Toxins negatively impact our health, longevity and performance in a variety of ways. Today we look at one of the most important toxins all of us are exposed to in today’s environment – mercury. It finds its way into our bodies in many ways: through our dental amalgams, the fish we eat, and vaccines, to name a few. Essentially, we are looking at quantifying your mercury burden and detoxification.

What is the impact on our biology, across the different systems and organs? How do we remove this toxin from our bodies once it’s there, and what data metrics can we use to monitor this? Are the effects from mercury toxicity heritable? Can we reverse chronic damage caused by this toxin? In this episode we’ll discuss these topics and more.

Today’s guest is Dr. Chris Shade who has personally pushed mercury burden quantification way beyond traditional tests to get a much clearer view. He has dedicated his career to tackling this problem and to the resolution and treatment of health issues related to chronic mercury contamination.

Dr. Shade is a globally recognized expert on mercury and liposomal delivery systems. He has lectured and trained doctors in the U.S. and internationally on the subject of mercury, heavy metals and the human detoxification system.

In 2006 Dr. Shade started his company, Quicksilver Scientific, which is a CLIA-certified laboratory that specializes in liposomal delivery systems, mercury testing and blood metal testing. He developed the patented mercury speciation technology used at his company. In this episode, we’ll gain a deeper understanding of the biological effects of mercury toxicity, including the effects on future generations.

“Some of these toxins have an effect which is epigenetic or transgenerational where they will actually turn down the response systems (of future generations). This is one of the biggest areas where we need to look at mercury, as a community toxin – as something that is affecting the whole gene pool.”
– Dr. Chris Shade

Besides being the mercury guy, Dr. Shade also has a wealth of information on general detoxification, and other cool subjects like binders, the glutathione system, and essential aspects of reducing general toxin burden. So we are excited to have a two part interview with Dr. Shade, incorporated here in one episode.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • How mercury acts as a toxin by competing for sulfhydro groups, displacing elements such as zinc in enzymatic reactions (4:28).
  • Mercury causes problems in the circulatory system, kidneys and brain (5:30).
  • How mercury affects your sympathetic nervous system, stimulating your fight-or-flight response (5:59).
  • Mercury’s toxic effects on future generations through heritable epigenetic changes to DNA that act to diminish the glutathione system (7:52).
  • An accumulation of metals in the GI tract disrupts the movement of toxins from the liver into the small intestines (18:13).
  • Intestinal binders such as clays and activated charcoal absorb toxins from your GI tract. Chlorella is an intestinal binder that is specific for metals (19:06).
  • Bitters normalize detoxification (20:30).
  • Discussion of sources of the mercury in our bodies- fish, amalgams and vaccines (30:10).
  • Mercury in amalgams is not inert, but volatizes in your mouth every day (32:30).
  • Master switch Nrf2 induces chemoprotective activity, releasing numerous antioxidant and anti-inflammatory genes and enzymes (35:09).
  • Phenomenal clinical response from intraoral liposomal delivery of glutathione-which is required for TH1 response of immune system (37:36).
  • Using molybdenum to enhance the effects of glutathione (40:58).
  • Problems with using the challenge test in determining mercury levels in your body (47:27).
  • Sources and relevance of different forms of mercury – inorganic and methylmercury (48:37).
  • A look at the symptoms of mercury toxicity- effects on the GI tract, joints, neurological system (anxiety and depression), glandular system (thyroid), pituitary system. Also, mercury causes fatigue (59:22).
  • How the brain and other organs accumulate mercury (1:03:58).
  • Large ocean-going fish and the risk of mercury toxicity(1:06:07) .
  • The importance of proper dentistry and amalgam removal (1:08:53).
  • Use of glutathione in binding mercury in the GI tract (1:12:02).
  • The causes of chronic damage from mercury and reversing it with glutathione (1:15:42).
  • Enhancing the production of the chemoprotective gene glutathione-s-transferase though R-Lipoic acid and polyphenolic antioxidants. Discussion of the natural sources of these substances (1:18:23).
  • Reversing epigenetic hyper methylation of genes, removing block caused by mold (1:33:07).
  • Hormetic effect of polyphenols (1:33:55).
  • Variation in length of time for mercury detox (1:38:58).
  • Dr. Shade’s personal regimen for mercury detox and data metrics he uses to track his own progress (1:49:20).
  • Healing of cavitations and rot left by wisdom tooth extractions using nanoparticles of DIM (1:53:04).
Thank Chris on Twitter for sharing his knowledge in the interview.
Click Here to let him know you enjoyed the show!

Dr. Chris Shade and Quicksilver Scientific

Tools & Tactics

Supplements and Interventions

Glutathione System Support

    • Quicksilver Liposomal Glutathione: Detoxifies body by binding toxins such as mercury. Also important for immune function. Liposomal encapsulation in Quicksilver Scientific’s product protects glutathione from digestive enzymes.
    • Quicksilver Liposomal Vitamin C & Alpha-Lipoic Acid: Used to enhance the body’s ability to make glutathione-s-transferase, which binds glutathione and mercury together.
    • Molybdenum: A trace mineral which is a co-factor in detoxification enzymes (SUOX) downstream from glutathione. As glutathione binds to Mercury to detoxify it, sulfites are generated and these need to be detoxified also. Molybdenum helps upregulate Sulfite Oxidase (SUOX), an enzyme that detoxifies the sulfites, and thus enables you to take more glutathione and detox faster without negative symptoms from sulfite intoxication.

Binders

    • Intestinal Metal Detox in “Detox Black Box”: Silica products that bind metals – a product of Quicksilver Scientific sold with other products in the Detox Black Box.
    • Chlorella: A type of algae grown in fresh water, which is used as an intestinal binder specific for metals.
    • Bentonite Clay: An intestinal binder. Binds toxins as it moves through the stomach, but does not get absorbed.
    • Activated Charcoal: Similar to charcoal, but designed to be ingested. An intestinal binder that traps chemicals, preventing them from absorption.
    • Acacia Fiber: A soluble, fiber-based intestinal binder.
    • Cholestyramine: Binds bile in the gastrointestinal tract to prevent its reabsorption.
    • Psyllium Husks: A bulk-forming fiber laxative used as a binder.

Bitters

Bitter herbs that stimulate flow from the bile to the small intestine, which is the route that the toxins take. These aid the body in detoxification by ensuring the essential transport of toxins.

Tracking

Biomarkers

Mercury Speciation Assessment & Other Used by Chris Shade

    • Methylmercury (MeHg): Methylmercury is the type of Mercury that bioaccumulates in our bodies the most. It originates primarily from fish consumption, with some made in the gut through amalgam mercury that is swallowed. Body burden of methylmercury is assessed through whole blood levels, while your ability to detoxify and excrete it is assessed through mercury hair levels, where most of it gets excreted. Ideally these should both be low, but if your body burden is high, it is better to have higher excretion levels, thus indicating a good capacity to detox this type of mercury.
    • Inorganic Mercury (HgII): This type of mercury does not bioaccumulate as easily, however it is far more damaging to the body than methylmercury. It primarily comes from metal amalgam fillings in the mouth. Body burden is assessed via a whole blood measure, while excretion ability is assessed via urinary inorganic mercury, as this is the main excretion route for inorganic mercury. High inorganic mercury levels are nearly always associated with amalgams, potentially hidden ones that you aren’t aware of.
    • Thyroid hormone tests T4 (Total thyroxine) and T3 (Triiodothyronine): A combination of excessive T4 and low T3 is a marker for metal toxins (mercury, cadmium and arsenic).

Popular Mercury Burden Assessments

  • Urinary Mercury Post-Chelation: Chris discussed this as a less accurate, but more popular mercury biomarker, and outlined why chelation challenges were was used based on the history of lab testing detection capabilities in order to estimate Mercury body burden by raising the mercury levels temporarily to more easily detectable levels.
  • Urinary Mercury: Sometimes also called pre challenge urinary mercury, this is a straightforward measure of all mercury excreted in the urine. Depending on the lab equipment used, this method may show you have low or no mercury levels, due to detection limits of the equipment used.

Glutathione System

  • F2 isoprostane, deoxyguanosine, and oxidized LDL: Oxidative stress markers used as downstream markers of glutathione rather than measuring it directly, because glutathione moves too quickly through your system. Made by Cheryl Burdette at Dunwoody Labs. We discuss these oxidative stress markers in depth in The Quantified Body Episode 4, so check there for more information. Dr. Shade just started a clinical trial looking at changes in these markers.

Lab Tests, Devices and Apps

  • Mercury Tri-Test: Testing done by Quicksilver Scientific which involves mercury speciation testing to separate methyl mercury from inorganic mercury, and measure each directly. See Damien’s Quicksilver lab report as an example.
  • Advanced Oxidative Stress Profile: Oxidative stress testing done by Dunwoody Labs, please check link for details.
  • Urine Mercury from Doctor’s Data: This lab which is the popular mercury test used by most doctors was discussed as a comparison method to the speciation method used by Chris Shade. It’s used for the pre and post challenge (chelator) mercury biomarkers. Many doctors use the post challenge test with DMSA as the chelator, and it is sometimes referred to the ‘gold standard’ (the reasons Chris believes this is not accurate are discussed in the interview).
  • Visual Contrast Sensitivity (VCS) Test: Damien mentioned he uses this test to monitor exposures to mold toxins and to test the effectiveness of detoxification binders. It’s on online computer test that provides a screen based on the fact that toxins interfere with your eyes ability to distinguish between subtle contrasts.

Other Resources Mentioned

People

    • Boyd Haley, PhD : Recommended by Dr. Spade. Developing a chelator for mercury detox. Also, he has a product, Oxidative Stress Relief, which assists glutathione in scavenging free radicals.
    • Cheryl Burdette, ND at Dunwoody Labs: Recommended by Dr. Spade. She has lectured together with him at the Metabolic Maintenance Institute. Cheryl is an expert in improving your health by measuring and addressing your oxidative stress; Please check out Quantified Body Ep.4 for details.
    • Leo Cashman at DAMS (Dental Amalgam Mercury Solutions): Director of non-profit organization which educates people on mercury-free and non-toxic dental solutions. Leo is a relentless advocate for safe dentistry, and keeps a list of good dentists.

Books

  • Diagnosis: Mercury: Money, Politics, and Poison: A book by Jane Marie Hightower. Dr. Spade refers to an excerpt about an investigation into the prevalence of mercury poisoning. Affluent women who had neurological problems were found to have high levels of blood mercury. It turned out that they ate large amounts of swordfish.

Full Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Chris, thank you so much for coming on the show.

[Dr. Chris Shade]: Thank you. I am very happy to be here Damien.

[Damien Blenkinsopp]: Excellent. So let’s dive straight into – you have made a really big name for yourself as a mercury kind of guy, and mercury as a toxin. So let’s just look at that straight away. Is mercury a toxin, and what kind of health impacts does mercury have on us? Why is it bad?

[Dr. Chris Shade]: That’s the funny thing. You know, is mercury a toxin? Like we haven’t known for 10,000 years that mercury is a serious toxin, yet for some reason the narrative from the dental associations continues it somehow. It’s not a toxin in your mouth. But it is most definitely a toxin and it has a lot of effects through the whole body and it is just a basic way that it does things. It is by binding to these things called sulphydro groups. They are special kinds of sulphur that really run your antioxidant system. They set the ground for the immune system working and they hold all of your good metals. So if you are using a zinc in an enzyme these sulphydro groups hold the zinc in place. But unfortunately the mercury has an affinity for those same sulphydro groups and it is actually on the order of one to ten billion times higher affinity for those groups than the zinc does. So it starts getting into all the enzymatic reactions and it is important that we are not thinking that these are digestive enzymes. Everybody thinks of enzymes, oh yeah, digestive enzymes.

Now, digestive enzymes make your stomach digest at infinitely higher rates than just the acid in your stomach would do, but enzymes in your cells make reactions happen that aren’t favorable to happen just in the milieu of the cell. So they are really responsible for the whole body really working the way that it does and mercury interferes in all that. At a systemic level it is interfering. At a circulatory level it is creating little inflammatory states in the circulatory system. It is creating porosity or leakiness in the circulatory system. It is creating porosity or leakiness in the brain. It is creating problems in the kidneys and that can go from adrenal fatigue to actual damage to your filtration mechanisms.

In the brain it has got a lot of problems that really set you up for failure. Very specifically it targets the glutamate receptors. So in your brain you have got GABA and glutamate being the dominance of your neurotransmitters. And GABA is sort of your zen neurotransmitter and it puts you into a parasympathetic or resting, digesting, repairing state. And glutamate puts you into a sympathetic system or a sympathetic tone to your autonomic nervous system where it is fight or flight. But it also does good things. It creates memory so you know to stay away from the tiger but it puts you in this stressed state. And when the mercury gets in there, there is a hyper stimulation of the glutamate receptors so you have an exaggeration of being in this sympathetic state. So you start to feel fight or flight all the time and that creates anxiety.

So anxiety is the dominant manifestation neurologically of that but then that leads to fatigue and depression as it burns out the system. So yes, mercury does a lot to your body.

[Damien Blenkinsopp]: Great, and I like the explanation you gave because we hear a lot about toxins today. And I don’t think anyone really knows what that means. We take something into our body and it hurts us somehow. But you know, you just described it in a pretty clear way, that it basically gets stuck to bits of our body and changes what it does into something that it shouldn’t be doing or it stops it from doing what it is supposed to be doing.

[Dr. Chris Shade]: Yeah, and ideally what happens is a toxin gets in there, irritates some part of the system, and there is what is called an hormetic response. Hormesis is irritating the body and the body bounces back with its repair signal to get rid of that. So it will detoxify and then repair. But some of these toxins have an effect that is epigenetic or transgenerational where they will actually turn down your response system and this is one of the biggest things where we need to look at mercury as a – what should I call it? A community toxin. As something that it is doing to the whole gene pool. One of the things that we find in research done on animals is that if we expose an animal in utero to a lot of mercury it is born and it may not have acute mercury toxicity but what it does is create a diminishment of the glutathione system.

The glutathione system is one of the dominant ways that you detoxify and then repair. And so you are suddenly born not with acute mercury toxicity, but with a lifelong susceptibility to further toxic insults. And those toxic insults can be from mercury or other metals or all of the organic compounds, [persistic – 00:05:59] organic pollutants, chlorinated, halogenated hydrocarbons like flame retardants. All of a sudden you are a susceptible organism. And somehow we get away as say industry gets away with saying no, there is no problem with mercury because look, you don’t have acute mercury toxicity.

But it just made this generation of children more susceptible to the next rounds of things coming at them. And the way these toxins will add together and have some of them make you weaker towards other toxins is really what needs to be seen and you and I were talking before the interview about me trying to get people away from thinking just about acute toxicity towards systemic ability to hold back this flood of toxins and really how the body’s defense mechanisms get weaker under various scenarios which then given a moderate burden with a system with integrity, there is no issue. But with a system that has lost integrity due to a number of factors that person is now going to suffer what looks like acute toxicity at much lower levels. So we need to integrate these views of what toxicity and defense mean.

[Damien Blenkinsopp]: Great. You touched on so many different angles there. Let’s just nail the epigenetics quickly. So you are saying that it is not actually a transfer from say the mother to the child of mercury itself, but the actual bias or the methylation or acetylation has been biased when it is being transferred because it was already biased in the mother. So you couldn’t detect mercury in that child, for instance. That is what I am kind of getting at.

[Dr. Chris Shade]: Exactly. You can right when they come out but it goes away very quickly. All these people – I mean, I started thinking about this when I came on to the scene and all these people come up to me and they are like, ‘I know I am mercury toxic.’ And they send in the test and there is nothing there. And then I went to interviewing them ahead of time. Well, do you have amalgams? No. Do you eat fish? No. It is from my mother. And so the scientist in me was kind of like yeah, yeah, it is all from your mother isn’t it? This is an emotional problem, I think. Until the data started coming out and they would take groups of rats and they would expose one group to mercury while the rat was pregnant with the pups, as they are called, and the other to no mercury.

And then they tracked these and just a little – they would stop the exposure right when they were born and after a couple of weeks the mercury is all gone. But the epigenome is still there. The genome is biased towards having a lower expression of the very thing that it needs. And this bias continued for some time. In fact, what is supposed to happen is that they are born and they are born with a weak defense system because they don’t want to reject the mother. And then it comes out and expresses itself over the couple of weeks after they are born. Because the detox and the immune system come up together. And they are reliant on each other. We never really understood that. We thought they were different things but if your glutathione system is low your whole immune system bias is towards TH2, which is why these sick people have no ability to respond to viruses, which is called TH1. But they are allergic to all their food, and that is called TH2.

So you have got this biased immune system that is predicated on the lowered glutathione system. So back to these animals that are born and their whole glutathione system fails to develop the way it is supposed to. There is no more mercury to point the finger at so we get away with saying, ‘See, it’s not mercury that is the problem but the system is now susceptible to every insult that comes its way.’ And it was because of the exposure at the mother’s level.

[Damien Blenkinsopp]: That is really interesting. Is this new research or is this ongoing?

[Dr. Chris Shade]: Well it has sort of just been pouring out over the last couple of years and you have to be able to see it and connect it to all the stuff that you have seen clinically and tie all those points together. I mean, we are at a point where there is so much research out there but those researchers don’t know how to get it out to you. And they don’t know how to tie it together with a couple of other things. And frankly they are scared, completely scared to say that it actually has any human relevance at all because they are afraid they will lose their funding. Because somehow something happened where all the funding for this kind of toxicity research only goes to environmental data. It only goes to working on animals and looking in the environment. It is never pointed at the human world.

There is some sort of fear, probably at the industrial level of what the – but also at the public health level or public health officials. I think they are afraid of what the implication is with their allowance of mercury in the mouth and in the vaccines. And there is some fear there. And it is very justified and we need people to be able to tie this stuff together that won’t lose their funding and will be able to continue in their profession. So it is people like me, because I don’t get funding from anybody. That may kill me but I don’t think that will be happen.

[Damien Blenkinsopp]: That is not going to happen anytime soon. You have been around long enough. You have been doing this for around 20 years now?

[Dr. Chris Shade]: No, it just feels like that. I had been in graduate school in mercury research since 2000. So that is almost 15 years. But I started this company in 2006 and I really only started doing clinical work in this company in 2009.

[Damien Blenkinsopp]: Great. So a couple of things that I wanted to tie up that you were saying before. You talked about glutathione and how mercury affects glutathione. Then you were talking about the fact that we have a toxin like mercury in our system and if we have things in our system that protects us we can be okay with a relatively high level of mercury if our system is really good at dealing with it, right?

[Dr. Chris Shade]: Exactly.

[Damien Blenkinsopp]: So what is that system? I mean, it is glutathione? Is it other things?

[Dr. Chris Shade]: Beautiful – thank you so much for saying what is that system because that is what I am always trying to teach. Glutathione on its own is relatively impotent. It needs – it has got so many functions through the body but it needs enzymes that drive it into each of those functions. So if we wanted to quench hydrogen peroxide or fix that lipid peroxide, we need glutathione peroxidase to make that happen. If we wanted to bind to mercury that is stuck to a protein, we need glutathione as a transferase. So we need the glutathione. We need the glutathione as a transferase to catalyze the movement of the mercury. Or, let’s side track – or arsenic, or cadmium. Transfer that from the cellular protein on to the glutathione.

Use the glutathione as a transferase. But now we have got, in the cell, a mercury-glutathione conjugate and we want to get that out of the cell. And now we need the transport system, and these are membrane transport proteins called multidrug resistance proteins and they are going to use ATP and magnesium to shuttle that mercury glutathione conjugate from the cell to the blood.

Now, we have got another transporter in that family to pull it from the blood, into the liver, then other transporter. Then dump it from the liver into the small intestine through the bile duct. Those transporters are also working in the proximal tubules of the kidney and they are working in the intestines. So we have this movement from cell to blood. Well, first, we have conjugation with the metal, movement from cell to blood, then filtration out of the blood through kidney, liver, and intestine. And right all there is the whole game of detoxification.

[Damien Blenkinsopp]: So you are talking about transporter proteins at each one of those steps?

[Dr. Chris Shade]: At each one of those steps so we need from inside the cell to out of the cell and then we need filtration and those are also transporter proteins and they go into the liver, right to the intestine, or into the kidney and into the urine. Of all those, the movement into the liver is the most important and that movement can be blocked and especially what gets blocked very easy is the movement and then the propagation of that movement from the liver into the intestine. It will move from the liver into the gallbladder through the bile transport and then to the small intestine. And what I see a lot of is a block between liver and small intestine.

Now, we go to our tribal knowledge, the greatest – we shouldn’t even call them tribal because they have become very scientific over 10,000 years – our systems of Chinese medicine and ayurvedic medicine. In Chinese medicine, liver, small, intestine, you bring that up to good TCM guys and they understand that as a communication system. And in our new biochemical science there is great work that demonstrates how liver and small intestine decide together how to metabolize toxins, both endogenous ones that we create and exogenous ones, the ones we take in. And when they lose the ability to communicate there is this disruption in detoxification and that disruption that blocks the movement from the liver into the small intestine I see all the time. And it can come through an accumulation of metal in the GI tract.

So in our teaching of how to detoxify, fundamental to it is to move the metals and other toxins out of the intestine and that goes back to really what has been known for a long time in naturopathy in what they call generically intestinal binders. Intestinal binders are things that move through the stomach and are not absorbed, but as they go through the GI tract they absorb the toxins. So this is the simplest of those, the clays and activated charcoal.

Then we move into ones that are more specific for metals and in the naturopathic world that is chlorella, which is insoluble cell walls of single-celled algae. And in those walls there are sulphydro groups that are bound to those walls and those sulphydro groups do the metal binding. And then you move up through ones that we have designed to have lots of sulphydro groups, like the product that we make that is a doctor product called IMD. And these are silica products, silica particles that are not absorbed. They have incredibly high surface area. They make clays look like low surface area – 300 yards per gram of this. And they have the sulphydro groups all bound onto that surface. And they go through and they bind all those metals and they take them away from those transport proteins and away from the walls of the stomach. So this chlorella can move more toxin down to the GI tract.

So working from the small intestine to clear up the small intestine, allow it to sort of reassociate with the liver, is really, really big. And one of the things that I am moving into my product line now that I am just totally enamored with is bitters. We have been using bitters – at the turn of the century it was the cure-all for everything in this new world here, but it is an old European thing. Forever the European [lineages 00:20:42] have loved bitters because bitter herbs like gentian and dandelion stimulate flow from the bile to the small intestine. And that is the route in which these toxins are moving. And we have cholestasis, blockage of the gallbladder, failure to move bile in for – bile does two things. It moves in to digest fats but it is also the highway along which all the toxins are moving. So, using bitters is really, really important for normalizing detoxification.

[Damien Blenkinsopp]: Great, so basically the main principle that you have here is you are trying to ensure that the flow is continued, right? That is one of the roles of the bitters, for example. And you are also trying to make sure the toxins are not reabsorbed and they are bound to exit them, which is what you are talking about with the binders. There are bile binders and then some of the other ones you are talking about. You did mention your product and you said it was a bit different. You called it IMD. What does IMD stand for?

[Dr. Chris Shade]: Intestinal metal detox.

[Damien Blenkinsopp]: Okay, all right. So the function of it, basically.

[Dr. Chris Shade]: The function is very specifically for the metals and it is to – so if we back up into the binders then we have got a world of different chemicals coming in. And there is no binder that can get every one of those different chemicals with all of their different properties. So there are classes of chemicals that each binder is good at. The most universal binder is charcoal and it does a little bit of everything. Now, you have got metal-specific binders like IMD – very, very powerful on metals and seems to do good on mold toxins but that is really its world there. Then you have got the clays like bentonite, zeolite. I know the zeolite marker is the thing that binds everything. But its ability to bind mercury is like zero. But it is very good on a number of different pesticides and herbicides.

In the mold toxins, almost all the mold toxins so on to charcoal beautifully except for the food-based mold toxin aflatoxin, which is very specific for bentonite or zeolite. And then you have got one of my favorite other binders chitosan. And that is known in the health world as being a fat binder but it is not a fat binder. It is a bio binder. The prescription biobinders are cholestyramine and welchol. Chitosan is virtually identical to welchol. The strongest of them all is cholestyramine but it can be a little binding in terms of making you constipated. So I liked a cocktail of cholestyramine, activated carbon, a little bentonite or zeolite and the IMD. And you covered everything.

The reason that we like the bio-binders that we didn’t mention in terms of toxins is because the biological toxins, Richie Shoemaker is the original guru on this. The biotoxins that you will get from molds, both growing in you and growing around you, are conjugated to different things like leukaronic acid and sulphate and they go down to the GI tract and they are biomed very effectively by cholestyramine, welchol, and chitosan, and protected against reuptake because they are internally recirculated. They have biliary recirculation and you reabsorb them. So you want those to stick on to the cholestyramine, welchol, or chitosan.

The other big toxins that are really big there are lime toxins. Lyme toxins are horrible for you, as are candida toxins. So all of those biological toxins really go after those what we call the biobinders. And that is their importance. So you put this cocktail together and you have got all toxins together and my experience with that was dramatic in terms of its clearing of my nervous system. I cleared my liver and kidneys and my immune system was functioning great by doing this metal-based stuff, but then when I did this cocktail of binders I had a very radical experience with my nervous system. It really brought it up to a higher borderline [inaudible – 00:25:17].

[Damien Blenkinsopp]: Right, I wasn’t aware we would have this discussion. I have been playing with binders myself a lot. I have been on the Shoemaker protocol because I had those kinds of issues. Later Lyme as well came along. So we are talking about these things and one of the things I was playing around with was substituting, because I was on CSM for a while, and substituting that with other things.

[Dr. Chris Shade]: Cholestyramine, yeah.

[Damien Blenkinsopp]: Cholestyramine, yeah, which I didn’t want to take forever because it is a drug and you mentioned some of the drugs. So I stopped taking that and I replaced with soluble fiber, just like Psyllium Husk supplements. And there is this thing called the VCS, the visual contrast sensitivity test. Mine is perfectly clear all the time now as long as I am taking soluble fiber.

[Dr. Chris Shade]: And if you stop with the fiber it gets worse?

[Damien Blenkinsopp]: Well, I haven’t done that experiment. I like to feel good.

[Dr. Chris Shade]: Because you kind of like it. Let’s list through the other fiber-based binders because my new best friend in the fiber-based binders is acacia gum and that is a soluble fiber. It is really cheap and one of the other things that these do, certainly the acacia gum, I think pectin does this, and they normalize the immune system and the GI tract to get you away from that hypersensitivity that people chronically get where they can’t eat everything but they host every bug under the sun. So to normalize that immune function there is a big thing and that is going to then keep down inflammatory states and increase detoxification because I didn’t say – GI inflammation breaks down this whole track of detoxification and it actually shuts down all the transport proteins until you can break that. So the soluble fibers are a big part of that and Gary Gordon was telling me that there is another product that he says replaces CSM and it is another fiber that we think of for prostate. It is almost a polyphenol. It will come to me – beta-sitosterol, that is also remembered to have these effects as well. And you are just using cilium?

[Damien Blenkinsopp]: That is what I have been using for a while. I was using chlorella and [inaudible 00:27:40] and throwing everything in there but I actually haven’t been doing that consistently so it is just the cilium. It’s an experiment. It’s an N equals 1 experiment.

[Dr. Chris Shade]: Yeah, well I would encourage you to try chitosan, charcoal, some clay, and IMD together, do the other fibers during the day and at night do this in a pretty decent dose, so you are taking a quarter to a half a teaspoon to see what happens. I mean, originally I started kind of stemming, like autistics do, and then there was this big flush of light through my nervous system.

[Damien Blenkinsopp]: Right, people are probably thinking this sounds crazy right now, but I have had some experiences where you bind this stuff and it is coming out of you. You will feel suicidal, you go to the toilet, and you feel like a new man. You feel great. So at first I thought I was going crazy but this stuff has happened several times. It is a repeatable experiment.

[Dr. Chris Shade]: And you get to see – I mean, you can do it at a slow rate and do it without having side effects if you are doing it – you have to have your system under pretty good control before you do high doses. I mean, one of the basics I teach are you start really slow and you titrate up because it can’t take you where we could go right now right away. It will disregulate the system instead of fix you. And the other thing is pulsing on and off with things that have genetic upregulation, the plant chemicals that turn up your antioxidant system and you have to pulse them on and off.

You have to work from slow up to high but once you have stabilized your system you’re not going to have what I call the cellular revolution, where you bring yourself up to higher functioning until you get through some high doses of things. But you have to get to know your system and you have to be able to know how to take yourself through those experiences.

[Damien Blenkinsopp]: This is fascinating stuff. You have obviously had a ton of experience to guide you through this because I haven’t had a discussion quite like this before. That is really interesting. I didn’t know we were going to talk about this. Let’s talk about this or let’s talk about mercury quantification, which we shall talk about.

[Dr. Chris Shade]: All the way at the limits of where this goes.

[Damien Blenkinsopp]: Well, it’s interesting because you started with mercury, of course. And then you led to this other stuff, which is all related because of the toxins and so on. So let’s just take a step back and say a lot of people don’t realize that we all have mercury in our bodies. But where is it coming from? Why do we all have mercury in our bodies?

[Dr. Chris Shade]: Mercury is an element. It is neither created nor destroyed, which means it is always out there but the problem is when we start focusing it into different areas and using a lot of it that it gets out in very high amounts on a broadly distributed level or mining of hydrocarbons that brings it out and fertilizes the air with it. Because mercury and the environment concentrates into areas that have a lot of organic matter like the jungles and swamps that produce our hydrocarbons. And so we fertilize it into the air and it rains down into the water bodies and where there is a chemistry conducive to it forming this form called methyl-mercury that moves up the food chain into the fish and we will have fish with one to ten million times higher level that water around it. So our fish are now a source of mercury.

They have always been a source of mercury coming out of volcanos and with natural cycling, but we have it at higher levels now than we used to. Then in the fish there are different fish that have high levels and low levels and in a second we will talk about them. So the main sources now, we have got the fish and then we have got where we have concentrated it down. We have mined it, we have turned it into a metal, and then we have stuck it in our mouth like that’s a smart idea. I mean, who the F thought of that?

[Damien Blenkinsopp]: Right, right. For the people at home if you have silver in your mouth basically, that is probably an amalgam, which means it has mercury in it, is that correct?

[Dr. Chris Shade]: Yeah, I mean unless it’s a nickel cast, in which case it is nickel. Do you know what the term nickel means? Nickel is Old Nick’s metal. Old Nick was the devil because the guys who worked with nickel – it just ruined them. They turned totally crazy and they couldn’t even figure out how to fix them. So it was Old Nick’s metal, that’s nickel. Mercury, [inaudible 00:32:03] HG was water silver, and it’s really a phenomenally useful metal in chemistry and it does so many different things that it was even used in medicine. But it is just such a slippery creature it easily turns bad on you. So your metal fillings were 50% mercury and maybe 48% silver and then a bunch of other metals that help harden it and bring it together. And the word from the dental people is that it is inert. It is not inert, it is just less volatile than it was as the liquid mercury. And it is volatilizing off of your amalgams every day.

We can put a little meter in there and show you. It is not only volatilizing but it is corroding and so you are swallowing one form as a corrosion product that goes through your GI system. You don’t absorb that but it disregulates your GI system and your detox system. The other form is inhaled as a vapor, which goes right into your blood, right into your brain, right everywhere it wants to. And then breaks down the mercury vapors called elemental mercury and then it breaks down into inorganic mercury, which is when it starts getting into your systemic reactions and your enzymes and your cells. That is when it starts wreaking its havoc. So our main sources now are fish and amalgam. Secondary sources are vaccines but vaccines are rapidly either losing their mercury and gaining aluminum instead. But mercury, if you don’t have amalgam or fish you likely don’t have a real big source unless you have a source in your house.

There was a lot of mercury in industry and pharmacy and there are houses people move into where somebody used to be a pharmacist and spilled a bottle of mercury in there. They used to bring it back and give it to their grandkids to play around with because it was a liquid and a lot of it would move around. And in the big picture I believe that we’re a lot more sensitive to mercury now than we used to be. That is kind of a long discussion about it but our earlier discussion about epigenetic modification of the system that makes you more sensitive to mercury is a big part of that. I think as a population we are more sensitive to the toxic inputs than we used to be. And then you are going to hate it when I tell you what happens when you get mold exposures.

[Damien Blenkinsopp]: I am really interested. I have been through all that protocol. What do you understand about Shoemaker’s and the connection there?

[Dr. Chris Shade]: Well I don’t think Shoemaker ever knew the connection. He just focused on the mold. And we think oh, well, it’s the mold that is making me toxic, it’s not mercury. So the mold – well, first let’s get back to your response to toxins. Your response is based on the glutathione system. But in the cytoplasm of the cell you have got this big master switch called the NRF2. When it gets triggered it goes into the nucleus and it tells your nucleus to turn on all the chemo-protective genes. So all the detox, boom, it comes up and clears everything out. The mold toxins epigenetically stop you from making the NRF2 protein.

[Damien Blenkinsopp]: That’s so nasty.

[Dr. Chris Shade]: It’s awful.

[Damien Blenkinsopp]: It’s really terrible and NRF2 is coming up a lot now because it is one of the tools people are using to detoxify.

[Dr. Chris Shade]: Yeah, so everybody goes okay, good, then we’ll throw these plant chemicals at them. It will turn it up and everything will get better. Now, that should have already happened. And it won’t. And it should have told you to turn up your glutathione level and get rid of all this stuff but it didn’t. So now, even when I come at you with a plant-based chemical to turn that up, it doesn’t work. The switch is broken so I have to give you glutathione and I have to find a way to get it in. That is a trick. I have to slowly, slowly nurse you back to health until we can get the toxins out and until we can get that epigenetic influence away and start you running your system yourself. That’s why it is so hard to fix the multi exposure, chronically-ill person. That is why it took you so many years and so many things to get back. That data is just coming out now.

[Damien Blenkinsopp]: Wow, so you are directly – I am guessing you are using your glutathione delivery [inaudible 00:36:32] and stuff to go directly?

[Dr. Chris Shade]: Right, and we have such great clinical response for that so using an intraoral liposomal delivery, you have to make the liposomes to do this in a certain size range, a certain purity range, and you can absorb right through the oral cavity as you are swallowing it through the upper GI. The liposomes have a great potential but they are really based around all their great data with all through subculture studies and injections. Once it hits the acid it is one thing, in the stomach, but the bile and the lipase – they are [surfactants 00:37:16]. They destroy your liposome system and so you really have to get absorption going as soon as you can in the upper areas.

So we have gotten phenomenal clinical response using this intra-oral delivery of glutathione and with the sick people we have to go real slow because it stimulates so much response in the system. And the most classical thing that we see is after a couple of weeks on our system the people who had Lyme disease but were the 70% of them that were non-testers, they go through a crisis and you test them and they all test positive. Because the glutathione is what the TH1 response of your immune system to that invasion is predicated on adequate glutathione. And when it doesn’t have it, it can’t create the immune response which is the basis of the testing for the Lyme.

So all of a sudden they feel like crap and I say go get your Lyme test or your Epstein-Barr test or your mycoplasma test. Test as much as you can and boom, boom, boom, I was positive for all these things when they weren’t before. And so it has really proven to be a great way to get the glutathione into the system.

[Damien Blenkinsopp]: So just take a step back there. You said that you can clinically test if it is having an impact. So when you add liposome or glutathione, what are you seeing? Are you looking at new blood markers or what is going on there?

[Dr. Chris Shade]: Well that was the problem in the beginning and it is true for all the guys who make any kind of delivery of glutathione. It is very difficult to look at blood levels of glutathione, give them a dose, and see it happen. Because the glutathione very quickly propagates through the system and your blood has kind of set points for the glutathione level in the blood. And that signal kind of wipes out what you’re trying to look at there. So you kind of have to look at end markers. And so as a sort of community of people who make glutathione products were just finding how to test these. So I had talked to you about using some of the marker tests. I talked to you about talking to Cheryl Burdette from Dunwoody because they have nice F2-isoprostane, deoxyguanosine, oxidized LDL.

We just started a clinical trial where we are looking at changes in those markers because really biopsies would be the best thing. But most people aren’t up for biopsy testing. It is a little tricky and so we are just starting to find all the markers to really read and to quantify that. When I say clinically it has been working out well, looking at people’s response to it. Now using the test is people are testing positive for Lyme where they hadn’t before because the Lyme tests were all based on the body’s immune reaction to Lyme, not on testing the Lyme itself. So the glutathione has been working out really, really well for us.

[Damien Blenkinsopp]: Excellent. We spoke to Cheryl Burdette before about those markers, so people can go and check out that episode if they don’t know what we are talking about there. But basically you are looking at the downstream impact of the glutathione rather than try to measure it directly. So you can see [inaudible 00:40:33].

[Dr. Chris Shade]: Exactly, it’s a real trick.

[Damien Blenkinsopp]: Well, it’s nice. That is a nice way to look at it. So you said that you have to go very easy with adding liposomal glutathione to people so I tried many times to use liposomal glutathione personally and I feel way, way worse whenever I do that. So I guess I am fitting into your situation there?

[Dr. Chris Shade]: Yeah, you have to move slow and make sure that you have enough [inaudible 00:40:58] in your system. I mean, that was one of the greatest things towards helping detox that has come from the methylation groups like Ben Lynch and [inaudible 00:41:08] and all the methylation obsessors. It is the integration of the methylation in with the sulphur metabolism cycle like [inaudible 00:41:19] beta-synthase and suox where they are taking sulphur groups, spinning them out towards sulphate, and they are building up as sulphite and you are getting sulphite toxicity. And so when you are taking things from the garlic and onion, the [altium 00:41:39] groups and the broccoli seed extract. A lot of people would feel much worse on them and they would say it’s a herxheimer or a detox reaction, or I am killing my bugs that are dying off. No, you have sulphide toxicity because they all have upregulated probably epigenetically as well as straight up genetically have upregulated CBS activity. They are spitting everything towards sulphate. It is building up as sulphite, which is a toxin, and they feel toxic from it. You give them Molybdenum and that whole pathway is smoothed out. I was one of them too.

And because they are like that I moved towards using polyphenols as NRF2 upregulators and the only sulfur compound I use is lipoic acid because I can get a lot of upregulation without a whole lot of sulfur. And I didn’t know exactly why that was and now I know it is CBS issues. And I stayed away from using too much of the alliums and the crucifers. But now we know molybdenum can help them use that.

Now, back to the glutathione you are bringing a lot of sulphur back into the system and you may need molybdenum to help move that but you want to start with low doses. A lot of people, like if you were using one of the other products that is out on the market. Most of them are dosed in teaspoons or sachets that are 400 to 500 mg per dose and it is way too much. And one of my friends who got me in early in this world is one of the now late and great old heroes in this movement and that was Hal Huggins. And he had done a lot of work with liposomal glutathione and he said no more than 100 mg, I think 25 mg. And there are a number of reasons for that. One is that you have to start high but you also have to see what byproducts are in the liposomal glutathione.

if you are smelling a lot of hydrogen sulfide that is not a liposome, that is hydrogen sulfide. And some of these products decay very quickly and so some of those can irritate the sulphur system. So you will have to nurse back – one, you have to deal with the glutathione stimulating your immune system and the detox system and two you have to handle all the sulfur that is coming into the system so you have to start low. I mean, ours can dose by the pump and each pump is 50 mg of glutathione and for really sick people it is like that once a day and then we slowly work you up. I mean, as you get into this deep, you might be doing 500 mg twice a day.

[Damien Blenkinsopp]: That’s amazing. Chris, you are full of a wealth of information on this detox subject. So anyway you have this company called Quicksilver Scientific where you establish this testing which is different to a lot of the functional medicine testing which looks at mercury.

[Dr. Chris Shade]: Oh yeah, this is totally different.

[Damien Blenkinsopp]: Right, can you give a quick background on the original testing that you were in that posed a challenge and the weaknesses of that and then what you have done to quantify the burden as best as possible?

[Dr. Chris Shade]: Yeah, so the challenge test is what was in place here before I got here. And there was a reason to use challenge tests years ago. There is still some reason to use them but they don’t give you a whole lot of information about your mercury. And this is for a couple of reasons. And they are also the hardest on the patients that need this the most, the really chronically ill people. So a challenge test, you take some chelater that solubalizes mercury in your blood and lymph and drops it through your kidneys. And it accentuates a signal that was already there. So if your urine is say, two points of mercury and we give the chelator it becomes 20 points of mercury. If your urine is three points it becomes 30 points. You know, maybe it is 100 fold.

We will go 100 fold for DMPS. SO it goes from 2 to 200 and 3 to 300, so it becomes much easier to see what is going on there. And we didn’t used to have super-sensitive equipment and obviously quite often we would see no mercury in the urine until we would chelate it and then we would see mercury. And that was just because our detection limits, how low we could see, weren’t very good. So we needed to stimulate the urinary output so that it came up to the window where we could see it. Right now we can see just about everybody at just about any level and we don’t need that stimulation anymore.

[Damien Blenkinsopp]: Does that go for everyone’s tests? Like the doctor’s data and all of these other labs? Are they a much lower detection limit now or is it your specific ones?

[Dr. Chris Shade]: Well, they could. I think they are still doing it the same way. They could have limits where they are much lower, but they are really running things the same way they always have and that makes it, for your end – it is making it affordable for you. It is a fairly cheap way to see all the metals at once.

[Damien Blenkinsopp]: Right, if you use the post challenge, like you were saying.

[Dr. Chris Shade]: Right, yeah, but if you want to really get all of the biochemical information, the biosignature of the mercury in the body, you have to move towards what we do. But now, just back towards one of the hitches with doing a challenge test, number one, if your excretion of metals out of your kidney is strongly impaired you will not get that metal that has been solubilized in your blood and lymph and out through your kidney you will get a false positive and you will feel like hell.

Number two, if you are – well, two is kind of an extension of the first one. If you are chronically ill moving that much mercury around other metals around at once makes you feel really bad. And that is not what you need.

Number three, you don’t know what form of mercury you are building up. Was it methylmercury from fish? Was it inorganic mercury from your amalgams? What was going on in there? So there is a limitation on how much information you get about source and of course, it could be totally blocked by excretion markers.

[Damien Blenkinsopp]: So they just put out one class of mercury. You don’t know what type of mercury is there? Are the only types that are bad for us methylmercury and inorganic mercury?

[Dr. Chris Shade]: Well no, there are other bad forms you just don’t get it so much. So methylmercury is an organomercurial but in the vaccines it was ethyl mercury, which was also an organomercurial. But the ethyl mercury pretty quickly breaks down into inorganic mercury in the body. So really you have got elemental mercury coming into you through the air from your amalgams or from your environment. That is becoming inorganic mercury. You have got methylmercury coming in from the fish, which stays as methylmercury but some of it breaks down to inorganic mercury. Then you have got ethyl mercury from vaccines coming in and that is really ending up as inorganic mercury too. So the most relevant measures are the inorganic and the methylmercury.

[Damien Blenkinsopp]: Great, thanks for that clarification.

[Dr. Chris Shade]: And then when you get over to our testing we want to know how much of which is in there and we are going to go – we are going to do blood, hair, and urine. And blood is – everybody talks about burden. What is the body burden? So a lot of what grew up around the challenge test is the challenge test was really a way that given our old technology we could see and get a good feel for what was in there for what we had available to us in technology. But everybody grew this mythology up that it was the only way to see the body burden and this mythology that somehow these chelators mystically got into every cell, took a representative amount, and came up through your kidney and told you what the body burden was. In those from the 90s through early 2000s, a lot of academic groups went and evaluated whether that was correct. And I have a white paper that is on our new website about challenge testing and it discusses those five papers. And those five papers came to the conclusion that all that signal was there in the testing without the chelators, the chelators just accentuated what was going on. However, you did need decent testing to show that. And now we have that testing available to us.

[Damien Blenkinsopp]: Has it got a specific name or are you using something different?

[Dr. Chris Shade]: The testing that we are doing is called mercury speciation testing where the speciation part is separating in the samples, separating the methylmercury from the inorganic mercury so we can look at them independently.

[Damien Blenkinsopp]: And is there a level you are looking at? Like, is there a specific – when you say it is lower level.

[Dr. Chris Shade]: Well people used to be able to test – first it was in the parts per million range and it didn’t seem much and then they got down into parts per billion. We can look into parts per trillion to parts per quadrillion level. And this was all necessary for doing environmental stuff. So I built my analytical system at the University of Illinois and we built it to look at this parts per quadrillion levels of environmental mercury and then when I came into clinical we applied it to clinical. And the other thing that was out there about clinical testing in the challenge world was that blood was a lousy marker and it only showed you the last two to three days of exposure.

Now, I don’t know how that go out there because since the 70s they have known that the half-lives of these forms of mercury were anywhere between 50 and 70 days in healthy people and out to 240 days in unhealthy people. But somehow the mythology became two to three days. But really blood’s problem was that it disproportionately showed you your methyl mercury burden over your inorganic mercury burden and once we separated these two it became very, very clear and that was just because of the way that methylmercury distributed between blood and organs versus how inorganic mercury distributed between blood and organs.

Once we separate them, they are phenomenal measures. In fact, methylmercury is a perfect measure of body burden. Inorganic is pretty good – it is not perfect but it is pretty good. It is a little bit slower to distribute between when the blood comes down and it is slow to come out of the organs and resupply, so it is a little bit slow. So urine had always been used for inorganic mercury exposure because urine is all inorganic mercury. And if your kidneys are working well it is a very good representation of what the blood is, which is then a representation of what the body is. But if the kidney transporters are not working well and this is almost universally how the sick people are – they have got low filtration capacity and the urine is falsely low, giving you a false negative. It is only once we can directly compare mercury in the urine, inorganic mercury in the urine, to the blood inorganic mercury that we have got a direct measure of the metal filtration capacity of the kidneys and with that marker right there, those combinations of the blood inorganic mercury and the urinary mercury was a beautiful one to see this blockage and detoxification.

[Damien Blenkinsopp]: Great, so the change for you has been a lower level of detection for the urine plus the blood and you also had the hair in. Why are you adding the hair test?

[Dr. Chris Shade]: So urine is our excretion measure for inorganic mercury. Blood is our reservoir or burden measure for inorganic mercury. Then blood is our burden marker, our reservoir marker, for methylmercury as well, so methylmercury as well, so blood methylmercury. And then our excretion marker for methylmercury is the hair. Ideally because methylmercury doesn’t come out the urine. It is conjugated to glutathione and goes through the liver, bile, small intestine, fecal excretion. But there is a lot of changes to it as it goes through the GI tract and so the ideal measure would be bile, a bile to blood measure, but we can’t get that.

Hair has a history of papers done on it where the sickest people for a given exposure have the lowest mercury levels in the hair. And so the hair to blood ratio, blood, methylmercury very hair, hair is all methylmercury. There is no inorganic mercury excreted in the hair. So the hair to blood is our methylmercury excretion measure, whereas urine to blood is our inorganic mercury excretions.

[Damien Blenkinsopp]: So it is showing how well it is getting excreted.

[Dr. Chris Shade]: Yes.

[Damien Blenkinsopp]: So it correlates well with the stool because some gets excreted in the stool?

[Dr. Chris Shade]: It correlates pretty well with the stool. Really getting a good stool measure, you would want two days collection homogenization and you send it in. People really don’t like doing tests.

[Damien Blenkinsopp]: Right. Is that why you don’t do it? It’s not something people like doing?

[Dr. Chris Shade]: There’s no compliance on that unless you have got serious GI parasites and then people will do anything. And if they don’t have parasites they don’t want to do that. They just don’t want to do that so we use the hair as a surrogate measure for how the excretion is working.

[Damien Blenkinsopp]: Great, excellent. So with this, what type of mercury it is and how well it is getting excreted or not?

[Dr. Chris Shade]: Yeah, we do. And once you get used to looking at that whole picture you can look at some other processes in there. For instance, say you have only got – now let’s talk about relative toxicity of the different forms. But not nearly as toxic to the cells as inorganic mercury is. And methyl usually has a rap for being the most toxic. But it is just absorbable. So if I feed you inorganic mercury you won’t absorb it. It will just ulcerate your GI tract. It won’t make it to the brain. But if I feed you methylmercury you absorb it, it goes to the brain, and you see it’s toxic. But once they are in the body the inorganic mercury is more toxic. And if we look at animals that eat fish, the ones that demeth a lot, they break down methylmercury into inorganic mercury, they have the highest toxicity in the body.

In the brain they have the highest neurotoxic lesions on the glutamate receptors, or what I was talking about before, this hyper anxiety which causes neuroinflammation. We are able to see fish eaters without amalgams who is releasing more of the methylmercury, breaking it down into inorganic mercury. We know that those people are going to do worse on fish than the people who don’t break down so much. So we contract that demethylation movement. In other animals the toxicity from demethylation is in the liver. So we know that demethylation is a risk factor for fish eaters and we’re able to see how that methylmercury drops down into the inorganic mercury pool. So there are a couple of things that we see about how the body is processing these different forms of mercury.

[Damien Blenkinsopp]: Great, fantastic. We have kind of already gone over our mark and there is so much more to talk about because you kind of know all these other subjects. Would it be better to have another episode another date?

[Dr. Chris Shade]: We can definitely follow up and talk about treatment approach and results that we have seen, hitches in the road. There is something down here about biomarkers I like to test. I think that should be a whole separate interview.

[Damien Blenkinsopp]: Yeah great because we have already covered so much here. So just to leave off today, just to get it clear for people, who should consider that mercury could be behind some issues they have, whatever they are. We talked about the anxiety, specifically, but in your opinion, if you are someone at home what kinds of things would you be suspicious of and think about, getting this types of tests?

[Dr. Chris Shade]: Yeah, well one, do you have the source? Because the dysfunction that comes is common to a lot of dysfunctions or common to a lot of disease states, these morbidities we talk about. But the most common ones that come around with amalgam-based mercury are GI, joint, then fatigue issues. It is wearing down and weighing on the system.

The neurological problems, and this can come from amalgam or fish are anxiety and depression. The depression can either go along with the adrenal fatigue and sort of chronic fatigue pain syndrome that can be caused by the metals or you can have anxiety and depression cycles where anxiety is keeping you sympathetically stimulated until you crash and go into depression. So that sort of constellation of problems is the most obvious one.

In the glandular system, mercury is a serious glandular toxin and thyroid is most commonly hit by it and you will see if you are looking at quantifying things, mercury and then also cadmium and arsenic poison the deiodinase that takes T4 to T3, so if you are pooling up T4 and failing to get adequate T3, that’s a pretty specific marker for metal toxins, mercury for one but cadmium and arsenic also do that. Pituitary disregulation on a metal side is more specifically mercury and it builds up in the pituitary.

[Damien Blenkinsopp]: Great, and the pituitary can have impacts on lots of things?

[Dr. Chris Shade]: Every gland. So if we were looking at hormones and you found it was your failure to make testosterone it is not peripheral, that it is – you are failing to get stimulation from the pituitary and you are not making the – I forget which one it is now, luteinizing hormone or whichever one it is that stimulates testosterone. If the pituitary is failing [inaudible 01:01:12].

[Damien Blenkinsopp]: Great, thank you for your overview, Chris. That will help people kind of put a frame around everything we have been talking about today. Yeah, let’s continue this discussion with the other parts to treatment and some of the products and protocols and things that you have used and how you have been tracking progress and so on on another date.

[Dr. Chris Shade]: Yeah, because then when we get to talking about that you will see that oh my God, this isn’t just mercury when we treat it. We are treating that globally-dysfunctional glutathione system. These things that we thought were side effects of detoxification like all this fatigue is the immune system actually responding to chronic infections. So it is a much bigger thing than going after mercury, it is going after bringing the wellness back to the body.

[Damien Blenkinsopp]: Well, that’s great. Chris, it has been great connecting with you, really. I think you have helped me with a few of my personal things with this discussion already and you are a fantastic talker. I look forward to having you on the show again.

[Dr. Chris Shade]: All right, thanks so much. You take care now, Damien.

[Damien Blenkinsopp]: Have a great day.

[Dr. Chris Shade]: Bye.

[End of Audio Part One

[Damien Blenkinsopp]: So, what I think we have left is to basically talk a little bit about finalizing the [inaudible 01:02:47] test. Is that the best we are going to be able to get in terms of mercury burden testing? Your perspective on that?

[Dr. Chris Shade]: Well, I think it is going to take some time but the next generation will be figuring out a way to be imaging it organs, especially the brain. I think the one trick that we still have is that we are trying to apply some number that we get to the mythical body burden. I think that certain people end up hyper accumulating it in different organs and this is something that people who do applied kinesiology or things like that have long –

[Damien Blenkinsopp]: Can MRIs pick this up?

[Dr. Chris Shade]: No, I don’t think they can.

[Damien Blenkinsopp]: Some of the scans they are using to identify lead in bones, for example, could use similar approaches?

[Dr. Chris Shade]: There might be something that they are using for the bone lead and they will figure out how to do it for mercury. Mercury is present at much lower concentrations. I think they just haven’t figured out how to do that yet. It may be ten plus years away or more, but eventually we will be able to see that because there seems to be a hyper accumulation that happens in some people. The brain, for certain, is a big issue when you have a lot on the brain and certain people exposed to it, certain mercury vapor, and can have a lot in their brain. And even after the blood levels and the whole body levels have come down, the brain, because of the blood brain barrier is very, very slow to release the mercury. So people that were dental assistants years ago, it is really hard to test them and know what is happening neurologically. I think other organs hyper accumulate too, especially the thyroid and maybe the prostate and ovaries. So that will be the next level up, doing that kind of a thing.

[Damien Blenkinsopp]: Yeah, but you think it is quite a way off, like a decade?

[Dr. Chris Shade]: Yeah, I haven’t seen that we have that technology yet.

[Damien Blenkinsopp]: And you also mentioned it is in lower concentrations. So it sounds like it is more toxic than lead at lower concentrations and we have lower concentrations so it is going to be harder to detect than the [inaudible 01:04:58].

[Dr. Chris Shade]: Yes, for sure.

[Damien Blenkinsopp]: All right. So, you also mentioned dentistry, like people working in dentistry and their exposure to mercury. I guess that is one of the most – the kind of biggest cases that you may come across in normal dentistry. So I am just wondering if that is a big area of your practice? People getting tested and coming up with the highest levels?

[Dr. Chris Shade]: I can’t say that they always have the highest levels because we are working with biological dentists, so they have already made the leap into understanding the toxicity and they are basing the value of their practice on offering mercury-safe dentistry. So they have already started to protect themselves. They remove things in a highly-protected environment. They don’t leave amalgams sittings around. They don’t install amalgam. So they don’t tend to be super high. If we were just getting general practice dentists, I think we would see them being pretty high.

But by and large, the highest people that we see are people who eat a lot of fish, that are high up the food chain. A lot of tuna and swordfish, large ocean-going fish. And usually if they have that and they have amalgams too at the same time their detox system is weak and they are loading a lot of mercury in, all the time.

[Damien Blenkinsopp]: Right. So to give you a quick personal thing, I had some mercury removed from my teeth last week in LA. It’s a bit of an interesting story because first of all, I didn’t realize I had any mercury and what happened is I was in Thailand three year ago and they have good professional dentistry and medical services and it is offshore, low-cost, but pretty high standards. So they did remove some amalgams but they didn’t remove them completely. They left some underneath the new composite resin placed on top, which I don’t know if you have come across before. And then they actually gave me a report which said there were no amalgams left. So I have had chronic health issues and I was going forward thinking like –

[Dr. Chris Shade]: Yeah, I do run into this fairly often because they leave that in there as a structural support and they are just kind of being too lazy to pull it out because then they will have to do some real reconstructive work.

[Damien Blenkinsopp]: Great, yeah, so it turned up in the x-rays that he biological dentist in LA was like, ‘Oh, this really shiny thing, that is probably mercury.’ And sure enough, once she dug in there, there was mercury that was oxidized. It looked really messed up in there. So is that something that happens a lot? I am just wondering if I am really unlucky.

[Dr. Chris Shade]: No, it happens more than we would like to think, even some of the biological dentists do that. They are not supposed to and most of the guys that I work with are really, really good. But I have certainly seen it happen before and for sure with a lot of the mainstream dentists because they regard it a good structural thing. And thing well now it is sort of buried underneath this composite and it is not reacting with the environment anymore and maybe it’s not a problem, but I have definitely been able to see that. If you come to me and you don’t really eat much fish at all and all your amalgams are gone and I analyze you I should see certain levels. So I have been able to pick that up in certain people and say yeah, you probably have amalgam under your crowns. And I am usually right about that based on just our testing and being able to see what is still left over.

[Damien Blenkinsopp]: Great. So it is pretty important to choose the right dentist if you want to get this stuff removed to make sure it is done properly. Do you have a list that you use or something? Or could we maybe link to a list that you have?

[Dr. Chris Shade]: There are various lists. The best – I don’t maintain a list. I do, when people ask me, I will tell them who I think are really good. There are two things going on. The one is safe removal that is protecting you against the mercury that you would inhale when you remove it. And most people doing this work get that right. The other thing is just being really good technicians and doing exceptional dental work. And it’s a big part of it. If you get all your amalgams out, but it wasn’t good technical dentistry it leaves you with a whole host of problems coming down the road because well-placed composite should last decades. And often it is not put in right so there are two aspects there. So I tend to keep my personal recommendations to people who I have seen their work. So it is not a really long list.

So I deferred to Leo Cashman at DAMS and Leo Cashman at DAMS.org, I think. They have a website and he has been a relentless advocate for safe dentistry. And he really does investigate whether people are doing a good job, whether dentists are doing a good job. He keeps a list of people he can refer and he checks up on them to make sure that they are coming through. And people, if they don’t like their work, complain to him and he checks up on that. So he is my favorite go-to list as far as a list that is not just a professional list. So he is who I would look to.

[Damien Blenkinsopp]: That is great. It was a pretty crazy experience. They put like a big vacuum in your mouth. They put oxygen on your nose and you are fully covered, your face as well. And they are wearing gas masks.

[Dr. Chris Shade]: Yeah, and people ask me about what I think about doing all of that. A lot of dentists who are new to holistic dentistry look at that and it is like, Jesus, people look like a bomb squad. And that is the best they can do to protect everyone involved but it has got a slightly traumatic feel to it. And so I don’t necessarily say that dentists need to go that far if they have at least a very clean environment.

But the dentists are out on the front lines getting this stuff out and no matter how much protection they have, there are still little micro bits of it that go right through all their clothing and they are being exposed. And so I spend a lot of time in the holistic dental world and we try to give them all the access to testing and we try to support them in however they want to detox because they do need that support.

[Damien Blenkinsopp]: Yeah. Thanks for looking at that because it seems like it is an important area there.

[Dr. Chris Shade]: It is huge. It’s huge. I don’t think we even understand all of the things that amalgams do to us. I think they have a strong effect on the GI tract and what I teach in detox is all based on being able to conjugate a toxin into glutathione or one of the other molecules we use for that. And transport it down mostly to the GI tract. When you have got a disturbance in the GI tract, including a buildup of metals, you block up that whole system and it has to sort of do the best it can. it pushes a lot to the kidneys and overloads the kidneys. I think there is a lot of collateral damage from amalgam beyond just the mercury that gets into our biochemistry.

[Damien Blenkinsopp]: Well this is just anecdotal but after a day of feeling a bit rough – and I assume that after all the precautions taken there would be some mercury released while they are taking this stuff out.

[Dr. Chris Shade]: Even just the changes to your bite registration have profound effects on you.

[Damien Blenkinsopp]: Yeah, exactly. Just the dental work itself is quite heavy. But after that I have been recovering in steps from my chronic issue and since then I have felt like I have jumped another step again. So just anecdotal. I haven’t done any more testing yet but just for the sake of taking another step.

[Dr. Chris Shade]: Yeah, and there are people, myself included, who have big experiences when they remove all that metal out of their mouth. There are so many things going on that we barely understand but a lot of people have profound emotional releases or spiritual changes or just physical changes. But there is no shortage of anecdotes of what happens to people when they get that out.

[Damien Blenkinsopp]: Great, great. So, in terms of other kinds of example case studies in the population where you would find higher levels, you are saying people who are eating a lot of fish. I don’t know – can you point out specific populations? Like body-builders, when I was body-building I was eating a lot of tuna and chicken, so I probably helped both my arsenic and mercury levels back when I was doing that. Are there any specific other populations or patterns that you see?

[Dr. Chris Shade]: They tend to be kind of affluent groups in the northeast and on the west coast that eat a lot of fish and they see it as a healthy choice for themselves. And they don’t buy the cheap fish, they like the affluent aspect of eating these tuna steaks and swordfish. You know, the most famous serious victim to it was the CEO of IMAX. And he still walks with a cane despite being in his upper 40s. And he was eating swordfish and tuna, two meals a day, and working out and thought he was super healthy until his nerves started failing him and he couldn’t hit the ball playing racquetball. And soon he was limping. And he had exceptionally high levels of mercury and he has got permanent neurological damage from that. There was another book put out by a doctor up in San Francisco, kind of scanning my bookcase for the name.

It was Diagnosis Mercury and I don’t remember the name of the doctor, but she had all these cases of these affluent women coming in and having these neurological issues and emotional issues that were neurological things, serious anxiety and depression and then they were starting to get neuropathies. And these women had very high blood mercury levels and it turned out they were rich women going out and eating swordfish all the time. And so I get a lot of LA, a lot of San Francisco, and a lot of New York and Boston people, and a lot of Hawaii people with very, very high levels just from the fish consumption.

[Damien Blenkinsopp]: So we talked a little bit about how to get this stuff out of you in terms of your recommended treatment approach last time. We talked about some of the binders and I think we touched on [inaudible 01:15:32]. Could you kind of outline how you approach getting this stuff out of people safely. How long does it take? You have noted there that some people suffer from this permanently, like they have permanent damage. Is that kind of how intense the mercury contamination has been, or is it prolongation even if it is kind of lower level? Or is it a combination of the two?

[Dr. Chris Shade]: I think it’s a combination of the two. I mean, in the IMAX guy’s case he had blood levels of 75 to 100. He might have gone up to 125 at one point. And those are radically high levels. I mean, those are ten times higher than what I say is high. And actually in the last year I have had a handful of cases also with really high levels, but it was elemental mercury or inorganic mercury exposure. But those very high levels create the permanent damage. The more chronic levels that most people are exposed to tend to produce chronic problems and they don’t tend to be as permanent. There are some things you can’t pull yourself out of or there will be some residual damage but for the most part with chronic toxicity issues, we can reverse that and reversing that, the core of doing that is turning up the glutathione system. And we will talk about the three major components of that and then what can be called the drainage system. Drainage is an old European word for having your kidneys, liver, and GI tract be able to filter your blood. So we need the cells to be able to push the mercury out, then we need – and they are pushing it out as glutathione complexes. And then those need to get filtered out.

So for the glutathione system to work, there are three main parts. Well, let’s talk from cell outward. We need glutathione, for sure, and we need adequate levels of glutathione. And then we are going to link the glutathione on to the mercury. And we need an enzyme called glutathione S-transferase that catalyzes that linking there. And then we have to transport that out, and that transport is from the cell to the blood, from the blood to the liver or kidney, and then out from there. From the liver it is going out through the bile tract into the small intestine. And from the kidney it is going out to the bladder and then out as urine.

[Damien Blenkinsopp]: SO when you give someone your liposomal glutathione – I mean, there are many products out there and I understand – I think we spoke last time that you have put yours at a specific level. You could probably re-explain that, but basically you give that liposomal glutathione to get the glutathione up. Is it feeding both of those systems you just mentioned? The glutathione and the glutathione transferase?

[Dr. Chris Shade]: Well, glutathione S-transferase is an enzyme that takes the glutathione in one hand and the mercury in the other hand, and links them together. So the glutathione S-transferase is a separate thing and it uses glutathione as a substrate. So the liposomal glutathione is certainly to get the glutathione levels up and provide glutathione to the system to use. The glutathione S-transferase, we can’t provide that directly. We need to turn up the body’s ability to make that. And so we use a combination of our lipoic acid and polyphenolic antioxidants.

So there is a trigger in the cytoplasm of the cell that when it is activated goes into the nucleus and turns on a lot of your chemoprotective genes. Chemoprotective genes like the glutathione S-transferase. And they are called chemoprotective because they are protecting you against chemicals that are coming in or chemicals that you are making inside your body that are bad for you. And this trigger responds to a number of things that are in our diet. And one group are polyphenolic antioxidants like you would get from green tea extra or red wine extract, grape seed extract, pine bark extract, or then you have sulphur-containing chemicals that come dominantly from alliums and crucifers. Alliums being garlic, onion, and leeks and crucifers being broccoli, cabbage, bok choi, that kind of thing.

Then the other sulphur-based chemical that does this and does it really well is lipoic acid and specifically the form called R-lipoic acid. So we use a blend to bring up that enzyme system and we use dominantly polyphenols and lipoic acid because of their ability to hit this main trigger.

[Damien Blenkinsopp]: Okay, yes, and I think we touched on before that you use the polyphenols instead of the sulphur-based.

[Dr. Chris Shade]: Yeah, I use them more than sulforaphane, which would come from broccoli seed extract because the mercury-toxic patients tend to have deranged sulphur processing and they over process sulphur chemicals down towards sulphate and they get held up as sulphite and it gives them some sulphite toxicity. And so the crucifers and the alliums seem to irritate that system. So we stick with the polyphenols. They tend to do better for that.

And then the one sulphur that we use is the lipoic acid. And I think it mentioned before it has two functions. One is to bring up the chemoprotective genes and the other function is that it stimulates mitochondrial biogenesis and improves mitochondrial efficiency. And that is a big problem for anybody who is chronically ill, having enough energy. The mitochondria get very damaged. And the mitochondria get damaged by heavy metals, most specifically mercury, cadmium, and arsenic. So if we can turn up detox and help the mitochondria at the same time then we have got a great compound to use.

[Damien Blenkinsopp]: And to be clear, when you are talking about the chemoprotective genes you are talking about NRF-2?

[Dr. Chris Shade]: Yeah, NRF-2 is the protein that is outside of the nucleus and moves in to the nucleus and turns up all of these. So that is what we are trying to stimulate. It is a little bit tricky when people are really sick. Sometimes those targets are hard to work with. I think I mentioned before that mold toxins epigenetically regulate NRF-2, meaning that you are not making so much of that trigger because it is not even out there to activate. So we need to get the mold toxins out so we are feeding in glutathione and trying to nurse the system back to health using whatever level of enzymes we have in there. And this is a big part of titrating up doses, starting low because a lot of these ill people, even if we wanted to hit all those targets once and get the body to tune itself up and throw out all these toxins, a lot of these targets are damaged or they are not being expressed right. So we have to slowly nurse it back to health.

