#23. Vital Hormones, Gut Resilience, and Detox - Your Path to Wellness with Dr. Shilpa Sayana

Welcome to the Holistic Dentistry podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. Hi, everyone. Welcome to the Holistic Dentistry show. I'm here with Dr. Shilpa Sayana.

Welcome. Thank you so much for having me. I'm excited to be here.

I'm excited to be here because, you know, we have so many neutral patients.

That we completely do. I mean, the mouth really is the beginning to all the guts and all the inflammation. So I'm really excited to share what I know.

Yeah. Great. So I'm excited to chat with you and I think all of you listening will find it very interesting how the rest of the body, especially the gut, is connected to the mouth and how we work together, because I really believe there should be more interaction between dentists and medical doctors.

Completely. I think when there is, it's like the best outcomes for patients.

Yeah. So let me introduce you here to everybody. You in medical practice now, over 15 years, you're triple board certified. Impressive in internal medicine, obesity medicine, holistic and integrative medicine, and a certified practitioner in functional medicine with a specific focus on women's health, hormones and medical weight loss, Correct?

Yes. I've kind of had a long journey to get here, but this is what I do, and we really have great results with patients.

Yes. You became interested in a holistic approach that attempts to figure out the root cause of illness after being diagnosed with a tumor that thankfully turned out to be harmless.

Correct? Yeah. It was a time when we just finished my training, I did a fellowship and I was traveling internationally wearing many, many hats. And after one of those trips, at that time, I was a mother to a toddler, was doing this global directorship in international health, and incidentally found out to have a tumor in my neck. It was benign after going through the journey of a biopsy, but it was a very scary time. First time being on the other side of healthcare. And that's when I really realized where the what's super important is kindness, connection, and real relationship with your patients. So after that experience, it fundamentally changed how I approach medicine. Because in regular internal medicine, as an internist, we don't have a reason why. And when I go into my colleagues, a lot of them are like, it's kind of sporadic. You had this thing, I'm like, have no family history. Like, why did this happen? And that's where I discovered functional medicine. And it's a root cause approach as to the intersection between stress, inflammation, genetics, and stuff you were exposed to.

Yes. And I think mostly in internal medicine, we don't really talk about enough emotions and how you feel and what's going on in your community. These are all such important things completely.

You know, and that's a sad thing, how we would train it as an internist. And in defense of all their traditional practitioners out there, we give them like 15, 20 minutes to get through a patient visit. And you want to kind of address the quickest thing. Then it's easy to write a prescription and say, you know what? Go on your way, as opposed to saying, you know, how is your stress level? Where would you rate your energy? What's your sense of community? What's your sense of belonging? What's your sense of purpose? Even though we know these three things impact your cardiovascular health, but we just don't have the time, and that's where that kind of medicine wasn't satisfying anymore. Also, in defense of regular medicine, we don't go deeper in terms of lab work because then we have to interpret it. Patients might get a lab bill, but truly, patients want to know. They want to know what their root cause is.

Absolutely. I always like to go to the root cause of issues myself. So that's how you and I connect so well.

Correct.

So with this tumor, like, what was it? Was it enough?

Yeah, it was a schwannoma. So it's a benign tumor on a nerve cord. I know in traditional medicine, they're like, you can remove it, I might lose function of my left arm, or you can monitor it, but it sits right on top of a big vessel, kind of flowing, that flows blood to my brain. And so it's kind of something I have to monitor and watch. And I know for myself, like, I need to be aware of my own stress levels, my own gut health, my own kind of toxic burden. So in a way, it's kept me in check as trying to be somebody who follows my own advice that I give patients.

So how do you find that go away on its own or.

So after going through my own functional health journey with my own health stuff, it actually hasn't grown. And so that's why we just monitor it. But it has a risk to growing regular medicine. Like, it could grow at any time. And that's why I really have to figure out what were the triggers and what are the triggers that could cause something like this to occur and to grow.

Yeah.

And that's where really drew me to a root cause medicine approach. And that's where I feel like with patients are just empowered with the knowledge of what's the stuff you can change, like your. Your stress response, your lifestyle in terms of toxic exposures, your dental health, like, what can you control and just give them power to make that choice.

Yeah. As a holistic dentist, I also talk to people about their lifestyle. Right. The chemicals they put in their mouth and, you know, for example, clenching and grinding. Make sure you do relaxation and meditation. But what I find, and I don't know if this is true for you, people are asking me, well, isn't it simple? Do you have a pill for me that I could take to make it all go?

Yes. You know, if you had asked me 15 years ago, I would have been like, it's all about, this is how we train in medicine. You know, what's the pill we can give you and what's the other pill we can give you for the side effects to the first pill? And that is really a quick counsel. We all are trained, and that's what we look for. But unfortunately, functional medicine, or root cause medicine, is a lot of work. And so much has to do with your lifestyle and what you're putting into your body, on your skin, in your mouth, your nutrition.

Yes, absolutely. So let's talk a little bit here about your area of expertise. You mentioned obesity, women's health, and people.

Dealing with fatigue and hormonal images.

Yes. Yeah. So which one is your favorite? Out of these three?

