Melatonin, Omega-3s & Protein Quality: Your Questions Answered

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 back for another episode of Q&A. Uh, thank you all for your premium subscriptions and patience for your membership at the practice. As always, these questions are general medical questions. They are not intended to diagnose, treat, cure, cure disease or be any substitute for medical care. That means that if you're a patient at the practice and you provide context about your case, or you're asking me directly, unfortunately, because this is a Q&A and not a consultation, I can't give you a direct answer. Okay. Speaking of that, the first question is actually from a premium subscriber or a practice member, uh, Michael, who asks, is there a Google Doc with a link to all the Google Docs for all the Q&As? So the way the Q&As are currently indexed is there's a Google Doc. Every Q&A's got an outline in the Google Doc from a year ago when we started approximately, and you can get an idea of what each episode is about. I'm working on improving this so it's more navigable. What I really want is say a page or a clear link in a table of contents to all the questions I've ever answered about progesterone or everything about melatonin or aluminum or whatever. That is going to take some time, some work, some heavy lifting on the part of my team and I. So just please be patient if you want. Better resources, I encourage you to upgrade to premium or be— become a member of the practice. Also, for many reasons, we are going to be moving the Q&A to behind a paywall. The reason for that is so that I can get into deeper levels of detail for people who are really engaged and know kind of the way that we do things. So I'm going to be announcing what that's going to look like. And I look forward to sharing that with you all.

Soon.

So now that the housekeeping is out of the way, let's jump in. Uh, first question, also from Michael: How should someone approach low-dose melatonin supplementation if they're already sleeping well but are working on mineral balancing? And this is his original question, to give you a little bit more context, was if someone's under 50. So let's unpack that for a moment. How do we approach low-dose melatonin supplementation in general? So as we age, our melatonin production drops. It drops very dramatically until in our later decades of life. Look at the graph, it's pretty dismal in your 40s and even your 30s, but it's really bad in 50s, 60s, 70s, 80s. My approach is whenever someone's sleep starts to deteriorate, we eventually add melatonin at a low dose. What's the optimal dose? No one has really worked this out, but Russell Reiter, the great of melatonin research, if I recall correctly from his book, he settled on about 8 milligrams a night, which he took well into his advanced years. And I believe Russell might still be alive. In fact, I, I believe he is last I checked, and he's gotta be in his 90s now, so he's doing something right. So I like a dose somewhere in the range of 5, 10, 15 as a rule for longevity, anti-aging. Again, we don't have robust evidence for that, but the best evidence we have, I think Russell Reiter has summarized in his book on melatonin, is very strong and very encouraging. I will go to higher doses if I'm trying to optimize someone's sleep or get them to sleep. And that's where our high-dose melatonin protocol comes in, which is available to practice members or to members of the Substack. It's currently behind the paywall. If you'd like us to publish more stuff beyond the paywall, subscribe, purchase our supplements. I'm so grateful for your purchases that allow me to do this kind of education that really allows me to help more people. But the only way that I can do it is if we've got some revenue coming in from the Q&As so that I can keep making them. So hopefully that made sense as to how I approach melatonin supplementation. We use the lowest effective dose to get someone to sleep. That can be half a milligram, 3 milligrams. What I see people doing though is they, they go to those low doses and then they don't know they can go any higher and they think it doesn't work. Trust me, it works. It's about, you know, high, high doses of melatonin are like a wrecking ball in a good way. Maybe the wrong analogy for sleep aid, but here we are. So that's my approach to low-dose melatonin supplementation. And then high-dose melatonin supplementation is more a matter of someone's sleep is destroyed, we have to get it back on track, and we don't have a lot of tools to do that, and we need to do it fast. You mentioned as well, or ask, if they're already sleeping well and are working on mineral balancing. So I don't generally use melatonin in all of my cases unless they come to me and say, well, I want optimization and anti-aging, what else can I do? And then we'll bring in melatonin in that context. Most of my patients are not on melatonin for the record, and there's many reasons for that. But one of the reasons is that there's such a significant burden of supplements with what we do already that I try to keep it simple. So I'm trying to keep my protocols for people between 5 and 10, 10 different things. And some of those are combination supplements like our