Uncensored Q+A: Calcium, Gallbladder & Autoimmunity

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Hello everyone, Dr. Stillman here. I am delighted to be coming to you as always to answer your questions. As always, thank you for your purchases from various supplements from the supplement store that we've just launched. As well as your premium subscriptions. Premium subscribers get a deep 25% discount on the supplements, which is pretty amazing. We worked hard to create that for you all, and we really appreciate the premium subscribers. They are how we're able to put out as much great content as we do. So without further ado, let's jump into this week's questions. So Donna, why might calcium be removed from one nutritional balancing formula compared to another? So let me talk a little bit about calcium formula formulations and calcium being included in our products. So calcium Calcium is a really tricky mineral. You need calcium to be alive, obviously, and you actually need pretty high doses of it. Calcium is not in NPK fertilizer, which leads me to suspect that our calcium intake's just across the border lower than historically. I believe it's been pulled out of our soil by successive generations of farming. And calcium is also, you know, the single densest food source is milk. Which a lot of, of people are avoiding because it doesn't agree with their digestive tract for one reason or another. Calcium medicinally in the, in the, and this really only is of interest to people in like the hair tissue mineral analysis world. When I look in like the conventional world and even most of the integrative world, most people are not interested in calcium, which I think is a huge error. By mass calcium, I think is, yeah, I think I have this right. Calcium is one of the most, if not the most abundant mineral in your body. To give you some scale here, you consume on average about a gram of calcium a day. Depending on what your diet is, you consume hundreds of milligrams of magnesium up to maybe a gram. You consume grams of sodium and grams of potassium, but the calcium is supposed to stay in your body. It's supposed to basically animate your muscles. It allows your muscles to contract. It's supposed to help your nerves fire. It's, it's supposed to make up a huge proportion of your bone mass as well as having other physiologic properties. So calcium is really important. And with low vitamin D, you don't absorb enough calcium. And this is where it gets tricky. In most of the integrative functional space, people are not using calcium supplements because they're using vitamin D and they're maintaining that the vitamin D is going to pull enough calcium into the body that the body will not need any more. You'll also find that the minerals like sodium, potassium, magnesium have very— as well as copper, zinc, manganese, molybdenum, et cetera. They all have these interesting therapeutic properties, but calcium is more subtle. I don't think it's less powerful, I just think it's more subtle. And in the functional integrative world, most people are using calcium, or rather vitamin D, in order to raise calcium levels or improve calcium absorption, whether they realize that or not. In the hair tissue mineral analysis world, there is a school of thought that people need way more calcium in order to balance their minerals and eliminate heavy metals. And I came out of that because Clark was the first person that I spoke to about HTMA and learned the pattern recognition from him. And in that world, you may use grams of calcium a day supplementally. So you may push someone to like 2, 3 grams of calcium a day. Why is there this split in this world of calcium supplementation? And I'm not even talking about the allopathic world where it's like they don't even know enough about calcium to bother even talking about. Well, it has to do with where calcium is and where it goes. As the body becomes more and more diseased, it tends to lose control of calcium and calcium ends up going into things like arteries, kidneys, your gallbladder, vital organs, your brain. We call this dystrophic calcification. It's calcium in places it's not supposed to be, and we don't want that. There's some concern that maybe high, high doses of vitamin D are driving dystrophic calcification, but that's very contentious because, you know, in the, and then the, in the functional integrative world, we're not just using vitamin D, we're using magnesium, we're using vitamin K2. These things have properties to help help direct the calcium to better places so it doesn't become dystrophic. A lot of this comes down to bioidentical hormones, which also control calcium and where it gets deposited in the body. In the case of, say, high-dose vitamin D therapy, la, the Coimbra Protocol, which we're learning, training in, investigating, and rolling out in the practice, they'll go with like huge doses of vitamin D, that is, that actually require you for safety to reduce your, your intake of calcium below like a gram, or their rule 500 milligrams at their doses, which are very, very high. We don't go that high immediately, which is why we'll allow people to just do a restriction to a gram of calcium a day. And if