My favorite is probably hormones, just because they're easier to fix. And also, I think the biggest hormone in terms of hormones we look at is four hormones. The first one is your stress hormone, your cortisol. And as internists, we just want to make sure it's normal. But as a functional medicine doctor, it's all about getting these hormones to be optimal. And, you know, I find, like, a lot of my patients feel like they're just running on a treadmill, especially my female patients. They're, like I said, so busy being a mother, having a job, having a relationship. And I think people just don't realize they have a choice in terms of getting off this treadmill. And the biggest hormone that's impacted by this is your stress hormone. And so measuring that and telling patients that, hey, you know, your feelings are actually validated by an actual lab test. And we can optimize this. You don't have to get out of your toxic job, which I prefer you to, but at least you can try some adaptogen, just supplements that can at least help your body pretend that things are okay until you can figure out to make those lifestyle choices that are better for your Health in the long term.

Yeah, Very nice. I actually really like adaptogens myself. I take Ashwagandha.

Yes. And I think that's a great. It's a great supplement to take. Can really help in terms of dropping your cortisol and helping you adapt to your stress. Things with ashwagandha. And I tell patients it's important to measure a few things, like measure your thyroid, because ashwagandha can make your thyroid work better. However, if you're already a thyroid is pretty checked, you might feel palpitations or you might feel some insomnia. Ashwagandha is great about helping your estrogen convert to testosterone, so it can really help you with energy and strengthening. However, if you have too much testosterone already, like PCOS patients, it might make things worse. That's really important to know the labs and see where you're coming from so you can build upon that. Kind of unique to your genetics and your labs.

Yeah, that's very interesting. I found out so much already talking to you. That's great. So basically, ashwagandha, since it gives you energy, is something that you would take more in the morning.

Yes, I take in the morning. And then some people who have really high cortisol at nighttime, we can use it at night to kind of help dampen that response. And it's about playing with the supplements to see when you feel best. But I feel like people are just so busy in terms of even being aware and attuned to their own bodies. So some sort of mindfulness practices are what I prescribe for everyone and sometimes hard for me to even meditate. And me saying, I'm doing that. But I tell my patients, you know, I'm going to try. You're going to try, but you just have to make out that time. Because meditation, as well as doing things that give you joy is the best thing you can do for your cortisol rather than a pill.

Oh, yeah, for sure. Maybe get a pet. I got two new kittens.

Definitely help in terms of helping your cortisol. And then the cortisol and adrenal glands are such an important hormone. Think of it like the grandmother and then your thyroid as a daughter and then all your sex hormones as the grandchild. So if you fix your address, your adrenals as root cause, all the other hormones tend to normalize.

That's amazing.

Yeah. And so don't take a step in medicine or in life to be like, let's just take a step back and see, you know, are you happy? Do you have community do you have purpose? And what are you putting into your body? And what do you know? What does that look like?

Yeah.

So I think we just took a step back and focused on adrenals would impact all the other hormones.

Fantastic. So, going back to hormonal health, do you see a big problem today in the world with hormone?

Yes, the biggest problem I would see the hormones is how hormones are processed. They're processed by your liver. And the biggest thing with the liver, it's so impacted by toxins. And I think there was an Institute of Medicine article from a decade ago saying that 90% of diseases are caused by endocrine disruptors, which are toxins, even though we know that we don't do anything about it in traditional medicine because there isn't a business model around it. And we know people are just not going to do anything about reducing that toxic burden. But you as an individual could reduce what you put on your skin. You could reduce what you make sure you're eating organic food, make sure you're at least trying to nudge your knees on plastic bottles of water. And I mean, for you, in terms of what you do, you at least have the privilege of seeing the mouth and the mucosa as to what's happening in there. Because if there's a bunch of inflammation in your mouth, and for sure there's inflammation in your gut, and we have to do a lot of blood testing to see is it leaky gut, what's the gut microbiome like? But it really all starts in the mouth.

Yeah, absolutely. I'm glad you mentioned that because I always say the mouth is the gateway to your health.

It really is.

Yeah. And, you know, we see endocrine disruptors actually affecting the mouth. I mean, there were, for example, like, night guards with bpa. BPA is a disruptor. Yeah. And every time it comes in contact with a warm, moist environment, then let's say people are grinding at night and they're wearing a BPA night guard. Now all of a sudden, that BPA kind of slowly rubs off and they swallow it completely.

Yes. And another big thing with your liver and toxins is what is your genetic variability? Because some patients I see, they have a bunch of toxic exposure, yet they don't have that level in their blood or in the urine. And it's all about genetics. So the couple genes that we test for a lot is MTHFR, which is a methylation gene, SOD2 and COMT. These are genetics that you can get from a23andMe, or you can get just basically a salivary swab. But people who have genes that activate it tend to do worse in terms of exposure to toxins. And another why all these hormones, all these toxins are endocrine disruptors. But another big thing is LA got the sad privilege of being number one in terms of the most polluted city in the US this is lost.

Oh, wow.

Hopefully that maybe that has changed. But because we are like exposed to all this gasoline and plastic, all those are also endocrine disruptors.

So it's important to know what your.

Genetics are and maybe you do detoxify well, but most of my patients don't. They usually come in with autoimmune diseases or kind of beginning of autoimmune diseases or high blood sugar or severe anxiety. Those things are. First thing I think about is how is your gut and how is your inflammation? And so it's so important for them to make sure they're getting regular dental visits to look at what's going on in their mouth.

