Functional Medicine Secrets: Proven Strategies from an Experienced Physician

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. I'm joined by my good friend, Dr. Patrick Lovegrove. We met through Joe Mercola. I was on his podcast. Dr. Love reached out to me, said, hey, you're a kindred spirit. We've gotten to know each other over the last few years. So I'm delighted to welcome you today to the podcast to announce your new book, which I think is really interesting. Not a lot of doctors write health books that are locally focused. If you want to tell us about your book for a minute before we jump into your history, tell us about it.

Yes, Leland Stillman, uh, it's a great, uh, being here, opportunity to kind of speak on your podcast, uh, tell you a little bit about myself. I'm a, you know, devout Christian. I called to write this book. I was part of a Christian CEO group that, uh, really encouraged me to write a book that just helps people, you know, treat their body as God's temple. That's the premise that started it. That's kind been the goal. And yeah, it's going to be local. You know, a lot of concepts are more national, but where I can have on-the-ground influences going into local community centers, churches, and so forth to speak about these concepts. And that's, that's kind of what's on my heart to do.

That's great. I like to ask everyone on the podcast who they are and where they're from.

I was born in Virginia, only child, no judgment please. You know, my parents were hardworking and they've since passed on, but they were heavily influential because both in up being business owners. My dad pretty much his whole life in construction, and my mother started off as a— in Safeway as a cashier and rose up in the '70s to be a manager of a national chain grocery store in Virginia. And so I had a lot of opportunities, you know, to see their hard work paying off dividends. We were raised— I was raised on a farm. My dad supplemented his general contracting work with farming cows and, you know, into our own like fruits and vegetables in the that we grew in the garden. The first thing I ever delivered was a baby cow. Even though I've had hundreds of deliveries through residency and family practice, it was those kind of experiences really shaped me and to who I am today.

Where did you grow up in Virginia?

It's the Shenandoah Valley, so it's towards the western part of Virginia in the mountains. And which town? It's called Staunton.

Of course I know Staunton. Do you know I went to UVA?

I think that was one of the connections. Yeah, I went to UVA also.

Okay, got it. And so you must have grown up You mean you grew up around Joel Salatin?

Yeah, of course.

He must have been just starting. That's very interesting connection. How did you get down to South Carolina where you are now?

The Air Force. So I started off the family business. My dad was architect, general contractor. So I went the architecture route at the University of Virginia. And partly because, you know, I think, you know, I really wanted to be a doctor. I just didn't know if I could stomach it because I had a traumatic experience, a 2-year-old having my end of my thumb cut off. And luckily they were able to salvage it. But I think it gave me a lot of PTSD that, you know, I wasn't diagnosed with that really kind of made me feel very uncomfortable about some of the surgical aspects of being a doctor. And so I was not the kid who liked to get his blood drawn or get any shots or anything. I remember running out of the doctor's office and hiding in places and really—

I did that once.

Yeah.

My dad had to hold me down for some immunizations. I remember that very, very clearly.

Yeah. My, my father, yeah, he's in construction. He was a tough guy and he's like, all right, give me the biggest needle they have. I tell you, son, I'll take the biggest needle they have, you know, and I'll show you I'll show you how it's done kind of thing. It was kind of funny. They pulled out like a spinal needle out of the drawer. I'm like, looking back on it, I don't exactly remember what they were going to plan on putting in it or what they were going to do, but he showed me how he could take the biggest needle. And, uh, yeah, didn't change my fear. More of what I did is once I realized that architecture, I was just kind of average at, I really wanted to follow my passion. I decided to get a job at a local hospital, uh, close to San Antonio. It's called Augusta Medical Center. It's since got a lot of affiliations with UVVA, but back then it was kind of more of a startup. It took a chance. I had no experience. I knew it was a summer job. They hired me as an emergency room technician and a phlebotomist and trained me on this. And here I am, soon to be junior in college, and I'm facing my fear. Being in the midst of those kind of situations, I definitely saw a lot of lacerations, amputations. I remember chest tubes. I remember very vividly how uncomfortable watching a chest tube for the very first time. I came out of there— call it desensitization. And ready to start the pre-med route.

I think when you said amputations, you mean traumatic amputations?

Correct.

Any, any particularly memorable ones?

A toe. I never saw a finger amputated that, you know, probably would've not gone into the room knowing my history at the time, but I did see a toe.

Not as— that's not as colorful or exciting as I thought it was gonna be.

Well, probably I don't want to talk a lot about it, right? It's been compartmentalized in my psyche.

So what was it about medicine that drew you in?

I just like helping people. I like imparting information that people find valuable, and it's nice to have a degree in which people think you know what you're talking about. Whether you actually have good advice or no, that's, that's a different level. But my big influences— once I got into medical school in 1997, I read Dr. Andrew Weil's— he was a Harvard MD— Spontaneous Healing book, and it was something that really appealed to me because I knew that going into medical school I was going to be a doctor, but am I going to be a healer. And his whole point is you don't have to be a doctor to be a healer, but just because you're a doctor, you're not a healer. And you have to have different concepts that push the limits of traditional allopathic medicine.

