Healing The Gut - The Functional Medicine Way With Dr. Ben Weitz

Lisa: Hey everyone, welcome in out there on podcast land, YouTube land, wherever you're listening to this from. Today I have Dr Ben Weitz with me, and he is a functional chiropractor, functional medicine expert, a clinical nutritionist. He's an ex-bodybuilder, he was Mr Los Angeles back in the day, very fascinating man. Today we do a deep dive into gut health, especially. We're looking at all aspects of gut health and also we do a bit of a dive into cholesterol as well.

Lisa: So I hope you enjoy this podcast. If you're struggling with any digestive issues, if you know that the seat of your immune system is 80% in your gut, then you know that's really, really important to look after your gut health. So I hope you enjoy this episode.

Lisa: Before we head over to the show, if you are wanting to test your microbiome, if you're wanting to do some functional medicine testing with me, please reach out. You can book a consult with me. I can help you work out what tests we should get for you if you want to look under the hood at what's actually going on in your body, whether that be organic acid testing, microbiome, heavy metal testing, thyroid hormones, DUTCH testing. There's literally hundreds of tests that we can run and help you work out whatever problem it is that you're dealing with. So head over to lisatamati.com. If you go over to the shop, there's a consultation button that you can look at, or you can just reach out to my team at lisa@lisatamati.com. Let me know what you're dealing with and we'll get back to you with some information on how we could work together. So without further ado, now we'll get over to the show with Dr Ben Weitz.

Lisa: Well, hi everyone and welcome back to Pushing the Limits. Today I have found another wonderful superstar for you guys to learn from. Dr Ben Weitz, welcome to the show. It's fantastic to have you.

Dr Ben Weitz: Lisa, thank you so much for inviting me.

Lisa: Oh, it's just going to be so exciting. We're going to dive into — we'll probably go all over the show, knowing me, because I'm a little bit ADHD — but we're meant to be talking about gut health. But Dr Ben, can you just give us a little bit of a background on you and how did you get to where you are today and what you do?

Dr Ben Weitz: Great. So I'm a sports chiropractor and functional medicine practitioner in Santa Monica, California, and I've been practising for 35 years. I started off as a sports chiropractor, but I was also into health and nutrition and did bodybuilding, and learned how to manipulate my body fat percentage, and so was really interested in how to use nutrition to modulate health and even appearance, etc.

Dr Ben Weitz: And every year I would go and listen to Dr Jeffrey Bland, who would give this annual talk, and I definitely became a Blandite. I used to get his audio tape — every month he would put out, we would get these cassette tapes we would play in the car, that gives away how old I am — and it was great. It was called Preventative Medicine Update and then Functional Medicine Update. So Dr Bland, for people who don't know, a lot of people recognise him as the father of functional medicine, and every year it would just blow my mind away with these new concepts about functional medicine.

Dr Ben Weitz: And then I went through the Institute for Functional Medicine and their training programme. And then I've had my own podcast, Rational Wellness, for the last six and a half years. I also organise a monthly discussion group for functional medicine practitioners and we bring in speakers. So I'm really devoted to spreading the word about functional medicine.

Lisa: Yeah, absolutely amazing. And to go from being Mr Los Angeles in 1985 — wow. I think you and I are probably about the same age or same vintage. And to where you are today, and to go through chiropractic, which — I've got so many friends who are chiropractors who are now going into the functional medicine space, and they seem to be very open to all of that. It seems to be a much easier sell than it is to the allopathic medicine community. There seems to be more chiropractors that are open to functional medicine, which is absolutely amazing.

Lisa: But you have a flourishing practice where you still do chiropractic, but you've just moved on into all these other areas and functional nutrition and all of this sort of stuff. What I really wanted to dive into with you today is into the gut, because the gut is the seat of our immunity. It's like 80% or something of our immune system resides in the gut, and so many systems are impacted by the gut, right? So we need to make sure that we've got good gut health, and you're the man to ask about that. And you've also interviewed — I love your podcast, Rational Wellness. Everyone go and listen to the Rational Wellness podcast, absolutely fabulous.

Lisa: Well, where should we take this conversation for a start? What are you seeing in your practice and working with your patients as being some of the most common problems in gut health?

Dr Ben Weitz: Well, the most common problems are things like IBS and reflux, and these fit into a category that we often refer to as functional gastrointestinal disorders. And by functional, what that means is there's nothing clearly structural. So typically patients go to see a gastroenterologist and one of the first things they'll do is they'll put a scope either up through your butt or down through your mouth, and they do either a colonoscope or an endoscope, and then they're looking for structural things that they can see.

Dr Ben Weitz: And unfortunately, with conditions like IBS and reflux, there's nothing you can see. And we can throw dysbiosis in there. So these are the types of conditions that are the most common and yet they're the least understood. And for years even gastroenterologists would often just think of these conditions as stress-related and sometimes prescribe antidepressants.

Lisa: You have something wrong up here.

Dr Ben Weitz: Yeah, exactly. Especially since IBS is way more common in women, and we know they're all hysterical anyway.

Lisa: Women — exactly. Isn't it rude? Wow, it is rude.

Dr Ben Weitz: The interesting thing though is there may actually be some value in taking antidepressants, not because of helping with their mood, but because the intestine has a huge number of serotonin receptors, and by stimulating those serotonin receptors you actually help to reset the motility of the gut.

Lisa: Wow. Well, is that one positive thing for SSRIs?

