If you actually listened to the “side effects portion” or TV ads or read through all the side effects of every single drug you ever put in your mouth, I guarantee you; you’d think more than twice. Fatigue, headache, nausea are mentioned constantly, and while “sexual dysfunction” might not be listed, do you think you’ll be “in the mood” if you have nausea from a pharmaceutical? Meanwhile, there are commonly used pharmaceuticals that specifically lead to a loss of libido. Here are some of the “big players.”

Antidepressants, oddly enough, are one of the main culprits. I say “oddly enough” because depression often causes a lack of sexual interest. So when you take a depressed person and give them antidepressants that make them even less interested in sex, you’re not doing them any favors. So here are the ones to watch for.

Serotonin and noradrenaline reuptake inhibitors (SNRIs) are the most popular category of antidepressants currently prescribed. Many of them will lower the sex drive in women and men. These drugs include venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta).

Running a close second and prescribed more by primary care practitioners are the selective serotonin reuptake inhibitors (SSRIs). These drugs and even a couple of drugs noted above are also used for menopausal symptoms (groan). Popular drugs in this category include escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac, Sarafem), sertraline (Zoloft), fluvoxamine (Luvox), and paroxetine (Paxil).

Non-functional doctors use tricyclic antidepressants (TCAs) to treat depression, some types of anxiety, fibromyalgia, and certain types of chronic pain. Examples include desipramine (Norpramin), doxepin (Sinequan), amitriptyline (Elavil), amoxapine- clomipramine (Anafranil),nortriptyline (Pamelor), imipramine (Tofranil), protriptyline (Vivactil) and trimipramine (Surmontil).

To round out the list without naming every drug on the market, let me mention (while we’re on the subject of mental health) that some medications used in Schizophrenia will raise prolactin levels and therefore depress libido. Then there are the very commonly used medications finasteride and dutasteride used for prostate enlargement. Next, as I’ll get into more, oral contraceptives might be a problem. Finally, many medications that lower blood pressure also results in low libido. A prime example of a blood pressure medication used to lower blood pressure, calm tremors, and even decrease anxiety is a beta-blocker such as metoprolol.

Lastly, alcohol or recreational drug use can cause low sex drive in women and men. And, it’s a bit of a mixed bag when it comes to “weed,” which will be discussed later.

Emotional and psychological factors

Most people do not have a so-called “psychiatric diagnosis.” But that doesn’t mean none of us have “issues”- in fact, most of us do deal with emotional and psychological factors that can hinder our desire for sex. Let’s start with relationship problems. A lack of trust, poor communication, any form of abuse, or stresses from financial, parental, or child-related issues can lower sexual desire on the part of one or both sexual partners. In addition, mental health issues resulting from undiagnosed depression, anxiety, eating disorders, poor self-image, or even prior sexual abuse can diminish a person’s interest in sexual activity.

Depression, Anxiety and other Mental Health Issues

Sexual disorders are prevalent problems in patients who have been diagnosed with psychiatric disorders.  As mentioned previously, medications such as antidepressants and antipsychotics will induce sexual dysfunction. A comprehensive review article looked at sexual disorders in psychiatric diseases such as bipolar disorder, schizophrenia, depression, obsessive-compulsive disorders, anxiety,  and eating disorders.

Panic disorder and obsessive-compulsive disorder are both correlated with less frequent sexual contact. Decreased sexual desire and sexual aversion are strongly associated with all types of anxiety disorders. The diagnosis of bipolar disorder significantly increases the risk of sexual dysfunction. In the manic phase, there is an increase in libido associated with risky sexual behavior. Depressive phases of this disorder or frankly depressive disorders are associated with low libido and dissatisfaction with sexual activity. In patients with eating disorders, libido and the level of sexual activity decreases, and the level of sexual satisfaction decreases as well.

The prevalence of sexual dysfunction in patients with schizophrenia is quite high among both those treated and untreated. Women who have schizophrenia have anorgasmia, decreased libido, vaginal dryness, and therefore dyspareunia (painful intercourse). Men who have schizophrenia have a decreased sex drive, difficulty maintaining an erection, and delayed orgasm.  The bottom line: if you are seeing a mental health professional, make sure to discuss your sexual needs with them.

Too much exercise

Lack of studies in females means just that: there is a lack of studies. However, it is well-documented in men that those who exercise at higher levels tend to have lower libidos. Thus, in men, higher levels of intense and greater durations of endurance training regularly are significantly associated with decreased libido scores.

Sleep deprivation

Most adults need  7 to 8 hours of good-quality sleep per night. Good quality means that the “sleeping hours” don’t include frequent arousals and are long enough for the individual to feel refreshed upon awakening. Yes, there are some (very rare) individuals who (genetically) require less than 7 to 8 hours of sleep each night. Lucky them. Most of us, when sleep-deprived, are simply pushing ourselves to sleep less. When we do this, we struggle to stay awake during the day, tend to have bouts of fatigue, and definitely suffer from a lower libido than if we were well-rested.

High cortisol

The hormone cortisol increases under stress-a good thing for your body in the short term. However, long-term high cortisol levels can lead to all sorts of physical problems. Physical problems, including immune system dysfunction, cognitive impairment, and much more, make this one of the most correctable and common functional medicine issues we see. High cortisol can also cause you to feel fatigued because the resultant decrease in mitochondrial ATP production interferes with regular sleep patterns. You can see where this is all going, right? Obviously, low libido is part of the end-game of this issue as well.

Fatigue can result from the two things discussed above: inadequate sleep and/or too much stress. Of course, many conditions interfere with sleep and many situations that may cause you to be stressed. If one of these issues is causing your fatigue, you need to address them before you regain your sex drive. If you have a “fatiguing illness,” that’s an entirely different story. I’ll explain.

Fatigue due to Mitochondrial Dysfunction 

Mitochondria (the organelles of respiration throughout the body) produce energy in the form of ATP, which your body then uses for fuel. Your brain, muscles, and heart cells contain more mitochondria than other organs such as the lungs, kidney, or liver. When your mitochondria are working “full tilt,” your energy levels are high, your brain is focused, and your muscles and heart are at peak performance. The creation of new mitochondria (mitochondrial biogenesis) is required for optimal aging and health. As you would predict, mitochondrial dysfunction tanks your energy and contributes to numerous symptoms and diseases. So-what causes this problem?

Mitochondrial dysfunction, characterized by a loss of efficiency in the synthesis of ATP, is a hallmark of aging, and essentially, of just about all chronic diseases. Loss of mitochondrial function can cause fatigue and even other symptoms in just about every chronic disease you can imagine. Examples of fatiguing illnesses with mitochondrial dysfunction include all toxin-related illnesses such as mold mycotoxin illness, anything lumped into the “wastebasket” of chronic fatigue syndrome, fibromyalgia, and autoimmune diseases, for starters. As a “side note,” when I treat these diseases, I also “treat the sick mitochondria” so patients regain energy quickly.

Bedroom Boredom

We’re all adults here. I put this header here so you’ll think about this topic and perhaps even discuss it with your partner. You don’t need me telling you what this means. You know.

Low Sex Drive in Women 

Causes of low libido in females can include anything that alters or interferes with the normal production of “female hormones” associated with libido, including estrogen, progesterone, testosterone, and possibly (but not probably) oxytocin. Let’s start by discussing the possible role of “the pill.”

Birth Control Pills

Common sense would tell you that when you interrupt normal hormonal functioning, you’d have sexual dysfunction. Not so fast! How about the psychological factors associated with knowing that sexual activity, using good oral contraceptives will generally not result in pregnancy? Do anxiety levels about pregnancy play a role? Studies have not examined that, but I suspect that it’s a factor. One very comprehensive study examined the libidos of women taking oral contraceptives in 30 studies. The results were basically “all over the place” as follows.

Menopause 

Most women experience a decrease in sex drive during menopause due to initially- drops in progesterone, then estrogen, and then testosterone. When a woman’s estrogen drops low enough, it not only suppresses her sex drive but also causes vaginal dryness and painful intercourse. In addition, a decreased production of testosterone has been linked in many studies to a decrease in female sex drive.  Conversely, replacement of these hormones with bio-identical equivalents (BHRT) can often restore a woman’s normal libido.

Pregnancy 

Hormonal changes that occur during and after pregnancy can affect a woman’s sex drive. These changes affect everyone differently. Some women may have an increased libido, while others might have little to no interest in having sex. Women’s hormones usually fluctuate during the postpartum months, which may affect sex drive during this time. Factors such as body image, breastfeeding, and fatigue all play a role in post-pregnancy sex drive.

Gynecological Issues

Medical conditions such as endometriosis, causing gastrointestinal cramping, pelvic cramping, or other symptoms can certainly dampen sex drive. In addition, post-menopausal women experience increased bladder infections due to the loss of lubrication of the bladder-also due to low estrogen levels. This type of burning pain, coupled with the other symptoms of bouts of cystitis certain dampen sex drive. In fact, any pelvic muscle problems or chronic pelvic pain will obviously result in low sex drive in women.

Causes of low libido in males 

Low testosterone 

Testosterone is the well-known sex hormone that males produce in their testicles. Testosterone is responsible for a range of male characteristics, including facial hair, muscle mass, libido, sperm production, erectile function, and bone mass. Low testosterone can be caused by trauma to the testicles, tumors, chemotherapy, and/or radiation for prostate or testicular cancers. In addition, anterior pituitary adenomas or toxins and pituitary damage due to traumatic brain injury can cause low testosterone in men. Furthermore, prior testosterone or anabolic steroid use can disrupt the testicular-pituitary axis, causing low T in later life. Lastly, any sort of chronic illness or heavy medications can lower testosterone levels as well.

Low estrogen

If a male has his testosterone replaced and is being treated too vigorously with aromatase-inhibitors, giving them virtually “no” estradiol levels, this can negatively impact male libido. In addition, occasionally, we find that a low progesterone level in a man will lower his libido and disrupt his sleep.

High Estrogen

On the other hand, testosterone which is endogenously produced but shuttled via the enzyme aromatase into estradiol as a conversion product, will impact libido when it gets too high. This is also found when testosterone is prescribed by inexperienced doctors who fail to check and then control estradiol levels.

What are Healthy Habits?

Every time I write a “what’s new” type of article, I hope the reader is up to speed with the basics of a healthy lifestyle and has at least a foundation of healthy habits for eating, exercise, and sleep. These are the real basics when we discuss healthy habits. Everyone wants to live a life absent from disease and frailty, a new term coined as a “healthspan” rather than a mere lifespan. Let me share with you the Functional Medicine developments that have taken hold as dogma over the last couple of years, making the following issues the basis of how you will (hopefully) augment your healthy habits with Functional Medicine “tricks” for a healthspan lasting until you’re 120!

Here are the healthy habits we’ll cover:

1. Healthy eating plans
2. Intermittent Fasting and Timed Eating Intervals
3. Exercise guidelines
4. Sleep updates
5. Microbiome health
6. Mitochondrial health
7. NAD enhancement
8. How to keep your mood elevated and your cognition sharp
9. CBD and Medical Marijuana
10. Lighting and EMF’s
11. Augmenting your hormones
12. Controlling your cortisol
13. Do we need to detox?
14. Proper peptide usage
15. More Emerging therapies

What should I eat to follow a healthy lifestyle? 

When I discuss the very basics of healthy habits, I’m not talking about “not smoking” or “achieve and maintain a normal weight,” which I believe are “givens” to everyone reading this article. However, what exactly constitutes a healthy lifestyle eating plan is up for discussion. You all know, as an example, that the more processed a given “edible” is, the less healthy it is for you. Most of you know that sugar (and for some: salt) needs to be kept at a minimum. I hope you know that non-GMO is the way to go, as is organic, non-factory-farmed meat, wild-caught (not farmed) fish, and minimal to no “fast foods” are best unless the industry makes huge changes.

I have covered the concepts of oxidative stress ( basically the opposite of your levels of antioxidants), inflammation regarding your food choices. Notably, I’ll outline each diet plan as healthy choices to be low in inflammatory foods and, if done right, high in anti-oxidant foods. I’m not going to cover basic supplementation in this article but let me re-iterate that a good multi-vitamin, high in antioxidants, with an accompanying fish oil supplement twice daily is a basic recommendation. Vitamin D is another widely accepted basic supplement. And then, some supplements augment immune function, which can all be found here. Here are the diet plans getting the most “press.”

Plant-based Diet

Plant-based dietary patterns include a Mediterranean and Nordic diet pattern, the dietary approaches to stop hypertension (DASH), Portfolio diet, and vegetarian- or vegan-type diet patterns. Plant-based diets- especially when rich in high-quality plant foods such as whole grains, fruits, vegetables, and nuts, have been associated with a lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits.

I am very much on board with the benefits to the environment, not to mention the abolition of factory farming. However, the association between changing to a plant-based diet and overall mortality remains unclear. Studies have not borne out any consistent associations between changes in plant-based diet indices and cancer mortality as a stark example. My only reservation to an entirely plant-based diet, as most are currently constructed, is that they are filled with lectins which we know cannot be tolerated by those with autoimmune disease, with the full jury being out on the rest of the population.

Keto Diet

Many of you are on the “keto kick” or want to eat a keto diet plan, but it’s not a good idea to eat this way “all the time” without a break. Why? Because long term, uninterrupted keto eating is thought to lead to a less diverse and therefore less healthy microbiome. Eating “keto” works for weight loss and diabetic control quite nicely. When you are eating a keto diet, it’s best to stop for the weekend every couple of weeks for the health of your gut. Long-term, when you are “keto-adapted,” you can go in and out of being ketotic at will. Now, this said, I’m not saying everyone should eat this way. However, if you have tried other ways to lose weight that have not been successful, this appears to be a great way to lose body fat, especially if it’s due to high leptin levels. A full explanation is found in the article referenced above.

Anti-inflammatory Diet

The healthiest diet (IMHO) is still a basic anti-inflammatory diet that excludes sugar and focuses on whole, organic foods. The latest twist in anti-inflammatory eating is avoiding lectins–especially gluten, most grains, beans, and all but high-fat dairy, preferably A2 dairy. As mentioned previously, all of the data isn’t complete regarding lectin restriction, but in my opinion, they are harmful to most.

AIP Diet

For those with leaky gut or any autoimmune disease, an autoimmune protocol diet is recommended. This AIP diet is also great for weight loss for those who can’t tolerate “going keto.”

The fashionable plant-based eating plan is actually how I used to eat (fully vegan) and what I try to maintain about two-thirds of the week with plant-based, AIP meals. However, with zero fish or eggs, I can’t get enough protein since grains and beans are off my list. If you haven’t tried it, nutritional yeast (I like Bragg’s) is a cheesy tasting topping that adds protein to veggie dishes, almond meal pasta, and more. Also, creative companies and Etsy bakers are making all sorts of tasty dishes with nut powders substituting for grains, making this diet much more palatable than it was 10 years ago.

Paleo Diet

I like this diet: it excludes the most potent nasty lectins; gluten, grains, beans, and dairy. However, I’m not too fond of the whopping amount of animal protein this diet not only allows but recommends. First, too much animal protein “jacks up” your omega-6 fatty acid load to make your omega 6:3 ratio way too high; into the “inflammatory zone.” Next, research shows we eat too much protein as it is. Protein helps build muscles, but it also stimulates the mTOR pathway too continuously, which might increase your risk of certain cancers. Lastly, with methane being a significant source of greenhouse gas, the amount of grain necessary to create beef (as well as chicken) is shocking. In my humble opinion, it is dangerous for the people on the planet to be consuming the amount of meat that Americans tend to consume; Paleo diet or no Paleo diet.

Modified Pescatarian Diet

My “vote” goes towards a Modified Pescatarian diet, which is anti-inflammatory and low in lectins. This diet is an anti-inflammatory diet that includes fish and a little bit of high-fat dairy; while recommending avoiding grains (other than sorghum), beans, and most dairy products. It’s fairly close to being an AIP diet plan.

I’ve heard about fasting, but it’s too hard! 

Unless you have been sleeping underneath a giant pizza, you have heard about fasting, and no, it is not a “fad.” Numerous studies show that it is anti-inflammatory to the point where some forward-thinking trauma centers are “fasting” acute trauma victims. In addition, studies show it assists with weight loss and maintenance, metabolic syndromes, cardiac disease, brain health, and mitochondrial health. The different intermittent fasting schedules include time-restricted feeding (TRF), true intermittent fasting (IF), different caloric intakes for fasting, and fasting mimicry (which is relatively new and, to me-not proved.) I’ll focus here on what works and what’s absolutely “doable.”

Time-restricted eating is doable, meaning you can fit it into your daily lifestyle and not have to count calories or “go hungry.” However, let me interject here that most Americans are not used to “feeling hungry” for long; I would suggest that you tune in to how you feel when your GI tract doesn’t have to work hard all day. As a result, you might find that you have more energy and mental clarity.

What’s the perfect “eating schedule?” According to studies, a 16/8 schedule of timed eating is superior, but a 14/10 (so doable!) schedule is pretty darned good as well. You can have black coffee in the morning and then decide when your eight or 10-hour window of food consumption should be. Ideally (primarily for optimal glymphatic “cleaning” in the brain while you sleep), you should be food and beverage free four hours before you go to sleep. My personal eating window is noon-eight o’clock PM. As a final word, caloric restriction is indeed one of the healthy habits to cultivate, and you can accomplish pretty close to what you need by doing a one-day-per-week “low protein day” and use that same day to skip dinner. You’ll awaken feeling great-try it!

How little exercise can I do to be healthy and active?

Each type of exercise (cardio, HIIT, stretching, forms of yoga, and strength training) has a place in your fitness routine. However, current research shows cardiovascular benefits, weight maintenance benefits, brain, bone, muscle mass, and other benefits as follows.

You can take your dog for a brisk walk five days a week for 30 minutes and do two or three (six minutes minimum high intensity) HIIT routines, and cardio-wise, you’re “good to go.” Stretching routines can be as little as five minutes twice weekly, depending on your flexibility. Strength training can be seriously streamlined down to twice weekly, with a good one-set-per-body-part routine like this. Contrary to popular belief (and Fitbit marketers), you do not need to take 10,000 steps per day. Studies have shown no benefit comparing 2,000-4,000 steps to 10,000.

Do I really need 8 hours of sleep?  

Other than the rare few people who have demonstrable genetics, along with others in their family showing that indeed they can “get by” on four or five hours of sleep per night, less than eight hours is woefully inadequate for proper bodily repair during the night. Studies have shown that a majority of Americans are not getting enough good quality sleep.

What’s new is using products such as liposomal GABA to stop brain-race and help both sleep initiation and re-sleeping problems. The use of melatonin seems to be somewhat controversial in the “mainstream” medical literature. However, in the Functional literature, it is well established as a sleep aid and an immune booster as well as a brain booster. Liposomal preparations are useful (combined with GABA preparations) for re-sleeping issues, especially in patients with posterior pituitary problems that cause low MSH, such as all patients with toxin exposures, including (mainly) those with mold and mycotoxin illness. For the severe insomniacs, which tend to include mold and mycotoxins patients, we have a very effective peptide called DSIP.

DSIP: (Trp‐‐‐Ala‐Gly‐Gly‐Asp‐Ala‐Ser‐‐‐Gly‐Glu)

Delta sleep-inducing peptide (DSIP) is quite remarkably effective when used for severe insomnia. Research findings in humans are yet sparse, but in several clinical studies, a few weeks of nightly administration of this peptide resulted in the resolution of previously intractable insomnia.

What’s new in microbiome health? 

The human microbiome comprises 10–100 trillion symbiotic microbial cells with unique genes, principally from bacteria (and some yeast) in the gut. Our “bad” or unhealthy gut bacteria, of which we have up to ten times more than human cells, thrive on the things that create inflammation in our body, including sugar, refined carbs, unhealthy fats, and processed foods (to name the biggest offenders.)