Yes, absolutely. I'm glad you're talking about that. You know, and another nice thing that you mentioned is that you test for genetics and this is not the norm. Everyone. You can still go to a lot of physicians out there and they don't even look at your genetics. They're not personalizing your medicine. Am I correct?

Absolutely. And again, they have 20 minutes or maybe 15. They just don't have the time to test and actually go through that process with you. But it's really important to empower yourself and say, okay, these are the things I know I need to get tested and then get a consultation from an integrated practice person and find out what are your genetic snips that make you sensitive to either toxins or to inflammation.

So why is it important for you as a doctor to know someone's genetics?

Okay, it's really important to know the genetics because these are like the on and off switches. So in the right setting with a lot of people who are exposed to a big toxin, we see a lot in LA is behind mercury. It's sushi is really popular. We have people with a lot of silver fillings and we just have to regular blood work, give mercury levels high and we can do more of an extensive test to see what your mercury level is in your body. But it's super important to know the genetics because for some people who don't detoxify well, their levels of mercury will be higher. Yeah.

And actually for those of you that don't know, MTHFR is one of those detoxification genes that you want to know?

Correct. It's super common. I mean, I have one of them, but I grew up in Southern Africa, which was really clean. I didn't have the environment to actually get any of these genetics switched on until I came to the U.S. oh, yeah. And then my kids. Yeah, exactly. My kids have now already have health issues, but basically they have detoxification genetics that I gifted them and they've been activated, which is our environmental exposure.

Yeah. I have the MTHFR SNP as well. So, you know, and I think what's the percentage of the population that actually.

Super common. You know, 50% of us have it and 15% of us have both genes, one from mom and one from dad. That's a lot of my patient population. They've kind of gone to lots of practitioners. They're like, have random symptoms and nothing is explainable physiologically. But if you look at it from a lens of toxins and inflammation, it's kind of obvious.

So if somebody comes to you with a 23andMe genetic test, can you use that?

Absolutely. And we just put it through, like a medical software. It tells us if they have detoxification genes. It tells us if they have an APOE gene, which kind of puts them at risk for dementia or Alzheimer's. And people who have those kind of genetics need to start working on their health, really in their 30s and 40s.

Yeah.

Because it could be switched on and kind of cause an epigenetic outcome in their 60s to 80s.

Yeah.

So, yes, 23 me is super helpful.

Great. I'm glad you mentioned epigenetics, because it doesn't mean that's your destiny. Right, Genes.

Absolutely not. Absolutely not. And remember to think about it as a triangle. So think about the genetics of the base of the triangle and the other part of the triangle as mediators or stuff you were exposed to. And the tip of the triangle as triggers your stress perception. So the goal is you work on your stress perception, community joy, movement, exercise, and we work on your mediators. We measure gut health, we measure toxic burden, we measure your gut lining, we measure your gut microbiome, and then together we can switch off your genetics. So just because you have a gene doesn't mean you're destined to have any disease.

Yeah.

So much.

Very, very important for everybody to know that. So start working on your lifestyle today. See a functional medicine practitioner. You practice?

I practice in Sherman Oaks in the mall at the Westfield Sherman Oaks Mall. Parking is amazing. Yes.

Because I've been there.

It's really changed the life of lots of my patients and it's just easy to get to. And yeah, it's been really great in terms of seeing patients and carrying them through the health journey and most importantly, empowering them with inflammation.

Yes. And I want to talk about the next gut health because you have this like pillars right to a patient care. One is hormones, gut health.

So, yes, four pillars. The first one is hormones. And the hormones we measure are your adrenals, which I mentioned, your thyroid, looking for any kind of autoimmune, thyroid disease, insulin and sex hormones. So that's the first pillar looking at hormones. The second one is gut health. And the gut is really your gut microbiome and your gut lining. You have the benefit of seeing that much earlier because you're looking in the mouth.

Yes.

And so you're seeing inflammation and you're seeing damage already there. You could already kind of predict they're going to have a leaky gut and they're going to have dysbiosis. Absolutely.

Especially when people have a white coated tongue. Usually can be a candida issue completely. How often do you get so often.

And it's so hard. It's so sad because it's not checked enough. People don't even realize that there's some basic, simple steps you can do to really improve those levels.

Yeah, this is what I like. I can see the mouth so I can make the right referral to you. And when I see a white coated tongue and inflammation of the gums, I ask them, you know, how is your digestion? How do you feel? And then they tell me, oh, you know what, I'm constipated. I remember actually I had one, this one patient and I started to ask about her diet. Yeah, oh, I don't eat fresh fruits and vegetables. And I'm like, wow, isn't it? And then she said, yeah, I don't eat it because if I eat an apple then I want another one. But she was constipated. Like she wouldn't go to that for days.

Constipation is such a common thing in the US we supposed to get around 45 grams of fiber on average and get 12.

That's so low.

It's so low. But yeah, and you see the mouth and you're seeing gut inflammation already. And all you have bad breaths, like, what's going on in my mouth? So much of it is really starting from the gut.

Yeah, absolutely. So how do you test for dysbiosis in the gut?

Yeah, so we do stool testing and we look at your whole Microbiome. We do a lot of sibo breath testing. Sibo is small intestinal bacterial overgrowth. Super underdiagnosed and super common. And patients can have bloating, some gut symptoms. But a lot of my patients with SIBO at 50% of them have no symptoms symptoms really. So we're just kind of unaware of.

