Uncensored Q+A: Mold, Hormones, Detox

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Hello everyone. Dr. Stillman back again to answer your fun, exciting, interesting, and engaging questions. Thank you as always to premium subscribers to the Substack, as well as members of the practice. You all get a wonderful discount on supplements from our new Shopify store. Thank you for your purchases. Thank you for your subscriptions. They keep me making content. And it means a lot. So I really appreciate all of you, and please let me know how I can improve the experience. So far, everyone has been raving about the Q&As, so we're doubling down on those. They will be coming out as podcasts very consistently rather than interviews. If you have anyone you'd like me to interview, I would love to interview them, so please drop them in the comments and I will get to them as I can. All right, so I want to open today actually with something a little bit different. Which is a story from my practice. And I have been trying to get more case studies put together for you all with things like screenshots of labs before and after, you know, literally what patients tell me in our consults, how much better they feel, what protocol worked for them, how they used such and such therapy. And I just don't have enough time and enough staff to do that. And so I thought I would just start telling you little anecdotes from the practice in the Q&A. And I had a particularly impressive story come to me this week. So I have a patient who came in with top priorities were to lose weight and resolve elevated blood glucoses, i.e., diabetes. And we did the standard protocols. We use vitamin C, MSM, iodine. If you haven't listened to the Core Protocols podcast I did with Amy, I strongly recommend you check that out. It's a great episode, really explains why we use those therapeutics the way that we use them. All of those protocols are coming out shortly and we should have all those supplements in the, in the Shopify store so that you guys can try them, use them. See what you think of them. And on that note, I actually am including now in the, in the podcasts, there should be a link to a testimonials form. If you want to submit testimonials to us, I'd really appreciate it. It helps me do what I do better, share better content, better advice, clarify our protocols, answer your questions so that you guys can all get better results. All that being said, I think this is the point when I'm supposed to say all of this is for general medical advice. Seek professional guidance and counsel from a practitioner, a qualified practitioner before making changes to your diet and lifestyle or trying any supplement regimen. And this case that I'm about to tell you about really, I think, illustrates that point. So we did our standard operating procedure. We did tailored supplements based on hair and blood testing. We did the vitamin C, MSM, iodine protocols, and I was really shocked when her labs looked worse rather than better. So we're very fortunate to have identified a new allergy test in the practice that is doing great things for our patients. And I recommended that she get this allergy test and She, uh, members of the practice, by the way, we have a great price internal to the practice. So make sure you order that through us. If you're interested in doing this test, it's called the mediator release test. For those of you out there who've got a doc, you can order it through. Uh, it's a great test. And I'll tell you about this result in a moment and you'll see why. So she got that test, started avoiding the foods that she was positive to. And at the same time, I had heard things over the years about chlorine dioxide having a significant impact on diabetes. And I said, look, let's stop mineral balancing supplements, MSM, vitamin C, iodine. Actually, we may have, we may have kept the MSM and the iodine going. I don't recall. And let's do chlorine dioxide. So she went on a 21-day course of chlorine dioxide. Her average daily glucose dropped from, I think it was the high 190s down into the 120s. And the effect, the magnitude of the effect was almost equivalent to a GLP-1 which is the new darling of the diabetes industry, uh, and is wildly expensive, by the way, whereas chlorine dioxide is basically so cheap that it's an obscure remedy because no one makes any money telling people to go do chlorine dioxide. So in 21 days, her glucose improved more than I've maybe ever seen a glucose improve other than on a ketogenic diet. And for those of you wondering if she'd tried that, yes, she tried that. And I've been shocked at the number of people who've come to me over the years who tried keto or were on keto for very prolonged periods of time and never were able to get their sugars down. One of the only cases of this that stuck with me for a long period of time, we kept noticing that she had these high levels of toxin markers on labs, and I started to ask more deep, deeper questions about what was going on in her environment. And it turned out she ran a boutique store with a lot of new material, a lot of new, new stock all the time that had a lot of smell, like chemical smell.. And so my theory on why some people develop diabetes in our modern world is that the chemicals are interfering with our normal glucose metabolism. They're degrading our cellular membranes. And so sometimes what's needed is something like chlorine dioxide that goes in and has these very complex effects on our bodies and our systems. But one of the main things I wonder about with chlorine dioxide is, is it oxidizing toxins and thereby removing their effect on the system, whatever that may be? And, you know, between the allergy test she did and the chlorine dioxide, night and day difference. Now, before you all run out and try this, I want to prepare you that she had some pretty profound detox symptoms, but given the magnitude of the improvement, it seems to have been well worth it for her. So I've been getting more and more questions about chlorine dioxide, more and more questions about how to use it, when to use it, why. That's a quick case study in how we used it in the practice. And, you know, I've also got patients in the last few months who've tried it and nothing's happened. They haven't felt any better. They haven't felt any worse. And, you know, one of them sort of came to me and said, like, I thought this was the universal antidote, which is sort of how it's touted. Like, why am I not seeing improvement with it? Well, clearly it's not universal. And this goes back to something I just said, which is it's really important to work with a qualified practitioner. I understand that those are in short supply, but there's still good ones out there. And I'm working to try and solve that problem. So if you want me to solve that problem, please upgrade to a premium subscription or become a member of the practice. I say that we have paused admissions to the practice until the new year. So unless you're like in process, you know, you've currently got in touch with a member of the team, we are pausing admissions