Dr Ben Weitz: Of course, absolutely. And people think of them as completely benign, but they actually increase your overall mortality rate.

Lisa: Yeah, and I mean, as someone who was on an SSRI for way too many years, they are addictive too. Like, you try and get — they are the most difficult drugs to get off of.

Dr Ben Weitz: Absolutely.

Lisa: Yeah, it took me three years to titrate down. And I got stuck on them in my early 20s when I was going through a breakup or something, and hello, you're stuck on these damn things forever and a day and you don't know how to get off them.

Dr Ben Weitz: And how irresponsible. "Oh, I'm feeling depressed." "Well, is there anything going on?" "I just had this bad breakup." Well, that's no reason to go on an antidepressant necessarily. There's a physical reason why you're having these symptoms and it's normal — unless it continues and goes on and on or becomes severe enough where you can't function.

Lisa: Yeah, exactly. And there's so much interaction. It's a bit the same with the contraceptive pill, which — how many, 80% of the world's women's population has been on or is on the pill — and the implications for gut health with the pill, let alone things like thyroid and the changes in the way you think, even, and the way you choose a mate, and all of these things are affected by the pill, cancers and all the rest of it.

Lisa: And this is the thing with functional medicine: you're looking for the root cause, you're looking for where is the problem. I mean, with contraceptive pills, what we're trying to avoid there, that's pretty clear, but knowing the implications of what you are doing — that often comes out years later, that, "oh hello, we've done this worldwide experiment with the female population and we've got a few problems that have popped up now."

Dr Ben Weitz: I mean, essentially you're putting women into chemical menopause and just shutting down a whole system in your body and expecting things to just be normal. Now, there may be cases where it's necessary, but there's a lot of cases where it's not, and it's just easy to throw birth control pills at a problem like PCOS or any sort of menstrual issues, etc, etc.

Lisa: Yeah, that's exactly — anecdotally, that's exactly what happened to me. At the age of 13 I was having problems because I had endometriosis, as it turned out years and years and years later when I discovered that. But their answer was stick me on the pill. It makes it easy, it goes away, all the symptoms go away. But yes, it's a bandage and a festering problem underneath. And infertility and all those sorts of things are the consequence.

Dr Ben Weitz: Yeah, I mean, really these birth control pills should come with a warning that says these should only be taken for a limited period of time, just like proton pump inhibitors, which are taken for reflux and basically a whole host of gastrointestinal symptoms. You have stomach pain, you have nausea — so what else? We'll just put you on a PPI, put you on an acid-blocking medication, which the label says is only to be taken for a short period of time, and yet patients are taking them for years and they're suppressing their hydrochloric acid secretion, and that has all kinds of effects, including increasing your risk for SIBO, which is the main cause of IBS.

Lisa: This is one of my pet peeves, PPIs, Omeprazole and co and all these things, because when we take away our stomach acid, the implications are huge. I had Dr Nathan Bryan on, who's a nitric oxide genius, amazing man — you have to interview him on that, nitric oxide — and the nitric oxide is no longer produced when you don't have enough stomach acid. And then there's protein synthesis and the mineral uptake and B12 and all of these things that are implicated by having not enough stomach acid.

Lisa: SIBO is rife, and SIBO is something that I've struggled with a little bit to learn, because it's a little bit hard to — the testing, there's controversy over the testing, and I know you've interviewed a few experts on SIBO. So tell us a little bit about SIBO. What is your take on what's going on and how common is SIBO — small intestinal bacterial overgrowth, for those listening?

Dr Ben Weitz: Right, exactly, small intestinal bacterial overgrowth. So this, we believe, is the cause of most cases of irritable bowel syndrome, or IBS. The studies indicate 60 to 70% of the patients with IBS have SIBO, and maybe even more. So the best way to test for SIBO is to use the SIBO breath test, and the most common reagent we use is lactulose — lactulose, not glucose.

Dr Ben Weitz: So basically what happens is you follow a low fibre diet for a day, because you want — so the concept of what's going on with SIBO is that your large intestine, that's where your microbiome is, and there's huge numbers, billions, trillions of bacteria —

Dr Ben Weitz: —that are supposed to be growing there. They produce gas, butyrate, etc., and it's fine. The large intestine is this large, expandable organ and we're used to having tons of bacteria. There's not a huge amount of absorption of nutrients that takes place there, and so that's all great. But the small intestine is a smaller tube, it doesn't expand as much as the large intestine, and that's where most of the absorption of nutrients takes place.

Dr Ben Weitz: So there's supposed to be a small amount of bacteria along that tube, but if you have more than a small amount, then that's going to, A, interfere with the absorption of nutrients, and B, whenever you consume fermentable fibre, those bacteria will consume that fermentable fibre and produce gas. And the three most common gases are hydrogen, methane and hydrogen sulfide.

Dr Ben Weitz: So the way we test for SIBO is, as I started to explain, we have the patient follow a diet that's low in fibre, especially fermentable fibre, and then they wake up in the morning and they breathe into these little bags to see if there's hydrogen, methane or hydrogen sulfide gas. And then they consume a substrate, and the most common substrate is lactulose. So lactulose is a fermentable fibre, and then you do another breath test every 10, 15, 20 minutes depending upon the protocol and the test you're using, for either two or three hours.

Dr Ben Weitz: And the general understanding is, if there is more than a certain level of methane, or if there's a rise in hydrogen of more than 20 — I forgot what the units are — within either 90 minutes... the current protocol is 90 minutes, it used to be 105, but there may be issues with what the time should be depending upon the person's transit time. The North American consensus is to use 90 minutes. If there's a rise within the 90 minutes, then the person is positive for SIBO, and then we specify whether they're high with hydrogen gas or methane gas. And the new trio test also measures hydrogen sulfide.