These 100 trillion “bugs” send out chemical messages to the brain to influence our gut health, overall health, and mood. To have a healthy body and brain, you need a healthy gut. Breaches in the gut-brain barrier (from “leaky gut”) are responsible for all sorts of brain-related issues. I’m going to assume you are aware of the importance of gut protection, prebiotic fiber, and so on. A review of that information can be found in the previously cited immune health article.

What’s rather new data regarding microbiome health is the proof that a more diverse microbiome tends to lead to better health. The latest data regarding microbiome diversity is in the arenas of prebiotics (the fertilizer) and probiotics (the seeds).

Prebiotics

Prebiotic fiber comprises non-digestible carbohydrate compounds found in fibrous foods that assist in the growth of healthy bacteria in the gut. Foods, spices, and supplements high in polyphenols appear to promote gut diversity. Hazelnuts, berries, dark chocolate, cloves, red onions, and artichokes are good polyphenols sources. The ECGC in green tea supplements, as well as grape seed extract, are good polyphenol-rich supplements. Evidence is emerging in favor of using fructooligosaccharides as prebiotic supplement powder or in foods.

Onions, leeks, and scallion, as well as chicory, garlic, asparagus, unripe banana, artichoke, are great “gut foods.” They are all thought to assist gut health by producing healthy-gut-bug-food such as butyrate. Speaking of which, if you cook with either ghee or MCT oil, you’ll increase your gut butyrate production.

Probiotics

Regarding probiotics, we like to give a nice multi-strain mixture of the bifidobacterium and lactobacillus probiotics to our patients. However, long-term, especially for those with inflammatory bowel disease or even irritable bowel disease (or possibly “everyone”), sporulating probiotics are probably a better choice. The two types of sporulating probiotics being most closely studied are two in the bacillus species; bacillus subtilis and bacillus coagulans.

How do I help my mitochondria?  

Mitochondria produce energy as adenosine triphosphate (ATP), which your body then uses as fuel. Some cells have more mitochondria than others. Your brain and heart cells are jam-packed with mitochondria, as are your muscles. You want your mitochondria working at full strength to keep your energy levels up, your brain sharp, and your heart and muscles at peak performance. The creation of new mitochondria is crucial for optimal and vibrant aging. As we age, we need to stimulate mitochondrial biogenesis with activities and supplements actively. There is great data for even “crazy-sounding” things such as IV and intra-rectal ozone!

This article should help make your life no less “livable” while you develop more healthy habits, so here are behaviors everyone should have as a part of their “mitochondrial health program.” Cold is your friend. If it’s winter where you live, go outside until you shiver once or twice a day. If you live in the tropics (as I do), when you take your hot shower, turn the water to cold at the end and stand under it for about one minute to produce a shiver. And if you really want to “get into it,” get a $99 ice vest online; it feels great to wear it for 20 minutes after a workout. Next, recall the section above on exercise, and be aware that it’s the HIIT that stimulates your mitochondria. Lastly, choose good supplements for your regimen so that your mitochondria are getting a daily workout from all angles. Here is one mitochondrial supplement we should all be taking, and yes, I am.

What’s all the buzz about NAD? 

Nicotinamide adenine dinucleotide (NAD) is one of the most important chemicals in our bodies. It is necessary for over 500 enzymatic reactions, and it plays a vital role in regulating almost every major biological process. For example, healthspan-promoting activities, including caloric restriction, fasting, and exercise, increase NAD+ levels in our body. Research findings suggest that increased NAD+ levels help counteract the effects of a poor diet, promote mitochondrial health, improve several well-known markers of cardiovascular health, and slow the aging process in the body and the brain.

NAD+ (which can be given IV, sub-Q, and intra-nasally) and its related molecules, nicotinamide riboside, and nicotinamide mononucleotide have been put into popular nomenclature thanks to Dr. David Sinclair (Harvard researcher with a best selling book which touts his research findings). He discloses that he has a financial interest in some supplement companies, but that certainly doesn’t discount his discoveries.

A growing body of research from Dr. Sinclair’s lab plus multiple other labs suggests that exogenous sources of NAD+ precursors, so-called NAD+ “boosters” – nicotinamide riboside and nicotinamide mononucleotide – increase cellular levels of NAD+. The implications for health and cellular age “reversal” are just astounding. Moreover, it is more than proven in mouse studies.

I use doctors-only NAD+ products for my patients administered intra-nasally and via sub-q injection- these are the “strongest” and will activate stem cells the most efficiently. However, I also prescribe a gram per day of nicotinamide mononucleotide for energy-on-demand, mitochondrial support and to help treat mitochondrially-based diseases.

What’s new in brain health? 

Recall that the brain is loaded with mitochondria, so do “take away” that any NAD boost is helping the brain. There has been more evidence linking poor sleep to dementia, so those of you not getting good, restful sleep should do something about it! In addition, the role of the glymphatic system of “nocturnal brain cleaning” has been elucidated even more over the last year. To emphasize again, leaving a good “window” between food or beverages and sleep onset is crucial for optimal glymphatic system function. And so is “good sleep.”

In the “brain supplements we know” department, we have learned that the optimal dose of daily oral resveratrol supplementation to boost BDNF is one gram per day. The evidence is now solid that those of us who avoid depression as we age fare better cognitively. This is an entire topic in itself, but for this article, let me discuss the peptide semax.

Heptapeptide Semax: (Met-Glu-His-Phe-Pro-Gly-Pro)

Semax is considered a nootropic peptide due to its ability to increase BDNF-brain-derived neurotrophic factor. It has also been shown to increase precursors to both dopaminergic and serotoninergic precursors, thus boosting mood. More definitive mood research is needed, but it’s looking terrific thus far. Next, a huge shout-out to the major BDNF-booster peptide called dihexa, given as an oral capsule in varying strengths. And then, there is the evolving data on VIP, a peptide given as an intra-nasal spray.

VIP:

Vasoactive intestinal peptide (VIP) is an important modulatory peptide throughout the CNS, acting as a neurotransmitter, neurotrophic or neuroprotective factor. In the hippocampus, a brain area implicated in learning and memory processes, VIP has a crucial role in controlling GABAnergic transmission, which appears to impact hippocampal-dependent cognition positively. It is currently used in patients with neurodegenerative diseases, including mild cognitive impairment and CIRS, but I anticipate we’ll be using it as another nootropic peptide soon.

Do I need CBD? Is marijuana use healthy?

For years, we have known that the endocannabinoid system has receptors all over the brain, nervous system, and immune system. It very well may be that everyone would benefit from some whole hemp-CBD1 and 2 receptor supplementation as we all age. The data appears to support its usefulness in boosting immune function and brain health, including treatment of TBI (traumatic brain injury.) Right now, we know that CBD1-whole hemp supplementation is useful for pain and sleep. We know that certain types of CBD are useful for some seizures, and other types are useful for anxiety.

Medical marijuana and, in fact, marijuana, in general, has become quite a political topic. While I favor decriminalization, I do not favor “blanket legalization,” and here is why. The “pot” that existed in the marketplace 30-40 years ago had multiples less THC than the recreational or medical marijuana contains now in 2021. The amount dispensed from all sources used by consumers most definitely does what mom told you pot did—it kills brain cells. 

Anyway, yes, THC is indeed useful for some clinical applications such as chemotherapy-induced nausea. But, otherwise, it’s the CBD in medical marijuana supplying a therapeutic effect, with rare exceptions. I have looked at the ratios of THC and CBD in medical marijuana preparations and studied the recreational market. But, unfortunately, at this time, there is no “brain safe” marijuana out there that I see or that I have read about in the literature.

If formulations of marijuana can be cultivated to contain less THC and more CBD, they may be less harmful to our brains. I would also point out that the delivery route should not be in the form of smoking, either. If you are going to use “weed,” you should at least use an equivalent amount of CBD at the same time, in any form, to try to protect your brain. And I’d like this phenomenon to be studied more, of course.

Do I need blue blocker glasses? Are EMFs dangerous? 

The state of the research is in serious flux, no pun intended. So if you want to look cool, go ahead, get those orange glasses, and wear them. Who knows when it will be proven that you have saved your eyes and your brain. Right now, my recommendation for you would be to dim your home’s lighting at sunset to lower your cortisol levels and re-enforce your brain’s circadian rhythm-something required for optimal health.

There is evidence that too much “blue light” (emitted from regular light bulbs and devices) after dark will possibly impact sleep quality and other bodily functions, including night vision. Therefore, in addition to dimming the lights, turn on a “blue blocker” app on your electronic devices. Also, consider getting a “red light” next to your bed if you sit up and read before turning in, as I do.

Some studies have linked excessive cellphone usage to a type of brain cancer, but nothing is conclusive. To err on the side of caution, use headphones or your speakerphone. The data on EMF exposure is similarly inconclusive, but again, it might be prudent for some people in some homes to turn off their routers at night. At the very least, make sure your devices are placed in “airplane mode” next to the bed.

A Word about Hormones

As you age, you become catabolic due to cortisol increase and testosterone and human growth hormone decrease. This phenomenon alone makes men and women lose muscle and gain body fat. That then leads to weight gain, diabetes, metabolic syndrome, osteoporosis, heart disease, and even certain cancers. Not to mention decreased physical activity, a decreased sex life, and overall reported life dissatisfaction. Therefore, I always suggest that everyone read about bioidentical hormone replacement to decide for themselves if they think it will enhance their life.

Cortisol

The only hormone that increases as we age-cortisol-increases under stress-a good thing for your body in the short term. However, long-term high cortisol levels can lead to immune system dysfunction,  increased plaquing on your coronary arteries, decreased mitochondrial biogenesis, depressed cognitive function, and put you at higher risk for all-cause cancers. In addition, it can make you feel fatigued because the decrease in mitochondrial ATP production and high cortisol levels interfere with regular sleep patterns.

High cortisol can trigger sugar cravings. It can be the main “driver” of menopausal belly fat. If you are trying to build muscle, it does just the opposite as it again is catabolic. It not only can decrease muscle mass, but it also reduces bone mass and can slow your metabolic rate by reducing thyroid functioning. Finally, it can trigger leaky gut syndrome, which causes systemic inflammation and is one of the main root causes of all autoimmune diseases.

We, therefore, lower cortisol levels for people under constant stress and most individuals 55-65 years of age and older for the reasons mentioned above. I often re-set the adrenals with adrenal adaptogens and adrenal glandulars. Sometimes I use integratives such as a magnolia bark derivative. Sometimes I use aromatherapy or liposomal GABA. Often, I’ll turn to the intra-nasal peptide called Selank.

Heptapeptide Selank: (Thr-Lys-Pro-Arg-Pro-Gly-Pro) 

Numerous clinical studies have shown that Selank has strong anti-anxiety as well as neuroprotective effects. In addition, the clinical effects of Selank are similar to those of anti-anxiety medications such as benzodiazepines, which enhance the activity of the GABA: the calming neurotransmitter. This similarity of effect is borne out in several clinical trials. In addition, there has been a documented similarity between the changes in the expression of 45 genes one hour after either GABA or Selank is given.

What about Detoxing?

Unfortunately, what may seem to be a “common sense thing” is just not studied in the general population. Yes, we know that most of us carry around a load of toxins, including plastics, BPC’s, and even some degree of heavy metals. However, we have no medical guidelines about detoxification other than for those who genetically cannot recognize biotoxins, those with MTHFR (methylation) defects, or those who may need something to augment their liver’s detoxification functioning during, say, chemotherapy. I will always recommend that you drink reverse osmosis water, shower in filtered water, and use non-chemical cleaning products. I discourage the use of “cleansing fasts” or the overuse of colonics as a detoxification method. The judicious use of activated charcoal blends on an intermittent basis seems reasonable, albeit not scientifically proven.

Any other peptides we should know about?

I prescribe a good deal of BPC-157 for gut issues and injuries. KPV is great for psoriasis, along with other integratives in our functional arsenal. CJC-Ipamorelin is just one anterior pituitary stimulant to increase HGH levels as a secretagogue but does seem to work the best. Sex lives will never be the same since the advent of kisspeptin and PT-141. The topicals we now have for hair growth (such as zinc thymulin) are simply amazing. Lastly, GHK-Cu in topical or injectable form works wonders for collagen and elastin stimulation and visible improvements to aging skin.

What’s new for our lifespan?

Cancer cures are just on the horizon, but as always, it’s best to take preventive measures and do all that you can to avoid getting cancer in the first place. Besides implementing the healthy lifestyle discussed in the previous paragraphs, high dose antioxidants, IV or liposomal vitamin C, and even low-dose naltrexone are gaining traction as standard functional medicine practices when someone is at high risk.

The research is ongoing and fascinating regarding our future ability to cure disease by repairing our genetic material. We use stem cells (mesenchymal, umbilical, and placental) for all sorts of regenerative purposes. Perhaps the most therapeutic cellular therapy will turn out to be what the stem cells secrete-packets of “young factors” called exosomes. Clinical trials are ongoing for neurodegenerative disease, autoimmune disease, and more with IV exosomes. Joint health is being addressed with injectable exosomes. Exosome therapy may even play a role in skin rejuvenation. A lot of preliminary data looks quite promising regarding the use of IV exosomes to treat illness and perhaps even, dare I say, reverse cellular aging. I’ll leave you with that thought. Remember, 120 is the new 60.

Is a Keto Diet Plan the Best Way to Lose Weight?

If you’re able to alter the way you eat and stick to the keto diet plan, this definitely does “deliver.”  Perhaps, you’re a “dieting” veteran, but still, that doesn’t mean you are versed in how to get ketotic, stay ketotic, and know exactly what to eat and when to eat it. You are also likely unaware of how long you can safely “do” ketosis, how to prevent side effects, and so on. Don’t fret—I’ve done all of the heavy lifting for you. In future articles, I’ll get into the health benefits of “going keto” such as control of Type 2 Diabetes, the role in the treatment of cancer, the prominent role in treating some types of cognitive impairment, epilepsy, diseases of female hormones such as polycystic ovarian syndrome and even Parkinson’s disease. Note: the verdict isn’t in regarding the long-term use of this keto diet plan, so my advice would be to use it when you need it and then eat an anti-inflammatory diet when you don’t. This particular article will focus on how and why to use the keto diet plan for weight loss.

Here’s a significant caveat: If you are using the keto diet plan to self-medicate a disease (which I never recommend, by the way), be careful that you don’t drop weight you don’t plan on dropping.

The new way to “do ketosis” is similar to the Atkins diet, which boosts the body’s fat-burning abilities by eating only low-carb foods and getting rid of foods high in carbs and sugar. Removing glucose and fructose from “carb foods” will allow the body to burn fat for energy instead of glucose. The major differences between the standard keto diet and the Atkins diet are the use of only healthy fats, less overall protein, and no bacon or other processed or seared meat. As an aside, I hope you know to never sear or burn your meat. High temperatures produce toxic, carcinogenic fats. Here is what I’ll cover in this article.

• What’s in the Standard Keto Diet Plan?
• Does Ketosis Suppress your Appetite?
• Your metabolism and (therefore) calorie count in ketosis
• Is the keto diet plan safe?
• Protecting your Microbiome During Ketosis
• What foods should you simply get out of your house?
• Step by step: the beginner’s guide to doing a safe keto diet plan
• What about the “Keto Flu”?
• What are all of the Specific foods, beverages, condiments I can have?
• How to calculate how much protein you need per day
• How many carbs?
• How much fat?
• What should your week and day look like?
• Your ketotic day at a glance

The Standard Keto Diet Plan

There are several ketogenic diets “out there” for people with mitochondrial dysfunction, athletes, and so on. However, for weight loss, we use the standard ketogenic diet. The guidelines are 70-80% healthy fats, 10-20% protein, and 5% carbohydrates. I’ll later translate this into a menu of what you should be eating. Also, remember there is actually no absolute limit to fat intake because energy requirements vary from person to person.

If you are already following my anti-inflammatory diet plan, you will notice the foods are quite similar. However, the noticeable difference is a significant increase in your intake of healthy fats. The key to this eating plan is that you will not feel hungry. Let me explain why.

Using Ketosis to Suppress Appetite

Ketosis is one of the best natural appetite suppressants. If you are eating a typical high-carb American diet, you are experiencing blood sugar swings that cause you to have bouts of intense hunger- sometimes within two hours of eating a meal.  When you start burning fat for fuel (ketosis) rather than using glucose for fuel (“regular eating”), your blood sugar will stabilize at a lower, healthier level, and the ketones made by your liver will suppress your hunger via two major mechanisms.

When it comes to the bulk of hunger pangs, we’re talking about ghrelin. Ghrelin increases appetite. When you eat a meal, ghrelin levels drop, but less so if you are overweight. When you lose weight, your body senses starvation, and ghrelin levels increase, but they do not increase if you are in ketosis. And then there’s leptin.

Leptin gets a lot of publicity as the “hunger hormone, ” but it’s really more of a “fat-storage hormone.” Ketosis doesn’t suppress leptin when you first start this diet. So at first, you might get a little hungry and even have some cravings. It’s not super common, but it’s possible via a couple of complex biochemical changes, including an increase in the relaxation brain chemical called GABA. If this happens, just “power through it” if you don’t have a Functional doctor like me, it won’t last long.

Anyway-back to leptin because this hormone is rather complex. If you are stressed, your cortisol level is up, which then raises your leptin level. Consuming a lot of grains and fruits (fructose) will raise leptin. Having an undiagnosed mold and mycotoxin illness will always raise your leptin. Doing this keto diet plan will help lower your leptin, allowing your fat cells to stop clinging to every calorie you eat. And then there’s the satiety hormone, CCK.

Ketones and CCK—the feel full hormone

CCK is a hormone released by your intestines after you eat. It seems to be a pretty intense regulator of food intake. In clinical studies, CCK injections make people stop eating. The normal decrease in CCK secretion with weight loss is circumvented when you eat a ketotic diet. So, another benefit of a keto diet plan for weight loss is that you won’t experience those annoying plateaus that occur with regular diets.

Your metabolism in Ketosis

You’ll be happy to learn that you don’t have to count calories. You. Just. Don’t! Eat until you are full and don’t snack. Ketosis is a natural metabolic booster, so don’t be afraid of the “fat calories.” You’ll convert the fat to brain-healthy ketones and use them for fuel, with the excess being excreted in your urine. Be careful not to add excess carbs, which could throw you out of ketosis. More about the number of fats, carbs, and protein you can eat coming up later in this article.

Is this diet safe?

Ketosis is safe if you are a healthy adult. If you have Type 1 diabetes, check with your doctor. If you have any lower GI issues such as Chrohn’s disease or leaky gut, you need to be very careful of food choices and length of time in ketosis. I always advise patients with “gut issues” to take the right supplements to heal the most common gut symptoms such as post-meal bloating, watch for flares and add a good fiber supplement to their regimen that serves as prebiotic fiber. Details about this coming up. During the first two weeks of your diet, it’s common to have some fatigue and brain fog.

Some people also develop dry eyes and sinuses. In addition, there is evidence that ketosis might disrupt mucous production in the gut, predisposing you to a possible leaky gut. It also might disrupt the microbiome.  I’ll therefore give you my recommendations on how to protect your gut below when I also discuss prebiotics and probiotics. Meanwhile, if the level of ketosis is too much for you, just adjust your level as I’ll instruct you to do further in the article.

Protecting your Microbiome During Ketosis

To maintain a healthy gut during the keto diet plan, use gut lining reinforcing products such as l-glutamine, colostrum, or even the peptide BPC-157. Also, eat or use prebiotics and probiotics: let me explain exactly how to do this.