I want to dig into that. I think a lot of doctors come into medical school with a very different frame. Their frame is very mechanistic. The body is a series of struts, hoses, tubes, pulleys, levers. I am a mechanic. And in a biochemical sense, it's, it's very much the same thing. There's pathways, we block them, we accelerate them, we them, I view the reductionistic view of the human body as being very, very mechanistic, as I said, but very like our thinking and our thought process is very manipulative. We're going to manipulate this joint. We're going to manipulate that pathway. In how you framed that, for some reason, you give me the impression that you had this frame of mind or frame of how you looked at the human body. And maybe it was Weil who unlocked this in you, but my experience has been that usually a book like Weil's Spontaneous Healing, usually it's not that it convinces people who don't believe that. It's that there's sort of like an openness to the idea that's grounded in early experiences that it clarifies or brings to the fore. Does that make sense?

Yeah. It was like a, an old Michael Crichton Travels book. He would just travel around the world witnessing with his own eyes the power of healing with people with no traditional allopathic training could do things that he hadn't even seen that in medical school. So you definitely are in awe. Is it wizardry, magic? Is it smoking mirrors? Obviously you gotta have a lot of doubt, but the exact same time, seeing is believing, particularly if you hear this story through a third party. But when you kind of see it with your own eyes, it doesn't feel staged.

What do you feel your parents raised you to believe about life, the human body, particularly with your background growing up on a farm?

There's a lot of traditional things that we did that there's a trend of going back to raising your own food, having your own animals that, that become your food, being more organic. Organic with, you know, just old weed pulling as opposed to having to spray for it. Community, just being more reliant on the local neighbors and integrated with that. My grandmother, she really didn't let anything waste. I mean, some of her chicken houses, we would stuff our pillows with chicken feathers. Now people have all this like sterilized stuff they call their down pillows, but we weren't sterilizing, we were just making sure that the feathers were fresh and stuffing pillows and bedding with it, leaving nothing to waste. We big canners, like that food where you, you raised, you harvested, you got through the winter eating it also, you know, fermentation, pickling process, those kind of things. And now they've become surging in understanding that these kind of things that our parents, grandparents, great-grandparents were doing, they were doing it, whether it's instinctively, how it was passed down, who knows, but it's what a lot of people are starting to adopt in modern day. So I find that kind of cool that I was doing it without realizing that I'm doing something that I can reuse again.

Absolutely. Was there an acknowledgement or belief growing up that these things were healthy? And I'm curious also if there's any tie-in with your, your faith to all this.

My family, and we definitely did church and I did Bible school programs and so forth. I felt more driven to explore my faith more than my actual parents in some ways, because they were, they didn't like some of the judgment of walking into churches. They moved into just kind of watching things from TV because at TV evangelism sort of become more and more popular. And they, even though they'd go to church here and there, I was going to church without them down the street. We had a few different churches that they felt comfortable with, but I found my own church that was actually walking distance from my house. And the pastor's son became one of my best friends. And I would, I just kind of self-integrated that as a preteen teenager into doing this on my own. Food, you know, I guess you say, how does it relate back to that environment. I think anytime you're farming, you're much more aware of God's existence and how he makes all this happen and to be thankful for it. Probably that awareness was not something my parents were driving home, but I think, you know, subconsciously it was there the whole time.

You mentioned Andrew Weil's book as being very, very— is it fair to say it was transformational in your thinking about health and wellness?

100%.

I'm very curious with a background as a Christian going to the church and particularly in that region of the country where in my experience, Christianity is very conservative, particularly compared to places like where I grew up in. I grew up in New York City. New York City churches are so progressive. They're almost not even really Christian anymore, but anyway, there's like a few holdouts in the city and I know some of them, but I'm really curious. What was it like reading stories of spontaneous healing? That weren't necessarily within, and I'm curious, were any of them within the Christian faith or was this all people outside of the church having these spontaneous miraculous healings?

Like I said, I read the book in '97, 1998. So you're talking about trying to remember a lot of the stories. I did not necessarily at the time thinking it from like trying to differentiate what stories God obviously was a part of and what stories that he wasn't. He would go into Buddhist villages and seeing that how they could do it, you know, shamans, different religion, a different faith. Now, I believe that God gives them the tools and he wanted it to happen, right? If it's, if it's going to happen, he wanted it to happen. And why he gave those people who aren't my religion to have those successes, I wasn't questioning that. I think who knows those people that they influence, who they become. You know, we don't always track the people who get healed and why does God want them to be healed? What are they going to do with their lives? And maybe they'll get closer to God. Maybe they'll seek out God. Maybe they'll look at different faces God than the religion that they, that they were born to. Who knows, right? And, but I didn't look at it that way. I just thought, you know what, traditional medicine definitely has a blind spot and I'm gonna be aware of those blind spots and always be looking to supplement the education.

Got it. And then you went into the Air Force and you did a family medicine residency.

