DNA Testing, Allergies, and Autoimmunity

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.

Good morning everyone. Dr. Stillman back for another Q&A. Thank you as always for your questions. If you're curious where these questions come from, they come from people like you. If you are a premium subscriber to the Substack or a member of my medical practice, your questions get priority. I will answer them always at the next Q&A that I host. It's usually every week or every other week. And if you are just a subscriber to the Substack, you can submit a question anytime through the free Q&A link, but I may not have time to get to it. So without further ado, let's jump in. Sarah asks, do you recommend DNA testing such as insert company name here to help guide our Wellness journey. So the answer is maybe. Here's how I think about genetics in terms of your wellness journey. So first of all, we have to always think about how much money are we going to spend on testing? Because what I've noticed is that people will go out and spend $2,000 on testing, get bad interpretations, spend half an hour or an hour with a clinician going over it, spend a bunch of money on supplements, come to me and say, I didn't get any results. Why not? And the answer is usually some combination of they did the wrong testing. They didn't interpret it right. They didn't put you on the right supplements. You didn't take the supplements. Supplements, you took too many supplements, or they put you on too many supplements, or they missed key diet, lifestyle, and environmental questions in their history taking, or lack thereof, that if they'd asked and known what to do with that information or made better recommendations, you would have gotten the results you were looking for, right? So I say that because I'm always being very strategic about how much money we spend on lab testing. The initial panel I like to start with is like $2,800, which is already a lot of money for many people. We get it for a better price than that, so we bundle it into our programs. But the point is you can go crazy on lab testing. And you've got to remember, what are we going to spend on this now, and what are we going to spend long term? Because one of the other things I tend to see happening is people will end up, you know, they spend thousands of dollars quarter after quarter, don't get the results they need, and then they burn out or they run out of money. That's not good either. We absolutely want to make what we do sustainable for people. One of the ways that I do that is I order the testing that will allow me to get them great results, right? And one of the things you don't catch me talking about very much is DNA testing.

Why is that?

