Integrative Medicine with Dr. Leland Stillman - Special Q&A Episode

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 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 here. Today I'm excited for another Q&A and I have an important announcement to make. So for a long time now, my premium subscribers on Substack have supported my work and fueled my writing habit, and I always love to thank them for their support. It's what has allowed me to do fun projects like this that help, or that I will say allow me to help more people than I can just by seeing patients one-on-one day after day. I've decided that we're going to ungate all the content on Substack. In other words, all of it will be free because we've now got an online supplement store. It's not quite live yet, at least as of this recording. It may be live by the time this post comes out, but I want you all to know that I really appreciate your supplement purchases because they allow allow me to make more content and write more. I think, or I hope all of you understand that one of the challenges we face as practitioners is that those of us who really care deeply about patients want to practice with integrity, which means that we want to offer really high quality supplements and a really high quality experience. What I have found is that we're essentially fighting for the truth in a world full of people who are being dishonest. And some of them are well-intentioned, and they're not necessarily lying intentionally, they're just confused. And so I do everything that I can to source the highest quality supplements and also share with you what's really going on and what I actually see in my clinical practice, which is very different from what I see out there in the health and wellness info space, which is just full, full, full of noise and confusion. So for a long time the premium Substack existed because I needed to make some kind of income off of it in order to sustain my writing habit. Thankfully, now we have supplements and I really hope you guys will source your supplements from us because the more you buy, the more content I will be able to make. And then the more you will be able to really see what's going on and get the truth rather than what I see out there, which is just so much noise, so much confusion. So thank you all. For your support. I really appreciate every single one of you. Also, premium subscribers, you'll still have the opportunity to share or ask me your questions. There will now, though, be a link that goes out to the entire Substack list so anyone can ask a question. However, I will not be answering all the questions I receive. I will be answering a select few from free subscribers. So premium subscribers and medical practice members will always get their questions answered., and people who are free subscribers will get their questions answered if I like, or I'm curious about the question and I have time. So without further ado, let's jump into today's Q&A. So Janice asks, do you find value in testing an ApoB, uh, for— sorry, test in addition to regular cholesterol screening for cardiovascular risk assessment? So I don't run this test, Janice, because I really haven't done a lot of advanced training in lipidology. And I'll tell you why. When I've looked at some of the outcomes in, in the literature with things like ApoB or some of the lipoproteins, like lipoprotein little a, it seems to me that there's, there's relatively little difference in relative risk for these patients. And when I've sent these patients to colleagues who are cardiologists, they've usually recommended pretty bread and butter supplements that we could either try without the advanced testing, um, or not necessarily conferring to them a significant benefit. So I've always looked at this as sort of, how valuable is this test? How much does this really help us? How does it change what we're going to do? I haven't really seen compelling case made that it should radically change our approach to, to healing these patients. Second question from Janice: Are there any health ramifications for forgetting to take a nightly hormone supplement such as progesterone once or twice a week? Uh, from my perspective, no. Uh, let's talk about the like health ramifications of hormones in general. So there is the argument that this will reduce your body's endogenous intrinsic, that is production of these hormones. And so you may become dependent upon them. I don't see that at low doses. I see that at high doses for long periods of time. And so I'm not worried about that. Some people will say, oh, well, I came off of this or that supplement or that hormone and I saw this huge withdrawal. In most of those cases, we can't say that it was the hormone causing them to withdraw and they're, because it suppressed their endogenous production. What we, what may have happened is their endogenous production waned as they got older anyway. And what they're really seeing is here's what it is like to go from high to low fast because you take away a supplement. I'm a firm believer in bioidentical hormones for