to the first of the year so we can improve our processes and make sure that we have a really high quality experience for all the patients, which I care deeply about. Okay. Hopefully you enjoyed that quick anecdote. And now onto questions. So Kathleen asks, is it accurate that vaginal estradiol or estrogen applications have minimal systemic effects, or does systemic absorption occur to a significant degree? This depends entirely on the dose. So if you're giving women, it's very common to use vaginal estrogens and estradiol in order to administer estrogens because that's where, that's the tissue where that has the maximum or perhaps most important effect on the female body. So it's very logical for us to use it at that location. Many practitioners will, however, use, say, like, and the standard menopause method drops dosing that we've been using for many years is On the outer deltoids or the inner, inner arms. There's other locations, but those are the top two that I share with women. And I wanna explain a, like some of the ins and outs of this. So you have to avoid giving estrogens near breast tissue because unopposed estrogen and breast tissue, we're concerned, could increase the, like cancer, breast cancer risk. So we generally keep it away from, or we very carefully keep it away from any breast tissue, which is why I said the outer part of the deltoid, outer part of the arm, no possibility of it getting over to the breast there. Right. Inner arms, theoretically at least, I mean, unless you're, I don't know, boxing, shouldn't be an issue either. Intravaginal though, a lot of women, the top symptom that they're complaining of when they start estrogen is that they have vaginal dryness or vaginal atrophy, which happen as menopause goes on. You have pain with intercourse, changes like lichen sclerosis, which is an autoimmune disorder in, in the anogenital region for women that can be very disabling. And so we'll often use estradiol vaginally in order to treat symptoms that are local. If you use a high enough dose, it's going to have a systemic effect. A lot of women wind up on very low dose estrogen that's intravaginal in order to just treat those local symptoms. So you can get significant local symptom relief with just a small dose, and then otherwise you can use higher doses in that area for both local relief or relief of local symptoms and systemic effects. So hopefully that answers that question. It just depends on the dose and so on. Peter asks, how can mold exposure contribute to chronic health issues such as fatigue, brain fog, or inflammation? And what are the key steps to take once mold is discovered in a home? Okay. First things first, I have to plug my friend Ashley. I did 3 podcasts with her on this. They were phenomenal. The first 2 weren't about mold. The third one was about her family's mold exposure and their recovery. She has a course on mold that I haven't taken myself, but I love Ashley. I think everything she does is exceptional, so I can't I recommend it to you. What I tell patients very briefly is we need to get out of the house if at all possible. And the worst the exposure is, the more important it is to get out of the house. It's very common for people to live in moldy houses and never get better. And when I say never get better, I mean like spend tens of thousands, hundreds of thousands of dollars trying to get better with every single herbalist, naturopath, nurse practitioner, physician's assistant, doctor, chiropractor, health coach, witch doctor, you name it. I mean, like, you'll find some really shocking stories of people just burning money trying to get better in a moldy house. So the best money you can spend getting over mold is to get out of that house. Ashley's story is quite funny because even though she lived at the time in northern Idaho, which is not the warmest or most hospitable environment on planet Earth, she moved out of her house in the middle of the winter to sleep in, I think, a tent or a van or something like that. Listen to the episode for more. So getting out of the house is key. Documenting the mold is key. Like, where is it? What is it? I like the ERMIE and the HERTSME test from. I think the company is Envirobiomics. I have no affiliate relationship with them for the record. I just find their testing helpful. And then everything we do in the practice as far as nutritional balancing, bioidentical hormones, iodine, MSM, vitamin C, all of that is designed to help people cope with mold toxicity. Dr. Stillman's detox powder, really, I formulated that based on a lot of the best practices and binders I heard from people in the mold and Lyme community as far as foods that help their patients detox and cope with symptoms and get better. So I really like Dr. Stillman's Detox Powder for these folks. And those are the key things that I share with patients about mold. There's a lot more there. Ashley has a whole course on it, as I mentioned. One of the things that she found most helpful, I'll mention here, and you can purchase these from me, and I appreciate your purchases because they help fund our content production. She found the LifeWave patches very helpful. And so I think her go-to for mold was X39 glutathione. They were so impaired that they had to be careful with the glutathione, wearing it only for a few hours at a time. Time or every other day. And if I recall correctly, but listen to her episode, you know, and if you want to ask her questions about it, buy the X39s or the LifeWave patches from her because then you can get on her team calls and ask her questions. But anyway, those are the things I found really, really helpful. So, so if it was me, I would be doing the protocols I use forthcoming. We're publishing them as fast as we can. They go to the supplements or with the supplements in the, in the Shopify store. And then I would try the LifeWave patches, X39, glutathione, And I'll leave it at that. Okay. How does one determine when it's unsafe to remain in a home with elevated mold levels? What is the typical timeline for seeing health improvements once exposure is eliminated? This is basically impossible to predict. And so my, my recommendation would be you can return to the home when the mold is eliminated and remediated. And, you know, I actually have to go back to Leviticus. So I think it's Leviticus chapter 13. The Israelites were commanded by God to demolish any building that had mold if the mold couldn't be scrubbed away with a single scrubbing. Pretty, you know, like people think we're paranoid about mold. God is like very paranoid about mold. Tough choices are here for people camping in cold places in the middle of winter. Not something you necessarily want, but at the same time, I can't endorse going back into a moldy home ever. Typical timeline for seeing health improvements. My goal is for people to feel better as soon as they leave that house, because by far and away, the top thing that's making them feel sick is the continued exposure. And one of the toughest things to do, if not impossible, is getting people well in a moldy home. So that's the top