custom mineral blends or many different ingredients, and they might be 5, 10 capsules or more a day for a patient, but I'm trying to keep them elegant, simple. I think it was Einstein who said, make it as simple as possible and no simpler. Uh, da Vinci said simplicity is the ultimate sophistication. I really try to live that in my practice. I hope that answered your question fully. If not, ask more. Second question inherent to your question: when is melatonin best viewed as an antioxidant versus a sleep hormone? Great question. So I don't tend to use melatonin as an antioxidant, and the reason for that is that I've got vitamin C and it's much easier for me to administer because the powder is very quick, very strong. Vitamin C will also naturally regenerate melatonin. Melatonin will not regenerate vitamin C. So I'll use vitamin C and that's one reason why I love the high-dose vitamin C protocol. You can go check it out. It's behind the paywall at the Substack. We have vitamin C in stock at the store. Check it out. It's one of my favorite supplements. Patients come back raving about it all the time. I've had multiple testimonials about it in the last few weeks. And so my point is I don't really use melatonin as a supplement for antioxidant purposes. I always use it as a sleep hormone. Now I will tell you that the people who need it most also need an antioxidant. And so I'll also use the vitamin C and the melatonin protocol together in those cases. All right. Next question. Also from Michael. What makes a high-quality herb supplier trustworthy? What should people look for? So this is the sort of meta question. The exact question was actually about the company I recommend, which is Mountain Rose Herbs. And hopefully you guys enjoy the context I'm giving here. I'm trying to keep the questions general and broad so that you get the thinking behind it, how I think, not just do this, do that, buy this, buy that, this product, that, that brand, whatever. These things change too. People go out of business, they rebrand. I change suppliers because I find someone better, cheaper, whatever. So what do I like about Mountain Rose Herbs in particular and in general as a, as an indicator of a high-quality brand? Practitioners use them. I cannot tell you how many herbalists I know who their go-to for any sourcing is Mountain Rose Herbs. And if you really want to know what works in anything, ask the people who do it every day and who don't get paid if it doesn't work. So part of why I'm so on fire for what I do, so passionate about what I do, is patients come back and they're so happy, they're so grateful, they're so positive, they're so encouraged by the big shifts they see and how they feel, how they function, their overall well-being, that I think I want to share this with as many people as possible. And they go out and they share it with their friends and their family, and that's why we run a very largely referral-based practice. Okay, so I'm looking for something where the people who are doing it, the people who are kind say the, the, if the saying is the proof of the pudding is in the eating, it's the people who are eating it every day. And herbalists, if their herbs don't work or if their herbs poison people, they're not going to be able to make rent. And believe it or not, they feel strongly about that. So they have a strong incentive for finding good quality product. Having tried their product, I've just always been impressed with, you know, they, they have good customer service. I've always found the products to be really, um, little things matter. They taste good, like their teas, their herbs. They have this wonderful smell. They have this wonderful fragrance, which is what you want. The teas are amazing. And then the people who wield them therapeutically see great results. And I must say, if you're asking me how— why do I think it's great results? I don't use a lot of herbs in the practice. I'll tell you what I do use from Mountain Rose Herbs. I use their, their ingredients to make, or I source ingredients for the detox powder, Dr. Stillman's detox powder from them. And we get testimonials from that all the time. It's one of my favorite things I've ever come up with. So that recipe is behind the paywall right now at Substack. If you want more, go check it out. We'll be publishing that as soon as we can get around to it. Your purchases and subscriptions and memberships to the practice help us make more content for you. Hopefully that made sense. Okay, next question from Michael. When is concentrated iodine preferable to food-based sources like kelp for iodine supplementation? A little bit more context here from the original question. Many people in the HTMA world recommend kelp instead of pure iodine because it affords additional trace minerals. Guess what's in Dr. Stillman's detox powder? Kelp. Why did I put it there? Because I wanted to leverage this effect. Why do I add a concentrated iodine supplement like the one we have in our supplement store and that we created the High Dose Iodine Protocol around? Why did we do that? We did it because you have to eat stupid amounts of kelp, unrealistic amounts of kelp, in order to get to the doses of iodine that we go to in the High Dose Iodine Protocol. Why do we