Prebiotics are nondigestible carbohydrate compounds found in fibrous foods which assist in the growth of healthy bacteria in the gut. One mechanism of action: good prebiotics often create short-chain fatty acids such as the very healthy-bacteria-friendly short-chain fatty acid called butyrate. Good sources of prebiotics include unripe bananas, raw leeks, raw or cooked onions, raw dandelion greens, Jerusalem artichokes, chicory, asparagus, raw garlic. You can also purchase prebiotic fiber blends and put them in smoothies or shakes.

Probiotics are live bacteria that are ingested, multiply in the gut, and have beneficial effects. One benefit you’ll love is that they increase your metabolism. Sources of probiotics are dairy or coconut kefir or yogurt and fermented foods such as kimchi and sauerkraut. A complete list is below.

• Yogurt (sugar-free), including non-dairy coconut yogurt (Homemade from starter cultures is best.)
• Cheese made from raw (unpasteurized) milk with the latest research showing that A2 dairy is the healthiest choice
• Kefir (fermented milk or coconut drink)
• Pickles (refrigerated, nonpasteurized)
• Olives (organic, no additives)
• Kimchi (spicy Korean condiment)
• Sauerkraut and other fermented vegetables (refrigerated, nonpasteurized)
• Kombucha (sugar-free, effervescent cultured drink)

Since you have to make a daily effort to eat sufficient probiotics, many people use probiotic supplements instead. State-of-the-art supplementation combines Lactobacillus and Bifidobacterium species plus sporulating probiotics (Bacillus species) to create more gut diversity and even some healthy yeast (Saccharomyces) if you do not have mold mycotoxins in your environment, making you sick.

In addition to the dietary additions above, there are modifications to typical keto diet plan foods, which are suggested by functional doctors who want to protect your gut. Multiple clinical studies show that plant-derived protein is far more beneficial for your microbiome (and your metabolism) than animal-based protein. A way to augment this effect is to take omega-3 fish oil supplements to offset the high amount of omega-6 fatty acids you consume when eating meat. Lastly, let me remind you how harmful to the gut processed foods and most artificial sweeteners are.  And while I’m discussing harmful foods, let’s segway right into what foods to get out of your house before you get started on your keto diet plan.

Get rid of these foods

Those of you reading this are coming from many different food worlds. Some of you are already trying to follow a healthy diet. Unfortunately, commercial diet plans may have hoodwinked others and now eat many processed (just like junk) foods from the diet plan. Still, others might be eating what they think are healthy foods such as whole-grain bread. So what’s wrong with whole-grain bread, you ask? Sadly, whole-grain bread cranks up blood sugar more than eating sugar!

Lastly, there may be some of you who are still eating a typical American diet filled with processed and fast foods, sugar, and starchy, processed carbohydrates. No matter what food world you are coming from, you need to clear your pantry and your life from a host of unhealthy and decidedly weight-gainer foods so you can lose the pounds once and for all. Please clean out the sugars, starches, packaged and processed foods from your pantry and freezer. You are going to eat whole, fresh, real food. Guess what? You will feel satisfied, and you’ll love it!

Other no-nos include eliminating most (but not all) dairy products (high in the sugar: galactose) and all grains. Recall you will only consume “healthy fats,” so hydrogenated vegetable oils (cottonseed, canola, sunflower, etc.), peanut butter, and soy products need to go. Don’t worry about the peanut butter because you can have healthy (raw, sprouted) cashew butter and some almond butter.

The beginner’s guide to using ketosis for weight loss (how-to’s):

1. Throw out (or donate) the unwanted foods and get psyched.
2. Get a ketosis meter or urine strips that measure ketones. Check morning and evening: .5-3.0 mmol/l is the range you’ll want to be in. I’ll discuss where “you should be” when discussing the keto flu in the next section.
3. Get a scale and weigh yourself in the morning before consuming anything.
4. Make a grocery list, health food store list, and online purchase list for the products and foods you will need for success. Find out local sources of organic, non-GMO vegetables, grass-fed meats, wild-caught seafood, grass-fed butter, and pastured organic eggs. Source out good, guar gum and carrageenan-free coconut milk. Source out natural shredded coconut and raw non-pasteurized nuts and nut butter. If you will get fancy and start baking, you will need to source out nut flours. You can get some of these things in health food stores, including MCT oil and a delicious casein-free butter called ghee. I love ghee. It adds a depth of buttery flavor to vegetables and even eggs.
5. Secure your healthy fats and the one type of fat that will get you into ketosis faster than any fat, MCT oil. Coconut oil has a fair amount of medium-chain triglycerides, but for best results, you’ll need some MCT oil.
6. Consider purchasing some “exogenous ketones,” which are supplements or supplement powders containing beta-hydroxybutyrate salts if you need a “ketone boost” in the situations described below.

You should not stay in ketosis for more than 2 weeks in a row for best results and overall health. Recall I discussed changes in GI mucous above. When GI mucous is disrupted, so is the microbiome, or gut bacterial protection. We don’t know the long-term ramifications of prolonged uninterrupted ketosis, but studies suggest possible leaky gut. In addition, studies show that one day of very low protein is likely a great health practice for everyone to do weekly. Some people notice drying out of mucous membranes, which isn’t good for prolonged periods, either. For most people, this results in dry eyes, easily relieved with lubricant eye drops.

For all of these reasons, you will “do ketosis” for 2 weeks, and then each week, you’ll pick a day when you’ll go very low-protein (less than 10 grams) and high-carb (up to 200-300 grams-but only with “allowed foods”). To follow, the next morning, you’ll get back into ketosis with your MCT oil or your ketone supplements. If you are having trouble with this diet on weight training days, you can do a high carb day 2-3x per week and still lose weight. Obviously, the high-carb days would be your “lifting days.”

Will I Get the “Keto Flu”?

The ketogenic diet will change your metabolism by putting you into ketosis and turning you into someone who uses fat for fuel rather than sugar for fuel. As a result, you’ll notice some (hopefully) minor issues in the first two weeks. The following symptoms have been named the keto flu.

Keto flu symptoms can include having difficulty sleeping, feeling lethargic, getting constipated, being moody, losing sex drive, getting foggy-headed, and having bad breath. Fortunately, these side effects don’t affect everyone and usually only last for 1-2 weeks. Symptoms will abate as your body adjusts to being in ketosis. Remedies include reducing your levels of ketosis and finding a balance of hunger control and symptom relief. Note that the ingestion of ketone pills makes keto flu worse. Here’s what helps.

Melatonin helps sleep—fiber and water help constipation. Lastly, “cold-shocks” (see mitochondria article referenced earlier) help brain fog and energy levels, and so does the supplement, nicotinamide mononucleotide (NMN).

Specific foods

Healthy Fats

Healthy fats include saturated fats such as grass-fed butter, ghee, MCT-containing coconut oils, and sustainably produced palm oils. Even gross-sounding things such as lard, chicken fat, and duck fat are allowed. Monounsaturated fats such as olive oil and avocado oil are also quite healthy fats, but olive oil should not be used for cooking. MCT oil can be used for cooking and can be taken on a spoon or added to drinks. If MCT oil gives you intestinal cramps or diarrhea, just take the ketone supplements when you need a ketone boost. I’ll go into this more in-depth in a moment. Omega-3 fatty acids are very healthy and should be supplemented if healthy seafood is not plentiful.

All fat should be used liberally except for omega-6 fatty acids found in animal products. You should consume more omega-3s than omega-6s. If you supplement with DHA/EPA omega-3 supplements, you don’t have to “watch everything” you eat regarding the recommended 2:1 ratio of omega-6 to omega-3 fats. Introduce MCT oil slowly, or it will upset your stomach. Start with a daily teaspoon. Your goal is 1-2 or 3 TBSPs of MCT in the mornings to help power your ketosis throughout the day. You don’t have to “eat fatty foods” specifically, as doing so would lead you to a lot of animal protein, specifically beef and pork, which I’m decidedly not recommending for health, and environmental reasons. I won’t “pound this concept,” but I would again like to urge you to source your animal protein products from small farms and avoid factory-farmed meat.

Proteins

Animal proteins contain few carbs but can be used by the body to make glucose, so don’t overdo it on these foods. This particular diet isn’t an “open bar” regarding meats as you might be used to if you have followed the Atkins diet in the past. However, with all the hunger-suppressing fats you will be consuming, you shouldn’t have to worry about the amount, especially during the first two critical weeks of this diet.

High omega-3 fish include sockeye salmon and sardines (in water) as the best choices. Beware of other fish unless you are sure it’s not farmed. Wild bass, mackerel, flounder, mahi-mahi, dolphin (no-not Flipper–the fish!), and anchovies are all healthy choices.

• All meats which are grass-fed, organic, and certified to be such are acceptable.
• Grass-fed organic meats are higher in omega-3s are just plain healthier for you.
• Organ meats are technically permitted, but I’m not crazy about recommending parts of the body such as a liver or a kidney because they are the toxin-filtering organs of the body.
• Cage-free “pastured” eggs are full of healthy cholesterol, and consumption of these products is no longer restricted. Poultry is the “least reliable organic” meat, but everything from chicken to quail, duck, goose, pheasant, and turkey is permitted. As always, source these products from family farms.

I allow all nuts other than peanuts. Other keto diets restrict nuts and seeds due to the amount of protein people eat when consuming nuts. However, you are all adults and can budget for the protein of walnuts, pecans, macadamia nuts, hazelnuts, and even high-protein almonds. Coconut can be consumed liberally and is encouraged.

Yes, I did say that dairy was a no-go, but you can absolutely budget some raw cheese and yogurt into your diet after the first 2 weeks.

Non-Starchy and Starchy Vegetables

During your first two weeks, you want to limit your veggie consumption to the very low carb group, with some of the low carb group carefully included. Then, after week 2, add in the moderate and high-moderate carb groups of foods and use the high carb veggies for your high carb day(s). Here are the groupings of your veggies.

Very low carb: Fresh herbs—close to 0 grams net carbs per 1-2 tablespoons. All leafy greens include romaine lettuce, endive, escarole, radicchio, spinach, collards, turnip greens, chicory, fennel, chard, and kale are most of the veggies in this group.

Low carb: Cucumber, zucchini, leeks, and chives, as well as onions and (my fave-on everything!) scallions, make up this flavorful group.

Moderate carb: Healthy and tasty cruciferous vegetables such as cabbage, cauliflower, broccoli, and brussels sprouts.

High-moderate carb: Asparagus, bell peppers, radishes, jicama, green beans, wax beans, water chestnuts, bean sprouts, bamboo shoots, and wax beans. Eggplant, bell peppers, and tomatoes are at the high end of the carbs and sometimes questioned as to their consumption during ketosis as the highest lectin-containing  “nightshade vegetables.” (Those with leaky gut or autoimmune disease should not consume nightshade vegetables, and so this question is “out there” as to whether or not they should be consumed in ketosis. I choose not to, personally).

High carb: All types of squashes, sweet potatoes, carrots, turnips, beets, parsnips, and rutabagas.

Fruit

You can consume berries, apples, and citrus in small amounts, starting after the first two weeks, as they are lowest in fructose. You should know by now to exclude fruit juices if you have been following my anti-inflammatory diet. If not, now you know! Let me do a big shout out to the fruit many people think of as a vegetable, the avocado. It has up to 8 grams of carbs per the whole avocado. Try to work this in as much as possible as it is one of the healthiest foods you can eat.

Condiments

Spices and herbs, apple cider vinegar, hot sauce (with no additives or sweeteners), unsweetened mustards, homemade mayonnaise (egg yolks, lemon juice, apple cider vinegar, extra virgin olive oil), and homemade salad dressings are all “on your list.”  Check out the Keto Social media groups for recipes. Also, check out the Keto Etsy bakers and the companies that now cater to making keto foods, snacks and desserts. Sweeteners considered safest for health include stevia and monk fruit. However, I’ll also include xylitol (toxic for dogs, so–pick up your gum!) and erythritol-not sucralose, which destroys the microbiome.

Drinks

Of course, you can drink water and unflavored sparkling water. Lemon wedges really add a lot of flavor, but remember to count the carbs from them. I hope you know that diet soda is “toxic waste.”   Coffee doesn’t need to be black and unsweetened or filled with “bulletproof” butter and MCT oil. I love my morning coffee and cannot stand oil in my coffee, no matter how good it might be to get me into ketosis when I occasionally “do ketosis” for health reasons.

However, if you want to try putting grass-fed butter and MCT oil in your coffee, go right ahead. Just heat your blender and blend this concoction. Power to you if you like it. I just don’t like it and can only “go so far” regarding healthy practices. For me, my morning cup of coffee is just plain sacrosanct. You can have coffee with stevia and coconut creme or a blend of coconut creme and almond milk. Or you can have heavy cream. You just need to account for the carbs. Drink all the organic (not teabag) tea you want, but the same rules apply. You’ll be happy to note that you can have very dry wine, champagne, or clear alcohol such as vodka, tequila, or gin in moderate amounts on my keto diet plan. As always, you need to account for the carbs.

How to calculate how much protein you need per day

You’ll need to keep re-calculating as your fat mass goes down and lean mass goes up. You can calculate this by figuring out your lean body mass. If you don’t have access to calipers or other body fat measuring scales, do an estimate. If you cannot take a “real” body fat measurement, use this calculator and then just experiment with amounts of protein, carbohydrate, and fat that can keep you in ketosis. It isn’t hard at all. Stick to the right foods and eat enough fat.

The Formula

Do you have your % of body fat? Your % of lean body mass is 100 – your % of body fat. Figure out what you weigh in kilograms by dividing your weight in pounds by 2.2. Take that number and multiply it by the % of lean body mass you have. That gives you the number of lean body kilos you weigh in with and tells us how much protein you need. You need a gram of protein per kilo of lean body mass.

An example is a 120 lb woman with 30% body fat, meaning, by definition, 70% lean body mass. 70% of 120 is 84. 84 divided by 2.2 is 38. Therefore, she only needs 38 grams of protein per day. This might be shocking as you are probably familiar with much higher quantities of protein in low-carbohydrate diets, right? Well, if you eat too much protein, it will convert to glucose. As a result, it will kick you out of ketosis.

So, watch the protein. It adds up really quickly. Ten almonds have six grams of protein! One egg has 6.3 grams. A piece of meat or fish the size of a deck of cards (4 ounces) has 20-25 grams. Be careful not to load up your protein into one meal, either. Your liver will kick you out of ketosis with more than 20-25 grams of protein at one sitting. All of this is obviously individualized. Everyone is unique. Figure out what you need and how much protein is in what you like to eat. Make a list if it helps.

How many carbs?

This is where you get to do some personal experimenting. Most people do the best eating somewhere between 20-50  grams of net carbs daily. “Net carbs” means you can subtract fiber and sugar alcohols (like xylitol) out of your daily carb count, but now that I’ve told you that- you could forget it; just eat what’s allowed and measure your ketones. I know this flies in the face of advice to “weigh everything,” measure everything and count all grams of everything at all times. I have read that sort of advice, and it makes me want to stab my eyes out just reading and imagining doing all of that. Doing this my way (which I’ll re-iterate at the end) just makes it all easier and more doable. Note that it is typical to lose a lot of water weight the first two weeks and experience thirst. Make sure to drink plenty of water during this time.

How much fat?

Let’s just say it will be more fat than you have ever eaten if you are a chronic dieter. It will feel quite odd eating so much fat, and you’ll wonder, “how can this be?” Well, let me assure you that the process of ketosis does indeed increase your metabolic rate, and you can just get yourself into ketosis and stay there with fat at every meal.  Again, you want to eat what amounts to up to 2-3 TBPS of fat at every meal—calculate this in with the fat in your meat, eggs, and so on.

What should your week and day look like?

Your week: Eat high fat, very low carb (<50g net carbs/day) 6 days a week, then have a carb re-feed on day 7 (150-250 grams of net carbs). Remember, this day is your low-protein day to help your body detox. This is 5-10 grams of protein only, and it “goes quickly!” If you have carb cravings on your re-feed days (it happens), have l-tyrosine and the SAMe handy to amp up your dopamine. If you can’t do the 6 and 1 as suggested for athletic (or just plain intolerance) reasons, do re-feeds as many as 2-3 days per week on your training days. Only restrict protein one day, though. These instructions assume you have done your first two weeks of ketosis where you eat controlled protein, high fat, and very low and low carb veggies only.

Your ketotic day at a glance 

Breakfast: If you get yourself right into a high level of ketosis each morning, you’ll have more “brain energy” and absolutely no hunger all day. Have your morning coffee as described above. Use MCT oil or ketone supplements as needed. After the first two weeks, if you want to add some eggs, that’s fine.

Lunch: Since this all “works better” and is healthier (due to good biochemical pathways being activated), if you confine all eating to a 6-8 hour window, and you will not be hungry until 3-5 P.M. anyway, delay lunch until 2 to 3ish. Then have a ton of low-carb veggies with a 1/2 card deck size of meat or fish protein.

Dinner: How does dinner at 7 or 8 sound? After the first two weeks, we can really have fun with this meal. Have some olives or a deviled egg made with your special mayo. Enjoy a cocktail; no mixers, but just as listed above. Have a lovely salad with homemade dressing. If you are at a restaurant, ask for EVOO (extra virgin olive oil) and lemon. Give back the breadbasket. Better yet: ask them not to bring it. Instead, have tons of vegetables, drenched in ghee and seasoned well.

Make your veggies creamy by taking 1/3 of whatever you made, putting it into a blender, and then blending it back into the veggies. Yes, you’re back home again. Now, go ahead and have some dessert. First, you can make “jello” by using flavored herbal tea, gelatin, and stevia. Next, you can make an amazing keto pumpkin pie and shave a teensy bit of dark chocolate and top it with whipped coconut creme.

Indeed, have dessert every night! In my world, that makes this eating plan 100% doable. You won’t miss chips if you can have chocolate mousse and/or specially made ice cream every night, will you? You can shave 85% chocolate on top of your coconut whipped cream every single night if you budget correctly!

I didn’t list “it” as I don’t want to encourage too much dairy, but you certainly can budget for some real whipped cream, stevia-sweetened, too. Search the internet, look for “keto bombs,” find a good cookbook and go to town. You can actually enjoy losing weight on the keto diet plan if you get creative enough.

Many of my patients tell me that they experience a surge of energy, brain focus and are just “happy as clams” doing this keto diet plan. It may or may not “be for you,” and you’ll know if it is “right” within the first 6 weeks. If it is “right for you,” my wish for you is that you achieve and then maintain your ideal weight for the rest of your life.

Natural Ways to Lower Blood Pressure: Intro

If you are not currently among almost one-half of U.S. adults with high blood pressure, then the odds are that you might develop high blood pressure at some point in your life without some preventive measures. In this article, I’ll discuss all of the proven natural ways to lower blood pressure.

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure is called secondary (rather than primary) hypertension (HTN), with those underlying conditions spelled out in this article. All types of hypertension increase your risk for serious health problems, such as stroke, heart disease, ocular blood clots, kidney failure, and dementia. So, it’s clear you want to have normal blood pressure. Below you will find a blueprint for achieving your health goals naturally, which will cover the following:

• Eliminate the basic HTN risk factors
• Do the “right” type of exercise
• Eliminate two toxic types of foods right off the bat
• Address the major metabolic issues: blood sugar, insulin, and leptin
• Normalize your weight
• Balance your omega fatty acids
• Eliminate internal inflammation and oxidative stress
• Control your stress levels
• Fix your broken microbiome
• Banish toxins
• Increase nitric oxide
• Increase vitamin D
• Consider other foods, supplements, and integratives

The Basics of Treatment for Hypertension

Let’s first review risk factors you can easily control. For example, you can stop smoking, control alcohol consumption and, for those who are “salt-sensitive,” control your salt consumption. In addition, you can increase potassium-containing foods (such as bananas and raisins) and take a good magnesium supplement. Estimates show that 80% of Americans are magnesium deficient, and magnesium relaxes vascular smooth muscle; to directly lower blood pressure. In addition, your weight and the amount of exercise you do affect your blood pressure.

