a history across all the layers and levels, you then. Diagnostically work out where, what do I need in order to help fill in the gaps of knowledge that this patient, uh, needs in order to diagnose potential. As we use the words antied mediators and triggers. And then I usually set out a whole series of labs, but I can tell you what I use more often than not.

Um, I almost always do a Q EEG. I look at the different speeds of the brain, the Delta theater. Alpha and beta brain waves. And I look to see if they’re amplified or depressed and the ratios between them. I look at the autonomic nervous system through heart rate variability. I do bio Imped studies, looking at fat muscle fluid content.

Um, look at the phase angle to see if the cell membranes intact. Then we always do never forget this piece. Always, always like if there’s one thing I’m passionate about is this one always do the NASA lean test, the 10 minute lying and standing test. Oh, okay. Because I tell you 20% of people are pots.

Right. Get really busy and, and you won’t treat anybody with, unless you get the pots under control. There’s no one. Yeah, yeah, yeah. So do the lean, you know, do that test. My staff are trained to do it on everybody and we train patients to do it at home.
And so many pots. Yeah. I also do a neuroco MRI. We looking at different parts of the brain.

Uh, we pixelate different frontal lobe. You know, temporal lobes, looking at the coordinate nuclear gray matter white matter, and looking at the amygdala, cuz you’ll see a amygdala hypertrophy from traumatized people who are highly stressed and anxious and also look at the thalamus. Cause the thalamus is richly innovated with my cells, this rich with my, and, and so we look at these different parameters, then I do all the sort of functional I do standard labs, everything I could possibly get my hands on that hasn’t been done before.

And you’ll often find all sorts of things, you know, find. Thyroid antibodies that nobody’s looked at before, or you’ll find, you know, tssh levels that are sort of suboptimal with a low T3, which if you just tweak that things improve, you’ll find prolactinomas, you’ll find, you know, pituitary, micro, OMAS, you know, you’ll find these things.

If you really keep your diagnostic net quite wide, I always do a Panex dental x-ray and then get a 3d coin beam and get a dental opinion on everybody. If somebody’s had a head injury, I always get a nuclear chiropractic assessment of C1 C two. And if there’s any suggestion of creating a cervical instability, I send people off to that group of people who specialize in that like Dr.
Boies and others. And then on the functional side, I do food sensitivities, not just I G G, but I G G IgE. IG, and I do the lymphocyte sensitivity test as well. Oh wow. And I look at the trends in it. I don’t look at one. People come with the, I G four test isn’t it’s hopeless, you know, so I look at all of those.

I do many stool tests. I do the GI maps. Mm-hmm  I do the Genova tool test. I do the dun wit precision lab Lin, his D AO, um, histamine levels and the lip polysaccharide I do that. I do the intro lab test. If I suspect any gluten issues looking not only for the, the genes, but looking for. Uh, tissue trans determinates antibodies and fecal fat mal absorption.
I also do, um, CIBO testing on half my patients. Cause most of them huge majority, if they have a history of bloating, uh, Sibos always a role, but there’s, CIBO, there’s C nav, quite the term. LIBO large bowel bacteria, Leto, the words we use, you gotta treat them all. And then you look at Vaal time, the whole motility issue, and that’s through heart rate variability and specific devices we used.

Then I look at the, I use the ion panel. I know some people use the, uh, neutro valve, but I, the ion panel I can read in 15 seconds and look at amino acids, minerals, antioxidants, steady acids, but for fatty acids, I mostly look at the Kennedy Krieger body bio fatty acid panel for am omega three, six distribution saturate a fat distribution, the ratios between minimal and look to see if the lipid content of the cell membrane is high or low.

Because if the lipid content is low, like minus 25 minus 30, and you go put people on binders for mold, you’re gonna crash that patient like instantly. And so I look at that. I look at fats, uh, we look at the organ, the oats, the part of the ion panel. I do oats testing. I do the great. It’s heavy metals and the microtoxin test, but I I’m really moving away from the microtoxin testing because there’s so much bad medicine being practiced at that test.

It’s it’s I think it’s, uh, I think Richie Shoemaker for all of his, you know, he’s, he’s, he’s got some certain opinions about. Things. And one of the opinions he has is on the microtoxin test, not being indicative of SARS, chronic inflammatory response syndrome. And on that, he’s incredibly correct. You cannot go and diagnose mold illness based on a urine microtoxin testing.

Don’t even begin to tell me, you can, you know, you can’t and it’s it’s bad medicine and I wish it would stop, you know? Yeah. I learned that too, because essentially if you’re healthy, you will be able to remove microtoxins from even your diet, um, in a urine test. So you can’t differentiate between a healthy person that’s releasing versus somebody that’s really poisoned from it.

And so you need more markers than that. What’s interesting is I’ll find some SIRS clients that will then take the microtoxin test and they’re not releasing any because I think they’re unwell. And so that part of it is interesting, but you’re right. The test itself is not enough, but well, they they’ve done testing with healthy controls and the healthy controls have the same microtoxins in urine cause they had corn and uh, pizza the night before.

Right. You know, if I was your patient and I didn’t have all the funds to do all that testing, is there a baseline you can start with with, based on my symptoms, maybe running some of the lab tests? Maybe not all of those, because that’s a lot. Well, I haven’t finished yet.  let me tell you the, let me tell you the test that I really rely on now.

Okay. That’s the IGL test out of Germany that. Has changed my practice, cuz that measures the ducts that sit on DNA, affecting DNA transcription, and you can find mold and mercury and aluminum and glyphosate affecting how messenger RNA is transcribed. It also tells you about cell membrane voltage. It tells you about mitochondrial numbers cuz when you have what’s called a cell danger response.

Mitochondria undergo oage die and you can measure how many mitochondria there are, and you can see it’s low or not. You can see if the cell membrane voltage is low, you can then look at superoxide DYS glut levels. You can look at phosphide choline, phosphide ethyl, OME, the outer inner membrane of the cell.

And you can see how depleted they are. You look at cardio lipins and whether that enzyme is making cardio Lipin. And on and on and on. It’s just a fantastic test. It also tells you about, it gives you a lymphocyte sensitivity test to mold, fungal elements and metabolites. So you can see if mold is sitting on the DNA or whether there’s fungal metabolites or fungal SPOs in the bloodstream to which the lymphocytes are sensitive.

So I find that very helpful. Now you’ll often find people with a microtoxin test in the urine that’s negative, but when you go and look at the DNA, there’s mold micro mold for sitting on the DNA affecting, you know, um, transcription wow. Of messenger RNA. And that person is often, far sicker than the one who’s got microtoxins in the urine is excluding them.

Right? So you in answer your question, what tests you run and how do I do it? Well, I’ve got to the stage in my career where they, everybody who comes to see me now, it appears has done lots of these things, you know, but never. Never enough. And so I say, look, here’s what I need. Here’s the tests. I also do Cyrex antibody testing.

I do the neural Zuma antibodies to brain. You know, I do all the almond lab mold, Lyme testing, and iGen X. If I have to. So I say, here’s what I need to complete your diagnostic profile. And my staff then send it to them. And then it’s their decision with their budgetary restrictions. I try not to interfere with that.

Cuz some people have funds. Some people don’t, if they don’t have funds, I then try and adjust my practice accordingly, but then you’ve gotta adjust their expectations as well, because they’ll always come with you and say, oh, I’ve got, I’ve got mold on this. Look at my microtoxin test. And then you take a two hour history and they’ve got 50 other determinants of being unwell.
Right? So then you give them the diagnostic roadmap to give them the, what you believe I believe is the insight into that. But then they on, you know, they’re they don’t have funding. So then you try and work with what you can, but you’ve got to taper your expectation and they’ve gotta taper theirs. And that’s a tricky relationship with people, you know?

They’ve been traumatized because if they don’t trust what you’re saying, they’re gonna project all they distrust onto you and then they’re going, you know, they’re gonna, it’s tricky. It’s a tricky relationship working with ill people. Not always, but it can be. Yes. Yes. So let’s, let’s talk about an example of sir, somebody that has the genetic haplotype, they’re all the blood markers that Dr. Shoemaker brings up, like the MMP nine TGF beta one, Ms. They’re all low or they’re all high. And the weight they’re all low, right? SOH is low. The other markers are extremely high and their environment isn’t the greatest because they don’t have the funds to really fix the environment. But then, then I meet people that are limbic system retraining specialists, and they talk about how they.

Force their body to rewire their brain and, and be able to get better, even in an environment where their army score isn’t the best. So, you know, you talked about all these layers of health. Yeah. How do we know that if we were to just pull the layer of trying to manage the brain and how it reacts to stress?

Like what if that will just heal some of the other areas, even if in tests they’re off tricky, tricky dynamics  so if you take the history there’s water exposure. Yes. You do the army testing. There’s positive, you know, all hurts me too above 10, and they got all the bad ones and the, the symptom questionnaire they’ve got, you know, 25 symptoms in 13, 12 clusters, and they fail a visual contrast test.

And then you do the Shoemaker markers and the TGF B is 10,000, the C four H 20,000. Ms. H is five, you know, and. The person is highly reactive to the mold that they’re exposed to. I don’t believe that you can only do DRS or Gupta’s retraining program and treat them with that methodology. I think that methodology is important when the amygdala gets sensitized.

And is hyper reactive to the incoming biotoxins, but I do think you’ve gotta work biologically to downregulate the innate immune system while addressing the amygdala hyperactivity at the same time. And often you’ve gotta work sooner logistically. Yes, but there’s even a deeper layer that the DNRs and crypto training program often don’t get to the hidden defenses of the individual who’s hyper reacted because they’re protecting their, the last vest of their innocence, which never got traumatized.

And they are so defended against anything. That’s could be perceived as toxic that they can’t downregulate the amygdala because the trust is not there and they can’t trust anything. And that’s when you need to go into internal psychotherapeutic work. Uh, and you can’t just work with dynamic neuro retraining or cook program.

You have to address the defenses of the individual. So it’s tricky, but it can be negotiated. And some of my patients with the amygdala sensitivity, they just think of mold and they react that they do. It’s a real reaction. It’s not, they’re just so sensitive. And you look at the neuro quite, and then amygdalas in the 98 percentile it’s hypertrophy is big.

It’s two standard deviations than everybody, and then their colleagues and their age match controls. So then you’ve gotta, you gotta do all sorts of neuro bio, all the whole things around neuroplasticity and cell membrane, integrity and fatty acid manipulation. And it’s complex. That’s interesting because that’s kind of what I’m coming down to.

So just to give you a background, I specialize in the carnivore diet because I believe it’s the ultimate elimination diet in terms of just getting food off the table as a culprit of your illness, and then we can work on everything else. And so there’s a handful of people, including myself that have healed a lot.

In terms of illness, mental illness through a meat, only diet. But as I worked with more people in more complicated cases that the food doesn’t fix everything. So they get a lot better, but not enough that they feel better. And so they start working with me and I started noticing there were people that had this serves and I fell into shoemaker’s work.

We started testing some of the markers and they had the genetic type. They had all the markers we just mentioned. And, and so they started some of the coolest tyramine. They did some of the excess fish oils and it wasn’t enough. And my guess is like, you mentioned that, um, Kennedy test, they would’ve probably had really low markers and you not touch tyramine unless, you know, the lipid content it’s fatal mistake.

Second fatal mistake. First is treating a person with, with a microtoxin test is having mold illness. Second is throwing tyin at they prematurely. Sorry, carry on. Yeah. Yes, yes. And so, well, that test is not part of the NA the original protocol. And so, no, no, no. I, I actually learned it from you and it made so much sense of, well, this is a bio acid reducer, which also was known to reduce your cholesterol.

And if you cannot take in fatty acids, you might not have the wherewithal to even take the colony remain. And so the, the phospholipid flush the, and the fatty. That all made sense, but this and cholesterol, cholesterol forms is structured in your cell membrane and is a precursor to all your hormones. You don’t wanna block cholesterol to the point of extinction.

You want a cholesterol to be sort of highish normal, not yes, yes. You wanna block Cho. And I think that’s where carnivore is so powerful that if somebody has been eating carnivore with a high fat diet and their cholesterol markers are high, they’re more prepared to take tyramine yes. Than the average person that’s eating a low fat diet.

Exactly. The don’t get me started on the vegan diet and I’m gonna get everybody’s kinda scream at me on social media. No, no. Well, my community is not plant based. Um, I actually got sick on a plant-based diet, so, but yeah, I was, I was the head of the vegetarian society for 17 years, so I’m familiar with it.

OK. But my experience, you don’t get people well on a vegan diet, if they’re in a chronic ill health multisystem, multis symptom, complex illness mode, it’s just not gonna happen. Right. Right. And I, and I fully agree with that. And so. Happened was some of the people as they got diagnosed with SIRS, they started going into the excess research of what do I need to do now.
I need to be super mindful of every building I go into and, you know, that fight or flight mode, just really high gear of stress and, um, just being in their illness all day long. And I think those people then using the, the limbic system retraining. So it seems like it’s a lot of these modalities together that can actually heal people more than a lot of them together.

Yes. Most of those people, and I say this generically and somewhat, I hope it doesn’t come off as sort of prejudicial, but a lot of those people with the limb. Hyperactivity have trauma. Oh no, I believe that too. And they can’t there’s no, there’s no re they can’t self regulate. There’s no window of tolerance.

And I send them to somatic experiencing trauma therapists. I don’t, they do good DS, but they often need to do body based body up therapy, where they need to actually learn how to tolerate more and develop a window of tolerance. Um, uh, that I use se practitioners a lot somatically. I refer to that. I’ll have to look into that.

That’s fascinating. Yeah. Just check that one out because it’s, uh, it’s a, it’s the game changer. Yeah. When DNRs fails and Gupta fails, think trauma think early thinks se uh, body base, you know, be off on cult’s book. The body keeps the score. Mm-hmm  yes. That’s real stuff, you know? Okay. And it’s, if you look at Robert Navo cell danger response, you look at PGES body vagal, uh, dorsal, Vago, shutdown, response, those people.

Autonomic nervous system shut down. Mitochondria are shut down. They’re in an inflammatory response. So is part of, uh, Robert NEAU cell danger response, number one. Okay. That makes sense. And they shut down and they don’t have a capacity to self regulate. It’s not happening cuz they, they, their whole system is in a state of freeze, not fight flight that’s, you know, beyond they’re beyond that.

Yeah. And they, and se practitioners know that stuff backwards and they can help you negotiate that territory. Yeah. And PGE developed a sat and sound protocol, which is a series of, of sounds and music and patients with severe trauma reduce up and sound. This is the feedback I’ve got. It found. It sounded.

My mother’s soothing voice had finally spoken and got through to me.  wow. Is that, that, what does the mother’s soothing voice do to a child? The child in trains with the mother’s voice and tone, the right prefrontal cortex of the mother resonates with the child’s right. Prefrontal cortex. They entrain with each other.

Over 30 years, the child looks away, looks away. Self-regulate looks to the mother. Mother’s still there. Mother still loves me, challenged me a bit, you know, support challenge. Over 30 years of neurodevelopment, the child learns to trust the environment, learns to trust safety, learns limbic resonance. They learn to self regulate their system.

If there’s been early trauma, doesn’t work self, a sense of self doesn’t develop the sense of self trust. And self-regulation, isn’t there safe and sound recreates that which is missing the mother’s voice. That’s hard like Clinton, like Clinton in the mother’s eye mother just has to have be 30% present, apparently to have a reasonable child upbringing.

oh wow. You be a perfect mother. You just felt be present about 30% of the time and you gotta support and challenge that child and give it appropriate sort of boundaries to work in and, and create a sense of trust and safety. So would you recommend then for a lot of the people that are dealing with chronic illness, chronic fatigue, let’s say they don’t have a lot of funds, but some of that trauma work and, um, the somatic, as you were talking about doing that can be very beneficial with, in tandem with someone like yourself that can also support improve, provide care.

It’s so difficult here, Judy I’m so used to working with a very broad diagnostic. Okay. That I, I can say yes, but, and you know, yes. What else is going on?  right. Is the theater brainwave feed standard deviations higher than the peer group. And if so, that person doesn’t do well. They in a disassociate in, in pathy.

Okay. So they may not be able to do safe and sound work, you know? Okay. Yeah. Yeah. I know. There’s always nuance and I, I totally understand that fully. I wanted to shift topics a little bit. I know that you, on your Instagram page, you share a lot about M a histamine responses. Yeah. Yeah. Can you share a little bit about in the carnivore community?

For example, a lot of people will remove certain foods and then they try to reintroduce it. It could even be salmon for example. And they say that they have more mass cell activation and more histamine responses eating the carni way. I don’t know if it’s because part of the reason is that they’ve removed the food for a while and now as they’re introducing it, they’re just a, um, reacting.

And maybe it just takes a little bit of reintroduction, but what are your thoughts? Well, histamine, you. Breakdown product OFTA Dean right rights more there. And where’s, HETA Dean found more in salmon. Right. So, you know, um, if they’ve got my cell activation and I, you, if you go and do an ion panel, you’ll see histidine there.

Oh, okay. And all my, my cell patients have high Heine levels. You see it all the time. And so if you’re introducing salmon in particular, if it’s not flash frozen on the boat. Sure, sure. Aged one of the worst triggers of myself that, and. You know, and all the fermented foods that are so popular now I know.

So, so you gotta be careful with that one. You gotta, you know, beef, if it’s, you know, a lot of beef is old too, they let it, the it, the, yeah, the it, and so of course, you know, that’s a, something duck for myel activation, but that’s where you gotta do the precision done Woody test and see what the DAOs doing and see what the histamine levels and the Lin levels, and then ready prepare them, you know, use your umbrellas or your, his Dao in huge amounts, 30 minutes along with chromosome.

You know, if you suspect you’re gonna react to meat or, or any food for that matter. And then you use all your myself, I’m very aggressive with myself. Like, cuz I use. Okay. I use pharmaceuticals and nutraceuticals, but I, I, I happen to use pharmaceuticals more than nutraceuticals because I find they get the job done quicker.

And I do intravenous myself blockade for the very sensitive people, the ones that just wiped out, they can’t function. They can’t leave their hospice. They’re reactor really. They they’re down to three foods. Right. So we, we bring them. Look for parts first, look for hypermobility. Number two, then treat them with intravenous ma cell Benadryl ol Aban.

We use I IV Avan, which is a Maal blocker. Unden Thero for some of the nausea and GI symptoms. Get them stabilized then onto pharmaceuticals. Then maybe nutraceuticals. I work that way around. I know lots of people work nutraceutical, but I, I just because I’m an MD, but you’ve gotta use them without excipient or diets.

You’ve gotta get compounded pharmaceuticals. Sure. So what is the root cause of this? M a right. So it’s obviously there’s a hypersensitivity to histamines. Not everyone has that same reaction. I mean, some of it is maybe they have gut permeability, but something triggered the M a to occur. Like, what is the root cause of why are people getting diagnosed with M a S and it, sometimes it just happens in their thirties and forties, but what is causing it?

And so Aron Lawrence Aron, who I work with. Okay. And part of his little group we wrote, he wrote the paper, which we co-authored on the consensus two statement of what is my cell activation, how to diagnose it. There are genetics to it. There’s not the same genetics that are there with systemic master psychosis.

So my cell activation syndrome is just an overactivity of my cells. Systemic mass cytosis, as you know, is increased numbers of milestones. So in, in my cell activation syndrome, you’ve got twitchy, my cells and my cells sit in all the surfaces of a body to protect you from incoming, toxic load and internal mental stresses.

LA Ron’s Han believes that the mental, uh, trigger of myel activation is more powerful than the physiological triggers. So what you have is, you know, these vigilant cells sitting there ready to pounce, whenever something comes in that shouldn’t be coming in and they send out thousand mediators of inflammation.

Right. Of which we measure 10 histamine is one of them and histamine. Yeah. So you’ve got these, my cells sitting on all the RFS in your nose, um, your GI tract, particularly richly innovated in the judum all the way through to the anus in the skin, in the brain, in the. Cardiac tissue and lungs in particular.

And they send out a thousand mediators of inflammation, histamine being one of them. Right, right. One out of a thousand. And they send out these in these signalings to try and dampen the incoming, toxic load. So they protect it. But they’re overreactive.
Why? Because. Look around you. We’re inundated all day long with, you know, toxins or triggers.

Biotoxins chemicals, metals, insecticides, pesticides, EMFs. Oh my don’t have you started on the EMF story, terrible trigger of muscle cell activation in a subset of patients. So those with the electromagnetic hypersensitivity syndrome, just to, for your, for your, um, clients don’t work without a building biologist, looking at the EMF exposures of your patients, ask them about it.

The same is don’t work without a biological dentist looking at the bite and the root canals and the capitations and the metals and the alloys and everything else. So the reason why the, my cells are so active is because our toxic load is so active. It’s so huge.

And so you get, there’s a genetic predisposition to some people.

For my cell activation syndrome. Mm-hmm  but it’s a toxic load. That’s exceeded like capacity to self-regulate once again. And so they’re just throwing out, you know, Ava trying, trying to keep the lid on a massive inflammatory response, but they trigger my cells, trigger oxidative stress. They trigger peroxide nitrate.

What does Pery nitrate do? It rips through your outer membrane and your inner cell membrane phosphocoline phosphine gets to your DNA, your mitochondrial DNA, mitochondrial DNA unravels goes outside the cell with ATP. Wow. Outside the cell. They become pro-inflammatory and they, then they call purines, they then trigger my cell activation to trigger Parx nitrate.
And all of a sudden you’re stuck in an inflammatory response you can’t get out of. So that’s the cell danger response, which is so beautifully described by Robert paver. Again, for your audience, please don’t go far without knowing his work backwards and forwards. Yeah, sure. And I’ll put that in the show notes.

Yeah. So then do you think if people get out of the toxic soup and they change their environment, work on some of the trauma, you know, and I’m saying it so simply I know it’s not that simple, but that we can actually reverse some of the M C. So that our bodies are not reacting as much. Oh, absolutely. Yes, absolutely.

Okay. I’ve had people, you know, they do the MQ symptom questionnaire, which is the IFM standard questionnaire for toxicity. All the symptoms score 180, 1 90 for add up all their symptoms, normals 20 or less. They come in a year later, they scores down at 20. Yeah. Now people get better. Now the ones who don’t get better are the highly traumatized individuals who with personality disorders, they are trickier to work with, you know, borderline and, and people with severe mental health issues like anxiety.

Sure. OCD, OCD is a big one. Yeah. They often don’t get better until they use it. S Sri or some form of control of the, uh, hacker activity of the system. How much do you think diet plays a role outta curiosity? A hundred percent, but is not the only thing. Diet is everything. Of course, diet in general, a hundred percent diet with M C.

99%. It’s big. You know, it is big now Lawrence Aron doesn’t believe diet is as big as some of us do in the functional world. But those of us who work in the functional world, I mean, there’s no way you’re gonna treat a severe mass cell person. Who’s eating eggs and drinking kombucha and you know’s drinking wine every night.

It’s not gonna happen. There’s no way. So you have them on lower histamine foods. Then I work with Justin Sanger and nutritionist, chef Revis, a cookbook together, and we do paleo autoimmune, low histamine, ketogenic, maybe FODMAPs, maybe isolates, maybe Oates. We do. We have to know all the diets. Yes. And that makes sense.

We know, we have to know how to juggle them. And we’ve developed a two page cheat sheet with every food color coded. So, you know, onions, it’s got a color code for oxalates orates or Fatma. So a food may have four colors on it because it’s got four different potential effects in the body and to try and work that out.

You’ve. Look at your food testing, you gotta take your history because the food testing doesn’t tell you about my cell necessarily, but you’ll see trends showing up quite a lot. You’ll see pineapples in there, Kiwis in there, Candis in there. A lot of the beans are in there. A lot of the beans are always in there.

That’s fascinating. Yeah. And so you just look at trends and you gotta think it through and you look at their diet and, and you eventually work out what to do. But I think the mildly ketogenic, paleo autoimmune low histamine is where, uh, we sort of trend towards to restore the cell membrane, integrity and repair mitochondria.

Yeah. And that’s where I love the carnivore diet. I mean, obviously I have my biases, but so I know that there are foods in the carnivore diet that are high histamine, but if you were to remove those, so let’s say the eggs, let’s say some of the fish, but if you were to focus on mostly meat based and then, um, I mean, it’s so similar to the paleo.
It’s just, I think I, I forget if the autoimmune paleo contains nuts. I don’t think it does, but maybe it does. Um, well, you take out all nuts in nap pale or two. I, I include three, three of the non mini nuts sometimes just in the beginning, Brazil, Nu pine. And I always forget the third one. Is it Macada okay.

Okay. There’s three nuts. That aren’t many. Okay. How funny? So people are really, I got no foods. We always use those to begin with. And then when you see, yeah. Oh, sure, sure. So you do it like a trickle down effect. Okay. Does that make sense? But I take out all grains, all legumes, all nitrates, all dairy, all fermented foods, all alcohol.

Oh, uh, you know, we take them out, right? We start from scratch meat, fish, chicken, stir fries, salads with oils and fats, the oils, and the fats are the piece that people do not do properly. I agree.  and, and that’s why if you stick, stick to mostly carnivore, you’re not eating seed oil. So then it becomes so so much.

I know it’s a lot more restrictive than at least giving them. Those three nuts, but in general, if you do a meat only, it becomes easier because it’s really easy to figure out which ones, um, you just focus on meats and then you’re not eating seed oil. So you’re just sticking to the lad or the, um, the sewed and other types of fat.
And, and then you may just have to have a list of what foods in the animal based world that are higher in histamines, and you may just have to reduce those. And it becomes a lot more simple when these people are trying to do so many different things.
And that’s where I personally like the Carver diet, um, especially as an elimination diet first, and then as they heal, they can introduce other foods.

So I think, I think it makes a lot of sense is another player on the, on the market these days is, uh, Gooden, ours work with plasmin. Okay. And he does a test called the prodrome scan where he measures all the, all the plasman and DHA and okay. Hospital co. So now I’m learning to work with that test, the, um, Kennedy KRE of fatty acid and the IGL mitochondria and our, all our work is to repair some membranes mm-hmm  and to work with the right fats to, to, uh, improve, um, neuronal tissue, uh, white matter, and to create a anti-inflammatory effect through DHA and so forth and so on.

But majority of people that come and see me are a omega six depleted. They all, none of them are doing all, uh, vegetable based oils and all of them are onco and they officially interesting. It’s completely suppressed the omega six side and the omega six side, the line lake acid is the raw material for phosphide choline.

That’s so fascinating. So a lot of people in my community are so scared of omega sixes because of the line lake acid that’s causing. Oh, obesity. No, no, no, no. So can you explain a little bit, so these people are, have been on a diet and they’re they’ve, they’re now becoming deficient in omega six, omega sixes.

Ole linolenic RONIC, it’s all wiped out. They minus minus a hundred on the, a omega six profile on the Kennedy Krieger test. And that’s the precursors to a lot of your phosphide co, which is the major fat that’s made from methylation that helps run outer and inner cell membranes go figure. And so the reason why they don’t use the vegetable oils is because most of them are toxic and they ran it and they got deodorizers in them.

Yes. Hide smell of the rans body bios fuit co I think is, you know, uh, is a fantastic omega six precursor. If you deficient in it, I would take the body bio balanced oil, which is ad. Oh, okay. Okay. I’m aware of that one. Yes. Yeah. And, and it’s, it’s, it’s prepared in a very clean, you know, cold press for okay.

Yeah. Very clean, no oxidation. And if you lower it in a lake, that’s what we plug in. Mm. Um, Justine St again, the nutritionist I work with, she, she consults on the plasman PLA the prodrome and the body bio fatty acid, and works people together with those nutritionally and supplementally. Yeah. It’s, it’s amazing that.

We hear certain context of certain nutrition and wellness, and then people take it to a lump to an extreme, and then they become deficient in omega sixes. And, and I started seeing that a little bit in my, um, I, I do a basic omega three, six test and people were starting to get more omega three rich because they were afraid of the omega sixes.

And now people are standing to get deficient because of all the polyunsaturated fatty acids that can cause obesity or insulin resistance. And also because of the fear of these seed oils. And, and now we’re becoming super more it’s either that we don’t have any fats or that we’re becoming more omega three rich, and we’ becoming deficient.

And I didn’t even think about the PPH ti choline. And that makes sense because I do recommend PPH ti choline, but without thinking about the omega six and the pre, because six often the omega the little lake is the, you. Pho often made from saturated that could be made from saturated. Fat was Lu lake is one of the major contributors towards fus curly.
Right? And so is the methylation panel, the folic acid, B12 zinc, magnesium ATP, that whole, uh, Sammy, that whole methylation panel, 70% of methylation and methol transfer is all to do with making phosphate. Possible is rules, you know? Right, right. And creatine, I mean the, the methylation cycle is big on creatine too.

So, you know, one marker in the service protocol is that our Ms. Sh is low and the goal is to increase thath so that our brain is not atrophying. And you know, a lot of the protocol says that the way that you increase sh is eventually you go through the whole Shoemaker protocol. Yeah. But you take V I P yeah.

But when I was doing some re research, the pituitary is what produces the UMH or melanocyte stimulating hormone. And some of it gets activated by UV rays. So couldn’t, we, some of us go outside every day. And get more UV rays and maybe it’s not enough, but could it actually increase some of theh? I don’t know the answer to that.

I do know looking, you know, at the sunrise and sunset has a tremendous effect on the duty function. Okay. Me production. But with Ms. Being low, most people with serves of low MSA, like sometimes super low. Right. And, and you’ve gotta all the up upstream, you know, inflammatory cytokines have to be downregulated.

And then you’ve gotta look for marks because the, you know, the nasal staff is what suppresses the MSA. Right. So you gotta treat the marks first. Treat the marks don’t regulate all the up, you know, all the steps, get them out of the toxic thing out the toxic building. And some people are now using peptides to help treat the Ms.
Stage or me. Yeah. Peptide. But again that you see that’s an N squared D squared thought process. Yes. Yes. Name of medicine. Name of symptom. Name of drug. Yes, it’s true. It’s not like that. You’ve gotta look systemically. How do I remove everything? That’s suppressing Ms. H right. And then how does Ms. H naturally start to find its way back up?

Yeah. And your patients, do you ever see them fully heal and their markers all normalize over time? If they follow the no, no, absolutely. Oh yes. Oh yes. Oh yeah. And, and white matter lesions in the brain disappear. How much do you think the environment needs to be pristine? Because that’s the biggest thing I get the hangup is it’s nearly impossible to have an environment that’s has zero mold.

So it depends on the level of the amygdala sensitization to that patient and the level of trauma and the level of trust it’s it’s algorithmically complex. So some people who. They are say HLA positive, but they’ve got good ego strength and have resilience. They can tolerate a lot more than somebody who’s, you know, in VEIC terms, vital imbalance.

Sure. Fatty active deficient, sympathetic dominance, or in polyvagal shut down. They can’t tolerate a lot. And so they just look at our building and if they just catch a whiff of a, of a nasty smell, they are in a full, you know, flare surge reaction. Yeah. It’s so individual, you never know. That’s so fascinating.

And that makes a lot of sense. When I think about my individual clients, how certain people are a lot more resilient, even though they have the haplo type and then other ones, just the fact that they have a split second, where they feel finally I have an answer, but then the split second later is, oh no, I have this haplo type.

And then they start reacting. So it is interesting, but because you see says. You can often not be exposed to mold, but serves in and of itself is the disease that you now have. Right? You have a chronically active, innate immune system that is now your problem. Yeah. And you may not be living in a moldy environment, but you haven’t gone through the steps of reduction of the, of the biotoxin that originally was there that triggered the whole surge response in the first base.

Right. Right. And that’s what nivo called the cell danger response. You stuck in the cell danger response and Robert nivo brilliantly said, we need things. He called the word emesis. You need to input therapeutic signaling to change the. The cell danger response. You can’t just hope to get better. One day, you’ve actually gotta do things.

You know, what are some of the examples that he, um, that Robert Novo recommends to improve the cell danger response? Well, he’s a researcher and he used the drug serum, which is a, uh, an old drug that you can’t get. Oh, okay. And serum blocked the receptors for the, um, DNA fragments and ATP fragments for triggering this whole self danger response.

Oh, okay. Okay. But he also did all the work on what are the biological changes on the self danger response and what is the one that is most consistent, fast choline? Vaso. Choline is big. That is so crazy because I do, I have been adding that before people even consider tyramine. So maybe do some of the omega threes.

I, I did see that balance of the omega 6 36. And I wasn’t sure if I was gonna use that one, but, and then I thought of the PPH title calling for the membranes, but it’s so fascinating. I’ll definitely have to look more into his research. Many people overdo the DHA component of omega three S yes or the EPA.

Now the I don’t, this is right Dr. Good’s research. I’m not sort of up on it as much as I should be. Okay. But I do know that alpha little Lennic. And EPA, uh, signaling molecules and they don’t do much for the whole equation. It’s a DHA that does everything. Okay. So here’s a Smogen DHA specific plasma Mogen, but you can overdose on DHA as well.

Right? So everybody who comes in with this amigo, you know, three, six index that’s off the chart for a MEUs sticks, the end danger of being very deficient in some of the essential fats to regulate cell membrane and mitochondrial functioning. So I wouldn’t go off those simple tests. I would, I would look at Kennedy Krieger or the, uh, fatty acid test.

Okay. No, no. Even the, even the ion panel, fatty acid is not robust enough. Sometimes it even contradicts the Kennedy credo and that’s fascinating. Okay. Okay. No, good to. A question about the IME test. So, um, I had a client that took a, you know, like a, I think it’s just a air sample from a person that normally, you know, sells homes and they do the mole testing.

And then I told him that he should pro and so his house came out clean, and then he did the IIE test and his number was maybe in the twenties. And I told him that you have high mold and that the other test is not really accurate. The first mold inspector came back and showed a link to the EPA saying that IMI tests are not supposed to be used.

Yeah. Yeah. What are your thoughts of the testing? So the answer to that question, you know, the one you, the person you want to read, who’s done so much work is Richie Shoemaker. Okay. He’s already dissected this issue backwards and forwards. Okay. And he did a series of, uh, articles in the tons and letter, which we just Google it.

One to five on mold and he discusses that question in detail. Okay. And so the world out organization has come out saying that the air sampling test is irrelevant. Uh, it’s worth us and meaningless because a you’ve gotta circulate air through. First of all, a lot of the toxins aren’t in the air, they’re on the ground.

Secondly, the particulate size of the, of the, the spores or the microtoxins are lower than 0.3 microns. And they pass through the, they pass through the replace. They don’t pick them up. And so, and, and thirdly, like STAs, the most damaging of all of them is on the floor. It’s not in the air. There’s this whole in the Shoemaker group anyway, this whole.

Sort of don’t they don’t use air sampling. It’s not used they, right. You see. And he says, do not even somebody comes at you with the air sample, throw them at your hearts, but it’s the industry standard. I know that’s and the lawyers and the insurance companies, that’s what they use. So, and army test was not supposed to be used clinically, but I can tell you now that I hurts me to test with the added Acton SIS and other components.

That’s what, I don’t even look at air sampling. I just wanted to clarify for the audience. I mean, there are people that’s, what we are known for is the air sampling. But if you have anyone that’s struggling with mold illness, the recommend the IEN and the SME. So I, it hurts me too. And looking at the aspergillus for, and the other thing is doesn’t differentiate the, the Asper species.
You don’t know if it’s for or Pallo. It doesn’t look for Olevia it’s it’s not good. Okay. Okay. Good to know. Yeah. There are some people that struggle with Lyme and Lyme is they say it’s really, really hard to detect that it’s really hard to figure out the co-infections people will do the Western blot and it doesn’t always, uh, show that you have it.

There’s like the other, the galaxy. And I forget the I Genix one, I think. But do you recommend a certain test that people can figure out if they have Lyme? No. And I, and I, I, it is just such a again, I mean, I, I think one word that’s coming on mouth repeatedly. It’s complex. And I hate to say that, but it’s complex.

I know you’ve gotta get a history from a patient. Okay. Not necessarily the tick bite and the MI, you know, the, the erythema rash and the weak followed by flulike illness. If you get that history. Okay. That’s great. But many people don’t have that history, you know? Okay. Yes. And so you’ve gotta do a history.

Then I do, I do questionnaires. I do the NCE questionnaire by Horowitz and I do the can lime questionnaire revised, which is from the Canadian Limus associate can lime.comal.org or something. And then I added Boris’s questionnaire and I made my own, okay. So I do Horovitz my own. I take a history and if I’m suspecting tickborne infection and co-infection, I then run T-cell testing or through Armon labs in Germany, and I run iGen X, full iGen X immuno block testing.

And if I suspect, and I’m looking there for IgM, I G G PCR, um, and I’m looking for RNA fragmentation, and I’m looking for all the.
Added lime biomarkers that have recently come up with relapsing fever and MIMO and things like that. So I do all of those iGen X, Y Armin lab, El spots. I don’t do the tick Plex plus much with Armin because I get what I need on the, um, agen X.

And then I run galaxy labs for . And then I sit with the awareness that many people will have negative labs and still have tickborne illness. And that’s the sort of current teaching. Amongs one of the PI all the pioneers in lime world, which is vilified by the, uh, I S D a association. There’s no such thing as chronic ly, right?

The test, you know, the testing’s irrelevant. It’s a, it’s a mess. It’s a minefield. And what I do know is that many people come in with a, you know, an I G G I X Lyme test. On one of the bands and say, I got lime. It’s like coming with a microtoxin test and say,
I’ve got first, that’s a perilous mistake to make.

Okay. You gotta really, you gotta have your wits about you from a, for a number of reasons. A if you, the diagnostic testing is expensive. Yes. B patients love to find single point causation. If they say you’ve got lime, you’re gonna send them down a rabbit hole of two to four years of whatever treatment you choose.

Sure. And C you are going to be vilified by your traditional colleagues.

If you’re not surefooted on this one. And most of our medical boards will take your license away. Wow. If you, oh yeah. If you start dabbling in this field, so it depends on your resilience to withstand the whole onslaught of the lime world. Now there’s people out there who do lime beautifully and who are experts like Horovitz and.

Steve Harris and others, you know, mm-hmm  and I recommend you probably go to the, the most prominent, most qualified, loud, you know, most outspoken expert in the field and go treated by them, but to be treated by an inexperienced naturopath or has been to one eyelids course and has one test, I be careful.
Yeah. It’s a perilous path. Um, okay. Yeah. As we’re closing, if people are, you know, have tried many different diets and they’re just not getting fully better and you know, standard care is really not been doing. Good for them. And diet helps somewhat, but not enough. And they’re just feeling chronic fatigue.

Where, where should they start? Like what should they do to maybe incrementally start getting better? Should they save up money to work with somebody? I mean, what are your thoughts? So a person who’s. Changed their diet, but still chronically fatigued. Yeah. I guess mostly fatigue. Maybe they’re still struggling with hypothyroid and they’re, I guess maybe we don’t take talk about the hypothyroid because maybe they have to balance their medication, but somebody that’s just still not fully feeling well.