I got a scholarship, the Department of Defense and United States Air Force. So gave me an opportunity to travel, see parts of the world. You know, I was in Korea for a while. So, you know, a little Asian influence and how they do medicine. I wasn't working necessarily in a Korean hospital. And then I went on to Germany, you know, some other places in Europe where that was for another couple years. Now, those kind of things are different because a lot of doctors, uh, well, one, I didn't have that debt load, right? So it's so nice to just have all that and graduate. You know, back when I graduated in 2001, most of my classmates were already $200,000, over $200,000 in debt. And we were a mid-range medical school. And as someone who not just had school pay forward, but it gave me a stipend to live, and I got to travel the world to be— and be a doctor. Unless you're a Doctor Without Borders or do some mission work and volunteer work, a lot of doctors aren't going to have an opportunity to just take their career path in other countries. I thought that there was a win-win there and took advantage of it. From a small town, my parents didn't travel. I never got on an airplane until I got in college. So we drove places and mainly stayed home. You got animals and livestock, you got responsibilities, you can't go far. You can't ask your neighbor to take care of your cows. Very long rides.

Very long is the key word there.

So, uh, we, uh, did not leave for long periods of time and definitely didn't do like any type of long trips. So I was itching to travel the world and see the world.

Where'd you do med school? Remind me.

It was, uh, Nova Southeastern. It's in Fort Lauderdale, Florida.

Right. Got it. You came down to Florida. Okay. So then you, you transitioned from conventional medicine somehow into integrative natural. I'm actually really curious. How do you, what do you like to call what you do now?

Yeah, it's going through a lot of different names. Just since I've been doing it. I mean, starting out integrative and then complementary alternative, CAM was like, I remember that, complementary alternative medicine for a while. This functional medicine, even though Dr. Bland kind of coined it around the same time I was writing, it didn't really probably catch fire for a name and maybe like 10 years ago. It's now, it's functional medicine's much more. But I remember too, people were calling our office 15 years ago and saying, hey, I want some homeopathic medicine. It's like anything that wasn't allopathic, somehow got labeled as homeopathic, even though I wouldn't say I do homeopathic medicine. I'd say it's more naturopathic medicine. I think they have more of a functional medicine basis longer than allopathy or osteopathy in some ways with just their mere existence of how they think and the items that they try to use and the tools they try to use because they, they don't dismiss the allopathic way. They don't dismiss the chiropractic or the osteopathic and and they, they do try to do a combination of different disciplines. So yeah, you know, being a medical doctor, but I feel like I'm more like a naturopathic doctor.

What kind of training did you pursue?

The— well, yeah, I mean, there wasn't residencies in functional medicine, and so a lot of it was just out of curiosity to do more training from 2005 on. So I was just starting, I just find different CMEs. So, you know, your medical education credits that had themes that I was very interested in. I really liked the whole, you know, started reading different things with like vitamins and minerals, but hormones were really something I felt that very passionately at first with a lot of influences. I talk about in the book from Gregory Petersberg and Neil Rousier, medical doctors who were very influential early on for me in different ways. Neil Rousier is, they call him the hormone doc because He has been training doctors for over 25 years in how to do hormones correctly using evidence-based medicine. He's kind of retired now. He's does a lot of different consult work, but he's all about what do the studies show? And, and I think a lot of doctors get into associative risk and not so cause and effect and laying their claims on grade D studies. He does things that I would not enjoy reading these really advanced studies, the placebo-controlled studies, and really going through the details. And really truly understand it, as opposed to some governing body in medicine making statements on their interpretation. He's been doing his own interpretations and making statements for a lot longer, and he'll go head-to-head that their interpretations are wrong and prove it why. And he's, he's had to take that to court before and win. So he, he knows how, he knows, uh, what the evidence is, and he's really passionate. And so I was so blessed to have come across him early on when I was on this mission to kind of do my own thing as I got out of the Air Force. And, you know, it was a lot of foundational stuff in hormone replacement.

I did a training with him maybe a month or two ago. He certainly doesn't seem retired when he gets up to speak. He's a very passionate man.

Yes.

So I'm curious, based on all the training you've done now, how long have you been doing bioidentical hormones in your practice?

Well, you know, I started when, when I got those courses, I felt much more comfortable about 2005. Really?

Wow.

Yeah.

So 20 years. We could do a whole hour on just bioidentical hormones and we didn't even plan on talking about them, but I, I'm very, I'm always curious to talk to colleagues about bioidenticals because they're so, they're so interesting. I also think the landscape is changing. I talked to a colleague the other day, she, she made the comment that she's not using Biast anymore. And you know, Brousier hates Biast. And yet I talked to a pharmacist the other day. I said, what do you, most of your doctors prescribing through this pharmacy? She said, oh, Biast. And what I found interesting about what my colleague said is she said, I just don't see Biast getting the results that my patients want, having the impact. So I've switched over to estradiol only, which is a Rouzier— the Rouzier textbook. And her point was that she believes this is happening. She's needing to use more estradiol than doctors had to use in the past because we have a more toxic environment with more estrogen-mimicking chemicals, and they're interfering with the estradiol. And so we need more of it with less of the E3 estriol. What are your thoughts on that?