go to the doses of iodine in the iodine protocol that we go to based on David Brownstein's work, along with other doctors who are very iodine literate and interested. They worked out that all comers in America in this day and age, optimal dosing for iodine was between 25 and 50, and that was based on a combination of blood and urine testing. You can read his book on the topic for all the gritty details. But end of the day, what we saw in, or what I saw in my practice, our practice, when I started to use high-dose iodine the way Brownstein was recommending it, which then led me to create the protocol I created. That I've alluded to. What I saw was patients were incredibly happy. Some of them saw incredible improvements in their thyroid function, their thyroid hormone levels. These are anecdotal. Individual experiences definitely vary. Some people also get hyperthyroidism, which can be triggered by taking high-dose iodine, which is why it's important that you understand this is a general Q&A and not medical care, and that you do need to work with a clinician, particularly if you're using, I think, high-dose iodine. And some of them are literate in it, but I digress. That's why I use concentrated iodine as a supplement. Supplement. It gets me results that I haven't seen happen with kelp. I think you'll probably get the same results with kelp over long periods of time, but I like the speed with which we get it with a high-dose iodine protocol. So that's that. Next question, Shelley. What bioidentical hormone options are available commercially without a prescription to a compounding pharmacy? Let's talk about that. So this came up in the practice recently because, and it comes up in the practice actually recurrently, because patients will note that the compounded bioidentical hormones are rather expensive or can be rather expensive. And so they're often curious if there's a cheaper, better a way to get their bioidentical hormones? And the answer is yes. So both estrogen, and I'm gonna be specific here, estradiol and progesterone are available as non-compounded commercially available products. The progesterone product as of this recording is Prometrium, and the estradiol has a wide range of different options. Now, there's many different opinions in the hormone replacement world about what's best and why that I'm not gonna wade into. But I want you to know that many practitioners are very serious about picking a very specific formulation. And so they're generally not friendly to the commercially available products. The other reason that we don't like the commercially available products is there's questions that we have about fillers, excipients, different ingredients that are not the active substance. And some of our patients in particular are very concerned about that. You know, a patient who's very sensitive to medications, fillers, additives, colorings. I was at the store the other day because someone in the house needed some kind of painkiller, aspirin, ibuprofen, and I was just floored at all the weird stuff they put in these pills. It could be 2 or 3 ingredients, you know, some filler and the active ingredient. Instead, it's dyes and preservatives and all sorts of weird things. And I know that they have biological effects. That's marketing for you, because what they're trying to do is leverage color and appearance and make the glaze right and all kinds of weird stuff like that, which actually indirectly sort of hacks into your brain to make you think that it's for you or more effective. If you want me to talk more about that, I can. This actually has to do with how your brain affects the efficacy of the things you take. Ask if you want to learn more. But I digress. Back to the bioidentical hormones. For that reason, I'm not a fan of, of the commercially available stuff or products. I can use them if a patient really feels strongly. Here's the other problem with commercially available pharmaceuticals of all kinds: the retail pharmacies are terrible. They're just awful. Their customer service is so bad. And I don't blame the pharmacists, because to be clear, the pharmacists are doing what they're being forced to do by corporate. And if you ever talk to a pharmacist who works retail, they are being squeezed ruthlessly to fill more and more and more and more prescriptions, and it doesn't sound pleasant. Everyone I know in the pharmacy world has moved out of retail pharmacies into compounding pharmacies because it's the only place where you can have some quality of work environment. So for whatever that's worth. We also saw some very discouraging behavior on the part of retail pharmacies in the last several years where they were refusing to fill meds that were appropriate but that weren't, let's say, endorsed by the official narrative. And I'm just going to leave it at that. You all know what I'm talking about, I think. So I have a strong bias for trying to work with compounding pharmacies only. They are independent business owners. They take better care of their patients. They take better care of their physicians. They're easier to work with. One of the things I impress on people is that the reason we have a membership practice is it allows me to pay for support staff who are there and who are present