And I guess the main symptoms would be chronic fatigue, maybe some brain fog. But just generally unwell, Julia, I hate to sort of be the bearer bad news, but you gotta do all layers, all levels. You gotta take your history. That’s fair. You know, if so, so let’s look at one of the variables. Yeah. A person may be uninspired.
They’re living a life. They’re not living their values system. They’re living their fathers. And they’re go to get up and go to work every day, not inspired and not being called from above, if you will, by that, which is speaks to them and evokes their creative spirit. Yes. And, but they got a positive microtoxin and a Mo or whatever test you want, and then you start taking the history and you realize.

Is this person, what do they have to get up to every day? What, what in sport calls I get up every day and do what I do. Cause I love to do what I do. What’s calling them from above to get up and do what they love to do. Why? Because the particular activating system in the brain is designed to shut you down when you’re not doing what you inspired to do.
Mm. So their fatigue, maybe just the fact that they’re not living their value system, they’re living their fathers, or they don’t even know what their value system is. They don’t even know who they are. They’ve got no self inside. They’re not inside. They don’t know why they get up every day. They’ve got nothing that calls them from above.

So yeah, you can go and do the mold in the diet. But they have no reason to get up every morning. And there’s a lot of patients like that, you know, and you have to start appealing to that aspect of them. Look at their value system and see what’s inspired them. And some of them, you know, patient, how many patients have you had chronic fatigue, sick unwell.
You work beautifully for two years. You go through every single test in the book, you do everything right. No better. And then you go. And you find out they go away and a year later they come back and they fine. What happened to you? I left my husband. I left my job and I fell in love. How much of, how many of us work in that?

You know, we ask about that, but you don’t know. Until the person has changed some of their experiences as to what role those played in their life. You may have hinted it, but until they, they get insight until they change, some of their determinants healing is must. We know so little, you know, We know so little, uh, and sometimes it takes, sometimes it takes, if you will, an act of God, it takes, I don’t mean that in a religious sense, but there’s some movement that sort of enters their field that pulls them into a new experience.

And all of a sudden they shift and they buy chemistry shifts and the molecular signaling shift shows, then they, they feel inspired and life’s meaningful. Again. I don’t know the answer to that question. No, I, I think that’s good. I mean, for me, I struggled with mental health and depression, anxiety. I didn’t like my job.

It was a very well paying job. I traveled the world. Everyone loved the kind of work I did in that sense. But at the core of me, I hated what I was doing. It wasn’t fun. I didn’t enjoy it. Um, and, and I struggled with depression and so I changed the diet and that helped me a lot, but it was really when I.

Found my purpose and yeah. Um, and God had something to do with it too. Yeah. And all of that together has healed me a lot.
So now I no longer share that. It’s just the diet because it diet helped me a lot, but it was like you said, it’s all the layers and I will always have something to work on in that whole sphere of things that you mentioned.
But I think acknowledging that because a lot of my clients will say I have stress it’s, um, that’s normal. This is just the life we live in nowadays. I think it’s making us more sick than we realize. Yeah. There’s a term in the integrated field called the allostatic load, you know? Yes. The incoming load versus the resilience and often that’s, you know, and people are often, people are so habituated to living in the world in a certain way.

They don’t know any other way. And so they think that’s their norm. Right. But then they go on holiday. They fall in love, they have another experience and all of a sudden they go. That wasn’t harmonious or coherent with my values. Now I can see. And only in retrospect, can they look back and see, or they leave a difficult relationship?

You know, sometimes people through Mayas, Bri typology or through attachment styles or VEIC styles, they just oil and water, but they try out of the goodness of their heart to make it work. And it’s, but it’s the allostatic load of that relationship is push them out of homeostasis and then something happens and that relationship breaks.

And all of a sudden the life force gets released and the patient’s back on track, but they were, they were just pushing against an aesthetic load that they weren’t conscious of until they somehow they got out of it for an act of guard or whatever, and then out and they look back and they go, oh my goodness, how did I persevere for so long?

It’s a lot to think about. And I love, I love it because I’ve just found so many of my clients that this is the way to heal is they have to touch everything in their life and it’s not easy. And people want the magic pill to fix everything. Whether it’s the diet, a supplement, a medication, a test. But I think from our conversation, it’s probably a difficult one to listen to because it’s not that simple, but if people really want to get to a level of healing that they can reach, um, It’s really looking into a lot of these layers that you so eloquently have brought up.

So thank you for that. Yeah. Layers, layers, and levels. Yeah. In the, in the roadmap thingy that I do here, which I haven’t published yet because I it’s in my book, but it’s, you know, each level is experience and anatomical conceptual designation as related science, a diagnostic method and the treatment method.

So it all layers. There’s sort of a template of possibilities and many people go to the wrong level. You know, they go, they go and see an acupuncturist when they should be seeing an oncologist or they go and see a shaman when they should be going to see a chiropractor. So there’s different layers and different levels.

So try and educate as to what layer, what level, when and how to integrate. All the possibilities. Well, thank you so much for your time. You, if so I know you’re in Canada. And so this was my struggle is I always need to find a service practitioner to work with my people that have the markers that need to start going through this journey, but you’re in Canada.
So one, how does that work with insurance? If people are in America, is your clinic open for new patients? So I, I do see new patients, but with the us patients, I act as an educator and guide an advocate because we, you know, we. Sort of practice across state lines, so to speak so I can suggest and guide, uh, but they have to have a primary care provider that will implement suggestions and, uh, advice.

And then do you normally have somebody in the states that you recommend? I recommend people go to the ICI website. I S E a I and find a practitioner in the area that has the most experience. Yeah. And so where can people find you your clinic? Um, in Calgary, Alberta, and, um, I have a website, that’s got a lot of my blogs where I write about all these things.
And that’s the Hoffman center.com center is T R E not the American ER . And then I think my staff may have sent you my Instagram thingy and yes, I’ll, I’ll put it in the show notes. I know. Yeah, I know you’re busy. Okay. No, no, no. I understand. I have read. Several of your blogs and you are so well versed and comprehensive, and I, I was totally drawn to you because of that.

So thank you for all your work. No pleasure. I’m glad you, uh, were able to make use of some of the late night research.  yes, no, I get that. Trust me. Um, so I will put all your information in the show notes. I’m excited to just see people really take a look at their illness and, um, take it to another level and look at the different layer.
And I would, I’d like to say thank you to all the, you know, the saying that’s cliche, but the standing on the shoulders of others, but Deri Khar Neil, Nathan, Richie, Shoemaker, Larry Doy, Deepak, all of these people that, you know, you just, you make your way. In relationship to all that they’ve done before you.

So we are not isolated in that way. And, uh, it’s good to say thank you to all your teachers and, you know, gratitude for what we can pass on and integrate and make new, you know, constantly reinventing the diagnostic and therapeutic. Uh, platform, you know? Yes. The goal is always the people and trying to get people better.

And if we can fine tune someone’s work, that’s absolutely the goal is because we want people to heal. So, yeah. And, and, and, and advice just stay related to your patients, you know, through limbic resonance, just, you know, the masks I done away with that, you know, The eyes, the tone of voice, the, the connection, um, that’s where trust gets established and that’s the, the hidden alchemy of healing, you know, that makes sense.

I love it. I believe it . Well, thank you so much. All right. Thank you, Judy. I was chatting to you. Okay guys, I know that this interview is not the most rainbows in unicorns in terms of healing. It may be a long journey, but always have hope that you can heal. Sometimes it takes a lot more extra work than the average person that may eat a meat only elimination diet, but you can still heal.

And there’s a lot that you can do, even with all the. Nuances and depends. And it’s complex from Dr. Hoffman. He says that diet is a hundred percent. Part of the equation. Carnivore is a perfect diet to do while you’re trying to heal all these other levels and modalities in your life that you need to focus on.

It’s never really about the carbs. It’s never really about the POAs. It’s never really about those other things. Oftentimes the illness is far deeper than that in our conversation. One thing that was really fascinating was that Dr. Hoffman brings up how a lot of his patients after having learned a lot about the damaging seed oils and the toxins in canola oil and soybean oil are now actually showing up that they’re really deficient in omega sixes.

He talks about how we need. Some of these essential omega six, such as linoleic acid and the other omega six is to even produce fossil tidal choline. We may be hurting ourselves by trying to reduce our omega six to the point of illness. It’s just something to consider. I know there’s a lot of advocates that are so against omega six to the point that we are just focusing on omega threes, but it is in balance and we are required for both for optimal health.

It’s just something to consider. If you are removing all levels of omega six in your. I hope that this conversation really makes you think and figure out what you need to do to help you get to root cause healing. Make sure to eat a lot of meat, take care of your bodies because it is the only place you have to live.

I will talk to you later. Bye guys.

Addressing Mold Illness in the Complex Patient

Addressing Mold Illness

This transcript was automatically generated, please excuse any errors.

Dr. Hoffman

Well welcome everybody. Today I’m going to be talking about complex patients and in the setting of mold illness, but I want you to know that this isn’t going to be about how to diagnose mold illness, sirs, and the steps A, B, C, D, E, F, G, which you can get, and I’ve listed some of the fabulous sites that are out there that you can go to to reference some of the logistics of how to diagnose mold illness and what to do about it every step of the way. This is more of just about what I, as a physician who treats complex illness, find when people present to me with a diagnosis or suspicion of having mold illness as a trigger for the complex symptomatology. And what I found problematic and difficult sometimes to negotiate when trying to understand where the mold may fit into the complex scenario. So these are some websites that you can go to Dr. Andrew hymens YouTube videos on SIRs are fabulous. Richie Shoemaker has been teaching mold illness for a very long time. The ici website has got some amazing people that belong to that group and present on mold all the time. They have an annual conference coming up soon. And then many of you may know Neil Nathan and his approach, real time lab have lots of information. And Dr. Dennis is an EMT surgeon who does a lot of work on sinus colonization of mold and performance surgery and treats mold illness as a occupant of hollow spaces. So those are some references for you.

But here’s the scenario. A patient presents at your office, this is what I see. This is what I see all day, every day. I’ve seen patients this week already with this type of presentation. patient presents, they say I have mold illness. So I suspect mold is playing a role in my symptomatology. And they’ve got many symptoms. You know, as we all know, when dealing with chronically ill people, they fatigue, they got body pain, they got brain fog, mood disorders, got GI tract is always involved, immune systems always involved, they feel inflamed, they hurt, they saw, they ache, and they very symptomatic. And they’ve often been that way for a very long time and have seen every specialist in the book and seen many times many naturopaths, chiropractors, you name it. They’ve been there. And then they show up with a host of lab tests and specialist letters and special investigations.

And now I once but to sort of sift through this and try and make sense of it and see where does mold fit into this complexity. So this is a common thing I get patients say I’ve got mold illness, and they’ve seen everybody. They’ve tried everything, and they always want to get onto Colas tyramine. I don’t know why. It’s a very common presentation. Can I get a colostomy today? Can you prescribe it for me, and I’ll show you as this presentation progresses, that this is probably the very last thing that you want to be doing. So the most common way people are presenting now is with a mold urine test. And they think that from this urine test of the mycotoxin, which is a toxic byproduct of mold, that they could have mold illness, and this is one of the biggest mistakes ever made. In my clinical career when it comes to dealing with complex patients and etiology of disease processes. This test cannot determine whether you have mold illness or not. And I hope my presentation will enunciate why I say that.

So where do we begin? So I’m not going to go straight into SIRs or mold illness right away. I’m going to just give you some background to how I sort of orient myself to these complex patients. You know, where do we practically begin? When we know in systems biology that everything’s connected to everything else? Everything’s embedded in deep chains and networks and systems and we are very tempted as physicians or clinicians to plunge into the typical n square D square approach to medicine, name of disease, name of drug, and this sort of prescribing an allopathic way, something to help relieve the patient’s symptomatology.

But over the years, I’ve developed a system of trying to work through complexity. And I adapted the eidetic model of the cultures or bodies, these different layers or levels to our reality model somewhat on a bit antic literature. It is very training that I’ve done in the past and also German biological medicine as developed by Dr. Dietrich Klinghardt. So I’ve sort of melded all these models together. And I look at the person presenting in front of me having different layers and levels of of their, to their reality.

So the first level is the environment. Outside, we can’t just do an exchange with our environment. So we all the toxicology issues come into play. Level two is the biochemistry and the structure, the physicality of our being. Level three is the energetics the sort of biophotons that radiate from us squeeze DNA, and the interaction with our nervous systems and brains. Stage four has everything to do with our emotional body and how we’ve been seen or not seen in our early developmental years, and what our attachment disorders may or may not be, and how we’ve oriented ourselves to the world in terms of developing a window of tolerance for self regulation in the midst of complexity and challenge. Level five is the the ego, the the operational sense of self that gets us through life. And that has our value systems, our defenses, our beliefs, or morals or values. And there’s a lot that goes on at that level.

And then level six is the so called Soul the most authentic part of yourself, that part of you, which is calling union, psychology the daemon. It’s your true authentic self that sort of, sort of holds yourself together consciously or unconsciously, it’s usually only accessible in the second half of life, I’m afraid to say. And I don’t mean that flippantly, it just seems to be that as we progress through life, the first 30 years or ego based, we driven to become something. And so we have these drives that that force us to be seen by our parents to be seen by our peers, to find a mate to procreate to educate and create some stability and safety in the world. But the second half of life is all to do with authenticity. Who are we really, and how much of our true self that we leave behind in this in this search for authenticity, or in the search for gaining something in the world and procreating the species.

And then the last level is that which is above and beyond and has nothing to do with our individual reality, which we call God or the grand organized design. And some people are very connected to that aspect of their non-local reality and other people aren’t. And it plays a role in diagnosis and therapeutics. So this is the model I use. When a person sits in front of me, can I use a practically very practically. And it looks like this on a map. Where we this is what it looks like when I when my book eventually comes out, this will be there. But this so these are the seven stages of reality and all the experiences anatomical designation sciences, diagnostic methods and treatment methods. And so here we have a lady to make it more practical and less easy to Tarek, a woman may present say, in her 50s with mold illness. And she’s got all these complex, additive diagnostics. That when you go through the layers and levels, they sort of show up. At the first level. Yes, she’s been exposed to mold. She’s lived in a moldy environment for 10 years and it’s deadly well since. But she also has other toxic exposures, mercury from fillings. organophosphates because she like lives next to a farmer’s field. She got a lot of dental issues, she’s lived in tick, bite country, and so forth and so on. You’ll see a lot of these different in functional medicine we call them antecedents, mediators and triggers of illness. Level two or two you know, we all know about food, gut, brain immune system issues, level three auditor electromagnetics and, and brain function, level four all about early trauma and inherited trauma from ancestors, level five or to do with ego strengths, personality disorders or mood disorders, and then level, that’s level five, and then level six, inherited family trauma, meaning and purpose in life.

Some people have no idea why they get up every day. And so people without that drive to, towards what we call a strange attractor, people get driven, there’s a biological urge to become something. And some people feel very disconnected from that, and that has vast diagnostic and therapeutic implications. And then at level seven, this woman had no connection to anything outside of her own reality. And so these sort of these, this sort of presentation becomes very palpable, very practical. I had a patient just last week, and she came to see me with severe muscle activation syndrome and reacting to foods she had, she was eating like three foods, she was breastfeeding her 15 month old son, who was also had very little to eat. Because everything was rejected.

He vomited continuously, she could only hold on a few foods. And this person was never sleeping through the night. She lived in a moldy home food was an obvious trigger as well electromagnetic fields, which as you’ll see are huge triggers of my cell activation and the so called Cell danger response, which we’ll get to in a minute. In a bit upon deep inquiry, it was apparent that she’d had a tumultuous upbringing with with lots of trauma, and interrupted bonds with the parents, their parents got divorced when she was three. And she spent the next two decades going to court and having to choose sides between her wearing parents. And she had allergies from a very young age.

And then I was just talking to her and I said, Oh, you know, I think we’re going to have to use a tighter, firmer h1, first generation h1 blocker for your son at night to help him with his micelle quietening. And to help him sleep. But she said to me, I just Google that in my chat group, and I heard that it’s gonna induce rage in children. So immediately, her fear based brain her amygdala was on high alert, she was already rejecting a potent life transforming treatment. Ketotifen is amazing when it works. And she had no trust in any allopathic intervention, she already had rejected it. And this you will see, when children had Don’t be unseen, and don’t have limbic resonance with parents, they often have, they’re not able to self regulate, and inhibit, they fear or they fight flight responses. And so they see everything as a threat. And they often have these very distorted relationships with their parents and projected onto therapists, doctors naturopaths, because our profession is very paternalistic, to put it mildly, in that we direct and tell people what to do. And so we act as authority figures. And if this person from a very young age has not been regulated appropriately by the parental influences, and there’s a lot of confusion and inability to self regulate, she will project her fear onto you as a parental figure. And she won’t be able to take anything in. So no matter if she has mold illness or anything else, it doesn’t matter what the diagnoses are, if no trust is established, and if no limbic resonance is established with her as a client, and no stable ability to self regulate is established, you will never get anywhere, no matter what the illness, you have to start at a much deeper level to try and really see that patient and understand the defense’s and understand the trauma before we drop into western or alternative functional medicine diagnostics.

So that’s one of the clinical pearls I would like to introduce when dealing with complex patients when they come in with a urine mycotoxin panel and say can we use code and stymied take a deep take a big step backwards we you know, we familiar with ranch rushing in and going you know, we take functional medicine, even a western medicine diagnosis and then we we want to treat it in diagnosis and then treat it but use a much larger or wider lens when you’re sitting in In front of these people and really start to see who this person is that’s sitting in front of you, what story is wanting to be told through this presentation? And where do you have to really start relating to this person? How many layers and levels are at play? Do they trust you?

Now, obviously, trust is a huge issue. And nobody’s going to trust you on their first visit, they’re going to not trust you on their first visit. So trust is earned. But if they were never seen by their mothers or their fathers, they won’t trust you. And so you can’t come on all strongly occupying the hero archetype and say, you know, I know what’s going on. And I’ll just, let’s do this and that, you have to really enter into the field and create the limbic resonance with them, and hear them and listen to them. They are dying to be heard and seen. So please don’t make that fundamental error of imposing all your knowledge on them. Right out the gate, really, really hear what they say. And these people, as you all know, have been to so many places and just got a sliver of information and not being able to do anything with it. Because in systems biology, there’s nobody practicing systems biology work. It’s all compartmentalized into silos, and square d squared, kind of organ systems.

Very few people are doing complex workups and treating them in a complex way. And again, be aware of the projection of unresolved early issues, the relationship to parents, because this is recreated in the clinical encounter, you will very often be the object of unresolved parental complexes. The other concept that becomes very important is to understand Robert Nivas work on the cell danger response. And also Steven Porges, his work with the polyvagal dorsal response, people who have been sick for a long time, their mitochondria are stuck, they are stuck in CD one or CD two roads famous responses, and they just can’t get out of it. They stuck. Even though the initial trigger may be gone, they stay stuck in this shutdown response. And in this collapsed response, and that’s a whole nother skill set to try and recognize if they in this shutdown cell danger response or if they you know, polyvagal, dorsal shut down, withdrawal from the world. And then you’ve also got to ask yourself, are they cognitively capable? And do they have enough ego strength to really take on the complex workup and treatment protocols? 

So we do all sorts of things to try and help us we do heart rate variability, you can see this person is highly in high sympathetic dominance with parasympathetics in the Negative Zone, you can see her Moca score was 2323 out of 30 is not good, there are some you know, memory issues and the hippocampal decline in this person. And then we redid the CNS vital signs computerized executive functioning test, she was in the low average too low to very low functioning capacity. This is not normal for a young, you know, 50 year old person. And then we did the Toba which is a method of ability to concentrate and stay focused and fail this one miserably. And then looked at a Qt T and saw that she had very high the CETA brainwave which is a slowed brainwave, which occurs as a result often of toxic and capital apathy.

Oxidative stress and toxicity generally came from head injuries as well. And that was associated with very high beta brainwaves with joy, anxiety brainwaves. Often this whole part of the brain is lit up like a Christmas tree due to early trauma, which which shows up in brain to E G’s. And then if you look here at the Alpha brainwave this alpha brainwave, here is the brainwave that chills, people are to calms them down, and that’s deficient. That’s one to two standard deviations below normal. So this person’s in fight flight. Her brain is slowed. So she’s cognitively impaired and she can’t regulate her. Her her her physiology, her autonomic nervous system, she’s really, you know, very ill and very depressed and very anxious and can’t sleep and fatigue and so forth and so on. So without these additive insights, you know, if somebody just walks in the room and they go mold illness put me on Curtis datamine and you don’t have some background data at the sort of higher levels of functioning.

You can really run into a lot of trouble and to, I don’t want to say harm, but really not be of much help. In the autonomic nervous system, we meant to self regulate and have coherence between the sympathetic and parasympathetic nervous systems. But many of our patients are in this fight flight, or even hyper freeze where they are actually frozen, they just they shut down. This is poisonous polyvagal theory, dorsal vagal, shut down. They, they they freeze, they withdrawn, they dissociate, they really sick and they stack you can’t get out of it. So, so learn to recognize these states. What you will then want to do is help them build a window of tolerance. And this is a slow process, they often have to refer to particular practitioners like Somatic Experiencing practitioners and others. We do a lot of work with neuro biofeedback as well as refer to Somatic 

Experiencing people and help these patients, you know, develop some capacity, some resilience, before they either hyper aroused or hyper arousal was completely shut down. Many of our patients they, you know, they are not thriving, they’re not incoherence, they’re not solving, self regulating. They are in crisis, they struggle, I can’t keep this up, I can’t survive, really learn to know these people and also learn how to diagnose and how to enter into a therapeutic relationship with them because you can’t go touch them mold, or their micelle or their life, you cannot go near those diagnoses, until this person has developed some resilience or some capacity to self regulate. So that’s the first sort of big insight. We’ve got three brains, as you know, the the reptilian brain, the mammalian brain and the human neocortex. It’s the it’s the neocortex, the executive function that learns to inhibit the fears of the amygdala, and the fight flight from early trauma and lack of trust. But many people’s prefrontal cortices are very damaged from mold exposure, and they can’t inhibit the impulses in their peers and they stay constantly upregulated. So the second sort of Pitfall, if you will, I don’t like after I wrote this, I thought, using the word pitfalls, pretty negative, but I hope you don’t take exception to this. It’s not implying it’s a pitfall, but it’s a sort of, it could be a stumbling block in your therapeutic encounter.

You’ve also got to know yourself a little bit. And you got to be attuned to your own blind spots, your unconscious complexes, your defenses, and where your knowledge begins and ends and don’t try and occupy the hero archetype and just be all knowing and impose everything without really relating to the individual. Are you present? Are you related? Are you resonant? Are you tuned? Your whole thing with these masks, you know, Porsche has has developed this polyvagal theory of social engagement. The ventral vagus is all to do with our tone of voice and eyes and facial muscles. And here we are walking. Two years we’ve all been unrelated and dissociated from each other for the last, it’s I think there’s significant consequences and, and a lot of parents notice, hence wanting to remove masks and things. So that’s another whole saga. 

But there is a there’s a physiological price we pay when we don’t establish trust, by by looking at somebody in the eyes and looking at the gaze and, and seeing the smile and hearing the tone in the voice because those are the unconscious signals we used to attune to others missing for the last two years. The other thing I asked you is, symptoms aren’t, they don’t fall out of the sky. You’ll those of you who are more experienced know that symptoms often point to somewhere in the system of this individual where unconscious dynamics need to be made conscious. I take symptoms as highly highly teleological they have they have they have meaning and often teach my patients to actually go quiet and go into their symptoms and ask their symptoms. What is it I’m not seeing? And sort of like a conscious meditation if you will, and you’ll be shocked at how many patients will come back with saying you know, I did that and I heard something my dream showed me something some synchronistic activity showed up and guided me through the process.

So don’t take symptoms. There’s objective, like we learned, let’s call a symptom that has to be destroyed and gotten rid of No, you vote lean into your center, what is it, trying to tell you that you’re not making a conscious symptoms are often pointing to what is silent or hidden in a system, or highly defended against so, so use symptoms teleologically again, are you acting as a authority figure upon which your patient projects all the rage? You know, if you look at the stages of emotion, anxiety isn’t an emotion, it’s a defense against emotion. But beneath that comes sadness and depression, anger and rage, murderous rage. So people are often highly defended against feeling things they don’t want to feel because those things are so awful, or were awful. So they will suppress a lot of the emotional self. And then because it’s so uncomfortable projected on you because it was projected onto the parent that they couldn’t engage with for various reason.

Again, what stage of life are your patients in first half first, second half and what defenses are active in you and them when you when you find when you find yourself becoming dogmatic and insistent know that you probably in a defense, you you’re activating your own core complexes. And it’s very difficult sometimes to not become self righteous and sort of have that patriarchal approach. We trained to have that approach, forged. As we’re learning more about trauma and empathy. Many of us have done you know, our work on this and know that that patriarchal attitude doesn’t really get you very far. You wanted in an era when you have a heart attack, you want to patriarchal person takes control and does exactly what they need to do to save your life. But in a therapeutic encounter, it can be disastrous. So, again, establish who is in front of you established your body felt sensations or the way you feel in your own body in front of this person? Are you in limbic resonance with them? Or are you completely disconnected? Know when people are shut down, know when they struggling to even show up with appointment? Know what the ego strengths and cognitive abilities, if they’ve got low motor scores, and they’re not going to be able to take on your program, you’re going to have to make some decisions on how best to approach that.

Person personality disorders are which they are out there borderline personalities, narcissist, and those people are difficult, be careful and know your way around them. Because those are the three that threaten to be lentiginous they often aren’t. It’s just a threat that they can be they can take up a lot of your time. But do your very best to create a trusting relationship? Not? Not? You know, it’s not it’s a genuine relationship. It’s not a false sense of camaraderie or anything. It’s a genuine sense of getting to know this person and what’s really what’s it like for them? You know, what’s the internal dialogue? We have 60,000 thoughts a day? What’s What’s the content of that thought process? Is it despair? Is it rage, often, you know, because it’s hidden behind the fences, and then help them to self regulate and create windows of tolerance. To to coin a phrase from Somatic Experiencing world and learn about neuroplasticity and neuro modulation, how the brain changes it states, there’s a lovely video of a guy who learns to ride a bicycle. And when he turns right, bicycle goes left. And he took him. It’s like a party trick. He goes on stage and asked everyone to come up, nobody can do it. And he took eight months to learn how to change is fun when you turn right.

The bicycle went left and he learned how to ride this backwards bicycle but to him eight months to do it. And the same is with your brain and your neuroplasticity and your defenses and your psyche. You can’t just shift a person’s consciousness overnight. And you’ve got to really almost juice that relationship into being through multiple modalities of information and salience and education and empathy and referring out to the right people. So I mean, I’m not trying to make this complicated, but just be a healer first and not a doctor. You know, just just the healing archetype is very different from the from the doctor argue To become a very good doctor know your western based diagnosis and treatment protocols, but also approach it from an empathic point of view. And a related point of view and know that any change is going to be particularly with these complex people is not overnight. It takes time, and learn all the ways to treat this neuro plasticity and vagal tone. And many of you know all these modalities, but I just listed some of them. And then know about the cell danger response. It’s an incredibly important concept to take into account.

It’s the concept that Robert Novo has developed over the years of research, which basically says that, when you’re, you know, you’ve got 30 trillion cells. And each cell is surrounded by a cell membrane inside of which there’s been 100 to 2000. Mitochondria, also surrounded by membranes with an electrical charge of approximately 170 millivolts. And the mitochondria are the canaries in the coal mine are the first thing to detect oxidative damage or any incoming stress. And as the incoming toxins come in, the the voltage on the cell membrane changes. And then that launches a whole host of metabolic changes, which leads to mitochondrial autophagy, which leads to the intracellular contents of the mitochondria going outside the cell, which creates another whole pro inflammatory response, and then the body stays in the so called Cell danger response never being unstuck, because the triggers are never addressed, and the metabolic machinery is never addressed. And so learning the cell danger response, I think, has become a very therapeutically, almost essential, We fortunately have some labs now, that can show us some of this before it was just in the research phase. But now, we have labs that can show us how to note if somebody is in the cell danger response. And we have therapeutics that give assist body by being probably the main one that I know of anyway, to help repair cell membranes, and how the outer leaflet the inner leaflet, how to get rid of very long chain fats that are produced by toxic load.

By using beauty rates and taxes and things. We’ll get to that a bit later. The important thing I know this is a mold talk I’m getting. But the mold exposure initiates a cell danger response. If you’d see the CDR one, and that is initiated by chronic activation of the innate immune system, and that can stay stuck in the cell danger response. Long after the initial signal has passed, people can just stay there and not shift. Now Robert Navarro has incredibly listed a number of different scenarios like the cell danger response, one cell danger response to cell danger response, three different conditions that are in different phases of the so called Cell danger response. So he’s reframed this, as I said, the pathogenesis of chronic illness in this way as a biological systems response that maintains disease, rather than focusing only on the triggers or triggers that initiated the original injury. We want to run a chain and cheat mode, but what’s happened to the metabolism of the organism? How can we identify and treat that and that’s where cell membrane medicine in the body byproducts have a fantastic role to play?

Yeah, so that’s just some more graphs of the cell danger response. And he’s also came up with this incredible insight that you know, we’re always rushing in, in functional medicine to look at oxidative stress and antioxidant defenses. And this is the teeter totter. But he’s positive the theory that you know, and oxidative reactive oxygen species are released by the mitochondria to protect the cells from further damage in a dysfunctional cellular response, and it continues to be activated despite the neutralization of the threat and these reactive oxygen species act, dysfunctional, damaging healthy cells, and he says he had contrary to long held beliefs about the etiology of these diseases. This D redefines reactive oxygen species activity in the context as a defense mechanism and oxidative shield. Therefore reducing reactive oxygen species would not necessarily address the root cause of disease, which actually lies within the destruction of the mitochondria and they have normal cell danger metabolism. Many practitioners were rushing to quench free radicals. I know I did still do for various reasons, with antioxidants, but this can actually cause further harm, as these free radicals may be providing a protective response very important to keep that in. Here’s the oxidative stress markers we often measure.

These are the antioxidants we often use. Common. The another pitfall that we encounter when we rushed into diagnose mold illness, is we we don’t consider a background understanding of other possible differential diagnosis. I use a lot of questioners, this is the MS Q questionnaire, which you’re all familiar with, I believe from AFM. I really have found it essential to know about methylation. And I like to look at methylation through the eyes of William Walsh’s work that he he’s is still teaching right now. On is the old Carl Pfeiffer work with over and under methylation, zinc copper issues and crypto Pio issues. He’s done a fabulous job of initiating the whole methylation complexity. And we need to sort of know that when we addressing mold illness, whether the person’s under over methylator, whether they have cooked up piles, and that they they have copper overload or cryptic barrels.

And then we have to sort of know this methylation panel backwards, because if you see here, here’s the stressors and total toxic load of environmental toxicity level one in my model and stage one more is there more than juicers, peroxy, nitrate peroxy, nitrate being the or it’s also called no or No, which is sort of the nature of free radicals that initiates the destruction of the mitochondria. And we can measure peroxy nitrite. There it is right there. If you do a methylation panel, from a company called Health diagnostics, it measures the peroxy nitrate there we can see how high it is and how much damage is caused into the mitochondria and whether the mitochondrial contents are being released from the cell along with ATP and when that’s released, that then triggers the micelles that they perpetuate this ongoing cell danger response that goes round and round in circles.

So we do have to know our methylation pathways. In red all the bad guys or pro oxidant issues and in blue are all the sort of good guys good to find catalase superoxide, dismutase. We don’t want to go rushing in with all antioxidants, when we don’t understand the cell danger machinery and we don’t understand all the triggers that are initiating the cell dangerous buttons. But we do want to use them where we need to Lyme disease which is which is a biotoxin illness in the same camp as mold illness. Very important to differentiate between biotoxin illness and chemical toxicity. Explain that in a minute. I use a lot of questionnaires I use Dr harvesters, MC lime questionnaire, and I’ve made up my own sort of conglomerate of many other question is that the basis of the kanlaon questionnaire, this is an alternative activist, patient advocacy group in Canada called kanlaon. And I’ve used the equation added some things to I found the use of question is very helpful. And then you’ve got to know your mast cell activation issues, because most of these patients with illness can’t tolerate a lot of things.

And if you don’t down regulate and put a lid on my cell activation before you begin your therapeutics, this patient will never get better, just like if you don’t help them self regulate and go from sympathetic to parasympathetic, which is the healing state. You can’t you know, if you don’t help them and assist them in that process, and if you don’t help them damp and myself, my cells are a consequence of the cell danger response. They don’t have cause just like people walk in and say, Oh, I have mold. They also walk in and say oh, because I’ve written many blogs on myself. They will say, Oh, I’ve got my cell activation syndrome, and I’ll go really okay. What are the triggers? Then then starts the whole diagnostic complexity where the triggers of my selector, so my cell activation is a consequence of an upregulated oxidative stress pathways and it’s our task to find out all the triggers we have which there are many, in my cells being they release 1000 mediators of inflammation, which damage the mitochondria, as do mold toxins. If you don’t understand my cell activation, know how to dampen it.

That’s another patient you can’t treat because they can’t take anything. If you give them 10 supplements as a one sometimes forget about it, they won’t be able to handle, they will, you know, they’ll have all kinds of reactions, and you’ll get lots of phone calls. This is the paper Lawrence app. And one of the main researchers put out on on the consensus of my cell activation, which is different from there’s different ways to diagnose myself. And this is a paper a whole bunch of us, co authored with him, but he was the main author. It’s a good paper, it’s on my website, if you want to read it. Know About pots, POTS is extremely important. Postural Orthostatic Tachycardia Syndrome, if you don’t, if you’ve missed pots, that patient will never feel better. Learn about it, learn how to treat it. And always have somebody in your office do blood pressures, that 10 minute blood pressure test.

You get them to lie down, you take the pulse rate and blood pressure, get them to stay in that one minute, three minute, five minute 10 minutes pulse systolic diastolic blood pressure, and then you work out the difference between the two. If they’re stuck if they post rate increases by 30 beats per minute. That’s parts by definition. And this is this simple little test. This is as good as doing a talk table. And many people will come in with the pulse rate differential 4050 beats per minute, that person’s not diffusing their brain. They’re not confusing their periphery. They’re not confusing the mitochondria. They are sick, and they know they sick but nobody’s done the 10 Minute blood pressure test. So when I learned about it about 10 years ago, I now I won’t see a patient before this is done by my staff before they come in the door. And if I’m doing a zoom consult, they have to go by a blood pressure cap and do this. The question is do you get dizzy when you stand up? 50% of my patients with mold illness or myself illness? Say yes. You have to learn to differentiate between parts orthostatic hypotension and idiopathic Tachycardia Syndrome. That that’s another whole subset of issues know about hypermobility and Ehlers Danlos.

These patients are very different are very difficult sometimes to treat because they so loosey goosey and they got so much muscle activation and their collagen fibers I’m tired and so they got leaky guts and leaky brain barriers and they really can be in quite a lot of distress. And no Dr. Andrew Maxwell cardiologist has put together that triads and paint ads, people who have my cell activation pots and Ehlers Danlos, plus dysautonomia, plus autoimmunity. These are groups of patients that you’ll get to, you’ll get to see them over and over again. And if you go on his website, he’s done some beautiful PowerPoint presentations on this complexity of how to put these things together. Never work with a patient without knowing their dental history. The the lower jaw the job, the trigeminal nerve goes back into the brainstem. So toxins in the lower jaw affect the brain in a dramatic way, just like the vagus nerve in the gut goes back up into the brain. And the sinuses affect the brain tremendous way you can colonize hollow spaces with mold and Candida.

I think 80 to 90% of all chronic sinusitis is yeast or mold related. So you got to know this area of the body. A good panorex X ray or 3d Cone Beam or getting somebody to interpret it for you, a biological dentist who knows what to do can help you tremendously. Root canals cavitations these are all issues that you’ll learn about as you get more deeper into complexity. Know about sleep. This is you know everybody knows the sleep issue. You you don’t you know you don’t restore If you don’t go into deep sleep, you don’t restore a lot of your circadian rhythms and your detoxification through your glymphatic ‘s, this doesn’t, things don’t go very well if you don’t get enough sleep every night.

So I know how to assess the patient and know how to take a sleep apnea history and I refer probably 95% of my patients now to sleep clinics for sleep studies, 90 to 90 and then also know every diet in the book you got to be very clued up on your diets because everybody’s got something else going on. From carnivore to low oxalate to. It’s everywhere and low mode, Candida. Justin who works with me as a nutritionist health coach, and also is very connected to the body by a team. We use a mixture of paleo, Paleo autoimmune, low histamine and membrane stabilizing. Those are that sort of scenarios where we get our most benefit. When we start treating patients, we often have to do low FODMAPs, low oxalates. And most patients now seem to do better on a ketogenic approach. But some people are really sick. We go, we haven’t do carnivore diets for a month or two.

Now we get two more. Sorry, they took a little bit, but the topic was more and complexity. So I address the complexity part first, now we get into more. So this is a pitfall not understanding chronic inflammatory response syndrome. If you look at the immune system, here, we’ve got two new parts, the adaptive and the innate immune system. The innate immune system is the primitive, not too intelligent by the immune system. And it’s the first thing to go into action when any threat approaches. But the innate immune system hands off to the more sophisticated adaptive immune system to T cells, by the use of antigen presenting cells, when the antigen presenting cells of the innate immune system detected danger, they envelop little epitopes little DNA fragments and present them to the adaptive immune system to the T cell, which then triggers the B cells to create antibodies and memory cells. Now, this is this is SIRs or chronic inflammatory response syndrome. It’s a chronic, chronic more than six months inflammatory response, where people get sick and remain sick and don’t know why. And what happens is people with this condition often have a poor transfer of the innate to the nt body part of the immune system.

They have an inability to hand off to the adaptive immune system to call in the troops to put out the fires of inflammation, so they stay stuck in a chronic innate inflammatory response. They don’t create a transfer, they don’t create an anti inflammatory response. And this has been shown by Richie Shoemaker and others to be dependent on the nine gene sequence on chromosome six was houses the so called HLA set of genes, of which he believes about 22% of the population have this gene set. Now this, this theory of the HLA origin of innate immune activation has been contested by a number of practitioners who’ve sort of broken away from shoemakers original research. But I I’ve sort of returned to it recently, because when people have this set of genes is HLA a set of genes. I do think there’s something to be said by the fact that it is those set of people with those gene issues that don’t get out of the innate immune activation, they just don’t have an ability to turn off the inflammatory response.

And I do think there’s something to it, although as I said, it has been highly contested by other people as not being reproducible in terms of research. Once you stay in a chronic inflammatory response being triggered by mold exposures or any biotoxin, whether it be Lyme disease, secretario, or any, any biologically active substance. If this immune threat increases, you can’t turn it off. You’re constantly making inflammatory genes and proteins that circulate, they go to the liver, the biliary tract go emulsified by bile. Many people have Kali cystectomy. They don’t make bile, and it’s dumped into the GI tract. Then it either go out through the store, that’s your where people use their binders. And that’s where they want to call the stymy to bind the toxins or remove them, or it’s reabsorbed through the entropy circulation. And this goes round and round around in circles, you just can’t turn it off, you keep recycling toxins.

