Written by Christopher Kelly
April 14, 2017
Christopher: I just checked the download numbers and last month 127 thousand people downloaded this podcast. I can hardly believe it. I’m so incredibly grateful. Thank you all for listening. Thank you for sharing this content. You’re absolutely amazing. But I’m a bit confused because only 228 people have signed up for a highlights email and I know you’re really, really busy. But this is the one email this going to get to the point, give you the references, and enable you to improve your health performance and longevity. Let me give you an example of something that appeared in one of the emails in the different perspective section. In a new popular book, a journalist describes knowing that he was losing fat because he could see it in his stools.
Though obviously, we weren’t there, we’re pretty sure that’s not a good thing. During normal fat loss, you oxidize the fat, breathing out as water and carbon dioxide. Fat in the stool is called steatorrhea and it’s often caused by malabsorption, gall stones or damage the liver or pancreas. Definitely not something to write home about. So, get to the point, give me the references, two of them right here head over to nourishbalancethrive.com/highlights. Now, over to the interview.
Hello. Welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and I’m joined by Dr. Deborah Gordon.
Deborah: Hi, Chris.
Christopher: Thank you so much for joining me today. For people who do not know Deborah, she is a family medicine doctor in Ashland, Oregon, and she received her medical degree from the University of California at San Francisco. And she did a family practice residency and it’s since been in primary care practice for more than 30 years. That’s pretty amazing. You must have seen and know a lot of stuff by now.
Deborah: It’s amazing to look back and say, “How on Earth has it possibly been 30 years?” But it is.
Christopher: I think that’s a sign that you’re having a lot fun.
Deborah: I am having fun and I’d say increasingly more so longer I practiced.
Christopher: Well, that’s amazing. Well, I wanted to start asking you, “Why you do what you do?” and I realize that’s a very open-ended question. So, let me be more specific. Back before I knew anything about health and fitness and I’m not saying that I know that much now, I know a little bit more I did at least 6 years ago. I went to see lots of family medicine doctors and one of the reasons I started my business later on was I got the impression that they really didn’t have the answers and they really didn’t know what they’re doing when they looked at my test results. And clearly, you are so much different from that and I know you’re looking at things through this is really powerful ancestral health lines and I know that because you’re a member of the physicians for ancestral health so tell me why did you do that? Why?
Deborah: Well, I’d say it’s been a circuitous route to get to where I am now. And it doesn’t have one of those I was really sick and healed myself stories that a lot of people have. I’ve always been pretty healthy and I’ve always been interested in health. And I didn’t go, I never grew up thinking I was going to be a doctor. I was a hippy, living in a TP in Northern California.
Christopher: That’s awesome.
Deborah: Like hey, you know what, maybe you should go to a medical school. And you know, I did pre-med after the fact my degree is an English Literature and went to medical school really intending always to do lifestyle medicine, to do preventive medicine. I unfortunately didn’t develop any resources when I was in medical school for doing lifestyle medicine, but I did carry that with me and I would say have been on a perpetual search that only began yielding results about the last 15 years. So, the first 15 or 20 years in my practice, I did my best to avoid giving people prescriptions, and in fact, my first job here in southern Oregon was as the medical director of a migrant farm worker clinic. And one day, the executive director called me into her office and she said you know I’m concerned you are not writing enough prescriptions.
And I said, well, I’m concerned then too because I haven’t done an adequate job educating my patients that they should be happy I’m not writing the prescriptions. But at that point, I had few resources to do things besides suggested them that they eat healthy and you know my idea of healthy then is not the way I ate, but I’ve always eaten really pretty well and never did avoid eggs and butter. But I adopted that whole gee, maybe Jean Ornish is right mentally for a long time. And then about 10 or 15 years ago, I gradually learned about the Weston Price Foundation, Gary Taubes, and ancestral medicine and that’s when I feel like things have really taken off. Really just giving me tools to understand what’s going on with my patients and to give them more helpful advice than I could before.
Christopher: Well, I’ve got lots of questions that are coming into my mind as you say that. But the first one that I want to ask is why not a naturopathic doctor or some other type of doctors like giving what you’ve just said, I’m quite surprise you ended up as a medical doctor. So why did that happened?
Deborah: Okay. But remember, I went to medical school now 42 years ago.
Deborah: You know, so I didn’t even know nature path existed back then.
Christopher: Right. Okay.
Deborah: So, I’m sure, if somebody asked me now, I’d say unless you want to be an ER doc you should be a nature path because they’re clearly, their level of training has become more sophisticated over the last 10 or 15 years. And they definitely have the right approach that most medical doctor’s lack.
Christopher: Right. And then how did you know the prescribing drugs was, in general, a bad idea?
Deborah: That is a really, you know, I mean, I could say that “Oh. My father was a Christian scientist and they don’t use drugs but he was not really a practicing Christian science.” I just always thought that - so when I was a little kid I remember playing in my cousin’s library and opening a book and finding about the word pantheism, which is like God is in everything, and I am no spiritualist, I mean that really sort of means nothing to me but it gave me a concept that our bodies were a lot smarter than our brains are. That the things that we create out of mental constructs are interesting and are great to play with, like literature but our bodies are smarter. And I just kind of grew up with that, and I’m not really sure where it came from.
Christopher: Well, that’s amazing. I just find it so surprising that when you’re young and impressionable and you go to a higher institute of education and everybody that you interact with just seems so it’s experiences, and so wise, and so amazing. Now, your automatic reaction is just to believe everything they say and to retain that to degree of independence in your thought. I think it’s quite extraordinary. So, I’m not sure I fully understand how you’ve manage to acquire that like it’s quite amazing.
Deborah: Right. I did sort of having this experience of as I was – I’d always thought I was going like to going to obstetrics or something. And I wonder, did a family practice rotation and it was really fun to not know who the next patient you’re going to get was seems to be constantly challenged. So I remember thinking, “Oh. This could actually be exciting, not just following a professional protocol.” That was the differences with family practice that you had to sort of shoot a little bit more from the hip because you could be in orthopedics’ clinic and someone could say, “Could you look at this rash on my hip?”
