LDN Video Interviews and Presentations

Radio Show interviews, and Presentations from the LDN 2013, 2014, 2016, 2017, 2018 and 2019 Conferences

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Shivinder Deol, MD - 27th Nov 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is Dr Shivinder Deol, who's an MD, certified in family medicine and anti-ageing and regenerative medicine. Dr Deol has served at Bakersfield, California community as medical director of the anti-ageing and wellness centre for over 35 years. He specializes in integrative preventative and family medicine as a primary care provider.

Thank you for joining us today, Dr Deol.

Shivinder Deol: Thank you for having me. 

Linda Elsegood: So could you give us your background? Where did you train?

Shivinder Deol: Sure. I studied in a private school in India, one of the top leading medical schools for some medical college. Graduated from there in 1975 and then I came. I did a course a year off a residency in India, and then I came and joined a University of Tennessee, Memphis and did my training in medicine, psychiatry, and family practice.

And then, I've been in practice, since 1982 in Bakersfield, California. I've taken extensive courses in regenerative medicine and anti-ageing. So my training, even though it was initially more family practice, and I'm board-certified three times and family medicine, but my interest went towards more integrative medicine and functional medicine. For the last 15, 20 years I've been doing more of that. 

Linda Elsegood: When did you know you wanted to get into medicine? Were you very young?

Shivinder Deol: No, I wanted to be an army man. My family is a strong army. But my mother wanted someone to be a doctor. So my older sister, then my brother, passed out and did not go into medicine. So my mom said:" You got to do it." And I said: "okay". I got into medicine, but I'm so glad I did because I think it was my calling and I really had an incredible journey.

You know helping people, learning and growing myself with medicine.  

Linda Elsegood: I mean, things have changed, haven't they? I mean, you must have seen it from when you first qualified. What was it? 1975 where you went to the doctors, you told the doctor what was wrong and they, I remember it well.

I got married in 76 that people had their symptoms treated. But they never actually had the root cause treated in those days, which then eliminated the need to treat the symptoms. So, you know, what is it you actually do in your practice? If a patient came to see you with complicated symptoms, why would you start?

Shivinder Deol: You know, we would just, you know, and it was a great business for physicians and all patients came in, they got better and it was just an ongoing process, drug after drug after drug, and then treating.

So no one really was treating the whole body or looking at the real cause of a disease. It was taking care of symptoms now and we'll worry about the things later. 

Linda Elsegood: Yes. So what do you do now? 

Shivinder Deol: Now my focus is changed more.  When a patient comes in, my focus is more nutritional based, first and foremost supposed thing I'm really interested in finding. So this to me, the most important thing anybody can do is improve their nutritional status because a body is constantly working and regenerating itself.

So we estimate we have close to 30 trillion cells, but out of that, almost 700 billion cells are being built every single day of life. And we have hundreds of nutrients and the food that they're eating, which is processed, and with cold storage and with cooking, microwave, we've destroyed a lot of the nutrients that the body does not get all the raw material it needs for all its needs that all the regenerative and repair needs on a daily basis.

So my focus is nutrition and then I do a lot of things with detoxification, removing chemicals, toxins, poisons, reducing inflammation in the body through Iv therapies, chelation, all kinds of different things, hyperbaric. And then we do more stuff at balancing hormones and neurotransmitters to optimize health, brain health, heart health, and overall, you know, endocrine help.

So we do a variety of things to help the body improve rather than just fixing. A sore throat, some,  my aim is if I can prevent a single heart attack, a single stroke, single cancer, we do a lot of protection for breast cancer, for instance. So, basically, if we can reduce any of these massive major diseases, it's far better than, you know, treating the simple sore throats and colds and allergies that most people will have, but they don't really affect on lifespan with these scans.

Linda Elsegood: Okay. What kind of testing do you do when you're probing the patient to find out the wrinkles? 

Shivinder Deol: Yeah. So basically, you know, the insurance companies, of course, we are all kind of stuck with insurance companies to some degree. So the standard blood work that insurance companies cover, I do that but for instance, in a standard blood test, a lot of doctors will do as a free T4 and a TSH. But the key hormone and thyroid, for instance, is there a free T3 which is the active hormone and not T4. So unless we look at three-T3   and reverse T3, you really know what the thyroid function is.

So I look at more in the functional way of looking at health and so we do a lot of hormone testing, but the best way to test hormones are either through a saliva test or a comprehensive urine analysis. And typically insurances don't cover that. We do testing for heavy metals and for chemical toxicities.

So there's a really nice chemical toxicity test that looks at literally hundreds, if not thousands of different chemicals that we have been exposed to. We do food allergy testing, again, not the one that's covered by insurances, which is an immediate food has to be, but more a delayed food sensitivity test.

We look at a comprehensive digestive stool analysis. Look at gut health, gut inflammation, and see if there's an imbalance between the good and the bad bacteria in the gut. So a variety of other specialized tests that we do that can look at the body in a more natural matter. So trying to hit the cause rather than just the symptoms or repair.

Linda Elsegood: And you mentioned hyperbaric oxygen there. For people that are not familiar with hyperbaric oxygen, could you tell us what it is and how it works and what results you have seen?

Shivinder Deol: Sure. So hyperbaric oxygen is basically,  you're in a large chamber, which we are pumping in oxygen under pressure and under the, if you have some, some people remember the physics, the Boyle's law.

They've been, we put pressure, any of the gases are absorbed deeper and greater into the tissues. So when we pump in the oxygen, it goes into every joint, every fluid in the body, including the spinal CSF (cerebral spinal fluid). And so this increase oxygenation. It helps you the healing process in the body.

So if you can put oxygen into any tissues, the body starts to repair process and also discourages cancers, infections of all kinds of any chronic diseases. If we can put the oxygen, the body will start the repair process and use, any of the toxic effects off infections or, other pathologies.

So it's a great way to treat strokes or heart disease or traumatic brain disease, injuries of any kind, surgeries of any kind. So, for any surgery, if you were to get a hyperbaric treatment one before and two or three treatments after surgery, you cut down healing time in half, you cut complications in half.

So it's a very nice way to help repair the body. Also, injuries of all kinds, helps repair, very, very nice treatment, and very safe. I've been offering that for over 20 years. 

Linda Elsegood: Is it covered by insurance in the US?

Shivinder Deol: Unfortunately not. There only seven indication for which a Medicare will pay for and things like diabetic ulcer are non-healing ulcers, but you know, severe diseases they are willing to pay.  For minor issues, you know, they will not pay.

So it is typically a cash payment.

Linda : Elsegood: Is it very expensive?

It depends. So in our office, we charge to believe by the $150 to $200. There are some places, where they are in the three, $400 range. And some places, if they are using a smaller chamber, low pressure, they even offer it for like $125 a soul. But if you use a high-pressure chamber, you know, it's going to be about 150, $200, at least, if not more.

Linda Elsegood: Hmm. It's that for an hour?

Shivinder Deol: That's for an hour. But by the time you get in and out, it's going to almost be an hour and a half. So it takes about 10 minutes To get the pressure optimized in by us, then to brings the pressure down. So it's almost like an hour and a half a treatment. 

Linda Elsegood: I actually had hyperbaric oxygen when I was first diagnosed but it took me about an hour to get there and an hour to get back. It was very, very tiring because fatigue was bad. But I have claustrophobia and I was not really thinking about it, but it was quite a big tank and I think it sat about eight people. So I sat in this tank and I was thinking how am I going to feel when they close the door?

I'm really nice. And then they came out with these masks you had to put over your face. Oh, that was a testiness itself. But I, I have kind of got used to.

Shivinder Deol: We don't use a mask for this reason because it is so much closing feeling and our chamber has three different windows that you can look throughout.

So yeah, there is some claustrophobia, but it's really not that bad. 

Linda Elsegood: This small porthole but they are up high. So you couldn't actually see out. You could just see the other people who were in there with you for that.  Was quite an experience but unfortunately, it was run by a charity and it closed down many, many years ago now, which is a shame because I think they did some really good work though. So with the testing, one of the things that people quite often ask me about is Candida. Do you do Candida testing? 

Shivinder Deol: Of course, and Candida is almost like cancer. So candida basically get thin, and it's very hard to clear Candida out of the body. So yes, we do quite a bit of testing for candida because I think of candida as a very severe, but just to be insidious, it's very quiet, a low-level infection that can just, go on for years causing a lot of damage. But people not even, sometimes be aware of it, and in the long run, can lead to greater complications in losing potentially cancer.

We made it, we believe that it may be a cause of.

Linda Elsegood: Well, so many people have asked me that they do a saliva spit test in a glass of water or something and I don't know how accurate that is. But people tell me that they try these remedies to get rid of it and they can't, and they've been to doctors and they've still got it. You know, if you have a persistent Candida problem, how do you go about fixing it?

Shivinder Deol: Well,  basically that is several things. But candida loves sugar. In fact, every bad bug cancer loves sugar. So to treat any chronic infection, the first thing you have to do is cut out the sugar, cut out the carbs, and remember all carbohydrates except fiber break down to sugar, all of them. So people will cut out sugar, but they don't reduce the carbohydrates, and it's still on getting sugar in the body.

And as long as you're getting sugar, the candida is going to be almost impossible to kill. So the diet, again, comes in really important on a low carb diet. And then we may want to make the environment on hospitable for candida. So whatever the candida likes, we would cut that.

So keeping the body made more alkaline, keeping the body more oxygenated. So using oxygen and ozone therapies. And really helped clear it up candida. But Candida will generally require a prescription medicine plus several strong probiotics, Saccharomyces, and several antifungal herbal supplements to help fight the candida.

And it's a longterm treatment. It's not a quick course of treatment that'll help clear it. 

Linda Elsegood: Wow. 

Shivinder Deol: It requires a long process treatment. Yeah. 

Linda Elsegood: I didn't realize that it was so difficult to get rid of. 

Shivinder Deol: It is. 

Linda Elsegood: So how long ago was it when you first heard about LDN? 

Shivinder Deol: I think it's been, well, over ten years or even longer than that, that I've been using and that I heard about LDN.

And I think, I'm not sure if I heard it in a conference or if one of my patients came to me originally initially and asked me about it, but I think it was over ten years that I used it and the first patient that I actually use it on happened to have such a dramatic result that kind of opened my eyes.

So this lady had severe Hashimoto's thyroiditis and her tilters were in several. And so we treated her with the LDN plus a few other things, lifestyle changes, iodine, cut out gluten and so on. And her tilters started coming down dramatically, and about a year, year and a half or titers were back to completely normal.

So we had cured her now, Hashimoto's, and this was, I believe, strongly related to the use of LDN. And, so that was a very strong eyeopener for me on this, on LDN and its potential efficacy. And since that time, I've used it on a whole bunch of other patients for a whole variety of other conditions. But fortunately for me, that I had, my first patient responded so well that, it really made me a believer.

Linda Elsegood: You said that you've treated in lots of conditions with LDN. Do you have any other case studies that have been remarkable in your practice? 

Shivinder Deol: Yeah, a few others. So I have a patient with severe ms. Was very fatigued, but she's got severe tremors and she was extremely fatigued, and so I put her on LDN, and within days she could tell the improvement in energy level and the fatigue had improved very, very nicely. But unfortunately, I did not see, or she did not see any improvement in her tremors. But as far as the energy level and a mood, she comes in smiling every time. Poor thing is shaking a lot, but she's smiling. And so it improved certain parts. I had another patient who came to me from New York and stayed with me for one week.

She was on heavy pain medicine, fentanyl and morphine for 30 plus years for back pain. I got her detoxed completely within one week, and I use an IV, NAD, which is an incredible nutrient to help with the detoxification, increasing energy level and then up, put her on LDN. And this lady wrote to me about a couple, three weeks ago saying she felt so wonderful and that she has not had a single pain medicine.

In fact, she said, I don't even take Advil orTylenol but rarely for pain now. And she was really grateful that she had done so well and all for 30 years, her life was all around pain, medicine, pain medicine, and so that was a very nice response. 

Linda Elsegood: Oh, that's amazing because if you're in constant pain the whole time, it must make you feel a little bit irritable and short with people because you have to deal with that level of pain. You can't live your life normally in pain. It's not possible. Is it? 

Shivinder Deol: Right. But see, unfortunately, that reality is, what people don't realize is that acute pain and chronic pain are not the same pain.

And it's a completely different set of effects, a completely different disease, acute pain. So somebody has an acute practice, acute injury, acute surgery, that's a completely different, set of effects in the body versus somebody who's had chronic bad back pain or neck pain or whatever for 10, 20, 30 years.

 There our need for pain medicines are different. They are now just dependent on getting that  pill, of course, rather than the true pain itself. So it's become more of a withdrawal-type pain and not a lot of ease. Opioid receptors are tight, are doubted out, and so the effectiveness goes down.

But when we use something like LDN, we recharge our opioid receptors. We reactivate them. We produce a resounding amount of receptors so that we are having much better, pain relief without the need for any external medicines.  

Linda Elsegood: It always amazes me how such a small amount of naltrexone can actually be more powerful than the fentanyl and morphine.

It's hard to understand.

Shivinder Deol: It really is. But you know,  I'm a true believer of this. The body is a true miracle. And the ability of the body to repair and regenerate itself is just incredible. Our challenges that we have, that our diets are horrible. We are living in a really toxic lifestyle. And then we have all these other stresses that are influencing neuro-transmitters and our chemicals and our hormones.

The body doesn't get the opportunity to repair and regenerate itself. So when the state garbage out of the body on necessity, medicines and toxins out, we balance some of the nutrients. We helped the body produce its own good nutrients and endorphins. The repair process becomes really dramatic and the body can pretty much heal anything.

So I see a lot of miracles, but it's really not a miracle. That's what the body is designed to do is to help. He looks healthy all the time, regardless of what's going on. So we are great healers.  

Linda Elsegood: And you were going to give us another case study before I butted in.

Shivinder Deol: I did not understand. 

Linda Elsegood: You were going to tell us of another case study. Another patient. 

Shivinder Deol: Oh yeah.  A cancer patient. Basically patient comes to me with metastatic cancer. LDN is great in supporting cancer. You can literally help stop cancers from spreading.

So this patient basically the doctors told him that just go home and die and he's a relatively young guy and he doesn't want to die. You know, who does? So he came in, you know extremely tired, extremely tired, and just basically depressed, no energy and kind of giving up. But the wife is wonderful.

Wife is so supportive of him. And so we've started him on a high dose, intravenous vitamin C, 75 grams three times a week. And he started feeling a little bit better. And then I added LDN to his regimen. I've got him on a lot of different things. So put him on a keto diet, very strict Keto diet.

And so we put LDN on, and his mood has improved a lot that he can tell, and he is now able to start to do a few things. So I don't know what the status of the cancer is. It's too early for me to do any scans on him, but I'm certainly hopeful that with his mood outlook, comparing his energy is improving that maybe we're going to get a decent result on his very widespread metastatic cancer.

...

Linda Elsegood: Well, I believe we've now come to the end of the show, so that has been amazing. When very quickly, would you like to tell patients how they can contact you if they wish to make an appointment? 

Shivinder Deol: Sure. My website is antiagingwellnesscenter.com. 

My email is support@antiagingwellness center.com and, the office phone is 661 325 7452.

Linda Elsegood: And do you have a waiting list? That's the other question.

Shivinder Deol: Do I have, what? 

Linda Elsegood: A waiting list? Do people have to wait to see you? 

Shivinder Deol: No, well we basically work people in. My philosophy always has been that we are in a service industry. We are providing a service. And  in the service industry, if you have, your electricity is gone, and you call the electrician, and he comes a month later, it doesn't work.

Or your car is broken down, you know? So if someone comes in that needs to be seen now, I'll see them the same date. I don't care. They may have to wait a little bit. We may have to work a little harder, but we take care of somebody who needs to be seen when they need to be seen. So I don't keep awaiting this for this reason.

Linda Elsegood: Oh, that's wonderful! Well, once again, thank you very much for having been our guest today, 

Shivinder Deol: Linda. Thank you very much and you take care.

Linda Elsegood: This show is sponsored by Dickson's chemist which are the experts in LDN at associated treatments in the UK. Dickson's chemist, the most cost-effective for LDN in all forms within the UK and Europe maintaining safety standard of what is required. Why would you choose to get your LDN from anywhere else?

Call 01414046545 today to speak to a LDN experts 

Any questions or comments you may have, please email me, Linda@ldnrt.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.

Dr. Judy Tsafrir, MD - Oct 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: I'd like to welcome my guest today, Dr Judy Tsafrir. Thank you for joining us today Judy. 

Judy Tsafrir: Thanks for having me, Linda. 

Linda Elsegood: I mean, you were telling me you were from Boston, um, in your practice. What's the patient population that you treat with LDN? 

Judy Tsafrir: Um, I'm a psychiatrist, a holistic psychiatrist. I see both children and adults, the more adults and kids, and people seek me out because they do not want a conventional psychiatric approach to their depression or anxiety, or whatever it is that's troubling them, which is typically just the prescription of pharmaceuticals and perhaps, um, some sort of counselling. So my approach is essentially functional medicine where I am looking for the root causes of what's going on with them and having conversations with them about their diet and their lifestyle and sleep and exercise. Um, also I trained with someone named Dr William Walsh, who is a biochemist from Chicago, and he has correlated certain laboratory studies with psychiatric symptoms, for example, elevated copper or, um, high histamine, and there are protocols of nutrients that can be prescribed instead of pharmaceuticals. A lot of patients come to see me because they are chronically ill and they're not getting help from other doctors like they're, I'm not usually the first stop so they may have many patients who have autoimmune conditions, um, which often presents psychiatrically; like there's an anxiety piece. And I've developed, um, over the past couple of years interest and awareness about mold toxicity. And so patients will come to see me because they are suffering from symptoms related to mold toxins.

And, uh. When that is addressed, that can have a big positive impact on health. 

Linda Elsegood: But isn't it amazing that you could take some supplements like iron and copper instead of a pharmaceutical drug? You know, because all drugs have potential side effects, don't they?  

Judy Tsafrir: Yes, and that, you know, the model is conventionally is to identify symptoms and suppress them. And instead of seeing the symptoms as communication that there's something wrong and looking for what it is, that could be corrected. 

Linda Elsegood: But when you said that you help people with autoimmune diseases, I mean, there were so many people, um, that I know of who have had, say, fibromyalgia or chronic fatigue, MS and before they managed to get a diagnosis so many of them are told it's in your mind, you know, that there is nothing really wrong with you and that is very depressing. 

Judy Tsafrir: and very invalidating. That's an experience that many patients have when they come to see me, that somebody, there's such relief that somebody believes them.

Linda Elsegood: And it's getting people to listen to you, isn't it? Rather than just brushing you off without investigating. 

Judy Tsafrir: Right. You know, I just came back from a conference. I actually was in a conference over the weekend in California, which was all about electric hypersensitivity and the effects of electromagnetic frequencies on our health, and this was on my radar but in a much less focused way then it will be now going forward because I would tell my patients to turn off their routers at night and tell them to not carry their cell phone in their pockets. But, um, it goes much further than that. There really needs to be a lot of avoidance and awareness about the way that electromagnetic waves are impacting our health. And I think there may be a number of patients in my practice who I've been treating for mould who may have mould or who do have mould, but maybe they would be so much better if I would also be addressing the, um, electric hypersensitivity. So this is something that has newly, like really come into focus for me,  just over the weekend.

Linda Elsegood: And what about children? You said that you treat children as well, and it's very ... 

Judy Tsafrir: yes. I mean children have an attentional problem, and they have anxiety, and uh, there can be, just the same as with adults, there can be imbalances, and I think that a lot of these kids are actually tremendously affected by the electromagnetic frequencies, like all of the screen time, that kids are doing. It's really, um, there was a child psychiatrist who spoke at the meeting who, um, kids who were so behaviorally dysregulated and suffering so much, and the families were in such a terrible state because of the child being, um, so, uh, symptomatic that with the screen, you know, with the electronic “Fast” of one month, the symptoms completely resolved. 

Linda Elsegood: Wow. But if a parent had a problem with a child, with, let's say, anxiety, I mean, how old are they normally? the youngest that you see in your practice? 

Judy Tsafrir: Oh they can be very young. They can be, you know, six years old.

They can be five years old. Just a kid who's not sleeping, who, you know, can't separate. Um, you know, I'm, I'm trained originally as a psychoanalyst and my model, previous to learning all of this functional medicine, would be to really think that there was some kind of, um, psychological dynamic going on between the parent and child, which they may also be, but there is so much to be understood in terms of what can be going on biologically In addition to all of that.  

Linda Elsegood: And would bed wetting come under that umbrella as well? 