Exercise

It’s important to have an exercise regimen that will help to lower your insulin levels. Studies have traditionally shown that “cardio”  or “aerobic” activities such as jogging and swimming tend to be the most beneficial for lowering blood pressure.

However, more recent studies reveal the good news that you don’t need a 30-60 minute workout to reap the insulin and blood-pressure-lowering benefits. Short, intense workouts such as high-intensity interval training (HIIT) are becoming more popular for both health and efficiency. It’s fairly easy to construct a HIIT regimen to do at home. You don’t need to do exact “timed intervals”; it’s just about getting short of breath, recovering, doing it again, and so on. If you have been exercising regularly, start “low and slow,” and if you haven’t exercised much since your “school years,” get medical clearance. Try doing burpees until you’re short of breath for 3 sets and work up to 6 sets, 2x per week. You can also do sprints on a track or in a pool. You can run in place, jump rope, or do jumping jacks.

Diet changes and precautions

Before I get into a more verbose discussion about non-inflammatory eating, I mention two food items we all used to think were healthy foods. Unfortunately, these so-called health foods have become poison for most people with existing high blood pressure, grains, and sugars (including fructose). Since many people still think grains and fruit juices are healthy choices, I want to emphasize they most certainly are not. Now, the science.

Addressing “Hypertension Pathophysiology”

Closely linked are the metabolic abnormalities of high blood sugar, high insulin levels, high leptin levels, and, therefore, insulin and leptin resistance at the receptor level.

Hypertension can be caused by cellular glycation (stiffening) from high blood sugar levels, so getting your blood sugar under control is a must. In addition, most people with hypertension have insulin receptors that don’t work efficiently, called insulin resistance. To compensate for this, your body produces more insulin. To lower insulin levels, you need to replace processed foods with real, whole foods. You also need to eliminate or dramatically reduce sugar and processed fructose (fruit) sugar and grains from your diet. Some studies show a closer correlation between fructose consumption and hypertension than even sodium! And then there’s leptin, another hormone that looms upward as you eat poorly and gain weight.

You can easily become leptin-resistant (with the attendant high leptin levels) by eating the same diet full of sugar (particularly fructose and grains once again.) Together, these foods will create the perfect environment for weight-packing bacteria to thrive in your GI tract; or microbiome. You then have your gut telling your metabolism to slow down and your high leptin levels telling you to keep eating and store more fat in your fat cells. It’s not a pretty picture, but it can be easily reversed. Other factors that play into the high leptin scenario include high cortisol levels (to be discussed) and other hormone imbalances. Often this trio shows up as belly fat. Lowering blood sugar, leptin, and insulin are partially achieved by simply losing weight which I’ll discuss next.

Normalize your Weight

I’ve talked about blood sugar, insulin, and leptin. To complete the discussion of the diet plan to normalize your weight for life, you must eat an anti-inflammatory diet. This can be a basic anti-inflammatory diet, a stricter autoimmune,no-lectin diet, or even a ketogenic diet plan. A paleo diet is effective, but you must be sure to compensate for the over-abundance of omega-6 fatty acids in meat. Here’s how you do just that.

Balancing the omega fats in your diet

Just about everyone needs to normalize their omega 6-to-3 fat ratio. Also, omega-3 fatty acids are vital for healthy blood pressure. Findings from a study of 2,000 healthy men and women between the ages of 25 and 41 showed that those with the highest serum levels of omega-3 also had the lowest blood pressure readings.

Both omega-3 and omega-6 fats are essential for your health, but most Americans consume too many omega-6 fatty acids in their diets and too few omega-3s. This is because we tend to eat more meat and milk and less omega-3 fish. Eating omega-3 fats is a great way to re-sensitize your insulin receptors if you are insulin resistant. It is also essential for normal, healthy blood pressure. Wild-caught salmon and sardines are both low-mercury and high omega-3 containing fish. However, it’s hard to consume enough to compensate for all of the omega-6s we eat, so I always recommend a good omega-3 supplement.

Inflammation and Oxidative Stress

Internal inflammation is associated with all disease states, including hypertension. Because approximately 70% of Americans are overweight, this alone is considered a major cause of reversible inflammation. In addition, eating the standard American diet (S.A.D.) described above will increase inflammation levels. Add in toxins such as heavy metals (mercury) and fluoride in drinking and showering water, and you’ve piled onto our national epidemic of inflammation. On the other hand, if you reduce your weight, clean up your diet, deal with toxins, stress and heal your probable leaky gut, then you will make a big “dent” in your inflammation problem and your blood pressure level, too.

Oxidative stress (defined as an over-abundance of free radicals which are not sufficiently quenched by antioxidants) worsens inflammation. But, this can be easily reversed with enough vegetables, fruits in moderation, and a high-antioxidant supplement.

Stress and Cortisol 

There is a publicly accepted long-term myth that stress raises your blood pressure. It does short-term, and some so-called “experts” still say it doesn’t raise it or can’t raise it long term. However, sustained high cortisol will routinely cause leaky gut, disturbing the microbiome and potentially elevating blood pressure. So, based on current research, it’s now not a myth anymore! Let me explain the role of the microbiome.

Your Microbiome

Leaky gut is caused by everything from a poor diet to high “stress levels” to proton pump inhibitor antacid drugs such as Prilosec. It sometimes produces little to no symptoms, but it always causes internal inflammation, which you now know is associated with hypertension. In addition, leaky gut always produces unfavorable alterations in the composition of the GI microbiome. And this is yet another factor in the creation of the hypertensive state.

Doesn’t it seem that lately, you read that all aspects of your health are more and more related to the health of your gut? It turns out that an unhealthy gut microbiome with less “healthy bacteria” (a dysbiotic gut) will cause hypertension; via a different mechanism than through leaky gut and/or inflammation. It also seems that “hypertensive GI tracts” have fewer bacteria that produce (healthy) butyrate and acetate.

There are two easy ways to increase gut butyrate levels that help with weight loss, insulin resistance, leptin resistance, and blood pressure. One way is to take sporulating probiotics. The other is to supplement with MCT (medium-chain triglycerides) oil. I use MCT oil for cooking and suggest that “trick” rather than MCT supplements which often cause diarrhea.

Avoid toxins

Biotoxins such as mold mycotoxins and Lyme toxins and heavy metals such as lead and mercury can damage the microbiome via other mechanisms, including (most often) the sirtuin pathway, and raise blood pressure. So next, let’s talk about sirtuins.

Sirtuins are enzymes that are produced in decreased amounts in many metabolic disorders such as obesity and metabolic syndrome. SIRT1 (the most well-known and studied sirtuin) causes an increase in leptin sensitivity. It also increases adiponectin production. Both of these actions have both anti-obesity and, therefore, anti-hypertensive effects. The SIRT1 pathway is disordered in toxin-related disorders and many disorders of mitochondrial function. Therefore diseases such as Parkinson’s disease, Hashimoto’s thyroiditis, or Chronic fatigue syndrome are also associated with SIRT1 deficiency, with a built-in risk for metabolic syndrome, including hypertension.

The Role of Nitric Oxide 

Nitric oxide (NO) protects the lining of blood vessels and vasodilates them as well. When arteries are damaged by inflammation, we see a decrease in nitric oxide near the smooth muscle linings of the blood vessels. In general, nitric oxide levels tend to decrease with age. To some degree, HIIT exercise enhances NO, but to make sure your levels are adequate, try foods or supplements. Below are some foods and supplements which raise NO levels.

Beetroot Juice 

This juice is high in NO3, which converts to NO. An 8-ounce glass per day will lower your blood pressure (on average) by 8 mm Hg (systolic) and 4 mm Hg (diastolic), demonstrated in those with existing hypertension. I find this to be much more palatable when mixed with “juiced” carrots and spinach.

Examples of other vegetables high in NO3 include whole beets, arugula (the best!), celery, cabbage, leeks, scallions, radishes, kale, turnip tops, spinach, mustard greens, eggplant, carrots, and string beans.

Vitamin D 

It’s a well-known medical fact that vitamin D deficiency is associated with arterial stiffness and subsequent hypertension. Still, a large study involving over 100,000 individuals has now demonstrated that low vitamin D levels can actually cause high blood pressure. To make the correlation even stronger, the highest vitamin D levels were shown to lower hypertension risk the most. High-D foods include the healthiest fish, wild sockeye salmon, and sardines, as well as eggs (only eat “pastured,” please). Most people are clinically deficient unless they take D3+K supplements, with most individuals requiring a minimum of 6000 IU’s per day.

Resveratrol

This multi-use supplement increases endothelial NO production, reduces vascular oxidative stress, and prevents smooth muscle proliferation, vascular remodeling, and arterial stiffness. In addition, resveratrol inhibits immune cell infiltration into the vascular wall and mitigates vascular inflammation. All these mechanisms contribute to the positive effects of resveratrol on vascular function and blood pressure.

L-arginine plus l-citrulline

A good NO-enhancing supplement will contain l-arginine and l-citrulline. Bodybuilders typically use these supplements for the increased “pump,” and some men use them to enhance erectile function. However, if taken often, they too will lower blood pressure by increasing nitric oxide.

The Role of the Oral Microbiome

Other Helpful Supplements

Vitamin E

Natural vitamin E (200 IU’s per day) has been shown to lower blood pressure. Natural vitamin E is always listed as the “d-” form (d-alpha-tocopherol, d-beta-tocopherol). Synthetic vitamin E is listed as “dl-” forms. Don’t take synthetic vitamin E, as it’s ineffective and might even cause harm.

Vitamin C

Studies (meaning a review of 29 studies done in 2012) indicate that 500 mg of vitamin C per day might help lower blood pressure. In 2020, another meta-analysis was done, focusing on 8 studies published between 1991 and 2018. Overall, 614 participants were included. The number of participants in the individual studies ranged from 12 to 480. Participants’ mean age ranged from 46 to 78 years. The duration of the intervention varied from 4 to 24 weeks. All participants had essential hypertension. The average SBP and DBP of the participants ranged from 143 to 173 mmHg and from 76 to 97 mmHg, respectively. The supplementary dose of VitC in the treatment group varied between 300 and 1000 mg/dL. The results? There was indeed a correlation between supplemental vitamin C and hypertensive control.

Why? At present, the main theory is that VitC increases intracellular concentrations of tetrahydrobiopterin, an endothelial nitric oxide synthase co-factor that promotes the production of nitric oxide, which is a potent vasodilator. However, there is also evidence that Vitamin C enhances the biological activity of nitric oxide.

Garlic

This can lower blood pressure by 10%, but only if you take it as a supplement. Although allicin is produced when raw garlic is crushed or chewed, much of it is destroyed during cooking. For about ten years, researchers have been aware the allicin made from alliin in garlic blocks the activity of angiotensin II—a substance that raises blood pressure. In addition, supplemental garlic elevates levels of nitric oxide.

Note, however, the health benefits of garlic supplements are due to ajoene, diithins, and allicin, not just due to allicin. So, shop carefully since ajoene and diithins are considerably more potent than “just allicin.”

Natto

Nattokinase enzymes have potent fibrinolytic (blood-clot-busting) activity, anti-atherosclerotic, lipid-lowering, antiplatelet (anti-platelet stickiness), and even neuroprotective effects.

In addition, with regards to the topic of this article, a well done double-blind, placebo-controlled, randomized study showed that supplementing with nattokinase for eight weeks resulted in a significant reduction of both diastolic and systolic blood pressure.

Nattokinase is an enzyme found in the food natto, which is a fermented soy product. Whether consumed as fermented soy or as a supplement, the natto enzyme has been used successfully for 25 years to treat hypertension and various circulatory issues in China and continues to be studied worldwide.

Odds and Ends

The idea that menopause or the associated estrogen decrease is associated with blood pressure increase is still under debate. The epidemiological challenge is the coincidence between menopause and aging and the evidence that both rising blood pressure and menopause have common determinants such as diet, body mass index, smoking, and even socio-economic class. In addition, there seems to be no correlation between testosterone levels in men and blood pressure levels. The bottom line, as always, is to eat healthfully, exercise correctly, and supplement smartly. For some, that might include nitric oxide supplementation.

How to Boost your Immune System

We suffered not just from sickness and loss; we have been shut in, shut down, and zoom-fatigued.  Something that has emerged as almost a national obsession has been the urge for lots of self-care, including care that prevents infection. Such care now includes strategies to boost our immune system. We want not simply  to mask up, but to also, well- “immune up!”  Shall we?

Basic Lifestyle Strategies for Immune Health

Diet: I advise all patients to eat some form of an anti-inflammatory diet. To keep it super simple-eliminate highly processed foods, watch your sugar and starchy carbs consumption, and be careful with gut-damaging lectins. Foods that are highly processed or high in lectins such as gluten-containing grains, beans, nightshade vegetables, and low-fat dairy products  lead to gut lining damage which means “leaky gut.” Eating this way then causes inflammation which is one of the root causes of all diseases. I’ll go into inflammation more in-depth in one of the following sections. See the first page of my website for a free, downloadable diet.

Immune-boosting foods include garlic, horseradish, and wasabi. Garlic is anti-viral, and while used as a supplement, I won’t explicitly cover its use in this article.  It’s also essential to eat to support the health of your microbiome. Microbiome health equals far greater immune health; I’ll cover that in a separate section further on in the discussion. Dietary constituents with exceptionally high anti-inflammatory and antioxidant capacity include vitamin C, vitamin E, and phytochemicals such as carotenoids and polyphenols. Let that sentence serve as an introduction to the next topic, oxidative stress, followed by inflammation.

Oxidative stress

What is it? Oxidative stress is an imbalance between the production of free radicals (will explain) and the ability of your body to counteract or detoxify their harmful effects via neutralization by antioxidants. Oxidative stress is the condition in your body when it does not have enough antioxidants to neutralize free radicals. Just as an apple not coated with lemon (an antioxidant) turns brown when exposed to air, our cells can “rust” when we have oxidative stress- caused by unopposed free radicals.

Free radicals are unstable molecules that react with certain substances in your body to damage cells or create abnormal ones. Free radicals chemically react with cell components such as DNA, proteins, or lipids and steal their electrons to become stabilized. This process destabilizes the cell component molecules, seeking out and stealing an electron from yet another molecule, triggering a large chain of free radical reactions.

A proper diet can reverse this unhealthy but common condition. Eat five to twelve servings of organic fruits and vegetables daily or supplementing with a high-antioxidant multi-vitamin. I always measure patient’s levels of oxidative stress with a Raman spectroscopy unit. Other Functional doctors may use blood or urine testing. The bottom line: if you’re aware of this phenomenon, you can prevent it! Here’s what to watch out for and adjust your intake of antioxidants accordingly.

What Causes Free Radicals? Free radicals are simply a byproduct of energy consumption in our mitochondria, the factories that produce energy in each of our cells. When we exercise, we increase our respiratory and heart rate, creating more free radicals that need to be quenched by good levels of antioxidants. However, the free radicals that deplete our antioxidant supply are environmental and result from our lifestyles. Here are the big offenders.

Exposure to tobacco smoke: Imagine this-tobacco smoke contains more than 4,000 toxic chemicals that all can cause oxidative stress. One cigarette produces millions and millions of free radicals. How’s that for incentive to stop? We who use Raman Spec scanners have discussed the data, which shows that smokers score in the lowest range, equivalent to those with active cancer cases!

Consuming a “bad” diet: As referenced in the “diet section,” it’s essential to eat as if your health depends on it (because it does!). Eating too many calories, sugars, refined or starchy carbohydrates, processed and fast foods, and lectins do indeed cause oxidative stress and inflammation. Unhealthy foods force our mitochondria to work harder and release more “exhaust,” creating higher levels of free radicals burning toxic foods for energy. Speaking of diet, let’s look at two other popular lifestyle choices.

Excessive alcohol: Alcohol consumption increases your levels of inflammatory cytokines-inflammatory molecules linked to oxidative stress.

Eating charcoal-broiled foods: These foods-not just meats-contain polycyclic aromatic hydrocarbons, which contribute to oxidative stress. And yes, char-broiled meats are indeed carcinogenic. Now, let’s move onto some other lifestyle factors in oxidative stress levels.

Excessive psychological stress: The stress hormone cortisol increases inflammation, which further increases free radical production. It also causes a leaky gut, an asymptomatic cause of chronic inflammation, and the root cause of autoimmune disease.

Exercising too much: Exercise (which will be discussed in another section) is crucial for optimal health. However, too much of it can increase oxidative stress in our bodies. As a rule of thumb, more than 60 minutes per day is considered excessive. Therefore, all elite athletes need to supplement adequately.

Lack of sleep: Sleep deprivation increases oxidative stress through a complex series of chemical reactions. Yes, I’ll discuss sleep in more depth, too.

Exposure to air pollutants: Air pollution, industrial pollution, and even airborne allergens increase oxidative stress.

Chronic infections: Hidden (asymptomatic) infections will contribute to oxidative stress. One example is a biofilm secreting sinus organism called MARCoNS, found in people with mold and mycotoxin illness. Dental infections are another excellent example. If you have root canals, you will not feel apical abscesses-so get a panoramic X-ray annually.

Ionizing radiation and EMFs: Exposure to x-rays, excessive sun, radon, cellphones, hairdryers, airplanes, electric blankets, and heating pads can all contribute to oxidative stress.

Exposure to fungal toxins: Environmental molds (like those in basements and bathrooms) and internal fungi (such as those colonizing your gut in excess) can produce mycotoxins that increase oxidative stress.

Inadequate GI-tract detoxification: When the liver is overwhelmed with toxins from food (e.g., too much sugar) or the environment (e.g.:exposure to pesticides or toxic mold), it becomes inflamed and then produces more free radicals. And now that you know what causes this problem go ahead and fill your diet with antioxidant-rich food, smoothies, and supplements to combat it. Next, let’s look at OS’s evil twin: inflammation.

Inflammation

What exactly Is Inflammation?: Let me first explain “acute inflammation.”  Think about what happens when you get a splinter in your finger. If you don’t remove the shard, the whole area turns red and gets a little puffy. That’s acute inflammation, and it’s a good thing, as it’s your body responding appropriately to a situation. It’s mostly your immune system rushing to the area to fight off any viruses or bacteria that might have gotten in. With a physical injury, if you leave the spot alone and don’t irritate it any further, the swelling will go down, and everything will go back to normal. The signs of acute inflammation: heat, redness, swelling, and pain will all dissipate.

However, if you keep stabbing yourself with fragments in the same spot, the re-injury would maintain the high levels of inflammation burning. That’s what is going on with chronic internal inflammation, but you can’t  “feel the stabbing.” The inflammatory response is short and relatively precise. When it’s chronic, inflammation can be “silent,” can make you feel lethargic, or contribute to many other health problems. Here are the major causes of chronic inflammation. 

Your weight: Inflammation risk is guaranteed if you are obese or even just overweight. Overweight and obese men and women have higher levels of inflammatory blood markers than men and women of the same age who are not obese or overweight. Inflammation drops when men and women lose weight, according to many clinical studies.

Unhealthy diets: I know you hear this repeatedly from me, but consider that it’s that important to eat a healthy diet. Common foods processed just like sugar and therefore considered”inflammatory” are sugary foods, high-processed carbohydrates, high-industrial fat, and seed oils, high-gluten, and all overly processed and fast foods, save the lone naked salad. I know this is the typical U.S. diet. Toxic foods are why our population is so inflamed!  Further, this poor eating pattern also causes oxidative stress, which in turn worsens inflammation.