So I think of DNA as being the blueprints for tools that the body uses to get the job of life done. What do I mean by that? You have a gene for an enzyme, right? Any name, any enzyme, it's got a gene. And from that gene, we then have this blueprint for creating that enzyme. But it's not about whether or not you have a bad copy of the gene, because there's also the question of, is it being expressed? Is it turned on? If it's turned on, is it going from start nucleus to finish expression of the actual protein? There are multiple steps in there. And there's many nutrients and there's bioenergetics that play into this, like light and circadian rhythms. And so there's all these factors that affect how your genome is expressed. And so what I found is that I'm, I'm much more a fan of doing what I call functional testing, which I think of as, do you have enough B6 to do the job that you need done? Do you have enough magnesium to do the job that you need done? Do you have enough zinc to express the genes you've got? And I really start here and I usually double and triple down on this. And frankly, that's how we get the results we get. I, I must say, I don't get into the DNA testing and I'm not very well versed in it in part because we get such good results and we have such word of mouth referral that I haven't had time to dig into it deeply. It's something I would really like to learn more about. But that being said, we always focus in the practice on what is going to move the needle for patients next. One of the things I'm looking at right now is high dose vitamin D. We're currently implementing that in the practice across different programs. Grams. And the reason why is that it seems to have these amazing results clinically that I had sort of heard about here and there, but it never really focused on. And how does it work? A lot of what vitamin D does is it changes genetic expression. So is DNA testing helpful? Absolutely. I think there's a ton of value there. Do you need it right now? And if you're going to do it, what are you going to do with that information? I cannot tell you how many people have come to me over the years, they have all this genetic testing, and I ask them simple questions like, what are you What are you going to do? Or what, how does this change your life? Crickets. No idea. So I view a lot of this ends up turning into this sort of gimmick of let's sell everybody another $400 test and make $200, and then it doesn't actually give them any results or doesn't change their diet or their lifestyle. That's fine. It's marketing, it's sales, whatever. But I just, I haven't gotten into this yet. I will probably find a way to integrate this into what we do along the way. And I may be more excited about it later on, but right now I don't see it as being the big thing for us to change in the practice that will move the needle for even more patients faster. Susan asks, is there a way to improve your coronary artery calcium score or keep it from getting higher than it already is? Yes. And I would say that everything I do and everything I think about in my practice is designed to help the body repair itself, heal, rejuvenate, renew, and avoid the deposition of calcium in the arterial walls. So that's basically a way of saying everything I write about, everything I recommend, everything I do in the practice is like part and parcel of that is minimizing CT scores like this. And this is because all of this comes back to fundamental physiology, right? People tend to, you know, want to know, well, how do I prevent dementia? Or how do I prevent heart disease? Or how do I prevent cancer? The roots of these diseases are very much the same. And so there may be slight differences in your approach, things you may emphasize more or less in one or another area, but at the end of the day, it's all the same. It's keeping the body as young as possible, as healthy as possible, as well-nourished as possible, as free of toxins as possible, and as free of infectious agents and such as possible. B, if someone went to an allergist who did a skin allergy test with the results being that they had no systemic allergies, but they had environmental allergic reactions such that the allergist said they had local allergic rhinitis and gave them allergy drops for allergens they thought the patient had, but after taking these drops for 4 years, the allergies only got worse, what would you do? Great question. Okay. So I'm not really a fan of skin testing. And the reason I'm not a big fan of skin testing is the false negative rate, which means that you'll get a test of the skin test, uh, skin prick testing or patch testing on the skin, and it will be negative. There will be no reaction, but the patient in turn is actually allergic to this. Where I trained at UVA, you know, I briefly was in the allergy division as a student. One of the top docs there, Tom Platzmills, he would do intradermals where instead of doing a prick, you do an intradermal injection of the allergen and you'd often get a positive intradermal where you had a negative skin prick test. I'm a virtual practitioner. I don't do this. It would be very impractical. I'm not terribly interested. Be great if I had like a huge center and could do this, but at the end of the day, here's what we do instead. Number 1, what is the likely allergen? This is mostly coming down to questions like, when are your symptoms