Gut Health Q&A Session: How Your Gut Controls Mood, Immunity & More with Becky Hartman (Ep. 6)

Welcome back once again and really super excited to have everybody here. We're going to be doing a question and answer session, and this is based on all the questions we keep on mentioning people can ask on the different social media platforms, whether it's YouTube, Instagram, Facebook, whatever. So these are questions you've actually reached out and asked us. We've actually gone through, honed some of them down. Some of the questions are already answered in the videos themselves or in previous videos. So we're trying to get to the most important ones you put out there. I think we have a list of roughly about 20. So I'm really excited to get into this. As usual, if this information is helpful, please, like, share, subscribe, click the little bell button as well. Put your comments, ask questions. That's kind of how this all goes about. And as a reminder, this is for educational purposes only. We cannot diagnose or treat anything, obviously, on social media, YouTube, podcasts, etc. But we need to say that for obvious reasons, and on that, we will get into answering your questions.

All right, so I'm reading these questions as the person asking them, just so that that's clear. These are not all my problems.

And if I have. If there's anything to clarify, you can part of having Becky as both my chief innovation officer and the person who does the back end. She also has a very strong clinical expertise as well as patient experience. So we're trying to use this to help broaden the. How helpful what we're doing is basically, and we've gotten feedback that's helpful. So if it's helpful, please tell us. If it's not, please tell us, because this is for you ultimately.

So sounds good. Okay, question one. I've had gum disease for years and also struggle with GI problems like bloating or constipation. Is it possible that bad bacteria in my mouth is directly causing trouble in my gut or even leading to things like sibo? And you might want to define sibo.

Yeah. So SIBO is small intestinal bacterial overgrowth. And the answer, the short answer is yes. Um, great question. It's interesting. Your mouth, the bacteria that grow in your mouth actually seed your GI tract. And so oral health, not only directly, because you have a, you know, gut brain barrier, you have a blood brain barrier, you have leaky gut, you also have leaky mouth. And so having dysbiosis in your mouth, which is bad bacteria in your mouth, also is associated with inflammation. There are blood markers like hscrp, which is a marker for inflammation in your arteries. That can be elevated. And so these are all related to the, the, the microenvironment in your mouth. And so if your mouth, your, your gums bleed easy, you have gingivitis, you get recurrent cavities, you have sensitivities, all these things can be markers of bad bacteria in your mouth. And there's actually testing can be done to help identify that, but that actually seeds your GI tract. And the reason this is important because oral health sets up for gut health which affects systemic health. So for example, if you wash your, your mouth with Listerine or there's now literature that, that actually changes the bacteria in your mouth and it's associated with increased incidence of heart disease and blood pressure. So it's really interesting how things we think are helpful for our mouth actually. Well, or for breath. Our breath can actually be bad for our gut. So your mouth, your. There are, there's a whole field of medicine, biologic dentists, which are dentists who specialize in this whole field. So it's, it's a big deal. And yes, it's a part of the gut health and systemic health.

Follow up question on that. How does bad breath play into that? Like if you're using things to cover up bad breath. Is bad breath indicative in and of itself?

Yeah, bad breath by itself. It's interesting when I talk to people and we evaluate them like we talk about, you know, the things I mentioned also do you have foul smelling breath? Do other people around you notice that it can be primarily related to bacteria in your mouth? You know, it's really interesting when you see people of lower who are just of lesser means when in the ER and in inner cities will have buildup of back tartar actually is a biofilm in your mouth and that will, that will create a certain kind of smell to your breath. If someone's a diabetic and they have elevated ketones which in this case is bad, you'll have more of a sweet smell to the breath. If someone has really bad sibo and has a lot of methane predominant bacteria in their upper GI tract, there'll be more of a feculent smell. And there's even one thing that's really interesting how these are things that I've learned clinically from practicing medicine for almost actually a quarter of a century now, which seems like a long time. But in traditional Tibetan medicine they would focus on actually bodily secretions. And part of their evaluation system was how's your breath smell, how's your urine smell, how your body secretions smell. So someone's breath actually can be a key to. Do they have dental issues or do they have upper GI tract issues or even gastric issues? So, yeah, your breath. So it's not. And covering that up, it's like, you know, it's covering up something that you can track and tell. It's like someone taking gas X all the time and covering up their gas and bloating. You change your diet, you change herbs, you change a whole bunch of things. How do you know you're getting better if you're covering up the symptom? I mean, if it's horrible, then you need to do it short term, but ultimately long term. The goal is to fix the issue, not just cover up the symptoms.

Some of this is going to just kind of go according to what order we have the questions in. So hopefully it sort of makes sense. But I keep hearing that most of our neurotransmitters are actually made in the gut. How can we realistically support a healthy gut brain axis so our mood and mental health improve without having to jump straight to medication? That's kind of a loaded question.

It is a loaded question. I mean, we have talked about it multiple places. I feel like all over. You know, 75% of all neurotransmitters for your brain are made in your gut. 90% of serotonin is made in your gut, 50% of dopamine, which is your primary, the ADHD neurotransmitter made in your gut. So supporting your gut is going to be huge for mental health. I mean, I did an interview with achina Stein. Who's Dr. Stein? Dr. Dr. Stein. Dr. Stein. She's a colleague of ours, but Dr. Stein, who is. Is a functional psychiatrist and that's like her jam, like working on the gut to help the brain. So it's a really big deal. But the primary mover of that is your diet. And sounds simple, just eat real food. But it's a big thing. Are you eating? And this is where it gets tricky. Because personally, for me, if I eat lots of carbs and lots of fiber, it messes my gut up. I need to. I can't do that. Some people can't do fermented foods because of small intestinal bacterial overgrowth, sibo stuff. But ultimately you need to use food, listen to your symptoms, listen to your body fasting, avoiding inflammatory foods. Your diet is key. We have so many resources on our website that can go into this. We have so many food plans. We got a whole bunch of stuff on our website. As far as Food sourcing stuff and the top six or seven keys to food sourcing. So there's just a lot of resources out there on our website. But the primary thing for gut is going to be your food, and you have to look at it as a drug. It's the best. It's the best medicine, or the. It's the quickest medicine, the slowest poison.

You know, I'm gonna skip ahead to a fermented foods question that's coming up. I get that foods like sauerkraut, kimchi and kombucha can be healthy, but what if they make me extra bloated or give me weird histamine reactions? You might also. I think it might be helpful here when you start answering to explain what a histamine reaction feels like, because I think people probably have them and don't realize that's what's going on. And then the follow up is just, how do I figure out if fermented foods are helping or hurting?

Okay, in general, fermented foods are good 90% of the time. If you have small intestinal bacterial overgrowth or mast cell activation syndrome, which tends to go together, what can happen is you have these quote unquote histamine reactions. They're a marker of something deeper under the hood. So if you have them, you need to go under the hood. So the question then becomes, what do they look like? It really depends on the person because it goes along with mast cell stuff. It could be, you know, the typical stuff is skin rashing, hives, itchy skin, feeling hot, feeling flushed, but people don't realize. Also fast heart rate, feeling anxious or panicky, lightheaded or dizzy. If you ever had food poisoning before, that's working through the histamine in your GI tract and your vagal nerve to basically get stuff out. So sometimes when people. I actually gave myself food poison about a week and a half ago. And personally, no, it was actually Monday. A week ago actually. And I got to personally experience my body doing what it's supposed to do. But when you have this abnormal reaction all of a sudden, the salivation, the nauseated feeling, sometimes the histamine response is just horrible, horrible gas. And so you almost feel like that I feel pregnant feeling. Sometimes there's a mood change, you know, not just anxiety, but poor. And one interesting thing is the night, how you sleep that night, you're checking your sleep. So all of a sudden, if your heart rate availability is goes down, your heart rate goes up and you can pour. REM and deep sleep. Those are other markers but when you think about histamine stuff, you're usually thinking about skin reactions, you're thinking about nervous system reactions, you're thinking about, well, the nervous system also is your. On your system reactions. And then you're thinking about the psych psychiatric response to that.

