Episode #142: Lipid Therapy with Dr. Kelly McCann, MD, MPH & TM

Welcome to Better Health Guy Blogcasts Empowering your better health and now here's Scott, your Better Health Guy. The content of this show is for informational purposes only and is not intended to diagnose, treat or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or or his information to facilitate self treatment. As always, please discuss any potential health related decisions with your own personal medical authority.

Hello everyone and welcome to episode number 142 of the Better Health Guy Blogcast series. Today's guest is Dr. Kelly McCann and the topic of the show is lipid therapy. Dr. Kelly McCann is on staff at Hoag Memorial Hospital in Newport Beach, California and has been in private practice in Costa Mesa since 2008. She founded Partners in Health at the Spring center in August 2009. Dr. McCann received a BA in Music from Brown University and a Master's in Library Science from University at Albany. She went on to receive her Doctor of Medicine degree and simultaneously earned a Master's in Public Health in Tropical Medicine at Tulane University in New Orleans. She completed both an Internal Medicine residency at Banner Samaritan Medical center and a Pediatrics Residency at Phoenix Children's hospital in Phoenix, Arizona. Dr. McCann completed a fellowship in the Program of Integrative Medicine at the University of Arizona where she worked with Dr. Andrew Weil. She is one of only 35 physicians worldwide to participate in this residential fellowship. Dr. McCann became certified in Medical Acupuncture through the American Academy of Medical Acupuncture. She is certified by the Institute of Functional Medicine and also Board Certified in Integrative Medicine by the American Board of physician specialties. Dr. McCann completed a master's in Spiritual Psychology at the University of Santa Monica in 2010. She is a Board member of the International Society for Environmentally Acquired Illness. She lectures internationally on mold, Lyme disease, and environmental toxins. And now my interview with Dr. Kelly McCann. I am currently personally exploring and implementing lipid replacement therapy based on the amazing work of Dr. Patricia Kane. This discussion is going to be full fat, so get ready. Today we have Dr. Kelly McCann with us to talk about everything lipids. Thanks so much for being here today, Dr. Kelly.

Thank you Scott. I'm so happy to be here with you.

Talk to us about what led you to the passion you have today in working with people with complex chronic illnesses like Lyme disease, like mold illness. Did you have a personal experience that led you down that path?

Of course. As with many people who come to chronic illness, I too had my own experiences, although that really Wasn't the reason initially I got involved. I was interested in holistic health. I actually contemplated going to acupuncture school before I ended up going to medical school. My entire time in medical school, I was always pursuing something alternative. I did massage classes, I did healing touch classes, I started a complementary and alternative medicine focus group for students, studied with an acupuncturist, all sorts of things, and then continued to do that through my residency as much as possible. And then finally when I graduated and was practicing, I did a whole host of training in acupuncture, medical acupuncture, integrative medicine, functional medicine, and, and then started seeing these really complex patients. After residency, I moved to Oregon and actually started getting sick myself and didn't really realize what was happening. I developed chronic fatigue, some depression, fibromyalgia type symptoms, and I didn't understand at the time. And I just, I left and fortunately, this is when I moved to, from Oregon to Tucson, studied with Andy Weil, and started learning integrative medicine more in depth. But it wasn't until years later that I was able to reflect back and figure out that I was exposed to mold in the office where I was working. It was a flat roof in Oregon where it rains all the time, and there was a ton of mold. It really opened my eyes to the damage that mold can do for people's health.

Since our focus today is on lipids, what are some of the symptoms or conditions that might lead you as a clinician to want to explore a patient's lipid balance or where lipid imbalance is a likely contributor?

So the symptoms of lipid imbalance are actually pretty subtle, with a few exceptions. Sometimes people can get what are called xanthomas, where there are bumps around their eyes that are cholesterol deposits or corneal opacities, premature cardiovascular disease, or strokes. But most of the time, I'm exploring lipid balance as part of a usual evaluation for patient. And when I find that they have very high levels of just cholesterol or very low levels of cholesterol, that may prompt a deeper dive into their lipid balances. And then certainly any patients who have complex chronic illness, they're most likely going to have a lipid imbalance. And so we need to explore that as part of their recovery.

When in a broader protocol of someone dealing with something like Lyme disease or mold illness, does that lipid exploration come into play? Is it something you think about as let's start at the onset and do it throughout, or is it more of A regeneration restoration activity after the primary stressors or those things that trigger the cell danger response, for example, have been mitigated.

You know, it makes sense to do it as a cleanup. But actually I find that investigating it early on and really starting with that healing process which is so critical. You know, our cells are made up of lipids. And so if our cells are not healthy, we really can't begin to work to get somebody healthy. And so, you know, it's interesting, oftentimes I'll find when I'm doing a simple cholesterol on somebody, their cholesterol may be grossly elevated far higher than I would expect given their medical history or their presentation. And sometimes that can be because the body is trying to flood itself with building blocks to help with the healing process. I get actually really concerned when people have low cholesterol levels because I think that at that point they're really not able to deal with the toxic insult of whatever it is they're facing. And so we can then go deeper and look at the red cell fatty acid analysis to understand the breakdown of the different lipids that are present for those patients.

It's interesting, I had a colleague at one time that was put on a statin medication by his provider. His cholesterol was down to 124, which to me was concerning. Anything less than 150 or 60, I actually think of as somewhat concerning. And so when I asked what the practitioner then was recommending relative to continuation of the statin medication, the doctor had said it was working so well that he should continue it, and he was having all of the muscle pain and some of the things that maybe you get from not having CoQ10 along with the statin medication. But it's definitely concerning when people have those lower cholesterol levels as well. Talk to us about the importance of fats in health. The ratio of omega 6s to omega 3s and why people generally think that omega 6s are bad or health negating. But why are those or the right Omega 6s, why are those health promoting?