So, that was kind of… And then I remember really clearly in my 3rd year of my residency, kind of feeling like I woke up and came back to myself, you know. Oh. I think I’ll go backpacking again. Oh, I could go camping. I don’t have to spend the next 4 weeks in some medical office and felt like you know maybe in the middle of that process, Chris, I was more going along with the attitude of the people that were training me because I thought they were smart and they were really great. But then I came back to, oh, wait a second, I’m going to take the least amount of medication possible and do my best for myself to avoid it and, gee, I had to try and do that for my patients too.
Christopher: And if I was to strip you of all of your credentials, what credentials would you go and get now?
Deborah: I would probably seek out something like being a functional medicine health coach.
Deborah: Although I really do, I mean I really do like some of the strictly medical stuff I’ve done. I love delivering babies. I love doing surgery. I liked it when I have patients in the ER or the ICU, and now, I like having that authoritative voice that I say when I’m looking at your lip at panel, this is what I know.
Deborah: As a doctor is the most important part.
Christopher: Oh. It’s definitely still a credential that demands a great deal of respect, but I’m really interested in what you said then about delivering babies. Do you believe that delivering babies should be a medicalized experience?
Christopher: Sorry. I’m not, I’m like, just bouncing from foot to foot here with my questions. You can see that I’ve got nothing planned, but I really love to know the answer to this.
Deborah: Right. No, it’s really funny. I was married at that time and I was delivering babies. Kind of early in my practice and my husband at the time said. “This can’t be right. You spent so much time with your patients.” And he actually called a friend of ours, who was a laboring delivery nurse. And said, “Is Deborah doing something wrong because she’s gone for hours when she’s got a patient and labor.” And she said, “No, Deborah’s doing a completely much more like a midwife than a doctor.”
And I prided myself on that as much as I could like trying to figure out like the only medical part is being the backup if something goes wrong. And knowing how to understand whether you should do some testing along the way, but no, I was trying to get my patients to walk in labor and you know move around and I don’t -- I was having my daughter, I’ve tried my best to have a home birth with a midwife, but I’m a doctor so I ended up with C-section you know.
Christopher: That’s really interesting, we have, the doctor I started Nourish Balance Thrive with. She’s also a medical doctor. She had a home birth. I thought I was quite wonderful even with everything that she knows and all the dangers that she really understands that she still wanted to do that but I feel having been through to the process personally with my wife. I feel like it’s something that benefits tremendously from the hind side, right. Like with hind side we think oh, we were idiots to go to the hospital. We should just stayed at home and then of course if something had gone wrong you never would have forgiven yourself for not being in the hospital.
Deborah: But a lot less goes wrong at home
Christopher: Right. Right. Yes, it’s like it’s a catch 22. It’s difficult.
Deborah: Yeah. My daughter, I figured, she showed her true colors because you know, so babies have to, you have to bend your neck. You have to submit to labor the process as a baby to be born and my daughter didn’t. She had her head up and she was looking to see if she could find a way out and you just can be delivered that way. You know if I didn’t have a C-section, she and I both would have died, but we had a plenty of warning, you know. I lived an hour from the hospital and it was not a difficult transport.
Christopher: Interesting. And do you get hard time from anyone in authority? Do you have a board or anyone else that gives you grief for doing diet and lifestyle medicine rather than just writing prescriptions?
Deborah: You know, I think I, in my local community no. I feel very comfortable and I’m lucky that I came here as a doctor who did the job none of the other doctors here wanted, so I was the doctor running the brand new [0:11:15] [Indiscernible] clinic. I had patients in all 3 hospitals. I had patients in intensive care and so I have my street cred kind of in my medical community and that said, there are still doctors become a quack and actually it’s more for the fact that I used to do in homeopathy, and I still do. Then that I do lifestyle medicine and then my hormone prescribing, I know, is a red flag that the or the medical board could use if they wanted to. So I feel happy every year I go by without attracting their attention.
Christopher: I’ve got to ask you about homeopathy now that you’ve mentioned it. So, you know I know better than to think that I understand why something doesn’t work. Right? At this point, I’ve been wrong so many times. I dare not doubt something that I don’t understand but at the same time I really don’t understand homeopathy. Not even a little bit. So, can you give me an insight here?
Deborah: Well, I have to say, you know, I only became really exposed to it because I broadcasted my utter cynicism and skepticism about it to some people whom I really respected, the who did work in other things. And they said, “Well, why don’t you give it a shot?” And even after I’ve been a patient when I entered the homeopathic training program and it was mostly MDs. I was the cynic in the room. This can’t possibly work. And I don’t I don’t think anybody can really say how it works except to, you know the closest I can come is that the way we pick a remedy, a homeopathic remedy for somebody is complex but ultimately, we’re looking for the secondary effect of a medication and what I mean by that is you know if you’re really tired and you have a cup of caffeine. It will wake you up but after the caffeine wears off, you’ll probably be more tired than you were before you had the cup of coffee.
Deborah: And so, we’re looking for a homeopathic medicine that so, for instance, if you had trouble sleeping, I’d give you the homeopathic remedy made from coffee. The coffee itself would wake you up but then when you distill it down to the remedy, it has its secondary effect. Now, why does that? I have no idea, but I’ve seen it work so I’ve also seen it fail brilliantly, you know. I am the best at picking the wrong homeopathic remedy that doesn’t work at all but my daughter broke her arm and she was screaming in pain and not able to have her X-ray taken. And we put some Arnica on her mouth and she was 6 or 7 years old.
It’s not like, I don’t think Placebo could have worked at that point and she completely stopped crying and cooperated with the X-ray. And actually, my first case, Chris, was my dog, so I had a – let’s see, we were backpacking in the Tetons and we woke up the next morning and my dog would not move. In fact, I thought she might have been dead. We put water in her mouth, and food in her mouth and she didn’t respond or didn’t move at all. And again, I put like a homeopathic remedy which I was just travelling with as a lark because I really didn’t believe in the stuff, in my mouth.