There's.

Those are the big paradigms. But ultimately histamine can react with any part of your. Your body. I mean, someone will get. They think they have a UTI and it's actually. The new term is lower urinary tract syndrome, but interstitial cystitis is the older term for a histamine bladder issue. So histamine is really super tricky. So getting to the vomit is super huge if you want your body to heal.

I feel like I learned a lot about histamine reactions during COVID because it was like, I don't know, we were just talking about it a lot and.

Oh, what way?

What do you mean? I just like. Because it was like a piece of the puzzle with a lot of how people were when they would get Covid and how they were responding. There was like a histamine and MCAS component to it. It's like I learned so much more about, like I started paying more attention. So not like I didn't know what was going on, but like I started paying more attention. I'm like, oh, like, like sometimes if you drink red wine, like, you know, you get like, your nose gets stuffy or your eyes feel itchy or whatever and it's like a headache.

You wake up the headache next day. Yeah, I mean that's, you know, the. For long Covid part or mast cell stuff. Part of the treatment is H1, H2 blockers, quercetin, low dose naltrexone. I mean there's a lot of. It is long. Covid is a mast cell activation syndrome variant. Just like chronic Lyme diseases. Just like a lot of people with mold illnesses. So really tricky because it, it's a symptom, but over re. Over crosses over with like almost everything.

Yeah, we got a lot of feedback about how weird it was to have PEPCID on the like Covid treatment. You know, recommendations for patients and stuff. People were like, wait a minute, but I don't have acid reflux.

Yeah. Yeah. One thing that's really interesting. Well, you know, one thing. Well, a couple things. One, histamine is a neurotransmitter. So, you know, I remember back early my training giving patients in the hospital hydroxyzine and shots of Benadryl in the psychiatric ward when they're having psychiatric breakdowns. And I, at that point in time, it was just something people did and it worked for really hard cases. And now it's like, oh, was that. Exactly. And I had this conversation with Dr. Stein about that kind of stuff, but it's really, you know, as a medical doctor, a lot of people come to us and they're like, oh, I want to do. I want to be all natural. I want to use just pl. You know, just plant based medicine or whatever. It's like as a medical doctor, we have a really big toolkit. And if Pepcid works better than, you know, you know, Rishi or Pepcid works better than nettles, then we're going to use Pepcid and we can. So that's where, you know, the whole MD medical doctor behind this just gives me a bigger. We can use natural things and we can use alternative things and different types of medicine, whether it's Ayurvedic or traditional Chinese. But we can also use good old fashioned traditional medicine because it works too.

We have a good segue to the next question, but I just want to mention, I'm not sure if Dr. Stein's interview is on our podcast channel yet.

But it is on, it's on YouTube right now. It'll be coming.

It's already on YouTube if anybody's curious, because we've mentioned it like four times now. Um, okay. I've been on a pro on proton pump inhibitors, PPIs for acid reflux. But I've read they can mess with your gut long term, which is very interesting that we were just talking about using them therapeutically too.

No, proton pump is different than pepsid.

Oh, that's right, that's right. Uh, we were talking about acid reflux things. Um, if you want to manage acid reflux more naturally and not be on meds forever, what are some safer strategies?

Okay. And remember that the question before also acid reflux and GI upset can be a mass cell thing as well. So. So I mean, there's a lot of things you can do. The problem with long term PPI use is that it's. Well, first, proton pumps actually are word on your mitochondria for making energy. So proton pump inhibitors can also be toxic to your mitochondria. So in some people, the proton pump inhibitors can actually have. Be super detrimental. They are harmful because they increase your risk for getting dysbiosis. They increase your risk for SIBO and sifo, which is small intestinal fungal overgrowth, which is another bad thing, and yeast infections. If You're a female with yeast infections or weird like vaginal infections or vaginal overgrowth or you know, weird smells, you know, BV kind of stuff. The PPIs can set you up for that as well. And it can also increase your risk for cardiovascular disease, renal disease, dementia, nutrient deficiencies, B vitamin deficiencies. They're amazing medications, short term for preventing ulcers, but long term. I agree with this question. You gotta find something else. The hardest thing is getting off of it and it has to be a slow wean because if you stop it all of a sudden. The proton pump inhibitors don't kill the proton pumps, they just basically block them and, and they just start trying to work harder and harder and harder and harder, but they can't get it out. And once you stop them suddenly you'll have a massive upswing in stomach acid. So people will feel horrible if they stop them too. Actually, one patient I'm working with, still working with right now, who got excited, lost a bunch of weight, felt great, and he stopped his PPI too quick and he ended up getting a stomach ulcer, bleeding, went to the hospital, got transfused a couple units of blood, we're down now he's went back, you know, obviously had to go back on it and get, has a gut heal and now he's only taking like an over the counter one like probably every other every third day. But you have to be careful. Like that's an extreme example of quitting, stopping quickly. So you want to have some kind of wean or taper where you drop the dose probably 10 to 20% every week or two or three. If you have symptoms, you stop, you don't keep on pushing it. You have to give yourself gut lining support. Glutamine being the best thing for that, zinc carnosine being the second best, which is actually used to treat reflux in Europe and then some kind of demulcent, whether it's decloserized licorice, marshmallow, aloe, something like that, that actually helps the barrier. Slippery Elm is another great one. Yeah, my wife is also. Becky, I'm sorry, is also a medicinal aromatherapist. So she has a lot of. We actually used to cocktail stuff for us at home and make concoctions. Well, you study, you study things pretty deeply when you do take dives. But the point is like those are the basic things. And then if you have any reflex symptoms, there are short term things, even, you know, Pepto Bismol, bismuth subsalicylate is a great coater. Protector for your stomach in certain situations. And I have, you know, again, H2 blockers like Pepcid we don't have. They've been around for a long. I mean, the first H2 blocker was simetidine, came out in the late 70s. So these things have been around for 50 years. Actually. My dad started back then because he had really bad stomach ulcers. And we don't have data that they cause the same symptoms as your proton pump inhibitors. So sometimes as you're coming off, you might sneak one of those in as you're weaning off if you need to. So lots of tools in the toolkit for that.

Can you do like a, like a super quick. What's the difference between like a pepcid and a PPI?

Like, okay, so Pepcid is a H2 blocker and which blocks the H histamine at the H2 receptor versus Urano. Histamine typically are like H1 blockers and those H3 blockers like Nazidine, which is another medication, this is more the pharmacology on the medical side. Um, so it's blocking histamine. They're not as strong, they're not 100% block, they're blocking histamine, the neurotransmitter and its impact, which is where you get into some trouble with Benadryl and the elderly and the association with dementia. You don't tend to have that with Pepcid or your second or third generation anti histamines, which is some of the concern right now in social media going around. But the difference is just the mechanism action. So you can think about H2 blockers lowering stomach acid production and PPIs halting acid production.

How do I even know if I have too much or too little stomach acid? Are there easy at home tests or common red flags before I go in for professional testing?

