Nicotine Patches, Hormones & Heavy Metal Detox: 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 here, excited to be back in the new year with a Q&A. I'm a little under the weather, so if I cough, sneeze, etc., that's why. Hopefully we'll get that in post-production and editing, but I just want to let you all know that. We've got great questions today, I'm excited to dive into them. As always, this is for general education, it's not medical advice. I'm not practicing medicine via Q&A. That's why the questions you submit are reformatted as general questions. You can ask questions by upgrading to become a premium subscriber at Substack today or by joining the medical practice. Those questions get priority. I take public questions from non-paying subscribers or patients as I have time. So without further ado, let's get into it. So question 1: Noel, what are your thoughts on low-dose nicotine patches for post-viral symptoms? I think they're very reasonable to use. I've opined on nicotine in past Q&As, so I won't repeat any of my precautions cautions here, except to briefly state that you just have to be aware that it's a, it's an addictive substance and you've got to be prepared to manage that. So using it as a tire patch, or as I call it, a bridge to a better place, is fine. So long as you're fixing the underlying physiology that's responsible for the post-viral symptoms, which in my view are a combination of nutritional deficiencies and metabolic imbalances. That's one of the root causes of disease in my view. Toxins, another of the root causes of disease, and then infectious agents, parasites, fungi, molds, stuff like that, things that invade the body. Those are my 3 big root causes of disease that I think through when I'm thinking of what's causing an illness, right? And that's what we walk patients through in the practice, through the lens of what we call repair deficit or lack of repair relative to what your body actually needed. When people say post-viral, I think, okay, this means the body didn't have what it needed to cope with an acute stress, whether that's a toxic exposure or the gradual accumulation of long-term damage. And what's happening is because the body doesn't have what it needs to repair and heal, it's having these lingering symptoms. So We nourish, we detoxify, and we purify the body of any potential things, what I call uninvited guests, that we need to get rid of. Hopefully that makes sense and it's helpful. So Shannon asks, for someone on hormone replacement therapy, what factors determine whether 25 milligrams or 50 milligrams of 7-keto-DHEA would be more appropriate to add to their protocol? This is a really interesting question. So in general, let me give you all a little context for those of you who don't know what this is. 7-keto-DHEA is a hormone that is similar to DHEA, but it is got this 7-keto group on it that means it won't metabolize into anything else. I've heard from other people in the anti-aging world, other doctors, that we shouldn't use this because it doesn't work because it's not the real thing. I would beg to differ based on the experience of a patient of mine who tapered up to something like 200 milligrams of this a day and was floored by how powerful it was for helping her cope with her illness. Now, to be candid, she had many different medical problems and one of Those problems was cancer. She's got very abnormal physiology. I want to share that with you though, because you'll get people, patients, and cases at the extremes of physiology where you will break rules and you will get great results. She broke rules. I don't usually dose anyone on more than 50 milligrams a day. She went to 200 and she got a big win, huge improvement. I obviously don't recommend that to anyone as medical advice. That's why this is a Q&A and general medical questions, but I think it's important to note there. And I remember always when I'm treating patients with hormones, I'm not treating numbers, I'm treating patients. Now, where the numbers are important is that we have an abundance of, of evidence that when you exceed certain numbers on lab tests, you can create real problems and diseases and it, and so on and so forth, right? So we also have a lack of evidence of safety. What I mean by that is no one on planet Earth knows what happens when you give people 200mg or any, in some cases, any milligrams of DHEA for long periods of time. We have basic understanding and experience with these products for many, many years, through which we infer that they are safe. But when you get to really high doses, you know, maybe you're playing with fire. Maybe there's problems that we'll find out years down the line. I'm not really that worried about that, otherwise I wouldn't use these hormones in practice. But I just frame it that way because I want you all to understand that context through which I view it as a doctor. Short version: how would I determine whether I'm using the right dose of, of DHEA in a patient? Are they responding to the therapy? Are they feeling better? And then for women, I target a level of about 250 in the blood. I can't remember the units. It's the basic LabCorp units. That's what we use in the practice. In men, I'm shooting for about 500, and I'll go outside of those ranges if there's an extreme case. We also do a 24-hour urinary hormone test in women to test their DHEA levels around the clock rather than just a spot level in the, in the blood. I won't go into all that here. If you want more details on that, you can ask the question if you want. But that's basically how I think about dosing. I want people to feel much better on DHEA. So whether it's 7-Keto or just DHEA, I want them to have more energy, drive, better sleep, better mood. I may not get all of that, but I'm looking for something. Okay. They may also report better libido. Most people report that their hair, skin, and nails are better, stronger, more youthful. Not a guarantee, just the individual experience of many patients of mine. That's how I use DHEA. That's going to be coming to the online supplement store soon because it is one of my absolute favorite supplements in the whole wide world. All right. Andy, what is the current evidence on blood filtration treatments such as in-use pheresis for reducing total body toxic burden. Do these treatments meaningfully reduce toxin levels? So I'm very excited by this. The evidence is accumulating. It's early, but I'm really excited about this. I think it's going to be an absolute game changer, and I do think the treatments are going to meaningfully reduce toxin levels. I will tell you that as someone who's a great student of human behavior, that when I think about what things cost, I actually always go back to— and here's why I'm mentioning that— I've had patients quoted $20,000, $30,000 for these treatments, and it's all well and good for people to spend money on their healthcare. If I were really sick and I thought this was a, you know, one of the options for me, you know, and I had the money, I would absolutely go out and do it. I'm not saying you shouldn't, but what I find is that when you get to these really expensive, intensive, and also invasive treatments, I actually go back to Alex Hormozy's value equation because he points out that people are going to charge more for things where there's less time and effort, there's