Combatting Environmental Toxins With Peptides

And even, you know, going back to the chronic Lyme talk we discussed, I think that, you know, while certainly I ascribe to the ideas you talked about, that 2 weeks of doxy or 3 weeks of doxy is often not enough, especially if someone's had this infection for, you know, more than 6 months, say, but endless antibiotics isn't the answer either. You know, there needs to be a point at which you say, okay, if you can't get off antibiotics because you just continue to have symptoms, then we got to lower the threshold at which your immune system is reacting because it's unlikely this organism is causing tissue damage anymore. And it's more likely that your own immune system is responsible for the damage and the inflammation that's coming and really restoring immune, you know, regulation and get rid of some of these toxins. And, you know, that's part of it. And it's a process for sure.

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Hello, it's Dr. Kent Holtorf with another episode. Today we're going to be speaking with Dr. Corey Tischauer, and we're talking about biotoxin illness and basically peptide use in biotoxin illness. A little bit about Dr. Corey. He grew up in Omaha, Nebraska, so a farm, farm-raised boy. As early as he can remember, he wanted to be a physician, which is interesting, is rare it seems these days. He graduated with honors from Cornell University with a BA in neurobiology and behavior. He earned his doctorate in medicine at the National College of Naturopathic Medicine. He's the owner and lead physician at Bear Creek Naturopathic Clinic in Medford, Oregon. Believe that the body has within itself the inherent ability to heal. Um, uh, Dr. Corey utilizes integrative therapeutic model designed to remove obstacles to health, simultaneously optimizing the self-healing mechanism of the body. Healing is accomplished through the rational and sequential elimination of infections and toxicity from the body while helping to normalize immune dysfunction, mitochondrial energy production, and cellular detoxification repair. And really looking at the whole system. And, you know, it's the one thing that I think standard medicine is just missing, you know. And so he— I know, I consider him a great friend. In fact, we're talking forever before, before we interviewed here. And he's just always on the cutting edge, treats everything, the sick of the sick, and, and just loves a challenge. And it's just so knowledgeable. I know you're gonna, you're gonna love this interview. He focuses on functional medicine approach within the realm of chronic infectious illness. Neurodegenerative diseases and autoimmune disease for the past 15 years. He looks a little young. I'm going to question him on that. With emphasis on tick-borne illness such as Lyme disease, he's a member of the International Lyme and Associated Diseases, ILADS. He's been a member of the International Lyme and Associated Disease Society since 2009 when he received a prestigious fellowship to receive formal training and treatment for Lyme. He also is an active member of the International Society for Environmental Acquired Illness, And so that's what we're going to talk a lot about today. He is well-versed in treatment of mold illness and CIRS, so chronic inflammatory response syndrome. And all these things are connected and they're so multi-system and it's, it's so difficult. I think of like what standard doctor could— would even look at that stuff. But it's just— and I see him at all the conferences and he's just passionate.

I love it.

And just wants the best for his patients and always investigating new treatments. He's always striving to improve outcomes and provide the best possible care. And he's really successful in the patients that have been everywhere. And lucky you, I know that goes, you get the patients that have been everywhere. And he's just doing such a great service. And getting great results. So hear a lot of great things about them as well. Again, we talked about so much beforehand and so many things are changing in medicine and some things for good, some not for good, but I think, you know, all these sickest patients are getting left behind, you know, and, and if a doctor doesn't know what it is, it doesn't exist or it's a patient's fault. But, you know, you should just tell me a little bit.

I didn't even—

hello, how are you?

Welcome.

I didn't even give you a chance here. Thanks. Thanks for being on. And you're up in Oregon and I see the news, the crazy stuff going on up there. But again, thank you for taking the time. I know you're a busy guy.

Hey, yeah, you're, you're welcome, Kent. Yeah, we just got through the fires down here in Southern Oregon, but you know, we're, we're looking good moving into the fall here and And I wanted to say thanks to you too on this topic because my knowledge and my passion for learning more about peptides really started from you as being the cutting edge on this topic yourself. I think that was maybe 5 years ago at ILADS when you first presented on peptide therapy as a unique option that I'd never heard of. And I don't know if you remember, but I think it was me like just pestering you for months after that and emailing you nonstop.

And who is this guy?

I gotta learn more about this. Yeah. And I didn't leave Ken alone. And here we are 5 years later and peptides have been a huge, huge part of my practice and improving outcomes and restoring physiology and neuroendocrine function and getting, you know, all these chronic people who are suffering with this multitude of, you know, chronic functional illnesses, fatigue and brain fog and pain and all these things that really the standard medical model doesn't have answers for. Peptides have been a huge component of the successes we've seen in restoring people's health.

Yeah, and, and it's interesting, you know, I give lectures on it and people just go, I can't believe there's all these studies, why haven't I heard about it?

You know, and well, because there's no drug rep, right?

You know, selling this stuff. And it's changed my practice, and I know it's changed your practice. For everyone from, you know, healthy people. I think it's the best, you know, anti-aging longevity ability to stay healthy. Like, you look at epigenetics, you know, increasing telomere length, to the sickest of the sick. And it's been those things that people have tried— IV antibiotics for years, you know. And then, you know, it's like— and you specialize in some of the toughest things like biotoxin illness. And, you know, what, what the heck do you do? And it's mentioned in my own story, my girlfriend just recently— I feel I'm good. I don't know if you ever get rid of Lyme. I think it's kind of like, you know, virus that— but it's, if you keep your immune system up and all that, it's fine. But she's developed, um, basically dermatographia out of the blue. And so we had a mold guy come around. We couldn't find any mold, but coming underneath the bathtub, there was mold toxins.