Insufficient omega-3 intake: Omega-3 fats are the precursors for anti-inflammatory eicosanoids, an integral part of the inflammatory response. Poor omega-3 status means inadequate production of anti-inflammatory eicosanoids and a lopsided anti-inflammatory reaction to normal stimuli. It’s easy to get good blood levels: eat omega-3-rich fish such as salmon or sardines and take good omega-3 fish oil supplements.

Excessive omega-6 intake: Omega-6 fats form the precursors for inflammatory eicosanoids, which are also an integral part of the inflammatory response. High omega-6 status (especially when combined with poor omega-3 status) means excessive production of inflammatory eicosanoids and a lopsided inflammatory response to normal stimuli. Cut down on your omega-6 intake by reducing your intake of meat.

Chronic stress: Life can be stressful, indeed. Everything all adds up, doesn’t it? Notably, if it becomes too much for you to handle, your body will have a physiological, inflammatory response to emotional stress. This physiological reaction includes a rise in cortisol, as mentioned earlier.

Lack of downtime: When you’re always on your phone or checking your social media accounts, you are not relaxing. When you hear a “ding” and rush to answer a text or email, you are always “on.” You may think you’re relaxing because your body is stationary, but you’re not relaxing-are you?

Lack of sleep: Poor sleep causes elevated blood inflammatory markers. Poor sleep is a chronic problem in the U.S. Either we go to bed too late, wake up too early, or use too many electronics late at night and disrupt the sleep quality we get. I’ll go more in-depth into the topic of sleep further on in this article.

Toxins cause Inflammation: Heavy metals, biotoxins such as mold and Lyme toxins, and more can cause chronic inflammation.

Lack of outdoor time: We all spend too much time cooped up in offices or, worse, in office cubicles, or even at home, doing zoom calls. We just plain don’t spend enough time in nature.

Your exercise and movement patterns: Insufficient exercise and even inadequate “movement” (more below) adds to inflammation.

Lack of movement: Most of us lead far too sedentary lives. A lack of activity causes systemic, low-grade inflammation. We don’t usually need to walk to get to our destinations. We take escalators and elevators. We sit for hours on end and then don’t make time for regular exercise. Suppose this is you-make time to move more. Get up on your feet for two to three minutes each hour you’re sitting. Better yet, do some burpees, jumping jacks, or push-ups.

Poor recovery and Overtraining: On the other hand, some people move, but they exercise too much, with too little rest and recovery. Overtraining is a form of chronic inflammation. Not just elite athletes, but even casual 10K runners and others who train frequently can overtrain. This degree of over-exertion can cause inflammation, as well as elevated cortisol levels, and disrupted sleep. Now that I’ve gone through some ways not to exercise, why don’t I discuss how to exercise?

Exercise 

Multiple studies in both humans and animals have demonstrated the profound impact exercise has on the immune system. There is an overwhelming consensus that regular bouts of short-lasting (30 to 45 minutes) moderate-intensity (e.g., brisk walking, vacuuming, dancing, doubles tennis, and “shooting hoops”) exercise is beneficial for proper immune function. This correlation has been demonstrated particularly well in older adults and people with chronic diseases.

Exercise is probably healthy for intestinal flora composition, so remember this when you read the section about the microbiome. Some investigations have shown that activity is associated with increased microbiome biodiversity with attendant beneficial metabolic functions. Gut microbiota (innately linked to all immune functioning) can, in turn, influence the pathophysiology of several distant organs, including the skeletal muscle. A gut-muscle axis may regulate muscle protein deposition and muscle function. This gut-muscle axis may involve maintaining skeletal muscle with aging and contribute to insulin sensitivity and blood sugar levels, which brings me to the next topic called glycation.

Glycation 

Cellular glycation is the stiffening and aging of all cells. It occurs at fasting blood sugar levels somewhere in the range of 75-85 ng/dL. Research continues to lower the bar at which we set the definitions of glucose-intolerant, diabetes, and simply “cellular glycation.” I don’t think I need to mention that blood sugar levels increase with increased body mass.

Higher blood sugar levels are associated with immune system depression, increased risk of dementia, heart disease, cellular aging, and even cancer. Cancer is an immune-mediated and mitochondrial dysfunction disease that is largely preventable. Some studies demonstrate that certain cancers respond to treatment more effectively when blood sugar is lower, achievable via ketosis or medication. Studies also link better blood glucose control to better sleep. Here’s what you need to know about sleep.

Sleep

Sleep has powerful effects on immune functioning. Studies show that sleep loss can affect different parts of the immune system, leading to the development of a wide variety of disorders. Here are a few interesting studies to consider before giving you my recommendations for adequate, restful sleep.

Sleep loss is a risk factor for lessened immune response and infection. Restricting sleep to 4 hours per night for six days, followed by 12 hours of sleep per night for seven days, resulted in a greater than 50% decrease in antibody production to influenza vaccination than subjects who had regular sleep hours.

Restricting the time allowed for sleep to 4 hours for one night reduced natural killer (NK) cell activity to an average of 72%, compared with NK cell activity in participants who had a full night’s sleep. NK cells are essential for infection clearance; they also have a significant role in killing tumor cells. Reduced functioning of NK cells is associated with an approximate 1.6 times higher risk of dying from cancer.

In addition, restricting sleep to 4 hours for (again) just one night led to the generation of measurable inflammatory cytokines, which play an essential role in developing metabolic and cardiovascular disease. So, how much “good” sleep do you need?

How Much Sleep Do You Need? There is only a little individual variability in regards to how much sleep we all need. Most adults need  7 to 8 hours of good-quality sleep per night. What’s “good quality sleep?” Good quality means that the “sleeping episode”  doesn’t include frequent arousals and is long enough for the individual to feel refreshed upon awakening. All wrist gadgets aside: most of us move correctly through the stages of sleep depth, including REM, and if we don’t, we don’t feel refreshed-plain and simple.

Researchers have identified genetic mutations in some people who naturally sleep six or fewer hours a day and appear healthy and functional. These people show less deterioration in performance when they are sleep-deprived under laboratory conditions. However, note that the percentage of the population with these gene mutations is minute. Most people who say they do not need much sleep are just pushing themselves to sleep less. As a consequence, they then struggle to stay awake and tend to function suboptimally during the daytime. They are putting themselves at risk for obesity and chronic illness.

Want to figure out your ideal sleeping time? The average sleep times across 5 to 7 relaxed days estimate your required sleep duration. Just record the length of time you sleep during a 7-10 day vacation, when you are awakening spontaneously, without an alarm, and go to bed when you are tired. During this time, remember to keep caffeine intake to no more than 2 cups of regular coffee a day (about 200 mg of caffeine). And speaking of a relaxing vacation, try to do an activity to reduce your stress levels daily at least a couple of times per day to mimic how you feel on holiday. Stress management is not simply to make you feel better; it’s a matter of your health.

Stress Management 

Stress depresses the immune system. It does this via several different mechanisms. First, sustained high cortisol levels caused by stress cause gut hyper-permeability (i.e., “leaky gut”), which causes inflammation and subsequent disease. Cortisol also interferes with T-cell (a type of white cell) production and function, making your body more susceptible to pathogens. Stress is why you get more head colds when you are under pressure. Finally, cortisol kills brain cells (neurons), further interrupting the gut-brain axis crucial for proper immune function.

Manage your stress before it manages you. Incorporate movement and exercise into your day. Activity can be as simple as making sure you get up from your chair and walking around for a few minutes every couple of hours. Exercise should be something you will do, not something you’d like to envision yourself doing. Deep breathing and meditation are great habits to cultivate. If you don’t have the patience, you can activate the vagal (parasympathetic system) nerve by singing and even gargling. Some people also benefit from liposomal GABA supplements and peptides with anti-anxiety benefits. I touched on gut health, and now I’d like to go a little deeper into that topic with a discussion about the microbiome.

Microbiome Health 
The human microbiome is between 10 and 100 trillion genetically unique (mostly) bacterial cells. The healthier your gut microbiome is, the better it is for your immune system, which is also (primarily) located in your gut. Unhealthy gut bacteria thrive on the things that create inflammation in our body, including refined carbs, sugar,  unhealthy fats, and processed foods. Conversely, the healthy foods and activities discussed previously all contribute to microbiome health. To augment all of these healthy habits, we can add prebiotic fiber and probiotics into the mix. First of all, we need to eat good prebiotic foods as “fertilizers” for probiotics.

Prebiotic fiber: This is non-digestible carbohydrates found in fibrous foods that assist in the growth of healthy bacteria in the gut. White and even tastier-red onion, as well as asparagus, chicory, garlic, unripe banana, and artichoke-especially Jerusalem artichoke, are great “gut bug food.” They assist gut health primarily by helping healthy gut bacteria produce substances such as butyrate. Butyrate helps protect the gut lining and has anti-inflammatory properties in the gut. Now let’s seed this fertilizer.  

Probiotics: High-quality kefir or yogurt (home-made) and fermented foods such as sauerkraut can supply a fair amount of good bacteria, but I generally supplement everyone to ensure they get enough probiotics to augment immune function. We see some good evidence that sporulating probiotics are more immune-supporting and microbiome-diversity-supporting than the strains of probiotics we used to recommend only recently.

Immune enhancement with hot and cold therapy

Heat shock proteins form in the body when you immerse your body in ice-cold water or a tub or sauna at 104 degrees F.  They are great for your immune system and will enhance many positive immune modulation functions.

Cold therapy lowers cortisol levels when you do it on a repeated basis. I just reviewed why you want nice, controlled cortisol levels, and this is now another way to get them. As a reminder, bringing down your cortisol will not only help your gut lining stay intact, it will enhance the 70% of your immune system which resides in your gut. In addition, studies show that cold therapy improves anti-tumor white blood cell activity. Finally, NK (natural killer T cell) activity also gets a boost with cold therapy.

Various heat shock proteins induced by saunas (conventional and FIR) trigger positive effects in the immune system regarding infections, autoimmune disease, and even cancer therapy. Suffice it to say, for this article, that hot and cold treatments are fantastic for your immune health. Now, let’s discuss supplementation.

Supplements to boost the immune system 

Multivitamin supplements

Over 10,000 vitamin companies are selling their multivitamins. You want to choose GMP, NSF certified, and high antioxidants, especially forms of vitamin A called carotenoids. Good MVI supplements also contain iodine and selenium, which are important for proper immune system function. The addition of polyphenols is an excellent “add” when you can find them, and they are suitable for the care and feeding of your microbiome. You need more vitamin C  than you get via multivitamins: I’ll address that separately.

Vitamin D

You need vitamin D for a properly functioning immune system. We’ve more than learned that during this past year’s COVID crisis.

Vitamin D inhibits negative (harmful) immune pathways and promotes positive ones. It also positively impacts the composition of the microbiome and enforces the gut barrier. Clinical studies show low vitamin D levels are a risk factor for coronavirus infection. Previous studies correlate low levels of vitamin D with more “flu”; in general.

Vitamin D dosing: You want a level of 75-80 ng/dL which requires most Americans to take doses of 5000-10,000 IU per day.

Vitamin C and Zinc 

Vitamin C concentrations in the blood plasma and white blood cells quickly decline during infections. Likewise, zinc deficiency impairs cellular mediators of innate immunity such as natural killer cell activity, phagocytosis of infectious organisms, and the generation of an oxidative burst.

Supplementation of vitamin C improves various components of our immune system: natural killer cell activity, migration of white blood cells (chemotaxis), the appropriate and proper proliferation of specific white cells called lymphocytes, and overall antimicrobial activity. Vitamin C contributes to the antioxidant status of cells, thereby protecting them against reactive oxygen species generated during the inflammatory response. Supplementation with zinc has shown similar benefits, which, in some studies, are augmented by the flavanoid-quercetin.

Therefore, both nutrients play important roles in immune function and help attenuate the risk of infection when taken as dietary supplements. They have reduced the risk, severity, and duration of many infectious diseases. When taking long-term zinc supplementation, make sure you are ingesting enough dietary or supplemental copper.

Zinc dosing: Ideal dosing is about 25-60 mg per day.

Vitamin C dosing: Liposomal preparations can be taken in doses up to 3 grams (usually 1 TBSP) per dose without GI distress for most people. Many clinical studies use 1.5 grams 4 times per day (6 grams total), but I generally recommend 1 TBSP 2x/day during “flu season,” including during this past COVID-year.  Take regular buffered vitamin C  as a 500 mg dose- just space that out accordingly.

Melatonin

Melatonin is a potent anti-inflammatory and anti-oxidant-not simply a sleep aid. The fact that it helps establish our circadian rhythm is an immune boost– right there. Many people find this surprising, but it’s accurate! When we are infected, It functions mainly to blunt our over-active inflammatory response, limiting tissue damage. It does much more, but for this article, I’ll state that it’s good for your immune system and will indeed help you sleep more soundly. There’s a good reason that the “expanded” use of melatonin won its scientists the 2017 Nobel Prize in “physiology or medicine.”

Melatonin dosing: Studies have the maximal efficacy at 10-20 mg per night.

Reishi mushroom extract

Many types of mushrooms contain polysaccharides called beta-glucans in their cell walls. Beta-glucans boost the immune system via several mechanisms. They enhance the action of macrophages (a type of white blood cell that kills foreign invaders), activate the “complement” component of the immune system, and boost natural killer (NK) cell function. There is an especially immune-boosting species of mushrooms called Ganoderma lucidum or reishi mushrooms. They are not especially tasty but are used to formulate potent immune-enhancing supplements.

Reishi dosing: Find a good brand that uses cracked reishi spores to make the powder put in capsules and take 1000 mg per day.

DHEA

The hormone DHEA is well known to impact adrenal function positively and, therefore, cortisol levels. It has verifiable anti-inflammatory properties and is most likely immune-supporting via several complex hormonal pathways.

DHEA dosing: Important note: Men with a history of prostate cancer and women with PCOS or a history of breast cancer must take the keto form of this hormone, if at all, since the keto form is not study-proven as an immune enhancer. Otherwise, men should take a daily dose of 50 mg; women-25 mg.

Nitric Oxide

Nitric oxide (NO) is bactericidal, which can act directly as an anti-microbial compound that can destroy bacteria.  Certain families of immune cells called dendritic cells can produce NO, contributing to the resolution of both viral and bacterial infections. The non-proven inference is that higher NO levels contribute to a more rapid and efficient clearing of bacterial and viruses. It’s good for your vasculature and heart, indeed very well might be immune boosting, so because of all of this, it makes my list.

NO dosing: Look for a product with an equal amount of l-arginine and l-citrulline such that you take 1.5 grams of each 2x/day.

The Research Continues

Many organ systems function better by restoring male hormones and female hormones to youthful levels, and we know that human growth hormone is immune-boosting. We understand that the alpha-thymosin 1 peptide is so good at boosting the immune system (increased NK cell activity, increased antibody response to viruses, increased T cell function, and more) that the FDA pulled it off the market. Yes, that happens all the time with compounded products used successfully by Functional doctors. But studies are ongoing with other peptides.

There are other varieties of mushrooms (lion’s mane, for one) currently under investigation for immune enhancement. And finally, the most exciting research involves the use of stem cells and exosomes.

Exciting New Therapies for Natural Pain Relief

In this article I review some of the basics of pain relief you might have learned in health class, including all the ways to increase your natural painkillers: your endorphins, enkephalins, and endogenous cannabinoids (some of this might be familiar too). I also touch on some integrative, supplement-type methods you can track down on the internet by yourself and will finish by reviewing exciting and new forms of natural pain relief available only through qualified Functional medicine doctors (not on the black market please!).

I will discuss:

• Most common natural therapies
• How to increase endorphins
• Cold for natural pain relief
• Helpful herbals and supplements for natural pain relief
• Cannabinoids
• Low-dose Naltrexone
• Selank Peptide
• Semax Peptide
• DSIP Peptide
• Concluding remarks

Common Natural Pain Relief Therapies 

But a Word About Diet First

One of the first things I do with new patients is to ask them to alter their diet. Most people aren’t aware how inflammatory, and therefore pain-inducing, some of the foods they typically eat can be. The absolutely most anti-inflammatory diet is my autoimmune protocol diet. Avoiding fast and processed foods, grains (especially gluten), seed oils, dairy, and other lectins such as peppers, eggplants or white potatoes, is totally game-changing. When it comes to natural pain relief, an anti-inflammatory diet is Job #1.

Below are some other basics, which may or may not be helpful, depending where you are on your own “pain journey.” Meaning, hang on. If you are farther along on this road, there are additional and exciting compounded alternatives you have not yet heard of that I will discuss.

Fairly Well-Known Methods of Pain Relief

Many of us know the comfort of a warm bath (‘hot soak’) and a wet, dry, or far-infrared sauna. A simple, long, hot shower helps muscular or non-inflammatory joint pain when we’re stiff and achy. Massage therapy is proven to improve lymph drainage and increase endorphin levels.

Remember that endorphins are your endogenous painkillers, produced (mainly) by the posterior pituitary gland. Although there is speculation about the relative significance of endogenous cannabinoids and enkephalins, endorphins are still considered the #1 endogenous pain reliever.

For most people, the following endorphin boosting methods will bring some temporary pain relief. Unfortunately, these methods don’t work well (if at all) for patients with some pituitary tumors or active mold and mycotoxin illness. But, as someone who treats a lot of mold illness, let me tell you that the posterior pituitary does “bounce back” and these methods will indeed work again.

Increasing your Natural Pain Killers: Your Endorphins

Massage: Yes, I am repeating myself here, but if you can afford it a massage is not just a feel-good activity. A nice, firm, muscle-kneading massage increases endorphins for several hours, adding yet another layer to pain relief.

Exercise: Most of you know that exercise increases endorphins. But do you know that a “runners high” is now thought to be (at least partially) due to endogenous cannabinoids, not to endorphins? And there is definitely something to be said for group fitness activities. A clinical study found that athletes who rowed together could tolerate two times the pain compared to athletes who rowed alone.

Laughter: Laugh out loud and your body releases endorphins! Read emailed jokes. Watch comedy specials. Laugh every single day as if your health depends on it.

Eat Your Favorite Foods: If you love it on your tastebuds, you will produce endorphins. And Yes, even healthy foods can be delicious, so keep this in mind when you’re looking for an endorphin rush.

Do You Like Dark Chocolate? Dark chocolate contains much more healthy flavonoids – and far less sugar – than milk chocolate, but a couple of squares of either will give your endorphins a boost. Cocoa also contains a mood-boosting substance called phenethylamine. It is the phenethylamine in the cocoa that gives your body an endorphin boost. Interestingly, however, phenylethylamine supplements do not have the same effect.

Eat Hot Peppers: If you have a strong, healed gut and can eat the occasional “nightshade” (a lectin), these really can give you an endorphin rush. Your body senses “heat stress” and responds the same way it responds to pain – by producing endorphins.

Listen to Music: Enjoy the music you love. But did you know that your brain produces even more endorphins when you take part in creating music. If you are not a trained musician…then hum to, or sing along with, or even dance, with abandon, to your favorite tunes.

Have Sex: As you might predict, sex releases a flood of endorphins as well as other feel-good brain chemicals.

Try Acupuncture: The minor amount of pain caused by acupuncture needles sends a message to the brain, which then responds with the release of endorphins. Less data is documented regarding the placement of needles, but logically, of course, there is “something to it.”

Get Some Sunlight: A mere 5 to 10 minutes of direct sunlight will increase mitochondrial ATP as well as endorphins. And if it gets too hot for you, some cold therapy afterwards might just feel great!

Cold for Natural Pain Relief

Now that I’ve discussed endorphins, let me add another method to my list. Any sort of cold or cryo-therapy will cause your posterior pituitary to release endorphins, but referring back to the “stress” concept, when your body experiences stress or pain, the brain releases endorphins.

