Uncensored Q+A: Better Health Guidance

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Good morning, everyone. Dr. Stillman back again for another Q&A. Thank you all for your questions. Thank you particularly to premium subscribers and practice members. If you would like to get your question answered for sure, upgrade to premium today. You'll get a different link to submit questions or apply to become a member of the practice. We currently have a waiting list because we're at capacity. Capacity, but we'll be taking patients in the new year. I also really appreciate any purchases through the product links below this. They help fuel this content production. And I want to open with a little story about this so you guys all understand the sort of why behind these episodes and how all this works. So this story is from the practice. I had a patient who I prescribed testosterone to. Testosterone, for those of you who don't know, is either injectable or topical. We used an injectable form, and I prescribed a 10 mL vial, 10 a 10-milliliter vial to their pharmacy, and I tried to use a retail pharmacy that was convenient to them because that's what most patients want. And the retail pharmacy said that's like $500, something absurd. And the patient came back to me and said, this is a lot for what it is. And I said, that's not what it actually costs. So for those of you wondering how you get good pricing on prescription drugs, here it is. You go to goodrx.com, and if this changes in the future, look up, Google, use AI, How do I find better prescription drug pricing? This is not a secret anymore. And if you're not using these kinds of tools in order to research how to get the right deal and appropriate price on things, you are going to pay a very steep ignorance tax. What ended up happening was they went to GoodRx, but they put in the wrong volume. I asked for a 10ml vial and they used a 10— a 1ml vial, and they ended up getting a price from the pharmacy of $150 or so for 10 1ml vials of testosterone. And this frustrates me because the 10ml $50. So they paid 3 times as much for the same quantity of drug. The pharmacy actually didn't honor the order that I made, which I find frustrating because I don't send pharmacies suggestions. I send them what are technically called orders. What is the point of this story? I try to protect my members from this kind of thing happening by doing this sort of very thorough, upfront, highly transparent, play-by-play, nitty-gritty details of medicine because I find the level of grift in healthcare and medicine to just be staggering. I mean staggering. And I want to explain part of how this works. So the retail pharmacies are going to price gouge patients as much as possible. The era of that is coming to an end through the internet, Google, AI models, and things like that. But I still see it happening like this. And I did everything that I could to prevent this from happening. I said, go to GoodRx, put in exactly what I sent you, but it, it still happened. This is one reason why I, I greatly prefer compounding pharmacies, and I want to explain why. Compounding pharmacies will sometimes be more expensive, they will usually be less convenient because there are fewer of them, but they would fill things that retail pharmacies would not fill and still won't fill for us at often a much better price, and they won't have horrible customer service. The retail pharmacies have atrocious customer service, and they also have bad service for us, and that's actually important. Here's why that's important. So the reason why so many of you are underwhelmed overwhelmed by your current medical care is that there's not enough money coming into the practice you're going to from your insurance or, you know, copays or whatever to afford the team the time to take good care of you. That's fundamentally what the problem is. And they're squeezing the providers and they're squeezing the pharmacists and they're squeezing everybody. And it's, it's awful. I remember being in managed care. Uh, I feel like I need to take a shower. I just say that term. They're squeezing everyone to get every little last drop out of them. And it's just awful. And I see a lot of patients thinking, well, I, I want to just do fee-for-service, or I just want to be able to see my doctor when I need them. I built a membership model for patients who understood that for us to take really good care of them and, you know, provide really full, excellent service, we need a monthly subscription fee that then affords us the time to deal with this kind of thing. And we didn't get what I wanted for this patient, which is part of why I'm telling you about it. I'm a little frustrated that our system didn't work. I'm working on it to make it better. I also want you all to learn from this, even if you're you're not a patient at the practice. And really, I want you to know that what I'm trying to do is build the model where this never happens. One of the things I would love to do at a members-only practice is I would love to have prescription drug pricing for our patients. Because even if you look at the cheapest prescription drug prices that you're getting out there, like the $4 list at Walmart, a lot of those drugs they're buying for like 10% of that. Whoa. When you actually get into wholesale drug pricing, it blows your mind. You actually start to wonder, how is it physically possible to sell this much stuff for this little money. You're just like, it makes your, my brain hurt. So I would like to do that because what I see happening is the retail pharmacies are gobbling up all of this money. They're providing horrible customer service, and then they're not doing the right thing when push comes to shove and doctors say, hey, I think my patient needs this. The pharmacies will sometimes say they don't, sorry, we're not going to fill your med. I accept that there's a safety element there. Pharmacists should only fill what is safe. They can prevent catastrophic medication errors that way. I'm very aware that I've seen it happen in clinical practice, but at the same time, there is sort of like an existential threat to our liberties and our availability, our ability to get critical medications when all of the retail pharmacies are owned by the same people. I will let you all make of that what you will. I think you understand probably what I'm trying to say. And if you don't understand, you can ask me a question about it in the Q&A link, which should be in this email or post or podcast or however you are consuming or listening to this. This also comes up with meds where, you know, I compound a medication routinely at a pharmacy in New Jersey and my patients are like, why do I have to get this thing from New Jersey? Isn't it at a Walgreens down the street? We get this drug from this company in this compounding pharmacy in New Jersey for like $10 a day. And if you want to get it from your retail pharmacy, it's going to be like $1,000. So the amount of time it takes to make sure that the meds are filled, the pharmacy, it does its job, whatever. It's like That comes in as the membership price, right? The cost of membership to the practice. And then what I think is so cool about these Q&As is you can ask me just about