and who can provide excellent customer service. We have 5 cultural commitments in the practice. One of them is exceptional service. I can't be perfect, but I'm always pushing the team. How can we be faster? How can we be more courteous? How can we take better care of our patients? That's part of our philosophy. Retail pharmacy, the service is terrible. And again, it's not blaming the staff. That's just what's being pushed on them by corporate. So you can get these commercially available. I don't like them. Jessica, what is the role of the appendix in gut and immune health? Great question. I had a friend or colleague who used to say that he thought the appendix was like the microbiome reservoir for if the microbiome got wiped out by some kind of poisoning event or gastroenteritis, because you have to imagine when a gastroenteritis, which means stomach flu in common parlance, happens, you dump all of your microbiome, right? As part of the diarrhea that you have, usually when that happens, how do you get your microbiome back? His proposal was that the appendix acts as sort of a reservoir for that. It must have some kind of complex immunomodulatory effect given where it sits, given what's in it, given how it, how it, how it operates. I recall looking some time ago as to whether or not the appendix actually made a meaningful difference in out— difference in outcomes in, in patients. And I didn't find that anyone had really studied it rigorously over long periods of time. And the way you would study that is you would say, okay, well, here are the people who got their appendixes out and here are people who are just like them who didn't. Do they have a difference in their longevity? And is there any difference like diet, lifestyle, environment, zip code, anything that we can see where, oh, these people over here, you know, had this exposure or this habit. Therefore, that makes them more likely to get, you know, appendicitis and therefore an appendectomy. Anyway, all of that being said, what does it do? It has some immune function. I'm not sure exactly what it is. Second part of Jessica's question, how might someone without an appendix approach gut and immune support differently? I honestly don't approach it differently in these cases, and maybe I should, but it does seem to be that the appendix does not play a critical role in our health and physiology. And I'm open to being corrected on that by future evidence and data. I just haven't seen it yet. It's very plausible to me that these folks may need more or different probiotics, may need more or different prebiotics, but it's too soon to tell, at least from what I recall from the literature I've reviewed on this. Colter, what do headaches during the MSM protocol typically indicate and how can someone adjust? So bigger picture, how do we handle side effects from some of the key protocols we we use at the practice, which are vitamin C, MSM, and iodine. Number one, what's the overall theory here? What you'll see, or what I've seen and observed, is that patients often feel worse when they're on the protocols we use as sort of our— what we call our core protocols in the practice. And these are in addition to mineral balancing or a multivitamin, multi-mineral like we have in the online store, plus vitamin D and plus fish oil and choline citrate and other things, good things like that. Other than that, we use vitamin C, MSM, and iodine, and I use them as separate protocols because I use much higher doses than makes sense to do daily for long periods of time. Frequently, people on the MSM protocol will describe headaches, flu-like symptoms, a general sense of unwellness. They may get abdominal pain and discomfort. There's a long list of other symptoms that I just look at as being what I call detox reactions. And why do I call them detox reactions? Because what you'll often see when people are having these symptoms is that some toxin is present in the blood or the urine or the hair, and it coincides with their body, uh, improving overall function and performance. So let me give you a very clear example. It's very common for people to come in and they've got severe pain, they've got headaches, they got poor sleep, they have low mood, they have poor focus, lack of mental clarity. We'll give them MSM. Some combination of those problems will massively change. Very regularly, patients come to me and say, that MSM protocol was a game changer. And All that being said, why would you get a headache? My theory would be you're detoxing. The other possible option is that you have a sulfur sensitivity, which is a whole nother story. If people wanna learn more about sulfur sensitivity, ask me and I'll answer it in a future Q&A. But headaches during the MSM protocol, either sulfur sensitivity or you're detoxifying your body. Toxins are coming out as they hit the bloodstream. People feel sick and unwell. What we generally do is cut the dose in half or cut it for 3 days total. Depends on the severity and depends on what the patient wants to do because if Frequently, if people power through, they feel better faster, but we would be loath to tell patients to do that and then have them regret how horribly, horribly they felt. So it's a bit of a, we call it a shared decision-making. You