Written by Christopher Kelly
Dec. 10, 2015
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Christopher: Hello and welcome to the Nourish Balance Thrive Podcast. My name is Christopher Kelly and today I'm joined by Dr. Robert Rountree. Hi, Robert.
Robert: Hi there.
Christopher: How should I address you? Do you prefer Dr. Rountree or is Robert or Bob okay?
Robert: I'm a Bob kind of guy. My patients call me Bob. I prefer the informality. I'm certainly willing to share my CV if people want to know if I'm credible but I would much rather have an informal discussion.
Christopher: I notice that you just won the 2015 Linus Pauling Award at the Institute for Functional Medicine, which I hold in great esteem. I know you're also the chief medical officer at Thorne. So why don't you tell us a bit about your background and your practice?
Robert: All right. I do wear a number of different hats and I have to say getting that Linus Pauling Award was quite a thrill. It was really acknowledgment for many, many years of hard work. I've been in clinical practice for about 35 years and I continue to be in clinical practice. I guess, you could call it family medicine but it's really much more progressive than that. I went to medical school in Chapel Hill, North Carolina and then I did a three-year family medicine residency in Hershey, Pennsylvania.
And right at the end of that time, I went and spent a week at the Omega Institute in Rhinebeck, New York and I studied with Dr. Jeffrey Bland and Dr. Sidney Baker and Leo Galland who were all the founders of functional medicine. So that was 30 plus years ago. Right out of my training, I got exposed to some of the great minds of our time and it really set me on a path that I've continued in my three-plus decades of clinical practice.
So I've done that. That's kind of been the basis of my work. But I've also been very interested in the nutraceutical industry for many, many years as an alternative to conventional drugs. I mean, I've prescribed my share of medications over the years and I think when it's appropriate to prescribe them I'm more than willing to do that. But I've also been intrigued by the reams of medical studies that have been done on using dietary supplements, on herbs and vitamins and other nutraceuticals. And so I've incorporated those into my clinical practice what you'd call an integrated practice for many, many years.
Christopher: That's brilliant. I wonder how long do you think it will be before we can drop the word functional?
Robert: Well, I think it's only just now coming into its own and, I think, there's an advantage to actually promoting its use more and more instead of getting away from it because if you look at what's happening in mainstream medicine especially with the advent of this new international classification of diseases, new to the United States anyway, there's more and more focus on the diagnosis. Here's the condition you have and then that's immediately linked up with a particular medication.
Christopher: Right, yes. So that's what I'm alluding to. I see that functional medicine is the way that medicine should be done and everyone else is kind of dysfunctional, therefore, how long before we get to a system where we can just drop using the word functional because that's the only type of medicine that there is?
Robert: Well, I wish I was optimistic that that's where the whole system would go. It may happen in other countries. We've been doing trainings in China for the last couple of years. We're going back to Guangzhou, China this December and the interactions we've had with some of the top leaders in medicine in the entire country of China had been very positive to the effect that some of these doctors we're saying we need to have China adopt functional medicine as the official form of medicine in China.
Christopher: Wow, that's incredible.
Robert: There's economic and political forces at work in the United States that would rather not have that happen. People make a lot of money off pharmaceuticals. And even though there's a lot of shortcomings of pharmaceuticals, why would we want to stop that cash cow?
Christopher: Well, today, we weren't actually going to talk about functional medicine even though I'd love to continue that conversation. But I wanted to talk about the mitochondria which I think is an extremely interesting topic. Maybe I can add some context here that will fill you in a bit, Bob. I work with two medical doctors and we do lots of tests on the athletes that we work with. We're calling this thing clinical coaching. So the goal is to run these lab tests with VO2 optimizing biochemistry to help athletes perform better and if we can help them feel better, think better, all of that other stuff, then that's fantastic.
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But really that's our main goal when we look at these test results is to improve performance. And we do a lot of blood chemistry, a lot of saliva, the four point hormone saliva testing and urinary organic acids and stool testing. So I have some background knowledge about mitochondrial function as it's seen on the organic acids test. And I can tell you that one thing I nearly always see with every single athlete is low cortisol.
And so we do this four point cortisol test and the cortisol is always low and people always think, "Oh well, that's my problem then. That's the issue." But the reason I'm telling you this is because I know that cortisol synthesis, it begins inside of the mitochondria of these cells inside of the adrenal glands. And so that if you care about the production of cortisol or estrogen or progesterone or testosterone then you care about the mitochondria, right?
In fact, that's true of anything. This is the way in which our cells produce energy. So it's in neuron and it's not producing sufficient energy you might have foggy thinking or poor memory. And if it's a muscle cell then maybe you would have weakness or something else going on. So do you think that's a fair sort of background? Can you think of anything else why people would want to care about mitochondria?
Robert: Yeah, I totally agree with your observation that for years if someone who was tired or not functioning optimally then we'd always automatically point to the adrenal glands. Well, you must have adrenal insufficiency or early adrenal failure. And I'm certainly guilty of that. I've certainly been in that camp for many years. But what I found over the years is that if I just treat people for adrenal insufficiency then often they don't get better. They don't see the kind of response that I'd like to see.