any question and you should get the answer within 7 to 10 business days, which is the amount of time it takes for me to record one of these, for my team to edit it, and then for them to post it on Substack or as a podcast like this. So I hope that was helpful for those of you who maybe have issues with this. Uh, and you definitely use the internet to figure out what a fair price is for anything you're buying, lab tests, supplements, all that kind of this stuff because people are paying the ignorance tax all the time, and it's totally optional in 2025 with the number of tools we have to answer these questions at our fingertips. And if you're not a member of a medical practice like mine, I want you to understand part of the value is good people who are creating these membership models. They're trying to create out of the time that the membership fees afford them a model where you just win. It's like, oh my gosh, we saved our membership fees this year in supplements and lab tests and clinical time. You know, we would mark up my time way more if we took members of the general public. Members pay a reduced fee relative to what people pay to, for like their first appointment to join the practice. And I just, that's because I want to take care of the same people for year after year after year. I want to make sure they get great results. I want to track outcomes. I want to do all this so that I can create an engine of medical practice that just does what I haven't seen anything, any practice, any system do, which is take people from variable states of health, from very healthy to very, very, very sick and get all of them to exceptional health and keep them there as long as possible. That's what I think a medical practice should do. That's what I think healthcare is, should be about. And everyone, it's how can we make the most money off of this person, carving out different organs and cutting off different extremities and putting in all these different devices. How can we kind of like, it's very sick and creepy to me and totally it's, and I want to be really clear, it's because of this fee for service. I only try to have someone fix me when when I'm broken model, that kicking the can down the line. And just from a purely economic perspective, like if you wait to become a customer of your local hospital until your first heart attack, they have to stay open for all those years. And yeah, there's people coming through the door today with that problem, but it's a super long cycle. And it's, it's in like ERs, you'll see this. They got to pay their bills the 7 days they're open with huge, giant, like floods of people at random times. So you pay a lot more. When you don't have a membership fee that's then paying for the infrastructure, the backend, the team when you're not in need, and then we can be there when you do need us. Anyway, enough about that. Let's get into your questions. Question number 1 from Shawna: Do LifeWave patches provide health benefits even when no immediate effects are noticed? Is it worth continuing if there are no noticeable changes in the first weeks or months, or do these products not necessarily help everyone? What a great question. So number 1, I always look at light therapy, which is what LifeWave is. Light therapy is a signal being sent to your body. And the body can only respond to signals with the, the material, the matter and energy within it themselves that they have. And so one of the top reasons you'll see people not seeing results with light therapy of any kind, LifeWave or otherwise, is that they don't have the matter in their body to respond. And that's why I created something called the 14-Day Reset. The 14-Day Reset, you can easily look up on Substack. It starts with putting the X39 patch on the back of your neck, and it's designed to be 14 days of really significant needle-moving, game-changing behavior change. Which I basically distilled down from, I don't know how many thousands of patients' visits to this is the, the, the top 5 or 6 things that you gotta do every day to see a huge, huge impact on your health. And so the X39 patch is the first part of that, but then I set it up so that you're getting 2 liters of spring water. Spring water contains electrolytes. It contains water. You need water. And this is where you can go see my quote, my article on optimal water and water filters. Put water into my Substack search and you will find it. You get plenty of hydration to run your cells because they need water to run. You get some electrolytes, hopefully from your mineral water, so you don't get demineralized because you need electrolytes to respond to light therapy. Then you got 3 square meals a day where there's a protein, there's a root vegetable, and there's a green leafy vegetable, and there should be a nut or a seed. Those have the mineral energy that you're going to need in order to respond to the light therapy. And then you need to wind down at night, give yourself darkness at night. Use blue blockers. I've got a guide to optimizing your light environment, where to buy blue blockers, what brands I like, discount codes, the whole thing. Usually, by the way, if you're like trying to remember an affiliate code for me, it's StillmanMD. Super simple. My last name, my credentials, my practice website are all the same. This Substack, all the same. Go through all that in the 14-Day Reset because those are the things that matter the most. And if you're going to see people not respond to light therapy, it's probably going to be because something in that rubric is not being observed. There's way more that can cause what I call therapeutic failure, which means failure of a therapy to get the outcome that you want. $10 term for like a 2-cent concept. Here's what I'll tell you, real-world experience, real-world cases. So first case I'll, I'll mention is my friend Kathleen Horstmeyer, who's got one of the most compelling testimonies I've ever heard. Within about 12 days, exactly 12 days of using the patches, a huge scar that she had disappeared. And that's Certainly not placebo. I mean, if somebody had a way to provoke the placebo effect to make scars go away, they would be very, very wealthy. That's definitely the patch doing something, and she tried everything. So clearly the patches do things. Like, when people tell me, they're like, I don't think it does anything, I'm like, let me introduce you to a few of my friends with these wild stories who tried everything, right? And then it's a question of, is it doing something under the hood? I'll give you another story. My mother used the patches for several months because she tries everything I recommend, and she said to me, Leland Stillman, I'm trying to clean up the credit card bill. I I just don't know what these are doing for me. I'm going to take a break. And I said, yeah, Mom, totally understand. Everyone's got to clean up the credit card bill at some point. Otherwise it becomes a monster that eats your— eats all of your money. And so she canceled her subscription. She took 7 days off the patches. I get this text from her: stopped patches, felt horrible, pain, terrible mood, wasn't enjoying things she liked to do, uh, you know, didn't want to get off the couch, didn't want to go out