And she like sugar head, sugar body, woke up and she was completely ready to go for the rest of the day. And so, that’s sort of like you know in medicine, we’re supposed to do by the scientific method and then at the same time, you can read the articles by the Editor of the New England Journal of Medicine that says research will completely point you down the leftward path now and in 10 years it’s going to turn you completely around and send you down on the rightward path. So, I also go by principle, so I, yes, I read evidence but I also go by principle which could be physiology, or it could be evolution, and then I also go by experience. So, if I put a homeopathic remedy on my dog’s mouth and she is completely better that counts, even I have no idea how it would work.
Christopher: Do you not think it could be the Placebo effect? Even with the dog?
Deborah: Yes, I think certainly, but then if you’re going to say that the Placebo effect works with animals then you have to acknowledge that there’s some level of communication between you and the animal or you and the infant because I’m used to infants too. That’s more powerful and irrational than anything I’d understand if it worked for you. So, if Placebo worked for you, you could easily say oh, you’re an adult. Your kind of wanted to have a bizarre experience with homeopathy. But how do you explain it that the 3-year-old with mumps by the time you put the 3rd remedy in their lap stops crying and gets down on the floor to play with the toys you know, it’s like?
Christopher: Yeah. Yeah. I, so I appreciate that and you know this is something I really learned from my wife who’d been around many small children, her brothers’, before we had our baby and right from the beginning she would talk to Ivy even when she was an infant and had completely no way of responding and then by the time, now she’s 3 years old. She’s like a little comedian. She has an incredible vocabulary. She’s extremely verbal compared to other children I’m seeing. Her comedic timing is phenomenal. She’s a really funny little girl and I’m sure, I mean maybe it would have been the same but I’m sure it’s because Julie knew to talk to her even when she was an infant. So, what that tells me is there must be -- they’re listening, right. There is a connection even though they can’t really talk back.
Deborah: Absolutely and I think you know, and I think there’s plenty of study showing that younger siblings don’t talk because they expect their older siblings to talk for them and that only kids, kids that don’t have siblings end up with an adult patter way before the kids were raised by their older, less verbal siblings.
Christopher: Right. And do you ever say to your patients – so the only thing that worries me about this, I’m all for harnessing the power of the Placebo, if that’s what it is. And I don’t really know that that’s what it is. But let’s say it is, I’m all for that. But do you ever worry the homeopathic medicine is going to displace real medicine in appropriate time. So, I’m thinking about homeopathic emergency room where I should link to this very funny video that people should go to the show notes. But do you ever worry that sort of thing?
Deborah: Well, my friends say that to me. Well, I think you have to be, yeah, you have to be smart about it, but there’s a lot, you know and sometimes don’t you think you’ve done someone a -- for instance, one of the great service, even if homeopathy turns out to be like totally disproven and I get to the point where I think, oh my gosh, that’s really ridiculous I can’t believe I did it. I just think I only wrote about 3 antibiotic prescriptions in 10 years of a heavy pediatric practice. So even if all I did was give them something to hold their hands while they survive their virus and you know calm down their fear, then I did a benefit by replacing the conventional medicines. So yeah, you have to be smart you know. If I thought somebody had appendicitis, I would you know the famous thing is I’d give them the remedy as I put them in the ambulance.
Christopher: Right. Yeah. Yeah, and I’m all for it, and who knows we’ve made enough U-turns at this point. Tommy just posted this infographic. They were sent to him by Mark Cucuzzella and it was instructions for athlete should do to fuel their activity and it is the exact opposite of what anybody should be doing. It’s absolutely phenomenal. So, I should link to that in the show notes too.
Deborah: I’d like to see it. You know, I saw him on the rowing team at – we have a rowing club locally and I’m on the women’s racing team. And the coaches’ wife is a dietician which makes me immediately suspect. And I know they’re great dieticians, but she had an evening class for eating for performance, and I couldn’t go but I wish I could have been a fly on the wall because I’m afraid she probably followed that info graphic.
Christopher: The spoiler is carbs, carbs and more carbs. Right? Carbs before, carbs during, carbs after. That’s that way.
Deborah: Right. Yeah. I think you know that I look around at group of a -- so in our rowing club, our ages span from middle schoolers to the, I think, our oldest rower is 87 or 88 years old. And you know the advice that you might give a teenager still has a risk of generating a diabetic athlete. Somebody like Tim Nokes who was never heavy. But I look around my peers on the women’s racing team, many of whom you can diagnose metabolic syndrome walking by them and I think I hope they didn’t go that talk.
Christopher: Yeah. Well, I really wanted to talk to you today about autoimmunity in post-menopausal women and so maybe I should start by asking you is this something that you frequently in your practice?
Deborah: It is something I see frequently. Often that I’ll either diagnose it or people are walking around with one, two or three diagnoses themselves.
Christopher: And tell me about the types of autoimmunity that you see,
Deborah: Autoimmune disease is so funny because you know if I think you’ve got an ancestral perspective, you look at what’s in common with all these autoimmune diseases. But of course, people and most physicians separate them out and put them in completely little different tiny packages. So, I’d say I see probably, well obviously, the most common is Hashimoto’s because that’s kind of the most common, I think, in general, but I also see Celiacs and Sjograns and different kinds of colitis.
Deborah: I think some of the inflammatory autoimmune colitisis that we know a lot about like Crohn’s disease or all sort of colitis, often hit people when they’re younger but there are diseases that are autoimmune and pertain to the colon that hit women more when they’re older. So, I mean in general that if you have four autoimmune patients, three of them are likely to be women. It’s much more common in women. So, I have two or three women who developed in their 50s or 60s a microscopic or collagenous colitis which is still autoimmune. Just not as well-known as Crohn’s disease or all sort of colitis, so it’s scattered all around. Sjograns is common though, pretty common. And you know what that is. That’s where the most common presentation of Sjograns is to have devastatingly, irritatingly dry eyes that bothers people most at night. But can bother them during the day too. But it can also be a presentation of a dry mouth. So, that’s one, I think I’ve got half a dozen of patients with some form of Sjogren’s, systematic or not.
Christopher: Do you think… Sorry go on.
Deborah: I was going to saying it’s all over the body. You know, different ones.