And that's partly what led me into studying mitochondria. I will tell you that the mitochondrial chemical pathways are the bane of every medical student. You start studying biochemistry and then they start showing you all these different pathways and you think, "Oh my god, I'll never get through this." So it's often seen by students as something to endure as opposed to something that is really core to all metabolic functioning.
Christopher: Yeah.
Robert: I think what's changed is that when I was in med school over three decades ago we thought that all that mitochondria did was make energy. All they did was make ATP. What we found in the last ten years is that mitochondria basically control how the cell functions. As you said, they modulate production of cortisol. They modulate iron production. In fact, any cell that's got an electrical charge on the membrane of the cell like a neuron or a gland that makes a hormone is going to have an electrical charge in the membrane and the mitochondria responsible for maintaining that electrical charge. So the mitochondria go out, all kinds of things begin to shut down inside of the cell.
Christopher: You're reminding me actually. I'm not a doctor. I've never done any formal medical training but I'm a computer scientist and I have an analytical mind and I like to geek out over stuff. I've been doing some training courses that cover a lot of biochemistry recently and my wife does have that background. She has a master's degree in food science and so she was forced to study all these biochemistry stuff. She says that I give her a kind of anxiety when she hears me watching these videos. It's like it brings lots of bad memories.
Robert: It brings bad memories because everyone just gets threatened by all the different steps and the pathways and thinking they have to memorize it. But the way I boil it down when I talk to people is to say you start with fats, carbohydrates and proteins and those are all based on carbon, right?
Christopher: Right.
Robert: You got various configurations of carbon molecules and all the process of digestion is about is breaking fats, carbohydrates and proteins down into two carbon units called acetyl-CoA or used to make acetyl-CoA in the mitochondria. And that's kind of the fundamental currency of the mitochondria. Once you've got that then that's the core of what you use to make ATP.
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So if you bypass all the details of all the different chemicals involved, it's really just that, breaking down food into two carbon units and then using those two carbon units to pull off electrons and move electrons around and that's what's used to make ATP.
Christopher: Yeah. And so this is some of the stuff that we can measure in the urinary organic acids, the citric acid cycle actually. I think you can think of it more of as a, rather than a cycle, as a traffic circle or a roundabout as we call it in the UK where certain amino acids can enter into the cycle and certain can leave. But the whole point of the traffic circle is to generate electron donors which then get moved around in the inner membrane to produce energy.
Robert: Just to give you an idea of like for your listeners, we have about 10 million, billion mitochondria in our body. It's about 10% of our body weight.
Christopher: Wow, I didn't know that. It's so hard to get your head around it.
Robert: If you weigh 200 pounds, you've got 20 pounds of mitochondria. And those mitochondria make your body-weighted ATP every day and they consume that much ATP every day. So if you weigh 200 pounds you make 200 pounds of ATP and then you consume 200 pounds of ATP. So we go through a lot of energy just to keep ourselves functioning, to keep our brain working, to keep our glands working and producing hormones, to keep our neurons firing. We need this constant source of energy. And I think that's important because if you stop eating of if you don't get proper fuel, then where does the body get the fuel from? Its own tissue.
Christopher: That's interesting to hear you say that because I've just been talking to somebody else that was talking about the benefits of fasting.
Robert: Well, I'm not a big fan of straight water fasting because eventually you will break down, you'll catabolize your own tissue. And the sad thing is that we tend to catabolize our protein tissue before our fat. So a lot of times what you do with especially prolonged fasting is you eat up your muscles. There's a limited amount of fasting. There's this process called autophagy where you will actually eat up dead cells and that could be produced by skipping breakfast, by going 12 hours a day without eating. That limited amount of fasting, I think is beneficial. It's just the prolonged fasting that's a problem.
Christopher: It's interesting to hear you say that. Very interesting. Maybe we should get back. I wanted to talk about the history of mitochondria? One of the things that blow my mind is that mitochondria have their own DNA so they synthesize some of the proteins that they use inside. So maybe I should ask you what a mitochondria is? What does it look like?
Robert: So they're little bitty sacks and they can have different shapes. They can be long tubes or big round spheres. In fact, the very name mitochondria refers to the fact that it can either be a thread, which is the mito, or it can look like a grain of rice which is the chondro. So when they first started looking at mitochondria in the microscope, they saw that they had all these different shapes and it was a bit confusing.
In a neuron, for example, the mitochondria has this long thread like appearance. But in a cell, like in a hard cell, where they're all crammed in together, they may be more like these grains. Basically they look like bacteria and that's because they are bacteria. They are bacteria. The prevailing theory is that roughly around two billion years ago you had these two different types of cell. You had bacteria and then amoeba like cells that ingested that bacteria and found that instead of gobbling those bacteria up they can hold on to them and enslave them then the two could work together.