Yes. Okay. So in the 1980s, fat became a bad word. And the whole nutrition dietary recommendations at the time were all about low fat, which meant that we had to substitute something for taste, which was sugar. And this really, I think, started the disastrous situation that we're in now where we still think many people still think fat is bad and we're deficient and then eating lots of carbs. So that's a nutritional problem for sure in terms of the fats. Let's Just break it down a little bit. You've got saturated fatty acids, which are mostly animal based saturated fatty acids. And then there's coconut, which is a saturated fatty acid. And then we have monounsaturated fatty acids. And these include things like omega 9s or oleic acid. Oleic acid is not an essential fatty acid. It's found in olive oil, things like avocado oil. And then you've got your polyunsaturated fatty acids, which are the omegas, threes and sixes. And then these have different hierarchies. So we've got some from plants. This would be your linoleic acid and your alpha linoleic acid. And then we have some from fish, DHA and EPA. Those are your omega 3s. And omega 3s play integral roles in cells throughout the body, especially in the receptors and the cell membranes. They trigger the production of hormones, regulate heart and blood function. They do all sorts of things. If we're talking specifically about the Omega 3 pathways, we've got alpha linoleic acid, which is flax, hemp, chia, those are great sources of plant based omega 3s. And then we have the fish oils, the EPA and DHA. Omega 6s also get a bad rap. And these are linoleic acid, which is found in most nuts and seeds, safflower, sunflower, things like that. And then the gla, which is evening primrose oil, and then arachidonic acid. And arachidonic acid is the pro inflammatory omega 6 fatty acid that causes people to think of omega 6s as bad. And early on in my career in functional integrative medicine, we used to give people a lot of fish oil without much thought to the balance between the sixes and the threes. And this actually is really problematic. Now that I understand that we can talk about the importance of the omega 6 omega 3 ratio. I found this really cool paper on the history of Omega 3. So it turns turns out that Omega 3s and Omega 6s are what we call essential. And interestingly enough, researchers and scientists didn't understand the essentiality of these omega 3 fatty acids or omega 3 or omega 6 fatty acids until the 1930s. They knew that carbs and proteins were essential, but they didn't understand that fats were essential too. And the researcher that figured this out was George Burr. And he got a lot of flak for many years and really actually never got the recognition that he deserved from identifying the essential nature of these fats. And then there were some research in the late 70s and early 80s that really firmly established that the Omega 3s were more important, especially the EPA and then later the DHA. But it wasn't until 1993 that an Israeli researcher, Yehuda, figured out the exact ratio of omega 6 to omega 3s that was needed for health. And this is the 4, 1 ratio that we've learned about what happens when people eat a lot of omega 3s. They dose themselves high in fish oil and they eat a healthy diet. They get deficient in their omega 6s and it's actually the omega 6s that we need more of.

Guilty as charged. I had that, that same experience when I did my testing that we'll talk about later, that I had tons of Omega 3s and even though I was using some Omega 6s, probably wasn't breaking them down well. So it's interesting what you're suggesting is that the linoleic acid, the LA and the GLA from the Omega 6 side are the healthier ones that we do need in our protocols or in our routines. And it's the arachidonic acid that is what most people think of when they say, oh, we shouldn't be having omega 6 is that those are potentially harmful. Fish oil versus what some call parent essential oil debate has been going on for a long time. And so do you use some fish oils in your protocols? Are there downsides to fish oil? And then I'm seeing more companies coming out with algal or algae derived oils and even people recommending caviar, for example. So what are your current thoughts on fish oil?

I tend to think that a little bit of fish oil, especially if it's cold processed, is going to be helpful. And it really depends on the person, it depends on their diet, it depends on how much of these other Omega 6s they have. So really it's ultimately about the balance. And for some people, they do need those Omega 3s in the form of fish oil. And then sometimes people can get away with algae forms too. But the, the flax, the plant derived omega 3s, as you mentioned, sometimes people have a difficulty converting that alpha linolenic acid into the EPA and DHA that we need for balance. And so for many people, I do have them take a little bit of fish oil as part of their supplementation of a healthy diet.

Any thoughts on caviar as a potential source of some of these healthy fats?

I think caviar is great. I have to say I haven't really looked at the literature surrounding caviar, although my understanding is that it also contains Resolvins and protectants.

Talk to us about cell membranes. What makes them stiff, what makes them fluid? And does having healthy cell membranes increase our ability then to absorb nutrients, our ability to remove intracellular toxins? Why are the cell membranes so important? And how do lipids play a role in cell membrane health?

We can talk about the cell membrane kind of like a circus tent. Cholesterol are the main beams that support the ceiling of the tent. And then if we remove them, the structure collapses. So we need cholesterol to hold up the tent. And then the saturated fats are the smaller poles that support the periphery of the tent. Too many will make it super stiff and increase the likelihood of being blown down by a strong wind. And then too few. The support is compromised. We need some saturated fats, then the flaps that allow the movement of the traffic. That's the essential fatty acids. We want to have free passage of food and energy into the cells and toxins out. The fabric of the tent is actually the phospholipids, especially PC. That's one analogy, when we think about it. The nucleus, when we're thinking about a cell, the nucleus of the cell is where the DNA resides. This is the information. But the DNA by itself doesn't really do anything. It needs the fats in the cell membrane to have an action. And we turn that DNA into proteins. Those proteins infiltrate the cell membrane, and then you've got connections between the proteins. But it's actually the cell membrane itself that dictates the movement of those proteins in the cell membrane. So the cell membrane tells the cells what to do and when to do it. The lipids allow that fluidity, that permeability of the cell, and those are in constant motion. Then let's talk about the cell membrane. The cell membrane is a lipid bilayer. On the outside of the cell. We have something called phosphatidylcholine, which we'll talk about. My favorite thing. And then we have sphingomyelin. These two things are in relationship to each other. On the inside of the cell membrane, we have other phospholipids, phosphatidyl and ethanolamine, phosphatidyl andositol, phosphatidylserine. We call them lovingly, PEPI and ps. All of these phospholipids are important. I have a little story I want to share about PC, though. Some of these researchers in the early 80s wanted to understand the composition of the cell membrane. They took some heart muscle cells from a rat. They stuck them in a pet. And they let those heart muscle cells collect together and they started beating about 160 beats per minute. This is normal for a rat. And they pulled out a couple of those cells and they analyzed the composition of the cell membrane, and they figured out that this normal, healthy cell membrane, doing its job, had 20% sphingomyelin and 80% phosphatidylcholine on their outside of the cell membrane layer. And then they let the culture grow. The cells start to die. They're about two weeks of age and they're only beating 40 beats per minute. And they looked at the ratio again. Now it's 50, 50. They put phosphatidylcholine into the culture and overnight those cells start beating 160 beats per minute again. That PC was able to be reestablished in the normal, healthy ratio in that cell membrane, and the cells were able to do their job.