Christopher: And what do you think is driving the diagnosis? Is it just limited? So sometimes I wonder whether many autoimmune diagnoses are happening because we just happened to frequently screen for the antibodies for that particular disease, right? So, Hashimoto is a very good example where it’s on every thyroid panel and so you’re more likely to see it, and maybe some types of autoimmunity we’ve not even developed the assay yet. So, you wouldn’t see it as much. And do you think that’s a fair comment or do you think…
Deborah: I think that isn’t fair comment, but I think you’re talking to some pretty unusual doctors if you think the Hashimoto’s antibodies are on most panels.
Christopher: It’s true. It’s true. I most likely am.
Deborah: Okay. You’ve had thyroid disease for 30 years. Has anyone ever tested you for Hashimoto’s? No. I’ve never heard of it. And you know 50% of those people probably end up do - that they do have some form. I’m always surprised. I found myself to be in low of thyroid a number of years ago, which really presented as cardiovascular problems which of course they wanted to treat cardiovascularly but all I had to do is take a little thyroid and they all went away. And I was sure of course that I have Hashimoto’s. Come on! Keep testing me. No, you don’t know Hashimoto’s.
So, you know there are, I think I go out on a limb looking for autoimmune disease in places where there’s reason to suspect it but people haven’t looked for it. So, for instance, one of the epidemics with metabolic syndrome and diabetes and everything else that we’re seeing. It’s a tro fibrillation. There’s kind of 2 heart-related epidemics that are a little weird. One’s congestive heart failure but that’s really because of Statin use. The other one is tro fibrillation and you know that you probably see it or it affects athletes.
Christopher: Right. It’s tremendously common. Yes.
Deborah: So, I like to get there are the Cyrex laboratories which has the most specialized testing. You have to have a patient who’s willing to pay for it. They have some, I think mild, they have a couple heart antibodies on there, but it’s pretty easy to get cardiolipin, anticardiolipin antibodies that’s a conventional lab will do that. And I think one out of every four of the patients with persistent arrhythmias that I test has antibodies which is associated with an increased risk of not just atrial fibrillation that other cardiovascular disease like stroke and heart attack. So, those are people where I can say, “OK. You don’t just have atrial fibrillation, you have to get more sleep. If we think this is an autoimmune disease, what are the implications in that for not only understanding why you have it but for treating it.
Christopher: Well, that’s fascinating. I’ve never heard this before. So tell me what is the treatment?
Deborah: Well, they treat autoimmune disease affecting the heart the same way you treat immune disease affecting the gut. So, there’s a triad that I think, I’m not sure who out this together but we genetic susceptibility and you have leaky gut and then you have a stressor and that can be an acute or chronic stressor. And those are the settings in which someone develops autoimmune disease. So, you just, your peace those apart. Okay, you can’t do anything about your genetics so you know that you’re someone, if you’ve got an autoimmune disease, who’s not only prone to continue having it but prone to get another one. So, once you have one, you’re more likely another one. But leaky gut, you know you know what to do for that. And then a stressor, you know what to do for that. So…
Christopher: Right. Well now let’s pretend that everyone knows. So, what would you do for a leaky gut? How do you diagnose it in the first place? That’s something that I’ve always wondered about for a long time. I don’t think there’s any really great test on the market that would reveal that you have a leaky gut or maybe you would disagree.
Deborah: No. I would agree with you and I would just say so I’m convinced enough of that triad existence and I really kind of more use it as a tool of argument. So, I say that wow, Chris, I think you know your HO fibrillation and these antibodies, you probably have a leaky gut and we can do some extensive testing or we can do what we would do to remedy that. And so, I talk to people about Persano’s paradigm of the tight junctions. I like to act things out. I’m kind of a ham and very dramatic and so you know I build a little intestinal lining model with my fingers wedged really closely together and I say for all of these when we eat gluten, those tight junctions spread and some molecules of food are absorbed way earlier in the colon in the intestine than they should be.
And of course, that’s going to provoke an allergic response of some sort, an autoimmune response. And if you’re healthy and gluten causes the junction between your intestinal cells to open but you’re healthy, it evidently must close up again or you must not react to your proteins. Or I don’t know what happens because you know you get leaky gut, you get increased intestinal permeability if you eat gluten but I mean I have heard enough about your gut that I know you don’t eat it. But you know you get intestinal permeability when you go out for hard ride.
Christopher: Right. Of course, yeah, there’s many factors.
Deborah: And so, you know, I would say to somebody who’s an athlete not only should they not eat gluten but they should be careful what they eat after they exercise.
Christopher: And do you ever get women, so say I’m a post-menopausal woman and I’ve just walked into your office and you’ve diagnosed me with an autoimmune disease. Do you ever see those women that still eating gluten?
Deborah: I’d say 3 quarters of the people that walk into my office have not fixed their diet on their own. So, you know I have much more of medical paradigm than a health coach paradigm. So, some people come to me having read my website and understood that I am going to take them off gluten. One woman came in. It was funny because not only did she go to high school with me and I didn’t even recognize her until she told me at the end of our appointment.
But she’d read my website and she knew I was going to take her of gluten but she had to wait and come in to see me to decide to do it. So, I’d say most people I’m encouraging them to make some dietary changes you know to do a real Paleo. So, I usually do it in 2 stages. I’ll encourage people to -- I assume gluten’s a problem and some people need to be shown that and so I will do a test at the hospital for gluten sensitivity and I say, “If you fail that test, you are absolutely gluten sensitive, and forget it, you just have to be off gluten for the rest of your life.” But most people pass that test and if they really need to be convinced, I’ll run them through Cyrix because you know that’s much more sensitive test for many more antibodies.
Christopher: And they usually fail that test?
Deborah: Right. I’m always amazed when people pass that test. Wow! You don’t have any gluten sensitivity. That’s pretty rare. But you know there’s definitely some people or it’s really minimal. And then even with that information, I’d still say I am only about 75% effective and making my case in getting people to change their lifestyle and younger, the better. Well, that’s not really true. I don’t know what it is. Some people food, I’m sure you’ve seen this, the hardest thing in the world is to get people to change what they eat. For some people, other people…
Deborah: Right. Do whatever you say.