a greater guarantee of a result,, and they're likely to get their dream outcome. I can't remember exactly the equation, but I, why am I sharing that with you? I share it with you because people are going to advertise this to you. They're going to recommend it to you. They're going to talk about it on social media and they're going to do that because they get paid to, and there's nothing wrong with that. However, overwhelmingly what I see happening is people underestimate the effects or the power of executing the fundamentals religiously and intensely. Every single day. So when we go back and we zoom out, what is, what is this blood filtration treatment going to do? It's going to get rid of toxins. Well, how do we do that? I packed a lot into the 14-Day Reset, which is the first thing I share with patients at the practice. You can look it up on Substack right now and go do it. I have this thing coming out called the 14-Day Detox, not ready with that yet, it's coming. And I, I pack all my best information into those two things. And when I think about all the things that move the needle for people, it's sauna, it's daily walks outside, it's X39 patches, it's proper nutrition it's getting their diet dialed in, all of that stuff. I gotta tell you, people are going to chase this as a shiny object. That's fine. It's going to do a lot of good for a lot of people. Never forget, always about the fundamentals. Usually what we'll see in clinical practice is that serious enough execution of the fundamentals over a long enough period of time will yield better results than stuff like in ephoresis in a short period of time. Sometimes you got a disease like cancer, you have a serious autoimmune disease, you need results fast. You can't play around. You're playing to win and time is against you. That's when I'm like, okay, well, let's just go ahead and spend that money and go do that. But I mentioned that because I just see that overwhelmingly people are underestimating the power of the fundamentals executed with intensity over a long enough period of time. All right. What is your experience or opinion on Oligoscan technology, which claims to measure tissue levels of toxins and nutrients? Is there validation for this testing method? Also from Andy. So yes, I've looked at the Oligoscan. I've compared the Oligoscan in some of my patients with hair testing, with other forms of testing. I'm tempted to buy this and test it in the practice, but if you knew how many things I'm trying to test in the practice, it's like I, I have to stop myself. I would literally I spend all my money and time just testing cool stuff if I only did that. And I, I can't do that. I have to pay my bills and take care of my family. So have I tested it rigorously? No. Do I want to? Yes. I think the idea is amazing. I've wanted this technology even before I knew what it was. What is your opinion on red light therapy beds available at tanning salons? I'm strongly in favor of them. I do not have an opinion as to brands or products because I haven't had the time to do the research, but I'm strongly in favor of these. Are there any concerns about the latest studies showing Prolonged melatonin use may cause heart issues. Deborah, I covered this in a prior Q&A, and the short answer is no, I'm not concerned. Basically all those studies, that study showed was that people who use melatonin are more likely to develop heart failure. The analogy I drew in my prior Q&A was basically, that's like saying people who are more likely to call an ambulance are more likely to develop heart failure. This doesn't mean ambulance rides cause heart failure. It means that sick people are going to take more stuff to try and feel better than people who are less sick. Right? So it's this flies cause garbage. Do ambulances cause train or car wrecks? Do fire trucks cause fires? You know, no, you find flies where you find garbage. You find fire trucks where there are fires. You find ambulances at car wrecks. But the wrong thing to do is say, I'm not calling the ambulance because my friend called the ambulance and he died in the hospital. Or I'm not calling the fire truck because every time the fire truck shows up, there's a fire. I'm not going to, you know, throw anything in the garbage pail because the flies come when there's garbage. It's like, no, that doesn't make sense. Unfortunately, study authors did not get that and did not present it in a balanced way. Anyway, can you elaborate on the research suggesting that statins and lowering cholesterol below 200 may increase cancer risk? Yes. So I'm not terribly familiar with this, but I have read certain studies showing that lowering cholesterol below 200 may increase cancer risk and You know, I'll share with you guys how I do research on this kind of thing. Now, I go to my AI assistant Perplexity, and I, I will put in something like this. You know, I'm researching the potential cost-benefit analysis of statins and lowering cholesterol with other therapeutics. Give me a for and against debate regarding whether or not the risks of lowering cholesterol outweigh the benefits. Now, what it's going to return to you is a bunch of literature in support of the drugs, I then ask it, how do we know that this literature is on the up and up and isn't compromised by pharmaceutical industry malfeasance? Because we know the pharmaceutical industry lies in its studies. This is not the world according to Dr. Leland Stillman. This is not just my opinion. This is a matter of historical fact. You can go back through the many, many, many lawsuits that the pharmaceutical industry has lost against state state, federal governments, class action lawsuits. The pharmaceutical industry is essentially a very, very criminal cartel. And I say that because they've lost in court a lot and they keep violating the law because guess what? The judgments against them don't do more than take a small divot out of the bottom line. So they're basically making money hand over fist, lying, manipulating data, cheating, stealing, buying politicians. That's why their reputation is tanking. I say that as well because unfortunately We don't know what literature they've manipulated and faked and what data they haven't. And so it's really hard for me to look at that kind of data and say, well, I know the truth. Why? I suspect all of the data. That might seem kind of nihilistic or overly negative, but the problem with liars is you don't know where the truth ends and the lies begin. And that means that you can't really trust anything that they say. And that's how I feel about the pharmaceutical industry. What is your experience with spore-based probiotics? Are there particular characteristics that make a probiotic effective for gut health? This question's from Donna. Yeah, so I don't tend to use a lot of probiotics in my practice, and the reason for this is that I've just found that we tend to get patients great results without them. It's also very well known in clinical practice and in the literature that it is the things you do to your body, from what you put in your mouth to the sunlight that hits your skin, that will actually affect the microbiome. So for example, there's a great study I recall reading years ago where they used UVB light and it actually affected the microbiome. So I would expect modern artificially lit, microwaved, processed