What'S one of those patients.

And yeah, you may be doing so many other good things that your body just doesn't kind of register that that's it, we're on. And why is it so important is that sibo is the most common cause of malabsorption. So you're eating all these good vegetables and fruit, but you're not absorbing those nutrients. And also sibo is super important for estrogen metabolism. If you have placebo, you can't actually metabolize that estrogen very well and you're more likely to have fibrocystic breasts, ufin, fibroids, heavy bleeding, pms. So once you kind of treat the underlying root cause, a lot of those hormonal imbalances just disappear.

Amazing. It all really starts from the gut. And that's a functional medicine. Definitely approach there. So with dysbiosis, is it a can somebody heal from that or.

Absolutely, you can heal from it and you know, dysbiosis being the umbrella term and see what we want of it. And then there's also sifo, small intestinal fungal overgrowth. So all of these little things, all of these kind of dysbiosis sources you can absolutely heal from until the next life stressor. Once you hit your cortisol again and you have high cortisol, your microbiome is changed so that now it's going to go back to inflammation. Your genetics just don't know the difference between you being cheese tiger and you having chronic stress is going to release your cortisol, pump out that insulin and give you the energy, the glucose right away to keep running. Unfortunately, if you chase by tiger, you either get eaten or you're saved and your cortisol has time to come down and for you to rebalance. So with current life stresses, people are just running and running and running on that treadmill and there's no time to pause. So your body thinks you're always being chased by a tiger and puts you in this pro inflammatory state.

And that in itself changes your microbiome.

Correct, it changes your microbiome to favor. Like if you have constant high stress, your body actually has more higher blood sugar. And so that's the perfect environment for yeast to grow.

I see.

So you have to. Yeah, it's not a quick fix. You have to work on all four of these pillars, and you also have to work big one on your lifestyle. And it's interesting.

We see the same thing with gum disease, you know, when people are stressed. Bugs in the mouth. You know, we get dysbiosis and we see leaky gums, which are associated with leaky gut.

Right.

Yeah.

And I think people just don't pay enough attention to the oral health and same thing with a gut health. And a lot of people in their early 40s kind of wake up to autoimmune disease and they're like, wow, how did this happen? It doesn't have to be a reactionary process. Really get data, and it could be very proactive with your health.

So basically, autoimmune that comes from a leaky gut and dysbiosis.

Correct. So just a quick personal for you. This summer, I spent a week in Italy. It was lovely. I do not have any sensitivity or genetics for celiac or for gluten sensitivity. I just don't. And when I was in Italy, we ate. I ate a lot of wheat. And we constantly think that European wheat is different. It's not as antigenic.

I think so, too.

Yes. But I ate weed for, like, four days straight. And on the fourth day in the morning, I woke up like, meat source. Wow. I couldn't even chew. So painful. And I was like, what happened? I'm not stressed. I'm. You know, I can't think of the triggers. What was I exposed to? In the mediator section, there's a ton of wheat. So I gave up on the wheat and my mouth was resolved. But when I came back, I did our regular, like, in depth blood work that we do on everybody every quarter. And I had my first time autoimmune antibody, an ANA from wheat exposure. Exposure with no testing for actually knowing that I was gluten sensitive. And I completely cut out wheat, went really low in dairy and low in processed sugar. And I just checked my ana, it's back to being negative.

Isn't that amazing?

The power of food. Power of food.

Yeah.

Yeah, absolutely.

Yeah.

Wow.

That's a great story. Because actually, canker sores. And I do tell that to patients. If people get canker sores, you probably have a weak intolerance.

Yeah. And it's a hard thing to hear because honestly, being gluten free is hard, as much as I recommend it to people, but it's just time and effort and not worth the price. Of autoimmune. And we have families with dementia. In a family, it's a small thing to give up.

Yeah. What about sourdough? I get this, asked this question a lot. Yeah.

So, you know, I used to, I would probably say probably in low doses it's okay, but after going through what I went through, I'm pretty scared of all wheat. But it's probably okay to have it complete as long as, you know, you really are managing the other, the other parts of the triangle. You're really not stressed, you're in a really good place. You probably have very low inflammation and your adrenals are balanced. Then you could probably mess around with a little bit of wheat, a little bit of dairy. Processed sugar is fine once in a while. Once in a while, yes.

So be careful if you go to Italy.

Yes. I think just be cautious.

So let's go back to dysbiosis and treatment. It's like, obviously people have to go gluten free for a little while.

Yes.

Long while, dairy free as well.

Yeah. And so, you know, it's nice when we have it in the blood work, when I can show them, hey, you have a celiac gene or you have non celiac gluten sensitivity, which is what we see a lot. It's an autoimmune disease. Autoimmune is once you have one autoimmune disease, you're very likely to get the net. And that was me. I thought it positive and I was like, I can't be going here. And I was like, I need to kind of change my lifestyle. But yeah. So when you have that lab test, it's really helpful just so patients can have the buy in. Sometimes it's hard to go, but gluten free, dairy free, sugar, light. But if you could just do it for like even a month, you would see a potential difference. And that is when you have your own experience. It really resonates with behavior change.

So what other things? So you mentioned mouth sores, but what about like skin lesions?