thing. And then that timeline, I look for, for quick symptom improvement so long as people are on the right protocol and out of the moldy building. If they're not improving out of the moldy building, I look for another moldy building or I look for another exposure. Like we have the most interesting case in the practice. We did a provoked urine metals test cuz we were at a loss of why this patient was sick and we found they were excreting 10x the normal concentration of barium. Barium. I had to look it up. I had to look it up on the periodic table. I had to look up its sources in nature. I had to email a friend about what it, what, you know, what to do about it. Very interesting and unfortunate. You know, it's that kind of thing is like I start looking for zebras when things are not making sense. And I always look for a second mold exposure when the first one has been identified and the patient's not getting better. Okay. Question 3. Can detox supplements help remove mold or mycotoxins from the body? Yes. That's why I made Dr. Stillman's Detox Powder. What other supplements or strategies are recommended to support X39, LifeWave, and the glutathione from LifeWave. I would also like the Aeon if you're having like racing thoughts, anxiety, difficulty focusing, pain, headaches, et cetera. Aeon's really good for that. And then the other supplements I really would tailor if someone is not on a mineral balancing protocol with me and we're not doing repeating HTMAs, then there's a multivitamin we stock at the Shopify store. And I picked that multivitamin because it is absolutely dialed in. I mean, it is so perfect, the formulation for all comers because it fixes, it covers zinc, it covers manganese. Most of you need more of both of those to just cope with environmental contamination. And it's got, I think, the best balance of B vitamins for people in our modern world, all comers who are sick. So when I have a patient or a friend or family member who can't do mineral balancing, they're too busy. They don't have the time. They don't have the money. They, you know, can't get— I mean, sometimes supplement sourcing is like a challenge. Somebody lives in East Timor. We can't get them Valens or we can't get them Bicon or we can't get them whatever. I mean, that actually hasn't come up, but let's just say it did. That's the product I recommend, the multivitamin, multimineral in our Shopify store. And I'll go up to like 2 to 4 capsules of that a day. Okay. I think that's a, that about covers that. Oh, I'll also mention our vitamin C. Patients with mold exposure have often remarked to me that they felt worlds better with our vitamin C. Question 4: What is the perspective on using zeolite and fulvic minerals for mold detox or for individuals with nervous system issues? And how should supplementation typically be adjusted while someone is still being exposed versus after remediation is complete? So zeolite, I have written, I think, an article that I've published on that. If I haven't, it's forthcoming. So the problem I have with zeolite is that no one can demonstrate that the aluminum in it is not getting into the human body. Now, that being said, I have friends in the mineral balancing space who swear up and down that there's no problem and that zeolite is incredibly effective. And in fact, the person I'm thinking of who I reached out to about the barium, Lisa Patel-Killer, who runs Vicon, said, hey, I've seen high barium in hair. I've treated it and I've added zeolite. To these people's protocols, and she says the effects have been positive. So I am sharing that with the patient in question, and I don't know what we're gonna see, but that is like very new, literally email inbox this morning, cutting-edge stuff from my practice for you right there. That being said, I haven't been using Zeolite in my practice because the reality is our patients tend to feel worlds better with the protocols we use. If we're adding things, we have to be very strategic because we're already doing a lot and our patients will already come back to us and say, we feel overwhelmed. Can we get the same results with less? Sometimes the answer is yes, sometimes the answer is no. So I'm wary of adding more and more stuff and overwhelming people. The other thing I wonder about with binders is I don't know if people are really thinking through, okay, I'm taking zeolite, I'm taking maybe humic or fulvic acid, but if you've got a big mineral or metal imbalance that you're not addressing, could you make that worse with one of these binders or mineral supplements? I think that's a reasonable question to ask. We've also had the experience of patients using products and getting poisoned by them. So I've had 3 men in the practice poisoned by lead due to a very common personal care product. I'm just going to leave it at that because lawyers are being contacted. I'm not going to say anything else about that. I've had patients— they're— I mean, practically every metal I can think of, we've got someone who's been poisoned by something, from well water to protein bars and powders to, you know, functional foods that are supposed to be good for you. So I'm always wary of, of recommending products that I don't have extensive experience with in the practice, because when I'm using something in the practice. Like yesterday, somebody was like, oh, Mountain Valley spring water has got arsenic in it, didn't you know, Dr. Stillman? And I'm like, oh yes, let me like pull the fire alarm and lose my mind over the fact that I drink Mountain Valley almost every day here at my office. Why am I not worried about this? Because guess what? Dr. Stillman has got thousands and thousands and thousands of dollars worth of lab testing on himself. And so if I'm poisoning myself with the spring water that I'm drinking, I'm going to figure it out and then I'm going to stop. Boy, do I sleep at night like a baby knowing that I'm not poisoning myself with my delicious sparkling water over here. How about that? Okay. So that being said, I hear people getting amazing results with zeolite and fulvic minerals. I am overjoyed for them. I just don't use them in my practice cuz I haven't found we need them. I do think that the vast majority of the trace elements you're gonna need are gonna be covered in the multivitamin, multimineral that I mentioned before. So that's that. Beyond the organic acid test, what other tests or assessments are useful for identifying and tracking mold burden in the body? What are the clinical applications and values of OAT test. So fun fact, I'm going to be interviewing Neil Nathan soon. He's the world expert on mold. We're going to talk all about mold testing, ins and outs, and you're going to hear me kind of quiz him the way I quiz another clinician on how do you know what you know? How are you sure? How rigorously have you tested this testing? So I want to give you an example of how I test testing, because it's very important to test testing. If you don't test testing, you have no idea what the test even means. So when I started to do my own labs, I would often get results that