of the house. And if you don't know my mother, she's a bright, funny, cheerful 81-year-old is so fun to listen to and hang out with. And so I can't tell you what it's worth to me to have a mom who's bright and sunny and cheerful and happy and funny. Uh, and the patches are making that happen at 81. And so she put the patches back on and this big change in how she felt reversed. Now notice she said, I don't know what these are doing for me. And then she took a holiday and then she thought, oh wow, these were doing a lot for me that I didn't realize. And this is a principle of therapeutics that I want you all to think about. So the more gentle something is, the more it tends to work with the body instead of sort of overriding or forcing the body, the fewer adverse effects it will have, as in the fewer people will not tolerate it, the fewer people who will wind up in the ER or the urgent care because they tried it, but the more subtle the effects can be, and then the less sort of credit the therapy can get. And so I see this a lot with what I do. You know, all of the therapies I use for the most part are pretty gentle and patients will often in consultation with me. You know, I had a couple consults this week that were really fun and gratifying because people said essentially to me, I feel so much better, but I'm not exactly sure why. And that always makes sense to me because it's almost always what they say. And then they kind of divvy up the credit because I force them to divvy up the credit. I force them to go through this little mental exercise of, well, 20%, it's the LifeWave patches, and 40% is the— this supplement, that supplement. And it's always different. It's always different. So, you know, one person gives the vitamin C 40% of the credit, another person gives 40% to the MSM. Some people give no credit to one thing that we do for everyone. One, which doesn't mean it didn't do something for them. It just means they didn't notice it. So I give you those testimonials as two extremes. I'm confident the patches are working for everyone. You know, you're asking me what's my longevity routine every day. I throw the patches on. I have two sleeves right here, just in case you were wondering. I'm wearing the Alevida and the X39, uh, right now. And I'm going to add the X49 back in in a minute. So I'm sure they're doing something positive for everyone, but you may not notice it. And then the next question I get from people is, do I really need this? But that's a very personal question in the sense that, well, are we talking about your last $100 in the bank for the next sleeve? Or are we talking about, you know, well, I can have this or get my hair and nails done. I don't know. I don't know. Make a decision. I would, I recommend them to everyone I work with who's trying to get really amazing results, which, you know, of course is everyone I work with. Hopefully that answers your question, Shawna. If not, please query me again and we'll, we'll go through it. Okay. Is sauna use always recommended? Should people continue sauna sessions when feeling sick, underslept, or unwell? And is this too stressful on the body during those times? Again, from Shawna. Great question. So the answer is sauna, you have to gauge to the individual's constitution, which is a dynamic thing. So what I, the endpoint for sauna therapy that I like most is a sense of subjective exhaustion, which is a $20 term for I feel pleasantly tired. So if I'm trying to do sauna for me, right, and I live a pretty high-stress, high-paced, intense lifestyle, I don't sauna actively right now for many reasons I could get into. If people are curious, you can ask me. But if someone's saying, I want to integrate sauna into my day, how much should I do? I say you should go in and when you, when you feel pleasantly tired, you should get out. And pleasantly tired is a sense you hopefully are familiar with. It's, I went to the beach and sunned myself for 40 minutes and now I feel like I need a nap. It's, I went to the gym and did a moderate to high intensity workout and now I feel, you know, not like I left it all in the spin room or I didn't leave it all on the weight rack or I'm not gassed or totally, totally wiped out or crushed or annihilated or any of these other weird hyperbolic terms people use to describe workouts. But I feel like, you know, I gave a 60, 70% effort. That's when you get out of the sauna. So you have this kind of internal barometer in my belief. And some of you, I'll be honest, that's probably broken. You probably, you're the overachiever. Like we tell you to go out and eat a salad and you go out to the farm and you eat every head of lettuce and like the first two rows. And then you're like, I don't know why I have diarrhea and abdominal pain. And we're like, well, you know, salad didn't mean two rows of iceberg lettuce in one sitting. Come on now. We figured that would be obvious. You know who you are. We love you very much. Okay. So my point with that is if you don't have that kind of internal barometer, and this is all comers anyway, I say 20 to 40 minutes, 20 to 40 minutes is a good sweet spot. The main thing I want with sauna is I want you to pour out some sweat. And why is that? It's because I want you to get rid of toxins in your body. Some people will say, no, it's about the infrared light and the mitochondria and the cytochrome and the da da da da. And that's great. That's totally right. But I don't think those people necessarily understand the power of detoxification. You have to get toxins out of your body every day on a regular basis through some mechanism. And the reason why is that our modern environment is a toxic soup. It's full of toxins. I see the most amazing toxic burden in people's hair every day in my practice, mind-blowing amounts of toxins. And I just got a text from my friend Clark Engelbert, who, you know, I I love to talk and geek out about hair tissue mineral analysis with, and who taught me that in the first place, he sent me screenshots of Lawrence Wilson's sauna book, which I have on my shelf over there, of his hair tests after like 40 years of mineral balancing with aluminum pouring out because he started a near-infrared sauna protocol. Pretty compelling evidence that there's aluminum still in people today, no matter what state of health that they're in, because they're not regularly engaging in sauna. And I gotta tell you, some of the most impressive case studies in my practice, I mean, the ones where it's like, I'm like, oh my gosh, I didn't know that that was even possible. They're people who took sauna seriously. It was like a job, right? So should you do it if you're sick, underslept, or unwell? If you feel tired already, don't go into the sauna. That's my rule. So you feel, and this is a very like tough thing for me to more clearly define. Cause let's say you're really gassed or tired from a workout the day before. Well, the sauna might actually help you recover, but if you feel sick, underslept, tired, unwell, I'd rather you do less sauna. But if you don't, if you feel pleasantly tired despite that, when you get out of the sauna, it's probably a good fit for you. Okay. I also do recommend that people consult someone about things like this who's a qualified