this seems academic and kind of out there, that's because it is. This is like really deep in the weeds, cutting edge. And the thing is, we have data like you don't, you don't get a survival benefit with more and more vitamin D. Seems like the sweet spot is something like 5,000 IU vitamin D a day or even less. Is There's many reasons why that may be. It may also not be true on a long enough time horizon. This is getting into like research methodology, which I don't really want to do. So yeah, it's complicated. And at the end of the day, why would we include calcium in one formula and not another? I've started dropping calcium out of my formulas because I'm using higher doses of vitamin D, and in most of the people where I'm planning on doing that or I am doing that, I am leaving the calcium out so that I can do the high-dose vitamin D protocol later. That's why I know that was like a lot of context and setup for that, and I don't even know if it all— it's a very nuanced, complicated, very academic question, but I decided I was gonna give you all that context and hopefully you enjoyed it. There are still gonna be cases, I think, where I use calcium, but I'm not sure exactly who's right on how much calcium is optimal in clinical practice. I think that's a very open question. You have the one camp over here that says we get amazing results with high-dose calcium. Everybody's gotta be on it. Should be in every protocol. You have another camp over here that may contains otherwise. And, you know, frankly, they both seem to have lots of raving fans and very happy patients. And so who's right? Maybe one day we'll have the data and we'll be able to say. But that's why I've stopped using as much calcium as I was. Jessica, what are your thoughts on orthodontic treatments, particularly regarding the long-term presence of metal and other materials in the mouth for a child with insufficient space for incoming teeth, a smaller palate, airway problems? When an orthodontist presents two options, tooth extraction or braces, what approach would you recommend? Previous interventions with customized mouthguards have shown some improvement, but not as much as hoped. Considering factors like potential toxicity, airway health, and financial constraints, what would you recommend? Very, very big question. I can't practice dentistry because I'm not a dentist via the internet. And I also can't practice medicine via the internet. All this is for general reference, not— you should talk to a qualified practitioner with about these things. What I found with dentists is it's really important to have someone you trust. So I have a dentist I trust in Tampa, St. Pete. His name is Tom Gilton. I will still drive to see him because I trust him so much. He was my best man. At my wedding. And so when I had orthodontic issues, I went to him and I asked him what I should do. And he gave me a very specific referral to an orthodontist locally. And that is who I went to see. And I went with his treatment plan. These can be very, very tough cases. I know from my own experience as a patient, not as a provider. And I think it's, I think the number one mistake patients make when it comes to dentistry is not getting an abundance of second opinions in tough cases, or when a lot of work is recommended. And I have to say this, I've had cases where a patient went to one dentist who said, you need X, Y, Z fillings. Fillings, they went to another dentist and they said, you're fine. Come back. You got a little bit of demineralization here. Fix that with some hydroxyapatite toothpaste. Come back in 3 or 4 months for a cleaning. Dentists have a horrific reputation for what is called drilling and filling. Let's just— they got them in the chair. Oh, that's a little brown spot over there. We might not really need to drill and fill that, but we're going to do it because we can bill whatever for it. And patients don't know any better. I don't like to say that publicly, but that's the God's honest truth. So I like to get multiple opinions when it comes to dentistry, and I like to not inform the dentist of what the other dentist said. I just show up and say, hi, I have teeth, you're a dentist, let's go and see what they actually say. And I had to do that because when I was working with, with Tom initially, I was not in Tampa and I was so frustrated and disappointed with the dental options I had out of Tampa. I said, well, look, I'm just going to fly to Tampa and get this done in Tampa. Very impractical, very inconvenient. Not necessarily my recommendation, but that's how much I think trust should factor into this decision because you only get one set of adult teeth. Cliff, regarding tetrahydroferfuryl disulfide, what is the upper recommended limit for supplementation? What's the appropriate duration of use, and are there any potential negative effects associated with extended periods of supplementation with this? What a great question. So I have become fascinated by the use of high-dose thiamine, and specifically a form of thiamine called tetrahydroferfuryl disulfide— say that 10 times fast— which is a form that has become popular for the treatment of various illnesses specifically. I was just learning about