And those bacteria that they enslave were the ones that were able to utilize oxygen. So this evolutionary step occurred right when oxygen was starting to increase in the environment. And so that leads into this whole notion of what's that DNA in the mitochondria doing? Most of the DNA is making proteins that are used to create enzymes that basically run a pump inside of the cell and that pump is the one that combines oxygen with these electrons to basically make water, to put out carbon dioxide and make ATP.
Christopher: And so is that ATP synthase you are talking about?
Robert: Yes. Yeah, which is basically like a big water wheel.
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Christopher: Right.
Robert: It's a water wheel. We're pumping up all these protons to the top of the water wheel and when we reach a certain level, then they spin down the water wheel and make it turn around and that when it's turning around, that's what allows it to stick phosphorous on to ABP and make ATP.
Christopher: Yeah. So this is -- I should probably post in the show notes for this episode. I should probably post this image that I'm looking at. But I think ATP synthase is a hugely complex protein and some of the proteins are synthesized by the mitochondrial DNA and some of them come from the nucleus of the cell in which the mitochondria is enclosed.
Robert: Yes.
Christopher: Which is just, again, it just blows my mind, the complexity of this. And then when you add the complexity of scale to that, like what you've just told me about how many of these things there are and how much of this is happening, it's just incredible.
Robert: Yes. It's pretty clear now that the nucleus of the cell has taken some of the DNA that used to belong to the mitochondria and held on to it. So the mitochondria really couldn't exist without the cell. They're totally dependent on the cell. And that gets into some very interesting observations about what it is that makes that interplay work better. For example, we know that there's a chemical found in red wine called resveratrol. Resveratrol actually helps that communication between mitochondria and the nucleus of the cell.
Christopher: So there's lots of studies that show benefit of supplementing with resveatrol. And do you think that's one of the cause of mechanism then?
Robert: Yes, I think that's one of the things that it does. I mean, the old simplistic way of looking at a lot of supplements was that they were antioxidants. And that makes sense because we know that just in the course of making energy the mitochondria create free radicals. They create free radicals made from oxygen and nitrogen. And those are very damaging molecules. And we also get exposed to free radicals from our environment, from automotive exhaust, from cigarette smoke, burning organic material, radiation, certain chemicals, heavy metals.
We're exposed to free radicals all the time. And those free radicals damage our tissue. And it makes sense that if free radicals are damaging our tissues then maybe using chemicals from food that neutralize free radicals would make us healthier. But it turns out that's not quite the case. It turns out that because we've evolved in this environment where there are a lot of free radicals around, that we've actually adapted to these free radicals. And small amounts of free radicals are good for you.
Well, how does this translate into athletes? If you give athletes, say, vitamin C or E or zinc, selenium, the standard antioxidants before they work out, those will neutralize any free radicals made by the exercise. But those antioxidants will also prevent you from getting more mitochondria from the exercise.
Christopher: Yeah. I'm so glad you brought that up. It's kind of really fun to have. Something we've already talked about independently validated -- I mean, I'm sure you've not heard the interview. One of the doctors I work with, Dr. Tommy Wood, is a Ph.D. fellow studying neonatal brain metabolism and we did a podcast on should athletes supplement with antioxidants or not. And that was the conclusion that Tommy came to. We have several good studies showing that you can blunt the effect of training by taking supplements before you do. So it doesn't make sense to try and shut down that oxidative stress. But, of course, like anything, you could have too much of a good thing, right? You don't want too much oxidative stress.
Robert: You don't want so much and that's -- So there's antioxidants and there's antioxidants. I mentioned earlier that I've been, I've worked with Thorne research as their chief medical officer and one of our sort of most interesting projects over the last five years that I've been with them has been to look at this group of chemicals found in plants that actually do lower oxidative stress but they're not antioxidants in the classic sense. For example, there's a chemical found in broccoli called sulforaphane. And sulforaphane actually acts on the body as a free radical. So it's a little bit of an irritant to the cell. And what that does is it forces the cell to make protective enzymes.
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And those protective enzymes come back and make the mitochondria work better. Resveratrol, as I said found in red wine, does the same thing. Curcumin found in turmeric does the same thing. Green tea does the same thing. So we're having to change our whole way of thinking about what these chemicals do. And now we call them secondary antioxidants in that they may not neutralize free radicals in the test tube but when you take them they actually stimulate this protective response called the general adaptive response pattern and that activates all these mechanisms that stimulate production of more mitochondria called mitochondrial biogenesis. And that's a really good thing.
So we're not throwing out all the antioxidants. We're just throwing out the old concept that the higher the dose of vitamin C the better, the higher the dose of vitamin E the better. Those supplements, those are fine to use but not necessarily in high doses.
Christopher: Right. Do you think Linus Pauling is going to take his award back now because of what you said about vitamin C?