So what turns on this in the heat system is a biotoxin, an organism or a fragment of an organism? tick borne illnesses do it, some pathogens do it or multiple pathogens to turn on the innate immune system. This is not a chemical, it’s not a plastic. It’s not a heavy metal. It’s not an organic type. It’s not glyphosate. This is a biotoxin that turns on. It’s an organism this is important to realize. So pitfall number four, you confuse SIRs with chemical heavy metal toxicity. A biotoxin is not a toxin, as we learned, many people think this is a toxic problem, and they go rushing into detoxify without really understanding the biochemistry underneath it. So this is a chronic, persistent, innate inflammatory response induced by biotoxin. And these biotoxins can be mold. buildings contain over 30 Different inflammatory foods, many of which are bio toxins like actinomyces, etc. It’s mycoplasmas. They are not just mold, there’s many other inflammatory diseases can cause all kinds of trouble, really secretaria for stereo, and these people, they can’t turn off this innate inflammation due to these HLA gene problems. So it’s a genetic is genetically influenced, epigenetics turn on but genetically stays on, you won’t get these patients better by detoxifying them.

You won’t get them better by doing chelation therapy. So last thing you want to be doing, even though they may have a heavy metal burden that has to be addressed at some stage, you’ve got to address this chronic persistent innate immune system activation first, but you’ve got to measure it first before you can address it. So another problem that people often make is confusing mold allergy with SIRs are many of the mold remediation specialists, they end a lot of the even even practitioners risk virologists make this problem that patients will go see them with, say, I have sirs and they said no you don’t you’re IGE antibody to mold is negative, complete. The two ends of the spectrum serves as a chronic innate immune activation. mold allergy is an IGE antibody induced response to an allergen like mold. This shows up on an IGE test, which I do all the time. Very different from innate immune activation. If you’re allergic to mold, your immune system is overly sensitive to specific spores and treats them as an allergen. Ige is often upregulated. But the markers of serves the innate immune system, they’re not touched, and there’s no downstream damage to hormones and other parts of the body that occur with innate immune activation. And so the pitfall here is not fully grasping the subtleties of the SIRs diagnosis and the treatment options. Often, you’ve got to you got to ask yourself when you start treating and do these patients fit the SIRs criteria, and I’ll show you how to determine that in a minute.

There’s a patient for further criteria for a tick borne illness notoriously difficult to diagnose. Lab diagnostics are not reliable by any means. That the person get bitten by tick, turn on the HLA genes and then get exposed to mold very common. Are they still being exposed to mold or is it historical exposure? Often the disease the chronic disease, the ill health of the person, it’s the chronic inflammation itself. It’s not the mold of a lamp. It’s the fact that these HLA genes are turned on in a system which is just running with recirculation of the biotoxin nobody’s addressed it. Nobody knows what’s going on. And so there’s a lot of complexity involved in making the diagnosis and then how to treat it, which is on the other side of the slide, which I’ll get to. So how do we make a diagnosis for mold toxicity, or biotoxin illness? First of all, symptomatically. It’s a multiple unexplained multi system non responsive symptoms across many organs or regions of the body. And this question is that we use to determine that there must be a past or present history of exposure to a water damage building. You’ve got to exclude other diagnoses like putts, although they often coexist. And your mold score count the DNA probe for mold spores must pass a certain threshold the either it mustn’t be more than two, or the five molds that are pathogenic Aspergillus Penicillium IDs Aspergillus vesicular, ketone, yum, Stacie, vitalism Alinea together and there’s a scorecard they must be greater than 10 to 15.

These questions here and these diagnostic assumptions, they help you make the diagnosis. And then in order to assist you go over to the proteomics to the labs that help assist you in establishing, you’ve got to have three out of six do you have this HLA set of genes, this is a relative risk of susceptibility. Some people get sick from mold and they don’t have the HLA genes. Dr. Shoemaker said the prognosis is much better. But those of us who sort of broke away the ICI people that Neil Nathan people, we have found people with the so called dreaded gene that Dr. Shoemaker has spoken about get quite well. And we found people without that gene stay sick. So it’s not as cut and dried and as linear as one things. And then the next thing we need to measure are the direct and indirect markers of innate immune dysregulation. And sitting at the center of that is melanocytes stimulating hormone. This is a brain hormone that gets damaged by the innate immune system upregulation of cytokines that then cross the blood brain barrier and damage melanocytes stimulating hormone in the anterior pituitary. And that’s a neuro regulatory neuropeptide that is very much suppressed when the brain is on fire, which is in mold illness, and it starts to drop, and when it starts to drop, all sorts of things go haywire. I’ll enunciate those in a minute.

Another test is C four a, it’s an alternative pathway of complement activation, it’s an expression of huge inflammation. MMP nine is a is a molecule that gets expressed whenever there’s breakage in in blood band barriers, it it causes endothelial disruption and allows like the lime bags and the mold toxins and mycotoxins to penetrate your tissues, anti diuretic hormone and osmolality, which get affected by mold. These are people who pee a lot. They drop their blood pressure because they don’t concentrate the urine because they don’t retain salt. That’s where you get your pots. And they appear they pee a lot. And often those are the people who, when they touched door handles, I get shots quite frequently because of all the sodium that gets excreted because they don’t have that antidiuretic hormone. And then often when Msh drops, you get dysregulation of the ACTH and cortisol pathways with lack of loss of feedback, which is very closely related to the hippocampus in the brain. Cortisol originally goes up saturates the hippocampus, the hippocampus degrades, shrinks, and then you get hyper adrenal states. Now people come and say, Oh, but I’ve been diagnosed with low adrenals. Low adrenals are a consequence of chronic inflammation. They not a diagnosis. So if anybody says I got low adrenals No, there’s more going on. It’s a down regulation of the HPA Axis due to chronic ill health. It’s not a diagnosis, just like my cell activation is not a diagnosis. It’s a consequence of incoming toxicity not being regulated through the cell danger response and getting you out of being stuck. So these are the tests. Now this is the fabulous.

You must know this diagram to understand biotoxin illness and those of you who’ve dealt with mold or SIRs know this pathway backwards, and it sort of summarizes everything, if you will. Here’s the bio toxins in HLA systems trouble person 22 to 25% of the population affecting and inducing inflammation cytokines, those cytokines then have an inflammatory effect on the hypothalamus. And they down regulate leptin, leptin receptors called Dark. These are people who get heavier and heavier and heavier because they can’t regulate appetite. Not it doesn’t happen all the time, but it does happen occasionally. But most importantly, it reduces melanocytes stimulating hormone. This is the main neuropeptide, that when that goes haywire, the consequences are traumatic sleep gets affected, pain gets affected, and melanocytes stimulating hormone controls. Guess what? intestinal permeability, here’s your famous leaky gut or intestinal permeable gut, which is at the root of many chronic diseases is often because the melanocytes stimulating hormone has been suppressed due to a biotoxin load, that then creates a permeability issue. That also when your Msh is suppressed, it allows for the growth of resistant staph in the nose, which releases the toxin which goes up and affects the brain. And then here, it affects the antidiuretic hormone it affects is the sex hormones, you get decreased libido, and you go into premature menopause.

And here’s the cortisol and ACTH. And hear you get all these hormonal consequences to biotoxin illness, as opposed to the other 75 80% of people they have, they don’t, they don’t have the HLA gene, and they just get rid of toxins and they you know, husband of a spouse will go what are you complaining about I’m fine. And not understanding the genetic, multi heterogeneity of the gene process. They they, they just, they have an antigen presenting cell that sends it to the B cell. And a B cell mounts an anti inflammatory response. And that’s the end of it, they don’t get sick. But in 25% of the genetically predisposed, this is the scenario that’s installed for them. And all these cytokines are released. And you get all these immune system dysregulation, downregulated T reg cells and shifting of the th one th two axes, you also get hypoxia because of VEGF, another hormone. And oxygen isn’t delivered for the mitochondria to make use of to make ATP. And these are the people who can’t take a deep breath and often do well on oxygen supplementation. These you can really affect your hypoxia of your cellular tissue. Here’s the I mentioned this already. Another pitfall is not understanding other conditions, parts myself, hypermobility, etc, we’ve gone over that. And another pitfall is not using this questionnaire, I encourage you to fill out this questionnaire and get your patients all of them to fill it in.

If they come on this questionnaire, they’ve got 27 symptoms in 13 clusters. And they don’t pass the visual contrast test that Asians got says until proven otherwise. Very helpful. I had a patient this morning, who had this folded patient presented with a head injury. And this was form and no history of mold exposure. So no history of modern exposures. So this questionnaire of four, which is anything less than eight is considered a pass. I didn’t go down the mold pathway. I didn’t ask him. I asked him as a mold on the windows and things but there wasn’t so mold wasn’t an issue with him. But this question helped this questionnaire helped me. Now, you cannot, you cannot tell what the exposure is based on the surface questionnaire, all you can say is that if you have more than eight, you look here, the symptom clusters. If you have more than eight of these clusters symptoms in eight of these clusters, the probability of having SIRs goes up quite substantially and if you have the HLA set of genes, this confounds the diagnostic probability. And if you don’t pass the visual contrast test, or the visual contrast test this is a test that Dr. Shoemaker and Dr. Hudnall in 1997 they, they show that if you’re exposed to by a toxic illness, the neurological functioning of the optic nerve, from the retina to the cortex, you aren’t able to discriminate between shades of colors. And the more the by toxic load, the less the discrimination. And you want to pass a seven C and 60, you want this whole bottom part of the chart to be the tick mark. If you’ve got this all filled in the probability of having SIRs with a positive questionnaire, symptom cluster greater than age 98.5%, shown in multiple studies, first one in 2005.

So just by doing that, taking a history of knowledge pleasure. And doing this, you right there, you being launched into the probability of mold exposures being part of a differential diagnosis. And people. I do this a lot. And when people are being treated, I follow this. And you’ll see these bars clearing beautifully, and the patient feels better than they know. A few people 10% will pass the visual contrast but still show signs of inflammation. And some people have very good visual acuity. Professional baseball players apparently can have sirs and pass the test because they’re so used to having visual acuity. And some other occupational exposures can cause you to fail the visual acuity but generally speaking, it’s a very good test. And that can be done online at surviving mo.com $15 I believe. And then another pitfall is not doing some of the additional lab tests. Now encourage you to study with shoemakers group, or read up on this, I’m not going to go into all the different tests that we do in order to substantiate and gray the severity of the illness. But there’s certain ones that are very important. The Urmi test, which is a measure mold spores in the house essential marchands is a measure of the infected bacteria in your nose that that releases neurotoxin.

And then see for a TGF beta, I run these tests on most of my patients, if not all of them. And then the one at the bottom where it will do quite a lot is the neuro quant MRI, the neuro quant MRI pixelate the brain so that you can put the different areas of the brain the temporal lobes the frontal lobes, the gray matter, the white matter, you can put it into algorithms based on age match controls. And you can see if the brain swollen or atrophied and you get specific findings in mold illness of deterioration in some of the basal ganglia nuclear and inflammation of white matter. So I do neuro cleanse, and probably 80 to 90% of my chronically ill complex patients just to see the state of the brain as it’s been exposed to mold or head injuries. People with a lot of early trauma have a enlarged Amygdala on an MRI two to three standard deviations above normal because they’re always in a fear and fight flight response. You’ll see that all the time. 

And that correlates with a beta brainwave being upregulated on the QE G, people with muscle activation syndrome will have very high thickened thalamus is because the thalamus is richly innovated with micelles, and those with head injuries will have asymmetry of between the two sides of the of the brain with the ventricles being different. It’s important to look at these things. If you if you need to know if that brains on fire or not, which you do need to know. One big pitfall is not looking through the lens of standard medicine and through functional medicine. And these are the list of you’re probably quite familiar with this list. I run many or most of these tests all the time on everybody. There’s a stupid thing which you’ve been exposed to that you can’t manage what you can’t measure. And it’s true. We try and do it because everybody, you know, nobody can afford the test. And that’s a given. It’s just a given that you’ve got to try and establish a practice whereby you are comfortable with the amount of labs you’re running, to give you insight to help the level of patients that you see. If you seen somebody just for hormones or leaky gut, then that’s fine. But if you see complex, sick people, we’ve been sick for 1020 years and we’ve got binders this thick and Mayo Clinic console.

You cannot run your practice by doing a few tests just I don’t encourage you to do that. So you have to find the ways and means to spread your diagnostics quite far and wide. Now some people have, who do you know, trickling hearts muscle testing protocols find that they can cut their costs by doing muscle testing, which is, if you skilled at it, I believe it has significant validity and I studied it for 10 years with Dieter, I prefer to work left brain with labs. But the drawback is the cost. People have been sick enough will often shift their value systems to find the means to pay for what they need in order to get better. And you really do need a broad diagnostic brush to bring a lot of this complexity together. You cannot do a stool test and treat these people do you know VCs and the urine mycotoxin test and hope to to help somebody it’s just impossible in my experience anyway. And so here’s some of the labs and all the links that I found helpful but again, that’s subject for another election.

And here’s the biggest bugbear I have is using the urine mycotoxin test is proof of diagnosis answers. I know neon Nathan and the real time people believe that this is enough. But I I think I think that’s too simplistic. Why? Because many healthy controls have lots of mycotoxin in the urine. So just because you’ve got mycotoxins in your urine doesn’t mean you’ve got mold illness. foods contain mycotoxins. You don’t know if you had mycotoxins in your urine, whether they were three years ago, one year ago last night what you had oatmeal for breakfast. And you don’t know if you’re good or poor excreta. I much prefer the next test which is coming up soon as the AGL test which actually measures cellular toxicity, whereby mold mycotoxins get attached to DNA and mitochondrial membranes, and they affect the translation of genes. And you may be a terribly terrible excreta of mycotoxins have a negative test. But if you do the ideal cell test, you’ll see that these micro toxins are sitting right on the DNA affecting translation of proteins and fats.

That’s a much sicker patient, often with neurodegenerative type diseases than somebody who’s got some mycotoxins in the urine. So please don’t make the mistake of just doing this test and diagnosing mold illness. And now that this, these tests have become popular, I see it, it’s everywhere. And I get this test all the time. And I get told I’ve got mold illness based on this one test. It’s not you can’t diagnose mold on this on this test. I hope I’m not sounding you know, the negative on this test, but I think it has to be. I think it has to be the truth has to be told on this one. If you join the ICI group, they debate this test back and forth in the States. It’s a fabulous dialogue to be part of, because Richie shoemakers work originally when he put this all together, he was most indignant that people were using this test and he made us made as those of us who pass these exams, write essays or why this test was so useful.

But then people left his group because some of the things that he said couldn’t be correlated with other evidence. And then those who left his group started to use this test and just use this test for diagnosis. And so the field is in its infancy, just bear with it. I’m sure over time, things will shake out in the wash you know. Many foods contain mycotoxins so one of the things we do you know, people outs and corn and peanuts, I mean, it’s full of market toxins. So these are everyday foods that people eat. So people do get put onto a low mold diet and sup to some benefit. But it’s, it’s really, you know, if you got my cell activation, you got to be on low histamine diet. I find that people got mold illness going on low mold diet isn’t isn’t the therapeutic input that makes the big difference.

Now, here we are back to the cell danger response and membrane medicine. See when these toxins come in which mold is one of the causes oxidative damage, they they destroy the cell membrane, and the sum of these toxins attached to the DNA. And this causes poor translation of messenger RNA into the ribosomes. And then often the cell due to this ongoing toxic insult, undergoes autophagy due to the DNA and the ATP go outside the cell becoming pro inflammatory, inducing my cell activation with 1000 mediators of inflammation and further destroying the cell. And this is this perpetuation of the cell danger response. And so, here we have a lot of research showing how mycotoxins which are the byproducts of mold spores affect the mitochondria, causing the cell danger response has been published. Here’s some of the publications and these mycotoxins disrupt the the Krebs cycle and the electron transport chain and many, many different sites. This is all being published. So we know mold damages, ATP production and citric acid and mitochondria. There’s many papers published presenting that by the way, there’s a very good presentation on the GPL Great Plains laboratory website by Kurt Warner, on mycotoxins and mitochondria.

It’s worth watching I got the slide from him. Sorry to say I didn’t obtain permission. But I do know him and I will seek permission when time permits but I’m acknowledging that I got the slide from him. And he got the slide from a publication. So mitochondria are these micro toxins they affect the mitochondria in many different pathways in this Krebs cycle, they you know, we have our macronutrients that have to be eaten, shut fats, for instance, shuttled through by carnitine into the mitochondria across the cell membrane, and all these mighty micronutrients that activate these enzymes that then activate NID, NADH, that then go through the electron transport chain on the inner membrane of the mitochondria that make your ATP here, and these mycotoxins disrupt these pathways in multiple sites, they are crud toxin A affects ATP production inhibits ATP production. Many studies done on this now. So here’s this test, which is sort of revolutionized the way I practice medicine the last five years is a German based test and you can actually measure it can measure mold, fungal species and mold, fungal metabolites, by measures measuring lymphocyte sensitivity to these mold toxins. And you can see here that all at the level of the genome and the mitochondrial membrane, you can get mold. You can get your lymphocytes being high, react highly reactive to mold species and to the mycotoxins. And this is this test is what I rely on now. Apart from doing my traditional shoemakers sort of workup, I look here to see if this person is has mold still in their system. I only saw two patients this morning. Because of preparing for the lecture and get everything set up. One of the patients was from Switzerland, chronic fatigue syndrome, 10 years, supposed to mold in Lyme disease. And she was here in Calgary in December doing very well in Calgary home. Normal. We’ve done me tests looking for mold spores. She went back to Switzerland.

And I got this test, which she had done a week after leaving Switzerland and she had dramatic levels of mycotoxins that had gone from her previous one we did two years ago. The levels jump from 1500 to 500 600. And I just looked at this and I said so and so you’ve you’ve been exposed to mold, you are highly mold, toxic. And she said I knew it. This house I’m living in in Switzerland, there’s mold everywhere. I’ve tried to clean it up and it keeps reappearing. It’s in my shower. It’s on my window. I said, and she was told she was in bed 90% of the time. That’s and she moved back to Switzerland two years, two months ago. She’s her levels of mold are gone up five times. So this test showed me at the level of a mitochondrial DNA. She had mold lymphocyte sensitivity, and she clinically confirmed it. She said, I know I’ve tried to clean it. I said you try to clean it, don’t go near it. So get out of that house right away. I can’t say very well. And then we had a big discussion about what to do because many of these people are chronically ill for prolonged periods. The innate immune systems go round and round around in circles and they stand exposed and they often it’s the home that’s causing them to be sick, or it’s the quality They took from the home or is the couch they took from the home or something that they took from a home.

And they just go around in circles and never get better until the cycle is broken. This test also allows us to measure ATP production to see how blocked it is. And here’s the beauty of the test. It also measures mitochondrial numbers so you can see if mitochondria undergoing destruction and is less numbers than they should be. It also can tell us whether it’s the mitochondria, mitochondria are expressing abnormal proteins and lipids, very long chain fats. And it can tell us about some of the mineral deficiencies that are contributing towards the cell membrane voltage being affected. Here’s the ATP blocking active sites 21% You don’t want that block more than 14%. And here you can see that the DNA which gets released when the mitochondria undergoing destruction is at a level of 17. It shouldn’t be more than nine. So they their DNA is outside the cell triggering micelle and further oxidative damage. And here you can see after a toxin you can see one of the mycotoxins from Aspergillus is sitting on cardio lipid and actually the the enzyme that makes the inner membrane of of your, of your cell in your mitochondria. 

There’s a toxin sitting on on that enzyme affecting cardio lipid. And there’s your phospho title fo Alameen, which is found in the body by PC, low, the inner membrane along which the electron transport chain occurs. And there’s your plasma title choline, which is the external membrane. And this Melange, the height you can see that the fats, the lipids in the body are oxidized, deficient, and the cellular machinery that making the lipids is impaired. That enzyme also requires manganese to work that the manganese deficient. That’s why you use the body by minerals and electrolytes. So mineral sessions. And here on the DNA you’ve got sitting on the DNA, formaldehyde, and there’s aflatoxin, there is a micro toxin from mold affecting translation of messenger RNA sitting on the DNA. This is huge, you know, this is serious business. This is not lightweight testing.

This is serious. And when people it’s going to affect the metabolic machinery of the cell, and it’s going to put people into chronic ill health that gets a stain unless it’s dealt with. This person also had zinc deficiency was incorporations. Zinc is the largest role to play. Regulating DNA destruction, and immune function. And then you can also see here, I can’t see the slides so small that’s the same same one sorry. Keep repeating this. Here, you can also look at your antioxidant states glutathione. You can see that it’s low in the bloodstream, here superoxide dismutase, the good guy that is sis glutathione and putting up peroxy nitrate. Here you can see conatins low so shuttling your fat into the cell to active cellular energy is low. Here’s the mast cell membrane, the cell membrane of 159, the voltage of your cell is low. This is dramatic because the electron transport chain depends on the cell voltage being normal, and that’s low. This gets affected by mineral deficiency, intracellular calcium, intracellular calcium triggering the NMDA receptors and causing the excited toxicity and magnesium there, which is found in your minerals. Magnesium is a calcium channel blocker.

This person was highly exposed to electromagnetic fields, which induce high levels of intracellular calcium and mast cell activation, the cell membrane was depleted that phospholipids were depleted this this cell is in a lot of trouble. He has a heavy metal test, you can see the telephoning, which binds to heavy metals is high because it’s working overtime, binding to barium. And when the telethon is running around mopping of metals, it drops off zinc and you become zinc depleted. And here NID vitamin d3 which is central for the electron transport chain is depleted. That’s why everybody is now on to nitrogen and other NADH or energy supplements. And then another beauty of this testing is we can look at the cell membranes and we can see the deficiencies and excesses, we can tell what the saturated fats are doing this is not now the AGL test. This is the the test we do the Kennedy Krieger looking at lipid membranes, we call it the body by a red soul lipid membrane test. We can look at saturated fats and Omega sixes, look at total lipid content.

Now look at this total lipid content. The total lipid content of this person is completely negative. And I can’t tell you how many people come in. And they get put on colas, tyramine and crash. Because Patricia Kane, who initiated this therapy many years ago, made the statement I don’t know where she got it from. But she said that if your lipid content is less than minus 25, and you use curl to stymie, you’re going to crash that person’s lipid membranes and create tremendous damage to the mitochondria. And I believe that statement is true, because I’ve seen it. I’ve seen I’m treating a patient right now with an ALS condition and that that’s his total lipid profile. And he did have mold and he was put on polystyrene, and he’s much worse right now. So we had to repeat this lipid content. It is omega sixes up to scratch, saturated fats structural bets, we can also test by the myelinating, making making white matter. And we can also see how many abnormal oxidized bad renegade fats are being made. Here’s where your butyrate and your tadka come into play, because those help get rid of these very long chain fats. And as you get healthier and healthier, these go down and down. So this, this IGR test in the body via red cell membrane tests are extremely helpful. And this is where the whole membrane medicine comes into place. And we start to repeat cell membranes, sweep toxins off the DNA and repair as much as we can.

With various therapies, of which body via products take a central role, I can’t say enough about how I’ve benefited and how the patients have benefited by repeating outer inner membranes using peterites and tadka. Replacing minerals, just you know, I’ve developed a shake, which I’m sure tastes awful, but very competent is very beneficial. And to sell membranes, Justin has the job of making it taste pleasant by using the only thing that we use is coconut milk and, and blueberries because everything else most of our patients have my cell activation behind us much else that we put into the shake, you know, PC and body bio balance and electrolytes and minerals and glutathione and superoxide, dismutase and resveratrol. So we make a shake of it. And we use blueberries and chopped vegetables for poly phenols. And most people find this very nourishing if if they can get past the medicinal quality of it. So here’s another pitfall we’re nearing the end, so we’ll be done pretty soon. pitfall is using color styling, inappropriately, not only the synthetic color styling, which is full of aspartame. But if your lipid membranes are very low, using polystyrene will rarely crash a patient very quickly, so it’s not appropriate to use color stymie right out of the gate.

Just very quickly. Other pitfalls using the wrong test as sampling is absolute. No, no. The settle plates are worthless. tapeless, okay. But the real test is the Urmi test, which I’ll show you in a second. Another big mistake people make is I have a new home it doesn’t have mold. I live in Arizona, it’s not wet and damn. new constructions are often the worst. I had a new condo, which was put up in the boom they didn’t put events in a flat roof and I had mold in three floors, condensing down the sides. No visible mold does not mean the building is safe. No musty smell does not mean it does not have mold, or crawl spaces and basements usually have mold. ductwork is often contaminated. And this is the Urmi test where you measure dust spores by either swip upright or vacuum cleaner and you quantify that according to specific algorithms. People call in mold inspectors and they don’t do a thorough visual inspection. You’ve got to go from the attic to the basement and outside and have a look. And he has some of the questions you want to ask. If somebody comes in waves a sample meter and walks out and says you don’t have mold, run for the hills.

Look at baseboards, pull out dishwashers go up into the attic. Do you have a front end loader washing machine? Is there condensation? Did they use a water moisture meter, you know the day to do thermal imaging looking for wetness behind dry walls. Here’s some fabulous references for people who do good work, shall see acres with a whole bunch of web videos on YouTube about how she’s an architect you have mold on us. She’s very thorough, and patients report doing her series is very helpful. So, in summary, mold illness is ubiquitous. It’s everywhere. It involves genomics. transcriptomics. Proteomics involves abnormal regulation of micelles hormones, mitochondria, autonomic nervous system. These conditions are everywhere. Look around, you’ll find them. They’re ubiquitous. There’s just a summary of some of the pitfalls. Here’s some papers and links to articles I’ve written on mold. Things you can find. And that’s my details. And that’s it for me. Am I doing 68 minutes? I’m sorry.

Thank you so much. Dr. Ruffin, can you just click on can you make me the host again, so that I can go over some of these questions. I’m trying to turn on my video, but it doesn’t look like I’m able to unless you give me permission. What do I do you go to the top of your video, there’s three little circles. If you just click on that those three little circles it should show up to make me the host. If not, it’s okay. I’m I can say off camera as well.

Doesn’t say it says pause recording stop recording raise hand.

Okay, okay. We’ll just leave it as is I’ll go over there’s quite a few questions. So do you have a few more minutes to answer your question? Okay. So the first question is from Christy. And she just was asking what the German test costs? You can answer that one or I can choose?

No, it depends on how many panels you choose. So they range in price. If you just go to the Igel website, and you ask them for to send the cost the the extensive panel that I do, it’s 1000 or two euros. But you could do subsets of it to get what you want to look at. And then you go

in there they are. That lab is expensive. I mean, I think I just ran it in last year. And I think it was close to $2,000. Canadian for whatever panel I did. So it’s not an inexpensive lab, that’s for sure.

But remember that is many in when that’s not one panel that’s like 10 panels. So you can if you want to just know your first blood lipids, you can just do that little panel. But if you want to do a complex mitochondrial workup, then it’s going to cost a lot more.

So the question is what is the next question is what is the difference between ErmI and Emma testing?

The Emma testing measures mycotoxins and spores, whereas the Ermias just pause. I don’t do any testing because I just historically have stayed with micro metrics. I do use other lab for actinomyces. I haven’t run many Emma tests. I don’t think the tests been validated. And so I just stick with what’s been validated by the think by the FDA. Let me test

Okay, thank you. And then Shelley. Shelley Wilson, who we love. Thanks Dr. Hoffman to Justine excellent presentation. We adore you, Shelly. Um, okay. And then Chris, you had another question is Well, what is the extensive

sorry, surely didn’t ask me a bone crushing question.

So, if you have a question I’m Christy I will find out if you can. So she just asked what is the extensive one called the IG L so if you email me I will find out from the girls at the front desk and and I’ll let you know I don’t think I don’t know that. I’m right now and I don’t think Dr. would know that offense either. Okay, um, now in the chat there was lots of questions I’m going to have to go back. Um, do you have an MRI and the neuro quant software at the clinic?

No, you’ve got to get me the neuro quant is quite complicated because you’ve got to, you’ve got to get the MRI company to do specific settings on the MRI to read the neuro quant the neuro con software, but that requires certain settings on the MRI. So you’ve got to buy the software from neuro quant, you’ve got to get your MRI company to be willing to use the settings on the different Siemens devices. And once they change the settings you can read neuro quant but it’s two parts to it. So it took us two years to get neuro quant in Calgary. I tried to get it through healthcare, but they wouldn’t do it. So a private company doesn’t. Because they wouldn’t do it because it requires changing settings and they don’t want to do that.

Okay, Allison just asked where she can find the recipe to the shakes, or recipe for the shake. So Allison, you can send me an email as well. I’m happy to send you Dr. Hoffman’s template, if you can just make sure that you give him credit

for our upcoming book. No, we’ll give it

Yeah, that’s true. We’re doing a cookbook that should be out in a few months. And the recipe will be there’ll be plenty of recipes in there. When working on cell membrane, what daily oral PC dose Do you work patients up to?

It’s a It’s depends on so many things. If you’ve got a very high micelle population, they can’t tolerate much of anything. If you’ve got a robust population, they are often much more able to tolerate higher doses, but they often need assistance with lipase and bile Oxbo. That’s a tadka. And we use a product called Beta plus. And it had Kali cystectomy is that’s another whole puppy sub population of people who can’t tolerate high fats. But it say all those confounding variables are taken out, we always start them slow, like half a teaspoon. And then we work up to you know, I don’t really go more than two tablespoons a day of both of them. The body by a balance we use a lot on food, not in the shake, because it’s pleasant, you know after you’ve cooked it and cook it up. But put it on stir fries and salads. And the PC goes into the shake because some people just eat it off the spoon, but it goes on the shake quite nicely. But I don’t usually use more than two tablespoons. But keep in mind, I tracked labs, I tracked the red cell membrane tests and attract the AGL test. And also there’s another variable there. I’ll think of it in a second. I forget what it was, but there’s another variable to it.

Okay, in addition to body bio products, would you recommend adding an all encompassing Mito booster supplement like mitochondria and RG from designs for health? You can

well, so a lot of the supplements that boost mitochondrial function oh, here’s what I wanted to say before I get back to the question. Our OPC helps strip the cell membrane, or helps repair the cell membrane because it’s got the three phospholipids versatile ever elevate hospitality knows at all. Whereas IVP PC which I use a lot of help strip the DNA of the acts of the toxins. And that’s a general rule. So I do IV password title choline with phosphine or butyrate and glutathione. And I do aro PC and body by a balance for different purposes. There is some crossover, but there is a different therapeutic reason for each of them. Just I just wanted to emphasize that point. And then sorry, what was the question

is so there’s so many questions there. Oh, the other one was on mitochondrial support?

Yes. So much. So using the micronutrients that support the mitochondria, I find is false thinking. You can do it. But you want to sit back and look at that cell and see what state it’s in. Look at the state of the individual look at the state of the food gut brain axis. And you can’t just start stimulating enzyme pathways without first repairing cell membranes and look Looking at the toxicology of cell membranes and the viability of the electron, the voltage of the cell membrane, whether there’s deficient numbers on line. So I don’t go use a lot of mitochondrial traditional support, until I’ve helped repair the cell membrane. improvement in the AGL. And lipid testing, I tend to, I do use carnitine and 210. And nada, I do use them. But if you go use those without preparing the cellular toxicology and the soul structure, it’s a it’s a, it’s a losing battle. You won’t get anywhere.

Yeah, and that’s something that I’ve seen too, which was what really what drew me to membrane medicine because without, I mean, you’re really just throwing things that people do first don’t repair the self.

Find remove as many incoming stresses, and then balance the cell by much and modulating the homeostatic mechanisms, the allostatic load, you know, you’ve got to sort of work this whole system.

But there are specific nutrients like B one, b two and B three will support that front end of the mitochondria and carnitine. And then the electron transport chain is supported by Coenzyme Q 10. NAC. Creatine is helpful.

Nitrogen.

Okay, let’s see here. I think I’ve covered all of them. Is anybody? Did I miss a question? Oh, if someone has recovered from mold toxicity, is it helpful to use the LPC long term? I will say? I will say yes. But now let you answer.

You know, I’ve measured igvault, postmitotic, choline and fllo mean, I’ve never seen levels outside of the range. So people stay on it. We’ve constantly under salt. So as a lipid bilayer is are very much susceptible to oxidative damage. So I think a daily intake of phospholipids is crucial to maintain cellular health.

And then I think it was a question about cosmologists in here too. We do use cosmologists have you? So yeah, we have definitely heard of plasma halogens? Um, regard? Have you heard of plasma ologists with regard to membrane lipids? If so, can you comment on any overlap between plasma telogen deficiency and sirs?

So I’m assuming of Doctor good enough. I’m learning his plasminogen I take them. But as you know, a doctor good enough. He’s a biochemist with a lot of knowledge and where players margins fit in. That’s another whole level of complexity. I’m just starting to get my head around. Justine actually knows a lot more about origins than I do, because she has studied with him recently. But it is definitely appears very exciting. And I think plasma legends will be playing a huge role. In the future, just like peptides came up and exosomes. These things have the, you know, the waves of fashion, but I think plasma origins are going to be a big deal.

Well, and I’ll just quickly comment to that too. So with plasma halogens are a subtype of phospho lipids, so about 20 to 30% of the brain is made up of plasma halogens, so it’s third so they’re made by the ProxySG. They’re endogenous, and you can’t consume anything that’s going to help to support plasma telogen levels. And with SIRs with that chronic inflammatory condition you burn through a lot of those plasma halogens because they’re a very potent antioxidant. So you’re, you’re gonna want to support with plasma halogens likely if you have sirs, the other issue too is with that chronic inflammation you are going to have compromised paroxysmal functioning. So your proxy isms are not going to be making adequate amounts of plasma halogens and then what they are making is getting used up as antioxidants.

Good enough as a test now to measure all of those which we’ve just started to use.

Okay, um What would you recommend to move a patient into dorsal Oh, when we have it an H bot? I don’t know if you talks about H button the lecture by H bot recommended after stabled with mast cell. Do you recommend hyperbaric oxygen?

I think hyperbaric oxygen has a very definite role to play. But I never use it in the front of any protocol. I often use it as a cleanup down the line. Particular In traumatic brain injured patients, so I never use it in the front end, I usually wait one or one one and a half years before I start recommending age parts.

And I think we have all the questions. Let me just go through one more time. If anybody has something like pressing that I did not ask, you can raise your hand. Oh, sorry. Okay, the dorsal are your questions about please see the q&a. Okay. Oh, my gosh, there’s lots.

You don’t want person in the dorsal vagal shutdown response. That’s when they are compromised. The withdrawn they depress the stack. So everything we spoke about today is attempting to shift the dorsal vagal structure into more window of tolerance, self regulation between sympathetic, parasympathetic. And there’s a complexity to it. I did, there was a slide that says what to do. If you go back to that slide, I listed about 20 different therapies vagal tone exercises Somatic Experiencing safe and sound protocols. resi Max, there’s a whole list of them. But if a patient has undergone trauma, and they’re in PTSD type response that requires sophisticated therapeutic encounters, referred to professionals who work with trauma, because that’s very hard to shift if there’s an underlying traumatic etiology to the dorsal vagal shutdown.

Okay, and then we have a few questions about Oh, where did it go? Snowy? You had two questions. One was, okay, how to get patients to tolerate oral PC when they have resistant? dysbiosis?

Chris? You, resistant dysbiosis? I, I just keep working with the dysbiosis until something ships? This that’s a very big discussion. But yes, you’re right. People can’t handle anything coming into the GI tract when it’s severely dysregulated. So you have to go through the whole gut fiber or whatever methodologies you use treats CBOs and levers and CFOs. And there’s a complexity to it. So those people who are in sympathetic dominance with poor vagal tone will have massive dysbiosis. I work around the issue and try and find out what’s what is the problem? Do they have lower last days with low lipase? Are they not making bile? I get gallbladder motility studies. So there’s a lot of complexity to it. It’s difficult to answer that.

And then this question, I laughed when I read this, I shouldn’t I shouldn’t have laughed, but I did. Because I’m excited to hear your answer. The initial part of your discussion, what is the best way to build the patience and love for patients with limbic disorders, especially when you’re seeing many of them and they drain you and your staff tremendously?

This is the million dollar question. How do you stay regulated when your whole world around you is dysregulated? Well, here’s my answer to that. I’m in my I’m in my 60s, I mean 65. So the longer you live, the more resilient you become. So that’s that’s to my advantage. You also learn to know your defenses and as soon as your palms start sweating, you know you’re in trouble and your defenses are up and you’re in a complex. You delegate you delegate low priority items to other people and hopefully you find good people to help you manage the complexity of managing complex patients. And then I find having policies and procedures and systems that hopefully get followed with lots of sort of patient education helps somewhat dampen the chaos get again shoo, which you can never fight, you know, get rid of because any patient any clinic with treating complex patients has a one or two borderlines there At least five or six severely traumatized people with PTSD, myself everywhere you look. And so you will get complexity. And if you love what you do if you just get up every morning enjoying and loving what you do that itself is a buffer against some of the, the stresses that hit you on a daily basis. So there were other things you can do as you can read about in the self help books, but that’s been my experience. It’s just my age has helped me become more resilient, great stuff. Most of the times when you lose a good staff member, chaos ensues and then just loving what you do. If you love in what you do is a high priority. You You can withstand some of the slings and arrows that come your way.

Okay, who do you have run the neuro quant for you? I’m looking to access the test software here in Calgary in Canada.

The only neuro quant in Canada is in Calgary, you have to fly here or you have to go to the neuro quant company and ask them to find the nearest neuro quant in your vicinity. Have you in the US? There is one in Seattle as well I believe so my patients go to Seattle or come to Calgary? I don’t know if there’s anyone close. They may have they may have one in Toronto or Vancouver by now but I much I don’t know that.

Okay, I think we have finished all the questions. Um, let me just double check one more time. There was a comment about oral PVC is worse because it can cause translocation of LPs into the blood and then raise inflammation significantly. I was curious to hear your comment on that because I have never seen that.

I think theoretically that’s true. And I’ve been I haven’t seen I haven’t seen LPs. Well the only test I have for LPS is the Dunwoody one. And I haven’t seen any of the LPS IgG IgM. IGA is getting worse in ever since I’ve run the test, which is the last 10 years. So I can’t vouch for that it probably from an academic perspective, we know how high fat low carb diets increase oxidative damage for LPS, but I haven’t seen it clinically.

Okay, thank you. Thank you all for joining us, right or I’m staying with us right to the end. And thank you again so much for the really really informative, lovely presentation. We’re really grateful that you were able to do this for us today.

Thank you very much. Bye now.