worse? If you have a clear fall spring predominance, you can link that back to what's blooming or leaf mold or whatever. Is it better in the winter or better in the summer? Is it worse when you're indoors more? And you can ask some questions. Is it— and there's basically a couple of big categories, right? So for example, there's dust mites, there's pet danders, and then there's molds, and then there's environmental allergens like trees, pollens, grasses, et cetera. We refer people to a company called Allergena, A-L-L-E-R-G-E-N-A, that has homeopathic allergy drops. I love these products. If you're a premium, premium subscriber, we get you a 20% discount through our Fullscript account, or if you're a patient at the practice, we get you a discount on those products. I've had patients completely resolve their allergies just with these homeopathic drops. I would never have guessed that allergies would be this treatable with something so simple. And they've got a few products. They've got a mold product. They've got pet danders. They've got seasonal allergens and local and regional allergens, like say Texas cedar fever. They have a product for that. It's based on zone. So there's like New England and the Mid-Atlantic. There's the South, there's the Upper Midwest, there's the South Central, and then there's a couple of regions in the Rockies and the and the north. And then did I mention they have a pet dander formula? So they've got all these different formulas for these things that you can buy and try. Now, along with that, I'm really curious about the person's immune system and their underlying wellbeing, because what you'll find overwhelmingly is that people who have allergies have a high total toxic burden. And that's where you'll hear these stories of people saying things like, for example, my friend Clark Engelbert, who you all probably have heard me talk about, he reported having, I think it was seasonal allergies disappear after he had a large elimination of lead on his on his hair tissue mineral analysis, right? So we'll get these stories of purifying the body and all of a sudden allergies just disappear. So my approach is always nourish, get the right nutrients into the body so the body can heal and perform at peak performance. Detoxify, get rid of the toxins in the body that are weighing it down and that are holding it back. And that would also mean the toxins that are creating these allergies. And then purify. And this is where you get these weird stories of people saying, I did this parasite cleanse and my allergies went away. I've got a post somewhere in the past on allergies, not allergies, parasites. You can look that up. I think it's behind the paywall right now. We do mean to release those beyond the paywall, but we're not there yet. So give us a little while to write those and iterate those. But anyway, my point is that's what I tend to do in the practice for allergies. I will of course do nutritional balancing based on hair tissue mineral analysis. We'll walk people through our protocols like vitamin C, MSM, and iodine. Those alone sometimes have huge impacts on allergies and also autoimmune conditions. So those are the things that I would use, I do in the practice if I get a case like this. Okay. Dennis, avoiding Teflon cookware is a no-brainer, but are there any nonstick materials or technologies you can recommend as being safe? I use this stuff called Greenware cookware. It's like some kind of diamond ceramic something. I've never done any like third-party testing on this, but it's Teflon-free and it says it's safe and we're using it. I don't see any toxins coming out in the hair, so I hope that their claims are correct. Nick, in your experience, are heavy metals or parasites a factor involved with fibroids developing? 100%, Nick. Yes. There's definitely a link between all of these different things. I can't say conclusively that it's heavy metals and/or heavy metals or, because I also have seen women report that when they got rid of their stretchy yoga pants or, and their other synthetic clothing, they had massive improvements in their, let's call it feminine wellbeing. So I'm fascinated by the role of these endocrine disrupting compounds that are, are synthetic chemicals coming into the body, as well as things like molds. But there's no question in my mind that heavy metals and potentially parasites can play a role in things like fibroids. Sue Lynn, hello. I wanted to get your thoughts on Morley Robbins's Root Cause Protocol and the Full Monty panel. I'm interested in doing the panel. Is that something that you support? Okay. Morley is totally wrong about copper, and I know this because I have tested copper levels and I can't I don't even remember how many hundreds of people. And you will rarely see deficiency, but it does happen. You will commonly see suboptimal levels, but not that often. You will frequently see excess levels of copper in the blood. And in the hair, you will see low levels, you will see optimal levels, and you will see high levels. When you look at the mechanics and the kinetics of copper in the body, Morley's just totally confused. And I, I literally have patients on camera saying, The Root Cause Protocol screwed me up so much. So I like Morley. I consider him a friend, but I really think he's confused about copper, zinc, the relationships of the other minerals. Is the Full Monty panel a good panel to run?