Yeah, I think a lot of the estriol is due to the theoretical breast cancer protection and the bias. Estradiol turns to estriol, so you're probably getting plenty. So a little bit of it is placating that possibility that your body's not going to convert well by just including in the formula, remember, the 0.4 milligrams of estriol just to stick with the studies. Yeah, I mean, estradiol is really where it's at and you, you, you probably really didn't ever need it unless you're one of those people who don't convert well. And I think, I think bioidentical hormones are something that people need to be more comfortable with if they, if they want to slow their aging process. And, you know, I call it voltage, right? So, you know, if we're starting to slow down with age, just like any type of mechanical thing, it's like a cell, cell phone signal. Do you want your cell phone or your computer running on a 1-bar signal? I mean, it's still functioning, but so hormones, they don't just become imbalanced, but they, they decrease over time as you age. So we need to be aware of that and get that voltage up. And you can see it if you do like brain speed testing. I've always been fascinated with some of my colleagues who test people's brains before and after off hormones. And I remember one first time I saw that with Eric Braverman. He was like a neuropsychiatrist and you can see the brain speeds just increase exponentially. For these, you know, let's use example, postmenopausal woman. When she's not on her hormones, she gets on her bioidentical hormones and all of a sudden her brain speeds are so much faster.

Has that been extensively published in the literature?

You know, when I saw it, it was at an A4M conference, so the American Academy for Anti-Aging and Regenerative Medicine. And like I said, there's, there's all kinds of publications. I just, I think a lot of it ends up being cohort studies and it probably doesn't grab some of the attention because they're not— there's not financial backing of this because if you look at brain speeds, well, there's multiple devices that do it. What company is going to try to corner the market and say their device measures the speed better and then publish a study, put all the money in, and then their competitors get to capture those studies and actually make more profit? They— the other company who put in them, they go out of business because they don't get their, their investment back. And I think those things get really difficult. And that's the reason why stuff I saw were more cohort studies. You know, they were very differently done.

I think this element of the science is really— scientific establishment, that is— is really broken. The way I think studies like that ought to be done is doctors like you and I doing diagnostics, therapeutics that we would normally do, show the trend over time with the change in treatment. And you can't control for a lot of variables in that setting. But where I think academic medicine has gone off the rails is they want to control every tiny variable, which is just absurd. And it also isn't in the best interest of the patient. I mean, you're going to leave somebody with a magnesium deficiency, deficient in magnesium, because you're trying to test how their hormones affect their brain speed. It's not really ethical. But at the same time, people saying, oh, well, these studies you could do are not going to be worth, worth doing. I don't think that's fair at all, but that's a bigger discussion. So we decided today earlier before we got on the call that we were going to talk about two things that you think are very unique about your your practice, and maybe we'll come back and talk about hormones sometime. The first was ligamentous disease. How did you first find out about this, and how do you explain it to patients?

What happened to me? Yeah, I always make the joke, uh, you know, uh, the Hair Club for Men— I'm not only like the founder, but, uh, you know, I'm a client. I tell people because it happened to me. I, I'm— I've, uh, I didn't invent prolotherapy, but I've been doing it now for 25 years.

What's that?