practitioner. Obviously these questions come from patients, so, you know, you can ask me in a consult, but the reason for that is that there are salt electrolyte balance issues where you need to be careful with sauna. Like I'll see occasionally a low sodium level in someone's blood, and that's a sign that that person's not getting enough electrolytes. And that's where I have a whole post on electrolyte replacement protocols that's related to sauna, by the way, that you can go read at your leisure. I include exact recipes and such. So enjoy that. Okay. What are your thoughts on different parasite protocols? Have you looked into Kim Rogers with Rogers Hood or Cellcore products? Uh, Noel. Uh, great. I've opined on this before. And so I am going to refer back to the prior Q&As. And if you're curious where those are, they're sprinkled throughout Substack. But if you're a premium subscriber or you're a practice member, you get an email regularly with a link to the Q&A document, which is a Google Doc, nothing fancy, very simple. You can search information, relevant information to your query, right? So if you go into that doc and you type in parasite, you'll get a bunch of different entries and you can see what I've talked about at various Q&As about this. Specifically to Rogers Hood and Cellcore, I have tried tons of Cellcore products and I've never had anything happen. I have had a number of patients come to me who came from Cellcore practitioners and didn't see really big improvements with Cellcore products. But I want to caution you to not to, cuz I've used Cellcore products. I, I don't suspect they're bad products. I've had some people say that they're concerned that they're contaminated with stuff. That's another story. Ask me a question about it if you want the details on that. It's a long one and it's very technical. But my patients who've tried it in the past with other practitioners, in a word, have been underwhelmed. I want to be really clear. That doesn't mean the product doesn't work. One thing that I think people don't appreciate in medicine is there's this selection bias. I get people from Cellcore practitioners who failed their protocols because that wasn't what they needed. And for all I know, 90% of the people who do the Cellcore protocol with that practitioner get a great result and are really happy with the product. I don't have a big enough dataset to have an opinion on it, frankly. Kim Rogers, I've heard of. I mean, she's got a great thing for like virality on social media. I gotta say, I haven't tried any of her products yet. It's on my list of things to try as I kind of like to try everything, but I have like a very long list of experiments and testing I'm doing, and all kinds of stuff that I haven't even told you guys about that's coming as soon as I have time to write it up. And I have one test I got to complete before I tell you all about my heavy metal detox results, which is super exciting. Anyway, that's that. And if you have more questions, just ask. What is the recommended order for vitamin C, MSM, and iodine protocols? How does someone know they've reached their max dose of C if they're experiencing loose stools? What supplements should be stopped before organic acid testing? And what's the ideal intake of potassium? Okay, hold on a minute. Let's tackle these in order. What's the recommended order for vitamin C, MSM, and iodine? So it's that order: vitamin C, MSM, iodine. That's usually the case. Sometimes if I'm consulting someone one-on-one, I'll mix it up and start one instead of another. And I have a podcast on core protocols that anyone who's curious about those protocols should listen to. Those protocols are all forthcoming on Substack. They've been behind a paywall because I needed to finance the team and the stuff to be able to have a supplement store. So the protocols are going to come out from behind the paywall. A couple weeks from now is the iodine, and then we'll get MSM at some point. If you want to see the protocols we use internally, and the vitamin C protocol is out, by the way, you can go buy our vitamin C. It's amazing. I just did a test of it versus another vitamin C, and I needed half as much of our vitamin C, almost half as much, almost half as much, to be really clear and not make a sensationalist claim that's not actually true. And then round numbers, I needed about 40 grams of our vitamin C for loose bowel movement. I needed about 70 of this competitor's, 70 or more. So that's a pretty stark contrast. That means our vitamin C is— and this wasn't like— I didn't buy like bottom-shelf Walmart variety vitamin C. I used a vitamin C that an old mentor of mine used to recommend to me and that I actually used to use and recommend to other people. I'm not going to name any names because I don't really want to find out how much the manufacturer cares that I talk about their product in a negative light. So, but yeah, our vitamin C is basically twice as potent as the one I tested it against. Wow. So people tell me our vitamin C is expensive. I'm like, yes, it is. But if you're buying something that's half as expensive and you need twice as much, then it's the same price. Plus, God only knows what else is in your vitamin C that's not actually vitamin C, which is why you need twice as much of it in order to induce a bowel movement. If you don't know what I'm talking about with the bowel movements, go to the Vitamin C Protocol. I explain there. How do you know if you've reached your max dose of C if you're already experiencing loose stool? So we'll have patients come in, they have diarrhea, they— the Vitamin C Protocol is dosed so that you take vitamin C until you have a loose bowel movement. And they're like, well, I already have loose bowel movements. How do I know how much vitamin C I can tolerate? What I tell them to do is take the vitamin, and this can break down in some context, which I'll explain in a minute. I tell them to take the vitamin C until they feel like it's causing them to have an extra bowel movement. So let's say you have 5 bowel movements in a day. I know that sounds extreme and terrible. Some of our patients have had that problem. It is what it is. Let's say you're having 5 bowel movements a day, uh, and you induce an extra one with the vitamin C. That would be your limit. I'm looking for something like 5 grams on the low end, which is like 1.5 teaspoons or maybe 1 teaspoon actually, uh, depending upon your teaspoon measure, up to like 10, 20, 30, uh, half teaspoons. And you can do the math in grams. So I'm just looking for there to be some stomach rumbling, maybe some gas and an extra bowel movement. And then I don't want people to have constant diarrhea when they're taking vitamin C. I want them to back the dose off. See the vitamin C protocol. That's my approach to that. The main thing I don't want to do is underdose people on vitamin C, because if they have a high requirement and we're gonna get a big lift or improvement clinically from the vitamin C, we need to get there. And so I want them to ramp the dose up to what they can tolerate. I don't obviously want to take someone who's having 5 bowel movements a day, which is already too many and is depleting their body rapidly of minerals and