Lisa: Is that a — because that one I don't think we have here in New Zealand. I think we've only got the old version, which has the two, the hydrogen and the methane. And methane can be low because doesn't the hydrogen sulfide actually eat — you know, the bacteria eat the methane sometimes, so it gives a false negative?

Dr Ben Weitz: Close, yeah, very similar. So the methanogens, by the way, the methanogens are actually not bacteria, they're actually primitive archaea. So it's a microorganism similar to a bacteria but different. And for that reason, instead of calling it methane SIBO, which we've done for years, Dr Pimentel calls it IMO, intestinal methanogen overgrowth. So that's one of the new concepts. And then hydrogen sulfide is the third gas, which required quite a bit of redoing of the test procedures, and now we have the trio test that measures that third gas as well. It sounds like that's not available in Australia yet.

Lisa: New Zealand. I'm in New Zealand.

Dr Ben Weitz: New Zealand, yeah.

Lisa: I believe so. I have to dig a little bit deeper into that, because you need to understand what type it is, whether you're methane or hydrogen or hydrogen sulfide positive. And when you have it, what are some of the symptoms that people could be looking for? Because this is more common than we realise, isn't it? Most people aren't aware.

Dr Ben Weitz: Yeah, estimates are 15 to 20% of the population may suffer with this, so huge numbers of people. And symptoms — the most common symptoms: number one, I think, is gas and bloating; number two is stomach pain; number three is change in bowel habits, so either constipation, diarrhoea, or alternating the two. There can be urgency, where you just have to go right away. There can be nausea. And then there can be a whole series of other symptoms depending upon the person. You can have skin issues like rosacea, you can have brain fog, you name it. There can be a bunch of other symptoms, but those are the most common ones.

Lisa: Yeah. The difficult thing with SIBO is that when you do a microbiome test, for example, and look through — does this person have parasites, bacteria, are they producing enough short-chain fatty acids, how are their digestive enzymes looking, their steatocrit, are they breaking their fats down, zonulin, have they got leaky gut — all of these aspects that we look at. And then we're wanting people to eat fibre, and we're wanting people to eat a lot more vegetables and get more short-chain fatty acids from eating fermentable fibres. But when it comes to SIBO, it's the opposite advice, isn't it? It's cut out all the garlic and the onions, and do a FODMAP, and do the low fibre. And it's like, oh wow, you've just chopped out all of these healthy foods. Explain that one to people, because they're like, what? I've been told all my life to eat my veggies, and now you're telling me don't eat my veggies.

Dr Ben Weitz: Look, you're absolutely right, and this is why most of the protocols that myself and some of the other leading practitioners in the world of SIBO and IBS feel that those protocols for reducing the bacteria need to be a short-term recommendation.

Lisa: Yeah, because if you do it for too long you're going to decrease your microbiome.

Dr Ben Weitz: Exactly. And there's a lot of controversy in this world. So I recently interviewed Dr Hawrelak, who's in Australia, and he's really worried that the antimicrobials we use can damage the microbiome. I personally haven't found that to be the case, but we're having an ongoing discussion about that.

Lisa: Meaning the pharmaceutical antimicrobials or no?

Dr Ben Weitz: No, even the herbal ones, even like oregano and things like that. And we've been exchanging some data. He showed me some studies about berberine showing decreases in the bacteria, but I think that my reading of those particular studies — we're getting into a bit of a controversy here — so berberine is a really interesting compound.

Lisa: I love it. I love berberine.

Dr Ben Weitz: So berberine is great, and it's a really commonly used tool in the functional medicine world. Not only is it a really effective antimicrobial, but it's great for managing blood sugar. It's one of the only compounds that's ever been discovered that has been shown in valid scientific research to reverse atherosclerosis, actually reverse plaquing in arteries. So berberine is amazing. And berberine has been shown to be equally effective as metformin.

Dr Ben Weitz: And people have been trying to understand exactly the mechanism for how metformin works, and I think we've discovered now that the way that berberine works to control blood sugar is by its effect on the microbiome. So the fact that the studies show a decrease in certain bacteria in the microbiome is exactly, I believe, how berberine is controlling blood sugar. And we think there's some evidence that that's how metformin works too.

Lisa: So modulation of the microbiome rather than damaging the microbiome. So you've got the Firmicutes to Bacteroidetes ratios — which way around is it? If you've got too much of the Firmicutes, you're extracting too much energy from your carbs. Does it increase the Bacteroidetes?

Dr Ben Weitz: Well, you know what, I think that ratio is kind of interesting, but my take on it is, in terms of the research on the microbiome, if we actually had the ability to measure all the bacteria and microbes and microorganisms and even viruses and fungi that are natural to the microbiome, I think you could take the most extensive stool test and it's measuring about this much, and this is how much the microbiome is. So I think even that Firmicutes-Bacteroidetes ratio is really just scratching the surface. I think it's way more complex than that.

Lisa: This is super exciting, though, because berberine is one of my go-to tools for everything. For a while I personally did metformin, and then I started reading the research around the deficiencies that metformin can cause and the gut problems that it can cause, and it inhibits the mitochondria.

Dr Ben Weitz: Exactly. And then when you're doing training and you're trying to get results with training, you can't produce as much energy.