Sure.

But I have to tell you, I think it's such a mistake to get a panel without a practitioner. First of all, if they know anything, they can get you a better deal on it than you're going to be getting somewhere else. Secondly, I just see so many people getting these panels and they don't get any kind of good interpretation or they get the wrong interpretation. So they wind up on the wrong supplements that make them worse. This drives me nuts, but it's your money. It's your time. It's your lives. We're here to clean up messes that other people make with clever marketing and bad ideas. Anyway, Alyssa, is there a reason to test for mold or does that come out with metals or how do you guys look at this? Great question. Funny story. I had a consult the other week with a young lady who's been to really top doctors, great people. I really, really. Respect them. They've been chasing mold for a long time. She's come to see me because she's just fed up with chasing mold. So a lot of people do mold testing and they do one test and they get a high level and they think, aha, I have the mold. The mold is the problem. Funny story. I've got more cases than I can remember. And one particularly memorable case of a guy with very severe mold toxicity, very clear exposure, very high levels. But we did this guy's hair testing and his blood testing, crazy levels of mercury in hair and blood. He went through chelation, got worlds better. So it's the kind of thing where you, if you stop thinking at, aha, have a positive mold test, you are going to miss heavy metal toxicity. You are going to miss petroleum chemical toxicity. You are going to miss smart meters and too much cell phone exposure and circadian rhythm disruption and all kinds of other stuff. So we don't run mold testing and I want to tell you why. We see a lot of noise in the data. And what I mean by that is levels will be high, levels will be low. People will have symptoms, they won't have symptoms. There's no apparent correlation between that. It also winds up adding another, I think it's like $200 or something like that. If you do a good panel to your quarterly lab testing spend, which turns into another $800 a Now, if you have money to spend and you would like to invest in your wellbeing, I wholeheartedly encourage you to get mold testing. Why? Because the only reason I know as much about testing as I do is I've had patients who were wealthy enough to spend sometimes what other people would call crazy amounts of money on lab testing to get to the bottom of things. And if you don't know this, I run all my labs in triplicate when I'm looking at a new lab to incorporate in the practice. So I spend a lot of my own, our own money in the practice on just, hey, is this test repeatable? Is this test worth doing? Does this test mean anything or is it just, you know, clever, whatever marketing? So I don't end up testing for it because we get people better without ever looking for mold. And we use a lot of the same products in some of our protocols and products that are used by the Mold Docs in mold detox. So there's a lot of commonality between how we detox people from heavy metals and how we detox them from mold. And if somebody wants to look at mold, I'm happy to do that. I just haven't seen enough value in the testing to add it when we're already doing the HTMA, we're already doing allergy testing, we're already doing a big comprehensive wellness panel. I mean, a lot of patients come back to us and say, I'm overwhelmed. Do I really want to overwhelm them with another supplement protocol tailored to another lab panel? Maybe I should, but right now I'm not. Jean, hi, Dr. Stillman. Is nano hydroxyapatite safe? I've heard it can increase risk of arterial calcifications. I brush my teeth with a toothpaste made by my my good friend Tom Gilton, my dentist, who was also my best man, and it has nano hydroxyapatite in it. So I am very confident that it is important to use in toothpaste. And his brand is called Happy Dentist, and— or maybe it's Hippie Dentist. I don't really like the brand, but it's a great product. For some reason, I think the only flavor they have is blackberry cardamom, which my wife is not a big fan of. I think it's fine. If you call their office, then you can order some. Becca, I read your article on parasite cleanses. Do you recommend fasting while taking those products? I do not. Second, what causes swelling "Swelling of the thyroid and how to know if it's from too much iodine?" What a great question. Okay, so first of all, you gotta be sure that it's swelling of the thyroid versus another, another structure in the neck, which is a matter of physical exam and/or ultrasound. The most common causing cause of neck swelling historically in world history has been called goiter, which is where the thyroid enlarges because it's looking for iodine because there's not enough around. So basically it just starts to increase the surface area that it has and it tries to get every last little drop of iodine from the blood. We don't tend to see that now because table salt is iodized, and so there's enough iodine in table salt to keep people from getting goiters, but not enough iodine in table salt to keep people well in the face of the onslaught of the toxic halogens in our food supply, personal care products, and environment. So what else could that be? I've seen weird things like thyroglossal duct cysts. That was a good case. And so rule all those out with a competent clinician. It needs a physical exam. Frankly, how to know if it's from too much iodine. I've never seen too much iodine cause swelling of the thyroid. I guess it could, and it's been taught that iodine can cause thyroiditis, which would cause inflammation and swelling of the thyroid. But thyroiditis, usually if it's going to be tender and painful and have swelling, usually there's, there's tenderness and pain associated, and you haven't mentioned that. So I, I question if that would be the diagnosis. And then in those cases, I just drop iodine. If I suspect it's driving the process or the thyroid can't regulate or use it. But like I said, I've never seen too much iodine cause thyroiditis. Otherwise, I don't, I don't know that I would actually prescribe it for that. Olivia, what are the testing— what testing is available to determine which autoimmune disease a person might have? This is a great question. We've actually been looking into this for the Autoimmunity Recovery Program. So here's the thing. Autoimmune diseases are these huge categories. Well, let me, Let me rephrase that. It's a huge category in and of itself with very small subcategories. And what will often happen is people wait years and years and years struggling with symptoms before they get a diagnosis. And this is because their serum, their blood labs haven't become positive for a conclusive diagnosis. What does that mean? What that means is that they wait years and years and years gradually deteriorating, wondering what their diagnosis is until the process is so far advanced that they have the lab proof of a specific diagnosis. So I don't worry about which autoimmune diagnosis a person has, except in the context of what drugs are we going to use or might use and why and how, and how else might we change our management. So like, for example, if somebody's got Crohn's or ulcerative colitis, there's completely different treatment routes for that. And I usually manage, I usually manage those in conjunction with a gastroenterologist. If someone has sort of, I've got GI illness, it might be autoimmune, it might not. I haven't had a biopsy yet. I recommend they get the biopsy so we can have a definitive diagnosis. And a lot of autoimmune diseases, by the way, are definitively diagnosed on, by a biopsy rather than a lab test. But here's the thing, regardless of where people are on this continuum of I am sick and think I might have an autoimmune condition because of my symptomatology, and I've got a full-blown concrete set-in-stone diagnosis, regardless of where they are on that, we just apply our framework. To improve their function, to help get them control over their symptoms, to help them get back to the life that they want to live. Because the reality is they all have the same root causes. And so when you, when you deal with those root causes, you can see healing just spontaneously occur. Mary, on the HTMA, is there a best type of oxidizer, fast, mixed, slow to be? The answer is no. My answer is, or my more complete answer is you want to be as balanced as possible. So one of the things that I'm fascinated by is that in my HTMAs, my own HTMAs personally, I have gone from wildly imbalanced all over the place to very balanced. And as that's happened, I've become very metabolically flexible and I feel great all the time. And I, on my most recent heavy metal testing, I have no heavy metals at all. Pretty remarkable. Took me somewhere in the neighborhood of 5 years to complete that. Your oxidation rate will fluctuate and you have to remember that you want it to be what it needs to be in order for you to deal with your your environment, your lifestyle, and your life circumstances.