For the sickest people you have got to be going back and giving them clay foot baths and clay baths and trying to use the skin as much as possible. Slowly having them eat small amounts of clay and charcoal and really going through a slow, slow detox that someone like myself, at the point I am at – I can take in a cup of clay internally and it isn’t going to provoke much of a change in me. But for someone who is really ill, even a teaspoon of clay is shaking the tree a lot. So we have to nurse a lot of these things back to health. And that is why you need something like a liposomal glutathione instead of just giving them precursors like cysteine or [inaudible 01:23:36] or whey protein.

[Damien Blenkinsopp]: Great. So you continue to detox yourself from mercury.

[Dr. Chris Shade]: Oh, yeah, that and everything.

[Damien Blenkinsopp]: Okay, so in your personal case do you think there are stores – kind of like, I spoke to Dr. Gary Gordon about lead reserves. And he talks about cases of lead where he will get his patients down to pretty much clear of lead and they come back two months later and it is 90% back out where it was because it is coming out the bones.

[Dr. Chris Shade]: Yeah, and he probably exaggerates his numbers a little because he likes – but the story is true. There you have got these bone reserves that are releasing it so you do have to come back periodically and go after it. In mercury we tend to talk more about proteins because there is less – it doesn’t work into the bone structure the way that lead does. So we talk more about proteins and deep inside the peptides as those turn over you are getting release from farther in there. And there definitely is sort of the available reserves or the available mercury that you can get out now versus what shows itself over time.

But we do a pretty slow detox. People are five months minimum on a detox unless it is just a little detox. But the sicker people are doing it as long as two years. But then I really want you to make detox and feeding these aspects of detox, the glutathione, the glutathione S-transferase, and the binders that we talked so much about last time. I want you to make those part of your life, not every day but in pulses. I mean, now is a great time of year to do a lot of detox. We are eating super heavy food and now we have availability to fresh vegetables all the time. But it is not the same as eating in season. So we eat heavy food and it is the end of the year. It is a good time to keep flushing a lot of that junk away. I see a lot of people get sick this time of year and if you are keeping yourself clean that doesn’t happen.

Then you are getting a lot of you are going to all these parties, you have got alcohol metabolites building up, and you clear those things out the same way you are clearing out all the other toxins. So we talk about mercury, but it is really everything. Because that same system, we are tuning up a system that throws all the junk out. It is not just the mercury.

But then back to the mercury, the brain takes so, so long to detoxify and I spent a lot of time last year – I mean, I really started my mercury detox back in like 2008 and figured it out. Maybe 2007 even because I really drove myself the wrong way using DMSA, and then figured out this whole system to pull me out of it. And then in 2009 I started getting it out to the world, so I have really been doing this for seven years. There is always more improvement to be found, especially neurologically. And this last year I was doing a lot specifically for the brain. And I am aging and I am in my mid-40s and really do slow down a lot, but on a lot of levels I am healthier than I have been since I moved out here and started this company in 2005. So you can just keep peeling off layers and bringing yourself to higher and higher levels.

[Damien Blenkinsopp]: That’s great to hear. So you said you pulse – to take you as an example, how often are you pulsing so your glutathione or the alpha-lipoic acid and stuff, are you taking that once per week? And are you taking the binders daily or are you – what are you doing on your own personal level?

[Dr. Chris Shade]: I am probably not as systematic as I should be for a scientist. I do it more as needed. So, in November I had four weeks in a row where I had a conference to go to every week. So I was on the road Thursday through Sunday four weeks in a row, including the last one, to Europe. And then I came back here and there was a health crisis in my family. And then I had one more show after that so I was really under the gun. And I was using a lot of products then and I was using – at night I used a lot of gaba and glutathione to let me recharge and let me sleep deep and recharge. I used a lot of C – lipoic during the day to just keep everything flushing through.

And so I was kind of on a long sort of support and detox while I was going through all that. Other times maybe I will take less and then I will think okay, it’s time to start using IMD for a while and I will take IMD every day. And I might take a little EDTA with that and some glutathione. And I will do that every day for two weeks. And then I will just – or maybe ten days. And maybe I will lay off of it for a while. The things I take the most constantly are the C – lipoic and the glutathione. I have a lot of snips for glutathione genes and for superoxide dismutase genes, a couple of methylation things. And so those, having those pretty consistently has been real good for me.

[Damien Blenkinsopp]: Great. When you say C-lipoic acid, is that helping the SOD? Or how are you supporting the SOD?

[Dr. Chris Shade]: Well the SOD – I don’t know how to directly activate SOD other than through NRF-2. So the lipoic acid should be bringing up SOD expression but then making sure that the rest of – you know, the antioxidant system is vastly interconnected with all kinds of antioxidants playing into these interweaving circles and so if I supply enough glutathione and vitamin C the SOD sort of has some of the weight taken off of it.

[Damien Blenkinsopp]: So the important thing you bring up there is the pulse approach. And I have started to hear about this more from people where basically we are talking about their organism, as you were just saying, is very dynamic. We have got lots of linkages between different parts of our body and our body also tends to try and adapt to things and there is regulation –

[Dr. Chris Shade]: Habituating to it.

[Damien Blenkinsopp]: Right, right. So if we are taking glutathione every single day, eventually is that going to start working against us? People talk about this pulse approach too.

[Dr. Chris Shade]: Yeah, it’s a great thing to talk about and I teach a lot on that because it is so huge. It’s biggest with therapies that are based on activating certain gene sets and the coolest data set I have on that was using St. John’s Wort and looking at phase two and phase three detox enzymes and they found two things. One is that you don’t upregulate at low doses, only at really fairly substantial doses. And the other big thing was how you could do it. And so they had these mice on this high dose of St. John’s Wort and they were watching the upregulation of these enzymes and they saw it climb from 100%, which was the baseline, up to 300% of baseline over ten days. So a threefold increase of expression, that’s pretty good.

Then, over the next 20 days, as they continue to take that dose it dove down to where at day 30 it was no different than day one. The total habituation to this input – and they probably started tearing apart the input before it would activate those genes. So we start people pulsing five days on, two days off, and then we move them up to ten days on, four days off. And in doing our detox based on glutathione system upregulation, it is crucial to do this. It is less crucial down the road in your maintenance phases where you are just sort of making sure all these inputs are in there. That is why I am not as methodical as I used to be about it because everything is working pretty well for me. But when you are trying to get yourself better that is really crucial because otherwise you are taking something – most of these plant compounds that we take are activating genes.

I love to use Chinese medicine as the quintessential early example of how to do pulsing. I don’t know if you have ever gone in your journey to a real, authentic Chinese doctor who will diagnose you and then will take you into his apothecary and pull out drawers of herbs, dried herbs, and will put out a big piece of paper. You will start putting all the herbs together on there until there is a pile, a big pile of herbs on there. And you are supposed to cook that down to a little cup of tea over like two hours and drink that and then fill it up with water and cook it down to another cup, then throw it out and do it again. So you are getting high doses and you are only doing that for five to seven days. And that is upregulation of gene sets. I know that we will find that out, that is what they are doing. And there are even some – I have data papers where they are showing upregulation of NRF-2 through using Chinese herbs. And we will start finding all kinds of other gene sets that were upregulating.

The most exciting stuff is reversing epigenetic hyper methylation of genes. It is turning genes off and there are starting to be data sets coming out with that. So really that is the most exciting stuff that I am doing right now. What I am really going to focus on in 2015 are new products that we release that are going to take away the epigenetic block from the mold so that we can access those gene targets more effectively.

[Damien Blenkinsopp]: I can’t wait for that to come out.

[Dr. Chris Shade]: Yeah, yeah, it’s pretty exciting stuff. So in March we are going to start releasing that.

[Damien Blenkinsopp]: Great, I will keep in touch for that because that is probably something I want to be using myself.

[Dr. Chris Shade]: Yeah, I want to get you on that. Maybe we could get you on it ahead of the game.

[Damien Blenkinsopp]: Yeah, that would be cool. Thank you very much. So I love this pulse approach because it kind of comes back to hormesis, right?

[Dr. Chris Shade]: Yeah, it is. All these things are hormetic. They are toxins. Polyphenols come at you as polymers of different monomers and like a monomer like [inaudible 01:34:10], if you bought it as a pure monomer and put a cell culture, it will kill the cells. As the polymer it is just less damaging and those targets – the NRF-2, the way it turns on the NRF-2 is by actually creating free radicals. It creates little free radical reactions and they are just not that damaging but they are enough to turn on the NRF-2. The sulphur compounds are better at doing it like sulforaphane but they are more cytotoxic too because it is generating a little free radical storm.

So all these things are hormetic and you want the most upregulation with the least challenge to the system. And make no mistake about it, they are all hormetic, so they all should be pulsed. And so my window is ten days as your optimum. And you can do less than that if you don’t want to challenge the system as much but anything beyond 20 is a waste.

[Damien Blenkinsopp]: Great, and that is something that you said you were going to be looking more at as an antioxidant marker and oxidative stress markers related to that to see the downstream effect?

[Dr. Chris Shade]: Actually that was related to the liposomal glutathione study going on right now looking at free radical gene damage that is [inaudible 01:35:26] guanosine and free radical damage to lipids – that is F2 isoprostanes. And then oxidation of LDL cholesterol. So right now we are looking at the liposomal glutathione for mitigating those damages. That we are doing because it is hard to measure glutathione in blood because there is a big background already. And so a lot of this stuff transports and gets places and gets used up really quick. Some stuff is easy – the B12 is easy, doing clinicals on EDTA was based on lead excretion, but glutathione was a little tricky so we are going to base that on damage.

I am trying to work with – it is not like she is trying to be difficult, I haven’t called her yet, but Cheryl Burdette. That is just me being [inaudible 01:36:14].

[Damien Blenkinsopp]: Actually, I have been in touch with her recently and just [inaudible 01:36:18] the labs, because I was going to get them done. So I think it is just a new year.

[Dr. Chris Shade]: So I will get with her and contract to do a certain number of analyses there. I do want to look more on the hormetic side of bringing down these markers, you know, how these different polyphenols and neutraceuticals turn up those protected mechanisms. The first one we do is glutathione and that is already starting right now but we will do more work that way and we will probably do that with Cheryl.

[Damien Blenkinsopp]: Great, and you are going to be able to compare? Your liposomal glutathione is different to others. Will you be able to compare the difference?

[Dr. Chris Shade]: It just depends on whether I want to pay a lot of money to measure somebody else’s product. Getting clinicals done costs $2,000 to $3,000 per person. It is really expensive.

[Damien Blenkinsopp]: Right, and how many people do you need to make it reasonable?

[Dr. Chris Shade]: Well, you need at least ten to get some pilot data going. So there you look at $30,000 just to get some data that validates what you have been seeing a few years and so it is not the kind of things that I want to – say, here is us compared to three other brands. At least until people start buying more and then we will go after that.

[Damien Blenkinsopp]: Again, I wanted to [inaudible 01:37:40] giving some people some ideas of recovery in terms of treatment. What kind of timelines do you see? You have mentioned a lot about the healing crises, right? So you have to go slow with many of them because if you try to go too fast it gets too problematic with detox symptoms. So what kind of timelines do you see? I mean, some people get better in a week and some people take two years – what kind of different variations?

[Dr. Chris Shade]: Yeah, it is really variable so maybe if we talk about some basic types of people. The sort of textbook example of the detox is you get into it, you are starting five days on and two days off. In your first month the first week you are a little tired towards the end of your first five days. And you are just a little bit pushed down and then on your days off you get your energy back and then the next week you are pushed down but not as far and you bounce back on your days off. By your fourth week at that dosing level you don’t notice it at all and then the next month you jump up to a higher dosing and you go through the same thing, first week, the first couple of – the end of the first week is a little hard and then it gets easier. And so you are going through that process with feeling it and over that first three months you are noticing overall your daily energy is getting stronger, some of the aches and pains in your joints are going away, your skin is clearing up, maybe your hormones are normalizing, and you go through the first three-month pack and then you move into the two-month pack and you get even more results. So a three-month minimum to sort of clear yourself up, five months is more average. But then you have other types of people.

So there is one guy here who is working for us who has got some neuropathy in his leg and about the third month his neuropathy started getting better and you could see a lot of changes in him. His skin color was getting better, his energy through the day was better, because the first month he said, ‘Is it normal for me to be tired?’ And I was like, ‘Yeah it is.’ And he was going through a little bit of a – he was feeling it. But now he is reaping the rewards and he is in about month three.

[Damien Blenkinsopp]: Is there any way to completely avoid the [inaudible 01:40:05]? If you go really slow?

[Dr. Chris Shade]: Yeah, if you really don’t have anything wrong with you, just protectively. But these are all pretty minimal symptoms, you are a little tired. You are going to go through some of this. But you are going to go through some of this stuff. If you go really, really low and slow, you may not. The more intensely you try to do it, the shorter amount of time, the more symptoms you are going to have. The more you spread it out the less symptoms you are going to have, but the longer it is going to take. But also, if you don’t get to higher doses you are not going to have the more profound changes occur. So there is a little bit of a mix here.

Now, on the harden end, you get to these people that you are in the low dosing and you are in the first week where they are just exhausted and you have to back off to half those or even a quarter dosing. These people are going to take a year to go through this and we used to back them off to drainage remedies or homeopathic or herbal remedies to sort of start the movement of the lymphatics and get the kidneys and the liver gently working again. And we still have those tools that we still use with good effect, but people who run into a wall and really can’t get past, they can’t get up in their dosing, almost always have a chronic infection and I think I mentioned before quite often they come in to this thinking that they have Lyme but their Lyme test was negative and they get two or three weeks into the detox and they are exhausted and then they go and retest for Lyme and they are more exhausted than they were when they started. Then they go back and they retest for Lyme and it comes to the positive. Because as you reboot the glutathione system and you get your glutathione levels back up. Your immune system turns back on until you get more of that TH1C response to the infection and those are the things that make you feel infection, they make you feel crappy. So then they know that they have got Lyme or Epstein-Barre or cytomegalovirus or toxoplasma and then they can go and treat those and once they get a little bit of that knocked back and they have gotten farther in their antimicrobial treatment, since it is a lot easier to get into our detox.

So we have pretty much found that if the detox isn’t working for you there is an infectious problem. And if it didn’t test for you before, it will now. So once you deal with that problem or start getting that under control, then you can get back into your detox and go farther with that. So it is kind of good news, bad news. The bad news is you weren’t able to detox and the good news is that at least we know now what was one of the other underlying problems with you and we can treat that and get you moving forward.

[Damien Blenkinsopp]: Right, and as you mentioned before it is like peeling the layers of an onion on all these chronic conditions. You find one thing, you solve that, and you feel a bit better. Then you find another thing and you kind of work your way through the maze.

[Dr. Chris Shade]: Yeah, but as you get through those layers you get more and more powerful. Your strength comes back and you go through each level much faster and your improvements are greater each time. And it is really important for the chronically-ill person to gauge where they have been and how far they have gotten, especially the real ambitious ones. And a lot of these ones that are poor methylators and have gotten really chronically-ill are incredibly ambitious and aren’t good at measuring their progress. And you often need family members or people who know them to remind them how far they have come.

[Damien Blenkinsopp]: And I certainly can reflect back on that myself by one of these ambitious ones. And unfortunately I have a ton of data as well and it can go oh, this can be very different. But there have been some points along the journey. I don’t know if I am getting anywhere with all of this stuff, but I clearly had.

[Dr. Chris Shade]: Yeah, because we habituate to wherever we’re at. We accommodate feeling absolutely horrible and then when we are up to kind of bad it still feels the same. And all we want is to be all the way back.

[Damien Blenkinsopp]: Exactly, that’s one I can talk about – 100%, you want to be 110%. I want payback for the time I was under 100%, right. So to learn more about the biomarkers we have been talking about today and some of the products you have been talking about – do you have research on your site? Or are there other places, books, you would recommend to learn more details and more about this research and stuff?

[Dr. Chris Shade]: Well, starting with our website, QuickSilverScientific.com – we just put up a new website and we are kind of populating it now. There is a fair amount of material under mercury and heavy metal testing on – and there are videos there of me describing our testing and showing a lot of different examples of it. Under the products there are a number of product pages about many of our different products. Some are just available by doctor login. And there is some basic information on the detox system and how that is supposed to work. I am still just starting to populate articles into the science section so you can read more about what this is all based on. This is all coming from basic research that is being done around the world, and I have been funneling it all down into a usable system. So I am sort of still getting to where I have time to publish all of this. So anything that I have put up there will be pretty – it is only for the connoisseurs. It is not for the – it will take some wading through the scientific material.

[Damien Blenkinsopp]: It is pretty technical, is what you’re saying?

[Dr. Chris Shade]: It is pretty technical and I am trying to get to where I have got some personal time to write some of this stuff up in some of the progressive medical articles, the integrated medical articles and journals. And so that will come over the next year or so.

[Damien Blenkinsopp]: Great. Is there anyone besides yourself that you would recommend to talk to about this area, like mercury systems you have been talking about or people you respect that you have kind of learned from?

[Dr. Chris Shade]: Good question. No, there is only me. That’s all there is. [Boyd Haley 01:46:32] has always been good on this. He is pursuing a chelator that he is developing now and so most of the things that he talks about are in support of why everybody needs this chelator. But he has got a lot of stuff in there over time. But this really – all this emphasis on fixing the biochemistry inside the body to be able to resist the load, this is really new. All the language before has really been how to use a chelator to get this stuff out of the body, not how the body naturally chelates it and how we turn that back up. So I am kind of at the forefront there and I’m the only guy really talking a lot about how that works.

But functional medicine is expanding at a rapid rate and there is really good work being done there. It tends to be mostly in the doctor world. Cheryl Burdette and I lectured at Metabolic Maintenance Institute, which is a doctor training institute where we both have the faculty appointments to George Washington University now and it’s real high-end. The material being lectured on there was all awesome but it is really just going to the doctor’s now and really funneling [inaudible 01:47:56].

[Damien Blenkinsopp]: I mean, you are getting the information out there now. So is it big classes of 50 people?

[Dr. Chris Shade]: I don’t remember what the – I think this was the first one they did of this particular segment. I think there were 30 doctors there and there will be more as we go. But it was very intensive lecturing. It was just all day, just all this really high level stuff coming from different angles and all the faculty there was top notch. Jim Lavalle is part of that, Andrew Hayman, Russ Jaffey. All their stuff was really, really high level. And so now it needs to funnel down into books too, and people ask me all the time. I told people I would write a book in 2015 and I don’t know how empty of a promise that has got to be. But we will see.

[Damien Blenkinsopp]: It seems like you could write ‘the’ mercury book.

[Dr. Chris Shade]: Yeah, I definitely could write the book now. It is just a question of the time to write it. So maybe it will be 2016 but I am going to have to come through with that and I will have more materials on our website. But all by way of saying I don’t know who to point you to. It is all coming together up at the highest levels of training the doctors, PhDs and MDs lecturing and doing research up there. It just needs to funnel its way down.

[Damien Blenkinsopp]: Now just a couple of questions about you and what you are doing in terms of your own personal stuff. What data metrics do you track for your own body on a routine basis, if any?

[Dr. Chris Shade]: I don’t do a whole lot of testing all the time. I do some standard stuff every couple of months – complete blood counts and metabolic panels, GGT and liver enzymes and lipid panels, hormone panels, and also the standard stuff that like an anti-aging doctor would do and make sure that my hormones are well-balanced and all my chemistry is clean. But even though I play the PhD on TV, I do a fair amount of energetic testing on myself just to see what supplements are best for me and what organ systems might be going out of whack before anything clinical happens. And I have been fortunate enough to learn a lot of good systems from people and they work well on monitoring myself and so I will use them to sort of gauge what supplements I am going to focus on at any one time.

[Damien Blenkinsopp]: Great, so what energetic systems are you talking about here? Can you give an example?

[Dr. Chris Shade]: Yeah, let’s see – there is one called a [inaudible 01:50:34] which is sort of a dowsing technique that I use. I use a lot of muscle testing combined with organ points, which are essentially acupuncture points. And there was this system SGOT, AK-SGOT – they started doing it. They defined all these muscle testing points for different reflex points in your body that are supposed to correspond to different organ systems, so a liver, gallbladder, kidney, small intestine, large intestine, brain points. And so I will use those. There was a guy named Bob Walker who taught me more about those. His system was called [inaudible 01:51:19]. I lectured a lot with [Klinghart 01:51:24] and I learned his system.

So between all those I came to something that works for me, but mostly it is by and large muscle testing acupuncture points and looking for disturbance along those and then what normalizes those. And that has worked out exceptionally well for me and I do use that with other people as well. I tend to get mostly doctors that come – I am a PhD. I don’t treat patients but I treat a lot of doctors.

[Damien Blenkinsopp]: Well, so it is very interesting that you are using this and I guess you are using that in areas where testing is not available or it is too expensive.

[Dr. Chris Shade]: Yeah, or testing only sees gross changes. So it is a combination of all of those. Do I want to draw some blood now? Do I want to pay for this test? Does this test actually show me what I am looking for or does it only show up on the test once it has gone pretty far? I think once you have learned the biochemistry and you have that all under wraps, then if you have some energetic testing to guide you that is when you really shine because you are left with a ton of different products that theoretically can do what you want them to. How do you work through what the best one for you is, or the best one that is out there on the market right now? And there you are stuck with energy medicine to figure that out. And when it is not right it is quite good.

[Damien Blenkinsopp]: Great. What is the one biggest insight that you have taken about your biology that has maybe had the biggest impact that you have drawn to date over time, the thing where you are like oh, my personal biology is like this. Because of something you have tracked?

[Dr. Chris Shade]: Oh yeah, the craziest thing that I have figured out in the last year was in the holistic dental world they talk about connections between what are called cavitations, the most simple cavitation would be where you pulled a wisdom tooth out and they leave this thing called the periodontal ligament in there and it rots over time. I had a cavitation in my lower back right molar where it used to be a wisdom tooth. And it was enough that you could see it on an [I-Cat01:53:34] and I wanted to figure out a way to get that better without digging in there and going in surgically and cleaning it all out. And I had tried ozone therapy and a lot of different things. It was giving me chronic GI issues, where I had to work on them constantly. They say it is on one of the meridians that goes down to your GI system and controls your GI system and your spleen. It was always – I mean, I was just working on my GI system all the time. And I would get ozone injected in there and it would be better for a couple of days and then it would go back. And everybody is at least using energy testing because nobody dug in there to do a biopsy or anything. And everybody said that it was a fungus that was in my GI tract and in there.

And if you recall what I was talking about with epigenetic changes from funguses, funguses have this ability to turn down a lot of your repair and defense systems. And one of the products that I have for reversing that is a nanoparticle of DIM. And I started using that, holding that over my cavitation, and it changed everything within a matter of a couple of days. I did that three or four months ago, I started doing that, and it reversed all of my GI issues. And people muscle test me on that cavitation and it tests strong now. And now I just think if I keep that therapy on for a year I am going to do another [I-Cat 01:55:04] on it and see if the hole is closed up at all. My dentist had said right before I started doing this – he did ozone and he said that hole – like, I put that needle in without drilling. You are going to have to work on that. And then I started doing the DIM and he was blown away. He was like, ‘I can’t believe that.’ So we will see.

But it was really – you know, I am around holistic dentistry all the time and they talk about these systemic problems that come from the dental area and this was mine and I reversed it this way and I haven’t had a problem since. And just whenever you see that happen it is like wow, this really is what is going on with a lot of people.

[Damien Blenkinsopp]: Right, that is great. I had never actually heard of the cavitation and how it can rot and cause problems in the gum bacteria and infection. Just last week I was talking to a surgeon about removing my wisdom teeth and he takes a biological approach where he clears it all out. And I guess most dentists don’t even look at that, right? They just leave it?

[Dr. Chris Shade]: No, they leave that little tip in the periodontal ligament and they assume that the body is going to repair after that. And it does not always do that. In fact, most of the time it doesn’t. And if they had gone in farther or dug it out more it would have been okay. And so you get this little pocket of rot and what they do usually to treat it is they go in and they scoop that stuff out. And I have seen videos of this and it is pus and rot and they say it stinks. And they have to grind down to new bone with burs and scrape up the new bone, and that stimulates it to come in and grow back. And even then it doesn’t always work but at least that does stimulate a regrowth.

[Damien Blenkinsopp]: Wow, okay. I am glad you brought that up. Well, Chris, thank you so much for all this information and detail. It is all this new stuff, as you were saying, this biochemical approach to healing these kinds of heavy metal issues beyond chelation, which I had never heard before. And I wasn’t aware we were going to get so deep into this when we started this whole journey in the first part of the interview, so thank you so much for all the information and it has been a pleasure talking to you.

[Dr. Chris Shade]: Yeah, and maybe to just tie it all together, with the biochemical approach you are not only getting rid of the metal but you are increasing your resistance to it. And so I talk about these three things you need, the glutathione, the transferase, and the transport proteins, and then I found a biochemistry paper that was a cell culture paper where they were finding cells – they had a big population of cells that they mutated to have different properties and they found one that was resistant to metals. And they found that it had these three things. And if they knocked out any one of those it stopped being resistant. And so there by ensuring that the biochemistry of the cell works properly that load of metal that is in that petri dish does not affect the cell. But when the cell biochemistry does not work properly that same load now becomes toxic. And so I want to get people away from thinking well, if I strip out the metals there will be no issue. Get your body to resist the metals and it will strip them out at the same time. Sometimes I think you have got to go in with a chelator. Lead I think does need some EDTA, but if you first fix the underlying system you are going to get vastly superior results.

[Damien Blenkinsopp]: Right, and as you say, to stay healthy and to do stuff that you really –

[Dr. Chris Shade]: Yeah, as opposed to waiting until that metal load gets high enough again to knock you out from running well. Like I said, if you can’t deal with our detox it is probably because you have got Lyme and now all of a sudden you see because we turned up your immune system and you are reacting to the Lyme – now, go fight the Lyme.

[Damien Blenkinsopp]: Yup, I have been there. Well, thanks again, Chris.

[Dr. Chris Shade]: Right, thank you very much again, Damien.

Have you tried to assess your Mercury burden? Do you have amalgams or have you consumed a lot of high mercury fish over the last years? Is it possible Mercury has had an impact on your health or performance?
Leave a comment below telling me what you have done (including anything quantifiable) and what you plan to do?

Leave a Reply

Functional medicine is a framework for tackling health issues and an approach to optimizing health that contrasts sharply with today’s “standard of care” medicine model. In this episode we look at assessing the body via the functional medicine framework and your detoxification system.

Where “standard of care” excels at dealing with acute health crises, like car accidents injuries and deadly pathogens and infections, functional medicine has grown to tackle primarily chronic health issues.

The argument for a future where we turn increasingly to functional medicine is that:

  • where traditional medicine seeks to manage disease (e.g. pharmaceutical therapy or surgery), functional medicine seeks to identify and resolve the causes of disease.
  • Where traditional medicine seeks to place you in a ‘disease category’ (e.g. multiple sclerosis), functional medicine takes a personalized approach.

We’ll get more into what these mean in the episode.

Today’s guest is Jeffrey Bland, PhD who is often referred to as the “Godfather of Functional Medicine“. He has been working for over 25 years in the pursuit of what today is functional medicine, he has over 120 peer reviewed papers on nutritional biochemistry and medicine, is the co-founder of the Institute for Functional Medicine founded in 1991, has served on many boards of health and nutrition companies, a highlight of which was serving as Director of Research at the Linus Pauling Institute where he worked directly with Linus Pauling for a time.

“We are in a health revolution right now that is second to none.”
– Jeffrey Bland, PhD (Godfather of Functional Medicine)

Jeffrey is also the author of “The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life“. This is a book I found to be a great read to understand the functional medicine framework and how it looks at the mechanisms for chronic disease and optimum health. I highly recommend it, in particular if you are a physician or if you personally are plagued by chronic health issues.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • How functional medicine differs from traditional medicine in its approach (5:00).
  • A concrete example of how functional medicine looks at disease: Multiple Sclerosis as a personal disease with many different causes (7:10).
  • What changes when you stop focusing on the effect (the disease) and start looking for the causes (13:00).
  • How people typically get led to the world of functional medicine – and what the root causes of illness are (17:10).
  • Do all headaches have real causes that can be investigated, understood and resolved? (21:10).
  • How the functional medicine framework puts you back in control of your health no matter the cause (23:30).
  • The birth of the functional medicine framework (the 7 core physiological processes), how it was designed and how it has stood the test of time (26:10).
  • In practice: What you can expect from a visit to a functional medicine doctor – what they’ll ask, what they may test, what process they will go through with you to diagnose and resolve your health issues etc. (30:00).
  • Example biomarkers, labs and tests used commonly in the realm of functional medicine. (36:30).
  • Detailed look at the detoxification process within our bodies (one of Jeffrey’s 7 core physiological processes from Functional Medicine) (36:30).
  • Are “Healing Crises” or “Detox Symptoms” necessary in detoxification or during health issue resolution? Or it something we should avoid? (52:00).
  • How ‘fasting’ can be counterproductive to the detoxification process (53:30).
  • The specialized set of labs and tests that are used by functional medicine practitioners (56:00).
  • Jeffrey’s perspective on the future of medicine and what he sees as a “revolution in healthcare” currently taking place including (A) “omics” revolution (genomics, proteonomics), (B) internet and social media and (C) big data analysis (59:00).
Thank Jeffrey on Twitter for the information and insights he shared with us in this episode. Click Here to let him know you enjoyed the show!

Biomarkers and Frameworks

    Frameworks

  • “Antecedents, Triggers, Mediators, Signs and Symptoms”: Functional Medicine framework that starts the process with a questionnaire or enquiry from the physician aiming to identify possible items from this list to look into in more detail with tests.
  • MECE (Mutually Exclusive, Collectively Exhaustive: A framework tool mentioned by Damien that is used extensively in the management consulting world to effectively define and solve problems.
  • Inflammation

  • hs-CRP (high sensitivity C-Reactive Protein): A marker of inflammation from blood labs that Jeffrey remarked as a useful tests as an early step in some cases.
  • Blood Sugar Regulation Measures

  • Hba1c (Glycated Haemoglobin): A proxy measure used to assess your average blood sugar over a period of time. Since haemoglobin is part of the red blood cells it is exposed to blood sugar over the lifetime of the red blood cell, thus giving a measure. As such this measure is used to identify blood sugar control issues. Levels of 5% or higher can be indications of blood sugar disregulation.
  • Triglycerides: A measure commonly reported in lipid panels that provides an indication of the excess calories coming into your body and getting converted into fats. High triglyceride levels indicate blood sugar management issues.
  • Cardiovascular Health

  • HDL (High Density Lipoprotein): Often referred to as the good type of cholesterol, this marker comes with your typical cholesterol panel. Higher levels of HDL are generally better as they are cardioprotective.

Links to Resources

Jeffrey Bland, PhD and the Functional Medicine Movement

Supplements and Treatments

  • N-Acetyl Cysteine: Mentioned as a supplement that helps to support detoxification (note: it does this via helping to increase glutathione levels).
  • Sodium Citrate and Sodium Bicarbonate: Jeffrey mentioned these as approaches to ‘alkalinizing’ the body’s cells and thus helping improve detoxification. Another supplement that works similarly is Potassium Citrate.
  • Coenzyme Q10 (CoQ10): Jeffrey mentioned the role of CoQ10 as a detoxification support.

Other People, Resources and Books Mentioned

Full Interview Transcript

Transcript - Click Here to Read

[Damien Blenkinsopp]: Great, Jeff, thank you so much for joining us on the podcast this morning.

[Jeffrey Bland]: My deep pleasure. Thanks so much, I’m looking forward to the discussion.

[Damien Blenkinsopp]: Yeah, your book is great. I really appreciate it. It really gives a great perspective on a number of things, a different perspective than most people are used to seeing. So the first thing I wanted to go into was functional medicine. What is the difference between functional medicine and contemporary medicine, the medicine we are used to when we are going to hospitals and primary care doctors and so on? How would you define the differences?

[Jeffrey Bland]: Well Damien, I think that’s a very good question and it really asks of us what is the elevator speech if you have only got a couple of floors in an elevator to describe the difference of how you would do it. And we have grappled with this question for some time and I am not sure I have completely gotten it down, but let me give it a try. The medicine that most of us are familiar with is insurance reimbursable kind of traditional hospital based or clinic based health care, that in which I was trained in and most docs today were trained in. It is focused on the disease, the primacy of disease, and so it is all about the diagnosis and then finding the appropriate treatment for that diagnosis.

The diagnosis is really related to a clinical series of presenting signs and symptoms so the patient comes in with whatever their complaints are. The doc reviews those complaints, they do whatever lab tests might be suggested from those complaints, and then from that name a title of a disease is finally given from which then reimbursement can occur and therapy can result, generally pharmacotherapy with some kind of drug or drugs and surgery. That, however, doesn’t ever really address the question of where these things came from, what is the cause of these conditions. so often we end up being able to treat effectively the signs and symptoms of it’s outcome, the disease, without treating its cause.

Functional medicine is all about the cause, it’s not about what you call it. It’s all about how you got there. So the most important thing for a functional medicine provider is to understand what we would call the journey that led to a diagnosis to treat the cause and not the effect, whereas medicine today I think is more involved with calling what the final destination is and treating its effect rather than its cause.

[Damien Blenkinsopp]: Great, and if we could take a concrete example I think that might help to clarify it for some people. One of the diseases that is defined by the world of primary care and so on is multiple sclerosis, right? So that’s a disease condition and there are a number of drugs and things around available to treat that. How would functional medicine look at that? What are the differences in the way you would look at multiple sclerosis?

[Jeffrey Bland]: I think that’s a really excellent example, actually. That fits right into this discussion very nicely and in fact it is actually one of the examples that i use in the book The Disease Delusion to help the reader to kind of understand the difference between the functional medicine approach and a traditional diagnostic pharmacology approach.

So a functional medicine practitioner, when they would see a person who has been diagnosed with MS would first ask the question in their mind – what do we know about MS? We know that multiple sclerosis is a member of the autoimmune family of disease. These are the diseases that are characterized with the body’s immune system attacking itself, attacking the body itself and leaving the collateral damage.

In the case of MS the body’s immune system is attacking the nerves. And specifically the insulation of the nerves, which are the myelin sheaths, the things that coat the nerves that are kind of like insulation on a wire that is plugged into the wall socket. It is the insulation on your nerves and it protects the wire, the nerves, from being damaged or having problems with transmitting electricity like you would have in the socket of a light.

And so when your body’s immune system attacks the insulation of your nerves, the myelin, it starts to lead to kind of a short circuit of the nervous system, just as if if you lost the insulation off the wire and it goes to your lightbulb, you might end up short-circuiting that and maybe sparks would fly out or you would catch the curtains on fire or any number of collateral damage could occur from losing that insulation. And so the treatment of choice is to give an individual who has that diagnosis of MS, drugs that are designed to try to block the effect of that immune reaction against your nerves, so it would be certain kinds of anti-inflammatory drugs or drugs that prevent the insulation of the nerves from being further damaged.

The functional medicine approach, however, would be to ask why is that person having the loss of the insulation on the wires of their nerves? What was the cause of this? And the first kind of assumption that many people have is well, that must be in my genes. Gee whiz, I have family members that have autoimmune disease or I have a family member that might have even have had MS. It must be my genetic inheritance. However, when the data is looked at as it relates to that specific disease, MS, like so many other of the autoimmune diseases, there is a very weak linkage between genetics and MS.

It is not a hardwired genetic disease. So it may have a weak linkage to certain immune relationships that give rise to autoimmunity, but it is not a disease where we can say this is a cause, this is caused by your genetic heritage. Therefore there must be another factor or factors, and this is where the functional medicine detective story emerges, because a functional medicine practitioner would then say let’s look at all the various factors that have been identified in the medical scientific literature that are associated with the cause of an immune system attacking the nerves. And this could be things like toxic chemicals, it could be things like heavy toxic elements like mercury or cadmium.

It could be things like reactions to certain food proteins that your body sees as foreigners, one of which would be gluten. It could be the result of insufficiency of specific vitamin factors, particularly vitamin D, which has been studied extensively by Michael Hollick, Dr. [Heeney 00:11:20], and Dr. [Holub 00:11:22] as it relates to vitamin D insufficiencies. Or it could be associated with situations that relate to the exposure to what you would call xenobiotic chemicals, certain agents that activate the immune system, including certain members of the drug family which certain individuals have immune response to and it becomes seen as a foreigner that the body’s immune system then starts attacking the nerves. So there is a whole laundry list of various agents that might trigger the immune system of a person who is considered normally healthy to now start developing an immune reaction to their nerves.

So rather than just jumping in and giving a person something that blocks the inflammation, the functional medicine provider would start going through as a detective might – the Sherlock Holmes of the etiology of the condition, asking could this person that has this condition have these problems? Could they be suffering from too much mercury? Could they have too much cadmium? Could they be suffering from exposure to certain chemicals? Could they be taking certain pharmaceuticals that activate the immune system? Could they be vitamin E deficient? Do they have certain food allergies like gluten that are inducing this immune response?

Then from that detective approach that the kind of examination, a tailored, personalized program for that individual’s own forum of MS would be developed, rather than just treat them as a person with MS like you would with any other person with that diagnosis, you now design a program based on their specific, unique presentation that is focused on managing the cause and not just the effect. And those results, when you deliver that model in clinical practice, can be extraordinary. It can be miraculous.

We have seen literally hundreds of patients over the years that I have been involved with the clinical research and overseeing clinical research centers and when patients come in with various forms of MS or various forms of autoimmune disease and how there are conditions once you identify the cause and not just the effect can be completely turned back and you go into remission. So that is a different model.

[Damien Blenkinsopp]: Yeah, thank you very much for that. So if I kind of retake it and see if you can say if this is accurate or not. Traditional medicine is looking at the effect and it is trying – the effects, and the symptoms you have. they are trying to categorize a number of diseases that they have on record. They have a hundred different diseases, cancers, multiple sclerosis, Parkinson’s, and all these things which have been categorized according to symptoms, a list of symptoms, whereas when we are coming from the functional medicine side we kind of ignore that for the moment and we say okay, just because they have these symptoms we don’t know what the actual cause is.

So we are going to do a number of different tests and we are not going to make any assumptions about what is actually causing this until we have done some investigation and the idea is that we can find any number of causes and they could end up at the same symptoms due to the mix of genetics, epigenetics, and the other processes going on in our bodies. But they can arrive at the completely different ending, the symptoms, from completely different causes. Is that an accurate representation of what you just said?

[Jeffrey Bland]: Yes, I think very much so and I think for the listener it is important to know that the number of diseases within the diagnostic handbook are literally thousands of different diseases. And often a doc might feel that their job is over once they have got a good diagnosis because then they can dial up a specific pharmacotherapy. But within each of those diagnoses, no matter what the name is, whether they have diabetes or arthritis or MS, every person with that diagnosis, that specific diagnosis, presents slightly differently.

They have a different reason that it gets worse and it has progression. So in the absence of personalizing treatment to the individual need and focusing on the cause and not the effect, you don’t get the optimal outcome. And that is the functional medicine revolution, looking at the person as a unique individual and personalizing their treatment program appropriately.

[Damien Blenkinsopp]: Right, thank you very much. Another aspect I wanted to see and what a value that I see in a functional medicine encounter where I came into contact with it from my personal story is because it is the story of categorization of systems there are many people that fall through the cracks, however, because their symptoms aren’t acute enough so they don’t meet a diagnostic criteria.

For example, an MRI wouldn’t show the white blips used for multiple sclerosis in those kinds of scans, for example. Or they are not meeting those diagnostic criteria which falls neatly into one of those categories and they maybe have some symptoms which are considered that everyone should have these days. For example, everyone complains of headaches and everyone has a bit of fat around their stomach these days and they find it hard to get rid of and they blame it on a number of things.

So my own personal story is that I kind of fell through the cracks because I didn’t fit into any categories and I know there are many people who do that. And we finally end up at functional medicine, and functional medicine seems to say we can try and resolve any condition that you have from a basis of looking at a list of potential causes and it is supposedly a comprehensive list of things that can go wrong in the body and working its way through that.

So is that another way to look at it? I know a lot of people kind of end up at the functional medicine road end of medicine because they have kind of fallen through the cracks or they have some chronic condition which doctors aren’t addressing properly. Is that a fair assumption as that is how most people arrive at functional medicine and also if you are able to in fact pretty much attempt to resolve any kind of symptoms or anything that is not working correctly in the body?

[Jeffrey Bland]: Yes, and again I think you really pointed to a major issue within the way that our healthcare system works right now, which is basically a disease-care system as we know it. It is not so much focused on health as it is the treatment of disease. So when a person has broad ranges of chronic symptoms that cut across many different organ systems, it could be fatigue and pain and low energy and cognitive dysfunction and gastrointestinal problems and alternating constipation and diarrhea and sleep disturbances and depression.

They may come with a whole laundry of different chronic systems and depending on what doctor you see, they are all going to try to drive those symptoms into a specific diagnosis and it is going to be based on their background. So they are going to find the disease that they are most comfortable with to use that as a name that they are going to apply to that cluster of symptoms that the patient presents with because they have to get a disease diagnosis so they can get reimbursed. So they are going to call it something. Well the something they call it may not be nearly as important, as you have said, as how the patient got there. And what were the various factors in their lifestyle and their environment that were really creating this complicated disturbance in the physiology that has caused their chronic illness?

It is not a disease as much as it is a disturbance that is caused by the mismatch between their genetic uniqueness and their environment. And if you don’t start asking those questions then you never really get the answer. What you do is you end up with kind of a round robin of different doctors with different treatments that treat different treatments with different drugs to suppress pain or inflammation or suppress sleep problems or to block stomach acid. What is unique to those is you are basically uncoupling the smoke detector, you are not treating the fire i the room. You are uncoupling the signs and symptoms that were there really to tell you there is something going on that needs to be addressed.

So the functional medicine model often is very attractive to a person who has a history who has a lack of success with the traditional disease diagnostic and treatment model because it just hasn’t been successful in managing the range of their clinical problems because they have never asked the right questions. And it turns out that if you look at the kinds of conditions that are dominant within our society today they are these chronic conditions. In fact, over 75% of healthcare expenditures in our system today are spent for the management of chronic illness – not acute disease, but chronic illness. Yet, when you go to have a chronic illness managed it is often managed with drugs that were used for acute care. They are not really drugs that treat the cause of the chronic illness, they are drugs that are treating the acute symptoms and not treating its cause.

So I think we have a very big mismatch of what patients would like and what the treatment approach that they are getting, where it is being applied. And that is where functional medicine has a big role to play.

[Damien Blenkinsopp]: Yeah, great, thank you. So just to give the audience a bit of an idea about this, would you say that headaches are resolvable? Is that the type of chronic condition that we – I have had some strange headaches when I got ill a few years ago and they sent me to a psychologist. And in the world of functional medicine I know that happens to a lot of people, or they keep getting the answer that everyone kind of has headaches and it is not resolvable. And I think headaches are a very common thing, a common complaint today. And a lot of people are going to pharmacies and taking medications for this.

Do you think this is something that is resolvable, like in 90% of the cases, with the functional medicine approach? Or at least there is a good percentage of those that can find some kind of cause behind that and it is not normal to just have headaches?

[Jeffrey Bland]: Well again, I think that is a wonderful example. You are picking some great examples. Headaches is one of those conditions that is a sign or a symptom and not a disease in itself that has many multiple functional contributions that lead to what we call headaches. So it could be a magnesium deficiency, it could be a vitamin B6 deficiency.

It could be, again, another relationship to a food or environmental sensitivity or toxicity of types. It could be related to a problem with the microbiome, that bacteria are producing toxic secondary byproducts that have an effect on the function that we see ultimately as a headache. It could have to do with the vascular effects that are associated with the lack exercise. It could be due to hypertension because the person is taking the wrong kind things in their diet and lifestyle that are increasing their blood pressure and putting them on a vegetable-based diet and lo and behold their headaches go away.

So a functional medicine provider would look at this list of potentials and start making a differential diagnosis of that individual patient or an assessment as to what their specific causation might be of their headache, and work with them not just giving them a headache treatment remedy and drug to again, uncouple the smoke detector of the headache and to treat the cause of that condition. When, in fact, that occurs, i don’t have a specific percentage I could give you but I would say for sure the vast majority of chronic headache sufferers will be in remission. Their headaches have been demonstrated to go away. So I think this is another great example of a clinical presenting sign and symptom that through a functional medicine systems biology approach it can lead to remediation because you treated the cause not just the effect.

[Damien Blenkinsopp]: Right, and what I love about the philosophy is that it kind of puts control back in our hands because we are saying that there is always some cause of what is happening and it is not just that in conventional medicine they will put it down to genetics or something that is not addressable. Often in functional medicine the locus of control comes back to us and it just says that we have to find the cause. If we can find the cause then we can fix it, no matter what is going on with the human body and causing these symptoms. Is that a fair reiteration?

[Jeffrey Bland]: Yeah, absolutely, exactly. If I was to try to kind of distill down the whole focus of my book The Disease Delusion, that is really what it is all about, returning the power to the individual for the control of their health. I think a lot of people have had their health kind of hijacked from them because they feel it’s either a consequence of their genetic lineage that they had no control over or it’s their doctor that is control their health. In essence what we have learned since the deciphering of the human genome in 2000 is that actually we control, each one of us controls how are genes are expressed. And the way that we think, act, believe, behave, rink, eat, exercise, sleep, have relationships with other people, think of ourselves as valued parts of society.

Those all have direct impact on how our genes are expressed and regulate how we look, act, and feel. So I think this is a hugely empowering age in which we live, in which the individual becomes much more important than they were in the previous period of society when we were all part of massification of society where we just wanted to be part of the average. Now, the power of the individual has become very, very important and we can give people the tools to not become doctors, but to understand themselves well enough that they can start navigating through life in such a way to design their own health program that is contrasted to their own disease treatment program, which comes from the doctor.

[Damien Blenkinsopp]: Excellent. So in a minute I would like to give us a little bit more a practical or quantified focus – we often talk about quantified aspects here – about how to make use of labs and data and functional medicine to identify the causes that you are talking about. But first of I just wanted to look at that basically you have a framework in your book The Disease Delusion, and it is this framework for saying these are all the potential causes of problems. The framework that you describe, is that the basis of functional medicine today? Or is that coming from you? Could you give us a bit of an overview of where that framework is? I think it’s really great, a lot of the aspects of it – I haven’t seen them described in that way before.

I think it seems like what we would say in consulting language – MECE was mutually exclusive and comprehensive, basically, so it covers everything. It is a very nice framework, I can say, from my consulting background. But just from your perspective, where does that come from? Is that something recent or is that something that has been used in functional medicine for a while? Is that something that you are hoping that will be used more and more going forward?

[Jeffrey Bland]: Yes, thank you. The way that this functional medicine concept was actually birthed was through 1989 and 1990 my wife and I hosted meetings about a week long each in Victoria pretty strongly on Vancouver Island where we invited about 30 or 40 of the top opinion leaders that we had met from different fields to kind of sit down quietly over a period of a few days with a whiteboard and address the question – what would be the best possible medical system that you could conceive of with your experience from the different disciplines they represented. Let’s not talk about reimbursement and let’s not talk about fair financing, let’s just talk about theoretically what would this system look like.

And from that to your exploration emerged the concept that we would develop a system that really looked at the individual and how they, over time, had altered function and we had different diagnostic criteria, different assessment tools, and we would be able to, earlier on, be able to understand when a person is heading at a trajectory towards a disease well before they become a cancer patient or a heart disease patient or a diabetic patient or whatever it might be. And that led us into asking what would be then the types of things we would want to know of that person so we would be better able to, early on, understand their trajectory towards not-optimal health.

And we started looking at the scientific and medical literature and this group of people were pretty good and understanding what was going on within the discoveries that were being made and we eventually started putting references and articles together and stacking them in different piles to see if they fit into different kind of what we call ‘buckets.’ And from that eventually emerged the fact that these conditions that lead to altered function that later became diseases as a person progresses towards more severity could be characterized into seven different buckets. And we call those the seven core physiological processes. And over the now-subsequent 25 years since that time lo and behold those buckets were pretty close to the way things have evolved in science and in medicine over the last quarter century. So those buckets included detoxification, they included immune defense, it included hormone signaling, they included gastrointestinal function and included structural relationships that included bioenergetics. Each one of these seven core physiological processes, by the way, I have described in individual chapters in my book.

Then we developed questionnaires for the patient that were associated with presenting clinical symptoms and signs that were associated with the dysfunctions in each of those seven areas. And to help the person to better understand where were their strengths and where were their weaknesses, and that formalism became then the functional medicine assessment program and approach. And obviously over the last 25 years it has become much more sophisticated and much more well-defined and well-understood. But I am quite amazed and what we birthed or germinated in 1989 and 1990 that has really proven out over the last quarter century to actually be very applicable to clinical intervention and to improving outcome in patients with chronic illness.

[Damien Blenkinsopp]: Great. I didn’t realize the structure of the framework had been around that long. I assumed it was actually maybe something that you had come up with pretty recently because as you say, it echos all the current themes of research and everything that is currently going on in it. So in terms of the process that you go through, if you could give us a very high view of what happens when you go to see a functional medicine doctor with some complaints that you are not sure of – is it a very typical process? Like, do you start with the questionnaires, you said, to kind of identify the different parts of that seven piece framework that goes wrong? Can you walk us through the kind of top level of what would happen if someone went to functional medicine?

[Jeffrey Bland]: When you go to kind of your traditional disease-focused practitioner, the whole drive is to try to get a differential diagnosis, try to get a name that you can put on your condition. And that’s different than the functional medicine practitioner. They may obviously be interested in a diagnosis if a person has one, but their approach will be different from the beginning in that the approach is to look at the antecedents, triggers, mediators, signs, and symptoms. Now, what does that mean?

Antecedents are the preceding factors in that person’s life that may have given rise over time to the clinical condition and the problems that they are experiencing. And that has to do with looking at your genetic background, looking at your family history, and looking at various kinds of things that may have happened earlier in life, it could be illnesses, surgeries, and just a really good what I call historical, history and physical, as well as bringing genetic information into the story and other aspects of their environment and lifestyle habits. That is antecedent.

Then the next question is what are the triggers that are triggering your antecedents? Those kinds of signs and symptoms that you are presenting with, the things that brought you to see a healthcare provider. Most patients, when they are most people and they feel perfect, they don’t wake up and say, ‘Oh gee, I ought to go see one of my health care providers because I feel so good today and I ought to find out why.’ But they come because they have a series of complaints. So the triggers could do things like maybe an automobile accident or maybe a severe trauma that you have had, a psychological trauma with a partner, a spouse, or a child. It maybe be an infection. It may be that you just were put on a certain medication, that you are having an adverse response to it. Maybe an environmental exposure so these are the triggering agents that then are the exacerbators, like the straw that broke the camel’s back.

The triggers then produce a series of what we call mediators in the body. Mediators could be different hormones, it could be inflammatory cytokines, it could be different types of things that relate to our body’s immune response that you can measure through laboratory testing. So these mediators are your body’s response to the triggers that laid on top of your antecedents. And then those then produce your signs and symptoms of different severity, duration, and frequency. The evaluation of that whole story that I have just described, antecedents, triggers, mediators, signs, and symptoms, gives rise to an understanding of the patient’s story. And the patient’s story is the most important part of this whole differential assessment that the functional medicine provider uses. Now, maybe that story will ultimately lead you to say that we can call the story diabetes. But it is diabetes of a unique type that is unique to that person, that needs their own type of intervention because of 100 diabetic patients there are 100 different stories with the same diagnosis.

So this is how one would come about developing a relationship with a functional medicine provider versus an individual that might just say, ‘Oh, you have diabetes. Okay, so you’re going to get metformin and you’re going to get Actos. That’s the drugs of choice.’ In this case, we are looking at a much more deep and broader relationship between why your blood sugar and insulin-related glucose problems are presenting based upon your own antecedents, triggers, mediators, signs, and symptoms.

[Damien Blenkinsopp]: And having been through this process myself, I would say that something that comes across very different from the first part is that the question I was put to first when I went through the process was I was asked when was the last time you felt completely well? And I think the answer to that comes back very differently to when you go into a traditional doctor’s office and I had to think back and I was like, ‘Well, actually, this has been going on for over ten years. There were some tiny things that were going wrong many, many years ago.’ So I think that is an interesting question and it really starts the whole discussion on a completely different level. Is that the typical question that would be asked.

[Jeffrey Bland]: Yes, I think you will notice in my book that the first questionnaire in the book asked that very question – do you feel your health has changed significantly within the last year? That is a very, very important question because it helps us to understand the trajectory towards change, the change in health which is related to functional change, which is related to there is something going on that your genes didn’t change in that year. Something happened to how your genes are expressing their function. And then we start asking the questions from there. So yes, that is a very first-level, important question.

[Damien Blenkinsopp]: Great, thank you very much. Now, how does this connect with what we call more quantified aspects of this in terms of lab tests or any other diagnostic tools. Is there a typical first stage in looking at lab tests? Are there kind of favorite areas of testing of functional medicine? What kind of things would you say are important in functional medicine when it comes to the testing aspect?

[Jeffrey Bland]: Well, I think this is a little bit like the layers of an onion. We start off with the easiest and the least expensive things first, which is a good assessment using the antecedents triggers, mediators, signs, and symptoms approach that is unique to functional medicine. You can do that by questionnaires and these are kind of pen and paper pieces of information and many of those questionnaires have been included in my book and also what I call physical assessment. And their functional medicine provider is very skilled in understanding how to assess nutritional inadequacy with presenting signs and symptoms and how to assess different immune-related dysfunctions so you have a good physical and history evaluation and start there. That is the least expensive and the least invasive.

Then the next level would be to say okay, we have identified certain areas, let’s call it a gastrointestinal area, where you have got recurring irritable bowel syndrome or you have got all upper GI dyspepsia where you have reflux disorder or something of that nature, so you have certain kinds of information around a particular area of the body that is experiencing problems and you want to get more information about what is the nature of that functional difficulty. Now, you would go into more detailed testing.

So for GI problems you might do a stool test to evaluate whether there are funny bacteria that are producing what we call dysbiosis and causing inflammation of the of intestinal tract, you might do a certain type of blood test looking at different types of inflammatory agents like high-sensitivity C-reactive protein, which is a marker of inflammation. So you then start to put together a series of questions as a practitioner that would be the questions that you think are most important as you try to decipher that patient’s individual problem, always remembering that you want to keep the cost of your assessment to the lowest level possible so you don’t throw the whole kitchen sink and you start to layer on the testing as you are making your discovery. And you may have if it is a very complicated, sophisticated case, it may require more testing and you may have to do fatty acid testing, amino acid testing, immune testing, and there may be all sorts of heavy metal testing. So there could be a whole range of different things you layer on, depending upon how sophisticated the problem that person is presenting with.

[Damien Blenkinsopp]: Thank you. Are there any particularly, amongst functional medicine providers, any particularly popular areas of testing or specific tests that you may have seen provided more value over time and then are kind of your go-to tests which you tend to find more information there and find them more useful?

[Jeffrey Bland]: Yes, I think there are. I think that you could start with probably the most common and also one of the most informative and that is to test glucose tolerance that person has. And this is how insulin is working in their body. So this would be, starting with a simple blood test of blood glucose and what is called hemoglobin A1c, to see if they have a problem in managing their blood sugar and managing their insulin reactivity in the body, and they probably would also want to measure in their blood what’s called triglycerides and we would want to measure HDL, the so-called good cholesterol. But that portfolio of tests that was specific to insulin would help us to identify whether that person might have an insulin resistance and a glucose intolerance. So if they had an elevated blood sugar, they had an elevated hemoglobin A1c, they had an elevated triglyceride and a low HDL, we would say, ‘Oh, now that is a person that has a form of what is called metabolic syndrome and we would want to start managing their therapeutic approach, the functional approach based upon the fact they are insulin resistant.

For another person, it might be that they are presenting with, as I mentioned, a long history of gastrointestinal-related problems. So in that person we would be more interested in maybe focusing on doing what is called a comprehensive stool analysis to look for things that are going on in the digestive system that are related to dysbiosis, inflammation, and food or toxic response. For another person, it might be that they have headaches and cognitive dysfunction and dysphoria and kind of depression symptoms and low energy. And we might think that sounds like a person that is more likely to be toxic so we would want to do something related to toxicity testing and probably do assessments of their liver’s ability to detoxify foreign chemicals.

All of this, by the way, I have described in the book in different chapters as to how you put this together. But based upon the presenting signs and symptoms that a person has, it helps guide the individual as to what the specific quantified information they would want in order to make their assessment.

[Damien Blenkinsopp]: Thank you very much for that and I would like to take a bit of a case example with detoxification because I think this is an area in which traditional medicine tends to address less and functional medicine tends to consider more strongly and look more at. So it would be nice to, as you say in your book, you go into each of the seven areas in a lot of detail. And you give a lot of good case studies, which is very helpful to connect to what is going on there. So in a detoxification case what kinds of things that you were just talking about, liver tests and so on, what kinds of things would you look at first to understand if someone had a level of toxicity of toxic burden that they had to deal with and that was potentially causing their symptoms?

[Jeffrey Bland]: I think there are two types of testing that are done for toxicity and its relationship to the body’s ability to detoxify. The first is to look at the presence of toxins in the body and there are a variety of different types of testing protocols or tests themselves that actually measure the level of things like [inaudible 00:41:25] or heavy metals like cadmium or mercury or lead or arsenic or aluminum that can induce toxicity. So these would be examining the presence of toxins in the bladder, in the urine, or in the sweat or fatty tissue. And the other type of test is to look at the individual’s ability to detoxify and our detoxifying system is controlled principally by two very unique enzyme systems that are present in our body. One are called the [inaudible 00:42:00] enzymes and the other are called the conjugase enzymes. And they reside to a great extent in the liver but they are found in virtually every other tissue in the body as well, including the gastrointestinal tract where these enzymes sort of clamp on to these foreign substances and to detoxify them and be able to eliminate it in a nontoxic form, even in the urine and the stool, to get them out of the body. And people have a significant difference in their detoxifying abilities from person to person. this has to do with both differences in their genes and their genetic ability to detoxify. One might have what we call a fat detoxifier effect for certain chemicals. Another might have a slow detoxifier effect. And secondly it has to do with how they have treated their detoxifying systems. In other words, have they eaten the right foods with the right nutrients that are necessary for the support of those detoxifying systems? Nutrients like magnesium, the B vitamins, Co-enzyme Q-10, N-acetyl-cysteine – these are nutrients that are known to be very important for support of our detoxification system.

So the detoxifying ability of our body is really related to how much toxin are we exposed to and what is the relative effectiveness of our detoxifying system in the body to get rid of them? And so we can have too much exposure or too little detoxifying ability, both of which leads to a state of chronic toxicity. I call it metabolic poisoning. And this condition is not so obvious that the person is acutely toxic, like you would have from a poison like strychnine, but the symptoms are often seen by what I call chronic both immune and nervous system toxicity. These are the two most sensitive functions of our body to toxicity. One is our immune system and the other is our nervous system. So the signs and symptoms that are seen with chronic metabolic toxicity are focused around neurological symptoms.

So this has to do with depression and sleep disturbances and foggy brain, where a person can’t think clearly – low energy and various forms of cognitive dysfunction where they can’t manipulate numbers or quick ideas as effectively as they used to. With immune toxicity it has to do with an immune system that is kind of working against itself. You have inflammation present and you also have increased rates and various risk to infectious organisms, viruses, and bacteria, so that the combinations of those symptoms often is associated with this cellular toxicity for which then the appropriate detoxification program for that patient that is based upon their own unique case can lead to extraordinary benefit and improve their function.

[Damien Blenkinsopp]: Thank you very much because I think also the area of toxins and detox – if you are working in a health store today – I am in LA and places like [Air One 00:45:14] or Whole Foods, there is a whole range of detoxification supplements. There are aspects of the products in the shops like alkaline water and so on. There are a lot of products now that are focused on helping to detox, but I feel like there is a fair amount of a lack of rigor in a lot of the scientific basis for a lot of these.

One of the areas that I have heard you talk about at the detox summit, which I thought was particularly interesting, is the topic of alkalinity, which comes up a lot. There is a lot of alkaline water that is sold in shops, for instance. And it is said that if we take in more alkaline we make our bodies more alkaline, and it helps us to detox better. What is the scientific basis for that and is it actually true? What kind of things can be done in reality if it is effective to actually make that change?

[Jeffrey Bland]: Alkalinity is related to the balance between acids and bases in the body. And for those individuals that are not necessarily up on their human physiology our body, in its natural state, if you look at the blood it is slightly more basic than it is acidic. It has what is called a pH, which is a measure of acid and base characteristics, and if it was perfectly balanced it would be a pH of 7, that is neutral. A number higher than seven means it is slightly more alkaline and a number lower than seven means it is slightly more acid. The lower the number goes, the more acid, and the higher the number goes, more alkaline. And the body’s pH is around 7.37 in the blood, which is slightly alkaline, slightly higher than neutral, which is seven.

The situation in terms of chronic illness is that often cells or tissues have pH that is lower than 7.37, meaning they are shifted towards a more acid side slightly, not into what we call metabolic acidosis, which is an acute situation that can be life-threatening, but just a slight shift in the alkaline balance. And this is a consequence of a whole series of metabolic effects that shift the pH of cells slightly towards a more acid side. When I say slightly towards a more acid side what I really should say is a less alkaline side.

The detoxification of the process that occurs within cells in the liver and other tissues requires a pH and a balance that is more close to 7.37. It likes that more alkaline state for optimal detoxification function. If a person has a poison in their cells, that poison often shifts their cellular pH to the more acid side, less alkaline. And there are many studies that in poison centers that have shown that if you administer an alkalizing agent to that person, and this could either be done intravenously or orally, meaning given something by mouth like sodium citrate or sodium bicarbonate, these are alkalinizing substances and it will then improve their detoxification ability.

Now, in the case of chronic metabolic toxicity you don’t need to use – and obviously administration into your blood of an alkalizing agent – but an alkalizing diet can be very, very helpful and these are basically vegetable-based diets. Animal-based diets tend to have an acid residue and they tend to be acidifying. Vegetable-based diets rich in plant foods tend to have an alkaline residue and tend to be alkalizing. And so you can use plant foods, a plant food diet and more vegetables and fruits in alkalizing or you can also use supplementary alkalinizing substances like sodium bicarbonate or sodium citrate, other things that will slightly shift your body’s balance more towards the alkaline state. And that will help improve your detoxification ability.

[Damien Blenkinsopp]: Great. So a couple of clarifications on some of the things that you spoke about there. You were talking about the blood pH 7.37 and if we wanted to measure this slight acidity change that you spoke about, is it possible run lab tests on the cell pH and the tissue pH? You were talking about those verses blood, which I believe blood is always kept roughly at 7.37 and it doesn’t actually change and it is just the cells and the tissues that actually change. Is it possible to quantify that and is it a very slight change or are we talking about 7.1, 7.2? So it is kind of like a [inaudible 00:50:02] test to understand that?

[Jeffrey Bland]: Yes it is, and I am talking here about very slight changes. More acute or more dramatic changes are associated with life-threatening conditions because your body needs to stay within a very close range in its pH in order to function, or the muscles can’t work correctly and the brain can’t work correctly. Your heart can’t fire correctly so if you change too much in your pH you can have very, very serious problems. So we are talking about very small shifts in cellular pH. As it relates to technology, yes, there are research technologies and there are probes, cellular probes, that can be used to measure intracellular pH. But these are not standard diagnostic pieces of equipment.

So most of the time an assessment of pH is really built on clinical signs which can be things like muscle cramping or things like in the case of moving acidosis you have people whose breath changes, it becomes sweet and acidotic. You have people who have difficulty with chronic pain that is often associated with a slight shift in pH. You know about lactic acidosis that we call the muscle pain and fatigue-related problem that occurs in the marathon and heavy exercise. There is chronic lactic acidosis that is associated with this as well as chronic muscle pain. So these are more common types of things that I think one uses for assessing pH balance versus using a specific diagnostic laboratory procedure.

[Damien Blenkinsopp]: Great, thank you for that clarification. The other important aspect I have seen about alkalinity is there is a lot alkaline water for sale now in a lot of the shops. From your perspective, does that help to change the cellular pH? Is that beneficial at all or is there no science behind that?

[Jeffrey Bland]: Well, I haven’t seen a lot of good research on it. I mean, a lot of these things that we see that are being sold commercially – I have a theory of interest but in practice there is no real clinical data to support their expense. And when we start looking at some of the cost and benefit relationships, the cost is reasonably high and the benefit is not so obvious. So I am a little bit skeptical of some of these claims that are being made.

[Damien Blenkinsopp]: Thank you very much. Another important topic and one that has always been relatively confusing to me on my journey of getting better is healing crises, or detox crises. Supposedly when we are detoxifying sometimes we have to go through this period of feeling worse in order to feel better. What is your perspective on that?

[Jeffrey Bland]: Yeah, I think that is another very interesting observation, having been involved with this field of metabolic detoxification now for the better part of 30 years and published many papers and seen literally thousands of different patients under controlled studies in detoxification over those 30 years. I have come to the recognition that the concept of a healing crises we ought to drop the term ‘healing’ and just call it ‘crisis.’ There is no such thing as a healing crisis. When you are in crisis if you have acute symptoms that is not a good thing. That is the body saying you are overdoing it.

A properly designed detoxification program does not produce a crisis. It may produce transient symptoms, it may produce a feeling of spaciness on the second or third day, ravenous hunger for a couple of days until you get your body adjusted. It may even have things like joint pains and headaches that occur, but these are not a crisis. They should be easily manageable and if they are not then that program that you are using for detox is inappropriate and it needs to be modified.

[Damien Blenkinsopp]: Thank you very much. What kinds of things could bring this on? Through my journey I was going through a lot of healing crises until actually I came across you talking in the detox summit. I finally got the answer to this question which I had been asking a lot of people for a long time about these healing crises, and if it is necessary or not. It makes it very hard to understand if you are getting better or if you are getting worse, so I think it is very confusing for a lot of people on their journeys, no matter the condition.

So in terms of where this comes from, since I learned about this – I don’t get healing crises anymore and it is really great. It is obviously a great benefit to the patient, and it keeps them more motivated as well. And from your perspective where is the healing crisis coming from? Is it something specifically that hasn’t been addressed and needs addressing? Are there a couple of routes that need addressing or is there some simple way of looking at that?

[Jeffrey Bland]: I think so. the model that I have used, which I believe is factually correct, is that a person who is overloading their body’s detoxification system through a detox program, meaning that they are releasing more toxins from stored fat tissue or within the body than their detox system can manage, now what they are getting is an amplified toxicity. It is actually their body is now toxic because they are not able to manage the toxins that they are releasing. And so the way that you prevent that is to slow the release of toxins and to increase the body’s detoxification program or detoxification ability.