Robert: I think if he knew some of the research that was coming out now, he wouldn't be saying it the same way he said it. I don't think you'd have to change his perspective that high doses of vitamin C were beneficial. I just think it's beneficial in a different way. For example, when you give vitamin C intravenously, it actually stimulates free radicals. It increases hydrogen peroxide production. And that helps kill all viruses and cancer. So vitamin C is still beneficial in those models but it's working in a very different way than we thought.
Christopher: Interesting. So I'm looking at this picture of the inner membrane. In fact, this is both membrane shown here of this mitochondria. It is especially important that the outer membrane isn't permeable. So this membrane is made by a phospholipd bilayer. And it would seem that a phospholipid might be a good target for a reactive oxygen species to just grab electrons to stabilize itself. And if that were to happen then this membrane, this mitochondria membrane were to become permeable, then the ATP synthase is useless. This mitochondria can no longer -- So that's why the oxidative stress is important.
Robert: And also the DNA in the mitochondria, they're not surrounded by proteins like the DNA in our nucleus. So the nucleus the DNA is protected by proteins called histones. The DNA inside this inner membrane of mitochondria, it's just a floating strand that has a little bit of protein but there's not much protection. So if you're making free radicals there, it can easily damage the DNA. And our DNA in our mitochondria are getting damaged all the time.
Christopher: Right.
Robert: Right, all the time. And so it's a matter of repairing. Our body knows how to do something with that. So as the mitochondria get damaged and stop working, the body just gets rid of them. And it's thought that with diseases like Parkinson's Disease, what happens is we can't get rid of them. Something goes wrong with the disposal system, the waste management department doesn't show up with their trucks to get rid of these mitochondria so they accumulate inside the cell and that's what's causing the problem.
And that's one of the theories behind why things like Coenzyme Q10 works so well to help slow down diseases like Parkinson's Disease or diabetes. I mean, you'd say, wait a minute. Isn't Parkinson's very different than diabetes? Both of them are mitochondrial disorders. And in many ways you treat them with the same kind of compounds. The sulforophane that I mentioned, which Thorne sells as a brand named called crucera, because it comes from cruciferous vegetables, that's useful for both Parkinson's disease and for diabetes. And I could say that because I'm a doctor.
Christopher: That's right. I can't say anything of that sort.
Robert: Yeah, you can't say anything but I can say it because I'm just telling you this is what I used in my patients.
Christopher: Wow, that's incredible. And then so what happens? So sometimes I see people with an elevation of pyroglutamate on their urinary organic acid which hints that they might be deficient in glycine and then, therefore, unable to produce as much glutathione as they should. Is that the sort of antioxidant that your body would produce more of in response to one of these so-called anti-oxidant?
Robert: The glutathione, you mean?
Christopher: Yes, exactly.
Robert: Interestingly, the sulforaphane that I mentioned stimulates the pathways that produce glutathione.
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Christopher: Okay. And I'm just wondering whether--
Robert: Glutathione is really a very useful antioxidant. And if you can activate your body to make more glutathione then you've got the problem solved right there. I also use nutraceuticals that increase glutathione like n-acetylcysteine I think is great. Terrific stuff. But taking milk thistle, for example, that will raise glutathione. Taking curcumin, that will raise glutathione. Taking sulforophane will raise glutathione. Yeah, that's a pretty good strategy for all of these chronic conditions where you've got mitochondrial damage like Parkinson's, Alzheimer's, metabolic syndrome, diabetes or even just chronic fatigue or under functioning.
Christopher: And then do you think -- So I'm a real advocate of the Paleo diet and just nutrient density in general and I sometimes think that most of the gains that I get for the athletes that I work with come from diet and lifestyle changes rather than supplements. But do you think -- So any of the compounds you talked about, do you think it's possible -- So cruciferous vegetable is an obvious example and maybe turmeric for the curcumin. Do you think it's possible to get the doses that are required for the beneficial effect just from food alone?
Robert: Actually, I think it's difficult. I heard Dr. Andrew Wild once say in a lecture that he just tells people to eat a tablespoon of turmeric every day. And I think, well, that's a brave soul that can eat a tablespoon of straight turmeric. It's quite bitter. It can cause nausea. And the other problem with turmeric is that it's not well absorbed. So you mostly have an effect in the intestinal tract, in the gastrointestinal tract but you don't get much of a systemic effect.
Most of the studies on turmeric that have shown benefits throughout the body were done with compounds that were mixed with something to enhance absorption. For example, if you mix it with soy lecithin, it increases absorption dramatically, dramatically, so that now you can take it and you can measure an increase in blood levels afterwards. If I take broccoli as an example, yeah, you can get sulforaphane from broccoli. You would need to eat several ounces of broccoli sprouts every single day to get that effect.
I think that's fine. And there have been studies where they gave people broccoli sprouts in a drink form and showed a benefit. But not that many people are willing to go to the effort of buying the broccoli sprouts or growing the sprouts and making the drinks et cetera. Whereas you can take a couple of capsules a day and it really bypasses that need. I would never say that food is unimportant. Food is the foundation. You start with food. But I see a lot of people in my practice in Boulder who have already done the diet and they're still having problems.
