Dr Julia Piper - 12th Feb 2020 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.
Linda Elsegood: I'd like to introduce my guest today, Dr Julia Piper from Private GP Services in Leicester in the UK. Thanks for joining me today, Julia.
Julia Piper: Oh, it's a pleasure. Lovely to speak with you Linda and all your listeners.
Linda Elsegood: Thank you. First of all, let's get to know you, what made you decide to become a doctor.
Julia Piper: Oh gosh, Linda, that was years ago. I think it was only six years old, and I always wanted to become a doctor. I remember my cousin was a doctor and I was completely obsessed with how wonderful she was. To do this and want to do it. And eventually, she became a haematologist.
I just never wanted to do anything else. My father said, why didn't you become an engineer? And I could, I just couldn't relate to anything else and that was it really. I mean, people tried to dissuade me over the years for a number of reasons, I guess, you know, to do with the number of hours you're going to have to work, but it didn't quite work, you know, it's like, I'm on my right path, let's put it that way.
Linda Elsegood: Oh, wow. So where did you study?
Julia Piper: Nottingham University. I chose that because it was very beautiful and green, and I liked being out of doors. I could have gone to London I guess because we lived in Kent at the time but, I chose Nottingham, and it had quite a different course. You were assessed by continual assessments so that you had exams at the end of every term.
You became a bachelor of Medical Science, so you learned how to be a scientist as well and apart from that it was very similar to other courses, but it was just this, that didn't have to sort of leaving everything to the finals. After two years you really sort of kept on top of things as you went through
Linda Elsegood: okay. So when you qualified, what path did you take then?
Julia Piper: Well, I always wanted to be a GP because I loved being out in the community with families and so on. And so I went into vocational training, and I did my own vocational training course, which, in those days, we were able to choose different specialities.
And we did that for two years. And then we had to do a year in general practice. And then I went into a GP practice in Yorkshire where I lived at the time and moved down to Hertfordshire in general practice there and now, and then moved up to Leicestershire, which is where I am at the moment. So I had quite a lot of experience in the NHS, you know, before I, I actually then eventually moved into the private sector.
I mean, it wasn't really planned this move into the private sector only that I guess I wanted a little bit more time with people and just to have a morning a week where people could just ring me up and say, can I have half an hour? I need more time. Because it was so, you were so stretched for time in the NHS, and so that was meant to be anything else but of, you know, we all know their life changes and evolves, doesn't it?
It changes, and they both send. Eventually, as I say, I went into the private sector and started to see a few patients privately. Interestingly over the years that changed because, I suppose with the regulatory framework changing with the care quality commission, and so on, we had to professionalize our systems and we were the first in the UK to be registered with the care quality commission.
And eventually, I had to make a decision to leave the NHS and some of it, a lot of the locum work I was doing at the time and move totally into the private sector. So I've been doing this now for 25 years, so it's a long time, isn't it?
Linda Elsegood: Very long time, but it must be very frustrating being a doctor if you have a patient that has a chronic condition, how do you possibly understand all the symptoms and everything they are going through in 10 minutes.
Julia Piper: Well, absolutely. It's interesting. I think that the way we were trained at medical school and the way doctors, in general, have been trained, up until recently things are beginning to move in different directions.
Now maybe. but I think we would, we were trained very much to give a label to a disease that that disease has certain evidence-based treatments with drugs or surgery. But what I found as I've moved through life, in particular as we had illnesses in our own family and also with my son's illness of schizophrenia, I have a son who’s has been in incredibly poorly and you know, I, I began to seek other routes to understand what I could do because I felt so frustrated it was like he would give me a prescription on your pad when it became a doctor, and you had to write on it, you know what the medication was or refer to a specialist or to surgery and it seems like we didn't really, we weren’t taught to do anything else. But as I moved into the private sector and I had a bit more time, I think I felt quite guilty that I actually thought I have people coming to see me who are really poorly and there must be more than this. And I think at a very young stage, especially with my sister dying from ovarian cancer, I started to look into alternative routes to heal people and to help to really understand, you know, why both the Chinese chose acupuncture?