That is why I am not a big believer in fasting as a focus for detoxification. Because I think in fasting you get into nutritional depletion and that then lowers your body’s detoxification ability and makes you more vulnerable to the toxins that you are releasing to produce toxic symptoms. So the approach that we developed starting back in the early 1990s through the studies that we did was to make sure a person is getting augmented levels of the specific nutrients that are necessary for supporting the phase one and phase two detoxification processes and obviously getting proper fluids so they are flushing out these materials and not storing them in their body, these liberated toxins, and that they are taking in adequate calories, particularly in the way of specific protein that is necessary to support the proper detoxifications.

So it is not a fasting, it is what I would call a modified detoxification, clean, nutrient-rich dietary program. What that leads to over the course, in our experience, of 14 to 20 days is an extraordinarily successful with lower adverse signs and symptoms in the patient or the person getting clean. And when they get clean, they know it. They think clearly, the act clearly, the sleep better, they have more energy, the chronic pain is reduced. If you have never been through that it is hard to describe those feelings to a person until they have done it. It is an amazing experience.

[Damien Blenkinsopp]: Great, thank you very much. Rounding off the interview now and thank you very much for your time. It will be very great to get these details on the basis of your book. There is one thing about functional medicine that I have found as I have been kind of going through my journey is that there are lots of different providers of tests today. There are lots of different labs with Doctor’s Data, Metametrix, Genova Diagnostics, BioHealth – there are many different providers at the moment. And it seems a little less regulated than traditional medicine where – I mean, everything seems to go to [Lab Corp 00:57:19] or some other big lab that may be a bit more standardized. And the measures on the tests are also different.

So I think for many people that can be – for instance, if you go to several different functional providers, functional medicine providers, they are maybe going to favor different tests and so on. So could you talk a little bit about the journey of functional medicine in terms of using lab testing and where you think it is going and what kind of stage it is? Do you see it as anything that needs to happen going forward in terms of standardization or anything like that?

[Jeffrey Bland]: Yes, I think obviously many of these tests that we are talking about or we have alluded to are especially tests – it doesn’t mean that they are unregulated and they don’t have standards of identity, it just means that they are not in the standard and customary tests that all physicians use, like you would have if you went to your doc and had a physical exam and they did a blood test and you had 30 different things in your blood analyzed. Those would be kind of your standard things. So these are more specialized tests that are used within the functional medicine practitioner environment. And this is one of the reasons that I really think it is very useful for a person if they move down this road and as they get more into tuning up their health that they have a functional medicine provider as their ally because these are things that have been skilled in the art and have been trained to know what to use and how to interpret these tests and not to just assume that testing just for testing’s sake is beneficial. It is the right test for the right person or the right set of circumstances, and then the right interpretation of the results.

So my belief is that testing is part of the functional medicine model but it is not the functional medicine model in itself. Much of what you can learn about a person doesn’t need testing, it needs the right way of asking the questions. And that is what I have tried to bring out in my book. The questions you ask determine the answers you get. If you never ask the questions you are never going to get those answers. So it is all about the asking about the patient’s story, understanding the patient’s story, in which then specific tests become part of a defining of I guess taking the hypothesis to understanding so that you can design a specific program for that person. It is going to meet their need and lead to the health outcome that they are desiring.

[Damien Blenkinsopp]: Great, thank you very much for that. So looking forward is there anything that you are excited about, say the next five or ten years, about the use of biomarkers in functional medicine? Do you see any opportunities in the future where it will be more like looking at epigenetics or anything new on the horizon that might help functional medicine practitioners to get better diagnoses or help people better monitor their health and so on? Is there anything interesting you see ahead or that you would like to turn up in the future?

[Jeffrey Bland]: Absolutely so, and this is actually a wonderful place to kind of bring our discussion to a close because really I think it is real time. We are in a health revolution right now that is second to none. This is equivalent in its extraordinary discovery periods to that of the turn of the last century when the origin of infectious diseases was discovered as caused by microbes. And then from that therapy antibiotics were developed, which really transformed healthcare. We are having that same extraordinary revolution in thinking right now and it is around how we are going to manage chronic illness based upon these characteristics of dysfunction. And there are three intersecting changes that are occurring right now that I think are absolutely revolutionizing this field.

One we have talked about and that is the ‘omics’ revolution – genomics, proteiomics, metabolomics, that really allow us to analyze certain aspects of how are genes are expressed and how they are able to be induced to produce good health through activating our resilience genes. And every one of us has some areas of our genetic weak spots. Unfortunately most of us have – in fact, I would say everyone, has resilience genes that can kind of neutralize our response if we turn on our resilience genes. So I think that this particular period that we are undergoing right now in discovery is helping us to understand what are those characteristics and how do we measure them? Soon virtually everyone will be able to have a full gene analysis done, the full genomic analysis, for the cost of a normal lab test, probably somewhere in the range of less than a thousand dollars and eventually for a few hundred dollars. And that will ultimately become insurance reimbursable and we will all have the ticker tape of our genetic information.

That, coupled with the internet and social media where information is now being communicated, transferred, and analyzed in ways never before so that it gives power to the person to own their own genetic information, their own personal health information. And then lastly, big data now in the cloud with what is called informatics that is allowing these huge amounts of new data to be made available to people to be analyzed in such a way that it becomes sensible and a person knows what it means, not just a bunch of ones and zeros but actually operational and instructive about a person’s own personal health program.

Those three things, which we used to think were way out in the future are now happening in real time. The wearable devices that we have like FitBits and Jawbones and so forth and the new devices that are coming out to measure all sorts of biometrics and how that data that each one of us generates about ourselves each day goes to the cloud and gets analyzed and comes back to us and helps us to assess what we need to do to be healthy throughout the course of our life. It is a disruptive innovation that is changing healthcare. And we are all living through it right now. We have a generation of kids that are all social media savvy. They are very comfortable with sharing things that their parent’s generation never was willing to share about their health and their genes. And all of this is transformative.

Within the next ten to twenty years the rules of the road that we have lived with upon doctor’s owning information and everything is about disease diagnosis and all of that is going to go away. We are being replaced with a whole new system that will emerge underneath us with the kids that are growing up in the video game revolution and social media and the age of genomics. That will be transformative.

[Damien Blenkinsopp]: Well thank you Jeffrey, that sounds like a very exciting future and that fits very well with what we talk about often on this show. So it is certainly what I am excited about as well. Thank you so much for your time today, Jeffrey. I know you are a really busy man and I really appreciate your many, many decades of experience in coming on this show and sharing your opinions with us and your ideas.

[Jeffrey Bland]: I appreciate it very much and I hope we have given some good information to your listeners. Thanks a million.

Leave a Reply

Today we’re looking at HRV- endurance training, adrenal fatigue, and future app developments.

If you didn’t listen to it, in Episode 1 we primarily looked at resistance training, or weight training.

Today we also look at some scenarios where the HRV metric can be confounded where an increase in it is not good, how it can be used to identify possible adrenal fatigue and how to improve its accuracy by combining it with Resting Heart Rate and qualitative measures.

Today’s guest is Simon Wegerif who founded ithlete, the first HRV app company, which appeared 5 years ago in 2009. In comparison to Andrew Flatt, whose focus was resistance training, Simon has a background in primarily endurance training and it was for this he originally became interested in HRV.

Since 2009, through working with its client base including a range of pro and amateur athletes and everyday gym goers, and now universities in connection with studies, ithlete has evolved its app to cater for specific scenarios like adrenal fatigue and understanding how individual factors are impacting training. Simon has been diligent in staying up to date with the research and adapting the ithlete app to take advantage of it as it evolves.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • The status of research on Heart Rate Variability and some of the issues to overcome such as standardisation.
  • HRV as a predictor of endurance performance – now as effective as running times?
  • Using “Active Recovery” to recover quicker from endurance and resistance training.
  • True overtraining vs. non-functional overreaching – how to improve training results by understanding how HRV indicates these two .
  • How to diagnose potential adrenal fatigue with a combination of HRV and RHR (resting heart rate) metrics.
  • The one situation where you don’t want your parasympathetic to become dominant (or your HRV to be high).
  • The need for HRV benchmarks to be established in order to compare your “health future” to others and as a proxy for aging.
  • The Palo Alto Prize spurring on new investment in research to improving longevity based on using HRV as a feedback mechanism for experiments.
  • Using yoga breathing (Pranayama) to increase Heart Rate Variability by up to 5 points within a few days.
  • The biomarkers Simon tracks on a routine basis to monitor and improve his health, longevity and performance.
  • Simon’s one biggest recommendation on using body data to improve your health, longevity and performance.

Give some love to Simon on Twitter to thank him for this interview.
Click Here to let him know you enjoyed the show!

The Tracking

Biomarkers

  • Heart Rate Variability (HRV): Measures how your heart rate varies over time. Research studies link HRV to recovery status, stress and other aspects of human physiology.
  • Resting Heart Rate (RHR): Measure of your heart rate at rest (typically measured upon waking).
  • Calories: We discussed the merits of measuring calories in and out, the current hype cycle around ‘calorie counting’ apps and devices, and its relationship with weightloss.

Apps and Devices

  • ithlete HRV App: The app Simon developed which includes some of the RHR and adrenal fatigue functionality discussed during this episode.
  • Polar H7 Bluetooth Smart Heart Rate Sensor: A chest strap heart rate sensor that works with the ithlete and other HRV apps (Damien uses this one).

Simon Wegerif and ithlete

  • ithlete: Simon’s company and the HRV app with the same name.
  • You can also connect with Simon on twitter @SimonWegerif.

Other People, Books and Resources

Resources

People


Full Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Hi, Simon. Thank you very much for making time today to come on the show.

[Simon Wegerif]: No problem, Damien. Really good to talk to you.

[Damien Blenkinsopp]: What I thought we would first do is quickly, where does ithlete fit in with the world of HRV apps and development, from your perspective?

[Simon Wegerif]: Okay, well, ithlete was the first HRV app available, and when I first started getting really interested in HRV, which was early 2009, I decided it was so interesting to me as an engineer by background, but also a keen recreational endurance athlete, trying to make the most of my own somewhat limited abilities, that the iPhone was just being launched early in 2009, and talking to a couple of people, I was looking for ways to realize my hopeful invention of a convenient, simple-to-use, but accurate HRV measuring device. And people said, you know, why don’t you do it as an app in the iPhone? So I started thinking about that, and I made that my target during 2009, and got the prototypes all done on an iPod Touch, and at that time, I think it was IOS version 2 was just coming out, so we were easily the first to bring even accurate heart rate measurement onto the iPhone, let alone HRV. So we’ve been doing this for a little while now, and the product, I think the current version of the app is relatively mature because of that.

It’s also — being the first gives you some advantages in the early — doctors in research started looking at it quite early on, and we’ve now got some good quality validation studies that have been done that show, in fact, the ithlete measurement to have an almost perfect correlation with the gold standard of ECG, which we’re very happy about. The ithlete finger sensor has also been validated.

[Damien Blenkinsopp]: Great, great. Well, you have three sensors. You’re using the finger sensor, the Bluetooth heart rate chest straps, and isn’t there another one?

[Simon Wegerif]: Yeah, the other one was actually the original one, Damien, so in the early days of the iPhone, there wasn’t any convenient and reliable way of getting a heart rate signal into the phone, so I designed a little adapter, a plug-in adapter which would go into the headset socket, which I still think was a good choice, because headset sockets are available, you know, on pretty much every phone, and the way they’re connected has remained standard, now, for three or four years. So it’s a little device which users can take from one phone to the next, be that iPhone, Android, or even Windows phones, if we do an app version for that. And that little receiver picks up the signal from the Polar type of chest strap, and, of course, that Polar transmission system has been around since the early 1980s, so there’s an awful lot of products in the market that support that.

In fact, although Bluetooth [Smarties 00:05:56] is, in many ways, the state of the art, and the finger sensor is the most convenient, we still sell a lot of the — what we call the little ECG receivers because of the massive installed base of Polar type straps and systems.

[Damien Blenkinsopp]: Okay, great. So I know you stay up-to-date with the research, and you’ve been following this since 2009 or before, so could you give us a bit of an overview, from your perspective, of the research? How much is there related to HRV? Where are the strongest areas, and, you know, how you look at it?

[Simon Wegerif]: Yeah, I think if you were to put heart rate variability into PubMed, which is the — you know, the recognized research database of peer-reviewed papers, I think you’d probably get about 14,000 hits. So there’s an awful lot of peer-reviewed research which has been done on HRV.

[Damien Blenkinsopp]: Do you mean 14,000 papers, separate papers?

[Simon Wegerif]: Yes, 14,000 separate papers, yeah.

[Damien Blenkinsopp]: Great, great.

[Simon Wegerif]: Which is quite a high volume. A lot of that is focused on disease state, so looking at autonomic dysfunction, for instance, in diabetes, cardiovascular diseases, cancer, and a lot of other disease states like that, but there is a fair body of research studies on sports performance and health as well. During my preparation for designing the ithlete app, I read about 500 papers during 2009, and I’ve now got about 1,000 in the collection, my collection that I’ve read.

Some of the papers have got some strikingly good methodologies and breakthroughs, and others are a bit weaker. I think one of areas where heart rate variability research has not done itself any favors is not standardizing in units or protocols. For instance, things like the duration of the measurement, the units that are going to be used, the position of the subjects, whether they’re lying down, walking around, standing, sitting, what are they doing. There hasn’t been much standardization there, I think partly because a standards document was never adopted in the industry.

[Damien Blenkinsopp]: So one thing I noticed about your ithlete app when I was playing around with it was that when you’re taking the reading, it’s got the breathing timer. It’s got this circle that moves up, in and out, with your breathing, which I thought was great to try and standardize that aspect a bit better in terms of how you’re breathing and just keep more rhythmic and controlled every time you’re doing it, instead of different. Is that why you put it in there, or?

[Simon Wegerif]: Yes. Breathing has a very important impact on heart rate variability, so when we talk about HRV, particularly in sports performance and everyday health use, we nearly always mean parasympathetic HRV, and parasympathetic HRV is primarily dependent on breathing. In fact, the HRV is caused as part of the breathing feedback loop with the brain. So as you breathe in, your heart rate gets faster; as you breathe out, your heart rate gets slower. And it always seemed to me, as an engineer, that unless you’re controlling your breathing in some way, that your HRV measurement process is going to be somewhat unpredictable, if you’re just relying on a breathing pattern which is uncontrolled. So controlling that breathing, but without creating stress, hopefully, in the user is the objective here, because everyone who knows much about HRV will know that stress lowers your HRV. So we don’t want to stress the person during the measurement, but we do want them to have a constant breathing pattern, and hopefully the ithlete breathing pattern is something that’s evolved over three generations of the app now, and we hope that people find it peaceful and relaxing to use.

[Damien Blenkinsopp]: Yeah, it’s kind of like this pulsing heart thing. I found it relaxing, and it’s just nice to have an indicator. Because I’ve used other apps, and, you know, they don’t have that. So every time you’re probably breathing a little bit differently, but you don’t notice it. So I thought it was a nice touch. Thanks for that overview.

So, you’ve done a lot of work in the endurance and aerobic areas. We haven’t looked at that yet on the show, so that’s what I’d like to explore a bit more with you. Any idiosyncrasies or differences compared to weight training, which we’ve looked at quite a lot with Andrew Flatt in the past. How would you say that it differs from weight training in the way HRV relates to endurance?

[Simon Wegerif]: Well, one thing, as a segue or a link from the body of research on HRV, Damien, is that a lot of the studies in the sports performance area have actually been done with endurance sports. So they’ve been done with running, cycling, rowing, cross country skiing, because, of course, Finland and the Nordic area has been one that has done a lot of adoption and research into HRV. So there is — the body of research in endurance sports is strong. It’s also something that I’ve been personally interested in, because one of the reasons I created the app originally was to improve my own performance, originally, in triathlon, but lately in long distance cycling.

And so HRV, interestingly, has been something which is really quite well proven and quite well applied to endurance sports. And one of the things about some of the research that’s come out in the past couple of years has been the very good correlations between changes in HRV and changes in performance. So there have been studies done at the national level on French swimmers where they measured their HRV before doing a weekly 400-meter pool time trial, and they found the correlation was so good between the individual’s change in HRV and their variation in performance on the Thursday time trial, that they said one or the other is good enough here. So if we measure their HRV, they don’t need to do the weekly time trial to assess performance improvement.

And a key researcher in this field also, Martin Buchheit, also found when club runners were training to improve their performance in 10K races, that only the runners that improved their HRV during — I think it was an 8-week training program. Only the ones that improved their HRV, improved their running times. The ones whose HRV didn’t improve, their running times didn’t improve, either.

So there’s been some very clear findings in the endurance area. And I think training guided by HRV is becoming more and more practical for endurance sports as a way of maximizing performance with the training time that’s available, but without risking overtraining.

[Damien Blenkinsopp]: Right, right. I know with respect to endurance, we’ve touched on this a bit with Andrew Flatt, he was talking about basically how he would be doing weight training, and his HRV would go down, but if he did a bit of aerobic as well, he would limit how far his HRV would drop the next day. How do you explain that? What’s going on there?

[Simon Wegerif]: Yeah, there’s been a pretty important study that came out, I think it was late last year from a couple of researchers in the University of Queensland in Australia, and again with Martin Buchheit involved, that built on work done by researcher Stephen Seiler, who’s been looking at the way, for instance, marathon, long distance runners have trained in Kenya for many years. And what he observed there is that they tend to follow a polarized approach to training. So the majority of their volume, say 80% of their training time, is conducted at what appears, to many athletes and coaches, to be really quite moderate paces, fully aerobic work. And in fact precisely defined, it’s a level of aerobic work below the first lactate threshold.

So essentially the lactate level in the blood is close to the athlete’s ordinary baseline. And recovery from that kind of aerobic work, although athletes can do habitually quite high volumes of that, you know, many hours a week, is very quick. And that’s reflected in HRV. But when you go above that threshold, then recovery takes much longer to achieve.

So in Andrew’s case, I think what he’s really enforcing is the fact that aerobic exercise really allows rapid recovery, and the fact that the metabolism is accelerated is helping to process the byproducts from the high intensity sessions and perform, essentially, what we call active recovery. Active recovery actually gets you back to baseline more quickly.

[Damien Blenkinsopp]: Does that reduce the stress, the stimulus to improve your body in any way? We’ve also spoken to, like, Doug McGuff of Body By Science. He talks about inroads, so, you know, one of the things about heavy weight training is you want to create a large enough stimulus to improve strength. So is this in any way — it sounds like it’s reducing, in a way, the stressor. Is that a correct way to look at it? I’m just wondering if that has an impact on how your body tries to compensate.

[Simon Wegerif]: Yeah, it does seem to be having that effect by stimulating the parasympathetic nervous system. And the parasympathetic nervous system is good for reducing inflammation, for rebuilding energy stores, glycogen in the liver, for ensuring that oxidative stress is reduced. And the really useful thing about long slow distance or aerobic training in endurance athletes is that it provides a good level of stimulus for mitochondria to adapt. So one of the things you want as an endurance athlete is an efficient metabolism with lots of mitochondria in the muscles, which are able to process fuels and turn those into energy. And what you also want is a metabolism that’s able to use fats as fuels. You know, your store of fats in any body, even thin people, is many, many thousands of calories, and fat is a very efficient way to store fuel. You know, it’s 9 calories per gram. Whereas, carbohydrate is 4.2 calories per gram, and carbohydrate is usually associated with quite a lot of water retained in the body as well. So if you can use fats as fuels, that’s a big advantage.

If you’re running a marathon, then you’ve only got enough glycogen for about — you’ve probably got about 800 grams. You know, you’ve probably got — your total body store is about 3,000 calories, of which your body will probably only allow you to use a couple of thousand, so your ability to supplement that glycogen fuel with fat stores is something that your body learns to do and learns to adapt to when you spend time training aerobically.

[Damien Blenkinsopp]: Yeah, we discussed this with Jimmy Moore. He’s done a lot of work with other people in keto diets and so on involved with training. So, yeah, it’s good for you to make that connection and bring that up in this context.

Okay, so kind of round off the impact — so you’re saying it helps recovery — it helps accelerate recovery by stimulating the parasympathetic system.

[Simon Wegerif]: That’s right, as well as building — building the cardiovascular system and energy stores and energy system to make you — make you efficient, really, and be able to go for a long time.

[Damien Blenkinsopp]: Are there any cases where we shouldn’t be doing this? If we’re just focused on HRV, it’s like, oh, well, it leads to a higher HRV, so — if we’re always just aiming to increase the HRV, which is part of the discussion I wanted to have today, so should we always be doing that? So if we’re weight training and we can do a little bit of aerobic to increase our HRV, so everyone be doing this?

[Simon Wegerif]: I think everybody should be doing a certain amount of it, but it’s not going to lead to good race pace performance unless it’s also complimented by some high intensity stuff. And the general adaptation syndrome of Selye, which was, you know, written a very long time ago, basically talks about stressing the system and then allowing time for it to recover, and when it recovers, it supercompensates, so the body is stronger than it was before. And high intensity work is a very good way of stressing the body sufficiently that it is stimulated to adapt and supercompensate compared to where it was before. And that’s a necessary component of high performance athletics.

[Damien Blenkinsopp]: Okay, okay. So it sounds like everyone — although it’s not going to lead to a higher baseline, by the sounds of it. If we think of we’re trying to increase our HRV over time in terms of kind of aggregate, rather than the ups and down adjustment cycle of just trying to time our training properly, doing a little bit of aerobic with our strength training probably isn’t going to increase the baseline. It just may help us to get back to another workout sooner than later in terms of recovering quicker. Is that a fair assumption?

[Simon Wegerif]: Yeah.

[Damien Blenkinsopp]: Or would that be, actually, kind of biasing the result, and it would be better to — I guess this area isn’t 100% clear as yet.

[Simon Wegerif]: It isn’t 100% clear. I’m trying to recall my own experience of doing a lot — because I’ve prepared for a pretty long cycling event across the Alps this summer, and I did a lot of hours of fully aerobic training, so I was very careful to keep my heart rate and intensity level below the first lactate threshold, and I accumulated a lot of hours, basically, about 15, 17 hours a week for about four or five weeks of this. I didn’t actually see my HRV baseline rise much. What I did notice was my resting heart rate went down during that period, though, and that was a very clear trend.

[Damien Blenkinsopp]: Okay, so let’s talk about that, because I know that’s something very important to ithlete. You track the HR, the resting heart rate, as well, and you use that in your assessment. And you see it as an important part. So what is the HR for you? What is it doing in terms of tracking and helping you to understand performance and recovery and so on?

[Simon Wegerif]: Well, resting heart rate, most people who do training and even people who know about health would recognize that a lower heart rate — a lower resting heart rate is very often a good thing. And most of the time, that it true, because it’s actually the ratio of your maximum heart rate to your resting heart rate that determines your VO2 max. So there is, for instance, a ready reckoner for VO2 max, which is your maximum heart rate divided by your resting heart rate times 15. So, you know, as your resting heart rate decreases, provided your maximum heart rate stays the same or only decreases a very little bit, then your VO2 max will increase.

Now, there are also situations, which can be due to either non-functional overreaching, so some states of overtraining, or even —

[Damien Blenkinsopp]: When we say non-functional overreaching, what does that mean?

[Simon Wegerif]: Well, non-functional overreaching is basically what you might think of as the third stage in progression of training load and recovery imbalance. So the first stage is shock, also known as the alarm stage, which is the body’s healthy response to a new stressor. And during that stage — so you do something intensive, your body is temporarily stressed. It reacts with an increased sympathetic tone, increased output of central stress hormones, increased adrenaline, norepinephrine, cortisol, and if you then allow time for the body to recover, then it supercompensates, and you actually end up you are a little bit fitter than you were before the stressor had been applied.

Now, overreaching is a deliberate imbalance of training and recovery, usually over a short period of time within a periodized block. So a lot of endurance training programs are periodized into a month or a 5-week block whereby you have a progressive overload, then, you know, ending up with a taper or a recovery week. And that is called functional overreaching, because you deliberately continue to stress the body, and then in the last week, you taper, and you supercompensate, and, you know, the benefits of training are imbedded in your system.

If the balance of training and recovery is such that, you know, your body really — it can’t cope with the amount of load that’s being applied, and that can include environmental conditions as well, so that can include bad diet, lack of sleep, all these other things which are, in fact, stressors to your body as well as training, then if, you know, after a short taper period you don’t recover and supercompensate, but you stay in the hole, as it were, then that’s non-functional overreach.

[Damien Blenkinsopp]: Uh-huh, okay.

[Simon Wegerif]: But people do even go beyond that. It is — yes, it is really — the way I would define non-functional overreaching is that when you take the training load away, you don’t see recovery or supercompensation within a few days or a week.

[Damien Blenkinsopp]: And does it take much longer, or would you have potentially basically lowered your baseline by overstressing the body?

[Simon Wegerif]: Yeah, and it can take weeks to recover from non-functional overreaching. And non-functional overreaching is still not as bad as true overtraining. True overtraining is really quite a serious condition, and it’s not that common, but it can takes months or even years to recover from. It can —

[Damien Blenkinsopp]: How would you differentiate the two?

[Simon Wegerif]: Yeah, true overtraining, again, is an extension of the states of overreaching, whereby you take away the training altogether, and the individual really remains in a chronically stressed state. I think it is quite rare, although certainly we’ve been contacted on a number of occasions by athletes and coaches who know that they are overtrained. And this is also known as the exhaustion phase in the General Adaptation Syndrome. And the body is basically continually failing to adapt to the chronic stress. And the chronic stress also starts to burn out the adrenal system, so the central nervous system starts to shut down production of central stress hormones. The adrenal glands themselves desensitize.

A sympathetic response is normally quite healthy.You know, when a person needs to have a fight or flight response, they want to be able to turn it on and turn it off again quickly. When somebody’s overtrained, that response is pretty much absent, to be honest.

[Damien Blenkinsopp]: Right. We talk a lot about the importance of parasympathetic. In one of our previous interviews, we talked about the fact that most people are sympathetic dominant, mostly because of lifestyle reasons today, and so on. So in the HRV Sense app, for instance, Ronda Collier, she noted that most people have a very high sympathetic in their LF, and their HF tends to be much lower. And over time, they can, you know, look at that for stress and so on. But now we’re talking about also that overdominance of parasympathetic can be a problem? Is that associated with adrenal fatigue?

[Simon Wegerif]: Yes, indeed. Once the body gets itself into this state whereby the sympathetic response is essentially impaired, then — it’s interesting. I mean, that’s a pretty bad state, right? I mean, that’s also a state where protein synthesis becomes impaired, so, you know, muscle damage becomes much more likely. Decreased testosterone and other anabolic markers, increased baseline cortisol, so basically, you know, the body is in quite a stressed state, although it’s sensitivity to the adrenal family of hormones has been reduced. And then, you know, parasympathetic becomes essentially dominant. You swing to a high HRV, which if you weren’t looking at heart rate, you might say that that’s a good state, right?

[Damien Blenkinsopp]: Right, right, right. So let’s be clear. What would the heart rate be doing that’s different to show that this is a negative HRV despite the fact that it’s high?

[Simon Wegerif]: Yeah, so what actually happens is that the resting heart rate decreases pretty significantly compared to your normal range. So all of the ithlete measures are based on solid statistics and smallest worthwhile change and things like that, so we’re always tracking rolling means and rolling standard deviations. We can look at the heart rate and see if that all of a sudden — you know, if that over a short period of time goes much lower than it should do normally, and coupled together with an unusually high HRV, then that is quite characteristic of parasympathetic dominant sympathetic burn out state.

[Damien Blenkinsopp]: Right, right. Have you come across many cases of this?

[Simon Wegerif]: Yeah, I’ve certainly see it in myself. We first came across it, because it’s not that well documented, so most of the textbook stuff on overtraining tends to talk about sympathetic dominance, and indeed that is the case through functional and non-functional overreaching. But then, you know, when people keep going, and there are some very motivated type A individuals that keep on going, and they get themselves further into this — into this truly overtrained state, the first time we —

[Damien Blenkinsopp]: Right. So would it be correct to say that your HRV would go down for a while, and if you ignore that, then you might get to this situation?

[Simon Wegerif]: Yes, absolutely. That is exactly what we see.

[Damien Blenkinsopp]: Right, right.

[Simon Wegerif]: The first time we noticed this, in fact, was in the beta testing of the original ithlete app in 2009, when we gave it to a national standard runner and triathlete, and he did a three-day running event in Southern England over the South Downs, and he said, ‘Hey, you know what, guys? My HRV was really high this morning, and I’m completely knackered. You know, what’s going on?’ And we started to look into it and talking to some researchers and developed this test, basically, out of that.

And we certainly have seen it a few — you know, a few times. I’ve seen it a couple of times myself. In fact, the day after I finished the Haute Route Alps, which was 1,000 kilometers in seven days across the Alps, I was six hours a day on the bike working quite hard, the day after that, the Sunday, my HRV all of a sudden swung from low, which had been progressively decreasing during the week, and it swung very high, associated with a much lower than normal resting heart rate, and ithlete went — gave me a straight red.

[Damien Blenkinsopp]: Right.

[Simon Wegerif]: So ithlete doesn’t mess about in that situation. It gives your a red card straight away.

[Damien Blenkinsopp]: It’s nice that it does that, ‘cause, you know, often I imagine most of the apps don’t pick that up, that scenario. So in terms of a swing of HRV, do you remember your — just to give people an idea, where did it kind of start from baseline, and it lowered steadily to what, and then it jumped up one day?

[Simon Wegerif]: Yeah, I can’t remember the numbers right now. I did do a blog post about it, in fact, so it’s on — yeah, myithlete.com/blog, I did a blog post about my HRV before, during and after this actual event. I think you can go look at that.

[Damien Blenkinsopp]: That’s good. So we’ll put a link in the show notes to help people. Okay, so this final thing on adrenal fatigue, is adrenal fatigue is a widely discussed topic today, because a lot of people, not just people who are training, but often it’s the weekend warriors, the people who are working during the week, and they got out and have pretty stressful jobs, and then they’re training at the weekends, or they’re doing triathletics and all these other things at the weekends. And there’s this question of when they start getting more and more tired is the adrenal fatigue. Doctors and clinicians argue about this and how to test for it. And many of the tests are considered not ideally accurate, there is saliva test, there is blood tests, and there’s a bit of discussion there. So I’m just wondering whether you think this would be a relevant biomarker, and if you’ve seen anyone try to compare it to some of those other adrenal fatigue tests?

[Simon Wegerif]: I haven’t. A practical test I could recommend for people, though, is if you suspect you might be starting to get adrenal fatigue, then the likelihood is that you won’t be able to manage high intensity exercise. You know, you simply — you hear comments like, ‘I was unable to get my heart rate or my power up into the right zone.’ You will notice that. And it is literally impossible. You just cannot manage the effort levels, no matter how hard you try. So your perceived exertion would go right up, but your metabolism and your body wouldn’t respond to the workload and energy levels that are required.

[Damien Blenkinsopp]: Yeah, yeah. So I noticed, also, that when you were talking about how to notice this, you know, you spoke about an athlete who came to you and said, ‘Look, my HRV’s really high, but I’m feeling terrible. I’m feeling really tired.’ So in ithlete, you have a bunch of indicators that you track whenever you track your HRV for training, in the morning you have sleep, fatigue, muscle, and stress, and mood, and diet. Do these filter into some kind of algorithm, or how are you using these to help people make decisions?

[Simon Wegerif]: They are going to. I mean, at the moment, these are quite widely used subjective metrics, and they are quite useful for tracking overall health and wellness, as well. So at the moment, it’s great for people to record those every morning, and on the ithlete, if they rotate the dashboard around to the landscape chart, they can visually for themselves see correlations between any one of those variables and their HRV, and in my case, I’m really not very good, if I’m lacking sleep, quality or quantity. So, you know, my HRV normally shows quite a good relationship with my sleep score. Other people —

[Damien Blenkinsopp]: Right. Is that the same for everyone, or do people have different weaknesses? You know, the high leverage weakness you’ve got to kind of avoid. So yours is sleep. Mine is probably sleep, too.

[Simon Wegerif]: No, I think people absolutely do have individual characteristics there. It could be stress for some people, or it could be diet in others, if they have particular dietary sensitivities. But what we are just starting to do, right now, in fact, is a cooperation with a UK university on some advanced statistical algorithms which will look for relationships between those individual subjective variables and the HRV over a period of time. So what we hope to be able to do within the next six to eight months or so is to be able to give users feedback and insight into their own data.

I — you know, for me, HRV has always been a journey of personal discovery. I’ve found out things about myself, what my body and my brain likes as assessed by HRV, and, you know, I’ve been able to keep my HRV sort of steadily trending upwards over the five years that I’ve been doing this; whereas, normally it would decline with age. But, yeah, what we want — what we aim to be able to do is to give users insights, exactly as you say, Damien, telling people, you know, over the past month, sleep was the most important factor for you, perhaps again, and diet was the second, and it seems like you’ve been having a lot of stress recently, and that’s been affecting you as well.

So I think there’s potential for this to go quite a long way, including things like, perhaps, looking at all the relationships between everything people are capturing, and then saying with some statistical confidence all of this stuff that you’re capturing isn’t explaining all the variation we’re seeing in your HRV, is there something else? Is there, for instance, travel?

You know, one of our — one of the members of our team just noticed that driving for periods above three hours was causing a big drop in his HRV the next day. So potentially we can also alert people to things that they’re not capturing or not trying to understand right now, but which nonetheless are affecting their health.

[Damien Blenkinsopp]: Yeah, yeah. So, yeah, just to be clear, because I didn’t bring this up before, but these ratings you enter into your app are basically from, you say sleep quality, and you just give a rating from weak — it’s kind of like 0 to 10, right?

[Simon Wegerif]: Yes.

[Damien Blenkinsopp]: Or you can put very strong, and that’s for each of them. So they’re qualitative measures, but as you say, you’re finding correlations with them, and you’re going to be looking into more of that.

[Simon Wegerif]: Yeah. We turn the position of the slider into a number, like you say, between 1 to 10, and I think that’s a technique — I think that’s called a visual analogue scale or something like that, and the statistics will be using those numbers to determine relations and give people feedback.

[Damien Blenkinsopp]: Right, great. Well, [00:35:23] we’ve explore a bunch of new topics and interesting scenarios that we hadn’t come up with before, because you’ve got this user base which is using ithlete. I think what would be interesting is, like, what do you see people mostly using this for, and what are the kind of biggest use cases, and most useful things people are using it for?

[Simon Wegerif]: We’ve got a wide variety of users. We’ve got well over 10,000 users now on the ithlete app, and they really vary. They do vary from weekend warriors to — all the way through to top professional athletes, both in team sports, endurance sports, things like boxing as well, through to health and wellness practitioners. So we certainly get quite a few bulk orders from chiropractors and holistic wellness practitioners and people like that. And I think it’s used for all kinds of things. It’s used by health conscious people who just think HRV is a good metric to track every day, and, of course, it is. It’s a sort of holistic measure of adaptation reserves or overall well being. So it’s a great thing for people to track.

I think in the more serious side of sports, people are looking in their training not to have dug themselves into too much of a hole, and they fairly quickly start to take the tool seriously when they get amber and red warnings, and they still go training on those days. They fairly quickly work out that that’s a bad idea, and they start to trust the tool more. We give them feedback on a day-to-day basis.

[Damien Blenkinsopp]: Is there any scenario where you wouldn’t trust it? I mean, we’ve highlighted one that you’ve identified and you’ve integrated now into ithlete, with that one HRV going up. Is there anything else you’ve kind of got on the horizon? Maybe there’s a couple of other scenarios that need to be looked into?

[Simon Wegerif]: Yes, definitely. One of those is taking readings at an unusual time. So the ithlete algorithms are based on you doing things at the same time every day. Ideally, it should be first thing in the morning, because then you haven’t got additional variables of drinking a coffee or not, or having something to eat, or looking at — opening emails, having an argument, anything like that. Those variabilities all eliminate it. And, of course, another advantage of doing it first thing in the morning is that you can plan the day ahead. So, you know, darn, I got an amber instead of a green, but it’s not too late, I can modify my training or something else that I was going to do today.

[Damien Blenkinsopp]: Yeah, that’s interesting, because in a future episode, I want to have someone talk about willpower, because I’ve read a fair amount about the correlation between HRV and willpower, and, you know, basically motivation and drive. So if I have a low HRV one day, I’m, like, okay, I’m going to take on less and less business tasks today. I’m going to focus maybe on one instead of trying to get five done. I kind of factor in like that. I mean, obviously you’re feeling like that as well, but I’m also kind of aware that maybe I need a recovery day in terms of just taking on work stressors and mental stressors and things like that, in order to be able to take on bigger stuff the next day and so on.

[Simon Wegerif]: Absolutely, or there might be some intervention which will help you a bit. So if I get an amber in the mornings, then I often, you know, I will change my training to an hour aerobic bike ride around a particular route in the local forest that I really enjoy, that, you know, is visually stimulating. And I know that will help me make the best of my current physiological state.

But back to the question you were asking about when would you not trust ithlete, or in fact any HRV product that compares to baseline, and that is if you get up significantly earlier or later than your normal time. So one of the things about the waking measurement is that you are taking it after you’ve had the cortisol awakening response, so basically when light starts to fall on the back of your eyes, even through your eyelids, it kicks off the cortisol awakening response, which basically gets your body ready to get up and start being active again. So it banishes the melatonin, and it starts the sympathetic nervous system to a certain extent, enough to get you out of bed and get moving in the morning.

Let’s say you normally do that at 7 a.m., and then one morning you have to get up at 4:30 in order to catch a plane or something like that. This is something that I noticed quite early on, that my HRV would, in that situation, be much higher than normal.

[Damien Blenkinsopp]: Ah, because parasympathetic is higher.

[Simon Wegerif]: Yeah, basically. Because my body was still in sleep mode, so the parasympathetic was dominant at that time.

[Damien Blenkinsopp]: So, basically, the circadian cycle is very important to control for.

[Simon Wegerif]: It is important to control for, and some people — I think everybody, once they realize that, that really your morning measurement should be +/- 45 minutes, something like that —

[Damien Blenkinsopp]: So I’m thinking jet lag is — because I just came from Europe to the U.S. a few weeks ago, and my HRV has been a little — I think I was surprised to see how high it was, given how tired I was feeling. So maybe that had some of the impact there.

[Simon Wegerif]: It could do. It could do.

[Damien Blenkinsopp]: Or do you think you adjust pretty quickly in terms of that cycle?

[Simon Wegerif]: I don’t think you do adjust that quickly. We’ve had so many stories reported back to us over the past few years. An Australian coach has said, ‘I never realized what an impact jet lag had on my body,’ and that was by doing HRV measurements, and he was flying backwards and forwards between Australia, Europe and America. And those are long haul flights. I think one rule of thumb is something like your body needs a day to adapt its circadian rhythm to each hour of time zone change. So if you’re doing all that trans-Atlantic or trans-Pacific travel, you’re going to have a really hard time getting adjusted, and your HRV is going to give you feedback on that.

[Damien Blenkinsopp]: Yeah. So the only other confounder is basically the issues is controlling for circadian rhythm and other things you’re introducing, like caffeine or those things. But in terms of actual scenarios, the only other one you’ve seen is where you continue to overtrain and eventually get to this adrenal fatigue situation, without introducing — and then the other scenarios are where you’ve introduced either a circadian or some other confounder in terms of stimulant or activity which is influencing your HRV?

[Simon Wegerif]: Yes, I would say so. Water has some interesting effects on HRV. Hydration level is something that — you know, some of the professional teams that are using ithlete, they want to control hydration level.

[Damien Blenkinsopp]: So are you saying dehydrated would lower your HRV, potentially?

[Simon Wegerif]: Yes, because it stresses the system, so, yes, that will tend to make you more sympathetic dominant. But, of course, that’s something that’s quickly fixable, right? You drink water, and within 15 minutes that HRV will have been restored, because your body absorbs water so quickly. So that will give you a false low.

[Damien Blenkinsopp]: Right.

[Simon Wegerif]: So if you woke up dehydrated and you were normally fully hydrated, you will get a falsely low — I mean, it is a low HRV at that point in time.

[Damien Blenkinsopp]: It’s relevant, yeah.

[Simon Wegerif]: But you have to take it — it’s relevant; it’s important, but you don’t have to take it easy the whole day —

[Damien Blenkinsopp]: Yes.

[Simon Wegerif]: — because recovery from that particular situation can be very rapid. You just drink large glasses of water and you’re right as rain.

[Damien Blenkinsopp]: That’s a good point. It’s a momentary HRV lapse, a decline. Are there any other scenarios where there are HRV’s you can quickly addressed? I’m thinking training scenarios. I mean, obviously, there’s, maybe a stress scenario, caffeine and things like that.

[Simon Wegerif]: Yeah, mental stress is important.

[Damien Blenkinsopp]: So people can account for those kind of things by — hopefully, if they’ve identified it, then they can retake their reading in an hour or so and see if it’s readapted to their usual baseline.

[Simon Wegerif]: Yes, they certainly could do that, yup.

[Damien Blenkinsopp]: Okay. Well, so you’ve talked about some of the things you’re going to be doing in the future with the algorithm and the correlation. Is there any other future developments and things that you — like, if you’re looking at the whole HRV app space, is there other things you’re looking forward to or that you see could be possible in the future, 5 or 10 years? Where do you see it all going?

[Simon Wegerif]: Well, what I personally hope for is that HRV, it is starting to get credibility now in sports training and sports performance. You know, it’s becoming, thanks to some of the really quality research that’s being done, it’s becoming more and more trusted. I’d like to see HRV trusted as a precursor to Western chronic disease, and in particular I mean conditions like high blood pressure. High blood pressure is an autonomic imbalance disease, and basically high blood pressure can certainly be caused by chronic stress over a period of time, and the blood pressure regulatory mechanism starts to go adrift. But you will see, in the case of not only high blood pressure, but type 2 diabetes as well, that HRV will go out of what ought to be considered acceptable normal ranges months or even years before those diseases take hold.

So what I’d like to see is HRV used as an ongoing wellness barometer, if you’d like. So I’d like to see normality of standards create for HRV measures, and for those actually to be something that people do, perhaps on their own initiative, but something that primary care physicians, general practitioners, etc., are happy to discuss.

[Damien Blenkinsopp]: Yeah, because — I mean, today we take our — if we go to the doctor for a standard checkup, we have our blood pressure and we have our heart rate, standard heart rate taken. What you’re suggesting is potentially HRV could be a better measure, and it should be included in those, if we could be more standardized and stuff, because you’d see it decline steadily over time if there were some chronic issues building.

[Simon Wegerif]: You would, and you would see it declining outside of a normal range. We exhibited — we launched the finger sensor in V3 of the Apple Consumer Electronics Show in Las Vegas in January. We probably did 200 demos during whatever it is, the three days that CES is on, and we had people who illustrated HRV values which, by looking at them, some of them were predictable, and in some cases, people really needed to pay attention. So we had a very large gentleman who came to see us, who said he got diabetes and he hadn’t been exercising recently, and he got 35 on the ithlete scale. And that shocked even him, because that is a very low number. I mean, that’s an extreme case, but —

[Damien Blenkinsopp]: Was that lying down or standing?

[Simon Wegerif]: No, that was sitting. So we did — all of these demos were done with people basically sitting at a table. But I would like to see some normative ranges exist for people. And also by tracking over weeks and months, that they’re able to do what I’ve seemed to been able to do, which is to basically find ways to keep my HRV increasing over the long term as opposed to declining with age. HRV is a very good forward looking indicator, and that’s why I sometimes call it a barometer. You know, it’s telling you about the weather to come, rather than the weather as it is right now. I would like to see it accepted and accredited.

And I think there’s been a useful start made in that area recently. There’s been this announcement about the Palo Alto prize, and that basically is, I think, either a half million or even $1 million award to researchers who can show initially in laboratory animals that they’ve developed techniques which would cause animals’ HRV not to decline over a period of time. The idea is that that will be applied to human studies later on, once the techniques are proven. So HRV is starting to become recognized now as a longevity indicator.

[Damien Blenkinsopp]: Right, right. You wouldn’t have seen it yet, but we also interviewed a guy named Todd Becker who’s very interested in hormesis and aging and longevity, and you might have read his stuff.

[Simon Wegerif]: Yup.

[Damien Blenkinsopp]: He plays around with that to increase HRV.

[Simon Wegerif]: I did read it. His article on HRV was excellent, really, really good.

[Damien Blenkinsopp]: Yeah, so he has some interesting points on that. Look out for the interview when it goes up, because it has some relation with this discussion.

So in terms of places where people could go to learn more about this, are there any people or particular journals where you think are good sources of information about HRV?

[Simon Wegerif]: One of my observations about HRV, there’s this massive body of research out there, but unfortunately it’s largely untapped, and I think that’s partly due to the impenetrable nature of medical research language. What we have tried to do is also to summarize a number of what we regard as some of the most important articles. So on the ithlete blog, we have done a number of research summaries where we’ve tried to take — captured the essence of what we regard to be some of the most important papers and put it up there for people to look at.

Also, we’re doing a new website where we’ll be putting more resources in there. I think Todd Becker’s article is an excellent introduction to HRV with a really good — a really good, if you like, approach to experimenting with different interventions on himself to see what made a difference. I think Andrew Flatt is doing some very good work at HRVtraining.com. There are a few sites around. And even Men’s Health carried an article or two on HRV over the past year.

[Damien Blenkinsopp]: Was that a good quality article, or was it just good that it’s getting the word out there?

[Simon Wegerif]: It’s good that it’s getting the word out there. I think reasonably brief at the moment. But HRV is getting more mentions in the mainstream press, which I think is important.

[Damien Blenkinsopp]: Great. Okay, so I’d like to round off with a couple of personal questions. I always like to get some information about how people like you, who’ve obviously spent a lot of time thinking about data on biology and working with it, actually make use of it. So what kind of data metrics do you track for your own body on a routine basis? HRV, I guess, obviously. But beyond HRV, or in the specific context of HRV?

[Simon Wegerif]: I’m always wrestling with how to quantify my training. So training load is something that’s interesting to me. And I don’t think that any of the existing measures are really adequate.

[Damien Blenkinsopp]: So is that — are you talking about cycling or — you’re talking about volume?

[Simon Wegerif]: Yeah, that is the point. So training load metrics, there are many of them. So how do you quantify any kind of workout? If it’s cycling, is it miles? Is that a good — is that a good indicator? Is it average heart rate? Is it something about zones, the amount of weighted addition of all the zones you are doing? In team sports, they use RPE a lot, which is rating of perceived exertion. They also do translations from GPS data using group statistics for acceleration levels and running speeds and things like that.

But all of this training load stuff, what are we trying to achieve exactly with respect to — you know, training is all about stimulus and adaptation. From what I can see in endurance sports, there’s two completely different kinds of stimulus that we provide to the body, both of which seem to be necessary, and both of which are very helpful. One is this aerobic stimulus, which some people call the long, slow distance, and the other one appears to be the high intensity stuff. So how should we quantify each of those, other than by observing Kenyan runners who win all the long distances races and seeing what they do? I’m really interested in the science and the biology and the physiology behind that.

There’s all the stuff about calories. How do we measure calories? Why do we measure calories? What exactly are we going to do with that information? That stuff is of interest to me. Calories was of interest, before I did this trans-Alpine cycling, because I wanted to lose weight, but I wanted to do it in a controlled way, and in a safe way as well. So I didn’t actually damage either my health or my sports performance, but I wanted to lose 7 kg, just a stone, a reasonable amount of weight, and I wanted to do it very safely.

[Damien Blenkinsopp]: So you focused on calories to do that?

[Simon Wegerif]: I ended up actually focusing on food types. So what I actually did as advised by my good friend, Dr. Mike T. Nelson, was actually just to deliberately introduce a lot more protein into my diet, and basically diet — there’s an easy way and a hard way to diet, and I think the hard way is to think about all the things that you can’t do. And I think the easy way is to introduce good stuff, and that will necessarily push out some of the other things.

And what I mean by that is — Mike’s advice, specifically, was to increase my protein intake dramatically. And one of the ways I chose to do that was by having a big omelet after training in the mornings every day. And that actually makes you much less hungry during the day for snack foods, biscuits, carbohydrates, things like that. I also asked my wife not to buy biscuits and not to put biscuits in the — or cookies in the cookie jar, so that those were just sort of taken out. I was also — with chocolate, I just said I’m only going to have two squares of 70% chocolate a day, and that’s okay. Because 70% cocoa chocolate is so strong that you don’t want lots of it anyway, but it does sort of just satisfy that need.

So by deliberately eating lots of protein, I basically pushed out quite a bit of carbohydrate, and that combined with the volume of training actually tailed my weight down quite nicely.

[Damien Blenkinsopp]: Right. You make an interesting point in calories, because there’s a lot of devices coming out to measure calories. One of the areas of investment. And obviously that’s been a huge focus for the last 30, 40 years in diet books and so on. However, there’s a fair amount of research now to say that calories are not necessarily the whole thing, input and output, and that it’s a bit more complex than that.

In our discussion with Jimmy Moore a couple of weeks back about focusing on fat. You focused on protein. He focuses on fat intake, and it has the same impact. It satiates you and you tend to lose weight, and you’re not counting calories.

Yeah, so this is arguing whether it is useful to count calories, and these are the kinds of discussions I love to bring up, because especially when the marketing and everything that is out there is saying, ‘Let’s count calories; it’s going to change our behaviors; it’s going to have an impact on our lives.’ But is it really as beneficial as it’s portrayed to be, or are there better methods, like we’re doing — we looked at using the ketonics, which measures your state of ketosis, and as long as you’re staying in a state of ketosis, you’re going to be losing weight. So there’s other approaches to it that may be more useful, depending on what you’re doing.

And the training load thing, I think, is also interesting, and difficult, as you said. There’s not really any measures. We talked to Doug McGuff from Body By Science. He has a very specific protocol which kind of allows to do that, but you have to use that exact training protocol; whereas, I think what we kind of really need to get to is like you were talking about, is we have the metabolic and the strength, or as you call it, the aerobic and the —

[Simon Wegerif]: The high intensity HIT.

[Damien Blenkinsopp]: The high intensity stimulus, and how do we quantify those? Is there any way to quantify those so that we can see what stressor we’re getting, and then we can see, oh, we got a decline in our HRV because it was that stressor. Right? And currently you’re trying to do this with qualitative measures, which is pretty much the best I’ve seen that exist today as well. I don’t know — so you haven’t seen anything? It seems you haven’t — on your journey looking for that, you haven’t yet found anything that might be better than a qualitative measure?

[Simon Wegerif]: No. I’m always looking for things which are practical, which people will actually do every day. So anything which is too complex to calculate, people might do it a few times out of interest, but then it’s not going to imbed itself as a habit.

One thing I will say about calories, though. This whole motto of ‘What gets measured gets done.’ So giving people some kind of feedback that they can relate to which motivates them is always important, and whether that’s steps or whether that’s calories, I personally don’t mind, so long as it motivates them to imbed good habits and to reach for smart targets and goals.

What I think the particular problem I have with calories is that, yes, perhaps you can measure calories out, calories expended. Calories coming in is pretty difficult, though, unless you’re really going to spend a lot of time not only looking at the back of food packets and weighing things out exactly, which can be done, but at the end of the day, it doesn’t seem to work out that well, either. I mean —

[Damien Blenkinsopp]: It’s very impractical. It’s very time consuming.

[Simon Wegerif]: It’s very impractical, and it doesn’t actually work out that well. So people who’ve tried to do this very exactly, like Nigel Mitchell, who is the consultant nutritionist for Team Sky and is a very well recognized and respected nutritionist, says that if you do this exercise exactly — so on professional cyclists, they use power meters. You can measure the exact number of joules that they have expended. They can also measure the efficiency of the cyclist in terms of oxygen consumption, they can work out very accurately how many calories in those guys should need, and even if you do do all the food weighing stuff and measuring and everything else like that, the weight balance doesn’t seem to come out exactly as you would have hoped. There’s some quite large inaccuracies in there, one of which I believe is potentially the fact that the calorie numbers on the back of the food packets are achieved by burning the product in pure oxygen and seeing how much heat it gives off, but to what extent does that really represent the way our digestive systems work? And do they always do the same thing with two forkfuls of pasta? Does it matter, you know, what else you’ve got in your stomach at the same time?

[Damien Blenkinsopp]: And your microbiome, which is another interview with recently did. Like, your microbiome can impact how you metabolize the food. So I think it is more than calories, and it seems like the research is steadily going towards that, but it actually seems pretty complex. You know, microbiome, the types of macro and micro nutrients that you’re consuming. But, as you say, if you’re counting calories, you’re potentially looking at helping yourself to behave better, so it potentially could help.

Just, I think there is a device and a crowd sourcing project which is tracking calorie input, so in a more convenient method, I think it’s still in crowd sourcing. I’ll put the link in the show notes, because I can’t remember the name of it, but it would be interesting to see if that one works out. Because, yeah, like noting down everything you eat is not something that I can see people doing for a very long time.

What has been the biggest insight about your own biology that you have drawn to date from any data or anything you’ve tracked?

[Simon Wegerif]: I will tell you, I haven’t mentioned before in this discussion, but it is actually HRV — so HRV biofeedback, which is another — another topic in its own right and may be one that you will cover in a future podcast, but one of the things in my journey to steadily increase my HRV was — I do tend to be quite a driven person. I do tend to get moderately stressed, and my wife is much calmer. She’s been doing yoga for a number of years, and she’s always told me, ‘Simon, you should try yoga breathing.’ And I must admit, I did poo-poo it a bit, until I actually had a chance to meet up with an old friend who was a yoga instructor, and he told me about breathing. And I started to relate that to HRV, and I built myself a little biofeedback app prototype, and that, over a period of just a few days, made a big change upwards in my baseline for about 5 or 6 ithlete points.

And that was a really — that was a really big insight for me, that I could increase my HRV and feel much better quickly by using basically guided, deep diaphragmatic breathing. And there are good reasons as to why that should work.

[Damien Blenkinsopp]: You were tracking — you were doing this for, like, what 10 minutes a day or something like this? And you were using an HRV device to see if you were raising it? Or were you just using the HRV for training every day, and just watching it? So it was like an experiment?

[Simon Wegerif]: It was like an experiment. I did my ithlete reading every morning, and then, I mean, you couldn’t help but notice how much it had swung upwards when I started doing this breathing practice. And what I found even more surprising was that when I experimented again by not doing it for a few days, my HRV remained elevated. So it seems to have a chronic effect on upwards HRV. And I think this is a technique that’s got a lot of potential for the future as well.

[Damien Blenkinsopp]: Yeah, very interesting. Great, great point. Okay, last question. What would be your number one recommendation to someone trying to use some form of data to make better decisions about their body’s health or performance?

[Simon Wegerif]: I think it would be do it consistently. Do it consistently. Preferably, you know, every day or several times a week, and do it for a period of time. And when you’re trying to — if it’s a measure that you’re trying to improve, like HRV, try to change just one thing at a time to see if that thing does make a difference. So just be a little bit scientific in what you do and how you do it. Because otherwise, you know, there’s so much data around now that actually deriving information from that data is in some ways getting harder, because there’s more and more data, more and more variation in it.

[Damien Blenkinsopp]: Great, great point. And yeah, the information overload is going to get worse as time goes on, because there’s so many devices and things coming out. I know I already have too many devices, and I’m trying to decide which ones I focus on. And HRV happens to be one I very consistently do, because it is very rewarding, and I notice the changes.

So Simon, thank you very much for your time today. It’s been a great discussion, and I can’t wait to put this out on the podcast.

Leave a Reply

A different philosophy: Leverage highly time efficient workouts to increase strength, build lean mass, promote cardiovascular performance and provide longevity benefits.

In 2009 I found my time getting swallowed up by the demands of my career job while starting my own business on the side and trying to keep to my crossfit workout program (which I dearly loved).

I barely had any time or energy to socialize or get anything else done. More worryingly my performance in my workouts was going down – not up. I found myself getting more and more tired during and after workouts, having to hold off on some exercises due to persistent muscle soreness and back and shoulder muscle injuries.

I finally stopped ignoring that my exercise program wasn’t helping.

Something was going to have to give – but I needed exercise for stress relief as well as to stay healthy. Right? I needed to find time-efficient workouts and how to optimize workouts for strength and size gains

Today’s interview is about how I fixed all of these problems, re-found greater health, higher energy levels and saved a crap load of time so I could work even harder on my startup. And discovered the joys of tracking workout results, and watching them improve… every single workout.

Enter the Time-Efficient Workout

The solution found me in a bookstore. The book’s title popped out at me as the answer to my problems (and seeming far too good to be true). “Body by Science: A Research Based Program to Get the Results You Want in 12 Minutes a Week“.

Today’s guest is Doug McGuff, co-author of the book, and an emergency doctor, gym owner and weight lifter.

His book describes how to perform, track accurately and optimize High Intensity Training workouts, and the many well researched benefits to doing this type of workout.

Doug himself has been practicing high intensity training since age 15 – that’s 37 years, and been training clients with it since 1997 (that’s 17 years!). As you’ll see in the interview Doug has a very solid grip on the research and science behind his workouts.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • Where high intensity training came from and its use in the world’s of athletics and rehabilitation.
  • How to reduce the volume (amount) of exercise you do and how different body types can benefit from different exercise volumes.
  • The neural development and psychological benefits of strength training and how you see them in terms of increased performance in the gym.
  • Using time tracking to optimize each workout and exercise by measuring by ‘muscular failure’.
  • Finding the right ‘load’ to use in training for each exercise based on a specific time measurement taken for each workout.
  • The speed bumps that each exercise (exercise movement) have – and how to surpass these and increase strength despite this barrier.
  • Why weight training, done the Body by Science way, trains your cardiovascular system – or in other words trains your metabolism and energy production (as effectively, or more than, traditional aerobic exercise like jogging).
  • Creating the largest stimulus for growth via ‘peak intensity’, in terms of strength per exercise and in terms of metabolism for the workout as a whole.
  • How approaching weight training with the slow protocol makes it one of the safest exercises and has translated to Doug McGuff never having seen a training related injury at his gym.
  • The unique calibration used in Body by Science workouts to optimize training stimulus vs recovery time so that you get the most growth and development out of your body and avoid overtraining.

Give some love to Doug on Twitter to thank him for this interview.
Click Here to let him know you enjoyed the show!

Biomarkers in this Episode

  • Time Under Load: The time in seconds your muscles are loaded with weights for a particular exercise. Typical times aimed for are 80 seconds (1 minute 20 seconds). Doug McGuff specified that when you have stabilized at 80 seconds for an exercise (i.e. can’t increase the time under load) for a couple of weeks you will increase the weight for your next workout. Increasing your time under load for an exercise indicates that your performance is improving (your time should not go down unless you increase the weight lifted).

Other Resources Mentioned in this Episode

    Doug McGuff, Body by Science and Ultimate Exercise

  • Body by Science: The original book describing how to do these workouts and explaining the science behind them in detail. Doug also mentioned his second book covering the workouts in more depth, named Body by Science Question & Answer book
  • You can also connect with Doug at his personal site, on the Body by Science website and on twitter @DougMcGuff.
  • Other People, Resources and Books Mentioned

  • Arthur Jones Inventor of the weight machines we see in all gyms today via his brand, which is still a leader in the field, Nautilus.
  • Tim Ferriss’ Geek to Freak blog post and his book, “The 4-Hour Body” including his “Occam’s Protocol” for efficiently gaining muscle mass. Both of these describe “Body by Science” style workouts.
  • Cross Fit workouts and gyms have becoming increasingly popular the last decade and advocate a high exercise volume approach to fitness.
  • Renaissance Exercise, founded by long time advocate of high intensity training, Ken Hutchins, mentioned by Doug for their equipment and perspective on training.
  • Mark’s Daily Apple/ Mark Sisson: Doug mentioned that he has submitted a book for publishing with Mark Sisson’s publishing company on how healthcare got to the state it is in today.

Full Interview Transcript

Transcript - Click Here to Read

[Damien Blenkinsopp]: Doug, thank you so much for coming on the show today. As I mentioned, I have been using your workout since 2009 and they really change the way I approach everything and really help me in various areas of my life beyond working out. So I think this is a fantastic, interesting topic and of course it has got loads of quantifying areas too, so thank you for coming up.

[Doug McGuff]: Thank you, Damien, It is a pleasure to be here.

[Damien Blenkinsopp]: Just to give people a little bit of background, you published your book, Body By Science, in 2009. Could you give us a brief background of where these workouts and this approach came from and a bit of the history and what led to you publishing that book?

[Doug McGuff]: Sure. It has been a lifelong interest of mine, probably since I was about 14 or 15 years old. I started working out around that time and I was doing it to improve performance as a BMX racer, which is a type of sprint bicycle racing, and it worked so astoundingly well that I was immediately hooked. And that was back in the late 1970s, and it just so happened at that time the nautilus training concept was exploding. That was invented by Arthur Jones to introduce the idea of high- intensity training, that by making the intensity level of the exercise higher, that the exercise could be more effective and more time-efficient. I traded my janitorial services for a membership at a Nautilus gym and while cleaning up in the office I found a copy of The Nautilus Training Principles Bulletin written by Arthur Jones. And the owner let me take a copy of it and I read it cover to cover in one sitting and have been interested ever since.

Over time, that concept of high-intensity training has been refined more and more over the years. The idea of a high-intensity training is that the intensity and the amount of training are inversely proportional out of necessity. And as more and more refinements were made to produce higher and higher levels of intensity, what was found was that for the body to recover and produce a good adaptive change that ratio, that inverse ratio, was actually quite disproportionate. For any incremental increase in intensity you are able to achieve through modifications in protocol or equipment, that the amount and frequency in training had to go down disproportionately.

Probably the first time that was really driven home was in the 1980s when Nautilus was researching the use of high-intensity strength training for the treatment of osteoporosis. And they created what led into the super slow exercise protocol, lifting and lower the weight very slowly in order to protect these elderly, frail women that they were training. And what they found was two things – one is very little went a long way. It was very easy to overtrain people. And two, a rate of progress that was much more dramatic than they had seen in the past. And they thought perhaps that was attributable to the fact that these were elderly and deconditioned subjects, but when they took the protocol and applied it to more normal athletic populations, they found a similar sort of response. And over the years from that point forward into time, that sort of protocol has been refined more and more by the inventor of the protocol, Kim Hutchins, as well as other people that have made different tweaks to that protocol along the way, both in terms of protocol and equipment, and that is kind of where we have arrived today, where we have really refined things so that it can very hard and very brief.

[Damien Blenkinsopp]: Right, and to give someone a kind of rough idea of what this requires, with the people you are training how often do they work out?

[Doug McGuff]: When you look at the population in general, how well you recover from exercise is kind of distributed on a bell curve. On the extreme left tail of that bell curve you have people with very good recovery ability that can recover from this kind of workout in 48 hours, but they are quite rare. On the opposite end of the curve you may find some people that need 14 days and sometimes longer to completely recover between workouts and in the middle you are going to find the average recovery time is going to float somewhere between four and nine days, with seven being roughly average.

So that is where most of our clients tend to fall out. We have a handful that train twice a week and do well at it and we have others that either because of their lifestyle, they are full-time shift workers, night shift workers, have small children, they will end up falling out to about an every 12th day frequency. So it is variable but the average is about every 7th day.

[Damien Blenkinsopp]: And how long does a training session last, typically?

[Doug McGuff]: Most of our training sessions will last somewhere between eight and 15 minutes with there being a certainty that any given client will do not one second more than that. The workouts that tend to run a little bit longer are actually in the less robust subjects. And small, petite females that are not so strong or our senior clients that are older and perhaps a little bit frailer, they require a little bit more time between machines and they can tolerate a higher volume of work because they are not bringing so much punishment to themselves, as is the case with a much stronger person.

[Damien Blenkinsopp]: So in that case you have to do more types of exercises, individual exercises, to get the more volume?

[Doug McGuff]: Yes, they can actually tolerate a higher volume of exercise and sometimes in order to deliver an adequate stimulus to them we actually have to do a little bit more than we do with someone that is able to train at a higher level. The clients with workouts that last a little bit longer is it can be either because they have some sort of limitation that makes us have to be more gradual about working our way up to muscular failure or just their tolerance for high-intensity exertion as such that we kind of have got to take an incremental workup to actually reaching the level of fatigue necessary to trigger the stimulus, whereas someone that is more aggressive and stronger can, for lack of a better term, do themselves in at a faster rate because they can tolerate a higher level of fatigue accumulated more quickly.

[Damien Blenkinsopp]: Right, so for the people at home I just want to make sure that they get all the concepts we are talking about. So when it comes to volume you are talking about – how would you explain that in kind of layman terms?

[Doug McGuff]: Well, we do typically anywhere between three to six, and typically about five movements. And each movement is done in only one set and the set is carried out in a way where the muscle is under continuous load and there is no escape and we typically use super slow reps, which is on the equipment we have an excursion in the lifting phase of around 8 to 12 phase, and the same in the lowering phase.

So the movement is quite slow, and that is to deprive the clients of using any momentum to get out from under the load, so the muscle is being continuously loaded and fatigued. And that results in reaching a point where they can no longer move that load, typically in about one minute, 20 seconds, to two minutes, the will typically bite the dust in that time frame. And then we move quickly from one exercise to the next.

So you go through those five movements very quickly, so you have got two minutes reaching failure on each machine and very little rest in between the two.

[Damien Blenkinsopp]: So in your case volume is really equating to time that you were actually doing exercise. If you add that up it is like the total volume.

[Doug McGuff]: Yeah, and the reason we did that was the way that we know whether a client is appropriately recovered between workouts is simply by the record keeping. We know the resistance that they used last time, what their recorded time to reaching muscular failure was, and on a subsequent workout if they are not performing in that realm or we see a drop off in performance, we know that recovery may have been inadequate and is a cause for that. So that gives us some sort of feedback on adjusting their volume and recovery so that they are showing improvement on a workout by workout basis.

What we found initially is that when we are using a very slow rep cadence, where you are going ten seconds out and ten seconds back, each repetition lasts 20 seconds. So simply counting repetitions provided too gross of a measure of performance for us. Because someone could do four repetitions and that could be the full 80 seconds or they could have stopped somewhere around 72 seconds and if you just recorded four you never would have seen the difference between the two.

So we started running a stopwatch on it just to get more of a fine-tuned dial so the drop off in performance when you are using such slow reps would then become evident to us.

[Damien Blenkinsopp]: Right, and simply put if you are lifting the same way as you said resistance, then you get a longer time, and then you are getting stronger?