Yeah, so unfortunately, the symptoms for too little stomach acid can sound like too much stomach acid. And so one of the things we've learned in the last 15 years, a lot of people who got put on PPIs will put on because their stomach acid was low. And because it was low, their gastric digestion slowed down a little bit and they'd start refluxing into their esophagus and they would get reflux and get GERD and a bunch of these, these stomach symptoms. And so instead of saying, hey, like, you know, why are you having a digestive issue? They stop acid production 100%. You would still reflux and have worse digestive issues, but you just wouldn't feel them anymore. And so what we've learned is a lot of people who had symptoms of acid reflux actually were low stomach acid, not too much. So. So how do you figure this out? Well, if you have either one, you have any symptoms you take like sodium bicarb, baking soda or atoms, you'll feel better because that's the whole PPI kind of thing. So there are two ways we, you know, at home ways of looking at. One is now this is of course, if you don't have red flags, you don't have weight loss, you don't, you're not coughing up, you're not vomiting up blood, you don't have blood in your stool, you're not having debilitating pain. Like, if you have any of the red flags, you can Google those and find out. All the red flags for ulcer disease or stomach cancer are. If you have any of those, you need to go see a doctor. Of course there's two basic at home tests. One is a, a betaine hydrochloride challenge test and then the other one is a basically a sodium bicarb baking, baking soda test. The betaine hydrochloride challenge test is. You can Google that online. It's pretty, pretty easy thing to find. We actually have a resource, we go out to patients from the ifm on this. And so you take like one capsule of betaine with a meal the next time, 2, 3, 4. And you keep on bumping it up with every meal until you get heartburn, basically. And if one or two of these acid capsules give you heartburn, you don't have, you have adequate stomach acid. I've had patients get the 10 capsules and like I still don't feel anything. I actually struggled with this initially and talked with some nature paths who've been doing this because they've been doing this betaine digestive stuff since like the 40s and 50s. They've been doing it for a while, you know, and I'm one of them actually trained. It was more trained some of the stuff with me through ifm and he went to Bastia and his thing was like, I stop at five or six capsules with a meal because anything more than that, you potentially can give someone an ulcer. So that's the betaine hydrochloride challenge test. The other one is the sodium bicarb test, which is where you take like a quarter to half a teaspoon of sodium bicarb and just put some water and drink it and you count how long does it take for you to burp, does it take a minute, three, five, six minutes? If you burp within a minute, you pro. You. These are both subjective, not objective tests. They're qualitative, not quantitative. They're kind of like going outside. Is it hot or cold or is it 82 degrees? You know, and so if you burp within a minute, you have to have acid. You miss because the base, you make gas and you burp. If it's one to three minutes, maybe your stomach acid is a little low. Do the betaine test. You start taking your three to five or more minutes. Throughout three to five, you have low stomach acid. If it's more than five minutes, it's like bicarb. You take sodium bicarb and put in a coat of, mix it with some vinegar, what happens? It just literally foams up like crazy. And so if you have stomach acid, it should do that and should burp. So those are both two subjective ways of kind of quantifying. Do you make adequate. The excessive amount. They're, you know, typically you need to see a GI doctor and they either do a Heidelberg scan or they do a little probe down your throat for 24 hours and measure. But that usually requires seeing a GI doctor do that. And their typical treatments are PPIs regardless.

So how do you handle that? Like when you see somebody who's dealing with that, like, how does it, how do you address it from a functional medicine perspective?

Well, first I've got.

You don't just send everybody to the GI to get a ppi.

No. Well, I could give them the PPAP I wanted and I can do high dose because, you know, I'm a medical doctor. But the thing about it is, do you have red flags? So you've done blood tests on them. What's your, is your hemoglobin stable? Is your sed rate elevated? How's your thyroid looking? Like all these. What's your liver, kidney status? You know, if someone has a crazy high LDH level on their testing, I might be worried about cancer, right? So you do all that testing. Is their weight stable? You do exam, you examine their stomach. Is there pain? Is it tender of your gallbladder? Is it tender of your appendix? Right. You need a good physical exam. If your gallbladder is tender and you, you have stomach pain and reflux when you eat meals and it's worse than fatty meals, you need a liver ultrasound, gallbladder ultrasound, potentially highest scan. So I do a good medical exam first and then. Or if they've already come with the exam and They've seen a bunch of doctors. And that makes it easy for me because it's like you've already had the fancy stuff done, then I can just do the functional stuff. Then you kind of walk through things, you know, and start. Glutamine's amazing. It's like the go to for. You can literally heal stomach ulcers. I've had patients who had endoscopies done. Stomach ulcers, erosions, they. When you off the medication, the GI doctor's like, you're crazy. Start them on glutamine, zinc, carnosine, and the fox Scopes. Three months later, they were clean. They actually healed. So these things work pretty well. And then you treat symptoms, whether it's gas and bloating with some kind of anti gas product. If they're having reflux symptoms with the demulcent, are they constipated? This is a big deal. If you're constipated, you will have more reflux, you'll have more GI issues because of things down south are blocked. It just feeds all the way upstream. So this is where it's a full or complete regular. Good. This is good medicine. You know, functional, integrative, translational, but whatever you want to call it, just good, comprehensive, precision, personalized medicine. I'm gonna start saying precision medicine more because we're talking about that later. So not today, but okay.

I've tried elimination diets to figure out my food triggers, but I totally get stuck when it's time to reintroduce foods. How do I bring foods back in without getting overwhelmed or losing track? This is. We have a whole program on this, but can you do it? Can you do a quick answer?

We do a whole program on it called Is that connective Cleanse? That's connected. Is that Connected health? No, connected cleanse. Connected cleanse. We have a whole thing on this, but the basic gist is I tell people to add back in the thing they miss the most. Now if it's dairy, if it's sugar, if it's bread. Yeah, you'll probably react with those. So it's like, what's the, the thing you miss the most that actually has a positive health benefit? Eggs or one of the things you eliminate, Maybe add that thing back in.

Maybe that's a trigger right now.

Okay, that's true. I'm sorry, Right now. I'm sorry. Once this goes out, hopefully we can get eggs. Right now there's actually. If you get your eggs from your local sources, you probably still can get eggs. I was able to get. There's eggs for sale right now in the Richmond area. On.

Soon.

Soon. Yeah. So actually, unfortunately, it's. We're just going through a winter where all the chickens stop laying regardless, so. But. And just start adding your favorite food in first. Yeah. After three to five days, you see if we react. If you react, you take it out and you leave it out for three months. Their next food in for three to five days. If you don't react, leave it in. Cool. Move to the next one. Just kind of slowly work in where people get. Now if you do this and you're like eight or nine foods in, and now you start reacting, remove it. You're still reacting, but then there's some combination. Maybe you added in eggs and you added back in some cheese because you do cheese better than dairy. And maybe add in some. And maybe it was spring and Birch and for me, for. For me, for Cynthia and ragweed messed me up with dairy. So all of a sudden, you're reacting because of the environment. So sometimes you can't really figure that out. This is your algae season, you know, right now, when we're recording this late February. For Cynthia, it's my season. I'm having some allergy issues, and I just don't do any dairy at all at this time of year because I will get a science issue and a bronchitis issue. So sometimes it's an environmental factor. So you really. That's the reason why journaling is really helpful, because it helps you figure out some of these nuances and you figure yourself out.

Yeah. Some people talk about gut infections like parasites, candida, or even chronic viral issues. If I don't have obvious symptoms, how can I tell if I have a hidden infection and which tests actually work?