Judy Tsafrir: Of course. I mean, that is often like a, um, an immaturity of the neurological system. And that can be developmental and can improve with time. But, um, everything that is going on, you know, can be due to, um, many different factors. Including trauma and, um, adverse experiences. But it's just, it needs to be looked at from so many different angles, including the spiritual. 

Linda Elsegood: I mean, you said that you look for the root cause, but to find the root cause for a child, obviously, you listen to the child, but their communication is going to be limited.

And of course, then you'd have to listen to the parents. How do you …?

Judy Tsafrir: And the school 

Linda Elsegood: Okay. And the school, how do you get to the root cause if you know, if there's somebody listening with a child that is having problems, what would be the process you would go through to find out what you could do to help a child?

Judy Tsafrir: The most important thing is the history and to try and get a sense from the parent, you know, what is going on, what has gone on, you know, like even going as far back as ancestrally, like, was there a lot of trauma in the parent's history? Because that can also be passed along epigenetically. Um. But then to learn about the birth and the child's development and the child's diet and the whole environment.

And when did the symptoms start? You know, was there any kind of car accident or death? I mean, our whole being is so, uh, it's such a mixture of mind, body, and spirit that it's really complicated, and you can't just typically pinpoint one thing, like you may have a car accident, but then that completely dysregulates the immune system and sets off a mass cell activation disorder.

And then they're having all kinds of very weird symptoms and maybe not tolerating foods and having strange neurological things. And, and this all may be totally exacerbated by the electromagnetic frequencies. It's just. It's very complex. So you want to try and understand as much as possible what are all the factors and try and support the person from many different directions. But it's usually not like one thing. It's like a whole confluence of different things coming together to create a kind of perfect storm. 

Linda Elsegood: So your approach would be more of a natural approach rather than, um, prescription medications? 

Judy Tsafrir: Absolutely. I mean, a lot of times people seek me out because they're on medications and they want to get off of medications.

And the typical approach for a person to get off medication, many psychiatrists are not willing to take patients off of medications, they're afraid that the patient will become destabilized and then they'll reduce the dose of medications way too quickly and then a person will have a reaction, like a withdrawal symptom; a syndrome from withdrawing from the medications and then the psychiatrist will mistakenly believe that this is as proof that “you see, you do need it for your anxiety because you are having problems”. But in fact, it's like a withdrawal syndrome and not the original problem. So. Like I, if somebody calls me and they want to simply, you know, get stimulants for their attentional problems, I tell them that I'm really not the right doctor for them.

And you know, if somebody is interested in working with me to come off of their medications, that is much more what I find interesting. And, um, I'm feeling it’s like a useful, valuable thing to do. 

Linda Elsegood: And what's your success rate with getting patients of pharmaceutical drugs? 

Judy Tsafrir: I would say probably about 75%. It's not everybody. You know, like some people, it's really difficult, particularly, um, some of the antianxiety medicines can be really hard to get off of, but you know, like this is like, I recommend, um. Low dose naltrexone to all of my patients, essentially. And you know, I also make dietary recommendations to all of my patients, and I make recommendations about, you know, hygiene with their electronics equipment and about exercise and about sleep, um, and all of those things together make it much more possible to withdraw from medications rather than just trying to withdraw from the medication without supporting the person in any other way.  

Linda Elsegood: how long do you think it takes a patient with anxiety problems taking LDN for them to notice it's doing something for them? 

Judy Tsafrir: It's so variable. I mean, I feel like low dose naltrexone is really unpredictable in terms of if it's going to be helpful, how it's going to be helpful, for what it's going to be helpful. So for me, because it's so safe and inexpensive and potentially so effective that I really recommend it to everyone for whom it's not contraindicated, like if they're on, you know, some kind of cancer protocol and immune suppression or, but I recommend it to everyone. And, um, it really is variable in terms of the response, quite variable. 

Linda Elsegood: And what sort of dose do you start the patients on?

Judy Tsafrir:  0.5 and then I asked them to work their way up as tolerated, as fast as it is tolerated for them to 4.5 milligrams. And that's, you know, in some people, you know, they feel well at three, but when they go up to 3.5, then they don't feel as well. So then we stay at 3, it's really titrated according to how the individual feels.  

Linda Elsegood: I mean, that's the thing with LDN, isn't it? It’s unique to that person. You know, you can't say ..

Judy Tsafrir: Unique to the person

Linda Elsegood: Exactly. Cause some people to find that 2.5 works really well. They go up to three that don't feel as well. But 

Judy Tsafrir: right. 

Linda Elsegood: Sometimes they've read everything online, and they feel that if they're not on 4.5, they're doing something wrong, that they should push themselves. But that isn't the case, is it? 

Judy Tsafrir: No, that's a misunderstanding. And you know, it really is like so helpful for so many different things. And so it makes sense to me that the dose would also not be one size fits all.  

Linda Elsegood: exactly. I mean, some people try to justify a dose by saying how tall they are and how much they weigh but that ... 

Judy Tsafrir: Right, that doesn’t make any sense

Linda Elsegood:  it doesn't because, I mean, there are some men who are rugby players who can't get any further than three. And then a small lady who's very petite, like five foot tall can take 4.5 no problem. So I always think that's a, a good rule to tell people that you, you just can't pigeonhole people. It's how your body responds. With depression, and you were saying that you treat people with autoimmune diseases. Um, would you say depression for somebody with an autoimmune disease might be to do with all the symptoms and the things that they have to live with that cause the depression? 

Judy Tsafrir: Well, again, I think it's such a multifactorial situation. I mean, very often depression is either caused by or mediated through cellular inflammation. So like when a person has inflammation in their body, they have inflammation in their brain, and they feel depressed. But then when a person has, Um, chronic illness and they're living with chronic illness, and they can't find anybody who's going to help them, and, uh, they're being told it's all in their head, and it's a very hopeless and depressing situation. Another thing that I recommend to my patients that I haven't mentioned so far is dynamic neural retraining system, DNRs, which is, it's like a program of visualizations and meditations and affirmations and something that you do with your consciousness that, um, helps rewire and retrain the limbic system, which is the deep structure in the brain that is associated with trauma. And when it's activated, it can cause all kinds of physical problems and all kinds of psychiatric problems, anxiety, depression. So if a person works with this program, uh, consistently, very often they're able to really calm down their autonomic nervous system and they will be in a state of, um, not in a constant state of like sympathetic overdrive, fight or flight.

And they'll just feel much calmer and much better, but it's not also alone. It's also, you know, in combination with diet, in combination with low dose naltrexone, with this combination with other supplements that are helpful for inflammation and for rebalancing, whatever it is that is troubling the person and in psychotherapy can be very helpful as well, having a relationship with someone where you can talk through things and someone who understands and who can help you make connections and can help you see that you're responding to the present because of something that happened in the past and that's not really relevant to today. I mean.

Everything together and, and, and I recommend the spiritual practice to my patients. Uh, prayer can be very helpful. Performing rituals can be very helpful. Uh, gratitude journals can be very helpful. It's just - there are so many different things that need to be recruited together to heal a person holistically.

And before I take a person into my practice, I have quite a long conversation with them on the phone and try to assess how motivated they are to make all of these different kinds of changes because it's not like taking Prozac. 

Linda Elsegood: It’s definitely something you have to work at, isn't it?  

Judy Tsafrir: Absolutely. It's a lot of work, but you know, instead of, you know, your health being degraded, you're optimizing your health  

Linda Elsegood: it's very easy to keep things to yourself in like a family situation, not talking to family and friends, but to actually be able to talk to somebody outside of your circle.

You can say what you like. You're not going to upset anybody. They're not going to feel guilty.

Judy Tsafrir: You don't worry about burdening them. And also there's somebody who is hopefully very trained and experienced in listening to people and knowing about what are dynamics like in the family and understanding a lot about human nature and the way people feel. I mean, I also think that meditation and yoga and Tai Chi and all of these kinds of, um, mind, body, spirit practices are tremendously helpful and stabilizing and help one not totally identify with whatever, you know, upset emotion one is feeling at the moment, that there are more equanimity and more peace brought into the person's life.

Linda Elsegood: I used to do a lot of yoga and I learned at a very early age, to put myself to sleep. And it still works today. You know, the deep relaxation and your breathing and focusing.  And I can, you know, even if my mind is spinning, if I can just stop my mind and actually relax and focus, probably about two minutes and I can be asleep.

Judy Tsafrir: I say that that's just like a practice, something that you've learned and it can be taught and um, it's just so useful and so much better than taking Ambien, you know, instead of taking a pill, but, you know, maybe then you feel like very tired the next day and forgetful and, um, spaced out. 

Linda Elsegood: I was going to say, who would want to feel like that? Waking up feeling like that at the start of the day.

It doesn't sound like something we would want to do. But I can remember when I was very sick, and people would say, you know, family, and look at you, how are you? And I would say, Oh, I'm fine. Because you didn't want to say, well, actually I’m anything but fine. 

Judy Tsafrir: Right, right, right. And I mean, and also when you're feeling that way, you feel like you don't want to burden people and you know that you can't really turn to people for help. And there's some kind of shame involved in the whole thing. Like, what's wrong with you that you don't feel fine? And, um, I mean, a lot of times for, you know, that there's like, we're not, for many people, like in my, in Boston, we're not living in a war-torn area.

You know, like, it's not like there are food shortages and bombs going off, and yet people are feeling terrible, but there's nothing to point at like that. 

Linda Elsegood: Yes. Yeah, well, I can remember being rather concerned that every week I was deteriorating and it was noticeable. And I can remember lying on the sofa, my cat lying on my chest and it hurt. And, um, my mother was here, and she took him off me because it was uncomfortable for me. And I was thinking, if I keep going downhill like this, I'm going to die. You know? And it was really scary, and it was frightening. And I had nobody that I felt I could say that to, you know, “Am I going to die?” 

Judy Tsafrir: .. terrifying and lonely, so lonely, and yeah you know, like, it's not surprising that people become suicidal in that situation. They just feel so alone and so desperate. And there's no light at the end of the tunnel. 

Linda Elsegood: Yes. But luckily for me, there was LDN at the end of the tunnel. So I had, I had the light. So, 

Judy Tsafrir: that really just turned things around like really quickly? 

Linda Elsegood: uh, in three weeks.

I mean, I just very quickly, the left-hand side of my body was numb with pins and needles. I had cognitive problems. It was like English had become my second language, I couldn't recall vocabulary. Everything muddled. I slurred my speech like somebody had had a stroke. I started choking on my food, forgetting things, tripping, falling, stumbling over nothing.

I lost my leg. Strength in my left, like at double vision, lost the hearing in my left ear, had twitching muscles, restless legs and pain. Um, and I'd been told at that point by the neurologist who checked me over and sat me down and put his hands across the desk, shook my hands and said, “I'm really sorry you're secondary progressive now, and there's nothing more we can do” and he opened the door to show me out  

Judy Tsafrir: you had multiple sclerosis?  Terrible, that’s terrible, and you're sort of taught in medical school, If a person has one symptom, okay, then you try and help them. If they have ten symptoms involving ten different organ systems, then it's all in their head.

You know? Then it's, it can't be real, you know, not understanding that that is more and more and more common these days with all of the toxins in our environment and all of the electrosmog and the GMOs and the degraded food supply that this kind of chronic illness is more and more commonly seen with involving multiple organ systems.

And it doesn't fit any kind of classically recognized pattern. 

Linda Elsegood: But in three weeks, um, and I'd lost my bowel and bladder control as well, but in three weeks I started cognitively -  in my head, it was like a television set, not tuned in, and suddenly somebody was tuning it in - and I started to be able to process thoughts, being able to see properly.

The hearing had completely gone in my left ear, and that started to come back, and it was amazing. It was absolutely amazing, but it did take me 18 months to feel like, yeah, I mean, I still know I have MS and I have learned to work around things, but I can achieve things again, which was very devastating.

I can remember I had to go and see the company doctor and he said he sent a letter, and it said that I was, I'm a workaholic. And he said that I was unemployable for the foreseeable future, and that was just like a punch in the stomach. It physically hurt. Um, and I kept this letter for quite a while, and they don't come across it, and I'd read it, and I'd have the same reaction.

One day I thought, well, why am I reading this letter. If I shred it, I haven't got it anymore, and I won't be able to read it, and it won't depress me, you know? I know it was there, but I don't need to physically keep seeing it. But my whole point was to prove everybody wrong. 

Judy Tsafrir: Right. So I mean it was the only thing you did was Low Dose Naltrexone or did you also do other things in addition to that? Did you, I mean you attend to your diet? 

Linda Elsegood: Because I was in the situation that I couldn't cook for myself my diet actually got worse originally. My husband did the best he could do which was just to put something in the oven that was frozen but gradually he learned to cook. Um, because I couldn't get out of bed

I was asleep most of the time, which was a blessing because I really didn't feel well. But, um, as I improved and he improved, we started to get a better diet. But I didn't become gluten-free, dairy-free and process sugar-free for quite a while. Um, I was given three courses of intravenous steroids in an 18 month period, and the first two were only six weeks apart.

I'm a very pale person, and my face blew up and I looked like a tomato. I was so red, and so round. And I gained, um, 50 pounds in these 18 months. And then, Hey, I was type two diabetic. Um, so I was then put on the Metformin, but once, and it was very difficult to lose the weight, not being active enough and exercise was too tiring.  Still is to a point. Um, but there are certain things you can do. But once I changed my diet, I managed and I'm now classified as a diabetic in remission so I don't have to take the Metformin anymore. And I'm really pleased and I didn't realize I was told that I'd have to have Metformin for life. Nobody had actually said to me it can be reversed. I did not know that. 

Judy Tsafrir: Right. And nobody told you that, you know, if you limited your carbohydrate intake or you didn't, you know, eat gluten and dairy or sugar, that that would be beneficial to you? 

Linda Elsegood: No. Um, my mother, I, um, unfortunately, she had cancer, and it was lots of other issues, and LDN didn't work, which knocked my confidence in LDN a little bit because I really wanted it to work. But anyway, my mother knew that she was dying and all she was worried about was the trauma that it would cause me with her dying. You know, what's going to happen? I'm not going to be here to look after you. You know, she was completely selfless.

And the, she asked the doctor to look after me after she'd gone. So the doctor wanted to see me. I went to see her, and I said, you know, I was doing fine. Um, and that I really watch my diet. And I was telling her, and she said, why are you doing that? And I looked at her, and I was feeling very sad cause I just lost my mother and I looked at her and I thought “seriously, you're asking me why I have changed my diet?”. What do I say? 

Judy Tsafrir: Incredible. 

Linda Elsegood: And I just said, “because it makes me feel better”. I couldn't bare the thought of explaining to a doctor why I had changed my diet, but I was really pleased, the fact that I don't have to have the Metformin, but it was quite funny because I was given Metformin initially, and it was a, I don't know what brand it was, but it was so strong - the nausea was so bad - I couldn't, I really couldn't tolerate it. I couldn't bear to eat anything or move my head or talk to anybody. It was awful and I suffered with it for about two and a half weeks and I went back to the doctor because “I was going to die” in inverted commas if I didn't take this Metformin.

So I went back, and I said to her, well, I think I'm going to have to die because I really can't take it, it is making me feel so ill. I just can't do it. And she laughed, and she said, “Oh, there are other versions you can have” And I thought, well, I'll just come back sooner. And I didn't realize that, you know, after the first two or three days.

So then I had Glucophage, which was a slow-release Metformin, and I can tolerate that. That was fine, but apparently, it was far more expensive, so they tried to get people on the cheaper ones first. 

Judy Tsafrir: Right. But all the money, 

Linda Elsegood: thanks actually, luckily, but it's been amazing talking to you, and I realize we've run out of time.

Thank you for having been my guest today.

Judy Tsafrir, MD is a board-certified Harvard faculty member with a private practice of holistic adult and child psychiatry in the Boston area. A special area of interest is environmentally acquired illness, in particular, mold toxicity and the chronic inflammatory response syndrome. Her website is https://www.judytsafrirmd.com/.  Phone number (617) 965-3020.

Any questions or comments? You may have; please email me Contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.

Dr Kirsten Singler ND - 4th September 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, my guest is Dr.  Kirsten Singler, who's a naturopathic doctor from California. Thank you for joining us today, Kirsten. 

Dr Kirsten: Thank you so much for having me, Linda. 

Linda Elsegood: So first of all, can you tell us,  what made you decide you wanted to become a naturopathic doctor? 

Dr Kirsten:  I was in my twenties going to graduate school on a completely different life path and I got really ill. And I think this is common amongst other physicians that are really passionate and have that drive for good patient care and have that personal experience.

In my twenties, I got really, really sick. I wasn't able to go to my graduate program, and I wasn't even really able to leave the house. And I went to multiple doctors and at that time I only knew really about mainstream medicine. And so I would go from doctor to doctor, and no one could figure out what was going on.

 I thought that I was so healthy because I was a raw food vegan and was so conscientious of what I put into my body, but still couldn't function properly. And a friend of mine took me to a naturopathic physician who did acupuncture as well, and it was so phenomenal. The doctor that I saw, a Dr.Brennan McCarthy in Arizona,  told me I would be better within two days, and this was after two years of really being ill. And in two days I was better and after that, I was determined that this was going to be my life path. I was so struck by it and even to remember it now I get goosebumps that something that was so grievous in my life turned out to be maybe the best gift that ever came into my life.  

Linda Elsegood: if you don't mind sharing what’s the issue that you had what? What was, did you get a diagnosis. 

Dr Kirsten:  I won't go into too much detail because it was female problems but it did have to do with hormone imbalance so severe that  I was basically very, very anaemic and that's why I wasn't able to function.  Now that I look back on it within the mainstream, none of the physicians I saw really evaluated my iron, my ferritin, those main indicators that now, of course, I run on every female patient that comes in our office, but at the time, nobody did that workup on me.  

Linda Elsegood: okay, when did you qualify as being a naturopathic doctor?

Dr Kirsten: That was in 2015. I graduated from SCNM in Tempe, Arizona. Before becoming a naturopath, I did work as a nutritionist and a herbalist and did consultations for ten years prior to that.  

Linda Elsegood: so knowing that acupuncture works so well for you, do you do acupuncture in your practice? Is that a.therapy option?

Dr Kirsten: Absolutely. Currently, our practice is so busy that just this year really, I haven't been doing acupuncture on patients directly, because it's more time consuming for each patient. So I refer to another person too. I did do the acupuncture prior to that  I absolutely did perform it, and I love it as a therapy.  

Linda Elsegood: okay. So when did you hear about LDN? How long ago was that?

Dr Kirsten: So in fact, the first time I ever heard about LDN was due to your book, the LDN book, it was my first Hashimoto's patients in the clinic. So this was when I was a student, and I had my first autoimmune case and my supervising physician,  handed me the LDN book, which I poured over. And then tentatively started my patient on it and had such good success. Then it's been part of my toolkit ever since. 

Linda Elsegood:  So what conditions would you say you have seen to date.

Dr Kirsten:  I don't mean conditions, which is broad, you know, autoimmunity covers like Hashimoto's, rheumatoid arthritis, lupus,  autoimmune, hepatitis,  dermatomyositis. That's a skin condition, a case of polymyositis. And that's—kind of a muscular, joint pain type condition. Ulcerative colitis, Crohn’s of course and fibromyalgia. I use it a lot for those cases. I've had pain conditions like trigeminal neuralgia work successfully with that. Also undiagnosed chronic fatigue.  

Linda Elsegood:  Well, I know that you said it was one of the tools you have in your toolbox. You know, if a patient came to you with let's say, Hashimoto's, what therapies would you use?

Dr Kirsten: Well, we want to primarily work them up for figuring out what's their root cause, right?  And figuring out what are the obstacles that they're facing. And then also evaluate their basic function. So we want to always pull back. 

You can look at the big picture of their health, and it's kind of zooming out from what their symptoms are, like the trees in the forest, and we want to zoom out and look at the forest and evaluate them for external environmental triggers. Which for Hashimoto's I feel is almost always the case that they have some form of, and for autoimmune in general, some form of external stressor, whether it's a psycho-emotional stressor or a toxic exposure like heavy metals or chemicals or some kind of physical trauma. Or exposure to some kind of pathogen, like a mould or a viral or a bacterial thing going on.

So we want to assess them for what's going on externally and then treat that. Say a patient comes back with high Epstein. Bart titers. Then we're also going to accompany the LDN with an antiviral protocol and an immune-boosting or calming protocol. Then we also want to look at what's going on with them intrinsically. Such things as what kind of inflammatory or immune dysfunction is maybe inherent. Or could have been going on lifelong, like how intact is their gut function, were they breastfed his children, were they put on multiple antibiotics, what's their formative nutrition were they raised on condensed milk, sugar and formula? Or were they fed a nutrient-rich diet, or is there a genetic polymorphism going on right. These are snips, changes in their DNA that affect their enzymes. And that can lead to saying, an inability to convert something like selenium in food. The active form in a Hashimoto's patient, their thyroid needs the conversion to perform adequately.