Christopher: Yeah. I was definitely one of those people were I just did know what I was doing and my wife then she said, “Yeah. You definitely stop eating these 2 really common food allegiance before you go any further.” Oh. Really? And you know once I have the information, it was trivial for me to execute it. I have no emotional attachment to food, whatsoever. And that’s not to say I don’t get addicted to things that are really addictive like caffeine, for example, or theobromine but yeah once I’ve got. Once I know the answer, I’m pretty good in executing that and I wondered whether you would be better because you can put on a white lab coat and put a stethoscope around your neck, I can say, doctor’s orders, no gluten and then people will take notice of you, but you’re telling me that that’s not true.
Deborah: Well, it’s also, I’m not really, you know I will something because of my MD, but I’m not really a very bossy sort of person. Maybe people who know me might disagree. I think I have more effectiveness than I imagine, but you know, I’ve got some very good friends. Well, I think it isn’t often that case that it’s your closest friends or worst your family members who don’t listen to your advice.
Christopher: Oh, yeah. Of course! Why would they? And even Tommy doesn’t try and work with his family members. We stayed with him in Iceland and his mom was asking him all sorts of questions. And he was the most evasive I’ve ever seen him being about health questions. He’s normally so willing to please. So, willing to respond all of those questions in the greatest of detail and, with his dear old mom, he was like trying to refer it to somebody else, you know.
Deborah: Yeah. One of my friends who’s a doctor in town, sent me her sister and she said, “You know, you’ll be able, you’ll be the one who’ll be able to get her to eat in a way better for her than, I can do.”
Christopher: It’s interesting. Well, tell me that, you mentioned an acute stressor of that triad. What do you think that is?
Deborah: You mean, why does that, why does that contribute to autoimmune disease?
Christopher: Yes. So, I’m just wondering what you meant by an acute stressor. So, when you say that I’m thinking of maybe some type acute or maybe chronic infection or maybe it was a stressful situation like a death in the family or maybe you just hate your job or what?
Deborah: Yeah. So, I have a patient who was, we had a local very successful political campaign here a couple of years ago, and our county and the adjacent county outlawed the growth of genetically modified crops and a patient of mine was very active and she was burning the candle at both ends. And not sleeping enough and really not just taking care of herself and she developed HO fibrillation in that setting and so that was her stressor that triggered it off. Looking at her, I would imagine that she’s the perfect paradigm of something that you mentioned earlier which is I had never diagnosed with an autoimmune disease before.
Deborah: But I wouldn’t be surprised that she had one.
Christopher: Right. Right.
Deborah: Because she’d always been just, you know, you see -- so one of things I see in my practice that I would assume is something along the lines of what you’re talking about is women who, or men but I’d say I just see more women, who are carrying something that looks like a mild chronic degree of inflammation. So there, if we do the HSCRP test which you know is cold by the conventional world normal below 3 but I really like it below 1. They might have a slightly elevated HSCRP around 2 or something like that. And they carry a little bit of extra weight around their middle and they don’t really, they may sleep pretty well but not great enough. And maybe they don’t exercise in a really healthful way but their bodies are just slowly becoming more and more unhealthy.
You know, gaining weight getting weaker, more muscle turning to fat and I - what if that level of inflammation that’s lurking in their body and it’s great.
This man came in to see me about 5 years ago, and he, that was -- he was a little bit overweight. He had high blood pressure, sinus problems, but he took the sort of paleo low carb message and he and his wife just ran with it. And you could just see over the next 6 months, something that you see in your coaching. But he really came to me for actually I think homeopathic treatment for his sinus infection but he heard the nutritional piece of it. And he got off, he’s I think, I think he’s on a still, a little bit of hyper tent-- anti-hypertensive but one-by-one got off everything and got what you would say is got his body back.
Christopher: Awesome. That’s amazing. And what would you do for the person that’s in this stressful situation? I’m really interested to know because my experience has been that obviously stressful situations exists, but for people that don’t have any stress they tend to invent something to get stressed out over anyway. So what do you do for people like that?
Deborah: So, you know, I wonder about I mean I would say the same thing. Just don’t get stress about what do you… But I actually think they just have a level of literal pathology that is harder for us to understand and it would be something on the level of anxiety, you know. In the realm of mental illness that you really think that they’re creating a rocky path for themselves where it needn’t be, but that really is their experience. And so, this can be a, it’s really trial and error from my point of view that it’s giving them some tools to relax. So, it might be, I mean you know, I went to the Dale Bretesen training. The session I think before you did last year.
And one of the tools that Dr. Bretesen referred to is the brain wave app. He says you know that’s meditation on steroids and I thought, “Great! Finally, a meditation I can do.” I can do it in 5 or 10 minutes. And somebody else is really doing it. I plug-in to the app. And it really, yeah, I do it when I’m pretty sure I’m not going to sleep well that night. I do it. And sometimes I do it other times and so I might say someone to try that. I have another patient who I suggested she do heart math, for her heart rate variability, or exercise you know it’s trial and error trying a massage, improve their vitamin D, get it not just from supplements but from the Sun.
And then you know, I’m looking myself because I really do believe people want to be healthy. So, when I have somebody who I think is putting obstacles in their own way. You know, I’ll look under all sorts of rocks to see what could be fueling, what seems to be self-destructive behavior, like you know, I’ll look for, I’ll do a Genova diagnostics nutritional evaluation panel to see if there’s some small nutrients or nutrients out of balance that might help with them. And you know, at few times, that’s what really helps or finding you know one little thing that’s out of balance and sometimes we can tweak it, right?
Christopher: Now, what do you normally see on these Genova panels? I’m quite interested in that.
Deborah: There’s a couple things that you can predicatively see. So, I think most people are low in vitamin A, which I think has way more to do with general immunity but could conceivably have to do with autoimmunity. And it has to do with you know people don’t eat liver. Do you eat liver?
Christopher: I do every morning. Yeah! We’re a big fan of US wellness meats, which is sort of cheating really because all you have to do is order and it turns up. And it tastes just like Deli meat you know Even my 3-year-old daughter loves that stuff so that makes it super easy.
Deborah: Right. So, you’re like eating the liverwurst or something like that.