I mean, if you don't have symptoms, you have to test, you know, and so that's where. For the viral stuff, that's usually blood titers. Looking at reactivation, which is a little. Its own kind of complicated thing. Deal with Epstein Barr and hsv, and you have to look at how much the titer goes up and which part of the virus gets reacted. So that gets a little tricky as well. People, you know, one of the things they don't talk about is Lyme disease. I had a patient with horrible eosinophic esophagitis with a bunch of GI tract issues on PPIs who had SIBO. Well, when we treat his lab disease, that all went away. Now he's on some medication with an allergist and some other things as well. But it Was really interesting how that required advanced testing, that required stuff. As far as your GI tract, there's a lot of things offered out there. I tend to use a comprehensive stool analysis from either doctor's data or a GI effects from Genova. They're pretty comprehensive. They look at pancreatic function, how you're digesting your food, they look for gut inflammation as well as they give you a record of bacteria in your gut. Whether it's through a PCR with a Genova or with the doctor's data. They give actually cultures Genova. I'm sorry, doctor's data also offers a GI360 which is this really cool microbiome analysis. A little complicated and by itself, I mean that's like requires a special field of training just to figure out how to interpret that test. But there are really cool tests that are out there that can help you figure out what's going on your GI tract. But if you don't have symptoms then you need to test. But if you have an autoimmune issue, by definition you have to have leaky gut, so you've got gut issues. If you have someone with a neurological issue, the gut brain axis is a thing. So if you've got neurological issues, your gut is probably messed up. So sometimes it's by association. It's not, you know, I'm fine, but I get panicking, anxious and have flares of my neurological issues or I'm having flares of my Hashimoto's or my hormones are off. There's a hormones are primarily detoxified through your GI tract. And so if you have pcos, endometriosis, those. To date I've not seen a single one of those patients who don't have gut issues. So sometimes it's an associated illness that people don't realize has a strong. And again, 90% of your immune system is in your GI tract. So any inflammation or immune related issues, you probably have a gut problem as well.

So you're sounds like you're saying you might think that your symptoms aren't related to those specific things, but they probably in reality are.

That's well said. Great summary.

Okay, we're going to get into picking the right probiotic. So they're like a million probiotic supplements out there now. You can get them everywhere, every literally everywhere. Even Walmart. Yeah, Walmart, Target has them. And then plus fermented foods like yogurt and kefir which we talked about a little bit already. But how do I know which ones are really effective and what like when they're a waste of money. Like, how do you figure that out?

That's okay. So as far as fermented foods, you mean? And then as far as supplements, I.

Think we can probably just stick with the supplements for this part. We talked a lot about fermented foods already.

Yeah. The supplement thing, that's tricky. If you look at consumer labs, which is the consumer reports of supplements, they'll pull stuff off the shelf, and sometimes they're pulling stuff off the shelf, they're six months, eight months after being produced. They. They test them. There's nothing in them or there's not what's in them that they say. So supplements are the wild, wild west. We've actually done. I've done a lot of videos. I actually did a whole series on our blog about, for example, calcium. This was a crazy statistic to me when I was reading it, that 25% of calcium that you get in your typical CVS, Walgreens kind of place has levels of lead over the EPA recommendation. So. Which is insane. And. Yeah. And so. And at one point in time, back in the 90s, 90% of the world's calcium and supplements was coming from melamine, which is a product of South Africa, which, you know, some people don't know what that is, but that's like, what they make. Like those 1970s, like, hard.

It's gotten really popular again. You can get them everywhere. Yeah. Like all the little Easter dishes that are like, plastic. They're melamine.

Okay. We have some.

It's like a. Yeah, like a hard plastic sort of.

Well, it's got calcium in it. So you grind it up. You can use it as a calcium supplement. Even certain we were actually talking with a colleague. Even some B12s, you know, you get a B12 supplement. I did not know this. I mean, the things you kind of know, like, that makes sense. But when you're talking to someone who has a B12 supplement line with a B12 drink thing, talking with them, and they're like, oh, yeah, it's. This is produced from a plastic derivative. Yeah. And like, wow. And you're a health guy. Like, oh, my gosh. Right. So you really have to know the man. You have to just go to the manufacturers, like, who's making it? And that's the reason why we vet all this stuff. That's the reason why, early on in my career, I'd say, hey, go get vitamin D, 2,000 units. And I'd get 20 emails. Which vitamin D? Which one? Or someone would buy some random thing on Amazon and who knows what they're getting. So that's the reason I quickly started making very specific recommendations for specific brands, specific doses through specific sources. Because that way it's least, like, at least I know if you take something, it doesn't work. It's because it doesn't work, not because there's not anything in it. If you're taking it worse, it's not because you're getting poisoned with something, it's because it's something. Melatonin is a great example. The American Academy of Pediatrics put out a warning statement thing a couple years ago about melatonin with kids because kids are getting poisoned by melatonin over the counter because it'd be like a 1 milligram or 3 milligram dose and the kids were getting 20 to 30 milligrams. And for a 2 year old, that's like way too much, you know. And so specifically for kids, you got to make sure the melatonin, you know, the sourcing, because they might be getting overdosed. Underdosing, not as bad an issue, but overdosing can be significant. So you really need to pick reliable sources. We have a whole bunch of resources on our website to go over this. You know, people who follow us can get stuff from our, our site online. So we, we have tons of resources on that, but it's a big deal.

So since we mentioned fermented foods, yogurt, kefir, you know, pickled things. Do you want to just really quickly talk about a lot of the fermented foods that are in the grocery store?

So a lot of fermented foods are not fermented, they're just pickled. So pickling is you just take something and put it in vinegar. I mean, you know, sometimes it's a chef trick. I got to make some pickled. Yeah, quick pickled, Quick pickled onions or quick pickled, whatever. And they'll put it in, soak in vinegar for two, three hours while they're cooking stuff. And then you got pickled whatever. That's what most stuff. If you're just buying rando stuff. So you really, if it's pickled, you look at the ingredients as like water, pickles and salt. Or it's, you know, it's cabbage, carrots, ginger, salt, spices. And there's nothing else they'll say, like, usually like well water, artesian water, or something like that.

Sometimes it'll say like lactic acid cultures. Sometimes it'll actually list that.

Okay, all right, well, cool.

For ones that are actually.

Yeah. And they'll say like, and they'll usually be like organic. You know, they're usually locally. There are some national brands that are. Are decent, but that's what you gotta look for. A lot of things are just, they're pickled, they're not actually fermented.

All right, when people start doing the 5R protocol, which is the remove, replace, reinoculate, repair and rebalance, which you talked about throughout this series, what are the most common oops moments or pitfalls they run into? And how can those be avoided? How can we avoid them?

I think when people remove things, they're not. They're not starting with real food. And so they remove something like wheat. They don't realize that it's a filler in something else. This is where it gets tricky because if you're not already eating real food and you're eating lots of box processed stuff, like, oh, yeah, I removed dairy from my diet and gluten and soy. And then you're like, but all the boxes, like, they're like soy lecithin fillers or something like that. So I think that's the first thing is like, you're not removing everything because you're not eating real food. Or, and, or they're like, remove, I'm going to do elimination diet. And so they were like, well, I don't usually eat. That's the first thing. Second thing is when they do an elimination diet, they're like, well, I'm gonna do elimination diet, but I really need my cookies and carbs and snacks. And so I'm gonna start using some other carbohydrate thing or I'll do lentils because they're, you know, good for me, but I'm gonna do lentil pasta. And they don't realize that the process of taking your lentils have a low glycemic index, but lentil pasta does not. You have a similar insulin sugar spike and insulin spike with lentil pasta as regular pasta. So the processing to put it in the. The pasta thing changes the food chemistry. So that's another thing with the, the remove part. I think people get tricky as far as, like, replacing putting things back in. I think sometimes people, like rush through too quick. They're so excited they add thing. If you do really good elimination diet, I mean, you know, it. I mean, I did one years ago and at the end of the month I was like, wow, I feel like pretty clear and good. It was. And we eat pretty good. It was just cutting out dairy and coffee and, you know, carbs for a Month just makes a big difference. I think with the reintroduction, we already mentioned some of the pitfalls, people fall in with that. And then I think the other thing is people don't think about, okay, this is four weeks elimination diet. I feel a little bit, we're doing this to remove 50% of the immune complexes that your body makes because of immune reactivity with foods. So a lot of people feel better, some people feel a little better. And so it's one of those things we're not realizing that really to remove all of the immune related inflammatory complexes from elimination diet, it really needs to be more like three months, not 30 days. But we do it 30 months because most people won't do 30 days. And we do some two week things because a lot of people won't do 30 days. So I think that's where people get a little confused is they don't feel like the diet, the elimination has quite the impact they thought it would have. Typically that's not the case, but that is sometime an issue. You go on.