didn't make sense to me. For example, I had a pretty low cortisol sometime earlier this year and I didn't worry about it because guess what? Cortisol varies an enormous amount in the average person, healthy person, day to day. Why do I measure it despite that? Because occasionally you'll find someone whose cortisol is just in the basement. And sometimes you'll find somebody whose cortisol is so high that you wonder, does this person have a cortisol-producing adenoma or something like that? An actual weird endocrine cancer. I wouldn't want to miss that. So I, I will do multiple tests. I'm about to wrap up a series of 9 heavy metal urine tests with 3 different protocols. So I did 3 different protocols to provoke urine heavy metals or not. And I did all of the lab tests in triplicate. You're welcome. Because I do all this on my own dime. I don't have fancy funding from, you know, whoever, the government. If you'd like to fund my research, get in touch. I'm sure we can find a 501 as a pass-through, but anyway, I just do it to satisfy my own curiosity. And so my big problem with mold testing is that I've had colleagues and I myself have noticed that the testing doesn't tend to correlate with symptoms. And if you have a known mold exposure, we assume and can safely assume that your mold toxin levels are going to be elevated. And if they're not elevated, then maybe it's just because it's stuck in tissue and it's not mobilized. So I don't tend to test for molds at all. Part of this is about prioritizing testing. If you come to my practice and you say, Dr. Stillman, I would like to get all of the testing, we will probably spend $10,000 on testing in the first quarter. And shockingly enough, most people don't want to do that. And amazingly, we have a system where we get people amazing results that we get without doing more than $400 or $500 worth of testing in the first quarter. Now, by, by no means is that a guarantee. I'm often in the first consult asking for more testing so we can get a little bit more traction, a little bit more insight, something like an organic acid test something like allergy test, but I just want you to all understand why I'm not crazy about mold testing. I usually just say, okay, look, you've got mold. We're going to do mineral balancing and all these supplements and various things, or we're going to do a multivitamin, multi-mineral that I mentioned earlier, and we're going to do LifeWave patches and all that. And we're going to get out of the moldy house and that should solve the problem. What are the clinical applications and value of the organic acid test? So the reason I like this test is it can tell me if someone's got a markedly abnormal level in a B vitamin, particularly in its function. And that can then lead us to doing higher doses of certain B vitamins. It can lead us to deducing that someone maybe has like an MTHFR issue, which we can then test further for. It can tell me if people have problems with, say, the carnitine shuttle, which is super important for health and wellbeing. It can tell me if people have problems with like a toxic exposure because we have some, some biomarkers on there for that. It can tell me if people have problems with a whole litany of other things way too numerous to get into in one Q&A. But that's what I love about the ODE test. What advice can be given to families who feel overwhelmed by the cost and logistics of mold remediation? What are the most encouraging signs that the body is beginning to recover after mold exposure? Most encouraging signs are that the person should feel better. To those feeling overwhelmed by all of this, I think the toughest adjustment for a lot of people to make is that, you know, I have a friend, he's been very sick in his life and he told me And when I say that, I mean, like, you know, for me to say that someone's been really sick because we attract some pretty sick people who've seen a lot of doctors, that really says something. He told me once, he said, I believe that happiness equals reality, your reality divided by your expectations. And I've always stuck to that. The really tough thing with mold is that your dream house can become your worst nightmare. And Ashley's story is one of that. Ashley, with, you know, her incredible aplomb— I can't believe I just used that word in a podcast, but here we are— she was just like, listen, we're going to close up our dream house, remediate it, sell it, whatever. They contacted some attorneys, which they cover in their, in her podcast with me, and we're going to move on and we're going to get out of this house and we're going to heal. And that is what they did. And her attitude reminds me of another thing I often say to patients, which is do what you can with what you have, where you are. I think the toughest thing is if you live in a moldy environment, in a very inhospitable environment. I did a couple winters in northern Minnesota as a hospitalist, and if you told me I had to move out of a moldy house in northern Minnesota in January, I would be looking for a job in Florida or Alabama where it's a little bit more hospitable in the winter. That being said, Ashley made it work in, and you know, the reality is like people have been living outdoors for most of human history. You can make it work. And that I think is the toughest thing for people is where do I go? What do I do? If you're asking me what I would do, it's sleeping bags, tents. If you're in Florida, in the middle of the summer, that is absolutely miserable. And so then it's like, do we want to just move somewhere? I actually did have a case of a, of someone who we had a pretty severe mold exposure within the practice who's doing much better, by the way, with everything I just talked about. And I said, look, if you're not, you know, doing anything else, then you should move to the mountains of somewhere and just enjoy being out in nature and spend as much time in nature as possible. That's exactly what she did. She feels great., right? I get that that is tough when it comes to jobs, family, support systems, but this just comes back to do what you can with what you have, where you are. And then the top thing is just how can you engineer your life so you can get out of the moldy house? Not always an easy thing to figure out. Okay. Janice, regarding sublingual drops for allergy treatment, can this type of therapy be administered remotely or does it require an in-person consult with an allergist? How might this integrate with other treatment approaches like HTMA and mineral balancing? So I always coordinate the supplements we're using with the allergy and it can be done remotely. If we do it remotely, then I usually start with the homeopathics I mentioned in my last Q&A. And then if those are not cutting the mustard or doing the job, we will do blood testing and then we'll base our prescription on the blood testing. The other thing that can be done is you can go to the allergist and you can say, hey, because a lot of people can get this covered by their insurance or, or whatever. You can go to the allergist and just say, hey, I would