So, uh, yeah, so I guess we'll go back here. So we're gonna, we're talking about ligament, um, laxity. And back in, you know, um, 1999, I had, um, a surgery for my knee that sent my whole spine into a different state of instability, specifically my cervical spine. I started getting a lot of symptoms, went to a lot of specialists, including neurologists, felt my career in medical school was in jeopardy because I really couldn't think clearly. I started getting these like atypical migraines and all they wanted to do is just put me on anti-anxiety medicines. And I'm like, I didn't have this before. I'm not this type of person. I can't control how my brain thinks. And I haven't been— I've had a good life. I've had a good family. I don't have any reasons, but I couldn't explain it. I finally found Dr. Alvin Stein. I remember him. He was a retired orthopedic surgeon down in Florida, Southern Florida. He walked in a room. He stood about 6'8", 6'9". And he had a reputation of just as a healer. He wasn't doing orthopedic surgery anymore. Instead, he got into more of this regenerative therapies and doing a lot of things, including like muscle testing and stuff. That was very interesting to be a part of someone mainstream and make such a change in how he practices. He introduced me to prolotherapy and said, what, I think I can help you here. I'm going to need to inject your neck because I think you have something called Barre Lieu syndrome. And what that ends up being is it's loose ligaments in the neck. That cause a vagus nerve instability, and the vagus nerve being one of the, you know, premier autonomic nervous system determinants of how relaxed you are. And if you're— if that is getting pinched, kind of an electrical cord getting pinched, you're going to have pulses that you still have function in your body, but it just sets off a lot of different system warnings. A lot of what I was getting was my symptoms would go away when I would exercise. It was very interesting. And I just started sitting in front of computers or just sitting and I would start getting my symptoms back and I just couldn't just exercise all the time. I mean, I mean, obviously I realized I was healthy, but what it is is that the muscles around in my neck were tightening up, pinching off a lot of different nervous system flows, including vascular emptying from the carotid vein. So I had, I had a tightness that was really due to an internal looseness in the ligaments. Around the cervical spine. So what did he do? Well, he injected those ligaments, and it was amazing. Within the first treatment, I was 50% better. One more treatment, and I was good for over 20 years until I started feeling little things come back in my neck a couple years ago. And I went back down to Florida and had, had it done. Who did you go see? I went to Dr. Ross Hauser and saw his physician assistant Danielle. I wanted to take this to the masses because why did it take so long for someone to diagnose me with this when it was an easy treatment and it didn't require drugs. They weren't calling me psycho or anything like that. It wasn't needing to go see a shrink to manage it. It was fixable. They just needed to know what the root cause was. And obviously my root cause, I played football, you know, I had diving accidents and swimming, which I definitely had a lot of things, but having this surgery on my knee and the position I had to lay in while I was rehabilitating really put my neck in a very bad position and sent it over the edge. So those ligaments' last little bit of being able to kind of keep me out of trouble just spiraled into the symptoms that had. And so the, the prolotherapy was a reset into those ligaments and then, you know, grows collagen, elastin. It's like if you look at a rubber band, and this is what misses on MRIs, like if they would MRI my neck, they probably wouldn't have seen a lot. Why? Because that is a static image. You have to be moving in order to see this laxity. Now, back then we didn't have the technology, digital motion X-rays. Now you can go through like fast moving photography, move your neck in all ranges of motion, and you can see the neck gliding too much in different parameters, millimeter, this this way, a millimeter that way is very significant. It's become very popular in personal injury, whiplash accidents, because lawyers are one of the only ones that want to spend the money to actually do the testing and establish the permanent defect due to the car accident. And then obviously the traditional mainstream, even though there's studies about it, they just really haven't picked up and send more of these people with different type of problems to get the ligaments evaluated. Once you establish the ligaments are an issue, there's a treatment. I was having more mental health stuff and feeling pressure in my head. Head and some dizziness. But for another person, it could be digestive distress, uh, you know, it could be heart issues, you know, palpitations. The vagus nerve is so influenced, and it can just be different things for different people. And thus, it's really hard for doctors to even tie all that together, even looking at it.

Absolutely. Yeah. And it's interesting that it's the kind of thing where people see such value in it therapeutically, but it's not mainstream. And I always think, well, how— if this went mainstream, how much would it change the face of of these different specialties it touches, because it touches gastroenterology, it touches orthopedics, it touches cardiology, neurology, psychiatry. All these issues that people can develop from this, they lead to a cascade of prescriptions that ultimately are refilled every month, every quarter, every year, escalating doses. As the underlying problem gets worse, people wind up on more medications. It all fuels the big pharma profit in the end. The, the pharmaceutical industry through their medical conference sponsoring tends to steal attention from things like this. And then of course the insurers are in bed with them, so they don't reimburse for this kind of integrative alternative care because it's, you know, not evidence-based. Because of course no one— who's— how are you going to do this study? These are very nuanced, sophisticated, also very operator-dependent things. They're not necessarily cookie-cutter, protocolized. It's very— from what my conversations with other doctors around this— requires a really skilled practitioner. Is that fair?

Very fair. And hopefully artificial intelligence comes around and, and helps doctors expand their differential diagnoses, because I think that's what this really comes— if you, if you haven't been around it or thinking about it, or maybe you're just having a day in which that's not top of mind, right? You kind of forget, leave it out of your differential. And I'm hoping at least whoever's pulling the levers in artificial intelligence will not leave out a lot of this natural medicine part of the analysis, because that would be so unfortunate.

Well, one of the really interesting things about AI, because I have some friends who are in— I don't know, industry, I guess, is the way to put it— is that because it's so scalable, you can customize it very easily. And it really doesn't take a lot for someone to create an AI Dr. Lovegrove or an AI Dr. Stillman. And in that way, we're going to be able to really decentralize our healing knowledge. And it will be really fun to be able to ask the same question of Dr. Lovegrove and Dr. Stillman's AI and see what comes back. But this is all in the not-so-distant future. So how did this change your practice?