A Holistic Approach to Complex and Chronic Illness

Holistic Approach to Chronic Illness

In this podcast with Dr. Trevor Campbell, we discuss how an added comprehensive, holistic approach using social, psycho-spiritual, family dynamics and generational issues can be used to treat complex and chronic disease. Early childhood trauma of any kind as well as neglect can enormously impact the pathogenesis of disease as well as the course of recovery. This approach is foundational to my 7 Stages to Health and Transformation Model (TM), a fundamental approach to  integrative medicine. Please scroll down to listen to the podcast.

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Could SARS-CoV-2 Spike Protein Be Responsible for Long-COVID Syndrome?

long covid

Abstract

SARS-CoV-2 infects cells via its spike protein binding to its surface receptor on target cells and results in acute symptoms involving especially the lungs known as COVID-19. However, increasing evidence indicates that many patients develop a chronic condition char-acterized by fatigue and neuropsychiatric symptoms, termed long-COVID. Most of the vaccines produced so far for COVID-19 direct mammalian cells via either mRNA or an adenovirus vector to express the spike protein, or administer recombinant spike protein, which is recognized by the immune system leading to the production of neutralizing antibodies. Recent publications provide new findings that may help decipher the pathogenesis of long-COVID. One paper reported perivascular inflammation in brains of deceased patients with COVID-19, while others showed that the spike protein could damage the endothelium in an animal model, that it could disrupt an in vitro model of the blood-brain barrier (BBB), and that it can cross the BBB resulting in perivascular inflammation. Moreover, the spike protein appears to share antigenic epitopes with human molecular chaperons resulting in autoimmunity and can activate toll-like receptors (TLRs), leading to release of inflammatory cytokines. Moreover, some antibodies produced against the spike protein may not be neutralizing, but may change its conformation rendering it more likely to bind to its receptor. As a result, one wonders whether the spike protein entering the brain or being expressed by brain cells could activate microglia, alone or together with inflammatory cytokines, since protective antibodies could not cross the BBB, leading to neuro-inflammation and contributing to long-COVID. Hence, there is urgent need to better understand the neurotoxic effects of the spike protein and to consider possible interventions to mitigate spike protein-related detrimental effects to the brain, possibly via use of small natural molecules, especially the flavonoids luteolin and quercetin.

Introduction

The SARS-CoV-2 infects cells by first binding to its surface receptor, angiotensin converting enzyme 2 (ACE2), via its corona spike protein [1]. The S protein is trimeric and cata-lyzed fusion between the viral and host cell membrane; his “prefusion” trimer has three receptor-binding domains (RBD), while the post fusion structure expresses N-linked glycans that may serve to protect against immune responses [2]. Infection then leads to a complex immune response that involves the release of a “storm” [3, 4] of pro-inflam-matory cytokines [3–11], especially IL-6 [12–15] and IL-1β [16, 17] leading to the development of COVID-19 [3, 18]. Most infected patients develop antibodies against the spike protein, but immune protection against SARS-CoV-2 may involve more than neutralizing antibodies [19]. A prospective study of more than 3,000 healthy mem-bers of the US Marines Corps concluded that those sero-positive could still be infected but had only 20% the risk of subsequent re-infection as compared to those who were seronegative [20]. It is not known if individuals who get re-infected do not mount sufficient neutralizing antibodies or lack some other aspect of antiviral immunity. New data from immunized individuals indicate that the rate of re-infection varies depending on the type of vaccine used [21]. There is emerging evidence of reduced neutralization of some SARS-CoV-2 variants [22].

Hypothesis/Theory

Some of the damaging effects of SARS-CoV-2, especially in the brain, may be due to direct action of the Spike protein, acting alone or in conjunction with other mediators such as inflammatory cytokines, on target cells.

Long‑COVID Syndrome

It is now recognized that many patients infected with SARS-CoV-2 develop a post-acute syndrome a few months after the initial infection known as “post-acute COVID” [23] or “long-COVID” [23–26]. Long-COVID occurs in 30–50% of COVID patients [23, 27–30] and is charac-terized by multisystem symptoms, primarily persistent fatigue and cognitive impairment [31] that varied consid-erably among patients [32] and were more common with increasing age and female sex [29]. These persistent symp-toms should not be confused or misinterpreted as persis-tent infection that has been reported in immunocompro-mised hosts [33]. Nevertheless, patients with long-COVID have not recovered even by 7 months post infection and continue to suffer mostly from systemic and neurological symptoms [34].

Long-COVID is particularly associated with neurologi-cal [35–43], neurodegenerative [38, 44, 45], psychiatric [46–52], and cognitive [47–57] problems, especially brain fog [23, 25, 26, 46, 58–62]. In fact, over 90% of patients who were initially hospitalized for COVID-19 and had neuro-logical symptoms had significantly worse outcome 6 months later [63]. Even though some of the mental fatigue experi-enced by long-haulers may be due to the perceived stress [64], the extent of this disability is unlike any other medical condition known.

In spite of early impressions that long-COVID may develop only in those patients who were hospitalized and intubated, increasing evidence indicates that long-COVID can develop regardless of the severity of the original symptoms [61, 65] and has been considered the “next health disaster” in the USA [66]. So far the duration of long-COVID symptoms is not known, but recent data indicate that it may depend on antigen per-sistence [67] and a sustained specific immune responses to SARS-CoV-2 [68].
The neurologic effects of COVID-19 may be due to SARS-CoV-2 entering the brain, but the pathways of such

neurotropism are still unclear [69, 70]. One possibility is that the virus crosses or damages the blood-brain bar-rier (BBB) [71], accompanied by basement membrane disruption, in K18-hACE2 transgenic mice infected with SARS-CoV-2 [72]. Similar findings were reported independently, and it was also shown that the virus was detected in human cortical neurons [73]. In another study, a fragment specific to SARS-CoV-2 was amplified from cultures of a brain specimen from a deceased patient with COVID-19, and associated pathology showed neuronal necrosis and glial cell hyperplasia [74]. Alternatively, the virus could enter from the nose by crossing the neural-mucosal interface of the olfactory nerve [75] and enter the brain via the olfactory nerve tract [76]. Viral entry into the brain via gustatory-olfactory trigeminal path-way eventually compromising the BBB was recently reported in deer mice infected with SARS-CoV-2 [77]. It is interesting that single-cell RNA sequencing showed that ACE2 was not expressed by olfactory sensory or bulb neurons but instead was expressed by olfactory epi-thelium and pericytes [78].

The effect of SARS-CoV-2 to the brain is also not well understood. One paper showed the presence of megakaryocytes in cortical capillaries that could lead to brain ischemia [79] and subsequent cerebrovascu-lar events [80–82]. In the autopsy report of an infant who died with COVID-19, there was evidence of corti-cal atrophy and severe neuronal loss, and findings were restricted to capillaries of the choroid plexus [83]. A recent paper did not document any molecular traces of SARS-CoV-2 in the brains of deceased patients with COVID-19, but detected choroid plexus perturbations associated with pathologic morphological changes in the microglia [84]. In addition to the evidence discussed above of neuronal damage due to SARS-CoV-2, a paper reported that the virus can enter a 3D human brain orga-noid and preferentially targets neurons resulting in their death [85]. Such pathology may be explained by the expression of the ACE2 receptor by human glial cells and neurons [86], exacerbated through the activation of the complement and kinin systems [87].

Increasing evidence indicates the involvement of neuro-inflammation [71, 88, 89] that may damage brain blood vessels [90, 91], as well as brain cells [88, 92, 93], pos-sibly via activation of microglia [94, 95] and mast cells [96]. In fact, long-COVID could be considered a state of “brain autoimmunity” [22].

In summary, the effect of SARS-CoV-2 to the brain could be direct via invasion or indirect effect via damaging endothelial cells and pericytes or via activation of neuroimmune responses as has been invoked for neurologic complications following HIV [97].

Direct Effects of Spike Protein

An alternative explanation of the CNS effect of SARS-CoV-2 may be due to direct effects of the spike protein. The spike protein is made up of the S1 subunit containing a receptor-binding domain (RBD) that attaches to ACE2 and the S2 subunit containing a transmembrane anchor that mediates fusion of viral and host cell membranes [1]. Most infected patients develop antibodies that neutral-ize the spike protein to various extents. A recent paper reported that blood of patients infected with SARS-CoV-2 contained, in addition to antibodies against the RBD that were protective, also antibodies against the N-terminal domain (NTD) of the spike protein that induced the open conformation of the RBD enhancing its binding ability and infectivity in vitro using cultured cells [98]. A more recent study of molecular modeling using an antibody from a symptomatic COVID-19 patient concluded that there was higher NTD binding with the delta variant resulting in antibody-dependent enhancement (ADE) [99]. Such inter-actions, where antibodies can neutralize one serotype but are less potent at neutralizing another, are known to increase the chances of ADE to the new serotype [100]. Even though ADE remains controversial, a recent paper reported that virus-mimicking anti-idiotype antibodies present after infection or after vaccination may potentially explain long-COVD symptoms [101]. These findings may potentially explain why those vaccinated against the origi-nal Wuhan SARS-CoV-2 strain and then exposed to the Delta variant may still get infected. Al alternative or addi-tional explanation may be the fact that immunity to vac-cines has been reported to decrease over time [102, 103]

It is not yet known if the spike protein is released extracellularly after the SARS-CoV-2 infects its target cells. Given the absence of infection of the brain dis-cussed above, the neuropathologic findings may be due to the SARS-C0V-2 spike protein. Indirect evidence of its presence within the CNS may be the detection of anti-SARS-CoV-2 antibodies in the CSF of two children who died with COVID-10 and had subacute neuropsychiatric symptoms [104], even though such antibodies may had crossed a disrupted BBB. Free spike protein could have a number of direct pathologic actions on different cell types (Fig. 1A). These include direct stimulation of peripheral nerves [105] and stimulation of release of pro-inflam-matory and vasoactive mediators [106, 107], especially platelet-activating factor (PAF) [108, 109].

A number of papers have reported direct pathologic effect of the spike protein by itself (without being part of the coronavirus). One paper reported that the spike pro-tein could damage the endothelium in an animal model [110], while another paper showed that recombinant S1 RBD can damage mouse brain endothelial cells in vitro by inducing degradation of endothelial junction proteins, thus affecting endothelial barrier function [111]. A recent paper reported rapid internalization of S1 RBD and of the spike RBD active trimer by cultured human brain microvascular endothelial cells, followed by increased permeability of transferrin and dextran, as well as mitochondrial damage [112]. Another recent paper using a 3D-BBB microflu-idic model showed that S1 upregulated ACE2 expression and triggered RhoA activation, a key molecule regulating endothelial cytoskeleton [113]. Yet, another paper reported that spike-transfected human epithelial cells showed increased senescence-associated secretory and inflamma-tory proteins [114].

Two other papers reported that the spike protein could disrupt the barrier function in an in  vitro model of the blood-brain barrier (BBB) [115] and that the S1 protein can actually cross the BBB and enter the brain in mice 116. Using transgenic mice expressing the human sigma protein, it was shown that intranasal infection with SARS-CoV-2 rapidly induced ischemic-like reactivity in brain pericytes and the S protein reached the brain of the mice [117].

In addition to direct damage, the spike protein appears to share antigenic epitopes with human molecular chaperons resulting in autoimmunity against endothelial cells [118]. Moreover, a recent paper showed that spike epitopes could form heterodimeric complexes with selected human glial proteins [119]. Interestingly, it was shown that three recom-binant sigma protein peptides exhibited molecular interac-tions with acetylcholinesterase and antioxidant enzymes both in silico and in tad poles in vivo [120].

Interestingly, symptoms experienced by long-COVID patients, especially cognitive dysfunction [121–123], are similar [106] to those present in patients with mast cell activation syndrome (MCAS) [124, 125], in whom mast cells can be stimulated by environmental and stress trig-gers [126], including viruses [127] such as SARS-CoV-2 [107, 128]. Mast cells are located perivascularly in close proximity to neurons, especially in the hypothalamus [129, 130], where functional mast cell-neuron interactions have been documented [130, 131]. Mast cells also interact with microglia [132] leading to their activation [133] and neuro-inflammation [134].

SARS-CoV-2 binding may not be limited to the ACE2 receptor. New evidence indicates that the spike protein also binds to heparan sulfate (HS) molecules expressed on the surface of target cells, with mutant variants having higher binding affinity to HS [135]. This binding may be due to the fact that the SARS-CoV-2 spike protein contains four more positively charged and five fewer negatively charged residues than SARS-CoV, thus increasing the binding affin-ity of SARS-CoV-2 for HS [136]. Apparently, binding to HS allows the virus to reach the ACE2 receptor, and the RBD portion of the spike protein can engage both HS and ACE2 without dissociation of one or the other ligand [137]. The S1 subunit can also bind to the surface glycoprotein neuropilin-1 (NRP-1), thus increasing infectivity, but also dysregulating angiogenesis, immune responses, and neu-ronal development [138, 139]. Different coronavirus variants have evolved more efficient electrostatic interactions to allow them to bind to the ACE2 receptor [140]. SARS-CoV-2 also appears to become “pre-activated” by the proprotein con-vertase furin, thus bypassing the target cell proteases for entry [141].

Long Covid diagram

Fig. 1. A Diagrammatic representation of how SARS-CoV-2 spike protein can stimulate different cell types and collectively contribute to the pathogenesis of long-COVID. B Diagrammatic representation of how SARS-CoV-2 can cross the blood-brain barrier (BBB) through endothelial cell gaps or how free spike protein can dam-age the integrity of the BBB and enter the brain.

SARS-CoV-2 can do additional damage by activating toll-like receptors (TLRs), especially TLR2, leading to secretion of pro-inflammatory cytokines independent of viral entry [142, 143]. Such immune-mediating molecules could contribute to neurologic symptoms [144] as a result of or in addition to the action of the spike protein. Moreover, activating TLR4 increases expression of ACE2 [145] further enhancing viral infectivity in an autocrine loop. Activation of TLRs may not only involve activation of inflammasomes [146], but also activation of the mammalian target of rapamycin (mTOR) complex [147, 148], which is invoked in the pathogenesis of many neuropsychiatric diseases 149. Increased levels of a number of pro-inflammatory cytokines have been detected in the CSF of COVID-19 patients [150], especially IL-6 [150, 151]. In fact, use of an anti-IL-6 antibody or IL-6 receptor antibody reduced neuronal injury in a mouse model, accompanied by inflammation and neuronal death unrelated to hypoxia [152]. Integration of serum levels of IL-6 and heparin-binding protein were shown to have significant predictive value for severity of COVID-19 [153].

Spike protein diagram

Fig. 2. Diagrammatic representation of how SARS-CoV-2 spike protein can stimulate endothelial cells, mast cells, microglial cells, and neurons first by binding to the ACE2 receptor costimulated by binding to heparin sulfate, and then acted upon by a serine protease before entering the nucleus. SARS-CoV-2 can also stimulate Toll-like receptors (TLRs) and lead to the synthesis and release of pro-inflammatory cytokines via activation of the inflammasomes and or mTOR. The diagram also shows the targets of the inhibitory actions of luteolin, methoxyluteolin, and quercetin (green line), which may be used to prevent or treat the development of long-COVID.

A recent paper reported cloning and expressing 26 of the 29 proteins encoded by the SARS-CoV-2 genome and showed most proteins, especially non-structural protein (NSP) 2, 5, and 7, induced significant changes in endothe-lial permeability [154]. These findings imply that SARS-CoV2-associated proteins other than the spike protein may contribute to pathologic effects on their own, sequentially or synergistically with the structural sigma protein.

Lastly, a recent paper analyzed human fetal expression of six different S protein “interactors” and showed weak expression of ACE2 and TMPRSS2, but high expression of furin with peak expression 12–26 weeks post concep-tion; moreover, using publically available single-cell RNA sequencing datasets, it was shown that these interactors showed higher co-expression with neurons [155]. This find-ing indicates that the spike protein can adversely affect the developing brain and potentially lead to neurologic com-plications in neonates of infected mothers [156], including autism spectrum disorder [157].

Discussion

A major unaddressed issue, especially with respect to the pathogenesis of long-COVID, is whether the spike protein that enters the brain or is expressed in neurons and glial cells can activate microglia directly or via stimulation of mast cells leading to neuro-inflammation [158]. This pathogenetic process would go on unhindered in the absence of any neutralizing antibodies since they do not cross the BBB, thus contributing to the pathogenesis of long-COVID. Moreover, such spike protein-induced neurocognitive damage could be worse in vulnerable populations like those with minimal cognitive impairment [159] or others suffering from traumatic brain injury [160].

There are presently no biologics that can block SARS-CoV-2 binding to its receptor(s). Certain biologics aimed at blocking IL-6 [161] or IL-1 [162] have been reported to improve clinical status of patients with COVID-19 However, a meta-analysis of clinical trials using IL-6 antagonists as an add-on to usual care did not reduce the risk of stroke [163], and a recent double-blind, randomized placebo-controlled study showed no benefit of an Il-6 blocker [164]. This conclusion may not be surprising as these humanized antibodies are not likely to cross the BBB unless it has already been disrupted. It is interesting that a main source of IL-6 is the mast cells [165–167], which have been reported to secrete it after stimulation with IL-1 [168] and acute stress [169]. Moreover, IL-6 can be constitutively released from human mast cells bearing the D816V-KIT mutation [170] and act on mast cell in an autocrine fashion to stimulate their proliferation [171].

This manuscript does not attempt to review and discuss all possible drugs, biologics, or natural molecules that could interfere with SARS-CoC-2 binding and its effects on tar-get cells. Rather, it focuses on certain natural molecules for

which there is sufficient basic and clinical evidence sup-porting their possible usefulness, both in prevention and treatment, especially in long-COVID. A number of recent reviews have discussed the potential use of natural molecules in that capacity [172–174]. Some simulation and in vitro studies have reported the potential benefit of small mole-cules found in Ginkgo biloba, such as the flavonoid quercetin discussed later. For instance, extracts from Ginkgo biloba leaves were identified as potential inhibitors of SARS-CoV-23CL(pro) using large-scale screening [175]. Another Ginkgo biloba extract was reported to block TNFα-induced reactive oxygen species from human aortic endothelial cells [176]. The Ginkgo biloba extract EGb 761 was beneficial in generalized anxiety disorder [177] and dementia [178], actions that may be useful for the neuropsychiatric aspects of long-COVID. Ginkgolic acid (GA) was shown to inhibit the fusion and synthesis of viral proteins [179]. Other stud-ies have shown that green tea catechins could be useful in COVID-19 [180, 181], especially against entry of SARS-CoV-2 [182]. The broccoli extract sulforaphane inhibited expression of IL-6 and IL-8 induced by the SARS-CoV-2 spike protein in bronchial epithelial cells [183].

Certain natural flavonoids [184] have been proposed as prophylaxis or treatment against COVID-19 [185–189]. Such flavonoids are found in green plants and seeds and possess potent anti-oxidant, anti-inflammatory, and cyto-protective properties [184]. However, their consumption as part of the diet does not provide sufficient systemic levels. However, there are a number of sources of pharmaceutical-grade purity (>98%) using different biomasses such as Cit-rus limon, Cynara cardunculus (artichoke), oregano, and Saphora japonicum.

In particular, a number of studies using in silico approaches identified the flavonol quercetin and the struc-turally related flavone luteolin as a potential strong block-ers of RBD [190–192]. Luteolin and some of its methylated analogues have a number of beneficial actions with respect to long-COVID: broad antiviral properties [193–195], inhi-bition of coronavirus entry [127, 196, 197], and inhibition of the serine protease required for spike protein process-ing [198, 199]. Furthermore, luteolin inhibits activation of both microglia [200–203] and mast cells [204, 205] via inhibition of signaling pathways involving the inflamma-some [206, 207] and mTOR (Fig. 2) in both mast cells [205] and microglia [203]. The novel luteolin structural analogue tetramethoxyluteolin (methoxyluteolin) is an even more potent inhibitor than luteolin [203–206].

With respect to long-COVID especially, luteolin could prevent neuro-inflammation [208–211], is neuroprotective [208, 210, 212, 213], and reduces cognitive dysfunction [214–218], especially brain fog [58, 60, 62].

Quercetin has been discussed in a few recent studies [219, 220], including an open-label clinical study showing good tolerability and benefit [221]. A double-blind, placebo-con-trolled, randomized study using a liposomal preparation of luteolin (PureLut) in long-COVID patients is underway. Combining quercetin with luteolin may provide additional benefits, especially when formulated in olive pomace oil (FibroProtek) that increases oral absorption, that is otherwise quite limited (<10%) [222]. Moreover, olive pomace oil provides additional antiviral [223] and anti-inflammatory [224]. Such liposomal preparations are available [222] and have been successfully used in pilot clinical trials [225] and reduced neuropsychiatric symptoms and associated serum IL-6 levels [226].

Conclusion

Further studies are urgently needed to address the neu-ropathogenesis of SARS-CoV-2 infection [227, 228] or the long-term effects of COVID-19 especially in the brain [229]. COVID vaccines have been enormously helpful [230–232], but there have been reports of rare neurological complica-tions including Guillain-Barre syndrome and Bell’s palsy [233]. These may be related to the recent finding that the spike protein expressed in response to mRNA vaccines was detected in the circulation as early as 1 day post vac-cination and became undetectable by day 14 [234]. Hence, we should try to limit or prevent spike-related detrimental effects especially to the brain and their potential contribution to the development of long-COVID.

Author Contribution: Single author

Availability of Data and Materials: Not applicable

Declarations

Ethics Approval: Not applicable

Consent to Participate: Not applicable

Consent for Publication: Not applicable

Competing Interests: The author is Scientific Director of Algonot LLC that develops flavonoid-containing dietary supplements.

Research Involving Human Participants and/or Animals: Not applicable

Informed Consent: Not applicable

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Male Andropause – Hormonal & Neurotransmitter Imbalances in Midlife

Male Andropause

Men do not usually present at the doctor’s office requesting an assessment for andropause, or “male menopause.” The more common scenario is a fifty-year-old executive, slightly overweight, appearing exhausted and irritable, reluctantly showing up in the doctor’s office for a consultation.  It was his wife, enquiring into her menopausal status the week before, who had mentioned to the doctor, “You know, I think my husband should have a check-up. He hasn’t been himself lately. He is grumpy. He lies down on the sofa any chance he can get. He complains of vague aches and pains, and I can’t remember the last time we had sex!” 

Upon closer enquiry, it appears that his symptoms were slower and more insidious in onset than his wife’s but, nevertheless, just as dramatic in their consequences. Men traditionally tend to have a more stoic and fatalistic approach to encroaching signs and symptoms, but as hormone depletion typically affects a man’s sexual performance first, this is often what propels him to seek medical attention.  The danger of ignoring all the other signs and symptoms of declining hormones is that andropause is not necessarily a benign process. It is often accompanied by profound physiological and mental changes that, over the long term, can have a significant effect on silent disease processes. According to Dr Jerald Bain, testosterone is much more than just a male sex hormone. It is an important contributor to the robust metabolic functioning of multiple bodily systems.[1] Men with low testosterone die earlier than those with normal levels.[2] Andropause can thus be considered a lethal disease. There is a 41 % decrease in the chance of dying with a testosterone level of 20 nmol/l compared to 12 nmol/l (average level 12-35 nmol/l).[3] For this reason, it is imperative that male andropause enters into consensual reality as forcefully and as well publicized as female menopause, lest we have a whole generation of men developing life threatening disease that may have been prevented with much earlier interventions.


[1] Bain J.The many faces of testosterone Clin Interv Aging. 2007; 2(4):567-76

[2] Shores MM et al, Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006 Aug 14-28; 166 (15):1660-5

[3] Ibid.

It has been estimated that among men more than 45-50 years old, the prevalence of low testosterone is at least 20-30 %.[1] Some of the more common and somewhat insidious presenting features of andropause include:

Loss of drive or competitive edge in business,

  • Various aches and pains in muscles and joints,
  • Loss of memory, a decreasing level of fitness,
  • Endurance and effectiveness in workouts,
  • Loss of muscle mass and increased abdominal obesity,[2]
  • Fatigue,
  • Depression,
  • Negative mood,[3]
  • Irritability
  • Most importantly, decreased libido and erection frequency, endurance, and strength, as well as unsatisfying orgasms.  Sex on a nightly basis turns into sex on a weekly basis as the desire and ability to perform decrease, while general fatigue increases.  Increasing loss of graying hair seems to be the final insult to an already distressing situation. However, this is just the tip of the iceberg. In addition, there may be many other subtle clues as to a declining sense of wellbeing. (See table 1) 

[1] Goepp J, Life Extension June 2010 pg 84

[2] Harman SM, et al, Longtitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrin Metab, 2001 Feb;86 (2):724-31

[3] Zitzmann M. Testosterone and the brain. Aging Male. 2006 Dec; 9 (4):567-76

Table 1: OTHER SIGNS AND SYMPTOMS OF ANDROPAUSE

  • Headache
  • Tinnitus (ringing in the ears)
  • Aging facial appearance with increased wrinkles
  • Quickly out of breath with physical activity
  • Unexplained numbness and tingling
  • Constipation
  • Hypochondriasis
  • Lack of interest in sports
  • Disturbed sleep with less than eight hours of uninterrupted sleep as trips to the bathroom increase due to prostate swelling as well a slower levels of melatonin
  • Hot flushes and sweating spells (mostly head and upper chest)
  • Prostate infections
  • Reduction in ejaculate
  • Gynecomastia (Fat accumulation in the breasts)
  • Longitudinal lines on nails
  • Hemorrhoids
  • Cellulite
  • Loss of hair on legs, especially the external sides
  • Nervousness and irritability
  • Poor concentration
  • Poor memory
  • Voice developing a higher anxious tone
  • Messy clothing (due to the depressive tendency and lack of the desire to be sexually attractive)
  • Becoming shorter in height, dry, thin (atrophic) skin
  • Dry glans penis (tip of penis)
  • Small, flaccid, atrophied penis
  • Peyronie’s disease (skew penis)
  • Lax testicles with reduction in size
  • Male pattern baldness (androgenic alopecia)
  • Dry eyes
  • Decreased axillary and pubic hair

If some of these symptoms and signs start to appear in your life or in the lives of your 40–50-year-old male loved ones, be very suspicious of the insidious onset of what has been termed male andropause.

What Is Male Menopause (also known as Viropause or Andropause)?

Male menopause is generally recognized as a gradual shift in hormonal, physiological and chemical changes that occur in all men between the ages of 40 and 45, although it can occur as low as 35 and as late as 65. [1] The term “hormone” is derived from the Greek word, hormo, which means to set in motion. This is precisely what hormones do. Hormones are involved in almost every biological process, including sexual reproduction, growth, metabolism, and immune function. They stimulate, regulate, and control the function of various tissues and organs and are manufactured by specialized groups of cells within structures called glands.


[1] Jed Diamond Male Menopause Sourcebook INC. Naperville, IL 1998, 1v

These glands, including the hypothalamus, pituitary, thyroid, adrenals, ovaries, and testes, release various hormones into the body as needed. The hormones that decline as a man age are Testosterone, Growth Hormone, Melatonin, DHEA, Progesterone, Pregnenolone and Oxytocin. (See table 2)   Hormone levels that usually go up with andropause are estrogen (the female sex hormone), insulin (the hormone responsible for sugar metabolism and the metabolic syndrome) and the stress hormone, cortisol. Testosterone, the main hormone responsible for andropause,[1] seems to peak in a man at approximately 30 years of age and then begins its gradual decline.[2]


[1] Rosick E.Male Menopause. Life Extension. Oct 2003,  pg 65

[2] Anawalt BD, Merriam G|R. Neuroendocrine aging in men. Endo and Met Clinics 2001 Sep; 30 (3): 647-69

Table 2: HORMONES & NEUROTRANSMITTERS DEPLETED IN ANDROPAUSE

  • Testosterone.
  • Growth hormone
  • Melatonin
  • DHEA
  • Pregnenolone
  • Progesterone
  • Thyroid hormone
  • Oxytocin
  • Dopamine
  • Acetylcholine
  • Gaba
  • Serotonin

The changes experienced by men during andropause can affect every aspect of a man’s life. These changes create not only serious, life-threatening health effects, but often they are harbingers of a deeper social and spiritual transition.  These changes signal the beginning of the end of the first part of a man’s life and herald in a new phase of his evolution, whereby the male may reexamine his life by asking sometimes frightening and often liberating questions.[1] If this transition is well managed medically, it may turn out to be the most productive and purposeful time of a man’s life.

This transition for men has been hotly debated for some time as to whether or not it was a real or imagined phenomenon. While the female menopause is often abrupt and life changing, signaling within a few months the change from her reproductive years to post reproductive reality, the male transition is often more gradual and not defined by reproductive incapacity.  Many people have long believed that levels decline as a natural consequence of advancing age, and thus there is nothing we can or should do about them.[2] Dr Morgentaler, associate professor at Harvard Medical School and author of  Testosterone for Life (McGraw Hill, 2008), explains, “That’s like telling a middle-aged person that since vision typically deteriorates with age, there’s no point in prescribing glasses- or that we shouldn’t treat atherosclerosis to prevent heart attacks, because it too is an age-related phenomenon. It just doesn’t make sense!” [3]

If one compares the physiological changes between men and women during this period of transition, there are striking similarities. For both sexes, as their hormones undergo this transition, body fat increases; well-being decreases; and sexual function decreases. Incidences of cardiovascular disease (heart attacks, hypertension, high cholesterol), type 2 diabetes, depression, obesity, Alzheimer’s and osteoporosis increase. Muscle wasting increases, and both prostate and breast cancer increase (as both cancers arise from similar embryological tissue).


[1] Hollis J. The MiddlePassage. From Misery to Meaning in Midlife. Inner City Books Toronto Canada 1993 pg 7

[2] Goep J..Testosterone Therapy for Life. Life Extension June 2010 pg 83

[3] Ibid, pg 84

Testosterone – Basic Physiology

Testosterone – Basic Physiology

Testosterone plays an essential role in the development of the normal male and in the maintenance of many male characteristics, including muscle mass and strength, bone mass, libido, potency, and sperm production.  Testosterone is also important in synthesizing proteins. It affects many metabolic activities such as the production of blood cells in the bone marrow, formation of bone, lipid and carbohydrate metabolism, and growth of the prostate gland. Testosterone production begins in the part of the brain known as the hypothalamus, which secretes gonadotropin-releasing hormone (GnRH). This hormone then signals the pituitary gland to make either follicular-stimulating hormone (FSH) or luteinizing hormone (LH). FSH helps to stimulate the testes to produce sperm, while LH stimulates the production of testosterone via the Leydig cells of the testes. Like the declining levels of eggs in a woman’s ovary as she ages, it has been estimated that men are born with 700 million Leydig cells and begin to lose six million of these cells yearly after his twentieth birthday. [1]

After testosterone is released from the testes, some testosterone is tightly bound to sex hormone binding globulin (SHBG) as well as loosely bound to albumin, a protein. Together, these are measured in the blood stream as total testosterone. Free testosterone is unbound to sex hormone binding globulin or albumin, and it is this hormone which exerts its powerful anabolic effects on the body (approx. 2-3% of testosterone). Bioavailable testosterone is also measurable – it is the sum of the unbound and the loosely bound portion to albumin. It is believed that the bioavailable measurement is the most accurate for assessing the amount of the most active hormone exerting its effect on the tissues.

As men grow older, not only do their bodies produce less testosterone, but the levels of another hormone called sex binding hormone globulin (SHBG) begin to increase. Levels of this hormone increase due to the aging process, increased alcohol use, increased obesity and estrogen levels, and decreased growth hormone and progesterone levels. As SHBG increases, bioavailable or free testosterone levels plummet.

As we age, testosterone is furthermore converted via an enzyme called 5-alpha reductase into dihydrotestosterone (DHT), a hormone responsible not only for aspects of a man’s libido but also most importantly, for hair distribution, heralding in the usually most unwelcome signs of male pattern baldness. Testosterone can also be converted via an enzyme called aromatase to estrogen, a vital hormone in men for bone health and cognitive wellbeing. [2] Too much estrogen production in men, a common event seen in obesity as well as seen more frequently in injectable testosterone replacement therapy.  This excess of estrogen increases a male’s risk of breast and prostate cancer.


[1] Morales A,Tenover JL. Androgen deficiency in the aging male. Urological Clinics North America 2002: 29 (4); 975- 82

[2] Nelson LR, Bulun SE. Estrogen production and action. Journal of Amer Acad Derm 2001 Sep; 45 (3): 116-24.

Lab Testing for Testosterone

When measuring testosterone levels, it is best to ask your doctor for total testosterone, free as well as bioavailable testosterone. One can measure levels in the serum and the saliva as well as through 24-hour urine collection. The benefit of saliva testing is that it is the only way to measure whether one has therapeutic levels of testosterone once transdermal creams have been initiated. It is absolutely useless to assess serum levels to measure the efficacy of transdermal creams or patches because it will require toxic doses of the transdermal creams to raise the serum levels to therapeutic serum levels. The reason for this is that, when applied transdermally, testosterone stays in the serum for a total of three seconds before being sequestered into the tissues where it exerts its effect. In order to raise serum levels, the tissue levels have to be super-saturated before the excess spills back into the serum. By this time, toxic tissue levels have been achieved. However, if testosterone is given via intramuscular injection, then serum levels are the standard way of measuring therapeutic efficacy.

The average range of male total testosterone levels and one that is considered “normal” by the US based FDA is between 12.15-35.76 nmol/l. However, no single number should be used as an absolute level. It is a man’s symptoms combined with his serum levels that should guide therapy. If a man’s symptoms are consistent with low testosterone and his serum levels are at the low range of normal, that man deserves a trial of testosterone therapy.

Once testosterone therapy is begun, it is advised to test the following blood levels every 3 to 6 months in the first year and then twice a year thereafter: Hemoglobin, hematocrit, total, free and bioavailable testosterone, estrogen, progesterone, pregnenolone, dihydrotestosterone as well as PSA. Blood testing should be accompanied by a yearly digital rectal examination (DRE).

Testosterone declines with age

Testosterone declines with age

Free testosterone declines at a rate of 1% per yr. or 10% per decade.[1] As our total testosterone levels only range from approx. 12-35 nmol/l, (extremely small amounts), one can deduce that, in 20 years, significant inroads may be made into one’s total testosterone stores.  In various studies, testosterone measures correlated with strength, bone mineral density, body composition and fat mass. [2] As our levels decrease, so do these parameters of health. [3] Half of healthy men between the ages of 50 to 70 will have a bioavailable testosterone level below the lowest level seen in healthy men who are 20 to 40 years of age. [4]

One of the reasons why men are not diagnosed as being hormone deficient is that the levels of the hormones that appear on standard lab tests are age adjusted for an aging population with an anticipated reduction in hormone levels. In anti-aging medicine, we aim to restore hormone levels to a healthy youthful range of a healthy 25–35-year-old.


[1] Decreased bioavailable testosterone in aging normal and impotent men. Nankin HR et al. J Clin.Endocrinol Metab. 1986 Dec; 63(6):1418-20.

[2] Measures of Bioavailable Serum Testosterone and Estradiol and Their Relationships with Muscle Strength, Bone Density, and Body Composition in Elderly Men.  Annewieke W et al. The Journal of Clinical Endocrinology & Metabolism Vol. 85, No. 9 3276-3282, 2000

[3] Morley J. Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men. Metabolism 1997 Apr;46(4):410-3

[4] Korenman SG, Morley JE, Mooradian AD, et al. 1990 Secondary hypogonadism in older men: its relationship to impotence. J Clin Endocrinol Metab. 71:963–969.

With declining levels of free testosterone as we age, the following health effects have been well documented

Cardiovascular Disease:

Man with cardiovascular disease

Men with coronary artery disease had significantly lower levels of total testosterone as well as free and bioavailable testosterone than the men in the control group. [1] Furthermore, exercise-induced myocardial ischemia (reduced blood flow to the heart) improved with the use of testosterone, showing significant improvements in pain perception with no negative alterations in cholesterol levels or blood clotting capacity. [2] This effect is thought to be due to a direct coronary artery relaxing effect. [3] The many cardiac benefits of adequate levels of testosterone include assisting in the heart beating stronger, widening the coronary artery lumen, increasing blood supply to the heart, reducing serum cholesterol, minimizing atherosclerosis, reducing hypertension by vasodilatation, and making blood more fluid by increasing fibrinolytic (breaking down of clots) activity and thus reducing blood clots. Of note, very high doses of testosterone may suppress the protective high-density cholesterol whereas low levels of testosterone are associated with increased levels of total cholesterol.  As cardiovascular disease is by far the leading cause of death in the aging population in developed countries, [4] it behooves our health practitioners to be extremely diligent in measuring and managing this highly preventable risk factor.


[1] English K et al. Men with coronary artery disease have lower levels of androgens than men with normal coronary  ngiograms.  Eur Heart J 2000 Jun;21(11):890-4

[2] English KM et al.Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: Circulation 2000 Oct 17;102(16):1906-11

[3] Rosano GM et al. Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation 1999 Apr 6;99(13):1666-70

[4]  World Health Organization (2004). “Annex Table 2: Deaths by cause, sex and mortality stratum in WHO regions, estimates for 2002” (pdf). The world health report 2004 – changing history. http://www.who.int/entity/whr/2004/annex/topic/en/annex_2_en.pdf.

Memory and cognitive function:

Multiple studies have proven that men with optimal testosterone levels as they age have fewer symptoms of senility compared to men with lower levels of testosterone. Testosterone supplementation increases working memory in men. [1]  It has also been shown to improve visual and verbal memory and visuospatial functioning as well as reduce the rate of decline in visual memory.[2] Testosterone levels correlate with cognitive function; as testosterone levels are replaced to therapeutic levels, memory and cognition improved accordingly.[3]


[1] Janowsky J et al.Sex steroids modify working memory.J Cogn Neurosci 2000 May;12(3):407-14

[2] Moffat SD, et al. Longitudinal assessment of free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab 2002 Nov; 87 (11): 5001-7

[3] Alexander GM, Swerdloff RS, Wang C, et al. Androgen-behavior correlations in hypogonadal men and eugonadal men. II. Cognitive abilities. Hormones and Behavior 1998; 33(2):85-94

Mood:

Numerous studies have shown testosterone replacement therapy is effective when psychiatric drugs do not work in with men with depression. [1] In this study, testosterone therapy improved both natural and spontaneous erections as well as mood.[2] Low testosterone was shown to be associated with fatigue, and testosterone therapy produces a sense of wellbeing.[3] Men with low levels of testosterone are more prone to depression [4]as well as dramatic mood swings. [5]


[1] Cooper MA.  Testosterone Replacement Therapy for Anxiety Am J Psychiatry 157:1884, November 2000

[2] Burris A et al. A long-term, prospective study of the physiologic and behavioral effects of hormone replacement in untreated hypogonadal men. J Androl 1992 Jul-Aug;13(4):297-304

[3] Margolese HC et al. The male menopause and mood: testosterone decline and depression in the aging male–is there a link? J Geriatr Psychiatry Neurol 2000 Summer;13(2):93-101

[4] Pope HG, Jr et al, Testosterone gel supplementation for men with refractory depression: a randomized, placebo controlled trial. Am J Psychiatry, 2003 Jan: 160 (1): 105-11

[5] Goep J. Testosterone Therapy for Life. Life Extension June 2010 pg 86

Mortality Risk:

Testosterone deficiency can be seen as a lethal disease as individuals who had the lowest levels of testosterone had the greatest mortality rates. In this study, during an average 11.8-year follow-up, 538 deaths occurred.Men whose total testosterone levels were in the lowest quartilewere 40% more likely to die than thosewith higher levels, independent of age, adiposity, and lifestyle.[1]


[1] Gail A.  Low serum testosterone and mortality in older men. J of Clin Endocrin and Metab. Vol. 93, No. 1, 68-75

Alzheimer’s disease:

Testosterone replacement therapy prevents the production of beta amyloid precursor protein in men,[1] thus reducing the risk for Alzheimer’s disease. In established Alzheimer’s disease, treatment with testosterone improved the patient’s cognition over 1 year, whereas the control group deteriorated. [2]


[1] Gouras GK et al. Testosterone reduces neuronal secretion of Alzheimer’s beta-amyloid peptides Proc Natl Acad Sci U S A 2000 Feb 1; 97(3):1202-5.