Christopher: Right, exactly.
Robert: Boulder is a pretty athletic town. There are really serious athletes here. I see triathletes that have burned themselves out from overtraining. And they've really pushed themselves beyond the limit. And frankly, a lot of them don't eat that well. They eat a lot of carbs. Because this whole notion, if they're going back to what we're saying about how the mitochondria make energy, they figure it's all the same, carbohydrates, fats and proteins. I get my energy from carbs. Does it matter if it's a potato chip or brown rice? No, it's all carbs.
If I just eat enough potato chips or get a shot of sugar, a power shot in the middle of my marathon, I should be fine. Except that it turns out that eating a lot of carbs is really damaging to the cellular pathways in the body especially in the mitochondria.
Christopher: Interesting. I'd love for you to tell me a bit more about that. How does that happen?
Robert: Well, a few things. If you eat more carbs than your body can handle, the insulin hormone that's supposed to get the glucose down gets overtaxed. It takes a certain amount of insulin to lower your blood sugar. So when you get a big surge in glucose, you have to make insulin in your pancreas. And if the surge is too big, then you can't make enough insulin to keep up. And so what happens is you end up with these surges in blood glucose. Well, we know if you take a blood vessel and you put it in a test tube and you mix glucose in there and then you measure free radicals, the free radical production goes up in parallel to the concentration of the glucose.
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So glucose actually, too much glucose stimulates mitochondria to make something called superoxide, which is a very potent free radical.
Christopher: And so you don't think this would happen with fat metabolism?
Robert: It doesn't happen because fat metabolism is much more slow. It's not, it's the glucose per se that's raising the superoxide production by the mitochondria. Circulating fats aren't going to do that. Now, if you get rancid fats in your body, if you eat a lot of trans fats which are damaging or you eat fat that's gone rancid, then that causes free radicals as well. But glucose is one of the major free radical generators in the body.
Christopher: Okay. And then so what do you recommend for your patients then? Do you have macronutrient ratios in mind for everyone or is each person different?
Robert: Well, the number one thing for everybody is to avoid refined carbohydrate. I think that if you go through the medical literature, there's really no dispute about that. The only reason that there might seem to be a dispute on a public health level at least in the United States is because the companies that make the sugar have spent a lot of money with this information campaign that say, "Well, a little bit of sugar is good for you." I mean, we've heard that Pepsi and Coca-Cola. They've donated huge sums of money to educational institutions to tone down their message.
If you look at the medical literature, there's really no question about it that these refined carbohydrates are bad. We've known this for decades. It's not really new information. And then the split comes with people who have different genetic background. Some people have a genetic background that allows them to handle a moderate amount of unrefined carbohydrates. So those people, I would say, sure, you could have a little brown rice. You can actually eat a little bit of bread as long as you don't overdo it.
But I've also seen people who had the genes that if they even look at a piece of bread they gain weight and they feel sluggish and they're out of sorts. I really think genetics play a big role. For example, I had my genetics tested through a company called Pathway Genomics and my array of genetic variation showed that I was better off on a big of a mixed diet, like a Mediterranean diet with a little bit of carbohydrate. So I feel better if I have a little bit of brown rice or a whole grain pasta, something like that. But again, I have patients that if they ate what I was eating, they would be in big trouble.
Christopher: Yeah, I think I would be one of them.
Robert: You will be one of them.
Christopher: Definitely, I know for sure. I've been in trouble and got myself out of it again by making the dietary changes that you just talked about. Tell me about that report. Is that something -- Did they use the 23andMe data or is that a standalone test that you did?
Robert: Well, I did 23andMe too. I didn't find the -- It's hard to get that kind of practical information out from 23andMe.
Christopher: Right, of course.
Robert: Pathway Genomics does their own testing. And they have profiles that are based around metabolism and athletic performance, et cetera. So they've done a lot of work to look at these genetic variations called single nucleotide polymorphisms to put them together in a pattern and say, well, this particular pattern, this would be diet that would work best for you.
Christopher: Interesting. And you've seen good results with your patients with that test?
Robert: I have. And generally, I find that if I do this kind of genetic panel and I tell somebody you should avoid carbohydrates like the plague, a typical response would be, "Well, I've already figured that out." They already know that to be true so it's more reinforcement than anything else.
Christopher: Okay. That makes sense. And then to get back to the mitochondria, what sort of test do you do to measure mitochondrial function?
Robert: Well, I don't do as much testing as I used to, I think, because I've just been in practice for so long that I have more of a, can I say, intuitive sense about it? I've heard this story so many times that I can tell. The one exception to that is I do like to measure a marker for oxidative stress called 8-hydroxy-deoxyguanosine.
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Christopher: Yes, I know it.
Robert: You know it, 8-ohdg. It's immensely useful because it's a direct measurement of mitochondrial damage.
Christopher: Right, right.