Yeah, the applications, you know, cuz we're talking about 1999 and then I teamed up with Dr. Hauser to do a randomized placebo-controlled study for just low back pain. So even though mine was neck and my symptoms, the number one pain was low back and that was something that, that I saw an opportunity to do studies. So I initiated St. Louis University. So the first ever family practice residency, everyone else is doing questionnaires and I'm actually doing randomized placebo-controlled study and I'm not a PhD, MD, you know, I'm just someone who's very passionate about getting getting this out because it helped me and I want to help others. Got very close to finishing study, but, you know, I was in residency and I had a commitment to the Air Force, and they, they deployed. My protégé didn't finish my work, and by the time I came back to the States 4 years later, I wasn't going to just pick back up with it. So I never got to publish it, but it was a great preliminary information with, uh, you know, low back pain and how well it works. But, you know, it's because we're a bag of bones, how to go rubber bands, you know, the bag being the skin, those rubber bands or ligaments ligaments, we get loose and it's a part of the aging process. And so, you know, I included it in the book because a couple of things. Number one, we're going to have aches and pains or clicks and pops and not being able to do this or that. And sometimes that's, you know, you're not ready for surgery, a knee replacement, and the ligament is not completely shredded where they got to put a new one in or sew things back together. We're just getting looser on a, on a ligamentous scale where our muscles and tendons get tighter. Ligaments get looser. That's a really bad degenerative place to be in. So if we can get those ligaments, restore their elasticity, then we have a better chance of all this flexibility stuff that we're hopefully doing working better. It's going to help that chiropractor adjust a spine and get, and get the, the, uh, the, the adjustment to hold. I think that's a frustration for a lot of people is because they feel good when they go to a physical therapist or chiropractor, but they're just not holding those manipulations. And it comes down to what is that ligament doing? Because that ligament is ultimately going to hold those types of interventions. I look at it as heart rate variability opportunity. I think there is a lot of people who have, which is head down in their desk, in their cell phones, bad sleeping position, too many pillows, car accidents or whatever, then the neck is, and the ligaments of the neck have really been stretched out even more so at a younger age because they're not just walking, looking at the horizon anymore. There's so many things— we're just head down doing, and, um, that is accelerating aging. And you can pick that up with just heart rate variability measurements because it's one of the easiest ways to get a real quick sampling of what that vagus nerve is doing. And so if you're not— there's a lot of things that affect heart rate variability that I haven't heard, like, on the circuit of speakers and a lot of people just talking about it a lot. And that's why I wanted to bring it up. I thought it was a more unique thing, is getting into what is the ligaments in our neck doing that's affecting this vagus activity, and how do we get them restored so their heart rate variability goes up and then our aging slows.

We've seen a couple of really interesting things in the practice with this. We don't do this procedure. I'm not really well trained in this, but I've been— for a long time I worked with a guy named Jim Laird, and we still refer to him, he still refers to us. He's a strength and conditioning coach. He trained with the Postural Restoration Institute and a bunch of other people, and I was shocked when he started to see patients with me because he would evaluate their physical body, how they move, their movement strategies. I would evaluate more their biochemistry. That was my passion in medical school and residency. I just wanted to look at pathways and papers on drugs and nutrients and things like that. For some reason, the physical medicine never appealed to me, but Jim was remarkable. He would, he could do things and people would see these amazing results. Like I remember he, he, he got a guy to change his shape, his posture, and his tinnitus went away. And I saw that happen, things like that. I didn't anticipate more than once based on shape and structure. And then of course, you know, you have these tough cases where they go to the chiropractor, they go to the physical therapist, they go to the personal trainer, nothing seems to work. But you find that stories like yours, you do some injections and all of a sudden things tighten up and symptoms that have been plaguing them for years go away. I have a couple people I'm thinking of right now who are in the practice who, you know, their HRV is just chronically low. Because what we'll see is some of those people, their HRV will go up as we bring in more restorative time, breathwork, fix their diet, their lifestyle, their environment. But some of them it just seems like nothing moves the needle. Nothing budges their HRV up past the single digits, the teens. So it's really interesting to hear that you've seen a profound impact on HRV consistently with this.

It's just another tool. It's another differential. And the thing too is when I was doing it, I had what, uh, I remember Dr. Hauser called the MRI. It's my reproducing instrument. So a lot of it is you're challenging ligament laxity by pushing on ligaments. And if there's a pain response, you likely got a loose ligament that correlates well. Digital Motion X-ray, can take these X-rays, and so you're not having to use your MRI. As I said, the traditional MRIs with the scanning isn't going to really show you what you need to see, but digital motion X-ray, if it's in the differential, then that's a good test to prove that you should explore that. Once you see the ligament laxity, because we are talking about injections in the neck, right? And, you know, that's not fun for anyone, scares a lot of people from even trying it. So sometimes you need some type of objective measurement, an examination that, that really says it's a good therapy.

The last thing I wanted to talk to you about that we spoke about before we sat down to record, I guess we're both standing, so it's funny I say sat down anyway, is pH. And you mentioned that you use this to infer things about the patient's physiology and specifically their microbiome. What are your thoughts on urine and salivary pH testing?

Yeah, I related in the book of just background in farming and understanding when we're trying to, you know, microbiome, billions of organisms inside our gut and maybe trillions, who knows. They dictate so many things yet we don't, can't see them very well. Unlike a garden where you walk outside and you could see if there's weeds, you could see if the right thing's growing, you could see the healthy plants and if they were, you could test the soil, you could do so many things like hands-on. And so when we get into pH, I think it's like, you know, the pH of the environment, you know, that mucosa that lines the digestive tract very much dictates what grows on it— good, bad, or ugly. It's an easy test to do to at least have some easy samples. So we'll do saliva testing. Sometimes I even tell them to do some urine testing at home and just watch what their pH of urine— I find the saliva is a little easier to do. A lot of people saturate the pH strips a little too much or try to do it. It's a little bit more labor intensive. So I do a lot of the saliva. Now that can be dictated by things you eat, so you kind of can't have food food or drink it, you know, an hour before. There is different times a day you're limited in doing it, but when you don't see your saliva being alkaline, it's unlikely from that— from, from down into the stomach, small intestine, and large intestine— that they're going to be the proper pH. Our saliva should be alkaline. Our stomach should be extremely acidic.