That's amazing. Makes me happy that I take a tablespoon every morning in my power shake. What are some of the common use in your patients? What are the oils, maybe that are also best for cooking? And then when we're trying to optimize our lipids, I know there's a number of dietary recommendations, things that we should and things that we should not incorporate. So what are some of those things that you do with your patients?

Okay, so let's talk about the diet recommendations first. We definitely want to minimize the grains, especially gluten, but also corn, as much as possible due to the mycotoxins. Oats are often contaminated as well, either with gluten or with mycotoxins. We want to avoid peanut butter, canola oil, mustards, because these things provide very long chain fats, which are going to be problematic. And we'll talk about those. And generally, seeds are better than nuts. So this again kind of harkens back to the flax seeds, chia seeds, hemp seeds, and eating those as part of a healthy diet are great. I do use some of those oils. So flax oil, hemp oil are good plant based omega 3 oils. We can also use something called balance oil, which has that right ratio of 4 to 1, omega 6 to omega 3. That includes safflower or sunflower based omega 6. And then the flax is the omega 3 in that product. I love that product. I use it a lot. It works great as a substitute for butter on food. You can put it on a salad, you can put it in your smoothie. It's so great for so many different things and really replenishes the Omega 6s and 3s in the right ratio.

I had that this morning as well. So I agree with you. The balance oil is another favorite.

Yes. I also use evening primrose oil because that's going to provide the GLA on that Omega 6 side that we want. And then as I said, a little bit of fish oil depending upon the balance of the patient's lipids. You asked about cooking. For cooking, really? Extra virgin olive oil is okay as long as it's low to medium heat because it has a low smoke point, 325 to 375 degrees Fahrenheit. Avocado oil has a slightly higher smoke point, 375 to 400 has a mild taste, so it makes it a decent option for cooking. And we can also cook with butter, lard, palm oil, or potentially even coconut oil. We can also cook with broth. I mean, we think about cooking with oils, but some people do cook with broth, which would avoid the whole potential oil problem as well. And then most of those seed oils, certainly the balance oil that I mentioned, those should not be heated.

Any thoughts on the use of ghee? I actually was fairly recently reintroduced to ghee and have been using it a lot and actually really enjoying it.

I think ghee is a great alternative, especially since a lot of my patients have problems with the casein and the proteins in dairy products. And ghee is clarified butter. It's really just the fat. And so that's an excellent source and it can be used for cooking or it can be used on top of your gluten free English muffin.

Right, Nice. Are there any conditions where you might be hesitant to replenish fats in the body? For example, Dr. Steve Fry talks about Protomyxoa rheumatica or Funneliformis mosiae suggests a very low fat diet. Some say that fats are a component of biofilms. I've actually recently heard some suggest that fats can actually be antimicrobial and might even help address biofilms, which is an interesting new perspective that I hadn't previously heard. Are there downsides to incorporating fats in some people? And are there cases where consuming fats could benefit the pathogenic organisms within us?

I know Dr. Fry has talked about this for a number of years. I gracefully beg to differ. That's not been in my experience. I've had plenty of success helping patients get well from their myriad of infections without having to put them on a low fat diet. And many of the genetic hypercholesterolemia syndromes that people might present with are so rare, we really don't see them that often. I know that there's some thought that patients who have ApoE4 genes, for example, should eat a lower fat diet to help protect them from cardiovascular disease. So maybe there are a few exceptions to the general rule that fats are helpful. And again, same thing. I haven't seen that giving people healthy bioactive fats has interfered with their biofilms or getting them better.

There is a very advanced lipid profile panel that's available through the Neurolipid Research foundation, through Body Bio that you uses Kennedy Krieger Institute. That can really help us determine whether or not we have the right lipids or fats to do things like build myelin around the nerves to provide structural support and to, as they term it, burn it, build it, balance it, and stabilize it. So I'm wondering if you can talk to us about how you use this testing in your practice, what it tells you and then how often might you repeat it once you're working on a lipid balancing protocol.

Great question. Okay. So I can use this test in virtually anyone, although I tend to use it more when people have neurological disorders, when they have evidence of potential myelin damage. I would use this in a patient with a cardiac disorder or as a foundation for cancer treatment to understand kind of how best to provide them with nourishment. That's going to be most helpful for cellular healing. And then of in our chronically ill patients, the mold patients, the chronic Lyme, et cetera patients. And when we do this test, it's a blood test, it provides a worksheet, body Bio provides a worksheet where we have the breakdown of the different boxes. I have mine here, got the burn it, build it and balance it sections. And this really helps help simplify actions for the patient and the practitioner to identify the kinds of fats that are problematic, as in we need to burn and get rid of them, build it, the ones that may be deficient, where we need to provide extra support so that myelin can be built and then the balance it. That's those omega 6s and omega 3s that we've been talking about.

I personally have done this test at least twice, maybe more. One was several years ago and then again fairly recently and had almost none. I mean, I was deficient in all of the myelin supporting fats, which was obviously very concerning. When you have a condition like chronic Lyme and mold and whatnot, and concerned about the potential for it. To advance to something like multiple sclerosis. So I was happy in my more recent one to not have any of those myelin associated deficiencies anymore. So, yeah, the information that it provides, I think is very actionable if you can work with a practitioner that understands how to interpret it. Because it is, it is very complex relative to many of the other types of labs that I think we're used to seeing. Other terms that I've seen in this test are things like Renegades and VLCFAs are very long chain fatty acids. I'm wondering if you can help us understand more about renegades and these very long chain fatty acids. How are renegades at the core of neuroinflammation and where do they come from?

Most of the renegade fats are from our diet. So when we clean up our diet, we remove the unhealthy oils. Hopefully those will disappear from the test results. Things like mustard and canola, peanuts and peanut oil. Those things are often renegade fats and they are supposed to be broken down in an organelle inside of the cell called the peroxisome. The process by which they're broken down is beta oxidation. We know that people can have problems with the peroxisome and it doesn't do its job. It doesn't burn the fats that beta oxidation is. Burn it. When we're unable to burn the renegade fats, these fats block detoxification, they block methylation path, and they may be associated with neurological disorders. For example, there is an inherited disorder of proxisomes called X link adrenalukodystrophy. This is the one that Lorenzo's Oil was about, that movie. What they figured out was that these boys could not break down these long chain fats. They died unfortunately of a complicated neurological condition. We know that these renegade fats can really interfere with our neurological processes.