Lisa: Exactly, yeah. And I use it in my mum's cancer protocol, and I think there it has a definite role to play, but I've actually swapped us both out now to berberine because of the deficiency problems in B12 and all those sorts of things that come with metformin.

Dr Ben Weitz: Yeah, I take berberine every day. I take 500 milligrams twice a day, and I'm mainly doing it for longevity purposes.

Lisa: Me too, management of blood sugar and weight management and all of that sort of stuff.

Dr Ben Weitz: Now, some people have called it a natural Ozempic, and I talked to one of the supplement manufacturers — I tried to order some more berberine and he said, "I've got to tell you, somebody wrote an article that berberine is the natural Ozempic and we're sold out."

Lisa: Hey, I've still got some of my range if you're really —

Dr Ben Weitz: I have to tell you, it's not a natural Ozempic, it doesn't do that. But it is an amazing compound and I don't think it damages the microbiome.

Dr Ben Weitz: So the strategies — I still like to use what Jeffrey Bland taught us so many years ago, which is the 4R programme, and that's remove, replace, reinoculate and repair. So the remove phase means reducing the bacteria that are either overgrown, as in the case of SIBO or dysbiosis, or getting rid of the parasite or the pathogenic bacteria or the fungi. And in my practice as a chiropractor, we don't prescribe medication, so we use various types of herbs and other nutritional products. And then we often put the patients on a lower FODMAP diet to decrease the amount of fermentable fibre that you were talking about.

Lisa: For a while, for a while.

Dr Ben Weitz: Well, the key is, depending upon what's going on, making sure that that's only for a limited period of time. And I try to emphasise to the patients at the beginning and over and over again that it's really important that we're not going to do this forever. Because the problem is, when they start feeling good they don't want to go back to eating all the other foods. But when we get back to repairing and rebuilding and reinoculating the microbiome, you need to be eating those fermentable fibres.

Lisa: It's really difficult, isn't it? These people are sensitive to all these fibres and stuff, but they need the fibres. So we're running people low — you can get away with it for a while because your nutritional status is hopefully good enough from the get-go. It's a bit like the argument with veganism, carnivore, and blah blah blah. I think all of these diets are good for a certain amount of time until you start depleting whatever that diet is deficient in, and then it stops working. So you might get some amazing effects being on a vegan diet for 12 weeks or something, and then, hello, you start to run out of things if you're not really, really careful and really putting in the right combination of —

Lisa: —of foods.

Dr Ben Weitz: There's kind of a general principle that I think a lot of us in the natural medicine world know, because it exists in so many different parts of health, and that's that there's a healthy balance and you don't want to go too far one way or the other. I was just working with a patient a little while ago and her cholesterol was up and she had a little bit of blockage in one of her carotid arteries. We've gotten the cholesterol down, we're using red yeast rice, we've changed the diet, and guess what happened? Her vitamin D started coming down, her testosterone started coming down. And I was explaining to her, that's because we got your cholesterol down. Oh, we tested, our CoQ10 is down too. Well, of course, there's this balance, and we want to tip it so it's in the healthy direction, but we don't want to do this and we don't want to do that.

Lisa: And that's why I love the natural stuff as first line, at least, because when you look at pharmaceutical interventions, most of them are just forcing pathways, and they're a single ingredient and they're not in a complex. And even on the nutrition side, there's that argument — I was talking with a colleague about spermidine, which I love. Spermidine is a fantastic autophagy inducer and a great longevity molecule. And then we were having discussions around the natural variants, with the spermine and the putrescine in it — it's that complex versus just being spermidine by itself. Is that a better effect? And most things in life, they come — ascorbic acid's another one. Getting it in the complex, in a piece of citrus fruit, the vitamin C complex of flavonoids and things that are in there, versus the ascorbic acid that's been extracted from that, is probably a better way to do it. I mean, not if you're doing intravenous, that's another thing.

Dr Ben Weitz: I will say, if you were the person who developed spermidine and then you decided to combine it with putrescine, your marketing department is probably saying you just picked the worst two names you could possibly pick if you want to talk people into taking a product.

Lisa: Yeah, we're actually using it in formulations at the moment and discussing the synthetic versus the natural variants and the pros and cons.

Dr Ben Weitz: Yeah, putrescine and spermine did not sound attractive.

Lisa: But you can use it in your marketing to go, well, this is a funny name — let's talk about the origins of these names and why it's in there and why it's not that horrible when you actually look at it.

Dr Ben Weitz: You're on the cutting edge of the longevity research, so spermidine is definitely one of those compounds.

Lisa: It's amazing.

Dr Ben Weitz: It is, it is absolutely amazing. Another product that has a horrible name is urolithin A.

Lisa: Yeah, that's one, and that one's so bloody hard to get. We're trying to get that at the moment for formulations, and also a very exciting one. Urolithin A is something that we produce in our microbiome, right? But if you haven't got the right bacteria... And I wonder how many compounds are like that, that if you don't have the right bacteria you're not actually producing the thing, like your urolithin A.

Dr Ben Weitz: Absolutely, yeah. I don't know if you've heard about the whole controversy over TMAO?

Lisa: Yeah, yeah, vascular risk.

Dr Ben Weitz: Well, the reality is, if you have a good healthy microbiome, you won't produce TMAO.

Lisa: Yeah, exactly.