Right?

So for example, if you're stuck in terribly deep slow oxidation and you are just really exhausted, but you need to be at your best and performing at a high level, right? Then that's not good. If on the other hand, you are meeting your needs and you are, let's say in like fast oxidation and you're a high performer and you're going super fast, you can burn out. Right? So you want your oxidation rate and state to be what it needs to be for you to perform at the level you need to perform without burning out. There's more I could say on that, but I, in the interest of time, I will keep it brief. PJ, can high-dose D3 cause insomnia? Yes, absolutely. Which is interesting because one of the things that D3 does is it tends to improve deep sleep. But one of the things that happens with pretty much anything we use is that you can get these paradoxical effects. So melatonin, by the way, massively improves deep sleep, but it can also cause insomnia paradoxically. What I would do depending upon the case, right, is if it's really severe, I would just stop the D3, give the person a washout period, and then restart at say 5K. But I'd want to take a fuller history because why are we using the D3 in the first place, right? And then more likely I would just say, hey, drop it to 20K because I wonder if maybe a smaller dose they would tolerate. Susan, on an MRT food sensitivity test, would a sensitivity to cow's milk also include raw A2-A2 cow's milk? Yes, it would. Would a sensitivity to wheat also include sourdough? If the sourdough is made with wheat, which technically it could be made with a bunch of other grains. Susan, my blender that I use daily for protein smoothies is on its last legs. When considering a new one, do you think it's worth the considerable extra expense to get one that is stainless steel rather than plastic? Boy, have not considered this. I would say probably not, or if it is worth it, it's a very small improvement because ideally blenders are made of very durable, tough plastic that's not going to leach out into your smoothies, but we don't have any data on this is what I would say. Ruth, what would you suggest to best help living with achalasia and esophageal spasms? I've used the X39 for the past year, but it doesn't seem to be helping as much as it used to. Okay. So we see this a lot. And when I say this, I mean people use the X39 and they expect it to get them to well and it gets them great results. But one of the things that you'll find with any therapeutic is there's sort of a law of diminishing returns. It will get you a certain part of the way, but if your diet, lifestyle, environment, et cetera, are not dialed in, then those results will always fade and you will wind up back or at least closer to square one. So I'm not an expert on achalasia and esophageal spasm. You've gotta run this stuff by your gastroenterologist. Those are complex diseases. So I have a case of eosinophilic esophagitis in the practice. They're, I think, 80% better or something like that on their subjective rating of how much better they are after about a year and a half, I think, of mineral balancing. And I wasn't sure what I would be able to do for them when they came into practice, and I told them that. I said, look, I have no idea what kind of results you're going to get. I've seen one case of this before. I managed it. They got good results, but they were also doing soft gel dilation, which is normal for that diagnosis. But she came in, did all the things we recommended, and boom, world's better in a year and a half. We still take care of that family. So I know that what we do works. Can I promise it would work for this? No, I would expect though that it would, because why wouldn't it? And this goes back to our whole philosophy of we're looking at all of the root causes of disease in our framework, and then we're, we're addressing those root causes of disease with our core protocols, which is vitamin C, MSM, iodine, plus mineral balancing, plus X39, plus we take a very good look at the diet, lifestyle, and environment. And I have a real curiosity with esophageal spasms because you got to remember, this is in many cases an autonomic thing. And so could breathwork maybe be effective?