food-eating, circadian-rhythm-disrupted people to end up with lots of GI issues. That's very well borne out in the literature. And I would expect them to all chase after probiotics as a, as a quick fix for this problem. And it may benefit them. I'm not saying it doesn't, but it also isn't the real root cause. The real root cause is all of these other diet, lifestyle, and environmental concerns. Now, are there people who are going to benefit? Yes. I don't give blanket recommendations in terms of, well, everyone should take this or we need this every day forever with probiotics because I just haven't seen that borne out in the literature. So hopefully that's helpful. I'm also not sure if this spore-based probiotic thing really matters. I just haven't had time to research it. It sounds like really good— I'm going to be completely honest with you, it sounds like really good marketing. And anytime I see something like, oh, that's really good marketing, I'm like, ah, does that mean that it's just not true? I don't know, let's find out. And then I go down the rabbit hole and I look and I try to find out. In a minute I'm going to tell you is how I'm now prompting AI to try and figure out if a product might actually be good. And that'll be fun for us to cover. Okay. What sweeteners do you recommend? Is stevia a concern? This is from Helen. Honey is my top sweetener. Molasses is one of my absolute favorites. I eat it almost every day. This is all in context of, I really want to know who the patient is, what their metabolism is, what their goals are before I'm even talking about sweeteners. Because, you know, if you come to me and you've got bad diabetes, We're not going to talk about sweeteners. We're going to talk about ketogenic diets. We're going to talk about, you know, slow carbs if we need them at all. Okay. Artificial sweeteners. I just had my daily dose of SkinSips available in our online store, store.stillmanmd.com. I love this stuff. It tastes yummy. It boosts my energy. You want to know more about it? Look up my podcast with Mary Rankin, the founder of the company. Shout out to Mary. Hello, Mary. I hope you listen to my Q&As. Um, it's a great product. I love it. And I combine it with our choline citrate, also available in our online store, and our vitamin C, also available in our online store, for what I call Dr. Stillman's afternoon pick-me-up, which is delicious. And I just had it this morning, so today it wasn't my afternoon pick-me-up, it was my morning treat. What does this have in it? I think it's allulose. No, don't tell me. No, I think they changed it recently. Yeah, it's just some allulose, and then there's some fermented sugarcane REBM. I don't really know what that is. Really good stuff. I love it. Now, I say that I recommend that you consume artificial sweeteners moderation. And I will tell you, Lucretius, Roman physician, said what is good food for one person may be fierce poison to another. And I can't believe this is, this is happening right now, but believe it or not, we, in our allergy test, one of the things it tests is saccharin, which is an artificial sweetener. We recently had a case of a woman with an autoimmune lung disease come into the practice. We did this allergy test. And she found that she had like a 6 level of reaction to this. Our cutoff for reaction is 1.9. So she was like 3x, 3 times as reactive to this as our threshold for telling someone to avoid a food. And she saw amazing results eliminating, I believe, just that from her diet. She'd been consuming it every day for many, many years. You know, she's not huffing and puffing when she goes up the steps now. She doesn't have any issues with her ability to exercise with shortness of breath. These are individual results. Individual results will vary. Very important for me to mention that, right? I can't guarantee that if you cut out artificial sweeteners, you'll get results like this, but she did. And so from my perspective, you know, her, her illness is basically, I can't say resolved. I can't say recovered. I can't say in remission, but it's, let's just say her concerns have been addressed by the program, including this allergy test. So anything can become a problem if you consume enough of it over a long enough period of time and you don't have your fundamentals in place. Your fundamentals I think of now as being like your roots. Your daily walks, your positive thinking, your affirmations, your good sleep at night, your avoidance of artificial light at night, your healthy diet. These are like roots you put into the ground. Without them, your health falls apart, your tree falls over, and you end up sick. Can supplements like glycine, vitamin C, and MSM be combined and taken all at once, or should they be separated? This is from Carol. Yes, they can generally be combined, but I will tell you that if you give people glycine, vitamin C, and MSM, many of them will have detox reactions. And so I start these usually one at a time to make sure that I'm not going to be pushing someone into a detox reaction with them. They're very powerful supplements, not to be underestimated. Okay, so that's that. What's your opinion on grounding mats as a therapy? From B. Hello, B, good to see you here. I'm open to them. I always like to remember, right, we shouldn't just mimic and copy nature in our therapeutics. We should go and do what nature offers us. Now, I'll be the first to point out that there are ways we can leverage these things more powerfully. You know, for example, we're using laser therapy for our son and his brain rehab, and it's working very well, but I still try to get him outside into the sun as much as possible. Do I think the sun alone would do what the laser is doing? I don't know. I can't say, but I don't think so. Let's just put it that way. It's doing pretty amazing things for him. More on that later. If you want to learn more about this or anything else I've said here, shoot me a question in the Q&A. I always answer subscriber questions as soon as I get around to another Q&A, which is usually twice a month, at least, if not weekly. So So yeah, ask me more if you want to learn more. So let me tell you about how I would use AI in order to prompt for this. So I like Perplexity for research. I have no affiliate relationship with them as of this recording, although I actually would like to. And I would go and I would say, okay, I'm curious about whether or not grounding mats could help me in general, right? Now, this is where I would put in your goal. You want to lose weight, you want to have more energy, you want to sleep better, you want I want to have less pain. I want you to put your goal in there. Okay. Then what I would say is basically let's separate marketing hype from people's real experience, lived experience. Can you find me real patient or user customer testimonials as to the power of this therapy device, whatever. And then I would look at the outputs and sort of make my own decision about, okay, is this hype? Is this whatever, or is this real? I remember talking to Bryant Myers. Bryant Myers makes PEMF mats and he reviews them. He's a— he's a PhD in physics— no, master's in physics. He's deep into the science of PEMF. He's one of the only people I trust in that space because there's a lot of bad PEMF products out there. Oh my gosh, do people waste money on that. Good Lord in heaven. But