There is quite an accumulation of positive data on everything from winter swimming to ice baths regarding pain relief, reduction of inflammation and, Yes, even endorphin production. How to bring on the cold? If you’re up north and it is winter, go outside in shorts and a T-shirt. If not, try an ice vest, or multiple gel cold packs, or a brief ice bath, or even a cryotherapy tank. Cold works, and not just for localized pain due to injuries as most people think.

Several inflammatory cytokines, including TNF-alpha and IL-6 (both of autoimmune disease fame), will increase pain. In clinical studies, levels of TNF-alpha, IL-6, and a host of other inflammatory cytokines have been shown to be epi-genetically down-regulated systemically with the use of cold packs.

Herbals, Supplements and Integratives for Natural Pain Relief Backed by Science

Curcumin suppresses inflammation, which is a root causes of all diseases. Curcumin is the most potent of the three curcuminoids found in the spice turmeric. It suppresses pain by decreasing inflammation. It has more mechanisms of action than non-steroidal anti-inflammatory medications such as ibuprofen, and even more than steroids such as cortisone.

Curcumin is a safe inhibitor of the same pathways that the most complex drugs block: COX, COX-2, and LOX. In fact, curcumin inhibits the entire arachidonic acid cascade. In clinical studies, curcumin has worked as well as phenylbutazone and cortisone for osteoarthritis, rheumatoid arthritis, and post-operative inflammation. Studies show that curcumin inhibits the COX pathway better than indomethacin, a very strong mixed COX inhibitor that is still used to treat gouty arthritis.

Notably, curcumin has quite similar anti-inflammatory action as NSAIDs, but without the side effects. NSAIDs can have dangerous side-effects, and the COX-2 inhibitors are even required to include black-box warnings. Long-term NSAID usage causes leaky gut in just about 100% of people. Generally safe, even at doses up to 8,000 mg per day, Curcumin must be taken with meals, and under a doctor’s supervision if at doses exceeding 1-2 grams per day.

Fish Oil: There is a good deal of clinical evidence that fish oils are very anti-inflammatory and therefore pain-inhibiting. As an aside, when my patients have “the occasional headache or backache,” I ask them to take some curcumin and fish oil.

Capsaicin (trans‐8‐methyl‐N‐vanillyl‐6‐nonenamide) is an extract from hot chili peppers. It is a decent topical analgesic for a variety of painful conditions.

Devil’s Claw is a plant native to the African continent. Iridoid glycosides are the active ingredients. Several studies demonstrate relief with topical use for osteoarthritis.

Phytodolor is an herbal formulation containing alcoholic extracts of Populus tremula, Excelsior, and Solidago virgaurea. Studies show that it is often effective in various inflammatory arthritic disorders.

Glucosamine and Chondroitin Sulfate are the principal components of cartilage. There are conflicting studies on the combination of glucosamine and chondroitin, with some demonstrating a beneficial effect on arthritis pain. More recent studies find that chondroitin alone does not reduce joint pain. Therefore, the use of chondroitin has dropped off but there is better news regarding glucosamine.

Glucosamine for Arthritis: There have been 30 or so well-done studies examining the efficacy of glucosamine for joint pain. On review of all data comparing glucosamine to either NSAIDS or placebo, the glucosamine edges out the NSAIDS by a hair. Recent data shows the mechanism of action is via blocking lectins. While there haven’t been any good studies comparing glucosamine to the elimination of lectins in the diet, “it’s a very good thought.”

Cannabinoids: CBD and THC

People rarely realize that CBD is most plentiful in the hemp plant, which contains minimal THC, and that THC is found in the marijuana plant, where the concentration of CBD is more scarce. Both plants are cannabis plants, by the way.

There are many cannabis strains that vary widely in the composition of cannabinoids, terpenes, flavonoids, and other compounds. These components work synergistically to produce wide variations in benefits, side effects, and strain characteristics.

When we discuss the benefits of CBD, we’re talking about “whole hemp CBD” because “extracts” of CBD are relatively useless. Yes, check to see what you have. Medicinal THC, however, can be made in many forms, but the best benefits are found in those plants with more CBD, and the best pain relief is found in those formulations that include the other aforementioned ingredients such as the terpenes.

In a 2018 review article, multiple studies revealed mixed results. It appears that cannabinoids appear to be most effective in controlling neuropathic pain, medication-rebound headache, and chronic noncancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain.

Something marijuana enthusiasts don’t mention is that THC-cannabinoid-based analgesia has been linked to memory deficits and cognitive impairment. As with all mood-altering substances, we must be careful of our usage, dosing, and (IMHO) brain health protection, so that we do not experience any negative effects on our most important organ: our brain.

Meanwhile, animal studies demonstrate that whole hemp CBD oil increases endorphins. This has particular implications for patients with chronic pain syndromes such as fibromyalgia, CIRS pain due to EDS (endorphin deficiency syndrome), and neuropathies. An online patient survey by the U.S. National Pain Foundation of 1,300 fibromyalgia patients rated CBD as more effective than Cymbalta, or Lyrica.

If you have fibromyalgia, please read on, as there is much more “out there” for you. Here is the first thing you might want to try.

Low Dose Naltrexone

Naltrexone, was approved in 1984 by the FDA in a 50mg dose to help addicts wean off heroin. Naltrexone’s initial use was an opioid-antagonist drug used in large doses to block opioid receptors, and therefore the effects of opioid drugs.

Naltrexone was since studied in doses of 1-5 mg (hardly even a “drug” at those doses) and was found to perform other functions. It blocks the receptors of the opioid hormones in our brain and adrenal glands. Doing so produces the anti-pain endogenous chemicals called beta-endorphins and met-enkephalins, known as the opioid rebound effect. Blocking opioid receptors also upregulates something called opioid growth factor (OGF).

The mechanism of action of pain relief via OGF is fairly simple. By up-regulation of OGF via the temporary blockade of opioid receptors, you will see an increase in circulating endorphins and enkephalins via reduction of the inflammatory response. LDN is used not only for pain relief, but also to treat many autoimmune diseases; notably Crohn’s disease via different mechanisms of action. In addition, LDN is neuroprotective via the inhibition of microglial activation. But it is in cancer research where the really promising data is being seen, where OGF is identified as an angiogenesis blocker which then suppresses the growth of many types of cancer.

Review of LDN for pain 2020

Eight articles were ultimately selected for evaluation, after hundreds of reports of benefits were identified. Six studies included data on fibromyalgia, two studies included data on chronic regional pain syndrome, and one study included patients with multiple diagnoses, including interstitial cystitis, fibromyalgia, and chronic pelvic pain. The primary outcome of all of the studies was absolute pain intensity reduction. The writers of this review concluded that “Low-dose naltrexone provides an alternative in medical management of chronic pain disorders as a novel anti-inflammatory and immunomodulator.”

Before I move on to the last three new and novel pain therapies, I want to do a quick review of peptides, in case this is your first time hearing about them. Peptides are not “drugs,” because they are recognized by our bodies as “self-produced,” much like bioidentical hormones. Peptides are short segments of amino acids, usually comprised of between two and fifty amino acids.

The peptides we use in functional medicine are derived from human secretions and, being bioidentical, there are no “drug side effects.” There are many excellent peptides that are utilized for various benefits in functional and integrative medicine, but three in particular are used in various forms and combinations for the treatment of pain. They are:

Heptapeptide Selank: (Thr-Lys-Pro-Arg-Pro-Gly-Pro)

Numerous clinical studies have shown that Selank has strong anti-anxiety as well as neuroprotective effects. The clinical effects of Selank are similar to those of anti-anxiety medications such as benzodiazepines, which enhance the activity of the calming neurotransmitter, GABA. This suggests that the molecular mechanism of action of Selank also arises from its ability to enhance GABA’s activity on its receptors. This is supported by the strong positive correlation – in several clinical trials – between the changes in the expression of 45 genes one hour after Selank or GABA is given. Additionally, there is the data that, across-the-board, anxiety increases the perception of pain.

Here is some insight into why this may be true. Examination of patients with various forms of anxiety demonstrates a considerable shortening of enkephalin half-life. Selank dose dependently inhibits enzymatic hydrolysis of plasma enkephalins. Selank has been found to be a potent enkephalinase inhibitor. In other words, the enzyme that destroys the enkephalins is blocked by Selank, which has been proven to reduce anxiety.

Study results suggest that high efficiency of Selank in the therapy of anxiety and phobic disorders is due to its ability to inhibit enkephalin hydrolysis. A very nice side effect of this is that higher enkephalin levels will reduce pain. Ongoing studies suggest that Selank may additionally act via other brain chemical systems such as those that control dopamine and serotonin. Meanwhile, the data regarding these two systems is strong for my next peptide, Semax.

Heptapeptide Semax: (Met-Glu-His-Phe-Pro-Gly-Pro)

Semax is considered a nootropic peptide due to its ability to increase BDNF-brain derived neurotrophic factor. It has the same, and perhaps more pronounced effect, as Selank on enkephalinase, leading to increased levels of enkephalins. In addition, several studies demonstrate its ability to cause the brain to release both serotonin and dopamine, enhancing feelings of well-being, which will also decrease the perception of pain. It is being increasingly recognized as a fairly decent analgesic, despite the paucity of human clinical trials.

DSIP: (Trp‐‐‐Ala‐Gly‐Gly‐Asp‐Ala‐Ser‐‐‐Gly‐Glu)

Delta sleep-inducing peptide (DSIP) has potent analgesic activity in mice. DSIP may play an important role in pain regulation in the central nervous system, but it currently is primarily used for severe insomnia in humans. Research findings in humans are yet sparse, but in a study of seven patients with migraines and vasomotor headaches, this peptide (administered for 5 consecutive days) significantly lowered the perceived pain levels of six of the seven. Additionally, as an “incidental finding,” mood was elevated in all seven subjects.

DSIP does not appear to have binding activity to any subtype of opioid receptors. Animal studies show that DSIP stimulates the release of met-enkephalins. It might also then stimulate a stronger binding effect of those endogenous pain relievers to opioid receptors. More research is obviously needed, but for those with sleep and pain issues it is a great add-on.

Additional Comments

If you are looking to ‘go it alone’ for pain relief, know that there is some data on DL-phenylalanine regarding inhibition of enkephalinase, that you can buy liposomal GABA preparations to decrease anxiety, and that you can purchase 5-HTP supplements to augment serotonin levels – all of this, in addition to the endorphin-enhancing behaviors and the use of ‘cold’ and exercise. Remember that exercise probably not only releases endorphins, but it probably also increases levels of endogenous cannabinoids.

What you do not want to do, however, is increase your use of over-the-counter drugs for pain. Acetaminophen is toxic for your liver (and somewhat so for your gut), and NSAIDs such as Motrin and Aleve are uber-toxic to your kidneys and gut and, in fact, cause many cases of leaky gut, which then leads to all sorts of other issues.

Get some help for pain that does not respond to some of the natural things I have written about here. My last word of advice: Avoid Black Market Sources of Peptides and LDN, as you simply cannot know what you will be getting.

Get Rid of Bloating by Addressing the Root Cause 

To get rid of bloating symptoms, you must identify the root cause. Depending on what is wrong, you’ll need to do “the basics” and then, typically, some other personalized steps. The gastroenterology literature compartmentalizes bloating into what they call “functional” (translation: they find no cause for it) and “non-functional” (translation: they can pinpoint a cause). Since Functional medicine prides itself on always finding and then addressing the root cause of symptoms, I’m not going to use this classification. What I’ll do, instead is go through some basic explanations, and then review the common causes and treatments for issues that cause bloating. You’ll learn not just how to reduce bloating but hopefully, how to get rid of bloating; either on your own, or with the help of a good functional medicine doctor.

• What is bloating?
• Can I “just” bloat?
• General happy gut hygiene
• Happy gut supplements
• Bloating due to Leaky Gut/Solution
• Bloating due to a Disordered Microbiome/Solution
• Bloating due to Insufficient stomach acid/Solution
• Bloating due to gut motility issues/Solution
• Bloating due to hypothyroidism/Solution
• Bloating due to SIBO/Solution
• Bloating due to SIFO/Solution
• Bloating due to carbohydrate intolerance/Solution
• Bloating due to food sensitivities/Solution
• Bloating due to Inflammatory Bowel Disease/Solution
• Bloating due to Celiac Disease/Solution
• Bloating due to Rapid weight loss or gain/Solution
• Bloating due to Irritable Bowel Disease
• Bloating due to Constipation/Solution
• Bloating due to Hormone Imbalance/Solution
• Bloating due to Chronic Stress/Solution
• Concluding comments

What is Bloating?

Bloating is caused by the physical sensation of having gas trapped in your belly. Put “more medically”-abdominal bloating is the subjective sensation of trapped gas, gassiness,  or a feeling of pressure or being distended with or without obvious visible distension. It is decidedly not caused by fluid retention. You might have a bloated belly but have some fluid retention in other parts of your body (such as your feet and ankles) if you have a condition that’s causing both problems.

Patients also describe a sense of fullness or pressure, which can occur anywhere in the belly. We like to break it down into “above the belly button” (epigastric), belly button region, lower belly or diffuse so that we can analyze whether it’s an “upper belly” issue such as undiagnosed reflux, a small intestinal issue such as SIBO, or a lower bowel issue such as inflammatory bowel disease. All of these conditions will be covered in the “16 health issues” below.

Abdominal distension is the objective physical manifestation of an increase in abdominal girth. Male and female patients commonly describe how they look- “like I’m pregnant” when they have moderate to severe bloating with distension. Abdominal bloating and distension can occur independently, although they often occur together. Studies have reported that 50% of patients with “bothersome” bloating report abdominal distension. Remember when I said I wouldn’t talk about “functional bloating?” I’m going to break my rule this once: in so-called functional issues such as irritable bowel disorders patients are less likely to pair up bloating with visible distention than in decidedly non-functional disorders such as SIBO. Now that you know this, you can forgot I mentioned it.

Nearly all of us has experienced, at one time or another, a sensation of being bloated, gassy, or distended. For many people, these are merely annoying but transient sensations that occur after eating, resolve spontaneously, and do not lead to medical consultations. For others, however, abdominal bloating and distension are chronic, bothersome, and negatively affect their daily lives, whether they have a definitely treatable cause or a diagnosis of irritable bowel syndrome.

The occurrence of bloating with distension is significant, ranging from 15% to 30% in the general population, and is as high as 65%–90% in patients with irritable bowel syndrome (IBS). Women generally report higher rates of bloating than men, while patients with IBS with constipation predominance (rather than diarrhea predominance) have higher rates of bloating with distension. Seventy-five percent of patients with bloating (who do not have IBS) characterize their symptoms as moderate to severe, while 50% report that symptoms are so severe that they cause a reduction in daily activities.

To simplify the concept of bloating think of your gut as a digestion and bacteria factory. For some reason, you have inadequate protein, sugar and/or carbohydrate digestion which then causes foods to ferment. This can be caused by any of the medical issues I discuss below.  You  also have an imbalance in your gut bacteria or microbiome. This just “goes with the territory.”

Non-functional etiologies for abdominal bloating and distension that will not be discussed in this article include pancreatic insufficiency, diabetes, gastroparesis, Scleroderma, Chronic idiopathic pseudo-obstruction, Acute gastroenteritis, Gastric malignancy, Bowel malignancy, Ovarian malignancy, and ascites; an accumulation of fluid in the abdomen.

It is unusual but possible for any gastrointestinal bloating to actually represent fluid collecting inside your belly. This is not bloating. It is a potential medical emergency, and what you think is bloating, we call “fluid distension.” It could mean an infection such as hepatitis or even cancer. It could mean bowel obstruction from scars caused by prior surgery or adhesions from ongoing inflammatory bowel disorder. If you have sudden gastrointestinal distention, please see a doctor ASAP! Now let’s talk about the bloating that you came to read about. First, bloating by itself: can it happen with no other symptoms?

Yes it can.  If so, it is typically due to SIBO, SIFO or food sensitivities which I’ll address shortly. Other than these three things, it’s very unusual for bloating to occur without gas (upper or lower), diarrhea, or constipation. Lower intestinal gas is the primary “second” symptom associated with bloating. Constipation is second and is often helped with proper “happy gut” measures.

How to have a happy gut=how to reduce bloating

Chewing is obviously the first step towards the digestive process. The enzyme (amylase) is released immediately from your parotid glands, and makes digestion much easier on your stomach. Sicca syndrome (dry mouth), aging or having even a minor reflux disease (heartburn: with or without symptoms) can interfere with this initial process and cause bloating. So, your first digestive “job” is to chew your food thoroughly. We’ll get into whether or not you’ll need digestive enzymes.

In addition to chewing your food thoroughly, eat enough soluble and insoluble fiber (25-30 grams per day) to keep your colon “moving along regularly.”

Both soluble and insoluble fiber help bulk up your stools and can be used as a food source for good bacteria in your large intestine. Soluble fiber draws water into your gut, which softens your stools and supports regular bowel movements. Examples of healthy high soluble fiber foods include broccoli, sweet potatoes, avocados and figs, to name a few of my favorite foods. Two great examples of insoluble fiber include nuts and cauliflower.

Hydrate well which just means drink enough water so that your urine is clear. Too much of any fiber without enough fluid-added at once will cause constipation. Add fiber slowly and make sure you add more water or fluids to your diet at the same time. The combination of hydration and fiber keeps the GI tract moving along the way it’s supposed to do.

Exercise regularly. Exercise also helps with the GI tract’s peristalsis which is it’s rhythmic propulsion forward.

Eat a healthy diet. Fast food and processed food causes an array of gut issues- from leaky gut to dysbiosis.

Happy gut supplements

Any time the GI tract is “stressed” (causing any symptoms), I advise patients to chew food more carefully, cook meat and veggies more thoroughly, and take digestive enzymes to decrease the GI tract’s workload. A good digestive enzyme will contain HCL or betaine, and enzymes made by the pancreas and gall bladder. If you’re a gardener you know that you get better results with good fertilizer and good seeds. Your gut fertilizer is prebiotic fiber. Prebiotics and natural prebiotic fiber are a great addition to anyone’s diet. Some examples of good prebiotic fiber food: onions, asparagus, Jerusalem artichokes and un-ripe bananas. Unless you are making your own A2-milk kefir or yogurt, it’s a good idea to take a sporulating probiotic daily. Other products are required for specific symptoms or issues and will be discussed in conjunction with their specific issue.

Bloating due to Leaky Gut

This extremely common condition is often caused by anti-inflammatory medications, antibiotics, stress (discussed later on in this article) or just “bad American food.” None of these things differentiate between “good” and “bad” bacteria when they are killing off organisms in your gut. Healing a leaky gut isn’t that hard. If you have one, you are likely not just uncomfortable, but you’re a set-up for autoimmune disease.

Getting you into remission from any autoimmune disease starts with fixing your leaky gut. Changing your diet to my A.I.P. diet plan is the first step in healing your gut and reducing your auto-antibody production. As you heal your gut over two months, your (probable) food sensitivities and, therefore, your bloating will diminish. If it doesn’t, it often means you have SIBO, which is not uncommon in those with leaky gut. We’ll discuss that in an upcoming section.

Solution: Use (under medical care) proper gut-healing peptides and (if needed), supplements for leaky gut such as l-glutamine and collagen powder. Vitamin D levels need to be normalized, and sporulating probiotics with their “fertilizer”-prebiotics, should be added when the symptoms start to subside. More about re-balancing your microbiome (the prebiotics and probiotics)  coming up next.

Bloating due to a disordered microbiome

An imbalance in our microbiome is called dysbiosis. Dysbiosis an be caused by seemingly innocuous things from using too much mouthwash to stress to the use of hand sanitizers and consumption of OTC medications. When we carry around more pathogenic bacteria than we should, and also lack the proper diversity and number of protective bacteria we need, the microbiome is unbalanced, unhealthy, and will not serve our bodies well.