I mean. There were clever. They had no science in those days, but they had observed and you had thousands of years of observation and knowledge that, you know, we didn't seem to be taking any notice of. So I trained in acupuncture, I trained in hypnotherapy. And moreover the last few years, I've been training into functional or biological systems medicine.
So that was the root really. It was just frustration. You know that we stopped too soon or we seem to diagnose a disease when it got there, but we didn't seem to do anything to help reduce the risk of developing it. And we didn't seem to do enough when we had made that diagnosis, we didn't have enough tools.
Linda Elsegood: And of course it would seem to me that doctors treat the symptoms rather than the cause, to find the underlying problem, and then the symptoms go away, but you don't actually need to then treat the symptoms.
Julia Piper: I see. Yes, that's right. I mean, that's really the way we're trained. I think that was my biggest frustration that and I can understand that, you know, once we’ve got a diagnosis, but sometimes medications can be incredibly helpful in the right place but they're not necessarily a panacea, sometimes say, Oh, but you know, we need to have these the tools and understanding this as a body so that we can recognize the causes and the pathway to illness. Because if we don't understand that we a) can’t prevent problems. But b), you know, it's more difficult to turn around some of the symptoms that we see, as you say at the root cause. I agree with you on that one completely.
Linda Elsegood: So how long ago was it when you first heard about LDN?
Julia Piper: Mmm. Interesting. Low Dose Naltrexone, I mean, I knew about it for many years actually with those patients that came to see me when I was working in the NHS who were taking Low Dose Naltrexone. So at that time, it wasn't on our list of things that we should be doing.
And so I, probably because I was too busy, you know, seeing so many patients with the NHS, I didn't really look into that further. But I came across it again about five or six years ago. Again, when looking at patients who are chronically ill, studying to a much deeper level with functional medicine and biological systems medicine and not trying to understand what was happening with the immune system because it seemed to me, that it became apparent anyway way to me, but actually much many of our symptoms in our bodies, be it headaches or tummy aches or you know, all the root of chronic illnesses such as MS, Parkinson's disease, where are due to inflammation. And that is so closely tied to the immune system. And that there’s a disruption in our immune system. When I think of the immune system these days, I suppose, I think of it as rather than an army who goes and tries to sort of kill the baddies. I tried to think of it as an intelligence service like MI5? It's very complex, actually working out who is for us and who is against us. Because actually, you know, under different circumstances, you know, that those situations can be, can co-exist right? So I think that's, in terms of, as I began to understand the immune system and look at, say for example, for those people who are au fait with the immune system, the TH1 & the TH2 parts of the immune system and how they become imbalanced, for many reasons and often associated with underlying conditions, depending on how unbalanced they are, you know, it became much easier to understand why a medication such as Low Dose Naltrexone would work and I think, you know, my first foray into that was with people who had autoimmune conditions and whose cellular immunity was not working as well as it might do. And who, probably alongside, developed chronic stealth infection but actually LDN was a very good tool to be able to correct some of the imbalances that had developed.
and as we know there are many, many autoimmune conditions. And as we develop the how-to, how to phrase it, sort of imbalances in the immune system or in the intelligence network that, you know, we need, we need more tools to be able to correct those. But also remembering that as we develop a problem within the immune system, that that really runs alongside some of these chronic stealth infections that then are allowed to develop.
So as I say, what I found with low dose naltrexone, it's a great adjunct. I mean, sometimes it's very good on its own but I find that on its own, the body becomes so complex that no one thing normally is enough to, to get us better. You know, if I've introduced Low Dose Naltrexone, it's on the background of someone that understands the importance of the gut and understands the importance of, you know, having a great diet that is tailor-made to suit them. We all have different idiosyncrasies with our diet, but really we've got to be able to work with our lifestyles and our relationships, our exercise patterns, you know, everything really, as well as having these tools that can help to modulate the immune system and give us that extra bit of support at a much deeper level.