vitamins and nutrients and all other stuff that they need to live and push them to like having 6 a day because that's a disaster. And I should mention here, I think that all of this is like general educational material, not medical advice. Consult people before you do this stuff. It's pretty intense, but it is how we get results in the practice. So just unfiltered, uncensored very transparent. This is what we do. This is how we get results. What supplements should be stopped before organic acid testing? Great question. I don't have a hard and fast rule on this because the truth is a lot of the time I'm trying to get people well and I don't want them to not take the supplements in order to— and the reality is I haven't seen supplements have a huge impact on organic acid testing. If you want to know what your baseline really truly is without supplementation, then my answer would be drop all supplements before organic acid testing for 2 weeks because that will give give your body enough of a washout time for you to see what your underlying physiology is. The thing is, if we start supplements I've recommended before organic acid testing and your organic acid test is normal, it either means we crushed abnormalities that you had had with the supplements we started, or you didn't have abnormalities to begin with and we can just move on. Hopefully that's simple enough. What's the ideal daily intake of potassium? My goal is based on the fact that hunter-gatherer peoples eat 5 to 8 grams of potassium a day, and that's my It is not easy for most modern people to do that for a long list of reasons. So where do I come down on, on ideal intake of potassium? If you're trying to get people well on less than 2 grams a day, you should just expect to fail. Sad. Very sad. If you're trying to get people well on 2 to 3 grams a day, you should also expect to fail, but you might fail less. If you are going to try and get people better on 3 to 5 grams a day, you have a shot. You have a shot, but you really need to get to that 5 gram threshold, in my opinion. And there's some caveats to this, like potassium is very strongly activating of the parasympathetic nervous system, which means that some people will notice that they're like really wiped out and tired by the protocol. Well, the protocol— I would use like Zeta-Ade for these people. And in those people, I then have to figure out, okay, well, how am I going to support their energy generation while I'm also correcting their potassium deficit? And that's like a very, very, very clinical one-on-one nitty-gritty detail thing that I have to take care of in the practice. And that one's way too much for me to answer. Those are the brass tacks on the ideal potassium intake. All right. Do you recommend hyperbaric oxygen therapy? Strongly. That's just, this question's from Brian. So it's funny, hyperbarics has been written about a lot. It, it's actually one of the therapies that you can, and I will actually use this query. I will go to AI and say, are there any contraindications to or rationales for the use of hyperbaric oxygen in diagnosis X, Y, or Z? And I like that query because it will immediately give me pretty much all of the literature that that's even tangentially related to HBOT about an illness, and that will give you a pretty good idea of how strongly the literature supports it. Whether or not you recommend it for a specific patient then comes down to, do they have any of the relative or absolute contraindications? And what's your clinical judgment on their case? I have a good podcast on this coming up with, uh, Dr. Scott Scher, who I really appreciate. I, I would call him a good friend. I really like his style and stay tuned for that episode. In all comers in my practice, I would probably tell 90% of my patients to get into the HBOT Hbot tank because it's— if there's like a Swiss Army knife of integrative medicine, it's the Hbot tank. You can apply it to almost any clinical context and get a win. And that's why, you know, I have a link to hyperbaric oxygen tanks if you want to know which one I'm currently using to rehab my son with after his brain injury. I, you know, am big on Hbot. I think every house in America in the next 10, 20 years is going to have an Hbot system. And the reason why I think that is that if you're going to run out and buy even a $25,000 used sedan, right? Like a used Honda Civic. You're gonna go buy that car. That's the HBOT tank you're buying. And you can use the HBOT tank for 10 years, 15 years, 20 years if you take care of it. And your Honda whatever, your Toyota this or that is not gonna like get you another 5 or 10 years of life. So if people are like, oh, I'm gonna buy 3 or 4 or 10 or whatever it is cars in my lifetime, well, just keep the car longer and buy an HBOT tank and maybe live longer. Plus, HBOT's very time-dependent in an injury situation. So if you have like a soft tissue injury, if you have a burn injury, if you have a head trauma, the faster you get that person in the HBOT tank, the better off they're going to do by and large. You know, consult a qualified practitioner before you do these things, right? Dr. Leland Stillman is not practicing medicine via Q&A or the internet. He's just providing background context information he wants people to have so that you can get better outcomes and results. And if you purchase a hyperbaric oxygen tank through my affiliate link, I do receive a commission and I'm deeply grateful for your purchases because they help me to fuel my content production habit, which you're enjoying right now. What are the recommendations for sun exposure when someone is on photosensitizing medication? So photosensitizing is a $10 word for a $1 concept, which is medications that make your skin sensitive to the sun. So my answer to everyone, pretty much regardless of context, is you should get sun exposure as tolerated, which means that if you burn, you need to stop getting sun exposure. And this requires a little bit of like, like, don't find my content and be like, oh, Dr. Stillman said the more sun I get, the better. So I'm going to take a day off from work and go from my fluorescently lit, totally dark cubicle to the beach in Australia in the summer. And I'm going to roast because you are going to roast. You're going to get a serious burn. Don't do that. You need to gradually introduce sun to your skin and see what your skin can tolerate. And if you're on a medication that photosensitizes you, you need to do that very carefully. You also need to be aware that morning and evening and midday sun are not the same. So UV light is very, very low in its presence on Earth in the morning and in the evening, and it gets higher and higher and higher in its intensity in the middle of the day. This also varies based on latitude. And the way you figure this out is you, you just look up on the internet, what is the UV index where I live today? And you'll be able to see what the UV index is different times of day and how it's changing over time. And also sometimes dependent upon cloud cover. And the reason this is important is that if you, if you mess up the calculation of like how much sun can I tolerate, you will either underdose yourself on sun, and that's not good because that's