Yeah.

And right in the bedroom, you know. And so it's major. And let me ask you just one question though. Do you find— because my thought, if someone gets Lyme, right, they're probably— if they're not treated well, they get 2 weeks of doxy, which studies show they relapse like 3 or 4 months later, 80% of the time. But if you have like nothing else, they're not going to be terrible.

It's like when all of a sudden they get—

they seem to be more sensitive to molds. Like, there'll be everyone in the house— this is what I hear even from my friends that we got, you know, like all our staff there are like, like Lyme patients, biotox patients. EMFs are seen to be causing a problem and cause actually mold to grow. And, you know, especially the husband goes, ah, that's crazy, you know? And, and, but the people that have the Lyme or another infection are much more sensitive now to the biotoxins. Can you comment on that?

Yeah, absolutely. So, so much to say about that topic. Definitely in these chronic infectious models, there's often a trigger that seems to precipitate the immune dysfunction and either the growth of the organism that previously may have been managed by the immune system or accentuates the immune inflammatory response to the presence of, you know, a latent organism that may not have actually been causing tissue damage in the first place. And I think Lyme is still something we really don't understand. As you talked about you know, can we ever really get rid of it? It's one of these intracellular infections that it's doubtful that we really can. And then you start talking about potentials for sexual transmission or in utero transmission.

And I think in utero is the biggest problem. I mean, I know my whole— that's where I got it. I look back, one pupil was bigger, maybe, but like, you know, one side of my body flushing, my left arm would stop working, you know. And I think that's just the huge— the biggest transmission rate. But anyways, I just had to comment on that.

Yeah, yeah, no, I mean, it's— it's absolutely— and, you know, if you start looking at just like PCR, like urinary PCR analysis, like there's— I know at least one lab's reporting almost 94% positives in cases that were sent to them, you know, which obviously presents itself as an issue in and of itself. And then you're gonna— if you want to diagnose everyone with Lyme, great, but that's probably not accurate. Probably represents that there's carriage stages of Lyme, and there's a lot of people who have small amounts of it in their body and have been exposed to it. And it doesn't necessarily mean you have an infection, but it's one of these—

sending people who you think have symptoms, you know.

Yeah, yeah. So I mean, you know, biotoxin illness itself is, is, you know, a term that I think is so associated with mold. You know, Dr. Shoemaker really popularized that, and a lot of what he what he wrote about is really brilliant, actually. But biotoxin illness is just this topic that incorporates everything that's exogenous from molds and solvents and heavy metals and anything that your body can create an immune inflammatory response to, to endogenous things that live in our bodies. We're carriers for a number of things. There's pathogenic organisms that are present, like that we can't get rid of, Lyme and Chlamydia, Coxiella, and, you know, Brucella, and all these intracellular infections. And then there's the question about opportunists. You know, we talk about Pseudomonas or Klebsiella, Proteus, even strep, that if it's in the wrong place or if it grows too much, we also can see an immune inflammatory response to that. And that question brings up, well, endotoxins and lipopolysaccharide and antigenic debris in general that generates these chronic immune inflammatory responses. And how do you restore your— you know, how do you restore immune regulation, I think, is the big question in this. And even, you know, going back to the chronic Lyme talk we discussed, I think that, you know, while certainly I ascribe to the ideas you talked about, that 2 weeks of doxy or 3 weeks of doxy is often not enough, especially if someone's had this infection for more than 6 months, say. But endless antibiotics isn't the answer either. There needs to be a point at which you say, "Okay, if you can't get off antibiotics because you just continue to have symptoms, then we got to lower the threshold at which your immune system's reacting because it's unlikely this organism is causing tissue damage anymore, and it's more likely that your own immune system is responsible for the damage and the inflammation that's coming." and really restoring immune regulation and get rid of some of these toxins. And that's part of it. And it's a process for sure.

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Yeah, I think we're just bombarded with so many things, like, and something we can't even test for, but You know, glyphosate, why is that even on the market still? PCBs. I was actually— it's kind of ironic, I went to environmental conference and stuck out, went and had lunch and sitting there, I was open up USA Today and on the intersection was a cover page was a killer whale died. I found on the ice and they did a blubber analysis and it had a thousandfold the lethal levels of PCBs, which was banned, what, 50, 60 years ago, you know. And then I think also, and emotional stress is just— wipes out your immune system, you know. We think it lowers it, but it really modulates it so you can't fight the infection. You get tons of inflammation, um, and, you know, with all now it's like, you know Before, I mean, we're growing up, it's like, oh, we'll send a letter, we'll wait a week, get it back. And now it's like everything's instantaneous. We're on our phones, we got traffic. It's like all just so many different— like, even in California, the regulations for fire retardants are so much higher, and everyone's just full of this toxic stuff even more in California. I mean, there's so many things, and it's just I think it's killing us, you know.