When you're doing this testing with your patients and implement specific recommendations, how long would you wait before retesting to anticipate seeing a shift in the positive direction?

It's a good question. Probably I would wait about about a year now. Most patients are hopefully working on a whole bunch of other things during this time. Not only cleaning up their diet, but doing treatments of various sorts depending upon what their presentation is. So I think annually is a reasonable time frame. Some people go longer, of course, when.

We have these very long chain fatty acids. My understanding is that it's like a fire that's burning, that we have this inflammation, that those can then produce what are called lipid rafts. That are larger than a cell, that create these bridges from cell to cell that actually facilitate the movement of viruses and retroviruses. And this microbial issue comes into the conversation. Talk to us a little about lipid rafts. What causes them, what problems do they present and what can we do to address them?

Lipid rafts are really interesting. I looked a little bit deeper into this in preparation for this conversation, and they're considered micro rich in cholesterol sphingolipids. And interestingly enough, there is still some controversy about their existence because they haven't been able to directly detect them. So a lot of the work is open to interpretation. But there have been studies that have shown that the viruses can seemingly move from cell to cell via these lipid rafts. So certainly an issue. The rafts are filled with saturated fats and they're a lot less fluid. It's literally like a raft, a bridge between these very fluid cell membranes. And that can cause all sorts of issues. I found an article in 2016 that described the mystery of these lipid rafts and the difficulties of directly observing them. The level of the bench science is that they recognize viral prote, namely influenza and hiv, can be clearly differentiated from the host cell plasma membrane. That's how they're able to identify that these lipid rafts are being created. The article goes on to acknowledge that the cell derived membranes are susceptible to modulation by diet. Basically, the article says, hey, if you eat healthy fats, you'll be less likely to have issues with lipid rafts.

When we have high levels of these very long chain fatty acids, why might antioxidants be moving us in the wrong direction?

The idea with antioxidants is that high doses may slow cellular metabolism, may interfere with this beta oxidation process. So the burning of these renegade fats and these very long chain fats, which is certainly problematic, and, and it may also interfere with some of the inflammatory mediators that we need, like prostaglandins.

I've heard Dr. Patricia Cain lecture and talk about how abnormal lipids are an indication of abnormal proteins, that we can have abnormal proteins that are misfolded or unfolded in a number of neurological conditions, Als being one of them. I've also heard there's a connection between abnormal proteins and the cell danger response. And I'm wondering if you can comment on abnormal proteins and the connection to abnormal lipids.

Yes. So there are several neurodegenerative diseases that are caused by defects in protein folding. In particular Alzheimer's, Parkinson's disease, Huntington's Chorea and then prion diseases. And once the disease specific protein misfolds, it causes a toxic accumulation of these misfolded proteins in the brain, leading to neuronal dysfunction, cell death, and what we see as clinical symptoms. It's thought that these misfolded proteins are a result of some pathological insult of some kind. I read an article recently that described a mice model where the aberrant proteins were actually formed in the gastrointestinal system due in part to a dysbiotic microbiome and that that translated upstream, presumably through the vagus nerve to the cns. Really cool, huh? And this may explain actually why doing fecal microbial transplants in neurological patients can be helpful. So perhaps the misfolded proteins are happening in the gastrointestinal tract now. In particular, I read an article about Parkinson's disease, which is a neurodegenerative disorder where the misfolded protein is called alpha synuclein. This protein plays a really important role in the regulation of the synaptic vessels, which are lipid rich membrane structures that contain the neurotransmitters. And their release allows for the propagation of nerve impulses between neurons. And so if the protein is misfolded, it's going to impact the functionality of those membranes in the vesicle. I agree. I think there is a connection there. Our understanding of that connection is, is rudimentary at best. And it's only now being evaluated in the scientific community as to how to deal with this, where Dr. Kane has recognized that this is an issue and been giving lipid therapies to help. Then later we can talk about some of the chemical chaperones that are also helpful for reforming those misfolded proteins.

Another area here that got me re excited in exploring it again was the idea that there are certain toxins that can sit on our genes, on our mitochondria, on our nuclear membranes, and that they can actually change the expression of our DNA. Wondering if you can talk to us about DNA adducts? How do they influence or block our gene expression? What are some of the more common toxins that can become a DNA adduct? And then how do you test for them? How do you detoxify them? Are lipid therapy protocols helpful in this realm as well?

Essentially any environmental toxicant mycotoxin can become a adduct. Many of the common ones include things like, like nitrosamines from charred meats, polyaromatic hydrocarbons from pollution, or from burning things, heavy metals, or oftentimes DNA adducts. And so what happens is that these toxins literally sit on the DNA, or they can literally sit in the mitochondria and they block the body's ability to express that DNA, so then it can't make its proteins that need to be made. This is hugely problematic. This is probably why we develop cancer. If you have a specific section of a gene that codes for a protein that helps with DNA repair and you can't now make that protein, you're not going to be able to repair your DNA. And that sets up a situation where eventually the cell will become cancerous and, and we know the downstream effects. Mycotoxins also are commonly DNA adducts. In some of the testing that I've done, I've seen it. They were on my own, they're on my own genes. So, yeah, those mycotoxins are pretty awful. And we know that mycotoxins are carcinogens. How do we get these DNA adducts off? There are a variety of different techniques. One of the methods that can help with removal of the DNA adducts includes hyperthermia, heating up the body. And this is a valid means in a medical study to remove the DNA adducts. Dietary changes can be helpful too. Fruits and vegetables. Sodium butyrate can also be helpful at clearing adducts, kind of back to the fruits and vegetables. Things like quercetin and some of the flavonoids have been shown in studies to clear DNA adducts. And then I certainly have seen oral phosphatidylcholine help tremendously, as well as IV phosphatidylcholine. I actually did find some literature, mostly Soviet literature, that used PC to help clear toxin exposures, although they weren't necessarily looking at specifically DNA adducts.

Yeah, it's interesting. I had this testing done recently, and I'd love for you to tell us about the testing itself and how people potentially can access that. But I have made detoxification a primary aspect of my own health improvement protocol for many, many years and still had indication of mycotoxins and herbicides in my cells. And so. So it's really interesting that even with a significant focus on detoxification, the environment in which we live continues to provide these toxins that then the body has to do something with. And it seems like once they get deeply embedded into our cells affecting the mitochondria, affecting the DNA, that more traditional strategies of detoxification might not be enough to actually get them out.