this the other night in, in this book about thiamine therapy for Parkinson's. So apparently a high-dose thiamine therapy can be useful in the treatment of a variety of disorders. I've been recommending it more to patients recently. And so far one case, one patient has tried it and been very, very pleased with the results. What is the upper recommended limit for supplementation? I don't have one. It seems to be totally nontoxic. I'm not aware of or familiar with anyone who's ever overdosed on this product. And I've looked into it and it's people in the world of Parkinson's and neurological illness. The doctor who did this work is a guy named Constantini, a deceased from Italy. He was going up to multiple grams a day. We usually dose thiamine in hundreds of milligrams a day. And in our standard formulations in the practice, most of the patients wind up on 100 milligrams a day or 200 milligrams a day, something like that. So to use thousands of milligrams a day, you would think there would be long-term complications, but apparently there are not. And there are people all over the world who can attest to the power of high-dose thiamine supplementation for the treatment of their illness. There are many forms of thiamine. TTFD, or tetrahydrofurfuryl disulfide, uh, is the long name for it, seems to be the most effective and the one that penetrates the blood-brain barrier the best, and therefore is the best for neurological issues. So what's the upper recommended limit? I'm not familiar with a dangerous limit on this. I will tell you that the therapeutic window where people get results is anywhere from a few hundred milligrams or 100 milligrams at the low end, up to thousands of milligrams or multiple grams a day. What is the appropriate duration of use? People seem to be using this for years and years and years for chronic neurodegenerative diseases like Parkinson's indefinitely. Now, I want to point out here, I'm very passionate about teaching people and, and talking to people about how to think about therapeutics. And I always think about therapeutics as I don't I don't want to just patch tires. I want to fix underlying problems in physiology. How do we do that? Right? So we do that by eliminating toxins from the body, by purifying the body of, say, infections if they've taken root. We do it by nourishing the body with all the things it needs. But at a certain point, let's say that somebody has Parkinson's and we're doing all those good things and they're doing the sauna and they're eating the healthy food and they're taking tailored supplements based on lab testing and all the rest of it. Right. And they're still not getting better. Well, we still want to give them some relief. So why not use something like, say, high-dose thiamine therapy. Makes sense to me, right? I would certainly do it if that were me in the, in that position. So you go to a high dose, you find that it's therapeutic. The question, patient says, how long should I use this for? The only reason I wouldn't use it indefinitely is if I think, and I, even then I would still consider it. What I don't like to see patients doing is using therapeutics to enable a dysfunctional lifestyle and unhealthy habits because that is going to end up haunting them in the end. On the other hand, it's not my life. It's not my money being spent on supplements. It's not ultimately my business. I just feel it's my responsibility to inform patients, hey, yes, your high-dose thiamine is improving this, that, and the other thing about your life. But in the end, it's probably better if you fix these underlying lifestyle issues that are probably making you deficient in it in the first place or reliant on it to mitigate the effects of these, of these bad habits rather than you just taking these high, high doses of it for the rest of your life. And I, I will often use a therapeutic like this in the following way. We're fixing the diet and the lifestyle and the environmental factors of disease. And we plan to taper or end or stop the thiamine therapy in the future. I call it a bridge to a better place. The thiamine gives us therapeutic relief and also accelerates results right now. That's the bridge. The better place is where we can stop the thiamine because we've fixed the underlying causes of disease. And that goes back to my favorite quote from Hippocrates, which is the greatest medicine of all is teaching people how not to need it. I don't know why I'm so obsessed with that, but I am. It just seems like the right thing to do. So appropriate duration of use, as long as is necessary. To control symptoms, create good quality of life. And that may be the rest of someone's life. I have to mention that there are cases in which I suspect the damage done is too deep and someone may well be dependent upon a supplement for the rest of their life, no matter what. Those are the— that's how that is. Potential negative effects with extended use. I'm not familiar with any reports of adverse effects from supplementation with this. It seems to be entirely safe in Very high doses. Danielle, can bioidentical hormones be used to treat endometriosis? What other treatment options are available for managing endometriosis? So