like sublingual immunotherapy. I would like you to sort that out for me. I don't want the injectable. Can you do that? Most of them will do it if you ask. They're just standard operating procedure is to go with the injectable because it's covered by insurance. So that's that. And the reason to go to an allergist is that they will get you skin prick testing, which may be more accurate than the IgE testing. Sometimes you'll get false negatives though. So that's where the quality of the clinician comes into play. Susan, what are the common symptoms associated with oxalate sensitivity? They're almost too numerous to mention. What I'm looking for is someone who's very sensitive, someone who has symptoms in their skin, severe itching, a general, like, burning, burning, or skin discomfort sensations. They may have weird rashes. They may feel like they're sensitive to foods, but they're not sure which ones. They feel like they eat a healthy diet, but they get worse. They will often have like brain fog, fatigue, sometimes like sadness or depressive symptoms. They may have severe anxiety. They may have a very like down negative mood because of all of this. It's very frustrating for them. Often they'll have GI issues, bloating, abdominal pain, gas, you name it. So it's really tough to sort of pinpoint an oxalate sensitivity, like clinical syndrome, because it's so many different things. And then I'll also mention, by the way, that a lot of the time they'll endorse some kind of genitourinary pain. So it could be like, you know, vaginal pain or what's called vulvodynia. It could be like pain on urination, interstitial cystitis. It might look like interstitial cystitis. So it's a, it's a huge, huge range of symptoms. B, hello B. What are the therapeutic considerations and safety profile of DMSO with the increasing interest in this compound? Boy, big one here. So I haven't been using a ton of DMSO in the practice. I've had patients who are trying it usually on their own recognizance, and they're usually trying something like a 5ml dose— that's milliliters— orally. And I've told them to not start there, but taper up from 1ml a day. I caution people that DMSO increases or rapidly increases absorption wherever it's placed. So if you put DMSO on the skin along with something, it will carry it into the body. That can be good and very dangerous because you can get therapeutics to where you want them very quickly, but that also cuts both ways. Ways. If there's anything on the skin that you don't want in the body, it can get in very quickly, right? And that's one reason why I'm very careful to buy my DMSO in glass. I'm very suspicious of any kind of DMSO product that comes in plastic. They're going to tell you, oh, it's a hard plastic, it doesn't off-gas. They say that about a lot of consumer packaged products, and I have the hair tests with crazy aluminum levels to prove that they are wrong. So I just don't trust anything that doesn't come in glass. With topical application, my patients have generally told me they're just applying it to the affected area And then I always tell them you have to make sure that it dries completely or absorbs completely before you put any clothing on, because, you know, God forbid that you put the clothing on and then the DMSO dissolves the ink. Because if you, if you put DMSO, if you drop DMSO on your jeans, you can suck the blue ink right into your body, which is not a good thing. So that's sort of the bottom line with DMSO. Why am I not using it very much? We use MSM a lot. We get great results with that. That it's safer from the perspective of this absorption issue. It's also less potent, so you need more of it. So will we get into more DMSO? I'm sure. I've got a couple patients who just swear by it. Particularly, I'm thinking of a patient of ours at the practice who has cancer. It's been life-changing for her in terms of the pain relief that it's provided her. But you just have to be wary of all those little things I told you. And then some people are intolerant of sulfur, which they'll figure out when they take it. And that's one reason why I don't start people at a high dose like 5ml. So that's that. Matt, are there specific lab markers on comprehensive wellness panels or other diagnostic tests that can be used to help rule in or out autoimmune conditions, particularly conditions like IBS, or is the diagnosis primarily symptom-based? From what I know, IBS is entirely based on symptoms. In the comprehensive wellness panel, there are many, many things that go along with autoimmune conditions like kidney function, electrolyte levels, and liver function tests, but very rarely are those lab tests abnormal in our patient population. The two 2 things in the CMP that I look at for autoimmunity are albumin and bilirubin, because albumin and bilirubin are the 2 tests that are most commonly abnormal in our patients. And the bilirubin in particular is a big clue because as bilirubin accumulates— and you can listen to my Q&A last week, I talked about it there in some detail— as the bilirubin accumulates, it's a sign that the gallbladder is not excreting toxins well. And so toxins are accumulating in the body, and this will drive autoimmunity because of the strong link between environmental toxins and the onset of autoimmunity. So that's that. Question 2: For someone who regularly consumes macadamia nuts and walnuts as a convenient food option while working, could this dietary pattern cause an imbalance in fatty, fatty acid ratios? What daily quantity of nuts and seeds is generally considered appropriate, particularly those who avoid— for those who avoid restaurants and seed oils? Okay. So when I go for nuts and seeds, I usually recommend a diversity of nuts and seeds. And the reason for the diversity is to make sure that you're getting a diverse fatty acid profile. So you'll find that if you overconsume anything, it will tend to show up in your labs. You know, case in point, just on the phone this morning with a woman who has a very high omega-6 level. She was like, well, could that be my almond butter? Yes, it's the almond butter. And that's why when I buy nuts and seeds, I'll go to nuts.com and I will order a whole wide variety, you know, pecans, pistachios, walnuts, chia seeds, flaxseeds, you name it. I'll just pick You can choose a whole bunch. I do that for not only the fatty acids, but also the micronutrients. When you look at nuts and seeds, they also have very, very different ratios of copper, manganese, zinc, magnesium, other minerals, as well as B vitamins. So I just want to get a diversity across the board of all the foods I eat, because you will tend to then have the most balanced nutritional profile. I learned that from a very clever mentor who really helped me. He, he made that really clear and it actually simplified what I was doing. Because if you just vary what you eat more, you're actually— you may be very surprised at how much better you feel and how much better your labs look. So that's that. When it comes to quantities of nuts and seeds, I'll usually say half an ounce to an ounce at each