In the colon, there are trillions of healthy (and unhealthy) bacteria which compete for space. When the number of “bad bacteria” outweigh the “good bacteria”, the imbalance can lead to abdominal bloating and gas.

We obviously require a higher ratio of gut-friendly microbes to outnumber the harmful ones in order to stay symptom-free and optimally healthy. Unfortunately, due to multiples of bad habits, most people’s microbiomes are filled with billions of potentially dangerous bacteria, viruses, and other pathogens.

Solution: It’s all about the fertilizer and the seeds: the prebiotic fiber and the probiotics. First, a quick note about yogurt. The only healthy yogurt is made from A2 dairy, using live cultures. Even then, we all recommend that you avoid dairy-based yogurt until your gut heals. Therefore, at least initially, your probiotics should be from capsules so you’re in charge of the dosing.

If your gut microbiome is unbalanced with “bad bugs” in the majority, you need to use prebiotic fiber to feed a lot of good bacteria (and-if there is no mycotoxin illness- a little “good yeast”) to overtake the bad bacteria. You want to consume about  50 to 100 billion probiotic CFU’s per day. Some of the literature suggests that a mixture (in your main probiotic) of Bifidobacterium species and Lactobacillus species is necessary. Also, add in some friendly yeast called Saccharomyces boulardii. However, the latest research supports the use of sporulating probiotics for most conditions, especially for the treatment of Crohn’s disease and ulcerative colitis. No matter what we’re treating, there are strong suggestions that the sporulating probiotics will result in a more diverse (and therefore more healthy) microbiome. Here’s what to look for.

Find a probiotic that contains a few strains of the bacillus species, which are all delivered to the gut as spores which then encapsulate beneficial bacterial strains. Look for b. subtilis, b.coagulans and b.clausii, as they have been studied and documented as beneficial. If the amount of CFU’s found in one of these probiotics (rarely) gives you diarrhea, simply open and empty 1/2 of a capsule out before taking it.

Bloating Due To insufficient stomach acid

Although it seems totally counter-intuitive, reflux-or heartburn- is the result of insufficient stomach acid. It is indeed sometimes caused by the H. pylori bacterium, but a short course of antibiotics and proton-pump inhibitor medication (or the natural alternatives if you’re my patient) are indicated solely in these documented cases. The bloating for this one condition tends to be around or above the belly-button.

Here’s the problem with PPI medications like Nexxium or Prilosec. They were intended for short-term use but instead, are either prescribed or bought over-the-counter and used for years. When you do this, it alters your microbiome, suppresses your immune system and may even increase your risk of heart disease. As for your gut heath, it’s awful for that, too.

Note this is not how the PPI drug was intended to be used–ever! In the instances where people take over-the-counter PPI medications for their heartburn symptoms, the low stomach acid impedes the digestive process, making those individuals a total set-up for leaky gut!

Solution: To correctly treat run-of-the-mill heartburn, you need digestive enzymes containing pancreatic enzymes and bile acids. If that isn’t enough to quiet down your symptoms, add betaine (HCl) capsules; taken 15 minutes before meals. If your heartburn persists, you should be breath-tested for H. pylori.  If you still have bloating (especially below your belly-button), you have lower gut issues. You might have developed leaky gut and/or food sensitivities, for instance. It’s time to seek Functional integrative care.

Bloating due to gut motility issues

In cases of leaky gut, with or without SIBO, as the gut lining becomes destroyed, some segments of the small and large intestine will propulse “out of sync” causing intestinal cramping and, often, constipation; sometimes, diarrhea as well. This can be easily addressed, but before we jump to the solution, let re-visit the concept of fiber a bit.

I’ve mentioned the need for fiber above but honestly, aren’t most people aware that they need to eat adequate amounts of dietary fiber for optimal gut health? To review: fiber is a non-digestible carbohydrate which you can find mainly in plant foods such as fruits, vegetables, legumes and whole grains. In addition, fiber helps maintain a healthy microbiome and supports healthy bowel movements (via motility and bulk) to decrease the risk of diverticulosis and colon cancer. The recommended amount of fiber is a minimum of 25 grams per day for women and 38 grams per day for men. This doesn’t even include the prebiotic fiber or “fertilizer” we’ve discussed previously. And yes, if you cannot manage to eat your prebiotic fiber it’s just fine to take powder-fiber supplement mixes which contain things such as inulin, citrus pectin, prune powder, and psyllium husk.

So, if you are experiencing cramping, constipation and some diarrhea while your leaky gut (let’s say) is healing, here’s what you need to do.

Solution: In this case, we usually recommend products to either bulk up the stool (e.g.: modified citrus pectin), and/or a fiber blend as noted above. We can also improve GI transit at the smooth muscle level with 5-HTP supplementation if constipation is the primary issue. While we wait for the 5-HTP to “kick in” we use non-stimulant and osmotic products to draw water into the colon and relieve constipation: trifala and magnesium hydroxide.

Bloating due to hypothyroidism 

Since gut motility decreases when someone is hypothyroid, due to sluggish, slower or weaker smooth muscle gut contractions, constipation is a common symptom of Grave’s and Hashimoto’s disease. The resulting constipation, due to decreased gut motility is due to a decrease in FreeT3 which acts directly on the gut’s smooth muscle layer. This decrease in Free T3 can be due to T4 to T3 conversion issues but is often due to an unchecked increase in rT3 which is clogging up T3 receptors, rendering a patient “effectively” hypothyroid. This occurs quite often when someone has developed constipation which leads to leaky gut and then leads to SIBO-something we’ll discuss in the next section. It’s estimated that a minimum of 50% of those with Hashimoto’s thyroiditis have untreated SIBO. SIBO symptoms are often confused with those of other GI disorders and will be reviewed thoroughly in the next topic. Meanwhile….

Solution: Make sure you have all of the right thyroid hormones and auto-antibodies checked, including a reverse T3. Correct the hypothyroid state, and augment gut motility (methods above) as needed. Check for, and treat SIBO as discussed below.

Bloating due to SIBO 

SIBO (small intestinal bacterial overgrowth) is an increased number and/or abnormal type of bacteria growing in the small intestine section called the jejunum, a part of the bowel that is supposed to be sterile. For years, a culture of the small bowel was the way we diagnosed SIBO based on the presence of ≥1 × 10⁵ bacteria (colony-forming units (CFU)) per cubic centimeter of jejunal aspiration. However, this definition is now under a great deal of scrutiny, and current thinking is that “normal” rarely exceeds 1 × 10³cfu/ml. Furthermore, the idea that someone needs to see a Gastroenterologist and have a procedure called an endoscopy is rapidly falling out of favor in Functional medicine.

SIBO It is associated with anything that disrupts intestinal mucous, the microbiome and happens to be a quite common, undiagnosed cause of chronic constipation. It is a frequent result of chemotherapy, is (naturally) associated with leaky gut and with mycotoxin illness. As just mentioned above, it’s quite common in people who are hypothyroid.

The most common symptoms of SIBO are bloating and flatulence; particularly right after eating. Other symptoms include abdominal discomfort, constipation with interspersed bouts of diarrhea. It can be labelled as irritable bowel disease due to the alternating diarrhea and constipation.  Multiple food intolerances are relatively common.

Solution: Diagnosis. First- get the right diagnosis!  As mentioned above, the endoscopic procedure of bacterial sampling and quantification has fallen out of favor due to the variability of data regarding diagnostic parameters, patient discomfort, and inherent procedure risk. Breath tests are now routinely used as an alternative to direct aspiration because they are noninvasive and considerably less expensive. The most commonly used breath test is the hydrogen breath test.

The lactulose hydrogen breath test (LHBT) is the most widely used hydrogen breath test.  After the oral administration of 10 grams of lactulose, we take breath samples at 15-minute intervals for 3 hours. There is a catch: there are a huge number of false negatives- up to 60%!  Because breath tests are not very sensitive or specific, many Functional doctors will treat a patient if they exhibit symptoms and have underlying reasons for them.

Treatment includes antibiotics that are not absorbed by the gut (specifically Rifaximin) or with natural (herbal) substances. Herbal therapies are at least as effective as rifaximin for resolution of SIBO in head-to-head clinical trials. Herbals also appear to be as effective as triple antibiotic therapy for SIBO therapy for rifaximin non-responders. Some effective herbals (which should be given under medical supervision) include berberine, oregano oil,  barberry, garlic, olive leaf extract, goldenseal, wormwood, Oregon grape, garlic, caprylic acid and pau d’arco.

As a last comment, in addition to the sporulating probiotics, often your bloating and gas will respond almost immediately to 10 billion units of L. plantarium daily.

Bloating due to yeast overgrowth-SIFO

Yeast overgrowth often occurs at the same time as SIBO. It occurs in the same scenarios as described for SIBO, and especially for those in moldy homes.

Solution: If you’re living in a toxic home, that needs to be cleaned up, or the SIFO just won’t get better. It is also very important that you exclude all sugars from your diet as this is what feeds the yeast. The medication nystatin is used by some doctors to kill intestinal yeast infections. Natural yeast-killers include oregano oil, olive leaf and caprylic acid.

Bloating due to Carbohydrate Intolerance

Lactose, fructose, and other carbohydrates intolerance means that you cannot digest certain carbohydrates due to a lack of one or more intestinal enzymes. Symptoms include diarrhea, bloating with abdominal distention, and flatulence. The most common carbohydrate intolerance is lactose intolerance. This occurs when the enzyme that is required to digest lactose (the sugar found in milk and various dairy products) is not readily produced in the body, leading to symptoms as minimal as mild cramping or as much as just described.

Solution: For lactose intolerance, the diagnosis is “clinical”-meaning-take away dairy products and the symptoms cease. For other hard-to-pin-down carbohydrate intolerances, a more accurate version of the hydrogen breath test is used. Treatment is simply-removal of the causative disaccharide from the diet. Or in the case of lactose intolerance, consumption of less-lactose-containing A2 dairy products in combination with the enzyme lactase, taken with the A2 dairy meals can be quite effective.

Bloating Due To Food Sensitivities

Food sensitivities are not the same thing as food allergies. If you have an IgE-mediated food allergy, you have an immediate and quite unpleasant reaction such as a rash or hives and/or throat tightening. We’re not discussing these issues, due to, for example: peanuts.

The foods which cause most food sensitivities are (in this approximate order) gluten, dairy, eggs, corn, soy, shellfish, peanuts, citrus, lectins (namely beans) and nightshade vegetables (tomatoes, eggplant, white potatoes and peppers.) Food sensitivities most often develop in conjunction with other issues such as leaky gut, SIBO, chronic constipation, mold exposure and so on. If you are indeed sensitive, eating any of these foods can contribute to inflammation and even autoimmune responses such as skin rashes, migraine headaches, weakened immunity and even worsen or trigger the onset of autoimmune diseases.

Let’s discuss a few important specifics. Sometimes GI symptoms are caused by mild  gluten sensitivity. This probably has to do with the fact that almost all U.S. wheat is GMO and is added to many products as a thickener. Estimates show that a minimum of 30% of the U.S. population has some variant of gluten sensitivity. Try removing it from your diet-if it’s the problem, your symptoms will resolve.

A last word about beans. We joke about flatulence being caused by beans. This is simply a matter of your digestive enzymes being overwhelmed or a true sensitivity to the lectins in the beans. An example of a high-lectin bean is the kidney bean, with lentils being fairly low in lectins.

Note there are sophisticated tests (Doctor’s Data labs, etc.) that can detect specific food sensitivities if you have eliminated the “frequent offenders,” fixed your gut, and other issues to be discussed below. However, most people find that removing the above foods and then slowly reintroducing them will pinpoint the foods you need to avoid. This doesn’t account for FODMAPS foods (to be discussed).

Solution: The vast majority of people find that their food sensitivities start reversing in concert with the reversal of their GI symptoms. You can try doing an Elimination and re-intro diet if you still have food intolerances. If you’d like more specific data, the lab “Doctor’s Data” does the most accurate food sensitivity blood testing. I have not found that Cyrex labs (who seem to be popular with the public- perhaps due to social media advertising) to be all that predictive.

Bloating due to Inflammatory Bowel Disease

If you have an inflammatory bowel disorder, you started out with a leaky gut, didn’t have treatment and it then produced more symptoms and finally evolved into Crohn’s disease or Ulcerative colitis. Leaky gut can indeed be asymptomatic, and you might shrug off some post-meal bloating as due to something you ate. Inflammatory bowel disease symptoms such as explosive diarrhea or rectal bleeding can come, seemingly, out of nowhere. To get the plethora of symptoms under control, and your disease in remission is not only possible, but something that we Functional doctors who “treat a lot of guts”- do all the time. When I discuss solutions, for this topic, getting into remission is not something you can do “on your own.”

Solution: You’ll need to start out with a strict AIP diet and make sure there are no environmental factors (e.g. mold) contributing to your problem. Next, you need your leaky gut healed, and if you’ve had bloating and constipation, SIBO and SIFO will need to be evaluated and addressed. We now use peptides and LDN to treat IBD, so find a good Functional doctor who can do this for you. You’ll need good prebiotic fiber with sporulating probiotics. It might even be a good idea to suppress TNF-alpha and IL-6 with supplements. Some patient also benefit from a low-FODMAP diet: please refer to the IBS section below for more details on this.

Bloating due to Celiac disease

If you feel that gluten is causing severe symptoms such as cramping, bloating and explosive diarrhea, you might have Celiac disease, which is not the same as gluten intolerance. Individuals with Celiac disease are considered to have an autoimmune disease, with detectable antibodies on lab testing.

Solution: Blood testing for Celiac disease and then elimination of all gluten from the diet. The website Celiac-dot-com is quite helpful.

Bloating due to Weight loss or gain

Rapid weight loss or (much more commonly) weight gain are associated with abdominal bloating. How common is this?  In one study, recent “COVID weight gain” occurred coincidentally with new onset bloating in 25% of the study participants. Why? A possible mechanism may involve an abnormal feedback mechanism from the abdominal adipose tissue which helps modulate the brain–gut axis.

Solution: You probably know that I’m going to recommend that you slowly achieve your ideal weight and try to “stay there.” If you have cravings or binges, a little tweaking of your brain chemicals is done with intra-nasal peptides or integratives which are precursors to “happy brain chemicals.”

Bloating due to Irritable Bowel Syndrome

IBS (Irritable bowel syndrome) affects 7–15% of the U.S. population. Many people with a diagnosis of Irritable bowel syndrome have a treatable disorder. For instance, diarrheal-type IBS is often a problem called bile-acid malabsorption (BAM). Leaky gut, as you’ve read, causes bloating, constipation and diarrhea; often similar to IBS. You might have a chronic parasite infection if you are a world traveler or live near and recreate in a fresh-water lake.

Constipation-dominant IBS is quite often undiagnosed SIBO. In fact, some studies show that up to 80% of those diagnosed with IBS have SIBO!

Solution: If you do indeed have IBS, the #1 currently effective treatment is a low-FODMAP diet. Eliminating high-FODMAPS from your diet will help with symptoms; specifically bloating. The FODMAPS acronym stands for Fermentable Oligo, Di- and Monosaccharides and Polyols sensitivity. Foods containing glucose, fructose, polyols, and lactose can all cause symptoms for everyone with IBS and some people with IBD.

The mechanism of action of low-FODMAP diets is probably a reduction in small intestinal absorption of osmotically active polyols, resulting in diminished intestinal water content and beneficial effects on colonic fermentation and subsequent gas production. Other treatments include stool bulking agents such as modified citrus pectin, good prebiotics and probiotics, and if needed; anti-spasmodic medications. A few clinical trials show some benefit from biofeedback and even meditation.

Bloating due to Constipation and Outflow Obstruction

Functional (meaning perceived with nothing in particular being diagnosed) abdominal bloating and distension may be related to constipation and to functional outflow obstruction. Now, this being said, I’ll bet you that most cases of “functional” constipation are just cases of diagnoses not being made. At any rate, retained stool in the rectum can cause impaired gas evacuation and slowing of intestinal transit.

Solution:

Yes, there have been positive clinical trials with drugs for constipation-type IBS, but since I don’t like the drugs one bit, I’m not going to name them. What I always go back to is “what is the root cause” of the slow transit. Let’s talk more about serotonin than we did in the gut motility section. Serotonin is the happy brain chemical that you probably think is made in the brain. However, in both men and women, about 90% is made in the GI tract!

When your GI tract is not making enough serotonin, not only are you anxious and a little depressed, you have less GI motility and therefore constipation. You can have low GI motility due to a lack of serotonin, be constipated and not feel depressed or anxious as a FYI. Slowly adding some 5-HTP to your evening supplements will increase your gut motility, as mentioned previously. And you can also add trifala and magnesium hydroxide if needed, too. Please don’t get into the habit of taking stimulant laxatives, as this can cause permanent neurological damage to the propulsion in your gut.

Bloating Due to Hormone Imbalance 

Bloating is a common sign of low progesterone. During the luteal phase of your menstrual cycle (after ovulation), both water and sodium retention increase with low levels of progesterone and high levels of estrogen. This occurs because the estrogen lowers the “osmotic threshold” for which water being reabsorbed in the body. When estrogen levels are high, this threshold is lowered and therefore less water is excreted through urine. This then causes the body to retain water and creates the sensation of bloating. Since this type of bloating, unlike “GI bloating” is indeed due to fluid retention, it’s different but often perceived as the same thing.

Low progesterone symptoms include the sensation of lower abdominal bloating. The bloating symptoms are usually accompanied by other low-progesterone (cyclical)  symptoms such as irritability, sleep disruption and a little brain fog. If you have low progesterone due to perimenopause or early menopausal symptoms, your symptoms are less cyclic and you might, then blame your GI tract. Be on the lookout for this mistake.

Since progesterone helps gut motility via serotonin increases, low levels will generally cause some constipation. Men can also suffer from low progesterone symptoms, in addition to low testosterone issues, by the way.

Can chronic low progesterone lead to SIBO? Or leaky gut? Interesting questions which haven’t been studied but I would say a definitive “yes.”

Solution: Treatment is simple. Bioidentical hormone replacement with progesterone will clear up the bloating and constipation. Sometimes a little 5HTP is needed as well. A temporary measure is to use pregnenolone (non-prescription) which partially breaks down to progesterone. Progesterone creams sold over-the-counter are absolutely ineffective.

Bloating Due to Chronic Stress

If you  “feel stressed” a good part of your workday, chances are good that you have a high fasting cortisol level. High cortisol levels can easily cause the breakdown of your GI lining. It slows down both GI motility and the entire process of digestion. As a result, some people experience “heartburn” while others have no symptoms whatsoever. Blood flow subsequently decreases to all of the digestive organs. This then adds insult to injury and results in a higher concentration of toxic metabolites which then whittle away at your gut lining. You can see that if the cortisol alone doesn’t give you leaky gut, the entire shutdown sure will. And if this isn’t enough, there’s actually more to this story. Simply being stressed out can lead to leaky gut, then to constipation, then to SIBO and food sensitivities.

Solution: Stress-management techniques are a must but it’s hard to find the time to do them if you’re already over-worked and over-stressed, right? If you can’t find the time for yoga, meditation or deep breathing exercises, try intermittent parasympathetic activation via your vocal cords. Do this by gargling salt water or even singing. You can get your cortisol down with adrenal adaptogens, as well. Do this not just for your gut, but for your brain, and arteries and more!

Final thoughts

If you have a little bloating once in a while, you can probably clean up your diet and your microbiome and maybe even identify an offending food or two, and voila, you’ll be fine. If you have been “abusing your gut” with processed foods, toxins, pharmaceuticals or stress, you’ll need functional medical help to get it all repaired and get rid of not just your bloating, but your other GI symptoms. GI symptoms are painful and bothersome. Don’t put up with them, now that you have some answers.