bioidentical hormones can be used to mitigate some of the symptoms of endometriosis, but I'm not familiar with them being used to treat in sort of a root cause way endometriosis. I'm not an expert in endometriosis. I tend to refer out to my friend Dr. Salomeh Mousgadi, who is an, not just an obstetrician and gynecologist, she's actually trained in gynecological surgery, which means that she is the kind of person that— the specialist who would do these sorts of surgeries to remove endometrial implants within the body. What I believe very strongly is that endometriosis and other diseases of the— that are associated with female hormonal abnormalities, and I guess I'll say like sexual health in general, the reason why I think these diseases are rising is the contamination of our environment with things like heavy metals, industrial chemicals, agricultural chemicals, herbicides, pesticides, All the things that you probably know about because you are here and you've heard of me. Most of you are very savvy about these things. And so when I look at a case like this, I, I will refer out for the treatment of endometriosis, but I will look at the case and say, what is in the patient's body that is causing them to have this very abnormal physiology? That's very distressing, sometimes downright disabling because of the pain. And what can we do in order to solve that? This problem, right? And that to me is all about detoxification of the body, which is a combination of— we've got to nourish the body, got to do things to detoxify the body with either supplements or sauna. Put those things together, that's how we get people enduringly well. And then you can use bioidentical hormones in order to manage some of the damage. I do unfortunately suspect that people today are so polluted by these chemicals that increasingly to have normal function, they're needing higher and higher levels of hormones. And that's why we're seeing more and more more people go on bioidentical hormones earlier and earlier in life. And in the men's health world, we're hearing stories of men in their early 20s with basement levels of testosterone. I mean, no testosterone around. Very distressing. I would point out, by the way, though, that we've been having— we've been producing toxic chemicals for generations now. Isn't it interesting that this is taking off in the last 5, 6, 7, 8, let's call it 10 years? And what big technological innovation has come about in that period of time? These— and I'll just leave it at that, because if we put this out on YouTube and Instagram and places like that. Saying bad things about wireless technology makes you very unpopular and can get you deplatformed, like my friend Meredith Oak, who had her YouTube channel just completely deleted out of the blue. No warnings, no courtesy call, no, hey, stop talking about how toxic our product is. Just gone overnight. Anyway, Noel, why do you think gallbladder issues and gallbladder removal surgeries have become so common? What sort— some sources suggest that high triglycerides may encourage gallstone formation and that nerve damage affecting gallbladder contraction Could be a contributing factor. What are your thoughts on gallbladder health in individuals who maintain a healthy weight and diet but still develop significant gallstone issues? So this is a great, great question. Number one, gallstone surgeries have become common because they're reimbursed for by insurance and they can help surgeons to make a good living. Be totally blunt. There's no respect for the role of the gallbladder in conventional medicine. It's kind of like, well, we can take it out and there's no downside, right? They're wrong. There is a downside. There's a long-term increase in the accumulation of toxins. I have not seen this born out in the literature. And what I would like to see and compare is do the people who have their gallbladders removed surgically have different mortality and life expectancy than the people who don't? I don't know if anyone studied that, but that's the study I would like to see on this. What I believe is happening with gallbladder, poor gallbladder health is it comes back actually to specifically to choline. So choline is a nutrient that we need. It's, it's been considered or suggested to be considered as a vitamin. It's so vital to health and choline's very, it's, it's very thin, I mean, and it thins bile, and so do phospholipids. So like when we in the mineral balancing world are dealing with something, somebody who's having a detoxification reaction, first of all, put it— we'll put everyone on bile acids. Why? Bile acids cause the body to remove more toxins because as you put bile acids in, they bind to toxins, and at the end of the small intestine, the body resorbs bile acids. Because they're very expensive to make and the body needs certain key ingredients, one of them being choline, in order to make them. And because the body has only so many of them, it will resorb more if there's less in the tract, GI tract. So the less bile acids you have, the more you're going to retain toxins. Isn't that interesting? And you know, I recently had a case where we dropped this woman's bilirubin from 1.6, which is elevated, to