Yeah, I mean, it's all getting into the groundwater. It's going up into this, you know, it's part of the whole water table and getting into the, you know, in the rain. I think, you know, they found glyphosate in the Sahara Desert. There's no place it isn't. And, you know, just incidence of chronic illness and incidence of cancer, like, these are things that have been increasing over the last 40 to 60 years. And I don't think it's a coincidence that that same time period represents the highest increase in, you know, our belief that, you know, better living through chemistry, right? That we can add more chemicals, we can manage agriculture, we can, you know, manage our forests, we can manage our food, we can do all this stuff. And yeah, maybe in the short term it helps, but in the long term, these, you know, biotoxins by definition is— I don't know by definition, but primary problems they represent is that they are fat soluble. So, you know, so these things end up depositing into areas of our body where we don't easily excrete it. And so they affect things like our, our, our, our, our endocrine function, pretty, you know, proportionally neuroendocrine system, our hypothalamus, our pituitary gland, and then just cell membranes. People don't realize, they think, oh, it's, you know, in our fatty tissue and You know, it doesn't mean it's in your butt. It means that it's like, it's taken into the cell membranes. It's in the mitochondrial membranes. And it causes, you know, these long-chain fatty acids, these odd-chain fat acids that, that really it's like cell scarring, right? And these are things that impair membrane fluidity, the ability to exchange nutrients and waste, you know, protein binding, second messenger molecules, fluid balance, peroxisome function. and ultimately you get this auto-intoxication as cells enter this, this cell danger cycle, right? As we've all heard about, which creates this, this senescence where the cell just kind of stops really operating.

We've talked about it, but can you give your little short definition of the cell danger response? Like how mitochondria—

yeah, you know, and I, I'm not going to profess to be an expert on, on Robert Naviaux's work, but The way that I see the cell danger response is that when you have an intracellular toxicant, whether that's an environmental toxin, something exogenous, or whether that's like the presence of an intracellular infection like Lyme or something else that our bodies aren't able to clear, right? So we have certain immune cells that are dedicated to this. We have peroxisomes that are supposed to push this stuff out. We have, you know, subsets of our natural killer cells like our CD57 sets that are designed to try and address this, but when the toxicity or the infections kind of reach these critical thresholds that the immune system can't manage it anymore, in order to prevent further damage to the body and the cell, you get senescence. You basically get a phenomenon where the cell goes to protect itself, and so in so doing, it, it, you know, you stop seeing recycling, you know, this autophagy, I guess, is the opposite of cell danger response. You stop recycling mitochondria, you stop stop, your ATP and your Krebs cycle slows down. You start to see lactate increasing instead of pyruvate. You see, you know, you know, all these phenomena associated with impaired mitochondrial function, impaired cellular function. You see increases in toxicity. You see, you know, cytokines that, that go up. And really all of this is self-preservation is the way I think of it.

I think, and do you agree, everything's a vicious cycle, you know, and it's like you don't have enough cellular energy to kick the stuff out of the, you know, like heavy metals, you need energy to get it out of the cell. If you don't, it's stuck. I don't care how much chelation you do, it's, you know, it's stuck in there. There's just so many things like that. It's either, you know, you're, you're getting healthier or you're getting worse. And I don't know, you may see the same. I think it's like, I can't go to a party where someone comes up and either they're so sick or their family member or their friend, you know. And I know you didn't see that, you know, 10 years ago, 20 years ago, you know.

No. And it's, it's, yeah, it's an interesting phenomenon. I think a lot of people ask the question of like, like what you're saying, you see this person at the party, you, you know, you, you're talking to a friend and he talks about it. Acquaintance or his wife or someone's like, why is she so sick? And the question is always like, well, we live together or we're in the same— we're exposed to the same thing. Why is this person sick and why am I not? And we already covered these sort of direct effects of biotoxins, how they impair our membranes and our cellular function. But the indirect effect, which is really what CIRS is all about, that chronic inflammatory response syndrome. Basically says that about, you know, call it 20 to 30% of the population lacks the— what's known as these HLA receptors that are needed to recognize toxins as they're presented from dendritic cells that are normally bound to these, these major histocompatibility complexes. So, you know, when you can't generate an adaptive immune response because you can't create CD4 antigen-specific T cells, you, you start driving a chronic innate immune inflammatory response, and you start to see cytokines going through the roof. You start to see, you know, impacts as the toxins end up binding into, you know, the hypothalamus and, and, and the leptin receptors. And so then you see this whole cascade that happens where melanocyte stimulating hormone drops off, and then you see a cascade of vasoactive intestinal peptide levels dropping down, and then the pineal gets affected. And of course, you know, we all love epiphalin, which is— personally, I do as well. And so you see this huge array, and, you know, as you look at the biotoxin pathway, you go, well, you know, why is it I have GI symptoms? Why is it I have pain? Why is it that I'm cold all the time? Why is it I'm, you know, achy? Why did my my libido drop off? Why am I peeing all the time? And it's because these upstream neuroendocrine hormones kind of direct a lot of these things. And when you shut off the spigot up here, you're not going to water any of the plants down here.

Controller. And it just— and even like, you know, mast cells, it's a huge thing. And, you know, I know you're on the Mast Cell Mastermind group and you're stuck on directly affect the mast cells. And I'm like, look upstream, you know. And it's funny, in little things, I ask patients, do you, you know, drink like a fish and pee like a racehorse? Like, what? Yeah, you know, you know. And, uh, it's interesting. And so many things— I've been doing some deep diving on some of these bioregulatory peptides, and like inflammation of hypothalamus just causes so many issues, and it just affects Everything. And yeah, so when you have a biotoxin illness, you're like, I guess the standard, you know, is the mold everyone thinks of, but really it's everything, right? It's—

yeah, that's just it. It's, it's, you know, that it's, as you just brought up with mast cell activation and, you know, why is this happening? And sure, we know ways to manage that with, you know, stabilizing those, the histamine response. But the question is like, what's what's driving it. And so that process of discovery of trying to understand what it is, is I think the first step in this. And there's definitely different ways that you can assess or diagnose someone with biotoxin-related illness. The visual contrast sensitivity test, I think, is still very helpful. You can do it online at vcstest.com for free or —where you can buy them.