health, longevity, vitality. I've seen them confer transformational results to patients. I'm currently using DHEA myself. This is Quicksilver's Nano DHEA. Love it. I really am enjoying it. And I gotta tell you, as a father of an almost 8-month-old who doesn't sleep through the night and wakes up multiple times a night and is pretty fussy sometimes, it's a game changer. I am really, really happy that I started DHEA and, you know, Exactly what hormones you should be on, you've got to work out with a qualified practitioner. We obviously do that at the practice, but I'm a big believer in these hormones as longevity anti-aging treatments. Okay, third question from Janice: I made a detox powder blend using equal amounts of various herbs. This is Dr. Stillman's detox powder, but excluded horsetail. Can you explain how herbal detox formulas work to support the body's detox processes? Great question. So first of all, there's the nutrients in these powders, and there's, there's a— I have this belief that nutrients in real food are different than nutrients in a supplement. I've heard this from mentors anecdotally, and I must admit that I feel different when I change, say, when I get— let's just put it this way— I feel different when I take supplements compared to when I eat certain foods that are rich in the same nutrients. Now, I don't know what that's really about. I think a lot of that is sort of unquantifiable, or maybe, you know, it defies our quantification. Maybe it's on this quantum level and we'll figure it out one day. I don't really worry about that. The bottom line here is how do herbal detox formulas work, a lot of it is the nutrition that they bring in, in my view. And that's how I built Dr. Stillman's Detox Powder, which, if you don't have it, it's over on the Substack. It's gated right now, or it's behind the paywall. We're going to be releasing it here in the next several months. It's going to take us a little while to get our premium content out beyond the paywall. So there's the nutrition piece of it. Then there's the fact that they have fiber in them, and fiber binds toxins and helps to excrete them from the body. It also helps to fuel an optimal microbiome. That optimal microbiome then helps the body to detoxify. Lots of research out there on how important the microbiome is for detoxifying the body of chemicals and such. So that's just a couple of ways. There's probably more. I don't have them off the top of my head. I just know that I love herbal detoxification formulas, specifically Dr. Stillman's Detox Powder. That's why we give it to pretty much every patient of the practice, and we, we hear pretty remarkable testimonials from people who are on a regular basis about the results they see with it. Trevor asks, do you have any suggestions for managing vertigo? So vertigo is, is tough because vertigo is so, we call it multifactorial. It has so many contributing factors and sometimes, in fact, most of the time it's transient. It's going to be what we call self-limited. It'll stop on its own. The body will resolve it in and of itself. What I always look for in vertigo cases is what's the big picture? What are this person's overall health concerns and issues? In general, my experience has been when vertigo is, say, very, very severe, it may have a specific cause that we can come up with a treatment for something like BPPV, benign positional paroxysmal vertigo. Say that 10 times fast. Sometimes it's very, very mild and intermittent, like I think you're describing. If that's the case, usually what I look for is for it to resolve as we address underlying causes of illness, like metabolic imbalances, nutritional deficiencies. Toxic exposures, things like that. And I, I can't make any guarantees about that for the record. And we don't get a ton of vertigo in the practice. In people who I think have an acute issue, like what we would call labyrinthitis, I will use high doses of vitamin C. And that I have found gives people a lot of relief from those transient supposed viral illnesses. PJ asks, if someone tests positive for the APOE gene variant associated with increased Alzheimer's risk, what preventative measures would you recommend? Would that differ if they were older and showing mild symptoms? So this is a great question. I would start with all the things we start with in the practice. So the thing I start everyone with is the 14-Day Reset, which you can look up on Substack. There's one thing I would add to that and be very, very serious about, which is silica-rich mineral water, which helps to get rid of aluminum from the brain. Very compelling evidence that Alzheimer's is due to the accumulation of aluminum in the brain. I don't think it's as simple as just that one cause because there's so many other metals, there's so many other toxins, there's so much more that goes into that. So when we get patients in the practice who've got a memory issue, we go after it with, you know, vitamins, minerals, hormones, detoxification regimens, you name it. And we've had some pretty compelling results. Uh, and that would be that. B asks, should someone in their