meal is the max. And there's many people who are sensitive to nuts and seeds, and what they need to do is they need to drop back their nut and seed consumption, sometimes to near zero. The most gentle protocols I'll use for these folks are soaked chia and flaxseed. And then I'll put those in a blender. And then I like pumpkin seeds in soups and stews for various reasons. And if anyone's got a problem with digesting nuts and seeds, which can be tough on the digestive tract, they're very big foods in the sense that like they take a lot of energy to break down and they have a lot of nutritional value, then throwing them into a soup or a stew is my go-to for making them more digestible and less hard on the system. And that's how I can introduce smaller quantities over over a period of time. Okay. Brittany, what are the considerations regarding deuterium depleted water for health and wellness? Okay. Great question. So I love deuterium depleted water in theory, but it is ridiculously expensive. And I have learned to be paranoid about claims made by companies because of all the things I've seen happen in my practice, products that didn't work, products that were contaminated. I hate to say it, but I really, you know, the Ronald Reagan quote, right? Trust, but verify. I verify because people lie. And sometimes they don't lie. They just conveniently don't test their own product enough. Let's just leave it at that. Deuterium depleted water. I mentioned this specifically because it's water and you could be sold deuterium depleted water on the label that's not deuterium depleted. It is a market that is ripe for abuse. It's incredibly hard to make. It's unbelievably expensive. If somebody has just crazy amounts of money that they'd like to spend on their health and wellness, we can you can go ahead and try deuterium depleted water, but I haven't heard the sorts of amazing success stories that I expected to hear when it came out. And maybe I'm missing them, but the kind of people I think who would go in for deuterium depleted water consistently for a long period of time, I don't know, maybe if you're listening to this and you have a great story or you have a friend with a great story, would you send them our testimonial link so I can hear about it? Because I just haven't heard the kinds of testimonials I was thinking I would hear. And so I don't want to recommend it and then be wrong, particularly because there's so much else we can spend our time and money on that I know works exceptionally well. And on that note, I believe the body depletes deuterium when you give it what it needs. I don't think it has any problem doing that. So I don't think it's necessary for us to have a deuterium depleted input. Okay. Susan, question 1. If one person in the house has a positive urine heavy metal test, is it advisable for their spouse to be tested as well? Yes. For individuals taking high dose vitamin D supplementation, what is the recommended frequency and type of laboratory testing to monitor safety? Efficacy. Great question. So right now we're doing a comprehensive metabolic panel, which includes a calcium and an albumin from which you can deduce the corrected calcium level and a PTH. We're doing a PTH because when the PTH is maximally suppressed, arguably the vitamin D activity is at its maximum, maximum level, and you're not likely to get more benefit from higher doses of vitamin D. That being said, I have seen and heard from other folks out there that they're doing testing like 24-hour urinary calcium, spot urinary calcium levels, ionized calcium levels, and more. I have a meeting with a physician who's trained in the Coimbra Protocol this Friday. I'm looking forward to picking her brain and, you know, getting more her thoughts on the, on the nitty-gritty of the clinical side of this. But right now I'm doing CMP and PTH and that's that. And I'm doing it every 6 weeks to start and then going further out after that. But a lot of this is going to be driven by how high the dose is and what the prior lab results are. So I have a feeling that a lot of people are going to do quite well on 30,000 20,000 IU of vitamin D daily, and they're not going to need higher doses. For people who go on to 40,000 IU a day or more, I have a feeling that we're going to do more testing for a longer period of time, more frequently. But we're really just rolling this out in the practice now. So more updates later. Jim, what strategies or resources are available for obtaining prescription meds at a more affordable price? So this came up in the practice this week. Somebody was saying, hey, I went to the pharmacy and tried to get this med you recommended to and prescribed for me and they said it was crazy amounts of money. What's going on? So whenever you have a medication that you are trying to find a good price for, at this point in history, the best thing to do is go to AI and say, hey, what's a reasonable price for this medication? And you need to be clear with the AI, what dose, what duration of therapy, what quantity. So let's take Armour Thyroid as an example. Let's say your prescription is for 60mg, take 1 tablet daily, 90 pills. Pills. You can literally ask AI, how much should this cost? And it's going to give you a range. And then the range is going to be pretty accurate, by which I mean it's going to be accurate to the point that it is unlikely for you to find a retail price lower than that. Wholesale prices will be lower. My favorite website as of this recording to find the best prices for things is goodrx.com. And if you go there and you enter in the exact prescription you're on, note that this, you know, varies, right? So like you go to GoodRx and you say thyroid, well, Armour Thyroid and P-Thyroid, 60mg, 90mg, 120mg. Are we talking about levothyroxine? Is this compounded T? So you have to be specific. You don't need a brand name, you just need to be specific enough. And if you're wondering what it should be, it's exactly what your prescriber prescribed. GoodRx has all these little things. Things. They'll tell you what it costs at every retail pharmacy near you. They'll tell you how to get a better price, and they'll try and sign you up for their membership program, which for all I know is great. I have no relationship with them. I just know that they give you the straight, straight up what something should cost and how to get it for an affordable price. And it's the pharmacy game of price gouging patients is basically pretty much over because everyone can use AI to figure out what things should actually cost. Lost. It's a shame that, that it happened at all, but you know, our elected politicians being the narcissists and psychopaths they are, here we are. All right, Treva, would Zeta-8 supplementation be potentially beneficial where someone was recently diagnosed with congestive heart failure? Maybe, but you have to be careful with the potassium because it's a super high dose. And so if that person has issues with handling potassium, which they often do in heart failure, it could actually be harmful. So if I was going to use that in a heart failure