[2] Tan RS. A pilot study on the effects of testosterone in hypogonadal aging male patients with Alzheimer’s disease. Aging male. 2003 Mar 6 (1): 13-7

Strength and Muscle Mass:

Man's arm flexing

Testosterone is a major predictor of skeletal mass, synergistic with growth hormone. In this same study, significantly improved strength was demonstrated with testosterone use even without exercise. [1]There was a more marked improvement when exercise was added to the program. With the increase in muscle mass, increased performances were noted in muscle power, strength, and endurance, with a resultant improvement in physical function, athletic performance and overall improved health related outcomes. [2]


[1] Bhasin S. The dose-dependent effects of testosterone on sexual function and on muscle mass and function. Mayo Clin Proc. 2000 Jan;75 Suppl: 70-5

[2] Ibid.

Osteoporosis:

A study of 403 healthy men aged 73-94 years proved that muscle strength and bone mass were at optimal levels in men with the highest levels of free testosterone. [1] This led the researchers to conclude that “a number of clinical problems present in older men may be related to testosterone deficiency, including reduced muscle mass, changes in body composition and loss of bone mass density.” Furthermore, using testosterone has been demonstrated to increase the bone mass of the lumbar spine in elderly men.[2]


[1] Van Den Beld AW, et al. Measures of bioavailable serum testosterone and estradiol and their relationships with muscle strength, bone density and body composition in elderly men. J Clin Endocrinol Metab 32000 Sep; 85 (9): 3276-82

[2] Snyder PJ et al. Effects of testosterone treatment on bone mineral density in men over the 65 years old. J Clin Endo Metab 1999; 84:1966-72

Diabetes and Metabolic Syndrome:

Testosterone therapy has been shown to reduce LDL cholesterol, blood sugar, glycated hemoglobin (a marker of long-term blood sugar control) and insulin resistance.

Testosterone replacement therapy

Most men choose to use bioidentical testosterone replacement therapy when they realize that many of their symptoms may be due to low levels of this hormone. The most obvious symptom that is desirous of being restored is loss of peak sexual functioning. Numerous studies now show the benefit of testosterone replacement in improving both libido and erection capability. [1] [2] [3]  The preferred route of administration is via a transdermal cream, applied to the skin or to the anal mucosal tissue. Anecdotal evidence suggests that some of the transdermal cream be applied to the glans (head) penis if erection strength is a dominant symptom. Some men prefer to have a weekly injection or to apply a hormone patch. Other routes of administration are via a subcutaneous pellet insertion under the skin every three months or via oral administration. The oral route is never used when replacing low levels due to significant potential for liver toxicity. There are also testosterone gels commercially available. A long-lasting injectable form of testosterone called testosterone undecanoate may soon be available. It lasts for 2.5 months. 


[1] Morley JE, et al. Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study. J Am Geriatr Soc 1993 Feb; 41 (2): 149-52

[2] Hajjar RR et al. Outcomes of long-term testosterone replacement therapy in older hypogonadal males. J Clin Endocrinol Metab 1997 Nov; 82 (11): 3793-96

[3] Wang C, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength and body composition parameters in hypogonadal males. J Clin Endocrin Metab 2000 Aug;85(8): 2839-53

Natural ways to raise testosterone:

If applying a cream or injections are not your preferred methods of treatment, there are some natural ways to improve testosterone function although, the truth be told, they are nowhere near as effective as getting a repeated dose of the real thing!

Testosterone supplements
  • Diets low in protein in elderly men (40-70 years old) may lead to elevated SHBG levels and decreased testosterone bioavailability.[1]  Eat a well-balanced diet, rich in protein and full of fresh organically grown fruit and vegetables so as to avoid estrogen producing chemicals. The estrogen mimicking chemical HPTE, a metabolite of a commonly used pesticide methoxychlor, causes a decrease in testosterone production from the Leydig cells.[2] Avoid plastic bottles, laundry detergent and other cosmetics which are man-made mimics of estrogen.
  • Increase cruciferous vegetable intake (cabbage, cauliflower, zucchini, brussel sprouts), or take DIM (di-indole methane). These foods and/or supplements help reduce the so-called bad estrogens (16-alpha-hydroxyestrones) and increase the “good” estrogens (2–hydroxyestrones), thus reducing prostate and breast cancer risk.[3]
  • Increase soy intake (fermented non-GMO varieties) as well as increase one’s levels of omega three fatty acids. Soy appears to inhibit the aromatase enzyme thus lowering estrogen levels.[4] Essential fatty acids, found in non-mercury containing fish and supplements, decrease levels of SHBG thus making more free testosterone available.
  • Engage in daily exercise and keep one’s weight as trim as possible. Strength training in middle aged men (44-48) causes an increase in free testosterone levels.[5]
  • The mushroom extract Cordyceps has been shown to increase sexual vitality in both men and women, particularly increasing male sexual performance. It appears to have a direct effect on the sexual center of the brain and the sex organs.[6]
  • Take Tribulus – 500 mg three times per day. Tribulus is a natural herb known for its testosterone raising properties in many different cultures. It is not a hormone but appears to exert its effect by raising the levels of LH, the hormone that stimulates testosterone production.
  • Take Zinc -30 mg three times per day. This mineral is involved in multiple aspects of a male’s sexuality, including testosterone production, sperm formation and sperm motility and is commonly used in male infertility.  In one study, with the use of 60 mg of zinc, sperm counts rose from eight to twenty million.[7] Supplementation of this mineral may become very important for some men as it has been estimated that with every ejaculate, 0.5 mg of zinc is lost!
  • Take Vit A- 50,000 IU a day for one month, then reduce the dose to 25,000 IU of a mycelized Vit A.
  • Take Boron – 3 mg daily.
  • Take Vitex agnus -1200 mg twice daily – this herb also stimulates the pituitary to make more LH.
  • Sweating in an infrared sauna increases testosterone and nitric oxide synthase (dilating the vessels to the penis, similar in effect to Viagra) by 1400 % and more than over 30 saunas have been shown to reduce toxic burden by two thirds.
  • The amino acid arginine, taken an hour before intercourse, has a milder but similar effect as Viagra. Use 2 grams twice daily or 4 -6 grams 1 hour before intercourse.
  • Use propionyl and acetyl L carnitine- 1 gram of each twice a day. [8] In this study, the carnitine group had a better response than the group given testosterone 160 mg a week. It has been shown that carnitine can be used successfully in prostate cancer patients so as to restore sexual potency after a surgical nerve block. Carnitine and Viagra together seem to be the best combination.
  • Lipoic acid 500 mg daily improves cognitive function as well as increasing libido.
  • Eat enough calories and follow a Paleolithic diet.
  • Use a mixed amino acid supplement or protein drink.
  • Avoid alcohol, vinegar, caffeinated drinks, sugar, sweets, soft drinks, cookies, breads, milk, tobacco, and marijuana.
  • Avoid tight underwear and reduce weight.
  • Avoid chronic stress and strenuous physical activities i.e., triathlon training.
  • Reduce the use of anti-hypertensive beta -blockers as they reduce testosterone levels.

[1] Longscope C, et al. Diet and SHBG. J CLin Endocrinol Metab 2000 Jan; 85(1):293-96.

[2] Kuipper GG, et al. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta. Endocrinology 1998 Oct; 139(10:4252-63)

[3] Muti p et al. Urinary estrogen metabolites and prostate cancer; a case-control study in the united States. Cancer causes Control 2002 Dec ; 13 (10):947-55

[4] Nagata C, et al. Inverse association of soy product intake with serum androgen and estrogen concentrations in Japanese men. Nutr Cancer 2000; 36(1): 14-18

[5] Izquierdo M, et al. Effects of strength training on muscle power and serum hormones in middle-aged men. J App Physiol 2001; 90(40 1497-1507

[6] Zhu J et al, Cordymax: A scientific product review. Pharmanex Phytoscience Review Series. 1997

[7] Netter A, et al. Effects of zinc administration on seminal zinc and fertility of oligospermic males. Ind J Phys

 Pharm 1987 Jan-Mar:31 (1) 30-34

[8] Cavallini G.Urology. 2004;63:641-646

If the serum free testosterone is low but the total testosterone is normal:

  • Pygeum – 3- 4 caps daily or
  • Urtica Dioscorea – 3 caps 2 times a day

If low testosterone with low LH- i.e., the pituitary is the problem:

  • Human Chorionic Gonadotropin (HCG) – 200-500 IU daily. If this is not helpful within 4 weeks, it won’t help, and one needs to stop
  • Vitex agnus – 1200 mg twice daily
vial from testosterone test

It is important to realize that testosterone replacement therapy can take many months before symptom improvement is realized. Restoration to normal sexual functioning may take as long as six months. It is advised to go slow and measure levels from time to time (remember to use saliva if using transdermal creams and serum levels if using injectable testosterone). Measure total, free and bioavailable levels of testosterone. In addition, measure levels of hemoglobin, estrogen, and prostate specific antigen (PSA), a biomarker for prostate cancer risk. DHEA, cortisol, pregnenolone and DHT should also be measured. Maintenance of a sugar and starch-free, as well as relatively alcohol-free, diet is recommended for maximum effect. Apply the hormone to large, hairless skin surfaces with high levels of penetration such as the forehead or inner thigh. Use a cream with a high concentration of testosterone and avoid areas of the skin with increased amounts of fat as fat tissue will have increased levels of aromatase and will easily convert the testosterone to unwanted levels of estrogen. Some individuals apply the cream to anal tissue to achieve a higher level of penetration.

Contraindications for testosterone therapy

An absolute contraindication is active breast or prostate cancer. A relative contraindication is active prostate infections or obstruction of urinary flow due to an enlarged prostate. Testosterone-replacement therapy has been associated with exacerbations of sleep apnea or with the development of sleep apnea in men treated with higher doses of testosterone who have other identifiable risk factors for sleep apnea.[1]


[1] Schneider BK, Pickett CK, Zwillich CW,et al. Influence of testosterone on breathing during sleep. J Appl Physiol 1986;61: 618-23.

Is testosterone therapy safe?

One of the most common questions asked of anti-aging physicians is, “Does testosterone replacement therapy cause cancer “? It appears that, at present, only about 5% of men with low testosterone levels are being treated.[1] It appears that it is the fear of getting prostate cancer that prevents a more proactive approach. Upon review of the relevant literature, the evidence is absolutely conclusive. Testosterone replacement therapy in physiological doses DOES NOT increase the risk of either benign prostatic hypertrophy (swollen prostate gland) or prostatic cancer.[2] In one study, not only was there no correlation between testosterone and increased levels of prostate specific antigen (a prostate cancer biomarker), prostatic volume, percent of positive cancer biopsies, biopsy Gleason score[3] or clinical staging of prostate cancer, [4] it was shown that, on the contrary, low free testosterone correlated with positive prostatic cancer biopsies and with a higher Gleason score (more serious staging of cancer). In another study, intramuscular testosterone injections at a dose of 100 mg, 250 mg or 500 mg a week (these last two doses are considered excessive and will exceed normal physiological levels) showed increased levels of serum testosterone with no change in either prostate volume or serum prostate specific antigen.

The Journal of the National Cancer Institute reviewed the work of dozens of world class researchers in the Endogenous Hormones, Prostate Cancer Collaborative Group who pooled all their data. Eighteen prospective studies that included 3,886 men with prostate cancer and 6,438 control subjects[5] concluded that serum concentrations of sex hormones were not associated with the risk of prostate cancer.

Another study showed that levels of dihydrotestosterone and testosterone were in fact lower than the controls in men with prostate cancer. In fact, with more advanced prostate cancer tumors, the same low levels of dihydrotestosterone held true.[6] It appears that it is not testosterone that is the culprit in the induction of prostate cancer, but that it is more closely linked to levels of estrogen in males, along with a poor western based diet.[7] An article in the World Journal of Urology summarized the current understanding by stating: “Estrogenic stimulation through estrogen receptor alpha in a milieu of decreasing androgens (testosterone, DHT and DHEA), contributes significantly to the genesis of benign prostatic hyperplasia, prostate dysplasia and prostate cancer.” [8]

Most interestingly, many experts are beginning to provide testosterone replacement therapy to men who have had prostate cancer, [9] an approach that was considered strict heresy just a few years ago. This approach is not, however, considered a mainstream approach as many oncologists and urologists are still concerned that testosterone therapy may increase the risk of cancer recurrence. [10]


[1] Rhoden El. Morgentaler A.  Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004 Jan 29; 350(5):482-92

[2] Morley JE. Testosterone replacement and the physiologic aspects of aging in men. Mayo Clin Proc. 2000 Jan; 75 Suppl: S83-7.

[3] Gleason score refers to the microscopic appearance of prostatic cancer which together with other parameters, is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy. Cancers with a higher Gleason score are more aggressive and have a worse prognosis

[4] Hoffman MA.Is low serum free testosterone a marker for high grade prostate cancer?J Urol 2000 Mar;163(3):824-7

[5] Roddam Aw et al. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008 Feb 6; 100 (3): 170-83

[6] Gustafsson et al.  Dihydrotestosterone and testosterone levels in men screened for prostate cancer: a study of a randomized population. Br J Urol 1996 Mar;77(3):433-40

[7] Coffey DS. Similarities of prostate and breast cancer: Evolution, diet, and estrogens. Urology 2001 Apr;57(4 Suppl 1):31-8

[8] Steiner Ms, Raghow S. Antiestrogens and selective estrogen receptor modulators reduce prostate cancer risk. World J Urol 2003 may; 21 (1): 31-67

[9] Morgentaler A. Testosterone therapy for men at risk for or with a history of prostate cancer. Curr Treat Options Oncol. 2006 Sep;7(5):363-9

[10] Goep J. Testosterone Therapy for Life. Life Extension June 2010 pg 89.

Man standing on dock looking out at lake

The other hormones involved in Andropause

Andropause is primarily due to decreasing levels of testosterone, but many other hormones and neurotransmitters may be similarly affected.

DHEA

DHEA is a steroid hormone secreted by the adrenal glands, gonads, brain and skin in both men and women, which also declines with advancing age. By the time we are 70-80 years of age, peak levels of DHEA are only 10-20 % of those in young adults. [1]As DHEA is the dominant and most abundant steroid hormone in the body and the precursor of all other sex steroid hormones, DHEA has extraordinary restorative effects on multiple aspects of one’s functioning. Low levels of DHEA are associated with aging and most diseases of aging. Specifically, a deficiency of DHEA has been found to correlate negatively with immune dysfunction, inflammation, greater risks of certain cancers, heart disease in men and osteoporosis.[2]


[1] Genazzani Ad, et al. Might DHEA be considered a beneficial replacement therapy in the elderly? Drugs Aging. 2007; 24(3):173-85

[2] Greenwell I. Life Extension. August 2001; pg25.

DHEA and Cardiovascular Disease

Studies have shown that the dramatic age-related drop in DHEA levels is accompanied by an equally dramatic rise in cardiovascular disease.  The mechanism of action is that it appears DHEA is incorporated into both high- and low-density cholesterol, protecting it from oxidation. As we age, the cholesterol-bound levels of DHEA become infinitesimal, thus the cholesterol molecules are much more susceptible to oxidation than in younger individuals. 

In the Massachusett’s Male Aging Study, following 1700 men between the ages of 40 and 70 for 9 years, authors found that men in the lowest quartile of serum DHEA at baseline were 60% more likely to develop ischemic heart disease than controls.  Low serum levels of DHEA were also a significant predictor.

In a study done at the University of Wroclaw, Poland, it was found that DHEA decreased the level of serum lipid peroxides in rabbits fed a normal diet but not in rabbits with induced severe hypercholesterolemia. DHEA was able to increase the activity of the platelet superoxide dismutase (SOD), a crucial antioxidant enzyme.  This increase in superoxide dismutase’s activity may partly explain DHEA’s antioxidant effects.[1]


[1] Bednarek-Tupikowska G et al. Influence of DHEA on platelet aggregation, superoxide dismutase activity and serum lipid peroxide concentration in rabbits with induced hypercholesterolemia. Med Sci Monit 2000; 6:40-45.

DHEA and Brain Health

It is well known that cortisol, the hormone resulting from chronic prolonged stress has harmful effects on the brain.[1]  DHEA, due to its action in suppressing cortisol, appears to protect the brain from these damaging effects. Furthermore, a Canadian study found that rats implanted with a high dose of DHEA showed significantly less hippocampus (an area of the brain associated with memory) damage after stroke was experimentally induced. There were 60% injured neurons (brain cells) as compared to 88% in the control group.[2] [3]


[1] Canning MO et al. Opposing effects of DHEA and dexamethasone on the generation of monocyte-derived dendritic cells. Eur J Endocrinol 2000; 143:685-95.

[2] Aragno M et al. Oxidative derangement in rat synaptosomes induced by hyperglycemia: restorative effect of DHEA treatment. Biochem Pharmacol 2000; 60:389-95.

[3] Aragno M et al. DHEA prevents oxidative injury induced by transient ischemia/reperfusion in the brain of diabetic rats. Diabetes 2000; 40:1924-31.

DHEA and Infection/Immune Health

DHEA has also been shown to not only enhance the immune response but also fight infection.  Several studies have confirmed its usefulness in combating bacterial, parasitic, and viral infections including HIV. DHEA has been shown to lower the levels of IL-6, a proinflammatory cytokine (a chemical messenger used by the immune system). [1] Furthermore, it lowers the production of another inflammatory cytokine, tumor necrosis factor alpha (TNF Alpha).  As we age, both of these levels rise, which indicates immune dysfunction and an increasing inflammatory state.  The ability to lower the levels of these inflammatory mediators may be an important part of the neuroprotective mechanism of DHEA.[2] Thus, the decline in DHEA levels is closely tied to immunosenescence.[3]  It can thus be shown that maintaining youthful levels of DHEA means less chronic inflammation.  It has been shown repeatedly that many of the diseases of aging, i.e., heart disease, Alzheimer’s, certain cancers, diabetes, osteoporosis are all linked to the inflammatory process. It thus becomes imperative to maintain youthful levels of DHEA so that we harbor less inflammation as we age.


[1] Greenwell I. Life Extension. August 2001; 26.

[2] Cardounel A et al. DHEA protects hippocampal neurons against neurotoxin-induced cell death: mechanism of action. Proc Soc Exp Biol Medicine 1999; 222:145-49.

[3] Greenwell I. Life Extension. August 2001; 26.

DHEA and Sexuality

DHEA’s role in sexual physiology of both men and women is that of a mood modulator. [1] One study showed that supplementing with 50 mg of DHEA every night for six months in both males and females, aged 40-70, improved energy levels, quality of sleep, mood, and the ability to handle stress.[2] In another study of men with advanced age (90-103), those who had the highest levels of DHEA had the highest levels of normal daily activities. [3]

The average dose for men is 25 to 100 mg and for women, anywhere from 1 to 25 mg.  Testing blood levels for optimal levels is indicated. Too much DHEA in women will cause either acne or increased hair growth. This can be avoided by using a form of DHEA called 7-Keto-DHEA.


[1] Cameron Dr, Braunstein GD. The use of dehydroepiandrosterone therapy in clinical practice. Treat Endocrinol. 2005; 4 (2): 95-114

[2] Morales AJ, et al. Effects of replacement doses of DHEA in men and women of advanced age. J Clin  Endo Metab 1994 Jan; 78(6):1360-67

[3] Ravaglia G, et al. The relationship between DHEA-S to endocrine metabolic parameters and functional status in the oldest-old. J Clin Endo Metab 1996; 81(3):1173-78

Natural ways to raise DHEA

Man tying his shoes about to start exercising

Diet:

A low-calorie ketogenic diet using less than 40 gm of carbohydrates per day (8:57) in rheumatoid arthritis patients resulted in a 34% rise in DHEA within a week. [1] In primates, calorie restriction has indeed been found to preserve higher DHEA levels indicating a slower rate of aging.  Fasting has also been shown to raise DHEA levels in men and women.  Anorexic and bulimic individuals likewise show higher serum DHEA.[2]

Exercise and meditation:

Exercise and meditation have been shown to raise DHEA in some individuals.[3]

Drum Circles:

Participation in drum circles[4] has also been shown to increase DHEA confirming the hypothesis that stress reduction in general boosts DHEA production probably through a shift of adrenal steroidogenesis from cortisol to DHEA.[5]


[1] Cutolo M. Sex hormone adjuvant therapy in rheumatoid arthritis. Rheum Dis Clin North Am 2000; 26: 881-95

[2] Montelone P et al. Plasma levels of Neuroactive steroids are increased in untreated women with anorexia nervosa or bulimia nervosa. Psychosom Medicine 2001: 63: 62-8

[3] Boudou P. et al. Effects of a single bout of exercise and exercise training on steroid levels in middle-aged type 2 diabetic men: relationship to abdominal adipose tissue distribution and metabolic status. Diebetes Metab 2000; 26:450-57.

[4] Bittman BB et al. Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Alternative Ther Health Medicine 2001; 7:38-47.

[5] Greenwell I. Life Extension. August 2001; 27.

GROWTH HORMONE

Growth hormone (GH) deficiency in aging males can have a dramatic effect on one’s sense of well being. GH is considered the master hormone with multiple protective roles. It is growth hormone which is responsible for our major growth spurt during puberty, without which we would all be dwarves.[1] In adulthood, GH maintains skin, muscle, and bone health. With a deficiency of this hormone, signs of aging are quickly accelerated.

Skin wrinkles and sags; fat soon replaces muscle. Growth hormone also helps maintain and repair the health of various organs, including the heart, lungs, liver kidneys joints, nerves as well as the brain. As growth hormone activates the calming, regenerative parasympathetic nervous system, a deficiency may result in increased tension, anxiety, depression, and an increasing inability to cope with stress.  From the age of thirty onwards, growth hormone levels decline fairly rapidly, about 1-3 % per year. This loss is quickly accelerated in the presence of obesity. The most efficient way to replace growth hormone is through subcutaneous daily injection, similar to a diabetic insulin injection. Some companies make precursor amino acid preparations (arginine, lysine, glutamine, and ornithine) which have a variable effect on raising GH. Most anti-aging doctors will not treat GH in the first year of restoring optimal hormone levels as a protein rich diet, adequate sleep, and exercise program, and replacing testosterone, progesterone, melatonin, and thyroid levels, may increase GH levels by as much as 20-30 %. (See table 3)   


[1] Hertoghe T. The Hormone Handbook . International Medical Publications. U.K. pg 54

Table 3: NATURAL WAYS TO RAISE GROWTH HORMONE

  • Take Amino acid supplement
  • Exercise daily
  • Replace all deficient hormones
  • Eat a protein rich diet
  • Avoid alcohol, sugar, sweets, breads, and pasta
  • Reduce weight
  • Avoid milk products
  • Avoid sleep deprivation
  • Avoid prolonged stress.

PROGESTERONE

The subject of progesterone replacement therapy in men was well covered in this magazine, Edition 3, 2010.[1] Men typically produce between 1.5 to 3 mg per day, and as men age, progesterone levels fall exponentially. From a biochemical point of view, progesterone is used in the production of cortisol (the stress hormone). Thus, if a man leads a particularly stressful life, it is highly likely he will have depleted levels of progesterone. Progesterone is vital in keeping the higher levels of estrogen in aging men in check and thus minimizing the risk of heart attacks, prostate enlargement, and prostate cancer.  A typical dose of progesterone may lower estradiol levels by up to 30 %. [2] Progesterone also lowers DHT, thus preventing or attenuating male pattern baldness.[3] Progesterone also blocks aldosterone receptors, thereby reducing excessive fluid retention and possibly high blood pressure caused by increased aldosterone production[4]. (See table 4)

Table 4: NATURAL WAYS TO INCREASE PROGESTERONE

  • Eat a diet rich in protein and cholesterol, a precursor of progesterone synthesis
  • Manage stress daily with stress reduction techniques
  • Herbs and nutraceuticals such as Rhodiola, Siberian Ginseng, and Liquorice root extract, Vitamins B 5 and C, and Ashwagandha

[1] Arthur D, Wessels M. Men and the forgotten hormone. Health Intelligence, 2010 Edition 3, pg 20

[2] Hertoghe T. The Hormone Handbook. International Medical Publications. U.K. pg 246

[3] Ibid.

[4] Ibid, pg 247

MELATONIN

Melatonin is another hormone that declines with advancing age. Symptoms suggestive of melatonin deficiency include a superficial, agitated sleep with many anxious thoughts, easy waking during the night, difficulty falling asleep and falling back asleep once awake, poor dream or dream recall, anxiety especially at night, depression (especially seasonal affective disorder) excessive emotionality and irritability, and restless leg syndrome with increased muscle spasms. Intestinal spasms or cramps may also dominate. A positive result of melatonin is the so-called regenerative or anabolic effect that it has on the parasympathetic nervous system, the part of our autonomic nervous system that is involved in rest and relaxation.   Melatonin has a positive effect on the parasympathetic nervous system, that part of our

autonomic nervous system that is involved in rest, relaxation- a so-called regenerative or anabolic effect. Without adequate levels of melatonin, the sympathetic nervous system dominates, leading to a heightened fight/flight response with an overall degenerative or catabolic effect.[1] Melatonin may improve sexual performance, enhancing serenity and relaxation after sex. [2]

Human and animal studies have linked a melatonin deficiency to hypertension, coronary artery disease, cardiac arrhythmias, obesity, diabetes, osteoporosis, lowered immunity with recurrent infections, breast and prostate cancer, and neurological diseases such as Parkinson’s and Alzheimer’s disease. The antioxidant effect of melatonin is responsible for its positive effect in cancer patients.  Some labs now offer a 24-hour saliva melatonin assay.

Treatment involves the use of either an oral or sublingual dosing. It is best to use the sublingual dosing for immediate, sleep-inducing effect, while using the oral route is best to assist in maintaining a restful sleep. Melatonin is best utilized when given in conjunction with vitamin B6 and serotonin precursors such as tryptophan or 5-hydroxytryptophan, which in the presence of the B6, convert to melatonin. High levels of melatonin may suppress cortisol, so use with caution if one desires an active immune system to suppress inflammation. Low levels of cortisol can produce many undesirable side effects, not the least of which is fatigue, headaches and low blood pressure. There are natural ways to raise melatonin. (See Table 5)

Table 5: NATURAL WAYS TO INCREASE MELATONIN

  • Increase morning daylight (a sunlamp may be used)
  • Make the room pitch black at night, use an eye mask
  • Avoid alcohol and caffeinated drinks,
  • Avoid stressful activities
  • Avoid electromagnetic exposures at night such as cell phones, electrical clocks and radios
  • Wear turquoise colored glasses 30 minutes before bed.

Some asthmatics may react negatively to melatonin as one study showed possible increased inflammation with nocturnal asthmatic exacerbations.[1]


[1] Sutherland E, et al Elevated serum melatonin is associated with the nocturnal worsening of asthma. Jour Allergy Clin Immunol 2003; 112: 513-17

[1] Ibid, pg 47

[2] Drago F, Busa L. Acute low doses of melatonin restore full sexual activity in impotent male rats. Brain Res 2000 Sep 29;878 (1-2):98-104

PREGNENOLONE

Pregnenolone is the forerunner of many of our major hormones. It is made from cholesterol and, once made, results in a series of metabolic reactions that lead to the production of other sex hormones such as DHEA, testosterone, estradiol, progesterone, cortisol and aldosterone. [1] In addition to functioning as a hormone, it also functions as a neurotransmitter in specific areas of the brain responsible for memory. Pregnenolone regulates the flow of calcium ions through the cell membrane, and calcium ion exchange determines how memory is encoded by neurons. In addition, pregnenolone increases the neurotransmitter acetylcholine, the neurotransmitter responsible for memory, as well as increasing neurogenesis in the hippocampus, the main part of the brain that stores memory.[2] The most common complaints of individuals with pregnenolone deficiency include memory loss and arthritic pains as well as dry skin and fatigue.  Replacement doses are typically 30 mg twice a day for memory loss.  In addition, one may choose to use other cognitive enhancing nutraceuticals such as:

  • Acetyl-L -Carnitine
  • Vinpocetine
  • Phosphatidyl Serine, combined with omega three fatty acids
  • Phosphatidyl choline
  • DMAE
  • G6PC
  • Huperizine 
  • Vitamin D
  • Blueberries

[1] Hertoghe T. The Hormone Handbook . International Medical Publications. U.K. pg 144

[2] Schumacher M. Neurosteroids in the Hippocampus: Neuronal Plasticity and memory. Stress 1997 Oct; 2 (1): 65-78

Stressed man

OXYTOCIN

Oxytocin, a hormone known to improve social bonding, is secreted from the posterior lobe of the pituitary gland. In women with newborn babies, it starts to flow in abundance at the first attachment of the baby to the nipple and aids in mother-child bonding.  According to researcher Dr Joan Borysenko, author of A Woman’s Book of Life, oxytocin helps a woman to become totally infatuated with her newborn, doting on every movement and every look.[1] Men and women both have endogenous levels of oxytocin naturally created by the body — it likely helps them fall in love, spurs parenting instincts and makes orgasms, well, more orgasmic. [2] It might also help women be so adept at reading social cues.

Researchers in the Journal of Neuroscience, after giving men oxytocin through a nasal mist, write “emotional empathy responses in men were raised to levels similar to those found in untreated women.” Not only were the men more affected by emotional scenes, but they also were better at learning tasks that required social cues. The effects didn’t last long though. The men needed another squirt two hours later. Oxytocin is presently being used by a few select practitioners to mainly enhance sexual arousal and bonding in men.


[1] Diamond J. Male Menopause. Sourcebooks, Inc. Naperville, IL 1998 pg. 211

NEUROTRANSMITTERS

In order for a man to feel at his best, there are multiple, interconnected physiological systems that need optimization to achieve this effect. For healthy sexual functioning this requires not only adequate hormone levels but also requires a healthy vascular system as well as psychological health. The “molecules of emotion” that link a man’s subjective sense of wellbeing to his biochemical pathways are called neurotransmitters and have a dramatic role to play in optimizing mood, sleep, pain, attention, relaxation as well as sexual function.   Sexuality in humans can be broken down into four components: desire, arousal, orgasm, and resolution. Each phase is governed by a corresponding neurotransmitter as well as a contributing hormone.[1]


[1] Bravermann E. Life Extension October 2008 pg 77

DOPAMINE

Dopamine is a neurotransmitter that we all seek out in abundance. It is involved in creating pleasure and a sense of joyful exuberance. Most people with any type of addiction, be it food, sex, drugs, alcohol, or thrill seeking, is self-medicating in order to raise their levels of dopamine. Low levels of dopamine result in loss of desire for sex as well as reduced arousal, interest, and energy for sex.[1] Dopamine levels can be raised by using the antidepressant Wellbutrin, the prescription drug L-dopa as well as naturally with tyrosine, phenylalanine, macuna bean extracts, gingko biloba and guarana.


[1] Ben Z, Tessler R, Cohen L et al, Polymorphisms in the dopamine D4 receptor gene ( DRD4) contribute to individual differences in human sexual behavior, desire, arousal and sexual function. Mol Psychiatry. 2006 Aug; 11 (8): 782-6

ACETYLCHOLINE

Acetylcholine is the main neurotransmitter involved in arousal and has significant effects on cognitive function, especially memory attention and creativity.[1] [2] A loss of acetylcholine particularly effects sexual arousal[3] as well as regulating internal moisture.[4]  Lower moisture levels can adversely affect semen volume in men.  The supplements used to boost acetylcholine naturally are Huperizine, acetyl- l- carnitine, phosphatidylserine, glycerophosphocholine and ginkgo biloba.


[1] Braverman ER. Younger you: unlock the hidden power of your brain to look and feel 15 years younger. New York, NY: McGraw-Hill; 2007.

[2] Amenta F, Tayebati SK. Pathways of acetylcholine synthesis, transport and release as targets for treatment of adult-onset cognitive dysfunction. Curr Med Chem. 2008;15(5):488-98.

[3] Andersson KE. Neurotransmitters: central and peripheral mechanisms. Int J Impot Res. 2000 Oct;12 Suppl 4:S26-33.

[4] Braverman ER. Younger you: unlock the hidden power of your brain to look and feel 15 years younger. New York, NY: McGraw-Hill; 2007.

GABA

Gaba is the main inhibitory neurotransmitter that downregulates anxiety in chronically distressed individuals.  Chronic anxiety often leads to loss of sexual interest and sexual dysfunction in men, particularly with loss of erections.  Gaba has been shown to be responsible for enhancing orgasms.  When Gaba becomes depleted, it is difficult to relax and let go of fear, anxiety, and negative thoughts, thus inhibiting orgasms. Gaba enhancing compounds also increase dopamine which, therefore, enhances sexual satisfaction.  Supplements which increase gaba are taurine, glycine, inositol and gaba itself.  A medical drug called Gabapentin has a similar effect.

SEROTONIN

Serotonin is one of our most powerful neurotransmitters and is responsible for modulating sleep, pain, mood, and gastrointestinal function.[1]  Low serotonin levels can result in negative thinking, a lack of joy and decreased feelings of intimacy.  Serotonin may also play a role in premature ejaculation, a condition which affects 20-30% of men.[2].  The commonly prescribed SSRI drugs, Paxil or Prozac, delay serotonin’s re-uptake into nerve cells and may increase ejaculatory control and delay ejaculation in men with premature ejaculation.[3]  Supplements which are helpful to raise serotonin are tryptophan and 5-hydroxytryptophan which readily cross the blood-brain barrier to exert their effect.  Other supplements that are needed to increase serotonin are magnesium and vitamin B6.


[1] Mohammad-Zadeh LF, Moses L, Gwaltney-Brant SM. Serotonin: a review. J Vet Pharmacol Ther. 2008 Jun;31(3):187-99.

[2] Ali ME, Abdel-Hafez HZ, Mahran AM, et al. Erectile dysfunction in chronic renal failure patients undergoing hemodialysis in Egypt. Int J Impot Res. 2005 Mar;17(2):180-5.

[3] Arafa M, Shamloul R. A randomized study examining the effect of 3 SSRI on premature ejaculation using a validated questionnaire.  Ther Clin Risk Manag. 2007 Aug;3(4):527-31.

Summary

Although a male andropause workup is not yet standard practice amongst primary care physicians, Dr Morgentaler,[1] believes that within 5-10 years, “individuals will know their testosterone levels just like they know their cholesterol and PSA levels today.” [2]  If all men (and their loved ones) were aware of a treatment that not only improved one’s sex drive, mental focus and energy levels but also reduced their risk of the number one killer, heart disease and associated metabolic syndrome, reduced the risk of all age related diseases while also having the potential to increase the quality of one’s life while increasing longevity, it is highly likely that this treatment would be the number one subject on everyone’s lips at the next cocktail party and/or braaivleis!

Furthermore, as a man approaches this phase of his life, it is time to take stock of multiple factors that may be preventing him from living at his maximum potential. This article has focused on only a small percentage of possible factors (hormones and neurotransmitters) that may be preventing him from living at the full capacity of his genetic potential. Other factors are infinite in their scope and include issues such as environmental toxicities, mold and chronic infectious exposures, dental cavitation, and root canal toxicity, nutritional deficiencies, structural imbalances, unresolved emotional conflicts and deep-seated toxic belief systems, family systems that block a healing resolution as well as a lack of a deep relationship to something other than one’s sole ego-based activities.

Our present generation tends to believe that, if something is not feeling quite right, it must be only a physical reason that is causing this sense of malaise. We run to doctors to get a traditional allopathic diagnosis and breathe a huge sigh of relief if there is no definable disease process. We also demand of our doctors that they provide a simple, drug-based solution that is effective almost immediately, does not take any time out of our busy schedules, requires very little effort by us and preferably is at very low cost, lest it interfere with our holiday trip to Majorca or our cosmetic surgery bill.  My answer is, “try showing up one day in your life without your brain or your body. “The fact that health concerns are seldom the number one priority in terms of individual’s value systems is a matter for grave concern in this emergent toxic, nutritionally depleted and stressed world we find ourselves in.

Our bodies and our minds are our greatest assets and must not be taken for granted! Our health and wellness should be guarded on a daily basis with the utmost dedication and the discipline to act wisely in a preventative manner, decades before disease manifests itself. Dr Myron Wentz, owner of the Usana line of nutraceuticals, makes the following profound comment, “Most of us spend our lives working hard to save enough money to enjoy the golden years, only to discover that we are going to have to spend a great deal of money and effort to regain the health we sacrificed in our harried pursuit of material comfort. Many of us think of health care after the fact, as a high-tech cure or series of treatments from a private practitioner or government agency, funded by insurance. We seldom view it as an individual responsibility.” [3]

In order to move away from this adolescent fantasy of someone else who is going to “fix us”, we have to become part of the solution. We all need to raise health as a dominant value in our lives, or at least define our highest values (it may be running a business or a large family) and link our health practices to this value. We need to ask ourselves, “how by staying fit and healthy  and working within a wellness, preventative model of health care, will I be even more effective at what I love to do?”

Every day we should devote time, energy, and money to the preservation of our greatest assets, our minds, and our bodies, and develop a heath team to assist us in this process. After all, the best way to avoid disease is to maintain health, not to get a disease and then treat it. Ask yourself “where do I fit on the health/illness continuum?” Are you experiencing a high level of wellness with education, discipline, regular assessments, and functional medicine[4] (not disease based) lab testing, or are you in the illness mode, experiencing signs, symptoms, and continued disabilities? It is my suggestion that if this is the case, that you act immediately as you may be heading down a slippery slope towards full blown illness, or at worst, a premature death.


[1] Morgentaler A. Testosterone for Life  McGraw Hill, 2008

[2] Goep J. Testosterone therapy for Life. Life Extension June 2010 pg 86

[3] Wentz M. “Invisible Miracles”. Rosarito Beach, Baja California:Medicis, S.C.;2002

[4] Functional Medicine looks at optimizing biochemical pathways so that maximum efficiency is attained in key systems i.e. liver detoxification, food sensitivities and gut health, immune balance and inflammation, nutrition, neurotransmitter and hormonal harmonization, structural alignment and mind/body health. This is not standard allopathic practice.