So if they have those kinds of polymorphisms and we want to be moving forward and making sure they get the right form of the vitamin and then evaluating them for other intrinsic type conditions like what's going with food intolerance. Do they have some kind of lactose intolerance or a food sensitivity that's affecting their gut that may be leading to an inflammatory cascade that's affecting their whole body or inhibiting their ability to absorb nutrition?

So it's really zooming out and figuring out what are the areas that need addressing and creating a pretty comprehensive plan for them. And then just taking baby steps with that plan wherever the patients are, you know if they're, say, a mechanic in a garage and they're getting lots of chemical exposure at their profession. And  I'm thinking, Oh boy, this guy's got to get out of that garage. Also, I'll start them on a detox plan and educate them about learning how to make better food choices. So at least he's reducing his toxic burden in his food. And then with the goal of figuring out how he can still maintain his profession without having so much exposure. 

Linda Elsegood: You mentioned heavy metals. How do you treat somebody who's been tested for having had? 

Dr Kirsten: So there are chelation protocols. And for the most part, naturopathic doctors are trained in this. We all take classes in environmental medicine and it's required, at least it was required in my program, to have an environmental medicine shift.

And the chelation can range from oral chelators (those are substances that will bind up certain metals, like bind up, lead, bind up mercury, and pull it out of the body through the alimentary canal).  There are other chelators, more aggressive, like IV solution. Now I don't do IV chelation.

If a physician is going to do IV chelation, that's all they should do because there can be so many side effects and patients have varying degrees of tolerability, especially when they're sick. But, the oral chelators are slower going and keep the body more in a state of homeostasis.

Linda Elsegood: Okay. How long does it take if you do it orally?

Dr Kirsten:  It varies on the vitality of the patient, the severity of their condition. You know, if, if they have like a severe Parkinson's and are wheelchair-bound versus mild exposure to lead that was stored when they were children. And then they don't have a current exposure and don't really have symptoms. So the vitality of the patient matters. The severity of pathology matters and then the degree of exposure. So has it been like lifelong, for example, you know, were they raised with it? Out on the dock here in California, we have a lot of dockworkers and there's a lot of pollution from the ships coming in, you know, a lot of inhalants.

Were they always there, out there on the docks, since they were kids up until adulthood and now adults, they're working on the docks or you name it. It really does vary based on the individual and their exposure. 

Linda Elsegood: Sure. Okay. So if you had a severe case, and they were on oral, would they have to be on it for a year or longer? You know, if it was a really bad thing. 

Dr Kirsten: If it was a really bad case. Okay. Say, somebody came back, and they had a severe pathology plus very high levels of heavy metals in their system. We would want to start figuring out where's the exposure coming in and remove that access. And second to that, take it really,  really slowly because it takes energy to detox. So when a patient's really sick, and they don't even have the energy to get up and walk around, perform daily activities, you want to drive up their vitality. So that could be starting with doing IV therapy, like IV vitamin C so that you're boosting up their immune system, boosting up their vitality, and then  build them up while you are slowly, intermittently, chelating them. So for a severe case, I guess the rule of thumb is for every disease a patient has, you're spending a month of active therapy. So if somebody has been ill for 20 years, you want to anticipate 20 months of active therapy. 

Linda Elsegood: Wow. 

Dr Kirsten: Okay. 

Linda Elsegood: Yeah. I'm just thinking of the age that I am. If you went back it would take 

Dr Kirsten: forever. It depends on vitality too. So some people inherently have phenomenal vitality. I had a Parkinson's patient, and she was wheelchair-bound and she had a full manifestation of Parkinson's and her medications were not adequately treating it. That's why she ended up on my doorstep. She was looking for something else. Actually, her children were looking for something else for her. She just inherently had such good vitality that as we started doing the IVs, it was really within three months that she was up out of her wheelchair. And walking around and could smile and could talk. And, you know, the first day I met her, she was mute, she couldn't smile or talk to me. So it does vary from patient to patient. Absolutely.  

Linda Elsegood: It's interesting that you said about Parkinson's patients. I have a friend who I went to college with who has Parkinson's and she came last week, and it's very difficult for her to get up.She's still walking, but when she goes to go through, or whether it's the stress of going through the door, I don't know, but she starts to do what she calls a dance, and she's popping up and down, and she can't get her legs to move. And it's every door that she goes through. Where would you start with somebody like that? Do you think maybe she has some of these conditions cause it's not that easy in England to see a naturopathic doctor. So that is a challenge in itself. 

Dr Kirsten: In England, do you all have evaluations? Do they evaluate for heavy metals and chemicals? Do they have tests like that? 

Linda Elsegood: I wouldn't know. I've never had a test. I have multiple sclerosis, but as far as I know, I've never been tested 

Dr Kirsten: There is a lab company that we use a lot. It's called great Plains labs and, I think that they are available internationally and their evaluation is through either urine,  stool, and saliva evaluations.And I think that that might be a place to start. She could look into that lab company and see if one of her physicians would be willing to run that lab and find out what kind of chemicals are going on. If there's heavy metal exposure, usually heavy metal testing is within the mainstream, you know, it's like a urine evaluation. I could look into it further and find out resources in your area. I can always email you. 

Linda Elsegood: Okay. That would be really interesting. That's good. We will have to have a look at that. She certainly could use some help. So have you found that your patients that take LDN and thyroid medication that they have to be very careful and reduce their thyroid medications?

Dr Kirsten: Well, yeah. Thyroid in my experience is ever-changing.  I've had patients that reduce their thyroid script just based on removing inflammatory foods from their diet.  So the better the gut functions, obviously the amount of inflammation is going to go down, which calms the autoimmune response. Number two, they absorb their medications more efficiently. So, a good rule of thumb that I always follow is I  run my labs every six months on the patients, and I'm always expecting them to change. Every once in awhile patients will come back stable. You know, these are people that have already seen naturopaths for years. They know their body. They're on a really good health program. But when people are first starting out, I am expecting to modify their scripts.  

Linda Elsegood: now you talk about the guts, and you did say at the beginning that you used to be on a raw vegan diet.  Is that the diet you're still on. 

Dr Kirsten: I'm not, but I do really subscribe to a philosophy of eating a lot of vegetables.

I get most of my nutrition and most of my food from vegetables. But they're going to be cooked and varied. And I'd say I'm definitely omnivore.  I think everybody should get most of their nutrition primarily from a vegetable source. 

Linda Elsegood: Now looking in supermarkets, and especially people that have several children to eat healthily,  it's very expensive.  I would think it's out of the reach of a lot of families where they have several children, you know, do you think in years to come, we're going to get rid of this high sugar, high salt, snacky type food? Do you think we will be able to educate people? You know what you eat, you know what goes in the gut really does affect your health.

Do you think that is likely to happen or is that just me being in cloud cuckoo land and you know, cheap food is going to always be there, and it's going to be full of sugar and salt, and people are going to continue to become type two diabetics because they are upsetting their immune system and having autoimmune diseases and thyroid problems and the like, you know, what's your opinion?.

Dr Kirsten: You're right. Similarly, I might be too idealistic, but I think that as they're teaching in the schools, and they're teaching children how to grow vegetables and cook,  that it all comes down to being able to cook for yourself. So I'm going through school. You know, when I was too broke to even buy toothpaste, right? I put myself through medical school and worked full time during that time and definitely knew financial pressures. Even during that time, I still cooked for myself. And you know, what I cooked was a lot of beans. I cook rice, and I cook a whole grain and actually did grow vegetables in my little garden in Arizona.I was successful in that way, but that all comes down to education. You know, cause I was raised in a family, that taught me how to grow vegetables and taught me how to cook beans and sprout seeds and like that. So for me, it comes as like second nature. I know it very well, but I think that with education, that will change.

And that's what I'm really hopeful for and excited about out here in California. There are lots of programs,  to educate kids on how to grow food and cook and changing the food systems within the school districts. And I hope that it just spreads throughout the United States, everywhere.

Linda Elsegood: Yes. And you know, if you went to buy, if you've got four children and you went to buy four apples, you know, the mother might go for the cost of the four apples of buying what we would call biscuits. You call them cookies and crisps, which you call chips and could end up with a basket full of snacky foods for the same price as for apples.

Which would be gone in minutes, you know? And that's what I find really hard. You know children are being given the wrong foods when money is a problem, which then causes lots of other issues further down the line.  I don't know if we can get healthier food at a more reasonable price. Yes, that might be an answer, but of course, it all costs money too for the farmers and things to supply the supermarket chains that also have to make a profit. And so it goes on. But it would be nice if all the snacky foods became slightly healthier as we go on, we have the sugar tax here. I don't know whether you have that yet, and they're trying to reduce the amount of salt that's being put in pre-packed food. So that's the style. But I think things have got to go a lot further. I mean, we were far healthier. I'm 62. My mother, when she was growing up, she grew up post-war, and they were very limited to what they had.  I think she was quite old when she had her first banana. She'd not seen a banana or an orange.But they lived on a farm. Had a pig, and a cow, and then when they slaughtered one of them, all the neighbours had bits and pieces, and then when they slaughtered something else, everyone got some of those, it was all similar to a barter type system. And they grew vegetables, so she only grew up with fresh meat, fresh fish, and vegetables. And  I think they as a generation were far healthier than my generation where, you know, fast food came in, you know, all of these prepacked foods, which I mean, in my mother's day, they didn't have, 

 I think we need to, instead of carrying on the path we're doing is to revert. Act how it was years ago in that eating your own vegetables. But for some people, that's still not an option if you live in a flat.  And you've got no way you could, you could grow things, but that's really interesting, What do you say about, if you had to give me the names of four top supplements that you mostly use. What would they be? 

Dr Kirsten: Oh, that's a great question. The pharmacist that I talk to the most, I send a lot of the patients to our compounding pharmacy and he was teasing me that I use magnesium for every single patient, which I have. I would say, okay. Magnesium is definitely on the list. I do think that people benefit from magnesium and commonly vitamin D. I've run a vitamin D lab on every patient, and they almost always come back in the deficient category. You know, I don't think it has to do with sun exposure. Everybody's either using sunblocks or staying out of the sun, and not eating vitamin D rich foods.  I almost always prescribe vitamin D3.  I would probably put some B vitamins in that cluster of supplements too,  so many of our patients, again, are compromised with their absorption. So either they're having issues, they're on like a. Proton pump inhibitor or there's something going on in the gastro system, and their B vitamins are deficient. Whether it's a B6 or a B12.  So I'd maybe put a B complex for those. And, getting back to the gut, I put almost every patient on a probiotic eventually. So it might not be the first go-round that we meet. But most people I think are gonna benefit from a good pharmaceutical grade probiotic.  And then. I will eventually put most patients on a detox.

So that could be mild. I could be taking botanical teas that helped move their liver and get their liver to function better. Or it could be more aggressive, like a box kit,  like something like the Standard Process detox kits cleanse that takes them through a list of foods that they can eat, have a list of foods that they can't eat, and then supplements that are really going to be pushing their liver through the phases of detoxification. I think that that would be my general toolkit for most patients. 

Linda Elsegood: So with the box detox kit, how long would you have to eat certain foods and restrict. 

Dr Kirsten: Well, there's a low intervention kit, by a company called Metagenics. That's a ten-day cleanse. And I like that when patients that have never done a detox before in their life, it helps them get confidence, know what to expect and get results. So usually, it's a one week cleanse and usually they're gonna feel more clear-minded, have good energy, and almost always lose weight because that's another component. Patients are always tracking their weight. Usually. And, it bolsters them. So after they've done a ten-day detox, then they could graduate to, you know, the next time they need to do a detox. they could do a month-long,  a 28 day cleanse.  I like to start patients where they're at. You know, sometimes I get a patient that has done multiple detoxes and then we can go straight into month-long cleansing. But I usually am going to start where they are. 

Linda Elsegood: Well, it's been amazing talking to you. I'd love to have you back another day and find out more from you. 

Dr Kirsten:  I would love that. 

Linda Elsegood:  Well, thank you, Kirsten. Absolutely amazing talking to you, and thank you. 

Dr Kirsten: Oh, absolutely. It is so nice to get to talk with you, Linda. It really means a lot to me. I've admired everything that you've been doing for a long time. 

Linda Elsegood: Thank you very much. This show is sponsored by Mark Drugs who specialize in the custom compounding of medications, assuring that the client gets the proper prescriptions for their unique needs and conditions. They work with practitioners integrating knowledge and treatment of experts to create comprehensive health plans. Visit Markdrugs.com or call Roselle (630) 529-3400 or Deerfield (847) 419-9898.

Any questions or comments you may have, please email me at contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today. We really appreciate it. Until next time, stay safe 

Dr. Michael Ruscio, DC - 14th August 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today, I'd like to welcome back my guest, Dr Michael Ruscio. Thank you for joining us today, Michael. 

Dr  Michael Ruscio: Thanks for having me. 

Linda Elsegood: Now you're a speaker at the LDN 2019 conference in June in Portland, Oregon. This is a prerecorded radio show, so we've actually had the conference. Could you tell us about the presentation you're going to be giving at the conference?

Dr  Michael Ruscio: Sure I'd love to. There is a growing problem in progressive thyroid care that I'm seeing at an alarmingly increasing rate. And I think it would really benefit providers of all stripes to better understand this: essentially there are maybe two or three big misses that are occurring in thyroid care. One is over-diagnosis of hypothyroidism, or you could turn this another way - when someone isn't truly hypothyroid, but they're being offered thyroid medication as support. What often happens is the patient doesn't realize that this is being used as a temporary support. The provider doesn't make that clear delineation that they're not truly hypothyroid. Some of your levels look a little bit low, so we're going to give you this medication to try to improve your symptoms. They don't make that delineation. The patients stopped seeing that provider, but they kept taking the medication. And now, there are a fair number of patients who've been on medication for years that they don't really need to be on. And so without getting too far into details of that, that's one key component, and we can fill in some of the rationale and the facts there in a moment. But over-diagnosis of hypothyroidism in cases that are not truly hypothyroidism is becoming fairly endemic in functional medicine. 

Linda Elsegood: And where is the source of the problem coming from, because of course, clinicians are trying to help these patients?

Dr  Michael Ruscio: I don't think anyone is over-diagnosing hypothyroidism with malicious intent. I think we're all saying, well, here's the patient presenting with fatigue, depression, brain fog, constipation, dry hair, skin, nails, whatever it is. What can we do to help this patient? 

And I think what we can do to help these patients in part is better to understand the importance of gut health. There is documentation to show that various maladies in the gut can contribute to thyroid function. Autoimmunity can contribute to non-responsiveness and malabsorption of thyroid medication. And by addressing these things, we can finally see these patients respond who had otherwise been unresponsive. And sometimes it involves using no medication, or even a reduction of the thyroid medication. So that's kind of the 30,000-foot view. And I’m happy to go into more detail on any of those points. 

Linda Elsegood: It's really interesting. I've met over the last few years, many people with thyroid conditions, and they don't generally tend to reduce their medication until they're on LDN and find that it's more effective than it was before. But that was interesting you saying, and I took it to be less, was more in some cases that you don't need such a high level over time. How, how does that correlate to the gut. I know that a lot of people with thyroid conditions say that they improve greatly if they don't take gluten. What else should they be doing? Say, if you've got a patient who's got thyroid conditions, what do they need to do to try and get that gut health in the right place? 

Dr  Michael Ruscio: You make a great point, which is therapy like LDN, through its ability to positively modulate the immune system, can positively modulate the gut. And that could help with malabsorption that could be occurring because of a problem in the gut. So that's one area that is sometimes overlooked, where someone may have various digestive symptoms, and the clinician may not fully connect that. Those digestive symptoms indicate that the person is not adequately absorbing their thyroid medication. And this may account for some of the instability seen when tracking someone's thyroid levels. And there are some papers that are documenting this now, most namely in either H pylori infection or those who have ulcers, showing that the treatment of H pylori specifically can actually lead to a reduction of thyroid medication.

And of course, as you noted, there are papers published on those who have celiac disease, who when they follow a gluten-free diet, can reduce their thyroid medication. Most clinicians are probably having their patients experiment with a gluten-free diet, so that is a great recommendation. It's probably not offering the clinician anything new that they haven't heard before, but looking into something like small intestinal bacterial overgrowth or H pylori, that may offer benefit. And again, sometimes we attribute this to healing the thyroid.  This hasn’t been fully borne out by the research yet, but my thinking is when you see a change in the need for thyroid medication where someone actually needs less medication that occurs over the course of a few months, that is almost for certain not going to be due to healing the thyroid gland, but more so due to improved absorption of the thyroid medication. We see this in some of the H pylori studies where patients were able to decrease their dose of medication. And we've published on our website a handful of case studies where we've been able to reduce, in some cases as much as half someone's thyroid medication dose.

At the same time, the patient is losing weight in a positive direction, meaning they were a bit overweight, and now they're at a healthier weight. They have better energy, better skin, less joint pain. 

And there's another parallel here that reinforces the same finding, which is using the liquid gel tab form of thyroid hormone known as Thyroxine. And also some research has been performed showing that in patients who have been unable to obtain stability in TSH and T4 and/or the resolution of symptoms use Thyroxine and actually are able to get many patients to a more stable TSH and T4 and improve their symptoms. And this is almost again for certain because Thyroxine being in a liquid gel tab is much more easily absorbed than some of your more traditional tablet forms. That's just a couple of ways in which the gut can directly impact the absorption of thyroid medication, which again, I don't think is being given the amount of attention that it deserves. And I can say in clinical practice. That can be the difference between success and failure in some of these cases.

And I'll just juxtapose that with - sometimes the clinician is really floundering with a patient on Levothyroxine and maybe they need to add in some T3 Cytomel, or maybe they need to switch them into a desiccated form something like Armour Thyroid or even WP Thyroid or Nature-Thyroid, or anyone of these medications that's a T4-T3 combination. 

And that's not really what the cause of the problem is. The cause of the problem is inconsistent absorption, and that is oftentimes addressed by improving the diet. As you noted, with something like gluten-free or if someone's already gluten-free, then considering some type of dysbiotic or infectious issue in the gut can then be what improves the gut health and allows the patient to more consistently absorb the medication, and then their blood levels look better and then their symptoms also look better.

Linda Elsegood: So how do people know what their gut health is? Like? How, what are the symptoms?

Dr  Michael Ruscio: That can be one of the biggest challenges because we're starting to learn that you can have - and actually, some of the older celiac research has shown this for a while - that you can have an active inflammatory issue in the gut that only manifests extra-intestinally. Meaning you have no digestive symptoms, but you may have something like atopic dermatitis or depression or fatigue or joint pain.

So one of the challenging things can be figuring out whether the gut is the root cause of this problem. Because you may have no gut symptoms, testing is oftentimes offered as a solution here, which it can be; but the testing is really imperfect, in my opinion. There are a number of things that we can test for, but there's also a number of things where the testing still hasn't been fully mapped out yet. And just as one example, we know that small intestinal fungal overgrowth does exist. Dr Satish Rao has published some research on this. But because doing a sample directly from the small intestine is impractical, then that's not something that we can really readily assess in clinical practice. So if someone could do a breath test for SIBO and a stool test for other types of bacterial and fungal dysbiosis, that's a great start. But we still might be missing something like small intestinal fungal overgrowth. 

So, in answer to your question, what can be used to help assess the health of someone's gut? Testing gives us a slice of information that can be helpful, but it doesn't give us all the information and the way I look at this is to consider taking steps to optimize your gut health kind of proactively. Even if you don't have a diagnosis of H pylori or small intestinal bacterial overgrowth, consider taking those steps to proactively improve your gut health.

If you've improved your diet, if you have a healthy lifestyle, but you're still not following optimally, well, so you're still not feeling optimal. Well, then. I think it's a good idea at that point to just, again, proactively and almost more so - empirically take steps to improve your gut health, because it can be challenging to get that definitive diagnosis on a lab test of various sorts.

Linda Elsegood: I've had people with thyroid conditions ask me questions about gut health, and they say, how do I know if I've got leaky gut? I've read that there are people that have leaky gut, and I seem to have the same kind of problems. What tests do you do for leaky gut? You mentioned that.

Dr  Michael Ruscio: Great question. And this is another area where the testing is really imperfect. We just performed a comprehensive review of the literature, literally looking at every test in humans on the markers, serum zonulin, which may be one of the better markers for assessing leaky gut. No marker really is perfect. Zonulin, that may be the best test now. Zonulin is a marker essentially of tight junction proteins in the gut and can be assessed via blood or stool, and it does correlate with various diseases like diabetes, metabolic syndrome; and in some cases, inflammatory bowel disease and IBS.