Linda Elsegood: Mmm. Yes. What have patient outcomes been? Could you quote us any case studies?
Julia Piper: Well, interestingly, I suppose my son was a very good case study in that he had a diagnosis of schizophrenia many years ago. He's 34 now, but he's done incredibly well. I mean, he initially was, had drug-resistant schizophrenia and eventually was switched onto something called Clozapine, and he remains on that for various reasons because we're still working with him. He now on a combination of Clozapine and low dose naltrexone, and he takes a lipotherm glutathione. but along the way, we had, you know, remember when the brain is inflamed, when you have neuroinflammation that our cognitive processes in schizophrenia and in many conditions, but particularly schizophrenia, completely change.
And therefore our perceptions completely change and there are times when the brain becomes fragmented. Schizophrenia is a form of dementia, okay. So that we've managed to turn that around a lot by diet and by diagnosing underlying stealth infections, which were treated. But interestingly, this combination of the medication, which again would be working, eventually, it may be to reduce that, but at the moment, he is stable on the medication. Plus, we initially had IV glutathione and now we're onto the liposomal form, remembering that that enters the cells and can pull out metal such as mercury, which we’ve measured, And we know that that's at the root of his particular problems. Part of it. the LDN availability the Low Dose Naltrexone in him has been a great success because with schizophrenia, the microbial activation that happens when you've got cytokines. Cytokines are little messengers produced by the immune system when there's a lot of these around, you know, the immune system of the brain, which is called the microglia, becomes activated and Low Dose Naltrexone, we know, calms that down and it restores the TH1 to TH2 balance. So it means that the tendency towards infection in autoimmune conditions and there are many of them, you know, obviously the inflammatory bowel diseases, Crohn’s disease, rheumatoid arthritis. I mean, there are over 100 different conditions. And many people may not realize that schizophrenia, for example, it's an autoimmune condition, but they are all helped when we address this TH1 to TH2 balance and increase T regulatory cells. That's a lot happening when we're using this, I've had great success, Linda, in David, my son, but we use it as part of a multidisciplinary approach because we're looking for particular weaknesses, if you like, of, or dials that we can turn in our biological systems that the body will be up to shift with. And when, when we're working on each of those dials simultaneously, at some point, there's a shift and the body is more able to sustain itself in a healthy manner. And I'd like to see more if this biological system of medicine really taught to university, I believe it's becoming more mainstream, I know Bristol university have a scientific department which teaches science underlying functional medicine and I know, a colleague of mine, her daughter's training there. So, you know, things are beginning to shift so that we understand, you know, what it is we're trying to do in modulating and change things at the root level. I think that's good, don’t you?
Linda Elsegood: Yes, definitely. Now, when a patient comes to see you and you've got more than 10 minutes, who obviously has some chronic disease, but they don't know what's wrong with them. How do you go about helping that person when they've walked in, and you know nothing about them? How do you set about treating them? What's the road map?
Julia Piper: That's a good question. I have a detailed questionnaire, because I really need them to fill out because I like to gain as much information on paper before somebody walked through the door, so it includes the multiple systems questionnaire, for example, I can see quite quickly if somebody is scored like two on the multiple systems questionnaire, then those two symptoms might be incredibly distressing
but I suppose somebody who's scored 165 and like you sort of just gets this. I think I know the questionnaire, I know what I'm looking for. You know, and we’re asking quite deep questions sometimes to get people to try and think down to the root. You know, what may be their pathway to illness and with functional medicine, we're looking at the detailed question, detailed history. And a road map. They're doing a flow chart as often as someone's life, just to see where these pivotal points are. And when you do that, it becomes much more obvious at what point and what are the triggers and the mediators and you know, the, um, the pathway to wellness, the antecedents, if you like.