case, I'd be very careful, and I'd want to know a lot about the person. Shawna, some healthcare practitioners promote regular aspirin use, with recent discussions suggesting benefits from— for daytime fatigue. What are the considerations around regular aspirin use from a functional health perspective? I'm perfectly open to trying it, and I do think that there's probably some value in the literature reflecting a mortality benefit with low-dose daily aspirin. I haven't looked into it deeply, and it's one of those things that I, I suppose I could add to what I do for longevity purposes, but then I get into the, the question of, so now everyone's taking a fish oil and an aspirin and bioidentical hormones and vitamin D and the detox powder and probably some magnesium or a multi-mineral or multivitamin or custom personalized supplement protocol. And the next thing we know, we're at 20 or 30 different supplements and people are like, hey, I came to you because I wanted simplicity, not, you know, 20 supplements which were just from different brands. Like my last practitioner put me on. So totally open to people trying this for daytime fatigue. I think the 81-milligram dose is probably all they need. Some people might get something out of more, but, and then for, for, for longevity, if someone thinks it's, it's a good move for them, I think it's very reasonable to do. And I'd have to look more into it to have more of a nuanced perspective. I hope that's helpful. Noel, what would be the functional medicine approach for working with someone in their 60s who's been diagnosed with pulmonary fibrosis? I think I've covered this on a couple recent Q&As where I talked about specifically idiopathic pulmonary fibrosis, which is the most common type. And so I won't repeat that here. If you have any questions about the approach that I didn't answer in prior Q&As, let me know and I will go back and answer more of your questions. What are the evidence-based benefits of vibration plates? I'm not familiar with any evidence-based benefits, and I love that you put that in there. Very specific. Anecdotally, they're very helpful and how they're helpful, where they're helpful. That is a, I mean, it's not really a question I feel like I'm adequately informed on to answer. So that's that. That. Is there a difference between the brands? Not that I'm aware of, but I haven't made a study on it. As far as validity of lymphatic drainage, blood circulation, peripheral neuropathy support, bone density, muscle strength, exercise recovery. The cool thing about this is all of that could be tracked and well, most of it could be tracked, I suppose. I don't really know how you'd track lymphatic drainage. Blood circulation might be tricky. Peripheral neuropathy. You could, you could track if somebody had symptoms, if they improved bone density, you could track, although DEXA scans are notoriously unreliable. So I would do your N-of-1 experiment. That's what I would do. What are the potential causes of lymphatic congestion presenting with swelling above the clavicles and what management strategies can be considered for addressing this condition? This is an extremely unusual problem. So usually what's, what's most normal for lymphadenopathy, that is lymph node swelling. Is for the lymph nodes to be swollen in the cervical chain. So like starting under the, under the jaw or just before and after the ear and then down the sternocleidomastoid muscle to the clavicle. There's lots of lymph nodes in there. You've almost certainly felt swollen lymph nodes yourself at some point when you've had an illness or sore throat or something like that. So that's very common. What's uncommon is when it's in the, the valley between the clavicle skull and the neck. Those are your, I think they're your infraclavicular or supraclavicular lymph nodes. And so those are actually concerning for malignancy, i.e., cancer. And that can be ruled out with a core needle or an excisional biopsy of the lymph node and/or an ultrasound. I don't know how specific the ultrasound is for that. And beyond that, why would someone get lymphatic congestion there? You have to look at the vasculature beneath that. Is there an obstruction in the thorax? Obstructions in the thorax. What kind of obstructions? Cancers? Anatomical problems? Could something like an aortic aneurysm or an aortic dissection present that way? Those are scary diagnoses, so I don't really like— I don't want to alarm you, but it's a very weird clinical picture, and it's where I would have an on-the-ground clinician who can see you physically and also refer out appropriately because this is the kind of thing where a primary care doctor or a general internist like me would look at it and think, well, I never see this in clinical practice. And when I do, oftentimes it's, you know, what I'm most concerned for, which would be a malignancy. And then I would say, okay, I would like to be able to refer to someone like a cardiologist or cardiothoracic surgeon for them to just see the case, take a look at it. Look, maybe decide if some imaging is in order. If I was going to do imaging, I'd probably do a CT, and I'd be very tempted to do a CT with contrast to get a better look at vascular structures in the thorax, because the problem sounds like it's in the thorax from what you're saying here. So I don't know if that's helpful. I hope it is, but it's— this is a super niche nuanced question. Almost never comes up. And by almost never, I mean it has come up once. I graduated med school in 2014. That's 11 years. Margo, what approaches and treatment strategies are available for managing Parkinson's disease from a functional medicine perspective? By the way, Margo, I saw your original question. All the questions are edited, by the way. If you're wondering why your question was slightly altered, it's because I make them all generalized. I can't answer your specific question about whatever your specific problem is, but I really enjoyed Margo's, and so I'm gonna, I'm gonna mention it. She asked me this, she said, do you cure Parkinson's? Coming right out of the gate. Hey doc, can you cure this, this reportedly incurable chronic neurodegenerative illness? That's very challenging. So I, for some reason I'm reminded of, I think it's, I think it's, I think Aristotle, maybe it was Socrates said this. They said, I cannot teach anybody anything. I can only make them think. And Hippocrates said the greatest healing force is the force within us. I'm paraphrasing. It's not exactly what he said. And then the trick is like unleashing that force. Course. So I mentioned that because when people come in and they say, I have Parkinson's, or I have early Parkinson's, or I have maybe Parkinson's, the question is always, well, what's the process behind the diagnosis? Why is your hand tremoring? Why is your gait faltering? Why are you stuttering? Why can't you find words? Why don't you have energy? Why do you feel like you're moving slower, more slowly? Why are you tripping over your feet all of a sudden, and that process comes down and I always break it down into what