Do you want to mention more? Like, why does that work? What is it?

Yeah, so I think it was developed by the Air Force, if I remember right, somewhere in like the '60s or '70s to find out when pilots had been exposed to excessive amounts of jet fuel, which is of course a solvent, and it would impair their bodies, you know, their central nervous system's ability to work. So the visual contrast test is It's looking at your brain's ability to distinguish contrast. So really it's like these gray circles with gray lines that go, that are hatched one way or the other or vertical. And you put yourself a fixed distance away from the card or the screen and you're looking to see which way those lines are going, these gray lines on a gray background. And what they've found is there is a strong correlation between the presence of biotoxins in the brain and the inability to process that contrast, to actually see it. The visual processing centers in the brain aren't capable of doing it. And it's fairly accurate, actually. It's a good way, and it's an inexpensive or even free way to actually say, hey, look, I think there might be something going on here. And, you know, and so that's, you know, that's that first step. and part of a big picture, of course. And from there, you know, you can do a variety of things. You can say, well, let's find out what it is. So the way I think of biotoxins is there's direct and indirect ways to assess for them. So, you know, directly, we know that you can measure mycotoxin in the urine, like you can use ELISA or mass spec to look for certain mold toxins. You can look for heavy metals, you can just do a blood draw and compare Like, is your level of mercury higher or lower than the 50th percentile? It's, you know, that you find in the NHANES data.

Let me ask you, what tests do you like to do for biotoxins? And, you know, like the Realtime or Great Plains, you look at urine and yeah, some people just like, everyone has, you know, and it's like, when does that become significant in your mind associated with symptoms? And then also with heavy metals, what type of testing do you like?

Yeah. So I've, I've, I've gone the circuit honestly, in a lot of these tests. I tend to prefer using ELISA studies or antibody-based tests with RealTime Labs right now for, for mold toxin because it captures all of the metabolites. Whereas mass spectroscopy, like you're only looking at a specific molecular weight, right? So you're, you're only able to capture that toxin in its conjugated form. And so if glutathione, for example, is bound to ochratoxin or gliotoxin, you're not going to pick it up. So you, you know, so the ELISA—

the stuff binds the stuff. Yeah. Yeah. So, so the—

yeah, exactly. And so the ELISA I use from Real-Time Labs, but if I'm looking at solvents, I'm, I'm, you know, there's, there's only a few labs that are doing this. US Biotech or Great Plains are both labs that I think are both good. I see great results on both, and looking— and those are mass spec tests, but they're looking at metabolites. So I think they're, you know, I think it's a better option because you're not looking at the conjugated form, which gives us better datasets. So if we're looking, you know, for petroleum distillates or herbicides, insecticides, you know, plasticizers, you know, PCBs like you were saying, all that can be reflected on, on those urine tests. I still tend to recommend that people do a glutathione challenge for a week before those tests, taking, you know, 1,000 milligrams twice a day to, to mobilize all this toxin. And then I, I tend to have them stop it within 24 hours so that we're—

just real quick, how do you like to give that?

Uh, I use liposomal glutathione, so, you know, Actually orally. I do oral— yeah, an oral liposomal glutathione. If they're able to do a sauna, say, for the, you know, the night before they collect their urine, I think that helps to mobilize things out of fatty tissues because that's really what we're talking about right now. You know, and then of course, in the mold toxin world, this has been a big topic, but you want to avoid foods that might have mold toxin in them for ideally a week before you do the test. If nothing else, at least 3 days. The problem is it's some of the healthy foods, right?

Yeah.

You talk about nuts and seeds or coffee or fruit, right? A lot of fruit or berries or aged cheeses or wine or any grain. Corn is notorious. All of these things are they're siloed in the United States. They can be siloed for years at a time, and you get mold forming in the column of grain, and then it gets milled into flour, and now you got mold toxin mixed with all this, which may or may not affect things like our gap junctions in our gut, but ultimately, it's going to result in false positives because you're going to be picking up things that are moving through your body.

It's thought to be the reason for, you know, one of the plagues on Egypt and the firstborn dying from mycotoxins in the grain. Yeah, you know, yeah, goes way back.

Yeah, everyone with her— like, even what was it, the French Revolution, or, you know, all those things like ergotamine and the grain supply, everyone's hallucinating from, from— yeah.

And you wonder, do you— I don't know, I just, you know, wasn't planning about it, but I'm wondering, are people's brains changed now and different?

Are they more like, I think, kind of fight or flight, basically polarized? Like, is that part of toxins? You know, stress plays a part, but I think toxins probably play a part too, you know?

Definitely they do. I mean, so again, like how toxins affect us, like we know they create these immune inflammatory reactions with, you know, all of these innate-driven cytokines like IL-2 and interferon gamma and IL-6 and all the things we don't want to see. But in the central nervous system, which is mostly fat, you start creating activated microglia, these cells that once they get turned on, they just— they're always screaming in panic. You know, you start to see NMDA. All of these toxins tend to have what they call excitotoxins because they stimulate the NMDA receptors and drive, you know, intracellular calcium buildups and things that actually do impair neurogenesis and paraligodendrogenesis and, and affect our— both our cognition as well as potentially, you know, creating or setting people up for things like dementia or cognitive decline or or worst case, you know, neurologic autoimmune symptoms. So I—

Yeah, because, yes, that, you know, glutamate and, you know, basically concytotoxin, which is a side story, is that I started stuttering so bad, right? I couldn't carry a cell phone because I couldn't say hello, you know. And then I read— I was going to go to actually one of the doctors I did a residency with and was on his team He stuttered really bad, but he opened a stuttering center in Irvine. And then I read an article on aspartame and stuttering. And I stopped, and I stopped stuttering in 2 weeks. Wow. And then if all of a sudden I get like, one time I changed from Starbucks to Coffee Bean and they didn't have, instead of sucrose, they had aspartame. I started stuttering again. I'm like, what's going on? But it's very, it's like Diet Coke too. It's like, it, like, I can't get off of it. It's like addictive. It's like, it's an excitotoxin, you know, you get amped, but it caused stuttering in me. So talk about a neurotoxin, you know, and that's mild compared to all this other stuff we're taking in.