So, for example, I mean, I suppose tick bites and the Lyme disease, or even what may turn out to be a chronic infection, for example. We refer to Lyme disease as something which is a chronic and difficult, in fact, the wording and the nomenklatura the naming of these long term conditions now and not so much Lyme as something called M-S. I. D. S. multiple systemic inflammatory disease and infectious disease. So disease syndrome of multiple systemic infectious disease syndrome. And these conditions can become chronic. But if you look at this questionnaire, and you look at the flowchart as someone comes in, you can see how they had, what are the triggers, you know, if there's something recent that suddenly made them present and pick up where your pivotal points are.
And if say for example, in the case of M-SIDS or Lyme, we can, if we can pick up someone lives in a forest or lives in an endemic area of the new forest in the UK, for example, and has had tick bites. Okay. That's not the only thing that's made them ill, but that's a pretty important point that we need to not to miss.
And we asked a lot about toxicology. We ask about—exposures about sensitivities. You know, people have multiple chemical sensitivities. At the root of functional medicine, in the end, two things. One infection and two, toxic insult to the body.
And we want to know what is burdening this person's body that they are suffering from so many symptoms. Almost list numerous systems, too many to this, or you can look at the systems that are going that had been affected that may be producing these symptoms.
So my map, if you like, to gain as much information, particularly about, it's about everything, but it's particularly at the root cause and particularly in a section of the body burden. Does that make sense?
Linda Elsegood: And how long does it take on the first consultation with a patient to go through.
Julia Piper: Well, I would say we normally try to allow an hour because by the time they've come to see me, people's often seen in quite a few different doctors. Physical a few little tests. They've been with them and then they've completed this questionnaire, which I find enormously helpful because I can get, I can, I get a really good feel quite quickly.
With what is going on because there's, you know, once you've understood and you've worked for systems biology for a long time and studied hard, you can start to see where the pivotal points are even sometimes before you've tested. There's that first time. Well, I'll do a flow chart to see exactly what's been happening over their lifetime, and I can pull it, pull into any tests that may be completely personal to just, you know, pinpoint and a little bit more exactly which dials we need to turn to get somebody better.
So we normally. Sometimes you can get a few little tests done on the day, but I don't normally like to do tests the first time I see someone, because I like to email everybody with potentially a few tests they may need and then you can have a little think about them. And then we can have another little chat often by phone.
because people would sometimes come from quite a distance so I don't want to drag them back. We usually do a little examination at the end of the first hour, and then I'll send them a list of things that I think would be sensible. And then you know, the sort of little few little thoughts about, how, I think the road map is and why we need these tests if any.
The test can be quite expensive, unfortunately. See, we don't always test, but sometimes it can just target you a bit easier. It's quite in order for patients to go back and get the simple tests and that GP of course, and we can sometimes, well since example, I do less just to give an example, less a food sensitivity test now I tend to do the elimination diet and take out things that we know can cause problems. And so it's possible to do things more pragmatically as well. So but that's, that's what I did today. So I'm kind of, I've got to go back and do a couple of emails to patients and, you know think about exactly which tests that we do.
Then when we get the results, we can start with low hanging fruit and then move forward. I'm actually in a situation to see a lot of people, people who are seeing different doctors. So I'm usually, they've had most of the tests done by the way. So my job is seeing where the gaps are and how else we can support, you know, in ways that haven't been considered at that point.
Linda Elsegood: And of course, a lot of people are still unaware that if they've had tests done by their own GP that you are allowed to ask for a copy. You can be charged, but everything you are allowed to have access to everything.
Julia Piper: And very important people know that they can have a test by the GP and go back and get them. I can write them down what you need, and you then go and ask them. And it's difficult because some people don't like to go and ask their GP for tests because you know, they, they feel that they might get upset or something. So that they'll only know if you could, I can write them down for you and then I can always write to GP’s if that’s necessary.
I think this is a shame really because a lot of doctors, understandably, I mean, I would have been in the same position if I'd been in the NHS. You know you haven't got time and having the study date, it takes years of study and understanding. When you look through a lens of root cause medicine, it's really hard, you know, because we were trained in such a different way.
