Core Protocols and Your Questions

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode.

Hello everyone, Dr. Stillman here for another exciting Q&A. Thank you as always for your questions. There is a public link if you are a subscriber to my blog and newsletter at Substack. There is a private link if you are a member of the practice or a premium subscriber. Uh, we answer premium questions first and then we go to public questions. So Without further ado, let's jump in. Question from Dennis. Is there anything that you can take for tinnitus? Great question, Dennis. So tinnitus is very multifactorial, which means there's lots of different things that can cause it. And we got a question the other week on vertigo, very related to tinnitus, right? Same sort of organ system. When it comes to tinnitus, what I do is just take a comprehensive approach. We fix nutritional deficiencies, metabolic imbalances, we detoxify the body, and we purify it of any kind of infections or pathogens that are playing a potential role. Our opening play, so to speak, of supplements, which I'm going to be sharing more about as the months progress and as we get our online supplement store up and running, we're still hard at work on that, which is part of why I'm not publishing as much as I was. I've seen this, those make a huge difference in issues like this. Individual results vary. And the number one thing with tinnitus that is challenging is that if it's an occupational exposure, You know, you spent a lot of time at the range, you were in the military, there's sometimes just too much damage done, but all the things we do, give the body what it needs to heal. That in my view is the best chance of healing from tinnitus. Treva asks, is it safe to take a ubiquinol supplement and a probiotic alongside other supplement protocols? The answer is yes. And I, I omitted purposefully the brand names here, folks, because I just don't like mentioning brand names here unless for various reasons, there's a compelling reason to. These 3 supplements, as far as I'm aware, don't have any kind of contraindications or interactions. And in general, when I'm looking for contraindications or interactions, the number 1 thing I'm looking for with, say, probiotics is antibiotics. I don't take those at the same time. And then ubiquinol or ubiquinone or CoQ10 is an antioxidant. I don't take that with oxidants. So people might be taking or using things like ozone or chlorine dioxide or hydrogen peroxide. You wouldn't want to take those with with an antioxidant. Likewise, I don't use iodine or as iodorol anyway, or Lugols, with antioxidants like C, vitamin C, that is, because of these interactions. There's very few such cases. There's a lot of information suggesting, uh, this is from Donna, that unless someone takes all 7 forms of magnesium, they'll be deficient. I think that's hype, quite frankly. The body takes what you give it and uses it the way that it needs to. The whole idea of like there's only 7 forms of magnesium, you can complex magnesium to literally anything in nature that's an anion. So there's so many different forms. What I focus on is, is it a high-quality magnesium? Is it very pure? Is it absorbable? And honestly, there's other reasons for using one form or another. So for example, glycine has all these very powerful therapeutic properties. It can also be a problem for people who are sensitive to oxalates. So I'll use magnesium glycinate as my standard because it gives me lots and lots of benefits. In the rare case of someone who's got issues with oxalates, will use a different form for that reason. Just one example. Some sources say pork is harmful to health. Is pastured pork still problematic? What are your thoughts on bottom feeders like shellfish and oysters? Big question. Okay, so first of all, I eat pastured pork. I don't have an issue with it. To be honest with you, if my family picks up pork at the grocery store that's not pastured, not organic, I'll still eat it. And maybe I'm making a mistake. I do think that the way they're treating pigs in factory farms is just atrocious. And there's not, as far as I know, a good source of pork in grocery stores. However, I haven't been able to source pork locally consistently that's farm-raised, and I would love to be able to just say, you know, buy a quarter of a hog or half a hog, but we just don't have that available here. So that's my thoughts on pork. Thoughts on bottom feeders like shellfish and oysters. I will still occasionally indulge in raw oysters because I do love them, and I'm also from Originally the Northeast, so they're sort of like a cultural staple for me. I have a lot of nostalgia around them, and so I still eat shellfish. I will tell you that they do accumulate heavy metals and toxins, so I'm not a fan of them. And frankly, the vast majority of my patients, and I'm very wary of where they're coming from. So shellfish coming out of the Mississippi Delta, frankly, the amount of pollution in that area makes me very nervous about eating anything that's coming out of that water. I am more open to eating shellfish that come from American and Canadian Northeast and from the American Northwest, those are arguably going to have lower levels. But I will tell you that the level of contamination in our environment is such that even the low levels are going to contribute to your total toxic burden, which is why I generally avoid these in sick people. And I only leave them as a delicacy for people who are really in robust health. Okay. Question from Becca. Do you use systemic enzymes in practice? Well, I guess I'm going to have to unpack this for a minute because you asked systemic enzymes. I don't use systemic enzyme therapy in my practice. And let me unpack this for people. This is a little bit of an obscure question from Becca, but Becca is very smart and very well-read. And so she's asking really tough questions. So there's digestive enzymes. I use those in every case. We're about to have our own line available to you all in the online supplement store. But we've also got the case and the example of Nicholas Gonzalez and his partner in practice, Linda Isaacs, who's still practicing in Austin, Texas. That is, they used enzyme therapy from the glands of animals. To treat patients with advanced cancer. Not getting into all the science and theory behind that, I don't use that in my practice. I'm very curious about it. Overall, what I have found is