early 70s be concerned about a coronary calcium score of 300? Are there ways to address this naturally? The person is healthy, takes no medications, but their doctor is recommending statins. All cholesterol levels are normal except LDL is slightly over. I think you mean total cholesterol slightly over 200. LDL is usually around 100, so for it to be 200 is quite a lot. So, uh, I don't usually worry too much about coronary artery calcium scores, and the reason why is there's not much for me to do about them. In my view, everything I'm doing in my recommendations is intended to resolve a patient's risk factors for coronary artery calcification. So why do the arteries become calcified? It's all about imbalances in minerals and vitamins and hormones and excess inflammation. And so what we generally see in the practice, and I'm trying to gather this data and actually get a clear number, what we generally see in the practice is people who come in and take our recommendations and do the things we recommend drop their high-sensitivity CRP rather quickly, as one example of reductions in inflammation we see in the practice. And so when I look at coronary artery calcium scores, I think, well, this is now— this is in the coronary artery wall. What am I going to do about it? It doesn't necessarily change what I was going to do anyway. So obviously I can't give any specific medical advice through podcast, But this is my approach that I take to it clinically. I recommend you work any of these issues out that we're talking about today with a practitioner. And a big piece I hope I've conveyed is that all of this requires a consideration of the individual's context. I generally just can't, you know, there's too many caveats. There's too many exceptions to rules for me to say everyone do this or everyone do that, or here's my protocol for vertigo, right? Shelley asks, do ionic foot detox baths have any proven therapeutic benefits? So I've never seen any rigorous proof of this. I've had mentors who I respected swear by them. I have no idea. I've never actually even tried one, and whether or not they work, I don't know. I hope someone does some rigorous study of it at some point, and maybe they already have and I just don't know about it. Susan asks, a healthcare practitioner mentions that well water with positively charged minerals may not be ideal and prefers reverse osmosis water. Should people avoid well water even if tested for contaminants? What about spring water in plastic bottles? Great question. So I addressed this in my post, What's the Best Water, recently published on Substack. And here's the bottom line: if people have too many minerals in their body, which can happen, and it also has to do with minerals and metals, and you load more minerals in through well water, they can feel worse. And those people may actually feel better if we give them reverse osmosis water, which will give them some relief from this congestion overload of minerals. What's more common is that people have the wrong minerals and they have heavy metals and they actually need the minerals in well water. And this is really about balancing, do we have too much water or do we have too much mineral density in the body and what do we need to increase or decrease in order to get results? Very nuanced. Very much individualized to the patient, has to be monitored over time because it will change. So do I tell people to avoid well water? I don't necessarily, so long as it's a high quality well and I do like to see it tested for contaminants. I really only trust deep wells for that reason. Spring water in plastic bottles. Great question. So my main concern with— obviously I don't like plastic. I still drink a certain amount of water out of plastic bottles just because of things like travel. And we don't have large glass bottled water delivery here in Florida. So sometimes we've got big plastic bottles instead. Here's the thing about reverse osmosis water that people— that I'm concerned about. Most of America's water, as far as I can tell, is coming from large water towers. And those water towers are now topped with cell arrays that are just constantly microwaving that water. And if you look at what happens to plants when you water them with microwaved water versus spring water or well water, it's shocking. So, you know, should you drink water that's been microwaved but is reverse osmosis filtered? Should you drink water that's been marinated in plastic? Should you drink— I don't know, this is very hard. And I'll be honest with you, there's not a perfect solution for many of you. Here's what I know. Our patients do really well and they drink a really wide range of different waters. We've got patients on well water, we've got patients on plastic bottled water, we've got patients on only glass bottled water. Pick a solution that's accessible to you and is better than tap water, which is basically poison, and stick with it. There it is. David asks, a researcher suggests that consuming more than 20% of calories from fat Could cause insulin resistance and cardiovascular issues, which seems