That's been my experience too, Scott. I had done boatloads of detox and phosphatidylcholine. And when I did my IGL test, I found the same thing. Those mycotoxins were still there. They were in my mitochondria. And a couple other things too. I think once they get stuck, adhered to the DNA, it becomes much more problematic. So doing a juice cleanse as a detox is not going to help. That will minimize current exposures by reducing your intake, but it doesn't help get stuff off. And I think that this is something that the functional medicine, naturopathic medicine community doesn't understand enough about. Detox is not a juice class. And maybe it's the patients too, that detox is much more involved and rigorous and has to be a lifelong practice because the world is so very toxic. And we are always going to have to be doing our best to minimize our exposures to stay as healthy as possible.

And this IGL test that you referenced, my understanding is that that's a company in, in Germany, that it can be accessed by providers that have been trained and are working with the Neurolipid Research Foundation. Is that how this test is accessed?

That's my understanding at this time, yes.

So now let's talk about PC. What is PC historically used for in a conventional medicine arena? What are some of the key reasons that it's used in functional and integrative medicine?

So PC was used, used conventionally for removal of toxic exposures, particularly recovering the liver when somebody had a toxic exposure that damaged the liver. It was also used to clear anesthesia for patients. Now, in functional and integrative medicine, it's used for all sorts of things that I love to talk about. As I mentioned, it's the building block of every cell membrane. The literature shows that there's benefits in using PC for just about anything. Gastrointestinal issues, liver. As I mentioned, esophageal reflux disease. There was a study using it for treatment orally for ulcerative colitis. They gave patients oral PC for three months and it cleared their ulcerative colitis. And the reason for that is that 90% of the phospholipids in the gastrointestinal tract are phosphatidylcholine. And folks who end up developing ulcerative colitis are about 70% deficient in the PC content in their mucous membranes. If you replenish the PC, you heal the ulcerative colitis.

Wow, that's huge. It's amazing that more people don't know that I'm A huge fan of PC as well. I have it every day. One of the cool things for me about PC is how it also helps to facilitate the bile flow and how we talk about the importance. So as we get these toxins concentrated in the liver, then moving them into the bile, into the gallbladder, into the small intestine, and ultimately if there's binders present to help bind onto those and minimize enterohepatic recirculation. But it's cool how, as you mentioned, it does so many things, but one of them being really to help facilitate detoxification and bile flow.

Yes, absolutely. I tell patients that oftentimes this is the cell. So my fingers are the cell and the pen is the toxin. And PC literally helps clear out the toxin and heal the cell. And now the body has to get that toxin out through the liver gallbladder. And the PC also helps there too. So it's just so magical. And it's good for things beyond that, too. Cardiovascular health, hypertension, and then brain health. And this is one of my favorite things about PC is that it's so nourishing for the brain, for the nervous system. When I was in a moldy house a number of years ago, I started developing muscle fasciculations and I was quite concerned that ALS was in my future. And really the miracle of PC was within 15 minutes of taking a pretty large dose of PC, the muscle fasciculations would stop. It was truly profound and really got me on the PC bandwagon.

We hear people talk about the dietary need for choline, and I'm wondering, is phosphatidylcholine different from choline and can it meet our dietary needs for choline?

So choline is an essential nutrient. Choline and phosphatidylcholine are not the same thing. But choline is a component of phosphatidylcholine. Choline is the head group, and then there's a phosphate and then there's the two fatty acid tails that make up the molecule phosphatidylcholine. Choline is related to water soluble B vitamins. The foods that are mostly high in choline include egg yolks.

We talk then about choline. What is the connection between phosphatidylcholine and acetylcholine, given that supporting acetylcholine can be helpful for things like the vagus nerve, like people dealing with sibo, for example, does phosphatidylcholine have the potential to help support the vagus nerve and potentially help those dealing with sibo.

There is a connection between PC and acetylcholine. Obviously, it's the choline. And CBC serves as a reservoir of choline needed to make that neurotransmitter acetylcholine. I actually use phosphatidylcholine in my SIBO protocol, in part because of the need for acetylcholine and the support of the vagus nerve, but also because of the mucous membrane needs that I mentioned earlier.

In people that have neuropathy or insults to the myelin around the nerves. And is it primarily the fats that we talked about earlier that are needed, or does phosphatidylcholine play a role in healing the nerves as well?

In my experience, it's all of those things, and especially the PC. I do find that we need that PC in addition to the Omega 3s and the Omega 6s.

Do phospholipids have an effect on our ability to create energy or, or ATP or support the mitochondria?

Not directly, no. But because the mitochondrial membranes are also composed of phosphatidylcholine, we need that PC for the mitochondrial membranes.

So indirectly, it could potentially be helpful in that using something like phosphatidylcholine is maybe helping to remove some of those toxins that are affecting the mitochondria.

Exactly.

Beautiful. So cool. Can you talk to us about apraxia and dyspraxia and how phosphatidylcholine could be helpful in patients with developmental delays? Could it even be helpful for children on the autism spectrum?

For example, apraxia is a neurological disorder characterized by inability to perform familiar learned movements on command. And then the dyspraxia is they can partially perform these things, but there's an inability there. I've just found that PC can be helpful in any situation that requires support for neurological. And this is obviously as part of. Of a healthy diet, other bioactive lipids like your omega 3s, omega 6s. But the phosphatidylcholine itself just seems to be magical at really helping these neurological issues for people, whether that's developmental or on the opposite end of the spectrum with neurodegenerative diseases. In fact, I looked at a study out of Japan where people with cognitive impairment mini mental status scores in the low 20s were able to markedly improve their scores in just five or six months. I think whether somebody is on the latter end of the life and dealing with neurodegenerative disorders, disorders or with developmental disorders that PC can be extremely helpful. There's a lot of support for using PC in patients with seizure disorders, particularly children with seizure disorders, also really helping stabilize those membranes.

Are there some people where phosphatidylcholine could be contraindicated or maybe not well tolerated? If someone has, for example, antiphospholip syndrome, will they still tolerate exogenous sources of phospholipids?