Christopher: Yeah. Liverwurst and Branchswakers[?] is really good. We really like the head cheese as well. But my wife will prepare. You know, when we can get them, we’re finding it increasingly difficult to get, not increasingly but difficult to get organ meats from the local butcher that’s embedded within our supermarket. But they do have some stuff sometimes and she’ll prepare liver. A liver paté is another really easy one that anybody can like…
Deborah: It is. So, I was at my daughter’s this weekend. She lives in Mezula and a friend of her who’s kind of my, you know my second daughter had been sick a lot recently. And she came over and we actually made chicken liver for dinner. There’s a recipe on the website for chicken liver mouse that I borrowed with permission from Ben Greenfield. And it’s a fantastic recipe for eggs, chicken liver, onion, apples, and spices. And it’s really good and so this woman came over who had been sick recently. And she said that, “I’ll just start with a really little piece of it.” She ended up eating several pieces of liver and taking some home.
And I think it will help her get over from cold but I think it’s very often and there’s 2 parts of it. People don’t eat liver and then you know there’s a genetic snip. And I learned about this from Denise Minger. The BCMO1 gene which has to do with how successfully you can convert beta carotene to vitamin A. And if you have that snip, if you have many fatty liver, if you drink alcohol, and if you’re over 50, you can’t very well convert beta carotene to vitamin A. So, I see a lot of vitamin A deficiency. In the people who do avoid grains or bread the way I tell them. Everybody is deficient in B1 and B2 according to Genova. I think it’s because we don’t eat fortified bread.
Christopher: That’s quite depressing. So what would you have people do instead?
Deborah: So, again, a lot of my practice is you know people over the age of 50 where they have a scattering of things and of things that might be deficient or flags for a deficiency and I feel very happy if I can get them to get this concept of nutrient density. So, I worry a lot about really whether they’re getting a wide variety of foods and getting enough nutrients so I’m a multivitamin proponent. I have a multivitamin that is specifically for older folks, you know, without copper and iron, which I think tend to accumulate to our disadvantage and a lot of older people. And yes so I’d throw a few – have them take a few multivitamins a day, oh, which you know one of the store in one’s where you’re supposed to take like 6 a day and I generally have people take 4 and try to cover the basis that way and you know for some people, wow I feel so much better since I’m doing what you told me to do from Genova panel and other people say well I can’t really see any difference. And then… I think that wasn’t the stone that needed to be turned over.
Deborah: Keep it in…
Christopher: Yeah. I absolutely still take a multi vitamin every day. I just got back from 3 weeks away in Colorado and I, that was the one supplement I took with me, was the Thorn EXOS multivitamin because I just really don’t want to go there right. Like the problem associated with nutritional deficiency that devastating whereas the problems associated with excess with the possible exception of maybe chronic [0:38:32] [Indiscernible] or as you mentioned copper that’s really not that many problems, right. I would much rather be in the nutritionally repeat camp.
Deborah: Yeah and I think you know that multivitamins get a bad rep because most people buy bad multivitamins.
Christopher: Right. Right.
Deborah: Or the one that’s wrong for them. So, you know a person, a non-menstruating woman or men or I mean they need to be careful of iron and copper, and…
Christopher: So how do you know that someone’s pass too much copper? Is there some testing that you do?
Deborah: I routinely do one of the tests that Dr. Brensin talked to us about and you learned about from him which is to compare your levels of serum copper and serum zinc. So, a little bit you know how like you need to balance your omega 3s and omega 6s because a part of omega 3s do is clean up some of the problems that omega 6s cause particularly in the brain.
Deborah: Well, it’s the same thing with copper and zinc. In that copper is really essential and you need it in the brain. But if you have too much if it, it can cause problems and you have to, you should balance it by having it and even higher level of zinc in your blood. So, that’s good for brain health and good for immunity. So I have been routinely testing copper and zinc levels in people for a long time. And I, its funny cause my friend, Dr. Anne Hathaway, whom you know.
Christopher: Of course.
Deborah: We were comparing our practices. And she says, “Oh no, all my patients are higher in zinc than in copper.” And I said, “Wow. All my patients are higher in copper.” And I’ve got to figure out a way to build up their zinc. So, you know, I don’t know if it’s living at this altitude or our local water of what? But I definitely see a lot of people relatively speaking deficient in zinc.
Christopher: Interesting. I should refer it to Chris Marchejon’s series of wonderful podcast done managing your nutritional status for all of these vitamins and minerals that we’ve been talking about. Have you been listening to those?
Deborah: I have it. I’ve been impressed. I definitely learned some things from him that I passed on. Really good.
Christopher: He’s absolutely on fire at the moment. Since leaving academia, he just cannot stop turning content out. Absolutely astonishing and his master class on antioxidant defense system is also quite incredible that I should link to those things in the show notes to this episode so that people can find the, absolutely incredible.
Deborah: Yes really good. I love his column on glutathione and have incorporated that but if you know you have either an acute or chronic pulmonary problem, you probably have a glutathione deficiency. What a nice little pearl to have that.
Christopher: And do you measure for any markers to oxidative stress?
Deborah: I do. I really do in the Genova nutria panels so they measure levels of co-Q 10 and glutathione and then they measure lipid peroxides and 8-hydroxy DG and the urine. I’ll do it that way and then so if I have a patient who has -- who I’m all worried about cardiovascular health. And I kind of have this awakening recently to remind myself that everybody who’s over the age of 50 should be concerned about cardiovascular health because still the number 1 problem no matter how healthy you think you are. So, I do test the HSCRP in everybody and if it’s elevated for more than once. Anybody can have it elevated once but if it goes back to under 1, that’s great. But if it’s stays higher than that, I’ll get Cleveland Heart Lab’s inflammatory panel. Do you know Cleveland Heart Lab?
Christopher: No. You’re going to have to tell me more about this?
Deborah: So, they’re an incredible lab for a couple reasons and the way I really was introduced to them is they have a wonderful policy that enables people who have a high deductible insurance to have the kind of co-pay that Genova does. So as long as you have an insurance you have a really reasonable co-pay. But then in talking to them, what’s really remarkable about them is the test they have to offer. So, if you have an elevated HSCRP I can order their cardiac inflammatory panel. And it’s really incredibly, reasonably priced. People, and I’m getting it for 10 % of the face value of the test if they have any insurance at all. So, it’ll measure oxidize LDL and LPLA2 and myeloperoxidase and then they’ve expanded it to include a couple other markers of cardiovascular stress like ADMA, MDMA, you can add it TMAO which I don’t really know what to make that. But I will look for, and each of these markers of cardiovascular inflammation correlates to a different degree of endothelial dysfunction.