Moustache drawing

Are High Oxalate Levels Harming Your Health?

Are High Oxalate Levels Harming Your Health?

You’re encouraged to eat a healthy diet, so you make sure you get your seven-a-day portions of goodness, often blending vegetables and fruits into a green juice drink. Yet despite all your healthy eating, you continue to feel diffuse pain, are fatigued, and generally spaced out. Or maybe you experience other symptoms, such as terrible aching in your joints, painful bladder conditions, or feel as if you’re always suffering from some variety of gum disease. Perhaps you’ve been given a mysterious diagnosis of fibromyalgia, a meaningless name that’s used to describe people who have muscles that hurt, or have sleep and fatigue issues, along with other symptoms resulting from diffuse inflammation of undetermined origin.

Unfortunately, a high vegetable or specific carbohydrate diet, while frequently touted as being healthy, may be making your chronic condition worse. Certain vegetables and fruits contain oxalates, which are naturally occurring compounds that comprise part of their natural defense system. Oxalates are believed to create bitter tastes that prevent them from being eaten by animals in the wild. Oxalates are found in large quantities in a plant’s roots and leaves, the part of the plant that’s essential for it to survive. For many people, a plant-based, vegetarian type, high-oxalate diet isn’t a cause for concern, but it can seriously exacerbate kidney stones, digestive issues, mineral absorption, and diffuse unexplained symptoms for those that experience oxalate sensitivity. We also produce small amounts of oxalates ourselves within our cell’s mitochondria, as part of the Krebs cycle. Some individuals with genetic polymorphisms will produce larger amounts of oxalates endogenously that the body is unable to clear, which result in subsequent health issues.

However, it is possible to break free from the effects of oxalate on the body, be tested for high oxalate levels, and treat the condition with the correct diet and with supplements.

What is oxalate?

Oxalate is a fascinating compound that your body commonly absorbs as a result of the consumption of plant-based food. Oxalate is a very simple compound that comprises two carbon and four oxygen atoms, along with two negative charges that seek out positively charged molecules, such as minerals, that are necessary for metabolism. Oxalate prefers calcium to other minerals but also searches for and binds other toxic metals and minerals, (the list appears below). Certain plants create oxalate as a tool to store calcium deposits. This is similar to how vertebrates use bone to store and sequester calcium that can be used later. Oxalates also create insoluble crystals that absorb light, which is essential for photosynthesis. These crystals can be the source of severe pain, acting almost like tiny razor blades or shards of glass on susceptible tissue like mucosal membranes. Oxalates even deter animals from grazing on their leaves, creating pain and toxicity when the animals eat these in large quantities.

Your body also creates oxalate when breaking down vitamin C. In this case, oxalate is a toxic end product that needs to be removed from your body as waste. Humans are unable to digest oxalate, so if your health is optimal, it’s processed from your body via the gut. Specifically, your gut microbiome digests the oxalates. The ‘good’ bacteria in your gut produce enzymes, which work to disintegrate oxalate. The remaining waste products are then removed from the body within your stool. 

When fat maldigestion occurs due to lowered bile production, our dietary fats aren’t emulsified and broken up, resulting in these fats binding to dietary minerals that are excreted in the stool, along with the fats. When this process occurs, the uptake of dietary oxalates by our gut is significantly increased.

Oxalate can also act as an antinutrient as it binds to trace minerals and nutrients, preventing your body from absorbing the mineral. 

Oxalate can bind to: 

  • Calcium
  • Magnesium
  • Manganese
  • Zinc
  • Aluminum
  • Cobalt
  • Mercury

High oxalate levels in the body can thus lead to malnutrition, but they’re also the leading culprits behind the formation of kidney stones, as oxalate prefers to bind to calcium. In fact, 80 percent of all kidney stones are caused by calcium oxalate. Your body can only flush out the calcium oxalate, not destroy it, so your gut acts as an extrarenal pathway to transfer this into your kidneys then into your urine. Unfortunately, as these crystals build up in the kidneys or bladder, they bind together, creating painful kidney stones that are difficult to pass. However, only about one percent of people with high levels of oxalates will go on to develop calcium oxalate kidney stones. In some cases, these oxalate crystals are extremely small, almost nanoparticle in size, binding to sulfate receptors in your body and undetected by normal medical imaging techniques. Connective tissue, fascia, and joints are very high in sulfate receptors and therefore the oxalates can bind to these tissues, causing joint or soft tissue tendon or muscle pain.

You may think that the easiest way to solve this issue would be to stop eating food that contains calcium. Unfortunately, reducing your calcium intake is unlikely to ‘fix’ the kidney stones or prevent your body from holding on to oxalate. Eating sufficient calcium creates the insoluble form of calcium oxalate, which is passed through your bowel and bladder. If your body doesn’t receive enough calcium, the oxalate becomes soluble and is then easily passed into the bloodstream. This means the oxalate circulates through your body, which is unable to remove it all.

If you have a gastrointestinal condition, such as leaky gut, inflammatory bowel disease (IBS), or Crohn’s disease, you may also be unknowingly dealing with high levels of oxalate. While kidney stones are a severe indicator of excess oxalate, there are other, and often more insidious, symptoms to watch for.

What do high oxalate symptoms look like?

Oxalate sensitivity or high levels of oxalate in the body don’t always manifest similarly between patients. If you have an oxalate issue, it may develop in a part of the body you least suspect, particularly if you also struggle with intestinal permeability or what’s commonly known as leaky gut. This is a disorder in which your intestinal barrier is altered, resulting in your gut wall becoming unable to adequately filter the gut’s contents. Harmful particles slip through the wall and into your bloodstream. If oxalate slips through, this can lead to consequences in the rest of your body.

High oxalate symptoms may include:

There may also be symptoms commonly associated with urinary tract infections or UTI, including pain during urination, pelvic pain, and the need to urinate frequently. Symptoms related to multiple sclerosis may also occur, including fatigue, pain, numbness and tingling, brain fog, and muscle weakness.

Some of these symptoms may have been misdiagnosed at some point along your health journey, as oxalate levels aren’t usually examined during routine tests. However, it’s clear that oxalate sensitivity can have a severe impact on your health and the way you live your life.

What health conditions are associated with high oxalate levels?

1. Oxalate arthritis. With this condition crystals collect inside the synovial fluid of knee, hip, wrist, and shoulder joints. Normally, this fluid keeps your joints lubricated while acting as a shock absorber, protecting your cartilage from wear and tear and filtering nutrients into the joint. A build-up of oxalate results in swelling, joint pain, and lack of movement of the joint.

2. Vulvodynia/interstitial cystitis and benign prostatic hypertrophy (BPH). Both these conditions cause chronic pain in the vulva, which can be unbearable for female patients that are afflicted. Vulvodynia is a misunderstood disease, which was linked to oxalate by the late Dr. Clive C. Solomons. He identified that high levels of oxalate can irritate the epithelium of the vulva and cause pain if there was prior trauma in the area. Oxalate aggravates a pre-existing condition, but also irritates the glycosaminoglycan layer in the bladder.

3. Cystic fibrosis. In cases of cystic fibrosis(CF), high levels of calcium oxalate in the urine of patients with the condition indicate a fat malabsorption issue within the gut. In patients with CF, oxalate is unable to bind with calcium. Instead, the oxalate binds with sodium and other minerals and is able to travel around the body via the bloodstream.

4. COPD. Oxalate has been found in the bronchoalveolar lavage fluid and breath of patients with chronic obstructive pulmonary disease (COPD). This indicates that a build-up of oxalate around the lungs can trigger inflammation in the surrounding tissues, with resultant pulmonary fibrosis.

5. Fibromyalgia. As oxalate can travel throughout the body through the bloodstream, it seems highly likely that the extreme aches and pains experienced by fibromyalgia patients may be due to high concentrations of oxalate. In the United Kingdom, Dr. Clare Morrison improved her fibromyalgia by means of a low-oxalate diet and encourages fibromyalgia patients to follow her example.

6. Hashimotos thyroiditis. This is a common cause of hypothyroidism. The symptoms of thyroid disorders can be exacerbated by an inflammatory response to the build-up of oxalate crystals in the thyroid. Hashimoto’s thyroiditis has been associated with high oxalates.

7. ADD. Many children with attention deficit disorder (ADD) require a higher supplement of magnesium in order to reduce their condition’s symptoms. High levels of oxalate can impede magnesium absorption, so there may be a link between extreme ADD behavior and oxalates.

8. Autistic spectrum disorders. Studies have indicated that children with autistic spectrum disorders have high levels of oxalates in their urine. Reduction in oxalate intake through changes in diet can often improve autistic symptoms.

9. Inflammatory bowel disease. The role played by oxalates in the gut also needs to be considered. There’s a connection between the health of the digestive system and where and how oxalate travels around and out of the body. High oxalate levels have also been linked with several gastrointestinal conditions, including  Crohn’s disease and inflammatory bowel disease, and intestinal permeability or leaky gut, which leads to greatly increased levels of absorbed oxalates.

10. Antibiotics. High levels of antibiotic use can also lead to imbalanced gut microbiome, with resulting oxalate issues. When your gut microbiome isn’t functioning at full capacity,oxalobacter formigenes is unable to metabolize oxalate, causing a build-up of crystals. This can often occur after taking a course of antibiotics, which can kill off your ‘good’ bacteria. Probiotics are often recommended as a defense against recurring kidney stones.

11. Intestinal permeability. In the case of leaky gut, when your intestinal permeability is damaged, your gut wall is unable to be as discerning as it once was, resulting in larger molecules, food debris, and toxins entering the bloodstream. Oxalate is also able to slip through the gaps in the gut lining, bypassing important safeguards and becoming more mobile throughout your body.

12. Mold toxicity. Mold toxicity or chronic inflammatory response syndrome (CIRS) is covered in my essay here. Aspergillus mold species will produce oxalates during their fermentation process. In fact, if I discover high levels of oxalates in a patient’s urine samples, I always look for mold species first and then treat mold as an initial step.

13. Anemia. Oxalates can bind to iron and subsequently lead to chronic anemia. The most common cause of unexplained anemia in women is the loss of menstrual blood due to heavy periods, but high oxalates may be something else to consider regarding unexplained iron or ferritin deficiency with anemia, low hemoglobin, or low hematocrit. If patients begin excreting oxalates bound to iron, they may discover that their urine is rust-colored due to the iron/oxalate deposits. 

14. Mitochondrial disorders and chronic fatigue syndrome. In these conditions, oxalates can destroy mitochondrial membranes and lead to vitamin B1 and antioxidant deficiencies.

15. Eye conditions. Cataracts, styes, and blepharitis are all eye conditions that may also be linked to oxalates.

16. Heavy metals. These are similarly associated with oxalates, as high levels may act as a binder, holding on to metals such as mercury. 

17. Other conditions. A variety of medical conditions in the literature associated with high oxalate levels include diverticulitis, breast cancer, sarcoidosis, osteopenia, osteoporosis, vertigo, endometriosis, and uterine fibroids. 

Resources

https://www.ncbi.nlm.nih.gov/pubmed/27002809

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300851/

https://www.ncbi.nlm.nih.gov/pubmed/28624518

https://www.ncbi.nlm.nih.gov/pubmed/24384768

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192488/

https://www.greatplainslaboratory.com/articles-1/2015/11/13/the-green-smoothie-health-fad-this-road-to-health-hell-is-paved-with-toxic-oxalate-crystals

https://www.ncbi.nlm.nih.gov/pubmed/18264917

https://www.ncbi.nlm.nih.gov/pubmed/18060273

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710657/

https://www.ncbi.nlm.nih.gov/pubmed/1816400

https://www.ncbi.nlm.nih.gov/pubmed/9322615

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2589049/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2589049/pdf/yjbm00034-0005.pdf

https://www.ncbi.nlm.nih.gov/pubmed/17526194

http://www.pulsetoday.co.uk/views/off-duty/could-a-low-oxalate-diet-reduce-the-symptoms-of-fibromyalgia/14635294.article

https://www.ncbi.nlm.nih.gov/pubmed/2435146

https://www.ncbi.nlm.nih.gov/pubmed/21911305

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396938/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300857/

Podcast: Practicing the Medical Arts

Practicing the Medical Arts

Full Transcript

This transcript was automatically generated, please excuse any errors.

Yoshino:

Hey everyone, welcome back to Artist Decoded. This is your host, Yoshino. And, this is yet another Mind/Wave episode. These episodes have been transforming over the course of time, but mainly my intention for these episodes is that I want to explore various modes of thinking. And, I want to hopefully give people an access point to create positive mental health routines. I’m a firm believer in conscious decision-making and in creating a solid foundation for self-reflection, self-care, and self-growth. Creating good habits in all aspects of life is extremely important, which takes a conscious effort to do so. I personally work out about 12 times per week, so that’s twice a day with one day off. I lift weights in the morning and do calisthenics in the morning, and do my cardiovascular activities such as walking, running, and cycling before sunset. I also know from personal experience that good habits, both physically and mentally, have to be developed slowly and over time.

This can be holistically compared to creating a solid foundation for a career in the arts, or just simply having an artistic practice because not everyone necessarily needs to have a career in the arts. But either way, this takes a conscious, consistent, and concerted effort to continue your craft. Which can be likened to anything in life, including developing positive mental health practices, which leads me to my guest for today, Dr. Bruce Hoffman, who is the founder of the Hoffman Centre for Integrative and Functional Medicine.

So let me tell you a bit about Dr. Hoffman. Dr. Bruce Hoffman did not choose the medical arts as a vocation. Originally, he wanted to be a writer and poet. His interest in health and healing developed later in life after a long and winding road of self-discovery, life experience and learning. He only applied to medical school so he could complete a residency in psychiatry and subsequently study Jungian analysis to understand the human condition and behavior. As life would have it, his destiny took him on a different journey. He never did formally pursue a psychiatry residency or Jungian analytic training, but his love for art, poetry, and psychology remains.

Dr. Hoffman was born and educated in South Africa and obtained his medical degree from the University of Cape Town. After two years of compulsory military training, his distaste for the local regime convinced him to immigrate to Canada in 1986, where he pursued family medical practice in rural Saskatchewan, Canada. Once ensconced in the practice of family medicine, he quickly realized that his interests in medicine were broader than just drugs and surgery. The allopathic medical practice was limited to treating symptoms and illnesses, but failed short in restoring the patient’s health entirely. Bruce embarked on a journey to understand what constitutes the human experience. What are the triggers and mediators that perpetuate human suffering? He wanted to assist his patients not only to be free of disease, but to realize their maximum potential.

Well, I hope you all enjoy this podcast episode. There’s a lot of rich information here, so stay tuned for that. But before we begin, please go to our iTunes page, leave us a review. It helps reviewers just like yourself to hear about the podcast. We’re also now on YouTube. There are a lot of new videos and content from past episodes up there. So, check us out over there and be sure to tune into our no wave cinema conversations on Clubhouse. The next conversation will be with me and Justin Dasher Hopkins. We’ll be talking about the classic 1964 Hiroshi Tasha Guevara film, Woman and the Dunes. We will be having this conversation on Wednesday, April 7th at 6:00 PM Pacific Standard Time. So definitely go check it out and listen to us over there. Maybe even contribute to the conversation as well. So anyways, without further ado, here’s my conversation with Dr. Bruce Hoffman. Hope you enjoy it.

Dr. Hoffman, thank you so much for taking the time to do this. And the main reason why I want to bring you on is to talk about good mental health practices and as Maslow would put it to hopefully reach self-actualization. And I think it’s really important for people in general, to be honest with themselves about every single aspect in their life, to live a holistic practice. And I was wondering if you can speak about your early pursuits for wanting to become a writer and poet and how that eventually led you down a path of studying traditional medicine.

Dr. Bruce Hoffman:

Sure. I was brought up in apartheid, South Africa. And initially in quite a conservative traditional home. But at a young age, when my parents got divorced at around age 10, my mother drifted off into more creative endeavors and found herself hanging out with Keith Anderson, who was a head of a circus, also an artist, a set designer with the opera company and the director of the opera company. And so, I found myself hanging out with Keith and his group of merry pranksters, if you will, because they were circus people, artists, creatives, and opera participants. And I found myself as a trapeze artist in a circus that traveled around South Africa, hanging out with these rather unique individuals, clowns, dwarfs, transvestites, just a crazy band of merry pranksters, which at a young age in conservative South Africa was completely unheard of.

So, I was exposed to alternative lifestyles from a young age. But then when my father got wind of this, he sent me off to an all-male boarding school, a thousand miles from home. And when I got to this all-male boarding school, they took one look at me and said; Hoffman, we’re going to knock you back into shape. So, then I was forced into this narrow, masculine boarding school mentality, and I was horrified it was like the worst thing that ever happened. But the school was an outward-bound school based on the boarding school that Prince Charles went to Gordonstoun and Prince Phillip went to. Just based on those same principles, go out into the mountains and find yourself. But after a couple of years of being at a boarding school, I had a school teacher by the name of Roger Loveday. And Roger was a devotee of a guru called Ramana Maharshi. He exposed me to the teachings from India and particularly the subset of Hinduism called  Advaita or non-dual Vedanta. And also at the same time, I got exposed to the writings of Jung; Memories, Dreams, and Reflections- his autobiography had a huge impact on me. And what ended up happening was I had a satori experience.

One day, Roger was speaking to me outside the school, outside the classroom, after he’d given a big dissertation on the bible and Christianity. After I was very cynically inclined at that time. I said to him; Roger, you don’t believe in all of those myths, do you? And he said to me, “of course I do”. And in that moment when he said, of course I do, I had a sudden awakening. I went into the state called non-dual state or satori. And, that’s where all space-time sort of, linear time disappears and you see behind the curtain, so to speak. You see the appearance of reality through the quantum lens, which is, there’s no time, there’s no future, there’s no danger, there’s no fear of death. Everything just dissolves into this oneness and where everything’s light. Which is well-documented in all the literature, many people have had these experiences. But that then set the stage for further exploration of these principles and these studies. I just continued to be inspired by the fact that there was a reality behind the reality that the rest of the world was operating on.

And then my mother applied for me to go to medical school, unbeknownst to me. Why, because she had a friend who had a friend who could get a scholarship for medical school, for somebody from the particular part of the country that I came from. So, she applied and I was actually up in Johannesburg building sets, scenery for a play with Keith Anderson and his group. I got a phone call and my mother said; Oh, by the way, you got into medical school. And I said, what? What’s medicine, I’m go to do what? She said, no, you got to go study medicine. I said, are you out of your mind? I want to go and study literature. Anyway, I ended up going to med school and not knowing what I was doing there. It is quite a peculiar experience. But while I was in medical school, I happened to go and stay on a remote farm up on the mountain. And there were a group of people around that area who were very influenced by the beat poets, Kerouac,  Ginsberg, et cetera. And I started to read them with great sort of joy. And, and then I ended up in my second year of med school, going to San Francisco and started to hang out with Gregory Corso and a lot of the other beat poets. And that was another inspiration for me.

I just got involved in creative endeavors, integrating Jung and Eastern thoughts and philosophies, and then finished my medical training, ended up in rural Saskatchewan as a family practitioner and really loved being a doctor, when I actually discovered what being a doctor was, because I had no clue. But then after a period of a year or two, I realize that this whole N2D2, name of disease, name of drug method of practicing was ridiculous. Even though it serves a function. And then I came across the writings and the videotapes of a medical writer and thinker called Larry Dossey. Larry Dossey had explored the interface between Eastern philosophies and Western medicine. I’ve written quite extensively about it. And, I watched his video and I was like completely moved. I realized that; Hey, I can bring back everything I learned in my youth that I thought I had to leave behind forever into the integration of this kind of medical practice. I flew down, met Larry Dossey, at a conference, had dinner with him. Very inspired, and then started off with that. To eat, discover, and study anything I could across the whole spectrum of medicine. Healing and the healing arts, including anything that could help an individual live at their maximum potential.

People enter into the medical office. I’m sitting in my medical office. I’ve just seen patients this morning and they come in with symptoms of depression, mold illness, Lyme disease, mast cell activation syndrome, a whole host of chronic fatigue or whatever. Then you start to work with a bigger lens are really entry points into a much greater dialogue and a much greater roadmap that you need to bring to the table in order to assist the person through this transformation of illness to wellness. People think they have a disease in which they label, and they think that’s where it begins and ends. But in the system I use and the method I’ve employed, and I’m proud to say that some of the success I have is that I employ a much larger roadmap. It was a much larger set of tools and hence have written about this new curriculum that’s necessary in order to interface with complex patients who can’t just be mechanistically reduced to a diagnosis. It’s actually absurd when you start to think of it. We’re just not trained to think with a different paradigm. We’re very mechanistic in our thought process, but there’s a lot more mystery that goes on into diagnostics and treatment.

What happened after that was that I started to study Chinese medicine, Ayurvedic medicine, homeopathy and German biological medicine, and the the sub-disciplines. And, happened to spend number of years with Deepak Chopra and David Simon. And when I discovered Ayurvedic medicine, they had an explanation of the different layers and levels of what they consider to be human reality, which is stepped down from soul to spirit, to mind, to emotion, to energy, to physicality, to outer world, out there, the expanded universe.

And I started to use that diagnostic model to think of human behavior and illness. And now I’ve incorporated that and expanded that and happened to also, at the time, meet up with a German doctor who’s still alive and still very active, Dietrich Klinghardt. He had also thought of these things and integrated some of these systems into his roadmap. And then I just expanded the roadmap. And now I use the Seven Levels of Diagnosis and Treatment TM across all layers and levels. And when a person enters my room, I use western diagnosis and their symptomatology as an entry point into a much wider dialogue and a much wider diagnostic and therapeutic potential roadmap. So that’s how I work nowadays.

Yoshino:

In terms of just like a, I want to say like a global scale, but I guess, you know, some of the pitfalls for allopathic medicine and the way that it’s practiced in a Western context, like what are some of the things that you’ve observed that needs to change within that context? And how do you think that you implement it in your particular practice?

Dr. Bruce Hoffman:

Well, being a trained western MD, I have the fortunate privilege of being able to look at disease through that lens. And the pitfalls are that the Western diagnosis implies that an organ system gets diseased, then you must find a pharmacology or a therapy or a surgical treatment for that. That is often the case, as we know. Sometimes when you got pneumonia, you want to get intravenous antibiotics, nothing wrong with that. But now we have a whole new paradigm upon us of complex multi-system multi-symptom disease presentations. And that model, that DSM- 10 classification of organ systems and pharmacological interventions is hopelessly inadequate to address those complexities. And it’s quite uncanny really when you start to work with complex patients as to how often western medicine gets it entirely wrong. And it’s only because their tool bag is so limited, it’s this perception that human beings are these mechanistic beings that, a little biochemical particles, that disease just falls out of the sky. And then you got to find a drug to kind of turn down the symptom.

Yoshino:

Do you think that that’s more of a systemic issue or what do you think the actual issue there is?

Dr. Bruce Hoffman:

Well, we think of human beings as being physical bodies, mechanistic bodies. So, it’s the paradigm, it’s the lens through which human beings are observed. That becomes a limiting factor. And we think diseases just fall out of the sky. There’s no antecedents, mediators, and triggers over the inflammatory disease process that is constellated. And we now know generationally, people exhibit, as you spoken with Mark Wolynn, people can come and present with disease processes that the initial triggers have been three generations before they were even born. And that epigenetic transfer of data is real. It’s studied at all the major universities. So that isn’t taken into account in the mechanistic model and the drug-based model. 5 minutes, 10 minutes, what diagnosis, what symptom cluster, what drug, boom. And in America is even worse because your insurance companies control what goes through the gates. And it’s ridiculous. I mean, it’s silly. It’s not how it works.

Yoshino:

Yeah. I think in America, it’s more capitalized, but that’s just part of the whole system. So pharmacologically, it could be traced from that. And also like the way that the educational system is structured as well.

Dr. Bruce Hoffman:

Yeah. It’s a disease-based model, it’s a mechanistic model. And the only therapeutic input that’s of any use is pharmacologically based, and the gateway to that is controlled by the drug industry and the drug lobbyists. It’s very bizarre how it’s all got set up. It’s very peculiar really. Because it’s not real. The human body is the final resting place of every incoming influence. And every top-down influence. The hidden and the obvious. And the body is the final kind of resting place of an individual for all of those influences. And if you don’t start looking at the toxicological logical input of a very diseased planet, the genetics of the individual, which can either detoxify or not that process. And then the influences of the energy body, because we basically, our DNA emits light, which then stands as a standing wave around us, either coherent or incoherently and is highly affected by electromagnetic fields. If you don’t take those things into account, and then the emotional influences we bring up from early childhood, we know from all the literature that children that have been either suffered from abuse trauma, or neglect trauma. Neglect trauma being often more damaging than abuse trauma. They have an infinite amount of increased disease processes later on in life. So, the environmental body, the physical body, the structural body, dentistry, chiropractic, if you don’t take all of those moving parts into play.

Like today, this morning, I saw a woman with a headache, but she had a bite misalignment. She had an overbite, with TMJ issues, had root canals, implants, and had a swollen back of the throat, which we call a Mallampati grade four with sleep apnea. I’m not trained about dentistry as a medical practitioner. I wouldn’t even look in the mouth as a doctor, but its obvious that her dentistry was playing a huge role in her headache presentation. I would just find a drug to treat the headache if I’m using my western practice.

So, the structural piece, then the energetic piece, and then the emotional piece, and then the ego development of the individual. The first half of life, ego structure, which takes us out into the world to become something that drives the first half of life. If we don’t know the internal dialogue of that person, the defenses they develop in order to stay safe, the thoughts that they have, the beliefs that they carry, the value systems, the hierarchy of values that they have. If you sitting in front of a patient and you don’t know their hierarchy of values, you can’t treat them because if their health is a fourth on their value system and running their businesses is the first on their value system, guess what? You have chaos in your low value systems, and you have order, you run your business well, but you’re going to delegate your health to your wife. And you’re not going to show up for all that’s required for you to transform your life. So, if you don’t know the hierarchy of values of people, you can’t really effectively relate to them where they are. Because they will come in and say, they want to feel better. But when you examine their hierarchy of values, it’s fourth on their value list. And unless they raise it, they’re not going to achieve any ends.

Yoshino:

Yeah. I think that’s really important to bring up because, even in that ICI presentation that you were giving, you were talking about how traditional allopathic approaches not taking into account different states of consciousness. And, you know, you could speak obviously more about this than I can, but I’m curious, how would you diagnose someone that doesn’t really take their health into consideration, but is more focused on maybe their business and work and value that as like something that is more important?

Dr. Bruce Hoffman

Oh, I take a history and I have a questionnaire. One of my set of questions, in my 70-page questionnaire, is determining your hierarchy of values. And I ask the question; how do you spend your time, your money, your attention, what you talk about, what you’re surrounded by? And if somebody says, well, I get up at six in the morning, I go to work. I talk business all day. I come home along the cell phone, I’m doing business deals and I’m surrounded by financial books and I watch business TV. It’s pretty obvious where their hierarchy of values is. Well, you got to “rob Peter to pay Paul”. If you want to get your hypertension under control, and  your diabetes under control, how much time are you going to devote to exercise, diet, meditation, sleep, et cetera? And they go, I’ll do my best. I’ll do my best, usually means not much.

Unless you’re inspired to have health as a high value, you have to be motivated from the outside, not inspired from the inside. Motivation lasts six weeks and then you give up, you can’t sustain somebody else’s value system to motivate you if it’s not inside of you.

Yoshino:

Yeah. It’s kind of like that traditional saying, you can lead the horse to water, but ask to take a sip. Maybe sometimes a much bigger sip. So going back to non-duality and speaking of…

Dr. Bruce Hoffman:

Hey, can I just say something? Sorry Yoshino, can I just say something quick just before we leave that subject. Mahatma Gandhi said that the problem with Western medicine is it works. You know, he said that. If you’ve got heartburn, you take a PPI, you take Pepcid, it goes away, nothing to do with what you ate before, how much you drank, blah, blah, blah. So people just take a whole bunch of suppressing drugs and they get on with their life, which is fine. But if you want, if you value health and wellbeing, you want to do a lot to get where you want to be. There’s this whole new group of younger people who are called bio-hackers, who make it their life’s work to study all that it takes to sustain a healthy cell membrane and a healthy internal milieu of the mitochondria. And a brain functioning and sexuality and libido, and they just devote the whole life to enhancing that. And that’s a full-time job. So, there’s is a gradation of what you can expect from a patient from just take a few supplements, to really devote your life, to turning your life around from a health perspective.

Yoshino:

But going back to the non-duality approach, how do you at the Hoffman Centre integrate that into the practice of educating people that are your patients, and then also integrating those more nuanced approaches with allopathic approaches and Western medicine?

Dr. Bruce Hoffman:

Well, the non-duality concept can’t be taught as you know, it’s either happens or it doesn’t happen. You either wake up to non-duality or you don’t. And it’s one of those strange events that other people experience or don’t experience. That’s when you start to see reality from behind, you see it with what they call One Mind. There’s no dual mind, there’s no you and me. We are just part of the same consciousness. Everything is consciousness, and that can’t be taught. Many gurus have set for decades on their stools, talking about the fact that the very thing you seek is preventing you from finding it. So, the very seeking prevents it, it just happens. But that’s a non-dual, that’s Level Seven in my model. But then there’s the other levels which I integrate in my model of assisting people achieve maximum potential within the realms of the dual life. The non-dual part is it can’t be imparted. It happens or not.

Yoshino:

Can you break down your seven-step method, essentially? I’m curious what exactly is in each part of the system.

Dr. Bruce Hoffman:

So, the Ayurvedic or Vedantic breakdown of human reality is we arise from Brahman. The one mind, the unified field, which we call spirit. You won’t be able to see this and I’m not going to attempt, but I sort of broken it down like this. Spirit, soul, intellect, emotion, electromagnetic, physical, extended (bodies). And on each of those stages, each of those layers of an individual’s reality, there’s definitely experiences, anatomical, designations, sciences related, diagnostics and therapeutics. So that’s the system I use. If you look at my website, I believe there’s a chart there, or that ISEAI lecture. That’s a system I practically use in order to assist people and get better. But they all enter through the physical, they come with a diagnosis and their symptomatology. And then I look at all the environmental influences, the biochemical imbalances, the genetics, the structure, the brain, I do, I have a brain treatment center. So, we’re always looking at brain function. And the electromagnetic, heart rate variability, et cetera. And I take a history of early developmental trauma. And then I look at ego structures and defenses and if need be, I send them for psychometric assessments. And then for the soul piece, for the family soul, I use a genogram and do Mark Wolynn’ s work or Bert Hellinger’s work, family constellation work. And for the individual soul, do dreamwork and Jungian type approaches.

So at each layer, there’s different ways of perceiving and experiencing human reality. And so, in a two-hour consult, you’re doing your best to sort of take as much in as you can to get to know that person and where the major blocks are. So even if they come in with Lyme disease, sometimes it’s a question of inherited family trauma, that’s really running the show. Or sometimes it’s due to a traumatic brain injury and they need brainwork. Sometimes it’s all layers, all levels. So having done this for a long time I sort of getting get better and better making the diagnostic and therapeutic recommendations.

Yoshino:

Can you talk a bit about your success stories with this process? I like to understand that a bit.

Dr. Bruce Hoffman

Well, all cases in the end sort of blur into one. But you know, there’s endless amount of patients that present with, say a diagnosis of Lyme disease or mast cell activation syndrome, who believe that that’s the only reason why they are sick. But when they start to explore all the other potential diagnostic possibilities, they all of a sudden realize that that was truly a teleological entry point into a much larger dialogue with themselves. And then they start to explore the whole of their lives and they start to make the necessary adjustments. I’ve got case histories in my upcoming book. I can’t pull one right now because this sort of endless variety of different presentations that I see on a daily basis. I mean, it’s just one little thing today. I saw somebody just very recently who was in her thirties, failed marriage, young child, no direction in life, presents with depression.

Her diagnosis is depression, on antidepressants. And could I help her with her depression and poor self-esteem. Upon further inquiry I found out that she’s moving back home with her parents at the age of 38. And she was very ashamed by all of that. At 38, I don’t know what I’m doing. I’m going back home. What a tragedy. And the man she just divorced, was castigating her for being hopeless, no good, et cetera, et cetera. But when you take a deep inquiry, you see that this soul has had interrupted bonds with her mother at a young age. Mother was separated from her for six weeks. She had a very poor diet. When she went to her mother in teens with developing puberty, her mother was offline, and didn’t see her. She never felt seen. And then she had the series of events, sexual abuse, medication and drug abuse, and then never really found her calling.

So, subsequently turns out that going home to mother and father at age 38 was an opportunity to actually reconnect and heal the interrupted bonds that she’d never been seen in heard for in the first half of her life. So instead of being castigated and feeling so ashamed, she now sees this as an opportunity to reconnect with her mother and father in a truly humble way where the parents, carry the greater weight, and she’s the child. And she can go back and start to integrate her life with her mother’s life and her grandmother’s life, both of whom were artists. She was a makeup artist, but always thought that her makeup career had nothing to do with art. But when it was reframed that she was disconnected from the feminine lineage and her makeup artistry was a continuation of that lineage, she all of a sudden blossomed into the realization that she was part of that maternal lineage and she need not be ashamed of it.

And even though she’d put the makeup artistry aside because of her child and she has to take care of the child because the hours were wrong, she realized she could always pick it up again, and she could step into that female lineage. And she did have a calling. She thought she didn’t, all of a sudden, she knew her whole calling was still on that feminine lineage. Her mother had had a transformation and had said to her; “darling, I realize I didn’t see you when you were younger. I apologize for that”. And all of a sudden, she had this entry into this greater feminine lineage that she could not use so she can pass on to her daughter. So, the daughter doesn’t feel as strained and shameful, et cetera, et cetera. So, yes, she’s depressed. She’s depressed because he’s in an existential crisis of not knowing. She was floundering in life, but she had all this opportunity that’s presenting itself. If she just turned the switches and started to see how it was all part of a grand design that was going to help her realign with her life calling. So, it just gets reframed in a new context and all of a sudden, the life force opens back up.

Yoshino:

Yeah. So, can you speak about the neurological significance of reframing, perceived negative events in one’s life and then transforming them into something positive in one’s mind?

Dr. Bruce Hoffman:

Well, the way I was introduced to, it’s a combination of neuro-linguistic programming and Jungian psychotherapy done cognitively, strangely enough, was through the work of a person by the name of John Demartini. And being exposed to his work, I was able to see how the perceptions that we take into life are often not real. And he uses this teaching tool. He says, look, basically in the quantum world it’s all light. Light gets broken down or dumbed down into matter. Matter is both equal positron and electrons, it’s got both sides. Our lower mind, which always seeks pleasure. One side is always excluding the other side. We always looking for dopamine and trying to avoid pain. And he says, the lower mind can see both sides simultaneously, but you can train your mind to see the integration of both sides to any event, if you just train it. It’s a cognitive restructuring of your mental processes. So, I learned how to do that. I learnt his methodology of how to re-perceive reality through non-dual, if you will, both sides, eyes. So, any event in the future, which looks disastrous, you start asking yourself, where is the upside to this so-called disastrous event? Anything you judge very negatively, like if you judge somebody with very negative trait, you’ll find out where you have the trait, how that trait serves, how that person’s negative trait is benefiting you. It’s not just something that should be a thorn in your side. And how, when you being challenged by a so-called person, who’s is sort of challenging you, where are you being supported? The universe is constantly in this flux of support and challenge, positrons and electrons, which is the basic nature of the quantum reality.

If you can train your higher mind to collapse the world into its opposites, as quickly as possible, you can stay poised in what John calls love. And love to him is just a synthesis of all opposites, where you see both sides simultaneously. And there’s no judgment or no lowering yourself into black and white unipolar perception. So, I try and assist patients like “you going home to mom, this is the most terrible thing at 38, but what is the soul wanting of you? “What is being asked of you? And once I took a history after, she came in saying that this is a horrible thing. She felt so ashamed. She left, she couldn’t wait to go home to see her mother to reconnect because it was reframed. She just saw how it had served her soul’s experience. It was necessary to go home, to receive the love of the mother in a new light, because she had had interrupted bonds all her life with mother. Her mother was ready. She had to be ready. She had to shift the perception from negative, to not positive, but just as opposite. As soon as reframed, boom, I’m going home. Thank God.

Yoshino:

No. Yeah, definitely. I mean, that’s a beautiful story, but I think, especially in the metaphorical sense, you know, when you think of a situation such as a purgatory situation, you can even think about it in certain ways, in a biblical context or in many different stories of purgatory. But we sometimes put ourselves in that purgatory by not seeing the positive association that could be taken out of that negative or what we perceive, quote, unquote, “as that negative lesson of the past”. And if there was something negative that happened the past, if I could say, Oh, that actually helped build my character for who I am today. And then constantly frame it in that context, you can find those lessons. But all those lessons are always there screaming at you to essentially, show themselves in a way that can benefit you. This is at least from my observations.

Dr. Bruce Hoffman:

Yeah. I have the firm belief that every experience that you have, whether it’s positive or negative is serving the projection, the evolution of your life experience. You sort of born over here; you die over there. The acorn does become the oak tree. The acorn needs the wind, the sun, the stresses and support of the environment to become who it’s meant to be. And, I’ve no doubt in my existence, your voids, the things you find most missing, the things you judge the most negatively actually become your highest values. In the end, you look back and I have the unfortunate and fortunate privilege of being in my second half of life. So, when you’re more soul based than ego-based not that you, without ego, not saying that, but you’re more trying to integrate the parts of you that you left behind in your pursuit and the drives of the first half of life when you’re driven. Adler drives, Freud’s drives, that you’re driven to become something in the first half of life.

And then in the second half of life, you try and pick up the pieces of the parts you left behind. And you try and reintegrate your authentic, innate self. And, in that process, you realize everything that ever happened to you was in service of your soul. There was never a mistake. You never were out of purpose for your soul’s trajectory. Nothing ever occurred to you that wasn’t in service of yourself. You have no regrets. And there’s nothing to forgive because everything was in service. Forgiveness is a ridiculous concept because it’s implying that, that one was given to you was wrong. And now you must forgive them. No, everything’s in service. Thank you for giving me that experience. Forgiveness implies I’m bigger than you. What you did to me, you were wrong, I’m right. And now I’m going to forgive you. How dare you, you know. Say, yes, thank you for giving me that experience. It’s always in service of our soul.

Yoshino:

So, speaking specifically about that forgiveness and you speak so passionately about it, but you know, if someone is suffering from some sort of shame or guilt, what sort of questions would you prompt to them to be able to have them question that shame and guilt and where that comes from. I’m curious about that.