like— sun's one of the most powerful healers we have— or you'll overdose yourself on it and you'll get a really nasty burn, and I don't want that for you. So hopefully that answers that question fully. What should someone do if they can't tolerate even small doses of iodine supplementation? Shawna. So my recommendation to them is look at Dr. Stillman's detox powder. That recipe is currently reserved for premium subscribers. It is coming soon to a public link. I just, I, I have too many things to publish. It's backed up for weeks, but it's coming. And I would use the detox powder formula. Premium subscribers, if you look up detox powder in the Substack, you'll get a detailed recipe. I love this stuff. My patients love this stuff. They routinely tell me that the detox powder is one of the big needle movers for them in their cases. And if you're wondering why you can't just like go to Amazon and buy it, it's because I do not have enough time and money to make it privately. And if you would like to help me make that happen, because it's an awesome product, it's better than anything else out there, please buy stuff. Because that is how I will have the time to do that. Okay. What are your thoughts on zeolite supplementation, David? Okay. So zeolite's a really cool supplement in the sense that it's a really interesting idea of this alumino— alumino silicates. Say that 10 times fast. I might even have butchered that. It might be something else. Basically, these are lattices of silica and aluminum. And what's interesting about that is that orthosilicic acid replaces aluminum in the body. And escorts it out. That's Chris Exley's work, the dean of aluminum research. And zeolite contains aluminum and silica, and it's supposed to detox people, and people swear by it. I see so many testimonials. If you have a testimonial about zeolite, there should be a testimonial link in these posts now. I'm going to remind Christie, who pushes send on them, to make sure it's in there, because I get these testimonials or see them online of people who are like, zeolite changed my life. I got so much better. My toddler's tantrums went away. My behavioral problems in myself or my spouse or whatever disappeared, or my pain or my this or my— I mean, amazing stuff, right? The thing is, I came out of a school of thought mentorship that didn't use these binders, and we didn't cover them in a lot of detail. But the idea was basically, if you put the right things in and you get people to sauna and earth and walk and do the things that we tell people to do, things in the 14-Day Reset, supplements that in this online supplement store, if you just get them to do that, you're not going to need binders. Overwhelmingly, I've found that to be true in my practice. I have a really interesting case right now of a woman who doesn't feel good no matter what we do. And it's like, I feel like I've thrown every last thing at this and it's like she's not feeling better consistently. And finally we did a urine-provoked heavy metals test and her barium levels are like 10x the upper limit normal. We don't know where the barium came from. We're trying to sort that out now, but I queried a friend of mine, Lisa Patel-Killer from Vykon Customs, who we source a lot of our mineral balancing supplements through. And she said, I've seen that before. That's why I get labs from a different lab that tests barium levels in the hair. I use zeolite for that. And I thought, oh, that's interesting. So that is currently where we're at with that. And when I give you that for, I give you that for context because she's one of a tiny handful of cases in the practice where they don't feel 50% better in the first few months. And when I say 50, like tiny handful, great. Of 90 cases we surveyed in the first half of 2025, uh, 95% reported they were 50% better within, within their period of time with us, which ranged from like a year and a half to like 3 months. Most of our patients coming out of programs report 50% or greater improvement during the program. The ones who don't appreciate us and, and like the care so much that they stay on as members anyway, which means we must be doing something right. And I just talked to one the other day, one of very, very few people who didn't reach that 50% mark. Benchmark with their initial program, which by the way was the shortest program, right? So people who do longer tend to get better results. She is now like 50% better in a bunch of different metrics, and a lot of her problems completely resolved. Fun fact, it was when she stopped the vitamin C that she felt better, which tells me or makes me suspect that the vitamin C was driving some detoxification of the body. I can't prove that, but interesting little tidbit there. So what do we do about Zeolite supplementation? I'm just open to the idea of doing it. I don't— I, I, I'm very skeptical of the premise that everyone needs it, day, and I would just think, you know, I would work with a practitioner to try and figure out whether or not you need it. All right, are there any tests available for detecting graphene oxide exposure? Also David, I have not seen any, but it'll be interesting to see if people come up with them. Okay, if a 24-hour urinary hormone test is collected on day 20 instead of day 19 of the menstrual cycle, does this significantly affect results? So it will affect results, but it will not affect them enough in my book to be worth recollecting, and I would just keep this and I would send it to the lab. How can you determine if hormone replacement therapy dosing is appropriate for women using testosterone? So, uh, this question comes from, uh, Jerry. So the, uh, the question here, or the, this, when I look at hormone replacement, I always get out my handy-dandy hormone replacement cheat sheet. And if you want this, it's a PDF that you can download from Dr. Stillman's Guide to Balancing Hormones. I think it's female hormones. It's something like that in menopause. If you look that up, it up, you'll probably find it. And this is very simple. There's the symptoms of too little hormone and the symptoms of too much. And I just— if there's too little, we ramp up until we get to too much. So symptoms of too much testosterone— or too little testosterone: diminished libido, loss of sense of security, body hair loss, diminished energy and stamina, flabbiness and muscular weakness, particularly in the upper thighs, upper arms, thighs, and cheeks. Too— and too much testosterone is manifested as hyperaggressiveness, excessive oiliness of skin, increased pimples and acne, increased hair growth on body, face, and/or place of application. Not listed here is sometimes women will describe like an irritatingly high libido, like they feel, and they're frustrated by it. They actually find it very distracting. Those women have had a tiny, tiny taste of what testosterone does to men for most of their adult lives. So when women are like, men should control themselves better, men shouldn't look at whatever, men should— it's like, have male testosterone levels, find out how hard it is to actually control yourself. That's why modesty laws exist. But I digress. How do you figure out if you're on the right dose? You should not see the symptoms of excess and you shouldn't