might also call it choosing your own adventure. Hopefully that's good context and helpful to people who also have that question. All right, Michael, how does living at high altitude affect mineral and electrolyte needs? So I look at living at high altitude as being a significant stress on the body and the physiology of this for the geeks in the crowd who You know, you know, I love you, is very complex because it has to do with the body shifting acids and bases in order to optimize oxygen delivery through the Bohr effect to cells and tissues. And honestly, I'd have to go back and review West's Physio— Respiratory Physiology to be able to give you like a quick masterclass on that. It does not come up that often in practice. Here is where it does come up. People at higher altitude have higher stress just because they're living there. They are going to need to be more tight, shall we say, with their diet, their lifestyle, their environment, everything they do on a day-to-day basis. And if they're not, they're going to be able to get away with less and less and less, and their illness is going to be more and more severe as a rule. How and what do we do to compensate for this? Well, I'm wary of patients with really serious chronic disease living at high, high altitudes. It's a significant stress on the body, and they may have a better shot at recovery if they're at sea level, or I think 2,000 feet is a good, a good altitude that's not overly stressful for the body, but also still, you know, gives you a really wide range of places you can live. And there's other benefits to living at 2,000 feet that I can talk about if people are curious. So I'm wary of people living at high altitude, particularly like 5,000 feet and up, you know, think Denver and higher than that. Is it a deal breaker? Does it ruin someone's chances of recovery? Absolutely not. Lots of people recover their health and feel great at high altitude. You just have to be aware that it's going to be more of a stress. You're going to be able to get away with less and you might need to add more minerals to your diet in order to compensate, because as a rule, the more stress you're under, the more minerals you need. All right. Next question from Kelly. This question had a lot of detail in order to boil it down to a general question. I had to really reduce it. Just want you to know I'm not dodging Kelly. I just, and we will get back to you. My team will get back to you regarding it. Anyway, question 1, how do bone density findings factor into mineral balancing and our approach at the practice with repair deficit? Okay. So DEXA scans, number one, are fairly unreliable. There's a lot of noise, which means that if I'm going to take one as gospel, I'm going to— and if I'm going to regard a change as significant, I either want to see it as a trend. There's a year-to-year change that's consistent, or it needs to be dramatic. Otherwise, I can't rule out that it's just noise, as in random chance. The operator was different. The patient got in the wrong position. Whatever. So that's my overall approach to looking at how seriously do I take DEXA scans. Now, the worse the DEXA scan is, the more aggressive I'm inclined to be with bioidentical hormones, vitamin D, weightlifting, optimizing diet and lifestyle. The vast majority of people that I see who are drifting into osteoporosis, here's the broad, broad strokes. They're not hormonally optimized. They are not on optimal doses of testosterone, DHEA, estrogen, progesterone, or vitamin D. They are not doing weight-bearing exercise. They are not eating. Often they're not eating enough calories. Believe it or not, you need calories to build bone. Amazing. They're often not eating the right foods. And I get this question a lot. What should I eat? One of the big mistakes I see with osteoporosis is that as people get older, they tend to eat less. That goes back to the low-calorie diet. But the other thing that I see is that they start to leave off the cooked vegetables. They start to leave off legumes like lentils and beans, and they tend to gravitate towards grains and proteins. Now, to be fair, people across all ages tend to do this. Look at the average kid. What do they want to eat? Chicken nuggets and French fries or whatever. This is human nature, let's call it. But this tends to get worse and worse and worse as people get older. What people don't realize is a lack of fresh food, a lack, a lack of cooked from fresh, cooked from scratch food, a lack of diversity in the diet. Then that's not just different food groups, but different foods within food groups. Like for example, if you eat chard and kale and collards and those are your only greens and you're eating them every day, you will inadvertently end up on a very high oxalate diet. Add to that some sweet potatoes and you are gonna have a bad time. So, What does that mean? When I go to the grocery store, when I'm counseling patients, I'm saying, look, don't just eat 3 greens. Go to the grocery store and get different things every week. Get a variety of things every week. And that protects us from a lot of the toxicity that comes in through food and also a lot of the nutritional deficiencies that I see people developing when they don't have enough