I call the three causes of disease. There are metabolic imbalances, which is basically you can have nutritional deficiencies, but you can also have nutritional excesses. Recent, pretty abrupt, severe dementia case in the practice turned out to have very, very high copper levels on urine and hair testing. So that's a copper toxic picture, right? Does that person have Parkinson's? Do they have Alzheimer's? Do they have frontotemporal lobe dementia? Do they have Lewy body dementia? Do they have I don't know. I honestly don't know, but that's the process I see going on in their lab work. Right. So I always look at the process and then I attack the process. Cause number 1, metabolic imbalances. Cause number 2, toxins. And I lump stress in with toxins because if you look at how toxins destroy the body, stress does it the same way. So I look at stress out of proportion to what the body can handle as basically being toxic. And then I look for infections because you will find that some people have something on board. That when you treat it with an anti-whatever or something like chlorine dioxide, which could be argued to work in a different mechanism, I will grant you, they get worlds better. So anyway, I look at those three things and I approach everything that way. Do people— have I cured a patient of Parkinson's? I can't say that I have, but I also think the, the, the phrase cure is a bit problematic. For example, I've heard stories of people on high-dose thiamine. I talked about that in my last Q&A as well, having all of their symptoms go into remission. Remission with high-dose thiamine symptoms of Parkinson's, that is. So are those people cured? I don't know, but they're in remission. I would just say we have someone in the practice who's worried they've got Parkinson's and we're going to do everything we can to make sure that they are optimal and that they have as little, if any, symptoms as possible. So, and I would use all the things I've talked about today. X39 patches. I like the glutathione patch for that disorder. I like the Aeon patch for that disorder. I like the detox powder for that disorder. I like the vitamin C for that disorder. I like MSM. I like iodine. I like— what else do I like? Mineral balancing. Oh my gosh. We get tons of toxic metals in the hair that we see that may be driving neurodegeneration. Neurodegeneration is very strongly linked to toxic metals in the brain of all kinds. So hopefully that's helpful. Carter, what are some favorite or recommended meal options for dinner that support optimal health and nutrition? I think Carter's question was actually, what is your favorite meal at dinnertime? I'll tell you what Dr. Stillman's Million and One Meal Plan is. I think it's a premium subscription. Post if you want to read it. It's basically, you need a protein, and ideally for most people, that should be about 6 to 8 ounces of protein, which is way more than most of you eat, especially you ladies. As you get older, you think not eating protein is okay, and you are wrong. 6 to 8 ounces of a protein—fish, shellfish, meat, poultry, whatever—and then how you like, 2 fists. We call them whacks in the practice. Shout out to Jim Laird, who brought brought that terminology to us of a carbohydrate. I like to lean into root vegetables over grains. Most people over-rely on grains that leads them to eat a low potassium diet, which leaves them feeling tired and sick. We incorporate root vegetables in order to solve potassium deficiency. And so we'll do turnips, beets, rutabagas, potatoes, sweet potatoes, carrots. Did I say carrots? Parsnips. I love root vegetables. I'm crazy about them. So I'll incorporate those in a lot of afternoon Um, or sorry, evening meals and any meal actually. And then if I'm not doing that, I'll still like sometimes have grains. So rice, quinoa, amaranth. I'll think of some more later, as soon as I finish the Q&A. And then the rest of the plate, 2 fists ideally, is vegetables, salad, cooked greens, some other kind of cooked vegetable. I'll rotate squashes and gourds in with the, in place of say like root vegetables or grains. Those are another good source of starches. Starch. But if you stick to that meal template, and then I'll usually add a half an ounce to an ounce of nuts and seeds on top of that, that meal template rocks. It has a ton of nutritional, nutritional value in terms of minerals, vitamins. It's also got the right macros, generally speaking. I eat that way, I feel great, and most of my patients eat that way and they feel great. And there's always going to be outliers who, for whatever reason, do better on keto or carnivore, or I don't know, whatever, whatever new weird thing people come out with tomorrow. Amy. Amy's question is about why can't you get licensed in Washington? So I thought about this because I have a lot of people in Washington who would love to work with us. The problem, Amy, that I've had is that, so some states responded to recent political unpleasantness, and I'll just leave it at that, in ways where they, for example, like took doctors' licenses. I know a physician in Oregon who lost his license. I know a physician in Maine who lost her license. And so I've avoided certain jurisdictions of practice because of how hostile they've been to people like me. Because losing my license would be unfortunate to say the least. And then I can't serve any patients. So I've chosen not to get licensed in Washington because their, their state political system, state politics have been so hostile to me. And I and other physicians like me are trying to figure out, you know, what does the healthcare system of the future look like? And it's going to look like decentralized is the word you used with different practitioners in different states, having having these small practices. They may be part of a bigger organization, but we'll see. If I'm going to expand more than I already have, probably what we'll do is we'll do it with NPs and PAs, but then we'll need to have enough people for the NPs and PAs to pay their bills. So we may do something like a launch where I say, hey, Washington, we've got a great NP or PA and they're ready to go. And we need 100 families paying a monthly membership fee of X in order to cover their salary because I can't finance the salary out of my pocket, it would be in, in what's the word I'm looking for? Unsustainable. And so we may do that in the future. I'd like that idea, but that takes a lot of figuring out. So that's my thinking on that at the moment. Okay. I have to go have lunch. Thank you all for your questions. Thank you so much for your subscriptions, premium subscribers, and practice members. I look forward to answering your questions again next week. Thank you for your purchases of things from the supplement store, from LifeWave. Join my LifeWave team. I love meeting with my team. I meet with them every Tuesday at 2:00 PM Eastern. If you'd like to jump on the call, join the team. If you buy as a brand partner, we'll email you and get you set up with the link. I would love to see you on there. Take care, everyone. Have a great day.