Yeah, I think is anxiety. Anxiety, anxiety. There's such a strong gut brain connection that a lot of patients who end up testing positive for the non celiac gluten sensitivity if you cut out the gluten, and the biggest thing they tell me six months later is, yes, they feel better, they have good, better energy, they lost a bunch of weight, but their mental health is so much better. That's crazy. And so some people come in, tried a bunch of medications and supplements and also, well, let's try the gluten have you tried gluten? Letting go of gluten? They're like, yes, but for a month or three months. But the magic number is six months. You can let go of six months. The antigen is gone. And you really see a powerful improvement in your stress perception. And why say stress perception is. Everybody has. You could have the equal amount of stress in your life. Two individuals. But what is your stress perception? And it's that choice that determines whether your body's going to go into a stress response or whether you're going to be like, it's okay. So that choice, I think I could just empower patients on choice that you have a choice to stay in this toxic job, you have a choice to stay in this toxic relationship, you have a choice to eat this toxic food, of course, but that choice is hard. And then until you can get there, get stronger with your choice, and then we can help you with at least supplements or showing you what it's doing to your body through that book.

Yeah. And, you know, actually, when I lecture, I have this great slide of two different people going down a roller coaster. One is completely terrified and the other one having a good time.

Exactly. And what's going on in those two people in their, like, neurotransmitters and their hormones, in their body, all those chemical messages are affecting your gut and affecting your oral inflammation. So it's super important in terms of kind of spending some time in terms of mindfulness.

Yeah. And perception is something. Perception of stress or of a situation is something that I work on a lot myself because I tend to worry about everything. So.

Yeah. And you need a practice. Like, what's your practice in terms of managing that daily? I'm sure you have so many kind of hats in the air. Yes. How do you manage?

Well, I have. Wendy, that's.

We need as many people as you can in terms of teams.

But yeah, actually, in the morning, I just practice mindfulness. And even if it's five minutes to kind of set up my day and visualize. I really believe in the power of visualization.

Yeah.

Visualize the day going smoothly and really focuses. Focusing on the three things that are important and especially, as you said, doing things with ease, I always picture that I'm doing things with ease and no stress.

And. Yeah, that's super important. And I think when we tell people, I tell a lot of people to try just even five minutes a day, it's. And I said, it doesn't matter if it's, you know, one to five minutes a day. But the key is Consistency, you can be consistent. Then you can rewire your brain into being like life's. Okay. And I got this.

Yes. That's the amazing thing. We can rewire our brain.

Yes, you can.

Yeah. And it's.

And it's just so important to realize everything's a choice from what you put into your mouth to how you take care of your mouth, to your digestion and to your movement. And another big thing we see is a lot of people just don't move enough. And Our goal is 10,000 steps a day, every 2,000 improves your health outcomes. But it's hard people in sedentary jobs. And so you have to really make an effort. And a choice.

It's a choice. Exactly. Sometimes it's an effort for sure. But with sedentary lifestyle, the problem is also the limit lymphatics.

Yes, exactly.

So especially for me and holistic dentistry, I'm trying to help people with detoxification of the mouth, but if the lymphatics are not working, can't detoxify.

And that's so important. Again, to go back to, like, you know, what are the genetics? And, you know, if you. A lot of people with methylation issues like MTHFR need a lot of glutathione, and providing that with N acetylcysteine, which is a supplement called nac, is to get or IV glutathione. But trying to help people kind of push through detoxification. And nothing that directly impacts lymphatics. Is hydration really. How many of my patients, maybe including myself, are dehydrated?

Yes. And myself included.

Yeah. It's like, oh, do I have to go to the bathroom every hour? Every one and a half hours. Yes. I should do the same thing. I try and make sure I drink my water in the morning, and I know for the next two hours I might have to go to the bathroom a bunch of times, but if you don't, again, a choice. It's not a good place, especially for weight loss and for all your inflammation.

Absolutely. Because everything gets stagnated. And to me also, you know, making sure the type of water that we're drinking.

Yes.

Is important, that it's not necessary. You know, it's at least filtered completely.

We use a reverse osmosis system at our practice and at home, mainly because it takes away arsenic. And especially in our city, we have a lot more arsenic in six levels. But really, should we really be drinking any arsenic water? So, yeah. And so that's why I tell patients it doesn't have to Be expensive. But you could get a kind of a reasonable reuse. The water drop from Amazon and it's like. And so change the filters and remember to change the filters. But it does a pretty good job.

Oh, that's good. I had no idea we had arsenic in the water.

We do. And it's kind of like acceptable levels. And a lot of it is acceptable levels, but especially if you're a poor detoxifier, those are not acceptable levels of. For you.

Yes. And I think that's the big difference with functional medicine. Because you have this within normal limits.

Exactly. And that whole, like, with. And that's a sad thing. A lot of patients come in, they're like, okay, you're an md. I'm here for functional medicine. What's the difference? And the difference is all about the labs. How do you look at them? We're looking for optimizing what's good, putting in that first 25% and then minimizing what's bad. A big one. Is vitamin D. Like, vitamin C levels at 30 to 100 is normal. But as an internist, if you're 28, normal. But as a functional medicine doctor, if you're 28, you're really low.

Yeah.

And try and get to at least 50.