Robert: It's a simple test that cost $110, $120. You do it in the urine. And many times people will have higher levels than they think. Now there's some scenarios where the level would go up pretty predictably. If a person smokes cigarettes, you can guarantee their 8-ohdg will be high. People with Parkinson's disease tend to have very high levels. I do measure that. I measure coenzyme Q10. I think that's a very useful test. A lot of people are much lower than they think that they will be. I sometimes measure oxidized LDL because we know that oxidized LDL is really the culprit in cardiovascular disease.
Those three tests are like jewels. I will often do the organic acids and the amino acids and all that as part of the overall profile. I like the NutrEval profile from Genova Diagnostics or sometimes their ION panel which is similar, will give you that information if I really got a complex case and I'm having a hard time figuring out what's going on. But many times I will just go straight for the nutrients to try to improve mitochondrial function.
Christopher: Interesting. That's very interesting. I've done a NutrEval. It is fabulously expensive and an incredibly large amount of information.
Robert: Yeah. It's a while to dive through it all. You can do the individual parts of it. You can do the organic acids or the amino acids by themselves. And that can be useful. So again, I sometimes do that kind of testing but a lot of times I just go right ahead with supplementation. And I have to say one of -- To my surprise, one of the supplements that I found is most beneficial is branched chain amino acids especially leucine.
Christopher: Oh, interesting. Why should that be?
Robert: Well, as I mentioned, you eat fats, carbohydrates and protein. They're broken down into two carbon units and then they go into the Kreb cycle. When you eat branched chain amino acids, they're immediately utilized as a form of energy. If you eat protein for energy, you've got to break the protein down which means you use up energy, catabolizing the protein. When you take branched chain amino acids, it bypasses all of that. There's transport mechanisms in the gut that get them into the blood stream and then into the cells.
So they basically are source of pure energy and can also be used for protein synthesis. So one scenario that I often see is people, older people with what's called sarcopenia, they've lost muscle mass. We don't completely understand what causes that loss of muscle mass, the sarcopenia. And we don't have a lot of really good treatments for it. But one thing that's been shown in the literature that's really helpful is branched chain amino acids with an emphasis on leucine. It really does work. And that's used for people that have muscle loss from HIV, from cancer, from aging, from all kinds of scenarios. I would say one of the top things in my armamentarium is an amino acid complex.
Christopher: Interesting. And then have you been using HMB as well?
Robert: I have. In fact, I just saw a woman yesterday, 74 years old that told me that she had been losing weight for five years, had every test you can think of, nobody could figure out what was wrong. And I talked to her about the literature showing that the combination of amino acids and HMB actually maybe better than either one alone. HMB, as you know, is a metabolite of leucine. And it's not so great for increasing muscle synthesis but it's good for preventing muscle breakdown.
Christopher: Right, right, which is so important.
Robert: So the aminos help drive your mitochondria, make your mitochondria work better. The mitochondria then becomes this biosynthetic machine that can make proteins start the process in motion to make more muscle. And the HMB keeps you from making your muscles, having your muscles melt away. About two grams a day, I think, is what's used in the studies of the HMB.
Christopher: Excellent. Yeah, I should find some of those studies and link to those.
Robert: The other nutrient I want to talk about that I think is amazing is called nicotinamide riboside. I don't know, are you familiar with that?
Christopher: No, not at all. This is great.
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Robert: So, yeah. So we all know about nicotinic acid which is niacin and we all know about D-ribose. D-ribose has been around for a number of years as a kind of bypass for making ATP. This is something that Dr. Stephen Sinatra, the cardiologist has been talking about for years. You put a little D-ribose in your sports drink and you sip it while you're working out and it can give you more energy. It turns out when you combine this niacin with the ribose to make this nicotinamide riboside sold as NiaCel, it actually drives the mitochondria to work more effectively.
And the reason that does that is because NR, as it's abbreviated, is made into something called NAD. So we were talking earlier about how breaking down food is really a process of pulling electrons off these big carbon based molecules. Well, NAD, I kind of think of it as like the receiver in a football game that picks up the football of the electrons and runs to the end of the field with it, you know what I'm saying?
Christopher: Right, I do.
Robert: So if you don't have NAD, mitochondria don't work. They just don't work. And as we get older or if we over train our NAD levels drop for a number of different reasons. But this has been known for many, many years. And so there's been a lot of work done looking for compounds that would raise NAD. And none of them do it very efficiently or effectively until it was discovered that nicotinamide riboside does. And this has actually been proven in human clinical studies where they've given people anywhere from 250 milligrams to 1000 milligrams of the NR and measured NAD in their white blood cells and found that, yes, indeed NAD levels go up. So we've been doing a lot of research with this at Thorne. We're actually going to sponsor some clinical studies, more clinical studies, but right now the research on it is just exploding. It's really, I think, a tremendous discovery.
Christopher: Awesome. Yeah. I'd love it if you could point me to the direction of some of the studies that I should be reading. That would be really cool.
Robert: Yeah. I'd be happy to send you some of the literature on it.