of the right foods in their diet. So all of those things have to be in alignment. And did I mention they have to have the right minerals supplementally and the right vitamins supplementally in order to optimize bone mineral density? That to me is the game plan for optimizing bone mineral density for as long as possible. Most clinicians don't do that. It's just, here's your osteoporosis drugs, which I have grave concerns about regarding the safety, let alone the efficacy of, which is another story that I'm happy to get into if you're curious. But that's basically everything that I would want a patient to know about the DEXA scan. If it's bad, we get more aggressive with all those things. And until we've got all those things on board, I would frankly expect for the DEXA scan to get worse and worse and worse and worse. Second question, what are the root causes most important to address when someone has multiple issues going on at once? Affecting many different systems. Big question. I always go back to the whole framework that we have, which is really, and I will share with you all something that's new that I've actually just come up with in the last week. I have this new teaching tool that I'm calling the Tree of Life. So this idea is that your health is like a tree and the tree has roots and the tree has branches, leaves, and fruit, and it has a trunk and it has bark and sap flows throughout the tree to help it be healthy. And then there's all, there's hazards and pestilences that come outside from the tree that attack the tree. And so these correspond to basically the 4 things that I use and see in practice. We have the roots. What are the roots? The roots are the things that make us healthy every single day. Eating the right food, having a positive mindset, having healthy relationships, taking 10-minute walks, getting gentle exercise, drinking the right water, all these things. The more you do that, the deeper those roots go and the stronger they are. And these people are resilient, just like a tree that has deep roots. The bark and the sap are diagnostics because what will happen is people's roots will be insufficient or they'll become eaten away by some kind of problem in the ground, or they'll get weak. They'll be poisoned. Let's say the sap is supposed to run through the bark and figure that out and then bring the tree's immune system to that place to fix it in a perfect world where the tree is well nourished. Right. And then the branches and leaves and fruit of the tree are where therapeutics live. So every branch corresponds with a root actually. So for example, you know, light therapy is a therapy, but light is also a fundamental habit that we have to have every day, like bright light outside. By the way, plug for a new thing we're doing. We're having a morning live, not every day, but it's going to be moving towards that over time. And the morning live will be coming out on the podcast periodically. It's probably going to be 10, 15 minutes. It's going to be a combination of current medical literature review, quick case or explanation of a study that's come out that's relevant to you all. And then beyond the study, there's going to be a couple questions that I, I integrate from past Q&As that I think are pertinent to the study or that I see in consultation with patients, or of course that you all submit. That's in the hopes that we get you guys faster answers to your questions faster and give you a bigger library on which to draw. So anyway, back to the tree of life. That's how I now think. And so whenever I see multi-system failure, multisystem impairment, I know that we have to get the roots nice and strong. We have to climb the therapeutic tree fast. We have to get the therapeutics we need in play. And if we don't, I don't expect to see very good results. If we do, I expect good results. And that obviously is caveated with, you have to have realistic expectations. There's only so much that we can do. You know, that's, that's part of life. Joni, what protein sources best support repair while minimizing inflammation? A little bit more context. The way the question was worded was, what are your recommendations for high protein diets that help lower inflammation? So this is a big question and it's very loaded. And I want to, want to start by saying, you know, if you want my diet and dietary recommendations, I think it's a premium post still. It's Dr. Stillman's Million and One Meal Plan. And there's another one that goes with it. That's How to Assess Your Diet in Minutes, which is basically the questions I ask patients in a consult when I'm trying to quickly figure out what do they really eat. So if you want to know my thoughts on that, it's there. I'm also conceptualizing right now. I'm still working on it. Like Dr. Stillman's food pyramid. Stay with me. I know some of you hate the food pyramid, but trust me, this one works. When I've got really sick patients who have a lot of inflammation and a lot of illness, I start with just 3 food groups. I need lean proteins, I need root vegetables, and I need green leafy vegetables. I have to be a little careful there because some of these people will be oxalate sensitive and have oxalate toxicity. You figure that out in consult, you try and get