Yeah. Thankfully a water-soluble thing that you stop it and within a few days, ideally it's clearing outta your system. Yes. Yes. Yeah. No, that's, that's a good example for sure.

Oh, so how do you approach a patient? So I'm sure you get these patients that have been everywhere, they have these complex symptoms, they get transferred from doctor to doctor, even neurology, whatever. Um, they come to you, what, what, how do you start?

What, what do you do? Um, I take a really, really good history. That's, that's the first part of it. I think that One of the worst problems we see in the medical system right now is—

No one does that. What are you talking about?

Yeah, I mean, managed care, right? Managed care has been a— it's great if you have a bladder infection, but if you've been suffering from chronic fatigue, I don't know how much someone's going to accomplish in 10 minutes.

So, you know, the box— they're great if you break your arm or something, but if you're outside the box—

and that's what I say, you know, I say, you know, the way the medical model right now is great. It's set up for heroic medicine. Like, if you're life is in danger, by all means, I would, I would, you know, I'm appreciative that the medical model we have exists. But if, you know, for the millions of people who are suffering from chronic conditions, there is a process of discovery. It's as you said at the beginning of this, you know, this talk, that it's a puzzle and it's, it is kind of gratifying to try and understand or unravel this whole puzzle. But so I'll start off with, you know, usually an hour and a half to 2 hours with someone. Which gives me enough time to hear their story, ask detailed questions on all of the different systems in their body, go back to when things started, try and understand the lineage, whether it was, you know, maybe they were in a house, maybe they were traveling, maybe they got a tick bite, maybe they were, you know, emotionally abused or had some sort of, you know, trauma to them. There's usually some sort of a trigger and you start there. You know, in the absence of that, what I tell people is let's throw out a big net, right? And, you know, because there's, there's usually some— I like that term.

I love getting lots of information, right? And so you're not running down a lane that— not that you missed this over here, you know? And people are like, you know, it's like we do so many tests, you know, that freaks out the phlebotomist at like Quest or whatever. And I went myself and they're like, oh, this is the doctor that orders all those tests. I'm like, yeah, I've heard he's like really cute.

Yeah, I will say it helps to have— we have a great lab in our office and our lab director is, I mean, unparalleled in her ability to process. Like, you know, she comes with like a lot of tubes this big, like, this is what you want to order? What—

if I don't mind, I said, what labs do you use? What— what?

Yeah, so it depends on what I'm looking for. So that wide net question that we sort of talked about a second ago. So if I'm like, I'm always going to say it's some interplay between infections, immune dysfunction, and environmental medicine. So that's kind of the three points on the triangle, right? And, and so, you know, on an infection level, depending on their history, I might do a really broad, like, antibody-based study like we'd see from— like Cyrex has got a great pathogen-associated immune reactivity. It just tests for antibodies. Doesn't mean you actually have it, of course. And, and I, and I think that's an interesting topic in of itself because, you know, in medicine we all hear about these IgM and IgG antibodies, and okay, IgM means it's, you know, it's recent, and then you should get IgG. But in these intracellular infections, as you know, Kent, like you see these IgM spikes that continue to happen. But at the same time, I've seen ILADS doctors, I've seen other Lyme doctors saying, well, you know, at least for me, I'm initially treating IgM patients, and once they seroconvert to IgG, or if I get an initial patient that's IgG positive, I'm going to say, is this really an infection, or is this just an immune inflammatory response to the presence of this infection? Maybe you do an antimicrobial challenge and you do an antibiotic or a series of them, or maybe do some herbal therapies. But if it doesn't make them better, or if it just makes them worse, like, you need to think that maybe the issue is really they've got this, this chronic immune-driven inflammation.

So just so again on the IgM, and so like infectious disease doctors, regular doctors, they say, okay, we've been taught from medical school you get IgM antibodies and you get IgG. But a couple things is that if you like, with the immune system dysfunction you see in these conditions so that Th1 T-reg is low and the Th2 Th17 is high, that you can't convert IgM antibodies to IgG. Yeah, and IgM antibodies are basically like— I think of them like a dog holding on to your pant leg, like— but IgG are more specific and they activate complement and they explode the thing, you know. And then all of a sudden you treat— you either treat the immune system or treat the infection all of a sudden they switch to IgG, but they'll go to the infectious disease doctor, says, well, this is false positive because you've had these symptoms for a long time and it's IgM. It's like, no.

And that's just it. And it's, it's interesting because again, as you know, we go through this, there's clues along the way like you're saying. Like, you can look for a split complement, you can look at C4a levels, and you know, you see a number at 20,000 and it's exactly as you're saying, like this is part of the reason why they're not seroconverting. Like, their bodies are constantly pushing this Th2 inflammatory reaction. They're not seroconverting. They're not getting an effective immune reaction. They're just generating a lot of smoke, right? They're— it's, it's, you know, it's a—

the body's trying. Yeah, yeah, effective. Yeah, yeah.