contrary to ketogenic diet benefits. How do individual responses to high-fat diets vary? They vary just so much as to defy description. So people are always going around and around in this argument of, well, this many calories from this and that and the other thing, and it's very hard to study in an actually quite rigorous way. I have a real respect for individual genetics and, and environmental factors affecting how we each metabolize things. And truthfully, I just try to feed my patients in a way where they feel well and they have low inflammatory markers and their nutritional markers look good. And that's what we do. A lot of them, if not the vast majority of them, are on more than 20% of calories from fat. But it does depend on the person. I don't see a correlation between fat intake in the practice and actual insulin resistance. For whatever that's worth. David, hello David. What considerations should patients have when combining MSM with NBMI, given that both are sulfur-based compounds? So I'm not familiar with any considerations or caveats to combining NBMI, also known as OSR, also known as Amaromide. I don't know of any, of any caveats. MSM generally helps things get into the body better, so I would suspect that it will help the NBMI get throughout the body. Whether that's necessary or good is a matter of speculation. I'm tempted to stack them myself, but I haven't done it yet. That's that. Kenna asks, during healing protocols, why might someone experience illness symptoms after a year, and is this actually beneficial to the healing process? So I think Ken is alluding to something I've said recently, which is that as people go through the process of healing, and I want to be really clear about something here. Most people who embark with us in the practice really only do what I would call 25 to 50% of the work to get to really excellent health. And they, so to speak, fall off the wagon because they're busy being well. 95% of patients who come to see us say they're 50% better within their membership or their program. What that means is that they are back in action and a lot of them have complete symptom resolution of the symptoms that they came to us for. Not all, by no means is that a guarantee. It's just a trend. And so what I've observed is that they don't have complete health. They still have some issues, but they're well enough that they can function. And for some reason, they're not motivated enough by their illness to actually completely resolve it. And I get that. You got to work, you got bills to pay, you've got family to take care of. I understand all that. But what's interesting about it is the people who undertake what I might call the deep healing, where they're on, say, mineral balancing protocols for 6, 9, 12, 24 months— I have very few of those patients— if they do that, they'll often have these healing crises that emerge at 6 months, 9 months, 12 months, somewhere in the longer range. Generally speaking, what you see in their hair testing is what we call retracing, which is their hair testing is arguably getting worse, but they're getting better and they're feeling what we call detoxification symptoms, which is sort of a catch-all for the body is healing and it's kicking out bad things and it's changing how it is. And it sounds very kind of hand-wavy and wishy-washy. And I— but the truth is I can't quantify this better than I have. Because patients are living, breathing, walking, talking, you know, they have their lives. I can't study them like microbes in a microscope. And so what you will see is they will have these, these— we call them healing crises. And if we withdraw some of the supplements that are causing them to go into this healing crisis and we give them things like high-dose vitamin C and other therapeutics we use in the practice, they'll get through them faster. And then on the other side of that illness, they'll feel better. And sometimes it's as simple as like a cold or flu-like illness. Sometimes it's weeks of feeling not so well, people would do things like coffee enemas, or they'll add sunflower lecithin or trimethylglycine or all kinds of other things that we can add. In any event, I see this as part of the healing process. And when it happens, I get excited because I know on the other side of it, something better is coming. There are times when I think maybe what we're doing is counterproductive and that we actually need to change our approach. I've found this to be the case with people who, for example, they had oxalate sensitivity and we didn't realize it and they took glycine and that was causing them to have this toxic effect from the glycine causing oxalate overload. Then we, you know, realize that, get rid of the glycine, they get better, treat the reasons for the oxalate intolerance, et cetera. Hopefully that's a clear answer or picture, Kenna, but basically the body is detoxifying itself and healing itself. And so they may feel ill as the body goes through this sort of acute or subacute process. Of healing. This is purely anecdotal. And like I said, it's very hard for us to document or