Dr Ben Weitz: So it's not a problem. This idea that you shouldn't eat foods that have choline or L-carnitine because they can be converted into TMAO in the gut — well, if you have a healthy microbiome that won't happen, you won't have elevated TMAO levels. So we're all focused on telling people not to eat eggs or not to eat meat, and of course it's become a new hammer in the toolchest for vegans to hit anybody who believes in animal products over the head.

Lisa: And that was suspect from the get-go. I mean, they were selling tests that were testing for TMAO. And yeah, I do think that everything is always overly simplified in the media, right? There's no nuance in any of the conversations, or any personalisation. And for me, personalisation is where it's at. When people say to me, what's the right diet? I'm like, well, that depends on your goals, your genetics, your stage of life, your comorbidities. Where do you want to start? What's your microbiome? What else is going on with you? What are your labs showing?

Dr Ben Weitz: What's your cholesterol status, your cardiovascular risk, your blood sugar levels? Exactly. There's no one size fits all. We want it to be, and anything that forces one size fits all on everybody is just wrong. I mean, if functional medicine stands for anything, it stands for personalised care.

Lisa: Yeah, and we're getting better and better at that. We didn't have all the opportunities maybe 20, 30 years ago that we have now with genetics and microbiome testing and all of this sort of stuff, where we can actually personalise. So it's an exciting time to be alive for people like you and me trying to work all this out. And it is a puzzle.

Dr Ben Weitz: It is a puzzle. And here I want to talk about something that's a little bit controversial. There's a trend among a few of the popular podcasters in the functional medicine world to say that we don't really need to do all this testing, it's just overly expensive and it's not necessary, and we can just tell from symptoms — you come in with gut symptoms and I could just give you some probiotics and just follow this protocol. And that's not personalised care. Personalised care requires knowing how your metabolism works, how your body works, how your body reacts to different stimuli, and we can only do that by testing. And unfortunately the testing most of the time is not going to be covered by insurance, but we do our best to make it as inexpensive as possible. And in terms of investing in your health, the amount of money you're going to spend, even if it's a thousand or two thousand dollars, in my opinion is a drop in the bucket for having better long-term health.

Lisa: Amen to that. And this is it. People think — we've grown up in a world, in a country, where you've got socialised medicine, everything's paid for, but it's created —

Dr Ben Weitz: Should I have to pay for it?

Lisa: Yeah, yeah. But you pay for what you get, I tell you. If you're in that system, you need to understand that that's going to cover the absolute bare minimum, and it's going to be promoting only pharmaceuticals, because that's the way it's set up. The system is designed and developed that way, and it's not going to be looking at anything outside of that box, and it's not going to give you the data, and it's not going to be cutting edge, and it's going to be 30 years behind the latest stuff. And it's a struggle, because you've got the wealthy people who can afford to do all of this, and then the ones who can't, and then you're always as a practitioner trying to guess, to a certain degree, because you can't afford to get every piece of data.

Dr Ben Weitz: Absolutely. We try to be as cost conscious for our patients as we can. I know I certainly am, and try to use the bare minimum amount of testing. But still, you need to have some data as to how that person's body works if you want to be more scientific and accurate.

Lisa: Yeah, and otherwise you're just playing a guessing game. It's a struggle, but we have this mentality: if I've got it for free, why should I be paying?

Dr Ben Weitz: I can tell you — have you noticed this? This is kind of interesting. I get into this discussion all the time, and patients go, well, I just had my labs done, I had everything tested. And they come back and basically they had a CBC and a chem screen. So I just got labs back from Vibrant: the CBC's on one page, the chem screen's on one page, and they come in and they have like 30 pages, because they put red blood cells on one page, white blood cells — every part of these tests they put on a separate page. I'm wondering if they're doing that just to make it seem like a lot of testing when it's really not.

Lisa: It's this much information that you're gleaning from it, exactly. And that's only serum blood levels. We know that there's limitations with things like B12 or folate or magnesium — you're not going to get a really good picture from serum.

Dr Ben Weitz: Absolutely not, absolutely not. Most nutrients — vitamin D is an exception — but most nutrients, serum levels are not going to be indicative of tissue levels of what your body needs.

Lisa: Yeah, and then it's really, really complicated with things like copper, for example, when you need to know your free copper and your ceruloplasmin and your zinc levels and your zinc-copper ratios and all of these sorts of aspects, that you think, oh no, I just checked that, my copper's not too high or too low. No, we wish it was that simple, but it isn't.

Dr Ben Weitz: I know. I was just reading an article in the New England Journal of Medicine and they had a guy who was a welder, and he was having all these cognitive dementia symptoms. Because serum levels of manganese are not accurate, they just assumed that he had manganese toxicity, which I guess is common from welding, and they put him on a chelation programme and he got better. And I thought that was great, that they recognised the dangers of heavy metals, but are you telling me that just because serum levels didn't show it, that there's no other way to test for manganese? We can look at manganese excretion through urine, there's other ways to test for it.

Lisa: Yeah, organic acids and all of that sort of stuff is really good testing, and heavy metals, and hair, and all of these tests. Some of them have limitations and they don't always agree, and blah blah blah, there's different accuracy.

Dr Ben Weitz: That's the case with all testing.

Lisa: Yeah, exactly. But you do get pushback from the allopathic medicine world of, what is this test, what is that showing?