[Doug McGuff]: Technically, yes, although you really have to be careful with that because the process we are trying to trigger is very intrinsic. The stimulus that is causing the adaptation we are looking for is called inroad. And inroad is the momentary fatiguing of muscle. If you start out with 100 units of strength at the beginning of the set, at the end of the set you end up with only 40 units of leftover strength, and how quickly and aggressively we can go from 100 down to 40 determines the quality of the stimulus.

So what you have to be careful of is that both instructor and client are focused on that intrinsic goal. It is possible to focus on the extrinsic goal, making the weight go up and down for longer. And if you focus on that goal extrinsically then what you can do is you can sandbag during the easy parts of the range of motion. You can squiggle and worm and do anything to milk out extra time to show apparent progress on paper. So the process only works if the subject and hopefully the instructor are blinded to the actual recording process.

So the client, we don’t show them their weights, we don’t let them know a goal time, we just have them – and literally sometimes what we are shooting for is actually a shorter time under load. We want them to police their form in such a way that they bite the dust sooner rather than later. Because it is possible to be coming very close to failure and then heave and jab and do some sort of form discrepancy which actually compromises the stimulus but gives you an extra rep. And that is what we very strictly want to de-emphasize and keep them blinded to their performance so that they are just focusing on that and performance occurs organically. And in a blinded fashion so that we can use that data in a meaningful way.

And our instructors, when they are running the stopwatch, they are not sitting there watching the stopwatch and comparing it to the prior performance because then you start to coax the wrong behavior out of the subject. The stopwatch is either hanging on the machine or held behind the back so that however it turns out is really just serendipitous to the process.

[Damien Blenkinsopp]: Right, so this is very interesting. You are basically trying to do it in a controlled manner so that the data isn’t biased, as you say squiggling and kind of cheating just because you want to hit the same mark. I remember when I was doing this that I have to admit that sometimes I wanted to get the same time or greater than the week before.

[Doug McGuff]: Yeah, it is a very strong human tendency to do that sort of thing when in fact if you are really becoming more refined and applying the stimulus to yourself. You may go from one workout to the next and all of a sudden you are reaching failure ten seconds sooner than you did previously, but for a good reason. So you kind of have to have some insight into that to be able to milk the most out of the protocol. But one thing that became evident as we did this in a blinded fashion is that when you have selected a proper weight, and there is a pretty wide range of what this proper weight can be, what happens is you end up recruiting the targeted musculature, the motor units in that in a sequential fashion.

You fatigue one set of motor units that are slow twitch and as soon as they drop out then you jump to the next set of motor units that are higher order intermediate twitch and if you fatigue those quickly enough you will jump next to your highest order motor units that are the strongest, but the fastest fatiguing. But when you do the set correctly, you are recruiting those in boxcar-like fashion one right after the other. And what the time under load ends up representing, and at least this is my theory, is a signature of what your fiber type and mix is. And what you will see is once you get up to a meaningful resistance, then on a workout by workout basis and in a blinded fashion the client starts to fail almost to the second. We first saw this when we had a client that would bail on the overhead, press at one minute 21 seconds, every time.

So once you have found that, you are now at a meaningful resistance. And meaningful resistance has a fairly broad range. If you want to progress the weight or the resistance, once you have found that recurring time under load or that signature time under load, that is a period in which you can jump the resistance on a workout by workout basis fairly aggressively. Now, eventually that falls off and there is a range of meaningful weight for that particular time under load. Eventually you get heavy enough where some imperfection in the machine strength curve or friction or something is going to make you have a sudden drop down in your time under load. But there is a broad range of weight where you are almost going to reach failure, to the second.

[Damien Blenkinsopp]: So when you say ‘reaching failure to the second,’ what does that actually mean? That means that you have reached a time that is going to be the same every workout?

[Doug McGuff]: Yeah, okay, so the instructor loads you in the machine and says to very gradually start the movement, get it moving, keep it barely moving, they reinforce what you are doing, not resting at a lockout, smooth turnarounds. But the moment you started the stopwatch is behind their back and they pushed start. And they police very good form and you lift and lower the weight until your fatigue reaches a point where you can no longer make the weight move because your forced output has dropped below the selected resistance. At that point they will have you try to attempt to produce movement even though it is impossible for several more seconds. And then that will reach a point of failure where you can no longer sustain the effort and then he presses the stop button on the stopwatch, again behind his back.

This workout it says one minute 21 seconds, he records that on that chart. You come back next week and we increase the resistance by four foot-pounds, repeat the process. You reach failure, the stopwatch is behind his back, he pulls it out, and it says one minute and 21 seconds.

[Damien Blenkinsopp]: So you are progressing in weight and the time is remaining still, which means you are getting stronger.

[Doug McGuff]: Correct, or it means that you are at least aggressively recruiting all of the musculature that you have available. Because what you will find is as people become very advanced, the limitations of this quantified approach are not the subject and his body, although that is somewhat of a contributor. The bigger contributor is the limitations of the equipment and the mechanics involved. Every movement has a sticking point, which is sort of like a little speed bump where the resistance is higher than it should be for your strength output and your leverage at any given point in the range of motion.

So you have this movement that has got a speed bump. But when you first start out and you are not very strong and you are not using a lot of weight it is like pushing a Yugo over a speedbump. But by the time you become very strong and you are using a higher resistance, that sticking point becomes much more meaningful. Now it is like pushing a mack truck over a speedbump.

[Damien Blenkinsopp]: So by speedbump do you mean certain muscle fibers are kind of like the weakest link?

[Doug McGuff]: No, I mean that there is something about the movement itself where there is a mismatch between the resistance the machine is delivering and the forced output of your muscles. So if anyone has ever done a chest press or a bench press type movement you will know that the hardest point in the range of motion is when you shoulders and your elbows reached 90 degrees, because the involved levers and moment arm of those levers have a lowest forced output at that point. And there is no real way to construct into the machine enough of a dropoff to account for that. So there will always be this sticking point as you come out of the bottom and your elbows reach 90 degrees. And that becomes a weight limiting factor after a certain amount of weight, where you will always fail at that point in the range of motion for purely mechanical reasons.

[Damien Blenkinsopp]: Right, okay, understood.

[Doug McGuff]: But that is not so important as by the time you reach that being a problem you have already progressed quite a bit and become much, much stronger. And then you are into a realm of the exercise that becomes more difficult to quantify, but is actually even more productive. Because what you come to understand then is you have progressed through this well enough to understand the internal process going on and you have become much more adept at simply using the resistance as a tool, the resistance as something to contract your musculature against because the continuous contraction against a meaningful load that produces a deep level of fatigue is the stimulus.

Eventually, increasing load over time is not just the load going up over time that produces the adaptation. It is your ability to contract against the meaningful load and produce a deep level of fatigue that is the stimulus. So you don’t have to forever progress the weight in order for there to be results. So what appears on paper does not necessarily always reflect what is going on internally, and that is because of the mechanical limitations of how we apply the resistance to the body.

[Damien Blenkinsopp]: Okay, honestly. So to take your example, I am sure you have been doing this for a very long time now. You are going to do this and you are going to get stronger week by week and eventually you are going to hit a peak genetic point, for a better word, where you have kind of built as much musculature and strength as you are genetically susceptible to do. How long does that take and what does that mean for the workouts afterwards?

[Doug McGuff]: Well, it is variable for different people. Some people ramp up to a full expression of genetic potential within a matter of 12 weeks. For other people it seems to draw out over many, many years with a quick rise up to where the curve becomes [inaudible 00:24:45] but then there are very gradual improvements over long, long spans of time. And those gradual improvements are eeked out by becoming more and more masterful in the application of the stimulus to your own body.

And that is where the really neat aspects of this kind of training come in, you get not only the physical adaptation but all of those sort of [inaudible 00:25:11], zen-like mind-body connection benefits that come along with that. And to some extent the science is starting to bear out how quickly you approach that [acentonic 00:25:23] curve and has a lot to do with your own genetic makeup.

[Damien Blenkinsopp]: I’m sorry, could you clarify – what does [acentonic 00:25:30] curve mean?

[Doug McGuff]: Well, if you picture a sigmoidal curve where you start off with a gradual rise in slope and then it becomes very steep almost straight up, but then the slope becomes more gradual. So it is like an S-curve, yes. So acentonic is when you get to the top of the S and you start to bump up against your potential.

[Damien Blenkinsopp]: Right, it starts. So you are getting less benefits per workout at that stage.

[Doug McGuff]: Correct. It is sort of a diminishing marginal utility, but it is because you are reaching the limits of your own adaptability and genetic potential.

[Damien Blenkinsopp]: Yeah, I think there is a lot of – I just wanted to bring up that since you popularized this method Tim [Ferris 00:26:09] also has popularized it with his 12-week Occam’s protocol and his posts about Geek to Freak, I am sure you are aware, has created a lot of controversy because people don’t believe that it is possible to gain that type of mass. But I just wanted to bring up that basically his is exactly the same method as your method. And that is why.

[Doug McGuff]: Yes, he actually consulted with me when he was writing the Four Hour Body. It was supposed to be a two-hour Skype consult, and I think he was in the Dominican Republic at the time or – but the electricity grid there was just very, very sharky so the two hours ended up happening over about a three month period. We finally got it all together where he gathered the information from me that he needed it anyway. It was a fun time.

[Damien Blenkinsopp]: Yeah, great, great. I am sure that people of aware of that also, just to make the connection that it is actually the same method and everything. One thing you just brought up is the mental aspect of this. And one thing that I have seen in myself and in other people using this protocol is that the first workout they will get to a certain level and then the second workout they tend to go a lot further. And i put that down to either psychology in terms of getting used to pushing themselves harder. or actual neural development of the links between the muscle, the muscle fibers, and in the neural connections, so they basically have more bandwidth to tell their muscles to contract. How do you look at that? Have you seen that kind of evolution?

[Doug McGuff]: Yeah, absolutely. And I think the answer to that is all of the above. What we are coming to find out about muscle is that it is more than just tissue that contracts and produces movement, it is actually turning out that it is the largest by mass endocrine organ in the body. It secretes all sorts of chemical messengers, cytockines that have been termed myokines. One of which is brain-derived neurotropic factor, which causes neurons to reach out to each other and make new connections, and that is kind of part of improving your neuromotor efficiency and your ability to aggressively recruit muscle.

Part of it is becoming tougher, simply. It is not that you are becoming limitless, but you are learning where your limits actually are and that they are in fact further out than you ever imagined them to be. And that is one of the benefits of this kind of training that goes beyond any objective, physical results that you can produce. It is just the psychological benefit that comes from doing hard things.

[Damien Blenkinsopp]: Yeah, it is like learning to overcome a challenge, which is really hard. The first time that people do this workout they find it very, very hard. And then they realize that just by trying harder mentally they can go a lot further. And that applies of course to other areas of their life. It kind of transfers and they can see that they can overcome hard goals and challenges like that.

[Doug McGuff]: Yes, and it is amazing that until you do this sort of thing you don’t realize the extent to which your body has almost like preinstalled software that sets up a panic reaction when you face muscular fatigue. When the window between what you are struggling against and what your capability is starts to close and narrow down, there is a panic point where you just try to escape that experience by any means possible. And it takes an understanding that this there and a deliberate mental focus to overcome it. And as you do that, your ability to overcome that panic and push through it reveals that where you’re actual endgame is much further down the road than you thought. And whether it is simply metaphor or if it is just a manifestation of the fact that this exists in many different areas of your life, I am not certain. But what I am certain of is that as you become more adept at doing this you become much more panic-resistant in almost any situation.

[Damien Blenkinsopp]: That is very interesting, and of course beneficial. So I think there is so much in these workouts that I am trying not to miss important details. One of the unique things about it is that you put all of the exercises very close together. So that is why we are getting down to this 12-minute window because you are starting with a chest press, you are going straight to a leg press and then a shoulder press. And literally you line up your machines, so if you are using machines to do your presses and then you are kind of ready to go with the right weights and you move from one to the other pretty much as fast as you can, is that the way that you run it?

[Doug McGuff]: Yeah, and you can go overboard with that concept where the metabolic effect of the workout can be a right limiting factor. And it is a little bit of a tweak or an art form to get the most out of it without causing it to be an unnecessary burden to the rest of the workout. So for most of our clients we do move them briskly between machines and it can be anywhere between five and 45 seconds between the movements, depending on their metabolic condition at any given point in time.

Your ability to deal with the waste products of high-intensity exertion is a trainable factor. So over time two things are happening and you have kind of got to juggle these a little bit. One is as you get stronger you are doing a much larger amount of both mechanical and metabolic work. So as you get stronger you are producing a lot more metabolic byproducts and fatigue, lactic acid and such. And your body’s ability to metabolically deal with that is trainable.

[Damien Blenkinsopp]: So is that, when we are talking about metabolism, would you put that down to the generation of ATP in the mitochondria and efficiency of your energy output?

[Doug McGuff]: Yeah, there is a lot to it though. I mean, it is more than just how quickly you can produce ATP. The experience at a cellular level is that the anaerobic portion of metabolism, turning glucose into pyruvate outside the mitochondria, doesn’t produce a whole lot of energy per cycle. But you can turn that cycle really, really fast, such that you can deliver pyruvate, the end product of that cycle, to the mitochondria at a rate faster than which it can use it. Now, once the mitochondria picks up pyruvate it can make 36 ATP per cycle, but that cycle can only turn so fast.

So when you are delivering pyruvate to the mitochondria faster than it can use it, pyruvate stacks up in the cell. When it does that gets shuttled through lactate dehydrogenase and you make lactic acid. That begins to drop the pH within the cell and as your pH goes from 7.4 down to 7.0 and beyond, the metabolic machinery and all the enzymatic processes within the cell start to fail and fall apart.

The way your body deals with that is, number one, your mitochondria adapt and learn how to handle pyruvate more quickly. Number two, your body finds other destinations for the lactate. The lactate that is circulating in your blood can be brought back to your liver and the enzymes that do this can up regulate. You can take lactate which is circulating in your bloodstream, bring it back to the liver, and that can go through a process of gluconeogenesis to make more glucose. And that is a process called the Cori cycle.

Your body learns to generate buffers to offset the acidosis. Your body makes a chemical called [2-3-diphosphoglycerate 00:34:01] that makes your hemoglobin molecule offload oxygen to the tissues much easier. And that enzyme exists in higher levels that lives in altitude, like Colorado Springs or high in the mountains, because you have to be more efficient at offloading oxygen. Well, you do this kind of training and you upregulate that enzyme. So there are multiple different things that make you more metabolically capable of high level of exertion and dealing with the byproducts of that high level of exertion.

[Damien Blenkinsopp]: Right, and well this metabolic aspect is traditionally a lot of people, say aerobics, when they are referring to these kinds of adaptations.

[Doug McGuff]: They do, but that is incorrect. Aerobics is a term that just took on a life of its own. Aerobic refers to that portion of metabolism that occurs within the mitochondria. But aerobic became synonymous with any metabolic work or any cardiovascular conditioning. As if somehow magically just the mitochondria could be hooked up to the heart and blood vessels. But that is not true. The entire cell is serviced by the cardiovascular system. And number two is the aerobic system cannot even run unless it is delivered substrate by the anaerobic system in the first place.

so, exercise of any type only occurs when we start to rise the intensity above a resting level and start to deliver pyruvate more rapidly to the mitochondria. And the type of training that we are talking about today is just taking that delivery mechanism to its ultimate expression by taking it as aggressively as we can.

[Damien Blenkinsopp]: Right, so what I wanted to make clear for people at home is instead of talking about cardio or aerobic here, we are talking about metabolic, which seems like a better term for it because it is more about energy production.

[Doug McGuff]: Right, and the book goes into that in great detail. Me and John LIttle, my coauthor, wanted to make a big, big deal in making this metabolic distinction, because not only do you not want it, and it is not really possible just to isolate a segment of metabolism and focus on it, what you really ought to be focused on in terms of having a level of fitness that is complete and actually confers survival benefit in extreme situations, is you want global metabolic conditioning. And that is what this delivers.

You can get more aerobic-type metabolic conditioning than out of most traditional protocols because you are actually causing the aerobic cycle to run as fast as it possibly can.

[Damien Blenkinsopp]: So it is like the HIT, the high-intensity training which people associate with cardio work as well?

[Doug McGuff]: Right, the spring interval type training. And it does a very similar thing. As you move from one machine to the next what you are doing is in a steer step fashion you are stacking these metabolic byproducts and you are incrementally forcing themitochondria to work harder and harder by delivering substrate to them faster than they can handle.

[Damien Blenkinsopp]: So you are trying to hit peaks of intensity in terms of metabolic output so that your body is like oh, we are going to have to be better at this next time because we have got to deal with these peaks.

[Doug McGuff]: Right, the advantage that doing it with controlled cadence weight training as opposed to an aerobic piece gives you is safety. In order to produce a level of meaningful intensity on any aerobic piece, you have to exercise in such a way that you risk injury because the forces have to go up exponentially, along with the intensity. But with appropriately done weight training, with a slow cadence, the forces – as the intensity goes up, the force is actually diminishing because you are becoming weaker and weaker but you are doing it through a controlled lifting and lowering of a fixed amount of weight.

So force is mass times acceleration. The weight you are using is a given mass, but the movement protocol is such that almost all acceleration is taken away.

[Damien Blenkinsopp]: Right. I think people can relate to that because when they are lifting the weight it gets harder every time. So when you are saying they are getting weaker, it is getting harder to lift the same weight.

[Doug McGuff]: Right, but the force that your body is seeing is actually staying stable or in fact going down because the force your body is going to see is never greater than mass times the acceleration and we have done everything we can to eliminate acceleration out of the movement so that your muscles are continually loaded. As opposed to being on an [inaudible 00:38:44] or a treadmill where you have to turn the speed up really high and everything is flailing around and you are pounding the surface harder and your joints are seeing more force. All the while you are becoming fatigued and the force is going up and your risk for injury is going up. As opposed to when you are doing a controlled movement leg press. When you hit failure it is because you are producing less force than the mass you are trying to lift. So at the peak of intensity it is actually getting safer, which is a very unique twist.

[Damien Blenkinsopp]: Yeah, so there are less injuries. I think one thing that we kind of skipped over is the major difference between this and traditional weight training, that with traditional weight training you have reps and rest in between each rep. So it is like one, rest, two, when you have got the barbel. With this method it is a constant load, you don’t stop in between, and there is no rest when you take the strain off completely. It is just a constant movement.

[Doug McGuff]: Correct, and depending on the type of movement we are using, we are enforcing a specific performance behavior to ensure that. So if you are doing a compound movement, a multi-joint movement, for instance – a pushing movement like a chest press, traditionally as you get out to the top of a chest press, if you wanted to you could lock your elbows and create a bone-on-bone power and give yourself a little bit of rest. And what we do in our training regimen is as you approach that lockout, we never go to complete lockout. We never go to complete lockout.

We stop our joints this short of lockout and we do what is called a turnaround technique, which is basically a change in direction like you are going over a loop, or cresting the top of a roller coaster, so that you change direction from positive to negative in this very slow, continuous loop that occurs prior to joint lockout so that your muscles never get any escape from the load that they are facing. As opposed to a single joint movement. Let’s say you are doing movement like a barbell curl or an arm-cross chest block. In that, when you reach the point where the weight is completely lifted and you are in full contraction, you are actually under a much heavier load and there is no rest from the weight in a single joint movement.

So in that we will actually, after the second or third repetition, induce what is called a squeeze technique, where the person actually contracts harder against the weight and their congested muscle tissue to make the load that the muscle is seeing actually increase. So there are specific behaviors that occur during different given movements that basically are carried out just to make it as hard as possible.

[Damien Blenkinsopp]: So, to give the listeners an idea, at the end of this workout you are really breathing hard. You are puffing as if you have been running. People are typically used to that kind of experience when they are sprinting, not so much when they are lifting weights, because there is this rest in between. So the metabolic aspect isn’t really pushed because it is like one, rest, two, rest. And there is that metabolic rest in between. But with yours, like, what is the experience at the end of the 12-minute workout?

[Doug McGuff]: It is dramatic. Your ears will be roaring, your awareness will constrict down to like you are looking through a paper towel tube. Your heart is racing, you’re breathing very hard and very fast as a means of your body is blowing off carbon dioxide and as a means of trying to normalize your blood pH from the severe lactic acidosis that has accumulated during the workout. So it would be very similar to the kind of metabolic experience if you ran an all out 440 meter dash. At its minimum it would be like that. I mean, it is a very profound and demanding metabolic experience.

[Damien Blenkinsopp]: Yeah, so we are basically saying that this workout can do everything for you – like, typically people will do weights and cardio because they want the balance. But in terms of this workout, because it has this metabolic emphasis as well as the strength emphasis, it is basically and all conditioning system?

[Doug McGuff]: Yeah, it does give you total conditioning. Now, if there is a specific metabolic oriented sporting event that you want to participate in, you will have to do some participation rehearsal of that kind of activity in order to turn your dial up or down for that specific combination of metabolic elements. But the workout will make you capable of doing that across a broad continuum. So if you want to go out and run a 10K, you will be in good condition where you can start off training for the 10K and then refine that without having to start from scratch.

By the same token, if you want to be a sprinter you are well-suited for that as well. But you do have to do some rehearsal of a specific metabolic activity in order to optimize your performance at it.

[Damien Blenkinsopp]: So what you are saying is adaptations are specific, so if you want to win a 10K run, you have got to do a 10K, yeah, exactly. Okay, so have you looked at other markers? I think a lot of people at home are not going to be like well, this cannot be the same as cardio. Have you looked at other biomarkers which illustrate the improvement in metabolic activities? Like [inaudible 00:44:10] or potentially mitochondria markers or anything like that?

[Doug McGuff]: Well, the book is replete with studies that kind of demonstrate that. So that is available in the bibliography of the book and if anyone just wants to plug into PubMed and explore that kind of thing you can see good evidence for that. Serendipitously we are not doing it deliberately as part of running the protocol in the business, but we do gets lot of reports from clients of improvements in all sorts of metrics. We have had plenty of type two diabetics that were essentially cured that were on oral hypoglycemics and started to have spells of hypoglycemia because they essentially no longer needed the medication and went off those meds.

We have had lots of clients go off of statins because all those numbers had normalized for them. Women who have had their DEXA scan done every year that have shown reversal of bone mineral loss and no longer carrying a diagnosis of osteoporosis. We have seen hemoglobin A1cs drop very significantly. We have seen people that keep track of that or their C-reactive proteins and other things, so very significant improvement. But that is all just anecdotal evidence that is by the reporting of our clients. That is not science, that is anecdotal evidence with a strong reporting bias built in, but it is still there.

[Damien Blenkinsopp]: Right it is kind of like N=1 experiments, each person just recording their own thing.

[Doug McGuff]: Yeah, I wouldn’t take any of that to the literature. But there is certainly plenty of anecdotal evidence through the facility. But that is not something that we are actively studying or seeking either.

[Damien Blenkinsopp]: I continue my own experience, just to add another anecdotal one. I was suffering from chronic fatigue and I was trying to battle it, just pushing it, so I was doing crossfit, and I was trying to eat Paleo and making various changes like this. And I was exhausted still and having difficulty working and things like this. And then I discovered your work and I started taking this basically very limited approach to stimulus, which is once per week. Or actually I actually got to the point where I think I was working out – one set of body parts we haven’t really spoken about, but one set with the legs once every 12 days or something. So I was really taking the long recovery approach.

And I found myself getting more energy, slowly having more energy days, less low energy days. And it got better for me over time. Where as crossfit seemed to push me the other, which is a very high-volume kind of program.

[Doug McGuff]: Yeah, and it will work but when you are faced with that kind of issue what you really have to understand is that this is not something that can be overcome with a warrior mentally or a Navy SEAL buzz training mentality. Because what you have to understand is that those sort of indoctrination versions of exercise are not done as a stimulus, response thing. They are not putting people through that in order to get them physically conditioned. They are putting people through that to weed people out to find out who are the most resilient intrinsically.

So that kind of Johnny Quest mentality to exercise can backfire on you because of this whole mindset of don’t force it, get a bigger hammer, really does not work because first you have to have the capacity and that capacity has to be brought out through intelligent programming that respects your body’s need for intensity and recovery.

Once you have done that, what you will find is once you have given someone the metabolic capability and the muscular strength to function at a higher level, then their activity levels will spontaneously rise. And then that starts to happen then you have people that are conditioned in such a way that they find themselves going to do crossfit activities as recreation but clearly I think that people that have chronic fatigue, fibromyalgia, I really do believe that is just a metabolic illness that involves mitochondrial down regulation, the ability to generate citrate through the mitochondria is just down regulated over time because of dietary and activity issues. And that can be cured with an intelligent application of exercise, but it cannot be fixed by saying okay, I am just going to man up and bring a sledgehammer to this process. Because that will just backfire on you.

[Damien Blenkinsopp]: Yeah, right, and there is a lot of controversy about that chronic fatigue or communities and so on where the approach has been psychological, like you are talking about. The psychological light, let’s push for it that kind of thing, versus your approach which is actually trying to define the exact stimulus you are capable of using at this moment in time. And then trying to identify the exact amount of recovery you need before you provide another stimulus.

[Doug McGuff]: Right, and the other focus is that by using a protocol that uses 100% of the mechanical work that is going on to try to use the highest percentage of that mechanical work for producing the largest amount of the internal process that is actually the stimulus. And a lot of people, the people that originated super slow that are now known as renaissance exercisers, they have a specific term for this.

Inroading is the internal process of producing rapid and deep fatigue. But they have this concept of inroading versus outroading. And outroading is just like moving furniture. It is doing a lot of mechanical work, but it is doing it with such a level of form that very little of that mechanical work is directed internally at producing rapid and deep fatigue, which is actually the stimulus. So you can have someone sling a sledgehammer at a tractor tire and do a shit ton of mechanical work but very little of that work will be brought inward to the body, producing a very specific focus of fatigue to produce a desired adaptation. So you can pound a tractor tire all you want, but not necessarily have spent all that mechanical work on producing much that is productive.

[Damien Blenkinsopp]: Right, exactly. One of the points that I think is really essential to this whole method is the recovery. And you talk about this extensively and we haven’t really touched on that. But how do you know when you need to recover more? This is the essential part which most people ignore and don’t focus on enough. And we have spoken about this in previous podcasts, the importance of recovery in any training program or, you know, in life in general. And obviously today we run around like stressed individuals and we push ourselves and we try to do exercise, we try to work and we try to sleep less. So there is a lot less emphasis on recovery. So how do you define, in this program, how much recovery is required before you train out again? And how do we know that we have to wait an extra few days? As i explained eventually I was doing the workout, so a kind of partial workout once every 12 days. So how do you get to that point in understanding because at first it starts at 7 days a week. How do you understand exactly how much recovery you should be putting into it?

[Doug McGuff]: This is probably one of the most important concepts of the book. And i will probably make this a final comment, since we are running out of time. But there are several ways of approaching this. One is when you have not appropriately recovered, when a client has not appropriately recovered, we can see that both on paper – there usually is a fairly marked drop off in performance, but also their behavior as they are administering the stimulus to themselves, tends to fall apart sooner, that panic that we spoke about earlier that they had mastered now expresses itself prematurely during the work set. So that is one evidence.

From a more qualitative standpoint in a given individual, you will feel it. You will feel it in terms of the day after a workout you will feel like you have been run over by a truck. You will have that whole flu-like syndrome going on. On a more protracted basis, what I always tell people is that the workout the next day, you should feel a little fatigued and maybe a little below baseline, but overall you should feel invigorated and have a sense of well being. And for certain, over the course of a week you ought to feel above baseline more days that you feel at baseline or below baseline. And that is a gross, qualitative measure that you can use for that. But certainly your performance record will reveal it to you. But you have to really pay attention to how you are feeling, both the day after a workout and over the course of the week between workouts. You should definitely be feeling above baseline more days that below.

[Damien Blenkinsopp]: Right, and before you go to your next workout you should basically be feeling great. If you are feeling in any way tired or anything it is a signal that you are not actually ready.

[Doug McGuff]: Right, and when I work out a schedule and you go into it feeling just kind of meh, that is not good. You want to go in raring to go. You want to feel like you can push a truck over, that kind of sensation.

[Damien Blenkinsopp]: And I would like to say that is one of the things I liked about this. It is like each – because you are only doing it once every week or once every ten days or whatever, you are actually really excited to go to the gym. And you have only got 12 minutes to make the most of it. So I found that it is a great, efficient exercise and motivation tool. Because you are like, ‘I am going to put as much in it, because I have only got this one chance in ten days to make the most of this.’

[Doug McGuff]: And the other thing that really drives that process is once you have an intellectual understanding of exactly what the stimulus is and how your body responds to it, then you really know that you want to apply that in the most effective way possible and that is very motivating. The link to my blog, through Dr. McGuff, DrMcGuff.com – if you go through there, there was a blog that I put in there that was called rock, hammer, nailgun. And it describes the difference between different types of workouts and using equipment and technology and mental understanding of the process to refine that and what you really want out of it is nail gun.

So having an intellectual understanding of exactly what you are trying to accomplish makes you much more effective at doing a really hard, brief, and effective workout.

[Damien Blenkinsopp]: The last point on the recovery was like in terms of the performance charts they are tracking the time, coming back to the time. I guess the biggest indicator that you need to recover more is if you are using the same weight and your time starts declining?

[Doug McGuff]: Yes, not necessarily that it starts declining because you can have a few seconds drop off as a result of refining your effort and doing yourself in sooner, but when you have not recovered adequately you will have a drop off in time that is significant. And that will be combined with a bewildering feeling of what in the hell is wrong here. Because you will reach failure suddenly, you will have that sense of panic come on way too soon. You will know that things aren’t right.

[Damien Blenkinsopp]: Great. I am conscious that time is running out. Thank you for so much information and detail. It has been great. Are you working on anything currently? Anything that you can update us on? I will put links, of course, to your blogs and everything but is there anything interesting that you are currently working on that you would like to bring up?

[Doug McGuff]: Right now we are just turning in a manuscript to Mark Sissen, Mark’s Daily Apple. He has a publishing company but this one is actually being done by me and a coauthor named Dr. Robert Murphy, who is an economist. And it is an expose and deconstruction on how the American healthcare system got where it is today. So that manuscript is being turned at this time and hopefully that book will be out in the near future. But right now we I just post my workout every week with a little subject on high-intensity training, some of the recent scientific literature is always on the blog. And I can always be reached for consultation and/or questions through DrMcGuff.com. I have got all the social links with Facebook and Twitter and post pictures from workouts on Instagram every week, so there is always something going on.

[Damien Blenkinsopp]: Yup, and I would add that your book Body By Science is extremely detailed. And we kind of jumped over many, many topics because it is so deep today. And it is so different, so really I would highly recommend that people get that.

[Doug McGuff]: Yeah, and actually if you go on Amazon for the book, the book has a companion with a question and answer book. When we originally wrote the book we turned in 840 pages of manuscript that had to be pared down to 209 pages. The question and answer book has everything else that was in there done in a question and answer format, and it is pretty informative as well.

[Damien Blenkinsopp]: Well great, Doug. Thank you so much for your time today. It has been a pleasure.

[Doug McGuff]: Yeah, Damien, it was my pleasure. I really appreciate it.

Leave a Reply

A couple of cutting edge and very relevant quantified body topics today- quantifying the microbiome and the state of crowd science

We’re looking at the microbiome, which you probably have seen is the big new topic in the health media and news the last few years. Research is increasingly relating differences in our microbiomes to a range of disease conditions, primarily chronic and gut related ones. If you’re already buying the probiotics or prebiotics in the health store – the reason you’re doing that, is for the microbiome.

But what, if anything, do the probiotic and prebiotic products do for us? How dangerous is taking antibiotics – through changes they make to our microbiome? How does what we eat influence our microbiome?

It’s hoped that quantifying the microbiome, understanding what types of bacteria and other things make it up, will provide a lot more insights into our microbiomes – but how far has the science behind quantifying it advanced? How reliable is it? – and can it lead to us making decisions that improve our microbiomes that in turn lead to better health and less disease.

As we’ll see this is really cutting edge currently – and changing fast. But we have an excellent guest today to bring us up to date on all this.

Jessica Richman, is CEO and co-founder of uBiome. uBiome is the largest crowd science, or citizen science driven project to date. uBiome, already the most popular of the consumer microbiome services, is just about to go through a revolution thanks to recently having gained significant funding, and the backing of Y-Combinator as well as many big name investors such as Marc Andreeson and Tim Ferriss.

“The best ideas are not the ones in our building because you can’t hire everybody in the world who is thinking about your problem. The best ideas are out there in the crowd somewhere and the idea is to bring [those ideas in].”

Jessica, herself, has an impressive background having started and sold her first company in high school… and having accumulated countless scholarships and awards in academic institutions including Oxford and Stanford universities since. Her major interests include network analytics, innovation, collective intelligence, and crowd science.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • What the microbiome is and how it varies across our bodies.
  • The many different aspects of the microbiome (bacteriophage, fungi etc) and why uBiome provides solely data on the bacteria in your microbiome in order to deliver their service at the low $89 price point.
  • The different areas of health that the microbiome and its status and and is increasingly being linked to in research studies.
  • Different approaches to quantifying the microbiome and their accuracy: cultures vs. microarrays vs. next generation sequencing.
  • 23andMe’s model for delivering consumer based low pricing via focusing on genetic SNPs (Single Nucleotide Polymorphisms).
  • The 5 body sites that you get quantified with uBiome (the same used in the Human Biome project).
  • How uBiome is avoiding the FDA regulatory landmine that 23andMe got hit with and which forced it to cut down the information, range and depth of services they were providing to consumers.
  • Citizen science or crowd science and what it means for the future of science and potentially the medical world.
  • Comparing different sequencing methods of uBiome, American Gut and others and progress being made to one common standard.
  • What should we be aiming for in experiments we run on our biome? Diversity? different ratios of the different types of bacteria?
  • The value of getting a baseline sequencing of your microbiome now to compare with in the future (especially if you should get chronically ill in the future).
  • Do probiotics impact the microbiome? If so, how do they impact it? Conflicting anecdotes, research studies and “marketing hype” from all the probiotic supplements and foods now available.
  • Personal insights from Jessica on how what she tracks about her own body, experiments that have worked, and her top 3 recommendations for people trying to improve their bodies and health through the use of data.

Give some love to Jessica on Twitter to thank her for this interview.
Click Here to let her know you enjoyed the show!

Lab Tests and Devices in this Episode

  • uBiome Microbiome Sequencing: The lab tests discussed in this episode. These can be ordered by anyone and done from a kit sent to your home.This is a sample chart output from their interface with my sequencing showing that I have more firmicutes and less bacteroidetes than the standard person on a paleo diet:
    damien-paleo-biome
  • 23andMe: The largest and cheapest service for getting your genetic sequencing (a subset of your total genetic makeup).
  • American Gut: The other main consumer microbiome sequencing company (not for profit).
  • Ketonix: The breathe analyzer for assessing your ketone body levels and whether you are in a ketogenic state. We covered this topic in detail in a previous episode with Jimmy Moore.

Other Resources Mentioned in this Episode

Jessica Richman & uBiome

Other People, Resources and Books Mentioned

  • The Human Microbiome Project The original NIH (National Institutes of Health) funded project to first sequence the human biome between 2007 and 2012.
  • Ilumina The solution uBiome is using to do their next generation sequencing of the biome.
  • 23andMe’s regulatory conflicts with the FDA
  • Jeff Leach Jeff heads up American Gut and has published his own self experiments to change his gut and move it towards a more diverse gut microbiome by interacting with Hadza hunters from Tanzania (read about it here)
  • Chris Kresser Chris, a functional doctor who works with patients on improving their gut microbiomes, has discussed that taking probiotics doesn’t change the microbiome’s makeup, but seems to impact it in via other changes or modulatory effects.
  • Probiotic foods: Jessica says she feels better with Quest Bars, while Damien has noted anecdotal beneficial effects with this Kefir product.

Full Interview Transcript

Transcript - Click Here to Read

[Damien Blenkinsopp]: All right Jessica, thank you very much for being on the show.

[Jessica Richman]: Hi, it is great to be here. I am really grateful for the opportunity.

[Damien Blenkinsopp]: Sure. So to kick it off for you, let’s talk about what the microbiome actually is. I understand it is not just the gut. So how would you describe the microbiome?

[Jessica Richman]: The microbiome are organisms, the microorganisms, that live on or in all of us. And there are many different microbiomes in the body. I think we should take a step back first though and say why is it called the microbiome? What is a biome? So a biome is an ecological area. So in the macrobiome, the biome that we are part of – you can be part of the rainforest, or a desert, or a tundra. And these are environments in which organisms live. And in the body, the microbiome where it actually could be anywhere, not just in the human body, but the microbiome are the microenvironments live in. So if you think about it, it is very different living inside your nose than it is living on the surface of your nose. So inside your nose it is windy, it is warm, it is slightly wet, and there are immune system interactions with human cells. On the outside of your nose it is probably colds, it is dryer, it gets sunlight, there are different kinds of cells that the bacteria are interacting with and if you think about it, it is a very different type of place to live for a bacteria.

[Damien Blenkinsopp]: So you could use the analogy of looking at the world and the jungles, the deserts, and all these different kind of things living in them?

[Jessica Richman]: Exactly, right. And if you think about it the outside of your nose is much more like a desert and the inside of your nose is more like the rainforest, let’s say. It is a very wet environment for an organism to live in. So if you think about it that way, it makes sense that there are microbiomes all over your body and all these spots have very different types of organisms in them and the microorganisms are very influenced by the environment they are in and what can survive in various environments. it is very different, just like plants of the rainforest don’t do very well when they are in the desert. But microorganisms that normally live in the rainforest die off when they are put in the desert. And it is not just bacteria, of course, there are also other microorganisms.

So there are fungi and yeast and all sorts of other organisms that live there and there is this whole ecosystem that we were just never able to see until recently because now it has just become less expensive to sequence the DNA on these organisms, some of which can’t be cultured. So previously you would figure out what was living there by trying to grow it in a petri dish, but that means you have to have the right food, the right conditions, it has to be able to be grown in that kind of environment and not all organisms can be. So now we are finding out things that were just impossible to see before. So now we know more about the microbiome and we have learned that my nose, the inside of my nose, is much more like the inside of your nose than my nose is like my foot, let’s say, because these are very different environments.

Our feet have more in common – the same spot on your body but very different types of places. So the NAH funded a project called the human microbiome project which was sort of supposed to follow after the human genome project to learn about the human microbiome, and they looked at 250 people and they established a lot of the sort of basic technology for doing this. And what we do with the biome is we have scaled up that technology and made it possible for anyone to have access to the same technology to understand what is in their microbiome at various sites and then what to do about it.

[Damien Blenkinsopp]: Is this like PCR DNA analysis?

[Jessica Richman]: So it is next generation sequencing, which is – there are a number of different platforms but kind of the leading one at the moment is by a company called Illumina, and they make what is basically a camera. It is funny, we just got one, and it looks like a printer/scanner – like an HP printer/scanner combo, one of those things you buy at an office supply store. It looks like that but what you actually do is you put a tiny tube of liquid in it that has the DNA in our case of 500 different people’s microbiomes, and it is seriously a tube that is less than an inch long. And you stick it in there and it is a camera that takes pictures of each of the base pairs of the DNA as it goes along and then tells you what the base pair is. So it is really amazing technology. They have really, they have changed the world.

[Damien Blenkinsopp]: So just to be clear, is that something you are going to be using or is that what you have used to date?

[Jessica Richman]: Yeah, so that is what we use right now. So right now we do next generation sequencing and we have been sending that out to various people to get – we sort of do all the processing and they just kind of – it is kind of like sending out your printing to Kinko’s or something. You prepare the document of what should be in it, and then they do the printing part. We have now brought that in house because we have brought in some funding and we sort of have the opportunity to bring it in house, which gives us a lot more flexibility, it is lower cost, we can do things faster because it is right here. So this is the technology we have been using all along and this enables us to really, inexpensively, make consumer price points for $89 to be able to tell you exactly what is in the DNA of all the bacteria that are living in your microbiome.

[Damien Blenkinsopp]: Yeah, so what are the limitations of this? Just a minute ago you were talking about the fact that the microbiome has fungi and bacteria. Today even there are viruses, bacteriophage, viruses that infect bacteria, and all this crazy stuff that we don’t hear about but it is so super complex. So are you just looking at the bacteria aspect of it?

[Jessica Richman]: Yeah, so we have the capability to look at fungi and even to do full metagenomic sequencing, which is to look at every organism, all the DNA that is in the sample, whether it is bacterial or human or plant or from the food you have been eating or every bit of DNA that is in the sample. But we currently sell to consumers the bacteria because it is simpler, it is easier to compare, and we have more people who have those kinds of samples. But there are definitely things that we are developing for the future, products that we are developing for the future based on specific other slices of the microbiome, like fungi. And full metagenomic sequencing is really expensive – it is thousands of dollars so it is not really a good – there is this much consumer demand for that.

[Damien Blenkinsopp]: Right, so that people understand 23&Me is pretty well known and they took a similar approach. They are only scanning certain aspects of genetics.

[Jessica Richman]: Well, it is a little different. So 23&Me looks at snips. So they look at our single nucleotide polymorphisms that are specific parts of the human genome that are known to be correlated with specific research outcomes. What we do is we look at all the bacteria. So there are other technologies that some people use that are based on microarrays that will only look for certain bacteria. So instead of – it is kind of an intermediate point between a culture-based method. That is maybe too technical. With culture you say is X bacteria there, yes or no? Does it grow or not? And maybe it couldn’t grow or maybe you did it wrong, whatever so there is some fallibility built into that. With the microarray method you say are any of these 96 bacteria there? And it can check for all of them. WIth the next generation sequencing you can find everything that is there and we are selectively looking at just bacteria because it is sort of priced so that the consumers can pay.

[Damien Blenkinsopp]: And is this a selection of bacteria I assume there is going to be classification, or a library of what is known well today? Maybe there are just some things that we don’t know there. so does it see everything?

[Jessica Richman]: That’s true, yeah. Well, it is everything that is known plus all the things that we are finding. so there are some public databases of bacteria and what we have done is we have taken the public databases and then added our own and basically enhanced them and so we had it in – they are polydatabases so people upload a lot of junk to them that they think is a good idea to upload and they are not very well curated academically. So we have taken those databases and cleaned them up and streamlined them and added a bunch of things to them to make them better.

[Damien Blenkinsopp]: Yeah, I think what is coming across is that this is quite new and it is exploratory. So the human microbiome project, how long ago was that –

[Jessica Richman]: So that started in 2007 and went until 2012 and we started our company with a crowdfunding campaign, actually, two months after the human microbiome project ended. So we sort of had this – you know, my background is not in biology. It is in computer science and economics and I was doing PhD in computational social science and learning about applied math relating to social networks. And I just saw there is so much interesting information relating to biology and some of the same skills that I was learning could be applied to this new information that was coming out. So we started this project right after the human microbiome project ended. And it is really new. The human microbiome project was really groundbreaking and helped establish this whole field. and you can see the number of scientific papers that are related to the microbiome is on this exponential curve up as the human microbiome project progresses. but we decided to take this technology and bring it to the public.

[Damien Blenkinsopp]: Yeah, and so at this stage now, for the consumers, what do you think – what can they get from it, if they get their biome? First of all you have talked about microbiomes. So you do the gut, you do the nose, genitals, mouth?

[Jessica Richman]: Mouth, skin, and genitals. Those are the ones we currently do. So we have the technical capability to do other sites and we are going to be launching some products that relate to the skin, for example, between your toes and things like that. But at the moment we do those five because those are the five that were in the human microbiome project. So it sort of gave us a basis for the data and sort of sample collection procedures that have been well validated. Yeah, we sample all those microbiomes of those five different sites. Then what consumers can get out of it is they can see what is in their microbiome, first of all, and then how that compares to other people and then how it compares to existing studies of the microbiome.

So right now in our [user interface – 00:12:50], it is very nerdy. It is very [inaudible 00:12:52] from our crowdfunding campaign, but you can see what are your bacteria, how does your distribution compare to other people’s distribution of bacteria, and then you can learn a little bit about each of the bacteria that are in your sample and how they relate to existing studies, which studies involved with which bacteria we are building right now. And this should be out in the next few months, like two or three months. We are actively in the development process and this is software that will go a step further and give you much more data analysis about what is in your sample.

The cool thing about doing it now is you are basically biobanking your samples. So if you sample now it is not like it is lost and you missed your opportunity, it is the only way to sort of grab what your microbiome is like now and then as our interface gets better and as our data gets better that sample gets better but you can also compare it to future samples.

[Damien Blenkinsopp]: Right, so it is the same as genetics. Basically you will be able to re-examine that same sample and still be updated?

[Jessica Richman]: Exactly, but actually we store the data so we don’t need to re – we can resample it later if technology changes completely and we need to totally resample it we can do that. but we also have the data from that sample and let’s say you sample now and you are like, ‘Oh, that’s interesting, my bacteria are fine.’ But then six months from now you want to make a radical change in your diet and you said, you know, maybe I need to cut out dairy, I don’t know, and you try that. Then we can sample afterwards and we can show you the difference between those two things. And we will have the earlier sample so we will know what it was like before.

[Damien Blenkinsopp]: Right, so you are talking about things that influence it and I guess it is quite an important point to mention that your microbiome can change. There is a lot of emphasis on the gut these days. that is the one they talk about most in the press and stuff so i guess it is the one with the most research?

[Jessica Richman]: It is, it is the one with the most research and it is also the one with the most – it is the richest environment for bacteria and that is why the most research is done there, because it has the most bacteria of any site in your body. And also obviously because that is where you process food and waste, and it has the most biological activity relating to all parts of your body. So they found really interesting connections between that and the brain, for example, that are not what you would expect. There are really interesting relations between the microbiome and depression or autism or things that you might not expect, but they don’t say that, for example, about the nose microbiome because that is just less likely.

[Damien Blenkinsopp]: Right, so in terms of you just mentioned a few diseases and conditions – there were things like obesity mentioned, diabetes, acne, allergies. There is quite a range which are now linked in some research to the microbiome. How far along do you think that is? Do you think that has got quite a long way to go or do you think it is interesting for someone to say, who has one of these conditions, to get their microbiome done?

[Jessica Richman]: I think it is not that far off, and I probably think that because this is our field and what we are working on and we know the possibilities, that things can happen quite quickly. I think it is not that far off because we’re collecting all this information that can be useful in actually doing something about it. At the moment this is a consumer product and it is not intended to treat health conditions or diagnose health conditions, but we will have the information and when we do find something interesting we can then pursue the proper channels in making sure that it is available to people who have health conditions and need it.

[Damien Blenkinsopp]: Yeah, so I mean, you stepped on the 23&Me landmine.

[Jessica Richman]: Exactly. Well, we didn’t step on it. We were collateral damage or something.

[Damien Blenkinsopp]: So you said something very important there, it is a consumer and not a medical product. How is that evolving? Are there things that you have to do or are there limits? Can you give us an idea of how you are going to go over that?

[Jessica Richman]: We try to be really careful. And we try to be careful because we don’t want to get into the trouble that they got into, but also because there is sort of a really important public health responsibility to not give people information that is dangerous, poorly understood, that will lead them to do things that are bad for them without understanding why or mistakenly thinking they understand why. I think it is really important to do that. So we are careful to – we are sort of pursuing a two-prong strategy.

One is for things that involve diet, wellness, health, and people’s curiosity about science that is fairly safe in my view. And then things that involve serious health conditions, we are being much more careful with that and we want to make sure we have much more validated information and that we go through the right channels and that people have expert consultation with their doctors or even at the very least with clinicians doing research to share that information. I think it is just a matter of trying to be conscious. And there aren’t any written rules. There is nowhere that we can say, ‘Oh here is where the line is, let’s be careful to make sure that we are on the right side of it.’ But we are just kind of using our judgement at this point to make sure that we are thinking through the issues and trying to be responsible about how we give people information.

[Damien Blenkinsopp]: Yeah, good to hear you are thinking ahead. So we talked a little bit about things that can affect it. Do you know of any clinicians that are starting to either take this themselves or maybe send their patients to give them an idea? A lot of clinicians are trying to tackle things which aren’t very well treated or documented, like dysbiosis and IBD, all of these kind of gut issues, which at the moment is hard to find some clinicians who can say this is the exact approach to fix this. It is not coded and it is more of an art to say the least.

[Jessica Richman]: Right, there is no standard care for a lot of things. And that is difficult because patients are then left without a good answer, even though he went to the doctor to try to get help. I think what we’re doing at the moment is that this is not a diagnostic test. It can’t be used by a clinician, and I sort of want to underscore that. But we haven’t evolved in clinical research, so if a doctor wants to put together a research study of their patients or the participants that they solicit, we partner with them and we provide them basically with a consumer produc. But since they are a clinical researcher they can have a study and they can sort of design this study the way that they want and then communicate with their participants the way they want, which is a way to sort of frame it experimentally so that it is not basing a diagnosis on it or giving medical advice based on the test, but they can use it to learn things about the entire population of people that they are working with.

[Damien Blenkinsopp]: Right, and it can better inform the doctors instead of guesstimating all the time.

[Jessica Richman]: Exactly, right, And it can also press for publishable research. Some of the doctors are doing really cutting edge things and they want to add this to the repertoire and say oh, this is really interesting when i compare patient group X to patient group Y I notice X has this interesting thing, their microbiome, that is publishable research. So we are contributing to science through clinicians who were doing clinical research. A lot of the doctors that are sort of on the cutting edge also do research as well as treat patients, so they can kind of wear both hats.

[Damien Blenkinsopp]: Great, right. I know that this kind of connects with the topic that you are a big fan of, the citizen science?

[Jessica Richman]: Yes, don’t get me started!

[Damien Blenkinsopp]: We will definitely put a link to your TED Talk on that for background, but briefly, what is citizen science? What is that about?

[Jessica Richman]: Sure, so citizen science is a word for non-scientists, non-PhD researchers who work in academic labs. Sometimes they are people who have PhDs but aren’t researchers. They are contributing to science in some way. It started with – and actually, it is really interesting. So Susan Science, that term and the use of that concept, was started by ornithologists, who study birds. And there aren’t enough ornithologists who gather data about all the birds. So there are a lot of amateur birdwatchers who contribute to the science ornithology by spotting birds in various areas or by reporting on the things that they have seen.

So it started out there but this concept of involving the public in research is really just a type of crowd sourcing. So the term we use for uBiome now is crowd science, because I think it sort of communicates the fact that this is not about their citizenship or what country you are part of or whatever, but the idea that the whole crowd can be a part of science. And not just data collection, as in bird watching, but also hypothesis generation, funding of science, evaluation of science. We haven’t done all these things yet, but we really want to.

[Damien Blenkinsopp]: That is interesting because uBiome is basically – you just brought up a whole bunch of things. And that is what uBiome is.

[Jessica Richman]: Exactly. So our goal is to use the fact that people are interested in the microbiome, that it affects all of us, that we all sort of are potential research subjects because we have a microbiome and that we do think that change, to allow us to change the way science is done and to have people fund science, evaluate science, learn about their bodies, and contribute that knowledge to help others, and i think that it is really a change in the way science, which is this very institutional system, it is very much like the change from only four broadcast channels to like YouTube.

[Damien Blenkinsopp]: Right, that is a perfect analogy. It is about – this is taken from your talk, but it makes perfect sense. It is like participation – a good example I thought you gave also there, I mean, obviously YouTube allows anyone to participate and everyone sees people putting forth innovation, innovative content, and that then goes to TV and other places, which is a good analogy. If TV was science, now and again they will find something in the crowd which is useful and they will integrate it, so it is kind of like taking that participation.

[Jessica Richman]: Exactly, and then it makes it something everyone can do. I mean, YouTube is full of teenagers covering pop songs or something that would never have even been possible to be shared before because you would never waste your really expensive broadcast spectrum on something like that. But you don’t know who is going to be the next pop sensation and you can find that. And it is kind of a trivial example, but you can see that in the world of science and you don’t know who will come up with a really interesting discovery. And this was part of the theme of that talk, that I think it is not – a researcher who is paid to study an area is obviously passionate about their work and is an expert and what they are doing is really valuable. But a person who is suffering from that condition is also really valuable and I feel like they have been totally excluded from the system at this point and integrating in their own knowledge about themselves can add so much.

This is an example that I didn’t give in the talk but I think is really interesting. A friend of mine is a spinal cord researcher and she told me – I should probably verify this a little bit better. What she told me was really interesting. She said that the field of spinal cord research changed really dramatically when – most spinal cord researchers are not spinal cord patients. Most of them are not – they kept on working on trying to get people to walk. What they finally realized after there was a researcher who was a spinal cord injury patient who did a survey to say, ‘What do you actually want us to be researching?’ And it turned out that most spinal cord injury patients have accepted the fact that they are not going to walk, and that is sort of just the way it is. But what they want to be able to do is all the things we do. They want to be able to get around easily, they want to be able to sit comfortably. They want to be able to socialize, they want to be able to go to the bathroom comfortable.

They want all the things that we take for granted. And that is actually what they care about, not learning to walk again. That would be nice, but that is not affecting their lives as much as just basic quality of life now. And that really touched me because I thought, ‘How much time and money is spent researching the wrong things that patients don’t actually care about?’ Because it sounds really good. We are going to make them walk again. It just sounds like you are the great savior that is going to come in and solve all their problems. But maybe they want totally different problems solved.

[Damien Blenkinsopp]: Yeah, and you see a lot of communities which get kind of negative and fed up with the way things are being tackled and they are also the most motivated as well as all the passion and motivation because obviously it is effecting their lives. So if we could harness that motivation and passion that could obviously help push things forward. But it seems like citizen science, what it needs and what you spoke about is basically helping to organize and structure this crowdsourcing because obviously if everyone just goes off in their different directions and it is not controlled that is just a mess.

[Jessica Richman]: Yeah, I think so. And I think our role is to sort of create the infrastructure that makes it easy for people to study things. And that is what we want to do that helps us business wise and it also just helps us make that change in the world happened have the average person be able to have access to these cutting-edge DNA sequencing technologies that most people don’t have access to just by making it as simple as you buy a kit, you answer some questions, and then you get some results.

So I hope to see this in other areas too because I think there are so many things that are sort of very disorganized in the approach of patients who have them or even just subjects of interest, or things that people are just curious about and that greater scientific establishment is not super concerned with, whether [inaudible 00:25:28] is good for you, or something like that. Nobody cares about that because they obviously have much more important things to worry about in terms of public health but it is interesting to people. And I think people should be able to fund the research that they either desperately need or that they just are curious about, and I think that should be open to everybody.

[Damien Blenkinsopp]: I think that another analogy is that if you look at businesses as entities and the way they have evolved over time. It used to be from top down they would design products and push them on the consumers and that wouldn’t work so well but they have become these marketing – they are a lot more integrated, they look at customer feedback and in a way you are talking about applying that same concept to science as well, having this feedback mechanism which helps to direct the research also from the end user or the end benefitter.

[Jessica Richman]: Exactly. I think that is true. I mean, it is sort of changing from the sort of theory of the firm and having this institution that broadcast things out to people, to this network where people can interact in a much flatter environment. And I think that is very beneficial for innovation because it will help us, the best ideas. This was something we were talking about, we work with some researchers and they were saying the best ideas are not the ones in our building because you can’t hire everybody in the world who is thinking about your problem. The best ideas are out there in the crowd somewhere and the idea is to bring them in.

[Damien Blenkinsopp]: Well, it is very exciting. I hope you help to push that movement forward, obviously.

[Jessica Richman]: I hope so, too. It is something I care a lot about.

[Damien Blenkinsopp]: Well, it is these kinds of things which really change. It is a revolution rather than just an evolution. So that needs to be given efforts. So the other thing I wanted to touch on is obviously there are a lot of different things that can affect the microbiome. Some of the things we have spoken about so far is diet, right? Everyone kind of understands that diet can impact it. And we look at things like probiotics, prebiotics, dietary fiber, high-fat versus low-fat diet, artificial sweeteners have been in the news recently. How do you kind of look at the diet influence and how far – how much understanding we have? Is it a big impact? Is it a major impact? Do we have to look broader than that?

[Jessica Richman]: That’s a good question. So it is a major impact but the questions are teasing. it is a very complex impact. So the question is – and this our science team, is trying to figure out teasing apart those different effects, people who eat very healthy diets also tend to exercise a lot and be young and healthy otherwise, and sort of have this cluster of things that is sort of separating out what is the effect of diet. What is the effect of exercise?

And we are lucky with the microbiome – it is sort of a great feature, the microbiome, that changes over time in response to a change – we can say, ‘Okay, you are not much older and you are still equally healthy but you have changed your diet and here is how your microbiome changed in response.’ And we can see those differences. That is very interesting, but there are a lot of effects to tease out. We definitely see huge differences. Now that we have looked at thousands of these we can say, ‘That is a vegetarian,’ because you can just kind of tell by looking at the microbiome. Which is really kind of fun, actually.

[Damien Blenkinsopp]: My results are actually kind of weird, like compared to everyone’s.

[Jessica Richman]: Oh tell me more, interesting.

[Damien Blenkinsopp]: I have got very high, very low [inaudible 00:28:25] and very high [inaudible 00:28:30], so like 78%.

[Jessica Richman]: Interesting.

[Damien Blenkinsopp]: Yeah, so I was actually looking at the American –

[Jessica Richman]: The American Gut.

[Damien Blenkinsopp]: Right, the American Gut and Jeff Leach and what he is doing in Tanzania with the hunter-gatherers. Could you give your perspective on that? I am sure you are aware of that more than I am.

[Jessica Richman]: It is very interesting. Their scientific project out of the University of Colorado that is working on some similar things, and I think are differences that were not just America and not just the gut, so I said that was sort of a very easy comparison to make in that way. And also they are non-profit and part of an academic research project and we are for-profit. But I think there are also some technical differences in terms of the sample, collection techniques, lab extraction techniques that are really technical, but suffice to say there isn’t a standard microbiome extraction method and we both used well-documented, very much validated research methods, they are just different methods.

[Damien Blenkinsopp]: Well just on that, because there was a little bit of controversy on that when someone published that. Could you talk a little bit about that? Is that because there are differences in samples? Are there differences in the approach? Because the two samples came back a little bit different from the two companies.

[Jessica Richman]: There are a number of differences. They came back a lot different and I think the reason is – there are a few things. We used a different sample collection technique so when you sample with the American Gut they take a swab and they rely on the swab drying out so that it doesn’t change in transit. Basically, you just send back a Q-tip, or a sterile swab, in the mail. And it isn’t preserved in any way and there is nothing to freeze the DNA at that point in time. So it leads to – there is an argument to be made that it leads to overgrowth because things are growing as you are transiting in the mail to their lab and before the sample is processed.

[Damien Blenkinsopp]: And maybe some things are dying as well?

[Jessica Richman]: Well, dying is okay, because they are there. When you look at the DNA, dying is okay but it is other things from the air landing on it, growing in it, and then you think that was what was in the gut, not what was actually – you don’t know what happened after the gut. And everything that is there you see is there. And they do some correction for that with bioinformatics, but it just leads to different results. The results are biased in different ways.

Then as far as the actual extraction technique, we both use slightly different – and this is too technical, but we use slightly different kits for the extraction of the DNA that leads to different results, but it seems to me to there is a reasonable way to translate between the two based on that part of it.

[Damien Blenkinsopp]: Right, and you had a blog post on that.

[Jessica Richman]: Yeah, we did a blog post on that.

[Damien Blenkinsopp]: If people are interested in the technical aspects of that.

[Jessica Richman]: Yeah, we did a blog post on that and I think going forward it would be – one of the things we are really interested in is having a more standardized method so that everyone is kind of on the same page about what that is. And I know there are some academic standards with this, but we would love to be involved in that and do some comparison studies and sort of see how they compare. Because it is in everyone’s interest to have a standard for how microbiomes are measured.

[Damien Blenkinsopp]: Right, and they have that now for DNA, right?

[Jessica Richman]: Exactly.

[Damien Blenkinsopp]: So you just have to do the work, the collaboration to get to the same point?

[Jessica Richman]: Well, everyone has to agree. And getting academics to agree on things is really an emerging field. I think this has happened in many emerging fields with their different standards and everyone thinks their standard is the best. So us being no exception to that. So I think we are a little ways from having a translation between the two methods. I think that will be much more important as we move towards clinical results, where you actually want to get the same result everywhere that you do it. Where as in academic research labs this is far from uncommon – only 10% of the studies in the biological sciences can be reproduced. So this is not something that has never happened before.

[Damien Blenkinsopp]: Yeah, and this is a common point that comes up in this podcast, whether it is blood samples or heart rate variability, there are different standards at the moment because a lot of this stuff is still new. So I guess the rule for consumers if you start with uBiome, stay with uBiome so that you can compare. If you start with American Gut, stay with American Gut because otherwise you can’t compare your results.

[Jessica Richman]: Exactly. And we wish they were more interoperable, but that is the current standard. I mean, the goal of American Gut is a little bit different too. Their goal is to map the American Gut, what is in it, which is a really interesting scientific goal and very laudable, but that is different than our goal, which is to give consumers valuable information about their own microbiome while contributing to science. So that is a very different goal because our main focus is on giving the individual what they want and then letting them have more control over science.

[Damien Blenkinsopp]: So going back to Tanzania and [inaudible 00:32:55] because what was interesting there is it is difficult for us to know what we are aiming for, what is good, what is bad in the microbiome. You are doing interesting stuff at uBiome because you have these categories which, if you don’t mind explaining quickly, what you do there.

[Jessica Richman]: Yeah, of course. So we compare – we sort of pick – so in our new version these will be much more flexible than they are right now, but what we did not for this first version is we have specific categories of people that have very different microbiomes from each other and you can compare yourself against them. And you can say here is my comparison against vegetarians, people on the paleo diet, people who have taken antibiotics recently, people who drink a lot – exactly, people who drink a lot of alcohol.

So we sort of compare against those categories and those are interesting ones that we sort of see a really dramatic difference right away, so it is very interesting for people to do that. Compared to hunter-gatherer tribes, it is really interesting. I was actually talking to someone and we do research projects for researchers also. I was looking at vaccines in the developing world and we usually come at this from such a totally different angle because people assume that people in the developing world had the perfect gut and if we could only go back to our hunter-gatherer ancestors we would all be so healthy.

And I suppose that is true for chronic diseases, diseases of civilizations, but it is not true when you are very sick with acute illness because your water isn’t clean and you want to be vaccinated against it, for example. So it was really funny to have this conversation with this vaccine researcher who was saying this is really interesting. You are assuming that the gut of people in the developing world is better, but maybe that isn’t true.

[Damien Blenkinsopp]: But yeah, it is just true. The whole point is they are looking at the [inaudible 00:34:36] and other people because supposedly haven’t changed much over time. I think the most interesting thing that I saw there was the diversity. How important do you think diversity is because the argument was that the [inaudible 00:34:45] have a much more diverse microbiome, so that is good. Is that true? Is that for sure?

[Jessica Richman]: That is such a good question. Many studies have shown – I will answer this a bit eventually. Many studies have shown that there are positive outcomes correlated with diverse microbiomes. For example, there have been studies in elderly patients that when they are sicker, when they have less diverse microbiomes, and perhaps that is part of the moving to a more institutional diet as you move into assisted care or assisted living facilities or something. Part of that is the microbiome becomes less diverse and that is worse for you. There has been a lot of research about how eating a variety of foods, sort of following [inaudible 00:35:28] food dictums will make you have a more diverse microbiome and that is associated with a lot of healthy outcomes. So there is a lot of research and I think that it makes a lot of sense that it would be healthier.

There is also research about that a lot of health conditions are because there is a cornerstone species you just can’t get rid of, for example, C. difficile infections are one species that has sort of taken over your microbiome and that makes you very sick. So I think the evidence is there and the diversity is good, but the scientist in me to some degree used to say this is good and this is bad because there is always some kind of exception to that.

[Damien Blenkinsopp]: Yeah, and like we said before it is very early stages. So it is just kind of indicators. So I guess an interesting thing when I am looking at your biome now and if I compare myself to people taking antibiotics. Antibiotics are known to kill of bacteria of course and part of your biome. So everyone can kind of see, yeah, that is not a good thing for your biome. I think that is kind of commonly accepted now. So that is one interesting thing you can do in your biome, and sort of compare yourself to people taking antibiotics. Am I more diverse, am I less diverse, or the same. And to give you a rough idea of how healthy you are?

[Jessica Richman]: Right, what we want to do – I wouldn’t make the claim that it makes you more healthy but we can definitely say that with antibiotics, how were you before you took them versus after you took them. I think that would be really interesting. So it is not just you to the population, it is you to yourself. And so you get a sample now, a sample after you take antibiotics, and and then see the difference between the two. And then sample a few months later and see if you have gone back to where you should.

Because most people bounce back to where they were, where they feel fine and it sort of looks like that microbiome is very similar, but maybe that is not true of you and it would sort of be the only way to tell. So there is a lot of really interesting stuff there in terms of tracking your own health and sort of having a baseline that you store now, so you find out, for example, that you have Lyme disease or some other health condition that makes you take chronic, long-term doses of antibiotics, you kind of know back where you were when you started.

[Damien Blenkinsopp]: Right, and then at least you are like okay, I was healthy at that point, maybe I should try to get back to where I was in terms of my microbiome. So at least you have –

[Jessica Richman]: And some of this is all in the future but the part that is not in the future is we can store the sample now and we can tell you what is in the now. And the part that is in the future is okay, how do we get you back to where you were and how do we know what is a good change and what is a bad change. Those are all the things we are working on really actively and we should have some answers, not in the next few months but in the near future. but there are just a lot of really interesting things we can do once we have the data stored then we can kind of have a basis for comparison.

[Damien Blenkinsopp]: So there are a whole bunch of people doing experiments right now, and I think we can call that citizen science or crowd science, right – there are people taking dietary fiber. I am quite amazed because I just got back to the US and I am going into like Whole Foods and places, and probiotics is huge. It has grown out of proportion and you see even in the drinks, like half of the drinks seem to be probiotic drinks now. So obviously that is really, really pushed but to some people, like clinicians like [inaudible 00:38:20] if you know him, and he is like well, there is evidence to say that probiotics don’t change your microbiome that much. So in terms of experiments, you might do one yourself or you might think are kind of interesting, what kind of things would you think?

[Jessica Richman]: Oh, this is so good. So one of the things that we would love to do and that we are sort of trying to set the infrastructure for is to test out different probiotics on different people. Well, we won’t test it on them – they will take it and then we will test them and you know, of course, this will be part of us researching the effects of the probiotics on the individual. This will be part of a study where we can compare like to like. Like people taking like probiotics and sort of their outcomes. I think it is really interesting.

There are a lot of studies that show that either probiotics are mixed or that they don’t work. But then there are a ton of anecdotes from people, and we hear from them all the time, who say this changed my life. This actually worked. And I don’t think that they are all making it up or they all – it is all the placebo effect. I think it really is having an effect on some people. But the question is who and under what conditions and how do you know and what is it doing. And these are all really good questions.