study this. It's really just empirical. Shannon asks, what type of magnesium and other supplements do you recommend for migraines? Great question. So a lot of people will say, well, magnesium threonate is the one. A lot of people find great value in Mag 3 and 8. Here's the thing, magnesium glycinate has many benefits in addition to MAG 3 and 8 because of the, how the glycine affects the brain. Glycine is one of my favorite supplements. It has so many therapeutic effects. It also has this, you know, other side where if you give it to someone with oxalate insensitivity or oxalate problems, you may make those problems worse because it metabolizes into oxalates. In any event, I still run to Mag Glycinate for any kind of pain because it's so effective. You can also use topical magnesium on these folks. And if you stack topical magnesium with something like MSM, you'll get better penetration. Fun fact. I will usually go after this. Let's try Mag Glycinate unless there's an oxalate issue, then let's try Mag Threonate. I really like the Mag Threonate from Quicksilver because Chris made it with phospholipids that also have some really healing properties for the brain. And what other supplements do I use for migraines? It runs the gamut. It, I mean, I use vitamin C, the choline citrate I recommend is very powerful. Ginseng is good for this. I mean, almost every supplement I use can be very effective for migraines. It just depends on the person and why they have migraines. And then beyond the nutrients and supplements, there's some other advanced stuff that we share with patients that I just can't get into here. B asks, is sublingual B12, uh, more effective than oral capsules? I believe so, because of how B12 is metabolized in the digestive tract. Susan asks, is it safe to take iodine and digestive enzymes while following a chlorine dioxide protocol? Yes, it is. Kelly asks, what type of light bulbs do you recommend for home use to support health and circadian rhythms? So I use warm incandescent bulbs because I bought them before the ban went into effect. I I now recommend low blue light LEDs, which are widely available on Amazon. I have a whole post on this called Optimize Your Lighting Environment over on Substack, stone md.substack.com. Just put in Optimize Your Lighting Environment. It will come up. So I love, I love fixing people's lighting environments. It has a huge impact on their health and wellbeing. If you've still got some old-fashioned incandescents, for the record, the color temperature I generally shoot for is in the low 2000s. And color temperature, for those of you who are not lighting geeks like me, has to do with the warmth of the light that you're seeing. So very bright white light is a higher color temperature. So think fluorescent bulb, 5000 Kelvin. Candlelight, more like 2000 Kelvin. I like the 2000 Kelvin temperature. Kelly asks, how accurate is HTMA and what preparation is needed beforehand, such as hair care products? Okay. So it's very accurate, 15 to 10% error, which is lower than other lab tests we run. And the best thing is there's not a lot of week to week or month to month variability. Why? Because you're getting a big sample. So you take a 2, 3-inch hair sample, you know, 2, 3 months potentially of data, right? And what I love about this is that I see everything going on in the person's metabolism. Now you make a great point, which is what about hair care products? I had a very weird test come back recently that I was very suspicious of.. And I asked the patient, he said, you know what, I don't think I washed my hair because he had very short hair for a couple days before I collected that sample. Sure enough, we repeated a sample and his numbers were completely different. Now what's interesting about that is that we actually saw more toxic metals in the hair and less nutritive metals. Very interesting. So you've got to have a skilled practitioner. It's not just as simple as send in your hair, get a protocol back. People who do that get uniformly underwhelming results. What do I recommend to my patients? So number one, the biggest thing you've got to watch out for is actually water softeners. If you have a water softener, it can radically alter your sodium and potassium ratio and completely derail the process of hair tissue mineral analysis and mineral balancing. So what I would recommend is that people who've got a water softener wash their hair— and I know this sounds like a lot of work— in distilled water for at least 3 days before they cut their hair for the test. Sorry. That's just how it is. I have had patients with water softeners not do that. And we realized it after the fact because it didn't really derange their ratios and we treated them and they got better and they felt well for whatever that's worth. Hair care products. It is best to wash your hair with a very simple detergent. I use pure Castile soap. Some of you need special hair care products. If that's you, what I would do is for 3 days before the sample, don't use those hair care products. Don't get your hair cut. Colored or highlighted for a week