Yes. Because, you know, I talk to patients about that, actually, because I see them, I ask on my intake form, what is your vitamin D level? Because it's linked to oral health as well. And a lot of people come and tell me, oh, my doctor said it was normal. No. Yeah. What does that mean? 28 or 60, what is it?

That's what's like referring patients to you because you speak the same language.

Yes.

And that's where like, we both asking about nutrition, stress about your vitamin levels. And I think that's really critical when you have a team that's speaking the same language. Because another big issue we have is patients seeing more traditional doctors. And they're like, well, what is this stool test? And what are these. Why do you care so much about hormones? And it's confusing for them.

Yes.

And it's really helpful when they're seeing people who are traditionally trained but have that extra layer of integrative specialty. And that's.

It's confusing. Especially when I say, no, 28. Vitamin D is low.

Yes.

But that's not what my doctor said.

I'm like, oh, yeah, exactly. And that's what we have good referrals on our referral sheet with people who may not appreciate integrative medicine, but at least the tolerant of it. Like, well, this doctor has not done harm. If anything, patients seem to reverse autoimmune stuff, so must be doing something.

Yeah.

So it's important to go to friendly faces who at least don't discount what we do, but at least are supportive and even better if they reinforce our messages.

Yeah, absolutely. So let's chat about obesity a little bit here. Because it's such a big problem in the world, we're getting fatter and fatter, not only as a nation, but globally.

We really are. And so much of it has to do with back to that triangle of what is your stress and what are the mediators you're exposed to? And quality of food, like quality of food in our school systems, quality of food in terms of you just really busy. What's really emphasized is keep busy, but don't pay that much attention to nutrition and what kind of foods are you getting? And a big part of obesity is actually endocrine disruption. So lots of these toxins that actually mimic your hormones and can cause the obesity. So it's again, important to know how to minimize that toxic burden. We use supplements, but we also use a lot of medications. And I tell patients I have my obesity medicine board, so I'm comfortable with the medications, but they temporary to give you the empower you to make those choices by yourself. Because once we take away the medication, you're going to gain some of this weight back. So how are you going to prepare for your new body?

Yeah, I know. You know, recently Elon Musk came out and with, you know, hey, I lost, I think it was 70 pounds of.

Ozempic and complete the GLP1 medications. Ozempic, Manjarobi is super popular and we do prescribe quite a bit of them. But the number one thing is, the number one complaint patients have is they exhaust it on them because they actually are malnourished. Because when you ask what they're eating, they're eating very little. And so it's really important to make sure that you're nourishing your body, taking maybe a multivitamin that has nutrients, maybe doing some IVs that are giving you those nutrients and having an endpoint. Because if you lose weight very rapidly, you lose it from your facial fat pads. Oh, no, they look older and it kind of ages you. So you want to make sure you go slow and steady and lose weight as well as when you stop the medication. A lot of patients seem to gain back the weight, 40% of it. And so it's important to do this in a kind of a holistic approach where you're like, okay, this is how much you're going to lose. How much of it is also going to be body fat versus muscle. Because a lot of my patients, especially women, are losing a lot of muscle when they lose a substantial amount of weight. So you really have to make sure you're working on improving your muscle and making sure your sex hormones, especially your testosterone, is optimized so you can kind of build back the muscle.

Yeah.

And another thing with these medications is they have been linked in animals to thyroid cancer. Oh, wow. So for all our patients on GLP1 medications, we do do a thyroid ultrasound just to make sure that there's nothing there, because the last thing we want to do is give somebody a helpful thing that's causing a horrible thing.

So I guess this medication is good as a kickstart.

It's a great kickstart. And for some patients, and it's amazing in terms of how much it works, but we really want to make sure we're dosing it appropriately and not make sure they're not losing too much muscle.

Yeah, we're going back to lifestyle again.

Exactly.

Nothing replaces a good lifestyle completely.

Lifestyle is so critical and we just don't emphasize it enough. Again, a 20 minute short insurance visit is not. You don't have time for that. That's right. And sadly, most of my physician colleagues themselves are so stressed and overwhelmed that to give the lifestyle advice, they're barely managing themselves.

Now, what do you think about all these diets? People are on so many different diets today for weight loss completely.

And I have patients that come at me, say, I'm on the fodmap diet placebo. I am gluten free, I'm doing the AIP diet. And the hot thing is, a lot of people become super malnourished because they're just not eating enough. And so a lot of the emphasis is on how much teaspoons of sugar are you getting in your diet. And to do that for some of our motivated patients is a very simple thing to kind of follow. But it's looking at the total carbohydrates minusing your fiber and divide by five. And your goal is 10 teaspoons of sugar a day. So I'm like, look at the label. And it's a simple calculation. If you can just do like my fitness pal for a week. And the big hack with that equation is fiber. So if you increase your fiber, you can have a lot more sugar, but fiber is just not our friend. Especially if you have a lot of gut issues. Yeah. You can react badly. So it's important to reduce the gut, stop and reduce inflammation so you can increase your intake of fiber.

Yeah, that's why it's important to see functional medicine.

Yeah.

Get the guidance. You can't just jump into treating yourself, which actually sounds like some patients, which I think it's bad to start treating yourself completely.

And I think that's dangerous to some degree as well. Because as you're listening to these, especially with the quick reels that people watch and they just kind of take supplements and overdose on them. Like I had a quick, quick story is a patient recently, she came in with very low platelets and she had gone to almost feel like getting a bone marrow biopsy.