[Damien Blenkinsopp]: Yeah, I guess from what we know it is not actually affecting the microbiome it is affecting something else. I mean, you call it the microbiome but maybe it is not the bacteria or who knows.

[Jessica Richman]: Right, maybe it is not the bacteria. I mean, it is an ecosystem there, right? So it could be –

[Damien Blenkinsopp]: Maybe it is protecting you from the yeast overgrowth. Or who knows?

[Jessica Richman]: It could be, right? Exactly. Maybe what you want is not the presence of that bacteria but the absence of something else. I think that part is probably the easiest. I think if it is doing something there is some mechanism, right? So that part we can figure out later. I think it was the most immediately useful to people who have questions or problems and want to take something but don’t know what or don’t know if it is worth it for them to do it. It is just to see what probiotics have what effects on what people. I think that would be really valuable.

[Damien Blenkinsopp]: I think it is really interesting in these areas where people are spending a lot of money. It is obvious to me that people are now spending a lot of money on probiotics and they are starting to spend a lot of money on prebiotics and you see all the supplements now and the people talking about resistant starch. If people are spending money on these things, I think it will be really useful when data actually starts coming out to prove it. The marketing always goes way faster, the hype goes way faster than any of this stuff really, and who knows – it is anecdotal. For myself, I think i do better with [keffir 00:40:33]. When I come to the US I love the [Keffir 00:40:36] so I will drink that and I tend to feel way better with that. But I have heard other people say that but who knows why or what that is about.

[Jessica Richman]: So don’t you want to – I mean, don’t have you have this natural drive to be like, why, why me? Who, and who else?

[Damien Blenkinsopp]: I will be doing another sampling of uBiome this month to see if that has change anything because I have doing more of that lately.

[Jessica Richman]: So I started eating – I don’t know if you ever eat Quest Bars, which have prebiotic fiber and it is [inaudible 00:41:02] invasively so they are indigestible fiber that is not supposed to count as carbohydrates. I feel differently when I eat them versus bars that have maltodextrin or something in them, and it is sort of obvious, digestible carbohydrate. So it is really interesting and we get to do a lot of experiments around here and just sort of see what the difference is.

[Damien Blenkinsopp]: So Jeff Leach is arguing that dietary fiber has a bigger impact on changing your microbiome based on his self tests. And what do you think of that?

[Jessica Richman]: So that is interesting. There are a lot of things you could say about that. And one, there are all those sorts of things. So I think the answer to all these thing is sort of more research. That is interesting, and a lot of things have been discovered by scientists looking at themselves and saying, ‘Huh, that’s interesting. I wonder why that happens.’ Or when I do X, Y happens, but I think you really do need – and what the crowd science lets you do and what the power of the internet lets you do is say okay, that is an interesting hypothesis. Now let’s have a thousand people test that and see what happens. Then you can find an answer to it. So I think that is the goal, and that is what is great about crowd science. It is not my opinion versus his opinion, it is his hypothesis versus the data that we see.

[Damien Blenkinsopp]: Right. I guess a good principle for the people at home is before you do anything get your microbiome done so that if you are going to take probiotics or you are going to take resistant starch or prebiotics. At least you can see what has changed, if anything has changed, especially if it has any health impact. Especially a negative one, and you want to kind of go potentially back to it in order to reverse that.

[Jessica Richman]: Right, exactly. Or even just to have it banked so that then in the future you will be able to win the science of therapeutics and diagnostics is caught up to the science of just processing the samples and the data will be there exactly.

[Damien Blenkinsopp]: So on that point, basically how stable do you see the microbiome in terms of we often talk about how often is it worthwhile and it adds value to track the data? Because it is not that expensive now, microbiomes, but it is relatively cheap and I assume eventually it will be even cheaper. But how quickly does the data change? We know that the microbiome changes but how long is it worthwhile?

[Jessica Richman]: We haven’t done the study. It would be really cool to just test everyone’s microbiome for a day, test 100 people’s microbiome for a day. And we haven’t done the study every day for like two weeks. We haven’t done the study yet but we have talked with certain partners about doing this. And we may be launching something about this. But there are research studies that have been done on this and there is sort of a change every two weeks for if you make a major change, if you change your diet you will see it within two weeks. Antibiotics of course act much more quickly but if you have a dietary change or a habit change you will see it within two weeks.

[Damien Blenkinsopp]: When you say a habit, what could that mean?

[Jessica Richman]: Let’s say you start running marathons or something. You start training for a marathon –

[Damien Blenkinsopp]: Exercise, or –

[Jessica Richman]: You exercise, you move, you travel to a different country and eat completely different food. I suppose that is a dietary change too, but you drink different water and it may not be that consciously you are changing your diet but you are in a totally different place.

[Damien Blenkinsopp]: We are still talking about diet a lot, but actually just if I am living in another country, it is the fact that I am touching things, if I am living in a different environment where the bacteria could potentially be different, or if I am living with a new partner, for example.

[Jessica Richman]: Right, well probably not your gut microbiome but definitely the oral microbiome changes when people start kissing a new person. So that makes sense.

[Damien Blenkinsopp]: Yeah, and the genital microbiome I assume, too.

[Jessica Richman]: Exactly, the genital microbiome as well. We do collect genital samples and we do ask questions about that, and it is really interesting. We are adding data insights for the other sites as we do for the gut microbiome, and it is really interesting.

[Damien Blenkinsopp]: I guess there are less people doing genitals because it is a bit more of a politically sensitive topic.

[Jessica Richman]: Yes, that is sort of it. Also, we sell it in a pack with the other sites. So yeah, I think there are definitely less people doing it but it is still kind of interesting, the kind of insights that you can come up with because you kind of see how people’s habits – and it may not even have entirely to do with sex, it may have to do with women after menopause, how is your microbiome different? Or different parts of your menstrual cycle, or in men if you are circumcised or not. Or if – you know, just sort of other things that are not directly related to sexual activity but have to do with your own body and how it changes over time.

[Damien Blenkinsopp]: Yeah, this is a fantastic subject. I would like to ask you –

[Jessica Richman]: It is always great to have genitals and mouths on the podcast.

[Damien Blenkinsopp]: For my next workup I want to get the whole thing but whatever, I would like to find it all out. I am not bothered about political sensitivities. So what do you think will happen in the next five or ten years in this area?

[Jessica Richman]: Gosh, I think it is going to be really exciting.

[Damien Blenkinsopp]: What are you excited about?

[Jessica Richman]: Oh, there is so much I am excited about. So I think there is going to be a real explosion of therapeutics, the proper word for this, but let’s describe that in a little more detail. I think that a real explosion of drugs, probiotics, diagnostic tests, and just really taking this data and doing something useful with it that helps out specific groups of people either with serious health conditions or even very minor health conditions like acne or athlete’s foot. I think there will just be this explosion of valuable products that come out of this kind of data. And I am really excited about that because I think there are a lot of really amazing problems we all have.

[Damien Blenkinsopp]: So out of interest, how would a product develop or work with you?

[Jessica Richman]: We do work with researchers that are doing this kind of thing and basically what we do are really big studies about specific questions. These really big study about specific questions, someone is looking at dandruff or if they are looking at athlete’s foot or they are looking at heart disease or autism or something, sort of a major – something with much more important consequences. We designed a study with them and then we partnered with them and they use our research techniques. And depending on the type of study, they will often just use our kits where we handle the whole study process for them. And they basically give the participant the uBiome product and then they also share the data so that they can use it for academic purposes to publish a paper about it.

[Damien Blenkinsopp]: That feels like a great model. That is real crowd science.

[Jessica Richman]: It is crowd science, exactly. And what is unique and what I really like is that in almost all cases the participant gets their own data too, which is really unusual in scientific studies. Usually you participate and maybe you even get paid to participate but you never get your own data. And I have never heard of a study where you get your own data. But here the participant gets to do their own study also at the same time. Their data is banked and they can access it later. They can do whatever they want with it and at the same time they are contributing to a scientific study that they find interesting.

[Damien Blenkinsopp]: The other exciting news for you guys is you have joined Y Combinator with [Anderson and Co. 00:47:52] and you have obviously got big investments now in terms of microbiome project and you are by far the biggest investment. And so correct me if I am wrong, but what does that mean for you and where you can take the company now?

[Jessica Richman]: So what we can do is we can scale up and we can make sure that the experience is as good as possible for the user, so revamping our website, revamping our boxes, and making customer service better. Like, all those sorts of things are just sort of making the experience better for people. But we could also be able to analyze the data in more detail and come up with really interesting insights for the participants so they could get valuable information. That is what that money is for, to sort of give us the resources to make things better much faster.

[Damien Blenkinsopp]: And a couple of personal questions before we finish, that would be great. What kind of data metrics do you track for your own body? Anything like the microbiome, anything else on a routine basis?

[Jessica Richman]: That is a good question. I track all my food in My Fitness Pal, me and like 25 million other people or something. It has got every food – you know, if you travel to China there is like the fast food chains that are in there too. It is sort of like every possible food.

[Damien Blenkinsopp]: So are you taking photos? Or how are you doing that?

[Jessica Richman]: No, I just enter everything.

[Damien Blenkinsopp]: Have you got a special app or anything that you like?

[Jessica Richman]: I use my fitness pal, which is the most popular one. I am probably in there six times a day logging everything I eat. And then I also do lots of little experiments with myself in terms of how much protein I am eating, how much fat I am eating, and I just started using [keto sticks 00:49:22] recently, and I had never used those before.

[Damien Blenkinsopp]: Yeah, oh, I just got – do you know the ketonics? I just did an interview, the last interview, but anyway the ketonics allow a slightly better correlated – because it measures your breath which is more correlated with the blood levels.

[Jessica Richman]: Awesome – I was looking at the blood kits also and they have those.

[Damien Blenkinsopp]: They are very expensive.

[Jessica Richman]: Yeah, they are very expensive. maybe that could be a business expense, I don’t know. Anyways, I am starting with the sticks and just sort of sampling and seeing how it can correlate how I feel with ketosis. If I feel warm and tired, then that is probably because I –

[Damien Blenkinsopp]: Are you going to be trying intermittent fasting or anything like that?

[Jessica Richman]: I might. I gained the startup 30 so I think I am trying various things. So we will see, intermittent fasting is really interesting and I don’t think I will do the warrior diet because that is the one where you eat once a day and I feel like I would just sort of keel over. But it is really interesting and I like that our users are generally people who are interested in these kinds of things and I like that we can bond over our various weird potions that we are eating and trackign about ourselves.

[Damien Blenkinsopp]: So what has been the biggest insight that you have learned about your biology through doing some kind of tracking or –

[Jessica Richman]: That is a good question. That is a really good question. I think in terms of the microbiome, I think I have sort of – my cofounder is a lifelong vegetarian who has never eaten meat in his entire life. And his parents were vegetarians and he hasn’t eaten meat. So his microbiome is very different than mine because I have sort of been an omnivore my whole life and it is really interesting to see the differences between people who share a lot of environments in common but eating very different foods, so I think that was a really interesting insight. As far as tracking myself over time, I think I am lucky and that I don’t have a health condition that sort of gives me an unusual microbiome. Mine is very normal so that hasn’t really shown up very much in the things that I am doing. I am tracking a lot of these dietary changes, which I just started doing, so we will see how they go.

[Damien Blenkinsopp]: Well, that is a good point you bring up. Someone could have a microbiome done and then if they fit straight in the middle of the road, then it is probably not a bad thing.

[Jessica Richman]: Exactly, it is a very good thing.

[Damien Blenkinsopp]: It also just depends on how extreme the experiments you are doing on yourself are.

[Jessica Richman]: Right, exactly. And I think I am just sort of dipping my toe in the water of cool things people can do to track their health, but there are definitely users who do much more interesting things and sort of want to see the effects of them.

[Damien Blenkinsopp]: Right, so what would be your number one recommendation to someone trying to use some form of data to make a better decision about their body’s health and performance?

[Jessica Richman]: I think there is sort of advanced versus not advanced. So I think the very basic thing is tracking what your food and exercise, it really changes your behavior dramatically. And I have noticed this and it is a very obvious thing and advanced quantified self people are going to be like, ‘Ha ha, I have been doing that for 20 years.’ But for the average person I think it really makes a big difference because you just start seeing – you don’t want to eat junky food when you know you are going to record it. And you start seeing how good you feel when you eat certain foods versus other ones and I think it is really motivating and it is really disciplining.

So I think that is sort of the basic recommendation. I think advanced recommendation is sort of don’t be afraid of scientific literature. Working with scientists and as a scientist, you see what goes into scientific research and you see that it is this really messy field where people are trying different things and sometimes they work and sometimes they can’t be reproduced. So don’t be afraid to delve into literature and see what is there for you and then try to make it work for you. And don’t sort of take it as received wisdom, that it has to be exactly right.

[Damien Blenkinsopp]: Yeah, that is a great point. Thank you, both of those are great point like the psychological benefits and accountability. I think that is probably one of the biggest things that is happening right now with all the devices and everything, just reinforcing behvaiors.

[Jessica Richman]: Yeah, I think it can’t hurt and it takes a little bit of attention, but I think it is attention well spent because it helps people learn to track themselves better and learn to understand what is going on when they feel a certain way, what is likely to be causing it. And I think it is really beneficial.

[Damien Blenkinsopp]: Jessica, thank you so much for your time today. I know you are very, very busy at the moment so it has been great that you have made the time for the show.

[Jessica Richman]: This was so fun, I am so glad. Thanks for taking the time to talk with me. This is really great.

[Damien Blenkinsopp]: Thank you very much.

[Jessica Richman]: Awesome, I will talk to you later. Bye.


Leave a Reply

What is it that makes our bodies stronger? Gives them greater longevity? Greater resilience to disease? Greater performance?

The strange answer to this is that often something that harms us, stresses us, is what ends up making us stronger. The process is known as “hormesis” and applies to pretty much everything we can think of. Low doses of all types of stressors can make us better by stimulating us to adapt – exercise, emotional stress, radiation, natural pesticides found in plants – also known as phytonutrients and so on.

When the dose is too high it proves to do the opposite – make us weaker. So it’s about balance – but how do we know when we get the “dose of stress” just right so that we get positive results?

Today’s guest, Todd Becker, runs the popular blog GettingStronger.org dedicated solely to the topic of experiments in using hormesis to improve HRV so we may improve our lives. Todd is a scientist from Silicon Valley working in biotech, and runs his own N=1 experiments with hormesis in a wide variety of areas from improving eyesight to improving estimated longevity and general health.

In particular he’s experimented with improving his baseline and temporary Heart Rate Variability, as a proxy for longevity, with a long list of activities, from the well researched to the more experimental. In this show he talks about the outcomes, what worked, what didn’t and the usefulness of tracking heart rate variability for general health and longevity.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • What got Todd started on his mission to experiment with hormesis – an experiment that reversed his myopia.
  • The hormesis framework, AKA the body as an adaptive system, with all the areas our health is modulated by hormesis.
  • Phytonutrients as natural pesticides, or toxins, and the work of Dr. Bruce Ames.
  • Can the gut microbiome also be improved via hormetic mechanisms involving probiotics?
  • The need for balance of the intensity of the stimulus given to your body to provide positive benefits.
  • Using lenses to stimulate growth in eye muscles, addressing myopia, sometimes in a matter of hours.
  • Why Todd sees the Heart Rate Variability biomarker as more useful than the majority of markers and chose it as the end result to aim for and measure.
  • A review of how heart variability works and illustrates our ability to adapt to stress.
  • The inverse relationship between the heart rate and heart rate variability markers.
  • The positive impact that cold showers can have on your HRV throughout the day.
  • How Todd increased his baseline HRV by 10 points over several months through eliminating a variety of lifestyle habits or modulating them.
  • Using fasting (also known as intermittent fasting) to increase your HRV.
  • The major factors Todd found that reduced HRV including alcohol, hot tubs and exercise.
  • Linking someone’s HRV to how they respond to emotional stressors and how additional stressors like alcohol can magnify emotional behaviors.
  • The amazing power of vacations to increase HRV, regardless of how you feel – food for thought before you skip that vacation this year.
  • Biomarkers Todd routinely tracks and finds useful to keep track of and his perspective on the value of tracking vs. anecdotal experience.
  • Todd’s and Damien’s benchmark values currently for HRV when well recovered or more stressed.

Connect with Todd on Twitter to thank him for the advice in this interview.
Click Here to let him know you enjoyed the show!

Todd Becker & Getting Stronger Blog

The Tracking

Biomarkers

  • Heart Rate Variability (HRV): Measures how your heart rate varies over time. Research studies link HRV to recovery status, stress and other aspects of human physiology. We have looked at HRV from a variety of perspectives in a number of episodes covering HRV.
  • Average Heart Rate (commonly referred to as heart rate): A high resting heart rate can be indicative of bad health, while a lower resting heart rate can be indicative of good health and fitness. Todd discusses how average heart rate often correlated negatively with heart rate variability.

The Tools

  • Cold Showers: Cold showers are a form of cold therapy that can be used at home to encourage the body to adapt. Todd’s experiments revealed that his HRV improved using these.
  • Intermittent Fasting / Fasting: Fasting involves fasting for several days typically, while intermittent fasting is based on a daily cycle. Standard approaches to intermittent fasting are 20 hour fasts, or 18 hour fasts.
  • Avoiding Alcohol: Alcohol effects HRV negatively so avoiding it or quitting it temporarily or permanently should enable you to improve your HRV.

Other People, Resources and Books

Full Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Hi Todd, great to have you on The Quantified Body show. Thank you very much for having your time available today.

[Todd Becker]: It is great, I am happy to join you.

[Damien Blenkinsopp]: So you have got a very interesting site, which is pretty much very dedicated to the topic of hormesis, which is called getting stronger. Could you tell me particularly what prompted you to take an interest in hormesis and this topic when you first started out?

[Todd Becker]: Well, it wasn’t any one thing. I just noticed certain patterns in what made me healthier and it really came from a variety of different areas. I would say probably one of the most pivotal experiences was learning that I could improve my eyesight without glasses, and that was probably almost 15 years ago, and understanding that the eye can respond to stimuli and the vision can improve, very [inaudible 00:03:18] to the way that weightlifters gain muscular strength by going into the gym and training. And then I started to think about how that is try about so many aspects of physiology from the immune system, which benefits by being tested and exposed and I think autoimmune and immune problems come from an underactive immune system or an overactive immune system.

It is not trained properly, thinking about how calluses form on the feet when you walk barefoot and how when I started doing barefoot running rather than these cushy shoes providing benefit by cushioning me and protecting me or actually weakening me and by exposing my feet and my calves and knees and really the whole musculature to the shock that it was designed to withstand actually got stronger and less prone to injury and then thinking about how bones and the skeletal system responds and it really almost requires stress when astronauts go out into space and experience weightlessness. They rapidly lose bone density and it is hard for them to regain when they return, so really just starting to think about the body as an adaptive system and think about the factors that influence that.

Then I did some reading and I think for me it was just the concept that lies really at the nexus of all of those different adaptive phenomenon.

[Damien Blenkinsopp]: So how long have you been playing around with this idea?

[Todd Becker]: I think if you go back to the vision improvement idea that is 15 years and even before that I think another experience that led into this low carb dieting, which I first encountered in the mid 90s, I didn’t really realize at first that ketosis is a form of hormesis but what happened is I started to think about this framework and how much you can explain with it. And of course it doesn’t explain everything and it is certainly not the only factor in health but I think it is an important one and it has been overlooked so that is why i felt that there would be an intro in a blog that really focused on that concept.

[Damien Blenkinsopp]: Right, I like the way you put it. It is a nice framework to be able to look at things and I know you have done a bunch of your own experiments, so that is what I wanted to talk about. Before that, give people an idea of how broad this is. There are a whole number of topics you have looked at and referenced, like exercise you brought up, phytonutrients in plants, like some of the things that we thought had antioxidative and protective effects actually are working on a basis of hormesis as well. You talk about sunlight, radiation – have you looked at the topic of pesticides?

[Todd Becker]: A little bit. I would say that I guess when we talk about phytonutrients these are really natural pesticides if you think about it in this biological arms race where plants want to avoid being eaten and predators want to eat them. So they develop more and more effective toxins to scare you off but predators that are able to detoxify those natural pesticides get the spoils. So it is kind of this back and forth but as far as artificial pesticides there is probably some element that we know there has been a somewhat controversial analysis of dioxin which is highly toxic and actually has some hormetic benefits at low dose. So even artificial toxins can play that role.

[Damien Blenkinsopp]: Yeah, you are aware of the work of Dr. Bruce Ames?

[Todd Becker]: Yes, right, I think he was instrumental there and he certainly has been critical of modern toxicology and the sort of linear, no threshold concept that everything is toxic down to the tiniest measurable dose. Even though he developed some of the institutional tests, like the Ames tests that are used to look at mutogenicity or carcinogenicity, he is critical of over-extrapolating with those tests. But just for your listeners who don’t really understand the technical concept of hormesis it is really the idea that something that is damaging or toxic at higher doses can actually be beneficial at lower doses. At first that seems like a paradox but then you realize that evolution required us to survive in the face of all kinds of stresses including toxins and UV radiation and heat and cold and if we didn’t have some method of fending off those stresses either by adapting to them and defending ourselves against them or repairing ourselves or our DNA once we have been exposed, we would perish.

So I think most organisms have some hormetic mechanisms that allow them to adapt to harsh environments and survive. The key is what is that level? What is that sort of magic dose that gives you stimulating effect as opposed to the inhibitory or detrimental effect and it can vary quite a bit. I mean, some substances like alcohol, for example, show hormetic effects at much doses than some, say, metals that are considered much more highly toxic and only showed the [inaudible 00:08:18] effect at much lower doses. And there are a couple of researchers who really have done a lot of good work to kind of document the ranges in which different stresses are hormetic.

[Damien Blenkinsopp]: Yeah, it is very difficult to kind of assess where it is going to be overwhelming. I guess it is not what doesn’t kill you makes you stronger, it is more like what doesn’t overwhelm your system makes you stronger.

[Todd Becker]: Yeah, I think the other interesting thing is if you look at the work of people like Edward [inaudible 00:08:46] that these are the guys who are really documenting all of this [inaudible 00:08:51] sort of static type of hormesis where they will expose say a worm or a plant or a microbe or an animal to toxins and they will find that dose that is causing damage or disease and that dose that is causing a benefit. But what I am also interested in here is the idea that this can be a dynamic type of range that progressively you can become more and more tolerant by gradually exposing yourself to increasing stresses. of course there is always a limit and you can only tolerate so much radiation or UV or exercise or cold and there is a limit. But i think you would be surprised at what that range might be.

[Damien Blenkinsopp]: All right, so going back to your analogy of strength training because I think most people understand strength training and that you are not going to walk in and lift 100 kg the first time, but if you start at 50 kg or whatever as your level, after a couple of weeks you work up to 60 kg and after some recovery you kind of go through this process. You can eventually move up to that 100 and you can say it is very similar and you have an ability to kind of get stronger across all of these different stressors and deal with all of them. Is that the way you look at it?

[Todd Becker]: Exactly. I think that the principle is the same, the details are different in each case. And you hit on I think a key principle of doing this [inaudible 00:10:13], which is gradulous. A lot of people jump in too quickly, have a negative experience, and conclude that they can’t do it. I think a classic example is exposure to cold. After initial, awful exposure people say, ‘I could never do that.’ Or fasting is another good example. Some people try to just jump in and skip meals all day and they will get ravenously hungry or have hypoglycemia and they will conclude that they are incapable of it, not realizing that if you had built up to it gradually you can adapt. So I think that is a key aspect there.

The other thing which you touched on a little bit is rest and intermittency. Weight lifters go in and they will lift heavy weights but they are essentially causing microtrauma or tears to their muscle fibers and they have to allow for the damage to be repaired. And this is true in any kind of overtraining where you are running anything. If you don’t allow that period of recovery you are not going to get the benefit. So I think gradualism and then a progressive increasing and allowing adequate rest and repair, I think these are probably the factors that people overlook and leave them to conclude that this doesn’t really work.

[Damien Blenkinsopp]: Yeah, that reminds me of one of my buddies at University who used to come with us to the gym once every three months and he would hit it really, really hard and he would go home and he would feel horrible for three days and be in so much pain and he wouldn’t come for another three months. You would never get anywhere of course, doing that, and he would be through a lot of pain. So that was a nice analogy. That is not the way to go about getting stronger as the theme of your blog. It is really to take it gradually, as you say, with all of these things.

So what are the mechanics behind how this works? Do we have any ideas about it or is the science very vague at the moment still?

[Todd Becker]: I think you can cluster these things into a few different categories. One is physical changes to tissue, so the example of building muscle. You stimulate – you apply physical stress and cause some damage or change and then allow the tissue to remodel. The same thing is true with bone that you apply to stress. And part of it is directly within the tissue, part of it is the nervous system, part of it is stimulation of hormones, growth hormones, but there is response. Another really interesting example is vision improvement and particularly reversing myopia.

This is a very interesting stressor where by incremental defocus and by causing a slight blur, you actually induce differential growth in the scleral tissue of the eye by stimulating neuromodulators that actually grow differentially and cause the eye to change shape. It happens very gradually over many, many cycles, but there have been experiments in chicks and chimpanzees and then most recently in humans, that fitting people with concave or convex lenses, plus or minus lenses, induce these changes in growth literally within a matter of minutes and hours.

So there are these physical stressors – calluses are another example of a physical stressor that causes growth factors to build up the tissue. So that is one type of hormesis. Then I think there are metabolic processes – for example, real shifts in nutrient balance, for example ketosis, deprivation of carbohydrate and sugar, causes a shift in expression levels of different lipases that causes a reduction in insulin and causes hormonal shifts that actually up-regulate the ability to digest fats. And again, this is a process that might happen over weeks. So there are kind of different time scales.

[Damien Blenkinsopp]: Yeah, just to jump in there – it can be different according to the person where they are starting from, the condition of their body and potentially even their genetics, as to how quickly your – if their ability is to adapt to them.

[Todd Becker]: Certainly – let’s take another example as the tanning of skin. Some people can readily respond by producing the melanin that allows them to tolerate UV and get a suntan and is actually protected. Others, probably some of your buddies from the northern part of the UK may have very fair skin or reddish hair and don’t have quite that same ability. Metabolically some people can induce lactates that allows them to digest milk very rapidly. Others have very low or little ability to [inaudible 00:14:41] significant genetic variation there.

[Damien Blenkinsopp]: Yeah, and here increasingly we have got this biosis when people have problems with their gut, which is pretty common these days. I don’t know if you know a guy called [Chris Cressor 00:14:52]?

[Todd Becker]: Sure.

[Damien Blenkinsopp]: He talks now about using probiotics like kefir but in very small doses to start with, otherwise it kind of overwhelms the gut microbiome. So it seems like he is using some similar principle to hormesis there and with his patients or people who have problems. It has to start very, very small but eventually it gets to a large extent where the gut is able to digest and use it afterwards.

[Todd Becker]: And really that is a good example that sort of also follows the model of what is called oral immunotherapy. It used to be thought that people who had, for example, severe peanut allergies just that there was no hope. They had to take immunosuppressant drugs for the rest of their life and children who were vulnerable to this just had to stay away from even the slightest dust from peanuts in the air. But then there was some really good research that showed that very gradually reintroducing an allergen like peanut under the tongue in extremely minute amounts allowed the immune system to learn to tolerate it to the point where there was no problem anymore. I think that is another good example of that gradual exposure.

[Damien Blenkinsopp]: That is an interesting one because that is where the immune system is overactive in response to a stressor. And then you are teaching it to just be balanced. So it is kind of a slightly different twist to it.

[Todd Becker]: Yeah, well we are talking about allergies and autoimmune disease and I think it is very relevant to point out this recent book that I got very excited about called An Epidemic of Absence by Moises Velasquez-Manoff, and he really updated the hygiene hypothesis, which a lot of people are familiar with which basically holds that allergy and autoimmune disease that has become prevalent in the western world ever since we have instituted a lot of hygiene measures and cleanliness and since people have moved off of farms and paradoxically we have conquered infection, but allergy and autoimmune have gone up. And the idea is that somehow we are not getting exposed to allergens.

But what Manoff does in his book is how is this in terms of the what is called the old friends hypothesis and the idea is that we co-evolved with [inaudible 00:17:07] organisms in our gut, parasites that we lived with basically for evolutionary reasons to outsource some of the functions of our immune systems to those organisms. And that sort of took some of the work away that our own immune systems have to do. But now that we have pretty much banished them through better hygiene we don’t have parasites anymore, our diets have changed so that the microbiome in our guts – we wash ourselves and we don’t have the benefit of the service that they were providing.

So all we are left with is an undertrained immune system with the sort of reserve or the emergency system, the IGV system that just goes crazy whenever it has the slightest insult, and so the idea is let’s reintroduce some of the old friends. But what is particularly interesting in the book is he goes through one autoimmune or allergy disorder after another and shows that there is sort of a critical period in infancy or childhood where if you don’t get that exposure you are prone to these autoimmune disorders.

[Damien Blenkinsopp]: So that is the idea of balance again. It keeps going back to this balance and this is why I wanted you to come on and talk about this, because you have actually tried to identify balance for hormesis using heart rate variability. In my own experience, I have had back injuries and I have had various things where you want to get stronger, you want to recover, and you understand that this concept of hormesis can help you, as you pointed out with your eyesight, right?

But if you push it too far you potentially go backwards rather than forwards. It is the same as like my friend from the university who is going to the gym and pushing it too far and is actually going backwards instead of forwards. And in my training over the years, experimenting with different things, I have often done that as well and figured out that I needed more recovery and I didn’t have this balance.

I have eventually come back to trust numbers. So I thought it was interesting that you were using heart rate variability to look at a little bit and understand if the hormetic effect was having a positive impact or not.

[Todd Becker]: Sure. Now, I know you are a big biomarker guy and you like numbers and I am a little bit more cautious about that. I would certainly like there to be a magic number that I could follow. I have done a little bit of experimentation with a glucose meter, which kind of helped me understand how I responded to diet and exercise in terms of glucose. And I found it a little bit useful but also potentially misleading. I have friends who are sort of in the quantified self movement who measure just about everything and kind of I think go overboard with it But one thing I have seen is that it is very hard to take a single number in isolation because there are always exceptions or what you might be looking at is not a cause but a consequence, so it is difficult.

I stumbled on heart rate variability and what i like about it is it is not just some random measurement of some intermediate metabolite in your body which may reflect oxidation or inflammation but who is to say what the right level is. In the case of heart rate variability you are actually measuring something very close to real function and what I found before finding HRV is to try as much as possible to look at functional measures of strength or performance.

[Damien Blenkinsopp]: Sure, could you give an example?

[Todd Becker]: So the vision is pretty easy, right? You can read a Snellen chart and see when you lift weights and you know how much weight you are lifting. So when you run you can use speed, right? These are very objective things but what I like about HRV, so what do you do in terms of just overall metabolic health? Is there something that sums it up?

[Damien Blenkinsopp]: Why don’t you just take a step back there and clarify? When you were talking about the running and the speed and if it is improving then when you are doing is having a good, positive hormetic effect, right? But if it is going backwards, if you are taking longer times, then you know that you are going backwards – just to clarify for the audience.

[Todd Becker]: Exactly, and there is no question. If you are overtraining and you are running slower, then okay.

[Damien Blenkinsopp]: Right, if you are lifting less weight, which happened to me with many of my experiments back in the days, I would be basically lifting less and you are like, ‘Okay, something is not going right here.’

[Todd Becker]: Right, so if you would like to find something like that for just overall metabolic health, that is a harder one. Maybe you feel good but subjective feelings may not be the whole thing. So what I like about HRV, heart rate variability, is I think it is sometimes not fully understood, what it is. What it is essentially is the variation in the heart beat. You can have a low heart rate but if the heart rate is getting exactly once per second that has got no variability, right?

So why is variability a good thing? And apparently it is. Apparently people who are very fit have a higher heart rate variability, which means there is more variation. Sometimes their heart will be 1.05 seconds and then 0.9 and then 1.03 and then 0.85 and then you look at the standard deviation of that or some transformation of that and the more variation beat to beat there is the better it is. But you would think, why is that good? Because we know of arrhythmias as being signs of pathology and certainly at some level they are.

[Damien Blenkinsopp]: Could you just – what is an arrhythmia?

[Todd Becker]: An arrhythmia would be not having an exactly precise regular beat, having some irregularity to it. And there is different deviations from the regular. So the question is why is it good to have this variability and I was kind of searching for this but I read this book, an older book by James Gleek, called Chaos. It was written in the 80s that in chaos really describes what are called non-linear systems which underlie a lot of what is going on in biology or in the brain and in society.

There are a lot of effects that aren’t just additive but interact with each other in very complex ways. So he had this insight, which is basically non-linear processes are necessary for homeostasis, the ability to handle a stress or a deviation, and come back into control. If you have a linear system and you give it a slight nudge, you cause some [inaudible 00:23:27] to it and it tends to go off course and stay off course. In non-linear systems they have all these interactive components and if you give it a nudge it tends to return to a center, what they call an attractor in mathematical terms. In biological terms, if you have a fever your body acts to cool yourself. If your blood pH drifts there is something that pulls it back. If you eat a big meal and your blood glucose gets too high, the insulin turns on and brings it back within range. So there are these feedback systems that tend to bring you back to center.

So what is interesting is that you have got these two systems which work in cooperation – the parasympathetic and the sympathetic nervous system. And the parasympathetic system is generally the one that kind of calms you down and gives you this resilience where sympathetic is the fight or flight which you need to energize yourself but if it goes too strong it can cause stress, high cortisol and eventually the parasympathetic system has to bring you back down to normal after you have met the stressor, some type of event that you have to deal with. Now, if you are adaptive you can switch between these two systems readily and the key one is the parasympathetic one because the sympathetic one tends to drive, just very strongly and calming down and bring – changing your ability to go at full strength and then slower and adapt to the day is really an adaptive strength. If you look at people who are older and have Parkinson’s and walk very stiff or rigid and you measure their gait or their heart rate it is very regular, very stiff. It doesn’t deviate. If you surprise them, shock them, ask them to suddenly run or something, they have great difficulty shifting into that higher gear and people who are stressed out likewise have great difficulty turning down the stress and shifting. So it is a sign of health to be able to shift gears quickly and be adaptive. And essentially that is what HRV is measuring.

If your heart rate naturally can sort of move around to these different frequencies then it can quickly tune into the faster one or the slower one and it can move quickly. If it is locked into a steady beat it is just harder for it to change and I think this manifests itself in a lot of ways.

[Damien Blenkinsopp]: So you see it as a measure of your ability to adapt to stressors, which is actually similar to some of the other discussions we have had. I don’t know if you have tried this but if you looked at your HRV when you are lying down versus standing up. So in our first episode Andrew Flatt was talking about how standing up is a slight stressor. So you can see how it impacts the HRV and you have a slightly different score and you are basically applying a very, very slight stressor to yourself just by standing.

[Todd Becker]: Yeah, and people even look at how quickly can your HRV when you stand or sit come back to equilibrium. That is sort of a secondary measure and athletes who can run and then sit down and bring their heart rate down quickly are typically the ones who are fit. But if you look at disease states, cardiovascular problems, cancer, infections, these show up very quickly in reduced HRV and it is kind of almost a leading indicator of a problem so it is has even been introduced diagnostically and i think it is pretty powerful. And I find that is useful because we are all individuals as a tool for self-discovery. You can find out what tends to drive your HRV up or down and I learned a lot of things that I was very surprised about myself.

[Damien Blenkinsopp]: Yeah, and like you I have been fascinated by this measure and if you read around it is really applicable to so many useful things as well. I have seen people applying it to willpower and there are studies on willpower and of course we all want more willpower. There are a whole range of uses for this but what have you specifically applied it to and found that was most interesting?

[Todd Becker]: Well, I tried a lot of things relating to exercise and found some of the normal things that athletes find which is that when you work out very intensely it drives the HRV down and it takes a while to come back up. And when it is back up you are rested and ready to go, and that is what everybody knows. But then I just tried different foods and definitely noticed a big effect except the one thing I did notice is that I practice intermittent fasting which means that I eat one or two meals in a part of the day, typically dinner or lunch and dinner, and fast a lot of the rest of the day. And I found that well into the fast my HRV would tend to go up and then after a meal it would go down. So that was kind of interesting.

[Damien Blenkinsopp]: Did you notice an increase in your base line? If we talk about the daily – the specific time you are doing the experiment versus changes which tend to be longer-term?

[Todd Becker]: Oh yes, I definitely have noticed that. So let me get to that after and I will tell you a few specific ones and then I will get into the baseline. So that was a big one and the other really big one which really surprised me is cold showers. So i thought I am going to get in the cold shower and see what happens and I am sure what will happen is my heart rate will go up, which typically means my HRV will go down because it is not precise, but they tend to be inversely correlated, right?

, I am somewhat adapted to the cold showers and I have been doing that for several years. I get in the shower and actually measure it while I am in the shower and my heart rate goes down and my HRV goes up. And I get out of the shower and it has gone up by ten points. And that is kind of the average, it goes up by ten points literally within 3 to 5 minutes and it stays high the whole day, which also corresponds to my subjective feeling that cold showers are a real mood elevator for me, unlike caffeine or sugar or whatever, which is just kind of a quick thing and then it fades. I do that and then I am good for the whole day and it is consistent and it is a big effect. So that was a big positive effect. So fasting and cold showers are kind of the two things that really drive it up.

[Damien Blenkinsopp]: So the cold there is a cold exposure, basically, so it is a minor cold – ?

[Todd Becker]: Yes, cold exposure. So I get in a pretty cold shower and I am in there for several minutes. I used to, when I started that, I would shiver quite a bit. But that only lasts a little bit.

[Damien Blenkinsopp]: So, that’s a pretty cold shower?

[Todd Becker]: Yeah, and I do ocean swimming and things like that which is really fun. But then I found some negatives and of course I found that if I worked out really intensely, I could drive my HRV down really low, which worried me. But it would come back as hot tubs that are really hot that would also drive it down. The other thing that would really drive it down was alcohol. Usually it would be maybe two or three drinks and one drink didn’t have much effect but two or three drinks would really drive it down.

[Damien Blenkinsopp]: Is this like for a few hours, say for the rest of the day?

[Todd Becker]: A few hours or the evening. And then I thought about this and this was really interesting. I thought, wow. The cold showers surprised me because I thought that was definitely going to get my heart rate up and it didn’t. And alcohol, that will make me relax so my heart rate will slow and my HRV will go up, right? No. My heart rate goes up and basically the body is trying to deal with the alcohol. It is a depressant so it is trying to fight that and you are impairing yourself and I think this was a real insight because what is HRV? It is your resilience, your ability to take on the next stress and you may think that if you have had a few beers that you can handle things but actually you handle them a lot more poorly. Driving, of course, is an example but your judgement goes way down.

[Damien Blenkinsopp]: Yeah, that is very interesting. You see a lot of fights with alcohol, for example. And that is because people are not able to adapt to them and they are overreacting and not able to deal with emotional stressors around them.

[Todd Becker]: Yeah, the adjustment goes way off. So basically these things that are kind of relaxing can impair HRV and then things that are stimulating, the cold shower or fasting, which also tends to sharpen your focus and help the HRV. Then the other effect is – these are the immediate effects.

[Damien Blenkinsopp]: So just going back to the heat exposure, I do saunas, infrared saunas, and I have been doing that daily for the heat shock protein benefits, amongst others. I don’t know if you have done that and unfortunately I am going to have to track the HRV specifically around that and I am going to have to start doing that to see what happens. Do you think that would be similar to the hot bath?

[Todd Becker]: I think so, but here is the other half of the story because these are the immediate effects, right? The things that you notice within hours or minutes, but then you have got to look at the compensatory effect of what happens later. So for example exercise obviously impairs your fitness temporarily but you wouldn’t do it if – one of the reasons you do it is to become stronger and get fitter. So you do it and then the next day your HRV is actually a little bit higher. It may take two days or whatever the recovery period is so there is almost this ratcheting effect where you temporarily drive it down and then it kind of comes back up to an even higher level and I think that is pretty interesting. So the question is which things work that way and which things are just direct? So the cold showers brings the HRV up and then I don’t see a fading of that. Exercise I see it going down and then it comes up stronger and I think hot tubs and saunas are a little that way where it drives it down, but I think it actually can improve.

[Damien Blenkinsopp]: Do you think this could be in relation to the way your body perceives the intensity of the stressor? Maybe heat is a larger stressor than cold so your cold shower just happens that it is at the right balance?

[Todd Becker]: It may be and also heat on some level relaxing and another level is a stressor, so it may be the degree. And it is similar with alcohol. Moderate alcohol didn’t have the same effect as –

[Damien Blenkinsopp]: Yeah, so if you had like a tiny sip of alcohol potentially your HRV could have risen a little bit?

[Todd Becker]: A little bit more. So let’s go to the baseline question. So I have actually increased my baseline HRV over a couple of months significantly and there is a lot of noise and fluctuation if you look at my graft but what I did is I am careful not to overtrain and I noticed that can really set me back. Then with alcohol I have realized that one or two drinks, I feel the buzz. It is social, it is fine. And I really cut myself off there and I drink less. And that has really helped the HRV come up quite a bit. So I am just kind of paying attention to the things that really set me back and that is probably the main change and then it has come up about ten points.

[Damien Blenkinsopp]: Yeah, so I mean it is important to point out also that as you age it gets lower, so that is another reason you kind of want the baseline to be going up rather than going down. As you said earlier it is an indicator of general health but as age also so you could say biological aging. So I have noticed with intermittent fasting that is the one where I have been looking at it the most and I have done – I did one month on intermittent fasting and then two weeks off and then back to intermittent fasting again. and I am about ten points higher pretty much every day. It takes a little bit, a little while to climb back up to where it was if I stop intermittent fasting. But after about a week it tends to be about ten points higher than when I am not intermittent fasting, so that is about three months of data so far. But for me it seems – and I feel, of course – I mean, a lot of people talk about the benefits of intermittent fasting but I feel much better and much more energy throughout the day and so on.

[Todd Becker]: One thing I did that really drove it up and of course you can’t do this all the time, I took a vacation. And it went way up. Obviously, that was useful.

[Damien Blenkinsopp]: Yeah, that is a really important point you bring out here because especially you are from the US and very well known for having not taken any holiday or you have your standard two weeks, I believe, in the US?

[Todd Becker]: Right.

[Damien Blenkinsopp]: But of course, many people work in corporate and if they are not taking their holidays at all. You see a big increase in HRV like that and that is a really big sign that you are probably really overdoing it and you need to emphasize more some time out. I don’t know if you thought of it that way, when you saw those numbers, maybe I should do this more often?

[Todd Becker]: Sure, I tend to lead a life that even though it is busy I don’t feel stressed out and I really feel in balance. So I wasn’t feeling overworked but of course maybe I was fooling myself.

[Damien Blenkinsopp]: I mean, this is the beauty of trying to quantify stuff because I will give you an example. My dad, he is a workaholic and he always has been. And so he doesn’t – when he goes on holiday he falls asleep. And my impression is that he is highly strung. So he is working and I feel the same way when I am working and I have often had the case where I am working hard and then I will take a holiday and I will get sick when I am on holiday. And it is kind of like your body is just trying to manage the day to day and why you are stressed is just dealing with it. But as soon as it has an opportunity to let go. It would be like okay, you can recover now and I can be a bit sick.

[Todd Becker]: Isn’t that true? That is a common effect, you finish your exams and you come home and you get a flip, right? But my vacations tend to be somewhat active with cycling, body surfing, running, and so I wasn’t just sitting on the couch all day either but I was really enjoying myself and that was the key.

[Damien Blenkinsopp]: Great, some great insights there. Have you found any other areas with HRV as being useful besides these we have already spoken about?

[Todd Becker]: There is Dave Asprey who has written something and he has a little company and an app he has created to use HRV to detect food sensitivities.

[Damien Blenkinsopp]: Yes, they are actually using heart rate. We actually had Rhonda Collier on the last episode. She is the CEO of Sweetwater, who is behind that app.

[Todd Becker]: Exactly.

[Damien Blenkinsopp]: That one is based on pulse rate but she does some very interesting stuff on the stress side, splitting out the frequencies. And I haven’t played around with the app a lot on the stress side, but I think you have to get into it quite a bit to find some benefits. She certainly has over time, but she has been using it for a very long time.

So coming back to the whole hormesis side, I don’t know if there are any other biomarkers besides HRV? You have mentioned the difficulties of trying to assess, basically saying how much oxidative stress do you need versus not? It is very hard to say what is going to be beneficial versus what is going to be overwhelming for your body, which is why you are looking at the endpoint, the end result?

[Todd Becker]: Yeah, the functional endpoint and what really matters in terms of performance.

[Damien Blenkinsopp]: So obviously you brought up some others which are more specific to whatever you are doing, how fast you are running and so on. Is there anything else you have come across that you have found useful for looking at hormesis and how to balance it?

[Todd Becker]: Not in terms of quantitative measures. I think in this discussion we have really focused a lot on the physical side of hormesis but I think it applies quite well also to psychology and to sort of the spiritual side of health because really what is stress? There are physical stresses but what we are really talking about is your reaction to events, right? And so how you handle stress I think is very important to health and there is this concept out there that we are overstressed, that modern life causes not just physical but psychological ailments because of too much stress.

I think what they are talking about there is chronic, repetitive, daily stress that we are not handling well but I think the underappreciated side of stress is that we need it and particularly we need it at certain frequency and certain natural contexts and we need intense stress. Our body, we evolved to be able to handle it and if we protect yourself from psychological stress we actually become more vulnerable to it. I think that exposing yourself to intense physical exercise actually makes you more psychologically resilient but I think it is also important to confront fears, anxieties, and push yourself to higher levels and also to become comfortable with discomfort just in general. In fact, it is even sort of a psychological benefit to things like cold showers and that you are throwing yourself into what you perceive to be an intensely uncontrollable, disagreeable situation and you are pushing through it and you develop more resilience to it.

[Damien Blenkinsopp]: Right, because you talked about this on your blog and I started doing the cold showers, as I mentioned to you. And you say that you are tensing your muscles and you are psychologically preparing yourself for it and it is quite a horrible shock when you start but later on you start really noticing it. I mean, I found this after a few weeks or something and I guess that is what you found over time. Do you still find that you react a little bit to the shock of the cold?

[Todd Becker]: Yeah, and it is less and less. And there is this theory called the component process theory of emotion that Solomon and others sort of pioneered and Solomon was looking at – he was trying to explain addiction and also thrill seeking and he said these are really sort of the opposite sides of the point. A thrill seeker is somebody who does skydiving and the first time they do it they are confronted with this intense, paralyzing fear. It is uncomfortable. But when they land there is this euphoric afterglow that tends to last for a lot of the day. But the more they do it the event itself becomes less and less uncomfortable and the afterglow effect becomes stronger and stronger so it becomes pleasurable.

Cold showers, it is a little bit like that. Exercise can be like that. And you said it is the flip side of addiction. In addiction people pursue a direct pleasure, whether it is alcohol, drugs, sex, gambling – whatever it is, it gets their dopamine going right away. But then when they stop it there is this down or withdrawal. So this is the reverse to where the more they do it they become tolerant to the pleasure and it is less fun but the down becomes greater, so they get into this addictive cycle because they just need to do the addictive activity just to get back to normal.

So exposing yourself to hormetic stress is kind of the opposite of addiction and what I find is that it makes you more resilient to just daily stressors, arguments and things that come up at work and it increases what I call my background level of pleasure. I mean, I am just basically always happy and things don’t throw me off or blow me out and I think it is because by forcing yourself to expose to these intense stresses, you develop this resilience. It is something that has kind of gone away from the kind of lives that people, pioneers who lived away from civilization, had to face these natural stressors – the weather, hardship, lack of food, moving around. And the fact that we are more protective and that we live in an environment that is so regulated from stress I think we failed to develop this resilience. And so by engaging in some of these activities I think you get an enormous psychological benefit in addition to the purely physical.

[Damien Blenkinsopp]: Right, so that is a great overview. Basically the way you are using hormesis is if you can do this in lots of different aspects of your life then they are all kind of tied into your organism and HRV is like an endpoint measure which is global, so it is useful because it is like if my HRV is higher today I am going to be more resilient to emotional stress. No matter what it is if I have to be motivated to do something or take on a new challenging task like if I got higher HRV some days then it is probably going to be an easier day to start something new.

I have been looking at that a bit because I have heard about this, but I don’t know if you have – when you notice that your HRV is high if you find it easier to start more challenging tasks or take on conflicts or these kind of more mental challenges and I don’t know if you have noticed anything about that?

[Todd Becker]: Definitely, and I think that is the case.

[Damien Blenkinsopp]: Great, so what you are doing in terms of your routine and where you use biomarkers or you don’t, you have already talked a little bit about where you have seen them be useful or not, but on a week-to-week basis what kind of things are you tracking in your life?

[Todd Becker]: Quantitative things?

[Damien Blenkinsopp]: Right, whether it be HRV – what is kind of your routine for using any type of data about your health?

[Todd Becker]: I would love for there to be an app that really gave me information that I found useful and used all the time. And I understand companies like Apple are kind of moving into that space. And there are a lot of devices out there. So I am always interested in them but I just haven’t been convinced in their utility. And I am also a little bit hesitant to become too tied to tracking. I want to be much more tuned to my actual experience and try to find ways to use that as much as possible. I am a bit of an advocate also of simple finds, like relying as little as possible on external things, whether they be glasses or supplements or devices so that I can be fully present.

But if I can find a few things to track and if they are pretty robust I will go for them. So HRV is probably – I mean, I was experimenting with a glucose monitor and that was helping a little bit but I didn’t find it necessarily reliable. So the HRV is maybe the closest I have found so far, although I don’t know if I am at a level where I fully trust it yet. So I don’t know if there is any you find particularly useful?

[Damien Blenkinsopp]: Yeah, I track a lot of stuff and I kind of bring new ones in and then throw them out as they become inconvenient. Also one of the biggest challenges I think right now is the convenience. If we had a watch or some device which tracked everything accurately in the background it would be really easy to have interesting data. But on the HRV I use the averages, seven-day rolling averages, because it does go up a little bit and down. There is a little bit of variance in it and also just in the way you are measuring it you can introduce little differences based on emotional stress and other aspects so you have to watch out a little bit for that. So I find that I am really watching more closely the seven-day rolling average.

[Todd Becker]: I tend to agree. I think the weekly average is just about right and that seems to correspond to something that I see as a real shift.

[Damien Blenkinsopp]: Yeah, and I feel remarkably different when I am ten points higher on that average, so that is what I am trying to do, get it as high as possible. So just out of interest, I don’t know if you are lying down or you are standing up, what HRV score are you?

[Todd Becker]: Yeah, so I do it sitting and I am using the RMSSD, the natural log times 20, so on that scale I am typically in the range of in the morning 70 to 80. And on really good days I have actually hit 90, which doesn’t happen very often. And on sort of off days I might be in the 60s. But I would say kind of typically bouncing around between 70 and 80.

[Damien Blenkinsopp]: Right, you are a bit better than me. don’t get up to the 90s. My high is at the 80s. I am normally between 70 and 80 when I am intermittent fasting. Otherwise I can be between 60 and 75, maybe a little bit lower at 60 to 70 and it will go as low as the 50s on bad days. But I am actually dealing with some health issues so I think that is responsible for that mess.

[Todd Becker]: Certainly. I wouldn’t consider myself an athlete, I would just sort of consider myself generally fit for being 58 years old. So to me as long as it is sort of in that range I am happy and as an indicator that it is sort of a warning sign if it were to plunge, I start to look into it.

[Damien Blenkinsopp]: When mine plunges I take the day off. I have had some really crazy crashes and sometimes I don’t know what is going on and you have got a virus or something. I got a crazy flu virus from my nephew just recently and it took me out for a week. But I knew about it the day it was hitting because of the HRV. Even if I felt not so bad in the morning, the HRV showed it beforehand.

[Todd Becker]: Yeah, I think you’re right – fatigue, infection, and it picks those things up right away. And intoxication.

[Damien Blenkinsopp]: Alcoholic intoxication. Well Todd, thank you so much for your insights today about hormesis, which is really very a broad and interesting framework to look at all sorts of things we could be doing to improve our bodies in terms of performance and so on, and your experience with HRV has been very interesting to hear.

[Todd Becker]: Well, I have enjoyed talking to you. Thanks for the opportunity.


Leave a Reply

In the first episode of The Quantified Body, we looked at the biometric of Heart Rate Variability or HRV and how to apply it to optimize training and workouts.

HRV has also been researched in other contexts such as stress management, general health, motivation, and willpower, where it can help you make decisions about how to improve these areas and identify what’s working for you – and what is not. So we’re going to continue to look at its use in these different contexts and the research behind it.

Today we’re looking at managing stress with heart rate variability and general health management, also our guest heads up the company which is currently leading the way in HRV apps targeting the stress management area.

Today’s guest is Ronda Collier, CEO of SweetWater Health, a company developing HRV applications for mobile platforms like the iPhone and Android. Ronda has over 25 years experience in technology product development and founded SweetWater Health in 2010 to focus on Heart Rate Variability.

She’s very hands on and working with a variety of companies in the area, so there’s a lot of practical details in our chat today and ideas from her on how HRV apps are going to progress over time.

The show notes, biomarkers, and links to the apps and devices and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • A review of the market of heart rate variability supporting devices and apps and the different standards and their accuracy.
  • What is required for accurate readings in terms of data input from the EKG compliance heart rate reading device (e.g. heart rate chest strap, ).
  • The best “use cases” Ronda has found for getting actionable data from heart rate variability.
  • The different measures of HRV: Time domain, frequency domain and non-linear.
  • Using HRV for stress management, to improve your stress baseline with activities like meditation and see the progress as well as identifying ‘high stress’ triggers for you.
  • Comparing the HeartMath coherence training to the use of the standard HRV stress measure (frequency domain).
  • How to use the SweetBeat and SweetBeat Life apps to monitor stress – some tips on Ronda on how to use effectively including health and less healthy (aka chronically stressed) benchmarks for HRV, LF and HF to compare your numbers to.
  • How the more advanced users are using the SweetBeat app and its more detailed metrics and functionality to improve their stress management over the day.
  • Other functionality on the SweetBeat and SweetBeat Life apps including food allergy/ sensitivity testing and correlating changes in a range of biometrics tracked by the app including HRV and other readings from devices it interfaces with.
  • Using HRV as an objective measure of effectiveness of alternative health treatments or techniques such as acupuncture or chiropractor.
  • The goal of raising your parasympathetic activity (HF) to lower chronic stress and the interventions and activities that have an impact on it such as yoga – Ronda provides benchmarks and examples of what they’ve seen work.

Give some love to Ronda on Twitter to thank her for the advice in this interview.
Click Here to let her know you enjoyed the show!

Biomarkers in this Episode

  • Heart Rate Variability (HRV): Measures how your heart rate varies over time. Research studies link HRV to recovery status, stress and other aspects of human physiology. See the specific measures below for which ones measure stress.
  • R-R intervals: Time interval in between heart beats (R = peak of heart beat).
  • RMSSD (Root Mean Square of the Successive Differences): The time-domain measure used to calculate HRV that has proven to be reliable and is used in a lot of the research studies – the industry standard for HRV.
  • lnRMSSDx20 (RMSSD with natural log and multiple of 20 applied): Applications have begun using this measure, which is basically RMSSD scaled to an index of 100, to make it more user friendly. SweetWater uses their own version of this.
  • LF (Low Frequency): Spectral measure that indicates combination of parasympathetic and sympathetic activation. The HeartMath algorithm uses a spike at a frequency within this band.
  • HF (High Frequency): Spectral measure that indicates parasympathetic activation.
  • LF/HF Ratio: The ratio of LF to HF gives a proxy measure of stress, or more specifically .
  • HeartMath Coherence Score: The HeartMath coherence score goes from 1 to 16 and measures your alignment with a spike at 0.1Hz on the frequency domain which is within the LF zone, and none or very low presentation in the other areas like the HF zone. LF represents both sympathetic and parasympathetic activity, so the 0.1Hz frequency is related to parasympathetic activity specifically. You find this within HeartMath
  • Resting Heart Rate (RHR): Measure of your heart rate at rest (typically measured upon waking). This is one of the measures Ronda tracks routinely to monitor her own health.
  • Blood Pressure: One of the biometrics that Ronda tracks for her own personal health.
  • The Coca Pulse Test: A measure of increase of heart rate that attempts to identify food sensitivities and allergies. You can read more about it in this book from the creator Dr. Arthur Coca, The Pulse Test: The Secret of Building Your Basic Health. SweetBeat and SweetBeat Life HRV apps use this test for their food sensitivity functionality.

Apps and Devices from this Episode

  • SweetBeat: The original HRV app that has been available for the last 2 years – it has HRV for training, HRV stress, food sensitivity functionality.
  • SweetBeat Life: Ronda’s new app that has extended functionality including the correlation function and additional data on HRV and real time HRV data.
  • Ithlete: One of the competing HRV apps with similar functionality to SweetBeat in the HRV for training area. Does not have HRV stress management functionality.
  • The Health Patch: One of the competing HRV apps with similar functionality to SweetBeat in the HRV for training area. Does not have HRV stress management functionality.
  • HeartMath: HeartMath use a proprietary algorithm measuring coherence with a variety of devices including the emwave2 and Inner Balance Sensor (iPhone, android).
  • Basis Watch: Watch that tracks heart rate and resting heart rate, but due its technology, has limitations in accuracy and sampling and is unable to record heart rate variability.
  • Mio Alpha: Another watch with heart rate monitor functionality which is working on a more advanced technology than the Basis watch, which may potentially track HRV eventually.
  • Bioforce HRV: Another application used for HRV for training similar to ithlete.
  • VitalConnect HealthPatch: A stick on patch that lasts for a number of days or longer depending on use that tracks heart rate and heart rate variability. The SweetBeat apps work with this patch and SweetBeat Life can use the data with its correlation functionality.
  • Withings WS-50 Smart Body Analyzer: This device weighs you and tracks other body data. SweetBeat Life interfaces with this and is able to use the data with its correlation functionality.

Other Resources Mentioned in this Episode

    Ronda Collier and Sweetwater Health

  • Connecting with Ronda Collier and SweetWater Health: You can connect with Ronda at her website SweetWaterHRV.com (company site) and also on twitter @BeatHealthy and facebook BeatHealthy.
  • Other People, Resources and Books Mentioned

  • Quantified Body Ep. #1 on “HRV for Training”: In this previous episode we looked at using HRV to optimize workouts and training sessions in great detail with Andrew Flatt, athlete and researcher.
  • The Quantified Self Conference: This conference takes place yearly in San Francisco and has many devices and apps companies attending as well as many presentations on quantified N=1 experiments and on the quantified self movement itself.

Who should I interview next? Please let me know by clicking here

Full Interview Transcript

Transcript - Click Here to Read

[Damien Blenkinsopp]: Hi Ronda, great to have you on the podcast.

[Ronda Collier]: Hi Damien, thanks for having me.

[Damien Blenkinsopp]: That’s great. I did see you briefly last year in the Quantified Self. Do you go to that conference every year?

[Ronda Collier]: Yeah, we have been the last – well, there have only been two and we have been at both of them. We presented at breakout sessions for heart rate variability. So they are pretty popular.

[Damien Blenkinsopp]: Yeah, and do you meet a lot of providers of HRV? You have been in this segment since 2011. How has it changed since then? How many players were there doing HRV stuff back then and how has it changed now? Are there different types of players? I noticed your proposition is changing a bit.

[Ronda Collier]: Yeah, back in the old days and really before smart phones, heart rate variability systems were big and clunky and expensive if you wanted to measure some of the standard HRV values like LFHV, which we can talk about. And nobody really heard of them quite frankly. I only know because that is our space. I think Heartmath really brought heart rate variability closer to the consumer with their M-wave products.

[Damien Blenkinsopp]: So they were the first ones, although theirs is actually a bit different to the standard.

[Ronda Collier]: Yeah, theirs is different and Heartmath is really more about coherence training, which is wonderful in itself, but they really had people talking about it in some of the more esoteric books, if you will. But I ran across Heartmath in reading some books for actually researching my thesis.

[Damien Blenkinsopp]: So how long has Heartmath been around? I know you worked there for a little while.

[Ronda Collier]: Yeah, they have been around about 20 years, yeah, for a long time. So they have an extensive amount of research on heart rate variability that is pretty interesting. And then three years ago you had iFleet starting to come out and that was really it. And then you have Zumio came out with their camera sensor, which is not very accurate but yet sort of furthering the cause of heart rate variability, which is important.

And moving all the way up until today where we are seeing a few more players like iFleet more in that space, Bioforce really not displaying all the HRV parameters like Sweetwater is, more the number used for training.

But I think the big news in heart rate variability is the Samsung, the new Galaxy is announced to measure heart rate variability.

[Damien Blenkinsopp]: Wow, yeah, that’s a big deal.

[Ronda Collier]: And even though it is just with the camera sensor, just for your listeners, a camera sensor is never going to be accurate.

[Damien Blenkinsopp]: Right, that is something I wanted to talk about today because I know you plug in with a variety of sensors. We did talk in our first episode with Andrew Flatt about some different sensors and some of the different measures and obviously we want to make sure people understand the practicalities and the accuracy, depending on which one they decide to go with. I think that is an important point.

[Ronda Collier]: It is – and so even though the Samsung is using the camera sensor, they are talking about it. And now that is great, and it means it is showing up in the mainstream. So we are really excited. It is such an important parameter that has just been kept in the closet for some reason.

[Damien Blenkinsopp]: Right, so let’s just kind of dive into the kind of accuracy since we are talking about it anyway and we won’t have to circle back. Obviously the thing about the Samsung Galaxy is they didn’t want to provide something external to the phone, and they want to try to have the device within the phone. And besides the camera sensor, is there anything else you could use that would actually come with the phone that would be able to help you track heart rate?

[Ronda Collier]: The closest idea I can come up with for you here is there is a company called AliveCore that has an iPhone and Android case, and it is actually EKG accurate, which is what you really need for accurate heart rate variability and that is all that Sweetwater will support, anything that is close to EKG accurate.

[Damien Blenkinsopp]: How do you establish that standard, EKG accurate? Is there a certain – I don’t know, is there sensitivity in terms of the speed of the heartbeat it has to be able to pick up? Or how do you rate that?

[Ronda Collier]: There is obviously the sampling rate. It has to be twice the heart beat. It is called Nyquist frequency for electrical engineers. But really what you need in simple terms are accurate, beat-to-beat intervals.

[Damien Blenkinsopp]: So you are saying that it has to sample twice as fast as whatever heart rate you are trying to –

[Ronda Collier]: At a minimum, yeah. There is something called the Nyquist frequency in electrical engineering, so if you want to get an accurate digital sample it has to be at least twice the frequency of what you are sampling.

[Damien Blenkinsopp]: Right, and for the normal population what is the maximum heart rate you are trying to track?

[Ronda Collier]: Oh we track, gosh, as low as 30. And if you are below that you are pretty sick and you probably aren’t using our product. Then up to about 200.

[Damien Blenkinsopp]: 200, wow. So you have to be running?

[Ronda Collier]: Some athletes actually get up close to that. My personal max heart rate is about 170, but people do get up in the 200s and we can measure that as well. So you have a wide range. But really it is getting accurate, beat-to-beat intervals that is the most important.

[Damien Blenkinsopp]: Yeah, does that mean with all of the different sensors you work with – because you have the application which interprets the data, and you work with a bunch of sensors from different providers, quite a few companies. Do you only work with providers which have the specification you just gave us? Do all of them fit that?

[Ronda Collier]: That’s right, that’s right. We support lots of shelf chest straps, like a Polar or a Zephyr, and there are a lot of Bluetooth heart rate monitors out there now, but now all of them work with Sweetwater. Some of them simply don’t transmit our intervals at all, and that is the beat-to-beat interval. So when I refer to R-R, that means the beat-to-beat intervals.

[Damien Blenkinsopp]: Right, so you are saying that some of them only track the heart rate and they don’t track the difference?

[Ronda Collier]: That’s right. And then some transmit the R-R intervals, but they are not accurate.

[Damien Blenkinsopp]: Could you give us examples of that? Is it because they are dedicated to a different application? Why is that?

[Ronda Collier]: I think that a lot of the vendors are starting to realize they want to transmit R-R intervals, but they just haven’t spent the time on it yet I would imagine, because we have worked with several vendors who did not have accurate R-R intervals and then worked with us to get there. Their focus was to get the Bluetooth heart rate monitor out first with an accurate heart rate and the R-R intervals were a secondary item. Then once they worked with us they got those to be accurate.

So that is usually the vendor is not interested in the R-R interval or they are interested in getting them accurate.

[Damien Blenkinsopp]: Right, and you think this is something that is changing, whereas people were just kind of focused on heart rate a few years ago, or three or four years ago, so these censors came out which didn’t look at the R-R now. Now would say most of them have this on their agenda in some way? Or is it still –

[Ronda Collier]: Yeah, I would say so. There are a lot of off brands that we haven’t even heard of, much less tested, that our customers are finding and then emailing us saying that their HRV doesn’t look correct. So we go and usually write the vendor and ask them before we go purchase the item.

But yeah, there are a lot and I am really surprised at the number of small companies doing the Bluetooth, low-energy heart rate monitors.

[Damien Blenkinsopp]: I guess that technology is relatively cheap, so there are a lot of chest straps and things like this that have come out. They haven’t necessarily done the full technical specification?

[Ronda Collier]: That’s right. So anyone that is going to use a heart rate variability app such as Sweetbeat or Sweetbeat Life, I recommend going to our website and selecting one of those, because we have tested those and we have actually measured that the R-R intervals are close to being correct.

[Damien Blenkinsopp]: So I guess the lesson here is there is no specific industry standard used by everyone. So if you were going to get something like Sweetbeat you should definitely go to your website, like you say, and check which ones are relevant – and it is probably going to be like that for a while, I guess?

[Ronda Collier]: Yeah, yes. Even the ones that look like they are working, we do a detailed test. We are all engineers at Sweetwater – the founders are all three electrical engineers so we are very careful about making sure that one plus one equals two. So what we will do is say a three-minute Sweetbeat session and then we will dump the R-R intervals, and they better add up to three minutes.

[Damien Blenkinsopp]: Okay, and yours is always three minutes?

[Ronda Collier]: For the HRV reading, yes, that is for the athletic reading. But you can do five minutes or eight minutes, but the R-R intervals need to add up. And some of the heart rate monitors don’t and so we work with the vendors to try to get that more accurate, because we want to support them.