So it does seem to correlate with diseases or symptoms, but not in every case. But where the argument falls apart a little bit more, unfortunately, is when we look at what happens when we treat people, we put people on a healthy diet or on a probiotic or what have you, and this is where there are much more inconsistent findings with zonulin.

There had been a few studies showing that in people with symptoms and with high zonulin, meaning leaky gut, they then improve their diet and see a drastic improvement in their symptoms. Yet their zonulin gets either worse or stays the same. Now to be fair, there are also studies showing that zonulin can improve after using something like a probiotic, but there are also studies showing that people will see no improvement in zonulin after taking a probiotic, even though their symptoms have improved. I know this may be a little bit unpopular for me to say, uh, that zonulin may not be quite fully ready for the routine clinical application, as there are some inconsistencies with testing for leaky gut.

So this is why I say testing gives us a slice and it can be helpful, but we really cannot fully hang our hat on test results alone. Because when you look at the data behind these tests, in many cases, what you see is the tests do not perform perfectly. They're only partially informative, and so the best test, arguably, for leaky gut would be zonulin, but it certainly is not something that I think is highly reliable. So it's one slice. But we also want to take the patient's symptoms into account. And so maybe to just paint a scenario here, if someone came in with rheumatoid arthritis and they wanted to know if their gut was contributing to that rheumatoid arthritis, or even their thyroid condition, what we could do is perform some testing, and that would be maybe one-third of the data that informs how we're going to proceed. And if we find something on testing like small intestinal bacterial overgrowth or H pylori, we can treat those. However, if the testing comes up negative, one still may want you to consider a round of treatment. And this is where using things as herbal medicines and probiotics make a much more of a tenable approach, because these things I don't think, require the same rationale as using something like an antibiotic or what have you. But treat the patient for a presumed imbalance in the gut and then monitor their symptoms. If their symptoms are improving or if the dose required for the third medication becomes more stable, or even they start to appear hyperthyroid like they need less medication, then that tells you that you're on the right track.

And again, I know it's easier if I were just to proclaim one or two tests to be the best and one or two markers, and that's the easy message I think we all want. But unfortunately, when you take that easy message into clinical practice, you get really confused. And if you take my message, which is a little bit more nuanced, albeit being a little bit more complicated, I think you'll see, it really interfaces into the clinical practice more consistently and delivers better results.

Linda Elsegood: Well, I mean, unfortunately, your stomach and your bowels, you can't see, can you? It's not like psoriasis on your hands or something that you can see what's going on there. When I have spoken to doctors and asked what they think are the top four supplements that people should be taking, probiotics are always number one that people should take. What kind of a probiotic would you suggest to patients who wanted to take that to improve their gut health? 

Dr  Michael Ruscio: That's a great question, and I would certainly agree that especially for someone who's trying to improve their gut health, then a probiotic is a fairly inexpensive intervention and very safe, or even now showing some secondary health benefits. For example, one analysis has documented improvement of mood. Other research has shown a small but significant ability to improve cholesterol, blood sugar, and even blood pressure. Again, the effects there are small, and I would say not clinically significant, but at least you're getting a small movement in a healthy direction.

So I'm just trying to showcase here the neutrality, or at least small side benefit, of probiotics rather than there being some downside. We know that probiotics can improve things like H pylori and, and be synergistic with H pylori antibiotics. And in my opinion, may help to kind of re-establish a healthier balance of H pylori colonization. And they can help to eradicate things like SIBO, and intestinal fungal overgrowth. So certainly the end reduces leaky gut and there's a lot of benefits that we can attribute to probiotics. 

It's your question that’s a more challenging thing: what probiotic do I use? And this is where I think both the clinician and the consumer are confronted with just a dizzying array of options in terms of the probiotic formulas out there. One of the things I write about in my book is organizing probiotics into three different categories. And this greatly simplifies the landscape in probiotics. And when, when you read enough of the research on probiotics, and you sift through enough of these meta-analyses that summarize the high-quality clinical trials, you start to see that we can break probiotics down really into technically four categories. But one category is hard to obtain, especially in the US, so I typically focus the conversation on the three categories. 

Category one is a blend of lactobacillus and bifidobacterium strains. The exact formulas differ slightly from product to product, but then, the underlying and unifying theme is you will see the strains in the formula are predominated by various strains of lactobacillus and bifidobacterium. Your category two is just one strength, typically, which is the healthy fungus, Saccharomyces boulardii. And then your category three - you have typically anywhere from one to maybe five or six strains that are often known as soil-based or spore-forming probiotics. What I like to do with patients is have them use a moderate dose of all three of these; or in more sensitive cases, they will likely have reported some reactions to probiotics in the past.

And what you want to identify as a clinician is what category do they seem to be reacting to? Because oftentimes people are taking a category one probiotic that's the most popular and common probiotic out there. They may have tried two or three or even four different probiotics, not realizing that each one was a category one, a category one, a category one, a category one. And so they come in and say they just can't do probiotics, they react really negatively. And that's where taking a quick history and seeing if they know the names of the probiotics, quickly looking them up and determining, okay, all of these were in fact category ones. So then you can have them start with category two and category three. There are some patients by just going through that exercise of having them try a probiotic category one at a time, you can pinpoint that that is a category that you react negatively to. Now we can use the other category or categories that you do tolerate, and then you can obtain that fairly impressive benefit that can be vectored by probiotics and help the patient navigate around that reaction that had been kind of slowing their progress previously. 

Linda Elsegood: Well, the first time I wanted to buy some, I went into a whole food shop, and they had rows and rows of probiotics, and some started at 10 pounds, and some went up to 50 pounds. And I was trying to read on the bottle what was in the 10-pound one, what was in the 50, and what everything in between was. And I was just so bewildered by the end of it I asked for some help, and the young man didn't know either, really. So I just went for a middle-priced one to try it to see what it was like. But you have to do your research. It's not easy to find out. It's a minefield because there are so many things on the market and some that are similar like you're saying category one, but they're still not the same price. You know, the convenience. Sometimes if it's a really well-known brand, I think you may pay more for the name as well. 

Dr  Michael Ruscio: So thank you so much for making that comment, and you're absolutely right, which is the quality of a probiotic does matter. We want to be careful not to think that more expensive automatically equates to better. And we also want to be careful that if something is drastically cheaper than others, then there may be some corner-cutting that is occurring.

So there are things that you can look for. These can be, I think, challenging for consumers, and also probably challenging for clinicians if you're not used to fact-checking these types of things. But you can look whether a company is following good manufacturing practices and is also having third party testing to ensure that their probiotic meets its label claims. And then also looking for companies that aren't using fillers. That can be irritating, especially when we're talking about people who have sensitive guts. Some probiotics, this more so happens with cheaper probiotics, they're not very potent, and they're kind of watered down with other fillers or things like prebiotics, which are significantly less expensive.

Another way around this is just finding a couple of companies that are fairly reputable and just try to use the probiotics that fall into the category system. Find those reputable companies - that's quite a bit easier than just going into a health food store and trying to figure out their 15 different probiotics. Which ones can I trust? Which ones can I not? 

Linda Elsegood: And of course, it's the same in America as it is over here. I mean, supplements aren't regulated, so you can have labels that make claims of what's inside it, but they don't have to put a percentage, so if it's not like pharmaceutical grade, where they can prove, as you were saying, what is actually in there is on the label. It is reassuring to know that you have done the best you can to try and find out what is in the probiotic or supplements of any kind, because the layperson just wouldn't know - so trying to get a good manufacturer, that's what I'm trying to say, is really the starting point, in my opinion, as a consumer. Someone that you can trust, because you can spend a fortune on the cheaper brands that, as you said before, might have fillers and all of this kind of thing. And actually not have that many ingredients that are actually going to help you. But you know, if something is a quarter of the price, it's a waste of money if it's not going to work, isn't it? So sometimes you have to pay that bit more to make sure that you've got a product that is going to do what it says it's going to do. 

Dr  Michael Ruscio: The way that I learned was with protein powders, where I was using the most expensive protein powder and I noticed it. You make your shake, and sometimes you put it in one scoop, maybe sometimes you're a little more hungry, you want a thicker shake, so you put it in maybe two or three scoops. And if I ever had more than one scoop, I would get bloated. And I later learned from one of my friends who owns his own manufacturing company, that you have to really watch out for companies putting in excipients, which are powders that help the machines run more quickly. And he explained to me that because the machines run more slowly when making his protein powder, he had to pay extra to have them not put the excipients in. So it is a legitimate thing, and especially if you have a sensitive gut, just making sure that who you're getting your product from cares about these things. And it may not be that a manufacturer is trying to do you harm, but they may be saying, well, we're trying to cater to a market that is very price sensitive. So we're gonna use excipients to cut down our costs. 

We're trying to provide these items that are most gut-friendly and maybe a little bit more expensive. But I think the customers that we're trying to appeal to understand that. A slight increase in expense, the quality would be worth that. So, yeah, it is important to find a company who is going to be attentive to these things and, and make those tough decisions of making the product more expensive when it's really in the best interest of the consumer.

Linda Elsegood: Let me ask you, what's your diet like, Michael?

Dr  Michael Ruscio: I loosely eat a paleo diet. I do eat quite a bit of dairy, and thankfully I have no problem with dairy; most meat, vegetables, fish; and I don't eat much in the way of grains. I do have some rice. I do generally avoid gluten. I do notice if I eat too much gluten, I do have a problem. Even though the healthcare consumer is told that everyone should avoid gluten, I think it is incorrect. And that's not borne out by what the best research on this topic has found. But essentially - lots of vegetables, meats, healthy fats, fish, moderate to kind of lower-carb diet. So some gluten-free grains, but not a high amount. Some kind of a moderate lower carb, paleo diet with some dairy would maybe be the best label that we could put on it. 

Linda Elsegood: Some people say that they find diets for eliminating food really restrictive. And they will ask if once they’ve started down that road of eliminating these foods, will they ever be allowed to eat them again? So you were saying that sometimes you still have gluten and you know when you've had it, so obviously you don't exclude it completely. 

Dr  Michael Ruscio: Right, and you make a great point, which is we want to be careful with diets. Not to think that an elimination diet means you eliminate forever. Most elimination diets follow the pattern of cutout foods that could be a problem for maybe a month, maybe two months. And then once you feel you've improved, then bring the foods that you can back in a kind of systematic manner, where you're bringing maybe one or two in at a time, so you can identify what foods sit well with you and if any foods are triggers.

And then it's not to say that because a food is a trigger you can never have any, but you want to be a bit more judicious with how you use it. That is really, in my opinion, a key distinction to draw because what I see happening with patients is they become so scared of food, and they may have little to no reactivity, let's say, to gluten. So they can get away with having some on some occasions. Now, if you're noticing some reactions to gluten, would I recommend making a dietary staple? Absolutely not. Right? There's also this ability to live in the world without being afraid. 

And this is where I think some of the hard-line messaging on gluten is really damaging people from a psychological perspective, because now these people are at a restaurant with their friends and should be enjoying themselves, and they're worried. They're sitting there frantically worrying internally, trying to hide it behind a smile on their face, about is there gluten in the sauce here? And now again, there are some people who are exquisitely gluten sensitive, and they have to operate like that, but I don't think that they would wish that on somebody else who at worst may feel bloated in forty-five minutes if they have some gluten. So, your level of avoidance should be required with your level of intolerance. I know that the gluten-free staunch advocates will take issue with that, but you have to weigh that against the psychological damage we do to people who don't have much of a physiological reaction but are inculcated and feared into thinking that they will have massive damage if they have gluten. And now every day in their life, they have this baseline level of fear that is damaging their health. And so when you weigh these all out, I think it's clear to see that, yes, we want to identify gluten as being a problem in those that it is and help them avoid it as best they can. But people that have little to no reactivity, they have some leeway, and we don't want to fear them into thinking that they have to eat like they have celiac disease. 

Linda Elsegood: Wonderful. Well, we've come to an end and where's the time gone? It's been amazing. Thank you so much.

Dr  Michael Ruscio: Yeah. It's been a pleasure chatting. Time always flies when you're having fun, right? 

Linda Elsegood: Well, we'll have to have you back again, so thank you very much for having been my guest today. 

Dr  Michael Ruscio: Thank you again. It's been a pleasure.

Linda Elsegood: Healthy Gut Healthy You by Dr Michael Ruscio is a long-anticipated and comprehensive guide to completely resetting and healing the gut. Arm yourself with the education tools to heal yourself from the inside out today. Visit drruscio.com for details.

Any questions or comments you may have, please email us at Contact@ldnresearchtrust.org.

I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep healthy.

Tom O'Bryan, DC - Gut Healing (2017 Conference) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Autoimmune diseases are the third leading cause of getting sick and dying in the industrialized world surpassed only by cancer and heart disease. Three things in the development of autoimmune diseases: having the gene for that disease, the environmental trigger that that sets it off, and the loss of intestinal barrier function. How you live your life determines whether or not you get that condition. You can arrest the development of the autoimmune disease.

Dr Tom O'Bryan: Well. Hello everyone. This is Dr Tom O'Bryan, and it's a pleasure to be with you. And this is for the Low Dose Naltrexone Conference, September 21 through the 24th of this year (2017) in Portland, Oregon. And it's with a great deal of gratitude that I am presenting there.

I'm very grateful for the work that Linda Elsegood and the entire team is doing to bring out information about low dose naltrexone to the world and how remarkable a tool it is, to use with many, many different health conditions. And in our presentations in the past in 2016 at the LDN conference, which I believe that presentation is accessible to you if you go to the LDN conference website, we talked a great deal about how LDN is a benefit with autoimmune conditions. I referenced that. And how if a person has a sensitivity to wheat, whether they know it or not, it can diminish the effectiveness of LDN. And, uh, just as a segue last year in 2016, I presented at the Fourth International Oncology Conference in Abu Dhabi and showed the studies that if a person has a sensitivity to wheat, a number of different approaches of chemotherapy will not work the way they're supposed to and is for a similar mechanism. And that is that wheat will bind down to receptor sites that LDN also binds onto and that chemotherapy can bind onto. So this whole thing about wheat is worth exploring in more detail, and you can learn more about that by reviewing the presentation from the 2016 conference.

And that's just a little of who I am. I like to start with this slide. This is a display in the museum of science in Florence, Italy. This is Galileo's finger. And Galileo bequeaths in his will that all of his inventions could be on display for all of the posterity as long as they also displayed his finger.

And I like to put that up because you're going to hear her so much marvelous information in this conference. And when I've sat as an attendee in conferences like this, I take pages and pages of notes, and I'll write down, check this for this patient, or read this article or look more into this topic.

And I have pages of notes, and then I go back home and Monday morning back to work, and I don't have time to do any of it. That there is so much good information that we get. It's hard to implement. So I came up with the principle that if there's one thing, just one thing, that I walk away from a conference, a weekend conference with that goes into my lifestyle or my practice for the rest of my career, that weekend was worthwhile.

The thousands of dollars to travel and stay in hotels and pay the registration and be out of my practice. It's worthwhile, if I can just pick up one thing, I wish I could pick up ten things, but if, if I can pick up one, then it is a value. And so that's how I feel about this presentation, that if we all understand the concept of autoimmune disease and the message that I want to give you here today, this will stay with you the rest of your life. And it will not only help you in making more informed choices in your health care but also your children, your spouse, your family.

The first part of this autoimmune disease concept is that there are four circles to consider when thinking about autoimmune diseases. Genetics, and this is not a talk about genetics today, but let me just say with genetics, if you have a gene for a particular disease, that does not mean you're going to get the disease. It means that you're vulnerable to getting that disease. So the way I say it to patients is, Mrs patient if you pull it a chain, the chain breaks at the weakest link. It's at one end, the middle, the other end. It's your heart, your brain, your liver, your kidney, wherever your weak genetic link is, that's where the chain's going to break if you pull too hard.

So the goal in life is don't pull so hard on the chain because if your weak link is your brain, that's where the disease will manifest. If you pull too hard, if the weak link in your chain is your skin, you may get psoriasis. If the weak link in your chain is your joints, you may get rheumatoid arthritis, but it's the pull on the chain that allows the gene to express itself with the vulnerability that you have.

So genetics is important, but they are not a sentence that you're doomed to get a particular condition. It's how you live your life. That determines whether or not you get that condition. Notice that the genetics in yellow there is not covering everything. That it's only the part of the genetics that merges with the infections, the toxic chemicals, the dietary components.

Those are the triggers that will pull on the chain. And then if the link breaks, the gene gets activated and here come your kidney infections. If that's your weak genetic link, or here comes your Parkinson's if that's your weak genetic link. So the goal here is to learn how to not pull on the chain so hard.

To find out what it is in your life, in your body, with your genetics, where the weak link in the chain is. So the classical paradigm of an autoimmune development, the pathogenesis of autoimmune disease involving a specific genetic trigger and exposure to genetic makeup and exposure to environmental triggers has been challenged by the addition of a third element. There are three things in the development of autoimmune diseases. You've got the gene for that particular disease, whether it's Alzheimer's or Parkinson's or rheumatoid or ms or diabetes. You've got the gene, the environmental trigger that that sets it off, the straw that breaks the camel's back, when you're pulling on that chain too hard. And there's a third element, and that is the loss of intestinal barrier function. The technical term is pathogenic intestinal permeability. The slang term is leaky gut, and we're going to talk about that in detail, so you have a clear understanding of what the scientists are talking about when they're referring to the loss of intestinal barrier function.

So in this article in autoimmune disease, in the journal, autoimmune diseases, they talked about the environmental triggers, whether it's food or something in the air or something like in your clothing. If you get dry cleaning and you're inhaling those chemicals, those minute amount of chemicals, all the time, you can't tell, but you are inhaling them.

So the trigger. Causes a breakdown in oral tolerance. That means that you no longer can tolerate this food changes your gut microbiota. The technical term is dysbiosis, which enhances gut permeability. You get this thing called pathogenic intestinal permeability or the leaky gut, which causes large macromolecules to get into the bloodstream that isn't supposed to get into the bloodstream, which your immune system reacts to, to protect you, which then can trigger autoimmunity.

And in this article, it was neuro autoimmunity. So I'm going to go through these concepts in more detail so that they're crystal clear for you. Increased intestinal permeability is, and I underlined this, is an early biological change that often preceded the onset of autoimmune diseases. The intestinal permeability comes first.

By the way, the way that I do my presentations is that this is the front page of the article I read, and in the upper right side, you see the name of the medical journal, the issue, the volume number, the date, sometimes the pages. And then in the yellow box are exact quotes from the authors, exact quotes. I haven't changed a word.

If I've added anything, it's in parentheses, but these are exact quotes. This becomes your reference library, this presentation on this topic because these are the exact quotes. Such increased permeability could be due to environmental factors such as infections and toxic molecules and allergenic foods that possibly initiate the autoimmune disease.

Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier with its intercellular tight junctions controls the balance between tolerance and immunity to non-self antigens. Non-self antigens mean, uh, environmental molecules you're exposed to, whether it's food or air or water.

It's not part of you, but it's inside of you. And when you lose tolerance to that thing and your immune system gets activated, now you have a non-self antigen. And this suggests the autoimmune process can be arrested if the interplay between genes and the environment is prevented by re-establishing intestinal barrier function.

This is the take-home point that you can arrest the development of rheumatoid psoriasis, multiple sclerosis, Parkinson's, or Alzheimer's, dermatomyositis. It doesn't matter—the autoimmune disease. Practically every autoimmune disease that we've ever looked at, we see this trilogy, which is a genetic vulnerability and the environmental trigger and intestinal permeability, and if intestinal permeability is the gateway into the development of the autoimmune disease when you take care of the intestinal permeability, you close the gates.

And when you close the gates, your immune system calms down. And I'm going to go through this in detail for you in this presentation. So if we take a look at autoimmunity, the National Institute of Health tells us the autoimmune disease coordinating committee that while many individual autoimmune diseases are rare, collectively, they are thought to affect about 8% of our population, about 24 million people. To provide a context for this, the impact of the impact on autoimmune diseases, cancer affects 9 million people. Heart disease, about 22 million people, but autoimmune disease, 24 million people. And Dr Jeffrey Bland went around the country, around the world, actually talking about autoimmune diseases, and he said, collectively, the autoimmune disease has been identified in about 24 million people in the US, but only one out of three are diagnosed.

That means there are about 72 million people out there with an autoimmune disease, and it's not looked for. Doctors don't look for it. Our system waits until the signs and symptoms are severe enough. With organ failure and organ can't function correctly anymore, and there's irreversible damage, and now you have symptoms, then we start to look for it.