Bryant's really on the up and up. He's really deep in the science. I really trust him. And, you know, he told me on a call when we were buying a PEMF mat for rehabbing our son last year, he said, you know, So there's this buzz that follows good products. People talk. I hear about it, you know, through the grapevine. This is one of the reasons why I'm actually passionate about network marketing is that the reality is if you have a bad product, it will not go anywhere with network marketing. Network marketing, there has to be something in the product or service that's delivered that's worth it. And you know, you'll see this, the companies that implode, their value is gone. It's disappeared. Maybe they have a problem with their supply chain. They have a bad compensation plan, whatever. Companies like LifeWave, where I'm building, they have this amazing product. I got so many testimonials about LifeWave this week. I had a young lady who had severe discomfort the other day, abdominally through her chest, this severe discomfort that she said was like a 10 out of 10 in severity. And the IceWave patches took it down to a 5 out of 10. In my world, we don't expect to do that short of very strong injectable medications or even controlled substances like opiates That's what I would expect in the hospital to use in order to get someone from a 10 out of 10 to a 5 out of 10. Pretty amazing. So not the only testimonial like that I've received about the IceWave patches in particular. And if you'd like to purchase them through me, I appreciate your purchases. They help fund our content production. And if you want to learn more about LifeWave, as soon as you enroll on my team as a brand partner, you get an onboarding call, you get some dedicated calls with me each week and a Telegram group and a school group where I can teach you how to use the product. So I'd love to welcome you to the team and show you why I'm so passionate about their products anyway. In most cases, by the way, you're going to see, yeah, there's some unhappy users, unhappy customers. This is because there's unhappy people everywhere. It doesn't matter who you are. You know, you can be the nicest person, best person on planet Earth. People will still hate you. I'm reminded of Plato, I think, who said, there's none who's so hated as he who speaks the truth anyway. But you'll also be able to sort of use the AI to figure out, is there like a real buzz around this Are there a lot of testimonials? Are there a lot of happy customers? Are there a lot of passionate users and evangelists for this? And that helps me understand, you know, is this kind of like just marketing hype or is this— there may be something really here. I really believe in people's lived experience as the bedrock of what we should pay attention to in medicine, which is in stark contrast to my colleagues who want this sort of like rarefied, double-blinded, randomized, placebo-controlled crossover clinical trial of everything before they'll even consider it, which I think is putting the cart before the horse. And then telling it to go backwards. Bizarre. Anyway. All right. What are the reasons someone might choose sublingual allergy drops over allergy shots? Are there concerns about ingredients in allergy shots such as heavy metals? This is from Philip. So one of the reasons why I'm not an allergist is that I, and when I say that, I mean I'm not a conventionally trained, conventionally practicing allergist, is that I found that there were practitioners out there using integrative and alternative methods to treat allergies who were getting way better results. For way less time, effort, and sacrifice for patients outside of that mainstream. And the numbers on the money side of allergy treatment today are insane. You know, we're talking about $1,000 a month biologics, and I've had people come in and they were on those, and I've seen them come off and have 95% resolution of their symptoms, and all of a sudden they're saving $1,000 a month. Wild. So I'm very skeptical, skeptical of the conventional treatments for allergies because of that. Specifically allergy shots, a lot of them have aluminum in it as a preservative, which isn't present at a significant concentration, but the fact that you get hundreds, if not thousands of shots over the course of your life is a problem because there's going to be an accumulation of the aluminum and aluminum is toxic to the human body. It is unsafe in any amount. And believe me when I tell you, I see crazy things happen when we get rid of aluminum in the human body. So that's why I avoid allergy shots pretty much universally, if not as a rule. I'm not going to say I'd never, because I, I don't know everything. And there might be cases where it's appropriate. But that's why I avoid them. When might a low TSH be a concern even, and, and when might it be acceptable? This is from Lori. Okay. So first things first with TSH, you have to understand that TSH can vary radically week to week. So my own TSH, I have no thyroid problems. My free T3 is in a great range. My own TSH varies from 1.5 to 4.5. That is a 300% difference. So people are like, my TSH was low. Well, what do you mean it was low that day? So I almost don't even measure TSH anymore because it is honestly one of the most useless lab tests in the world, but I'm still ordering it. Oh, check back with me later. When am I worried about it? If it is very suppressed for a very long period of time in the presence of a very high level of free T3, that's when you could convince me that there might be issues with this. There's also people out there saying this whole thing about TSH and worrying about suppressing it and whatever is all a red herring. I'm open to that. I just haven't had time to read the literature on it yet. So I'll get there. And when I say low, I mean, you know, below the reference range. Otherwise, I'm, I'm not really— I almost don't pay attention to TSH at all. Is it possible to have an overactive gallbladder, and would that be treated the same way as a gallbladder with sluggish bile flow? This is from Olivia. Olivia, great question. Okay, so, you know, is it possible to have an overactive gallbladder? I'm going to tell you that if you walk into a hospital and ask a bunch of doctors that, they're going to say no. Here's the reality, the way I look at the gallbladder and the liver The gallbladder is very powerful in terms of its effect on your overall wellness because bile from the gallbladder is necessary for the absorption of fat-soluble vitamins. It's also necessary for the regulation of the microbiome, which is why I will frequently see patients who have all these different diagnoses. They've been told they have SIBO, they've been told they have this weird bowel infection, they have IBS, they have other diagnoses. Will put them on a bile acid-containing enzyme. Guess what? Dr. Stillman's Digestive Enzymes Plus in the supplement store has bile acids in it because they are one of my favorite ingredients. They do so much good for patients because they help regulate the gut microbiome. Amazing, amazing, these impacts. They help you absorb your fat-soluble vitamins. And the more bile acids you have in the gut, the more toxins from the hepatobiliary axis— that's the liver and gallbladder— your body is going to excrete. So one of the trends you'll see is that people