Yeah, I was just going to say, unfortunately the, I think the word diet in there and the fact that we have like a history of several decades of like dieting and diet culture, usually that means like, you know, I can't have cake or sweets or I can't have these things. And you know, you're avoiding something, but it doesn't mean that you're actually doing this type of thing where it's almost like a challenge where you're like pulling something out that needs to stay out. And so I think when you're on a diet, you can cheat. You can have like a carb loading day or you can like, you can cheat it. And that can actually work. And sometimes it can work better if you're trying to like lose weight or whatever.

Carb cycling or something like that.

Yeah, that can actually like be effective. But if you're on a elimination diet, you start the clock completely back over if you introduce one of the items that you took out. So you can take them all out at the same time, but you can't put them all back in at the same time and you start the clock over. You know, if you have a, a glass of milk seven days in, well, you have zero days of avoiding dairy then, which I heard recently that some people think it's really weird if adults drink milk. So maybe ice cream is a better example because people probably do that more than they drink a glass of milk.

I have a lot of patients who consume ice cream, eat ice cream yeah, at night. Yeah.

Yeah. Anyway, okay. I keep hearing stories of people going full carnivore. It's like a big trending thing and claiming that it fixes autoimmune flares or major gut problems. Is an all meat diet really safe long term and do we still need fiber or plant nutrients? Where do you stand on carnivore in a functional medicine context?

So that's a good point because it's been very popularized by some very high level social media influencers and very brilliant people who, who've done a lot of research. But this is, you know, they popularized it, the carnivore diet. I think part of the. First of all, there's a lot of people have dysbiosis and sibo and bacterial overgrowth and yeast overgrowth and strep overgrowth and a bunch of things. And a carnivore diet is a kind of elimination diet. You're eliminating carbs, you're eliminating plant food and only doing animal based stuff. And so if you have inflammation in your gut from dysbiosis, yeast overgrowth, strep. I've had patients with rheumatoid arthritis, rheumatologic issues, who just cutting out like things that cause yeast and staph to grow, they feel so much better. So it is a kind of elimination diet is one way to think about it. The other thing is that because we don't get. The average American does not get enough protein in their diet. If you look at what we need. And the older you get, the more protein you need, just because you don't process it quite as well. And it's really interesting, some of the stuff I was doing recently, looking at peptides, people know what peptides are, whether there are natural peptides that occur in natural sources of protein, that actually help your body's immune system and your body to function, you get from food. So all of a sudden now you're getting, your body's getting flooded with real peptides. You're getting flooded with tons of protein, which is one of the three macros. You absolutely, you don't need carbohydrates to live. Like, like what's the minimum amount of recommendation for carbohydrates to survive? You don't need any. There's, it's zero. There's reason you do need fats, you do need protein, you don't need carbs. You'll get them from meat and other things. But, and so what happens is you're getting a lot of protein, you detoxify better. But we Also have massive deficiencies in trace minerals in our diets. We've done these hugely processed diet, you know, up to 90 depending what study you look at. 90 to 100% of Americans are potassium deficient, 8% of Americans are magnesium deficient. What is one of the best sources of potassium? Meat. You know, bone broth is a great source of potassium. What are you doing? You take meat, you boil it out and you get potassium in. And so I think part of the magic of carnivore diet is people getting a lot of these trace minerals at high levels. A lot of B vitamins, a lot of other things they don't get because of our highly processed diets. And then there's a whole thing that roughly, and this is my estimation, it's really interesting. Hypermobility is a big issue. You look at kids, 20% of kids are hypermobile, 13% of college students are hypermobile. Then you get in adulthood, it kind of disappears. And it's like it doesn't disappear, it's just we're not looking for it. I mean these kids, it doesn't go away. And this population has a huge need for more protein, more trace minerals. And the people I've seen talking about this in social media world, looking at them, they really look hypermobile to me. So I'm wondering if a lot of people out there, not only because our diets have a lot of nutrient deficiencies, trace minerals, rare ethnol deficiencies, protein deficiencies, with all this fascia connective tissue stuff, we're just meeting that need now. The question long term, is this an amazing long term thing? And most things, well, you know, you know, there are certain things you only get from animal sources of things and there are certain things you only get from plant sources of stuff. And there's certain things, you know, we've learned this, this whole new field of medicine on phytochemicals, polyphenols, there's the colors to food. The reds, purples, yellows, these plant molecules, resveratrol, curcumin, quercetin, all these things actually moderate and modulate our immune system. And so our bodies were designed or made to have that apart. We're omnivores, we're not carnivores and we're not ruminators. One of the interesting things I was learning recently as well is with, with people were always compared to chimpanzees, monkeys and chimpanzees and stuff. But they spend eight, eight to ten hours a day chewing plants, right? And because they don't get enough B vimins in their diets, they'll actually eat their own feces because the bacteria, they're going to make B vitamins, they'll poop it out and eat it to get their B12, you know. So, yeah, gross, right? But the point is like, we're not that and we're not mountain. Were not tigers caught in the wild who input in to zoos stopped reproducing and then, and then in the early 20th century realized you got to feed them organ meat. We started feeding them organ meat. In nature, they a liar, tiger kills thing, eats the internal organs, leaves the carcass for the hyenas. And the other ones, they, they need the organ meat stuff, right? So that's not us either. And so I think what's happening is people who have significant inflammation, significant nutritional deficiencies are doing a very type of elimination diet that's giving them all of this stuff. But it's just like the whole vegan question, you know, long term, do we have any cultures in the history of the world where vegan grandmothers are having vegan mothers or having vegan daughters? And the answer is no. Do we have any culture in the history of the world where carnivore mothers are having carnivore children, are having carnivore kids? And the answer is no. People refer to certain indigenous the Maasai or other tribes in Colombia, for example, that. But it's interesting how when they've gone back and visited those tribes at different times of the year, their diets changed. And so there's this one thing about this group in Colombia, like, oh my gosh, they have the most amazing microbiome. All it is like nuts and seeds and da, da, da, da, you know, from 10, 15 years ago. And they're revisited, you know, five, 10 years later. And they went to a different time of year and they were hunting monkeys and eating animals. And because its season was different, it was like, oh, that's interesting. Their microbiome changes seasonally with what they eat. So we do examples of like the Inuit, Indians in Alaska and North America, a certain season, eating nothing but whale blubber, candlefish. But that's a seasonal thing. In the summertime, they're eating plant stuff. So I just, you know, it's one of the things I'm glad people do well with it. Just like, I'm glad people have done well with ketogenic diets. I'm glad people have done well with fasting. I'm glad people done well with juicing. But the question Is, is this something that we have data saying it's healthy to do this forever or we have examples in history. You know, I look at history of medicine, I look at other medical traditions and I just look at people groups over time. You know, do we have any examples of someone doing this for a really long time and having a really robust people group? And the answer is for this particular, for carnivore, we don't. Does that mean it's bad long term? I don't know.

Do you think this is like kind of a product of our current culture where it's like, I don't know. If you spend any time on social media, you'll see people that are like, well I did blah, blah, blah, blah. And this is what happened. And my labs were great and this and that and the other thing and, and they're just like perfectly happy to be like you're, you're lying, that this isn't good because for me, I have great labs right now and blah, blah, blah. And they're not thinking even three months from now, much less five or 10 years, 20 years out. But they're going to insist that like this is the, this is the way because I'm doing great and I feel fantastic. Like, do you think that's just like a product of like kind of the culture that we're in or I heard this thing.