Seventy-two million people, autoimmune diseases are the third leading cause of morbidity. That means getting sick and mortality. That means dying in the industrialized world surpassed only by cancer and heart disease. So this is what we're up against. Many times when you start looking at this world of autoimmune diseases, autoimmune diseases can affect any part of the body.

There's no part of your body that can not have an autoimmune mechanism going on. And it takes an inordinate amount of time and perseverance by the patient. Look at how many years it took on average for diagnosis of autoimmune diseases. In the last, uh, almost 20 years here now, 20, 21 years since 1996.

How many years did it take? How many doctors did the person have to see, and how many were told it's just in their head, and they're just a complainer—the years to diagnosis for different autoimmune diseases. The number of doctors seems to get a diagnosis for different autoimmune diseases. The per cent that was told, their diagnosis imagined, or that they were overly concerned that it was just in their head.

Half the people are told it's just in your head, and they've got a devastating disease that's killing off their tissue. These are not exceptions. These are the averages. Why so long and difficult is to correct, to get a correct diagnosis. Physician education was identified as a contributing factor.

The American Autoimmune and Related Diseases Association did a study of family practitioners, family doctors, and this is what they found when asked in medical school, how much training in autoimmune diseases did you receive? Look at the numbers here. 18.5% one lecture, 27.8% two lectures, 18.5% three to five lectures.

That means more than half the people. Half the doctors had some less than five lectures. Now, that's not courses. That's a lecture. This is just unacceptable. Would you agree that you received enough training to diagnose and treat autoimmune diseases? Look how many doctors feel they don't agree with that statement, that they did not get enough training.

What is the level of comfort in diagnosing autoimmune diseases? Half of the physicians interviewed were uncomfortable. Half of them because they just didn't get the training. They don't know how to identify this until it's so obvious that it's just staring you right in the face. So before I go onto this first premise, I just want to say it's not our doctor's fault that patients have to see so many doctors to get the right diagnosis.

They just weren't trained. They weren't trained in this. Now it is their fault. When they tell somebody, it's all in your head. Rather, an appropriate thing would be to say, you know, I just don't know what's going on here. I'm going to have to send you to somebody else cause I just don't know. I take issue with telling people it's in their head. Okay, let's move on.

Premise number one. Just how prevalent is the development of autoimmune diseases? Well, I'm going to introduce a new concept here about the true prevalence of autoimmunity. Autoimmune diseases are the third leading cause of getting sick and dying in the industrialized world surpassed only by cancer and heart disease.

However, if we think a little more closely about this, immune driven inflammation is key to the development of cardiovascular disease. We think the number one cause of getting sick and dying in the world is cardiovascular disease, but it is immune driven. Atherosclerosis is increasingly considered an immune system-mediated process of the vascular system.

Autoimmunity plays a major role in the development of dyslipidemia and atherosclerotic plaque formation. Atherogenesis the development of atherosclerosis has been proposed to be considered an autoimmune disease. Now, this is the World Journal of Cardiology talking to us. Thus, if the cardiovascular disease has an initiating autoimmune component, arguably what becomes the number one mechanism in the progression of getting sick and dying in the world today. If we think about it, and if cardiovascular disease is autoimmune in its initiating phases, then autoimmunity becomes the number one mechanism for getting sick and dying in the world, your immune system attacking your own tissue, and I'm going to show you why this happens, but whether it's number one or number three, it doesn't really matter. The point is it's in your practice every day. It's in your family every single day.

Premise number two, how can we identify people at risk for the development of autoimmune diseases? The National Institute of Health tells us that there are six potential mechanisms by which biomarkers can really help with identifying autoimmune diseases. They enable a diagnosis before the onset of symptoms. I'm going to explain this. They predict specific organ involvement. They predict disease flares.They identify clinically meaningful disease subsets, and they predict and monitor response to therapy and describe organ or tissue damage. So once again, if autoimmunity plays a major role in the development of dyslipidemia, atherosclerotic plaque, the next sentence in this article, what they said was the mechanisms underlying these changes include the interplay of inflammation and autoantibody formation. So the mechanisms underlying these changes include the interplay of inflammation and autoantibody formation. So we can predict organ involvement. We can enable diagnosis before the onset of symptoms. We can predict and monitor response to therapy. We can identify clinical, clinically meaningful disease subsets.

And here's what I'm going to show you how. This articles by Arbuckle and her team and came out in the New England Journal of Medicine in 2003, and she went to the Department of Veterans Affairs hospital system,and looked for people with the autoimmune disease - lupus, systemic lupus erythematosus -and she found 130 people in this one VA centre with lupus. Now, if they're in the VA system, they're veterans. If they're veterans, they were in the armed forces. If they were in the armed forces, they had their blood drawn many times over the years when they were in the armed forces when they were healthy in the Army, the Air Force, the Navy. What most people don't know is that the US government has saved all of that blood since 1978. They've got tens of millions of samples of our service people's blood.

So Dr Arbuckle went to the VA and asked for permission to look at the blood of these people currently diagnosed with lupus from when they were healthy in the Navy or in the Marines, and she received permission to do it. And what did she find? She found that antibodies are typically present many years before the diagnosis of lupus.

That the appearance of these antibodies follows a predictable course with a progressive accumulation of the antibodies, you keep producing more and more and more before the onset of lupus, before the, while those patients are still asymptomatic, they have no symptoms. So this graph from her research article shows that with the antibodies in general, they were 50% above the limit of normal six years before the patient ever had symptoms, six years, and the average was six months after the start of symptoms before they got the diagnosis of lupus in this particular study. And these are the seven different antibodies of lupus. There are seven, and you can see every single one of them. Zero is normal. So if going from left to right, the zero lines are normal and every one of those antibodies was elevated years before there ever were symptoms and referred to as the first manifestation of SLE, systemic lupus erythematosus.

Years beforehand, the antibodies were elevated, and you can see how they kept climbing up every year, going up, going up, going up until they start to plateau. After you get symptoms, you've pretty much killed off enough tissue where you're getting symptoms now. So let's just back up. Let me just tell you something here.

Why is it normal to have antibodies to your own tissue? To your thyroid or to your brain or to your muscles or to your skin. Why is it normal? Because for most patients, we have an entirely new body every seven years. Entire new body. Some cells reproduce very quickly, like the inside lining of your guts—every three to five days.

Other cells are very slow, like bone cells are very slow. So every seven years you have an entirely new body. Right? So when cells get old or damaged, they get bruised from oxidation, bad foods, radiation when you fly in it in an aeroplane. There are many reasons why our cells get damaged. When that happens, the body has to make antibodies to get rid of the old and damaged cells, to make room for new cells.

That's how we create new cells. You've got to get rid of the old ones to make room for the new ones. So there's a normal reference range of antibodies. To your thyroid, to the myelin that wraps around your nerves, to the cerebellum in your brain, to the hypothalamus, in your brain, to your skin, to your joints.

We have a normal reference range of those antibodies, but when you have elevated antibodies, like in this slide here, you see all seven antibodies to lupus are elevated years beforehand, you're killing off more cells than you're making. And if the mechanism that's causing the elevation of the antibodies - remember environmental trigger genetics and intestinal permeability - if the mechanism continues, you keep making more antibodies, more antibodies, killing off more tissue, killing off more tissue, killing off more tissue until eventually, you've killed off so much tissue now that organ can't work right now, you start getting symptoms. Then it takes years to get the right diagnosis.

As you saw in the slides from earlier, it takes years to get the right diagnosis while you're still killing off tissue. So Dr Arbuckle refers to it as the prodromal period—that period before you have symptoms when you're killing off tissue. And the entire goal here is to identify the prodromal period for people before they've killed off so many tissues the brain can't work right anymore, or the heart can't work right anymore, and they get diagnosed with cardiomyopathy, or they get diagnosed with Alzheimer's or they get diagnosed with Parkinson's. So the goal here is to understand this prodromal period, and I'm going to talk to you about the testing to identify if people are in this prodromal period killing off cells.

So Dr Arbuckle drew this graph. You have normal immunity, a normal amount of a normal immune system. You get some benign auto-immunity. You're killing off a few cells to make room for new cells. Now you get pathogenic autoimmunity where you're killing off more cells than you're making, killing off your tissue, destroying your tissue, destroying your tissue until eventually, you get the clinical illness.

Now back in 2003, Dr Arbuckle did not know about the intestinal permeability part of this. So she's got two of the three, she's got the genetics on top and the environmental factors underneath. But the third one, the gateway that caused that allows all of this to happen is intestinal permeability. So immunologists all over the world said, well, that's brilliant what Dr Arbuckle did. Let's go back to the blood banks and look and see about other diseases. And there are many, many papers now published on the world of predictive autoimmunity. So look at this graph. If you have any antibodies to lupus, any of these seven antibodies elevated - the PPV stands for positive predictive value - you have a 94 to 100% positive predictive value. You're going to get lupus within 7to 10 years. For scleroderma, if either of these antibodies is elevated, 100% you're getting scleroderma within 11 years. Rheumatoid is 52 to 97% depending on the antibodies, within 14 years, you're getting rheumatoid Sjogren's; primary antiphospholipid syndrome is 100%. Now in this one, the bottom one, beta-2 glycoprotein 1, this is the antibody that's elevated for many women with unexplained miscarriages. It's an autoimmune mechanism causing a clot, blocking the blood flow into the uterus, into the placenta, and the woman miscarries.

So every woman, of childbearing age, in my opinion, that has a family history of miscarriages, should do this test to see if they have elevated antibodies to beta-2 glycoprotein 1 because it's such a very common trigger for the loss of a pregnancy, unexplained loss of a pregnancy, especially in the second trimester, but not exclusively in the second trimester.

If you have TPO antibodies elevated, especially postpartum, it's 92% you're getting Hashimoto's within 7 to 10 years. Primary billiary cirrhosis, 95% 25 years; type one diabetes, Addison's. 70% of Crohn's disease. Look at this. If you have sacharomyces or BCA antibodies elevated, that's ASCA antibodies. ASEA it's 100% you're getting Crohn's within three years.

The science has done on this. I mean, predictive autoimmunity is where we all want to go. We all want to include. What's cooking inside of me right now? What is it that I might be able to nip in the bud before it progresses by killing off enough cells that finally I'm now I'm diagnosed with dementia or Parkinson's or schizophrenia.

So this is a test that's available that looks at 24 different tissue antibodies in one blood draw. The top four, the grey ones are to the gut. The next two are to the thyroid, the adrenals, four for the heart, the reproductive system, three for the muscles and ligaments. Then the bones, a couple for the liver and the pancreas, and the bottom six are for the brain. You do this blood test, this single blood draw.

When I did this, I had three of the ones on the bottom elevated. I had myelin, basic protein, AGL, gangliosides and cerebellar antibodies elevated. I was 45 years old. I was at the peak of my triathlon career scoring in the top 10% of the 30 to 35-year-old. So I thought I was really healthy physically, but my immune system was killing off my brain, and I never knew. All outward appearances were that I was healthy.

I'll give you another example, a 44-year-old guy comes in to see me. His father died of a massive coronary at 44; his two older brothers died in their early forties of massive coronaries. He was 28 when his last brother died, and so he went to a cardiologist who put them on a statin right away, preventively. Now he comes to me 16 years later. He's been on a statin for 16 years, but he's the picture of health, really smart guy ,and learned the potential complications of statins. So he was taking a lot of nutrition to protect himself, including coincide Akutan. His diet was squeaky clean. He never ate junk, only good food, good healthy food. His body fat was 16%/ He had an excellent job. He was an executive. Happy family life. Everything looked great to doctors every year he got his physicals,. They said you're as healthy as a horse. When he came to me and said I want to do your tests, he wanted to do this test because he had heard about it. So we did this blood draw on him.

It came back: all four antibodies to his heart were sky-high, all four of them. He said, why is that really worrisome? And I said I don't know. Let's find out. It turns out that he was allergic to wheat and to dairy. When we did the right tests for him, he was allergic to wheat and dairy. I talked about those tests in last year's presentation at the LDN conference, on testing accurately for sensitivity to wheat. So he's allergic to wheat and dairy, and we put a wheat-free dairy-free. I didn't do anything else. He was already taking a bunch of good vitamins. All of his other markers were as healthy as could be. Six months later, he comes back, and then we retest—his heart antibodies are down to normal. The autoimmune mechanism killing off his heart had stopped. It was a reaction to the environmental triggers of some of the food that he was eating. And he said you saved my life. And I said, well, I don't know. You know, the doctors that did this work, they did all the research on this. That's really what we need to be grateful for. But this test is an introductory test to identify where is the pathology in your body right now. You know, no one gets Alzheimer's in their sixties or seventies. You get Alzheimer's in your twenties and thirties. It just takes decades of killing off brain cells before the damage is so extensive that it becomes obvious, and as you kill off more brain cells, the rate of the increase goes up, so you kill off faster as you go forward, as the antibodies keep going up and up and up and up.

Premise number three, what's the trigger to the production of antibodies to yourself? And the extremely important function of the GI tract is its ability to regulate the trafficking of macromolecules between the environment and the host through a barrier mechanism. What they mean here, Mrs Patient, if you could take a doughnut and just stretch a doughnut out, and if you look down that stretched out doughnut, looked down the hole, that's your GI tract from your mouth to the other end. It's one long tube. It's 20 to 25 feet long. Winds around inside your abdomen there, but it's one big long tube. So when you swallow food, it's really not in your body yet. It's in the tube. And it's gotta be broken down to go through the walls of the doughnut into the bloodstream.

We have to digest that food, break it down. Think of proteins like a pearl necklace. Hydrochloric acid made in your stomach undoes the clasp of the pearl necklace. Now you have a string of pearls. And the digestive enzymes that we make in the pancreas, in the gallbladder or in the microbiota., these digestive enzymes act as scissors to cut the pearl necklace into smaller clumps of the pearl necklace, and it keeps snipping them, snipping them, snipping them until you snip it into each little pearl of the pearl necklace.That's digestion.

Now you've got this long tube, the inside of the tube, it's got Shea carpeting, but the surface of it is lined with cheesecloth. The cheesecloth only lets really small molecules get through. If you remember your grandmother pouring gravy into the cheesecloth, only the liquid comes through the other side and all the clumps, they stay on the outside. They can't get into the gravy pouring dish. That's the way our system is. The inside of the tube is lined with cheesecloth, so only each little pearl of the pearl necklace can get through the cheesecloth and get in the bloodstream. Then your body uses these acids that are called amino acids to make new bone cells and brain cells and heart cells. That's the raw material you make your new cells from. But it's got to be in the form of the amino acids. As you're snipping down the pearl necklace, that 33 pearl clump, that 17 pearl clump, that 19 pearl club, they're not supposed to get through into the bloodstream. They can't get through unless you have intestinal permeability.

If you get tears in the cheesecloth, then larger clumps of the pearl necklace get through the tears in the cheesecloth. They're called macromolecules. They get through the tears in the cheesecloth into the bloodstream before they're supposed to be able to get through into the bloodstream. They're supposed to go further down the digestive tract. That's one reason why your intestines are 20 to 25 feet long, because prime rib takes a whole lot longer to break down than bananas. So you've got to snip, snip, snip, snip, snip. But if you've got tears in the cheesecloth, that's intestinal permeability.

If you've got tears in the cheesecloth clumps of the prime rib, clumps of that food molecule get through before they're supposed to. They're called macromolecules, big molecules. They're not supposed to get through, but they do. And when they get through your immune system says, Whoa, what's this? This is not something I can use to make new bone cells or brain cells. I better fight this. And your immune system makes antibodies to protect you from that food.

What we see here is what's called the healthy gut. And you can see the lining of the gut here. These are the shags in the tube, in the intestines, and the shags are all lined with cheesecloth. Now, and here's what it looks like. Those big molecules can't get through into the bloodstream. They can not get through. Only the little molecules get through, and doctors notice that the absorption of the small molecules is both between the cells, paracellular, and through the cells. That's really important when we talk more about high-fat diets later on. But this is normal. This is what a healthy gut is supposed to do. Only the small molecules get through, not the big molecules. Now when you have a gut that's been damaged, and you've got the tears in the cheesecloth, if you will, now you see the big molecules get through that big green mile. You'll know don't tell this chicken out. You're going to be allergic to chicken. Oh no, not beef. You're going to be allergic to cantaloupe. Any macromolecules that get through the tears in the cheesecloth into the bloodstream, your immune system then in an effort to protect you from  the macromolecule is going to make antibodies to that molecule.

Now you become sensitive to that food - and the people who do 90 food panels, IgG panels, look at 90 different foods - and it comes back they're sensitive to 25 different foods. They say, Oh my God, that's everything I eat. What am I going to eat? Well, of course, it's everything you eat. It's because your immune system's trying to protect you.

When you heal the gut, which we'll talk about how to do when you heal the gut, you wait six months and go back and check again. Now you're sensitive to maybe three foods. This is so critically important to understand because it's these macromolecules that get into the bloodstream. Your body fights these macromolecules, the immune system trying to protect you, fights it, and then there's this whole world of molecular mimicry, the antibodies against the food start attacking your own tissue.

So a common initial autoimmune pathway and therapeutic target to the degenerative disease include the immune response to intestinal antigen presentation. That means, when these macromolecules get into your bloodstream, your immune system responds trying to protect you, which triggers intestinal inflammation from that antigen getting in, which triggers activating the tight junction proteins, which triggers antibody production to the barrier proteins, which triggers leaky or leaky gut, leaky brain, leaky bladder. Which triggers pathogenic intestinal permeability antigen and macromolecule translocation into the bloodstream and immune response to the antibody production, molecular mimicry, and other pathways that occur and the development of the autoimmune mechanism.

This is the mechanism that's responsible for so much of the autoimmune disease that we are suffering from today. Arguably, number one or two or three cause of morbidity and mortality in the industrialized world. This is the mechanism. When you understand this, and you start addressing this mechanism, you will find so many of your patients not only get dramatic results in a few months, but they're so grateful, and you extend the quality of their life and most likely the length of their life, but certainly, the quality causes you to calm down this inflammatory cascade.

The autoimmune process, once again, can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function, you can arrest the development of the autoimmune disease by healing the gut. Most critical is healing the gut. Well, what? How do you heal the gut? Well, first you have to stop throwing gasoline on the fire. You have to find out what the person is sensitive to and reacting to, and then you heal the gut. We'll talk about that in a little bit.

Premise number four, can foods trigger pathogenic intestinal permeability. This is a great study that came out of Harvard a couple of years ago using confocal endomicroscopy. They took patients, I don't remember how many patients, 36; they took 36 patients at Harvard diagnosed with irritable bowel syndrome, IBS, who were complete failures to every protocol they had tried for a year. The minimum was a year of no results. Still suffering dramatically, and this is Harvard.

So they took these people - confocal endomicroscopy is taking pictures of the inside of the gut - when, they looked at the inside of the gut, they found that the microvilli were closely attached to each other without space between. This is what it looks like. That's confocal endomicroscopy on the left, and that's a scanning electron microscope picture on the right. With confocal endomicroscopy, you get much clearer pictures of what's going on. So they exposed these 36 patients to cows milk, wheat, yeast, soy, and sterile water to see was there any reaction in the gut when they were exposed to these common antigen foods, antigenic foods. Lots of people are sensitive to these foods, so they said, well, let's, let's try it on these failure patients and see what happens. Within five minutes of exposure to food antigens, intraepithelial lymphocytes increase, epithelial leaks and gaps form between the cells and the intervillous spaces widened. This is what it looks like. It shows that the villi are close together. They injected a white dye, and I think they injected it into the femoral vein. I'm not sure. I think that's where they did so that the dye would be flowing through the blood vessels in the intestines. And then when they expose the intestines of these people to these different foods, they look to see if they got intestinal permeability. Did the dye leak out of the blood vessels out into the lumen of the intestines? So it's kind of a reverse permeability, you know? But are there gaps? And this dye is leaking out and look at B, multiple eruptions represent breaks in the wall, and they put white arrows where these eruptions are. See, the white dye is out into the lumen of the intestines, now. This all occurred within five minutes, people. Within five minutes.

Now this one is really cool. This is a five-minute video, and if you scroll over the video, you'll see the arrow comes up, and if you click on it now the videos starts, and you'll see it looks the same for a moment. But notice that the white starts showing itself more on the surface here. Remember the dye's inside. Now you can see the gaps forming. See that gap on the right side there, and it's white. Watch what happens. This is intestinal permeability as it's occurring. Look at all the white that's coming in up. The gaps between the cells that are not supposed to be there. This is how macromolecules get into the bloodstream that isn't supposed to be there.

Aren't the video's cool? To see this. This is at Harvard, within five minutes of being exposed to these foods that the clinicians thought these people might be sensitive to. After food challenge, 22 of the 36 patients showed an immediate and dramatic mucosal response to these antigens. Increased permeability is an early biological change that often precedes the onset of autoimmune disease.