I would say I don't really think there's any contraindications to PC. I mean, if we're talking about giving IVs, there are a few rules about giving IV PC that need to be followed. But I haven't found anyone who couldn't benefit from phosphatidylcholine. Even those patients who have antiphospholipid antibodies, bodies, the idea is that they have an autoimmune disease caused by some sort of toxic insult. And so the PC is going to help clear that toxic insult and then hopefully the immune system can calm down and they can heal. So I actually use PC a great deal in my autoimmune patients.

So I know that it can be important to titrate up the phosphatidylcholine slowly so that you don't end up having a larger number of toxins, toxins that are mobilized than the body can handle. But with that consideration aside, would you say that phosphatidylcholine is one of the better tolerated things? And even in the ultra sensitive patient population in some cases, I've found that.

There'S really no side effects to PC in the vast majority of people, although absolutely we have to start low and go slowly with people and especially when they're more sensitive. I have had a number of patients for whom oral PC is not tolerated because it costs too much, GI upset, too many bile dumps, and we have to even start with the iv or vice versa. And yeah, low and slow is the name of the game for very sensitive patients.

Talk to us a little bit about the PEMT gene and how it connects to the phosphatidylcholine conversation. Do people with a PEMT mutation potentially, and notice I said potentially, do they potentially need more supplemental phosphatidylcholine?

So PEMT is one of the pathways by which we create phosphatidylcholine for our cell membranes. And so yes, potentially, people who have a PEMT gene variant may be less capable of making adequate amounts of phosphatidylcholine for themselves. However, we have a variety of other pathways by which we make PC. So I wouldn't necessarily require somebody who only has a PEMT gene variant take excessive amounts of phosphatidylcholine.

Some people have observed their TMAO levels going up when using phosphatidylcholine. What is tmao? What are some of the potential problems that may result from phosphatidylcholine in this arena? And then when do we need to consider the potential impact of phosphatidylcholine on tmao?

So TMAO stands for trimethylamine N oxide and it is considered a cardiovascular risk that is generated when the bacteria in our gastrointestinal system take a few different molecules, presumably phosphatidylcholine. In addition things like carnitine and different sort of meat containing foods, the bacteria in our guts, depending upon what our composition is, it takes these foods and supplements and turns them into tmao, which then is thought to be related to cardiovascular risk. However, there wasn't a distinction that was made between some soy lecithin or real phosphatidylcholine. And so I think if the quality of the PC is good, the increase in the TMAO doesn't actually occur. So there's a problem with the scientific nomenclature in calling things that are labeled PC which aren't good, high quality aren't really the phospholipids, those things can turn into tmao. So it's really telling us that we need to be careful about our choices of supplementation, which products we might choose for that PC. I have observed in my own patients who have been put on PC that I choose to use the products that.

I choose and you can mention products.

The body bio products don't cause an elevation in the TMAO in my observations of my own patients.

So we have then these soy based, like the body bio product you just mentioned, there's a number of sunflower based oral lipid blend products on the market as well. Do you find generally that one is better than the other? And then extending on that, can soy lecithin provide some of the same benefits at a much lower cost? Cost?

In my experience you get what you pay for really. And I found so much benefits with the body bio products that I don't really see the reason to spend money on less quality products. Can the sunflower based oral products made by reputable companies be helpful? Sure, I'm sure that they can, but there's a lot of crap out there. And so my encouragement to your listeners is to consider body bio. And then if they're using other products, they really want to see if there's benefits because these things are expensive. And so you want to make sure that you're getting as high a quality as you possibly can. And I don't know if there are benefits in taking lesser quality products. I just, I don't think that you're going to get the benefits that you really need. And it may be more problematic. As with the case with tmao.

The idea of a power shake is one that I personally find amazingly beneficial. Mixing things like the fiber blend, collagen, protein powder, an omega blend like the balance oil or hemp oil or flaxseed that we talked about earlier and then the phosphatidylcholine and actually it's the oral product. So it's actually a full blend of the different lipids that you talked about with, with the PE PI ps, for example, are there any ingredients or nutrients or supplements that we should not mix with phosphatidylcholine in something like a smoothie or power shake?

Not to my knowledge. Except, you know, anything artificial. You don't want to put artificial sugars or flavors or peanut butter since that'll could potentially have those renegade fats in there. There. And then making sure that the collagen, if you're using collagen, is mold free and that it's from a good source. Anything that you mix with the PC does become liposomal and helps it get into the cells when you're mixing that oral PC.

So that's a really good point then, that if we're using these oral PC blends like the body bioproduct, we really want to make sure that everything else that we're putting in with it is also high quality quality, because if it has other binders or fillers or whatever, we're also potentially then increasing our absorption of those toxins that are coming from those other products, right?

Yes, absolutely. I like to add things like sbi. Sometimes I'll add some probiotics and I do add things like glutamine. I have a favorite glutamine product that.

I like and is that the orthomolectic molecular products, SBI protect that you're talking about with the bovine immunoglobulins and yes, beautiful. What is phospholipase A2 and how does it break down our lipids when we have too much sugar and too many refined foods in our diet? And how is phospholipase A2 tied to inflammation?

Phospholipase A2 is actually not one thing. It's a family of enzymes. And so there are a variety of, of different enzymes that are responsible for breaking down different things. So for example, Lp or lipoprotein phospholipase A2 is considered an inflammatory enzyme related to unstable plaque in atherosclerosis. And then there are other PLA2s that are more inclined to break down those phospholipids on the membrane brain. And as with anything, we want to have a balance. When you have low concentrations of PLA2, it's going to act on the membranes themselves of cells that are getting ready to die. It's important for cellular differentiation and then the destruction or apoptosis of the cells. So we need PLA too, is my point. But when it's in excessive amounts and high concentrations, that's when things become problematic. Things that stimulate or upregulate the activity of PLA to include any kind of chemical toxicant, biotoxins like mold, things like mercury, heavy metals, high carb intake, as you mentioned, insulin, anything that's inflammatory, an injury. And then of course, bee venom or different kinds of venoms contain high amounts of Plheim enzymes. And then things that lower PLA2 would be a low carb diet, high fat diet, hyaluronic acid, glutathione, and PC.

So is that to say then that if someone's doing B venom therapy, which is increasing PLA2, that they, they need to be aware of that because it potentially then could be breaking down the lipids that we're actually trying to replenish.

Yes, I do think that that's really important, and I suspect that a lot of people don't realize that it will work when it's done at the right time. And then it may be very important to follow that up with the bioactive lipids and the phosphatidylcholine to really help heal the cells that are left if somebody has success with bee venom therapy.