that people generally benefit significantly from enzymes, which is why we stopped worrying about, do you have GI issues, do you have pancreatic insufficiency? We just gave them to everyone, particularly because to test GI sufficiency and enzyme levels, we had a certain false positive and false negative rate. And on top of that, it was more expensive to test than it was to just supplement empirically and see who responded and who didn't. So in my view, all conditions can improve with enzymes. It just depends on which ones and when. And do I pair them with mineral balancing protocols? Absolutely. Okay. Is it safe to combine multiple supplement protocols like Zeta-Ade, vitamin C, and MSM in one glass of water 3 times daily rather than taking them separately? This question's from David. So I try to keep Zeta-Ade apart from anything else, and I try to get it in RO or distilled water. And the reason why is very simply that Zeta-Ade is, is designed in its concentrations to maximize blood flow and your zeta potential. And when you mix it with other things, you are changing the chemistry and you should expect to see a reduction in its efficacy. So I don't combine Zeta-8 as a rule with anything else. Now, vitamin C, MSM, I combine those routinely. This morning's beverage right now, this is, uh, SkinSips and our vitamin C. So I love combining those two. I think they taste great together. What are your thoughts on extended water-only fasts, specifically the benefits, the recommended precautions, and the minimum intervals. So my first thought is, is the person optimally nourished? Because if someone is not well nourished, then I'm very wary of fasting. And arguably, if you're dropping weight, you are already in a fasting catabolic state where you are breaking down your body, and driving you further into that can get you into really hot water. It may surprise some of you to learn that losing a little bit of weight below your optimal actually increases your risk of death more than gaining weight in the opposite direction. So I constantly see this, women who calorie restrict, don't eat enough protein. They're 50, they're 60, they're 70. They're not on the right doses of hormones. And they think that they look so good and they are headed for an early death because they do not understand how much they have to eat to maintain their muscle mass. And they think they're thin, but in fact they're skinny fat. What that means is they have have low muscle mass and on top of it, they have fat, but because their muscle mass is shrinking, actually have— they don't look like they're overweight. I see this all the time and it drives me nuts because it comes from this place where women, as in their youth, they learn that if they calorie restrict and they exercise, they'll lose weight. And when you're young, that works because you can get away with it because you have big levels, high levels, and balanced levels often of hormones. But as the hormones wane, you cannot get away with that anymore. And I see this coming back around to haunt women. Which is why I'm so passionate about teaching them. This is what you actually need to eat for your age and stage of life. And, you know, you might not like it and you might not even like how it makes you look, but the answer is not calorie restricting more. It's weightlifting more. I see women often, they're thinking, well, I, I could do Pilates. A lot of the time, the load is not adequate to induce muscle mitochondriogenesis. It's not enough to maintain muscle mass. It's not enough to build muscle mass. You've really gotta work in my experience with a personal trainer who's, or strength conditioning coach like our friend Jim Laird, who's very experienced. And then you have to absolutely dial in your diet. It's work, but you want to live a long time and have good quality of life, strap yourself in because that's key. Anyway, rant. All right, back to fasting. If a patient comes to me and is well nourished and we have a disease that may respond to fasting, I may explore this possibility with them, but I don't like fasting for long periods of time. Reason being, You lose muscle mass, you lose weight. It's very hard to gain that back, particularly as you get older. That's that. What brand of salt do you recommend? Recent testing showed some popular brands like Redmond's have concerning heavy metal levels. From Susan. Hello, Susan. This is a great question. So I sat down the other week with Steve Rye and a guy named Ryan Boland who are both supplement industry insiders. And we talked about COAs, certificate of analysis. When people test a product or when they, when they ask a supplement company for what's called a certificate of analysis, what they're doing is they're testing a specific sample for its concentrations of heavy metals, nutrients, etc. The problem is that you've got to remember everything in nature exists for the most part on a Gaussian distribution, which means there's this big fat middle and then there's these big tails, right? And these little tails are extremes. And so if you do enough certificate of analysis, like if you run 100 certificates of analysis on salt, you're going to get 5% that are really high and 5% that are really low, and everything else is going to be in the middle. And the reason that's so important is that people will often cherry-pick their data for their certificate of analysis in order to pass muster or in order to frankly, like, damage a brand. So I remember when people were trashing— I think it was Celtic Sea Salt— for their lead level, and they posted this hilarious meme of a famous actor. I think it's— his name is Cillian Murphy, but don't quote me on that. And the guy is just yawning and looking bored, and they're pointing out that there's more lead in the average beet today than there is in something like a tablespoon of their salt. And I don't remember the exact quantity, but you get the idea. So I hear this fearmongering a lot. It's often coming from people who don't actually understand inorganic and organic chemistry and just the sometimes maddening realities of chemistry. All that being said, what kind of salt do I use? I haven't really been picky. I think we're using Redmond's salt on the table right now. We've got Baja Gold Sea Salt, we've got Celtic Sea Salt. I don't tend to worry about this. I want to caveat this. There are times when products really genuinely do get contaminated and you want to avoid them.