Or we have a, we have a, we have an obsession with novelty in the new. We have an obsession with cutting edge, the best, the brightest, the smartest. And that makes us always look for the shiny object. That's just, that's what marketing does, you know, that's just a thing, you know. So I think part of it is that applied to diet fat. How long have die fads been around? I mean I can look at commercials back in the ads back in the 1800s, you know, for all kinds of crazy stuff. Snake oil is called snake oil for a reason, you know, so it's. And because they, you take this and it heals everything and it's then, you know, people, they actually used to use strychnine in small amounts as a purgative to help treat with illnesses. We used to use mercury as a antibiotic to help stuff actually put on kids. And there's actually kids would get this disease where they're going to fall off and they have this horrible thing from giving kids mercury. Like we've done a lot of kind of. And they'll sold and advertised. You know, there's actually a skincare product right now that's popular in the Latin American population. Comes from south, doesn't come from America. It's a skin lightening thing and uses mercury as the main element for skin lightning. Look how well this worked for me. Like, someone checking mercury levels, Like. And so I think, like, you know, you know, as a clinical scientist, I learn from literature and I learn from patients. And so I'm never going to say, hey, this is amazing. I'm glad it's working for you. Let's track and follow it for six months or a year or longer. If your labs stay great, you feel amazing. You know, I mean, if you're smoking and doing other things, I'm gonna say you still stop, Right? But, you know, there's examples of people having horrible, you know, Burns. What's not? Jim Burns, old guy diamonds 101. Burns.

George.

George. George Burns. Great example.

Yeah. Cigars.

Yes, Cigars and whiskey. Cigars, whiskey, women. And he died. Was 101. Like, great, I'm gonna do cigars, whiskey and women. You know, I will not make it for a week or two. I will be. You will shoot me and you won't shoot me. But the point is, like, but it's. You may shoot me. Yeah.

Now, if something ever happens to you.

I know if I disappear, then, you know, well, I'm glad we both have life insurance policies. Right? But the point is that, that we have examples of people doing some interesting things that have lived a long time. We don't make a practice of medicine out of that. And so. But because we like the new shiny, that's just our human nature. Sometimes tradition is good. Sometimes. That's because I like the idea of blue zones, and I like the idea of looking at health patterns in ancient civilizations. I like Weston A. Price's research, I like Sir Albert Howard's research. Looking at what people have done who lived robustly and well without cavities and without tuberculosis when it was rampant. What are they doing? None of them are vegans. None of them are carnivores. They ate real food and their diets look totally different based on where they're at in the world.

All right, this is related, but kind of the flip side of carnivore. After watching Forks Over Knives, which just for context, is a documentary film that is promoting vegetable, you know, vegetarian lifestyle over animal products. It says, I'm freaked out about animal protein and chronic diseases, but I also hear you say the quality of animal products matters a lot. Do we really need to cut out all animal foods or can they be part of a healthy plan? Obviously you haven't advocated for cutting out animal foods and we just talked about them for a while, but. And you've kind of talked about some of this. Like there's no vegetarian culture that like.

Well, vegan.

Vegan, yes.

Yeah, there are vegetarian cultures. Yeah.

How do you.

So you know, if I take, if I take a. Well, Greg, I'm Al. When I was talking with. I didn't realize this. I was talking with Joel Salton about the eggs he raises. He's actually tested the nutrient deficient concentration of his eggs and they had over a thousand micrograms of folic acid and his eggs, which is more than what's recommended for pregnant women to prevent neural two defects. It was like five to six times more in a store bought version. Why? Because his chickens are running around eating bugs and worms and digging through cow patties and pulling stuff out. And it's like happy, healthy chickens make happy healthy eggs, if that's a thing. And so you look at cows that are, or chickens that are. It's really interesting. The, the, the nitrogen content is so high that they have to use an aluminum ash in the chicken farms to make the babies survive for the first couple of weeks, otherwise they'll die from ammonia poisoning. When they get old enough, they can handle it. They're inhaling their own feces or if you can smell the things for miles away and they're being fed pelted genetically modified soy with glyphosate and all stuff like that. And if you eat that, is that going to be good or bad for you? The, the same thing goes for cows in an animal. And when you eat. This was actually a great example. Silent Spring. Rachel Carson wrote about them spraying DDT in college campuses in the Midwest in the 50s. And it would kill, kill all the mosquitoes, whatever, get in the sorrel. The worms were fine with it. Worms concentrated in their bodies. Birds ate the worms and died. So, so in the spring you had no, you had no bird songs. That Silent Spring. It's kind of eerie to walk out and just not. I mean, I'm hearing birds right now. And so the idea is that these things will, animals will concentrate wherever they eat. And if they're eating genetically modified soy and corn, if they're eating corn that actually has its own, makes its own toxin, BT toxin. If, you know, if they're being fed some kind of animal ground up bone meal, they concentrate all that into their tissues. Yeah, that's not gonna be good for you. Like don't eat that. So the first thing is, are you eating real food? The second thing, there is a subset of the population. This is where, you know, doing advanced testing can be helpful. Like the Cleveland Heart Labs has a lab called a tmao, Trimethylene oxidase. And it's actually made when you cons you have a bad gut bacteria and you eat carnitine, which is in egg yolks and red meat.

I have this problem.

Yeah. And if you eat that, the bacteria actually make that level high in your blood, and that's associated with an increased risk for cardiovascular disease. The issue isn't the carnitine. The issue is the gut bacteria. So all of a sudden, like, you can treat the gut, clear the bacteria and retest. So, you know, I kind of remember the book Upton Sinclair, the Jungle. And part of that, I mean, the, you know, we've learned a lot of things about his. The historicity of that. I'm not going to go into that right now. But the gist is that it was really bad. People would get tuberculosis from drinking cow's milk back in the day. I mean, the animal processing was horrible. Like kids walking around blue milk. And it just is crazy. There was a point in time when things were horrible, but now we have a lot of opportunities to actually choose to know your farmers to, you know, that's one of the things. Joel south and he like has happy pigs rooting around, getting nuts. The cows are eating, you know, eating salad bar. Refer to a salad bar beef. Like fresh microgreens. Every day they move around like that's another thing up there. Yes, folks, ain't normal. Yeah. So, but the gist is like, that's where I think, you know, if you're not sourcing it. Well, yeah, cut it out. That's where sourcing real food. Find what you're eating is huge. And then your appropriate testing does your body process it the right way. If you're eating red meat and you don't have enough bile in your stomach and it's making you really gassy and bloating, you have enough stomach acid or taking a proton pump inhibitor, you're not going to break down the red meat. It's hard to break down, but so is uncooked vegetables, actually. And you might have some issues from that. So I think, you know, yeah, great, great point. But I think if you take a deeper dive into that, actually Shanahan, the deep nutrition, wrote the book. Kate Shanahan, Kate Shannon wrote a book kind of Maryland. Maryland. Yeah. Wrote actually read the book like 10 years ago. I was looking this up the other day but talked about this concept about ancient healing traditions. And I think part of her story actually if I remember correctly, it's been Walton's wrote the book was she actually was a elite athlete college and actually injured out of college. I think she had a scholarship, I don't remember but. And part of that was her horrible diet. And so it's like, you know, if you're an elite athlete, you're. You're highly motivated person. You need like real food. And as in a human, there's some things we just don't. Some things we cannot get from plants. We need to eat things that make them for us and concentrate it for us. You know, there's, you know, saturated fats. There's really not a really great plant based source of saturated fats which are an essential fatty acid for us to get in. Another interesting thing if you know there's certain tests. I do, I'm sorry. That we look at how people process omega 3s and omega 6s. I see this routinely where someone will have elevated alpha linolenic acid level, but their EPA level will be low. There's an enzyme elongase enzyme that they don't have. So you need all the flax you want, but your body has a hard time converting it. You know that person just give them some good old fashioned fish oil. You know, there's some people have a problem, they might have a high linoleic acid, which is an essential Omega 6, and you'll go down. They won't be converting into GLA or DGLA, which for women for progesterone is ridiculously important. It's one of the reasons eating primrose oral some women does great actually as they helps improve progesterone functional receptors. If you're not making that because you're not converting, you know, you need to plug that in. So sometimes you have to test to find out if you have an issue making certain fatty acids that your body's not converting, which you need to get from some kind of animal source. This is the, the GLA is not a good example because that's a plant source. But the point is that testing can help figure out, you know, doing some precision personalized medicine stuff can help us figure out like what's really going on under the hood.