Mitochondria are the key to energy and health

Mitochondria are involved in many vital processes in human cells, including energy production, fatty-acid oxidation and the Tricarboxylic Acid (TCA) cycle, calcium signaling, , apoptosis (cellular death) and heat production. However to simplify things lets talk about energy and longevity which is what their function translates to for practical purposes. And to help this occur, we can review the health practices, along with the best supplements to improve mitochondrial function.

• Why do we want well-functioning mitochondria?
• What happens when mitochondria malfunction?
• What about mitochondrial function and aging in general?
• Mitochondria boosting health practices
• Mitochondrial specific exercise
• CoQ10
• Alpha lipoic acid
•  PQQ
• L-carnitine
• D-ribose
• Phospholipids
• NAD
• Miscellaneous supplements
• Final words

Mitochondria: Why do we care?

First, let’s discuss the “energy part.” Mitochondria  produce Adenosine Triphosphate (ATP). In the cell, the energy in the form of ATP is produced in two ways: in the cytosol as a product of glycolysis, and in the mitochondria as a product of oxidative phosphorylation. The substrates, in the form of fatty acids and pyruvate, are oxidized via fatty acid β-oxidation and the TCA cycle respectively. The Nicotinamide Adenine Dinucleotide (NADH) and flavin adenine dinucleotide (FADH₂) produced by these reactions are used by the electron transport chain to generate ATP. Just remember from this complex discussion of energy production that you need ATP and you need NAD+/NADH to make that ATP so you feel as if you have enough energy.

Proper mitochondrial functioning is crucial for every enucleated cell in a body. A number of diseases are characterized by dysfunction of muscular or neural systems or metabolic reactions. All these diseases and pathophysiological conditions are developed against a specific genetic background, together with environmental factors.

Mitochondria produce energy as ATP (adenosine triphosphate) which your body then uses to fuel your daily activities. Some cells have more mitochondria than others. Your brain, muscles and heart cells are full of mitochondria. Putting diseases and aging to the side: you want your mitochondria working at full strength to keep your energy levels up, your brain sharp and your muscles and heart at their peak performance. The creation of new mitochondria (mitochondrial biogenesis) is needed for optimal aging which we now call our health span. Not to be repetitive but always remember, this is mandatory to keep your energy levels at peak. It’s also a part of what’s needed to protect you from oxidative stress. As you would predict, mitochondrial dysfunction tanks your energy and contributes to numerous physical ailments.

Mitochondrial Dysfunction and Disease

Mitochondrial dysfunction, characterized by a loss of efficiency in the synthesis of ATP, is a characteristic of aging, and essentially, of all chronic diseases. Loss of function in mitochondria can result in the excess fatigue and even other symptoms in just about every chronic disease you can imagine.  These conditions include neuro-degenerative diseases, such as Alzheimer’s disease and Parkinson’s disease and Amyotrophic Lateral Sclerosis.

Metabolic syndrome, heart disease, and diabetes are all associated with mitochondrial dysfunction. Metabolic syndrome is a group of conditions which combine hypertension, hyperglycemia, abdominal obesity and abnormal cholesterol or triglyceride levels. Metabolic syndrome greatly increases the risk of cardiovascular disease, stroke and Type two diabetes. There are numerous reports mentioning mitochondrial dysfunction and lower oxidative capacity in patients with Type two diabetes compared with healthy individuals.

The cardiovascular system strongly depends on mitochondrial function. Cardiomyocytes (heart cells) have very high mitochondrial content in order to produce the necessary ATP, and mitochondrial dysfunction inevitably leads to the development of cardiovascular diseases.

There is now increasing evidence of mitochondrial dysfunction in Alzheimer’s Disease, Parkinson’s Disease, Huntington’s disease, and Amyotrophic lateral sclerosis. Even some psychiatric conditions, such as autism spectrum disorders, schizophrenia, and bipolar mood disorders are included.

In addition, mitochondrial dysfunction plays a significant role in the inflammatory response in acute human pathologies. Systemic Inflammatory Response Syndrome (SIRS) is a pathological state with a systemic immune reaction to severe damage, including ischemia, acute pancreatitis, trauma and sepsis.

Autoimmune diseases such as rheumatoid arthritis, Crohn’s disease and systemic lupus erythematosus all are characterized by mitochondrial failure. Of course, truly fatiguing illnesses, such as CIRS (mycotoxin and mold illness and Chronic Lyme), Chronic fatigue syndrome, Fibromyalgia, and Gulf War Syndrome have mitochondrial near-failure as a prominent component. Lastly, as you might predict, cancer and chronic infections round out the list of disorders. If you have any one of these disorders, you will need to  improve your mitochondrial health and function in order to recover.

Mitochondria and Aging

A number of age-related processes (e.g. “normal aging of the brain”) are associated with mitochondrial dysfunction, so most of the popular aging theories take this into account. The mitochondrial theory of aging posits that the accumulation of damage to mitochondria DNA promotes the  process of cellular aging of both humans and animals. The theory claims that there is a  vicious cycle involving the accumulation of damage in mitochondrial DNA which then leads to more oxidative damage due to defects in the mitochondrial respiratory chain. Let’s say that this theory is true. What then can we do to save our precious mitochondria and therefore slow the aging in our cells and help prevent diseases?

Mitochondrial health practices

Eating an anti-inflammatory diet is one of the easiest ways to improve mitochondrial function. Polyphenol-rich foods such as blueberries, red and purple foods (e.g. raspberries and purple cabbage) and many fresh green foods are high in healthy mitochondrial-boosting polyphenols. Using intermittent fasting methods such as timed eating and intermittently “going keto” are also mitochondrial boosters.

Heat shock proteins produced by extreme cold or extreme heat are great for your mitochondria. Cold exposure is an easy way to give your mitochondria a boost. Studies have demonstrated benefits with “ice jackets”, facial submersion, and ice baths. Even cryotherapy tanks! And “ice swimming.”  Based on what I personally find tolerable and affordable, you can get enough of a boost by doing the following. At the end of your daily hot shower, just turn the temperature to cold for 30 seconds. It is mostly quite invigorating!

Far-infrared saunas are another way to generate heat shock proteins.  A FIR is a great investment in your health, as it is also a great way to do a bit of a detox.

Meditation and yoga also boost your mitochondrial output.

Ten minutes of direct sunlight is great for a burst of mitochondrial activity. Conversely, most data suggests that fluorescent lighting puts a damper on ATP production and mitochondrial biogenesis. The data is rather murky when it comes to EMF’s, blue-blocking glasses and so on, but it’s something to watch, as there seems to be some correlation between better health and less high-level EMF exposure, as well as less blue light exposure.

Exercising For Mitochondrial Health

Many types of exercise are mitochondria-healthy. Walking is great. Running is great. Weight training is great. Yet, the very best type of exercise for your mitochondria is high-intensity interval training. This doesn’t need to be complicated, but do get medical clearance if this is a new activity for you. Do you know how to do a burpee? Do burpees until you’re short of breath. Then catch your breath and do it again. Repeat this a total of 6 times if you can, less if you can’t.

You can do HIIT outside, too of course. If you have access to a track, great! If not, use a treadmill if you’re inside or run in your neighborhood if you’re outside. Sprint one lap. Or a half of a lap. Whatever gets you short of breath. Then, walk until you catch your breath and you can even lie down on your back for faster autonomic neurological adaptation for up to 90 seconds if you need that long to catch your breath. I do this in our lap pool and it’s far more fun than simply “swimming laps” to me.

Now, lets discuss the best supplements to improve mitochondrial function.

The best supplements to improve mitochondrial function

I see people perk right up within (literally) 24 hours of proper mitochondrial supplementation. If someone has a chronic and/or fatiguing illness or are just suffering from age-related mitochondrial failure, supplementation absolutely works. It sure beats energy drinks which end up causing adrenal issues and potentiating energy problems.

Here are the mitochondrial supplements that have been studied and proven effective.

Co-Q 10

CoQ10 is an essential electron carrier in the mitochondrial respiratory chain. In other (more complex) words, CoQ10 passes electrons between NADH-ubiquinone oxidoreductase,  succinate-ubiquinone oxidoreductase or succinate-cytochrome C oxidoreductase. You can now just forget you read that and rub your eyes. Basically, CoQ10 can be found in both oxidized (ubiquinone) and reduced (ubiquinol) forms, and the conversion between these oxidized and reduced states allows it to act as a cofactor of enzymatic reactions via the transfer of electrons.

CoQ₁₀ is a critical part of the mitochondrial oxidative phosphorylation system. Over ten well done studies show that supplementation with this vitamin-like antioxidant compound in individuals with reduced CoQ₁₀ levels results in increased energy production and reduced fatigue. The most dramatic results are in in those individuals with degenerative diseases. Here are some examples.

In studies using Alzheimer’s disease models, CoQ₁₀ administration significantly delays brain atrophy and characteristic β-amyloid plaquing. In a 4 month clinical study on around 100 Alzheimer’s patients who took an oral mixture of vitamins E, C, CoQ₁₀, and α-lipoic acid, the group receiving supplementation showed significant reductions in oxidative stress markers and subsequent DNA damage.

Individuals with Parkinson’s disease tend to show increased levels of oxidized (and by definition: damaged) CoQ_10.  They also have significant increases in markers of oxidative stress and damage in their brains, which is partially reversible with CoQ₁₀ administration.

One last important clinical note: recall that the heart is filled with mitochondria which are partially powered by CoQ_10. If you are taking a statin drugs, please be aware that they deplete your body of CoQ10, so supplementation is a must.

Alpha-lipoic acid

ALA is a potent fat and water soluble antioxidant vitamin. It is also a metal chelator (helping to remove iron, copper, mercury and other heavy metals). It is also a fairly decent anti-inflammatory supplement. Clinically, α-lipoic acid has been used mostly to help treat complications associated with diabetes such as neuropathies and vascular (blood vessel)  complications. It also improves cognitive (brain) and mitochondrial function, adding to the evidence linking oxidative damage to mitochondria and cognition. The use of α-lipoic acid for chronic fatigue syndrome (CFIDS) has not yet been studied in controlled clinical trials. However, it is widely used in “fatigue regimens” (200-600 mg) as a way to both support mitochondrial function and reduce oxidative stress.

Despite its various potentials, the therapeutic efficacy of ALA is reduced due to its “pharmacokinetic profile”. Data shows that ALA has a short half-life and bioavailability (only about 30%) due to degradation in the liver and chemical instability in the stomach. The R isomer of ALA (R-lipoic acid) shows better pharmacokinetic parameters, including increased bioavailability as compared to the S isomer, ALA. Translated: just use R lipoic acid or a double dose of alpha lipoic acid for approximately the same results.

PQQ

Pyrroloquinoline quinone (PQQ) is  contained in fruits and vegetables such as kiwi fruit and green peppers. It has received a lot of research attention in the past several years. PQQ can reduce reactive oxygen species (ROS) levels and improve apoptosis (death) of tumor cells. PQQ protects tissues by regulating the redox (electron transfer) reaction. Moreover, PQQ protects overall tissue function by improving the mitochondrial function of the liver, neurons and other important tissues. It can also reduce atrophy in mouse skeletal muscles.

PQQ decreases oxidative stress (production of ROS) and inflammation which, by definition will protect mitochondria. It also increases mitochondrial biogenesis which is the formation of new, young-acting mitochondria. It is neuroprotective, too. Here’s how. Recall that you have read about GABA versus glutamate or inhibitory (relaxing) versus excitatory (too stimulating) neurotransmitter activity. We want more GABA than glutamate, plain and simple. Too much glutamate damages brain cells. PQQ protects neurons by preventing the long-term over-activation of the glutamate (NMDA) receptors, which results in toxic excitotoxicity of neurons. This over-stimulation of brain cells is associated with many neurodegenerative diseases and seizure disorders.

Recall again that you have the largest concentration of mitochondria in your brain, heart and skeletal muscles. The brain “wins” pound for pound by a little edge, which is why you feel tired after using your brain all day. With this in mind, remember that when we protect the brain, we’re protecting brain mitochondria. PQQ protects the brain (to a certain extent) against neurotoxicity induced by mercury and other potent toxins such as mold mycotoxins. Lastly, it too helps to prevent the accumulation of amyloid tau and beta proteins associated with Parkinson’s and Alzheimer’s diseases.

Acetyl-l-carnitine 

Acetyl-l-carnitine is a naturally occurring fatty acid transporting amino acid. L-carnitine supplementation has long been studied and then used in many mitochondrial dysfunction disorders. These disorders are also characterized by low concentrations of serum l-carnitine levels such as heart disease, diabetes, kidney disease and overwhelming infections.

An important cellular longevity function of l-carnitine has been to increase the rate of mitochondrial oxidative phosphorylation (ATP production) that declines with age. A  study where old rats were fed acetyl-l-carnitine resulted in the reversal of age-related decreases in l-carnitine levels, an increase in fatty acid metabolism, and an increase in mitochondrial activity. Acetyl-l-carnitine also reverses the age-related decline in muscle mitochondria.

Clinical studies show that L-carnitine supplementation may also be useful in alleviating fatigue symptoms in hypothyroid patients, especially in those younger than 50 years and those who have hypothyroidism after thyroidectomy for thyroid cancer. Note: L-carnitine is the nomenclature used for many clinical studies, but due to l-carnitine’s ability to increase TMAO, experts suggest that all human supplementation be done with acetyl-l-carnitine.

D-ribose

We know that D-ribose has documented positive mitochondrial effects for those who are genetically d-ribose deficient. It’s a popular bodybuilding supplement which “hardcore” bodybuilders credit as being helpful with their with muscular fatigue. Studies have looked at neurodegenerative diseases such as Multiple Sclerosis and ALS with promising results. Due to these studies, I decided to use it in a protocol on a dog named Charlie. Charlie is a very beloved and smart standard poodle, belonging to a favorite patient of mine. The patient (another M.D.) contacted me, quite distraught that his dog had received the diagnosis of degenerative myelopathy or “doggie ALS” as I  found upon doing some research. Charlie, it seemed, couldn’t get himself up off the floor. The same mitochondrial problem has been identified in both dogs and humans. So, I got to work on Charlie’s protocol.

I calculated doses of supplements based on Charlie’s 48-pound weight. I recommended a mitochondria-boosting ketogenic diet. Then I added ALA, ALC, CoQ₁₀, PQQ, and NAD (discussed below) as well as some d-ribose powder. I had my patient add some antioxidant powder to Charlie’s food, too. “Why not”, I thought. My patient said that 24 hours after Charlie started his regimen he was noticeably stronger, up and walking and even playing! The patient’s Veterinarian was astounded and has gone on to use my protocol on other dogs. Now, let’s give an honorable mention to another concoction.

Phospholipids

Mixtures of probiotic, phospholipid, and antioxidant preparations have shown some clinical promise in fatiguing illness. This mixture is made using antioxidant powders, probiotics and phosphatidylserine. The bulk of the studies have been with patients who have fibromyalgia and/or chronic fatigue syndrome (CFIDS).

NAD

NAD is now the big news, thanks largely to the research by Dr. David Sinclair and his best-selling book, “Lifespan.” Recall the mentions throughout this article about the  conversion of NAD+ to NADH, and vice versa, as essential reactions in creating ATP. Recall that ATP is cranked out by mitochondria, and give cells (and you) energy. Therefore NAD and it’s substrates are crucial for cellular energy, mitochondrial biogenesis and it turns out; cellular longevity. All that remains to be seen, is proof positive that one “form” of NAD is superior to another. Here’s some of the data.

Oral NADH supplementation can reduce symptoms in patients with chronic fatigue. One study on patients with chronic fatigue syndrome treated participants with micro-encapsulated, oral NADH or a placebo for a month’s time. 8 of 26 study participants (about 1/3) responded positively with increased well-being and energy levels to the NADH compared with 2 of 26 (8%) in the placebo group.

This supplement also shows promise for neurodegenerative disorders such as Parkinson’s and Alzheimer’s  diseases. The increase in measured NADPH levels correlates with a marker for aging: an increase in telomere length.

NAD will stimulate the SIRT1 pathway which is notably dysfunctional in those with metabolic syndrome, diabetes and more. When you stimulate the SIRT1 pathway, you lower leptin levels, making it again possible to lose weight, improve blood sugar, cholesterol and triglyceride levels, and in fact, all aspects of metabolic syndrome.

Taken orally, NMN (nicotinamide mononucleotide) is rapidly absorbed and converted to NAD+. In numerous studies, supplementation with NMN increases NAD+ biosynthesis, suppresses age-related fatty tissue inflammation, enhances insulin secretion and it’s action, improves overall mitochondrial function, and in the brain, it improves mitochondrial as well as neuronal function. In animal studies, it extends lifespan. In fact, NMN given to mice does quite a bit. Before I discuss NMN, let me give a shoutout to nicotinamide riboside- also converted to NAD+. As well as NMN? We don’t know, and the research continues. Meanwhile, we have a lot of data from mice studies.

Orally administered NMN is rapidly converted to NAD+ in mice. NMN has been shown to enhance energy metabolism and physical activity, suppress age-associated weight gain, improve insulin sensitivity and even improve ocular function. It improves mitochondrial metabolism and prevents age-related negative changes in gene expression. In mice bred to be obese or diabetic, NMN improved both the action and secretion of insulin.

NMN also protects the mouse heart from ischemia and/or reperfusion injury. It restores skeletal muscle mass in aging mice. Of special interest to those of us who treat many patients with brain issues, it has been shown to slow cognitive decline in a mouse model of Alzheimer’s disease, by improving the survival of neurons, improving energy metabolism, and reducing oxidative stress. It may also help maintain the integrity of the blood brain barrier.

NMN also probably suppresses the increase in systemic inflammation associated with aging-based on the studies which show that it lowers adipose tissue inflammation associated with age. In fact, surprisingly enough, older mice appear to be more responsive to NMN, in comparison with younger mice.

Some studies appear to suggest an increase in blood vessel formation called angiogenesis with artificially increased NAD levels for prolonged periods of time. This is why, despite the fact that I use a lot of NMN and intra-nasal NAD in my clinical practice, I have patients take intermittent breaks from it, and will do so until more data is available on this phenomenon.

Additional supplements with much promise

Studies are increasingly showing that mitochondrial illnesses are fueled by oxidative stress; implicating the use of antioxidants such as natural vitamin E and NAC (the precursor to glutathione) as well as glutathione as additional treatment considerations. We know that the sirtuin pathways are boosted by resveratrol and ECGC-green tea extract; implying  mitochondrial benefit. Branched chain amino acids, vitamin D, and creatine are all pro-mitochondrial health supplements as well, despite being poorly studied for this particular issue. Finally, there is emerging data for mitochondrial health with berberine, magnesium threonate, selenium and even immune-boosting melatonin. B vitamins are likely involved as well. It appears that the more useful a supplement has been proven to be (vitamin D as a prime example), the less it is studied for other, more complete benefits.

Final words

In any good health regimen, you want to eat an anti-inflammatory diet and take a few supplements. It makes sense to take vitamin D and a high antioxidant power or supplement for many reasons, including mitochondrial health. At this juncture, if you are healthy, and have specific goals in mind, you might choose, let’s say, some acetyl-n-carnitine if you are lifting weights, or some PQQ if you have a family history of neurodegenerative disease. And currently, if you have metabolic syndrome, SIRT pathway issues or fatiguing illness, it seems prudent and helpful to take NMN and/or NAD intra-nasal spray. Yes, IV NAD is beneficial, but I am “not a fan” of this current craze of “drip bars” and feel that consumers are being, quite frankly, ripped off by this trend, when alternative routes of administration can be utilized.