Christopher: Okay. Okay.
Deborah: And you would address them all a little bit the same way although all a little bit different you know… You take out the inflammatory sources in somebody’s lifestyle and increase the anti-inflammatories but some of them are more specific, for instance, if you’re working with people who are APE4, so at risk for heart disease or Alzheimer’s disease then maybe the oxidize buildia means something that it wouldn’t mean in an APOE3 person. Maybe it means they’re having too much dairy or too much Coke. We’re really going far field from autoimmune disease, aren’t we?
Christopher: Yeah, I know. But it’s good though. I like to just follow the flow you know. You’re me making me think about, I’ve just got back from Brian Welsh’s training in Denver which was just unbelievable. So maybe do you who Brian Welsh is? He’s a naturopathic doctor from Ireland.
Deborah: I know his name but I don’t know his work.
Christopher: He’s taking blood chemistry to the next level. He really is a quite astonishing critical thinker and biochemist and I think most people listen to this podcast would be by now familiar with his metabolic fitness pro training course where he teaches the basic biochemistry and I think you really have to good handle on that before he can properly interpret blood chemistry. But Bryan’s mission is to get as much information out of the basic blood chemistry as people are currently getting from all the advanced fancy testing that some of what you just have been talking about. So, for example, he spends most of the day talking about how you can use belly robin and uric acid and GDT which are three vary inexpensive markers on most blood chemistries as markers that can tell you what’s going on with if you’re antioxidant defense systems. So, I’ve seen incredible; unfortunately, these resources are not available online at the moment but you can go back to Denver and see Bryan present this. It’s just unbelievable. It was 800 pages of stuff in 2 days and he spent time on the whiteboard as well. So, absolutely amazing, highly recommend that.
Deborah: It’s great because you know sometimes you have to talk people, those who benefit very specific testing that things like the GGT. That’s very specific too and might prevail upon somebody to really see if they have fatty liver or something like that. And sounds like you can read all sorts of other stuff into it too.
Christopher: Yeah. Absolutely, so he presented and this is all published in the literature of fatty acid, a fatty liver index that has a very complicated formula but it seems to be 80% accurate in its ability to predict fatty liver and then there was other formulas that he presented that would actually show the different stages of fatty liver. So, you can have simple steatosis and then you can have like the fibrosis muse and it’s actually three stages of fatty liver. And so, he presented the formula to predict each of them. And this turns out to be more accurate than doing a biopsy because you may see physiological changes with the liver which are uneven and so when you do a biopsy. You make it a good bit or making it a bad bit, you don’t really know.
And so you really have to do ultrasound to diagnose this thing and it’s amazing. He presented some data that show the liver enzymes of a whole bunch of people. I think it’s thousands of people that had all been diagnosed with fatty liver via ultrasound. And the liver enzymes were not completely normal. It is not a good way to diagnose but to live or whatsoever so you really have to. The formula that he presented, it took into account some of the biomarkers that were not blood. So, it was actually BMI and I wonder whether that form and it could be even better if it was the hips to waist ratio.
Deborah: Right. Or waist to height. I like waist to height.
Christopher: Yeah. Yeah. So, I’m just super, there was no way that you could implement any of what he was teaching without some software to support this. So, I’m quite excited to a get cracking with one of my software engineering friends, who’s actually been on the podcast actually, Fabian so we’re going to implement some blood chemistry software to see of who can bring to life to some of what teaching in this weekend.
Deborah: That would be great because you know some people really do just need a little bit of information about what you think is going on them and they can run with it. And you know and other people, they want you to do the whole test because they can’t really believe that they have to stop eating whatever you’re telling them to stop eating.
Christopher: Right. Yeah. I know absolutely. I’m one of those people that when you show me a test that tells me this is not working for me. I’m sure as hell going to do something about it you know. It’s so very powerful stick.
Deborah: I had to be dragged, kicking, and screaming you know. To give up… I actually I’ve been sort of playing around with the whole paleo thing, but really couldn’t imagine that I could give up my bread. But I was set to go to Paleo effect, so it was the first time, it’s about 5 years ago, and so I decided I had to stop bread for at least a month before I went to Paleo effects. And even then, like you don’t even look back. It’s like what was I thinking?
Christopher: Yeah. Yeah. And absolutely I agree I mean if you’re in France and there was a baker around the corner that bakes bread twice a day. I can understand why you would not want to give up bread but in the US, I’m sorry just don’t make any good breads. You really need to go to France to appreciate that.
Deborah: Well, I like all that you know crunchy Granola whole wheat stuff but you know if I can, I don’t have a big explosive gastrointestinal reaction. I just know it’s better for me not to eat it. So I can sneak a few pieces a year and that’s fine.
Christopher: Right. I really wanted to ask you. I know I’m running a bit long time here. But I really wanted to ask you about what potential stressors you might see in the gut and if you do any gut testing. And whether the micro bio might be playing a role in autoimmunity?
Deborah: You know I do look at the gut and that so I you know I mostly use Genova diagnosis but I also use doctor’s data, stool testing. And I’ll go with some of their markers for leaky gut and I find that part of their test really useful you know look at the level of inflammation in your gut or look at the degree you know eosinophilic protein or IGA something and that’s pretty consistent for with what I usually expect to see in people. When it gets to the microbiome I have like different parts like sometimes you’ll get a pathogen and that’s helpful because then you can figure out what you’re going to do about the pathogen.
By far the more common usefulness for me in the microbiome in particularly with people over certain age is that incredible paucity of lactobacillus and Bifidobacterium. Yeah, we should have a lot of that and really almost everybody over 50 doesn’t, they may have Bifidobacterium on that looking at the species there. But once its cultures out the Bifido doesn’t culture out, so it’s not a really vital part of that stool. You know that part of the microbiome report where it really talks about the actual [0:49:17] [Indiscernible] species. I don’t know what your experience has been.