see the symptoms of deficiency. There's a big window here where it's like, well, I don't know, I'm not as muscular as I was when I was 20, but I'm more muscular than I was before I started the hormones. So should I increase the dose? And the answer is not necessarily yes. When you're somewhere in that window, we do a 24-hour urine hormone test and that urine test, that is, and that's when we figure out, okay, are you underdosing or are you overdosing? And that's just how we do hormones. At my practice. I want to tell you all something really interesting about this that does occasionally come up, which is, can we test blood levels? They're faster, they're cheaper, they're a lot easier to test. You can test blood levels. What I want you to know is that for women to have optimal testosterone function and be free of symptoms in menopause, you actually usually have to drive them to a supranormal— and a higher than normal testosterone level. And And they'll often worry about that or freak out about that because they'll say, oh my gosh, I have a 270 testosterone level. And I freaked out about that when I was a newbie as well, because I thought that can't be right. That doesn't seem like a safe or smart thing to do. But the truth of the matter is that in the hormone replacement literature where we've seen higher than normal or higher than physiologic testosterone levels in the blood, these women tend to do better across a variety of metrics. And so if you do test your blood testosterone level, don't be alarmed as a woman on testosterone in menopause or postmenopause. Don't be alarmed if it's very high. The free level matters more. I don't check blood levels of hormones most of the time, and the reason I don't check them is that they are notoriously unreliable. What I mean by that is there's a significant amount of day-to-day fluctuation. A skilled clinician who orders them regularly should be able to read through that that and take an adequate history to determine if the person needs more or less hormone in conjunction with the test. This is one reason why I'm such a critic of direct-to-consumer lab testing. There is so much nuance. There is so much detail that goes into interpreting these tests. The only thing that would, would make sense if with direct-to-consumer lab testing is if you had like a massive and very well-trained large language model from a very qualified clinician and you had a lot of data collection from the patient that gave you the clinician all the context they needed. Did you take medication or hormone, when did you take it, how much did you take of it, what route of administration did you use, how often do you take it that way, like an enormous amount of information. So we use all of that data to then make a decision, clinician and patient, about what the optimal dose of testosterone is for the patient based upon that interpreted through what we know from the literature. That's how you determine that question. What do you recommend for addressing tick bites? Okay, uh, this is from Joel. So great question. Uh, it comes up occasionally in practice because I book out 2 to 4 weeks weeks. We're working on a system where VIP patients in the VIP tier can get access to me within 1 to 2 days these days. We haven't totally fixed that yet, so it's coming. No additional fee to the VIP folks. And the, the reason is I kind of had to split this difference. And if you're a practice member, I'm happy to get your feedback on this. I had to kind of split the difference between, okay, I'm booking out 2 to 4 weeks. If I'm gonna, I don't want patients to book out longer than that because I, then I can't address problems proactively in a reasonable frame of time, but the only way to I have fewer consults is if I either fire patients, that doesn't feel right. And it's actually like legally not allowed in some respects. It's a long story, not very interesting though, so I won't tell you. Or I raise prices and people just quit because it's too expensive. And that's like the, the like business owner, you know, make the most money answer. I haven't done that either for various reasons, but basically what I decided was, okay, I can't, I can't cover all my patients the way that I would like. I'm too booked up. We're going to book out 2 to 4 weeks, which means I basically can't do urgent care for the people who are not in the VIP tier, but I'm going to be available same or next day or the next 2 days, business days for the VIP tier, because I do want to be able to tackle this. So if you find yourself in a scenario where you either are not my patient or you're in the wellness membership and you cannot get an urgent appointment with me or another member of the team who's qualified to handle this, this is how I approach it. So first of all, what is the tick? You can easily look up what tick carry infectious diseases and which ones don't. I, I have friends in the 'there are no viruses, there are no bacteria, this is all a big scam' camp. I'm not in that camp. I love and believe that antibiotics have an important place in modern medical care. And so when I've got a patient who's got a good story for a tick bite that could have contained or, or transmitted some kind of illness to them, I'm happy to write a prescription for an antibiotic. And I would rather do that than flirt with the possibility of something really ugly like Lyme disease. So that's my general approach to that is I actually follow the standard of care. I don't always follow the standard of care because I do functional integrative natural medicine. We have a different way of doing things. If you didn't know that, welcome. But I actually do pretty much do exactly what my colleagues do for, for tick bites when they happen and there's concern about some kind of infectious disease. Okay. What are, and by the way, if the tick doesn't have a serious chance chance of, of transmitting Lyme disease, I don't treat it. I watch and I wait. What are your thoughts on pyroquinolone, quinone for fertility and ovarian reserve protection? Are there any considerations regarding increased likelihood of twins? So I haven't deeply researched this topic. I would like to before I opine. That's what I would like to do. What are your thoughts on folate and B supplement for fertility and neural tube defect protection when an HTMA shows certain metabolic patterns? Also from Becca. First question was from Becca. This question's from Becca. I use 1.2 milligrams of folate and 0.5 milligrams of B12 in every nutritional balancing protocol I do at this point in my practice. And the reason for that is that before I did HTMA, I did tons and tons of NutrEval, which is an organic acid test plus blood test from Genova Diagnostics that has markers on it for folate and B12 status. And what I did was I realized that tons of people have folate and B12 issues, not surprising, and they usually line up with a slow oxidizer pattern. On the HTMA. So in the slow oxidizers on the HTMA, I was covering them with these, but then I started to cover the fast oxidizers because they'll often have the problem as well. And we're covering both now. We don't see any negative effects of this. Our protocols for hair tissue mineral analysis, nutritional supplementation, are, I