Now I've shown you a video of what permeability looks like. And that foods can trigger it. There are many things that can trigger it. We'll do another session on that. I've got a full day course that I'll be doing this year at the LDN conference, going into great detail on all of this. There's just not enough time to go into all the detail now.

Premise number five the more lipopolysaccharide or weed peptides that pass through a permeable intestine, the stronger the inflammatory response. So there's a correlation between the degree of systemic inflammation and the increase in intestinal permeability. The more permeability you have, the more systemic inflammation you have; the more systemic inflammation you have, you're pulling on the chain; the more wherever the weak link is and the chain develops.

I have a gift for all of you, and the gift is I'm giving you all 43 studies that I'm using in they're all available to you. Now, 31 of those studies were free. I got them for free, so I'm giving them to you. For the others, I'm giving you the link to the abstract so that you can read the abstract. So many of these studies that you want to learn more about and read the study here they are. All you have to do is go to my website, https://thedr.com/LDN17, and all of the studies are there for you. It's my gift to you because I want you guys to really get this. You really need to know this because it's a foundational platform of healthcare. This is so common in your practice. Every day you will find six, seven out of 10 people, when you check them, they've got elevated antibodies to their own tissue. They have an autoimmune mechanism going on. Obviously, if it's the platform for most of the degenerative diseases, including atherosclerosis and cardiovascular disease, it's got to be going on in most people. So you'll have the studies here. This is what your handout will look like, the scientific references from this talk.

Premise number six. So how do you arrest pathogenic intestinal permeability? How do you arrest this process? You have to put the fire out. If, if every degenerative disease, as far as I know, every degenerative disease at the cellular level is a disease of inflammation, you have to stop the inflammation, so you have to stop throwing gasoline on the fire and then put the fire out. So how do you do that?

The first concept is a pleiotropic concept. It's a good Scrabble word. Pleiotropic it means all roads lead to Rome. You know, there are many, many ways to heal intestinal permeability and put the inflammation out in your body. There are many ways, and because certain products like glutamine, it's a great product to heal the gut. Glutamine turns on certain genes, but vitamin D turns on genes in the gut that glutamine does not. Curcumin turns on genes in the gut that vitamin D does not. And so there are many different paths to get a comprehensive treatment protocol that's going to work in the vast majority of your patients. Here's an example for curcumin. These are all the inflammatory and anti-inflammatory pathways that are impacted by taking curcumin, and I'll talk more about that in a minute. So all roads lead to Rome. A pleiotropic approach to addressing pathogenic intestinal permeability.

There are three categories to consider. First, avoid inflammatory triggers. Stop throwing gasoline on the fire. Critically important. So the question about is gluten sensitivity really limited to just celiacs or is there's this thing called non-gluten sensitivity? This is about the world of non-celiac gluten sensitivity. So in this study, this is a study that Hollon and his team at Harvard did. They took celiac patients recently diagnosed, so they had villous atrophy and lots of inflammation. They took celiac patients who were in remission at least a year on a gluten-free diet, so their microvilli had healed, and the inflammation was greatly reduced. They took people who had a problem with wheat but didn't have celiac. They refer to them as non-celiac patients with gluten sensitivity. And then they took people that didn't have a problem with wheat at all, all four groups, and they exposed them to wheat. The peptide, the clump of the pearl necklace of poorly digested wheat called gliadin, alpha-gliadin. Their conclusion: increased intestinal permeability after gliadin exposure occurs in all individuals. And one part in there, they said in all humans, so any of you that is human, every time you eat wheat, this is what happens to you irrespective of how you feel when you eat it. This is what the science tells us. Well, I don't feel bad when I wheat. It doesn't matter if you feel bad. The lucky ones are the ones that feel bad. Then if they continue to eat wheat, that's their problem to deal with. But the unlucky ones are the ones that don't feel bad when they eat wheat, because you can't feel when you tear the cheesecloth. But remember, Mrs Patient, the fastest-growing cells in the body are the inside lining of the intestines; every three to five days, you have all new lining of your gut. So you eat toast for breakfast. You tear the lining of your gut, but it heals. You eat a sandwich for lunch. You tear the lining of your gut, but it heals. You have pasta for dinner. You tear the lining of your gut, but it heals. Croutons on your salad. Tear the lining of the gut, but it heals. A cookie tears the lining of the gut. But it heals. Day in, day out, day in, day out until one day. And that can be when you're two years old, 22 years old or 92 years old. One day you cross that line. You lose oral tolerance. You don't heal anymore.  Now you get tears in the cheesecloth that don't heal. That's called pathogenic intestinal permeability. You don't feel that now the macromolecules get into the bloodstream; that now your immune system produces antibodies against those macromolecules; that now because of molecular mimicry you produce antibodies against the weak link in your chain, your thyroid, your brain, your liver, your kidney. Now you're on the autoimmune spectrum. That's how it happens.

It's so cool when you look at this science, and you realize, wow, this is so very common. This is an underlying mechanism that we can identify years in advance. And that gives you a heads up to do something different. Well, what do you do differently? Well, first stop throwing gasoline on the fire and then heal the gut. So this is the book that came out in September of last year. This is 35 years of my, professional life. But it's all about this mechanism in great, great detail. And I think everyone should read this book, not because I wrote it, but because this gives you the clear, precise, step-by-step mechanisms and what causes the primary mechanism in getting sick and dying in the world.

The immune system is attacking your own tissue. The autoimmune mechanism. Alzheimer's is autoimmune, cardiovascular diseases autoimmune, cancers are autoimmune, and all the studies are in the book with explanations on how to explain it to patients. And when you see this, you go, my God, that's profound. I make $2.10 or something on a book, so this isn't going to pay for my grandchildren's college funds. I'm not saying buy the book because of some personal benefit. I'm saying buy the book because you're really going to learn so much. Or you can take my old day course at the LDN pre-conference in September. You learn so much about this, you'll really understand it, and you can apply it in your practices.

In the book, I recommend a three-week protocol for people to give up wheat, dairy, and sugar for three weeks. And we give lots of examples of breakfast, breakfast for your kids, breakfast for the family, lunches, dinners, snacks for three weeks. And just see how you feel. Just see what happens. Cause most people can't afford or don't have access to the tests. So just do this, and you say, Oh my gosh, my headaches are gone. Oh my gosh, I'm waking up, and I've got more energy. Oh my gosh, I'm sleeping better. Oh my gosh, my child's doing better in school. They're sitting still in school. You just see a condition after condition after condition that's better after doing or during this three-week protocol. So that's a recommendation that I give to people who can't have access to the tests for one reason or another.

The second category in the pleiotropic approach to pathogenic intestinal permeability is included foods that heal intestinal permeability. The first one, of course, vegetables, and one of the benefits of the vegetables is, as you know, the microbiota work on the fibres in vegetables, insoluble fibres, to produce short-chain fatty acids like butyric acid or butyrate. Mrs Patient, the past is growing cells in the body are the inside lining of the gut. Every three to five days, you have a whole new lining to your gut. The fuel for those cells to reproduce is called butyric acid or butyrate. That is why butyric acid is so critically important. If you don't have enough butyric acid, you make your house out of straw instead of brick. And you find so many studies, just go to Google and type in butyric acid and colon cancer. And when you have low butyric acid, you're at a much higher risk of developing colon cancer because you made your house out of straw instead of brick. So you need butyric acid . How do you get butyric acid? it's the good bacteria in your gut working on the vegetable fibres that produce butyric acid.

My good friend Terry Walls, who is a brain neurophysiologist, a professor of medicine, and she developed MS, and being a brain neurophysiologist, she knew all the cutting edge techniques of how to deal with MS and they didn't work. Within seven years, she was in a wheelchair, and her brain wasn't working very well anymore, and a friend said, wake up. What you're doing isn't working. Do something else. It's not working. And she did. She went back to the basic literature, and she found studies on animals that they had induced MS-like symptoms, and they changed their diet, and the animals got better. So she changed her diet to mimic what they did for the animals. She started feeling better. So then she went to functional medicine courses, and she learned about this, and she completely reversed her MS, and she has what she's called The Walls protocol. It's a great book on how to reverse MS. And Terry, applies these principles at the VA Medical Center in Iowa, where she's associated; and she's taking these veterans who are completely disabled. They'd lost a limb, or they've got PTSD, and they can't function in life. She's taken these bedrooms, and she's completely reversing them, getting their brains working normally again, getting rid of their chronic pains.And there are a couple of things that she's doing that I'll talk about here.

The first one, they have to eat 12 cups of vegetables a day before they eat any starches, like pasta and bread and stuff. What does that mean? It's kind of hard. There's no room for pasta after 12 cups of vegetables a day. Right? But that's how she gets them to do it. You eat 12 cups of vegetables a day, five different colours, then you can have some pasta or some toast or something.

Prebiotics, originally defined as nondigestible food ingredients, had beneficially affected the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon. That's what these vegetables are. Some of these vegetables are prebiotics. Here's a study demonstrated the apple derived pectin could modulate gut back microbiota. Here's a study that shows that apple pectin treatment attenuated the level of lipopolysaccharides and reduced intestinal permeability. So what they did here on the left, you see high-fat diets, how it changes the gut microbiota, and it causes more inflammation. And the change in the gut microbiota is to microbiota that induces weight gain. So you get more of the formicilis's family (as I understand the family of G. formicilic (Geriger)) of microbiota that hoard calories, survival, survival, hoard calories. So you store more calories, thus you gain weight. Plus you get the inflammation. Then when they did the same high fat diet, but they added pectin from apples, you see the benefits that occurred from that suppressing weight gain and healing tight junctions of intestinal permeability.

The next category here, or the next component of category two, is bone broth. And once again, Dr Walls with these vets, she has them drink one quart of bone broth a day, not a cup, a quart of bone broth the day. And how do these guys do it, because they don't have any money, they can't work because they're disabled. They can't afford to buy quarts of bone broth a day. They make their own. So these guys go out hunting. They harvest an animal, they make their own bone broth, and they're very proud to be so active in taking care of their own health in a way that they can relate to. They go hunting, they kill a deer, and they make bone broth.

Now about bone broth. Gelatin Tannet is in bone broth. It's a strong anti-inflammatory. Next fermented vegetables. And focus on diversity. Mrs Patient goes to the local natural foods store and buy five different types of fermented vegetables just to make sure they're not pasteurized because pasteurization kills bacteria. So get sauerkraut, get kimchi, get fermented beets, get kvass, get Italian flavoured fermented vegetables, curry flavoured fermented vegetables. Get five, six different types. Keep in the refrigerator. Every day, walk by, take one fork full of fermented vegetables. And somebody said, well, why can't they take more? They can take more. I'm happy, if they get a fork full, then they can take more. Do it twice a day. Why? Because every family of vegetables that ferment produces different species of probiotic bacteria, the good bacteria, and we now know it's not lactobacillus or bifidobacteria that are the commercial ones we've used for 20 years that change the gut microbiota. They help. But you really want the diversity of hundreds and hundreds of different species of good bacteria in your gut. And how do you inoculate for that? Eat fermented vegetables every day.

So you're changing the microbiota because if you have intestinal permeability, you've changed the microbiota to be more pathogenic. That contributes to more intestinal permeability. You take the nutrition and stuff to heal the gut, but if you still have dysbiotic gut flora, you're going to get more permeability. So you have to change the gut microbiota, and by doing the vegetables, doing the fermented vegetables, 12 cups a day, vegetables, bone broth and the fermented vegetables, you're going to change the microbiome.

Fermented foods and beverages were among the first processed food products consumed by humans. The ingestion of fermented foods potentially increases the numbers of microbes in the diet by up to 10,000 fold in one day. It doesn't take long to do this.Consumption of fermented foods may provide an indirect means of counteracting the hygienic, sanitized, Western diet and lifestyle. Many of these species found in fermented foods are either identical to or share physiological traits with species relevant to promoting GI tract health. You know, docs, so many of you just don't have time to talk about foods with your patients. That's understandable. Every office should bring on board a nutritionist or a registered dietician, or have one of your staff people trained, so that you can just prescribe what needs to be done, and the expert can sit down with the patient and walk them through how to change their lifestyle habits. They don't do it in a day by giving them a handout, you know it's going to take some time, and we talk about that in the full-day course, how to get the right people and how to train them, and all of that.

Next, the third category of the three categories, is nutrient supplementation. You want to do nutrient supply admin supplementation to address the inflammation, rebuild the microbiome and healing of the intestinal epithelial lining.

Vitamin D plays a role in the aetiology of autoimmunity. Vitamin D causes assembly of the adherence junctions. That's part of the control for intestinal permeability. Here is a drawing of the adherence junctions right there, and this is a drawing of two full cells, and on the outsides is the start of a third and fourth cell. Vitamin D plays a critical role in the mucosal barrier homeostasis by preserving the integrity of tight junction complexes and the healing capacity of the colonic epithelium. Vitamin D markedly enhances tight junctions by increasing junction protein expression at the kissing joints, and preserving the structural integrity of the tight junctions. Here's the visual, that's the tight junction strands. Here's the drawing of the whole thing. The upper left one is the one you saw previously. The letter B is a picture of a tight junction. Now when you see they blew up that tight junction in the lower-left corner, you see that it's looped the tight junction where food goes through, vitamins go through, its loot. Think of the Panama Canal. The gates open, the food comes down a little bit in between the cells, the gates close, the immune system checks it out. The next gate's open, the food goes down a little further. The gates close behind it, then another part of the immune system checks it out. The next gates open, the food goes down further, the gates close, the immune system checks it out. That's how we check out foods and things that we're being exposed to through the oral cavity coming down into the gut.

And then you see the drawings of these kissing joints. Now, that extracellular space, that's where the tight junctions are. That's the Panama Canal. You are going through that extracellular space. Now watch how much, and then on the right is the drawing of the kissing joint itself. And so you see the paracellular space, the extracellular space there on the right side of the drawing and the zonulin family of proteins are like shoelaces and the shoelaces, you untied the shoes, they open; you close, or you tie the shoelaces, they close the gates, open the gates, close. Now watch how much of this is controlled by vitamin D. All of those are controlled by Vitamin D. Vitamin D controls the gate opening the gate closing, the shoelaces opening the shoelaces closing, all controlled by Vitamin D.

Here are some recommended protocols that you can review. There are three main mechanisms of how probiotics contribute to human health. They shape the ecosystem by a competition for the resources and the adhesion sites. They decrease the local pH, and they produce specific antibacterial substances.

Probiotic strains can not only affect the intestinal microbiota directly, but also affect other organs by modulating the intestinal inflammation and permeability. Changes in gut microbiota modulator. Endotoxemia. By a mechanism that affects gut barrier function and increases intestinal permeability. Look at the journal diabetes metabolism that this is a critical, critical component of dealing with diabetics, is having a healthy gut and closing the intestinal permeability and rebuilding the microbiota.

Our findings that the human gut microbiome can rapidly switch between herbivores and carnivores. Functional profiles may reflect past selective pressures during human evolution. Consumption of animal foods by our ancestors were probably by little, depending on the season and forging success with readily available plant foods, offering a fallback source.

So that's why you eat meat. You change your microbiome in one day. Not saying it's bad, not saying it's good, just know it changes the microbiome. So you have to see what type of microbiome you have to determine what kind of foods you should be emphasizing more. We found that microbiota changes on the animal-based diet could be linked to altered faecal bile acid profiles and the potential for human enteric disease.

VSL Number 3 is a type of probiotic that you can use. There are some really good studies on SL Number 3, and its multi-species. You always want to go through varied species, not just take one type of probiotic, but the key is diversity.

Here are some recommendations on dosing. Fish oils exert much of their anti-inflammatory benefit by suppressing NF Kappa B, which is the major amplifier of inflammation in the body. The safety of fish oils is high, has been well established in numerous clinical studies. Drug interactions are extremely rare. A dose of up to three grams a day has been determined to be safe for general consumption.

Here are some dosing recommendations. Glutamine is the most commonly used amino acid in the gut. In a study giving 30 grams a day, every ulcerative colitis patient got better. It didn't matter how bad they were, even the really severe ones, but when they stopped the glutamine, the disease came back. And why is that? Well, it 's because the lifestyle was still throwing gasoline on the fire, and they didn't heal the gut, and they still have the microbiome of the altered lifestyle. You can't just give a pill and expect to heal the gut. We have to change the environment, the ecosystem of the gut. Glutamine is a very clinical, useful, useful tool. But it's also a substrate for lymphocytes and macrophages. So you gotta be careful, Mrs Patient. I give people, I call it the gluten sensitivity packs. There are six pills in a pack. MrsPatient, can you take one pack a day? Yes, they can. And so, okay, now if you have any reaction to the pack, you get a little bloated, you get a little cramping, anything like that, just stop that one pill. And that's the glutamine. Just keep them in a little container. Wait two weeks, take everything else to calm down the inflammation, and then you're going to be fine. Then you can take them again, because glutamine is a precursor for lymphocytes and macrophages.

Here are some recommendations. Tumeric is remarkable in its benefits. Tumeric is anti-amyloid. Orogenic. It's neuroprotective. It enhances cognition. It's a diagnostic marker. It's an antioxidant. It's an anti-inflammatory. Here are the dosings on all of these different studies. Just depending on what you're dealing with and what your target is that you know you, you can be aggressive with a tumour. It's extremely safe. And here, once again, are all the pathways. Inflammatory and anti-inflammatory pathways that are modulating to produce an anti-inflammatory effect. Here are all of the diseases that there are studies showing curcumin is of great benefit for, and how many of them are autoimmune.

Recommended protocols. Colostrum. High intestinal permeability is normal in newborns. Their guts are very permeable. That's one of the main purposes of colostrum. The first three days of mother's milk is not breast milk. It's colostrum, and one of the main purposes immediately is to turn on the genes in the gut. Say okay, baby, let's close these tight junctions now. Come on. Let's get these cells going. Close these tight junctions. Colostrum also says, all right, let's build the receptors for this good bacteria. Let's start colonizing this good bacteria that you just got washed through as you came down the birth canal. Let's start building these receptor sites. So colostrum helps to set up the environment of the gut for a healthy, well-functioning gut. It also promotes recolonization of the bowel by the friendly bacteria. It's the best remedy known for all-around gut help. Restores leaky gut to normal permeability, contains growth factors and hormones to repair damage to the lining and restore gut integrity. It's unmatched as an immune system stimulator and modulator. There are numerous note products lining the shelves of natural food stores that claim to stimulate the immune system. Only colostrum plays the entire symphony. Colostrum.

If there was only one product I was going to use, it would be this, and it would be this colostrum, produced by the author of this book, Andrew Keech. Dr Keech grew up on a dairy farm in New Zealand. He learned really early in life that you have to give these newborn calves colostrum, or they die in a week. They die. And he then learned that the humans, when they were sick, they drank the colostrum, they got better. So he decided he's going to devote his life to colostrum. So he went to Oxford and got a PhD in mechanical engineering, and I said to him, Andrew high five to you, high five Oxford PhD, way to go, man, way to go, but mechanical engineering, what is that? And he said, well, Tom, I knew I was going to make the best colostrum in the world, and no one is doing it. So I was going to have to learn how to build the equipment to do it. So he spent eight years getting a PhD in mechanical engineering to build the equipment to produce the best colostrum in the world—grass-fed antibiotic-free, hormone-free. Every batch is checked when it comes in, every batch, every time. It's the most powerful product that I know of. It's on my website. You'll see it there. My website is TheDr.com. The product is called GI Restore. It's really quite remarkable.

The two key developmental time points of the regulation of gastrointestinal tract help occur postnatally, the first few days after birth, when all the gut digestive functions are launched by first colostrum ingestion; and then the second when weaning, when the digestive system has to modify its function following a switch from mother's milk to solid food. Two critical developmental time points. The first time point is particularly relevant for all mammalian species since it's associated with a complex of dynamic changes in the gastrointestinal tract structure and function, leading to a temporary drop in gut permeability barrier. So when the guts on fire, the body's on fire. This is a protocol that will work for you. Eliminate inflammatory foods. Give prebiotics, give fermented foods, give probiotics, give Vitamin D, give glutamine, give fish oils, curcumin, colostrum; and I want to note there are many other beneficial anti-inflammatories that can be used to heal the gut, reduce inflammation. There are many. I'm not saying these are the best. These are just well referenced in the literature, and it's a safe protocol that everyone can do, and you'll get dramatic results when you do this.