I talked about this a little with Michael Rosio and I’m just not really sure where this goes. So, if I, you know, the Genova panel, they rate you. Do you know, do you have not very much diversity in your microbiome or do you have a lot of diversity? And the patients I have who have a lot of diversity. Have all been sick, you know, not very healthy patients so one woman with MS, one woman with fibromyalgia and the people who have lower than the optimal diversity that doesn’t… I don’t think that that’s a very… I don’t think we understand that yet.
Christopher: No, absolutely not. I totally agree with you. And I get it the analogy is imagine a bar that’s really, really crowded and you’re a pathogen on outside and you’re trying to get into the bar to order drink and you wouldn’t be able to because the bar is so crowded. But what happens if the bar is already crowded with the bunch of vipers, right? People that are not – so maybe that’s what it is. It’s a diverse and unfavorable microbiome.
Deborah: Maybe you know I mean if you think of the whole hygiene and kind of hypothesis and the fact of autoimmunity corresponds with greater affluence and a more hygiene, hygienic environment and so you think that diversity would be good but yes, you’re right. I guess it’s different, we don’t know about the nature of diversity. Right. Your diversity of the whole bunch of good players who’s keeping the bar well stocked, clean and with really good music, and Jane on the other hand over here has a bunch of drug dealers. Keeping the bar stocked. That’s two different kinds of diversity.
Christopher: And have you had any good luck manipulating the gut microbiome and if so what type of treatments do you use?
Deborah: I think I’ve had better luck dealing with small well not really, I don’t really try and manipulate the whole, well I guess I do in that if somebody has a paucity to lactobacillus or Bifidobacterium, I will just suggest they take a lot more of it and I have a few different products depending on what – that I rely on, depending on what the key problem is, so you know, if their problem is more on the upper gut or in the lower gut. Am I trying to move things along.? And I’m trying to improve their immune functions, so I will push Bifidobacterium in somebody who has a paucity of Bifidobacterium and they get sick a lot. And do I think it works? I don’t know, I can’t really keep the data well enough. But you know…
Deborah: Everybody should be either eating fermented foods on a regular basis. I do believe that there is a link that’s more complex that we can understand that I can just cut to the chase and say, “If you’re not eating fermented foods on a regular basis or farming or living with animals, you need to take some kind of probiotic on a regular basis.” And then will begin to pick and choose which might be better. What do you do?
Christopher: Yes. Something very similar. Right. We do kind of a weeding and then seeding right. So, if we do some gut testing and you got full of a whole bunch of vipers, so for example I sort of tested the day where giardia was present. Right? So, I mean that’s a known pathogen. It’s not controversial at all. You really need to get rid of that before you can start worrying about putting back some of the beneficial bacteria. And then we do use probiotics but I’m starting to wonder whether the most effective strategy is perhaps using some prebiotic fibers. But then in particular eating a wide variety on non-starchy vegetables and I would refer people in to my interview. My recent interview with Lauren Petersen where she had been doing a longitudinal study using many different types of gut microbiome sequencing and then also doing food logging. So, she was able to see which were the foods that were leading to an increase in beneficial bacteria. And I think that she agreed with me that the maybe that was the best strategy and that probiotics although they do have their uses, may not be the solution long term.
Deborah: Certainly, in a general routine way I agree with you that you need to have the prebiotic fiber in there. And so, we, there’s a whole nother rabbit hole which I want you to go down with somebody on your podcast.
Deborah: These zero-carb people who are just eating meat and eggs and I’ve talked to them via twitter. So, it’s not completely in great depth about what happens to their bowel function and their general immunity. Their general health as their completely avoiding what we think are so essential, these non-starchy vegetables. They’re just eating meat and eggs and they claim after a week or two everything’s great.
Christopher: Yeah. Now, I absolutely agree with you. I should refer people… Hopefully the video will be published by the time this podcast interview is out but I Jeff Gerber is a medical doctor from Denver and he had his physician’s assistant and I apologize for not remembering her name, but she gave a really nice presentation on this exact thing. Right. So, they must be seeing this in their practice that people they go on a very low carb diet and that means no vegetables and with what I know about the gut microbiome which is not much. I think this is a pretty bad strategy but the only thing I would add to her presentation I thought was missing that we know that some, there’s animal fiber right. So, certain things inside of whole animals like if you eat sardines, for example, you’re eating the whole animal then some of the collagen maybe fermentable and I’ll link to Bill Legolas from calories proper has written about this. So, I link to his article which I thought was very interesting but I’m still going to eat my vegetables. Right. I don’t think that’s an optimal strategy.
Deborah: Yeah, we’re having a little debate at the house, I’m saying, hey do you want to try this zero carb for a few weeks? No. No.
Christopher: Well this has been fantastic. I have one more question for you which is, and I honestly don’t know the answer. This going to sound like a greasy used car salesman pitch, but is your practice still open at the moment?
Deborah: At the moment, it’s not. I open it about every 6 months for about a month? And then during that month, the next 6 months, tends to fill up. So at the moment, it’s open only to memory care patients. So, patients who are interested in doing doctor Bredesen's protocol. I’ll let them in at any point but for general purposes it’ll probably be opened again in June or July.
Christopher: Excellent yeah and I know that you did a presentation for physicians for ancestral health on the Bretisten protocol. And I haven’t actually seen that talk. I couldn’t see it on the physicians for ancestral health channel. Presumably it’s unlisted but…
Deborah: It will be… It hasn’t been posted yet and I did it you know a little bit on the general protocol but really specifically a kind of little no tropics of things like bacopa monerea and ashwagandha, things that we as medical doctors don’t really know anything about.
Christopher: Okay. Well, I will find that video and I’ll link to it and show notes so people can learn more about the Bretisten protocol. Is there anything else that you’d want people to know about?
Deborah: Yes, million things but I think we can stop there.
Christopher: Okay. Well, in that case, best I have you back on in a few months’ time and we can talk about something completely different.
Deborah: That would be great. It’s so nice to chat with you, Chris, to have to meet you in person sometime soon.
Christopher: Yeah. Absolutely, we will. We will. Thank you so much.
Deborah: Thank you Chris.
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