But to me, the two can live together well. And the new young doctor at the DePaul side plan, bring out the functional medicine because there's a frustration in the way that they and I do some work at the investor heavy recently in Leicester. And we had a few students, one by one coming in, one sitting with me, and then we had a meeting with them at the end. And I just sat down with them for a day, and I just tell them my son's story, you know? And I said, how much nutrition training have you had? And it's actually zero. Yeah. And it was a shame and I feel so sad and I think to myself, you know, really when I trained, I didn’t know anything about it either, you know, and I say, I think life has changed.
It's for the better. I know we, so, gosh, there were on the internet and wifi, and EMF obviously, we have to limit our exposure, but I feel like there's a lot that's getting better because people understand so much more now. But having said that. I'm thinking it must be very frustrating if you're on an HSG PA traditionally trained these days because a lot of patients that got anything about being ill will know more about it than you do as they come through the door, because they've looked at some of the root causes, and I think it must be very frustrating to be
A doctor in this day and age with such knowledgeable patients because I'm contrary to what a lot of people, and I think Google is amazing. I think the knowledge has got on there, you know?
Linda Elsegood: Well, we're nearly at the end of the show Julia, but just wanted to ask if a patient goes to the doctor and explains that they've been to see you, would you be happy to work with the GP as well?
Julia Piper: Oh, gosh, yes, very much so. I mean I think a lot of GP’s are very, very busy and you know, again, some people probably feel a bit upset because they feel a bit threatened and that's a shame. You know, it's difficult I think in some cases we have quite a few patients who, especially when their children are involved, you know we have to look after the family and communicate to all agencies because a lot, there's a lot of misunderstanding around children with multiple symptoms and where traditional diagnosis could not be found. Sometimes there’s a lot of pressure put on the families that maybe they're making them up or making the child ill or whatever. So, you know, I do a lot of work with working on explaining carefully what we're doing and actually that is some problem going on and here with the test results. And so we do do that. And sometimes it can be very difficult, you know because people do feel a bit threatened, especially when they don't understand something. Obviously you were working with weird situations and with thought processes,..... mass guidelines.
And so I haven't set up, I mean, B12 injection, somehow we use B12 is something that's actually within the nice guidelines and sometimes you end up, you know, just explaining, well actually you can give this because this person has their neurological condition. And that's what it says in the novice guidelines that sometimes you have got that backing.
But I think the answer is yes, we will work with the NHS under the doctors, and we should be working as a team, and we should be trying to separate things out that sometimes, in reality, we have to, but that's, that's the decision. If the patient, when it comes to a child that has no choice because it's not that time particularly.
Well, you know. Cause of child children in need or child safeguarding. We all compelled to communicate, and we have to communicate. So am I making that up? Yes, I am. I'm just kidding. Basically, yes. And sometimes that's a choice in it, and sometimes there isn't.
Linda Elsegood: Okay. Now if people want to come to see you, do you have a waiting list?
Julia Piper: Not at the moment no, we don't. We have, I don't, you know, I think at the moment, I don't work all day, every day seeing patients because I tried to keep a balance but we have other doctors here who I work with and we have a lovely coach, health coach and a nutrition coach and a nutritionist who came in and went with us as well.
So, that's the way we do it. So sometimes if you know, I didn't need to do everything, then I can ask them, and I'll tell them certain things. And I find that you know, you can sort of work out what you might need to do in life and then you need that little bit of extra sort of access from a motivational perspective.
She may not change, cause sometimes that isn't so easy, you know, so it's not just me we've got other people that we know that can help as well. Wonderful.
Linda Elsegood: So could you give us your website address, please do. There.
Julia Piper: Yes it's https://www.privategp.com/. We rebranded this year before we were very much more like a traditional practice, but I think my daughter said to me, mum, you need to make your website who you are. And so she helped me to, to do that and it was difficult—the time. I remember my father was very poorly. I mean, we lost him in the end.
I found it somehow we've managed to do it despite everything and which we did it. We launched it in May this year. And I hope you like it. So, any feedback would be gratefully received.
Linda Elsegood: Well, all I can say is thank you very much for sharing your experience with us today. It's been really interesting.
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