What's alkaline, right?

So alkaline would be, you know, pH which should be over 7.0, which would be, you know, so pH strips. I don't know how you would want to explain it, uh, opposite of being acidic, right? Which is less than 7.0. You know, these pH strips, people test their pools. You have pools, probably Florida pools. I mean, a lot of people I've never— yeah. So people are familiar, I think, knowing— I mean, biochemistry is a long time for most of us that ever done it, but I mean, people will be testing those type of waters. You can test your saliva. And I think once we know that the saliva is— if it is acidic and it should be alkaline, you can imagine that from that stomach, small intestine, large intestine is probably not the right pH either. I mean, it is an association. That there can be some correlation there. And I think there's just got to be further analysis or trial of things that try to change that. I mean, diet can change the saliva pH, which should change obviously the microbiome pH. But the stomach— remember a presentation I had, people joke around that problems in the South began in the North, and he was always referring to the stomach causing problems in the, in the small intestine.

That is such Southern Joe.

Yes. Yes. But, but I, I thought it was so clever. But yeah, so he, um, he would really focus on getting that pH of your stomach 1 to 2. A lot of people are diagnosed with reflux and that's like a, an over acid production, but it may be low acid and then you become high acid all within the same like half hour, hour timeframe of eating. But if you would have supplemented your food with acid, cause your stomach's not making enough or your pH isn't correct, you wouldn't have reflux. So it's a very much a paradoxical way of thinking. So if that saliva is extremely acidic, one of the first things we're doing is giving things like betaine HCl, which is, you know, a, a good old way of immediately changing that pH to be closer to this natural pH of 1 to 2.

Interesting. So you're saying that when you see an acidic salivary pH, you will recommend, generally speaking, betaine HCl to dropping the stomach acid pH to an appropriate range. You can get relief of symptoms and you can also get normalization of the salivary pH?

Correct. And you start having all these changes in the microbiome. A lot of people get diagnosed with small intestinal bacterial overgrowth, otherwise known as SIBO, and the medications can wipe away the overgrowth, but it likes to come back at least 50% of the time. And mainly the reason why it comes back is a pH issue. I don't feel like I ever hear a, you know, a digestive specialist, usually gastroenterologist, really talking about, okay, we got some things that we can take down this bacterial overgrowth with, but we have to reestablish your pH of your gut. Your gut. Well, they— when they scope you or image you, they can't see it, and they're usually not doing these— any type of stool test that can give them that information. So they're kind of blind on what the pH is, so they don't even like recommend it. But we know that one of the big reasons is that the small bowel is supposed to be alkaline, the large bowel is supposed to be acidic, and if the small bowel becomes acidic like the large bowel, the organisms creep north. So they creep into the small bowel, and that's a big problem. And so wiping them out is a part of the therapy, but you also have to reestablish pH.

So you'll add betaine HCl. What else will you typically add in a given case?

Well, we're gonna do stool testing.

What do you do for stool testing? Do you do PCR for microbes and, and different families of microbes? Do you do elastase? Do you, what are your number one biomarkers?

IgA, inulin. When you're able to see exactly what's living in that micro, you know, microbiome, looking for parasites, looking for yeast, and those are the weeds, right? Going back to that garden example, those are the weeds. And so when you're doing stool testing, you need to know what weeds you have inside your gut because you want to go after those weeds and remove the weeds, change the pH, change the environment. Yeah, throw in probiotics if you, you know, certain lines facilitate the growth. But just because you throw grass seed out in your— or, or some type of plant seed in your garden doesn't mean it germinates.

Absolutely.

Right. So germination is a big part of, you know, something I saw saw when we were farming is germination is not guaranteed. You can't just throw it out there. You got to cultivate the soil. And I don't think there's enough cultivation going on. So you definitely at least got to look at the soil. You got to look at this stool, get some ideas. You got to fix that leaky gut because if you don't fix the leaky gut, that's a ticking time bomb.