Gotcha. You just mentioned evening primrose and we're transitioning into women's health. So for pcos, which is polycystic ovarian syndrome, ovary syndrome or endometriosis, I'm hearing that fixing Your gut first is more important than jumping on hormone meds or hormones. Hormone meds, That's a weird sorry if that's true. What should we focus on like specific diet tweaks or certain tests to get to the bottom of hormone issues.

So pcos polycystic ovarian syndrome is part of metabolic syndrome where people women have insulin resistance. So what happens is there are two organs that aren't insulin resistant, your kidneys and your ovaries. So you hold on to fluid, you get high blood pressure as you get older and the females get polycystic ovary endometriosis. And they're both are autoimmune spectrum disorders. So there's an autoimmune component to it, particularly endometriosis. It's actually people talk about stem cells and all that kind of stuff. It's literally cells decide to create something else in your body and they go somewhere else and you get, you have endo or adenomyosis or even fibroids which are can become autonomous which actually happened with you where you had fibroids and they basically decided to make all the estrogen they wanted. They couldn't stop and had to be removed. So gut health is super important because it addresses all those issues. There are a lot of easy hacks that can be helped with like low dose naltrexone. Metformin are ways to help sensitize your body. If you're test, if you're testing, you can track insulin levels, track different metabolic markers. Berberine is a natural version of melatonin. Sometimes the GLP1s which you know, for better or worse are super popular right now. Those can actually help with insulin resistance as help as well help with mast cell stabilization which interesting enough with PCOS endometriosis there's a mast cell component to it which is kind of fascinating to me as well. So you really need to kind of. PCOS endometriosis are tricky because usually women are dealing with it when they want to have kids or they come in when they have fibroids and they think about surgery. So is it really. It's a time push, but there are a lot of different things that can be done for that gut health's a big issue. Clean up your diet's huge environment. There's a lot of environmental factors called neuroendocrine disruptors, petroleum based chemicals, plastics, healthcare products, phthalates, which makes plastic kind of soft, which are a lot of female healthcare products. This smooth silky stuff. These things act like estrogen and mess up female's Hormones. So all of a sudden detoxifying work on your gut. Detoxifying your environment can have a massive impact. I've had patients who've done those few things and had with a little dose. Obviously they're seeing me, so I'm giving them a little Lotus naltrexone as well and some other insulin sensitizers. And then wait, if you have some metabolic syndrome issues, look for other things like if you've got endometriosis and, or pcos, you know, what's your triglyceride level look like, what's your fast against look like? What's your glucose, your A1C, you know, do you have other markers of metabolic syndrome? Doing a gut test can help you with that as well because all those can play in with the treatment. But if you have something like that, you probably should be working with someone because just kind of winging on your own and seeing how you feel is, you know, get you five, six years later down the road. You're having to get fibroids removed or whatnot. So you want to really catch something like that early before you make fibroids that become autonomous or you get in the rush where you want to have children or family and then you're, because of time constraints, you're going down the IVF route.

I'm, I'm going to take a little tangent here and just mention that I love makeup. I think it's really fun. It's like art on your face. But it is like a daily like application of a lot of the things that you just talked about. Most like lipstick products have like waxes in them that are essentially, they'll be like cosmetic waxes but they're essentially a petroleum byproduct. A lot of the things that are like on the higher, you know, like, like they're really like a lot of the really high rated cosmetics have things in them I'm not anti, like chemical. There's a lot of great things that you can find that actually like are doing things in a way that's not super. It's thankfully happening more with like fragrance items. Like you can actually find like fragrances now that are, they're not necessarily like all natural, but they're like extracted in a way that they're like avoiding phthalates and parabens and stuff like that, which is just an interesting trend that I've noticed. I still can't like go super far down the fragrance realm, but it's just interesting that that's trending ahead of like the actual like color type products that we put on or even like the skin care. A lot of it has, you know, parabens, phthalates, like again, waxes, a lot of petroleum byproducts. Like the really good moisturizers that you're like, it stays on and it like soaks right in and it's not oily or greasy and it'll have stuff in it that's so bad. Um, it's just an important consideration. It's complicated because it's kind of hard to find great options and there are a lot of like just big words and you know, you'll open a cause. It's not like food where you can be like, it has five ingredients or less. It's probably, you know, relatively healthy because there's probably going to be 14 ingredients no matter what. Um, there are two apps that are pretty good though. One is called On Skin. My opinion, the drawbacks of it are I think it kind of rates things a little bit harshly. And based on my personal research, it will give certain products a really low rating when they contain certain things that I'm not sure. For instance, I've done some cosmetic formulation, so I believe that you need to have something to preserve any product with water in it. Um, otherwise they're like, they need to stay in the fridge and you have to use them like three to five days. Um, just like your food's gonna go bad, it's gonna go bad. So. So there's some preservatives, like, I tend to steer more clear of like the parabens type stuff where you know that it's like ending up in breast tissue and things like that. But then you're still left with things that maybe aren't the best. But is it worse than whatever fungus that's gonna grow on your product? So there's like this very deep level that you can go to, which I tend to go those deep levels because I'm weird like that. But On Skin is pretty good, maybe grades a little harsh. There's another one called Think Dirty that's also pretty good. And a lot of cosmetic products are in there. You can actually even like scan ingredient labels from things and it will, they'll use it to populate their database. And that can be helpful just to sort of like begin to get an idea because it'll show you what actual ingredients it thinks are not great. And, and it will give you an idea of like what they are and why. They're like, this is an endocrine disruptor or this is an allergen like if you sometimes things are like just highly allergenic in your skin and so those will be downgraded. But is that worse than like endocrine disruptors? You know, like, so sometimes you're kind of having to learn like, what are the trade offs I'm willing to make? What do I think is something really important that I need to worry about? I've tried some really beautiful natural products that like gave me like puffy red eyes because they probably, you know, didn't have the right, like whatever. They weren't doing something right in the way that they were formulating the product. So there's always sort of the trade off with those things. But those are two apps that are actually really good. I think they're both paid, but it's not a lot of money and it's a lot easier than like trying to learn the names of every single chemical that goes into those items. That was my tangent.

Great. I was gonna ask you about that because patients always ask me, what does your wife use? And I was like, I don't, I.

Don'T use like one certain brand. I will just. This is going to be controversial and I always get comments when stuff goes on YouTube. But it is what it is. I do not purchase ever from multi level marketing MLMs. Um, it's like a blanket rule that I have and I won't go into extreme detail. I don't want to hurt anybody's feelings, but I do not buy products from them. And a lot of them also have very problematic ingredients anyway, so that's all I'm going to say about that. But yeah, I don't buy things from just one brand. So it's really hard to answer that question. And there are some brands that are like, you know, higher end, regular mainstream brands that are fine and there's some cheap brands that are fine. CoverGirl actually has a clean line now that most of the stuff in the clean line like on these apps, you know, they're formulating it differently. So they're okay. Target for a little while had a thing where they would mark the certain cosmetics as with a clean label and they stopped doing it. So I don't know what happened there. But Sephora has a clean section or clean label that they do as well.