So what did we talk about here in this little over an hour? Just how prevalent is the development of autoimmune disease. If the cardiovascular disease has an autoimmune component, what becomes the number one mechanism? That's how prevalent it is. Premise number two, how can we identify people at risk for the development of autoimmune disease? You do the test, and you find out. Number three, what is the trigger? in the production of antibodies to self. The addition of the third element, the loss of intestinal barrier function. Number four, can foods trigger pathogenic intestinal permeability? Yes, they can. Number five, the more LPs or wheat peptides that pass through a permeable intestine, the stronger the inflammatory response. Number six, how do we address pathogenic intestinal permeability?

Once again, we have a full day course. We'll be doing it as a pre-conference workshop in Portland in September. We guide you on all of the testing, the supplements. How do you diagnosis, how do you think about this? How do you talk to patients about it? You can find out more on the LDN Research Trust website about this. We also offer the online, you can do the course online, but I think it's better in person. You get all of my, visuals and my emphasis when it's live. For those of you that don't know, we did Betrayal, the Autoimmune Disease Solution. It aired in November and we're going to be launching it again in the very near future. I think by the time you're watching this, it will be launched again. You can find it at betrayalseries.com. I interviewed 85 of the world's leaders in autoimmunity, and the scientists, and then clinicians applying the scientist's principles, and then the patients who went through the protocols recommended by the clinicians. For example, Linda, talking about LDN, and it's really quite remarkable. And if you go to betrayalseries.com, you can find out more about that.

So take care of yourselves. Hope you have a wonderful time in Portland. Make sure to tell those important to you how much you love them.

And this is the last slide, a very good book to read about genetics The last paragraph in this book, throughout your life, the most profound influences on your health, vitality, and function are not the doctors you visit or the drugs or the surgery, the therapies you've done. The most profound influences are the cumulative effects of the decisions you make about your diet and lifestyle on the expression of your genes.

And with that, I would say thank you very much for your kind attention.

Linda Elsegood: Thank you for listening to this presentation. All past conference presentations can be found on our website, www.ldnresearchtrust.org.

 

What the Bleep Can I Eat?! Making Sense of Conflicting Autoimmune Diets (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Improve gut microbiobes to heal leaky guts, to prevent or halt autoimmunity. Help low dose naltrexone (LDN) via adequate Vitamin D, good nutrition. Difficulty adhering to diets being studied, resulting in practical strategies.

Dr Pamela Smith, MD - 6th March 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: I'm joined by Dr Pamela Smith, who is an MD from Michigan. Pamela has written ten books, and she has just released the 10th book, and the 11th book is going to be coming out next year. Thank you for joining us today  Pamela could you tell us about your new book that has just come out?

Pamela: Absolutely, and thank you so much for inviting me on the program. My new book is called "What you must know about vitamins, minerals, herbs, and more". And it really is an anthology of looking at all of these kinds of nutrients. And the whole idea is choosing the right nutrients that are right for you.

We have different sections of the book. We have vitamins as the first part of the book. So we do look at vitamins A, D, E, K, etcetera. We have a section on minerals, one on fatty acids, one on amino acids. We have section number five, which is on herbal therapies. 

Section six of the book I loving call it "other nutrients" because it covers things like Coq10.

Alpha-lipoic acid, probiotics and other things that really don't fall into a traditional category. And then part two of the book is on a health concern, meaning we actually go through different disease processes like hypothyroidism, low thyroid function: hair loss, insomnia, dry eyes, all these different things.

And we make suggestions from the medical literature: which nutrients work better for those clinical conditions.  

Linda Elsegood: So, do you test people of their minerals and vitamin levels, or do you, increase vitamins anyway for certain conditions? How does it work? 

Pamela: Well, basically, that's an excellent question.

You can do many things. You can measure 28 vitamins in someone's body. There's a test called the nutrient testing available worldwide, where literally you can measure all of those levels. You can go by eight. As long as people have normal kidney and liver function, for example, starting at the age of 50, most people make less of some of their vitamin sources.

They make less coenzyme Q10, less lipoic acid, et cetera. So you can make some generalities as well.

Linda Elsegood: Okay. So, once you decide which path you're going to take to treat a patient, what is the next step? Do you titrate them up or do you work out what would be the appropriate dose?

Pamela: Oh, my favourite way is obviously the measure.

I'm a physician. I'm a scientist. We'd like measuring people. So for example, if you measure vitamin D, vitamin D is a fat-soluble vitamin. That one should always be measured because vitamin D you can get toxic in. So we try and measure that, but we want the patient to have optimal levels and not just normal. Vitamin D is so, so, so important.

But the question is: What does perfect mean? So, when you look at vitamin D in American units, which are what is used most commonly internationally when you look at vitamin D, you want the revenue to be 55 to 80.  44 is normal, but it's not optimal. So you want that patient literally to have perfect levels because then vitamin D decreases the risk of developing breast cancer, colon cancer, Parkinson's, ms diabetes, high blood pressure, and really a number of different disease processes if you get the right amount of vitamin D. I mean, we can go through and talk about each vitamin. It is so important to have vitamin K adequate bone mineralization, so you don't get bone loss. It's very important for heart health.

It's very important for blood clotting, and so each different nutrient plays a very important role in the body. 

Linda Elsegood: You mentioned probiotics. Now I've had so many doctors tell me that when I've asked what are the top four nutrients, vitamin supplements that you would always rate highly and probiotics. It's usually maybe number one and in your book, you said that you're talking about probiotics. It's a bit of a nightmare, isn't it?  When I was looking to find out, which was the best for your money because you can pay a ridiculously high amount of money for a very good brand where you may be paying for the name as well.

But how do you assess when you are looking to buy a probiotic, which is the best one that you should be taking? How do you navigate your way around that?

Pamela: That's an extremely good question because first of all, new literature is showing for most people, not all, but the general population, we probably should rotate probiotics.  May mean that they shouldn't take them all the time, the same one. So for most people, take one really good for six months. Then the next six months alternate into another one. A good doctor has prescribed a particularly probiotic for you. Otherwise, for the general population, it's good to rotate them. Most of the really good probiotics do require refrigeration, and so we do keep them in the fridge.

I usually like to take my probiotics separately, so they're not taken with other things because sometimes nutrients interfere with that. So it's nice just to take them by themselves. 

Linda Elsegood: Okay. I didn't know that. And how do you go by the different strains. What we should be looking for?

Pamela: Well, you want a good general probiotic so that it carries a number of different things, and you also want something that's what's called pharmaceutical grade.

Nutrients come in different grades, and pharmaceutical grade means two things. Number one, it means that it's bioavailable meaning it gets into the body and does what it's supposed to do. And it is also, pharmaceutical-grade means that it's guaranteed to be 100% sure with outside verification. When you look at the idea of probiotics, you want a well-mixed probiotic for overall health because probiotics improved digestion. They help the immune system function as well, your gut, your GI tract.  70% of the immune systems is right in the gut. So the gut has to have that good bacteria and also people don't think about it, but probiotics help manufacture biotin, folic acid and niacin so that they're all in the right amounts.

So, if you asked me: Are there three things I suggest for every single patient in the world? There are.  Anybody who's an adult:

1. a probiotic

2. a multivitamin, and then 

3., it may be somewhat variable with people and depending on where they live, most people do need additional vitamin D, unless they're out sunbathing.

Okay? But the third one that everybody else needs otherwise is Omega fatty acids, otherwise known as fish oil. Most people don't get enough Omega 3's. So, I do take two fish oil tablets a day, every day, because I don't eat fish every day so it gives you really good fats.

Linda Elsegood: And there are so many people, patients, that I speak to who will tell me that they have a very good balanced diet. They don't need to supplement it at all. But as you were saying that once you reach 50, your body is lacking in certain vitamins, minerals, supplements, and is this something that you discuss in the book?

Pamela: Absolutely. It is something I discuss in the book. We look at things on what happens with age. Absolutely. There are also interesting things that happen when you combine food with medications. For example, grapefruit. I discussed this in the book. Grapefruit increases caffeine levels, and so, some people, if they eat grapefruit and they drink a cup of coffee, they're going to get nervous.

Great food also can increase the levels of different medicine like warfarin, which is a blood thinner. In fact, there's even a trial showing the grapefruit can cause hives if taken with Naprosyn, which is a nonsteroidal drug. So interestingly, even foods can have an effect on what happens in the body. And we do discuss all of this in the book.

There's a whole chapter looking at mixing supplements, drugs, and food. 

Linda Elsegood: Hmm. Well, I was mixing my probiotic with yoghurt. Is that allowed or not?

Pamela:  You should be taking it by themselves? 

Linda Elsegood: That's interesting. Very interesting. So what else do we learn in the book?

Pamela: Well in the book you're probably going to be surprised to realize that most people cannot eat their way into health. Believe it or not, in today's world, because things get genetically engineered, and we don't always replenish the ground with nutrients, almost everybody does need to take a least a multivitamin.

People tend to be surprised about that. Other things that people tend to be surprised about, and they look in the book, but there are actually many medical trials showing that if you look under health conditions, there are studies showing ways that we can all look at things to prevent cancer. There are studies showing that Chlorella taking a teaspoon a day decreases the risk of developing cancer. Not eating a lot of sugar decreases the risk of developing cancer, eating too many bad fats and salt—just some common sense things. And then again, a lot of it depends on what you're interested in. So, for example, if you're interested in the prevention of cataracts, then, believe it or not, there are medical trials showing that alpha-lipoic acid, B vitamins, bilberry, carnosine, which is an amino acid, N-acetylcysteine, glutathione, your basic vitamins,  Selenium. Those things help prevent cataracts, so a lot of it is prevention as well. It's always best to prevent the disease.

Linda Elsegood: Absolutely. You mentioned multivitamins there. And again, it's a bit like the probiotics. There are millions of different multivitamins, you know? Where do you start? What is a good multivitamin? What should you be looking for?

Pamela: You always want to look for pharmaceutical grade and a broad spectrum. And those are the two things you look for, and the trouble is that you usually if you're in my age group and you're over 60 you will only usually end up with a multivitamin where you have to take a number of them.

It's not like when you're 20, and you may just take two multivitamins in a day, that's enough. I really do have to take a number of them because you want to prevent disease and treat things. I have high triglycerides so I personally take Omega 3 fatty acids, which many studies have shown help lower triglycerides.

So, you know, my goal is that I may still have a heart attack because I inherited high triglycerides from my dad, but I'd like to be 95 when I had that heart attack and not my current age of 64. It's also important to have nutrients to keep the body going well. So, for example, the thyroid gland has to have enough iodine.

So if you'll never,  ever eat any fish, then you probably want to see your healthcare provider, have your iodine levels measured and see if you need iodine. If you're not eating your way into it.

Linda Elsegood: Oh, that's interesting.

Pamela: I think a fascinating one in the book has to do with high cholesterol. Everybody thinks high cholesterol is, I ate too much, this, that, and the other. Of course, it can be, but people don't realize that high cholesterol can be due to buy it to the deficiency.

Biotin is made in your gut. So if you've got reflux, IBS, GERD, all those things you've got, it's not healthy. You're not going to make enough biotin. You have to have carnitine. You have to have some of these nutrients in order to lower cholesterol, including vitamin C. So there's nutritional things that are important for the body but I think sometimes people don't realize So that's part of the reason why I wrote the book. I want people to have a good idea of vitamins, minerals, herbs, and more. More of a personalized approach to them, and it's called a concise guide to better health and longevity and that's what we want people to be, as healthy as they can be.

Linda Elsegood: Well, that's interesting that you talked about high cholesterol. I suffered for many years with acid reflux. My mother had a heart attack in 2000. Well, Christmas 1999, just before the New Year, and she had what they called hereditary high cholesterol, and they wanted to check me and my two daughters.  My cholesterol level was so high that I could have had a heart attack or a stroke at any time.

My eldest daughter's cholesterol level was fine. My youngest one was borderline, so they put me on a statin, and I had to see a consultant. And I said to her: " I would rather not take anything.  Ultimate diet Is something I can do so I don't have to take this statin?

And she said: "If you were to live on a glass of water and a lettuce leaf, you would still have high cholesterol." 

Pamela: Exactly. You have inherited that pattern. That is correct. 

Linda Elsegood: So I altered my diet. I have to say,  listening to doctors, Tom O'Brien. I'd stopped eating gluten and literally in days of stopping the gluten, the acid reflux stopped, and I was able to stop taking the anti-acid tablets. So that was amazing. So that's not a problem. But would I still be able to reduce that level of cholesterol naturally, or even if I have to still take the statin,  I don't care, but I would like to try and bring it down. So because the doctor had said to me, as I get older, I might have to increase the amount of starting I take, and if I can do something new and I'm 62,  I may not have to take a higher dose. Do you see what I'm trying to say? 

Pamela: I can absolutely see what you're saying. The goal is that you take the right dose of a statin drug and so side effects do go up with any drug.

The higher the dose you take. So number one, anybody taking a statin drug, they get deplete on important nutrients. Coenzyme Q 10. So they need Coq10 if you're on a Statin drug. So for you, for example, you're over the age of 50, so you need a 100 mg of CoQ10 and another 100 mg because of the Statin drug.

Are there other ways that come over cholesterol? There are pages and pages in my book. My personal favourite is bilberry. I absolutely love bilberry. Bilberry, 200 mg, twice a day is a great place to start. You can go all the way up to 500 mg,  3 times a day. Very effective to lower cholesterol, even coenzyme Q 10. Gugulipid. People may not be familiar with that one.

It's G. U. G. U. L. I. P. I. D. 50 mg,  twice a day, lowers cholesterol. Policosanol works very well for those out there. If you haven't heard of that one, it's P, O, L, I, C, O, S, A, N, O, L, 20 mg,  once a day or 10 mg, twice a day. Another one of my favourites is tocotrienols. It has a special kind of vitamin E, 400 to 800 international units a day. Very good to lower cholesterol. So, all of these can be very effective, and most of them do mix with a statin drug. Not all, but many of them do. 

Linda Elsegood: It is like a foreign language or hasn't heard of these.

Do you have to take all of those or just one or a combination? 

Pamela: For most people, I suggest starting, like for you, for example, you're on the statin drug, make sure you are on Coq10,  start a little bilberry, 200 mg,  twice a day. As long as you have normal kidney and liver function, that would be great.

Linda Elsegood: okay. Wow. This is really educational, isn't it? And it's all in the book. So people who are listening to this can follow your recommendations, and I'm sure they would get a really good idea of the guidelines of what you're suggesting now. 

Pamela: Absolutely. They'll have all of us in the book and more.

I mean, we didn't talk about amino acids. The body produces amino acids, eat your way into some of the amino acids. They're very important for memory and energy. So yes, we hope everybody picks up a copy of what you must know about vitamins, minerals, and more because there's a lot in here and it's written in bullet style format so that it's easy to read.

Linda Elsegood: Well, that's good because if you see chapters and chapters of text It's hard going, isn't it? But you can pick it up and put it down easily if it's in bullet points and it's easier to remember, I think as well. 

Pamela: I do too. I think people learn in bullet style format now because of computer systems. So it does make it easier.

Linda Elsegood: As we said, this will be the 10th book you've written. What other books have you written? What have they been about? 

Pamela: Well, I've written two books on hormones. My most recent is: " What you must know about female hormones". Let you know about women's hormones. Has done very popular.

Probably my most popular book is: " What you must know about memory loss and how you can stop it."

Linda Elsegood: And of course you're going to be a speaker at the 2019 conference in June, so we will actually get to meet you. So that's really exciting. 

Pamela: I'm very excited myself. 

Linda Elsegood: So, all the things that you talk about in the book, do they complement LDN?

Pamela: They do. They absolutely do. I have the world's best editor. She is so fabulous, and she makes sure, but they all complement each other.

Linda Elsegood: Oh, that's wonderful. And where can people buy your book? 

Pamela: People can buy my book at almost any major bookstore. You can order online from Amazon or any major outlet and online worldwide.  

Linda Elsegood: And do you have a website? 

Pamela: Actually, the website for this is going to be changed as the book is coming out because they're updating it.

So that part I'm not going to give to you because that one would be difficult, but if people can't find my book, they can always email me at faafm63@yahoo.com, and we can give you that new website as it comes up next week. 

Linda Elsegood: Fantastic! Well, absolutely amazing talking to you! But if patients want to see you, do you have a website for that?

Pamela: Yes, people can absolutely come to see me or any of my partners. And probably the easiest way of accessing that is to literally call as opposed to get on the website. But we are, if they want to be on the website and look at us, we are the Centre for Personalized Medicine. So if you type that in, then everything will come up.

If you're going to go on the web. 

Linda Elsegood: And what numbers should they call if they would like to make an appointment?

Pamela: as I'd like to make an appointment. (313) 886-4060  

Linda Elsegood: And are you, not just yourself, but your partners in the clinic there too?  Do you have a long waiting list too? Do people have to wait to see you?

Pamela: Well, our goal is there's not. I do have four partners, so I'm very blessed to have great partners that are all fellowship-trained and metabolic, an anti-ageing and functional medicine. They've all done an entire fellowship, so we hope that people will be happy seeing any of us. So we tried for there not to be a long wait.

Linda Elsegood: Well, thank you very much for joining us today and speaking about your fantastic new book. I mean, I've made so many notes here. I'll certainly be getting a copy and checking it out. 

Pamela: Good! I hope you enjoy it and I hope everybody in the audience enjoys it as well. It truly was a labour of love, but I'm very happy with how it turned out.

Linda Elsegood: Fantastic! And just where we go, you said there was another book to come out. What is that one going to be about? 

Pamela: Yes. That one is scheduled to come out November 2019, and it's called "What you must know about autoimmune diseases." But believe it or not, there are 105 autoimmune diseases. Certainly, all of them are not going to be covered in the book, but the major ones are.

There's more and more to know about autoimmune. So yes, that will be November 2019. "What you must know about autoimmune diseases."

Linda Elsegood: Well, we'll have to have you back talking about that because obviously, LDN works amazingly for autoimmune diseases. Not saying it works for everybody, but it does seem to work really well.

So that would be a really interesting topic as well. 

Pamela: I would be honoured to do that, truly.  There are three things that I do for every single patient with an autoimmune disease, and one of those is to put them on low dose naltrexone, LDN. There's not a single patient in my personal practice with any of the autoimmune diseases that is not on LDN.

Linda Elsegood: The million-dollar question that people will ask is: How long would I have to take LDN before I noticed an improvement? What would your answer to that be? 

Pamela: 30 to 90 days.

Linda Elsegood: That's amazing! So a short period of time, isn't it? 

Pamela: Yes, it is a short period of time.

Linda Elsegood: Awesome! Amazing!  Well, we have to go. We've come to the end, but thank you very much for being with us today, Dr Pamela Smith, and we'll have you back again. 

Pamela: Well, thank you so much! Everybody. have a great day! You as well have a happy rest of it, of everything because I just love this time of year and spring is about to blossom.

It's such a happy time. Thank you. Bye-bye. 

Linda Elsegood: This show is sponsored by Dickson's chemist which are the experts in LDN at associated treatments in the UK. Dickson's chemist, the most cost-effective for LDN in all forms within the UK and Europe maintaining safety standard of what is required. Why would you choose to get your LDN from anywhere else?

Call 01414046545 today to speak to an LDN experts 

Any questions or comments you may have, please email me at Contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.

Martha Grout, MD - 10th April 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Martha Grout, MD has an integrative medicine center in Scottsdale, Arizona, dedicated to natural treatments of cancer, Lyme disease, diabetes, metacarbolic, irritable bowel, and other chronic diseases. She endeavors to treat the whole person, body, mind, and spirit, and in searching for the root cause to patient symptoms. She has conducted much continuing education on a variety of subjects not taught in allopathic medicine.

Dr. Grout first heard about low dose naltrexone (LDN) when she moved to Arizona in 1997, and began using it on her pain patients, and those with brain function issues – adults with brain fog and confusion and early memory loss – but not yet for children. She learned that not everyone could tolerate LDN 4 mg – some could not tolerate the endorphin boost – and she had to lower the dose, and now prescribes between 1 – 4 mg LDN. She finds it boosts the immune system, but hasn’t done controlled studies on this.

New patients undergo standard and functional testing. Standard testing provides a very gross delineation of organ function long after they have been functionally incompetent. She tries to get patients before they get to that point. For functional testing, she uses labs like Genova diagnostics and Doctor's Data International, Hygenics, and DNA Connections and several labs like that that do more specialty testing, particularly for immune system dysfunction. Thyroid testing is an example, where patients have symptoms of low functioning thyroid but normal conventional test results. So she looks for other means, and in such patients LDN is helpful.