Right.

But I just see this all the time making the rounds on social media. I think a lot of it is just fearmongering. And I really take it with a large grain of salt, pun intended. Okay. What are your thoughts on using PEPCID for MCAS? It's a great tire patch, by which I mean a bridge to a better place. You can use it in order to help yourself recover and more than that, really I don't have a strong opinion on it. Are there any treatments for tinnitus? That's so funny. We got two tinnitus questions in the same Q&A. This one's from Constance and this one's about hearing aids. So your question, Constance, because I just answered the tinnitus thing, are hearing aids recommended despite the EMF exposure? So we're actually going through this with a family member of mine right now. We're actually in the process of testing the hearing aid to see if it transmits even when it's not being changed by the remote. They've told us that when your phone's not communicating with the headphone or the hearing aid, it's not in transmit mode. I'm very skeptical of that. I've just found so many devices where they're transmitting when they say they're not. Crazy, but true. I'll let you know when I do some more testing.

Okay.

Last question from Marlene.

Hello, Marlene.

A NeuralZoomer Plus test from 3 years ago showed positive anti-aquaporin-4 levels. 27, normal is less than 10. How reliable is this test and should this result be concerning given its association with certain neurological disorders? Great question, Marlene. Here's my take on this. So I've not done a lot of this testing in the past, and the reason why is that a lot of it is hit or miss. You'll get a positive here and a positive there, and then it'll be negative next week or next year. And the vast majority of the time, these tests don't actually change what we do. And I'm all about testing that changes what we do. So if we're doing testing that doesn't change a supplement recommendation or a medication or a diet dietary recommendation or a lifestyle choice, then my question is always, why are we running this test? I will tell you that we get people in the practice with all kinds of symptoms, many of them neurological. We apply the framework that we use and we see them get great results. Why do they get great results? In my view, it has to be that we're correcting the underlying cause of the illness, the root cause of the illness. And that's really, in my view, the name of the job. And I wanted to read this to you. I did a little bit of reading on this before sitting down to record. So although the presence of aquaporin-4 IgG, that's the antibody, predicts relapse risk of neuromyelitis optica, changes in antibody titer over time do not reliably predict relapse or disease activity in individuals, and the majority of seropositive patients remain positive with stable titers. Seroreversion is rare and may be transient and does not guarantee remission. Translation of this: the immunoglobulin is associated with the illness but doesn't predict anything about it. Which tells me that more than the antibody level, I care what's your diet and what's your lifestyle, what's your chemical exposure. We recently had a case in the practice with an absolutely astonishing amount of cadmium, and the lead level is not nothing to scoff at either. Very, very, very, very toxic individual due to some occupational exposures. We see it all the time. And that absolutely, in my view, trumps pretty much anything else in the lab testing. We know why people get sick with autoimmune disorders, of which aquaporin-4-associated diseases are in that category. We know why they get metabolically imbalanced and nutritionally deficient. They get poisoned by toxins. They get beset with all kinds of different pathogens. More on that in future Q&As, posts, et cetera. And the name of the game is address those root causes and watch people flourish. So as always, thank you for your questions. Please submit them. I look forward to answering them every week. Take care. Have a great day.