So let's talk then a little bit about the types of phosphatidylcholine that we can use. So there's the oral phosphatidylcholine, which in the body bioproduct that you're talking about, again is that full blend with the phosphatidylethanolamine and phosphatidyl inositol and phosphatidylserine and phosphatidylcholine and then there's also IV forms of phosphatidylcholine, which are not blends that are just phosphatidylcholine. And I'm wondering if you can talk to us about why we might want the full blend in the oral product rather than PC alone. And what is the goal of, of administering PC orally versus iv? What are the benefits that we hope to get from introducing it one way as compared to another?

In an ideal world, we do both depending upon what people, what people's issues are and what finances are, you know, what they can afford. So the oral, as you mentioned, is going to be that whole complement of phospholipids that are going to help heal the cells. And the way that I think about it is there's a distribution. When you take something orally, you're going to heal the gastrointestinal system. The majority is going to go into the liver, and then it eventually does infiltrate the rest of the body. But it does take time. One reason that somebody might choose to do IV in addition to the oral is if they have a pressing issue that needs to be addressed faster, because oral PC takes time. If somebody has a neurological issue, if somebody has cancer, if somebody has a cardiovascular disease that they need to address quickly, the IVs are really the way that I've found work well, because it's getting to the area of the body that needs it as quickly as possible, but it does need to be complemented with that PCPE that's going to stabilize those membranes. So the IV PC I think of as more clearing the toxins, healing the outer cell membrane. But we need that full complement of phospholipids to really stabilize that cell membrane.

So it sounds like when we're talking about the DNA adducts that we can explore with testing like igl, that the oral options are probably not going to go quite deeply enough to get at those intracellular toxins, and that doing the IV phosphatidylcholine is what's going to be able to help us kind of wash out those intracellular toxins in a more efficient manner. Is that a reasonable thought process?

I think that's a reasonable thought process. And amongst our German colleagues who have greater access to tests like the IGL and the Acumen labs, that's really borne out in their clinical practice that they're looking at the IGLs following that with IVs, and then able to see the washing out of those DNA adducts.

Now let's talk a bit about fat digestion and assimilation. My personal experience was that I was using lots of oil but still had a number of these fats that were low in that Kennedy Krieger analysis. And I'm wondering how often do you find patients that have fat digestion problems or fat assimilation, they can't break them down and need then additional support to benefit from the fats that they're consuming in their diet?

Yes, I actually see that a good deal. I think that some of the infections that we treat, the mycotoxins, they actually have an affinity for the gallbladder and then the gallbladder dysfunctions, which causes issues with their fat digestion and malabsorption because their gallbladders aren't working very well. And additionally all our toxic insults cause microbiome dysregulation and then this compromises our ability to absorb, absorb our fats and our nutrients. And so it's, it's really a challenging situation where we've got a variety of different things working against us and so oftentimes we have to use higher doses than we would expect. And you know, we really need to think about our, our fundamental processes of health, healing the gut and detoxing.

And it's interesting because what you were just saying about the gallbladder, if I think of phosphatid phytocholine is also helping to support healthy bile flow, in my mind that also means that it's supporting in some way the gallbladder. And so is the incorporation then of oral phosphatidylcholine. Is that helping us to be able to absorb and assimilate other dietary fats at a better level?

Yes, I would think so. And especially if you're putting it in your power shake and you're making it liposomal and you're at adding additional medical foods like some of the protein powders, the anti inflammatory protein powders. I happen to use orthomolecular or metagenics. Those are great things to add in your power shake that are going to enhance the absorption because you're making it liposomal with that PC.

Beautiful. Yeah, I use the metagenics ultra advanced every day. And it's actually amazing. Amazing. I mean I, I mean I do exercise most days, but I would say I have probably more muscle now than I did when I was 20. And I saw a huge difference once I started putting that power shake in place. I mean it was, it was really very, very obvious. Let's talk now about digestive enzymes, ox Bile tudka in terms of supporting the breakdown and assimilation of these fats. Why do we maybe need digestive enzymes when we're talking about absorbing and breaking down fats? And is it primarily lipase or do we need a blend of enzymes? What are some of your favorites in this realm?

Okay, I love digestive enzymes in particular. I don't know about you, but I love this guy.

Enzo Lace. Yeah. For people listening in the audio version, it was the master supplements. Enzylase.

Yeah, enzylase is pretty magical. Good for all sorts of things, including helping metabolize the alcohol. But it actually works. Works amazingly well as a digestive enzyme, too, and can even recover somebody who's having an adverse food reaction. I gave it to my sister after feeding her some chips and she didn't do so hot with them. And, you know, 30 minutes later, after a couple of enzylase and she's good to go. It was pretty awesome. So, yes, I find that digestive enzymes are needed for so many people because of their increased intestinal permeability. Sibo, gut dysregulation, et cetera, et cetera. And so that's part of most of my protocols for people. And those digestive enzymes are best if they are combo digestive enzymes. So they do have the lipase, but they've also got other enzymes that are going to help break down fats as other fats, as well as the proteins and the carbohydrates, and really need to. We eat whole food. We really need our digestive enzymes to address all the foods that we're eating.

One of the other areas that I've heard some debate and I've actually heard people have opinions on both sides, and that is, do you find that patients that have mold and mycotoxin illness react to any of the digestive enzymes that are maybe produced using aspergillus as part of that process, or is the end process product generally fairly well tolerated?

I actually haven't seen that very much, Scott, thankfully. Yeah, that hasn't been my experience.

Great. All right, so now we'll jump more into the ox bile and tudka or taro urso, deoxycholic acid. It's clear why we just call it tudka.

So what are you said that.

So what are ox bile and tudka and how are they the same or different? Why are they important when we're using these healthy fats? And what if someone is vegan or vegetarian? Can they use these or not?

So ox bile would probably not be good for a Vegetarian or a vegan, but todka can be. So these are essentially the nutrients that we need to help us break down fat. And todka also has these other amazing qualities. It is a, what's called a chemical chaperone. So hearkening back to our conversation about the misfolded proteins, todka can actually help reverse the misfolded proteins. So it's actually a great option. And the body biotka is a synthetic source and so eventually that will be good. They're looking into vegetarian capsules right now. They are currently using gelatin ones. So stay tuned for that. Tadka is water soluble and it is taking that bile and then adding a taurine to it, making it water soluble. And so it can help with digestion of fats, but also has these other components to it.