Christopher: Yeah. That would be great. And then does Thorne have a product already?
Robert: Yeah, it's called NiaCel.
Christopher: NiaCel. Sorry, you did mention that. Yeah.
Robert: NiaCel. And where are we using it? In any scenario where you think the mitochondria are not working right. So the most obvious thing would be someone who is persistently fatigued or somebody who just doesn't feel like they're reaching that edge of performance that they ought to be. They're already on a terrific diet. They're training as well as they could. But they're just not getting to that next level. This could help take them to the next level. And we're already getting reports from athletes that are telling us exactly that, that using about anywhere from 250 to 500 milligrams a day, which is not a lot.
It's just two to four capsules a day, are noticing significant improvements in their ability to sprint up the hill, ride their bike up the hill. So you get that short little burst of energy that makes all the difference. As I mentioned, I think it works terrifically well when you combine it with amino complex, which is the high leucine branched chain amino acids. Because then you're fueling your mitochondria and at the same time you're increasing the NAD so that the NAD can run that machinery, can push the ball down the field.
Christopher: I've got some homework to do. So what supplements are there that you think that can help with our mitochondrial health?
Robert: Well, I mentioned Coenzyme Q10.
Christopher: I'm wondering like what you think about what dosages are required and what type of CoQ10 and what quality it might have to be in order to be useful. Because I see so many like multivitamins with CoQ10 in it and then when you look at the dose, it's like almost like a tenth of what you'd see in a product from Thorne, a standalone product.
Robert: Yeah. I mean, most people, if they want to use CoQ10 for a performance, they probably need 50 to 100 milligrams a day. When you're using ten milligrams, 20 milligrams, it probably isn't helping much. And if you're using CoQ10 in a powder form, that also doesn't help very much because CoQ10 is very poorly absorbed. I think it's around 1% absorption. The CoQ10 that we have is mixed in three different fats and a combination of fats we call a trilipid preparation.
[0:45:01]
The guy that formulated it is one of the world's top Co10researchers. He's been doing this for 30 years and has really gotten down on the ground level of different formulations and found that this particular mixture was the most effective one for raising blood levels of CoQ10. I've used it in my practice for at least seven years now and repeatedly measure people's blood levels and found a really good response to it. Like I said, in those range, 50 to 100 milligrams.
Occasionally for somebody with Parkinson's disease or Alzheimer's disease, I might use 200 or even 300 milligrams but for most people lower amounts are fine. Another supplement that I think is really useful is quercitin. Quercitin is a yellow pigment. It's found in apple skin and onion skin. And there's actually some pretty good studies showing that if you give it to athletes and put them in a training program, they make more mitochondria.
Christopher: Okay.
Robert: So the name of the game here that we're going after is mitochondrial biogenesis.
Christopher: It's a fancy way of saying making more mitochondria.
Robert: Making more. I want that. You want that. We all want that. If an athlete wants to improve their performance they want more mitochondria. If you've got an overweight individual with metabolic syndrome who is resistant to insulin, they need more mitochondria. There's studies showing that -- If you think about it, somebody is overweight, they're eating more than the rest of us. But they have less energy. They can't walk down the block without getting tired. Why would they be eating more fuel but less able to use the fuel?
Well, if you take an electron microscope and you look at their mitochondria, their mitochondria are often empty. There's nothing inside them. So they have fewer mitochondria and the mitochondria they have don't have all those folded membranes inside of them. They just can't make ATP. So they eat so much because they're trying to get energy. So they will want more mitochondria. You want to stimulate them to make more mitochondria. I think the solution is, first of all, cutting out all those refined carbs which are stealing the person's energy and getting him on graded exercise program, getting them do any -- It doesn't matter what it is. Just get him to walk, get him to move.
And then I use supplements like the quercitin or the nicotinamide riboside to help jumpstart their mitochondria so that they can actually make more mitochondria and have the mitochondria that are there work more effectively.
Christopher: Interesting. I have one final question for you, which is how do you -- What supplements do you take personally? How do you prioritize? I'm sure you get given a lot of stuff free as well. How do you choose?
Robert: Well, I don't get it free. I get a discount. I mean, I have a little pharmacy in my office. I buy the stuff for my patients and I've been known to go home with bags. There's a couple of things that have happened. One is because I've been lecturing on this material for years, I spend a lot of time going through the research. So if I'm going to stand up in front of a group of doctors and say CoQ10 is good for you, I've got to have the studies. I find myself reading the studies and then standing up in front of doctors saying, "I think you should be recommending this to your patients." I hear myself saying that and I think I should be taking that.
Christopher: Yeah. And then when you read enough studies--
Robert: I read enough studies and I go, "I guess I'm going to have to add that one." And then I talk to my patients and I say, "You know, I think you should cut back on salt and cut back on carbs and take nicotinamide riboside." And I go, "Are you talking to your patients or are you talking to you?" So I hear myself saying that and so I just add things to the program. I think because I've been taking supplements for a long time I don't really think about like how many or count them. Everything I talked about today, I take myself.