or two before the test. And even if you do, trust me, a good practitioner can read through these abnormalities. And actually, it's one of the best ways to find out if one of your products is contaminated. We had a patient with a hair lead level that was— I didn't think it was compatible with life. It wasn't just a high lead level. It was the highest level in the practice. And it wasn't just the highest level. By a small margin. It was the highest level by a country mile. It was something like 82. Highest I can remember measuring any time in the practice is around 1, and I struggle to come up with a test like that. Usually it's from— I mean, a bad level would be 0.5 to 0.9 or 1. So anyway, we've caught a number of bad products that way. And I got to tell you, the people eating consuming food out of aluminum cans, aluminum, uh, snack packs, they're just playing with fire because a lot of those products wind up contaminated with aluminum. And aluminum is a toxin no matter what the idiots in charge tell you. It is a poison and you must avoid it for optimal health and well-being. Anyway, all right. Jean asks, for high-dose supplementation protocols, what is the therapeutic window and how can one determine if dosing is excessive? I love this question. I love talking about the therapeutic window, but we have to talk about the therapeutic window so that you all understand what it is because it's kind of a niche term. So the therapeutic window is the window within which a supplement will give a patient results. So on the low end, you've got, okay, I just took X dose and now I finally feel something. And then on the high end, you've got the dose where you're no longer getting improvements or benefits, you're getting problems, side effects, adverse effects, right? So I'll use vitamin C as an example because we use a ton of it in the practice. If you start taking vitamin C and you taper up and you take very little, you will not see much of an effect at all, which is part of why I'm not a fan of using vitamin C supplementation without understanding someone's unique biochemistry, without them doing our, our protocol for it. As they get up to a, a high enough dose, they, they generally see mild improvements in their wellbeing, their energy, all kinds of other things. As they increase the dose, they will gradually get stomach gurgling, rumbling, and then eventually a loose stool. So the therapeutic window is the window where I feel better on the vitamin C that I'm taking. And now way up here at the top, I'm now having loose stools and I can't take anymore. So that's the therapeutic window. And how do we establish that? It really has to be determined in conjunction. I mean, how do you determine it? You, you've gotta decide what you're treating. And this gets into just the philosophy to me of therapeutics, which is, and, and this is my philosophy, you're either treating signs and symptoms of disease or you're treating numbers. So a sign or a symptom of disease is I have a headache and when I take more and more and more magnesium, the pain gets better. That would be treating a symptom of disease. You could also say I have a low vitamin D level, and I'm going to say that that's a sign of illness or poor health. I'm going to take vitamin D until I've optimized that level. There you're treating a number. So you got to pick your therapeutic goal, and only then can you define the therapeutic window. As far as determining if dosing is excessive beyond that, there's other caveats. Like, for example, you're using glycine to manage headaches and lack of focus. And it's going really well. All of a sudden you have crippling flank pain. Turns out you've got kidney stones that are oxalates. The oxalates you didn't realize were a problem. Now you've got kidney stones because you just didn't think of that. Part of why I like to consult with people before I make recommendations. Anyway, Jean asks, for patients who seem to need binding agents during detox protocols, are there specific genetic variants, SNPs, that predict this need? Do binders also support lymphatic system function? So the answer to the first question is Not that I'm aware of, but it wouldn't surprise me if they were. It's not something I'm deeply studied on. Do binders support lymphatic system function? I suppose you could say that they do, but I don't see how they directly would because the lymphatics are distinct from, you know, the gut where the binders are supposed to be. So that's all the questions we have for today. Again, thank you all for your, uh, your questions. Thank you for your premium subscriptions to the Substack. Thank you for your memberships at The Practice. We look forward to answering more free subscriber questions through Substack now that the Substack is going to be completely free. And I thank all of you for your supplement purchases in the future. Once our supplement store is online, they mean a lot to me. They help fuel my writing habit, which helps me help more people. So that means a lot. Thank you everyone for watching. Thank you for your questions. Take care. Have a great day.