like 0.6. Which is very normal, and she developed severe copper toxicity. I'm not just talking on her hair test. Her hair copper was elevated, her blood copper was elevated. She had severe symptoms from this. She's feeling much better now that we're getting this down. You eliminate the copper that you, you have in your body through your, your bile, and people don't realize this is actually very important. So we put bile acids in. As we put more in, the body excretes more of them, i.e., lets it go out through the rest of the GI tract. And as you put bile acids in, you will drop total toxic burden from all kinds of toxins— heavy metals, xenoestrogens, xenobiotics, all the industrial agricultural chemicals I mentioned earlier. And that's one reason why I'm incredibly enthusiastic about bile acids. I think they're one of the most underrated supplements out there for people who do or do not have a gallbladder. For the people who don't have a gallbladder, I'm very insistent that they take them with every single meal for the rest of their life, just so they have that normal physiologic function going on. So as our diets have changed and as our environment has become more and more polluted, we've seen this rise of gallbladder issues. This probably has something to do with hormonal effects on gallbladder flow function, et cetera. But that's way out in the weeds of hepatobiliary physiology. And I don't know enough about that to opine on it. I'm just taking a wild shot in the dark on that one. You know, a really informed shot in the dark, I guess I'd say. In mineral balancing, we want to thin the bile because we can then get more toxins out of the body. People feel better when we do that. So we use things like sunflower lecithin. What is sunflower less than have a lot of phosphatidylcholine and other phospholipids. Why are phospholipids important? They're very important for the health of your neurons. Did you know that there are protocols like Patricia Kane's protocols, the PK protocols, for introducing phospholipids into the blood, into the blood, and therefore the body intravenously? Very rapid administration. Some people will have very profound healing as a result of that. I'm not clear on how effective it is in terms of this many people present or go through the procedure. This is what the kind of results they get. I'm not clear on that, but seems to have a lot of promise. So we We give these things supplementally in order to improve bile flow, sunflower lecithin, and potentially things like choline. I actually take choline citrate every day. You can buy choline citrate in our online dispensary. I like it. Actually, I love it. I think it tastes great. It's a liquid. I take a teaspoon a day, so like a tiny 5ml volume. I just put it in water. I'll add vitamin C most of the time because I think they taste really well together. And why do I do this? Choline helps us to not only thin the bile, it's also a precursor to the neurotransmitter acetylcholine, which runs your parasympathetic nervous system, which allows you to relax. So if you're feeling stuck in overdrive, maybe you have a choline deficiency. Did you think about that? Choline, like I said, is also required for optimal neurological function. So I take it for that reason. Acetylcholine is the neurotransmitter of memory. Boy, do I care about being able to remember all the things that I'm supposed to remember in order to just do my job. So anyway, strongly encourage you guys to try the choline citrate. Another reason is it helps with the absorption of magnesium. A lot of people don't realize they can't correct their magnesium deficiency because they don't have enough choline and you need choline in order to get the magnesium into the cell. Really interesting chemistry there. So this is why I recommend that people eat a varied diet with nuts and seeds and animal proteins and fish, because if you get enough healthy, non-rancid— and this actually goes back to another principle of chemistry— so you need to not have rancid fats in your diet. If you look at the people who wind up with gallstones and gallbladder surgeries, they tend to rely on a lot of ultra-processed food. And the more you rely on ultra-processed food, the more likely you are certainly to get gallstones. What does ultra-processed food do? It tends to hydrolyze hydrogenate and to oxidize, i.e., make rancid the fats within it. And as that happens, the fats will tend to become more stable and more viscous, which means that they have a higher resistance to flow, which means that they are more likely to become concrete, be turned into a ball, a stone. Nuts and seeds and fish oils are liquids at room temperature. They're liquids until you get down to cold temperatures. Like you can put a lot of nuts and seeds like fish oil, for example, or those seed oils in the refrigerator and they still be liquid. Now, I'm not a fan of nut and seed oils, and I really prefer fish to fish oil, but I am gonna be honest with you, I still take fish oil every day for various reasons that I'll be talking about in an upcoming blog post. But let me wrap this up cuz you asked a big question. I feel like I've been talking for 20 minutes now. People are having