who don't have a lot of bile may wind up with elevated bilirubin in their blood. That's why it's one of my repair deficit markers. It's in the repair deficit panel, which is one of the things I use to gauge progress and evaluate how sick and severe a case is. Fun fact, if you haven't read my repair deficit post, it's one of my monster most value on Substack posts. It's also kind of overwhelming for the average person. So check Just disclaiming it that way. You don't need to know everything in it, but man, is it a lot of value. Okay. So bile acids help us excrete bad things, help us manage our microbiome, and help us absorb fat-soluble vitamins. That's why every single patient coming through the door of the practice winds up with a recommendation to take them as a supplement. Just rolled out Dr. Stillman's Digestive Enzymes Plus. So if you're a patient and you're listening to this and you're like, why am I not on that? It's because I literally just stocked it in the online supplement store where you can get as a premium subscriber to Substack or a practice member 25% discount on the supplements, which is really, really, really deep. I worked very hard to get that for you. So I hope as a member of the practice or the premium subscribers, you will use it. Okay. So I, I mentioned this because what I believe, and I don't have a ton of evidence to support this for the record, is that when we supplement with bile acids, we help the gallbladder to expel bile acids and bile in general. One of the things I wonder about, because you'll see this on MRI and ultrasound reports, is that there's sludging in the gallbladder. And there's this idea that, okay, the gallbladder is dysfunctional because it's got these sort of small accumulations of material that are sort of coming together. Think of it like sand, like sand in an engine. And this is causing the gallbladder to sludge, or the bile to sludge, and this can then cause some biliary dysfunction. I believe that if we load bile acids in, we're gonna help solve that problem. Just like if you had sand in your oil pan in your car, are, well, what are you going to do? I don't really know because I'm not a mechanic, but I imagine one of the approaches might be drain the oil, get rid of the sand, throw more oil in. Just a, just a thought, just a thought from a simple country doctor. So I'm a big fan of putting in bile acids for anyone with any gallbladder problem. Other things I think are really interesting about this: choline, Choline Citrate Plus, or Choline Plus. Dr. Stillman's Choline Plus is now— should be now in the online store. If not, we do have a choline product that's still there. I think we're about to run that though, just so you know. Amazing product. Got the most amazing testimonial about it for mental acuity, brain function, from a young lady the other day. She said it really, really helped her focus, even to the degree that she was comparing it to pharmaceuticals she's taken in the past for, you know, focus, mental clarity, energy. So choline, one of the reasons I stock it and believe in it is that it's necessary for the production of neurotransmitters, specifically acetylcholine, which runs the parasympathetic nervous system, which helps you go into rest, digest, rejuvenate It also helps your body absorb magnesium. So when I see a low magnesium despite magnesium supplementation, boom, I go straight to choline. Let's get the choline in there so it can help the body absorb it, right? Choline helps thin the bile so that the gallbladder can expel it. Really cool. I also am a fan of phosphatidylcholine. Choline obviously is used to make phosphatidylcholine in your body, which is why I stock it in the supplement store. I'm also a big fan of sunflower lecithin in some cases. I've also had some patients allergic to sunflower and lecithin. So there you go. But these things help thin the bile. And the, and that's the main problem that I see in people and with gallbladder issues in general is they just have stones. They have sludging. This creates discomfort. This creates pain. I believe it creates long-term gallbladder disease. And anyone coming to me who's got a lack of a gallbladder, it's been taken out surgically. I'm like, look, please take this for the rest of your life. One of the very few strong recommendations I take, I make for a lifelong supplement is when the gallbladder has been removed. And that's because you push out a huge quantity of toxins through your bile. And so when you don't have bile coming in or you don't have a gallbladder to store it, my suspicion is that the body starts to accumulate toxins. And that's why, my gosh, the number of patients I see, I was healthy, then I had my gallbladder out, since then it's all been downhill. That is a very common story I hear. All right. That was a big brain dump. Hopefully you enjoyed that, Olivia. All right. What type of light bulbs would work for someone wanting to build a DIY red light panel on a budget? Olivia Olivia, great question. I mean, I would think about brooder lights from Tractor Supply. That would be my top, my top thought or pick. I don't really have another option for you. Are you familiar with Andy Cutler protocol for mercury detox and the deranged mineral transport statistical test for assessing mercury toxicity through hair analysis? Have you observed inconsistent results between different hair testing laboratories? Also from Andy. I've heard of Andy Cutler. I've not looked into his protocol in detail, and so I'm not familiar with his work. I can tell you, I've done a lot of hair tests, and I will tell you that I only use two different labs for hair testing. One of them is TEI, Trace Elements Institute in Houston, and one of them is Analytical Research Labs in Phoenix or Scottsdale. Everyone I know in the hair tissue testing space agrees these are the gold standard labs, and basically everyone else does something to the hair and has a methodology that we don't— that we think disrupts our results. So So that's who I use for testing. Okay. Which at-home neurofeedback devices or clinics would you recommend, Natasha? So I've been referring patients to Andrew Hill at Peak Brain Institute. If you're a patient, we have some kind of code or link that's in our Mind-Body Medicine protocol that we can send you for, I think it's a reduction in the price of your, your initial QEEG, your initial analysis. If you're a patient, let me know. The staff can send you that. So you can get a good, a better price on it. There are neurofeedback direct-to-consumer devices. I would use the AI queries I recommended earlier to evaluate whether or not those are, are worthwhile. And then it gets into kind of like, is that a good idea? Feedback's pretty complex. And I've heard some people say they've got great at-home devices that don't require clinician oversight. But then again, I, I look at what I do and I try to make it as simple as I can and not any simpler, to quote Einstein. And there's a time and a place for expert consultation to help you get better results faster with things like neurofeedback. So I'm wary of recommending a device that doesn't have a clinician helping you really guide its use. And that's one of the things I like about Peak Brain Institute, by the way, is that you get Andrew and his team in your corner kind of helping you figure out what to do and what protocols