Hey, let me close this blind really quick. I'll do that. This thing is driving me nuts, Kent.

Hey, live TV. Hey, there we go.

I'm getting a lot of lines on my face. So anyway, so testing. So direct testing I'll do again, like we can look at individual organisms, individual infections. I use IGENEX for a lot of that testing, but broad nets, things like Cyrex for mold, I'll use Urine Mycotoxin with Real-Time. For solvents, I tend to use Great Plains Lab. And for heavy metals, it's a whole topic, but I think a lot— a big part of the problem is people jump straight to doing challenge tests. They start doing EDTA, DMPS, things like that. Of course you're going to be high. There is no reference range for someone after they've done DMPS. So the way that I think is most high— the best integrity way of looking at heavy metals is just do a blood draw. Just measure your, you know, blood mercury, blood lead. You can do urinary arsenic. And there's the federal—

is that going to show this recent exposure?

So if they're having recent exposure, you're usually going to see really, really high levels, or you're going to see it in urine, right? Like, you shouldn't ever see urine mercury or urine lead. Arsenic, definitely you're going to see that no matter what.

But Other things you're gonna— Where does the arsenic come from?

Arsenic? Well, it's in rice, it's in certain— like if you have chickens or livestock, I know you'll see it in some of those. It's a contaminant in well water for certain areas of the country.

Like, for anything you can eat, you know, it's like, it's scary because it's like, all right, it gets up in the atmosphere and it rains. Like even all these, you know, basically biodynamic and, you know, stuff, it's It rains on there, you know. I—

there are things that would be helpful, and maybe, you know, maybe it would be part of this like preventative, like you want to stay healthy, like humic and fulvic acid is a great way to bind stuff in the gut. Chlorella probably has some good binding ability. I mean, there are binders, but if you start getting into talking about, um, you know, like clay or charcoal or prescription cholestyramine or you know, glucomannan or any of these other things, my concern long term is that you might be impacting your ability to bind a bunch of nutrients.

And can you just mention the theory with the binders? Sorry, what was that? Mention the theory, like why, why you do binders.

Yeah, for sure. So, so again, like when you— if we're talking about the chronic patient and we're looking at like toxins embedded in fatty tissue. Well, your body's always trying to move this stuff out, right? I mean, on some level, your body is trying to get it out. It's maybe not efficient. Maybe you don't have this HLA receptor recognition, but you're still going to mobilize things on some level. So anything that's fatty is going to ultimately end up in your bile and get eliminated through renal excretion. Usually you see this hydroxylation followed by conjugation in the liver. and that comes out through bile, which of course is where most fat-soluble toxins go. That's going to get excreted into the small bowel, and ideally it's going to get eliminated with stool. But the problem with fatty things like fatty toxins is you get enterohepatic recirculation. So all of this gets reabsorbed back through the distal part of the small intestine, back into the bloodstream, back into the hepatic vein. Where it gets redistributed back into the tissue. So again, it's just driving all this. So binders like we're talking about, whether it's, it's a natural binder like green clay or charcoal or a prescription like cholestyramine, it's designed to grab onto that bile and, and prevent those toxins from being reabsorbed back into the body so that you actually have a net loss, right? So things are moving out of you. So it's one of the reasons why, you know, you're always going to take these binders an hour to an hour and a half before you eat. And in my patients, I'm always working to give them some koligat, something that's going to stimulate a bile release, right? And that could be something simple like a bitter, or you could use something stronger like that also has benefits, reparative benefits, like phosphatidylcholine, or, you know, some, some lipotropic formula. To really get that.

Make a nice drink with bitters. What's that? Make a nice drink with bitters.

Yeah, yeah, exactly. Get a Manhattan. You know, that's the best way to get your bile moving. But it's scary.

I mean, it should be everyone taking binders all the time. You know, when I eat sushi, I take, you know, chelators with it. And I take Alinea, you know, for parasites. For parasites. And Dr. Stuppy, who's in LA, GI, did a little study on— oh, what was the parasite? But on where all the parasites were, all the patients he had, and they were not in the low-income areas, they were in the high-income areas. And so we're trying to figure out why. I mean, my thought was, you know, either cats or sushi.

Yeah.

So don't even get me started on cats, Kent. But, but, you know, it's funny because that, you know, I— we call it the executive problem. You know, you see the same thing in with heavy metals. Right? Like people who are not often in the most socioeconomically depressed area are buying more fish, eating more sushi, and predictably mercury levels are much higher than in many other— Oh, you can't eat anything. You know, I know. So you got to take your DMSA. And, you know, and like I was saying with heavy metals, like it's really not magic. You can Google the NHANES data, N-H-A-N-E-S. It's the federal NHANES data. It's updated every 6 years typically.

Not our alternative quacky, you know, stuff. Not even alternative, not wacky.

And if I remember right, the way— so it's all divided into percentiles. So you're at the 25th, the 50th, the 75th, 90th, or 95th percentile for mercury, lead, arsenic, cadmium, whatever. And if you're at the 75th percentile or higher, I think the terminology is it's likely that the heavy metal load in your body is contributing to some disease process. As soon as you reach the 90th percentile, that, that, you know, the terminology changes to say it's likely that the heavy metal level in your body is causing symptoms.

And the problem is though, they'll just adjust the reference range to be 95% of the people. Well, that's just it. Yeah. So now you're normal. It's like with testosterone, they keep lowering the range because people are lower now because of all the right things, you know. Right. It's nuts.