But ultimately what you buy will drive what gets produced produced. So if you, you vote with your money, what would you purchase? It's gonna be a little more. But I mean, I passionately talk about this topic since I don't really put any makeup on. But the few Times I've bought stuff been like, holy moly, this stuff's expensive. So I was buying from my wife, not personally, so not there's anything wrong with that. But, but so it's just one of those things like even the bad stuff's expensive. So you just pay a little more.

Get better stuff sometimes. Sometimes you pay more and it's worse. So there's, there's some awesome brands that are like so fun. And you pick it up and you're like, oh, I would love, I would love to play with this. But it's not, it's just bad. It's got bad stuff. So some of the rest of the questions are going into territory that I don't know if I might. We might need to do like a little separate.

We're also running out of time, so we might.

And some of them we already covered. There's a bunch of stuff about like feeding families, which is a little bit more my territory. And I'll just put a plug right now I am working on, I think it's going to be a bonus that's attached to our online program where I will go like a deep dive into. Right now there's already a basically kind of like a downloadable product that just goes into like how we handle various situations and what I do to get good food on the table for the family. What we both do to get good food on the table for our family that's a big plug, is that it helps if multiple people are willing to make sure that good food is getting on the table. We're actually getting ready to work on our kids contributing more in that way as well. But I can go into more detail about that at another time. I'm trying to make sure there is one more that I want to ask because it just kind of ties in with a lot of what we've talked about. Um, someone on YouTube I believe at basically said, I love this root cause approach, but I can't find a doctor near me who practices this way. Why aren't more mainstream doctors doing this? Is there a particular training or certification? And how do we get more doctors to switch to this type of medicine, like functional medicine, personalized medicine, precision, whatever you want to call it.

I mean, that's hard. It's hard when roughly 70% of physicians don't work for themselves. It used to be normal when doctors work for themselves. Now they work for organizations and so you work for someone else. So they can't just say, I'm going to start practicing this new kind of medicine that's not reimbursed by insurance, requires more time, more effort, and doesn't create any more revenue for my boss. Like that just is hard to do in our current system. So part of it is the educational system, part of it's the reimbursement system. We just don't pay for cognitive work, which is the reason why more procedures are done in our country. You know why? You know, it's really easy to get a lot of fancy testing done, but you can't get time with someone to talk about the testing of the results or whatever. So I think you know how to, how to. Individuals listening to this enact change, you have to look for it again. You shop with your money, maybe drop, you know, drop little clues in your, your practitioner's ear, hey, I've been looking at this. What are your thoughts about that? But ultimately, you know, I think what happens is it's, it's now catching on. I mean, people now know what functional medicine is. 10 years ago they had no idea what it is. So I think patients, people just need to vote with their opinions. When they, when they give all the, all the hospital systems around here, it's hca, bonsa cores, vcu. When they ask your feedback, you should say, I wish you all did functional medicine. So amazing. You know, I have no problem paying extra money for better care. And just start. When you get these surveys about your healthcare, what your experience was, just start putting those plugs in there. How many times do people get, how often you get those? Every time you see a practitioner, you're probably getting one of those or at least once a year from your insurance, like, but there's plugs in there. You know, that's, that's kind of what your part, but ultimately the training part, it's just, it's hard because it takes extra time. It's, it's, you know, I've personally spent close to $200,000 on my education after, after my residency program and over 10 years, you know, it's a lot of time. It's a lot of time. So I think we're creating resources where we're kind of connected health. One of the things we're putting out there, where it allows people to kind of figure out their own path and hopefully they'll have labs and some other things associated with that. So we are creating some things to actually meet people where they're at, but you have to go search for those resources and find them. So it's a great question. I'm hopeful. But part of me is just Pragmatic with the way our current health care system reimburses. If you only want to pay for what your insurance pays for, you're only going to get what your insurance pays for. So unless we change our system from a sick care system to a health care system that actually tries to prevent illness, which hopefully will be happening in the next couple years, I'm hopeful. But waiting for the government to change, you might be waiting for a long time. You really need to be your own agent for change, which is kind of how we got down this pathway. And it's how most of the providers I know that are in this kind of medicine, that's how they got down this pathway.

So yeah, if you listen to our podcast or YouTube channel, that that's where it all, like all that episode started was sharing some of those stories. Do you think that with the rise in popularity of functional medicine, there's a bit of a risk that people are kind of just slapping that on there? Yeah, I mean this is what I do because it's getting a little more.

It'S the wild west. It's like supplements. You know, you can say I'm a functional medicine person because you did a weekend course, maybe you did a six month, you know, functional whatever kind of thing. And it's like, and it's diet, exercise, sleep. I mean, you know, 80% of it's diet, exercise, sleep, meditation, self regulation, sense of purpose, value, meaning like that's not super complicated. But what if you have an all immune issue? What if you have, you know, abnormal lab values? What if you've got significant symptoms? Then you probably want to work with a licensed healthcare practitioner, which is a. Totally changes the level of the person going into it. So it's, it is very much the wild west. But, but it's interesting. I've, I've. Some people I did training under were amazing chiropractors, some people that I trained and they were major, were amazing nature paths and acupuncturists. You know, you know, obviously I'm a medical doctor and I do this stuff as well. But it's, it's, it's, there's really. Because there's no standardized, acceptable, generally accepted educational platform or the ones that are out there are expensive and take time, people are looking for shorter ways to do it. You know, um, so that's, you know, I've, I've, I'm currently working on a personalized medicine certification at the University of South Florida. Um, it's, you know, 2,520, almost 25, $2700 per course. Um, pretty intense. Um, about 50, 40, about 5, 40 hours of lectures per each one of those over the period of three to four months. It's probably the shortest educational thing out there. But still, that's $7,000 plus travel time, plus your personal time. It's, it's a, that's, that's a lot of time, you know, versus the most expansive one would be the American counted anti aging. There's this seven, eight courses, huge over probably two years. And IFM has a little paradigm version of that same price point. You know, I've done, I've done all those, are currently doing one of those plus a bunch of other stuff. I just, it's hard to find someone who's going to be that dedicated to their education, to their patients. Ultimately my stories that what drives me is my family and then patients. And now I've gotten the point where I can kind of sit back and just do it for the joy and fun of it. But it wasn't like that in the front end. It's hard. I agree with that. So I would just encourage that person to find a reliable source of information to study, to learn about their health and find someone that'll work with them. And in our connected health thing, we actually have a whole section we talk about how do we talk to your healthcare practitioner if you have someone who's open to this but they just, they don't have the thousands of dollars of, of money at a time, but will they come alongside you and kind of like learn with you? If you have someone like that, we've actually have a resource that helps you kind of work navigate that, you know, so that's. And I think that's probably the, not the best place that'd be the lowest hanging fruit place to be. We find someone who's open to it is. And you'll be wanting to walk alongside you. But yeah, I'm not going to take two years off and spend, you know, tens of thousands of dollars and be with my family for two years to get this certification, you know, which is 100 reasonable, you know. But I'll come alongside you any way I can. Like that person I think is gold for you. Stick with them and bring stuff as you're learning with them. And that's, that's a true, I think through Dr. A true patient practitioner relationship was where they're learning with you about you for you. And that's kind of, you know, my two cents on that.

Do you want to wrap us up?

Absolutely. So those are our questions. Thanks again for coming out. Again, if you like this, like share, subscribe, click the thing below. Make sure you comment as well on social media, which is how this stuff gets out there. We'll be doing more of these as we finish future things. This one again was with the Gut series we did. We have a stress and sleep series that's out there on YouTube, but that'll be on podcast soon. So if you have questions about that, put them there and we'll be answering them when we get around to that as we go through this. Otherwise, take care, be well, and we'll talk to y' all soon.