more gallbladder surgeries and more gallstones because they're eating ultra-processed food where the fats have been either destroyed or selected to be more likely to form stones. They're not eating traditional food sources in high quality where the fats are still intact. Where they're eating nuts and they're eating seeds and they're eating cold water fish that's got healthy fish oils and omega-3s in it. And then they're introducing all kinds of toxins that are gonna make the fats even more rancid. And so, bada bing, bada boom, you get a stone. All right, that's it. Thank you for your question. Cliff, what are your thoughts on using Praziquantel at a 700mg dose? Could digestive issues combined with a B12 and B9 deficiency despite supplementation potentially indicate a parasitic infection such as tapeworm Could this also be related to symptoms like bruxism? This is an interesting question. So yes, that all seems reasonable. I've not used ProziQuantel in practice. I'm open to it. The diagnosis of parasites is very tough. I don't actually test for them anymore because the test is so often negative and patients so often feel better on antiparasitics or after antiparasitics. So what we do in the practice is we give people an herbal protocol of antiparasitics, very mild, very bread and butter, very sort of sort of, these are antiparasitics we know work. I have yet to have anyone have a kind of like amazing life-changing result with these antiparasitics. And for that reason, we're now adding and changing and using more and different protocols. And if you have, by the way, an interesting herbal protocol that you've seen work, particularly from a specific company, I'd love to hear more about it because as soon as you get into parasites, it's like a huge world. Everybody and their herbalist around the corner has their own unique thing and they're like, no, this is the spiragic berberine that we collected from the Atlas Mountains in the Full moon of— and you're like, why does this matter? Like, people go crazy about parasites and I'm not saying they shouldn't. And there, I do intend that as a pun because parasites can drive you totally nuts. But I haven't settled on a favorite for antiparasitics and I've used a variety, wide range of products, spent hundreds of dollars on antiparasitics for myself and I've never seen anything happen. So let's just say I'm underwhelmed at this point. Is ProziQuantel right for everyone? No. Is it right for you? Maybe. Okay. Eli, what health coaching certifications or training programs would you recommend for someone interested in entering the field? I would recommend that they join my LifeWave team where I train people on how to use the patches because it's one of the best tools I've ever found. When you're a health coach, there's two big challenges, and I'm going to speak more broadly in terms of becoming a practitioner. There's two big challenges. The first big challenge is getting great results. The second big challenge is creating a business or a practice that you actually want to operate and own. I cannot tell you how many practitioners I see, they hang up their spurs, they give up, they burn out, or they keep going and they're utterly miserable. They're so unhappy. They're so burned out. It's because they don't create systems. They don't follow good practices. And you know, I love my practice at this point. I don't love it all of the time, but I love it. And I love it because I've worked really, really, really hard to make it great. And that's one of the things I help practitioners on my LifeWave team figure out is how do you run this thing without it destroying your life and making you miserable, which I hate to say it, it happens to a a lot of people because sick people, man, it's a lot of tough energy to carry around and get through. And there's just a lot hanging on what you do, even if you're, you know, you're not a doctor, you're just a health coach. So train with me on my LifeWave team. For other certifications and training programs, this is very specific to what you actually want to do. And I'm not really familiar with any health coaching certifications and training programs that I really, really like. And a big piece of that is, is, as I said, it has to do with what do you want to. And health coaching and training might not even be the right field for you. It might be better to do some kind of professional school. If you're asking me what I would do if I were to go back, I would have a really long think about it because I'm torn between wanting to go back and instead do chiropractic instead of what I did and wanting to do what I did originally and just doing it smarter and better and faster and wishing that I hadn't done any kind of medical training at all and had done something way more out there. But here we are. So that's that. Hopefully that's helpful. Dennis, what is the best approach for managing allergies? We use homeopathics from a company called Allergena. We get great results. And then we use vitamins and minerals to help balance the immune system so that people— to control symptoms, or I mean, I've had patients completely resolve their allergies. Not to brag, but it's happened. Not a guarantee, by