Dr. Bruce Hoffman:

So, guilt is the perception, that in the past you’ve done something that’s caused others more pain than pleasure. So, the only question you need to ask is where do you think that experience that you gave that individual, where did it serve them? How did they perhaps benefit from that experience? Could you please look in the seven areas of their life? We have spiritual, which is our calling. We have relationships, social friends, we have health and beauty. We have careers, we have making money. And we have intellectual, mental development. If you feel guilty by some act you’ve done, it’s incumbent upon you to ask; where do you think that person benefited in those areas of their life that served their evolution? Keeping in mind that everything serves, everything is in evolution of the soul’s progression. So where might it have served them? Not where did it damage them? We know that there’s both sides. Yes, it was maybe painful to them, but how did it serve their evolution in the end? And if you ask those questions, which of the seven areas did they benefit, you could find? Some people because of pain, you’ve caused them, branch out and start to develop. They read, they go to courses, they connect with their family because they sort of destitute and in pain that they have to reach out to whoever they can. So, they start forming relationships back with strange family members. They form new friendships. They go online, they go to self-help, they go to retreats. They build careers around the adversity that you caused them. So, at the end of the day, you’ve got to ask the right questions of individuals.

Nobody suffers without gaining. If it doesn’t exist, the universe is not one sided. It doesn’t work that way. Which brings into question the whole victim mentality of “I’m a victim”. No, I’m not, this can provoke a whole outlandish backlash that victims will be up in arms but if you look through the lens of moral and ethics, yes, there’s victims and perpetrators. I’m not questioning that. But if you look through the eyes of the soul, there’s a balance there that’s evolutionary. And, if you look through the right lens, you can see an evolutionary projection. It’s just how I tend to see the world.

Yoshino:

No, that’s great. And I think that it’s interesting because of your background in more traditional western forms of medicine. And also, how you combined the western perspectives and also these eastern perspectives. Or what would be deemed as western and eastern. And, you’re able to eloquently, within practice, like what you do at the Hoffman Centre within practice, to be able to mold these things. And even on your bio, you said writing and poetry, which led you to the medical arts. I think that’s very important because that is what you do. Cause you’re essentially utilizing all of your experiences, your own personal pursuits, such as your pursuit of literature and poetry. And letting that inform you in a way to ask the right questions of your patients. But at the same time to ask the right questions of yourself.

Dr. Bruce Hoffman:

It’s so important Yoshino that you know to stay in an inquiring mode, a student mode. And once you have the privilege of having lived longer is you start to see patterns and trends. You’ll see an individual present with anxiety and OCD and anorexia and so forth and so on, and like a young woman in her thirties. And then you’ll see this archetypal trend that exists that she’s addicted to perfection. And she’s following the value system of a patriarchy, which is inculcated. And she’s introjected somebody else’s value system, like an overbearing father and wants it to achieve. And you see these archetypal trends emerging in your practice. And that’s based on reading, is based on literature, is based on knowing. In the ancient Greek temples, once you’ve gone through, this is in my lecture, the outer healing and the inner healing, you are then sent out into the theater where you watch Greek tragedies, which were archetypal or depictions of life. And you see these trends occurring. You see these people in certain stages. If you don’t know the stage of life the person’s in. Your first half of life patients, very different from second half of life patients. They’re not the same. They’re different flavor, different. You approach them differently. You got to be sensitive to the stage of life. And if I wouldn’t have known that. If I hadn’t been exposed to all these different paradigms of insights.

Yoshino:

Uh, I’m curious. You were speaking of liking essentially, or interested in Jungian philosophy, but also have you read a lot of Joseph Campbell? I’m sure you have.

Dr. Bruce Hoffman

Well, when I first got interested in Jungian work, Joseph Campbell was very popular. He had that PBS series, I think, in the 90’s…

Yoshino:

Power of Myth. Is that right?

Dr. Bruce Hoffman

I don’t know how old you are, Yoshino. Hahaha

Speaker 5:

No, I’m 34.

Dr. Bruce Hoffman:

You probably were. But, Joseph Campbell did the Power of Myth. It was everywhere on PBS. And we watched that series. I’ve got all the videos. We have all the VHS videos of that. I still have that.

Yoshino:

I know I’ve seen them.

Dr. Bruce Hoffman:

I still got them in my library right there. And I read his books and yes, very moved, very beautiful. He was a big influence.

Yoshino:

No, I was just curious, because you were talking about seeing certain patterns and archetypes.

Dr. Bruce Hoffman:

You do see them; you see them over and over again. It’s quite uncanny when you tune to those archetypes. And, you can see when a person is presenting with symptomatology, when it’s got nothing to do with the western diagnosis. When it’s actually a calling from the soul to wake up to a deeper transformation, that’s being asked of them. And you just get used to knowing how to have that dialogue with people and when to watch out for signs and symptoms. And know that, oh, the Lyme disease is not Lyme disease. It’s the fact that they are misaligned with, they haven’t integrated an aspect of themselves, which is calling to be integrated. They’re still living out the first half of life, dictates, which need to be given up at some stage. You can’t,  a 70 year old man in a Ferrari, that’s diagnostic. It’s just is.

Yoshino:

Yeah. I mean, I’m sure you can see many examples of that from either people that are also in your working profession or there’s so many examples of that. And, just someone having a Ferrari at any point of life, you just have to ask, like, what is the reason for that? You know, and also you can only drive one car at a time. They can’t drive two at a time, at least not from what I understand.

Dr. Bruce Hoffman:

Yeah, there’s all those clues, the history taking is filled with clues. And you just got to be sensitive to them and hopefully tuned in as much as you’re able to. And so that requires a whole new curriculum for the healers of the future. It has to be rewritten. The curriculum must be rewritten. Not to say that MDs must become healers. I disagree. Doctors should stay doctors. Stay with all that. Stay with a mechanized symptom-organ system- method medicine. Be very good at it, be the best at it. And leave them alone. Don’t ask them to become healers. Let’s have a new curriculum for healers. People are called into a different way of interrelating with their patients. And let’s have that curriculum outlined. And let’s co-exist with each other in equal exchange, which doesn’t happen. Doctors have this peculiar arrogance that what they’re not up on, they down on. And so, anything that doesn’t fit into that model, they tend to dismiss, which is unfortunate.

Yoshino:

Makes sense. I mean, it’s essentially breaking up the paradigm that if you believed in this certain way of life being educated by the system. And it creates a certain type of way that you think about the world and your perception of your space in it, essentially.

Dr. Bruce Hoffman:

Absolutely.

Yoshino:

I have one more question for you because I don’t want to take too much of your time and I appreciate you for taking the time to be on the podcast, but what sort of advice do you have for artists and creatives?

Dr. Bruce Hoffman:

Wow. I spoke to you before we got on,  that my great love is art. Now in the last 10 years, I rediscovered this huge passion, interests, and I was deeply moved by art and still to this day. Before I answer the question, I was estranged, I was South African living in Canada, and I felt deeply homesick. But as soon as I started to buy South African art with its imagery and symbology, I could bring it over and have it in Canada, I settled down, I had living symbols of my African heritage with me, and there was no such need to go back home. So, I mean, artists generally are tuned in, at a deeper dimension and they bring forth symbolic messages and are able to translate archetypal stories, like poets. When they tuned in and the higher their skill, both intuitive and skill, the deeper the symbolism, the deeper the impact on that, because we all resonate at some level with archetypal symbolism. It hits us like a break when it’s true. And it speaks to us.

So advice, I’m in awe of artists. I mean, those surrealists’ artists like Leonora Carrington. Oh, my goodness. I mean, what were they bringing forth? And what’s really going on. I’m fascinated. I believe some of their outer lives are maybe quite chaotic, but they sort of balanced it with this inner rock of their own unconscious that just pours through them. So, I think it’s an equal balance between outer neuroses, if you will. Then in a solidity and what a beautiful exchange, what a beautiful gift to humanity.

Yoshino:

Well, I mean that’s a sound observation. It sounds like you have a very deep love for and appreciation for the arts and what the arts can provide for humanity.

Dr. Bruce Hoffman

Yeah. Poetry. I mean, Mary Oliver, The Wild Geese. Oh man. When it speaks, it speaks and you just fall over into ecstasy. It’s so archetypally resonant. It’s just makes life meaningful. Provides meaning. It’s a beauty. Beauty and meaning.

Yoshino:

I agree. I agree.

Dr. Bruce Hoffman:

Have you ever seen that movie? The Great Beauty?

Yoshino:

I haven’t, no. When did that come out?

Dr. Bruce Hoffman:

Oh, it’s by that French (incorrect- Italian) director, Paolo Sorrentino. It’s about a man who gets to be in the 60s and nothing inspires him anymore. And so this whole movie is about him visiting sights and sounds. And is in Rome, all this opulence and decadence and nothing excites him. And he’s just like desperate. Until he realizes that at some stage he was moved by a great beauty. It happened to be in the form of a woman he loved. But all of a sudden, he just wakes up to some things that he’s left far behind. And he wakes up into another phase of his life, realizing how many years he’d lived in this outer world without connecting to his true inspiration. It’s a beautiful movie. Wow.

Yoshino:

You know, what that reminds me of,  have you seen Citizen Kane recently?

Dr. Bruce Hoffman:

You know, I saw it once and I read it. I’d read how perfect a movie it was. And when I watched it, I thought, what are they talking about? But after 10 minutes, I watched each frame and I immediately got the majesty and the marvelous sort of symmetry and exactness of the whole development of that movie. And I’ve got why it’s one of the greatest movies of all time. I just could see it just so obvious actually, you know, Jungian.

Yoshino:

Definitely. Well, I just bring that movie up because what you’re talking about specifically at the end of the film. I don’t think I need to say like spoiler alert because this film came out in, I think 1945 or 43, but at the end of the film he just keeps on saying rosebud. And then you find out what that symbolized to him. And so, I think, he does all these things throughout his life to attain power, to attain wealth, but then this was it, I believe it’s a sled when he was a child carried so much meaning and symbolism to him. And it’s just interesting how there’s that consciousness shift. So it just kind of sounded similar to the film that you were telling me about.

Dr. Bruce Hoffman

Well, now I’m going to watch both movies back-to-back and then keep that in mind to see the connections. Well, we live our lives through symbols and meaning in the end, the outer world is just a playground for meaning and symbol.

Yoshino:

It’s interesting. Just to leave you with this, but yeah. I’ve been meaning to crack open Jung the Book of Symbols. Is that what it’s called? I have it downstairs and I need to spend some time, cracking that open. But anyways, thanks so much for doing this and taking the time. I appreciate you for doing this.

Dr. Bruce Hoffman

Yeah, absolutely lovely. I’m going to look at your podcast and see what else you’ve done. That it is inspired me through your connection to the artists and artistry.

Speaker 2:

Yeah. You might like some of the artists, you know? All right, Bruce. Well, thank you very much. I appreciate it.

Dr. Bruce Hoffman:

Thanks for the talk. I appreciate the talk. Thank you.

The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine, and today is no exception. I am delighted to be with a very longtime colleague, Dr. Bruce Hoffman. We’ve got an exciting sort of depth conversation planned for you today. Let me actually spell out why it’s going to be a deep conversation just listening to his extensive training will suggest where we’re going.

So Dr. Hoffman is a Calgary, Canada-based integrative and functional medicine doctor. He is the director of the Hoffman Centre for Integrative Medicine, also The Brain Center of Alberta, specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He’s got a master’s in nutrition. He’s a certified functional medicine practitioner through the Institute for Functional Medicine.

He’s board certified with a fellowship in anti-aging and regenerative medicine. He’s trained in the Shoemaker Mold protocol. He’s a certified Ayurvedic practitioner. He’s trained in Bredesen ReCODE brain treatment, in the MAPS autism training. He’s a certified family constellation therapy specialist. He’s trained in ILADS for Lyme and co-infections.

He’s also a contributing author to the recent paper, which is available. In fact, we’ll link to it on our show notes, from Dr. Afrin’s group titled Diagnosis of Mast Cell Activation Syndrome: a Global Consensus-2. So mast cell activation is something that he’s also focused on. I actually also want to bring to your attention more, just kind of the rich depth. I mean, clearly, Bruce, you’re a lifelong learner, but I think you’ve really kind of taken these things in. I just want to give you a little more of his background.

He’s trained in Chinese medicine, and homeopathy, and German biological medicine. You almost went to get board certified in psychiatry. You wanted to be a Jungian analyst. I found that really interesting, Dr. Hoffman, in your history. And so you bring that to your work now with patients. So you did some of that training, even though you didn’t move into psychiatry, but you did some of that training. You worked with Jon Kabat-Zinn, with Deepak Chopra, with Dr. Klinghardt, with Ken Wilber.

I mean, first of all, welcome to New Frontiers.

Dr. Bruce Hoffman: Thank you, Kara.

Dr. Kara Fitzgerald: And what haven’t you done?

Dr. Bruce Hoffman: It sounds like I don’t have a life.

Dr. Kara Fitzgerald: It’s extraordinary, I want to spell it out. I know that you’re just doing this amazing work with your patients, and you’re fusing this intense training that you’ve undergone, and that you continue to experience into what you described as the Seven Stages of Health and Transformation. So it’s not like you do a weekend course and then the books go away, or the PDFs are put away.

I mean, you’re actually working with these tools and making them into something your own. And it’s called the Seven Stages of Health and Transformation. And I know that you’re working with very complex patients in Canada, and actually beyond Canada. I know people are drawn to your work from all over the place. And so, I want you to talk about the seven stages, and what your approach is to these complex patients that are coming to see you.

Dr. Bruce Hoffman: Yeah, sure. When I was a young teenager, I was exposed to a schoolteacher in South Africa who was very different. And he took us out of our sort of South African apartheid, white, privileged background and sort of threw us into … threw me in particular into an alternative universe whereby I was exposed to the world of psychotherapy, psychoanalysis and eastern thought.

And I had, at a very young age, an experience which they call satori, which is this sense of seeing space-time as a continuous whole and not seeing cause and effect as being linear. And it was a sort of … Many people have these. They are sort of called awakening experiences or high experiences. And that just sort of catapulted me into a different way of looking at things, and then initiated in me a curiosity about all aspects of the human psyche and human development and human potential.

And originally, I sort of got interested in Jungian psychoanalysis and wanted to become an analyst and went to med school only to become an analyst. And I was actually accepted into the psychiatric residency, but actually didn’t go through with it. I worked for two years in psychiatry in the military. I had to go to compulsory military training. But I didn’t actually do my residency.

And I do feel quite privileged in the sense that by not taking that particular route, I was able to keep expanding across all layers and levels of experience. And what I found was when I ended up just being a family doctor in rural Saskatchewan, and seeing the limitations of drug-based, which Majid Ali beautifully named it N2D2 medicine, name of disease, name of drug.

Once you start to see the limitations, and then you start to look at the potential of human achievement and what they can aspire to, one sort of moves out of just treating disease to trying to get your patients to look at optimal potential of their entire existence. And so, what I do now through the seven stage model is view pathology, or the so-called disease states or complex symptomatology, as this entry point into a dialogue with a patient.

But I’m also looking at other aspects of the psyche and the experiences to see what it is that their soul, if you will, is asking to come through. What is it that they’re trying to achieve? Symptoms to me are etiological. They’re sort of pointing towards hidden subjects that need to be brought to the surface. I never see symptoms as linear. I always think of them as what is the body attempting to do by throwing out these particular imbalances?

And with that approach, and using my early exposure to Ayurveda and Advaita, which is a system of Hindu philosophy that I was exposed to by the schoolteacher, and I was able to build a model called the Seven Stages of Health and Transformation, which looks at the human experience as being divided, which is a silly term, because there is no division. But it’s conceptually divided into these layers and levels of experience.

The first level being the outer world, the external environment. And that’s sort of level one in this conceptual field. And from that, we draw everything to do with what’s going on in the chemosphere, outside of ourselves, the toxicology and the infectious load. And we look at that from etiological point of view. That’s level one.

Level two is the physical structure, which is made up of biochemistry and structural aspects. And that is what we do in both traditional medicine and in functional medicine, and in all the structural modalities like chiropractic, and bodywork, et cetera. And then level three is to do with the brain, the peripheral, and the autonomic nervous system, and its electrical effects on physiology and biochemistry. And then what are the manmade EMFs effects on that.

And then level four is to do with the emotional body. And as we know, that many people have these adverse childhood experiences, which then get laid down neurologically in the brain as specific defects particularly in right frontal lobe development, and activation of the amygdala, and the fight-flight response with down regulation of the vagal nerve. And because I have this brain treatment center, you can diagnostically look at this and treat it accordingly.

And then level five is to do with ego development, how people negotiate the slings and arrows of this … The world is a tough place. We’re sort of always somewhat vigilant against the next thing that’s going to arise. And so, we develop in the first half of life a very different set of strategies from in the second half of life in terms of how we develop our ego, which is our sense of how we negotiate the world and our belief systems, our values and our defenses.

People grow up with a way of orientating themselves, but they also remain highly defended to those things which are most traumatic. And depending on early childhood experiences, defenses can be highly helpful or healthy, you could say. But they can also be highly pathological when people suppress anything that comes close to an early experience of trauma, and the so-called PTSD response.

So level five is everything to do with the ego and how it negotiates its way in the world. And the first 30 years are all about ego development and they’re characterized by certain drives, drives of the libido, drives of full power, drives to know oneself. And all the great psychoanalysts of the 19th century were very … They had great insight into these mechanisms.

But they’re now used therapeutically in a system called ISTDP, where psychologists look at different structures that people bring to the therapeutic encounter and work one on one with them in transference and countertransference to try and get behind that which they’re defending against and which is asking to be brought forward. So that level is very important.

And then level six is that what we call the soul. This is the most authentic part of who you are, the most instinctual part of who you are, which never really comes to any sort of conscious assertion until the second half of life, I would say. Carl Jung, the great psychoanalyst wouldn’t look at patients before the age of 40. He said they’ve taken up two drives. There’s no conscious awareness of their deepest self to work with. And so he wouldn’t work with anybody under the age of 40, which is rather strange, but it’s true.

Dr. Kara Fitzgerald: It’s very interesting in this anti-aging obsession that we have, isn’t it? I mean, clearly, there’s some wisdom, but keep going.

Dr. Bruce Hoffman: Yeah. So, in our personal, when we’re born and we’re born into our experiences, very often when you’re not seen by your parents adequately, and being seen by parent, you don’t have to be perfectly seen but a good parent who will always support and challenge a child accordingly. But if there’s any neglect or abuse and neglect-trauma appears to be even more traumatic to a child, an abuse trauma.

The child will develop a provisional self, an adaptive self to go out into the world in order to achieve what it’s meant to achieve. But the authentic self, the instinctual self will often go underground and then be hidden by these defenses and this comes up. I can’t tell you how many people present to me in sort of midlife … Midlife being anywhere from 35 to 55. It starts at somewhat of a younger age when entropy starts to set in.

And they are being driven to ask deeper questions of themselves and to reclaim those parts of themselves, which they know instinctively, they left behind in their pursuit of safety and being seen. So their provisional selves go out, achieve something in the outer world, but there’s something crippled and something quite damaged, or well preserved. Some innocence, well preserved, but it’s hidden from sight.

And people in midlife generally kind of know that. And they want to often go back and retrieve those hidden parts of themselves that they know are manifesting as symptoms, but they have no conscious connection with them. So part of the work I do is trying to find out what … I don’t ask this question out loud, but I’m asking it while I’m interfacing with a patient is, what are these symptoms telling me, and what does the soul want?

What is the innate wisdom and innate creativity of this patient that needs to be brought to the forefront? And that’s the fundamental question that sits there while I’m looking at all the functional medicine, toxicology, biochemistry, hormones, mitochondria. I’m always having these conversations in my head, what does the soul want? What is being asked of this person? What do they need to manifest in order to bring parts of themselves back home?

And that is the second half of life quest really, how do you gain your creative, instinctual self. And not only that, but there’s also another hidden part and that’s a hidden part of your family system. Family systems carry secrets and carry hidden entanglements that often manifest themselves epigenetically and get expressed through biochemistry as symptoms.

And I’ve done some marvelous work with, or I haven’t. But I’ve partnered with Mark Wolynn, who is an exceptionally gifted functional family constellation practitioner. And we looked at, once a year, we used to do a workshop where we looked at the symptoms of patients who came to my clinic and try to link them to any inner entanglements or the family system two to three generations before the patient is even born.

And it’s extraordinary what entanglements you find and what dynamics you find, which can manifest as symptomatology in the patient. And this research is very well established now to all the major universities, that there’s an epigenetic chapter of trauma through the generations. And then lastly, is spirit. The level seven is the spiritual body. And that’s the part of ourselves that’s transcendent to any ego-based space-time demands. And that’s where you surrender to some intelligence greater than yourself and just sort of stay open to that potential. And that’s sort of the whole realm of what we call the one mind beyond space-time.

So I use that model. So when patients present, I’m just trying to sense, they come … One of the great tragedies that I find, or one of the great challenges, not tragedies so much as challenges, is that when you become well versed in functional medicine, people will present and they’ll write in their entry forms. You ask them, “Why are you here?” And they’ll say, “Well, I’ve got mast cell,” Lyme or mold, and whatever.

And they will sort of have reduced their entire symptomatology to what they believe to be a lab test or a symptom that they’re experiencing. And it’s never the case. It’s never the case. Those are just inquiries as an entry points into a much deeper dialogue, in my experience. And so, I’m always curious. Yes, you may have a trigger called Lyme or a trigger mold and mast cells have gone awry. Yes, that’s true.

But really, what’s the deeper reality that we need to sort of work with? And sometimes I get to it, and sometimes I don’t. Sometimes I just treat mast cell, and Lyme, and mold and be done with it. But other times, not. Yeah, sorry?

Dr. Kara Fitzgerald: I mean, what an extraordinary entry into our conversation, thanks for all of that. I mean, it’s amazing. And I can just tell that you are sitting with all of these levels. And I think that, in functional medicine, they talk about gathering before the patient encounter.

Dr. Bruce Hoffman: Yes, that’s right.

Dr. Kara Fitzgerald: And I can hear that you’re gathering at all of those levels, which creates a possibility in the encounter. It’s been extraordinary. So is this written? Have you written about this? Have you-

Dr. Bruce Hoffman: Yeah, I’ve written. I’ve got podcasts with transcripts, and I’ve written a book, which unfortunately, sits on my laptop.

Dr. Kara Fitzgerald: You can link to it on our show notes then. I’m kidding. But it’s powerful. And, well, we’ll bug you about it so that we can link to what you’ve got available in our show notes. It’s an expansion on functional medicine principles in a very important way. So that was one question. And then the other thought that I was having and you started to touch on is, so the presentation, this phenotypic presentation of mast cell activation, or Lyme, and it’s true that our patients will come to us with pretty rigid ideas on this, and what it means.

And as you said, either you move beyond it or you don’t, and you address it and life goes on. But you alluded to in the beginning of your unpacking the seven stages, you alluded to sort of these as having information in and of themselves, like what kind of a … Is there kind of a personality type or somebody who comes with a certain type of a family constellation structure that might be more vulnerable to Lyme and co-infection or might be more vulnerable to autism or MCAS? And can you speak to that?

Dr. Bruce Hoffman: Well, the interplay is complex as you know, from genetics to diet, to sleep, to rest, to toxicology. And to ever increasingly, obviously, to early developmental experiences. I can’t emphasize how profound those experiences play on auto-expression of biochemistry. It’s unbelievable.

Dr. Kara Fitzgerald: I want to just say as an aside that I am with you on that. I mean, we’ve just published a study in looking at DNA methylation, so looking at the epigenome. And one of the things that’s just stopped me in my tracks is this idea of biological embedding, which is exactly what you’re talking about, where the signatures of the psychic experience are laid down on the genome.

Dr. Bruce Hoffman: It’s quite extraordinary. And if people come and they see me, say for mast cell, and then they find themselves doing acute EEG, and the NeuroQuant MRI, and doing neuropsych questionnaires and they go, “Why are you doing all this? I’ve got mast cell.” Well, mast cell is the expression of your, mitochondria undergo the cell danger response. They released ATP, ATP caused the granulation of the mast cell, and the release of a thousand mediators.

So yes, you had mast cell activation syndrome, but what’s underlying, what are all the triggers in functional medicine, the antecedents, mediators and triggers that provoked this mast cell to go crazy? The brain is the interface between one’s epigenetic and early developmental experiences, and one’s outer experiences. The brain is the interface, and if you look at acute EEG, and even a NeuroQuant MRI, you can read biographies of those. They’re so alarmingly informative.

And so, I look at a body-based stress assessment. I look at heart rate variability, as we all do. But then I look at acute EEG, and I look at this sort of juxtaposition of the delta-theta-beta-alpha brainwaves, and you can really see imprints of early developmental trauma. And you can see people who are stuck in fight/flight responses, people who stuck in Porges’ polyvagal, dorsal vagal responses.

You can see it right there in the biochemistry and the physiology. And you know that that person, say, who’s stuck in Porges’ dorsal vagal shutdown response, that’s a whole different patient and somebody who just got a few allergies. You’re dealing with a whole different kettle of fish there. And you can’t just jump right in and just do your normal functional medicine and try a few supplements … It’s a whole another experience, which you have to be sensitized as a practitioner to those layers and levels of complexity. And I use these tools to interpret it.

If you look at it and do a NeuroQuant MRI, you can see the amygdala hypertrophy at like 97 percentile. It’s like twice the size of the standard, the paired match group. You can see amygdala hypertrophy. You can see the thalamus hypertrophy, and the thalamus is rich in mast cells. You can see white matter being decreased, and so forth and so on. You can see all sorts of fingerprints of these complex triggers that can create symptomatology in these complex patients.

Dr. Kara Fitzgerald: Absolutely. It’s just extraordinary. So somebody comes in a typical allergy, seasonal allergy, maybe they’re bad, and so you’ll just treat them accordingly and get them balanced, but it’s relatively straightforward. But you’ve got somebody else also coming in and sneezy, allergic, et cetera, et cetera, but you diagnose this amygdala imbalance. I mean, you go down this whole different direction. Just roughly describe your entry into treatment with these two, with similar phenotypic but very different underlying causes.

Dr. Bruce Hoffman: Well, first of all, I don’t see patients anymore with just simple allergies. I wish I did. But those, I would just treat with H1 or H2 blockers, and Quercetin and vitamin C like all of us know how to do. But people with complex illness who have these multiple layers and levels of imbalances, I throw quite a large diagnostic net. I mean, I do a lot of tests. I’m criticized for it because of costs. But I also know myself well enough to know that without it, I’m going to be just another practitioner along the long chain of practitioners who took a little swipe at something and didn’t get much done, and didn’t look at the complex interface of all the different parameters.

So I do throw a large diagnostic net and do ask for the tests we know so well. Food sensitivities, gut microbiome, histamine levels, zonulin, DAO. I do all the mast cell mediator markers. I do all the ION panels and things like levels in methylation. I do all of that. I look at toxicology.

But I also do quite a lot with the brain, heart rate variability, autonomic nervous system functioning, and often refer for psychometric assessment to look for psychiatric diagnosis, whether they’d be cluster B personality disorders or whether they’d just be mood disorders. So I refer out for those. And I gather all this data. I also refer a lot to dentists and chiropractors particularly NUCCA chiropractors, visceral manipulation therapists.

We do a lot of diagnostics and trying to gather an insight into what hierarchically will be the entry point into this person’s therapeutic experience. I left out the most important, which is I look, apart from food and gut, which of course trumps most things. We look at the mitochondrial functioning and we look at the fatty acids because as you know, the mitochondria, the canaries in the coal mine, and they’re the first thing to sense any danger whether the danger is perceived or real, chemical or imagined.

And we have this credible capacity now through the IGL test in Germany to look at mitochondrial functioning and through BodyBio or the Kennedy Krieger fatty acid test to look at fatty acids. And those are the two tools that have trumped everything else in my practice.

Dr. Kara Fitzgerald: Wow, what is that? Tell me just briefly what the IGL is and then we can link to the … And the Kennedy Krieger and we’ll link to both.

Dr. Bruce Hoffman: So before this test came along, we in functional medicine would look at mitochondrial dysfunction, all we really had was a cheek swab. We had the organic acid test, but now we’ve got this ability to look into about 300 lab parameters that tell us the following: A, mitochondrial numbers, if they’re normal or if they are low in number. And mitochondrion, as you know, when they’re low in number, they must be undergoing some form of autophagy or cell death which ties into Naviaux’s cell danger response theory, that when we’re under threat, perceived or real, mitochondria start to self-destruct and release their ATP extracellularly, that then sends off a whole inflammatory cascade that oxidizes lipid peroxide, cell membranes and leads to this innate immune activation, mast cell activation, et cetera, et cetera.

Dr. Kara Fitzgerald: What’s the specimen? What’s the specimen for that test, sorry?

Dr. Bruce Hoffman: Blood. It’s a blood test.

Dr. Kara Fitzgerald: Both are blood tests, okay.

Dr. Bruce Hoffman: Yeah. So, it goes off and then they measure ATP production. They measure percentage of ATP that’s blocked. They measure cell free DNA. I mean, DNA that’s outside the cell shouldn’t be there.

Dr. Kara Fitzgerald: Where it shouldn’t be here.

Dr. Bruce Hoffman: They look at DNA adducts, toxins sitting on the DNA interfering with protein expression, interfering with the DNA expression of all the factors that go to make up messenger RNA and enzymes, et cetera, et cetera. It looks at phospholipid production. Phospholipids, phosphatidylcholine genome, most potent of all the cellular membrane ingredients.

It measures phosphatidylethanolamine, the phospholipid on the inner membrane which transfers electrons and the electron transport chain. It looks at outer phosphatidylcholine. It looks at cardiolipin synthase enzymes to see if they are making cardiolipin which is part of the inner membrane. It looks at whether you have what your amount of cardiolipin is so you’re looking at your phospholipids content.

It also looks at mold markers, markers for fungal metabolites. It looks at microtoxin metabolites. It looks at superoxide dismutase level. It looks at occupation of cell membranes. It looks at glutathione peroxidase, glutathione transferase. It looks at cell membrane voltage, incredibly helpful. When you’re looking at membrane voltage below 170 millivolts, it’s like 150.

And you’re looking at intracellular calcium excess or magnesium-potassium deficiencies. It looks at methylthionine levels. It’s incredible insight into toxicology and mitochondrial homeostasis. And from that, combined with the Kennedy Krieger fatty acid panel, which looks at your polyunsaturated omega 3, omega 6 levels, and it looks at renegade in very long chain fats and it looks to see if you’re myelinating adequately, et cetera, et cetera.

You can really transform a person’s biochemistry into something that ships them from this so-called cell-doubt, cell-danger response into a healthy response. And it takes an average four to six months of hard-work. But if you address the mental, the mind-body, the defense, the psyche and the biochemistry and toxicology in a hierarchical manner, and sometimes you got to stop biochemical work and you got to go work psychologically or even spiritually sometimes.

But if you start working with complex patients in this way, you’ll very soon know when to stop by a chemical work and to work at another level. If you’re sitting behind a desk and the patient is in front of you, and you’ve done beautiful biochemical work and you know that your work is impeccable and the patient is still sick, you know you’ve addressed the wrong level and it’s time to look at another level.

Dr. Kara Fitzgerald: I would imagine that you’re not … I mean, you said hierarchical, and I think that is true. But you’re doing it concurrently as well. I mean, you must be.

Dr. Bruce Hoffman: You always are. You always do it concurrently, but you learn to sense when it’s time to address, say, amygdala overactivity and vagal nerve shutdown as opposed to doing intravenous lipids and butyrate. Sometimes you’re doing all these beautiful biochemical interventions repeating the nutrition, food, gut and hormones and the patient stays resistant and/or hyperreactive.

And then you know they got an overactive amygdala and/or underactive vagal nerve. And so, you’ve got to shift focus and go down a different path. And just having done this for a long time, I’m sure you have experiences. You get to know when you probably are working at the wrong level.

Dr. Kara Fitzgerald: Yes, it does. This is such a simple thing, but in my residency, we don’t do IV therapy in my clinic here in Connecticut. We mostly do telemedicine these days. But in my residency, back when you and I used to talk, that was also in a clinic setting as well. And just that IV experience, I thought about it because I know you’re doing IV. We set up the environment to bring the energy down and so, even for those individuals who don’t want to hear it, that there’s a psychological component to their presentation.

There’s sort of backdoor ways to enter into that healing relationship or that healing, meeting the needs for healing in that space even when patients don’t want it.

Dr. Bruce Hoffman: It’s such a dance that goes on in this complex relationship between the so-called healer and the one who’s coming for your help. That if you’re not cognizant of the complexities that may arise, one can attempt to impose therapeutics onto a patient when the psyche is not intending to cooperate. It has no intent to allow that vulnerability.

And if you don’t know sort of the trauma of that person, the defenses, the fragility, the resistances, you can often rarely get into a difficult therapeutic encounter. And so it behooves us as healers, whatever the word may be, to stay very conscious of our own projections and our own inabilities and our own blind spots when we’re interfacing with patients.

And yes, they may have amygdala upregulation. They may be fragile and highly resistant. But does that mean that we get rid of them and say, I can’t help you anymore? Does that mean that we have to dig deeper into our consciousness to try and meet them where they are. And if we can unlock the door that’s previously been not open to them, we can assist in unlocking that door, there’s an incredible flood of therapeutic material and healing material that gets unleashed.

So I don’t like to do neuro biofeedback and amygdala training. If the psyche of that patient isn’t receptive to it, so it-

Dr. Kara Fitzgerald: Absolutely.

Dr. Bruce Hoffman: … a lot of conversation and a lot of negotiation sometimes around some of these issues. And people can remain hyper reactive and highly fragile and resistant. And that behooves us to just stay with that patient if we can until something shifts in the psyche and so often it does. Often it does.

Dr. Kara Fitzgerald: Yes, that been my experience as well that when they don’t achieve what they came to me to achieve or they get through some but not all, then perhaps they are open to a broader inquiry. I want to just ask, so I want to talk about, I want to get to your interventions. I know people will be very interested in how you’re addressing some of the mitochondrial issues that you’re seeing. But I just wanted to ask in your time and practice …

I mean, your practice now is self-selecting for challenging cases because you’ve been doing this for a long time and you’re just recognized as an expert, but are you also seeing sort of uptick in these kind of complex patient presentations?

Dr. Bruce Hoffman: It’s all I see now and sometimes, I wish it wasn’t.

Dr. Kara Fitzgerald: Right, I want to go back to insulin resistance case there.

Dr. Bruce Hoffman: Hormone replacement therapy, sure. But I am excited by the challenge. As you know, there’s no rest. I’m in my 60s and I don’t think I’ve studied more now. I mean, when I was a young medical student, that is nothing. This is boot camp all over again. You better stay ahead of all the research and all the latest series and all the latest issues that come across us.

But yes, am I seeing more complex cases? Absolutely.

Dr. Kara Fitzgerald: And there’s a change though, would you just say there’s sort of a change in the challenge of cases? I mean again, just going back to when you and I talked a lot, SIBO might be a challenging case. But those days seem …

Dr. Bruce Hoffman: SIBO is like one of 24 things that need to be looked at. As we’ve expanded our diagnostic possibilities and as new researchers have come up, Afrin and his mast cell activation syndrome along with the other writers and the other researchers, that’s thrown a huge level of insight into a certain presentation that we didn’t have 10 years ago. So, we have that and Naviaux’s mitochondrial cell danger response, unbelievable what that’s done to our consciousness as practitioners.

It just opened up … Now, before when we did functional medicine training, we learned about food, gut, hormones and nutrition. But now, that’s a subset within a subset of complexity. And that stuff, we have to know backwards, otherwise, we can’t get to anywhere. But what else do you bring to the table? And now, we’ve got to bring in all these other things, all these other factors into the healing relationship.

And it is far more complex. There are a lot more sicker people. And they are still looking for N2D2 solution. Even the ones who are educated, they will come and say, “I’ve got mold, Lyme, as I said in the beginning, and can you treat it?” I say, “Sure. But is that what you really have, or is that just what’s showing up as a presenting feature?” People come with false positive antibodies on Lyme test, and they say, “I got Lyme.” “Oh, it’s three on the Armin Lyme EliSpot. Is that really Lyme disease? Is that a false positive?”

And so you got to know all these subtleties. You got to constantly be in touch with the researchers and the lab directors and you got to listen to all the experts in our fields. You got to shine the light of the single aspect. And you got to know how to incorporate that clinically in patient because patients are smart now. They come with all their research.

Dr. Kara Fitzgerald: Yeah, they are.

Dr. Bruce Hoffman: And they know stuff and sometimes, it’s misguided. Sometimes, it’s spot on and they intuitively can often sort of guide a path that is previously hidden from you. They were often uncovered and helped shine a light down a certain pathway. People are smart.

Dr. Kara Fitzgerald: I want to talk a little bit about your approach. I mean we could look at mast cell activation or I mean, the mitochondria. The conversation I think is pretty provocative and one that’s interesting. I mean, are there core biochemical imbalances that you’re looking for?

Dr. Bruce Hoffman: Absolutely, yeah.

Dr. Kara Fitzgerald: Can you just talk about some of these? Let’s pull together somebody with mitochondrial dysfunction, like I want to just kind of pull together how you’re going to address it and maybe what you’re looking for in laboratory and other tools of evidence and then how you’re actually addressing it clinically?

Dr. Bruce Hoffman: Yeah. When people present their history, two, three-hour history, you do your biochemical workup. Take a very extensive dietary history. Usually get dental workup, get sleep studies, NeuroQuant MRIs, brain studies, et cetera. And once you have those in front of you, what do you do first of all? The first thing I do is always look, I use my traditional medical insight and I look at straightforward pathology.

Free T3 is low and the TSH is high, B12 is low. I’d look at straight biochemistry and I never bypass it. I pay very close attention to traditional medicine’s biochemical imbalances, and look at nutrition in great detail. And it behooves us now with all these complex illnesses to know all those approaches to nutrition that are out there whether it’d be GAPS or paleo autoimmune low histamine, et cetera, et cetera.

So, I look at traditional biochemistry. I look at nutrition and then I use nutritionist chef health coach, Justine Stenger, on our staff to take a dietary history and start to introduce a dietary approach which is commensurate with their presentation. And most of the time, it’s a paleo autoimmune low histamine diet, sometimes low FODMAPs, sometimes low oxalate. But generally, I find getting people off some of those major foods that are inflammatory and getting onto paleo autoimmune low histamine diet quietens the microbiome to an extent that we can begin to repair.

So, traditional biochemistry, nutrition, dietary approaches and then start to look at all the things that most functional medicine doctors look at. The food sensitivities, status of a gut, nutritional levels, macro and micronutrients, antioxidants, toxicology, heavy metals, chemicals, mold, fungi, mast cell activation in great detail, and look at hormone levels.

And I look at hormones in three distinct compartments. I don’t just look blood levels. I look at blood, saliva and urine all on the same day to look at the different compartments of how hormones are attached to transport proteins, how they show up at the cell surface and how they get metabolized through the methylation pathways. I’ll look at all three to start with.