Butyrate is another ingredient that is commonly discussed in lipid radio replacement protocols. What is the role of butyrate when taken orally and then also when used in an IV as part of a lipid replacement protocol?

So butyrate is a short chain fatty acid. Typically we think of butyrate as being produced when by our gut microbiome when we eat fiber. So it takes the fiber and it turns it into this short chain fatty acid called but butyrate. And we can also take butyrate as a supplement, both oral and iv as you mentioned, I typically use the oral for a variety of different conditions, usually along with the lipid therapy because it works both as a chaperone but it also has its own anti inflammatory effects and it also tends to break things down. So it helps with some of those non healthy things, fats, those very long chain fats that we want to get rid of.

How does one know the type of oral butyrate to use when there's so many options on the market? There's calcium, magnesium, butyrate, sodium butyrate, sodium potassium butyrate. Now there's even more recently various liquid butyrates as well. So how do you decide which one is going to be better for a given patient?

The sodium butyrate is recommended for people who tend to have low sodium levels or those who, who have excess sodium loss as if, as when they're sweating. If they sweat profusely or work in hot environments, do a lot of sauna, those people might need the extra replenishment of this sodium in the sodium butyrate and then sodium potassium butyrate can be used kind of by that same population. But if they're sodium sensitive with hypertension, they would choose the, the One with the potassium to help stabilize that sensitivity. And then calcium magnesium tends to be the most commonly used one. It's the most popular because many people are deficient in calcium and magnesium. And so it's replenishing those. The oral liquid butyrate, that's a newer option that doesn't have the sodium, potassium, or calcium magnesium attack attached to it. It might be preferred for children or for people who don't want to take as many capsules. There's a variety of different reasons people would choose that option. Butyrate doesn't smell very good, so it's one of those that I would recommend you stick in a freezer if the smell really bothers you, and then, yeah, maybe pick it up with gloves, put it in your mouth without touching it. It's a good idea.

Can we get adequate. Get butyrate from ghee or butter?

Okay. Butter actually is a high butyrate food, but we can't get butyrate from eating butter, sadly. It's really, as I mentioned, we have to eat those prebiotics, the fibrous foods that will. That will then be turned into butyrate by our microbiome.

I know you work with lots of patients with mold illness. How does the lipid conversation, the membrane conversation, how does that fit in with supporting your patients with mold illness? Do you find that these strategies can help them detoxify their mycotoxin burden? And is there a place for phosphatidylcholine after a mold hit in someone that maybe was previously treated for biotoxin illness but then gets a re exposure?

PC is absolutely cornerstone of my mold protocols for patients. I just found it to be tremendously helpful. So it is really at the beginning, we start talking about PC, both oral and iv, and for many of my patients who are mold exposed, and especially the ones who develop mast cell activation, the level of sensitivity that they experience can really be helped tremendously by both oral and IV PC. I think PC would be a great treatment option for a mold hit. I do have patients who come in periodically after they've been mold exposed, and then they kind of go on hiatus. And if they do get another mold hit, they'll come in and do a series of IV PCs along with ramping up their oral PC to help clear. Clear the mycotoxins out.

How important is it to go low and slow with these strategies in more toxic patients? And can lipid replenishment therapy lead to detoxification reactions if done too aggressively?

Yes, absolutely. Low and slow is the name of the game. I didn't know any better when I first started. And so I did my course with Patricia Kane, and I came home and I put a tablespoon of Body Bio my shake, and I did that for a couple of weeks. And all of a sudden I had terrible acne. It was like the most disgusting thing ever. And I realized, oh, yeah, I've got, you know, toxins coming out my skin. So I'm glad I learned that lesson on myself first. And then subsequently have found with patients, yeah, some of them have to be very, very gentle with how they start. And being too aggressive, increasing the doses too quickly can cause all sorts of detox reactions. So very important to go start low and go slow.

Can you talk to us a little about how these approaches with lipid replenishment have helped some of your patients?

Yes, as I said, I'm a big fan and I have quite a number of patients, particularly patients who have been exposed to. Exposed to mold. And they have had their lives absolutely transformed. People who come in with fatigue, brain fog, all sorts of weird, wacky neurological symptoms, neuropathic pain, peripheral neuropathies, and they are so much better. They feel like they've really gotten their lives back on track. They have good energy, they can tolerate their environment, more things, and it's been hugely transformative for them.

How can people find a doctor that implements these type of strategies in their practice? If they're interested in what we've been talking about today, there are a couple.

Of resources they can contact. Body Bio. Body Bio does have a list of practitioners who utilize and sell their products. They can also contact Neurolipid Research. And then there are professional organizations of which I'm a member that will hopefully continue to do education, such as ici, the International Society for Environmentally Acquired Illness, and aaem, the American Academy of Environmental Medicine.

Beautiful. Yeah, I'm a huge fan of those organizations. And ici, I think, is just doing fantastic work. And so I just want to thank you for being part of all of that collaboration that is so important. My last question is the same for every guest, and that is, what are some of the key things that you do on a daily basis in support of your own health?

Well, as you probably could guess, I do take PC regularly and I recommend it to everyone. So, yeah, I take PC, I take long walks with my dog and really try and get in touch. 10,000 steps a day, as much as possible, and then take time with my family. I think spending quality time with the people that we love, connecting with the people that we love is so important for our health, especially given how difficult this past year has been. We need to connect with those, even if they don't live with us, who are close. That's really nourishing for our souls.

Beautiful. This conversation was certainly full fat. I loved it. I loved all of the insights that you had to share with us. I think these lipid replenishment strategies can be very, very helpful. I think it's at least worth exploring where people's balance of omega 3s and omega 6s are and being able to make some adjustments in a protocol and helping to support those dealing with complex chronic illness. I appreciate all that you do and just want to thank you for being generous with your time today and just honor you for all of your work. Dr. Kelly, thank you so much.

Thank you so much, Scott. It's really been a pleasure.

To learn more about Today's guest, visit thespringcenter.com that's the springcenter.com thespringcenter.com thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter or MEWI, you can find me there as Better HealthGuy. To support the show, please visit betterhealthguy.com donate to be added to my newsletter, please visit betterhealthguy.Com newsletters this and other shows can be found on YouTube, Apple Podcasts, Google Podcasts, Stitcher, and Spotify.

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