the way. By no means can I guarantee that. I've had lots of people where we tried everything and we still struggled. But generally speaking, I would say there's overwhelmingly an improvement in allergies in our patients. Jawida. Hello. What are your thoughts on heartburn and its management? Okay. So big, big, big, big, big, big, big topic. First thing that I think when I hear heartburn is actually, first of all, what is the level of stress that the person is under? Because there's a long, long and storied connection between stress and heartburn. More stress equals more heartburn. Second thing is diet, right? So what kind of diet is this person eating? I always go for more bland, and cooked food when someone's digestion is tender. And I think of heartburn as being exactly that. Trying to identify trigger foods becomes very relevant. And then a huge proportion of people with heartburn actually have low stomach acid. And so I will use a combination of supplemental stomach acid and bile acids and digestive enzymes. That product is coming to our supplement store soon, probably sometime this winter. Winter. So I start there and then there's all kinds of other places you can go with it. Susan, if high-dose vitamin D supplementation depletes magnesium, should additional magnesium be taken? If so, what would be an appropriate dose? So magnesium supplementation is really interesting to me because it's one of the minerals I give everyone and it makes me wonder if I'm overusing it. And so I've already— I'm already giving it to anyone who's taking vitamin D, let alone someone I'm recommending high-dose vitamin D With magnesium, the absorption curve is— you, you rapidly absorb more magnesium if you are deficient and if your diet is low, but you get this law of diminishing returns where you add more magnesium and you're only getting an incremental increase in absorption. What I would do is I would trend serum magnesium levels and make sure we're maintaining someone in the top quartile, which is where mortality is lowest, and make sure that they are not in the lower quartiles. And if someone was in the lower quartiles, I would be very serious about giving them something I've already mentioned today, which is is choline citrate. How about that, right? And so, so long as we're supplementing magnesium at some level, do we need to add more? If the serum level looks good on repeat examinations on the current supplement protocol, I'm not going to add more mag. And I have to tell you, in the practice, based on thousands of tests, we don't struggle to keep people's magnesium levels in the upper ranges. Not at all. It's actually pretty easy. So I'm not worried about high-dose D depleting magnesium. And I mentioned that in light of the fact that, you know, Coimbra started his high-dose vitamin D protocol 20 years ago and hasn't reported any patients with significant magnesium depletion. He does recommend magnesium and choline and other nutrients, as far as I can recall. Don't quote me on that. Don't quote him on that. That's me remembering it. And that's one of the reasons why I use them supplementally in everyone. We're also adding magnesium to the online supplement store as soon as we can. I don't even know why it isn't there already. Anyway, Alexis, where can I find the book referenced in your podcast about using patches for different health issues? Alexis, Amazon has got a bunch of patch manuals. Um, I don't actually know where mine is. Otherwise, pull it out and tell you the exact title. And following a mineral balancing protocol, as the body shifts and changes, is it possible for personalized formulas to stop working effectively or even become counterproductive? Yes. So I wish I had this before and after to show you guys, but I have a before and after from a recent case of a patient who first follow-up appointments, she was like, you're amazing. Years of problems have disappeared. I can't believe it. I've tried everything. I'm a health coach. I thought everything was I thought I knew everything. I didn't know what to expect. I'm so happy. And then at 6 weeks, she says, I'm terrible. I have all these new or different changing problems. What's happened? We retested her hair because my rule is basically if someone is getting worse or not getting better, or their results just don't add up, I will typically retest. And I have a great case that I, you know, recently I just showed this to a patient to illustrate this. They had a very different hair test result from one month to the next. And it was very different. I think, or I know actually, because they, they didn't, like, they hadn't showered for a few days before the first sample, which just, it's in the instructions, but they just didn't read that part. Anyway, so whenever someone's not responding to the formula the way that I think they should be responding, I am apt to repeat a mineral hair tissue mineral analysis, and we will often see a massive change. And indeed, in the lady who I was mentioning earlier, she had a massive elimination of manganese. Her manganese was like 10x what it had been., and I think she had a couple of other things coming out, but don't quote me on that. I don't recall. So you'll