Dr Ben Weitz: Well, unfortunately they don't read all the literature, and they're busy, and a lot of the information they get is when the pharmaceutical rep comes by and tells them what the latest drug does and gives them some information, or drops off some handouts or some study. And for some reason, if you publish a study on vitamins or minerals or nutrients and it's negative or shows no benefit, it gets published in the New England Journal of Medicine or the AMA journal, and if it's positive it has no chance of getting published there — it gets published in the American Journal of Clinical Nutrition or one of the other journals that those of us in the functional medicine world are more likely to read. In other words, we kind of have, like, in the United States, if you're a Republican you watch this channel, if you're a Democrat you watch this channel, and we're not even getting the same —

Dr Ben Weitz: ...information. And unfortunately, that's sort of what's happening between allopathic medicine and functional medicine.

Lisa: We need to come together and work together.

Dr Ben Weitz: Yeah, wouldn't that be great?

Lisa: I think the functional medicine space is definitely growing, and health coaches are growing, and allied professionals are starting to have an impact. I think people are starting to get frustrated with the current model, at least over here, where you've got 10 minutes with your doctor, it takes two months to get in, and you come out with a pill that you don't know what it does or how it works. And you've ended up with 10 pills, and there's no crossing, there's no checklist. I was listening to Dr Peter Osborne, who I love — he's fabulous — and he was talking about if you've got a client that's come in, or a patient that's come in, who's got 10, 11 different polypharmacy, we don't know the interactions of all those polypharmacies. And we don't actually know the interactions of some of the supplements too, by the way. But when you put all these chemicals together, it's not one plus one equals two, it's one plus one could equal something new, and we don't know what that new is. And rarely do they really get told about all the side effects. How many times when somebody gets prescribed an antidepressant are they told that this is going to decrease your motility?

Dr Ben Weitz: Never.

Lisa: Never. That wouldn't be selling drugs very well, would it? But let's rein it in, because I think we could get on our soapboxes right now.

Lisa: Coming back to the gut, I've got a curly one for you — no pun intended. A very tricky case that I wanted to ask you about. I've got a case where someone has had a full colectomy, like the full colon taken out, and Crohn's disease, and lots of issues — leaky gut, dysbiosis, you name it. They've been put on proton pump inhibitors, steroids, et cetera, et cetera. What the heck do you do there when that part of the body is now missing, so you've only got the small intestine where you get your nutrients, you've got SIBO? That's a complicated one, eh?

Dr Ben Weitz: It is a complicated one. I guess in some patients there's a little sack that forms where you can have some microbiome.

Lisa: That's what I'm wondering, whether it's creating — yeah, where is the microbiome? If the microbiome is so important, how can you be healthy without a colon if that's where your microbiome is?

Dr Ben Weitz: I've asked Dr Pimentel this question, and he says that patients can be healthy, and there are patients who seem to do pretty well. I don't quite understand exactly what happens with the microbiome in such patients. But in terms of, do you treat them for SIBO — it depends if they have the symptoms. I wouldn't test them just to test them, but if they're getting a lot of gas and bloating and constipation or diarrhoea, I would test them. And one of the things about using the herbs is they're going to modulate the system, they're not just going to wipe everything out.

Lisa: And I think too, with people like gallbladder removals, which is another very, very common "let's just whip out an organ" — does the body adjust itself? I think that the body will go, okay, we've had this massive insult, but let's try and rearrange itself. But it's very hard to know if that's what's going on, whether the body's created its own colon-type part of that small intestine microbiome. How else would you be surviving, right?

Dr Ben Weitz: Exactly. The thing about the gallbladder is the gallbladder doesn't produce the bile, it just stores it. So bile is still being produced by the liver, it's just that it's not being timed with when you're eating a meal that has fat in it. So you might not be properly digesting your fats, and that's one of the reasons for doing a stool test as part of your workup, because you can see the steatorrhoea, which is the fats that have been undigested. And then you can give them a supplement that contains some ox bile.

Lisa: TUDCA is my favourite sort of go-to, or ox bile. And I think that that's a really good one for SIBO too — do you think so as well, like TUDCA?

Dr Ben Weitz: I think it can be. And then the other way to go is with herbal bitters, which stimulate your body to produce bile and HCl and pancreatic enzymes.

Lisa: Yeah, and things like phosphatidylcholine. I don't know if you're aware of Dr Ben Lynch's work — you need 10 parts phosphatidylcholine to one part cholesterol, and when you've got too much cholesterol in the gallbladder, or when you're producing bile, then it's going to get very sludgy, or stones, and block up, right? And that whole methylation thing, because phosphatidylcholine is produced from the methylation process, so if your methylation is mucked up then you're going to maybe have issues with your gallbladder amongst other things — many other things. So that's an interesting one. But just putting phosphatidylcholine into the diet isn't necessarily the answer either, because although that can be supportive for brain health and cholesterol and lots of other things, you've still got to digest that fat with the bile that you don't have, with that sludgy —

Dr Ben Weitz: Fortunately, you still have some lipase, which is produced by the pancreas, which helps break down fat.

Lisa: Yeah, good point.

Dr Ben Weitz: And like I mentioned, the liver is still producing bile, it's just not perfectly timed.

Lisa: It's not squirting out of the bag.

Dr Ben Weitz: But it's still going to pump out periodically, and it takes a while to digest your food, so potentially you might still have enough bile to break down your fats.

Lisa: Yeah. And just keeping an eye on the toilet bowl and seeing if you've got floaty poos or not, skid marks on the bowl — sorry for being so graphic, everybody — but those are sort of signs that maybe you're not digesting your fat.

Dr Ben Weitz: Absolutely. Analysing poo is an important part of the job.

Lisa: It's a very important job. Everyone should have the Bristol stool chart on their wall.