By the way. That's really bad. Low platelet.

Yes, low platelets, you can bleed. People are thinking about, is this cancer? Is this something really scary? Whereas we went for a supplement list, she was all self prescribed supplements. She was taking a super high dose of green tea. Green tea is great, but in moderation. And that was what was impacting her platelets. And we kind of stopped that supplement and her platelets normalized in six weeks.

That's incredible. Even like a health food.

Yes. Can be dangerous. Too much. And that's I think really important with functional medicine. I'm so glad that many people are getting functional medicine trained. But it's important to also have an MD in the mix because you want to make sure that they kind of crossing the T's and dotting the eyes. Regular medicine plus adding the functional medicine as another cushion.

Yeah, that's very, very important. So basically don't start on a diet, especially if you're suffering. Right. Does that message here completely?

Don't start on a diet. Just get data. Like I think get data to empower yourself. So we have a quick thing called lab consult where patients who can just call our office and say, I want to do a lab consult. And so we order that intensive panel that I did myself when I came back from Italy. It's about 160 tests. They just order the labs. We order the labs for them without meeting them. And then they have a review with me three weeks later and it's an hour and a half and we kind of talk about their blood work and it's amazing. How sad. I like, why didn't anybody ever listen to you before and test this? You have an autoimmune condition or you have really low vitamins in your system, or you have hypothyroidism, but it's kind of easier for people to just want that information who may not be ready to act yet.

Yes, exactly. It's so important to know if you're not feeling well, you're gaining weight, and you don't know why you might be eating the same things. That red flag right there, you should consult.

And that's also the biggest thing in their 40s, young, early 40s, is patients like, what worked for me before is not working anymore.

Anymore.

And why. And the big thing is that how is the inflammation and how are the hormones and to optimize those safely because you really want to. If you want to give somebody hormones, we do a lot of hormone replacement. You want to make sure their liver is working and the liver is detoxifying well, so it can make room for tomorrow's hormone doses. People who have side effects to hormone replacement, generally their liver is already very congested. Now you're adding more burden to them liver, and then they have side effects.

I see.

So, yes. And unless a lot of people come to us for hormones, because traditional medicine doesn't prescribe them as much. But it's important to go to someone who's also going to be looking at your liver and your gut so you can make sure you don't have side effects with hormones.

Yes. Because I have heard that from patients saying that, oh, you know what? I had side effects. It's not the right thing for me.

Right. And another big thing, you want to make sure they're bioidentical. Same risk as regular hormones, but at least your body can recognize them better and make sure your liver is optimal so you can detoxify. So look at your genetics. Look at your gut health. Are hormones right for you? And then we can go forward with either estrogen, progesterone, or testosterone levels, too.

Yeah, Very, very important. I mean, I feel so much better when my hormones are imbalanced and I'm less stressed.

Yes. And kind of magical when you can optimize them. The biggest thing, patients are like, oh, wow, I feel amazing. That's why hormones are my favorite. I see.

Yeah. So basically we talked about the pillars.

Yes. So that first one is hormones, the four hormones. The second one is gut health, and that's the gut microbiome and the gut lining. The third one is toxic burden, and the three toxins we measure are the biggest one is heavy metals. The second one is persistent organic pollutants, which is like the air pollution, gasoline, bpa, and then the third one is mold. So people who had water damage or lived in a building that had water damage can have a lot of toxic bulb. And then the fourth one, probably the most important one and the one we really emphasize is lifestyle.

Yeah.

So what is lifestyle? And you know, what are you doing? Things that give you joy and don't believe you're choiceless because you're really not.

Absolutely. But let's talk about heavy metals because I like this topic. A lot of people come to me, of course, to remove the mercury in their mouth because they've lived somewhere that it's bad for them. And I always recommend that they get tested first.

Yes.

To see where they're at, their detoxification enzyme completely.

And that's super helpful to know. Like they just don't detoxify well. And a lot of people have a ton of fillings in terms of heavy metals. And the biggest thing we can see with specifically with like mercury toxicity is a whole array of symptoms from eczema to acne. Mercury is, it mimics estrogen so it can cause things like heavier bleeding, it can cause fibrocystic tissue, it can impact the gut and cause severe constipation. So it's really important to get those feelings removed safely because if you don't get them safely, they can just flood the body and cause even more havoc.

Absolutely. That's so important. In terms of mercury, what's your favorite way to test for mercury toxicity?

Yeah. So, you know, we used to do a lot of provocation, so we give you a medication and that would make you, your toxins come into your bloodstream. And then we've measured in the urine, but we stopped doing that because our patients are very sensitive. So now we just check it in the blood and we look at the ranges. You should really have no toxins in your system. And if you do have toxins, we already know we have stuff to deal with and we don't do. We do a lot of plant based chelation. So it's very gentle because we don't want people to have side effects because our patients already have so many balls in the air. They already are pretty stressed, pretty inflamed. But to do any detox we have to make sure of two things. One is the adrenals are balanced because they already are not suboptimal. They are going to crash and burn and they're going to have side effects effects. And then the second thing is that gut is already optimized because if they got inflamed, they're just going to recirculate the toxin and have side effects.

Yeah, makes sense.