them to eat a diversity to protect them from that. By the way, why lean meats? These people often have poor digestion, poor assimilation, and a high protein need. The leaner meats have far more protein. Let me give you a really concrete number here. So if you look at fatty ribeye, compare it with a lean sirloin, there's almost twice as much protein in the lean sirloin and twice as much fat comparatively in the ribeye. Why does that matter? Because compounded one meal after another, One person could eat hundreds more grams of protein in a week than the other person. So this looks like chicken breast, chicken bone broths, meat broths, lean meats, not fatty meats. It's not that you can't have them, it's that you've got to make it— strike a good balance. And a lot of people who are really sick and have a lot of inflammation will tell you they can't tolerate very fatty foods. Not all of them, just some of them. To give you another, another counterexample, many of them will tell you they feel better on carnivore, certainly not a low, low-fat diet. Benefit. So those are the 3 foods. The second one is root vegetables. I use that for the potassium and the minerals and the phytonutrients that are in it that are very healing. There's often a lot of antioxidants in roots and root vegetables, and they also are a really good source of slow carbs that help people maintain a nice, even, steady blood sugar. And then the green leafy vegetables, which are critical for a combination of sulfur minerals like the alkaline earth minerals and other, you know, family 1 and family 2 of the periodic table. Those vegetables really need to be in place, and I like the fiber benefit. Now amongst that, I've had patients get better on carnivore. I've Patients get better on more of a vegetarian or vegan diet. It runs the gamut. So I don't want you to think that I'm just locked into like, well, all the sick people just eat this. No, that's the base. Why is that the base? Because the sicker the person is, the more likely they are to react negatively and be unable to tolerate the things further up the pyramid. So what's the second level look like? My second level would look like things like dairy. It would look like things like dairy, you know, cheeses, yogurts, kefir, et cetera. Second level up would also be nuts and seeds. And these things often, and also I would put eggs here, these things are very nutrient-dense and they're very healthy. And they're really important in my view for people who have a high metabolic rate and a lot of demand, pregnant women, women who may become pregnant, nursing moms, high-intensity athletes, high performers of all kinds. I don't care if you're a CEO flying a desk 16 hours a day, or if you're a track athlete, or if you're doing manual labor, if you have a big physical demand every day, nuts, seeds, eggs, dairy, they can be huge. For getting you to the caloric load you need to sustain that, and also getting just the micronutrients, everything from calcium down to phosphorus, that you need to maintain that high level of performance. Okay, the top of the pyramid is what I would call extreme foods, and this is a category that has a ton of different, ton of different things in it. It's things like, for example, oysters and other shellfish. Why? Shellfish are, are very, very high in minerals, and that's a good thing if you're trying to nourish someone who's very mineral deficient, which we do see on a regular basis, but they also have these big shifts in ratios that you don't see in other foods. So let me give you a really clear example. If you look at the copper-zinc ratio of say fish and shellfish, and by the way, fish, shellfish, there's like a huge diversity in those, in that, in those foods nutritionally in terms of their micronutrient content. Oysters are nothing like shrimp. They're nothing like cod and they're nothing like salmon. Various similarities, very different foods. That's why people don't think about the food pyramid this way. It's kind of clunky and convoluted and, and nuanced. But I digress. Shellfish have really high concentrations of things like copper, manganese. In people who do not have firm base and resiliency and a good mineral balance, those things can really derail them. And that's why naturally you ask a very sick patient, very elderly, frail patient, would you like to have a dozen oysters? Most of them will say no, I don't think I can handle that. That's their body saying no. Other things in this category category would be many of the organ meats. So the organ meats, depending upon the animal, tend to accumulate certain nutrients which can become present in toxic levels. Great example of this would be— I can't believe I get into like esoteric stuff like this with you all, but I hope you enjoy it— polar bear liver contains such a high concentration of vitamin A that it's actually lethal to humans if they eat any significant quantity of it. When I say that, I mean a small polar bear liver steak contains more vitamin A than an entire bottle of vitamin A you might find at a vitamin store. You know, at a retail store. Just wild amounts of vitamin A. We found this out because Arctic explorers didn't know this. They started to eat polar bear liver, and the first two people who tried