Christopher: Yeah. I'm in broad agreement with you. I used to be -- Five years ago, I used to be a guy that had never taken any supplements. And now I do take a lot of supplements, I do admit. And I feel great on it. I notice the difference when I stop. And so I keep taking them. It's really that simple.
Robert: I have to say we live in a toxic world. That's no surprise. We live in a toxic world and our bodies are being subjected to more and more chemicals than ever before. And I think we need more than food to help bolster our resistance against all those chemicals.
[0:50:05]
I recently tested myself for glyphosate which is the active ingredient in roundup. It's just that the test became available for that a few months ago.
Christopher: Yeah, I saw that.
Robert: And I said, okay, I've got to know that. I think it's feed the world or something that it does and it's part of organic consumer organization. I said, "What the heck! I want to test it." And I was surprised to find that I indeed had roundup in my body. And I thought, well gee, I eat a pretty clean diet. I eat mostly organic foods, et cetera. If I've got roundup then everybody's got roundup in their urine. And that's not good. It kills healthy bacteria in your gut. We don't know what it does to mitochondria. But I think that is just one example of many chemicals that we're all swimming in. So that's part of my argument for taking dietary supplements, is to just help us deal with the toxic world.
Christopher: Right, of course, yeah. And then for the people listening, most or maybe many of them are athletes, and so they're just tearing through more of these nutrients that I think are challenging to get from food in the first place.
Robert: Yes, absolutely.
Christopher: Well, this has been fantastic. You've given me several rabbit holes to go down now.
Robert: Great.
Christopher: Which I will enjoy tremendously, no doubt. So, yeah, I'm thankful for that. And thank you so much for you time. I know it's kind of a lot for you to just give up an hour of your time like this, so I'm very grateful for that.
Robert: It's been my pleasure.
Christopher: Thank you. Is there anything you want people to know about Bob? Where can they find you? Tell us about your practice?
Robert: Well, I'm actually not taking new patients so I'm not looking for patients. Most of my work is either lecturing with the Institute for Functional Medicine. So for the healthcare practitioners out there, I would point them to the functional medicine website. And I also feel that my work with Thorne research has really become a source of major inspiration because this is the only supplement company, and I've worked with a number of them over the years, but this is the only one I've seen that really wants to change the world by doing research on supplements to show that these things really do work. It's not just, "Here, I'm glad you bought my vitamin D, I'll see you later." I mean, they really wanted to reach out to the mainstream medical community and say, "You guys should be using these things in your practice."
Christopher: Right. Yeah, I know. I totally agree with you. That's why I always turn to Thorne as my first choice. I do that with other things as well. I'm a mountain biker and you can buy these perfectly good carbon fiber frames from manufacturers in China. It's the same thing. Thanks very much for buying my bike frame. That's the end of it. They don't do any design, any engineering at all. They're just basically knocking off somebody else's stuff. I know that if enough people only buy that crap then eventually there's not going to be a Santa Cruz Bicycles and Ibis Bicycles who employ engineers in the first world doing really good work that allow us to have such amazing things in our lives. Yeah, I like to support Thorne for that reason, if no other.
Robert: Well, people also need to understand that there's a wide range of purity in products that you buy. I mean, if you go down to local discount store and buy a vitamin D, you really don't know what's in there.
Christopher: Right, of course.
Robert: I mean, there's things that are on the label like we found that a lot of companies were selling vitamin D that had lactose. They were cut with lactose. So a person is lactose intolerant and they're taking that vitamin D they may have intestinal upset and not know why.
Christopher: Yeah. That's awful isn't it?
Robert: We think full disclosure is extremely important. And I'll also tell you that we reject a huge percentage of the raw materials that come our way. And we reject them because we find contamination. We find toxins in there that, I don't know, other people apparently aren't looking for these things. So because I know there's products that we've rejected that other companies are still selling.
Christopher: Right. It's pretty amazing. And I know this is important especially for the elite and professional athletes that get tested. You don't want to be buying some supplement that could potentially be contaminated with something. I'd been talking to one of the guys at Thorne. He's able to pull the Certificate of Analysis for any of the products which basically kind of tells you what was in that particular batch of something you bought. For some of the elite athletes, that could turn out to be really, really important. You don't want to be buying your stuff from some high street store where it's just nothing like that level of quality.
Robert: Well, you don't want to find out there was a hormone in there that shows up in your urine and the next thing you know you didn't actually win the Tour de France.
Christopher: Yeah. It can end your career, exactly. It's important.
Robert: Yeah.
Christopher: Well, this has been great. Thank you very much. I'll try and end it a second time. I think that last part was important. I'm glad you touched on that. I sort of forgot about it. That's important, thank you.
Robert: Well, I hope to talk to you again.
Christopher: Yeah, thank you. Cheers then.
Robert: All right, you bet. Bye now.
[0:55:41] End of Audio
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