So.

Because I did actually the provocation test.

Yes.

But that actually also pulls mercury out from the past.

Yes. And so some patients are not ready for that. And we kind of, we really do attract those who are sensitive. And so those patients were like, I'm never going to do detox. That test was really hard.

Yeah.

So we just try and meet them where they are and say, no, you have some toxins. Usually if you can even give them glutathione or NAC before you can bring out some of those. But I have patients who can't even tolerate some of those and supporting antioxidants. So it's really about like tiny steps. Let's work on your adrenals, let's work on kindness to yourself. Yes. And then let's look deeper.

Yeah, that's so important. Nothing can be done overnight. So sometimes it takes how long? Like a year.

You know, you take a good detox, 18 months. And it's really important for them to partner with someone like you to look at their mouth and not only to look at the fillings, but look at the health of their gums.

Absolutely. A lot of toxins can hide there.

Absolutely. And infections and you know, Right. In the dentist don't seem to know exactly how to look for those.

Yeah.

And so that's important to again, work collaboratively but also give patients expectations that it's probably take them decades to get where they are. Yeah, it's not going to happen overnight.

Exactly. And same for us. We have so many more testing that I'm utilizing today versus 20 years ago.

Absolutely. What kind of testing?

Like I use actually a saliva test for pathogens. Kind of like.

Yeah.

Because I want to know what's there, you know, what's some of those. I'm sure you probably find them down in the gut.

Oh, absolutely. And in terms of testing, our kind of menu is so wide now and I feel like people just don't know enough of them. And one of the tests we use a lot of is called gallery. So gallery test measures for. It's an FDA approved test that measures for 70 or 80 different cancers, like in the moment. Wow. And you know, it's not yet caught on to being insurance being covered by insurance, but it's a test that exists. It's a tool. It doesn't do great with like cancers that are covered in a membrane. It's really good for things like pancreatic ovarian cancer stuff we just don't have tools for yet. So it's about again, let's use every tool we can to give you the best information.

Yeah. Is gut dysbiosis related to cancer?

Right. Absolutely. So again, you know, if you think about all the inflammatory conditions which are things such as cancer, autoimmune, including Alzheimer's and dementia, I would say the biggest thing that is related to them is inflammation. So your gut, you really want to have a clean canvas so that none of these diseases can happen. So gut inflammation and then your levels of blood sugar, you can improve those two things. You should live pretty long.

Okay. Yeah, that's great advice. I would say that's one of the takeaway messages from today.

And inflammation.

We covered so many things. Shilpa, I'm so glad you're here. Is there, what's the last topic that you want to talk about or last.

Message that you want to send everybody? I would just like them to reconnect with themselves. In terms of choice. I feel like so many people are living lives, lives where they feel like they're choiceless in terms of their profession or their job or their relationships or their relationship with food, with movement. But it's a choice. And if you can't do something that's good for you, it's about baby steps. Like what's the one thing you could do for yourself today might just be being kind to yourself.

Yeah.

I feel like we have a lot of people who are just very self critical and are just not able to make small changes because they overwhelmed help.

Yes. And I think even the choice of seeing the right doctor.

Yes.

Don't feel like you're stuck in the system that you can't go see somebody like you.

Yes, absolutely. We really try to meet people where they act. You know, we have different payment options. We're trying to do this foundation quite even found it yet. But we're trying to kind of do an application system for patients who can't afford anything but need a functional program. And we hope to have that live in the next year. But it's really something that should be accessible to everyone. But the choice is really who are you going to see? Who are you going to partner with? And always ask questions as patients and make sure if you have a doctor right now, make sure you can partner with them and if they're not open to partnering with you, find a new person.

Yeah, absolutely. You want to have access to your doctor for sure. And that's one of an amazing thing you do. You actually have this open texting with patients that are completely.

So before what would happen is when we were more in the model of, like, one off visits between appointments, patients had tons of questions like, should I take this supplement with this one? Can I do this? I'm not feeling good on this. What should I do? So now we just have a messaging system. And it's really great because they're like, I took the supplement. This is what I'm supposed to expect. Or I went on a trip and this is what happened. Or I have sores and I'm in Italy. Can you help? And that's. I think the communication and the partnership is a really critical for a good therapeutic outcome. And I love texting you. I'm always like, I'm seeing this patient. This is what I'm seeing. It's just nice to know that they're experts we can partner with to help our patients.

Yeah. Well, it's really a pleasure to work with you.

Yes. I really have enjoyed our friendship and our professional relationship so much.

I always learned so much from you. You're a wealth of information and I know that all of you listening to this podcast feel the same way.

Oh, you're so welcome. And I keep learning and I want to learn more. I think where we are in medicine is just like the tipping, tipping point of where we'll be maybe in like five to 10 years.

Exactly. I'm sure you and I are going to sit down in a year or so.

Yes, we'd love to.

And we're going to bring up new things that's, you know, what's new. Because what we know now might not be even true in a year completely.

And just being open to that and then quickly being a little early adopters to adopt that information and give it to our patients.

Okay, great.

Thank you so much. Take care. I have such a big, great time.

Same here. See you next time.

Thank you.

Please make sure you check out the show notes for any links mentioned in the show. Do you have a question you'd like me to answer? Message me on Instagram. Doctorsanda. This is Dr. Sanda. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.