Is—

could this person be in sympathetic overdrive? And then there's other things that cause achalasia, like for example, I think Chagas disease. Is a parasitic disease, causes this. So then maybe antiparasitics would be helpful. So this is the kind of case we would come in, we'd do our standard operating procedure. As we got results or perhaps didn't see the results we wanted, we would go up the therapeutic tree and pick higher and higher levels of therapeutics until we get the results we want with the obvious caveat that there's no guarantees. Okay. Jenny, do you have a protocol for alpha-1 antitrypsin deficiency? I do not. It's too niche for me. I haven't seen it yet in my own practice. Cynthia, I've been working on reversing type 1 diabetes. I've been able twice to increase my C-peptide. It was at undetectable levels and then And then twice it increased from 0.2 to 0.28. I was told this is impossible. Please let me know if you are familiar with how this may be possible. I am now back to undetectable levels. Okay. One of the things about lab testing that I really stress to people is that, so your labs vary a lot. I don't have a lot of data on C-peptide. I've never run serial levels of C-peptide. It's kind of a niche lab test. Mostly the endocrinologists run this, if anyone, but I know from testing other things in the blood, some of them peptides, that you're going to get these big spreads. In type 1 diabetes, you've lost your cells that produce insulin and therefore C-peptide. And so, but the thing is, did you lose all of them? So you must have some quantity of these cells around making this trace quantity. It's also possible that there's an error in the lab. They're reading C-peptide, but really it's some other small peptide. That would be a question for the analytical chemist working at the lab. Either way, this fluctuation up And then back down, very consistent with what we see in labs all the time and could just be an analytical problem. It doesn't necessarily imply that you were on your way to regrowing these cells and now you're not. And I've never heard of anyone reversing type 1, by the way, and that's in the integrative world. Like, I don't know anyone who's ever done it. Maybe they're out there. Some of this will depend on age, right? Because you get more stem cells when you're younger, fewer when you're older. So if you can intervene sooner, right? You get better, you, you would expect better outcomes across the board.

All right.

Matt asks, I have an amazing assistant who lives in the Philippines and works US hours. She has lupus and regularly struggles with migraines, light sensitivity, and other autoimmune issues. She's unable to get much sunlight due to immune reaction, and the night schedule doesn't help her circadian rhythms. We're trying to gradually transition her to a more asynchronous workflow so she can shift closer to a natural sleep-wake cycle, but she still needs to work some, uh, Pacific time hours to support her family. What other strategies have you used to work with individuals struggling with lupus? What a great question. So That's gonna be my book, The End of Autoimmunity, coming out this coming summer. And everything I write about on the blog, mineral balancing, all the rest of it, that's what I would lean on for this. We're also looking into high-dose vitamin D therapy, which I haven't heard cases of in lupus, but I'm very curious how effective it would be in lupus. So that's something she'd have to work out with a, a doctor for monitoring and dose adjustments. Rachel, could one supplement with silica capsules to avoid buying bottled water? What would be indicated? Milligram dosing? Marcy has basically the same question. So here's the deal with silica, guys. Silica needs to be in, in water as orthosilicic acid, not just silica or silicone dioxide or whatever. And the form matters. Now, this is according to Chris Exley, the Dean of Aluminum Research, right? The, the, the big heavy hitter in the aluminum toxicity world, arguably. And so what he's established in his work is that only orthosilicic acid helps get rid of aluminum in the body if it's present in a high enough concentration. So that's the name of the game. Get the orthosilicic acid level level high enough. From my understanding of his work, you have to get orthosilicic acid as in an aqueous solution. Dennis Krause has a recipe for that. You can look it up. I think it's freely available. I think he's made it freely available online. If not, he's got a book where he's got the recipe in it. Maybe someone's got a silica supplement out there that's effective. I just haven't tested it and haven't seen the proof. So until I see the proof, I have to recommend the thing I do have proof for. Otherwise, I'm arguably just risking wasting my and my patients' time and money. So that's that. Okay, everyone. That's all the time we have for today. Thank you as always for your questions. Please upgrade if you haven't to your premium subscriptions. I look forward to answering your questions in the next Q&A. Take care, everyone. Have a great day.