It's totally true. What is normal? And this also brings up the idea of like, what—

cancer is normal when you get older. Cardiovascular disease, say, oh, you have cardiovascular disease, you're normal.

Yeah, right, right. And, and, and it's, it's— and there's really sensitive people, and people react individually, and you can't treat everyone like a cohort, right? And this brings us to the topic of like, well, how do you know if it's affecting you? If you— so now you have high levels of mold or heavy metals. So that brings to the indirect testing, and that's all of the shoemaker markers. That's like looking at your MSH levels, your VIP levels, TGF-beta-1. I love that test. No one ever— I don't think people understand it very well. But I know what lab you like to get that from. You know, it's— yeah, so I bounce around, but MSH, VIP, I use LabCorp. TGF is LabCorp. LabCorp. C4A, we were using National Jewish Health out of Denver for that.

They screwed up like half the time at least.

Well, and actually in truth—

Quest is screwing up sending it. Yeah. Yeah.

So Quest has told us they won't do pass-throughs anymore. We live in too small of an area, so we're not even able to do C4As now. We use a lot of LabCorp. We do VEGF and MMP9 through LabCorp. ADH and osmolality is Quest.

VegF with Quest, it's zero 90% of the time. It's just they process it wrong. Yeah. So yeah, and that's— and just, I don't want to be a downer with patients, but I think, okay, labs are like, you know, the gold standard. I sent our web guy just for basic labs. He did LabCorp. This is LabCorp Quest at the upper level. He walked downstairs, or labs right above each other. And walked down to the same test at Quest. One, he was diabetic. The other one, he had great insulin sensitivity. Like, hemoglobin A1C was 6, the other one was 5.4. Insulin was 18 on one and I think 8 on another. Like, that's basic stuff. Yeah. And think about all these other tests, you know.

I have seen so many botched tests. I mean, I could go off on a whole— someone who I had a simple UTI. Well, it was pyelonephritis, but they reported no bacteria at all. And so I'm thinking, oh my God, this is—

Got a new tech looking and yeah.

Yeah. And you know what I get as an answer is like, well, have you ever tried to look at an anthill under a microscope? It's all black. So if they have too many bacteria, you can't see it. I was like, oh my God. So, you know, meanwhile I'm ordering all these other tests, sending someone to urgent care when really they just needed to be treated with an antibiotic for an infection, actually. And it was—

See, but you have to be an expert in everything.

Right, right, exactly. You know, but, but yeah, all those indirect markers are really helpful to understand. Okay, now you got the toxin, like how's it affecting affecting you. A couple other markers I really like, 8-OH-DG is— and don't ask me to tell you what the full name of that is, but you can do that test with Doctor's Data. It's a urinary test and it's actually a marker of DNA damage. And what was it again? Uh, 8-OH, like 8-hydroxy-DG. And it's really, you know, tends— it really tends towards heavy metals and saying like, are the heavy metal levels actually affecting your DNA, but it can be used for a lot of things. Tyglyglycine is a marker of mitochondrial— impaired mitochondrial function that you see on the Great Plains Solvents Panel. And these are markers that you can see improve, right? So it's, it's great. You know, similarly, we talked about all these—

like, I mean, that's serious, you know, and it's not gonna hurt you tomorrow, but 10 years down the road, you're going to have a lot of issues, you know, people. And I always tell the doctors, like, I think our first job is convince the patient they're in the right place. And how do you do that with— okay, these tests, like, I'd love to get all these tests, right? But a lot of times it's not cheap. Yeah. And, and so it's kind of the art, like, do you do some indirect tests? So, hey, there's something going on, which I kind of like to say, so now we need to dig deeper? Do you have a little kind of a strategy to how you— because it's where the patient's going to go, okay, give me all these, you know, you know, 10 different panels from different labs. How do you approach that?

Yeah, so I guess there's two answers to that. One is what can you get away with with insurance, right? So all these Quest and LabCorp tests that we talked about A lot of the times we can get insurance coverage for that, so that's hugely helpful. In a scenario where we're looking at out-of-pocket testing, hopefully a good history sort of helps to direct in that way, but ultimately there's no easy answer, Kent.

It's a lot of gut, right? It's a lot of seeing a lot of patients.

It's just a lot of familiarity. I know that there's, you know, there is energetic testing like, you know, like ART, Autonomic Response Testing, or kinesiology, or electrodermal testing. And I don't do that. There is a provider in my office who, in some cases, I'll send to him and say, "Hey, you know, run up one of these energetic tests for me and just give me your top 2 things that are hits." And that helps sometimes to hone things in for some people. But as I kind of alluded to earlier, like these big nets, this idea of like, let's, let's just do a general antibody study. You know, maybe we need to measure immunoglobulins to make sure they have enough of them to even, you know, see a result that's quantifiable. But in, you know, assuming that their humoral immune system is working, you can maybe do just general screenings for like, again, like a chemical immune reactivity, which is a Cyrex test, or a mucosal immune reactivity These are going to look at, you know, solvents and some heavy metals and some infections. You combine it with a pathogen-associated immune reactivity test, you get this, you know, you test for everything from strep to chlamydia.

You know, there's not the antibodies but the, um, the, the, the basal lymphocyte test to see their reactivity.

So it's a different type of test.

It's a diff— yeah, it's just saying you've been exposed, right? It doesn't really mean anything more than that, but it does help to funnel things a little bit more. If I had my way, and ultimately I try and encourage patients to do as much as they can because the more information you have when you start, the quicker you can get from point A to B. And honestly, a lot of the times the less expensive it is because you're not heading into tangents that you don't need to go down.