see that regularly people have these big eliminations and then can they become counterproductive if the pattern changes in terms of the ratios of the minerals? Yes, they can become counterproductive. And that's one of the reasons why if someone's not improving as we expect, we have to retest in good conscience because we may be moving in the wrong direction. And part of why I believe in mineral balancing and HTMA is is that, you know, I've seen what happens with this sort of random supplementation. It's way better than not taking the supplements if that's your option, because I realize there's an expense both in time and money with mineral balancing. But at the same time, if you really want to get the amazing results I've seen, it's because we tailored the supplement protocols to the person's labs. And that's where these, like, and not just their labs, but their clinical scenario, how they said they felt, their symptoms, all the rest of it. That's why I think this whole push with like direct-to-consumer labs, I hope it helps people, but man, you're giving people so much information. They may not have any context. Like, just look at how much context I gave you guys for seemingly simple questions today. All of that is going through my mind when I'm analyzing a case. Is it possible to build, say, a large language model and have it spit the labs out? Yeah, it is. But I don't see that happening in the direct-to-consumer lab push that's happening right now. It is some very, very— I just don't endorse it right now. That's all I'm going to say about that. Garth, do you have any experience treating interstitial lung disease and/or rheumatoid arthritis in a case where someone has both conditions and worsening lung function and is not tolerating standard treatment. What alternative approaches would you consider when conventional healthcare providers are recommending additional pharmaceuticals? Garth, this is so funny you ask because we've actually got a case in the practice. I'm assuming this isn't the person you're talking about, but I could be wrong. We have a case in the practice coming in of interstitial lung disease, and I was just catching up with this person's family member who referred them the other day, and they asked me if they, if I thought it could have anything to do with the drugs they were on. And it turns out that everyone should this, a certain amount of autoimmune disease is actually caused by pharmaceutical drugs. Some of the drugs this person was on, notably a statin drug, are associated with autoimmunity. In other words, the drug can trigger autoimmunity. The good news about this is that when you stop the drug, the autoimmunity tend to go— tends to go away in a matter of weeks, which is a lot. It's quite the, quite the break or stroke of luck when you compare that to autoimmune diseases that are not drug-linked and persist for potentially years or decades, even despite aggressive treatment. So my first move in that case, when I see them, is going to be discontinue all medications and supplements. And, and if there's a reason to use a med, we're just going to try and find another med that doesn't have this association and is in a different drug class, or we're going to use a supplement to get the same effect. Hopefully that makes sense. In ILD and rheumatoid arthritis, there's a very strong association with environmental triggers in both diseases. Lots of people will get their autoimmune conditions under control when they stop being exposed to something in the environment. So I'll give you an example with the interstitial lung disease. We had a case when I was in residency of an old lady who developed ILD, that's interstitial lung disease. And it turned out that she had these wood pellets in her wood pellet stove and we got her to stop using the wood pellet stove and the ILD went away. So that could be like bird fancier's lung is a disease close to interstitial lung disease, slightly different, but related. It could be dusts. It could be, you know, You name it. I don't know all the different causes of ILD, but I look always for environmental causes. And then what I do is I look at what can we do with supplementation and detoxification of the body in order to help this patient feel better. And so that is what I have seen with this, and that is what I would recommend, not specifically to you, but in general. And obviously I can't practice medicine via the internet or via Q&A. This is just for general medical awareness. That's what I've seen in my practice and what I think about these issues. And I think to just to be clear, beyond all that, I would do my standard operating procedure. We have very carefully designed protocols for nutrient supplementation to balance the body, to optimize health physiology. And that is the backbone of our approach. So thank you all for joining me. Take care. Have a great day. Thank you for your questions. I appreciate your purchases at the supplement store. I appreciate your purchases of premium subscriptions. They mean the world to me because they allow me to do this kind of thing, which allows me to help more people, which is what I am most passionate it about. Thank you all. Have a great day. Be well.