to use and so on and so forth. What are some ways to make mineral detox powders more palatable for those who struggle with the taste? Susan, great question. So, um, I'm going to separate this into two questions. So first of all, we do custom mineral powders in the practice for patients based on HTMA testing. We offer to encapsulate those through the third party that we purchase them through for patients. And so you could have them encapsulated and get around the taste if that's what you're asking about. If you're talking about Dr. Stillman's detox powder, which by the way is a recipe in the premium Substack for people who want it now, it's coming. We're going to make it publicly available as soon as I can get the time to publish it. And Dr. Stillman's detox powder, if, how do we make that more palatable? I would mix it with something like molasses and I would think about mixing it with something like a really strong juice. Like apple juice, for example. Other than that, it's tough. One day I'd like to encapsulate that myself and sell it directly to people, but I have not had time to do that yet. Hopefully that's helpful. Okay, what's the best approach for detoxing arsenic when levels are significantly elevated? Great question. So first of all, this is also from Susan. So first of all, most important thing to detox any heavy metal in my book is, aside from all of the fundamental things that we do in life to support a healthy healthy detoxification and elimination system, many of which I've already mentioned today and won't go back over again. Pushing the right minerals in is very powerful. So we have a multivitamin, multi-mineral in the online store. I think we're about to run out of this one too, and we're going to have one in stock soon called Dr. Stillman's Vitality Plus. I picked this specific multivitamin, multi-mineral because I have seen so many labs, and I frequently see labs that have been deranged and messed up by supplements that people didn't realize were not right for them. I'll give you a very clear example of this that I see in clinical practice on a regular basis. A woman or man, but most often a woman, doesn't realize she has problems eliminating copper because she has a disrupted hepatobiliary axis because of, say, a cholecystectomy, so gallbladder removal, or she's got, you know, just medical problems that lead her to not have brisk bile flow. I believe that has to do mostly with toxin accumulation. She doesn't realize that because she has a lack of bile acids coming out that she's also then therefore for not eliminating copper. You lose copper every day in your bile, and you need to lose it, otherwise it will bioaccumulate. She winds up with copper toxicity. Where we first see this is we start someone detoxing and their hair copper level skyrockets. And while they're detoxing all of that inorganic copper that's accumulated in their body, they start to feel worlds better. They've got better mental clarity, focus, their mood is better, they have more energy, they have better sleep. They may have detox symptoms that correspond with this where often they're saying, I'm tired, I'm moody, I'm up and down, I can't focus. That's what we look at as copper toxicity, sort of the most common symptoms in my view. She then ends up— and the extreme of this is where you actually have elevated blood copper levels. When I see a copper over about 100, 103, 104, I get concerned. And the reason why is that as copper goes over that number, your risk of overall death actually goes up. Now, just so you don't all freak out, you ladies who are in your childbearing years, you're going to have natural fluctuations in your serum copper based on your, your female hormones. You're also gonna have crazy high copper levels during pregnancy. Don't worry about that. That's normal fetal— fertile female physiology and pregnancy physiology. It's a problem when those hormones are not in play. So if I've got a 55-year-old woman with a copper of 180, she actually has a very high risk of death based on her serum copper level. We need to get that copper out of the body.— that's where the bile acids come in. That's part of why I like choline, because it helps the bile acids to move them. The multivitamin, multi-mineral I picked doesn't have copper in it because I'm concerned about this. I'm not saying you can't supplement with copper. Fun fact, I had a patient this week, he set the record, the all-time record for low copper in the practice with a rock-bottom level of 48. So I said, you need to take beef liver, you need to eat all these copper-rich foods, and and, you know, you need to do it every day. If that was overwhelming because you feel like I just told you some of you need a lot of it and some of you need none of it and to avoid it religiously, I don't know what to tell you. You're all different. You all need different things. This is why I love testing. This is why I gave you guys the repair deficit panel to just go reference. I gave like clear guidelines for how I use it in clinical practice too, so hopefully you find that helpful. But I digress. The multivitamin, multi-mineral I picked also has very high levels of something called B6. Vitamin B6 in it because this is one of the key vitamins that people do not get enough of, that they need a huge dose of in order to adequately detoxify a lot of the things that I see ruining their health, namely arsenic, to get back to your question, Susan. So I can go on and on about why I like the multivitamin, multimineral we use. For patients at the practice who are wondering, well, should I go take the multivitamin, multimineral instead of the personalized supplements Dr. Stillman and the team came up with? Absolutely not. We personalize the supplements over here with higher doses and different ingredients, stuff that's is not in the multivitamin, multimineral over here. So I hope that's really clear. But yeah, we do all the basic fundamental stuff to get rid of arsenic. The other big thing I'm a huge fan of for all heavy metals is sauna. Sauna, sauna, sauna. I have a whole guide to that on Substack if you want to learn more about what sauna I use, why I like it, how I use it, et cetera. Information's there. Just put in sauna to Substack. It should be one of the top entries. Okay. And rant. Many women report feeling better during the estrogen dominant phase of their cycle and worse during the progesterone dominant luteal phase. What causes this pattern? Is it insufficient progesterone, excess estrogen in tissues, or something else? Does this differ between women in reproductive years versus menopause? Olivia, this is such a great question. So here's my overview of basically female hormones and why I think there are so many problems with them today. We live in a world where there are a lot of estrogen-mimicking chemicals, and what's paradoxical is you'll sometimes see that women have low levels of estrogen in terms of estradiol or estriol, two of the bioactive bioidentical hormones in their bodies, but they have all these symptoms of estrogen excess. And what I infer from that is that patients do not have enough of the actual bioidentical product around to do the job that the hormones need to do. And at the same time, they have an overabundance of these toxins that mimic them, but not in a good way. So if I had to tell you, like, give you an