Absolutely. It's so fun to talk to you about this because we have a slightly different approach, but it's— there's so much overlap. Lab because it works really well, right? I tend to rely on urinary pH more than salivary pH. It's a general marker of mineral loss and mitochondrial acidosis and also acid-base load in the diet. What I found when I got patients to do a very detailed dietary histories was that there was an overwhelming proportion of them who had low potassium diets under 2,500 milligrams a day or 2.5 grams a day, which is a disaster. You will manifest chronic disease if you do not get more than 2,500 milligrams of potassium a day. It's almost guaranteed. And I will allow exceptions to that. I mean, I'm sure there's people out there doing this and they've got some weird diet that's working for them. I'm glad. I wonder if it'll work forever. But we noticed that they were often doing that because they overrelied on grains because grains are low in potassium as a source of carbohydrate. So we would, we would switch them over to more cooked vegetables and root vegetables. Cooked vegetables are the highest potassium food group by calorie, not by mass, root vegetables are the highest per calorie. Like a potato, large potato's got 1,600 milligrams. You're halfway to your sort of our lower limit. And what I find fascinating about that is the, the pump for the stomach acid is a hydrogen potassium ATPase. And so I thought to myself, do all these people have digestive issues because they don't get enough potassium? And so I started to just lateral everyone over from, okay, you're eating grains and whatever else, you're going to eat more vegetables, cooked vegetables, and and root vegetables worked very well. We added digestive support, like you mentioned, betaine HCl. I don't know if you use ox bile or bile salts. I think bile salts are amazing. They alter pH, they're directly antimicrobial, so they help improve the microbiome. I see so many patients with low vitamin D, with low hormone levels, and particularly things like DHEA. And when, with DHEA, what I find interesting is we'll often supplement people and then some of them won't respond. And I wonder, are they not responding because they're not getting enough fat? They're not getting enough bile acids. They're not absorbing the supplement. Right. So we'll do that. And then the urinary pH, what's so interesting about it is it, it implies they've got a low total body alkaline mineral balance and they need magnesium, potassium, sodium, calcium, and the trace elements in some quantity, which we then supplement across the board. And that alone gets people so much better. We, we tailor it based on their hair, hair and blood testing. We could talk for a long time about what you guys do for, for tailoring those supplements. I found with the stool testing. Testing. If I have a complex GI case, I'll do it. But I found that so many of them would respond to just the dietary recommendations and then a couple of supplements. I would just start there, see if it worked. And then if they wanted to come off those supplements at some point, we could try. And if they didn't, weren't able to come off, we would make some changes or do some testing. The other thing I found fascinating was the number of people who responded to antiparasitics who didn't have parasites in their stool testing. And I don't know if you've ever encountered this?

Yeah, I think it's much more common. I mean, I know that these stool companies love to tell you how good they are about detecting parasites, but I don't think their control is accurate because I think the true control is probing the large bowel. Where I know that there's practitioners out there that they collect their own stool sample in the office and they actually are, are probing the bowel, kind of like giving a colonoscopy, but in a little different way where you're you're pulling those parasites out of the bowel because they're so strongly adhered that they need some help coming out. And a lot of the processes, even though they detect things maybe that are there, I don't think they get to see them because the parasites are holding on for dear life and we're just not seeing enough fragments to pick up. So yeah, I tell people, yeah, at best it's 50%. So a lot of times, yeah, you know, you look for those other markers like good travel history and just try it. Let's see if we feel better. If they got some mustard-colored stool, orange-colored stool, something is a little like that?

That's interesting. I've never heard those as cues for parasitemia. We tend to try tough cases on various antiparasitics, usually pharmaceuticals at this point, but we'll also use herbs. Pun intended, it's sort of always a shot in the dark as to whether or not it's going to work. But we had a, have a very interesting case right now of a young lady with a pretty severe neurological symptoms, and she just talked to Amy the other day, and Amy told me that this is the first day she's reported being symptom-free since she can remember. And it's one of the most exciting frontiers, I think, in my practice, because we attempt to attract a lot of these cases of people with particularly autoimmunity, which then responds to these antiparasitics, which is a whole nother story. So it's very interesting to hear you've had this similar experience.

Yeah, I wish there was better tests. And in general, I don't have any time to plan on probing for specimens in my office, nor would I think patients, uh, they may be walking out of the door if that's a part of the, uh, physical exam appointment. But I think it's just what we just have to realize is that, yeah, if it walks like a duck, quacks like a duck, even though your stool test doesn't show it has parasites, you probably should try it. It's— at the end of the day, a lot of these are benign treatments, so why not?

The other thing that I think is fascinating is if you look at most of these antiparasitics, they have a very broad range of other effects. Like berberine's fascinating, you know, it has all these effects on metabolism in addition to parasites. And I think it's, it's fascinating as a Christian to think about how God set all this up. There's all these, there's so many different connections. It's really amazing. It's part of what makes practice so fun and endlessly fascinating.

Yeah. It's very humbling too.

I absolutely agree. It's very humbling. Uh, yeah. It's been a pleasure having you. We'll have to have you back for more deeper conversations about things like pH and ligamentous disease.

Yeah. Love being here. Love connecting and, uh, wahoo. Wow.

Where can people find out more about you, your practice? What's the name of your practice? Where can they find your book?

Yeah, so they can go to our website, uh, mergemedicalcenter.com. There's a link to our book too, which is also on Amazon. You know, it's Healthy Aging for the Carolinas and Beyond: Treat Your Body as God's Temple. Yeah, I'd love to get the word out. You know, trying to— is a self-help book, so it's trying to just take my 20-plus years of experience in the field and just lay out home to-do items that's not too complex, not too complicated, just so that people start feeling better.

Thank you for joining me. Thanks everyone for tuning in. We'll see you all on the next episode.