[Damien Blenkinsopp]: Yeah, and it is better for everyone if you can support more sensors. So there are a bunch of different things coming out. There are the chest straps, which we have spoken about – so you are working with Polar, 60Beat, Zephyr, and Wahoo. And then there are biosensors, where you have these plastics that stick to you, basically?

[Ronda Collier]: Yeah, we just released our second product called Sweetbeat Life, and Sweetbeat Life works with what is called the health patch, which is a product by Vital Connect. So the health patch looks like a big band-aid, about three inches long, and that is an FDA-approved, single-lead EKG. It also measures respiration, body temperature, body surface temperature, calories burned – accurate, by the way, because it is measuring your body temperature and heart rate – as well as activity.

It is a real doozy, it has got everything in one. We are really excited about that because we are going to get a whole bunch of new metrics and be able to correlate that with heart rate variability and stress and provide more information.

[Damien Blenkinsopp]: That is great. How long does someone wear a patch like that for? How long does it work for?

[Ronda Collier]: That is a great question because we came up with a use model that Vital Connect never considered. Their original use model was it comes with a separate module, the patches are disposable and so you plug the module in and stick it on and their use model was you could wear it for three days until the battery dies.

[Damien Blenkinsopp]: It’s 24 hours?

[Ronda Collier]: You can, yeah, if that is what you want to do. What we do is we just keep the plastic that goes on the back and rather than have to put a chest strap on in the morning when you are doing your morning HRV reading you actually reach over and grab your patch, stick your module in, and stick it on. And so I get the patch to last for over a month.

[Damien Blenkinsopp]: You basically have this sticky part on you and then you just plug the electric part in every morning?

[Ronda Collier]: I peel the band-aid off, like take the band-aid off, and you pull the module out to save the battery, and I just have that sitting by my bedside. And in the morning I grab the band-aid and I stick the module back in and stick it back on.

[Damien Blenkinsopp]: Oh, so it sticks on and off without a problem, basically?

[Ronda Collier]: It does, and it is funny – different skin types can do it more than others. But if you are laying flat on the bed for your HRV morning reading it works pretty well for like a month.

[Damien Blenkinsopp]: You said two interesting things there. The first was you said FDA-approved for EKG. So does the FDA approve certain monitors and sensors and say they are EKG standard?

[Ronda Collier]: You go through a process, basically, to get a device clearance. But yeah, so this particular one is FDA approved. And for over-the-counter, obviously, because we are selling it to consumers.

[Damien Blenkinsopp]: Do all of them have to be FDA approved?

[Ronda Collier]: No, this is a consumer product. Although we – our product is we want to have values that are clinical grade and we do tests to make sure they are accurate. And I do want to note that HRV is very sensitive to the data going in. So if you have the wrong R-R intervals or the wrong interbeat intervals you are not going to get accurate data. So it is super sensitive. So anyone who is interested in HRV, make sure that you are aware that you have a quality heart rate monitor, whatever that is.

[Damien Blenkinsopp]: Definitely, and I want to talk more about the accuracy and use cases. The other interesting thing that you said though was you are using it and it sounds like you are using the HRV for training in the morning. Is that your main use for it? How else do you use it yourself?

[Ronda Collier]: Well, I use it for HRV for training in the morning. I also use it to track my circadian rhythm. I am really curious what is going on with me, quite frankly, at naptime in the afternoon. And it is very interesting – my parasympathetic nervous system actually increases in the afternoon?

[Damien Blenkinsopp]: Is that because you have a nap?

[Ronda Collier]: Yes, I will back up. Heart rate variability has a circadian rhythm, and I look to be curious, to see what is going on. And sure enough at 2:30 in the afternoon my parasympathetic or HF, HRV parameter increases.

I also use it especially early on with Sweetbeat. I used it when I was sitting at my desk to figure out what was going on and why I would get triggered. Because you are working all day and suddenly your neck hurts. And you are like, ‘What was I doing?’ You don’t even know because we do it all the time.

So I have actually learned that if a browser doesn’t load when I think it should, my face gets in the screen and I tense up.

[Damien Blenkinsopp]: You told me about this at Quantified Self. I think everybody hates that and we just don’t really realize how much.

[Ronda Collier]: Well, the important point here is that if you can learn one thing that you are doing all the time, then you can reduce your stress.

[Damien Blenkinsopp]: Yeah, and is that an HRV reading? You are using the stress monitor with your HRV app for that?

[Ronda Collier]: Right, right.

[Damien Blenkinsopp]: Okay, and previously we have talked a bit about HRV for training, so I think the audience has a reasonable grip of that and then how that works. And we didn’t look at all on the stress side, and that is a different calculation. Can you talk a little bit about what is behind that? How does it use HRV and how is it different with HRV for training calculation?

[Ronda Collier]: Yeah, absolutely, so the HRV for training calculation is based on – let me back up because I think it is better to give a high level of review. Heart rate variability, in itself, is just that – the variation of the heartbeats in the beat-to-beat intervals. It can be measured in several different ways. One is called time domain, or statistical analysis, like standard deviation. Root mean square of successive differences. The RMS, those are all typical statistical measures.

Then there is another way to measure the HRV and that is called frequency domain. And this is using [inaudible 00:16:43] fast forms and for you engineers out there, you kind of know what that is. And looking at the frequency components of the R-R intervals.

And then thirdly there is actually non-linear, which we are not using in Sweetbeat at this time. So the HRV for training uses a time domain parameter called RMSSD and that is a measure, it turns out, of your vagal tone. And the vagus nerve is the tenth of 12 cranial nerves in the nervous system, in the [inaudible 00:17:12] nervous system. And that particular piece of the nervous system is what gets fatigued during overtraining and endurance sports. So we measure that time domain measure for the HRV for training.

[Damien Blenkinsopp]: And you were saying that you specifically use that because the research has been based mostly on that measure?

[Ronda Collier]: Yes, that’s right.

[Damien Blenkinsopp]: So just one clarification on that – when you have actual score in Sweetbeat, the last time I spoke to you, you said it was based on 100. Is that the natural log of RMSSD times 20, or are you using something different? I think iFleet uses the natural log times 20.

[Ronda Collier]: Yeah, it is similar to iFleet but it is not the same.

[Damien Blenkinsopp]: So if you went out and got one and then a month later it broke or whatever and you went and got a different one, then you can’t have all of those values in Excel and compare it back for two months because they don’t necessarily fit?

[Ronda Collier]: No, no. And that’s actually a great point, Damien, because we have had people ask why is it different in iFleet? Because we use a different algorithm. We were 10,000 miles apart, having the same idea, but doing it differently.

[Damien Blenkinsopp]: So there is no industry standard, and it is basically because everyone decided it was going to be better to have it on a roughly 1 to 100 rating?

[Ronda Collier]: Yeah, it is a consumer thing. But there is an industry standard for HRV, but it is in numbers that a consumer would have a hard time with.

[Damien Blenkinsopp]: Could you give us a quick example?

[Ronda Collier]: Sure, so RMSSD, depending on who you are and HRV is very individual – while you sit there and in three minutes it can go between let’s say 60 and 68 – and it will sit there and vary because your nervous system is very dynamic. And then maybe the next day you get up and it is 54. So these numbers are just not easy for people to deal with.

So by scaling it from 0 to 100 it is easier for people to understand.

[Damien Blenkinsopp]: Yeah, that makes sense.

[Ronda Collier]: The stress level, so that is the HRV for training piece. And then the stress level, we actually use the frequency calculations of HRV and we measure the low-frequency components, which correspond, in simple terms, to the sympathetic nervous system. Actually, it is a combination of sympathetic and parasympathetic, but mostly sympathetic-dominant.

And then the high-frequency components, which are a measure of your parasympathetic branch of your autonomic nervous system. So for the stress level we look at those two and then we measure the balance between the two. So when you are sympathetic-dominant, you are stressed, sympathetic or fight-or-flight dominant, you are stressed. You want to actually be sympathetic-parasympathetic balanced.

But when you are really relaxing or just woke up in the morning and are sort of chilling, then you actually want to see yourself being a bit parasympathetic-dominant.

[Damien Blenkinsopp]: So if you are at work you would want to be a little bit sympathetic-dominant? So you are working on something and you are writing or doing a presentation?

[Ronda Collier]: Yeah, you normally would be. But you don’t want to be chronically that way.

[Damien Blenkinsopp]: Okay, so you are saying that balance would be 1-1, so LF and HF would be equal?

[Ronda Collier]: Yes.

[Damien Blenkinsopp]: What is bad? What kind of ratio is starting to look bad? Is it 2-1?

[Ronda Collier]: No, 2-1 is still pretty okay. You don’t want to be that way 27/7, but a lot of people are. When you start getting really bad is when you are over 4 or 5, which you would be surprised, is pretty darn common and people are even higher.

[Damien Blenkinsopp]: And you were saying it is throughout the day?

[Ronda Collier]: Every time you do a measure you are always – you are sitting at your desk and you can never, ever, get anywhere near 3, no matter what you do.

[Damien Blenkinsopp]: Even if you do some relaxation techniques, some people can’t get it down?

[Ronda Collier]: They can’t get it down.

[Damien Blenkinsopp]: That would actually probably be me, because mine won’t. I know there are some specific reasons, it is not because I am a really stressed out individual. But yeah, that would be me. And I was worried about it a bit more at first until I learned a bit more and I spoke to you at Quantified Self about it.

What is yours, for example? You were talking about when you get stressed at your computer. What does that tend to go up to? What would it normally be if you -?

[Ronda Collier]: I will qualify that with I have been meditating for a very long time. And I did a lot of coherence training with Heartmath for years, and so I will qualify that. But I am pretty balanced. Mine will go up to maybe 2 or 3, which is if I am really stressed. Otherwise I am usually anywhere between 0.8 to 1.5.

[Damien Blenkinsopp]: That sounds ideal, I guess? Is that?

[Ronda Collier]: Yeah, I am pretty balanced. I have worked hard to make my life that way, by the way. It was not always the case. I used to do chip design, which is very high pressure at Silicon Valley startup companies. I wish I had this app then because it would be interesting to see what I was running on, probably full time.

[Damien Blenkinsopp]: I was just going to ask you – that would be so interesting to know how that sort of evolved over time. And especially – this is when I started more meditation, this is when I did this, and you could see the steps down. Because I recently started – I didn’t really know how to track my meditation and if it was effective in any way. And I have been looking for a way to track it for a while.

So these days I go to the part and I switch on Heartmath. I have been using Heartmath to just track my meditation and it seems to be getting better, but honestly I don’t understand the difference between that and say the HRV for stress reading. Could you give me – like, could I use both of these for meditation and try and track how effective my meditation is? Or do you think that is not a reasonable use of it?

[Ronda Collier]: It is. This is a great question and we get this all the time in our support questions. Heartmath is a coherence training device or app, and what that does is get you into a state, basically getting your nervous system and all of your nervous system operating a – it’s called coherent, but in the frequency domain all you have is a little bit of energy at your breathing rate of 0.1 hertz.

[Damien Blenkinsopp]: You told me once before that this was in the LF zone?

[Ronda Collier]: And that falls into the LF. We don’t define what makes HF and what makes LF. So LF is 0.04 to 0.15 hertz, and HF is 0.15 hertz to 0.4 hertz, and that is an industry standard because we follow the HRV standards, and that is what it is.

So if you do coherence training you are going to have a huge spike if you are coherent at 0.1 hertz. And you won’t have anything anywhere else, because that is what coherent is. There is not going to be any energy in the HF range at all, or anywhere else, even in the VLF range, which are the very low frequencies.

So really it is a spike there at 0.1 hertz. And so that will show up as high stress in our app; however, if you are meditating and not doing regular breathing, your breathing normally and then you should be able to see your nervous system actually have a power increase. So that could be a measure of your meditative quality.

[Damien Blenkinsopp]: Do you mean the HF, the parasympathetic, would increase?

[Ronda Collier]: Actually, you could see the whole thing increase. It will stay balanced but the whole thing can increase.

[Damien Blenkinsopp]: I will go and try this for a few days. I go and meditate and I switch it on to the stress and then there is a chart in your app which looks at the LF and the HF and it shows it charting over time. Is that the screen you would look at?

[Ronda Collier]: That’s right, and Sweetbeat Life actually does it in real time now.

[Damien Blenkinsopp]: Okay, what is the difference?

[Ronda Collier]: It doesn’t show LF and HF graph in real time. Sweetbeat shows it in numbers in real time, but Sweetbeat Life, if you go to the landscape mode on the monitor screen, it shows it in real time. So it is a little more intuitive if you are meditating to look at a graph than read numbers.

Be aware though, if you have been doing Heartmath you just go coherent. When I meditate, I just automatically go coherent now so I don’t use it for that anymore. But I do use it in [inaudible 00:25:07].

[Damien Blenkinsopp]: Did you say you don’t go coherent in meditation anymore?

[Ronda Collier]: I do go coherent. All I have to do is think about meditating and I am coherent.

[Damien Blenkinsopp]: Oh, okay. And if you look at the research I am not actually sure that meditation correlates with coherence all the time. And actually if you look on the forums in various places, you will see some people who have been meditating for a while and they try to use Heartmath or something else and when they are in their usual meditation zone, they get a lack of coherence. THey go out of coherence and then when they focus on getting coherent, they go in under coherent. So I don’t know if there needs to be more research done around that. Do you know anything about that?

[Ronda Collier]: Once your nervous system is trained for coherence, and this is my experience, and our other founder Donna Lever, also as soon as she sits down to meditate, she is not trying to go coherent and she doesn’t have a device, but we go coherent. If you want to, you have to be mindful about not doing that regular breathing that brings you coherence. So there are a lot of meditative techniques where you breath in and hold at the top and focus and then that goes – so you just would do a different breathing technique.

[Damien Blenkinsopp]: Right, and breathing does seem to be essential. I think it makes quite a big difference in the Heartmath side. In your app – let’s move back to Sweetwater – does breathing make a big difference to stress numbers, the LF and the HF, in your app?

[Ronda Collier]: Absolutely. While we are not a coherence training device, if you go coherent you are going to see it. And so it will look like – you will see it once again as a spike at LF and so it will show up as stress.

[Damien Blenkinsopp]: Yeah, which in your app would be red, I am guessing?

[Ronda Collier]: That’s right, the stress levels are blue, green, yellow, orange, and red; however, you would be able to look at your power numbers and see what you are doing. You would want to see a super high power number in the LF.

[Damien Blenkinsopp]: Right, and so in your case when you were doing meditation, specifically, you would look at the LF and the HF screen, rather than the bar with the ratings? But just for general stress like you are talking about, you want to understand a situation like if you are stressed or not and if you are feeling a bit rough or looking at your screen and not feeling good or for presentation or whatever – would you use the LH-HF screen or would you use the bar with the red and the yellow and so on?

[Ronda Collier]: I think I would use the bar initially – for your listeners, definitely just use the bar and then once you start figuring out what you are looking at then you can actually look at the LF and HF and that can become second nature, once you are done with the bar then we tend to look at the geek screen at the LF and HF.

[Damien Blenkinsopp]: Right, and then as you said higher power is good as well as the ratio?

[Ronda Collier]: That’s right. When you are really feeling kind of dragging, if you look at the power numbers you could be – I am going to make numbers up. I have had listeners quote my numbers and there is so much variety in HRV numbers, so I am just going to use some average numbers. Some days your LF and your HF might be around 100 or less.

[Damien Blenkinsopp]: Both of them?

[Ronda Collier]: Yes, somewhere around there.

[Damien Blenkinsopp]: So is that a bad day?

[Ronda Collier]: For me that is a bad day. That is a low day where my energy is zapped or I have done something where I am emotionally or physically drained. Then there are other days where you are just on top of the world and you are at 2,000 to 3,000. So that is where you won’t see that from looking at the bar from blue to red, but you will see that looking at your numbers.

[Damien Blenkinsopp]: My numbers would be like – most of the time my LF is like 1,800 and my HF is like 200 or 300, if I am lucky. So if my HF isn’t high enough –

[Ronda Collier]: That’s right. And Heartmath should, over time, improve that.

[Damien Blenkinsopp]: It definitely helps and you can feel it. I guess you recommend to do this kind of thing, but once you identify something that is stressing you in your life and you do a Heartmath session or a meditative session and use the device, then you definitely come back afterwards and you have got more energy, you can get back to what you are doing, and it definitely makes a huge difference in my productivity. Once I discovered this it was pretty much a game changer for how I work.

[Ronda Collier]: Yeah, and you bring up a great point. One of the reasons that we created Sweetbeat was to not only provide you with feedback that you would go off and meditate or chill, but to provide you with real-time feedback so you can actually, right then and there, go, ‘Oh, I am doing this and I have been doing it all the time and I didn’t even know it.’ And then learn to actually correct your behavior right then and there. Put your shoulders back, uncross your legs, sit back, take a deep breath at your desk, and then reset.

[Damien Blenkinsopp]: Right, and so the idea is that you can be watching the screen and you can watch when your numbers readjust or go back to normal and then you can tell when you are in a better state.

[Ronda Collier]: That’s right, and then next time Sweetbeat gives you an alert if you change your stress state and you can program it to do that. So that is how I learned about the screen thing. Other customers have used it while they are driving and it starts beep, and they realize that they have just stressed out over something that they deal with every day. And so it brings to consciousness things that have been previously unconscious that are contributing to heart disease and hypertension in middle age.

[Damien Blenkinsopp]: Would you say this is the most common use case? I was going to ask what you find people are using the most. I guess you have this big database now with everyone’s data. I am not even sure if you have come to grips with that because you have all this data.

[Ronda Collier]: We have not come to grips with it yet. It is going to be a huge issue. What we do is when customers write in and want to know about their data we can help them with an analysis if we have time. We go ahead and look at some of their sessions and give them sort of a bird’s eye view of what is going on for them and so we are still doing that.

[Damien Blenkinsopp]: Yeah, but you can’t do things like understand what, on average, the users are using that for?

[Ronda Collier]: Oh we do, and we have done that. We have a large percentage – the micro market is lead athletes and even fitness enthusiasts using it to guide their training.

[Damien Blenkinsopp]: Right, so that is every morning as soon as they wake up?

[Ronda Collier]: That is that group. That group is also using it throughout the day, running 20, 30-minute sessions just to see how they are doing. Then there is the other market segment, which are quantified selfers and they are wanting to run it for like 8 hours.

[Damien Blenkinsopp]: Right, to see where they spike?

[Ronda Collier]: Absolutely. They want to run a session all day and then they want to sleep in it. They are just running it constantly.

[Damien Blenkinsopp]: When I first got mine I wanted to do it 24 hours and I think I even wrote to you about it.

[Ronda Collier]: Yeah, your phone won’t hold all that – there is a lot of data.

[Damien Blenkinsopp]: That’s what you told me.

[Ronda Collier]: But with the health patch we are working on making that a little easier for folks. So the health patch will make the full time monitoring much more accessible because it is actually comfortable and you don’t even know it is there. You can sleep in it without the strap on you, though some people don’t mind. I don’t sleep well with the strap, but the little health patch just sits there and it is not a big deal.

[Damien Blenkinsopp]: Anyway, the idea behind the 8-hour or the 24-hour is people are trying to figure out, and using the stress monitor, what kinds of things are triggering them throughout the day. This is what they are doing, right? They are just mapping the whole day and they are like, ‘Hmm, at 1 o’clock and 3 o’clock I got really stressed out, what was I doing?’ and that kind of thing?

[Ronda Collier]: Yeah, that’s right. And also they are tracking LF and HF. A lot of the folks have gotten big into looking at those numbers because once again, the stress meter only tells you the balance of LF and HF. The numbers themselves tell you the power levels.

[Damien Blenkinsopp]: So it is more interesting once you start looking at LF and HF?

[Ronda Collier]: People love the power levels, so yeah, it is really great and we were really pleased with that.

[Damien Blenkinsopp]: Yeah, is there a more detailed understanding though? As you have already described? A lot of people probably want to get their HF up higher and I guess there are two ways to look at it as the baseline, where you are from day-to-day. And I don’t know if you do kind of averages of how people evolve over time and they manage to address that kind of baseline versus –

[Ronda Collier]: You are bringing up a really important point for your listeners. Because HRV has a circadian rhythm, if you are going to do a day-to-day comparison you need to do it at approximately at the same time in the same position. If you are laying down and then stand up your heart rate increases to equalize the blood pressure. So really your position is important.

Also, your mental state will be important. So if you measure it at the same time each day but one day you are all stressed because something happened in your family, your HRV is going to be different. That is why we recommend that people do it first thing in the morning and really mindfully don’t start thinking about your day because that can affect the reading.

[Damien Blenkinsopp]: Yeah, what I do every morning now is I lie down and then I do a standing up reading as well. Which do you do? Do you both or do you just do lying down or standing up?

[Ronda Collier]: Well I just do lying down. I am lying in bed and I am not thinking, because once I get up then my mind starts thinking about my day and so that can affect the readings. We have done measurements where something was going on in my family and I was just sitting here and already had the strap on when I was testing in the early days and something happened and just from my thought and looking at what happened my stress soared right in front of my eyes and it was kind of crazy.

Our other founder, Joe Beth Dow, had the same thing happen. So really your mental and emotional state, if you are going to do the day-to-day comparison, you need to be mindful of that. And if you see it drop just really go inside and go, ‘What am I feeling sick? Or sad, or angry, or upset, or something like that.’

[Damien Blenkinsopp]: Right, to kind of detect if it is something you are causing yourself or if it is the underlying how you are feeling today, that is a good point.

[Ronda Collier]: That’s right. It can be physical, emotional, psychological, or environmental.

[Damien Blenkinsopp]: Yeah, I can definitely relate to what you are saying about it is easier when you are lying down when you first get up and then you tend not to think about it so much. But I do the lying down one and then I do the standing up one and I tend to start thinking about things. And I have to kind of catch myself, especially if I am thinking about work or something. So I think you are totally right about that, if you are going to do the standing one it is good to keep in mind that it is at the same time.

The other thing is movement. HRV for training is a very specific, three-minute reading. So you either do it lying down or standing up or sitting down.

[Ronda Collier]: Do your three-minute reading and you are done, yeah.

[Damien Blenkinsopp]: And you always do it the same just to keep it the same. How about movement? I guess some people doing these 8-hour cycles are also tracking all sorts of things throughout the day. Is it relevant to track HRV while you are moving? Is that an accurate reading? I had some experience with this before and I couldn’t really figure it out. What is your take on that?

[Ronda Collier]: That is another great question. You should see your heart rate variability changing through the day. When you go from sitting to standing or lying down to standing your heart rate should increase and your sympathetic should increase to increase that heart rate. So you should see nice cycles throughout the day. If you are not then that is a serious problem and that would be indicative of someone with some heart disease.

[Damien Blenkinsopp]: You are saying if the power levels aren’t changing, as you are doing different things?

[Ronda Collier]: That’s right, or even the stress level, which is the balance because I will repeat the example and when you are lying down and standing up – when you go supine to standing your sympathetic nervous system kicks in to increase your heart rate, to pump your blood, or to equalize the blood pressure. And that is normal.

For people who have low HRV to a point that maybe it is a heart disease, they have a hard time and their heart can’t respond and their nervous system is brittle, if you will. And so when they go from lying down to standing up their heart rate doesn’t increase the way it should.

And so if you were to go throughout your day in 8 hours and not see a lot of variety in your power levels and your stress levels, that would be a problem.

[Damien Blenkinsopp]: The HRV readings are accurate in terms of the LF and the HF – it is accurate data when you are moving around it is just that it is changing a lot. So your HRV should go down, I guess? In this case it is going to be the stress. So would you be more stressed when you are moving around, if I am walking or running it is going to be more sympathetic? Or can it vary per person?

[Ronda Collier]: It really depends. We were wearing it at CES the last year, or the last two years, and these kind of things usually stress me out. I guess I decided that I am not going to let trade shows stress me out anymore. I did, actually, mindfully because I will just go bonkers. And I needed to be present to go talk to all the people were were going to meet with.

And so I was walking around CES with a completely balanced green to yellow stress, which is pretty good. And really the numbers were high and I was just in a good space. Now, if you are running and exercising then your HRV is going to drop and that is just the nature of the beast.

But it is really more about that you are going to see the variation when you stand up and sit down and sit down and stand up or have an emotional stressor, or anger or environmental something coming at you.

[Damien Blenkinsopp]: Yeah, so it is not that there aren’t any people using this to track their exercise – are they tracking their HRV or their stress?

[Ronda Collier]: Oh, these guys use it for everything.

[Damien Blenkinsopp]: Is there any research behind that? What kind of understanding could you get?

[Ronda Collier]: Sweetbeat was not designed to be used while you exercise. There are some things you can glean from that. In fact, you can see where you hit aerobic to anaerobic if you know what you are looking at.

[Damien Blenkinsopp]: That is interesting.

[Ronda Collier]: It is, it is very interesting. We just having pursued that, but I can see it.

[Damien Blenkinsopp]: Can you give us a quick add to that or is it more complicated?

[Ronda Collier]: Yeah, it is okay – so your stress level goes up and your whole power levels just plummet. Your HRV plummets because everything is moving so quickly. And when you hit that threshold your stress level on the colored bar actually goes down when you hit that threshold, so that is the easiest way because your HF actually kicks in.

[Damien Blenkinsopp]: Your HF you are saying will go up when anerobic starts?

[Ronda Collier]: Yeah, and remember you are down in numbers in the teens now. So your listeners that want to try it, yeah.

[Damien Blenkinsopp]: Yeah, they should try that out.

[Ronda Collier]: Look at the geek screen and watch the numbers. Pay attention and then you will be in the red and then suddenly when you go a little harder it will back down and the bars will be like in the yellow and in the green.

[Damien Blenkinsopp]: Wow, that is really interesting. That would be interesting if you guys do something with that later.

[Ronda Collier]: And there is a bunch of research on that too. It is so dynamic and it is kind of hard to do in an app, but we think about it.

[Damien Blenkinsopp]: So I guess you will have some complicated algorithms you will have to develop and it might take some more research. It would be interesting if you could do that because currently the tests – I looked at different breath tests and so on you can do to establish anaerobic threshold. And it is not easy, you have to go to the labs and mess around. So eventually if we had an app like your iPhone app that would be really cool.

[Ronda Collier]: Yeah, I have done one and they pushed me too hard – I need to warm up. I do. And so they got completely wrong measures, said my max heart rate was like 150, which is just not true. I go to the gym and hit 165 all the time but I need to ramp up. So going on a full-force run in the first minute just doesn’t work for my body.

It would be cool to have an app that would let people – there needs to be a protocol because we have done enough looking into it with that, but not in the first minute, come on.

[Damien Blenkinsopp]: You have probably got your hands full with all the other stuff going on in your app already, so it is probably not for tomorrow. I just want to go back and we have touched on circadian rhythm a few times, saying how it distorts the figures. So I want to make sure the audience doesn’t get confused with that point. Is there a specific pattern? If I am looking at stress over the day, is there any way I can picture it in my mind so it will be a bit higher at this point or a bit lower at this point?

How do you look at the circadian rhythm? I guess the first thing to say is if you are doing HRV for training it should be at the same time every day? I woke up at one time at 4 o’clock in the morning, which I sometimes do, and then other times I will wake up at 8 o’clock and do my reading then. And one day I did it at 4 o’clock and it was completely different. It was actually a lot worse and I don’t know if that fits the typical theory. But I was like, ‘I think I better take this a bit later.’

[Ronda Collier]: It’s going to be individual, but typically – and I am just going to give you a typical case. Your HRV will be highest in the 6 am, 7 am, 8 am. And then it dips down in the early afternoon and then it comes back up in the evening.

[Damien Blenkinsopp]: And then it stays up during the night?

[Ronda Collier]: While you are sleeping your HF really should kick in and that is why people measure it when they are sleeping. If your HF isn’t kicking in then you are maybe not getting very good sleep.

[Damien Blenkinsopp]: That’s me, but we won’t get into that. That is why at 4 o’clock it was terrible. So you basically gave us the outline there. So in terms of stress that would be reflected in the stress levels as well, so you are saying in the afternoon you probably have the worst stress levels? It would be harder to be non-stressed in the afternoon, is that what you are saying?

[Ronda Collier]: Actually, I can give you mean. All I have is research numbers, so the only thing I can tell you from personally looking at the HF and LF numbers are that my HF kicks in the afternoon, which causes my heart rate to decrease, and I am sleepy.

[Damien Blenkinsopp]: Is that because you have trained yourself to have a nap?

[Ronda Collier]: But everything is low, so my HF will go from maybe 3,000 in the morning down to 900. But I am still HF-dominant, so once again, that goes back to the power numbers. They are just really – once people use Sweetbeat and get used to the stress levels then really dive into the power numbers because that is saying so much about what is going on for you.

[Damien Blenkinsopp]: And so your aim there is – 3,000 sounds incredible, like for my levels. You are saying that over time you would really like to get the HF up, that is the idea? To increase the power of the HF?

[Ronda Collier]: Yeah, most people want their HF up because they are sympathetic-dominant and kind of chronically stressed. So we have done a few case studies with yoga, so actually a young woman was one of the case studies in her early 20s who just felt stressed out, always. So her HRV was always on the low side and she was sympathetic-dominant. So she did yoga twice a week for six months and brought that into balance. She raised her power levels and brought herself much closer to balance.

[Damien Blenkinsopp]: How was she tracking that? Or how would you advise if someone is doing a long term intervention like that where they are doing classes twice a week or they are doing meditation once every day, how would you advise them to best use the app to track that?

[Ronda Collier]: I would do the HRV for training but if you are looking at LF and HF, I should mention this, it is better to have a five-minute reading or longer because with our algorithm, once again we use the industry standards for heart rate variability and there is what is called a short-term measure, which is five minutes, and a long-term measure, which is 24 hours.

So our algorithm is designed for a minimum 5-minute window. So you would not want to really use HRV for training because that is designed for the time domain accuracy and it is not the best. You are not going to get the most accurate LF and HF in the three minute, but you want a five minute.

[Damien Blenkinsopp]: Great, so your HRV for training switches on and off and it does the three minute and then it is finished. It is all built in so you don’t have to worry about that and it is going to do it for you?

[Ronda Collier]: Yeah, that’s right.

[Damien Blenkinsopp]: But what you are saying is that for the stress monitor it is labeled stress monitor in your app, as I remember, and that one you have to do for five minutes?

[Ronda Collier]: Yeah, at least. And usually you just want to put it on either right when you get up in the morning and do that, or still when you are kind of relaxed somewhere, maybe watching TV in the evening, or pick a time when you are kind of unwinding. So if you are doing the six-month intervention, pick a time a couple of times a week or every day that you go ahead and measure yourself and the history and the charting and you can see what your trends are.

[Damien Blenkinsopp]: So ideally that is the same time every day and should be the same activity, like you are saying – if it is always watching TV, although I think if you are watching an action film versus a romantic film or something it might have a little bit of an impact there too, so you have to watch out for that. Great.

[Ronda Collier]: That’s right, and if you have a favorite program that you always watch you should measure during that.

[Damien Blenkinsopp]: So you mentioned yoga – are there interventions that you know people have done in your user base? Are there examples of good things to try out in terms of experiments? What would be the top five things to try to raise the baseline?

[Ronda Collier]: Definitely yoga and meditation, those kind of go together. Nutrition, of all things, stop eating anything that is out of a box. Read the labels and if there an ingredient you can’t pronounce, don’t eat it.

[Damien Blenkinsopp]: So that would be easy if you start a diet on the first of the month. And then you can, over time, probably see some change over the next weeks if it is a positive change or a negative change?

[Ronda Collier]: That’s right, because our bodies are completely interdependent and interconnected. All the systems are connected to the other. Sweetbeat also has, which I haven’t mentioned, a food sensitivity test. And it allows you to test for foods that you may not be allergic to but you are sensitive to. And these foods can actually cause your heart rate to increase by quite a bit, even if you are just sitting.

So we have case study after case study of people sitting quietly at their desk, watching TV, or relaxing, and their heart rate goes up 20 beats after eating the offending food.

[Damien Blenkinsopp]: Did you base that on research? Where did that come from?

[Ronda Collier]: It’s called Dr. Coca’s Pulse Test – I think it is Coca’s Pulse Test. And Dr. Arthur Coca was a renowned immunologist in the 50s, founder of the journal of immunology, so he was quite well-known at the time. And he came up with this simple test to help his wife, who was having issues where they couldn’t find it in allergy tests, but they were suspecting that she was allergic. And so he came up with this pulse test for her and so she was able to fix a whole lot of ailments by using the pulse tests and eliminating offending foods.

And so all of the inflammation and all of that interacts with cortisol. There is stress cortisol and that is why I mentioned nutrition, because it is all interrelated and so if you are eating things that you could even be slightly sensitive to it can affect your heart rate variability.

[Damien Blenkinsopp]: Is it in peer-reviewed journals, this kind of research, as well? Or is it Dr. Coca’s? It sounds like it makes logical sense. Has anyone done any studies on it to validate it?

[Ronda Collier]: I could not find any peer-reviewed journals on this; however, they do teach it in medical school so a lot of allergists know about it. So yeah, it is very interesting that I have been unable to find any because we at Sweetwater go to the National Institute of Health database for our research. We want peer-reviewed research that will back up our algorithms. So yeah, the Coca pulse test, no, but a lot of functional medicine doctors, MD or not, use the pulse test and are familiar with it.

[Damien Blenkinsopp]: So it is worth finding out to see if there is something?

[Ronda Collier]: Absolutely.

[Damien Blenkinsopp]: Is there anything you would advice – and maybe you don’t know about this – but say if something is showing up and it looks like an analogy, what would be the next step for someone to try to get more validation around that? Have you got any suggestions, or is that something kind of out of your area?

[Ronda Collier]: Take it out of your diet. If you eat something, what the app does is if you are wearing a heart rate monitor it automatically will take your pulse at 30, 60, and 90 minutes. And assuming you are not out running or exercising, if your heart rate increases then that is not good.

So what you would do is note that and basically remove the offending food.

[Damien Blenkinsopp]: Yeah, so a lot of functional doctors these days advise – because a lot of the allergy tests aren’t that consistent either, so a lot of them advise you on elimination anyway. So I guess if you really wanted to validate it afterwards, don’t eat it for a month. And then eat it again and see what happens to you or if you feel worse, and again do the test with your app, for example. That is probably the next best thing to do?

[Ronda Collier]: That’s right. I wasn’t testing anything but I ate – and a reasonable, regular serving of cherries about a month ago. And I was just sitting at my desk and I was testing the Sweetbeat for something else and I wasn’t doing a food test, but I noticed my heart rate was 79. My resting heart rate is about 50 and I was like, ‘What is this all about?’

So I looked it up and a lot of people are sensitive to cherries. And I could feel my heart pounding. And so I am really aware, and I am going to retest cherries.

[Damien Blenkinsopp]: You are probably becoming a lot more aware about yourself and notice a lot more things because what I have found when you are using these kinds of apps it kind of validates tiny little – like if you feel a little bit off, it starts to validates you and you start to get more confidence in trusting yourself and starting to notice more because of that. So it is probably not something you are telling everyone, but using these HRV apps for this kind of apps for this kind of thing can help build your awareness of yourself over time as well.

[Ronda Collier]: That reminds me, sort of back to what people have done to improve their HRV. [inaudible 00:49:14] cofounder, walking in the park, in green – she learned a few things because her HRV was on the low side when we started Sweetwater and now even through a whole bunch of life events, a mother passing away and so her HRV has continued to increase through the years because she learned the things that increase it so she does them every day, versus doing them haphazardly.

[Damien Blenkinsopp]: Let’s get back onto the – what other kinds of things have we missed? We talked about yoga and meditation.

[Ronda Collier]: That is another one, we have done some research on – another one is acupuncture so we have done lots of case studies and actually there is peer-reviewed research on acupuncture. We have done some ourselves and your nervous system just balances and power levels increase during and after an acupuncture session, so that was another interesting one.

[Damien Blenkinsopp]: That is quite a controversial area. I know there is a lot of functional doctors who really support it and there is also a fair amount of research there. But when you bring up acupuncture a lot of people find it controversial still.

[Ronda Collier]: Well that is changing, and insurance reimburses acupuncture for people with arthritis. So Western medicine does acknowledge and that is why there are a lot of peer-reviewed papers surrounding acupuncture. They know and they can measure that the pain receptors have changed, specifically around the points for arthritis treatment.

[Damien Blenkinsopp]: Well here is the thing – I think acupuncture is a bit of an art, so some people might be better at it than others? Is that the way that it works? Could you evaluate the quality of the acupuncture you are getting based on the impact on HRV?

[Ronda Collier]: Yeah, absolutely. I have a good acupuncturist so I have seen my nervous system change about 20 to 30 minutes after the needles go in, which is about what you should expect. Another is chiropractic – we hold our stress in our bodies and there are, once again, peer-reviewed papers on chiropractic and HRV.

You can see whether the adjustment made a difference to you or not, so it is sort of an objective measure in general to some of these treatment venues that some people are not sure of, like acupuncture and chiropractic. You can actually measure whether it made a difference.

[Damien Blenkinsopp]: Yeah, so it is useful, especially if you are doing something new that you are not sure about, whether it is yoga or whatever you are trying that is new. I guess it also help your motivation, so if you can see the numbers changing it is this low thing, but if you can see that positive feedback you are like, ‘Oh, this is making a difference.’ Whereas sometimes – that can give you more motivation just to keep at it because you can see things changing.

So I know we have gone on quite a long time here and I wanted to make sure we cover a couple of other things, which is your new app and the correlation in particular, which has been added. Is there anything else new that has been added or is that the main thing?

[Ronda Collier]: Better graphing features and like I said, some of the real-time graphs. The Vital Connect patch so you can see real-time calories burned, once again accurate. I have a Fitbit so don’t get me wrong, but it is not accurate. Neither are the machines at the gym, by the way, but this gives a real accurate calorie burn.

It also gives – let’s see, respiration, body temperature, and calorie burn. It does measure number of steps and all that, as well as all of our HRV values.

What is new in Sweetbeat Life besides the Vital Connect patch, which has all that new information for you in real time – we have a correlation feature that allows you to basically correlate your HRV and stress levels to all the other parameters in the Vital Connect patch as well as correlate to your Fitbit, the number of steps you are taking, your calories burned, your calories eaten, and we also connect to Withings, so we have the withings scale and so your weight is in there as well as the Withings blood pressure.

One can learn what am I doing when my HRV is good? How many steps, how many calories? Or what am I doing when my weight is where I want or not want? I personally learned that it is not calories in versus calories out for me that helped me get to my desired weight – and we are talking three pounds here and it is important. It is the calorie out. I need to eat more and burn more and then I actually can lose weight easier. So that was important for me.

[Damien Blenkinsopp]: Right, so you are saying you saw a correlation with intake and activity levels?

[Ronda Collier]: That’s right, burning 1500 and eating 1200 I didn’t lose weight. But eating 1700 and eating 1400, I did. And so that was really important for me. And a lot of people will be concerned about what they are doing to maintain the proper blood pressure or stress levels and so on, so it is really a great tool to bring meaning to all this data.

[Damien Blenkinsopp]: And when did you launch this? I think it is the early stages in the understanding of the use cases.

[Ronda Collier]: Yeah, we launched in May. And if anyone does decide to try out Sweetbeat life, we have great videos embedded in all the screens now. For the correlation function we have put a lot of information on a very simple screen, so it is very important to watch the video and pay attention. Because once you know what you are looking at then you hit the buttons and there are all these buttons to see all this great information and you know what you are looking at.

But when you first go looking at it, you are not going to understand it, so please do take the time to look at the video. That is just the nature of trying to convey a lot of information on a small screen.

[Damien Blenkinsopp]: Yeah, and so what are your plans for that? Right now the correlations are between data of the Fitbit data and the Withings scale. What are the main areas people are correlating?

[Ronda Collier]: And the map my fitness, to measure how many mets your workouts are as well – just adding more, first we are going to stay where we are right now and get customer feedback on this. Once again, it is a lot of information crammed into one tiny screen, so we want to get that right first and find out what is useful to the customers and then do an iteration there and then just start adding more of the popular tracking devices.

[Damien Blenkinsopp]: Yeah and it sounds like you are going to learn as you go because you don’t know what is going to correlate either. And eventually patterns are going to pop out so it is going to be more interesting to integrate with some devices versus others.

[Ronda Collier]: That’s right, and one of our favorite scenarios is with the athletes that have been training using Sweetbeat and measuring all these things with let’s say blood pressure, weight, you name it, for a year and then they have Iron Man coming up. What we want to do is provide them with meaningful information of what they were doing that consistently got them into the most rested and ready state.

[Damien Blenkinsopp]: Yeah, like you were saying if they have six months of data or whatever that would be pretty amazing.

[Ronda Collier]: Yeah, and then they can go back and create this is what I was doing that consistently gets me to where I want to be the morning of the race, and so this is what I am going to do.

[Damien Blenkinsopp]: Whose idea is this? I don’t think anyone else is doing this yet. Obviously this is where people have been talking that things should go in terms of correlation.

[Ronda Collier]: This was our idea and oddly enough this came from an app challenge that we were going to do with Qualcomm Life. And Qualcomm Life collects data from so many different devices and so we were just going how can we show the value of the Qualcomm Life platform? And so that is what really led us to do this at the timing that we did it. So we are very grateful to Qualcomm LIfe for having that app challenge when they did because it really pushed us to get this together. So we really are the first people creating useful information besides just a dashboard with charts for all this data that everyone is collecting.

[Damien Blenkinsopp]: Yeah, and it will be interesting to see what kind of experiments they try to run and what correlations they can come up with. So how many users do you have using the Sweetbeat versus the new one? It has been out since May?

[Ronda Collier]: The new one has only been out since May so we have under 1,000 on Sweetbeat Life and tens of thousands on Sweetbeat.

[Damien Blenkinsopp]: I know you have got all this data – have you got any plans to try and sort through any of that? What are the most exciting things coming up next that you have ideas about? Or do you have ideas that you hope to do in the next two years?

[Ronda Collier]: I would have to kill you if I told you.

[Damien Blenkinsopp]: I thought it might be something like that.

[Ronda Collier]: We have a lot – that’s all of our secret road map. But we are doing some really cool stuff coming up and we are so excited, that is all I can say. And the health patch has really enabled this because it opens up a whole new market of people that frankly are not going to wear a chest app. They are just not going to put it on, so the patch really makes it more accessible. That allows us to create products for an audience beyond the Quantified Self hacker that will stick to the strap on or the athletes that already have straps.

[Damien Blenkinsopp]: How much does the patch cost?

[Ronda Collier]: So the starter kit is $199 and that comes with five patches and the electronic module.

[Damien Blenkinsopp]: So it is like $40 a patch, and they last – you said you used yours for -?

[Ronda Collier]: Well the replacement patches are $20, so a month or more depending on what you are doing with it .The price point is high because it is a brand new product, but that is going to be coming down as the volume ramps up, obviously.

[Damien Blenkinsopp]: It is brand new and I saw it.

[Ronda Collier]: It is brand spanking new. The only place you can get the health patch right now is through Sweetbeat, and we are the first app out with it. Consumers can expect that number to coming down in the years to come, like I said, as the volumes ramp.

[Damien Blenkinsopp]: Great, thank you very much. Just a couple of questions more about you and the way you use data in your life. What would be your number one recommendation to someone trying to use some form of data to make better decisions about their body’s health performance? What would be your number one recommendation?

[Ronda Collier]: Actually I think our correlation feature is our number one recommendation for me because it is giving you really useful information. HRV, for your listeners, should be measured along with your blood pressure, your weight, and your cholesterol because HRV perturbations are early indications to something that hasn’t shown up physically yet.

So if you are monitoring your HRV as you go through your life and you suddenly saw a drop, a consistent drop, then there is a problem. And then with the correlation feature you may be able to go back and see other aspects start to change with the lowering HRV. You can’t take one thing in isolation.

[Damien Blenkinsopp]: So you are using it as a discovery problem that you can’t see, because most health problems in our life take us by surprise.

[Ronda Collier]: Yeah, so I have the Withings scale and the blood pressure cuff and a Fitbit and I use iFitness.

[Damien Blenkinsopp]: So it is like risk management?

[Ronda Collier]: That is right, that is right, and learning what I can do. Sometimes, especially with weight loss, people are like, ‘I don’t know – I count calories and I do this and I do that. Why am I not losing weight?’ Then suddenly they will lose a couple of pounds and this will give some really useful feedback. I also want to mention on that vein that getting accurate calorie burn during the day – if you are really on a serious need and you need to lose 40 or 50 pounds, that is a long haul.

And 200 calories a day is a big deal when you are tracking, so getting an accurate calorie burn throughout the day is important. So really being more accurate, and Sweetwater health is really about more accurate feedback for the consumers and athletes.

[Damien Blenkinsopp]: Yeah, because there are a lot of apps out there and they are definitely not the same. I got the Mybasis watch and I think you know that compares unfavorably to some of the other trackers.

[Ronda Collier]: Yeah, we bought a Basis to check it out. And you have to wear it too tight on your wrist that it is not comfortable if you want heart rate. And it just doesn’t match my outfit.

[Damien Blenkinsopp]: Right, and just talking about the My Basis quickly, the reason you can’t do heart rate variability is that they are just not sampling quickly enough? Have you looked into it?

[Ronda Collier]: Any wrist face device, like [inaudible 01:00:52] use pulse oximetry, so what they are looking at are the capillaries in your skin as they expand and contract, so it is just very difficult to get very accurate beat times.

[Damien Blenkinsopp]: Right, so they are using averages to get the heart rate and they need way more accuracy to get to heart rate variability, which is more difficult than a heart rate. On My Basis if you start running around it starts losing track because your heart rate is moving, so it can’t even keep track of your heart rate.

[Ronda Collier]: Because it is motion and the pulse oximeters are very motion-sensitive because they are basically measuring capillaries and if you move your skin the capillaries are moving. And so Mio, just for those athletes, the Mio Alpha has done a terrific job of eliminating motion artifacts. You can actually use that one while you are running and still get an accurate heart rate.

[Damien Blenkinsopp]: A heart rate, but not heart rate variability.

[Ronda Collier]: No, and they want to do heart rate variability but they are also engineers and so they just know that they can’t.

[Damien Blenkinsopp]: They are struggling but potentially one day that technology might –

[Ronda Collier]: Potentially one day, yeah. If you can get the processing power without draining the battery in a watch it can be done.

[Damien Blenkinsopp]: You have probably told us some of this already. What data metrics do you track for your own body on a routine basis, like the things that you would keep in mind every month or every six months? What are the key five things that you think are most important for yourself?

[Ronda Collier]: I keep track of my HRV and I am aware of my blood pressure. I am also aware of my resting heart rate and I don’t know why, but I want to know. Mine actually drops low sometimes so I am worried on that end, it gets around 40 and I sort of want to keep an eye on that. I weigh myself, and weighing yourself every day is stupid, sorry. I weigh myself probably once every month or two and keep track of that.

You don’t want to – because pounds creep up and suddenly you are ten pounds overweight. And I track my steps because I work at home and you want to make sure you are moving your body. I exercise every day but man, if i don’t go out to the gym or go hike or do something like that –

[Damien Blenkinsopp]: Thank you very much for that. it is always interesting to hear what different people are focused on, especially when you are so involved in tracking yourself, so it is always interesting to hear what you focus on. Ronda, this has been an exceptional interview with tons of detailed information about how your app works and how you can use it. Thank you very much for your time today.

Leave a Reply

Today’s episode takes a look at Methylation, it’s role and importance for many body functions, how it can enhance our quality of life and performance when running properly, or expose us to greater health risks like heart disease or cancer when it doesn’t.

Addressing methylation SNPs (genetic mutations that we all have some of to varying degrees) and related biochemical imbalances personally made a very big impact to the quality of my life, eliminating issues like migraine headaches, improving sleep, and enhancing my quality of life and productivity by smoothing out “mood dips and bumps”, and helping heal my body from chronic disease.

If you’ve listened to our other episodes you’ll have noticed that many of the guests have referred to methylation in some way. Because it affects so many people in so many ways, this is a topic that while not mainstream yet, is going to become increasingly so over over the next years. It has only just started.

Enter today’s guest, Dr. Ben Lynch. He is one of the people who has led the way in researching and helping both physicians and consumers understand methylation and how it is affecting them.

Dr Lynch is well known for his work and insights into treating methylation defects which has been his focus since 2011. He has done some incredibly detailed work in mapping out the various methylation pathways, how environmental and lifestyle factors affect them and how they can be supported. And as a result he is a highlight appearance at the conferences on topics related to methylation – which are growing in number and breadth.

His background is in environmental medicine and biochemistry and he has a doctorate in naturopathic medicine. He has worked with 100s of people with methylation defects, notably have started with the MTHFR gene (also “known as MotherFucker” gene because of the risk defects represent for cardiovascular health).

Besides insights into methylation, Ben makes some excellent points on how and when biomarker data is useful, what the most impactful actions are that we can take and optimizing methylation. I thoroughly enjoyed it and I hope you do too.

The show notes, biomarkers, lab test and links to everything else mentioned are below. Enjoy the show and let me know what you think in the comments)!

itunes quantified body

Show Notes

  • Methylation’s role in the body as a balancer of all the body’s functions.
  • How it drives detoxification via its production of SAMe (S-Adenosyl-Methionine) with links to Homocysteine and Glutathione.
  • The role of methylation as a deactivator of genes in the body and how under-methylation can cause a cascade of gene regulation problems turning genes on that typically aren’t.
  • Food, water and stress as the primary factors influencing the quality of our methylation.
  • Creatine – making up 70% of SAMe’s use, thus methylation, and its importance in athletic performance.
  • How epigenetics trump genetics with examples of the Agouti mice and the queen bee with completely different health, function and role outcomes.
  • The issues with therapies of supplements or foods targeting specific genetic SNPs and why they are unlikely to work.
  • Typical methylation related health issues like insomnia, anxiety, chemical sensitivity, digestive issues and fatigue.
  • Methylation’s role in mitochondria health and output via its production of Adenosine for the mitochondria’s use.
  • Measuring homocysteine, a recently popular metric for cardiovascular disease, and how it isn’t as straightforward as having high levels and supplementing to reduce them.
  • The range of labs and biomarkers related to methylation and what can be effecting methylation that Ben likes to look at.
  • Ben’s use of biomarkers and his strategy for making sure that values across tests are relevant and prevent a useful picture to identify issues or make clear assessments.
  • How eating sufficient protein can influence your dopamine and serotonin balance.
  • A look at the future of methylation and other areas: How Ben would like to see IT and applications get developed to predicts methylation biochemistry in connection with genetics and other biomarkers he’s looking forward to using and other important areas of development.
  • Ben’s current work looking into how supplements don’t work with certain cases to avoid creating the negative symptoms they sometimes drive with, in particular, people who are sicker.
  • The biomarkers and things Ben keeps track of for monitoring his own personal health and fitness.

Give some love to Ben on Twitter to thank him for the advice in this interview.
Click Here to let him know you enjoyed the show!

Dr. Ben Lynch

  • Connecting with Dr. Ben Lynch: You can connect with Dr. Ben in several places including his DrBenLynch.com (personal site), MTHFR.net (information on methylation and MTHFR specifically) and Seeking Health (his supplement company).

    You can also connect with Ben on both twitter @DrBenLynch and facebook Dr Benjamin Lynch.

  • MTHFR Basics: This book by Dr. Lynch provides an introduction into MTHFR.
  • Methylation Pathways Planner: You can download Dr. Ben Lynch’s map of the Folate and Methionine cycle and an 80 minute video training on folate metabolism.

Biomarkers in this Episode

  • MTHFR SNPs: Absolutely recommends getting tested for this via 23andme or other service, especially if you are planning pregnancy.
  • Red Blood Cell (RBC) Magnesium: The RBC Magnesium test is more often used for identifying magnesium deficiency as it provides a better evaluation than the serum magnesium, which can be high despite body magnesium deficiencies (very common in the population).
  • Serum Ferritin: The standard measure for iron in the body, most people’s levels, in particular men’s are too high. Ben discussed his wife’s inability to raise her serum ferritin because of pathogens in her gut sequestering it.
  • Iron Panel: Besides serum ferritin, other iron markers can offer insights into the functioning of iron metabolism. Iron panels often include serum iron, serum ferritin, TIBC (Total Iron Binding Capacity), Transferrin Saturation and UIBC. Chris Kresser has a good presentation covering the use of these iron biomarkers here.
  • Homocysteine: Ben discussed how it can be a useful value if it’s high, but if it’s low it’s not necessarily predictive of health risk factors. He also noted how it varies between children and younger adults versus older adults.
  • S-Adenyl-Homocysteine (SAH): The precursor to homocysteine. Ben sees it as a more useful test than homocysteine for diagnostic of methylation issues.
  • Biomarkers of mitochondrial function

    Ben mentioned several markers you can use as proxies for mitochondrial health and damage.

  • Lactate: Lactate elevation is an indicator of mitochondrial damage. Blood lactate is more accurate, but urinary lactate is more available via labs.
  • Lipid peroxidation: Ben referred to these markers generally. We looked at each of the specific lipid peroxidation markers in episode 4 on measuring oxidative stress.
  • Plasma Ammonia: Blood plasma levels of ammonia that are elevated can be an indicator of mitochondrial damage.

Lab Tests and Apps from this Episode

  • 23andMe Genetic Testing: The largest genetic testing service for consumers. You can download or connect your data from 23andme to better understand it with targeted applications looking at specific sets of genes. While health analysis data is no longer provided in 23andMe itself, you can simply download the data and use it with other gene analytics services.
  • MTHFR Support Variant Report generation system: This online application allows you to upload your 23andme data to it to get additional information about a wide variety of areas of your body including eye health, detox, tongue tie/cleft palate, methylation, allergy/mold, IgE, IgA, IgG, clotting disorders, thyroid, celiacs/gluten intolerance, mitochondrial function and sulfonotransferase genes.
  • Genetic Genie: Similar as above, an online application that allows you to upload, or connect, your 23andme data to it to get analysis of your detoxification and methylation SNPs (Single-Nucleotide Polymorphisms).
  • Doctor’s Data Adenosine Profile: Dr. Ben noted that he has been talking about getting Doctor’s Data to provide an Adenosine profile (not yet available).
  • Doctor’s Data’s Methylation Profile Plasma: A limited methylation profile that just covers the methionine cycle. Ben noted the usefulness of the SAM, SAH and SAM/SAH ratio in particular.
  • Health Diagnostics Research Institute – Methylation Pathways Panel: The most complete profile of methylation biochemistry currently available on the market – mostly used by Dr. Ben, notes that time lag of delivery of results is a bit slow.
  • ION (Individual Optimal Nutrition) Panel @ Genova Diagnostics: Ben uses this as a good place to start when looking for issues and things to optimize.
  • CDSA (Comprehensive Digestive Stool Analysis) or CSA (Comprehensive Stool Analysis): CDSAs / CSAs aim to cover a range of markers via a stool sample related to types of bacteria, to parasitology to digestive markers. Several labs run these tests with differing sets of analysis. Ben mentioned CDSA @ Genova Diagnostics, CSA @ Doctor’s Data and biohealth (this latter he found to be insensitive, not finding what he had found in other tests).
  • Mitochondrial Functional Profile: Acumen Labs’ mitochondria profile was mentioned by both Ben and Damien. The profile is used in research and clinically by Dr. Sarah Myhill.
  • Spectracell’s Micronutrient Test: Ben gave this test as an example of intracellular assessment of nutrients level, being better than traditional blood, serum or plasma levels. The spectracell looks at the nutrient levels in lymphocytes, a type of white blood cell.

Supplements

  • TMG (TriMethylGlycine): A supplement used in connection with methylation supports, and in particular can help lower high levels of homocysteine.
  • B-Complex: Another methylation support in the form of a B-complex combining B12, B6 and methylfolate. The Thorne version contains the active forms.
  • Creatine Monohydrate: As one of the most expensive molecules biochemically to exit from methylation, it can be helpful to support with creatine.

Other People, Resources and Books

Who should I interview next? Please let me know by clicking here

Full Interview Transcript

Transcript - Click Here to Read

[Damien Blenkinsopp]: Dr. Lynch, thank you very much for being on the show.

[Dr. Ben Lynch]: Yeah, thank you Damien.

[Damien Blenkinsopp]: First of all, I want to jump in to look at the area of methylation and how it relates to our health, performance, and longevity. What are the links with these objectives we have today?

[Dr. Ben Lynch]: With methylation?

[Damien Blenkinsopp]: Yeah, how does methylation impact our health, our performance, our longevity, our whole being, essentially.

[Dr. Ben Lynch]: Well it is central. It is absolutely central. So the mitochondria are the engines of the car and it seems that methylation seems to balance how everything works. So methylation is needed to create certain things in the body. So it creates SAMe, and a lot of us know what SAMe is.

SAMe is a primary methyl-donor which goes around the body and helps makes our neurotransmitters. It gets rid of them and it helps make a compound called phosphocholine for our cell membranes. Then we have quite a bit of methylation around. The body will say okay, we have got too much, and it will speed up one enzyme to help make glutathione and it will make creatine so our kidneys and our muscles will be happy.

So you can see a lot of issues with low creatine in people. It balances our immune system, it helps make immune cells, it supports creatine and CoQ10 formation, which are pretty important. It is very central. It helps regulate genes, turning them on and off. In fact, most of our genes are turned off and if we have low methylation then some of these genes will turn on and they will stay on and then we know what happens from that. The cancer can ensue. So those are some of them and there are probably some other major ones that I am not remember offhand.

[Damien Blenkinsopp]: Yeah, that is great. So does it play a role in detoxification?

[Dr. Ben Lynch]: Yes it does because methylation is a very small role if you look in the toxicology textbook. And when I read that I was kind of disheartened and sad. But at the same time when there is a lot of SAMe around, then SAMe will help promote the enzyme which takes homocysteine and moves it into glutathione. So homocysteine, which some people call ‘the evil marker’ on labs, if it is too low that is a problem and if it is too high that is a problem.

So we need to make sure there is adequate homocysteine because homocysteine will actually move into glutathione production. That in itself is a pretty direct connection between a major thing for a xenobiotic detoxification and glutathione is the mothership for that.

[Damien Blenkinsopp]: So to let the people at home visualize what methylation is, would you call it – is it like a biochemical process where the enzymes are many biochemical processes taking place through a whole line of enzymes which are required for the body? How would you explain it in a simple way or how would you tend to explain that?

[Dr. Ben Lynch]: I would say that methylation is a process by which there is a carbon with three hydrogens, which as a methyl group will bind and dock to certain thing. And it will bind to neurotransmitters. It will bind to chemicals, it will bind to DNA, but it seems the biggest methyl donor of the body is again [inaudible – 00:06:05]-methionine. And so what that SAMe does – methylation is a long, complicated process and there are multiple methyl donors.

Choline is one, SAMe is another one, methylfolate, glycine, and all of these are methyl donors because the body creates redundancy. Basically these methyl groups, as you said, will support various enzymes in the body and then these enzymes are proteins which do work. If these enzymes are malfunctioning due to various toxins in the environment or nutrient deficiencies, then these enzymes won’t be able to do work. And if you back up even one step further, where do enzymes come from?

Enzymes come from genes so if these genes are not functioning very well then they will not be able to make their end product. And so everybody knows about the MTHFR gene defect, making methylfolate needs that MTHFR enzyme, and that MTHFR gene to work so it can go in and do its job.

In summary, I would say that methylation is the process by which genes will produce an end-product which will then have a certain of functions and sometimes a singular function. And there are hundreds and hundreds and possibly even thousands of functions that are going on in our body that are due to methylation and I know that there are hundreds. There could be more than that. You need to also understand too that it is much bigger than that because think of a pyramidal shape – at the top of the pyramid you might have MTHFR and it is just one gene, but the downstream effect of that one gene will form a base of that pyramid. So the impact of that one gene not working is really broad.

[Damien Blenkinsopp]: Yeah, that can cascade down pretty quickly.

[Dr. Ben Lynch]: That’s right.

[Damien Blenkinsopp]: So what are the biggest methylation challenges that you see? Or the most common ones?

[Dr. Ben Lynch]: Stress, food, intake, and water I would say are the biggest ones. And I say that because if you work as a physician, you work with patients. And if you can modify their diet and their lifestyle alone then their methylation will balance very, very well. Of course, there are other things too like toxins in the environment, lead, and yeast overgrowth producing acetaldehyde and alcohol intake, those are other big ones. But I would say food, water and stress.

Stress is a big one because glucocorticoids, cortisol stimulate methylation. So you are saying well, that is good. It is good, but if you have ongoing stress you are pushing methylation all the time, which then means you need to be able to produce more methyl donors. And if you are eating McDonald’s or you are eating inappropriately and you are not eating your leafy greens or your grass-fed meats then your methylation is going to suffer.

So if you are under chronic stress and you are eating carbs to make you happy, you are not getting the proteins and the leafy greens and you are going to be in big trouble. Then it also goes back to our water levels here in the America that are pretty high in arsenic. And then so is our chicken because they use antibiotics laced with arsenic. And when they feed those chickens before they are butchered these chickens get bioaccumulation of arsenic throughout their life and then we eat that chicken. And then we eat another chicken and another chicken.

So our bioaccumulation of arsenic goes up. And then you have got arsenic in rice, which is a big issue. And then greens as well. So our bioaccumulation of arsenic is a really big deal in the United States and I think it is commonly missed. And arsenic is a real tough one to eliminate because it requires both glutathione and SAMe in order to get it out of the body. So our primary methyl donor and our primary antioxidant or detoxification compound need to be in their prime in order to get arsenic out of the body. And if you just have one or the other then arsenic transforms into a more brutal marker because our body will transform it into something more toxic.

So just the basic lifestyle being calm I think is really important. And another thing too I want to add to that really quickly about stress is not only does cortisol increase our methylation cycles but what neurotransmitters increase from being stressed? We have got norepi and epi. So these things also require methylation to get rid of. So if the norepinephrine increases then we need SAMe to convert norepinephrine to epinephrine, so again that is very catabolic.

And stress in itself is also very depleting of things like magnesium. And then also our adrenals might get shot and we might not be able to function very well and aldosterone levels might drop, so now we are peeing out sodium and other minerals that we actually need. So it is a big deal. So stress is a big one.

[Damien Blenkinsopp]: Right, so when you are talking about stress that is both emotion and physical. So it could be things you are doing like training?

[Dr. Ben Lynch]: Yes, excellent point – training and overtraining is a huge problem. I was a collegiate athlete at University of Washington. I did crew there and I wish I wish I knew about this. I would have been a way better athlete. But anyhow, creatine is a major user of SAMe and the more muscle mass that you have the more it takes for your body to make that creatine because your muscles will use up creatine.

So if you’re methylation is deficient and you are a bodybuilder then I know a lot of bodybuilders that supplement with creatine, which is great, but some of it is garbage. There are definitely inferior forms of creatine out there. But if you are eating grass fed meats and you are eating your veggies and not overtraining then creatine by itself is very important. They say that creatine and phosphocholine consume the majority of your SAMe in the body. I think creatine is about 70% of SAMe’s use.

[Damien Blenkinsopp]: Great. In terms of genetic defects we hear about the MTHFR and other snips – how big of a role are they and how important is this in the population compared to the other factors you have spoken about?

[Dr. Ben Lynch]: Well I would say that genetic factors are important but not nearly as important as the lifestyle and diet. So the epigenetics are what control the genetics. the epigenetics are the things that are around the outside of the actual gene itself – just our environment and our perception of the environment as Bruce Lipton so beautifully explains in his videos or in his book, the biology of belief. The epigenetics are so far more important than the genetics themselves. Do you ever watch that video, A Tale Of Two Mice, from NOVA?

[Damien Blenkinsopp]: I haven’t seen that.

[Dr. Ben Lynch]: Yeah, so you’re listeners need to see that. If you Google ‘NOVA A Tale Of Two Mice,’ you will see a perfect example of what I am talking about because these mice – I won’t get into too much detail. There are these mice and they are genetical. They are called agouti mice and they are genetically predisposed to cancer, cardiovascular disease, and diabetes. They are genetically predispositioned for this.

This means they will go through live and get it if their lifestyle and diet are going to be a mess. And so what they did is this mouse had little baby pups, mice pups. The pups were divided equally and they were genetically identical because they came from the same mom. They were absolutely genetically identical. They were divided in half and one group of these mice got methyl donors with their chow and the other group just got their standard chow.

Now they also had some BPA in there and that was another experiment because BPA messes up your methylation. But anyhow, the baby rats who were fed the methyl donors and the rat chow did not go on in life and get diabetes, cardiovascular risk, or cancer and their fur was a lot healthier. The other rats went on and they got basically everything under the sun. So that is a perfect example of epigenetics.

And another one that I like to talk about too is the queen bee. So the queen bee is genetically identical to the other worker bees but the epigenetics of them are totally different because the queen bee was nurtured and she was fed the royal jelly and all that. So that is another living example of how epigenetics is more important than genetics.

[Damien Blenkinsopp]: Great, thanks for making that point. I remember the rat and mouse from your Chicago presentation, actually. So is it worth us getting genetics tested for to identify snips in MTHFR and other area or do you think it is more worthwhile working on lifestyle first and then maybe later if we still have some problems looking at the testing?

The other question I have is doesn’t everyone have snips in some of the methylation process? We were just talking about how it has got hundreds of working parts to it. So isn’t everyone who has got some snips in part of the chain that is taking place in our body – we are pretty much all going around a bit and some of us are healthy and some of us are not so healthy. So like you said, is it more about the epigenetics side of it?

[Dr. Ben Lynch]: Well it definitely is but you have to take every situation in context for that specific individual. So while genetic testing is useful, and that is how evolution occurs – we evolve through mutations and these mutations can be hopefully selected and be an improvement for something in the future. So not all mutations are bad.

They have their various functions and even MTHFR has its benefits. But I would say if the person is going along and they are doing well, not going to doctors and not on various medications, they are just humming along and they are young and pretty confident in their health and how they are feeling and there is not much family risk, they look at their family and their family has a long life of good health and history, then I say it is not that big of an issue.

Now if you are born from a family that dies early, your parents are dying in their 50s or 60s, then you might want to be taking a moment, even if you are healthy because a lot of athletes, as you know, might look and appear healthy but the next thing they know they are in a wheelchair or they are dead. And they say this guy had super high risk for cardiovascular disease. Or he had the [inaudible – 00:00:16] genes and he had Alzheimer’s risk and his cholesterol was not normal but if you look at the cholesterol subfractions he was a mess. So sometimes you can just test for those things or you can look at the genetics, or you can do both.