it, or groups that tried it, the ones that didn't die of liver failure because of hypervitaminosis A, their skin peeled off starting at their lips and at the palms of their hands and feet and ascending, or moving out from those areas across their skin, because that's what vitamin A does. It helps the epidermis to differentiate, and the extreme of that is it looks like it just peels off. Off. I don't know if any of you enjoy that anecdote. I think it's fascinating, weird stuff, and I enjoy it. That's why I share it with you. I guess if you want more, ask for it. If you don't, let me know. We can cut the weird esoteric stuff. I think it's fascinating. So anyway, not that any of you are eating polar bear liver or should try— obviously I think I've just explained you shouldn't— but beef liver, tons of vitamin A. And not just beef liver, but all of the animals that chew the cud and eat grass, because there's lots of copper in grass and they're bioaccumulating it in their So people don't realize this, but beef liver can cause these massive swings in copper levels and vitamin A levels. And that's not something that someone who's sick and frail can accommodate. And what you'll find is you'll, you'll find that these people wind up in very high copper levels, very low zinc levels. They'll be in these extremes of physiology where nutrients have been very imbalanced for long periods of time. And it's created this picture of dysfunction that when you start to actually diagnose it and then tease it out and figure out, okay, well, you know, what are we going to do? How do we fix this imbalance? Well, we got to restrict this and we got to emphasize that. We got to add this supplement. No, this vitamin plays a role. So that might have been more than you wanted, but you got me really going. That's a great question. Did— I hope I did answer that question, because the short answer, the short version was lean meats. Lean meats are my favorite for supporting repair while minimizing inflammation. And I'm not talking about lean meats like organ meats or shellfish. Talking about maybe fish, chicken, poultry, turkey, beef, maybe pork. More on that if you want it. Happy to answer questions about pork, beef, etc. Question 2: How important is the omega-3:6 ratio? How should people think about it practically? So I think it is very important. That's why I still take fish oil to this day. I take 2 to 3 grams a day of fish oil. We have some in the, on our online store. We appreciate your purchases, by the way. One of the reasons I'm a big enthusiast of omega-3 supplementation is the cognitive enhancement that we see in studies of people who take fish oil and omega-3s in particular. I want my brain to work optimally for as long as possible. Pretty much everyone I've seen in the dementia space who has any real clinical chops and experience is using omega-3s in their practice. So how do we get to a healthy omega-6 or 3:6 ratio? Formerly, it seems to have been 1:1 in our diets a long time ago. Now it's more like 1:20. We need to shoot for ideally 1:4. This is one reason why we'll test the OmegaQuant in the practice. I can talk more about testing omega-3s and 6s if people want, but in the interest of time and brevity, I'm just going to stick to what's the optimal ratio. I shoot for 1:4 omega-3s to omega-6s based on that test. I strongly I encourage people to look at their diet in an app like Cronometer. Why? Because what you will find is that you can predict your fatty acid levels in your blood pretty reliably from Cronometer. You'll also find that there's a fair amount of variability. So I was looking at some the other day for a gentleman who'd had it done at multiple labs over multiple months, and there was a swing of 0.5 or more percentage points in his omega-3 level, which can have huge impacts on your omega-3:6 ratio. So don't think that the lab testing is the be-all end-all. My goal in a diet is 2 to 3 grams of omega-3s every day. That's from a combination of all sources. This is the other reason why I don't just blanket say everyone needs fish oil. You will actually find some people tend to oversupplement on fish oil. The sweet spot is if you get 2 to 3 grams of omega-3s a day, predominantly from fish, you will tend to have an optimal omega-3 to omega-6 ratio. Now, I can't exclude that somebody is eating popcorn and deep-fried whatever, because that will radically alter this ratio. That's where the omega-6s come in. And we'll often find— I mean, I almost always find that somebody who's got a high omega-6 level, you know, do you eat a lot of peanuts? What nuts and seeds do you eat? You know, do you, do you eat out a lot? There's restaurant oils that are high in omega-6s. Their favorite snack is, you know, and there's nothing wrong with these foods for the record, pistachios, cashews, you know, almonds, and they're eating a lot of them. So nothing wrong with these things. But coming back to the food pyramid analogy, they belong in the middle. That means you can't make them your base. And that means you gotta have some moderation there. So more on that. If people want it, ask the way, ask away for future Q&As. That's all I've got for today. Thank you as always for your questions. Take care, everyone. Have a great day. Be well.