analogy here, it would basically be this. Imagine like cars on a road. Imagine you have a bunch of cars that don't have working engines. They're stalled at stoplights. They're sitting there at stop signs. They're clogging up the flow of traffic. So if you ask, are there a lot of cars on the road? Yeah, there's lots of cars on the road, but not all of them are working. Some of them are actually getting in the way of traffic, normal traffic flowing. So hopefully that analogy works. I'm looking for a better one than that. I'll let you all know when I find it. But here's why I talk about that. The vast majority of women, whether we're talking about a luteal phase issue or, you know, any other time of their cycle, the vast majority, their symptoms relate back to low progesterone. And it's the first hormone, female hormone, I tend to give women. And the reason why is that there's not progesterone-mimicking hormones in our environment. And if you look at one of the big hormone-disrupting factors in a, in a patient's case, it's often their body fat. Their body fat contains an enzyme called aromatase, which will take— it will take things like testosterone and DHEA and turn them into estrogen. So we're living in this very estrogen-dominant world, so that can play a role in this as well. Okay, so I just look at this as across the board, women today tend to have low or insufficient progesterone, and they have excess— they have assess endocrine disruptors that are estrogenic in nature, and they may have low or high bioidentical estrogen. Hopefully that was clear and not just confusing, because that's pretty high-level practitioner-type stuff. And yes, it varies in women, reproductive years versus menopause, because in menopause the levels just should completely drop out. That would be the definition of having been fully through menopause. Perimenopausally, it can be all over the place because levels are deteriorating at different rates. What are your thoughts on thyroid and adrenal glandulars, particularly for use in children? Shauna, thyroid and adrenal glandulars are really interesting because they're very helpful. I look at them as nourishing these glands. I haven't seen patients actually increase hormone levels on lab testing taking glandulars. I also haven't seen patients taking the doses we use experience withdrawal from glandulars. I have, and you will find, people reporting withdrawal from adrenal or thyroid glandulars at higher doses. So what do I think about using them in children? I think they can be used at low doses, and I do use them in children at low doses if they're in specific metabolic patterns that suggest that those glands—thyroid and adrenal in this case—need to be nourished. Okay, since iodine and vitamin C are typically taken separately, should detox powders containing iodine also be taken away from vitamin C? The answer is yes, for best results. Can you elaborate on the root causes of autoimmune conditions beyond just receiving an autoimmune diagnosis label? Boy, this is a great question. So I mentioned earlier that I look at all causes of disease as arising from one of three roots. So there's metabolic imbalances, there's toxins, and there's infections. Okay. So if you look at all autoimmune conditions in the literature and you go back to what are the things that predispose to this condition, you're always going to find one of these three things. You're going to find, for example, that patients who are exposed to this or that toxin have a higher rate of autoimmunity. You're going to find that patients with this or that lifestyle imbalance, which might be they work at night, shift work, very strongly associated with autoimmunity. They have an occupational exposure to say like EMF or time zone changes and circadian dysrhythmia, like flight attendants. They have an increased rate of autoimmune conditions. I look at stresses like flight, EMF, et cetera, like that. I look at those as actually being toxins because of the way they work at the cellular level is actually the the same. As far as infections go, you will find that there's often a lot of literature saying, oh, well, people with chronic X, Y, Z have a higher rate of, say, MS. Like, there's a really strong literature showing an association between Epstein-Barr virus and MS. But why do people wind up with these chronic recurrent infections or signs thereof? It's because they have toxic exposures. It's because they have nutritional deficiencies and metabolic imbalances. On the metabolic imbalances side, you'll find that nutritional deficiencies are strongly associated, often low magnesium, low zinc, zinc, inadequate choline. That's one of the reasons why I'm a big fan of, of choline more and more, the more I learn about it. And also you'll find that the toxins create an increased burden and demand on the body for nutrients. So one of the most consistent trends in the practice I noticed, particularly in the most severe autoimmune cases, is they had raging out of control B6 deficiency. I noticed that based on urine testing and organic acid testing. It's part of why I picked the multi we have. It's got a super high dose of B6. So those 3 things, if you really drill down into the literature, you will find that they are associated with all or the vast majority, I would say, of autoimmune conditions. And I'm going to elaborate much more on that in the book. And then the stuff that comes beyond the book, free gifts for book owners and purchasers. All right. What recovery strategies can help with a back injury from sports like pickleball? Julie. Okay. So we have actually a pretty clear-cut playbook in the practice for you have an acute injury or you're recovering from a surgery. And I cover this pretty regularly in the practice. Practice. So number one, I use the X39 patch right on the injury. Okay. I feel very strongly about this. I have had case after case, story after story come back to me of, oh my gosh, I put the patch on that thing and was amazed with the results. Okay. Those are individual results. They do vary. Some people try them for that and they don't get a response. I still encourage them to continue using them because I believe they must be doing something long-term under the hood that you may not notice. By the way, I also love the IceWave patches for any kind of discomfort that people experience whether it's acute or chronic. And there's a clock face method for placing IceWave. You can look that up anywhere, YouTube, social media, tons of different tutorials on how to do that. My other favorite placement for the IceWave patches is on, it's called the bubbling springs or kidney 1 point on the bottom of the foot. You put the white patch on the right and the tan patch on the left. Love LifeWave patches for this. Another element I would add to that would be the Aeon patches from LifeWave, cuz people often report that they really help with reducing discomfort, improving function. They feel better, they function better, they have, say, like better mobility. I hear that all the time with that. So I like those 3 patches for recovery from illness, injury, or surgery. Okay. I also like our vitamin C for recovery from these things because one of the things you fundamentally have to do in order to bring the body back together is you have to produce collagen and you have to cross-link it. Vitamin C is the rate-limiting