Linda Elsegood asked about unraveling all the issues that a Lyme disease patient has getting a diagnosis, being told it’s all in their head, and how Dr. Grout treats it. Dr. Grout responded that first is to get adequate testing, typically not through conventional testing. Many that have had Lyme infection or any of the varieties of co-infections, have been sick for a long time, and many are also nutritionally depleted, their brain and immune system aren’t working well. Often they have such gut dysfunction and microbiome dysfunction or abnormality that they can't even absorb nutrients very well through the gut, so IV nutritional therapies help get them filled faster so they can begin to function better faster. She also uses IV antibiotics if they can’t take them orally; but orally they take longer to reach the effectiveness of IV therapy. They promote healthy probitics and healthy diets - non genetically modified, basically organic when possible.

As to IV antibiotics, Dr. Grout relates that they may be needed for a long period of time, and relates Katie’s story (video on Dr. Grout’s website). Katie was on IV antibiotics for 18 months virtually every day. This is an unusual case, but she has had no relapse. Other people require much less.

Dr. Grout wrote a book with Mary Budinger, An Alphabet of Good Health in a Sick World, using a lot of information from her website. The book is available on Amazon, and through Dr. Grout’s office, and she’s happy to inscribe it. The book is about nutritional status being paramount. It's when our nutrition goes off the rails that things start to go south and it can take many years depending on where we started out. If our mothers were healthy, we started out with a better base. If our mothers ate junk food, then we started out with a less good base, and it probably won't take us as long to get sick.

A person low in vitamins may feel fatigued, without energy, have poor memory, and sometimes insomnia. Testing for vitamins is done through Genova Diagnostics, using both urine and blood, and measures functional levels of vitamins, fatty acids, and chemicals that are produced by the gut. It measures if there is an unhealthy gut, if there are products of protein in the stool, or if there are markers for unusual and unhealthy organisms in the blood. So long as the patient is doing well the test is not repeated; and it’s quite expensive, but a useful test.

Summary from Dr. Martha Grout’s LDN Radio Show from 10 April 2019. Listen to the video for the show.

Keywords: LDN, low dose naltrexone, brain fog, early memory loss, pain, endorphin vitamins, nutrition, integrative medicine, Lyme disease, thyroid, microbiome

Dr Melissa Coats, LDN Radio Show 14 Nov 2018 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Linda Elsegood: Today my guest is Dr Melissa Coats from Arizona in the US. She is a naturopathic oncologist. Thank you for joining us today, Melissa. 

Melissa Coats: Thank you for having me. 

Linda Elsegood: Well, could you just give us an idea of your background, first of all, please? 

Melissa Coats: Sure. Initially growing up, I always knew I wanted to be a physician, I think, or in medicine. And when I went to school far away from home in Lynchburg, Virginia at Randolph-Macon Woman's College I focused on biology. And then after that, I didn't exactly know what part of medicine I wanted to do. So I decided to get a Masters in bioethics while I was deciding, and when I discovered bioethics, I stumbled across naturopathic medicine. Once I read the philosophy and what it was all about, I knew that was where I needed to be. Once I finished my Masters at Midwestern University, I went on to the Southwest College of Naturopathic Medicine, which was in Tempe, Arizona. And I didn't even realize it was in my native state. And so I learned all about naturopathic medicine and went on to school there, and ever since, here I am.

Linda Elsegood: Wow. And when were you first introduced to LDN? 

Melissa Coats: I believe my first introduction was through my mentor and colleague, Dr Daniel Rubin. He had co-written an article about low dose naltrexone, I think back in 2006, for its use in pancreatic cancer. And Dr Berkson who uses it a lot at his clinic, where he does a lot of hepatitis C treatment, also was very interesting to me So I learned a lot from both of them. And from then on, I've been doing more and more research and just using it in a multitude of ways with different types of things beyond cancer. But cancer is obviously one of the bigger ones that we focus on here at our clinic.  

Linda Elsegood: Could you give us an idea of your protocols for treating cancer patients, and which cancers you've actually treated with LDN?

Melissa Coats: Probably one of the bigger ones we typically put people on it for are those who have breast and colon and pancreatic cancer. Those are some that we definitely do, but we know there's some efficacy with ovarian and neuroblastoma and glioblastoma and even squamous cell carcinomas. Pretty much because of the natural killer cell and the immune stimulation that it gives.

We've found it is a very nice adjunctive thing to add on to most treatment protocols, so we utilize it quite often, usually starting with a lower dose. Depending on the sensitivity of the patient, maybe 1.5 all the way up to 4.5 milligrams, depending on what's going on and making sure that we're not conflicting with any pain medication use, of course, if the patient's had surgery or things like that.

We also, me particularly in the clinic, like to use it for other things as well. One of my very first patients actually wasn’t an oncology patient that I utilized it in - it was a person who had undiagnosed celiac disease for 25 years, and her gastrointestinal system was just a giant mess, and she was miserable. It was one of the things that I decided to introduce to a kind of calm her autoimmune issues that were going on, including her thyroid. And it really seemed to calm her gut. And she said it was like a miracle to her, and we even tested going off of it briefly to see if that was truly what was happening. And it was definitely the low dose naltrexone that was helping calm things for her. And so that was one of my first introductions to the power of it. And from then on, I've been utilizing it in many ways since  

Linda Elsegood: What are the therapies you use alongside LDN?

Melissa Coats: Currently, here in Arizona, we have the ability to give IV nutrients, so we use IV alpha-lipoic acid alongside the LDN. Sometimes it's vitamin C, IV. We utilize other supplements, as well, to focus on different parts of what the person needs as far as support if they're during chemotherapy or radiation or other treatments who may have anything going on.

We also utilize sometimes another natural killer cell stimulator, which is mistletoe, but we only give that in a sub Q injection versus IV here in Arizona. There's often a combination of things that we utilize with LDN to help the patient get the best for their immune system and whatever other issues they're having.

...

Melissa Coats: Sometimes, most of those patients are already on LDN, so it's definitely a good part of the mix. We definitely like to make a treatment plan very individualized to each patient, and so there's often quite a multitude of things going on at once, whether it's ... LDN, IVs, a diet plan, whatever it is. We like to bring it all together for them so that they can feel their best. 

Linda Elsegood: And you mentioned a diet plan there. Of course, with cancer, sugar. Is a no, no. What kind of a diet do you suggest patients follow? 

Melissa Coats: A lot of our suggestions as far as diet are either to focus on a very anti-inflammatory or a Mediterranean style diet. The ketogenic diet is obviously big news right now. So that is definitely utilized depending on if the patient's in a good place to do that or not. If they're in a very cachectic state or their weight is very low, we may or may not utilize that, but if they're in a place where it looks like they would benefit greatly from the anti-inflammatory effect of being on the ketogenic diet, we definitely introduce that. Definitely a big part of our consults with patients is spending a lot of time on the diet because we believe food is one of the greatest medicines you can put in your body if you're utilizing it properly.  

Linda Elsegood: And what's the age range of the patients that you treat? 

Melissa Coats: We have little tiny babies all the way up to, I think one of our patients right now that we have that I also believe is onLDN is 89. So we have quite the age range going on here in our clinic. I would say the majority of my patients range in their mid-twenties to like in the seventies and eighties. So we have quite the group. 

Linda Elsegood: And you were saying that you treated the lady with celiac disease. Have you treated any other autoimmune diseases? 

Melissa Coats: Yes. Of the ones that I've seen some benefit, a few patients who have lupus who've seen some benefit; in rheumatoid arthritis we have definitely seen some help in calming some of that; a lot of Crohn's and colitis. I definitely really see a lot of benefit with LDN when you bring in GI issues that are very inflammatory and sometimes immune-mediated. So it's definitely been helpful. I also have utilized it quite often with Hashimoto's thyroiditis to kind of calm the thyroid antibodies, and they seem to note that their thyroid works more efficiently and we see better numbers on labs when they're on the LDN, and less need for medication, which is nice.

Linda Elsegood: So the patients that you know are on LDN for thyroid, do you taper up slowly? How, what is your protocol for that? 

Melissa Coats: The patients mostly have been able to start at three milligrams, and I haven't really had to taper them per se, up or down. Sometimes we just watch the numbers and kind of see how they're feeling, and I may start them at three and just have them check-in with me about how they are feeling, whether that's too much, too little? It hasn't seemed to cause any major side effects, which is why I love using it so much because most people have a great response. 

I forgot about one case that I specifically wanted to tell you about. I have two patients that have autoimmune hepatitis that has been very difficult for them to wean off their steroids. And we have been utilizing LDN probably for the last year and their numbers as far as their liver markers, their AST and ALT have definitely decreased significantly since starting the low dose naltrexone, and I have finally been able to taper to a much lower dose of their steroids, which is wonderful because they hadn’t gotten to a low dose before without the LDN. And we found that using the LDN has made them much more successful and they're very excited about that. The thyroid becomes more efficient with the use of the LDN. They definitely need less medication, which is wonderful. So I usually check thyroid labs when I'm changing things up, every four to six weeks. And so definitely I've had many patients have to reduce their dose because of the LDN, which has been great.

Linda Elsegood: So when a patient comes to see you, let's just say a cancer patient, how would you go about putting that plan together? What is the procedure you follow?

Melissa Coats: When we meet, we initially have at least an hour consultation. We have really extensive forms that they fill out ahead of time, so that I have a really good understanding of their history, and we try to request records so we’re already in the know of what's going on so that we can spend a lot of time talking with each other about goals and where they want to begin.

While we're in consult, we actually type up a protocol so that they leave with a piece of paper that says what labs they are going to get., what treatment plans and treatment options we are interested in doing, whether that's IV or starting low dose naltrexone or some supplements. And then we make sure that there's a clear understanding if we need to check-in and get a diet diary, or what changes should be made immediately.

So they leave with that protocol in their hands so that they feel like not only did we meet and get a good understanding of what's going on, but we have a plan in action that first day, which I think is very powerful in making a patient feel empowered about taking control of their health. And we also kind of keep updating that protocol each time we meet so that if a supplement doesn't work out or we need to add something, they know exactly what's going on and can keep track, which is helpful to everybody involved.

Linda Elsegood: I was speaking to Dr Berkson, and he taught me that alpha-lipoic acid is to be taken intravenously, that it wasn't as effective in tablet form. And the other day somebody was telling me that no, the tablet form works just as well as the intravenous. So I'm now confused. Has it changed? What's your take on it? Exactly. 

Melissa Coats: My understanding is with IVs, you're bypassing the GI and you're getting full absorption; whereas orally you'd have to take a lot more, and obviously the doses are different. The IV amount we go up to is about 600 milligrams, whereas orally we're giving someone up to 1200 milligrams a day. Typically we use both, so when they're not here, they're on it orally. And then when they're in an office, they don't need to take their oral dose that day because they're getting the IV version of it  But from a strengths perspective, and I'll have to check the latest studies, I guess now that you say that, my understanding from Dr Berkson and his protocol that I've been utilizing for a number of years now, that the IV seems to be pretty vital.

Linda Elsegood: That's what he told me, so I've just wanted to check that. 

Melissa Coats: We haven't changed our protocols yet as far as I know. When I can't get numbers to move from oral dosages of things, I definitely bring in the IV protocols, and that seems to make a difference. 

Linda Elsegood: And what about vitamin C taken intravenously? Is that really effective that way? 

Melissa Coats: For absorption issues and things like that? I would say yes, because, from the standpoint of orally, most people can't handle maybe roughly above six to eight grams because it causes a lot of GI distress, even if it's buffered, whereas IV we give people up to a hundred grams, which is way past what anyone could take orally. We know that that creates a different type of stress on the cells, that it can help with reducing vascular endothelial growth factor and other inflammatory markers related to cancer.

Linda Elsegood: And if you read about vitamin C and it talks about water-soluble fat-soluble and it's flushing out of your system if you take too much, or you take too much intravenously.

Melissa Coats: It’s pretty much individualized as well. Some people can't handle certain doses. There are some patients that feel great at 40 grams, and others that can take a hundred grams and feel just as great. So it kinda depends on the person. There are tests to check also whether their plasma level of vitamin C, so that's something that we have utilized in the past.

And then based on our clinical knowledge from using it for a long time. We have kind of figured out where people tend to do well. Yes, it doesn't stay in you forever. It is leaving the body, and there's a lot that's going through the kidneys and being voided out, but for the time that it is in the body and doing what it's doing to the cells.

And if you come on a fairly regular basis, you are creating an environment that is, less available for cancer to grow. So you're creating an environment that is not what they will utilize. So that's why we use it so often. We also use alpha-lipoic acid because it's a powerful antioxidant. And then some of the other nutrients that are out there too. 

Linda Elsegood: A few years ago I had an operation, and as I came to I was in quite a bit of pain, and they gave me intravenous paracetamol, and I was thinking to myself, the pain was quite bad, and I was wondering why they are giving me paracetamol? You know, that's not gonna do any good. And it worked. I was absolutely pieced. I thought, paracetamol isn't very strong, but apparently, it's stronger if it's taken intravenously, as it goes through the metabolism by the liver. It just goes right in. I was surprised at that.

So, vitamin C, minerals, and supplements. Do you have any favourite ones? I mean, obviously, it's individually tailored to the person. But on the whole, what would you say? 

Melissa Coats: We utilize a lot in the oncology world, things that basically kinda change the terrain for cancers. So one of the things that I've utilized a lot is modified citrus pectin, which targets galectin-3, and by lowering that, you allow protection of good, healthy cells and keep other tissues healthy. So, for example, with a woman with breast cancer in one breast, you want to try and protect the other breast. So that we found that this can be helpful. And if she's going to be having surgery or a biopsy, having this on board can kind of help prevent the spread of the other rogue cells. In studies, that's what's been confirmed. So it's something that we've utilized a lot. 

And I use some mushrooms, a whole bunch of different ones. Coriolis mushroom, to help your white blood cells keep your immune system healthy. So that's a big one that we use. And then things that target vascular endothelial growth factor, which is basically kind of a signal for angiogenesis or blood vessels to grow around a tumour.

And so there are numerous things that target angiogenesis. One is a magnolia extract. There are other herbs as well that do that. So obviously vitamin C. And then there's some thought that if you stimulate things like the natural killer cell function with low dose naltrexone, that you may be inhibiting some of those other pathways in a roundabout way. So that's why it's a of things. Quercetin, resveratrol; and curcumin is a huge one, which is the active constituent found in turmeric. There's a lot. And that's why we constantly are trying to throw different curveballs at the immune system to help people fight cancer. And so that's why we utilize so many different things, because if you just use one agent, obviously the immune system and the cancer is going to figure that way around it. And so you want to make sure that we help. 

Linda Elsegood: Do probiotics play a role?

Melissa Coats: Oh, yes, definitely. The GI health and having a really good balanced flora of good bugs in the body is definitely key.

When I'm not focusing on cancer, I really do believe in the gut-brain connection. If your gut is unhealthy, so will your brain be unhealthy. And so making sure that you have good flora can definitely help people's mood and their anxiety and stress responses. It's pretty amazing. So I love probiotics and what they can do. 

Linda Elsegood: I was looking at probiotics, and you start off with what I would call a reasonably priced product. So I was reading the labels - this one has that many million and this one has got different strains in it. I was just lost. I didn't know what it was I should be behind. Which was the best? Is it a case of the more money you spend, the better the product you're getting, or should you be looking deeper than just the price you're paying? 

Melissa Coats: I think it's probably a combination of both. Hopefully, the more expensive products are good. If not, then they're just gouging you. But the main thing for us is it's good to get a variety of strains. So not just acidophilus always. You want to make sure you're getting lactobacillus and bifidobacterium, and you want multiple strains of those types of bacteria depending on what you're trying to work with, with the gut. Also, we're a big fan of billions versus millions because you don't know how much is actually lost or killed off into your absorption and what your stomach acid is doing to those bugs. Depending on how they're put into a capsule, there's always some that aren't going to make it. So the more, the merrier, hoping that you'll be colonizing the gut with some good stuff. I always tell people to rotate brands, and also research the brand and make sure that however they have them, they can prove that when they get their product on the shelf, that those bugs are still alive in there if they're supposed to be, and not been heat shocked in transit and are no longer anything other than a pill filled with nothing. So it may be that that is cost-prohibitive, but normally most of the products that are pretty good are similar in price. 

I think that there's some that are really high in the billions that are intensive protocols that you may only be doing for a week or two, that may be more costly. It just kinda depends, which is why we recommend you usually see someone who has done the research versus just buying a product at the grocery store that's just been sitting on the shelf for you have no idea how long. And so it's good to kind of find that out before you spend the money and then are disappointed.

Oh, vitamin D is another one. Yes, it also depends on the person's absorption. Sometimes I've switched patients from a capsule form to a liquid form and have them hold it under their tongue because they didn't seem to be getting anything from their capsule. And that could be a reflection of the way they absorb through their GI, or if it needs to be more sublingual in their case. And usually, the dose probably needs to be higher than they thought it needed to be. Based on our labs, if someone's our range - here for example, one of the labs we use the range is 30 to 100, and we like to see people between 60 and 80. And so that may take them taking 10,000 units a day for a while, and then they may be able to ramp back, or they may have to take more than that depending on their absorption status. But you kind of play with what seems to work for them. And yeah, there's a lot of different brands on the market. 

Linda Elsegood: What about omega-3s?

Melissa Coats: Yes. The key thing with omega-3s for me is making sure that it's a very pure product, that it's not from fish that are in a farm lot being fed dog food or something horrible like that. They need to be deep-sea coldwater fish, hopefully sustainably raised. And then the capsules themselves, when you're looking at it, you want to make sure that they're fresh. So hopefully the product has some sort of date on it that tells you that those haven't been sitting and becoming rancid.

The key is to look at the EPA and DHA content. If it's fish oil it'll typically show you EPA and DHA, and you want that to add up to over a thousand milligrams within just one or two capsules versus having to take ten capsules to get there because otherwise, you're not getting the benefit of the anti-inflammatory effect, the good healthy cholesterol effect and everything else that goes along with it.

Linda Elsegood: I was talking to a nutritionist a few years ago now. And she was saying if you had an inferior product, they usually have vitamin A in them. And the more tablets you take, the more vitamin A you're taking and you can overdose on vitamin A.

Melissa Coats: Yeah, you've really got to make sure it's a pure product. That could be bad. And that will give you a nasty headache and make you not feel good at all. But the one I believe that we carry here, as far as I know, is just really focused on the omegas aspect of it.

Linda Elsegood: Yes. And what about people who are vegans? Can you take flaxseed oil to do the same?  

Melissa Coats: You could do flax or chia seeds. Also just eating healthy oils like avocado oil, olive oil, coconut oil. You know, there's a lot of different ways to get in. Omega fatty acids that do not necessarily require a fish or krill.

Linda Elsegood: I was reading the other day an article on coconut oil where they were saying that previous research was incorrect and it wasn't as healthy as they made out. What is your stance on that?

Melissa Coats: I don't think it's the healthiest oil, but definitely, but I still see some benefit in using it, particularly the medium-chain triglycerides that come from coconut oil. Or we use MCT oil sometimes instead of just coconut oil. But if someone is just occasionally throwing a little bit of coconut oil into their smoothie, I haven't seen it detrimentally affect them and I've seen some good studies with Alzheimer's and Parkinson's research, that it helps the brain. So the MCT from coconut oil is helpful. 

I think it's also a matter of where you're getting it. If it's this big tub of coconut oil from a big box store, that may not be great versus actually getting small organic coconut oil, which might be a better option. With the ketogenic diet, they often mentioned using MCT oil does help supplement your fat content. And that's been a very pure product, and it usually doesn't have a coconut taste, but it's from coconuts. So people can use that if they don't like the coconut flavour. 

And it's nice because if you need to gain weight, it's a good way to add a hundred calories or more. Most people are not looking for that, but sometimes in the oncology world, we need to help people get more out of their meals. And because that doesn't have a taste like coconut oil, it's helpful. I don't think coconut oil is horrible, but I definitely don't recommend it to be someone's only source of fat for sure. And definitely, it is not an oil that cooks well at high heat. It will actually oxidize it and make it an unhealthy thing. So we usually recommend people use avocado oil for that. 

Linda Elsegood: Wonderful. The half an hour is up. It's gone very quickly. This was Dr Melissa coats and thank you so much. Before we go, can you tell people how they can contact you? 

Melissa Coats: Yes. You can contact us through our website at www.listenandcare.com, or you can give us a call at (480) 990-1111. And you can even have a 10-minute free consultation if you like.

Linda Elsegood: Oh wow, so we have nothing to lose and everything to gain. 

Melissa Coats: Thank you so much for having me.

Linda Elsegood: This show is sponsored by Dickson Chemist, experts in LDN and associated treatments in the UK. Dickson Chemist, the most cost-effective for LDN in all forms within the UK and Europe. They are maintaining safety standards far in excess of what is required. Why would you choose to get your LDN from anywhere else? Call 0800 027 6910 today to speak to the LDN experts.

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