And then I look at infectious agents, and I tend to do quite extensive infectious disease workups, both B cell and T cell assessments. I find if you just do T cell, do ELISpots, it’s not enough. And if you don’t do B cell, you often get very confused and go down the wrong pathways.

Dr. Kara Fitzgerald: What tests are you using? Tell me what tests are you using?

Dr. Bruce Hoffman: I’m using the ArminLabs. I do the ELISpot, and I use IGeneX. I do the IGeneX ImmunoBlots and I do the co-infection panels. I use Galaxy labs for the Bartonella. And I do also use MDL labs for some of the other infections, Garth Nicholson’s lab. Those labs are usually used to look at infectious load. And then, so once I had that diagnostic roadmap, and then therapeutically as I said, I’d correct any traditional metabolic imbalances, thyroid, hormone, whatever.

Dr. Kara Fitzgerald: So, you’ll start … So, you’ve got diet. And then you’re going to start them on some thyroid if they need it, some magnesium, some B12, et cetera. So, you’ll do those foundational first step?

Dr. Bruce Hoffman: Yes. And often if there’s great dysregulation in the qEEGs and/or in the stress assessments, and/or in the MoCA cognitive assessment or the CNS vital signs or TOVA, I’ll often start them in neurobiofeedback. I’ll start them on biofeedback programs and start them on neuromodulation techniques using different devices that we use from traditional feedback to Vielight to photomodulation. We’ll use different techniques.

So I often start those concurrent with food and traditional interventions whether it’d be hormones or nutrition. And if the toxic burden is extremely high, I never go ahead and start to detoxify them day one. And I never treat infections in the beginning. Even though Naviaux is very clear that unless you get rid of the threat, you’re not going to change the cell danger response.

So, I usually start out by using oral and intravenous lipid therapy or membrane therapy to try and provoke a mitochondria backing to more of a healing response. And I found that profoundly influential and help in patient outcomes.

Dr. Kara Fitzgerald: What is that?

Dr. Bruce Hoffman: I do a power drink or a membrane stabilizing shake, if you will, where we put into a blender phosphatidylcholine from BodyBio. BodyBio is the only phospholipid I use because of its very high phosphatidylcholine content, which doesn’t break down in the gut. And it contains the phosphatidylethanolamine. It contains all the subfractionations of phospholipids.

So, I use BodyBio phospholipids and BodyBio balanced oils, usually the 6:3 ratio and 4:1 ratio. You put that in the shake along with minerals and electrolytes and then any other ingredient that has shown up in the test that could be instrumental at restoring some homeostatic imbalance. So for instance, if they have low aminos on the ION panel, we use amino acids. If they have low glutathione, we use liquid glutathione as well as oral glutathione as well as oral NAC, all the standard things we learn as functional medicine doctors.

We put in tons of Resveratrol if we can. People tolerate it. And we use usually half a cup or quarter cup of blueberries. We found most people don’t seem to react adversely to blueberries. And then learning from Dr. Kharrazian, we chop up … On a Sunday, I advise patients to go and get every vegetable they like provided it’s not histaminic or oxalates or something on their testing shows they shouldn’t. Organic, chop it up, put it into the freezer. Every day in your shake, you take a couple of tablespoons or half a cup and you put that into the shake with the phospholipids.

And then that becomes a liposomal polyphenolic compound that then crosses the blood brain barrier and exhibits this antioxidant effect intracellularly. So, that’s been a gamechanger for my practice along with intravenous therapies. I start with very, very low dose phospholipids, sometimes vitamins and minerals just to provide the micronutrients for the enzyme systems, sometimes with intravenous amino acids.

But generally, I move over slowly but surely into phosphatidylcholine and glutathione intravenously, not to provoke a massive detoxification response but to try and repair cell membranes. Cell membrane repair is better done with oral phosphatidylcholine, but the IV phosphatidylcholine conjointly with the oral not only helps the cell membrane repair but it also starts to gently sweep adducts off the toxins that are sitting on the DNA of the mitochondria.

But it’s not aggressive. It’s very gentle. Later on, we start to use butyrate and other short-chain fatty acids to further the removal of adducts in toxins.

Dr. Kara Fitzgerald: How are you introducing those?

Dr. Bruce Hoffman: Intravenously and orally. I use them quite a lot. I use oral butyrate and IV butyrate quite a lot.

Dr. Kara Fitzgerald: What’s the oral butyrate? I mean, it’s kind of smelly, but in a capsule like in an enteric-coated capsule? What do you-

Dr. Bruce Hoffman: You can get different kinds. There’s the cal-mag butyrate. There’s the sodium butyrate. There’s sodium potassium butyrate. So, you got to look at the electrolyte balance of the patient and then introduce the specific butyrate formulation that is going to be most helpful for that person’s biochemistry.

So, if they’ve got intracellular calcium deficiency, you’re going to use the calcium one. If they have POTS syndrome … By the way, that’s one of the greatest. One thing I learned 10, 15 years ago was to make sure every patient does the 10-minute, cheap, lying standing test. If you misdiagnosed POTS, that patient is never going to get better.

And I know you’re familiar with it but I do suggest that any young or new practitioner, just get yourself an Omron blood pressure cuff. Every patient that comes in your door, lie them down, do their blood pressure and their pulse after they’ve laid down for a minute or two. Stand them up one minute, three minutes, five minutes, 10 minutes, look at their blood pressure and pulse and look for drops in systolic blood pressures and look at rises in pulse rates.

And those patients don’t perfuse the mitochondria or the brain and they won’t improve until you get increased perfusion to their cellular structures into their brains. They just won’t. You have to treat that first.

Dr. Kara Fitzgerald: And are you addressing it with this protocol?

Dr. Bruce Hoffman: I address that with the standard POTS approaches with increased fluids with salt, a lot of salt, two to three teaspoons of salt. Salt sticks compression stockings and I liberally use Florinef and Midodrin and other medications. And it’s a gamechanger. It’s absolutely a gamechanger in certain patients.

And many people are misdiagnosed. There’s a combination of sort of different … You can get orthostatic hypertension. You can get postural orthostatic tachycardia syndrome, and you can just get pure tachycardias. And they’re different and if I need to differentiate, I send them to cardiologists.

And we have one particular one in our city who does tilt table testing. He’s written lots of papers, very experienced. And so we refer to him to sort of introduce further medications if need be. And patients always know about the triad of dysautonomia and mast cell and gastric motility issues. Many patients present with mast cell activation, POTS, and Ehlers-Danlos syndrome with dysautonomias and gastric motility issues. And they’re called triad or pentad patients as per Afrin’s group.

Dr. Kara Fitzgerald: Why are we seeing more of these people?

Dr. Bruce Hoffman: I think the stresses imposed upon our modern society are overwhelming our defenses. We just become extremely vulnerable to this incoming toxic load. We’re not genetically resilient enough to withstand this onslaught, whether it’d be electromagnetic fields or chemicals or foods. Even the fact that we could open the fridge five times a day, eat what we want, I mean that’s a stressor on our system, it’s unbelievable.

We’ve got out of sync with our innate biorhythms and there’s been a huge movement in the functional medicine community through biodiversity and regenerative agriculture. And we’re paying lip service to this need, but I don’t know. I think our DNA and I think microbiomes will eventually adjust to these incoming onslaughts. I don’t think we’ll be extinguished. It always appears that stresses on the system create greater resilience down the line and barring a sort of huge six apocalypse. I think we will become more resilient as we sort of evolve through this toxic phase that we’re going through.

But right now, I think we’re very vulnerable and we are under a lot of stress, under a lot of toxic load.

Dr. Kara Fitzgerald: Well, we’re kind of heading towards the end of the podcast. This is to clinicians, and so this is going to create a lot of interests in your approach to care. I guess I have two questions. One is, where do people learn more about this model that you’re working from? This sounds so powerful, and I certainly appreciate you’re casting a very wide net and people are coming to you because of that and so forth.

But as you described such a careful start to the journey … By the way, we’re going to try to piece together that shake recipe. That was so awesome. We’ll put it on the show notes, people. It’s just the most sophisticated shake yet, so I want to see if we can pull that together and put something on the show notes.

But I mean you must be seeing some pretty good outcome just after this evaluation and you’re pushing the ship from the shore. I mean you must be seeing some good change. And if not, I’m sure you’re just really going back to rethinking.

Dr. Bruce Hoffman: I don’t have a research assistant in my office, so it’s hard to know outcomes. One believes that one’s practice is achieving remarkable outcomes, but I think unless you have a statistician in there, a hardcore research, we’ll never really know. But what I’ve noticed … By the way, a lecture I did is on my website. I lectured to the ICI Conference and it’s on my website. We are doing one and a half hour synopsis of the seven stages.

Dr. Kara Fitzgerald: Okay, perfect.

Dr. Bruce Hoffman: I think it’s the most insightful sort of snapshot of the levels and layers and complexity that’s possible. So, the outcomes we have from what I can tell, because one never really knows the drop-off rate. I don’t think it’s very large. When patients present with complex illness and you do your due diligence and you throw the net far and wide and the patients can keep up with it, and many patients can because they’re so educated and so driven, they’re so sick and tired of seeing hundreds of people and not getting any better.

And you’re looking at your data and you’re looking at mitochondrial function and fatty acids function and ION panels and things and you do repeat them from time to time. It has been my experience that within six months on average, on average, the test itself reverts from highly problematic to restored function, the IGL test. You will see mitochondrial numbers go from low to normal. You will see phosphatidylcholine go from extremely low to normal. You will see glutathione levels come back. You will see microbial toxins disappear. You will see mercury, lead, cadmium, glyphosate levels disappear.

But concurrent with that, the patient will tell you, “I feel completely different.” And we keep objective, we do different score systems. But I use the old MSQ from IFM. And patient’s levels drop from 180 to 20 once you start working from the mitochondria outwards into the whole complexity of the mind-body and familial inherited system. If you start using a broad map and you just don’t run down too many rabbit holes, and you keep your head above you and you just work it through. And if you hit the blank wall, you just ask more questions. You don’t give up.

Somewhere along in that experience, the patients, they feel better, their symptoms improve and they move through that cell danger 1, 2, 3, into the cell danger 3 response, the healing response. And they feel amazing. We have a large amount of patients who do experience that once they’d gone through their process, but we always preface it with, “Look, this is only as successful as the amount of effort you put in. If you stay passive, there’s nothing we can do. You have to be a cooperative partner in this experience. If you have side effects, you don’t throw baby out with the bathwater. You come to the table. We find out what happened, and you work through this process. And if you can’t, you get yourself somebody, an advocate, who can help you.”

In that sort of dynamic and with the staff, the great staff I have and the support systems and the ability to rerun lab tests from time to time, I would hazard a guess that the majority of our patients get better, the majority. I wish I had the statistic to tell you, but I don’t.

Dr. Kara Fitzgerald: Maybe now is the time to get a PhD student in your practice. It would be really nice to gather. I know you’ve been at this for a long time. It’d be nice to maybe get some data.

Dr. Bruce Hoffman: I think I should, yeah.

Dr. Kara Fitzgerald: Yeah, get a student, that good PhD work. Well, Dr. Hoffman. It was just really lovely to connect with you and talk about this. Folks, we will gather as much as we can for the show notes and link over to the site to some of the content that he’s referencing. And if you think of anything else, just let us know. Thanks for joining me today, for this really nice dive into what you’re doing.

Dr. Bruce Hoffman: Thanks, Kara, and nice to speak to you again after all these years.

Dr. Kara Fitzgerald: Right, absolutely. And hopefully, I’ll see you in person at AIC, not this year but next year.

Dr. Bruce Hoffman: Yeah, maybe, who knows? I quite enjoyed this sort of remote telemedicine, teleconference …

Dr. Kara Fitzgerald:  Thank you kindly, for your time. Much appreciated.

The podcast was originally posted on Dr. Kara Fitzgerald’s website here.

How Does Time Restricted Eating and Intermittent Fasting Work? Part II

How Does Time Restricted Eating and Intermittent Fasting Work? Part II

Intermittent fasting or IF is a practice involving alternating fasting time and/or calorie restriction with periods of feeding that has proven cellular benefits, metabolic gains and remission or reversal for a variety of symptoms and disease states. Time restricted eating is compressing an eating window to a specific number of hours each day. An example of this would be eating all the day’s food within a 6–8-hour window. 

With the prevalence of obesity and chronic disease impacting our healthspan and quality of life, implementing the practices of intermittent fasting or time restricted eating may prove to be an important lifestyle tool for maintaining health and vitality as we age.

In Part One of this series, I went into detail about how intermittent fasting and time restricted eating works along with the long list of health benefits that have been linked to these lifestyle tools. In today’s article, Part Two takes a more practical view regarding the different ways to structure intermittent fasting and time restricted eating. We will also cover some of the most common questions about the safety and details of these two lifestyle practices. This will essentially be a guide to intermittent fasting and time restricted eating for beginners and experienced fasters alike.

This article covers the following topics:

  • How to intermittent fast
  • Does intermittent fasting work?
  • Intermittent fasting times
  • How to do time restricted eating
  • Is intermittent fasting and time restricted eating safe?
  • Are these two practices different for men and women?
  • Can you drink coffee or tea?
  • Does intermittent fasting and time restricted eating promote weight loss?
  • Can a ketogenic diet be combined with intermittent fasting and time restricted eating?

By the end of this article, you’ll know if intermittent fasting and time restricted eating are for you and how to get started.

Time restricted eating meal plan hours – 16:8, 18:6, and 20:4

There are many ways to implement a time restricted eating and/or intermittent fasting plan. Let’s look at some of the most popular schedules for time restricted eating and intermittent fasting.

Type of time restricted eating or intermittent fastingExplanationSample scheduleWhat to eat in your windowTips
Time restricted feeding (TRF)Fast for 16 hours overnight and condense meals into an 8-hour windowFinish dinner by 8 pm then fast until 12 pm the next dayRegular dietMay be practiced daily or a few times per week
Time restricted feeding 18:6 (TRF)Fast for 18 hours overnight and condense meals into a 6-hour eating windowFinish dinner by 6 pm and fast until 12 pm the next dayRegular dietMay be practiced daily or a few times per week
Time restricted feeding 20:4 (TRF)Fast for 20 hours overnight and condense meals into a 4-hour eating windowFinish dinner by 6 pm and fast until 2 pm the next dayRegular dietMay be challenging to meet nutrient needs if practiced daily
One Meal A Day (OMAD)Eat only one meal per day and fast for 23 hoursEat between 12 pm and 1pm each dayRegular dietMay be challenging to meet nutrient needs if practiced daily 
Alternate Day Fasting (ADF)24-hour fast every other dayFor example Monday – Fast Tuesday – Eat Wednesday – Fast Thursday – Eat  Regular dietSafe for several months, long-term challenges (1)
5:2 fasting (periodic fasting)24-hour fast 2 days per weekMonday, Tuesday – Eat Wednesday – Fast Thursday, Friday – Eat Saturday – Fast Sunday – EatRegular diet 
Fasting-Mimicking Diet (FMD)5 days of plant-based dietMay be practiced monthly for between 3 and 6 monthsPlant-based diet of 800 to 1000 calories per dayFood available through Prolon or Whole Food FMD program, available through the Hoffman Centre

With so many options, it may be challenging to determine how to start time restricted feeding or intermittent fasting. For example, do you just dive in or do you ease into it more slowly? I recommend starting with either time restricted feeding (TRF) or with the fasting-mimicking diet. (FMD). With that experience, you can then work with your provider or myself to determine if you’d benefit from other practices.

TRF may begin with a simple 12:12 schedule, meaning that you begin fasting overnight and then eat your regular diet within a twelve-hour eating window. For many people this isn’t that much different from their typical pattern, although they may have to be aware of any tendencies for late night snacking. A fast from 8 pm until breakfast at 8 am the following day is a good schedule to start with. Once you have this under your belt, you can expand your fasting window, in increments if needed, to a fourteen-hour fast with a ten-hour eating window. You can then potentially lengthen this to include a fast of sixteen hours or longer.

The fasting-mimicking diet (FMD) is a five-day program, typically practiced once per month for between three and six months, and then one time every 3-4 months as a maintenance program. During the five day fast, you follow a plant-based, calorie-restricted diet. The diet is derived from plant sources like vegetables, nuts, seeds, and fruit. The diet relies on plant foods for protein, olives, coconut and nuts and seeds for healthy fats. The diet constituents are carefully chosen by a nutritional expert. There is a commercially available program involving packaged constituents called ProLon.

With calories restricted to approximately between 750 and 1100 per day, with day one containing the most calories. This represents a réduction in calories of around 50 to 60 percent, this diet is designed to mimic molecular and cellular fasting while increasing patient compliance. The stomach sees food, while the cells see fasting. (2, 3)

The fasting mimicking diet has been clinically studied as a therapy for a variety of conditions including autoimmunity, breast cancer, and metabolic disease such as heart disease and diabetes. Extensive studies in mice have been completed, along with a few human clinical trials.

In the most recent randomized controlled trial from 2021, obese women received either a five-day fasting mimicking diet or their typical diet with a calorie deficit of 500 calories each day. This particular study didn’t indicate a difference in weight between the two groups, but the women following the fasting-mimicking plan showed reduced insulin resistance and improved appetite regulating hormones, along with preserved muscle mass and metabolic rate. (4)

At the Hoffman Centre, Justine leads a whole food fasting-mimicking program which I’ve personally undertaken three times and seen the dramatic results. An additional benefit to this structure is the group dialogue component and support provided throughout the process.

Learn more about this program here

It’s important to note that many fasting trends such as juice fasting don’t have the same benefits and may even have risks. Prolonged fasting of more than two days without food may contribute to electrolyte imbalances, dizziness, exhaustion, and other symptoms, making compliance quite challenging. Both time restricted feeding and the fasting-mimicking diet offer the benefits of fasting with intermittent fasting rules that are easy to follow.

Frequently asked questions

Let’s dive into some of the most common questions that I’m asked about intermittent fasting and time restricted eating, who it’s recommended for and who it’s not recommended for, along with some details to help you feel more confident moving forward.

Are intermittent fasting and time restricted eating safe?

Intermittent fasting and time restricted eating are safe and effective practices for many people. However, it’s important to work with your doctor, especially if you have a medical condition or take any medications. A doctor should look at your medical history, complete a physical exam, and review any laboratory testing. Please however note that your doctor may not be that familiar with these approaches to nutrition nor know the science behind it. Be sure that you are practicing the most well informed kind of patient advocacy and be prepared to educate you doctor on the subject .

While intermittent fasting and time restricted eating might be beneficial in a variety of medical cases, as explained in Part One, there are many cases in which intermittent fasting and time restricted eating are not indicated including:

  • Pregnancy and lactation
  • Anorexia, underweight, or chronic malnutrition
  • Type 1 diabetes or insulin-dependent Type 2 diabetes (as insulin requirements may plummet dramatically requiring a lowering of insulin dosing)
  • Recent stroke or heart attack
  • Pulmonary embolism or deep vein thrombosis
  • Cardiac instability or atrial fibrillation
  • Advanced kidney disease
  • Advanced liver disease
  • Advanced heart disease
  • Porphyria, MCAD
  • Inability to discontinue medications
  • Inability to obtain adequate rest while fasting
  • Active growth, such as with children or adolescents
  • Current fever, cough, or signs of an active infection (5)

Alternatively, if you’re working on any of the following imbalances or disease states, it may be worth discussing intermittent fasting and time restricted eating with your personal doctor or with myself.

  • Excess weight or obesity
  • Elevated cholesterol
  • Elevated blood pressure
  • Cardiovascular disease
  • Metabolic syndrome or type 2 diabetes
  • Lymphoma and other cancers
  • Digestive imbalance, including SIBO
  • Autoimmune disease
  • Dependency or toxicity

Fasting side effects may include fatigue, weakness, headache, dry mouth, menstrual irregularity, memory impairment, muscle pain, constipation, sugar cravings, and brain fog. Be sure to stay well hydrated and avoid strenuous exercise or extreme environments while fasting. Fasting is the ideal time for rest.

Is intermittent fasting and time restricted eating different for men and women?

While much of the initial intermittent fasting research has been conducted on animals and human men, we’re starting to learn more about the unique needs of women when it comes to fasting. Whereas men have similar hormonal patterns from day to day, women’s hormones fluctuate on a monthly cycle and then decline through perimenopause and menopause. You can learn more in my article on hormone replacement therapy.

Women seem to be more sensitive to over-fasting and restricting their food intake too much, too often. They might see imbalances in stress hormones, thyroid hormones, and sex hormones. In extreme cases, too much fasting may lead to amenorrhea or the loss of a woman’s period, especially when percentage body fat drops below a certain percentage. When it comes to intermittent fasting for women, it’s important to note that more fasting isn’t always better. A less-is-more-approach often applies.

And while each woman is different, it’s challenging to provide advice for fasting in women on a worldwide basis. For example, some women with autoimmune disease do very well with implementing intermittent fasting practices, while others might do more poorly. Remember that fasting is a stressor on the body and this can be a good stressor that leads to autophagy, detoxification, and cellular rejuvenation. Yet if the system is already stressed, fasting can sometimes be the straw that breaks the camel’s back. Often, if a woman is exhausted, overwhelmed, and feeling burnt out this isn’t the time to add even more stress.

In a study of obese women, intermittent fasting combined with calorie restriction was shown to reduce weight over a ten-week period. (6) However, many restrictive methods work in the short-term and we may need to learn more about the long-term results of fasting for women.

In another study comparing men and women in a forty-eight-hour fast, it was noted that women tend to accumulate triglycerides in their muscles, while men accumulate these in their livers, although other physiological aspects during the fast were similar. (7) We certainly need more research to further establish the differences related to long-term fasting practices and the different types of intermittent fasting between men and women regarding the potential benefits fasting.

As always with functional medicine, a personalized approach is best. As discussed above, I recommend starting with gentle time restricted feeding or with the fasting-mimicking diet.

Can I drink coffee or tea during fasting hours?

This question about hot drinks usually leads to hot debate! Whether you can drink coffee while intermittent fasting may depend on what works best for you as an individual.

Experts in the fasting field recommend “complete abstinence from all substances except pure water.” (5) Biological fasting is the absence of anything that triggers nutrient-sensing pathways. (3) This certainly means no protein, carbohydrates, or fats, but most likely no vitamins, minerals, or plant compounds either.

While black coffee or tea, doesn’t contain any calories, it does contain caffeine, which can influence the hormones cortisol and insulin. It also contains phytonutrients, the antioxidant compounds that are absorbed and which rely on digestion and metabolism.

So, what can you drink during intermittent fasting? If you want to be a purist, stick to only water during your fasting window then enjoy coffee or tea with your first meal of the day or at any time within your eating window.

After that, you can experiment with plain coffee or tea within your fasting window and see whether it improves, or deters from, your results. Coffee or tea with added fat, such as bulletproof coffee, should be enjoyed during the eating window.

Does intermittent fasting and time restricted eating help with weight loss?

Weight loss is difficult and traditional strategies are largely based on reducing calories and increasing exercise. However, these strategies, especially extreme versions, typically only produce short-term results. Many factors contribute to weight, including hormones, sleep, stress, nutrient levels, toxin exposure, mindset, and so much more. Simply looking at calories doesn’t always address the situation and a short-lived fast may only result in a Band-Aid effect. Yet for some, even a quick boost in hope and confidence that the body can lose stubborn weight can be a catalyst for deeper change. That’s why discussing how to use fasting with a trained professional is key.

Using intermittent fasting and time restricted eating for weight loss might be a solution, or just part of the weight solution, especially for someone who spends the majority of their time in the fed state. Fasting might provide the metabolic balance that will address some of the underlying physiology contributing to weight gain, such as inflammation, elevated insulin, and oxidative stress.

In a review of different types of intermittent fasting, IF produced similar weight loss results to those derived from caloric restriction. 5:2 fasting was similar to restricting daily calories in nine out of eleven studies. In addition, the majority of the weight loss occurred in the first three months before weight hit a plateau and results were similar with different distributions of macronutrients. Time restricted feeding and caloric restriction also seemed similar as far as weight was concerned. (8)

In a long-term study that compared alternate day fasting or ADF with daily calorie restriction in obese adults, weight loss after one year was 6 percent in the ADF group compared to 5.3 percent in the calorie restriction group, so there wasn’t a huge difference. (9)

When examining human studies involving individuals with diabetes, those practicing time restricted feeding as opposed to consuming six small meals per day lost more weight. The studies also showed more results with intermittent fasting in terms of decreasing A1C and blood glucose, which are markers of diabetes, compared to a common recommendation of eating frequent small meals. (10)

The definitive answer to this question regarding the intermittent fasting weight loss diet may not be clear in the science. However, I’ve seen it used successfully in my practice for patients who are good candidates, along with other functional medicine interventions.

Does intermittent fasting and time restricted eating work while following a ketogenic diet?

Ketogenic diets, time restricted eating, and intermittent fasting are often discussed as going hand in hand. Keto, which is an abbreviation for the ketogenic diet, is a high fat, low carbohydrate eating pattern that in its own way mimics the fasting state through the restriction of dietary glucose. The ketogenic diet, time restricted eating, and intermittent fasting all have the potential to increase ketones in the blood that can be used as fuel by the cells instead of them employing glucose. The ketogenic diet combined with time restricted eating and intermittent fasting may also have similar benefits related to a treatment approach to chronic and metabolic diseases.

To answer the question, yes, intermittent fasting and time restricted eating can be combined with a ketogenic diet. Those following a ketogenic diet that are in a state of ketosis, where the body is efficient at turning fat into ketones and using them as fuel, may have a better experience with fasting and fewer negative side effects. Similarly, those with an existing fasting practice might have an easier time transitioning to a ketogenic diet because their metabolism is already primed to use ketones.

So, while intermittent fasting or time restricted eating combined with a keto diet may certainly be an important dietary approach for some people healing from chronic disease or working to promote longevity, it may be too restrictive for others. This is another reason why working with an experienced practitioner can be so helpful. You can dial in your nutrition plan and then have support adjusting, and even expanding, the diet over time.

We all want to remain healthy and high-functioning as we get older, but it’s about more than living a long time. It’s about improving our quality of life. Intermittent fasting is meant to mimic the balance between feast and famine that humans have always experienced throughout history. Regular feasting is a relatively recent development and this excess time in the fed state may deter us from experiencing all of the important health and longevity benefits that come from fasting. The best part about intermittent fasting is that it makes fasting simple, gentle, and fit into modern life.

To learn more about working with me individually or to join our next group fasting-mimicking diet, please contact my office.

References:

  1. Stekovic S, Hofer SJ, Tripolt N, et al. Alternate Day Fasting Improves Physiological and Molecular Markers of Aging in Healthy, Non-obese Humans [published correction appears in Cell Metab. 2020 Apr 7;31(4):878-881]. Cell Metab. 2019;30(3):462-476.e6.
  2. Di Francesco, A., Di Germanio, C., Bernier, M., de Cabo, R. A time to fast. Science. 2018;362(6416),770-775.
  3. Hong, K. Intermittent Fasting and Fasting Mimicking: Clinical Applications. Presentation. University of Southern California.
  4. Sadeghian M, Hosseini SA, Zare Javid A, Ahmadi Angali K, Mashkournia A. Effect of Fasting-Mimicking Diet or Continuous Energy Restriction on Weight Loss, Body Composition, and Appetite-Regulating Hormones Among Metabolically Healthy Women with Obesity: a Randomized Controlled, Parallel Trial [published online ahead of print, 2021 Jan 9]. Obes Surg. 2021;10.1007/s11695-020-05202-y.
  5. Goldhamer, A. Can Fasting Save Your life. TrueNorth Health Center.
  6. Klempel MC, Kroeger CM, Bhutani S, Trepanowski JF, Varady KA. Intermittent fasting combined with calorie restriction is effective for weight loss and cardio-protection in obese women. Nutr J. 2012;11:98. Published 2012 Nov 21.
  7. Browning JD, Baxter J, Satapati S, Burgess SC. The effect of short-term fasting on liver and skeletal muscle lipid, glucose, and energy metabolism in healthy women and men. J Lipid Res. 2012;53(3):577-586.
  8. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019;11(10):2442. Published 2019 Oct 14.
  9. Trepanowski JF, Kroeger CM, Barnosky A, et al. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med. 2017;177(7):930-938. doi:10.1001/jamainternmed.2017.0936
  10. Muñoz-Hernández L, Márquez-López Z, Mehta R, Aguilar-Salinas CA. Intermittent Fasting as Part of the Management for T2DM: from Animal Models to Human Clinical Studies. Curr Diab Rep. 2020;20(4):13. Published 2020 Mar 12.

How Does Time Restricted Eating and Intermittent Fasting Work? Part I

How Does Time Restricted Eating and Intermittent Fasting Work? Part I

If you’re interested in living a healthier lifestyle, you’ve probably heard of time restricted eating, or intermittent fasting and the success stories associated with incorporating these practices into your life. Despite living longer these days, the healthspan of many Americans is actually cut short as the average person spends seventeen of their final years living in poor health. This is due to chronic diseases such as diabetes, heart disease, cancer, and Alzheimer’s. In fact, 80 percent of older adults have at least one chronic condition, which is primarily related to their lifestyle.

What if time restricted eating or intermittent fasting could be a solution, one of the tools in the kit, to help combat the underlying factors that contribute to such diseases? Is time restricted eating and intermittent fasting simply a diet trend? Or is there a substantial and credible scientific basis to warrant its therapeutic use?

In this two-part series, we’ll explore these questions, and more.

In Part One we’ll examine the nature of time restricted eating and intermittent fasting, how it works, and the health benefits of both practices.

Part Two will cover methods of fasting and time restricted eating, along with answers to the most commonly asked questions regarding this popular practice.

What are time restricted eating and intermittent fasting?

Time restricted eating, (TRF) and intermittent fasting, also referred to as IF, are often treated as if they are one and the same, but there are actually some major differences between the two.

Time restricted eating involves simply alternating periods of eating with periods of fasting. With TRF, all of your eating is compressed into a 1 -12 hour feeding window. Most hours of the waking day, you’ll spend in a feeding state—say from 8:00 am to 4:00 pm. The other hours, you don’t consume any calories, although you are allowed calorie-less drinks, like water, sparkling water, decaffeinated tea and black coffee. Some people, (known as OMAD’s), eat only one meal a day (OMAD) and fast for 23 hours. 

The term intermittent fasting can be confusing and inaccurate. The term ruffles some researchers feathers because there are many different forms of fasting or restriction. It’s important to distinguish between them. The other problem with the term intermittent fasting is the flexibility around the term “fasting.” Most studies on various intermittent fasting schedules allow up to 700 calories per day on fasting days, while others don’t allow any calories. I want to be very particular about the definitions because I think different forms of fasting and different types of restriction may have different physiologic effects, and by lumping all forms of fasting together, we may dilute such insights.

Intermittent fasting includes the fasting-mimicking diet or FMD, where your intake is restricted to between 750 and 1050 calories (approximately) per day for a five-day period out of the month. This has been shown to mimic some of the physiological benefits of water fasting.

In addition, intermittent fasting also includes alternate day fasting or ADF. With this type of fasting a regular diet is followed for one day followed by a day of fasting. Another option is 5:2, which involves five days of regular eating followed by two fasting days in one week. With each of these methods, the fasting days can feature either a water fast or a calorie-reduced diet.

In contrast, a long-term or prolonged fast is considered more than two days and up to several weeks without food.

As you can see, there are several versions of intermittent fasting in which individuals can engage and that have been explored with scientific research. I’ll cover these in more detail when we discuss an intermittent fasting schedule and how to implement it in Part Two of this series.

How intermittent fasting works

If we take a look back in time to more ancestral or hunter-gatherer ways of eating, feasting was always balanced with famine. There were naturally times of the year when food was abundant and times of the year when food was scarce. The human body has the ability to adapt and thrive in both cases.

With the onset of our modern agricultural system, most of us in the developed world no longer have natural periods of fasting and life is a perpetual feast. We have access to whatever food we desire, grown anywhere in the world, every day. It’s no wonder that rates of obesity are the highest they’ve ever been, leading to inflammation and chronic disease. These days the body’s systems never have an opportunity to rest and reset.

So how exactly does intermittent fasting work? To answer this question, we need to go behind the scenes and into the cell to understand what’s happening on the cellular level, in both the fed state and the fasting state.

When we eat a meal, the body’s system is dedicated to processing food, which places the cell in growth mode. Insulin levels are higher, signaling the cell to grow. More specifically, insulin signals mTOR, meaning mammalian target of rapamycin, which instructs the cell to grow and divide. mTOR also decreases autophagy, the process of cellular recycling, that’s predominant during fasting and important for regular repair and maintenance of the cell. (1)

Autophagy naturally declines with age and decreased autophagy is related to neurodegenerative disease, cardiomyopathy, cancer, metabolic syndrome, suppressed immunity, and signs of aging. Boosting autophagy by means of intermittent fasting methods may help to slow or reverse these changes.

In the fasting state AMPK, or 5’ AMP-activated protein kinase, slows down mTOR. This causes fat breakdown and works to activate autophagy, allowing the body to run on its own stored fuel in the form of fat. AMPK also cleans up and repairs parts of the cell that don’t work, an important process that contributes to healthy aging and preventing diseases such as cancer. (1)

In addition, fasting, intermittent fasting, and calorie restriction down regulates IGF-1, or insulin-like growth factor-1. IGF-1 signaling is important for protein synthesis, as well as blood sugar regulation and growth. Later in life, increased IGF-1 can accelerate the aging process and decreasing it, through methods such as IF or time restricted eating, may increase longevity. Studies in mice indicate that employing different types of intermittent fasting can result in an increased lifespan. (1)

When food is scarce, the body conserves energy by downregulating or decreasing both mTOR and IGF-1, which increases stress resilience and protection on the cellular level. In fact, this can be considered inner rejuvenation, which reduces inflammation and increases autophagy. The results include increased stem cell regeneration and improved immunity, especially during fasts lasting more than a few days or by means of fasting-mimicking. (1)

Decreasing IGF-1 also decreases cellular senescence, in which the cell loses its ability to divide, as measured by telomere length. This process of cellular senescence is caused by underlying factors that produce oxidative stress, changes in the epigenetic gene expression, metabolic dysfunction, and mitochondrial dysfunction and the process is considered irreversible. However, decreasing IGF-1 or mTOR increases sirtuins, via the antiaging molecule NAD+, autophagy, and enables DNA repair. (1)

When the body is in a fed state, cells are highly acetylated so that genes are turned on. This helps cells to survive and proliferate. When these genes are on, the ones that are more related to fat metabolism, stress resistance, and cellular repair are turned down. (1)

This is what happens metabolically throughout a longer fast or a fast-mimicking diet over the course of five days.

  • 12 hours: The body transitions from primarily using glucose as fuel to increasing ketones as the preferred fuel for cells, including cells in the brain. (2) This causes an increase in BDNF, or brain-derived neurotropic factor, which allows for increased brain plasticity and neurogenesis. (1)
  • 18 hours: Ketone levels continue to rise. More ketones lead to a decreased need for glucose and insulin, along with more BDNF.
  • 24 hours: Cells increase autophagy, allowing for recycling and the breakdown of old or broken cellular components. (3)
  • 48 hours: Growth hormone (GH) is five times higher than normal, helping to preserve lean muscle mass, reduce fat, and is important for longevity. (4)
  • 54-72 hours: Insulin sensitivity increases and new stem cells and immune cells form. (5)

In summary, on the cellular level, fasting results in the following:

  • Decreased mTOR
  • Reduced IGF-1
  • Increased AMPK
  • Increased autophagy
  • Greater NAD+ and sirtuins
  • Increased ketones
  • Increased BDNF
  • Increased GH
  • Reduced levels of insulin and blood glucose
  • Decreased cellular senescence
  • Increased fat metabolism
  • Improved resistance to cellular stress
  • Reduced inflammation

Our bodies still need both the fed and fasting state, but in our modern culture the balance strongly favors always being fed. Intentional fasting may be a way to add greater balance to the system by allowing for these natural cellular processes that primarily happen in the fasted state.

Health Benefits of Intermittent Fasting and Time Restrictive Eating

Now that we’ve covered the science of fasting and time restricted eating, the question I’m often asked is whether these practices work in regard to health and longevity. This is an exciting area of study, using a wide variety of animal models, along with increasing numbers of studies in humans, in order to decipher the potential benefits of intermittent fasting and implementing time restricted eating.

Research has indicated a number of positive clinical benefits related to intermittent fasting and time restricted eating

  • Weight loss
  • Changes in body composition/fat loss
  • Improved insulin sensitivity or decreased insulin resistance
  • Reduced oxidative stress
  • Increased cellular autophagy
  • Stem cell regeneration
  • Optimized neurogenesis
  • Enhanced parasympathetic nervous system response
  • Improved gut motility, which is important for conditions like SIBO
  • Reduced heart rate
  • Reduced blood pressure
  • Improved lipid/cholesterol balance
  • Improved cognitive function
  • Improved detoxification
  • Improved physical performance
  • Improved sleep patterns
  • Improved immunity (1,6,7)

Taken together, all these clinical benefits translate into important applications related to longevity and chronic disease reversal. Intermittent fasting results are clearly beneficial for a variety of disease states and populations, including those with cardiovascular disease, diabetes, obesity, dementia, cancer, depression, and a number of other conditions. (6,7)

Intermittent fasting addresses the metabolic root causes that contribute to disease over time. IF and time restricted eating may be an important lifestyle tool, along with diet, physical activity, and stress reduction, that brings health more into balance.

In Part Two of this series on intermittent fasting, we explore the specifics of the different types of intermittent fasting, along with how to implement an intermittent fasting schedule. We’ll then cover some frequently asked questions on the topic and provide details and guidance to get you started.

If you’re looking for more personalized guidance, or are interested in our whole food fasting-mimicking program available through Justine Stenger and the Hoffman Centre for Integrative and Functional Medicine, please contact us for more information.

References:

  1. Hong, K. Intermittent Fasting and Fasting Mimicking: Science and Molecular Mechanisms. Presentation. University of Southern California.
  2. Anton SD, Moehl K, Donahoo WT, et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018;26(2):254-268.
  3. Alirezaei M, Kemball CC, Flynn CT, Wood MR, Whitton JL, Kiosses WB. Short-term fasting induces profound neuronal autophagy. Autophagy. 2010;6(6):702-710.
  4. Hartman ML, Veldhuis JD, Johnson ML, et al. Augmented growth hormone (GH) secretory burst frequency and amplitude mediate enhanced GH secretion during a two-day fast in normal men. J Clin Endocrinol Metab. 1992;74(4):757-765.
  5. Klein S, Sakurai Y, Romijn JA, Carroll RM. Progressive alterations in lipid and glucose metabolism during short-term fasting in young adult men. Am J Physiol. 1993;265(5 Pt 1):E801-E806.
  6. Hong, K. Intermittent Fasting and Fasting Mimicking: Clinical Applications. Presentation. University of Southern California.
  7. Goldhamer, A. Can Fasting Save Your life. TrueNorth Health Center.
  8. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019;11(10):2442. Published 2019 Oct 14.