Dr Ben Weitz: Exactly. I interviewed Allison Siebecker and she has a coffee cup on her desk with the Bristol stool chart.

Lisa: That's taking it a bit far. But yeah, everyone, look up the Bristol stool chart for an image of what your poo should look like, and check in the bowl, check what is there. And if it's not looking like that and you're having problems, then maybe it's time to go and get a microbiome test done, because most of the time you do find something — there's some parasite, some bacteria, something that you could be working on to improve your health.

Lisa: I was talking about my mum previously with you, and the latest drama. After getting the MRI back that said the cancer was still clear, and we had none of that — on the very same day she went into hospital with GI bleeding. So she ended up very, very sick, and they nearly took out her colon, the whole colon. And whether she would have survived an operation like that at 82 was very questionable, and whether she would have ever gotten back. So we held on that decision as long as we possibly could, and the bleeding, thank God, stopped. But we had 16 units of blood with her. Now, we've had a long history of diverticulitis, and when they did the brain surgery for the tumours, the motility stopped. So the vagus nerve must have been impacted by that operation, I don't know how, but the motility in the gut and that migrating motor complex is no longer working. And you've got diverticula, which is diverticular disease, where you've got little outpouchings — a lot of older people have this — and they can just let go. So by telling that story, I just want to share that the gut is not — you can die. She nearly died, and we're still waiting for colonoscopies and things like that to find out where the heck this is. It's not something that they can easily repair when something like that goes wrong. Okay, she's had a history of cancer and all the other stuff that she's gone through, so we've been dealing with a lot.

Dr Ben Weitz: Yeah, and that fits into the category — we've been talking about functional gut disorders; that's clearly a structural gut disorder. Unfortunately, what would be called a repair would be just cutting out that part of the intestine.

Lisa: Well, over here the whole thing is just take the whole thing out. And I was like, can't you find just the part? But that's all — if we're going in, we're going in, we're going to take the entire thing out. We managed to dodge that bullet, thank God, but touch wood, she's still at risk. But just to understand that these things — in Crohn's and ulcerative colitis and things — they can be deadly. They can be deadly. So looking after your gut health is not just about optimising, but can be preventing major catastrophes as well. Not to mention, of course, the risk of things like colorectal cancers and things that go up when you've got ongoing problems in that department, or even problems in the liver.

Dr Ben Weitz: Anytime you have chronic inflammation, that's something that increases your risk of cancer.

Lisa: Exactly, and that's what's going on in so many cases. Okay, Dr Ben, so we've beaten to death the gut. What are some of your other sort of favourite topics to talk about in the functional medicine world? What's got your attention at the moment?

Dr Ben Weitz: Cardiovascular risk factors. I've been doing a lot of investigation and looking into some of those situations. Here's one topic that I've been somewhat focused on: when it comes to looking at your risk for cardiovascular disease, and when we look at, say, your LDL cholesterol levels — better than the LDL estimated number that's part of a standard lipid profile, we like to look at the LDL particle number, or now a lot of us are starting to look at ApoB.

Lisa: Yep.

Dr Ben Weitz: And so the higher that gets, the more it can increase your risk of atherosclerosis, or blockages developing in the arteries. Now, it's not that simple. You've got to have some inflammation in those arteries; a lot of it has to do with the health of the endothelium, which is the lining of the arteries. But there's been a tendency to say, especially in the functional medicine world, let's just drive down those cholesterol levels as low as possible.

Lisa: No, not good.

Dr Ben Weitz: I recently heard Peter Attia, who's a brilliant practitioner who has a very popular podcast, The Drive, and he's advocating lowering your LDL or your ApoB down to 30 or 40 level, and that will eliminate cardiovascular disease. And people who argue this claim that there's no negative effects on the brain function. But I just don't see how that could possibly be the case.

Lisa: I don't think it is the case.

Dr Ben Weitz: I think there's plenty of studies showing that brain function gets impaired when you drive that LDL level too low.

Lisa: Yeah, and your hormones, and your hormones.

Dr Ben Weitz: Absolutely. So we were just talking about how you lower your LDL and all of a sudden your vitamin D goes down, your hormones go down, your brain health goes down. So there's got to be a healthy balance.

Lisa: Yeah, and this is an area that I'm studying too, and in the weeds and not understanding all of the nuance of. I've been following Peter Attia for a while and, my God, if you want a technical podcast, people, that's a good one. He goes deep and he's a very clever man. But with someone like my mum, or I work with a lot of stroke or Alzheimer's patients, if you drive their cholesterol down you do see an impact on the brain. I see it very quickly. If I drive Mum's cholesterol down too low, then we definitely see an impact on brain function and cognitive impairment. So I think it's a really fine balancing line of trying to get that right and understand the Lp(a) and the ApoB, the LDL and the different particle sizes that there are. And this is not a normal work-up. It's something that I'm studying and working with a couple of mentors on and trying to get my head around it all, because it's a big one. But I think even in the hormone space, this is also — you've got a menopausal woman, and when you drive that too low, again you're going to impact so many other systems. So cholesterol isn't the big bad wolf. It's also the inflammation in the arteries, and what's actually happening in the endothelial lining is very, very important as part of that whole picture.