I know, but it's hard. It's like, well, I don't want to do that. I don't want to do the patient who's so sick. No, I don't do that. I want to do that. Like, I want to get the information because there's likely— look, you've been to 22 doctors, right? It's something. Let's look down some different paths. But it's, it's tough. I mean, people are paying a lot. They have insurance, like, oh, it's not covered, right? And that's what, you know, the medical system is— it's tough. And, and these patients with these chronic multi-system illnesses are are— it's just a tough, tough—

but, you know, even speaking to that, like, maybe, you know, and, and maybe even to just leap into the topic of peptides a little here, like, you know, we had this idea of like upstream versus downstream things, right? Like, we know that how things get affected. Sometimes it's helpful to just test for these upstream modulators. Like, if you test an MSH level in someone and it's not measurable, like it's, it's less than 8 quantifiably, you know, something is probably bound to that leptin receptor. You know, something is disrupting the melanocortin system and, you know, you've already identified one thing. So, you know, this is where like Melanotan comes in and I don't think people really realize that Melanotan is synthetic MSH and you can use it and and it works great to like work on all these peripheral cytokines, work on reducing activated microglia in the brain, like preventing these NMDA receptor, um, you know, you know, constant stimulation.

So there, you know, there are simple ways, but you know, I just, I mentioned like melanotan, sort of like the Barbie doll peptide where you basically get tan, you lose weight, You lower inflammation and yeah, and you increase libido. Like, hey, sign me up. But, but you do get pigmentation change. If you're young, I like it, but oh my God, I did it and I turned so dark. It's like, oh my gosh, what is this guy, you know? But also if you're older, you get some dark spots and come out, so it's, it's not the best. But, but that whole system is something that I think is Finally, doctors are recognizing it's so anti-inflammatory, mast cell activation. Yeah. And, you know, I think inflammation is what's killing everyone. I mean, there's, you know, one common pathway: inflammation, mitochondrial dysfunction, which go all go together. Um, and I think that's a great— so there's KPV, which is the tripeptide, is the piece of it which, which attaches to those receptors but doesn't cause the hyperpigmentation. Yeah, yeah.

And people don't— I don't, I don't think it's really realized in that, as you mentioned, inflammation drives all of this. And melanotan and KPV have both been shown to have anti-inflammatory properties comparable to prednisone without any of the negative consequences of using a systemic corticosteroid. So wow, right? Like, isn't that a huge deal? And similarly, BPC, you know, so you start thinking of like inflammatory bowel diseases or rheumatoid arthritis or other things that really, you know, or, you know, ankylosing spondylitis, all these things that people are on chronic steroid therapy. This is such a better option for so many of these folks.

Yeah, and even if they're on steroids, you give it, it counteracts it, you know. There you go. And it's like, yeah, you reduce the inflammation, but actually anabolic rather than catabolic. And yeah, so what are your favorite peptides, or what are typically the order you use them? I understand there's gonna be variation, like, you know, what tests come up and— yeah, but what, what in general are your go-to peptides?

So, so I guess what I'd start off by saying is, like, I categorize peptides in terms of, like, what they do. So the way I deal with any biotoxin illness is, like, I kind of have this 7R program in my head that I think of, which the first one's always removing or detoxifying the substance, right?

Like, get out of that environment or whatever it may be.

Yeah, get it out of the body, okay? Whether you got to kill something or help, you know, excrete toxin. Then we have replenishing upstream neuroregulatory hormones, then reducing inflammation, then rebalancing the immune system, restoring endocrine function, repairing mitochondrial function, and then finally rehabilitating impaired neurologic function. And the reason I'm telling you that is because I start in that top-down approach, okay? So as we talk about the first thing— well, the second thing after removing the substance— replenishing neuroregulatory hormones. So we already talked about melanotan. I love the stuff. I use it a lot in a lot of patients, and I find it's incredible.

VIP, do you have problems with people getting dark spots or— Yeah, I do actually.

And so the way I tend to use melanotan is I tend to kind of think of it as a priming the pump where I'll use higher doses for roughly, you know, sometimes 6 to 8 weeks, which is the life cycle of a, of a T-cell, right? So we're, we're trying to actually impact that immune inflammatory response. And then I'll reduce the dosage frequency or amount pretty significantly because by that point, you know, as you're seeing, you're seeing melanocyte deposition, you're seeing dark spots, you're seeing all of this stuff happening, and that, that's, you know, helpful to sort of modulate it. KPV, as you talked about, won't do that. Unfortunately, as soon as I had wanted to start using it, regulatory bodies that we shan't speak of, sort of like pulled that off the ability to—

Hey, we're bringing it back. We should have it in a month, I hope.

Yeah, well, I'm gonna— yeah, I'll be all over you on that one because I'm excited because theoretically KPV, as you mentioned, has some of the same benefits of using melanotan from, you know, its ability to reduce all of the inflammation in the body, Cutting down, it's more potent. Is it? Okay, I didn't even know that. Yeah, so that, that's something I didn't know. But people don't realize the, you know, these MSH or the terminal fragment with KPV, it upregulates IL-10 and it induces CD4 and CD25 markers on T-reg cells. So it improves antigenic tolerance, the presence, you know, of these things. It, you know, in models of RA and inflammatory bowel disease, um, ARD. I think it's going to be huge.

And they even have, you know, psoriasis. You rub it on, hour later it's gone. And when my girlfriend was getting the dermatographia, rub it on, like 10 minutes later it's gone.

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