think, really well dialed in. I'm sure they could be better because it's planet Earth and nothing and no one is perfect, but I'm working on it. And so they're working really well. Patients are getting great results. They're also tolerating what we're doing really well, and that's super important because when I was more aggressive with certain supplements, I found that people would just bail on the therapy because it was too— it was too unpleasant. I made the protocols a little bit less intense, and we're still getting great results, and we're covering everyone with folate and B12. If I see or have— or if something does not make sense, I will get an organic acid test to make sure I'm covering their folate B12 requirements adequately. Recently we had a case of someone who— very complex history, but she did need, and we did pull the trigger on injectable B12 for her, and that's just got to be a clinical judgment. One of the reasons why I don't open with a NutrEval or an organic acid test anymore is that for best results, I still want the hair. So I got the hair and the NutrEval. Now it's like $500-something, $600 in lab testing costs. I want to do that quarterly. So now we're at like $2,400 in lab testing costs per year. Not— I mean, you know, and here's the thing. I did a lot of samples of HTMA compared to NutrEval. When I looked at them, I did not have a lot of scenarios where I said there's a big difference between my protocol based on the NutrEval versus the HTMA. And so I just said, I'm getting the same results with $100 of testing versus $600. And as someone who feels like they should be a steward of their patients' finances and not just spend money like it's water on lab testing, I just said, well, if we're not going to get any worse results, are we going to do all this extra testing, which also turns into more time spent with me analyzing and interpreting it, which then means I can take care of fewer people and get fewer people great results. So I said, okay, we can do the same quality of work for more people with less testing. And it's way more convenient. There's no FedEx with HTMA, you know, it doesn't spoil in the mail. I got a great post on HTMA coming out to you guys. It's going to be really, really interesting in the next couple of months, probably. So hopefully that So, okay, but you asked me specifically folate, B12 for fertility. I cover with the recommended dose of folate in, in pregnancy. And I don't remember what it is for B12, if they recommend a baseline for fertility, but I wouldn't deviate from that. And that's largely because I am not a fertility expert. It's not what people tend to come for me, come to me for. They will come to me because they're really sick and they can't conceive. But once we get them healthy enough, I haven't had people needing a ton of support support for their fertility. For those living in northern latitudes with limited sun exposure, what are the considerations between natural light exposure and therapeutic lamps? From Becca. Okay. So if I lived in a cold, dark place, which I have, and I would again, because I like them and they're, it's fun to have the four seasons. What I would do is I would have a Sperty vitamin D lamp and I would have SaunaSpace. It's my favorite sauna, discount code StillmanMD. They think they have a Black Friday sale going on. Good time to pick it up. It's a big ticket item. Your affiliate commissions to me help fund and fuel my content production obsession. Thank you very much. I appreciate it. I really do. So I have a SaunaSpace and then I have a Sperty D and I would set those up and I would use them every day in a, in a cold dark place. If I couldn't tolerate sauna, I would use something like an EMRtek. If you want a discount code for that, it's Leland Stillman MD, and I've got a whole, like, whole post on infrared and red light. It's a guide to red and infrared light therapy. I would use an EMRtek model like the, I think it's the Inferno. I really like the Inferno. It's a big long panel. I've used that lot. Those are my 3 picks for products. Then this gets into the weeds of like, should you be taking an oral vitamin D for some reason versus UVB light? And I like the UVB light for all comers, but I like the vitamin D for some of my patients who I'm trying to treat like an autoimmune or an allergic condition because you can overthrottle the vitamin D, which people will fearmonger you about, but they're wrong. It's a great option for that. Okay, that's all the time I've got for questions today. I've got some extra questions from the public Q&A that I'm going to kick over to next week because I had so many from my practice members and premium subscribers. If you would like to take your question to the priority list, upgrade your Substack subscription or become a member of the practice. I appreciate all of you for listening, for your purchases. Thank you for your support. It also really means a lot to me when you share what I'm doing, and I want to tell you why. I hope you, you'll share it. I'm, I hope you'll share it because the more people I reach, the more content I can make for free. And that I think is really noble and important, and I would like to make more of it because I answer these questions all day in my practice, and I've just realized I can't possibly see everybody in my practice. It just is not physically possible, temporally possible. But I would really like to have all these answers out there so you guys can, can have the benefit of the education, the context, the understanding, because it just— I just get one patient after another wasted money on labs, wasted money on supplements, wasted money on consults. So much waste. Waste in American medicine and a lot of waste in integrative functional medicine, just bad product. The, the example I gave you earlier of, you know, the vitamin C I tested versus our vitamin C that you can buy at the Shopify store, links below, that vitamin C, it took me almost twice as much to get the same effect. Amazing. That's amazing that it takes twice as much. And this fits with my friend Russell Jaffe's statement to me. He said, look, Leland, I know from testing that 30 to 70% of the vitamin C on the shelf in the supermarket, grocery store, Amazon store, whatever, 70% of that is not vitamin at all. And that agrees with my clinical experience, which has been that when I used less high-quality, lower-quality vitamin Cs, I didn't get the same kind of stories and testimonials. You know, people felt better, but it wasn't anything like what I've seen with the high-dose vitamin C protocol with the high-quality vitamin C we stock now. It's just a night and day difference. And so I'm passionate about really creating a high-quality experience, getting great results, great product, high integrity in everything that we we do at the medical practice here in my content. And so I'm just deeply grateful for all of you for being here, for sharing the content with other people, and for your purchases that help me to do more. And if you have questions, suggestions, feedback, requests, happy to look at them, although I can't do everything all at the same time, you know. Yeah. So thank you all for joining me. Take care. Have a great week. We'll see you next week.