Dr Ben Weitz: Absolutely. The argument about cholesterol and the brain, it's similar to the issue with the relationship between the gut and the neurotransmitters in the brain. For example, we know that 80% of the neurotransmitters are produced in the gut, yet the neurotransmitters like the serotonin in the brain are actually produced in the brain. So you might say, well, the brain has nothing to do with the gut. And we don't know exactly how they interact, but there's plenty of data to show that if your gut is unhealthy you're going to have more problems with the neurotransmitters. The connection between the brain and the gut is real. And how is it that neurotransmitter production in the gut affects neurotransmitter production in the brain, even though they seem like they're separate? They're definitely connected in some way. And the same argument is made for cholesterol, which is that the cholesterol in the brain is made in the brain, and it's separate from the cholesterol that's made by the liver that's seen in the arteries. And that may be the case, but there's definitely a connection.

Lisa: Yeah, I agree totally, and I don't think we've got it completely worked out.

Dr Ben Weitz: No, I don't think we have either. I think that science will eventually show what that connection is.

Lisa: Yeah, the vagus nerve communication. And it's a two-way street. The vagal nerve speaks down to the gut, but the gut also speaks up as well. And so many people that have depression, have ADHD, have all of the mood disorders, those types of things. Like, I know if my histamine levels get too high I become a raging maniac. I get so angry. It just immediately hits me. And also your methylation status. If I over-methylated myself a while back with some folate — just took a bit too much — that really impacted the mood, and I was really snappy and irritable and grumpy, and I was like, whoa, pull back on the folate. And these things seem very benign, but they're actually powerful, powerful. And the methylation cycle — oh my God, don't get me started on that. I'm trying to understand the whole methylation piece.

Dr Ben Weitz: But all of when you have mood and behaviour disorders — depression, ADHD, all of these mental things — they are impacted by the state of your gut.

Lisa: So look there. Look there first. Look at the methylation perhaps as well, and see that you're getting the nutrients that should be coming in to help support that.

Dr Ben Weitz: Yeah, there's really something wrong with our health care system if patients are being seen for mood disorders like depression and anxiety and nobody's even asking about their gut health.

Lisa: Yeah, they should be. Number one, they should be running a microbiome test and seeing what's going on there, and then maybe looking at the methylation cycle, if they're able to, getting a genetic test, seeing where all of their methylation genes are at, and their status as well — not just their serum levels, but trying to get, again, going back to that whole work-up if you possibly can. Because otherwise you're just giving them an SSRI when perhaps they genetically don't do well with that, because if you don't have enough serotonin, you might be able to inhibit the reuptake of serotonin, but you had none to begin with.

Dr Ben Weitz: Well, that's exactly it. And in the functional medicine world, we're not okay with "this is low, this is high". We want to know why is this low, why is this high.

Lisa: Yeah, yeah.

Dr Ben Weitz: And then let's try to figure out why your body's not producing the right amount of what it normally should, that it needs.

Lisa: Exactly, exactly. And then playing around with the combinations that you have to sometimes tweak and change and develop, and then doing the basics right. Going back to just finishing up maybe with the lifestyle interventions, because we can do things like getting sunshine, walking in the forest —

Dr Ben Weitz: Walking in the forest, getting some infrared, breathing properly through your nose, avoiding a toxic environment. Well, that's a difficult one nowadays, but doing the best you can to avoid toxins in your home and avoid cleaning products that are really poor.

Lisa: The hygiene hypothesis — that's another one of my pet peeves, that we just kill 99% of all —

Dr Ben Weitz: So we shouldn't walk around with a mask and gloves for the rest of our life? That would make us the most healthy we could ever be.

Lisa: Oh my God.

Dr Ben Weitz: Because we would never ever want to get exposed to any germs ever for the rest of my life.

Lisa: So that your immune system becomes that fat dude on the couch.

Dr Ben Weitz: Exactly.

Lisa: Yeah, exactly. And this isn't a mask mandate discussion, but wearing those things is so detrimental to your health. That's the funny thing. It's just really not, and as we know, it doesn't — there's a place in certain settings.

Dr Ben Weitz: Yeah, if you're in surgery, you're in the hospital, okay, absolutely, absolutely.

Lisa: Absolutely. But ideally don't wear them for 14 hours a day, because you're not going to be healthy yourself doing that. Dr Ben, you've been absolutely amazing. We've gone all over the shop, but it's been fun.

Dr Ben Weitz: I apologise for not being particularly disciplined about the topic.

Lisa: Oh no, I never am. People who follow me know that I sort of wander and all sorts, so it's okay. A bit of ADHD, you see, so I'm there with you. I'd love to have you back on again. It's been absolutely fabulous. I had your colleague Dr Rob Silverman on the other day, just two days ago, and oh, what a fabulous man he is as well. So that was really, really fun. Hey, Dr Ben, any last words? Where can people find you? Can people work with you over telehealth? Your Instagram, all of that sort of good stuff.

Dr Ben Weitz: Yeah, absolutely. The best way to find me is through my website, drweitz.com. You can come to my Santa Monica, California office. We can do a functional medicine consultation. I can work with you through Zoom. You can follow me on Instagram, Dr Ben Weitz. I'm on Facebook, I'm on X, I'm on all the social media stuff. But contact me through my website and I'd be happy to help you promote your optimal health.

Lisa: Absolutely. And your Rational Wellness podcast.

Dr Ben Weitz: That's absolutely — please check out the Rational Wellness podcast, Apple Podcasts, Spotify. There's a video version on YouTube. Check it out, please.

Lisa: Yeah, it's really, really well worth it, believe me, guys, and I'm a podcast fiend. So thank you, Dr Ben. It's been absolutely wonderful.

Dr Ben Weitz: Thank you, Lisa.