Now, I am all about disease prevention and optimizing lifestyles, especially in unborn children. So if someone is looking to get pregnant then I absolutely recommend genetic testing through 23andMe and then running it through MTHFRsupport.com, with which I have no affiliation. Or these other things like genetic genie. The reason I say this is because there are specific genes which do mess up your methylation and it is good to know which ones they are. And then with proper education you can bypass these things. Also, if you look through history and see your family line was anxious, they had bipolar, they had breast cancer or various cancers, then again I think it is important to do genetic testing just so you can see which genes are the issue. And if you know which ones are the issue that you can focus more on that.

So it has its places in both sides where you can and you can’t. But it also depends on where you are mentally. If you think the genetic testing is going to scare you more than benefit you then I wouldn’t do it right away. I would maybe start with MTHFR and work on that or work on all the diet and lifestyle things so you can be less stressed out and then order the genetic testing under some false name if insurance kind of concerns you in the future.

[Damien Blenkinsopp]: I would like to talk about what is going to have an impact – so with some tests you can get a test but you can’t really take much action after that. So there is not that much benefit. It is nice to hear you talking about getting your lifestyle fixed first. That is probably going to have a big impact and if you want to refine things, maybe some testing will help you get a bit further. Is that the way you look at it?

[Dr. Ben Lynch]: Yeah, and I always tell doctors this because they come to conferences and they hear this term, methylation, and they see all these complicated pathways. And I say, ‘Look, you guys are already doing this.’ Diet and lifestyle are absolutely number one – food, water, sleep, loved ones around you, and getting some form of exercise. And breathing fresh air and all these things are so, so important and the basis of not having a toxic environment around you too.

So all those things sound very simple but in our current modern lifestyle we are not conducive to any of it. They are plugged into their phones all the time and so on. So the basic lifestyle is so, so important. And I cannot tell you how many patients I have worked with that have these genetic defects and that have gotten better with just the absolute basics. If you focus on the snips and you treat the snips, the genetic mutations or polymorphisms as a more appropriate term.

If you focus on these genetic variations and you give meds or supplements or even foods that target these specific genetic variations and you miss the big picture, you are going to be chasing your tail and you are not going to be going anywhere. So you have got to do all the basic groundwork first and I cannot stand when I see these genetic tests come back and there are long recommendations of a whole bunch of nutrients to take.

That just outright pisses me off to be honest and it is very self-centered and very incorrect because these patients will never get better because they are taking supplements or meds or certain lifestyle things that are targeted to their genes, and that isn’t right. You have got to do big picture.

[Damien Blenkinsopp]: That is great. Thank you for that clarification. I think one of the things is that we don’t hear about methylation that much and it is still kind of a new topic. So what kind of chronic health issues or symptoms do you think methylation can be related to that people don’t typically think of?

[Dr. Ben Lynch]: Anxiety, insomnia would be another one, fatigue, depression, addictive disorders, generalized fatigue, skin issues, digestive issues in terms of if you have ulcerative colitis or Crohn’s and obviously there is big picture there too, but methylation is a major component of that as well. Chemical sensitivity.

[Damien Blenkinsopp]: You have quite a long list. I guess the point is that it is kind of there and it is this big important part that you have been talking about but there is not a lot of information about it there and it links with that yet.

[Dr. Ben Lynch]: I think the best way to summarize that question and keep it as simple as possible is methylation has its fingers in every symptom out there. That is really it in a nutshell. It might not be a direct effect but it is definitely an indirect effect. So I would say whatever symptom is out there, methylation is playing a role somehow. So while it might not be the primary treatment thing to go after it is definitely something that needs to be looked at in every patient, no matter the symptoms or the condition.

It needs to be optimized all the time and it is constantly shifting. Methylation reactions are occurring in every single cell of your body every single millisecond. It changes based upon how you are feeling, if you are stressed out, if you are overtraining. If you are overtraining and running say, a marathon, and you are burning through all this ATP and your muscles are using a bunch of creatine and you are not re-supplementing yourself, then you might be depressed and fatigued after. And you are like, ‘Why the hell am I depressed? I just ran a marathon and I won the damn thing, but I’m so depressed.’ So it is connected to everything.

[Damien Blenkinsopp]: How do you think methylation relates to mitochondria and oxidative stress in the body? I am aware of problems with mitochondria and oxidative stress causing chronic disease as well now. So how does methylation relate to those two things?

[Dr. Ben Lynch]: From my understanding right now it is an indirect thing. And I am trying to put the pieces together more succinctly so I can explain it better. When you methylate there are leftover things and when your SAMe does its job of making creatine, then after it makes the creatine it makes adenosylhomocysteine and that homocysteine then will convert into adenosine. And we know what ATP is, adenosine triphosphate.

So methylation does form adenosine through its end reactions and it helps make this adenosine and while it is not the primary formation of ATP it is a big player because if your adenosine levels get built up for various reasons due to deficiencies in B6 or Kreb cycle intermediates – or end-products there like NADH, your adenosine if it gets too high will shift your metabolism. And we have shifts in metabolism in order to protect us. So if we are running we are primarily, in the first few minutes, we are probably mostly going through aerobic energy.

There are pyruvates going to acetyl-COA and it is making our NADH. But after a while our muscles are going to be running out of those primary – it is going to be running out of acetyl-COA and there is going to be adenosine building up. And then as that adenosine builds up it will be shifting pyruvate into lactate. And that is good, we need that anaerobic shift because our body can only fuel so much glycogen in the muscles and then that shift in metabolism occurs so we can run off of lactate.

The problem is that some of these people are running off lactate all the time. And if their adenosine levels are high because their methylation cycle is inhibited that is a serious problem. If your adenosine levels are high that is going to lead into metabolic disorders, diabetes, high cholesterol, fatty livers, and the end result of this is going to be cancer and death. So a long-term metabolic shift that is due to elevated adenosine, which comes from methylation, is a serious issue. And it is not looked at and getting tests and doctors to even know what adenosine is is a big problem.

There are very few labs that look at pyruvate levels or adenosine levels. They do look at lactate, and lactate is a very important marker to look at, but if you have fatty liver or your GGT or ALT or AST levels in your liver enzymes are elevated then your adenosine is up and you have got to fix that, now. And I think that adenosine is a huge marker. And I have been working with doctor data for the last few months. As you saw at Chicago I was beating them up during that conference. And they are coming out with adenosine on their methylation profile at some point here so I am very excited for that.

[Damien Blenkinsopp]: Great, and obviously I want to talk about some of the testing and the metrics and so on. Where would you start? If you have a patient would it be like a 23andMe genetics test or would it be something more like a methylation profile from the doctor data that you were just talking about?

[Dr. Ben Lynch]: Well when you say where would I start, do you mean where would I start initially?

[Damien Blenkinsopp]: Let’s say we have been working on lifestyle and these things are fixed but we still have some problems where some things are not optimum. Are there certain tests you tend to go to first because you find them the most useful? Biomarkers that you are looking for because they help elucidate the situation more quickly or tell you a lot more? They are a lot more actionable.

[Dr. Ben Lynch]: 23andMe I will get if I am struggling. So I will order 23andMe and it takes about a month or month-and-a-half to get. Once we get that done I will send them to Genetic Genie or MTHFR Support. And I like MTHFR Support report better because there are some genes that I told them to get that are on the report now, like GAMT for creatine for example, or phosphocholine production or vitamin A production.

[Damien Blenkinsopp]: So just for the guys at home, they have to download their data from 23andMe in a file and then upload it into these other sites, right?

[Dr. Ben Lynch]: That’s right, and if you go to those websites they will walk you through it. There are diagrams and maybe even a small video of how to do that. I know there is on MTHFR Support, the basic instructions, and it is very easy. But yes, you are right. Money is an issue and unfortunately it is for a lot of people.

I will do that 23andMe and I will just base everything off of signs and symptoms. And once you get good at it you can see these pathways in your head. But if you are not good at it you can see these pathways in your head. But if you are not good at it initially then I would be getting that methylation profile from doctor’s data and that is important to run but again you have to understand how to interpret it. And on [inaudible – 00:25:59] there is an article on there along with a podcast in the learning center about methylation profile analysis.

And I give a walkthrough of an actual test that I interpreted and discuss why these markers are the way they are. And I give various recommendations and that is a good thing to look at. So I would say with the methylation pathway I like organic acids a lot.

[Damien Blenkinsopp]: So you said that methylation – because the doctor’s data panel is called methylation profile, is it? Or is it the pathway? Because there is another company I know you have mentioned before and I have used before also, this Health Diagnostics. They used to be called [inaudible – 00:26:31] Diagnostics.

[Dr. Ben Lynch]: Yeah, I love their test. The problem is the turnaround time is pretty bad. But it might be hit or miss and I did hear from someone that if you call them for results and tell them to email the results it might speed up the return of the results by about three weeks. So that is worth mentioning, Health Diagnostics Research Institute. I think it is HDRI-USA.com or HDRI-Labs.com, something like that.

[Damien Blenkinsopp]: Yeah, we will put the links I am sure.

[Dr. Ben Lynch]: Okay, great. Their methylation test is the best out there right now. There is no question.

[Damien Blenkinsopp]: So what do you like about that versus the doctor’s data one then, for example? What helps you?

[Dr. Ben Lynch]: Well doctor’s data is basically – even Dr. [inaudible – 00:27:12] has stated that the methylation profile with doctor’s data is basically just a methionine cycle and it touches the transsulfuration cycle just a tiny bit. But we have no idea what is going on in the folate pathway. And the folate pathway is a significant pathway that leads into the methionine cycle and if we don’t know what is going on there, we don’t know why these markers are doing what they are doing in the methionine cycle. So you have to assume and assuming is not good. You want to know.

So the Health Diagnostics Research Institute will give all the folate derivatives, which is useful to the primary ones which is very useful. They don’t give the B12 in there, which I think would be nice, but you don’t really need it because if you see methylfolate as elevated and tetrahydrofolate is low, then you can know right there that there is a methionine synthase block of some sort, whether it is B12 or oxidative stress, lead, or yeast overgrowth or what have you. So I would say that Health Diagnostics is better in that regard.

They also look at adenosine. And adenosine isn’t in the methionine cycle but it is a beautiful marker once you understand how to use it. Again, I am still learning but I am getting better at it and I believe I know how to reduce it now. I know caffeine reduces adenosine, which is very interesting.

[Damien Blenkinsopp]: That is good news.

[Dr. Ben Lynch]: Yeah, for those coffee drinkers. I am not saying go and suck down coffee by the gallon, but –

[Damien Blenkinsopp]: Don’t quit your daily coffee.

[Dr. Ben Lynch]: Yeah, I mean a little bit of caffeine can be good, especially with D-ribose. I think some people, too, not to deviate too much but this is something I have recently learned, where if people aren’t doing very well in terms of they are getting post workout fatigue or soreness, that D-ribose is something beautiful. D-ribose is really important for producing ATP and it is very demanding to produce in the body.

So D-ribose and a little bit of caffeine, part of exercising, might keep that adenosine level low and then you might be able to use aerobic metabolism for a longer period of time before you shift into that lactic acid build up, the lactate. You might be increasing endurance that way. When it comes down to labs, if I am going to order labs what I would really like to do is just – they are expensive but you spend the money up front. Because if you order labs and one day you order the CBC and Chem and you get your serum ferritin and all that in there, your basic labs and you get those back and you find some things and you work on that.

Then you still have some symptoms and you order the CDSA and you look at the digestive function and you find some things there and you work on that and you say, you know, we still have some issues and you get the organic acids and you find that you are low in B12 or something else. And if you keep doing these labs this way then you are not connecting them. And the beautiful thing is if you order all those labs at once you can lay them out on your desk and you can stare at them with this built-in pathway planner which you have the privilege of staring at it in Chicago.

[Damien Blenkinsopp]: It’s huge, just for the readers. It’s huge.

[Dr. Ben Lynch]: Yeah, so I have got a whole new updated one so I will get you a new copy of that, Damien, for your listeners. So if you do all these tests at once and you look at it with the pathway planner then you can see how everything interacts and why maybe the CBC is bad because of this and this and this.

Or maybe why their methylation profile is bad, because of that and this and that. And you can see the underlying causes and you can say okay, look, now we know we have a pathogen in your gut and you are anemic and your iron levels are low, and your magnesium levels are low and your homocysteine is high. And your tetrahydrofolate is high and your yeast overgrowth is high and now we can say we have all this data and we can know why all these things are abnormal now, and the underlying causes are this, this, and this.

And so you work on those main underlying causes and you make such fast headway in the patient. It is an initial investment but the speed in which your patient can get better is tenfold because you are not chasing things. Now, mind you if the patient is under 30, or 30 and younger, and their main complaints are not that serious then would I do all this testing?

No, I would probably do most things empirical, meaning I just go for the lifestyle and dietary changes without looking at some labs but if it is the first, if they haven’t had labs done for years, then I would go ahead and do all this testing too. So it depends on if they have already had some baseline testing done. If they have never had baseline testing done then it needs to get done.

[Damien Blenkinsopp]: Right, so when you say baseline it sounds like you are doing – how many tests are you doing? Stool tests, urine tests, the methylation – ?

[Dr. Ben Lynch]: Yes, and I will get you that list too for your listeners. I have a list and I do what is called a roundtable for doctors. So I am going to Japan this fall and prior to going I am making them do all these different tests. And then what we are going to do is they are going to share their patients that are struggling to get better. And then I have a list of tests that I told them to get.

And so I will just get you that list if you like. Ion Panel by Genova is pretty good. The Ion panel looks at fatty acids. It looks at organic acids, it looks at amino acids. It looks at lipid peroxidation. So if you were to order just one test to keep it simple then the ion panel with the CBC chem panel would be something to look at. It is not perfect, no test is perfect. They all have holes, which is why I have a laundry list. But I think the Ion panel by Genova is definitely a good start.

[Damien Blenkinsopp]: So I guess one of the main points there is a lot of these tests are about biochemicals and they are not long-term markers that are changing over time and they are connected to each other. So unless you get the whole picture, like you are doing, then if you work on some problems with the CDSA then the methylation test you get could be different and it might not fit with the problems you have identified in the first place? You are looking in the wrong direction. Is it because the biochemicals are moving around too much?

[Dr. Ben Lynch]: That’s right and not only are they moving around too much, but why are they moving around? So if you order that methylation profile in 23andme because you are a doctor that specializes in methylation – and this is a big problem too, because methylation is not the tool. It is another tool.

If the patient comes in, they come to you because you are the methylation expert and you to MTHFR and the 23andme and the methylation profile and you just work on those things, and then you could be missing the underlying picture of why their methylation is wrong in the first place. And I cannot tell you as a physician – I would slap myself in the face multiple times for missing screening for pathogens.

And screening for pathogens is so hugely important because we are so susceptible to them now because of this stress and the lifestyle that we have and the likelihood of us having a pathogen is so high whether you have symptoms or not. And if you don’t have symptoms that is because you are supporting it through your lifestyle and diet or supplements or meds trying to mask the destruction that pathogen is doing on you.

So my point on this is that if you order the methylation test or your CBC and you get the things back and you work on that you might be missing the underlying picture of arsenic exposure or perhaps there is no pathogen there and maybe there is lead or mercury or maybe there are mercury amalgams in their teeth or root canals that were done that were festing anaerobic bacteria. That is why it is important to do all of these tests first so that you can see how all these things are.

And I have recently learned too is that some doctors already know this stuff but it just takes forever to link everything – but iron. I had my wife, for example, her serum ferritin just doesn’t go up. It just will not climb and her RBC magnesium too is just chronically low. And I have very good nutrients to work with this with all the cofactors and everything it is still low. Like, what the hell. And so RBC magnesium – I was reading this book and I don’t remember the title but it is by Dr. Myhill and it is her new one.

She talks about RBC magnesium being chronically low in people possibly because at rest I need to find a research citation to see if she is right or not but she says at rest 40% of ATP is utilized for moving minerals back and forth between the cell membrane. It’s like holy God, that’s big. So 40% of ATP at rest, not at exercise but at rest, is to move sodium and calcium and calcium and magnesium across the cell membrane. That’s big so magnesium has to be pumped in and so does potassium.

Potassium is a huge component that I think most people are deficient in. But my point here is RBC magnesium, I mentioned ribose earlier and this is also from Myhill, that she thinks that if people are chronically low on RBC and red blood cell magnesium it might be because their D-ribose levels are too low because their ATP levels are too low. And I give my wive ribose and I recommend it to her, but is she compliant? Sometimes. And the serum ferritin is low I believe because pathogenic bacteria in the gut, which we have recently found from the CDSA by doctor’s data is she has some pathogens in the gut and they suck up iron like crazy.

So why we are taking these nutrients, these high-quality nutrients – the pathogens in the gut are taking them all. And if you have yeast overgrowth in the gut then these things the yeast are using, your B1 and magnesium, to make acetaldehyde which is then converting to ethanol, which is disrupting your methylation cycle. So the gut is so central too – and I would do the ion panel with the CDSA probably first, and I like the RBC.

[Damien Blenkinsopp]: So the CDSA is the doctor’s data stool test?

[Dr. Ben Lynch]: I like that one.

[Damien Blenkinsopp]: Versus say metametrics or some of the other ones?

[Dr. Ben Lynch]: Yeah, there are a lot of them out there. I think Genova’s is getting better. I didn’t like Genova’s for a long time and I think GI stool effects was not very good. I like doctor’s data. I ran another one and I think I ran Biohealth and it came back with basically nothing so that everything looked fine. I did it for my whole family and I didn’t trust it, no way. And so I did the doctor’s data and it came back with all this useful data, so it is very important that you order the right test too.

[Damien Blenkinsopp]: So are there any methylation or other tests you have done which you didn’t find useful, whether it is for accuracy reasons that you didn’t trust or other reasons?

[Dr. Ben Lynch]: Well I would have to think about that one for a while.

[Damien Blenkinsopp]: I think you mentioned in a presentation homocysteine and it is in all of the main labs like LabCorp and Quest and so on, and it is obviously something that lots of people are getting tested now. How do you find that test, for example?

[Dr. Ben Lynch]: Well homocysteine is good if it is high, so if it is high it is useful and you know there is some type of blockage going on. And when I say it is high I am not talking about the standard range. I am talking higher than seven in an adult. Now, in kids homocysteine levels tend to be lower. And I think they are lower so normal in a kid say under 14 or so, shooting from the hip, I have it somehow in the forum of [inaudible – 00:38:20] and I need to remember the range is here and it is important. But anyhow younger kids have younger homocysteine levels.

So they might come back at five and he is like oh, that is too low, I need to work it up. No, they naturally run low and they naturally run low, probably because methylation cycles is humming along super quick because of their growth. So the younger you are the more methylation you burn through because you are growing. Look at autism, their methylation cycles are messed up and these kids are hurting big time.

But with homocysteine, my point here is that homocysteine is a good marker of a tie and the problem is that it is extremely rudimentary and we don’t know why it is high. So it is important to know why it is high but at least it is high. So doctor’s might take some action and get some B12, B6, TMG, methylfolate and so on, but the problem is if it comes back low, as you saw Dr. [inaudible – 00:39:06] lectured on about homocysteine and S-adenosylhomocysteine in the cardiovascular risk patients, because there is research out there that says look, homocysteine levels are not correlated with cardiovascular risk and you say well BS because all these other papers look at homocysteine and it is related to cardiovascular disease.

But some of these papers that are actually published are legit and they say homocysteine isn’t. But now if you look at S-adenosylhomocysteine, S-adenosylhomocysteine levels can be elevated while the homocysteine levels are normal and they are correlated. So those two things will be correlated to cardiovascular disease. So homocysteine, before you get to homocysteine is S-adenosylhomocysteine. I think while your listeners are listening to this show they should have this pathway popped up so they can follow me along a little bit but S-adenosylhomocysteine is above homocysteine and that pathway is bidirectional. SAW goes to homocysteine but homocysteine also goes back to SAW, so it goes two ways. So that is important to know, that homocysteine goes back to SAW preferentially.

So if you are to draw and write homocysteine on your piece of paper and homocysteine is your left hand and SAW is your right hand – there is going to be a bigger, heavier arrowhead moving from left to right from homocysteine to SAW than there is from SAW to homocysteine. So the pathway to moving back from homocysteine to SAW is fatter and now if your SAW is elevated your adenosine can get elevated. And if your adenosine gets elevated then it is metabolic syndrome, it is diabetes, and so on.

So you are absolutely right that homocysteine is very rudimentary and that is why methylation’s profile by doctor’s data is not as good as Health Diagnostics but at least it does look at SAM SAW and the ratio.

[Damien Blenkinsopp]: So that is right, the SAM SAW and the ratio, that is what you find useful in that one.

[Dr. Ben Lynch]: That’s right.

[Damien Blenkinsopp]: So another thing you just mentioned is some of the reference ranges are a bit different. Is that in a lot of the tests? Some of these tests are a bit young as well, like the methylation pathways from [inaudible 00:41:12] Diagnostics or [inaudible 00:41:14], as you said. Now, I am not sure how much data they actually have in a database to establish what a reference range is and what kind of populations – so how do you go about looking at reference ranges?

[Dr. Ben Lynch]: You have to remember that just like you said earlier a lab test is a snapshot in time. So I am going to answer your question here and I am a little bit delayed, so if I get too off track you can hit me on the head and I will get back to the answer. But in short a lab test is a snapshot in time.

So if you are stressed out and you are stuck in traffic to get to the lab test and somebody cuts you off or there is construction and now you’re late and the doctor is bitching you out for being late or the kids are screaming in the back of your car and then you draw your blood for the methylation test – it might make some impact. And then if the doctors don’t handle – or the lab tech doesn’t handle your sample properly, there can be some issues there.

Then it finally gets to the lab and maybe it gets lost in transit or maybe it is sitting in the back of the FedEx truck for a couple of extra days and that sample gets messed up. Maybe it doesn’t and say everything now is still on the way just fine and there are no hiccups, and then the sample gets processed in the lab and is done by humans – humans can sometimes make errors like adding too much reagent, being tired and not writing things down properly, or maybe the computer isn’t reset or reconfigured every morning and then didn’t do it properly that day.

They put the results on a beautiful PDF that looks fantastic and they have these little ranges on there and you get the results back and you are like, ‘What the hell? This doesn’t look right.’ You always need to look at the lab as a piece of paper and you need to match that to how your patient is at the moment. So if the lab comes back one way and your patient is completely the opposite, maybe the lab is right. But most likely I would say this is possibly a lab error.

Now, getting back to the ranges, I know for a fact that the Health Diagnostic Research Institute – their lab values for that methylation test was they tested 100 medical students. Now, when I was in medical school I was the sickest I had ever been in my life. I was tired, I was just run ragged and med school is the toughest thing I have ever done in my life besides rowing for UW. And I would say how healthy were these medical students? Were they drinking? Were they not?

Using the word ‘healthy’ medical students is such an oxymoron to me. So that is where those lab values came from, those ranges. So you have to keep that in mind. The ranges on all lab tests are coming from the population to some degree. So in our population as a whole it is pretty sick. I don’t know the historical thing but there is a really good book out there. Do you know it, Damien? It is about homocysteine. I think it is called – could it be your B12 levels? Or is it your B12?

[Damien Blenkinsopp]: Yeah, that was one of the first ones.

[Dr. Ben Lynch]: And that is a pretty good little read. It is pretty basic and it is pretty good to read and he talks about, or I believe – or she – the ranges of homocysteine and how they have historically elevated. And look at arsenic – George W. Bush, Jr. increased arsenic levels that are “safe.” So the safety level of arsenic now has been inflated over time. So the ranges – you are going to really have to take those with a grain of salt and again match it with your patient.

And I know some doctors can really dial in where they like the ranges and it would be so great if doctors could share their data, saying I find from my clinical experience that this range is the ideal one. But for some reason they latch on to these things and they keep that information private, and I don’t know why. But yeah, so homocysteine I believe a lot of them say it is greater than 11 for an adult and some even say if it is greater than 15, and that is way too high. I would say 7 is ideal, or 9 you have definitely have some work to do.

[Damien Blenkinsopp]: Yeah, and coming back to when we spoke a couple of times about supplements and we spoke a couple of times about supplements and we spoke about people using supplements to lower homocysteine. So some people have done some work on their methylation and some of them have been taking supplements, the B vitamins, the folates, and other supplements for their methylation and they will feel better.

But as you were talking about earlier the underlying condition – they basically have to take these supplements all the time now to keep themselves going. Is that a good idea? You were talking about continuing to look for the pathogen or whatever causes it. Are there dangers from supplementing? Or do you think it is a good idea to control symptoms for a while if you are still trying to figure things out and you should always be aiming to get off of them?

[Dr. Ben Lynch]: Palliation is removing the symptoms and the irritation of whatever is causing disturbance in your patient or yourself quick – that is what drugs do fast, super fast, unless they are causing other issues. I call it drive-thru medicine. You go to your doctor and say, ‘I’ve got a headache,’ and they prescribe headaches.

And maybe your ergonomics at work are not right or maybe you are not drinking enough water or maybe you are drinking aspartame or you are sucking down caffeine all the time – there are a million reasons for headaches. But if you are taking an aspirin and the body is saying, ‘Hey, listen to me and fix it,’ and you tell it to shut up, I am taking an aspirin – now, you are telling it to shut up too if you are taking methyl donors and you are not addressing the alcohol intake that you are drinking every night if you are drinking beers and wines and whiskeys and vodkas all the time.

You have a job as a real estate agent and you are celebrating house closings all the time with your patients. Then yeah, it is a social thing and it is fun to have your wine but if your methylation is not appropriate or you have yeast overgrowth in your gut that is inhibiting your methylation or you have got lead toxicity.

If you order the lab tests and you see your methylation is messed up due to the lead and you know you have elevated lead – or say you don’t know you have elevated lead but you are bypassing it with these methyl donors, these methyl donors only do so much. But the lead is still causing oxidative stress. It is still blocking other pathways that have no relation to methylation. And so while some pathways are being bypassed, others aren’t. So it is a big deal to address the underlying cause.

Let me give you a brief example here. I had a friend of mine who was drinking not a lot but he would have a few beers every night. He would wake up tired and his kidneys were sore and he was getting kind of sick of it and he asked what to do. I told him to quit drinking and he just kind of looked at me and laughed. So I said all right, take some B vitamins.

So he took the B vitamins for a while and that helped but after a while it didn’t and I said, ‘Well, now I know about methylated B vitamins, so take the methylated B vitamins. So he started taking those and he wrote to me and goes, ‘Thanks man, now I can drink even more and I wake up in the morning feeling fine.’ I was like that really defeated the purpose. But now he is making more but he feels fine.

Then I told him that drinking was a mitochondrial toxin that was affecting his mitochondria and that leads to a big issue. And that got him because he was a former athlete too and he likes to be fit. So as soon as I told him that alcohol is a mitochondrial toxin he went, ‘Oh crap,’ and he stopped drinking pretty darn fast.

But he kept going on these methylated B vitamins and he was just taking additional methylated folate and B12 as well. And he was starting to get really irritable and angry. Before he was just fine and then he just kept taking it. And he didn’t tell me this and we would talk about what I was doing these days and talking about niacin and if people took too much.

So one day he was driving down the highway and he had auditory hallucinations. The radio was off but he was hearing the radio. He kept cool because he knew it wasn’t him. He knew something was wrong and I remember Ben telling me that this could happen. So he stopped the methyl folate and he started taking niacin and everything was normalized. And then he stopped taking the methyl folate at all. He just stopped taking it. And he reduced the methylated B and he became fine.

So my point is that he had this environmental trigger that his body had to handle, which was alcohol and acetaldehyde. So his body was using all these methylated nutrients to clean up that garbage but as soon as that garbage was no longer coming in, too much of that nutrient now was causing other things. So he stopped it and lowered his dosages significantly. So I usually tell people before they reach for a supplement bottle to understand what it does and if they need it or not.

[Damien Blenkinsopp]: There are a lot of these polymorphisms. Are there any situations where you have a polymorphism in your methylation process where you may have to take a supplement for a long period or maybe forever?

[Dr. Ben Lynch]: Yeah. I don’t know what that is yet but I would say let’s look at a couple real quick. With MTHFR if you have the 677 homozygous variant then your ability to make methylfolate is reduced by about 70% to 80%. So you are making about 20% of methyl folate compared to the standard person who has no MTHFR.

Now, if you are eating a lot of leafy greens in general and you are also eating grass fed meat and you are not that stressed out and you are leading basically a perfect life then you might not need methylated folate. I think those with MTHFR 677 might need some methylated folate to some degree pretty much the rest of their life but if they are getting it through their uncooked leafy greens and they are definitely eating quite a bit then I think they are going to be good through that.

Now, there is a paper I talked about that is on the video at MTHFR.net – a lot of the information there is dated but it is still pretty accurate. That video there is free and I show the polymorphisms in various populations like the Chinese, Indians, Hispanics, and so on, that have a very, very high rate of – Italians, too – that have a super high rate of MTHFR.

Now at the end of that video I talk about neural tube defects in Mexico and the United States being related to folate. Then they did another study that looked at neural tube defects and MTHFR, Hispanics, and the Americans and those were all directly related. The researchers also looked at Italians in MTHFR and neural tube defects, and there was no correlation.

So the neural tube defects in Italy, these people with their lifestyle seems very protective, even despite the MTHFR polymorphism over there. So they eat a lot of salads and they drink a bit of wine that is a little bit as good, and not too much not. And their lifestyle is a lot less hectic than us Americans and we chase this American dream which is just a complete nightmare for people. So the American dream is the American nightmare – I think it should be renamed.

Then if you look at another gene – GAMT of creatine, I think people with the GAMT polymorphism may benefit from taking creatine and some form of creatine or at least eating meat. If you are a vegetarian and you have GAMT then you are probably going to be in trouble.

[Damien Blenkinsopp]: That is interesting that sometimes it can inform your lifestyle choices as well.

[Dr. Ben Lynch]: Yeah, and vegetarians and vegans – I was a vegetarian for a while and I felt terrible. Looking at my genes I think I could understand why, plus I didn’t know how to be a vegetarian properly. I was a carbitarian and I didn’t eat properly. I think if you are a vegetarian and you know how to eat very well and you are supplementing with choline, creatine, phosphocholine and B12 then I think you can be okay.

But some of the most ill people I have worked with are vegans and vegetarians and I would say the majority of women that have had recurrent miscarriage or can’t get pregnant were vegans and vegetarians. So in most pregnant women whether they are vegans or vegetarians or not, most pregnant women are deficient in choline. And most cancer patients are deficient in choline as well. So choline is a very, very important nutrient and that comes from meat, plain and simple.

[Damien Blenkinsopp]: And our friend, liver, in particular.

[Dr. Ben Lynch]: And our friend liver, yeah.

[Damien Blenkinsopp]: Great, thank you for all of those insights. I want to round off with a couple of questions a bit more about where you see things going over the longer term. So in the next five or ten years with this whole area of methylation, where would you hope it would go? What kind of things are you excited about in this area?

[Dr. Ben Lynch]: Well I am most excited about disease prevention with it and I think if it is utilized properly, meaning still focusing on lifestyle and diet and the basics, I think if there is a company like 23andMe that provides very clinically relevant polymorphisms and not a million polymorphisms that may mean nothing – but reducing it down to one 8.5 by 11 report of genetic polymorphisms that are very clinically relevant, that have been researched, that can bypass through lifestyle, diet, and nutrients, I think that would be very useful.

Right now there are a lot of polymorphisms that are published that may or may not have any clinical relevance. And I think that the 23andMe has – even with MTHFRsupport or Genetic Genie I think there are variants on that test report that are bogus, meaning no clinical relevance. I would like to see variations that are clinically relevant with actionable steps and understanding how to take action on them in simple, systematic ways and not so complex and convoluted – which I know some of my presentations can be.

I am trying to simplify things and would would be really cool too is to have some type of computer program that looks at all the polymorphisms that individual has along with their lab markers that are off, their diet, lifestyle, heavy metal exposures, and so on. You plug all that information into a database and the computer program will spit out some generalized recommendations for the physician to evaluate such pathogens or heavy metal screening or some certain things to look for, or nutrients that they absolutely must be taking and nutrients and meds that they absolutely should be avoiding.

So computerizing this I think would make it a lot more actionable. And also with prenatal screening, I think every person now should be taking some type of genetic screening that are actionable. There are things out there called Counsyl that looks at genetics that cause issues in the fetus during development. And why that test is useful – it also scares the hell out of the future parents, and having fear while you are pregnant is definitely no good because fear also messes up your methylation and a bunch of other pathways and blood flow to the baby.

So if you order a test which has actionable things that they can do through diet and lifestyle and the mother knows that and so does the father, because the father’s genetics are also significantly important for the baby’s development too, then I think that is the way to go. So I think that, in a nutshell, for disease prevention is important. And also mitochondrial disorders are really severe and you see a lot of early death in people who have mitochondrial dysfunction.

And as you may remember from the Chicago conference I talked about maternally-inherited mitochondrial disorders, because mitochondria is basically inherited from the mother. If you see a list of diseases that are all down from the mother’s side of the family or the women’s side of the family then it is probably a mitochondrial disorder and if you do any genetic testing on that you might be able to support the mitochondria immediately through NADH, COQ 10, glutathione, and so on. So again, I think disease prevention automation and specific targeted recommendations is where I would like to see it.

[Damien Blenkinsopp]: Yeah, in terms of tests is there anything that you see missing? I know mitochondrial tests, for example, you mentioned Sarah Myhill and I know she has a test she is doing, but I don’t know many other tests. Are there any other tests you feel would be useful to be available or are hard to access or they need further development?

[Dr. Ben Lynch]: Yeah, tons of them. And I would love to see this stuff on one panel and I have notes on these things trying to get other labs to look at it. So Acumen Labs, that is over in Wales or UK, Myhill promotes and works with a lot. Again, a test like this – not to spend too much time on it, but they were looking at a snapshot of ATP, ATP’s realization, and so on. And some of those tests look at causation too so I would say those are good tests. But would I necessarily order those? If they are not too expensive, yeah, and if they are expensive, no.

The reason why is because if I see lactate elevated on a patient, lactate is a very readily-available marker. So if lactate is elevated then I know immediately that the mitochondria in this patient are suffering, along with lipid peroxidation. If lipid peroxidation is elevated then we know their cell membranes are getting damaged. And if their cell membranes are damaged, then their mitochondria will be damaged.

I want to give you the markers now that are already available. So lactate, lipid peroxidation are great. Ammonia elevation is also a marker of mitochondrial dysfunction because mitochondria process ammonia, for the most part. So if that is elevated then we know the mitochondria are not working very well and creatinine is a great one for that as is general mitochondrial support. And so looking at –

[Damien Blenkinsopp]: You mentioned that it was difficult to access. Is that urine?

[Dr. Ben Lynch]: I don’t know, I don’t know what is better. I think blood lactate can be either, but I know urinary lactate is available. And I don’t know about pyruvate. And now looking at B12 – B12 is a nightmare. There are really no tests – well, I shouldn’t say that. Holotranscobalamin and methylmalonic acid are pretty good for B12.

You can look for macrocytic anemias too, elevated MCH, MCV, but those can be missed because you could have normalized MCV, MCH and still have a masked anemia because of folate, so a masked B12 anemia, I should say. So you want to be looking at methylmalonic acid and you want to be looking at holotranscobalamin, but the issue with B12 is if there is low glutathione reading about this now I have a bunch of papers on it actually, but glutathione is needed to carry B12 around and so if the patient has low glutathione their B12 levels may look elevated on the lab tests and serum cobalamin.

So serum levels of pretty much anything are not that useful. You want to look at intracellular and if it is an intracellular nutrient. And we know that B12 has to get into the cell. So if you see a serum folate and serum cobalamin elevated and your red blood cell, B12, and folate, I know Spectracell looks at T-lymphocyte testing for B12 and folates and that is intracellular, so that can be really useful for people.

Now to answer your question about tests that I want to see in the future, if you want to see oxidation, I want to see oxidized biopterin and reduced biopterin. These labs are looking at biopterin but they are not telling you if it oxidized or reduced. And if your biopterin levels are oxidized – say your biopterin levels are normal, but your patient still is having neurological symptoms or cardiovascular symptoms or they are having some type of mental or emotional imbalance.

Biopterin is really critical for this because biopterin recycles and helps revert your tryptophan and serotonin and tyrosine into dopamine and your arginine into nitric oxide for your cardiovascular systems. So with these things if you have oxidized biopterin and your biopterin levels are normal then this is going to be an issue so oxidative stress – if you measure oxidative stress this is why I also recommend looking at multiple tests at once, not just one at a time.

This is a beautiful reason why. So if their B12 levels are elevated and their folate levels are elevated in their serum – if their biopterin levels are normal but their oxidative stress is high and you know their oxidative stress is high through their lipid peroxidation, their lactate, and their glutathione levels are low and glutathione peroxidase enzyme is high or superoxide dismutase levels are high or their manganese levels are low and their zinc levels are low and so on.

If you put all these together you can immediately understand and say, ‘Hey, your oxidative stress is high and it is disturbing all of these enzymes downstream. It is messing up your glutathione, it is messing up your biopterin, your B12, your folates, your cells. We have got to get that oxidative stress down. But we need to understand your oxidative stress is elevated in the first place. So you can bypass the need for these new tests that I want to come up with if you order all these different things at once. But it is expensive, it is a pain in the ass, and it is time-consuming.

[Damien Blenkinsopp]: So it would be better if you could go straight to – it is kind of like you have to take these proxies and these indicators rather than getting directly at the issue.

[Dr. Ben Lynch]: Yeah, inflammatory cytokines can be really useful to look at, So [inaudible 01:02:00] 1, 6, 10, and then if you look at TNF alpha, these are coming back elevated and that can be a problem but again, why are they elevated? These mess up things too. I would like to see different forms of B12 and I would like to see adenosylcobalamin, I would like to see cobalamin itself, I would like to see oxidized cobalamin, and I think that would be very , very useful.

[Damien Blenkinsopp]: Especially with so many people supplementing these kinds of things.

[Dr. Ben Lynch]: Yeah, and if they are taking B12 and most of that B12 is going to oxidize cobalamin, which is causing more damage to their body, then they need to stop taking that B12, support the glutathione, but if they can’t support the glutathione because they are reacting to the sulphur or they are not hydrated enough, then that’s a problem. If they have urinary – they are not peeing well for various reasons because of dehydration or what have you, taking glutathione could be a big problem.

Or if they are sensitive to sulphites, glutathione if you take it then it can build up your cysteine levels and your cysteine levels go down and they make sulphites. That could be a problem too, so if people feel like crap taking glutathione, it could be they are not hydrated or their cell membranes are not appropriate, they are not healthy, or their sulphites are messes up and too elevated.

So it gets tricky fast, as you saw in Chicago, because I try to teach all this in an hour-and-a-half, just like we are talking now for an hour-and-a-half. But the point is just take this stuff and listen to it and relisten and if you glean one or two things from this, that is great. And if you listen to it again you might glean something something else or you might have an a-ha moment for this particular pathway in one patient and an a-ha moment for a different part of this combination in another patient. So it is bit by bit.

[Damien Blenkinsopp]: So you are obviously doing a lot of work on this research. What are the most important things coming out for you in that area? What are you working on right now, maybe for next year? What is the most interesting for you?

[Dr. Ben Lynch]: What is most interesting for me right now is why people react unfavorably to certain nutrients, like methyl folate, B12, glutathione, and so one and then understanding how to identify these patients before they even take these nutrients to say hey, you have this and this and this. You need to optimize this and this before you take this and this.

That is what I am working on right now. I am trying to prevent patients from flaring by identifying where they are currently and if they can respond to a particular nutrient or not and getting the reason why. That is what I am working on because I know that the majority of patients who are under 30 or even under 40 and they are not too bad, a lot of them can be taking these methyl donors and feel great.

But you start getting in the conundrum cases with the Lyme patients, the autistic patients and so on – the cancer patients. And if you start with them out of order you can flare them. If you flare them you lose patient compliance and you lose trust and it can take longer for them to get better. So what I am doing now is trying to do that work flow.

Part of that work flow seems simple when I say it like that, but the issue is I am tying it to the mitochondria and I am tying it to the hormones and inflammation. So I have always had a big hole in hormones and so I am looking at hormone-related connections. But if you look at hormones, how are hormones affected? Well, they are affected by methylation, inflammation, and mitochondrial function. And Sarah Myhill so eloquently stated in her recent book that every single pathway in the body is affected by mitochondria.

So my biggest focus right now is mitochondrial health, which is I am reading her book, because she is very well-versed in it. I agree with a lot of things in her book and she has provided me quite a bit of insight. I also disagree with a few things in her book but that is how medicine is. None of us are perfect and I say things that are wrong and we will collaborate and I will give Sarah a call or an email here at some point after I finish her book. But what I am working on now is that and when I was at that part two conference at [inaudible 01:05:57] and there were 300 docs there and I asked them what do you want me focusing on next? A few things were brought up and then I said, ‘What about mitochondria?’ And then the whole room was just in an uproar. Right now it is mitochondria in a nutshell.

[Damien Blenkinsopp]: Yeah, have you connected with Dr. [Terry Wyle 01:06:14]?

[Dr. Ben Lynch]: No, I haven’t. I know of her book and I know what she went through. I have read her book. I haven’t connected with her yet but she is another one I need to look into. And her book was pretty basic for me but she definitely recovered, which was beautiful.

[Damien Blenkinsopp]: I spoke to her a couple of weeks back so maybe I can connect you with her if that is interesting for you.

[Dr. Ben Lynch]: Yeah, that would be great, it definitely would be. And my thing too is this is all about collaboration. The stuff I am working on is the stuff that I want to give out and give people and not holding and hoarding. If I am able to help a doctor or two or 1,000, then that is my ultimate goal here. So the more doctors I can work with and collaborate with, the better.

[Damien Blenkinsopp]: And the more feedback you get as well so that is useful to you as well.

[Dr. Ben Lynch]: Yeah, exactly. Every doctor out there has got something that I don’t know. So Terry is going to have something I don’t know for sure and she might answer the puzzles faster than me sitting here in my office, digging through PubMed and she is like I wish I knew that ten years ago.

[Damien Blenkinsopp]: Yeah, collaboration is definitely the way to go. So what would be your number one recommendation to someone trying to use data to help them with the area of methylation? Is there once piece of advice you would give them?

[Dr. Ben Lynch]: Don’t be biased – look for bias. I don’t know if that is what you are going for, but bias is a big problem in research. So if you are reading papers and you are trying to gather data or you, yourself are working on a particular project make sure that you are eliminating bias. And I say that because when I got called in to present to the Cancer Treatment Centers of America and they wanted me to talk about MTHFR I quickly told them that cancer is about more than just MTHFR.

And I could have presented an hour-and-a-half on how MTHFR is related to cancer but I would have done them a major disservice because there are a lot of articles out there and papers that talk about MTHFR and how it is not related. So I could have presented an hour-and-a-half of totally biased research and when I say bias I mean personal bias. And some of these papers on MTHFR and cancer, a lot of them are totally legitimate saying that MTHFR isn’t related and some of them saying it is.

I think it is a bigger picture than this. And that is another thing, to keep the bigger picture. So if you dial down into MTHFR is not related to gastric cancer then you need to understand the bigger picture. You have got to zoom out, so keep the bigger picture when you are collecting data and you can’t forget the basics of diet and lifestyle. And I think that is so hugely important and compliance is super important and however you get your patients compliant, whether it is with 23andMe and MTHFR tests and you plop down in front of them and say, ‘You are a mutant,’ or you tell them, ‘Mitochondria are being destroyed because of your alcohol.’

You have got to find that pain point for that particular individual to get them compliant. So anyway, I would say keeping the bigger picture, don’t zoom in too close and make sure that you are not being biased and you are not reading papers that are biased.

[Damien Blenkinsopp]: Great, thanks for that. Okay, last question – looking at yourself, are there any data metrics or biometrics that you track for your own body on a routine basis yearly or whatever it is?

[Dr. Ben Lynch]: I look at fatigue for my own. I don’t look at data points and I look at my fatigue and my mental capacity and my moods. I look at a few data points with me personally. So if I am more tired than I should be then I ask myself why and then I review what I have been eating, if I have been more stressed, or if I am not exercising or exercising too hard. I am 40 years old now and you hit 40 and your mitochondria slow down more and more.

So I would say I look at my ability to think and my ability to maintain endurance, not only mentally but also physically. Muscle mass I think is super important because the more muscle you have the more mitochondria you have, so I am going to be starting lifting here soon so I can restore my glycogen and make more ATP. Muscle mass is a very important marker to look at. I am not going to be the Incredible Hulk by any means but if I am 213 pounds now I don’t know what my body fat is, probably 10 to 15.

But when I was rowing at UW I was 213 pounds and I was 4% body fat. I am not going to be 4% body fat again probably but I look at leanness and weight and the ratio of muscle to fat, so being fit is a marker that I am focusing on right now.

[Damien Blenkinsopp]: Great, thanks for that. Those are very interesting ones. Also the mood is something I think a lot of people don’t think too much about. They think they are in a bad mood today but do you always kind of relate that to something that might have gone on? Do you think there might be some kind of biological basis or could it just be stressful events?

[Dr. Ben Lynch]: Yeah, great question and I think you are absolutely right. If there is a stressful event you need to be able to understand that. But you should be able to adapt to a stressful event. And it is interesting – I was just at this conference last week and you know how loud noises can sometimes make people jump?

I was sitting there and the room was absolutely dark and people were holding up candles. It was the end of the conference and it was this little ceremony that we do every time which is really cool. So they turn off the lights and hold up candles and it was quiet for a long time. I was thinking this was going to be really interesting, how are they going to end this period of silence? Is somebody going to scream and whoop and go crazy or is there going to be a gong or a bell? What is it?

So I kept waiting for it and all of a sudden the band behind us just really laid into it. It was really loud and the woman next to me jumped and I was just as calm as can be – so your ability to adapt to stress is so important. So we started this whole conversation today about adapting to stress and adrenals and so I think adapting is really important. But your original question of moods, so if I am stressed I immediately know that I need to be focusing on my adaptogens, licorice and [inaudible 01:11:56] and what have you, and eating smaller amounts but more frequently with some type of protein, and healthy carbohydrates and veggies are super important.

And not only eating it but chewing it well and absorbing it is even more important but if I am moody when I wake up, something is wrong. And I have to say that I don’t wake up in moods. I don’t wake up on the wrong side of the bed anymore. I might wake up tired or foggy-headed because I am working too hard or I stayed up too late. But I don’t wake up pissed off or irritable or sad. I don’t have those moods. And if I do get mad – I have got three boys and they can definitely put you over the edge sometimes, but I always look inward in that situation and say, ‘Okay, why am I doing this? Do I need more support in something?’

I am MTHFR compound heterozygous and I have got histamine snips, I have got GAD snips. And when I say GAD, GAD is a big one. So I am more prone to have lot of glutamate in my head compared to GAVA, because the GAD enzyme works with converting glutamate to GAVA. I am very conscious of this and so I will take some more magnesium and B6 if I notice I am a little bit on edge and protein for me is very, very important.

But your mood is super important. If people are moody, depressed, sad, glad – sad and glad are great, but if they are overly glad then something might be off too.

[Damien Blenkinsopp]: Right, just what you were saying about yourself and how you understand your own biology thanks to some of the work that you have done with methylation and you understand that protein is important and so some certain vitamins might help you if you are in a mood and stuff. You can see how important this is to inform our lifestyles and they could just be like I need to eat a bit more liver or whatever it is at the moment because my mood is a bit off, or whatever. And so this is an incredible area, this methylation.

I would really like to thank you for all the information you have shared today. It has been really amazing.

[Dr. Ben Lynch]: Yeah, and one thing too Damien is when I presented at the [inaudible 01:13:56] I talked about how important food was from a research standpoint because there are a lot of MDs that come to my conferences and they don’t have any nutrition training to speak of. So I talk about nutrition and how important it is and I talked about how carbohydrates increase serotonin and proteins increase your dopamine.

So you think wait a minute, proteins also increase your serotonin. But tryptophan is very tough to absorb. So that is why carbs can increase the serotonin and so if people are down and out then they get addicted to carbs and you need to understand and sit back – why are they doing this? Maybe because they are trying to selectively increase their tryptophan levels because if they eat protein they are not really getting the tryptophan because the tyrosine competes with it.

So my point here is that the last paper I presented on this is that if the person eats a fair amount of protein consistently, 75 grams was what they used and I think they used 75 grams because the average weight of a person is about 150 pounds – so 75 grams and 75 kilos of weight as a really rudimentary measure of how much protein to get. But my point here is people who ate adequate protein in a day had consistent neurotransmitter balance.

So if you eat adequate amounts of protein your neurotransmitters get balanced. So it is not only eating it but you have to absorb it. You have to make sure your absorption is also good. So people who have difficulty absorbing it is an issue but again my point here is if you are eating a carb-based diet because you are sad and you need to increase your serotonin levels but you don’t know why you are eating carbs, that could be one reason. But just eat more protein and that might be the answer.

[Damien Blenkinsopp]: Well thanks. As I say again this has been really amazing and information-filled. I know the audience is really going to learn a lot from this.

[Dr. Ben Lynch]: Good. Thank you Damien for asking fantastic questions. You ask some fantastic questions that no other interviewer has asked me before. So thanks for that. I think people will get some good information from this.

Leave a Reply

The paradox: We spend a lot of money and time on increasing our antioxidant intake through foods and supplements. Yet most of us never know if this effort is making any impact on our health. Should we be checking our oxidative stress levels as often as we check our cholesterol?

Not a day goes past that we don’t hear about oxidative stress in the news and interwebs, and how it is shortening our lifespan or causing diseases like heart disease, diabetes and cancer.

Unless you’ve been living under a HUGE rock, you also know that antioxidants protect us from oxidative stress. And you most probably spend some of your dollars on antioxidants through healthy food choices and supplements.

But how do you know if those dollars spent.. or the time you spend thinking or reading about antioxidants, rewards you with any real benefit?

Today we look at measuring oxidative stress and how you can use biomarkers to assess your health status and whether your efforts, such as making buying choices based on antioxidant content, are paying off.

“In my ideal world, I would love to see most people looking at their markers of oxidative stress once a year…. if once a year we could get an idea of antioxidant status in our system and know if our antioxidant level is keeping up with damage in our body, it just gives us a much better window into prevention.”
– Cheryl Burdette

Dr. Cheryl Burdette is president of Dunwoody Labs, a lab that specializes in cutting edge labs for integrative medicine, and a practicing physician at Progressive Medical Center, the largest center for integrative medicine in Atlanta, U.S.

She is currently lecturing on nutrition and cancer at the University of Bridgeport and has a number of published studies in the journals Alternative Medicine Review and Clinical Chemistry.

As education director at Dunwoody Labs she is involved in clinical trials of different nutritional products as well as development of functional testing profiles – and an area she has looked at in particular is oxidative stress.

The show notes, biomarkers, lab test and links to everything else mentioned are below. Enjoy the show and let me know what you think in the comments (click here – in the comments)!

itunes quantified body

What You’ll Learn

  • The usefulness of oxidative stress markers for managing and improving health.
  • The implications of high oxidative stress found in the body with connection with damage and cancer, heart disease and neurological conditions.
  • The two perspectives to understand your oxidative stress status: the direct measure of oxidative damage and reduced intracellular anti-oxidant status.
  • Glutathione’s role in protecting your body from oxidative stress and its relation with health and disease and what you can understand from its status.
  • The relationship to goals of longevity and physical performance of antioxidant enzymes like Glutathione.
  • Lipid Peroxides and the specific damage they relate to in the body, and the differences in biomarkers available: TBARS, MDA (MalonDialdehyde), F2-Isoprostane.
  • How oxidative stress levels negatively impact methylation processes and its negative feedback dynamic with mitochondria.
  • Some of the criteria Cheryl has used to select the oxidative stress markers for her assays and panels from amongst the over 30 currently used in research.
  • How taking supplements like bioavailable forms of curcumin, sulforaphane from Broccoli, and alpha-lipoic acid or resolving chronic infections can resolve raised oxidative stress levels.
  • Trends in use of the oxidative stress markers that Cheryl has noted such as use by integrative medicine practitioners and across the U.S. geography.
  • Appropriate testing strategies for healthy individuals for routine assessment of oxidative stress and how it can highlight future potential health risks vs. individuals that have some chronic or pathological condition.
  • Do we need oxidative stress? Can you overload on antioxidants so that they have a negative impact on your biology rather than positive?
  • Looking at oxidative stress markers in athletes or people who exercise heavily to understand issues they may have with their performance and their recovery.
  • Some of the trends, new research and tests Cheryl Burdette is looking forward to coming out in the next 5 years.

Dr. Cheryl Burdette & Dunwoody Labs

  • Dr. Cheryl Burdette: Her profile on Progressive Medical Center, where she works as a physician.
  • Dunwoody Labs: Cheryl’s lab, where she is president and education director.

The Tracking

Biomarkers

Used and Recommended by Dr. Cheryl Burdette

    Lipid Oxidization Levels
  • F2-isoprostane: A more direct marker of lipid peroxidation levels in your body than TBARS and MDA.
  • Oxidized LDL: A measure of the amount of your LDL (Low Density Lipoproteins) that are oxidized. This is considered to be a much more predictive marker of cardiovascular disease than straight LDL measures.
  • Intracellular Antioxidants and Enzymes
  • Glutathione Peroxidase (GPx): The body’s main enzyme for detoxification and for neutralization of free radicals (oxidative stress). This biomarker measures your current blood levels.
  • Superoxide Dismutase (SOD) I: Levels of an intracellular antioxidant that resides in the cytosol (inside your cells). More association with conditions like ALS.
  • Superoxide Dismutase (SOD) II: Levels of an intracellular antioxidant that resides inside the mitochondria. More association with fatigue and cancer, and general health status of mitochondria.
  • DNA Damage
  • 8-OHdG: 8-hydroxy-2′ -deoxyguanosine is tested via a first void urine test to show levels of oxidative stress in the body. This marker is supported by over 1000 research studies. See the Pubmed entry here.

Mentioned But Not Recommended by Dr. Cheryl Burdette

    Lipid Peroxidation
  • MDA (MalonDialDehyde): MDA is one of the most widely used markers for lipid peroxidation found in the research.
  • TBARS Assay (ThioBarbituric Acid Reactive Substances assay): As with MDA, this marker has been used extensively in the research.

Lab Tests

The Tools & Tactics

Supplements

  • Curcumin: Bioactive compound in the spice turmeric. Works as an antioxidant in part through the process of hormesis – a low-dose form of stress that stimulates the stress adaptation response in a healthy way. The most effective forms of curcumin are Curcumin BCM95 and Liposomal Curcumin. Learn more about hormesis in episode 8 with Todd Becker.

People and Other Resources Featured

Other Organizations Mentioned

  • JAMA: The Journal of the American Medical Association, also the most widely peer-reviewed journal circulated in the world. JAMA covers general medical topics with no specific focus.

Full Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Cheryl Burdette, thank you very much for coming on today. It is a real pleasure to have you on. I was recently at a conference where I saw you highlight the importance of oxidative stress biomarkers for working on both disease conditions and aging. Could you give us a quick overview of why you think it is an important area of biomarkers and where it is most useful?

[Dr. Cheryl Burdette]: Absolutely. I think that the reason that these are important biomarkers are because they help us to answer some of the critical questions that we are looking at when we seek out preventative medicine and when we are trying to slow an aging process in the body or to turn down the inflammation of a pathology. And so oxidative stress markers, simply put, are ways that you can measure antioxidant status in the body.

And you are hard-pressed to find somebody out there who hasn’t heard that antioxidants are good for us or the fruits and vegetables that are the things that protect our DNA and lower our risk of cancer and heart disease and really the major players out there in terms of pathology; however, for some reason they are not routinely done. And so, for example, a marker called 8-OHdG, a hydroxy-2 deoxyguanosine – long name.

But basically it is a simply first morning urine that tells you you have too many free radicals in your body and it tells you if the DNA is being damaged. And when we go to the research and see how predictive is this marker, how strong is this marker, if we look at the peer-reviewed research in the past five years, you find about 1,000 clinical trials that show that it is predictive for things like cancer and heart disease.

Yet for some reason it is not routinely done yet. So that was another part of my drive for starting the lab, to be able to take these well-researched biomarkers and make them more available to people so that we could use them to help predict health, and to have better outcomes.

[Damien Blenkinsopp]: So you mentioned cancer in particular there, but where are the main areas where most of the research is being done? I also saw you talk about things like neurology, neurological conditions. Now what would you say the brunt of the research that is already existing has been done relating these two issues and things we can track?

[Dr. Cheryl Burdette]: So when we talk about oxidative stress it would depend on which marker we are speaking to and if we are talking about 8-OHdG, then that one probably is most often seen in terms of a risk factor for cancer. The higher it is the more damage there is to your DNA, and the more damage there is to the DNA, the increased chance there is for cancer occurring.

So, for example, we can think of cancer as a seed and not every seed will always sprout, not every seed will always produce a plant; however, if the environment is right around that seed this is what allows it to grow. So if 8-OHdG is high, that is an environment that is more favorable to a cancer growth. If we can see it is high then we can do something about it. We can increase antioxidants in our diet, we can use certain nutraceuticals to help with that.

But this is not the only oxidative stress marker out there, there are also markers for how damaged our fats are in addition to DNA or how damaged the mitochondria is or how damaged proteins are and so when we are looking at the body of neurological evidence now you look at a marker called F2-isoprostane. WHen this is high it tells us about our fats being damaged. Well, the brain is 85% fat, the outside of the nerve is all made up of fat, and the membrane of every cell is made up of fat. So if your fats are damaged then you are more likely to have conditions where there is fat in the body – i.e., your central nervous system, your peripheral nervous system, as well as cellularly.

So in general we see a lot of oxidative stress research around things like cancer, heart disease, and neurologic conditions. And from there you would pick and choose markers. Certain ones will have certain strengths base don the tissue type and based on the condition.

[Damien Blenkinsopp]: So as I understand, you have talked about lipid peroxidation and DNA damage markers there. As I understand it there are kind of two ways to look at this. There is the direct measure of oxidative stress and damage, which is already being done and the two markers you brought up, look at that. And then there is also reduced antioxidant status in the cells. Is that the correct way to look at it coming from those two perspectives?

[Dr. Cheryl Burdette]: Yes, absolutely. I would say that is spot on.

[Damien Blenkinsopp]: Okay, so some of the other areas that I saw that you are looking at, you have the antioxidant intracellular status and the enzyme assays – could you talk about those a little bit in the context of those?

[Dr. Cheryl Burdette]: Absolutely. So glutathione is our major intracellular antioxidant. What that means is the antioxidant that is most preferred in the tissue – so when we take in things, for example people may have heard of resveratrol from grapes, that is in wine and is associated with longevity and what is called the French paradox – even though they eat more fat they don’t get fat, and why is that?

Well, because of the resveratrol and so these plant-based antioxidants will often have the effect in the body of increasing our own production of glutathione and that is one of the more powerful ways that they work, to turn on our own antioxidant systems. So we can measure something like glutathione to see if people have the right level of this in their cells and then when we think about okay, what is that associated with?

Higher levels of glutathione are associated with a low risk of cancer, low risk of neurologic conditions, and glutathione is the major intracellular antioxidant for the liver. So it helps us to detoxify and keep up with toxic body burden from the environment and from chemicals on food, etc. It is also a highly-useful antioxidant in lung tissue. So if it is low you are more at risk for different respiratory conditions and we can use it as a treatment.

By increasing glutathione status in the lung tissue you will see improved respiratory outcomes and you will see decreased shortness of breath and a wide range of improvement. If you think about it, if every cell needs glutathione then increasing the levels can help many, many things.

[Damien Blenkinsopp]: Great, one of the things I was thinking about as you were talking about that, on this side we have the resources or the capacity to fight oxidative damage. So with glutathione, for instance, you are looking at that. Does that necessarily mean that our DNA damage markers and our lipid peroxidation markers – there is actually going to be damage?

Or can that also be if someone has had a very solid diet and they have lived a very healthy lifestyle with plenty of antioxidants, could those markers be higher than usual? And would the opposite be true – would they have used up, if they have some kind of chronic condition, would they have used up a lot of those resources, these antioxidant and glutathione peroxidase, so they would actually be lower and that is how you use it? You can use it as an indicator that there could be some chronic issue there because it is used up, even if perhaps it is not lipid peroxidation or DNA damage?

[Dr. Cheryl Burdette]: It’s an excellent question. So typically if you have high levels and you have strong levels of glutathione you should see less levels of damage in the system, less damage to the DNA, less damage to the lipids, and less damage to the protein; however, there will be times when let’s say, for example, maybe somebody has a chronic viral load and the infection is brewing but it hasn’t created symptoms yet and you can begin to see a depletion of glutathione before harm is done.

And so it allows us to capture things early and then also to intervene so that we don’t continue to slide into a state of disrepair. So on one hand you would think maybe if I am low on this antioxidant I would feel it but for example we measure things like cholesterol once a year for heart disease and we don’t necessarily feel it when that is increasing. The same could be true here. Your glutathione could be decreasing and you might not have outwardly signs yet but if we take time to look at it we can capture this trend and we can treat accordingly.

[Damien Blenkinsopp]: Right, right. And i think people are interested in longevity and human performance, whether it be in terms of brain performance or physical performance in terms of athletics or fitness and so on – would these markers, do you think it would be a useful thing to keep an eye on them in those contexts also?

[Dr. Cheryl Burdette]: Absolutely. That is a great point that you bring up. First of all, preventing pathology, but also optimizing. Because glutathione is the major intracellular antioxidant it is critical to the part of the cell called the mitochondria and the mitochondria is the part of the cell that makes energy, or ATP. So that ATP is what gives us energy, what gives us good performance, what gives us good muscle building, etc. So inherently necessary for optimizing performance as well.

[Damien Blenkinsopp]: So there you are talking about – correct me if I’m wrong – are those the enzyme assays, so superoxide dismutase I and II that look specifically at the mitochondria?

[Dr. Cheryl Burdette]: Yeah, so superoxide dismutase I is in the cytosol, and II is the one specific to the mitochondria. So the one specific to the mitochondria helps to improve function there, lets us know that the mitochondria is recovering like it should, and if we see that low then we can choose the right things to increase that, and know that we need to do more mitochondrial work.

[Damien Blenkinsopp]: Okay, great. So with these it looks like you can actually identify where different problems are; however, why is it that when we have oxidative stress in our bodies it doesn’t necessarily affect the whole body? You are talking as if it is different parts of the antioxidant and oxidative stress systems that will potentially give different patterns.

You take all of the biomarkers and it will give a different pattern depending on the chronic disease you have or the potential issues you have or potentially you are dire in antioxidants. Is that what you have seen in the labs? That people can have different patterns which can show you interesting facts and sort of paint different pictures? Or do you find it can be more or less across the board that there are problems?

[Dr. Cheryl Burdette]: It depends on the markers. So the glutathione might have more ubiquitous issues because again that is the antioxidant everywhere, but yes, you are absolutely right – certain markers are more associated with certain conditions. For example, that is why i choose to not do a total superoxide dismutase and tease them out because one is in the cytosol of the cell and it will have more association with particular conditions like ALS, whereas the one in the mitochondria has more association with fatigue and cancer. So if you are just lumping them all together you won’t get that picture.

[Damien Blenkinsopp]: Right, perfect. When I was looking at this I saw there were at least 30 biomarkers currently available in labs related to oxidative stress in some areas. Why is it that you chose these particular ones? I noticed that some of the areas you haven’t looked at include protein oxidation. You mention this a little bit – protein oxidation and nitration, the reactive oxygen species, assays, and RNA damage and repair. Could you talk a little bit about what you see the merits are and why you made the choices you did about the markers you chose?

[Dr. Cheryl Burdette]: Yes, I think the first thing is I wanted markers that were extremely well-researched. So like the 8-OHdG, if we just look at the past five years, over 1,000 clinical trials with that marker in terms of predicting oxidative stress and free radical loads. So that was my first consideration – do they have a strong body of research? Are they clinically relevant?

So I chose the ones that had the highest clinical relevance and then of course as a lab, the second part is how reproducible are they? How stable are they? How much changes once it goes into the test tube from coming out of the body? So, for example, F2-isoprostane, that is a lipid peroxide. That is a marker of how damaged fats are. And there are other lipid peroxides out there and people – some of the more common ones are things like T-BARS or MDA; however, those are not produced in the body so the T-BARS – the RS on the end of that stands for ‘reactive substance.’

And so it is an extrapolation that is done in a lab and it is a pinnacle reaction that is used to then say, okay, but we don’t make T-BARS inside of our system. They are not endogenously produced. It is extrapolation that is happening in the body; however, F2-isoprostane we make – it comes when you measure the blood. There is F2-isoprostane in it and so it is a better marker because it is more directly related to pathology and symptoms.

So two things for me, how evidence-based is the marker and then how reproducible is the marker as well. So those are the things that I look to. A third thing is then is it unique, does it bring us new information that we are not able to get? So as clinicians, one thing that you will often notice is you will go to the research, you will read about something, and you will think, ‘Wow, that is fascinating. I didn’t know that could be looked at. I didn’t know that could be measured.’

So an example is an enzyme called diamine oxidase, and that is something that we measure – it is the enzyme that degrades histamine. Well, you can see if you have a lower level of that you are going to be more at risk from anything that is histaminergic, meaning yes, of course hives, itchy eyes, runny nose, but also headaches and guy issues and a whole host of symptoms that can be made worse in a high histamine environment.

So you read about this and you say, well, how interesting that would be to know my body’s ability to break down histamine. But then you go to laboratories and you can’t find it. So a lot of these things are very heavily researched in academia but for some reason don’t make the crossover to be available to the general public. So that’s another focus for me as well, taking things that are highly researched and making them more available.

[Damien Blenkinsopp]: Right. I noticed one thing that you have done and correct me if I am wrong you have two different panels. So you have grouped a lot of the markers that you have been talking about today – you have grouped them into one panel so you take those all at the same time. Is that correct? I think you have a blood and a urine panel.

[Dr. Cheryl Burdette]: Yeah, we have probably 20 different panels that we offer – some are blood, some are urine, some are saliva, and some are even hair and some are stool – it just depends on what the best specimen is for what you are looking at. But yes.

[Damien Blenkinsopp]: Is this all on oxidative stress?

[Dr. Cheryl Burdette]: No, we have an oxidative stress profile, a leaky gut profile that looks at zonulin and diamine oxidase and lipopolysaccharide with a neurotransmitter profile that measures things like serotonin, epinephrine, and norepinephrine, adrenal stress testing, thyroid testing, heavy metals.

[Damien Blenkinsopp]: What I was trying to get at is have you tried to simplify – because you are saying each marker should kind of contribute something which is unique to decision-making and tracking and understanding status. So have you combined all into one oxidative stress profile the markers we have been talking about today? Or do you have two or more?