step in that. Okay. I'm usually looking at a case in my practice and making sure that while we're all doing all these things, we also have the other micronutrients necessary for collagen production on on board. Why do I mention that? The gentleman I mentioned earlier who had a copper level of only 48, he can't produce collagen, and the rate-limiting step for him might not be vitamin C, it's actually copper. So he needs to load copper into the system so that he can make collagen again. And most of my patients, the vast, vast, vast majority, do not have deficiency of copper. They're right in the sweet spot for it in general. So I don't load copper in, I just have to take it on a case-by-case basis. And I mention that because if you're not sure where your micronutrient status is, and I had to pick a supplement to cover micronutrients, everything from magnesium to the B vitamins, it would be our multi. And that's part of why I picked it. So we've got vitamin C, we've got the micronutrients, minerals, and vitamins. Then MSM is one of the supplements I love for recovery from injury. People report that it really helps them with pain. It's very well studied for reducing pain. People will also use DMSO. DMSO is— I call it a wrecking ball while MSM is more like a sledgehammer. You know, if you want to learn how to use DMSO So I'm not the guy to tell you. I can't do it in Q&As anyway. I'm working up our protocols internally on that, but there's lots of other resources out there on that that you could check out. Between MSM, vitamin C, vitamins, minerals that are core and key. I like adding supplemental magnesium, which we also have in the online store now. Thank goodness it was missing for a while. I don't know how that happened. It's one of my favorite supplements. Magnesium is good for reducing pain. It's essential for your stress response, helps keep you relaxed, which is what you need in order to recover. And any stress increases the wasting of magnesium. So wind up in a low mag state if you don't take supplemental when you have an acute illness like that. So I like to stack that as well. So I think I got the full stack. It's X39s, IceWaves, Aons, some kind of multivitamin, multi-mineral to make sure you're covered there, vitamin C, MSM, and magnesium. Those are the key things for me for optimal healing after any kind of insult, injury, surgery. I'm a huge fan of using bioidentical hormones in these cases. Because my goodness, do the hormones powerfully heal the body. But those are mostly by prescription. The only one that's not is DHEA. What are your thoughts on peptide bioregulators marketed for heart health? What should someone consider before trying these products? So Greg, this is a really interesting question. You added a specific product URL and my AI removed that in generating the question for me. And partly that's because, Greg, I don't want to get in trouble with, with defamation lawsuits, but it's also because I haven't had time to research all the products in the world. And so I don't want to speak sort of out of turn without taking the time, which I also don't have in my schedule because that would be like a full-time job. Fun fact, I've considered actually hiring someone to just do full-time research if we had the money, which by the way, we would if all of you bought lots of stuff from the online store. That would be amazing. I would love that. Anyway, I will refer you back to the prompts I used for how I evaluate a product. Is there real buzz about this? Are people really using it and seeing results? What do the unhappy customers say? Are there any themes there? What could we infer about who's not a good candidate? I'll give you a real, real example using LifeWave, which is one of my favorites, if you hadn't figured that out. So one thing I've noticed about LifeWave is the vast majority of people who have some kind of wild, over-the-top, incredible miracle testimony— the vast majority of them are over 40. Why does that make sense? Well, the peptide the X39 patch has been documented in the literature to upregulate regulate, that peptide declines as you get older. So of course the older people are going to have a better result. That isn't to say that young people don't need it and don't benefit from it. We patch my son and he's hardly a year old. So hopefully that's helpful. I will tell you a big picture here. Very hard to know with the peptides and bioregulators because we just haven't had that much time to study them. And I say that it's also important to note that many of these peptides and bioregulators were originally discovered covered in the Soviet Union. They're called— they are called the kava peptides. And so the Soviets and the Russians have research that I'm not sure has been translated into English, and that stuff's all very much on the cutting edge. So I hope that my thoughts here, since I don't have a clear answer for you on a specific product, are at least helpful in terms of you doing some research, figuring out if this is the right thing for you. I will tell you that for heart health, in my practice, I'm a huge fan of the X39, X49, and Aeon combo, but I also really do tailor this to the, to the patient and the case. But I've heard some pretty compelling testimonials along those lines for those products. All right, when do mineral balancing protocols— when doing mineral balancing protocols, is it normal to develop a black tongue? Could this be a detox reaction? Also from Susan. Uh, so black tongue's actually well described as an idiosyncratic fungal infection. And when I say it's idiosyncratic, I mean it can come out of the blue and no way to predict it. I know this because I woke up one day and had a tongue and I ran to the internet and said, what is happening to me? Turns out it's a fungal infection. I did nothing about it and it went away. Why did that happen? Why does that happen? I have no idea. More than that, I can't give you medical guidance on, through Q&A, how to manage it. And even I, because I so, so infrequently see it, I've only seen it in myself, would have to go back and do some research and look at some notes and stuff like that in order to figure out a game plan around it. Could it be a detox reaction? I have no reason to believe it wouldn't be. So hopefully that's helpful. All right, everyone. That was a long Q&A. It was overdue because we, I took some weeks off over the holidays. Thank you always, as always for your questions. Thank you for your premium subscriptions, premium subscribers. Thank you for being members of the practice. To my patients, thank you all for making purchases at the online supplement store. If you're a premium subscriber or a medical practice patient, you get a 25% discount on the store. If you don't know where that discount lives, contact a member of my team. You can reply to the premium emails. There should be a link in the, in the header and the footer to all your premium emails on some Substack, if you're a premium subscriber there, that links you to the post where your, we call them the premium subscriber goodies live. And if you're a practice member, you should get a weekly email from a member of my team that includes the monthly discount code for that 25% off. So thank you all again. Have a great day. I hope you all had a very Merry Christmas and Happy New Year. Take care, everyone. Be well.