[Dr. Cheryl Burdette]: It’s a little bit of a tricky question because so many things can result in oxidative stress. But in general, the ones that are more intimately considered oxidative stress markers are on that profile but from a clinical standpoint you never have to order the entire profile. You can order single analyze – that is something that is more appropriate for that patient. Let’s say you do the entire profile first and only one thing is abnormal.

For followup purposes you can just run that one thing so that it is less expensive and more targeted to that patient; however, there are a couple of other markers that might get to the question of oxidative stress that are on different profiles – like on my cardiovascular profile, oxidized LDL. And so that is definitely a marker of oxidative stress and it is the truly bad cholesterol.

So people are taught that LDL is the bad cholesterol but it is once it is oxidized, the fat, that the whole story changes. LDL is taken up by the liver and it is utilized in cell membranes and in the brain. But once it is oxidized the liver can no longer recognize it and that is when it starts to be moved instead into these plaques in our arteries.

That does not occur until it is oxidized. That is definitely a marker of oxidative stress but it is not on that profile, it is on the cardiovascular profile.

[Damien Blenkinsopp]: And just to be clear, that is not typically available? Because we have all had cholesterol lab tests and it is pretty general to get your LDL and so on. But that is not a typical test to get?

[Dr. Cheryl Burdette]: No, and it is a great example of what I am talking about. Even journals like JAMA say that it is 17 times more predictive for heart disease than cholesterol itself but yet it is not being routinely offered. The research is much stronger than oxidized LDL and it would give you different treatment options too because if we’re trying to produce the LDL, which is the opposite of oxidizing – oxidizing is when it is charged by a free radical, reduced is when you have antioxidants to accept that free radical. And so if we are trying to reduce it so that it doesn’t become sticky and doesn’t become a plague former.

Then now you are going to use different treatments than just lowering the overall level. You are going to add more CoQ-10. You are going to add things like sulforaphane from broccoli sprouts. It improves our ability to treat these things too.

[Damien Blenkinsopp]: That’s great. So who today is actually using these? When it comes to Dunwoody Labs, what sort of people are using these markers and how are they using them? You mentioned some people use just one marker or some people use a whole panel. So what kind of trends do you see in the moment? Who is using what?

[Dr. Cheryl Burdette]: Because we’re a laboratory, you have to have a physician’s orders in order to get to the testing. So obviously, doctors are the people using them but more specifically the type of doctors that tends to be ordering these are what I would call an integrated physician practicing integrative medicine.

And these are people that are combining things like pharmaceuticals or standard of care, but adding to that – adding lifestyle interventions, adding vitamins, adding supplements, adding these other pieces and so these are typically people that have seen limitations in standard of care and so they are looking for more cutting-edge biomarkers to match their more cutting-edge therapies.

[Damien Blenkinsopp]: Great, thanks for that. Are there any particular trends that you have seen at all in the types of those? You said integrative medicine, but I don’t know, are there different areas of the US which seem to be working more on this? Do you work internationally? Are there specific cases, like you have seen a lot of people using cancer or for other chronic conditions?

[Dr. Cheryl Burdette]: In terms of areas of the country, interestingly I would have had a different answer ten years ago. There were more pockets where you were seeing it, and you likely might expect more West Coast, maybe a little stronger up in the New England area, but really now it has permeated much more than just kind of the periphery of the country.

People everywhere want good medicine. And good medicine demands that we think about lifestyle, that we think about diet, and that we look for better answers because nobody out there would say that we have the best answer to cancer, heart disease, or even the common cold yet.

So there is a lot of area where we still need to dig deeper. We need better answers, and we need better treatment. And so i am finding that really it is not just pockets of the country, but it is everywhere. And it is international as well. So we have associations with labs in South Africa and England, so really people are demanding better answers to help solve problems.

[Damien Blenkinsopp]: So you talked about a few areas where there is a lot of research. Which areas do you think these kind of markers would be very promising or potentially you are kind of experimentally, or others are experimentally, using them for treatment. But the research isn’t strong enough and we kind of need more research to strengthen up our opinions there and the clinical evidence?

[Dr. Cheryl Burdette]: These are applicable to many areas of research and the reason for that is because so often the way we have defined conditions is to say what is the condition? And that is important, absolutely, and they need to know a diagnosis. So for example, why do I not feel like myself? Well, I have a condition, I have a diagnosis of depression.

And then the way that is approached is to say well, in depression, we know that serotonin is low, so we will give a medication that increases serotonin; however, it misses a whole piece of the puzzle and that pieces of the puzzle is that even though there is depression and serotonin is low, why i shte serotonin low?

And so it turns out that an environment that is very high in oxidative that has too many free radicals would be an environment that makes it harder for serotonin in the brain to be made. And so in research they have often been focused on here is a medication, now does it make serotonin go up rather than saying what are these other pathways, what are the other things that are influencing this level of serotonin?

So we are seeing more and more studies wanting to look at underlying cause, measuring things like oxidative stress markers, measuring things like gut health, perceive patterns for the process that is causing the diagnosis. Is there a process of toxic body burden, nutritional deficiencies, inflammation, oxidative stress, and mental and emotional stress that is contributing to this.

[Damien Blenkinsopp]: Right, right. So it sounds like you really see that there is a lot of potential across the board with all sorts of applications which haven’t been explored fully in the research.

[Dr. Cheryl Burdette]: Correct, yes.

[Damien Blenkinsopp]: So in the conference where I saw you, you talked a lot about the link between mitochondria function and methylation function and oxidative stress. Could you talk a little bit about how they are related and how one can influence the other?

[Dr. Cheryl Burdette]: Absolutely. So methylation is a very complicated topic because it is not like there is one site in the body that is methylated. We have methylation of DNA, we have methylation of enzymes, and some things that will increase methylation in one place will decrease methylation in another. You might find something that up regulates methylation in the liver but can down regulation methylation in the brain.

So it is complicated and it gets very tricky to identify that singular pathway and then modulate that accordingly; however, we know that there are broad strokes and then we know that again there is this process that can influence changes in methylation. So for example, high oxidative stress will impact the body’s ability to methylate appropriately – whether or not that is hypo- or hyper-methylation. You will see improvements with that when we lower this burden of oxidative stress.

So for example, one of the things that is really starting to be understood mroe about oxism is they have a lot of problems with methylation and this will make it difficult to turn on neurotransmitters; however, that same problem with methylation makes it difficult to eliminate toxicity from the body. And so what you see is that there is often an insult of oxidative stress that skews the methylation and it is this one process that then causes worse outcomes. And so if we can look and see how much oxidation is going on then this gives us another way to improve methylation in the body too.

[Damien Blenkinsopp]: Great, because that sounds a little bit like a vicious cycle – once you have oxidative stress it is negatively affecting methylation which, as you said, affects your ability to resolve so many issues in the body.

[Dr. Cheryl Burdette]: Yes.

[Damien Blenkinsopp]: I haven’t heard of this before. Is that something that is quite new or unique to you? Or is it something that people are starting to talk more about? What kind of stage of development is methylation versus linked to oxidative stress, as being discussed in research?

[Dr. Cheryl Burdette]: I think that you would see hints of this back even a decade ago, but really this deeper level of understanding and how intimately intertwined they are. I would say that is probably a little newer. And again it gives us – when you speak methylation you are talking about genetically.

What people are measuring is probably polymorphism and you see these little snips, these little mistakes in the DNA pattern. And there is not a lot to do about it at that time; however, if we can improve the environment of oxidative stress we can improve the ability for those damaged genetics to function better so it gives us something very treatable to go after.

[Damien Blenkinsopp]: That’s great. So as i understand it, mitochondria has a similar kind of vicious circle dynamic going on with oxidative stress as well.

[Dr. Cheryl Burdette]: Yes.

[Damien Blenkinsopp]: It is similar, right? Correct me if I am wrong, but the oxidative stress will damage the mitochondria and the mitochondria will start to create more oxidative stress, which creates a negative dynamic.

[Dr. Cheryl Burdette]: Absolutely, and so while I characterized that marker 8-OHdG as a marker for DNA damage, what they are seeing in the research is that the damage in the DNA will also influence expression of the mitochondria too, so you can think about it as a marker for causing damage there as well.

[Damien Blenkinsopp]: Okay, so looking at some kind of typical scenarios where you have been using these biomarkers and found them of the most use, where would you say they are very useful for assessment of status, for help with diagnosis at the moment? Where would you mostly use them or mostly see the types of tests that people are most using it for at the moment? In which kind of cases?

[Dr. Cheryl Burdette]: Well on one hand, in my ideal world, I would love to see most people looking at their markers of oxidative stress once a year. And the reason for that is because I find them to be highly more preventative in their nature than cholesterol ever thought of being, for example. So if once a year we could get an idea of antioxidant status in our system and know if our antioxidant level is keeping up with damage in our body, it just gives us a much better window into prevention.

But otherwise if we are thinking about them in terms of where is oxidative stress, what pathology is oxidative stress most linked to, then I would say that the area where that shows up the most is probably cancer, heart issues, and neurologic.

[Damien Blenkinsopp]: Is that to assess status, like how bad it is? Is that kind of what you are trying to do with that?

[Dr. Cheryl Burdette]: You are trying to assess the environment and that pathology that it is in. Is this an environment that is going to cause the pathology to flare more? Or is this an environment that is a possibility of remission?

[Damien Blenkinsopp]: Right, great, so it gives an indicator. So you mentioned that it would be appropriate to get these taken once a year. Does that vary per biomarker? Basically, how quickly did these change in values over time? Are there some markers that it is relevant to take more often?

I mean, depending on the context as well. So for instance, someone who is just healthy and they and they just want to understand the level of oxidative stress for aging or performance preferences like optimum health, would it be most appropriate for a year because they don’t really change that often?

[Dr. Cheryl Burdette]: So if you were in a state of pathology, many pathologists deplete your antioxidants, so that is going to cause them to change more frequently. If we are generally well then once a year is probably enough because we are not seeing huge shifts in the system.

But any time there is a pathology or it gets advancing then I would say you want to look at it more often, maybe every three months, to make sure that you are changing the environment so that the pathology doesn’t continue to flare.

[Damien Blenkinsopp]: To go kind of out on this, if you do the intervention, say you did a month intervention would it be worthwhile redoing these biomarkers of oxidative stress tests again, or would you have to wait for three months because it isn’t really enough time to assess any change?

[Dr. Cheryl Burdette]: Some will change more quickly than that but in general to really get to see saturated and to really change terrain, you want to get the body – it is more of the body probably. You want to give the body – it is more the body, probably. You want to give it a good three months to really have that opportunity as it is more like building a muscle. That doesn’t happen overnight.

[Damien Blenkinsopp]: Right. So are there any inaccuracies or confounders to this data? For example, do they vary, a bit like cortisol can throughout the day? Does it vary throughout the day so that it would depend on what time of day? Are there any other confounders involved in how you collect the data that you have to be careful of?

[Dr. Cheryl Burdette]: Yes, some can change throughout the day; however, if the marker that is susceptible to that, then we do things to control for that. We say this one has to be withdrawn fasting in the AM before a certain time. So depending on the test it will do some things to adapt to that; however, if there aren’t specific instructions in terms of collection then know that those are the ones we have found to be stable when we look at multiple samples throughout the day and throughout the week, that they are consistent.

[Damien Blenkinsopp]: You mentioned also earlier that you try to choose the best, most accurate labs, which don’t have issues that say they move out of the body. I know you have seen labs in the past where you can get them taken and sometimes if they are not frozen immediately with the correct protocol that can skew the lab values and then you have got inaccurate data.

Are there any of these markers which require kind of a very careful protocol which has to be followed? Or are these kind of like standard blood tests where you can basically just give the blood sample and as long as you get the blood sample in reasonable standard condition it is fine?

[Dr. Cheryl Burdette]: So we have checks for that too, so when we receive a sample if it looks off for any reason, if it is hemolyzed or something of that nature, then we notify the clinic that we reject the sample. We we don’t run anything that we are suspicious of how it how it looks, but otherwise we have tried to choose things that are pretty stable because just for that reason, it will improve the validity.

Now, some things have a timeline so many of them will have them shipped overnight or shipped with ice to help preserve the quality of that specimen. And then we are very picky about, from our end, on receiving how quickly those things get processed and even moved to a -80 freezer in order to store these things in a way that they don’t degrade.

[Damien Blenkinsopp]: Right, that sounds like standard procedure, rather than any of these markers having specific instabilities, which would mean it would be more difficult – I think I am thinking of TGF-beta I and markers like that. I may be wrong here, but I have had had a history of the values being different based on the way the blood was taken.

[Dr. Cheryl Burdette]: Absolutely. So we try to do a lot around education. Every kit comes with very specific instructions that whoever is drawing it should follow and so we try to do a lot around quality control.

[Damien Blenkinsopp]: Right, so you have leaflets and brochures explaining how it should be taken. Because these are getting drawn now in different places, right, your samples?

[Dr. Cheryl Burdette]: Right every tube for every draw comes with a set of instructions that says exactly how it should be handled.

[Damien Blenkinsopp]: Okay, so at the conference you talked about some specific interventions which may have an impact on some of these markers. I would love for you to talk about those a bit. Now, you talked about things like [inaudible 00:34:32]. Which interventions have you found to be effective against these markers and to effectively lower them or increase them in terms of the antioxidant status?

[Dr. Cheryl Burdette]: In general some of the things I have found to most profoundly shift these markers of oxidative stress are nice, bioavailable preparations with things like percumins and cuminoids and those are compounds that come from turmeric and when those are put with certain black pepper extracts that really increases the plasma bioavailability and to see various shifts of the markers.

Also things like sulforaphane, which comes from broccoli, that I have seen be quite helpful in terms of improving glutathione and lowering F2-isoprostane; however, the interesting things about it is what is going to be the most effective for shifting the marker is going to be to treat the pathology – to treat the cause of what is going on.

And so sometimes it is not an antioxidant at all, but figuring out there is an underlying infection and getting that under control, or figuring out that there is some heavy metal toxicity and lowering the toxic body garbage. Or figuring out that there is a particular nutritional deficiency and increasing that or figuring out that somebody’s main reason for the oxidative stress is coming from a gut issue and treating that accordingly.

So that can be one thing that is really nice about these markers. There is no profile out there that is going to measure every chemical and every bug and every exposure that we have that you can see that it is doing damage to the body and now you can track that to make sure you are getting improvement.

[Damien Blenkinsopp]: RIght. So have you seen scenarios where you talk specifically about pathogens and infections and metals where you have targeted those or moving those and you have seen these markers improve without adding [inaudible 00:36:25] or any other thing to help with the markers?

[Dr. Cheryl Burdette]: Yeah, Lyme disease is a good example of that for two reasons. First of all, the infection itself is hard on the mitochondria and then second of all many treatments that are used for Lyme involve antibiotics and in fairly high doses and long term. So in terms of getting those up, treating the Lyme infection will help to improve some of the glutathione status and the mitochondrial status. So yeah, definitely, we see it all the time.

[Damien Blenkinsopp]: So does alpha lipoic acid have an impact on the oxidative stress or is it more working around moving heavy metals, so it is kind of working around the origin of the problem rather than the oxidative stress itself?

[Dr. Cheryl Burdette]: Things like alpha lipoic acid have so many different ways they work in the body that I think that is the nice thing about it. One the one hand it is a gentle chelator but it is a big chelator of metal, so it is a lower toxic body burden. on the other hand it is going to even just decrease the lipation of the foods you eat, which is going to decrease oxidative stress on the body that way.

It will facilitate and acetylcysteine part of the peptide that makes up glutathione and helps to pull that into the cell. So it helps to make glutathione that way. It recycles glutathione so that is the other way it is going to reduce oxidative stress. So think that is the beauty of the natural therapies, that they are not limited to just one mechanism by which they work and that is why we see such changes in things like that.

[Damien Blenkinsopp]: Great, thank you. We are coming towards the end of the interview now. There is one particular dynamic that I have seen discussed quite a bit lately, and that is there can be too much antioxidants. So I was wondering if these biomarkers, some of them have a U-curve or an N-curve, I guess you could call it also.

There is an optimum value and if it is too high often people will look at it in the media and the news and it will be like the more antioxidants you can get the better, no matter how much you take. So potentially you can take a ton of [inaudible 00:38:24], for example. But do you see scenarios where you could be overloading the body with antioxidants and it would push it the other way and cause problems to people who are potentially thinking about being aggressive with these kind of antioxidative stress strategies? Do you see that kind of dynamic in the labs?

[Dr. Cheryl Burdette]: You can, like for example there is a condition where if someone is missing the enzyme to recycle glutathione that can build up and that can even cause certain pathology; however, it is hard to do on planet earth. We are so assaulted by pollution and junk in the air and junk in our food that it is more difficult to overload in terms of the antioxidant piece of it now.

On the other hand, for example one of those markers we are talking about, 8-OHdG, there is more oxidative stress and to my knowledge there aren’t studies that talk about that if it is too low being a problem. But you could have an overload of an antioxidant causing issues elsewhere, it is just that 8-OHdG is not predictive on the low side for the condition.

[Damien Blenkinsopp]: Right, I see. So it is kind of missing the DNA breakdown because you are keeping it low. Because I understand that your 8-OHdG is a blood marker for damage that has taken place. Is there any way that you can have DNA damage taking place but somehow you have suppressed that marker? Is that what you are saying?

[Dr. Cheryl Burdette]: Well I don’t know that there are conditions that are associated – I don’t know that it is bad to have low DNA damage is I guess what I am saying. I don’t know that.

[Damien Blenkinsopp]: It sounds like in general in the labs you haven’t seen any – it is better to have high antioxidant status on one side of the markers and low damage and you haven’t really seen any cases where that isn’t the case?

[Dr. Cheryl Burdette]: Absolutely. I mean I am with you though. We have to have some oxidative stress. That is what causes us to have improved performance with athletics and some oxidative stress that comes up opens up our blood vessels. So yes, it is absolutely possible.

[Damien Blenkinsopp]: You just mentioned athletic performance oxidation. Do you have benchmarks? Would you be able to tell the difference to someone who has been training too heavily, for example, or when someone is not training? Can you tell the difference between someone who exercises a lot every week and someone who doesn’t based on oxidatives tress?

[Dr. Cheryl Burdette]: Yes, because in general even though exercise creates some oxidative stress when someone is performing well they will have better recovery. And so you won’t see DNA damage. You won’t see damage to the fats because those are more long term and they are more tissue markers and more of that long-term status.

So what you are seeing is that someone is not recovering from that oxidative stress that the exercise is creating and that is markers that start to go up. And I think of a particular patient who was a triathlete and she was not seeing improvement in her performance anymore and she was having troubles with recovery. When we got her oxidative stress markers down into more of a normal range then her performance picked up again.

[Damien Blenkinsopp]: Which markers specifically in that case were out of range?

[Dr. Cheryl Burdette]: Her 8-OHdG was elevated and her total glutathione was low.

[Damien Blenkinsopp]: So you basically helped her to rebuild the glutathione. Was she training too much? What did you link for the 8-OHdG to be too high?

[Dr. Cheryl Burdette]: Actually, interestingly it was part of the training but she ended up being one of those who had an underlying infection as well. So when we got her infectious load down her 8-OHdG came down and her marker of oxidative stress. Her performance went up and we also saw an increase in her white blood cell count.

[Damien Blenkinsopp]: I think you make a great, important point there. I think a lot of people are seeking – when you try to push yourself to performance, maybe it is working extremely hard or it is like doing fitness and athleticism. If you see problems in your performance it could well be there is a tiny infection or other issue that is holding you back.

So it is probably worth looking at these oxidative stress markers and that might help you. And seeing a physician to see if that can be resolved, then you can get back to performance. So it is interesting that people should really be thinking about this if they are suffering in their performance and what they are doing.

[Dr. Cheryl Burdette]: Absolutely, and you see a lot that just the wear and tear of training is a big deal. For example, athletes are uniquely susceptible to leaky gut all the time and [inaudible 00:42:41] less time than it takes to digest, so they will have markers of leaky gut that are off. And then when we treat those the oxidative stress improves as well.

[Damien Blenkinsopp]: So we talked a little bit about how these markers aren’t so widely available at the moment. What do you think are the main challenges to get them? What can be done to spread the use of these oxidative stress markers more?

[Dr. Cheryl Burdette]: Education – I think that people understand that having good antioxidant status is protective and preventative. Just the more we understand about them, I think the more motivated people will be to look at them. But the education needs to happen for physicians as well.

Now, in the States part of it is the way that our healthcare system is structured in that our health care says if things are for prevention they are given certain codes and these are less likely to be reimbursed by insurance companies. Now, as backwards as that seems you would think that insurance companies would be interested in prevention but it is not quite logistically the way it is set up at the moment. So education of patients, of physicians, and of our infrastructure too.

[Damien Blenkinsopp]: Okay, so what kind of things do you think will help or that you are carrying out in terms of projects at the moment, to improve the education? I know that you do a lot of conference talks.

[Dr. Cheryl Burdette]: Yes, absolutely out there they are talking about these things. But that is another reason that Dunwoody Labs is so intimately involved with research, because the way we are going to make our big breakthroughs is to publish more, to get the data out there, and then when that happens and we are able to validate these things more and more they will end up in clinical practice.

And so unless we support this research, we are never going to see that happen. So I am a big advocate of that and more training as well, increasing things like nutritional training in medical schools. All that will be important to really seeing a shift.

[Damien Blenkinsopp]: Great, thank you for that. Now, looking towards the future – I know in the next ten years, are there any areas you are looking forward to with excitement? In terms of the evolution of these markers. Are there new markers that are going to be available? New tests or anything interesting that is going to happen over the next ten years that you can foresee that is going to be pretty cool and going to help us to see a lot more?

[Dr. Cheryl Burdette]: Yeah, I think that what a lot of these markers are coming out and helping us to realize is that I think before there was a focus to find a biomarker that was shifted by a drug, and if you had those two things together – a drug and a biomarker – then that was really the package that healthcare was looking for to sell, so to speak. However, I think a lot of these markers that are coming out now, what the natural consequence of them is is that the real way you would treat them would be to change the diet, to increase exercise, to make some lifestyle changes.

So I think we are seeing more and more emphasis on markers that let us know about how lifestyle is affecting us and therefore more and more people will be motivated to change that. But beyond that the second thing I am really excited about is we are bringing on a suite of genetic testing and this is just fascinating because now I can look at somebody’s genes and I can say, ‘Based on your genetics, here are some of the functional markers that we need to look at once a year in you.’

So you could even individualize someone’s testing workup based on areas of weakness and you could say based on your genetics you should not take this medication because you are more likely to have these side effects or it just won’t work for you or here is a botanical that makes the most sense for you based on your genetics. Here are some food interventions that make the most sense.

[Damien Blenkinsopp]: That sounds great for preventative health, in particular. So what kind of time table are you looking at for that? Is it five years? A lot of people get 23 and Me today. Is that something you can use or does it need to be a lot more specific than that?

[Dr. Cheryl Burdette]: I think that is a great start and it gives you some information. But we are bringing on this genetic testing and it will be in the next month or two.

[Damien Blenkinsopp]: Well that’s great to hear. Cheryl, thank you very much for your time today. It has been a great chat and we have learned a lot about these markers. I look forward to seeing them in the [inaudible 00:46:40].

[Dr. Cheryl Burdette]: Yeah, thank you for having me on. I really appreciate it.

Leave a Reply

Are your autoimmune and chronic health issues driven by mitochondrial damage? Could nutritional and other simple approaches targeting improved mitochondrial function provide the answer to many of our modern day ailments?

When we think about health risk, and reducing it, most of us are thinking about cancer, heart disease and strokes.

Autoimmune and other chronic health conditions aren’t top of mind, because they don’t tend to get the same attention in the media – and have much smaller research budgets currently.

But if you look at the numbers you are statistically much more likely to face autoimmune problems in your lifetime than heart disease or cancer or stroke.

In the US at any one time it’s estimated there are 9 million cases of Cancer, 22 million of heart disease and between 23.5 to 50 million cases of autoimmune disease. (Source: National Institutes of Health, American Autoimmune Related Diseases Association)

Autoimmune disease is becoming a growing collection of diseases as researchers identify more and more diseases which have autoimmune mechanisms behind them. Diseases assumed to be included are big names like Alzheimers, Parkinsons and Arthritis to name the best known.

But if we came to understand autoimmune diseases having a common mechanism – like mitochondrial health, that could quickly change how we look at treating all of them.

Today’s guest is currently running clinical trials to evaluate the impact on autoimmune disease of a “simple nutrient dense” protocol – a protocol that enabled the researcher herself to recover from one of the worst autoimmune diseases – Multiple Sclerosis. The basis for her protocol was supporting recovery and repair of the mitochondria.

“The fact that I have improved to such a dramatic degree really means that the current understanding for multiple sclerosis has some gaps in it because this would be considered not possible.”
– Terry Wahls

Dr. Terry Wahls was diagnosed with secondary-progressive multiple sclerosis in 2003. This is the irreversible form of MS and by 2007 the disease had progressed to the point that she was restricted to a wheelchair and unable to walk.

But in 2007 she turned her condition around, taking her first steps within 3 months, and riding a bike again before the end of the year. Hers is the only known recovery from Secondary Progressive MS, and has been based on insights she took from published research on mice mitochondrial health amongst other things.

In this interview we dig into the details of her current clinical trial, some of the biomarkers she tracks, and her views on linking mitochondrial health to autoimmune and chronic disease, and how nutrient based treatments can work to heal these conditions.

The show notes, biomarkers, lab test and links to Terry Wahls and everything else mentioned are below. Enjoy!

itunes quantified body

What You’ll Learn

  • Terry Wahls explains her degree of recovery as it stands today including remaining symptoms from Secondary Progressive Multiple Sclerosis and gives the context to this recovery, as she is the only known case
  • An overview of the clinical trails that Dr. Wahls has been leading, their current status of progress, the results and the research to be done as next steps
  • The broader range of autoimmune, neurological and chronic diseases that Dr. Wahls is treating with her protocol
  • The top areas Dr. Wahls is receiving positive feedback as to efficacy of her protocol – including Multiple Sclerosis, Parkinsons, and other autoimmune diseases
  • Improvements in quality of life and performance that healthy controls, such as the researchers working on the trials, have experienced with the Wahls protocol
  • An overview of the Wahls protocol and how it works
  • The methylation, epigenetic and mitochondrial mechanisms behind disease and why the symptoms vary so much despite having similar mechanisms behind them
  • The concept of “nutritional reserve” and how it can be a balancing act as you recover to keep this building (especially where travel is an aspect of your lifestyle)
  • How the Wahls protocol provides for many many times the RDA nutritional recommendations and why
  • The list of biomarkers Dr. Wahls uses in her clinic, in her clinical trials for research and for her own personal tracking.
  • Dr. Wahls’ view of the effective use of the various testing labs currently available considering economics and insights or useful information they can provide.

Thank Terry Wahls on Twitter for this interview.
Click Here to let her know you enjoyed the show!

Dr. Terry Wahls and the Wahls Protocol

Specific Research & Studies

Tools & Tactics

Diet & Nutrition

  • The Wahls Protocol: Incorporates the nutritional, exercise and lifestyle guidelines that Terry Wahls has tested, devised and which she is working on validating through clinical trials.
  • Increase Nutrient Density: A key pillar of the Wahl’s protocol is to increse the nutrient density of the diet. The idea is to provide sufficient nutrients for the body to be able to repair the functioning of the mitochondria, which as a knock on effect reduces autoimmunity.
  • Learning How to Cook: In her years of experience working with MS patients Terry has found that one of the most important steps is that a person (or family) learn how to cook the types of nutrient dense meals that fit with the Wahls protocol. In her experience this is the biggest hurdle that people wanting to implement the Wahl’s protocol face. This includes the basics, such as how to stock your kitchen with the right foods, to having clear recipes that fit with the protocol. Having recipes for smoothies, juices, salads, soups, and other meals that can be quickly prepared and are of reasonable budget make or break the protocol for most people.

Tracking

Biomarkers

  • Serum Vitamin and Nutrients: Dr. Wahls uses standard blood vitamin and nutrient labs to follow her own progress. She likes to see the values in the top quartile (top 25% of reference range), and mentioned specifically the B vitamins, this would be including Vitamin B12 and Vitamin B9 for example.

In Dr. Wahls Clinic she uses:

  • Lipids (e.g. LDL, HDL, Triglycerides, Total Cholesterol): Markers of cholesterol are commonly used with primary docs.
  • Homocysteine: An indicator of inflammation and of how well your methylation processes are running. Dr. Wahls likes to see this acutely improve.
  • hs-CRP (High Sensitivity C-Reactive Protein): A predictor for heart disease, more pain with fibromyalgaia and Terry uses to track progress via lowering inflammation. Dr. Wahls likes to see this improve significantly by declining, and that it takes some time to decline.
  • HbA1C (Glycated Hemoglobin): A proxy measure of your average blood glucose levels over the last 3 months.
  • Fasting Glucose: A measure of your blood glucose in a fasted state.
  • Micro Systems Questionnaire: Dr. Wahls uses a very detailed list of symptoms to use like an index to watch with parents, and watch their progress (e.g. as the number of symptoms decline).

In Dr. Wahls Clinical Study for learning purposes she uses:

  • NutrEval from Genova Diagnositics: Vitamin and anti-oxidant levels in the cell, How well enzymes are performing in the krebs cycle and electron transport chain and the fats.
  • Urine Toxicology: Using a challenge like DMSA, Dr. Wahls looks at the presence of heavy metals in the body.
  • Microbiome: Tests that look at the biome of the gut and the ratios of different bacteria that are occupying it.

Lab Tests

  • NutrEval: Dr. Wahls uses this specific test in her current clinical trial – at this stage primarily to see what patterns emerge.

Other People, Books & Resources

Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: So, Dr. Wahls, you had a diagnosis of secondary progressive multiple sclerosis, which is worst case, as I understand it. Could you explain briefly about what that diagnosis means?

[Dr. Terry Wahls]: Most people, I would say 80% of the folks with multiple sclerosis, are diagnosed with relapsing Multiple Sclerosis. And in that case there is an episodic worsening disease called the relapse, and improvement, called a remission. Most people’s relapse will be well within 15 years, and convert to secondary progressive.

So they have no more spontaneous improvement, they simply are experiencing the gradual sudden decline. In my case I was diagnosed in 2000 but within three years I had already transitioned to that steady decline and was in that secondary progressive phase.

[Damien Blenkinsopp]: All right, so in a typical situation is there any remission from the secondary progressive stage?

[Dr. Terry Wahls]: I don’t believe any have been reported other than mine in the scientific literature. There are some books talking about improvements, but if you are looking for a case report I am on the only one who has reported an improvement like that.

[Damien Blenkinsopp]: Great, so do you consider yourself in remission today? What remaining kind of symptoms do you have?

[Dr. Terry Wahls]: I am very clear that this is not a remission because this is not in a disease phase that has remission. The fact that I have improved to such a dramatic degree really means that the current understanding for multiple sclerosis has some gaps in it because this would be considered not possible. We have done clinical trials to show that in fact this level of improved function appears to be quite possible in others as well, not just me.

[Damien Blenkinsopp]: So today what symptoms do you still have? Or do you have any?

[Dr. Terry Wahls]: I am not as strong as a 58-year-old woman my age, so I can stand easily to give a lecture for an hour but if you ask me to stand for two hours that would be difficult. That is still fatiguing. I can go out and jog a mile and a half because I am continuing to improve. I have faith that will continue to improve.

My strength continues to improve remarkably but it is probably not quite as strong as you would expect for a normal, fully-healthy, athletic, 58-year-old woman. I want to stress the key point that I am continuing to steadily improve.

[Damien Blenkinsopp]: Great, that’s great to hear. I am very glad to hear that. What are the areas that you are targeting? You just mentioned your clinical trials. What are they targeting? I heard one explanation around your latest study was clinical trials are to prove the effectiveness of a nutrient-dense Paleo diet to reduce autoimmune disease symptoms. Is that kind of the best definition?

[Dr. Terry Wahls]: Actually, that’s really pretty close. I am very interested in diet and lifestyle and I studied that for traumatic brain injury and I am studying that for multiple sclerosis. We are writing grants to study it in other disease states as well, such as fibromyalgia and Parkinson’s disease. So we will see if we can get other people interested in funding it as well.

[Damien Blenkinsopp]: Great, great. So right now it is very multiple sclerosis-focused?

[Dr. Terry Wahls]: Right, so that is where I have the relationship and the funding sources, with a foundation that is particularly interested in multiple sclerosis-related research.

[Damien Blenkinsopp]: So the first study, the pilot study, was about 20 people. Could you give a very quick update on where your studies were?

[Dr. Terry Wahls]: Yeah we had initial funding to study 20 people using the diet, some targeted vitamins, meditative practice, exercise, and electrical stimulation of muscles. Because this was such a radically new concept the institutional review board, which is the safety committee that monitors research, told us that we can enroll ten, run the study with the ten, give them safety data, and then come back and enroll the second ten.

So we have published our results from the first ten that we got enrolled and that came out in the Journal of Alternative and Complementary Medicine. And the big challenge was finding other scientists who felt comfortable reviewing an intervention that was so broad-based, so that took a bit of time to find the appropriate reviews.

[Damien Blenkinsopp]: Okay, because normally they are trying to control the variables so it is changing one thing, but you have got many interventions stacked together there.

[Dr. Terry Wahls]: Right, and that is a very unusual study design. We were really testing with good people to implement the same, very complex regimen that I did and could it be done safely. It is called the safety feasibility study. So we want to know that people can do it and that you don’t hurt anyone. Because these are small studies all you are really hoping for is to have a trend in a favorable direction because it is [inaudible 00:09:23].

[Damien Blenkinsopp]: Okay, great. and you have another study underway now. Could you talk a little bit about that one?

[Dr. Terry Wahls]: Yes, so we have actually a couple of studies I am involved with. Because the first study used diet, vitamins, meditation exercise [inaudible – 00:09:43] and we wanted to begin to break apart the study to see how important those race components were.

So i have one study that is looking just at the exercise [inaudible 00:09:53] portion of the intervention and another study that we’re recruiting furiously for right now – which is a diet and lifestyle intervention where we are really just focusing on teaching them a Paleo diet that has been structured in a very specific way to maximize nutrient density.

[Damien Blenkinsopp]: So kind of summarize what the Wahls protocol is – how would you summarize it? Is it 80% nutrient?

[Dr. Terry Wahls]: This is really very intense nutrition. I stress vegetables, green leafy vegetables, sulfur-rich vegetables from the cabbage, onion, and mushroom family, and deeply colored. So if you’re a guy or you’re a very tall lady, that is 9 cups a day. If you are petite it is going to be much smaller, perhaps in the 4-6 cup range.

And the protein is sufficient protein, like 6 to 12 ounces of meat a day. And in the first level we can do it for vegetarians and vegans then as we advance I have some additional requirements to then move the diet to a more ketogenic diet for the more advanced person.

[Damien Blenkinsopp]: In terms of advanced do you mean people who are dealing with the worst severity of symptoms or as they get used to compliance and getting used to it?

[Dr. Terry Wahls]: Well we are testing in my clinical trial to see if the ketogenic version is more defective that the standard Wahls version, so I don’t have the answer yet. In my book I talk about why ketogenic diets may be beneficial and the research that is going on in the ketogenic diet around seizures, chronic headaches, schizophrenia, Parkinson’s, and my research in MS – there is also a lot of research with cancer and ketogenic diets.

This is a very exciting area and it may be another decade before we have the full answer, but I am thinking for those who are highly motivated, highly interested in a ketogenic diets, there are health benefits. I talk about the potential risks of a ketogenic diet as well. So it gets much, much harder to maintain really excellent nutrition while in ketosis over the long term.

[Damien Blenkinsopp]: Is that because you are limited in the vegetables you can eat?

[Dr. Terry Wahls]: Yes, absolutely.

[Damien Blenkinsopp]: Okay, great. So talking about your book a bit, the Wahls protocol is positioned a bit more broadly than just multiple sclerosis. Can you talk about who you are aiming at with the world’s protocol and the book?

[Dr. Terry Wahls]: So what i have discovered in my clinics time and time again is that by using the Wahls protocol to restore the health of the cell, the health of the person over the next three years steadily improves. They often need fewer and fewer drugs. The weight falls off without being hungry, blood sugars, blood pressures normalize often to the point where no medication is needed.

The most immediate people who are going to benefit are the folks with autoimmunity or folks with a lot of pain and the docs can’t make a diagnosis. But we’re also observing that people with medical problems requiring medication often find that their medication needs steadily decline. the mental health problems also often steadily improve – anxiety, depression, irritability, focus, autism, and other neurological disorders.

We have many, many folks with Parkinson’s who have reached out to say that their symptoms do not include [inaudible – 00:13:38] and of course the folks with MS who are telling us how much they have improved as well.

[Damien Blenkinsopp]: Right, so that was my next question – where are you getting the most feedback in society as you spread the Wahls protocol and the word about it? Which areas have you heard the most feedback from people that have these positive results?

[Dr. Terry Wahls]: Multiple sclerosis and then Parkinson’s probably next. Diabetes would be probably third and then fourth I would say I have so many folks with a wide variety of autoimmune problems that are telling us that symptoms have been markedly reduced. Many of these autoimmune diseases I have not encountered before so it just lets you know about the diversity of autoimmune problems with inflammatory bowel disease, psoriasis –

[Damien Blenkinsopp]: There are like over 160 classified –

[Dr. Terry Wahls]: Yeah, and we keep adding many, many more every years. I would not be surprised if in the next two decades we begin to rethink our autoimmunity to the point where it is a matter of nearly every chronic disease having some level of autoimmune component. That is my prediction but we will see if that turns out to be the case.

[Damien Blenkinsopp]: That is very interesting. So moving kind of away from health issues and also a bit more generally, on Dave Asprey’s Bulletproof Radio you mention that some of your research staff have been using the protocol and I think also they also followed the protocol so that they understand it and while they are all healthy they have noted some positive impacts as well.

[Dr. Terry Wahls]: Yeah, actually it’s really interesting. So students come volunteer in my lab and I ask them to fill out the forms and follow the diet for a couple of weeks just so they get a sense of what our subjects have to do. So these young kids are healthy, robust, and we think at the peak of their game and they nearly always discover that their attention improves, concentration, memory, sleep, and mood improves.

Several kids had their chronic headaches go away. And a couple others realized that some of their family’s health issues could be addressed by diet and lifestyle and this had a really nice favorable impact on their extended family.

[Damien Blenkinsopp]: That’s great to hear. We have been talking a lot about acute conditions before but in terms of long term disease prevention, risks, aging, and potentially talking about cognitive performance, improvements, less headaches, and so on, do you think there is a lot of application for these areas as well, beyond the acute illness and where it started from?

[Dr. Terry Wahls]: This will be very beneficial for chronic health problems. Certainly in my book I talk about autoimmunity a great deal and then I acknowledge that my other medical issues that we don’t think of traditionally as autoimmune also seem to be dramatically helped with weight issues, diabetes, high blood pressure, cholesterol problems, mental health, and the traumatic brain injuries that I followup and take care of.

[Damien Blenkinsopp]: That’s a very broad area. In term sof the areas you see it positively impacting, are there any similarities of the issues? What are the underlying mechanics? Like the way that you are looking at it today, how that is being addressed?

[Dr. Terry Wahls]: I am looking at the health of the cells and the effectiveness of the mitochondria. And so I am looking at the nutritional needs of the cell and how to provide them using food, because I think food is safer than supplements and probably much more effective. And so with just the mitochondria you need basically all the B vitamins and you are going to need minerals, magnesium, zinc, and sulphur.

You need a lot of fats, the omega-3 and omega-6 fats, the saturated fats, cholesterol fats, to make healthy membranes. Then you have to protect the mitochondria so things like zinc, mercury, and lead, and some of the [inaudible 00:17:51] that we take a lot of, like antibiotics, which are tough on our mitochondria. And by maximizing cellular nutrition then we start much more effectively having our epigenetics factor set.

We have basically more efficiency in all of the biochemical processes in ourselves, which over time will lead to healthier organs and of course a healthier person. Some things go away very quickly like the fatigue and the brain fog. Often that is dramatically better within 12 weeks. Things where you have to replace or rebuild proteins that may take one to seven years, depending on what organ in the body you are trying to rebuild.

[Damien Blenkinsopp]: Right, so do you have a theory as to why are mitochondria behind autoimmune disease? There is a whole variety of issues taking place in the body. Do you have some kind of underlying mechanism as to how this works and how the damage is caused to the mitochondria in the first place?

[Dr. Terry Wahls]: Well I think there are many, many reasons our mitochondria can get damaged. The toxic load that we are all exposed to continues to climb every year and many of these toxins will have negative impacts on some of the proteins involved in the mitochondria and how the mitochondria manages the electron transport chain. So that is one problem, straight up. Just direct toxic effects for mitochondria.

These toxins in addition to the direct toxic effects will interact with the DNA, putting adducts on the DNA, and causing certain parts of our DNA to be read and other parts to be silenced and not read, so that shifts how my DNA would have been read by the presence of these toxins. And that changes our biochemistry.

[Damien Blenkinsopp]: Are you referring to – is that working for methylation processes?

[Dr. Terry Wahls]: Methylation is one of the processes and I will also predict that we don’t really understand all the ways that epigenetics impact their DNA. Methylation is one way and changing the histone protein is another way. And we may find that there are even additional ways that we have not yet unraveled.

But clearly toxins are interacting with our DNA, turning genes on and off without changing the actual DNA sequence. So we have lots of toxins that are doing this. And some of those toxins, by the way, include the drugs that we take and the antibiotics and the things that have gotten into our groundwater. And of course all the food and indoor environments, etc.

[Damien Blenkinsopp]: Great, so in terms of I think for people at home to understand, it is like if the mitochondria are behind the problems you are encountering, why is there such a wide different variety of conditions, such as Parkinsons?

[Dr. Terry Wahls]: You know, that is really something I talked about in my book and that conventional medicine, over 100 generations of stuff. We have been classifying diseases based on the history, the symptoms, physical exam, and then more recently laboratory testing. And we did all of that before we understood the molecular basis, how these diseases evolve.

But what is startling to physicians and scientists, and medical students as well. Now that we begin to understand the molecular basis of these diseases, with what is going on at the molecular level, the cellular level, we are seeing that the diseases look more and more alike. There is often inappropriate inflammation of the body attacking itself or having too many inflammation molecules.

We have mitochondria that are not generating energy appropriately with too many free radicals being generated, causing early aging. We often have a sense of excessive toxic exposure and toxins are stored in the fats and in the tissues. We’re seeing the production of inflammatory molecules.

We often have problems with the gut with the wrong bacteria mix living in our bowels, created a leaky gut and allowing for contents within the bowels to slip into the bloodstream and bringing it along with them for some bacterial protocols with incompletely digested foods, all of which will create more inflammation in the body. What is so startling is we see those same core abnormalities whether or not the person has schizophrenia, depression, diabetes, MS, chronic fatigue, fibromyalgia.

We see a slightly different mix but those same, less-effective cellular processes are present to varying degrees in nearly every chronic medical problem, mental health problem, neurological problem, or autoimmune problem.

[Damien Blenkinsopp]: Yeah, do you think that the pattern that shows up in each person is probably down to genetics and epigenetics?

[Dr. Terry Wahls]: Well actually the pattern is maybe 5% or less epigenetics. The rest, the 95%, is due to the environment, and that includes diet, activity level, toxic exposure, and stress level, probably as the big four. Then infection, exposures, family relationships, social bonding, social networks, and all of that will interact probably through the person’s epigenetics to some degree directly to toxins in the cells and nutritional deficiencies to the cells themselves is another thing.

All of those are factors and because we’re all unique with our unique DNA, so even if i had a twin sister and we share the same DNA and we grew up in the same house we would still have differences in our environment and it would be enough to affect those genetics slightly differently and to create a different health status for both those individuals.

[Damien Blenkinsopp]: Right, another thing I think is interested is – I was diagnosed with chronic fatigue syndrome and one of the first things I was looking at was MS – multiple sclerosis – because I had difficulty walking and a symptoms list which kind of fits with that at first. As you were talking about it already, you are talking about the list of symptoms as a diagnosis but it can be very difficult to judge based on symptoms.

I think there are a lot of diseases which we have in categories which often have a list of very similar symptoms and the differential diagnosis isn’t being made in a lot of the cases and it is kind of a fuzzy line at the moment. So do you think instead of my presentation here which is potentially I have something which is chronic fatigue/MS, where I had that, and then somebody else has maybe 100% MS is the classification. And there are all these mixes out there but they are getting split into different categories based on who looks at it.

[Dr. Terry Wahls]: You know, one of the things I’m observing is that [inaudible 00:25:41] Clinic, where we treat people with chronic health problems and they can be mental health problems, physical problems and the big thing that they have to do is agree to the diet and the lifestyle, and [inaudible 00:25:53] for them.

And what I find is I am less and less interested in the names of their diseases and much more interested in diagnosing all their environmental factors addressing those. And I will use the same types of interventions across many disease states and I find that to me the most important thing I need to know is diagnosing their diet and lifestyle choices and exposures that they are doing and helping them address those. my young students are intrigued that my approach is so different to what they were taught. And it appears so remarkably effective, although making the diagnosis is far less important than understanding a person’s diet and lifestyle issues and diagnosing that.

[Damien Blenkinsopp]: Right, that is very interesting because then you can look at the weakest areas of someone’s lifestyle, if you have a blueprint for a more ideal lifestyle.

[Dr. Terry Wahls]: Oh yeah, and you have to work with them, work with their family, have them evolve this collaboratively. So if you are in my trial you have to evolve in one fell swoop in the trial, but if you’re in my clinic we negotiate with people to adopt these concepts at the pace they are willing to live with.

[Damien Blenkinsopp]: Yeah, because compliance can be an issue with a lot of these diets. So just going over the Wahls protocol in a bit more detail, there are some things that you want to remove? Can you talk quickly about the items you want to remove from a diet and why?

[Dr. Terry Wahls]: Well I look at what are the foods that at least in Westernized society are most likely to cause abnormal immune response and the top on is gluten-containing grains, the wheat, rye, and barley as most common. But many of the ancient grains have gluten so it is not – you want to reduce those gluten grains because the gluten and dairy overlap and you also take away all the dairy proteins, so we take out dairy as well.

And because the third most common is eggs we take out eggs and then in my book I give people directions on how to take out the next level of problems if that more simple approach doesn’t resolve things for them.

[Damien Blenkinsopp]: Yeah, so is that just [inaudible 00:28:20] or are there other items as well? Does it get more complex than that?

[Dr. Terry Wahls]: That’s the top three and then it’s a much more sophisticated conversation about what else to consider. And I am really very reluctant – some of the Paleo authors give people a very detailed elimination diet but from my perspective you are just increasing the risk of micronutrient deficiency when you have an excellent probability that just taking those three out would have a dramatic, favorable impact.

Now, if it doesn’t then you may need to go through a more comprehensive elimination diet in a step-wise fashion. That’s the approach that I am more comfortable with and I have had marvelous success.

[Damien Blenkinsopp]: Have you seen – because you emphasized it is pretty much a heavy intake of micronutrients in terms of the variety and the [inaudible 00:29:16]?

[Dr. Terry Wahls]: Oh yeah, and the rationale for that is I am a very simplistic thinker. So when I look at the literature I see the traditional society is still eating the traditional foods, traditional lifestyle, and eat radically different things in each locale but what is consistent is there is an extraordinary micronutrient density of vitamins, minerals, and fats per calorie.

Now, there is a huge variety in what the percent of fat, protein, and carb is across the various localities. So my interpretation of that data is that our mitochondria are actually quite flexible. They can burn sugar, fat, or protein and get energy for us to run the chemistry of life. But it appears that our ancestors identified what foods would give you the highest micronutrient density.

Sometimes it was going to be a fat-based diet, sometimes it was a protein-based diet, and sometimes it is a carbohydrate-based diet. So I then went around and used science to help me figure out what were these key micronutrients I could track as I designed my diet. So now we have 36 that we track and then I designed a diet using foods that I could get through agricultural means that would give me the various antibiotics, vitamins, minerals, and fats that science says my brain needs.

And once I redid my diet like that it was dramatic – within three months my fatigue was gone and I clearly was beginning to recover.

[Damien Blenkinsopp]: About your recovery, one of the things I heard you mention before is nutritional reserve and how at the beginning you would have something like a 36-hour crash window if you weren’t continuing to take in the amount of nutrients that you are currently doing.

[Dr. Terry Wahls]: Yeah, and now in retrospect I think in the first two years or even three years from my recovery is as I was improving I still hadn’t had enough recovery yet so that when I traveled, because I was now having enough energy to travel again, that my vegetable intake dropped and then my fatigue would come back, my brain fog would come back, and I would be craving greens. So I would come home to this huge salad bowl of greens which I would immediately scarf and begin feeling better.

[Damien Blenkinsopp]: Just out of interest, how long would it take you to feel better?

[Dr. Terry Wahls]: About 24 hours – actually probably 12, because I would eat that after I got home that night from my flight and then by morning my thinking was more clear and my energy was back up. And then I began to travel with a head of cabbage because that travels easily and you don’t need to refrigerate it.

I would just consume that and it seemed to work pretty well. Now I am well enough that I don’t need to travel with food, so if my vegetable function dips for a couple of days or a weekend that doesn’t bother me now. Again, because I think I have so flooded myself with nutrition that they just have a lot more reserve than they had before.

[Damien Blenkinsopp]: That is great – so the first 20 or 30 years of your life and you didn’t have multiple sclerosis, do you think eventually if you built up enough nutritional reserve you could walk around for a week – I imagine that in your 20s most people weren’t eating an ideal diet and you can eat that kind of thing, or do you think there is no way, like once you have had some kind of condition you already have to be very compliant with this for the rest of your life if you want to keep symptoms at bay?

[Dr. Terry Wahls]: Those are great questions. My observations from our clinical trial is if you deviate from the protocol you lose ground. If you go back to giving yourself substandard nutritional support and things will begin to decline and you will end up with more rapid aging and probably more diffuse symptoms.

[Damien Blenkinsopp]: All right – in terms of how much we’re talking about here, if we think about someone who has got a typical modern diet and someone else who has got a typical kind of Paleo diet, how much more vegetables are they eating every day?

[Dr. Terry Wahls]: Well when people come in – and I am trying to give this to you from memory here – and I believe that based on fruit and vegetable intake it was one-and-a-half servings a day. At 12 months the typical intake was seven-and-a-half. And most of our people are women and we just had a couple of guys so they were really doing an extraordinary amount of fruits and vegetables.

My nutrition colleagues told me that in the nutrition science world if you get someone to shift their vegetable intake just one serving up a day that is considered a phenomenal success. And for us to have shifted the vegetable intake from one-and-a-half up six more cups, she is thinking it was unheard of and no one had been able to do that previously.

[Damien Blenkinsopp]: Yeah, that’s pretty impressive and there are more benefits for the people on these trials than the average I guess. In terms of recommended daily amounts you are far exceeding the nutrition values of recommended daily amounts. What do you think about the recommended daily amounts of the vitamins and so on? Do you think they are sufficient for everyone and sufficient for some people?

[Dr. Terry Wahls]: Likely not because they are designed to prevent you from going into an acutely diseased state associated with that particular vitamin or mineral. So we will take, for example, vitamin C. They set a level to prevent you from acquiring scurvy, which is vitamin C deficiency.

But we don’t know what level is required for optimal health, which might be 50% more or 500% more, but I think what might be a more valid way of thinking about this would be if we looked at what were the RDAs that people hit who were eating traditional foods, traditional diets, and traditional societies, that likely those societies over time that figured out how to get these micronutrients for optimal health.

And when we use those values the intakes are two-to-ten-fold above the RDA depending on the nutrients. And actually that was one of my goals, to get my nutritional analysis pattern to look like hunter-gatherer societies to get two-to-ten-fold and we get two or maybe eight-and-a-half fold. We are very pleased.

[Damien Blenkinsopp]: And so from the safety standpoint of your pilot study, one of the ideas was to see if you are doing 1000% RDA?

[Dr. Terry Wahls]: We get as high as eight-and-a-half times the RDA from food. And again it looks very much like the hunter-gatherer societies. The biggest side effect was if you are overweight or obese you lost weight without being hungry and got back to a healthy diet again.

[Damien Blenkinsopp]: Okay, and there were no toxic issues at all?

[Dr. Terry Wahls]: No toxic issues. Some people had – some of the vitamins had some GI upset, some nausea. And we told them that if anything seemed to bother you just to skip it. So they did and we had a few people who couldn’t eat as many greens as we advocated so they just titrated down to what their tummies would agree to.

[Damien Blenkinsopp]: But I guess that would be down to like the ability to process – ?

[Dr. Terry Wahls]: Well that’s right. It’s microbial, it’s deficiencies of their own particular enzymes, so there is probably a combination of who have got living in the bowels and what was the efficiency of the set of enzymes that you have that you are born with. And it would seem that some people do not metabolize sulphur quite as well so they need either more sulphur or less sulphur in their diet and how their enzymes are working.

[Damien Blenkinsopp]: Right, I think some people have – I think I have a partial issue with this, detoxification of sulphur. So too much sulphur can cause issues because you have to detoxify it as well.

[Dr. Terry Wahls]: We are all unique. And I stress that in my book, that we are all unique. I have got a public health message out here that will be good for everyone, but I certainly can’t guarantee it will be good for an individual so they have to really pay attention to how well they feel on this and work with their personal stock because they definitely may need things adjusted because of their unique DNA and unique health issues.

[Damien Blenkinsopp]: So which types of biomarkers are you looking at when you are tracking this data and you are in the clinical trials?

[Dr. Terry Wahls]: It was divided into two questions in my clinical practice. We don’t do any fancy functional medicine testing. We do things that primary care docs will feel very comfortable using – lipids, glucose, hemoglobin A1c, B12, folate, C-reactive proteins, and homocysteine levels. Primary care docs should feel comfortable looking at that stuff. In my clinical trial we are doing things just to see how they change over time and I am not changing my protocol based on these results.

We are just trying to learn the mechanisms of what is going on. So we measure things like who and what is growing in the poop for microbial analysis, what heavy metals are showing up in the urine, so that is the toxicology. And that is done with a very mild kelator. Then I do a nutri-eval, which is by Genova Diagnostics, which gives me a detailed look at the vitamins and antioxidant levels within the cells, a really nice look at the generation of HET to the mitochondrial electron transport chain and how well that’s working.

It gives a nice look at the fats and how the fat metabolism is working and making the long chain fatty acids or arachidonic acids, [inaudible 00:40:01] acids. We get lots of detail that we will be able to use to write up our papers and project why we have these very lovely results that we’re seeing.

So that’s fun research stuff. It is not what I am doing in clinic and in clinic what I am finding is careful history, a thoughtful exam, and some very simple labs like primary care docs get a lot of the time.

[Damien Blenkinsopp]: Because you are working with patients who are working with other people so you are talking about the language here that you are enabling the patient by using language that they can talk to with other people easily?

[Dr. Terry Wahls]: Yes. So we want to address that lifestyle. We want to have some guidance. I do use these labs. You need to think about functional medicine things but you don’t have to spend tens of thousands of dollars for functional medicine assessments. You could just address all the lifestyle stuff very thoughtfully and very comprehensively, get someone to do a thoughtful history for you and I would say there is probably a 90% probability that your health will steadily improve as a consequence of those actions.

[Damien Blenkinsopp]: And you would be tracking that based on symptoms and how the patient feels?

[Dr. Terry Wahls]: Yeah, the most sensitive ritual that we have is what we call the medical symptoms questionnaire which I have got in my book. It’s a detailed list of questions asking about how your eyes and ears and nose – it goes through your entire organ system and you can get scores from zero to I think almost 300 points if everything is not working.

So that is a very nice way to look if the chemistry of all of your organs are working well or if there is some level of problem. And that is the best number for us to track with how well people are doing and how well we are doing for them.

[Damien Blenkinsopp]: Great. In terms of – like, you mentioned some things and everyone accepts today the chronic headache pains for example. Would you consider that as a condition, a symptom that shouldn’t be there?

[Dr. Terry Wahls]: Absolutely. And again, I have many people with chronic headache pains and we get them to address the diet and lifestyle issues. And those headaches finally resolved.

[Damien Blenkinsopp]: So amongst all the blood tests you have mentioned and you said they use them because it is easier to talk with our primary care doctors, do any of them ever stand out as interesting? You mentioned the symptoms list is actually the most interesting. But you mentioned inflammation markers, homocysteine -?

[Dr. Terry Wahls]: Well homocysteine and CRP are acutely – I would like to see those improve. That tells me there is too much inflammation or the brain can’t metabolize the vitamins very well. And then the hemoglobin A1c lets me know how many carbs they are eating, how much insulin they have to use, and trying to get that number lower and lower. That takes a little bit more time but again that is a very helpful intervention to follow.

[Damien Blenkinsopp]: Great so CRP, as far as I understand it that isn’t really related so much to autoimmunity. That would be more related to dietary inflammation?

[Dr. Terry Wahls]: And again I predict that in ten more years we are going to overlap that together. More and more disease states we are recognizing. If your C-reactive protein is elevated you have too much inflammation in the body and that is a predictor for worse heart disease, worse risk for stroke, more pain with your fibromyalgia, so it is an independent risk factor and if we get people on nine cups of vegetables a day, get rid of the gluten and dairy, that CRP will typically fall.

[Damien Blenkinsopp]: Okay, because I guess your protocol is so nutrition based, in terms of the tests you are doing I think it is mostly nutribalance and blood plasma tests for vitamins – what interesting things have you seen in terms of nutritional status? Have you seen any patterns in the people you get where it is showing up that their nutrient status is very low or with different patterns?

I spoke recently with William J. Walsh. He has worked with brain neurology for many years and he found some nutritional deficiencies were driving or often contributing to symptoms of schizophrenia or other diseases and correcting those would help them. So I am just wondering to what extent you might have seen some kind of patterns where specific nutrients are showing up a lot?

[Dr. Terry Wahls]: Those analyses are ongoing right now and I can’t comment yet.

[Damien Blenkinsopp]: Okay, no problem. If you were looking at – because we spoke a lot about mitochondria and what the status of those are and if you wanted to understand from a more testing standpoint the status of the mitochondria. Are there any particular tests you would look at with the nutrival test or any others that would be useful to understand what is going on with the mitochondria?

[Dr. Terry Wahls]: Nutrival is certainly one that I would use. Several of these functional labs have tests and use the nutrival, that can give you insights into how well the enzymes are performing at every step of the electron transport chain and the Kreb’s cycle. That can be very helpful to follow that over time and then provide nutritional support and free enzymatic steps that appear to be blocked.

And that would just – order the nutrival and follow those guides along. But again I remind your listeners that one can do that if they have had diet and lifestyle interventions very effectively for a year and haven’t gotten where they want to be. These tests are extraordinarily expensive and you follow them all the time and it is a $1000 to a $1500 excess, so it is not cheap. So from my experience at the VA I frankly don’t think it is clinically necessary for the vast majority of people.

[Damien Blenkinsopp]: Right, but for you it is more interesting to basically do a project and say I am going to use this protocol for six months and see what happens in terms of symptoms rather than doing tests to figure it out.

[Dr. Terry Wahls]: That would be my preference and I would certainly still work with the primary care doctor and have that basic primary care testing to help guide and refine things a bit. But I don’t think that it is – rarely do you need to spend $20,000 to $30,000 on testing to understand the mechanisms of why diet and lifestyle will make you better.

And that is what functional medicine testing does, it gives you the mechanism to explain why you should make these interventions and why they are going to help you. Or you could just make all the interventions to begin with and see if that would help. And then if it doesn’t then yes, you may need to spend a lot more money for a very thoughtful, functional medicine [inaudible 00:47:17]. But yeah, unless you have a lot of money to burn, try to do diet and lifestyle first.

[Damien Blenkinsopp]: Right, it sounds like a lot of these tests – you don’t see the value in them for most cases and it is better to spend some time and some money on the actual protocol as a test rather than spend the money on these tests which are currently a lot more expensive. You said the primary care tests are a lot more general?

[Dr. Terry Wahls]: Well you can easily spend $30,000 if you run down the functional medicine testing to understand everything that is potentially [inaudible 00:47:50] wrong with you. I think it is not money well spent for the vast majority of folks.

[Damien Blenkinsopp]: I see. One thing we didn’t look at but I heard you mention before is one of the issues you see with the mitochondria is membrane fluid – what is the issue around that?

[Dr. Terry Wahls]: Well it was probably in the 70s where we had a public health campaign against butter. You are also not supposed to use margarine with a lot of trans fats in it. And we have flipped out the beef with the deep fryers and fast food, and lard for vegetable oil, which increases the risk of trans fats. So our trans fat intake soared – and we all felt that was a good thing for us.

Now we realize trans fats are very rigid. They stop the fluidity of the membranes and it accelerates aging. It accelerates the risk for heart disease, cancer, dementia, and other neuroregenerative processes. Somehow after World War II we developed the fat theory for clogging of the arteries and then fat became demonized and so we switched to this low-fat diet but on a low-fat diet you don’t get enough of the fats that our membranes need to keep things nice and flexible and keep things fluid.

So you cannot have the bad fats, which are trans fats, vegetable oils that are heated, and you want to avoid those.

[Damien Blenkinsopp]: Have you looked at, I think it is called lipid exchange, where you purposely try to take in more fats and more fats of different types in order to promote – is that something that you have figured into your diet in terms of the fat intake?

[Dr. Terry Wahls]: We talked about fat at great lengths in the book and as I put people into ketosis we definitely increase the fats and have opinions about which fats they shoudl be eating, absolutely.

[Damien Blenkinsopp]: Another thing you mentioned earlier is supplements versus food. I know you are a proponent more of food, but you did take supplements to start with?

[Dr. Terry Wahls]: Yeah, I took supplements and they slowed my decline – they did not lead to recovery. When they added more supplements in the functional medicine folks that leveled things out and when I redid my diet is when I began to recover. So supplements targeted in a very, very thoughtful way may be useful but it is very difficult to have a big public health statement saying, ‘These are the supplements you ought to take.’ It really should be individualized based on that person’s story and their current health status.

[Damien Blenkinsopp]: Right. And you mentioned safety of supplements – what is your concern?

[Dr. Terry Wahls]: Well most of them are made in China now so I think people need to remember that and many of the supplements are made by genetically-modified bacteria. They do it, think about that as well.

[Damien Blenkinsopp]: Well I have lived in China and I have read the news a lot there so I can attest to the supplements used there.

[Dr. Terry Wahls]: Yeah, so they may be useful but you really have to think carefully about how useful they are.

[Damien Blenkinsopp]: And in terms of economics, I know some of the extremes for you guys and I think you actually grow some of the food in your back garden. Can you talk a little bit about the economics of you are a proponent of organics versus conventional? In terms of the economics of food, is it a lot more expensive?

[Dr. Terry Wahls]: I am going to vigorously disagree with this. I think the problem is people want someone else to cook the food and when you have someone else cook the food it is going to cost you more versus you buying the ingredients and cooking it yourself. And we have a number of lovely articles in the New York Times and I compared that – that are going to fast food restaurants and they cook the food versus you buy it and make it yourself. It is always cheaper to buy it yourself.

Now, if you want to go organic and grass-fed, which does have more health benefits, yes, that does become more expensive. But you can eat vegetables, clean protein, ditch the glutens, sugar, and processed foods for less if you cook it at home than if you are getting either fast food or something that corporate America has cooked for you.

So I like to see people go organic and get grass-fed if their monetary means allows that. You can still recover just eating more vegetables in the pattern that I have described. It will take you longer to clear all the toxins than if you were able to go grass-fed and organic. So you will begin to heal but it will take longer.

[Damien Blenkinsopp]: Right, now that is very – it is not yet proven by research. Is that something you are going to look at, the split of conventional processed – ?

[Dr. Terry Wahls]: That will be a wonderful project for us to do. We will see if we can get someone to pay for it.

[Damien Blenkinsopp]: Yeah, I bet you have got many projects in your head that you would like to do soon. What do you think will happen in this whole area in the next five or ten years in the area of testing and biomarkers and things like – well, what interesting things would you like to be able to test for?

[Dr. Terry Wahls]: I think the public is going to race out rapidly ahead in probably the medical field. I think it will be interesting to see ultimately that we could do rapid genetic testing and tell you which enzymes that you have are less effective and perhaps which vitamins you need to stress, which foods to stress, which foods to avoid. That would be very interesting.

And likely there will be a time that we can do that and then what we could probably do would just be the swish, gargle, and spit it out into a cup and get a readout of recommended dietary choices, recommended vitamin supplements.

[Damien Blenkinsopp]: Do you think that will be available within the next ten years?

[Dr. Terry Wahls]: I have no idea. I have to warm you I have clinic in two minutes so we should be wrapping this up.

[Damien Blenkinsopp]: Yeah, nearly there – great, and thanks for your time. What comes next in your research? What are your sort of next steps that you are looking at? I understand that you are crowdfunding projects?

[Dr. Terry Wahls]: So as a matter of fact tomorrow I will be talking with someone about a project that we are thinking about and throwing it up for crowdfunding. So I am going to be learning about that. I am submitting a grant to the MS Society and that is why I am feeling a lot of time pressure today because that is due here in the next couple of days.

And this Fall it is very exciting to know that the national MS Society here in the US is convening a programming meeting to talk about research priorities and programming for diet, lifestyle, and wellness. And they asked me to be one of their experts. So I was very excited about that. I thought that was –

[Damien Blenkinsopp]: Well that is a big milestone for you. That is kind of where you started all this.

[Dr. Terry Wahls]: Yeah, that will be huge. That will be very exciting.

[Damien Blenkinsopp]: That’s great to hear. So if you were going to track some biometrics of your own on a routine basis or do you track any biometrics for yourself?

[Dr. Terry Wahls]: Well I like to know where my vitamin D is. I like my B-vitamin levels at the top quarter of the reference range. And in general I am looking for nutrient biomarkers and I prefer they are in the top quarter.

[Damien Blenkinsopp]: Are you using nutrival or some other test for that?

[Dr. Terry Wahls]: No, that’s too expensive. I just use the straight primary care labs that folks get for these vitamin levels.

[Damien Blenkinsopp]: That is just plasma levels?

[Dr. Terry Wahls]: Yeah.

[Damien Blenkinsopp]: Great, okay. Well Terry, thank you very much for your time today. I know you have got another meeting.

[Dr. Terry Wahls]: Send me the link to the interview when it is available and I will shoot it to my social media team as well.

[Damien Blenkinsopp]: Great, I will do. It will go up in about three weeks’ time – that is when we are launching it.

[Dr. Terry Wahls]: Thank you very much.

[Damien Blenkinsopp]: Good luck with your meeting.

[Dr. Terry Wahls]: Okay, bye now.

[Damien Blenkinsopp]: Bye.

Leave a Reply